Fat Health Care

Peggy Elam at On the Whole has a terrific post (inspired partly by La Di Da) on going to the doctor as a fat person. It includes tips and resources for finding a good doctor and educating her about Health at Every Size — as well as some information that will make you furious.

A study in the 1998 Archives of Family Medicine found that the higher the weight of women, the less likely they were than thinner women to have had either a clinical breast exam, a gynecologic exam, or a Pap smear in the previous three years, even though they had as many or more doctor contacts. (The only cancer screening performed regularly on larger women was mammography.)

In Women Afraid to Eat, Francine Berg reports that a study of 1,316 physicians showed they were more reluctant to perform pelvic exams on very fat patients. Higher weights of female patients was related to negative physician attitudes about patients’ appearance, which in turn was related to lower frequency of pelvic exams. She noted that researchers warned that the lower level of preventive care large women are getting may account for some of the increased health risks found with “obesity.”

Emphasis hers. Oh, and then there’s this:

By the way, a 2003 Obesity Research article by M. Schwartz et al also reported that health professionals specializing in “obesity” displayed significant anti-fat bias, endorsing stereotypes of fat people as “lazy, stupid and worthless.”

Obesity “specialists” tend to be anti-fat? Oh, I’m stunned. Fetch the smelling salts.

So, the doctor who specializes in your “condition” thinks you’re lazy, stupid, and worthless. The gyno doesn’t want to touch your fat vagina. (Which is just disturbing on so many levels. I mean, do they especially enjoy giving pelvic exams to thin women, then?) If you go to the doctor to have a suspicious mole checked out, you’ll be lectured on weight loss. You might even be counseled to consider dangerous surgery to become thin — when you showed up with a cough. If they can’t come up with a diagnosis for your stomach problems, say, the prescription will inevitably be: “lose weight.” If you’re immobilized by arthritis, you’ll be told a replacement joint would be “wasted” on you. If you need surgery, you might not get it unless you diet.

Peggy also mentions a 1994 study that showed 32% of health care workers with a BMI above 27 put off going to the doctor because they knew they’d be weighed — and, presumably, given crap about it. Who would know better what it’s like to be a fat person in a doctor’s office than the people who live it every day?

Marilyn Wann became a fat activist in the first place because she was denied health insurance because of her weight. (Which was 245 lbs.) Are the people who won’t shut up about how fat people are so unhealthy, and taxpayers will have to foot the bill for their ER visits, and they just won’t “take care of themselves” aware that some fat people are not even allowed access to doctors?

And it gets worse. One of my readers recently lost her mother. In 1984, her mother’s doctor declared that her whole problem was being fat, and he didn’t want to see her again until she lost weight.

So she didn’t go to the doctor again for 23 years.

And someone lectured this (also fat) reader of mine, at her mother’s funeral, about how her mother would have lived if only she’d lost weight.

Yeah, either that or if only her doctor had offered her medical treatment instead of a judgmental, impossible ultimatum.

Fat kills, all right. Just not in the way people think it does.

16 thoughts on “Fat Health Care

  1. Oh my God! The stories you report are just terrible. Women being treated in a disrespectful way always sucks, but that story about your reader whose mum was told basically to “lose weight or die” by her doctor really is disheartening. It’s like we’re placing conditions on who receives quality medical treatment in this country. Health insurance costs are already sky high, and patients pay inordinate amounts of money for pretty shoddy care most of the time. Now everybody is supposed to be an anorexic “beauty queen” to receive treatment from a doctor? That’s messed up.
    On the subject of being fat, not being fat, etc. What are your thoughts about the new weight loss supplement Alli? Have you heard any bad/good comments on it yet?
    Al;though I’ve been reluctant to use supplements like this myself in the past, this one has actually helped me quite a lot so far.
    I’ve been using it for about three weeks in combination with my usual diet and fitness plan, and I noticed that it did allow me to lose extra weight – and it seems the fat is gone, not the lean muscle mass. But it’s still early in the game yet.
    I’ll be interested to see how people do with Alli. So far it seems to hold a certain amount of promise, especially for the morbidly obsese who are tired of looking forward to losing just one pound a week. As far as my use of it goes, so far, so good!
    Dharma G

  2. What a wonderful entry. There’s so much here I’ve personally experienced I found myself nodding my head all through this entry.

  3. I maintain a Fat Friendly Health Professionals site with many patient recommendations of fat positive (or at least not fat-hating) doctors and other health professionals. Some health professionals even refer themselves. There are some tips on how to find a doctor who will treat you without blaming all your problems on weight, and how to communicate with a new doctor about your attitudes on weight and health.

    It doesn’t make up for or prevent all the negative experiences fat people have with doctors but it’s a small start anyway.

  4. So, did she punch this person at the funeral? Because I totally would have. And then dragged her from the funeral home by her hair and threw her into the street. You don’t say things like that to people.

    And Alli? Come on. Crapping your pants for a few extra pounds? Uh, no.

