Consider the following true stories:
A doctor tells a fat patient that they need to exercise more without asking them how much they exercise. When the patient says that they do exercise instead of asking for details the doctor says “That can’t possibly be true.”
A fat person goes to a personal trainer, explains that they practice the Health at Every Size method and want to increase their strength, stamina, and flexibility. The trainer ignores their request and chooses a plan that they think will create weight loss.
A fat person is out for ice cream with their thin friends. Ignoring the fact that the thin people are eating the same thing someone walks up and tells the fat person “This is why you’re fat.”
Paula Deen eats a hamburger on a cruise and a website puts up a poll asking if that’s “ok” or if she “should only be seen eating healthier foods”
What do all of these situations have in common? If you answered “They are all effed up” you are totally right but it goes beyond that.
Fat bodies are seen as “evidence”. People try to claim that our bodies are evidence of unhealthy behaviors, lack of willpower, lack of self-care and any other appearance-based stereotypes they enjoy believing and perpetuating Then they claim that this evidence is compelling enough to make it ok to target fat people for for shame, stigma, bullying and humiliation “for our own good”.
Even more damaging, fat people start to internalize this message thinking “If I’m fat then I deserve to be treated poorly and have my body and choices treated like public property.”
This is just not true. Fat bodies are not public property, they are not evidence, and they are not a sign that we need someone to step in and tell us how to take care of ourselves. First because nobody can tell what our habits are based on our body size. Second because our habits are our decision regardless of what size we are and health is not an obligation, barometer of worthiness or entirely within our control, and that our choices are limited by the resources that are available to us. (Those interested in making an argument about fat people costing tax dollars are welcome to head over to this post.)
Fat bodies aren’t evidence of anything except that fat bodies exist. Claiming to be for health while running a ridiculous “A healthier world one shamed fatty at a time” campaign is evidence that someone isn’t so much interested in improving health as they are in being a bully and then blaming the bullied, while being seriously mistaken about the location of their beeswax.
It’s less than a week away! Check out the Fat Activism Conference Three days, 40 speakers, 30 workshops, teleconference style so that you can listen on the phone or computer from wherever you are, recordings so you can listen live or on your own time, tools for everything from armchair activism to marching on the White House only $39 with a pay-what-you-can-afford option to make it accessible to as many people as possible. Check it out!
Book Me! I give talks all across the country about self-esteem, body image, health and wellness for people of size and more, and I’d love to speak to your organization. (I’ll be in Northern New York and Central Pennsylvania in the next couple of months if you are in those areas and would like to add an event to those trips.) You can get more information on topics, previous engagements and reviews here or just e-mail me at ragen at danceswithfat dot org!
Like this blog? Consider supporting my work with a donation or by becoming a member! For ten bucks a month you can support size diversity activism, help keep the blog ad free, and get deals from size positive businesses as a thank you. I get paid for some of my speaking and writing (and do both on a sliding scale to keep it affordable), but a lot of the work I do (like answering hundreds of request for help and support every day) isn’t paid so member support makes it possible (THANK YOU to my members, I couldn’t do this without you and I really can’t tell you how much I appreciate your support!) Click here for details
Here’s more cool stuff:
My Book: Fat: The Owner’s Manual The E-Book is Name Your Own Price! Click here for details
Dance Classes: Buy the Dance Class DVDs or download individual classes – Every Body Dance Now! Click here for details
If you are uncomfortable with my offering things for sale on this site, you are invited to check out this post.
46 thoughts on “Fat is Not Evidence”
A few years ago during a jog, I was cut by glass deeply enough to require stitches. During the ensuing emergency room visit, I saw two doctors. One, the doctor who did the stitching, was wonderful. We joked around while he was working, he answered my questions about how long I’d have to wait to start training again and what kind of exercises I could do, and gave me some antibiotics and a slip for work. High on my list of best doctors I ever visited.
The other, who did the follow-up… kept insistently referring to my “car accident,” no matter how many times I (or the nurse assisting him, for that matter) reminded him I’d injured myself while running.
Sometimes fatphobia sends you straight into the Twilight Zone.
Wow. That goes right down there with the whole slew of doctors who lectured Mr. Twistie at every doctor’s appointment for about five years that he needed to quit smoking… despite the fact he’d never smoked a cigarette in his life. He finally offered one doctor a hundred bucks if he could find evidence anywhere on his (Mr. Twistie’s) chart that he was a smoker. Amazingly enough, that ended the harangues, but still, sheesh!
