Your patient is a person: A narrative medical approach to weight discrimination in medicine

Pervasive negative attitude toward overweight patients

It would likely be frightening to anyone to suddenly lose one of their senses. While visiting her family, Aubrey Gordon abruptly lost her ability to hear and experienced sharp pain in both of her ears. Her anxiety was twofold, though, because (1) something was clearly medically wrong in her body and (2) she would have to go to the doctor, and she is fat.

An overweight person's health is usually considered dubious, and never more so than when seeing a new doctor for the first time. Gordon chatted with the nurse as her vitals were measured, and the nurse took her blood pressure multiple times with different size cuffs. After the third failed attempt, Gordon asked the nurse if something was wrong, and the nurse responded that Gordon's blood pressure was “coming back great, but that can’t be right [because] overweight patients don’t have good blood pressure.” ⁵

As Gordon notes, this is a familiar moment that overweight patients have come to dread. No matter the objectivity or reliability of technology, the nurse still cannot accept that an overweight person can be healthy. Rather, poor health is anticipated and anything better is unbelievable.

Negative reactions toward overweight patients are not uncommon from physicians, either. A study conducted by Mikki Hebl and J. Xu analyzed the attitudes of 122 physicians within the Texas Medical Center in Houston toward overweight patients. Physicians reported that “seeing patients was a greater waste of their time the heavier that they were, they would like their jobs less as their patients increased in size, and they felt less patience the heavier the patient was.” ⁶ R.M. Vaughan's physician did not seem to have the patience to analyze his medical issue. ² As soon as the physician saw Vaughan's stomach, he dismissed Vaughan's condition as just another symptom of being overweight. Vaughan did not see another physician for more than a decade. When doctors stop seeing patients, patients stop seeing doctors.

In a study in the journal Obesity Research, 50% of a group of 620 physicians who participated in a questionnaire described fat patients as “awkward, unattractive, ugly, and noncompliant.” ⁷ It is these negative attitudes that perpetuate the weight discrimination that the same physicians likely impose on their overweight patients.

Alyssa McCord had an experience similar to Vaughan's. When she visited her family physician to discuss consistently heavy menstruation and fatigue, her doctor told her that her stomach was cramping because she is fat. Instead of ordering the usual tests (blood work, abdominal ultrasound, etc.) physicians order in such situations, he told her that the pain would disappear if she lost weight. She later learned from a different physician that her cramps and heavy bleeding were caused by an enlarged uterus and the fatigue was caused by anemia resulting from the excessive blood loss. ⁸

Though it is difficult to gauge the pervasiveness of weight discrimination in medicine, nearly all overweight people share similar stories: disbelief of normal blood pressure or absence of diabetes, ill-fitting gowns and blood pressure cuffs, cringes from medical staff when they step on the scale, negative comments about their weight, or, like Vaughan and McCord, blaming any and all symptoms on their weight.

As previously mentioned, Gordon is another overweight individual who went almost a decade without medical care after experiencing weight discrimination. A few years after her last appointment, Gordon began to ponder a disturbing question: Was her experience of weight discrimination all in her head? She began her own research to answer this question, and the countless stories she found offered a crushing sense of validation.

These stories are so prevalent that it makes weight discrimination in medicine a challenging issue to explore in a narrative medical context because all of the accounts are essentially the same: the patient is reduced to their weight and treated as a subhuman, so they either do not return to medicine for a long time, if at all, or they miss life-saving or improving treatment due to misdiagnosis. There has yet to surface an account in which a patient who experienced weight discrimination boasted about their doctor's success in diagnosing and treating them.

Although federal legislation that prohibits discrimination upon the basis of race, gender, and age has been in effect in the United States for more than 40 years, there is no such legislation that legally protects overweight individuals from discrimination. Michigan is the only state that currently has legislation preventing weight discrimination. Thus, overweight patients have few avenues for recourse when they experience this weight discrimination. ⁹

Healthcare is willfully ill-equipped to treat overweight patients

Sarah Bramblette's doctor instructed her to lose weight by limiting her caloric intake to 1200 calories a day, even though the physician could not answer her simple question beforehand—how much does she weigh? ¹⁰

The scale at the doctor's office only measured up to 350 lbs, but Bramblette's weight exceeded that. The inability to answer the baseline question of her weight leads to additional concerns; for one, how would they be able to tell if the weight-loss treatment was working if they could not measure her weight? This seems like a situation of putting the cart before the horse. Perhaps they recognized this as well, so the physician proposed a humiliating solution: Sarah was to drive to a nearby junkyard that could weigh her. She weighed 502 lbs.

