“We need to stop weight shaming people & not make them fearful of seeing a Dr., but we also need to find a supportive way to talk about obesity.”
– TikTok commenter
“You’ve got to get on TikTok,” everyone kept saying. Launching a web-based life and weight coaching platform for teens, I begrudgingly decided it was time to jump in. I felt like I was putting on an ill-fitting scuba mask and snorkel and diving into the underworld of TikTok.
Then, one day, while in the thick of a TikTok trance and while we are still in the trance of a COVID pandemic and disparities, I scrolled onto a comedian’s post about his visit to the doctor:
“Why are doctors always like? Everything looks good; just watch the weight. Ya mama … I didn’t come here today for you to crack jokes, doc … I have a mild grade fever, and I got the chills. I’m a little scared. And you talking about weight. I ain’t got time for jokes.”
I laughed, hit the like button, and kept on with my TikTok trance. I kept going back to it. Of course, he was being funny, but I thought, that’s dangerous. COVID has health disparities, and he is at risk, and I thought it’s dangerous for the doctor to ignore the chief complaint and then to say, “just watch the weight.”
I decided to duet the video, which means you show the original video, and then beside it is me basically nodding my head. I typed at the top, “This is medical gaslighting and is dangerous during COVID.”
Waking up to a viral TikTok post is surreal. I had to put my “readers” on and do a quick cartoon-like double-check to see that my post had gone from a few thousand views to 44,000 overnight and then up by 1,000 views every two minutes. Most remarkable, I noted the comments blowing up with real stories of the harmful consequences of weight stigma and bias in health care.
“I don’t even want to go to the doctor for anything anymore. My doctor is trying to shove surgery on me. I barely eat, but he thinks surgery will fix it.”
“Started losing weight by starving myself & the first thing my dr said was “whatever you’re doing to lose weight, keep doing it! It’s working great!”
“OMG, me too. I passed out cuz I was eating very little, and I went to the doctor, and she told me to watch my weight after I had lost 70+ lbs was bones.”
“Same here. I wasn’t eating because I couldn’t afford groceries smh.”
“I thought I was the only person to deal with this.”
“My eating disorder wasn’t taken seriously until I entered a ‘normal’ weight category and had extremely low vitamin levels. It had been years.”
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“Me too … I was anorexic for a full year, and my doctor was like … you’re looking great!”
“Medical gaslighting caused me to go for years being improperly treated for Type 2 diabetes when I actually have Type 1. Now I have complications.”
“I was palmed off for years by doctors. They blamed all of my pain and symptoms on my weight. At 44, I collapsed with a pulmonary embolism and almost died. It turns out I had had lupus all along. I don’t take it from anyone anymore.”
“I had undiagnosed renal failure for years because my doctor said all my symptoms were weight-related.”
“I lost 60 lbs. when I was pregnant, and a Dr. had the nerve to tell me I was doing a great job … I felt like I was dying and I was terrified.”
According to recent multi-national studies from the UConn Rudd Center for Food Policy & Obesity, across each of the six countries investigated, 13,996 participants, the most common interpersonal sources of weight stigma were family members (76 to 87 percent), classmates (72 to 76 percent) and doctors (58 to 73 percent). These experiences were most frequent and distressing during childhood and adolescence.
According to Obesity Reviews, weight stigma is defined as physical character traits labeling the bearer as having lower social value, and with weight bias, victims become targets of prejudice and unfavorable treatment.
For this qualitative TikTok study, from the hundreds of comments, four themes were observed, based on the commenters’ experiences, and then further filtered out to show the most common harmful consequences of weight stigma and bias in health care, many of which often resulted in medical gaslighting.
Medical gaslighting, seen in many of the commenters’ patient experiences, occurs when medical professionals downplay or silence marginalized patient’s self-reported experiences with illness.
Secondly, we observed four diagnoses within the commenters’ experiences that were particularly triggering for medical gaslighting and consequential if the diagnosis or complications were missed.
Many of the responders’ experiences fit into more than one and up to four of the different harmful consequences and/or diagnostic categories.
Harmful consequences of weight stigma and bias in health care per TikTok study (listed from most common to least common):
- Ignoring the chief complaint, ignoring patient concerns, medical gaslighting, not listening
- Not treating weight as a chronic condition, medical negligence, weight shame, and blame
- Delay in getting an accurate diagnosis and/or treatment delay
- Delays in seeking care for the patient
Diagnoses not addressed due to weight stigma and bias in health care per TikTok study:
- Eating disorders (undiagnosed in patients with overweight or obesity)
- Pregnancy complications
- Mental health (depression, anxiety, post-partum depression)
- COVID-19
Disrupting weight stigma and bias in health care starts with calling it out. The power of stories and shared experiences highlights the collective voice. I’m coaching TikTok Followers to own their health power and start speaking up during clinic visits to make sure they get their questions answered. Future directions and next steps are to disrupt weight stigma and bias by speaking up, calling it out, and calling on doctors, nurses, and all of health care to do better. Back to TikTok!
Karla Lester is a pediatrician, certified life and weight coach, and diplomate, American Board of Obesity Medicine. She is founder, IME Community, and can be reached on Twitter @DrKarlaA, TikTok, Instagram @ime_community, Facebook, and YouTube.
Katherine Lester is a premedical student.
Image credit: Shutterstock.com
