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This week Bianca is joined by Toronto-based writer and speaker Priyanka Saju to talk about advocating for your body and humanity while navigating the healthcare system in a racialized, fat body. Priyanka offers her thoughtful scripts to interact with healthcare providers while challenging the racist history of the BMI that is BMI racist and discussing the many ways in which implicit bias affects the care we receive.
Click here for the transcript
This week featuring:
Bianca Sprague feels especially passionate about creating access to quality pre & postnatal care for marginalized communities. She is an advocate for mental wellness for the entire family, and especially for the birthing parent, after suffering from PPD in silence and losing her father to suicide in 2012. She recognizes the barriers put in place for female entrepreneurs and believes that understanding the evolving online space can even the playing field for women in business.
Priyanka Saju (she/her) is a South Asian-Canadian writer, speaker, and space holder. Her work focuses on how we negotiate identity, find self-acceptance, and access inner knowing. She explores topics like your body acceptance, mental health, motherhood, and the middle places of cross-cultural upbringing. Priyanka approaches these with the type of humour and humility that can only be gained by tripping face-first into growth.
Hot + Brave The Blog-Cast:
What is implicit bias?
On this week’s episode of the Hot + Brave Podcast, Bianca and writer, Priyanka Saju dive deep into implicit bias, and how it shows up in the healthcare system. To start, what is implicit bias? Implicit bias is a bias, or prejudice one might hold without even knowing it. Research suggests that people can act based on stereotypes and assumptions, without even trying to do so. But don’t worry, Priyanka is very assuring in stating the fact that, having an implicit bias does not mean that we are good or bad/right or wrong. It is only when we are not working to know where our own biases may show up; or in recognizing our own biases that we are irresponsible. It is about challenging where the stereotypes that inform us come from and how we are dealing with them that really matters. How we deal with implicit bias impacts how we care for and interact with others.
People can challenge implicit bias
First, it is important to see where we may even be impacted by implicit biases about ourselves. When was the last time you said to yourself, “I feel fat” – when really, your body size had nothing to do with how you were feeling. Sometimes, as Priyanka notes, it is really helpful to dig deeper into what you mean. When, in exasperation one says “I feel fat” do they mean; unattractive, bloated, silly, lazy? If so, what biases, derived from a fatphobic society led them to blame body size for these feelings.
Weight Bias
These types of biases or stereotypes associate characteristics like your body size with markers such as intelligence, productivity, care for themselves and so on. How we treat folks in bigger bodies can be based on implicit bias where you assume negative attributes about them all because they are ‘fat’. Priyanka voices this in this week’s podcast stating, “there is a deep implicit bias that those in larger bodies are less capable, less intelligent, […] less compliant, less interested in their health… all of those things that kind of come backwards from the ways that we’ve coded what it means to be a fat body”. All of the examples given show that stereotypes related to those in bigger bodies are very damaging and frame those individuals in a very negative light.
In healthcare, these negative assumptions can be the difference between life and death. For example, in a recent study where bodies were examined after death showed that larger bodies were 1.65 times more likely to have died with a major undiagnosed medical condition than folks that they autopsied that were in thin bodies. Being in a larger body, and needing medical care is not a straight forward action plan. Most often, fat folks are told to lose weight before the doctor will even treat them. However, diets have a 95% failure rate – so what happens to the 95% of patients who had a real health concern but couldn’t lose the weight? Well, they simply never received the care they needed. A bias against fat bodies leads to serious issues in access to care. Listen Virgie Tovar podcast about diet culture
Considering this, finding good medical care providers and doctors is key. Some tips in finding a good provider include asking yourself the following set of questions: Are they paying attention to me? Are they looking me in the eyes? Are they critically assessing the thing that I’m raising as a concern? Are they dismissing me and telling me to come back when I look different? Are they making assumptions about the way that I live my life, or how active I am? This list of questions could go on and on and will look different based on who you are. Intersections of race, class ability, age could all impact the assessment questions that will help you find the right doctor.
