healthcare providing like a fat babe does

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Don’t let the nurse-y side eye get you down.

Babes. I have a confession. I try not to tell people unless they already know me and think i’m not the actual worst. I’m four posts in to this blog so I’m thinking if you are still with me that you are ready. Here it is: I am a health care provider, a nurse to be specific. A fat one, but still. And on behalf of healthcare providers I would like to offer you fat babes my sincerest apologies for our dickish behaviour towards fat. We, as a group, are deeply uninformed, thoroughly incompetent, and essentially body phobic assholes. Its not you, it is so totally us.

We don’t read the articles about health(if you want that) at any size, we don’t see the journal articles about how fat people live longer, we have never heard of the ‘obesity paradox’, we don’t go out of our way to learn about how to make space for fat bodies in healthcare. And for this i am deeply sorry.

We consume the same epic bullshit media as the rest of the world and it makes us bad at our jobs. You know what i mean, yeah? Oprah talking about bread and weight watchers in the same breath, vogue cosmo marie claire who do a ‘size issue’ once a year (as if that gets them off the hook for the other 11 months), celebrity magazines dedicated to dissecting celebrity bodies (too thin, too fat, what not), and shame-y public health campaigns that, for some reason, love to use exactly no evidence for their social marketing. Healthcare providers have been trained in the same way that  all of us have – to hate our bodies and to believe that changing our physical appearance is the answer to living life to the fullest (Fun Fact: it’s not).

Then your friendly wannabe docs and nurses et al go to healthcare school. In the beginning it’s ok. We learn that there is no magic bullet in healthcare, that healing is complex. So far so good.

Unfortunately for fat babes everywhere, eventually shit gets really real in healthcare school and we learn the most messed up logic fail in medicine:

That ‘lifestyle changes’ are the solution to it all- wait, what? Especially for fatties – oh hell no.

Suddenly, despite that earlier training about how there is no magic bullet in healthcare, we are taught that, for fat people, there is and that bullet is a diet. It is this moment where everything goes sideways and all of a sudden losing 20 pounds will cure cancer.

And so this begins our training in talking out of both sides of our mouths; learning to say things like ‘dieting doesn’t work’ at the same time as we tell you that ‘losing ten pounds will cure whatever ails you’. It is nonsensical at best, and, actually, harmful at worst. Yay.

We are totally and hopelessly fucked up when it comes to taking care of fat babes.

I am not going to get into it with anyone about whether losing weight is or isn’t good for you – perhaps another blog I will just post an epic list of journal articles backing up my shit, but not today. BECAUSE THE POINT IS MOOT. The fact is that all of this conditioning and weird health care training has lead healthcare providers to believe that we get to have an opinion about someone else’s body. The straight up truth is: no, we fucking don’t.

We don’t need to weigh you at every check up to do our jobs, we don’t need to lecture you about your food choices, we certainly don’t need to give you gowns that barely cover your hot asses, and we definitely don’t need to prescribe weight loss as a cure all. Doing these things is not healing, it is not sound medicine, and it is not trauma informed. It is about punishing you for being a hot fat babe that believes you have a right to be cared for by the healthcare system (which you completely do, FYI). Ima say it again to be totally clear: none of this stuff is about true healing nor is it about health. It is about being a massive douchebag.

You have the right to come and see us with a flu, or a sexually transmitted infection, or a broken bone without hearing about how your body needs to change. You have the right to talk about post partum depression without being told to lose weight. Hell, you have the right to see us about high blood pressure, diabetes, and sore backs (you know ‘fat people problems’) without us talking to you about how your body needs to change. Unsolicited advice, lectures and shame are not acceptable healthcare interventions nor are they effective.

And yet. And yet.

So many fat babes see their healthcare providers with dread in their hearts. Or they don’t go at all. We are denied healthcare(however subtly) because of how healthcare providers talk to us, or we get healthcare that doesn’t actually get at the heart of healing. And we internalize it – we blame our fat, or our lack of strength, our confidence or our motivation. We turn it inwards instead of looking at why we feel these ways.

