"Fat broken arm syndrome": Negotiating risk, stigma, and weight bias in LGBTQ healthcare.

Abstract

In the U.S., the weight of LGBTQ people-and sexual minority women in particular-is a key focus for those addressing sexual and gender minority health disparities. Sociomedical stigma related to both fat and sexuality, however, complicates patient-provider perceptions and discussions about weight and health. I analyzed data from interviews with LGBTQ patients, healthcare employees, and observations at a LGBTQ healthcare organization to reveal how weight bias becomes a barrier to care for LBQ cisgender women, transgender men, and nonbinary people assigned female. Understood by patients as similar to "trans broken arm syndrome,"-wherein providers attribute health concerns of trans people to minority gender identities and gender affirming care-patients report "fat broken arm syndrome," wherein providers are perceived to attribute patient health concerns to weight. Patients interpret weight bias as intersectional stigma-related to multiple marginalized identities and embodiments-that puts their health at risk. Healthcare professionals make sense of risk, however, through competing fat frames. Although patient narratives suggest the promise of utilizing stigma-reduction approaches, many providers-typically those who do not share patient standpoints-emphasize the importance of framing fat as an urgent health risk in order to "do no harm." This case advances knowledge by demonstrating the relational process through which interventions designed to ameliorate health disparities may inadvertently discourage marginalized, "at-risk" patients from healthcare access and adherence.