Running Head: FATPHOBIA IN THE AGE OF MODERN MEDICINE 1

Fatphobia in the Age of Modern Medicine and Failures to Address the Obesity Crisis

Anna Wagner

Appalachian State University

Author Note

Anna Wagner, Beaver College of Health Sciences, Appalachian State University

FATPHOBIA IN THE AGE OF MODERN MEDICINE 2

Abstract

In the past half century, efforts by physicians to end the obesity crisis have involved prioritizing

weight loss instead of promoting a healthy lifestyle in general. Drastic weight loss is

continuously prescribed despite decades of research proving that diets do not work. Physicians

should be unbiased but have succumbed to the fatphobic views encouraged by society and the

medical field, which has led to the neglectful treatment of heavy patients. The diet culture that

has permeated medicine harms patients by lowering their metabolisms and pushing the belief

that the quantity of food eaten is more important than the quality of it. There is a need for a new

approach in tackling the obesity crisis in which all patients are taken seriously, and their

treatments personalized and realistic. Most importantly, there is a need for physicians that are

trained to have meaningful interactions with heavy patients and have the skills to provide help

that is based in fact rather than bias and long-held cultural beliefs.
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Fatphobia in the Age of Modern Medicine and

Failures to Address the Obesity Crisis

In the past fifty years, rates of obesity in America have expanded rapidly. Society tends

to view the obesity crisis with disdain. Being fat is seen as a personal failure, and shame is used

as a tactic to promote weight loss. Medical professionals are not infallible to these deeply-

engrained societal norms, and their primary response has also been to blame heavy people for

being that way. They have consistently prescribed diets, despite proof that diets do not work.

Similarly, these professionals are supposed to be unbiased pioneers of health, yet have fallen

under the same delusion as all of us: that weight and health are perfect synonyms. The methods

doctors have used to help fat patients for the past half century have been counterproductive at

best and neglectful at worst.

This neglect is often not addressed, but it is both common and widespread. Countless

surveys find that nearly 50% of physicians describe their obese patients as “awkward,

unattractive, ugly, and noncompliant” and a third go further to say they are “weak-willed, sloppy,

and lazy” (Anderson, et al. 2013). Doctors also say fat patients are less likely to benefit from

treatment and less likely to improve than thinner patients (2013). On average, doctors spend less

time with heavy patients than they do with thin ones (Hobbes, 2018). This points to the massive

issue of physician discrimination that is based in little or no evidence. Many doctors illustrate a

lack of empathy with their heavy patients and are unwilling to help without a patient first losing

weight. Doctors often overvalue thinness to the detriment of ailing patients as well, assuming

somebody is “taking care of themselves” if they begin to slim down without meaning to when
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weight loss may be a sign of serious illnesses (Brown, 2016). Personal stories are good

illustrators of the disconnect between doctors and their fat patients.

Terri, 38, is a bank examiner in New York City. She describes how 25 years of weight

cycling wrecked her metabolism, and that when a doctor demanded her to lose weight and she

couldn’t, the doctor believed she was lying about her exercise and diet habits (Brown, 2016). In

her own words, another woman describes how her doctor of many years would “sit across the

room and talk to me… When I got a sebaceous cyst on my arm that kept getting bigger, [I had to

convince him to examine it because he didn’t want to]… He got a glove and some tissue. And it

was in that moment I realized he’d never listened to my breathing or actually touched me.”

(2016). In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14

percent had barred all new patients weighing more than 200 pounds (Hobbes, 2018). This bias

even extends to children. In 2010, a pediatric endocrinologist diagnosed an obese ten-year-old

named Claudialee Gomez with Type 2 Diabetes and recommended weight loss. As young

Gomez lost the weight, Dr. Mercado felt that she was improving and even stopped monitoring

her, telling her to keep up the great work. However, if Mercado continued monitoring her

patient’s blood work, she would have seen that the child’s blood sugar levels were still rising:

Gomez had Type 1 Diabetes. Claudialee collapsed into a diabetic coma and died a preventable

death.

Although this example is extreme, it still illustrates that fat bias is prevalent in many

fields of medicine (Brown, 2016). The unprofessional, discriminatory, and dangerous ways in

which professionals handle heavier patients have serious consequences and are completely

unethical. It is no wonder that overweight and obese women often delay or avoid going to the
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doctor and get fewer Pap smears, mammograms, and other routine cancer tests, which can even

explain the link between higher BMIs and cancer deaths (Amy, et al., 2006).

Usually, the first thing a doctor will “prescribe” to a fat patient with any ailment is

dieting, often because doctors simply do not know better. But if diets truly worked, why does

there always seem to be a new one popping up every new year and bikini season? Research

conducted since the late 1950s has come up with the same conclusive evidence regarding diets:

around 95 to 98 percent of attempts to lose weight fail, and two-thirds of dieters gain back more

than they lost (Hobbes, 2018). Losing weight sets off a biological alarm, because the human

body is designed for survival. Research shows that a loss in just 3% body weight can result in an

average of 17% metabolic slowdown (Hobbes, 2018). This starvation response bombards the

brain with hunger hormones and drops internal temperature until the body rises back to its pre-

diet weight (2018). Even if the dieter is heavy, the body does not know that the weight it lost was

“excess” and responds with the same survival instincts that kept mankind alive during famine

and scarcity throughout history. Therefore, it is nearly impossible for dieters losing significant

amounts of weight to keep it off for more than a few years, battling constant hunger the whole

time (2018). Undergoing this starvation process multiple times by continuously losing and

gaining back weight puts immense stress on the body.

There is a strong belief that when it comes to dieting, the ends must justify the means.

