A bit of fat activism
Nov 20th, 2008 by heidi
A lengthy entry – this is the response I made to someone on my INFJ mailing list who was discussing weight issues. The bold lines are my original comments, the italicized are his, and then the lines in regular type are my response.
It’s a lost cause arguing this with most people but I guess I always hold out hope that someone will pay attention.
As a woman who’s been fat all of my adult life, I would venture to say that if your patient is a woman, especially if she is overweight/obese (I prefer the word “fat” – it doesn’t carry the same innate judgement!), she has almost certainly been on at least one diet in her life and probably many. I can honestly say that if I were to have a doctor tell me that I should lose weight, I could present (and have presented), approximately three pages worth of my diet history, which spanned fifteen years and just about every diet and weight loss
method under the sun. Thanks to being told to “watch what you eat, or you’ll get fat!” by my father and grandmother, when I was the venerable age of nine and THIN, I obsessed my way into compulsive overeating and yo-yo dieting. Funnily enough, my sister didn’t get those messages (perhaps because she was a pickier eater and therefore less healthy than I was at the same age), and she is not fat. Being told by a doctor that I should lose weight is as triggering to me (although of the opposite behavior) as it would be to tell an anorexic that she looks fat.
I appreciate that doctors worry about our health – that’s what you’re paid to do! I wish more doctors would be sensitive to the fact that telling people to lose weight does not help obesity. If it did, we would all be thin.
If I were a doctor in that situation, I think I would have to bite my tongue regarding weight loss and suggest gentle, non-painful exercises (without mentioning weight loss as a goal) that might RESULT in weight loss, but which would almost definitely result in increased stress-relieving endorphins as well as added fitness/strength that would help the back pain to improve. I would suggest starting small…maybe just walking to the front door and back every day…and build on that step by step until the person felt ready to walk up the driveway, up the block, whatever. Exercise, for me, is also extraordinarily triggering, because it is so closely associated with the feelings of shame, guilt, and self-loathing that accompanied every gym class where I was the clumsy kid that got picked last for every. single. sport. Even when I could run a mile in nine and a half minutes I thought I was fat and hideous – if only my PE teachers had praised the things I did well, the progress that I made, instead of constantly telling me that I wasn’t good enough, that I needed to try harder, perhaps I would still be able to run that mile in under 10 minutes.
Not automatically, but if you come to a doctor, you’re already considered to have an issue the doctor needs to address…
But is it necessarily one that relates in any way to my weight? All of my health issues are chronic ones that have existed since before I was overweight (or could not possibly have been caused by my weight, namely, autoimmune hypothyroidism). My bad ankle? Completely unresponsive to weight loss and absolutely unrelated to weight, although it’s the first thing any doctor suggests before I mention that at the worst it’s ever been, I had just lost 50 pounds! They STILL can’t figure out what’s wrong with it, even after an MRI and I’m scheduled to have another MRI in the next couple of months.
Being active is the single most important factor in good health, NOT weight. America’s obsession with weight loss is, in the end, driving more and more of us into disordered, unhealthy eating. If the country’s focus were on increased fitness instead, eating whole foods, and overall wellness, perhaps fewer of us would be fat…but even if we weren’t, we all would be healthier.
Personally, unless I bring it up as an issue, I prefer a doctor keep out of my business with regards to weight – most fat people know that the medical profession as a whole thinks they should lose weight…and most of us have tried (and had diets fail us) many, many times. If dieting were ever going to work for me, it would have on the first try.
While I would appreciate your concern for my health, as your patient, if my weight were brought up I would be struggling not to be shoved back into that cycle of self-loathing, depression, and binge-eating (and I probably wouldn’t come back to see you ever again). Even if every single health problem I have COULD be solved by weight loss, I have an eating disorder, but unfortunately not one of the ones that most doctors and laypeople recognize as a valid one. Compulsive overeating is the larger, less acceptable cousin of anorexia and bulemia…but we get seen as lazy. They are seen by the general public as having such incredible willpower, such control and power, even when the absolute opposite is true (for both of us). As I once read, nothing takes more willpower than that shown by a woman (or man!) who diets, loses, regains weight, forces herself to diet again, loses, regains weight, and even after the failing cycle is repeated time after time, continues to tell herself that this time she WILL do it, trying to put aside those past failures. THAT takes willpower and dedication.
Telling a patient to lose weight will almost certainly never work and may well exacerbate the weight issue in the long term. The doctors who get me coming back are the ones who encourage my overall fitness and emotional wellness and leave my weight alone, because making it an issue will almost certainly backfire in the end.
I stopped dieting six years ago and have stepped on a scale only once since then (because I needed an accurate weight for a dosage of medication). The notion of dieting is (thankfully) alien to me now – while I still have a long way to go in self-acceptance and positive self-esteem, at least I’m not trapped in the endless cycle of disgust and despair that I see so many women in my office (and in the world) buying into: dieting and deprivation that results in eating more of whatever it was that they denied themselves than if they’d just had a piece and moved on in the first place. I feel so sorry for the thin women in my office who hover over cake, cookies, or a single breadstick and say, “Oh, I really shouldn’t! Oh, that cake is so EVIL!” as if it were a bad thing to eat sweets/carbs/bad-guy food of the day. Women half my size complain, in my presence, about how FAT!!!! they are…and I think, “Gee, I’m twice your size and my body image is healthier than yours is! Which one of us really has the problem?!”
I don’t mean to attack you, T, and hope that it has not come across that way – I’m simply trying to point out the perspective of many of those of us who are fat (and the reason many of us don’t go to the doctor even when we know we need to go). You sound like a very caring doctor, and I’m sure your patients appreciate that. I’d just suggest looking into the notion of “Health At Every Size (HAES)” as a possible approach for those of us for whom the mention of weight loss is, frankly, dangerous both to our emotional and physical wellbeing (and probably for your other patients too, for whom the world is already weight-obsessed enough).
