There’s a thing that happens to me a lot. It’s happening even more now that I’m training for an Iron-distance triathlon. Perfect strangers, upon seeing or hearing that I’m a fathlete, will ask me “how are your knees?”, often wincing like it pains them to even think about it. When I say that my knees are fine, people suddenly become psychic. “It will catch up to you,” they tell me. They ask my age and then add five or ten years. My knees were going to go when I was 25, 30, 35… (Again I ask: If they can tell the future would it kill them to give me some lottery numbers with their bullshit judgments?)
Let’s get a couple of things cleared up before we get into this. First of all it’s possible that I’ll have trouble with my knees someday, many people – of all sizes – do for lots of different reasons. As I’ve spoken about before, using the possibility of future disability to try to insult fat people or manipulate our behavior is fucked up ableism that needs to stop right the hell now. Also our joint health isn’t anybody else’s business unless we ask them to make it their business so asking random fat people about their knees is just weird – so maybe don’t do it. I have been known to respond to “How are your knees” by saying “Great! How are your bowel movements?”
The subject came up recently when I was giving a talk to a group of soon-to-be personal trainers about working with fat people. One of the guys said that he was worried about working with fat people because of the potential for knee injury.
I asked who in the room had had a knee injury in the past. Almost everybody (not surprising in a room full of jocks.) I asked who had been given an option for treatment of their knee injury other than weight loss. Almost everybody. I asked them to raise their hand if they had only been given weight loss as a treatment option. Nobody. I asked whose knee injuries had responded to treatment and gotten better. Almost everybody. Just like the ideas of weight causing health issues, the discussion about fat and joint health is also much more complicated than many people would have us believe.
There have been a few times in my life, at various weights, when I’ve had knee pain. When I was less fat doctors looked at things like muscle imbalances and tightness, gait, and sure enough they were the (solvable) problem.
When I had knee pain a few years ago the only explanation offered to me by doctors was that I needed to lose weight. Because I had the luxury of knowing how they treat these issues with smaller people, I asked the doctor if people who weren’t fat had knee problems. After some pushing he admitted that they do. So I said that I wanted to be treated like they treat thin people. I was told that there was no point in treating any other issues until I lost weight. What with the who now? So I left the doctor’s office and did some research. I started working with a massage therapist and when we cleared up the tightness in my quads and IT bands the knee pain disappeared. Losing weight would have done NOTHING to help the actual issue.
In fact, continuing to work out so that I could get thin so that I could somehow “deserve” evidence-based healthcare would have been more likely to have exacerbated the problem from one that could be solved through a couple good massages to a more serious issue which would then have been blamed, not on my doctor’s incompetence, but …wait for it… on my weight!
In general I think that a diagnosis of “fat” and a prescription of “weight loss” is always just lazy medicine. Anytime someone tells you that weight loss is the “solution” to your health problem, I would suggest that you ask if thin people have the problem that you do. If they do (and they definitely do), then ask how they are treated and insist that you start with that.
A medical model that suggests that in thin people “knee pain” is the diagnosis and “interventions shown to help knee pain” are the prescription, but that in fat people “fat” is the diagnosis and “attempt to be less fat” is the prescription is seriously sketchy.
And let’s remember that there’s not a single study that shows that weight loss works long term for more than a tiny fraction of people long term. So prescribing weight loss to cure joint pain (because it almost never works, but it will be great if it does) is roughly the same as prescribing flying. I’m mean, if you jump off your garage and flap your arms really hard you probably won’t fly, but think of the joint pain relief you would feel if it worked and your feet never had to touch the ground!
I don’t know about you but my healthcare professionals need to do a little better than trying to sell me a big bag of magical weight loss beans. Because it isn’t just phenomenally lazy medicine, it’s also medically unethical without informed consent – which requires your healthcare professional to explain that weight loss is almost never successful and most of the time results in weight gain (and when’s the last time I doctor ‘fessed up to that during your appointment?)
So if you are dealing with joint pain and you’re being told that weight loss is the only thing that can help, you are absolutely, positively, one hundred percent being lied to. It may be that strengthening the supporting muscles, correcting movement patterns that lead to imbalances, massage, stretching, physical therapy, ultrasound, surgery, mobility aids or the many other things that are prescribed for knee problems in thin people might help. You can also check out the work of Cinder Ernst who helps specifically with knee health for fat people.
Or maybe the pain is something that’s not curable and/or those solutions aren’t something you want to/can pursue (remember that lack of access to healthcare due to everything from oppression – including racism, ableism, ageism, sizeism, classism etc. – to financial situation, to geography and more can limit people’s options) – there is absolutely no shame in that, regardless of your size or situation – fat people shouldn’t be shamed because people believe that our knee problems are our “fault” any more than athletes should be blamed because people believe that their knee problems are their “fault.” Everyone should have access to whatever they need to navigate the world. and nobody should be shamed or made to feel guilty about that. We should also have access to compassionate, competent, evidence-based health care and that includes our knees.!
If you’re looking or support for talking about fitness from a weight-neutral perspective, you are welcome to join us at the Fit Fatties Forum, it’s for anyone, of any size, who wants to talk about fitness without weight loss talk, diet talk, or negative body talk.
I also wrote an update to this piece called “Does fat cause arthritis? Does that even matter?” You can read it here!
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