I talk a lot on this blog about how to advocate for yourself with healthcare providers – facts and figures that you can use, and phrases that help etc. I want to make sure I’m clear that fat people shouldn’t have to do any of that, and that the ability to do it is a privilege and a luxury that not everyone has.
I talked about this recently on Christy Harrison’s fabulous podcast Food Psych. I have a lot of privileges that allow me to stand up to doctors – I’m white, cis, currently able-bodied and neurotypical, currently have “good numbers,” and am typically assumed to be hetero which, because of racism, transphobia, ableism, healthism, and homophobia gives me a ton of privilege. Add to that, I have a good memory for facts and figures (if not for names and dates!) an education in research and statistics, a lot of doctors to choose from (thanks Obamacare!) and the ability in these situations to be furious and remain calm and logical (which, because so many doctors have screwed up ideas of which patients should be listened to and respected, gives me a better chance of being listened to and respected.) That’s a lot of luck of the draw stuff that helps me out.
So a question I get a lot, especially after my recent post about self-advocacy at the doctor’s office, is what about people who don’t have this as an option. It can happen for lots of reasons – from a lack of choice of doctors, to not being a physical mental space where someone can self-advocate (and, again, there’s nothing wrong with that since we should have to prepare for a doctor’s appointment like we’re on the frickin’ debate team.)
First of all (yes, I’m going to say this again) remember that you shouldn’t be in this position in the first place – doctors should not try to prescribe dieting at all since the most common outcome is weight regain, with a majority of people gaining more than they lost – so weight loss does not meet the criteria for ethical, evidence-based medicine. Basically, your doctor is committing malpractice and you’re having to overlook it because of your circumstances, and that sucks, and it’s not your fault.
I want to dismantle medical fatphobia, but I also want the people who are being harmed and killed by medical fatphobia to get help now. Knowing that, each person needs to decide their own personal boundaries, including taking into account that there may be downsides to misleading your healthcare professional – it’s sad that sometimes we have to take those risks just to get a chance at decent healthcare, but that’s what happens when we have healthcare in a fatphobic world.
The most common situation that I hear about happens when a doctor is trying to prescribe weight loss for a health issue for which a thin person would get an evidence-based intervention (which is basically every health issue that exists.) Consider asking a question like “Out of curiosity, what is the treatment for thin people who get this health issue?” or “If I lose the weight and still have the health issue, what would my options be at that point?”
Once you’ve established that there is an actual treatment protocol besides attempting to manipulate your size (and there always is,) then you can request a simultaneous treatment, for example “That makes sense. Since dieting can be so unpredictable – especially for people like me with a life long history of yo-yo dieting, and can take a long time regardless, I would like to start the treatment that you just mentioned, and I’ll try weight loss as well, that way we’re doing everything we can for my health.” Then you can do the actual treatment and skip the weight loss. When you come back ask the doctor to focus on the actual health issue and say you’ll keep trying with weight loss.
When the doctor is asking you to consider amputating part of your stomach the stakes get a lot higher. I once had a doctor tell me that he would withhold treatment unless I went to a stomach amputation recruitment rally (though I’m pretty sure they called it something else.) I refused and argued, but I could just as easily have said “sure, I’ll go.” It’s not like he could have un-set my broken toe if I never went (and unless I was actively protesting it there’s no way I would.)
Sadly in some cases doctors are insisting on stomach amputation (also known as “weight loss surgery”) as a requirement before a fat person can get other medical treatment. This could not be more fucked up. First of all, I can’t believe how many people I’ve heard from whose doctor said they couldn’t do a routine surgery because it they claim surgery is too dangerous at their size, and then recommend… you guessed it, stomach amputation surgery.
While people are allowed to choose to have their stomach (or any other body part as far as I’m concerned) amputated, I want to make it very clear that if you are going to choose WLS, then the thing you are trying to fix/improve had better be worth dying for, because dying is a distinct possibility. It’s also a possibility that you’ll be one of the many, many people who has such horrible lifelong side effects that they would do anything to take back the surgery. To me, a doctor requiring that I amputate my stomach before they’ll treat an actual health issue is time to pull out all the stops – look for a doctor out of network (or the state, or the country) and try to find a way to fund it, file a medical ethics complaint, do whatever I can do because that is a line that I will not cross.
