When May Partush complained of back pain, the doctors sent her to go on a diet and failed to diagnose what was later discovered to be advanced cartilage erosion. When Ronit Cohen was diagnosed with endometrial cancer, she was told she was too fat to undergo an operation and would have to receive conservative treatment. The doctor treating Sol Kantor, an endometriosis patient, ignored her pain and said she needed to get gastric bypass surgery, and Bat Sheva's doctor told her that even though her blood tests were normal, she should take weight loss injections before her pancreas gave out.
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Dozens of complaints Israel Hayom has collected in recent weeks attest to a serious phenomenon: doctors across all medical disciplines who make offensive remarks or dispense unsolicited advice to overweight patients regardless of their expertise.
Such comments have devastating effects, causing patients to avoid visiting doctors for treatment and even wrong diagnoses. Most of the complainants are women, but men also suffer from the phenomenon, indicating that the Israeli healthcare system is plagued by fatphobia: bias or discriminatory behaviors targeted at overweight and obese individuals because of their weight.
The scope of the issue is nothing short of outrageous and includes doctors who refused to treat women until they lost weight; medical conditions that worsened after patients avoid seeking treatment over derogatory remarks; doctors who work in the health insurance funds, hospitals, and even private specialists who show contempt toward overweight patients, thinking that they are helping them and encouraging weight loss.
In many cases, however, these unwarranted comments have the opposite result.
"Doctors feel that they are saving their patients' lives when they tell them to lose weight, but they don't know what happens to the patients after they leave the room," says Dr. Lena Sagi-Dain, head of the Prenatal Genetic Services Department at Carmel Medical Center in Haifa and a senior lecturer and at the Technion, who studied the phenomenon.
"People can feel so hurt, that they stop coming in for tests or ignore pain because they are constantly told that their pain is due to obesity. This is a difficult and serious phenomenon that must stop."
The doctors who treated Sol Kantor, 31, couldn't bring themselves to look past her weight, either.
As a teenager, she avoided going to doctors altogether, but years later, when she was diagnosed with endometriosis – a disease of the female reproductive system that causes severe pelvic and back pain – she could no longer avoid frequent doctor visits.
Being overweight all of her life means constantly dealing with fatphobia, she said. Of the myriad of examples she detailed, one stood out as the most egregious: "I've undergone three surgeries to excise endometriotic lesions over the past few years. The last surgery, which was complex, was in March 2020, and recovery proved difficult. My friend recommended a specialist – a gastroenterologist, who treats endometriosis patients – so I made an appointment," she said.
"I arrived with a binder containing my entire medical history but before she even looked at it, she looked at me and said that I was obese and that my illness was irrelevant. She added that I needed to undergo gastric bypass surgery, and her tone was one of 'I don't care what you say, this is what needs to happen.'
"I was furious. She knows nothing about me; she didn't look at my medical file or bother talking to me about blood tests or anything – and I know my tests are fine. I told her that according to my BMI, I'm not a candidate for gastric bypass, but she didn't care. It didn't matter that I wasn't there to talk about surgery but for something else. To her, I was fat. End of story. I'm sure that had I emailed her and she wouldn't have seen me in person, she would have reacted differently. Her attitude was beyond dismissive."
Since that meeting, Kantor has avoided seeing any gastroenterologist. Other doctors, she said, also focus primarily on giving her advice about her weight.
"It drives me crazy that when doctors see a fat person, they don't see beyond the weight. It's exhausting. I'm a woman with hormonal problems who can't lose weight because every time I try my body goes into shock, I experience excruciating pain and I end up in the hospital, where I have to endure comments from doctors, who say, 'Everything is fine, you're just fat.'"
Naama Paska Davis, one of the most prominent body-positive activists in Israel, manages a Facebook community numbering over 6,700 women, who share their daily experiences with fatphobia.
She shared her own story about degrading remarks from medical personnel over her weight, and it resonated with group members in more ways than one. Dozens of stories from members who experienced similar treatment were not slow to arrive.
"After my first pregnancy, I suffered a hernia," Davis, 36, shares. "I underwent surgery to repair it, and during a post-op checkup, the doctor noted, 'You know that some women get gastric bypass because their husbands want them to?' My partner was sitting next to me, and he was also shocked. That remark was unrelated to anything. I said 'fine' and that was it, I didn't take that stupid comment to heart.
"Early in my second pregnancy, four years ago, I went to the doctor on the sixth or seventh week with bleeding. It's very early [in a pregnancy] and it's unlikely that you can really see anything on an ultrasound. The doctor immediately declared that I had a miscarriage and rebuked me, saying I needed to see a nutritionist, adding that she won't be able to see anything [on the ultrasound] because of my fat.
"After that, I started seeing private specialists because I was unwilling to take that kind of attitude. Near the end of that pregnancy, I had to undergo an ECV," she recalls the procedure, an external cephalic version, in which a doctor attempts to rotate a baby from a breech position to the head-down position. "I was exhausted – it was a very advanced stage of pregnancy – I went to the doctor and he said, 'So big and with such a weak voice?' It was very offensive. Everything was normal with me and the baby except for the fact that he was in the breech position. There was no reason to comment on my weight."
