Welcome, Washington Post readers

As you can see, this is First, Do No Harm.

As mentioned in the recent Washington Post article, this site was conceived in the aftermath of three posts I wrote regarding the death of my mother, for the Shapely Prose blog, entitled Fat Hatred Kills.

When I wrote the series, I had no idea what I expected to happen. Mostly, I just wanted to express my anger over my mother’s death, which perhaps could have been prevented with proper medical care, to people who would understand what I was talking about when I said that fat is not a disease.

I was in no way prepared for the onslaught of stories similar to my own that arrived in the comments to those posts. Over and over came the same refrains:

- Fat people whose very real ailments went misdiagnosed and/or mistreated, if they were treated at all, because their doctors were too busy judging their fat bodies to do their jobs

or

- Fat people whose previous experiences with medical professionals had terrorized them so badly that they were afraid to seek medical care, no matter how badly they might truly need it, so that even life-threatening conditions were going untreated, sometimes for years at a time.

Even now, half a year later, I generally wind up in tears whenever I look through those comments.

All I see are the brothers and sisters, mothers and fathers, sons and daughters, aunts, uncles and cousins, friends, neighbors… the men and women who are needlessly suffering and sometimes dying, all because there are some doctors out there who believe that some of their patients deserve proper treatment, and some of their patients deserve lectures, scorn and occasionally open loathing.

Is it any wonder then, that many fat patients would literally rather die, than risk going to see a doctor when they are sick?

The other thing we saw, over and over, was that so many victims of medical professional harassment thought they were alone. That they were the only ones who had been treated so poorly, and in fact many had been convinced that they deserved no better.

I spent much of July 12, 2007 weeping. For myself, for my mom, and for all the people like us – people suffering, people dying, families torn apart.

And when at last I dried my tears, I emailed Kate and said, “We have to do something.”

First, Do No Harm is that something.

As long as fat prejudice remains hidden, it flourishes. So we have created a place where men and women can share their stories, to bring the ugly truth of fat hatred to light. Here we seek to provide resources, so those who have been harassed by a medical professional can learn how and where to report these incidents, in the hopes of ensuring that all patients, fat or thin, receive proper medical care when they require it.

So welcome to First, Do No Harm. If you feel you have been mistreated by a health care professional due to the size of your body, you can find resources on how to lodge a complaint here. And if you have a story you’d like to share, please feel free to email us at fathealth at gmail dot com.

Barbara Benesch-Granberg (aka Thorn)

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14 Comments

  1. Thank you for your courage, as always. It is appreciated.

    Reply
  2. cardsguy

     /  January 29, 2008

    First, I agree that doctor’s should never make a patient feel as if they are sub-human because of their weight. However, being underweight or overweight has serious medical consequences. For example, not having enough adipose tissue (fat) can initiate a pathophsyiologic process called ketoacidosis, which can result in myocardial infarction (death of heart tissue), cerebral edema (causing brain damage), pulmonary edema (leading to respiratory failure and cor pulmonale — right heart failure), hyperglycemia, etc. On the other hand, being overweight leads to many things such as having constantly increased levels of tumor necrosis factor alpha (TNF-alpha) being put out by excess adipose tissue (fat). TNF-alpha is a mediator in our body’s immune response to foreign invasion, normally released at a high circulating level by a class of immune cells called granulocytes and monocytes. When released, it also decreases glucose uptake and fat oxidation. This is beneficial when our bodies need to mount a temporary immune response to a pathogen. However, if constantly released, TNF-alpha results in high blood glucose levels, triglycerides, and general inflammation (normal tissue destruction), which results in many systemic conditions such as athersclerosis, joint destruction, diabetes, increased susceptibility to infection, increased general anxiety, etc.

    Therefore, while a doctor should ALWAYS do a thorough physical and history, especially with a new patient, s/he knows that our bodies are a complex biological system. There are many confounding variables, effect modifiers, and intermediate conditions, in addition to direct causal variables (like a H. pylori infection causing GERD), that may be contributing to seemingly unrelated medical problems (such as sinusitis, arthritis, breathing problems, cognitive functioning, etc.) Excess fat/lack of fat is an important consideration that cannot be overlooked when attempting to treat a patient for his/her specific presenting health problem.

