Weight bias affects health, especially when it comes from healthcare providers. Image is of two young women in larger bodies, standing in a forest holding hands, with their backs towards the camera. One woman is wearing jeans, a blue casual jacket, and a black stocking cap. The other woman is wearing black skinny jeans, a black knee-length coat, and a large light gray blanket scarf around her shoulders, under her long blonde hair.

If this blog were to have a theme this week, I would have a tough time deciding between “weight bias” and “trust.”

Weight bias, because an article that I put blood, sweat and tears into (well, not blood, actually) was published in Today’s Dietitian magazine: “Weight Bias in Dietetics Education: The Impact on Student Well-Being, Professional Diversity and Patient Care.” I don’t generally call my own articles “important” (objectively, perhaps some of them are, but it feels a bit egotistical to actually say it), but this one, yeah, it’s important.

Not only have many people reached out to me to tell me how glad I am that I wrote it, but it’s a definite conversation starter about a topic that a lot of people don’t really want to talk about. Let’s face it: no one wants to acknowledge that they may be biased. But we can’t reduce or eliminate bias if we’re not willing to have the uncomfortable conversation, along with perhaps some cringe-inducing introspection. That’s true whether we’re talking about bias based on weight, race, sexual orientation, gender identity, ability or anything else. Then, when we know better, we can do better.

Trust, because that’s the theme of the keynote talk I’m giving at the Seattle Go Red For Women luncheon on Thursday. (I’ll post a copy of my speech—it’s only 10 minutes long—on the blog Thursday afternoon.) We need to trust in ourselves, trust in our own bodies.

A tragic cocktail

Both of those things, weight stigma and trust, often clash in unfortunate—and by unfortunate I mean fatal—ways. Specifically, when healthcare providers can’t see past weight, not only might they not provide patients with appropriate care, but they might misdiagnose them altogether. I’m talking about:

  • Sitting in your doctor’s office with a sprained ankle or knee pain, and being told to “lose weight” instead of being referred to physical therapy—as a thin person would.
  • Having horrible back and abdominal pain, or abnormal bleeding from one or more orifices, and being told it’s related to “being obese” and being told to “lose weight” instead of, oh, being sent for some kind of diagnostic test—as a thin person would.

Lest you think I jest, I’ll present you with evidence. Among the copy that was left on the metaphorical cutting room floor when I wrote about atypical anorexia for The Seattle Times last month, was an anecdote that UW researcher Erin Harrop told me. A woman she knows, a triathlete who happens to be in a larger body, broke her foot on a hike. She heard a popping sound, and obviously felt the pain. She went to her doctor, as one should when they suspect a fracture, and was told that her pain was because of her weight and she needed to exercise. So she hobbled around on a broken foot, unable to do her usual exercise because she had a broken foot.

But wait, it gets worse. (You probably guessed that.)

Weight bias in healthcare

Last month, a perspective piece published in the Journal of the American Medical Association, “Addressing medicine’s bias against patients who are overweight,” highlighted the case of Ellen Maud Bennett of Victoria, British Columbia, who was diagnosed with inoperable cancer a few days before she died. Here is an excerpt from her obituary:

A final message Ellen wanted to share was about the fat shaming she endured from the medical profession. Over the past few years of feeling unwell she sought out medical intervention and no one offered any support or suggestions beyond weight loss. Ellen’s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue.

What if her doctors had offered support or suggestions beyond weight loss? Perhaps she would have been diagnosed with operable cancer instead of inoperable cancer. Unfortunately, her family and friends will never know for sure.

Fighting for her life…and yours

Following up on that thread, I present the case of 30-year-old plus-size pinup model Elly Mayday (born Ashley Luther), who died March 1 after her third bout of ovarian cancer. Not only was Elly a body positivity activist, she advocated for people with all kinds of body insecurities, being very open about her journey through cancer treatment, including not hiding her bald head or her surgical scars in photos.

Elly was diagnosed with Stage 3 ovarian cancer in 2013, about three years after she started experiencing symptoms like lower back and stomach pain, bloating and constant fatigue. Ovarian cancer has a higher death rate than many cancers, in part because there’s no screening test for it (unlike cervical cancer, breast cancer and colon cancer) and because the symptoms are maddeningly unspecific and easily mistaken for other symptoms, especially in younger women. Elly went undiagnosed for nearly three years, in part because her doctors were quick to dismiss her back and stomach pain as being due to her weight or lack of core strength. Their prescription? Exercise.

One thing that Elly used her platform for was to encourage women to trust their bodies and seek treatment, or second opinions, if they sense something isn’t right. In this video, Elly talk about her fight to be taken seriously by her healthcare providers, her hopes that other women will listen to and trust their bodies, as well as her mission to promote body positivity:

Weight stigma kills

Does that sound like too strong of a statement? Sadly, it’s a true statement. While weight stigma—when people direct their internal weight-based biases and stereotypes towards people in larger bodies–doesn’t kill directly, in the way that cancer, a car accident, or a severe case of measles can, it can kill indirectly.

When someone internalizes weight stigma—they believe that the bias and stereotypes directed against them are legitimate—they are less likely to take care of themselves by eating good food, moving their bodies and managing stress. That last part is important, because weight stigma has been shown to increase levels of the stress hormone cortisol, which itself is harmful to health. Individuals who have internalized weight stigma are also more likely to engage in behaviors that harm health, such as disordered eating, substance abuse and not wearing a seatbelt.

People—especially women—who feel stigmatized by their healthcare providers are also less likely to seek preventive healthcare, especially if it’s very body-focused. You know, things like Pap tests, mammograms and colon cancer screenings. All very intimate, and very hands-on-the-body. This likely explains at least part of the association between higher body mass index (BMI) and increased risk of death from certain cancers. Even though an association between two things doesn’t necessarily mean that one thing causes the other, many people assume that carrying around “too much” fat tissue causes these diseases. It may well be that it’s the avoidance of healthcare screenings—coupled with doctors who can’t see past body weight long enough to actually listen to their patients’ concerns—that leads to cancer not being identified until it’s already in a later, harder to treat, stage.

For a humorous, yet fact-based and quite frankly spot-on take on the impact of weight bias in healthcare, I recommend watching the “Thicc not Sick” segment from Full Frontal with Samantha Bee (note: NSFW)