I read this post from Dr Samantha Thomas over at The Discourse and I must say, while I’m absolutely disgusted at the way Amanda Bell has been treated, sadly I am not actually surprised. Because most of us who live in fat bodies know all too well that respectful, dignified health care is not something we can find easily, and that part of the reason so many of us find ourselves ill is because we avoid going anywhere near medical providers due to the amount of shame and bullying that is heaped on us when we do.
As I mentioned in my last post, I have recently been diagnosed with Type 2 diabetes, which is a chronic illness that comes with a whole host of it’s own shaming, which is compounded when it is suffered by someone who is fat. I am lucky, I have a GP who is supportive, sympathetic and treats me with respect and dignity. She also listens to me. However I was in my 30’s before I found my beloved Doc Jo. But I dread the thought of needing a specialist of any kind, because it is fresh in my mind the horror of having to deal with fat shaming and the general disrespect of fat-hostile medical professionals (and I use the term “professional” loosely).
But as I have read more and more on the topic of T2 diabetes, all I have found is further fat-shaming from both health care professionals and from every “expert” member of the media and the public who profess to have an opinion on a chronic illness that they neither suffer nor have studied. The most common message is that T2 diabetics, or to be specific, fat T2 diabetics, have “brought it upon themselves” and are now “clogging up our health care system on something they did to themselves.” Somehow thin T2 diabetics escape this criticism and are often heaped with sympathy and disbelief on how they should get a disease that the commenter believes is something that only “unhealthy fat people” get.
And just tonight, on Twitter I have had some two-bit television doctor from the UK dismissing me as “being silly” when I tried to speak to him about the disrespect and shaming that fat people suffer at the hands of medical professionals. Clearly he fails to see that a patronising tone is not an adequate argument.
What I want to talk about today is the commonly held belief that fat people do not deserve respectful, caring medical attention and are unable to advocate for their own health. Now, let’s pretend, for just a moment, that all the evidence we have found about there being no causal links between fatness and disease, only correlation, and we’ll pretend, just for a moment, that there are no healthy fat people, nor unhealthy thin people, and we’ll even pretend for a moment that 95% of diets and weight loss regimes do not fail over the long term. So if we ignore all of that evidence, and pretend, just for a moment, that fat really is something that can be controlled and eradicated by diet and exercise.
Let’s just pretend for a minute (bear with me).
If that’s the case, wouldn’t that mean that EVERYBODY who engages in risky behaviour or does things that are detrimental to their own health should be shamed, bullied, intervened into and vilified for their behaviours? Wouldn’t that mean that ANYONE who is not in 100% tip-top physical form through some kind of activity or behaviour that may possibly do damage to the human body should be held fully financially responsible (without any support from private or public health care) for their illnesses and injuries?
Let’s think about that.
Do you tan/sunbathe/expose ANY of your skin to the sun? Well, that counts you out for respectful health care, because you’ve let yourself get skin cancer. Do you drink alcohol? No respectful health care for you, if you let yourself get cirrhosis, stomach ulcers or alcohol related illnesses. How about anyone who plays sport? If you let yourself get injured on the field/course/track/court – no respectful health care for you. Have you ever had sexual intercourse in your life? Well if you get any of the long list of illnesses and diseases that can be contracted from just one sexual encounter, then it’s your fault, you are also exempt from respectful health care. Do you drive a car? If you have an accident, you let it happen, so off the list you go too. Take public transport to commute to and from work? Well, if the bus has an accident, or you get the flu from other people on your train – you let that happen by engaging in behaviour that has risks, so you’re off the list there. Choose to get pregnant? Well, all those things that can happen during pregnancy and childbirth – you let those happen by exposing yourself to that risk, so nope, no respectful health care for you either.
