Imagine What We Could Actually Fix

Bad DoctorAlmost every fat person I know has a story where they went to a doctor for a health problem and were given a body size solution.  Knee pain? Lose weight.  High Blood Glucose?  Lose weight. Strep throat?  Lose Weight.  Hit by a van?  Lose weight.

The problem is that weight loss hardly ever works in the long term so even if it would help, it still doesn’t meet the criteria for evidence based medicine.  It’s like telling people with knee pain that they should learn to fly.  Maybe it would help but we have no reason to believe it’s possible so we don’t tell people to jump off their roof and flap their arms as hard as they can.  Weight loss only has about a 5% better chance of working than flying, yet doctors send people home with diet sheets every day.  That’s not just poor medicine, it’s actually incredibly harmful because while fat people are basically jumping off their roofs and flapping their arms really hard, their actual issues are completely ignored and untreated.

If we, including the medical establishment, accept the simple fact that weight loss almost never works, then we could actually start treating people’s health issues.

Knee pain?  Here are some strength and flexibility exercises and movement pattern correction that improve knee function (like we give thin people with knee pain.)

High blood glucose?  Here are some interventions that are shown to help control blood glucose (like we give thin people with high blood glucose.)

Strep Throat?  Here are some antibiotics (like we give thin people with strep throat)

Hit by a van?  Here is medical care that directly addresses your injuries (like we give thin people who get hit by vans.)

It’s not that complicated.  We have to quit giving people a “prescription” that has the opposite of the intended effect almost all the time.  It’s not just bad medicine, it’s remarkably  stupid.   If Aspirin made your headache worse 95% of the time, but the doctor kept prescribing it, would you keep taking it? If Viagra gave guys more erections in year one but resulted in impotence from year two on would doctors still prescribe it?

This has got to stop.  I’ve written before in detail about ways to talk to your doctor, but one basic thing that you can do is ask for the evidence basis of their treatment- is there research in which a majority of people have successfully lost the amount of weight that your doctor wants you to lose, and is there evidence that the weight loss had the health benefit that the doctor is looking for.

If the answer is no (and it will be no) then consider asking them how they feel weight loss meets the criteria of evidence based medicine.

Or, simply insist that you be given a treatment plan for which there is a basis in evidence – sometimes a simple way to do this is to ask what treatment protocol you would be given if you were thin and presenting with the same issues.

The fact that every day fat people’s actual health issues go untreated as we walk away with a prescription that hasn’t worked in 50 years of studies, almost always producing the opposite of the intended effect should be considered medical malpractice. If we let go of the idea of weight loss fixes everything, imagine all the things we could actually fix.

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Published in: on July 4, 2013 at 7:16 am  Comments (44)  

44 CommentsLeave a comment

  1. One thing I learned really early on when I was sick is that patients need advocates. Someone who’s sick or in pain is easy to dismiss or bully, because they’re not in a position to stand up for themselves. Or they’re grateful for the attention. Or they don’t want to challenge or annoy the person they’re relying on medically. Now I think it’s incredibly important to take someone with you, if you think you’re going to be fobbed off in any way. As annoying as it is, sometimes medical professionals will actually listen to a third party, rather than the patient themselves.

    • I think it’s once again the old problem that the opinions of fat people don’t count. We are not deemed reliable witnesses to our own experience.

  2. This is a perfect essay to read today before heading out to see well-meaning relatives. Ragen has always got my back! –Jen

  3. Ragen, thank you so much for this post. My Tuesday afternoon basically consisted of “PCOS and resultant insulin resistance that’s gone untreated so long it’s progressed to diabetes? Lose weight!” so, yeah, timely.

    I am so tired of every piece of progress I make in getting medical professionals to treat me like a human being ending up back in the same place. Despite bracing and arming myself beforehand with information, I have a really hard time advocating for myself in general; I need to try and work on that, because I am just done, at this point.

    • I have PCOS, too. What I really love about that advice is that a. it’s known that people with PCOS are going to have an even harder time losing weight than your average person, and b. there are thin women with PCOS. So uhm… tell me again how losing weight will “cure” me?

