CHAPTER 7
FIRST, DO NO HARM
I was twenty-six years old the last time I saw a doctor. I visited urgent care for an ear infection, a mildly embarrassing, infantile reaction to stress that my body had never seemed to move past. At work, we were at the height of a campaign, and I had yet to learn how to manage my stress more effectively. So I laid awake at night, restless and worried, until my body reacted. On this particular day it meant an ear canal so inflamed that it had nearly swollen shut.
I was accustomed to the routine: step on the scale and listen to a medical assistant wince and apologize for the fact of my weight. I usually sit on the chair next to the exam table, in case the table can’t support my weight. Explain patiently to the doctor that despite being an adult, I still face this childlike condition. Joke about bubblegum-flavored chewable amoxicillin. Leave with a prescription for ear drops and ten days’ worth of antibiotics. And, that’s typically how it goes.
I had developed a skill set—a charm offensive as a preemptive strike against the assumptions that come along with a body like mine. Usually, it worked; nurses and doctors loosened up, lightened up their lectures, eased up on expressing their deep judgments and issuing mandates. But today, the charm offensive was useless. The doctor was a severe man without much humor to him. My jokes fell flat, my smiles went unreturned. With him, my warmth was somehow a liability. So I reverted to an all-business approach, mirroring his own. The appointment continued, cold and direct, without event. I thought I may have escaped the de rigueur lectures, the condescension, the heavy judgment that so often followed from healthcare providers. I was wrong.
As the doctor handed me prescriptions for ear drops and antibiotics, I asked about any after care I should take on. He sighed, eyes stern and brow furrowed in disapproval.
“You should lose weight,” he said plainly. “Immediately.”
My shoulders dropped, muscles going slack in the face of an exchange I’d had so many times before.
“My ears didn’t get fat,” I snapped back, without thinking, surprised at the force of my own irritation.
“You asked,” he snapped. He glared for a moment, heaved another sigh, then left, his door slam thwarted by the muted, slow work of the door’s quiet hinge. We were both frustrated, and neither of us got what we were looking for.
That sneaking wave of anger didn’t emerge fully formed from whole cloth that day. It had been a long time coming. This was far from the first time a healthcare provider had prescribed weight loss for what I was certain was an unrelated condition. Every symptom I described, every malady that led me to seek treatment, had all been attributed to my size. If I weren’t fat, I’d been told, I wouldn’t have gotten strep throat, ear infections, a Charlie horse, or a common cold. I sat through countless appointments with doctors walking me through the BMI chart, pointing to my BMI of 50 and explaining to me that I was considered super morbidly obese. My body was a death sentence, and the only way to save my life, they insisted, was to get me to a “healthy weight” of less than one-third my size.
I had dieted and exercised, lost weight in major spurts (if only to regain it later), and the lowest weight I had ever managed was 275. Under the unforgiving rubric of the BMI, this was a failure of my character. I simply lacked the tenacity, the work ethic, the determination to become thin enough to save myself. My life was on the line, I was told, and I would only have myself to blame if I couldn’t manage the impossible.
Not every healthcare provider lectured so sternly, but their anti-fatness showed up regardless.
I was visiting family in California when my hearing cut out. It was disorienting and alarming, losing one of my senses so abruptly. The world sounded muffled, like it was tucked away behind a closed door, distant and unreachable. A sharp pain somewhere between my ear and my skull served as a piercing reminder of the loss of my hearing. Alarmed and sympathetic, my mother drove me to the nearest urgent care that takes my insurance.
The nurse who greeted me was kind and warm. We talked freely as she took my vital signs, though our conversation was complicated by my failing hearing. She took my blood pressure, then looked at the cuff with a crooked frown. She took my blood pressure again, then made the same face. She excused herself to get another cuff—larger, this time.
I felt my heart beating in my throat. What if something’s wrong? What if my ears are just a symptom of something more sinister, more alarming? What if this is the death they’ve so long said was coming for me?
“What’s the matter?” I asked, trying to temper the frightened shake of my voice.
