Fattiboombalatti Goes to The Doctor
*Trigger Warning for mention of eating disorders and typical medical shaming things*
Ahhhh.. doctor’s offices…. Aren’t they just the nightmare for the Fat Girl? Like many of you, I avoid them whenever possible. As long as being of an overweight category means I will be shamed, ignored, trivialized and disrespected while seeing a health “professional†about physical matters it will always be an appointment of absolute necessity. As sad as it is to say it.
So I get called in and have a health aide walk me directly over to the scales. Now, I do not weigh myself. I have not in years. I do not want to ever again. Why? The number will never ever ever be the number I want. It will always be higher and trigger very old recurring panic attacks that then begin the very terrifying slide down into a very scary and horrible place, a place that lacks all logic and is pure panic… I do everything I can to avoid Body Dimorphic episodes… weighing myself is the Queen of all triggers.
So as I am being walked to the scales I say to the young lady, “No… no, I do not do that. We can skip this portion of today’s visit.†I’ve got this down to a science, this whole, “refusing parts of treatment†thing. Most people do not realize they can refuse any part of their treatment… most people have been raised to view their health as something they just have to “open and say AHHH†to… and that we are not allowed or should not voice things that make us uncomfortable or awkward….
So, I have gotten pretty good at voicing my own needs but every time I do it I always get such interesting reactions from people. The last time when I said,  “We can skip this.†There was a middle aged woman, perhaps of the same size, maybe a little less, walking towards us in the hall… (of COURSE the scales are in the most public, most well trafficked part of the offices just to add a little more shame to your otherwise stellar day) and she actually backed up a step with a shocked, “what?!?!†that was half laugh, half incredulity…half wonder… so I responded, “I know I’m fat… so what’s the point here?†and she kept staring at me as I rocked it down the hall. Her reaction was a mixture of WTF/yes you need to get weighed, fatty/could I do that too?/she is going to get into trouble/and, I wish I had done that, too. This is very typical in terms of reactions.
A couple of years ago I would tell people, “I am a recovering Bulimic†and even though I had no basis of understanding why, I just knew that if I said that people would back off and become compassionate or they would ask me, “is your Bulimia under control? Do you get triggered often?†It seemed funny to me that being the same person in the same size that I am would get a compassionate, understanding response if I claimed that my issue was in regards to my attempts to become thin… but I get a whole range of responses (none compassionate) I do not play homage to societal norms.
How would people react if my authentic response was, “I do not weigh myself because I am struggling with overcoming body dysmorphic disorder due to years of horrific social abuse because I was and am fat and weighing myself only triggers intense feelings of shame and guilt that I know are reactions to not attempting modify my body to the cultural ideal.â€
What say you darlings, should I try this line and see what the outcome will be?
So instead of telling others I’m bulimic I just let it ride as it is. I do NOT have to explain myself or my choices to you. I do not have to place myself in a medically induced state of anxiety nor do I have to deal with practices or a conversation which are not only completely useless in terms of my weight but actually is harmful to my mental health, well-being and physical wellness.
So after my little scale avoidance episode I am left in the office to await da’ Man. While in the office I took note of my surroundings. On the walls of the office were:
A calendar
A “Quit Smoking†flyer by the American Heart Association
3 flyers calling for participants in various studies at the local research hospital
1 poster detailing the symptoms of depression (brought to you by Zoloft… no I’m not kidding)
1 poster giving me a number to see if I qualify for Gastric Bypass Surgery
1 flyer to see an in-house “Nutritionistâ€
…. Uh…. Well, I….don even…..
The only flyer that actually is concerned with health and wellness is the quit smoking one.  So in case you aren’t ALREADY coming to see the Doc for depression, anxiety, etc etc etc… ZOLOFT wants to make fucking sure that just in case you didn’t actually “know†you were depressed well ZOLOFT has is right there in a 2 by 3 foot poster… and the remedy…hmmm… lemme guess…Zoloft?
And the other one… the OTHER ONE…. Same thing…. Say, let’s not talk about health, REALLY… let’s not talk about lifestyle, holistic health practices or just taking a fucking walk every day no we want you to know that we are there for you… if you want to cut your stomach in half… we are here to “helpâ€.  And if you don’t want that then we have a Nutritionist because you, fatty, you we are sure do not know how to eat… as if eating well is a science… have any of you seen a Nutritionist? You get weighed, you are given a menu then you have to cough up your weekly write-in diet and get shamed for bad choices…. Hmmm what does that remind me of? Oh yes! Every other weight loss plan out there!!!!
Before I am even seen by my doctor I am bombarded by messages… no, not messages… billboard advertising… telling me what my problem is and what thing I can buy to fix it.
First a patient is weighed. Then she is left to sit in a room with a Zoloft and gastric bypass ad. It doesn’t get any more genius than that, does it? The doctor need not say a word… the system is doing all the work.
