For Fat Patients and Their Doctors

If you are here for the evidence list, it’s at the end of the post!

Two patients have high blood pressure.  One is thin, one is fat.

The thin person goes to the doctor and receives recommendations for interventions that, evidence shows, are likely to lower blood pressure.  When that person goes back for a check-up, the doctor will test their blood pressure to determine if the interventions are working.

The fat person goes to the doctor, and there is a greater than 50% chance that the doctor will view them as awkward, unattractive, ugly, and noncompliant, and a nearly 30% chance that the nurse will be “repulsed” by them.  (All of the evidence is linked at the bottom of this post)

The doctor recommends weight loss to “cure’ the high blood pressure, but does not tell the person that 95% of the time people gain all of their weight back within 5 years, or that some methods of weight loss are likely to make the high blood pressure worse. The doctor also doesn’t explain that weight loss is not guaranteed to lower blood pressure even if they are in the 5% who successfully maintain weight loss. Rather, they tell the patient that everyone who tries hard enough can lose weight permanently. When the patient goes back for a check up, the doctor puts them on the scale to test their progress.

There are a few issues to explore here with respect to the doctor’s behavior with the fat patient:

The first is the concept of evidence-based medicine.  Based on the evidence that we have, there is no reason to believe that this patient can lose weight long term.  Often doctors try to explain this away by citing the evidence of correlation between fat and various diseases (“but being fat is so bad that’s you should try to lose weight no matter what the odds!”)  It does not matter what issues fat is correlated with, because we don’t know how to make people thin in the long term. Saying that we do is a lie, whether it’s intentional or not.  If your doctor tells you that weight loss works, ask her or him to produce a study where a majority of participants were able to maintain a weight loss of the amount that she/he is recommending for you, for 5 years or more.  They will not be able to do so.  Prescribing weight loss has no efficacy basis in evidence.

The second is an issue of diagnostic criteria.  When we use weight as a stand-in for health, we are putting a middle man where we don’t need one.  We can test a patient’s blood pressure, give evidence-based interventions to lower it if it is too high, and then test the blood pressure again to see if the interventions are working. It doesn’t make sense to prescribe a body size intervention for a health problem.

Prescribing weight loss for high blood pressure is like prescribing weight loss to cure cancer. (the difference being that weight is simply a body size and cancer is a disease, but it still makes an apt comparison in terms of the way that they are both used in modern medicine).  Although we are aware that the treatment for cancer often leads to weight loss, we don’t tell cancer patients that weight loss will cure their cancer.  When they come in for check-ups we don’t weight them to measure the efficacy of the treatment.  We understand that with cancer interventions weight loss is a side effect.  It’s the same with treatment of high blood pressure, diabetes etc.  It’s possible that the behavior changes that are recommended for disease intervention will lead to a change in weight, but that’s merely a side effect, it’s typically temporary, and it’s not a proper diagnostic criteria or efficacy test.

The third issue is of informed consent.  Going back to the cancer example, a doctor can recommend a risky procedure to treat cancer.  They must tell the patient the odds for success as well as possible side effects and what happens if it fails, and give the patient a prognosis.  They do not tell patients that anyone  who tries hard enough can beat cancer. They also have to let them know if there are other options. Then the patient makes an informed decision.

A doctor can prescribe weight loss, but informed consent would require that they let the patient know that it only works 5% of the time, and that includes people who are only trying to lose a few pounds.  When we talk about dramatic weight loss the figures drop even lower. They also have to let them know that there is a great deal of evidence that shows that healthy habits lead to healthy bodies regardless of weight.  They cannot correctly tell the patient that anyone who tries hard enough can lose weight – that’s not supported by the evidence. They should also inform them that these diseases happen to people of all sizes, but that patients of a lower weight who present with the same symptoms are given a different treatment plan, and explain that plan as an option.  Their fat patient may now make a truly informed decision.

Your doctor may not be making these mistakes intentionally.  He or she may not know about the studies that I am referencing here. All the same, the evidence is there and we trust doctors to be working from the principles of evidence based medicine, proper diagnostic criteria and informed consent. We should be able to go to the doctor with the expectation that they will not make these mistakes, but that is not the situation in which we find ourselves.  So, as my friend Darryl Roberts is fond of saying, we must be the CEOs of our own health.  (Or as I am fond of saying, we must be the boss of our health underpants.) If we are to get good healthcare we must be informed and steadfast in our requirement that doctors treat us based on the evidence.  Most versions of the hippocratic oath include a phrase to the effect “I will not be ashamed to say “I know not.”  If your doctor is still making these mistakes and is surprised to hear about this research, then now is the time for them to invoke that.

