In Defense of a Person’s Concern About Gaining Weight

Mother and ChildWeight neutral approaches to health and healthcare are the subject of well-deserved attention. The World Obesity Federation recently published a position statement on recognizing and reducing weight stigma. One of nine recommendations was to “engage in weight-neutral health promotion.” But what does this really mean? How should a healthcare provider respond to a patient’s concern about gaining weight?

Experiences of Real Life

These are not hypothetical questions. Mara Gordon is a family doctor and writer in New Jersey. In a recent commentary for NPR, she describes seeing a patient who gained 25 pounds as a result of having a baby. Two years after her pregnancy, the patient told her, “I want my body back.”

Gordon replied that losing weight might not “bring her peace with her body” and that medically, “I didn’t think she needed to lose weight.”

Weight Neutral?

Reading this prompts the question of whether this encounter is a genuine illustration of weight neutral healthcare or an example of another sort of judgment that can enter into discourse about health and weight. The patient in this case persists in expressing her concern about having gained weight. The doctor apparently dismisses the concern. She asks a question which the patient cannot answer in this encounter with her physician:

“What would it feel like to love your body the way it is?”

In defense of the patient, 25 pounds is not a trivial amount of weight to gain. It makes a difference in how a person moves, looks, and feels. It is easy to imagine that this patient would leave this encounter feeling judged or dismissed.

For those who take note of BMI (a subject for another day), gaining 25 pounds would take an average American woman in her 20s from a BMI of 28 to a BMI of 33. For now, maybe her labs are normal. It might even be that she’s not having joint pain. But an objective look at prospects for future health tells us this may not continue to be the case if her higher weight persists or she gains further weight.

In short, this person lives in her body every day and appears to have a legitimate concern about gaining weight. Dismissing her concern does not seem like “weight neutral” care.

Care That Starts with Listening

If this story illustrates anything, it tells us a lot about how important listening to a person’s lived experience can be. Clinical psychologist Robyn Pashby explains that concerns about weight cannot easily be boiled down to a simple narrative about fat phobia:

“I’m always on alert for weight bias. It is dangerous and it is everywhere, to be sure. But it isn’t the full and complete story. It’s only a part of people’s stories and that is why physicians need to send people to specialists in psychology to untangle the story.”

It is seldom possible to do all the necessary listening in a brief primary care visit. But leaving a person feeling dismissed or judged is not helpful.

Click here for Gordon’s essay, and here for the position statement on recommendations to recognize and reduce weight stigma.

Mother and Child, painting by Pablo Picasso / WikiArt

Subscribe by email to follow the accumulating evidence and observations that shape our view of health, obesity, and policy.


March 25, 2024