Thank you for the work that you are doing with your patients, in the medical community, and here on Substack. You've made so many important points here and the ending "Either medical education cultivates anti-fatness or it does a terrible job correcting it. Or both." cuts right to the heart of the issue (and, for the record, in my experience it is most definitely both.) I'm so glad that your patients get to have you on their healthcare team and grateful that you are doing this work more widely and that you are modeling how we can do our own work to uncover and dismantle anti-fat bias in healthcare!
Nearly all of my classmates in medical school class was a thin-bodied person, as well as the educators. I didn't see it during the time when I was in training, because at that point I definitely was embracing the diet culture. Now, looking back, it feels so wrong to sit in a classroom of people in thin bodies blaming people in large bodies. (It feels...cult-ish.) Gives me chills, actually, not the good kind.
Thank you for your comment and your openness to collaborate and be a resource! I wonder if Anti-Fatness in Med-Ed would be something we could collaborate on. I am also open to other ideas! I will email you soon to connect.
Thank you for writing this. I remember in my early twenties, I went to the doctor for hives on my arm, and the nurse talked to me about my weight. I was filled with shame and guilt. Several years later, while seeing a doctor for follow up on an unrelated condition, she talked to me about I need to do something about my obesity. Turns out her MA put my height into the computer wrong -- even though he hadn't even checked my height.
Since then, I've learned that I have lipedema, a rare adipose disorder that doesn't respond to diet, exercise, or even bariatric surgery. I feel much more able to advocate for myself and partner with my doctors to learn together about a diagnosis that gets no air time in residency. I feel fortunate to say that in the last several years, I've never had a doctor bring up my size or weight in a way that's unrelated to the matter at hand. I think it's doctors like you, Zed, who are helping to transform that medical culture, so thank you.
You are a great self-advocate! Though I wish you didn't have to be....Imagine if people living with lipedema are urged to undergo bariatric surgery and the harms that might come along with it!
Many years ago I went to a small village in south China to do some health screening. The villagers farmed from sunrise to sunset -- everybody walked everywhere, all able bodied. Yet when I measured their BMI (I didn't know better back then lol), everyone was "overweight" or "ob*se"!! Turns out when you arbitrarily divide your weight by your height twice, short people (or anyone who isn't a able bodied white male astronaut) has irrelevant and "abnormal" numbers!!!
What a strange medical world we live in (invented by those who don't look like us) lol.
Whoa, that’s such a great example of how this metric is meaningless! I have a friend who is a professional basketball player - 6’4, all muscle - and according to her BMI, she’s ob*se. This metric is trash, and so is the concept of weight=health.
You mentioned, "I have learned by now that I must always have a box of tissues ready when I do because almost everybody cries when they hear these words." After reading your essay, I nearly had to reach for my own tissues! I am so glad, at age 83, to finally ready such an eloquent essay on this topic by an MD. I have had individual MD's apologize to me about their colleagues' insensitivity toward fat patients (such as my friends and my female family members have experienced for countless years). But your essay is the first I have seen with these sentiments in the written word. Thank you so much. For your own reference, I have been active in size acceptance since 1969. My worst experience, that helped make me into an activist, came when my late first wife needed to get a blood test and was ushered in to see a new doctor in Great Neck, NY. When he asked her why she wanted a blood test, she showed him the form that the State of NY required in order to get a marriage license. (It was required in those days.) He looked at her fat body with astonishment, and asked "Who would want to marry you?"
Wow, Bill!! Honored you read the piece and liked it. Thank you for the important work you have done (since 1969! you are the OG) and are still doing (though I hear real retirement is nice, too lol).
I have so many questions....
1. what was the reason why NY required blood work for marriage license? I image and read it was to help prevent syphilis? It's kind of crazy as we have penicillin now....I was required to be tested for syphilis as well as an immigrant. And the healthcare professional I encountered explained to me that was because, "you know, to prevent people from coming to the US and spread diseases, like what happened to Covid!"
Does she really think that's what caused the pandemic? Some US-trained Chinese physician hopped on a plane and started the pandemic? What ignorance.
2. 😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤 What did your late first wife say to this????
First, back in 1964, which is when we married, NY State was, indeed, looking for syphilis. Perhaps the law was a legacy of the old pre-penicillin days. My theory is that they left the law in place to slow down impulsive wedding license applications. It surely slowed us down!
Second, my fiance was very sad that this happened. She knew that it would not deter me from marrying her, but was afraid of my angry reaction. I just filed it away in my memory, and it surfaced five years later when I became an activist. As a husband of a large woman, I personally witnessed countless examples in which she was discriminated against--including the NY Times being unwilling to publish her engagement photo. In those days, they had an official policy of not picturing fat women, even though she had a socially prominent father. (Around 1995, they revised the policy.)
Such and important topic! Patient shaming for any reason is unacceptable and fat shaming or “anti-fatness” is so prevalent. Admittedly, I felt called out in the article because I’ve definitely been guilty of thinking those shaming thoughts about others and about myself. Fortunately (an odd choice of words in this dysfunctional context! 😅), I’m only vocal about those directed inward at myself.
Me too! I still have so much shaming thoughts toward myself. I have (I think) stopped doing that to others. Perhaps self compassion is harder than other compassion...
