The first time I coughed up blood, I shook it off.
June 27, 2015 3:47 PM   Subscribe

Medical Fat Shaming Could Have Killed Me Sex educator Rebecca Hiles (Frisky Fairy) details the years of being told to lose weight to deal with her persistent cough before doctors finally diagnosed her with lung cancer. Part I of her cancer story.
posted by emjaybee (184 comments total) 46 users marked this as a favorite
 
A friend of mine shared this and it made me so angry...telling someone who has been exhausted and coughing up blood that it's due to weight is ridiculous.
posted by xingcat at 3:53 PM on June 27, 2015 [5 favorites]


Wow! I can't imagine going through that...especially at 23 years old!
Thank you for sharing!
posted by Andrew Thewes at 4:05 PM on June 27, 2015


This makes me so angry. I have been misdiagnosed (or more appropriately, not diagnosed at all) due to my weight before, but not on something this critical.
posted by rednikki at 4:18 PM on June 27, 2015 [1 favorite]


I have this kind of rage about no one diagnosing or treating my sleep apnea because they kept treating my tiredness like it was just a part of my depression, as opposed to the other way around, and I had to do an enormous amount of self-advocating while so exhausted I wanted to die just to get the treatment I needed for that. The burden the medical establishment puts on those who are already overburdened with the stresses that just dealing with illness puts on time, emotional and physical energy is sick and cruel. I've only ever had to deal with a fraction of the fat-shaming that Hiles had to put up with, and even that pissed me the hell off. I'm glad that she, and others, are writing about this, because it's just one of the hundreds of axes where the medical establishment exacerbates existing marginalizations and fails to provide the care that should be a basic right, not only something that's freely accessible without going into debt but something that shouldn't have the mental health costs that come with doctors treating you like shit because of your size/gender/race/etc.
posted by NoraReed at 4:32 PM on June 27, 2015 [58 favorites]


I have a ton of sympathy for her. I do. Nobody deserves to get cancer. Fuck cancer.

However, obesity causes a great number of health problems, and when you present to a doctor as an obese patient with breathing problems, it is understandable for them to suggest you lose weight: after all, it's far more likely for an obese patient to have problems related to their obesity than it is for a 22 year old to present with lung cancer.

If she had been given (or, more likely, followed) the advice to lose weight via diet rather than (or in addition to) exercise, and then still presented with the problem, the doctors would've begun narrowing down the potential causes sooner.
posted by sonic meat machine at 4:48 PM on June 27, 2015 [43 favorites]


She WAS still presenting with the problem. She was walking nearly two miles a day and actively working to lose weight until she couldn't breathe and was continuing to cough up blood.
posted by angeline at 4:55 PM on June 27, 2015 [85 favorites]


Failing to do proper medical tests and listening to patients' reports about their own symptoms simply because you believe all their problems are simply because they're overweight is medical fat shaming.
posted by lilac girl at 4:55 PM on June 27, 2015 [110 favorites]


Nobody deserves to get cancer. Fuck cancer.

However,


Uh-huh.
posted by E. Whitehall at 4:56 PM on June 27, 2015 [186 favorites]


That story is terrifying. No one should have to go through a series of misdiagnoses and accusations for years before finally discovering the true cause of their illness. I can understand that being misdiagnosed repeatedly and being told to do some standard but inapplicable thing is infuriating. I've been misdiagnosed twice for two different conditions, and only got real help through much complaining and a lot of research (gee turns out your ACL is fully split in half after all! sorry we gave you shit for complaining).

I do have trouble, given her story, seeing that her weight was the sole or even main cause of the misdiagnosis. She even says:
"During this time, I began seeing a new doctor. She did her damndest to help me, and requested a preference that I lose weight, but was never pushy or demanding about it. ".
This doctor even gave her a CT scan, nothing showed up at that time (or the doc misread it). It was only years later that something showed up on a CT scan.

I've had to recognize that a lot of the limitations I've encountered in my own medical history were due in some cases to simply being an outlier. I was negative for a lot of the signs of an ACL tear. Maybe an MRI wasn't cost-justified statistically. The fact is that differential diagnoses are not aiming at perfect, they aim at probably right.

All that being said, medical science is wrong staggeringly often, and doctors often have a lot of hubris despite that. I've been to doctors that over-treat which is also a real problem (Do you want antibiotics for that virus? Please don't complain to my boss!). That's why I've learned to do a lot of my own research. It's helped me multiple times (especially in PT). I can't pretend that would have helped here if all her scans came back negative, but medicine is an imperfect thing.

I feel really bad for this woman's experience. But I find it hard to attribute this solely or mainly to discrimination given what she's put out there on her blog post. It sounds like any complex problem that was probably handled incorrectly due to either incompetence or a lack of data at the time (maybe it was too small to be seen on a CT?).
posted by sp160n at 4:56 PM on June 27, 2015 [23 favorites]


It's not fat shaming to suggest someone lose weight.

It's fat shaming to suggest that all of her health problems were related to her weight, and not the fucking cancer that destroyed her lung.

As someone who has gained weight because of medication prescribed to deal with serious chronic health issues, a lot of her story rang true. When I went in to my doctor last, the first thing she said was, "Wow, you've gained a lot of weight since I've seen you last. You should really be exercising more and eating less."

Or you, know, it's because my thyroid decided to completely stop working.

But the reductive view that weight is the biggest problem is insensitive at best, and extremely harmful at worst.
posted by guster4lovers at 4:57 PM on June 27, 2015 [63 favorites]


I would guess that greatly complicating her diagnosis was that she mentioned she didn't have health care for awhile. Without a single, consistent PCP the doctors aren't going to recognize the progression. Just another way a lack of healthcare kills the poor.
posted by sbutler at 4:57 PM on June 27, 2015 [28 favorites]


Uh-huh.

Thanks for your considered and erudite rebuttal.

Look: obesity is a health problem, and causes others. Identity politics may be ascendant on the left right now, but medical professionals viewing a health problem that can cause breathing issues as something that should be addressed when a young person presents with breathing issues is common sense.

The advice to exercise might have been insufficient, as well. Exercise is not enough to lose significant weight. Walking two miles per day would burn roughly 340 calories (ballpark guess; I don't know her weight, so I estimated 300 pounds). That's less than you get from drinking a bottle and a half of Mountain Dew or a single Hostess honey bun. It is likely she was recommended calorie reduction as well, but did not follow through.

The sorry state of health care, so that she couldn't get a consistent primary care physician, is a much larger issue than the fact that doctors recommended that she address one of her most obvious health problems.
posted by sonic meat machine at 5:07 PM on June 27, 2015 [29 favorites]


when you present to a doctor as an obese patient with breathing problems, it is understandable for them to suggest you lose weight

Right, right. Every obese patient should just lose weight before they get treated for anything else, because probably it's just due to their fatness. As we know, losing weight is easy to do and anyone can do it very quickly, much faster than other problems can progress. This is a clearly successful way to treat fat people who are sick.
posted by jeather at 5:08 PM on June 27, 2015 [140 favorites]


yes, it's the victim blaming that's the important point to make here. let's not lose sight of that fact.
posted by poffin boffin at 5:10 PM on June 27, 2015 [53 favorites]


Thanks for your considered and erudite rebuttal.

Let me put it another way.

An Incomplete List of Things That I, Personally, E. Whitehall, Have Been Told to Lose Weight Before They Can Be Addressed:

earwax
flu
ankle sprain
carpal tunnel
pneumonia
food poisoning
constipation
poor eyesight
deafness
hallucinations
allergies
split fingernails
warts
sinus polyp
throat infection
broken tooth
broken wrist
yeast infection
thyroid dysfunction
sebaceous cysts
genetic defects

You may be able to imagine why I consider your need to say but she was fat! irrelevant in the face of lung cancer.
posted by E. Whitehall at 5:16 PM on June 27, 2015 [220 favorites]


If you shouldn't expect medical care until you're no longer fat that amounts to saying only non-fat people should get medical care. Or that people who already feel sick now need to starve and work themselves to death so they look right first. If your medical problem is causing you to be unable to lose the weight then God help you.
posted by bleep at 5:17 PM on June 27, 2015 [37 favorites]


If you shouldn't expect medical care until you're no longer fat that amounts to saying only non-fat people should get medical care. Or that people who already feel sick now need to starve and work themselves to death so they look right first. If your medical problem is causing you to be unable to lose the weight then God help you.

You should probably read the article.
posted by phaedon at 5:21 PM on June 27, 2015 [8 favorites]


An Incomplete List of Things That I, Personally, E. Whitehall, Have Been Told to Lose Weight Before They Can Be Addressed...

Is that true? Or, when seeking treatment for other issues, have the doctors mentioned that you need to lose weight as an aside or additional advice? I know which was true for me when I was overweight; but perhaps I simply had better doctors.

As we know, losing weight is easy to do and anyone can do it very quickly,...

Losing weight is easy. All you have to do is eat less than your body burns. What makes it difficult is that we have a food culture that is fundamentally disordered. We snack too much, we eat trash, we associate too many emotions with the act of eating. I lost 20+ pounds to reduce from the low end of obese to normal weight without doing significant exercise. My best friend, who weighed 320 at his heaviest, has lost 110 pounds with a combination of diet and exercise.

Obesity killed my mom, via liver cancer. She had a "losing weight is hard" mentality, refused to consider that her diet was bad (she considered any change in diet equivalent to "fad diets"), and finally died of a cancer whose risk has been found to be correlated with obesity.

So, yeah. Fuck cancer. But also fuck obesity, because it kills people, too.
posted by sonic meat machine at 5:23 PM on June 27, 2015 [28 favorites]


If you shouldn't expect medical care until you're no longer fat

Good heavens, noone is saying this. Obesity has consequences, but noone is even claiming that had she reduced weight as suggested by her doctors that they definitely would've spotted the lung cancer earlier.

What I do see is people saying that she was not dismissed by her doctors, and that a lack of continuous access to a primary care physician was likely a contributing factor. According to the ACS, less than 2% of lung cancer cases occur in people under 45. It was absolutely reasonable of her doctors to pursue other avenues.
posted by tiaz at 5:25 PM on June 27, 2015 [16 favorites]


Every obese patient should just lose weight before they get treated for anything else, because probably it's just due to their fatness.ight, right. Every obese patient should just lose weight before they get treated for anything else, because probably it's just due to their fatness.

That's an uncharitable reading of sonic's statement. It is a fact of life that many diseases are difficult to diagnose, and that they are especially complicated when the presenting symptoms are shared by other diseases that the patient either has or is at risk of having. Obesity-induced asthma is relatively common amongst overweight people, while lung cancer, particularly in somebody as young as this, is very uncommon.

I think these stories should be told because people should be aware of the limitations of the medical institution and one should always be prepared to actively advocate for their own health. As a tangential point, lot's of the really rare diseases are frequently diagnosed by the patients themselves after doing their own research, because it is simply impossible for every doctor to be an expert at every disease.

This is not a commentary on fat-shaming. The prejudices of current practitioners of medicine vary just as much as they do in society, and their bedside manner varies accordingly.
posted by kisch mokusch at 5:31 PM on June 27, 2015 [14 favorites]


Coughing up blood is probably never due to obesity unless you're like 800 pounds. Her doctors were shitty and narrow minded.
posted by Burhanistan at 5:31 PM on June 27, 2015 [36 favorites]


[One comment deleted. If your impulse is to comment "everybody loves playing the victim" or "it's easy to lose weight", or generally that obesity is bad, please reconsider because we've had this fight a million times and it would be great if we could have a better conversation about this stuff without just going around in the same old circles.]
posted by LobsterMitten (staff) at 5:37 PM on June 27, 2015 [35 favorites]


Sonic meat machine, I believe you are conflating simple with easy. It'd be easy to be a skinny human if we weren't so damned *human*.

Should we also get rid of birth control, because it's so easy to just not have sex until you want a baby?
posted by politikitty at 5:37 PM on June 27, 2015 [33 favorites]


Losing weight is easy.

Seriously? I'm glad you managed to do it and your friend did as well, but that doesn't actually mean it is easy, or that everyone can or will be able to do it successfully, or that their other illnesses will patiently wait until they are less fat. (This assumes, too, that the methods they use for weight loss don't exacerbate the illnesses.)

Most people fail at losing weight, or succeed only temporarily. At some point, doctors have to treat the patients they have, not the ones they want.

It is a fact of life that many diseases are difficult to diagnose, and that they are especially complicated when the presenting symptoms are shared by other diseases that the patient either has or is at risk of having. Obesity-induced asthma is relatively common amongst overweight people, while lung cancer, particularly in somebody as young as this, is very uncommon.

You can always find a justification for telling a fat person to lose weight, yes. That doesn't mean it's the correct thing to do. Sure, at the beginning it sounded like it was about the pneumonia she had, but eventually "can't ever breathe properly" and "always has a cold" and "coughing up blood" while taking asthma medications should ping something further.
posted by jeather at 5:38 PM on June 27, 2015 [16 favorites]


In addition to being fat, she was also a young women. And, in my experience with the health care system, young women are presumed to overreact to everything, are never trusted as experts on their own health, are condescended to, and are explicitly treated worse when they try to advocate for themselves. And I was not a fat young woman. My friends who are fat consistently tell stories just like this, of conditions long left untreated because no one would actually take them seriously and listen to them. Everyone telling her what she should have done differently who has never themselves been a fat young woman needs to consider the possibility that you don't know what you are talking about. And show some fucking compassion.
posted by hydropsyche at 5:39 PM on June 27, 2015 [152 favorites]


Losing weight is easy.

I think it's more accurate to say that losing weight is simple.

It can be incredibly hard to do though. It's not that people don't know that creating a calorie deficit is required to lose weight, it's that the discipline required to do so is hard to maintain over the long run.
posted by dyslexictraveler at 5:41 PM on June 27, 2015 [18 favorites]


Yes, it's true. I've had doctors send me away with a bill before they would treat me. I've had doctors refuse to treat me until I promised them repeatedly that I would try to lose X amount by X date and I had better come back and show them I'd done it. I've had doctors tell me they can't do anything for me, because I am fat and I should lose weight. I can go through the list, if you like.

earwax: No, I won't take a look, you need to lose weight, it's common in obese patients, and no, I won't note that you wear hearing aids, even though they are known to increase wax production.
flu: if you lost weight you wouldn't have such a fever, here's a prescription for an OTC fever-reducer and no, I won't write you a doctor's note, you need to lose weight.
ankle sprain: if you lost weight you wouldn't have sprained your ankle (from falling two metres because my best friend at the time pushed me off a wall).
carpal tunnel: If you weren't so fat you wouldn't have problems typing.
pneumonia: You must not be able to breathe because you are fat. Have you considered breast reduction?
food poisoning: It's your body reacting to the toxins in your fat. Have you considered yoga? I will write you a doctor's note for today only.
constipation: You must not be eating enough fibre. You should lose weight so your colon has more room.
poor eyesight: If you weren't so fat you wouldn't find it harder to see when you look at something long distance, because you squint! Learn not to squint.
deafness: If you lost weight it would be better. There can be fat in your ear canal, you know. You should lose weight.
hallucinations: It's because you drank 3 litres of Coke last night. You didn't? You must be lying. Too much sugar can do that to you, you know. You should lose weight and lay off the Coke.
allergies: You're fat, that's why you have hives. You shouldn't eat fatty food. Did you have KFC? It's not good for you. You didn't have KFC? You must have had something to make this happen.
split fingernails: Your fat must be inhibiting your vitamin intake. Have you considered losing weight?
warts: Your fingers are too fat. You should lose weight and the warts will have less room to burrow down. Have you considered pilates?
sinus polyp: Your weight is causing the post-nasal drip and discomfort along your cheekbone. You need to lose weight and it will reduce the size of your cheeks.
throat infection: You need to lose weight. If you eat junk food all the time this is what happens. Avoid sugar, it's bad for you, and I don't think it's relevant that you are coughing pus. Lose weight.
broken tooth: You need to lose weight, and I will fill your tooth when you beg but I will lecture you the entire time about drinking soda, even though you've told me that you don't drink soda and have told me that your tooth broke when you bit down on a bit of chicken bone in a restaurant.
broken wrist: You need to lose weight. That's a fat bump. Stop yelping, I'm trying to help you.
yeast infection: You need to lose weight. Your thighs touch, that's why you're having problems. Medicine? What medicine?
thyroid dysfunction: You need to exercise more. You're a competitive rower and you're steadily gaining weight? You need to exercise more.
sebaceous cysts: If you weren't so fat the fat wouldn't deposit under your skin like this. I don't care that they're painful to the touch and I can palpate them between my fingers. Stop crying.
genetic defects: Everything is your fault and there's no reason for you to be depressed or to consistently lose hearing whenever you're struck on the head or blow up a balloon. You need to lose weight.

Best part: I have more where this came from!

Ah, to be a fat young woman.
posted by E. Whitehall at 5:43 PM on June 27, 2015 [103 favorites]


Yes, jeather, dyslexictraveler—I should've probably said "simple" instead. The issue is complicated by our food culture, as I noted above. I do think it is important, however, to counter the common narrative that losing weight is this thing that only "some people" can do... and I also think it is very bad to make being obese part of our identity rather than viewing it as it is—a serious health problem that should be, and can be, successfully addressed.

E. Whitehall, those sound like horrible doctors and I hope you've escaped their grasp.
posted by sonic meat machine at 5:47 PM on June 27, 2015 [11 favorites]


Sonic meat machine, you're missing the point.

Every doctor I have ever had has pulled this shit bar one whom I found last year. This is not unusual. A lot of fat women have similar stories, or worse. (I'm privileged enough that I could even go to another doctor and not risk insurance issues, or go to other doctors at all.) This list covers a span of time from when I was five to just last year. It covers GPs, it covers emergency doctors, it covers specialists.

This is what happens when doctors look at you and use your fat to explain away everything else. This is what happens when your fat is more important than your life. This is what happens when your ability to live is less important their disgust when they look at you or touch you. (One doctor utterly broke my heart when she was formerly kind to me, but as soon as she had to touch me, she started to grimace, and when she hadn't previously told me to just lose weight, she started a diatribe about how I should lose weight and I'm going to die of fat, while rubbing her fingers together, and gave me absolutely no treatment for what I had asked her to take a look at to begin with.)

