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Medical fatphobia, a profound discrimination with dramatic consequences

Medical fatphobia, a profound discrimination with dramatic consequences The hard looks and guilt-inducing thoughts of some doctors have a lasting effect on obese or overweight people, who then desert their offices and take the risk of no longer being treated. Testimonials and decryption of stigmatization at all levels of the medical environment.

"There's a thin person inside of you just waiting to live." Pelphine is still a teenager when her psychologist lets go of this assertion. At 30, the fat activist behind the Instagram Corps Cools project still remembers the "infinite violence" of the moment. Later, it was her dentist who advised her to have bariatric surgery.

Behind these guilt-inducing words hides what is called medical grossophobia , an attitude of stigma and discrimination towards obese or overweight people on the part of doctors and other caregivers. The resulting consequences, such as the refusal of treatment or misdiagnoses, can then be devastating for those who are victims.

A less attentive ear, a more severe look

Marine, a 24-year-old special education teacher, ended up changing GPs because the latter kept telling her, and whatever the purpose of her consultation, that she was overweight and needed to lose weight. What she already knows. "It is not because I am overweight that I am not aware that this constitutes a risk factor for my health and that I am not vigilant", annoys the one who renamed herself Marine Plus Size on Instagram, a network where she advocates self-acceptance.

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Once, when the Lensoise made an appointment for angina, her doctor told her that this inflammation was due to her weight. However, Marine had already told him that he had fragile tonsils for a few years and repeated angina. What the doctor did not hear or take into account. "If I slim down, will my tonsils also slim down? Not because they're the ones that bother me!", she retorts. An ENT will then confirm that angina can happen to any patient, of any build.

"Studies have shown that physicians routinely advise their obese patients to lose weight, while they prescribe imaging exams, blood tests, or physical therapy for normal-weight patients," Joan points out. Connecticut College researcher C. Chrisler at a conference of the American Psychological Association (APA) in Washington.

The testimony of Pascale, a Corsican teacher, illustrates well the analysis of the American researcher. “You have the choice between dying of a heart attack or having a stroke,” his nutritionist brutally tells him. Problem (other than her lack of tact):when she made this remark, she had not yet looked at the test results of Pascale, at the time thirteen kilos overweight. "How could she say that then?" asks the 50-year-old again, marked by this painful memory.

The ears of these doctors become less attentive in the presence of a fat patient. And their eyes sometimes reveal their disgust. Marine remembers a practitioner who had "stared at her from head to toe" when she entered his office. She had felt his judgement, through that hard, insistent gaze. Joan C. Chrisler describes a "disapproving attitude" of doctors towards their overweight or obese patients. There are, on the one hand, the hurtful and infantilizing reflections, "inevitable when one is a fat person", according to Pelphine, and on the other, these "implicit attitudes" which the patient can "experience as micro-aggressions", warns the researcher.

"Doctors can explain this fact in a benevolent way and the patients concerned will hear it, thinks Marine. The problem is the way of speaking to the patient and looking at him."

The obsession with weight loss

Pelphine's father is a doctor. In their home, the diet has always been balanced and healthy. "He saw me grow up and feed myself the same way he did. And yet the idea remained in him for a long time that if I got fat, it was because I ate more. Even though he saw my plate! ". The activist against fatphobia illustrates with this personal example what she denounces on a large scale:the cliché that fatness and poor food hygiene always go hand in hand.

“There were no fat people in the concentration camps,” his doctor told him one day. Understand:when you eat less, you inevitably lose weight.

"We have to stop perceiving these patients as people who only eat," says the specialist educator, indignantly, before recalling that thyroid disorders or genetic predisposition can also be the causes - eclipsed by these doctors - from a high BMI. "You also have to realize that there is a story behind each body. Take into account the patient's medical file rather than their physical appearance," she claims. On the other side of the globe, in Washington, researcher Joan C. Chrisler asked caregivers to no longer consider obesity as a disease that can only be cured by diet, but to take more account of the context.

"The thin swallows, the big swallows", loose facing the camera a general practitioner in front of 1.9 million viewers. The shock sentence of the speaker of the show Operation Renaissance , hosted and produced by Karine Lemarchand, broadcast on M6 on January 11, scandalized Marine. "In front of my television set, I was angry and sad at the same time, confides the young woman. I thought:if a specialist validates this cliché, we will never move forward in the fight against grossophobia." And to regret:"We are only interested in obese people when they want to lose weight...".

Pelphine was also revolted by the broadcast of this docu-reality featuring bariatric surgery courses – to which she is “radically opposed”. "We neglect the psychological impact and the risks of such an operation," she worries. "These things, we keep quiet, because there is, once again, this idea that you have to lose weight at all costs to be healthy and happy."

