Quick hit: WaPo on fat prejudice in medicine

Roni Caryn Rabin is quickly becoming the fatosphere’s new best friend, perhaps the more wired-in version of Gina Kolata. On the heels of the fatosphere article, Rabin linked to SP/F-word side project First, Do No Harm in a Washington Post article on fat prejudice in medicine and the assumptions that doctors make about their fat patients.

Two studies in the journal Obesity Research in 2003 found that many physicians harbor negative attitudes toward fat people: A University of Pennsylvania study of 620 primary care physicians found that more than half reported viewing obese patients as “awkward,” “unattractive,” “ugly” and “noncompliant”; a Yale study reported that health professionals strongly associated being overweight with being “lazy” and “stupid.”

Such negative views, some experts charge, may be helping to drive patients away: These experts point to a 2000 study of 11,425 women, which found heavy women less likely to obtain cancer screenings such as Pap smears and mammograms even though they’re at higher risk of dying from cervical cancer and breast cancer. Newer research has produced similar findings: A 2006 study of 498 women, published in the International Journal of Obesity, found that obese women delayed cancer screenings more than other women. Negative attitudes of health-care providers and disrespectful treatment were among the reasons cited for postponing care.

This is a subject that I honestly think almost nobody has written about but us bloggers — Thorn in her incredibly affecting series of guest posts, and our contributors at First, Do No Harm. Fear of the medical establishment brought on by systematic mistreatment may be one of the biggest contributors to the correlation between fat and ill health, but it’s almost never called out — with the result that many people who experience it think that they’re the ones doing something wrong. Rabin deserves kudos for helping to expose a dirty little medical secret. She’s shown herself to be uncommonly good at maintaining equilibrium in the face of undoubtedly strong editorial pressure to pass more judgment on fat, so I hope she stays on the beat for a while.

I do wish she’d been able to insinuate a little more about the real causes of the “obesity crisis” (so, you say fat people can’t get equal medical treatment, either corrective or prophylactic? And you say that being fat is associated with health problems? Well gee, I can’t for the life of me see how those are connected). But it’s pretty radical to envision any cause for obesity-correlated health risks beyond “fat kills,” and I can’t really expect the world.

What do you think? And what’s your experience with the medical profession? (Mine’s been pretty fortunate, aside from the GYN who told me I was having pain during sex because I “sweated too much” and the doctor who sent me a note saying “EXERCISE AND LOOSE WEIGHT AND AVOID FRIED FOODS ,EAT A LOT OF VEGETABLE.” If you know anything about my habits, the second one is particularly absurd.)

Edit: If you’ve had a good experience with your doctor, please consider adding him or her to the Fat-Friendly Health Professionals list!

Edit 2: And if you’ve had a bad one, consider filing a complaint.

170 thoughts on “Quick hit: WaPo on fat prejudice in medicine

  1. I’ve been lucky in terms of how doctors have treated me when I’ve seen them…but I’m one of the 47 million unlucky Americans with no health insurance, so I don’t see them much.

    In fact, just last month I finally finished paying for the two emergency room visits I had to make last spring to deal with the lovely case of Pertussis (Whooping Cough) I managed to pick up when Mr. Twistie’s boss decided he needed to come into the office while he was sick with it. Mr. Twistie caught it, though we didn’t know what it was at the time and he recovered without formal medical care. We thought it was just a really bad cold until I got it and couldn’t eat or sleep for a week. That’s a slight exaggeration, but not as much of one as I would have liked it to be.

    Luckily the doctors I saw for the Pertussis made no attempt to relate it to my waistline.

    Painful sex due to sweat? Man, Fillyjonk, what was that GYN smoking? And I love the other doctor making random assumptions about your diet without discussing it with you and then handing you such a nasty, badly spelt, grammatically cringeworthy note about it.

  2. I mentioned this over on The Rotund’s blog too, but man, those comments are terrible. I blew my Sanity Watchers points for a month.

    But I liked the article a lot, and maybe it’s good to have the kind of things out there in the mainstream media that get the kind of vitriolic fatphobic reaction we see in the comments there. In fact, I’m pretty sure it is.

  3. I don’t understand why news articles even HAVE comments. If you have something to say, fucking email your friends or get a blog. The idea that you can talk back to every fucking thing on the internet is getting really old. IT’S THE WASHINGTON POST. YOU DON’T GET A SAY.

  4. Yeah, some of them do. But the ones who don’t don’t comment.

    And we’re changing the zeitgeist. That’s what’s important.

  5. I’ve had pretty good experiences so far, then again, I’ve only been “overweight” for five years or so, and I don’t think I’ve had a physical since I crossed the line into “obese” a little less than a year ago.

    My old doctor expressed concern about my weight gain (I had gained like 50 pounds in 3 years, from a starting weight of 105, so I don’t think it was unreasonable of her to be concerned), I told her I’d been eating poorly and not excercising because of school, and she just told me to work on that. My mom had really bad experiences with that doctor though, she blamed all my mom’s back and hip problems on her weight. (My mom stood up for herself though and insisted on getting the MRIs and being referred to a specialist). So I’m glad that doctor is gone. My new doctor seems pretty good, I think I was close to the border of being between “overweight” and “obese” when I had my last physical with her, and she didn’t say anything about my weight… at the end of the appointment she even told me I seemed “very healthy”. Hopefully I’ll continue to have good experiences with her.

  6. We got Kaiser where I am, which is one of the medical providers mentioned in the article, and while all of the doctors I’ve seen are far more tactful about fat than any of the ones on First, Do No Harm, it’s ultimately become a matter of stealth.

    If I make even the slightest mention of something that might be taken as a symptom of diabetes, she instantly puts in a request for a blood draw. For example, I mentioned I was having frequent urination, especially at night, and without requesting any explanation whatsoever, “Let’s get you tested for diabetes!” Nevermind the fact that I was working night shifts and would suck down 6 cups of coffee before the sun even came up then chug water the rest of the day to stay hydrated.

    When taking vitals, the medical assistant will pump the blood pressure cuff to 200, but it only needs to go to 160. The only reason it would ever need to be up that high is if the patient has a recorded history of high blood pressure, which I don’t.

    So sure, they don’t bring blame every single thing on fat or start into a lecture about it, which is a big step up, but that doesn’t stop them from making silent assumptions based solely on fat and being an all-around annoyance. Maybe my fat ass costs more money because I have to get blood drawn all the time for pretty much no reason.

  7. I finally found a doctor I liked years ago – who tells me that I am one of the healthiest patients she has. I had a doctor before her who told me – unprompted and after telling me that all my stats were terrific – that I needed to eat right and exercise daily. When I explained that I worked out 2 hours a day and ate a balanced diet with no sugar, junk food, fried foods, refined foods, etc etc and that I counted all my calories and kept it under 1200 a day… he looked me up and down and told me (in so many words) that I was lying. When I produced food diaries and workout logs – he told me that I must not be doing it right or writing everything down properly.

    I told him he was an asshole – left and found another doctor.

  8. Caasana, Oh my god the bloodpressure!!!

    I had a UTI in DisneyWorld a few years ago, I actually had it for about 48 hours before I went to a nearby clinic to get some meds. I must have spent 3 hours in their waiting room with a UTI, not wanting to go pee because I knew I would have to go pee if they ever called me. So yeah, here is me, in excruciating pain for 3 hours. So I go in, and they do all their unnecessary measuring me stuff, and I go pee in their cup, and then I go sit… and wait… for another thirty minutes with a very painful UTI.

    And then the doctor comes in and says “Your bloodpressure is a little high. Are you watching that, because at your weight….” *headdesk* I had to reassure him about 20 times that this was the first time any doctor had ever told me I had high blood pressure he finally gave me antibiotics with an admonishment to be sure to keep an eye on my blood pressure.

    *Hate* Plus, the meds he gave me made me so sick I couldn’t keep food in me for the duration.

  9. I found the comments of the M & J Show host Mike (“Do people look at you and assume you’re unhealthy?”) ironic for a number of reasons, but most ironic because my doctor never even mentions my weight. It’s just not relevant to my health and wellbeing.

    I have a thyroid condition – a disorder even Roth couldn’t claim is caused by fatness – and so I have to go in yearly for a checkup. Also, I have to go in every year to check my heart, because I damaged it during my eating disorder. Otherwise, I rarely get sick and rarely go to my family doctor.

    My doctor knows about my eating disordered past, obviously, but this is only one reason she doesn’t bring up weight. Since she is the only other one privy to my health records, she knows I am healthy even if I am fat.

  10. It’s the little things about the visits, too. I (heart) my GP for not really making a big deal about my weight, but really the best part of the visit I had last year was that the intake nurse took a look at me and just grabbed the bigger sized blood pressure cuff off the wall without saying a single word. This was so much different than at my previous doctor’s, where the nurses would routinely try and take it with the usual cuff, look askance at the number, do it again, then get the larger cuff out of a closed drawer with an audible huffy sigh and sometimes a snotty “Oh, I guess I need to use the other one”.

  11. Maybe I’m just in a weird mood lately, but the comments on the article made me laugh.

    Article: Studies show that a lot of fat patients receive substandard medical care due to their doctor’s inability to look beyond their weight.

    Commenter: OMG! Put down the donuts! Fat people eat too much! Obesity kills! I did it and so can you!

    It’s like people are just programmed with 4 possible responses whenever someone mentions obesity.

  12. attrice, that’s an awesome mood to be in — share it around!

    Every so often — more and more often, actually — I can also hit that sublime state of mind where fat hatred just looks ridiculous. It’s such a relief. Because it is ridiculous, but the pervasiveness can really get you down if you lose sight of that.

  13. It’s like people are just programmed with 4 possible responses whenever someone mentions obesity.

    You’re right there, there’s not a lot of originality. The ones that get to me are the people who admit, straight up, that yes, they do hate fat people and think we’re ugly, lazy, stupid, self-indulgent.

    Ugh. Just ugh.

  14. I don’t think I’ve ever been treated badly because of my weight by a doctor… because I almost never went. I was too deeply shamed by the way I already perceived myself because of parental and peer pressure.

    When I was 17, I developed a lump between my breasts. Ironically this was actually when I’d *lost* weight, going from around 185 to 165 on my first ever weightwatchers attempt. I was terrified I had cancer, but I didn’t say anything to anyone for about six months. The idea of taking off my clothes in front of the doctor was just as terrifying as finding out something was wrong with me. I literally had to work myself up into some kind of sobbing frenzy one day after *months* of having this lump before I could bring myself to tell my mum I needed to go to the doctor.

    The doctor was actually fine (of course I also wasn’t all that overweight then), told me it was probably a cyst, and to come back in a week.

    I never did go back – I was relieved by the probable diagnosis and just didn’t want to go through another doctor visit. And eventually the lump disappeared. But how crazy is it that a 17 year old has to think she’s dying before she’ll go to the doctor?

    In general, I have very little faith in doctors, though. When I was 25 I basically diagnosed myself with chronic fatigue after suffering from a collection of symptoms that wouldn’t go away. The doctor sent me for a few blood tests, found that everything was ok (first time I’d ever had blood results, and at 250 pounds by then, I was amazed that the results were so good since obviously I had to be unbelievable unhealthy if I weighed that much) and did nothing else to help me. I’m just lucky that the symptoms went away after 8 months, because there was no help for me medically and I wasn’t very good at advocating for myself since I was so ashamed of my body.

    It has only been in the past couple of years *I’m now 34) that I have been able to look at my body’s imperfections as just those; a collection of imperfections in an extremely complicated organism, and not moral flaws, sins that I have committed that show what an evil disgusting person I am. It is beyond reprehensible the way society blames fat people for their bodies.

  15. As a patient, I’ve had pretty okay experiences with doctors, who have never seen my weight as a big deal. I finally got the PCOS nod last year after I figured that was my menstrual issue and directly asked my new general practitioner to test me, and she was really good about it. She sent me directly to a gyno who was specialised in PCOS who’s also great.

    The doctors who have been asses to me were also asses when I was younger and not so fat. So, in all probability their communication skills in general weren’t up to par.

    But from my med student perspective, I can’t say everything is as unprejudiced. I remember, a couple of years ago, we had to do some community research, and I have to say, the research that was most highly praised was the weight-related research, however flawed because *obesity crisis kills*. The attitude of a lot of my fellow students was indeed that fat people were doing something wrong, and often did attribute negative characteristics to fat patients. Needless to say, when physical examination practicums came up (ie, take your clothes off and examine each other in teams), I didn’t want to be partnered up with any of them… But looking at it now, I think maybe I should have, if only to show that I *am* fat and still smart and confident, and knowledgeable about my body.

    My med school did get two important things right, though:
    1) it’s the only med school in this (european) country that can kick students out for bad attitude toward patients (and trains us in the correct one), and
    2) has a fat dietitian as primary lecturer on nutrition.

  16. My last doc appointment was Monday. He said “how are you feeling” I said “great”.
    He looked at the papers in front of him, and with great incredulity said “your diabetes test came back… negative”.
    “I’m not surprised. I feel great”.

    “You’ve gained 11 pounds since your visit last month”
    “That’s not right. On my scale at home, I’ve gained 13 pounds in 5 months”.
    “You’ve gained 11 pounds since your visit last month”.

    So the fat girl couldn’t *possibly* not have gestational diabetes. (Ok, I’ll give him that one, since I had it with my last pregnancy, it’s close to 90% likely to develop again.) But the fat girl couldn’t possibly be aware of her weight gain, because if she had any clue how fat she was, she wouldn’t be so fat? After all, it isn’t like my last visit was 2 days before the whole office moved, staff was distracted, and then *his* scale got moved across town… no wait… it is. Ass-hat.

    *takes out phone book, starts looking up midwives*

  17. Every so often — more and more often, actually — I can also hit that sublime state of mind where fat hatred just looks ridiculous. It’s such a relief. Because it is ridiculous, but the pervasiveness can really get you down if you lose sight of that.

    I had a moment like that yesterday — a guy friend sent me a link to one of the Anti-Gym’s ads, which I’d never seen. It was so…completely idiotic and dumb that I didn’t feel angry afterwards, just kind of oddly amused because it was just that stupid. (Note: the guy friend sent it because *he* was offended by it, not because he was trying to send me a “message”.)

    As for me and the medical community…I’ve been lucky. Never had an MD give me hell about my weight, never got “the talk”. I’ve been remiss about finding myself a new GP, though, as I moved…well, two years ago. I’m someone who goes only if there’s a problem.

  18. Its always awful to hear some of how people are treated so sterotypically for being overweight; for being fat and still healthy.

    I have noticed the sublte things recently with my own visits (no matter what I go in for I get weighed and that BP taken each time…and a “Huh *rattles off numbers that mean nothing to me*.” me: “Is that good??” “Its excellent” says nurse in baffled tone).

    But one memory that will never leave me (or my mother who was in the office with me at the time) was when I was like 10 or so and slightly overweight for my age group (or based on those 5 pounds per inches crap; whatever)…the doctor was a very large woman, I have visual still (I’m 27 now) of her sitting down on that little stool and her bottom flowing over both sides (um…hey get a better stool!) and she looked at me and told me I needed to lose weight.

