It happened again –apathetic care from yet another physician who offered substandard healthcare to me – a fat person. This latest incident really cut me to the core.
Let me explain. When I saw the nurse practitioner at the heart failure center April, 2021, she suggested that, perhaps, the swelling in my legs was a result of lymphedema. My primary physician at that time referred me to a vein specialist who ordered a compression pump to help rid me of edema in the legs. Because diuretics trigger several health issues for me (agonizing muscle spasms, A-fib, gout), I was hopeful the compression pump would be exactly what I needed.
Unfortunately, after using the system only three times, I was hospitalized unable to breathe. The pump had pushed all the fluid from my legs into my lungs, and by time I arrived at the Emergency Department via ambulance, I had no air movement in my lungs.
I was admitted to the hospital for four days while strong diuretics were administered to remove the fluid from my lungs. An echocardiogram revealed a deterioration of my heart failure.
I was eager to see the cardiologist at the heart failure center to discuss what had happened with the compression pump.
Additionally, I wanted to stop taking a medication due to kidney damage and worrisome short-term memory problems. But mostly, I wanted to discuss the Barostim Neo, a relatively new heart failure device that has been energizing patients when other forms of therapy have failed.
I had been promised a co-appointment with both the nurse practitioner and the director of the center. The NP exhausted most of my appointment time with pointless, nit-picking questions which reduced the amount of time the director had for me. I have no doubt it was designed that way. When he finally entered the room, I was totally caught off guard for what happened next. He blamed me for everything.
“I’m not treating you for your heart failure because you’re intolerant to medications or unwilling to do what’s necessary,” he spat contemptuously. (I guess his reference to my unwillingness was my inability to tolerate high doses of diuretics so I self-regulated the higher dose as necessary for edema).
When I defended myself, stating I lived alone, got gout from diuretics and had to be able to walk and take care of myself, he snapped, “See, right there. You can’t do what I need you to do.”
It’s not an excuse. In fact, I got gout during my stay in the hospital while on 40 mgs per day of Torsemide. Then a regiment of Prednisone had to be prescribed because I could not put any pressure on my right, gout-infected knee. That’s exactly why I hoped the compression pump would help.
Excuse me but isn’t it the cardiologist’s job to assist my body, not blame my body? To try different medications to see what might work best for me? However, from the minute he walked in the room, he was blaming me instead of seeking a solution.
He did little to hide his disgust and anger. “Your heart will get weaker and weaker, and you will die,” he stated coldly. He insisted the new heart failure medication Verquvo and the Barostim device would be of no value to me. After stripping me of all hope, he walked out.
I learned later via participation in an online Barostim Webinar with an Atlantic physician that my cardiologist – the director of a heart failure clinic – was wrong when he told me I could not have both a defibulator and a Barostim.
The doctor running the Webinar suggested that I return to my carteologist and have another discussion because yes, I could have both devices, especially if the synchronized defibrillator was not handling my congestive heart failure.
It would seem that my cartiologist didn’t know what he was talking about, but he was adamant about putting me in my place and letting me know I wasn’t the important one in the room.
I figured it was useless to have another one-sided conversation with the doctor. My primary physician is making a referral to another heart failure carteologist as I write this.
More importantly, what kind of a person says that to a heart failure patient? Would he talk to a cancer patient in that manner? I’m not dead yet.
Ten days after the carteologist told me I was going to die anyway, a new defibrillator was implanted in my chest because it needed a generator.
Since this device procedure, my heart rate went from pacing in the 70s to erratic fluctuations with a daily heart rate in the 90s & into thé 100s. Moreover, the in-home remote monitor to regulate the device is on back order for three weeks. Curently, the heart failure clinic has no way to monitor what’s going on with my heart.
I have a suspicion the new defibrillator was not paced.
According to a 2015 review of studies, doctors spend 25% less time with patients in larger bodies and fail to refer patients for diagnostic testing or to consider alternatives for treatment.
As Cat Pause at Massey University in New Zeeland states in his article, “Die Another Day: The Obstacles Facing Fat People in Accessing Quality Healthcare,” “Doctors may deny life-saving, preventative care or diagnostic procedures (MRIs, for example) because they are blinded by their own weight bias.”