Here is the research, including quotes from each piece:

Research about the failure rate of dieting:

Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J: Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer (link goes to article)

http://www.ncbi.nlm.nih.gov/sites/entrez/17469900 (link goes to study)

“You can initially lose 5 to 10 percent of your weight on any number of diets, but then the weight comes back.  We found that the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority. Diets do not lead to sustained weight loss or health benefits for the majority of people…In addition, the studies do not provide consistent evidence that dieting results in significant health improvements, regardless of weight change. In sum, there is little support for the notion that diets lead to lasting weight loss or health benefits.”

http://www.academia.edu/4796404/Tomiyama_A._J._Ahlstrom_B._and_Mann_T._2013_._Long-term_effects_of_dieting_Is_weight_loss_related_to_health_Social_and_Personality_Psychology_Compass_7_12_861-877._doi_10.1111_spc3.12076

We believe the ultimate goal of diets is to improve people’s long-term health, rather than to reduce their weight. Our review of randomized controlled trials of the effects of dieting on health finds very little evidence of success in achieving this goal. If diets do not lead to long-term weight loss or long-term health benets, it is difcult to justify encouraging individualsto endure them

Miller, WC:  How Effective are Traditional Dietary and Exercise Interventions for Weight Loss

“Although long-term follow-up data are meager, the data that do exist suggest almost complete relapse after 3-5 yr. The paucity of data provided by the weight-loss industry has been inadequate or inconclusive. Those who challenge the use of diet and exercise solely for weight control purposes base their position on the absence of weight-loss effectiveness data and on the presence of harmful effects of restrictive dieting. Any intervention strategy for the obese should be one that would promote the development of a healthy lifestyle. The outcome parameters used to evaluate the success of such an intervention should be specific to chronic disease risk and symptomatologies and not limited to medically ambiguous variables like body weight or body composition.”

Methods for voluntary weight loss and control. NIH Technology Assessment Conference Panel

A panel of experts convened by the National Institutes of Health determined that “In controlled settings, participants who remain in weight loss programs usually lose approximately 10% of their weight. However, one third to two thirds of the weight is regained within one year [after weight loss], and almost all is regained within five years.”

Bacon L, Aphramor L:  Weight Science, Evaluating the Evidence for a Paradigm Shift

“Consider the Women’s Health Initiative, the largest and longest randomized, controlled dietary intervention clinical trial, designed to test the current recommendations. More than 20,000 women maintained a low-fat diet, reportedly reducing their calorie intake by an average of 360 calories per day and significantly increasing their activity. After almost eight years on this diet, there was almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm)”

Field et. al Relationship Between Dieting and Weight Change among preadolescents and adolescents

“Findings from this study suggest that dieting, and particularly unhealthful weight control, is either causing weight gain, disordered eating or eating disorders; serving as an early marker for the development of these later problems or is associated with some other unknown variable … that is leading to these problems.  None of the behaviors being used by adolescents (in 1999) for weight-control purposes predicted weight loss[in 2006]…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors, including significant weight gain…Our data suggest that for many adolescents, dieting to control weight is not only ineffective, it may actually promote weight gain”

Studies about healthy habits leading to healthy bodies

Matheson, et al:  Healthy, Lifestyle Habits and Mortality in Overweight and Obese Individuals

“Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index.”

Steven Blair – Cooper Institute

“We’ve studied this from many perspectives in women and in men, and we get the same answer: It’s not the obesity, it’s the fitness.”

Glenn Gaesser – Obesity, Health, and Metabolic Fitness

“no measure of body weight or body fat was related to the degree of coronary vessel disease. The obesity-heart disease link is just not well supported by the scientific and medical literature…Body weight, and even body fat for that matter, do not tell us nearly as much about our health as lifestyle factors, such as exercise and the foods we eat…total cholesterol levels returned to their original levels–despite absolutely no change in body weight–requiring the researchers to conclude that the fat content of the diet, not weight change, was responsible for the changes in cholesterol levels.”

Paffenbarger et. al. Physical Mortality:  All Cause Mortality, and Longevity of College Alumni

“With or without consideration of …extremes or gains in body weight…alumni mortality rates were significantly lower among the physically active.”