    I already ate great home-cooked wonderfully balanced meals and went swimming and biked and yet nope; because I had started reading more often I was told to lose weight. Not to increase any particularly healthy habit (like I was ALREADY doing) but just to lose weight.

    *sigh* We’ll see how things continue with my new doctor….

  19. Oh, dear goth in heathen… I’d never heard of the Anti-Gym and I just went and read up on it, including an entire blog devoted to boosting it which wonders why any men would ever complain about the Anti-Gym’s commercials and then concludes that it’s because they’re afraid of their fat wives (who can’t get hubbies because they’re fat).

    I’m so gonna get chewed out for my binging at the next Sanity Watchers meeting.

  20. Wow, please send me a referral to your doctors! I haven’t been so lucky. I’m 5’5″ and weigh about 190. I had to go to the doctor for panic attacks two years ago, I was working long hours at work and only sleeping 3 hours a night. After the initial consult his nurse called me to ask insurance questions. I answered them and then she blurted “FIRST OF ALL, YOU NEED TO LOSE WEIGHT.” I said “Excuse me? YOU’RE not my doctor. YOU weren’t even in the examination room. YOU have no idea what my problems are.” I was so livid I emailed the director of the hospital. They wrote back and said they would take care of it.

    For my next appointment the bitchy nurse avoided me but the doctor turned his wrath on me when I questioned his prescription for a statin drug. No exageration here: He said “if you don’t take this pill YOU WILL DIE.” I said “We’re ALL gonna die.”

    I never went back. This occured at Lee Memorial in Fort Myers, FL. Avoid that place like the plague.

  21. My experience with doctors has been pretty decent, although it’s only in the past year that I’ve seen a GP again, as opposed to just going to OB-GYNs. I’ve moved a lot in the last few years, so I’ve had three different OB-GYNs since college (I’m 29 now).

    Usually the only comments I’ve gotten on my weight have come when I’ve gained since the previous visit. I have absolutely no idea what my setpoint is, because I’ve never actually had a stable weight for more than a few months, but that’s a discussion for a different day. My weight has fluctuated a LOT during my 20s, so I can see how doctors might be concerned about that.

    I’m a little worried right now, because my husband and I want to start trying to conceive soon. I have an appointment with my OB next week, and I’m worried that she’s going to tell me to try to lose weight before conceiving. So we’ll see how that goes.

  22. I can think of two bad, two good right off the top of my head.

    First was a doctor at the health clinic at my college with a reputation for tellings girls who came in for responsible things like birth control or totally unrelated things like sinus infections that they needed to lose weight. I was, at that time, 5’1″ and maybe 135 pounds and I got the little lecture. *sigh*

    Second was a GP I saw when my first baby was six months old. I initiated the weight-related conversation, mentioning that I was having trouble getting my old body back. Instead of pointing out that, hello, maybe my old body had gone the way of, say, my virginity, he trotted out the “calories in, calories out” line, adding in a disdainful, “you’re an engineer, surely you understand the science behind that.” When I expressed concern about snoring, he sent me away with a “lose ten pounds and it should be fine”.

    Fortunately, good is the two regular doctors I have now. A GP who showed no sign of making assumptions when he asked me if I was getting regular exercise (I find this a totally reasonable question when I was in for mood-related complaints) and when I confessed that I wasn’t, still didn’t say a single word about my weight (which is probably 50 pounds over “ideal”), only saying that regular exercise would probably improve my mood.

    And my OB/GYN is a real gem. During pregnancy, obviously they track weight gain, but unless you ask (or there is a concern), he doesn’t even tell you the number, let alone make judgmental comments. I asked about it once and his response was along the lines of, “you’re a grownup and I find that nagging women about their weight gain doesn’t accomplish anything except to make them feel bad”. Novel concept, that.

    What’s interesting is that I knew these were bad and good experiences LONG BEFORE I HAD EVEN HEARD OF ‘FAT ACCEPTANCE’. I intrinsically knew (in spite of being in a place where I was, myself, hating my body and trying desperately to change it) that those were inappropriate ways to be treated. Even if you accept the premise (which I totally did) that ‘fat is bad’, doctors should still be treating patients with respect. Period.

  23. Since my husband and I moved to Canada, not one doctor has told us to lose weight. We’ve been encouraged to “move more” but not to drop a pound. Every doctor I saw in the States told me to lose weight!

    I am a little worried about a doctor’s visit coming up soon – we’re seeing a fertility specialist, and I’m pretty worried he’s going to tell me to lose weight. I’ve been doing research on infertility online, and most of the articles say that fertility can be negatively impacted by weight. I don’t know what to do about that – how do we know when an illness IS related to weight and when it’s not? There’s a certain level of trust you have to put into a doctor, but how does one balance the “convenient fat diagnosis” with “problem actually caused by fat”? And of course, if it IS, what the hell do I do about it?

  24. I have really great blood pressure, but am terrified of hospitals and surgery. At my doctor’s office I have 100/68, but at the hospital on Monday at my prescreening appointment for surgery it was pretty high. Any guesses why? Oh probably because I am terrified of hospitals.

    I also cry, always, the first time I see a new doctor. Right now I am preparing for surgery, so there’s a lot of doctors appointments, not good. I’m an inbetweenie, and I mostly feel unheard by doctors. In my appointment with my surgeon I don’t think I finished any sentence with her. I am so thankful for nurses.

  25. That other Deborah? She’s not me. Not that there’s anything wrong with that, but with two Deborahs commenting, I just thought I’d clarify.

    Here’s what gets me:

    heavy women less likely to obtain cancer screenings such as Pap smears and mammograms even though they’re at higher risk of dying from cervical cancer and breast cancer.

    “Even though” is simply not the right connector here. “And perhaps that’s why” has some plausibility.

  26. Ohhh… don’t get me started on the doctor issue…

    In the last 6 months, I was finally, finally diagnosed with both PCOS and hypothyroidism. I am also a recovering anorexic. I am also “overweight” (as most folks with PCOS and hypothyroid are). In the whole diagnosis process, I went to see an endocrinologist. I found him via a “Top Docs” list for the Washington DC area. I figured he’d know his stuff.

    Note now that I had an ED relapse just 3 years ago and at that point started seeing a fantastic and well-known dietitian in the area, one who many, many ED-therapists around here refer to (I keep finding more and more folks who sing her praises, and I have to agree).

    The endocrinologist told me that he wasn’t sure he should provide me with meds for the PCOS because it might dissuade me from losing weight (does that even make sense?). He said that what I really ought to do was go on the South Beach diet and then come back in 3 months and THEN if I’d lost enough weight we’d evaluate whether or not I got meds. He was holding them out there like a little carrot, dangling them in front of me… meanwhile, without the meds, I had not menstruated in close to 7 months. It’s not like it was candy he was providing me. I really needed this!

    I gave him my well-rehearsed line about how I am seeing several professionals including a dietitian for my eating disorder and that I would stick with the eating plan that she and I have worked out together. He says to me, “You’re seeing a dietitian, are you? Well, it’s obviously not working!”

    I nearly wrestled him to the ground to get the prescription from him, started the meds, and promptly went to find another doctor. I’m now seeing a fantastic doc at an integrative medicine clinic. She’s helped to get the PCOS under control, gave me some thyroid support, and consequently I’m feeling better than I have in ages. She said to me, “I see that you’ve got a history of an eating disorder and that you’re seeing insert-dietitian’s-name-here. So given that, the only thing I’m going to remind you about your eating is that you need to make sure you’re consuming something every 2-3 hours so that the meds don’t make you hypoglycemic. Otherwise? Keep doing what you’re doing.”

  27. I’ve never had anything completely horrible happen to me at a doctor’s office before, but at pretty much every physical I’ve ever had, when I tell my doctor about my activity level and eating habits, they proceed to tell me I need to exercise more. Honestly, I could be on a national swim team and still get the same little talk. Oh, and a few months ago they sent me a brochure in the mail which talked about diet and fitness. Yep, we’re all just BIG FAT LIARS.

  28. Oops, pushed button too soon.

    After my first knee injury, my doctor told me I should lose weight to take pressure off the knee (which is actually not unreasonable, because a knee is a weight-bearing joint). But he ALSO told me to increase my fat and protein intake to promote healing.

  29. Deborah Lipp, THANK YOU. I actually copied that line down somewhere so I could remember to mention it when I made this post, and then promptly forgot where it was and could not for the life of me find it again even when combing the article this morning. So glad you’ve got the eagle eyes I lack.

    That’s EXACTLY the point at which I said “oh man, couldn’t Rabin have drawn the picture a little clearer?” Because it just flies in the face of reason to imagine that there’s not a connection between lack of care and higher disease incidence.

  30. And libbyloo, christ on a cracker. I think a friend of mine had a similar experience with a local endo, though probably not the same one — she was definitely put on South Beach for PCOS, and ended up getting gallstones from the rapid weight loss.

    If you hadn’t found someone you liked, I’d recommend my doc at Maryland Endocrine. I should add her to the list.

  31. I love my PCD in large part because when I went for my physical after being on zoloft for 8 months or so and told her that my only side-effect was gaining weight across my hips and low belly, she without a blink said, “that’s nothing to worry about, you’re very healthy, everything looks great” after years of working through disordered eating and thinking patterns and being so worried that this was going to be a tipping point, it was such a release to hear her reassurance… unfortunately, she’s only at NYU, but I recommend her to everyone!

    I also wanted to add that this is my first blog comment ever, but I have been reading SP almost daily for months and between the bloggers and commenting community, it has been such a wonderful find!

  32. Thus far, I’ve had a fairly positive experience with doctors over the years… I did have my very first gyno try very hard to assume I have PCOS based entirely on my weight and frighting amounts of facial hair that I usually wax every month… I’m not trying to say she was wrong per se, but I don’t normally have irregular periods or anything like that. She seemed to say, “you’re fat and hairy; there must be a reason for that”, and started diagnosing based on those two “symptoms” alone. It was weird.

    My current general practice doctor is awesome, though. I found out last summer that my cholesterol was high, in part because my *good* cholesterol is quite high, and that drives the combined number up. She did mention that high cholesterol is likely to happen in people who are overweight, but she never suggested weight loss to me. She suggested adding specific foods to my diet (things that help lower cholesterol, allegedly) and trying to find an exercise routine that I could enjoy on a regular basis. Basically, she suggested HAES.

    She also gets bonus points for treating a yeast infection that I had for over a year and for being highly patient with me while I look for a form of hormonal BC that works for me in the aftermath of said yeast infection. (I used to be on the NuvaRing, but after 14 months of painful vaginal irritation, the idea of keeping something in there scares the crap out of me).

  33. p.s. I forgot to mention that when I confronted the nurse about her not being my doctor and that she wasn’t present at my exam she slammed the phone down on me. SHE HUNG UP!!

    I guess she wasn’t used to a “fattie” fighting back. I have to say though, her rage towards me blind sided me. And I talked back to her like the piece of shit that she was….. When people treat us that way we need to tell them where to get off. Fuck them.

  34. I’ve had a lot of negative experiences with doctors over the years that have left me very reluctant to get help, even when it’s clearly necessary.

    The worst experience was getting sick at the age of 29 and I couldn’t hold down food. I was vomiting an average of 7 – 10 times a day, at some point I was living off nothing but Ensure puddings. Sometimes I would look at a person eating a sandwitch and cry because I wanted to be able to eat a sandwitch again.

    Long story short(er) the doctors flat out didn’t believe me. They insisted it was “functional” (meaning mental) and tried to put me on anti-depressants. The Paxil I was given caused vertigo and vomiting – try to think of what this does to a person who can hold almost no food in her stomach. After blacking out and landing face-first on the floor (at home – thank goodness) I swore I’d never take them again. The doctors lectured me about how I could never get help from them if I wouldn’t take the pills they were giving me.

    While this was going on, I’d put my weight at apx. 145 – 150 lbs, and I’m 5’1, so I was “overweight.” My metabolism slowed dramatically (to keep me from starving to death – thank you metabolsim!) I truly believe this was a big part of why they wouldn’t take me seriously, because they saw me as too fat to be in a state of starvation. The doctor I was seeing took my weight at 142, I commented that I was losing and she rolled her eyes contemptuously at me and said “You HARDLY look like you’re wasting away!” The last time I saw her, now simply resigned to never getting better I noted I felt dizzy and weak, but I was trying to just get used to it. She looked puzzled and said “I wonder why you’d be weak.” I never went back after that.

    It was a chiropractor who finally diagnosed me with a hiatal hernia and started adjusting my stomach so it could line up in such a way that food could pass through it. I still see him about once a month 8 years later.

    I can only imagine if this is what I was put through, without even being “officially obese” what very big people are put through. And I’ve seen some of it through my husband, who has a 46 BMI, but I know it’s even worse for women. I’m so glad this travesty is finally getting the attention it deserves.

  35. Andrea, FWIW, high cholesterol and yeast infections can be PCOS signs too. Not saying you should necessarily pathologize your fat or your hair, though, and if you’re looking for hormonal BC you’re doing half to two-thirds of what’s available to do anyway.

    Rose, that’s a fucking horror story. You should send it to fathealth@gmail, we can put it on the site.

  36. I’ve had plenty of crappy experiences with doctors, but none based on my weight. That may be because I’ve never seen a traditional doctor for well-woman care or my pregnancies, only for specific ailments (like ear infections) that they’d have to work pretty hard to work the weight angle in. Heh. I’m seeing an ND right now, and she is very size positive and can do all the stuff an MD can do, so I’m happy. Anyway, I do hear a lot of awful stories from frequenting a parenting discussion forum for the past several years — and my perception from what I see there is that discrimination based on weight is *rampant* in ob/gyn, especially the obstetrics part of that. Fat women have a higher rate of c-section, which some doctors believe is due to the extra fat hindering the emergence of the baby. OBs also automatically label obese women “high-risk” which the attendant required interventions.

    I have a midwife friend who has a high proportion of fat clients, perhaps because they’re more likely to experience poor OB care, and so more likely to switch to the midwifery model. Her c-section rate for her fat clients is nowhere near the average, and she has had a lot of clients who had previously had c-sections and were told that they couldn’t vaginally birth a baby (either because they were too fat or because their supposed gestational diabetes made the baby “too big”) who went on to have perfectly normal vaginal births. It’s our suspicion that the higher c-section rate for fat moms is due to OB’s expectations of fat moms being disabled or abnormal in some way — a self-fulfilled prophecy sort of thing — and that there is nothing about fat in itself that makes vaginal birth more difficult. (FTR, I’m “obese” and have had four normal vaginal births, at least one of which I have no doubt would have been a c-section under traditional obstetric care.)