We could go on like this for ever. Because every single action we do in our lives, can and does have health risks. Not to mention that we humans do a lot of very stupid things to ourselves and end up sick or injured because of it. We drive big metal and glass vehicles at high speeds, we perch atop small things with wheels on them and hurtle along roads, down hills and around car-parks in the name of fun or transport. We hurl balls, sticks, spears, discs and other projectiles at each other in the name of sport. We jump out of planes, strap huge cans of air to our backs and dive to the bottom of the ocean with big creatures that have teeth that and see us as food, we go places where there are things that can bite, sting, spear and poison us. We have sex with all kinds of people and things, we use mind-altering substances and we engage in all kinds of purely cosmetic procedures that can go wrong. In the name of entertainment, pleasure or convenience, we do hundreds of things that are not entirely necessary, and carry risks to our health.
Such is life. Simply being conceived, gestated and born is the riskiest thing any human being can do – all the stuff afterwards is just the icing on the risk cake.
So why is it that fatness is singled out? Why is it that there is this general perception that fat people aren’t capable of making informed, conscious choices about our own lives and the risks associated? Why is it believed that we need to be shamed for our own good?
Because it’s not about health. It has never been about health. It is about appearance and moral superiority. A fat person offends the eye of a fat hater (and fat hatred is encouraged in our society), so they need to be shamed and bullied until they are either thin, or hidden away where the fat hater cannot see them. Or better still, eradicated. And our culture encourages people to feel moral superiority over others, so as we are encouraged to hate fat, who better to claim moral superiority over to make ourselves feel better than the fatties?
Yet so many people still can’t understand why fat people avoid going to the doctor…
Fat Heffalump 
So why is it that fatness is singled out?
Just to avoid the oppression Olympics, fat is not the only thing singled out. Smoking, having babies “too young” or “too old”, not having babies at all, having a mental illness, illicit drug use, not speaking English well, having poor dental health for any reason…all of these attract blame and stigma, too. This does not invalidate your point – in fact, it strengthens it – but I do sometimes hear that attacking fat people is “the last acceptable prejudice” when it is no such thing. It’s just a very popular prejudice!
Just to clarify, when I say “singled out” it doesn’t mean it’s the singular thing that is vilified by the medical community, it means that it is placed in spotlight on it’s own as the subject of vilification. (Regardless of other factors influencing health such as genetics, environment, behaviours etc.)
I am well aware of the trope of the false assumption of “the last acceptable prejudice” and am in no way using it here, now or in any other posts.
That’s great – it’s something I see a lot (and you obviously do too) so the words “singled out” were alarming to me! I absolutely agree that fat is singled out from other factors!
Thank you for stating this. I have had depression for 5 years, the first time I tried to get it treated my GP could not wait to kick me out of the consulting room and made me feel like I was wasting her time. I ODed a year later, the paramedics were lovely but once at hospital many of the staff did a bad job of hiding their contempt for any for of self harm.
So many doctors are good and supportive but many forget that their job is to treat, not to judge.
Depression and other mental illness are also dismissed very quickly in fat patients, as though fatness somehow “causes” depression, anxiety or any other mental illness.
I recently read the updated version of the Hippocratic oath, and I believe many doctors are in direct violation of their oath – the empathy, support, respect and dignity for the patient are so often missing.
Definitely agree with this. I have a particular mental illness which is a popular reason for medical professionals to disregard me as being a hysterical, manipulative attention-seeker. If I didn’t have that label, or have any traits to point to it (because I accept I fit the diagnosis, and don’t have a problem with it, just hate the prejudice in the medical world) I would be treated differently.
Sadly, this isn’t the case, and I was extremely lucky to find and cling onto a therapist at the early stage of diagnosis before the psychiatric team let me slip through the cracks (not that they cared, they spent my entire inpatient time telling me I didn’t deserve to be taking up space when there were people with -real- problems waiting for my room).
