Weight Stigma: A Blog with Usha Ganesan, MD

Hi Dr. Ganesan! Can you tell readers a little about yourself?

Hi! I’m a board-certified pediatrician in Orange County. I earned my undergraduate degree at UCLA, followed by medical school at St. Louis University School of Medicine, and then completed my residency in pediatrics at University of California,Irvine.

I have been personally affected by body image concerns and disordered eating for the majority of my early adulthood, and thus have always had a special interest in treating these mental health issues. As I was seeing the rates of anxiety, depression, and disordered eating rise, I became convinced that not enough is being done to prevent these mental health issues.

 In 2022, I created Beyond The Reflection, an organization dedicated to teaching kids, teens, and young adults how to develop resilience to the toxic world of diet culture that we live in. In 2024, I established a practice in Orange County and San Diego, exclusively focusing on medical management of eating disorders and body image concerns.

I’m  married and have three kids, 2 in college and 1 in high school. In my free time, I enjoy spending time with family, traveling, reading, and watching my favorite TV shows!

Awesome! I love your passion and your authenticity. Both were so evident the first time I met you. Can you tell readers a little about weight stigma?

Weight stigma is the term used to refer to negative attitudes, stereotypes, and discrimination directed at people based on their weight. It most often targets individuals at higher body weights. Weight stigma can show up in various ways, from overt discrimination (such as being denied a job or proper medical care) to more subtle forms like teasing, body shaming, and engaging in stereotypes that people in larger bodies are lazy, unhealthy, or lack willpower.

Weight stigma, especially in contexts like airplane seating and plus-size clothing, is a significant issue with broad social and psychological impacts. People in larger bodies often cannot fit into airplane seats which were designed with “the average sized” body in mind. They often have to request a seat belt extender, or pay for an extra seat, which can lead to discomfort and embarrassment. Retailers often do not carry a wide variety of plus-size clothing, often having to resort to less fashionable or more expensive brands.

The effects of weight stigma are wide-reaching. Research has shown that it can contribute to both physical and mental health issues, including stress, anxiety, depression, and lower self-esteem. It can also lead to disordered eating and often discourages individuals from seeking medical care.

Weight stigma is especially problematic in medical settings. It can lead to biased treatment and misdiagnoses, as healthcare providers may attribute various symptoms to a patient’s weight without bothering to do the same evaluation that they would do for a person in a straight-sized body. This stigma can deter patients in larger bodies from seeking medical care, fearing judgment or dismissal of their concerns. Many patients will avoid preventive screenings and routine check-ups, which increases the risk of late diagnosis for otherwise treatable conditions. Additionally, the lack of adequate facilities and equipment—such as appropriately sized blood pressure cuffs, examination tables, or even waiting room chairs — can make healthcare environments uncomfortable or inaccessible.

Experiencing stigma in healthcare can cause significant emotional distress, affecting mental health and body image. This stress and stigma can also exacerbate health issues, creating a vicious cycle for these patients. Addressing these biases through weight-neutral training and inclusive care practices is essential for fostering a supportive medical environment for all body sizes. It is important that more physicians learn about and adopt the Health At Every Size approach to healthcare.

 It’s absolutely essential. Can you share more about Health At Every Size?

Health at Every Size (HAES) is an approach to healthcare that promotes health and well-being without focusing on weight as the primary measure of health. HAES emphasizes healthful behaviors like eating a wide variety of food, moving one’s body for joy, emotional well-being, and access to respectful healthcare, regardless of body size. This framework is based on the idea, backed by research and evidence, that one’s weight does not directly determine one's health. HAES advocates for a weight-neutral approach to healthcare, which can lead to more inclusive and personalized care for people of all sizes. By focusing on behaviors rather than weight, HAES seeks to improve overall health outcomes without reinforcing the harmful messaging of diet culture, which can lead to problems such as disordered eating or avoidance of healthcare. This approach is especially helpful for individuals who have felt stigmatized in medical settings. HAES encourages a shift in focus from appearance and weight to sustainable health practices that support both physical and mental well-being.

 What would you recommend to someone who has experienced weight stigma?

If you or your child have suffered due to weight stigma, especially in the healthcare setting, it is understandable that you would feel hesitant about going to the doctor. However, there are things that you can do.

Find a weight-inclusive provider, one who is familiar with the HAES approach. Many providers advertise these approaches, and patient reviews or directories can often provide insight into their practices.

Call ahead to discuss with staff and your provider that weight should only be taken if absolutely necessary, or if it is the focus of your symptoms or concerns. If it is necessary to take your weight, you can request for a blind weight (only the staff member/provider will see the weight) to be taken.

If this is a visit for your child, you can request that the provider does not discuss the growth chart/weight/BMI when your child is in the room.

Bring a trusted friend or family member with you to the appointment. This person can offer emotional support and help you advocate for yourself during the visit.

Make a list of your primary concerns and symptoms, and any questions you may have. If the conversation shifts to weight issues, do not be afraid to redirect and refocus on the concerns that brought you in. If the provider says that weight loss is part of the treatment, ask the doctor politely what advice or treatment they would suggest to a patient in a smaller body.

ASDAH (Association for Size Diversity And Health) provides advice on how to advocate for yourself in medical settings. Becoming more informed about weight stigma can empower you to better communicate with your provider.

Remember, you and your family deserve respectful and compassionate care, and it’s okay to speak up if you feel uncomfortable or judged. Seeking a provider who prioritizes your overall physical and mental health can make a significant difference in your healthcare experience!

 I couldn’t agree with you more. Where can people reach you to learn more about your services?

They can email me at beyondthereflectionmd@gmail.com or visit beyondthereflection.com. I’m also on Instagram at beyond_the_reflection_md.