Yesterday, our friends at Jezebel posted a story about research from Harvard’s Project Implicit which indicates that doctors may be victims of their own biases when it comes to providing treatment to overweight patients. Of course, the comment section exploded. Among all the comments completely misreading the actual words in the article, our own Slay Belle came forward as the voice of reason. The rest of P-Mag’s editors jumped into a conversation, and it was pretty interesting. [TW for talk of disordered eating.]
Here’s Slay’s original comment:
I think maybe you’re mistaking what people complain about when they say doctors are ‘shitty’ to fat people. It means that their concerns are not taken seriously, that any issue they come to the doctor about can be overlooked because of their weight, and even people who are perfectly healthy — by medical standards, blood tests and pressure and all that fun jazz — can be subject to really horrible shaming and dismissal by their doctors.
I’ll give two brief examples. When I was still in university, I went to my university doctor complaining about incredibly painful menstrual cycles and strange periods of weight gain that didn’t seem connected to my eating or exercise habits. I was told I ‘probably’ had endemetrosis, was offered no explanation or treatment options, and my doctor said I was probably gaining weight because I ate too much and maybe I could take up swimming. This went on for 4 years, almost laughably to the letter. I had no access to outside doctors because my insurance came from the university and I was left bewildered and upset.
Now, as an older person with health benefits, I’ve been incredibly lucky to find a really excellent, caring doctor. My blood work was great and I was heavy (ier) than I wanted to be, but my doctor was clear that all my exercising and diet was paying off, and was willing to refer me to seek additional outside office help if I needed to lose weight. And then he was able to diagnose me with PCOS, which I had been suffering from since college, but since he actually listened to my concerns about my symptoms, he was able to give me a diagnosis.
During this time, I played roller derby and fell after a game without my wrist guards on, bending my fingers almost back to my wrist when I threw my hand out to catch myself. I was unable to move my fingers at all afterwards. I called the office but my regular doctor wasn’t available and was given an appointment with a different physician. Despite the fact that I knew EXACTLY how I injured myself, that doctor insisted I was suffering from carpal tunnel syndrome brought on by being ‘fat’ (her words) and when I told her what my normal work out routine was — 20 hours a week of high intensive cardio for derby, plus weight lifting — she told me I was lying. She didn’t hedge around it. She looked me right in the face and told me I was lying.
This is what people mean when they say they’re worried about going to the doctor ‘while fat’. It’s not because they don’t want someone to help them.
And here’s our conversation:
Selena: Slay Belle, you are a saint in that doctors hate fats post. I can’t believe more people haven’t read it and had their eyes opened. Instead it’s all about POOR DOCTORS CAN’T SAY ANYTHING OR FATS WILL EAT THEM, or FAT ACCEPTANCE IS TERRIBLE BECAUSE FAT, or FATS ARE TOO STUPID TO KNOW THEY ARE FAT. I don’t understand how a group of people so aware of the effect of bias, prejudice, and cognitive dissonance just refuses to read the words people actually say when it comes to fat. Or race, usually. Or ability. COME ON. WE’RE SUPPOSED TO BE THE GOOD GUYS.
Slay Belle: Thanks. I really hate that ‘Omg, who cares about your feelings’ shit posted by concern trolls. They don’t have any idea what is really behind the issues, they don’t understand that doctors can have biases too, and that there’s a long and documented history of physicians dismissing women’s concerns or complaints. The truth of the matter is I would have had a diagnosis over a DECADE before I got mine if my doctor had taken me seriously and I wouldn’t have mistakenly thought that 9 day long periods with crippling pain and bleeding to the point of anemia was totally normal. I didn’t even tell the story about the doctor who called me after I lost a pregnancy and left a message on my phone saying they found abnormal cells in my pap smear and I probably had cancer.
Selena: I had lifelong period problems that were chalked up to my being overweight, or having a history of depression, and now I don’t have any periods because I was afraid to go back to another vagina doctor until I thought I was dying. There are journal articles that say 90% of women exaggerate about their problems with their menstrual cycle. And we’re the silly ones for wanting to be treated like people who are also fat. Be 1. fat, 2. female, and 3. have a history of mental health diagnosis, and never expect any medical professional to listen to you again.
Liza: 4. All of the above. ‘Sup.
Slay Belle: Exactly. The medical industry isn’t some bias-neutral place where everything is equal and every medical professional is a paragon of open-mindedness and constantly up to date on the latest advances in care and diagnoses.
Liza: The irony* is that both my fatness AND my period problems can be chalked up to PCOS, but any ailment would be met with telling me to lose weight. (*The kind that makes me want to kick crotches.) Look, biases are mentioned all up in practically every chapter of my research methods book. I know that social sciences are even more subjective but the point is that EVERYONE HAS BIASES.
Slay Belle: Me too, Liza. That was part of the story I shared on Jez. My doctor — the current one — was actually really amazing about my treatment. He mentioned trying to lose weight, but he was more concerned that I kept exercising and treating my issue than waiting around to see if I shed some pounds and things got better.
Liza: Gotta love when weight loss is prescribed for a disorder that by definition makes it impossible to lose weight. I guess I’ll go chase my tail or something.
