Medical shaming is the term given to less than respectful treatment by health-care providers, often in an ill-fated attempt to motivate their patients to change their behavior. Most doctors, nurses and other health-care providers are probably guilty of it at some time.
People with chronic medical problems such as fibromyalgia, depression or substance abuse may experience it. But most commonly, it is related to being overweight — so called fat shaming.
Encouraging lifestyle changes may be the most important thing that a physician can do; two-thirds of Americans are overweight, the incidence of diabetes is increasing dramatically, and many of the complications that occur later in life can be decreased by making such a change. But, making someone feel bad about who and what they are is not helpful.
I was guilty of this several months ago when discussing the potential perils of the ketogenic diet with a patient. This man, who was overweight and had severe coronary disease, had been following this diet for several months, and was proud that he had lost weight. My response was to talk to him about how dangerous this diet could be, and what he should be doing, instead. He did not call me out on my actions, and I do not know whether he was upset or angry. But, thinking that I could have done better, this encounter led me to look a little deeper into what constitutes shaming.
There are several studies that deal directly with medical shaming. In a survey, people who had diabetes and followed the keto diet did not let their doctors know they were following this diet, for fear of being criticized or pressured to change their behavior. Conversely, their doctors thought the therapeutic relationship was excellent and supportive. This suggested a large mismatch between providers and their patients when it came to the perception of being shamed.
Another study showed that most shaming is directed toward the overweight. Examining the connotations of weight-based terminology, participants rated “weight” and “unhealthy weight” to be more desirable terms, while “morbidly obese” and “fat” were the terms that caused embarrassment.
In a 2017 article in the British Medical Journal, the authors pointed out that medical shaming is so insidious and pervasive that its vital role in health and illness needs to be recognized and assimilated into medical practice. In a study examining physician-patient communication, the main finding was that doctors had decreased odds of showing respect for what obese patients had to say, decreased odds of listening, and decreased odds of spending enough time with obese patients compared with non-obese patients.
Even simple language can make a difference. Labeling someone as a diabetic or an addict, rather than as someone with diabetes or a substance-use disorder, can change their perception toward feeling shamed.
In a sign of our times, lawyers are advertising for such clients. One Florida law group states: “Missing a patient’s health concerns simply because they are overweight is most certainly a form of medical malpractice. … All patients, regardless of weight, appearance, health, or circumstance, deserve the absolute best care for their ailments. When they receive anything less, it’s a potential form of medical malpractice.” This call for clients looking to file a lawsuit is predictable, and no doubt such ads will soon be coming to a park bench near you.
Here are some things that can be done to counter the effects of medical shaming:
Symptoms such as chest discomfort, shortness of breath, racing heart, or intense fatigue should never be blamed solely on being overweight. A medical workup is crucial to exclude another reason for these symptoms. For example, if you are having worsening shortness of breath, a full evaluation, often including cardiac testing, is mandatory before attributing a symptom to deconditioning and weight.
A reluctance to touch an overweight patient, or wincing when noting a patient’s weight can lead to not-so-subtle feelings of shaming. If you experience this, let your doctor know how you feel.
The “F” word — fat — should be avoided in medical settings. Telling someone they are overweight is likely much less painful than calling them fat. Body mass index, or BMI, is a better term to use when speaking about body weight. This measurement accounts for height as well as weight, is a more accurate assessment of risk, and is a way to begin a discussion about the importance of lifestyle change.
Studies show doctors and their patients may be perceiving messages very differently. Let your doctor know if he or she is not hearing what you are saying, or if you are feeling shamed.
Encouraging lifestyle change is more important than telling someone to diet and lose weight. Yo-yo dieting can result, which is associated with an increased risk of heart problems, as well as a higher chance of developing diabetes.
Many overweight people are healthy, especially those who exercise regularly and follow a careful diet. Complications occur from being sedentary, smoking cigarettes, eating junk food, drinking sugary beverages, and not dealing with diabetes.
David Becker, M.D., is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.