Fat, Health at Every Size, Medicine

First, Do No Harm

The response to Thorn’s beautiful series of guest posts was overwhelming. I’ve rarely gotten so many comments on a Shapely Prose post as I did on her first post, outlining how a doctor’s callous words led to the death of Thorn’s mother.

So when I was about 11 years old, and Mom went to see her doctor because of some problem she was having, and he scathingly told her that her problem was she was fat, and not to come back to him until she’d lost 50 pounds? Yeah. It hurt her. It hurt her bad. But she believed in the rules. And so she tried to ignore how hurt she was and focused on trying extra-hard to get back to following those rules…

Having been unable to meet her doctor’s demand that she lose 50 pounds, she followed the only part of his stated rule that she could: she didn’t go back.

From that point on, whenever she got sick or injured and someone suggested she go see a doctor, she brushed them off. “Oh, they’re just going to tell me I’m too fat. Don’t worry, it’s just a cold/a sprain/a whatever. I’ll be fine.”

If you haven’t read the whole post yet, go do that now.

And if you haven’t read the comments, which are full of heartbreaking stories about the way doctors treat fat people, I’ve collected some of the highlights here.

I have PCOS and am overweight. My husband and I had serious infertility and loss issues. I was told by several OBGYNS to lose weight and I’d get pregnant. If only it was that simple.

I wish that the medical community would read this, and really take it to heart. They must be reminded of the words they swore to uphold, “First do no harm.”

I went through a disturbing incident last winter when my husband, Jeff, suffered two bad falls on the ice in less than a month. The orthepedic surgeon he was referred to didn’t want to write him out of work or even do an MRI because he was just looking at my husband has a fat, out-of-control man who he couldn’t help at all until he lost 130 lbs! Jeff weighed at that point 350 lbs, the doctor ordered him down to “at least” 220 lbs before he could really treat his condition!

Fortunately, he was referred to a physical therapist who was very good to him, and rather than view him as lazy, viewed him as one of his most hard working and dilligent patients. He was the one who insisted that Jeff take some disability time for his recovery. My God, the man could hardly walk, he simply was in no condition to make it in until he had a chance to heal from the accidents! But that one doctor just wanted him to go to work like that, as some kind of punishment for being fat.

I’m glad Jeff is better now, but I won’t forgive that doctor for the shabby way he treated him anytime soon.

My mom has been getting very sick over the years and refused to go to the doctor because she didn’t want to be belittled for her weight. But I have a wonderful doctor so I pressured her and pressured her and she finally went to see her a few months ago. Afterwards I asked her how it went and my mom just started crying, “She was just so…kind…”

That was the first time she’d seen a doctor since walking out of the hospital after giving birth to me 28 years ago.

My father’s discomfort with going to the doctor (a lot of which has to do with his weight) resulted in undiagnosed lung cancer. Luckily, it was successfully treated with surgery, but he’d probably had this for over a year before it was discovered.

I would toss a “just wow” into the ring, but unfortunately this outrageous crap is all too common. My MIL met a similar fate, not going to the doctor when she was panting like a German Shepherd just walking to her car, and when I told her that was NOT “normal,” she said she wasn’t going to bother going to the doctor about it because when she mentioned it to him before she’d just gotten the “lose weight and it will go away” lecture. And next thing I knew, she was dead.

My Mom died a few years ago, and your post is making me revisit all of the fury I had with her doctor, all the while thinking, “Well shoot — at least when she could afford health care, maybe I should be glad she went to the damn doctor.”

My Mom struggled with her weight and smoking her whole life. When I was really young, our family doctor “helped” her with her weight “problem” by prescribing “diet pills” (speed, to which she became highly addicted) to suppress her appetite and Valium (also addictive) to help her relax from the speed. To say that it made her moods erratic would be quite the understatement, and was pretty confusing to us kids!

