So, on Thursday of last week, I had my annual genital business exam. My husband charmingly refers to this as checking under the hood and getting my oil changed. Don’t ever change, babe!
Ahem.
Anyway, no muss, no fuss, as my doctor is about as stress free with these things as it is possible to be. They took my blood at the end and I went on my merry way.
I am often asked what would happen if my doctor recommended weight loss to me. My answer is usually that I would talk with her about WHY that was being suggested. Because I trust my doctor and I believe she is actually looking out for my health. And in my head, I’m pretty sure she’s never going to come out with “lose weight, fatty” as a prescription. Still, it’s one of those things I’ve considered, what my response would be.
Today I got the phone call about my bloodwork. “Looks great,” the nurse says. “But your cholesterol is a little higher than it was last time, and the same for your triglycerides. The doctor wants you to do about a half hour of activity every day and maybe try a lower carb diet. We’ll recheck it in six months.”
I thanked them and that was pretty much that. Except then I got to thinking about how differently this conversation could have – and has in the past – played out. Because, as I suspected, it wasn’t “lose weight, fatty” – but it was, in a really gentle way, a reminder to get more exercise and eat less (well, less bread, anyway). And it was almost shocking to realize – it didn’t bother me at all.
See, I know that when my doctor says “lower carb diet” she isn’t talking about, like, Atkins. She’s saying, hey, see if reducing your carb intake at all has an impact on this. She’s not talking about weight-loss dieting and she’s not talking about something extreme and unmaintainable. She’s asking me to see what my body does if, like, I don’t eat pasta every single day.
That’s fair, I think.
In the past, I’ve had weight loss recommended to me as a cure-all for just about anything I went to see a doctor about. “You have allergies; you should lose some weight – have you tried eating less and exercising more?” “You have strep throat! You should try losing some weight so you won’t get this again!” “You’ve got asthma – have you tried a starvation diet coupled with intense physical exertion in order to lose some weight?”
Let me tell you, I am sensitive to that shit now. Possibly, because I am contrary and stubborn, I am MORE sensitive to it than many other people.
But when weight loss is removed as an imperative part of the “cure”, I don’t get that knee-jerk been-burnt-by-this-before kind of reaction. I trust my doctor. If she says a half hour of activity is going to help my cholesterol, I’ll give it an honest go – especially since I know my activity levels have been way lower this year than has been usual for me in the past. We’ve started relying on convenience foods a little more lately – a reminder to return to the way we eat when we’re cooking all the time is a useful reminder. Means all that stuff I usually do because it feels good actually DOES have an impact on my body. And it means it in ways that have nothing to do with my weight (which has, incidentally, remained exactly the same).
When weight loss is the goal, instead of some actual health metric, you (and your doctor) are buying into a system that doesn’t work. You try and you try and you fail – and then though your general health is actually improved, you feel like a failure and give it all up. When weight loss is the goal, even if you say you’re doing it for your health, chances are reeeeeeeeeeeeally high you don’t actually give a shit about that cholesterol number. You’re too busy monitoring the number on the scale, the number on the tag in your pants.
Remove weight loss as a goal, and you’re more likely to actually stick to changes that you make in order to physically feel better (and the more those changes are likely to work for you as an individual with the entirety of your body and mind being taken into consideration). Remove weight loss as a goal, and you get to measure things that are actually meaningful, that actually provide valuable information about the inner workings of your body!
It’s kind of fascinating to me that doctors scream about your health and then seem to do everything in their power to turn folks off of actually being connected to what is going on in their bodies. That’s some kind of counterproductive, yo. Pursuing health at every size means being so much more involved, so much more knowledgeable about your body than the usual – just equating weight and health and leaving it at that. People are always telling fatties to take personal responsibility. Well, I’d argue that I’m WAY more personally invested in my health and responsible for the things I put into my body than someone who is just not thinking about it because they fit into the mainstream cultural idea of what a body should weigh.
This is what personal responsibility looks like. And this is what it looks like when the medical profession gets it RIGHT – I’ll be dancing around my living room tonight (or possibly my bedroom) to get in some more activity and I’ll be ramping up our veggie intake again. I’ll also – because I’ve been under a lot of stress and stress can contribute to higher cholesterol as well – keep going to therapy and taking melatonin to help me sleep. And in six months, we’ll see what happens. I trust my doctor to help me figure it all out.
