Seriously Bad Medicine

Bad DoctorThe American Heart Association, the American College of Cardiology, and the Obesity Society released new guidelines urging doctors to be “more aggressive” in urging fat patients to lose weight.  I don’t know what doctors other people go to, but the doctors who I see couldn’t get any more aggressive unless they started threatening me with a weapon.

But what do they mean by “aggressive?”  The guidelines are [trigger warning]:

  • At least once year, calculate patients’ BMI, measure their waists and tell them if they are overweight or obese.
  • Develop a weight-loss plan that includes exercise and moderate calorie-cutting.
  • Consider recommending weight-loss surgery for patients with a BMI of 40 or for those with a BMI of 35 who also have two other risk factors for heart disease such as diabetes or high blood pressure.
  • Refer overweight and obese patients who are headed for heart problems to weight-loss programs. Specifically, discuss enrolling them in at least 14 face-to-face counseling sessions over six months with a registered dietitian, psychologist or other professional with training in weight management.

First of all, BMI and waist circumference are not measures of health at all, the suggestion that doctors should recommend any intervention based on these numbers is highly problematic, especially with so many studies that show that habits, not body size are the best determinant of health.

Even if weight loss was a health intervention (and I don’t believe it is), there is not a single study where more than a tiny fraction of people have maintained long term weight loss.  Weight loss simply does not meet the requirements for evidence based medicine doctors attempting to “develop a weight-loss plan that includes exercise and moderate calorie-cutting” will be repeating an intervention that has been nearly completely unsuccessful in every study that exists.  Most people will lose weight in the short term and, when their body adjusts, they will gain the weight back and many will gain back more than they lost. Prescribing something that a mountain of research has told us almost never works, and telling people that everyone who tries hard enough succeeds, absolutely defies medical ethics.

Weight loss surgery is dangerous including horrific life-changing complications, and a seriuosly increased chance of death   and the evidence for efficacy is dubious at best: “most comprehensive independent review of bariatric surgery, conducted by the Emergency Care Research Institute, a nonprofit health services research agency, examined evidence from seventy studies. The investigators reported that while significant weight loss occurred, patients still remain obese. However, they noted that the evidence demonstrating that associated diseases improved was weak, and it was not evident that surgery resolved heart disease or extended life span. They report that claims of improved “quality of life and long-term health impacts are less conclusive.”

Oh, and that counseling?  “The panel [that recommended the counseling intervention] acknowledged that one problem with its recommendation was that no studies have shown such intensive programs provide long-term health benefits.” Why are medical professionals so willing to let go of the concept of evidence-based medicine when it comes to fat people?  Not to mention the idea that someone’s height to weight ratio suggests that they need counseling is highly problematic. This is about trying to force fat people to be the non-consenting participants in experimental medicine and blaming us when, like almost every time of the many, many times before, the experiment fails.

You all know that I do not ever want to tell you how to live or what to do (unless I’m telling you not to try to steal other people’s civil rights by an inappropriate use of power and privilege).  That said, I want to implore you to please speak up against this if you in a position to be able to.  This is not our fault but it becomes our problem and in my experience the way to change things is for those of us who can speak up against it, to speak up against it.

When the doctor suggests counseling or a diet intervention, we can demand the evidence that it will 1. lead to long term weight loss of the amount that they suggest you need to lose and 2. that the weight loss will cause the health improvements that they are suggesting.  They will not be able to provide us with this because it does not exist.  There is no study showing that even the tiny fraction of people who manage to maintain weight loss actually have improved health because of it.

If the doctor suggests weight loss surgery ask about the increased mortality rate,or if they can guarantee that you will not experience horrific side effects, or just tell them that you refuse to be have your vital organs mutilated or amputated for a surgery that brings no guarantees of long term weight loss or improved health, and often results in the opposite.

Demand health interventions (not body size interventions) for health problems, ask if thin people get this health problem (Pro-tip:  they do), ask what they prescribe to thin people, insist on that intervention.  Yes, even if the problem is with your joints.

We have the right to refuse to be the subjects of experimental medicine.  We have the right to demand evidence-based medicine and the evidence basis for interventions the doctor prescribes. We have the right to be treated as individual patients and not ratios of weight and height.

