You Don’t Say

Overweight women find health care access and attitudes a constant struggle.

“The participants in our study described the experience of seeking healthcare as a constant battle and struggle and were upset by the reactions of healthcare staff” says lead author Professor Emily Merrill from Texas Tech University Health Sciences Center.

“They told us that they felt even more uncomfortable with specialists than with their own family doctors and nurse practitioners.”

Four themes emerged: struggling to fit in, feeling not quite human, being dismissed and refusing to give up.

Women talked about feeling shame and embarrassment because they did not fit into the normal healthcare environment because of their size and needed larger gowns, blood pressure cuffs, scales and chairs.

50 thoughts on “You Don’t Say

  1. WATER: WET
    BEARS: SHIT IN WOODS
    POPE: CATHOLIC

    That said, sometimes people need a formal study before they will accept something that’s as plain as the noses on their faces. So maybe this will help the terminally clue-free.

  2. This has been an update from the department of the obvious.

    (Says the girl who has been postponing doctor visits for two months because she doesn’t want to talk about her weight with her doctor.)

  3. I’ve been waiting to see a doctor for a fairly unpleasant chronic digestive issue, because of this very problem. The last doctor I saw would not shut about how I need to lose weight, and so I’m waiting until I can switch insurance providers and go see someone else. It should be soon, now.

    Also, this seems very obvious to all of us, but to the unenlightened masses out there, it’s news. What? Fat people know they’re fat and expect to be treated badly about it? We thought they were blithely going through life thinking everything was hunky dory!

  4. I injured my shoulder a few years ago after a household accident. My doctor sent me to an orthopedist to get it checked out. The orthopedist told me it was just arthritis from the strain of being fat for so long. I said, so arthritis suddenly appears one Saturday afternoon after I tripped and fell and landed on my arm wrong? And being fat puts a strain on my shoulder?!?! (I can understand obesity putting a strain on my feet and knees, but shoulder)?

    He called it acute arthritis or something ridiculous like that. He did an Xray, but said an MRI wouldn’t be necessary because it was arthritis caused by being fat. I’m not looking for unnecessary tests, but I don’t believe for one second that I spontaneously developed arthritis so painful that I couldn’t lift my arm above shoulder height after I fell onto my shoulder one Saturday afternoon!

    Sigh

  5. A note on the study: it was of eight women, which is less a study and more a collection of anecdotes. I’d also like to know what was said in the newspaper advertisements soliciting volunteers: did they ask for fat women to share their experiences with the healthcare system, or to share their experiences of how the healthcare system let them down because they were fat.

    In other words, a stupid ‘study’ making good points.

  6. I’d also like to know what was said in the newspaper advertisements soliciting volunteers

    There’s been an ad on the el for the past six months, looking for “healthy overweight women” for a study on PCOS…this kinda cracks me up, because aren’t “overweight women” automatically unhealthy based on the whole “overweight” thing? How are “overweight” women supposed to think they’re healthy, what with everyone everywhere (especially in the Medical Establishment) telling them how soon they’re gonna die?

    Talk about your cognitive dissonance….

  7. We thought they were blithely going through life thinking everything was hunky dory!

    Kate, did we ever do that “I can’t hear you, I’ve got fat in my ears” post?

  8. What an amazing coincidence!

    Through a series of dumbass (and likely illegal) moves by my husband’s employer, I no longer have health insurance. I’m scrabling to find something temporary, and met with a guy who I guess is an insurance broker. He wanted to put me on a temporary plan with Kaiser Permanenete, and was shocked to discover that they had very recently changed their acceptance critieria for temporary insurance to limit women to under 250lbs, men under 300lbs. NICE. I am 285 and if I hadn’t JUST been to the doctor had had recent proof of my weight, we might have been able to fudge it a bit. So now it’s back to the drawing board to try to find 3 or so months of health insurance until I am hired permanently for the company I’m contracting with. THIS IS SO FRUSTRATING AND ARBITRARY! 250lbs??? So “we’ll take fat chicks, but not REALLY fat chicks, and we”ll pick a number out of the air to base this on.”

    I am so irritated and pissed off about this!

