“This doctor knows shit about you, but the first thing he says is, ‘you need to lose some weight’”: Anti-fat bias and the contradictory effects of fat medicalization in Czech healthcare

ABSTRACT

The anti-fat bias that is built on the premised principle antagonism between a fat and a healthy body remains entrenched in healthcare. Despite evidence that being fat is conditioned by many factors beyond a person’s control, fatness is often seen as a result of irresponsible behavior and moral failure and fat patients report being exposed to mistreatment, discrimination, and shaming in healthcare. Drawing on semi-structured interviews and written testimonies, we examine the experiences of people with fat embodiment in Czech healthcare contexts and explore how they approach their health, biomedicine, and weight management. Although obesity specialists are trying to address the weight stigma and create a respectful environment, an anti-fat bias dominates in the rest of the Czech healthcare system. Moreover, even if the medicalization of fatness contributes to reducing weight stigmatization in some contexts, it also reinforces the perception of fat as a medical pathology, which, in turn, creates an obligation for fat individuals to seek biomedical treatment. We identify three strategies that fat people employ to minimize their exposure to weight-based discrimination: avoiding all healthcare contexts; seeking out younger physicians, whom they find to be generally more supportive; and going to great effort to find a doctor with a non-judgmental approach to obesity. In conclusion, we argue for a more well-being-oriented than weight-centered understanding of human health that will go beyond standardized indicators in favor of more personalized care.

KEYWORDS:

• Fat embodiment
• fat shaming
• medicalization
• public health
• weight stigma

Acknowledgments

We would like to thank the anonymous reviewers, the journal editors, and Hana Porkertová for their valuable feedback on this article. This work was supported by the Czech Science Foundation [Grant Number 24-12497S].

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Grantová Agentura České Republiky [24-12497S].

Notes on contributors

Varvara Borisova

Varvara Borisova is a junior researcher at the Institute of Sociology of the Czech Academy of Sciences and Ph.D. candidate at the Faculty of Humanities, Charles University in Prague. She specializes in the anthropology of medicine and technology.

Tereza Stöckelová

Tereza Stöckelová is a senior researcher at the Institute of Sociology of the Czech Academy of Sciences and an associate professor at the Faculty of Humanities, Charles University in Prague. Her research interests include political ecology, biosocial metabolism, and technologies in and of the Anthropocene.