It might seem odd to write about what high-weight patients would like when they meet with their doctors. Don’t they want what every patient wants? The answer is yes, but the fact is, they often don’t get it due to implicit anti-fat bias among health professionals.
In my 30-plus years of practice as an eating disorders therapist, I’ve heard the same laments from high-weight clients: Doctors only want to talk about weight, blame every health problem on being large-sized, always want to put them on a weight-loss diet, and advise them to get out and exercise. Clients know from experience at varying weights that they’re treated differently when they’re thinner from when they’re fatter.
To make a solid, positive connection with high-weight patients, consider that:
1. They want to be listened to and feel heard, especially if sick or hurting, and taken seriously. All it takes is to acknowledge what they say with a few words of empathy. Maintaining eye contact and open body language by sitting facing your patient and offering a nod of understanding all cement connection. Establishing a respectful relationship may take more effort with high-weight patients than with ones whose size is closer to what is deemed normal.
2. They hope to have their health concerns addressed independent of their weight. Sure, knee or back pain or a heart attack may be related to high weight, but the place to start is wherever they do. Give them a chance to discuss their presenting problem before offering solutions. Imagine having a toothache and visiting a dentist who immediately starts lecturing you about eating too much candy.
3. They fear being judged for their weight or eating. High-weight patients are braced for being judged because it’s so rampant in society by friends, colleagues, family, health care providers—and even strangers. Because they may be (rightfully) sensitive to weight bias, choose your words carefully. If weight must be mentioned, “high or higher weight” is preferable to “obese.” Use gentle curiosity and, for example, ask what they’re doing that helps their medical problem or what they would like to do. If they bring up losing weight, it’s okay to follow their lead, as long as you steer clear of weight-loss diets.
4. They dread being told to go on a diet. Many of my clients have lost and regained 50 to 100 pounds more than once. They don’t want to go on another diet but are eager to make peace with food and don’t know how. If they have food problems (overeating, bingeing, chronic deprivation, emotional or stress eating), direct them to an eating disorders specialist (most do in-state teletherapy) or a registered dietician who uses an intuitive or mindful eating approach.
5. They desire to be seen in their entirety, not simply as a fat person. Try to get to know them as a whole person in the brief time together. Maybe they’re already eating healthfully and exercising and are at the lowest weight they’ve been in a long time. Maybe they’re a trauma survivor and have underlying issues that contribute to anxiety or depression. Maybe they’re healthier and fitter than they look. Or maybe they’ve tried and failed so many times to keep weight off that they’ve given up.
Doctors have so little time during an appointment to do so many important things and are stressed to the max no matter where they practice. I suggest putting aside preconceived ideas about how high-weight patients care for themselves and following my five tips. If you do, you’ll provide tremendous service to these clients, perhaps even greater than the medical wisdom and advice you impart.
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