Doctors, Bedside Manner, and Weight: Fat Prejudice in Health Care

Doctors, Bedside Manner, and Weight: Fat Prejudice in Health Care

I know I’ve written about this before… but if not, I don’t mind saying this again:

I remember being in high school.. and my doctor never – never – mentioned my weight. I can’t say, for sure, exactly why that was… but this very cheery, young, happy doctor would tell me “Well, you’re 215lbs, but that’s ok.. you’re just tall.” He wouldn’t look at last years chart to see whether or not I’d gained 20lbs in one year. He wouldn’t talk to me about food or activity levels at all. He’d just bypass the subject altogether.

I’d eventually go on to gain weight at a pretty ridiculous rate for the next few years.

Needless to say, I didn’t experience that which I’m about to write about… but that doesn’t mean I can’t highlight the confusion, here.

Welcome to First, Do No Harm: Real Stories of Fat Prejudice in Health Care. This is a website that chronicles stories of medical bias and prejudice occuring between doctors and their patients.

Every so often, I get someone who comments about their doctors and how uncomfortable their doctors have made them in regards to their health. There’s even a tale on this site of a woman who’s doctor clearly overlooked signs of pneumonia because the doctor wanted to primarily focus on the patient’s weight. It’s easy to see that many of us fear going to the doctor – something all too common in the Black community – but you’ve got to admit, this poses a big problem for us. For those of us who can move beyond the “Ahhh, I don’t neeeeed to go to no damn doctor” attitude and actually go… if we – Black Americans, of whom, approximately 60% are overweight – go to the doctor and are met with bedside manner like that mentioned below… how many of us will actually keep going?

Last April, after four months of hard exercise and healthy eating with only four pounds of weight lost, my mom suggested I get tested for hypothyroidism. She had recently lost about 40-50 pounds after getting her hypothyroidism under control, and it had also been diagnosed in my grandfather, aunt, and cousin. Considering it’s hereditary, I figured I might as well and set an appointment with a doctor at Austin Regional Clinic to get tested. I’d heard a lot of negative feedback about ARC, mostly that they treat illnesses, but don’t deal with/care for preventative treatments. They were the only people I could afford that took the s—ty insurance I had though, so I really didn’t have much of a choice.

When the doctor came in to see me, she didn’t even look me in the eyes before she flipped a page on her chart and said, “You know you’re obese, right?” She didn’t even make fucking EYE CONTACT with me before she just came out with her b—s— BMI calculations to tell me that I needed to lose weight. I said, “Well yeah, that’s why I’m here. I work out hard and nothing happens, so we thought it might be a thyroid problem.” She lectured me for a bit about needing to eat better and work out longer, but didn’t let me explain that I do eat well and I do work out.

The most commonly accepted threshold for TSH levels is 5.0, but I had read some studies saying that the reason those TSH levels were so high was that there were a lot of people with untreated hypothyroidism included in the studies to determine the average. My mom’s doctor, who spotted and subsequently treated my mom’s hypo, follows a couple of studies that came out a few years ago saying that the recommended TSH levels are actually 3.0, with another expected drop to 2.5 in the next few years. To accurately diagnose hypothyroidism though, you need to compare those TSH levels to triglycerides, blood sugar, blood pressure, cholesterol, etc, and you can’t base a positive or negative diagnosis just on TSH levels. It also helps to have a family history when diagnosing, so you can determine when the spike in TSH levels generally occurs in your family, but when I tried to tell her about the other members of my close/immediate family that experienced this, she shushed me.

After the embarrassing lecture from the completely inept doctor, I tried to bring up the new studies with the lower TSH levels, but I was so frazzled and she was so uninterested that she wrote me off with what amounted to “I’m a doctor and you’re not so shut up.” She shuffled me off to the lab so I could get my blood tested, without telling me what she was actually going to test. I guess I figured “she’s a doctor so she knows what she’s doing” and didn’t question the lab tech about what was on my chart. I got an automated call two days later with my results, a TSH of 2.56, but no explanation or diagnosis of those results.

I called and left three messages for the doctor before getting a returned call from her one week later. She succinctly said, “You don’t have hypothyroidism,” and when I asked her about the other aspects she was supposed to test, she said, “I decided not to test those.” When I told her about the specific scientific journals where I read about the new TSH levels, she basically said she hadn’t read/heard about that and didn’t really care.

I was talking to my mom over Christmas about something I thought was entirely unrelated (okay it was constipation you guys, are you happy?) and she said that was something she experienced a lot of before she started getting her thyroid under control. I went home and looked at related symptoms for hypothyroidism, besides unmanageable weight, and it was basically like a checklist of s— I deal with that I thought was just my own bad luck – unnaturally heavy and unreliable periods, very dry skin, sensitivity to cold, brittle nails, and achy muscles.

