A Sensitive Topic

“I know this is a sensitive topic,” you say to me as I sit on your examination table.

Don’t go there, please don’t go there, can we just get through one appointment without this conversation? We had this conversation last time and it was so awful it had me in frustrated tears for hours after my appointment. 

But you go there anyway.

“We need to talk about your weight.”

I’m at this appointment because something is happening with my legs. One of my legs has gotten so swollen and painful that it sometimes interferes with my mobility. It has begun to keep me from doing things I want to do, like taking walks with my husband, going to the park with my dog, or even just walking through the grocery store without pain. I am terrified it is a blood clot because I am on hormonal birth control and traveled on a plane very recently. I told you at the beginning of this appointment that I have had fat legs my whole life, but this problem is new and frightening. Sometimes I will lose control of my legs and they will just shake and shake and they won’t move. I trip over my feet and lose my balance, even when I’m not moving. I am in pain. I’m scared. I want help.

Instead, you want to talk about my weight.

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Here is what I want you to know, doc. This isn’t a topic I want to avoid because I’m “sensitive” about it, because it hurts my feelings when you acknowledge my body weight. It’s because this topic results in me receiving poorer medical care. It’s because the last time we had this chat, we spent 80% of the appointment going in circles on this topic and only a few minutes on the actual reason for my visit: the swelling and pain in my legs that had just started. You held my swollen, painful leg in your lap and pressed on the swelling with your fingers. “Yep, you’re definitely retaining fluid there!” You said this and you offered absolutely nothing else. No diagnostic tests, no suggestions, no treatments. Because you wanted to talk about my weight instead.

This is a topic that can drive me to tears. It’s not because you’re Getting Real™ with me in a way no one ever has before. And it’s not because I have never once considered that I am on the higher end of the weight spectrum and you are bringing this to my attention for the very first time. It’s because I get so angry and frustrated that all I can do is cry. The anger chokes me, burns in my chest, and wells up in my eyes. Do you know how many times I have had this conversation? If I had a dollar for every time as doctor has sat on their little stool Getting Real™ with me about my weight, I’d be searching for a new McMansion with a pool and media room on HGTV. But, alas, I’m the one ponying up the cash for this discussion.

I’m tired. I came to this appointment with a list of possible diagnoses that I had Googled and crowdsourced. I wrote down a list of things to ask for: an ultrasound on my legs, a referral to a specialist. You tried to offer me diuretics with zero qualifiers, but I said, “I don’t want to take diuretics until we know what kind of fluid this is because if it’s lymph fluid, diuretics could make it worse, and if it’s a blood clot, it’ll do nothing.” You nodded your head and said, “You’re right.”

I am tired of being my own doctor.

This may come as a shock to you, but I am aware that I am fat. I know! I even have a whole entire blog about it! I’m aware that I’m fat because I live in this body and have been fat for 36 years. I was aware of it when my pediatrician advised my mother to put me on a diet before the age of 10. I was aware of it when a school nurse suggested I join Weight Watchers in 4th grade, because I “would be so beautiful if only I’d lost the weight.” I was aware of it when my mother encouraged me to go on Atkins with her at 17, and I ended up with gallstones, that my doctor did not diagnose for a full year because she thought I was making up my symptoms. I was aware of it when that same doctor prescribed Phentermine to me in my senior year of high school, and was annoyed that I stopped taking it because I couldn’t sleep (because it was speed). I was aware of it sitting in endless Weight Watchers meetings, learning how “healthy swaps” and Greek yogurt would save me. I am aware of it each and every time I travel, especially by air. I am aware of it when I cannot fit into a seat. I was aware of it when a gastroenterologist compared my body to “an overstuffed suitcase.” I was aware of it when I worked for an employer that refused to send me to a conference I helped plan because I was not fit to represent the organization. Jesus Christ, my blog post about going to Disney World is one of the first Google results for “fat at Disney.” Believe me, doc, I am aware.

And I want you to hear me when I say I have accepted that my fatness is not a temporary state. This is it! This is my body. I spent the vast majority of my life trying to unleash the skinny bitch within, but much to my dismay, she was never there. I have tried everything short of surgery to will my body into being smaller than it is, but it just hasn’t happened. In fact, these attempts have wrecked my relationship with food and movement. I couldn’t even tell when I was hungry, full or thirsty after years of restrictive dieting. I have tried and tried to mold my body into something different. I have spent thousands of dollars. I have cried thousands of tears. I have invested years and years of effort. And what did I get for that? I get to have this fucking conversation, yet again.

