If These Guys Can Get Healthcare

Bad DoctorIn response to my blog about “really fat people“, many people commented, e-mailed and facebooked me to let me know that they had an experience where a doctor refused to treat them because of their BMI and insisted on weight loss prior to working on them. Many people who contacted me were told that it was simply impossible to properly diagnose someone of their BMI, or that treating them is a “waste of time” since they are likely to re-injure themselves anyway.  One woman was told that, at 5’4, 250 pounds, she was simply to big to get an MRI.

I find that interesting because last week the following people received the absolute best medical  treatment, including in some cases MRI,  with no discussion of weight loss at all:

6’2, 308 pounds   – knee injury – “class 3 obesity” (Super Fat!)

6’4, 285 pounds – arm injury – “class 2 obese”

6’4, 263 pounds – ankle injury – “class 1 obese”

6’3, 260 pounds  – achiles injury – “class 1 obese”

These are, in fact, just a handful of “obese” people who were afforded evidence-based medical care for injuries without being required to lose weight and despite the fact that they are very, very likely to re-injure themselves. These people are Jerel Worthy, Justin Smith, John Abraham and Terrell Suggs and the thing they have in common is that they all play in the National Football League.  As of 2012 there were 352 players over 350 pounds. Every week during football season hundreds of guys who meet the BMI qualifications for being obese, including “super fat”, are given high quality medical treatment.  Apparently if you can  play football we can find an MRI machine that will fit your 6 feet tall 350 pound ass but if you’re a 5’4 250 pound woman we just can’t get it done.

Now, I’m not suggesting that there is no difference physiologically between a professional athlete and someone who is not a professional athlete, regardless of size. I am also painfully aware of the amount of money that people are willing to pay for medical treatment of professional athletes versus those who do something other than throw, catch, kick, and run for a living.   My goal is simply to point out that a doctor saying someone’s BMI category makes them untreatable, or that a risk of re-injury is a contraindication to treatment, is disingenuous.

I also think it highlights some of the major issues that stem from the amount of weight bias among doctors and those planning to become doctors.  I would personally like to see more healthcare professionals at the forefront of activism to help fat patients.  I would like to see more of them railing that they have sick patients and they don’t have the tools they need to treat us.  I would love to see them fighting for the right to use whatever MRI is used for the defensive tackle on the nearest NFL or College Football team.  I would like to see a word where fat people and our healthcare professionals are fighting against the problems that prevent us from getting good treatment, not healthcare professionals insisting that fat patients are the problem.

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Published in: on January 15, 2013 at 9:30 am  Comments (52)  

52 CommentsLeave a comment

  1. Good Morning Miss Ragen,
    I just have to tell you about my daughter’s experience at the doctor yesterday. Usually my daughter, who has spina bifida and is fat, is told by her doctor that she needs to lose weight. I have been reading your blog and was all too ready with quotes from you to have a discussion. The doctor surprised me though. My daughter is 4’8″ and 187 pounds. She has lost 7 pounds since her last visit, not because of trying to lose- but due to a change of medication (getting rid of one that was causing lethargy) and because of my families focus on health and movement of late. The doctor asked her how things are going lately. My daughter admitted to watching tv whenever I wasn’t around to motivate her to move (which is a lot since she is 19 and I have a full time job). The doctor didn’t mention the weight loss, didn’t tell her that she was obese, didn’t quote her usual speech about her bones not being able to carry her if she continues to be obese, etc. She focused on the health benefits of more movement, and the great things that healthy eating would do for her (more energy, better digestion, improved mood, etc). I was impressed. So much so that I asked why the change of script. She said that so many parents had complained about their children were leaving and feeling badly about themselves, that her old speech was actually having the opposite reaction that she hoped for. She said that someone had brough HAES to her attention and she believed that HAES has the outcome that everyone wanted. My daughter left this doctor’s office with the best attitude that I have seen in a while, coming out of an appointment. So, keep up the good work. Remind people that their voices can create change, as yours has done.
    And don’t tell anyone that I am a little let down that I don’t get to argue. I wish I had been that parent that had been braver earlier.

