When They’re Concerned About Your Health

Bad DoctorIn response to my post about dealing with body shamers I had a number of people ask me how to deal with concern trolls – ie:  those who say something like “I think it’s fine that you like yourself, I’m just concerned about your health.”  These people may be well meaning, but here’s the deal with this – our health is none of anybody else’s business unless we choose to make it their business. The difference between education and concern trolling is request and permission.  If we don’t ask someone for their opinion about our health, and we don’t give them permission to discuss it with us, then they are allowed to feel concerned (or anything else) but they’re going to have to learn to self-soothe.

This can be difficult to deal with because, since people seem well intentioned, we can feel obligated to appreciate what they are doing, or accept it as ok.  Like everything, it’s your choice how to deal with it, but for me this is not ok.  People are allowed to be concerned about whatever they want, but it is not ok to unburden that concern onto me. Peter Muennig from Columbia did research about body size and shame and found that women who are concerned about their size have more mental and physical illnesses than women who are fine with their size, regardless of their size.  So, being incessantly barraged by the message that I should be concerned with my size is contraindicated for improved health.

And let’s not forget that however well-intentioned it might be, this kind of concern is based on all kinds of myths, misunderstandings, and misinformation that conflates weight and health. Health is not an obligation, barometer of worthiness, entirely within our control, guaranteed regardless of behavior body size or anything else, or anyone else’s damn business.

There are lots of reasons that people may choose to express their concern.  There are some who are truly  well-meaning, for others it’s about feeling superior, feeding their ego, or just killing fatties with kindness. For some it’s a knee jerk reaction from tons of programming that they’ve received about body size and health.  But if it doesn’t fit within what you consider acceptable behavior it does not matter why someone does it.

So when someone says “I’m just concerned about your health,” here are some options for dealing with it.

Basic responses:

  • No need.
  • I’m not currently soliciting opinions about my health.
  • My health is none of your business.

Responses for a teachable moment if you want one:

  • I practice Health at Every Size, if you want more information I’m happy to send you some resources.
  • According to research out of Columbia, people who are concerned about their weight have more physical and mental illness than those who aren’t – regardless of weight.  So every time you try to make me concerned about my weight you may be putting my health in jeopardy.
  • Can you tell me how you justify your beliefs based on the findings of Matheson et al., Wei et. al, the Cooper Institute Longitudinal studies, and Mann and Tomiyama 2007 and 2013?
  • The most likely outcome of weight loss attempts is weight regain, so even if you believe that fat is bad, weight loss attempts are the worst thing that you could recommend.

The things I think but do not say when I’m having a bad day:

  • My path to health is something that I’ve spent hundreds of hours researching – how about you?
  • I’m concerned that you don’t understand what is and is not your business.
  • I’m confused – what was it I said that made you think it was appropriate to make wild guesses about my health?
  • So it seems like you lost your beeswax, sorry I but haven’t seen it.
  • Are you feeling ok? I think you just hallucinated that you’re my doctor.

Edit:  It has been suggested that the last bullet point was ableist – disparaging to those with mental illness that cause hallucinations.  I wrote it specifically to avoid this since hallucinations can be caused by so many things (dehydration, lack of sleep, ingested substances etc.) and aren’t a definitive diagnosis of any mental illness. That doesn’t mean it’s not ableist but I wanted to leave it with discussion  and my apologies rather than simply deleting it and acting like it didn’t happen.

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36 thoughts on “When They’re Concerned About Your Health

  1. Oh boy I wish I had seen this yesterday. There is a bigot commenting on another blog who just will not believe you can be fat and healthy and has called me everything under the sun for calling her to task on her assumptions!

  2. I love your blog! And I love reading the comments almost as much as the posts. My life has changed a great deal since I started reading your blog and I find myself happier than I’ve been in decades. I am ready to shed my inertia and start LIVING again, despite my size and current lack of fitness. So, thank you for the work you do – it reaches people all over the world (I’m in South Africa) and it’s changing lives for the better.

    I get a lot of concern trolling. My boss is a master of that, despite the fact that at roughly 400 pounds my blood pressure, blood sugar, kidney function, cholesterol levels, iron levels, etc (you know, the actual markers for good health) are all normal. Last week I suffered from a head cold/sinus infection and he all but blamed my weight for it. Last time I looked, colds and flu are caused by viruses and infections by bacteria, NOT FAT. Thanks to you, Ragen, I’m learning to stand up to him and he’s not liking it so far, but he’s just going to have to learn to live it. At the age of 44, this doormat is getting off the floor!

