As the mainstream media constantly harp on the ‘obesity epidemic’ and warn us all of the growing numbers of fatties sweeping the nation, one thing people seem reluctant to do is to adjust medical education when it comes to teaching trainee doctors how to interact with fat patients. As this is a world where fat is considered ‘bad’ both socially and medically speaking (despite evidence to the contrary), the assumption seems to be that doctors should approach fat patients as projects to be fixed, rather than human beings. This approach is devastating for fat people who need medical attention, with fat bias sometimes causing fatal consequences.
It’s clear that we need some significant reforms to both the practice of medicine and medical education with regards to fat.
- To begin with, doctors and other care providers need to be educated about fat and the actual ramifications of fat and health. Rather than relying on folklore and ‘conventional knowledge’ about fatness, doctors need to be turned to evidence-based medicine and ample studies indicating that fat is not nearly as dangerous as historically believed, and that, furthermore, diets generally do not work and can sometimes cause extreme problems. This should include exposure to real information on fatness and health in medical school to help doctors learn about when fatness is a legitimate health risk — and when it isn’t. It should also include continuing medical education to keep people updated on how fatness interacts with health.
- Doctors need to be trained to learn to distinguish between fat related to a health problem (such as weight gain caused by a tumour or hormonal imbalance), which needs to be addressed, and a patient’s natural set point. A patient who abruptly gains a great deal of weight is a cause for medical concern and should be evaluated. A patient who slowly gains weight over time is simply following known patterns of weight gain and aging.
- Training about the psychological ramifications of hounding fat patients also needs to be included in medical education. Fat talk kills, as they say, and doctors must learn about how their words and actions can contribute to eating disorders, self-harm, and other problems for fat patients — such as being too afraid to go to the doctor, and thus missing opportunities for early diagnosis and treatment of medical problems.
- Medical professionals need to learn that it’s not appropriate to make personal comments about a patient’s body, as indeed they need to learn more about treating fat people as human beings rather than objects. It’s not appropriate to be derisive or insulting about a patient’s body, or to make comments that could make a patient feel uncomfortable or disrespected — thus, for example, a gynecologist shouldn’t be making comments about how a patient’s genitals are hard to reach or visualise because of fat.
- When medical intervention related to fat is warranted, doctors need to be provided with training on handling that responsibly. This can include recommendations for testing and other procedures to determine the cause of rapid weight gain, as well as referrals to nutritionists for patients with dietary concerns. If a doctor believes a patient is not eating well or could benefit from a more balanced or different diet, that doctor should turn that patient over to an expert in nutrition, rather than providing what is effectively lay opinion or testimonials for various fad diet programmes.
- Doctors need to learn that ultimately, no matter why a patient is fat, that patient is a human being first, and that patient deserves to be approached with respect, compassion, and honour. Ultimately, doctors don’t get to decide what weight their patients should be, as weight is a highly personal matter, and they do not have the right to pressure, shame, or mock patients who don’t fit within a narrow realm of supposedly ‘acceptable’ weights, especially given the overwhelming science on fat and health. Whether a patient is fat because she chooses to be, because she has medical problems, because of her family history, or for any other reason, she shouldn’t be belittled for being who she is. She should be accommodated and treated with respect and dignity at all times.
The medical establishment seems strangely reluctant to reevaluate the way it approaches fat and fatness. Part of this is the result of entrenchment: doctors are notorious for not responding well to new medical information and new recommendations on the practice of medicine, with treatment sometimes lagging far behind the latest medical research. This can be especially stark in older practitioners who have years of experience in medicine behind them, and thus are reluctant to change what they believe has been working for them, sometimes to the grave detriment of their patients, who could benefit from more modern medical techniques.
It’s also, however, the result of larger social attitudes about fat. Fat is regarded with hate, fear, and disgust, and this transfers over into the medical profession, despite the fact that doctors are supposed to be above social attitudes so they can focus on patients and their individual care needs. Though they may swear an oath and pledge to look after patients, doctors throughout the ages have turned away from patients who need them, or made those patients feel worse, because they’re driven by social stigma, hatred, and harmful attitudes just like the rest of society.
For fat patients, these issues have real-world consequences, and it’s time for these consequences to be acknowledged. The widespread belief that fat is unhealthy has had numerous holes poked in it, with more happening all the time, but in a strange way, there’s actually a grain of truth in it: fat can put patients at severe risk of medical problems because medical professionals are biased and mistreat, abuse, and belittle fat patients, leading to medical complications and needless suffering. But it’s not the fat that’s unhealthy here: it’s the way people conceptualise and interact with it.