strange to be in the care of someone you anticipate will hurt you
March 31, 2023 10:58 AM Subscribe
Dismantling medical fatphobia. An essay by public health scholar Marquisele Mercedes for Pipe Wrench's 2022 special issue on fatphobia. Content warning for medical trauma. An essay on how fatphobia affects patients looking for doctors: "How much can I figure out in advance about this person’s fatphobia? Can I get any clues that they’ll treat my symptoms and problem, or will this be another conversation about my body size that ignores the actual issue? Will they actually touch my body or treat me with disgust?"
The issue includes A Visual History of Futility or, Diet Ads of the 20th Century and Valuing Fatness: A Fat Studies Reading List.
Ragen Chastain on Things to Stop Saying/Doing To Fat Patients At The Start Of Their Appointments
The issue includes A Visual History of Futility or, Diet Ads of the 20th Century and Valuing Fatness: A Fat Studies Reading List.
Ragen Chastain on Things to Stop Saying/Doing To Fat Patients At The Start Of Their Appointments
Just wear two gowns.
It’s bad enough to find that a facility hasn’t bothered to purchase gowns that fit you, but this is often followed by a suggestion that you wear two gowns
Also from Mercedes (post includes a photo of a person standing in their underwear and bra): posted by spamandkimchi at 11:02 AM on March 31, 2023 [2 favorites]
There have been multiple separate news articles about different women going to the Dr where the story goes like this
Patient presenting to the Dr with abdominal pain and swelling
Dr = "You just need to lose weight"
Patient = "I am eating very little, eating hurts"
Dr: "You are lying, your stomach would be flat if you ate very little"
[time passes]
Dr: "Whoops, turns out you have stage 4 Ovarian cancer/Stomach cancer, and what I thought was abdominal fat was in fact a giant tumour, too bad, too late to save your life now!"
posted by chariot pulled by cassowaries at 11:20 AM on March 31, 2023 [10 favorites]
Patient presenting to the Dr with abdominal pain and swelling
Dr = "You just need to lose weight"
Patient = "I am eating very little, eating hurts"
Dr: "You are lying, your stomach would be flat if you ate very little"
[time passes]
Dr: "Whoops, turns out you have stage 4 Ovarian cancer/Stomach cancer, and what I thought was abdominal fat was in fact a giant tumour, too bad, too late to save your life now!"
posted by chariot pulled by cassowaries at 11:20 AM on March 31, 2023 [10 favorites]
Amanda Lee is 27 and has Stage 3 colon cancer that has spread to her lymph nodes. When she first went to see a doctor, he diagnosed her as fat
"He was praising the fact that I was not eating. Doctors are killing us and calling it care."
posted by chariot pulled by cassowaries at 11:22 AM on March 31, 2023 [4 favorites]
"He was praising the fact that I was not eating. Doctors are killing us and calling it care."
posted by chariot pulled by cassowaries at 11:22 AM on March 31, 2023 [4 favorites]
Women Are Calling Out ‘Medical Gaslighting’
Studies show female patients and people of color are more likely to have their symptoms dismissed by medical providers. Experts say: Keep asking questions.
posted by chariot pulled by cassowaries at 11:23 AM on March 31, 2023 [3 favorites]
Studies show female patients and people of color are more likely to have their symptoms dismissed by medical providers. Experts say: Keep asking questions.
posted by chariot pulled by cassowaries at 11:23 AM on March 31, 2023 [3 favorites]
I have read so many painful and infuriating stories here on MetaFilter from people who have suffered fatphobia from their medical professionals. It breaks my heart and appalls me.
I have only gotten halfway through the first article, but I am so angry on Mercedes's behalf, and so sorry for her that she went through any of that.
This is an extremely painful read, but I'm glad to have the opportunity to hear these truths, to know what's happened to so many people. Thank you for posting this, spamandkimchi.
posted by kristi at 11:31 AM on March 31, 2023 [5 favorites]
I have only gotten halfway through the first article, but I am so angry on Mercedes's behalf, and so sorry for her that she went through any of that.