It’s well documented that faultfinding, especially responses of disgust, anger or blame from health professionals jeopardizes care and discourages many patients from seeking help or returning for appointments.
The media and society reinforce stereotypes that fat people are lazy, unmotivated, undisciplined, and incompetent (Puhl & Heurer, 2009; Tiggemann & Anesbury 2000).
Moreover, other studies have shown that physicians associate fatness with poor hygiene, noncompliance, hostility, and dishonesty. This, in turn, affects how they are treated by medical professionals, usually blaming them for poor health.
The attitudes of nurses are no better. In a one study by D. Maroney & S Golub (1992) nurses insisted that obese persons are unsuccessful (24%), overindulgent (43%), lazy (22%), and experience unresolved anger (33%).
With these attitudes, is it any wonder people with larger bodies receive poor health care?
Hopeless comments from the arrogant cardiologist mentioned above is only the latest in a long list of poor healthcare I’ve received over the years. Take these prior examples (sadly not a complete list):
• A surgeon broke off the drainage tub after performing gall bladder surgery when I was only 13 years old. This blunder required a second surgery to search for the wandering tube. He charged my mother for two surgeries while I missed 6 weeks of school.
• A primary physician told me my heart was “good, very good” (2008) as I suffered three heart attacks which resulted in severe heart damage, 6 cardioversions, 9 stents, eventual congestive heart failure and a greatly reduced life caused by inactivity and depression.
• A surgeon who missed a spinal fracture at L-3 on the MRI and subsequently performed a lumbar fusion from L1-L5. ( 2014). When I was unable to complete the rehab, another MRI revealed the screws and rods lying loose in my back. The initial hardware was removed and replaced with bigger screws and rods which required two major spine surgeries within 18 days all of which left me with crippling nerve-pain, dependent on a walker since the surgeries, and taking a huge toll on my heart.
• A cardiologist nicked my artery when implanting two stents, (2017) needing to implant yet a third stent to shore up the damage he had done. In the meantime I was lying on the surgical table feeling as if I were having a heart attack as he and his colleagues frantically searched through drawers for the right size stent because they weren’t prepared for this error.
• Ureter repair by a surgeon, inexperienced in using the new De Vinchi robot (2012). He dumped me on my head which left me with a hematoma the size of an acorn squash in my abdomen. I was labeled “adult failure to thrive” and kicked out of the hospital after 9 days. I was re-hospitalized three more times because I could not eat or drink.
• A general surgeon who insisted my CT Scan showed no bowel problem (2009) as I pleaded with him about my pain. He then pushed on my abdomen so hard, I screamed. His actions put a hole in my bowel which required bowel resection surgery, removing 16” of bowel.
• A general surgeon, who had a hissy fit over my insistence that I could not take the antibiotic he prescribed (2013). He stopped all antibiotics and I subsequently, developed infection which required that my stomach be re-opened to remove a liter of blood and infection. The wound was packed from the inside out for the next five months.
How can so many medical errors happen to one person? What I find is that medical people pay very little attention to fat people. They are MIA because they blame and judge the larger body and don’t give the larger person their best. In some cases they treat fat people out of resentment.
The Hippocratic Oath says: “to treat the ill to the best of one’s ability”. Where is that promise for the person with a larger body? I rarely encounter it. Look at the research.
They also treat the fat body as if you’re an elephant with tough skin that has to be pushed and prodded and poked with harshness. My skin and organs are as sensitive as those of the smaller person.
What do you do?
First, leave all healthcare professionals who offer inferior care. It is your life. It’s the only one you have.
Moreover, do not let any physician or healthcare professional define you. I felt blamed, that it was my fault that I couldn’t take certain medications. But it was his job to find a protocol that would work for me. Instead, I was silenced and left defenseless in the patient-physician encounter.
Deal With Your Emotions
Being treated disrespectfully by the medical profession is extremely stressful, especially when you are dealing with a life and death disease. Studies show that humans increase their food intake, particularly high fat and high sugar “comfort foods,” when exposed to stress.
If, like me, you obsess about situations where you are stigmatized and treated inferior, you can re-enact the scenario in the confines of your home or other safe place to release your feelings and offer a new ending to the storyline. It might save you from eating your feelings.