    Julia — there’s a very good resource for fat pregnant women here: http://www.plus-size-pregnancy.org/

  37. Delurking after 4 months to share my own favorite crazy doctor story:

    I went to go see an endocrinologist last year to check on my thyroid levels (family history). In the year after college, I had gained maybe 10 pounds, which bumped me right up into the overweight BMI range (I’m very short, under 5 feet). I was self-concious about it, and I asked the nurse not to tell me my weight, although I was ok with being weighed in general. She was incredibly judgmental about it, and when I went in to see the doctor–a sixtyish man with no social skills–he immediately asked me how much I ate every day. I told him the truth–that I tried to keep it at 1200 calories; I was in a bad restrictive phase, even though I was working out about 4 times a week.

    He mumbled without making eye contact that this was “too much,” and that I was going to have to eat less. I was so embarrassed. As I fought back tears, he shared with me the helpful anecdote that his niece was about my height, and had had similar struggles. “I don’t know WHAT she eats now,” he said.

    Of course this triggered a lot of shame and even more restrictive eating and obsessive calorie counting–a phase which really just ended this fall, when I discovered Shapely Prose…so thanks.

  38. I went to see a gastroenterologist a few years ago, when I had severe abdominal pain and my GP was afraid it might be auto-immune hepatitis. The GI LAUGHED at me, poked me in the belly, and said, “Your middle is fat, so your liver is fat.”

    I haven’t been back.

  39. Wow. I had never heard of Anti Gym before today…and now I seriously wish I hadn’t. Public shaming and fear of being thrown out of the program as incentives? Gee, who wouldn’t get thin on that sort of ‘support’? Cage dancers? Yeah! That’s what I need to get fit! And hey! I don’t even have to give up pot…which makes me sick anyway.

    But boy, I can’t wait to pay for the joy of having someone call me up at six in the morning to call me names, all so my husband won’t be disgusted by my fat, loathesome body. [/sarcasm]

    Oh, and my husband is interested in me with the lights on, with the lights off, in the bedroom, in the kitchen…honey, I don’t need to be yelled at to be sexy to my guy.

    Also, it’s nice to know that genetics, thyroid, etc. don’t matter as long as you have the ‘will’ to get thin and stop buying into ‘victim mentality’. Did MeMe Roth create this dump?

    Okay, I guess I wasn’t quite done with the sarcasm.

    Now if you’ll excuse me, I’m going to go get some broccoli…because fat or not, I happen to adore the stuff.

  40. I’m lucky with regards to OB-GYN care, that I had my children 20 years ago. I never heard a single word about how they couldn’t examine me, couldn’t monitor the fetal heartrate, couldn’t do the amnio, couldn’t do an ultrasound, would find a C-section riskier, etc. None of that. Yes I’ve experienced Dr. prejudice since then, but never during my pregnancies or deliveries.

    It seems like doctors have all gotten stupider in the past couple decades (what do you mean you can’t examine me?) and have bought into the culture of fat-hatred as well. People kept telling me that the overly medicalized view of birth was getting better in hospitals, but I guess they aren’t fat. Shudder. I knew I’d never do it in a hospital again if I had to do it over – this just cements that.

  41. Mrs. Millur: So the fat girl couldn’t *possibly* not have gestational diabetes. (Ok, I’ll give him that one, since I had it with my last pregnancy, it’s close to 90% likely to develop again.)

    You may already be aware, but there is some controversy surrounding GD issues — for one thing, questions about whether for most women it constitutes a real disease at all.

  42. Well, speaking as a Brit who belongs to a surgery on the wonderful (yeah, right….I assume some of you have heard what they want to do re limiting treatment of fat people) NHS, I have had no anti-fat spiel at all from the doctors I’ve had. The last five years or so, I’ve been with a surgery where no doctor has ever weighed me or commented on my weight. The one before that, I was weighed once when I signed on there, was around 180-ish (which at 5’5 is definitely overweight and possibly bordering on obese, I can’t remember), but absolutely nothing was said about it.

    The odd thing is that this is in Norfolk, which now is one of the NHS trusts that’s telling obese folks they can’t have knee or hip surgery. Maybe I simply have been very, very lucky, I don’t know. They are pretty anal about testing blood sugar, but that’s everyone’s, fat or thin – although as I explained on another thread, they’re none too careful about how they do it (I almost had a post-breakfast glucose marked down as a high fasting result because nobody thought to ask beforehand).

    Some of my dealings with doctors in the past have been…well, dubious on the weight front. More later as I have a husband waiting to use to PC right now…

  43. The blood pressure cuff is my big bitch. My bp is consistently around 120/80, but I swear every time I go to a doctor the nurse will pump that sucker up to around 200, let it down super slow, and then pump the damn thing back up because he or she doesn’t believe the first reading.

    My other pet peeve is the knees and/or joints lecture. I tell them I’d rather end up with a blown-out knee than osteoporosis and a crumbling spine — which is what the skinny folks get.

  44. The first time I tried to get diagnosed with PCOS, I was 22, not on hormonal birth control, had thick facial hair and couldn’t lose weight for anything. I got the dildo cam and was informed that since I had no visible cysts I clearly did not have PCOS, eat less, move more, your fat is your own fault; that was it.

    So five years later, when I had been trying unsuccessfully to conceive, I went to a fertility doctor and when I walked in the room she knew I had PCOS. Unfortunately, she retired shortly after our visit, and I went to a doctor highly recommended by a coworker with PCOS.

    According to this doctor, if I eat 1200 calories a day, I would surely lose enough weight to get pregnant.

    So now I’m taking time off from trying to conceive. Instead I’m focusing on exercise and eating whole foods and trying every day not to fall back into disordered eating. I have an anxiety disorder and I’m pretty obsessive anyway — calorie counting sends me down a crazy spiral.

  45. I’d never heard of the Anti-Gym and I just went and read up on it…

    Please don’t publicize this too much. Paul from Big Fat Blog alerted us to a news story in which the gym owner revealed that he hires people to infiltrate blogs and bring this subject up so that people will get pissed, blog about it, and spread publicity for his site. He also hires people to protest at his events to get more publicity.

  46. Re: pregnancy and fat. There is also a lot of research out there that says losing any amount of weight before getting pregnant is actually detrimental to a healthy pregnancy. I’ll say it again – I was 230# when I got pregnant for my first and am somewhere around 265# with this one. Other than a fibroid, I have had no problems with either pregnancy. I had a very successful homebirth the first time, and will be having another this time. I also don’t gain much more than baby weight while pregnant, probably because I have enough reserves… and still had an almost 9# baby.

    Best of luck to everyone trying to get pregnant. It is difficult going through unsuccessful periods of trying to conceive, but when it happens, it’s amazing!

  47. Don’t worry fillyjonk – that was THEN and this is now. I still work out because I enjoy it – not because I feel I have to – and I still eat healthy because I like those foods – but I don’t do all that restricting anymore. I am learning to like myself and not try to be something I can never be (I’m 5’8 and 225 lbs and a very lovely size 18). The “fatosphere” – which I only discovered this week – is helping immensely. God bless you all! I thought I was alone here in super skinny, image-obsessed Manhattan.

    I have another nightmare doctor visit story – it had to do with an OB/GYN who only used paper gowns. They were all labeled “one size fits all”…. well not this “one”. I tried to put it on and it just ripped in half. I hopped up on the examining table buck-naked and when the doctor and nurse arrived – they told me to put the gown on. When I held it up the torn pieces and asked if they had anything larger – they said “no – we don’t have anything big enough for you” – so I did the exam totally naked. Actually – they were more embarrassed than me… but it was hard not to feel humiliated. It was my first and last visit to THAT doctor.

  48. Wow, this couldn’t have come at a more opportune time: we moved recently and I’m going to be looking for a new GP soon and it scares the living daylights out of me. In fact, I’m driving about an hour each way to pick up a prescription for my annual bloodwork, and then I’m going to have to do the same to get the results because at least I have a history with this office. I don’t even know how to get started finding a GP (or OBGYN) who is on board with HAES.

    I’ve learned through trial and error that a little preemptive polite assertiveness goes a long way towards establishing a good working relationship with a medical professional. Things like even before they get the BP cuff out, I just say “please get the large cuff”. Or if they pump it up too high, I say “please stop – that is hurting me”. It was hard to get started doing that because like many people, I was raised to see doctors as gods, but they’re not – they’re professionals I hire and I can fire them.

    I just wish I could get my mother to do the same. She does have many real health problems, and some of them are exacerbated by her size, but a lot of her weight is a symptom of forced immobility, not the cause of these problems. And she won’t tell her useless doctors to go to hell.

  49. Hi,
    I am a medical student that is nearly done with medical school. In a few months, I will be a doctor. What they say to your face is nothing compared to what they say behind your back. They do not all do it. But there are ones without the balls to say anything to your face and will do it behind your back. The OB nurses are probably the worst I have seen so far, which is really odd.

    I am obese. I am a big, strong woman. I try to call them on it as much as possible. I say, “You don’t know what she has been through. You don’t know this woman.” Or, “She might have just lost forty pounds!”

    Many doctors are assholes. But if you get an asshole for a doctor, REPORT HIM to the state licensing board. His/her behavior is unacceptable.

    I have had my depression, anxiety, insomnia, etc., blamed on my weight. It couldn’t be my abusive childhood right?

  50. themoreloving1, if that’s a reference to the Auden poem that we have a tie for most badass new username in this thread. (Except you might not be new, because I didn’t have to approve the comment, but I feel like I’d know if I’d seen that name before.)

    Another link I should add to the main post: Here’s First Do No Harm’s section on how to file a complaint.

  51. Can someone explain or point me to a link explaining the mechanism of taking a blood pressure reading? I got the big cuff for the first time at my last gyno visit and up until then I had no idea it even existed. How high do they need to pump the cuff to get a reading, and what is the benefit to docs or the detriment to a patient in pumping it up higher? (Well besides that it hurts, which in my deeply entrenched medicalized view of healthcare is totally okay – I mean isn’t it supposed to hurt to go to the doctor???)

  52. Rose (and everyone), I think the more stories like yours we get into the public consciousness, the better. It is definitely helpful.

  53. what is the benefit to docs or the detriment to a patient in pumping it up higher?

    I was state licensed as an EMT about a decade ago. To obtain a BP reading, you first have to pump it up really high to get the systolic arterial reading, which is the point at which you can first hear thumping. Then you let out the pressure slowly to the point when the sound disappears, which is the dystolic pressure.

    One of the reasons you may pump it up higher for some people is because it may difficult to obtain a reading on them. This can be for a number of reasons, including arterial thickness and size, or if the person is not rested or relaxed.

  54. i’m heartened that i see others with PCOS on this list. i was diagnosed a few years ago, but the treatment lapsed when i lost my health insurance and then moved. i’ve had a string of bad experiences with doctors (nothing truly horrific, but a steady stream of “just lose weight and it will go away” and shady diet advice ["a 20-year-old woman should be able to limit to 1200 calories a day while engaging in 45 minutes of strenuous exercise every morning. in the middle of the hottest summer in fifty years. no problem."]) and have very little faith in my new doctor, based on this history. she also hasn’t helped her case much in my first two visits.

    i’m terrified about what she’s going to say when i go in for a checkup next month. my overall cholesterol is fine, my blood pressure is fine (despite suffering from serious white coat syndrome), i generally exercise at least five days a week (racquetball, biking, and walking), i eat a lot of veggies, lean meat, and whole grains. but, my “bad” cholesterol is high (common in PCOS), i’m insulin resistant (common in PCOS), i have some family history of heart disease (but no diabetes), and my BMI is a shocking 46.6 (thanks to PCOS and 15 years of skillful dieting).

    she’s already mentioned that she wants to “help” me lower my BMI. This was followed by the “portion size” lecture, which I tried to cut off, and a declaration that i should not eat any dairy (“it makes you fat. i’ve seen too many women cut it out and lose a lot of weight to think otherwise.” i’m from wisconsin. i won’t live without dairy.). i also got an “you need to move more” mention.

    i’m not helping my case, as i stopped taking the prevacid she prescribed for me (the symptoms it was supposed to treat go away when i graze enough to keep my blood sugar stable and exercise regularly) and not taking the antidepressant at all after her office went through a bunch of hoops with my insurance company to get it approved.

    so, if any of y’all have advice on dealing with her so that i can get the care i deserve, i’d appreciate it. or if you have any suggestions on ways to treat/handle the PCOS, i’ll take those, too.

  55. OTM – I just recently learned how to take blood pressure. The pressure should only be done up to 160. A lot of things can cause blood pressure to be higher, something simple as just crossing your legs. A smaller cuff is going to put more pressure on the arm so it’s going to give a much higher reading. If the cuff can be loosely closed then it fits. High blood pressure is a strain on the body, so it’s important to maintain a lower blood pressure and constantly getting false readings may lead your doctor to put you on a medicine you don’t need as also having low pressure will strain the body.

    And just a heads up for people who are still afraid to go see doctors – they’re human. They don’t know everything in the universe, they will screw up, they will make wrong choices, they don’t have a complete understanding of every aspect of every part of the human body. It’s true that you can fire your doctor, but you might also consider him/her to be your coworker – work WITH your doctor, bring your own research and knowledge to the table, don’t take every thing the doctor says at face value. Demand that the doctor explain everything to you in detail. You don’t let a contracter into your house and say “Have at it!” – you demand to know what they’re doing and how they’re going to do it. If you want something done differently, say so. It’s YOUR body, you own it, you have a right to know the details about everything that’s being done to it.

    So always ask questions, always ask to have things explained to you. If you’re told to lose weight, ask why, ask for specifics. How will this help me? In what way is this related to my problem? If the doctor refuses or gives half-assed answers, demand to be seen by someone else.

  56. I just switched doctors because of weight/food related issues. To be fair, my previous doctor was not bad, and I was the one who asked why I seemed to be gaining weight endlessly without diet or exercise changes. So, we tested for a number of things, came up with hypothyroidism, we talked about diet…. but then he’d repeatedly bring up diet, not every time I went in, but often. Show me the food chart (wow, I’ve never seen that before! ), tell me to go on a 1200 calorie diet, etc. Meanwhile, I’m learning to deal with some compulsive eating issues (disordered eating, not an eating disorder), and going to see him generally triggered a major binge, just because I felt so ashamed. I started associating going to see him with the diet lecture, and putting off needed visits.

    I decided this year, I had to change doctors. So, I picked someone who shared an office with someone listed on the Fat-Friendly Physicians list. They actually run a weight clinic, which creeped me out at first, but I think it’s made them more sensitive to the fact that losing weight is nigh-to-impossible, and certainly not the simple “calories in, calories out” thing. Also, I think it’s made them more aware of what a sensitive issue this is. So, I asked not to be weighed, and gave the doctor a letter based off of Hanne Blank’s letter to her doctor. I was treated respectfully, and not given any lectures about diet or exercise. There was no post-doctor binging.

    I was actually really amazed that all I needed to do was say “I prefer not to be weighed” and “Here’s a letter about my health”…. I wish I’d done it years ago.

  57. Eight months ago I started having mysterious pelvic pain. First one doctor told me to start using Byetta, an injectible diabetic medication, for its appetite surpressant effect. I told him I did not eat excessively and so had no need for an appetite surpressant. The pain remained.