  4. I have been to the doctor twice in 3 years, to get medical certificates for taking time off work for flu … otherwise I avoid the doctor like the plague – luckily I enjoy a Healthy At Every Size lifestyle and don’t actually fall ill very often, because otherwise I would be constantly prescribed weight loss – grrrrrrr.

    • I just feel the need to add here that following a HAES lifestyle doesn’t necessarily mean not getting ill or needing to see medical professionals.

      My physio took my condition as evidence of an unhealthy lifestyle and responded accordingly, and that was a big part of the problem, as she assumed I must be very inactive and unfit, and that my problems could be fixed simply by becoming more active.

      • Hi K, thanks – I should have worded my statement a lot better!! I didn’t mean to say that a healthy lifestyle automatically equals minimal doctors visits, nor the converse – no disrespect meant by any stretch and I’m sorry to hear that your physio was not helpful 😦

  5. So I don’t know if there is evidence that supports the healthcare argument that fat people cost the system more money, but I wonder if some of that cost is because we can’t get treated for diseases until they become an emergency. The repeated nontreatment ‘lose weight’ responses are basically turning away overweight patients. I know personally that a lot of times now when my husband suggests seeing a doctor, my reply is “they’ll just call me fat.” and I don’t go.

    • I’ve made that same argument. If it’s true there’s an increased cost (and I don’t believe it has been proven true), then it’s likely because we’re given so much poor medical advice and put under so much stress to do something that is nearly impossible.

  6. My lovely doctor of the past 3 years who has never judged me for my weight just left my practice. I do hope the doctor he referred me to is as wonderful I worry. I hate being a worry-wart, but it’s who I am. 😦

    We were in the middle of trying to diagnose some issues I’ve noted of late and really, really hope that this doctor picks up where he left off and doesn’t prescribe weight loss. Unexplained weight gain IS one of my symptoms. Sure, I have eaten more chips than is my norm–but I think that has more to do with my insane salt cravings (another symptom). Add brain fog, super tiredness…. I wouldn’t be surprised if whatever is causing these symptoms is treated properly if I did lose a little weight. But not beyond going back to my previous “norm” which is still in the “obese” range.

  7. The first time this happened to me I was aghast. Having been the same size for about 5 years I suddenly had trouble with swollen ankles. The orthopedist my MD sent me to said “lose weight”. I was so shocked I didn’t know how to respond; I took his bullying and insistence that I ‘join a gym’ or ‘go to a pool’ and said yeah, maybe I could magically come up with the time/money for such ventures, and my swollen ankles would be cured! Plus I could lose all that weight! (lol) Kaiser is Very Well Known to me now for such practices and I have only recently begun to stand up for myself. (You really *don’t* have to weigh me when I come in for a routine Mammo). I’m grateful for the support of this community.

  8. I went to the doctor because I had shoulder pain from too much veil work in belly dance… I was told to take some Advil and lose weight. I asked how excess weight was impacting my shoulder and got THAT look.

    • I have fibromyalgia. I was treated by a very thin doctor who clearly didn’t approve of my refusal to get weighed, and who prescribed exactly what I’d already tried that did not work. She also never did the tender point test – which would’ve meant touching my fat body, something she clearly didn’t want to do.

      I later wrote her a scathing letter and said “my neck doesn’t hurt because I am fat,” among other things. She contacted my doctor and basically said she was “concerned” for my “mental” well-being.

      Just… fuck you.

      On the plus side, after my experience with that specialist, my primary care doctor no longer refers any of her overweight patients to that woman. She knows that they won’t get quality treatment.

  9. Massive Trigger Warnings for health and doctor talk:

    I have digestive tract issues because of scarring left over from cancer surgery. I made appointments for specialists at a world renowned hospital to see what could be done to help. After waiting months for the appointments, my husband took a day off work and we drove 2.5 hours to get there.

    Might as well have stayed home. The fat prejudice and unwillingness to see me as a real person who is a competent witness to her own experience was just as bad there as here. I was surprised and disappointed because some of the greatest doctors on the planet teach and research there. I was saddened and left feeling without recourse. If these great minds are still reduced to bigotry at the sight of me, what hope do I have of getting well anywhere?

