The Fight for Weight-Sensitive Health Care in Mexico

PUEBLA, MEXICO — In 2019, Angel, who has diabetes, noticed that his vision was blurry. Having used glasses since childhood, he was surprised by how quickly his vision had deteriorated and decided to go to the doctor.

He explained what he had experienced to the primary care physician at the clinic assigned to him by the Mexican Institute of Social Security, the country’s largest institution for health care and social services. Angel assumed he would be referred to an eye doctor, a process that requires authorization from the primary physician. But that’s not what happened.

Instead of performing an examination, Angel says, the doctor avoided eye contact and told him that he needed to control his weight to prevent the progression of what the doctor considered to be obvious: Angel’s blurred vision could be a symptom of diabetic retinopathy, an irreversible complication of diabetes that can cause blindness if blood glucose levels are not controlled.

Angel, who has been considered “big and fat” by friends and family since childhood and who asked to be identified by first name only for fear of repercussions, thought there was nothing else he could do. He lived in fear of losing his sight for nearly two years before discovering he had been misdiagnosed. After learning about similar cases on social media, he realized that what he had experienced during his medical consultation was discrimination for being overweight.

Mexico has the second-highest adult obesity rates in the world. The 2022 National Survey on Discrimination revealed that of people over age 18 who reported experiencing discrimination at least once during the year prior, 30% of women and 23% of men said they had been discriminated against due to their weight or height.

Medical environments are not free from this type of discrimination, which is associated with an automatic bias known as fatphobia. Patients who experience fatphobia are usually considered responsible for their health problems and are told to lose weight before being examined properly, say experts on the subject. Hailing from a variety of fields, these specialists are promoting comprehensive health care that deemphasizes weight and enables patients to receive dignified treatment.

The stigma of being overweight

“I’ve spent my whole life knowing I’m fat,” says Alejandra Oyosa, an independent researcher in feminist and gender studies as well as body and weight studies. She says she has experienced medical mistreatment in public and private institutions, where she’s received health care based on her weight instead of her symptoms. “The priority was, ‘We’re going to get your weight down, and then we’ll see what you have,’” she says.

This focus on weight put her life at risk. In one instance, she says, she went to a private doctor’s office seeking treatment for exhaustion and trouble sleeping. A doctor there prescribed her metformin, a medication that lowers blood sugar, despite the fact that Oyosa does not have diabetes.

“My hands got super inflamed. [They turned] purple with white spots,” says Oyosa, who had an allergic reaction to metformin.

After a series of studies, another specialist informed her that the issue was related to her thyroids and did not require metformin. Oyosa suspended the treatment and her health improved, she says.

“[Health care professionals] often inflict damage on their fat patients, whether by spending less time with them, asking fewer questions about their medical history, or requesting fewer physical exams and lab tests. They diagnose [these patients] based solely on their weight, and even insult or humiliate them because of their bodies,” says María de Jesús López, a research sociologist who specializes in overweight bodies.

Angel remembers that, on another occasion, the same doctor who told him he might have diabetic retinopathy refused to examine him for knee pain. The doctor told him to stop “eating bread and drinking soda” and referred him to the nutrition department, he says.

Organizations like the Council to Prevent and Eliminate Discrimination in Mexico City have raised the issue in panels and publications. Yet, López explains that there are currently no protocols about the proper handling of fatphobia complaints.

In 2023, poor doctor-patient relationships was the fourth-leading category of complaints resolved by the National Medical Arbitration Commission, known as CONAMED, the organization that manages complaints about possible irregularities in the provision or denial of health care services. This category covers aspects like ethical communication and keeping abreast of ethical codes but does not disclose information about discrimination complaints. The Mexican Institute of Social Security, which is cited in the largest number of complaints CONAMED has resolved, was not available to comment.

López says there is also a contributing social factor. “People don’t reveal or share their experiences around health or the medical treatment they’ve received because of their body size, not even with their family.”

Seeing beyond weight

Traditionally, medical professionals have measured body mass index, the ratio of a person’s height to their weight, as an indication of health.

“[Measuring BMI] is very important, first, to reduce cardiovascular risks; second, to prevent the early onset of chronic degenerative diseases — diabetes, hypertension, dyslipidemia — and third, to reduce hormone overproduction,” says Dr. Claudia García.

In Mexico, 36.9% of adults live with obesity, making this condition the country’s “main health problem,” according to the National Institute of Public Health, an academic organization that reports to the Ministry of Health.

However, García says that weight is not the only factor to consider. Recent research backed by the World Obesity Federation states that although BMI is widely used, its limitations have been formally documented, and it should not be used as the sole determinant for diagnosis in a clinical setting.

The Asociación por la Liberación Corporal y Alimentaria para Iberoamérica, a group of activists against violence and discrimination toward overweight, diverse and nonhegemonic bodies, released a list of guidelines for the positive treatment of overweight people in health care settings. These recommendations focus on comprehensive health and advise against weighing patients unless it is necessary for treatment.

María José Díaz, a doctor who has embraced this approach, has removed the scale from her office to create a space where her patients feel more comfortable. Her priority, she says, is to be conscious of diversity and to take time to understand her patients better.

For Angel, being treated by a doctor who couldn’t see beyond his weight had a significant impact. He stopped driving because he couldn’t see properly, he had trouble focusing on his computer screen, and he couldn’t read the prices at the supermarket. Angel remembers those days with despair. But in 2021, he saw a different family doctor, who referred him to an eye doctor after an examination. The specialist gave Angel uplifting news: His condition was not irreversible. He had cataracts.

Diabetic retinopathy and cataracts are both possible side effects of diabetes, according to the American Academy of Ophthalmology, one of the world’s leading associations of eye doctors and surgeons. However, unlike diabetic retinopathy, cataracts can be removed with surgery.

After a procedure, Angel’s vision is “better than ever” and he has started speaking with family and friends about fatphobia to prevent cases like his from happening again.

“There are a lot of people like me,” he says. “People with big bodies who long to be treated like we matter, not like pieces of paperwork [health professionals] have to push around until we die.”