November 20, 2009

In Which Jo Gets Extremely Crabby.

I'm not a big follower of Fat Acceptance or Health At Every Size. Pretty much all I've read is Kate Harding's Shapely Prose and Melissa McEwan's blogs on the subject, although I did snag a few copies of the original "FAT! SO?" back when it was a 'zine. (Doesn't that bring back memories of the 1990's? Imagine, children: we used to have to self-publish things on paper before Blogger!)

Part of this is because I'm not "really" fat. I'm what's usually called a "tweener"--sometimes wearing a 12, sometimes a 14, sometimes a 16 if it's a top and it's fitted. People looking at me wouldn't automatically call me "obese", though that's what my BMI says I am. I feel sort of like I'd be co-opting a valuable movement if I horned in on Fat Rights without really having experienced any discrimination in, say, insurance coverage or hiring on account of my weight.

Another part of it is because the hospital where I work, which I call Sunnydale General (shout-out to Buffy!) does a lot of complex bariatric surgery. I'm talking super-bariatrics, the sort of surgeries done on people who weigh 500 pounds or more, or who weigh 300 pounds and have so many co-morbidities that nobody else will touch them. I've seen the health effects of super-obesity up close, and that makes me (probably unwarrantedly) skeptical about some branches of the FA movement. "Health At Every Size" is a fantastic idea, and it's reality for a lot of fat folks, but it's *not* reality for the people I run across.

That said, I think I might have to get more active. I had a little run-in with my doctor the other day, and am now looking for a primary-care physician.
I went in with a week-long history of right upper quadrant pain that started after I ate one of my bimonthly cheeseburgers (nom nom nom nom). I came in hypertensive, as I always am when I visit the doctor, and fifteen pounds lighter than the last time I visited him.

He did not focus on the hypertension. I got the usual quick lecture about cardiomyopathy and aneurysms before reminding him that my own trending of my blood pressure (at work, away from anything that could cause white-coat syndrome, and yes, I'm aware of how ironic that is) showed that I have perfectly fine, not-concerning blood pressure. My worry was the possibility of a gallbladder problem, and I said as much.

"Well," he returned, "You do have the five risk factors for gallbladder disease." Then, because I am a nurse and he likes to quiz nurses, he asked, "Can you name the five risk factors?"

"Fair, fertile, forty, female, and fat" I returned.

"Yes, especially fat" he replied. "You are far, far too fat."

I am five-foot-two and weigh 173.8 lbs. My body fat is somewhere between okay and too-high, though it's improved since I weighed 188 lbs. I work out three times a week with Atilla and have an active job. I eat mostly whole grains, lean proteins, vegetables (in fact, I have a mostly-vegetarian diet), and stay away from sweets. My two big vices are caffeine and beer. I can outlift, out-cross-train, and outlast nearly everybody else I know. The one thing I can't do is run long distances, though I can maintain an aerobic heartrate for two to three hours at a time without falling over.

I told him all this. I pointed out that my muscle mass is approximately half again what you'd expect for a forty-year-old woman, that my bone density is the shizznit, that all my trends are positive.

Yet he came back again to the same point: "You are far too fat. You must lose more weight."

Dude. I know I'm fat. Why do you think I joined Weight Watchers? Do you think I don't own a mirror? The *point* here is that, although I might be producing and storing more estrogen than is normal (because of that added body fat), I am a healthy individual, aside from some right-upper-quadrant pain and some white-coat hypertension.

The last medical person who expressed concern about my weight fell silent when she removed the drape from my upper body and saw my back. "Never mind," she said, "I see you carry....some muscle."

Not my doctor. He kept harping and haranguing, and I left his office feeling, quite frankly, like shit. I have a training routine that makes even personal trainers turn pale, I eat well, I've lost and kept off more weight than most people can ever manage to do, and yet I felt like shit.