    • EVIDENCE IN ACTION!!! Oh, I LOVE this doctor. It’s a mark of true maturity when one is teachable as an adult. Her patients DO matter and that’s fantastic!!

      • I have tons of respect for a doctor who is able to see and openly admit that she was wrong and change her work accordingly.

  2. I am 5’3″ and about 270 – 280 lbs and when I went for an MRI there was no mention at all about my weight. Either as a cause for the joint pain I was getting, or as an excuse for not giving me the MRI. This was in the UK so it was under the NHS.

  3. I had an MRI when I was around that weight. No mention of problems either. However, the reason I had an MRI was because apparently I had “too much fat for a conclusive ultra sound”.

  4. I’m 5ft 4 and about 260lbs, my physio told me that there is nothing wrong with my joints (after a cursory examination not appropriate to my condition) and my pain and fatigue (which is due to a connective tissue disorder) is due to me being “so unfit” and overweight. She told me I didn’t need any specific exercises and should “focus on cardio and weightloss”. Funny how she can tell I am very unfit and inactive just by looking at me!

    A friend with the same condition has lost weight to get her BMI below 25, and she has been told that since she has “done everything she can to help herself” they will refer her to a rheumatologist.

    Without appropriate physio and support my condition will continue to deteriorate. I am not denying that my size doesn’t help me, having weak connective tissue it is true that it puts extra strain on my joints and I am already at higher risk of osteoarthritis due to the condition. But surely I should have the same support that a thin person would get, regardless of my size or ability to lose weight! I am not able to lose weight, so should I be barred from treatment forever? And how am I supposed to do cardio when I am in constant pain and have joints that shift out of place painfully?

    • Screw the cardio and go for very low-level weight training. I know there are some personal trainers in the room. Anyone have any suggestions or thoughts?

    • Really, your size has very little to do with any of it. There is a slightly higher risk of osteoarthritis in the lower extremities earlier on in larger people, but as we age, we are ALL at risk of osteoarthritis. Many of the things that are said to be “fatty” diseases are actually diseases of aging, that we all become at increased risk for.
      People with very slender phenotypes are at higher risk for osteoporosis, but you don’t see them being berated and told to gain weight.
      I have fibromyalgia. I’m fortunate that I work in a place that has a therapy pool, which I can use after hours. If you can find a place where you can work out in a pool, whether it be a health club or a health care facility that allows the public to use their fitness center, you might try it. Working out in the water puts a lot less stress on joints than traditional land based exercise and yes, it is equally as effective. There are actually books out there with water exercises. Look up “Dr. Jane Katz” on Amazon.
      If you can’t find a facility with a pool, you might consider yoga. Of course you may have already done some of these things. I’m just going off the top of my head.
      Your doctor is, unfortunately, an asshat. I hope you can find one that isn’t, but I know sometimes that’s not possible.

    • Dude, I’m 5’6″ and weighed about 375 pounds when my doctor suggested (no official referrals needed with my health insurance) I see a rheumatologist. I advise you to insist that you be allowed to see a rheumatologist. You’re your own best advocate (I think Ragen’s said), and I wholeheartedly believe that. Don’t let them give you any bull crap. You know what you need, so speak up so you can get it. (And if I seem terse/abrasive, it’s not toward you; it’s toward your idiotic docs who can’t get past their own weight biases.)

  5. I’d be curious to see how the breakdown of medical costs for obesity look if you remove those who play professional sports and who’s treatment is due to their profession, not their size. It would also be interesting to see the base cost versus what was paid ie, how much it would be if health were not a profit based industry.

    I’d also be interested in seeing the cost differences between prompt treatment of conditions versus waiting until people lose weight or get desperate enough to see someone despite being afraid of weight shaming.

    I suspect prompt, compassionate, evidence based healthcare would reduce a lot of costs.

  6. This is just sad! How can doctors be so biased? I remember going to a doctor and him telling my father that my back problem can be cured by weight loss (not even bothered to prescribe exercises for my back).

    All while making fun of me that I’m ‘thick’. Of course I got yelled at by my father in the car because I look bad (he didn’t even bother to worry about my ‘health’ and he is obese).

    The thing is that I have never gone to a doctor about this since then. I know it’s stupid but I was too humiliated. It’s not that bad but still.

