When a doctor chooses to brag about that particular certification, there are three assumptions I need to make in order to keep myself safe as a fat patient:
1. From the moment I walk into their office as a fat person, they are trained (and certified!) to see my body as a problem to be solved.
The word “obesity” was literally created to pathologize a body size. It’s very possible that they won’t be able to see past their weight bigotry (including their tendency to blame nearly anything on my size) to give me care for any health issue I may actually be having. By extension they may, without notifying me, suggest treatment options not because they have the greatest efficacy in dealing with my actual health issue, but rather because they believe that they might result in weight loss, or prevent weight gain. Similarly, they might withhold viable treatment options because they have a possible side effect of weight gain.
2. They are willing to risk my life and quality of life to make me thin.
They have willingly joined a branch of medicine which centers around the idea that it is completely acceptable to risk a fat patient’s life and quality of life for the smallest chance that we might get a bit thinner, and there is no guarantee that they will feel obligated to be clear about the risks because of the paternalistic nature of their specialty.
3. They either don’t understand, or don’t care about, research.
They are willing to base their career on embarrassingly poor, shockingly shoddy research – so they either aren’t capable of understanding the issues with the research upon which their certification is based, or they don’t care. Either way it doesn’t bode well for their ability to practice ethical, evidence-based medicine. Not a good look.
So when a doctor tells me that they are board-certified in “obesity medicine” I have every reason to believe that I am sitting across from someone who doesn’t understand the basics of research, and who truly believes that it’s worth risking my life to make me thin (and who might choose their fatphobia over accessibility.) I have to continuously remind myself that everything they say to me is said through their filter, which includes the belief that my life is less valuable and more risk-able than a thin person’s life.
Sadly, since “obesity medicine” also tends toward corruption (see, for cample, the “Obesity Action Coalition“) I also have to wonder (and try to research) if this doctor is in the pocket of a company like Allergan or a pharmaceutical company that manufactures dangerous weightloss drugs, giving them a financial incentive to harm me.
Depending on where I live and what doctors are available to me, I may still need this doctor’s help. If that’s the case, then I’m going to have to be hypervigilant – researching everything they say and recommends – are they prescribing that medication because it’s actually the best thing for my condition? Or is it because weight loss (however small and temporary) may be a side-effect? Is that medication they suggested going to risk my health and life? Are they going to push me toamputate a perfectly healthy organ in a dangerous surgery that, if it doesn’t kill me, could leave me with horrific lifelong side effects? Are they going to withhold needed care until I comply with their desire for me to look different? I may have to lie to get the care I need.
The bottom line is that as a fat patient I have to worry about medical fatphobia with almost every healthcare provider (though, happily, the number of weight-neutral, Health at Every Size based practitioners is growing!) but I know that I can never trust a doctor who brags about being certified in “obesity medicine” to look out for my actual best interests. That sucks, but at least their certification gives me some warning.
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5 thoughts on “What “Board Certified in Obesity Medicine” Means to Me as a Fat Patient”
Well said, Ragen.
I just assume the docs are biased, till I find otherwise. My primary knows to leave it. I don’t care if they weigh me. They get all embarrassed FOR me. “The dreaded Weighing-in…” Do I care? One RN said: “You’re ALMOST into the regular cuff.” For the blood pressure cuff sizing. Ass-uming I was on the going down end of weight gain / loss cycle. Do I care? Just smile and let em get on with it…
I wonder, as I get older and the doctors get younger, when they meet me on a one off appointment, when my primary is unavailable, do they really think that their shy/bold, broaching/announcing of various weight loss solutions/sentences are things I have never heard? Really, by 2020? By almost fifty?
Ugh! It’s absolutely ridiculous that we can’t get ethical evidence-based care without having to swim through a moat of fatphobia. So frustrating!
appreciate all the points you’re making and have been down with my fat for well over half my 60 years on the planet. I am also an activist, albeit sporadically these days. Furthermore I’m a serious advocate of eating cake regardless of body type and at any opportunity where cake is an option. But I have a different take on the concerns of the commenter whose points you’re dissecting.
I felt similarly when I attended the very first London Plus Size Fashion Weekend where there was was a cupcake stand and absolutely nowhere to sit down and eat them. (Admittedly there were also no changing areas other than the toilets and that was where the only mirrors were too. Organisation wise it was a shambles). Given that the event attracted a fair bit of coverage in the UK press in print and online, I kind of winced at the stereotypical optics of fat ladies eagerly rifling through racks of clothes with cupcakes in their hands. Not because I think fat ladies shouldn’t be eating cupcakes but because fat phobia is at an all time high in the UK and I knew the haters would be using the event per se as a means to ridicule and pathologise. In a culture where fat people, particularly women, are portrayed on a regular basis, doing normal day-to-day things in advertising, fashion photo shoots, and the big and small screens, a fat woman holding a cupcake wouldn’t be a remotely big deal – but regrettably we are far from living in that culture; so I get the need to disassociate from images that feed into popular prejudice. For me it’s more like “assume crash position”.
understand what you are saying, and in the past have made similar arguments. What I’ve come to realize – at least for me – is that pandering to haters and bullies doesn’t actually help create change. If they never saw a fat person eat a cupcake again they would still be fatphobic. If we all only ate dressing-less salads in public they would still be fatphobic. They will either find, or fabricate, some other “reason” to be fatphobic bullies. . The only thing that happens when we pander to what the haters might think or say, is that we miss out on experiences, or the enjoyment of them, which means that we are letting their fatphobia control where we go and what we do when we get there.
It can also mean that we actually become the enforcement arm of haters and fatphobia, doing our bullies work for them, by telling other fat people that they must choose their behaviors based on what the haters might say. That’s not something I want to do or be.
I think that we can fly the plane, rather than tucking our heads between our knees and letting them crash it. But of course that’s just my perspective.
I agree, they tend to be arseholes whatever we say or do. I just think in the case of an advertising campaign it’s wise to avoid perpetuating hackneyed tropes because fatphobes don’t need any more ammunition.