Really Fat People with Health Problems

Things you can tell by looking at a fat personToday I got a comment from a nurse asking some often asked questions about health and fat, specifically for the “super fat” (of which I am one)  You can read the full comment here (it may be triggering, though I feel it was asked very respectfully) but the basic question was -and I’m paraphrasing – what about when very fat people have health problems, surely then obesity is considered a medical problem?

The first thing I want to make clear is that, as Ann mentioned in her comment, there are simply no proven ways to make fat bodies thin. In fact statistically the far and away most common outcome of intentional weight loss attempts is weight gain, so even if one thinks that being fat is a medical problem (and I don’t agree that it is for the reasons that follow) then prescribing dieting is no better than prescribing a cancer treatment that cures cancer a tiny percentage of the time, but the vast majority of time makes the cancer worse.

But I think the real solution is to take weight out of the health discussion and treat the medical issues as the patient wishes (which is to say that people are allowed to make choices for the prioritization of their health and the path they choose to get there including medical care).  If a thin person is dealing with immobility, we treat the immobility.  If a fat person is dealing with immobility, we “treat” the body size.  I think that giving body size interventions for health problems is a major part of the problem. If a person is fat and has mobility issues, then we should treat the mobility issues with options including physical therapy, massage, surgery, mobility aids etc.  If a fat person has diabetes, then we should give that person interventions that are shown to control diabetes (weight loss is not one of them.)

Studies show that, no matter what size someone is healthy habits are still the best way to increase our odds of health (though of course nobody is obligated to do so), and working on fitness goals like strength, stamina and flexibility, at whatever level the person in interested in doing, is still the best way to improve strength, stamina and flexibility.

I think that the medical world would be helped greatly by treating a fat person with a medical issue the same way they treat a thin person with the same issue.  For example, when I was thinner and had knee pain I was given tons of options – physical therapy, medical massage, surgery, crutches etc.  When I was fat and had knee problems I was told to lose weight.  Because of my previous experience with a knee issue I was able to use the same things that had worked when I was thin to solve the issue but had I increased my exercise as the doctor suggested in a bid to lose weight, I would have been almost certain to exacerbated the injury.

In order to give fat people appropriate medical care, there are three main things that the medical establishment needs to do:

First, they must stop confusing body size with a physical or mental health diagnosis.  A doctor cannot tell from someone’s size what their health status is, if they have an eating disorder, or anything other than the size of the fat person’s body, and that doctor’s preconceived notions about people that size.  I believe that healthcare professionals need to be specifically aware of, and manage, their preconceived notions and prejudices.

Second, they must let go of the fantasy of weight loss as a miracle cure all, or as evidence-based medicine at all.  Healthcare practitioners need to stop prescribing weight loss for everything (I’ve been prescribed weight loss for a broken toe, a separated shoulder,and strep throat.) In fact, they need to stop prescribing weight loss at all.

Once we give up the weight loss fantasy, we can start giving actual evidence-based health interventions to fat people. Once we take weight loss off the table, it can open our eyes to other treatment options.

Finally, we must work to end shame and stigma against fat people by the medical establishment and beyond.  If fat people are ashamed of their bodies or shamed for their bodies or health conditions then they are less likely to take care of themselves and more likely to avoid the doctor, and avoid things that can help them (like mobility aids) and that’s definitely detrimental to fat people’s health.

If we take weight out of the health discussion we give ourselves the opportunity to actually, finally, have a health discussion and that’s better for  the health of everyone of every size.

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Published in: on August 30, 2013 at 2:32 am  Comments (80)  

80 CommentsLeave a comment

  1. THIS!!! Thanks for being awesome Ragen. I was prescribed weight loss to “cure” bipolar disorder….that’s when I ran far far away from the doctor. I have a mental illness and I am fat, but I had a mental illness when I was thin. Neither helped the mental illness and weight loss is certainly not going to cure any mental issues I have. Yet doctor after doctor is completely disinterested in listening to my actual problems, instead choosing to focus on my weight. Then when I say I don’t have blood pressure issues or cholesterol issues they insists I must and try to prove it. Terribly frustrating as I am a public patient and I only get a tiny fraction of time with a dr and even then they are so busy trying to prove they are right and pushing weight loss on me that they never get time to actually hear the issues I have.

    • Good grief, that’s horrible. Are you getting this from psychiatrists as well as medical doctors?

    • Not to mention that most of the effective treatments for bipolar carry the potential side effect of weight gain — and it’s a side effect that seems to happen more often than not. So if you take the right meds for a life-threatening condition, you find yourself getting hassled over weight.

      There seems to be a cottage industry of “research” finding statistical correlations between various maladies and plastering the results all over the news with the assumption being that fat causes the problem. And ice cream consumption causes drownings, too.

      • My last psychiatrist told me that psychiatric medications couldn’t cause people to gain weight. According to her, patients who gained weight while taking them were simply eating their feelings, then lying about it and blaming the weight gain on the meds.

        I found another psychiatrist. Quickly.

        • You have got to be kidding me. You’re telling me someone with untreated MI, going through crashing depressions is going to suddenly start “eating their feelings” when their moods stabilize?? It’s a well-known side effect for most of the meds, for crying out loud. In fact, it’s one of the things that causes people to go off the meds even if they really, really need them. People get so freaked out about weight they take dangerous chances with a dangerous illness. The LAST thing somebody who’s trying to get an MI under control needs is their psychiatrist beating up on them for being a glutton.

          Good for you for bailing. I think “flee screaming hysterically” would have been a rational response to that one.

    • Wow! Well, then I should have been cured of bipolar disorder back when I was in my teens and actively bulimic. Dang, I wonder why that didn’t work. It’s probably my fault. You know us damn fatties. We cause all our own problems with our fatness.

