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Weight Stigma Awareness Week: My Past

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[Content Notice: body image, weight]

me at 5 years old
I was happy to have cake at home with family. It meant I didn’t have to eat in front of people.

The cruelty regarding my weight started when I was very young and only got worse as I got older. It seemed to me that social interactions were all opportunities for people to be mean to me about something I didn’t know how to manage or control. Before I had learned to count high enough to track my caloric intake, I was certain that, by merely existing in my body, I was asking for poor treatment.

Others’ reminders that I was fat did me no favors not only socially, but also medically. Although I do appreciate the data about the harms of fat stigma — it’s a metaphorical glove by which I can more aristocratically slap the anecdote police — my health history bears witness to how anti-fat stigma can lead to adverse health outcomes.

I knew other women and girls who thought they were fat. Others would tell them that as long as their doctors said that they were healthy, they shouldn’t care. I, on the other hand, was medically overweight, and later, obese. To make matters worse, the ways in which my doctors handled the matter were not quite as professional as you’d imagine. For example, when I was twelve, my doctor pointed out that she, a mother of three who was two inches taller and two decades older than me, weighed twenty pounds less than I did. I needed to get my BMI in order, she chided, while I was still young.

To my relief, moving away from the area a few months later meant that I could I stop seeing Dr. Smug Comparison. To my chagrin, I was to find that other doctors weren’t much better. Even if the doctor didn’t shame me using herself as a counter-example, doctor’s visits were a minefield. I would have to be weighed by a nurse who wouldn’t announce my weight aloud as she did with the other patients my age, then led to a room where the entire conversation would be about my fat body while I shivered in a thin paper gown. As you might expect, incredible amounts of anxiety built up in me in the days leading up to any doctor’s visits.

During one such visit when I was fourteen, I produced a rather high blood pressure reading. Assuming that I must be gulping down copious quantities of unhealthy food, my doctor told me to eat less food, especially the salty kind. If I didn’t shape up, she warned, she’d have to put me on blood pressure medication. That my period had stopped around that time allegedly corroborated that my fat was out of control. I spent a lot of time freaking out about it, obsessively exercising and monitoring my food intake.

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A few months after that doctor’s visit, I stayed in London for a month. After I returned home, I got my first period in eight months and my follow-up visit yielded a normal blood pressure reading. My doctor briefly praised what she assumed had happened — that I’d lowered my salt intake — before issuing an even-more-frantic version of her usual “lose weight” refrain. This was because, hilariously, I had stopped fretting so much about my body during my trip thanks to the intervention of a sympathetic cousin — and had actually gained weight eating saltier foods than my usual. I found out later that though amenorrhea and high blood pressure can be associated with being overweight, they’re also associated with stress.

More frighteningly, when I was fifteen, anti-fat bias nearly impeded a correct diagnosis for the issue with my right knee. My doctor claimed it must be a minor sprain upon which my overweight body was putting too much pressure. My insistence that I could definitely feel something moving inside my knee led to her reluctantly order a CAT scan. The resulting images clearly depicted symptoms of synovial osteochondromatosis, a rare chronic disease of the cartilage.

This story has a happy ending because I no longer believe doctors to be unquestionable authorities on all things. As an adult, I’ve managed to find excellent doctors, caring medical professionals who I consider part of my team rather than stern figures unhelpfully lecturing me. Sadly, too many others’ stories have quite a different outcome. There are plenty of fat people who avoid going to the doctor to avoid shaming — and the ones who do go can be misdiagnosed and underdiagnosed. I’m sure most doctors mean well and I doubt that there was an intention to harm feelings and health outcomes in the case of even Dr. Smug Comparison. If we actually want fat people to become healthier, though, we need to consider the fact that doctors are people and don’t always behave in the best interests of their patients’ health.

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18 Comments

  1. Thanks always for sharing. I got a taste of this once when seeing a new Ob/Gyn for my yearly: first thing she said to me when she walked into the room was to lose 5 pounds, without asking a thing about my food and exercise habits. I was gobsmacked–I had just run 3 miles that very morning, fuck you very much, and had taken a perfect blood pressure reading, to boot. Soon after, I found myself partaking of a spiteful post-exam second-breakfast binge including a cupcake as big as my face and an extra-large caramel sugar-ccino-something with whipped cream on top.

    I never saw her again, that’s for damn sure. I can clearly imagine the harm I’d inflict on myself in the pursuit of even minor weight-loss, knowing from experience what a neurotic, obsessive, cranky, fatigued, and hangry monster that calorie counting makes me into (gee, thanks college!). These days, I have a doc who’s never mentioned my weight (which is the same) but always asks if I’m exercising the same as recorded last visit, to which I can eagerly respond in the affirmative.

