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If you’ve ever been told by a healthcare provider to “lose weight” or simply “be healthier,” you’re not alone. Too often, providers give these directions without ever asking about health goals, eating habits, activity level, physical limitations, sleep habits, cultural norms, access to food, or financial considerations. Perhaps more importantly, they may never ask if you have any personal sensitivities around body image, being weighed, disordered eating behaviors, or other concerns regarding weight and food.
Weight loss seems to be the go-to recommendation (from just about anyone) when it comes to most health-related concerns, especially diabetes. But weight loss and diabetes management often get conflated; the first doesn’t necessarily improve the second. That’s not to say that weight loss doesn’t help some people on their health journey, but solely focusing on weight ignores many other factors of health and wellbeing. Additionally, mainstream media has perpetuated the severely false idea that diabetes is caused by weight gain, and thus can be easily cured by weight loss.
Health exists on a spectrum and fluctuates constantly as an individual’s life experience changes.
“There is no standard of health that is achievable for all bodies. Our belief that there should be anchors in the systemic oppression of ableism and reinforces the notion that people with illnesses and disabilities have defective bodies, rather than different bodies,” said by Sonya Renee Taylor in her book, The Body is Not an Apology.
Too often, a person’s weight can lead to discrimination and harmful stereotyping when it comes to health care access. Here, we’ll discuss how a person’s weight can lead to bias and discrimination in healthcare, the Health at Every Size® approach, and a few steps we can all take to create a more body-inclusive culture.
Weight Bias in Healthcare
Weight bias is negative, judgmental, and stereotypical assumptions about people based on their size. A 2021 study found that healthcare providers share both implicit and explicit weight-based attitudes towards people with obesity. You can actually see and experience the results of weight bias in a health care clinic—scales with limited capacity or blood pressure cuffs that are too small.
It can also be found in the attitudes and assumptions of healthcare providers, who may view people with obesity as lazy, unmotivated, or medically “non-compliant.”
Whatever the health concern is, too often the prescription for a person who is overweight or obese is to “eat less, move more.” These negative and limiting views can cause serious health conditions to go unrecognized and untreated. People with obesity can also be subjected to higher health insurance premiums, which highlights the systemic nature of weight-based discrimination.
And in many cases, the people on the receiving-end of this bias develop anxiety, depression, decreased sense of self-worth, and harmful eating/dieting behaviors. The trauma that comes with being treated this way may eventually cause a person to avoid the healthcare system altogether.
Weight Bias in Politics
A recent example of political weight-based discrimination in the diabetes community is the response Florida Congressman Matt Gaetz gave in response to his vote against the proposed Affordable Insulin Now Act, which would cap monthly insulin costs at $35 per month starting in 2023. In defense of his opposition, he said, “Arbitrary price controls are no substitute for individual weight control…in other words, the price of insulin increases as waistlines increase.”
This narrow and ignorant view completely dismisses the myriad of factors that play into body size, and both type 1 diabetes (T1D) and type 2 diabetes (T2D). Every single person with T1D and a significant percentage of those with T2D require insulin therapy in order to survive and protect their organs from severe damage. Insulin is not luxury or a choice. Diabetes management is far more complex than simply exercising regularly and eating a healthy diet.
This kind of candid political weight-based discrimination is further limiting access to life-saving diabetes therapy.
Health at Every Size®
The Association for Size Diversity and Health (ASDAH) is working to end weight-based discrimination, by promoting a holistic view of health. ASDAH states: “Health status should never be used to judge, oppress, or determine the value of an individual.” Nor should it limit access to life-saving diabetes treatments, such as insulin. ASDAH recognizes that attempts at weight loss are often unsustainable in the long-term, and alternatively promotes the Health at Every Size® approach, with these principles, last revised in 2013:
Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
Eating for Well-Being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
According to their website, ASDAH is revising these principles in the 2022-2023 year to be more supportive of those most impacted by fatphobia, or the fear and hatred of fat bodies. They plan to remove Life-Enhancing Movement and Eating for Well-Being from their list of principles, deeming these useful tools, though not core components of their mission to reduce weight-based stigmatization and discrimination.
Living in a Weight-Biased World
Weight bias and fatphobia go far beyond healthcare and politics; they pervade our social media streams, beauty standards, relationships, public transportation experiences (tiny seats), job opportunities, and everyday conversations.
While there is so much work to be done in reframing the mindset of our healthcare and political systems, there is also room for improvement in our own personal biases.
For starters, this quiz can help identify any implicit weight bias you may have. Reframing and using respectful language is another step we can all take to create a more body-inclusive culture.
When was the last time you said, “Wow! You look great—have you lost weight?” or “I need to work on my summer body” or “I feel so fat after eating that meal”? Comments like these, though they may seem harmless, perpetuate fatphobia. They suggest that there is an ideal body type, and anything other is substandard. Here are a few tips when it comes to inclusive, respectful language:
- Refrain from commenting on a person’s weight—even if you think it’s a compliment.
- Refrain from offering unsolicited weight loss advice or promoting or participating in fad diets.
- Reframe your language. For example, instead of saying, “I feel so fat,” (fatphobia) consider using more descriptive language, like “I feel bloated.”
- Advocate for the health concerns that are most important to you, and correct healthcare providers who make assumptions.
Health is a spectrum, and no standard of health or body size is achievable for all people. Weight-based discrimination, bias, and fatphobia are systemic problems that can actually interfere with a person’s ability to get the health care they need. The ASDAH is working to address this problem by promoting their Health at Every Size® principles, which emphasize respect and acceptance of different body shapes and sizes. By taking the focus off of weight, not only in healthcare, but in our everyday lives and conversations, we can create a more body-inclusive and respectful culture.
I faced a weight bias when trying to join a stem cell clinical ţrial. I was told by Vertex my BMI was too high.
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Hi Emily – thank you for writing this article!
I have experience discrimination based on my weight from family, friends, strangers, and doctors. One doctor I had, on our first visit together, instead of listening to my concerns and what I was there to see her about, sent me to what I call a “fat camp”. The only problem was, they didn’t accept Type 1 diabetics. She assumed I was type 2 even though I clearly said I was type 1. It was completely deflating to not even be heard by the doctor. But, that’s only one example. Being overweight and having diabetes is a double-slam on things that doctors blame and shame the patient for.
I love this “Health at any size” mindset. Going from a “positive punishment” (i.e. adding punishment to an already overloaded patient) system to something that a person can actually work with and make confident and beneficial changes sounds like heaven!