Dr. Howard Schubiner, Director of the MindBody Program in Southfield, MI, stated in a recent Swedish mindbody conference on YouTube that many people are doing emotional expression work because they are angry with their doctors. Schubiner facilitates an ISTDP (Intensive Short-Term Dynamic Psychotherapy) program to help patients release anger. I sought his services after I was ambushed and upset by the cardiologist. Anyone can learn to use it.
Recall the situation.
Get in touch with your feelings about it.
Express the emotions you did not allow yourself to express at the time it happened.
Pretend the person who upset you is in the room. Speak to him without restrictions. Say whatever you want. This person is not there to silence you like when you were in the throes of a one-sided power dynamic at the office. What would your anger or your impulse want to say or do? For example, I wanted to choke the cardiologist so I didn’t have to hear his hopeless words.
I allowed myself to imagine doing just that.
Next, I told him in no uncertain terms, “You fool. Congrestive heart failure is difficult enough without you stripping me of all hope. Who do you think you are? I came here for help. You don’t deserve this position?”
Finally, I fantasized reporting him and having him stripped of his position as director of the heart failure center.
When I had no more words, I pictured myself walking away with my head held high. “Good riddance,” I yelled, slapping my hands together to express a job well done.
I continued: “My anger is justified. I have no guilt about it. Now I choose to let the anger go. You are not worth holding a grudge against. You don’t get to take up space in my brain anymore. You no longer have the right to stop me from having hope for a better possibility. Good riddance!”
With each deep breath, I let the anger go.
When Sadness Arises
It’s common to feel sad over a situation where you must leave or have been deeply invested or disappointed, but remember that the sadness expresses the care and concern you hold for yourself.
When you’re fat, there are many times when you must be your own best friend, your own caretaker, your own parent or protector.
For example, a study published in the Advances in Nursing Science 2004, points out that large people are reminded daily by family, friends, peers, healthcare providers, educators, employers and even strangers that they are inferior to those who are smaller. This denigration, condemnation, stigmatization and discrimination is so pervasive, it has been referred to as “civilized oppression.” It is like racism. (Harvey J. Civilized Oppression. Lanham, Md: Bow man & Littlefield; 1999).
Think for a moment how much internal rage that would trigger within a person who has had to live a life of inferior treatment when they knew it was untrue. Is it any wonder fat people feel “braced” for life all day every day?
After doing the emotional therapy work, spend time breathing in compassion and love for yourself
Maybe not today but at some point you might want to give your perpetrator a break, to let them off the hook for their ignorance and insensitivity.
Dr. Fred Luskin, Director of the Stanford Forgiveness Project and author of several books on forgiveness explains that the definition for forgiveness is: (1) giving up all hope for a better past; or (2) making peace with the word no. In other words, one must grieve that they didn’t get what they wanted and then find a way to accept that and move forward. When you become ready to do that, you will feel better.
A big treat for our family of four was fresh-baked doughnuts from the bakery on Sunday morning.
When I was 4 years old, I woke up early one Sunday morning, found the bag of jelly-filled doughnuts (called Bismarks) and ate one as I rode my tricycle up and down the sidewalk in front of our house while the family slept.
Because it tasted delicious, I consumed a second one as I rode my tricycle outside. By time the rest of the family woke up, I had devoured 5 of the 6 bismarks intended for the family’s breakfast.
As I’ve mentioned before, I had been taken to the University of Michigan Hospital in Ann Arbor twice by time I was 16-months old because my mother said I would eat forever if she had let me. I don’t know the precise reason for my voracious appetite, but I already weighed 42 pounds (twice the size of a child that age).
The physicians assessed that there was nothing wrong with me. “Take your baby home and love her,” the doctors instructed. I don’t know who decided, but I was put on a diet at 16 months of age. I think I was perpetually starved from that day forward. Maybe before.
This much I know. If a toddler is taught to tune in to his or her body (intuitive eating), that child could never consume that many doughnuts and not feel full. A child who is nutritionally fed and securely loved could not eat that much without getting physically sick unless there was a serious physiological malfunction or humongous psychological disparity.
