Are Doctors Insensitive/Ignorant To Body Image Issues Or Do We Expect Too Much?

Is it the responsibility of doctors to watch their words to avoid upsetting patients? Or is their job simply to identify and communicate “facts” truthfully?

I coach women who struggle with emotional eating and poor body image and I’ve recently been getting more client emails over weight-related drama at the doctor’s office.

Their doctors either told them their weight when they didn’t want to know; or told them that their BMI was on the “high side of healthy” (or something along those lines), in a way that was seemingly accusatory or construed to be insensitive.

What's unclear is whether or not this “news” was being delivered with an active tone of judgement and accusation, or if it just felt that way to the individual being told. (As I’ve also personally experienced, being told you’re overweight usually feels like someone punched you in the baby-maker, regardless of how it’s being delivered).

Nonetheless, this particular medical conversation is inherently touchy, and it seems in most cases, the issue could be handled with more care than is currently standard at the doctor’s office.

While some patients seem to think that their doctors are actively “fat-shaming” them, it seems to me that doctors are simply not thinking about the implications of what’s coming out of their mouths.

Doctors often tell patients “Your BMI’s a little high” -- or some version of you’re kinda fat -- like it’s no different than being Vitamin D deficient or having high blood pressure.

The thing is...hearing that you’re overweight, is a very different experience than hearing that you’re Vitamin D-deficient, or have high blood pressure. Discussion of weight is inherently sensitive, because of a whole slew of cultural messages, that have nothing to do with our physical health.

Shouldn’t that be pretty obvious? Particularly when dealing with young women? I mean...duh.

So why don’t doctors put in a little bit of extra effort in conversing about this one, hyper-sensitive and generally uncomfortable topic?

I consulted my doctor-friend-of-friend, cardiology fellow, Dr. Scott Greenberg, to get some clarity on why things are the way they are. It’s possible, after all, that I’m the one with unreasonable expectations.

The first thing I asked him, of course, was if there was any “sensitivity training” around body image issues in medical schools. And the answer, not surprisingly, was no, not really. (I was pretty sure of this answer before actually asking it, but thought it best to cover my bases).

When it comes to delivering any kind of “difficult news,” doctors mostly “learn that part on the job,” says Greenberg. (And for the record, “difficult news” could be anything from telling a young women they’re a little overweight, to something more dire, like telling someone they have six months to live).

Whether practitioners should or should not be formally trained in how to handle emotional situations is debatable. Is it the responsibility of doctors to watch their words to avoid upsetting patients? Or is their job simply to identify and communicate “facts” truthfully?

How much of a patient’s sensitivity to weight-related issues is “the patient’s problem” versus the doctor’s? (This question came up several times when I was discussing the topic casually with friends).

“Unfortunately, there’s not much more we can do than tell people to lose weight when needed...our responsibility is to identify problems and get the patient to an expert if we’re not trained to handle the specific issue at hand,” says Dr. Greenberg.

Additionally, how patient information is communicated is going to vary from one professional to the next. Some will be very sensitive to the emotional experience of patients, and some won’t, depending on both the personality type of the practitioner and their own personal experience.

Well, ideally, practitioners would make a point to learn more about their patients’ personal history with food, before making generally self-evident, non-helpful statements like “You need to lose weight.”

Why not start with “So how are your eating habits?” Or even “How is your body image?” (crazy question for a doctor, I know) just to get a sense of where that person stands on the topic.

Maybe that person’s been trying to lose weight for a really long-time, but struggles to maintain healthy eating habits for emotional reasons (my favorite topic). Or maybe that person eats incredibly well, but is dealing with some kind of hormonal or other medical issue that has nothing to do with their behavior. Or maybe that person is just fine, and the whole Body-Mass-Index thing is a horrible idea.

If doctors opened up the discussion by inquiring about behaviors and habits, before calling someone fat, they’d likely have more luck getting to the root of the issue.

Unfortunately, however, compliance with my request that all doctors handle their patients with this level of care is unlikely, if not a total pipe dream, so here’s my backup plan:

Patient Self-Advocacy.

For the most part, it seems we have to advocate for ourselves in medical settings where are bodies or relationship with food are being questioned.

For instance, I always ask to be weighed backward, and request not to be told any numbers. I preemptively request that the issue be handled with care, and let my doctors know it is sensitive issue for me.

Being honest with your doctor about your relationship with food and body is always the best policy...even if it feels a little embarrassing. That’s a doctor’s job: to listen to your embarrassing health concerns.

Usually, making a request is all you need to do; however, if you find yourself in a position where a clinician denies your request, or continuously makes you feel uncomfortable, that may mean it’s time to shop for another doctor.

On a secondary note, wouldn’t it be nice to “get to the place” where we don’t take our weight so personally? The place where we legitimately don’t care about the number on the scale any more than our cholesterol or Vitamin D levels? I imagine this is a goal for many of us, as difficult as it may sound with all the cultural “you’re-too-fat” noise we have to combat on a daily basis.

Nonetheless, it’s certainly a goal worth shooting for. In my mind there are few things less important than trying to “un-learn” the message of “you’re not good enough.”

I remember the first-time I forgot to tell a new doctor not to say my weight out loud and it didn’t bother me. The number, which I hadn’t looked at in many years, irked me for about 30 seconds, and then I let it go, sans judging myself to death or analyzing the doctor’s tone of voice. Woohoo!! Progress!!

If you’re interested in learning more about my road down the path of self-acceptance, check out my blog where I talk about overcoming the food and body wars in more depth. Hint: Negative Body Image goes hand-in-hand with Emotional / Binge-Eating.