The corrupt and pervasive nature of medical fatphobia

Weight must have always been a determinant of health, right? Considering the importance our medical system places on weight, one would naturally assume that health has never been determined without it. In reality, however, scales didn’t appear in the doctor’s office until the early 20th century. Before that, health was determined without a scale. If this was possible then, why is weight so critical in healthcare now? 

As the world evolved and health insurance and pharmaceutical companies grew, so did the many outside pressures on doctors to bend their established practices to the whims of those in power. At the beginning of the 20th century, life and health insurance companies began to use categories of “normal weight,” “overweight,” and “underweight” to determine premiums, the amount an individual pays for insurance after their predicted need for it has been assessed. Insurance companies required that this category be provided to them by doctors to decide if someone was a risky insured individual, and as such, doctors followed suit.

Pharmaceutical companies began influencing doctor’s decisions as well. Weight loss drugs hit the market in the 1920s as the international obsession with thinness grew. Big Pharma soon realized the profitability of these drugs and began pushing for doctors to prescribe them to their patients through the use of gifts and monetary favors. At the time, there were fewer regulations on what doctors could and could not accept from pharmaceutical companies, making it fairly easy for these companies to influence medical decisions. 

And this is when true health was disregarded for the “health of thinness.” Doctors began prescribing thyroid medications to otherwise healthy people, and weight loss supplements became a frequent recommendation despite proven negative effects on the kidney and liver. And while these effects were ignored, medications that have weight gain as a side effect had everyone’s full attention and were not prescribed. Kidney failure was a side effect less serious than weight gain. 

The numbers and the history may seem distant and hard to comprehend, but the seriousness of these issues can be seen in people’s individual experiences. I, myself, was prescribed an antidepressant that can cause suicidal ideation to worsen as a side effect over one that had weight gain as a side effect. It seems, for my doctor, death was less dangerous than weight gain.

But it doesn’t simply stop in medications. After weight loss drugs came weight loss procedures that disregarded health even more. In 1949, some doctors created the National Obesity Society, a group that believed that “any level of thinness was healthier than being fat.” This inspired a number of new “treatments” for “obesity,” including stereotactic surgery, which involved burning lesions into the hypothalamuses of people with what was arbitrarily defined as “gross obesity.” Jaw wiring was another extremely dangerous and almost abusive procedure that gained popularity in the late 1900s. People in smaller bodies were not given such dangerous recommendations when they exhibited the same health issues as a fat person: a thin person with high blood pressure was given medication, while a fat person was given a jaw wiring recommendation. The fact that burning and wiring were considered “treatment” for them is a tribute to how little significance the true health of fat people was given by the public and the healthcare industry.  

In the status quo, these dangerous recommendations continue to be made. We would think that in the 21st century we have made progress, but unfortunately, bariatric surgeries where 80 percent of the stomach is removed are still considered “effective treatments.” You don’t have to be a medical expert to see the issues in cutting out almost your entire stomach. Weight loss drugs, diuretics, and laxatives are still prescribed despite a plethora of research linking them to disordered eating and significant gastroenteric issues.  

Doctors have knowledge and education that goes beyond many of us. But, current medical school teachings put more emphasis on treating weight than on treating diseases. For instance, the findings of a recent study on heart disease showed that of 700-plus women who had a heart disease risk factor, only 16 percent were told about this risk by their doctors. Instead, they were told to lose weight, even though weight is not factored into risk factors for heart disease. There is so much that doctors must study, but that makes it so much easier to miss things. A little nudge of teaching from you as a patient may not only make a difference for you, but it may also make a difference for the next fat patient that comes to see the same doctor as you. 

I want to mourn those who died in these surgeries. Who died from these weight-loss drugs. Who died because they were given the wrong medicine that didn’t have weight gain as a side effect. Who died because of the utterly pervasive and debilitating weight bias in healthcare. And it’s even more important to mourn that most of the people who suffered through this had to simply because they were fat.

But, we don’t have to sit with this and allow it to occur. Someone else, even if they’re a doctor, cannot know more about you than yourself. Be assertive. Explain what you know about fatness and its false disassociation with health. Show them the studies and the science. And tell them that you would prefer not to discuss your weight and instead discuss the issue that you have come to see them for. It seems scary and intimidating, but you may just teach them something new. Something that they failed to be taught in medical school because of pharmaceutical and insurance companies in the early 1900s.