At this point it's not even really about fat acceptance. It's more about, if I hadn't had an advocate with me -- and yes, I had an advocate for most of this, and all doctors were comfortable with either repeating what they said to me when I asked them to repeat so I was sure I heard, or with my advocate repeating to me -- if I hadn't been able to doctor-shop long enough to find someone who would listen to at least one part of the patchwork involved in my issues after being so ignored for so long, I would be dead. As likely would the woman who is the subject of the FPP.

I'm fully expecting that when I inevitably get breast cancer, as has every woman in my family for generations, I will die of it because I already can't get anyone to take me seriously that I might need screening or genetic testing, even though half my aunts and uncles are dead of cancer and I have siblings who died of cancer, and that's something I kind of have to come to grips with, that my being fat overrides this overpowering, frightening genetic history I have in the eyes of doctors who look at me and see my fat instead of my life.

So, you know. I don't actually care that obesity may or may not be a big issue. I don't care. I care that it is seen as the issue, that it obscures our lives and our hurt and our value and our right to breathe without pain.
posted by E. Whitehall at 6:07 PM on June 27, 2015 [72 favorites]


The issue is complicated by our food culture

Not as much as it is by a culture of sedentary lifestyles, desk jobs, and driving everywhere? There's quite a lot of evidence that says dieting doesn't work for most people, and lifestyle changes that might lead to sustained weight loss are difficult when the environment conspires against you...most people work relatively sedentary jobs, to which they must commute some distance, by car, for instance...and there's also evidence that indicates that some of the causes of obesity may be environmental (a virus has been implicated). There seems to be a sort of American tendency to regard obesity and poverty similarly: moral failings brought on by poor choices and a lack of discipline. This isn't an especially useful way of looking at either of those issues.
posted by Pseudonymous Cognomen at 6:08 PM on June 27, 2015 [20 favorites]


Weight loss can also be made next to impossible due to medications like birth control, antidepressants, steroids, NSAIDS, a huge host of psychiatric medications, and any other number of every day medications millions of people take daily.

It can also be made next to impossible due to pre existing conditions like tendon weakness, ankle deformity, knee pain, arthritis, asthma, etc. . So yeah.

"Easy"

Tell that to me again. I eat less than 2000 calories a day, take a medication used as an appetite suppressant, and weigh 200 lbs. at 5' 4". I used to weigh 111 pounds. TELL ME AGAIN HOW EASY IT IS.
posted by strixus at 6:10 PM on June 27, 2015 [57 favorites]


Sympathetic as I am to knee jerk medical fat shaming (which is very real), that is not what almost killed. What almost killed her is very likely to be either a misread on a CT of the chest (bad medicine) she had early on, or a pneumonia masking a spot on that CT (bad luck). I'd love to see the images from that study.

/pulmonologist
posted by drpynchon at 6:16 PM on June 27, 2015 [36 favorites]


My mistrust of the medical system is so high that I know it's a problem. But this type of story is very very common, though usually with less dire (short term) consequences.

However, obesity causes a great number of health problems, and when you present to a doctor as an obese patient with breathing problems, it is understandable for them to suggest you lose weight.

I understand what sonic meat machine is getting at, but it actually confirms the problem. The human body is very complex. If one is forced to make diagnoses in 15 minute increments, one has no choice but to guess the most probable thing. But unless the distribution of possibilities is very tight, this is likely a pretty shitty guess. And when the most probable thing is a good guess, it's frequently because at that point the problem is much farther advanced than it should be. In fact, it's a lazy diagnostic strategy, to make you keep coming back until your problem has deteriorated to the point of being easy to diagnose.

This situation is largely the result of monetization pressures and the belief that they supercede professional responsibility. Be let's be real: there is no fucking way someone can adequately untangle various physiological possibilities a quarter hour at a pop. If that were possible, the science would be a lot easier than it is.
posted by mondo dentro at 6:18 PM on June 27, 2015 [16 favorites]


I am positive that fat shaming happens routinely in doctors' offices. (Happens to women and people with mental health diagnoses on their records too.) But most doctors are loathe to order a test if it doesn't make sense for the stats. Lung cancer in a 23-y/o is highly unlikely. I'm a smoker in my late 30s who gets yearly bronchitis and my doc won't screen for it. (Because I don't fit the stats, still.)
posted by cotton dress sock at 6:18 PM on June 27, 2015 [3 favorites]


Remember, losing weight is easy, all you have to do is this one thing. Or maybe this other thing. Or maybe a third thing. It's definitely easy, though, focus on that.
posted by Bulgaroktonos at 6:29 PM on June 27, 2015 [35 favorites]


[Couple of comments deleted. Let's bring it back to the article rather than going into individual members' weight or theories of the obesity epidemic?]
posted by LobsterMitten (staff) at 6:30 PM on June 27, 2015 [3 favorites]


Obesity is an epidemic in the United States. That means that both a lot of people suffer from it, and it's a problem. A doctor's obligation is to provide good healthcare to these people. I don't think it's "fat shaming" to inform a patient that they need to lose weight, repeatedly if necessary, but if that diagnosis is getting in the way of discovering other problems, in enough people, or causes mental health problems, then it becomes a public health issue.

Hopefully that aspect of the problem will be addressed; this is not unlike the need for frontline, chronic pain management training.
posted by phaedon at 6:35 PM on June 27, 2015 [7 favorites]


Yeah, not for nothing here, but I was a national competitor in gymnastics. I danced from the time I was old enough to wear shoes. I have always starved and survived on 1500 calories a day on average. I have a tumor on my thyroid that is literally the size of a robins egg...more than 23cm in length. I gained 100 pounds in less than 3 years, despite not changing my diet, and eliminating alcohol, and continuing to exercise at a rate that would hurt most humans. Guess who can't get any doctor to put me on thyroid medicine until I lose 50 pounds?
posted by dejah420 at 6:35 PM on June 27, 2015 [59 favorites]


What almost killed her is very likely to be either a misread on a CT of the chest (bad medicine) she had early on, or a pneumonia masking a spot on that CT (bad luck).

This seems extremely possible to me (given my experience of "unremarkable" scans despite chronic neuropathy in a foot). I've read that the inter-rater reliability can be pretty poor for some kinds of imaging/body parts.
posted by cotton dress sock at 6:40 PM on June 27, 2015 [4 favorites]


I've been fat my entire life and never been fatshamed by a doctor even once. There are good ones out there.

(If anybody in the Philly burbs wants my Docs name, let me know!)
posted by Drinky Die at 6:40 PM on June 27, 2015 [9 favorites]


What almost killed her is very likely to be either a misread on a CT of the chest (bad medicine) she had early on, or a pneumonia masking a spot on that CT (bad luck). I'd love to see the images from that study.

I was thinking this too. I'm not an MD but .... if we can't see DEAD LUNG on CT, presumably lack of vascularization, total lack of inflation, and all sorts of stuff that should surround dead tissue in the body, then why are we having them at all?

I can understand where the starting point for every new doc that she saw was a benign, not malignant, cause, but - really? DEAD LUNG, and ... nothing? Because fuck the extra radiation, it's the lack of seeing dead things that I'm worried about.
posted by Dashy at 6:40 PM on June 27, 2015 [9 favorites]


E. Whitehall: An Incomplete List of Things That I, Personally, E. Whitehall, Have Been Told to Lose Weight Before They Can Be Addressed...

sonic meat machine: Is that true? Or, when seeking treatment for other issues, have the doctors mentioned that you need to lose weight as an aside or additional advice?

Please don't accuse a total stranger of either lying or having a less accurate grasp of their own personal firsthand experience than you do, just because your own experience was different.
posted by FelliniBlank at 6:44 PM on June 27, 2015 [103 favorites]


This hits close to home. It hurts even.

I lost my dad three years ago. He was morbidly obese. He started to diet and exercise regularly and lost 100 pounds. Then he started gaining it back. And doctor after doctor lectured him, hectored him for backsliding. He wasn't, he would say plainly. He was still exercising and eating better. Oh, the side eye they would give him.

Then one day we had to rush him to the hospital with chest pain. There was fluid around his heart. Actually, they found he was overwhelmed with fluid from neck to toe. They have him lasics (sp?) and he dropped 70 pounds of water weight in 6 days. And then it started to come back. Maybe it could be a kidney thing, the doctors conceded. But probably, it was just because he was fat and not taking care of himself again. More trips to the ER. More fluid. Various meds. My Dad and my mom booked a shabby hotel next to the Mayo Clinic in Minnesota and refused to leave until there was a better answer. They found two congenital heart defects he'd been living with without knowing about his entire life. He went in for surgery to repair them and even though he insisted I didn't bother, I flew up to be there. He cried when they made him take off his wedding ring. I told him I'd see him later.

My mom and I waited eleven hours for him to come out of surgery. He made it out of the OR, but he never came out of anesthesia. We lost him at 63.

And yeah, I think if diagnosing him had been half as satisfying as judging him for being fat, he might still be here.
posted by DirtyOldTown at 6:48 PM on June 27, 2015 [148 favorites]


I'm so sorry, DirtyOldTown. So sorry.
posted by E. Whitehall at 6:52 PM on June 27, 2015 [13 favorites]


I believe E. Whitehall because I have been told the same things in the past -- severe migraines? Lose weight and they'll go away. Repetitive stress problems with my wrist? Lose weight. Anxiety? It's because you're too fat. Hell, it's taken me until the age of 42 to have my insanely painful and heavy periods looked into and the cause (a great big freakin' polyp) diagnosed and treated, because every other doctor I mentioned it to? Told me I'd have magically lighter periods if I was skinny. (My current doctor, who treats me like a person instead of an ambulatory mound of fat, also finally figured out why I'm so damned tired all the time -- the heavy periods have left me anemic. No one else checked that because FAT.)
posted by sarcasticah at 6:54 PM on June 27, 2015 [26 favorites]


Oh, DirtyOldTown, I am so sorry. That's horrible.
posted by sarcasticah at 6:55 PM on June 27, 2015 [1 favorite]


I'm not obese, but but I had gotten a little chubby. I was about 40-50 lbs over weight when my integrated pain therapist told me about how carrying that excess weight was likely to be causing my joint pain. Except, we had just gotten through discussing the fact that very peculiarly, my pain was limited to my arms and legs (at the time) and did not affect my joints at all.

Then we have the high blood pressure, fatigue, and rapid heart rate which started in my late 20s when I was thin and active. At the time, my dr was really concerned for me. Ten years later, and the problem has not gone away, but now it's because I'm fat and old. Someone in their late 20s who is thin presenting those symptoms is a concern. Someone in their late 30s who is out of shape, well the problem didn't go away, but now I'm just another women in my demographic with expected problems.

In fact, it's a lazy diagnostic strategy, to make you keep coming back until your problem has deteriorated to the point of being easy to diagnose.

This is quite literally my diagnosis plan right now. I had to fight to get doctors to admit that essentially was the plan. It might be lazy, but for millions of women, that's the only option we're given.
posted by [insert clever name here] at 7:02 PM on June 27, 2015 [26 favorites]


Lazy/shitty doctors taking the easy way out for diagnosis is a problem, a big problem. Doctors making the wrong diagnosis is a big problem. Medical science not being exact is another big problem.

But they are separate problems from discounting doctors/anyone recommending someone to lose weight.

Lets not conflate the issue of incompetent doctors/imperfect science with the need to reduce obesity.

Unless you are proposing that incorrect diagnosis is a bigger reason for obesity around us than incorrect lifestyle, talking about doctor's mistakes is misleading.
posted by TheLittlePrince at 7:03 PM on June 27, 2015 [2 favorites]


#notalldoctorsrecommendingweightloss
posted by DirtyOldTown at 7:06 PM on June 27, 2015 [19 favorites]


I thought the issue was the undiagnosed lung cancer, not so much the obesity in this case (except as the offered explanation for medical bias).
posted by cotton dress sock at 7:06 PM on June 27, 2015 [3 favorites]


I've had a doctor refuse to treat me, telling me only to lose weight, when I presented with strep throat.

Fuck anyone who pulls that "but are you SURE you were mistreated by a medical professional, or are you just saying that because you're fat and overly sensitive about it" horseshit.
posted by palomar at 7:07 PM on June 27, 2015 [56 favorites]


Yeah, losing weight is easy. Unless you happen to have a condition that causes you to gain weight when you are eating 1200 calories a day.

I wouldn't wish thyroid disease on anyone. It's a shitty condition to live with, and the only shred of hope is that maybe someday I'll stop gaining weight, even when I'm eating nothing. Forget trying to lose it.

My story is not unique. And anyone who believes in "simple" stories haven't spent enough time with those stories. Nothing is simple. Seeing other people complexly is part of our job as humans, though.

I'm glad she told her story. It chips away at the simple story, and I hope it inspires people to see others more complexly.
posted by guster4lovers at 7:08 PM on June 27, 2015 [16 favorites]


In addition to being fat, she was also a young women. And, in my experience with the health care system, young women are presumed to overreact to everything, are never trusted as experts on their own health, are condescended to, and are explicitly treated worse when they try to advocate for themselves.

This has absolutely been our experience, and it seems to only get somewhat better with age.

I think it's more accurate to say that losing weight is simple.

Well, it's simple to talk about, especially in terms of someone else's life. It's obviously not so simple in practice, because even highly motivated people with lots of resources tend to struggle significantly.
posted by Dip Flash at 7:17 PM on June 27, 2015 [8 favorites]


Oh you guys, it was just garden-variety not-giving-a-shit, you can't pin it down to the one factor that she and thousands of others have identified.
posted by bleep at 7:30 PM on June 27, 2015 [22 favorites]


What makes this story particularly interesting is that certain kinds of lung cancer can actually cause weight gain via Cushing's syndrome. She says in her earlier post that it was a carcinoid tumor, and carcinoid tumors can cause cushings.

I don't know if that's the case, but imagine the irony.


(And Cushing's syndrome is just one of many endocrine disorders that keeps weight loss from being neither easy nor simple.)
posted by [insert clever name here] at 7:41 PM on June 27, 2015 [4 favorites]


This is really upsetting. It's the second story I've heard in two months about somebody insisting to their doctor that their cough needs to be checked out further, and having that pooh-poohed.

The other one was a very dear former teacher of mine who started having a terrible cough at the beginning of the year, only to be told it was just bad allergies. He started coughing up brown stuff. A lot. No, just allergies. He started coughing so badly he pulled muscles in his chest and back. Allergies. He brought up the fact that both his parents died of cancer, and that he had been a smoker for 25 years. No, no, just allergies. It took him coughing up blood in the doctor's office before anybody took him seriously. He still had to beg to get a CT scan, not just a chest x-ray. And by then it was Stage IV lung cancer. It actually had been lurking for quite some time, but when the brown stuff showed up, it seems like it would have been an appropriate time to take more vigorous action.

I understand that we're at this crossroads where medical professionals are finally understanding they shouldn't order tons of unnecessary tests on a patient just to cover their asses, but I hope these two cases aren't indicative of the pendulum swinging over to the "never order tests" side.
posted by queensissy at 7:44 PM on June 27, 2015 [11 favorites]


I used to be anorexic. Now I'm overweight and starting to get the comments from doctors. And honestly I've just stare them down and say 'did you know I use to starve myself? Let me tell you the laundry list of problems I had then...' and They generally shut up. (My pcp is awesome though).

I am on Lyrica right now and I love it. It has changed my life in so many amazing ways. No pain. Energy. I have motivation and concentration. It seriously changed my life. One of the things it messed with is my impulse control. And I can say from someone who used to turn away from food without a second thought, on this medication it is like a burning feeling that I must have. I sometimes obess over food And it is terrifying to me. I would not be on this medication except that my life is super better. And I use to think losing weight was easy. After all I starved right? It is simple. But now getting a glimpse of a normal brain (I think) I have lots of compassion and understanding. I have admiration for people who successfully lose weight healthily. I can't do it right now. But I can work. I can enjoy my day and spend time with my family. If a doctor gives me shit I just give it right back. I'm happier this way and actually healthier.
posted by AlexiaSky at 7:53 PM on June 27, 2015 [30 favorites]


When I was a teenager, they told me all of my health problems -- particularly insomnia -- were because I was underweight. Now that I've had two children and I'm chubby, yo, they keep telling me that all my health problems -- particularly insomnia -- are because I'm overweight.

I JUST WANT TO SLEEP THROUGH THE NIGHT.
posted by Eyebrows McGee at 8:05 PM on June 27, 2015 [46 favorites]


From what I can remember reading, early-stage screening for lung cancer is controversial, because the non-CT tests just aren't that good yet, and along with issues mentioned above, the CT itself can contribute to cancer risk and can yield lots of false positives. So they screen selectively (people "55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years" [CDC]). Like it's not just a CYA or economics-driven type of thing. And the unfortunate thing with this is that it does usually look just like a cough, until it really doesn't.

Hiles' doctor ordered it anyway. What horribleness happened, happened. Her story is tragic (although luckily and thankfully, she made it), but I think it doesn't serve as a super strong example of bias against obese people, particularly.

The stories people have shared here, on the other hand, make the point extremely well.
posted by cotton dress sock at 8:08 PM on June 27, 2015 [11 favorites]


Not gonna threadsit but damn, did not expect the amount of "Why didn't you just lose weight while you were unable to breathe and coughing up blood?" to show up here. But whatever. Let's go outside medicine. Do fat people get paid less? Yes. Are they discriminated against in general? Yes. So, why is it so hard to believe that being fat could lead to worse treatment in the doctor's office also? We know medical mistreatment and undertreatment happens with race. We know women, in particular, get taken less seriously when reporting pain. I mean, this stuff is out there, it is not controversial.

Also sincerely, if you think everyone who says "weightloss is incredibly hard for me," is lying or lazy...I would beg you to consider that your body is not the same as everyone else's. You might be well-meaning, but it's a lot like someone who can drink or not drink wandering into an AA meeting and wondering aloud what all the fuss is about, just stop drinking, jeez!

