Fat Folx: You Are Not Responsible for the Re-education of Health Trolls

Last month I wrote a couple of blog entries about my experience living in a larger body, specifically about dealing with my somewhat clueless doctor and a ridiculously out-of-line massage therapist. These experiences resonated with many of my readers and I received quite a bit of appreciation from people who have experienced or witnessed fat bias and health trolling. Among such wonderful feedback, I also received this public comment from a somewhat estranged family-friend that was rather troubling. 

I love you and we are miles apart on this topic. I agree with much of what you say regarding the bias, but my training in Exercise Physiology (and my own history with weight gain and loss) is not on the same page with much of what you say on the physiology side of things. This topic and your history are complex, but I think we should chat sometime, so I can better understand your perspective and also offer you another viewpoint. 

I could hear the swish and flap of red flags waving as he breathed these words of concerned curiosity on my Facebook post. His commentary smacked of self-importance and the politely repressed anticipation of proving me wrong in the name of Science and the spirit of Dialogue. 

I was almost tricked into thinking this person actually cared about what I had to say and was interested in dialoguing further because while we may not see eye to eye, his response ended with an invitation to discuss these differences further. But if he was truly interested in understanding my perspective, wouldn't he have privately messaged me instead of very publicly performed his dubiousness surrounding my thoughts on being fat? Why perform this public display of dissent among so many affirming comments and shared stories?

As I composed my message to him, I realized that I had absolutely no interest in discussing any of this further with him nor to educate him about fat bias, mental health, and Health At Every Size. If my assessment of his personality and this situation was correct, he just wanted to tell me that I'm wrong and he's right and prove to me that he knows better than me. Here is how I responded:

I appreciate your offer and hope it will hold until I have the emotional energy to have that conversation. To be completely honest, I am just not in a place to fairly listen to the other side right now. Also, I feel like I've had the other side crammed down my throat for my entire life. However, if you can offer any readings you find helpful, I'd probably better be able to digest those. If you're truly interested in the viewpoints I mentioned, I'd recommend reading Anti-Diet and looking up the Minnesota Starvation study, as well as the 4th edition of Intuitive Eating. I also have an academic paper that has been recommended for sharing with health professionals. 

I figured if he was dedicated to showing me his truth, he could point me in the direction of the readings he found the most informative and maybe I would take a look. I doubted very much that he was as interested in understanding the work my perspective is rooted in; nonetheless, I offered him titles of the texts I've found most influential in my 2021 quest to deprogram myself from body shame and Diet Culture.

I sidestepped his passive-aggressive demand that I defend my experiences and I called his bluff on wanting to understand my viewpoint. I've been doing the work; if he wants to dive deeper into the beliefs, history, science, and studies of weight, diet, and exercise, then he is going to have to do his own work. So when he responded that he does not have any specific readings or research to recommend and that he does not have the desire to read anything, I was not surprised. A little disappointed, but not surprised.

It's so easy to fall into the trap of defending our experiences as people living in larger bodies in a world that is designed for those living in average bodies. 

But how can we begin to explain the isolation we feel when we have to wedge our substantial hips and bottoms between the constricting arms of waiting room chairs, wait as nurses search for the bigger blood pressure cuff that will actually fit around our biceps, and wince when we see the markings in our charts labeling us as "morbidly obese"? 

And how can we convey the frustration and anger we feel when we are constantly told that everything that ails us would be cured if we were not fat: that our pain, injuries, and illness are our own fault; that character flaws like weakness and lack of willpower are the reason we are fat.

We are constantly told that, if we just tried harder, we could fix all of our problems by shrinking ourselves. 

But we are people, not problems to be fixed. 

We are not broken, our healthcare system is.

We don't need to be fixed, the healthcare system does.

We don't need to be fixed, our society does.

