America's healthcare system is fatphobic. Doctors need to finally treat fat people with respect and prioritize their health.

Crystal Cox/Business Insider

• Medical fatphobia can be traumatizing, and even deadly, for fat folks.
• COVID-19 vaccine access highlighted medical fatphobia and the healthcare system's ability to prioritize marginalized people.
• It's time for the healthcare system to treat fat people with respect and prioritize their health and comfort at the doctor's office.
• Reina Sultan is a Lebanese-American Muslim freelance journalist.
• This is an opinion column. The thoughts expressed are those of the author.
• See more stories on Insider's business page.

Going to the doctor can be scary for anyone. For fat people, a visit is at best traumatic, and at worst, deadly.

I've been dealing with medical fatphobia for years, but the most egregious example happened when I went to an endocrinologist to deal with several health issues I'd been facing. He told me that I should go to Weight Watchers. Two months later, I was diagnosed with an eating disorder and my symptoms (thinning hair and nails, multiple vitamin deficiencies, chronic fatigue, among others) were a result of my body starving.

This experience and others like it have made me deeply distrustful of doctors, which in turn has made me extremely nervous to seek care when I need it, fearing that a doctor wouldn't be able to see past my weight.

That's why I -and many other fat people - feared that getting COVID-19 would be an even greater risk for us. We've been told that COVID is deadlier for us because having a high BMI makes the disease more dangerous. While that's true, I can't help but ask: how much of that risk is heightened by doctors who don't treat fat patients with the same level of care as thin patients?

A matter of respect

That is the question that people like Hayley, 24, weighed when finding out they were eligible for the COVID-19 vaccine based on BMI. "During the pandemic, I immediately began to notice that many people assumed that fat people would stand no chance against COVID, regardless of their risk level otherwise," she says, "I was also terrified that if I was hospitalized by the virus and there was a shortage of ventilators, it would be possible that I would be given a lower priority level due to fatphobic biases."

Sam Tyron, a registered dietitian and eating disorder specialist, agreed with Hayley's assessment. "I wish I could say this isn't a fear based in truth, but I think they are right. This is the reason why despite the roots in inaccurate medical weight stigma, I was glad to see folks in higher weight bodies being prioritized when it came to getting vaccinated", she says, "The way medical providers talk about fat people is sometimes subhuman which leads to devaluing their lives and prioritizing the treatment of thin bodies."

This type of devaluation - and the subsequent trauma - is unfortunately common. Hayley has always been extremely anxious about going to the doctor. "As a child and young teen, I was constantly berated by my pediatrician to lose weight," she says, "The doctor would frequently ask me to eat different foods or less food, exercise more, even though I had a similar diet and exercise output as my thinner peers."

25-year-old grad student Cassidy avoids the doctor as much as possible. While working as a medical scribe for two years, she saw patients experience so much fatphobia from the providers that she says she developed second-hand trauma from her time there. Since she is also fat, she doesn't want to risk that same type of treatment when going in for medical care. Sam says she sees this anxiety manifest in her clients all the time.

"Medical weight stigma absolutely prevents people in larger bodies from going for routine preventive care or seeking medical care until their symptoms are unbearable. Would you want to voluntarily pay money to be shamed for your weight and 'lifestyle?'" she asks, "I wouldn't. I have stories of clients who go to urgent care thinking they may have strep and the provider lectures them about their weight. If the person isn't even going to be listened to by their provider it is understandable that they would not seek out that abuse."

Cassidy currently studies the sociology of health and medicine, where she is particularly interested in fat studies research. When the opportunity arose, she signed up for a COVID vaccine trial because she felt it was important for there to be data showing that the vaccine is effective for fat people. (You may remember the debacle about fat people finding out Plan B doesn't work for people over 160 pounds).

To qualify for the trial, she had to undergo a medical exam. During the exam, the doctor - an older, white man - made Cassidy deeply uncomfortable by essentially backing her into a corner and grabbing her breast while listening to her heart and lungs. To make matters worse, he followed this assault by asking, "So, how long have you been fighting your weight problem?" Cassidy tried to put an end to the conversation, but he pressed her, trying to get her to explain "what [her] obesity is doing to [her] arteries."

He continued to admonish her, telling her she didn't understand her own body, until she was finally moved into another room for the nurse to administer the vaccine. Cassidy began to panic. As she cried and called a friend, she realized she couldn't stay because getting the first dose meant she'd have to come back to get the second, meaning she'd have to see that doctor again. She fled the office and "cried so hard that by the time [she] got down the eight floors" that she started vomiting. "I self-harmed when I got home," says Cassidy, "It was really bad...This is something that is going to affect me for the rest of my life."

Violet, 44, has been experiencing fatphobia since childhood. In college, a doctor told her that she would have diabetes at any moment, but lied to her about her blood sugar being abnormal. "It set off a long period of disordered eating where I ate as little as possible trying to avoid a disease I have yet to develop, 25 years later and considerably fatter," she says. Because of previous issues with fatphobia, Violet avoided the doctor even when she began to get really ill.

Her chronic illness began with digestive issues, then leg pain, then brain fog. Her doctors suggested the pain would go away if she lost weight, despite the fact that she'd just lost 80 pounds prior to the pain starting. She remembers, "The neurologist I saw was so sure that my weight was causing it that he refused to do an exam and instead literally yelled at me that if I wasn't willing to lose weight that he wouldn't bother to diagnose me."

Violet qualified for the COVID-19 vaccine because of her BMI, shockingly before she qualified for being immunocompromised. "The form I filled out was kind enough to ask if I would need a wheelchair...I marked my form indicating I was applying to be vaccinated in group 1B because my BMI made me eligible, but I would also need a wheelchair because of my disability," but when she arrived at the hospital she was annoyed to discover they only had small wheelchairs available.

On a day that fat folks were meant to be getting vaccinated, they failed to provide roomier bariatric chairs. Medical tools like "exam tables, wheelchairs, and blood pressure cuffs are not built with fat people in mind, so truly accurate diagnoses are compromised" according to Sam, showing yet another way the medical industrial complex risks the lives of fat people by not prioritizing our even considering us.

I want to live in a world where my health is taken seriously because everyone's health should be taken seriously. I want doctors to believe me when I tell them my symptoms of any illness, rather than blaming them all on my size. The fight for fat people to be treated fairly at the doctor's office is far from over, and our struggles with fatphobia have always extended beyond accessing care or vaccines for COVID-19.

That being said, fat folks being prioritized for the vaccine - albeit for a misguided reason - showed me that it's possible for marginalized people to be given priority by the healthcare system. If it was possible once, it should be made possible always.

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