Any posters about health? Wellness? Meditation? Yoga? Walking? swimming? The benefits of a vegetarian diet? Managing stress? Nope.
I wonder how much Zoloft pays doctor’s offices to allow them to place their posters up in each and every examination room.
So anyway, that is why I avoid seeing my health practitioners as much as possible. A for profit system can never be honest in that it has your health and wellness as a primary concern, nor are the health prescriptives based on health as much as it is the bottom line. As long as society is pulling its collective hair out running around in circles, “OMGOBESITY!!!! Run!!! RUN FOR YOUR LIVES†and the government supports it and Hollywood supports it then there is good money to be made in making fat a medical issue worthy of reduction at all costs… and even better, at a high cost.
I think they don’t technically pay doctors’ offices, they just give them lots of stuff. Free lunches, branded office supplies (you’ve seen these, every clipboard and pen you’ve used in a doctor’s office has a drug name on it), “informational seminars”, posters. Free samples, even, to give to their patients. It’s bribery without the money part.
Rebelle: But many medical schools are sponsored by big pharma and even the beef and dairy councils, ironically. I agree that they get kick backs and perks over actual payment, but even that seems hardly crossing the line now days.
The issue of physicians getting medical information from pharmaceutical salespeople is a big problem, and I am glad you have noted it. The situation is the same in every doctor’s office that I have visited: posters, pens, notepads, even anatomical models are all branded with a drug company’s name. Of course these products are given freely to the physician. And of course we hope that our doctors are learning about medicine from sources more objective than a drug company! (Something I say as a medical librarian.)
I disagree, however, with your dismissal of nutritionists. A registered dietitian can be an ally in your health. I believe that vitamins are best absorbed from foods, not from supplements, and a fat positive nutritionist can guide you towards foods that make you feel good. Of course it is possible that the nutritionist is not qualified (always ask about the individual’s education–you can get a master’s in nutrition, it is a science!–and whether he or she is registered as a dietitian) or will just parrot the medical establishment’s current paradigms about obesity equaling poor health. So find a nutritionist that advocates Health At Every Size. Tell this person your goals (e.g. having more energy, preventing fractures later in life, supporting local farmers, staying out of the doctor’s office, whatever) and make sure he or she will support you.
I am a big fan of the Fat Nutritionist blog as well: http://www.fatnutritionist.com/
Arpita: I cannot speak for Fattibloombatti, but I agree with you about nutritionists and the sad truth about supplements. I will say though, no matter what I go to a doctor for, I am always walking out with a damned referral for a nutritionist, even when I broke my foot. I have no doubt that were I seeking such guidance I would get it from a qualified nutritionist, but I have yet to feel the need, personally. Thank you so much for sharing your thoughts.
as a bulimic who DOES USE im bulimic and you will never weigh me because if it, we dont mind if you borrow us as an excuse. “if im bulimic” makes it easier for you than to have to explain to someone who doesnt understand body dismorphia syndrome nobody will be mad at you…and only you can tell if it matters or not. if you feel you are in a place where you need to express that part of it, then do it.
I myself am going through an incredidibly scary time right now health wise. i have suddenly started having grand mal seizures out of the blue. so far i have had 6 over the course of 3 years in clusters. (4 of them in the past 2 months) every time i have had them i have been dehydrated and puking, and i’m scared to death that 20 years of bulimia somehow fucked up my electrolyte system. The meds they want to give me are debilitating, making me stupid and sleepy all day long. If i was falling down doing this all the time it’d be one thing…. and of course the doctors answer is just take the meds…and “i’ve never heard of puking causing epiliepsy” lol and then the next breath he wants to talk about triggers /headdesk
Erylin: I’m so sorry hun. That is scary and awful. I hope you find a solution soon, meds that make life worse are a terrible reality. I don’t know if you have, but I would always recommend a second or third opinion, even looking into eastern medicine options. *Hugs*
@Aripta you are very right and I also love the Fat Nutritionists’ blog but in this context more often than almost never… the goal here is caloric restriction as much as it is nutrition and in the context of my doctor’s visit and the paradmigm most nutritionists operate under… it is very much like what I describe above from every person who has seen a nutritionist that I have talked to… so please take my story here as not an objective statement about the whole study of Nutrition Science… but rather a subjective story based on the experience I and many others have undergone by nutritionists in the current “standard” sense.
@erylin… I am so sorry you are dealing with this very scary health problem… my sister had a seizure and fell face down cold in a bank… never having had one and no one in my family having had one and they cannot find out way… its a terrifying time for us and so I can only empathize with your medical issue. 🙁 I hope you get better and I hope the treatments are effective for you!