    Thus, it’s the duty of every doctor to encourage their patients towards a more healthy weight. This does not mean that a doctor should harass a patient, make them feel ashamed, or treat them paternalistically. It does mean, however, that a doctor might bring up weight when treating a patient for a seemingly unrelated condition such as an ear infection! Once the subject of weight is breached, it should be approached with encouragement, supportive education, and follow-up appointments so that the patient is actually empowered to change.

    Reply
  3. fillyjonk

     /  January 31, 2008

    All very nice, cardsguy. How do you recommend that they do that considering that diets are actually counterproductive and naturally thin people can’t gain permanent weight any more than naturally fat people can lose it?

    Reply
  4. J.S.

     /  January 31, 2008

    Absolutely, Fillyjonk.

    And Cardsguy, even if what you’re saying is all well and good, the trouble is that too many doctors present larger patients with obesity as a diagnosis, not a risk factor to be considered in reasonable discussion. Read through the stories on this site, and you’ll see that we are told that any kind of pain or symptom is the result of our size. Only much later, after much suffering, do we find out that it was not. THAT’S the problem.

    Reply
  5. Guess Cardsguy hasn’t actually taken the time to read FDNH, eh….oh the irony.

    Reply
  6. No Sharp Edges

     /  January 31, 2008

    This is hilarious, cardsguy. (Is that meant to imply that you’re somehow involved in the field of cardiology, or did you just pick up a medical reference book and eeny-meeny-miney-moe a few pages from it?)

    Do you think you’re blinding us with science? If that’s the case, you’ll have to try a little harder. I’m afraid I can’t trust the judgment of a medical professional/wannabe/whatever who can’t be bothered to spell “pathophysiologic”, “atherosclerosis”, or [ahem] “doctors” (not “doctor’s”) correctly.

    Reply
  7. fillyjonk

     /  January 31, 2008

    Oh, see, I assumed he was a gambler.

    I can forgive typos, but you’re right — when you’re copying right out of the book, how hard is it to check your work?

    Reply
  8. littlem

     /  February 1, 2008

    @cardsguy: Blah blah **** ing blah.

    Thank you for your devastating display of conformity in regurgitating everything you learned from your professors in med school.

    Now. Any chance you’re going to think for yourself, since you’ve started practice? Or is that taboo ’cause you gotta keep up on those yacht payments?

    “It does mean, however, that a doctor might bring up weight when treating a patient for a seemingly unrelated condition such as an ear infection!”

    Um.

    Dude. Your lack of syllogistic reasoning is beyond farcical. Oh, wait — guess they only teach that in 600-level philosophy and law, not in med school.

    How in the name of Hippocrates can you causally link an ear infection and overweight?

    Oh, wait — it’s idiopathic, right?

    THAT, reduced from med-speak to English, means the DOC DOESN’T KNOW WHAT THE H*LL IS GOING ON.

    *kthxbai*

    Reply
  9. Cardisguy, look.

    The problem is quite simply that doctors will ALWAYS attempt to find a link, however tenuous, between whatever ailment we come in with and our weight. This happens up to and beyond the exclusion of other possible causes and diagnoses, and results in possibly life-threatening ailments being misdiagnosed until it is either too late entirely or, at the least, permanent damage has been done.

    And even without that, do you have any idea how humiliating it is to be weighted by your doctor and have him insist, INSIST on blood pressure readings and a lifestyle discussion when you come in with a chest infection? Or a minor physical injury? Or tonsillitis? Or just to arrange an appointment to replace your contraceptive implant?

    Humiliation doesn’t make me lose weight. It makes me go home in tears, throw away all the food in the house, starve myself for two days and then stuff myself with something while crying at how weak and disgusting I am.

    Reply
  10. queendom

     /  February 2, 2008

    @cardsguy: I suggest you have a look at this article http://www.ajph.org/cgi/content/abstract/AJPH.2007.114769v1

    I am not even denying that there might be certain risks associated with being fat, at least in the upper percentiles, but the psychological and as suggested in the articles physical effects of feeling bad about yourself and your body are very serious as well – and usually ignored by doctors and other health professionals. In addition, as long as you or someone else does not come up with a method how people can lose weight and keep it off for good that is safe and works for more than a tiny percentage of people, what exactly are we fat people supposed to do when our doctors tell us to try and lose weight?

