STAT News, which I quite like as a source for health journalism — other than their acceptance of funding from the pharmaceutical industry — ran a piece written by Laura Fraser. The article covered what by now can only be understood as an extremely familiar narrative. Namely, Ms. Fraser’s sister Jan died six months after being diagnosed with an aggressive form of endometrial cancer. But a series of health care providers failed to diagnose accurately because they were unable to see past the patient’s fatness:
Jan might have had a better chance if her doctors had looked beyond her weight and their prejudices about fat middle-aged women; if she hadn’t been so reluctant to seek medical treatment because of the fat-shaming lectures she knew awaited her; and if she’d grown up thinking that her body was OK the way it was, and she should love it, move it, and take care of it.
This is a tragedy. It is also all-too-common a story. If you take the time to really listen to fat people, engage with fat activists, read blogs, zines, and narratives in the Fatosphere, stories similar to that noted by Ms. Fraser are legion. Hence, I tweeted:
However, I’d like to take a moment to further unpack the notion of stigma as a population health harm. Most people, especially those connected to health care, can readily understand the idea that stigma erects barriers both to seeking treatment and to the shared decision-making that is integral to safe, effective, and humane health care. (One of the bugaboos of the latter is known as “premature closure,” in which the provider determines, prematurely, that the patient’s problem is X and closes off further inquiry and discussion that might open up the field of potential diagnoses and interventions. This is precisely the error that seems to so widely affect fat people seeking health care).
However, thinking about the harms of stigma solely as an impediment to health care is a big mistake, because it drastically understates the extent to which stigma harms health.