I am a fat woman and I have been fat most of my life. I have my issues with my weight, but overall I believe that fat people (especially women) are unfairly treated in western culture, and the health care system is no exception. I have suffered the humiliations of going to the doctor as a fat woman more times than I care to remember. For me, going to the doctor - even if it is for something completely unrelated to my body size, like a hurt shoulder - means being stripped down to nothing more than body fat. I am reduced to a child; a complete moron who must not know anything about weight loss or nutrition or exercise and who desperately needs a talking-to by the nurse/physician's assistant/doctor or whatever other self-righteous health professional is seeing me that day.
This problem is always worse when I am seeing a new doctor for the first time. I moved to the UK a couple of weeks ago to start a master's program in Gender and International Relations. It has been great so far. However, today I had to go to the (free!) student health centre to get me some birth control pills. I was prepared for some bullshit, given my past experience, but my reaction was no better than any time before. I sat down with the nurse who checked my height and weight, determined my BMI and then started in on me.
"Oh my, your BMI is high. I think I will sign you up to see the nutritionist, she can help you figure out some better eating choices. And have you thought about signing up for the gym here on campus?"
And on, and on. 1) How the fuck does she know how I eat? I could live on salad and water for all she knows. In fact, I have before. 2) I am already signed up for the gym and I just came from a workout there. Her assumptions that I have never heard about weight loss/exercise/nutrition before, that a fat woman cannot possibly be active or eat well, or that it has never occurred to me that I am fat is just mind-boggling to me.
But here's the kicker:
"Women with a BMI over 30 are advised not to take oral contraceptives in the United Kingdom, so you are going to need to choose another method of birth control."
WOW. I was stunned. No doctor I have ever seen has implemented this rule with me before. I realize there are risks associated with taking the pill, especially for fat women, older women, and women who smoke. Those risks are rare and I am an adult who can make that decision on my own. I cannot believe they won't let me have the pill. Apparently it is some kind of rule in the UK that completely discriminates against fat women. It is ridiculous, but I have decided to just have my home prescription shipped to me here because I wouldn't want to go back to that place again anyway.
Overall, the way this woman spoke to me was astounding. It's as though because I am fat, I was stripped of my agency as an adult woman. She had no respect for me, and you could hear in her voice that she thought I was just some idiot who let herself go and has no idea how to eat or what to do to lose weight or just be healthy. She knew nothing about me. She didn't know that I have been on every diet and read every book about nutrition/weight loss I could get my hands on since I was 10 years old, and that I am therefore probably on par with the nutritionist when it comes to knowledge about this stuff. She didn't know that I have lost close to 75 pounds over the last three years. She had no clue that I need to be on the pill to keep me from having one, long period due to issues with my reproductive cycle. In her eyes, I was reduced to an alarmingly simple being, because I am fat.
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As a fellow fat woman I'd advise being very assertive - which I know is really hard at the doctor's office. But the bottom line is that you can almost always switch doctors. So if after you've explained your position, the doctor isn't willing to work with you on your terms then tell the clinic you need to see someone else because that doctor wasn't respecting you as a patient and a person. Seriously, sometimes complaining up the chain of command is necessary.
Remember that it's your health and while doctors can advise you and in some cases deny certain treatments and medications, final decisions are ultimately yours.
And I wouldn't take "no" on the issue of hormonal birth control, especially given that you've taken it before and need it for issues other than contraception. "Advised not to take" is not the same thing as a legal prohibition.
thanks, emflow for the advice. if i do end up returning there, which is likely, i will indeed be more assertive, especially about the BC. i have told off a few doctors in my day, but i usually back down because, after all, they do know more about "medical stuff" than i. i'm still so burned up about this whole experience that i can't help wishing i could go back in time and really give her a piece of my mind!
I hope if you have to go back that it's a much, much better experience.
I'd say write the doctor a letter. And write her boss a letter. My mom is a nurse (in labor & delivery so she works with a lot of female patients), and one of the things she's noted is that patients don't always speak up on their own behalf when there's something that upsets them. It sucks, but to a large extent we have to be our own advocates.
In england your birthcontrol is provided by the goverment, who don't want to get sued. Thats why they don't allow people that are at risk to take the pill.
But if the doctor documents that s/he has gone over the risks with the patient, wouldn't it be unlikely that the patient would win a suit? Why are patients not allowed to make their own choices regarding what risks they are willing to take? I don't understand why the government would be any more likely to be sued than an individual doctor would be in the U.S.
I really wish you could speak to one of my friends, who has turned her own struggles with being overweight into a career and area of focus as a soon-to-be professor of sociology.
She could provide guidance and support much better than I ever could, but what I will say is that we like to project our own feelings of discomfort and anxiety onto other people without bothering to take into account the full story. I think when lots of people criticize someone for being fat, what they're really voicing is a fear that they might become overweight themselves soon. So what was said to you often is all about them and little to nothing about you. This is true in all sorts of areas, and as selfish as we are, we'd be less upset if we could understand that criticism often speaks more of the person who says it than the intended target.
