Let me begin with a disclaimer: I did not know what the term ‘gaslit’ referred to until the idea for this story was suggested to me. Once I read up on the definition, it became clear that gaslighting as a practice has a home in health care, especially in the areas people categorized as “overweight” or “obese” are subject to. These individuals are all too familiar with going to the doctor with concerns, only to have their ailments blamed on their weight — and that’s if they go at all. The anticipation of weight stigma at the doctor’s office leads many to avoid going or scheduling appointments with health care physicians, which is dangerous as serious conditions can continue to go unnoticed. Medical gaslighting is so prevalent in the field, especially toward women, that it makes me wonder if medical schools have a unit on it in their already fatphobic curriculum. 

It doesn’t take much effort to find stories of patients (many of whom are again, women) who have had horrific encounters with medical professionals. Scrolling through the comments section of this article alone where numerous individuals shared their experiences is heart-wrenching. While most would agree it is terrible to experience such utter disrespect at the hands of your doctor — a person who is supposed to care for you — too many still see this mistreatment as an unfortunate consequence of necessary “health” advice. This perspective of claiming to disagree with the doctor’s explicit fatphobic remarks, while also believing that the doctors are still telling the truth, just not nicely enough, is still fatphobic. You are missing the point entirely if you only take issue with how the doctor addresses the patient’s “weight problem,” because really there is no problem at all. At least, not on the individual’s part. 

Fatphobia and weight stigma are the forgotten systems of oppression that activists all too often glance over. Still, it’s not my intention to berate them for doing so. Other pressing systems of oppression do appear to be of more importance right now, those being racism, sexism and classism. But when you neglect fatphobia and weight stigma from the fight for equality and just medical treatment for all, you are turning a blind eye to yet another way marginalized populations are neglected and isolated from not only opportunities to live a more fulfilling life, but also from the quality of care that allows them to live at all. I’m not asking you to turn your back on the fight to eradicate racism and its many branches — I am asking you to see fatphobia as one of those branches. 

Fatphobia, and diet culture as a whole, was born out of racism and white supremacy. Sabrina Strings, Ph.D., an associate professor at the University of California – Irvine, wrote extensively about fatphobia’s roots in racism in her groundbreaking book, “Fearing the Black Body: The Racial Origins of Fat Phobia.” Strings puts forth a compelling argument as to why scientists were wrong when, in the late 1900s, they began pointing to “cultural deficits,” such as unhealthy diets and a lack of self-control, as the main reasons why health disparities existed between whites, Blacks and Latinos. It is true that, on average, Black people tend to be heavier than their white counterparts, but this is due to body composition and bone density, not culture. Furthermore, we know weight alone, or one’s body mass index, is a poor indicator of health. On the topic of BMI, it’s also important to note that the metric was created based on European men and is thus not inclusive of the many other body types that exist. 

All in all, the BMI categories branding some as “unhealthy” right out of the gate, according to one number, is inaccurate and harmful. These categorizations only serve to lock people out of quality health care. Those whose BMI’s fall above the “normal” range face weight stigma not only in individual settings, which can look like snarky or condescending comments from your health care providers, but also at an institutional level. This includes health care providers withholding beneficial medical procedures until an individual  loses weight or not getting hired because of one’s body size.

This is explicit discrimination based on body size. Furthermore, the arguments that such isolating acts by some doctors are done for their patient’s best interest are a reach. Having a BMI above the “normal” range is not a death sentence. Using BMI as an indicator for health resulted in over half of metabolically healthy participants in a 2008 study being subsequently labeled “overweight,” and a University of California – Los Angeles research team saw similar results in their more recent 2016 study. They found that 54 million Americans labeled “obese” or “overweight”t were healthy according to metabolic indicators. 

Those falling under the constructed “overweight” and “obese” categories do not receive the same quality health care and they do not garner the respect of their health care providers that their thinner counterparts do. The weight stigma that comes with being in a larger body thus serves as another barrier to quality health care for many Black people and people of color, who may also be of lower-income, given their higher likelihood to be categorized as “overweight” or “obese.” 

Furthermore, these effects disproportionately affect Black women and other women of color. Black women are more likely than any other group in the United States to be categorized as “overweight” or “obese.” This adds to their already high likelihood of being gaslit by medical professionals due to their gender and race. Thus, we cannot relegate the effects of weight stigma and fatphobia to the individual level and think of it in the context of a disrespectful interaction between individuals when the issue at hand is systemic. 

We have a dire social justice issue at our hands. The weight stigma that these women are subject to in the medical field, and the gaslighting that it manifests itself through, can be fatal. Some studies have begun documenting the effect of such stigma on Black women, but unfortunately, there haven’t been many, further proving that researchers are neglecting it as a topic of study because “weight stigma remains a socially acceptable form of bias.” 

As activism for unconditional equality in rights, liberties and access to resources has revved up and become more of a progressive norm, it is imperative that we don’t neglect the rights of those in larger bodies. A society obsessed with “health,” or shall I say thinness, has obscured the mistreatment of larger individuals by hiding behind the guise of concern trolling

This justification for their discrimination and prejudice has been widely accepted by medical professionals and everyday people alike. But enough is enough. It’s time that fatphobia and weight stigma become seen as the forms of oppression they are, and we as a society need to rethink how we view health. Because currently, the collective idea that it has a certain look is creating yet another social hierarchy where many people are deemed less worthy of basic dignity and resources for a happy and healthy life. 

Nyla Booras can be reached at nbooras@umich.edu.

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