Dear Doctor, Pediatrician, Gastroenterologist, Cardiologist, or OBGYN,

The time is now. Your patient in a larger body size is sitting across from you. She/He/They appeared in your office with a variety of concerns, none of which happen to be about their BMI.

Before you do anything—STOP. Reconsider that probing question about their weight. Why? Because you took an oath to do no harm. And, simply put, the fatphobia that you are about to display does not comply with that oath.

Listen, I know that what I am saying may sound radical. I understand that the medical model by which you received all of your training focused heavily on the “obesity epidemic.” In fact, I do not blame you for your hyper-focus on weight. I believe that you truly believe that you are upholding the oath to do no harm when you are suggesting weight loss to your patients.

I also know that society has your back—by that I mean, we are existing in a society that demonizes folks in larger bodies. We are utterly obsessed with weight loss, and have lost ourselves to a defective binary of blanket “right” and “wrong” foods. Hence part of your inclination to comment on weight is due to your training, and is due in part to our society at large. Again, there is no blame here. Just a plea for you to listen closely.

Here’s the thing: the medical focus on the “obesity epidemic” is deeply flawed. All you will need to do to shed light on this is ask yourself, “When is the last time that I recommended weight loss to a patient, and it worked?” The next step would be to ask yourself, “When is the last time that I made an error and missed my patient’s true medical issue due to my focus on his/her/their weight?”

So, have you thought deeply about this? If so, if you are being truly honest with yourself? I am guessing that you will have very few instances of “successful” dieting and weight loss among your patients. You will also likely be able to call to mind a recent incident in which you may have missed the mark due to a person’s higher BMI. I am arguing that the reason for this is three-fold: 1) “Healthy bodies” come in far more shapes and sizes than the medical model accounts for (assuming the medical model uses the dated system of BMI which, last time I checked it still does), 2) Weight is much less-correlated with health status than medicine suggests, and 3) Dieting does not produce weight loss for 95% of people.

SO, back to the patient sitting in front of you. With all of that being said, I am asking you to consider a few key questions:

• How would you treat their ailments if they were in a thin body? Would you ignore the pain in their knee, their upper respiratory infection, or their complaints of infertility if they were thin? Would your blanket response be to suggest a dietary change in reference to all of these ailments? OR would you listen to their symptoms, ask probing questions about their trajectories, and create a thoughtful and informed hypothesis for what may be going on? This thoughtful and informed hypothesis is what the patient sitting across from you deserves, regardless of body size.

• How may your focus on their weight harm the person in the future? Many folks in larger bodies fear doctor visits, and this fear is not unfounded. Most have had repeated experiences of doctors ignoring their concerns, commenting disparagingly about their weight, or flat out refusing a treatment due to their weight. These occurrences ultimately lead people to defer doctor visits. This means putting off getting help, which tends to lead to worsened long-term medical problems. Chances are your patient is already wary of potential mistreatment. They are likely bracing themselves for a belittling comment or two. So please save the wrinkled brow and sigh of concern as you look at the paperwork. Chances are, they are already aware of their weight, doc. Don’t be a contributing factor to their continued mistrust of the medical professional—it is this mistrust that may ultimately lead them to sadly forgo help in the future and hence suffer.

• Is there a potential for weight-loss suggestions to result in a deadly eating disorder? Short answer—yes. As a psychologist who specializes in eating disorder treatment, I cannot tell you the number of patients that I have that name a doctor’s warning about their weight as a key contributing factor to the development of their eating disorder. We cannot know ahead of time if someone has the vulnerability to developing an eating disorder. What we do know is that dieting is hugely correlated with the development of most eating disorders. Once a person begins a restrictive, regimented diet, there is the potential for an eating disorder to develop. Does the patient sitting across from you have the genetic predisposition for an eating disorder? Do they have a history of an eating disorder? You will likely not know, because the majority of your forms don’t pull for this information. So instead of recommending weight loss, why not focus on whatever ailment they came to you for?

So, doctor, that patient sitting across from you? Please think long and hard about the questions that I posed before you comment on weight. Open your mind to the idea that the medical profession’s hyper-focus on weight may not be helpful or even founded in sound theory. Consider that there is a much larger range of “healthy” weight than we, as a society, embrace. And furthermore, consider that every human has the right to dignity and respect regardless of size OR health status. Finally, think about how impactful your next steps and comments will be.  They have come to you for help. Go forth, toss out any BMI chatter, and do what you do best!

Sincerely,

A body liberation advocate and ally