PUEBLA, MEXICO – In 2019, Angel, who suffers from diabetes, noticed his vision was blurry. Having worn glasses since childhood, he was surprised at how quickly his vision deteriorated and decided to go to the doctor.
He told the family doctor at the clinic assigned to him by the Mexican Institute of Social Security, the country’s largest health care and social services agency, what he had experienced. Angel assumed he would be referred to an ophthalmologist, a process that requires approval from the primary care physician. But that didn’t happen.
Instead of conducting an exam, Angel said, the doctor avoided eye contact and told him he needed to control his weight to prevent the progression of what the doctor thought was obvious: Angel’s blurred vision could be a symptom of diabetic retinopathy, an irreversible condition Complication of diabetes that can lead to blindness if blood sugar levels are not controlled.
Angel, who had been viewed as “big and fat” by friends and family since childhood and wanted to be referred to only by his first name for fear of repercussions, thought there was nothing else he could do. He lived in fear of losing his sight for almost two years before realizing he had been misdiagnosed. After learning about similar cases on social media, he realized that what he had experienced during his medical consultation was discrimination based on his excess weight.
Mexico has the second highest adult obesity rate in the world. The 2022 National Survey on Discrimination found that among those over 18 who said they had been discriminated against at least once in the past year, 30% of women and 23% of men said they had been discriminated against because of their weight or height .
This type of discrimination also occurs in medical settings and is accompanied by an automatic bias known as “fatphobia.” Patients who experience fatphobia are usually blamed for their health problems and asked to lose weight before a proper examination, say experts on the subject. These specialists, who come from a variety of disciplines, promote comprehensive health care that focuses on weight and provides patients with dignified treatment.
The stigma of being overweight
“I’ve spent my whole life knowing that I’m fat,” says Alejandra Oyosa, an independent researcher in feminism and gender studies and body and weight studies. She says she experienced medical abuse in public and private facilities where she received medical care based on her weight rather than her symptoms. “The priority was, ‘We’ll get your weight down and then we’ll see what you have,'” she says.
This focus on weight put her life in danger. In one case, she says, she went to a private doctor’s office to get treatment for fatigue and trouble sleeping. A doctor there prescribed metformin, a drug that lowers blood sugar, even though Oyosa does not have diabetes.
“My hands became extremely inflamed. (They became) purple with white spots,” said Oyosa, who was allergic to metformin.
After a series of studies, another specialist told her that the problem was related to her thyroid and that she did not need metformin. Oyosa stopped treatment and her health has improved, she says.
“(Health care professionals) often do harm to their fat patients, whether by spending less time with them, asking fewer questions about their medical history, or requiring fewer physical exams and laboratory tests.” They diagnose (these patients) based on their weight alone and are abusive or even humiliate them because of their bodies,” says María de Jesús López, a research sociologist who specializes in overweight bodies.
Angel remembers that on another occasion, the same doctor who told him he might have diabetic retinopathy refused to check him for knee pain. The doctor told him to stop “eating bread and drinking soda” and referred him to the nutrition department, he says.
Organizations such as the Council for the Prevention and Elimination of Discrimination in Mexico City have raised the issue in committees and publications. Nevertheless, López explains that there are currently no protocols for properly dealing with fatphobia complaints.
In 2023, poor doctor-patient relationships were the fourth most common category of complaints resolved by the National Medical Arbitration Commission, known as CONAMED. This category covers aspects such as ethical communication and compliance with ethical codes, but does not disclose information about discrimination complaints. The Mexican Social Security Institute, which is named in most of the complaints handled by CONAMED, could not be reached for comment.
According to López, there is also a social factor. “People do not disclose or share their experiences with health or the medical treatment they have received because of their body size, even with their families.”
See beyond weight
Traditionally, doctors measure the body mass index, the ratio of height to weight, as an indicator of health status.
“(Measuring BMI) is very important, firstly, to reduce cardiovascular risks; Secondly, to prevent the early onset of chronic degenerative diseases – diabetes, hypertension, dyslipidemia – and thirdly, to reduce hormone overproduction,” says Dr. Claudia Garcia.
In Mexico, 36.9% of adults live with obesity, making the condition the country’s “biggest health problem,” according to the National Institute of Public Health, an academic organization that reports to the Health Ministry.
However, García says weight isn’t the only factor to consider. Recent research supported by the World Obesity Federation states that although BMI is widely used, its limitations have been officially documented and it should not be used as the sole determinant of diagnosis in clinical settings.
The Asociación por la Liberación Corporal y Alimentaria para Iberoamérica, a group of activists against violence and discrimination against obese, diverse and non-hegemonic bodies, has published a list of guidelines for the positive treatment of obese people in health care. These recommendations focus on overall health and advise against weighing patients unless necessary for treatment.
María José Díaz, a doctor who has embraced this approach, removed the scales from her practice to create a space where her patients would feel more comfortable. Her priority is to be aware of diversity and take time to better understand her patients, she says.
For Angel, being treated by a doctor who couldn’t see beyond his weight had a significant impact. He stopped driving because he couldn’t see properly, had difficulty concentrating on his computer screen, and couldn’t read prices at the supermarket. Angel remembers those days with despair. But in 2021 he visited another family doctor who, after an examination, referred him to an ophthalmologist. The specialist gave Angel some encouraging news: his condition was not irreversible. He had cataracts.
According to the American Academy of Ophthalmology, one of the world’s leading associations of ophthalmologists and surgeons, diabetic retinopathy and cataracts are possible side effects of diabetes. However, unlike diabetic retinopathy, cataracts can be removed through surgery.
After a procedure, Angel’s vision is “better than ever” and he has started talking to family and friends about fatphobia to prevent cases like this from happening again.
“There are a lot of people like me,” he says. “People with big bodies who long to be treated like we matter and not like paperwork (health care professionals) have to struggle until we die.”
The Mexico City Council for the Prevention and Elimination of Discrimination recommends that medical personnel:
Individuals who have experienced discrimination based on their weight in a medical setting in Mexico can file a complaint with the Mexico City Council for the Prevention and Elimination of Discrimination and the National Council for the Prevention of Discrimination.