Fat at the Doctor: A Very Real Problem
I went to the doctor recently and this is the cheeky summation of how that went down:
Me: “I’m here for a totally not-fat-related-but-most-definitely-stress-related problem I have that I need to make sure isn’t something more than I think it is. I think the problem may resolve soon because my stress is decreasing due to my new less stressful job that I get to walk to vs. my previous unbearable commute… but in the meantime can you please tell me I’m not dying of something horrible even though it seems innocuous?”
Doctor: “That’s great that you’re walking to work. Maybe we’ll see that weight come down now.”
As much as I write about this stuff all the time, as much as I am abso-fucking-lutely okay with my body, this turn of conversation stunned me into momentary silence. How the hell did this turn into something about my weight? Especially when I had refused to even get on the scale this visit??
Make no mistake: weight bias is a real thing in health care. Scenes like this (and much worse) play out for fat people in doctors’ offices with alarming frequency, and often with more serious consequences. Sometimes visits to the doctor by fat people end in something like, “We will not provide this treatment for you until you lose weight.” Or, “The treatment for this fat-unrelated condition is to lose weight.”
For a long time, when I was not fat, I had forgotten the shame of being fat and going to the doctor. My first weight-related medical care incident occurred when I was 15 years old (and 20 pounds less than what I weigh now) and my doctor told me I was getting too fat (except he didn’t say the word “fat”) and that I needed to lose weight (and then offered up no further solutions). My mom was livid on my behalf (for reasons that only made sense to me much later in life, she was always worried I would develop an eating disorder), and I always wondered if she gave that doctor a talking-to, because he never brought it up again. My response was to refuse to be weighed at any appointments after that and thankfully, I didn’t go on a diet in my teens, a behavior that is well-known to have disastrous consequences, from the development of eating disorders to fucked up weight regulation lasting into adulthood.
Flash forward 30 years. Things are not better. In fact, thanks to rampant fat phobia, healthism and weight-based discrimination, weight bias in health care is a bigger problem than ever. I have worked in health care for the last three years and have witnessed this first-hand. Patients who need life-changing operations are being denied these operations based on their BMIs – and nothing else. In medical rounds, we discussed a dialysis patient with perfectly acceptable metabolic labs, who is by most standards healthy (aside from not having working kidneys) who won’t get a new, functioning kidney for one reason – his weight doesn’t fit into the completely arbitrary “normal” category on the BMI. People have been denied knee surgeries unless they can lose weight (read more about the topic of being fat and knee injuries here and here). A woman posted on my Facebook page that her doctor wanted to treat her muscular dystrophy with a 100-pound weight loss because he felt her muscles simply wouldn’t be able to accommodate her weight – despite the fact that weight loss is a catabolic process and will contribute to diminished muscle mass. Oh, and despite the fact that the science shows that the most probable long-term outcome of weight loss is eventual weight regain. Need more examples? Read here.
More than a few times, I was mortified by the utter disdain and lack of compassion shown by medical professionals for fat people who needed real, compassionate medical care. One skeptical doctor I know said, “I really don’t think weight bias is a big deal when there are so many other problems that are worse.” Well, yes, I suppose if you are not fat, this weight bias thing isn’t as big of a deal for you. But the existence of other problems does not diminish this problem. This is one of the big problems.
Now that I am technically “obese” (after having given up dieting in favor of a healthy relationship to food and my body), I don’t weigh myself again, not because I’m ashamed of my weight, but because the act of getting on the scale for so many years was fraught with anguish that I don’t wish to relive. I know generally what I weigh and I told my doctor my estimate when she asked. And that’s when, minutes later, she started haranguing me about losing some weight.
Once I had recovered my senses, I said to her, “I really don’t work on weight anymore. I just try to eat nutritiously and exercise and let my weight be what it will.” Still, she insisted, she felt my weight would decrease by walking to work more. She acted as though I hadn’t exercised a day in my life before this (I exercise regularly). I asked her if she had ever heard about Health at Every Size® – she hadn’t, but said it sounded fine when I explained to her. Then she apologized for offending me about my weight, and I had to explain that I wasn’t offended, but that I simply wasn’t interested in pursuing my weight as a health outcome. And that was that.
