n July 14 , 2018 , the Victoria Times Colonist of British Columbia published an obituary for Ellen Maud Bennett , who died of “ inoperable cancer ,” at the age of 64 , shortly after her diagnosis . The loving tribute remembered a vibrant , funny , creative soul who made her last days count . Her “ death bed edicts ” included fresh lobster shipped from Nova Scotia and bouquets of fresh peonies .
Bennett also asked her family to share a message in her obit , “ about the fat shaming she endured from the medical profession .”
“ Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss ,” her family wrote . “ Ellen ’ s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue .”
Bennett ’ s death was not a tragic-yet-rare incident of malpractice . The prejudice she endured plays out every day in doctors ’ offices across North America and the world , often at the hands of wellmeaning practitioners who believe that weight is , indeed , the most relevant health issue affecting the people sitting in front of them . We ’ ve all heard the message , from TV and social media and magazines in the checkout line : lose weight , look great , live longer . The same message gets a health spin in medical school lecture halls , where future physicians learn , incontrovertibly , that too much weight causes type 2 diabetes , hypertension , cardiovascular disease , stroke , arthritis , cancer — the list goes on .
So it ’ s hardly surprising , in a culture that reveres skinniness and demonizes fatness , that doctors steeped in that same milieu share those biases . In studies and surveys , doctors have said people in larger bodies are lazy , lack willpower , and worse . Unsurprisingly , these negative attitudes translate to shorter office visits and less proffered care .
Weight stigma “ prevents you from seeing the person in front of you as a human being ,” Warren Alpert medical student Uchechukwu Onwunaka says . “ You just dismiss their concerns without even
giving it a second thought . It ’ s why you can sit in a doctor ’ s office and hear people talk about weighing fat people at the zoo as opposed to at the clinic .”
Meanwhile patients who perceive that bias are more likely to delay or avoid care , for fear of being judged . When doctors are dismissive , and patients are afraid to show up , the consequences can be dire . Horror stories abound , in the medical literature and the popular press : undiagnosed cancers and kidney conditions and pulmonary disorders , ignored until , like Ellen Bennett , the worst happens , or nearly so .
Carly Goldstein , PhD , is an assistant professor of psychiatry and human behavior at Brown who works with cardiac rehabilitation patients after a heart attack or other major event . “ I have met numerous patients ... who hadn ’ t been to the doctor in 30 years , because they went to the doctor and the doctor said something disparaging about their weight , and they decided to not go back . And think of all of the literal decades of preventative cardiovascular care that person did not receive that maybe would have changed the outcome ,” she says . “ And that ’ s barely a horror story . That ’ s literally what I encounter all the time .”
Goldstein believes that higher weight can be a risk factor in cardiovascular disease , and her research aims to help people lose some of it “ when appropriate .” But she and a growing number of experts say that focusing too much on the number on the scale can be harmful in itself . The stress and even trauma patients feel when pressured to lose weight can have the paradoxical effect of weight gain . Some studies have even suggested that shame and stigma are more harmful to health than excess pounds .
“ I tell providers all the time that being at a higher body weight is not going to kill most people overnight ,” Goldstein says . Investing in a respectful , long-term relationship with each patient goes a long way toward improving their health , no matter what they weigh .
PATIENTS WHO FEEL STIGMATIZED IN THEIR DOCTOR ’ S OFFICE ARE MORE likely to avoid the place . “ I ’ m a fat person myself , and ... doctors would tell me , if you lose weight , everything will get better ,” Christina Roullard , DO , says . “ As a patient , I always felt like I wasn ’ t allowed to seek medical care because I was fat .”
Now a family medicine physician in Dallas , she regularly sees patients whose prior doctors ignored their concerns “ for years ,” and instead prescribed weight loss . That ’ s not news to Roullard , who has asthma , and has gone to the doctor wheezing and been told to lose weight .
12 HEALTH DISCOVERIES l WINTER 2023