    And this “especially for the morbidly obsese who are tired of looking forward to losing just one pound a week.”?? Come on. Seriously? When any medical professional with an ounce of sense will tell you that losing more than two, three pounds a week at most, is unhealthy? Really? Do we need to hear this again, plus a leak to the Crap Your Pants For Three Extra Pounds pill?

  5. Dharma, I edited your comment to take out the Alli link. I don’t want to advertise for diet drugs on this site. And Zan is exactly right: losing weight fast is even more likely to fuck up your body than dieting in general. From what I’ve read about Alli, I think it holds exactly zero promise. I’ve already written about that.

    Stef, thanks for stopping by. I didn’t link directly to you because Peggy linked to you in the post I linked to, but I really appreciate your site.

    Cynthia, thanks.

  6. I remain eternally grateful for my lovely doctor.

    When I’ve had to see a doctor that’s on the Weight Loss! bandwagon, it’s always made me wonder about their competence in other areas. If they’re not willing to consider that it might not actually be tragically unhealthy to be fat, or that weight loss doesn’t work, what other knowledge are they lacking?

    I guess at least the blatant fat-hating docs are obvious about it. (Sigh.) I really hate the stealth ones that you see a couple of times and it looks like you’re going to get on well – and then they pull the “I’d like you to lose some weight” thing out of nowhere. Which is where Stef’s tips and Hanne’s letter really come in handy, you can find out sooner rather than later.

  7. There was also a thing about 18 months ago about overweight people not getting proper med dosages. I blogged it here.

    Made me flippin’ MAD.

  8. Ooh, Deborah, thanks for that link.

    La Di Da, you nailed it:

    If they’re not willing to consider that it might not actually be tragically unhealthy to be fat, or that weight loss doesn’t work, what other knowledge are they lacking?

    That is right fuckin’ on.

  9. I haven’t been to the doctor in, oh, 5 or 6 years. I headed to an allergist this past November and for the first time in my entire life since I fattened up as a child have not had my symptoms blamed on my weight.

    This highly encouraging event has led me to consider finding a new general practitioner and gyno. But I’ve been sitting on the optimism for 6 months because, quite frankly, I still absolutely dread it and don’t know quite how to summon the energy.

    The allergist office weighs me but they make it clear it is to determine proper dosage. They take my blood pressure (which is perfect, I’m told), and check other general things to make sure that giving me allergy tests or allergy shots is not going to make me more sick. The only time weight loss came up is when the doctor said the body being unable to process foods to which it is allergic can cause weight gain and so, if I am avoiding the foods on my allergy list, weight loss might be a side effect. She mentioned it as one of a host of things that might happen.

    It was amazing. Because for once, the goal of a doctor was to help me breathe instead of to shame me for my weight.

    So, yeah, this resonates very personally for me

  10. I have been going to the same gynecologist for over 20 years, and she has never given me a hassle about my weight. Last year I saw her for a UTI and she asked about my menopause symptoms. I told her they were mild, and that my only problem was the weight gain and loss of my waistline. Her response then was “Welcome to menopause.”

    Six months later I went back to my regular exam and suddenly there was this diet that it was HIGHLY URGENT that I go on. She went on it and lost 40 pounds in 2 months for her high school reunion.

    Now I am a big believer in Chi Gong and Chinese medicine and there may be something to the accupressure part of this. But here’s why people lose weight on this diet: It’s because the diet consists of the following:

    Day 1: 20 oz. of full-fat milk. That’s it.
    Day 2: 1-1/2 lbs. of vegetables. That’s it.

    Continue until you lose the weight.

    In 1983 I went on Cambridge Diet and went from 118 to 105. The minute I went off it I started gaining — and never stopped.

    I don’t eat fast food. I don’t eat sweets excessively. I do yoga, I walk. And I am now a size 16. And I have a doctor telling me to go on a crash diet after years of telling me not to worry about it.

    According to her staff, she was a bitch on wheels while on this diet….sort of like I was when I was on Cambridge because I WAS HUNGRY ALL THE TIME.

    But this is the medical profession for you.

    I don’t even have a problem with a doctor who wants me to lose weight — if he or she is willing to provide constructive help and understanding that for some of us, calorie in/calorie out doesn’t always apply.

  11. Holy crap, Jill, how ridiculous that a health care professional would advocate such dangerous malnourishment.

    And the funeral story? GAAAAH. Even if the person who died was the most self-destructive person who ever existed — even if she was a frigging crack whore who turned unprotected tricks to get fixes — it’s in jawdropping bad taste to mention it at the funeral. And being fat =/= crack whore, not even close.

  12. My mom had a stroke 4 years ago. We think it was triggered by seizures that were triggered by the beggining of Menopause (It is also related to a massive accident from 20 years ago). It was a major stroke, she temporarily lost all function to her left side. She is walking again and getting around pretty well, sometimes she still acts crazy, but I can’t imagine going through The Change plus recovering from a massive stroke. She manages to do it all with relative cheer.