  9. Interesting what constitutes as ‘News’. I think I’ve exceeded my dose of obvious for today.

    I went to the doctor earlier in the week because I was concerned about my foot – it felt uncomfortable in my shoe during a Body Jam class, but didn’t begin hurting until during a Step/Pump class a few days later. I went to the doctor and he told me I ‘put too much pressure’ on the leg, and that’s why it’s hurting. Lose 20 kilos and I should be fine, a brisk walk after dinner will do the trick for a beginner!

    SO offended. I have done a triathlon, a 5k race, and am currently training for two ocean swims. Who does HE think he’s calling a beginner? He didn’t believe me when I told him about the amount of exercise I do, and said that I ‘would look very different if I really did that much’.

    *headdesk*

  10. Heh. I’m dodging calls from my cardiologist right now. He knows I have PCOS, but thinks I’ll be able to “work the weight off” despite 32 years of ineffective dieting. He never fails to mention it, usually in a condescending tone, as if he knows I’m secretly living off whipped cream and blood sausage despite what I tell him.

    So his calls are going unanswered.

  11. I am sooooo my new RNP greeted me with, “So you’re 41 years old, you’re young and healthy, let’s keep you that way.”

    Even when I went in for knee pain that an XRay showed was arthritis in both knees, she didn’t advise weight loss – she sent me to physical therapy.

  12. Kate, did we ever do that “I can’t hear you, I’ve got fat in my ears” post?

    I don’t think so, though it’s a concept we mention often enough. Whole post is good idea.

    I do recall telling a troll who said I’m just bitter ’cause no man will fuck me, “I can’t hear you, because MY BOYFRIEND’S GIANT COCK IS IN MY EAR.” But that was different.

  13. “I do recall telling a troll who said I’m just bitter ’cause no man will fuck me, “I can’t hear you, because MY BOYFRIEND’S GIANT COCK IS IN MY EAR.” But that was different.”

    Bwah!

  14. Marshmallow, that’s sixteen different kinds of ridiculous and insulting. In addition to the stuff you explicitly point out: if your foot hurts from putting too much fat-filled pressure on it, what will a brisk walk do besides put more of that fatty pressure on it?

    Also, I lost about 20 kilos once, through walking, in the space of about 2 1/2 months. I walked for 2-3 hours a day, 5 days a week. While smoking, which I think should count as extra effort, since it’s one thing to walk that much without cigarettes, but to do it while smoking took extra stamina. ;)

    Oh, and I would splurge on cheese and crackers once day a week, and the other six my diet alternated between jell-o and ONE Lean Cuisine dinner one day, and just jell-o the next.

    So, yeah, like a brisk walk after dinner would do ANYTHING.

    Oh, and in case anyone is concerned-I quit smoking January 12, 2007, after smoking for 16 years or so.

  15. I think JPlum is quite right: Stories from eight women are interesting, and many fat women’s experiences obviously parallel these, but it’s not possible to make any general statement based on that sample. A study of 800 women would be more to the point, to prove anything .Though indeed it might very come up with very similar conclusions to this bitty little study.

    (And my sympathies, Evilsciencechick: I’ve been in the middle of an employer-related insurance brouhaha myself, and it looked for a good while there like I was going to end up uninsured. I hope you can find something that works for you soon.)

  16. … I don’t believe for one second that I spontaneously developed arthritis so painful that I couldn’t lift my arm above shoulder height after I fell onto my shoulder one Saturday afternoon!

    Erm … this can happen. It did to me back in 1989 — not after a fall, but after a day’s hiking and scrambling in Yosemite — and it turned out to be acute onset of rheumatoid arthritis. In retrospect, I’d had a few other symptoms dating back about four-five months, but nothing that stood out.

    Mind you, fat had nothing whatever to do with it, and wouldn’t have even if I had been fat back then, which I wasn’t. I was also fortunate to have a GP who recognized what I had, because most doctors could not — even these days, I rarely run into a doctor outside of rheumatology who knows jack shit about arthritis. They mostly *think* they do, I find, but then will come out with uninformed foolishness like that orthopedist’s acute nonspecific arthritis caused by fat. Oh, man. My rheumatologists would tear strips off him.