Later on in her too short life, she would only visit a doctor (who was a friend of a friend) who she felt wouldn’t shame her about her weight and smoking because he was a heavy man and a heavy smoker. I am by NO means saying he was a bad doctor because of those things — but she had a bureau full of pills pills and more pills and then pills to counteract the side effects of those pills (blood pressure, diuretics, blood thinners, inhalers and fucking Vioxx) so I was pretty concerned. Any attempt to talk to her about getting a second opinion was met with “No, I know what they’ll tell me.” And I have to wonder … if I had been magically able to get her to the best doctors in the world (whatever the hell that means) would she have been able to put down her defenses and then listen to their advice? Shit, I’ll never know. But I do know that fighting with her about it until her (suddenly) last day was not the way I would have preferred to have our relationship play out.

Even though I am a fat activist with a supportive partner who comes with me to doctor visits, and even though I have told each and every one of my doctors, in writing, that deliberate weight loss efforts are not going to be part of my treatment plan, they bring it up anyway. One comment about my weight or one momentary disgusted look on a doctor’s face will add months to the period between visits. I know they are my employees, but the societal pressure for me to feel that they are authorities over me is really strong.

And if it’s this hard for me, I know how much harder it must be for people who don’t have the fat-acceptance knowledge I have. Something really must be done. I wish I knew what.

What also resonated with me, though–and my own mother’s experience–was the part about “following the rules” and dieting, only to find that the rules didn’t work. My mother tried everything to lose weight, including two stomach stapling surgeries. She was lucky enough to have a sympathetic doctor she liked and saw on a regular basis, but her body went through a lot over the years and through all the efforts.

She never learned to be healthy at her size. She didn’t eat well or exercise because for her these things were punishments that didn’t “work” since she couldn’t lose/keep off the weight. When she got cancer she wasn’t in a very good condition to fight it, because by then, failed dieting and the weight problems that came with it had convinced her that her body was a lost cause.

I hate that. I’m still angry about that. I can’t be angry at a doctor or point to any one thing that should’ve been different, that would have given her more time. But I’m angry that fat has been so misunderstood so many years, because that ignorance definitely took its toll on my mother.

I remember bursting into tears at the doctor’s office about 10 years ago…because she was kind to me. Simply kind. She did a comprehensive physical and asked about all sorts of things not related to my weight. For the first time at the doctor since becoming fat, I felt like I was actually receiving health care, not just scolding for being fat. It was so transformational to be treated with care and kindness rather than hostility and shame, I was overwhelmed with emotion.

My mom had a similar experience. She went to a (male) doctor for her severe depression, and he told her it was just PMS and he couldn’t help her. She didn’t have the confidence to stick up for herself and tell him it was more than that, so she continued to suffer for 20 years… until I started suffering from depression, and saw a (female) doctor who prescribed me Prozac. I convinced her to see my doctor and she got on medication that’s really helping her. But 20 years of depression because some sexist ass assumed any problem with a woman’s mood must be PMS. I’m not a violent person but I want to hurt that man (and the one who was dismissive of Thorn’s mom, what the fuck is wrong with doctors?)

The scariest part is, you just described me.

Your post describes the precise reason that I stopped seeing a “regular” doctor — I now visit an MD/ND — a male, which is a surprise for me — because he doesn’t give a rats ass about my weight — he cares about helping me to be healthy.

Insurance doesn’t cover most of his services, but I’m healthier than I’ve ever been in my life, with his help, and it’s been worth every penny out of my pocket
-Portly Dyke

It’s been eight years since my aunt died and I still get pissed about it. She was fat too, about the same height and size as your mom. She’d been having pain and symptoms for a looong time, but never went to see a doctor (and she worked in a fucking ICU!!! She saw doctors every damned day!) because she didn’t want them to tell her it was all because of her weight. She was treating her symptoms on her own, taking samples from work. And then, when she was 42, she had a stroke. And even when she was having the stroke, she still wouldn’t go to the hospital. She had talked to her brother that morning, told him she wasn’t feeling well. He was concerned, so he asked their other brother to check on her that afternoon. And so, nearly five hours after her stroke started, her younger brother gets her on the phone, hears her slurred speech and freaks out. He gets her to the hospital, but by then it was too late. She died less than a week later, after having another series of strokes that left her pretty much a vegetable.