  2. All of this *seems* like common sense, doesn’t it? The only thing I can figure is that people just assume that all fat people just live on cheesecake and big macs and lay on the couch all day. Which we all know is about as stupid as assuming all skinny people are heroine addicts or anorexic, etc. Yet it’s still there, and sadly the former is still infecting our medical professions all over the place. I guess I just don’t understand how we can be so advanced, yet be so dumb at the same time.

  3. Thanks for this post. No matter how long we have been involved in the size acceptance movement, no matter how evolved we have become, we need constant reassurances to combat all of the negative chatter we hear every day. I needed to hear it. Recently, I had an appointment with a doctor whom I had seen before and had never really talked about my weight. This time, he noted I had gained 10 pounds (last I saw him was a year ago). The remainder of the appointment was about how I needed to lose weight. Instead of confronting him with all of his misinformation (who has the energy to do that all the time?) I just let him natter on. He was not happy with my non response, so he pushed harder. I think he was totally confused by my response. I think he expected me to become very upset about the weight gain and promise I would diet. When I didn’t, he treated me like I was stupid. I didn’t tell him about my education level and occupation. He did tell me that I was shortening my life expectancy by being fat. When I told him I had already reached age 68, seemed like I was doing OK so far, he said that some people reach 80. All I could think about is how many old people had he harrassed about their weight? I was angry when I left, but, at least, thanks to people like Ragan, I am armed with the truth and refused to be shamed.

    • I will be 64 next Friday & I would have told him that, yes, quite a few people reach 80 or 90 or beyond, that I have known many & been related to more than a few, & that the majority of those old fat people I have known were fat. And I think I would ask, “So, what’s your point? The older one gets, the more losing weight increases mortality risks, & the older one gets, the more protective of health fat is.” I would have flatly told him that he was wrong, being fat does not shorten a person’s life expectancy at all. However, being a jackass of a doctor around me might shorten his.

      I get extremely fed up with the vague future health threats & the death threats. Most people are likely to have some kind of health problems at some point & everyone…EVERY living thing, animal or plant…dies, including every genius, with or without a medical degree, who tries to tell us that we will die. My mother-in-law is 91, & she has FINALLY gotten old enough or at least found a doctor sane enough to be told NOT to lose weight, even though she constantly harps on how much she needs to do so. I told her that the reason he told her that is that, if she does lose weight, she will die. Besides, she eats so little these days, she would have to stop eating completely, which tends to be hazardous to one’s health.

      Weight loss does not work permanently for the vast majority of people & comes with many side effects, often with damaged health, & an end result of higher weight. And since dieting does not work & does a lot of damage, why & how is it assumed that, if a person has a health condition, it will suddenly magically work & not further debilitate a person who is already less than healthy? It makes just about as much sense as bloodletting. And my standard response has always been much like Ragen’s…there are no diseases fat people get which thin people do not also get, so if I have a problem, give me the same treatment you would prescribe for a thin person. Why is that so hard to understand? It seems pretty simple to me.

    • “He did tell me that I was shortening my life expectancy by being fat.

      Such bigoted statements like the one above infuriates me and I usually respond to such stupidity with either or all of three things: 1: The biggest problem for older women is osteoporosis, if women didn’t spend their life dieting thereby forcing their body to take the calcium and nutrients from their bones, we’d have a lot more healthy women and a lot less osteo. 2: Wasting syndrome is one of the biggest causes of death among sick people–esp elderly sick people. If they had more fat stores they’d live longer. So people—especially women and the elderly (not mutually exclusive groups), would do a lot better to have more fat on their body. Oh, and my genetics.. most of the people in my family have lived past 80, and their body-type is like mine.

  4. A beautiful answer to a very good and respectful set of questions. You always present yourself with eloquence and clarity. Brava!

  5. Thanks for your blog posts. This post, I think, is inspiring me to write a blog post of my own, hopefully up in a little bit. I disagree with you that it is impossible for large people to lose weight, though I want you to know I recognize all the multiple factors and grey areas you write about, and agree with most of what you say. You are a great communicator.

    • I think you’ve misread something, and I encourage you to go back and reread through this more carefully. Honestly, I would challenge you to find anywhere in Ragen’s writings where she said that it’s impossible for a fat person to lose weight. She has never said that at all. In fact, she outright reminds us regularly that fat people are unique and what is possible for one may not be possible for another. It is rare that she makes absolute statements with such words as “no,” and “all” or “impossible.”

      What Ragen HAS said on repeated occasion is that long term (5 years plus) weight loss is all but impossible as it has a very poor success rate (5%).

      And it’s perfectly OK to say “fat” instead of “large.” It’s just a descriptor, not a weapon.

    • As Amy mentioned in her reply I don’t say it’s impossible, I say that it’s highly improbable. To be clear, that’s not my opinion, that’s based on the research that exists (you can see a list of quite a bit of it in this post if you’re interested https://danceswithfat.wordpress.com/2012/04/21/for-fat-patients-and-their-doctors/) I think the fact that, per the research the vast majority of attempts at weight loss fail, and the majority end up with weight gain is information that people should have available to them, but I think that they are allowed to make their own choices including attempting weight loss.

      When you say that you disagree, is that based on your opinion or on research – if you’ve seen research indicating the success of dieting I would be interested in reading it!

      Thanks!

      ~Ragen

    • Many people can lose weight for a while. I’ve done it numerous times. It all came back and then some. I had to stop yo-yo dieting so I wouldn’t get fatter. When I stopped dieting, my weight stabilized.

  6. My husband (who is 6’2″ and about 300lbs. He’s got muscular arms and legs and a big belly) went to a doctor last year because he was having some issues with his skin. He’d never seen this doctor before, and the doctor sent him off to have some bloodwork done. I was already suspicious; what did this have to do with my husband’s skin? The results came back: my husbands cholesterol, blood pressure and blood sugar were all fine. The doctor’s response? “This can’t be right, we’ll have to redo the tests,” he said, “I suspect you have metabolic syndrome.”

