In Devon (UK), people who are classed as “morbidly obese” and higher (a BMI of 35+) will be denied any and all routine surgery until they lose 5% of their weight. An amount which experts explain “is not only remarkably lax but has no medical rationale.”
The issues with this should be obvious. First, the use of BMI in healthcare settings is deeply problematic. Also, for many people losing 5% of their weight won’t change their BMI category at all so they will be approved for surgery at a weight at which they would be denied if it was their weight when they walked in. Then of course there’s the fact that they have no evidence that this weight loss can be maintained or that it will improve health (in fact, evidence points to the opposite conclusion.)
But you know what’s even less likely to improve your health than weight loss attempts? Not getting the surgery you need until you manipulate your body size by some arbitrary amount. And that doesn’t even take into the extreme and unhealthy things that people are likely to do to “make weight” so that they can access basic healthcare.
“Routine surgery” is not the same thing as “elective surgery” so please understand that they consider a medical procedure that fat people’s doctors have deemed necessary, to be a perfectly reasonable “carrot” to dangle in front of us to try to force them to lose weight.
It does not matter how much anyone thinks losing 5% of our body weight will help a fat person, it’s inappropriate to force us to choose between accessing healthcare, and attempting weight loss (for which their is, by the way, no evidence basis.)
Fat is a body size and not a behavior – fat people are as varied in our behaviors, health, and habits as any other group of people who have only a single physical characteristic in common. But let’s be clear that even if those who would deny healthcare based on body size are so dense as to believe that you can tell someone’s habits, behaviors, and health just by knowing their height and weight, that still doesn’t justify their behavior.
They are suggesting that fat people should be denied routine surgery because our body size is considered our fault, and is changeable. But they aren’t not forcing people with sports injuries to give up sports. Or people who need routine surgeries because of injuries sustained while they were drunk to quit drinking. Or people whose need for routine surgery followed the exclamation “Hey y’all, watch this…!” to sign a contract promising to stop hurling their bodies at solid objects, or people who are injured because they were driving cars to quit driving etc. (nor should they!) That tells us pretty clearly that this is nothing more than appearance based discrimination in healthcare.
In response to a Boston Globe article about medical mistakes, the brilliant Lesley Kinzel started the hashtag #diagnosisfat and people took to Twitter to discuss the ways that their doctors’ antifat bias led to substandard care. What they talk about will not likely be surprising to any fat person who has ever tried to access medical care:
A doctor prescribed weight loss for my sinusitis.
Told doc I was a dance major. He said, “if you were, you wouldn’t be fat.” I went for a tetanus shot.
GP’s withholding pain-management meds ’til I lose weight.
Went to clinic w/ a deep wound on sole of my foot. NP told me it was caused by my “excess weight.” WHAT? It was a rusty nail!
And it goes on and on (as someone who has been prescribed weight loss for a broken toe, separated shoulder, and strep throat, and who has been sent countless stories from my readers of medical mistreatment because of their size I am saddened but not surprised.) I encourage people to add their stories to the thread.
When it comes to fat patients, the healthcare system is rife with bias and the kind of misinformation and mistreatment that happens when “everybody knows” is considered as good as evidence-based medicine, and when bias, stereotyping, stigmatizing, subhuman treatment and other oppression based on appearance are encouraged by the healthcare establishment and governments that are proudly using fat people’s tax dollars to wage war on us.
I can’t help looking at the juxtaposition of anti-fat healthcare bias with “public health” messaging suggesting that the goal of our society should be eradicated from the Earth, and notice how it seems like they are happy to achieve “victory” in the “war on obesity” by making us thin or killing us, and they don’t much care which.
I think that the solution to this is going to have to be large scale activism – fat people recording their doctors, naming names when it comes to fatphobia, refusing to leave the doctor’s office until we get proper treatment, rating doctors on rating sites, perhaps creating our own rating sites, lists of fat friendly doctors, filing malpractice lawsuits etc. If what they say is true (and I’m not saying it is, but I’m not above using our oppressors own messaging against them) that the majority of people are fat and we have above average healthcare costs, then we have some real leverage to bring to this particular situation.
All of this type of activism comes with risk and some of it will end up hurting the person doing the activism (I already know people who have been blacklisted by doctors in their small town because of their refusal to accept a diagnosis of fat and a prescription of body size manipulation when they have health issues for which people who aren’t fat get actual proven interventions.)
That’s the thing about creating social change – in order to create change a lot of people have to risk a little, some people have to risk a lot, and a few people will risk everything. We shouldn’t have to do this, this is not our fault but it becomes our problem, and we each get to choose how to deal with it – nobody is obligated to be involved in activism, but the option to be involved in activism is there.
Regardless, the current discrimination against fat people, and the treatment of body size as a diagnosis and barrier to healthcare are just plain wrong, and the only appropriate health care for people of all sizes is blame free, shame free, and future oriented care. Until that is the standard, fat people will suffer and some will lose their lives due to anti-fat bias in healthcare.
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