    “Self-soothe”? Priceless.

  3. Excellent posting! Along the lines of concern for our health…I would be interested in your thoughts on Obamacare and the requirement that EVERY doctor visit and doctor weigh you at EVERY visit. I went to my podiatrist and they wanted my weight and height! Never have they requested it of me before now. They acted as if it was the law and basically told me I can’t refuse. I tried to find out what the actual law was (if there is a law) but was unsuccessful. I was hoping you would have some input on this issue. I am brand new to your blog so I don’t know if you have already addressed this issue. Thank You!

    1. Hi Deborah,

      Glad that you liked the post and excellent question. Your podiatrist? Sigh. I’ve had really good luck by smiling and firmly repeating “no thank you.” In the case that I am told that I’m “required” I explain that I have the right to refuse medical treatment (if they push I source the Supreme Court’s decision in Cruzan v. Director, Missouri Department of Health) and offer to sign a waiver that I am choosing not to to get weighed AMA, as well as explaining that should a medical reason actually present itself (I have to take a prescription that is dosed based on weight etc.) I’ll be happy to revisit. I hope that helps!


    2. I don’t think your podiatrist can be right about this. The Affordable Health Care Act regulates how insurance is provided and what services insurance must pay for, and requires that insurers must provide some preventive services free of charge. It does NOT require that any specific patient must undergo any specific procedure.

    3. Seems oddly suspicious to me, like they are compiling a database to determine who should be allowed. Reminds me of the head measurements to determine criminality in the late 19th century or Jewishness during WWII.

      We are going down a slippery slope indeed.

    4. Tell them to show you a copy of the law, exactly where it says that. It doesn’t, so they won’t be able to, but since it’s over a 1000 pages long, it should keep them busy looking for quite a while.

      What they told you is absolutely false, and you have the right to refuse ANY medical treatment or procedure you don’t want. I would tell them that I’ll be contacting the state licensing board about this unlawful coercion, because that’s exactly what it is.

    5. I did let my gyno’s office weigh me, but I informed the nurse that I am recovering from EDNOS/self loathing issues, haven’t weighed myself in months because it’s triggering, and would appreciate some compassion. She didn’t say the number aloud, or make any comment, and everything was fine. My doc never said a word, and he was as awesomely kind/approachable as ever!

      I’m not sure what will happen when I see my new GP in November, but I have hope it will be okay. I switched practices because my old one had me in tears as I tried to explain that I was in counseling and had gotten shin splints when I ran too far. Realized that she could push back into that horrible dark place, so I switched to my mom’s doctor.

      If they won’t take a refusal, complain to the office manager. Let them know that if your voice is ignored, there are other practices that can be switched to.

      The only reason I still okay weighing is because loss/gain can sometimes signal a problem (diabetes runs in dad’s family), and I’m on medication. Being upfront at the time of being weighed made a difference.

      1. Normally yes. When dealing with a judgemental mother to whom your fatness is just one more bad choice you’ve made….not so much. Still back to normal now 🙂

  4. I swear there has never been better anti-conern troll ammunition than the Meunning study! I love to quote that one.

  5. Mine comment to anyone who says anything about my body, my food or any health issue (or that of the person I am with): Are you a doctor and more importantly are you MY doctor? Cause you don’t look like her.

  6. My MIL was “concerned” for me on our family vacation, a cruise to Alaska the I’d been looking forward to for SO long. She and my FIL were concerned after they saw me short of breath. I was hauling luggage while having a hot flash at the time. They brought it up the 2nd night of the cruise, on formal night when we were trapped at a table with just the 2 of them. I felt prettier than I had in a long time that night and my MIL chose THAT MOMENT to voice her concern. I immediately said “I really don’t want to talk about this right now” but in her cocktails + half a bottle of wine state, she would not be stopped. My FIL finally managed to change the subject and a few minutes after that I excused myself and went back to my room. It put a cloud over the rest of the trip and I avoided being alone with or sitting near them for the duration of the trip. Thankfully we were traveling with a large group. We still had a wonderful time but I haven’t been able to let go of the anger at her sticking her nose where it didn’t belong. To her credit, she’s been nothing but pleasant since. My FIL and brother-in-law have apparently both talked to her but I’ll never completely forgive her for making what was to be “the trip of a lifetime” be something I have a good chunk of negative memories of. I’ve written her a “back off” letter but I haven’t had the nerve to send it. It’s complicated…

  7. I just thought of a sassy one this morning:

    Thanks for playing “are you smarter than my doctor” – unfortunately you lost this round and I don’t hand out consolation prizes.