42 Comments
If my doctor took weight-loss out of the equation my visit would look like this “your stats are great!’ Instead of “have you considered bariactric surgery” then “your stats are great!”
My cholesterol, bp, bloodwork, heart all KICK ASS (I attribute this to a vegan diet and a lot of cycling) but the first thing the doofus asks me is if I want my stomach mutilated. This is before anything except getting on the scale. I think he just doens’t like how fat ladies look.
I admit to being envious of your doctor’s manner.
It makes me a lot more likely to go to the doctor when/if I do have an issue and I stay on top of my preventative care/well woman visits. I realized this time around I haven’t been in to see her in almost exactly a year (about a month more than that, actually, since my last annual exam) but I’ve had several positive interactions with her staff when/if I’ve had questions. I feel like they are a resource – not a punishment.
It drives me up a wall that going to the doctor is, like, one of the least mentally healthy things lots of fat women can even contemplate doing, you know?
ETA: And just to harp on it – it shouldn’t actually matter what the stats are. In fact, I think it’s even MORE important for doctors to lay off the weight loss message with people who are having health issues so that a trustful relationship can be fostered and actual solutions sought.
i totally get what you’re saying here, that expectation is key and intent is sacrosanct. i don’t mean to be nitpicky here and maybe i’m missing something crucial, but how is reducing your intake of (i assume) processed carbohydrates going to impact your cholesterol level? shouldn’t your doctor encourage the activity and a decrease in cholesterol-bearing foods? or is the global war on carbs actually gone this crazy? O_o
Carbohydrates do influence cholesterol, specifically triglyceride levels. It’s not a war on carbs to see if the recent increased reliance on processed, carb-heavy foods (which tend to be quick, easy, filling, and cheap) is what’s behind a corresponding increase in my triglyceride levels. No one, least of all my doctor, is suggesting carbs are evil or to be avoided entirely.
In fact, if she were to suggest I stop eating cholesterol-heavy foods, I’d have to laugh – we don’t eat fried stuff very often at all and I’m allergic to eggs. I actually really appreciate that she doesn’t default to “this fatty much eat only fatty foods!”
Actually, eating foods with dietary cholesterol hasn’t been shown to have much of an effect on cholesterol levels.
Eating monounsaturated fats, and high fiber whole grains, on the other hand, definitely helps.
It’s a pain in the ass to be allergic to all of those grains, I tell you what. *laugh*
love this!
Thanks!
I recently left my gyno due to a similar situation. At my annual exam in March, I talked about how much better I’ve felt since going off the bc pill, how I’ve been focusing on exercise as a form of stress relief, and how I am listening to my body and eating learning which foods make me feel my best. I am a vegetarian and recently stopped taking an expensive liquid vitamin so I asked her if she could recommend a good multivitamin. She said that I shouldn’t worry about vitamins if I’m eating a balanced diet and then proceeded to tell me that she believes I’m eating too many carbs because I’ve gained a “significant” amount of weight since I first saw her 6 years ago. Mind you, this is after I went on and on about how great I feel and how proactive I’ve become about my health. Her answer to “How can I supplement my vegetarian diet to ensure I’m getting everything I need?” is Weight Watchers.
ARGH! That kind of thing is so frustrating!
It’s like doctors just… don’t trust their patients at all.
Exactly. The time before she suggested e-diets without being prompted. She might be a shill. Either way, good riddance to bad medical advice.
I was just thinking today about the difference between HAES and dieting, and after being diet-free for about 15 years, I feel like diets are like magical thinking. You do action A, and hope it’ll result in weight B, but there is no action A(or Z) that will guarantee weight B. But if I set my goal to increasing my activity or eating more protein, all I need to do is actually DO that. And shazam – goal accomplished! It feels so good to cut out all the wishful thinking and go straight to measurable goals.
This is such a great – and succinct! – way of describing it. Thank you.
LOL, Marianne, I don’t think anyone’s ever called me succinct before! Thanks!
