Table 1 Podcast episodes titles and summary points

1. Introduction to the podcast: “By undervaluing weight stigma, clinicians are perpetuating harm.”

 ▪ Like other forms of systemic oppression, anti-fat bias harms people across the life span and can lead to chronic stress and significant impacts on health and wellness

 ▪ Sustained weight loss is unachievable for the vast majority of individuals; by focusing on weight loss, clinicians are perpetuating a culture of eating distress

 ▪ An individual’s unique social identity includes categories such as race, gender, and sexual identity, all of which intersect with fatness. Weight-based stigma can heighten experiences of oppression at these intersections

 ▪ Fat people deserve to be seen, heard, and respected as human beings, and for their health and wellness to be considered outside of the context of body weight

2. Introduction to speakers and language: “I love that there is power, that I can take power back by using that word.”

 ▪ Treatment experiences in healthcare settings for individuals living in larger bodies often intersect with body weight, health behaviours, and feelings of shame

 ▪ Words often used by medical professionals (e.g. “overweight,” “obese”) can be experienced as violent, othering, and deeply harmful

 ▪ Each patient will have language they prefer and language they don’t. The best practice is to ask them what feels right to them and follow their lead

 ▪ For example, the word “fat” has been reclaimed by many individuals and communities as a source of empowerment and resistance and is a neutral descriptor rather than a derogatory term. However, not everyone living in larger bodies is comfortable using this word

3. Lived experiences I: “Regardless of what I go in for, I leave feeling like my body is wrong.”

 ▪ Healthcare providers commonly centre appointments around body weight and weight loss regardless of the reason for the medical visit

 ▪ Unnecessary focus on weight in an appointment can elicit feelings of shame and discourage people from seeking health care

 ▪ Experiencing care and respect from medical professionals can be rare

 ▪ When healthcare is sought, numerous additional barriers impede access and meaningful treatment

 ▪ Considerable emotional labour is required to prepare for, participate in, and recover from medical appointments

4. Lived experiences II: “You are the problem…and that’s why you can’t do this thing.”

 ▪ Fertility challenges experienced by the educator were immediately connected to body weight by medical practitioners

 ▪ The language a clinician uses is very powerful; it can invoke fear, shame and guilt and silence a patient’s voice and ability to self-advocate

 ▪ The messages the educator receives about herself at every medical appointment are harmful to her overall mental health; immense amounts of time and emotional labour are required to recover following appointments

5. Health impacts of weight stigma: “You would be very surprised to know how many fat folks walk out of a doctor’s appointment feeling like absolute shit.”

 ▪ Diagnoses among fat patients can be delayed or missed altogether because symptoms are often attributed to body weight

 ▪ A lack of furniture, equipment, and clothing that comfortably fit larger bodies can be dehumanizing and traumatizing

 ▪ Medical appointments that primarily focus on body weight leave fat patients feeling blamed, shamed, and scared to return

 ▪ The stress of weight stigma takes an incredible toll on fat patients’ health

 ▪ Empirical measurements (e.g. blood pressure, blood sugar) may be influenced by anxiety and fear experienced in anticipation of criticism and shame during a medical appointment

6. Distressed and disordered eating: “Your weight is going to determine how you’re treated, versus your actual needs.”

 ▪ Many individuals who experience disordered eating identify interactions or interventions within the medical system – often as early as childhood – as being at the root of their eating distress

 ▪ Disordered eating is often not recognized in fat patients, who are praised for losing weight and becoming “healthy”

 ▪ When disordered eating is diagnosed among individuals in larger bodies, the treatment received and support available can differ substantially from those received by individuals in smaller bodies

 ▪ Intersecting social identities and weight-based discrimination can compound eating distress; one educator describes the incompatibility between the criteria for gender-affirming surgery and recovery from disordered eating

7. How can clinicians do better: “Give control and self-determination to us, to make our own choices on how we want to speak on our bodies.”

 ▪ Be ok with not knowing all the answers

 ▪ Get comfortable having uncomfortable conversations; ask patients if they would like to talk about body weight and, if yes, what language they’d prefer to use. Listen to and respect their wishes

 ▪ Familiarize yourself with the current evidence about weight and health

 ▪ Familiarize yourself with the potential harms associated with a weight-focused approach and prescribing weight loss as an intervention

 ▪ If you think it is necessary and relevant that a patient’s weight be discussed, ask their permission

 ▪ Ensure that all body sizes are represented in medical education and training

 ▪ Ensure that your practice includes medical equipment, clothing and furniture that fit all body sizes