Heart Disease

The Human Cost Of Fat Bias In Healthcare

Doctors are often quick to dismiss overweight patients to just lose some weight to feel better. But such carelessness can be deadly.

In October of 2016, Megan Sears went to the emergency room. Her heart was having palpitations, she was short of breath, and she had chest pain. She was 36.

She was also 5’3” and weighed 300 pounds. She was hypertensive and pre-diabetic. Doctors advised her to lose weight, but they also took her heart issues seriously and diagnosed her with a heart defect. 

Sears, who lives in Oregon and works as a school assistant, was lucky there; many times, physicians turn heavier people away with a warning to lose weight, and nothing more.

A Culture Of Fat Bias

“It is all too common for women to be affected by weight bias,” says Melissa Majumdar, a registered dietician and spokesperson for Academic of Nutrition and Dietetics. “Sixty-nine percent of people who are overweight have experienced bias in healthcare. It can be not having properly fitting gowns or equipment, or assumptions that healthcare professionals make.”

Sixty-nine percent of people who are overweight have experienced bias in healthcare… Some doctors prefer to not even touch their higher weight patients.

“It’s well-documented that physicians harbor weight stigma toward their patients,” agrees dietician and exercise physiologist Rebecca Scritchfield. “They are more likely to believe higher weight patients are lazy and non-compliant. Some doctors prefer to not even touch their higher weight patients.”

Not only can this result in missed diagnoses, but it can affect the relationship patients have with their doctors and the world in general. According to Implicit Association Tests put on by Harvard University, 75 percent of people have a preference for thin people over fat people. This affects even new relationships with new medical professionals because people automatically assume they’ll be judged for their weight.

“When someone isn’t listening to you because of your weight, they aren’t understanding the full story,” Majumdar said, “and the patient is the one who knows their story the best.”

Megan Sears at her heaviest at 300 pounds, and today.

How Obesity Can Disguise Congenital Issues

In Megan’s case, she knew something was wrong, and when her doctors had her wear a heart monitor for 48 hours, she decided to take control of one of the few things she could regulate about her health on her own.

“The day I was given that heart monitor was the day that changed my life,” Sears says. “Something clicked inside me, something said, ‘Megan, you are not headed to a good place! Staying on this path will only bring you more struggle, discomfort and fatigue.’ That day I changed my entire relationship with food; I started on an eating plan that worked for me.”

At the time, Sears was a single parent to a 10-year-old girl, and she wanted her child to see her providing “an example of strength, determination, and overall fierceness of the womanhood she was about to enter.”

Having been heavy her entire life, Sears had tried multiple diets before, and knew that carbohydrate restriction worked for her in moderation. That’s where she started, and the results kept her spirits high. She lost 20 pounds, then 50, and by the time she was scheduled for her cardiologist’s visit the next year, she was down 100 pounds.

“I was so mentally prepared for a huge pat on the back and being sent on my way. What I didn’t know was that my congenital condition was progressive,” Sears says. “My condition had changed from moderate stenosis to severe, and it would require open heart surgery.”

Weight loss helped Megan Sears’ doctors diagnose her aortic valve stenosis, but would never have solved her congenital heart issues on their own.

Weight Loss Isn’t A Universal Health Cure

Her weight loss, while it had alleviated her hypertension and stemmed her pre-diabetic condition, had not slowed her aortic valve stenosis. That condition means valves in the heart don’t work properly. Sears’s valve leaflets were not closing or opening the way they were supposed to. The valve and port narrowed radically.

“I was essentially walking around with the valve of a toddler.”

Sears had been diagnosed with a murmur in 2001, and no one caught the defect until 15 years later. Women, in particular, experience a gap in care if their weight is a factor.

“The healthcare women receive is secondary to how we are viewed aesthetically.”

“In the last week, at least four other female or female identifying friends have gone seeking healthcare. For each one of us, we were told to lose x amount of weight, and we’d feel better. Pneumonia? Lose 20 pounds, and you’ll feel better. Knee problems? It’s because of all the extra weight you’re carrying around. Body dysphoria? If you lost that tummy weight, it would fix everything,” says Mahasin Ameen, a librarian in Indiana who wanted to feel better without being shamed. “The healthcare women receive is secondary to how we are viewed aesthetically.”

After experiencing bias from medical professionals enough times, patients begin to view doctors as an enemy, not a friend.

“When we go to a new provider, our previous experiences come with us, and so we see things through the glasses of having experienced bias before, and that can taint the new relationship,” Majumdar says.

Sometimes this mindset stops people from even trying to get care.

“Higher weight people experience so much stress over the looming health care appointment, they may delay or avoid care,” Scritchfield says. “This contributes to poor outcomes and higher costs in the long run.”

Majumdar says medical professionals can approach weight differently, and it would make all the difference.

“They can ask instead of tell: would you be comfortable if we discussed your weight? Would it be okay to look at how weight could be affecting your holistic health?”

She also advises using patient-focused language. Instead of saying ‘that obese patient,’ she says, they could say ‘patient with obesity.’ That gives the understanding that it’s a disease.

Primary care physicians give referrals and one of the referrals they could make is to a dietician, trained to help with these matters. They could frame it as a question, instead of a demand, Majumdar says.

How To Protect Yourself From Medical Weight Bias

If you are feeling judged by your weight or like you are being ignored by your medical professionals, there are steps you can take to protect yourself. Majumdar advises taking a friend or family member with you to the appointment so that an unbiased person can hear the discussion and interpret when needed. You can also keep a journal of your body statistics.

“Patients can provide data. Keep a journal that concerns your health issues and what can be tracked. That way you have objective information as well as your subjective information,” Majumdar says.

“Health care providers need to welcome conversations about weight and health in a stigma free form,” Scritchfield says. “What people need is compassion, not a lecture, and support in habit changes as the primary focus. When people are being judged for their appearance constantly, they are disappointed that their efforts toward healthy self care. The shame spirals, and they are less likely to keep going.”

Sears wanted to lose weight on her own to help with her medical conditions once they were properly diagnosed, and when she left her cardiologist’s office with the news that her stenosis was worse, her world spiraled.

“When your health is good, and you are exercising, making an effort to change that voice in your head, eventually it changes on its own.”

“I sat in my car in that parking lot for almost two hours, crying, calling my parents, friends, any and all who loved me. I was so scared,” she says. “I wanted to fall back on my old habits with food, but even though my new lifestyle did not reverse my heart condition, I did not let that fog my tunnel. I was even more focused.”

Sears had her surgery in July of 2018 at 180 pounds. She recovered with support from her family and partner. Her daughter is now 13. She says she managed her eating habits by changing the habits she had around eating. She replaced watching a show, which would have involved a snack, with reading aloud to her daughter, which kept her hands and mind busy. She changed her commute home to not be tempted by her typical fast-food stops. She says it’s her own form of self care.

“When your health is good, and you are exercising, making an effort to change that voice in your head, eventually it changes on its own,” Sears says. “It starts talking to you, and you feel that you are worthy of health, and you are worthy of feeling powerful. Putting yourself first pays off, and then you literally can’t imagine another way.”