Further to that, I used to smoke and I remember the disgusted glances I used to get when I tucked myself away from other people who I wouldn’t disturb them with my smoke. People hate smokers, regardless of whether or not the person goes out of their way not to disturb others with their smoking. I can’t tell you the amount of times someone came up to me with a determined look in their eye to tell me “That is bad for you. You should quit.” Uh yes, it is bad for me, I know all the risks and went into it as an informed adult. Please f off now. *shrug* I get similar comments for being fat. “Being fat is bad for you. You should lose weight.”
Alice that’s one thing I have noticed. While I personally hate smoking and the smell/smoke spread around by it, so long as it is kept away from me, what other people do to their own bodies is none of my business. It’s a different story if I am being subjected to that smell/smoke, but what affects their own body is their own problem.
However I do think people try to apply the same thinking to fatness. They try to claim that our fatness “affect” them in some way – which is frankly, absolutely ridiculous. Unless I am directly sitting ON someone, then my fatness has no affect on them at all – except their own prejudice.
I HATE Dr Christian and his pseudo-science with a passion. Embarrassing Fat Bodies started last night here in the UK. Just what we need – another sphere where it’s okay to laugh out loud at bodies like mine.
It’s a very virulent cultural trope to just dismiss the lived experiences of fat people. It’s everywhere and the more it shows up, the more it grows.
But as Ghandi once said:
“First they ignore you, then they laugh at you, then they fight you, then you win.”
We’re in the thick of the laughing at us and starting to see some of them fighting us. We WILL win.
Dr. Christian looks like a smug jackass. If I were a doctor, I would be patronizing to smug jackasses. Hell, even though I’m not a doctor I’ll be patronizing to smug jackasses! They are just the upper class version of douchebags.
I had gotten to a point of such self-loathing about my body that I was very seriously considering weight loss surgery. My mind still plays with the idea but I’m trying not to go there. There are so many potential complications.
I don’t like to wish ill on anybody, but maybe if Dr. Christian developed some nice Cushing Syndrome, he would see what it’s like to live in a body that is determined to be fat no matter what. That would be some justice!
He’s a patronising misogynist. All this mansplaining and calling women who are challenging his methods “darling” and “dear” and stating “debate over” with no legitimate response to call a debate is so incredibly patronising and misogynistic. For him to stigmatise fat women, then call for women to get regular pap smears moments afterwards… with no clue at all that his very behaviour is the thing that PREVENTS women from going to get regular pap smears – is absolutely astonishing levels of ignorance.
And yes, sometimes walking a mile in someone else’s shoes is just the thing that is needed to see how people like that would cope. They probably wouldn’t.
I’ve just read Dr Samantha’s Blog post & the Melbourne Herald Sun article & I agree with it all. As a Primary Lymphoedema sufferer (& I DO suffer) from a young age, my gradual yet inexorable increase in body size has happened despite ANYTHING I have done. I’ve been forced onto Very Low Calorie diets as a teen (800 calories a day anyone?) to no effect & spent my adult life active & walking (no more diets!) with absolutely no effect on my ever-increasing limb size. I’m currently taking part in a Clinical Trial in the use of a new model of Lymphatic Pump & am very pro-active in my own healthcare & management of this condition despite, at every turn, being met by a helluva lot of medical ignorance.
Oh yeah, I have Progressive MS too; also NOT an ‘obesity related condition’ & I’m managing that too!
I was just talking to Sam too, and one of the things we were discussing with how damaging stigmatisation and “doom and gloom” approaches are to anyone with an illness, injury or health condition. Instead of scare tactics and stigmatisation, wouldn’t we be wiser to OPTIMISE health? To promote further good health anywhere we can get it?
Are you name dropping me Darling? Xxx
Mwah! Love your work!
This coming from the media tart!!
“Because it’s not about health. It has never been about health. It is about appearance and moral superiority.”
Exactly.
Exactly.
Sad, isn’t it?