Wut. That’s… wow. Insisted he smoked when he didn’t! And having to put down an ultimatum like that to make the lectures stop. It *sucks* the burden of proof is always on the fat person.
Sorry you had to deal with that. If it makes you feel any better, it took several doctors to finally take my thyroid tumor seriously, and I found one who diagnosed me with Thyroid disease and isn’t a super a-hole. They’re off my case completely now that my blood pressure is normal, my A1C is 5.5, glucose is normal, and my cholesterol is in the range that you usually only see in vegans or extreme athletes. I work out and eat extremely healthy. AND, FYI, I believe that even if I didn’t.. it’s nobodies damn business. I hope, someday, doctors can urge patients to work towards better numbers on the blood test and not on the scale.
I’m glad you found a doctor who actually investigated.
That reminds me of when I went in to the ER for chest pain, shortness of breath and vomiting. The doctor on duty was more worried about taking a call from another hospital then properly treating me. She smacked my back a couple of times and said it was bad heartburn and my back injury, lose weight and it would go away.
Fast forward to the the next day and I saw my own doctor at my clinic since we had made my the appointment but everyone freaked the day before when I couldn’t breathe. He thought it may be my gallbladder, so he pokes around my ribs and actually could feel it starting to swell through my ribs.
Lone behold I end up back in the ER and am treated by a different doctor and not only do I have gallbladder problems, I also have a severe case of pancreatitis. When my consulting surgeon heard about what happened I am pretty sure that doctor who first saw me got yelled at because if they had left it any longer according to the ultrasound I would have been dead with in two weeks.
Man, that’s terrible. I’m glad your doctor caught it, and I hope that tool who diagnosed you via stereotype caught hell. At least my brush with ER fatphobia was just weird and not dangerous; the doctor still treated the wound properly and gave me the right antibiotics. Incidents like yours are blood-boiling.
Oh she caught hell, after my surgery I registered a compliant with the hospital and the provincial health care system. To my knowledge it was investigated but I don’t know what happened to the doctor seeing I haven’t had to go into the ER in almost three years.
Truthfully this is why I fear the day my doctor retires. He has been my GP for the last 20 years and not once has my weight come into the conversation.
Reblogged this on Jessica A Bruno (waybeyondfedup).
I’ve been called a liar by several doctors. Or I’ve been told I must be “mistaken” or “miscalculating”–the latter having to do with counting calories. I had an obgyn tell me “You need to take it easy with the cakes and cookies.” When I explained that I don’t eat cakes and cookies he snorted. Explaining that not only was I eating healthy, drinking tons of water but I was still exercising regularly, fell on deaf ears. He ignored all of it and stuck to his guns that if I would just take it easy on the carbs I’d stop gaining weight….during pregnancy. He also suggested I go on atkins…during pregnancy.
Of course my issues stem from thyroid disease so I guess that makes me a “good fatty” ??? During a very recent conversation with my best friend, she was talking about another friend of hers who is fat and exercises all the time but she has thyroid disease so that explains it. I tried to explain that bodies are just bodies and there are a lot of healthy people, with no AI diseases, who work out and exercise and are still fat. Exercise doesn’t magically make you thin. Your body settles where it is going to settle. I love my friend like a sister. We’ve been best friends for 26 years. But she looked skeptical and said that when she focuses on exercise and eating healthy the weight comes off every time.
So, because that is how it works for her, she assumes if everyone (without a thyroid issue) was working out and eating right they’d lose the weight too. The fact that they are fat proves they aren’t because when she slacks off she gains back. Basically, since that is her experience, she assumes it is everyone else’s as well. So, in her mind a fat person is a person slacking off because when she slacks, she gains weight. I let it go. I knew there was no convincing her and I didn’t want to risk getting into an argument. But I know this line of reasoning is prevalent.
We can explain it to them, but we can’t understand it for them. I know this all too well, but it always makes me a bit sad to see it confirmed again and again.
This is exactly it. My “normal” weight friends and relatives look at me, think how much extra they would have to eat to be as large as I am, and assume that I MUST be eating that much. The evidence of their own experiences with me (that I eat about the same as they do) somehow doesn’t override their assumption that the way their metabolism works is the way everyone’s metabolism works.