I’m for healthcare without bigotry and from a Health at Every Size paradigm. Until that’s a reality, I’m for people doing whatever they have to do to get the care they need within their own personal boundaries.
Upcoming Talk
Hey, are you in or near Lexington, Kentucky? Because I’m going to be. I’ll be speaking in Lexington on the 25th. Click here for all the details. (I’m also open to doing other talks while I’m there so if you know a group that would like to host a talk or dance class, or a class that would like a guest lecturer, e-mail me at ragen at danceswithfat dot org!)
Did you miss the fourth annual Fat Activism Conference? Good news – for two weeks you can still get access to all the materials (recordings, transcripts, and handouts) for listening, reading and downloading!
Click Here to Register for the Fat Activism Conference
If you enjoy this blog, consider becoming a member or making a contribution.
Like this blog? Here’s more cool stuff:
Become a Member! For ten bucks a month you can support fat activism and get deals from size positive businesses as a thank you. Click here for details
Book and Dance Class Sale! I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!
Book Me! I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!
If you are uncomfortable with my selling things on this site, you are invited to check out this post.
Dances With Fat 
I had a friend die from weight loss surgery. You make very valid and serious points. She wasn’t even hugely overweight either.
I am so very sorry about your friend. At the same time, I’d like to ask you to rethink using terms like “overweight” or “hugely overweight,” since they are body shaming (since they suggest that there is some right weight that people are over, rather than just realizing that bodies come in different shapes and sizes, and it makes it sound like we might think that this kind of life-threatening surgery is something that should be foisted upon people with larger bodies.) Thanks!
~Ragen
PAhahaa. Just had this one and as someone with a mental illness living in poverty I know I am seen as some sort of trapped hose-beast that the medical students (literally) can experiment on. I go to a clinic and can guarantee I will see a different Dr. PA, nurse, tech or what not every time I go in, as I go in as little as possible, I am assured I am an unknown entity more or less. I watch em, listen to em talk, and just wait for it… I know it is coming as sure as verbal harassment outside a junior high school. It is there just waiting to happen.
Most recent doc, while essentially well meaning, just as indoctrinated as the rest and I got my meds updated, he looked at a funny mark on my leg, assessed my overall situation and then sort of pulled himself back and looked away and then looked at me and before he even opened his mouth I said “No.”
“No?”
“No.”
“No what?”
“No” to what ever weight loss surgery you are gonna suggest.”
He looked embarrassed and leaned toward gently defensive. I added.
“You are NOT ripping my guts out to try and make me a unhealthy thin person.”
“We”, yes some weight loss surgery is very invasive, have you heard of the lap band…?”
“I don’t have an eating disorder, believe it or not (not) and I am not interested in having my guts rearranged in hopes of making less of me…”
He seemed to want to add to it.
“No.”
Thank you, good day!
Must note, when I came in last week, they didn’t weigh me. Must not of had time…hehheheh.
I don’t feel the need to jump down their throats but fact is, they have all just spent what 9+ years having fat female body equal death hammered into their brains at med school all the while living in a society the shuns fat people like carries for a modern day plague, added to what ever personal bias they have about weight and body size and it is a given I’m gonna get the whole song and dance.
I must admit, it’s been some time since I had a nurse read my results with irritation. still, there is some surprise at my numbers all being low and average across the board. I have gotten so snarky as to tell them not to worry some day I am sure I’ll have something nasty and then they can feel better. I think that might have ended up in my chart too…
What can I say, I am poor and mentally ill and fat. The trifecta of things NOT to be in modern American society. If only I was stupid,,, Somehow, I get the feeling that that would make the other stuff easier to deal with, if I lived that long.
Health in spite of the health care system… It takes some doing. And some lying…
Good on you for taking them to the task. It’s just sad that you have to fight with the people who are supposed to be there “for your health.”
I know this won’t be an option for everyone, but I think you can bring a friend/advocate with you to any doctor appointment.
