What to Do With Doctors Gone Wild

Stand up speak up fight backA 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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Published in: on January 22, 2015 at 8:44 am  Comments (16)  

16 CommentsLeave a comment

  1. After the good news of my psychiatrist not shaming me for not keeping a food log on Tuesday, yesterday I got some pretty bad news. And again your blog is so perfectly timed because I am considering ways that I can take legal action against a litany of doctors who have shamed me over the years.

    I went to see my endocrinologist and orthopedist yesterday (they share offices in a medical building so I always try to schedule these appointments on the same day to save my insurance from paying for two trips in the shuttle). I had been having major pain in my foot that was pretty unexplained, well because of the way my fat is stored in my belly and hips I am not able to look and see the bottom of my foot. I had my endocrinologist look and sure enough I have developed diabetic ulcers on the bottom of my feet. For those of you who know diabetics, you will know that this is not good news at all, and I will save the trigger warnings and leave out what the usual next step is.

    Well I took this news to my orthopedist, with whom we have been working up to getting a knee replacement so I could hopefully start walking short distances again. Well when he found out about the diabetic ulcers he said that he could not in good conscience allow me to go through with the knee replacement until we had further news about what was going to happen with my feet. He was very nice and very upbeat about the results saying that in his experience, its not always a forgone conclusion as to what happens after a person gets diabetic ulcers and he’s happy to re-approach the knee replacement after we learn more about how the endocrinologist wants to proceed. Apparently they were going to talk yesterday afternoon. I have not heard the results of this yet.

    I am devastated as you can imagine, I have worked really hard to take care of myself to the best of my abilities. I have followed every fat shaming doctors advice, even when it embarrass me or makes me feel depressed. I have been on severe calorie restrictions, Atkins, South Beach, shakes, nutri-system, WW all at THEIR urging. AND NOTHING HAS EVER WORKED…and what do I get for their shaming me? Again, its so triggering I don’t even want to talk about it in writing. Again, I did MY best, the best that my genetics and my SITUATION allowed me to do. Can I say the same for the doctors who treated me? NO. With the exception of my cardiologist who has never, ever, ever made me feel shamed for my bad heart, the rest have been complete assholes who only seem to want to make me feel bad instead of actually trying to help.

    I have put in several calls for Mal-practice attorneys yesterday and intend to hold every doctor I can accountable for the horrible treatment I have received that has put me in this condition today. I suffer from severe anxiety and depression and may have to go back to inpatient treatment today (my mother is on her way over to take me as I write this) so if I don’t write for a couple days I am find and where I need to be but I will update on this and will seriously start publicly naming names of these SHIT doctors on my own blog as soon as my lawyers say I am able.

    • Simon- Geez, I’m sorry for your situation.

      RE: finding an attorney
      Have you used the San Diego Lawyer Referral Service?
      https://www.sdcba.org/index.cfm?pg=MainLRIS

      Specifically the Medical Malpractice section:
      https://www.sdcba.org/index.cfm?pg=medmal

      Might use the free 30 minutes consultation to get some guidance in finding the best attorney for your situation.

      (they sure helped me with an unlawful detainer action last year)

    • I’ll be keeping my fingers crossed for you, Simon. I’ve been keeping an eye on Mr. Twistie’s feet for more than twenty years watching for any sign of diabetic ulcers, so I know what you’re facing.

      Take care of yourself, emotionally as well as physically.

    • I hope you get the care you need and deserve. No one should be made to jump through hoops to get medical care.

      I don’t know if it would help, but you might want to look for an inspection or telescoping mirror, might help you check your feet amongst other things.

    • Wouldn’t being able to walk increase circulation to the feet and allow for better healing? I’d think a knee replacement would be the first line of defence!

  2. My sympathies. I wish you the very best in your health battle-I wish I had some advice to give. Ditto, any attempt to hold medical professionals who’ve mis-treated you accountable for any neglect. If medics practiced weight stabilization, as a policy, many people’s weight would not continue to rise and rise under the influence of slimming rebound weight gain.

    During my long 17 year diet career, I was pretty much dietproof. That meant I literally could hardly get my body to succumb to weight loss dieting.

    My defences were so strong and overwhelming, that few attempts could I get past them. Because of this I often wonder whether I avoided rebound weight gain, because I could rarely manage to lose much weight. There’s also metabolic exhaustion, when your system slims and rebounds once too often and seems to become unresponsive to even quite extreme calorie restriction and/or you find storage of body fat accelerates.

    By imposing a diet or nothing framework, they’ve effectively put themselves in a position where they’re unaccountable for the results of their insistence on WLD because all “blame” lies on fat people.