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Do you know that it took a tremendous amount of courage to even come here to ask for your help with this problem? Because I knew what you would do, and you did it. I spent days dreading this appointment. I rehearsed my speech about why I do not want to have weight loss surgery in my car on the way to this appointment. I rehearsed my attempts to get you to refocus on my presenting complaint. I’ve fretted and imagined every possible direction this conversation could go in. Last time I was here and I declined weight loss surgery, you said, “Well, if you have cancer in your breast and getting a mastectomy would remove the cancer, you would do it, right?” So you know how to throw some serious curveballs at me. At the time I just gaped, because I had never before heard someone insist that my healthy, functioning stomach was diseased before. That was a new one for me! You keep me on my toes, so I had to be ready this time.

At this point I’m just done with the shame. I am done with the notion that every ache, every illness, every difficulty, is something that I’ve done to myself. I am done with being labeled “noncompliant” because I refuse to submit to an expensive, permanent surgery that I don’t want. I’m done defending my own humanity. I don’t want to have this conversation anymore, because I have a right to receive evidence-based, compassionate medical care, and you are not providing that. Even if you furrow your brow and look at me with your best Pity Face, you’re failing me. You’re falling short. You’re wasting my time. I swear, I am not being fat at you. I am just a fat lady, sitting in her socks in front a medical practitioner, asking for medical care.

I want to know what you expect to get out of this conversation. Do you expect me to look at you in shock and go, “Oh my god, I had no idea I was fat! Please, explain what a vegetable is!” Or, do you expect me to go down to the bariatric surgery center and get operated on immediately, just so you can begin treating my legs, even though you have no idea what is causing the pain & swelling because you have not done anything to diagnose it and there is no evidence that weight loss surgery will cure or treat whatever the fuck is happening? Do you just want me to cry? Do you like those tears? Do they make you feel better about yourself? Or do they make you feel like maybe I had a breakthrough, and one day I will give you credit for saving my life? Am I supposed to apologize? Is there an apology threshold I must meet before you deign to treat me? Let’s say we take it for granted that my weight is the one and only cause for this mystery issue. How much weight must I lose for you to treat me? 20lbs? 50lbs? 100lbs? How thin do I need to be to be worthy of medical treatment? How long will that take? A year, two years, more? What if I never get there? Do I just accept that this is my life now and no one can ever help me? If I never become worthy of treatment, do I deserve to just live with pain? Is that my just desserts?

It’s confusing because, aside from weight loss surgery, you have offered no advice. You have not asked me about my diet or lifestyle. You don’t even know what I do for a living, nor did you care to ask. (You seem to be under the impression that I am unemployed, come to think of it.) So, you just drop this bomb at my feet, this discussion about my weight you insist on having, and then you leave. What am I supposed to do with it?

My biggest fear is that one day my weight will kill me. Not because I am too fat to live, or because of all of the “obesity-related” diseases out there, but because I will be suffering from something life-threatening and you will not notice. You will not be able to see past my fat body (with a pretty face, you note) and you will insist on having this conversation yet again and something will kill me. Who knows what it could be! Cancer, a blood clot, an aneurysm like the ones my mother had that may run in the family, a stroke, a disease. I imagine myself sitting on the table in my socks, like I am now, and you sitting there with your best Sympathy Face on telling me that I did this to myself and I need to lose weight. And then, BOOM, I am dead from something you didn’t even try to diagnose. BOOM, that bomb you dropped at my feet kills me.

My other fear is that one day, you will wear me down, and I will get part of my stomach removed. I will do this so that perhaps you and others like you can maybe see past my weight, or at least appreciate my compliance, enough to offer me medical treatment. And that I will die on the table, or after the surgery I will suffer from painful complications, malnutrition, my hair and teeth will fall out, and then I will die. I have nightmares about this.

All I want is for you to do your job. I think you feel like this is your job, because you would be irresponsible if you let someone as large as I am just walk out of your office without a thorough tongue-lashing about how I should be smaller. And, sure, you want to be able to bill my insurance for “obesity counseling.” I know how it works. But in reality, you’re just refusing to treat me.

I ask you what evidence or facts you have that my weight is the cause of my issues with my legs, and you have none. You admit that it is just a feeling. Who knew that your feelings were science?!

You press on. I feel them coming, the tears. My throat locks up and my eyes start to burn. My eyes well with tears.

You inch in closer. Oh god, you’re going to hug me, aren’t you? You fucking did it. You gave me a goddamn hug. You chastised me about my weight, refused to listen to me, refused to treat the problem I came here for, and wasted my time. And you gave me a motherfucking hug.

I got your notes from this appointment the next day, through the patient portal.

“Tried to discuss patient’s weight but she is sensitive about it and prefers not to discuss it.”

Oh, fuck you. 

