The Fat Tax, Both Tangible and Invisible

Many obese people have made the same point in various ways, like Devika Menon:

Even when you go to a doctor for medical aid, some of them will point out that whatever illness you’re going through is in your head and it will all get better when you lose some weight.

Yesterday’s post recounted two obese people’s negative experiences with the medical world, and the literature contains many more. The prolific Aubrey Gordon (aka Your Fat Friend), who has weighed as much as 400 pounds, has written many articles describing the judgment, rejection, disrespect, bullying, and outright disdain she has been subjected to. She also provides readers with facts like these:

62% of fat women report that they’ve experienced inappropriate or stigmatizing behavior at the doctor’s office.

The American Journal of Public Health concluded that anti-fat bias leads to “serious risks for psychological and physical health, generates health disparities, and interferes with the implementation of effective obesity prevention efforts.”

Even seeking treatment for ear infections has led to lengthy weight loss lectures from my providers.

That seems to be a common complaint. Of course, if it’s a weight-loss clinic or an obesity specialist, the patient’s size is fair game. But a person who shows up to, for instance, have a severed finger reattached might not want to talk about their Body Mass Index on this particular day.

Your Fat Friend has spoken of what she calls the Fat Tax, a fee that is both tangible and metaphorical. Being disbelieved and discounted are items on the psychic “fat tax” list, parts of an extra layer of difficulty that the obese need to overcome in order to obtain life-saving help. She writes,

The fat tax finds us in health care too. If we see a doctor who doesn’t dismiss our symptoms out of hand, brushing them off with a simple “just lose weight,” many of us will be required to seek care out-of-network and pay out-of-pocket just to access the same health care as thinner people.

The writer points out how travel might be necessary to find an MRI or CT scanner that can accommodate a large body. Insurance does not cover the extra expense. For a fertile woman over 175 pounds, the “morning-after pill” will probably not work. Wheelchairs, walkers, and crutches for overweight patients are very expensive. Life insurance costs more if it can be gotten at all, and an oversize casket might cost twice as much as a standard one.

Your responses and feedback are welcome!

Source: “Woman Loses 75 Pounds So That Doctors Would Finally Diagnose Her Instead Of Blaming Her Weight,”, 02/26/21
Source: “10 Requests from a Fat Patient to Her Health Care Providers,”, 02/10/20
Source: “The Fat Tax Is Real — and It’s Getting Worse,”, 04/09/19
Image by Sergio Santos/CC BY 2.0

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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