That's all I wanted to add. Carry on.
posted by emjaybee at 8:10 PM on June 27, 2015 [57 favorites]


my best friend at the time pushed me off a wall

...what?
posted by aramaic at 8:10 PM on June 27, 2015 [3 favorites]


My mom tried to get me to lose weight by telling me that people with diabetes can loose their feet. I avoided going to a doctor for over a year, scared I'd be told I had diabetes and she'd be able to say "I told you so."

Turns out... I don't have diabetes. I don't have high blood pressure. I don't have high cholesterol (indeed, apparently my cholesterol is "perfect"). I was anemic. And I'm fat. People spend so much time taking the last characteristic and assuming all of the ones before it (except for the anemia) are caused by the fat, but there really is no evidence of that at all. It's so pervasive, though, and so unavoidable that even though intellectually I know that, I cling to the piece of paper saying I have no diabetes like it's magic.
posted by Deoridhe at 8:11 PM on June 27, 2015 [13 favorites]


If somewhere in the quarter-inch pile of papers I have to fill out when I see a doctor for the first time there were a checkbox titled "I recognize that I'm overweight and I feel very confident that it'd be counterproductive at best for my doctor to bring it up so please don't", I'd have been to a doctor more often in my adult life, I'd have talked more about my health concerns, I'd have listened with more openness to my physicians' advice, and I feel extremely confident I'd weigh at most what I weigh right now.
posted by glhaynes at 8:21 PM on June 27, 2015 [18 favorites]


Er, I find it difficult to exercise when I 'just' have sinus infections (thanks aging congenital deviated septum!), nevermind if I was coughing up blood. Losing weight via exercise involves cardio work. Which relies on breathing properly. what kind of unfeeling doctor tells someone they need to exercise harder to lose weight when they are coughing up blood? *shivers*
posted by mollymillions at 8:40 PM on June 27, 2015 [5 favorites]


(aramaic, I love that that's the part you got stuck on. It was a moment of panic on her end; we were skiving a bit on the beginning of post-lunch class to finish eating and she heard a teacher coming and shoved me. Fortunately I landed on the non-teacher side so I could hobble to class without getting detention. Teenage foolishness.

And FelliniBlank, thanks.)

More on topic, I just wish there was more of a way to be believed that the pre-eminent focus of a fat person's life isn't generally actually the fat part, when they go to the doctor? I mean, fat people know they're fat, generally, please take it as read and concentrate on the issue? Let them tell you what they're there for? Like others have said to a greater or lesser degree, I learned a long time ago never to go to the doctor with anything vague because the more vague it is, the more likely it is that I'll have wasted time and money to be told what I've already been told -- that I'm fat, that I should eat less, exercise more, etc., and then in the meantime I've still got a plugged ear, I've still got a sprain, I'm still fat.

Two of these things are immediately able to be addressed, so why not address them? Why let the long-term thing get in the way of addressing the short-term thing at all? Why even look at somebody and go "you've got a thing to work on for a long time, so let's not deal at all with things I can help with right now". Why prioritise someone's long-term cosmetic changes (because, yeah, at that point, it's cosmetic judgement, it's "you look fat", not anything that would involve dealing with the actual body in front of them) over things that are actually hampering their lives and causing them pain right at that very moment? It's frustrating to deal with, to say the least.

(I'm doing my best not to threadsit, I swear. This article really struck home because I've had coughing blood repeatedly dismissed as nothing, too, and oh do I ever feel her on the "coughing in the shower uncontrollably leaking from all ends" front.)
posted by E. Whitehall at 8:43 PM on June 27, 2015 [11 favorites]


Awful (and probably avoidable) situation all around, but I don't understand the author's use of the word "fat-shaming." That unfairly implies that the doctor's misdiagnosis was intentional, and, I dunno, supposed to make the author feel ashamed of being overweight(?) I very much doubt that was the case.
posted by Kevtaro at 8:48 PM on June 27, 2015 [3 favorites]


A nurse at my son's pediatrician blamed -his- anemia on my weight.

(Typechip is 14 months old in this story)

"Well there's a family history of poor eating choices, I don't think he needs this blood test. You just need to stop giving him cookies and soda."
"Excuse me? "
"You and your husband are overweight."
"Excuse you? Are you in my kitchen watching what I feed my kid?"
"But you're overweight."
"Get me Dr so-and-so now."

(yes, diet related, but not because of unhealthy choices in the way the nurse was thinking - but because Typechip refuses most dark greens, most meat, and would be happiest if we let him eat nothing but fruit all day - a quick heads up about iron-fortified food, and some supplements, and he's perfectly healthy now)

But the assumptions - that I was giving my kid SODA at 14 months, that I was making unhealthy food choices for my child because I carry weight and the total lack of any assistance - fat shaming doesn't just affect the patient directly, it affects their families too.

How many families kids' are under-diagnosed because the assumption is "well they're just (symptom) because you let them (bad food habit)"?
posted by FritoKAL at 9:03 PM on June 27, 2015 [52 favorites]


I think one important thing for physicians to keep in mind is that nobody ever chooses to be overweight. This is true of both patients with lung cancer (it sounds like she had Cushing's) and it is also true of patients who are non-compliant with exercise and diet regimes. Non-compliance can be a choice, sure, but only to an extent. There are biological, psychological, social, and economic/financial barriers to being fully compliant with weight-loss programs that aren't within the patient's control. And even if the patient were perfectly compliant, sometimes genetics and underlying medical conditions get in the way.

If doctors kept this idea in mind-- that nobody ever chooses to be overweight (or any other shitty reality, for that matter)-- instead of subconsciously associating obesity with some degree of moral failure and lack of responsibility on the part of the patient (as a substantial chunk of general society seems to do), this would change the way they interact with their overweight patients, which would in turn give patients like Rebecca Hiles more opportunity to feel heard and welcome in their doctor's office. It is truly an awful feeling, to forego basic healthcare as a result of anticipating that you won't be taken seriously.
posted by gemutlichkeit at 9:21 PM on June 27, 2015 [27 favorites]


Lazy/shitty doctors taking the easy way out for diagnosis is a problem, a big problem. Doctors making the wrong diagnosis is a big problem. Medical science not being exact is another big problem.

But they are separate problems from discounting doctors/anyone recommending someone to lose weight.


Doctors are using "you're fat, lose weight" as a diagnosis. We are not in a culture where fat people do not know they are fat and that they should lose weight. This isn't new information for people. All it does it tell fat people -- particularly fat women -- not to go to the doctor anymore. (Possibly a subconscious goal.)

The problems aren't separate, unrelated problems.
posted by jeather at 9:38 PM on June 27, 2015 [39 favorites]


Are there really people in the thread who believe that the rush to blame just about any medical problem on obesity isn't driven, at least in part, by a) the pressure on primary care physicians to reduce costs and referrals for costly procedures by any means necessary, and b) a very strong tendency to dismiss the medical concerns of women, sometimes on incredibly spurious grounds? Data point: even though I've been overweight, to one degree or another, virtually my entire adult life, I've very rarely had doctors directly blame my diet or degree of physical activity for various medical problems, even when it's likely that those really were factors in the problems. (The 'beetus, for example, which emerged when I was drinking too much and eating a lot of junk food while my bicycles gathered dust.) I think a lot of dudes really don't get it.
posted by Halloween Jack at 9:42 PM on June 27, 2015 [34 favorites]


Doctors should be telling people to lose weight if they are dangerously overweight for the same reasons they should tell them to quit smoking. Even if you are currently healthy, it's putting your future health at risk. It doesn't matter that people generally know, sometimes they need to hear it from a professional they trust. That doesn't mean they should lazily assume weight is the source of all problems and weight loss the cure.

Data point: even though I've been overweight, to one degree or another, virtually my entire adult life, I've very rarely had doctors directly blame my diet or degree of physical activity for various medical problems, even when it's likely that those really were factors in the problems.

That's been my experience too. I had back pain that was eventually solved with weight loss, which my doctor had not recommended when I went to him. But remember, people are talking about their own experiences here. I think we should trust them about what their Doctor's motivation was, since they were there and we were not.
posted by Drinky Die at 9:46 PM on June 27, 2015 [5 favorites]


I've been fat my entire life and never been fatshamed by a doctor even once. There are good ones out there.

Also, you're a man (I think? If not I am so sorry), and doctors pull this shit less with fat men than fat women. (God help you if you're fat and nonbinary.)
posted by NoraReed at 9:46 PM on June 27, 2015 [13 favorites]


Doctors are using "you're fat, lose weight" as a diagnosis.

I don't think this is the problem. We include obesity on the problem list in our medical notes, because obesity is a health condition, albeit a socially charged one, with deleterious consequences on almost every organ system in the body.

However, as a healthcare provider, I would never want to put it so crudely.

In other words, the problem lies in the way in which physicians deliver this diagnosis and interact with the obese patient. "What changes can we work on to make weight loss a possibility for you?" is very different from "You wouldn't have sprained your ankle if you didn't eat KFC all the time."
posted by gemutlichkeit at 9:47 PM on June 27, 2015 [6 favorites]


"What changes can we work on to make weight loss a possibility for you?"

Is this really the right response to "I haven't been able to stop coughing for years?"
posted by bleep at 9:53 PM on June 27, 2015 [35 favorites]


Awful (and probably avoidable) situation all around, but I don't understand the author's use of the word "fat-shaming." That unfairly implies that the doctor's misdiagnosis was intentional, and, I dunno, supposed to make the author feel ashamed of being overweight(?)

I don't think the term is being used to mean something malicious or purposeful but as a descriptor for a discriminatory or stereotyping mindset or inequitable system: i.e., "weightism" or "fat-ophobia." Like, you know how when you go to any sort of medical appointment, it usually starts with stepping on a scale and getting your blood pressure and pulse taken. Sometimes a height measurement. Vital statistics. No prob. But it's amazing how, if you're perceived to be even mildly or moderately overweight, that can magically then become the main or entire topic of conversation, regardless of what you are there to see the doctor about. Whereas nobody gets all fixated on the relative slowness or fastness of your pulse unless it's totally off the charts and/or you have medical symptoms directly related to that stat.

My rheumatologist is fantastic, love him. But on a couple of occasions, his former nurse-assistant, after gathering the vital stats info, gave me totally unsolicited "I see you've gained a few pounds" lectures. Which is sort of oddly apropos of nothing when you consider that the sole reason why I see this doctor every six months is to manage/monitor psoriatic arthritis in my distal interphalangeal joints (fingertips), a probably genetic autoimmune condition I've had since age 12, 41.5 years ago, when I was 5' 2" and weighed 103 pounds. But hey, any random person working in or near a healthcare facility is somehow qualified and entitled to dispense fitness, nutrition, and healthy weight maintenance advice -- much of it laughably awful -- whenever they feel like it. Says so right in the Hippocratic Oath.
posted by FelliniBlank at 9:55 PM on June 27, 2015 [23 favorites]


My stomach infection that had me throwing up daily and losing 18lbs in a month got met with congratulations. Only got treated by repeatedly going in every two weeks which of course everyone has the energy to do when throwing up and starving to death. Four months later he begrudgingly ran a test. Same with my Celiac's. Just either a result of my fatness that's caused my chronic anemia because I must be living on ice cream and pop. He admitted that he didn't think I had it and was genuinely shocked when I got the results.

I'm tired of having to literally beg doctors to look at something else besides my weight or my mental illness. I still can't get my periods treated after trying for years. And I don't know how good of a patient I have to be when I already lost 120lbs. But still slightly overweight so that must be it. My chronic pain being treated s a pipe dream.

I've stopped going. I'm too tired to fight to get treatment for issues that are severely impacting my life. I give up.
posted by kanata at 10:00 PM on June 27, 2015 [37 favorites]


I hope that this lazy/incompetent/uncaring doctor thing is a mainly US problem.

It doesn't matter that people generally know, sometimes they need to hear it from a professional they trust

At which point many people cease to trust their doctor, I suspect.
posted by five fresh fish at 10:09 PM on June 27, 2015


Are there really people in the thread who believe that the rush to blame just about any medical problem on obesity isn't driven, at least in part, by a) the pressure on primary care physicians to reduce costs and referrals for costly procedures by any means necessary

I'm curious what pressure are you referring to.
posted by phaedon at 10:11 PM on June 27, 2015


I give up.

Don't, kanata.
posted by cotton dress sock at 10:30 PM on June 27, 2015 [15 favorites]


So, I'm a thinnish person and I still managed to be fat-shamed by a midwife, of all people. During the birth of my first child, I tore some muscle in my leg and had pain issues for about 2 years. During the second pregnancy, some of the pain came back and I mentioned it during an appointment. Midwife spent most of the appointment urging me to do some sort of prenatal meditation something-something. But she phoned me after I left to tell me that I was in pain because I had gained too much between appointments and I should "lay off the cookies." (At that point in the pregnancy, I weighed less than I did at the same point in the prior pregnancy.) Uh, thanks. Very helpful.

Yes, I absolutely believe that otherwise well-meaning care providers are sloppy and default to "lose weight" instead of making thoughtful diagnoses for each patient.

And as dumb as it is, I have been procrastinating making an appointment to see a GP about some fun new hip/pelvic pain, because I am only 5 months post-partum and not fully back to pre-baby weight, and I am afraid that it won't be properly diagnosed. Aarfgh.
posted by stowaway at 10:32 PM on June 27, 2015 [12 favorites]


MetaFilter: It doesn't matter that people generally know, sometimes they need to hear it from a professional they trust.
posted by glhaynes at 10:33 PM on June 27, 2015 [2 favorites]


Ironically, weight gain has been linked to stress and dieting.
posted by Deoridhe at 11:33 PM on June 27, 2015 [11 favorites]


I've mostly been lucky enough to have had good health care professionals, from GPs to physios and podiatrists. I do have health issues that are affected by my weight (osteoarthritis in the knees) which are in turn affected by other health issues (achilles tendinopathy) so it's been a factor. Nearly all of them have understood the complexity and inter-related aspects of physical issues and then also the mental health issues (I have depression).

But there was one surgeon I saw for a consultation who initially began talking to me like a normal person. Small talk about my job, my expectations, etc. His demeanor began to change when he saw me without all of my clothes on. Once he'd weighed me, it was as though my brain had suddenly been taken over by fat and could no longer actually function properly as he tried to convince me that all my problems were related to my weight, that I should have gastric bypass surgery instead of the surgery I was there to ask about, that I had a demon inside me that was preventing me from being thin. Yup. At one point I began to cry, mostly in frustration and anger, and he didn't even offer me a tissue. Needless to say, I found someone else to do my surgery.

So yeah, I get it. I may not get it all the time, and those of you who have more consistently had this response from your HCPs, my heart goes out to you. I know how awful that experience was for me and I can imagine how much more it would be to get it for everything from earwax (!) to undiagnosed heart defects. At the same time, at least in Australia, there are HCPs who are not blinded by fat. I hope that becomes the norm instead of the other way round.
posted by Athanassiel at 11:37 PM on June 27, 2015 [5 favorites]


Failing to do proper medical tests and listening to patients' reports about their own symptoms simply because you believe all their problems are simply because they're overweight is medical fat shaming.

100% agreed. But this is neither tumblr, nor metafilter. Doctors are in their own world. Telling them that they are "medical fat shaming" someone makes them go "so what?"

Unless there is some kind of consequence for this (legal or otherwise), doctors won't give a shit.

Maybe this doctor should have been sued hardcore for malpractice or at least negligence. Thats the only way doctors are going to change behaviors.
posted by hal_c_on at 11:49 PM on June 27, 2015 [2 favorites]


Yeah, losing weight is easy. Unless you happen to have a condition that causes you to gain weight when you are eating 1200 calories a day.

And often that condition is "previously dieted." Human bodies are not actually machines that function on a calories-in/calories-out equation. Bodies that think they might face starvation in the future, because they've faced it in the past, are more likely to hold onto weight as a safeguard against that future famine.
posted by jaguar at 12:04 AM on June 28, 2015 [24 favorites]


The human body is not a simple machine, but it's not complex enough to make energy out of thin air either. If you burn more calories than your body absorbs for a long period of time, the body will use it's own stores. Another long term calorie deficit is the future famine.
posted by Drinky Die at 12:19 AM on June 28, 2015 [4 favorites]


[Reminder: this isn't an article about if it's easy/hard to lose weight, or whether reducing calories will help lose weight, and as LM suggested, "it would be great if we could have a better conversation about this stuff without just going around in the same old circles." Please just try.]
posted by taz (staff) at 12:32 AM on June 28, 2015 [14 favorites]


But I have to tell everyone how awesome my regimen is.

It is awesome.
posted by Burhanistan at 12:53 AM on June 28, 2015 [5 favorites]


I'm surprised more people haven't mentioned the role of our shitty healthcare system in this situation. It sounds like she did not have access to steady healthcare for multiple years when she was going through this, and the end result was bouncing from doctor to doctor, never being able to stay long enough with one to really dig into the problem (nor have the option to find a doctor who will take her concerns seriously). And the one regular PCP she did have apparently did not see anything in a CT scan save a "touch of pneumonia". Which sounds fucking crazy to me, because that was five years into the cough and less than a year later she had to get a lung removed and half of it was dead. I understand she loves that doctor, but damn, I can't help but wonder if there isn't a malpractice suit in there.
posted by schroedinger at 12:57 AM on June 28, 2015 [10 favorites]



I don't think the term is being used to mean something malicious or purposeful but as a descriptor for a discriminatory or stereotyping mindset or inequitable system: i.e., "weightism" or "fat-ophobia." Like, you know how when you go to any sort of medical appointment, it usually starts with stepping on a scale and getting your blood pressure and pulse taken. Sometimes a height measurement. Vital statistics. No prob. But it's amazing how, if you're perceived to be even mildly or moderately overweight, that can magically then become the main or entire topic of conversation, regardless of what you are there to see the doctor about. Whereas nobody gets all fixated on the relative slowness or fastness of your pulse unless it's totally off the charts and/or you have medical symptoms directly related to that stat.


I gathered that was the effect she was going for when she selected the term, but I really think that particular word choice not only unfairly characterises the doctor from her story, but also, perhaps to a more damaging effect, demonizes any doctor who discusses or asks questions about a patient's weight in a manner that makes the patient feel uncomfortable.