So now here I am, almost a year later, and still basically the same exact weight. I work out HARD for about 1.5 hours a day, I eat remarkably well, and have even started eating m—–f—– vegetables. I do everything a person is supposed to do to lose weight, and I’ve made practically no progress. My mom and I have decided that I really need to be tested again, and this time by a doctor who actually knows her s— and not some worthless s—head at ARC.

Which leaves me in a jam. I am broke. I make like negative dollars in my paycheck, and I have a lot of bills to pay every month. I don’t have $100 to spare on a monthly basis, but I need insurance if I want to get this treated. My only other option is to pay $353 for the initial tests and hope the doctor can figure everything out on the first try because I can’t imagine being able to scrape that together more than once.

What would you do? Would you stay chubby and hate yourself a little more every day, while losing the will to continue working so hard to lose weight and because you see absolutely no results? Or would you go into debt in the hopes that you do have hypothyroidism and all of this could change, while risking the chance that it isn’t and you’re back to square one? [source]

Or…

I’m 22 and I have multiple mental illnesses – complex PTSD, OCD, social anxiety disorder, depression and a sleep disorder – most of which are the result of surviving rape and sexual abuse. I’ve had disordered eating for most of my life, which is currently manifesting as compulsive overeating disorder.

I had lap-band surgery in 2007 and lost a lot of weight, but my doctors kept telling me I needed to lose more. My psychiatrist told me that she thought my social phobia would go away if I achieved a ‘nice figure’. Since my metabolism has been affected by the various medications I’m on, as well as years of yo-yo dieting, it is exceedingly difficult for me to get to a BMI below 28.

My psychiatrist decided to adjust my medication 8 months ago, which caused me to start regaining weight. Since the new antidepressants didn’t work, bingeing was the only way for me to regulate my emotions in order to stay alive. I am now back on the original antidepressant, but it hasn’t been as effective since then.

I saw her a few days ago. Within the first 10 minutes she started attacking me about my weight. It started with the usual spiel about the supposed link between high weight and various diseases, but she seemed angry which was out of character for her. I calmly told her that my weight gain was mostly due to a higher dose of anti-psychotics (which I take to get to sleep). I admitted that I had been eating more, but said that if I didn’t binge I would probably kill myself. She responded by saying, “You are killing yourself” (meaning I would give myself diabetes or hypertension). I told her that I didn’t wish to discuss it any further. When she persisted, in an increasingly censorious tone, I got up to leave and told I wasn’t there to be lectured about being fat. She told me that I was being irrational and making ridiculous accusations. I have low self-esteem and am very sensitive to criticism, so this made me feel as though I’d been struck.

At this point I was sobbing and feeling like I was watching myself from outside my body. I now realise that I was having a panic attack. I thought the gate was locked and I was waiting for her to unlock it (she works from her home and has a locked gate in front of the door for security). Feeling trapped is especially triggering for me because I was raped in a locked house when I was 13. I was struggling to breathe, and being ordered to “stop hyperventilating” wasn’t helping matters. I told her, between sobs, that my problem was my trauma and not the fact that I’m fat. I also kept saying that I wanted to leave. When she asked me why I didn’t just leave, I told her that I couldn’t get out. This seemed to enrage her, and she said, “You’ve been coming here for 6 years and you know you can always open the door, you’re being ridiculous”. I didn’t know this because she is always the one to open the door and the gate and I hadn’t thought to check whether the key was in the lock (which it was).

I left feeling like my stomach had been ripped open. I don’t think I’ve ever felt so betrayed in my life. I’ve told her every detail of every trauma I have, and I trusted her completely. It’s very hard for me to trust anyone, and I’m so angry with her for making it even harder. I don’t know how she can justify what she said when she knows that I’ve been struggling with suicidal thoughts and that I’m not able to handle any more stress at the moment. I’m scared that I’ll have to either stop taking my medication when my prescription runs out or go through the hell of trying to find another psychiatrist, who most likely will turn out to be just as ignorant and judgmental as she did. [source]

One more, sigh:

When I was 10 years old I went my pediatrician for tonsil problems. However, all that seemed important after getting off the scale was my weight. While I was sitting there in terrible pain from tonsillitis (which I’ve been seemingly getting monthly my whole life), he just kept going on about how dangerous it was that I was 10 pounds “overweight.” He guaranteed her that I’d get type 2 diabetes. This is not the first time my doctor visit has went like so. As soon as I was at risk of being “overweight” when I was about nine, he’s been telling my mom to put me on a diet.

