by Keisha Ray, Ph.D.
A sudden and rapid weight gain of 15 pounds over the span of two weeks, despite exercising almost daily and following a nutritionist approved diet sent me to a primary care physician. I have been fat for all of my adult life so I am familiar with the disbelief, questioning, and distrust that comes with being a fat patient complaining of poor health. So I went to this doctor’s appointment prepared. As anyone who follows me on social media knows, I am a meal prepper. On almost every Sunday of the year I prepare 5-6 days’ worth of meals according to an anti-inflammatory, nutritionist approved diet, weighing and measuring all foods, and I post the pictures to my social media. I arrived at my doctor’s appointment ready to show her these pictures of my neatly laid out glass containers filled with clean (not processed) foods, lean meats, vegetables, fruits, and whole grains that I eat most of the time. I also brought with me screenshots of my workout statistics-duration of workouts, calories burned, etc. I was ready for a doctor, who based on past experiences would require me to prove my case, prove that I was not a couch potato who ate junk food every day and now wanted her to prescribe a quick fix for my weight gain.
After going through intake with the nurse and a student, the doctor walked in. She informed me that she had been briefed about my concerns and wanted to know more information. I told her my concerns and I immediately began to prove my case because her furrowed brow was one I’ve seen so many times on doctors’ faces. I tried to show her my pictures, my proof, but she barely looked at them and seemed uninterested. I then pulled out a worksheet given to me by my nutritionist that I use every week to make sure that I’m eating the appropriate servings of food and macronutrients (protein, fat, and carbs) at every meal for a 1600 calorie diet. She didn’t even look at it. I then reminded her that I have polycystic ovarian syndrome (PCOS), which is very common among women and can make weight loss very difficult. She acknowledged that my weight gain was likely due to PCOS, that I could “smell a cupcake and gain 10 pounds,” and that there was probably little I could do to lose the weight. But then followed this acknowledgement with “Well have you tried dieting”?
Diets don’t work. Neuroscientists, physicians, and scholars have all told us this. People who go on restrictive diets are more likely to end up “yo-yo dieting” and even when they lose weight they often gain it back. I prefer to practice mindful eating—staying active and making good food choices that fuel the body, while reducing stress and sleeping more—such as Dr. Sandra Aamondt advocates. Mindful eating, although not always called this, is the generally agreed upon recommendation for maintaining a healthy weight, not fad dieting.
After telling the doctor that I don’t believe in dieting but that I’ve found a way to eat healthily and that I’m constantly reworking my diet within the parameters of clean eating, sometimes even trying vegetarian or pescatarian diets, I again tried to show her the pictures of 3 meals and 3 snacks for 5-6 days a week neatly displayed on my kitchen counter but I couldn’t even get her to glance at them. But what I did see on her face was a familiar disbelief. As she questioned me about what kinds of foods I eat and whether I’m active I could feel myself giving up the fight. If I could just get her to look at the pictures I could prove that I do eat well. I tried one last tactic—even more honesty. I told her I try to practice the 80/20 rule, which means I eat healthily for at least 80% of the time and indulge, with some restraint 20% of the time. I laid my cards on the table and said I am by no means a perfect eater, if such a thing existed. I told her that while on vacation I eat what I want. I told her how I have a few pieces of candy a week. I even told her about how I sometimes eat Thai food or Vietnamese food for at least 1-2 dinners a week. This was a rookie mistake and I should have known better. I thought if I could show her that I can be honest about my eating habits this would make her more likely to believe that I’m telling her the truth and that my sudden weight gain is not because I’m eating take-out every day. My honesty about my occasional indulgences just made her question everything we had previously discussed. Now she really didn’t believe that I eat healthily most of the time. Now she didn’t believe that I was being honest with her at all and her follow-up questions showed it. Again, this is a place I’ve been before and as a fat patient I should have known better.
I left the office with all of my proof that the doctor never looked at, suspicions of being a liar, and an order for bloodwork, which the doctor suspected “will come out fine” because after all, nothing is medically wrong with me. I just need to keep trying to lose weight.
After I shared this experience on social media, the number of women and men who have had almost this exact same experience was astounding. So many of them knew the disbelief, the accusations of lying, the diet suggestions, and the overall lack of care that they so desperately needed from their doctor. Some were trying to maintain healthy weights after giving birth, some were trying to get pregnant, some were experiencing pain, but because their bodies had excess fat their complaints fell on deaf ears and they were left uncared for.
The experiences of these women and men and my own experiences may be anecdotal in nature, but the research suggests that we are a part of a growing group of individuals with fat who are finally speaking up “anti-fat” bias in healthcare. Scholarly articles and texts tell us that fat people face suspicion, discrimination, and poor care from their caregivers. Research also tells us that many physicians, nurses, and nutritionists see fat patients as more likely to be non-compliant with medical advice and associate fatness with moral failure.
As a fat patient myself, what stands out is caregivers’ disbelief. No matter what I say, no matter how much proof I bring with me, the fat on my body is all the proof that they need that I am not a reliable narrator of my own story. The fat on my body says to them that I cannot be trusted. But unfortunately, what their suspicious attitudes and unwillingness to treat my fat body says to me, and so many other patients like me is that they cannot be trusted with my care. Weight stigmas and fat biases are killing patients and perhaps this awareness is a small step in mending the relationship between caregivers and their fat patients.