Let me tell you a joke. An overweight woman walks into her doctor’s office and says, “doctor, it hurts when I bend my arm.”

The doctor says, “well… lose some weight.”

Unfortunately, that’s the reality for some overweight and obese people seeking medical treatment, including me. I remember the first time I realized my medical provider was more interested in my weight than my actual health. I was 23 years old, living on my own in NYC, and it was one of the first times—if not the first—I had made my own doctor’s appointment. In spite of my begging and pleading, my medical provider at the time completely dismissed my symptoms of persistent mental fog, memory loss, and depression. Instead of helping me, my doctor “prescribed” weight loss via vigorous exercise, because “exercise releases endorphins and endorphins make you happy!” (Yep, they quoted Elle Woods, the character from Legally Blonde, at me). It wasn’t until almost a decade later, at the age of 29, that I was properly diagnosed with adult attention-deficit/hyperactivity disorder (ADHD), a mental health disorder that affects every part of my life.

I suffered for years with the belief that everything I was feeling was a side effect of my weight, not realizing that I had an underlying problem that my medical provider failed to identify. And I am not the only one.

Medical Bias Is Hurting Overweight Patients

Multiple studies have shown that due to medical practitioners implicit biases against fat bodies, overweight patients may receive worse care than our straight-size counterparts; and it can lead to deadly consequences. Some experts argue that when overweight patients present symptoms doctors may not take them seriously, and the patients’ actual issues can go undiagnosed. In one study of over 300 autopsy reports, those who were overweight were 1.65 times more likely than others to have significant undiagnosed medical conditions, including serious conditions like endocarditis (an infection of the heart) or lung carcinoma (a cancer that begins in the lungs). Meaning that while other patients might be given life-saving tests and care such as CT scans and MRIs, overweight patients with the same symptoms might just be told to go home and lose weight.

“Yes, there is a weight bias in the medical community,” says Priscila Rodrigues Armijo, MD, Assistant Professor and Researcher at the University of Nebraska. Dr. Rodrigues Armijo has been conducting research on how environment and the total life of an overweight and obese patient should be a deciding factor in the treatment they receive from their health-care provider.

“The bias exists in not only how the [medical provider] sees the patient, but how they even interact with the patient, which is a problem,” says Dr. Rodrigues Armijo.

Fat Patients Fear Going to the Doctor, to Our Detriment

I didn’t realize it at the time, but the lack of diagnosis was the least of my issues with my then-doctor. Their not-so-subtle distaste for me and my fat body continued to bother me long after I had stopped being a patient there. In fact, for a long time I wouldn’t even go to the doctor. I was so convinced that every ache and pain I experienced was because of my weight and if I “just lost weight” then any health problem I had would magically disappear.

Anti-fat stigmas and body shaming do more than misdiagnose, they stop fat patients from even seeking medical treatment. In fact, according to research from the American Psychological Association, these anti-fat stigmas may be causing patients more health issues. Fat shaming and negative anti-fat attitudes from medical providers can actually cause psychological stress in patients and turn them away from visiting the doctor.

Additionally, further studies indicate that doctors aren’t even necessarily interested in their fat patients.  A 2013 study shows that when it comes to overweight and obese patients, doctors are less likely to try and build a rapport. They also show less empathy, concern, and understanding for overweight patients.

After my encounter with that particular doctor, I didn’t return to a doctor’s office until almost four years later, when even after losing 60+ pounds I was hobbling around with a mysterious ankle injury. Every doctor I had ever went to told me that losing weight was the key to optimal health; that if I just wasn’t fat, my ailments would magically go away. Turns out while exercising to lose weight, I suffered from an inflamed Achilles tendon. No amount of weight loss would have helped me get over that injury and I still suffer from the painful condition to this day.

A Stigma that Starts Long Before Patients Come Into the Picture

“I think the problem starts even when they [doctors] are medical students,” says Dr. Rodrigues Armijo. “They are taught how to treat the disease, but not empathy and not culture.” The research agrees with her: In a 2014 study of over 4,000 first-year medical students, 67 percent exhibited explicit fat bias, and 71 percent exhibited implicit bias. It seems that across disciplines, future doctors’ fat biases are fixed before they even don their white coat.

And while Dr. Rodrigues Armijo feels that more of the medical community is waking up and starting to take anti-fat biases more seriously, there are still no industry standard courses or workshops for medical students that address fat biases. One way Dr. Armijo sees students becoming more aware of their own bias is through assessments and overall better education around soft skills, such as bedside manners and communications. “We [medical programs] are starting to focus more on soft skills for medical students,” she says. “How can we assess and better see what our students are lacking? Such as empathy. That’s the first step in helping to remove weight bias.”

Fat Patients and How to Advocate

Rather than wait another 10 to 20 years for the next batch of more empathetic doctors to emerge, I decided to take my health into my own hands. I started searching for a doctor who didn’t see fat as inherently bad. I looked at sites like Healthgrades (basically a site of report cards for medical providers) and went as far as to interview doctors on the phone. Eventually, I found a medical provider who takes my concerns seriously, and gives me the treatment I know I deserve. Dr. Rodriges Armijo urges others in the same predicament to research their doctors, be open to honest and helpful conversations around weight and health, and don’t be afraid to just “go to the doctor.”

Hopefully, as we become a more tolerant society, fat stigma won’t even exist anymore. Until then, fat people will need to keep advocating for ourselves. If you’re unhappy with the treatment you’ve received, speak up and demand that you receive the same standard of care, no matter your size.