The Fatphobic History of Medicine

Modern medicine is Fatphobic AF.In last week’s blog post, we explored how the medical profession has pathologized fatness. We talked about eugenics, race science, and the systematic exclusion of fat people from the narrative of health.

Today, I want to bridge the gap between history and our present reality. Why? Because understanding our past is how we learn to navigate our present and how we shape our future.

The Eugenics of Modern Medicine

Let’s be honest; despite our advancements in medicine and supposed commitment to equality, traces of eugenics still linger in our healthcare systems. The medical profession, unwittingly or not, perpetuates the notion of a superior race by subtly—or sometimes not so subtly—marginalizing fat individuals.

And never is that more obvious that in the world of fertility and obstetrics. While it’s illegal to deny someone the right to continue a pregnancy, doctors sure know how to make Fat pregnant people miserable. I can attest to this from personal experience.

During all three of the pregnancies I carried to term, I was made to feel inadequate and irresponsible solely because of my weight. I was told I was putting my baby at risk, myself at risk, even other professionals at risk. Because what if I had to be lifted during an emergency? What would that do to their backs? 🙄

Discriminatory Practices in Reproductive Healthcare

I’ve heard countless similar stories from others—tales of being dismissed or belittled by healthcare providers based on weight alone. My friend Nicola Salmon once told me about a private fertility clinic who offered IVF to individuals with a BMI over 40. This clinic faced immense pressure from local hospitals, because how dare they let Fat people get pregnant and force them to “clean up the mess”?

There’s more. Forced sterilisation has existed for a long time. Governments decided that they didn’t want certain groups to be able to reproduce, so they stopped it from happening. They primarily targeted Indigenous, Black and Disabled communities.  

And in case you’re thinking that’s a thing of the past, did you know that women in Californian prisons were sterilized against their will well into the 21st century? Wanna take a guess as to what those women looked like? Until very recently, Ethiopian Jews in Israel were given contraceptives without their consent. Why? To stop them from having Black babies, of course.

The Medical Profession’s Disregard for Fat Lives

So riddled me this – what’s the difference between forced sterilisation and forbidding people over a certain BMI from accessing fertility treatment. Sure, the practices are different, but the outcome is still the same, right?

Eugenics is alive and well folks. Just look at the medical profession’s altogether indifferent stance toward fat people’s health outcomes. Weight stigma is an independent risk factor for poor health, yet the medical profession does nothing about it.

Worse still, the medical professionals are some of the most prolific perpetrators. We’re the ones causing the harm in the first place, forget putting a stop to it.  If that’s not proof that the medical profession doesn’t care, then I’m not sure what is!

The Sanctimonious Truth Behind Modern Medicine

When doctors discuss weight with Fat patients, the conversation almost always revolves around diet and exercise. Why? We know that there are several factors that control our weight. But doctors  only seem to care about two. The answer is rooted in the assumption that fat people are lazy and gluttonous—a moral judgment masquerading as medical advice.

Last week I talked about Dr. Lulu Hunt Peters, a doctor and author who epitomized this moralistic approach by equating restriction and calorie counting with virtue. This kind of thinking persists within the scientific community today.

There’s more to life than diet and exercise

You notice it whenever we get together to discuss how to improve the health of a particular community. No matter what, the conversation always comes back to diet and exercise.

For example, when we discuss the importance of green spaces, the focus is often on providing areas for people to exercise. Never mind the broader benefits such as mental health, social well-being, and reduced pollution.

Similarly, when we talk about food deserts, the conversation tends to centre on so-called ‘unhealthy’ food choices and weight gain, rather than the fundamental issue of food insecurity and the impact this has on mental and emotional wellbeing. 

It’s as if our primary goal should be to make people eat less and exercise more, and everything else comes in a distant second.  

Assumptions that are rooted in white supremacy

Doctors often make assumptions about their patients. They ask questions like, “Don’t you want to live a long time and see your grandchildren?” Or “Don’t you want to be productive and able to keep up?” Or my all-time favourite “You don’t want to be a burden, do you?”

They ask these questions to coerce or even blackmail people into losing weight. They make broad sweeping statements like “If you want to live to see your children grow up, then I suggest bariatric surgery”. Or “unless you want to develop diabetes and have a heart attack by the time you’re 50, you need to start Ozempic.”

First things first – doctors are not psychic. There isn’t a shred of evidence to support any of their claims. Whilst we can make some predictions about 10-year cardiovascular outcomes using data like blood pressure, cholesterol levels, and pre-existing conditions, even these calculations are flawed.

But beyond that, the focus is on living long as opposed to living well. Being productive, as opposed to being happy. Ultimately, this reflects a moral judgment that being fat makes a person unproductive and therefore a burden to society. Abelism much?

The Fatphobic Reality Of Modern Medicine

The majority of doctors hold both explicit (conscious) and implicit (unconscious) anti-fat biases. But we don’t need studies to tell us this. We experience this firsthand.

It’s in the way doctors look at us with disgust, even if it’s just a micro-expression. And the way they examine or avoid examining us. Doctors are often  uncomfortable touching their Fat patients, and we notice this discomfort.

Hands Off!

As a Fat person and a doctor, I’m very conscious of my body language and facial expressions when examining patients. I try to reassure them that they are safe in my hands. However, I’ve noticed that this isn’t a universal experience.

I remember accompanying a friend to the doctor because we were worried she might have appendicitis. She kept apologizing for her body, saying things like, “I’m sorry my tummy is in the way.” She was trying to make the doctor feel comfortable, even though it was his job to examine her, and he was being paid handsomely for it.

Her almost pathological need to apologise for her Fat body was driven by his apparent disgust. He did nothing to reassure her. Just ignored her and carried on palpating.  

It’s getting worse

Nowadays, doctors blame our weight for all our health issues. They are becoming increasingly brazen when it comes to prescribing extreme weight loss measures such as surgery or injectables. They have no issues denying us treatment because who’s going to stop them?

The doctors are fatphobic. The people in charge are fatphobic. Medicine is fatphobic.

A thin person with shortness of breath will get a set of bloods, a chest XRay and respiratory function tests as standard. A fat person with the same symptoms will be told to eat less and exercise more.

Clinical decisions are made through a fatphobic lens, and this causes actual harm. Not only do we have evidence to show it, but we also experience it on a regular basis. Join me next week for part two of this exploration of the fatphobic history of medicine. 

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