  17. A while back, I recounted a painful conversation I had with my girlfriend and her good friend — both of whom work as physician assistants in family clinics and both of whom seem to have bought the idea that fat is pathogenic it and of itself.

    Basically, my girlfreind called the thin parents of a fat child liars because they *had* to be over-feeding.

    Twice now, my girlfriend has asked me “how would you handle this discussion* with a fat patient.

    I told her that it would be folly to pretend there aren’t health risks associated with obesity, but obesity doesn’t cause sore throats or every twinge of back pain known to man. I told her about HAES. She actually checked it out. I think she’s un-learning the medical rule that mandates fatty = object, not human.

    Just linked this to her.

  18. Evilsciencechick, that is EXACTLY the reason I won’t let my doctor weigh me (much to her annoyance). I have, in the past, been denied care on the basis of that number (I was deemed twelve pounds too heavy to have reproductive help), and I don’t intend to let that happen ever again.

    As for the “we need to know if you suddenly gain or lose weight” argument, I am perfectly aware of my body and will let them know if there are any sudden or unexplained changes.

    (Of course, if I ever need a weight calibrated medication, I will consider making an exception.)

    I hope things work out for you.

  19. RNP greeted me with, “So you’re 41 years old, you’re young and healthy, let’s keep you that way

    I want a health care provider who can keep me young, too.

  20. Yeah, you know, I love my primary care doc, I really do, because she does in fact listen to the problems and does not blame them on weight (well, except for the acid reflux, but I can forgive that) but if she asks me to lose ten pounds one more time I may have to smack her with a fish. They are investigating me for an autoimmune disorder. Ten pounds is not going to suddenly make my immune system stop attacking me. That, and telling me to stop eating both carbs and sugar until we’ve got this thing figured out?

    Uhhh…yeah, don’t say that to someone who has been skirting justthisclose to an eating disorder diagnosis her whole life and is only now beginning to be able to read her poor body’s hunger cues. At least give me a list of things I can eat, because now I go to the grocery store and feel like I can’t buy anything. No dairy, no wheat (so no bread, crackers, pasta, etc.), no sugar; with the new “no carbs” thing I can’t even have my non-wheat bready stuff now, though I do once in a while and damn the consequences, which are, erm, gastrointestinally dire.

    Fuck, I’m hungry. I was doing so well NOT missing early signs of hunger and now I’m back to where I was months ago, which is mentally blocking all my hunger signals until I’m shaky and headachey from malnourishment. I am tired of this.

    So, yeah, doctors! Please please please be more thoughtful!

  21. I find it interesting that this study was done by doctors from the Texas Tech Health Science Center. I have NEVER been treated with such disdain because of my size as I was by doctors at the Texas Tech Health Science Center.

    In short, rather than diagnosing my very advanced case of endometriosis, which caused me constant pain for over a year, my doctor instead decided to spend each appointment talking about weight loss, even though I countered each of her suggestions with factual evidence that it wouldn’t work: Jenny Craig, Alli, other drugs, surgery…

    Eventually I flipped out in my OB/GYN’s office, he took me seriously enough to do exploratory surgery, and he found out that I had one of the worst cases of endometriosis he’d ever seen. My fertility has been damaged because of the delay in my diagnosis caused by fat hatred.

    I’m getting steamed now just thinking about it.

    So, yeah, in the larger sense, no shit, sherlock. In the smaller sense, watch out for the doctors at Texas Tech! Bah.

  22. Can we expand this little social epiphany to people avoid health care because doctors treat them like liars in general?

    I fall in “normal” BMI and I can’t stand going to the doctor because I always feel like I have to prove I am sick instead of the Dr. accepting me at my word. I always end up feeling like im in elementary school and the school nurse is giving me the evil eye because she thinks I just want to get out of class. There have been several occasions where I have had to insist Dr’s do an actual test because they think I am over reacting, then low and behold it comes back that I am right and I actually have some sort of clue what is happening with my own body. I think there is an over all issue with patient care and bed side manner that should be addressed.

  23. I posted the same study (or a link to a link) earlier. Then I read about one of the guys on DWTS being all zomg fattie dancers lose weight! Douchenozzle.

