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.

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.

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.

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.

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.

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.

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)

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”.