This is an extremely painful read, but I'm glad to have the opportunity to hear these truths, to know what's happened to so many people. Thank you for posting this, spamandkimchi.
posted by kristi at 11:31 AM on March 31, 2023 [5 favorites]
Gonna read this ASAP but as a (small fat) fat chick, I am delighted to report that my GP said exactly nothing about my weight at my mid-year checkup this morning. I have definitely had problems dismissed because of my weight (looking at you, former rheumatologist) but I feel very happy with my current doctors. There are a few good ones out there.
posted by gentlyepigrams at 12:28 PM on March 31, 2023 [6 favorites]
posted by gentlyepigrams at 12:28 PM on March 31, 2023 [6 favorites]
Probably spend 10x as much time trying to talk people out of wasting effort on losing weight and instead devoting their self-care bandwidth to any type of mental and physical health improving exercise. Once a person is overweight or obese the odds of any real reduction long term is pretty low to the point of it being a charade and cruel to imagine success. But also the arc of aging is determined by luck and movement, and almost not a bit secondary to weight. So yes, I agree it is moronic, cruel, and disingenuous to spend time discussing weight with patients when it is not asked of us.
We will see pharmacologic options improve in the near term so that in cases where weight loss is medically critical we can offer patients a fighting chance.
I do think we need to acknowledge, if possible, that obesity does make treatment of some issues challenging if not impossible. But that is true for lots of things.
posted by docpops at 2:23 PM on March 31, 2023 [3 favorites]
We will see pharmacologic options improve in the near term so that in cases where weight loss is medically critical we can offer patients a fighting chance.
I do think we need to acknowledge, if possible, that obesity does make treatment of some issues challenging if not impossible. But that is true for lots of things.
posted by docpops at 2:23 PM on March 31, 2023 [3 favorites]
I'll wait to comment on the main article until I've finished reading it, but I have to say that the "A Visual History of Futility or, Diet Ads of the 20th Century" link is both fascinating and horrifying, to see how these have been advertised over the years.
posted by Dip Flash at 3:51 PM on March 31, 2023
posted by Dip Flash at 3:51 PM on March 31, 2023
About 15 years ago I had a massive depression incident that lasted two months and I almost lost my job as a result, but I did finally get out of it enough to get psychological help.
Except the one that insurance sent me to was convinced that my entire problem was my weight and she ended up almost sending me into that depressive fugue again.
A goddamn psychologist should know better than to give a patient information about Overeaters Anonymous and Weight Watchers.
posted by mephron at 8:26 PM on March 31, 2023 [6 favorites]
Except the one that insurance sent me to was convinced that my entire problem was my weight and she ended up almost sending me into that depressive fugue again.
A goddamn psychologist should know better than to give a patient information about Overeaters Anonymous and Weight Watchers.
posted by mephron at 8:26 PM on March 31, 2023 [6 favorites]
mephron, I am so sorry you had to hear that. She should have known better. Once I went through intensive group therapy with a number of women from a lot of different experiences, and there were rules about what we shouldn't mention to avoid triggering people. One was food, in any capacity. I was chided (though very gently) for making a joke about cheese.
The damnedest thing about that list of ads is that there is something, something inside me, that says: did they work, though? I mean, I know the "reducing soap" and the rubber garments didn't. And I know the cigarettes did, at a price I can't pay. I'm also old enough to have tried the Special K diet and Slim-Fast as a teen -- I kept getting too dizzy to stick to them, which at the time I thought was my fault. And for that reason, I'm old enough to have that button installed inside me that the ads can still push, even though the products are long dead (or have had their ingredients replaced). I really hope more young girls and women don't feel this way.
posted by Countess Elena at 9:00 AM on April 1, 2023 [2 favorites]
The damnedest thing about that list of ads is that there is something, something inside me, that says: did they work, though? I mean, I know the "reducing soap" and the rubber garments didn't. And I know the cigarettes did, at a price I can't pay. I'm also old enough to have tried the Special K diet and Slim-Fast as a teen -- I kept getting too dizzy to stick to them, which at the time I thought was my fault. And for that reason, I'm old enough to have that button installed inside me that the ads can still push, even though the products are long dead (or have had their ingredients replaced). I really hope more young girls and women don't feel this way.