    I changed doctors. My new doctor then claimed that my pain had to be weight related back pain (even though it never changed, no matter what I was doing or not doing) and badgered me to go on Weight Watchers or Jenny Craig. The pain remained, and got worse.

    Finally I freaked out in the lobby of my OB/GYN, convinced that I had undiagnosed ovarian cancer and that nobody would ever believe me because I’m fat. To his great credit he took me seriously and scheduled me for surgery, which I had yesterday.

    I do not have cancer. I did, however, have one of the worst cases of endometriosis he’d ever seen. And guess what wouldn’t ever cure endometriosis? Goddamn WEIGHT WATCHERS.

    Thanks to the tips on “First do No Harm” I am going to lodge complaints against both of the doctors who poo-poohed my pain and did not bother to diagnose me as anything more than fat.

    On a side note, I was talking about the issue of size and medical care with a friend who’s an optometrist, explaining how so many of our doctors refuse to believe what we say about our own symptoms, or lifestyles. I said that if my doctor won’t believe me why should I even see her? My friend was shocked, and said that if our doctors don’t believe us then we’re receiving VETERINARY care, not medical care, and I thought DAMN, she’s right! It’s the ultimate dehumanization of fat patients, that we’re being treated as dumb (ie voiceless) animals, not self efficacious, individual, humans.

    Can you tell that I’m pissed off???

  58. said that if our doctors don’t believe us then we’re receiving VETERINARY care, not medical care

    Oh wow. That’s a bucket of cold water to the face, isn’t it?

  59. Oh, hell. My vet is much, much better than any of the doctors I’ve dealt with. He calls the same day with test results and will make house calls.

  60. When I held it up the torn pieces and asked if they had anything larger – they said “no – we don’t have anything big enough for you” – so I did the exam totally naked. Actually – they were more embarrassed than me… but it was hard not to feel humiliated.

    I haven’t worn those things for years. What are they going to do, decline you care if you don’t wear the stupid paper gown? I’ve never had anyone say a word about it (and if they did, I’d have something to say back to them.) If you take care to wear loose-fitting clothes, they can do anything they need to in a general exam. When I get gyn exams, I keep my regular shirt on and ask for a towel to cover my lap.

  61. fillyjonk, it is a reference to the Auden poem. I adore the last four lines. I am fairly new here- I posted just once, earlier this week.

  62. Linda, thanks for the plus-size pregnancy link. Will have to check it out.

    A thin friend of mine who just had a baby recommended pregnancy.org for their forums and general info. I checked that site out, and, while it still toes the party line about obesity being bad for you, it nonetheless had a lot of great resources and information for fat women. FWIW.

  63. Linda- thanks for that link. I hadn’t really done my research. That gives me some hope that despite my high-risk status, a good, fat-positive midwife might still take me on.

  64. I have several bad experiences, but nothing too horrible (though I’ll admit they add up and I avoid going to the doctor until I’m absolutely at my last straw because I just assume they won’t take me seriously). The most annoying one, however, was a gynecologist. I’d gone to him because my regular GYN wanted to do a test to find out why I was having such severe pain during my period, but it required general anesthesia and my insurance wouldn’t cover the hospital she worked at. It took me a while to find a GYN who would take a new patient, even if just for one procedure, and who my insurance covered, but I finally found one.

    I arrived at his office and they weighed me and took my vitals. He then walked into the room, and before introducing himself or asking why I was there or anything else, he said, “Have you considered weight loss surgery?” Seriously?! You don’t even start with, “Hello, I’m doctor X”?! (I’d name him and warn people away, but I’ve long since forgotten his name.)

    When we finally left the topic of weight loss surgery and he finally asked why I was there, he then looked at what my doctor sent over (examination details and ultrasound results) and refused to do the procedure because, as far as he was concerned (having never examined me or asked me anything or, well, anything) my problems were all related to my weight. Yeah, he was a real winner.

  65. Once upon a time I would have said that I’ve had relatively few bad experiences with doctors, but after reading this article I realize that isn’t true. It’s been a long time since I’ve had a doctor be mean about my weight, but I now believe I’ve received substandard care because of it. I am certainly one of those people who never goes to the gyno, and I really ought to. I believe that I have painful fibroids and possibly endometriosis, and I have been suffering for years. But every time I went to the gyno, I was told that they couldn’t do extensive exams because of my weight. They need to do ultrasounds to confirm the existence of fibroids, and the ultrasound technicians always tell me they can’t see anything because I’m too fat. They also tell me they can’t use a camera because I’m too fat. After going through this again last year I just haven’t gone back. I just assume they’re telling the truth, and I’m too fat for the ultrasound, how would I know otherwise?

  66. Definitive, ask for a transvaginal ultrasound. It isn’t the most dignified of procedures, but it will get the job done, and nobody can claim that the inside of your vagina is too fat for them to see your organs!

    There are good OB/GYNs out there, like mine, but it can be a hell of an ordeal finding one. Don’t give up. You owe it to yourself to get the care you deserve.

  67. It took me years to get a diagnosis for PCOS and when they finally removed the cysts, the OB/GYN happened to notice a metric fuckload of endometriosis as well. What, you mean screaming agony isn’t normal and completely deserved?

    Every time I think of all the doctors who told me to “just lose weight” as if that were a quick and easy magic cure-all, I want to spit nails. At doctors.

  68. When I get gyn exams, I keep my regular shirt on and ask for a towel to cover my lap.

    What a good idea! I’ve got some wonderfully big shirts, too, that wouldn’t get in the way of anything. Flannel ones, even, and damn, I am so *tired* of the chill in exam rooms. I mean, those paper coats are inadequate by any measure, and what with my arthritis, my joints always ache and gel up in the cold. Because, despite all claims to the contrary, fat is not that insulative … though I have discovered I can warm my hands beneath my boobs if need be.

  69. definitive.dot, it’s true that fat gets in the way of a regular ultrasound, but a transvaginal ultrasound works no matter how fat you are. It’s kind of unpleasant – you’re getting, um, violated by a probe – but it’s not painful (at least it wasn’t for me) and it produces as clear pictures as an ultrasound can.

  70. Definitive – this is what my last post was about. Ask them how you’re too fat. Have them explain how the procedure would go and at what point your fat would be hindering the process. You don’t have to understand everything about ultrasound, bad logic is very easy to spot.

    By the way, fat is squishy, there should be nothing stopping them from pushing if it’s truly that much in the way. If they continue to insist on it, point out that they must simply really suck at their job and ask to see a more skilled technician.

  71. I’m just going to say that I didn’t come equipped with the standard issue plumbing for a woman, so maybe I’m missing something here… but what exactly makes weight the likely culprit for these kinds of pain, anyway? Are ovaries load-bearing? Does the vagina act as some kind of keystone that holds up everything above it?

  72. problematic, yuck about the dairy thing. My doctor told me I should go to the weight loss program in the mall because “a lot of people do really well on it.” I realize now this probably meant “I have one patient who went there after I badgered her to and she lost some weight, not that she has been at it long enough to know whether she will keep it off.” Doctors seem to love to make unsubstantiated statements about what works for “lots” of people. What, your doctor did a controlled study and found that numerous patients of hers cut out dairy completely (I don’t even believe that more than a few people did that unless they were allergic to it) and lost a lot of weight and kept it off? Uh-uh. More likely it’s “I kind of think you shouldn’t eat dairy because I feel persuaded by those arguments about how it’s only for baby cows, and cheese has all that fat and stuff.” But since she’s a doctor, she’s probably used to making strongly-worded pronouncements of her opinion and having people accept them as fact.

  73. I have chronic lower back pain…A few years ago, when it started to get really bad, I saw a few doctors. At the time, I was what you would consider “obese” by BMI. The Drs I saw never had any real treatment options for me – some mild physical therapy, talk about how it was likely a slipped disc and I should try to get more exercise – no real discussion about weight, but just a very unhelpful attitude. Then I got diagnosed with PCOS/hypothyroidism, started taking meds for both, and lost 40lbs (due to meds). Went back to the Dr for back pain and all of a sudden everyone was very helpful – MRIs and talk about how I was “too young to have to deal with this sort of pain” and all sorts of treatment suggestions. Before I lost the weight, I never thought Drs were treating me differently because of my size. Now, I see the difference in their attitude and willingness to try and correctly diagnose me, even for simple things like allergies. I hate that this is happening to everyone.

  74. I had horrible experiences trying to get my hypothyroidism diagnosed. I had developed a goiter and went to see my primary care doctor who did a blood draw. The blood test came back and she told me it was normal and that I was just depressed and gaining weight. I pointed out to her that I had a fucking goiter and the depression and weight gain started around the same time and all she would say is that my blood tests came back fine.

    Fast forward about three years. I still had the goiter and one day, I got a fever and my neck started swelling like crazy. After years of being told not to worry about it, I went back to my doctor who didn’t have a clue what was going on and sent me to a surgeon. The surgeon didn’t know what was happening either and got me in for a partial thyroidectomy. The surgery went well, no cancer or anything.

    After surgery, I started feeling worse and worse. I was cold all the time, losing my hair and eyelashes, my memory was terrible, I was confused all the time, depressed, and very, very, tired. I went to my doc again and she again did a blood draw and later told me my “numbers were fine.” I felt like every time I hit rock bottom, I’d fall a little farther and hit rock bottom again. I sit at work and not be able to remember what I was supposed to do after doing that same job for three years.

    My doctor checked me for diabetes, had me go for a sleep study, and sent me to and endocrinologist. The endocrinologist said my numbers were fine and accused me of being fat and depressed, a hypocondriac, a manipulator, and said my mom was enabling me by listening to my crazy stories.

    Finally, I had had it. I felt so horrible all the time, I was almost wishing to die. I couldn’t imagine that this is how I would feel forever because no one would listen to me. I bought several books on thyroid disorders and started putting together my research. It just so happened that I had to go see my regular doc during this time and the day before I went in, she had a patient come in for a thyroid prescription refill while her doc was on vacation. She demanded her medicine even though her numbers were “fine” and had my doc call her endocrinologist. Apparently, this endocrinologist got it through my doctor’s head that some patients have hypothyroidism even though their numbers are “fine.” Not everyone is healthy within the medically determined “healthy range.” When I went in the next day, my doc put me on medication.

    After getting my medication, it took a couple months before I started feeling better. Even so, every time I went to see my doctor, I got a lecture about how I needed to exercise and lose weight. One time she even told me, “you look bigger than the last time I saw you” as soon as I walked in. At the time, I was exercising more than I ever had in my life and was feeling fantastic.

    Let’s just say I don’t see that doctor anymore. I now have a naturopath I adore!!

  75. Being a youngster, I’ve been lucky. I went to the same pediatricians from birth up till graduating college. They knew that I was a fat kid and didn’t hammer too hard on me being fat as I got older; I think they also were just kind people who didn’t think shaming me would help. (My parents also helped by being very outspoken – and having a fat but healthy dad probably helped too.)

    In college I mostly went to health services, where they were more interested in getting me out the door as quickly as possible than in assessing my total health. The only bad experience I’ve had was with the GYN this year at my university’s health services (grad school) – she said she couldn’t do the exam properly given my size. Which, my old GYN never told me that, so whatever, dude. I probably won’t see her again given the rotating nature of health services.

    (PS : still the same Nomie, now shamelessly linking my fledgling FA blog!)

  76. Can someone explain or point me to a link explaining the mechanism of taking a blood pressure reading? I got the big cuff for the first time at my last gyno visit and up until then I had no idea it even existed. How high do they need to pump the cuff to get a reading, and what is the benefit to docs or the detriment to a patient in pumping it up higher? (Well besides that it hurts

    As mentioned, they need to pump it above the systolic reading initially. Some practitioners will pump the cuff far above normal. This may be convenient in that if the patient turns out to have high blood pressure, they don’t have to re-do the reading since it’s already high enough. However, pumping a BP cuff too high can hurt quite a bit, and pain is – you guessed it – one of the things that can spike a blood pressure reading temporarily. Many practitioners also, when they see a fat patient, assume the BP must be high and therefore overpump the cuff, something of a self-fulfilling prophecy.

    Other things that can cause false high readings:
    – Using a too-small cuff
    – Failing to allow the patient to sit still and relax for 2-3 minutes before starting the reading
    – Emotional stress (such as arguing with or insulting the patient just before or during the BP reading)
    – Putting the patient’s arm lower than the heart.
    (I’ve had practitioners do all these things to me during a BP reading. Sigh.)

    This page is a good starting point for some of these issues.

  77. Jen from Ft. Myers: My mom lives in the same part of the state as you, and she complains constantly about the poor quality of health care there. She’s a size 4, and she’s had multiple run-ins with idiotic practitioners. It’s not just you, if that makes you feel any better.

    I can’t recommend the Fat Friendly Practitioners list enough, for those of you who are fortunate enough to live in the areas it covers. But even when I’ve gone outside it, I guess I’ve been fortunate not to encounter too much weight-related abuse. I did have one doctor who should have known better (and was otherwise wonderful) attribute my low back issues to meralgia paresthetica, which is a nerve damage issue widely (har) attributed to fat, but I later saw a chiropractic neurologist who poo-poohed that diagnosis, saying that I probably did not have MP if my symptoms improved with standing and walking or lying on the side where I was experiencing the numbness.

    The only doctor I have ever seen who “prescribed” weight loss was the endocrinologist who first diagnosed my PCOS. And even she did not prescribe the usual “eat less, exercise more” blather; she said, “You have a metabolic disorder, and you need to come to my off-label drug clinic to try and treat it. You’re not going to be able to lose that much otherwise.” (Since this “clinic” was something not covered by my insurance, and it was all kinds of expensive and felt weird besides, I didn’t go.)

    Everyone else I’ve seen has understood about the combination of PCOS and psych meds making me fat and has not given me rations of shit about it. And this is in 7 different West Coast and southwestern cities. I may not have had too much luck in my life overall, but this is one area that seems to be an exception.

  78. Whew. All these horror stories!

    What happened to me sounds pretty mild by comparison, but anyway…

    Back during my first marriage, I had one doctor who claimed that falling asleep at work ‘and overeating’ (which I hadn’t mentioned, incidentally) meant I couldn’t be depressed – everyone knew depressed people lose their appetite and can’t sleep, right? A barrage of tests found nothing physically wrong, but I got the impression that, come hell or high water, this guy wanted to find something weight-related up with me. Preferably, since I also had unresolvable urinary issues, diabetes. (I could have told him exactly where all those cystitis attacks stemmed from – they were ‘miraculously’ cured when I separated from my ex – but nobody ever thought to ask about that, and I was too scared to bring it up myself.)

    Years later, my current doctor – who actually diagnosed me for the first time during what I think, looking back, has been about my third encounter with the Black Dog – nodded sagely when I recounted this incident and said, yes, depression often manifests in exactly that way. I’m a more assertive person now than I was then anyway, but when your brain is in that state the last thing you’re ready to do is argue with a medical professional.

  79. and nobody can claim that the inside of your vagina is too fat for them to see your organs!

    They can damn sure claim it’s too fat to do a pap smear.