Is BMI racist?
What is so important to remember about implicit bias is that sometimes we don’t even know we are being impacted by it. That’s why being informed and advocating for yourself is so important. A great example of where bias can come into play is with the use of your body mass index (BMI). The BMI is an inherently flawed tool in evaluating health, but it is so widely used that its flaws are rarely addressed. Is BMI racist? The truth is that the BMI is a racist, sexist, and classist indicator of health that has its roots in eugenics.
By measuring health as based only on weight and height it over represents health risks in those in bigger bodies without context (for example, are they an athlete?) and underrepresents risk of those in smaller bodies. Is BMI racist? Further, the baseline used in BMI is based on bodies and was derived, originally in a study of European soldiers. This assumes a very specific body type and level of musculature. It has been repeatedly shown that BMI should not be used as a standard or on an individualized basis to assess one’s health because it is not accurate. Priyanka presents a clear example, saying “It [BMI] doesn’t account for what your body type is, you could be an Olympian, with like the most jacked Olympian body you could think of, with like the most muscle mass, and you would be morbidly obese” and have the same BMI.
Is BMI racist? The Body Mass Index (BMI), often used to discriminate against persons of color in particular, has been an issue in recent years. Due to the history of racism in the medical and healthcare industries.
Bias in Healthcare
Based on these facts, what can we do to ensure we get the care we need, despite implicit bias of healthcare providers? If you are concerned that you may not be receiving adequate care based on your stereotypes that exist because of your body type it’s always best before you see your doctor to make a list, not only of your symptoms but of any questions you may have in general. With a list ready to go, you are less likely to get caught off guard, get defensive, or steered in the wrong direction. If you think your doctor or healthcare provider is biased, ask: what would be the standard of care be for someone who presents with these symptoms? If you are not receiving the typical treatment provided for a person with your symptoms, it is completely reasonable and within your power to ask why you are not getting the same as anyone else – or to be blunt – why being in a bigger body makes you ineligible for the same care that someone in a thin body gets.
Some other great tips shared in this week’s episode that can help keep us safe and cared for in the healthcare system include; taking a friend or advocate into your appointment if you are uncomfortable asking some questions. Sometimes, just having someone there can make us so much more comfortable and confident to speak up. Also, having a witness to how your doctor actually treats you can be telling. Another tip, and this might be the most important, is to keep your receipts! This means, get your doctor to write down if they have denied you a treatment based on weight . This can come in handy for insurance and liability reasons, so that they can be held accountable for deciding that you did not receive the typical plan of care for your symptoms.
We have so much power to demand the care that we need and deserve. Sometimes this may require extra work, but if you are able to reveal the existence of implicit bias in key aspects of life you can challenge it. And if some people, especially healthcare providers see these biases and do nothing, it might be time to cut them loose.
What else is going on at bebo mia?
Turn your passion into a career!
Join our free workshop to support you in understanding the steps to make your dream job a reality. The workshop is packed full of useful information and it’s super FUN (hint: there will be prizes, y’all) so click the link in our bio or at bebomia.com/babieswebinar/, mark your calendar and get ready for a good time! The fun is happening February 22nd from 8:00 – 9:00 PM EST.
Book Club!
Doors are now open to register for our next book club which is happening on Tuesday February 28th, 2023 at 1pm EST. The book we’re reading this month is The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma by Bessel van der Kolk, M.D.
How can I register?
Sign up for free at https://bebomia.com/bookclub/ or via the link in our bio
Support a great cause!
The Ember Blueprint is raising funds for tuition for women in trades as well as stipends for students to provide care to under-resourced families. With over one thousand applicants in the last 5 years, it is clear that access to tuition is a barrier for women entering the trades.
Links and resources:
Connect with Priyanka on her Instagram @priyankathewriter or in a deeper way through her newsletter, Strategically Overthinking Everything at priyankasaju.substack.com
Follow us on Instagram, Facebook, TikTok, YouTube, Pinterest, LinkedIn or Twitter.
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