The one good point of the visit was when he took a look at my upper legs as part of the full physical. I have some bruises-turned-scars there (that's the "fair" part), and he asked what they were from.

"Oh," I said, airily, "those are from when I put my neighbor's washing machine into his truck for him."

"Washing machine?" he asked.

"Yep," I replied, "he couldn't get it into the truck bed by himself, so I grabbed the strap and lifted it up there for him."

There was dead silence in the room for a moment. Then he said, "You still need to lose weight. You are far too fat."

I am looking for a new physician once this possible-gallbladder, maybe-it's-a-toomah crisis is resolved. And I might just have to go buy Health At Every Size, just so I have better comebacks for doctors like him.


  1. Wow. What a nasty piece of work he is! At the same height as you, I felt fine at that weight and although I am working towards a "healthier" weight now, I still feel 170 odd isn't so drastic. What an idiot and very unhelpful. That is just the sort of comment that sends many of us scuttling home to bury our heads in a vat of icecream.

    Glad you are seeking out a new doctor.

  2. Holy Christmas. That is just awful. I'm sorry you had to go through that

  3. seems to me that too few general physicians have real knowledge of weightloss and fat/health issues. they know they need to tell patients to lose weight but they are so unfamiliar with the process (other than the basic eat less move more) that they have no idea how to direct patients to do that.

    clearly you are doign exactly the right thing, are on the right path and doing tremendously well at it. Go you! and his insistence is just unconstructive and demoralising for you. ignore him!

  4. This annoys me on so many levels, because I too get those looks. My doctor will give me the "Sure you do" questioning look when I tell her my normal workout routine, which lately hasn't been so stringent but in the past consisted of 3 days of 2 hours of classes and the remainder of a 1 hour class and one day of working out at home. 6 days a week with one day off and eating southbeach....I swear she was thinking, I know you eat dove bars and cheetos all day long by the horrid look on her face. Finally I got her to let me see an endochronologist who took one look at me without running any tests and said You have PCOS (which has been the back and forth does she or doesn't she question for many years from doctors)...and not only that, she said she had no doubts in her mind how much I worked out, because that's how it tends to go for those with PCOS. FINALLY SOMEONE WHO UNDERSTANDS ME!!!

    It really bothers me that doctors take one look at you and assume you are lazy and don't eat right, I've been sent to two nutritionist and each time, I knew more than they did about nutrition and basically they said you really don't need me you know what your doing.

    Of course I do, I've been overweight most of my life, I get the food part...unfortunately for me, this other hormone factor has been playing evil games with me.

    You rock Jo! Keep up with your bad self! and don't let this donkey get you down.

  5. This is exactly what I HATE about a lot of Md's I've encountered - they focus on that stupid bmi and a number on a scale instead of something more useful like fat % or waist measurements. Ignorant.

    I agree with you on the FA. While I AM a big girl, I can't get my head around how narrow the views are about surgery or weight loss in general. Although, I like the overall message. It's just not my tea, but I'm glad others are spreading a little more acceptance messages in any form.

  6. Your BMI is 31.8. That's obese. Whether you change doctors or not, like the ostrich, sticking your head in the sand will not change that!

  7. BMI does not account for muscle weight. While its true that even accounting for this, you might be moderately overweight. I think its time we as a society stopped judging people by an arbitary number. Whats right for everyone else does not have to be right for you. And no one has the right to set standards of acceptance for someone else. My own BMI falls in the normal range, but frankly Jo, i'd give it all up to be as fit as you. Dont let this jerk bother you. I think you're awesome.

  8. Yes, you need a new physician. What a goombah.

    There's ways and ways to say that. I was fat (BMI 29), fair, fertile (3 kids), and forty, and my gallbladder was shot. But nobody ever said the 4Fs to me and my gastro even said kindly that I did not look forty. There's ways to inform and motivate and there's ways to upset your patients and make them feel needlessly awful such that they seek a new doctor. Happy searching! Are you seeing a surgeon? My brother's kind of babying his and he's done okay. I tried that route and had further problems-- wish I'd had it out. Good luck.