When stories of medical fatphobia in Israel began going viral on social media, Sagi-Dain approached Davis and asked if she would partner with her on a study of the issue.
"They never talked to me about discrimination on the basis of being overweight. Not as a student, not as an intern, and certainly not as a senior doctor. I understood that this was an important issue and contacted Naama so that we could gauge the extent of the phenomenon."
First, do no harm
The two formulated a research questionnaire, which Some 1,697 subjects answered, 96% of them women. The questionnaire was intended for people with a body mass index (BMI) of over 25. The results were jarring.
While about half of the respondents agreed that being overweight placed them at risk for various medical issues and stated that they were interested in losing weight and would even be happy if the medical staff could offer them practical tools for doing so, 60% said that the fact the issue is raised in medical situations causes them considerable frustration.
Many said that they were told to lose weight despite having no interest in discussing the matter; 60% said they were told to lose weight regardless of the reason for which they sought medical advice; 58% reported being subjected to insulting, insensitive and judgmental remarks, as well as being told that their weight is the issue causing all other medical problems, and 40% stated that they frequently skip required medical treatments or tests so as to avoid being dismissed over the fact that they are overweight.
"These are very unfortunate results, they made me lose faith in humanity," Sagi-Dain lamented. "People reported hearing remarks like 'There were no fat people in the Holocaust,' to illustrate that you can lose weight if you don't eat, or 'Start eating lettuce,' which mostly indicates ignorance because eating only lettuce is also unhealthy. The results of our study made me more sensitive in my conversations with patients, and I strive to effect change among other medical personnel by giving lectures that specifically relate to the treatment of overweight patients."
Q: How do you raise awareness among colleagues?
"I start by explaining BMI and the damage of obesity and explain that while it's supposedly correct to tell patients that they should lose weight, we have to think about how to do it without offending them and making them distrust doctors.
"Think about how many medical issues we missed because patients didn't want to go to the doctor: fractures, herniated discs, genetic diseases of excess cholesterol that went untested because the doctor simply thought it was obesity. One of the subjects said that she went to the doctor over shortness of breath and was told it was because she was obese only to learn later that she had a heart problem – that can't happen," she stressed.
"I tell my colleagues that yes, being overweight is a health risk, but you have to be smart when broaching the subject. If we really want to help patients, we need to convey the message correctly. You can ask them if it's okay to talk about their weight. If they refuse – that's their prerogative."
Davis said she was not surprised by the results.
"The answers and data validated the extent of the phenomenon. I'm intimately familiar with the issue of avoiding medical treatments and receiving derogatory treatment. I encourage the members of my community to complain about doctors' attitude, mainly to raise awareness of the issue and show that a change can be made."
Q: How?
"HMOs and hospitals should train doctors. They should attend conferences and lectures on how they should behave when meeting overweight patients. With all due respect to the knowledge and experience senior physicians have, they still believe that obesity is dangerous to one's health and they must spare no effort to save this patient – including making remarks they shouldn't. We all have a common goal: to provide patients with the proper treatment."
The results of the study show that when doctors comment on patients' weight in an offensive way and without being asked for such advice, they do more harm than good and can often even aggravate the patient's medical condition – a fact to which 23-year-old May Partush could attest.
Partush complained about severe lower back pain for years, but three different doctors attributed it to obesity and didn't send her for further tests.
"Three orthopedic specialists told me that I was in pain because I was fat and didn't exercise," she recalled. "It was only when I enlisted in the IDF that I went to an orthopedist who decided to send me in for an X-ray. A week later he called me and said that I had a gap between two vertebrae in my lower back, which means that I'm missing cartilage, and all that was left was to treat the pain with local anesthetic injections.
"It was two-and-a-half years from the moment I complained of pain until I actually received treatment. It's possible that had they been more throughout from the get-go, they would have discovered low-level cartilage erosion that could still be treated. Maybe I would have become pain-free sooner. Anything is possible, but I missed that chance because the doctors only saw obesity and not the problem."
Partush underwent gastric bypass surgery two years ago. "I had a hard time with my weight, and I felt that I needed it. I'm not thin now, but I'm definitely thinner than I used to be, and when I go to the doctor, I'm treated differently," she said.
Things were much worse for Ronit Cohen. Over the years, the 57-year-old mother of four avoided tests and treatments for fear of facing comments about her obesity, including skipping knee replacement surgery, because she was told she had to lose weight first, which only made her give up in advance.
In mid-2020, however, she was diagnosed with endometrial cancer and was shocked by how the specialist whose help she sought treated her: "The doctor made my life miserable. He told me that they wouldn't operate on me because I would die on the table; that if I didn't die I would need constant care, and that let's face it – maybe I was 'going to die soon anyway.'
"I was stunned, speechless. When a doctor tells you something like that you think that the situation is really serious," she recalled. "They wanted to perform a certain test without anesthesia and I refused because it's a very painful test. He told me that the test was only painful because of my weight and that he wasn't about to put me under for that.
