Weight bias in health care and how to advocate for yourself

A research review warns that providers may put symptoms down to weight and skip tests they would otherwise do. In one study, medical students were far more likely to give lifestyle advice to a bigger patient with breathing problems.

Studies found that providers reported less respect for patients in bigger bodies, built less rapport with them, and in one study said they would spend 28% less time with them.

Women in one study named unasked-for weight-loss advice as a reason they put off cancer screening.

Scales, blood pressure cuffs, gowns and some exam tools are often designed for smaller patients. This can be humiliating and can affect results.

Rude or disrespectful treatment was one of the barriers women named in a study of cervical cancer screening.

In a U.S. study of nearly 500 women, those at the highest weights were less likely to have had a recent Pap test (68% vs 86%). They named embarrassment about being weighed, disrespect and equipment that was too small as reasons for delay.

A research review also found that women in bigger bodies are less likely to get some recommended cancer screenings.

People with conditions such as PCOS (now also called PMOS) often hear weight blamed for everything. An international guideline says many women with the condition experience weight stigma in health care, and asks clinicians to recognise their own weight bias.

Women who also face racism, ableism or other bias may find that their concerns are brushed off more often. You are allowed to name this and to seek a provider who takes you seriously.

Note down

• How it affects your daily life
• The main problem, in one sentence
• What you have already tried
• When it started and how often it happens

Hand the list over or read from it at the start of the visit.

Questions to ask the front desk

• “Do you have chairs without arms?”
• “Do you have larger gowns and blood pressure cuffs?”
• “Is weighing always needed for this kind of visit?”

A friend or relative can take notes, remind you of your questions and speak up if you freeze. Agree beforehand on what you want them to do.

You can ask what a test is for, what the options are, and what happens if you wait. You can also ask for a copy of your visit notes. This is general information, not legal advice.

A respectful clinic should be able to explain why. If it isn’t needed, you can ask to skip it today.

Some people step on the scale backwards and ask staff not to read the number aloud or mention it unless it is medically important.

Being weighed in a busy hallway can feel exposing. It is reasonable to ask for privacy.

Try

• “I understand. Can we look at this problem first?”
• “I’d like to focus on the pain I came in for today.”
• “I’m not here to talk about my weight today.”

Try

• “What else could be causing this?”
• “What would you suggest for someone in a smaller body with these symptoms?”
• “Which tests would rule other things out?”

Try

• “Can you write down what we decided?”
• “What is the plan if this doesn’t get better?”
• “When should I come back?”

Try

• “I feel like my concern isn’t being heard.”
• “I’ve had bad experiences with weight comments, so this is hard for me.”

Many providers will slow down when they hear this. If they don’t, that tells you something useful about whether to keep seeing them.

The American Heart Association reports that a wrong-sized cuff can give inaccurate blood pressure readings, and this is especially common for people who need large or extra-large cuffs.

In a clinical trial, readings were about 10 points higher when people who needed an extra-large cuff were measured with a large one.

Experts have recommended that clinics provide equipment for all body sizes. It is reasonable to ask for a gown that closes, or an extra sheet.

Exam tools come in different sizes. You can ask the clinician to explain each step, use a size that is comfortable, and pause or stop if you need to.

You can see another provider about the same problem. Ask for copies of your records and test results to bring with you.

Ask the front desk or hospital website for patient relations or a patient advocate. They can help you raise a problem or request a different provider.

Keep a record of

• Names of staff, if you know them
• The date and place
• What happened and what was said
• What you would like to happen now

If you live in New York City, weight-based discrimination in hospitals and other public places is covered by city human rights law.

If you can, look for a provider others recommend as respectful of bigger bodies. Your insurer or local clinic may be able to help you change.

Telling a trusted person, or writing it down, can help you make sense of it. It can also help if you decide to give feedback later.

Remind yourself: “I deserved respect today. Asking for good care is not asking too much.”

If health care now feels frightening, or you keep reliving a past visit, you may be carrying medical trauma. It can be helped.

Call ANAD free on 1-888-375-7767, Monday to Friday, 9 a.m. to 9 p.m. Central.

Call or text 988, or chat at 988lifeline.org. You can also text HOME to 741741 to reach Crisis Text Line, 24/7.

Visit findahelpline.com to find free, confidential helplines in more than 150 countries.