How Doctors Dismiss Overweight Patients

If you go to the doctor for a health issue or concern, or because you are in pain, you would expect a thorough examination to get to the root cause. This does not always happen for those who are overweight or obese, because many doctors have a bias against individuals in larger bodies. Let's learn about undiagnosed asthma and weight bias in healthcare.

About 2 out of every 3 of Americans are overweight or obese. According to doctors who use the BMI measurement, those who are overweight have a body mass index (BMI) of 25 or greater, and those who are obese have a BMI of 30 or greater (it’s important to note that BMI has received a lot of criticism in the past decade or so, and to remember that BMI is merely one number that doesn’t tell your entire health story). This means that a large number of people going to the doctor for a concern might face unnecessary biases due to their body shape or size.¹

Body size and weight bias in healthcare

Weight bias in medicine may stem from a variety of factors, including the minimal education about obesity that doctors get in college and in medical school. There is also little to no education about weight bias, stigma, and their impact on overweight or obese individuals. If there is no education or discussion about these issues, doctors tend not to see it as a problem or even recognize the issue exists.¹

A complex condition

Obesity is a complex condition that is not merely “eating too much.” Factors can include:¹

• Genetics
• Hormonal issues
• Developmental issues
• A history of trauma
• Environmental issues

A strictly medical approach sees obesity as only an issue of weight gain and the idea of fatness as a disease, with weight loss as the cure. This way of thinking influences how doctors approach health concerns or complaints: the excess weight must be the culprit.²

This kind of thinking can also lead to doctors or healthcare providers unconsciously viewing overweight or obese people as having poor health habits or lacking self-control. This might influence their attitudes toward the person in a negative way.²

How does weight bias affect people with asthma or other health conditions?

If an overweight or obese person has had negative interactions with their doctor because of fat-shaming or being made to feel bad about their size, they may be less likely to go to the doctor, especially when there is a problem.²

The health impacts of weight bias in healthcare are widespread and can include:^1,2

• Exclusion from medical studies
• Under-dosing of antibiotics, chemotherapy, or other medications
• Not taking health complaints seriously
• Assuming any health complaints or symptoms are due to being overweight
• Failing to run the right tests to make an accurate diagnosis
• Negative effects on mental health, including depression, anxiety, substance abuse, and suicidal tendency
• Reduced trust in the healthcare system, leading to less engagement with it
• Physiological reactions like increased blood pressure and blood sugar

In a study of more than 300 autopsies, obese people were 1.65 times more likely than non-obese people to have significant undiagnosed medical conditions. This suggests that they were misdiagnosed or did not have access to appropriate care.²

For overweight or obese people with undiagnosed asthma who are experiencing chest discomfort, this might be brushed off as a side effect of excess weight. For women especially, whose complaints about pain may be more likely to be dismissed, this exacerbates the problem.

Doctors may suggest diets or exercise instead of ordering the right screening or diagnostic tests that would find signs of asthma. All of this leads to delays in diagnosis and treatment, worsening of symptoms, and reduced quality of life.

Things to consider about asthma and weight bias

It is worth it to find a doctor you like and trust. Talk with them about your health concerns, and if you experience weight bias or inappropriate treatment, ask to speak with the office staff about your experience there. They might not be aware of how their biases show up in their treatment.

If you are overweight or obese and experiencing pain, any other health symptoms, or have concerns, see your doctor. Let them know what you are experiencing. If need be, bring a friend or family member for support. If the doctor recommends a certain treatment, ask them if they would recommend the same treatment for a person with a BMI they consider “normal.” If the focus remains on your weight, redirect it to your symptoms and concerns.²

You deserve relief from your symptoms and an accurate diagnosis. Find a doctor who will work with you to find out the underlying cause of your symptoms so you can get proper treatment.