One Woman's Story of Medicine's Bias Based on Body Size
/I just had lunch with a friend. She shared with me her recent visit to the doctor for a physical. There are so many things wrong with this story that I think you are going to need to make sure that you are sitting down. You might want a warm blanket, a cup of tea or a teddy bear too. You are going to need it.
I don't even know where to begin. I also know that this story doesn’t even begin to scratch the surface of the injustices that larger bodies have suffered in the medical community. This needs to change.
Let's start with the fact that my friend did not even want to go to the doctor. She had gained some weight over the last few years and at her last physical/appointment he told her that if her weight kept going up they were going to have to have a serious discussion about it.
Because of that, she did not go to the doctor at all the following year and this year she made an appointment with the nurse practitioner when the doctor would not be in the office.
Has this ever happened to you? Sadly - it happens to too many people. They are shamed about their weight and then too embarrassed to go back to the doctor and so they put off getting medical care. For some, this avoidance has deadly circumstances.
So my friend goes back to the doctor’s office and meets with the nurse. Turns out she has gained more weight over the past few years. The nurse tells her she is now obese according to her BMI.
I don't want to digress too much - there is so much more to get to - but here is something to explain why BMI is bullshit.
On with the story. Next, the nurse tells her that they will get some blood work done, but it is likely that they will be talking about high cholesterol and diabetes and "who knows what else" when the results come back. The nurse just wanted to give her a heads up.
So here we have a nurse telling a patient what her blood work is going to look like solely based on her weight. Is that a thing? Is that what we are doing now? Guessing conditions based on weight and sharing them with the patient while shaming her at the same time?
Oh, but the story gets better. My friend acknowledged that she had not been active for the past few years. The nurse asked her why not and she responded that she didn't feel like it. So this nurse diagnosed her with depression! Just like that! No psychologist needed or anything! Isn't that amazing?
Next my friend acknowledged that sometimes her knees hurt because she has osteoarthritis which contributes to her not moving as much as she used to. So the nurse suggested physical therapy. Great! “That's a good idea”, my friend thought. And then she saw the PT request form that the nurse gave her. For conditions, the nurse listed "overweight" and "major depressive disorder". She didn't mention the knee pain at all. Seriously?
Then the blood work came in. My friend was then told that her cholesterol was getting higher and she had prediabetes. So the nurse had been right? Or had she? Is prediabetes even a real diagnosis? (Hint: No - it's not but more on that in another blog.)
My friend reflected on the course of events - from wanting to avoid the doctor to being shamed by the nurse about her weight and then having all her physical issues blamed on her weight. For a moment she started to get sad and then she remembered me and my work and realized what was happening.
My friend was being fat-shamed at the doctor’s office and her health problems were being blamed solely on her weight. Unfortunately, she is not alone as this article begins to address (please ignore the use of the terms overweight and obesity - we still have a long way to go as far as the language that people use.)
Here is what the doctor and nurse did not know, ask about or mention - and this is what makes me feel sad and enraged.
My friend has a family history of high cholesterol and it had shown up as an issue as far back as 12 years ago when she was first put on high cholesterol medication (before any of the weight gain.) Oh, but now the cholesterol is related to her weight - right?
My friend has had arthritis in her knees since she was a highly competitive volleyball player and had her first of three knee surgeries starting at 20 (before any of the weight gain.) Oh, but now the knee pain is related to her weight - right?
My friend had recently gone through the tragic death of her sister at age 48 to terminal cancer. Her sister who was her only remaining immediate family member. Hmmm - that sounds like that might make someone not feel very good and maybe not want to move their body for a period of time.
(It also bears mentioning that my friend’s sister was an avid cyclist who ate only organic foods and lived in a thin body. Thin bodies that engage in routine movement get diseases too so why do larger bodies get shamed for that?)
This same doctor had also prescribed antidepressants around the time of her sister's death because my friend "couldn't get through a doctor’s appointment without crying". I'm sorry - but what is the appropriate response when you sister dies of cancer at age 48 and it makes you sad? Has anyone ever heard of grief?
But no one mentioned that this same antidepressant might also cause weight gain while they shamed my friend a few years later for weight gain. How is that even possible?
I haven't even mentioned that my friend is also in perimenopause of which weight gain is also a symptom. Weight gain is part of our body’s plan for survival at the time of menopause. Gaining weight is a normal and necessary function - but nope - no one mentioned that either.
So here is what we can conclude from this experience.
When the doctor's office shames you enough that you don't want to go for your annual visit, find a new doctor if you can, or at least find someone who understands this phenomenon enough to help you stand strong in the face of the shaming.
When the doctor's office blames all of your medical conditions on your weight and assumes you will have these conditions, find a new doctor.
When the doctor's office prescribes you a medication that will make you gain weight and then shames you for your weight gain, find a new doctor.
When the doctor's office tells you that crying over the loss of a loved one is depression, find a new doctor.
When the doctor's office writes "overweight" and "major depressive disorder" on a request for physical therapy without mentioning your knee pain, find a new doctor.
When the doctor's office tells you they are going to lecture to you if you "gain one more pound", find a new doctor.
When your doctor doesn't take menopause into account for a woman of in that age range and doesn't understand how weight changes at the time of life, find a new doctor.
When the doctor's office does not understand the big picture of your life and is blindly going about treating symptoms and blaming them all on your weight, find a new doctor.
Shit - looks like most of us are going to need a new doctor. Or maybe the doctors need a new approach.
The good news is that there is a new approach! And it works to make people feel seen and heard and valued as people and not judged based on the number on a scale. Incredible right?
The approach is called Health at Every Size and every doctor's office should be learning more about this approach. The principles of HAES are as follows:
1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
The Health at Every Size approach would mean for my friend that her weight change would be noted on her chart and perhaps the doctor might want to say – “Your weight has changed, is there anything you want to talk about with regard to this?”
Or, “Your cholesterol is up, but I see you have a family history and so this makes sense. Sometimes moving more can also help with cholesterol so that is something you might want to consider if that is possible for you.”
Also, “Oh, you have knee pain? I will write a script for PT in case that can help you (doctor then writes "knee pain" on the PT form.)
Lastly, “You had a tragic loss recently, which can affect our body and our mind in a number of different ways. Please don't be hard on yourself because healing takes time. Do you need extra support related to your loss? I can recommend a therapist to help you talk through your loss and how you are feeling.”
Now would that be so hard?
Image by tortugadatacorp on Pixabay.