Thank you for the work that you are doing with your patients, in the medical community, and here on Substack. You've made so many important points here and the ending "Either medical education cultivates anti-fatness or it does a terrible job correcting it. Or both." cuts right to the heart of the issue (and, for the record, in my experience it is most definitely both.) I'm so glad that your patients get to have you on their healthcare team and grateful that you are doing this work more widely and that you are modeling how we can do our own work to uncover and dismantle anti-fat bias in healthcare!
I agree, it's definitely both.
Nearly all of my classmates in medical school class was a thin-bodied person, as well as the educators. I didn't see it during the time when I was in training, because at that point I definitely was embracing the diet culture. Now, looking back, it feels so wrong to sit in a classroom of people in thin bodies blaming people in large bodies. (It feels...cult-ish.) Gives me chills, actually, not the good kind.
Thank you for your comment and your openness to collaborate and be a resource! I wonder if Anti-Fatness in Med-Ed would be something we could collaborate on. I am also open to other ideas! I will email you soon to connect.
Thank you for writing this. I remember in my early twenties, I went to the doctor for hives on my arm, and the nurse talked to me about my weight. I was filled with shame and guilt. Several years later, while seeing a doctor for follow up on an unrelated condition, she talked to me about I need to do something about my obesity. Turns out her MA put my height into the computer wrong -- even though he hadn't even checked my height.
Since then, I've learned that I have lipedema, a rare adipose disorder that doesn't respond to diet, exercise, or even bariatric surgery. I feel much more able to advocate for myself and partner with my doctors to learn together about a diagnosis that gets no air time in residency. I feel fortunate to say that in the last several years, I've never had a doctor bring up my size or weight in a way that's unrelated to the matter at hand. I think it's doctors like you, Zed, who are helping to transform that medical culture, so thank you.
You are a great self-advocate! Though I wish you didn't have to be....Imagine if people living with lipedema are urged to undergo bariatric surgery and the harms that might come along with it!
Many years ago I went to a small village in south China to do some health screening. The villagers farmed from sunrise to sunset -- everybody walked everywhere, all able bodied. Yet when I measured their BMI (I didn't know better back then lol), everyone was "overweight" or "ob*se"!! Turns out when you arbitrarily divide your weight by your height twice, short people (or anyone who isn't a able bodied white male astronaut) has irrelevant and "abnormal" numbers!!!
What a strange medical world we live in (invented by those who don't look like us) lol.
Whoa, that’s such a great example of how this metric is meaningless! I have a friend who is a professional basketball player - 6’4, all muscle - and according to her BMI, she’s ob*se. This metric is trash, and so is the concept of weight=health.
👆👆👆👆👆👆👆👆👆👆👆👆
Thank you. It gives me hope to see a doctor write this. Please keep speaking and sharing loudly.
Thank you Megha! It gives me hope to have my writing read, haha!
You mentioned, "I have learned by now that I must always have a box of tissues ready when I do because almost everybody cries when they hear these words." After reading your essay, I nearly had to reach for my own tissues! I am so glad, at age 83, to finally ready such an eloquent essay on this topic by an MD. I have had individual MD's apologize to me about their colleagues' insensitivity toward fat patients (such as my friends and my female family members have experienced for countless years). But your essay is the first I have seen with these sentiments in the written word. Thank you so much. For your own reference, I have been active in size acceptance since 1969. My worst experience, that helped make me into an activist, came when my late first wife needed to get a blood test and was ushered in to see a new doctor in Great Neck, NY. When he asked her why she wanted a blood test, she showed him the form that the State of NY required in order to get a marriage license. (It was required in those days.) He looked at her fat body with astonishment, and asked "Who would want to marry you?"
Wow, Bill!! Honored you read the piece and liked it. Thank you for the important work you have done (since 1969! you are the OG) and are still doing (though I hear real retirement is nice, too lol).
I have so many questions....
1. what was the reason why NY required blood work for marriage license? I image and read it was to help prevent syphilis? It's kind of crazy as we have penicillin now....I was required to be tested for syphilis as well as an immigrant. And the healthcare professional I encountered explained to me that was because, "you know, to prevent people from coming to the US and spread diseases, like what happened to Covid!"
Does she really think that's what caused the pandemic? Some US-trained Chinese physician hopped on a plane and started the pandemic? What ignorance.
2. 😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤😤 What did your late first wife say to this????
First, back in 1964, which is when we married, NY State was, indeed, looking for syphilis. Perhaps the law was a legacy of the old pre-penicillin days. My theory is that they left the law in place to slow down impulsive wedding license applications. It surely slowed us down!
Second, my fiance was very sad that this happened. She knew that it would not deter me from marrying her, but was afraid of my angry reaction. I just filed it away in my memory, and it surfaced five years later when I became an activist. As a husband of a large woman, I personally witnessed countless examples in which she was discriminated against--including the NY Times being unwilling to publish her engagement photo. In those days, they had an official policy of not picturing fat women, even though she had a socially prominent father. (Around 1995, they revised the policy.)
🤯🤯🤯🤯🤯
Such and important topic! Patient shaming for any reason is unacceptable and fat shaming or “anti-fatness” is so prevalent. Admittedly, I felt called out in the article because I’ve definitely been guilty of thinking those shaming thoughts about others and about myself. Fortunately (an odd choice of words in this dysfunctional context! 😅), I’m only vocal about those directed inward at myself.
Thank you for being so forthright in sharing!
Me too! I still have so much shaming thoughts toward myself. I have (I think) stopped doing that to others. Perhaps self compassion is harder than other compassion...