I like to think of myself as confident and self-assured. And I am, most of the time. My big blind spot is my weight and always has been. But the nature of that uncertainty has shifted over the past year. For most of my life I’ve felt there was something wrong with me and that it was my job to fix it. I have struggled for over 20 years to restrict my eating and have exercised for the purpose of weight loss until I was blue in the face (or red, to be more accurate). All for “nothing” and I have failed, at least by generally accepted standards. I am bigger than I have ever been in my life. *gasp* And somehow, I am the happiest I have ever been with myself and within myself.
I’ve gotten to the point where I truly believe I’m better off without the food restriction and punishing workouts. I know that I am taking BETTER care of myself by not engaging in those disordered behaviors. The next step is to share these beliefs in a world where “common knowledge” asserts the exact opposite. I feel really self conscious about it, especially around people I love who think otherwise. I do believe it’s OK and possible to agree to disagree, but I still get that funny feeling in the pit of my stomach knowing that these people disapprove of me.
I thought about all this briefly before heading in to an appointment to get a Rx for psoriasis on my scalp. “They’ll probably weigh me,” I thought. Well, refusing to go through with that would make it a much bigger deal than it should be. “Just do it,” I thought. It’s only a number and has no power. It’s simply some feedback. And it was a big number and I felt the familiar pang. I banished it and went into the exam.
What I wasn’t prepared for was the fact that my weight would take over the appointment. “You’re almost in the obese category,” the doctor said in hushed tones. To my credit, I let her know I’ve been technically obese for my entire adult life, even at my smallest weights. “What you mean is that I’m almost morbidly obese”, I said to her shock and horror. “So what are you doing to work on this,” she asked. I started to explain that I’m working to heal after years of food restriction and am currently experiencing some rebounding weight gain but was cut off with offers of healthy eating courses offered at the health center. I felt that she had no genuine concern for what was going on with me. The number on the scale was larger than she “liked” so she was supposed to recommend weight loss classes and warn of all the harmful affects of not losing weight. There was no time for or real interest in discussing the issue. So I shut up. I smiled and nodded and got myself out of there. She made sure to remind me before I left the room and tried to press a flyer in my hand for the weight loss classes.
I did not leave feeling good about the encounter so I decided to contact the doctor after the fact. I felt compelled to at least express my truth to her in the hopes that a little crack of understanding might creep into her mind before embarking on a similar conversation with another patient. Her response was pretty noncommittal and I doubt much will change, but I did my part and for that, I feel good. I know it took quite a few exposures to the ideas of Health at Every Size before I let it in. Maybe this is one that will help her be more receptive next time…
Here’s my letter (I was limited to 1000 characters so it’s concise):
Thank you so much for seeing me last week - my scalp is much better. However, I wanted to share some thoughts about the discussion of weightloss.
I can understand the desire to take advantage of any doctor-patient contact to bring up pressing concerns about general health (i.e. weight). However, knowing “the weight talk” is coming causes me & others like me to avoid getting medical care. Telling someone she’s obese & needs to lose weight for her health/recommending a weight loss class is disempowering. Telling her she can see improvements in her blood pressure by finding movement she likes & doing it consistently is much more specific/achievable.
Please visit http://www.lindabacon.org/pdf/Podcast_HAES_HlthProvider.pdf for a concise overview aimed at health care providers on how focusing on weight is not helpful. Please take a moment to entertain a different point of view & hopefully gain some sensitivity to the situation your obese patients are in. Thanks in advance for listening.
So what do you think? Was I right to be offended? Do you think sending the letter was the right course of action? Have you ever experienced something similar and what did you do or wish you had done?