    This is not conducive to facing the reality of diet risks and liabilities and leaves fat people unnecessarily exposed to the consequences.

    Though some medics have a great sense of grievance about legal action being taken by their patients, looking at the way they treat fat people is proof of what happens when they’re barely held to account.

  3. As someone working in health care and working closely with doctors, I can affirm that they definitely don’t want to be sued and will really work to avoid this. So while no one *wants* to go that route, I think it’s the way it’s eventually have to going to go to start getting equitable treatment.

    • It says something that the only way to get real medical care is to go through a lawyer. I’m sure lawyers don’t have unlimited time and resources to constantly battle incompetent doctors.

  4. I already told my story regarding my gynecologist making unsolicited comments, so I’d like to know what you guys and gals think about my step-dad’s comments, which aren’t specifically directed at me, but still annoying. I didn’t get any replies when I posted the comment below earlier, so I wanted to try again.

    I was tempted to say something to my step-dad at dinner a few days ago when we were all chatting about a story his visiting daughter told us. I bit my tongue because I am a non-confrontational person who also has social anxiety. I reminded myself that it doesn’t matter what he thinks anyway and, besides, I try to not give my power away to others.

    Anyway, his daughter recalled a story about how, when her child was younger and threw a tantrum in a grocery store, a busybody woman riding a scooter criticized her parenting skills. His daughter added that the woman didn’t need the scooter but was just using it to get around.

    Step-dad asked if said nosy woman was heavy. WTF? Why does it matter if she was/is heavy? He asked the same question not too long ago about a different woman when talking with a relative via cell phone, if I remember correctly.

    I wonder if he asked so he could say to himself, confirmation bias unknowingly by his side, “Ha! Fat people ARE lazy!”

    I hope he’s not doing this deliberately in an attempt to be a jerk and it is more of a case of ignorance and a lack of critical thinking skills.

    I doubt he even knows what confirmation bias is, as I’ve tried to explain logical fallacies to the man before but he failed to grasp the concept — or at least seemed to do so.

    Reply

    • I did see your comment, but I wasn’t sure how to reply. The only thing I can think of is to come back with: “babies don’t really need buggies/strollers, they’re only using them to get around, they’re obviously too lazy.”

      Incidentally, my grandma (who died just over a yr ago) needed a walker and wheelchair to get around (she also lived in a nursing home). She was definitely not fat. We recently went through some pictures of her and my grandad from the 1940s, and they were basically the same size their whole lives.

      Another thing to consider is if thin ppl “really need the scooter”. After all, they’re just using it to “get around” too.

    • I think step-Dad is simply self-affirming his beliefs. Small-minded people need to re-affirm their ignorance at every opportunity. Makes for a very narrow-minded approach to life.

      Be glad you don’t share his genes. Clearly this is someone you shouldn’t spend a whole lot of your time and interest on. There are way better folks out there to get to know that will affirm the goodness in humanity for you.

      And, exactly how does step-Dad’s daughter know “that the woman didn’t need the scooter but was just using it to get around”? The woman could very well have breathing issues, joint issues, muscle issues that don’t present by appearance. Like to know where she got her medical degree.

      • Thanks, everyone.

  5. Thank you for sharing the fat friendly doctor list! I just moved and need to find a new doctor ASAP and I’ve been dreading it. There was actually one near me – yay!

  6. I have been labeled at non-compliant all my life. I’ve done much of what they have told me to do, and it irks me to no end that I’m “non-compliant” because I haven’t lost the weight. The last time I was marked non-compliant, the doctor said I refused to take my diabetes medication, but I had lost 30 lbs. and every time I took the meds, my blood sugar dropped dangerously low. I stopped taking them after calling him and telling him about the drops, and he TOLD me to stop taking them. But then he put in my chart that I was non-compliant because I stopped taking them. Needless to say, I stopped going to him.

  7. Sorry this comment is so late… Another thing we can do if we have a bad encounter with a health care professional is submit a formal grievance. Hospitals/clinics usually have instructions on how to do this posted on their websites.


  8. Thank you for this great roundup of all the arguments doctors might make and ways to counter them. Making your (my) own arguments can be hard and it is wonderful to have a guide.

    There are definitely a lot of bad alternative medicine practitioners and they can be pricey. The good ones will often have sliding scale appointments or free clinics or work-trade options (so you can, for example, work in an herbalist’s apothecary for so many hours in exchange for a clinical visit). Ask alternative medicine schools in your area if they have a student clinic (which tend to be free or very low cost) and ask practitioners if they offer a low-income rate or work-trade. (This kind of policy does not automatically mean fat-friendly.)


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