Okay, now I’m a bit curious. I went several years without medical insurance and now that I do have it, it’s full of suck. It’s like paying full price in hopes that if we reach the bench mark/deductible it’ll be a worst case scenario. I did have an urgent care visit in Nov. ‘09 and while it turns out I have BPPV (benign form of Vertigo) the first thing they asked was for me to get on a scale. My response, “NO! I’m going to throw up! I need to sit down!” my world was literally spinning. The nurse looked shocked (gee, my symptoms were vomiting & extreme dizziness) and simply rushed me into a room. I’ve never had a doctor recommend anything more than a nutritionist, but I did have one blame a period gone awry on my fat. I gave her the look of death and that was that. I do wonder what my numbers are like right now. While I get way more exercise than I used to (puppy loves to run)and try to eat better (was doing great for so long) now that we’re basically broke/poor we can’t eat all of those fabulous organic stuffs we used to. And now that I’m all full of FA facts? I actually feel bad for the next Doctor who even pushes the weight loss recommendation at me. Thanks for this!
“I went several years without medical insurance and now that I do have it, it’s full of suck.”
What I’m about to say doesn’t really contribute to the discussion, but — yeah, I *hate* that.
To the larger discussion, I’ve found it helpful to think of veggies as carbs. They’re just complex carbs, not simple ones.
(The last also makes it easier to shop, when you don’t have a lot of time. You don’t have to think as hard.)
I think of veggies as DELICIOUS. *grin*
I’m curious, though – how does it make it easier for you to shop? Do you shop based on food group? I’m so interested in how other people juggle this stuff. We usually go and I say, “OKAY. I WANT SALAD.” And then we sort of build around that.
I once had a doctor critically inform me that I would probably need the larger speculum because of my size, before I had even taken my pants off. Then, when it turned out I only needed the regular ol’ speculum, she smarmed, “ohh! you’re not so big down there! we love that, don’t we?” As she did the palpation part of the exam, she told me she wouldn’t be able to do as good of a job on me as she would a thinner person. Oh, sorry, I forgot to take off my fat for this exam? Let me just do that right now.
I never went back to her, but I don’t feel that was punishment enough. It was one of the first times I ever went to a doctor as an adult, with my own insurance (whole ‘nother issue), and I just didn’t know enough about how the game is played. It was a truly violating experience, made more so by how no one wants to talk about it. (So thanks for talking about it!)
I had another doctor tell me the same thing as your example- “sore throat? lose weight.”. Actually, she told me this as I tried to explain to her that I knew it was strep; I work with kids who had it. She wouldn’t listen. Went to urgent care, got a rapid test, and bingo. For that one, I wrote a scathing letter to their practice, received a response that it went into her file, and I never received a bill. Before giving up on that practice entirely, I tried another doctor, who once walked into the room reading me helpful information she’d just printed off an obscure medical resource called…Google. Surprise! It told me to lose weight.
Now I go to a doctor who listens to me and trusts me. It’s an amazing thing and all too hard to find. It’s not that we never talk about my weight, but we do it in the context of health, and she follows my lead on the emotional side of things. I love that woman.
I thanked them and that was pretty much that. Except then I got to thinking about how differently this conversation could have – and has in the past – played out. Because, as I suspected, it wasn’t “lose weight, fatty” – but it was, in a really gentle way, a reminder to get more exercise and eat less (well, less bread, anyway).
Actually, it sounds from the rest of the post that the “less bread” aspect was the doctor’s main and only point about eating less. I think this is important, because if there had been a generalized recommendation of “eating less,” that would have been quite different.
People are always asking me if I’m trying to lose weight, even when I’m NOT talking about eating better and exercising more. And because I’m a bitch, I ask how THEIR blood pressure and cholesterol and lung function and digestion is working out for them, because hey, MINE IS GREAT. Anyone looking at my stats would assume I’m half my weight. It infuriates me that I’m seen as unhealthy when my friend with through-the-roof cholesterol must take care of herself because she’s skinny.
I went to see a nutritionist because I’m tired ALL THE TIME and wanted help deciding how to eat better to give me more energy, and it’s like….there’s no room for that. It’s all about weight-loss. Yes, fat puts you at higher risk for some things. I understand that. But that’s a RISK, not a FACT. I am NOT unhealthy because I’m fat.
Can you please send me your doctor?
