What to Do With Doctors Gone Wild

A lot of people have contacted me, understandably very upset about the horrible “guidelines” for treatment of fat patients that I blogged about yesterday (the quick version is that the guidelines, written by a doctor with some major monetary ties to the diet drug industry, recommend that fat people not get treatment for actual illnesses until they’ve lost weight with, you guessed it, diet drugs.)

Fat people going to the doctor with actual health issues and leaving with a diet instead of the evidence-based healthcare that thin people would have received is not a new thing.  We are working to change the system but here are some things that fat people can do right now.

Before we start I want to be clear that these are suggestions that have worked for me and/or people I trust – there are no guarantees and there may be consequences – including having your doctor drop you as a patient, and of course your mileage may vary.  The solutions are predominantly US-based, and, sadly, they won’t be available to everyone due to the expense involved, the power structures involved, and additional oppressions that can come into play in the world of healthcare including things like racism, ableism, healthism, transphobia,homophobia, classism and ageism.)

Here are some suggestions, I welcome you to add yours in the comments:

Find a Fat Friendly Doctor and Tell Other People About Yours

Use the Cat Dragon Fat Friendly Healthcare Providers List (contains listings for multiple countries) both to find fat friendly doctors, and to add fat friendly doctors who you know of so that others can find them.

Call Ahead

Before going to a new doctor, call ahead and let them know that you are practicing Health at Every Size and so aren’t interested in weight loss interventions and ask if they are willing to agree to treat you on that basis.

Be Prepared

Prepare for the doctors appointment by using the media circle.

Ask Questions

When a doctor prescribes a weight loss solution to a health issue ask one or more of the following (feel free to change the wording to feel natural to you.)

• I’m really interested in researching my healthcare, can you point me to a study where [the weight loss intervention you are recommending] worked on people my size to both [decrease weight long term as much as you are recommending] and [have the health benefit you are looking for]?  Spoiler alert:  They can’t because the research doesn’t exist.

• I’ve been prescribed weight loss interventions [since I was a child, for the past 15 years etc.] and they’ve never made me healthier, thinner, or happier. My research of weight loss interventions tells me that my experience is very typical. What other interventions are available?

• Out of curiosity, do thin people get this health issues?  (Spoiler Alert:  yes, they do) What is prescribed to them?  I practice Health at Every Size so rather than trying to manipulate my body size, I’d like to start by doing the same evidence-based interventions that you would recommend to a thinner person.

• If offered weight loss drugs that you aren’t interested in :  My understanding is that those drugs [have some pretty serious side effects including everything from uncontrolled anal seepage, to addiction, and even death.  That many countries have refused to approve them because of safety issues, they they don’t result in that much more short term weight loss (only about 4 pounds over a year) and that in their own studies people began regaining the weight right away.]  I can’t give informed consent to that, what other treatment options are available? (consider asking the question about what thin people are prescribed above)

• If offered weight loss surgery that you aren’t interested in:  My research has shown that weight loss surgery is extremely dangerous with serious long term side effects and a real risk of death. I’ve heard and read stories from many people with irreversible life-altering side effects. I can’t give informed consent to that, what other treatment options are available. (consider asking the question about what thin people are prescribed above)

Try an Online Doctor

A friend of mine who identifies as a Super Fat was just telling me that she has had great luck with online doctor services (she used Heathtap – which offered her a free month to try them out and then costs around $100 a month – and there are others available.)  Because the doctor couldn’t see her she was able to get the good healthcare without dealing with any size-based prejudice the doctor may have held from seeing her.

Try Urgent Care

When you have an issue that needs quick medical attention that one time visit can provide (like strep throat, the flu etc.) Urgent Care can be a better choice – often they are more likely to treat the actual issue that you came in with and skip the weight loss lecture.

Try the Alternative

There is plenty of fatphobia in “Alternative Medicine”  but I’ve personally had much better luck with those practitioners than practitioners of “Western Medicine.”  Perhaps due to the fact that they can’t be bought by big pharma, they tend to actually be involved in wellness care rather than waiting for us to get sick, and the relationship is different because, even though they are a respected and trusted counselor, they tend to agree that I have a place in the conversation about my wellness and that we are working in cooperation. It was still hard work to find practitioners who work this way (and I definitely med some duds along the way) and it’s expensive since it’s not covered by insurance.

Ask to see/update your chart

The HIPAA Privacy Rule requires that doctors allow you to see your chart in their office, and get a copy of your char (though they can charge you for copies). You can also add a note to your chart to correct mistakes – even if your doctor doesn’t think it is a mistake, you still have the right to have your disagreement noted in your chart. (here is an overview, and here is the actual HIPAA page ).

If you refuse weight loss interventions your doctor may have marked you as non-compliant.  This has actually been used to deny future life-saving treatment to people (organ transplants etc.) on the basis that the person will not do what is necessary to make the procedure a success because they are a “non-compliant patient”.

If this happens to you, you can add a note explaining your choice not to comply.  It might  say something like “Doctor suggested weight loss as a cure for [whatever].  I explained that based on my research the intervention wasn’t likely to lead to long-term weight loss, or long term improved health.  Doctor was unable to provide evidence to refute my assertion or validate her choice of intervention – I refused to give informed consent on the grounds that the intervention prescribed did not meet the requirements of ethical evidence-based medicine and I did not feel that, in this case, the risk of such a procedure was worth the possible benefit since other treatment protocols (like those given to thin patients who have the same health issue) are available which do meet the requirements of evidence based medicine.”

If you feel that your blood pressure reading was too high because the doctor didn’t have/refused to use the proper size cuff etc. , or if the doctor ignored your actual health concerns to focus on your body size etc., you can make a note of those mistakes as well.

Say It Loud

If you have a terrible (or a great!) experience with a practitioner, find them and leave a review – try places like yelp, Zocdoc, Google their name and see what review sites they are listed with, contact the reporting board in your state etc.

Litigate

I know that the idea of lawsuits is not everyone’s cup of tea and that’s ok. For me, I think that when fighting fat bias in medicine on the grounds that fat bias is wrong doesn’t work, and our lives hang in the balance, hitting healthcare practitioners in the wallet might be a good option.  Maybe we should start a legal fund for those who want to sue and/or find lawyers who are interested in helping us find the best way to go about it.  I think that if mistreatment of fat patients starts leading to expensive lawsuits, then we’ll see some guidelines for treating fat patients that make more sense than denying us  treatment until we lose weight.

These things that are being done to fat people under the guise of healthcare are wrong.  We shouldn’t have to deal with them, they are not our fault.  Unfortunately they can become our problem.  Each fat person gets to choose how to deal with this in their lives and all of those choices are valid.  I think that if we want change in the healthcare establishment, it’s going to take a whole lot of standing up, speaking out, and fighting back to get it done from fat people and our allies.

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