Author's note: This is the second post in a three-part essay. This first post addresses weight stigma in healthcare. The next post is about weight and the Am I Hungry? Mindful Eating Programs. The third post (next week) is about the conflict between mindful eating and weight loss.
I love the mission of Weight Stigma Awareness Week and all of the online activity around this important issue, but it is hard on me too. I end up reading countless posts about the stigma people have faced from their own doctors. It makes me feel ashamed to be part of the healthcare profession. What happened to "First, do no harm"?
What happened to compassion, care, and nonjudgment?
I believe that most physicians (at least the ones I know) wouldn't intentionally hurt their patients' feelings. I also know that the majority of physicians are compassionate, caring, and nonjudgmental. I want to believe that a physician wouldn't dismiss their patients' symptoms, concerns, and illnesses as a consequence of some perceived "failure," then suggest weight loss, however elusive, as some miracle cure for just about anything wrong with an obese patient. Yet the research and personal anecdotes show that it happens all the time.
For the sake of argument (and based on some of the horrifying stories of weight stigma in medical settings, there is room for argument), I believe that the majority of the time, weight stigma in a healthcare setting is a misguided attempt to help. But that does not excuse rudeness, shaming, guilt, scare tactics, cruelty, or poor medical care.
An Old Problem with a New Target
We've been down this road before, and we should know better.
Early in my career as a Family Physician, I was very active in the politics of the American Academy of Family Physicians (AAFP). At the time, nearly two decades ago, the AAFP leadership decided to actively address the needs of underrepresented physicians and patients by establishing what is now known as the National Conference on Special Constituencies (NCSC).
As volunteers representing Women, Minority, Gay, Lesbian, Bisexual, Transgendered (GLBT), New Physicians, and later, International Medical Graduates (IMG), we came together annually to debate issues relevant to our constituencies and send elected representatives and resolutions to the AAFP Congress of Delegates. You could argue that such a conference should not need to exist, but it did and it does, and I feel that the AAFP was courageous in admitting it and doing something about it.
The AAFP had given us a seat at the table, so it was often uncomfortable, but necessary, to challenge this large medical organization to examine and address the challenges and issues brought forth by our constituencies. While I am well aware that inequality, bias, prejudice, and discrimination sadly still exist, I know that the activities and voices of the NCSC helped moved the needle on the awareness, attitudes, and policies of AAFP for the benefit of ALL physicians and their patients. As Maya Angelou said, "When you know better you do better."
At the very least, we've finally arrived at a time when blatant discrimination based on sex, race, and increasingly, nationality and sexuality, are not tolerated, at least not openly. There is still much work to be done, but we are slowly headed in the right direction.
So why is there a need for a week dedicated to understanding the serious problem of weight stigma?
Weightism: The Other Stigma
It never occurred to me during those early days of NCSC that a group (now in the majority), defined by their body size, would be increasingly stigmatized--and by the medical profession no less! How is it that weightism is tolerated, and even encouraged? How is weightism any different from stigma based on the color of one's skin or other personal characteristics?
In their defense, I know that my healthcare colleagues are being bombarded from all sides about the "war on obesity" (who isn't?). They are even sometimes blamed for not doing enough, and criticized for not raising the issue with every patient, no matter what they came in for. Medical journals are packed with research about the effectiveness (or more accurately, ineffectiveness) of various "treatments" and conflicting data on the causes and risks of obesity. Still, physicians are pressured to talk to their patients about losing weight, even though most don't have any better advice than "Eat less, exercise more," or "Have you thought of going to Weight Watchers?" (Uh, yeah, thanks.)
I know better now
I am not blameless in all of this. In the next post, I will share how my own approach to weight has evolved over the last 14 years and where I stand firmly today. For now, let me share a few of the things I know after 14 years of working with people who struggle with the issue of weight:
- Focusing on weight leads to dieting.
- Diets don't work.
- Diets often lead to disordered eating.
- Mindful eating can heal a broken relationship with food.
- Mindful eating is a doorway to vibrant living.
- Mindful living is about being in the present moment, not postponing one's life until you attain (or in order to attain) some idealized version of beauty or health.
- Health is a personal and evolving concept for each individual, one that cannot be measured in numbers.
- Health comes in all shapes and sizes.
- Beauty comes in all shapes and sizes.
- Weight is a poor indicator of health.
- Using BMI as a surrogate measure of health is misleading and lazy.
- Weight stigma hurts.
- Shaming and threatening people doesn't improve their health.
- Weight stigma hurts health.
- All people deserve respect and a life free of judgment about the size of their bodies.
What should patients do?
- Set clear boundaries with your healthcare providers, preferably at your first meeting, but anytime will do! For example, you could say, "I am looking for a doctor who will be a partner in caring for my whole self. I am interested in living a healthy lifestyle, but I am not interested in lectures, guilt, or scare tactics. I want my symptoms, issues, and concerns to be taken seriously, and I will not accept 'lose weight' as the treatment for whatever ails me. Can you be that kind of partner in my healthcare?"
- If you feel that you are being stigmatized by a healthcare professional, educate them about the issue (see resources below) and set firm boundaries. If the problem is severe or persists, find a new healthcare professional. You deserve better!
Resources about weight stigma for health professionals
To my colleagues, if you are still reading this, you are already headed in the right direction. Please, know better so you can do better! Here are a few resources that will help:
Next Post: The story about how Am I Hungry? has evolved to be a weight-neutral program