The following was in response to a query from a colleague who’s been asked to sit on a committee designed to address medical responses to fatness in elders. I answered way more than “The brief,” as they say on GBBO (and probably in British schools, though I don’t know). Thanks to Revs. Kate and Molly for the query and the typing up and cleaning up!
What do I wish medical professionals knew about being fat in a medical environment?
“1. Medical professionals WAY before you have treated us poorly, guaranteed. Dismissively. As though we’re lost causes unworthy of help with our overall health. One fat woman I know with a cyst on her breast has had three surgeons see her and walk out. One mumbled, “sorry.” None gave his name.
2. Stay in your lane. No, it is NOT the job of every medical professional of every rank and kind to either a. Ask us to lose weight, b. Ask whether we’ve ever dieted, c. Ask “Have you considered weight-loss surgery?” Consider before your speak how it is possible that we could not only live in this culture, but also be in a big body and NOT consider those things.
3. The most conservative numbers show that, at five years out, 85% of dieters have gained all their weight back. Of those, (raised hand) 40% will gain more than we lost.
4. We know that weight cycling, or “yo-yo” dieting, is significantly more damaging to health than being “overweight.”
5. In The Obesity Myth [transcriber’s insert: Paul Campos, 2004], the author looks at the numbers and discovers that those deemed “overweight” in fact have the longest life expectancy. (Though see BMI note below.)
6. Fat people can be orthorectic, anorexic, have binge eating disorder, or be intuitive and attentive to their bodies and therefore, healthful eaters.
7. Speaking of knees… a. YES, many more heavy people have BETTER outcomes than smaller people. b. Not only that, but why do you get to decide that our pain is immaterial, when you’d happily treat the pain of a thin runner? At what point does our pain matter to you? And furthermore, c. Risks are just that, risk. There are may reasons people do things. Many. And not one of them… not ONE (I am using the microphone for those who didn’t hear)… is because of laziness. Lazy should be excised from all our vocabularies.
8. Damn, I have many things to say on this topic. BMI was never intended to be an individual instrument of measurement, but rather a sociological statistical tool. It also correlates with (other) racist health care practices. Read Fear of the Black Body: The Racial Origins of Fatphobia by Sabrina Strings for more on this topic.
9. Paramedics, CNAs, nurses, transfer and transportation staff, interns, residents, and ATTENDING doctors need to have regular familiarity with or at least training in the pain management, wound care, movements, pitfalls (like areas for pressure sores), and the use of bariatric equipment all pertaining to fat people’s experience/needs.
10. Well over 85% of us have dieted at LEAST once in our lives. And yet the rate of success is so low… how would your reckon those as surgical odds?
11. I remember first being told, “You don’t need that,” by one of my aunts when I reached for a cookie at three or four years old. I was on my first diet in second grade. I now weigh 600 pounds, after well over twenty (at least) rounds at intentional weight loss and several prescriptions of psych meds. You do the math.
12. Some of us—like me—are like previously kicked and abused animals. We ASSUME we’re going to be hurt. So at the first sign of aggression we exhibit trauma responses BECAUSE WE HAVE LIVED THROUGH TRAUMATIC EXPERIENCES. Ahem.
13. Gowns. Waiting rooms. Beds. Stretchers. Why do we have to call ahead, check in, be our own fat case managers? Gowns are too small — if they may be too small, tell us in advance to bring our own. If we even HAVE our own, given who has hospital gowns lying around? Waiting rooms MUST, that’s MUST have large chairs, love seats, and/or (ideally and) chairs without arms. Thin people who are occupying one of these should know to get up and switch seats when we enter the room. We shouldn’t have to ask.
14. Patisserie’s dozen. Interrogate the fact that the people who know best how to use surgical tools appropriate for the very fat among us are those who practice “bariatric”—that is, “weight loss”—surgery. They are those trained in the use of the longer instruments needed to address our bodies’ surgical concerns.
All surgeons—and other health care providers—need to stop blaming our bodies and start blaming your training and enculturation. (Wow, that last line sums up a lot!)
Good authors are Lindo/Linda Bacon, Lucy Aphramor, Ellyn Satter (especially for parents!),Sabrina Strings, and the founders of Be Nourished.
Last—the best way to keep your kids from hating their bodies is not to pour shame upon your own, Let us be kind. Even and especially to ourselves, no matter our size.
Nope, not last… this is last: being fat can be so hard, Why would you make it harder? People have already tried blame and shame and it hasn’t worked. We cannot hate our way to health on any axis. First, do no harm.”
Beloveds, hear me, ALL of us–we cannot hate ourselves or our bodies into anything good. When did hate make flowers grow? Tender, gentle, persistent compassion makes things grow and flourish. May we all shower ourselves with compassion, and so, then, make it our mission to learn about those different from ourselves, and thereby create a better world for our Descendants of Blood, Choice, or Spirit.
Blessings on you, my dears. Blessed be your bellies. Blessed be –