If the patient in your example presented an abnormally high blood pressure, the doctor absolutely should discuss that with him/her during that visit, because high blood pressure can lead to of number of serious, life threatening health problems. It would irresponsible NOT to discuss it. The same is true of obesity, although the manner and frequency is a matter of tact, as weight is obviously a more sensitive subject for most people than blood pressure. (And unfortunately, there are tactless doctors and nurses just as there are tactless people in any other profession.)

I guess what I'm trying to say is that I find it counter-productive to frame this and similar situations as "fat-shaming," because I think that leads to an "us vs. them" mentality among overweight patients regarding their health care providers that breaks down patient-HCP trust, which is absolutely essential for effective health care.
posted by Kevtaro at 2:05 AM on June 28, 2015 [4 favorites]


It's not labeling something as "fat-shaming" that breaks down patient-HCP trust, it's the doctors treating their patients like shit and ignoring their real medical conditions because they are fat. There isn't any fucking trust to lose there. Just more lives.
posted by NoraReed at 2:30 AM on June 28, 2015 [29 favorites]


If it's not overtly about personally wanting to make me feel bad--and I don't think that poorly of them--then it is about the fact that they're members of the same culture as the rest of us, which teaches people who are not fat that they are morally superior to people who are.

And the longstanding way that morally superior people are supposed to "help" morally inferior people is with shame. If I don't trust doctors, it's because as a group they have all the same prejudices of the privileged upper classes in the US, and I'm not going to trust the rich just because they have MDs. I don't want doctors to shut up about this--but trustworthy doctors should be discussing food and fitness with all their patients, even the ones who look (and even are currently) trim and fit. I think that most obese people, at least, would probably lose weight if they ate better and exercised more, as that's how it usually works for me. That's not the same thing as "obese people should lose weight". "Eating better and exercising more" describes something almost everybody should be doing. And those who don't need to eat better or exercise more are people who should still be asked about their habits periodically for the sake of things like injury prevention. That's what real concern for health, or even costs, looks like.

If you believe it's that unusual for doctors to be making moral judgments about their patients, try being queer, or trans, or a woman who doesn't want to be pregnant anymore, or a woman who just doesn't ever want children. Doctors have lots of moral judgments about patients.
posted by Sequence at 2:56 AM on June 28, 2015 [14 favorites]


It's not labeling something as "fat-shaming" that breaks down patient-HCP trust, it's the doctors treating their patients like shit and ignoring their real medical conditions because they are fat.

I can only speak from my own experience (five years as an ER nurses assistant, and most of my immediate family works in health care, FWIW), but I just don't think that there are that many doctors who "ignore" medical conditions because their patient is overweight. Most doctors are so afriad of being sued for malpractice that they order far more tests than are necessary or appropriate, at great expense to the patient.

The case under discussion was a very unfortuante misdiagnosis, but as many have pointed out, the assumption that the author's breathing problems were weight related was not unfounded or completely out of left field. It was a (big) miss by the diagnosing doctor, but it was not a case of the doctor intentionally deciding not to diagnose cancer because his/her patient was overweight. "Fat-shaming" implies that the misdiagnosis was made consciously and born of ill-intent, but nothing in her story (or many of the stories shared in this thread) justifies the accusation that these doctors intend to harm or endanger people simply because they are overweight.
posted by Kevtaro at 3:32 AM on June 28, 2015 [6 favorites]


I'm not going to trust the rich just because they have MDs

This seems like a way of thinking that could cause more problems than it solves. There are rich scientists, rich professors, rich researchers... Turning your doctor into a class enemy doesn't seem like a good idea.

I don't think doctors are prejudiced against fat people because of their (real, supposed, or relative) wealth, I think it's because doctors are trained to think in broad terms and to rely on what could be called stereotypes. The more overworked a doctor is, the more likely they are to rely on the most obvious problem they see. And here is where inequality and a shitty health care system really come into play. A wealthy fat person likely gets the personalized care that they deserve.
posted by chaz at 3:58 AM on June 28, 2015 [6 favorites]


"Fat-shaming" only implies that she was being shamed for being fat, and that shaming her for being fat distracted from giving good health care. No matter how many times it's asserted in this thread, accusing someone of "fat-shaming" is not accusing them of "intentionally deciding not to diagnose cancer because his/her patient was overweight." Fat-shaming is simply spending a lot of time making moral judgments about someone because they are fat, for instance that they are just not trying hard enough to lose weight. Which has happened many many times in this thread.
posted by hydropsyche at 3:59 AM on June 28, 2015 [11 favorites]


I love it when people share their personal experiences and then someone rolls up in the thread to argue that because they don't see it happening at their own health care job, it must not really be happening. So classy.
posted by palomar at 4:00 AM on June 28, 2015 [35 favorites]


"Fat-shaming" implies that the misdiagnosis was made consciously and born of ill-intent, but nothing in her story (or many of the stories shared in this thread) justifies the accusation that these doctors intend to harm or endanger people simply because they are overweight.

This only follows if one believes that the only way one can shame others for their behavior is to maliciously and intentionally set out to do exactly that. In which case, how many people in the world are actually that evil? Most of the shaming that's ever been done has been entirely well-intentioned, according to the subjective standards of the ones doing it. How many people do you think shame single mothers out of some kind of malicious intent to harm or endanger them? The shame comes from people treating you like a lesser creature out of their usually genuinely-held belief that something you are doing is bad enough that you can't just be allowed to find your own way back to correct behavior, that you must be enlightened as to the error of your ways or even encouraged back to the righteous path. The shame comes because the thing these people have usually decided is so wrong is often something you can't help or that's the inevitable consequence of things the rest of the culture actively encourages.

I mean, strictly speaking, I'm sure there are a few people in the world who do this sort of thing because they're just basically evil and like hurting people, but the whole problem is how much good intent there is and how little actual empathy.
posted by Sequence at 4:02 AM on June 28, 2015 [14 favorites]


This article reminds me of the fact that I, as a young woman, have had to figure out most of my chronic health problems on my own with the help of the internet and experiments with my diet, because I've had such a hard time finding doctors who take me seriously.

When I got out of college, I was a little overweight. I changed my diet and started exercising more, and starting losing weight. But then I kept losing weight and I couldn't figure out how to make my weight stabilize: I felt like I was on a water slide with no way to get off and I started to get worried. I also had stomach pain and nausea and digestion issues, and I thought the two things might be related, but I couldn't get anyone to help me, because every time I brought it up to a doctor, they poo-pooed my stomach issues, because I was losing weight and that was a good thing, right? After reading about gluten-intolerance on Metafilter a couple of times, I decided to give the gluten-free diet a try, and after three days my stomach stopped hurting and from that point on, my weight stabilized. When I told my doctor about my experiment and its results, he said, "Oh, that makes sense."
posted by colfax at 4:02 AM on June 28, 2015 [15 favorites]


I also realize that once again there are still people in the world who don't know about implicit bias. You may think that you are a completely objective person, and you may even openly state that you believe men and women are equal, that you are not biased against people based on ethnicity, and even that you treat fat people the same as skinny people. But you may have implicit biases that you don't know about that, for instance, cause you as a doctor to not trust a fat young woman when she tells you about her health.
posted by hydropsyche at 4:11 AM on June 28, 2015 [27 favorites]


Hi there!

The author here, and first I want to thank you all so much for posting and commenting! I feel incredibly special to have so many people that have looked at my blog :)

I do want to address a few things that I saw in this thread, and offer the opportunity for anyone to ask any follow-up questions. I was very emotional as I wrote this, so I know some things got missed/left out.

In terms of my diet, much of it was bad at first (I mean, I was in my late teens/early 20's), until I couldn't stop coughing and the coughs got worse. Then I got my act together. I ate gluten free and mostly vegetarian for about 3 years, I also had a gym about half a mile from my apartment during that time, and I walked to it regularly. Not only did I not lose weight, I gained more. Now in terms of weight loss I try to eat twice as many vegetables as carbs, and that helps. Also, I got a proper diagnosis for my mental health, and the medication has made me far more conscious of what I'm eating and when I'm eating it. For the first time in my life (after starting those meds), I've lost more than 10lbs at a time.

In terms of my bouncing from physician to physician, I was living in Pittsburgh, then York, then Virginia. I had a PCP that I saw in Pittsburgh, who I continued to drive to after I was in York. I didn't have a PCP in my area, and I know enough about medicine to know that working with a care team that doesn't often change nets results faster.

As for the comment (sorry, I can't find it again), that my PCP was not able to read the CT and diagnose me. Both CTs that were taken were at ERs. Unclear how, but my PCP never got the results to those. The chest x-rays also showed a bit of pneumonia. I think I still have the images from my CT (I *really* love keeping my imaging after procedures), but even my Pulmonologist said that it would have been easy to miss.

As for the fat-shaming. There is a huge difference between "I would like to see you lose weight", "Let's work on losing weight" and "Losing weight will cure all your problems". My PCP in Pittsburgh had me on 3 different inhalers (and I was still coughing-obviously haha), and still felt that asthma and weight loss was the correct diagnosis.

I also do think that part of it was the fact that I was young, and who thinks to look for cancer in the lungs of an otherwise healthy 23 year old who smoked socially for two years before quitting completely. Though, I did have a number of blood tests and panels that checked for as many things as we could. All of my bloodwork came back normal. Turns out there's a special set of tests for carcinoid cancer.

Please, if you have any more questions I'd love to clarify!
-Rebecca
posted by TheFriskyFairy at 5:01 AM on June 28, 2015 [106 favorites]


Thank you for telling your story Rebecca! People need to know this stuff happens.
posted by triage_lazarus at 5:25 AM on June 28, 2015 [7 favorites]


I've never had anything as life-threatening as this, thankfully, but I have had doctors repeatedly attribute my health concerns to my weight without bothering to investigate alternatives. This has been the case even when the health concern in question provably had nothing whatsoever to do with my weight, such as when I got Lyme disease a decade ago. Pretty sure ticks don't exclusively bite fat people.

Everyone in Western societies "just knows" that fat is unhealthy. They won't even consider otherwise at this point. What I find especially infuriating is that the research many medical professionals rely on to bolster this assertion does not control for the negative social consequences of weight. Fat people often receive worse medical care, less social support, and are under more stress than thin people. Lack of social support is bad for the health. Prolonged stress is bad for the health. Not receiving required medical treatment can be deadly. Aaaand then you can point and say, "See! The fattie died because she was fat!" GRARRRR.
posted by mysterious_stranger at 6:38 AM on June 28, 2015 [13 favorites]


I also do think that part of it was the fact that I was young, and who thinks to look for cancer in the lungs of an otherwise healthy 23 year old who smoked socially for two years before quitting completely.

This is what I was thinking, too, reading your story. I am a relatively young woman (38) with breast cancer, and over the past several months of treatment have heard absolute horror stories of young women with lumps in their breast being told, "oh, you're too young for breast cancer, don't worry about it," and being sent away without even a mammogram, much less a biopsy. And because when we're young we tend to believe we're invincible and that doctors can be trusted because they're older than us and have fancy education, and because we don't really have the experience (or money) to demand second opinions and further tests, these women believe their doctors, and then by the time they are finally diagnosed with cancer months or years later, the situation is much, much more serious. I actually feel lucky that I was immediately taken seriously.

Just because something is rare doesn't mean it doesn't happen, and young people are particularly vulnerable in this type of situation, being unaccustomed to fighting the system and to the idea of their own mortality.
posted by something something at 6:58 AM on June 28, 2015 [4 favorites]


Yes, thank you for telling your story. This is underreported and it's important for people to know this happens.

My stomach infection that had me throwing up daily and losing 18lbs in a month got met with congratulations.

I have had this too! I was listing off symptoms for the intake nurse -- "heart palpitations, insomnia, lost 10% of my body weight" -- and she stopped and said "Wow, that's fantastic, good for you losing that weight!" Um, no, I lost the weight because I had a serious illness. (Thankfully my endo, who this nurse worked with, is terrific, although to be fair I seem to be on the hyper-reactive side of Thyroid World so I have no idea how she'd be if I had "normal" T4 readings and had hypo symptoms.)

I've also had the other side, where a (non-sleep doctor) specialist told my that my symptoms could be consistent with sleep apnea "but that can't be it, because you're not morbidly obese."

My PCP is terrific, but it's a crap-shot seeing specialists, and never knowing if you'll be too fat/thin/dehydrated/stressed/young/old for your symptoms to be taken seriously.
posted by pie ninja at 7:03 AM on June 28, 2015 [2 favorites]


Thanks for sharing your story, Rebecca, and for stopping in to say hi personally.
posted by DirtyOldTown at 7:07 AM on June 28, 2015 [1 favorite]


I'm sorry this happened to you, Rebecca. And thanks to everyone sharing stories in thread. I'm sorry this happens to you too. Doctors who ignore alarming symptoms are bad doctors, period. Doctors who manage to bring weight issues into a conversation about earwax need to fucking stop. Shame never works and I sincerely hope the world can get to a place where doctors and well, everyone, realize it. I've had the opportunity to work with a lot of great doctors recently but I've also had my eyes opened about some I previously thought were great when they reveal that they think shame is a viable tactic :(.

The issues surrounding access to health care, cancer screening, and pressure to reduce medical costs and to follow evidence based guidelines definitely play a part in this story because it is an event that occurred in the context of the US health care system but this story can still be about all of the doctors who failed her because they were blinded by only seeing her as a fat person.
posted by bobobox at 7:25 AM on June 28, 2015 [7 favorites]


Nice to see you here, Rebecca!
posted by internet fraud detective squad, station number 9 at 7:26 AM on June 28, 2015 [1 favorite]


I hope that this lazy/incompetent/uncaring doctor thing is a mainly US problem.

Unfortunately, it's not.

My main GP is awesome. I go "Man, I feel terrible. My throat and my head are killing me." He looks at my throat and touches my face and when I'm wincing and coughing, he goes "Yep, sinus infection." I say "I'm not surprised, I'm walking a lot more, and I bet I picked it up during that," he says "Cool for walking more. But how are you doing at work? Things better there?"

However, there's another GP at the practice, and I don't know if she's having a midlife crisis or what, but every time I end up seeing her (and she's usually the on-call GP, so if I need to see a doctor that day, I end up seeing her), it's all about my weight. I say "Man, I feel terrible. My throat and my head are killing me," and she says "You should lose weight. We have surgery you can get on the NHS."

One time, I went in for an ear infection, and it became less about my ears and more about how I should lose weight, quit my job, sell my house, and move out of Nottingham, if not the UK entirely, because, obviously, if I completely changed my life to fit her daydreams, my ear infection would go away.
posted by Katemonkey at 7:36 AM on June 28, 2015 [12 favorites]


The psychiatrist I was seeing after leaving my abusive marriage left the clinic I went to and I was assigned a new doctor. Before each visit, they weigh us and check our blood pressure using a machine like those you see in Walmart by the pharmacy. I walked into the room and before I had even sat down fully, I was told, "Your blood pressure is high and you're obese. Your anxiety and insomnia is probably from sleep apnea caused by obesity. I want you to see your doctor about your weight before you come back here."

Apparently my years of emotional and verbal abuse, history of sexual abuse, and my marital rape were totally not to blame for my anxiety, depression, and insomnia. I was just fat all along! Whew. Good thing she told me.
posted by FunkyHelix at 9:00 AM on June 28, 2015 [26 favorites]


In my early 20s, I developed neurological symptoms. Numbness, tingling in my hands and feet, extreme fatigue, difficulty walking, headaches, etc. I was told I need to lose weight. I even had one neurologist tell me to my face that I was attention seeking and that if I wanted to have more energy I should try aerobics and stop eating fast food (I don't eat fast food and never said I did. She ASSUMED I did based on my weight).

Later, I developed horrible joint pain in my hands, feet and knees. Again I was told it was because of my weight and that I was drug seeking.

This went on for 15 years, with my condition getting steadily worse and my weight continuing to rise because of my decreasing mobility. Each doctor treated me with an eye roll and refused to do anything useful other than tell me to join Weight Watchers (which I did to little or no avail). A few mentioned it looked like I was developing arthritis because of my weight and the pressure on my knees, but none of them had an answer for how this was effecting my joints in my hands.

Finally I saw a decent rheumotologist who figured out I had rheumatoid arthritis. Not long after that, I went numb from the rib cage down and was diagnosed with multiple sclerosis. Sadly, in those 15 years, much damage was done to my joints, and because my MS was untreated for so long I will never get the use of my left leg back or be able to walk farther than 20 yards without my legs feeling like they are covered in stinging ants.

Most recently I developed chest pains and high blood pressure. Long story short, after many lectures about how my weight was killing me, it turned out that a combination of of prednisone and omeprazole was the problem. Within 48hrs of stopping the omeprazole, my blood pressure went back to normal. This was something I had to figure out on my own, because my doctors refused to believe that was the cause, it HAD to be my weight. They were almost smug and triumphant that I had FINALLY developed high blood pressure, just like they always said I would. The fact that I pointed out to 4 separate doctors months ago that the problems started right after I started the omeprazole didn't matter.

I am not stupid. I am acutely aware of the problems that fat people can get. I am also aware of how my weight can effect my other conditions.

Anyone who thinks weight loss is "easy" has never been fat. They especially have never been fat and had mobility issues that impede your ability to exercise effectively. You can reduce it to "calories in, calories out", but I AM NOT A MACHINE. You cannot reduce my life experience to a simple math equation and shrug your shoulders at my misfortune and perceived lack of discipline. To paint this image of fat people as shiftless whiners who love their Big Macs more than their health is beyond fat shaming, it's dismissive asshattery. Being fat is not a "choice", if it were no one would fucking choose it. People are rude, abusive, and cruel to you on a daily basis. Everything in our culture is designed to make you believe that not only are you unhealthy, you are ugly and an embarrassment. You are stripped of your sexuality, denied promotions at work, and people think it is perfectly acceptable to mock or insult you in public in the guise of being concerned about your health. If losing weight was "easy", every single fat person in this country would chose that over the hell being overweight in this country has become.

Stop blaming all my health problems on my weight. It is the symptom, not the cause.
posted by evilcupcakes at 9:28 AM on June 28, 2015 [57 favorites]


Drinky Die: remember, people are talking about their own experiences here. I think we should trust them about what their Doctor's motivation was, since they were there and we were not.

