Death by Stigma: Why We Must Stop Weight Stigma

Suzanne Dooley-Hash

Suzanne Dooley-Hash, MD, is on staff at the Department of Emergency Medicine at the University of Michigan, and is the Medical Director at the Center for Eating Disorders. She serves as Chair on the BEDA Scientific Advisory Board.

BEDA promotes cultural acceptance of, and respect for, the natural diversity of sizes, as well as promoting a goal of improved health, which may or may not include weight change.  The views expressed by our featured bloggers are their own.

As soon as I heard the story, I knew things were not going to go well. Some ER doc in the middle of nowhere wanted to transfer a sick patient to my emergency department. We take transfers all the time, so that wasn’t necessarily a problem. But something in the doctor’s voice told me he was worried about this guy. And it’s never a good thing when a seasoned ER doctor is worried about a patient.

I listened and wrote down the details of the case, hoping the patient wouldn’t arrive until after my shift was over. I’d already seen my share of really sick people that night, and this one was going to be sicker.  30 minutes before the end of my shift, I heard the overhead announce yet another critical patient in “Resus Charlie” so I  went to greet the ambulance crew as they rolled the patient into the resuscitation bay.

The doctor at the other hospital had told me the guy was “big” – maybe over 500 pounds based on his last known weight – so I wasn’t surprised by his size. It was his condition that caught me off guard.

The patient had walked into the ER at the other hospital. He had been talking and acting normally the last I had heard but only hours later, he lay in front of me unconscious and barely breathing. It had been a long ambulance ride and he had deteriorated throughout the trip.

The first thing he needed was an airway. He was not breathing on his own, and we needed to do it for him. Having to establish an airway emergently can be a little unnerving because the stakes are high, and it isn’t always easy.  We were all a little on edge but we soon had an airway and were able to breathe for the patient.

The bigger problem still remained that he had a hole somewhere in his intestines which needed to be repaired quickly. Our surgeons argued that his chances of surviving surgery were poor, given his current condition but they also knew that, without surgery, he had no chance so they rushed him to the operating room. By the time they opened him up, it was too late. He became increasingly unstable and died early that morning without ever waking up again.

Losing a patient is always hard. This particular loss, though, was more unsettling to me than many, and I needed to understand why. In the days that followed, I spent hours combing through my memories of the case and I was deeply saddened by where that reflection took me.

Weight stigma. This patient was a victim of weight stigma.

What I remember most about that night was the patient’s sister begging me, “Please don’t let him die just because he is fat. He’s a good man.”  At the time I could hear her anguish, but I didn’t fully grasp all that her words were truly saying. Maybe I was naïve, but, before that fateful night, it had never occurred to me that a man wouldn’t receive appropriate medical care just because of his size. That’s what doctors do, take care of sick people, regardless—right?

Nor could I understand why she felt she needed to tell me he was a good man despite his weight. What did his size have to do with him being good or bad or with his inherent worth as a human being?

This is called weight stigma.

Then I thought back to my earlier conversation with the ER doctor from the other hospital and realized that was exactly what had just happened. None of the surgeons in that small town hospital would touch him because of his size.

 

They all cited the increased operative risks of major surgery and higher mortality rates in morbidly obese patients. They quoted statistics about how those risks were even higher in people with other medical problems, like diabetes and heart disease, which this man also had. They talked about how he was unlikely to survive the surgery, and, even if he did, his quality of life, which was already poor in their eyes, would be awful as he struggled to recover.  Meanwhile, they all knew that his mortality risk was increasing with every additional minute that passed and that he would die without surgery.  Despite this knowledge, they refused to take him to the OR and instead recommended he be transferred elsewhere for further intervention.  On a stormy night they shipped him off on a five-hour ambulance ride toward almost certain death.

 

I had talked with his sister for quite awhile, trying to reassure her we would do everything we could for him. She told me how he hated to go to the doctor because he felt judged due to his weight. As a result of this weight stigma, he didn’t get regular medical treatment and often went without his medications for months at a time. His diabetes was poorly controlled. His depression and sense of isolation worsened. His weight continued to climb as he became more and more reluctant to seek medical care.

The last time he had been weighed had been a humiliating experience – someone recommended using a truck scale and he hadn’t seen a doctor since. Not until early this morning, when his intestines ruptured, and he went to an emergency department in pain and asking for help.  Once again, he was a victim of weight stigma, because he was judged based on his size and this time, this weight stigma cost him his life.

The official cause of death was listed as being due to an infection secondary to a perforated bowel but his sister and I know what really happened that night.  He died because of weight stigma.