If you want more information on how to talk to your doctor, including some practice, I’m teaching an online class this Saturday the 23rd from 12-2pm Pacific.  The class will include scripting to use with your doctor, a discussion of patient rights, the research on weight and health, and optional chances to practice, ask questions, and role play.  You can join by audio, or video and participate or just listen in.  There are only 8 slots, and the class is $35 ($15 for danceswithfat members).  You can sign up here.  If there on no spots left just shoot me an e-mail at and I’ll get you on the list for first dibs on the next class.

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If my selling things on the blog makes you uncomfortable, you might want to check out this post.  Thanks for reading! ~Ragen

64 thoughts on “Seriously Bad Medicine

  1. I suspect “aggressive” intervention will include things like forcing patients to visit weight loss “experts,” and take prescriptions such as Belviq. Makes me glad I’ve got both good doctors who know better, and a healthy (bordering on unhealthy) mistrust of authority.

    Belviq scares the shit out of me, btw. Apparently, the side effects are hellish, and it alters your brain chemistry to kill your appetite to the point that people have to set timers to tell them when to eat. I seem to recall something about it being based on SSRI’s. Well, if it affects serotonin levels, there’s a massive amount of serotonin in the gut. Was this taken into consideration during R&D? Also, has any incidence of, say, serotonin storm been documented with it, as has been with SSRI’s? And what happens if you give it to someone who already has a small appetite? I know if I was forced to take it, I’d be on a nasogastric tube within two weeks because I wouldn’t eat a damn thing. (I’m also the queen of psych side effects. My poor neurologist has THE hardest time giving me migraine meds, because my responses to the list he reads off are, “Tried to kill myself, tried to kill myself, wanted to kill myself, wanted to kill myself and others, slept for three days, paranoid delusions, ceiling melted….”)

    On a more positive note, I went out with a friend for his birthday tonight, and I looked fucking awesome. 🙂 Patrick Nagel would have sworn I stepped right out of one of his paintings. (You know, if he wasn’t dead.)

    1. Is it wrong that I giggled at your responses to migraine meds? I totally hear you. My neurologist is very reluctant to prescribe meds due to the side effects. I take 400mg of B2 a day to prevent migraines. Thus far my only side effect is neon yellow pee. B2 IS used as a yellow dye…

        1. Cool, cuz you gave me a good giggle. I’ve recently become a vitamin lady… Still have some meds, but their usage is close to nil. Hope the vitamins continue to be beneficial without their own side effects. I don’t so much mind the neon pee… 🙂

      1. Does the B2 actually work? Mine have improved a bit this year, but maybe it’s the vitamin deficiency. I can’t take tylenol anymore, only advil.

        1. Actually B2 works to prevent occurrences… but it doesn’t lessen the migraine pain or duration when you do get a migraine. In studies it has consistently reduced occurrences by 50%. In me? @ 75%+ I LOVE B2.

          Not 100% sure I can give B2 all the credit. I’ve also been on a high dose of B12 (you can’t OD on that either) and have raised my D levels from deficient to about normal (D you can take too much of and hurt your liver–so don’t over do that one).

    2. I’m with Tara – is it okay that I laughed out loud at your comment – with a healthy side of appreciation for you sharing this. Thank you.

    3. I have the worst time on migraine meds too! My doctor says that’s really abnormal, but I don’t know if that’s true or not. Pretty much everything I’ve tried has been ineffective or caused serious mental health issues. When I was on a beta blocker, I was all murder/suicidal, if the medicine hadn’t made me insanely hungry ALL THE TIME, I probably would have killed my husband and myself, literally. I am so glad I realized it was the medicine before that happened.

      What do you take? I just started on verapamil and I’m not sure if it’s going to work or not. I had been on topamax, which worked okay, but recently stopped working.

      1. I just weaned off Topamax, due to severe cognitive impairment, and my neuro is trying me on Zonisamide. Just took my first dose tonight, so we’ll see how it works. He’s also recommending me for Botox, because with treatment I still get about three minor migraines and 3-4 major ones a month. Keep in mind, this is down from a new one every single day, so…. I have a constant tension/fibromyalgia headache, too, so that’s in my favor, treatment-wise.

