On fat people, fat stigma, and healthcare


I was excited to receive an invitation to speak at the Renal Society of Australasia conference this year. A member of the organizing committee was familiar with my work, and convinced the cmte that I should be an invited plenary speaker (meaning I spoke to the entire conference). I was given a thirty minute slot to speak about fat stigma and its role in healthcare settings.

This is a topic I know a great deal about, as a super fat woman, a fat activist, and a Fat Studies scholar. I have published scholarly pieces on the topic, written about it before on my blog, talked about it on my fat positive radio show, Friend of Marilyn. The challenge, then, was how to deliver a short talk on the topic that would be meaningful for those in the audience. I wanted it to be informative, persuasive; I wanted them to walk out with frameworks for thinking about fatness differently and with tools for bringing a fat ethic into their own practice.

I opened my session with the story of Ellen Maud Bennett, a Canadian woman who recently died. In her obituary, Ellen shared that her dying wish was for fat women to advocate for their own health, especially in healthcare settings.

I continued with a story from the The Evening Standard in the UK about a fat man whose tumor went undiagnosed for a decade because of antifat attitudes. When it was finally removed, it weighed 55lbs. And I shared that these are only two stories of thousands – that fat people around the world received poorer care than non-fat people because of fat stigma, discrimination, and bias. These stories, which once we only shared in whispers among fat people, or loudly by the rare activist, are now shared en masse in online spaces; Web 2.0 tools have provided a medium for fat people to share their individual stories with the larger collective. To see they are not alone; to support one another; to share strategies for next time.

It is the antifat attitudes and beliefs of doctors that are responsible for fat people receiving unethical care. Numerous studies find that doctors believe their fat patients to be gross, undisciplined, non-compliant. Doctors do not want to palpate a fat abdomen (if they even know how); they spend less time with their fat patients. Part of the responsibility falls to their lack of education in providing care for fat people. A growing literature is dedicated to documenting that healthcare providers do not know how to appropriately administer anesthesia to fat patients; how to locate veins and administer appropriate levels of drugs to fat patients; how to appropriately perform CPR on fat patients.

All of it creates a hostile environment for fat people. And so many fat people avoid it.

Jan Fraser died of cancer after her symptoms were ignored by doctors and her weight loss was celebrated by all, even her family. As shared by her sister, Lara, “the hospital’s gynecologic oncologist removed the largest endometrial tumor he said he’d ever seen, the size of a volleyball. It had peppered her pelvis with cancer, infiltrating her bladder and other organs.”

In the final part of my talk, I suggested there were three things that those in the audience could do to improve the care they provided to their fat patients. First, make sure your physical spaces are fat friendly. Are there chairs without arms? If gowns or BP cuffs or other materials are needed, do you have ones large enough for fat bodies? Second, recognise your own bias. I pointed them to the Harvard Implicit Attitudes Test, which is free online and has a range of bias tests, including for weight. Lastly, I urged them to treat people’s symptoms, not their body size. And I recommended that they check out NAAFA’s Guidelines for healthcare providers for more information; I also invited them to check out the writings of fat people online about their healthcare experiences.

I ended up speaking for half my time, and then it was opened to questions. There were a lot of them – people were willing to stand up and approach the mic and ask what was on their mind. Some were predictable, “But what about their health?” – yeah, what about it? How can promote the health and well-being of fat people if they receive shitty care and shitty attitudes? Others were insightful, asking questions about intersectional experiences of fat people. It was a nice reminder that fat people are not a monolith (and a point for me to acknowledge that the three examples I used were all of white fat people). Overall, the response from the audience was positive and I left the podium feeling that I made a real difference in this space.

When similar opportunities arise for me, I’ll take them. Because speaking in their spaces is important, and one of the ways we can enact change for the fat community. If only a handful of people in that room have changed the way they treat fat people, that’s a win. If only a handful more left thinking about fat people differently, and sharing that new perspective with others, that’s a win. If the ones who left pissed at me went and shared their anger and frustrations with others, who may then hear some of my main points during their rant, that’s a win.

I will keep speaking about fat people – for fat people – in the spaces I have access to. And whenever possible, I’ll pass that mic along to other fat people who do not have accessibility to those same spaces. We need more fat voices in the fray, not fewer.