If an overweight patient finds a physician who is able to see past their fat, the next step in diagnosis is often a scan (computed tomography (CT), magnetic resonance imaging (MRI), etc.). However, heavily overweight patients cannot fit in such a scanner that typically has a weight limit of around 350 to 400 lbs. Although scanners are manufactured which can hold patients weighing more than this limit, at least 90% of emergency rooms across the country do not invest in them. ¹¹ When hers was one such hospital without an appropriate scanner, one patient was sent by her doctor to the zoo to receive a scan. She was so humiliated, she has not spoken publicly about it since. ¹⁰

Laura Baker, retired special education teacher, was 18 months into her diagnosis with brain cancer when she began to experience some concerning symptoms. She needed to receive a CT scan of her brain, but her hospital's scanner could not accommodate her frame. She posted on Facebook requesting help to raise money for a portable CT scanner and wrote that the experience was “frustrating” and “humiliating.” She died 9 months later. Though it is unknown whether the CT scan could have led to life-prolonging treatment, it is yet another example of healthcare's failure to be equipped to medically diagnose and treat overweight patients. ¹²

There are many facets of healthcare's unpreparedness to treat overweight patients. Though it can be scales or MRI machines that are not built to hold enough weight, it also includes surgeons who categorically refuse to provide hip and knee replacements for overweight patients.

Sometimes it is as simple as not calibrating a drug dose to account for a patient's weight. According to Dr Clifford Hudis, chief executive officer of the American Society of Clinical Oncology, the trend in obese patients with cancer experiencing poorer outcomes than nonoverweight patients with cancer is almost certainly due in part to compromised medical care. Drug doses are often based on decades-old data indicating standard surface areas of bodies from a time when the average body was thinner. ¹⁰ This could lead to the underdosing of overweight patients receiving drugs not only for cancer treatment, but for other drug treatments as well.

One might express concern that this seems to be more of an issue of odds than one of justice. It would, indeed, be reasonable for a hospital to invest less into equipment and treatment for overweight individuals if that equipment would likely only be used in rare instances. However, obese individuals are not a rarity in the population, and it is unjust to presume that they would not need assessment and treatment like any nonoverweight individual. In fact, 42.4% of the US population is obese (139.7 million individuals), and 9.2% of the population is severely obese (30.3 million). ¹³ Given the large percentage of obese individuals in the population, medical centers seem to be willfully ill-equipped to treat overweight patients. It is unsettling that this is still in question after over two decades of obesity labeled as an epidemic. Are we going to acknowledge obese individuals exist in epidemic proportions, yet still deem them marginal and undeserving of basic medical treatment?

Negative attitude toward overweight patients perpetuated in medical training

In a national sample of 4732 first-year medical students, 74% of the students exhibited implicit weight bias, and 67% of them exhibited explicit weight bias. Explicit attitudes were more negative toward obese individuals than toward racial minorities, gays, lesbians, and impoverished people. ¹⁴ In effect, medical students seem to enter medical school with preconceived biases against overweight individuals.

In an effort to determine whether medical school affects weight biases, Adeline Goss et al. explored the relationship between a gross anatomy course and medical students’ attitudes toward weight and obesity. Of 319 students, 22% responded that the course changed how they felt about individuals who are overweight. Qualitative analysis revealed three overarching themes in the students’ descriptions of bodies which were perceived to have excess weight in the gross anatomy lab: (1) difficult, (2) unhealthy, and (3) evoking disgust. Students who extrapolated from their experience with cadavers imagined interactions with future patients, relying heavily on the narrative that an overweight patient is a difficult patient. ¹⁵

This narrative is not a new one in medical training. Isabelle Lomax-Sawyers claims to have always been aware of her fatness, but even more so now that she is in medical school. During the weeks they practice physical examinations by palpating each other's bodies, she feels glad that her colleagues get to practice examining diverse body types, but also as if her body type is a “huge inconvenience.” Lomax-Sawyers acknowledges that it is already difficult to learn how to recognize bodily structures by touch, but she adds a layer of fatty tissue to try to feel those structures through. “I hope I don’t get a really obese patient,” one of her colleagues told her with a chuckle. ¹⁶

Assumptions exacerbate negative attitudes toward overweight patients

Several assumptions are commonly made about the health consequences of being overweight. While it is necessary to consider any health concerns relating to an individual's wellbeing, assumptions made without data to support them can prove to be detrimental, as it has in the case of weight discrimination in medicine. Linda Bacon and Lucy Aphramor addressed these assumptions in their paper challenging the conventional, weight-focused paradigm in weight science. ¹⁷

It is vital to include their findings in this paper because the negative assumptions made about health consequences of obesity serve to exacerbate the pervasive negative attitude toward overweight patients, which ultimately generates bad medicine—that is, medicine based on inaccurate “junk” science.