    When my husband told me all this, I told him that the doctor was wrong. His tests were fine, he didn’t have metabolic syndrome, and the doctor was only saying that because he’s big. It had never occurred to him that a doctor might have a bias like that. We’ve refused payment for the appointments, but they’ve send it into collections anyway.

    Oh, and we asked around and determined that he has eczema, and home treatment has been working just fine.

    • That’s awful. Not surprising, but awful. As a side note, it might be a good idea to get legal advice about what you’re obligated to pay for services not rendered and how you go about fighting that formally. (Since having it sent to collections can destroy your credit history.) My non-expert opinion is that you can probably show that you didn’t receive the services you asked for in the appointment, since he went in for a skin condition and the doctor did nothing about that, but that you might have to pay for the tests anyway, since it’s not the lab’s fault that the doctor ordered irrelevant tests.

    • My husband went for treatment for cellulitis, and the urgent care doctor declared just by walking into the room and seeing his size “You have diabetes and high cholesterol”. After 2 days of continuously normal blood sugar levels and a normal cholesterol test the nurse told him to tell the lab person to go find someone else to poke.

    • Ever since I was a kid, I´ve had a skin condition that makes it really dry and terrible itchy all the time and it´s caused me to be covered with open wounds and scars from head to toe since I can remember. Everytime I mentioned that to any doctor, they said that since I was fat and had dry skin, I probably had a thyroid problem and had me tested for that. About 8 or 9 tests later, they were still negative. Then the doctor´s answer were “it´s just nerves, you should relax and you´ll be fine”. I spent 29 year of my life believing it was my fault to have this, and that I was failing at making it stop.
      And then I had to go to the emergency room for a non-related medical issue and the doctor said “are you getting treatment for your atopic dermatitis?” Turns out she was the first to see beyond my fat and discovered I have a valid skin condition. After a prescription for a special soap and a body cream, I´m a new person.

      • That’s awful.

      • That’s fantastic! We need more doctors like the one in the ER!

    • When I was pregnant with my second child, at a weight of 220, the doctor was noticeably perturbed at my excellent blood work, including a lack of diabetes and high blood pressure. (It should be noted that he was not my usual doctor.) At my first appointment with a rheumatologist, he prescribed a medication with serious side effects–but said that it would “help lower your blood sugar and cholesterol.” I replied that my blood sugar and cholesterol were just fine and needed no lowering. He stammered a bit, managed a weak, “Oh, really?” and quickly changed the subject.
      It goes on and on…and when we speak up, we are derided as “delusional”. Uppity fatties irritate people, I guess. 😦

  7. Hi Ragen,

    I wasn’t sure if you had seen this article before. Your posting about medical recommendations and attitudes towards obesity made me think of it. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233961/pdf/bjgp58-112.pdf

    These doctors are trying to apply evidence in their recommendations. They haven’t quite “got it”– they suggest recommending weight constancy for people who have unsuccessfully dieted before (vs recommending it first, before the patient has to have bad dieting experience). But it’s one of the few places in the published medical literature where I have seen doctors putting forth recommendations that other doctors NOT try to get their patients to lose weight, due to the evidence against the success of weight loss attempts.

    I enjoy reading your blog, and thanks for the work you put into it.

    Sara

    Sent from my iPad

  8. Another thing I think might be relevant here is that there’s not, as far as I know, a particular weight at which a person becomes “too fat to move.” There’s a variety of weights that any given person’s musculoskeletal structure could support (which could be increased with PT, etc.). And a variety of other issues, at a variety of weights, which render people immobile.

    I think people tend to assume that if a 300 or 400 lb person is bedridden, the fat must’ve caused the immobility, but there are also 300 and 400 lb people who are able to be very active, so it wouldn’t follow that that’s the only cause.

    I would sort of expect that if someone were bedridden solely because of their fat, they would have to have either gained weight really rapidly (basically outpacing what their muscles could keep up with) or been extremely inactive (again, making it so their muscles were no longer able to move their new weight).

    And both rapid weight gain and total inactivity would suggest an underlying condition (thyroid issues, depression, etc.). So, even with a person who truly is bedridden solely because of their weight, the original cause might be thyroid issues or some other medical problem that caused that initial rapid weight gain or activity nosedive. I’m sure those things get missed in a medical culture that’s big on blaming people for their ills, particularly if those people are fat.

    Besides which, since, as Ragen pointed out, there’s no proven way to make a fat person thin, the treatment for mobility issues would be the same whether the fat was the cause or not.

    • Yes, this. I tried to convince someone of this on a forum and they just kept saying, “I’m not talking about THOSE people, I’m talking about the ones who are so fat they can’t move.” Facepalm.

    • Spot on. I saw on TV last week, a woman saying she’d gone on a diet because at 300lbs she fell getting off the bus and couldn’t get up again due to her weight. Well I am 300lbs and have a joint condition that limits how much exercise and activity I can do, but I can do full squats and spring back up again and I weigh the same as her. When I was about 200lbs I actually believed it was my wieght making it hard for me to get up off the floor but actually it was because I was unfit and had an undiagnosed medical condition.

      • I’m 300 pounds, have fibromyalgia, sciatica, and bad knees. Except for climbing stairs, I can move just fine. In fact, since I started exercising in the therapy pool, I move a lot better than I did when I was a fair bit smaller.

    • You talk about weight gain “outpacing what their muscles could keep up with”…

      But just as most people cannot gain an unlimited amount of fat even if they tried, there is usually a limit to the amount of muscle/strength a person can gain, even with steroids or hormones. So it is conceivable that a person could stay active and gradually gain weight, and eventually start to notice subtle limitations, until one day they fall down and cannot get up (the example given by Kitty).