    Besides, what alarms me is that so many doctors use BMI and never question its scientific accuracy.

    Maybe it’s the system, maybe it’s the mentality but I think it’s both.

    • AAAAHHHHHH!!!!!!
      You can’t “cure” back pain with weight loss! Particularly if it is caused by herniated, slipped, or fractured disks! This doctor is an idiot.
      One can strengthen one’s back by doing targeted exercises, which can lead to reduced back pain if there isn’t a more serious underlying cause.
      I don’t blame you for not going to the doctor after that. I know it’s irrational, but I haven’t been to a gynecologist since my son was born. He’s almost 23 now. I have a history of sexual molestation, and I can’t bear to have anyone fishing around down yonder.

      • I can’t stand the gyn either. I went when I had to due to bleeding issues. They said it was cancer, when it turned out not be to cancer, they said it was because i was fat and I should have WLS. Turns out, it was low thyroid, only took another 10 years to get diagnosed and treated. I’m going to be hard pressed to go back to the gyno. (I also have a history of sexual molestation).

        • I have underactive thyroid too. I feel your pain there! It’s really more of a pain in the butt than anything else. Nonetheless, it’s been hard to regulate. And when it comes to periods, I don’t bleed, I hemorrhage.

      • So sorry to hear that! I feel for you both, Cie and kprofou. The thing is that he also made me stand there without my bra in front of another doctor and a nurse and I felt like everyone was judging me. I’m still so very self conscious.

        I actually asked him what could I do for my back but he never bothered. I hate it when they do that! I even went to a private clinic for skin problems and was treated like crap, my own opinions ignored.

        Exercises do help alleviate pain. I did aerobics and stuff but I admit I need to start exercising seriously. It’ll also keep my depression from coming back.

        As with the gyno, as long as it’s a woman I feel less embarrassed and more OK with it although it all depends on the doctor. Some have no clue how to talk to patients.

  7. As somebody who has worked in health care management for the last 30+ years, I can assure you of one thing…when it comes to getting care, if you have enough money to spend, you can get anything you want. You can get a doctor to come to your house. You can get an MRI on demand (ever notice that when a pro baseball player gets hurt in a game, he has an MRI, like, 10 minutes later? Do they have a machine and a radiologist waiting in the parking lot?). You can earn yourself a hospital stay for conditions the rest of us would have to suffer out at home (George HW Bush just got out of the hospital, where he spent weeks getting treated for bronchitis. I get bronchitis at least once a year. I might get to take a day off from work and stay in bed. At home). Ever notice how many celebrities are hospitalized for “exhaustion”? How exhausted have you felt sometimes? Anybody get offered a nice hospitalization so you can rest up? Nope, I didn’t think so. Anyway, great post, Ragen.

  8. I’m 5’5 1/2″ and 222lbs, a few years ago I had to see a doctor because mine was on holidays and I was having horrible at the time what I thought were period cramps, now this isn’t anything abnormal for me to need perscription pain meds for my cramps now and again.

    So I explain to this guy what I am pretty sure it is and what my doctor prescribes for it. This jackass looked at me and said “Well I can tell you right now, if you lost weight, you wouldn’t be having such horrible cramps, besides the fact all PMS symptoms are all in your head.”

    I just looked at him and said “Yes because you know having this problem since I was 12 and feeling like my uterus is turning it’s self inside out is all in my hard!”

    A month later it was worse and I went to the ER because I was actually vomiting and was told by that doctor that I needed to lose weight to help my back injury and to help stop the acid reflux.

    Went to my doctor the next day because I couldn’t believe what I had been told, told him what happened and he looked at me poked around my ribs and my gut and said to me “I have a feeling it is actually your gallbladder, I am setting you up for an ultrasound and here are some T3’s to manage your PMS cramps.”

    Few hours later I ended back up in the ER, I was told it was my gallbladder and the next day I was told if my gallbladder didn’t come out I would die. Both doctors got yelled at by my doctor and my surgeon because they could have killed me all because they couldn’t see past my weight.

    • Head. Not hard. Autocorrect is great.

