Finding Fat-Friendly Health Care

DU + AmpleI am often painfully reminded of the fat phobia perpetuated by the medical community on a regular basis. Not just from my clients and others who have countless stories of being denied adequate health care because of their weight, but also from my own personal experience.

I was 15 years old when I went to the doctor for my annual check-up, stepped on the scale, and was told that I was getting “too heavy” and would have to eat differently. Since at age 15 I was still largely reliant on my mother for meals and my school cafeteria for lunch, I could not imagine what “eat differently” looked like, especially as it pertained to my weight. Luckily, my Mom must have delivered a private screed to this doctor (the one that later dismissed her expanding belly as “weight gain” instead of the ovarian cancer it actually was) because he never mentioned it after that and my strategy to never get on the scale again worked until my early 20s, when I turned to dieting to manage a major life crisis. Notably, after that comment from my doctor, my eating became increasingly disordered as I internalized the shame of that visit.

I was reminded of all this the other day when I went to a “sleep class” to diagnose possible sleep apnea (a long shot, but my doctor thought it was worth a try for some recent stuff going on). The person leading the class explained how to use the equipment we would take home to monitor our sleep that night. She also said, “If you are diagnosed with sleep apnea and you weigh too much, you will have to lose weight, because that is probably why you have it.” She went on to say that thin people had it for other reasons, and that once we lost weight, they could look to see if we also had it for those other reasons. As though our weight was an impermeable barrier that would obscure any other problems we could potentially have.

It took all the willpower in the world for me not to stand up on a table and have my Norma Rae fat-solidarity moment, and luckily we found that no matter what we weighed, if we had sleep apnea, we would get the APAP machine anyway. Because, you know, “you need to be able to sleep so you can lose weight.” Whereas I thought we needed good sleep for health and to feel well, silly me!!

Anyway, all this to say that we need medical care and medical providers that aren’t fat phobic, that don’t prescribe interventions that are temporary at best, and who provide us with the medical care that people in smaller, more conforming bodies get. But where can we find these providers?

That’s where Ample comes in. Aaron and I recently did a podcast with Alissa Sobo, one of the founders of Ample, a rating site for people in marginalized bodies (think fat, trans, people of color, disabled people). The creators of Ample know that when someone fears stigmatization from the doctor, they don’t go, and that can lead to worse health in the long run. But we need to know who can provide stigma-free health care – and that’s where Ample comes in.

I hope you’ll give this great Dietitians Unplugged episode a listen to find out more about Ample and how you can help build this amazing resource. THIS is how we exercise the power of voice that we do have — and we CAN create a better future.

Ample

Listen now:

Episode 50 – Finding Fat Friendly Providers on Ample with Alissa Sobo

Show notes:

Is it Ample? Aaron and Glenys talk to Alissa Sobo, the creator of Ample, the first app that rates businesses specifically on their accessibility and inclusiveness towards marginalized bodies (fat, trans, people of color and more). In this episode, Alissa talks about her origin story of being fat-shamed at the doctor when she was pregnant and why she decided she needed to create a review site for people in marginalized bodies whose needs are just not being met. She also explains how this amazing resources works and how we can all help build on it. This is something all our listeners can help contribute to and we can’t wait to introduce you to Ample! BONUS CONTENT: stay tuned to the very end to listen to our first fun bonus content!

ample logo

Need help with non-diet diabetes care?

HAES Care for Diabetes starting soon – get on the mailing list to be notified first when registration opens!

image

 

Fat at the Doctor: A Very Real Problem

Thinker, by August RodinI 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 about HAES®.

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.

 

Dietitians Unplugged podcast – episode 6 available now!

Episode 6 is called “Clean Eating or Toxic Ideas?” and we had so much fun talking about this subject.

Listen on Libsyn or iTunes. Give us a review on iTunes if you like us — this helps to spread the non-diet love to more people. Check out our Facebook page for our latest news and more weight neutral, HAES® friendly podcasts!

The Verdict Is In: The BMI is a Poor Predictor of Health

bmiRecently a new study was published on something most of us have known for quite some time: the BMI is not an accurate or reliable predictor of health.

But here’s what the latest evidence reviewing the effectiveness of BMI in diagnosing ill health found: it grossly overestimates the number of “unhealthy” people whose BMIs are in the overweight and obese categories.

Just to recap, the BMI is your weight in kilograms divided by your height in meters squared. It was developed as a way to compare weights in large populations, not a medical diagnostic tool. People in the 18-24 range are considered “normal weight” while people in the 25-29 range are considered “overweight” and over 30 are “obese.” To give you an idea of how arbitrary these ranges are, they were all adjusted downward in 1998, upon recommendation by the NIH Obesity Task force, despite all the available scientific evidence that actually pointed toward raising the ranges. According to one Task Force member, “We were pressured to make the standards conform to those already accepted by the World Health Organization” (Health at Every Size, Linda Bacon). And the International Obesity Task Force who recommended to the WHO the cut-off of 25 for the normal weight category received funding from pharmaceutical companies who made diet drugs. So the ranges are, you know, totally scientific.

It’s totally shocking, then, that this simple math equation, whose ranges were defined more by politics than by science, doesn’t totally tell us everything we need to know about a person’s health, right? That was sarcasm, by the way.

I’ve written before about how problematic it is to rely so heavily on mathematical equations in relation to our bodies, especially when it comes to weight. There’s a ton of stuff we still don’t know about weight regulation (witness the continued insistence on weight loss for health when it’s been shown over and over to not work long term for most people) and while we mostly have the same parts and general bodily functions needed to live, there can be a lot of variability from person to person.

So what this study found was that using BMI alone, “an estimated 74,936,678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy.”

Oops!

This is not surprising, but now we’ve got yet more evidence to back it up. Yes, it’s one paper. Let’s get some more research behind this so we can finally put the BMI as a health measure to death. In fact, want to help? I just found out about the ongoing study called Health Registry of Obesity (HERO) by the same study authors of the above-mentioned BMI paper.

By the way, I don’t believe that good health is a measure of worthiness or an obligation, so if you are fat and unhealthy or thin and unhealthy, you have the exact same rights to medical care and everything else that healthy people do, without being penalized. I am interested, however, in stopping the lie often perpetuated that fat=unhealthy and thin=healthy. People are being denied important, life-changing operations (kidney transplants, knee surgeries) simply because they are in the wrong BMI category, despite otherwise good health. (Ironically, no one hesitates to perform bariatric surgery on fat patients. Hm….). This needs to stop.

I know many doctors; most of them want to do the right thing (at least the ones that I know), but usually they are under pressure to move fast and work cheaply. The BMI represented a cheap, quick shortcut to preventative health care for them. But now we know it’s bunk. And we have real, useful tools at our disposal: blood pressure, blood sugars, lipid panels, insulin resistance, c-reactive protein (a measure of inflammation in the body). These are the indicators that the study authors used, and they are what our health professionals should be looking at before they declare us sick or not sick. Because this is not only a huge problem for fat people who are over-diagnosed and prescribed an intervention that fails 95% of the time, it’s a huge problem for the normal-weight people who are not being diagnosed at all.

My guess is, this paper won’t be the end of the BMI in medical care. It’s probably going to take a lot more scientific study (much of which already exists), head banging, fist wringing, and just plain shouting to get through a resistant medical establishment. But it’s a good step in the right direction.

 

Have you listened to the Dietitians Unplugged Podcast yet?

Listen on Libsyn or iTunes. Give us a review on iTunes if you like us — this helps to spread the non-diet love to more people. Feel free to like our Facebook page!