Regarding the insidious influence of pharmaceutical companies–and yes, I do speak from an embittered position as a former pharma employee: The impact of industry on science is huge. Not only do pharma companies give promotional items to physicians (a relatively minor offense), they also sponsor continuing medical education events, which are many a physician’s only chances to keep up with the current research. And the research itself is often sponsored by drug companies; some pharma companies have even been exposed to have ghostwritten journal articles published under a physician researcher’s name.
It would be impossible to remove the influence of pharma entirely from medical and scientific research; our government does not have the money singlehandedly to fund research. But we certainly can think critically about these issues, question assumptions/”objective research”, and call the so called authorities on their bullshit.
Speaking of nutrition, there has been criticism even of the government’s new “My Plate” food recommendations (http://www.choosemyplate.gov/). Harvard has an alternative “plate” that it says is not influenced by the food industry which lobbied the government to include dairy in its guidelines. Here is Harvard’s concept:
http://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/pyramid/
Love this post! The last time I went to see my PCP, I filled out the routine check-in questionnairre that they give you and I noticed that there was an item that you could check that said “I would rather not discuss my weight with the doctor” or somethng to that effect. I believe that I also got something in the mail that gave patients the option of communicating this preference in advance. So, I think that some medical facilities (Kaiser in my case) are starting to get it, if only a little.
I love what you said about being able to chose what services you want and that the agency is really with the patient, even though the structure of the medical system is set up to give the opposite impression. This reminds me of the times I have gone to the dentist for a routine teeth cleaning. They always want to do an x-ray, and I always stop them when they lead me to the x-ray station without even telling me / asking me if thst’s something I want. “You may do an x-ray once a year and no more; my last x-ray was less than a year ago” The receptionist always says that she has to ask the dentist if that would be ok. And I always end up snapping at her that I don’t need the dentist’s permission to get a teeth cleaning without an x-ray! Arggg!!! Then she goes to the dentist’s office and I can see her and a group of dentists conferring about me through the glass window, they, glancing in my direction, looking me up and down like I’m their crazy, difficult patient. Argg!!!!!! Of course they always provide me with the teeth cleaning service without the x-ray.
I know that they try to force the uneccesary x-ray on me because my insurance pays them more for that than just the teeth cleaning alone and no resources are exepnded on their part to do the x-ray, so it’s just any easy way for them to make money. But they put patients at greater risk by exposing them to radiation every 6 months!
This is just a minor/trivial example, but because I anticipate having to fight everytime I see a dentist, I have not had my teeth cleaned in a year.
Alena: On the dentist thing, yes and I have had the same thing happen, even with my own dentist that I’ve been seeing for ages. I straight up said I wouldn’t pay for x-rays so unless they wanted to do them for free…end of discussion. It felt kind of good, actually. As for the post, it’s a guest post by Fattiboomblatti and it’s a tale far too many of us have lived through. I was unaware of any new check boxes or communication regarding weight at the doctor’s office, but that is fabulous. I just say no and leave it at that. I get confused looks, but little else. I feel for the nurses, but they need to listen to the patient as much as the doctors do. Scratch that, they need to listen to the patients more because the doctors never manage to. Thanks so much for sharing your experience and thoughts here. Hope all is well with you.
Hi, I really enjoy your blog and your perspective on fat acceptance and health at any size! It seems like such an important message to get out there – how much better for both body and mind would it be if we could all focus on being happy with ourselves and properly nourishing our bodies rather than worrying about weight loss – which is of rather questionable benefit anyway.
That said, I find your characterization of physicians deeply troubling. In one of your recent posts, you refer to doctors as greedy and ignorant, uninformed and interested only in profits and weight loss. Honestly, I have never experienced the fat-shaming at doctor’s offices as I am on the naturally small side, but some of your experiences sound really deeply humiliating – it’s so unfortunate that you would avoid doctors at all costs because of this.
I guess what I am getting at is that, especially as someone who is sincerely intending to become a family-practice doctor in the next few years, is that I don’t think the intent is to shame. I think that most doctors go in to medicine because they genuinely want to help their patients lead better, healthier and more fulfilled lives. There are far easier ways to make money, and most of the physicians I talk to, and students hoping to become physicians, are coming to the medical field out of a desire to genuinely serve their patients in the most knowledgeable, effective, and compassionate way possible.
I also have a question for you, and I would love any insight from people who read this blog and have had unpleasant experiences at the doctor due to their weight! If I am a doctor, there are times at which weight or weight related topics have to come up – for example, to determine the dose of a medication, or to ask people about their general health, nutrition, and excersize (completely aside from weight, these things are important to health), or even to council people about their diet – if someone is trying to lose weight, I would want to talk to them about doing so safely, and of course screen people for eating disorders. So weight related matters I think will sometimes come up no matter what. So, how can I ask these things respectfully and with sensitivity? What can a doctor do when talking about weight to not make you feel shamed?
I honestly would love any perspective on this. It is such a sensitive thing to talk about, and I want to be able to do so in a way that isn’t triggering or belittling. Thoughts?
