Why avoiding your doctor makes complete sense

 Weight stigma doesn't just happen inside the consultation room: it keeps fat people out of it entirely. In this episode, you'll meet Ren. Ren hasn't seen their GP in eighteen months, not out of laziness or neglect, but because the last appointment cost far more than it was worth. 

I make the case that medical avoidance is a completely rational response to a system designed to punish fat bodies. The resulting missed diagnoses, untreated conditions, and compounding health consequences aren't a fat problem, they're a doctor problem. 

But this episode isn't just about what's broken. It's about what you can actually do right now: how to walk into that appointment armed with your rights, set your own agenda, and reclaim the power that was always yours to begin with. 

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Transcript

Hello, and welcome to Season 6 of the Fat Doctor podcast, Episode 20.
I'm recording this just a couple of days after releasing my book, No Weigh! Everything You've Been Told About Weight Loss is a Lie, and I'm feeling rather excited — and a little bit smug, if I'm honest.
The one thing I recognise about this book is that it does a really good job of explaining all the things that are wrong with the way that doctors treat their fat patients. So you might get to the end of the book and just go: well, fuck. Now what?
I thought I would spend the next few episodes of this podcast really trying to speak to people — to fat patients, to fat people in general. And even if you're not a fat person, you probably know fat people who will benefit from this. Or you're an ally, or a healthcare professional who's trying to do better by your fat patients — in which case, great, this is for you as well. But I really wanted to focus on the experience of going to see the doctor. What can you do in the here and now?
In an ideal world, the system changes. The world becomes a kinder and more respectful place for fat people, especially within the healthcare profession. I do believe that's going to happen. I think there are people out there genuinely interested in making a change, and that gets me very excited. But what do you do in the meantime? Because right now, you can't wait for things to change.
So I have created a few composite characters. They're not real people, because I don't like sharing real people's information on the podcast, even if they give me permission. I'm creating characters based on my own experience with my own patients, but also the hundreds and hundreds of you who have, over the last few years, told me your stories — been so generous as to share them, and told me what it's really like, what you're really struggling with.
You might see some of yourself in these characters. That's not intentional — I'm not speaking about you personally. But there's a reason you'll see yourself in some of them: it's because this is really common stuff. This happens to most fat people. You are not alone. So, today we're going to talk about Ren.
Meet Ren. Ren is in their early 40s. Ren works from home, doing something techy and analytical, because they're an analytical person. I'm not saying they're autistic, but I'm not saying they're not autistic either. They live alone, and they are quietly competent — the kind of person who researches everything thoroughly before making any decision, who has acquired a lot of knowledge over time. That includes knowledge about their own body and about medicine, even though they're not medical.
Ren has been managing a persistently, but intermittently, sore throat. It comes and goes, but it's always there — it's been there for years, actually. They occasionally develop a hoarse voice, especially during Zoom meetings, sometimes randomly, and it'll be there for a few days then go away. It's never been bad enough to warrant seeing a doctor, although deep down, I think Ren knows: this isn't right, I probably should see someone about it. They're just avoiding it — pretending it's not there, burying their head in the sand, hoping for the best.
This is really, really common — for everyone, really, who has medical symptoms, because you're afraid of what it might mean. But it is especially true if you're a fat person. Why? Because the last time Ren went to see a GP, the GP spent the first ten minutes talking about their weight before Ren even got a chance to talk about why they were really there. Because actually, they were there for a rash — granted, in a part of their body that was slightly fuller than some people's, but still, just a rash. The GP launched straight into a weight loss lecture. It turned out the rash was contact dermatitis that hadn't responded to over-the-counter medications and needed a stronger steroid — that was all. But it resulted in a ten-minute weight loss lecture.
There's the whole "one appointment, one problem" thing that doctors have drilled into their compliant patients. And at that point, Ren just wanted to get out of there. They couldn't even think about mentioning the sore throat, so they left it. That was eighteen months ago. They don't want to go back — totally understandable. And Ren is not the kind of person who avoids things in general. They're just someone who has learned that this particular thing costs too much. This particular thing isn't worth it.
So what do they do? They Google their symptoms, ask around, go on Reddit and Facebook, and have convinced themselves it's probably nothing to worry about — even though they know, deep down, it might be. They've convinced themselves they're okay. They have a well-worn set of coping strategies: herbal teas, honey and lemon, supplements. They try not to get too involved in wellness content, because they know there's a very fine line between helpful content and really problematic, far-right, hideous content. But they're doing whatever they can at home to manage this sore throat — anything that feels like they're doing something — because otherwise they're going to have to walk into that GP's office again.
