How to Navigate the Anxiety of Doctor’s Appointments When You’re in a Larger Body
Contributing writer and disordered eating therapist Jenny Weinar shares tips on how to combat the weight stigma of a broken medical system.
Jenny Weinar is a Philly-based body positive psychotherapist and certified yoga teacher who’s passionate about helping clients struggling with disordered eating, chronic dieting, over-exercising, and weight preoccupation find their way home to their bodies. This is the fourth of a series of posts that will (hopefully!) help our readers do the same. Read Weinar on Be Well every other Tuesday.
This post has been updated.
Medical appointments can be fraught experiences for any number of reasons. But for those seeking to heal their relationship to food and body image (and trying to pursue health from a weight-neutral perspective), a visit to the doctor can be especially anxiety-provoking — due to the pervasive weight stigma perpetuated by the medical system.
Given our cultural obsession with thinness and the wrongful conflation of weight with health status, stepping on the scale is one of the most feared aspects of medical appointments. For those who have struggled with disordered eating, the number on the scale might reinforce harmful eating disorder thoughts or trigger unhealthy behaviors relating to food and weight. Upon being told by her provider that she had gained weight since her last annual visit, Lexi, an educator in Philly, told me it felt “like my recovery should be put on pause.” Many of my therapy clients recall similar feelings around being weighed.
And most patients living in larger bodies, regardless of their relationship to food, are accustomed to weight-shaming by physicians. For many, this either provokes intense anxiety leading up to appointments or causes them to delay or avoid visits altogether. Even worse, patients’ symptoms may not be taken seriously at first, due to their body size, an oversight that can sometimes result in death.
So, how can you protect yourself against anti-fat bias in the healthcare system when you are trying to pursue health in whatever size body you’re in?
First and foremost, the solution involves trying to find providers who are aligned with the principles of Health At Every Size, or are at least open to learning about weight-neutral care. Unfortunately, when I searched fat-positive provider databases, I found no results for physicians in Philadelphia. But I was lucky enough to connect with Rachel Fox, physician assistant, and Elliot Goodenough, a family medicine doctor. Both are primary care providers who subscribe to the HAES philosophy and were able to offer a little more insight.
For starters, you don’t have to get weighed at every visit. Fox and Goodenough both confirm that, with exceptions such as monitoring “fluid overload” (a problem with certain health conditions) and providing the right dose for weight-dependent medications, the weigh-in is unnecessary. You may simply decline to be weighed, and your provider can document in the chart that you refused, or you can offer an approximation if you know your general weight range.
Fox, who first learned about HAES from a patient, also notes that individuals in larger bodies often receive falsely elevated blood pressure readings due to the use of a blood pressure cuff that’s too small. Requesting providers measure your arm to ensure a properly fitted cuff could produce a more accurate reading and better overall picture of your health.
There are also ways to advocate for yourself if you’re prescribed weight loss for any number of health conditions. One strategy is to ask your provider what intervention she would recommend for a thin person with the same condition. If the doctor’s office refuses to send you for appropriate testing or procedures until you’ve lost weight, you can request the staff document this in your chart. Goodenough recommends this printable card of other helpful phrases from fat activist Ragen Chastain.
While it can feel intimidating to broach these subjects with medical providers, planting the seed might eventually yield a paradigm shift within the medical community. Fox shared that her experience of hearing about a patient’s weight-based medical trauma “led me to re-examine my own biases and the ways I may be incorporating fatphobia and other marginalizations into my medical practice.” Goodenough, who began researching anti-fat discrimination in healthcare during their medical training, explained how fat-positive care has empowered them to minimize harm by focusing on patients’ actual medical concerns rather than using weight as a proxy for health.
If you feel comfortable with your provider, it might be helpful to share how attempts at intentional weight loss have impacted you emotionally and psychologically in the past and how it would benefit you to focus on health-promoting behaviors rather than obsess over the number on the scale. At the same time, it’s ultimately not your responsibility to educate your doctor, and if your provider can’t readily commit to non-stigmatizing, non-traumatizing care, you might consider seeking care elsewhere.
Engaging with the many size diversity resources out there (including books and podcasts) can also help bolster your confidence around these issues. Building your own fat-positive community through Facebook groups, Instagram, meetups, and by connecting with like-minded friends or family will provide opportunities to share frustrating experiences, exchange tips with others and celebrate victories. Above all else, know that you are worthy of dignity and respect at any size. And you have the right to health care that affirms this.