    After my first knee injury, my doctor told me I should lose weight to take pressure off the knee (which is actually not unreasonable, because a knee is a weight-bearing joint). But he ALSO told me to increase my fat and protein intake to promote healing.

    Fat and protein are used to build new tissue, you can’t heal without it. Also, anyone who is deficient may lose weight when they increase fat and protein. Fat and malnutrition are not mutually exclusive.

    I think anyone who is trying to get pregnant should also increase the fat and protein in their diet. You are trying to grow new ’tissue,’ also.

  80. Kelly, I have lower back pain too, and I’m afraid to go to the doctor about it. I went once when it was acute (before the chronic stuff started, actually), and the doctor gave me some exercises to do and told me to lose weight.

    When the acute popped up again my my boyfriend practically had to threaten to break up with me before I went to see the doctor. My RNP (who I like a lot, actually, and has never given me crap about my weight) gave me a prescription for Valium (as a muscle relaxer, and I really wish I still had some left) and sent me to a chiropractor. I go every month now, which seems to be keeping me from throwing my back out again, but I’ve had this chronic pain for over three years now and it’s not getting better. My shrink thinks I should ask for an x-ray, but I don’t want to get into it with my RNP because even if she’s supportive the x-ray people might not be, and what if I end up having to see someone else?

    Seriously, I’m kind of messed up about it. I believe in FA but I can’t wrap my mind around trying to convince other people that my back pain might not be attributable to my fat. And I’m not convinced it’s not the weight of my belly pulling my spine out of place.

    It’s a long, hard road, isn’t it?

  81. It is interesting to see all of the PCOS diagnoses around. I was finally diagnosed last year by a normally wonderful endocrinologist who told me all my other dr’s were idiots. Apparently, it is not just the levels, but the ratios of the levels to each other. While my blood work always came back normal, when she compared ratios, things were really wonky. We are making progress in working on getting things treated and finding out the source of the PCOS (mine is apparently in the adrenal gland.)

    She fell quite a bit in my esteem this last visit, though. She came in and we were chatting and she asked what I had done over the holidays. I kind of shrugged and said spent time with my boys. She came back with “I will tellyou what you were doing, eating! You have gained 5 pounds since I last saw you 2 1/2 months ago.”
    I looked at here and my jaw dropped. I asked her quietly if she remembered why I came to her in the first place. I had not changed my diet or activity level in the last 4 years. For 2 years I lost 60 lbs (and lost my gall bladder during the process from rapid weight loss) then it all came back + some.
    I told her I had been sick off and on over the holidays and ended up barely eating during the “big meals” and otherwise my diet hadn’t changed. She had the grace to look abashed.

  82. Seeing everyone talk about their diagnoses of PCOS, I’m actually envious. My doctors didn’t do anything beyond telling me to lose weight — one prescribed metformin but it made me constantly nauseated so I stopped taking it.

    I am trying to get used to the fact that I might never have a child.

  83. Robotitron, I saw your earlier post and thought “wow, that sounds like my story.” i got put on metformin and BC by one doctor (who also said to lose weight). my period started back up, but no magic weight loss (which was sort of implied). since then, nothing. nada. minimal treatment. i have had a hard time convincing the three doctors since that i had PCOS (despite looking like a poster child for it). most of what i know about it comes from doing research on my own (thank god for working at a research university).

    even with all of that, i’m terrified of getting diabetes (the thought of which had me running around in a panic for most of yesterday) and of just dropping dead. from teh fat. and, even though i don’t want kids, it would be comforting to know that i have the option if i change my mind.

    so, you’re so not alone in that boat. *hug*

    while i’m thinking about it, any of you PCOS/insulin resistant folks know if there’s anything to this “insulin resistance wears out your pancreas so you’ll become diabetic” thing i keep seeing?

  84. Rachel, you were an EMT? Wow! Is there anything you can’t do?

    Sadly, I have yet to master the art of rubbing my tummy and patting my head at the same time.

  85. Reading through all of these stories, and those at FDNM, I want to go hurt someone, bad. It’s been a long time since I had to deal with any overt fat-hate with the medical establishment, but I think that has something to do with the “do NOT eff around with me, or I will cut you” vibe I seem to give off without even trying.

    But one time, when I was an undergrad, I was having horrible pain in my left knee. I’m 5’9″ and at the time weighed around 180 (that was about 100 pounds ago, and I thought I was the fattiest fatty who ever fatted). I was working out five or six days a week on top of walking all over campus. So, I was pretty stinkin’ active and healthy. I went to Health Services because I could barely walk and was concerned that I’d torn something.

    I was seen by a male nurse practitioner, and after I explained my symptoms, he told me I was too heavy and that of course my knee would hurt, given how fat I was. He hadn’t even examined my knee! I pointed that out and he started to examine – the *wrong* knee. Eventually, he handed me a pull-on ace wrap to wear, but when I said that it was too small, he said that was too bad, because that was all I was getting from him. I went back to my dorm room and collapsed in sobs.

    My roommate was so thoroughly pissed on my behalf she called to complain, but no one would talk to her (this was pre-HIPAA, BTW). It was so bad that my mom ended up, with my permission, talking to and thoroughly chewing out the Director of Health Services, who then saw me herself and diagnosed bursitis from *over* exercising. I was on crutches and out of the gym for three weeks. I was told that the NP who was so horrible to me would be “dealt with”, but who knows what really happened.

  86. when i was 21 and just 115 lbs, the doctor who performed my abortion said, “well, at least you’re not fat.” he complained that it was harder to insert the instruments if the patient was fat.

    i’m sure he meant it as a compliment, but hearing that — during the procedure! — seemed incredibly insensitive and judgmental. as i’ve aged and gained weight, that comment pops into my head frequently. that was almost 15 years ago: which is a testament to how powerfully shame lingers, and how long some doctors have been anti-fat.

  87. Eve,

    I just want to give you a great, big, hug. I know that words from a stranger on the internet can hardly be expected to change a lifetime of hurt and insecurity, but if they make any dent at all I would like to tell you this: you are worth taking care of. I know there are a lot of horror stories out there, and that it can be frightening as fuck to go out there and fight for yourself, but I hope you will try. You don’t deserve this kind of pain and I’m highly doubt that you did anything at all to cause this pain.

    If you trust your RNP, tell them that what your situation really is, and that you want to figure out the root cause to see if it can be remedied. Bring your boyfriend or a supportive friend with you, and tell them ahead of time that if anyone suggests the diagnosis of fat, and you get flustered, that they will have to speak up for you until you regain your words. And if anyone giving you an X-ray gave you trouble I would suggest pulling a quarter out of your pocket, giving it to them, and telling them to call someone who gives a shit about their opinion.

    I know this is all easier said than done, but I hope you’ll give it a whirl. We only get so much time on this earth, and you shouldn’t have to spend another minute in pain.

    You are in my thoughts!

  88. The worst part is when doctors assume you have PCOS. My doctors pushed PCOS treatments on me for years without bothering to actually look for it. I got a new doctor who ran the right tests, and it turns out I don’t have PCOS at all.

  89. I am wondering if I have hypothyroidism – my mother has the genetic form. I have been constantly cold, constipated, losing hair and very fatigued the past few months. I am afraid to bring it up, because I think the doctor will just say it is because I am fat.

  90. themoreloving1, I have Hashimoto’s myself. (My immune system is attacking my thyroid.) Those are classic symptoms; make your doctor run TSH, T3, and T4 blood tests. They’re easy to do.

  91. I also have hypothyroidism and it does have a correlation to weight – only it often causes weight gain, not the other way around. If you think your doctor might say this, maybe it’s time to shop around and get a new doctor.

  92. eli, I think it’s incredibly unprofessional of a doctor to say something like that – either to a fat patient or a thin one. It doesn’t even sound like he was complimenting you or anything – “at least” always sounds like “You’re not a treat to work with, but it could be worse”.

    I think doctors should accept that in their job, they will inevitably run into varieties of body types. And learn to deal with it.

  93. It’s been really interesting reading all these comments. I’ve had so many horrific experiences with medical professionals that I literally get nauseous whenever I have to go to the doctor. The process and resulting anxiety of finding a new one when I moved nearly put me in the ground.

    I’m purposefully not writing about the month I spent in the eating disorder clinic or the numerous other doctors I’ve dealt with because it’s really not worth my getting that upset about.

    But here is a perfect example of why I can’t stand going to the doctor. I actually had an appointment this afternoon and wasn’t nervous or anything because my doctor is normally fantastic. But the second I was called back, things went south very quickly. The nurse who took me back wouldn’t take no for an answer when I said I didn’t want to be weighed and very snippily said that she was only doing her job. When I got to the room, I knew my blood pressure was through the roof (hello, anxiety much) and I had to force her not to take it. Then she got worse, “well, the doctor isn’t going to see you if I don’t have your stats.”

    The whole look in her eyes was ‘you fat disgusting cow.’

    After she finally left, I could hear her through the door talking about me to another nurse, saying stuff like “she’s so fat” and “she’s just a heartbeat away from diabetes. I bet she’s already diabetic.”

    Any question of why I can’t stand going to the doctor was just answered right there.

    Thankfully, my actual doctor is great, didn’t even mention the no weight/BP/other shit and went off again of how there was no way in hell he’d ever be able to do what I do and how my numbers are better than his.

    I wasn’t in the mood to complain about little miss priss, so I just left. Everyone else on staff there is great, including the other nurses. But if she pulls that shit again, her job will be mine.

  94. Bring your boyfriend or a supportive friend with you, and tell them ahead of time that if anyone suggests the diagnosis of fat, and you get flustered, that they will have to speak up for you until you regain your words.

    This is helpful even if your SO or what-have-you doesn’t speak up for you. Or, so I’ve found — just having my husband there with me has resulted in consistently more courteous and patient treatment, right out of the gate. He doesn’t even look threatening, either, so I think it’s just the fact someone’s there as potential advocate and witness that does the trick.

  95. definitive – I can tell you, from personal experience last week, that they can do ultrasounds on fat women and see your uterus and ovaires, etc just fine. I had to have an ultrasound last week for post-menopausal bleeding. The tech did the ultrasound on my belly, and then the trans-vaginal one with no problems at all (and I weigh 377 lbs at 5′ 8″). So anyone who tells you they can’t do it is full of shit. I still don’t have an answer on why I had the bleeding, I have to see a gyno next week for an endometrial biopsy (my pcp couldn’t do it, she said I have cervical stenosis and she just couldn’t get the sample she needed). So it is possible to get good ultrasound results, even if you are fat, you just need a good tech (and the one I had was awesome, she explained everything she was doing, why she was doing it, and turned the monitor so I could see too).

  96. I live in Canada….I had pretty crappy experiences when I was younger, where health problems were automatically blamed on my weight and/or I was always being told to lose weight. I didn’t get a diagnosis for exercise-induced asthma till I was 30 – before that, everybody, including my docs, thought I was gasping during running because I was fat. And then when I was 17, seeing a new doc to get the pill – after having dieted and aerobicized 55 lbs off myself, down to a size 16 (to date, my smallest size) – the doc said, casually, “You could lose some weight.” I wanted to hit him. He was nonplussed when I told him what I had already done; he just said, “You lost 55 pounds? On your own?”

    I think things are improving, or else I’m much better at advocating for myself now – I’m very upfront at the get-go with everyone that I used to be bulimic, and I don’t want to know my weight, and I don’t want to hear the diet talk. Though actually, I live in a university town, and I know from my time working in a women’s organization that the local nursing program is very involved in Eating Disorder Awareness Week, promoting healthy body image, and all that. When I was in the hospital this time last year, near death’s door, I found all the nurses were absolutely wonderful to me, and so amazingly hard-working – I actually sent them a thank you card afterwards. And my specialist, in trying to discuss the choices of treatment options (I was about 18 lbs too heavy for one of the machines), just basically said, “Listen, I’m overweight, you’re overweight, and this is the issue,” trying to emphasize that his concerns weren’t about how much I weighed. Ditto most of the other health professionals I’ve dealt with lately – they’ve been really great, and my weight has never been an issue.

    Well, okay, I did have some issues with my new Ob/Gyn, when he said he wanted to test my insulin levels to find out if I had PCOS. (I do.) I brought up the eating disorder issue, said I was very adamant that no matter what, I was done with dieting, and I also emphasized that I didn’t want this to be the automatic go-to diagnosis just because I’m fat. And he seemed to get most of it, but when I got the diagnosis and he put me on glucophage (metformin) for treatment, he said, “Once you start taking this, it’ll reduce your hunger levels so you’ll want to eat less, and then you’ll start losing weight and you’ll feel physically better.” I didn’t really have a response to his comment, but it still pisses me off a bit, because after all that, his assumption was that I ate a lot and that I must somehow feel physically like crap, you know? (Nevermind that I was first sent to him because I was anemic and it was thought to be related to my periods, not because I was feeling crappy.)

  97. Rachel — that is a huge pet peeve of mine. I’ve got both hypothyroid and PCOS, and have been told that I’d have neither if I were thin. Soooo wrong. Both cause weight gain. So many doctors and so much of the media is either uninformed or unenlightened on that one.

  98. Rachel — that is a huge pet peeve of mine. I’ve got both hypothyroid and PCOS, and have been told that I’d have neither if I were thin. Soooo wrong.

    Me too. Apparently, I made myself fat, which made me get PCOS and ruined my metabolism. The fact that I was 60 pounds lighter, dieting, and exercising an hour a day when I first started to feel the PCOS symptoms doesn’t matter, because Earth logic doesn’t apply to Teh Fat.

  99. I couldn’t deal with a GYN who couldn’t differentiate between the homonyms “loose” and “lose” and just disdained singular and plural (Eat more vegetable? WTF??).

    I think I’d have to call him/her up and make fun of him/her, and then say “Now why am I supposed to take your advice again?!?”

    Eeesh. Do Not Want.

  100. Eight months ago I started having mysterious pelvic pain. …
    [descriptions of doctors doing nothing to find or treat the pain]

    I did, however, have one of the worst cases of endometriosis he’d ever seen.

    I have a similar tale (and I am so, so sorry you went through that), and although no one ever directly said it must be due to weight, four different doctors over eight years did absolutely nothing helpful: “It’s probably stress, just relax.” “Maybe it’s bad gas, or a reaction to something you ate.” “It might be your gallbladder, don’t eat fried foods.” And it might have gone on that way if I hadn’t by chance had a horrifically painful experience with one of the ovarian cysts from the endo right before I saw a new doctor two years ago. That she was a doctor who actually took time to listen to me talk about my overall health and habits undoubtedly had something to do with her taking me seriously about it and sending me for an ultrasound.

    I’ll note that at our initial appointment, when we talked about the things I wanted to focus on, I pre-empted any weight or diet talk by saying, “I know that I’m overweight. I don’t consider it to be an issue and I will not be actively trying to lose it. I eat a good, varied vegetarian diet and I know what foods work for me. I am not as healthy as I could be [which was true at the time], I don’t exercise enough, and I would rather focus on that, on my endurance and strength and flexibility.” She said, “Okay then. We’ll work with that. What kind of exercise do you enjoy?” Not a single word since about weight or size, only about health. (And the surgeon who removed my cysts and confirmed the endo was awesome in every way, and fatter than I am. No weight talk from her.)