Wei et. al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men

Research about doctors perception of fat patients

Rebecca M. Puhl and Chelsea A. Heuer The Stigma of Obesity -  A Review and Update

“In a study of over 620 primary care physicians, >50% viewed obese patients as awkward, unattractive, ugly, and noncompliant. One-third of the sample further characterized obese patients as weak-willed, sloppy, and lazy.”

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Published in: on April 21, 2012 at 9:28 am  Comments (38)  

38 CommentsLeave a comment

  1. And there is of course the also possibly unintentional side effect — after being burned a few times by doctors who prescribe weight loss for issues that cannot possibly be related to one’s weight, it is unlikely that one will choose to deal with that again until the situation is truly dire.

    Especially since you just know they’re not just going to treat the condition or issue you go in there for. No, they’ll have to test your blood pressure and your blood sugar and anything else they can think of, cluck at you about those numbers for a while (even if they’re bloody spot on NORMAL, you get the lecture because they’re clearly going to change any second now and kill you dead), and then they’ll theorize thirty ways your weight could have caused your illness/injury, followed by sending you hope with a prescription for weight loss instead of anything actually useful that they’d give a thin person with the same issue.

    Why even bother? I can save $500 and just go be fat in public. Same shaming, less expensive.

  2. Thank you so much for linking to the studies. I often see you quoting statistics from these studies but it’s extremely helpful to be able to read them directly.

    • ^ This. :)
      This entry will be bookmarked for the next time I need to fend off “but you can lose weight if you eat less and move more” nagging, or have to deal with another ignorant doctor. I wish I’d had it years ago when an anaesthetist fat-shamed me during a difficult labour then visited me in recovery to assure me I could “jog it all off” once I’d recovered from the emergency c-section! What a sanctimonious git he was!

      • Yes, I really really appreciate it when people cite their sources. It makes it so much more believable, and it’s so important to be able to check sources.

        On that note, I would request that you include the full citation (journal, year, authors) in your reference section, not just linking to the abstract/article (linking is fine in the text itself). I don’t have time to click on every link, so I usually scan an article and see which citations seem most interesting to look up, then follow up with those. Having the full citation helps with that, and also is more professional-looking.

        Just a suggestion to make things even better. You already do an awesome job; this is one way you can take it to the next level.

        • Hi,

          Thanks for the suggestion. I completely understand what you’re saying but to be completely honest I’m not likely to do it. I prefer to link to the studies and if people are interested they can click through. I’m happy with the level of the blog and I’m much more concerned with being accessible and un-intimidating than appearing professional or academic. If you decide that you want to post the links with the full citations I’ll be happy to link people to your blog though!

          Thanks!

          ~Ragen

  3. I have wanted a list like this to take with me when I see new doctors for awhile. It is invaluable! Thank you!!

  4. I love your posts!! On this same note, I can say I am over 200 pounds. I have more lean body mass than my skinny friends, lower cholesterol, lower blood pressure, better blood sugar numbers, and can tolerate exercise longer. Why do doctors still view skinny people as “healthy” and overweight people as “unhealthy?” I beg to differ. I am currently running circles around one of my workout buddies who weights 80 pounds less that me. Doctors need to wake up. Their bad advice is getting old.

  5. I wish I could clone my doctor and give her to everyone. Last year, I had some health issues, including constant stomach problems, fevers, and changes in my blood pressure and heartrate. My doc never even once suggested weight loss as a “cure.” She sent me for all the right tests, and she was so respectful. It turned out that I was suffering a constant low level of chronic illness because my son went to school for the first time and was bringing home germs. My body wasn’t acclimated. My doctor helped me figure it out by treating me the person, not me the fat person. We determined ways to boost my immunity, and I mostly just had to ride it out. My son was having all the same symptoms, and he was also checked for everything (including mono). I’m in great health now, as is my son. But I doubt it would have had a happy ending if I’d been told that I just needed to lose weight. I wish all doctors were as compassionate. It makes me do angry when I hear these stories about how others have been treated.

  6. Thank you for this, the timing couldn’t be better for me. I’m seeing a new doctor in two weeks for headaches that have been rather constant for a few months. I already have three other conditions (psoriasis, psoriatic arthritis, and Hashimoto’s) that I see other doctors for on a regular basis and although I’m not thrilled with having to see that many doctors, I’m at least comfortable with them. So while I’ve been waiting to see a neurologist for my headaches, I’ve been doing some crack internet doctoring and the thing I think I have is frequently blamed on obesity and I’ve been totally preoccupied with how the new doctor is going to treat me. At least now I’ll have some defense.