    I am also one of those people that usually go home in tears whenever a doctor addresses my weight and then either starve myself for a while or binge (or do first the one and then the other). You could argue that most health professionals don’t try to shame me and don’t want me to starve myself but just to eat a “healthy diet”. But a) doctors have to be aware that many fat people have been told to be ashamed of their weight pretty much all their life and that when someone addressed this topic – even addresses this topic in a nice way – will support that shame b) no matter how much you want it to be true, diets or “lifestyle changes” aimed at weight loss don’t work, no matter how sensible they might seem and c) pretty much all the doctors I have met congratulated me to any weight loss without EVER questioning my methods – and believe me, starving was usually part of it.

    Reply
  11. La di Da

     /  February 2, 2008

    Doctors discussing one’s weight wouldn’t be a problem if all of them did it with respect and common sense. Bedside manner, if you will. A medical practitioner ought to be acutely aware that weight and body size is a hugely stigmatised thing in our society and people, especially women, are highly likely to have been humiliated and shamed and mocked regarding their weight, and that it can be a very sensitive issue. Even for the people who don’t look fat.

    If the patient is seeing a doctor for an ear infection or broken finger, there really is no need to have a complete “lifestyle” discussion. There just isn’t. If they’re seeing them for a condition which has been linked to weight, the doctor could bring it up tactfully, such as “X has been linked to high/low body weight, but I’m going to investigate this fully and not dismiss your concerns”, etc. Most fat people are well aware that there plenty of things for which weight might be a risk factor: it’s pretty bloody hard to avoid hearing about it these days. There are ways of asking a patient about their exercise and eating habits without admonishment and judgement. “Sometimes condition Y can be aggravated by a vitamin deficiency. Can you tell me about what you eat?”, for example. And then LISTENING. And reassuring the patient that no judgement is being cast, both by spoken and body language. I KNOW it’s possible, because I’ve had doctors that have been great like this, as opposed to the arseholes described in this blog.

    Doctors that blame any and everything on weight are both lazy and incompetent. Doctors that feel the need to discuss “lifestyle” at every visit are patronising.

    Reply
  12. J.S.

     /  February 3, 2008

    I’ll also add that the “discussion” of weight in a doctor’s office is very, very rarely an actual discussion. From my experience it is more likely to be a doctor telling me that I am fat, and then not listening to my explanation that I exercise in moderation and eat reasonably. Instead the doctor will then badger me with “information” about dieting, appetite surpressants, diet pills, and weight loss surgery, none of which would be remotely relevant if she believed what I just told her: I exercise. I do not overeat. My weight is not a result of “bad” behavior on my part, it is simply a physical characteristic, like my height, or the color of my eyes.

    This, I feel, has been the most damaging result of “discussions” of weight weight my doctors. These moments show me that my doctors do not believe what I tell them about my own symptoms and behaviors! They remain convinced that I am a depressive, inactive overeater, no matter what I tell them to the contrary. And, as a doctor friend of mine recently pointed out, if my doctor does not listen to what I say, does not believe me, then I am not receiving medical care. I am receiving veterinary care.

    This does not help my health. It only makes me angry. And distrustful of every doctor who has pulled this on me, which would be most of them.

    Reply
  13. DivaJean

     /  February 5, 2008

    The only dictators I have seen as physician care providers have been when my primary doc is out and I have an urgent problem- ie- sore throat, etc.

    Once, one of these goombas recommended weight loss surgery when I was in with tonsilitis. I can’t swallow ANYTHING and you’re worried about weight loss surgery?!? Hello? I point blank walked out of the room, grabbing my chart and had the office nurse find someone else in the group to see me. No deal.

    Reply
  14. teqjack

     /  February 5, 2008

    I’ve been lucky about this.

    My “primary” doctor is actually a clinic at a hospital, largely staffed by students in their last year (I sometimes get to hear whether they graduated), so every year I am assigned a new “doctor.” I don’t particularly mind them bringing up my weight at the first meeting, it is expected (hey, I am FAT).

    But none were offensive. And over the years, most stopped after that first encounter when I point out a couple of things from my history –

    1. At 62, I weigh fifty pounds less than I did at 18 – even if that is still 235 (at 6` 1“) – and I ask them how many other relatively healthy people they think can say that.

    2. A few years ago, I spent two weeks in hospital. Normal ward food, normal (non bed-ridden) ward exercise. And GAINED 12 POUNDS!

    Reply

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