Navigating a HAES-Ignorant Health Care System

I remember exactly where I was standing when I received a frenzied series of text messages from a client who was sitting in her doctor’s office for her annual physical being warned (mansplained) of the dangers of obesity and strongly advised to lose weight.

She was perfectly healthy by all lab measures. Interestingly, her doctor was in a larger body.

There was the teary phone call I shared with another client after she had been asked to be weighed no less than seven (7!) times by medical assistants, nurses, and finally her doctor.

She was there to get an antibiotic prescription for a sinus infection.

And then there was my pregnant client who sat on my couch bereft, relaying how her obstetrician had told her to “lay off the carbs” because she was gaining too much weight.

She and the baby were perfectly healthy. She was also going through a horrifically
traumatic personal situation and occasionally used food to soothe herself – which might
have come out had the doctor asked “how are you, really?”

With each of these clients, I had discussed this possibility. We had talked about misconceptions in healthcare about weight and weight loss. We reviewed the data showing that efforts to lose weight are directly tied to weight gain, weight cycling, and decreased measures of physical and mental health.

And we highlighted the fact that despite the mounting evidence against weight-loss diets and in support of attuned eating styles such as Intuitive Eating and healthcare approaches that prioritize wellness over weight such as Health at Every Size, many medical professionals persist in their biases against people in larger bodies. We lamented the fact that no amount of data could dissuade many of them from the deeply held notion that fat is unhealthy and the root of (route to?) all illness. That they are in fact humans with blind spots – very influential humans whose blind spots cause all sorts of physical and mental mayhem for their patients, but mere humans nonetheless.

Weight stigma – the prejudicial and negative attitudes, beliefs, stereotypes, or discriminatory behaviors targeted at individuals because of their weight – affects the medical care received by people in larger bodies. It often leads people to fear and avoid preventive and regular medical care. In some cases people don’t go to the doctor until an illness has progressed.

This is wrong.

Weight stigma seems to be the norm, but it is not normal. It is the last bastion of acceptable bias against other humans, but it is not acceptable. It is often medicalized and rationalized, but the medical evidence does not support it and it is therefore irrational.

Don’t rebel against an ignorant healthcare system by not going to the doctor. Go to the doctor differently:

Educate yourself: You may already know plenty about HAES, Intuitive Eating, and the scientific evidence against dieting. If you don’t – or if you want a refresher – check out this, this, this, and this.

Be assertive: Be that woman. Don’t hesitate to put your own boundaries front and center. If you don’t want to be weighed, say so. If you don’t want to discuss weight loss, say so. If you have a preferred term to refer to your body – fat, for example, instead of overweight or obese – assert that need. Just remember how many times you yourself have been made to feel uncomfortable in a healthcare setting and for once don’t worry about making other people uncomfortable.

Practice self-compassion: This is hard. Be very gentle with yourself. Know that you are on the right side of science (and social justice, and human rights). Make sure that you take care of yourself before, during, and after these interactions by getting enough rest, drinking enough water, eating satisfying foods regularly throughout the day, and speaking to yourself as you would a loved one.

Support yourself: Bring a supportive friend, partner, or family member with you who understands your needs and who is willing to be your wingman/woman. Speak to a nutritionist or therapist aware of HAES and Intuitive Eating to run through scenarios before going to the doctor. And please feel free to bring and/or offer your healthcare provider this postcard in support of your needs.

Hope for the best (but don’t be surprised by the worst): I believe we are heading in the right direction in terms of fat acceptance, equal treatment in the healthcare system, and body positivity, but there is much to be done and many people just won’t get this. Your willingness to go toward this inherently uncomfortable situation with knowledge, intention, and self-care might just plant a seed in that healthcare setting that will ripen in the unknown future.

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