  8. I have a problem with friends who concern-troll themselves. What I mean is friends who feel the only way to be healthy is to lose weight. One of them skips meals regularly. I’m pretty sure her mysterious bruises are a result of not enough vitamins/minerals.

    I keep reminding her, when she brings up her concern of diabetes, that her regular exercise is more important than losing weight. She’s so happy that she is thinner, that I mostly keep my mouth shut.

    Seriously, I love these people and hearing them insist that losing weight is the only healthy solution bugs me so much. Underpants rule.

  9. Take that, complete stranger who walked into my workplace, took one look at me, and started giving me weight loss advice!

  10. Yup, been having crazy flank pain… pretty sure it is my liver reacting to terrible medicine I was prescribed, so my mother was super excited to tell me (while I was about doubled over in pain) that doctors shouldn’t help me because I refuse to lose weight. Once I pointed out that this pain started after I lost 15 lbs in a week from being sick (after lots of me yelling at her in other ways that her stance was bullshit), she realized, oh yeah, maybe this does have nothing at all to do with being fat and maybe has to do with medicine that keeps my cells from dividing…

  11. Any suggestions for getting the diabetes police off your back? All the health concern trolling is exponentially worse if you happen to have diabetes,which seems to be a shameful disease to have in the first place. Even people who should know better question my food choices!

    1. For that one I just keep repeating that my doctor and I have made a plan that I am following.

      It won’t necessarily shut them down completely, but it helps.

    2. I’ve been known to smile airily and say “That’s why god created insulin. Excuse me while I order more dessert.”

      If they keep it up I tell them flatly that my food choices are not up for discussion, and if they want to talk about personal matters we can talk about their vagina or dick problems (depending on whether the troll is male or female). That usually shuts them up.

  12. What do you suggest when it is not an annoying stranger/coworker/acquaintance but a beloved friend or family member expressing their concern out of love? While they may be misguided in their beliefs, they want the best for me. And I am not one of those healthy, active fatties who can point to all my medical measurement numbers and fitness level being satisfactory. I have just been told that my glucose levels, which for many years have been at the high end of normal, are in pre-diabetic range, and of course my doctor’s advice for that is to lose weight. =P So the truth is, I am also concerned about my health and due to knee issues have become much more sedentary in the past few years. I have gained more weight, going from a place where I was comfortable with my big curvy shape to a place where I am not happy with my size and shape in addition to being worried that at this rate I will just continue to get bigger until my size limits my activities even more than it already has.

    I realize this is somewhat beyond the scope of the current topic here, but these are some things I have been wanting to say to a sympathetic forum, so thanks to all for reading and contributing anything you have to say.

    1. I completely sympathize–my numbers aren’t good either. For me, the main thing that has helped lower my glucose back into the ALMOST-high-normal range has been walking 30 to 40 minutes a day. With your knee issues, I’m not sure if you can do that or not, but my impression is that if you can manage any exercise at all, that would be beneficial for keeping your glucose from going higher. And remember, it’s okay if it stays in the “pre-diabetic” range; the goal is to keep it from rising to diabetic range if you can.

      Even without exercise, you may be able to modify your glucose levels through diet. What I have found very helpful is NOT to think “I’m making these food choices in order to lose weight” but rather “I’m making these food choices to moderate my glucose levels.” You might want to talk to your doctor about that and get him/her on board with that way of looking at it. I finally found an endocrinologist who shares my view of this — we measure my success by my glucose levels, NOT by whether my weight has gone down (or up, for that matter). He views my weight gain over the last few years as a symptom of my insulin resistance, NOT as a cause of it, so he doesn’t berate me for not losing weight. Instead, he congratulates me for keeping my glucose just at the borderline of high-normal/pre-diabetic for the past several months.

      When I talk to family members about this (which overall I try to avoid doing, but there are a couple that I don’t mind talking to), what I tell them is pretty much what I’ve written here. I’m insulin-resistant. No-one knows why some of us are. It is more likely to be the cause of my weight than the result of my weight, and in any case it doesn’t matter whether the weight or the insulin resistance came first. The important thing now is to try to control the insulin resistance/glucose levels. I’m doing that through eating carefully and through exercise. What I weigh is irrelevant; the important measurement is my glucose levels. If my glucose levels go up in the future, I may need medication — and that will not be an indication that I’ve done anything wrong or “failed” in any way. It will simply mean that insulin resistance is complicated and not always controllable without medication.

