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.