        For acute migraines, I take an Imitrex, 5mg oxycodone (courtesy of my pain specialist), two Aleve, a Prochlorperazine (for nausea – I get unholy nausea), and a nap with at least one king-size black-cased pillow clamped over my head like an oxygen mask in space. It doesn’t help my postdromal period, which is its own fresh hell, but the combination gets me out the other side of the worst of it, unless I’m having one of the rare-type bastards. Those are the migraines that, say, go after my language centers and leave me illiterate and unable to speak for a minimum of hours. At least I haven’t had to go to the ER for an apparent holy-shit-I-can’t-feel-half-my-body-oh-god-I’m-blind stroke since I realized peanuts are BAD for me. (Yes, that was a migraine. Son of a bitch fought me tooth and nail for six weeks!)

        Do you ever get abdominal migraines? I know they’re controversial, but I get bouts of ripping pain and nausea that have me wishing I could lose consciousness. I can only describe them as migraines, but in the wrong spot. I should probably mention them to either my neuro or my primary, but my digestive system is so screwed up that it kinda seems like, why bother?

          1. TY! 🙂 I noticed some improvement immediately, though the Zonisamide is kicking my ass. I swear it’s giving me a headache. Thank Elvis my pain doc keeps me supplied with the good stuff–I need it to get rid of ANY kind of headache! (I don’t take pain meds as often as I should, mind. I figure my brain chemistry is as screwed up as it’s gonna get from pain, so I’d rather suffer until it’s unbearable than risk addiction.)

  2. Going to the doctor today, and this is a new one. Had the old one for soooooo many years, we trained each other! But now all I need is a mammogram referral and flu shot. DREADING IT. This blog post came at perfect timing. —-Jen

  3. The more that we learn about the benign nature of adiposity and that dieting usually results in weight gain, the more the medical community digs in with its idiotic recommendations and interventions. I sit here exasperated.

    1. For *serious.* I guess they’re doubling down because they don’t want to admit their ‘health interventions’ (aka “diets” that are fatal in the long term and more unnecessary surgery than Ivo Shandor) actually made those patients they’re sworn to protect significantly LESS healthy. Or, y’know, money.

  4. Translation: Shill our sponsors in the weight-loss industry harder!

    Srsly, LapBand? WW/Nutrisystem? “Lifestyle” coaches? Diet sheets with food purchase suggestions? Did they miss anybody who regularly greases their palms?

  5. Completely not to make anyone envious, rather to say there is hope out there – I have the greatest medical people in my care team – my family doctor, psychiatrist, and a host of others. Very positive people, very aware of the “weight loss” industry and myths. I am so grateful that I take it for granted if that makes sense. Good luck to everyone – there are fantastic doctors out there.

  6. Jen here, back from the doctor, got my physical, mammogram ordered, flu shot received blood pressure fine, pulse “great” and doctor AWESOME. I live in WestVirginia, not one of the thinnest states, and yet…with research, gossip and referrals, I have a doctor younger than me that I hope will be mine forever. YAY!

    1. WOOHOO!!! =D

      Though I’ll warn you, my dad’s outlived two doctors younger than him. The current one is my age and nervous. 😉

  7. I know from my experience being treated for fat my whole life and being stigmatized enough by it to take many risks to get to that state of thin perfection that even weightloss surgery affects everyone differently. They tend to put us all into one group of fatties that need surgery but don’t really do much more than that. Yes they do standard testing to make sure you will/should survive the surgery and many insurance companies require psychiatric evals to make sure you will be “compliant” after the surgery but that doesn’t mean that we’re all going to face the same problems afterward or lose weight afterward or not gain weight back afterward and of course the dreaded die afterward much sooner than expected.

    I know with the lapband there are those it does appear to work for just like jump starting any new diet if you wrap your head around it. Some people can work this band. A port is installed near your naval and fluid is pumped into this port to tighten your band. Some people never get restriction some people get restriction and can only puke up food once they’ve eaten it. Of course there are those who have actually had it eat it’s way through the stomach wall or break and have to have it removed again surgically.

    It’s a difficult piece of machinery to master and even then depending on what your food loves are prior to the surgery you can do well or you can drink milkshakes all day and and gain weight. Especially if they put you on a liquid diet for a month prior to the installation and you’re already in starvation mode! Some people are not aware that it’s not as perfect as they advertise and almost anything if crunchy enough or soft or liquid enough will go right through making the band totally useless. Just like any diet it come back on full throttle.