  9. That's so funny. Well, not funny "ha ha." I guess I just find it interesting how widely different the responses can be. Doctors are in short supply around here, we pretty much have to take what we can get. Five or six years ago now I went to see a new doctor for the first time. Before I went in they weighed me, which was a new experience for me. At the time I had been working out regularly and doing my best to eat healthy and watch my calories, trying to lose weight and getting nowhere. I almost had myself convinced that this is just where my body wanted to be. I'm 5 feet tall, and back then was around 135 pounds which is overweight for my height.

    So I asked the doctor about it and told him about my exercise and eating habits. He looked at a chart and told me I needed to lose 15 pounds. That was it. Didn't matter if I led a healthy lifestyle. I needed to lose 15 pounds.

    Fast-forward to last year, that doctor has gone and Husband and I are off to meet a new one. Despite my best efforts, I have gained another 10 pounds instead of losing 15. This doctor sent us for blood tests, etc, so when we went back to hear the results (which were all good) I asked him about my weight, and told him that I do work out, that I try to eat a healthy diet. Know what he said? Just keep doing what you're doing. I was pleasantly surprised not to get a lecture. Really hoping this doctor sticks around.

  10. Yes, you do need a new doctor. He seemed a bit blunt, I hate doctors like that. Just because you pass a test that says "HEY I YOU'RE A DOCTOR" doesn't make you a decent human being with a caring bone. But, and I'm not defending him by any means, if there's one thing I've learned in the last few years that giving something a chance may surprise you.

    I have a story. My husband is a big guy. He's 6'4 and at one point weighed about 265. He, like you, gets beaten up by his trainer twice a week. His doctor always said, you know, it would be good of you to lose some weight. I see you've got some muscle, but in a none pushing way, just saying hey, it wouldn't hurt. Well, one day came where his pants were a little too tight. Funny enough, he later admitted to hating his work clothes because they were too tight all along. But he didn't want to buy new ones. So he joined weight watchers and paid attention to what he ate. He was always under the assumption that the silly BMI thing said he should be under 200 lbs to not be obese was ridiculous. I did too actually. He was fit, yeah, a little heavy, but physically in good shape. But he gave it a chance. It can't hurt. He's now one of those results not typical people. You should hate, I do. He lost 60 pounds and now hangs out at a skinny 193-5. He feels better. He was having some stomach issues that were spawned by a stomach bug, but were most likely retained due to his weight. They went away. He's more fit now and can do even more ridiculous things with his trainer.

    I get that you don't like your doctor, and I absolutely think you should find someone new. You should like your doctor, and if you're lucky, the office staff too. But, just try it, for a little bit.

  11. Thank you for this post! I appreciate your honesty and I am one of those that has been labeled obese since I was a young child.

    My blog, Big Girl Bombshell, just happens to be along the lines of acceptance. SELF-acceptance rather than just FAT acceptance. Same ideal and practice just a what I am working on -- SELF.

    FAT is no different than any other prejudice. Everyone has an opinion, its the attitude within that gets us through!

  12. Your encounter just makes me sad. If, as a doctor, this is his educated opinion, did he have anything of value to add to his proclamation? Any advice, suggestions, help as to how to lose the weight he thinks you should be losing? And what a way to tell you! It strikes me as pretty inappropriate.

  13. I worked in the medical field for 10 years, both clinical & administrative sides, so I can recognize an a@sshat doctor when I see one & hon, you've got royalty there.

    As far as Health at Every Size...borrow it from the libraray instead of buying. My take may be different than yours but it felt like one big giant set of excuses to me. A lot of the stufies quoted were questionable when I researched a little online & I got tired of hearing "it isn't your fault you're fat it is _________'s fault".
    I may never be thin, and I do have some hormonal crud that contributes to my weight, but no one held a gun to my head & forced me to hit the drive thru or eat those sugary high fat foods. That was all me...which means it is all me making the changes as well.