Can you imagine a world where people really were vilified for risky behaviour? One of the biggest risky behaviours is alcohol consumption by women – it has an extremely tight correlation with breast cancer. Yes, I know correlation is not causation, but the relationship between alcohol and breast cancer has become alarmingly clear. Yet breast cancer has achieved an almost saintly aura and attracts extraordinary funding and publicity. I am not suggesting for one minute that breast cancer sufferers should be shamed or denied treatment, because that would be nasty beyond belief, but the reality is that female alcohol consumption has risen in tandem with breast cancer statistics. Can you IMAGINE the outrage if it was suggested that breast cancer patients be stigmatised the way fat people are? Yet if you want to look at a cohort of people who are contributing to their illness, there would be a sizeable proportion of breast cancer patients who would fit the bill. So why do fat patients have to suffer it, when the relationship between fat and ill health is not as clear cut? The reality, as you point out, is that it has nothing to do with health at all. (And, she points out wearily, I am not suggesting for one minute that breast cancer patients should be stigmatised, just pointing out how stupid the cruel the whole stigmatising of people for supposedly ‘self inflicted’ illnesses is.)
The one that always gets to me are sports injuries, especially extreme sports injuries. If a sportsperson injures themselves during their sport, the media heaps on the sympathy, people all say “poor [sportsperson]” and who knows who foots the bill – health insurance or even government funding for professional sportspeople.
Yet sport is a non-essential activity, people choose to do it and many take risks they are well aware of. But fatness, which is a far more grey area by way of it’s impact on health is villainised as a “dangerous lifestyle” and anyone who dares get injured or ill while fat is vilified for costing our society X amount of money.
Double standard much?
Sadly, Alexie, as I mentioned in a comment on a previous post here, fat breast cancer patients are already, to some extent, stigmatizing themselves by blaming their fat for them getting the illness – anc conversely, I quite often see articles by thin women who’ve also had the misfortune to develop breast cancer, saying ‘I don’t know why I got this, I’ve always taken care of myself’ (read: stayed thin).
There is actually some evidence that being fat may increase the risk of breast cancer (note: can increase, not ‘you will definitely get it’), probably by the mechanism that fat produces its own little supply of estrogen. But that risk only applies after the menopause – if you’re fatter before the menopause, you’re actually less likely to get breast cancer. That said, the estrogen-related breast cancers are that much easier to treat and have a better prognosis than the non-estrogen-related type, HRT is risky for similar reasons but you won’t find doctors barring it because of that, and age and genetics are still the biggest risk factors overall anyway. (There is another: one of the docs in the path lab where I work, who comes from a very large family himself, says breast cancer was much less common back when women had back-to-back pregnancies for most of their reproductive years – also for hormonal reasons. But, as he said, who wants to do that just to decrease their cancer risk?)
And, italicized because it’s important: over and above all this, NO study has proven that weight loss (leaving aside the near impossibility of long-term weight loss) can decrease your risk of developing any cancer, or improve your prognosis once you have it. This is from straight from the horse’s mouth of the NCI, who should know, yet cancer charities continue to tout weight loss as a cancer prevention method as if it were gospel. Grr.
To be honest, it’s not just fat people who are being stigmatised. Everyone these days is being held accountable for their health in absurd ways. I finished treatment for Stage IV cancer – one that’s not a ‘lifestyle’ cancer – only three months ago. I’m sill rejoicing in hair coming back, being able to go back to work, being alive etc. Last weekend a friend actually had the nerve to say to me: “now that you’ve recovered, have you thought about changing the behaviours that made you so sick?”
I told her that was just superstition and I didn’t do any “behaviours” that made me sick, but I could tell she didn’t believe me. I’m still steaming about it.
You’re absolutely right – healthism is an issue across the board – health is the new morality. And that’s fucked.
However, fatness is the one physical feature that is instantly pathologised as “unhealthy” on sight. With no other indicators of someone’s wellbeing, lifestyle or actual medical markers, fat people are deemed as inherently unhealthy simply by virtue of the size of their bodies.