    I swear to you though, every time I go home she is on some other god damned diet. Every time she goes to the doctor he harasses her about her weight. I know their are concerns like high blood pressure, but the woman goes to the gym for half a day three times a week and barely eats anything. She’s much healthier than my Dad who is on her case constantly. She was on Nutri System, the california diet, some weird thing my dad found, I’m sure they’ll be “cutting carbs” again when I go home for the fourth.

    For a while there she was eating cottage cheese for breakfast every morning because it was “low carb” and then she went to the doc and her cholesterol was thorugh the roof. SHOCKER. I mean this woman has serious medical problems, but they aren’t just because of her weight, high blood pressure, cholesterol, everything runs in the family.

    Why can’t they give her a break? Like it isn’t depressing enough to not be able to drive, she’s not allowed to eat either. Raaaah.

  13. You know, every once in a while I have to stop and be thankful for my excellent doctors. My size? Somewhere upwards of 450 pounds. When I go to the gynecologist, she sends me for an ultrasound in case there’s something wrong that she can’t feel because of my size. When I went to the doctor with breathing problems, they check me for infections. They never suggest that a sinus infection would be cured if I lost weight. Yes, they want me to lose weight, and I do, too, because my size keeps me from doing everything that I want to do. It is *not* senseless brow-beating because they think I’m lazy or stupid.

    Everyone is a human being, and thus deserves the same respectful medical treatment that any other human being would receive.

  14. Oh, I can’t wait to check out some of these links.

    But I don’t think my sister will listen to anything I have to say. She has been fat since childhood. My brother and I have tended to be more average weight, although since hitting menopause and taking various medications for severe depression (meds that are helpful, if not life-saving), I’m carrying about 25 pounds of unhealthy belly fat. This annoys me.

    But mostly I can camouflage the belly fat, and it hasn’t seriously hampered my activity. My sister has been obese since childhood. There are a lot of family dynamics involved, but …wait, I have no business talking about this aspect. Gah.

    Let me move on to a conversation I had with my sister a few years ago. I’d just had a breast lump removed (benign benign benign! Yay!, so medical stuff was on my mind. I asked her about her mammograms, and she said she’d never had one. She grudgingly told me that she’s never had a pelvic exam or a PAP test in her entire life. At this time, she was 49 years old.

    My family is not close, and the intervening years haven’t mended that. My sister doesn’t like to talk to me about these things, or anything (actually, she doesn’t much like me) but she opened up enough back then to tell me this.

    I was the one who had to tell her that she’s the consumer, the doctors and nurses are hired by her to provide medical care, for which care they are paid, and to urge her to believe that she has the right to get a PAP test without additional commentary. And that the world wouldn’t end if she said straight out, “Look, I’m here for a PAP test. That’s what I want. I am fully aware of my size and weight and do not want counseling from you on that subject.”

    Since then, I’ve worried about her, and I’ve been uncomfortable with having said stuff like that to her. I don’t think I said anything wrong, but I’m not sure I conveyed my assumption of her intrinsic value, or my recognition that her situation kinda sucks. You know? She comes from a family in which the parental dialog was “We’d love you more if there were less of you to love”, so obviously it’s not gonna be easy for her to go into a doctor’s office and demand to be treated with respect.

    What’s her leverage, anyway? Fat people continue to be targets, and there’s very little public pressure for that to end. Fat peoples’ very flesh is assumed to be public property for comments, criticism, observations, contempt, pity….

    My sister is not as healthy as she could be even without losing a pound. You know one of the reasons why? Maybe twenty years ago, during one of the times she was living with our parents, she fell and injured her ankle. (She probably broke it.) She never went to the doctor (habitual shame); our parents never insisted that she go (so expensive when it’ll probably heal on its own), and ever since then, she’s had increasing pain and restriction when walking or weight-bearing of any but the most minimal kind.

    She can’t go for walks, or hikes. She has to miss the fresh air and seasonal changes and bone benefits and heart benefits, and all the soul-healing benefits that the outdoors has to offer, regardless of whether she ever lost one damn pound of weight.

    You’d think I could do something about this, but believe me when I assure you that I can’t.

  15. I am sitting here at work, reading this and crying. I didn’t even realize that I had Done Something when I avoided going back to a PCP because every time I went she berated me about how I was going to get Type 2 diabetes because both of my parents got it if I didn’t lose weight. So I just never went to see her again.

    She didn’t ask me what I ate, or if my diet was markedly different than my parents’ (I was eating tofu and ground turkey in the 80s when they just made fun of me). Or anything else about my life.

    and it happened again today. she’s telling me what my bmi was, and i just said, “you know, i’m fully aware that i need to lose weight, and i want to lose weight, and i’ve tried every diet that exists.” there was no need for her to take my bmi. i’m fat, i know it, okay?

    they just don’t believe you.

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