Diets can make one thinner and therefore certainly healthier according to the warped view of

health held by many professionals. However, there is much evidence that proves dieting is

actually harmful, especially in “yo-yo” cycles. The negative effects of weight cycling include a

decreased muscle mass, increased cardiometabolic risk, increased blood pressure, and a higher

risk of becoming overweight or gaining more weight in the future (Pietiläinen, et al., 2011).
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Similarly, being thin does not guarantee that a body is healthy, just like being overweight does

not necessarily mean that one is unhealthy. It is true that most population-level studies find that

fat people have worse cardiovascular health than thinner people (Hobbes, 2018). However,

individuals are not averages: studies find that anywhere from one-third to three-quarters of

people classified as obese are metabolically healthy, showing no signs of elevated blood

pressure, insulin resistance or high cholesterol. Conversely, roughly 25% of non-overweight

people do exhibit these symptoms and are what epidemiologists call “the lean unhealthy”

(Hobbes, 2018). A height to weight ratio only tells part of the story, but a variety of factors

ranging from exercise level to vegetable consumption to grip strength make better indicators of

health and longevity (2018). As obvious as it may seem, health professionals often forget to look

at the big picture when it comes to fat patients, usually making assumptions that their patient is

unhealthy based on looks without running tests or asking about activity level and diet. One

patient named Andrew recounts that his doctor pronounced him dangerously overweight, but

“didn't even ask me what I was already doing for exercise. At the time, I was training for serious

winter mountaineering trips, hiking every weekend and going to the gym four times a week.

Instead of a conversation, I got a sound bite. It felt like shaming me was the entire purpose”

(2018).

Herein lies a huge issue that must be addressed. As one article describes it, the irony is

that “for 60 years, we’ve approached the obesity epidemic like a fad dieter: If we just try the

exact same thing one more time, we'll get a different result” (Hobbes, 2018). The problem begins

in medical school, where in 2015, nutrition education for students averaged just 19 hours in four

years – five hours fewer than they received in 2006 (Hobbes, 2018). Doctors are not adequately

trained on how to interact with heavier patients and are not properly informed on what can be
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done to help these people realistically. And so, doctors fall back on recommending fad diets and

delivering half-hearted motivation to heavy patients, which has cost millions of lives in the past

sixty years. Consequently, according to Kimberly Gudzune, an obesity specialist at Johns

Hopkins, most doctors also believe that weight falls under their authority (2018). “Instead of

focusing on realistic goals to improve a patient’s wellbeing, like playing with their grandchildren

longer or stopping their cholesterol medication,” most physicians believe that it is their

responsibility to encourage sudden weight loss when they could be pushing a variety of more

sustainable lifestyle changes over time to promote overall health (2018). Recreating a system in

which doctors are better informed and taught to have meaningful interactions with patients

would result in fewer preventable deaths and less dread on behalf of the patient, encouraging

more frequent visits. Unfortunately, insurance companies also push the belief that obese patients

need to lose weight to prevent them from becoming a liability. According to Hobbes’ article,

Everything You Know About Obesity Is Wrong,

physicians are often required, in writing, to prove to hospital administrators and insurance

providers that they have brought up their patient’s weight and formulated a plan to bring

it down—regardless of whether that patient came in with arthritis or a broken arm or a

bad sunburn. Failing to do that could result in poor performance reviews, low ratings

from insurance companies or being denied reimbursement if they refer patients to

specialized care. (Hobbes, 2018)

The system as it stands now is shamefully focused on profit and is powerless against the massive

private insurance companies that dominate healthcare in this country, leaving out the patients

that truly need the help.

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As far as what change needs to happen at a cultural level, there needs to be a shift in

belief. Public shaming of obese individuals is justified due to the belief that those feelings will

inspire change, but the opposite is true. In fact, kids who are unhappy with their bodies are less

likely to be active and exercise than kids who feel good about themselves, no matter their size.

“Weight dissatisfaction may actually discourage people from engaging in healthy behaviors”

says Christine Blake, professor of health promotion at University of South Carolina. “People

who are unhappy with their weight are more likely to give up while people who are

overweight/obese but reasonably satisfied with their bodies are more likely to be active in a way

they enjoy,” (Blake, 2013). Overall, an increase in empathy and increased education about

improving health that have nothing to do with weight loss would work wonders in reversing the

obesity crisis.

In conclusion, the prolonging of the obesity epidemic is a direct result of the significant

disconnect between science and practice. The lives and happiness of millions have been claimed

because of the inadequacies and bias held by the health professionals who people trust with their

lives. A new era of healthcare would not be able to reverse the damage that has been done, but

would ensure a revolutionized system in which the livelihoods of all patients are taken seriously

and based in fact and understanding rather than bias and long-held cultural beliefs.
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References

Amy, N. K., et al. (2006). Barriers to Routine Gynecological Cancer Screening for White and

African-American Obese Women. International Journal of Obesity, 30, 147-155.

Anderson, E., et al. (2013). Weight cycling increases T-cell accumulation in adipose tissue and

impairs systemic glucose tolerance. Diabetes, 62 (9), 3180-3188.

Blake, C., et al. (2013). Adults with greater weight satisfaction report more positive health

behaviors and have better health status regardless of BMI. Journal of Obesity. Retrieved

from https://www.hindawi.com/journals/jobe/2013/291371/citations/

Brown, H. (2016). Body of truth: How science, history, and culture drive our obsession with

weight and what we can do about it. Philadelphia, PA: Da Capo Press.

Hobbes, M. (2018). Everything You Know About Obesity Is Wrong. Retrieved from

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-

wrong

Pietiläinen, K.H., et al. (2011). Does Dieting Make You Fat? A Twin Study. International

Journal of Obesity, 36, 456-464.