They found out, via autopsy, that she had an undiagnosed autoimmune disease. It was causing her blood to clot and destroying her blood vessels. She’d likely had it for years, up to as many as 20 years, undiagnosed. If she’d been diagnosed? The treatment is one pill, one small, stupid, ridiculously inexpensive pill, once a day. But she wouldn’t go to the doctor, because she was so very ashamed of being fat.

Doctors tried to do the same to me, too. I’d been sick for years, but they couldn’t find anything wrong with me. Just told me I needed to lose weight and learn to relax. Gave me antidepressants. For years this went on and finally? I got tired of putting myself through it. So I stopped going to doctors too. And then my aunt died and, once I got over being horribly sad, I got mad. Extremely mad.

And I finally, finally found a doctor who would listen to me. (And yes, like so many others, I started to sob in her office because I was so expecting her to dismiss me.) And within a month, I was diagnoised with Lupus and Fibromylgia. My test scores were so high initially that they were afraid I was having organ damage. Years and years dismissed and it onlly took two doctors who were willing to listen to me, to treat me as a person, to figure out what was wrong and to start fixing me up. So now, six years later, I’m back to being healthy and happy. It’s just a shame it took my aunt’s death to get me here.

About 10 years ago I went to see a strange doctor whom I’d picked out of book when I changed jobs and got new insurance.

I had just lost 20 pounds. He looked at me and said, “you didn’t gain all that weight through immaculate conception.”

I cried all the way home.

What I have to add doesn’t parallel it in severity obviously, but I thought I should add my own experiences to the discourse. I’ve suffered from a rare and life-threatening respiratory disease for nearly ten years now (since I was in my late teen years). While I always struggled my weight, I crossed the 200 lb. mark due to steroids. Once I got truly fat, I couldn’t get doctors to take my disease seriously anymore. I was literally passing out from lack of oxygen at one point because they refused to acknowledge the severity to which my breathing had become compromised. All they could see was the weight *that they had caused me to gain.* Although my graduate school performance never suffered in terms of grades, the in-class difficulties I faced were never excused because I was – let’s face it – considered ugly. Life was hell. When I got a spot of melanoma, I had a doctor leave a ragged, keloid 5-inch scar with stitch marks (prone to infections and splitting open) instead of using a skin expander like she should have because, what did it matter? It would be covered with clothes. God forbid I ever want to take them off in front of someone. I’ve been starving myself at about 600-800 calories for several years to get to a low weight where my collarbones and cheekbones pop and my stomach is flat. I’m not underweight, but I look thin now (calories in, calories out, my ass-I should be invisible). My disease, at this weight, makes me look nearly as sick as I am, all black circles and veins and frailty. And, finally, I get proper medical treatment without judgment. In other words, I have to hurt my body to get it help. Nice world we live in, huh?

I’m 54 years old, ‘morbidly obese, and I haven’t seen a doctor in four years. The last time I went was when I had taken a six mile hike, gotten covered with tick’s and developed Lyme Disease. By the time I got to the Doctor, I’d been running a 102-3 degree fever for almost two days and my blood tests came back with elevated liver enzymes. Immediately, and despite that I had saved all the ticks that bit me, he said the spike in liver enzymes was due to chronic gall bladder disease secondary to morbid obesity. He wanted to take my gall bladder out! But since I’m a nurse and it was my dime, I told him to treat me for Lyme and (to be on the safe side) ehrlichiosis, another tick-borne disease. Grudgingly, he did so. Voila! A week later I was nearly 100 percent cured and a month later my liver panel showed normal values across the board. I remain fat, healthy and active to this day.

What fat woman hasn’t gone into a Doc’s office only to hear him say, “You know, you’re very overweight!” It doesn’t matter what you’re REALLY there for, whether you have poison ivy or tennis elbow or got a piano dropped on your foot! No, no, the first thing the Doc has to tell you is that you’re FAT. Like you don’t already know. Like you’ve lived in a house without mirrors for fifty years and never caught a glance of yourself.
“Gee Doc, but for you I would never have known I was fat. Thanks, Doc, from the bottom of my fat, old heart.!”
-Maggie Kamp

This is the exact thing that scares me, my mother is about the same size yours was. She is always depressed, talking about herself (in reference to her weight) as ‘a giant waste of space’ like nothing she does is meaningful because she’s fat. She’s a smoker, a drinker, and one of those people that spread themselves so thin they barely have time to think. Everytime she tries to fix one area she magnifies another problem, she tries to stop smoking and gains more weight, she tries to lose weight and ends up working even more, she tries to work less and ends up drinking and smoking more.