      Not everyone can gain enough muscle to be perfectly mobile at 300 or 400 or 500 lbs.
      It’s not necessarily because a person hasn’t
      done enough to stay active or build muscle.

      • Sure, it’s conceivable. But it’s also conceivable that someone who weighs 100 lbs might not be able to gain enough muscle to be perfectly mobile at 150 lbs, even if the “too heavy” weight is viewed as healthy from a BMI standpoint.

        I would still think that if you’re gradually gaining up to 300, 400, or 500 lbs (rather than that being the weight you’ve had for your adult life), something is screwy metabolically, whether it’s an undiagnosed illness or repeated yo-yo diets.

  9. another winner post, Ragen. I’m printing this one out and keeping it with me as companionship for my next check-up. Thanks.

  10. Apologies if I’m commenting twice, my internet is playing up. Anyway, this comment is directed at the person who inspired the post. They’re questions were respectful and open-minded, but I noticed something that s worth keeping in mind. Also, TW for content -self harm stuff

    You keep talking about anorexia and compulsive eating as though they are reflected by body size. I know the DSM criteria for anorexia includes weight, but the DSM is an imperfect and continuously changing thing.

    There are lots of people diagnosed with ED-NOS. Including lots of fat people who fulfill many of the criteria for anorexia, but who are disqualified by their doctors from that diagnosis due to their weight.

    A person suffering from mental health issues that lead to self-harm, starvation, compulsive exercising and purging can die from the damage those things do to them EVEN IF THEY ARE FAT. A fat person can starve to death. A fat person can suffer damage to their bones and organs through long-term malnutrition. A fat person can be triggered by diet talk, people focusing on their weight, etc. And many fat people never get help to work their way out of these problems because the response from their peers, their family, their doctor when they finally get the courage to ask for help is “Good for you! Keep it up!”.

    I speak from experience. I could tell you horror stories about my experiences dealing with my past – I’m a self-harmer, and I used to use dieting as a form of self harm. And yet I only ever ended up getting bigger. And one time when I signed up for a new doctor and he asked me what I was doing to lose weight? I confessed that I was at the time only eating every other day, and consuming massive amounts of water the rest of the time, and he asked me sarcastically if I thought I was doing enough.

    Diet advice, “concern” for my weight, discussions of how I needed to work harder to be healthy… none of that ever helped me. Fat acceptance and HAES saved my life.

    If you are truly concerned about the health of your patients, focus on healthy behaviour, not weight. Don’t assume you know a person’s diet or health habits based on their size or shape. Don’t assume someone does or does not have a particular mental health condition based on their size and shape. And if you would find it horrifying to hear a thin patient confess that they only eat every other day, consider that you should find it equally horrifying no matter the size of the patient.

    • Bunny, thank you! We have very similar stories. I’m too touched to comment further right now….I just had to thank you.

    • Bunny, you make some excellent points I failed to bring up in my initial response to the poster on the other page. Well said.

      Also, what ever happened to “First, do no harm”? I’m flummoxed as to the misinformation about body shape/weight/size that is handed to doctors who then use it to foist their malpractice on an oppressed and vulnerable fat population in a criminally misguided attempt to make them fit a fictitious ideal. Ridiculous.

    • Very well said. Thank you.

  11. I have been very impressed by my current doctors; not one of them has mentioned my weight, even though I weigh probably around 400 lb.

    I have a long-standing problem with my left ankle; for ten years I’d occasionally mention it to doctors, and they’d tell me to lose weight. Then I moved to this medical practice, mentioned it to a doctor, and he was APPALLED that I had been suffering from an unstable, aching ankle for so long without anyone even X-raying it.

    He X-rayed my ankle. Turned out I’d broken it.

    So I had surgery to remove the bone fragments from inside the ankle joint, and I’ve changed from someone who couldn’t walk 200 yards without pain and sprains into someone who walks over ten miles a week and swims the odd km as well (though not at the moment, I strained my achilles walking five miles cross-country!)

    The irony here is that tackling the ankle problem by treating my obesity led to me becoming MORE OBESE. Tackling the ankle problem by treating the ankle would have led to a far more active patient; not to mention a less buggered ankle at the end!

    • I just read this aloud to my husband, an RN. His reply: This was malpractice.

  12. I’m so grateful to have my current doc (and the last two before her). I sometimes fall into a DeathFatz panic (I’m in the morbidly obese BMI and it messes with my head every once in a while, although I know it’s just a height/weight ratio). Once I went in saying my feet were cold and I was afraid I had bad circulation and was going to have a heart attack. She didn’t tell me to lose weight. She told me to calm down, that my circulation was fine.

    I’ve finally gotten to a point where I’m fine with seeing a doctor regularly. I had a pediatrician as a child who really traumatized me. I used to have nightmares about him. He told my mom I’d have a tendency to gain weight (although at the time I wasn’t fat) and went on and on about it. I was in about the 3rd grade and I felt so horrible. I felt like a freak. He put me off doctors for a long time.(I don’t know why he decided to work with kids. I remember that I couldn’t pee once when he wanted a urine test. He told me that he could give me a shot. My mom told me to drink some water. He also once told my mom that I was exaggerating how much an ear ache hurt. Arrrgh!)

    Anyway, a doctor who doesn’t prescribe weight loss for everything–so wonderful.

  13. In framing discussions about fat patients and their ailments, health care providers should also remember the built-in bias of their profession: they see mostly sick people! So if a physician says that all the patients with a body weight of over X pounds that she sees are suffering from some ailment, it’s important to remember that that’s possibly because they’re PATIENTS, not because they’re fat.

    Would it be oversimplifying to compare this to a physician saying that every single patient for whom she signs a death certificates has severe respiratory problems?

