Obesity Discrimination and the Gendering of Health Care

When Jess Zimmerman reported for her annual gynecological exam last February, her doctor was interested in assessing more than just her vaginal health—he wanted to talk about her weight. "He asked what I ate, but he didn’t wait for an answer," Zimmerman writes. "I had to exercise more, he said, having no idea how much I was exercising. I also needed to eat less [of] whatever it was I was eating." When it came time for another checkup, her experience of being bullied by a doctor who "made incorrect guesses about my habits based on my body" made her think twice about making another appointment. "Something as mild as a pre-smear dressing-down can seriously wreck your trust in doctors for a while," Zimmerman says.

In 2007, researchers from Yale University asked more than 2,000 men and women to report the weight-related stigma they've experienced in their everyday lives. Across a range of BMIs, women were more than twice as likely as men—10.3 percent to 4.9 percent—to report “daily or lifetime discrimination due to weight/height." This discrimination comes from all sides—employers, teachers, family members, even doctors. And heightened health care discrimination against overweight women has been shown to deter them from seeking needed medical help.

"Our research shows that obese women who experience stigma because of their weight during a health care experience are more likely to avoid, cancel, and delay future medical services because of these experiences," says Rebecca Puhl, director of research at Yale University's Rudd Center for Food Policy & Obesity and a co-author of the study. That's particularly troublesome in light of the fact that weight-based stigma can actually cause medical problems. Says Puhl, "we know from many studies that individuals who experience weight stigmatization are at increased risk of depression, anxiety, low self-esteem, suicidal thoughts, eating disorders, binge eating, higher calorie intake, and avoidance of physical activity."

Across America, both male and female waistlines are expanding—today, one-third of adults in the United States are obese—and the shift has huge implications for the gendering of health care in this country. The ways some doctors are approaching this phenomenon says more about culture than it does science. Puhl says health care discrimination targeted at overweight women can be attributed to "stringent ideals of female physical attractiveness," which expect women to keep their weight down irrespective of their actual health status. Meanwhile, overweight men are dealing with the "myth of men," says bariatric surgeon Dr. Joseph Colella. Men subscribe to the "myth of being larger creatures," Colella says. Doctors, too, can buy into that image. When men show up for a checkup carrying a few extra pounds, "they may be perceived to carry the weight better," Colella says.

Stigma may deter overweight women from seeking health care generally, but it does increase their participation in one medical procedure: Colella says that 80 percent of all patients who undergo bariatric weight-loss surgery—which reduces the size of the stomach to restrict food intake—are women. Colella explains this by saying that women are more likely to be aware of weight-related medical problems. But the fact that far more women than men undergo surgery in an attempt to lose weight can not be wholly explained as a positive. In fact, this health care gender divide isn't good for men or women. When women seek health care, they can be bullied out of making their next regular checkup—or compelled to staple their stomachs. When men visit the doctor, potentially problematic weight gain may simply be ignored.