19 thoughts on “A Sensitive Topic

  1. “I swear, I am not being fat at you.” So well put. I hope you find a doctor who will do their f**king JOB and give you an actual diagnosis and treatment.

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    1. Seriously, it’s like we’re asking them to lasso the moon by asking them for any treatment beyond, “You should stop being so fat.”

      FWIW, after pushing and pushing and pushing, I did get a referral for an ultrasound, which I’m scheduled to have tomorrow, so that was a small victory.

      Liked by 1 person

  2. This was so well written, I’m so sorry you have to go through this. I know the struggle. Not to this extent but I am told I’m obese every time I am at the doctor’s and it’s getting very old. Like I don’t know that I’m overweight. I have a mirror in my house for God’s sake. I can see myself! I have PCOS and losing weight feels impossible but no one seems to understand that. They thinks it’s just this easy thing. Cut carbs and exercise. If only it was that easy. Stay strong ❤

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  3. You are living the same life I did. I am now 52. I had gallstones in 3rd grade not removed until I was 47. I almost died. I had high blood pressure because I was FAT. No. I had high blood pressure from 3rd grade because I have a vascular disease that creates Aneurysms all over my body. I almost died. I finally found a doctor who gets it. Don’t atop advocating for you. If they make you cry, get the fuck out of there. Ask your friends, ask the nurses, ask the gal scheduling your appointment if your doctor treats fat people. Not if they see fat people but if they treat fat people. Don’t stop until you get answers because it matters. You matter. Sending healing love and light. Doinmything67
    Liz

    Liked by 1 person

    1. Oh gosh, that is so awful, I’m sorry! As I mentioned, it’s my worst nightmare that something serious is happening and no one notices because they’re too busy lecturing me about my weight. I did finally, after INSISTING on some sort of action, get a referral. But I’m going to be looking for a new doctor. It’s just stressful, because I don’t want to have to start from square one with this discussion again, you know? Ugh.

      Liked by 1 person

      1. I completely understand. Having to explain yourself one more time is exhausting. It’s easy to give up but you can’t. I avoided doctors for years for this very reason. I finally found one that understood the hurt. You will be alright. You will. Your fear will manifest in your body and create symptoms to mimic your fear. My left leg is larger than my right and pain radiates down it. I found a massage therapist who found that the fascia in my lower back that goes around the outside was messed up. Still working on it but better. Breathe and research doctors. There’s a reason is called the Practice of medicine! Not all are equal!!

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  4. Seriously, fuck that noise. Also, if you have not investigated the possibility that you have lipedema, it might be worth looking that up.

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  5. I have the opposite but the same root problem I lost almost 200 pounds and I go in because now I csnt stop losing weight and I am exhausted and I have a doctor who keeps praising my “progress” and telling me my exhaustion is just me getting used to things

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  6. I have received this load of garbage before, too, and from skinny female doctors. However, as soon as they understood I was a lawyer they shut up and got to it. Here is my suggestion: the next time a doctor does that, pull out a notebook and start writing. Write the date, the name of the doctor, and what the doctor is saying. Then calmly state, “thank you for that advice but can you tell me in your professional opinion what is causing my XXXX symptom?” Do not engage with them on the subject of your weight. Redirect the conversation. If they say your weight is the issue, ask “are there any other possible causes for my XXXX symptom that should, possibly, be investigated to just rule out any other type of medial treatment?” Write down whatever they say. Ask them to repeat it if you need them to. If they still harp on weight ask, “what are the possible risks to failing to investigate these other possible causes?” (Reminding them that they have a liability for failing to do their job.) Write that down. If they ask why you are writing this down say your memory is bad and you want to track your medical information accurately. If they say don’t worry about this they will put this in writing, just say thank you but this works for me. At the end tell them you wish to have these other tests done to rule out these other possibilities and ask how “we” can get this done? If they refuse, document their refusal. If they say there are no tests for these other possibilities, ask, “other than weight” what is the most logical cause of XXX and what is the treatment for such. Continue discussing each possible cause, symptoms, tests, treatments, etc. and write that information down. This gives you the information you need to make an informed decision as to what treatment is best for you. A handwritten notebook is gold, much better than an electronic version because it is much harder to edit. Use a bound notebook and keep it with you every single time you see a doctor. If you end up leaving without any appointment for further testing, or some sort of treatment options other than the weight, go to emergency room immediately after your appointment. This creates a record that is very powerful. You have a powerful voice with this platform. Please use it to educate others on the power of demanding respect and the treatment we deserve. No more tears, no more accepting of this lack of treatment. Document and fight for professional care instead of lazy ass condescension on the part of the medical community. For the record, I quit the Bar nearly two decades ago and am no longer an attorney (to care for very ill child) so this is NOT intended as legal advice but, rather, life advice on asserting ourselves as women. I wish you good luck.