    • This is an excellent point, most doctors do see mostly sick people. It reminds me of that jackass tv doctor, Dr. Oz, who claimed he had never had a fat patient who didn’t have heart disease. Well, he’s a cardiologist, for God’s sake, so he also never had a thin patient who didn’t have heart disease. How in HELL some people can finish 8 years of college when they are so stupid is beyond me!

      Amen, absolutely, it is just like saying that everyone for whom one signs a death certificate has severe respiratory problems. They obviously are no longer able to breathe.

      • I hate that a$$ clown with the fiery passion of a thousands suns going supernova.

        • My dad lives and breathes for Dr. Oz and the Doctors. Takes everything as gospel.

          • My husband & mother-in-law tend to be very much like that. I have talked until I am blue in the face, I have presented facts & figures & shown evidence in writing, but it is like beating my head against a brick wall. If someone says it on tv, it MUST be true. There are just days when I must keep myself away from blunt instruments.

  14. Thank you so much for writing this today, Ragen. I am in a bit of a quandry with my health at the moment. I have Type II diabetes – diagnosed about 2 years ago – but, probably had it or insulin resistance for many years. At any rate, I have been under a doctor’s care and have been faithfully taking my medication, etc., etc., but am still having issues. Unfortunately for me, there is no other way to keep my sugar at a sane level than to keep track of my carbohydrate intake – both type and number. The quandry for me is that I have made great strides in accepting myself and letting go of a lot of shame and food issues. This counting carbs thing is making me feel like I am “dieting” and I’m feeling a bit on the edge about it. I’m not counting calories or limiting food types because of calories, but I have to read the labels and keep track of those carbs – and it feels so very similar. I am trying really hard to wrap my head around this and still feel like I am accepting of myself, but it’s proving to be very difficult. I can’t just let it go and eat what I choose because then I get very ill and feel horrible and exhausted for days on end. That won’t work either. I am trying to resist weighing myself to see if I’ve lost anything because of the changes in eating. I can’t get into that or it will definately turn into a full blow “dieting episode!” I know I have to get through this, but the struggle is oppressive to be sure. I will keep reading your blog and taking comfort from you and the others on this site. I almost feel like a traitor to my own cause!

    • Oh yes, they also told me I have an allergy to gluten and rice. Holy crap!

      • La, welcome to my world… really, I’m smiling at you and holding out my arms for a hug. I also am type 2 and have wheat allergy issues. When the nurse in the diabetic clinic had me track all my danged carbs, I was triggering post traumatic dieting issues.. and I would just wig out.. was making me a real pain in the arse to be around.

        I’m at the point with my diabetes that I am bolus loading short acting insulin (a shot) based on the amount of carb ‘servings’ I’m going to eat in the meal or snack I have. I also take in long acting insulin in the evening and a little more the next morning to help my levels. It’s alot of meds and hassle, but I’m so much happier than when I was just taking pills and ‘dieting’ for the cause. I’d be more than willing to listen to you or correspond with you about this if you need to talk. amazonsue@aol.com

        Also, don’t let the wheat thing beat you down. There’s loads of easy, non-wheat stuff out there and transitioning to other grains can be liberating and really enhance the flavors of things you enjoy.

        I was very strong and pround of myself when I used techniques suggested by this blog to address the ‘triggering’ issue regarding dieting/anxiety with the diabetics nurse. As soon as I told her that counting carbs and tracking my food was triggering eating disorder stuff for me and to please not ask me to do that anymore, she shifted to a different perspective.

      • Have you heard of Ener-G brand? They are an Israeli brand of kosher baked goods, that are gluten free, dairy free, lactose free, and sometimes yeast free. I buy their “Wheat Free Crackers” and use them for my 15 min break during work. They taste awesome as the base for cheese spread or little cans of salmon or tuna. Do you have the Laughing Cow where you are?

        http://www.ener-g.com/

        http://www.thelaughingcow.com/

    • It might be helpful for you to schedule some sessions with Michelle Allison, the Fat Nutritionist, or to just read her blog. I know she talks a lot about giving yourself permission to eat and, when you do have limitations because of illness, figuring out how to reconcile yourself to them while still eating things you like and having a happy relationship with food overall.

      Just off the top of my head, one thing that might make it less stressful is to look at the carbs when you plan and shop, broken down by meal, so you don’t have to pay attention to it as much when you eat. For example, after tracking for a while, if you can say, “For this meal/snack, I want to be between X and Y carbs.” and come up with a list of things you can eat that are in that range, then you don’t have to be looking at labels and counting carbs when you actually go to prepare food and eat.

      • Yes. Meal planning can bring up specters of the dieting past, but for busy people, it can save a lot of time and fuss during the week. Planning your meals ahead of time can go along with planning them with a stack of grocery store sales flyers at your elbow, so you can save money as well as weekday stress.

        • And you also don’t have to plan in great detail. A lot of my meal plans look like: “Grilled chicken, rice, random frozen veggie.” So whether I do a soy-ginger sauce or lemon-herb chicken, or whether I have broccoli or corn or green beans, is dependent on what I’m in the mood for when I go to cook. (Though if you’re doing it to monitor your carb intake, you would have to pay more attention to the ingredients in different marinades and the carb content of different veggies.)

    • If you’d like some suggestions for resources for wheat free eating, support from another fatty who is gluten-free (and trying to remove rice, corn and other grains from my diet as well), feel free to email me: reeneejune@hotmail.com. I’d be happy to talk with you, be a listening ear, whatever… it’s hard to go it alone.