"I was really distressed when I left his office. I cried a lot, and I felt humiliated and angry. It's true, I'm fat, I'm battling my weight, but you can point out that it's not healthy in a different way. I didn't know what to do with myself. I was devastated. I couldn't function or work. I thought maybe it really was time for me to die."
A relative convinced Cohen to seek a second opinion from Dr. Liron Kogan, head of the Department of Gynaecologic-Oncology at Hadassah University Hospital in Jerusalem.
"He was very pleasant. He explained that there would be risks in the surgery because I am obese but it could still be performed. He even stressed that would be very unwise not to treat this disease because it could metastasize, from which there would be no going back.
"I had the operation, and although it was difficult for me to wake up after it, I recovered relatively quickly. I went to him without hope – I thought he would also tell me that I was fat and that there was nothing I could do. But the day after surgery I was up and out of bed, and in less than a week I was back to work. I got my life back," she said.
"Every patient should receive the best possible treatment, no matter how much they weigh," Kogan stressed.
"It surprises me that there are still doctors who are wary of treating such patients. This is 2022, and the Western world and obesity has been an epidemic for a long time, so even those who are overweight should receive the proper treatment. regardless of weight loss.
"In most cases, we can and do know how to do it, and those who do not specialize in these cases should refer them to someone else. We can and should treat everyone."
Kogan noted that an extensive British study found that women who are obese are at higher risk for endometrial cancer, due to the high presence of insulin and testosterone hormones.
"It used to be very difficult to operate on obese women but today, women who are significantly overweight can undergo robotic surgery to remove the tumor, as the robot can work in small, tight spaces," he explained. "It's amazing, because you can perform major surgery like a hysterectomy and using a robot, and you're able to cure a woman who used to be really difficult to treat."
Commenting on Cohen's case Kogan said that "unfortunately, this is not the first time I've encountered women who were refused surgery due to their weight and were told to pursue conservative treatment. Sometimes it's good enough, but in cases of advanced cancer like Ronit's, we couldn't wait."
Q: Is there really no risk in operating on an overweight person?
"Obesity can interfere with surgery when the volume of the intestine and the fat take up considerable space in the abdomen, making it technically difficult to reach various organs. Fat tissue also bleeds more easily. But even when we're talking about complex surgery, we can handle it and robotic surgery has clear advantages in such cases."
As for doctors commenting on patients' weight, Kogan said, "It's impossible to instruct a woman who has been overweight her entire life to suddenly lose weight because we warned her about it. I'm not the one who will be able to change that."
While women suffer from medical fatphobia the most, men are also at its receiving end, as 43-year-old "Yaakov" learned.
Last year, he sought the advice of an orthopedist due to knee pain but received a scolding over his weight, instead.
"I came to him because of knee pain, caused by an incorrect movement during exercise. Yes, I'm overweight, but I'm in good shape. The orthopedist took one look at me and all he had to say was that there was nothing wrong with me other than the fact I was obese, that no matter what treatment he prescribes, I need to lose weight, and that if I wasn't fat I wouldn't have had come to him in the first place.
"He was very blunt. I left him without answers and with knee pain that didn't go away even after I lost weight. I guess doctors find it easier to say such things to men, thinking we're probably less sensitive about our weight than women, but when I go to the doctor I expect to get medical treatment - not unsolicited advice."
Obese medical personnel are not immune to medical fatphobia either. Adva Forer, a nurse at a baby wellness center, received quite a few comments about her weight from doctors, as well.
"I suffered from prolonged menstrual bleeding following my second COVID vaccine," she shared. "The appointments to see an OBGYN were few and far between, so I went to my HMO's women's healthcare center. All the doctor saw fit to say was that I was fat and that all my side effects were the result of being overweight.
"I told her that my weight had nothing to do with it – there was clear evidence at the time that the COVID shot could interfere with the menstrual cycle and that it should be checked. The doctor examined me and said, 'Everything is fine, lose weight and that's it.' Lose weight. That's all she wrote in her notes, too - "morbidly obese, recommended to the patient to lose weight.' It was a complete disregard of why I sought medical attention and utterly unprofessional."
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Forer noted that fatphobia was "a known phenomenon among specialists like orthopedists, surgeons, and gynecologists. When I complain about pain in my leg, they talk to me about obesity. It's very easy to say that it hurts because I step on it with excess weight, but they ignore the fact that I'm on my feet for eight hours a day, for example.
"As a nurse, I can attest to the fact that the growth curves the baby wellness clinics used to follow and the ones we follow today are worlds apart," she added. "I've come across plenty of young doctors who get it, but the older ones don't. True - being overweight is a risk factor for hypertension, diabetes, etc., but when an overweight patient walks through the door, there's no reason to label them as suffering from every disease out there without first diagnosing them correctly.
"As part of the [healthcare] system, I have a better understanding of how words can affect a patient, so I choose my words more carefully. It all comes down to education."