    The gastroenterologist didn’t even try to hide his contempt. I asked about the virtual testing that is available there. He said that he would have to find out if the equipment would hold me, which he doubted. So here we have brand new state-of-the-art equipment but they didn’t design it to accommodate people like me. Even though everywhere you go the Obesity Epidemic is trumpeted, these great doctors didn’t think to accommodate fat people.

    He gleefully went on to tell me that the virtual test required a 3 day fast which he thought was an EXCELLENT idea for me. I tried to explain that I can’t fast that long right now because my thyroid medication isn’t adjusted correctly and I get ill when I wait too long between meals. He looked at me like, “Yeah sure right…”

    I suppose it didn’t help that there is a major bariatric surgery center in the very office suite I was seen in. I made It VERY clear up front that WLS surgery was NOT in the game plan. He still brought it up several times.

    The endocrinologist I saw that same day there was no better. I went to see if he could help me with my thyroid problem. I can’t seem to get to a therapeutic dose of medication. This issue is atypical and perplexes my own doctor. I made it clear I wasn’t there about blood sugar issues which I take care of just fine with my own doctor. But he insisted that he work me up for diabetic care. I figured he was trying to do due diligence, so I let him. He kept on about wanting to talk to the gastroenterologist about what sort of diet he could put me on. I tried to explain that my digestive tract isn’t working right so I can’t be put on any particular diet, but he didn’t hear me. The entire visit was spent on what he wanted to focus on, not what I went there to see him for.

    When I called back to see about coming a second time (another two and a half hour drive and another day off for the husband) to try to get to the thyroid issues I wanted to deal with in the first place, his nurse wanted to set me up with an appointment with a dietician instead. I didn’t make the second appointment. I haven’t been back to the gastro either.

    If fat people’s health is in any way worse than thin people’s it is because of things like what we go through to try to get health care that thin people take for granted.

    • I’m so sorry that you had such a terrible experience! It’s exactly stories like this that have me worrying like crazy every time I see someone new for medical help.

      • If possible, always take someone with you. It helps. I have found that the worst of the disrespect and rudeness are mitigated when there is a witness.

    • there are lots of MD rating websites out there. Make it known that they screwed up. I think that if everyone used these rating websites doctors would be more careful about actually doing their job. They are in a position of authority over others and reporting on them is a way to take some of the power back. I doubt you are the first person this happened to- wouldn’t you have been glad to have been warned? You can do it anonymously most of the time also.

  10. .I was hospitalized with pneumonia twice, and the hospital and Drs. were not particularly displeased with me for being fat, but they were not happy, either. My primary doc wanted me to be seen by a specialist, pulmomary, dr. I have been a dancer for many years, (Fatimas, yay! Shameless plug). Before I went to USC, I took pics of myself dancing in various outfits and placed them on my phone. Proof positive that I don’t lay around on the sofa eating bon bons all day! Got to say, these doctors were impressed and I was amazed that on my history they wrote that I was a professional dancer! Sometimes the proof in in the pictures, and you gotta do what you gotta do.

    • I really wish evidence wasn’t necessary to disprove a stereotype though. I still have coworkers insist to try and carry things for me and ask if something is too heavy despite seeing me carry them every day for the past year. I shouldn’t have to make videos of me carrying things or take pictures of me doing things to get quality care. I’m sorry that you had to deal with doctors who needed “proof” that you were a “good” fat person to give you proper care.

      • Indeed, and what if there is no impressive activity you can prove, or if your condition itself has forced progressive inactivity as it worsens. According to my physio, my increasing weight and inactivity causes the symptoms I have, whereas I know that it is as the symptoms increased that I have had to cut down activity and gained weight and become less fit.

  11. Thank you so much for this blog. I have been medically obese since I was 6 months old. I finally found a Dr. who believed that I was living a HAES lifestyle and was unable to gain or lose weight when I changed my lifestyle. I have been tested for thyroid, diabetes and high-cholesterol on an annual basis and I have none of these. This new Dr. sent me for additional testing and found that I have a genetic iron-overload condition (Hereditary Hemachromatosis). This condition has caused joint pain for more than 2 decades, loss of hair, skin excema patches, and enlarged my liver. (Of course, much of my health-care was instructions to diet) As soon as I began treatment, most of my symptoms disappeared and I lost 40 lbs without trying. Without this Dr. I would have had cirrhosis and diabetes within 10 years and I would have been blamed for it by the general medical community! PS, if you are suffering from fibromyalgia, please get your ferritin and ferritin saturation tested, there are correlations between these syndromes especially if you are racially “white.”