    I’ve only ever had one specific mention of my weight, which was after I got a small tear in a meniscus (the cartilage in the sides of the knee); the ARNP who checked me out said, “This isn’t uncommon in women as they get older and gain weight.” It wasn’t said in a way that seemed demeaning, and nothing was said about me losing weight, so I think it was observational, not critical.

    There is one instance where I wish the doctors would have talked about weight, which is when Zoloft put 50 lbs. on me in less than a year. Nobody even told me that was a side effect until I’d already gained it or even questioned why I was putting on weight so rapidly; and when I did finally learn about it, my therapist just shrugged and said, “You could have kept it off with more exercise.” Since I didn’t really exercise to speak of at the time, I didn’t take issue with the comment at the time, but in hindsight the entire situation really annoys me.

    And who knows if I’ve been getting substandard care because I’m fat without it ever being thrown in my face. All those doctors who couldn’t find my endo might have just been assuming it was because I’m fat. My mother has Hashimoto’s, and I have been trying to find out if I have a thyroid disorder as well, but my symptoms are not entirely conclusive and they consistently tell me I’m “in normal range,” even though most of us know now that “normal” is too high for many people–maybe they’re just assuming I’m looking for an excuse for my fat. Maybe being fat is why nobody took my pelvic pain seriously. I don’t suppose that I’ll ever know for sure.

  101. fatgirlonabike, that’s horrible. I’m glad the doctor has more sense than the nurses, but I’m so sorry you had to hear that horrible stuff. I’ve had a couple experiences with that except in my case it was because I was in a wheelchair with an undiagnosed, very serious illness (long story) and the nurse yelled at me because I wasn’t exercising instead of sitting in a wheelchair and “giving up.” I deteriorated and nearly died some time later, and the doctors were pretty surprised I managed to stay alive, much less get around in a wheelchair. Sometimes nurses can be horrific. I hope you find the courage to bring it to his attention – there was no excuse for what they said.

    At my Dr’s office the nurses are really wonderful. They actually don’t bother asking me to get on the scale (not that I ever refused or that they’ve ever made a comment about it at all). He’s satisfied so long as my blood pressure stays good and I let him take blood occasionally (every year or so.) In other words, what my *health* is, not what my weight is. If there’s ever an actual need to weigh me, he’ll tell me why. I’m sure he wouldn’t hesitate if I ever asked him to help me lose weight, but why would I do that? Hehe.

  102. while i’m thinking about it, any of you PCOS/insulin resistant folks know if there’s anything to this “insulin resistance wears out your pancreas so you’ll become
    diabetic” thing i keep seeing?

    Your pancreas wears out only if you have a genetic defect. IOW, does diabetes run in your family? If you don’t have a defect that affects your pancreas you can be PCOS, resistant, fat and growing fatter, etc. and your pancreas will keep making new ß-cells to keep insulin production up. From:
    http://www.phlaunt.com/diabetes/14046621.php
    “Some people with type 2 diabetes appear to have a defect which makes their beta-cells die when they attempt to reproduce in response to a need for more insulin. For these people, insulin resistance can cause the beta-cells to try to divide and then die, hastening on the degenerative process.
    It is also possible that some people who develop type 2 diabetes have a genetic defect which prevents their beta-cells from storing insulin though their beta-cells are still capable of secreting it.
    Scientists have discovered dozens of different genetic defects which cause beta-cells to fail or die in humans and animals. ”

    High levels of insulin increase insulin resistance so you can reduce the resistance by reducing the need for insulin. Metformin can do this, but also reducing or rationing carb (spread evenly over the day so you never have much at
    once) can help a lot.
    You can gauge the results of your efforts to reduce resistance by dividing your fasting triglycerides by your HDL. Usually, the lower the number, the lower the resistance.
    ex. my ratio went from 138/48=2.8 to 77/54=1.42 in a few weeks just from metformin and reducing carbs. (No other restrictions and no excess hunger at all.) Losing a substantial amount of weight after that has not changed that ratio significantly (80/55=1.45) People with no insulin resistance often have a ratio under 1.

    To reduce insulin resistance and blood sugar if you are already having postprandial glucose excursions, try:
    http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

  103. “I have had my depression, anxiety, insomnia, etc., blamed on my weight. It couldn’t be my abusive childhood right?”

    I had to laugh at this (although your past is no laughing matter), because I’ve been ‘diagnosed’ with depression from a primary care physician SOLEY based on my weight. He tried to push anti-depressants on me, telling me that when I wasn’t depressed anymore, I’d lose weight. Because we all know that a common side effect of many anti-depressants ISN’T gaining weight right?

    The really ‘funny’ thing about this is that I also have issues stemming from childhood abuse, and am seeing a clinical psychologist. He and I together have both agreed that, at this stage in my healing, I do NOT need pills. I told the PCP this (many times) and yet he STILL kept trying to push pills on me.

    I finally stopped going to see him because I was tired of hearing him say in one breath that he didn’t believe in prescribing medicines for no reason (the reason he was denying me the metformin I *DO* need) and yet pushing anti-depressants that the expert I’m seeing for my issues says I don’t need.

    Yeah. He SO doesn’t believe in prescribing unnecessary pills huh? *rolls eyes*

  104. For the most part I’ve had fairly good doctors in my life, although I can’t recommend them, because oddly enough, they’ve all quit their practices.

  105. Pingback: Poor Treatment « Heavy Thoughts

  106. I’m the Deborah from before – figured i’d add the M so it would be easier to differentiate me from Deborah Lipp. Been reading for a while but only started posting recently.

    “while i’m thinking about it, any of you PCOS/insulin resistant folks know if there’s anything to this “insulin resistance wears out your pancreas so you’ll become diabetic” thing i keep seeing?”

    from what i understand, insulin resistance is one step along the path to full-blown diabetes, ie it’s a related condition but not as severe – however, it is also possible to stay insulin resistant your entire life without actually developing diabetes.

    i’m 100% sure i’m insulin resistant, although i’m not diabetic. this because of the way my body reacts to carbs and sugar; constant hunger and cravings and total lack of satiety when i eat them. i have never actually been diagnosed with insulin resistance – never had that full blood sugar test. i discovered all this on my own (because of aforementioned fear of doctors). i’ve also never been diagnosed with PCOS but i do strongly suspect i have it – my sister has it, a cousin has it, and of course my own weight gain right around puberty, together with the insulin resistance and hirsutism point to it too. by the time i got to around 250lbs in my early twenties (after a bout of low-fat dieting – i’m sure if i’d never screwed my metabolism doing that i’d never have gone over the 180lbs i was as a teenager) my periods went from regular to very irregular and light. i didn’t go to the doctor about it – as i said before, i avoided the doctor as much as i could. i’d never heard of PCOS at that time and i naively thought that maybe the period changes were due to the chronic fatigue i had even though my periods remained irregular and light for years after i recovered from the chronic fatigue.

    a friend originally told me about PCOS, because she had it (this was years before my sister’s diagnosis), and when i researched it (what i would have done without the internet, i don’t know) it was like a lightbulb going on. it was the first time i thought “wow, there really might be a medical reason why i’m fat *and* hairy *and* have dark patches of skin on my neck and other places – acanthosis nigricans, which is also related to hyperinsulinemia which is related to PCOS. it was almost a relief to discover that. Because of the link between PCOS and hyperinsulinemia I read that eating lower-carb is recommended. So i started eating less carbs, and restricting any complex carbs/sugars to once a day.

    Within a month my period went back to normal, after years of being irregular. This was nothing to do with losing weight – I was still at least 230lbs but now my period was normal. Having continued to focus the majority of my eating as low carb for 6 years now, my acanthosis nigricans is also gone, and my period is still normal. I have lost weight, too – but my focus here is health, not weight loss. My triglycerides are a third of what they were. Cholesterol and blood sugar and everything else you find in regular blood tests is normal – although as I said, blood sugar has always been fasting, I’m sure it would go through the roof if I had one of those proper insulin/glucose tests. I’ve done laser removal on the hair and it’s worked pretty well.

    I’m planning on starting to try for a baby in a few months, and I’m very nervous about conceiving, even though my body now seems to be normal in every way. I’m tracking my temperatures and it’s clear I ovulate. My sister has had 3 kids even with PCOS. But she’s only 27 and I’ll be 35 in a couple months. It’s scary, but I’m hopeful. And as someone else said, I have no intention of dieting before conception, and I already eat plenty of fat and protein (I’m around 155lbs at the moment – not sure exactly how much as I haven’t got on the scale in a few months).

    i guess this is slightly off topic – just answering a question with my own experience.

  107. a quick question, but does anyone know if PCOS ALWAYS makes you gain weight?

    Im paranoid i might have it as my periods are all up the spout, i have unruly hairiness (not on my face though) and i have a high risk of hereditary diabetesand im sensitive to blood sugar drops. Im also prone to bad skin.

    My doctor took one look at me and said ‘no.’ This was while i was talking to her about my period not turning up for 80 days at a time. I feel she dismissed it because i wasnt big, but i know of one other person who is slim who has PCOS. i have a pretty stable weight, although its ‘overweight’. Im wondering if its worth pushing for some tests….

    From time to time i think ‘nah, im fine’ and then the fear comes back and i wonder if im just being completely irrational and a hypochondriac.

  108. does anyone know if PCOS ALWAYS makes you gain weight?

    Nope, it doesn’t. Plenty of thin people with PCOS, and certainly it can make you gain weight over your life but not catastrophically. There’s a complex relationship between weight and PCOS — in my case the worst symptoms were actually set off by additional weight gain from Lexapro, as near as I can figure.

    The thing about PCOS is that the S is for “syndrome” — fancy word for “loose collection of symptoms one or more of which might be present.” So you can be diagnosed with PCOS without being fat, or without being hairy, or without having ovarian cysts (!). This of course means that there’s probably something else going on with most people diagnosed with PCOS, but since they usually only give you meds to treat the symptoms you actually have, that’s not as much of a bad thing as it seems.

  109. a quick question, but does anyone know if PCOS ALWAYS makes you gain weight?

    Nope, it doesn’t always. I just checked, and the Mayo Clinic website (who I presume to be fairly reliable… ??) says about 50%. I’m no doctor, but if you’re worried about it, I’d personally go ahead and have them run the tests.

  110. i see this “complex carb” thing all time. what the hell is a “complex carb”?

    i’m under the impression that it’s whole grains/brown rice/sweet potatoes … but when you get right down to it, fruits and veggies are carbs … and i had that one doctor who said i should try atkins or south beach (i refused)….

  111. I once had a nurse take my bp (it was 100/65, where it always is) and she sputtered in disbelief “wow!! That’s a great bp for someone who’s so…” and then just trailed off. I was 5 ft. 6 and about 290 at that point. Yep, lady, the people in my family have a genetic tendency toward low bp, no matter their size. Funny how that works.

    I’ve never had horrible care. It helps that around here they always ask you to put your job and employer on all the forms, so they can see I’m a lawyer and I work for a big, “brand name” firm. It helps dispel the idea that I’m fat and therefore an uneducated moron. Also, they tend to be afraid of pissing lawyers off. :)

  112. a quick question, but does anyone know if PCOS ALWAYS makes you gain weight?

    No, and unfortunately, the lean women with PCOS are always used as a weapon against those of us who gain weight. PCOS doesn’t always necessarily stop your periods, either. Some of have extra periods that are extra long. :roll:

  113. I haven’t had any bad experiences with doctors lately simply because I’ve been too scared to go. In college I saw two different doctors at the infirmary for a bad chest/sinus infection that I’d let go for too long (also because of my fear of doctors): one convinced me that if I didn’t lose 80 pounds I WOULD be diabetic within ten years; the other told me condescendingly that if I’d just switch from regular to diet soda I’d immediately lose 20 pounds. (I tried it and didn’t lose any, of course.)

    Terrified by the first doctor’s threat of diabetes, I started eating mostly vegetables. I was always hungry and miserable, but I lost 15 pounds in two weeks! Jubilant, I went back to the clinic to tell him and he blew me off. I was crushed. He should rightfully have been worried about that kind of rapid loss! If I were prone to eating disorders, that could have started one.

    Once I found a job and got health insurance, I picked a GP and had my thyroid tested (family history) in case it was a cause of my weight. The doctor was openly scornful of the whole thing and, when the tests came back negative, instead of being glad I didn’t have a medical issue he lectured me about diet and exercise instead.

    I didn’t even know that there were larger blood pressure cuffs until I saw something about it here. The cuff my GP uses is literally painful to me; it’s one of the reasons I hate going. Since I’m so terrified of going to the doctor, my BP is always shockingly high when I go in. In college they had to measure it twice every time I went, once coming in and once leaving, to get an accurate measurement.

    My two latest doctor experiences have both been negative; although they’re nominally unrelated to fat, I feel like I’m brushed off and not listened to because I’m large. I need a lot of work done to my teeth, and every time I go in the dentist lectures me in broken English about “too much soda, too much soda!” Oh, then having genetically horrible teeth with soft enamel (my whole family has this issue) and being without insurance for ten years and unable to go for cleanings has nothing to do with it? It’s just because I’m fat and gluttonous, I’m sure.

    I’ve also recently developed nasal polyps. The allergist I went to when I got sick and couldn’t get better wanted to give me allergy shots; when I pointed out that allergy shots have no effect on polyps and wouldn’t help, he got huffy and simply refused to speak with me about options. I need to find another allergist or eye-ear-nose-throat doc in northern VA to see about this, but honestly I’d rather have a permanent head cold than deal with idiots who want to make money off allergy shots and not deal with the actual problem.

    Sorry for the entire book, but it felt so good to get all that off my chest. I’m so used to being dismissed and treated poorly due to my weight that I expect negative treatment every time I go to a doctor. So far they’ve lived right up to my expectations.

  114. problematic, complex carbs are indeed things like grains, sweet potatoes, rice etc. simple carbs are sugar, etc. i think that if you look at the GI index things people are touting nowadays, the things that are higher GI are simpler carbs, and the lower GI they are, the more complex they are. which basically means something along the lines of they don’t spike your blood sugar as much as simple sugars, don’t make your insulin go out of whack as much. proteins and fats don’t affect your insulin nearly as much; fat not at all and protein only a tiny bit.

    yes, almost everything has carbs in it – even cheese and eggs. the only things that don’t are pure fat and meat/fish proteins. which is why ‘low-carb’ is never ‘no-carb’, just low. fruit and veg are carbs too, indeed, but veg are pretty low carb so don’t affect your insulin unless things like potato and corn. i find fruit varies; i can have some, a moderate serving of fruit salad, for example, but if i eat more than that i can feel the insulin response kick in. but that’s me – i think even people who have insulin resistance have varying levels of it, i may very well be an extreme case, possibly *because* i ruined my metabolism with the low-fat dieting i’ve tried over the years.

    so, by eating low carb, i mean that i eat meat, fish, poultry, dairy including yoghurts, pulses occasionally, fruit occasionally and lots and lots of veg of all kinds including sweet potatoes. i avoid bread, rice, pasta, sugar, except as an occasional thing. it works for me. and by that i mean keeps me healthy, and with a ‘real’ appetite, as opposed to an insulin-induced one.

    by the way, if you want a very academic but amazingly fascinating read about food and health, read Gary Taubes’ Good Calories, Bad Calories. Absolutely fascinating and mind-blowing. I honestly believe that it would be the single easiest way to get health care professionals to start treating fat people better, to make them sit down and read that book.