So, i would like to say a few things as a healthcare provider. The poor care and cruelty we display in serving fat people is not your fault. Your dread and fear and avoidance are brilliant goddamn survival strategies. You have adapted to shaming and problematic healthcare in the most reasonable and honest way. You are protecting yourself in the best way that you can from a system that is far from kind. Fat babes deserve better. We deserve healthcare providers that honour how our bodies have gotten us this far, that see that fat babes are the strongest survivors, and that our fat bodies have carried us through life, have created life, have survived trauma, and have made us the fierce hot babes that we are.

I know that most of us don’t get that kind of care. I know because I don’t get it either. So, fat babes, survive healthcare providers, survive us however you have to: by stepping on that scale or by refusing to, by demanding better care from your provider or by quietly searching for someone new. However you navigate your way among us is the right way. Your glorious bodies are not any of our business unless you want them to be.

You are beautiful and you are fine. Your soft bellies and strong thighs are getting you through this world, not us.

Smooches.

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That tank top says ‘blah blah blah blah’. Im not saying i wear it to the doctor’s, and im not saying i dont. 😉

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11 thoughts on “healthcare providing like a fat babe does

  1. As a physician I agree with you on many of your points. Having said that, it’s really difficult to do a good physical exam on someone obese. It scares me that I can’t be confident that I’m providing good care when I can’t do part of my job well. And I’m still a big believer in doing a good history and physical. It gives me most of the information I need to order appropriate investigations. Also, there are a number of problems directly related to extra pounds; knee pain, back pain, chronic heartburn, diabetic control, to name a few. But, you’re right, healthcare providers don’t need to be assholes about it. And, in general, I agree fat is less of a problem than we have made it out to be. Hopefully people will be brave and seek the care they need, but sometimes that care involves being advised to lose some weight.

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    1. Hey Terri thanks for the comment. A couple things: I really believe that we can all do better about not shaming our patients when they come through the door. And I agree that different bodies have unique health considerations. And I LOVE a good history and physical- for real, done well it allows us to learn about our patients and build a solid provider patient relationship- I am totally here for that. I guess I take issue with the fact that when it comes to fat people we make generalizations based on our fatness that can lead to incorrect assumptions. Too often we do not take the time to do the thorough explorations you are describing, and instead many of us fall back on bad practice that is outdated and honestly, kinda mean, an off the cuff remark as patients leave our exam rooms about losing weight when we have just come in to talk about a cold, or an assumption that fat people are less active than their thin counterparts. Healthcare does a bad job of behaviour change at the best of times and we rarely elicit the motivation and confidence needed when speaking to patients anyways (why no one taught us motivational interviewing in nursing school is beyond me!). And yet we continue to demand behaviour change in a way that alienates our patients and ensures we definitely won’t get a thorough history from them. We also know from a ton of literature that straight up telling people to lose weight is not effective, and yet we continue to recommend it – my guess is it is a knee jerk reaction that is so ingrained in us that we don’t even think about it. Nurses, in my experience are particularly bad for what I refer to as ‘tsk tsk’ or ‘finger wagging’ healthcare. Surely we can do better than the approach my 89 year old granny uses when she sees my mum use salt at the table-cause you know that shit doesn’t work on most of us. Now, you and I could likely spend hours talking about whether or not recommending weight loss as an intervention is sound practice, (we could probably both whip out article after article which does appeal to the nerd in me)but at the end of the day if we can’t approach our patients in a way that creates safety and partnership it doesn’t really matter- they aren’t gonna do what we say anyways. In an ideal world I would love a HCP who talks about the ‘health at every size’ model or who has read the literature on the obesity paradox and the limitations of recommending weight loss. Barring that I just wish we used a trauma informed approach to working with our patients. What we say to people carries weight and our tone and approach can make the difference in whether we ever see a patient again. It sounds to me, based on your comment, that you are a clinician with a heart for healing and for careful clinical care. That is a rare combination. I am also heartened that you took the time to read my extensive, f-bomb riddled rant – thanks for hanging in with me. I am glad that this is something you are thinking about in your practice. The more clinicians that honour their clients and their bodies in all their strength and all their flaws the better. That kind of practice is what fat babes need so thanks for your critique and curiosity.

