Hi, I'm in medical school and I'm doing my best to understand thin privilege and not commit hurtful errors. My view is that any weight can be healthy as long as one eats well and does the exercise one can. I remind everyone to eat well and exercise, not just those with a high BMI (which I acknowledge is a bullshit scale). Is there a sensitive way to recommend healthy habits to a fat person--the same tips I'd give anyone--without making them feel that it's about their weight? Thanks

Asked by

titpquestion-blog

Thanks for the great question. My suggestions:

1. Don’t assume your fat patients eat ‘badly’ or don’t exercise because they’re fat. Maybe preface with, “I just wanted to let you know that I ask everyone this, it’s part of what I believe is the best way to approach preventative care for every person.” Then ask them about their eating/exercising habits.

2. Don’t assume everyone can eat or exercise the way you want them to, even if they’re otherwise able-bodied. Some people might not want to go to the gym (or can afford it). Fat people in particular often have had bad experiences with being verbally or otherwise abused when exercising in public, even walking up and down their street. Also, please don’t encourage them to join gyms that cater to fat people unless you research them first, as the vast majority of these places are centered around weight loss as a goal.

3. The vast majority of fat people have been on diets before, and many have had eating disorders. So please be careful about what you assume about their background and knowledge of nutrition — it’s likely they have been on restrictive diets multiple times. Maybe ask them about how *they* would like to change their diets for the better, and then encourage them if the changes are reasonable (I’m assuming you’ve taken at least a couple nutrition courses and would have an idea for what this would be). If they have complicated issues with eating that you don’t think you can tackle, ask if they want to be referred to a nutritionist, and preface that you offer this option for all your patients (they’ll understand what you mean by this is both your thin and fat patients).

4. I assume you’re familiar with Linda Bacon’s “Health at Every Size” and related articles/research? If not, she has much more practical advice about how to frame preventative wellness for fat patients in a way that doesn’t stigmatize their weights or necessarily suggest they become thinner than I could ever give you here.

In summary, I think talking to fat patients respectfully is a matter of empathy and framing. Following blogs like this one is a good start, because we present a lot of firsthand accounts of fat people that prove they have the same kind of lifestyles as thin people, and want good health care just like anyone else, and care about their wellbeing just like anyone else.

I would also suggested following Michelle’s Fat Nutritionist blog, reading through the ASDAH Resources, reading up on the Well Rounded Mama for your pregnant patients, and reading through the archives of Junkfood Science.

-ArteToLife