So I got off easy that day: I don’t have a life-threatening condition, and I am not large enough to attract the truly terrible treatment other larger people receive regularly. Although god forbid I need knee surgery some day in the future.
This clearly needs to change. We need doctors who are aware of the evidence around weight and health, or at least willing to hear it in the first place. We need doctors who are aware of their own bias against fat people.
Not everyone wants to be an activist, but I do encourage you to fight for your right to real, unbiased health care. If you’re looking for a fat-friendly physician, check out this list. If you already have a fat-friendly physician, consider adding yours to the list, because it’s not nearly long enough yet. For my part, I make sure I talk to every medical professional who will listen.
This free eBook Dealing at the Doctor’s Office by Ragen Chastain of the blog Dances with Fat may be helpful if you are dealing with these kinds of problems. Ragen’s blog is chock-full of information about being fat at the doctor’s (and I’ve already referenced some of that material here), so if you are looking for more on this topic, I suggest heading over there.
Let’s not stop fighting this together until everyone has the same access to medical care that everyone else does.
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Sorry, but how and where do we “fight?” By definition, any doctor that recommends making weight “loss” attempts is at best dumb on one subject and at worst a quack about everything. The bottom line is we have no access to medical care that we can trust. (This goes for all women, actually.) How and where are we fighting for accountability in research and practice? Where are the malpractice suits? The peer reviews? The registry a la “No Free Lunch” for doctors committed to practicing evidence-based medicine (for fat people and everyone?) Recently, I wrote to ASDAH and asked why they have no MDs in their membership. They said, “Yes, we do!” and then crickets. I’ve seen lists of psych counselors and eating disorder specialists who are practicing HAES (aka. evidence-based medicine), but nowhere on any list have I seed any MD other than a handful of ob-gyns who may or may not actually be practicing HAES. I’ve asked this same question every ten years or so and only get verbal abuse in response. (And, the same people who verbally abuse me also tend to plagiarize my writing, but that’s another war…) We don’t need forty blogs are casual, extra-marital fat sex and clothes clothes clothes. We do need a concerted effort to call for peer review and investigation of quacks who are still recommending dangerous and pointless weight “loss” attempts. We need to reveal ALL instances where MDs are getting very illegal kick-backs from diet pushers. We need to identify online, with door stickers, in the press those doctors (all five of them) who are willing to provide legitimate medical care for fat people, and we need to list and identify those doctors guilty of killing and maiming fat people through neglect or yoyo dieting. We’ve had more than enough of the ultra-left wing, pornographic self-esteem bullshit. We need to grow up and do the boring, multi-partisan (Yes, evangelicals and lefty radicals might have to share air space) footwork in Congress and with state and federal oversight agencies to expose and eliminate the exploitative, illegal and immoral quacks who are killing fat people for fun and profit. There’s nothing in “Dealing at the Doctor’s Office” that solves the trust problem; a bad doctor relying on bad (or no) research who thinks of fat people as walking corpses to be exploited for profit and then buried won’t be changed by a single speech from a single fat person. All the “fatshion” and orgies in the world won’t bring a victim of medical murder back to life.
Well stated! With what science has shown, why are so many medical professionals still hung up on bmi? Can they not clearly see that it is a flawed system? Thankfully my doctors look at overall stats rather than judging my health on my weight as it fits into some bmi chart.
Also, kudos to your mom for putting that doctor in his place when you were younger.
When I was early in my ED recovery process (my restrictive habits followed the same path as yours, from what I can tell), I had my blood work done at the office of the doctor who had encouraged me to seek help. Although the MD was incredibly compassionate, clearly the nurse with hadn’t bothered to look at my chart; when she called to tell me I had high cholesterol (completely genetic — EVERYONE on my dad’s side of the family has it), said nurse suggested I watch what I eat to try to bring it down (fewer fried foods! More exercise!). Um… okay. At that point I was eating fruits and veggies almost exclusively and exercising three hours a day. Perfect advice for an anorexic.
That’s terrible – I’m so sorry that happened to you.