In my experience, and I've heard this from others, campus health centers generally suck. The doctors are understaffed, overworked, and probably underpaid. It's not exactly an ideal job for a doctor, and those clinics probably don't attract the best and brightest practitioners.
I went to mine during freshman year, now I avoid it like the plague. It costs a bit more money to go to a doctor somewhere else, but I feel a little more confident about the quality.
I HAVE to contradict you here. I understand it likely varies by school and region, but my mid-sized midwestern university has an EXCELLENT student health clinic, with the most amazing and supportive doctor I've ever had (she came to see me in the hospital--twice!--after doing an initial exam to determine what my stomach pain was [pancreatitis]). I don't think school clinics "generally" suck. Perhaps yours did, but mine was great!
Shout out to Dr. Fritzsche!
Yeah, I think there's a good deal of variance here.
Where I did my undergrad (private New England university), I had a fantastic experience with the student health clinic. The nurses were super friendly and great about sexual health issues. When my suitcase with all my birth control pills was lost on the way to school one year, the nurse on call sold me a month's worth of my pills, no questions asked, even though the clinic was officially closed for Labor Day (as was Planned Parenthood, and my doctor at home would not call in an emergency prescription to my local pharmacy because her answering service didn't consider my situation an "emergency").
On the other hand, the institution where I am now (large public Southern university), I've heard horror stories about the student health clinic. One woman told me she went in for a routine STD screening, and was a little bit nervous / uncomfortable. The nurse basically told her that if she didn't like getting tested for STDs, she shouldn't be having sex! Other students have reported going in with cold or flu-like symptoms, and being told that they should stop partying so hard. Thanks for assuming and judging!
How you were treated is awful, and unacceptable. And I say that as someone who hopes to be a physician.
One thing you should be aware of though, if you aren't already, is that standard oral contraceptives and minipills in particular tend to be less effective in overweight women simply because the hormone dose is calculated based on a mythical 'average' weight. Not enough hormone = less effective.
The solution to that though isn't to deny you oral BC. It's to customize your dose or advise you - if you *really* want to avoid pregnancy - to double up your protection by using condoms too.
The doctor may also have been concerned about side effects with BCPs - there's the increased risk of blood clots, I personally was informed about possible cravings & weight gain, and the potential for a raise in my blood-pressure. Not that those concerns in any way justify the doctor's behavior or immediate denial of BCPs.
True, but the OP already seems aware of those concerns ('I realize there are risks associated with taking the pill, especially for fat women, older women, and women who smoke. Those risks are rare and I am an adult who can make that decision on my own.') so it seemed a little redundant to bring them up.
I agree, it sounds like the OP is fully aware of the rare potential side effect of BCP's. I just wanted to share my personal experience and didn't feel it was redundant info in the larger discussion of fat women's health / health care / reproductive health.
did you not read that she takes the pill in order to prevent hormonal issues that result in month long periods? A lot of women have this issue. Generally it can be traced back to PCOS or something similar but it does not mean that giving her that speech is going to be effective at all. I'm tired of being told about these kinds of things when I go in to the doctor to get the pill. Its not fair and its not okay at all.
They have to or risk being sued. Believe it or not republicans want to make it much harder to sue for malpractice-specifically about cases like these. Place warning labels on everthing and if you can't read it you'll just have to ask someone to read it for you. But if anything goes wrong they aren't liable because the warning would suffice.
I don't think that's a bad idea because then people wouldn't have to hear the "safety preaching" that annoys so many of you.
... standard oral contraceptives and minipills in particular tend to be less effective in overweight women simply because the hormone dose is calculated based on a mythical 'average' weight. Not enough hormone = less effective.
Yeah, when I gained weight, I had to switch to a different pill with a slightly higher hormone dose because I'd begun spotting at sort of random times. My doctor at the time told me that spotting is an indicator that the hormone dose is too low. But If the OP isn't having any of these issues on her current pill, I don't know why she should assume that she's not on a high enough dose.
My mother is fat and has been struggling with it for years. Once, after loosing several pounds, she went to the doctor only to have the nurse (who was overweight herself) acted incredibly dismissive of my mother's efforts because she was was still fat. The experience horrified and humiliated my mother. She didn't go back to the doctor for years. I can't tell you how afraid this made me, my sisters, and my father, especially considering the incidences of cancer and heart disease among my mother's siblings. My mom understood our concerns, but was not willing to discuss the topic or change her behavior - she was that upset about it. I wish I had the ability to track down that nurse and let her know how her inexcusable behavior kept my mother out of a doctor's office for years, further endangering her health.
My mother's story doesn't really contribute much to this discussion. But I have been so afraid and felt so helpless about this, I couldn't help but vent.
Happy ending - my mother was recently forced into a doctor's office by a scary, but ultimately not serious, emergency. While she was there, she had a very positive experience with the attending physician. I have no idea what this doctor said or how she said it, but my mother finally agreed to come in for her first physical in years. I can't tell you how excited my family and I are and how grateful we are to this new doctor.
