I Don't Feel Cared For: Combatting Fatphobia in the Medical Institution
Navigating the healthcare system as a fat person means constantly being shamed and gaslit by medical professionals, while having to constantly advocate for your actual health concerns. Emily Win shares her story and gives tips you can use to combat fatphobia in create your own definition of health and wellness.
The white pantry door was the place where we kept graduation announcements, family baby pictures, pencil marks indicating how tall my siblings and I were growing. It was the centerpiece to the kitchen, the place everyone wanted to be because it contained all the ingredients needed for family: love and food. Up until I was 12, I loved walking into that pantry to find what fun snack my mom bought next, or what fun dessert we could bake that night. I loved food and most people could tell.
I was used to shoving off a nickname or two about being a "bigger girl." My middle school softball nickname was French Fry, and I wore it with pride. If I couldn't control what other people called me, I could at least control how I carried myself after the fact. Up until high school, I was only concerned with the world I was creating in my head. This fantasy world instantly crumbled on one particular day when the pediatrician told me I was at high risk for diabetes. "She needs to lose weight" was all I heard, the dissatisfied tone of the doctor ringing in my ears while I sat through the longest five minute car ride I had ever endured. Getting out of the car, I braced myself for what was waiting for me in the kitchen.
I tried to zone out the rising tones between my parents. They weren't yelling, but the seriousness in their voice cut through the silence of the house. "Emily Rose Win, don't go up into your room." I knew it was serious because my mom used my middle name.
"Come over here," my mother continued sternly, "no more junk food."
She and my dad briefly talked about all of the things I couldn't eat, homework assigned by my pediatrician that day. Staring at the pantry door with my parents looking down on me, I knew the contents behind it would soon be inaccessible to me.
This moment flipped a switch in our household. Suddenly, every move I made was judged. I couldn't eat a meal without being examined. I couldn't leave the house without being examined–I couldn't look fat. I was discouraged from having friends "on the bigger side." Soon I was taken out of music classes and put into sports I certainly didn't know how to play. Every glance in the mirror became an opportunity to beat everyone else to the punch.
In my early 20s I was diagnosed with PCOS (Polycystic Ovarian Syndrome), which essentially means I have cysts hanging out in my ovaries that prevent me from having a regular period. According to the CDC, people with PCOS are often insulin resistant and also produce higher levels of androgens, which can stop eggs from being released. As many as 5 million people with periods in the US have this and the only solution medical providers offer us is to lose weight.
The funny thing about PCOS is that it actually prevents you from effectively losing weight.
People with PCOS build up an insulin resistance, which makes it difficult for cells to convert sugar into energy. Because of this, the sugar gets stored as fat, which explains why the prevalence of overweight and obesity in women with PCOS is as high as 80%.
Primary care physicians started referring me to gynecologists, who did the usual interventions like ultrasounds and biopsies, but could never find a reason as to why I was fat. After telling me to workout for at least two hours a day, they referred me to endocrinologists, who also ran tests and found no answer. These specialists then referred me back to my primary care physician and the cycle began again. This is when I adopted a newly learned behavior. I started going into each doctor's consultation with my script ready: "Oh, I actually exercise five times a week and I don't eat carbs." After a brief staring competition between me and the person so completely concerned with my weight, they usually repeat some line about how I should watch my "health." Navigating the weight of fatness in medical institutions always seems to lead to doctors trying to cure my size, as if that is always the underlying and most pressing issue.
My first understanding of fat was shame as a child. My second understanding of fat came from a reclamation movement I quickly adopted from the podcast Maintenance Phase, where I learned about why the BMI is trash or why The Obesity Epidemic is a literal scam. In my current healthcare journey, I find myself questioning how fat folks can safely move forward and also how clinicians and practitioners can eliminate fatphobia from their work and diagnoses.
FOLX clinician and nurse practitioner Lauren Brannon knows this experience all too well. As a self-identifying fat medical professional, she's witnessed the harm from both sides of the rolling chair. In speaking about fatphobia in the medical establishment, she expresses concern and doubt about weight loss as a blanket fix for fat people's medical concerns.
"It's not something I generally prescribe or recommend. If someone can show me a study that shows that intentional weight loss is achievable, then we can talk about what the health benefits might be. Significant weight loss is just simply not achievable for most people over the long term, and weight cycling can cause harm to mental and physical health. And so why are we prescribing it so indiscriminately?"
Brannon also compares a weight loss "prescription" to any other sort of pill or liquid: "Do we prescribe any medicine that works less than 5 percent of the time?" Of course we don't; no one would want to take those chances. So why do providers continue to push this?”
Weight loss and wellness culture believes that we can choose the way our bodies look. Brannon notes that around 75% of our body fat is genetic, saying, "There's this idea that we can just ‘personal-choice’ our way out of our body size [...] It's just not about our personal choices. It's about the environment we live in and the genetics that we have." Instead of obsessing over a person’s size, Brannon feels it’s much more beneficial to focus on healthy behaviors like joyful movement and eating foods that promote wellness. Ultimately, your body belongs to you, and your provider should treat you with dignity and collaborate with you. Shame and fear at the doctor’s office have no place in wellness.
It's rare to come across a provider who understands the complexities and nuances of accompanying fat people in their healthcare journeys. I've known too many friends and family members who put off going to seek medical attention out of fear they will be shamed for their weight, which can be a real issue in terms of health disparities.
We simply aren't getting the care we need because "there's an expectation that you owe somebody the vision of health that they have rather than the vision of health you have."
This gap in care would be closed if all fat people could have a provider like Brannon, who understands "that mental health is as important as physical health" and true (health)care is "a direct form of activism."
Unfortunately, weight stigma runs deep within the medical establishment. What I've experienced in doctor's offices, even as a small-fat person, is only a fraction of the battles fat people of all sizes face when simply dealing with friends, families, coworkers, and random harassers. Showing up to a medical space, whether for a check-up, a broken bone, or sleep issues, I feel a sense of helplessness around how I'm treated, knowing that my weight will always be a part of the conversion, if not the cause for any particular medical issue. However, I know that I'm not alone in this feeling, so here are some steps we can take to better navigate fatphobic institutions.
- Set boundaries. You can refuse to be weighed any time you are the patient. You have a right to say no. When Brannon goes into a doctor's office, she declines a weight check and declines discussion of intentional weight loss so that there is enough time and space to discuss her actual concerns. Even though you may be "labeled as noncompliant," you absolutely deserve to have control over the care you receive.
- Consume good media. If you "fill up all your social media with fat positive people," you can create "a safe place, especially when you don't feel cared for or listened to." Additionally, you can set up boundaries around the TV and films you choose to watch. For example, you can cut out shows about dieting, weight loss camps, or detox cleanses.
- Celebrate your body through "joyful movement." Instead of focusing on exercise programs or activities "tied to weight loss," focus on "building confidence about what your body can do." By using the phrase "joyful movement," it invites you to find something that makes you feel happy and healthy, instead of struggling "to do this really extreme exercise to make your body a different size."
As much as I'd like to say that I can move forward into more medical spaces and feel a sense of confidence in boundary setting, I know that isn't the reality. I will still need to show up and defend myself. I will still need to spend hours every week practicing self-acceptance. I will still need to convince myself that I am not at fault and fatness should be celebrated. I combat fatphobia by claiming my body as nurturing, assuring myself that I am its most trustful provider of care.