Medical grossophobia is also to think that losing weight will solve all the problems, by obscuring those that the operation can create. A 2018 analysis from the National Health Insurance Fund, cited by Pelphine, indicates that 15% of people operated on had to be hospitalized again for surgical complications during the six years following the operation, 19% for digestive complications non-surgical, 5% for serious nutritional complications and 22 to 46% of them saw their diabetes relapse after a remission phase.

The activist behind Corps Cools also co-created the Brussels association Fat Friendly. One of her associates in this project had surgery and yet was never informed of the potential consequences of this surgery, she says. "Would losing weight deserve all the sacrifices and all the violence?", the activist is indignant.

After a bad experience, the risk of medical rupture

The nutritionist's remark was so traumatic for Pascale that she never wanted to go back to see her. Even more serious consequence:this painful moment blocked her from going to consult elsewhere for nearly two years.

Like her, the founder of Corps Cools was traumatized by unfortunate experiences. She says she was on medical break for about seven years. If today she goes again to the general practitioner and the gynecologist, she remains paralyzed by the dental consultations, because of the “striking memory of a humiliating and paternalistic dentist”. The same one who had taken the liberty of directing her to bariatric surgery. From now on, Pelphine warns at the start of the consultation:she is committed to the fight against grossophobia, she no longer wants to be the victim of this violence, and if the meeting goes badly, then she will leave immediately. . Previously, she suffered grossophobic remarks without responding to them. “I was mute, in a state of amazement at this violence,” she recalls.

Pascale and Pelphine are no exceptions. For fear of being devalued or made to feel guilty again, some people who have already been stigmatized for their weight by a caregiver leave the medical system. Psychologically destroyed, they flee the cabinets. And the consequences of this grossophobia which led to their medical precariousness can be dramatic. Because without regular medical follow-up, patients remain in poor health and certain diseases can be detected late.

Three different studies have shown that overweight women are more likely to die from breast or cervical cancer than other women. "This result was partially attributed to their reluctance to consult a doctor" and therefore, to be detected in time, as explained in a dense decryption entitled "Everything you know about obesity is wrong", published in the American edition of the Huffington Post.

Apart from this distrust that leads to no longer consulting, medical grossophobia can also lead to errors or delays in diagnosis that can prove fatal.

To allow these people who have been out of the circuit since a bad experience to be taken care of again, the Gras Politique collective has created a directory of "safe doctors " (but also "not safe "). For her part, Pelphine has a project with her association Fat friendly to open a medical center in Belgium, in which isolated people would be welcomed with kindness if they did not feel like going back to the doctor.

"The goal is to build a place where we know that if we come for an ear infection, we will be treated for an ear infection, and that we will not leave this consultation with a voucher for a bariatric operation", summarizes the co-founder of the project.

Where is the equipment suitable for fat people?

The layout of the medical center will also be designed for these patients. No armrests on chairs in waiting rooms, for example. This also applies to treatment tables. "There is often a step on these tables, small and narrow, which must allow you to climb on it. Sometimes you can't even do it," explains Pelphine, for whom "medical grossophobia also lies in the lack of accessibility in care areas".

The 30-year-old feels a terrible paradox:"On the one hand, it seems that the fat body belongs to everyone, since everyone has an opinion on the health of fat people, and on the other, this same body is invisible and nothing is made to cure it."

And when the material is adapted, it is all the same problematic, guilt-inducing. Witness the general practitioner and novelist Baptiste Beaulieu, with this anecdote lived and told on France Inter .

"I see an overweight patient, and because I can't take her blood pressure with a standard cuff, I grab a large cuff. The patient starts crying, and I realize that there is wrote 'Obese' on the armband, in white, very visible, you can't miss it. Of course, 'Obese' is a medical term. However, a language is alive, it lives through shifts in meaning" , defends committed physicians against discrimination in the medical environment.

"My patient does not need an armband to express to her what society has already been bludgeoning her from childhood," he asserts. A useless stigma, and above all avoidable, in short. So Baptiste Beaulieu challenged the brand of armbands on social networks the same day and it indicated that it was immediately changing their production chain and that it would now register "XXL".

Obese people, ignored by research

Medical grossophy is also expressed in the exclusion of overweight people from research protocols. Researcher Joan C. Chrisler pointed out that the dosages are not appropriate for overweight people. In other words, the molecules are under-dosed for them, which, in time, can have dangerous effects.

Medical grossophobia is therefore not just remarks. It is also a constant forgetting. Listening, space, and sometimes, humanity.

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