In fact, my parents have already tried to put me on a diet. They’ve been trying since I was 8 years old. After that doctor visit my parents humiliated me and said they’d pay me $10 for every 10 lbs I lose. I decided to go on a diet. By the time I was 12 I was 5’5′ and 72 lbs. I was very underweight and couldn’t go to the mall without passing out from exhaustion. My mom brought me to a doctor to see if I was anorexic. I would not admit it then but I was. I ate no more that 400 calories a day and thought about nothing but calories. We went to my pediatrician (the same one as earlier) and he said that I was going through what all teenagers do as far as worrying about my weight and that my parents shouldn’t worry. I ended up having to go to the emergency room a week later because I was unable to defecate in over a month due to starving myself. After that ordeal I was sent to a eating disorder clinic. Point being, my doctor saw being 10 pounds “overweight” and even at risk of being “overweight” as a serious issue. Anorexia however, was not. [source]

I have words for this… but I’m not going to share them just yet. What are your thoughts? Have you experienced this kind of fat prejudice? Has it affected your desire and willingness to visit your physician? How prevalent do you think this is in our community?

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By | 2014-10-03T13:25:56+00:00 October 3rd, 2014|Health and Health Care|23 Comments

About the Author:

The proud leader of the #bgg2wlarmy, Erika Nicole Kendall writes food and fitness, body image and beauty, and more here at #bgg2wl. After losing over 150lbs, Kendall became a personal trainer certified in fitness nutrition, women's fitness, and weight loss by the National Academy of Sports Medicine. She is also certified in sports nutrition by Precision Nutrition. She now lives in New York with her husband and children, and is working on her 6th and 7th certifications because she likes having alphabet soup at the end of her name.

23 Comments

  1. Jubilance September 14, 2010 at 10:54 AM - Reply

    OMG those stories were horrible! I cannot imagine.

    I recently got a new gyno & she was the first doctor to talk to me about my weight. She has a lot of PCOS patients, and even though I don’t have it, she still counseled me about my weight. She was perfectly nice about it & I talked to her about the weight I had already lost (I was down about 15 pounds when I saw her). She recommended a low-GI diet, which is pretty much what I follow being a Primal eater.

    Anyway, it seems like doctors either have 2 extremes – ignore the weight completely or be a jerk & think that a person who is fat is a lazy slob who eats all day. Both are dangerous but the latter really is. There are plenty of medical reasons that make a person gain weight & assuming its all their fault & just a willpower issue means that the doctor isn’t doing their job in looking for the possible medical cause.

  2. Ebony September 14, 2010 at 11:49 AM - Reply

    I have absolutely experienced this. Unfortunately, like the last example, I once had a pediatrician tell me when I was six or seven years old that I was fat. Not that I needed to slim down, or any other more gentle explanation. He straight out called a 1st grader FAT. And didn’t understand why this was a bad thing to do.

    Later in life, I developed an aversion to going to the doctor unless absolutely necessary because on so many occasions I’ve gone for severe symptoms (including a trip the ER for severe sharp pains in my head that would not go away after taking Tylenol w/ Codeine!), only to have some doctor ignore everything I said, tell me to take some Advil (which I said at the beginning of the meeting WAS NOT working), and lecture me for 20 minutes on how I needed to cut my carbs (which I wasn’t eating a lot of) and lose weight.

    That man so nearly got my foot stuck in his you know where… UGH.

    Anywho, I had a bunch of bizarre symptoms, but everyone only wanted to tell me to lose weight so I stopped going to the doctor and did my own research (turns out I have Gluten Intolerance, most likely Celiac Disease). I totally understand all of these experiences. Being overweight is not the source of everything that ails you. In some cases it could be the byproduct of something much worse. It’s a shame that a doctor would rather lecture you about something you already know you have to deal with, rather than assist you with the issue you actually came in to talk about…

  3. Kim September 14, 2010 at 1:14 PM - Reply

    Yes, I have experienced weight prejudice at doctors’ offices. My solution? Go to a new doctor. I’m thankful that I have health insurance that allows me to switch practitioners (unlike some folks who have had to stick with physicians who obviously were not trying to hear them at all). I wish that I had the nerve to write a letter or otherwise let these doctors know why I refused to see them again, but I just don’t have the time or energy.

