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When you work pretty exclusively with plus-sized women, like I do, you hear some harrowing tales of stigma.

To be honest, though, the most horrifying and enraging stories I hear often take place in a doctor’s office.

I’ve noticed that many of my twenty-something clients were told at some point in their lives by some white-coated medical professional that they’d never reach the age of twenty-five or thirty. It seems like the majority of my clients, regardless of age, have been told things like, “Your fat is killing you” and/or “If you don’t lose ___ number of pounds, you WILL get diabetes, heart disease, etc.”

Not only are these statements patently false, but there’s a major argument to be made that the statements themselves are dangerous.

First, Do No Harm? Antifat Bias Is Not Just Anecdotal
Scratch the surface of Internet fat blogs and you will find hundreds and hundreds of accounts of mistreatment and misdiagnosis of fat people by doctors. What you’ll notice from these stories is that the patients’ fat gets the blame for a host of symptoms and diagnoses.

There are many problems with this reality, but one of the main ones is that when the diagnosis is obesity, then the recommended cure is weight loss. Since weight loss itself fails at least 95% of the time, has no permanent health benefits, has its own negative effects, and often has nothing to do with the patient’s problem itself, fat patients are struggling to get the care they need.

All of this would be bad enough in a stigma-free situation, but the doctor-fat-patient relationship is rarely stigma-free. Study after study has shown that doctors and other health professionals tend to view fat patients negatively, commonly believing that they’re lazy, indulgent, and non-compliant solely on the basis of their weight. These beliefs about fat patients affect the exam and diagnosis process. More than two-thirds of fat patients report being stigmatized by a doctor because of their weight. As a result, fatter patients delay preventative screenings and doctors’ visits due to the negative treatment they receive.

The Dangerous Health Effects Of Stigma

It’s scary to think about the misdiagnoses and ill treatment that results from the stigmatization of fat patients, but what about the dangers of stigma itself?

More and more research is showing that the shame and stress of stigma has serious deleterious effects. Researchers have found that the pain of fat stigma is leading to higher incidents of depression, anxiety, and low self esteem among fat people. Perhaps even more important from a public health perspective, there is evidence that many of the diseases that get correlated with obesity (like type 2 diabetes and hypertension) may be correlated with obesity because of the stigma of being fat, not because of the fat itself. In other words, fat isn’t causing your friend’s diabetes, though the stress of the stigma of being fat may be.

Despite this growing evidence, doctors, public health officials, and many, many laypeople continue to promote the “shame is healthy and will make you skinny!” paradigm. Fat and the fear of fat is used to promote everything from drinking less soda to getting kids to be more active. Those aren’t necessarily bad goals, but drinking a lot of soda and not getting much activity isn’t just an issue for fat people. Couching these issues in those terms vilifies fat people as being dangerous to the community, and allows not fat people to assume that all fat people have bad habits.

In terms of public health, we have to ask ourselves if this messaging is helpful or harmful, considering that a large portion of the public is fat, and considering that mental health is an important aspect of health. Is it healthful to demonize a vast segment of the populace based on how they look? I would contend that it isn’t. Unfortunately, this sort of messaging feeds into the ongoing shaming of fat people in the medical environment and elsewhere.

What About The Nocebo Effect In Particular?
Fat activist Marilyn Wann, has been talking about the nocebo effect in relation to fat health for years, but for some reason it finally crystallized for me this month when I was reading Lissa Rankin’s book, Mind Over Medicine. A nocebo is an inherently harmless substance or thing that creates a harmful effect.

Dr. Rankin notes a number of studies where an otherwise harmless placebo created a negative response in a patient when a legitimate medical professional told the patient that the placebo would induce a negative effect. She mentions studies where people thought they were getting chemo but weren’t, and 30% lost their hair. A group of patients were told that a sugar-water solution would make them throw up, and 80% vomited. Three quarters of patients in one study who received an antihistamine placebo got very drowsy from the placebo. Another study examined asthmatics who inhaled a harmless saline solution that they were told contained allergens. The patients felt short of breath, wheezed, and experienced actual bronchoconstriction.

In other words, the power of suggestion is, well, powerful.

So I wonder, what are doctors, medical professionals, the media, and public health officials doing when they tell fat people things like, “You’re fat, so you’re going to get diabetes/have a heart attack/die at age ___?” Aside from the fact that they’re often wrong, aside from the fact that (newsflash) thin people get sick and die too, what sort of influence are they having in creating disease? How dangerous are these words, especially when coupled with the legitimacy of a white lab coat?

Next Steps
I would love to direct this section toward the actually dangerous purveyors of the nocebo effect. Unfortunately, I’ve been writing about these issues for over five years and have little hope that anything I say will have an effect on the medical or media establishment. All I can say is that it’s important to look at your biases and make sure you’re not creating disease and reinforcing shame.

So I’m directing this toward my fellow fatties. I hate to put more pressure on you, but I know you’re used to it. I just ask that you take the medical “truths” that you hear with a big grain of salt, especially if a diagnosis is based on little more than “your obesity.” If a doctor tells you your fat is killing you, do your best to get another doctor. If the news has a report on why your fat is killing you, it is completely safe to ignore it. Your fat is not killing you. A diet or bariatric surgery is not going to save you.

And as best you can, don’t swallow the nocebo!

Golda is a certified holistic health counselor and founder of Body Love Wellness, a program designed for plus-sized women who are fed up with dieting and want support to stop obsessing about food and weight. To learn more about Golda and her work, click here.