Abigail Saguy on Health Care Provider Bias

There’s a great article in The Washington Post about bias against fat people in the medical community. It’s good to see someone pointing out the inferior medical care fat people receive after hearing all the people, in the wake of the latest BMI and life expectancy study, saying that fat people must live longer because they receive better and more aggressive medical care. (It’s hard for your doctor to prescribe an “aggressive” treatment plan for your diseases if you avoid going to the doctor at all!)

She makes a good point on diabetes:

I don’t deny that there are health risks associated with higher body mass. The clearest case is Type 2 diabetes, which becomes more likely as weight goes up. Yet, as many medical researchers have pointed out, it’s not clear whether obesity causes diabetes, whether diabetes causes obesity or whether both conditions are caused by a third factor, such as poor nutrition, stress or genetics. Moreover, the association between weight and Type 2 diabetes is not perfect. Some thin people develop the disease, and many fat people never will.

But she undersells it a bit: it’s not that “many” fat people won’t get diabetes–most won’t. 75% of obese people never get diabetes. I wonder if she omitted that because she’s worried that a lot of people would find it too incredible?

I liked like Saguy points out the detrimental mental and physical effects of fat stigma:

Anti-fat attitudes also take an emotional toll. For instance, fat children are more likely than their thinner peers to be bullied. And weight-based bullying does not end with childhood: Women speak of young men hurling insults or even food at them in public spaces. Fear of such humiliation leads many heavy women to avoid exercising in public. In extreme cases, these women might not go out at all, depriving them of the face-to-face social interaction that is vital for mental and physical well-being.

Humans are social animals (much as I’d like to forget that sometimes). Health isn’t just about nutrition and exercise and taking your medication, you know! It’s easy for me (and probably most people) to forget that, though, because we tend not to discuss that as much


I ended up reading some of the comments; it’s mostly filled with a few dedicated Outraged People who are having particular trouble with this part, near the beginning of the article:

Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their weight for any health problems they have. [emphasis mine]

Their reaction goes well with this part, near the end:

Other studies have shown that individuals who think people can control their weight are more likely to believe that weight-based discrimination is justified.

The main reason I read the comments was because I was looking for this comment (one of the three or so previewed when I originally read this on my work computer). (And then I decided to skim through them and look for comments I could read more carefully and “like” until I got to the comment I was looking for.) I will pull it out of the muck for you:


BillBrann writes “They aren’t worth the care.”

They aren’t worth the care. Goes right along with the opinion that we should curb and cap funding for end-of-life care. I mean, those old people aren’t “worth” it, right ? The only people worth our medical care, our funding, our taxes, our concern, our planning are those that are either contributing toward society (healthy adults) or are being raised to contribute toward society (children.) The rest are not “worth the care.”

Talk about a lack of humanity.

[BillBrann is one of the dedicated Outraged People, leaving multiple comments.]

Of course, most fat people are contributing toward society, it’s just that some people think they might be using more health care than average.

Saguy ends with this (I suspect that she’s been reading First, Do No Harm):

In our rush to cure the obesity epidemic, we are not only ignoring but may be worsening anti-fat prejudice and size profiling. If medical professionals want to improve public health, they might start by renewing their pledge to “first, do no harm” by treating patients of all sizes with dignity and respect.

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