Fatphobic doctor holding a clipboard and pen.

Fatphobic doctors are especially problematic when you’re recovering from an eating disorder. Creative Commons license.

She was 5-foot-4-inches and had short brown hair. Her blue floral dress hung from her very slim frame as she shuffled around in her chair, typing notes faster than I had ever seen anyone type.

“Okay, if you can just take a step over there onto the scales and we’ll get your weight,” she said, motioning towards the scale in the corner.

A lump formed in my throat and my heart sank. This was the first time I’d been weighed since recovering from a long battle with anorexia, and I’d been dedicated to not even going near scales. I knew the triggers they held for me.

“Can I take my shoes off first, doctor?”

She smirked.

“You’d need to take off far more than those shoes to get down to a good number, hon!” she said standing up and clasping my hand as she pulled me up onto the scale.

I was speechless, paralyzed by not knowing what to say or do next.

I didn’t want to be weighed. I didn’t want to look at the number. I didn’t want to let her comment get to me. But weighed I was, look at the number I did and hurt I most certainly was.

Breaking news: Doctors are people, too. Like, not saviors of the world but actual human beings who, along with their medical degrees, also carry their own set of experiences, traumas and bias.

And for a lot of doctors, part of their bias often includes fatphobia.

In the words of writer and activist Ragen Chastain,”These days doctors have very limited time with patients and when you’re fat many doctors simply diagnose you as fat and prescribe weight loss, no matter what you came in for.  I’ve been prescribed weight loss for a broken toe, separated shoulder and strep throat.”

It’s well documented how fatphobia impacts fat people … but what about non-fat people?

What about when it masquerades as a generic kind of weight bias and impacts slim people? Athletic people? Or, dangerously, eating disorder survivors like myself?

Recovering from an eating disorder is already an impossible-feeling task, and when you throw fatphobic medical practitioners into the mix, in a culture that’s already heavily saturated with messages correlating a high personal worth with a low personal weight, it gets even more challenging.

And while some may deem eating disorders and fatphobia unrelated, the truth is that they are very deeply connected. Many eating disorders deal with some degree of weight-related anxiety, which is physically manifested in individual attempts to manipulate one’s own body in a harmful way to reach a (frequently shifting) personal ideal.

Particularly in Western culture, the predominant social ideal is that thin bodies are inherently more attractive, capable and worthy. Despite media consumption merely being a catalyst to the onset of eating disorders (and not the root cause), there is still a growing body of evidence showing that even short-term exposure to thin-idealized media can increase individual levels of body dissatisfaction (which can exacerbate already triggering environments for eating disorder-prone individuals).

Related: When I Had A Stroke at 35, My Age — and Gender — Led to Misdiagnosis

The impacts of this thin ideal are widespread — not just in the media that we see, but also in the reinforcement of stigma around mental illness, perpetuation of harmful stereotypes and fatphobic attitudes towards those who have eating disorders (not just in the midst of the disease, but also throughout recovery). And, sadly, many medical professionals receive insufficient ongoing training in changing attitudes to mental illness, eating disorder treatment and a Health at any Size/non-weight centric approach.

When you consider that fatphobia can act as a trigger for eating disorders, this makes it even more dangerous.

So — as an eating disorder survivor facing a fatphobic doctor, what choice (if any) do you have?

Believe it or not, you do have options. And you are most certainly allowed to empower yourself, protect yourself and trust yourself, even if your own mental wellbeing seems contrary to what a certain doctor is telling you.

Back when I was first subjected to fatphobia from my doctor, I left her office bewildered. Instead of celebrating my recovery, I was contemplating how much weight I should lose. I told myself I could just go back to my old ways a little bit and that I’d be OK.

(How wrong I was. That incident sparked the beginning of my very first major relapse.)