  12. My current “favorite” is over at First, Do No Harm. In a nutshell: Woman whose weight has not changed in some time develops constellation of unprecedented and troubling symptoms. Doctor diagnoses sleep apnea because fat. Patient has pneumonia, ga-doy.

    Bonus: Patient has normal blood pressure, as one tends to do even while fat (raises hand), and the nurse is so fixated on how obviously baddeathfattyfat the patient is that she takes a reading multiple times on both arms–and when it’s still obstinately normal, dismisses it as a fluke!

    • Oh goodness I can relate to the first sooooo much! I’m currently seeing an ENT due to my enlarged thyroid. He mentioned “after the surgery, we’ll discuss options for your sleep apnea.” I looked at him dumbfounded because I don’t snore. Never had… up until recently…. because of my *suspenseful chord* enlarged thyroid that’s being removed because it’s restricting my airways.

      Even my husband said that I’ve only recently started snoring and only when on my back (when the thyroid is weighted down on my trachea)

      He asked if I’ve ever stopped breathing in my sleep, husband says ‘no’.

      ENT still thinks I have sleep apnea even though, so far (at least from what I can tell since being started on thyroid meds), my weight has been going down because my weight gain was due to my hormone imbalance due to my thyroid.

  13. Until I found this blog (thanks for linking it on MFP), I thought I was the only person who had such issues with people, especially the medical profession.

    The multiple BP readings is now the instructed way to take BP. *rolls eyes* Notice how they never give you time to relax again or at all and just crank that pressure up to max.

    • Mine’s always “slightly above normal” because of 1) I’m introverted. I have a hard time expressing my thoughts as words to another person. This makes me nervous. Nervousness makes my heart beat faster. And they always do it the very first thing so I can’t get acclimated past nervous introductions! 2) I’m overweight due to a health issue so discussing this and not knowing how it’s going to be reciprocated adds to more stress. The unknown if you’re going to get a doctor who will listen or a doctor who will give you a weight lecture definitely doesn’t help with the BP!

      • I really feel my HBP is mostly from having it taken with a too small cuff and white coat syndrome. I have no medical training, but I’m fairly sure my arm isn’t supposed to go totally numb with pain and flail around like a dying fish. Nurses/doctors give me nasty looks when that happens, like I’m doing it just to piss them off. I explain that my nerves are going nuts because of extreme pain. Knowing that it’s going to be super painful makes it go higher. I’ve had BP taken by a couple of people where it didn’t hurt (I’m always shocked because it’s always painful, like I’m a junkie getting a fix but I don’t get the fun high.) and BP is spot-on normal (120/80).

  14. I had a bit of this issue at my dental clinic. The student I was seeing that day kept trying to insist on taking my BP with cuffs that either barely closed or didn’t close and none of them fit properly. Not surprising my BP read as high though funnily enough the better fitting the cuff the lower it got. I had just had my BP taken two days before and it was fine and yet they seemed to believe I had dangerously high BP even though they could plainly see the cuffs were not working properly. If I hadn’t kept insisting they find a cuff that actually fit me in some way (they ended up with a wrist cuff) they would have refused me treatment despite it was their equipment in the wrong.

    Oh and why they didn’t have the large cuff despite having it before? It’s broken and they hadn’t gotten it fixed or replaced.