    I believe the average age for weightloss surgery is 50 and I was 49 when I had my gastric bypass. Went through all the screening hoops and weeks of starvation liquid diets prior to “shrink the liver” as it’s done laproscopically but they still don’t do much to gauge your health afterwards. For example my group makes you take a supplement in chewable form 4xs daily and that should be enough to keep you healthy as long as you also eat enough protein a day and other healthy foods. (They also sell this supplement at their office for convenience). Also exercise is usually required and yearly blood tests with the group to make sure you are not deficient.

    Prior to the surgery you meet with them and get weighed and they announce to you your BMI and you should be losing weight beforehand and usually if you’re not on their recommended diet of choice you don’t get the surgery. After surgery you go a few times to make sure you’re doing well and there are no post-op issues and also to weigh you to document your weight.

    After a year or so due to the surgery you drop weight automatically and have a much smaller stomach or pouch as they call it as the other half the larger half is stapled apart from “pouchy”. Due to the bypass this happens and usually without much effort. But then the calorie bypass part stops and you stop losing but vitamin and minerals are still not being absorbed from your food and barely from your supplements and so you look thinner but it’s a different thinner, I think, it’s a more haggard thin. It happens and then you eat the same amount of food and you gain back some or all or more, that’s always possible but you can still be malnourished even though you’re eating what you think are healthy foods and taking what you are told are the right amount of vitamins and supplements.

    So my point is this, after writing half a term paper (so sorry) that they really can’t tell unless they know you have some time of disease or disorder that they know beforehand making you a risky patient who will do well after the surgery. When I say do well I’m not speaking of weight loss I’m speaking of survival and thrival (coined a new one there). As of now I’m 53 but feel like I’m 83. I was compliant in all ways but one I did not follow up after a year and a half due to the weight gain and my “shame” of dealing with it. But even if I had gone in for lab work I still would be in the same condition because they still think I’m fine and I’ve had 4 other doctors tell me I’m anemic due to my RNY. So that’s quite a risk people take and I know it happens more than is reported. I do take responsibility for this but now feel like I need to help other people to really understand what they’re going to put themselves through and that it’s not worth any of it! Sorry to write so much, Nan.

    1. I read every word and so appreciate you posting this. My aunt also went through WLS and has experienced several horrific side effects as well. When she was fat, she was perfectly healthy; now, though she has lost and maintained a significant amount of weight, she has suffered both physical and mental side-effects of malnutrition (not to mention how much the WLS exacerbated her already existing alcoholism). While she’s my mother’s younger sister, she looks and has the affect of a woman about twenty years older than her (even though my mother is fat and my aunt is now thin). It simultaneously breaks my heart and fills me with rage that our fat shaming society and fat shaming medical professionals drive people to this drastic and life-threatening surgery. I do not know one single person whose quality of life was improved by WLS, and the fact that doctors use their authority to convince their perfectly healthy patients to undergo WLS is maddeningly disgusting.

      My aunt went into surgery yesterday for her THIRD perforation since getting the LapBand. My family is hoping and praying for her recovery, but even so she is a shadow of the woman that she was before WLS.

      1. I’m sorry for you and for your aunt but if she is having bad side effects from the lap band it’s removal is a pretty simple laproscopic procedure, something I myself have had removed prior to my RNY. Of course I don’t know what internal damage has been done. Anyway wish you both well!

      2. Correlation between WLS and alcoholism? This is not publicized anywhere (what a surprise) but it should be, because I’ve heard of this before. My friend’s ex-husband had the procedure and has really stepped up his drinking now that he can’t eat! She’s worried about him.

    2. I had to see my regular doctor’s partner a couple years ago for an “emergency” visit. Basically he preached WLS to me as treatment for a cold! My throat was raw and red because of all this fat around my neck, you see. He said “Have you considered bariatric surgery?” to which I replied, “Yes, I consider it a hate crime against fat people!”