Adiposity significantly increases mortality risk. This is perhaps the most common misconception associated with health consequences of being overweight. In fact, body mass index (BMI) only weakly predicts an individual's longevity in statistical extremes. Many studies have found that individuals who are overweight typically live just as long as individuals of normal weight. ¹⁸

Significance of weight discrimination on the individual level

It initially seemed melodramatic to declare that weight discrimination constitutes a matter of life-or-death, but minimal research into the issue proves how clearly it does. Rebecca Hiles spent years being dismissed by doctors who told her that her persistent cough and walking pneumonia were due to her weight before she was correctly diagnosed with cancer. ³⁴

Amanda Lee was experiencing intense stomach pain that prevented her from eating to the point that she lost a significant amount of weight. When she told her doctor that even eating applesauce left her in physical pain, her doctor suggested that her inability to eat was a “blessing.” She found a new provider who immediately ordered a colonoscopy, through which it was discovered that Lee had stage 3 cancer. ³⁵

In Ellen Maud Bennett's case, she attempted to receive medical care for years before a physician could see past her weight and diagnose her with cancer. It was far too late for her, and she died within days of her diagnosis. A final message Ellen shared in her own obituary was her dying wish that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue. ⁴

The dangers and consequences seen in these cases are obvious, but there are others that may not be so apparent. In the cases mentioned earlier in this paper (Gordon, Vaughan, and Johnson), patients stopped going to physicians altogether, sometimes for more than a decade. The humiliating experience of weight discrimination in medicine often leads people to avoid seeking medical care, even for life-threatening medical issues. The smaller medical ailments that go undiagnosed and untreated over that time can worsen until they become severe, as well. Once again, it could be the difference of discovering cancer in its earlier stages as compared to stage 4, when it has metastasized.

Significance of weight discrimination on the public health level

It is first necessary to understand that those seeking medical care are vulnerable emotionally, physically, spiritually, and often financially. Compounding that vulnerability is an imbalance of authority and knowledge and the importance of health to the patient seeking care. ³⁶ Overweight patients are uniquely vulnerable because they are routinely subject to weight discrimination in the healthcare environment.

Second, to pursue effective care, a patient must trust the physician with their body and their private information. It is inherently difficult to trust a physician with one's body when an overweight patient is so often made to feel by the physician as if they cannot be trusted with their own body. If an overweight person's practices are healthy, those are invalidated by their body. If their practices are not healthy, those are proof that the person deserves to be overweight. In any case, the overweight person is not given the opportunity to be heard or believed, and trust cannot be achieved.

There is also a loss on a more medical side of trust which stems from the previously discussed misconceptions about overweight patients. That so many physicians practice bad medicine based on inaccurate science is detrimental to the trust patients given to physicians. Who would want to visit a physician who cannot be trusted to practice medicine based on up-to-date, accurate science?

In general, trust in healthcare has declined over the past half-century. In a 1966 survey of adults in the United States, 73% said they had great confidence in the leaders of the medical profession. However, in a 2012 survey, only 34% said this. ³⁷ Though there is no data collected to corroborate the assumption, it is not unrealistic to assume that overweight patients are even less inclined to trust physicians. Without that trust, there is not a foundation upon which many patients would feel comfortable enough to share private information with the physician. Though this certainly affects the individual patient's quality of healthcare, it could also entail serious implications for public health and safety.

If patients do not feel comfortable telling their doctors private information, what does that mean for public health events such as the HIV epidemic or the COVID-19 pandemic? Public safety protocols such as contact tracing are built upon the basis of trusting one's physician or healthcare system enough to report the identities of individuals with whom the patient may have come into contact.

Contact tracing has shown to be effective at getting more people to test for HIV and detecting undiagnosed HIV cases. A study found that 63% of notified partners got tested for HIV, and an average of 20% of those tested were positive for HIV. ³⁸ Without some level of trust, those individuals might not have been reported and could have remained undiagnosed until much later, if diagnosed at all.