    • I was not overweight as a teenager (although I had bulimia and body dysmorphia and thought that I was horribly fat) but I had heinous, heinous, heinous menstrual cramps. Menstrual cramps have nothing to do with size. This idiot should be keelhauled.

      • I’ve been overweight since I was 8/9ish because I hit puberty early, but didn’t start my period until I was 12, and it got to the point I was out of school for 3-7 days a month. Since being on birth control when I was 17 (turning 24 this year) it has been better but I do get them now and again still, and when I had my gallbladder attacks it was competely and utterly horrible. The strange part was the gallbladder attacks only happened around the time I started my period. The day I had surgery I started my period on the table.

  9. The real trick is finding a facility with an open MRI vs. a closed MRI. My co-worker, who has spent more than her fair share of time in MRI machines, says that she’d be amazed if closed MRIs could fit someone heavier than 200 pounds.

    I wonder what the price difference is between the two machines? If an open version is not that much more expensive, then people should “fire” their docs until they purchase an open machine. They would then also be able to scan people with claustrophobia.

    • I live in Canada so price may very and all dollars are in Canadian money.

      My friend needed a MRI and because there was a back log due to having renos done on the hospital’s he was told he could go to a private clinic and spend between $950-$1000 for an in closed MRI or get an open one for $1500-$3000.

      • I think the OP meant, how expensive would it be for the clinics to purchase an open MRI versus a closed version.

    • I nearly had a full-blown panic attack when they tried to suck me into one of those. I was partway in and just kinda freaked out. The open ones are MUCH better.

      • I’m very claustrophobic. I know they’d have to sedate me to put me in a closed MRI. Agh! I’m getting the willies just thinking about it!
        My late father was also very claustrophobic. He was a big man, well over six feet tall, and before he had the stroke, about 225 pounds.
        The doctor wanted him to go for an MRI because of some of the symptoms my father was describing but my father couldn’t bear the thought of getting into one. I think the medical professionals dropped the ball, because they didn’t tell him that he could be sedated. Nor did they mention open MRI. He had the stroke in 2004, and I’m quite sure they had those then.

    • I don’t know the cost differential, but I’m 5’6″ and certainly more than 200… I’d hazard to guess 220-230 and have had 2 closed one open MRI. I must say I much rather prefer the open MRI. My nose was probably less than an inch from the top of the machine (or so it seemed) when I had to do the closed MRI for my back. And there was very little clearance from my arms to the side. I most definitely felt like a sardine…

      I’m not claustrophobic, but it was hard to remain still without being able to stretch between scans, and I was in there due to horrible back pain. Trying to get off of that skinny little sliding table was actually the worst part of the scan. I was laying flat on my back, of course. I have degenerative discs and at the time one was hitting my sciatic nerve. I don’t know how many of you suffer from such pain, but getting up from lying flat on my back is really painful when my sciatic nerve is “engaged”. I generally find a way to roll to my side before attempting to get up. Rolling is not an option on that skinny little table, thus getting off said table was tantamount to torture. The tech was a really really small younger lady who lacked the arm strength and height (for leverage) to help me. She did what she could, but she was not strong enough to appropriately assist me. In retrospect I should have asked her to get more assistance, but I couldn’t think clearly enough to do so.

  10. I was watching the Seahawks v Falcons game and one of the commentators was marveling how fast one of the heavier players was. Ticked me off.

    I realize it isn’t directly related to weight and health care, but even football players can get dissed for being ‘heavy’ despite the fact that football players are supposed to be big guys and still be able to run.

    • That’s acutally really common. I often feel like tossing something at the screen when they do that.

      Another interesting thing that has been bugging me… These guys get this access to top medical professionals and then those professionals sometimes “let them down” by allowing them to return to play before their bodies are ready.

      From this last weekend a good example would be Gronkowski of the Patriots. Friggin playing with a fractured forearm then landed precisely on that arm with all his weight when trying to catch the ball. He now will undergo more surgery.

      Then there’s RG3 of the Redskins. The doctors and coaches did him a disservice by allowing him to go back on the field on multiple occasions. Of course the kid wants to play… but if he shouldn’t–get him the hell off the field! Take away his helmet, take away his shoes… something!

