More Than a Number: Weight Bias in Rheumatology Care

When I was first diagnosed with SLE/lupus, I gained 50 kilos — caused by a combination of corticosteroids, limited mobility, and constant fatigue. My body changed rapidly and so did how I was treated. At every appointment, discussions about my lupus or osteoarthritis were overshadowed by my weight. Even when I needed a knee replacement, surgeons refused to operate until I lost weight. It often felt as though the number on the scale mattered more than my pain or disease activity. This focus on weight, instead of the complex interplay of medication side effects, inflammation, and mobility challenges, left me feeling unseen and blamed for something largely outside my control.

Recently, I have lost 62 kilos, and the contrast in how I am treated is striking. Suddenly, my symptoms are taken more seriously, and I feel that my voice carries more weight — ironically, only after losing it. This experience highlights how weight bias can shape access to care and clinical decision-making in rheumatology. Addressing this requires more than awareness; it calls for systemic change. Training for healthcare professionals should include weight stigma and its impact on patient outcomes, and clinical guidelines should promote person-centred communication that recognizes the biological and social factors affecting weight. Policies that support equitable care — regardless of body size — are essential to ensure that all patients with rheumatic disease receive the respect, empathy, and evidence-based treatment they deserve.