Avoidance is completely rational. This is not irrational behaviour. I hear some doctors say, "It's not my fault if the patient doesn't present with the symptom — how can I treat them?" That is really shifting the responsibility. No — avoiding the medical profession because you experience so much stigma and trauma is a completely rational response. It's not a personal or moral failing, it's a rational response. There's nothing wrong with Ren. There's something wrong with the system.
Now, the turning point comes one day when Ren is chatting with a friend, and the friend mentions that their boss was recently diagnosed with a form of lung cancer. The cancer had been pressing on the laryngeal nerve that controls the vocal cords, and as a result the boss had a very hoarse voice that didn't seem to settle for several weeks. They went to the doctor, had an x-ray, and a tumour was found. And of course — Ren panics.
Oh shit. I have a sore throat, I have a hoarse voice. What if it's cancer?
And then there's that terrifying moment, because Ren knows: I can't ignore it anymore. They probably knew all along, but shit just got real, because now it's someone they know of. It's no longer something they can ignore.
Don't worry, folks — Ren doesn't have lung cancer. Now I'm diagnosing fictional characters like I'm in an episode of House, because I don't have real patients anymore, and the thing I miss most is the diagnostics. I love a good puzzle. So, if I had to guess: Ren almost certainly has reflux. The reflux is causing the change in their voice, and may also cause a cough. Reflux is very, very common — and always gets blamed on weight, when actually it has nothing to do with weight. It has to do with the sphincter at the top of the stomach not doing its job properly. It's supposed to close when you're not eating and only open when you are, but if it doesn't — if it opens when it shouldn't — acid from the stomach can reflux up the oesophagus and get into the throat, causing a cough (especially at night when you're lying down), a sore throat, and intermittent hoarseness. So there you are. I've just diagnosed my fake patient.
It's really easy to treat. And if Ren hadn't experienced all that awful weight stigma every time they saw their GP, and wasn't avoiding the GP, most GPs would have come to that conclusion pretty easily — tried omeprazole or lansoprazole for a month, seen if it made any difference. Pretty standard stuff. It's just that Ren didn't feel comfortable talking about it, and never got the opportunity.
And that's the real cost of staying away, isn't it? Yes, I can tell you some horrendous stories of diagnoses that got missed — people literally dying because of it — and those stories are powerful and I don't want to diminish them. But I also want to point out that for most people, it's the little things: putting up with a sore throat and hoarseness for years on end because you just don't want to see the doctor. It's all the little things adding up — a bit like microaggressions. There's the explicit prejudice and discrimination, which is really horrible. But it's the quieter, less obvious things that get to most people, and I can't stress enough that those matter just as much.
There's the "don't miss the lung cancer" part, of course. But there's also everything you miss in the meantime — not getting a chance to treat the reflux. That's just as important.
I talk about the consequences of medical weight stigma in Chapter 4 of my book, No Weigh! — I think it's personally the most powerful chapter. I basically make the point that doctors are making their patients sick because of weight stigma. If people are staying away and not getting the care they need, not only are important diagnoses getting delayed or missed altogether, not only are the little things causing distress over time — we're also not picking up things we would be picking up in thin patients, like high blood pressure. We know that if we don't treat high blood pressure, people are more likely to have a heart attack later on. Fat people are more likely to have heart attacks. Who's to say it's not because of weight stigma? In fact, there's a strong argument to be made that it is — a combination of medical avoidance, missed symptoms, not treating the root cause, and fobbing people off with lifestyle and weight loss advice instead. And the stress of not getting adequate healthcare. Put all of that together, and it's no wonder fat people are more likely to have heart disease.
But who's responsible?
We cannot accept a healthcare system that is designed to punish fat people, because fat people will stop coming. And we know this. There are certain groups of people who won't report symptoms unless we create an environment where they feel safe enough to do so. That's why sexual health clinics have specific provision for young people. That's why there are clinics for the LGBTQ+ community. That's why we're trying to encourage men to report mental health problems. There are times when the medical profession is finally cottoning on to the fact that maybe we ought to be doing this better. But when it comes to fat people — nobody cares. Conditions are caught late, symptoms are normalised, fat people avoid seeing the doctor, and weight stigma is the root cause of all of it. Not laziness. Not even neglect. Weight stigma.
Chapter 4 of the book covers what fat patients have come to expect from seeing their doctor. If you're fat, you know what I'm talking about before I even say it. First of all, there's the look. You know the look. You've experienced the look — as you're walking in, as you sit down. You can tell that they've already entered "weight-related joint pain" or "weight-related fatigue" into the computer. The diagnosis has already been made. Decision made. Before you even have a chance to explain what's going on.