    I think you're awesome. I am in complete & utter awe of your PT workouts & think I'd drop dead after about 10 minutes. ;)
    Don't let jerk-o the wonder doctor bring you down!

    Best wishes,

  14. Oh Lord, did he offer any suggestions as to what you should be doing in addition to WW and working out like a superhero on steroids?

    I sure hope the gallbladder-ish issue turns out to be nothing, and that you can find someone who feels more like an ally in your pursuit of health and fitness, not an enemy!

  15. I've been there with the Doctor situation, though not quite that obstinate.

    After having lost half of my goal of 20 pounds, I started up with a new doctor and went for my yearly check-up. Do I get a pat on the back and a congratulations on the 10 pounds already lost? No, I get a "You have too much stomach fat and need to lose 10 pounds to be in the normal BMI range. Try to reduce your portion sizes." Well thank you for that tremendous piece of motivation, Dr. Bedside Manner.

    Luckily, my doctor wasn't quite as persistent as yours or she may have gotten a serious piece of my mind.

  16. Thank you for this post.

    The whole FA movement has made me feel a little squicky, and you've managed to put my jumbled feelings to words.

    I don't think it's right to judge people on their appearance, but at the same time, I don't think it's good to be encouraging society as a whole to think of fat as normal. There's definitely a fine line there, and many FA sites go past that line...

  17. Awesome post. I hope you do get a copy of Health at Every Size - and not just because I stand to make a little money if you do. Actually, let me suggest you get it at the library, so this comes across less as self-promotion. (I’m the author of Health at Every Size ( The HAES movement isn’t saying that everyone is healthy regardless of what they weigh. What we are saying is that we can all benefit from good health habits, regardless of where we fit on the weight spectrum – and that we should direct our attention to supporting everyone in good health rather than fat-bashing. Fat people experience a lot of discrimination in health care, as you know firsthand. Your doc made an automatic assumption that you weren’t eating well or exercising – and it just wasn’t true. So he wasn’t “treating” you, he was just treating his notion of who he thought you were, which is all about his prejudice. Thinner people get screwed over by this prejudice too – some of them have poor health habits that make them more vulnerable to disease, but the disease doesn’t get noticed because the assumption is that as long as they keep their weight down, they should be healthy. Anyway, I just want to support you in delving further into HAES. Bet you will find the comebacks you’re looking for in my book. It’s meant to support people across the weight spectrum in feeling good about themselves – and to arm them to take on weight stigma, in themselves and others.
    All best,

  18. Thanks so much Linda for contributing to the discussion-- I've heard great things about your book and about the HAES movement!

  19. I love reading your blog--it gives me so much motivation...and with a sense of humor, which is hard to find on a fitness/weight loss blog. I'm sorry you had to put up with such a crappy doctor. Sounds like he needs to realize that people are not numbers and statistics.

  20. What a f*cking asshat your doctor is. I really hope you write him a "Dear John" letter when you leave his practice and tell him exactly why you left.

    I had gallbladder issues in May/June of this year and ended up having mine removed in July - after experiencing that kind of pain with the attacks, it was the best thing to do. Hope you get some answers before your next cheeseburger (and btw, that was what triggered my second attack)!

  21. Hey, welcome to the FA fold! If you're looking for books, I'd recommend Kate Harding's new one Notes from the Fat-o-Sphere. All of the facts, plus the great snarky attitude and the examples that show that they've been through it all too.

    Also, check out the First Do No Harm blog -
    You're certainly not the first person to have a doctor focus only on your fat and not on the actual problem. Which is why I'm having so much trouble convincing myself to find a doctor out here - I'm right on the cusp of "morbidly obese" and I just don't want to deal with it.

