Fatphobia, or weight stigma as it is often referred to, impacts us all, but impacts people in larger bodies the most.
We are a culture that equates *fat* with ill health, and often describes fat people as lazy, unintelligent, or sloppy. This diet culture that we live in creates a fear of fat and blatant discrimination for people of size.
My story is about someone who could be you, or any one of your friends, or your patients if you are in the health field. This is a true story, although names and details have been changed.
This story is a cautionary tale about fatphobia, particularly in the medical setting, and the many ways it can negatively impact an entire family. It describes the impact of using a weight-neutral approach to health referred to as Health at Every Size®.
Alex’s Fear of Fat Story
A client (I will call her Alex) was referred to me by her therapist for nutrition counseling.
Alex had a history of binge and emotional eating, as well as many years of chronic dieting, starting when she was just five years old when her mother “put her on a diet” to slim down. By the time Alex came to see me, she was married and a mother herself.
She felt very bad about being fat and was upset by her inability to lose weight and keep it off successfully.
Whenever I work with an individual who binge eats, I look at their history of dieting because they usually go hand-in-hand. The first step in recovering from binge eating is to let go of dieting for the pursuit of weight loss and to get rid of the scale with its focus on weight.
The first step in healing binge and emotional eating is to stop dieting.
Alex was educated on the correlation between binge eating and dieting, but she was too nervous to just “let go” of the safety and structure of dieting. She couldn’t shake the idea that she was somehow “cheating” by eating anything she wanted.
We worked together first to “loosely” design a pattern of eating that included three meals and three snacks from different food groups. Alex noticed that when she ate regularly, her desire for binge eating decreased. She also started to identify her feelings when she had an urge to eat emotionally. She became better equipped to decide if she was physically hungry or, perhaps, needed something other than food in those moments. Alex acknowledged that her mind and body were often disconnected. She started to feel more confident in herself and even started exercising at a gym, something she had never done before.
Doctor’s appointment reveals the ugly underbelly of medical weight stigma & fat shaming.
Alex went to her doctor for a routine physical. She was feeling good about her new pattern of eating (consistent meals and snacks) and the fact she had started exercising for the very first time in her life. Alex also got a clean bill of health from this doctor who indicated that all her labs and vital signs were normal. However, at the end of the visit, the doctor turned to Alex and said, “Well your labs are good now, but have you ever considered bariatric surgery to reduce your weight? Your BMI puts you in the obese category.”
Although flustered, Alex told the doctor that she had no intention of having unnecessary surgery just because she was in a large body. She explicitly told the doctor that bariatric surgery can lead to life-threatening side effects, and she was now improving her health behaviors, including regular meals and exercise.
This doctor had never inquired about Alex’s eating OR exercise habits.
This happens all the time in medical offices around the world. In fact, Alex’s husband, Bill, was large also, and he had avoided going to the doctor because he knew how badly he would be treated and just didn’t want to deal with it.
A *fat-friendly* doctor diagnosed a medical condition.
Alex did encourage Bill to see a doctor and had to search long and hard to find one who would not shame him about his weight. It was just good luck that the new doctor discovered her husband did have some medical issues that needed to be addressed. This happens ALL THE TIME. People are afraid to seek medical treatment for fear of their doctors commenting negatively about their body weight, or just ignoring their health issues and attributing any and all medical problems to a person’s body weight.
Her daughter was referred to a “diet doctor” by their pediatrician.
When it was time for Alex’s daughter, a very active 9-year-old, to have her annual physical, both Alex and Bill accompanied her to the pediatrician. Yes, her vitals were good, her diet was balanced, but the doctor pulled out her growth chart and plotted her BMI (body mass index). “Over the 95th percentile,” said the pediatrician, who promptly referred the family to a specialist in “childhood obesity.” Nervous about their own daughter suffering the same fate of being bullied as a chubby kid, both Alex and Bill made the appointment with the obesity specialist and took her together.
An obesity specialist is really a “diet doctor “in disguise.
During the short doctor visit, the little girl was given education on how to read food labels for calories, fat, saturated fat and fiber. The doctor weighed her, and then lectured Alex and Bill on the importance of home-cooked, family meals. They were encouraged to keep any and all sugar out of the house in the way of packaged snacks and desserts so their daughter’s weight would “level off.” The family was educated on the importance of physical activity.
- Not once did this diet doctor inquire about the actual amount of physical activity their child had, or the type of foods that were brought into the house.
