My Big Fat American Healthcare System

Noted public health expert Lizzo teaches us that “thick thighs save lives,” but for many of us, being fat is killing us – and not for the reasons you might expect.

Today we’re talking about our healthcare system’s impact on fat folks AND how misconceptions about fat folks impact our healthcare policy! Recent studies have shown us two things: A) that weight isn’t the major driver of health that the medical industry has believed it was for a very long time, and B) that treating weight like the end-all-be-all of health actually causes fat folks to avoid seeking care, which leads to some pretty terrible health outcomes.

Our guest Jordan Berg Powers, the Executive Director of Mass Alliance, has helped elect new progressive leaders across the state, recruited progressive champions to run for political office, and trained hundreds of grassroots organizers. Jordan is active in campaigns for saving public education, as well as promoting medicare for all and a more progressive tax system for the Commonwealth.

Noted public health expert Lizzo teaches us that “thick thighs save lives.”

Show Notes

Language note: we’re saying fat and not “fluffy,” “curvy,” or “obese.” Fat is just a way of describing people –  like short or tall or red-haired. It may have negative connotations in our culture right now, but a lot of fat folks are working on reclaiming fat as a neutral term. We shouldn’t need euphemisms like “fluffy” to describe what we look like. Obesity is the idea that fatness itself is a disease, which we’re going to be pushing back on throughout this episode!

Jordan and Gillian share their stories about they way society draws conclusions about fat people, including about their intelligence, their cleanliness, and their health. Both have experienced medical appointments where the first thing the doctor said was “have you considered losing weight” no matter the health concern that brought them in. Gillian shares another health concern that took eight years to address because doctors repeatedly blamed her weight for it. Instead of protesting, she accepted what they said, and believed that her pain was her fault and she didn’t deserve to feel better until she lost weight.

Jordan explains how the fatphobia he’s experienced has been combined with racism. One of those doctors who told him to lose weight said it would be easier if he “stopped eating fried food” like fried chicken, even though he’s a vegetarian who rarely eats fried food.

Why is anti-fat bias in healthcare a problem?

When it comes to healthcare, how the least of us is treated, ends up being how the rest of us are treated. Many women report their pain hasn’t been believed. Many Black people avoid doctors because they’ve experienced racism in the healthcare system. Many fat people also avoid doctors after being blamed for their own health problems due to their weight. Their actual health concerns often go untreated, often leading to worse outcomes. The vast majority of Americans (73.6%) are considered overweight, so this isn’t an insignificant problem.

The most frustrating part of this approach to medical care is that science doesn’t back it up. Lowering weight isn’t a magic bullet. Even if it were, it has become clear to scientists that most people are not capable of losing weight permanently. Body size is largely predetermined by genetics. So it doesn’t make much sense when we go to the doctor and the only treatment plan we get is “lose weight,” because for most of us, reducing our body size in a sustainable way isn’t possible. 

One of the most prevalent standards in healthcare, which determines much of the way a patient’s care is planned, is the Body Mass Index (BMI). It simply tells the person’s weight divided by their height, and categorizes them as either underweight, normal weight, or overweight. BMI does a poor job predicting a patient’s overall health or life expectancy, but because it’s a free and easy calculation to make, it’s often still used by doctors.

The origins of the BMI go back to the insitution of slavery. In “Fearing the Black Body: The Racial Origins of Fat Phobia,” sociologist Sabrina Strings writes “ … the current anti-fat bias in the United States and in much of the West was not born in the medical field. Racial scientific literature since at least the eighteenth century has claimed that fatness was ‘savage’ and ‘black.’”

Just like the healthcare industry, there is big money in the diet industry that influences what we and doctors believe about weight. The diet industry has been trying to sell us get thin quick schemes for over a century; it preys on fat individuals by telling them their weight makes them unhealthy and it’s their fault. It tells society that some people are worthy and some people are not, based on their weight. Jordan says there’s a lot of benefit to people in power to telling people that they’re not worthy and should be judged.

One of the reasons this issue is so critical is that fat people have become the boogeyman of the American healthcare system. We hear A LOT that the reason other countries can have a Medicare for All- style universal health program, but the US can’t is because Americans are so fat. Are we the real reason we can’t have nice things?

Like the for-profit healthcare industry blames individuals for their health problems instead of the systems in which they live, it blames individuals for being fat. Rather than examing them as a whole person existing within systems of oppression and inequity, the healthcare system points to the individual as the culprit. We just really want to believe that fat people make themselves fat and can make themselves unfat, so it’s a lot easier to focus on that than treat actual health problems.

How would this be different if we had Medicare for All?

The for-profit healthcare system is largely responsible for training doctors, providing information on the newest treatments and discoveries while giving doctors less and less time with each patient. Insurance literally won’t pay doctors for the time they need to learn about patients as a whole person. The for-profit health system forces doctors to take shortcuts based on assumptions about a patient’s weight, race, gender and class because there’s no profit in spending more time with a patient to learn about their individual circumstances.

Medicare for All won’t fix everything; racism and fatphobia won’t instantly go away with a public insurance system. But removing the profit motive will allow clinicians to spend the time to treat patients as full human beings. It can also force science back into how patients are treated. Doctors are currently trained to make these cost-effective treatment decisions based on weight because the profit driven system won’t pay them to do anything else.

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