I do; I should be more clear (I wrote my comment late last night when I was pretty tired) that I thought that my PCPs hadn't blamed my health problems on my weight because I'm a man, not because I don't think that it doesn't happen.

phaedon: I'm curious what pressure are you referring to.

Here's a WaPo article on the subject. You can tell the general tenor of the article by the lede: "For many adults, a routine visit to a primary care physician might involve blood tests, a urinalysis, an electrocardiogram, maybe a bone density scan." I don't know who "many adults" are, but as someone with chronic medical problems, who sees a doctor every six months, the only routine test I have is bloodwork, which is to be expected for a middle-aged diabetic with past problems with high cholesterol. Occasionally, they'll ask for a urine sample, I've had one EKG, and I've never had a bone density scan (that may be more for women my age or older). There are some other red flags in the article, as with this bit:
And patient expectations drive some of the spending as well, say physicians, who note that sometimes simple directives, such as drinking less alcohol or getting more exercise, aren’t what patients want to hear. “If a doctor says, ‘Let’s talk about weight control,’ patients aren’t usually too happy,” says Campos-Outcalt. “They feel like there should be some testing.”
Especially with that pesky coughing-up-blood business, right? I'm all for evidence-based practice standards and not prescribing antibiotics for a viral infection and so on, but I also see something of a tendency in medicine for something to be overused and then get cut off when there's a backlash, as witness the overprescription of artificial opiates, followed by a reluctance to prescribe them to people with severe and chronic pain, leading to a spike in heroin addiction.
posted by Halloween Jack at 10:00 AM on June 28, 2015 [5 favorites]


I had a doctor diagnose me with diabetes because I'm overweight and had a rash. Nevermind that I have a history of eczema and it was consistent with the eczema I've had forever, nope, had to be diabetes. When I rolled my eyes and got up and left she chased me out into the parking lot screaming at me about how we had to get my diabetes under control. Saw a dermatologist the next week and she walked in and went "Oh, eczema," and sent me on my way. Still don't have diabetes over a decade later.

I've had doctors flat out refuse to believe I eat the way I do (clean, high protein). I've had them accuse me of faking food logs so they could launch into their "You really need to stop eating so much McDonald's" lecture (I haven't been inside a McDonalds in years). I've had them refuse to believe I worked out as much as I did. I pulled up a picture of myself at one of the races I did and they accused me of Photoshopping it to fool them, because I'm fat so I couldn't run road races, I had to sit on my couch eating Ding Dongs and Ho Hos and guzzling Coke.

One of many stories in this vein.
posted by Ghostride The Whip at 10:17 AM on June 28, 2015 [30 favorites]


Especially with that pesky coughing-up-blood business, right? I'm all for evidence-based practice standards and not prescribing antibiotics for a viral infection and so on, but I also see something of a tendency in medicine for something to be overused and then get cut off when there's a backlash, as witness the overprescription of artificial opiates, followed by a reluctance to prescribe them to people with severe and chronic pain, leading to a spike in heroin addiction.

Quite frankly your previous assertion that doctors are intentionally under-treating patients is totally incorrect. The article you've linked to doesn't even support it. In fact the problem is in quite the opposite direction. typically as a result of economic forces that are literally completely out of the physician's control, and I don't think has any bearing on the OP's story.

At the very least I appreciate you backing off some immense generalizations about the attitudes of all primary caregivers. This is an incredibly complex issue, not the least of which obesity is actually a tangible, preventable disease which requires addressing and kills people in ways that go beyond "they're fat haha." You could even go so far as to say the shift to preventative care is an extremely important one.

And furthermore, when you co-opt my mention of chronic pain management, it should be stated that overprescription is a far bigger problem than underprescription. It is much easier for a doctor to say, "here's your oxycodone, get out of my office" not only because it's simpler to give a pill, but because patients come in asking for it in droves, they become addicted, and they for damn sure never miss a refill appointment.

A mess all around, for sure.
posted by phaedon at 11:35 AM on June 28, 2015 [2 favorites]


If she had been given (or, more likely, followed) the advice to lose weight via diet rather than (or in addition to) exercise, and then still presented with the problem, the doctors would've begun narrowing down the potential causes sooner.

You sound an awful lot like a doctor I fired in a hail of profanity ten years ago.

I get that sometimes you just don't expect certain diseases to manifest in certain individuals because of their age - I went through that as a teenager, was sick with fever, swollen joints, stiffness, and terrible pain for a year. No one thought to check me for Rheumatoid Arthritis because I was 16. I moved to Germany, it flared up again, and I got a diagnosis at 17. RA is not so common in teenagers, but there I was.

But this? This is bullshit, and this sort of thinking is why I spent 20 years with untreated depression and PTSD. Doctor after doctor told me "Well, if you'd just lose weight, you'd feel better." Mind, I was pretty thin until I had kids. Then I just couldn't get rid of the weight. I couldn't sleep more than a couple hours a night. I was angry and upset and anxious all the time, and in spite of eating a very good diet, I gained weight.

"Lose weight, you'll feel better."

I took up bellydance, and lost about 100 pounds over the course of 3 years. Then I stopped losing weight. I still couldn't sleep for shit. I was still angry, upset, anxious, sleepless. I started weight training, but my weight stayed put. I gained back 30 pounds.

"Lose weight, you'll feel better."

My doctor put me on a severely calorie restricted diet. I adhered religiously. I not only didn't lose a fucking ounce, I was STILL angry, upset, anxious, sleepless, AND HUNGRY ALL THE FUCKING TIME. I tracked my food with LiveStrong.com's "My Plate". My doctor looked at my food log and called me a liar, and told me that if I wouldn't lose weight, he couldn't help me. In all that time, he never did bloodwork once. And I had had enough. My relationships were suffering, my body was suffering, the arthritis flared up a lot more often because I was so stressed out, and that was that. I don't recall exactly how many variations of "Fuck this, fuck that, fuck you, and fuck the horse you rode in on!" I unleashed on him, but it took me a good twenty minutes to finish, and then I walked out.

I made an appointment with my current doctor, an old family friend who I had not been going to because my MIL worked for him, and who wants their MIL all up in their medical bidniz? But MIL had retired, so I went to see him. "You look like hell, kid. What's going on?" And he asked a few questions, and then some more, and then more questions still. "Sweetheart, are you suicidal?" And I burst into tears and yelled "No, I'm HOMICIDAL! I want to set everyone on FIRE and watch them BURN!"

Major Depressive Disorder. PTSD. Did I want to try an anti-depressant? And let's get a full workup, you're too young to feel this bad. Something else is going on besides the depression and the RA.

Lo, we learned: My cholesterol is PERFECT. Lots of inflammation going on, no surprise there. Thyroid is in good shape, dead in the middle of normal. But the insulin receptors? The insulin receptors are borked. No diabetes, but if we don't wake the insulin receptors back up, it's a possibility. Let's try a supplement for that, and see how that works.

Three weeks after I started taking Lexapro, I started feeling like life was worth living again. Three months after starting the Lex, I started feeling HUMAN again. My sleep started to straighten itself out. Ten years later, my insulin receptors are still being stubborn assholes, but the banaba leaf helps, and I am verrrrrry sloooooowwwwwly losing weight again. Diabetes is pretty much off the table. The RA, alas, is worsening. Not because I'm fat, but because that's a thing that RA does. Autoimmune disorders suck. If I end up doing methotrexate, which we are trying to avoid, weight loss will happen, but not in a healthy way. And now I'm perimenopausal, so all kinds of fun is in play. Doc says weight loss isn't a priority, because we need to treat the ACTUAL problems I have. As long as I keep up with my good diet, my bellydancing and walking, and take my meds, as long as my thyroid and cholesterol and such remain good, that's all he cares about.

Lots of us aren't sick because we're fat. We're fat because we're sick, and no godsdamned doctor will listen to us when we tell them what is wrong. Stop making excuses for them.
posted by MissySedai at 11:41 AM on June 28, 2015 [69 favorites]


Anyone who thinks weight loss is "easy" has never been fat. They especially have never been fat and had mobility issues that impede your ability to exercise effectively. You can reduce it to "calories in, calories out", but I AM NOT A MACHINE. You cannot reduce my life experience to a simple math equation and shrug your shoulders at my misfortune and perceived lack of discipline.

Yeah, it was pretty easy for me to drop some weight when I did it, and I've been fat my whole life. At other times I've tried it has been near impossible. None of these experiences are universal to all fat people. It's easier for some and harder depending on a million different circumstances. I think the reason people get so adamant about talking about how simple it can be with stuff like calories in/out is that there is so much bogus information about weight loss out there. Diet pills that don't work, magic exercise routines, a new vilified ingredient every other week. It's not saying that the goal is easy to achieve, just that we know what it is.

In some ways it's saying that weight loss is hard, because a lot of the fad hookum consists of trying to sell shortcuts that don't work. It's an exploitative industry that prays on people's anxieties about weight.
posted by Drinky Die at 12:34 PM on June 28, 2015 [2 favorites]


Telling them that they are "medical fat shaming" someone makes them go "so what?"

This language isn't for the doctors, it's for those of us being treated by them, being dismissed by them, being told that injuries are a result of being fat and we should exercise even when we can't walk (happened to me! I was using a walker due to an injury - but I really should do vigorous aerobic activity to lose weight).

The biggest purveyors of fat shaming aren't doctors, they're people in general - like the people in this thread who are so quick to repeat the false idea that fat is a cause of illness when it's more often a symptom of illness, and who repeat the false idea that diets work instead of diets causing weight loss followed by even more weight gain.

Gods damn you people are cruel to other people on MetaFilter! There are a bunch of fat people IN THIS THREAD talking about our personal experiences, but the drum beat of "FAT IS BAD YOU ARE UNHEALTHY FAT IS BAD YOU ARE UNHEALTHY" is so powerful - the fat shaming is so powerful - that it becomes every argument and every response. A fat person says she is healthy except for anemia = "fat is a symptom of illness in of itself". A fat person is unhealthy = "it must be the fat, at least in part! and even if it isn't, stop being fat!"

Dear gods above and below, the people arguing against this and dismissing it as "tumblr" and peoples' feelings getting hurt make me TIRED and SAD. People are dying or becoming vastly more ill than they needed to because the drum beat of "FAT IS UNHEALTHY FAT IS BAD" is so strong that all other possibilities are ignored - and the evidence for it being strong are in this very thread, with every person who hears a story about a fat person's symptoms being dismissed and respond with "Well, you should lose weight. Being fat is unhealthy."

There's an implicit bias test for fat. I failed it, and I am fat.
posted by Deoridhe at 12:36 PM on June 28, 2015 [40 favorites]


From my personal experience, to keep a positive perspective on the situation it's best to keep firmly in mind that it is both a cause of and symptom of many serious things.

The pattern is clear - the more an individual weighs and the younger their age, the greater the effect on their health,” Dr. Grover adds. “In terms of life-expectancy, we feel being overweight is as bad as cigarette smoking.”
-
and who repeat the false idea that diets work instead of diets causing weight loss followed by even more weight gain.

A long term calorie deficit does not cause you to later gain weight, a long term calorie surplus later does. It took me a few tries before I quit smoking for good. I guess in a way not-smoking was the cause of my relapses, but that isn't really the whole story.

I am very, very uncomfortable with the version of advocacy for the human rights and dignity of people like me that engages in minimization of the scientifically established health risks and engages in arguments that suggest losing weight is a hopeless cause for fat people in general. I'm uncomfortable with it because in trying to fix one huge problem, the absurd and terrifying amount of fat shaming in our culture and medical communities, it at times promotes other problems like people ignoring the future health risks they are increasing and feeling hopeless about changing their weight if they have a desire to do so. I don't feel that thinking weight loss is a hopeless goal is always conducive to promoting the well being of fat people.

When I felt that way, my personal experience was that I felt more depressed, shamed, gained more weight, and my health suffered in general. I feel better about myself, fat or less fat, when I feel that I can control my own destiny. I would like to see more advocacy for people like me that focuses on the dignity, humanity, and positivity of my body without also promoting the idea that I should accept risks that may take decades off my life because the ability to reduce that risk is out of my control. For some people, it is something they can control. I care about my body and I feel I have value as a person. I want that person to live as long and full a life as possible.

But there are no universal approaches here. Fat Person A and Fat Person B may be completely different in every single way humans can be different besides that one thing they share, so I am not intending to try and speak for others on any of this. Some people are not in control of their own destiny when it comes to weight loss for a multitude of reasons and telling them that they are is the damaging thing.
posted by Drinky Die at 1:38 PM on June 28, 2015 [8 favorites]


Quite frankly your previous assertion that doctors are intentionally under-treating patients is totally incorrect. The article you've linked to doesn't even support it.

I was citing that particular article as evidence of the backlash against overprescription of tests, which I believe is leading to an overcorrection in which there's a reluctance to order necessary tests, as witness the numerous testimonies in this thread to that effect. As I noted above, I think that the article somewhat exaggerates the situation. And I'm sorry if you got the impression that I was blaming primary care providers exclusively; in general, they're among the most overworked and undercompensated of practitioners, and they're under a lot of pressure from HMOs to keep costs down.

it should be stated that overprescription is a far bigger problem than underprescription. It is much easier for a doctor to say, "here's your oxycodone, get out of my office" not only because it's simpler to give a pill, but because patients come in asking for it in droves, they become addicted, and they for damn sure never miss a refill appointment.

That used to be more of a problem, before doctors started getting penalized for it.
posted by Halloween Jack at 1:45 PM on June 28, 2015 [5 favorites]


This language isn't for the doctors, it's for those of us being [...] dismissed by them

It is true that obesity is not the cause of every medical ailment. It is also true that obesity is, especially over time, the cause of many medical issues. Doctors are not harping on about obesity every time an obese patient comes in to see them for aesthetic reasons.
If a completely unrelated medical issue is overlooked due to the patient's obesity, that is a tragedy. That isn't what happened in this article, and all too often it goes the other way: an incipient medical issue caused by obesity is left unaddressed over medical advice and becomes a serious one. (Just in case: that is also not what happened in the linked article.)


Some people are not in control of their own destiny when it comes to weight loss [...] and telling them that they are is the damaging thing.

Telling everyone else that they aren't (even "aren't necessarily") is damaging. There are many more people who don't want to do what it takes to control their weight than those that cannot*. Spreading the idea that obesity is something that just happens to some people and cannot be controlled encourages people who otherwise could get it under control to give up before they start trying.

* I am not saying it is easy. I am saying it is possible, although some can't do it alone.
posted by tiaz at 2:11 PM on June 28, 2015 [6 favorites]


I was citing that particular article as evidence of the backlash against overprescription of tests, which I believe is leading to an overcorrection in which there's a reluctance to order necessary tests, as witness the numerous testimonies in this thread to that effect. As I noted above, I think that the article somewhat exaggerates the situation. And I'm sorry if you got the impression that I was blaming primary care providers exclusively; in general, they're among the most overworked and undercompensated of practitioners, and they're under a lot of pressure from HMOs to keep costs down.

If you read your article a little more carefully, you will actually notice that there is pressure from doctors to discontinue unnecessary testing, as it can be frivolous from a medical perspective (which has now taken a back seat to other considerations), and it is costing a lot to their patients. It is actually the HMO's, vis-a-vis standardization, that are causing an explosion in costs both for the system and the patient. So overall your article is not outlining a problem; it's outlining a feature. Believe it or not, doctors care about the quality of living of their patients in more ways than one.

More importantly, you will note that your WaPo article has nothing to do with "fat shaming," or the testimonies offered in this thread, which in turn have nothing to do with an overall trend to cut costs; in fact the original post clearly states she was given CT scans from the get-go. These scans were not "misread" to cut costs.

This is not about doctors telling people that they're fat and sending them home in order to save money, which is basically what you asserted from the start. This is about a fairly-justifiable diagnosis of obesity amounting to a dismissal of other alternate diagnoses, patients not feeling like they are heard, as well as the lack of any true support in the area of weight loss beyond a simple admonishment, creating at least the beginnings of a public health crisis, at a time when, on top of everything else, obesity happens to be an epidemic.

This is, in my opinion, a cultural problem. And doctors eventually have to deal with and adjust to cultural issues all the time. If you simply follow the trends, and live a life and consume things the way the television tells you to these days, you are completely fucked from a medical standpoint. There's the rub.
posted by phaedon at 2:26 PM on June 28, 2015 [6 favorites]


she wasn't given CT scans from the get go; she was given CT scans only after she found a good doctor who was willing to look past her fat.
posted by The Underpants Monster at 3:03 PM on June 28, 2015 [4 favorites]


MeTa
posted by lalex at 3:24 PM on June 28, 2015 [2 favorites]


she wasn't given CT scans from the get go; she was given CT scans only after she found a good doctor who was willing to look past her fat.

What I'm wondering is WHEN she disclosed to the doctors that she had been "socially smoking". There are two huge blog posts about her experience, but only from her comment on metafilter do I know she was smoking.

Also, its weird that these coughing problems started at 17 or 19, yet she stopped her 2-years of smoking socially at the age of 23. Which would mean she started smoking at 21. AFTER the problems started. What?

How forthcoming was she with doctors about her social smoking? As forthcoming as she was in her blog posts, or as forthcoming as in her metafilter comment?

Either way, cancer sucks, and I'm sorry she got it. It just seems like the issue of the cancer not being detected is not related to being fat. It happens to most people who are diagnosed with cancer. They catch it later than the patient wants, and this makes the patient angry.

I'd be angry too...but I think she did get the same standard of care that everyone else gets.
posted by hal_c_on at 3:50 PM on June 28, 2015 [3 favorites]


(Thanks for posting the MeTa link lalex.)
posted by emjaybee at 3:59 PM on June 28, 2015


Since I never smoked but I was around smokers basically 24/7, I probably had more intake secondhand than a social smoker would have over two years, and I never would have dreamed it was relevant at that age to my medical care if I wasn't asked directly in a way that included casual/secondhand use. And I remember the claim being made at the time that, if anything, tobacco was good if you tended to have that tickle-in-your-throat kind of coughing. It might very well have been bullshit, but Googling a bit suggests it's not all that hard to find people now who find cigarettes to soothe coughs, even when they know they should be quitting. It's not like this is a thing where only a crazy, irrational person who had a persistent irritating cough would ever light a cigarette.

