I’m often contacted by someone who has just been diagnosed with a health issue, and their healthcare provider has blamed it on their size and, in most cases, suggested dieting. The person contacting me has been practicing Size Acceptance/Health at Every Size (usually after a lifetime of failed dieting) but they are wondering if maybe they should try dieting again considering this new diagnosis.
Of course I’m not a doctor and I’m not giving medical advice, but I always tell them what I would do. If it were me I would look at it in two parts. First – is it true that body size causes this issue. Second, if so is attempting to control my body size a good healthcare option?
Part 1 – Is it true that body size causes this issue
Determining this can be tricky because our medical system is so steeped in fatphobia that people extrapolate causation from correlation, and extrapolate correlation from nothing (I’ve had doctors prescribe dieting to me for a broken toe, a separated shoulder, and strep throat, so we have to assume that healthcare professionals may be viewing our health through an extremely fatphobic lens. Almost any fat person can tell you that “diagnosis fat/prescription weight loss” is a huge barrier to fat people getting competent healthcare.)
When it comes to health issues that can affect, or are affecting, mobility plenty of this is just ableism re-packaged into fatphobia. The desire to manipulate someone’s disability – including and especially lying to them about the possibilities of changing their disability through weight loss – is a form of ableism that should absolutely called out and eradicated.
The question that I’ve found to get to the bottom of this is “does this happen to thin people” If the answer is yes (and it always is,) then I know that being thin can neither be a sure preventative nor a sure cure. (If the answer is “yes, but it happens more often in heavier patients” The follow up questions would be “based on what research” and “how much more often are heavier patients tested for this than thinner people.” )
Part 2 – Is attempting to control my body size a good healthcare option?
If I were to decide that my size is causing this issue, the next question would be “is attempting to control my body size a good healthcare option?”
There is not a single study where more than a tiny fraction of people have succeeded at long-term weight loss, and very often these “successes” lost only 5-10 pounds. Almost everyone who attempts to manipulate their body size (through whatever method, whether it’s called a diet or lifestyle change, or something else) ends up gaining back their weight, and the majority gain back more than they lost and end up at a higher weight (that was exactly what my dieting attempts led to)– so if we’re considering body size to be the “problem,” then attempting to manipulate my body size is the worst possible choice based on all the research, and my personal history with dieting. So that would be a no on the weight loss attempt.
I would ask my healthcare provider(s) what thin people are told to do for whatever this health problem is, and I would go from there in terms of choosing a course of action.
I think that doctors telling fat patients to attempt to become thinner (to solve health problems that thinner people also have) is not just lazy healthcare, it’s unethical, unsupported by evidence, incompetent healthcare and, if I can help it, I won’t put up with it.
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I remember the doctor telling me the plantar fasciitis in my left foot was “because you are heavy”. “But I’m just as fat on the other foot!” I replied Fifteen or so years later a Feldenkrais practitioner noticed that my left foot didn’t flex much and digging deeper discovered that the bones in my left ankle weren’t aligned normally. The bone misalignment was probably left over from a traumatic ankle sprain many years before, which was followed by lots of lower limb pain including the plantar fasciitis. She was able to realign the bones (if she hadn’t known how to do it I would have looked for an osteopath or chiropractor who could do it), and over the following year I got full range of motion back, which led to no longer having pain in my feet and eventually even my knees. And I was much heavier then than I had been fifteen years earlier when the doctor had said it was because I was fat. Not all problems can be fixed, and it can take a long time to find someone who can deal with even the fixable ones.
My GP assured me that weight loss would help my foot problem, but when I saw a podiatrist he was certain it was due to an old injury. He said he had seen the same problem fairly often in Nebraska,in folks who worked with cattle and got their feet stomped.
Well, I had my foot stomped by my horse when I was fifteen. Nearly forty years and untold miles of walking later the injured cartilage provoked arthritis. It’s also the top of my foot. I’m pretty sure weight is unrelated.
I encounter plenty of ordinary people who are convinced they will be healthier when they are thinner. It is sad.
I’ve been battling shortness of breath since January. Like have to stop & rest after 60-70 steps. It’s awful. Been back & forth between Cardiology and Pulmonary, with a stop at Nephrology in between. Amazingly, none of the docs I’ve seen have blamed this on my weight. No one thinks my weight helps (simply because my heart & lungs have more to do than for a smaller person), but not one has hinted that it’s the cause. And they are actually continuing to test until we figure it out! So refreshing!
Very! This is one where be your own patient advocate can mean the difference between pain and suffering, and very possibly death and getting the health care you need to live a productive life. If ya think it might help, go ahead and lose weight, hope it stays off and if it doesn’t, and the issue does not increase in severity with the extra weight, maybe it had nothing to do with it at all.
Never assume, know they will. Do your research. Keep asking questions. When you know you are not being heard or respected, when it is possible, seek another provider. Good doctors are out there.
Thank heaven I found your blog, and have reading it an ton.
This hits home because my GP just sent out letters that if your BMI is in the obese range, you have to sign a contract and actively try to lose weight.
The doctor went on to write, “I went to medical school to help people get the best health possible. I’m tired of treating people who do nothing and wind up with diabetes, high blood pressure, spinal problems and bad knees. Expecting me to wave a magic wand and make it all go away is not possible.”
It is a 5 month wait for a new GP in my area, so I’m actively looking now. His gripe with me is “Why doesn’t you lose the 50 lbs and get down to a normal weight? It’s not like you have to lose 200. Why are you so lazy?”
I’m so tired that the size of my ass determines my worth as a human.
OMG. If you have the money, run off every document on the success rate of weight loss and unprovable health results and mail them to him, daily.
What a jerk! I am sorry you had to endure that nimrod. Best wishes finding a decent GP!