Fat-shaming happens, even if you aren’t “fat”

EB writes:

I have never been anything that anybody could reasonably call fat. At 5’5.5″ I stayed around 125 from the ages of fourteen through 26. At 27 I weighed myself (usually a bi-yearly event or so) and discovered my weight had crept up to 135. This didn’t bother me because I was getting fat (because I wasn’t) but I thought maybe I was consuming more calories than I needed. I hadn’t noticed because at this time I wore mostly drawstring-waist clothes and hadn’t seen a change in the way they fit. I kept a cursory eye on what I ate, keeping in mind that I was clearly getting as many calories as I needed and maybe a few more. With no further effort on my part my weight came down to 130.

Then I found out I was pregnant.

And then I got hungry. Constantly, crushingly, insistently hungry. This was not the normal First World hungry or even the “I’ve been hammering boards together all day and boy am I famished” kind of First World hungry. This was something different. And I had to feed it. So I adapted my diet as best I could, in the interests of staying a functional human being.

I went for my ten-week checkup and was scheduled with a nurse practitioner who I had not seen before that day. She walked in, stood by the door, didn’t bother to introduce herself, and asked me how I was feeling. I didn’t feel much like discussing how I was feeling, since I’d discussed it to death with everybody, including having discussed it five minutes prior with the woman who took my blood pressure, but I answered dutifully with a response along the lines of “I’m making it”. She queried me more closely and I told her that I was constantly hungry, eating all the time, and kind of fatigued.

She told me this was normal for pregnancy. Which I already knew, which was why I didn’t want to discuss it because what was she going to do to fix it? I told her I wasn’t really feeling nauseous but mostly it was just that I got sick of certain foods because of eating them when I had no desire to eat them. She didn’t seem to understand this concept and I said “You know how sometimes you’re like ‘Man, a sandwich would be really tasty?’ Well, it’s the opposite now. It’s more like ‘Man, I really don’t want a sandwich, but I’m starving and I have to eat SOMETHING.'”

She asked me how often I ate and I told her honestly that I would eat five times a day and snack in between.

She then proceeded to jump to conclusions about how MUCH I ate at each of these meals, telling me I’d gained 10 pounds since before I was pregnant and that during the first trimester I was only supposed to gain about a pound a month. [Let’s not discuss here how much of that might be breast tissue; I’d also gained a couple of cup sizes by that point.] Wait. WHAT? I challenged this and she said that my record said I had weighed 125 before I was pregnant.

Now let’s discuss the poor data-gathering I observed at this office. At the first prenatal appointment the provider asks how much you think you weighed prior to getting pregnant. You answer and that, apparently, gets added to your record. If you happened to be wrong about that, then how are you going to know? My guess would be I said my pre-pregnancy weight was 125, 130 or so, and she wrote down 125. They would then weigh you at each visit and the medical assistant taking the weight seemed not to care if you leave your shoes on or take them off or if you’re wearing your coat or who knows what all else. So you have to figure any reported weight could be off by 2-3 pounds. Add in the effects of, say, wet hair, a full bladder, having your wallet in your pocket, or having just eaten breakfast. That’s another 2-3 pounds that you could be off. Therefore, if you are the provider and looking at this number, you need to bear in mind that it is a ballpark figure.

But what the heck. Look at a garbagey number, compare it to an equally garbagey number, and criticize a starving pregnant woman and tell her to eat less.

Anyway, she said that I’d weighed 129 at my last appointment a month previously. So if I was supposed to gain a pound a month, I was 5 pounds over and apparently deserving of this lecture? I was distinctly irritated by this point and commented about full bladders, and she dropped the mention of specific numbers but then said something about how if I was eating five meals a day and snacking in between that was probably too much, as if she knew how big of meals I was eating. Then she started to say something about how maybe if I wanted a sandwich I could just eat a really small sandwich, which I cut off by saying “I know about portion control.”

