Today I came across an article called Big Bias that talks about the barriers fat people face in the health care system. There’s an accompanying video here.

Throughout my adult life, I’ve had some unsavory doctor’s appointments because I’m queer. Several doctors have skipped basic screenings and exams because they’ve interpreted lesbians’ “reduced risk” as “no risk.” One nurse suggested I seek therapy when I told him my partner at the time was a transgender man. Though these interactions stung, they had an internal logic. I could retrace the mental footsteps that led to those remarks & choices. Maybe she misread my chart. Maybe he wanted to make sure I had support in the face of homophobia and transphobia.

But those experiences pale in comparison to the way I’ve been treated as a fat person. Nurses wince when they ask me to step on the scale, or they take it upon themselves to announce that they’re going to have to look for the larger size hospital gown. Doctors act put off, too, and their advice feels tinged. No matter what I seek care for, the answer always seems to be weight loss. I’ve been told to lose weight to deal with everything–even ear infections. There may well be truth and urgency to what they’re saying. But from where I stand, most doctors just end up sounding like the boy who cried “fat.”

Earlier this year, I was given a big diagnosis. It has proven a tectonic shift in the way I think about myself, the way I interact with the world, and the way I seek medical care. And I’ve had it from birth. It’s been repeatedly confirmed that it’s in my DNA, and all the medical literature I’ve been able to find eschews any link to weight gain. But when I saw a new primary care provider last month, she told me in my very first visit that I’d been misdiagnosed, that I was “just obese,” and that I should lose weight. When I asked her how my weight could interact with this congenital condition, she said, “I think it’s premature to make any diagnosis for you without losing weight a substantial amount of weight first.”

I don’t think doctors are mean, or thoughtless, or fatphobic. And I don’t think the advice I’ve been given is necessarily wrong. Lord knows I’m in no position to judge the merit of any medical findings.

But there’s a whole lot of moralizing that happens when we in the US talk about fat people. We all hold deep-rooted assumptions about the hygiene, strength, character and fundamental worth of fat people. We have strong ideas about what fat individuals should do, what they shouldn’t wear, how confident they should feel, when and whether they should date, and how they should act, eat, socialize and live. Even as a fat positive fat person, I still catch myself giving other fat girls the stink eye for wearing cropped jackets or cap sleeves. And practitioners are just as subject to this pervasive thinking as anyone.

Although doctors and nurses are highly trained in the mechanics of human anatomy, and in how to intervene in complex bodily crises, there doesn’t seem to be similar training in confronting the biases that could prevent issuing appropriate diagnoses, or that could create barriers to patients’ compliance with treatment. And as a result, the increasing numbers of fat people receive incomplete health care (for example, because their doctor might not have a blood pressure cuff that fits their arm). Others steel themselves to contend with doctors’ prejudices and stereotypes. And some fat people even stop seeing doctors altogether in order to avoid the sting of shame and judgment.

I don’t have a call to action, or a tidy wrap-up for this post. There just seems to be a broad lack of understanding about just how many social barriers, big and small, that fat people face on a daily basis. So I thought I’d share.

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