Opinion: I’m a fat medical student. I refuse to let myself be shamed for it

“What are you doing? You can’t wear those here!” the nurse exclaimed, speed-walking down the operating room entry hall to me. She was the third person that morning to remark on my scrubs. It was only 7:05 a.m. I explained to her, as I had to the others, that I was a medical student, and that the hospital had given me the bright turquoise scrubs because they were the only plus-sized ones available. She lifted a suspicious eyebrow, but ultimately walked away, allowing me to proceed into the OR, where I already struggled to feel comfortable. (The future primary care physician in me would much rather talk to a patient than cut into an anesthetized one.) Before I started medical school, my primary care doctor, a larger-bodied person herself and practitioner of Health at Every Size (HAES), warned me to brace myself for the disgust for fat people that is embedded within medical education, keep my head down, and power through. She was both right and wrong. I’ve had negative interactions — but I’ve also had joyful ones. And I haven’t kept my head down. Yes, I’ve experienced body-shaming myself. Yes, I’ve witnessed health care workers openly mocking patients’ weight (often ones who are much smaller than me). Yes, I’ve watched a parent berate her 9-year-old daughter for her size and snacking habits, witnessing the little girl’s self-esteem crumble. Then there’s the bruises from hours spent in lecture hall desks piercing my abdomen, the absence of a coveted Patagonia fleece that doesn’t come in my size, and the white coat drop-down menu that didn’t include plus sizes — which have all been stark reminders that future doctors are not expected to come in large sizes. To some attendings, I look more like a patient due for GLP-1 counseling than their future colleague. It is well documented that medical doctors hold strong weight biases, both implicit and explicit, and I suspect there is some degree of discrimination against fat applicants to medical schools. The body size of doctors and medical students does not nearly represent the size distribution of the general population. Although weight stigma’s effect on medical student admissions has not been studied extensively, one 2019 study did find “preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection.” One of my mentors at a different medical school noticed the number of fat students increase in the post-Covid era of virtual interviews, suggesting that appearance-and-size-based biases may have played a role in medical school acceptance decisions, especially when interviews were held in person. Virtual interviews may have helped mask body size from admissions committees, leading them to unknowingly accept more fat applicants. We talk a lot about representation in medicine in health equity work, but fat patients and clinicians are left out of the conversation — perhaps because in medicine, we are taught that fatness is a transient disease state to be fixed, rather than an identity or a community of people worth consulting and including with intention, whose perspectives may add value. As a medical student in a larger body, I have often been ostracized, othered, made to feel different, like I’ve invaded a secret society of thin people. Sometimes, it feels like my identity as medical student is a magic cloak obscuring my identity as a fat woman. It has been both revelatory and deeply hurtful to witness how doctors and students speak about people who look like me, in front of me. During sign out, when doctors tell each other about patients at shift change, body mass index was a constant source of eye rolls and jokes. One day when reviewing the list, one of the physicians shouted, “They’re all huge!” At times, colleagues seem to talk at my brain disembodied, with complete disregard for my physical being sitting in front of them. When colleagues and teachers fail to consider my body during academic conversations about weight, I see it as a missed opportunity to engage with my lived experience and emerging professional expertise on this topic. But that doesn’t mean all body comments are welcome. One day on my psychiatry rotation, I called out “happy Friday” to the friendly security guard manning the exit. Instead of waving goodbye, he caught the door behind me and followed me into the small vestibule separating the locked psychiatry ward from the rest of the hospital. There, he told me that he had lost over 50 pounds on a GLP-1, suggested I talk to my doctor about it, and added that he was “doing a good deed” by raising the subject with me. Saved by the ding of the elevator, I retreated, the shock spilling over me as the elevator doors slammed shut. Instead of shrinking, I decided early on in my training to stand up to stigmatizing ideas and question the “thinner is better” approach to medicine. I made a choice to openly discuss my body with faculty and students as a form of advocacy and resilience. During a lecture on nutrition counseling, I pushed back against a professor preaching sweeping assumptions about larger-bodied patients. On a clinical rotation, I spoke up to inform a room full of doctors that “morbid obesity” is a slur. I even secured an annual slot to teach about weight bias in the M.D. curriculum. Each time I invite classmates and faculty to consider my perspective, I draw attention to my own body. Contrary to my own doctor’s warning, and some of the indiscretions I described earlier, I have mostly been pleasantly surprised to find support from fellow students and seasoned physicians. Many have shown genuine curiosity and an openness to changing their ways. Now, as I reach the end of medical school and prepare my applications for family medicine residency, I am actually hopeful medicine is ready to move in a more positive direction. So rather than remaining invisible, I proudly told that 9-year-old girl that healthy bodies come in all shapes, sizes, and colors, despite her mom glaring at me from the corner of the room. Through small moments with my own patients, and broader advocacy efforts, I strive to continue to improve the way medicine and society treat larger-bodied people. I am hopeful that we are ready. Jessica Rosenblum is a fourth-year M.D./M.P.H. student at Tufts University School of Medicine, director of Medical Students for Size Inclusivity, and a board member of the Association for Weight and Size Inclusive Medicine. These views are her own and do not represent any organization she is affiliated with.