I recently started following your blog and all I can think of to say here is THANK YOU. I loved this post.
Thank you and welcome!
Well, I must say that the reactions of the some of the doctors in the article PISSED ME OFF! The whole thing is just ridiculous. Some of them really do think that we’re lazy and just sitting around eating all day. Then they push the diet programs and we become even fatter in the long run. Don’t they know the statistics? Why are they pushing something that makes us sicker? I just saw a post on facebook – one of my friends is doing some weird diet where he eats protein, 13 asparagus spears and an apple sprinkled with cinnamon every day. How can we do this to ourselves? I just can’t do it anymore – I refuse. I’m going to be a happy obese woman, if it’s the last thing I do!! Okay, I feel a little better now. Have a great day everyone.
By the way, I’m in the U.S. – and it’s certainly not any better here than the UK and Australia. We’re all in the same boat.
It’s because many doctors (and people in general) don’t see fat people as PEOPLE. We are The Obese. And there is an epidemic that needs to be eradicated. We’re not seen as human beings with lives and feelings and needs and responsibilities and restrictions. We are just an amorphous blob of fat units.
That is true, Kath – we are seen as “less than human.” A sad state of affairs, to be sure. It would be one thing if it was dumb asses making rude comments, but it’s doctors and employers and other important people in all our lives and they can make us or break us, help us or hurt us. We have to take our power back. The FA world is one place where we can begin to do that.
That it really isn’t about health is hammered home to me every time some so-called health professional suggests my purely genetic condition (no treatment, no cure) would improve or go away if I lost weight. Sure, I’ll get right on that. And when so-called health professionals dismiss the lived experiences of fat people as well as the excellent body of research on why fat stigma/discrimination/harassment does not help at all with what amounts to “LOL! UR FAT”, well, it just proves your point again and again.
Actually I don’t know why Dr Christian didn’t just call his TV show “LoL! ur fat!”. It’s not like he/it has anything more to offer fat people than your average internet concern troll.
Yup Madam Q, I refer to it as “point and stare/laugh” television. Disgusting.
While I don’t agree with his thoughts on obesity, I’ll forever be indebted to Dr Jessen for pulling me up at a Tesco of all places two years ago when I was on holiday in London to tell me I really should get a mole on my neck seen to ASAP. It was malignant. So I think ‘two-bit television doctor’ is a bit harsh.
I don’t think it’s harsh at all. He’s a hack who makes money off parading the misery of others on a television show for entertainment.
That doesn’t mean that he hasn’t had any successful diagnoses, it just means that his current behaviour is reprehensible and damaging.
He comes across from his Twitter comments (slightly less so on TV) as a man who doesn’t like or respect women very much. My late mother’s old doctor used to be like this; after we’d had some trouble with her GP (it involved over-prescription of antidepressants when she was in fact developing Parkinson’s – long story), a cousin of mine told me he was her family doctor too, and that while my uncle had gotten on fine with him, he’d been quite patronising to my aunt, and to the cousin herself and her sisters. Fat hatred may or may not get picked up within medical training, but some people enter the profession with other prejudices they don’t bother to check at the door.
Oh it’s very, very clear that he doesn’t have any respect for women. From referring to various women who tried to engage with him on the topic as “dear”, and “darling”, to dismissing women with “Now you’re just being silly” and completely disengaging with women the minute he realised they had some serious background experience in the field to simply “mansplaining” in a patronising tone, it’s abundantly clear he has no respect at all for women.
Out of all the true and spot-on points made here, the thing I agree with the most is at the very end, the bit about moral superiority– La mentioned her friend with that utterly neurotic diet.
Shit like this is clearly NOT healthy yet it’s behavior that is met with adulation and respect! You’re regarded as morally superior for putting efforts to stay thin/lose weight above anything else.
Really, I feel sorry for the people who can’t turn those parts of their brains off, in the guise of “doing it for health” when really it’s all because society just wants us to feel ashamed for actually feeling happy and fulfilled regardless of size.