I also suspect that my parent could not have been heedful of responsive feeding – verbal and nonverbal hunger and fullness cues that a caregiver notices when feeding their babies so that they respond accordingly.
Instead, it became a moral issue where I was pummeled with shame, guilt and anger. What I heard was, “You’re a selfish pig. Shame on you.” At an early age, I learned that it was wrong to be fat and wrong to be hungry.
Now I know that my fat body was not my fault. If you grew up fat, it wasn’t your fault either. As psychologist Dr. Dan Ratner states in a YouTube video Generational Trauma, (https://youtu.be/se9auyz3MeM ), “The parent is responsible for the child 100 percent. The kid is influenced by the parent, not the other way around.” He further explains that parenting is hard, that they make mistakes, but that doesn’t let them off the hook for those mistakes.
If you grew up fat, stop blaming yourself. You do not need to walk around feeling ashamed of yourself or the size of your body. Accept it and focus on the person you want to be now.
People today think intuitive eating started with two registered dietitians, Evelyn Tribole and Elyse Resch, in 1995, who wrote a book, Intuitive Eating: A Revolutionary Anti-Diet Approach based on their experience working with clients. But I was exploring this concept via Gestalt Therapy in the 1970s.
Fritz Perls, the founder of ‘Gestalt therapy’ encouraged his patients to understand their lives by the way they eat. He believed that if you paid attention to how you relate with food, you would learn how you live your life.
I took a Gestalt workshop in the 1970s based on this concept. We were to be curious about our food and how we ate. Did we eat fast without smelling, tasting or enjoying it? Did we avoid food like we might avoid confrontation or other uncomfortable feelings? Were we constantly focused on what we would eat next rather than what was in our mouth at the moment? What was the texture? Did we like the food or were we using it to distract ourselves?
Be curious was the theme.
I specifically remember how I got in touch with my anger while eating a hard, crisp, Delicious apple. It triggered some anger issues that were occurring at that time; I wanted to bite someone’s head off.
At another time I got in touch with strong resistance to the suggestion that I pay attention to my food without any distractions. I liked to watch TV while I ate. What was this resistance?
Noticing that I wanted to ignore my food brought up the painful feelings of being treated “second best” in my family. I ignored food the way I had felt ignored. Indeed, intuitive eating showed me how I related to myself, my body, and life.
Furthermore, I started the first Overeaters Anonymous group in Grand Rapids, Michigan in the late 60s. Their “dieting methods” at that time were dreadful, based on denial and deprivation. You could eat nothing white, such as, white sugar, white flour, white rice, white potatoes, etc. When I fell off the restrictive OA wagon, I went on a huge binge and gained back all my lost weight plus more within 6 months. Sound familiar? I had been starving an already starved person and my body needed more nutrition.
It was after that OA debacle that I decided to use the Gestalt method. I allowed myself to eat whatever I wanted. I felt so utterly deprived after denying most foods, I ate four big bags of M & M Peanuts over the course of a few days until I got sick on the candy. As I listened to my body, I slowly started to eat in moderation and chose nutritious foods. I also started to lose the weight I had gained after being on a restrictive diet.
The basic idea is to tune in to your body and listen to your hunger cues. You might go on a few binges before you learn what your body needs, but trust that your body knows what’s best for it. In doing so, you will learn to:
Reject a diet mentality that is unhealthy and sets you up for failure.
Feel your feelings without abusing food.
Honor your feelings of hunger and know when you are full.
And enjoy a doughnut or two on your intuitive eating journey.
“People who hate fat people see body love as a move toward people taking charge of their lives and choosing what they want to do, no matter what the culture says. This is really scary to a lot of people. The anger they express is actually toward themselves.”
Things No One Will Tell Fat Girls: A Handbook for Unapologetic Living ― Jes Baker
I know exactly what writer and fat activist, Jes Baker, means in the above quote. I had a medical appointment at the Heart Failure Center last week. It went the way of most medical appointments – me arriving home feeling worse about myself because I was not taken seriously. Healthcare for fat people is frequently far removed from a healing experi6ence.