      • Yeah, encouraging anybody to do an activity before they are completely healed is nonesense. That is the downside of making money.

        • Actually, much of the time it’s the athlete who is chomping at the bit to return. They want to be out on the field. Not only are they competitors but they are afraid of being ursurped by the back up. Regardless of the sport, coaches and the doctors have a role in ensuring an injured player does not go back out on the field, no matter how much he or she wants to.

          I find these instances where the doctors sign off too early with regard to the return to play a little like the sycophants who prescribe unnecessary prescription drugs to stars (look how that worked out for Michael Jackson and Anna Nicole Smith). Maybe they are bullied by the status of the star athlete or coach, but I still think they should get a piece of the blame.

        • BTW, I hope I didn’t/don’t go overboard on this… I really love football and have been quite unhappy with some unnecessary re-injuries/furthering of injuries this year. They play a dangerous, contact sport. I get that. But they have excellent medical care readily available to them!

          • I didn’t think so. I know part of it is the players pushing to go back in. They can’t make the big bucks if they can’t show their stuff. The whole professional sports system seems to be messed up.

            • Good to know! Last thing I want to do is make any enemies here–I love this blog!

              I worry about anyone who is denied good health care, either because they are one of we normal folk who happen to be fatter than others or if we are star atheletes who are put in danger by their doctors/coaches.

              I am not a health professional, but several members of my extended family were/are. They have difficult jobs. I can only hope that they all perform them with the utmost of care and compassion.

    • On the Kelly Ripa and Michael Strahan show this week, they were fat-shaming the football players with big bellies by mocking how tight their jerseys are. Strahan did redeem himself, though, by making the point that it is ridiculous that the Miss America contestants were given much longer to show off themselves in their bikinis than they were to answer the interview questions.

      • This is so annoying to me!!! I mean, come on! Michael of all people should know just how athletic every single one of the players are on those teams. Ugh. I understand Kelly not necessarily getting it, she will run with something whether it’s appropriate or not, but he’s her conduit to the Football world!

        Sorry, I love football, have since I was a little girl. Had we been allowed to play back then… :-)

  11. I’m 5’9 and currently weigh around 350. Back in 2005, I was having knee pain and my leg would lock and stiffen while walking. I decided to have it checked out. I had to have an MRI. It was an open one and I fit in there just fine. I was about 330 at the time. Turns out my knee had slight internal bruising. At the time I was a nursing home activities assistant and on my feet almost all day five days a week so I’m sure I injured it while at work. Luckily, I wasn’t fat-shamed at all. I also had a great experience when I had to get ultrasounds for my gall bladder and later,to check my uterus for fibroids. I had gall bladder surgery and the surgical team had no issues with my weight.

    Except for one time when I went to see a new doctor at my office for a viral infection and she decided to focus on nothing but my weight, forgetting while I was there in the first place (she is no longer there so I don’t have to worry about her) I’ve had decent doctor experiences. But I get so tired of hearing about others who almost die or have to suffer because their doctors refuse to treat what’s actually wrong, and instead try to cure it with weight loss. Weight loss is not the magical cure-all for every fat person on this planet. If I have the flu, a diet isn’t going to fix it!!!!

    • A little off topic here – I wonder if it’s because of your height? I’m 6’0 and 370. The only 2 times I’ve had troubles with doctors or nurses was when they didn’t know me (new fertility doc who greeted me with WLS pamphlets even though I weighed almost the same as when I had my daughter, nurse in the ER who lectured me while I was laying down. Ironically, she was telling me I needed to start exercising and I was in the ER after falling down the stairs at 5 am on my way to – wait for it – the gym! You’d think the workout gear would have been a clue!). Anyway, I wonder if being a taller fattie intimidates some of these people who seem to get off talking down to people since they literally can’t talk down to us! Just a curiosity thing on my part.

      • I don’t know about intimidation but I believe sometimes my height gives me a pass from the brunt of public shame because as I’ve been told quite a few times, I’m in good proportion because of my height and now I take that to mean “you look more visually appealing as a fat person than someone who is your weight but shorter.” You just don’t know with people anymore.

