Weight discrimination in healthcare

Samson Grzybek
June 29, 2025
Köln

Julia Krause, you have written a specialist book on weight discrimination in healthcare. What prompted you to tackle this topic – and why now?

The topic had been on my mind subconsciously for a long time because I am affected by it myself and feel uncomfortable with many doctors. During my sociology studies, I became increasingly aware of various structures of discrimination and realised that lookism is a major issue, but one that is not addressed enough in my opinion. When I then discovered the field of fat studies, my specialist knowledge and my own experiences came together and I realised that I would write my master’s thesis on this topic. Since the devaluation of overweight people is closely linked to health discourses, it was an obvious decision to focus on the different approaches to and exclusions from healthcare. I received so much encouragement during my master’s thesis that I decided to expand the work a little and publish it.

In the current political situation, in which the fundamental rights of marginalised people are being increasingly restricted both abroad and in Germany, and many states are knowingly disregarding human rights despite court rulings, I believe it is very important to take a stand against the unequal treatment of people, e.g. by constantly addressing these injustices. As I have been dealing primarily with weight discrimination in recent years, this is my primary topic.

When people think of discrimination, they often think of issues such as racism, classism or homophobia – weight is often excluded. What exactly do you understand by weight discrimination in a medical context, and how can it be recognised?

Weight discrimination in a medical context means that medical staff exclude overweight patients from examinations and treatments that patients of normal weight receive. Or that these measures are delayed. A typical example is when overweight individuals are first told to lose weight in order to alleviate certain symptoms, and only then are further examinations or treatments considered. This delays the discovery of other possible causes, or prevents them from being discovered at all. In addition, overweight individuals are regularly underdosed with medication, which has a negative impact on the course of their illness – sometimes with drastic consequences.

Another example is when patients go to doctors with complaints that have nothing to do with body weight, such as flu-like infections or similar, but the medical professional nevertheless addresses their diet and exercise habits as problematic. Often, patients’ statements on these issues are not believed. This means that the doctors’ assumptions take precedence over the patients’ self-assessment, which can lead to dangerous situations.

What consequences can it have for patients if they are not taken seriously or inadequately treated because of their weight – both mentally and physically?

It should be obvious by now that this often leads to poorer healthcare. This, in turn, means poorer physical health. In addition, these experiences naturally affect patients’ mental health. Those who are frequently not believed lose confidence in their own perspective. Those who have not been helped lose trust in the healthcare system. Those who are fat-shamed by medical staff develop greater feelings of shame, which creates barriers to seeking further contact with the healthcare system. It also has a negative impact on self-esteem, and eating disorders are a common consequence.

Shame and psychological stress are major issues for almost all of my interviewees.

What specific experiences do disabled, queer and/or racialised patients have?

The extent of weight discrimination experienced is higher the heavier the patients are and the more they are affected by other forms of discrimination.

CN: Transphobia

One non-binary trans male respondent reported that access to testosterone was made more difficult due to concerns about weight gain in the context of the increased appetite often associated with testosterone. Similarly, the path to mastectomy was hindered by the argument that body dysphoria might be reduced if weight were lost.

CN: Ableism

One interviewee gained weight due to the side effects of medication for serious illnesses. Subsequently, some doctors blamed her weight for these very illnesses. She was also advised to exercise more, even though she is unable to do so due to rheumatism and osteoarthritis.

CN: Racism

The same interviewee is downright insulted as a Black person in a medical context. Since fatphobia is used as a catalyst to attack other marginalised groups, such as BIPoC communities, which would provoke much more opposition if addressed directly, it can be assumed that this is done with racist intent.

In your book, you show that weight discrimination is not an isolated experience. How deeply rooted is this problem in the structures of our healthcare system?

Very strong. The attribution of blame is particularly problematic. Overweight people are blamed for not fitting into the norm, which for many results in a supposed justification for shaming them. This way of thinking is widespread in both the health sector and all other parts of our society. Various studies have concluded that the individual’s ability to control their own weight is much more limited than is generally assumed.

However, attributing personal responsibility for health and thus for a normal weight or thin body causes further stress, which in turn has a negative effect on health. It is a vicious circle from which we as a society can only escape by recognising different bodies as equal and breaking down stigmatisation.

What role do medical guidelines, education and societal perceptions of ‘healthy’ and ‘unhealthy’ play in perpetuating weight discrimination?

An immense one. The problem is that all studies conducted over the past decades that portray being overweight as unhealthy are distorted by other influencing factors such as stress, experiences of discrimination, genetics, diets and poverty.

This is also due to the fact that the origin of equating illness with being overweight stems from ideals of beauty. When the ideal of slimness became increasingly prevalent at the beginning of the 20th century, medical professionals opposed it for a long time and warned of its harmful effects on health. Even the classification of ideal weight limits does not originate from medicine, but from the field of life insurance. Over time, however, the ideal of slimness has also become established in medicine.

The ideal of slimness is therefore ever-present, with the result that studies are characterised by fat-phobic assumptions that produce corresponding results. This supposed knowledge shapes both social perceptions and medical perspectives.

Over time, many affected individuals develop strategies to protect themselves, while others avoid visiting the doctor altogether. What would you like to see from medical staff in order to rebuild trust?

Staff should listen to patients and take them seriously. In addition, they should undergo further training in weight sensitivity and discrimination awareness. This means not allowing prejudices about patients’ health to influence their own actions and treatment.

What responsibility do doctors, therapists and other professionals bear – and how can they begin to work in a more discrimination-sensitive manner?

They bear a great deal of responsibility in deciding who has access to medical care. They need to be aware of this and therefore be as accessible, trustworthy and individual-oriented as possible. Professional training is therefore a must. In addition, medical professionals must also apply their knowledge by constantly questioning and adapting their own approach. A key question for them could be: How would I treat a thin person in this situation?

Certainly, there are health restrictions that should be discussed in relation to a change in diet. But that should not be the only solution – and it must be realistic for patients to implement. Consequently, an individual approach must be developed together.

Finally, is there anything in particular you would like to say to queer, neurodivergent or multiply discriminated people who have had negative experiences with the healthcare system?

I have a few things I would like to share with all people who experience (weight) discrimination. However, this may be even more relevant for people who are marginalised in multiple ways, as they are also more severely affected by discrimination.

Realise that what you are experiencing is not an individual experience, but rather systematic injustice. It is unjustified and you do not deserve it. Join forces and exchange ideas.

Get involved with the fat acceptance movement. Activists have been fighting for the rights of overweight people for decades and offer many helpful tips for changing your own perspective on body shapes and dealing with the healthcare system.

What you can do specifically for your next healthcare appointment: prepare yourself emotionally, come up with a strategy and arguments, and take someone with you!

Above all, choose the right practices. Queermed Germany is a wonderful platform for this. Benefit from the experiences and tips of others and support both your health and medical staff who strive to provide discrimination-sensitive treatment!