A lack of trust could proliferate into much larger issues in public health events in which there is an amplified need for trust in healthcare and its physicians. Because of the widespread negative impacts of pervasive weight discrimination in medicine, this trust is being undermined. Physicians should act in such a way to foster and maintain the public's trust in their expertise, rather than continuing to dismantle it.

Significance of narrative medicine in addressing weight discrimination

Due to the danger it poses for health and its promotion of weight discrimination, particularly in medicine, health interventions must cease to be weight focused. The continuation of the weight-focused paradigm will only exacerbate uninformed, negative attitudes toward overweight individuals, as well as the practice of bad medicine. Narrative medicine could be a powerful force in shifting from a weight-focused paradigm to one in which health behaviors are promoted for all patients, regardless of weight.

There are multiple branches of ethics that integrate human experience into the study and practice of ethics (e.g. ethics of care, personalist ethics, and narrative ethics). The value of human experience in the improvement of addressing ethical issues—in this case, weight discrimination in medicine—has been established many times over. However, the current lived experience of overweight individuals and the discourse about such might point to the notion that we have failed to fully integrate this human experience and further work is needed in order to do so. The idea is that narrative medicine will get us closer to ethical practices such as these which emphasize human experience. Doing so will likely improve the diagnosis and treatment of overweight individuals, as well as the experience of all involved in these patient interactions.

As shown through the anecdotal evidence up to this point, many healthcare practitioners do not actively listen or effectively communicate with overweight patients. Narrative medicine provides a means for patients to express themselves openly. In discriminatory environments, a patient is not encouraged to communicate in this way, let alone encouraged to provide honest feedback about their experience and the direction of their care. For example, Gordon, whose narrative medicine accounts we explored above, recounted that she “expected to discuss [her] weight with [her] doctor in certain situations, but [she] faced a monologue instead. Regardless of the condition that brought [her] to the office, the response to every question was the same: ‘Just lose some weight.’” ¹ Gordon's case is a clear example of an overweight patient who was not allowed the opportunity to be an active participant in their own healthcare. Again, she did not see a physician for over 8 years after experiencing this discrimination. Gordon did begin to write, however. She describes the transformative practice as follows:

“I started revisiting experiences I’d long since blocked out, too absurd to address in the moment, and too frightening and painful to remember now. […] As I wrote, my perception of the life I’d lived began to shift. I had long thought of myself as living a charmed life […]. But that perception was contingent on continuing to ignore experiences that were the direct result of anti-fat bias. These were experiences that I had excused at the time, passively accepting them as a natural consequence of daring to live in a body that was so inexcusably fat. But the more I wrote, the more I realized that I had spent a lifetime haunted by a Greek chorus of strangers, eagerly foretelling my death, proudly insisting upon what they saw as my inevitable future illness. […] Only through the project of writing about these experiences could I peek behind the curtain, and see all that bluster and force for what it was: a desperate attempt to contain bodies that look like mine, and a sad and limiting insistence that people my size and larger simply don’t deserve to be seen, to be loved, to be respected, or even to be left alone.” ³⁹

Overweight patients know all too well the surreal feeling that pervades the experience of weight discrimination in healthcare, and it is not one that often affords response in the moment. Narrative medicine is a form of communication wherein the pain and fear wrought by discrimination can be expressed without the pressures of that same discriminatory environment on the patient. Of course, writing after the incident does not change its occurrence, but as evidenced by Gordon, it can be a valuable tool to reflect and heal from the experience. Only through writing about her experiences of weight discrimination in medicine was Gordon able to face the injustice she suffered and begin to address it.

As stated above, the idea of the narrative approach to ethical issues in medicine is not a new one. In Stories Matter, Charon and Montello provide a series of essays supporting the use of narrative in medical ethics. ⁴⁰ They write that “at the center of each case described in these chapters lies the recognition that serious illness raises the veil in the lives of those involved.” They recognize that serious illness is often accompanied by immeasurable changes for patients and their families, and “narrative methods are uniquely capable of capturing, rendering, and conveying what these times are like for people for whom the veil has been lifted.” Narrative medicine allows for patients to better express their stories and physicians to understand it in a way they otherwise might not be able to.

