To be honest, this was a little hard to share. But I really feel like I need to because these kinds of fatphobic healthcare interactions happen every day. And they happen to populations that are more vulnerable than me. When dealing with medical professionals I try to go prepared to defend my position that I will only accept a weight-neutral approach to my health. I work in this area so when dealing with fatphobic doctors like the doctors I saw I have a few extra tools to handle the situation, but for others they may not be aware of all of the facts, all of the studies and all of the research. So I felt it was important that I share this horrible experience with you even though it scares me.
This will be a little bit of a long post so if you chose read, thank you.
About two weeks ago now, I just had a terrible experience at my primary healthcare clinic.
For the past little while, I have been feeling more tired and lethargic than usual and I was concerned that there was a medical reason for it. I have been anemic in the past.
So I booked a doctor’s appointment with a locum (there were no available appointments with my regular doctor). At the appointment, we discussed what could be happening with my energy levels and set up a bunch of tests for my iron, thyroid and b12.
Now although this doctor didn’t discuss it with me or inform me so that I could consent to it, this doctor also tested me for diabetes. The only reason I know this is because I looked at the requisition form and saw the A1C test checked off and I know A1C is the test for diabetes. Otherwise I would have had no mental preparation or expectation to receive a diagnosis for diabetes. Can you imagine your doctor not discussing cancer with you at all, but doing the test for it without your knowledge and then showing up to your follow up appointment completely unprepared to receive a cancer diagnosis?! This is not ok. This is not practicing informed consent in healthcare.
And of course, I can’t be sure, but I don’t doubt that some weight-bias played into his decision to test me for diabetes. But this isn’t the worst of my experience.
A week later, the test results came back and I needed to go in to see my doctor to discuss them. Again there are no appointments available with my family doctor (who is body positive) so I book in with a (different) locum.
I am very skeptical that this will go well. I am really worried about having to discuss diabetes with a doctor I don’t know. And I am pretty sure this locum doctor will not take a weight-neutral approach to health care.
The appointment really did not go well.
My test results, however, were pretty great! All “normal range” results except for slightly low iron, which is actually an improvement from my previous levels.
Cool. So the treatment is increasing iron intake and low iron explains the fatigue I have been experiencing. Now I just want to get a copy of the results and get out of there.
However, this doctor didn’t stop there. With no prompting, and even though she is just a locum and not my regular doctor, she starts talking to me about my weight. I immediately tell her that I practice a weight-neutral approach to healthcare and encourage her to read the book Body Respect by Dr. Linda Bacon so that she can learn more about Health at Every Size and ultimately provide better healthcare for people of all sizes.
But she doesn’t understand. She goes on to say that if we figured out my weight we could figure out my Body Mass Index (BMI) and if my BMI is above 40, then (lucky me), I could have bariatric surgery (weight loss surgery)!
This is coming out of nowhere!
I have expressed no desire to lose weight or concern about my weight and in fact I have told her the opposite. I have told her that I practice a weight-neutral approach to healthcare. But she must be so indoctrinated that she goes on, almost as if she doesn’t hear me.
Normally I might wonder if I missed something or perhaps I didn’t explain myself clearly, but my partner was there in the room with me to witness all of this. Because the medical world doesn’t have the best record for healthcare for queer and fat bodies, my partner and I now always practice having a witness and advocate in the room with us, when dealing with healthcare.
I can’t believe she is bringing up the BMI! I hold back from saying “we all know the BMI is bullshit” and instead say “we all know the BMI doesn’t tell us anything other than a person’s height and weight so why would we use it to determine if a person should have major surgery?”
She says it is the standard of care to offer bariatric surgery to people with a BMI over 40. We don’t even know what my BMI is and my BMI tells us nothing of relevance.
So I say, “I haven’t seen any peer reviewed studies showing that bariatric surgery will help one lose weight in the long term (over 5 years), in fact most people gain the weight back and more after 5 years. And more importantly, why would I, a healthy person by all reasonable medical standards, want to have elective major surgery that basically guarantees surgically induced malnutrition for the rest of my life?”
Even if my weight was causing a health issue, bariatric surgery doesn’t seem like the best option to me.
She says it’s true some people don’t take well to bariatric surgery. But she’s seen some people have “amazing transformations”. And there it is, the aesthetic reason for pushing bariatric surgery. This is a medical doctor and we are talking aesthetics at the cost of health. This does not seem like a good “standard of care” to me.
But she tries to bring it back to health.
She says being obese does lead to disease. And I press her, “What diseases? I haven’t seen any medical studies that have shown more than a correlation of weight with disease. What studies have truly studied weight alone and held constant other factors like, socio-economic status, weight-cycling (dieting), marginalization, access to food, access to healthcare, etc?”
She says obesity could cause arthritis down the road. Again, I have not seen any medical studies showing a that obesity is a direct cause for arthritis. But even if it is, this doctor is essentially saying that I, as a currently healthy person minus low iron, should have a risky, elective surgery that may or may not give me the intended results (weight-loss) and that has serious health consequences (malnutrition for the rest of my life), on the chance that I might develop arthritis later on in life and that that arthritis could possibly be due to my weight. This doctor is absolutely not providing a good standard of care. This doctor is dangerous!
So after listening to her, and questioning her without any progress or understanding, I decide it’s time to end this appointment and all I want is a copy of my results. But she can’t figure out how to print them. She says printing is an administrative task and by asking her to do this I am slowing down the clinic.
Ummmmmm, nope. I am pretty sure that what’s slowing down the clinic is her talking for about 15 minutes about an unnecessary and very risky surgery that is all about her bias against body size and nothing about her patient’s actual health. And I am pretty sure as a doctor she is the one with the authority to print things like prescriptions, requisitions and your patient’s test results.
The huge irony is that the primary health clinic also has some new posters up from the Canadian Medical Association encouraging patients to question when doctors recommend tests or procedures (see below for the poster that was in my patient room).
And as I waited for 30 minutes after the scheduled time for this appointment I had been wondering about that poster. The poster makes it sound like it’s about patient rights, but really all of the questions are biased against getting tests and procedures instead of a balanced set of questions that would be good to ask your doctor.
If I had been thinking, I could have directed this doctor to the questions that were posted on the wall behind her.
- Do I really need this test, treatment or procedure?
- What are the downsides?
- Are there simpler, safer options?
- What happens if I do nothing?
I feel like the situation was essentially this:
I am healthy and bariatric surgery doesn’t have great results, but let’s push for it since it’s better that we erase fat bodies, than have well-nourished ones. It is mind-blowing to me that this is what we call health care!
And outside the office another poster, encouraging doctors and patients not to do tests and procedures with a food shaming image.
Medical school you can do better. The Canadian Medical Association you can do better. Primary Health Care you can do better. Doctors you can do better.
I know this story might bring up a lot of feelings, and different feelings for different people. If you have a similar story and if you feel that you haven’t received adequate healthcare for whatever reason, including your weight, here in Northwest Territories you can reach out to the Patient Representative at (867)873-9095 or firstname.lastname@example.org. I know I will be officially filing a complaint because this is not ok!
Thank you for reading. Wishing you all the best healthcare you truly deserve.