    • After awhile, you will have a sense of how much insulin you need to cover a meal without going through the crazy making carb count. Also, key to this is to test a lot. I’m always arguing for more test strips. It is important to not view your glucose meeter as a scale. It’s not the same thing and not judgment on how well you are doing. It is information to figure out how much insulin you need. Frankly, when I switched to insulin, I loved the amount of control I have over my blood sugar. I know it is very hard to separate carb counting from calorie counting, but it is doable.

    • I am also Type II and dislike the ‘carb counting’. I took a whole class on diabetes that helped me out.

      Here are the things I found most helpful:

      Most vegetables are basically safe to eat since they are generally low in carbs. Figure out which ones you like and keep them handy.

      Eating some protein and fat with carbs helps keep my blood sugar from spiking. Both slow your digestion down.

      This one I am not as good at – walking after a heavy meal will help your body to regulate your blood sugar. Heck, regular exercise/movement will help overall.

      DO NOT WORRY ABOUT WEIGHT.

      The food/movement is to protect your organs from long-term damage. That is the goal. With practice, you can figure out a system that works for you. You can still love your food.

      Also, nobody is perfect, don’t get down on yourself when things don’t go as plan.

      *HUGS*

      • Thanks for your suggestions and kind words everyone. I do appreciate your caring very much!

  15. Oh My Word, I had an upper respiratory infection one time, I used to get them all the time when I was younger so I knew exactly what it was and what I needed. My normal doctor was out on vacation at the time so I went to another doctor in the same building that I had never seen before. I told the nurse exactly what was wrong and she documented it all in my chart and when he came in he automatically started in on the diet song and dance. He never once listened to my chest to hear the infection in my lungs, never once checked my throat or glands just assumed that it was b/c I was fat and wrote me a rx for diet pills.
    I left his office and threw the rx in the trash on the way out and got his license number and reported him to the state. 2 days later my normal doctor was back in town and I went to see him. He immediately chastised me for waiting to see a doctor b/c my lung infection had turned into pneumonia and when I told him that I had been to his colleague 2 days before and what happened he immediately got on the phone and proceeded to rip him a new one. This is why I love my doctor!!

  16. If it’s any consolation, a lot of people are counting carbs these days for strictly health reasons.

  17. Ragen, thank you for this post, and especially engaging a medical professional willing to listen.

    It’s awful enough that there are people out there who think that bullying fat people is helpful, or that fat people really don’t know they’re fat unless a bully does them the “favor” of telling them so. It’s far worse when a medical professional takes the same view.

    I’ve had high blood pressure since I was 18 years old — just like my mother, who was diagnosed when she was 18, and maybe weighed 110 pounds soaking wet. For nearly two decades, I put up with doctors who swore up and down that my blood pressure would improve if I would only lose “even five pounds”. Of course, no matter how many times I lost five pounds, my blood pressure stayed the same, because it has nothing to do with my weight!

    I finally switched doctors due to that kind of attitude, and found one I’m happy with. He never harps on my weight, although he has made suggestions of healthier eating and exercise habits to help with a metabolic condition I *do* have, in addition to appropriate meds.

    But I shudder to think of all of the people who either don’t trust their knowledge of their own bodies or have such blind faith in medicine that they believe such fat-shaming is competent medical treatment. Just imagine if I had worked to lose five pounds and stopped taking my blood-pressure meds because the doctor kept saying it would work… ugh.

  18. I have high blood pressure (I found out at the dentist and the eye doctor) and decided not to go to the doctor again–because they just try to put me on a diet. It’s dumb. I have added more exercise, started doing all my own cooking, and made a lot of other changes for my health and haven’t lost any weight but my health has IMPROVED IMMENSELY. I’m living proof that it isn’t the size (I’m “morbidly obese”) that had made me unhealthy but other factors that I needed to change. Now I’m a health, happy fat girl!

  19. Thanks, as always, Ragen for making your blog a safe place for people to ask respectful questions and learn. I thought the nurse who prompted this blog entry did an excellent job in framing her concerns and she found a respectful, welcoming community. As a HAES advocate, I really believe in making it as safe as possible for people to ask questions so they can start to think differently. You are always on the top of my list when people ask me “How can I learn more about this HAES you’re always talking about?”

  20. Awesome. As a health care provider and fat woman it is a challenge to seperate weight and health. Someitmes I have patients get mad at me when I question their assumptions that thiness = health. So many colleagues just don’t believe encouraging dieting is harmful. Medicine is a broken system that frequently relies on fear of death and intimidation and shaming.

  21. Anybody reading along who doesn’t believe that this kind of mistreatment is common: Go to First, Do No Harm (fathealth.wordpress.com). Some of the stories there will blow.your.mind. The one that currently haunts me concerns a man who endured undiagnosed, untreated multiple sclerosis for years because a whole bitchslap parade of doctors refused to do any tests until he was socially acceptably thin.

    • I remember reading that one, and thought how could anyone do that? I recently learned that the daughter of one our friends has MS, and is mostly going downhill. She taught me piano when I was a little kid.

      • Did you see the latest? The contributor was recently diagnosed with a congenital ailment in which her brain begins to bulge out of the hole in the bottom of her skull and instead of corrective surgery she’s getting the Fatty Boombalatti Song!

  22. TW for fat phobic talk: There are barriers for sick fat people that do not exist for sick thin people. I get it all the time: If you’re sick it is because you’re fat. And you’re fat because you have no self-discipline. Therefore being sick is your own fault.

    I know that getting through med school must take a supreme amount of self-discipline. So… if someone who manages to become a doctor thinks YOU don’t have self-discipline, they don’t think much of you. Doctors starting with that premise think that if you don’t care why should they?

    Doctors have refused to treat me in a number of ways.. I have been denied treatment outright and sent away by more than one physician. Another told me the price for treatment was to lose an absurd amount of weight in a short time. The doctor said he’d do surgery IF I could lose 50 pounds before our next appointment in a month.