Every doctor she’s ever been to has told her that she needs to lose not 50 but 80lbs. So like your mother she doesn’t go to the doctor unless her problem is serious, the last time she’s been to a doctor was when she had an ear infection that she let get so bad it affected her balance and couldn’t walk without the room feeling like it was spinning. The first thing the doctor said to her was “Ma’am you seriously need to lose weight.”

My sister had a horrible time with lots of doctors when she was bigger- she was in and out of hospital for a long time before she got a doctor who took her seriously (probably because that doctor was also quite big).

I’ve just qualified as a RN, and having seen what my sister went through, I swear I will *never* treat any of my patients like that, whether they’re overweight or have any of the the problems commonly thought of as “self-inflicted”. Unfortunately, despite the mandatory ethics course, I can’t say the same for all my classmates.

I am about your mother’s size and it is difficult to live in a world that has decided that you are bad because your body is out of style. I am so lucky that my slender little doctor is not a fat hater, never tells me I need to lose weight because she can see that dieting doesn’t work for me. How I wish that your mother could have had a doctor like mine.
-Maya’s Granny

And if you complain about leg pain (a college problem I had), you are told “well, you are 100 lbs overweight…” and no one ever checks to see if there could be another problem, because being 100 lbs overweight wasn’t exactly a new condition in my life!

My mom’s death was also preventable. A week before she died of an aortic aneurysm, we took her to the emergency room because she was short of breath and her face was greyish. She mentioned that she’d run out of her thyroid meds and was told “Well, then you’ve gained some weight and it’s making it hard for you to get your breath.” And she was handed some samples and sent home.

A week later she was back with crushing chest pain, but her EKG was normal (it wasn’t her heart after all). She was retaining water severely, short of breath, and her chest had a bluish tint. All symptoms of a bleeding aneurysm. She was given lasix and put in CCU for observation. 24 hours later she was dead, and no attempt had been made to find out WHY her chest hurt and she couldn’t breath. After all, she was fat.

This is the “obesity crisis,” people. Doctors neglecting, terrifying, dismissing, and misdiagnosing people because all they can see is fat. People in pain and suffering, too afraid to go to the doctor, because they know they’ll be scolded and shamed for their weight — and whether they’ll actually be treated is much less certain.

My own story is nothing compared to these, but I’ve got one: when I fell down some stairs and twisted my knee, the best pain management advice my doctor had for me was “lose weight.” Same doctor once said, “So, what are we going to do about your weight?” while giving me a breast exam — ’cause that wasn’t a particularly vulnerable moment for me or anything. And I’ve never even been over 200 lbs.

If you aren’t outraged enough yet, check out some of the stories at Fatshionitis.

Stef, the fat acceptance activist quoted above, maintains a list of fat-friendly health professionals and tips on obtaining good health care. These are amazing resources, but the need for them is tragic and shameful.

Anybody want to tell me again how fat people don’t take care of themselves and burden the system with their doctor visits?

14 thoughts on “First, Do No Harm”

  1. I’m a little late to this one, but I wanted to share my story. After years and years of being overweight, I went on a crazy (anorexic-like behavior) “diet” and lost 75 pounds in 9 months. I was working out hours a day to achieve this loss. But I was still in the “overweight” category.

    I started having aches and pains in all my joints and muscles, which usually were worse after working out. Every single doctor I saw (and I saw many, trying to find one who would be sympathetic), said, “well, that’s what happens when fat people exercise – you’re so out of shape, you’re bound to hurt yourself. You need to lose some weight, then it’ll stop hurting.”.

    What the fuck? I’m working out 2 hours a day and have just lost 75 pounds, and you’re telling me I’m too fat to exercise without it hurting!???

