The Lady Bears, fat activists, educators and artists JDP and Sookie Bardwell, introduce five requirements to create ‘a fat medical utopia’. In this first part, they explore what patient centered care means for fat patients, and the need to move beyond equating healthcare with weight management.
Introduction
As fat, queer, dis/abled, non-binary femmes, our experiences interacting with the Medical Industrial Complex have been consistently dystopic- and we both benefit from the myriad protections provided by our whiteness as Canadian settlers who are not also being targeted by Medicalized Racism within a healthcare system built on a foundation of colonial White Supremacy (Andreou, 2021; de Leeuw, Loppie, & Reading , 2014; Dryden & Nnorom, 2021; Gunn, n.d.; Rees, 2020; Tello, 2017). In our attempts to navigate a deeply fatphobic system, we’ve both been subjected to shaming and mistreatment by healthcare practitioners; had pressing medical concerns overlooked or neglected in lieu of a diagnosis of ob*sity; and been denied access to care unless we first achieved a substantial weight change. In all instances, these experiences of discrimination, exclusion, erasure, and neglect have taken place in interacting with practitioners whose vocations centre a professional mission to provide care and support well-being, and some of whom have even made a promise to “do no harm”.
Unfortunately, we’re far from alone in our experiences of Medicalized Fatphobia. Weight bias, stigma and discrimination in medicine are pervasive across disciplines and impacting practitioners’ beliefs, attitudes and practices throughout their careers (Fruh et. al., 2016; Hebl & Xu, 2001; Miller et. al., 2013; Rubin 2019; Sabin et. al., 2012). This has serious adverse consequences for fat patients, including increased stress in medical settings which often results in an aversion to accessing care. The impact being, late and less effective diagnosis and treatment of pressing health concerns; misdiagnosis because of bias, and poorer overall health outcomes that are then taken as confirmation that fatness is a stand-alone indicator of ill health (Cody Standford, 2019; Lee & Pausé, 2016; Phelan et. al., 2015; Sagi-Dain et. al, 2021).
These shared experiences have ignited a passion for Healthcare Equity which informs both of our work as activists and professionals. Through our individual and collective efforts, we work to address the weight-based disparities in access to care in whatever way we can. We support professionals in developing size-inclusive, Body Liberation-centred attitudes and practices. We offer support to other fat folks dealing with the ongoing impacts of Medicalized Fatphobia as they navigate the perils of a system that is not built with our bodies in mind. Fat people require this help because the system actively pathologizes us and endangers our individual and collective well-being. We also facilitate educational programming in a wide variety of settings which aims to address fatphobic violence and increase individual, interpersonal, and institutional knowledge and capacity around Fat Acceptance and Body Liberation. Informed by this work, we’d like to offer our thoughts on 5 key requirements for a Fat Medical Utopia.
5 Key Requirements for a Fat Medical Utopia
1) Patient focused care
As folks living in bodies at the intersection of multiple marginalized identities, we offer you a different perspective on how to offer patient-centered care. On countless occasions, we have both been diagnosed as fat while trying to access care around health concerns completely unrelated to our body size- as if shedding critical parts of our bodies would magically fix cancer or repair torn ligaments in lieu of appropriate, evidence-based medical care from a trained practitioner. Unfortunately this is an incredibly common experience- so much so that the Association for Size Diversity and Health has funded the creation of Health Sheets based in the principles of Health At Every Size® in order to support “blame-free, shame-free” access to care. These resources aim to provide “weight-neutral, evidence-based care options” around a wide array of medical conditions that are frequently attributed to having a larger body alone, and for which fat folks are commonly prescribed weight loss in lieu of effective treatment. Familiarizing yourself with resources like these is one way in which you can gain a better understanding of how to support your patients in affirming, unbiased and non-discriminatory ways. When in doubt, ask yourself- how would you treat this concern if it presented in a non-fat patient?
Failing to do so can have dangerous consequences. We are both survivors of disordered eating (ED) which we developed in a dangerous attempt to control our unruly bodies so that we could experience less violence and access more respect and care. When our ED was at its worst and our health was most at risk, we were both congratulated by our healthcare providers for the drastic change in our weight with little notice or concern for the fact that the same radical fluctuation would have been cause for serious alarm in smaller-bodied patients. We are both fortunate that we have been able to access healing around ED through personal work and collective/community care but have both been left with lasting impacts on our bodies that negatively affect our well-being, and which could have been prevented had our physicians been able to see past their own weight bias and provide us with adequate care.
Invest in appropriate tools and equipment and practices for all bodies
We deserve the same access as all your patients. If you have equipment in your office that doesn’t support all body types, that tells us about your practice- specifically that we are not welcome there Prepare for the reality of body diversity and think about negotiating every aspect of your practice through a dis/ability and size-inclusive lens. Offer wide comfortable furniture without arms in your waiting and examination rooms that is easy to get in and out of and make sure that there is ample room to get around your office in a larger body or using mobility devices. This includes getting in and out of washrooms if patients need to provide samples. Account for larger bodies in all of your equipment. Take this opportunity to communicate the importance of addressing this gap to manufacturers and providers if the equipment doesn’t work for us. If you’re unsure how to integrate these considerations into your practices or the design of your space, hire a fat consultant to get help with your office set-up.
2) Healthcare that is not focused on weight management
Weight loss is not a cure for a single medical condition. Please diagnose and treat us as if we were any other patient deserving of your time and care.
Check back tomorrow for Part Two tomorrow!
About the Authors
JDP (they/them) is a Fat activist, community organizer, peer counsellor and white settler on Treaty Six Territory in so called Canada. They have been educating doctors on their biases and fighting for better healthcare for the last 10 years. Ask them about how they convinced a third doctor to finally treat them for cancer via surgery instead of weight loss.
Sookie Bardwell (she/her/hers + they/them/theirs) is passionately committed to the work of helping people be better together. She is a white settler invested in the work of decolonization and racial justice. They are also a fat, queer, genderqueer femme living with invisible disability. Her work is informed by all of these ways in which she moves through the world. Sookie is a multimedia artist and co-editor of the Far Too Fat Zine. She is also an OCT certified teacher and Opt BC certified sex and relational health educator, who holds an MA in Gender Studies and Feminist Research from McMaster University where her research focused on self and community/collective care for support and social justice workers. They are also a founding member and the Director of Content Development and Learning Design with the Challenge Accepted Learning Collective. She has been involved in social change/justice work for almost twenty years as an educator, trainer, and facilitator on topics including LGBTQ+ equity and inclusion, Body Liberation, emotional and relational skills, and sexual health. She is honoured to do this work alongside her Challenge Accepted, Chub Love, and Body Buddies collaborators in a wide variety of spaces including through her relational coaching work, as part of student wellness and anti-violence programming on elementary, secondary and post-secondary school campuses, in workplaces in both corporate and not-for-profit settings, and in providing support to folks seeking healing from distressed and disordered eating. They believe that everyone deserves to be treated like a person (i.e. with basic respect and decency), and that we all deserve access to- and have the capacity to develop- the knowledge and skills needed to move through the world with compassion, kindness and a genuine curiosity in encountering difference.
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