This was me, back in March. After more than 12 years with a unicorn doctor who never ever did weight related crap, who knew and understood my ED history, who knew my overall terror of medical shit (more than just fear of fat-hate), who responded like a champ when I asked the practice to discontinue printing height-weight-BMI on treatment summaries, who has been in my corner through thick and thin—-out of the freakin’ blue, suggested that I consider WLS as an “aggressive way” to treat T2D, rather than going on insulin (for the record, I had no problem with the idea of going on insulin, beyond the obscene cost). My response was shock and then a furious “I can think of much more efficient ways to kill myself, tyvm, if I were so inclined.” But honestly, he threw me for a loop. Decades since the last ED behaviors, and they are back full force. I tell him I am now severely restricting, and his response is “well, that’s what you’re telling me anyway”, which is code for “I don’t believe you, Fattyfatfat.” I am devastated. I thought I was prepared for medical malice coming from other healthcare providers along the way–I never expected it from left field from my trusted PCP. My trust is gone.
REPORT THAT DOCTOR.
It’s all over the literature that stomach amputation can GIVE PEOPLE SOMETHING THAT LOOKS A HELL OF A LOT LIKE DIABETES. Your ability to cope with concentrated sugar coming down the pipe is effectively shot. You get the pukes, the shakes, dizziness and diarrhea if you don’t eat on a precise schedule in carefully measured amounts. And that’s if the damn surgery doesn’t kill you first. What a dipshit!
As someone who has diabetes, I don’t suffer from most of the symptoms you mentioned. I do get light-headed and shaky if my blood sugar goes too low, but I don’t have issues with vomiting or explosive diarrhea. Gee, you might think that maybe diabetes isn’t as bad as an amputated stomach or something crazy like that.
Huh. I wonder why they described it as “diabetes-like symptoms” and then went on to list the above…before I mention it anywhere else, I’d better go find those papers again, find out who they were quoting, and figure out WTheck.
On the other hand, one of the signs that got my SIL to go get a T2 diagnosis was that if she didn’t eat certain things on a certain schedule, HORK.
Oh, and yeah, she is now living quite comfortably with her condition–was off meds until she had to start taking something for another problem that kicked the diabetes up a notch–and it’s very hard to find a gastric amputee who can say the same.
I’m so sorry that happened to you. I had a similar experience, although at least my doctor didn’t suggest stomach amputation. My doctor isn’t perfect by any means, but for a long time he didn’t bring up weight loss, knowing that I wasn’t receptive to the suggestion.
My doctor changed health care groups and I was without one of my blood pressure meds for three weeks. I wanted to make clear to him that it was essential that the office call the pharmacy and authorize a refill because my BP had been elevated without it.
He says to me “If you would lose just five pounds…”
Like five pounds is going to make a damn bit of difference when the fifty that I’ve lost since being diagnosed with diabetes (not because of dieting or orthorexia but because of my endocrine system) hasn’t.
I went into a period of about two weeks of anorexic behavior in spite of my diabetes, and I had been doing so well.
I’ve been using Lantus, which would be prohibitively expensive, but if you go to the manufacturer’s website (Sanofi, in the case of Lantus) and look for a discount card, you can actually get the medication at a greatly reduced cost. Using insulin isn’t the end of the world. My blood sugars and A1C have improved greatly since starting Lantus.
My niece recently sprained her ankle. She went to the doctor, who said it was caused by her being too fat (she is way thinner than a lot of fat people who have no foot issues at all).
I asked her, “Did he wrap your ankle?”
“What?”
“Did he wrap your ankle? Did you wrap your ankle? Did anyone wrap your ankle to treat it?”
“Well, I put some ice on it.”
So, for an acute injury, caused by stress and motion, her doctor recommended weight loss, and did not actually treat the ankle. Great.
I have talked to my sister-in-law about this, and am going to talk to her, and my niece, again. Weight loss should never be recommended treatment for an acute injury! And even WITH weight loss. whatever happened to RICE (Rest, Ice, Compression, Elevation)?!
I am so ticked off for my niece. She doesn’t know that she can advocate for herself, let alone how to do it. Yes, definitely need to have a serious chat with her about this.
Note: The part about her being thinner than fat people who have no foot issues is just to point out that if the injury were caused by fat, I’d see more of it in people who are much bigger than she is.
It seems to me, a sprained ankle was caused by, I don’t know, EXERCISING!
GRRRR.