    So I stopped working out. And gained all the weight back. And the pains got worse and worse. Back to the doctors I went. Of course, this time, I got the “well, you’re really fat, all that added pressure on your joints is causing the pain. You need to lose about 100 pounds”. Never mind the fact that BEFORE I lost the weight in the first place, I never had any pain.

    So, I toughed it out for 3 or 4 years. The best I could get out of doctors were some steroids, which made my weight balloon even more. The pain got worse and worse.

    Finally, I couldn’t take it anymore. After tons of research on the internet, I self-diagnosed myself with fibromyalgia. I found a local clinic that specializes in treating fibromyalgia, and got on the waiting list. Within 3 minutes of my first visit, the 2 nurses were crying in sympathy over what I’ve gone through. Finally, I’d found someone who “got” it.

    I have a classic case of fibromyalgia, and it’s often triggered by traumatic physical/emotional stress. It’s very likely that my “diet” and obsessive exercising CAUSED the fibromyalgia to appear.

    These awesome nurses sent me to physical therapy to work out in a warm water pool. On my first visit, before taking any medical history or even weighing me, the PT gave me a 10 minute lecture about how I “wasn’t too young for a heart attack, given how overweight” I am. She cautioned me that she would only be able to help me a little bit, because my real problem was my weight, and my heart disease and stroke risk (even though I don’t have ANY other risk factors for those disease, except the weight).

    Needless to say, I found a new PT.

  2. I’m a little late too, but it reminds me of my daughter. She has a rare genetic syndrome that has effects similar to autism. People with this syndrome have a tendency to be overweight as well. Anyway, she was put on Risperdal (an anti-psychotic) in order to deal with her uncontrollable and violent behavior. One side effect of this medication is it spikes appetite and weight gain. She gained a lot of weight way too fast. Which, of course, was a concern for her neurologist, who was prescribing the meds.

    But that was the only thing he wanted to talk about in our meetings. We’d bring up behavior issues that were threatening the family as a unit, anger outbursts, the fact as a family we were crumbling because we couldn’t address her outbursts. But he brought back every conversation back to her weight gain. To him, it was the only issue that needed addressing.

    Eventually, we found another doctor. We moved her to a medication without the weight gain side-effects. Yet, the new doctor, while keeping an eye on her weight, would actually respond to us when we talked about managing her behaviors.

  3. I am in the thick of being mistreated and misdiagnosed by doctors regarding some serious health issues. I have been told repeatedly that my fat is the problem. Dieting and exercise are not making me skinny or making me better. I am done dieting. I am willing to eat for health, to keep my blood pressure low, whatever — but never again just “to lose weight”. I need to be treated, not given bullshit excuses. I’m angry and frustrated, and I don’t want to go blind or lose my toes!

  4. Thanks for linking to my fat friendly health professionals site. I got several new recommendations as a result, including the second one ever for Kansas.

  5. We train doctors on everything except how to treat people. It’s like going to the IT help desk for your body, except I feel more warmth and sensitivity from the tech support guy. Oy.

  6. Wouldn’t it be fabulous if there was a book which presented a look at attitudes of doctors to fat people in western society, where lots of fat people supplied anecdotes or perspectives. It would be such a valuable eye-opener for doctors-in-training, and a useful motivational tool for fat people to stand up and start demanding the treatment they need from their doctors (y’know, the “human being” treatment).

    There’s a start right here…

  7. This is going to continue, I think, until some brave souls sue these fat-hating doctors for malpractice. At the very least, we should be very meticulously documenting when we’re treated dismissively and reporting it to the AMA or whatever appropriate organization.

    It is absolutely inexcusable for these doctors to be neglecting their patients’ real health problems as a punishment for their being fat. It’s malpractice, plain and simple.

    I’m fortunate enough that, now that I am unafraid to advocate for myself, I have a compassionate primary care doctor. If I didn’t, though, I’d be more than happy to lead the crusade.

  8. I have had PCOS for 41 years. I was normal until about 10 years ago when I finally had children (after 12 years of infertility treatments) and then I got quite sick. I have fibromyalgia and a host of overlapping syndromes.

