Anti-fatness in health care is rampant, and has deleterious impacts on the health and well-being of fat people. Research shows that anti-fatness (or alternatively, weight stigma, fatmisia, or fatphobia) is common among health care providers and students alike, with professionals and students holding damaging beliefs that fat people are lazy, weak-willed, sloppy, dishonest, unhealthy, non-compliant, and lacking in self-control, among other damaging and inaccurate beliefs (e.g., Bessey & Lordly, 2020; Bessey et al., 2021; Pausé, 2014; Rinaldi et al., 2020).

Anti-fatness is often inaccurately conceptualized as an individual issue, as health care providers who incidentally have unconscious biases that impact the way they treat fat patients, and who simply need to work to overcome these biases. However, as Mikey Mercedes (2022) outlines in her article “No Health, No Care: The Big Fat Loophole in the Hippocratic Oath,” medical fatphobia is violent, violating, innate, and inherent to the health care system. Physicians and other health care providers are educated in a fatphobic educational system that reinforces outdated and harmful beliefs about fat people and their bodies. These biases infiltrate all aspects of health care, and have wide-reaching impacts on the care received by fat people. Fatphobia also intersects with racism, misogyny, ableism, and other forms of oppression within systems (Friedman, 2020), including in health care:

[Anti-fatness] intersects with other social status markers used to restrict access to categories of parenthood and citizenship such as race, ethnicity, income, and ability, often surfacing in reproductive care settings in the form of blame. This blame is leveraged in a way that is used to prop up control of bodies deemed “risky,” as these people are assumed to be “unable” to make “correct” health choices (LaMarre et al., 2020).

These fatphobic beliefs and attitudes have material impacts on the health of fat people. Many cardiometabolic health outcomes that are often blamed on fatness can be connected to experiences of oppression and stigmatization based on weight (Hunger et al., 2015; Vadiveloo & Mattei, 2017). For example, Vadiveloo and Mattei (2017) found that self-reported weight discrimination was related to twice the risk of high allostatic load at a 10-year follow-up, increasing risk of metabolic dysregulation. Fat people are also often ignored and dismissed, or told to simply lose weight when they present with health concerns, leading to inadequate screening and treatment, as well as health care avoidance (e.g. Amy et al., 2006; Drury & Louis, 2002; Lee & Pausé, 2016).

One well-known example of this mistreatment is the experience of Ellen Maud Bennett, who was repeatedly dismissed by her doctors over a number of years, before being diagnosed with terminal cancer and passing away days later. She used her obituary as an opportunity to advocate for awareness of the harms of anti-fatness in the medical space, which received significant media attention.

Beyond the ideological beliefs about fatness that drive anti-fatness in health care, anti-fatness also materially shapes the health care space. For example, Fady Shanouda’s (2021) chapter in the book Weight Bias in Health Education addresses the built-in fat phobia in health care that is embodied by medical equipment like Magnetic Resonance Imaging (MRI) machines. In the chapter, Shanouda describes his own encounters with anti-fatness in the health care system:

I am scared to get sick. I am not frightened of the consequences of illness—pain, suffering, discomfort, even death. These are inescapable truths. No, I am afraid of being denied the most basic care because I am fat.

This fear started when, in an offhand comment, my general practitioner conveyed how difficult it might be for me to get a magnetic resonance imaging (MRI) scan given my size. The same doctor has tried to weigh me by balancing each leg on a different scale and has waved off testing my blood pressure because the cuffs in her office were too small. Medical equipment embodies the anti-fat bias inherent in the medical community (p. 30).

Reproducing Stigma

The Reproducing Stigma project also speaks to experiences of medical fatphobia, specifically for women and trans people who have been labelled “obese” and who are accessing reproductive health care while trying to become pregnant. This project highlights the importance of not only evidence-based health care, but also storied care, where fat people’s stories and experiences are seen as central to achieving equity within reproductive health care (Friedman et al., 2020).

Video: Seeing My Body Differently by Emma Lind

In Emma Lind’s story, Seeing My Body Differently, Emma highlights how medical fatphobia often starts at a very young age, telling the story of how her doctor told her mother, when Emma was only eight years old, to stop putting apple juice in her lunch in order to stop making her fat. This encounter led to a decade of shame, pain, and hunger.

Video: Fear, Fat, Food and Failure. Feminist Ruminations on Birthing by Kelly

In Fear, Fat, Food and Failure, Kelly discusses her early experiences with digestive problems, her subsequent food and eating issues, and her anxiety about whether her body is “good enough,” including to bear children. She describes her turbulent childhood, and the anti-fatness she experienced in her family, and the fear she carries that her fatness might lead to hers or her babies’ death. Kelly’s story highlights her conflicting feelings about her fat body, and the intertwining of mental health, poverty, trauma, and other aspects of her experience.

Video: Too Much by May Friedman

In her story, Too Much, May Friedman describes how she has viewed her body outside of pregnancy with suspicion, as “too fat, too loud, too hairy, too ethnic, far too out of control to ever fit in.” May reflects on her changing relationship with her body before, during, and after her pregnancies, and how, in her own words, her “body actually did [something] right” when it came to pregnancy the first three times, only to eventually encounter unluckiness in that realm too. Was she being punished for being greedy, for daring to take up space?

Further Learning: Ragen Chastain’s Weight and Healthcare Newsletter

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