  7. Thanks for compiling all of the studies and links!

  8. This is why I fear the day when my doctor retires. I had have issues with cholesterol, and at the time I went in to review my cholesterol numbers, I had actually lost a few pounds. When I mentioned this to my doctor, he told me that yes, he noticed, but that my weight wasn’t what concerned him, it was my high cholesterol numbers. He did suggest excercise and a low fat diet as a way to help, but he had also given me a prescription to take as well. He told me diet was only a small part of my cholesterol problem, and that most of it was genetic.

    In the same visit he also mentioned that he tells his thin patients that they can’t expect to eat all the junkfood they want and still be healthy just because they’re thin.

  9. I had an infuriating conversation with an orthopedic surgeon yesterday. He had done two knee replacements on me six and seven years ago. Five years ago I was in a very bad car crash and broke both lower legs and crushed my right ankle. Since then, I’ve had increasing pain and lessened mobility in my right knee. I went to see a couple of local orthopedic surgeons but they referred me back to the original surgeon, who works at the Mayo Clinic, because of my weight and because I have diabetes.

    The Mayo Clinic surgeon called me yesterday and basically told me that since I hadn’t lost weight since he saw me last, that he wouldn’t do surgery on me again. I told him that weight loss was his goal for me, not my own goal for myself. I started to give him the 95% fail rate of dieting and he cut me off.

    He said he didn’t know much about obesity and dieting but since I would probably wear out my replacement again (just the plastic needs to be replaced) and I’d be in the same situation or a worse one. He even threatened me with losing my leg. Inwardly, I laughed. I had been told over and over again that I could lose my foot or leg after the car crash, through the nine surgeries I endured. – I worked hard and I put up with infection after infection in the process. I didn’t lose my foot or my leg.

    Anyway, here’s a surgeon castigating his patient for not accepting a treatment that fails 95% of the time. So now I’m looking for another excellent surgeon who won’t be so negative about my size. Any suggestions? I live in Portland OR but will travel if necessary.

    • I have no suggestions, but could you please post here (or comment at my blog) if you find someone. One of my friends is in a similar boat (complicated by the fact that her knee replacement was some experimental thing that they don’t do anymore, so it’s weird). I’d love to be able to tell her of a doctor somewhere who won’t just use her weight as an excuse not to mess with her tricky knee.

      • Dr. William Wilson at Swedish Orthopedic Institute did my hip replacement last year. He also does knees. I will say that he wanted me to get under 300 lbs before he would do surgery (from 335) but he was very respectful about it and was able to cite studies on increased risk of infection at higher weights. I was willing to take the risk but did lose the weight while i was waiting (and of course regained most of it after). I would recommend him without hesitation, and hope to have him replace my other hip later this year.

  10. It’s ridiculous. My best friend and I see the same doctor. I go in for a scratchy throat and the doctor is practically lunging at me with a blood test needle because she’s positive that I’m diabetic (I’m not). My thin friend goes in with actual symptoms of diabetes and she’s told to stop drinking so much coffee. No blood test. WTF? I wish that doctors realized the potential damage they are causing with this attitude.

  11. Well said! I address this with my patients all the time, and have done a piece with the same message many months ago: http://dropitandeat.blogspot.com/2011/04/lies-theyre-feeding-you-about-your.html I hope to do some speaking with residents to make a dent in how they get educated to improve the experience of patients like your readers! Great piece.

  12. Just a quick note, when you go to the Dr., and he/she blames your hangnail on being fat, just ask them how they would treat a thin person for the same condition and go from there. In addition, I know of more than one case being overweight has kept a patient alive through a serious illness or cancer

  13. During my last pregnancy, the same medical practice that had provided shadow care for the first two was convinced en masse that THIS TIME I was going to fulfill their dire prophecies, develop gestational diabetes and extremely high blood pressure, explode, and die. So when I refused the glucose tolerance test, they had me in to test my pee every week for signs of the dreaded diabetes. Meanwhile I was feeling more and more debilitated and achy, with weird orange pee. I mentioned this. I was brushed off. The midwife did her own low-budget pee test with a paper strip and a Dixie cup and she caught the urinary tract infection that would have put me in the danger zone for miscarriage if it got any worse. Any word of apology from the practice for being so obsessed with my fatness that they didn’t bother to screen for real dangers? Pshyeah right.