I’d rather be a size 18 and thinking about how I have kickass friends, a great career, the abilities to do several left-brained activities like taxes and C++ programming but also be a great writer and pixel artist at the same time, than spending all my time feeling like a goddamn failure because despite eating “right” and hitting the gym 4-5 times a week, I still can’t squish into a size 8 dress.
The latter? Is a really fucking miserable way to live. Yet in my experience, it’s actually been these goddamn doctors more than the media, family, peers, random trolls, etc. that have encouraged that type of thinking within me!
You’re totally on the money with the whole violating the Hippocratic oath thing– who really enforces it though? Who actually polices them? I mean, as an EA, if I violate the code of conduct dictated in IRS Circular 230, my ass can get totally fried and I could be disbarred. What actually happens to these doctors who encourage these downright unhealthy behaviors in the name of shaming, make judgments without actually investigating anything (like just assuming you’re healthy because you’re thin and unhealthy if you’re fat), and treating patients with disrespect?
To end my rant, I’m also sick to death of these doctors that just tout weight loss as a fucking cure-all for everything. I would seriously love to get paid just to bullshit like a lot of them do.
And my friend is posting his weight loss on facebook – he’s down 13 pounds already. I think he’s been doing it, at the most, a week. Now, how can that be healthy?
Seriously! If you lose that much weight within a WEEK, that’s usually indicative of some kind of problem– and is probably losing muscle and water weight from depriving the body of nutrients it needs to function, not fat.
It’s simply not. Nor is it permanent.
Rachel, nobody polices that behaviour – but they encourage and reward it. Those in health care are rewarded for bullying and intervening in the lives of fat patients. That’s when they’re considered to be “doing it right”.
But as we’ve seen on the website First Do No Harm (http://fathealth.wordpress.com/), the actual health and wellbeing of the patient means nothing.
We may as well be attending a vet, rather than human medical care, when this is the case.
Indeed, it’s just sick and sad. I just hate seeing that kind of bullying get rewarded.
On the note of vets though, I’ve seriously met more vets who are really caring and compassionate about animal health and DO MORE in a single visit than most freakin human doctors, period.
I hope it was OK as I took part of this post with quotes and source info and emailed to my daughter who has seen 5 Drs in the last week for a horrible outbreak of (finally diagnosed today) contact dermatitis in a very private area that has made her life unbearable.
You really summed up my feelings as of my 58th Birthday.
I remember saying to my wonderful female “slightly chubby” Family Dr (when I was 29 yrs old) that I wanted to start a family but was concerned because of my weight. She replied: fat woman have healthy pregnancies all the time and skinny women can have difficult ones, too. Two daughters later (with no major problems except C-sections due to my first child wanting to be born foot first), I can’t imagine life without them.
Of course it’s ok, please feel free to share away, just credit me any time you do.
Thanks for writing that, I soo needed to read this!
I watched Embarrassing fat bodies (I live in the UK) and was surprised that they were not aware of the latest research that has debunked the apple/pear theory about where you have your weight and your chance of having heart disease. In fact the latest study found that BMI was helpful in predicting chronic illnesses of this type if you had other indicators to go on. Quote: further finding of this study is that BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.
BUT the study’s authors have been quick to downplay the lack of relationship between BMI and heart disease because no one would want to actually say that it is possible to be fat and healthy would they?
My experience of doctors, even during pregnancy, has been positive. I usually ask to weigh myself (out of interest and don’t have scales at home) and often ask if my weight will have any impact on x. y or z (eg when I was pregnant). To be honest my health is pretty good so not a regular visitor. Was one doctor years ago when I was a student who really really annoyed me. I had hurt my ankle playing sport. Competitive sport. And all he want on about was my weight (it wasn’t a injury caused by weight bearing). Annoyed me but I also found it funny.
OOps, should say BMI was NOT helpful in predicting…