In fact, they probably could not become my size even if they tried. We have one very thin family member who decided in his 20s that he WOULD gain weight. He ate an entire pint of chocolate-chocolate chip ice cream every single night for a month, and gained not one ounce. That’s 1200 extra calories a day, and no weight gain. What fascinates me is that each night after he ate the ice cream, he would feel very hot and begin to sweat — i.e., his metabolism revved up and burned off that extra fuel, to preserve his natural size. After a month he was so sick of ice cream that he couldn’t stand it any more and gave up the useless effort to gain weight.
My relatives all believe this — they all love this story. But somehow they still think fat people are gluttons. It mystifies me that they can understand that it’s impossible for a thin person to gain weight voluntarily but nevertheless firmly believe that a fat person must be eating too much.
This is indeed very sad.It seems that everyone loves the thin persons “valiant attempts” to gain weight and fail to do so, while overweight people who try to lose weight and fail to do so are vilified….
It does amaze me that what they see as nothing but a random metabolism issue running one way they see as nothing but a gluttony issue running the other way — even if seeing it that way requires them to presume that you’re binge-eating in shame alone and only eating “normal” amounts when you’re around them.
I still remember the day it occurred to my dad that it was weird that I ate a good deal less than him, yet he remained very thin while I was putting on weight. It was so great to have someone close to me think that way rather than trying to caution me every time I ate more than one cookie at a time.
@Elizabeth People aren’t rational about this. They admire/feel jealous of thin people who cannot gain weight (although I know a few think people who would love to gain some and cannot do it) yet they judge a fat person.
Bottom line is that no matter what we eat they will still believe what they want to believe and it would be a shame to live our lives according to their irrational beliefts about how we should live ours.
know a few thin people*
What you write about that thin relative of yours reminds me of a friend of mine. Last year, at a doctor’s appointment, she was told she “simply had to” put on at least 3 Kg in order to improve her health. Apart from that arbitrary number, she was not given a word of advice on how she was to gain those oh-so-vital 3 Kg.
To achieve the goal that her doctor had set, she started eating the most caloric foods she could think of, in amounts that were unusually large for her habits. The result? She did not gain a gram more than 1 Kg, no matter how hard she tried, and she developed a liver problem, which thankfully reversed itself when she went back to her usual food intake. Her body just won’t go above a certain setpoint, no matter what she eats or how much of it she eats.
So much for the idea that one’s weight can be manipulated.
Amazing. In other words, her doctor told her to treat herself like a goose being fattened for foie gras — and sure enough, she got liver trouble. I’m glad to hear it resolved for her, but what a horrifying and illustrative story. We just CAN’T alter our basic metabolisms, and ti’s infuriating that so many people insist we have to try to.
Agree wholehearthedly. A school nurse in High school wrote that I should be on a diet in my file based on my weight alone (did not ask about my habits at all).
To be honest, I had told the other nurse that I didn’t want to know my weight (but that was because I used to have an eating disorder and part of my recovery was not worrying about numbers on a scale but didn’t want to tell them because they weren’t my doctors anyway).
People always assume that you must WANT to lose weight no matter what. Even at the gym I kept my friends that I was there to focus on health (including mental health, exercise does help BTW) and they were all about losing weight.
There was one single doctor in my life who actually did understand that health does not equal thin but includes all kinds of bodies.
I am way too frustrated to deal with people that don’t understand (especially online) because they don’t care about us! It’s all about THEM and THEIR need to validate opinions. However, since I became fully in control of my body (eating disorder free for years now!) people have stopped mentioning my weight most of the time. That is probably because I am confident or I stopped hearing their bullshit.
But ugh, you can’t stop but being mad at doctors that should know better! They should be compassionate and scientists not biased assholes.
When I went to the hospital for a hysterectomy, my doctors and nurses kept checking everyday whether I have Diabetes. I even had a nurse ask me how I could be so overweight and not have diabetes. They were sure the tests were wrong and that I HAD to have diabetes because I was fat. One doctor, Dr. Amy.. she told me that for someone of my weight, I was in good health and she commended me. She didnt say I needed to lose weight or anything. She said I was healthy. And she gave me great confidence that day. The others made me want to punch a wall because they had this Fat=Diabetes theory in their heads they just couldnt get rid of.