  15. I have had pain in my right knee off and on since about 2000. It originally started with a torn meniscus and I had surgery and it was fine for 7 years. Then I fell and twisted it and it was incredibly painful and the doctor told me it was arthritis. I went around for 3 years in pain and was basically ignored. I found a new doctor who seemed ok, and he said I didn’t have arthritis. I had another surgery and found more torn cartilage. But after a year the pain came back, so I kept going back to the knee doctor and he gave me cortisone shots. I always felt something more was wrong, but he was treating it like arthritis even though he originally told me I didn’t have that. But the shots helped, so I just lived with it. THEN, in February I tripped and fell in my kitchen, and knew immediately I had ruptured my ACL. I am a nurse. I have seen enough of these injuries to know, and I FELT it tear and it was excruciating and I couldn’t get up for 15 minutes. I was home with my 2 year old son so I had to get up, I couldn’t walk on the leg. I had to limp around the house. I went to the doctor and he AGAIN treated it like arthritis. The only reason I got an MRI is because I insisted, but I think he thought I was faking. So when he called to tell me the ACL was ruptured I was not surprised. I WAS surprised when he said fat people can live without their ACL but he would so surgery if I wanted. He said skinny people need theirs. I couldn’t believe it. Weight has nothing to do with it. It has more to do with what kind of activities you are involved in. He never asked what activities I do. The doctor never offered physical therapy, pain meds, crutches, or anything. I mean, I could barely walk at all. He SAW me limping. I had to hold on to the wall to get around. He said I shouldn’t be having pain since the ACL was completely torn. REALLY? Despite my knee being swollen to the size of a watermelon? Needless to say I found a new doctor and was treated like a human. I got PT, and chose not to have surgery and my knee is better than it was before I injured it. I can’t prove it, but I think something was wrong with my ACL all along. Nothing else can explain why it no longer hurts the way it did before.
    It was a horrible experience to know the doctor was only ignoring my symptoms because I was fat.
    Sorry to be so long winded.

    • I’m not knowledgeable about this, but what is ACL?

      • Anterior cruciate ligament. It’s in the knee.

  16. Ugh. I notice this all the time at the doctor. (I am, for whatever it matters, someone who is naturally so thin… and short… that I fit in silly tiny sizes.)

    No one ever asks me about exercise.

    Despite a family history of early, and deadly, heart disease.

    Despite the less-than-hilarious point at which my boyfriend, only a few months after HIS heart attack (under 50, fantastic diet and exercise, normal to thin weight), could outrun me easily.

    No one cares if I exercise. Because I’m thin.

    Oh, on the flip side, the same doctor couldn’t be bothered to ask about actual risk factors when I got an HIV test. Had her nurse call me back with ‘indeterminate’ results and no explanation. Gave me a WORSE explanation than google did overnight by the time she would talk to me in the morning.

    Never asked me a thing about risk factors. I mean, I’m getting an HIV test, I must be a slut or something right?

    [I got retested… negative. Which made a whole lot of sense given my virtual zero chance of exposure since my last test. Which a doctor who had like… asked me about my risk profile would have known.]

    I never did go to the infectious disease specialist she suggest I get an appointment with; something that would have taken WEEKS. When I went back the doctor didn’t believe that I’d done the sane thing and sought immediate re-testing. I went in for migraines (reluctantly) a couple months later. She resubmitted the referral and I told the whole story to a horrified receptionist who agreed I did NOT need another appointment.

    The clinic? Still won’t let me switch primary care physicians.

    Anyway, I just wanted to say… as someone who doesn’t look as unhealthy as she is? (Except for being a slutty slut who gets tested I suppose.) I absolutely notice the bias on a regular basis. I wish I had more support for exercising because, ya know, it might feel good or something.

    • I just saw my doctor today and she actually said she has to tell her thin patients frequently that they are LESS healthy than her overweight patients. She said that a lot of them don’t eat properly, or exercise, because they don’t have the social stigmas and pressures that her overweight patients do. I found that really interesting, and it’s nice to see a doctor readily admit to the bias, and I’m glad she addresses it in her practice.

    • I actually do worry about some of my thin friends who eat poorly and don’t exercise, but don’t worry about that because they are thin. An unintentional result of anti-fat bias in medicine is, ironically enough, that the medical needs of many thin people will go ignored, too. If our culture began seeing exercise as a way to get and be healthy, and to feel good, rather than being only for weight loss; this would greatly help people of ALL sizes be much healthier.

      @ Luciebluebird – you are very fortunate to have such an honest and thoughtful doctor! Now that’s a keeper.