You might be doing your mother a huge disfavor with this.
Doctors are little more than inspectors for the insurance industry. During your annual physical, they make lists of all the tiny indications that something might go wrong in the future, and submit these to their employers.
Years down the road, when a serious medical issue develops, your mother will be denied medical coverage because of all kinds of "preexisting conditions", and her weight on file alone could mean that she might be uninsurable in the future.
Doctors earn nothing on preventative care and keeping patients healthy. Think about it, what would their incentive be?? So I think your mother has it right, and she will be much better off not going to the doctor unless a life-threatening emergency occurs.
So I think your mother has it right, and she will be much better off not going to the doctor unless a life-threatening emergency occurs.
This sounds inaccurate. Are you basing this on evidence or inference?
As the daughter of two doctors- I would like to say, there are ALOT of health risks accompanying obesity. Several widespread and serious disorders, like diabetes and heart disease (related to high cholesterol), have immensely increased risks of occurring with obesity. Obviously, there are going to be extra precautions taken; ie, a medication which also increases the risks of heart disease should probably be dropped in favor of one which doesn't, as the obesity already has an increased risk of heart disease.
That being said, BMI isn't really all that accurate. A person who is active, has a healthy diet, and is overweight will have MUCH better health than an inactive person of good weight on a bad diet. So while it does matter how much fat (esp. accompanying factors like cholesterol) one has, its more important that one is active and has a healthy diet.
And also, if the nurse was being rude about it, then yes you should be upset... Otherwise, well its not my business, but you know, there are legitimate medical issues associated with obesity.
I am sure the person who posted this has heard 100 times over (whether she wants to hear it or not) the medical issues associated with obesity. That is not what this post is about. It is about people however well meaning (like yourself) assuming that she is ignorant and must be lectured to every time she goes to the doctor as well as being patronized and even treated like a child (to the point where she is denied contraception though she is aware of the risks) by those who assume she knows nothing about health/eats junk every day/is inactive. I used to avoid the doctor when I had an eating disorder for issues related to my weight also. Mentally I could not deal with being weighed and then more often then not having my weight told to me (if I could avert my eyes and avoid seeing it in front of me) as well as having doctors make comments if they noticed my ED history in my charts. I suppose I could have made special requests for them not to tell me my weight but I was younger then and less assertive.
She wasn't denied contraception; she was told she must take another kind of contraception because of the health risks. This is completely legitimate; nobody wants a malpractice lawsuit because they prescribed someone with a pre-existing health risk a medication which increased that risk (especially when there are alternative medications, and the condition being treated was not life-threatening).
And yes, I do realize that the OP probably has been told about the health risks of obesity; but when most of her post seems to deny their existence, or at least tend to point to discrimination instead of health issues when told about ensuing steps to be taken, one has to assume things.
Another assumption was that one wasn't given much information. The OP was a new patient going to get more medication, and was told 1) something which the new nurse had no idea whether or not she was told so before and 2) that the medication she wanted was not going to be prescribed because of the health risks. Was the nurse rude about it- and if so, was she simply a bad nurse? Or was the nurse under-informed or under-informative- and if so, again, was she simply a bad nurse?
Actually, she WAS denied contraception - a type of contraception that she had safely taken for a considerably long period of time. And she was denied appropriate care because of the anti fat bias of the doctor.
You are the dughter of two doctors. You are not a doctor. Please read more about Fat Acceptance and about the truth about obesity before you perpetuate the stereotypes that this post is talking about. http://www.junkfoodscience.blogspot.com/ is a great place to start, as is "The Obesity Myth" by Paul Campos.
thanks, jenngirl, this is a great blog. will be following from now on.
"You can say I'm not a doctor baby
But can you prove I'm not a doctor's soin"
-Professor Longhair
Do you mind if I lol? As I said in the post, I am the daughter of two doctors. One would assume that this information would be irrelevant if I was a doctor myself, as I would have merely said that.
That being said, I would also like to say that I am much too lazy to read a blog, although I did skim over it a bit. I would also like to say that the information I presented was gleamed from not just what I had been told by said parents (which isn't really nothing of a sufficiently reliable medical info source), but also from reading those medical magazines my father got in the mail from cardiology/pulmonology/critical care groups (which did contain info from reliable sources, such as professional studies and etc).
I really have to disagree with this - Junk Food Science is heavily tied in with with "consumer choice" groups which are a front for agrobusiness. The cherry-picking and misrepresentation of data there are astounding; they are concerned with McDonald's profits, not anyone's well-being. Paul Campos is a lawyer; I really cannot advise taking him as an authority on health or science issues.
Right. And I'm sure doctors and researchers have absolutely no ties to pharmaceutical and weight loss companies.
Also, I wanted to clarify:
Junkfood Science is not affiliated with ANYBODY. It is a one woman show (Sandy Szwarc, BSN, RN, CCP) which runs on donation by readers ONLY. Do not pass around lies in order belittle somebody you don't agree with.