This is where we get around to something being victim blaming, when we somehow expect people to in retrospect to have guessed that an occasional cigarette over the course of a couple years was going to lead to lung cancer in the early 20s. Normally, we'd call a 20-something who thought that they'd smoked briefly and now their cough was lung cancer a hypochondriac. If patients both have the burden of guessing these sorts of things but also not wasting doctors' time with frivolous issues, then it's impossible to win.
posted by Sequence at 4:32 PM on June 28, 2015 [10 favorites]


I was always a heavy teen who got terrible grades in PE, except the one year I did weight lifting and realised that gasping and staggering on those mile runs while weighing three times as much as some of my classmates meant that I had a kick like a mule and could leg-press the whole stack (I think it only went up to around 800lbs, but they had to get a new pin for the machine because it wasn't rated for it). I'd been chasing buses with backpacks full of hardcover books for years, and that kind of built up some strength if not endurance.

So yeah, I had a lot of weight on me that was hard to get rid of, but by some narrow measures I out-classed my whole school for fitness.

So in my late 20s I went to get a physical before leaving the US to move abroad. Someone hooked me up to the usual run of monitors and measurements along with some I hadn't had before. Then I was told the doctor would be in to go over the results with me.

Doctor comes in and says "Okay, let's talk about your blood pressure. You're going to have to make dramatic changes in diet and exercise regime from now on..."

So while he's going all wah-wah-wah like the teacher on the old Charlie Brown cartoons, I'm thinking holy shit how did this happen? I've been learning to cook and eating even more healthily than usual and I have this sweet volunteer gig with the National Parks Service on Alcatraz once a week where I walk up and down the Rock for eight hours giving talks about its history and I've started walking from Oakland to Berkeley and back more often and...

...and then he picks up the numbers from the tests for the first time. "Oh. Oh...These are good! These are really good..." and then I couldn't swear it but he mumbles something that sounds like "better'n mine!"

I recently went through a physical for an insurance plan, and I was worried again that I'd slid in the past decade. But all the numbers were really good except my weight. Result: can't afford life insurance, despite all useful indicators of health going strong. I looked into insurers that cover weightlifters, but they use muscle mass calculations I can't live up to. I'm still soft up top and iron down below, so I can't get a "that's not fat" bonus.

But I'm getting older, so just to be sure I've taken up cycling.
posted by rum-soaked space hobo at 4:32 PM on June 28, 2015 [12 favorites]


What I'm wondering is WHEN she disclosed to the doctors that she had been "socially smoking".

I can't imagine why that would matter.

When a patient presents with a persistent, years-long cough AND is hacking up blood, it's a pretty good indicator that something is wildly wrong and she needs to be thoroughly checked out.

My current doc would flip his shit if I called in and said "Mark, I'm hacking up blood!" His response would not be "Lose weight, you'll feel better!", it would be "Get your ass to the hospital, I will meet you there, we are getting you an MRI."

Fat, skinny, smoker, non, doesn't matter. Coughing up blood is not normal at ANY age, FFS.
posted by MissySedai at 4:35 PM on June 28, 2015 [19 favorites]


I'd be surprised if the doctors didn't know about her smoking. In my experience, this is one of the standard things asked on new patient forms (smoking, drinking, medication, pregnancy, allergies, family history, etc.).

But 'What I'm wondering is WHEN she disclosed to the doctors that she had been "socially smoking" ' is a pretty accusatory way to talk about it. It's not the patient's responsibility to bring up every relevant or possibly relevant factor. That would not even be possible to do in most cases.
posted by thdavis at 4:52 PM on June 28, 2015 [6 favorites]


oh hey hello

my mother is overweight

she had heart palpitations for fifteen years and never once mentioned them to a doctor because every doctor blamed all her health problems on her weight

boy, did they all look silly when it turned out the weight problem was a symptom, not a cause!

(ha ha ha ha ha I'm lying, of course, the doctors pretended that didn't happen because beep boop these facts do not fit my equation, your fatness is the cause of every problem you have beep boop)
posted by subbes at 5:00 PM on June 28, 2015 [22 favorites]


I had to change doctors a couple of years ago because of network stuff, and I was dreading it. DREADING it. Because the physician I'd had for years was extremely supportive of my fitness-related efforts without being shaming in the slightest. She'd even gone so far as to explicitly point out when my diet modifications and 10 hours a week of exercise had made a massive difference in my labs, even though I'd barely lost any weight at all, and offered to write me a letter on her practice letterhead that said "KathrynT has the bloodwork, blood pressure, heart rate, and lung capacity of a triathlete. If you think she's not healthy because she's fat, STFU." (I wish I'd taken her up on it.) And when you're as fat as I am, any new doctor is rolling the dice yet again, and I was signing into a big HMO, which meant that switching doctors was not going to be trivial in the slightest.

Imagine my joy when my brand new doctor said "We have a practice here at Giant HMO Consortium of setting personal goals for health maintenance issues. However, I do not support including weight loss in those goals, because you don't actually have direct control over how much you weigh; there are so many factors that go into that that are opaque to us. What you do have direct control over is what and how much you eat, and how much and how often you move, and those are things that have a much greater impact on your health than the raw number of your weight. So that's where I'd like to talk about goals." I was ecstatic.

Because yes, absolutely, it is part of my doctor's job to talk to me about how those things affect my health, and to encourage me to make choices that will maximize my long-term experience of life. But glaring down his nose about the number on the scale and acting like my own persistent refusal to stop drinking a gallon of soda is the only reason I'm in so much pain I can barely walk or am bleeding so profusely every month I pass out at work or or am so fatigued I have to rest in the supermarket halfway through my shopping trip -- none of which have happened to me, but all of which have happened to friends of mine -- is not the way to get people to better health.
posted by KathrynT at 5:01 PM on June 28, 2015 [38 favorites]


she wasn't given CT scans from the get go; she was given CT scans only after she found a good doctor who was willing to look past her fat.

It sounds like she only got CT scans at the ER, and the ER docs were the first ones to refer her to a specialist (!!)
posted by RobotVoodooPower at 5:33 PM on June 28, 2015 [1 favorite]


and lol now I'm within hailing distance of the age at which my mother got those palpitations and I'm getting palpitations toooo and unlike my mother I am going to a doctor about them tomorrow and I am expecting the smug nurse practitioner - the same one who told me she "had never heard of anyone" prescribing spironolactone to a pt with pcos (if you want to go and put that into google scholar and see the hundreds of results, I'll wait) - to tell me it's because I'm fat and she won't refer me to any specialist because weight loss will fix all this and the five pounds I have been sweating and bleeding to lose in the past 3 months just aren't enough and I will be filled with shame and self-loathing on my birthday and I just can't be doing with this but no other PCPs in the area take my insurance and are accepting new patients and even if I do find one, I'll fill out the new patient form with all the things I have going on and request an extra sheet of paper so I can be extra detailed and include the ICD-9 codes and everything and I'll pay the $GDP_OF_A_SMALL_NATION copay and go and be weighed and I'll ask them not to tell me the number and they'll be very careful not to tell me while tutting and then I'll wait in an exam room for 90 minutes and the doctor will come in and they'll just take one look at my chart and maybe a glance at me, me and my extra 50lbs, and say "it's because you're fat, fatty, put down the fries" and I will leave the office and sit in my car and cry because I just paid a professional to tell me that all my medical problems are because I am a worthless fat piece of shit with a vagina
posted by subbes at 6:10 PM on June 28, 2015 [18 favorites]


a study about the harm that fat shaming does (NBC news article about it); it often actually makes it HARDER to lose weight
posted by NoraReed at 6:49 PM on June 28, 2015 [17 favorites]


If you've found a fat friendly doc or are looking for one, hit up Fat Friendly Health Professionals List
posted by subbes at 7:24 PM on June 28, 2015 [8 favorites]


@hal_c_on

In regards to my smoking. I started smoking at 18 (when I wanted to meet people at college), I stopped at age 20. I smoked occasionally outside my dorm, but my pack of cloves lasted about a month or so. At age 20, I was getting sicker, and my partner had asthma, so I figured it wouldn't hurt to stop.

That being said, my Pulmonary Specialist, Surgeon, AND Oncologist have all said that the smoking had nothing to do with my cancer. Carcinoid Cancer isn't brought on by smoking. In fact, NET cancer (the terms are interchangeable) is often found in the stomach and bowel, and presents as gastrointestinal issues (IBS, Celiac, Chron's, etc) before it is found.
posted by TheFriskyFairy at 8:51 PM on June 28, 2015 [8 favorites]


Thanks for posting that NoraReed.

There were four years between baseline and followup. Participants that experienced weight discrimination were 2.5 times (non-obese-at-baseline group) or 3 times (obese-at-baseline group) more likely to be obese at followup than those that didn't.

In the discussion section, the authors cite as possible explanations: physiological effects of discrimination and also studies which suggest that weight discrimination/stigmatization can increase avoidance of physical activity and overeating.

This study was about weight discrimination in general, not specifically from medical providers, but a lot of the treatment from doctors that people report (for example, in this thread) certainly qualifies as discrimination and stigmatization.

I agree with others' comments that doctors have a responsibility to inform their patients about lifestyle changes and choices they can make to improve or maintain their health but I just don't believe that there is a justification for framing this in terms of obesity and 'obesity related conditions'.

If someone has high blood pressure or high cholesterol or bad blood sugar levels or whatever the concern is - tell them about the diet, exercise, alcohol, caffiene, etc. things that might be worsening the condition or could be done to improve it. (And believe them if they tell you that they are or aren't already doing that). Why does weight loss need to be the overarching goal? Sure, some people will lose weight by changing their diet and exercise. Some people will lose a lot of weight, some people will lose a little weight. And some people might not lose any weight at all, but still can improve their health.

What good does framing it all in terms of obesity and weight loss do? What's the benefit? I don't think there is one. I think it just causes harm (stigmatization, embarrassment, avoidance of/reluctance to get medical care, possibly increased probability of weight gain in the future; not to mention missed diagnoses due to attributing other medical conditions to weight and failing to investigate other possible causes).

People (in this thread and also in almost every other conversation I've had about weight and health in my life) keep pointing out that it's important for doctors/people in general to be aware of and try to combat obesity because of all the health problems it supposedly causes (I say supposedly because in my opinion it's a correlation not a cause).

But if the goal is to combat these health problems and the way to do that is through diet and exercise changes, why is not enough to recommend these things because of the health benefits/health problems that are a concern. Why does it need to be talked about in terms of weight?
posted by thdavis at 9:11 PM on June 28, 2015 [8 favorites]


But if the goal is to combat these health problems and the way to do that is through diet and exercise changes, why is not enough to recommend these things because of the health benefits/health problems that are a concern. Why does it need to be talked about in terms of weight?

Well, isn't that just how it's gonna shake out if the medical community disagrees with your view on it just being correlation? Either way, doctors should encourage everybody who can do it to be a little active and eat well regardless of their weight.
posted by Drinky Die at 9:23 PM on June 28, 2015


Yeah, I think that is how it often does shake out, because many people, medical providers included, conflate thinness and health and deny the possibility of being simultaneously fat and healthy, etc.

But there obviously are doctors, like KathrynT's doctor, who don't feel this way.
And I guess my hope is that as more research is done, and weight and nutrition and metabolism are better understood, and if more people stand up against discrimination and stigmatization, that there will more doctors like KathrynT's and fewer like those described in some other comments. But that's a change that probably will happen in the medical community along with happening in the culture in general, not independently.

So I think it's worth asking other people too, not just doctors, why do you think it's so important to focus on weight and not on the more precise health concerns? Like the commenters in this thread who have said that. (Not saying that was you specifically Drinky Die, I just read multple comments about the dangers of obesity, etc.)
posted by thdavis at 9:42 PM on June 28, 2015 [7 favorites]


the possibility of being simultaneously fat and healthy

Health is not a binary measurement. When I say that obesity has, depending on its severity, shorter- and/or longer-term health consequences, I mean that there are specific conditions which obesity puts one at massively increased risk for, not that I have subtracted 10 from whoever's Health Percentage because I hand demerits out to fat people, and not that it is the only thing worth considering.

Additionally, given what is known about the inescapability of the longer-term consequences of obesity, it is worth considering, whether that is in addition to more specific and immediate ailments, or by itself. Noone lives forever, but it is a tragic fact that as a population the obese live shorter lives than the non-obese.
posted by tiaz at 10:37 PM on June 28, 2015 [3 favorites]


[Hey folks. I think maybe we can take it as given that just about everyone participating here is aware that obesity can have negative health consequences, and move on from the fear that no one is considering that. The linked post talks about a specific problem that we can discuss, and the simple fact of discussing it does *not* mean that nobody understands that obesity can have negative health consequences, so let's please not keep reiterating. Thanks. ]
posted by taz (staff) at 10:47 PM on June 28, 2015 [18 favorites]


I wouldn't have really thought this way a few years ago, but the reiteration about obesity being a health issue is or can be a kind of subtle way to keep the fat shaming going. Think about why you might feel the need to remind obese people about it when they already most assuredly know the extra weight is there.
posted by Burhanistan at 10:53 PM on June 28, 2015 [10 favorites]


I aimed to respond to a specific question (why it's important to focus on weight and not on the more precise health concerns), not to shame or remind obese people about anything. I've put particular effort into speaking generally and inoffensively. I'm sorry if I failed in any of that, but I don't see how I could have answered without said dangers being a part of what I wrote.

I don't want to overstay my welcome in any thread, though. I'll see myself out.
posted by tiaz at 11:08 PM on June 28, 2015 [3 favorites]


I've long suspected that a reasonably substantial factor in why the obese live shorter lives is because they get treated like shit and because any and all symptoms and illnesses are blithely dismissed as being due to fat. And by the time the illness has been neglected for long enough that the symptoms are serious and obvious enough to get through that blanket dismissal, of course it's going to be more serious than the same illness would be for a thinner person whose doctor took seriously and did their job.

In general when illnesses aren't diagnosed and treated they get worse over time. So if you have a population whose illnesses are being actively ignored for literally years, then it is blindingly obvious that said population is going to be more severely affected by any given illness. If you have two patients with the same cancer and you treat one of them at the first signs but ignore the second until after it's already stage 4 and terminal, then of course the second patient is going to die sooner. Not because the original cancer was any more serious, but because you treated them like shit.
posted by talitha_kumi at 3:31 AM on June 29, 2015 [22 favorites]


“In terms of life-expectancy, we feel being overweight is as bad as cigarette smoking.”

Smoker here. I am sure to tell my doctors that I smoke on all my intake forms. I have yet to have a doctor assume my ailment is from smoking and that the cure is just to quit, even for respiratory issues. I would say only about half the doctors even say anything about me smoking at all. If smoking is worse than obesity, how come I'm not getting a lecture to quit every time I visit the doctor?
posted by LizBoBiz at 6:51 AM on June 29, 2015 [14 favorites]


@TheFriskyFair

I just looked up "Carcinoid Cancer". What sucks is that diagnosis can be done non-invasively by blood/urine tests.

WHAT THE HELL! All you required was to pee in a cup or get a lab tech to run one specific test to run on your blood...and that didn't happen?

One of the tests claimed that 80-100% of the people with that same type of cancer will show up on the test results.

That just made me angry. This wasn't a case of a doctor having to find a tiny tumor somewhere within the human body. This was a case where all you needed was 1 of like 5-6 specific tests to confirm the presence of cancer in your body, and that didn't happen.

You have my condolences. Have you thought about legal action? I think it would put you in an uncomfortable spot, but you seem rather brave writing about all of this. Either way, it would be tough on you.

I wish you the best of luck in the future. Take care and enjoy your life.
posted by hal_c_on at 7:48 AM on June 29, 2015


I just looked up "Carcinoid Cancer". What sucks is that diagnosis can be done non-invasively by blood/urine tests.

WHAT THE HELL! All you required was to pee in a cup or get a lab tech to run one specific test to run on your blood...and that didn't happen?


Why, it's almost as if everybody lazily proclaiming on the "facts" in this case didn't have the first clue what they were talking about!
posted by dialetheia at 9:18 AM on June 29, 2015 [15 favorites]



WHAT THE HELL! All you required was to pee in a cup or get a lab tech to run one specific test to run on your blood...and that didn't happen?

One of the tests claimed that 80-100% of the people with that same type of cancer will show up on the test results.


The performance of biomarker tests for carcinoid tumors is highly dependent on the source of the cancer. For carcinoid tumors originating in the lung, the sensitivity and specificity of these tests is not very high, and certainly not as high as for other types of carcinoid tumors -- that is, they won't be able to conclusively 1) "rule-in" carcinoid given a positive result (sensitivity), and 2) "rule-out" carcinoid given a negative result (specificity)

Given that the author had no other symptoms suggestive of carcinoid, and that she was young, I'm assuming it wasn't high up on the list of her doctors' differential diagnoses, and an abnormality in one of these biomarkers would not be immediately suggestive of carcinoid as other biomarkers would be of other cancers -- CA19-9 for example. The biomarkers you're talking about and carcinoid just aren't that tightly coupled.

In conclusion, it's just not that simple, even though it might seem that way in retrospect.
posted by un petit cadeau at 11:42 AM on June 29, 2015 [10 favorites]


(coming in late but...) Thanks to Rebecca and others for sharing these stories. IAAD & I think the impulse is always to assume that one is doing a good job, being fair, treating people equally--but of course there is so much implicit bias, which can lead to such awful results. I appreciate the reminder to check in with my own snap judgments and prejudices, to consider whether I see things as clearly as I think I do, and to think about the implications of what I'm saying to patients.
posted by n. moon at 12:17 PM on June 29, 2015 [18 favorites]


If smoking is worse than obesity, how come I'm not getting a lecture to quit every time I visit the doctor?

