Why Do Doctors Fat-Shame People ?

by Farzana Rahman

Everything You Know About Obesity is Wrong

Michael Hobbe’s made a bold claim in his recent article on obesity, claiming that ‘everything you know about obesity is wrong.’ It’s a daring statement and good click-bait, but is it accurate?

The medical community and policymakers often talk about the obesity epidemic and the many complications that arise from being overweight. However, the article makes a salient but somewhat depressing observation; that despite widespread attention to this problem, the medical community is failing patients who are overweight.

There are a number of people featured in the article that relay upsetting stories about their interactions with the health service. Stories of rolled eyes, cynical questions and unhelpful advice.

Fat-Shaming and the Medical Community

The main criticism of the medical community is that we regularly use shame tactics to motivate people to lose weight. This can create lasting trauma in patients and cause them to completely avoid the health service. Hobbe’s cites some interesting research. Doctors have been shown to have shorter appointments with fat patients and have less emotional rapport. A study of patients with headaches showed doctors to be inherently biased against fat people, classifying them as less compliant, even though there was no evidence of this.

Fat-Shaming and Myths About Discipline

Although this makes for sobering reading, it is also unsurprising. In my experience, most doctors (myself included) have an element of obsession that borders on freakish. It’s not surprising; having neurotic tendencies helps you to become better at your job. Triple checking results, feverishly documenting every consultation and exhausting all possibilities is part and parcel of good medical practice. However, fostering these qualities comes with a trade-off. Fastidiousness, discipline and obsessiveness seep into our personal lives. We value willpower and self-regulation and fear losing control.

Obesity is seen as the embodiment of poor discipline and it leaves us bewildered. It’s interesting to observe some doctors talk about fat patients compared to chronic smokers or alcoholics. The difference in the lack of empathy is, at times, striking. The knowing smirks and quiet comments rooted in a sense of incredulity as to how anyone could let themselves get this way.

Losing Manners

Yet the situation is never that simple. Obesity is a complex, multifaceted issue that does not simply boil down to a lack of willpower. Research about gut bacteria, genetics and social factors has shown us that it’s rarely as simple as self-control.

Perhaps we have just internalized what we see around us. We are trained to loathe obesity, whether it’s yourself or those around you. The author Roxanne Gay has talked about being gawked at on plane or having her picture taken because of her weight. The writer Lindy West has described years of horrific trolling where large numbers of people are obsessed with her size.

It seems that as a society, we’ve forgotten etiquette and embraced humiliation. Perhaps it is this that has trickled down into the medical community. In Hobbe’s article, he quotes Sean Phelan, a Mayo Clinic researcher as saying obesity is the ‘last area of medicine where we prescribe tough love.’ In the UK, the Chief Medical Officer has lamented that she could no longer see the ribs of children at the beach and that it is not possible to be fat and healthy.

The Value of Positivity

Yet, there is little evidence that shaming individuals leads to any real change. There is a wealth of research highlighting the value of tapping into self-motivation, self-worth and positivity to create lasting behaviour change. Successful public health initiatives in areas such as heart disease and diabetes have used positive frameworks and support networks to produce impressive results.

Dean Ornish, a Cardiologist and founder of the hugely successful Ornish Lifestyle Program for heart disease, stresses that support networks and love are crucial to healing. As doctors, perhaps this is what we need to focus on when it comes to obesity. This is not about being overly sensitive or succumbing to political correctness, it comes down to evidence. If we are to make real meaningful change, we are unlikely to get anywhere by shaking our heads and shaming people.