Someone in the family was saying, “But she’s not fat!” I wanted to unpack that, but didn’t have the words for it, at the time. She is not “Hollywood thin,” for sure. But even if she was, it’s irrelevant, because the treatment was so messed up, anyway.
I pray she does not wind up with the typical American Female body-hatred and eating disorder.
Once I got a doctor who BSOD’d so hard when I showed up with a sports injury he made up an alternate scenario where I’d gotten it in a car accident and lectured me on driving more carefully. That was so weird I couldn’t even feel insulted.
…actually, that’s still really weird.
ok, i have to ask… BSOD?
Blue Screen of Death – when your computer does the I CAN’T HANDLE THE INFO thing and just freezes up until you restart it.
Wut.
Seriously, no words. He MADE UP a car accident?!
Maybe it’s because I’ve been in four car accidents, but I just find this incredibly hurtful of him.
Or maybe it’s because he literally could not believe that you (a fat person!) could actually participate in sports, let alone have a sports injury.
I’m not sure this is fat related, but it reminds me of your story. I went to the walk in clinic day before yesterday because Podiatry didn’t have any appointments. I explained that I had my toenails trimmed by the Podiatrist and I think she went too short because now I have an ingrown toenail. He said um humm a few times then told me to be more careful where I get pedicures. I explained again that I had seen his colleague, a doctor of podiatry. A few minutes later he told me again not to go to any fly-by-night nail salons… The only thing I could figure was that my fat caused him to go deaf. 🙂
Saw an incident of adipose tissue fear induced brain dead behavior from an EMT once. This was many years ago. Came to grandmother’s house and she was nearly comatose on the couch, grandfather held a bucket under her face like she needed to vomit. (Yeah he was a big help.) Any how when EMT arrived the woman EMT asked if it was high blood sugar. It was Low Blood sugar. Even After they tested it and confirmed it, she seemed to insist it had been High Blood Sugar. I mean, these people can and will kill you and sometimes they don’t even intend to. Talk about needing to be pro active about your health care…what do we do if we are ever unconscious and they just ass-ume they KNOW what the problem is with us fatties?
how in the world do these so called “experts” just assume that because some one is fat, they “must” have high blood sugar. Even though scientists have already determined to insulin intolerance occurs first and weigh gain is a symptom/side effect of it. And even then, just because some one is fat doesn’t mean they have sugar issues. It would be like assuming that because some one has a cough that they “must” have the flu.
Before my joints started really hurting, I used to walk a lot. Long free strides, miles at a time. While fat. So one time I didn’t see the tiny tree stump in the tall grass, caught it with my toe, and hyper-somethinged my knee while simultaneously taking an unplanned flying leap down a hillside.
The hospital had no braces in my size and no idea where they could even find one. The doctor wrote me a prescription for muscle relaxants at such a dosage that I could basically do nothing but sit and stare at the wall, with infinite refills, and sent me home. Weeks later, somebody not-a-doctor asked me how my physical therapy was going, and that’s when I found out that I was supposed to be getting PT. Not one mention of it at the doctor’s office. Not one follow-up call. Nothing. Because OMG they might have had to think about a fat person having mobility that needed restoring and actually (gasp!!!!) living an active life. (Or just having a damn job I needed to get back to…)
So I got myself into PT and was back to walking and working within a couple of months.
That sucks beachballs through a straw.
I’m so glad you actually got your therapy, and got back to walking and working.
This shit is sooo demoralizing, and scary. These people have so much authority and assumed unbiased integrity. When the doctors whos code is do no harm start going full on for harm to fatties vs. harm of them just existing, scary bad things are going to start happening, or should I say ramp up? For the moment, it seems a person still has to agree to these dangerous and pointless operations and medical suggestions…?
A few years back, the health plan at my work started covering weight loss surgery, so a ton of people started getting it. I would say as a rough guess, about 2/3 lost a significant amount of weight, and most (including the ones who did not lose weight) would up with chronic physical issues – and that’s just the one’s who talked about it enough for me to be aware, I’m sure that others were unwilling to discuss it because some of those health problems are pretty embarassing. Since that whole trend exploded, all of the people who I am still in touch with have gained much of the weight back, but still have the chronic physical issues to deal with.