      • @Rachel – I’m not even sure what I think the doctor should do. It’s not like adding to the number of people getting shamed for not trying hard enough is going to make me healthy. I’m aware that I’m not taking care of my body. (And I’m also mentally reliving my mother telling me I could be happy if I really wanted to…)

        Now that I’m thinking about it… probably focus on how much better I’d FEEL. And refer me to a nutritionist who has practice with teaching people how to cook and eat, and break the change down into (bad pun warning) bite sized changes.

        And help me find exercise I can afford to do, in a setting where I won’t be humiliated by my inability to keep up.

        Weird idea huh? Seeing people, especially women, and thinking about what they want to do with their own damn body and not how appealing it might look.

  17. Yes I have one of those stories, a very serious, life-affecting one involving a physio offering me “cardio and weightloss” as the sole treatment for a genetic collagen disorder.

    How about this We need to keep making our voices heard.

  18. Has anyone seen the documentary America the Beautiful 2?

    • I have, but then I’m in it… 🙂


      • I didn’t know about this documentary until today, I only saw 2 minutes of it, funny when I saw a scene where there was a girl dancing and thought…”OMG is that Ragen?” now i know indeed it is you. Hopefully i get to watch it tomorrow.

    • I just added it, and the first one, to my Netflix queue!

  19. Mich, sorry, but I didn’t see your question because of the long holiday weekend. The ACL is the Anterior Cruciate Ligament. It is a ligament in the knee that holds the bones together and gives the knee stability. A lot of athletes, like football and soccer players tear this ligament; it usually happens from turning and planting the knee, which is kind of what happened to me, except I was not playing sports. I tripped on a vacuum cleaner, lol.

  20. I firmly believe that anti-fat prejudice is not about health or even thinness, but about control – and this alone is enough reason to believe so: Despite the mountains of evidence that diets not only do not lead to lasting weight loss 95% of the time, but actually increase weight over time in most patients; doctors keep prescribing diets and people keep putting pressure on fat people to diet! Even mainstream people know this is true – this fact is not seriously disputed.

    And yet, how come doctors do not instead advise their fat patients AGAINST dieting? Why, when people see a fat person eating a small meal, do they not tell them, ‘hey, quit that dieting!’ Why do anti-fat haters not stick their noses into people’s business at weight loss groups and yap about how dieting will make them fat? Since ongoing dieting is shown to make people gain more weight over time, it would seem logical that if the true goal of medicine is for people to be thinner, then getting people to stop dieting would be a key aspect of that goal! And yet they do the opposite. If you pressure people to diet, then it seems you want them to be fatter, no matter what you say. So it’s really about control and wanting to feel superior.

    I remember that in high school, I weighed around 210, which fluctuated to a small degree. On my tall, muscular frame, that was about a size 14 or 16. Looking back now, I think that was a natural, healthy weight for my body. But like most girls, I did not see it that way then, and I very much wanted to be thin. So I went on a series of self-starvation episodes (also known as dieting) over the years. I would lose weight, but then gain it back and more. I now think of dieting as, ‘thinner tomorrow, fatter next week’. And this vicious cycle continued until after a few years, I weighed 360 pounds. 150 pounds up…using the most commonly prescribed method for weight loss. And for the people who would say things like, ‘well, you are supposed to diet sensibly, not extremely!’. They still fail to take any responsibility for the damage that people like them inflict on young girls! When you shame people and send them constant overt and covert messages very day that they are never good enough, this is what will happen. That is the normal, not unusual, consequence.

    After recovering through treatment from the depression which ensued, I was able to feel much better about myself, and know that the haters are wrong, and I am much better, smarter, and kinder than them. Interestingly, my weight dropped to about 290 then and has stabilized for a few years now – without dieting. As an issue separate and apart from body size diversity, people do sometimes have drastic weight changes both ways if their mental well-being changes – that is something I also wish doctors would pay more attention to, and realize that often a person who is suddenly gaining (or losing) a lot of weight may need compassionate help and understanding, and not cruel judgment. I won’t lie – I would like it if I could be closer to my original, natural weight again, but without suffering or compromising my health. Not thin, but back to that comfy 210ish. My reasons are entirely to do with that being how I was made (something the culture took away from me forever when it pressured me to change it), and because I remember it being easiest to do the physical activities I love then. It does not make me love or accept myself any less. I love HAES, body type diversity, and equal rights for people of all sizes.

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