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Author’s Note: **In this blog post I will be using the word fat.  Fat is a neutral word and a descriptor for larger bodied folks.**

In the reproductive rights space, we often talk about access to care. Who gets it, who doesn’t, and what we can do to bridge the gap. Black, Indigenous, and people of color face worse health outcomes due to their lack of access to care. Biases in the medical industry resulting in unequal treatment are only exacerbated further by their other intersecting identities like being LGBTQ+, gender identity, being disabled, or being fat.  

Something we talk less about though is the fear that can come with trying to access health care, particularly as the member of a marginalized group. 

Fear of receiving biased treatment from medical professionals is not an anxiety that is unique to fat folks.  This is a collective experience shared by anyone that doesn’t meet the Eurocentric standards of what is an ‘acceptable beauty,’ which are a direct result of colonization, imperialism, white supremacy, ableism and fatphobia. These ideals don't allow BIPOC, LGBTQ+, disabled folks, fat folks or anyone that doesn't subscribe to these ideals a seat at the table to receive fair, safe, and equal access to health care. Medical biases are a problem whose reach stretches way beyond the experiences of fat folks, but today I want to highlight and bring forward the inherent medical biases and ableism that fat folks accessing care often receive.

This fear of mistreatment and anti-fat rhetoric when seeking health care often leaves fat folks hesitant to seek the medical help that they need for fear of being dismissed, not listened to, and denied the potentially lifesaving care that they need.  Because, well, the reality many fat folks face when seeking necessary, unbiased care are met with remarks about their overall health based on merely a glance of their physical appearance by a medical professional rather than the in-depth analysis and diagnostic care needed. You cannot tell the depths of someone’s history or medical conditions by looking at them.  Regardless of your weight, your doctor should care about your medical history and your experiences. 

The reality is that thinness doesn't equate to being healthy, and weight is not an indicator of someone's overall health. Until we can understand this sentiment and move past it as a society -- and particularly in the medical industry -- fat folks will not be included or able to receive equal and fair medical care. 

So how did we get here? Many of the ideas surrounding this anti-fat sentiment are connected to the Body Mass Index (BMI).  BMI is an outdated tool rooted in white supremacy, created some 200 years ago. It was never intended to measure an individual’s body fat, build, or health and is based on the same western ideals of beauty that I discussed above.  Not to mention that BMI measurements disproportionately affect Black women who are more likely to be diagnosed obese than their non-Black counterparts.

How do fat biases play out in reproductive health care?

From weight restrictions for the Plan B pill to on-site abortion to IVF treatments, anti-fat biases are intricately woven through the reproductive health care system.  

For instance most fertility clinics will not admit you as a patient if you are obese,   despite studies showing that fat people are just as likely to become pregnant as folks that are a ‘normal’ weight. Also, the Plan B pill has a weight limit of 166 pounds, and anyone above that weight is less likely to have success.  

 When fat folks want assistance in getting pregnant they’re often denied, and when fat folks want assistance protecting themselves from unwanted pregnancy they’re met with barriers that thin folks don’t face.  Until fat folks are honored and brought into the conversation about health care and our bodies, we will continue to feel isolated and unheard from the medical community.  This leads to avoidance of the medical care a person needs, which can be dangerous and even deadly. 

I recognize that fat phobia in the medical industry is bigger than the patient, with strong connections to the social powers that be and deeply entrenched biases within the health care system as a whole.  While we may not be able to control these overarching themes in our lives, we are able to control how we respond to them.  Here are some examples of language you can use and reminders for you to address anti-fat biases with your provider and protect your general wellbeing:

You can tell your Doctor/their assistant that you DO NOT want to be weighed.

There are some situations when recording your weight is medically necessary, like if dosages of medication are being calculated based on your weight.  In these situations, you can ask if it is medically necessary to be weighed.  If it is, ask to be blind-weighed (stepping on the scale facing away from the results) and request that the person weighing you and your doctor don’t discuss how much you weigh with you.

If your doctor is making irrelevant comments about your body you CAN speak up.

A good way to address this issue is to bring the doctor back to the reason that you came there.   For example, you can say something like, “I understand that you have opinions about this aspect of my body.  In our limited time, can we please get back to discussing XYZ?”

If your doctor is discussing weight loss/diet plans with you without your direct consent…

The best way to respond in a situation like this is to acknowledge their concerns, but redirect the conversation back to the reason you’re visiting their office. To challenge their anti-fat biases you can approach it from a different angle:  “Fad diets are harmful to my health and mental wellbeing, and 95% of folks who decide to diet fail. Can we get back to discussing XYZ?”

If your doctor is dismissing your concerns and blaming your symptoms on your physical appearance…

You can simply say something like, “I acknowledge your concerns about my weight.  How would you go about treating a thin patient with my same symptoms?”

If you don’t like your doctor, you can break up with them and find someone who honors you and addresses your concerns.

You can report any anti-fat biases you experience at the doctor here:  https://www.obesityaction.org/action-center/report-weight-bias-issues/

Remember: You are not alone.

You deserve health care.

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