The detrimental impacts of anti-fat bias in healthcare have been extensively documented. While implicit biases regarding race, skin color, and sexuality have either remained stable or shown minimal changes, implicit anti-fat bias has seen a concerning 40% increase between 2004 and 2010. Moreover, research has demonstrated that fat-shaming contributes to worsening health outcomes over time. Addressing anti-fat bias in healthcare is crucial for ensuring that individuals, regardless of their body size, receive the appropriate care and treatment for their health needs.
How Should We Discuss Fat?
Various approaches exist for discussing fat in a respectful and inclusive manner. Dr. Sarah-Ashley Robbins, MD, a physician at the Gaudiani Clinic specializing in treating individuals with eating disorders, adopts the Health At Every Size® (HAES®) approach in her practice. This model prioritizes treating patients’ medical conditions without emphasizing intentional weight loss. Dr. Robbins opts for non-stigmatizing clinical language, such as referring to patients as “individuals in larger/smaller bodies,” rather than using terms like “obese” or “overweight,” which can medicalize fat.
Within the fat acceptance movement, there is a movement to reclaim the word “fat” as a neutral descriptor akin to terms like “tall” or “brunette.” Some individuals also use terms like “superfat,” “small fat,” “mid fat,” and “infinifat” to describe different body sizes. However, preferences vary among individuals, with some preferring person-first language (“person with fat”) or choosing to avoid the term “fat” altogether. It’s essential to engage in open discussions and respect individuals’ preferences regarding language when discussing body size.
Understanding the Origins of Fat Stigma
Historically, attitudes toward fatness have undergone significant shifts. In Europe from the 1500s to the 1900s, fatness was associated with privilege, evident in art and fashion of the era. However, Sabrina Strings, PhD, in her book “Fearing the Black Body: The Racial Origins of Fat Phobia,” traces the origins of fat phobia to colonial ideologies associating Black individuals with sensuality, lack of self-control, and obesity. These attitudes gave rise to a toxic diet culture, which persists today and is perpetuated by societal ideals of thinness.
Fat Stigma in Healthcare Settings
Anti-fat bias manifests in various ways within healthcare settings. Studies have shown that healthcare professionals spend less time with fat patients, develop weaker emotional connections with them, and may engage in behaviors that contribute to patient discomfort. Moreover, weight discrimination has been linked to higher mortality rates, and children as young as three years old can internalize negative attitudes toward their bodies due to weight stigma.
Misdiagnosis of eating disorders is also common in fat individuals, particularly among racial and ethnic minorities. Healthcare providers often attribute symptoms to weight without conducting thorough evaluations, leading to untreated conditions. Addressing fat stigma in healthcare requires both internal and external efforts, including acknowledging and confronting implicit biases among healthcare professionals.
Mitigating Fat Stigma in Healthcare
To address fat stigma effectively, healthcare providers must undertake both personal and systemic changes. Taking implicit fat bias tests and engaging in ongoing self-reflection can help individuals recognize and mitigate their biases. Additionally, promoting inclusive language and creating environments where patients feel respected and heard regardless of their body size are essential steps toward combating fat stigma in healthcare.
By fostering a culture of acceptance and prioritizing patients’ holistic well-being over weight-focused approaches, healthcare providers can help mitigate the harmful impacts of anti-fat bias and ensure equitable access to care for all individuals, regardless of their body size.
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