  24. “Oh, and in case anyone is concerned-I quit smoking January 12, 2007, after smoking for 16 years or so.”

    Way to go JPlum! I quit on January 11, 2006. I smoked a bit longer than you, though, 33 years.

  25. This study may be a collection of anecdotes – so let’s add our own.

    I’ve never been “fat” so much as just chubby. Even at my slimmest, I have lots of muscle in my hips and thighs, which doctors ignorantly mistake for fat. You wouldn’t think I’d get much grief, but I have PCOS, which they used to believe was always caused by fat (even when I weighed 114, one ob-gyn said, “Some women have to become underweight to curb PCOS.”

    I tried everything to lose weight. Doctors were so discouraging because they absolutely refused to believe I was eating under 1200 calories most days and exercising and still not looking like they thought I should. I now have proof it was an insulin disorder all along – no diet/exercise regime will burn fat if your body refuses to use its insulin properly.

    But for 20 years, I mostly just suffered the low quality of life that often goes with PCOS to avoid having Those Conversations with doctors who clearly assumed I was lying through my teeth about my lifestyle.

  26. JPlum: Awesome work on the quitting smoking!

    At the doctor, when he first came up with the ‘you’re putting too much pressure on it’ argument, I was scratching my head thinking, “But that just doesn’t make sense!” It was only when he said ZOMGLOSE20KILOS that it began to click what he was saying, hah! Totally blindsided.

    Can we expand this little social epiphany to people avoid health care because doctors treat them like liars in general?

    Very true – my Dad is on cholesterol regulating medication and he’s been religious with it (the name of the medication is Bezalip Retard, and because of the ‘retard’ in the name, we have great fun reminding him to ‘take his retard pills’) and when he went to have his cholesterol and blood sugar levels checked, it was on the high side and the nurses didn’t believe that he hadn’t been taking the medication properly. (he’s a thin thing, so the cholesterol isn’t ZOMGURFAT related)

    *middle fingered salute*

  27. Yesterday morning, had my doctor suggest that diabetes or pre-diabetes may be the cause of a pesky skin infection, despite the fact that he has tested me at least half a dozen times in the last several years for diabetes, and I DON’T HAVE IT. I’m 26. I’m just fat, and have a skin infection. He still requested that I get another blood test, which I probably should have refused, but I went with it….. might as well prove him wrong for the umpty-zillionth time.

    I’ve looked for other doctors, but haven’t had any success yet :-P At least learning about FA has made the whole thing less triggering, so it’s not followed by compulsive eating (ZOMG, you can’t tell me what to eat! Watch this, I’ll eat everything in sight!!!!). I just get righteously indignant instead, and write about it on the internet.

  28. I hate seeing any doctor other than my doctor at home. The very worst thing about living in Japan is that no matter if I’m studying or working I’m required to see whatever doctor they care to choose once a year, and the doctor doesn’t say anything at the time, but sends me my results afterward, which are ZOMG YOU ARE FAT STOP IT.

  29. At my first gynocological visit with my student health practitioner in grad school, I could not fit into the gown they gave me (I call them “dignity smocks”). I must not have had my Wheaties that morning, because it didn’t even occur to me to try to deal with it– the practitioner walked in and found me sitting on the table stark naked reading a newspaper. She said something about my comfort with my body being on the level of an artists’ model’s, and I told her that I was more comfortable naked than in the dignity smock because it was too small and afforded me no dignity.

    The next time I had a gyn appointment there, they had a wider range of dignity smock sizes.

    And she really was a great healthcare person for the rest of the time I was at school.