You may want to check out the Fat Nutritionist’s site. She also takes online clients
Linda Bacon’s book Health At Every Size helped me, mainly by getting me to pay attention to fiber more. If I eat more fiber, I don’t have as many sugar lows & I feel better…but that’s me
I have a very nice Korean doctor, well I guess you could say two, because if the regular one isn’t there, his brother who’s also a doctor can fill in. They both don’t think weight has much to do with overall health. In fact after my mom went to him over concern about some slight weight gain, he told her just as much and I was really surprised, given the current climate regarding fatness.
I’m not all that familiar with Korean culture, outside of the character Mashimaro that’s a bunny who looks like a marshmellow, he’s kind of like Korea’s version of Hello Kitty. I wonder if you get a doctor that hasn’t been taught in America, and not been indoctrinated with the fat phobia and discrimination that seems to be prevalent in American health care, that they will have a more reasonable look at it and not see it as a big deal.
I don’t know if I’d say anything to a doctor if they told me loose weight, I’d probably leave and let my abscence of payment speak for itself.
Hi, this is my first response, but felt I had to say something about your Korean doctor experience. Two things to say: 1)I totally envy you. 2) I’m sorry to dash your hopes that Korean culture might be less critical of fatties. I’m an American living in South Korea, and I have to tell you that Korean culture, and the Korean medical establishment in particular, is extremely fat-phobic. Every doctor I’ve visited here has been negative about my weight, telling me I need to lose weight even when I go in for something like an upper respiratory infection. I went in to a gynecologist for a birth control presciption because my periods are usually really monstrous and the pill works wonders. When I told him about my periods, he immediately said it was because I was fat. (I didn’t bother arguing about my many thin friends who have had similarly monstrous periods.) I have yet to find a fat-accepting doctor here. Of course, with language difficulties (my Korean skills are just at the survival level and the doctors’ English skills are generally limited to basic medical stuff) I’m a bit more reluctant to keep trying and generally just stick with a doctor who’s not too mean to me. I’m kind of new to this whole fat-acceptance thing anyway, so the concept that a doctor might not harass me about my weight is a bit of a novelty. Sorry to be a downer, but on the plus side, finding this website has actually made me feel much better about living in a land of mostly thin people.
Hi Kris! Where are you living? I’m in Iksan (Jeollabukdo).
Hi bookeater! I’m in Busan.
Hi, I’ve been teaching English in Korea for a year and a half. The culture here, I’m sorry to say, is even more fat-phobic than in the U.S. Fortunately, I’ve found a couple of doctors who listen to my health concerns without immediately suggesting a diet. So far, no one has brought up weight-loss surgery, though I know people do have it here.
Hi again bookeater! It may be off-topic, but I’m wondering how your employer treats you. Weight discrimination is really common in hiring here. I know I’ve lost out on jobs due to my size. I had one employer who threatened to send another worker home after she arrived at a larger size than she appeared in her passport photo. (Really, who can tell from a headshot anyway?) He actually claimed she’d tricked him by not sending a photo that accurately represented her size. I think he felt he was over his quota having one fattie already. Fortunately, my current employers don’t seem to mind what size I’m at as long as I do my job well.
I’m totally skeptical about most doctors. It takes a lot to get my trust. The worst is when they advise weight loss then recommend some shonky weight loss pills! If you really cared about my health, would you be recommending speed??? I’m pretty sure they are thinking more about getting their next free holiday to Bali from the drug company than my health.
Anyway, rant over. Thanks for this post. It’s a great reminder that diet is so much more than a weight loss thing.
I had a similar visit and I’m still riding high. I have pcos and she offered Metformin but I said no thanks (it never helped much) and she said OK. End of discussion. Wow. Healthcare practitioner who listens. Go figure!
I wish my doctor was like this. Then maybe I wouldn’t reguarly lapse in seeking care for my hypothyroidism and PCOS.
The last time I went to the doctor, in May, I had elevated liver enzymes. They suggested that the reason is fatty liver syndrome and I got the “come to Jesus, your fat is killing you” talk. And as fat-positive as I’ve conditioned myself to be, getting that talk still sends me into old eating-disordered patterns and self-hate until my wife or my mom (both who are incredibly supportive) say, “Knock it off, you’re being ridiculous.”