      My regular doc knows better than to even bring up this subject. Before I even started going to her, when I called her office “doctor shopping” for a doctor here in my new town of residence, I told the secretary who answered that I was NOT open to any kind of weight loss pressure or “advice” that I had been there, done that, and none of it worked and I was having none of it, and that I would NOT get on the scale. But her partner apparently was not informed of this and I think he would be too arrogant to pay any attention to such things anyway. As it was, he was actually speechless for a few seconds after above “hate crime” remark before he came up with that crap about how I would suffer more from colds than other people because of all this fat around my neck. what a (__o__)

  8. Let’s also not forget these complications of these medical protocols:

    Poverty, for instance. I physically cringed when I read the suggestion of 14 sessions in 6 months!!! on top of whatever other ridiculous things they want you do do, who can afford such a thing?!

    Also, we must be prepared that when we question our docs about evidence and increased mortality rates, and thus decline to participate in dangerous interventions, we are then labeled non-compliant to treatment. arg.

    1. They screw us coming and going. No doctor I’ve ever had tells me what they write in my charts that go to the insurance companies. For all I know, they’ve listed me as suicidal, antisocial, morbidly obese, etc. etc.etc. So, I get labeled going in.. .and if I’m protective of my rights and health, I’m labeled non-compliant to treatment.

      What a sham…….



    2. Same happened to me. I was prescribed a diet and nutritionist for coming in fat with “arthritis”. I’ve since discovered on my own, after quitting those, that my “arthritis” is triggered by plants (eg. veg, bread). If I eat only meat, then the clicking in my knees and hand knuckles goes down. I also think iron levels effect it too.

      1. My joints click like that, too, when my thyroid replacement isn’t adequate. It goes away again when I get a stronger, dose of Synthroid. That clicking is one of the warning signs I get that tell me I need to get blood work done again.

  9. Ragen – a tiny typo made me giggle. “If the doctor suggests weight loss surgery ask about the increased morality rate,” Given the holier than thou attitudes of some of the people I’ve known who had WLS, I’d say they think it offers an increased morality rate. Naturally most of them have regained much of the lost weight, and are a lot less preachy now.

    All kidding aside, it’s incredibly dangerous surgery. ANY surgery is dangerous and should not be taken lightly.

    Also, you know how they say it “cures” diabetes? Well, there’s evidence to suggest that all it does is mask diabetes, making it harder for patients with diabetes to get adequate treatment.

    1. On junkfoodscience blog, she discussed this a bit. The masking occurs because you’re not eating enough. People who eat less ALWAYS have lower blood sugar, because the sugars are an indication of nutritional status. Even poor people in africa or wherever (“those starving kids in africa”) have lower blood sugar. I know I did when I was starving!

  10. But weight loss is magic doncha know? I went to an orthopedic surgeon to help determine how we were going to treat my knee that has no cartilage and a torn miniscus. He dismissed me entirely with a “you need to make a lifestyle change.” I never knew weight loss could spontaneously grow cartilage and repair a miniscus. Fascinating!

    I also told my doctor (when I went back to her after the surgeon) that since he recommended a lifestyle change, clearly that meant I shouldn’t be working out 6 days a week anymore or eating healthy food. Oh yeah, that’s right. He either assumed I was lying or didn’t read my history that detailed a very healthy workout and eating regime. My doctor wanted to throttle the surgeon.

  11. When I read about these latest developments in the medical community, I got really scared because of the issue of noncompliance. I have many health issues, and I need continued treatment. My decision is that I will just lie. Diets don’t work anyway, so how would they know that I am not seeking weight loss? I could mention HAES, but I doubt that would satisfy them. It would be nice if we could get a HAES program as one of those to which we could be referred? It doesn’t solve the greater issues of civil rights, but at least those of us who are caught in this latest diet industry coup could continue to get health care. And some HAES counselors could get government money to share the word.

    IN one of my more recent doctor visits, the pulmonolgist went on a more aggressive tone about weight loss. I was shocked as he had not done so in the past. He told me that if I continued to be fat, I could shorten my life. I mentioned that I am 68, how many more years did he think I would shorten my life. He mumbled something about, well, some people live into their 80’s. Wouldn’t it have been wonderful if I had the quickness to respond by asking him if being short could limit my life span, should I try harder to not be short? Instead, I just told him that I was doing my best to follow healthy habits including rest, good nutrition and exercise. He was baffled by why I was still fat and insisted that I must be overeating. He actually asked me if I ate pasta or chocolate. I was too stunned to work on educating him. I’m sure I know more about nutrition than he does. And, no I don’t eat much pasta but I do like my chocolate. So what??