  4. BlackBerry Molasses September 14, 2010 at 4:47 PM - Reply

    I had one unfortunate experience that caused me to find my fabulous doctor. I was having severely painful periods and abdominal bloating– and after me being my own damn doctor at since this horrible GYN practice wasn’t LISTENING to me, I was finally diagnosed with fibroids and large ovarian cysts. The surgeon that practice wanted to put me in the hands of seemed genuinely disinterested in doing my surgery, because of my size (hell, I’m not that big– and even if I was, SO WHAT?). Even on the sonography report it said something to the effect of “suboptimal visualization due to lg (large) body habitus”. Excuse me?

    This surgeon actually proposed removing my ovaries altogether. Saying that the reduction in estrogen would help me lose weight (seriously dude? I’m a healthcare practitioner as well. that’s a bunch of bunk!)Taking the ovaries of a young married woman who wants to have a family… are you kidding me?

    Luckily, since I didn’t trust this doctor as far as I could throw him, I was seeing my current doctor who also happens to be a family friend, and a specialist in reproductive endocrinology. When I told her what he had said, she was incredulous (to put it mildly). She performed my surgery, takes excellent care of me and actually talks to me about how I’m caring for my body overall, not just my weight.

  5. Kristina Brooke September 14, 2010 at 6:56 PM - Reply

    The first story really touched me as it could be my story.

    I was where she is until this February. I had insurance but all of my previous doctors were not listening. Then I decided to have weight loss surgery and I was sent for extensive blood test that the surgeon requested. He mentioned that I had all the symptoms but my regular blood work was not showing anything. After the test I was diagnosed with HypoParathyrodism (which is not quite a thyroid problem but has many of the same symptoms). Anyway, I did go on thyroid meds and lost weight (22 pounds in 3 weeks) but the meds have some bad long-term effects. So I researched natural remedies and began learning as much about it as possible. http://www.naturalways.com/thyroid.htm

    Please find a new doctor. Go to a clinic. Lie and tell the doctor that you have been having heart palpitation- whatever you need to get them to run a full array of test. Don’t worry about paying- medical bills don’t accrue interest so!

    • Gloria May 1, 2012 at 4:01 PM - Reply

      Thanks for the link, Kristina! 😀

  6. Kait September 14, 2010 at 10:24 PM - Reply

    As someone who is in the process of applying for medical school, these stories both anger and scare me. Yes there are legitimate medical issues associated with being overweight. And yes carrying extra weight may cause some medically-related difficulties. But regardless, it is not my job (nor any physician or physician-in-training’s) to judge, criticize, or do ANYTHING but attempt to serve a patient.

    Though I have never personally experienced this prejudice, I have had some awful experiences with insensitive, rude, and incompetent doctors who have left me alone feeling scared and vulnerable. I pray that I will never lose sight of my beliefs about medicine as a healing vocation and that I will never treat any patient in this way.

  7. Missb1203 September 15, 2010 at 8:52 AM - Reply

    These stories made my heart leap into my chest. My mother is going through a similar experience. My mother was unenmployed for a period of time. This resulted in her losing her house and seemingly broke her spirit. During that period of time my mother gained alot of weight. She is also going through menopause and had an hysterectomy two years ago. She says she just cant motivated to get out of the bed some days. She has asked her doctor over and over to perhaps test her for depression etc. Instead of listening to her concerns, the doctor gave a forty five year old woman who has high blood pressure phentermine and told her to start walking. While i acknowledge that weight loss would probably alleviate her body aches and back pain, alot of the time doctors ignore what their patients are going through emotionally. Some of them treat their patients like cattle. They hand you your meds and send you on your merry way. And emotional/psychological problems can take a huge toll on your motivation to eat right and exercise. Why should i exercise or eat these veggies and fruits when i cant even get out the bed? it really is a shame.

  8. Tina Fite September 15, 2010 at 5:59 PM - Reply

    I’m dealing with a various version of this right now. I am a military spouse and in order for me to leave with my husband next month to move overseas, I have to go through an overseas screening. They will not send you to the next duty station if the facilities on that base cannot care for all your needs. Well, since I did not receive care on base and went through an outside source for care, I had to get my records copied to give to my overseas screener. Now, mind you, I have been with my doctor for four years and he has only mentioned that I needed to lose weight, even further suggesting methods that would help that process such as Jenny Craig or Curves. However, my beef with him is that he never mentioned the problem. It’s like a math teacher giving the answer of “2” but not telling you the problem of 1 + 1 =?

