The fat shaming has to stop. Period. I’m not just talking to trolls who harass people online. I’m calling out my fellow doctors too.

Fat Shaming Is Everywhere

You cannot look at someone and know if they are healthy or not. In that snapshot, you cannot make accurate predictions about their body fat or muscle mass. You sure can’t tell what their fitness level is or if they are active in their everyday life.

Unfortunately, so many people judge each other based on appearances. They make assumptions based on unfair stereotypes (e.g., “fat people are lazy”) and unreasonable societal expectations based on what they see in pop culture and the media (e.g., “if you’re not thin, you’re not healthy”).

We come in all shapes and sizes. People should feel comfortable in their bodies, not attacked for them.

Looks Can Be Deceiving

Let’s be clear. A pound is a pound whether it’s made of muscle or fat.

The difference is that muscle is more dense. This means a pound of muscle takes up less space than a pound of fat. Visually, for the same weight, someone with more muscle looks like they weigh less. They are also more likely to wear smaller clothing sizes. That doesn’t change the fact that both people weigh the same and their BMI, for the same height, is identical.

People, doctors included, who put too much emphasis on BMI could be mislabeling people as obese.

Don’t assume that someone who is heavier is not fit either. There are plenty who could run circles around folks who are thinner than they are.

Behind Closed Doors

The doctor’s office is supposed to be a safe place where you can ask questions and get support. You should be comfortable asking questions and in no way should you be put on the defensive. Unfortunately, many people feel this way when it comes to their weight.

Doctors don’t even realize they are shaming their patients half the time. They calculate a BMI and if the number is high, they dive into a lecture on obesity and weight loss. Despite their good intentions (they want to decrease obesity-related health problems), they fail to ask themselves if the BMI is even accurate. Are they offering information that will be helpful? More importantly, are they delivering it in a way that will make their patient receptive?

Too many doctors give these lectures without offering practical solutions (what specific thing can their patient actually do?) or taking consideration into what the patient has already done. Even when someone says they’ve tried “everything”, the doctor often gives them the same generic advice — diet and exercise. When doctors give token advice this way, it can come off as not caring or even that they are fat shaming their patients.

A 10-Step Approach for Healthcare Providers

Healthcare providers should not tip toe around obesity. It can have real-life health consequences and it needs to be addressed. That said, there is a better way to approach it, a healthier way that puts an end to fat shaming. We need to be more accepting of people and their bodies, regardless of their size.

1 — Don’t rely on BMI alone to diagnose obesity.

BMI, at best, is a screening tool. Consider body composition (e.g., body fat and muscle mass) and other measurements (e.g., waist circumference, waist to height ratio, waist to hip ratio) before you diagnose someone as obese.

2 — Go beyond BMI to track weight changes.

When someone starts an exercise program, they may not lose weight. They might even put on weight if they increase muscle mass. Relying on BMI alone may make it look like they haven’t made any gains. If you want to track their actual progress, check body fat percentages too.

3 — Don’t pontificate.

Words matter. You can explain the risks that come with obesity but scare tactics won’t work. In fact, they could do more harm than good. Be honest but focus on what people can control.

4 — Look past the numbers.

A person is more than a BMI or body fat percentage. Each person will have different circumstances and stressors in their lives. Ask about them so you can better understand how to help them reach their goals. There is no one size fits all solution.

5 — Respect cultural differences.

Asking someone to change their diet or lifestyle in a way that affects their ethnic or cultural background is wrong. No one should feel they have to change their identity. There’s always another way. Be open and get creative

6 — Set reasonable goals.

Don’t tell your patient how much weight to lose. Ask how much THEY want to lose. After all, this is about them, not you. Involve them. When you make a plan together, they are less likely to be overwhelmed and are more likely to succeed.

7 — Be patient specific.

Everyone knows that diet and exercise is good for them. Don’t give token advice. Tailor a plan for THIS patient. Even small incremental changes can make lasting progress.

8 — A healthy lifestyle is for everyone.

People should never feel targeted because of their weight. This can come off as fat shaming. Remember that EVERYONE benefits from a healthy lifestyle, not just people who are overweight. Let them know you talk to all your patients about diet and exercise.

9 — Support them.

When someone loses weight, congratulate them. When someone doesn’t lose weight, encourage them for having tried. It’s important to acknowledge their effort.

10 — Take a step back.

Losing weight is hard and there can be any number of obstacles. Not everyone will succeed. Instead of badgering people about weight at every visit (which could make them feel like a failure), focus on how you can optimize their health in other ways.