When Weight Bias Delays a Diagnosis, Here’s How Black Patients Can Self-Advocate

According to the U.S. Centers for Disease Control and Prevention (CDC), 72.4 percent of Americans who were 20 and older were considered to be overweight or obese as of August 2023. While medical professionals generally note that this issue requires a multifaceted approach, a new problem has emerged. People who are having trouble managing their weight can also experience stigma that leads to healthcare disparities. Not only can this affect how well their weight-related health issues are handled, but it can also delay the diagnosis of other illnesses. How can you handle a situation where you really need a doctor to listen to you?

How Obesity Stigma Can Affect Healthcare

According to a 2023 review of literature on how obesity is perceived, stigma related to the condition pervades media, entertainment, social media, the internet, advertising, news outlets, and the political and public health landscape. Although research has shown that weight gain can be caused by different factors–some of which are outside of an individual’s control–the perception that being overweight or obese is a personal failing persists. 

As a result, many people who are overweight face discrimination in many areas, including healthcare. The available information shows that obesity stigma in healthcare can contribute to poorer healthcare. Healthcare providers may have strong biases toward people who are living with obesity, believing that they are lazy, undisciplined, greedy, and have poor willpower. These beliefs can then influence how the providers respect, treat, and make decisions about someone’s health. 

According to the same review, some healthcare providers go as far as believing that people who are overweight are less likely to adhere to treatment protocols, attend follow-up visits, and follow a self-care routine. Most interestingly, these medical professionals may spend less time in consultations with patients who are overweight, attribute all symptoms to the patients’ weight, fail to consider alternative diagnoses, fail to discuss much-needed treatment options, and hesitate to conduct a clinical examination. 

RELATED: Weightism: Is Weight Bias Just As Harmful as Obesity?

How Obesity Stigma Can Affect Your Health

As you can imagine, medical professionals who are less likely to listen can leave you in distress. In fact, the review above noted that obesity stigma may be a strong contributor to the fact that people who are living with obesity are 32 percent more likely to develop depression. Being treated differently because of their weight can also lead to higher rates of obesity instead of decreasing them. In short, being rude to people who are overweight has no effect on them losing weight. Worse yet, there’s some evidence that people who experienced obesity stigma had a 60 percent higher mortality rate even when researchers accounted for common risk factors.

When seeking medical intervention, people with obesity have reported being mistreated, ignored, or denied care entirely. As a result, some of them don’t go to the doctor unless it’s unavoidable. If this happens, the impact on your health can be significant. Being overweight has been linked to multiple illnesses, such as:

• Type 2 diabetes
• High blood pressure
• Heart disease
• Stroke
• Metabolic syndrome
• Fatty liver diseases
• Some cancers such as colon, rectum, prostate, breast, uterine lining, and gallbladder
• Breathing problems such as asthma and sleep apnea
• Osteoarthritis
• Gout
• Diseases of the gallbladder and pancreas such as gallstones and pancreatitis
• Kidney disease
• Pregnancy problems such as gestational diabetes and preeclampsia 
• Fertility problems
• Sexual function problems such as erectile dysfunction
• Mental health problems such as depression, poor self-image, and long-term stress

As you manage your weight, it’s important to reduce your risk of developing other conditions and effectively manage any you’ve already been diagnosed with. 

Additionally, not getting proper healthcare may mean that doctors miss other issues that may be the source of your weight gain. Some factors that can lead to unexplained weight gain include:

• Taking certain medications that are used to treat epilepsy, depression, psychotic disorders, and high blood pressure, among other conditions. 
• Some endocrine diseases, such as polycystic ovary syndrome (PCOS), Cushing’s syndrome, and hypothyroidism. 
• Damage to your hypothalamus, a small area of your brain near the pituitary gland.
• Depression
• Long-term stress.

Finally, if your doctor isn’t examining you properly, they may miss conditions that have nothing to do with your weight. According to personal accounts, doctors who didn’t take patients’ symptoms seriously led to delayed diagnoses of scoliosis and a rare tumor in the lung.

How to Self-Advocate For Your Diagnosis

So, what should you do if your concerns are being dismissed? While some people have suggested different ways to fight obesity bias in healthcare–including advocacy at varying levels–, you have to practice self-advocacy now. Self-advocacy is defined as gaining and using knowledge in a way that lets you actively participate in health care decision-making.

The first step is learning about your symptoms or condition by talking with medical personnel, reading reputable websites, using library resources, attending support groups, or talking with others on patient forums. This information can then guide how you discuss your issues with your health provider and what you ask for when advocating for yourself. 

One way you can make the interaction easier is to call your provider’s office beforehand to discuss your preferences. For example, you can request not to be weighed or to have a body composition analysis instead of having decisions made based on your weight. It can also help to write your points down or bring self-advocacy cards for guidance. These cards can contain information about what you want to cover with your healthcare provider. 

Using what you’ve learned, talk to your doctor about your treatment options if you’re addressing weight management. This can include asking about evidence-based nutrition plans and guidance for physical activity, clinical monitoring, and accessible monitoring tools such as smartphone applications. 

When meeting your provider, though, you can’t ignore the importance of asking the right questions–especially if you’re concerned that your symptoms aren’t associated with your weight. While you don’t want to be rude, you should be firm in ensuring that your provider is providing the right level of care. 

Some questions you can ask are:

1. “Do those without obesity have this health problem? What would a doctor typically recommend for them?”
2. “Research shows that conventional weight management has a high failure rate, and many people who diet regain the weight. What are the alternatives that you would recommend specifically for me?”
3. “Is there clinical evidence that shows a majority of people succeeding at the amount of weight loss suggested?”
4. “How would you proceed if someone with a typical weight had my symptoms?”
5. “These symptoms have persisted despite lifestyle changes. What are your recommendations outside of weight loss?”

Of course, that’s not an exhaustive list. You should personalize them based on what you’re dealing with, so your provider can give you specific answers. If you’re not getting anywhere, though, it may be in your best interest to find another provider. Your health is too important to be left in the hands of people who won’t listen to you. 

People who are living with obesity still face stigma that affects their daily lives and how they can access healthcare. If your healthcare provider isn’t giving you the care you need, it’s good to practice self-advocacy. Doing this can lead to breakthroughs in weight management, finding the cause of weight gain, or diagnosing another condition. If it doesn’t help, consider finding a provider who isn’t still a prisoner to obesity stigma.