What about fat people who want their doctors to address weight loss?

A while back, in a casual situation, I had a conversation with someone who was telling me about her health challenges. The conversation started out in the realm of health insurance, but it then evolved into a doctor’s treatment of this person, who I’ll call Heidi for the purposes of this post.

Heidi said she’d had a problem that her doctor ignored for a long time, that she knew the source of, and, after 8 painful months, her idea of what was wrong was confirmed in an ER visit within about 15 minutes, and required emergency surgery at that point.

Heidi also had, during this timeframe, asked her doctor for assistance with losing weight. Heidi said that the doctor told her “you’re not that big,” and when her BMI was looked at, the doctor was surprised — based on what she told me, and estimating her height, her BMI might have been around 45. After repeatedly asking to be tested for diabetes, a test did show her blood sugar was elevated, only to be told that she wasn’t fasting, when she had been (due to the painful symptoms she was being treated for causing her nausea and vomiting).

This is substandard care she was receiving. My advice to her was to change doctors. She was asking me if I thought it had to do with the type of health insurance she had, and I said I thought it was more likely just that particular doctor — but I understand her wariness, and weariness, of having to seek out another doctor.

When interacting with Heidi, I wondered if part of what her doctor responded to was what I was responding to, here was this very competent, vibrant, intelligent, confident person who I didn’t perceive as “sick” telling me she wanted to lose weight, mostly in order to have more mobility and be able to do things she enjoyed. I encouraged her to talk with her physical therapist about what activities she could do now that could increase her strength and endurance without exacerbating her injuries. I didn’t encourage her to pursue weight loss, but I did encourage her to investigate the treatment of diabetes if she has another test to confirm that her blood sugar truly is high. I didn’t have a chance to talk with her about how insulin resistance can lead to weight gain. Heidi felt she had steadily been gaining weight and that it was something she wanted to reverse — not to get to a particular size but to get back to a more comfortable spot. Her doctor had referred her to a RD, who showed her the plastic portion sizes, something Heidi felt was condescending — information she already knew.

I don’t know if I gave Heidi good advice or not — I told her I thought she would benefit from talking to her health plan’s ombudsman, switching doctors, talking with her physical therapist to find out what would help her gain strength and endurance without making injuries worse. I recommended looking into Nordic walking, which I thought might provide her with some additional support while she was gaining endurance. She said that due to some dietary changes of her own, she had lost about 30 pounds, and I suggested a resource to support her in the direction she was headed in terms of the make-up of her diet (mostly plant based — not restricting amounts of foods) — not for weight loss, but to help her feel supported with the changes she has already made. I also said that treating diabetes, if that is indeed something she is grappling with, might also help her feel better and maybe also get back to a more comfortable spot, weight-wise. I talked with her about the first-level diabetes medications that might be offered to her, and that some of them might be contraindicated because of her other health issues, but that once she had a health care provider she liked and trusted, she could discuss those options then. Heidi told me she was in her 30s (I’m terrible at estimating a person’s age, I would have believed her if she said she was 27 or 45) and wanted to be able to keep up with her family, which I understood.

In part, Heidi was frustrated that she wasn’t offered treatment for weight loss. “Weight loss treatment is sort of a hot potato” I said, that the insurance companies don’t want to pay for and that is perceived as “individual responsibility.” But Heidi’s perception was that since her weight was having an impact on her health, and her ability to be physically active, it was something she ought to get treatment for. On one hand, part of me was glad that Heidi’s doctor wasn’t focused on weight, but on the other hand, it definitely sounded like her doctor wasn’t listening to her overall, not just about weight.

I am wondering, from a HAES perspective, from a size acceptance perspective, from a body autonomy perspective, from a “person-first” perspective, what would you recommend for Heidi?

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2 Comments

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2 responses to “What about fat people who want their doctors to address weight loss?

  1. I’d recommend a new doctor, but networking first to find likely candidates rather than hoping to hit it lucky in a reasonable number of tries.

    http://www.cat-and-dragon.com/stef/Fat/ffp.html is a list of fat-friendly professionals as a starting point.

    It’s possible that her doctor was just a lousy doctor– it doesn’t sound as though they were fatphobic.

  2. I think I would have recommended exactly what you did. While you didn’t offer weight loss suggestions, you did treat her with respect and offer practical advice. While your advice came from a viewpoint that believes there are behaviors that can help with mobility, energy, and condition management whether or not they lead to weight loss, you did not tell her not to try to lose weight, and you did not ignore her concerns. You also did not tell her not to pursue weigh loss.

    If she continues to focus on weight loss as her goal, there are plenty of places where she can get advice, and many of them are free or very low cost. Showing her respect includes accepting that she may choose a very different path from the one you’d like her to, and you did that just fine.

    Most of all, you told her to advocate for herself and her own healthcare, whatever you may have personally thought of her current mindset about weight loss. Her doctor ignored her wishes repeatedly without offering any alternative theory to her fears, nor any treatment for a condition that landed her in surgery.

    This is unacceptable on the part of a physician.

    If I came to a friend with a situation like this, the best thing I could hope for would be a reaction like yours that offers options and empowers me to find the answers I need to find… even if they aren’t the ones you might want me to find.

    To make a long story short (a bit too late at this point!LOL!), you done good.

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