Then she shifted gears to talking about exercise. I admitted that I didn’t exercise much because I felt lousy most of the time. She asked, in the same sort of perky voice that she had been using through the entire conversation, what I liked to do. I said walking and she said I should shoot for walking 30 minutes a day. I pointed out for the second time in two minutes that I feel lousy, fatigued, not up to it, and she pointed out that exercise produces endorphins that make you feel better (which I knew, but I so did not need this lecture on this particular day). I cut off this conversation too and said that this wasn’t even what I wanted to talk about and I had other questions, and she mercifully dropped the subject.

So, short version, I got criticized for supposedly gaining too much weight, for almost no reason whatsoever, after I’d just told her I was hungry constantly.

I ended up switching practices. I never reported this lady, though I wish I had. I ended up gaining almost 50 lbs before delivering my daughter, and the new providers I saw never said word number one about it—at each visit they told me my weight was fine. My daughter was an average weight, neither of us had any complications, and I was back to 125 by six months postpartum. Apparently whatever horrible thing was supposedly a risk because of those extra 5 lbs never materialized. I wonder if it is worth reporting this provider as this was 2 1/2 years ago. I shudder to think of the effect of this conversation on someone who actually had an eating disorder or even food issues (since aside from food aversions in pregnancy I have the least food issues of anyone I know.)

Crohn’s disease? Congrats on losing weight during a flare. . . .

Rachel writes:
(I really appreciate your blog! I am not very overweight, but I still get judgment for it all the time, so I can only imagine what reality is like for other people. Ugh.)

I’m a 21-year-old woman and have somewhat struggled with my weight since hitting puberty (I was a 14/16 US in ninth grade). I’m not obese, but I’m tall and big-boned with slightly odd body proportions, making my current 10/12 size look bigger than it really is, though I’m really only a few pounds over my max healthy weight.

Anyway, I was diagnosed in the summer of 2012 with Crohn’s disease, a serious digestive disease that affects the way my body digests food and absorbs nutrients. Many patients lose massive amounts of weight because they literally cannot digest food. The way I cope with the debilitating pain and diarrhea is by overeating between flares – my body’s way of trying to make up for malnutrition while I can handle eating solid food. In other words, I look healthier than I really am.

After my diagnosis, I had a major flare that lasted the second half of the fall of 2012, and I was very sick.

However, when I went to see my gastroenterologist in December 2012 for a follow-up appointment, the intake nurse (his medical assistant) took my weight and then CONGRATULATED me for losing 10 pounds!

She is a specialist in gastrointestinal diseases! She of all people should know that such rapid weight loss in a Crohn’s patient is a sign of serious complications!

I still struggle with guilt because I have Crohn’s disease and yet am still overweight.

(PS: She was not exactly thin herself, either!)

Gastric bypass for sleep trouble

Anon. writes:
I was feeling unusually tired and out of energy. My GP told me to diet and exercise, and take iron supplements. I tried this for months, but it wasn’t making much difference. I talked about it with my mom, and she told me she has sleep apnoea. She asked if I had considered this. I am a snorer and being overweight can make sleep apnoea more likely, so I thought this might be the problem. So I finally went back to my GP and got a referral to a sleep clinic.

After an assessment, I got to do a sleep study where I’m monitored throughout the night to see if I stop breathing. I talked to the doctor in the morning after the sleep study. It turns out I didn’t stop breathing in the night so they could rule out sleep apnoea, but he said he thought my weight could still be keeping my energy down.

So I asked him “If it’s not sleep apnoea, then how could my weight be affecting my energy the past few months when I’ve been this size most of my life?” He said he didn’t know, but people who lose weight usually “just feel better.” I told him that I have been making an effort; I had been restricting my calories to lose one pound a week and lost 10 pounds. He said that little amount of weight loss was unlikely to make much of a difference, and often after diets people just “balloon back”. He asked if I would like to be referred for a gastric bypass. I was shocked, and told him I thought that was a serious decision and it’s not one I would take so lightly.

At the time of the sleep study, I had a BMI of 36. I’ve lost another 10 pounds I’ve lost since then, and I have moved me from the “morbidly obese” BMI category to the “obese” category. It’s a challenge, but I’m still losing slowly and healthily. No gastric bypass required, thank you very much. Oh and it turns out the tiredness was due to seasonal affective disorder. I’ve got a sunlamp and vitamin D supplements and have since been feeling much better.