I dunno, my doctor lectured me on it but not obesity. Doctors vary.
posted by Drinky Die at 12:39 PM on June 29, 2015


KathrynT: "Imagine my joy when my brand new doctor said "We have a practice here at Giant HMO Consortium of setting personal goals for health maintenance issues. However, I do not support including weight loss in those goals, because you don't actually have direct control over how much you weigh; there are so many factors that go into that that are opaque to us. What you do have direct control over is what and how much you eat, and how much and how often you move, and those are things that have a much greater impact on your health than the raw number of your weight. So that's where I'd like to talk about goals." I was ecstatic. "

Are you in northern California? If so, I'd like to hear from you about which consortium/practice you're using.

If not, BITTER TEARS OF ENVY.
posted by scrump at 4:03 PM on June 29, 2015 [4 favorites]


My mom just had to go to the urgent care here because the foot that's been aching her finally gave way. He referred her to a podiatrist as an emergency, because she has a broken foot. Apparently, she's been to her GP several times about it and he's sworn up and down there's nothing wrong with it. However, he's also rigorously tested her cholesterol levels and hassled her about her diet every time she saw him. Getting in a cast and starting the healing process is doing wonders for the foot pain.
posted by Ghostride The Whip at 6:26 PM on June 29, 2015 [9 favorites]


That just made me angry. This wasn't a case of a doctor having to find a tiny tumor somewhere within the human body. This was a case where all you needed was 1 of like 5-6 specific tests to confirm the presence of cancer in your body, and that didn't happen.

That is not what carcinoids are about. It's NOT a case where all you needed was 1 of like 5-6 specific tests to confirm the presence of cancer. You are confusing carcinoids with carcinoid syndrome. Having episodic bloody sputum is not a cause for a medical inquisition, despite all the presumptions. Carcinoids are very difficult to diagnose. Extremely. Blood tests aren't helpful, nor are they typically part of the evaluation and management of this presentation.

It's falling on deaf ears, but I'll say this one more time. Carcinoids are incredibly rare, rarer still in 20-somethings, and they typically take forever to diagnose and multiple visits to multiple doctors over years. If you're skinny. This timeline and story are not atypical for endobronchial carcinoid. In a skinny person. I have no doubts she was fat shamed, not surprised. But people are making lots of inane assumptions about the standard of medical care in her case.
posted by drpynchon at 6:39 PM on June 29, 2015 [22 favorites]


Drpynchon, don't take this as a LOL DOCTORS AMIRITE, but many people - including myself - have observed a medical tendency, when confronted by something without a clear etiology, to seize on something that is easy to diagnose and hard to refute. For instance, a relative of mine recently had a fall after knee surgery. She wasn't recovering; she couldn't raise her foot; and the attending physician and the rehab staff blamed it on everything from laziness to brain damage to a secret desire to enter a nursing home. An x-ray didn't show anything physically wrong; they had her evaluated by a psychiatrist to see if she were depressed; and I think they even did an MRI to rule out brain damage.

Very fortunately, her daughter is a physiotherapist. She thought that her mother might have torn her quadriceps, and she pushed and pushed for further examination. They did an ultrasound (!) and the radiologist confirmed the diagnosis of a torn muscle, but the surgeon initially declined to even look at the results. He said that in twenty years he'd only seen a couple of torn muscles in these circumstances, that she should wait for a few weeks more and see if things got better. The daughter basically forced him to look at the ultrasound results and he scheduled surgery for the next day.

After the surgery - which confirmed the torn muscle that had made the patient unable to raise her foot - the surgeon reiterated his point that in twenty years he'd only seen a couple of torn muscles in those circumstances. Well, of course he had. Most of his patients were old; they didn't question his judgment; he didn't request radiology or do surgery to confirm his (mis)diagnoses; and his patients consequently got shunted off to nursing homes, where they'd eventually die without any challenge to his diagnoses. It was only because he was forced to investigate that he found anything to change his opinion. He may have been misdiagnosing people for decades.

Rebecca Hiles reports a lengthy history of pulmonary issues. She was unequivocally misdiagnosed, repeatedly, because she tells us that she kept on being given antibiotics for her cough and steroids for her bronchospasms and she was taking medication 3-6 times a day from "a gallon sized ziplock of medications". This is bad diagnosis and treatment, right there. Her life was miserable. Even if the cancer is rare (and that this isn't another example of confirmation bias) there was obviously something that was not being addressed by her palliative treatment. You imply that this is hard to diagnose - I have no way of refuting that - but why did they keep telling her to lose weight? There was obviously something there besides the weight issue. My answer is: obesity is easy to diagnose; it's almost always "good advice"; it is a pseudo-diagnosis that defers the need for a serious one. And that's a problem.
posted by Joe in Australia at 8:20 PM on June 29, 2015 [27 favorites]


Drpynchon, don't take this as a LOL DOCTORS AMIRITE, but many people - including myself - have observed a medical tendency, when confronted by something without a clear etiology, to seize on something that is easy to diagnose and hard to refute.

No arguments here. That's very common practice. But the dirty truth of the matter is that people expect answers. At the same time, there are tons of situations where the safest and most medically sound thing to do is to defer a diagnosis, live in uncertainty, and give things time to better declare themselves. Patients don't accept that easily, and a practicing clinician doesn't have the time in a 15 minute appointment to provide a lecture on Bayesian statistics and the idea that doing nothing is the best choice among a number of options.

Which is not to say that doctors are perfect. Assuredly not so. I see tons of crappy care all the time. But rather than speaking in generalities it's best to take things one case at a time. I think if you step back and reflect on the case you describe, you might agree that rather than a case of the doctor's just picking the easy answer, they were just plain bad at diagnosing the problem. I mean it's not like they did nothing. They ordered an unwarranted MRI of the brain because they couldn't do a decent exam of the leg. That's going down the wrong path because you're just plain a bad doc, not being a lazy diagnostician.

You imply that this is hard to diagnose - I have no way of refuting that - but why did they keep telling her to lose weight? There was obviously something there besides the weight issue. My answer is: obesity is easy to diagnose; it's almost always "good advice"; it is a pseudo-diagnosis that defers the need for a serious one. And that's a problem.

It's easy to diagnose yes. But at the risk of enraging the pitchfork carriers in the audience, it turns out to be a much better physiological reason for exertional shortness of breath than an early-stage endobronchial carcinoid is -- in fact dare I say, an endobronchial carcinoid so early and small as to not be visible on a CT scan just plain doesn't explain shortness of breath. Obese patients are significantly more likely to suffer from cough related to either asthma or GERD. Pulmonary function testing in obese patients demonstrates objective, measurable reductions in lung volumes. So it's not like the case of fat shaming and jumping on obesity because you come in with strep throat or a broken foot. It just isn't. And as pat advice, entertaining weight loss when there isn't a clear answer to someone's shortness of breath and cough is probably a well-intentioned, and dare I say decent idea as long as it doesn't interfere with due diligence.

The crowd here assumes that obviously there was something there besides the weight issue. So did her doctors. That's why they tried a host of medications. You're quick to ignore the very fact that the medications were tried is demonstable proof that her symptoms weren't blown off or purely ascribed to weight. Those weren't weight loss pills. The cognitive dissonance here is that you are surprised by all the meds, I'm not. Put the fat shaming issue aside for a moment. Let's say we were talking about this story in someone thin. Then the dominant narrative would just be about how bad a particular set of doctors were in misdiagnosing a person's carcinoid. But from the standpoint of someone who sees cough and shortness of breath all day long, its not a particular set of doctors. It's just doctors. And medicine. Chronic cough is extremely common and in the vast, vast majority of cases of 20 year olds, it's benign, and related to one a handful of things (asthma, GERD, post-infectious, post-nasal drip being most common). The medical work up to chronic cough is a very unsatisfying trial and error approach that typically involves a best guess, not tons of testing in the absence of red flags. So people do end up on reflux drugs, and allergy pills, and inhalers until something works. Not surprisingly, a very small fraction turn out to have something more insidious, but present without major red flags, and it takes forever to get the right diagnosis. I wish there were an easier way to diagnose everybody but there just plain isn't. If a CT couldn't catch a carcinoid, then the only test that might is a bronchoscopy, and even then, in the early stages it would be really easy to miss until it got much bigger. And these things grow slowly.
posted by drpynchon at 8:58 PM on June 29, 2015 [19 favorites]


Not to comment on this particular case but to defend drpynchons points a little, doctors like to, and have to, play the numbers, cause the numbers are mostly right. I completely agree that there are times when the numbers aren't right, as someone with a frustratingly generic presenting autoimmune disease (colitis), my path to diagnosis was long and frustrating. And symptoms like bloody coughing, like my symptoms, present a huge differential diagnosis, and the process that drives winnowing that down is essentially a process of elimination going from most probable to least probable, with other reported symptoms and factors taken into account. It's like that, because for most people, most of the time, it works, and it works best.

The process doesn't work for some people, but that doesn't obviate the process (or the fat shaming reported in this story and the thread), because it does really work for most. And remember this reduction is not always clean, symptoms contradict each other;patients consciously and unconsciously misreport symptoms, progress, setbacks etc, they're might be more than one disease in the mix. And doctors, especially gps, may not know much or anything about esoteric or unusual conditions. My doctor might disagree with me, but I know I know more about lymphocytic colitis than she does, because it's all I have to know about. It's not her fault.

I guess I'm saying in medicine you can have shit outcomes, missed signs, wrong diagnosis and more, it's a frustrating, fraught, frail discipline, still to this day, and it can happen with the best doctors giving the best care.
posted by smoke at 10:14 PM on June 29, 2015 [7 favorites]


The medical work up to chronic cough is a very unsatisfying trial and error approach that typically involves a best guess, not tons of testing in the absence of red flags. So people do end up on reflux drugs, and allergy pills, and inhalers until something works. Not surprisingly, a very small fraction turn out to have something more insidious, but present without major red flags, and it takes forever to get the right diagnosis.

Years ago I visited a friend and came back from the trip with what I thought was a bad cold. It escalated into a horrible chronic cough that lasted for months. I was coughing up blood, coughing until I vomited, and then the vomiting would set off a bloody nose and it was all a big mess. In retrospect it was almost certainly pertussis, because I had every symptom, was long out of date on the vaccine, had come back from a very crowded city, and my cough sounded uncannily like the "whoop" of diagnosed patients.

Anyway I had no health insurance so I didn't get scans, but otherwise was put on the same treatment plan as the author: try this allergy med, here's an inhaler, let's give you antibiotics, have an opioid cough suppressant, take Prilosec and see if that works. Nothing really worked but those were the only options given. There was no testing for anything else (certainly not pertussis). And I was at a healthy body fat level and involved in strenuous athletics for ~20 hours/week so it's not like they were dismissing me on the basis of weight.

This is not to dismiss the shaming the author experienced, but to illustrate drpynchon's account of mysterious cough diagnosis.
posted by schroedinger at 10:21 PM on June 29, 2015 [4 favorites]


I guess also I feel like we have a cultural narrative that encourages us - and encourages doctors, too - to think of illness and treatment and health in a certain way. In this discourse, doctors take on an almost mystical, oracular status, with an omniscient view to our essence and an almost boundless capacity to diagnose and treat.

When that discourse is undermined by our turgid experiences in the medical field, we feel betrayed. Our trust in medicine, which I truly do think carries a religious undertone in one form or another, is rejected and our compact to put our lives in the hands of doctors in exchange for a cure, is broken.

We are left feeling vulnerable, mortal, abandoned and alone.

When you overlay this with the capitalist belief that money can buy everything, and the vast sums poured into ineffective treatments, and the miracle treatments we receive for our more common or manageable illnesses, I think it can lead to a hard time for everybody when you have something from the 1%, or 0.01% of cases. We want them to be the same and resolve the same, but they are different.
posted by smoke at 10:26 PM on June 29, 2015 [7 favorites]


I read the article, and the entire thread.

First: I know how it feels to be an obese woman attempting to get health care in the US. I gained 60 pounds in 6 months, went to an endocrinologist, was told it was "in the normal range" and I should just wait 6 more months so he could recommend me for weight loss surgery.

Second: I have had countless physicians be at least dismissive and at most insulting due to my weight. I had an OB/GYN dismiss my problems for years because I was fat. She said I had horrible periods but they'd get better if I lost weight. Guess what? I had a HUGE fibroid that filled my entire uterine cavity. That was what caused my menstrual problems, not being fat.

Third: When I finally found a GP that actually listened to me, I got treatment for hypothyroidism. I got a caring doctor who wanted me to get my blood lipids into normal range but wasn't a dick about it. This was six years after the first endocrinologist visit.

Fourth: It is infuriating and frustrating being an overweight or obese person in at least the U.S. health care system, and I'm sure more worldwide. Many doctors assume you are lying. It sucks. But there is room for improvement. If doctors would assume that what their patients are telling them about discrimination is true, then they can better help their patients.
posted by bedhead at 10:38 PM on June 29, 2015 [11 favorites]


scrump, alas, I'm in Washington. My new doctor is with the heavily maligned Group Health, which I have personally found to be utterly fantastic.
posted by KathrynT at 11:44 PM on June 29, 2015


Oh and as regards the "doctors playing the numbers" thing: they do. It's very appropriate. I wish sometimes they didn't present the statistically likely option as being the only possible option, though.

About six weeks ago my 8 year old was cracking sunflower seeds between her teeth when one of her friends made her laugh, and she sucked the seed right down into her throat. She panicked and came running to me screaming that she was choking -- I pointed out that her running and screaming were a pretty sure sign that she was NOT choking, but she had some retractions and stridor, so I called paramedics. The paramedics showed up, verified that her lungs sounded clear, verified that her pulse ox was 99%, and said "She swallowed it. We see this all the time. One hundred percent, she swallowed it, you have nothing to worry about."

Six days later the ENT surgery team at Seattle Children's removed it from her left lung under general anesthesia in an emergency bronchoscopy, after her lung collapsed in the ED where I'd brought her because her hacky cough had gotten so suddenly so much worse. She's fine, absolutely fine. But I called the paramedics the next day and said "yeah, maybe next time don't be SO certain that she swallowed it."
posted by KathrynT at 11:54 PM on June 29, 2015 [17 favorites]


KathrynT, what does "retractions" mean in this context?

As for "stridor", that's a fine word, a ten dollar word if I ever saw one; I only knew what it meant because Lovecraft uses "stridulant".
posted by Joe in Australia at 3:46 AM on June 30, 2015


She's fine, absolutely fine. But I called the paramedics the next day and said "yeah, maybe next time don't be SO certain that she swallowed it."

Define certainty? Is 99% enough? 99.9%? The paramedics sees a 1000 cases like yours. By the time he shows up, symptoms have subsided because coughing and moving have displaced the seed to a different non-obstructive but precarious position in the airways. The exam is normal. Almost uniformly this means the seed was coughed out of the airway entirely. People beg for reassurance and certainty. They desperately want to be comforted by their providers. They sometimes have crippling anxiety about their health. He could tell everyone, "Well this is really unlikely to be anything serious but there is a small chance it could be horribly life threatening. Gee, guess we'll have to wait and see." In my experience people respond very poorly to this, and I say that as someone who embraces and speaks very openly about medical uncertainty with my patience. It's easier said than done. Surely sometimes providers speak in overly certain terms because of arrogance, but it turns out reassurance is awfully difficult to provide without a sense of certainty.
posted by drpynchon at 4:23 AM on June 30, 2015 [6 favorites]


Hey, drp, thanks for commenting and bringing your medical expertise to the discussion. I'd like to ask you a question and see if you have some good advice on it.

If you are a patient who is in a situation where you feel very strongly that you are being misdiagnosed because of your weight, what are the best steps you can take to get yourself the care that you need?

I'm not specifically talking about situations where something might be very difficult to diagnose like you are talking about with the carcinoids, but for a start more focused on some of the more day to day stuff people have brought up. E. Whitehall got the business from a Doc just for earwax which is like...mind boggling to me. My Doc just had the nurse flush it out and pointed me to some OTC ear drops and problem solved.

Are there good strategies you can take to come to a better relationship with your doctor, because switching is always hard, or should you start working with another Doctor if possible when you see these problems popping up?
posted by Drinky Die at 4:43 AM on June 30, 2015 [1 favorite]


Are there good strategies you can take to come to a better relationship with your doctor, because switching is always hard, or should you start working with another Doctor if possible when you see these problems popping up?

This is where I don't defend doctors. I see fat shaming all the time. It's very real. And I think to be honest, my disdain for it partly springs from reading and not discounting the many experiences described above which have cropped up on other posts on MeFi and elsewhere. The burden shouldn't be on the patients to change, it should be on the doctors. So I don't want this to come off as victim blaming.

Obviously the perfect answer is find a doctor who doesn't do this shit, but that isn't easy. If you have to work with a diagnostician with an over reliance on bringing weight into the equation, then from the patient's standpoint the natural inclination is to disconnect and not seek care for fear of negative reinforcement, something a lot of people have expressed. Hard as it may be, I suspect (and this is just a very lay opinion) the more effective strategy to get necessary care is to be persistent, come back repeatedly with your complaints if necessary, and (unfair as it may be) to not spend the visits adversarially engaging about the weight issue. I guess I would shift the conversation as quickly and unemotionally as possible back to alternatives. "Fine, I'll keep working on my weight, but what else do you think this could be?" But this is a crap therapeutic relationship to be in if you're stuck with someone who doesn't genuinely empathize or is to the point of being diagnostically biased by weight. I'm as curious as you are about other people's experiences with effectively dealing with this in a way that doesn't sour the therapeutic relationship.
posted by drpynchon at 5:13 AM on June 30, 2015 [13 favorites]


I'm in a health system that specifically asks their doctors to address weight at a separate appointment but they do press you to make that appointment if you're obese. I've also had good luck admitting that part of a problem is caused by my weight (eg my GERD is certainly related to my weight) but that it takes time to lose weight, so what else can we do? That way they don't feel the need to inform you all about how weight loss would help.

I've certainly had docs that were just assholes though and in that case I have no tips. It's a terrible feeling to be vulnerable and be treated poorly. After my most recent run in with a terrible gynecologist I'm really avoiding doctors.
posted by internet fraud detective squad, station number 9 at 7:22 AM on June 30, 2015 [5 favorites]


Joe in Australia: KathrynT, what does "retractions" mean in this context?

