I had to hit the doctor's office this week, because I couldn't put it off any more — and after my last experience, I wasn't exactly thrilled with the prospect of going again. I prefer to focus on my actual medical needs while meeting with the doctor, rather than sit in an exam room on a table covered in crinkly white paper, being told that I'm horribly fat and should lose weight before I keel over and die in the street.
After spending most of my adult life requesting that weight loss not be discussed at medical appointments, I'm used to gritting my teeth through it when it comes up anyway. Most doctors I've met seem to have an obsession with ignoring self-advocacy on the part of patients, especially when it comes to concern-trolling over things patients are already aware of and can request help/advice with if they want to.
It's not like I'm not aware that I'm fat. It's pretty obvious, considering that all I have to do is look in a mirror. I don't need to see numbers on a scale or ask someone else for confirmation of the obvious. It's a known issue — a preexisting condition, if you will. I also don't have a problem with being fat. I'm comfortable in my body, I like it the way it is, and it's all good.
I don't think that fat people need to defend their existence by explaining that they're healthy or their weight isn't something they can control. Being fat is just dandy and fat people deserve to be treated like anyone else, but their typical experience in the medical system is to be handled like radioactive waste, told they need to be neutralized before they cause some sort of massive (ha ha) environmental contamination. Which doesn't exactly make fat people feel great about themselves, and moreover doesn't actually work in terms of clinical care.
If the goal is to get fat people to lose weight, for whatever reason, fat shaming is not effective. This isn't just me talking about anecdotes: Research indicates that people who feel discriminated against because of their weight not only don't lose weight, but can in fact gain it. Professor Jane Wardle, the senior author on the study, told University College London that:
Our study clearly shows that weight discrimination is part of the obesity problem and not the solution. Weight bias has been documented not only among the general public but also among health professionals; and many obese patients report being treated disrespectfully by doctors because of their weight. Everyone, including doctors, should stop blaming and shaming people for their weight and offer support, and where appropriate, treatment.
I don't agree with her classification of human beings as "problems," but I'm pleased to see that there's some change in how the medical and science community views fat people, and fat patients, at least in the UK. Distressingly, though, new guidelines distributed to practitioners in the US recommend that doctors push weight loss before all other treatments, even at the expense of taking patients off existing medications or pressuring them to take weight loss drugs and undergo risky surgeries. First, Do No Harm documents the very real consequences of these kinds of policies, providing a strong argument for, you know, not treating fat patients like garbage.
Armed with the news that the US medical community was recommending a radical crackdown on fat patients in direct contradiction of actual studies showing that this doesn't work, I was understandably nervous about going to the doctor's. The last thing I wanted was a lecture on my weight, since that wasn't what I was there to talk about, but it turns out that my assumptions about what would happen behind that door were pleasantly disrupted.
We didn't talk about weight. At all. At no point during my appointment was it brought up. Towards the end, I asked about a referral to a nutritionist, explaining that I wanted to meet with someone to talk about some of my disordered eating patterns. My doctor said that wouldn't be a problem and put in an order to have the nutrition/health education department call me to set up an appointment.
As she made the note, she asked me if there was anything else I wanted to discuss with the nutritionist, I said "No," and we left it at that. She went on to note that the most important thing from her perspective was that I was happy in my body, saying that her priority was my health and that a sense of wellbeing was critical to being healthy.
Maybe her words had to do with her specific training and experience; DOs tend to be more focused on whole body care with an integration of, for lack of a better word, spiritual concerns as well. As a practitioner, she's been trained to look at the big picture in a way that many MDs are not. For her, the goal is happy, healthy patients, and she doesn't zero in on specific traits or features.
Or maybe she'd been reading the research about fat shaming and rethinking her approach to medicine, wondering if it might be more productive to treat fat patients respectfully and without judgement. Her friendly, non-pressuring stance made me feel much more comfortable, and if weight loss was a goal for me, I would have felt more secure about asking her for support and ideas.
It's also possible that the hospital as a whole is considering fat education for doctors and integrating research, understanding, and patient feedback into protocols and recommendations for care providers. While every doctor has a different approach to medicine, policy recommendations matter — and this is where we are likely to see the greatest change at doctors' offices and hospitals. If we can stress that fat patients need to be treated with respect, we can change the way we interact with health care providers, which means that more fat patients will feel comfortable going to the doctor when they need to.
My experience shouldn't have been unique, and I shouldn't been shocked and pathetically grateful to have been treated like a human being. Hopefully this was a sign of things to come.