posted by Countess Elena at 9:00 AM on April 1, 2023 [2 favorites]
Medical professionals think pain, trauma and early death are apt punishments for people who dare to be fat (or who sin in other ways, like having a substance addiction) and that they're perfectly justified in enabling these things to happen by not doing their fucking jobs. Do no harm my ass.
posted by Stoof at 11:39 AM on April 1, 2023
posted by Stoof at 11:39 AM on April 1, 2023
Had a hard cry looking through the Diet Ads of the Twentieth Century. How aware of and hostile to this bullshit I’ve been all my life (a relatively slim mother perpetually talking about her need to lose five pounds, Slim-Fast and workout videos bought for my beautiful, strong, thick sister) - and *yet* how deep in my brain all these hateful messages are still stuck. The work continues.
posted by rrrrrrrrrt at 1:19 PM on April 1, 2023
posted by rrrrrrrrrt at 1:19 PM on April 1, 2023
i once had to a do a stress test naked from the waist up (sensors and whatnot) because they didn't have a gown to fit me. nice and shameful being fat with my titties flopping around as i tried to trot for as long as i could at a steep incline.
posted by misanthropicsarah at 12:35 PM on April 4, 2023
posted by misanthropicsarah at 12:35 PM on April 4, 2023
The word "noncompliant" in medical records enrages me every time I see it. Both as a fat chick (where "noncompliance" is "not doing the impossible by losing weight") and as a person with chronic illness (where "noncompliance" is refusing to take medication whose side effects are, for me, not worth the good I get from the medication).
Noncompliance is about the practice of medicine as a machine caring for machines (the human body as a machine). It's about the mechanic telling you what to do with the flesh machine according to the specifications, which may not have anything to do with you, to get the numbers (weight/cholesterol/blood pressure/etc.) right. And a lot of that is driven by for-profit medicine where doctors get money (financial incentives) when they get their patients' numbers in the correct zone and lose money when they don't. Some doctors are better about not succumbing to this than others but the incentives push doctors to be assholes.
Also my doctor is not the boss of me! I pay the doctor (through my copays and my insurance payments) to help me maintain my health. The doctor's incentives are to push me to do things to benefit them and their relationships with their employer, the insurance companies, and the drug companies (among others). But my incentive is to live my life with a balance between the best health and things like happiness. I don't care if my numbers are great if I can't get out of bed because of pain or medical side effects! So the incentives of the person I'm paying to take care of me are radically different to mine and that's an underlying problem with the health system (in the US, YMMV elsewhere) for fat people and lots of other folks.
posted by gentlyepigrams at 2:49 PM on April 4, 2023 [1 favorite]
Noncompliance is about the practice of medicine as a machine caring for machines (the human body as a machine). It's about the mechanic telling you what to do with the flesh machine according to the specifications, which may not have anything to do with you, to get the numbers (weight/cholesterol/blood pressure/etc.) right. And a lot of that is driven by for-profit medicine where doctors get money (financial incentives) when they get their patients' numbers in the correct zone and lose money when they don't. Some doctors are better about not succumbing to this than others but the incentives push doctors to be assholes.
Also my doctor is not the boss of me! I pay the doctor (through my copays and my insurance payments) to help me maintain my health. The doctor's incentives are to push me to do things to benefit them and their relationships with their employer, the insurance companies, and the drug companies (among others). But my incentive is to live my life with a balance between the best health and things like happiness. I don't care if my numbers are great if I can't get out of bed because of pain or medical side effects! So the incentives of the person I'm paying to take care of me are radically different to mine and that's an underlying problem with the health system (in the US, YMMV elsewhere) for fat people and lots of other folks.
posted by gentlyepigrams at 2:49 PM on April 4, 2023 [1 favorite]
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