As for Paul Campos, he is not just a lawyer. He is also a professor and journalist who has documented the so-called "obesity crisis" for years now. He is more of an expert than most people on the subject.
Oh thank you, nobody, thank you so much. See, since I am a fat person I am also automatically quite unintelligent, and I have NEVER EVER heard about how 'there are legitimate medical issues associated with obesity'. I know absolutely nothing about health or ntrition! Of course I never eat any fruits or vegetables; my diet consists entirely of baby-flavoured donuts and whole cakes. My body shape means that wherever I go, especially for a routine check-up, I am silently begging to be informed of how unacceptable I am by people who must know more about health than me because gosh darn it, if I knew anything about nutrution or healthy eating I obviously wouldn't be so fat and disgusting! Duh! Clearly my lack of massive (heh) weight loss is due to the fact that, let's face it, it's just so much fun being fat in our society, why would I ever want to change? All those people telling me how great I look, constantly affirming my horrible horrible eating habits with a barrage of compliments and empowering speeches. Looking like me is just so great, I don't even understand how objectively disgusting I am or how objectively unhealthy and on my death bed I am. So thanks, nobody. I think you've saved my life. Gotta go lose 100 pounds now that I understand how much healthier that is, but when I get back you're going to get a big hug! (Okay, not a big hug, a small hug...since I'll be thin and all).
haha. thanks for the giggle. i needed a little dose of biting sarcasm in my day. :-)
Anytime, meganaut ;)
LOL!
What you look like does not matter and is completely irrelevant to anything and everything I said; I did not mention looks at all- in fact, "looks" are unrelated to whether or not one is overweight. Also, as I said in my post, being overweight and healthy is better than being a normal weight and unhealthy. And finally, I was not talking to you, lol; do you think I approach people in the street and tell them about the health risks about whatever they have? If you talk about how you are upset that you are being told according to the health risks, I will, however, say that there are health risks behind this that you are being told.
That comment was pretty incoherent but going from one of your previous comments which states that you're too lazy to try to understand others' perspectives, I'm just gonna assume that your wilful ignorance renders you incapable of contributing to this discussion. Allow me to return to dying of heart disease now.
I don't recall saying that- please point to where? Maybe when I said that, although I had read some, I didn't feel like reading (implied: most of/rest of) a blog? Seriously?
Let me put it this way: You don't know why you've offended people. Someone links you to a blog that touches on fat activism. You dismiss it and continue on your merry way, still not understanding why you've offended people. To make a tenuous comparison, let's say I made a comment on a post about trans people, someone was offended, and I was pointed to a blog about trans issues. Whether or not I planned on reading the whole blog, do you not think it would be unacceptable of me not to at least read up on trans 101 before even attempting to interact with trans activists? Like plenty of other intersections, fat is a feminist issue. You need to educate yourself.
Word.
You know, there's something I've begun thinking about lately in regards to fat people, fatness, and the reactions of others to fat people and fatness, particularly the whole "OMG don't you know being fat/obese is UNHEALTHY??" thing, and this comment reminded me of it. Hence, I'm posting this little thought of mine here.
Leaving aside for a moment all the arguments about whether or not being fat or obese is really that unhealthy, or whether or not anyone thinks we fat people have or haven't heard it all before, I personally think it takes an astounding amount of privilege or entitlement or something to feel like you (general "you" there, not directed at anyone in particular) have the right to make such comments to anyone, especially total strangers. The folks running around talking about fat being unhealthy might be completely right. They might even be concerned for my health for real, and not just using concern to mask some other issue, like disgust or fear. But why why WHY does anyone feel like they have the right to say these things to a total stranger on any issue, whether it be weight or smoking or anything else?
Maybe someone else can take this a bit further. Like I said I've only begun thinking about it recently so it's not that solid yet.
... have the right to make such comments to anyone, especially total strangers.: You're absolutely right. People never feel they have a right to harass or humiliate smokers under the pretense of "saving" their "health." And even when people DO disapprove of smokers, rarely does the level of utter disdain exceed that reserved for fat women. Fat as a "health problem" is greatly influenced by gender-specific beauty standards and expectations placed on women to maintain their appearance for the people who are looking at them (usually men).
Some "thin"-figured women I know have the frickin' unhealthiest habits I've ever seen, like a coworker with a habit of drinking an energy drink for breakfast every single morning that contains like 70 grams of sugar. I'm always like ... "I may weigh more than you, but that shit's just gonna kill you." Thin women I know do everything from skip meals to refuse to eat vegetables out of pickiness, but I'M supposed to watch my food intake? I think not.
I agree with this. I've never had a weight problem but I've basically dedicated my entire existence to staying that way (which is EXHAUSTING and FRUSTRATING!)because of terrible genetics (a drunk aunt once told me: "Face it kid, look at your parents, you're going to be a fattie.") Well anyways, some of the healthiest women I know are considered at least overweight on the BMI scale whereas some of the thinnest people I know eat fast food 5 times a day and drink Mountain Dew like it really is fresh water from a mountain spring! If we must have the healthy living talk with patients why can it be an open convo with everyone? If nutrition is really what these people and doctors are after, why aren't they quizzing everyone on their eating habits instead of fat-bashing?