        • My husband the joker says it just means our boobs are in eyesight and half the population gets distracted! :)

  12. For the ladies that have trouble going to the gyno because of molestation, I wonder if it would help if the doctor invited a female PA or nurse in during the examination. Not to observe, just to be in the room. My doctor does that and it does feel oddly better.

    • Holy SHIT where are you that this isn’t already a required practice?! Where I live, all providers MUST have someone else in the room while doing gyno exams unless the client specifically requests otherwise!

      • I’m in Seattle. As far as I know, it isn’t a requirement, and I have had unattended paps/breast exams.

  13. Don’t forget that you don’t have to see a doctor to have an annual pap smear etc. Midwives absolutely do GYN work as well as catch babies, and they are covered under most insurances. Letters after your name don’t guarantee sensitivity of course, but most of the time, midwives tend to take more time and be more gentle in pap smears and pelvic exams. I know I’ve had better GYN experiences with most midwives than with most OBs.

    NPs (Nurse-Practitioners) and PAs (Physician Assistants, not the med aides who take your BP but medical professionals who have extensive training and are basically mini-docs) also do GYN work, and many are women. When I don’t see a midwife, I see a NP for my GYN needs.

    I think it really helps to remind the care provider that you are a sexual abuse survivor before the exam. Ask them to tell you what they are going to do beforehand and to be as gentle as they can, or whatever it is that might be most helpful to you.

    • Lovely advice!

    • That is good advice. I may think about it. Still embarrassing, considering that nobody ever goes “down yonder” except me!

    • I had a great experience with a NP, sadly she is not longer covered under my insurance (until I get mine through work). I still was not comfortable enough for them to do a exam, but at least she didn’t try to rush me. I don’t recall any weight loss talk either.

  14. One thing that would be absolutely essential to getting better treatment in a medical setting would be if medical schools actually required all students to attend a lecture by a fat person explaining their POV about how they are treated, from seating in the waiting room to prescribing WLS for a sinus infection, and so forth.

  15. I live with two athletes who are large: both are 6’5″, one weighs (“a fit”) 300 pounds the other 240. The quotes are from his pediatric cardiologist. My larger son is HUGE! Broad doesn’t even describe it. I now weigh 300-ish pounds and I am nowhere near his size, even being nearly a foot and a half shorter. He’s pro-footballer size and so much bigger than any other regular overweight person I have ever seen. So I’m finding it hard that anyone would have trouble fitting into an MRI machine because of their weight/size…

    • This “not fitting” just makes me want to headdesk. Large bore devices which will fit even the most broad-shouldered men exist, and while there might be reasons a hospital does not have one, there are no good reasons at all to pretend that no one has.

  16. The “Too fat to treat” comment really shows how fat-biased our society has become. I blame a lot of it on the media and the idea that the splashier, the more controversial the better. I am not hairy -eyed about all media just the ones who want to sell their product whatever the cost. I was a newspaper reporter for 21 years. Doesn’t make me blind to the avarice and prejudice in the media world.

    At any rate, I recently had a kidney removed because of a cancerous tumor. It was found by accident after having a CT scan done for another procedure. I am 5’8″ and one half inches tall and I weigh 254 lbs. , as of this morning but I was at 265 lbs. when the CT scan, and then an MRI, were done. My body-mass index registers at morbidly obese. I carry al my weight between my armpits and hips. I still fit in the old style MRI machine. Weird experience! I am a veteran and the military is notoriously weight biased but since I am no longer enlisted and officially and “old broad at 65″ they didn’t have any problem treating me. Yes, I am part of the VA MOVES program but most of that is learning good nutritional habits.

    Oh yes. My husband of 44 years is a vet too. He is 5’11” tall and weighs 360 lbs. He too is an apple shape. Docs don’t have any trouble fitting him in CT scanners or doing ultrasounds for kidney and bladder or gall bladder problems. He’s also had an MRI done in one of the open-arm set ups. No body told him, or me, we were too fat to treat.

    My advice to snyone who has been subjected to that kind of health and body bias is to find a GOOD doc, not some wanna be.

    Thanks for listening.

  17. This is a really great post! Way to dig up the super fun research, as always…


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