Because I was fat-shamed at my previous appointment, I had sent the Nurse Practitioner (NP) an article I had written entitled, “Fat Shaming in the Medical Profession.” Instead of her/them being open and receptive to this critical problem, I felt full backlash at my appointment last week.
In general, the anti-fat medical profession does not accept fat empowerment. They see excess weight as a health hazard, a killer disease, a moral failure, and self-indulgent. They persevere in the belief that the only path to wellness is through weight loss. They wear hearing aids without batteries when you try to explain your situation.
The NP never acknowledged that she got my article or read it. Instead, she was cold, defensive, and rejected most of what I said. Nothing can be changed that isn’t recognized, but egos frequently run rampant at the doctor’s office.
As usual, I was treated differently than a thin patient. Let me explain. I’ve gained a considerable amount of weight this past year due to Covid-19 shutdown and severe leg and muscle pain (perhaps Complex Region Pain Syndrome which is called the “suicide disease”). It’s torture to move so I’ve been physically moving my body much less this past year.
Interestingly, weight gain during the pandemic was not unusual. There is currently a “quarantine 15” meme circulating because many slim people added as much as 15 extra pounds during a topsy-turvy year that triggered undue anxiety, stress, revised eating, increased screen time, and less physical activity for most. Financial hardship and the unavailability of fresh produce and nutrient-rich foods limited most people’s healthy choices. A little more food and a little less movement equaled more poundage.
Of course, the media and weight loss companies are capitalizing on this increased body weight by making people feel guilty after one of the most stressful times in their lives. The diet culture message is loud and clear: It’s shameful to have anything but a thin body, which translates into feelings of inferiority and unworthiness for many people, especially larger ones who cannot lose weight and keep it off.
My point is this. If thin people gained weight during this traumatic year, then why isn’t that the same reason fat people gained weight? In the medical field, the right diagnosis is the whole it enchilada. She was resistant to almost everything I said; she was not about to allow me to feel like a powerful fat person. Or, heaven forbid, an equal.
However, the NP at the Heart Failure Center gave no indication that she was aware of anyone gaining weight in 2020 and actually rolled her eyes once when I was trying to explain my lifestyle and the possible reason for weight gain.
Due to a plethora of fat-shaming in the medical arena, larger people are never sure if they can trust that a medical opinion is unbiased. I came away from that appointment feeling as confused as rain during sunshine and as angry as a wild boar searching for food. The goal of healthcare should be to help people, not to make them feel degraded and undignified.
For The Record
Fat bias is the mistreatment of persons based on their size and appearance. It is more prevalent than racial discrimination and elicits similar stress. It manifests through bullying (teasing), isolation (exclusion from society), discrimination (harmful or unfair treatment), and disrespect.
Fatphobia is the pathological fear and dislike of higher-weight people. A medical provider who never touches a fat patient is likely fat phobic. The last I checked, fatness was not contagious.
Anti-fat bias is widespread in both society and medicine and well documented, explains Angela Alberga, an assistant professor at Concordia University in Canada. “You actually experience a form of stress,” she explains. “As cortisol spikes, self-control drops, and the risk of binge-eating increases.”
Fat shaming is also linked to despondency, anxiety, deflated self-esteem, eating disorders, and avoiding exercise, points out Alberga. The intensity of harm increases when people internalize weight bias and turn the hatred upon themselves.
When I got home from the medical appointment, I wanted to eat everything in sight. Instead, I got on a Facebook page called Living While Fat, vented my frustration, and received emotional support which saved me from vicariously biting off the NP’s head using food.
Down With Diets
A plethora of research confirms that 95% – 98% of diets fail and dieters regain the weight − often more − within 2 to 5 years. In fact, cycling or ‘yo-yo’ dieting is linked to an increased risk of heart problems, which is more damaging to health than maintaining a stable, higher weight.
How many times have you gone on a diet and anticipated getting to your goal weight once and for all? Both dieters and healthcare providers hold unrealistic expectations for weight loss. In one study, subjects anticipated losing 20–40% of their body weight – amounts that are achieved only through bariatric surgery.