  22. Last night I wrote "I don't need a BMI chart to tell me I'm healthy, my body tells me I am".

    Good luck finding a new doc!

  23. I've had this reaction from doctors too. And when a doctor does that to me, I find another doctor. They have to learn to deal with all sorts of people with compassion or get out of the business.

  24. @Anonymous poster who talked about ostriches:

    BMI is a terrible indicator of health. The author of the formula even states that it should not be used to determine the health of an individual. It was invented by a mathematician and sociologist in the mid-1800s for the purpose of aiding social science education. A much better indicator of health is body fat percentage, because it accounts for a person having an elevated lean body mass and differences in frame size.

    Have you seen Kate Harding's Illustrated BMI Project? It's very eye-opening.

  25. I'm your height and within a few pounds of your weight. I don't have your training routine and I couldn't lift a washing machine if it were sitting on my foot. Find another doctor.

  26. People can be overweight & still healthy & fit. Was this guy even in shape... you know sometimes they are not even in shape themselves & are handing out advice they do not follow... OR did he have a short man complex... I know, getting into bad joke territory! :-)

    I am glad you are looking for a new doc. There was no excuse for this guys behavior.

    I always weight more than a lot of people at my height but they see I have muscles.

    Brush away his crap & have a great weekend!

  27. Ugh. Yep, sounds like an arrogant jerk to me. And given what you told him about your regimen, he couldn't think of anything more constructive to say than "You're fat, you need to lose weight?"

    Given that BMI is not the most useful number for gauging fitness, I wonder why more doctor's offices don't have those body fat meters that they do at the gym? You'd think that would be a far better indicator for advising a patient on how much body fat they need to lose.

    Good luck with finding a new PCP, and I hope you can get your issue resolved soon!

  28. Ridonkulous. He's your doctor, not your mother. At least be helpful and not just critical.

    I'm one of those folks that carries way more weight than most people think (I'm often 20 pounds heavier than what people estimate). Partly because I carry a lot of muscle, partly just my frame. My BMI says I'm nearing obese. Yeah freaking right.

    Keep rockin' it. Girls rule...dumb doctors drool. :) And definitely time for a new one.

  29. What a crap doctor! I would have walked right out on him and told him to kiss my a$$!

    Like others have mentioned BMI isn't the greatest indicator of health. I myself am in the overweight BMI range but after I got my body fat % taken I was told by a medical professional that I don't need to loose anymore weight. I'm one of those women who carries more muscle because of how I workout. I was trying to kill myself to make it into the normal BMI range and it wasn't happening and now I know why cause my body was at a healthy place already.

  30. Sorry to hear you were treated so disrespectfully.

    Good luck finding someone with a better bedside manner and I hope you get your possible GB issues resolved.

    I said goodbye to mine a couple of years ago and was very pleased with the results.

  31. I'm sorry you had such a negative experience with your doctor. If you happen to have a similar experience with your new doctor (you'll get a new one, right?), I suggest asking what he would recommend to someone like you who wasn't fat. Because guess what! Thin people have gallbladder problems, too.

    Even if you commit to losing that weight, isn't there ANYTHING he can recommend in the meantime? Weight doesn't just vanish because you decide it should!

    Good luck, and hope this was a false alarm.

  32. That doctor is going to feel pretty darn silly when he reincarnates as a cockroach.

    Karmic payback's a bitch.

  33. You sound like my twin! I finally had my gallbladder out at 45. You can keep the gall bladder limping along on a low-fat diet (under 20% of calories) but eventually it will have to come out.

    I'm 49, 5'5 and 167 lbs (down from 180 a few years ago)and always between a 12 & 14 (curvy). And really strong and prone to brusing. For me the secret is to limit sugary foods & drinks (including the ones with fake sugar), and to keep an eye on those carbs. I still lapse, but it's never far from my mind.

    TIP: the flavored seltzers without the fake sugar (Canada Dry, Talking Rain, and the generic organic variety at QFC) are awesome. Fizz + taste!

