Doggone fat: an analysis of the barriers to top surgery for fat trans and nonbinary people in Canada

Abstract

ABSTRACT The use of BMI to determine eligibility for gender-affirming surgeries, specifically for top surgery, is not based in science. The present work analyzes current policies regarding BMI limits alongside research participants’ experiences with BMI limits when attempting to access gender-affirming surgeries, arguing that BMI use presents a major barrier for fat trans and nonbinary individuals seeking transition-related surgeries. Based on previous literature and research participants’ experiences, this work further argues that BMI limits (and the lack of transparency regarding these limits) are harmful insofar as their use may result in denials or delays for these surgeries, prescriptions for weight loss, and negatively affect the mental health of those seeking surgery. The use of BMI may be grounded more in concern about aesthetic surgical outcomes rather than concern about health. Variation in coverage in Canada for all essential parts of top surgery (specifically the lack of coverage for liposuction and its classification as cosmetic in some provinces) present economic barriers that affect fat individuals more than those who are thin or average.