    Oh, and three fast births, all at home, everyone is okay.

    • And, yes, the practice was looking at my urine samples every single week and nobody in the lab stopped to think, “Wow, orange pee? Maybe the fat lady has something wrong with her besides her obvious bad horrible icky fatness. Maybe we should test for infections.”

  14. Thanks for citing all these original articles; I’ll bookmark this post as a reference for future discussions.

  15. Thanks Ragen for some more wonderful posts, sometimes I don’t go online that often(slow computer/lap top)and read 2 or 3 in one go. I was going to comment that I was surprised to read about a radio (BBC)personality, older woman here in the UK write about her personal dieting in a newspaper article. But why am I surprised, plus the paper is at the home of a friend’s and not one I would buy. She is in her 50′s I think and said she had gone on the “Dukan” diet and had lost 5 stone(sorry don’t know the equivalent, but 1 stone is 14 lbs) and she had gone from 19 stone to 14 stone and was really pleased. But guess what, she has now put all the weight back on about a year later I believe. But even worse than this she has now decided to go on the Weight Watchers diet but not physically attend a “class” as she said “she couldn’t face it” and had lost some weight again and felt it was more re-educating her eating habits. but I personally felt she was protesting too much and was trying to justify it.

    I have to admit I am really surprised at this particular woman doing this newspaper article(under “health” section, of course!)as she was someone I respected and thought she was above this kind of thing, but I was wrong! I get passed this particular paper’s Sunday supplements by this same friend and while I mostly enjoy what’s in them, most weeks the magazine part has some kind of dieting article, always aimed at women and it really aggravates me. Last week, one of the articles was about women who had lost quite a bit of weight but who strangely were surprised that their lives didn’t suddenly become better, one even said she thought she was more fun before! The previous week there was an article on weight loss surgery and the different options available. Actually I was concerned about a comment from a “consultant” in this(not clear on his medical credentials)and wondered what you or anyone else thought on this?

    He says “In fact research shows that for anyone weighing more than 16 stone, metabolic(or bariatric)surgery is medically safer and healthier than staying big”.

    I personally buy an Irish paper locally that is ordered in on a Saturday and though I enjoy reading about “the old country” the magazine supplement with it has many weeks under “health” got some story about diets/weight loss and usually tied in with celebrity women. It really does aggravate me and perhaps I will have to reconsider getting them?

    Marion, UK

    • Marion, check out the site http://junkfoodscience.blogspot.com/
      Scroll down and you’ll see there is a series on bariatric surgery. The author’s evaluation of mortality statistics shows that bariatric patients have a higher risk of death, and they also have higher medical expenses. They just trade one set of health issues for a different set.

      • Thank you so much Ragen for your reply to my recent post about that awful article in a newspaper supplement here in the UK about weight loss surgery and comments made by a “consultant”, I think(unclear who he is&more to the point, what his interest is?)I have just had a brief look at the site and it looks really interesting, so have bookmarked it to come back to later and for future reference. I feel we are constantly being lied to and manipulated by Governments and money making companies about food and weight loss etc, The truth is out there, we just have to find it and no where to look or know someone who does-like you! Marion, UK

  16. This post came at a really great time for me.

    I’m 25, 95kg, obese and I have high blood pressure. I have a family history of it so it’s not surprising. I went to a new doctor last month and, after hearing about my family history and taking my blood pressure, the first thing he did was prescribe weight loss. Even after I told him that I eat well, limit junk food, and exercise regularly (to which he replied “Exercise doesn’t have much of an impact on weight”). He was really patronising about it too, saying things like “It’s about picking the low hanging fruit; don’t have the second bowl of ice cream or extra bit of cake, that sort of thing.”

    I know when I go back, it’ll be brought up again and I’ll have to confront him about it. Thanks for arming me with these studies, Ragen.

    • I would suggest making a “Yelp” page for your physician or calling the insurance agency and complaining about the patronizing behavior. I also suggest that unless said physician has done full blood panels on you and is also registered as a nutritionist, he should shut up about “knowing” what will make you lose weight.

      Doctors should be your allies- after all, you pay them to help YOU. If they’re not willing to do that, perhaps they ought to have one less patient.

      • PS: You may be able to switch to a newer more size friendly doctor if you ask the practice if you have any “size friendly” physicians. Often, the office staff will know the doctors who are the best with larger patients without being disrespectful or using diet talk.