  34. Definitely time for a new doctor!!!! And when you find one, maybe you could write him a letter or email letting him know exactly why you won't be using his services (or paying him) anymore. If there's a website where you can post a comment about his practice, you could post this.

  35. I'm so sorry you had to go through that. But really happy that you've shared your experience here.

    It's awesome that Linda Bacon, the HAES lady herself, commented here!

    Also, Gretchen left the web address of the blogsite "1st, Do No Harm". You should check that out when you get the chance. Unfortunately, the kind of knee-jerk reactionary medical bigotry you experienced is all too common, and with sometimes tragic results.

    BTW, on a very loosely related topic: I read on the Intertubes today that Oprah had the lady who was mauled by a chimp on her show. And this lady is extremely disfigured, missing her hands, blind and with much of her face missing, and can only eat food through a straw. And Oprah said something along the lines of, "Well, at least you won't have to worry about your weight."


    This is our world ladies (men too, but especially ladies). Illness and disease pales in comparison to being, OMG fat!

    To be fair to Oprah, I'm sure she was trying to bring some humor into a tragic situation, but really, she should know better.

  36. Bench press as much as I do and then you may tell me that I am overweight. Tool.

  37. That doctor needs to have his license to practice set on fire, run through a shredder, pureed in a blender, and flushed down the toilet.

    So, so very sick of this crap.

  38. My money's on you outliving us all!

  39. I am really sorry that you had to go through all that. I can't believe a doctor would even express himself/herself that way. To use the word 'fat'is just nasty and unnecessary and it certainly does not encourage weight loss.

  40. Thanks, all, for your comments. A couple of points:

    AnonOstrich and JavaChick, please note: I know I'm fat. That's why I'm doing Weight Watchers--believe me, it's not for fun. Although, even after this last 20 lbs comes off, I'll still be "overweight" by BMI standards....but I'll be overweight with some really kick-ass, cut triceps.

    Miss L. et al who took issue specifically with the word "fat": I have no problem with the word "fat". It's merely a descriptor of my food-baby, and doesn't describe my brain or my personality or anything that matters. I'm fat. *shrug* What bugs me is that Dr. Dorko didn't bother to look at anything else.

    And, for everybody who had tips on gallbladder management: Thanks so much! I've been tested sixteen ways now, and am just waiting for the results; in the meantime, the doc gave me a scrip for Zantac, which (*whisper it softly*) seems to be working so far. Who knew? Maybe I was just hyper-acidic all this time.

    Again, thanks everybody for your feedback. It made me feel a whole, whole lot better.

  41. Just discovered this blog and I finally feel like I'm not alone with my feelings about myself and my body. Thanks!

  42. Wow, you sound a lot like me.

    Twenty pounds into a 70 pound weight loss I had my first and unbelievably painful gall bladder attack. Two months later, I also had pancreatitis as well as a totally jacked up gall baldder...and a trip to the ER that resulted in the gall bladder getting taken out (thank goodness...I was like 'get it out!'...those attacks are insanely painful).

    I'm more worried that your doctor seems to be concentrating on your weight and not possible gall bladder issues. I was diagnosed with PCOS 8 years ago, and the endo I went to sounds like your guy...all hung up on my weight and didn't pay attention to anything else. He ended up putting me on metformin without doing ANY insulin tests...just because he assumed I must be insulin resistant because I was FAT.

    Well, guess what? I was not insulin resistant at all, and the met made me horribly, horribly ill.

    And I never, ever went back.

    Since you are a nurse, I'm sure I'm not telling you anything you do not know, but I just want to encourage you to find a doctor who really listens and don't hesitate to 'dump' those that don't cut it. Some doctors seem to think that a person's weight is to blame for everything, and then ignore other really serious problems.

    Good luck!

    Also, I'm in pre-nursing courses right now, and I'm super excited about being a nurse someday!!!


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