“I’m just not getting a good read,” she said, adjusting the cuff once again.
“Is everything okay?” I asked, more afraid than before.
“It’s coming back great,” she said, the good news belied by her befuddled tone. “But that can’t be right. Obese patients don’t have good blood pressure.”
She had learned that being fat meant being sick, and invariably, that sickness would lead to death. Just looking at me, she became certain that I must be in poor health. And her certainty was so great that it overrode the data in front of her. My sickness was inevitable, so good health was unfathomable. I entrusted her with my health, and she couldn’t see it. Even outside the doctor’s office itself, bias seemed to follow me everywhere. In the waiting room of the mental health department at my local Kaiser Permanente, I waited for an appointment to treat my panic disorder. Another patient leaned over to tell me a woman your size shouldn’t wear belts.
I wondered what treatment she was seeking.
Between appointments with healthcare providers, I found myself researching the experiences of fat patients and the most biased policies of providers. Somehow, that surreptitious research both quelled and fueled my growing dread and anxiety about my next visit. Shortly after my spat with the urgent care doctor, I stumbled upon a story from the South Florida Sun Sentinel. The reporter surveyed local obstetrics-gynecology practices and found that 14 percent had set a weight limit on their patients. “Fifteen obstetrics-gynecology practices out of 105 polled by the Sun Sentinel said they have set weight cutoffs for new patients starting at 200 pounds or based on measures of obesity—and turn down women who are heavier.”1 Three years later Helen Carter, a primary care physician in Massachusetts, publicly announced that she would no longer accept patients over 200 pounds.2
Every interaction around my healthcare became a minefield. Every conversation about my health left me nursing a wound that wasn’t allowed to close long enough to heal. This was Groundhog Day, and I was stuck repeating the same doctor’s appointment until—until what? Until I learned to act differently? Until I stopped hoping? Until I somehow became thin? Or until I gave up on my healthcare altogether?
Notably, my experiences are not unique—and they’re far from the worst of their kind. Across the country, fat people are routinely denied medically necessary tests and care, regularly shamed by physicians, and assumed to be in ill health regardless of their bloodwork, heart rate, or blood pressure.
In 2016 Sarah Bramblette shared her story with the New York Times. Bramblette lives with lipedema, a condition impacting an estimated 11 percent of women, according to the National Institutes of Health.3 Lipedema often stems from hereditary and endocrinological issues, though the causes of the condition are not confirmed, leaving women with significant deposits of fat in their legs.4
Like many women with lipedema, Bramblette was fat. And like many fat people, her doctor prescribed a very low-calorie diet—1,200 calories a day, the minimum amount that wouldn’t trigger a starvation response, causing her body to cling to its fat. Bramblette wanted to know how much she weighed, so that she would know if her prescribed diet was working. But the doctor’s scale only went up to 350 pounds—well below what Bramblette needed. She asked her doctor how she could be weighed. “The doctor had no answer. So Ms. Bramblette, 39, who lived in Ohio at the time, resorted to a solution that made her burn with shame. She drove to a nearby junkyard that had a scale that could weigh her.”5
As a fat woman, Sarah Bramblette’s experience terrifies me, not as some nightmarish dystopian future but as an ever-present, current possibility. The casual and thoughtless humiliation of fat people in medical settings takes place both intentionally—through shaming, mocking, berating, and “tough love”—and unintentionally when offices lack the exam tables, stirrups, gurneys, and scales that will hold us; the blood pressure cuffs that will fit around our arms;6 or the crucial CT and MRI scanners that can accommodate our bodies.7 Drug dosages, too, are based on appropriate amounts for thinner people. Testing is rarely performed on fat people, and drugs are often less effective on us, leading to underdosing of everything from antibiotics to chemotherapy.8 Famously, Plan B—the emergency contraceptive—loses its effectiveness in those whose BMIs are in the overweight range, to say nothing of those of us who are categorized as “obese” or “extremely obese.” That is, if a fat person needs emergency contraception and uses Plan B, they are significantly more likely to end up with an unplanned pregnancy. Despite this known vulnerability, as of this writing, no public research has been made available about the effectiveness of emergency contraception for fat people.9
Another patient, who asked to remain anonymous, shared her story with the New York Times. She walked through her home every day without incident. But, suddenly, that same short walk to her kitchen left her breathless and terrified for her health.