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  2. I’m just a little too old to be a ‘babe’ but I got the fat thing going on. My daughter, on the other hand, is most definately a babe as well as a fierce, fascinating and beautiful woman both inside and out who qualifies as fat.

    As her mother, who loves her beyond words and whose heart breaks every time she is subjected to the ignorant behavior you outlined, thank you.

    Thank you for recognizing the systemic disrespect and neglect she has suffered. Thank you for reinforcing the truth that she is a babe. Thank you for encouraging her to leave the guilt and shame exactly where it belongs. Thank you for reminding her that she has the option to vote with her feet. Thank you showing my beautiful, amazing, intelligent, baby girl the respect she deserves.

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    1. Deb, oh man what a bold fierce loving mama you are. As a mum myself I can relate to that big mama bear love. Thank you for being the kind of mum that celebrates her daughter’s brilliance and fat babe status! 😉
      Fat babes to the front!

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  3. Thank you so much for this! I avoid my doctor after 10 years of trying to get the help I need. When I first started seeing him, I was recovering from an illness and was a size 8 (which is too small for a woman of 5′,7″!). Then I started feeling better and the weight started piling on, despite the fact that I exercise every day, eat healthier than most people due to food allergies and had not changed either habit. The only time I’ve been skinny is when I have been extremely ill. I asked to see a specialist about why my weight was going up and down like a yo-yo and was told “Well, maybe you’re just fat and it’s not a hormonal thing.” (by the specialist)

    My energy levels, along with my vitamin B12, iron, cortisol (crashes at 11:00am every day) and thyroid are all low. I’ve shown other doctors my test results and they ask how I even get up in the morning. My doctor just says “You just need to exercise and eat better.” I used to be a personal trainer. I know how to exercise and I do it every day. I’ve seen dieticians who have all told me that my diet is perfect – perhaps too low on the calories, but the food is right! My body type is the exact same as my mother, her grandmother, my cousins and female relatives going quite far back. One of the meds I’m on has a side effect of weight gain, but it keeps me from getting sick again.

    So, yes. I’m fat. I exercise, eat right and do all the right stuff. Can any of the doctors out there tell me how I can lose weight because the “normal” methods of losing weight don’t seem to work for me! It may be hard to do a physical exam, but it’s also hard to get looked at like a fat, lazy blob when I’m doing my darndest to lose weight. Please start looking at possible solutions beyond the lifestyle changes. I’ve been there, am still doing it and not getting anywhere.

    Thank you in all sincerity!

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  4. Maggie! You are as articulate and empowering as always. I wish health care could be delivered in a kind compassionate way to all people including the obese population. I know that being over a hundred pounds over weight is hard on my body. I don’t need every 120 pound care provider to spell that out for me. I can see it in my tortuous varicose veins that ripple my inner things and feel it in my hips after being on my feet for 12 hours. I think there needs to be a philosophy recognizing and embracing that people will continue to live at risk. We need to kindly determine what a persons personal health goals and objectives are and work within this. Providing care to an obese person may be challenging in terms of having adequate equipment and differences in body shape can make physical exams more challenging. It may be frustrating for health care providers that feel obesity aggravates conditions that may be ameliorated by weight reduction. I feel the focus needs to be on screening for illness, treating concerning findings (whether they are correlated to obesity or not) and encouraging healthy lifestyle choices and providing education and resources. Regardless, shaming and patronizing people does little more than decimate a persons self worth and make them apprehensive to seek healthcare. This does not motivate people to love themselves or make positive change. I would like to shackle haters with 100 extra pounds to carry around for the day and then have them tell me how weak I am for being obese. I am not weak for being obese. I am strong for carrying my weight around, and while I hope to one day not to be obese, I am not less of a person because of it. And it is an excellent radar detector for assholes. xx Sarah G

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