Why doctors who fat shame are hurting their patients

Doctors who deliberately shame their patients over their weight, believing they will help to motivate them to lose weight, are doing their patients more harm than good, say psychologists.

Presenting at the 125th Annual Convention of the American Psychological Association this week, several psychologists discussed sizeism in medicine.

Psychologist Maureen McHugh from the Indiana University of Pennsylvania told the conference that studies have found that fat shaming is not effective at reducing obesity or improving health, and instead injures a patient’s psychological health.

In a presentation entitled “Sizeism is a Health Hazard,” Joan Chrisler, a professor of psychology at Connecticut College, says doctors who shame a patient about his or her weight can often lead that patient to stop making doctors’ appointments at all.

Chrisler said physicians often engage in “microaggressions” against overweight patients; for example, shaking one’s head, wincing, or ‘making “tsk” noises while noting a patient’s weight in a chart, she said.

These microaggressions become stressful over time for patients and contribute to feeling stigmatized.

“Disrespectful treatment and medical fat shaming (in an attempt to motivate people to change their behavior) is stressful and can cause patients to delay health care-seeking or avoid interacting with providers,” she said.

Physicians who are “sizeist” often assume a patient’s medical concerns are simply the result of their weight. That can cause them to dismiss a patient’s complaints, to miss diagnoses or to delay testing or care.

“Research has shown that doctors repeatedly advise weight loss for fat patients while recommending CAT scans, blood work or physical therapy for other, average weight patients,” Chrisler said.

In some cases, providers might not take overweight patients’ complaints seriously or might assume their weight is the cause of any symptoms they experience, Chrisler added.

“Thus, they could jump to conclusions or fail to run appropriate tests, which results in misdiagnosis,” she said.

McHugh says physicians who have a “weight-centric model of health” assume that higher weight is equated with poor health habits, and that weight loss is always within a patient’s control.

Both Chrisler and McHugh agree the medical profession needs to acknowledge and confront weight stigma. They also advise that treatment for overweight patients should focus on improving a patient’s mental and physical health, not simply their weight.