Life
Heart health is something many people don't think about until it's too late — unless they already know their risks. But too many people with concerns about their heart health go to the doctor, only to get pressured to lose weight before their health-care professional will talk about any other treatment.
"Body shaming in the healthcare profession is unfortunately common and even impacts whether people choose to seek medical care for problems they are having," Stephanie Byer, a registered mental health counselor, tells Bustle.
Evidence shows that being body-shamed by your doctor can actually worsen your cardiovascular health. A study in 2017 published in Obesity found that women who'd been fat-shamed were at more risk of high blood pressure. Studies have also shown that patients have better experiences and more effective care when their doctors don't judge or shame them about their weight.
Weight doesn't mean you're automatically at higher risk of heart issues. Research has found that there's often a correlation between a higher body mass and higher blood pressure, but not in all people. A 2013 study published in Science also found that body mass index (BMI) is a particularly bad measure for measuring a person's risk for cardiovascular disease, which makes sense when you realize it's just a ratio of weight to height. Being underweight is also associated with a heightened risk of heart problems and high blood pressure. Heart health is complex, but everybody has the right to feel respected by their doctor when they're talking about it.
Here are the best ways to talk to your medical professional about your heart health — without getting body-shamed.
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Talk To Your Doctor Beforehand
Vetting your doctor before you turn up can make sure that the issue of body-shaming is on the table early. "Request a brief phone consultation before scheduling a medical appointment," therapist Jessica Vechakul, Ph.D. tells Bustle. "You can say something like, 'I'm looking for a provider who focuses on my health, not my body size.'"
If you're comfortable doing so, you can tell your doctor about any previous experiences with body-shaming or being pressured to lose weight in medical situations, and ask what the provider's approach is to treating the problem you're experiencing. If they struggle to come up with a body-positive approach over the phone, you know they're not the right person for you.
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Research Body-Positive Healthcare Professionals
Health At Every Size (HAES) is a movement including healthcare professionals of all kinds that embraces the idea that all bodies can be healthy bodies. Byer and Vechakul recommend looking for a doctor who's aligned with this approach, so you know they'll be size-inclusive before you even step into their office. "Some good places to start are the Association for Size Diversity and Health, Fat-Friendly Health Professionals, the HAES Community, and Ample," Vechakul says. "If you can't find a provider in these online directories, you can join the HAES Facebook Group to ask for recommendations."
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You Can Decline To Be Weighed
Your weight doesn't have to be recorded for your doctor's visit. "You have the right to decline to be weighed," Dr. Vechakul says. Byer notes that often, the only reason for weight to be absolutely necessary at a doctor's appointment is to assess a medication dosage or anesthesia before surgery.
"If you get pushback, you can offer an estimate or say that there hasn't be any significant weight change since last time [you visited]," Dr. Vechakul says. If they insist, ask why your exact weight is necessary at this time, and if the answer isn't satisfying to you, decline. Asking the medical staff to include a note in your records not to weigh you can also be helpful, as can asking the nurse not to tell you your weight.
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Keep Your Own Records
Blood pressure can be affected by many things, not just weight: stress, smoking, and genetics are just a few. Keeping a record of your symptoms over time can help open your doctor's eyes to other possible causes for concern. "Keep records of your health symptoms (e.g., frequency, duration, intensity), any influencing factors (e.g., stress or sleep), test results, treatments tried, and responses to treatments," Dr. Vechakul says. This is a good approach for all illnesses, not just for blood pressure; it makes it much harder for a doctor to recommend blanket weight loss as a solution for everything.
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Role-Play Scripts Before You Show Up
If you're not feeling confident in your ability to be firm, practice before you turn up in the doctor's office. "Practice in a mirror or role-play what you might want to say," Vechakul says. Byer suggests having these scripts in reserve so you can pull them out at a moment's notice. "If the provider starts talking about your weight and/or shape, you can state, 'I am not here to discuss my weight', or 'I came here today to discuss XYZ and I would like to focus on that.'"
Write down your responses if you want to have them on hand. Vechakul recommends activist and health coach Ragen Chastain's collection of printable postcards for the doctor's office. They have phrases like, "Shame is bad for my health" and, "Please provide me with evidence-based medicine and informed consent," which can help you feel strong in the moment.