I’m not sure it’s still up, but at one point the NIDDK website posted a statistic saying that 85 percent of people with diabetes are overweight or obese, and then strongly implying that obesity causes diabetes. This kind of claim is made all over the net. “obesity causes diabetes”.
Only one glaring problem with that. Elsewhere, statistics show that possibly as many as 30 percent of obese patients, and fewer overweight patients, have diabetes. If anything can be inferred from those statistics, it would be that diabetes is more likely to cause obesity, than the other way around.
Which makes sense. Type 2 diabetes is commonly treated with insulin, and insulin is the agent that facilitates fat storage. Duh.
And some of the studies I have read state that, at any given time, 88-90% of the fat people in this country are NOT diabetic & that 75% never will be, & that about 25% of thin people are or will be diabetic, which sounds pretty evenly distributed to me. Also, type II diabetes is as genetic as type I, so I am not sure what being fat would actually have to do with that.
When I went to a new endocrinologist a few months back and said that I was puzzled about why I’ve gained over 30 pounds in the past three years despite eating the same amount and increasing my exercise, he said “Because you’ve become insulin-resistant.” He just stated that as fact — the insulin resistance causes the weight gain, NOT vice versa.
But it’s frightening how many doctors have never even heard of insulin resistance! I had a podiatrist get really rude with me years ago because I hadn’t told him I was diabetic. I snapped right back at him that I hadn’t told him because I WASN’T diabetic! He basically accused me of lying because I was on metformin, and I said I was on it for insulin resistance — he looked at me as if he thought I was making it up, but at least he shut up then.
I never went back there, obviously.
I can sure see why you never went back!
One more comment about my new endocrinologist — when he was doing the work-up, he looked at my very thin “male-pattern-baldness” hair and commented that that’s absolutely typical of insulin resistance/pre-diabetes as well. Somehow, I felt this as truly vindicating (much as I hate and suffer over my sparse hair). No-one would look at me and say “You lazy slob! Why don’t you just suck it up and GROW MORE HAIR???” Everyone realizes that my hair loss is not voluntary. But … BUT …. here’s this endocrinologist saying that my hair loss and my weight gain are part of *the same* hormonal/metabolic pattern. So one is no more under my control than the other. Somehow that allowed me to let go of the last remnants of “guilt” over being fat.
Hi Ragen, I love your blog! I’m not sure if this is the right place to post but I was hoping to get some feedback. I’ve been overweight my whole life, and I know I’m destined to be overweight for the rest of my life. I’ve been on diets for months at a time and never lost anything. It’s only recently that I’ve discovered your website and others like it and I’m thus in the process of learning to love the body I’ve been given. But I’m having trouble doing that. Could anyone share what it is that they love about their own bodies? I’ve been indoctrinated since I was a young girl into believing that there’s nothing to love about being overweight, that it just isn’t “normal” and that guys won’t find me attractive and it’s hard getting over this indoctrination and self-doubt. I was hoping some people could tell me the benefits their own bodies give them.
Well, my big ass is great at making sure the car door is shut! Haha.
Jokes aside, we can’t tell you what to love about your body, you’ll figure that out though, as you go. What do I love about my 380lbs body you ask? Well, I love how soft I feel, I love that when I have the right bra, I have some damn nice cleavage. I love that my boyfriend loves my ass, and tells me it fits awesomely in his hands. I love that it gave my son the home he needed to be in, and was able to be the healthiest I have ever been during my pregnancy. There are many things I love about my body, and my self, but it has taken many years to get to this point, and it’s a every day struggle for me. Some days, I can’t get over how pretty I am, others I don’t even look in the mirror. You have to start small, and slowly work to where you want to be with your self love. Find the things that you like about yourself, find people to be around that love you for you, and keep reminding yourself that no matter what you have heard in the past, or what people may say to you know, you are a beautiful, amazing person, and you are worthy of all the love in the world.
I would advise paying attention to your thoughts. Because fat people hear so many negative messages about their bodies, they often internalize them.
My way of dealing with that is to reframe any negative thought into something positive. If “I hate my body” pops into my head I deliberately think of how my body takes me anywhere I want to go. Or how my body enables me to give and receive hugs. Appreciate a sunset.
It takes practice but the payoff has been huge. My body is my friend and ally, not an enemy. It will be with me until the day I die so hating it is clearly counterproductive. Appreciating it has made me stronger mentally and emotionally.