Frightened, she went to a local urgent care center, where the doctor said she had a lot of weight pressing on her lungs. The only thing wrong with her, the doctor said, was that she was fat.
“I started to cry,” said the woman, who asked not to be named to protect her privacy. “I said: ‘I don’t have a sudden weight pressing on my lungs. I’m really scared. I’m not able to breathe.’”
“That’s the problem with obesity,” she said the doctor told her. “Have you ever considered going on a diet?”
It turned out that the woman had several small blood clots in her lungs, a life-threatening condition.10
In 2019, Rebecca Hiles made headlines with her story of medical neglect. As a teenager, Hiles had developed walking pneumonia that stayed with her for years. When she began to cough up blood, doctors prescribed an inhaler, and in subsequent visits, doctors insisted she should “just lose weight.” Later, Hiles’s coughing led to bladder leaks and vomiting. “When blood tests kept coming back normal, her doctors would say, ‘We don’t know what to tell you—it’s clearly just weight related.’” It took six years to find a doctor who would refer her to a pulmonologist. Shortly thereafter, a CT scan revealed a malignant tumor, leading to near-immediate surgery. Hiles lost her left lung, “the bottom half of which was a black, rotting piece of dead tissue.”11 She soon learned that an earlier diagnosis at one of her countless doctor’s appointments and emergency room visits could have saved her lung, and that a later diagnosis could have cost her her life. Hiles wrote on her blog:
When my surgeon told me a diagnosis five years prior could’ve saved my lung, I remember a feeling of complete and utter rage. Because I remembered the five years I spent looking for some kind of reason why I was always coughing, always sick. Most of all, I remembered being consistently told that the reason I was sick was because I was fat.12
Hiles’s experience illuminates the ways in which many healthcare providers rely on understanding their patients through what health policy and women’s studies scholar Anna Kirkland calls “actuarial personhood,” in which groups of people—such as fat people—are defined solely or primarily by the risk they are seen to pose.13 According to Kirkland, actuarial personhood features “the collapse of traits of the person as a bodily individual with other features of her environment, family health history, and so on, such that the relevant description of her includes many details beyond her character and control.”14 In Hiles’s case, doctors saw her first as fat, complete with those “many details” they assumed must describe her. Only years later did she find a provider who saw her as someone whose health needs might be as complex or dire as a thin person’s. When it comes to fat patients, our bodies have been labeled an epidemic, our very presence somehow a threat to the health of those around us. For years Rebecca Hiles’s doctors could only see the risk they projected onto her by virtue of her body, ascribing her symptoms to her size rather than her cancer.
Fat transgender people bear dual stigmas in medical settings. Those seeking surgery are frequently required by their doctors to lose significant amounts of weight prior to surgery. In most states, health insurance plans are free to exclude transition-related care, such as hormones and surgery, despite covering the same procedures in cisgender people (hormone replacement therapy, mastectomies, oophorectomies, and so forth). As of 2015, one in four trans people had been denied hormone therapy in the past year alone, and a staggering 55 percent had been denied coverage for surgery.15 In TLC’s Too Fat to Transition, fat transgender people are followed as they try to lose the amount of weight prescribed by their surgeons in order to receive the healthcare that may save them from bullying, discrimination, suicide, and murder.16
For thin people, these stories of fat patients simply trying to access basic healthcare may be sobering. But for fat people, they may elicit a combination of deep terror and sad familiarity. In 2016, 45 percent of women of all sizes said that they delayed doctors’ appointments until they lost weight.17 A study published in the Journal of the American Academy of Nurse Practitioners showed that the degree of avoidance increased with fatter women. “Weight-related reasons for delaying/avoiding healthcare included having ‘gained weight since last healthcare visit,’ not wanting to ‘get weighed on the provider’s scale’” (or, as in the case of Sarah Bramblette, not having a scale that would hold them), “and knowing they would be told to ‘lose weight.’”18 In a cruel twist, a study called “The Ironic Effects of Weight Stigma” revealed that weight stigma increases the likelihood of eating caloric foods like candy and chips. The study subjects who perceived themselves as fat—regardless of their actual weight—were more likely to eat those foods than those who didn’t perceive themselves as fat.19 Another study, published in 2018 in the journal Body Image, found that the fatter a woman was, the more likely she was to internalize anti-fat stigma, to harbor guilt and shame about her own body, and to avoid health-care.20 A 2013 study found that fat people who internalized anti-fat stigma had lower self-esteem, higher levels of depression and anxiety, and worsened overall health.21 Research has also linked internalized weight bias to prediabetes and “a conglomerate of cardiovascular disease risk factors that strongly increases the risk for diabetes, heart disease, and stroke.”22 That is, what we think of as health risks associated with being fat may in fact be health risks of experiencing discrimination and internalizing stigma.