  30. Since I suffer with heavy and over the top painful periods since the onset of my menses at 13 (Im now 42), my body has decided in the last 6 or so years to develop anemia. Every year or two I come down with all the symptoms for it-fatigue, malaise, dizziness, lack of concentration, lightheadedness, etc. It’s been 2 years since I was last treated for anemia. This past Feb I had surgery to have a large fibroid removed from my uterus and hopefully try to stop the tremendous blood loss I suffer monthly. In May, I noticed the anemia symptoms again so I emailed my doctor and asked her to authorize a simple blood test to check for it. After some hemhawing, she decided to let me have the test and sure enough, I’m anemic. So much so that she wanted to hospitialize me and give me a pint or two of donated blood! Uh..no. WHen I came in for the follow up visit, her exact words to me were: “You area very intuitive about what’s going on with your body”. As if I couldn’t possibly be clued in to the inner workings of my own skin. And this from a doctor who doesn’t try to shove down my throat that I need to lose weight every time I see her. I was totally turned off by that comment and now hesitate to continue seeing her again if she thinks that people of size are that out of touch with what’s going on inside of them. Granted, I can’t see my feet when I walk, but that doesn’t mean Im not aware that they are still there! I am as much aware of what is going on with my body as any other person who cares about their body. Just cuz mine carries extra weight doesn’t mean Im disconnected from it.

  31. Tari: I’m taking part in a study on metabolism which wants healthy men and women aged 17-65 up to 20 stones (280 lbs) to provide background control data. I think that’s pretty cool.

    They want a wide cross-section of people without thyroid or other metabolic disorders so they can make better comparisons with their actual patients.

    I’m really looking forward to seeing the results. I’ll ask them about why the upper weight limit though. They’re really good so far about explaining exactly what they’re looking for and how things work and so on.

  32. Regina, unless she said ‘Wow, you’re very intuitive about what’s going on with your body…for a FAT CHICK’ then you may be overreacting. Most people are not, in fact, terribly aware of the signals their bodies send them, so her surprise is pretty natural.

    And not all bodies send signals strong enough to read. I, for example, know all the signs that tell me ‘you’re going to faint’ as opposed to ‘you’re a bit dizzy, it’ll pass. But despite having been anemic in the past, I would have no way of knowing if I’d become anemic again without a blood test. All the symptoms could just as easily be attributed to something else.

  33. Today on cnn .com they had an article about people getting angry at having to wait so long for their scheduled appointments. I totally relate. I was left waiting an hour and a half in a waiting room at the gyno at one point then an additional 45 minutes in an exam room. Then my Dr. didn’t even show up, she left and they swapped out Dr’s without even asking me if I was comfortable with that. I was so angry I have never been back to that Dr. If I did not show up for the appointment they would have charged me extra, but apparently they can not show up and expect you to just deal with it. Turns out they had double booked me with a routine scheduled C section, not an emergency one. Now had they been up front about it when I got there or maybe even 30 minutes after It would have been one thing. But I will never go back to a Dr. that doesn’t even consider their patients opinion or position.

  34. I sympathize, moonlight. Last time I had to see an endocrinologist, I had an appointment at 3:30. I didn’t get into an exam room until 7:00. Seriously, the office had closed, and the receptionists had gone home. I’m just going to try to let my GP and my gyno handle my thyroid and PCOS medications. I don’t have five hours to have an appointment with this asshole. (According to the nurse, he’s often in the office seeing patients until 9! Because he’s so dedicated, you know.)

  35. Regina, I didn’t know I was seriously anemic until the first time I tried to donate blood. The tech was testing to check my iron levels and blood type, and she said I was so anemic she was surprised I was able to stand upright.

  36. JPlum and Nomie…..
    I understand what you are saying about not knowing if you are anemic or not. The first time I ever had it was when I was 23 and had ulcerative colitis in which I lost a lot of blood. I never knew I had anemia at that time and I WAS hospitialized during that episode and received 3 pints of blood because of it.
    Since I have had it in the past, my point was, I am very conscious of the symptoms that lead to being anemic and was put off by the doctor questioning whether or not I could be aware of it. Wouldnt someone who’s had it 3 times in the past 6 years be aware of the symptoms?
    I guess I just hate having my symptoms questioned. I expect a doctor to BELIEVE me when I tell them what Im feeling and have many times been dismissed because what Im feeling MUST be related to my size and not an “actual” problem. Treatment then gets delayed and I am miserable until I develop significant worsening that could have been prevented. I hate taking pills, having tests run, blood drawn or being hospitalized, but if any of those things can keep the quality of my life at the level I strive for, then so be it.
    Two months ago I had to have my appendix out. Because I didn’t have ALL the classic symptoms, I was sent home and told I probably pulled a muscle. 3 days later I am having emergency surgery for a ruptured appendix. It’s BS to dismiss a patient’s symptoms because they are large. Especially when smaller sized people get better and faster treatrment.