Then there's the way they push you — like they've got an agenda. The doctor is convinced this is weight-related, and all their questions steer you in that direction. They're not willing to consider other options. And often, the moment they get an opportunity, they'll jump in and start talking to you about weight. That's really bad practice, by the way — doctors are supposed to start with open questions, shut up and actively listen, before dispensing advice. The dispensing-advice part is supposed to come at the end of the consultation. But doctors are really quick to derail it by going into weight loss territory. This is especially true now in the GLP-1 era — the sales pitch is just at the tip of every doctor's tongue. Have you considered GLP-1s? Have you thought about Ozempic? Because they're desperate to sell it to you. And there's a reason why — that's in Chapter 8 of the book — but let's just acknowledge for now that this is the reality for most people. That's why Ren dreads making this appointment. That's why Ren's been putting it off. And as I said, it makes complete sense. The system is working exactly as it was designed to work: to pressure and coerce people into losing weight. The system is designed this way so that the weight loss industry — pharmaceutical companies and weight loss companies — can make good money, without doctors having to do any of the heavy lifting. Just a few comments here and there, a couple of derailed conversations, and cha-ching.
So the system is working exactly as it's supposed to. And you might be wondering: well, Asher, what am I supposed to do about it? Good question. That's what I'm going to spend the rest of the episode talking about.
I was having this conversation with my therapist the other day, and I said something I thought was quite profound: I often feel powerless. But I recognise that it's because I give my power away — it's not that I am powerless, it's that I allow other people to have too much power over me. I've spent a lot of my life trying to create situations where I feel more powerful, and I suspect going to medical school and becoming a doctor was one of them. Who has more power than a doctor? But the irony is, I never felt like I had any power in the consultation. Logically, objectively, I had all the power. Subjectively, I had none — because every single patient, as far as I was concerned, had the potential to destroy my medical career. I was actually very afraid of patients, because I knew that if I upset them, they had the power to complain, to initiate an investigation, and that could mean serious problems for me — up to and including being struck off the medical register.
I'm not asking you to feel sorry for me. I'm telling you this because you actually have more power than you think you have. As a patient, I imagine you sitting in front of the doctor thinking they have all the power and you have none. And also — as a doctor — I can tell you I didn't want to mess up, and I didn't want you to complain about me. In the UK, the complaints process is no fun. Every time a complaint is made against a GP, not only do they have to answer it, they have to discuss it during their annual appraisal, as part of revalidation. If you've got ten complaints, you've got to talk through all ten of them. If nothing else, it's rather humiliating.
I'm not saying don't make a complaint — I'm saying you should make a complaint if it's warranted. I'm saying that if you knew how much power you actually had, that might make life easier for you.
One of the ways to feel empowered is to understand your rights. What to expect from your doctor. What they should be doing. Because then, if they're not doing it, you can say: hey, you're not doing your job. And worst case: I'm going to make a complaint. You don't usually have to take it that far.
I really want you to know that you have more power than you think you have. And the power comes from knowledge — not knowledge about your symptoms or your medical condition, by the way. Your doctor is literally getting paid to have that knowledge. I understand why you end up doing your own research, and sometimes it becomes necessary, but what I'm talking about is knowledge about what you are entitled to. Know your rights. Isn't that always the case? Isn't that why society is so afraid of unions, of educators, of libraries, of books — because once people know what they're entitled to, they can no longer be fobbed off by lazy, incompetent, fatphobic doctors.
Knowing what you're entitled to, knowing what should happen — that's probably the first step. I talk about it in the book, and for those of you who've joined the No Weigh! movement, you're entitled to a free script. You get a free script when you join. You can literally bring it to your doctor's appointment so you know what to say and how to open the conversation on your own terms.
Doctors are supposed to be patient-led. We're supposed to provide individualised care — which means we need to know what you think, what you believe, what you want, what you're concerned about, what your expectations are. Sometimes it's just easier to be explicit about it. Just say: this is why I'm here, this is what I'm expecting. That's where the script really comes in handy. You've got it written down, you say it out loud, you set the agenda right at the beginning — and instead of being derailed into the GLP-1 sales pitch, you can say: can we get back to my agenda, please? Because your agenda is the one we're supposed to be following. Not the doctor's. Yours.
If you set the agenda and your doctor tries to derail you into weight loss territory, you can be quite explicit: "I'm just going to stop you there. I really don't want to talk about weight loss today." Or: "I refuse my consent to discuss weight loss today." Whatever feels right for you — a hand up in the air, a firm stop. If you don't want to talk about weight loss, your doctor has to stop talking about weight loss. And if they keep bringing it up even after you've said so, you can get more and more firm: "I've already said I don't want to talk about it. I refuse my consent. Use the language of consent — because they really don't have the right." And if they still insist: "I'm going to have to ask you to document in your notes that I have repeatedly said I don't want to talk about weight loss, and you keep doing it anyway."