But this internalized stigma doesn’t simply emerge cut from whole cloth. It is woven into nearly every aspect of society in the United States. The Rudd Center for Food Policy and Obesity at Yale University and Harvard University’s implicit bias research both indicate that anti-fat stigma is on the rise in the United States, and healthcare providers are no exception to that trend.23 Like the rest of us, doctors, nurses, and healthcare providers of all stripes have internalized deeply flawed, harmful stereotypes and judgments about fat people. But unlike the rest of us, healthcare providers are in positions of immense power. We count on them to define what the symptoms in our bodies mean. We count on them to tell us how to prolong our lives and stave off early death. And we count on them to interpret our bodies clearly for us, trusting them implicitly with our very lives. But for fat people, as stories like Rebecca Hiles’s show, healthcare providers’ interpretation is clouded by their judgment with staggering regularity. And despite healthcare providers’ extensive training on the mechanics of our bodies, the training is modeled on the realities of thin bodies and rarely teaches providers to confront their own bias. In some cases, it may even enhance their bias.
Over the last two decades, a growing body of research has indicated a frightening trend of anti-fatness among healthcare providers. In 2001 the International Journal of Obesity published a study that found those anti-fat judgments caused material differences in the outcomes of care received by fatter patients. In office visits with fat patients, the study found that many physicians wrote notes “suggesting a belief that those who are overweight must also be unhappy and unstable,” including comments like “this woman has a very unhappy life,” “suffering underlying depression,” and “most likely a drug addict.”24 Of the 122 primary care physicians who participated in the study, 10 percent suggested anti-depressants for their fat patients. Fat patients also received shorter visits. The average office visit for a thin patient with a migraine headache is 31 minutes. For a patient with an BMI considered as “obese,” that time drops to twenty-two minutes. “Certainly if physicians give additional tests (whether weight-related or not) to heavier patients, they may be giving compromised care—they are doing more tests in a much shorter period of time. [. . .] The pattern of responses seems to reflect that physicians feel more negativity toward heavier patients.”25 The fatter the patient, the more likely the doctor will describe the office visit as “a waste of their time” and the patients as “more annoying.” If a physician saw more fat patients, they said, they “would like their jobs less.”
A 2003 study published in Obesity Research confirmed that “primary care physicians view obesity as largely a behavioral problem and share our broader society’s negative stereotypes about the personal attributes of obese persons.”26 Of the 620 physicians who participated in the study, more than half described fat patients as “awkward, unattractive, ugly, and noncompliant.” Over one-third called fat patients “weak-willed, sloppy or lazy.”27 Among health professionals specializing in the study and treatment of obesity, research findings are similarly bleak. In a 2012 study, researchers used the Implicit Attitudes Test to measure weight bias in 389 researchers, students, and clinicians. Participants overwhelmingly believed that fat people were “lazy, stupid, and worthless.”28 As the study’s authors note:
These findings are noteworthy given that the sample was comprised of professionals who treat and study obesity, a group that understands that obesity is caused by genetic and environmental factors and is not simply a function of individual behavior. Hence, the stigma of obesity is so strong that even those most knowledgeable about the condition infer that obese people have blameworthy behavioral characteristics that contribute to their problem (i.e., being lazy). Furthermore, these biases extend to core characteristics of intelligence and personal worth.29
Even the experts to which fat people are expected to entrust our health and our very lives exhibit not only implicit bias but explicit personal judgment of the patients they study and treat. More troubling, younger participants showed greater bias against fat people, particularly around perceived worthlessness, lack of goodness, and lack of intelligence, seemingly indicating that the problem of anti-fat bias may persist well into the future.