I personally lost a bunch of weight just by diet and exercise, but discovered that my results were basically unsustainable without devoting every waking moment to exercise and limiting my calorie intake to a ridiculously low amount. Since I have a job, and a partner, and friends, and other things I like to do, I’m no longer at a weight that aligns with the “healthy chart” at the doctors office. Fortunately, my Doctor is really cool and just tells me regardless of what size I am, to keep active because in her words “the overweight active person is healthier than the skinny couch potato.” So I keep running and don’t worry about my shape so much.
Prior to getting connected with my current doctor, I saw another one who was actually ANGRY at me for having good blood pressure, good blood sugar, and everything else, this after she told me that any friend who tells me I look good is lying to make me feel better. I didn’t report her because I was afraid, but a number of years later, somehow the records got updated with her as my GP, and I reported her then, and advised them that it would be traumatic if I were to inadvertently have to see her. They actually apologized.
Something I learned the hard way RE refusing weight loss surgery and trying to get control of that automated type of response from doctors… 1) Clearly state, and submit to the clinic that you “decline to have that procedure”. If they ignore it or you switch doctors and it comes up again, do it again, but write up an essay that is clear about the decline and why, and ask that it be attached to your diagnoses on your chart. This means when a doctor pulls up your chart, they will look at the weight stuff, and see a flag and it will basically cover what has already been tried/suggested/refused. If they STILL bring it up (They are not supposed to be allowed with that flag on there.), if there is a Patient Relations department, go to them and push it up the administration. I’m about to go to another new doctor because in spite of all this my doc keeps trying to find SOME way to get me to loose weight in spite of having no medical reason or test result for that to be a path to go down… so we’ll see how this plays out. My file is well set up and clear, and future doctors should be seeing this before opening their face about it!
*heavysigh*
So today it finally happened to me. Although he was not a Doctor, he was indeed a medical professional. I have been having a terrible time with what I think may be Carpel Tunnel Syndrome from years of computer work so my NP sent me out for a Nerve Conduction Test. This test was scheduled at a physical therapist’s office and they had me fill out the standard new patient paperwork. This included the general questions about any medical conditions – including Diabetes – and the listing of all current medications.
When the testing was about to begin, the PT asked about the arthritis I’d listed which is in my knees — hereditary, as my average sized mother had terrible arthritis in her knees too. It began when he said “you know you are carrying a lot of weight” (like, DUH! his eyes work)… then he asked what I intended to do about it… (rolleyes). I told him that ship had sailed long ago, that I have several different medical condtions, some that were undiagnosed for decades like the PCOS that prompted the Insulin Resistance and that, coupled with the broken down joints and my COPD, exercise and weight loss just aren’t going to happen. Then he says “Oh well, it looks like I may be too late for you to lose weight by dieting so have you considered looking into weight lose surgury?” (rolleyes x2). I said that I had read up on the subject and decided that it was not a risk I’d be willing to take… then he said “Well you should do it because it will really help turn your Diabetes around”.
(excuse me while I beat my head with a brick for a moment… OK, better now)
I said to him, “What Diabetes are you referring to?” and he said “Well, you ARE Diabetic, right?”… So I told him sorry but, no, I am not Diabetic and, in fact, ALL my numbers are good although my NP would like to tweak my triglycerides a bit. Then I referred him to his own checklist and the fact that Diabetes is not listed there and neither Insulin nor Metformin are listed in my medications. He seemed really disappointed that I was not willing to conform but that is his problem. Just to remind everyone, I was there to have the nerves in my hands, arms & shoulders assesed for nerve damage which has zero to do with my weight nor any conditon that causes or is affected by my weight.
Next time I will use the Regan method of dealing with a health care professional. This time, however, I was caught by surprise and ended up having the conversation with him. Sheesh.
OOPS, I meant the Ragen method!! 🙂
Been livin this one myself. Been a while since I had snotty nurses tell me resentfully…”We’ll, you don’t have diabetes…”
Last time I had a new Doc I got a full apt, then watched him gird his loins for “The Talk.”
I literally looked right at him and before he could open his mouth I said “No.”
Was Hilarious.
“No, what,”
“No, to what ever diet and weight loss stuff you were going to say…”
Same thing you had He offered the surgery. I said I was not interested in having my guts ripped open.
My policy is to assume I am gonna hear some crap and always be prepared. Fun way to live eh…