You are right on the money! It does take an incredible amount of arrogance to lecture total strangers about their bodies and their allegedly "unhealthy" body type!
Many of these "legitimate" problems linked with obesity are assumptions, at best. There is no direct evidence that obesity is the SOLE CAUSE of diseases like diabetes, hypertension, and cancer. Nine of the ten cancers linked with obesity have dropped in the past 15 years. All of this information comes from JAMA - one of those fancy magazines about health you like to read.
Correlation does not imply causation, thanks very much.
What does any of that have to do with the ugly reality that many medical workers routinely insult their fat patients?
We're not stupid - we're just fat!
We read, and we have been bombarded with the being fat is bad message all of our lives - so having some jackass in a white lab coat insult us for being fat (and having to pay a $ 20 co pay to be insulted) does not help!
Question - do medical professionals get some kind of sadistic pleasure out of insulting their fat patients?
They must, because doctors and nurses are not stupid, so they must KNOW that berating a fat patient for being fat Does Not Help Them Lose Weight!
I always thought that being a smoker was the big birth control pill risk factor. I've been fat for all of my life, too (varying degrees, was a size 12 in college and a 14 in my 20s...back up to an 18 after law school and am down to a 16 now after recently losing 18 pounds), and I have never heard this from a doctor. I have been on the pill since I was 17. Weight alone is not a determining factor in reproductive health.
Fat shaming is alive and well in most doctor's offices, unfortunately.
I'm only 19, and I'm overweight, and pretty much every time I go to the doctor I get a warning about how I need to lose weight (which my mom would usually reinforce, despite the fact that she herself is more overweight than I am). I'm really sick of this crap. I'm a college student, and so my options of what to eat both within the school dining plan and outside of school are limited. And I don't always have time to exercise, though I try to put in a little bit of time if I can. Frankly, my weight is pretty low on my priority list, and while I probably should make an effort to eat healthier, it has little to do with my weight and everything to do with the fact that I know I don't get enough of each food group and I am often tired.
Are you me?
It really sucks that the doctor made you feel that way, and it's not fair. You have ever right to be frustrated.
But, uh, could you please not use the word "moron" in that manner?
i tried in my post not to use ableist language, but i see now that i definitely missed a big one and i thank you for pointing that out, Audentia. i actually never thought about the connotations of the word "moron" and i am glad to be aware of it now. i realize my not knowing is a sign of my own privilege when it comes to mental ableness, just as the nurse's treatment of me was due to her privilege as a health professional and a thin person. thanks again for making me aware of that problematic term.
I completely understand. I too, feared going to the doctor because as a young girl I knew I was fat and have been severely made fun of since I was very small for that and various other ways I don't live up to perfection. Kids can be so cruel...
I will say though, that deciding to lose weight made me learn some things about myself. And no it wasn't easy... I almost wish someone had said something to me before. I always hated the idea that I was simply fat because I ate bad and was lazy. I am seeing a psychiatrist for the first time tomorrow and it is overdue by many years. Once I lost a lot of the weight, I started to realize that no matter how much I lost I wouldn't be happy. I grew up truly believing that if I were thin I would be so happy. My life would be perfect, I'd finally have friends, nothing would be wrong. I had severely low self esteem and blamed it on being fat. As a little girl I used to pray to God to make me thin--that's how bad I felt. I've since discovered that I have a binge-eating disorder which, while I won't know entirely until talking to the psychiatrist tomorrow, I believe stems from my low self esteem paired with the stress of being so ignored in school because of my weight. I also am starting to realize that my low self esteem may come from being adopted. So losing weight for me has been something incredible. It has allowed to me to realize that all this stuff I always blamed on being fat was wrong. Being thin isn't the answer for me, although I am glad that now I can do things I couldn't before...like hike and stuff...but I know now that I can get help for the problems that have been hiding for so long. My husband has always told me I have low self esteem and I agreed...but I figured it was just because I was fat. It's not. And now I can finally attempt to get help.
I'll say this though, while I know much of my self-esteem issues possibly came from the underlying rejection of knowing my being here caused someone else (my first mother) severe pain and heartache, and that me being born was the reason for her suffering, there were other factors. Once I was fat, I was also very made fun of. There are no "cool" clothes for fat people, at least not in the small town I grew up in. People assumed I was lazy, although I was on the swim team. People are cruel. We need to start accepting people for who they are. I lost weight, but I shouldn't have to to gain acceptance. I'm glad I did because of the reasons I stated before, but also because I'm bombarded with the idea that being thin is perfection. Why else would a little girl believe her life would be perfect if she were thin? We need to do something about our daughters, students, nieces, ect.'s self esteem. Let them know they are fine the way they are, and make sure they don't make fun of others. Kids now are even worse than they were when I was a kid...so I'm scared for the girls who don't fit the "mold"--what will become of their self-esteem?
