I’m Your Patient, Not a Problem
Before talking about the kind of discussions I have with medical professionals, it is important to note that visiting a doctor’s office can be problematic physically as well as mentally.
I don’t fit.
Before I even talk to my doctor, I am set apart from the other visitors by my size. Chairs in waiting rooms and treatment rooms may be too flimsy for me, or have arms that prevent me using them. Sometimes I attempt to sit on an examination table and it groans, or I will be asked not to sit on it at all. More than once I have had to stand during my appointment, or ask for another chair, or sit on the floor whilst waiting to see someone. Every visit to a doctor begins with the anxiety that this will happen, and the embarrassment of dealing with it if and when it does. This is the starting point for my interactions with doctors—the physical reminder that I am apart and different and that it is not their job to take care of me but my job to change and accommodate them. In this way the physical limitations of a doctor’s office are emblematic of the relations between patient and doctor.
This is the first thing that all my visits to doctors have in common. The second thing is that since I first hit my teens and was told I was obese, I have never had a doctor’s appointment where my weight was not under discussion.
Since I was first told to diet, I have had many different doctors due to frequent movement around the country and large practices not being able to guarantee me the same doctor when I visit. Every one of these doctors, in every one of these appointments, has brought up my weight. This is not something confined to a single doctor, or a single practice.
I can visit for a rash, or a stomach bug, or contraception, or just be registering with a new doctor, but every appointment will become about my weight. No one will explain how my rash is symptomatic of my weight, but somehow it is. As a fat woman, any health problem, however temporary or seemingly unrelated to body size, is put down to my weight.
Sometimes my problem may be put down to a condition associated with weight, such as high blood sugar (which I do not have) or high blood pressure (which I do not have), but it is assumed I have because of how I look. Wheezing and heavy breathing due to the flu are considered to be due to my weight. If I contradict, I am considered a liar.
When I talk about my diet no one believes me, because I am morbidly obese and everything I eat must be fast food. If I talk about enjoying long walks, I must be lying, because I’m morbidly obese and therefore can’t be exercising. If I talk about avoiding group exercise activity due to discrimination, I must be lying about its occurrence, because they have not experienced the same discrimination. Clearly I am just lazy.
When I visit regarding contraception, my doctors are amazed that a woman like me is sexually active. At my weight no one could ever find me attractive, so I must be lying.
When I tell doctors that I don’t want to be thin, that I like my body just how it is, they assume that such a thing must be impossible, that I am making excuses not to put in the effort of dieting, and I must be lying.
Doctors have always assumed that I lie if what I tell them doesn’t fit their narrative of what a morbidly obese woman eats and does and feels and experiences and should be and should want.
It is not only that they see me as a liar; my body is a liar. Why doesn’t it have the responses they feel it should? Why am I not experiencing the health problems that I should? Why am I still moving around and living my life and not suffering immobility and heart problems at the weight of 28 stone (392 lbs)?
I have had my blood pressure taken five times in one appointment because I have low blood pressure, so the reading must be wrong, or the equipment. A morbidly obese woman having a problem with low blood pressure seems inconceivable to most doctors. Meanwhile, I am just trying to deal [End Page 110] with the fact that the blood pressure cuff does not even fit me and I’ve had to get embarrassed and request a larger one, if there is one.
Given these preconceptions about the cause of any health problem I may present with, getting effective treatment is difficult at best. This becomes even harder when few doctors know how to treat my fat body.
How will my greater body mass process standard contraceptive pills? Should they give me more? What happens if they don’t? I can establish the need for treatment, but this doesn’t guarantee me an effective one.
I have been taken off and put on various forms of contraception by various doctors who were either unaware of the risks of certain contraceptive methods for larger women, or were aware but couldn’t think of an alternative, or were uninterested in discussing contraception in favour of weight discussion.
Sometimes a treatment with weight loss side effects is given to me; and its use encouraged despite other side effects being so harmful that it’s better to live with the original problem. When I was offered Metformin for my Polycystic Ovaries, my reaction to it was so severe as to cause me to throw up all my meals, go through frequent dizzy spells and deal with chronic stomach pain. My doctor advised me to stick with the tablets, because it seemed that I was losing weight. My pain did not seem to be a factor. After two months and occasional fainting, I chose to throw them away anyway.
This was the first time I realized that to my doctor, my prospective weight loss was more important than my wellbeing.
I am constantly put under pressure to diet or go through weight loss surgery, because if I stay at the weight I am, I will die. It seems curious to me that I am being told I will die, but not when or why. Other than a general level of unfitness, I don’t even have high cholesterol. I don’t have high blood pressure, or impaired liver function, or high blood sugar, or heart problems. But yet, it is clear that I’m going to die, because I am morbidly obese. Now this is a disease, I suppose it’s legitimate to assume that I will die of that alone.
The risks of constant weight cycling are never explained, as I am pressured into yet another diet. The risks and side effects of weight loss surgery are never explained, as I am encouraged have a major procedure. I have been recommended weight loss surgery in many of my encounters with medical professionals. The increasingly forceful proclamation that “something needs to be done about your weight” is characteristic of my time with doctors. My refusal to have these surgeries and my assertion of the risks and problems make these professionals angry. I’m “in denial”, I’m “not even trying to help” myself.
Why do I need help? I’m doing just fine. I don’t have a problem with my weight. You do.
The first time I tried to tell a doctor that I didn’t want to diet anymore, she pressured me so hard to change my mind, telling me everything she thought was wrong with my body and my appearance, that I broke down and cried. She said that I clearly had mental health problems related to my weight, or that wouldn’t have happened. She continued to insist that I had to diet as I tried desperately to stop crying, and she told me to try harder.
When I was on a diet, I was congratulated and treated like a human being. I was sensible and compliant and taking responsibility for my health. When I’m not on a diet and refuse to go on one, I’m deluded, belligerent and have mental health problems.
To me, a visit to the doctor is something to dread and be avoided at all costs. A doctor’s surgery is not, and has never been, a safe place.
Sometimes I can’t summon the courage to face a doctor that might do this to me. Sometimes I go, and I leave being told to diet again without the energy or well–being to fight for proper treatment. Sometimes I am feeling strong enough in myself to assert that I will not have weight loss surgery, that I will not diet, that I will not be sent away without a treatment for my problem, but the doctor hasn’t the faintest idea how to treat me. They only know how to treat thin people.
Explaining my obesity is not something that I should be forced to do. I am a human being, and [End Page 111] I deserve healthcare as much as any other human being, regardless of my weight. If I had every health problem my doctors think I should have at my size, I would still deserve that. If I had lost a leg to diabetes, I would still deserve that. I am a person, not a problem for people to solve, not a disease or a moral failing.
The AMA’s decision to further medicalise my body and refer to it as diseased—a body that I love, a body that is carrying me around with no health problems, is just another reason for me to fear the medical establishment that wants to hurt me and have me thank them for it.