  37. I’m having a health issue right now and I need to go to the doctor, but I’m 90% sure that whoever I go see will tell me I need to lose weight and that will fix the problem. I’m just so…. UGH.

  38. I just think you should give your doctor another chance, Regina. I suspect that your experiences with bad doctors is leaking into your interactions with what seems like a good doctor. There doesn’t seem to be any indication that her surprise had anything to do with your weight, so don’t lose a good doctor by projecting your other bad experiences onto her.

  39. Regina, I’ll second JPlum; it sounds like general surprise that could be directed at anyone to me. Plus, now that you’ve “proven” you’re in touch to her, she’ll take you more seriously next time.

    A big boo for the doctors who didn’t diagnose your appendix properly!! A burst appendix is deadly!

  40. I think you’re right JPlum and Piffle. I am probably being a bit gun shy given my experiences over the years. She IS a good doctor for the most part and one I have cultivated a good relationship with. Im sure you can understand the frustration if you had similar experiences.
    Thanks for your feeback! :)

  41. I’m presently at about 175 on a fairly fine-boned 5’8″ frame, and I am grateful that I live in a fat city because neither my primary care physician or my psychiatrist has hassled me about it. Probably because I’m not diabetic, etc. Obviously I’m at the light end of large, but I still weigh more than I feel comfortable with.

    *I* brought up my recent 20 lb. weight gain (because I’d been relatively stable between 145-155 for several years with no attempt to diet) with the shrink and was surprised to find that Depakote/Zyprexa overeating/metabolic messups could kick in even if you’d been on them long-term. He said some of his patients had successfully used Glucophage to counteract those drugs’ weight-related side effects–anybody tried it?

  42. Just a note here about qualitative studies like this one. They’re not just “collections of anecdotes”, and they usually do have realtively small sample sizes. I haven’t read the study or even the abstract, but from the press release it sounds to me as though it was basically a content analysis of interview texts, where the aim is generally to “achieve saturation” (interview people until they stop telling you anything new). You would never do such a study with 800 participants, as one commenter suggested, because the only way not to achieve saturation within the first couple of dozen interviewees is to have a study question which is too vague to be useful.

    You do of course have to be careful about generalising the results of this kind of study, but that doesn’t mean it’s a “stupid” study, nor does it mean that it wasn’t conducted systematically, nor does it mean that its findings aren’t important.

  43. JPlum, i am actually completely with Regina here. It’s true that fatter people are treated so much worse than thinner ones, but actually, the pattern of doctors not believing patients can identify their own symptoms seems widespread to the point of being almost universal. It drives me so fucking crazy (yes, by the age of 29 I actually know exactly what strep and sinus infections feel like, because I HAVE LIVED IN THIS BODY FOR 29 YEARS). There is a SERIOUS problem in how doctors are trained, if so many of them write off any familiarity with your own body as EVIL “self-diagnosis.” Good lord, I hate that term, too (or the condescension with which it’s said, at least). It’s one thing if they just want to confirm, and with a new doctor I especially expect that, but it’s just insulting when a doctor expresses really annoyance and doubt over my ability to know what I’m talking about if I say, “My throat hurts and it hurts the way it always hurts when I have strep, and it doesn’t hurt this way with anything else, so I might have strep.” Or better yet, “I have a yeast infection. I know it’s a yeast infection because I have had recurring ones, and also vaginosis so I can tell them apart, and I can’t use the OTC treatments. Can you please write me a prescription for oral antifungals?” Or oo oo “My leg hurts.” etc. etc. etc.

    Summary: Any doctor that does this is not a good doctor, in my book, and that’s true no matter what size you are. My new PCP has proven herself to be pretty bad in this way, and as soon as I can find another doctor in the area that accepts my insurance, I am anxious to switch. I’ve just found that it takes serious shopping to find a doctor that is okay if I ask questions, can describe my own symptoms, and want to be treated like a fucking adult.

    Regina, I have UC, too! Heh, maybe this is a common problem among people with chronic illnesses. We know our shit. ;-)

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