Reduce fatphobia in medicine and medical settings

Require and provide training on interacting with plus-sized people. Put a strategy in place to reach equitable outcomes for plus-size patients. Ensure that doctors do not jump to assuming a condition is weight-related, resulting in late or missed diagnoses and worse health outcomes. Ensure doctors are aware that weight gain is frequently a symptom of a condition, rather than the cause. 
Ensure that doctors are taught and reminded to use signs and symptoms to make a diagnosis, rather than assumptions. This will also help patients who have not had the care they need because they are thin and doctors assume that all people with that condition are plus size. For example thin people who have battled for years to get tested for sleep apnea, despite having all the symptoms, and eventually being found to have the condition. It would also avoid situations where patients who are rapidly losing weight due to an undiagnosed condition are praised and not listened to, instead of treated for the potentially life-threatening condition that is causing the weight loss. 
Ensure that medical equipment, mobility aids, beds, gowns, blood pressure cuffs, etc etc are freely available everywhere at all sizes. 
It seems there is currently evidence that plus size people have worse outcomes that are not because their weight influenced the illness, but because it influenced the care received. Because of the fatphobia rampant in the global health system it is actually probably impossible to tell for sure what conditions being plus-size is in itself a risk factor for, and what conditions are just having worse outcomes because of a lower standard of care for plus size people, and what conditions actually cause weight gain in themselves. But it is obvious that plus size people are treated terribly in the health system, and are disbelieved, and blamed for our medical conditions or disabilities. 
Ensure that health campaigns employ a health at every size approach, and do not equate a healthy lifestyle with one body size. You can't look at someone's body size alone and assume their activity level, diet, or health. 
Ensure that medicine that should be administered based on body weight actually is, rather than only ever using standard adult doses based on an average adult weight and not the actual patient. 
NOTE: I prefer the term fat for myself, I have used plus sized because it is likely to be the least contraversial term, and this isn't about the language, it is about equity. 


Why the contribution is important

Here is a tiny sample of the fatphobia I, one single fat, disabled kiwi have faced. 
Every plus sized person deserves the best medical care, and not to be judged for their weight, regardless of the reasons for that weight. 
It is also important to remember however that many medical conditions and disabilities actively cause weight gain (or weight loss), and that the fatphobia ingrained in the medical system is then actively making those outcomes worse, due to a symptom of the disorder they should be treating. So. 
Things that have caused my weight gain:
Hashimoto's thyroiditis
Long term antidepressants (better to be fat than to unalive myself, I can't believe I even have to say that one)
Binge eating disorder and sugar addiction (for which I have been seeking and denied help by our mental health system for many years)
Neurological condition that means exercise that gets my heart rate going fast also makes me dissy, nausious, and in pain. 
Undiagnosed ADHD leading to poor impulse control and seeking dopamine
Being functionally blind leading to reduced accessible exercise opportunities, and a reduced ability to get to them. 
Poverty, leading to an inability to afford good tasting high quality food when highly proccessed foods are cheeper and more easily available, and pre-prepped high value foods are waaaaay to expensive. 
Disabilities including Autism that mean it is very hard for me to cook and prep my own food, and to meal plan. 
Yo-yo dieting, including dieticians as a treatment for non weight related depression. 
So, those are the reasons I am fat. Its impossible to tease out which exactly caused what, but the timeline on some is obvious. Yet my weight is treated as some kind of moral failing, an indication I don't care about my health, and an answer to literally every medical problem despite there being no scientific evidence to back that up. 
So, here is some of what I have faced: 
- Being told by a junior neurologist that my neurological condition was caused by my weight and being referred to a dietician instead of an MRI, a neuro-opthalmologist, or an expert neurologist. When I finally got the tests and experts I needed, it was revealed that there was absolutely no correlation indicated for weight and those with this condition. 
- Having to go to multiple pharmacies and eventually a doctors clinic to access a plus size bloodpressure cuff, then not being believed that my pressure was high because I had just had to run all over town and be humiliated with pharmacy staff trying to painfully squeeze my arm into their one 'standard' size cuff. I had to get the pressure re-done with yet another doctor's visit. 
- Having to learn from the radio that a longer needle should be used for plus size people getting the covid vaccine, then being told by multiple vaccinators that I was wrong, then having to ring the national vaccine info centre at Auckland university, despite it not being open to the public, to actually get the info confirmed that plus size people were not getting full coverage with the 'standard' needle size. 
- Having to fight to get a wheelchair approved by ACC for a temporary injury, because a wheelchair is a standard in stock item, but a plus size wheelchair is not, and my assessor was not on my side because she thought I was resisting getting exercise, despite the instructions for my injury being to rest and absolutely not do any exercise that causes pain (which walking is causing). Finally had to get a letter from the physio confirming that no, I wasn't supposed to just push through the pain, and being forced to by being denied a mobility aid was making things worse. 
- Getting a knee ultrasound for an injury (that had nothing to do with my weight), being told by the ultrasound technician "You have a lot of arthritis in your knee, do you know what you weigh". Believing for 24 hours that I had a lifelong, degenerative condition. Doing research on arthritis and discovering that at my age it would likely be caused by a genetic autoimune disorder, and while weight loss is recomended to reduce pressure on arthritic joints, it is likely not the cause at all. Then discovering from my doctor that: Arthritis can't be diagnosed by an ultrasound. I have bursitis not arthritis. It is due to my injury, and possibly all the physical activity I was doing at the time. 

Then there are the barriers to life and activity. For example I can't go on the outward bound course for people with physical disabilities, because their safety equipment doesn't work for my weight. 
Get active, they said. It will be fun they said. 
Having to wear a seatbelt as a lap belt in a taxi because the seatbelt was too short. 
Chairs everywhere with tiny seats and armrests. 
Life-jackets not fitting on boats. 
And of course, being yelled at in the street if seen exercising. 
The fatphobia in society is horrific. People are taught to despise  plus size people. Doctors are people, they have also been taught this hate. In fact this hate has then been integrated into medical training and practices. 
These are just a few, a very very few, of the times I have had problems accessing healthcare while fat. Fix it. 


by AceTimelord on April 22, 2023 at 03:58AM

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  • Posted by AceTimelord April 24, 2023 at 00:29

    Update: On the positive side, the wheelchair I need to recover from my injury has FINALLY been approved.
    On the negative side, I will not be able to get the only available chair in my size... through a 'standard' doorway.
    I will have to have someone with me, stand up and use my crutches to get through the door while the human with me folds the chair in to get through, then sit back down again. At every 'standard' size doorway.
    This is while I recover from a temporary injury, I'm not a long term wheelchair user. However if I were, I imagine not being able to get through doors would probably be more than a little frustrating?
    Anyway, point is, don't be sick or injured or disabled or chronically ill while fat/plus-size.
    Or, you know, the people creating the barriers could fix them instead!
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