Reactive major depressive episode? Have a weight loss drug!

Anon. writes:
I was suffering a second episode of depression after some personal issues had arisen. I had finally decided I wanted to do something about it and booked an appointment with my NHS GP to get a referral to therapy.

As usual the surgery was running late and was rushed. When I finally got called in, I told the GP that I had been feeling really low again. She interrupted me, saying she noticed I was overweight (oh, really? how insightful) and that could affect mood. She asked if I had considered losing weight? Of course I’ve considered it, and I’ve tried, but I’ve been fat my whole life (and not depressed my whole life). Being depressed I really didn’t have the energy to do much about it right now. I told her this, and she asked if I had tried a weight loss drug, Alli. I told her no, that’s one thing I hadn’t tried and asked how it worked. She told me it stops me from absorbing fat (but neglected to tell me that it makes you poop/leak orange oil and basically deters you from eating). She wrote the prescription, and then acted as if problem solved, appointment over.

Fortunately I did press the issue of therapy, so we returned to the actual issue of depression. By this point we were nearing the end of the allocated time for the appointment so she was rushing. She gave me a self-referral number, and asked me “you haven’t thought of jumping off a bridge or anything, have you?” – what a sensitive way to ask a patient if they might be suicidal. When I told her no, she said “good good”, thrust the Alli prescription in my hand, and sent me out the door.

Blood pressure high all of a sudden? Lose weight and take this medication. . . .

SS writes:
I have been overweight since puberty. Right around age 16 my body settled into a size that has stayed pretty consistent over the years, give or take a few pounds. I can’t remember a time since that I’ve been to a doctor without my weight being mentioned, whether or not it was relevant to the visit. Reading the stories here has been both horrifying, because so many of you have had it so much worse than me, and reassuring, because at least I know I’m not alone in this struggle.

I have had a few bad experiences with doctors, but one in particular has stuck with me. About two years ago, at age 26, 5’4″ and about 220 lbs, I had my first ever high blood pressure reading. I was at the obgyn to get a new birth control prescription, and was told that I couldn’t go on the pill until I figured out what was going on. Obviously, this was a disruption in my plans, and I had always had good blood pressure, so I had no idea why it had suddenly become a problem.

I immediately followed up with a new general practitioner. The appointment was terrible from the start. My new doctor took one look at me and immediately started making assumptions about my lifestyle. She asked how much weight I had gained recently. I said I hadn’t gained any, that I had been at a pretty consistent weight for years. She looked skeptical, but let it go. After a few questions about my diet and alcohol consumption, she said that I should lose 10 percent of my weight and that she would put me on medication in the meantime.

At this point I got upset, because she still hadn’t addressed why my blood pressure may have suddenly skyrocketed. I didn’t understand how I could go from being healthy two months ago to suddenly having this problem, with no noticeable changes in my life. Other members of my family have high blood pressure, but none of them had it until their 40s. Wasn’t I too young for this?

She basically ignored those questions and told me again to lose weight. Then the condescension really started. “Just try to walk a little bit,” she said. I was taken aback by the assumption that I move so little that a bit of walking would make the pounds shed away. I replied: “I live in the city. I walk literally every single day, everywhere I go. I would say that I walk a minimum of a couple miles a day.” She didn’t believe me; it was all over her face. “Just try to increase your walking, you’ll be surprised how much it will help. Take the stairs instead of the elevator, little things like that.” I lived in a 5th floor walk-up at the time of this visit.

At that point, I felt utterly deflated. She didn’t want to hear the truth about my lifestyle, she was content to carry on with her assumptions. I left that appointment with no idea why this problem had suddenly come up, and no real plan for addressing it. When I went back to my obgyn, she decided to put me on the Depo shot, which did not have risks associated with blood pressure. Of course, while the shot is great in many ways, it has a major downside: weight gain.

Two years later, I am now at 230 pounds, and my blood pressure continues to be a problem. I’ve switched doctors, and my new doctor is much more empathetic and kind, but he still says the same thing at every visit: lose weight. I’ve been trying, believe me, but I can’t help but think that there must be more to it than that, and that my doctors are doing me a disservice by refusing to look past my weight.