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  7. It sounds like you may have Lymphedema or even Lipedema in your legs. Many doctors misdiagnose Lipedema/Lymphedema as obesity and therefore, many women are left untreated as their legs become bigger and more painful. There are many doctors who have never heard of Lipedema. The best kind of doctor to diagnose Lipedema or Lymphedema is a Vascular surgeon, as they spend more time learning about the lymphatic system than the simple primary care doctors. I have Lipedema and it is a constant battle trying to find a doctor who understands it. They love to just prescribe weightloss, as if that will magically make all other illness go away.

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  8. This sounds exactly like what I went through with my former doctor. He could not see past my fat. I kept going in to see him because (like you) my legs were swelling and painful and I had no idea why. I ended up in the ER 10 times in one year with severe infections in my leg that required I.V. antibiotics. Things got so bad I needed a pic-line and home-care, and still, my doctor kept telling me I wasn’t trying hard enough to lose weight. My legs were splitting open and leaking! But somehow that is normal? Every appointment was the same – lose weight, exercise. And every appointment I told him the same thing, something is wrong with my legs, and as I told you last time, I’m on Jenny Craig and go to the gym 4x a week. But my legs are getting bigger!! Then one day, I ended up in the ER again for the umpteenth time, and the doctor in a slightly angry voice said, “Why aren’t you treating your lymphedema? If you started working on that, you wouldn’t be here so often.” When I said, “What’s lymphedema?” He just about hit the roof! He had thought someone, like my GP, had told me that my lymphatic system was shutting down. And that was why I was getting so many serious infections and why my legs were swollen and hurting. He sent a report to my doctor with my diagnosis. And what did he do? He said he knew me better than an ER doctor, and I wasn’t trying hard enough to lose weight! That was the day I dumped him. Found another doctor, who listened to me and read the ER reports and agreed I needed to see a specialist immediately. I found out from the specialist I had two diseases, lipedema and lymphedema. Long story short I am in the last stages of both conditions because my doctor couldn’t see past my fat and listen to me. I hope you get the answers you are looking for.

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  9. Oh god, this is my life. I start having panic attacks every time I have to go to the doctor now. I have myotonic dystrophy, which is a form of muscular dystrophy, which is degenerative. My GP never even mentions it, but he does mention my weight. My sleep doctor told me to get WLS even though surgery is dangerous for people with weak breathing muscles. My diagnosis on my records is “morbid obesity” before myotonic dystrophy. I will die before they see past my weight, and that is not an exaggeration.

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  10. Wow. Well first off, fuck ALL of that. I am so sick of the medical community/doctors’ fatpobia, because yes, it can literally kill people. Fat people are fucking people. We deserve to have our humanity and our human rights respected. We deserve medical care, and we deserve to exist in our bodies as they fucking are. I have leg problems, too. I was diagnosed with chronic venous insufficiency about five years ago. Apparently, it’s something you can get if you’re sedentary, fat, female, and/or pregnant. I was the smallest I’d ever been in my adult life, which was still over 200 lbs, and I wanted to lose 80 more because haha I have body image issues/ED and have been fighting with my weight/body since I was a child. Literally wrote a fucking diet book when I was eight. Anyway, I was jogging at least three times a week and going to dance aerobics at four times as well all while staying under a low calorie limit. Turns out CVI has a major genetic component, but now when I go to the doctor much fatter than I was before, he points out that my weight makes it worse of course. This causes leg swelling and I’m also dealing with lymphadema, which my brother also has (we suspect our mother did, too). It’s a damn shame you have to advocate for yourself, but I’ve heard that if you suggest a test/treatment and they refuse, ask them to put that refusal in your record, and they might be more prone to listen to you. There’s no damn reason they can’t have you get a leg ultrasound to see if it’s a vein issue, which is causing the problem. If you can get compression stockings that’s another thing to try. Also wtf wouldn’t they make sure you DON’T have a blood clot? I’m so fucking angry for you.

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  11. OMG. You have just described almost every doctor’s appointment I have had for the last 10 years. I have even had a fat doctor lecture me about my weight! I am saving this post and subscribing to your blog, because I feel more seen and heard than I have for a long time. And I am so thankful you are changing doctors!

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  12. Yes, yes, and yes. One of my motivations for losing weight was so when I am ill and go to the doc, they don’t immediately dismiss my problem as weight related. Several years ago I went to a physician for a problem and the doc left the clipboard in the room to step out. On it she circled the word “obese” with an exclamation mark. It was at that moment I realized I was not going to get the same level of care as my smaller counterparts.

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