As Health at Every Size (HAES) aligned dietitians, we believe that every person has the right to receive respectful health care. This should be the default whenever you seek out care from a physician or other healthcare provider. Unfortunately, those who live in larger bodies are far more likely to receive traumatic care than individuals in thin bodies. This is because weight stigma and fatphobia are rampant in medical settings like the doctor’s office [*].
It is entirely understandable if you have been avoiding seeking out medical care because you want to avoid feeling shamed and stigmatized because of your weight. Avoiding routine medical care is one of the ways that weight stigma promotes poorer health outcomes for those in larger bodies.
Weight-centric physicians and researchers may point to the association that individuals in larger bodies get sick and experience life-threatening disease more often than those in smaller bodies, and believe it’s because of the weight itself. However, the experience of weight stigma, shame, and avoidance of medical care can explain almost all of the health issues associated with living at a higher weight [*,*,*,*].
You deserve to be heard and respected, and to receive medical care that centers your concerns – not your weight.
Remember that your healthcare providers are working for YOU. It may feel as though doctors hold power over you, and that you have no choice but to follow their weight-centric advice. You are allowed to disagree with your doctor, to voice your concerns, and to ultimately seek out providers who treat you as an individual.
We’re here to support you int he process. Let's review five ways to advocate for yourself at the doctor's office.
5 Ways to Advocate For Yourself at the doctor's office
Prepare for your appointment
Take some time before your appointment to write down the important issues you want to cover. You’re not alone if you find yourself clamming up once you're in the paper gown, face to face with your doctor who talks a mile a minute. Use the notes app in your phone, or a small notepad, to jot down things you want to be sure to discuss with your doctor.
You might consider writing a letter to your provider in advance of your appointment to let them know more about how you would like weight to be addressed as a part of your care. If you are currently working with a HAES-aligned therapist or dietitian, don’t be afraid to ask them to help coordinate your care and back up your request for weight-neutral medical care.
Here is a template you can personalize and send to your healthcare provider.
Dear Dr. X,
I am looking forward to meeting with you on [date] and discussing [primary concern].
Prior to our appointment, I would like to share with you how I feel about weight loss and discussion about my weight. I have read that individuals in larger bodies often do not receive appropriate care because of their weight, and I want to make sure I receive the right care from my providers.
I am not interested in pursuing weight loss at this time, as dieting for weight loss has still not been proven to be effective for improving health in the long run. Research has shown that dieting for weight loss predicts weight cycling, preoccupation with food, and eating disorder behaviors all of which are harmful for my health. Though there is research that connects weight to the risk of disease, some or all of the correlation can be explained by dieting attempts and the impact of weight stigma on health.
My weight is not a lifestyle behavior. I am happy to discuss lifestyle behaviors that you feel would benefit my health and my [primary concern].
[I am currently receiving care for eating disorder recovery and discussion of my weight is harmful to my treatment progress and a detriment to my health goals]
bring a support person
Consider bringing a trusted support person with you to your appointment. This could be a friend or family member who can back you up, take notes for you, and ultimately advocate for respectful care alongside you. Perhaps most importantly, it can be helpful to have someone there for emotional support and comfort, and to debrief your interactions with medical staff after the appointment without judgment.
decide how you want weight to be addressed
Did you know that you can refuse to be weighed at the doctor’s office? That’s right! In most cases, there is no medical reason that your weight needs to be documented in order for you to receive quality care.
Your doctor’s office may look a little confused when you tell them you would prefer to not be weighed, since it’s still considered a standard practice in most cases. However, know that you are completely within your rights to refuse stepping on the scale. In most cases, doctors will be able to document “weight refusal” if needed in order to submit their claims to insurance.
Consider bringing some Don’t Weigh Me cards to pass along to the nurses and medical assistants who ask you to step on the scale.
There are a few reasons your doctor might need to know your weight. These include prescribing accurate doses of medications (though in most cases an estimate of weight is sufficient), preparing for surgery, monitoring certain medical conditions like congestive heart failure, or as part of eating disorder recovery (though monitoring weight is not always necessary in ED recovery).
In this case, you can request a blind weight. This means that you would step on the scale backwards, or in a way where you would not be able to view the number. Be aware that a blind weight may still be documented in your medical chart.
Remember, doctors are there to serve YOU and to make sure you understand their recommendations. If you feel that your provider is unfairly centering your weight, here are some things you can say.
- “I am really concerned about X… I’m curious what recommendations you might give to someone in a smaller body dealing with the same issue?”
- “In my experience, trying to lose weight has given me an unhealthy relationship with food that I’m working on healing. Do you have any other recommendations aside from weight loss?”
- “Focusing on my weight isn’t the reason I came today. Can we get back to talking about X?”
it's okay to switch providers
As much as we wish every doctor was clued into the research surrounding weight stigma and Health at Every Size, it is unfortunately still common to find yourself seeing a provider who places a heavy importance on weight or BMI.
While requesting not to be weighed, sending a letter in advance, or refocusing your conversation away from weight loss during your appointment are all great ways of advocating for yourself, these are not your only options.
It’s not your responsibility to change the way your doctor thinks. You may have the energy for a conversion and desire to plant a seed with your medical providers, but know that is not necessary as someone living in a larger body. You deserve respectful care without needing to ask for it. And it’s okay to switch providers if you aren’t receiving the respect you deserve.
Here are a few resources you can use to seek out respectful, HAES-aligned care:
- Ask your HAES-aligned therapist or dietitian for a referral
- Ask trusted allies in the community. HAES facebook groups can be a resource to ask for word of mouth referrals if others have had good experiences.
- In provider directories, look for words and phrases such as “HAES-aligned” “weight neutral” or “weight inclusive” in the provider bios.
Remember you are worth advocating for
We are here to support you in advocating for yourself and demanding respectful care at the doctor’s office. Consider working with a NourishRX dietitian who can help you find vetted providers, advocate on your behalf, and help coordinate your care so you feel heard and respected. To learn more about Health at Every Size, and why weight isn’t an accurate predictor for health, we invite you to read our blogs below.