- Not once did the diet doctor ask them about their typical meals and meal patterning, or what and how much their child ate.
- Not once did the topic of puberty come up. (Kids often gain weight in preparation for puberty.)
Alex and Bill left the office disillusioned and very clear that they would never bring their child back to this doctor.
How Health at Every Size® saved this family, and how it can save yours!
The basic premise of health at every size, is that well-being and healthy habits are more important than any number on the scale. This is how I practice as a weight neutral dietitian.
Alex reported all of the unhelpful and negative comments made at these doctor appointments to me.
She had someone on her side with a weight-neutral approach and we worked together on everything. We looked at the wisdom of not focusing on body weight as an indicator of good health, but rather on behaviors. That support that professionals like me offer can often be the saving grace in situations like this. Without an added, neutral voice to help work through all the conflicting messages, the healing and progress may never have happened.
Alex and I were able to tease apart the doctor comments and incidents that were specifically fat-phobic:
FATPHOBIA BEHAVIOR 1
A physician encouraging a healthy person to have bariatric surgery.
Bariatric surgery comes with many risks and is considered voluntary surgery, meaning NOT REQUIRED. I have seen many individuals with eating disorders and disordered eating prior to bariatric surgery and the consequences can be grave. People have died from nutrient deficiencies, poor surgical outcomes, and have developed addictive behaviors such as excessive drinking or gambling. I have seen new eating disorders such as anorexia or bulimia develop post-surgery. This surgery is NOT TO BE TAKEN LIGHTLY AND SHOULD NOT BE RECOMMENDED FOR A HEALTHY INDIVIDUAL. Good medicine is supposed to do no harm.
FATPHOBIA BEHAVIOR 2
Assuming that Alex’s child was unhealthy, based on a single BMI reading, and noticing that both parents were in larger bodies.
Assumptions are often incorrect, as was the case here. There was blatant fat-phobia both on the part of the pediatrician, as well as the “diet doctor” they were referred to. Neither had asked if this child was physically active (yes, she was) or if she had a balanced diet (yes, she did) or if home-cooked, family meals were served (yes, they were!).
FATPHOBIA BEHAVIOR 3
Doctors in the past making fat-phobic comments leading to Bill’s avoidance of proper medical care.
While this is self-explanatory, it was quite a challenge to find a physician who would be neutral about a person’s weight. In addition to weight, every individual, despite their body weight, shape, size, race, religion, sexual orientation, gender, or socioeconomic status, should be treated with dignity and respect and offered the best medical care available.
Body Diversity is a Fact of Life
Unlike many healthcare providers, I understand that my clients come in all shapes and sizes for a variety of reasons. Some of them are naturally larger or smaller. Some of them have conditions that affect their weight. Some of them have metabolisms that have become damaged from years of dieting and weight cycling. When we yo-yo diet, we end up slowing down our metabolism and ratcheting our set-point (the weight range at which you are biologically programmed to be most comfortable for your body) every time. So, your avoidance of weight gain leads to weight gain.
It’s probably not something you want to hear, but many of my clients have suppressed their body weight with chronic dieting. Because of this, I help my clients to accept and nourish their “here and now” bodies!
People find freedom and happiness from learning to listen to and learn from their bodies through this exploratory process. This process of accepting their bodies and letting go of weight loss is the cornerstone of transforming their relationship with food. Body diversity is a fact of life.
We aren’t all meant to be the same size!
Alex and her family are now thriving, both physically and mentally. This is despite the interference of doctors who actually believed they were trying to help the family “avoid the perils” of living in fat bodies. Alex, the family gatekeeper with a history of binge eating disorder, was able to learn and understand the problems of diets and diet culture and was able to advocate for herself, despite numerous physicians attempting to change her body for none other than aesthetic purposes. She understood that doctors who pushed diets and voluntary weight loss surgery (stomach amputation) just did not see the harm they were doing. Thankfully, Alex and Bill’s daughter is a natural-born intuitive eater and they have all been able to celebrate the joy of eating for health, as well as taste, satisfaction, family bonding experiences, and just living freely in the world without obsessing about food or their bodies.
Online Programs to Help You Make Peace with Your Body and Food
Intuitive Eating Essentials for Midlife, Menopause and Beyond: This is a self-paced program that explores your relationship with food, your dieting history, readiness to integrate intuitive eating into your life, and teaches you how to use your values to make peace with food. Click here for all the details!