  115. So, another PCOS question… I’ve always wondered if I had it, because of my weight. I have a dark patch on one thigh. My mother thinks that she probably had undiagnosed PCOS, but she’s had a hystorectomy nearly 20 years ago, so it’s a bit hard to tell. I’ve asked lots of doctors and they’re all kind of blase about it, like “Well, we’d put you on the pill, and you’re already on the pill, so it doesn’t matter.” I also have fairly normal periods, and while I think I’m hairy, I think that’s a skewed body image thing (I have body hair, supermodels don’t have any, my brain decides I must be freakish). My doctor thinks the level of body hair is normal.

    I finally was really insistent, and got both blood work (inconclusive) and a sonogram (is that the same as a trans-vaginal ultrasound? It seems like the same thing people have described). The sonogram was negative for ovarian cysts.

    I know PCOS is a bitch to diagnose…. so I’m wondering how conclusive the sonogram is? I mean, should I keep pushing this, or can I say with confidence that I don’t have it? I wonder sometimes if I’m trying to pathologize my fat (there must be a medical reason for it!) instead of accepting that some people are fat, and I am one of them. At the same time, I don’t want to let the doctors push what could be a serious issue under the rug. Thoughts?

  116. caffeine, I see Dr. Yanowitz in Silver Spring/Gaithersburg for my allergies, and he’s never lectured me about my weight. I know he’s out-of-state, but if you have a serious problem, it could be worth it. Also, since I’m on a maintenance allergy shot regimen, I only have to see him once a year, and he has Saturday hours, so I make the trek from Alexandria.

  117. Karen, your doctors are kinda right that there’s not a lot else they can do if you’re already on the pill. It’s not like there’s a treatment for PCOS, just for its symptoms, and the Pill is the treatment for several of those (irregular periods, high testosterone levels, acne). If your blood sugar test was inconclusive, I definitely recommend getting another one, and get your triglycerides checked as well. But if you’re not insulin resistant, there is literally no other thing they could do for you besides give you a hair-removal cream.

  118. Karen, also, I’m hardly an expert, but a trans-vaginal ultrasound, as I understand it is an internal scan (you would actually have the equipment inside your vagina) and a typical sonogram looks in from the outside (like the kind we see whenever someone is having a baby).

    Hope that helps.

  119. In that case, it was a trans-vaginal ultrasound. It was definitely an internal exam.

    FJ — I think he was mostly testing my FSH and LH (hormonal) levels, but I’ll check on that when I get home and can look at my test results. My GP does general check my blood sugar levels regularly, though, so I feel like I would know if there are insulin resistance issues.

  120. I don’t want to belittle anyone’s bad experiences or legitimate concerns, but wanted to mention that as I’ve been reading through all your stories, a handful sound like the same level of questionable advice and misdiagnosis that doctors give everyone–fat, thin, and in between. Joint/muscle pain, vague abdominal pain and discomfort, and a lot of other common symptoms, especially in an otherwise well (walking, talking, getting by in daily life) person, are often mysterious to everyone, doctors included. In those situations, they’re not failing to diagnose or treat your problem because of your weight, they’re failing to diagnose or treat because they have no blessed clue what’s going on.

    There are better and worse ways for doctors to deal with being clueless (and there’s definitely a subset who are more clueless than they should be and probably ought to deal by not sleeping through their continuing medical education sessions), and I can’t say for sure that fat people aren’t subjected to the “worse” ways more often than people who aren’t fat. But it’s not by any means exclusive to fat patients and from what I’ve seen (as someone who’s had a lot of mysterious, undiagnosed symptoms, seen a lot of doctors, been both not-fat and fat, and is now training for a healthcare profession myself) it may have more to do with the doctor’s standard operating procedure for cluelessness than with anything specific to the patient. Does that make it good or acceptable? Probably not. But it may be a different problem from fat prejudice.

  121. Karen, it’s not the blood sugar level that shows insulin resistance. it’s the ratio of insulin to blood sugar. in my case, which i was told by an endocrinologist was insulin resistance, my fasting blood sugar was in the normal range, but the amount of insulin was higher than normal for that sugar level.

  122. If you’re not getting weird fasting blood sugar results, and your periods are normal, I wouldn’t worry about it. As you can probably tell from above conversation, it’s not really clear what we talk about when we talk about “having PCOS” — there’s no one thing that it means to have PCOS, so it’s only really useful to talk about individual symptoms. The only ones that are really dangerous (vs. cosmetic) are increased risk of diabetes because of insulin resistance and increased risk of endometrial cancer because of not menstruating. Well, and it can raise your triglycerides, which could be dangerous. So if you’re menstruating and your fasting blood sugar is okay, there’s no real risk to you.

    ETA: Oh hm, but I’ve never heard about what problematic is talking about, and that’s certainly worth taking into account.

  123. The only ones that are really dangerous (vs. cosmetic) are increased risk of diabetes because of insulin resistance and increased risk of endometrial cancer because of not menstruating</i.

    True. but the cosmetic symptoms can drive you nuts as well. A fellow-sufferer called it “being hit with the ugly stick” which is harsh, to say the least, but some days it feels like that, especially if you’re depressed. By the way, I’ve read in a few places that depression is also considered part of the syndrome, but whether that’s because of the hormonal crap or the shitty way women with PCOS are often treated is not known.

  124. Thanks…. all of that is really helpful. I’m going to be extra-vigilant the next time I get blood work done, and see where the sugar and insulin levels are, but otherwise, I’ll let the PCOS thing go.

  125. re-lurking now: Sure, there’s an element of “doctors are human”/”doctors don’t know as much as they pretend” (depending on how generous you want to be). But surely you read the stories in which people’s doctors told them directly that their problems were because they were too fat? I think the statistics from the article speak pretty loudly as well.

  126. Agreed on that, Sniper! PCOS is a bitch because its cosmetic symptoms line up beautifully with things that are deemed aesthetically unacceptable. Women are widely supposed to be slim-waisted and hairless, except for their head hair which should be full, and they should have clear skin. Women with PCOS tend to have fat tummies, extra hair, thinning head hair, and acne. NOT. FAIR.

    But on that stuff, doctors are not necessarily more helpful than OTC stuff like fancy shampoo and face soaps. You may not get that far with what you can buy at CVS, but a doctor won’t get you much further with a prescription. Or if you do enlist medical help, it may be more effective to go to a dermatologist than an endocrinologist. (I’m still talking here about people who are already on the Pill and don’t need Metformin.)

  127. Ugh. I’ve read through the comments here. We have a sad state of affairs when it comes to medical professionals!

    I worked for a doctor for six years, as a medical receptionist. He was always kind to me about my weight – he treated me for free and just giggled when I refused to get on the scale.

    But, when he visited my sister in the hospital – she just had major surgery to remove gall stones – he told her the bright side of the operation was all the weight she lost.

    He also made a crack comment about a big guy who was of Iraqi descent. He said the guy was so big, there was no way Americans could evade blowing him up.

    And then – yes, another story – a friend of mine has been suffering from knee and back pain. Every time he came to see the doctor, the only advice he’d give him is to lose weight.

  128. My worst experience? Being denied fertility treatments in the UK as well as various clinics here in the US because of BMI.

    But then I went to the clinic in my home state (listed in the fat friendly doctors page) and am now pregnant with my first (but hopefully not only) child. Also, my OB-GYNs and the staff at my local hospital/birthing center rock so hard it makes me want to cry.

    There are good doctors and clinics out there, but sometimes they are so hard to find. Oh, and a shout-out to Planned Parenthood, which always gave me quality of care.

  129. My freshman year in college I was having major issues with anxiety and depression and I felt overwhelmed with being away from home for the first time as well as my college work. I went to the local clinic to see a psychiatrist. He asked me what I came in for, and after I talked for an hour about all of my worries and anxieties, after near silence, at the end he said to me, “I think you would feel better if you lost some weight. You need to exercise more, and eat less things like cookies and cake and more things like carrots and lettuce.” I just kind of stared in disbelief at him and got out of there as soon as possible. I had a break down and my mom called them REALLY pissed off about it.

    FYI. I went on that diet and lost 27 pounds, and subsequently flunked out of school.

  130. Oh, forgot to add that as I have borderline gestational diabetes I was referred to a dietician at the hospital. She wanted me to more than double my carb intake, which of course confused me because the point was to lower my blood sugar, not raise it.

    Yesterday I saw my OB and reported what the dietician said.

    Dr B was not happy.

    She was all, Oooh nononono. That’s totally counterintuitive and just no and WHAT’S HER NAME??

    Then she broke out the pen and paper and told me to continue low carbing, eat plenty of veggies and protein, and gave me (free!) a glucosometer so I can test 2x a day. Ah, it’s good to get vindication…

  131. PS I am pretty terrified to go to an OBGYN. I refuse to go to a man and I’m still scared about a woman. I have very irregular periods and I just know they’ll try to get me to go on a diet.

  132. I do encourage you to go if you’re not always having your period, Jasmine. It turns out that can put you at a higher risk for endometrial cancer. Would it make you feel better to go to a Planned Parenthood clinic or other women’s clinic instead of a doctor’s office? I feel like there’s something disarming about places like PP, since they’re pro-woman spaces.

  133. My sister wasn’t diagnosed with PCOS for years because she didn’t have all the symptoms. Maybe she didn’t have cysts, I don’t know, but I do know that she has none of the hirsutism that I suffer from. She put on tremendous amounts of weight *after* having her first child, despite not eating differently to before, and she tried without success to have another child for at least 2.5 years. Doctors just kept saying – you don’t have all the symptoms, you don’t have PCOS. then she moved countries, went to another doctor, who gave her metformin – she was pregnant within a couple of months.

    I couldn’t agree more about being hit with the ugly stick – it seems like the ultimate injustice, being hit with almost *every* unattractive thing. I can certainly imagine depression being connected to PCOS because of the way it makes you feel about yourself! About the only thing I didn’t have was the thinning hair on my head; I had thick dark hair on my legs, arms and face – I couldn’t go *out* each morning without lengthy time spent with tweezers, I had dark patches of skin on my neck so I could never wear my hair up, I had worse spots than I’d had as a teenager, and I was of course more than a 100lbs over what was considered attractive for my height.

    When my periods started to be regular again it was a pretty good indication that I was doing the right thing, eating low carb. But when my dark skin on my neck literally went away, I was amazed. I’d had that since I was 12 years old. I hated it so much – it looked like I was dirty, like I didn’t wash. Nothing took it away, I even tried bleach! And then I changed the nutrient composition I took in, and my skin changed! Sadly, nothing that I know of about diet can change thick dark hair to light hair, but I signed up for laser and it’s made a huge difference. It’s bloody painful, and it takes a year or so to see real results, but now I don’t even think about shaving my legs when before if I shaved them last thing at night they were already stubbly by morning, and the hair on my face is fine enough now that I can bleach it blonde and it looks fine.

  134. I swear this is going to be my last comment.

    I’ve got PCOS too, but as I’ve said before, my bloodwork and cycles are absolutely normal, so fillyjonk, there is cause to worry.. Heck, according to my bloodwork I ovulate every month, so don’t go by bloodwork alone. I also have extremely low insulin resistance. I was put on Metformin for 1/.5 years and lost a whopping 13lbs, gaining only heart palpitations in return. However, apart from hirsutism and irregular periods, I have all the other symptoms of PCOS, right down to skin tags, depression, dark patches on the skin, yadda yadda. Really, you need a tv u/s to see if have string-o-pearls ovaries, as I do. IVF was my only option for conception, but some women have success with IUI and/or Clomid (please, for the love of all that’s holy, see an Reproductive Endocrinologist and NOT and OB-GYN for fertility issues. OBs, unless they are also trained as REs, DO NOT have the medical training to be fooling with drugs such as Clomid) and other drugs.

  135. I agree that it’s a different situation if you’re trying to conceive, but I was assuming Karen wasn’t as she’s on the Pill.

    Funny thing about acanthosis nigricans… my endocrinologist was examining me last time I was there and she said “hunh, you’ve got some hyperpigmentation on your neck, weird.” I said “yeah, I kind of always assumed that was PCOS-related” and she said “nope, this is different.” Just a very, very faint birthmark, apparently, or maybe some heavily clustered freckles. I don’t know how she could tell.

  136. Er, I’ve never in my entire life had my arm higher than my heart than for a BP test.

    Sorry, didn’t mean to suggest that. Your forearm should be supported right at your heart level. Not above, not below. Either one will screw up the reading.

  137. “The endocrinologist told me that he wasn’t sure he should provide me with meds for the PCOS because it might dissuade me from losing weight (does that even make sense?).”

    That’s some horseshit. When I first suspected I had PCOS, my GP referred me to really great reproductive endocrinologist, (A field I didn’t even know existed until then!) who told me, and I quote, “Your numbers are all good, so I’m not worried about your weight if you aren’t.”

    When I confessed that I actually was a bit concerned, having gained 50 pounds in a year without changing my habits, and considering my weight was stable for 10 years before that, he prescribed two meds immediately. Changing my BC and putting me on spironolactone to reduce testosterone. Then he told me that if my weight didn’t stabilize (not go back to what it was, or into the “normal” range, just stabilize) that he would put me on metformin, because I might be insulin resistant. And, actually, it does seem to have stabilized. I may have even lost a few pounds, but I don’t weigh myself, so I don’t know for sure.

    Of course, this doc actually believes that maybe PCOS might cause weight gain, as opposed to fat causing PCOS. Hmm, you think maybe whacked out hormone levels and insulin resistance might make someone fat? Duh!

  138. PCOS as “ugly stick,” oh man, I can relate to that. I have the male-pattern baldness (I wasn’t diagnosed until I was 33, which gave the androgens plenty of time to do their thing), and according to my OBGYN (who also has PCOS) I will never see a full head of hair again. Knowing I will never have a beautiful haircut again hurts me a lot worse than being fat does, truth be known. Just passing salons and seeing women with foils on their hair makes me want to cry and throw things at the unfairness of it all.

  139. He also made a crack comment about a big guy who was of Iraqi descent. He said the guy was so big, there was no way Americans could evade blowing him up.