    Golda Poretsky also wrote today about the harm that doctors’ anti-fat bias can cause. http://www.bodylovewellness.com/

  2. I want to pre-empt the shaming that I expect might crop up with the following:

    For the data-driven: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2771236/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386473/

    For ones who are interested in a few of the stories behind the numbers: http://fathealth.wordpress.com

    Heina: I’m sorry you had to deal with this, and I’m sorry for how you continue to deal with this. I wish society weren’t like this.

    • I’m afraid people are deeply committed to focusing on shaming and simple(minded) solutions. They just won’t or can’t move their thinking to habits instead of weight.
      Probably because you can’t judge strangers’ habits at a glance, so there’s no sport in it.

      • The thing is that CICO makes sense? Because: thermodynamics. But the people who think this is the sole answer forget that the CO part is essentially impossible to measure. You can count how many calories you’re eating but there is no way to guarantee that you’re expending a greater number without actually eating nothing.

        People do lose weight by eating nothing for weeks or months, and I reckon the fat shamers think that every overweight person should do that. Indefinitely, because once you start eating again you run into the same CO-cannot-be-counted problem you had before, so starving literally to death is clearly the morally correctly solution.

        • Re: Thermodynamics–By setting your treadmill to a certain percent grade, walking a certain distance, calculating the “height climbed”, multiplying by your current weight (units of force, not mass) and converting that amount of energy to kcal you can set a lower bound on the number of dietary calories expended in that exercise. And it is always depressing how few “calories” of actual work was done against the treadmill. The same calculation should be possible for weightlifting, and I bet the result would be similarly depressing.

          In Geekworld, every treadmill, rowing machine, or weight machine would have the option of displaying the results of this calculation, some geeks would get competitive about it, and I suppose that would further the purpose of the exercise machines.

          • Err? Are you seriously suggesting that the 100-500 calories that an average person is going to burn at the gym should be greater than the number of calories that person eats? How long do you think you can keep eating less than 500 calories/day, before the lack of energy starts to reduce the amount of exercise you are capable of doing, thereby reducing the number of calories you permit yourself, rinse repeat until you are back to eating nothing?

          • This is technically true, but the lower bound is so low as to be meaningless. For an obvious demonstration, consider setting the grade of the treadmill to zero: the “lower bound” of calorie consumption is always zero, no matter how vigorously you run. The problem is that biomechanics is way more complicated than simple physics. I don’t know any actual figures off the top of my head, but my intuition is that the raw “work done” estimated by considering the human body as a point particle represents only a fairly small fraction of the total energy consumed during exercise. Consider all the various organ systems that have to actually work harder (and themselves burn more calories) just to sustain a higher power output (e.g., the lungs and the heart).

            If the point of having such a calculation on a machine is just for fun, that’s fine, but it would be absurd to take that as a useful index of true calories burned.

          • I think skeith and biogeo are actually agreeing with pciszek, if I read this comment correctly.

            The calories calculated by the exercise machine are a lower bound, often a depressingly small lower bound, on the CO side of the equation. It’s only one factor and the other, usually much bigger, factors are difficult if not impossible to measure.

            And the other factors can and do change as a result of changing either or both of eating and exercise habits, often in unintuitive ways whose mechanisms are far from being understood.

            This make CI=CO (calories in = calories out) impractical in real life, and telling people just to eat less and exercise more is an almost useless platitude.

  3. Thank you for sharing. It always amazes me how people equate losing weight to health and beauty. When I was pregnant I was extremely sick, so much so that I lost 15 pounds in the first trimester. (And I started out in the normal weight range.) Everyone kept telling me how great I looked since I lost so much weight. When I told them I was sick and pregnant, the response was often “well, at least you lost weight!” As if losing weight was the ultimate goal of everything.

  4. Heina- I’m wondering if you (or anyone here) has a suggestion about how to bring up weight with patients in a non-judgmental, non-threatening way. I tend to limit my weight loss discussions to patients for whom it may offer some clear therapeutic benefit: PCOS patients looking to get pregnant, women concerned about endometrial cancer, women with incontinence. My colleagues will often bring up weight at every annual visit- I talk instead about nutrition and exercise (my feeling is that patients know if they’re overweight). Do you think there is any utility to bringing up weight loss on a routine basis?

    • If medicine comes up with a weight loss method that has a good success rate, that would help.
      As it stands, recommending a patient lose weight and *keep it off* should come with information about the long term failure rates of weight loss. Even medically supervised diets are more likely to fail than succeed.
      Otherwise, you’re setting them up to fail and then blame themselves.
      The only way to maintain weight loss is to adopt it as a hobby. The people who are successful must put a great deal of energy (mental and physical) into maintaining weight every single day for the rest of their lives. I think honesty is best.

