This essay contains difficult content about weight, eating disorders, sexual assault, and medical care. Please proceed with care for yourself.
I am a fat person who has always been fat and I am tired of having my health concerns addressed by thin medical professionals who have no idea what it’s like to exist in my body. Even though you have no idea, y’all make plenty of assumptions. Numerous studies back this up: in one, more than 30% of medical providers viewed patients with obesity as weak-willed, sloppy, or lazy and over 50% viewed their fat patients as awkward, unattractive, ugly, and noncompliant.
Who knew your doctor’s role included assessing how pretty you are?
I went to urgent care this weekend with fear of a UTI and knot in my lower stomach. Not a nervous knot of anxiety, an actual, physical, hard knot. The recently graduated PA-C was too afraid to even touch me. My fat is a leprosy that cloaks me in medical offices, a jacket of shame I can never remove.
Even after telling him about it, I had to specifically ask the PA-C to palpate and identify the place of concern, hidden a bit by my soft tummy. This young man was observably uncomfortable and noticeably shocked to inform me that it’s a knot in the connection of my oblique muscles, which are somehow wicked strong despite the fact that he had evaluated my health to be shit because of the outward appearance of my body.
But despite the fact that I’ve spent nearly 20 years trying to be thin, it’s somehow my fault that I’m fat, so nobody cares. Not only is discrimination against my body acceptable, it is encouraged for my own “good.”
Yesterday, on a scorching Wednesday afternoon, I went to a new gynecologist with hope. A queer leftist with green hair and a big mouth had wholeheartedly recommended her. But the recommender and the doctor were both thin, so I had a bit of pause. When I arrived, the lobby had chairs without arms, body-inclusive art. The nurse didn’t insist on telling me my weight. The exam room had progressive, inclusive signs and my sexuality didn’t feel like as much of a burden as usual. Maybe this was a place I could receive weight-neutral healthcare.
But of course, it wasn’t. The problem was very clearly my bladder, but the first thing the thin blonde doctor wanted to discuss was my BMI. A woman of big bones and dense muscles, I have never had a “healthy” BMI, not even when I was 12.
I explicitly and repeatedly told Dr. S that my weight does not pose any physical problems for me. She insisted on observing that my BMI could be a few points lower anyway. This is not a necessary conversation for doctors to have with their fat patients. Our society is hyper-obsessed with thinness and extremely fatphobic. Fat people know that we are fat, and we know that you want us to lose weight.
Repeatedly telling fat people to lose weight makes us no slimmer. It simply fuels the internal shame until it is nearly unbearable. As one self-identified fat medical student put it:
“Bludgeoning fat people with a suggestion we should be less fat every time you see us actually doesn’t make us less fat. It makes us avoid going to see a doctor when we need one. But most importantly, it makes us feel awful, and contributes to the already crushing stigma we experience living in our bodies every day.”Isabelle Lomax-Sawyers, “On being a fat medical student, at the start of our metabolism module.”
Dr. S didn’t have much to say when I pointed out that (1) the BMI scale is based on the bodies of men, centuries ago and (2) the cutoff numbers for obesity changed overnight in the 90s, making millions of Americans arbitrarily overweight.
Like my old psychiatrist, Dr. Alice, with her turning paper wheel, Dr. S insisted the BMI is still useful, but offered me no evidence as to how. She reported that she has “overweight” patients who run marathons, but “obese” patients like me could really stand to slim down.
Dr. S did not have much to say when I pointed out that I do hot vinyasa regularly and can readily turn my entire self upside down. Dr. S hadn’t touched my body and felt its strength and density. She hadn’t evaluated what I eat or my activity levels. She had seen no blood work. But she had already decided I am less than healthy.
When Dr. S asked about my sexual abuse history, I revealed a little slice of childhood trauma, and suddenly she decided that she “understands.”
Oh, so this is all protective, she smiled at me, looking at my body, assessing the layers around me.
Oh, I wanted to snarl back at her, this fat has never protected me from anyone. If anything, it’s made me more vulnerable. As Aubrey Gordon succinctly put it, what drew these predatory men to me “was that my body made me too untrustworthy to be believed, so I would never speak up.”
My rapists couldn’t have cared less what I weighed.
I kept telling Dr. S my weight causes me no physical issues, but she has only ever studied bodies like mine as a problem. A problem that, overwhelmingly, doctors believe is the fault of the patient. A whopping 74% of medical students studied from 6 different first year cohorts thought obesity was the result of ignorance.
