When Linda said she wanted to weigh 150 pounds, her doctors balked. In the fall of 2020, Linda weighed over twice that number. Her obesity was causing her debilitating knee pain, leading her to miss work as a mammography technician, a job she loved.
Wanting to return to what she enjoyed, Linda underwent bariatric surgery. With a large portion of her stomach removed, she began a stringent diet and exercise regimen, determined to meet any challenges ahead of her with her characteristic optimism and resilience.
I had the privilege of getting to know Linda through a class at Stanford University’s d.school, in which students are matched with patient volunteers to develop designs for healthy behavioral change. In our first meeting, three months after the surgery, Linda expressed dismay at how her medical providers had viewed her goal weight as unachievable.
Already, she was significantly lighter. Her knees were starting to feel better. Why did the people who were supposed to support her health dismiss her goals?
Linda isn’t alone in her experience. Consciously or not, doctors can be major offenders when it comes to stereotypes and misconceptions about weight.
Research has shown that when a patient is obese, physicians are less likely to listen to them, show respect for what they say and spend enough time with them.
Even health professionals who specialize in obesity hold anti-fat biases. Not only do these biases lead physicians to provide inferior care (for example, by failing to diagnose serious conditions), but patients who face discrimination from their medical providers based on their size are more likely to avoid health care in the future.
This consequence of anti-fat bias is paradoxical considering that patients who struggle with weight would benefit the most from health care providers with the empathy, understanding, and time to support their patients’ health goals. Lectures on dieting and exercise, packed into an already time-constrained primary care appointment, are futile without compassion for the complex, intersecting factors underlying weight issues.
Diet culture has stigmatized obesity by perpetuating the myth that maintaining a healthy weight is simply a matter of self-control, with weight being a reflection of motivation. In reality, obesity often develops as a result of multiple circumstances, medical and otherwise, over which we have no control.
In our conversations, Linda shared that she grew up in a food-insecure household, a known risk factor for obesity. Her family’s fridge was never full, and her dinner often consisted of eggs or cereal.
Mental health issues run in Linda’s family, and she experiences depression, which the CDC states is associated with obesity. She noted that she has less control over her food choices when she feels sad, which exacerbates her emotional state by triggering guilt.
Additionally, beginning from an early age, Linda helped to take care of her mom, which shaped her personal priorities. As she told me, “After being a caretaker for years, I never thought about what I wanted for myself because I was always thinking about what others need.”
With this context, we reoriented Linda’s weight loss mission from a medical prescription to a self-care journey. As she reflected, “If you’re not doing it for yourself, then you shouldn’t be doing it at all.”
Linda prioritized advocating for her own wellness, with losing weight as one component of that goal. As she maintained her diet despite several significant obstacles, she sought out other ways to exercise her growing confidence. In difficult conversations with family members, she learned to stand up for her own mental health. She resolved to fit an activity that she loved into her busy schedule at least once a week. Determined to break out of what she called her “bubble,” she took steps toward doing things that scared her, like riding the bus where she had previously injured her knee. In one of our last meetings, she repeated, “I deserve to be happy.” I hope she never forgets that.
Behind every patient diagnosed with obesity is a story like Linda’s — of obstacles and successes, challenges and resilience. Each of these stories is unique, necessitating an approach that embraces the diversity of patients’ life experiences, of which weight is just one quantifiable manifestation.
Physicians who take the time to explore their patients’ stories, and medical systems that invest in training and supporting these conversations, will undoubtedly see better health outcomes. Perhaps most meaningfully, they’ll also come closer to practicing what medicine is meant to be — a partnership between doctor and patient, advancing a human story toward the next chapter of healing and health.
Jennifer Neda John is a premedical student.
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