Abigail Saguy, an associate professor and vice chair of sociology at UCLA, is the author of “What’s Wrong With Fat?”
Obesity is widely regarded as one of the greatest public health crises of our time. Yet there is another health risk heavier people face that won’t appear on their medical charts: anti-fat prejudice. In fact, discrimination against heavy people, by the general public and medical professionals, might be a greater health and social problem than any extra pounds they may be carrying.
Despite the fact that body weight is largely determined by an individual’s biology, genetics and social environment, medical providers often blame patients for their weight and blame their weight for any health problems they have. When I was doing research for a book on social perceptions of fat, one woman told me about how she visited a vascular surgeon because she had developed a superficial blood clot after a fall and her primary doctor had recommended an ultrasound to make sure there wasn’t a deeper problem.
The surgeon never asked about her relevant medical history — including whether she smoked or was on birth-control pills, or how long she had had varicose veins — she told me. Instead, he took one look at her, concluded that she fell because of her weight and began talking up fen-phen, a weight-loss drug that has since been banned. Scores of studies have shown that medical providers typically regard fat patients as lazy, self-indulgent and noncompliant. As a result, heavy patients don’t always receive the health care they deserve.
It’s similar to racial profiling — when police, for example, are more likely to suspect that a person of color has committed a crime. For health professionals dealing with overweight patients, this tendency could be called “size profiling”: They assume that a person has — or will develop — a particular ailment because he or she is heavy. Neither form of profiling necessarily intends to discriminate, but both involve judging people based on generalizations about a group to which they belong. Both types of profiling lead to false positives (people wrongfully accused or medically overtreated) and false negatives (people who get away or are medically undertreated).
Many heavy women told me that doctors routinely blamed any ailment, from a fall to a sore throat, on their weight. Studies document this pattern. Convinced that a patient’s weight is the underlying problem and that the patient can control his or her physique, many doctors don’t conduct the diagnostic tests they would otherwise perform on a thin person. Instead, they tell their heavy patients to lose weight or recommend weight-loss surgery. In many cases, such size profiling leads to problems that could have been avoided with proper diagnostic tests.
I don’t deny that there are health risks associated with higher body mass. The clearest case is Type 2 diabetes, which becomes more likely as weight goes up. Yet, as many medical researchers have pointed out, it’s not clear whether obesity causes diabetes, whether diabetes causes obesity or whether both conditions are caused by a third factor, such as poor nutrition, stress or genetics. Moreover, the association between weight and Type 2 diabetes is not perfect. Some thin people develop the disease, and many fat people never will.