Is fat bias affecting your medical care?


We are all guilty of having biases. Some of them we know about, and even proudly flaunt. Some of them have been ingrained in us so deeply we do not even know they exist. Weight is an issue that brings out strong biases, and multiple studies have demonstrated a high level of bias from physicians against overweight and obese patients. Obese patients are often treated rudely and are not given the same level of medical care as non-obese patients. One study (Huizinga MM, et al. J Gen Intern Med. 2009) even showed that as a patient’s weight increases, physician respect for the patient decreases. Think about that- the more overweight you are, the less value you are perceived to have as a person. As both a physician and someone who has until recently been obese for my entire adult life, I can personally attest to the prejudices which exist within our field.
I myself, even as a doctor, have been fat-shamed by other physicians. (Note: by fat-shamed I do not just mean told to lose weight. Discussing weight loss is part of our jobs! I mean that my treatment as a patient was of poorer quality than if I had been of normal weight). There is so much stigma and negativity around obesity, it leads many care providers to blame every patient complaint on their weight. Let me be very clear: yes, many many complaints and health issues are actually due to obesity and can be improved or cured with weight loss. And absolutely every chance we get we should counsel our patients on weight loss.
But our job as physicians is to help guide patients down the right path with support and encouragement. To individualize recommendations that will help our patients succeed. To give them resources and ideas. To be compassionate. Not to just judge patients at face value and dismiss them. Empathy and understanding go a long way. Even if you find it hard to relate to someone struggling with obesity, treating every patient with respect and dignity is the bare minimum requirement!
In my time during medical school, residency, and now as an attending I have been privy to many discussions among providers about obese patients. A prevailing attitude through the years has been that obese patients “did this to themselves.” Meaning, the patient is at fault for being fat and therefore at fault for having whatever complications and co-morbidities befall them. This is the same attitude I see towards drug abusers and alcoholics- that their medical problems are somehow less important because they are “self inflicted”. Just as many factors contribute to drug and alcohol addiction, so is true of obesity. If we just focus on providing empathetic, non-judgmental care we will have better relationships with our patients and their health outcomes will improve. So let’s all put our biases to the side and focus on providing the best care possible to each and every patient.


  1. 365evermore says:

    Interesting post, I have definitely felt this bias many times not only in relation to seeing my GP or any other medical professional but also in employment situations for instance. Before I was diagnosed with Hashimoto’s thyroiditis and I addressed my slow weight loss despite being very active and eating healthy my GP would blatantly show disbelief in my claims of activity level and food regime. As if being over-weight always equals being lazy and out of control. In GP’s (and other health professionals) defence, I suppose that many patients often have a lack of awareness of what they actually eat during a day, but it is sad to see that so many GP’s have stopped to actively listen to what is being said by the client. It is such a pity that far too many medical doctors abuse their expert status in such a vile manner and subsequently ignore the extreme vulnerability of their clients. Anyway, thank you for raising this subject!


    • jkhartsock says:

      Thank you for the comment! I will Be the first to admit I agree we don’t actively listen. We are so set up to just go through the motions and check off conditions, that we don’t really pay attention to what is the root problem that has caused diabetes or high blood pressure or sleep apnea. I think that’s such an excellent point!

      Liked by 1 person

    • Paula says:

      I have Hashimoto’s too. The doctors were always telling me it was all in my head and that I was not sick. I just needed to diet and exercise more. Oh my God, I was exercising and eating 1200 cal a day and being told I was lying. That it was impossible for me to be gaining 30+ pounds doing that much exercise and eating that little. I’ve finally went to a functional medicine Doctor who actually listened. What a difference. It took a long time, but I am managing my illness. It is tough because functional medicine is not covered under insurance. But my doctor is a MD that chose to be a functional medicine doctor so she can write Rx and order any tests needed.

      Liked by 1 person

      • 365evermore says:

        That is basically my story as well. It took me years to finally find someone that took me seriously, I too was exercising 5-6 days per week (i.e. running, rowing, swimming, lifting weights in the gym etc) and ate 1200 calories or less per day (calculated and weighed everything!). I am very much of a perfectionist and love stats so kept everything documented in an excel sheet, despite this many GPs (before I was finally sent forward to a specialist) simply ignored all my efforts. I was even asked by a GP if I knew that sugar was an ingredient in sodas. A question that came out of the blue as I never drink sodas and never have (allergies), it was at that point I realised that I had to be a lot more proactive in my search for answers and expert advice. Don’t get me wrong, there are amazing medical doctors out there (I have four in my family!) and I can only imagine how difficult it must be for people that may not have the kind of support I have had. Anyway, I am happy for you that you found a doctor specialising in functional medicine and that you are on the mend so to speak. Hashimoto’s is not a fun disease to live with, but it can be okay if you have the right support from medical professionals. Best of luck to you!


  2. Paula says:

    I can relate. I had a gynecologist tell me that I was fat. That if I didn’t start trying to lose weight I would just keep getting bigger and bigger. I dreaded going to the doctor so much that I stopped going to doctors all together. I suffered with other illnesses simply because I would not go to the doctor to be insulted about my weight. I regret that I just didn’t attempt to find a good doctor instead of ignoring my health.


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