When is Weight a Symptom?

Bad DoctorI received a question from a reader that I want to address :

Is there a point at which you think that it’s reasonable to view a person’s weight as an outward symptom of a health issue? …I don’t ask because I want to get into someone else’s business, but only because I’m trying to make sense of it as representative of the human condition. …I realize that there is a wide range of normal human size, shape, height, weight, and so on…. but there must be a point at which a person’s appearance becomes a concern. BTW, that goes the other way as well; how do we tell when someone is naturally thin, and when they may be anorexic and need help.

First and foremost other people’s health isn’t our business unless they ask us to make it our business, (or it is legally our business and even then I think we should be cautious to take people’s choices into account when we consider what is in their best interest.)

I think that there are times when body size can be a symptom of a health issue – several health issues have unexplained weight changes (both increases and decreases) as a symptom.  There are some health issues that cause weight gain and make even the short-term weight loss that most people are able to achieve difficult.  There are some health issues that cause weight loss and/or make weight gain very difficult. There are some health issues that can lead people to be very fat or very thin.

Of course there is no shame in any body size, health issue, or combination thereof. If someone is experiencing one of the issues above and wants to explore it, I don’t think it’s a problem to take it into account within the picture of their health, to do any necessary tests and see if there is a medical issue etc.

There are, however, a bunch of ways that this can, and often does, go wrong – like when we consider body size a definitive diagnosis.  When body size as a symptom gets reinterpreted as body size as the medical issue and medical professionals “diagnose” people as fat “prescribe” a diet. When fat people with health issues are told to diet first and that they will be given actual interventions for their health issues after they’ve lost weight.  When we believe in Size Acceptance and/or practicing Health at Every Size unless someone is “really fat.” When we (especially health professionals) confuse our stereotypes and preconceived notions about people of a certain size with what is true.  When we treat thin people with a health issue by giving them interventions that are shown to help that health issue, but we treat fat people with the same health issue by giving them a diet.  When other symptoms are ignored, or take a back seat, because the health care practitioner focuses on body size to the exclusion of anything else. When we understand that long term weight loss does not meet the criteria for evidence-based medicine since it only works for a tiny fraction of people, but somehow think that magically changes if people are a certain size and suggest that those people should go ahead and diet.

So, in short,  if someone hasn’t asked you to be involved in their healthcare, then their body size and what it does or does not mean doesn’t have a thing to do with you, so if you’re looking for your beeswax, you’ll need to look somewhere else.

If someone has asked you to be involved in their healthcare (or if it’s your health we’re talking about) then, while there are situations where body size or changes thereof can be a symptom, I would be very cautious about foregone conclusions (ie: at your body size [insert health issue here] must be an issue) or trying to treat health issues by attempting to manipulate body size.

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11 thoughts on “When is Weight a Symptom?

  1. Precisely!

    There are situations where a sudden and/or drastic change in weight can be a significant symptom, but weight itself is not a symptom. It’s just a fact.

    For instance, I have a brother I don’t speak to anymore. Why? Well, one of the reasons I don’t talk to him is that every time we did speak for a long, long time, he would at some point in the conversation ‘diagnose’ me. Out of the blue he would announce as indisputable fact that I have: diabetes, hypertension, severe constipation, and heart disease. How did he know all of this? Quite frankly, he pulled it out of his ass.

    The real fact is that I’m pretty darn healthy. That nasty cut I got last week healed itself without even a band aid within three days, so I doubt I have diabetes. The only time my blood pressure reading was high was the time an incompetent person caught a flap of skin in the velcro on the blood pressure cuff and apparently didn’t hear me yelling in his ear that he was hurting me. Okay, I did have a slightly high reading the next time someone took my blood pressure, but when it was taken again five minutes later, the reading was textbook normal. Constipation? One bout in my entire memory. It lasted a day and a half. Just as I was starting to wonder if I should take something for it, it cleared up on its own. As for my heart, well, it seems to beat just fine. No palpitations, no pain in my left arm or chest, no problems exerting myself physically… in short, no symptoms. Oh, and no particular family history, either, unless you count the relatives who just went to sleep one night at eighty-five or ninety and simply didn’t wake up again.

    If I did have any of these health troubles, it would be no shame. But being fat isn’t a clear symptom of any of them. Mr. Twistie has three out of four of them, and yes, he’s fat… but then his rail-thin co-worker has the same three problems.

    Even if there is a sudden drastic change, I’m still not a doctor. I can express concern, but I cannot diagnose someone from that change.

    1. I was constipated for about a decade, but I now know that it was caused by dieting and celiac. I would go for 2 weeks without anything happening, and the docs recommended (pediatrician): laxatives, mineral oil (nasty side effect of anal leakage, stink, and stained pants), Metamucil/fibre, more freaking exercise, enemas. Once I was in such bad shape I called a friend (my parents were out that night) to take me to the hospital (I was in high school).

  2. When you think weight change might be a symptom, consider other possible symptoms like hair loss or sleeping a lot or very little or unintentional changes in eating patterns etc.

    Write down ALL the changes to take to the doctor. Some health issues, like my own Polycystic Ovarian Syndrome don’t really have a test, so they have to use the collection of symptoms to determine what is going on. PCOS messes with the hormone balance, which causes other health issues like heart disease. It also tends to cause weight gain, hair loss and other things.