    I’ve had doctors play “hot potato” with me saying my problem was not theirs and referring me off to someone else only to have THAT doctor do the same, sending me on to yet a third. Once, the anesthesiologist who was slated to do my surgery just… decided not to AS I WAS LAYING IN PRE-OP. Fortunately, the head of anesthesia was there that day and he took on the hot potato that was my fat self.

    I’ve been tested unto madness in order to make sure it was “safe” to do surgery on me; far more tests than would have been done had I been thin. And people shriek about the high cost of treating fatties. At least part of it is over testing.

    Another part of the problem is when you get denied or foisted off the medical problem doesn’t get addressed. I can tell you first hand I am suffering with issues that would have been resolved if I had not been fat. I am in far worse health than need be because I can’t get the help I need that others take for granted. Doctors just do not want to deal with me and I am the one who suffers.

    First do no harm? Ha.

    • “Doctors starting with that premise think that if you don’t care why should they?”

      But wouldn’t going to the doctor in the first place be the prime indicator that you do care? And wouldn’t not going to the doctor and spreading an infectious disease or not getting a vaccine be proof that you don’t care?

      • TW for doctor talk. I would think so. But, they sure don’t act like it. Most recently I was at a gastro’s office talking about the benefits of a virtual colonoscopy over a conventional one. He said that IF the equipment would hold me, which he doubted, it would require a three day fast… which on second thought would still be great for YOU either way. To me, at least, that doesn’t sound like someone who cares about me or has any respect for me whatever.

        • I’ve had experiences like that where they thought I was stupid for coming in, since I obviously wasn’t taking care of myself before.

          One doctor I saw at a medicentre in Edmonton while I was living in rez away from home, I went to see on the last day of the month since my drug coverage was being cancelled after that day in my plan. (Canada, I know, you’d think drugs would at least be covered.) I went to get some menstrual pills since at that time they were like I was dying from pain, and he kept going on about how fat I was, and not addressing why I came there. I had to explain dozens of times why I was there, and he kept asking me what the pills were for, did I know how to use them. It sounded like he had never heard of the pills or he thought that I was just coming for a hit or something.

          Finally I got them, plus a Rx for antiobiotics for these bumps on my breasts and underarms (I didn’t know at the time they were caused by a wheat allergy/intolerance), and he said those were infections caused by my skin rubbing. Right, how come they aren’t anywhere else then, and how come you don’t have them? I didn’t have the courage to ask those questions, but I went back to rez and told my story to others and they all agreed that doctors (esp. male doctors) only like to look at thin women who will turn them on.

          The rez population was a mixture of races and sizes. I made friends with them all.

          • It is a shame that doctors who obviously are well-read, intelligent people can still succumb to bigotry. It is a real shame that finding one who will treat a fat patient with dignity and respect is the exception and not the rule.

  23. Reblogged this on The Cheese Whines and commented:
    Blaming everything on a person’s weight is bad medicine. This not only results in heavy people being undertreated or not treated at all, it also results in misdiagnosis for slender people, because medical professionals are taught that thin equals healthy. Thin people can also have heart problems, diabetes, hypertension, and whatever else people currently believe can only happen to fat people.
    Sometimes there’s a correlation between a certain body type and a certain condition. For instance, hypothyroidism (which I have) tends to be correlated with a larger body type, where hyperthyroidism tends to be correlated with a more slender body type. How much of a factor the condition is on the person’s size will depend on the person.
    It is also bad medicine to take a “one size fits all” approach. My son had an EMS instructor who advised the students to TREAT THE PATIENT, NOT THE CHART! Best advice ever!

  24. So many appalling stories. Thanks for the place to come together, Ragan.

  25. My husband suffered a mild heart attack in December 2011. He stopped smoking that same day, and was also told that he had to lose weight to “help” his condition. They’d found a blocked blood vessel, but didn’t need to fit a stent, because he responded immediately to medication. His cholesterol, before he had the heart attack, was under 4 (UK measurement, anything above 5 is considered to be high, for some reason). He was instantly prescribed statins, though. One of your earlier respondents mentioned that her cholesterol was considered normal, despite her being overweight, but that doctors were doing their best to “prove” that it couldn’t possibly be, because of her weight. My husband, too, proves that this is clearly a nonsense. He still takes a statin because the doctor says he should, even though his cholesterol must now be almost non-existent! In my opinion, his heart attack was clearly not caused, or contributed to, by “high” cholesterol. Your respondent also mentions that her blood pressure is within a normal range, too, despite her size, but that doctors keep trying to insist it can’t be, again because of her weight. I pay an extra amount for my life insurance for my mortgage, because my BMI is considered, by the insurers, to be too high. Forget the established facts that I don’t have high blood pressure and never have, I’ve never smoked, and that my cholesterol measurement is considered to be well within “normal” – no, the fact that I’m at least two stones heavier than they feel is “normal” for my height means I literally pay a penalty! I am considered a far bigger risk than someone who might be a “normal” weight, but might have high blood pressure – if they’re receiving medication for that, it’s fine! How wrong is all this? I am absolutely in agreement with you, Ragen, about not using someone’s weight as something with which to beat them up over other medical conditions. I think it’s a cop out on the part of the medical profession.

    • This is scary as the most reliable evidence shows that low cholesterol causes more heart attacks than high cholesterol. According to junkfoodscience.blogspot.com and second-opinions.co.uk anything less than about 5.5 mmol or 200mg/dL is a cause for concern (unfortunately most doctors don’t see it that way).

      My parents joined this new guru diet club, and had to have blood tests, and I saw my dad’s cholesterol at 2.75mmol (which is 105mg/dL). That is about 1/3 normal or safe for his age and gender as 7mmol (270mg/dL) has the least amount of disease, alzheimer’s and cancer. I urge you to read those links and make an educated decision.