Like you said, even doctors are prejudiced. That doctor had no right to tell you what she did. Again, it goes back to that whole "women are children" thing. She assumed you were "stupid" and needed guidance on how to get fit. How sad that a doctor would be that way. Doctors also need to accept everyone for who they are and not be rude. Then they are no better than the kids who called me a pig in school.
Sorry I went on but this post triggered something in me. I've never told anyone about this stuff except my husband. It's painful. And letting it out has helped. Hopefully I can get some help tomorrow...otherwise I'll never get over the past. My self-esteem should not be nonexistent, and I don't want to be this way anymore.
Please, please submit your story to the First, Do No Harm website at www.fathealth.org. The site collects true stories of size-based discrimination in health care.
meganaut524, not trying to derail, but I'm really interested in the program you're enrolled in for gender and international relations. I'm applying to schools for next August. If you see this I'd really appreciate an email exchange about how you're finding the program.
Thanks,
Julie
junoble@gmail.com
Just FYI - I've studied and gotten student health care in the UK too, and it's my understanding that policy there is to avoid prescribing hormonal contraception to patients with a BMI over 30. (It's regarded as a potential contraindication in North America and an absolute one in Britain.) For all the problems with the nurse in question, it's my understanding that someone in her position is not authorized to waive that rule, period, although a private OB/GYN might not be so closely regulated. I'm not sure about NHS GPs.
Hmmm. I really want to separate the two apparent issues here:
1. You were treated very badly by the nurse.
2. You were denied hormonal contraception.
As far as I can see #1 is never, ever acceptable. No-one should be rude, there's never an excuse - ditto being dismissive, patronising, and frankly insulting. Additionally making assumptions about a patient's lifestyle is exceptionally bad practice and potentially medically dangerous.
#2 however is a bit different. Given that the NHS, and therefore UK taxpayers, provide this service there are strict prescribing guidelines which GP's and practice nurses are not allowed to bend, no matter what. Yes, some of these guidelines are a little ridiculous (i.e. based on BMI as a risk factor when BMI is famously shite at indicating fat ratios, and fat ratios famously shite at indicating general health) but they are based in medical research. For example, a woman who uses a wheelchair would also be denied the pill as she would be at a higher risk of DVT than a more mobile woman. This is based on research, not discrimination.
Basically, from where I stand you have four practical options:
1 - return and ask for the mini-pill, which is much lower risk for those of us with a higher BMI. While you're there make a whopping complaint about the uber-rude nurse;
2 - go private and pay for it. Expensive, yes, but you're almost certainly going to get what you want;
3 - take it higher and try to get prescribing guidelines changed; or
4 - very unhealthy, and not an option I approve of but you could technically lose the weight to get the prescription, but then return to your usual self and just get repeats. Doesn't always work though as some insist on quarterly check-ups.
The NHS has many advantages (which I'm sure Mr Obama has made you all aware of) but it also has some serious drawbacks, and this is one of them :-(
Well said - whatever the circumstances rudeness is never okay! And whatever you choose to do about your situation make a complaint anyway - people over here don't complain enough at poor services, that's why they tend to remain so very poor!
I went to my GP when I put my back out after some heavy files fell on me - my BMI is quite high but I'm actually only a UK size 12 (UK bloggers will know that's actually smaller than the average size here) and I'm very fit (I walk at least 6 miles a day, every day because I don't drive). The very first thing he said to me was that I'm obese and losing weight will help with my back problems!
He shut up, though, after I asked him whether it would also prevent me from being hit again by any flying objects.
Lovely comeback—it really is ridiculous how quickly so many doctors immediately blame weight for any physical misfortune a fat person might have, and not the actual cause of the injury.
I think the idea of denying a fat woman hormonal contraception because of some very rare side effects is fatphobic bullshit.
I'm deathfat, live in Australia and have NEVER been denied hormonal contraception. We too have our medicine subsidised by the government. I know the plural of anecdote is not data but... If all the fat women in Australia on hormonal contraceptives were having pill induced blood clots and heart attacks I think we would be hearing about it a lot more.
What can happen for fat women, especially with the mini pill is the does needs to be adjusted to make the medication effective enough to have a reliable contraceptive effect.