    WTF?! WTF WTF WTF

  140. (I guess I lied about the re-lurking)

    Fillyjonk, I agree that there is fat prejudice among doctors, just like there is in Western society in general, and that it can be particularly destructive in the medical setting. And some instances of doctors attributing people’s symptoms to weight do arise from fat prejudice. But some arise from a general habit of grasping at plausible-sounding straws when faced with not having a certain, evidence-based answer. This happens all the time, with completely non-weight-related things too (e.g. recommending smoking and alcohol cessation for acid reflux disease seems totally plausible based on the physiology of the disease and doctors make those recommendations all the time, but clinical trials show no evidence that they actually improve the symptoms: http://archinte.ama-assn.org/cgi/content/full/166/9/965). More of medicine works this way than anyone would probably like to admit. Complicating things further, it takes sophistication on the part of the doctor to (a) realize how imperfect their knowledge is and (b) communicate that in a way that doesn’t blame or dismiss the patient.

    I don’t deny that everyone who’s posted has had a bad, unsatisfying experience with their doctor and that a lot of those reflect fat prejudice. But there are times when I worry that people jump too quickly to that conclusion (or any other favored go-to explanation) rather than distinguishing among experiences that are bad because the doctor treats a certain group badly vs because the doctor treats everyone badly vs because that doctor has nothing useful to offer for your condition vs because the entire medical profession has nothing useful to offer for your condition, and so on. All bad (and potentially overlapping) situations, but possibly requiring different solutions.

  141. PCOS is a bitch because its cosmetic symptoms line up beautifully with things that are deemed aesthetically unacceptable. Women are widely supposed to be slim-waisted and hairless, except for their head hair which should be full, and they should have clear skin. Women with PCOS tend to have fat tummies, extra hair, thinning head hair, and acne. NOT. FAIR.

    I’ll never forget how ashamed I was when I developed those symptoms. It was as if I had failed in some terribly important way, or had been deemed unworthy by… I don’t even know… the universe? It took many visits to many doctors to get a diagnosis , and for years I couldn’t even bear to have someone look at me. I still can’t stand people looking at the top of my head, which is too damned bad because I’m 5′ 1″.

    That, my friends, is fucked up.

  142. i’ve got the PCOS dark facial hair thing (and have had horrible self-esteem issues in part because of it). after 2 years of electrolysis (oh! the agony!) seemed to do nothing, the hair removal creams screwing up my skin, tweezing causing breakouts, i’d settled into a routine of daily shaving. until christmas, i used a ladies’s shaver (something about that made it more acceptable for me to use). then my girlfriend convinced me to go get a men’s electric shaver. my god. what a difference. i have to use it every day or face five-o-clock shadow, but, it works so much better and i feel so much better.

  143. Laser can work well also, but it costs a fucking bomb. One of my, um, laserologists (?) who was also a nurse said she felt it ought to be covered by health insurance because so many women with hormonal issues really suffer – emotionally – with hirsutism.

  144. Sniper, I don’t have PCOS but I have had troubles with acne and hirsutism, and my old dermatologist said that he has sometimes been able to convince insurance companies to cover laser on a case-by-case basis. Basically, he said he argues that if they can cover the acne treatments that are caused by the same problems (hormonal interaction with skin/hair follicles), then they should cover the hair treatment too. (He offered to try to do that for me, but then I moved away. He was a nice doctor, come to think of it!)

  145. Ugh. I have PCOS, but I can’t help but think I have some sort of advanced stage or something. My doctor (who while actually caring about health, is a goddamn nag and bitches at MY ENTIRE FAMILY about losing weight) prescribed all the good stuff usually given to PCOS sufferers. MetforminXR, BCPs, and because it runs in my family, some sort of water pill to drive my blood pressure down (never mind it’s high because going to college is literally killing me).

    NONE OF IT WORKS. Metformin didn’t do anything about my weight and just gave me the shits and nausea for 10 months straight. Birth control hasn’t done anything except screw up my cycle even further. I still have excessive hair; I have to shave every day. It’s too dense for waxing, and depilatories just burn my flesh off and leave the hair. It’s literally on every square inch of skin on my body except the soles of my feet. My skin’s still extra dark where the skin might crease. I get little skin tags. My hair is a mess ALL THE TIME, and my scalp falls out in ugly chunks no matter what I do to it. Depression is only compounded by it (my guy becomes afraid of me when I get violent, and he’s a fighter). The blood pressure medication worked for a little while, but she took it away, I don’t know if it’s because I’m not supposed to stay on it long or if she wants me to work harder on losing weight. It’s going to stay high as long as I’m constantly subjected to unhealthy levels of stress.

    Meanwhile I walk a couple miles every day out of necessity, eat more veggies in a day than normal people see all week, and love to get out and move around. I just pile muscle under fat, making me even bigger. Nothing works.

  146. Violet, could that be some sort of thyroid issue along with the PCOS? Is there any chance you could see a proper RE rather than your regular GP?

    Seems like a lot of us PCOS gals have acne too, anyone else have Acne Rosacea?

  147. Violet- Was the medication Spironolactone? That is what I am on, and while it is a diuretic and lowers blood pressure, the main use for PCOS is that it is an Androgen reducer (Male Hormone). It works somewhat for me because I have a high free testosterone level that is driven by high DHEA levels. The main medication it looks like my endocrinologist will be using will be steroidal in nature. I can’t go any higher on the Spironolactone because I also have low blood pressure (and low cholesterol- my total number is 80) and I already get dizzy sometimes.

    Researching what is wrong with you is like learning a whole new language, but like was mentioned before, doctors are human, and they often only have 15 minutes with you. If you come in prepared and knowledgeable, a good doctor will work with you. A bad one will give you crap because you have been “self-diagnosing”.

  148. does anyone know if PCOS ALWAYS makes you gain weight?

    Fat cells and muscle cells can have different degrees of insulin resistance. Whatever your weight, if it is stable it means they have equal amounts of resistance, if you are gaining it means your muscle cells are more resistant, etc.

    Thanks…. all of that is really helpful. I’m going to be extra-vigilant the next time I get blood work done, and see where the sugar and insulin levels are, but otherwise, I’ll let the PCOS thing go.

    I don’t think fasting insulin is a standard test, at least I’ve never had one. You can estimate your insulin resistance by dividing your fasting triglycerides by your HDL cholesterol. Under 1 (mg/dl) is very little resistance, over 3 is very resistant, the higher it is the more insulin resistant you are. It is also a cheap way to estimate your relative LDL particle size. A lower number points to less CVD risk than a higher number. (In the mmol parts of the world the 3 would translate to 1.3)

    I agree with Deborah M, Good Calories, Bad Calories is a very enlightening book. (It wasn’t his first choice for a title, btw, I think the working title was A Big Fat Lie, or something like that)

  149. None given – I didn’t know there was a way to measure your insulin resistance! That’s very interesting, thanks. Now I’ll have to check my latest blood results and see what that says about mine! (although i guess another question would be if i’ve been controlling my insulin resistance through diet for six years already, will that have affected the results?)

    Laser *is* ridiculously expensive, and I agree that it should be something that is covered, hirsutism causes such emotional pain. I have been through three phases of laser. The first was privately, in London, where I’m from. Just on my face, ridiculously expensive, and I went to a few sessions, and it didn’t really work. Then I continued in Israel, where I live now; a frankly obnoxious doctor who charged through the roof, so again, only did it on my face. I did six sessions, they made some dent, but I couldn’t afford to go back.

    Then I discovered that if I signed up for the highest form of coverage from my HMO (or whatever the equivalent is here), and paid an extra few dollars a month (or rather the equivalent in shekel, obviously), it would cover part of laser therapy at a particular place. It was still crazy expensive, but seeing that I was going through a particularly down phase, my parents offered to help. It was half the money it would have been without the HMO’s help, and the good thing with this place was that you paid for the overall treatment until it is done, not per session. So I’ve been doing my full legs, the ‘hairline’ on my stomach, my lower arms, and my face/neck for around two years now. Started out every month, then every two months, now every four months. It really has made a huge difference.

    But yeah, it’s really, really expensive.

  150. I don’t have PCOS, or thankfully any nightmare doctor stories, but I have had baby hair since birth. It’s fine and wispy and brittle and floofy and oily, so even though it’s not thinning it sometimes has the appearance that it is. I’ve found amazing hair success with Nioxin. It seems to treat all my hair issues and I end up with less breakage and pretty decent looking hair, plus my eczema has cleared up nicely. I never had much hair loss at all, but now I have close to none, which makes a huge difference when your hair is as fine as mine.

    One woman at the salon I go to was having very bad hair loss issues and she started using Therapro and her hair is coming back in at her temples. I haven’t tried it (allergic to the soy protein ingredient) but if you want to try non-Rogaine formulas, those might help since they both address dihydrotestosterone, and people have had success with them.

  151. “I once had a nurse take my bp (it was 100/65, where it always is) and she sputtered in disbelief “wow!! That’s a great bp for someone who’s so…” and then just trailed off. I was 5 ft. 6 and about 290 at that point. Yep, lady, the people in my family have a genetic tendency toward low bp, no matter their size. Funny how that works.”

    Berryblack, my family is the same way. My father – who generally runs at about 90/60 and is about 275# at 6’1″ – has had nurses take his BP and say “Do we need a crash cart??” Maybe we’re related? *grin* It took going on testosterone supplements to bring my BP up to anything like a “normal” range – and I generally run about 110/70. I have white coat syndrome so I regularly ask for them to measure my BP after I’ve been in the office for a while.

    I annoy doctors. I’m not sure if it was in these comments or on the WaPo comments site, but I regularly get the “You should be diabetic/hypertensive/blahblahblah because you’re FAT!” and also the “You obviously eat too much of the wrong things.” I’m a semi-vegetarian and I cook almost all of my own food. They just ASSUME that I eat junk food because that’s the popular bias. It drives me crazy.

  152. I have white coat syndrome so I regularly ask for them to measure my BP after I’ve been in the office for a while.

    Whoa. I have never thought of this.

    We should do something on First, Do No Harm about ways to advocate for yourself before doctors discriminate against you, and this (and knowing whether you need the big cuff) should definitely be on there.

    I also have hereditary low blood pressure — as in, when I stand up fast I get headaches and tunnel or greyed-out vision. It’s gotten better since I stopped dieting — white coat syndrome used to push me into the normal range, and now it pushes me into the “still basically normal but nurses no longer comment upon how low it is” range. But since I’ll take anything I can get as far as staving off bad treatment from doctors, I’d rather get credit for having low BP! :) And if it becomes low enough to be a problem, I want that to be recognized. Both of which require cutting out the white-coat response.

    Hey, re-lurking now, now that I’ve finally rescued your comment from the spam filter, I just want to mention that I think your points are all really valid. I don’t want to discourage people from seeing fatphobia where it exists, because we tend to be very inclined to ignore or excuse it. But keeping in mind the fact that medicine requires guesswork for all patients is definitely worthwhile.

  153. sweetmachine, that was my response too. But seeing that this guy regularly hit on us each time he came in, maybe he was being defensive!

  154. Krista- Nope, it was just specifically a diuretic for lowering blood pressure. I asked about spironolactone, and she gave me the “OKAY, WHO’S THE DOCTOR HERE?” look. I also suspect she was hinting that if I did everything I was supposed to, the hair would go away when I lose weight. Lies. LIESSSSS!

    Orodemniades – I don’t know if she tested for any thyroid problems, but it would make sense. I should probably see a specialist before I get kicked off my father’s health plan.

  155. I just wanted to say that a few years ago, my partner’s grandmother was having chronic problems with UTI’s and bladder infections and for almost a year she tried to convince her doctor something was wrong. The doctor even told the daughter that her mother was just not cleaning herself properly due to being overweight that that was giving her the infections.
    It turned out the poor lady had a tumor located beside her bladder that was the size of a football and that was what was causing all her grief. She died a year later as the cancer made it’s way through the rest of her body.
    It also makes me wonder when I have seen doctors and their diagnoses have been off because they assume it’s all due to being overweight. Sometimes their subtlety isn’t always obvious and a lot of people do not question them.
    Just one more area for me to be paranoid and defensive in.
    Also, not that long ago, a man made a very rude comment about my being fat and lazy when I was temporarily parked to drop my daughter off to day camp. Ironically enough, that’s where he stopped as well and majority of the other parents used the same spot. Anyways, after the initial shock wore off, I sped off and tailgated and honked at him til he got out of his car. Not sure why I went beserk that day, but to be honest, I wasn’t sure if I felt more bad about his comment or that I had resorted to a lower form by going nutty on him. I am still embarrassed by that event.
    But it goes to show how years of separating childhood bullying can bring you right back to feeling inferior the moment a idioit like that opens his mouth.

  156. Thank you for a very fine post that shows me I am not alone in the feeling that my doctor (a physician’s assistant, actually) operates under the assumption that “obesity” is an automatic death certificate. I have observed her behavior for years, and have grown increasingly uncomfortable with it.

    I’m a male, 46 years old, 6’3″, big boned and 290 lbs right now. Seeing me on the street, the average person might not even judge me “fat,” but rather “stocky.” I do have a pretty good approaching- middle-age paunch, but so do a lot of guys, and I hide it well by wearing loose fitting sweaters, etc. I’ve gained a good bit of this weight over the last seven years, or so and as I have gained, her demeanor has changed. The first time she became aware of my weight gain, she suddenly pulled out her scope and press it to my the large arteries in my neck. Made me feel like I was at death’s door, or something. This became an ongoing process, and always the weight lecture.

    So, tomorrow I have an appt. to see her for nothing more than to write a refill for a prescription that I’ve been on for many years (state law says you have to be seen once a year, minimum, to get a refill). In my mind’s eye, I can see it right now – the nurse will take me over to that scale which can be seen by other patients from certain vantage points in the waiting room, she will silently write down the weight and take me to the exam room.

    I tell you what: I don’t wanna be weighed. Since the beginning of the summer I’ve begun a concerted effort at cutting my portions at meals, and I don’t want the lecture, again. I don’t want her poking at the veins in my neck with her stethoscope. In my family, on both sides – but very markedly on one side – there’s substantial longevity (all my great aunts and uncles were in their 90s with at least one centenarian) and virtually no advanced heart disease – and that was in the days of bacon and eggs before crestor and lipitor etc.

    Here’s the rub. My physician’s asst. is the proverbial “rag-o’-bone and hank-o-hair.” Almost painfully skinny, super athletic playing on local soccer and baseball teams, and doubtless eats like a bird. There you have it: gung-ho on fitness, trained up in the attitudes of the medical establishment towards obesity, and predisposed to assign me a “leper” status because I’m overweight.

    Being employed in the sciences, I have done much reading about the philosophy of science, attitudes of scientists, and the idea of “paradigms.” And I honestly begin to get the sense, from reading sites such as this, which broach the subject of fat prejudice, that there is a lot of “paradigmatic” thinking among health professions on the subject of obesity which is divorced from quantitative data, from controlled studies (also from misinterpretation of same), etc. A paradigm that says, “Hey fattie, you’re a time bomb.”

    I get agitated just thinking about going to see the doc on Wednesday. But I’ve made up my mind. No scale this time. I’m just gonna say that I don’t wanna be weighed. I don’t wanna be lectured. Just write the damned refill, charge me the $100 and let me out of there.

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