If you live in a country where it is legal to record someone without two-party consent, you can record all of your conversations. You know that, right? You can just record them. If you have a telephone conversation with a doctor, chances are it's being recorded anyway.
The more you stand up for yourself, the more you exercise your power. You can say: I said no, you did it anyway, and that's wrong — you can't do that. It's called consent. It's one of the many things you are entitled to.
We'll cover more over the next few weeks, but it's all laid out in Chapter 4 of No Weigh! — what you're entitled to, what you can expect from your doctors. I even quote the General Medical Council's Good Medical Practice standards — there are very explicit expectations of doctors, their duty of care, the standard they're held to. And if they're not meeting it, they are in breach of their duty of care. That's a serious problem, because appraisal is annual, revalidation is every five years, and you can't revalidate if you're in breach of your duty of care.
Know that you have power. I don't want you to go around trying to ruin your doctor's careers — that's probably not the healthiest attitude, although I will say there are moments when I meet some doctors and I think... you really are pushing all my buttons. In general, though, the more balanced approach is: I have rights. I am entitled to certain things. And if you're not doing your job, that's a you problem and not a me problem. And I'm going to do whatever it takes to get you to do it.
It helps to have community. My community is called The Weighting Room — it's a community I've designed with neurodivergent people specifically in mind, though of course everyone is welcome. Frequently, people will say, "I've got a doctor's appointment — wish me luck," and just knowing there's solidarity, that there are people in your corner who you can vent to and who can support you — that's so important. It really helps.
It also helps to bring an advocate with you to every appointment, if you're a fat person. I'm a big believer in that.
It helps to recognise the systems around you — why, for example, doctors are so hell-bent on prescribing GLP-1s. Knowledge is power.
It also helps to understand what's happening in your own body. In high-stress situations like a doctor's appointment, you're likely to go into fawn mode even if you don't want to. Fawning is a survival technique. Most of the time, we fawn, then we get out of the appointment and think: fuck, why did I do that? It's normal. Flight mode is also very common in these situations — that feeling of just needing to get out of there, where you'll do whatever it takes to leave. Even if it means agreeing to something you didn't want to agree to, or forgetting half the things you wanted to say, or abandoning your list entirely. And then there's freeze, which is also very common.
Knowing what's happening in your body — understanding how you personally respond in these situations — is important. Understanding the hypervigilance, the defensiveness, your communication style. Sometimes it's worth naming it explicitly to your doctor: "I've had some really bad experiences with doctors. I'm actually really stressed right now. I'm worried that you're going to dismiss me because of my weight." Being explicit and naming these things can actually be really helpful.
But all that advice aside — if you've got a symptom and you've been avoiding the doctor because you don't want to deal with the weight stigma: I get it, I totally do. But I also want you to go and see your doctor. Even if it's not anything serious — it's probably not cancer, no matter what Google says — I still want you to go. If nothing else, because you shouldn't have to suffer in silence.
And I want to remind you: it doesn't have to be perfect, it just has to happen. It might be a really unpleasant experience, or it might go much better than you expected. You don't know. But sometimes we're so desperate to get it right first — I'll go once I've done the research, once I've figured out what's wrong, once I've lost the weight — don't do that. Just go. Make the appointment. Tell someone you're making it so they can hold you accountable. Get someone to make the appointment for you if you can't do it yourself. Whatever it takes, get there. You don't have to be perfect, you don't have to be great. You just have to show up.
There is a script available. If you're already a member of No Weigh! and you want it, just email me and I'll send it to you. If you join the No Weigh! movement, you'll automatically receive it. Personally, as a doctor, if someone came in and literally read from a script — just laid out in thirty seconds why they were there — I would have been eternally grateful. It makes my life a whole lot easier: I know why you're here, you've given me everything I need to know, and you haven't overwhelmed the conversation with things that aren't relevant. Cards on the table. Everything clear and explicit. And there's a little section in there around not wanting to talk about weight, weight loss, Ozempic, bariatric surgery — you can be very explicit: that's not what we're here to talk about today.
So if you haven't got it already, get the script. If you haven't ordered the book, get the book. And if you want to know where to start, check out noweigh.org/start-here — because it really is a very good place to start.
I'll see you back here next week, when I introduce you to a new character with a different problem who I'm going to attempt to help. Thank you very much for being here. Take care.