    But, about 5 years ago my marriage finally imploded – it was bad and my ex-H is very abusive. After years of my begging for him to come to counseling with me – he dragged me to a Marriage counselor himself. She was very rude about my weight and told me if I would lose weight and wasn’t disabled my husband would treat me better. She acted like I smelled bad and she was very rude – even told me “abuse” was a buzzword and implied no man would ever want to sleep with a fat woman.

    I kept praying my ex would start dating her. No such luck!

  9. This is also a little late, but I thought I’d throw it in anyway.

    I hit puberty early, and was my height now at twelve and wearing a b-cup when most girls were still in training bras. But I didn’t start my menstrual cycle until I was almost sixteen. And after less than a year of spotty periods, it stopped altogether. I was frightened and worried about what my mother would think. And since I was at an age where I no longer needed a pediatrician, I was uncertain about who to turn to; especially after the first doctor my old ped recommended to us said “She’s awful heavy for a girl her age.”

    For almost a year-and-a-half, I went without a period and without seeing a doctor. Finally, at eighteen, I told my mother what had happened and her (being in the medical field at the time), jumped on the horn and found me a doctor…and then another one…and then another one. You see, every doctor I went to said “She just needs to lose the damn weight and exercise.” Now I had put on a substantial amount of weight for no apparent reason. I mean, I ate tons of veggies and not only had a full-time job (in high-school nonetheless), but did karate and theatre as well. I was active, I ate right (not all the time, true, but a lot better than most of my other friends), and I was still heavy. Not to mention getting more and more depressed by each doctor we saw.

    Eight doctors later, (yes eight, I counted), we finally were referred to a specialist ob/gyn, who took one look at me, and one look at my chart with numerous, ridiculous, and pointless tests, and said “Honey, you have PCOD. We’ll get you on birth control and glucophage to balance out these levels and you’re going to be just fine.” I nearly cried. She promised that as long as I kept being active and took my meds that my weight would drop and I’d feel better. Eventually I found a doctor who treats me with respect, always is courteous, and never comments about my weight unless I bring it up.

    Another little anecdote is when I went to see her about an infection, she was on maternity leave and the doctor they set me up with was the coldest person I had ever met. He didn’t look at me the entire time he spoke to me, didn’t shake my hand on entering, and when I described the symptoms (it was a lady-parts problem), he asked if I had been sleeping around. I told him I was with one guy and that we were monogamous, but hadn’t used protection. He rolls his eyes and writes a script. Doesn’t examine me, doesn’t ask me anything else, just leaves the room and instructs me to pay at the front.

  10. My story is pretty mild compared to some here but it’s 5 years ago and I’m still fuming.

    It took years for me to be diagnosed with PCOS, I was sure I had it as I ticked all the symptoms but I just kept getting told “you’ll grow into it”.

    Anyway a new doctor sent me for tests including an ultrasound and bug surprise I have PCOS. I’m then sent to see the consultant at the hospital. Once I finally got my appointment I headed in to find this man being treated as something approaching a deity. A woman (she never explained exactly what her role was though she wasn’t a nurse) ushered me in and quietly, while he made no eye contact, explained to him whi I was and gave him my notes. I sat there feelign rather like a lemon.

    After looking at my notes for a few minutes he looked at me enquiringly and asked why I was here. I said something along the lines of I’ve been diagnosed with PCOS, I;ve been sent to see you to talk about next steps. He said, well there’s not a lot we can do, you could try losing some weight and doing exercise. I explained I was eating healthily and exercising and gaining weight.

    He then asked if I was trying to get pregnant. I said, no not right now, but my periods were really painful (when they came) and I was rather hirsute and trying to lose weight and I had read about this drug caled metformin which seemed to be helping women with PCOS.

    He said he didn’t believe in prescribing it for women with PCOS and I should come back and see him when I wanted to get pregnant. He then kind of stared at me in a way which I read as – you may go now. So I did. And I’m cross with myself I didn’t try harder to argue but I was 22 and intimidated and it seemed like there was nothing else to do.

    Insult to injury, my periods are still really painful, I’m still pretty hirsute. However discovering FA has helped me ditch dieting ( I was never very good at dieting anyway – food just tasted too good and meh life’s too short for guilt) and remind myself how much I adore me.

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