How Fat-Shaming Leads to Patient Noncompliance

feet on a scale
feet on a scale

“Noncompliance” in medicine is used with regards to a patient who does not take a prescribed medication or follow a prescribed course of treatment. Fat-shaming leads to patient noncompliance. Confused? Let me explain.

Consider patient X. Patient X is diagnosed with epilepsy. The doctor prescribes a drug. This drug is an anticonvulsant and is commonly prescribed for epilepsy, fibromyalgia, anxiety and nerve pain. One known side effect is weight gain. Patient X gains weight as a result of taking the medication. People notice the weight gain, poke some fun about it and some make outrightly mean comments about it. Suddenly, patient X doesn’t feel so good anymore. Patient X becomes unsure about continuing the medication. Patient X decides to stop taking the medication altogether. Patient X decides that they would rather have uncontrolled seizures and risk their health rather than gain weight because of how society treats weight gain. Patient X has become noncompliant.

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The issue of noncompliance with medication due to weight gain has been such a big problem that studies are now being conducted on it. One study suggested mitigation of weight gain in patients by counseling. This sounds like a good idea, but how much of a good idea is it really if the patient is still going to be existing in a society that believes in fat-shaming and weight stigma?

Epilepsy drugs aren’t unique when it comes to weight gain. Many medications, including antidepressants, antipsychotics, mood stabilizers, corticosteroids, beta-blockers, hormonal contraceptives, insulin and even allergy medications such as Benadryl are known to cause weight gain, with some patients being more susceptible to this effect than others. This side effect — weight gain — has often come up as one of the reasons why patients become noncompliant, from antipsychotics noncompliance to antidepressants noncompliance to contraceptive noncompliance. This is extremely dangerous for obvious reasons. Noncompliance puts the patient’s health at risk, and it can even be fatal. Take insulin, for example. There have actually been diabetic patients who intentionally underdose their insulin in an attempt to lose weight. This has become one of the markers for a condition known as diabulimia. This is a very dangerous practice that often ends up in a condition known as diabetic ketoacidosis which can be fatal.

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This is where weight stigma has brought us as a society; people can’t even take their medications in peace. So there you have it: fat-shaming, a practice rooted in weight stigma, leads to patient noncompliance.

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