    Today, yes, today 9/15/2010, I discovered (yes, I read the medical copies) that I had been having some serious medical issues since 2006 that could have prevented my hospital stay in February of this year had I known about them. I had no idea that my cholesterol (which is under control now thanks to a hospital stay earlier this year which ultimately revealed many issues to which I have eager responded with a 60+ lbs weight loss since March 2010) was 207 or that my LDL was 135. Not once did he mention that in 2006, I was past the verge of being the “borderline diabetic” that he said I was at that time and that I was a full-fledged diabetic. Now I do know that medical guidelines change from time to time, but as I stated, I have been going to him for four years and if there were changes to any of those issues, I had no idea what was going on in me, and I trusted him enough to listen to the statement that I just needed to lose weight.

    I am upset because as a person with PCOS, we are more susceptible to things such as heart disease, diabetes and cancer. We have to keep a check on all things and harmonize our bodies as soon as possible to get the best usage out of our bodies. By not knowing this, I have been charged with holding unnecessary guilt towards myself for not being able to have a child, for continuously gaining weight without explanation and for not understanding the true need to lose the weight. However, as my wise-beyond-his-years husband said earlier today, it is not so much about what happened in the past as it is about what are you going to do about it now. So now that I know better, I’m doing even more preventative work by going totally holistic.

    If anything, I would say to make sure you at least know and have records of your most recent blood work and learn how to read it. It is well within your rights to request a copy of them for your personal usage. Because what the doctors may not tell you can be found on that piece of paper they shove in your medical file as they simply tell you to lose weight. And that could mean the difference in the type of health you have from that point of time on. Just a thought…

  9. Msladee September 17, 2010 at 10:15 AM - Reply

    I’ve been thinking about this for a couple of days as I’ve experienced medical foolishness so many times, it’s unreal (I have a scar behind my ear from my 4 surgery on it to prove it). Anyway, if these “doctors” were publicly held accountable for such shenanigans, they would lose their clients with options. I definitely wouldn’t go to any of the doctors described above if I knew who they were. If you can’t treat me before or during my weight loss journey, I certainly don’t want your help at the maintaining level. Yes, doctors provide so many wonderful things, but at the end of the day, they are SERVICE workers too, and they can be replaced.

  10. Adrianne September 20, 2010 at 11:27 PM - Reply

    I experienced poor medical treatment with an OB/GYN. He was extremely popular (it took weeks to get an appointment) and seemed really proud of the “thousands” of women he’d “helped.” He was recommended by my GP because I’d been experiencing unnaturally painful periods for months that she suspected might be related to fibroids or endometriosis and this doctor was considered an “expert” on the issue.

    At our first meeting, he immediately harped on my weight and said that any reproductive problems I had were because of my “excessive” weight. My husband came for support, but the doctor said that he was glad my husband was there because “women should not make reproductive decisions without their spouses.” I was like, hey, nobody said a darn thing about babies. Plus my husband and I had decided long ago that babymaking wasn’t in our future. I mentioned that and he immediately pooh-poohed that and said, “You’ll change your mind but it will be nearly impossible to conceive at your weight and if you do, you’ll be high risk.” He also said that even if hysterectomy was my best medical option, he refused to do that on women as long as they were of childbearing age.

    I felt like I was in the Twilight Zone. He listened to NOTHING I said. Dr. Giggles had a better bedside manner! I should’ve walked away then, but I was so desperate to relieve my symptoms and he was supposed to be the “best.”

    The final straw was in the middle of a follow-up visit, he said he wanted to do a uterine biopsy. He failed to explain why that was necessary but said that it wouldn’t be as invasive as a pap smear. Well, I’ve had those before and while uncomfortable, are usually bearable. There is a HUGE difference between grabbing cultures for a smear and actually REMOVING tissue for testing. It was terribly painful. When I started crying, the nurse that was present immediately grabbed my hand. When I practically broke it, she said with horror in her voice, “Did you take any pain meds? It shouldn’t hurt this bad.” I told her I didn’t know he was going to do this. She gave him the meanest look. The doctor said, “Please, this procedure used to require an overnight stay in the hospital. You should be glad you can go home today.” I had no idea walking into that appointment that day that I would be having a surgical procedure! Before he left, while I was still in tears, he instructed the nurse to give me a maxi pad, telling her to do her best to “find one that will fit.”

    Needless to say, after that I went back to my GP and asked for another referral. My new doctor was so wonderful, she made me realize just how awful the prior one was and I got angry. I made a lengthy complaint to my state medical board and told them that I would follow up to make sure that my complaint had been taken seriously. They definitely paid attention when I mentioned that a surgical procedure was performed on me without prior notice. He received a formal letter regarding the complaint, but he was not censured. I don’t think he lost sleep over it, but it at least made me feel better about standing up for myself and perhaps if the next person he mistreats makes a complaint, there will be record to back them up.

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