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Write A Letter Or Bring A Friend To Help
Being an advocate for yourself in a high-conflict situation is a hard skill to learn. "Knowing your comfort level can help you prepare for an appointment, especially with a new provider," Byer says. If you know you're likely to be stymied or upset if the doctor starts talking about weight, Vechakul recommends bringing a friend or loved one to the appointment who can help supply words in tongue-tied moments.
"You can also write a letter summarizing your health needs and boundaries regarding body positivity and size inclusivity," she says. "The letter can be handed to your provider to read when you first meet and also included in your medical file." She recommends using educator-activist Hanne Blank's letter to her doctor as a potential template.
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Ask What They'd Prescribe For A Thin Patient
If you feel your doctor is focusing on size instead of the health issue you brought to them, Vechakul and Byer both recommend asking, "Do thin people get this health issue? What do you recommend for them?"
"This separates your body shape and weight from your treatment recommendations," Byer says. "You have the right to insist you receive the same treatment protocols [as anyone else]."
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Educate Your Doctors
If there are no HAES doctors in your area, there are some options for you. "You can direct your regular doctor to some educational resources," Vechakul says. "The National Association to Advance Fat Acceptance provides free printable brochures for healthcare providers." Contacting somebody on the HAES list for advice on how to communicate with a doctor who might body-shame you can also be a good option.
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Go Somewhere Else
You're not stuck with the same doctor if you feel they're not respecting your body or your medical needs. "If you are body-shamed by your healthcare professional, you can ask to see another provider in their office or [for] a referral to another provider," Vechakul says. Talk to your insurance, the other doctors at the practice, and anybody else who might be able to provide a more inclusive approach. This might feel rough, but it's worth it to get the treatment you deserve. "You deserve a provider who listens to your concerns, honors your requests, and treats you with respect," Byer says.
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Just because your doctor went to medical school doesn't mean they're immune to prejudice and weight discrimination. You have the right to talk about your heart health without feeling shamed or judged.
"We might feel our providers would know best since they have the medical training and we shouldn't challenge them," Byer tells Bustle. "It's important to remember, though, that you are the expert on you and need to advocate for yourself." Arm yourself with resources, scripts, friends, and support, and go forth to get the medical help you need.
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Studies cited:
Ahima, R. S., & Lazar, M. A. (2013). The Health Risk of Obesity--Better Metrics Imperative. Science, 341(6148), 856–858. doi: 10.1126/science.1241244
Linderman, G.C., Lu, J., Lu, Y., et al. (2018) Association of Body Mass Index With Blood Pressure Among 1.7 Million Chinese Adults. JAMA Netw Open. 1(4), e181271. doi:10.1001/jamanetworkopen.2018.1271
Pearl, R. L., Wadden, T. A., Hopkins, C. M., Shaw, J. A., Hayes, M. R., Bakizada, Z. M., Alfaris, N., Chao, A. M., Pinkasavage, E., Berkowitz, R. I., & Alamuddin, N. (2017). Association between weight bias internalization and metabolic syndrome among treatment-seeking individuals with obesity. Obesity (Silver Spring, Md.), 25(2), 317–322. https://doi.org/10.1002/oby.21716
Phelan, S. M., Burgess, D. J., Yeazel, M. W., Hellerstedt, W. L., Griffin, J. M., & van Ryn, M. (2015). Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16(4), 319–326. https://doi.org/10.1111/obr.12266
Puhl, R. M., Phelan, S. M., Nadglowski, J., & Kyle, T. K. (2016). Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity. Clinical diabetes : a publication of the American Diabetes Association, 34(1), 44–50. https://doi.org/10.2337/diaclin.34.1.44
Salahudeen, A.K., Fleischmann, E.H., Bower, J.D., Hall, J.E. (2004) Underweight rather than overweight is associated with higher prevalence of hypertension: BP vs BMI in haemodialysis population. Nephrology Dialysis Transplantation. 19(2), 427–432, https://doi.org/10.1093/ndt/gfg523
Experts cited:
Stephanie Byer, registered mental health counselor
Dr. Jessica Vechakul, Ph.D., therapist
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