        You can also shut them down by having them put in your chart “Do not discuss dieting and/or weight loss options with this patient. Patient must be diagnosed the same as a thin patient.” If someone tries to disrespect these wishes, tell them to refer to your chart.

        Remember, YOU are in control of your health care- and the second the doctors convince you that they’re the experts just for wearing the white coat, you are in trouble.

  17. Thanks for the cites. I’ve also heard that weight loss surgery has only a 7% “success” rate, altho’ i don’t know the source of that stat, nor how “success” is measured. (And we know how expensive and highly risky it is, to boot….egads! All that for a big 2%?!?)

  18. Thank you for writing this , I just found you through Voluptuous Vixens ,and reading this reminded me of a knee injury I had. I told the doctor I was having problems with my knee and it hurt on occasion . He basically told me to lose weight , and now a few years down the road I was still having problems with it. When my mom and I were at the circus and I complained about it , my mom said I probably have arthritis in my knee from the injury it makes sense. I wish my doctor had told me that and not my mom.

    • That is interesting. I’ve been having knee problems for years which my doc said was from being fat. But I’ve fallen on and down stairs loads over the years, all of which have bunged up my knees. My right knee I call my “rice krispie knee” since it cracks and pops so much.

      I didn’t know arthritis could be caused by injuries.

  19. Hey!!

    I just spent about 20 minutes looking for this article on your blog, because I seem to need to have an argument with my therapist about HAES. It would be useful if you had a link on the front page or in the sidebar to “Evidence,” or some such, to make it easier for folks like me to point to a clearing house of information on why dieting makes no sense.

    Thanks!

  20. I have had such a hard time finding a doctor because of this sort of thing. The few doctors i’ve been able to work myself up to seeing have been awful. The most recent one prescribed me blood pressure medication, EVEN THOUGH my blood pressure was smack dab in normal (especially with me freaking out and being nervous) just because i was fat and she said “well, it may be normal now but this is probably a fluke, so i want you to take these.” When I told her I was not interested in being told to lose weight, she said “This is a wellness clinic. If you will not attempt to be well, then I cannot be your doctor.”

    That same doctor also seemed incredibly surprised when I told her my knees were fine, and I didn’t have any pain in my legs. She kept asking me if i was sure, or if i had gotten used to it.

    I just really wish there was a way i could go to the doctor and not be diagnosed before they even talk to me. It’s made me too stressed to go to other doctors now.

  21. Reblogged this on Free psychology and commented:
    This doesn’t pertain to the topic I usually write about here, but I thought it very informative and useful. Please be sure to read to the end, and check out the research studies cited.

  22. Just saw this on Yahoo News – I have heard this before. Really sad.http://ca.shine.yahoo.com/blogs/shine-on/worst-weight-loss-trick-ever-tapeworms-180748489.html

  23. Reblogged this on THE BODY PRINCIPLE and commented:
    A very well researched article … love the phrase ” we must be CEOs of our own health”.

  24. I’m 5’10 and the last time they weighed me at the Dr’s (I refuse to have a scale in my house) I was sitting just over 255 pounds. I had my annual check up. My blood pressure in just below “normal”, my blood sugars are perfect, my good and bad cholesterol are right where they should be. Am I overweight? Yes. Am I healthy? Yes. Could I stand to get a little more exercise and drop a few pounds for the sake of my aching feet that are horribly abused in at my retail job? Heck yes.
    But I am healthy. My Dr (and his PA) have both told me that I don’t need to be overly concerned with my BMI and that if I find myself wishing to lose a significant amount of weight and if I need help to let them know, but otherwise I am healthy overall. My husband and I have been together for almost 7 years, he tells me I’m beautiful several times a day. My three boys (8,10 and 13) aren’t embarrassed to be with me at the swimming pool and on the rare occassions I don’t go in with them they get mad at me “just put your swimsuit on and GET IN!”
    I”m thankful to be surrounded by people that love, appreciate and accept me without the condition that I must be thin as well. And in fact, the ONLY time I get frustrated about being a size 18/20 is when I’m shopping because for some ridiculous reason the people that design women’s sized clothes think we want to look like we just skinned an african animal or like we’re the most recent addition to the crazy cat/puppy/bunny lady club. I’ve learned to avoid certain stores Walmart/Kmart/anyskinnypersonstoreinanymallanywhere to prevent myself from thinking there is something wrong with me because I must either starve myself to fit into nice clothes or subject myself to wearing things that are ugly and don’t fit right.
    If a person is healthy and happy with themselves, who cares what they weigh.