    If this is not you, but someone you care about, then unless you are close enough to spot the other symptoms, you can’t make any conclusions about what is going on with their health.

    I fully respect Ragen’s point about staying out of other people’s business. I also think that you can gently, lovingly and respectfully express concern (which is different from weight-trolling) about someone’s health if you are close to them. Once. Then you have to leave them alone.

    When I say close to someone, I mean the kind of close that let’s you talk about very personal topics, not just someone you see regularly.

    I would also like to remind folks that Ragen has a lot of super advice about dealing with health care professionals if you are fat and expect to get hassled.

  3. A person’s appearance is a concern only when it changes drastically in a fairly short period of time (relative to the amount of change). Also, this kind of diagnosis is best made by trained professionals, not the person sitting across from you in the restaurant.

    Now, let’s assume there are cases where being fat is a symptom of an underlying disease process. If so, let’s stop focusing on weight loss.

    *We do not cure an illness by getting rid of a symptom.*

    We look at those symptoms and see what diseases they point us to and work to cure the underlying cause–or that’s how the disease process *should* be looked at.

  4. The whole “mind your own business and keep your opinions to yourself” is an excellent 21st century mantra many people should practice.

    OTOH if you are genuinely concerned about a friend or family member then do speak up – but I’ve noticed in real cases of physical appearance indicating illness many people are hesitant and keep their mouths shut. It’s odd. Perfectly willing to dispense “information” and “advice” as a way of shaming or scaring people but in real cases, nope, mouths shut and heads turned away.

  5. I had a DOCTOR, an emergency room DOCTOR, simply decide that I have diabetes!!! I’m still stunned & yes I filled a complaint! He asked my how a medication interacted with my “diabetes”! I never have had any sign of diabetes!!! He 100% diagnosed me as fat! I very quickly & mostly politely straightened him out. It scared me, & made me wonder what would’ve happened if I had been unconscious!

    1. Yeah, I got to experience the fun when somebody, who never grew gonads big enough to ‘fess up, wrote a diagnosis of gestational diabetes in my file after three pregnancies during which regular testing for GD failed to produce even a borderline result. That is, when I wasn’t even pregnant! Cuz fat. I got pretty loud when I found out about that one. Oh, and during the last pregnancy, after I had refused to chug that sick-making sugar glop they use for the glucose tolerance test, they demanded to see my pee once a week instead and let me go with a UTT almost to the point of miscarriage. When my pee was cloudy and orange, and I was reporting burny crotch and lower backache. Cuz obvs. fatties only get fatty diseases, donchaknow.

      It was my midwife, who does not give a damn what size you are as long as your uterus has a connection to the outside world, who told me to insist that they check for bacteria. She was treating her client. The clinic, which was supposed to be providing shadow care, was treating my ass size.

  6. Wow, I’m really amazed that you answered my question in the blog – I didn’t think it was blog-worthy! Thank you! So if I understand correctly, as a society we should be encouraging our medical practitioners to keep weight/size in its place as a possible (and I stress possible) symptom of a medical condition and not the condition itself. Therefore, the medical condition should be treated with the appropriate therapy, not just a diet as is commonly done today. It seems that you are saying that it might be possible to see someone of a particular size, either exceptionally large or thin, and think that they may have a medical condition. Of course, that doesn’t make it any of our business, but it may help us to be more compassionate and less judgmental as long as we are cautious of not falling into the traps you discussed. For those of us who are not medical pros, if we want to be size advocates or just help change stereotypes and overall perceptions, then if we hear someone make a comment about another person’s weight/size, we could maybe make a more positive comment along the lines of “weight and health are not necessarily correlated and normal humans come in many shapes and sizes”, or whatever. I’m not implying that we have an obligation to make any comments, and I have heard you say that many times in your blog, but only that if we have true understanding, then maybe we can help to spread that understanding so that one day it becomes universal knowledge and weight/size stigma goes the way of racism and other narrow-mindedness. As I said in my question, I would never presume to intrude on someone else’s health concerns, but I want to have understanding in my own mind so that I can avoid mistakes and seek truth. I hope I’m understanding what you said accurately and I appreciate you taking the time to help educate me and so many others! Thanks for addressing my questions and for all the work you do!

  7. This line from the reader’s question seems to sum it up . . .”there must be a point at which a person’s appearance becomes a concern” . . . Basically, this person seems to be saying that if someone is big/fat/heavy “enough” THEN it’s okay to make assumptions about their health, that they have some disease, etc because if they’re that big then SURELY they must have ______ (fill in disease/health condition that they assume fat people must have) and need some intervention. Nope! No matter how big someone is, you cannot tell anything about their health purely based on their body size and even if they do have ______ disease then it is none of anyone else’s business unless they choose to make it so. No one should concern troll anyone else, period, no matter what, even if they’re really superdy duperdy fatty fat fat. Nope nope nope.

  8. Thank you Ragen.

    I see so many comments online which seem to imply that there has to be some unspecified size at/beyond which (x) is okay (where x = concern trolling or shaming or assumptions or offering unsought observations of any kind). Frankly, the answer is NO. There is no point at which any unsolicited comment is okay about any body that isn’t yours.

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