'You should see a dietitian to help you lose weight,’ says my GP during a consultation last week.
You should see a dietitian to help you lose weight,' says my GP during a consultation last week. I was seeing her about something completely unrelated to my body weight and I hadn't even raised the subject.
I've just had a baby so my weight gain is most likely temporary, and I'm lucky that my body has always fit within the bounds of cultural acceptability. I can't recall ever experiencing any weight-related prejudice before.
Despite this, being fat shamed by my doctor cut so deeply that I sat in my car and cried for about half an hour and then vowed I'd never return.
And before you say 'Your doctor was just doing her job promoting good health', think again.
My doctor didn't bother to find out about the three exercise classes I do each week, or the fact that I rarely eat processed foods. She has also never asked anything about my history or even my health. She made her unsolicited and day-ruining diagnosis on the basis of looks alone.
My experience isn't an isolated one. Doctors are reported to be the second most common source of weight-related stigma.One study found that 69 per cent of women surveyed experienced stigma from a doctor once and 52 per cent on multiple occasions.
The fear of being weighed is the most significant factor in women postponing or cancelling medical appointments.
Author of If Not Dieting, Then What? Dr Rick Kausman says that weight policing by doctors does more harm than good to women's health.
'Research shows that many women in the higher BMI categories are not going to the GP for standard regular preventative health care such as mammograms and pap smears for fear of being "told off" about their weight', he says.
Mother of three, Cate (45) has avoided her doctor since she was told to lose weight to solve a knee problem. Cate was dumbfounded and embarrassed when her doctor told her that the best thing for her knees was to lose some weight, in spite of the fact that she was fit and healthy.
'"What weight?" I thought,' Cate said. 'I continue to exercise with sore knees and have never been back for anything unless I am coughing up a lung.'
Dr Kausman, who is an Australian pioneer of healthy weight management and a board member of The Butterfly Foundation, says that a large part of the problem is inadequate doctor training. GP's on the frontline of our health system have little understanding of the relationships between weight and health. And many seem totally oblivious to the emotional distress that their insensitivity can cause.
'Many doctors aren't aware that people come in all shapes and sizes and you can't tell just by looking at someone if a person is above their most healthy weight or if they are just a bigger person,' Dr Kausman says.
Even when doctors do make some cursory effort to find out about their patient's health, they often resort to using theBody Mass Index (BMI) which is a crude and often inaccurate measure.
'BMI is a terrible measure of someone's health,' says Dr Kausman. 'If you want to know about a patient's health then you have to take a proper history. If a person is above their most healthy weight then doctors need to be respectful and compassionate in the way they discuss it.'
Psychologist and director of BodyMatters Australasia Sarah McMahon says that many GPs have internalised societal and cultural biases against weight, which they bring into the consulting room.
'Regardless of what a patient is presenting with, and where their weight might be sitting, diagnosing them as "fat" and prescribing a solution of weight loss simply isn't acceptable. Indeed it's discriminatory and runs the risk of being medically negligent,' she says.
Compounding matters, GPs often don't have the necessary time to spend with each patient to really listen and support a person to become their most healthy weight.
Despite considerable research about patients experiencing weight-stigma from GPs, the Royal College of General Practitioners (RACGP) does not accept that there is a problem.
'General practice training recognises body image as a clinical issue,' says RACGP President Dr Frank R Jones. 'Empathic consultation skills training are embedded in practicing the science and art of general practice.'
Others see room for improvement, and are taking steps to increase understanding about weight and health.
Dr Kausman has teamed up with the Australian Primary Health Care Nurses Association (APNA)* to train nurses to better support patients in general practices by using a non-dieting approach to healthy weight management.
As well as covering topics like appropriate language and why judging a person's health and lifestyle by looking at them isn't medically valid, the training will address how to make a general practice less hostile to people who are a larger size. This includes having chairs without arms in the waiting room, and examination tables, gowns and blood pressure cuffs that are able to accommodate larger bodies.
APNA Program Director Bronwyn Morris-Donovan says the training is a great opportunity for practice nurses to support patients to become the healthiest they can be, and as a result the healthiest weight they can be.
'We know from the literature that nurses have more time than GPs and they are really open to learning this new skillset,' Ms Morris-Donovan says.
No doubt some people will call this initiative political correctness gone mad. For the fundamentalists, obesity is a moral issue: it's the result of poor choices. As such, shame and bullying are the preferred methods to motivate people to lose weight.
Aside from the fact that all patients should receive the same level of respect and care from doctors, regardless of their size, the tough love approach simply doesn't work.
'It's far more likely to result in hurt feelings than weight loss', say Dr Kausman.
*The APNA training courses will be held in the first half of next year. Registration is now open.
Kasey Edwards is a writer and best-selling author. www.kaseyedwards.com