      You say you’re in the UK, but from what I’ve read doctors in the US get paid according to how many pills they sell, and if they are a specific brand, as part of the Pay-4-Performance insurance. So they are only going to give you pills and not treat actual symptoms or diseases based on this principle.

      I know enough to never go on statins ever, they are waaaay too dangerous.

      • I had a very bad reaction to statins, very bad. I ended up having to use a cane due to muscle weakness and severe pain, I had to set a potty chair up by my bed because I couldn’t get to the bathroom from my bed. I even had some dementia. My Drs were convinced it could not be any of my meds, they ran many tests and at least one of them wrote me off as as an attention seeker. One night I decided to start researching my meds starting with the newest, when I got to Statins I found this forum: http://www.spacedoc.com/board/ and I knew what had happened to me. I quit taking them and began my recovery. I still have to use a cane when I have to walk very far and I still have some memory problems, but I am mostly myself again. My current group of Drs also claim Statins can’t cause those kinds of problems, so I told them to mark statins as an allergy, because I can not take them.
        My husband had a heart attack 5 years ago and has been on Statins ever sense. I don’t fuss with him over it because research shows that the only group of people that are truly benefited by them are middle aged men who have had heart attacks. They are a very powerful anti-inflammatory so I suspect that is why.

        • I read spacedoc.com too. He explained how the standards have been gradually getting lower from 300 to under 200. Truly shocking. My mom’s on statins again because her HDL is high (but LDL is absurdly low). She was on Lipitor before but got the high creatine kinase that indicates liver failure, so he took her off them. She’s on Crestor now, but I don’t see any diff. in any of those pills.

          I personally don’t think anyone should ever take a statin. Spacedoc said that for men who’ve had a heart attack it’s unknown how long to take them for, 2 weeks, 2 months, a decade? Who knows! My family has a history of dementia and alzheimer’s on both sides, so lowering the cholesterol so early in life, like 45 yrs before it would naturally occur, seems stupid to me.

          And those doctors who say that statins don’t cause those things, they just don’t want to lose a sale. Modern medicine is driven by $$$ not knowledge.

          • Obviously, no one’s told your mother’s doctor that statins just don’t do anything for women, ever, at all! Here in the UK, it would be considered a brilliant thing for someone’s levels of HDL to be “high”. What irritates me is the way that “experts” and therefore the media and every one else refer to “good” and “bad” cholesterol. As we know, there is only one type, and that’s cholesterol. HDL and LDL are lipoproteins, and undertake different tasks within the body. Oh, and of course, it does not necessarily follow that all fat people have “high” cholesterol…..

      • I agree totally, Mich – Ian, my husband, reacted very badly to the first statin he had – Simvastatin, and stopped taking them after I found some evidence on the internet for his symptoms. It wasn’t until we were allocated a new doctor that he was told he should be taking one, and he now takes Atorvastatin. He’s not reacted to this, but I still don’t believe he needs one at all. I suspect that GP practices are paid a certain amount by drugs companies for how many prescriptions they issue for certain drugs, but obviously, I can’t prove that. I wish I could convince him that he really doesn’t need statins at all, but I’m sure that he is scared, understandably, that were he to ever have another heart attack, it might be because he didn’t take those dratted statins! He also takes medication for high blood pressure, and has done for about eight years. I wish he didn’t believe that if the doctor says he needs it, then it must be right.

        • Atorvastatin is Lipitor, what my dad’s on. These doctors are getting scary, hoodwinked by Big Pharma. On Sandy’s blog, she reported on the drug trials that had more heart attacks and repeat attacks on those taking the drugs, than those who didn’t. Scary.

          For your other comment about the UK, I agree with the good vs. bad: these are not moral elements or molecules. They exist for a reason, and if it was a detriment to our bodies, our bodies wouldn’t make them. I think for those ppl who have hypercholesterolemia (really high, like 1000+) they’re seeing it as more like cholesterol resistance: your body needs it but can’t receive them in the cells, so calls for more to be made. This doesn’t mean you’re on your way to get a heart attack, but that your cells are starved of what keeps them running and functioning normally. The best way to fix it is to get the cholesterol into the cells. Unfortunately the standard treatment is: a statin (which reduces artificially the cholesterol and doesn’t solve the problem).

  26. I work in the medical field and feel like I am constantly fighting this battle. A doctor who recently arrived on one of my wards seems like he might be a real pro-diet guy – he wanted one of our patients, who is in the middle of wound-healing (which needs to be anabolic) to be put on a diet (which is catabolic) because he’s fat. I had to explain that I just couldn’t do that (I’m an RD) because he’s in the middle of wound-healing and putting people on diets during this process (or ever) isn’t evidence-based healthcare. Argh. This is the same person who said to me, “1800 calories seems like a lot of calories.” Uh, that’s what I eat in a day. Might I also add that doctors generally get less than 25 hours of nutrition training?

    • That’s like only 1 day of training. I got more language training in Hebrew, and that was 10 yrs ago, and I still know it.

      According to Sandy’s old blog junkfoodscience, doctors get nutrition “education” from others who likewise don’t understand nutrition either, so it’s self-fulfilling stupidity that keeps going around, like a cycle of violence.

  27. I’m very fortunate to have the primary doc that I have. She has NEVER brought up my weight unless I initiated the conversation first. I wish all my previous docs were like her. I’ve had weight loss prescribed for strep throat, bipolar disorder, fibro, and even for a miscarriage caused by a nasty kidney infection. I was even told by my ObGyn doc to not gain any more than 5 pounds during my pregnancy with my second child (I was around 240ibs at that time). What kind of doc tells a pregnant woman that? I found a new Ob-Gyn fast after that appointment. It’s sad, frustrating, and rage-inducing that so-called health professionals can’t see past the fat to treat the patient.


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