Charon and Montello assert that a particular medical case only comes into being through the narration of it and that the physician's duties are borne of listening to that narrative. The narrative is then retold in many forms through physicians’ notes, patient charts, rounds, to ethics committees, etc. Physicians are typically taught to recount the narrative in a clinical, nonpersonal style. Suzanne Poirier, author in Stories Matter, writes that “when people with different values or moral beliefs are among the many tellers and retellers […], this prescribed voice is not equipped to accommodate the ethical or emotional complexity that follows.” ⁴¹ Utilizing the narrative approach would provide an avenue for accommodating such complexity.

Writing about weight discrimination in medicine could also serve as prevention. Like the anecdotes shared throughout this paper have hopefully inspired empathy in readers, these accounts will conceivably strengthen physicians’ empathy for the overweight patients with whom they communicate and encourage self-reflection for them as well. This greater understanding would foster a more empathetic, collaborative physician–patient interaction and lessen the likelihood of weight discrimination in the first place. Discussed in the following section, narrative medicine can indeed lead to improved attitudes toward overweight individuals across a variety of contexts, as well as promote useful narrative and communication skills for developing healthcare professionals.

Moreover, narrative as a form of ethical strategy is prone to receiving less credibility than other forms of ethical studies and communications. This is deeply concerning, as this means that we regularly misattribute credibility to the very accounts that we aim to address—in other words, we commit epistemic injustice. In particular, hermeneutical marginalization is defined by Rachel McKinnon as a form of epistemic injustice wherein a “socially disadvantaged group is blocked—whether intentionally or unintentionally—from access to knowledge, or access to communicating knowledge […] due to a gap in hermeneutical resources, especially when these resources would help people understand the very existence and nature of the marginalization.” ⁴² This can be applied in the context of narrative medicine and weight discrimination in multiple aspects.

First, the accounts shared by overweight patients are often not given credibility. I do not mean to say that we do not believe these individuals when they share their experiences; rather, the issue is that these accounts are not given enough consideration within the academic and literary fields as compared to other forms of ethical argument. This is evident through the fraction of experiences shared by overweight patients in this paper alone. Working to better incorporate narrative as a credible, valued form of ethical argument could get us closer to understanding and addressing the lived experiences of overweight individuals in medicine.

Additionally, narrative bridges the gap between academic study of morality and everyday experience, and this comes with multiple benefits. The first is that is gives us a better understanding of how to apply concepts of morality to our own and others’ experiences. For example, it might be useful to define and discuss a particular ethical approach, but it would ultimately amount to little if it were impossible to apply to our experiences and actions. The second benefit is the better understanding that we get as individuals who may not share the same experiences. It would be hard to believe that the best way to address any issue is one in which the individual has an incomplete understanding of the experiences of those affected by the issue. Finally, as McKinnon noted, it increases our understanding of the nature of the marginalization itself. This is valuable not only for individuals trying to understand marginalization, but for those who experience it. The average person may not be trained or practiced in reading academic papers or ethical studies, but they are likely able to comprehend narrative. This breaks down barriers to understanding marginalization.

Within medical training and healthcare settings

Healthcare professionals and students must be educated about what weight bias and discrimination are, how it affects their patients and colleagues, and how it is perpetuated both overtly and subtly. Education could explore the research regarding shortcomings of BMI as an indicator of health, as well as the different roles of obesity as a symptom and underlying causes. More knowledgeable and compassionate physicians could create a more accepting environment built upon empathy and respect. Moreover, focusing on wellbeing and healthy behaviors instead of weight loss will provide more effective and accurate healthcare, as well as work toward re-establishing trust between overweight patients and physicians on the basis of sound medical practice and an inclusive, safe environment.

Ethics education has been shown to have the potential to improve medical students’ attitudes toward obese patients. At the beginning of a study:

70% of students reported a thin preference, 18% were neutral, and 12% reported a fat preference,

Narrative medicine could also prove useful in medical training. Because they would be exposed to similar accounts to those portrayed by “House” and their own struggles mentioned above, students’ attitudes toward overweight patients could be improved by the inclusion of narrative medicine in medical training curricula. Additionally, the creativity and writing skills developed by participating in narrative medicine would have multiple benefits for students. This would strengthen their own communication skills, which leads to better expressive habits that are crucial to practicing medicine in a nondiscriminatory way.

Though more studies are needed to determine long-term effects of narrative medicine training and intervention for medical students, Milota et al. ⁴⁴ found in a systematic review that narrative medicine is an effective tool with a measurable impact on attitudes, knowledge, and skills.