((((hugs op))))
I've experienced this as well. My "best" experience was when I went to get a yearly pap smear at a Planned Parenthood. As some of you may know, you never get the same doctor/nurse when you go to Planned Parenthood, so I didn't know the woman who was examining me. As soon as she saw me, sitting there on the table covered by the paper, a look of disgust crossed her face. I was shocked. She was a doctor, for gods sake! The pelvic exam was hurried, about half the time other doctors had spent, and then when she was doing my ovary exam (where they push down on your stomach and feel around) she looked up at the ceiling the whole time. During the breast exam, she was rough and even though I said "ow" she didn't seem to care. When she was done, she said "I'm done" and abruptly left. Two weeks later I got a letter from Planned Parenthood saying that I needed to come back in for another pap smear because the one I got was incomplete. Awesome. So this doctor was so disgusted by my fatness that she hurried through what is a very important (sometimes life-saving) exam just so she wouldn't have to see me? The woman is a doctor, for god's sake (I know, I'm repeating myself) has she never seen a fat person before? And really, the way to deal with it was to treat me with contempt and disgust the whole time? REALLY? It was awful, and also the last time I ever went to Planned Parenthood. I ended up getting my pap smear redone at my college health clinic. Funny, even though the doctor who saw me there was a man, he seemed more concerned with giving me an adequate pelvic exam then giving me dirty looks cause I'm fat. Nice guy.
Wow. I'm sorry you had that experience at Planned Parenthood. I'm fat as well and had a couple exams there and they were great; the female doctor even sat with me to talk for like half an hour about my health in general, because she knew I'd just been kicked off my parents' insurance. In fact, my local Planned Parenthood office has several plus-size women working behind the desk.
Anyway, it pisses me off when I hear stories like yours because I think Planned Parenthood is a really excellent organization, so I'm like ... where the fuck are these people coming from?
... where the fuck are these people coming from?: As in, the jerks who work there. :o) Not you. Sorry.
I have had a few similar experiences where it was obvious that the doctor was less-than-thrilled to be touching/looking at me during an exam. It is one of the most humiliating and degrading experiences I've ever had, being treated like you are disgusting by someone who is a medical professional and has ostensibly seen people of all shapes and sizes, inside and out. I realize we can't ever expect a total lack of bias from anyone (just the nature of human beings) but one would hope for a little courtesy or that they would - at the very least - put on a happy face and pretend they aren't grossed out by my fat body. It's so indicative of the deeply-ingrained structure of beauty in our culture that says that fat is not just unattractive but dirty, disgusting and wrong.
I've been overweight for most of my life, and I've never been denied hormonal contraception in the UK because of my BMI.In fact, the doctor looked at the figures, looked me up and down and then said "You're just really short. Your blood pressure is fine. Come back in 6 months and we'll check you over again." She was much more concerned about BP and whether I smoked than how much the BMI was.
It's the same here in Germany, except the doctors seem much less concerned about smoking. My weight has only been measured once. My gynae doesn't care that I'm fat, just chats merrily away while examining me. And the only things they want to know are a)BP and b)any unusual goings on, such as pain, headaches or spotting.
My advice: If you can't find a doctor who treats you well, go to another. It's hard in smaller communities I know, but it's worth getting a recommendation from a friend.
I have put on 100 pounds since my children were born, and like most people, I have tried everything from low-cal to low-fat to high-protein to veg only, and I walk my dogs at least an hour a day and I'm generally active and work a lot, but I do believe that obesity is an illness and not a lazy habit.
But anyways, in those 10 years I have only been to the doctor twice, once because of pneumonia and once because of the shingles.
Both times, it was somehow *my* fault because you know, being overweight and "eating badly" weakens the immune system, and you know, "I'm much more concerned about your weight than about the enormous, excruciating pain of your shingles right now".
Thanks, doc. Have not been back since, have no intentions of ever going again. It's like when you are overweight, you lose any right to medical treatment.
So I have decided that if I had cancer or something else, I would rather want to die quickly than to go through years of humiliation and mistreatment for using up societal resources of which I clearly am not worthy...
My mom, who has been fat all her life, hates going to new doctors because of this very reason. We used to joke that fat people could go to the doctor and say "I stubbed my toe" and they would say "its because you are fat."
The unfortunate side of this is that my mom has almost started "shutting out" doctors. If she goes and see one, and they even mention her weight, she gets discouraged and just basically stops listening. And of course, it seems like EVERY doctor that she sees feels it is their job to mention that she is overweight - like she didn't realize that before and they are the first person ever to mention that to her.
YES! I've experienced this, but, sadly, not from my doctor; from my mom. I have epilepsy, and in seeing my neurologist one day (I see him about once a year) he was asking me the usual questions, how's the medication was going, etc, when suddenly my mom piped up (she was there cause I was only a teenager at the time) "Do you think her weight has anything to do with this?" I threw her a very irritated look, and the doctor also looked slightly confused. "No," he said slowly. "Her weight has nothing to do with her NEUROLOGICAL BRAIN DISORDER." Afterwards, I asked my mom about it. I don't think she realized how humiliating that was for me. Since then, every ache and pain, every illness can be attributed to my AWFUL, AWFUL FATNESS. Back pain? No, that's not because you're carrying a 50-lb backpack around all day for school, if you were skinny you wouldn't feel any pain! Your foot hurts? Probably because of the gargantuan amount of weight it has to shift around! Headache? You're fat! Depression? Skinny people don't get sad! It's very, very annoying, and we've had many arguments about it. She only stopped because I out-and-out told her to never, ever bring it up again. The last time she said anything was when she tried to blame an especially heavy and painful period on my weight. That was the last straw, and I threatened to move out if she didn't cut it out. It's weird, cause it's not like she's skinny, herself. Her weight has fluctuated her whole life, every once in a while she'll go to an OA meeting...you'd think she would know how it feels. But she seems to glorify thinness. She told me that you know you're too fat when "other people" notice. Yes, when it cannot be concealed with clothes, and other people can see your disgusting body, that is your cue to start the lettuce-and-water diet again.