Eating disorder? Nah, just some bad habits. . . .

A reader writes:
A few years ago, when I was in high school, I suffered from an eating disorder. I would binge eat (and really binge eat… like, 6000+ calories per day), then literally starve myself for days, then binge again. I didn’t gain or lose much weight because of my alternating habits, but I was suffering a lot. Not only was I severely depressed and doing poorly in school as a result, but I was fatigued and malnourished.

Finally, I decided to see a psychologist to deal with everything that was going on. I told her about everythingI told her that I wanted to lose 70 pounds, which would have put me severely underweight. I told her that I was absolutely certain I wouldn’t be happy until I was thin. Her response? “Okay. Maybe we should set you up with a weight loss counselor, then. That might be more helpful.” I asked her if my behavior constituted and eating disorder and required more therapy… she told me I just had some “bad habits” that had made me gain weight, and I was going about changing them the wrong way. According to her, it was teenage silliness and nothing that couldn’t be fixed with a healthy diet and exercise. If I had an eating disorder, I would have lost weight already.

Long story short, she declined to take me on as a patient, and five years later, I have lasting problems due to my eating disorder (which has now been diagnosed and treated, thankfully.)

Fat and pregnant? You MUST have gestational diabetes (even if you don’t)

gnrkrystle writes:
Two years ago, I found myself in a scary and exciting position. My husband and I were pregnant with our first child! I was over the moon, but it was scary to be in another country (I’m American and I lived in Canada at the time), far from family and my usual OBGYN. First, let me say, I LOVE my OB/GYN at home. She has talked to me about my weight, but always in a positive and helpful way. She understands that I am currently healthy and my being overweight does not mean that I’m about to break down an die at any minute. Her concerns about my weight are founded, but always delivered with respect and sensitivity, and never over done. After what I went through with the Canadian OB/GYN, i feel endlessly lucky to have my American doctor.

So, first of all, it’s very hard to research doctors up here. The way the system works is, the GP or family doctor refers you. You can tell them who you want, but if you don’t know any doctors, you get the luck of the draw. I was not so lucky. I was referred to a doctor, let’s call her Doctor Meanie-Pants. Because I was American, without OHIP (the state sponsored insurance), I had to pay out of pocket for every visit, the delivery, everything. Okay, that’s fine. But when you paid as much as I did…you should be treated like a costumer. All I got for my money was emotional abuse. On the first visit Dr. Meanie-Pants turned to me and said, “You are obese.” Jeez. Thanks, lady. I didn’t know. I rolled my eyes and bit my tongue. I was used to this, after all. Every time I’ve had to see a doctor that I didn’t already know, I got the same song an dance. Yes. I’m fat. I know. Now, can you please treat me.

I never felt comfortable with this woman. She was obsessed with my weight. I gained almost no weight for the entire 4 months she saw me. I was watching what I was eating, and the baby was burning a lot of calories. Given that I was large to begin with, I didn’t need to gain much. But she seemed to think I was “cheating” the scale or something. How could such a big fat, fatty possibly be pregnant and not be blowing up like a balloon?

It was durning one of her weight tirades that she proceeded to inform me that, at the next appointment we’d be doing my Gestational Diabetes test, but that she was certain I would have it. “As overweight as you are, it’s a certainty,” she said. I smiled brightly at her the next appointment when it turned out I did NOT have GD. Two appointments later she sat me down and told me that she was referring me to a specialist because she couldn’t risk her medical license with a possible American lawsuit. Because “since I don’t take care of myself” complications in the delivery are almost certain. Incidentally, I DID have complications…that had nothing to do with my weight, and it was a good thing I didn’t have this incompetent fat hater delivering me when it happened. I have no doubt my son would have died in the time it would have taken her to lecture me about me weight on the delivery table.

Symptoms? Lose 10 lbs first, then Dr will consider diagnosing. . .