I’d trusted that doctor implicitly, even though it was the first time I’d ever seen her. I was only there for her advice on starting a contraceptive pill, yet because she was a doctor I took her judgement, opinion and wry smirk as gospel. I didn’t understand that it was possible that she may be carrying her own internalized fatphobia. If I could go back in time, I would’ve used one of these strategies instead:

1. Tell your doctor that you’re uncomfortable with being weighed.

Many ED survivors find it hard to open up to strangers and telling a new (or existing) doctor about your mental health and body image struggles might be the last thing on your to-do list, especially if you’re visiting your doctor for a concern unrelated to your weight or mental health. However, we need to all understand that mental and physical health work in tandem and as a medical professional, it’s your doctor’s job to get to the bottom of any medical issues — to do this, they need a full, clear picture of your life experiences. Including the stuff you don’t want to tell them. If your doctor suggests that they need to record your weight, I strongly advise letting them know that you’re uncomfortable with being weighed. This doesn’t have to be a scary experience. Say to your doctor, “I’ve previously struggled with an eating disorder and the scales have been a bit of an issue for me; is it possible that we continue without recording my weight?”

If your doctor is a compassionate and understanding person and their treatment (e.g. treatment that does not include calculating drug administration based on body mass) doesn’t rely on your weight, they’ll do everything in their power to make you comfortable — including not weighing you. They should explore how they can help you stay mentally well.

If your doctor deems that weighing is necessary to assist with your treatment, you can also request to be blind weighed — this is where you step onto the scales backwards so that you can’t see the number, and the doctor will record your weight without telling you what it is. Please note, this option may not be suitable for you if you’ll find the temptation to ask your doctor what your weight is too much to bear, or if merely standing on the scales will act as a trigger for you. Please be aware of your own Safety/Caution/Danger behaviors.

2. Use your own discretion.

If your doctor insists on weighing you, ask yourself whether your weight is actually linked to the problem you’re there to see them about. If you have your doubts, don’t be afraid to ask your doctor why your weight is important to their diagnosis of the specific issue that you’re having. If you’re not satisfied with their answer, you are of course entitled to seek a second opinion from a different doctor.

3. Do your research before picking a doctor.

I advise doing a bit of homework on the doctors in your local area and seeing their backgrounds. Some doctors will have a background in dealing with eating disorder treatment and will be more sensitive to your specific mental background, while other doctors who practice a HAES approach also register themselves so that patients looking for a weight-neutral diagnosis can find them.

4. Take a loved one with you for support.

You can ask that anyone else be present during your appointment, so if you have someone that you’ve confided in or someone that understands your history and is sensitive to your recovery, you can take them into your appointment with you. This may give you some confidence in knowing that if you lose your nerve to speak up or find yourself backed into a corner, they can assist with asking your doctor about the reasoning behind weight-centric treatment.

5. Keep self-care your highest priority.

If at any time during your appointment you find yourself feeling overwhelmed or distraught or unable to continue without being panicked, please remember that you can reschedule your appointment (unless the nature of your appointment is urgent, of course).

6. Keep in mind that your doctor might not be deliberately trying to trigger you.

Unfortunately, many doctors may genuinely believe they’re helping a patient by continuing to push weight as an issue or by limiting sensitivity around the issue, even when that patient has indicated that they don’t consent to that conversation. And ultimately, weight sometimes can contribute to a person’s problems so on one hand, doctors have a duty of care when it comes to eliminating all possibilities for a medical condition. Even so, sensitivity and informed consent should always be provided to the patient. This is why it’s crucial to let your doctor know of your history and concerns, to give them the best chance possible in assessing your healthcare needs. On the chance that your treatment does require recording of your weight, it’s important that they approach this in a manner that’s considerate of your wellbeing.

Because just like it would be cruel for a doctor to punch a patient with a broken arm right in the bicep to test the muscle strength, it’s equally cruel of a doctor to force or coerce a patient into taking/discussing their weight when that patient has indicated that it will cause them significant distress.

7. Consider therapy in addition to any physical treatment you’re undertaking.

Ongoing therapy is a wonderful solution for many eating disorder survivors, as it can give you tools and strategies for dealing with these situations, as well as addressing underlying mental themes that may exist within your character (such as internalized fatphobia that your doctors’ comments may be reinforcing subconsciously).

Above all else, remember that your recovery is of the utmost importance and just because a doctor is your family doctor, has a lot of certificates on the wall, is closest to your house or has been seeing you for years does not oblige you to consider seeking medical advice from them if you feel that they’re insensitive of your background and concerns.

You deserve healthcare that’s considerate of all that you’ve been through.

You deserve healthcare that’s supportive of your recovery goals.

You deserve healthcare that takes into account the inextricable link between mental and physical wellbeing, and prioritizes your mental wellbeing as part of this.

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