    1. There is a lot of nutrition, as well as pleasure, in chocolate. It is not only good for us emotionally, but it has a lot of health benefits, among them an indication from several studies that those who eat chocolate regularly have a much lower incidence of heart disease/heart attacks than those who do not eat chocolate. Also, chocolate is made from cocoa beans, which are a leguminous vegetable, so chocolate is INDEED a vegetable. Pasta, at least enriched pasta, is also a very nutritious food, & no food should be categorically omitted for reasons other than allergies, personal preference, or genuine, documented medical contra-indications. Most doctors are such narrow-minded, uninformed, fat-hating jackasses, which is part of why I haven’t been near one since I needed my earlobe sewn back on in the emergency room over 5 1/2 years ago. I have been extremely fortunate with my health for over 64 years now, but I expect that someday my luck will run out & I will again find myself at their mercy. However, I do not go quietly & tend to be a very pro-active, outspoken consumer of medical care.

      BTW, he probably also thinks that my fat 91-year-old mother-in-law is taking years off HER life by eating a diet of mostly processed foods & chocolate. I am not too worried & she is fortunate to have a doctor with a functioning brain, at least about his very old patients, who told her to eat more salt because she didn’t NEED lowfat or no fat everything & categorically told her that, no, she cannot go on a diet.

      1. I meant low SALT, guess we hear lowfat too much. Her sodium levels were dangerously low because she insisted on buying reduced salt or salt free versions of everything because “they say on tv that salt is bad.”

    2. BTW, my mil is only 5 feet tall & I have a 78-year-old sister-in-law who is 4’11”, so I have my doubts about the short thing. I also wonder more as I grow older how the hell OLD we have to be before they stop trying to tell us that being fat is taking years off our lives, when in actual fact people who are at least somewhat fat tend to live longer & function better in old age. As for the lady who said she believes that genes trump anything else, I tend to agree. I live in Maine, with a lot of poverty, a high percentage of smokers, far too much alcoholism & a growing drug problem, but also a lot of decent down-to-earth people who mostly work hard, sometimes two or three jobs, & eat what they like, or, very often, what they can afford. We also have a lot of fat people. In my family & my husband’s families, a large number have lived beyond their late 80’s, some well into their 90’s, I had one great aunt who reached 101. You see a lot of old people around here, enough so that, in small towns, when anyone does before reaching 100, the obituary often says he or she died ‘unexpectedly.’

      1. yes, RIGHT ON about the genetic factor! On my mother’s side, they are all fat, chain-smoking alcoholics who die off in their late 60s to early 70s. On my dad’s side, they are all fat, chain smoking alcoholics who die off in their late 80s-early 90s. do we see any kind of correlation here??

  12. I had a horrible run in with an ortho over my hip. Yes it has arthritis, but it also has bursitis and a tendon issue. Anyways, he was horrible, got really snarky about calorie control, without even asking about what I eat or how I exercise. Finally I got out of there, with some dignity preserved, but something my Dr said on follow-up made me realize he had left some nasty comments about me in my record. I mulled it over and decided to write a one page letter, with no hyperbole(Like;”He wore his buttocks as ear muffs and did not hear a word I SAID.”) I simply explained what had happened and why I would never accept medical care or advise from this man. I took it to my Dr and had her scan it into my record. And yes it has made a difference in how other Dr have treated me since. By the way, if you really want to see what they say about you, you can request copies of your records, I have done this in the past, you may have to pay for it, but it would allow for some damage control. I have decided the next Dr that treats me that way will have a formal complaint registered against him/her.

  13. I had a doctor recommend WLS to me. I asked him if he’d read my chart. When he wanted to know why I asked that, I told him “It says, IN MY CHART, that I had a VBG 8 years ago (it’s been 15 years now). It worked so well, as you can see. WHY do you think WLS works? I’m living proof that it doesn’t always. And NO, I WILL NOT have my VBG revised to an RNY or a gastric sleeve. You assholes had your one chance to kill me, I’m NOT giving you another one.” Then he had the balls to say that obviously, I HAD to be overeating. I told him yeah, right, when eating more than a cup of food is guaranteed to make me barf, and eating something with too much sugar, too much fat, or fried is almost certain to cause dumping and the subsequent explosive diarrhea. I think part of that could be that I no longer have a gallbladder, but part of it is also the WLS.
    If my doctor tries to pull any of this crap on me, he’ll get told off in no uncertain terms. No diets, no WLS, and no counseling. It won’t work, it’s not going to fix any of the problems I have (arthritis, fibro, and mutilated digestive system are not things that have cures, and even if they did, weight loss wouldn’t be one of the cures). I’ll be non-compliant and the powers that be can kiss my fat ass (and they’d better bring a lunch, it’s an all-day job).