M.: First thing’s first: Thank you for reading my blog and you are always welcome to comment with your thoughts, opinions and experiences. I am always open to differing opinions and have personally had my world views expanded as a result of such sharing here on this blog. Please never fear judgment or shame here, ever.
As for my own beliefs regarding Medical Doctors, yes, I have been shamed and humiliated and I do feel that many are ignorant, greedy and deeply insensitive if not downright mean/rude. But not all of them. I have had one or two decent ones, one or two who didn’t mention weight at all or simply took it into account without judgment. My heart belongs to nurse practitioners though, because they were always the ones who explained things in human terms and held my hand or gave hugs when I needed them most. I don’t know what the major difference might be for them compared to MDs, but their overall manner is night and day. A friend of mine believes that something happens during the residency. They come in all fearful but eager to work and come out drunk with power and an ego to fill a stadium. I cannot tell you why this happens, just that it does. Perhaps you’ll be able to buck this trend. I do think returning to more small town type of medical practices is on the rise and will become more and more necessary as time goes on.
Now, I have no problem getting weighed at the doctor’s office IF it is medically relevant, as you mentioned with medication. I personally do not think a doctor should bother telling a patient anything about A diet, but general food intake information given in the proper tone/setting should be okay. If someone is seeking weight loss advice from an MD, well, I think they are barking up the wrong tree. There is no such thing as safe and permanent weight loss. It does not exist except for about 2-5 percent of the world’s population. To say otherwise is an outright lie. I would rather they be referred to a therapist and nutritionist, but I would prefer they read health at every size by Linda Bacon PHD, and get the truth without the opinions and judgments. But without additional training, I really don’t see how most MDs could screen for ED patients, especially since many will deny it until it’s possibly too late. Yes, weight does occasionally matter, but the way in which doctors approach the subject and explain it to their patients and go about the whole thing entirely, is usually wrong. I am sick and tired of people buying into the Diabetes myths about fat causing Diabetes…it does not! In fact unexplained weight gain is a symptom of diabetes and many other illnesses. Yet we are treated like criminals against humanity. How dare we be fat?! Don’t we know it’s not allowed?! What can a physician do to make this situation better or go away? Stop using the BMI charts as anything other than a fucking joke! That would be so nice. It’s hard to take someone seriously when they rely so heavily on something they don’t even know the history of themselves, let alone the validity of it. Perhaps have as a common practice patients to be weight facing out so they don’t even see the number. Or ask if they would like to be weighed rather than defaulting to a mandatory weighing scenario. The truth is patients of all sizes feel pressured to play along even when they are extremely uncomfortable, offended and worse. We are expected to simply fall in line and do what we’re told. I don’t buy into this anymore, but millions do. And they wonder why malpractice insurance is outrageous…treat people like people instead of toys and problems, stop seeing people as diseases, quit looking for pathology where non exists: as in with pregnancy and fat people. Believe your patients when they tell you that they get plenty of exercise and eat a healthy diet. That is a big one for me. Being called a liar by someone while sitting in an ill-fitting paper “gown” has got to be one of the worst offenses by a physician for me. Telling me that my one-time lady issue was caused by my fat and then refusing to answer why now when I’d been at a stable weight for years or any other questions. Treating me like a fucking charity because I’m fat. Insisting I have high blood pressure, Diabetes, hypertension, etc, when no tests have been completed…and suddenly having nothing to say except diet talk and weight shaming when those test results all come back normal!
Sorry, I kind of went off there. The abuses long suffered at the hands or words of the medical profession by fat people all over the world is horrendous and appalling and that’s minimizing it, I think. There’s just no reason to treat people like garbage, ever. Not when you’re suppose to be a trusted professional. Now I don’t avoid the doctor at all costs, but I also don’t have insurance right now, so there’s little I can do there. The insurance I did have we couldn’t use because the deductible was so high. It seems health and care are for the privileged and no one else. Perhaps if the system itself were entirely different, medical doctors wouldn’t feel the need to treat people like cattle…I don’t know. Feel free to hit me up with more questions. Perhaps we could do an entire post about it next week? Especially if my rant above left you with any more unanswered. Thanks again for speaking up.
I’ve never noticed what’s on the walls in the exam rooms when I go to see the doctor – I always take a book with me to read because the wait is so boring (that and I don’t want to read the magazines in the waiting room either, they all have photo-shopped models, diet ads, and recipes for gooey desserts – contradictory messages, anyone?).
But our clinic wouldn’t need to put anything on the walls about WLS/diets/nutritionists – the doctors there say enough about it when you go to see them without having to have posters on the walls (if you’re fat, they do, anyway). That’s why I only go when I’m sick and need a prescription, or when I have to have the lab tests for my TSH/T4 for my thyroid meds.