Weight Bias in Healthcare

Note: This will have a few spoilers for season 2, episode 8 of the show The Pitt.

Weight bias in the healthcare industry is unfortunately nothing new. I experienced it myself when I was in college, when a doctor insinuated that I got a staph infection because I was overweight and therefore must be unhygienic. (Never mind that staying at a hospital is a high-risk factor for getting a staph infection and was almost certainly where I got mine.)

I do think there’s more awareness now, as well as efforts not to treat people poorly because they’re a larger size. But there’s still work to do, as a recent episode of the show The Pitt illustrated.

For those not familiar with The Pitt, each season follows one shift in a Pittsburgh emergency department, with each hour of the show being one hour in the department. It’s a training hospital, so the staff includes experienced professionals like Dr. Michael "Robby" Robinavitch, a senior attending physician, and Dr. Cassie McKay, a third-year resident, as well as medical students.

In season two, episode eight, which takes place at 2 p.m., one of the patients was a very overweight man named Howard. Howard wasn’t sure how much he weighed, except that it was probably over 400 pounds. The staff realized they needed to weigh him because their CT machine only supported patients up to 450 pounds, and they didn’t want to damage the machine.

How not to act

This is where the show illustrated how not to treat someone in this situation, using a medical student named Ogilvie. In previous episodes, Ogilvie had already shown himself to be quite insensitive and focused mainly on proving how smart he was.

In fact, the show has an accompanying podcast, and in an interview with the actor who plays Ogilvie, he said that he was worried he was being too much of an asshole, and the producers told him he needed to be more of an asshole.

That behavior came through clearly with Howard. When the team discussed what to do if Howard was too heavy for their CT machine, Ogilvie asked – within hearing distance of Howard – if they should take him to the zoo.

Dr. McKay was rightfully horrified and pointed out, “He can hear you.”

But Ogilvie still didn’t seem to get why this was a problem. He started asking Howard about his activities and why he didn’t exercise or take Ozempic, in effect blaming Howard for his size. It also felt like Ogilvie thought Howard’s weight was the cause of his current medical problem, even without knowing what the problem was.

Then Howard explained, “It took me 25 years to get this way. Car crash, burn unit, four leg surgeries over ten years. Laid me up so much I lost my job.”

Only then did Ogilvie begin to grasp that his assumptions and ideas about someone that large were false.

Modeling how to act

Thankfully, the rest of the staff treated Howard much better and tried to change the subject when Ogilvie kept hounding Howard about his weight. When the exercise question came up, a third-year medical student named Whitaker pointed out that they should focus on addressing Howard’s current problem, and Dr. Robby was quick to agree.

Later, when Dr. McKay was in the elevator with Ogilvie, she suggested that he ease up on his weight comments. When Ogilvie tried to defend himself by saying he just wanted to know how Howard got that big and how they could help, Dr. McKay replied: “We can help by finding out what’s wrong with him and treating him with respect.”

And apart from Ogilvie, that’s what they did. No one else made any judgmental comments or gave Howard disparaging looks. They also didn’t treat him like he was a problem, even when they had to bring in a large contraption to weigh him and found out he was over 450 pounds. Instead, they brainstormed and realized they could bring him to another nearby hospital with a CT machine that could manage patients up to 650 pounds.

Howard apologized for being so much trouble, and Dr. Robby replied, “It’s okay. It’s what we do.”

When Howard nodded with tears in his eyes, I got the sense that he hadn’t always received this much care or kindness from medical professionals. I also suspect that many other people have experienced weight bias, though I hope more doctors are like Dr. Robby, Dr. McKay, and Whitaker, and less like Ogilvie.

Weight bias still exists but may be changing

Much as I hope we’ll eventually get to a point where weight bias is a thing of the past, we’re definitely not there yet, and that includes in the medical industry. But seeing how The Pitt portrayed most of the doctors, and also made it clear that Ogilvie was an outlier, made me feel slightly more hopeful about weight bias in the field of medicine.

Since I lost so much weight and have kept most of it off, this isn’t something I worry about anymore when going to the doctor, but I avoided doctors for years because of it. I hope that most people no longer experience that and feel like they can get the medical help they need, no matter their size.