And those attitudes aren’t just internal—they significantly impact the care fat patients receive. Another study, published in the journal Obesity, found that primary care physicians “demonstrated less emotional rapport with overweight and obese patients.”30 In 2009, the Journal of Clinical Nursing published a study finding that anti-fat attitudes extended to nurses, too, and that professional nurses were more likely to harbor anti-fat bias than nursing students. “The majority of participants perceived that obese people liked food, overate, and were shapeless, slow, and unattractive. Additionally, over one half of participants believed that obese adults should be put on a diet while in hospital.”31 Yet another study of more than three hundred autopsies showed that “obese patients were 1.65 times more likely than others to have significant undiagnosed medical conditions [. . .] indicating misdiagnosis or inadequate access to healthcare.”32 Even providers who specialized in eating disorders exhibited significant anti-fat attitudes.33
Medical students exhibit striking rates of anti-fat bias, too, according to the journal Obesity. Seventy-four percent of medical students surveyed for the study exhibited some form of anti-fat attitudes, including dislike, blame, and fear. Sixteen percent agreed with the statement “I really don’t like fat people much,” 13.5 percent reported that they “have a hard time taking fat people seriously,” and 36.6 percent—over one-third of medical students—held the belief that “fat people tend to be fat pretty much through their own fault.”34 Research shows that anti-fat bias may be contagious, catching from doctors to the medical students they instruct. In one of their studies, Mayo Clinic researcher Sean Phelan asked students if they had witnessed medical school faculty making jokes, making derogatory statements, or taking discriminatory action against fat patients. On average, students’ explicit bias increased during the course of medical school, often influenced by faculty’s openly anti-fat attitudes and actions.35 “We found that having experienced these things was a predictor of weight bias getting worse over the course of medical school. It speaks to a hidden curriculum,” said Phelan.36
At every phase of their careers, healthcare providers of all stripes exhibit staggering levels of both overt and implicit bias against fat patients—and the fatter you are, the bigger the price you pay. These damning findings, confirmed time and time again, suggest that fat patients don’t just feel uncared for when we seek medical care—there’s a good chance we are uncared for.
The bias of healthcare providers hasn’t gone wholly unchallenged within their field. Despite this powerful current of anti-fat bias, some providers are swimming upstream, creating and using radically different frameworks for addressing fat folks’ health needs.
Perhaps the most widely known of these is Health at Every Size, a framework popularized by Dr. Lindo Bacon. Health at Every Size (sometimes shortened to HAES) focuses on moving away from exercise and dieting as a punishing, endless march toward a tenuous beauty standard most of us will never attain. Instead, Dr. Bacon’s approach focuses on mindful, intuitive eating, honoring our bodies’ hunger and fullness cues, and exercise from a place of joy and fun. That is, rather than constantly self-flagellating for our failure to become a vision of perfect thinness, and rather than focusing on looking like a healthy person (what does health look like, anyway?), Health at Every Size prioritizes taking on the behaviors that contribute to greater overall health—regardless of the number on the scale.
Dr. Bacon isn’t alone, either. A growing number of “anti-diet dietitians” are changing the conversation among registered dietitians. Michelle Allison, Christy Harrison, Vincci Tsui, Anna Sweeney, Dana Sturtevant, Rebecca Scritchfield, and others are focused on shifting our cultural conversations about nutrition, diet, and our bodies. Like Dr. Bacon, many of these dietitians are working to center acceptance of our bodies, rather than rejection.