It means that every time she took a breath, the structures of her neck collapsed inwards, the way a straw would if you were drinking bubble tea and one of the pearls got stuck in the straw. You can find many good examples on YouTube.

As for "stridor", that's a fine word, a ten dollar word if I ever saw one; I only knew what it meant because Lovecraft uses "stridulant".

I'm having a really hard time reading this as anything other than totally snarkily dismissive, to be honest. "A fine word"? "a ten dollar word"? It's a medical word that describes an audible creaking sound on breathing, which is what she had, so that's the word I used. I know what it means because my other child has a terribly significant croup history and his doctors have explained it to me during our multiple ER visits for that issue. Sometimes people use words not because they're trying to be all fancy but because they are the appropriate terms to describe the issue.

drpynchon: Define certainty? Is 99% enough? 99.9%?

Call me crazy, but I think a medical professional should only say "No other outcome is possible" if that's actually true, which it demonstrably was not in this case. I'm not saying they should have rushed us to the hospital or even told me I should take her to the hospital; I'm saying that I would have preferred this if they said "We see this all the time, and we're confident that she swallowed it. If her symptoms don't resolve completely over the next 48 hours, though, you should follow up with your doctor." Because I delayed care because of their certainty -- I had the very strong sense that something was wrong, but I didn't want to be the dumbass mom who hysterically insisted that something was wrong with her precious baby when I had been told in no uncertain terms that was impossible. I know how doctors talk about those mothers; nobody wants to be the subject of those discussions. Like I said, she's fine, but she was pretty freaking close to not-remotely-fine by the time my gut instincts punched through my inherent trust in my medical providers.

People beg for reassurance and certainty. They desperately want to be comforted by their providers.

It's very frustrating to have doctors saying both "But we have to tell you the Truth(tm) about how being fat affects your health, even if it makes you uncomfortable and ashamed and is probably not connected to your symptoms, because we are doctors and the truth is more important than your comfort" and "But we have to lie to you and tell you that bad outcomes are impossible and that everything's going to be fine, because you people desperately want to feel comfortable."

I recognize that it's a difficult needle to thread, and that different patients need different kinds of handling, and that it's not appropriate to walk out the full differential with everyone or maybe even most people. But I don't think it's outrageous to suggest that you shouldn't tell someone that life-threatening complications are impossible unless they actually are.
posted by KathrynT at 8:06 AM on June 30, 2015 [17 favorites]


I'm as curious as you are about other people's experiences with effectively dealing with this in a way that doesn't sour the therapeutic relationship.

I've had good results by beating them to the punch, kind of. When I see new providers or specialists, I usually start off by saying "I am aware that I am fat -- you don't have to pretend that I'm not. It's been a lifelong struggle for me, and while I have occasionally been successful at losing significant amounts of weight, maintaining that rate of loss requires more resources than I reliably have available. Rather than beat myself up about the fact that there are only 24 hours in a day, I choose to maximize the resources I do have; I find that if I avoid sugars and refined starches, manage my portions, and get 3-4 hours of moderate exercise a week, I can keep my labs in a decent range and at least not gain weight, without compromising my ability to run my life and care for my family."

Then, if it's appropriate (and I can usually force it to be appropriate one way or another), I say "One of the reasons I'm so motivated to get {whatever the issue is that I'm seeing the doc about} taken care of is because it's really affecting my ability to eat well and exercise, and it's crucial to me that I be able to do those things -- not just for long-term health reasons but to help my mood, sleep, appetite, and energy levels day-to-day." It's a lot harder for a doctor to say "Well your knee wouldn't hurt so bad if you'd just lose weight" when you've opened the conversation by saying "Doctor, my knee hurts so bad I've had to stop working out, and I'm concerned about what the long-term effects of that are going to be."
posted by KathrynT at 8:23 AM on June 30, 2015 [9 favorites]


Hi! So one of the things I want to note @drpynchon is that you're absolutely right. Endobronchial Carconoids are incredibly rare. The whole "When you hear hoofbeats think horses, not zebras" is the reason my cancer ribbon is zebra print ;) For anyone who is curious, this particular flavor of cancer typically presents in the bowel, not the lung, and even in the lung, the chances of it being inside the bronchial tube is much, much lower. It's a rare cancer... I *am* a special snowflake (sorry, I thought it was funny haha).

I do want to make a a couple of other notes. I don't blame the doctors for asking me to lose weight. I had clear panels, sugar, cholesterol, all of it was well in the normal range. If an otherwise healthy 23 year old patient is coming in having trouble breathing, I would *also* recommend an attempt to lose weight.

What I wouldn't do is decide that (after interventions ranging from a check in-check out log at my gym to a food journal to a strict diet that eliminated most allergens [after about 3 months that shit stopped, because amaranth and quinoa are DISGUSTING]) the problem is only connected to the weight, and shrug it off with a throw away diagnosis and add meds on top of my meds. If they couldn't figure it out, they just sent me to another doctor. There was a point when I was telling my doctors that medications weren't working, and instead of pulling the meds, they added more on top, when I had side effects, they treated the side effects instead of the problem.

In terms of physical aspect, from middle school to age 23, I walked anywhere between 2 and 3 miles nearly every day. In Pittsburgh my high school is one one hill, and my house was on another, so I got the added bonus of getting to say I walked to school uphill both ways, in all kinds of weather ;) In college it was just one particularly nasty hill haha. I've also been dancing (jazz, ballet, and tap) since I was 11 or so? I performed in theatre rather often, and so much of my time not walking was attached to dancing. I originally majored in musical theatre (with a focus in vocal performance... I feel like that's an appropriate use of the word Irony haha)

Around the time I finally saw my current PCP, I was already having trouble walking 2 miles, much less 3. So when I got to her office, I sat there and we talked about weight loss, and I told her my routine, showed her my food journal. When I talk about how amazing she is, it's because she's the first doctor who didn't say "well, let's try this medication while you lose some weight" but rather "I'd like you to lose at least 33 pounds (10% of my then body weight), but let's see if there's something else going on." She scheduled an assload of blood work, a ton of x-rays.

As a quick note about my PCP for missing this, my partner and I moved to Alexandria VA in December of 2011, I didn't see her for the first time until sometime around February/March or so. I was diagnosed 7-8 months later. She was helping me get rid of meds that didn't work and substitute meds that did. During that time she ordered every test she could think of that might explain my symptoms (though, she's not an oncologist, so the specific test that my oncologist *does* do [Chromogranin A blood test, and 24 hour 5-HIAA urine test, sexy] wasn't really in her repertoire). The last test she sent me for before I got my final diagnosis was a complete allergy test.

One final thing to note here, the fat shaming was problematic because doctors were very quick to dismiss my concerns with my weight, even when I was telling them that something felt VERY wrong with my body. I am not being hyperbolic when I say that I was researching inpatient facilities before my diagnosis. That being said, typically carcinoid cancer and carcinoid tumors present with carcinoid syndrome. That includes Skin flushing (temporary), facial skin legions (spider like veins on face), Diarrhea, Difficult breathing (temporarily with the skin flushing).

The only symptom I had was consistent Diarrhea, which we attributed to the medications fucking with my gastrointestinal tract.

Sorry I'm not keeping up with the conversation, it's been a busy week here. Thank you all for sharing your stories though!
posted by TheFriskyFairy at 8:32 AM on June 30, 2015 [9 favorites]


It's a lot harder for a doctor to say "Well your knee wouldn't hurt so bad if you'd just lose weight" when you've opened the conversation by saying "Doctor, my knee hurts so bad I've had to stop working out, and I'm concerned about what the long-term effects of that are going to be."

Funny, no doctor I've ever been to has ever had a single moment's difficulty doing exactly that.
posted by The Underpants Monster at 8:40 AM on June 30, 2015 [4 favorites]


Hit "post" too soon. The usual reaction to a comment like that is to shrug, laugh, or say, "Well, I don't know what I can do for you, then."

And yes, it would be nice to have the luxury of "just finding another doctor." But we don't all live in big cities with plenty of doctors in every specialty, especially ones in our insurance provider network, especially ones who are taking new patients, especially ones who can see you sooner than several months from now. We don't all have insurance where you can self-refer, so that can mean another trip back to your PCP for a referral, if they'll give you one just for the asking, and if you can get in to see them right away. And even if you have a relatively low copay, those buggers start to add up, especially if you're managing multiple chronic conditions. If you have one of those conditions where the standard treatment is a long chain of stab-in-the-dark prescriptions where you throw pill after pill at the wall and see if one sticks, those copays add up, too. I'm not even taking into account the mental, emotional, and physical stress of starting over and over again. So, doc-shopping isn't really the most practical solution for everybody.
posted by The Underpants Monster at 8:49 AM on June 30, 2015 [1 favorite]


The usual reaction to a comment like that is to shrug, laugh, or say, "Well, I don't know what I can do for you, then."

ANGRY HISS

This is the sort of shitty dismissiveness I forget about because it's never really happened to me, probably just due to sheer luck. I am so sorry. And yeah, I totally get it on the copays and the doctor switching -- my copay right now is $40 and it doesn't take too many of those before you're talking about a significant sum of money.

In a situation like that one I would be very tempted to say "So, you think it's appropriate for me just to become resigned to a sedentary lifestyle, with all the associated comorbidities that brings? Can I get a letter to that effect to give to my insurance company?" but that would DEFINITELY "sour the therapeutic relationship" as drpynchon put it.
posted by KathrynT at 9:22 AM on June 30, 2015 [1 favorite]


Call me crazy, but I think a medical professional should only say "No other outcome is possible" if that's actually true, which it demonstrably was not in this case.

I agree with all your points and frustration, though certitude to a point of "no other outcome is possible" is unquestionably harmful in my experience. Just visit any ICU to understand why. If at times a call to truth is used as an unfair crutch for bull shit fat shaming then it should be called out as such. I think the way you phrase how the advice should have been given is excellent, and plan to use something amount to your story as a teaching case with your permission. I guess my point was that these things can be well-meaning and come from a good place, and not necessarily from hubris.
posted by drpynchon at 9:24 AM on June 30, 2015 [4 favorites]


Wait... people really think coughing up blood is a normal consequence of being fat? Really?
posted by bgal81 at 9:25 AM on June 30, 2015 [2 favorites]


What I wouldn't do is decide that (after interventions ranging from a check in-check out log at my gym to a food journal to a strict diet that eliminated most allergens [after about 3 months that shit stopped, because amaranth and quinoa are DISGUSTING]) the problem is only connected to the weight, and shrug it off with a throw away diagnosis and add meds on top of my meds. If they couldn't figure it out, they just sent me to another doctor. There was a point when I was telling my doctors that medications weren't working, and instead of pulling the meds, they added more on top, when I had side effects, they treated the side effects instead of the problem.

100% agree. That's bad medicine, clouded by prejudice. Still, carcinoids are sneaky fuckers. Usually they don't get diagnosed until they are easily visible on a CT, there's full on carcinoid syndrome, or someone is coughing up blood almost continually. Every case I've seen (maybe 15) met one of those criteria prior to diagnosis.
posted by drpynchon at 9:34 AM on June 30, 2015 [3 favorites]


I think the way you phrase how the advice should have been given is excellent, and plan to use something amount to your story as a teaching case with your permission.

Absolutely you may! If you memail me, I can send you a link to a video of my daughter's retractions and stridor that you can use as part of that.

When the deputy chief of the paramedics called me back, after we established that I was providing feedback for future situations more than filing a complaint about this one, he told me "This case is going to be the keystone of this month's ride review" (which I guess is like an M&M for paramedics?) "because it's such a good example of why you can't let your professional experience override your knowledge. Because, we get this call ALL THE TIME! Once a week at least, once a DAY between Thanksgiving and Christmas when people are eating constantly. And every single time that we've shown up and people have had unobstructed breathing and good oxygen saturation, it's because they've swallowed the obstruction. Every time. But that doesn't mean that we should be so firm that it's the only option, because it obviously is not." I was really pleased by that response.
posted by KathrynT at 9:42 AM on June 30, 2015 [7 favorites]


nobody ever chooses to be overweight.
Sure they do. Some people are over the 'ideal' number on the charts, but are quite happy with their bodies. Or at least, that's what they say, and I see no reason not to believe them. If you decide that you prefer to be a certain weight, or just that you prefer a particular way of eating, and you're happy with your weight, it's none of my business.
posted by theora55 at 5:04 PM on June 30, 2015 [2 favorites]


Malpractice attorneys make a great living because docs assume instead of diagnose. There is no reason for the behavior except laziness. It does not take any longer to do it right. Perhaps we need computers to process patients.
posted by OhSusannah at 8:45 PM on July 3, 2015 [1 favorite]


Many years ago, I worked for a psychiatrist who (among other niche specialties) had a thriving practice working with parents who had youth who were "problematic". By which I mean, kids and teenagers who were acting out in huge ways - legal problems, significant addictions, violence toward family members and strangers alike, running away from home, skipping school.. far, far beyond "normal" rebellious behaviours.

The parents were usually in crisis by the time they called and had exhausted all the options available to them. It was not uncommon for me to answer the phone to someone who was already gasping for air through their sobbing - who couldn't even tell me their name, let alone why they were calling. I'm talking about parents who were just beaten down. Desperate. Willing to pay hundreds of dollars per week to get some sort of meaningful help.

To get into the support group and the private counselling, the parents had to come for an intake - fill in some questionnaires, talk to the shrink, and explain what they had tried and what had failed. It was usually really emotional, of course, so I'd often see parents red-faced and puffy eyed on leaving.

One woman left the appointment seeming more distressed than I'd ever seen - she stormed out. The shrink came out and told me to move her file to the "hold" section, meaning that she either needed time to think about it or there was some other barrier to her participating. The shrink explained to me that the woman was just too fat.

22 year old me - already chubby, but probably not really "fat" yet - was confused and said so. The shrink told me that he would not help this woman because it was clear that she was already out of control herself. That he could not provide her with support, or guidance, until she lost a significant amount of weight. If she didn't, her kids would never take her parenting authority seriously, she could not expect to change her kids' behaviours, and well, she basically deserved to live in this hell. How absolutely, ridiculously, preposterously wrong is that perspective??

That was the first time I realized that doctors are not gods and have biases and prejudices like the rest of the world. I really wish I had held on to that belief a few years ago when my own doctor started telling me that everything wrong with me was because I was fat (which I am). I have recently switched doctors to one who is, so far at least, much more reasonable - but those were some long years in between..
posted by VioletU at 3:03 PM on July 4, 2015 [4 favorites]


Ugh. Fatphobia among mental-health professionals is longstanding and horrific, with the assumption that a client who's fat must automatically have deep-seated psychological problems causing the fatness. I wish body size was talked about more as a cultural-competency topic in training programs so that more therapists and psychiatrists would be confronted with their own biases so they could learn to better correct for them.
posted by jaguar at 4:09 PM on July 4, 2015 [4 favorites]




Whoah. What, exactly does he get?? I read the whole thing and, yeah, thanks for throwing fat women a bone and acknowledging that we're usually treated shittier than fat men, but everything else is either towing the party line or worse. I don't find it at all helpful--or frankly, even necessarily believable--for this dude to explain his huge weight loss as having been so simple and easy. IF he's telling the truth about that, he's an extreme rarity, but many people who are already prone to blaming fat people will use this as fodder for their narratives about how easy it would be to lose weight if only the fatties would try. And the usual uncritical recitation of the supposed health risks of being fat per se, I mean, seriously, do we need that yet again? What does that add to the societal discourse?
posted by mysterious_stranger at 2:52 AM on July 12, 2015 [1 favorite]


As long as people are engaging in science denialism about the "supposed" risks, then yeah we still need to discuss them because what they add to the discourse is truth and understanding.

As for what he gets, I think points 3, 4, 5, 6, and 7 are areas where (especially) men who have experienced weight loss often really don't get it right but he does.

many people who are already prone to blaming fat people will use this as fodder for their narratives about how easy it would be to lose weight if only the fatties would try.

I think he does as good a job as he could to make it clear his experiences are not universal. The reality is his story is one story among many story overweight people may experience. It sucks that weight loss is harder or impossible for some people. But it also sucks that some people go through life wanting to lose weight and not realizing that for some people it is possible without it dominating your entire life and making you miserable.

So, you kind of have to try and strike a balance. Don't preach that weight loss is impossible or that being overweight is without health risk. Don't preach that it's easy for everybody and anybody who doesn't get on bored is irresponsible, weak, and going to die of a heart attack tomorrow.
posted by Drinky Die at 3:30 AM on July 12, 2015 [1 favorite]


I think it's also really important for people to realize that men and women have vastly different biological systems for weight loss/gain/retention, so if a man's story doesn't ring true to a woman (or vice versa) that might be because it's simply not applicable. People should also be very careful about thinking there are weight loss truths that work for men and women. I think women really get screwed on this because we're told to do the things that work for men, when they don't work for us.

For example, women tend to have increased appetite when we do lots of physical activity, whereas men tend to have decreased appetite when they do lots of physical activity. So maybe for a lot of women, limiting their activity and not doing lots of cardio could help them stick to a good weight-loss diet. But the standard advice is diet + exercise.

Obviously exercise is good for you for a number of non-weight-loss reasons, but if you're specifically dieting to lose weight, you might choose to make it easier for yourself by limiting cardio for a certain period of time. It's worked super well for me to just diet and limit activity, whereas diet + exercise has inevitably collapsed in a few days or even led to weight gain.

Nobody says this, though, it's always diet + exercise, and so then when it works for men it obviously "works" and the people it doesn't work for must be fucking up. That's not the case, though.
posted by internet fraud detective squad, station number 9 at 8:23 AM on July 12, 2015 [3 favorites]


As long as people are engaging in science denialism about the "supposed" risks,

Well I think the key word here is "risk," as an, "it may happen and it may not." I know fat people who've never had a sick day in their lives, and plenty more whose illnesses and injuries have been completely non-weight-related. A lot of people act like the risk of weight related illness is not a risk, but an inevitability.
posted by The Underpants Monster at 10:37 AM on July 12, 2015 [3 favorites]


« Older “We look for people who are isolated,” he said.   |   All Engine Running Newer »


This thread has been archived and is closed to new comments