Keep reading this blog. It has helped me so much. This is just a healthy, positive place to hang out and get recharged.
It helps to change the images you’re surrounded with. TV, magazines, billboards, ads, they all tell us there is One Right Way to have a body, and it’s a body even the women in the ads don’t have, because it requires photoshop and professional make-up. Ditch magazines filled with “bikini body tips” and similar. Go online and seek out images of glorious fat people living life and being happy and themselves and surround yourself with them. Check out things like the BMI project, and fat acceptance OOTD blogs and tumblrs. Check out Beaucoo.
When you see a wide variety of bodies every day, take the time to appreciate them. Think something positive about each one. Notice how every single one of them has something awesome about them. The greater the variety of people you see who you can acknowledge are awesome, the easier it will be to start realising that you’re no less awesome than they are.
Treat your body kindly. Touch it. Dress it in things that make you feel good. Eat things that make you feel good. Move it in ways that feel good.
I totally agree with the suggestions above, especially the ones about making a conscious effort to pay attention to the thoughts that come into your head when you are feeling bad about your body. If you can identify what exactly you are thinking during those dark moments, you can “talk back” to those thoughts, which I find takes away a lot of their power. One helpful tool for doing this is the David Burns “triple column” technique, which was developed by a leading cognitive behavioral therapist. I learned it from reading his book, Feeling Good, and have found it immensely helpful (ironically/sadly, the book does have a bit of fatphobic language in it. I still think the strategies in it are very useful, but if you’re worried about being triggered by that, you might want to just Google the triple columns technique instead of reading the book).
Another thing I’d recommend is practicing thinking and talking about yourself in a positive way. Self-deprication is so built into the way we communicate with one another that it can be had to even be aware of it after awhile. Also, for me personally, learning to love my physical appearance was (and sometimes still is) very challenging, so practicing having pride in and compassion for other aspects of myself was a good way to “work up” to loving my body. One thing I do is try to make a list of at least five successes I’ve had at the end of every day, even if it’s something as simple as “remembered to empty the cat litter box.” Learning to think of myself as an intrinsically valuable, worthy human being (as all of us are), made it possible for me to stop linking my worth to whether or not I fit an arbitrary, unrealistic, industry-funded standard of beauty. And in turn, this is allowing me, little by little, to decide and discover what *I* like about the way I look.
Good luck! 🙂
It is not about benefits. You have your body, you ARE your body. Your brain is part of your body so your personality and moods and movements are all connected.
I have learned to be grateful that my body did not give up on me even when I did and wanted to punish myself for not being thin. All those diets and years of indoctrination have done harm to your brain and body. This is actually more about how we think. Thankfully, you have taken the step to get better!
1. shut out negative thoughts by surrounding yourself with positive messages and people. Your friends say hurtful things about your body? They are not your friends, tell them to be considerate or get out. Tabloids? Shows like Big Brother? Articles about dieting? Thinspo? Eliminate them!
2. remember that people have no idea what they are talking about when they talk about health=thin and they are oh so concerned for you. You will encounter great resistence from people so ignore that!
People in general are shallow and don’t do things for their health (sensible exercising and eating well, suited to your needs and lifestyle) they do things to “look good”.
3. “look good” does not exist because beauty is not standard as everyone believes it is. So let go of the guilt and fantasies that tomorrow you will be skinny and life will be great. If you have to say it in the mirror say it every day: tomorrow you will be fat and life will be great.
4. BTW clothes are made to fit you, not the other way around. YOU are not a coat hanger!!! So practice self respect if you want respect (that is probably the most important thing)
5. you will have crappy days in which nothing will fit, will feel that everyone is judging you and the mirror hates you+ so much self doubt. It is OK to have bad days so accept them and move on. There are far more important things in life than whether a piece of cake will make me fat, my cellulite or if my stretch marks are visible. I mean think about it, there are many poor and sick people in the world, wars, climate change. The size of my a$$ really does not matter. Period. To concern myself with it is to waste my life, one minute at a time.
I love my body because it is imperfect, because it has been with me all these years. There is so much strength in my body. It has a nice shape (although yes I have a big belly and some days I just wish I didn’t). I can do amazing things such as walking my dog, jogging, reading, listening to music, dancing all night long, hugging my friends, talking, laughing. These seem trivial to us but imagine life without those things.
