One of my favourite elements of online activism (especially fat activism) is its ability to make the personal political. I love how fat activists are getting the message out there that we are not just headless fatties. We are real people, individuals, with diverse interests and values and needs and talents and stories.
For a couple of those stories, you might want to check out this wonderful short doco about young fat women. (Link to film, which contains some NSFW images from the Adipositivity Project, which is also probably NSFW incidentally!)
Here’s a story from me, about the realities of life as a fat person. To be honest I’ve been unsure about whether I want to share it because, well, trolls. But I think it’s important that we speak up about how grindingly difficult it can be to just be heard, as a fat person, and how trying to focus on Health At Every Size instead of embracing the commercial weight-loss industry is some kind of radical act (despite, really, it resembling so many kinds of common sense).
I’ve been having some (relatively minor but annoyingly persistent) health problems; it’s been difficult to find the best way to cope with these, especially given that they are exactly the sorts of things that doctors struggle to either take seriously or find the cause of. Without going into detail, I will say that they boil down to fatigue and are probably linked to metabolic problems related to my polycystic ovarian syndrome. The logical thing seemed to be to seek a referral to an endocrinologist.
I’ve written a little bit about how fat stigma can interfere with patients receiving sound health care. I’ve previously had a little experience of that (like the time a GP recommended Weight Watchers as a ‘treatment’ for post-natal depression). Yesterday the endocrinologist gave me the full stigma experience.
I want to be clear: Dr M was a pretty nice guy. He was friendly, he looked me in the eye, he didn’t say anything ‘mean’, he answered my questions, he wasn’t dismissive. Occasionally I hear people saying that fat people only complain about doctors because they don’t like being weighed (he weighed me, I was totally fine with that) or because they don’t like hearing hard truths. That’s really a mis-characterisation of why we complain about fat stigma in health-care settings. It is about so much more than hurt feelings (although, frankly, hurt feelings matter too, especially when a bad experience with one rude or dismissive doctor can be enough to keep an already socially stigmatised person from seeking health care when it is really important to do so).
What was most frustrating about my appointment with Dr. M wasn’t that he outwardly fat-shamed me (he didn’t) and it wasn’t even that ‘prescribed’ weight-loss (although I didn’t particularly appreciate that, given that I started with a spiel about how I wanted to focus on health, and not weight). What is most upsetting is that I paid this man $220 to spend half an hour talking to me about how I could get thinner when what I wanted was for him to listen to me and offer me solutions and alternatives that might actually do something about the underlying cause of my symptoms and which may actually make me, you know, healthier. And even if you believe, as Dr. M clearly does, that weight loss would make me healthier — even if I believed that — the fact would still remain that he didn’t listen to me, that he discounted almost all possible causes for my symptoms aside from one which is not qualified to diagnose himself and … fatness.
Make no mistake: I know that this only happened to me because I am fat. If I were a thin person and I walked through his door with the symptoms I described, he would have been forced to dig deeper. To ask me more questions, to hopefully come up with a wider range of options. Maybe run more tests.
Instead he saw a fat woman sitting in front of him, and I’m quite sure that he, seemingly decent chap that he was, thought that he was offering me wonderful advice and providing an answer to my ‘struggles’. Except that he wasn’t. This is the problem with the pervasiveness of fat stigma and the failure of some health professionals to treat patients as individuals with individual health needs, not as statistics in a ‘war on obesity.’
In case y’all are wondering, this is basically how the appointment actually went:
[After a brief chat about medical history and symptoms...during which, he didn't actually ask about my dietary habits or exercise levels.]
Dr. M: So, you’ve been struggling with your weight?
Me: Well, I wouldn’t really use the word ‘struggling’. I have gained weight, yes. I think that might be a symptom of some of the underlying issues I have.
Dr. M: Yes, definitely because [explains some likely hormonal causes for weight gain as shown by my blood test results etc.]
Me: Like I mentioned to begin with, I would just like to be healthy, rather than concentrating on weight. I’d like to have more energy and vitality, that’s my main concern at the moment.
Dr. M: Ok, that’s a sensible approach. So what have you been doing to try to lose weight?
Me: Well, as I said, I’m concentrating on health, not weight. I’m not actively trying to lose weight. I have recently increased my exercise by seeing a personal trainer again, and I’m making sure that I eat regularly to keep from having so many mood swings and energy dips.
Dr. M: Yes, sounds like you’re really on the right track. Well, here are some options for you, although I’m not pushing you into anything.
Me: Ok, sure.
Dr. M: You could try a meal replacement programme… [lists a few different commercial programmes and warns me that I'd still have to eat vegetables or I'd get constipated]
Me: Ok, well, as I said I’m really interested in health and vitality. I’m also concerned about the potential negative effects of yo-yo dieting so I tend to avoid ‘diets’.
Dr. M: Yes, fair enough. Well, another option is Reductil and those types of drugs [yes, he seriously did recommend a banned weight loss drug (which, prior to the TGA withdrawing approval, was shown to have limited effectiveness anyway) to someone who had already made it clear that weight loss was not a goal.]
Me: *incredulous stare*
Dr. M: Of course, your best bet for long-term benefits would be surgery. There is a surgical option called gastric banding, which, the latest ten year studies are showing, does offer the best long-term solution for weight loss.
Me: Ok. If I was concerned about weight loss I might want to talk more about that. At the moment though, I’m interested in finding out more about why I’m having these symptoms, and dealing with those.
Dr. M: Yes, well… allow me to refer you to another doctor who can investigate [X] possibility with you. [Explains]
Me: Sure, okay, that’s worth looking into, I’ll have that checked out. What about what [X] and [Y] test results say? Do you have any thoughts about that?
Dr. M: Well, you can try [X] drug. The big benefit to that is that it might reduce your appetite.
Me: Ok, well, that’s fine, but remember I mentioned that one of my symptoms, that I wanted to address, was reduced appetite and irregular appetite?
Dr. M: Oh, yes, that’s right. Well there are other benefits too. It may hold off the onset of diabetes.
Me: Well that sounds like a good benefit. But I thought you explained that I don’t show any signs of diabetes or even pre-diabetes. And I confirmed that I don’t have a family history of diabetes?
Dr. M: Yes, that’s right, you don’t have pre-diabetes. Yet.
Me: Sure, ok. Can you tell me what the other benefits are to taking that drug? Will it help with any of my symptoms? Because what I would like, why I’m here, is because I’d like to be healthy and have some more vitality…
Dr. M: Yes, that’s a sensible way to look at it. Well, how about you keep doing what you’re doing, and come back and see me in six months to reassess things?
Me: Thanks for your… help.
I reckon I need another new doctor. What do you think?
** NB. I have included more details about my personal health than I feel entirely comfortable about sharing publicly, but I needed to include them in order to illustrate my point. This doesn’t mean that I’m open to people offering diagnoses or cures, so please, don’t do that. If I want your opinion about my health status I will be sure to ask you for it. What you are most welcome to share in comments though, if you would like, are your experiences of fat stigma in health care or, if you can, happy stories about when doctors get it right. Sometimes it’s hard to remember that some of them really do!