      The short version of that, of course, is “my doctor and I have a plan to deal with my glucose levels. Thank you for caring about me.”

      I hope some of that is helpful — if not, ignore it!

    1. I think that is a wonderful proposal. It’s simply giving consumers more information, not making a value judgement.

      Since I have diabetes and limit sugar to one dessert a week, I have to read food labels religiously to avoid eating any more. And sugar is put in damn near everything. Does a slice of whole wheat bread really need 5 grams of sugar added to it?

      To me, accurate information is always a good thing.

      1. I agree completely. People who want to ignore the nutritional information can. For those with diabetes or pre-diabetes, having accurate information about the amount of added sugar in a particular food would be a real boon.

        I’m juggling a couple of conditions here — congestive heart failure which absolutely requires strictly limiting sodium, and pre-diabetes/insulin resistance (very likely exacerbated by my heart medications!!) which means it’s a very good idea for me to pay close attention to carbohydrates and sugars. While I wish I didn’t have to keep track of these things, unfortunately I do — and accurate information on food labels is crucial.

  13. this post is pure awesomeness and i’m going to use the shit out of those answers you suggested, THANK YOU.

  14. I do believe the ACA (Obamacare) now requires doctors who accept Medicare/Medicaid to counsel patients whose BMI is above “normal” — because this happened to me about a month ago for the first time in my life! I’m healthy and not really even fat (if my husband and friends are to be believed). My eating is good, all my numbers are good, I’m fairly active, etc. But last time I was in the doctor’s office, she said, “Now, let’s talk about your weight loss plan.” I responded that I am NOT interested in losing weight, that my weight is stable and has been for many years (like, at least 30 years — I’m heading towards age 60 in a few years), and that I didn’t agree with the BMI categories. She backed off and said, “Oh, well, if you’re stable and you have energy … better not to fluctuate.” But I still couldn’t believe it. Crazy stuff. And for the record, I am very happy that we have the ACA. But this BMI stuff is a real problem. I could lose 60 pounds and still be in the “normal” range — but I’d also be a bag of bones. No thanks.

    1. I don’t think so — it requires insurance policies to COVER obesity “counseling” and screening, and requires Medicare and Medicaid to make their clients aware that such counseling is covered, but it doesn’t (can’t) require any patient to avail her/himself of such coverage.

      I think this is pretty much true of any of the coverage that the ACA addresses. It’s a law about coverage, and as such it requires that all insurance plans cover certain procedures and practices *for those patients who request them*. But it is not a law requiring patients to have certain procedures. It’s quite possible, however, that some doctors’ offices are confused about that distinction.

      1. Yes, that’s true — no one is required to follow any treatment. I was told, though, that the doctors are required to TELL you if your BMI isn’t “normal.” Mine actually pointed to the BMI number on her computer and said, “But this says you’re overweight.” And a few days after my visit to the doctor, I received a call and then a letter in the mail from my insurance company telling me I had been referred for a program where you can consult with a nurse to deal with your chronic health problem — which I’m assuming is this BS; I haven’t called to find out. My concern about this is — I wonder how much damage this is doing to people, unnecessarily? Either if they do the weight loss thing or if they just are made to feel bad. It kind of did a number on me, and I know intellectually it’s ridiculous.

  15. Oh God, I think I love you. This blog entry made me smile yet once again. It was just what I was looking for. Next time people make stupid comments again, I’ll just redirect them to their blog. I’m just afraid that they’re not intelligent enough to comprehend what’s written here.

  16. Another one that occurs to me: “Should you eat that?” “Why, does it non-obviously have something in it I’m allergic to?” Because that’d be, like, the one situation where an acquaintance jumping in to second-guess your food choices might be reasonable..? I dunno.

  17. I love your blog so much. It’s come to mean a lot to me. I’ve been lurking and reading for months now, and it’s always a valuable reminder to help resist the messages I get from pretty much EVERY other media outlet and person in the WORLD, that I am unacceptable and unhealthy and yadda yadda. I’m going to become a member, because I want to help make sure the work you do keeps on going. Thank you for everything you do!

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