Pileofmonkeys: So, so, so not the same, I know, but one of the reasons I was misdiagnosed so many times when I was younger (I was treated for bipolar, and am not) was because apparently my first psychiatrist noted in my record that I was in deep denial about my obvious eating disorder. Along with not being bipolar, I’ve also never had an eating disorder, but Dr. Fucknut assumed I did and treated me based on that assumption. I was a 5’10″ 14-year-old (hit 6′ when i was 16). Shit was going to be weird with my weight.
Liza: Can’t win either way.
Slay Belle: I totally think is the same problem, pileofmonkeys. Doctors not trusting/believe (women) patients to know what’s wrong and be honest about their issues.
Selena: That’s exactly the same! Some shit-ass doctor tried to save time by diagnosing you based on a five second appraisal. And THAT IS NOT SCIENCE. And it’s shitty doctorin’.
Pileofmonkeys: Exactly. If doctors wouldn’t assume we’re lying and/or stupid, we’d get correct diagnoses. Thank god my current doctor is a unicorn.
Liza: There’s just generally a lack of understanding that all bodies are different, and that the person who has been living in it for X years might know what it is supposed to do, weight-wise, more than a doctor who has spent 4.3 seconds looking at it. I have told this story a million times, but probably not here: part of the reason I’m extremely sensitive and a little reactionary in my anti-diet ways is that I had a doctor who pressured me onto a diet that HE SOLD FROM HIS OFFICE that was basically all liquid, and when I said I was too hungry to continue instead of increasing my caloric intake he just prescribed pills.
Selena: Jesus, Liza.
Liza: This is the part I don’t normally share, but I’m cool with having it out there: during that diet I actually went on pro-ana sites for tips a few times.
Slay Belle: That story makes me so angry, Liza. I can’t believe that some doctor was still pushing amphetamines as a weight loss aid in this day. That’s some serious Mother’s Little Helper shit.
Pileofmonkeys: That’s fucked up, Liza. That guy is no better than vets peddling shitty-quality Science Diet out of their offices for a cut of the sales.
Liza: And when I told the doctor I wanted to stop, he basically just said “yeah but you’re still obese.”
Selena: Fuck that, I hope he catches shingles from his chicken pox patients. Nut shingles.
Slay Belle: Nut shingles!
Liza: The only plus side of those pills was that I had a lot of energy and focus.
Slay Belle: I heard a couple of years ago that Adderal was being prescribed off target as a weight loss drug so I asked my Dr. about it. He was firmly against it. At the time I was really angry about it — I was frustrated and disappointed to work so hard for so little result — but now I’m relieved he was so responsible.
Pileofmonkeys: There’s just something so inherently paternalistic to being told that whatever’s wrong with you is obviously your own fault and that you couldn’t possibly have any idea what’s normal for your own body. It’s awful.
Sara B.: Nut shingles to them all.
Selena: My GP told my mom to put me on a diet when I was eight. We did Weight Watchers, and I don’t care how much it’s evolved, all I remember is having my weight yelled out to a room full of strangers and being told every week that I wasn’t trying hard enough, even though I thought about NOTHING ELSE BUT LOSING WEIGHT that whole summer. That was the summer I stopped swimming, because I was sure all my friends would hate me if they saw my fat in a swimsuit. I fucking loved swimming.
Slay Belle: Ugh. Kid diets.
Selena: I’ve never had a normal relationship with food since. It’s either too much or obsessive portion control.
Liza: When I went for a physical a few months ago (different doc) she basically insinuated that I didn’t know how to walk. We were talking about exercise and I mentioned that I was living pretty far (like 3/4 mile or so) from the nearest subway, so I felt like I got a decent amount of walking every day. She got super condescending about how if it takes me 30 minutes to walk that far (more like 15), I should strive to go a little faster every day and that most people don’t know that you need to keep going even after you feel tired. Blah blah blah I’m fat so I’ve obviously never exercised before and don’t know how to walk.
Slay Belle: Ugh! HULK SMASH.
Liza: Oh I was also put on diets as a kid. My mom feels bad about it now but didn’t know better than to listen to doctors back then. Vagina shingles for that one because it was a ladydoc.
Slay Belle: I don’t think I ever did any kid diets — I did have a Get In Shape Girl work out set though — but I remember watching my mom do all sorts of messed up diets. Like the cabbage soup diet.
Pileofmonkeys: Kid diets are horrifying. Obviously not the allergy kind, but the weight loss kind. Talk about fucking up your relationship with food for the rest of your life. I had a Get in Shape Girl, too! It had that rad streamer-on-a-stick thing!
Liza: Now I believe there is research that shows kid diets actually make you fatter as an adult. And if a pregnant lady diets it’s more likely that her kid will be fat. I don’t have the actual studies on hand but it was something like that. I don’t think I’ve had a normal relationship with food since I was like 8 years old.
Selena: It was the ’70s, you could still get legit speed from the doctor, so no one had any excuse to be fat, apparently. Even second graders. Also, fuck Get in Shape Girl.
Slay Belle: I was just told to ‘remember where I came from’ (my biological father’s side was very obese) and then told I couldn’t get up from the table unless I ate everything on my plate. Talk about prescription for an eating disorder.
Selena: Word, Liza, AND THAT FUCKING SUCKS. FOOD IS AWESOME.
(After that, the conversation turned to a Cosmo article on smooshing bananas in one’s vag. I chose to edit that part out. ~Selena)
And that’s it for another episode of Editorial Masterbitch Theater. Feel free to add your own two cents in the comments, and feel free to pass on stories you’d like to see covered here.