And there are other things which could be raising my liver enzymes. I have a script for a blood test to rule out hepatitis or a tumor, yet I’ve been procrastinating on it for two months because if fatty liver does happen to be the issue, I just don’t want to hear about it. Because I don’t know if there’s any treatment out there other than “lose weight fatty.” And because of the havoc it will wreak on my ability to trust myself and my body.
It’s a bad place to be, yet I stick with this doctor because I know it could be worse. She’s never suggested WLS and she GENERALLY refrains from bringing up my weight in appointments. I am scared of inadvertantly jumping from the frying pan into the fire.
I’m a long-time lurker and love your blog. May I link to it on the blog I’ve just started? It’s not going to focus primarily on fat stuff, but I will be writing about that sometimes.
I think one of the great aspects of your doctor visit story is that her recommendations regarding exercise and diet (and by diet I mean the food you eat, not “diet, to go on a”/restrictive) correlated directly to actual findings in your blood work. I imagine this is why you didn’t mind it. So often we get a generic “You will be healthier if you lose weight” or “You are at risk for ____” based on nothing but a glance and a weigh in.
Marianne – Some of it may also depend on where you’re at. You trust your doctor. Someone who didn’t, who had her “fat” chip on her shoulder, might have taken the “eat less carbs” as “eat no carbs” and freaked out.
Just a sense that good communication is a two-way street
I finally went to the doctor June 1 for some severe pain in my uterus (yay, diagnosis of endometriosis) and I have avoided doctors for over a year. On the new patient form, there was a space for “anything else we need to know.” I wrote something along the lines of, “I realize I am overweight [I am, according to my BMI, morbidly obese]), but I feel like I live a very healthy lifestyle and I’m not interested in losing weight as long as I’m healthy.”
My doctor didn’t say a single word about teh fatz to me. Which is the first time since I was 10 that I’ve gone to the doctor and not felt like shit afterward.
It is such a relief. To have a doctor finally diagnosis my pain and also not to blame it on my weight. I never thought I’d find a doctor who treated me like a human, but yay! I did. Glad you have one too!
I appreciate how your response was based in reason. I am usually beset by a great deal of emotion when I visit the doctor after a long history of bad ones who treated me poorly because of my weight.
When it comes to doctors, trust is a huge issue for me. Reading books like Our Daily Meds and On the Take, I became informed about just how influential the pharmaceutical industry is in the medical industry. It gives me pause when I weigh the advice offered by the doctor, especially when a prescription is involved.
Approaching any health decision with rational thinking and balanced information definitely makes a difference. I like what you said about personal responsibility. Every arena of our society would improve if more people practiced that.
Thanks for this discussion. It’s time for me to schedule my annual “under the hood,” and I’ve been scared to do it. My gyno is actually pretty nice and has in the past said things like “it seems like you’re doing everything right,” but that was before I had a blood test last year that showed slightly elevated blood glucose. The problem wasn’t with her but with the primary care physician I went to after the test, who literally told me I should start living my life like the people on the biggest loser. That was the end of my relationship with her. I did see a diabetes nurse a couple of times and do some regular blood sugar testing at home which I then shared with her, and she felt like I was doing well, but I’m still supposed to find a primary care physician who can be my regular point of contact for managing this. I’ve never been diagnosed with diabetes–my blood sugar wasn’t even close to diabetes levels–but it was treated as a big deal because of my weight. This is one of those areas where things get more complicated because I can’t just walk in and be all “hey, perfectly healthy fatty here, thanks very much,” and everyone believes fat is the root of my particular problem. In my mind, my fat and my potentially impending diabetes are both symptoms of the same issues I’ve been dealing with throughout my life: yo-yo dieting, overeating as a means of dealing with stress, and the many years I spent as a “good food-bad food” believer until I went through treatment for Binge-Eating Disorder a few years ago. So, yeah, the eating disorder thing complicates it too, and while I strive to live HAES, I don’t always succeed. Anyway, there’s a peek inside the swirl of thoughts in my head, but after reading these posts I do feel like I can at least get through going to the gyno.
I was a fat teen…not a death fat, but enough that it was an issue…and at 17 my mom scheduled my first gyno appointment right before I left for college. I am from a small, rural town. The caliber of doctor is just as you would expect. I was already shaking with nerves in the waiting room.
The doctor walked in. Brief chit chat. Clothes off, put on the robe, feet in stirrups–you know the routine.