I hope you will embark on a big journey of self discovery, learn how to love your body and embrace life.
One time I went to the ER, for bronchitis. The doctor asks me how med X interacts with me diabetes! I’m dumbfounded because not now or ever have I had diabetes!!! NOWHERE in my chart (& I’ve been there more than once) does it say I’m diabetic!! I said, “I’m fat not diabetic, one doesn’t garuntee the other!!” I’m still shocked! What if I had been unconscious & given a less effective medication?!?!
Recently, a lifetime of abuse over my weight, combined with a lifetime of bad medical advice on how to deal with it, all came to a head leading to my losing, well, pretty much EVERYTHING. So much so that a local newspaper ran an extensive story on my plight.
So….. apparently a local bariatric surgeon saw the article, and wrote to the reporter, saying that he could not help but wonder how nobody has ever had a discussion with me about bariatric surgery.
This from a guy who has NO KNOWLEDGE of me other than my size.
He goes on to say that it is a shame that I had surgery to remove excess fat and skin “yet never had a discussion about surgically treating the problem at its root.”
I’m so mad I could scream. I considered calling, or writing this doctor and EVISCERATING him over his ignorance. Clearly, he is convinced that fat **IS** evidence.
Saxman – am wondering if you had a panniculectomy and would be willing to talk about your experience. I am considering one due to severe chafing issues which can cause me mobility problems.
Yes, Meg, i did have a panniculectomy, and yes, I would be willing to talk about it. How do I contact you?
I submitted an article to Narrative Inquiry in Bioethics mentioning, among other experiences, the time a doctor wanted me to worry about developing diabetes in the near future because I have a history of GD. There it was in big letters in my file, so it must be true.
Except that in the course of three pregnancies, one of which involved me checking my blood sugar every flipping day because I had finally put my foot down about that barf-inducing glucose tolerance test, I had never had even a borderline result. Because of the date when it was mentioned to me, I can infer that somebody came along and wrote that note in my file some time after my last child was born. Just a few pages below that note is the evidence that I have never in any way shape or form had even borderline diabetes of any kind, but who needs to look at the facts when I am so visibly fat?
The article is in the Fall 2014 issue, BTW.
Has the issue been published, or is it just submitted for publishing at the moment? Once it’s published, I’ll make a note to look for it! This is why I’m part of my alma mater’s alumni organization, one of the perks is access to the library database. 😀 Only on-site access, but that’s still a far cry from having to pay for scholastic articles myself. They have a pretty good nursing program, so hopefully they’ll have this journal.
It’s up at nibjournal.org, but you have to have a Project MUSE subscription–or access to a public or academic library, and let me just take this opportunity to say hooray for libraries–in order to read the full article.
If not, check out your interlibrary loan!
I think I found it in the summer issue, as fall is not out yet, but I read the story about not being GD with 3 pregs, and then finding it added. I could only read an exerpt though.
“Fat bodies are not public property, they are not evidence, and they are not a sign that we need someone to step in and tell us how to take care of ourselves.”
THANK YOU. I am going to have to have this conversation at some point with my soon-to-be father-in-law who seems to think he has the right to question my judgment, my health status, and what I’m “doing about it” because I am marrying his son. Buddy, if your son isn’t concerned about it, then it is less than none of your business and this will be the last time we discuss it. GRRRR.
About doctors, a thing that I’ve gotten is disbelief. I went to this one doctor for blood pressure issues, and she asked me how much I exercised. At that time, I did about a half hour on an elliptical machine three days of the week. At the end of my visit, she told me I needed to start living “a less sedentary lifestyle.” I mean, sure, I guess exercising three times a week isn’t what some people consider ideal, but that’s far from sedentary. It’s like she’d totally bypassed all that I had told her just because of my weight. I ended up dieting and trying to lose a bunch of weight. I lost some, but not all that she wanted to (which was way up there) – I later ended up gaining it back (of course!). Somewhere along the line, I came across this website, and quickly became hooked, and that’s where I am now.
But this kind of stuff is frustrating. It makes me not want to visit the doctor for any reason, ever. I feel discriminated against.
@RedFeatherFalconHawk: I’ve been like that for a lot of years now. I only go to the doctor when I have a a problem. Rarely. And, fortunately, **knock on wood**, other than being so big I can barely move, I seem to still be metabolically healthy.