How to navigate medical appointments when you have body image struggles
What this post covers: Why doctor visits feel so awful when you struggle with body image, what to actually say when a doctor comments on your weight, how to prep beforehand, and how to take care of yourself after. Because you deserve better care than what most of us have experienced.
What's Inside:
Why Do Medical Appointments Feel So Triggering?
Most commonly, clients come to me feeling tremendously anxious, already beaten down by the system. They expect (and often from reasonable life experiences) that there will be assumptions made, pressure applied, and their key concerns diverted to weight loss.
They dread the "ok, we need your weight" moment, stepping on the scale in a hallway in front of passersby, or even just in the private exam room. Then comes the flood of assumptions from appearance and that dreaded Body Mass Index (BMI) that inevitably comes up once the doctor enters the room.
It's an experience of powerlessness and being controlled by a medical system that doesn't want to hear their true concerns. Many put off appointments for quite a long time as an act of self-protection and preservation.
It makes SO much sense that people with body image struggles feel terrified or frozen in medical settings. This dynamic is inherently imbalanced. There's an authority that comes with entering a doctor's office, and often across the board, there can be a belief that we have to do exactly what the doctor says because they know best. This automatically puts patients in a place of feeling less than, less knowledgeable about their own body and experience, and minimizing things that are really bothering them (especially when the assumption is that weight is causing every ailment a person has).
And let's name something: people with body image struggles are hypervigilant to the tiniest gestures, tone, etc., from every contact in the doctor's office. That's a trauma reaction that is valid and protective, and it can be completely overwhelming and totally exhausting.
What Else Feels Shaming at the Doctor (Besides the Scale)?
Beyond the scale, there's so much that feels triggering or shaming in a medical office:
The chairs in the waiting room being too small, or IN THE EXAM ROOM. Like, please can we have armless chairs or a bench!?
The blood pressure (BP) cuff size being too small, causing physical pain or plainly not fitting properly to give an accurate reading (don’t even get me started on THAT problem).
The gowns you're provided. I can't tell you how many times I was given one way too small gown and had to peek my head out asking for a second gown to wear backwards to cover my other side.
Then of course the actual reason you came to the doctor and that sinking fear that your knee pain, headaches, or stomach aches are nearly always going to be approached as caused by weight, somehow.
And the dreaded after-visit summary with your weight and BMI plastered boldly right on the front page, as though we could ever forget.
Why do so many people feel they have to comply with weight-focused advice even when it hurts them? Like I mentioned before, it's a power imbalance that puts the doctor as the automatic expert who knows your body better than you do. Especially if we haven't been introduced to body neutrality or the concept of weight stigma, we might not even know there's an alternative. And even if we do know, it's scary! Standing up or pushing back is honestly anxiety-provoking. And I mean, I know I'm perpetually fearful of being labeled as a "difficult patient" — anyone else flashback to Elaine Benes' on Seinfeld. IYKYK.
What Can I Say When a Doctor Comments on My Weight?
Why Does a Weight Comment Feel So Devastating?
When a doctor comments on a patient's weight, the immediate reaction is often shame - a deep, penetrating shame that goes right to the core. It hits on every comment, every critical thought, every diet ad, every image of the "ideal body," a lifetime of judgments and assumptions that can feel like an internal collapse.
Listen, that reaction makes SO MUCH SENSE. We've been through it, we've heard the underlying comments of people, and in today's world we're just holding our breath until GLP-1/GIP medications (like semaglutide or tirzepatide) enter the conversation. It makes sense to have these feelings arise, AND we can approach them in a compassionate and understanding way.
What Are Specific Phrases I Can Use in the Moment?
Here are specific phrases you can use in that moment. Choose what feels most authentic to you (or make up your own):
• "I'd prefer to focus on my symptoms today."
• "Comments on my weight are not helpful for my care. Can we move on?"
• "How does my weight specifically relate to the issue I'm here for?" (You might even add: "What do you suggest for your thin patients with this issue?")
What If My Doctor Gets Defensive or Dismissive?
If the doctor gets defensive or dismissive, here are your options:
• "It seems we have differing beliefs that don't align in a way to best support me, so I'm going to have to end this appointment now."
• "I'm not here to discuss my weight. If you can't respect that, I need to leave."
• Silence and stand up and exit the room — there may be times this is the best way we feel we can support ourselves and get out of the situation.
• Silently nod and when they ask if there is anything else, you can just say no and leave the room. This could be followed up with an online message detailing why you will be seeking a different provider, or simply calling the scheduling line and setting up an appointment with someone else.
How Do I Take Care of Myself After a Bad Appointment?
First and foremost, take deep breaths as you leave the space and walk out of the building. It's okay if tears come — that's real and honest. It's also okay if they don't, or if anger rises, or if we feel completely disconnected. Those are all understandable responses to the experience we might have just had.
Call a support person, someone who you know can listen.
Schedule a check-in or session with your therapist.
Take out your journal and write freely until you feel that you've let it all out.
Do whatever you need to have a tiny bit of comfort and soothing.
AND please know that this doctor's weight stigma and assumption does NOT say anything about who you are as a person or your value in the world. You are worthy, you are valuable, you are important just as you are right now. Hard ideas to take in, but really very, very true (even with so many parts of us that want to shoot it down).
How Can I Prepare Before a Medical Appointment?
How Do I Ground Myself Before Walking In?
Some of my best suggestions for prep:
Talk with someone you trust and who supports you. Let them know you're going into a tough appointment.
Write your key points down, a note in your phone or an old-fashioned piece of paper. Just have the reasons you are going in top of mind so you know what you need answers to and what is not relevant to your concern.
Have some phrases ready like some listed above: "No thank you, I'd prefer not to discuss my weight today," "I would prefer to discuss my symptoms today," etc.
How Do I Find a Weight-Inclusive Provider?
Try asking some of these questions:
"I'm in recovery from disordered eating/body image issues. Is this provider able to provide weight-neutral care?"
"I require weight-neutral care. Is this something your office can provide?"
“Is your office Health at Every Size-aligned?”
What If I Couldn't Advocate for Myself? Is That Okay?
I want readers to feel they have a few tools to take with them that can help them feel even a smidge more grounded walking into the doctor's office. And to feel that they deserve the same respect and care that someone in any other body shape or size deserves. They are worthy of compassionate and kind medical care.
You're not alone. The systems we live in suck and cause a lot of harm, AND there are people who have your back. There are so many wonderful people who understand that all bodies are deserving of care. Even if you go into the appointment and you don't even look at that list you prepped, or you rush home and cry, or zone out, or scroll for an hour - it's OK! Those are still valid responses and really wise ways we learned to care for ourselves.
Just the act of considering your true worth and inherent value is a massive act of compassion and a step toward strengthening your trust in yourself.
About the Author
Sarah Jane Thomas, LMFT is a licensed therapist in private practice specializing in body image, disordered eating recovery, and weight-inclusive care. She helps people move from control and shame toward self-trust and body liberation. Sarah offers virtual therapy for clients across California.
Ready to Explore This Further?
If you're feeling overwhelmed by the medical system and want support navigating it, I'd love to hear from you.