    1. Being non-compliant can be so satisfying, as can reminding the arrogant gits that they work for YOU, not the other way around, & they can be fired.

  14. A win for HAES today: I have gotten sucked into this “weight management” group which is looking at implementing a – you guessed it – weight loss program for the particular population I work with. Maybe it’s a good thing I’m there, because when they finally got around to asking my (the RD’s) opinion, I said, “I’m usually the voice of dissent in these discussions…I’m not for weight loss focused interventions because they almost always fail between 3 and 5 years if not sooner, and everyone gains back their weight and more. I advocate an approach to health that is about building healthy habits around food and not focusing on weight loss, because healthy habits are better indicators of health.”

    And the amazing thing was, all the doctors at the table said, Yeah! True! Great! Let’s do it!

    Crossing my fingers this goes the HAES way. At the very least, it won’t be ME promoting weight loss.

  15. I see the usual bat puckey about the BMI** and fatty fatties lolling around doing nothing and yadda yadda. You know what I don’t see on this list?

    *Test for conditions that have obesity as a known symptom; if any is found, treat the condition, not the patient’s pants size.

    *Inquire about medications the patient is currently taking or has taken in the past and check your reference materials to determine whether obesity is a known side effect.

    *Take a history of patient’s attempts at weight control and alert patient regarding the documented rebound effect of calorie restriction.

    *Counsel patient to report any sudden weight gain or loss that does not have an apparent cause because both events can be danger signs.

    It’s all “fat = bad naughty patient = punish punish supervise supervise lecture lecture cut cut medicate medicate.”

    Also, how the HELL is HIGH BLOOD PRESSURE an indicator for GASTRIC SURGERY?

    **How I first understood that the BMI is not a measure of anything useful: I know a woman who could probably whip the pants off any Marine of a similar age and build, but she was denied insurance because her BMI was too high. She farmed for a living–it was all muscle. Similarly, I know of two Coast Guard members, one of whom was forced literally to make himself waste away in order to remain in the service while the other was not. They both had a BMI that was “too high,” but the one who wasn’t forced to starve himself had big bulgy muscles because he was a bodybuilder, while the other was “just” a teacher of medieval fencing-in-the-round, so he was very strong and fit, but not groomed and “cut” and always at the gym looking shiny.

  16. I would have been the first reply with this, but I didn’t know how others would comment and I didn’t want to start it off with what I had to write. So here’s what I was going to say since I’ve loved all your sassy replies!

    If my doctor decided she needed to get a little more “aggressive” in her dialogue with me, then I guess I’d have to get a little more aggressive.

    You want to talk to me about weight loss surgery? Okay. I have one. Here’s a teaspoon, you can start eating my round posterior. That’s at least guaranteed weight loss, right?

    Oh, you want me to take some face-to-face counseling sessions? I’ve got something even better and it will make me feel a lot better. It’s called fist-to-face stress reduction. It’s a double win. I reduce my stress AND I get the added bonus of strength training. I think it’s win-win.

    Doctors want to be aggressive, I can be aggressive right back.

  17. Being tall increases cancer risk. I occasionally ask if I should just saw off a few centimetres for my health.

    After I lost weight, my bloodwork (always good before) has become just weird. Low iron, low B12 (despite being omnivorous), high cholesterol (half of it HDL), low blood pressure (which some doctor’s aide with a bad grasp of Latin entered into my file as “hyper” instead of “hypo” — imagine the fun and games *that* would cause if I weren’t borderline underweight!), blood sugar so low that there’s only about five minutes of intense craving between “I’m fine, really, no, not hungry” and getting the shakes so bad I can hardly stand. And have I mentioned the cold?

    OTOH, my chubby, sedentary, cake-and-beer-loving grandaunt lived to be 89, just like my athletic grandmother and my haggard, chain-smoking other grandaunt, so I have decided to believe that genetics trumps most risk factors for now. (Most common cause of death in my family in the last 100 years was war/starvation, anyway.)