Fat people aren’t ignorant. We know more about dieting and losing weight than you do. We have tried thin folks’ weight loss suggestions, and they are rarely helpful. The way that a thin person loses 5 pounds for a beach vacation has nearly nothing in common with the mechanics of losing 50+ pounds.
Since Dr. S was so certain my weight was a problem, I asked her what she would like me to do about it. We had just briefly discussed my restrictive eating disorder, and I had excitedly shared my recent progress in restricting less, and eating more. I disclosed that I have habitually and wickedly restricted my own access to food for years and years. She asked me nothing else about my diet and eating patterns. I’m sure if you make good choices, the weight will come off, she says, smiling as she winds her bony legs together.
Why won’t you listen when I tell you my body isn’t the problem? I wonder.
It really isn’t helpful to tell someone with a decades long eating disorder history to “make good choices” around food. At best, it’s confusing. More probably, it’s a recipe for relapse.
But like so many other fat women, my eating disorder is glaringly ignored by professionals and entirely denied by insurance companies, who decide whether to cover eating disorder therapy based on patients’ BMIs.
I have no dramatic photo of myself at ninety pounds, all skin and bones and anguish, so my pain is not real. My despair is cloaked by fat that makes me abhorrent instead of sympathetic. A small person receives concern for the self-denying, punishing behaviors I am encouraged to continue.
If you develop an eating disorder when you are already thin to begin with, you go to the hospital. If you develop an eating disorder when you are not thin to begin with, you are a success story.
So when I evaporated, of course, everyone congratulated me on “getting healthy!” Girls I had never spoken to before stop me to ask how I did it. I say “I am sick. They say, “No, you are an inspiration.”Blythe Baird, “When the Fat Girl Gets Skinny”
I don’t know what choices Dr. S was insinuating I should make. I don’t eat fast food, I rarely eat processed foods, and the vast majority of my diet is fruits, vegetables, meat, dairy, and whole grains. But that didn’t matter. She had already made an assessment of my quotidian habits based on my appearance. She probably thought I was lying about the restriction, about what I eat. A fat doctor would know better.
I literally and explicitly told her that I am guessing. That I have no idea how “normal” people eat. Still, Dr. S offers no advice, nutritional or otherwise. For her, my weight is a problem, but apparently not one she is prepared to help me solve. You’ll never be model thin, she says, but you could be a bit smaller.
You’re so thin, I think, that you think being fat is a choice.
The rest of the exam was equally unhelpful. I tried not to let her judgments resonate through my body as I undressed. Dr. S offered platitudes and canned stories she’s told a hundred times. At first glance, her bedside manner was personal, but it quickly felt performative.
As she pressed into my soft belly, I felt frustrated. She didn’t even know where my uterus is, she was palpating pieces of me that seemed entirely irrelevant, ignoring my pelvis of pain. My body was falling apart from the inside out. She offered no suggestions for resolving any of the issues I presented.
When Dr. S left, I looked at my unruly body in the mirror and wondered what it would feel like to exist as a thin person. I wondered how much more accepted I would be as a yoga teacher. I wondered how many more jobs I would’ve gotten. I wondered how much more quickly my eating disorder would have been treated. I wondered how much more I would’ve gotten to play on the volleyball team. I wondered how much prettier my grandmas would think I was. I wondered how many times I could’ve shopped in a store I felt too expansive to enter.
I thought about all of it, and then I cried my fucking eyes out. I cried for everything this body has had to go through just for existing as it is. I cried because this body is falling apart and if I was thin I would be receiving help right now. I cried because I know that this visit was actually, comparatively, not that fatphobic and terrible compared to other things I have experienced in my life. I cried because I had nobody to call who would understand or care. I cried because despite all of the doctor’s “concern,” nobody in this situation has demonstrated true concern for me, at all.
I am tired of uneducated healthcare professionals pushing a fatphobic agenda and thinly veiling it as concern. There is extensive scientific research demonstrating that diets do not work and that body size is not a behavioral choice. Doctors, who are overwhelmingly thin, have an ethical and professional responsibility to immerse themselves in that research. It’s treacherous to become a fat medical student, and even after starting school, the odds are stacked against you—according to a study at Duke, obese candidates are half as likely to get residency interviews.
Fat people need representation in the medical field. We need to receive care from people who understand what it is like to exist in a larger body, not from naturally thin MDs who think we are lazy and see our bodies as a weight loss project. Every day I lose more hope that I will ever be able to access Western medicine in a way that provides an overall net benefit to me. I dream of the day I am finally proven wrong.
Although limited, a list of fat-friendly medical providers has been indexed here.
Be well and strong,