A growing number of doctors, dietitians, nurses, and other healthcare providers are questioning our cultural dogmas around weight and health, finding new and more forgiving paths to nurturing our own mental and physical well-being. But there’s still so much more to do. While fatness has been widely and readily blamed for all manner of ills in healthcare spaces, little has been explored about the relationship between weight stigma and health. Despite prioritizing the social determinants of health—economic stability, food security, the built environments that surround us, access to culturally competent healthcare, and discrimination, among others—many healthcare providers and researchers still remain oddly silent on the topic of weight stigma. When research is conducted on the overwhelmingly negative impacts of anti-fatness, it seems to change little in healthcare provision itself. Even the anti-obesity research to which many healthcare providers are exposed is far from impartial and is funded and publicized by diet companies or pharmaceutical companies with weight-loss drugs to sell.37 Not only are healthcare providers underinformed about the impact of their bias on patients’ health and well-being, they are also selectively informed by moneyed interests keen on promoting their products.
The evidence that we do have about the impacts of weight stigma is troubling at best. One study showed that when participants experienced anti-fatness, “their eating increases, their self-regulation decreases, and their cortisol (an obesogenic hormone) levels are higher relative to controls, particularly among those who are or perceive themselves to be overweight.”38 Another found that experiencing anti-fatness led to avoidance of exercise.39 Most damning of all, a study engaging 13,692 older adults found that “people who reported experiencing weight discrimination had a 60% increased risk of dying, independent of BMI.”40 Anti-fat bias, not fatness itself, may be fat people’s greatest health risk.
But when it comes to turning the tide of medical bias against fat patients, research shows there’s hope in a number of tactics, some of which are surprisingly simple. In 2011 researchers found that just one lecture on weight stigma and weight controllability significantly reduced psychology students’ anti-fat bias. (Notably, following the lecture, students were also less likely to describe fat people as unattractive.)41 A similar study in 2013 found effective bias intervention with a video that was just seventeen minutes long.42 A 2012 study found that healthcare professionals who watched short films designed to reduce anti-fat bias did indeed curb their explicit bias, though their implicit attitudes remained intact.43
A meta-analysis of weight bias interventions found that, while none fully eradicated anti-fat bias, many led to a “small to moderate” shift in attitudes.44 But given the relentless stigma so many fat patients face at the hands of their healthcare providers, even a small change could make a major impact. All we have to do is try.
At thirty-four years old—eight years after my last visit to the doctor’s office—I made another appointment. The night before the appointment, I laid awake in a sleep mask, eyes open in forced darkness. A tidal wave of memories crashed over me, and I was submerged: The nurse who took my blood pressure four times, frowning, because she couldn’t believe it was healthy. The doctor who prescribed weight loss as aftercare for an ear infection. The doctor who refused to touch me and, therefore, refused to treat me. The flush of my face when I say, Yes, I eat vegetables and I cook my meals at home. The familiar look of skepticism that follows, often paired with a long sigh. Look, I can’t help you if you’re not going to tell me the truth. The doctor after doctor who denied even simple tests or exams for nearly every health condition until I lost weight. The prescription for anxiety and depression: lose weight. The treatment for a persistent, mysterious hormonal imbalance: lose weight. The intervention for endless bleeding: lose weight. The frustration at being told I wasn’t worth caring for until I was thin. Basic healthcare was a carrot, and these visits were the stick. Unlike so many before me, horses broken and tamed by constant punishment, I felt certain I’d never get what I needed so desperately, dangling just inches from my hungry mouth.
On the afternoon of my appointment, I was ragged, frayed from lack of sleep. I walked into the doctor’s office, voice shaking and legs weak with anticipation. The medical assistant called me behind the glass, into the depths of the office. She was kind and outgoing, chatty and engaging, and I was grateful for the distraction. She measured my height: five feet, ten inches. She measured my weight: I looked away.
In the exam room, she took my blood pressure only once and, thankfully, noted my vitals without comment. She removed two vials of my blood, thick and blackish red. I was struck with the surreal vertigo of seeing my body outside itself. She asked if I was sexually active and about the gender of my partners. I told her I was and that my partners over the years had been multiple genders. Her face shattered into a smile.