  18. I was so pissed off after I read the info in post, and a little sad.

    I so much appreciate your blog, Ragan, and everyone who comments here. It’s great to have a little sanity spot.

  19. I read this. I feel empowered. I feel able to confront mistreatment and ignorant, lazy, prejudiced medical “care.” Reading your blog has done more to make me feel like a real person who is entitled to live and exist and take up space and enjoy my life than any other single thing that I can point to. You are doing at least one person – me – a TREMENDOUS amount of good and I am beyond grateful and thankful. Not just what you say but the articulate and informed way that you present it – HUGE HUGE value is added to my life. I really cannot overstate what your work and writing and activism mean to me in my life as a person and as a mother of a fat 12 year old daughter. I am in a position where I have no funds for anything beyond our absolute day-to-day needs at present and so am unable to put my money where my mouth is and support your work financially right now. However I want you to know that I would be and WILL be a contributing subscriber when I am able. If I tried to place a monetary value on what I have gotten from you already, you’d be looking at (at least) a midsized luxury car’s sticker price. What the hell, make it a fat luxury car! 🙂 The overarching emotion of my life has been shame, and nearly all of it has come from the culture’s abusive attitude towards and treatment of fat people. You are helping me to shed my shame, and I would much rather lose that than any or all “extra” lbs I have been carrying. The shame was killing me faster than my weight. Truly, if you take nothing else away from this ridiculously long fan letter (lol) let me say it very plainly – letting go of the shame is making my life truly feel worth living for what feels like the first time ever – I am 44 years old. Knowing I can work to spare my daughter some of that shame by sharing your work with her – well, my daughter means more to me than anything. To have the information and the opportunity and the tools and encouragement I need to help spare her some of this pain, there are no words for the gratitude I feel. (I know I have USED a lot of words, but even all of these can’t convey.) Finally (sorry for this lengthy message) I wanted to mention that it has occurred to me recently while being treated for severe anemia that the surgical intervention (gastric bypass) I had in November 2006 was not only unsuccessful in the sense that I only went from 400 lbs to 280 lbs (I am 5’5″), but also the intentional malabsorptive state that was created has caused this permanent debilitating anemia (and possibly other health problems.) I was not pre-diabetic at 400 lbs… I was healthier BEFORE the surgery. Which I realize will not surprise you. Furthermore, surgically altering/removing healthy functional organs (my stomach and nearly all of my small intestine) is CLEARLY NOT good medicine. Pushing my surgery through to get done before my job and insurance ended despite my having “flunked” the psychological in-depth evaluation required – well, what does THAT tell you? And the surgical risk that is inherent to any open abdominal surgery – unnecessary. (My surgeon only did “open,” not laparoscopic.) The upshot? I currently weigh 365 lbs, and none of my health issues are fat related. NONE. All of which dovetails exactly with your data on the weight loss failure cycle money machine. (Note that it did not interest my surgeon or grab his attention that me losing my health insurance would mean I would not be able to afford the “intensive follow-up” program they had. His practice was absolutely aware that I was losing my insurance because they deliberately and with some difficulty moved up my surgery date to get it done before the 12/31/06 end date.)

    On my list of things to be thankful for, please know that you are in the top ten. Best wishes and thank you. Thank you.

    Melissa Adams

    1. Wow, very meaningful post, Melissa, every single word. It’s true, when you’re shown an option to the common thinking on “being fat” it can change everything. I’m 54. I was a 12-year old fat girl once. My mom (god love her, she wasn’t intending to be mean) pointed at the “fat lady” ahead of us in the check-out line and whispered “Now you don’t want to end up like her, do you?” Now we know better. Thanks for sharing your story.

    2. good for you, Melissa. I have a 12 yr old also (son). One thing I’m really careful to do when clothes shopping with him is not say a word when the clothing is too little for him. Its one thing if he has to physically grow into something—thats what childhood is for!, but I’m not doing what my folks did and blame the kid because there aren’t enough comfy large size children’s clothes. —-Jen

    3. Melissa, I’m so happy you’re here. 🙂 I’m so sorry you’ve had to go through so much bad medicine. I hope things even out for you, health-wise. *hugs* In the meantime, come take some strength from us. 🙂

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