The minute he tried to insert the speculum, every muscle in my body tensed. I had never even come close to having sex at that point in my life, but my first thought was, “Oh my God, if my muscles down there are this strong, I will crush the first guy I have sex with.”
Fantastic doctor that he was, did not try any other strategy but to shove the thing in harder. I clenched even more. I told him it hurt. He said, “Just another little bit and it will be in and the pain will go away.”
I was crying but trying desperately to hide it. A tear escaped and the nurse said, “Doctor, maybe we could back out and start again.”
He kept pushing.
True story. His next words to me…while trying to shove a piece of metal through my impossible-to-penetrate vaginal muscles while I was crying…”I’d like to see you lose some weight. Ideally 20-30 pounds.”
Right after he said this, he stood up, removed his gloves and said, “I don’t think we’re going to be able to get a sample. But since you have no sexual activity or abnormalities in your family medical history, you really didn’t need to come in for an exam this early anyway.”
I barely made it to my car before sobbing. I had to pull over several times on the way home because I couldn’t see the road from crying.
When I got home, I tried to go straight to my room, but my mom (a death fat) saw me and, rightfully so, I think thought I had been raped or something. She demanded I tell her what happened, but I knew that if I did, she would be like, “Yeah, he’s right. You should lose weight.” so I somehow got out of telling her what had happened. But I spent the entire night in bed sobbing.
While I have fully recovered from the situation and am incredibly thankful that it is the worst violation I have ever experienced in my entire life, this was 15 years ago and I still remember it very clearly and am fairly certain it happens all the time.
Wow. Just. Wow.
I am so sorry that you had to go through with that. I am speechless.
It really is amazing just how good an excellent and caring doctor can make you feel. My GP was so good at caring for the person and not the illness/weight/whatever. I never once got a lecture about how much I weighed and I always felt like she went above and beyond to make me comfortable and care about my actual health.
Take heart fellow fats, there are some really good doctors out there.
This was such a timely post for me today. I am new to your blog/podcast and I just read the book a few months ago. My friend (Tanya!) recommended it to me and it has really changed my perspective on myself and made me stronger in dealing with other people.
Even with this newfound courage I was terrified today of going to a new doctor. My last doctor was amazing and never brought up my weight as I am very healthy and it wasn’t’ an issue. I had myself all worked up for no reason.
They let me get on the scale backward, she came in introduced herself talked to me about my concerns/prescriptions. And she did mention my weight as in “Do you have any concerns about your weight do you feel it impacts your life.” I told her no, I have always been about this weight even before having my twins. She even mentioned that if I did ever have concerns or blood work or it starts bothering me in the future we could discuss it then and said if I had a family history of overweight people it could just be hereditary.
Overall it went so much better than I expected and like usual my blood pressure was fine we’ll see about my blood work. The only issues came from my raised heart rate but that was from bouncing my 15month old on my knee and trying to talk to the doctor at the same time haha. Which she acknowledged and didn’t turn to “OMG YOU”RE SO FAT YOUR HEART CANT KEEP UP”
I’ve been blessed to find a great doctor too. When I first started seeing him, during one of my visits, I asked about losing weight…
He says, “Why?”
I said, “To be healthier”
He said, “But you just had a physical… you’re healthy.”
Huh. Good point.
He went on to explain that it’s healthier for me to stay the same weight – even if it’s “overweight” than it is for me to yo yo – and in his experience – most of his patients trying to lose weight just yo yo… and that it’s unhealthier than if I’d just stay the weight I am and “eat right and exercise”.
He’s been my doctor for over 10 years now and we’ve never talked about my weight again.
Thanks for this post- it’s really helpful for me to read it right now. I was diagnosed with diabetes last week, and while I was in the hospital they showed me several “educational videos” which really awfully conflated the necessary carb counting and so on to manage my blood sugar levels with something that looked an awful lot like dieting- “choose lean meats and low-fat foods!” As if that had anything to do with my blood glucose! It has been really stressful to me to be out looking for sugar-free foods, diet soda and so on, because it makes me think of dieting and calorie restriction and all of that bad. This post is a great reminder that changing the way I eat, watching my carbs, snacking less etc. is NOT the same as weight-loss dieting, and IS important for managing my diabetes, no matter what size I am. So thank you.