  25. I was in tears as I read this tonight because your opening lines are exactly what happened to me. They are why I haven’t seen my doctor in 2 years. They are why I have debated with every illness or injury if going to see my doctor was worth getting the “you haven’t done enough to loose weight and your blood pressure won’t get lower until you do…walking isn’t real exercise, you have do to cardio” lecture. (My husband, 90 lbs heavier, gets the “you’ll have to stay on cholesterol lowering drugs until you loose weight” lecture, but is told that he only needs to “walk for 30 minutes each day.”)

    Last week I stupidly started to run/jog downhill in 10 lb ankle weights and ended up with a level 2 hamstring pull/tear according to the hours of research I did online. Had I not had such constant fat shaming at the doctor’s office, I would have gone in immediately. Instead, I waited until the next day to see if my leg had gotten worse or if it was simply yet another injury I could treat at home. The pain had lessened, the bruising wasn’t too bad, and so I didn’t go in.

    I didn’t have to go and face what I feared – being told that I hadn’t lost enough weight, even though I HAD lost 15 pounds in the last 2 months. Only those pounds were what I’d gained after the last time I was there. The time the doctor didn’t know I was eating only 1/2 an apple and a few cucumber slices, desperate to not get the lecture, only to get it anyway because HER scale said I was still morbidly obese at 225 and “wasn’t doing enough” and that’s why my blood pressure continued to be high. (I swear my bp jumps just going in.) I was now 230 at home (her scales always show me at more.) I wasn’t ‘good enough” to be seen by her and in my mind, I won’t be until I’m thin.

    I didn’t have to try and futilely explain that I’m now far stronger and have more endurance than when I was skinny. That I am more fit than my 16 yr old, 130 lb son. That I managed to work up in just 2 months to running/jogging, for short stretches of time. Something I never could do when I was skinny and dealing with constantly sprained knees, and had worked myself into believing that running is something only thin people can do. I wear ankle and wrist weights (well, not anymore after this injury) at the request of hub and son so they can try (and fail) to keep up with me on family walks. I also lift dumbbells because I love seeing my biceps get bigger (kneading homemade bread had always kept them in shape) and I try to ignore the skin hanging down underneath. :) I workout in ways I want to for ME. It started out as a way to loose weight, but now it’s a rush of “look what I can do that I never could when I was 20 years younger and thin as rail!”

    But to the doctor, I felt like none of this would matter. I would still be her morbidly obese patient who obviously wasn’t trying hard enough to loose weight and therefore reduce her blood pressure.

    And I write all of this at 5:30 in the morning with my leg wrapped in ACE bandages, elevated by blankets, forced by necessity to stay off the leg as much as possible for the next 3-5 weeks, only slowly, slowly working in stretches and short walks, careful not to re-injure the muscles again because all the literature says that a 2nd tear is highly probable and could be worse if proper care isn’t done the first time. (Hub had to go in for his own problems, mentioned my leg, and the doctor confirmed it.)

    Lastly, I write this as a person who is (as evidenced by a conversation I had with a thin person last Sunday) seen by the world as a fat person who got injured because they were fat and if they had only been thin it wouldn’t have happened, even though every medical article I read mentioned only that it’s an injury that athletes and athletic people get. And of course the reality was the injury was caused by a physically fit, overweight, person doing something stupid – trying to run downhill in 10 lb ankle weights.

    • Can you research and find a new doctor? It sounds like yours doesn’t get you or your symptoms. If it’s not possible to find a new, more sympathetic one, consider writing your doctor with your version of Hanne Blank’s letter to her doctor, shaping it to fit your situation. Of course, this is meant to be handed to a new doctor, but it has the right tone to it.

      http://cat-and-dragon.com/stef/fat/hanne.html

      • Thank you. :) I read your reply and started searching for another doctor. Turns out a new (overweight) friend likes hers and the doctor is not only overweight herself, but has never had the attitude of “everyone of your problems is related to weight.” I’m calling tomorrow to see if she accepts new patients. While my leg seems to be healing, I want to make sure there’s nothing else I should/should not be doing and to make sure it’s healing correctly. Plus, I’ve missed out on so many typical “wellness” things a person my age should have done, not to mention dealing my high bp.


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