Chretien et al. ⁴⁵ conducted an assessment within a narrative medicine course for third-year medical students in which students interviewed patients, translated the interviews into narrative format, then returned the narratives to the patient. Postcourse interviews and focus groups reported that students found that the exercise helped them develop an understanding of a patient as more than simply a disease, enabling them to slow down and listen to their patients. The students also reported that it was clear that patient stories improve patient care.

In their study, DasGupta and Charon conducted reflective writing exercises (featuring the same process as narrative medicine) in which students wrote about their own personal illness experiences. ⁴⁶ DasGupta and Charon assert that such reflective writing develops self-awareness that is key to being able to “witness, interpret, and translate their own and each others’ experiences to gain a better understanding of themselves as practitioners, and, in turn, of their patients” and “more fully enter the reality of the patient world.” Participants of the study indeed reported that they felt their improved self-awareness and reflection on personal illness experiences connected them more closely with their patients’ experiences.

Faculty seem to benefit from the use of narrative medicine training as well. Utilizing pre-training and post-training surveys, Bhavaraju and Miller found that faculty showed increased confidence in writing and leading writing and literature exercises. ⁴⁷ Participating faculty also reported integrating narrative medicine tools in their curricula.

Similarly, Balmer and Richards analyzed a narrative medicine training program for faculty and participants reported “professional growth (learning teaching strategies, applying these strategies to multiple courses), personal growth (perspective taking), and collective and communal support (seeing the ‘other,’ affiliation, and a sense of rich connectedness).” ⁴⁸

It would be negligent to omit that narrative medicine is for healthcare professionals to communicate with each other and general society as well. It provides them with a valuable outlet to communicate their experiences and the impact they have had on their understanding of medicine, as well as the issues they recognize and want to address in healthcare. It is a platform for communicating to other physicians and across disciplines. Utilizing narrative medicine would be beneficial for all individuals involved in healthcare.

Within public policy

Public health messaging must cease the usage of shame tactics to place blame on overweight individuals in its attempt to promote public health. ⁹ For instance, headlines during recent years attributed some blame for rising fuel prices and global warming to obese people.^49,50 When these messages include elements of fat-shaming, it is not only perpetuating stigmatization—overweight individuals already engage in self-blame and feel shame about their size—but this normalization of stigma also condones harmful weight discrimination, regardless of the intentions of the messaging.

Public health efforts do not need to introduce weight into the equation at all. Rather, they should be focused on promoting the health and wellbeing of all individuals, regardless of weight. This shift in messaging can easily be accomplished by encouraging healthy habits and well-rounded nourishment for any individual.

As previously stated, there is no federal legislation protecting overweight individuals from discrimination upon the basis of their weight. Only in extreme circumstances can individuals with exceptionally high BMI pursue legal protection under the Americans with Disabilities Act (ADA). There must be federal legislation including overweight individuals in order to protect them from weight discrimination in any environment. ⁹

Legislation prohibiting weight discrimination could provide a greater deterrence for the behavior in medical practice. Thus, it could act as a preventive measure, though its efficacy as a preventative measure would be admittedly limited. The prevalence of discrimination against those living with disabilities despite the ADA exhibits this limitation. ⁵¹ More importantly, federal legislation would provide an avenue for legal recourse for overweight individuals who do experience weight discrimination.

Within general society

Individuals in positions of influence can be pivotal in shifting societal attitudes toward overweight individuals. ⁹ This can occur either by the individual acting as a positive role model in their attitude toward obesity or by the individual facing negative consequences when they discriminate against overweight individuals.

Tomiyama et al. believe that healthcare providers might be the ideal candidates to flag such demeaning behavior due to the higher social status conferred by their profession. Though that does seem like an appropriate choice, it has been well established that healthcare providers have their own biases to address, and only after doing so can they be effective advocates for overweight individuals.

Weight discrimination can certainly be overt, but it often appears as subtle nuances in daily behaviors. Though the person discriminating may not realize the effects of their actions, it is often realized by overweight individuals who are being demeaned in the process. For instance, a physician may hold eye contact or try to chat with a thinner patient but may not do the same with an overweight patient. These seemingly minor daily behaviors culminate to inflict harm in healthcare practices.

Educating people in general about weight stigma and discrimination, the overt and subtle ways in which it presents, and the struggles overweight individuals face could improve behavior toward overweight individuals. This could occur through public service messaging, ethics sessions, social media campaigns, etc.