Likewise, primary care physicians hold an inflated view of patients, expecting them to lose 21% of their initial body weight. In reality, the best outcomes are 5–10% of a dieter’s average weight. So a 300-pound person might only lose 15 to 30 pounds on a diet. And unfortunately, gain it back plus more because calorie reduction and loss of muscle mass lowers the metabolism and changes the setpoint once a dieter returns to a natural eating pattern.
All of which begs to ask this question: If weight loss has a 95% to 98% failure rate, is it ethical to prescribe dieting? Would you take a drug or engage in another type of therapy or treatment that promised such a low success rate?
Weight Stigma From Medical Professionals
Sadly, studies reveal that at least three in five fat people tolerate weight-related discrimination from healthcare professionals. Women cite doctors as the most widespread source of this stigma, second only to family members. It is not just doctors though. Nurses, medical assistants, dietitians, psychologists, and even obesity specialists embrace these anti-fat sentiments.
The minute you walk into a doctor’s office, you are probably fighting fat prejudice. The research concludes that 97% of physicians and medical students rate fat people as stupid, 90% view them as unsuccessful or weak, and 86% judge them as lazy, followed by weak-willed, awkward, and ugly. Doctors have complained that heavy patients are noncompliant, waste their time, and make their work less enjoyable.
In a study by by size.
In like manner, I saw a neurosurgeon who had lost 35 pounds after gastric band surgery. He told me that I should “run down the street” to get weight-loss surgery, and then return for back treatment. He pointed to my petite sister, asking: “Wouldn’t you like to look like her?” Then he threatened, “Do you want diabetes because you’re going to get it.” That was 2007. I do not have diabetes, but I saw him in 2014, and he had regained his weight.
This is what we’re up against, folks.
What To Do?
During the Renaissance period, fatness was admired, indicating wealth and power. Prosperous families could afford food while the poor could not. Now it’s the reverse. The poor can only afford unhealthy, junk food, causing weight gain while the wealthy are able to buy organic, healthier foods. If we lived in a different time, we would not be battling this stigma.
Long story short, do not give up educating the medical profession about fatphobia even when they might retaliate. Stay on the message that large people should be treated no differently than thin people. The health treatment offered to a thin person should be the same treatment given to you.
Here are some tips for dealing with the ramifications of fat shaming:
Be grateful for what your body has done for you and focus on issues of greater substance and compassion. Stop accepting other people’s negative attitudes toward you because you’re fat.
Praise yourself for making it through a difficult time, such as the pandemic or medical prejudice. You are enough as you are. And you are so much more than your body image.
Unless your current medical problem is related to weight, refuse to be weighed at the doctor’s office. If medical professionals don’t focus on the weight of thin people, neither should they make that the core issue for a fat person. If they accuse you of noncompliance, explain that getting weighed can trigger an eating or mood disorder. If they insist, stand backward on the scale and tell them you do not want to know the weight.
Arm yourself with knowledge and confront medical professionals who try to prescribe methods that you know will not work permanently, such as a ridiculously low-calorie diet that is nothing short of starvation. For example, a two-year-old needs 1200 calories a day. You know your body. The medical profession does not have a corner on how your body responds. Hum Frank Sinatra’s song, “I’ll do it my way.” Then do it your way.
When others make jokes about weight, either counter the comments or walk away. It says nothing about you. It means the person uttering it suffers from fatphobia. They obviously pair fat with ugly, but if you have lived it, you know better. Do not internalize it. Fat is merely a description. How could it possibly define the worth of a human being? Refusing to engage in “fat talk” is one way to start teaching others, especially healthcare professionals, that it is never acceptable to body shame anyone.
No one else is responsible for how long you live. Stop allowing others to pretend they care more about your life than their own. Do the best you can do. As Lindy West writes in her book, Shrill: Notes from a Loud Woman, “I hate the way that complete strangers waste my life out of supposed concern for my death. I hate knowing that if I did die of a condition that correlates with weight, a certain subset of people would feel their prejudices validated, and some would outright celebrate.”
Large people know they are fat. They don’t need others pointing it out. Fat stigma can be brutal, but don’t let that stop you from pursuing your aspirations. You have a right to give your gifts to the world. Show the haters exactly what they underestimated. Do something wonderful with the space you take up. In short, unconditionally love yourself as you give fat-shamers the middle finger.