    • Treat actual ailments, not people’s appearance. What would you recommend for your thin patients suffering the same issues? The fact is, intentional weight loss does not meet the standards for evidence-based medicine and it is unethical to prescribe experimental treatment without clearly identifying it as such and letting the patient choose.

      It also sounds as if your colleagues may benefit from learning about the science behind the HAES approach. “Psychologist Deb Burgard examined the costs of overlooking the normal weight people who need treatment and over-treating the obese people who do not. She found that BMI profiling overlooks 16.3 million “normal weight” individuals who are not healthy and identifies 55.4 million overweight and obese people who are not ill as being in need of treatment. When the total population is considered, this means that 31 percent of the population is mis-identified when BMI is used as a proxy for health.” http://www.nutritionj.com/content/10/1/9

      • I’m not sure where you get your information from, but for the three examples I cited, all are evidence based suggestions. The PCOS data goes back nearly two decades. Here is one of the more recent articles I found (but there are many, many more from the nineties): http://humrep.oxfordjournals.org/content/24/8/1976.long
        And urinary incontinence: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877497/
        This is the opposite of what you have written. It is disingenuous to say that weight loss is “experimental” for treatment of these conditions. I will grant you that weight loss cannot be proven to decrease an individual’s risk of endometrial cancer, but it certainly will decrease the relative risk. And if I offered a patient a drug that would reduce their risk by fifty percent, why would I not also offer weight loss as an option?

    • This is simple, just ask “Do you want to discuss your weight?” If the answer is “no” then accept that and move on to other issues.

      You’re right, we do know we’re fat. I also find fat a more accurate word than overweight. When I’m called overweight I want to ask, “over what weight?” I weigh exactly what the laws of physics predict for my mass. I am certainly over the weight of the Metropolitan Life height/weight tables from 1943 that became the basis for our “ideal” weights. Also, if your BMI calculations only use height and weight as inputs then you are really only using obfuscated height/weight tables.

  5. As a fat child in the 70s I was rounded up with all the other fat children at my school to be interrogated by a visiting doctor. It was serious, my mother was somehow obliged to be there. So were two of my teachers. And the interview was about how come I was so fucking fat. It was a long, long time ago but as I remember it, the intention was as much to make us cry as it was to tick non-existent boxes. I had to show my penis to the doctor and two nurses, for some reason, but he said not to worry because I didn’t have to show my penis to my mother. You know, I suspect she’d already seen it. I still don’t understand why gazing at my penis was diagnostically relevant, especially when the doctor said “o….kay…..right” and wrote something down.

    But anyway, we fat kids were singled out and everyone else in the school knew that we were singled out for medical attention because we were fat.

    And the ‘medical attention’ proved to be just weighing us and telling us we were fat as though somehow we didn’t know that. As though somehow we didn’t spend most minutes of every day having that explained to us by children and teachers.

    Suddenly we had it explained to us by doctors, who humiliated our parents into making us Not That.

  6. CICO doesn’t work (or at least not for me). I have been fat all my life and as a kid, I was very active including walking everywhere. I never lost weight – I just kept getting fatter. It wasn’t until I hit my highest weight (437 lbs) in my late forties that I finally figured out what eating plan would work for me. At that point, I was also disabled so exercise was not on the table. Now at age 59, I’m currently 210 lbs smaller, all without exercising. I was hoping to lose another 90 lbs or so but may have to be content with remaining stable at the weight I’m at now. I’m OK with that.

  7. I know exactly what you went through, because my story is remarkably similar. I gained weight very quickly during my adolescence, and unfortunately saw doctors extremely frequently due to what I saw as my own mother’s stress because of me. I felt that my existence was a medical emergency most of the time. My asthma was supposedly due to my weight. My colds were due to my weight. My constipation, my diarrhea, my flues and everything else was because of my weight. I spent a lot of time in the clinic with all male doctors (it was the seventies and early eighties and it’s what we had), and then spent large swaths of time out of school. I faked it. I was stressed out by the bullying, and I didn’t want my parents to know, because I witnessed one bully being chased down and cornered by my brother, which scared me to death. I hid the real reasons and started presenting a rather convincing cough. Luckily, I really didn’t need that time to do really well in school anyway. The “asthma” died out in high school. I think I really arrived when, at sixteen, I fired “my” nutritionist and quit diets completely.

    Now I am back in the clinics constantly, but because of an airborne virus that gave me an auto-immune disorder. I have a team of doctors too, and I’m not getting so much of that fat-concern as much as I did. But those voices are still there in my head. Even as a sort of radicalized, aware person, those voices persist and I actually am still obsessed with the way I look. I’m still worried about people making fun of me. I could have used the motorized scooter many times during my illness, but I didn’t because I’d be the fatty in the scooter, using something that someone “really” handicapped could use. The fat thing, it seems, is still my emergent oppression. And it’s just all my fault, isn’t it?

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