“Hey girl!” she beamed, holding up an ID tag marked with a strip of rainbow tape. I laughed, surprised by the force and volume of my own voice, a little loosing of so much tension. When she left the room, I felt my heart’s contractions in my chest, but the tight, pulsing anxiety that gripped my head had faded. Oceans of blood still rushed behind this dam of my body.
When the doctor entered, he met my eyes, smiled warmly, and got down to business.
“Smoke?”
“No.”
“Never?”
“One cigarette in high school. I was like a cartoon of an after school special. Those weren’t my real friends,” I joked. He smiled kindly, the way you do when you’re humoring someone, stopping just short of pitying them.
“Drink?”
“One or two.”
“A day?”
“A week. I’ve never been much of a drinker.” “Recreational drugs?” “No, never.” “Cannabis?”
“No.” He nodded, smiling as he noted it on my chart. “I know,” I added ruefully. “I’m boring.”
“There’s another word for that,” he said. “Healthy.” The word hit me hard. Despite years of organic eating and focusing on nutrition, no one had ever called me healthy.
He asked more questions and finished taking my medical history. I answered his questions honestly and asked for the tests I thought I needed. He never objected, never contradicted, never rolled his eyes or heaved a sigh. He listened, and as I watched expressions flicker across his kind and pensive face, it struck me that he might even have believed me.
“There’s one more thing we should talk about.” I felt my voice shake as I said it. “It’s just about my history with doctors.” He looked up from the chart, still calm, but more alert.
“I feel like I know what you’re going to say,” he said, nodding. “Go on.”
I told him that I’d only been to emergency care for the better part of a decade, and I knew it wasn’t helpful. I told him that I stopped seeing doctors because they stopped seeing me. So many wouldn’t touch me, wouldn’t examine me, wouldn’t ask questions, wouldn’t refer to specialists, or write prescriptions. Everything, I told him, led back to the weight loss that years of dieting and disordered eating never delivered.
I told him I was happy to talk about behaviors, and I meant it. I would talk about practices and food, and I wasn’t seeking medication or kid gloves. But the answer to nearly every health problem I had faced had come without investigation, without curiosity, without seeing anything but the size of me. I told him that my body cast a long and wide shadow and that every doctor seemed focused on its silhouette, not the body from which that shadow stretched. If every prescription was to suddenly stop having the body I had always had, I said, that wasn’t going to happen. After all, twenty years of constant, punishing effort hadn’t changed the shape of my skin.
I told him about everything I’d done to manage the health that was so readily ignored by providers. I tracked food and vitamins in a daily diary; used a nutrition tracker to calculate vitamins, minerals, macronutrients, and amino acids; kept a calendar of exercise to ensure I was regularly moving; maintained mental healthcare and kept going to the dentist; prepped meals at home from local produce from farmers’ markets and CSAs. I told him about hiring a personal trainer, and about trying every diet I could for a decade.
As I spoke, the rushing waters built beneath the skin that was so thick for so long. Those waters, that blood, were turbulent with the force of experiences that had gone unheard and unregistered for years and years. I heard my voice crack when I told him that I had tried everything I could since my teenage years. In that time, my body did not change. Neither did my healthcare.
“It sounds like your health matters a lot to you,” he offered, his eyes meeting mine.
And suddenly, I wept. Mine was a wailing and irrepressible grief, called up only by this simple act of recognition. All the years of effort, all the machinations to avoid humiliation and erasure, and someone had finally noticed. Later that day, I realized that despite years of trying, no one had ever told me that I cared about my health. And I did. I do.
“I’m sorry,” I told him. “I don’t know why I’m crying.”
But we both knew. The dam had burst.
In the coming days, I waited for test results, nervous as anyone would be. But my heart beat steadied. The blood calmed in my veins. The waters found their cadence, flowing easy and fast over the wreckage of the dam.
I didn’t know what came next, but I knew that at least I’d be heard.