Let's Get [A] Physical: Anti-fat Bias & Medical Professionals

on my way to the doc

I'm not the first person living in a larger body to leave my doctor's office feeling anxious and icky. Doctors are well known for their lack of understanding and empathy when it comes to matters of size. Diet Culture is so pervasive, so insidious, no one is immune to anti-fat bias -- even health professionals, no matter how good their intentions might be. 

I chose my doctor, nurse practitioner, and office staff because they are women of color working in a racially and socioeconomically diverse community. She was also cited by Noom (more on Noom another time, suffice to say I no longer support or recommend Noom to anyone because 1. They are a diet, no matter what they say and 2. My views on size and shrinking the self have changed drastically since then) -- which I was using at the time of my GP search -- as a fat-friendly doctor (not Noom's term, whatever they said I can no longer remember). This means that the office provides chairs that my ass can fit into and has large blood pressure cuffs in each exam room, things that make people living in larger bodies feel like normal people. 

At first, she and her NP were pretty decent about not overtly harassing me about my weight; however, as I have gained weight the past few years, there have been more suggestions about food restriction, exercise, and so on, including last week when I had my annual physical.

The past two times I have gone to my GP, both times for my annual physical, I have opted out of the weigh-in portion of my visit. Did you even know that was an option? I didn't until my 2020-2021 quest to deprogram myself from Diet Culture. I was so tired of overtly and covertly being told that there was something inherently wrong with me, something broken that needed fixing, because I am living in a bigger body. I learned that BMI is sham science and to question causation versus correlation when weight is blamed for health issues. Okay, so keep in mind that my doctor has no idea what I've weighed the past two years. She has no data, other than last year's bloodwork, upon which to base her conversation with me. And yet, she brought up food choices and intake -- not because of my health, mind you -- but because of my appearance. 

As she talked at me about lean meats and portion sizes, avoiding "junk" foods, and not buying these things so they're not in my house, I gritted my teeth. Has it ever crossed a doctor's mind that people are not necessarily fat because they eat like pigs at a trough (dehumanizing) or keep fun foods in their homes (weight is not about self-control)? I am overweight because of genetics, a history of food restriction since early childhood that messed up my metabolism and the always-accompanying disordered eating that comes along with that, poverty in my youth and access to food, trauma and the resulting influx of cortisol and other hormones, as well as several injuries/surgeries and chronic illness that have made it extremely difficult to engage in physical activity.

I am fat. I don't need to be fixed. I am still an awesome human worthy of love and respect.

So, I took a deep breath and defended myself: I'm a vegetarian (it's been twenty years); I am deprogramming myself from Diet Culture and disordered eating, I do not restrict my food and as a result I am not eating entire packages of cookies when I'm sad or stressed; yes, I have fun foods in my house because I like them, I eat them, and I have children who like and eat them; I will not restrict my eating ever again, I spent years doing that and it's done more harm than good, like disrupting my hunger signals; I am following the Intuitive Eating model and, yes, have met with a dietitian and am currently working through the IE workbook; I am newly diagnosed with RA and we're still figuring out my treatment, so I'm dealing with painful flares and swelling that make it impossible for me to engage in movement and activity with regularity -- especially because I have a history of pushing myself too hard and rendering myself unable to do anything for days after.

I now remember having a similar discussion with her last year after she suggested "weight loss" surgery, not stomach amputation but the gastric sleeve which is maybe a little better but also NO. I explained to her then that my issue was in my head, not in my stomach. That I was working with a therapist to deal with childhood trauma, unhealthy relationship paradigms, and the sudden loss of my mother. Why was I having to revisit all of this, and then some, again now at this visit?

No one should have to defend themselves and their actions to their doctor to prove themselves free of fault when it comes to their appearance and deserving of care when it comes to their health.

I left my physical feeling exhausted. It's exhausting to feel attacked. It's exhausting to feel the need to defend myself. It's exhausting to explain the effects of trauma, food restriction, and chronic illness to a person who has Thin Privilege and doesn't know what it's like to deal with chronic pain and mobility issues.

I think it may be time to find a new doctor. Again.