LW writes:
My mother’s doctor refused to consider her symptoms until she lost 10 lbs. She did. Then he told her to lose 20 more. She tried, but she was in constant pain and couldn’t exercise. Plus, she was 60. Finally, he “humored” (his wording–he was still convinced it was her weight) her, ran some tests, and found that she had…rheumatoid arthritis. She suffered for months and sustained permanent joint damage because he didn’t like the way her ass looked.

Fat and pregnant? You must have gestational diabetes. . . .

Jennifer writes:
I got a shock at my latest annual physical. Dr. W. opened my file, glanced at the summary page, and told me that my history of gestational diabetes was a matter for concern.

I have had three pregnancies, all with care provided by the same group practice. I have never had gestational diabetes. At one point they were so sure that I was going to keel over and die that they had me checking my own blood sugar every morning, and I have never even once shown any sign whatsoever of GD–not even a borderline result. But somebody at this practice decided that because I am fat, evidence be damned, I must must MUST have had GD, and wrote it on the front page of my file. This must have been done after my last pregnancy or I would have heard about it before.

Dr. W., who is generally a nice guy, agreed that nothing in my file revealed the slightest sign of GD and promised to correct the front page. But now I have to wonder, when I go there, whether Dr. Z. or Dr. B. or Dr. L. or Dr. J. will completely ignore the evidence of their own instruments and prescribe care based on my pants size. And I can’t always count on being able to see Dr. W.


MS diagnosis delayed by 2 years due to obesity

P F writes:
My husband is fat. He was a fat baby, a fat child and now, at 5’8″ ranges between 280 and 320 lbs. So not just fat, but DEATHFAT! My husband was always very coordinated and graceful, quick and extremely strong. Even today, he can bench press 300lbs 10 times without straining at all. To the surprise of every doctor everywhere, he was always very healthy as well, with great cholesterol, low blood pressure, low heart rate and good blood sugar.

Until 5 years ago when my husband lost his colour vision. He could see, just not colours. After 4 hours at an ophthalmologist, a preliminary diagnosis was made: Multiple Sclerosis. (The first symptom is typically vision problems, though loss of colour vision alone is unusual.) He was referred to a neurologist who said “You should lose weight.” He ordered no tests and did not even mention MS. My husband was demoralized at yet another doctor calling him a fatty and his vision returned to normal, so he ignored the diagnosis and went on with life.

Then, 3 years ago, the stomach symptoms started. He couldn’t eat. My husband could keep down some liquid, but solids he threw right back up. (It turned out to be gastroparesis, essentially a paralysis of the stomach leading to an inability for food to move into the intestines. The food rots for a while, then the body ejects it, i.e., vomiting. It’s not uncommon with MS.) He went to his GP, who was delighted that my husband had lost 20 pounds. The fact that my husband was puking up every meal didn’t matter- he was losing weight!

Within 4 months, my husband had lost 120 lbs. He could no longer walk. His feet burned, he was losing feeling in his fingers and his teeth were a rotten mess from all the stomach acid. Doctor after doctor ignored the how and focused on how wonderful it was that my husband was losing his deathfat.

One night, I come home to find my husband passed out on the floor in a pool of blood. The constant vomiting had damaged his esophagus. The ER doctor was horrified. The burning feet? Neuropathy (permanent nerve damage) from vitamin deficiencies. Several of his teeth were abscessed. My husband was dying, and this was the first doctor to care. I cried tears of relief that someone actually cared.

The ER doctor ordered an MRI and a lumbar puncture (spinal tap). Because of my husband’s size, the LP had to be done with a flouroscope because they couldn’t feel his vertebrae well enough. The doctor doing the LP was angry at my husband for being fat. When he was told they didn’t have the right size needle, the one on the tray was too big, he used it anyway and my husband has had severe back problems since. (He never had them before.)

Turns out, my husband had MS all along. Weight is irrelevent to MS. There is no correlation between MS and weight. If anyone had cared to see past his weight, he could have avoided permanent nerve damage. His stomach still causes him huge problems, and we’re $5,000 into $15,000 of tooth repair. He’s in pain every day and struggles with everyday tasks. At least they didn’t kill him.

Thanks for listening.