Okay, that deviated a bit from the doctor angle. Sorry about that, I just wanted to share my experience about someone in my life who blames all my pains and illnesses on my weight. (That lettuce-and-water thing was sarcastic, too. Just so everyone knows that.)
please keep in mind, though, with prescription medications, none of us (men, women, skinny, fat, in between, whathaveyou) get to make the decisions about what we consider an acceptable risk on our own. if i need antibiotics, i don't get to run over to the drug store and pick some up without seeing a doctor first. when i'm in pain, i don't get vicodin at will. one could certainly make a valid argument that there shouldn't be protections on any prescription medications, but under the current system in the US and the UK, with doctors as the ultimate deciders on what drugs we can (legally) consume, it's hard for me to be convinced that fat hate or sexism is to blame in this case. one doctor may just be more risk-averse than another.
also, i have to wonder about whether or not it's reasonable to go to a health professional for care and then take offense when they bring up something that is pertinent to one's health. that would seem to be poor health care. however, there's no reason to treat someone poorly or to shame them for any reason or not to listen when they have another health issue. my mom, who's a smoker, has stopped going to the doctor unless it's a dire emergency, because every time she goes, they try to get her to quit smoking, and she doesn't like hearing it. (yes, i realize that obesity is not directly akin to smoking and the relationship between obesity and health is nowhere near understood.) i think it would be really bad care if they stopped offering her smoking-cessation advice. likewise, if someone is obese, it strikes me as reasonable to ask an obese patient if they feel they need nutritional advice or to inquire about any lifestyle changes, etc. it's never okay, however, to treat someone with disrespect.
please keep in mind, though, with prescription medications, none of us (men, women, skinny, fat, in between, whathaveyou) get to make the decisions about what we consider an acceptable risk on our own. if i need antibiotics, i don't get to run over to the drug store and pick some up without seeing a doctor first. when i'm in pain, i don't get vicodin at will. one could certainly make a valid argument that there shouldn't be protections on any prescription medications, but under the current system in the US and the UK, with doctors as the ultimate deciders on what drugs we can (legally) consume, it's hard for me to be convinced that fat hate or sexism is to blame in this case. one doctor may just be more risk-averse than another.
also, i have to wonder about whether or not it's reasonable to go to a health professional for care and then take offense when they bring up something that is pertinent to one's health. that would seem to be poor health care. however, there's no reason to treat someone poorly or to shame them for any reason or not to listen when they have another health issue. my mom, who's a smoker, has stopped going to the doctor unless it's a dire emergency, because every time she goes, they try to get her to quit smoking, and she doesn't like hearing it. (yes, i realize that obesity is not directly akin to smoking and the relationship between obesity and health is nowhere near understood.) i think it would be really bad care if they stopped offering her smoking-cessation advice. likewise, if someone is obese, it strikes me as reasonable to ask an obese patient if they feel they need nutritional advice or to inquire about any lifestyle changes, etc. it's never okay, however, to treat someone with disrespect.
I would agree with you on this if it wasn't for one thing - if your mother had gone to the doctor and it was something that was smoking-related that she was asking about (e.g. can I have my drugs for lung cancer, or even how can I help clear up my allergies) then bringing up her continuing smoking is obviously a related subject, and the doctor or nurse would be silly to NOT mention it. If, however, your mother went to the doctor about something entirely unrelated (e.g. can you give me a referral to hospital to get my bad knees checked out) then it is off-topic and uncalled for. And I say that as an ex-smoker (you know, the horrible kind who now can't even stand the smell of it on other people?)!
In Meganaut's case at first it seems a little less clear, since she asked to be put on the pill but it was down to her BMI being too high that made them say no, but the initial comments made by the nurse trying to prescribe unwanted treatment were uncalled for and nothing to do with what she'd gone to the doctor for - that was down to the nurse making her opinions known, not answering the query. It should have been a simple case of "this is not available to you because of your BMI, would you like some information about alternatives?"
Medical practitioners just have to learn to deal with the fact that the people we're talking about here are adults, fully mentally sound ones at that, and whether or not they like what we do it's not their place to make that kind of decision.
There's a really great mailing list you could check out for some advice. They are midwives, but they don't just deal with childbirth. I find it a little surprising that you were told you weren't allowed to take oral contraceptive, as in most cases I know of related to childbirth women ultimately have control over what their choice is.
As an example, many obese women are told "you can't have a homebirth" because of their weight, when actually it's the womans choice and the NHS is there to support it no matter what it is. When they take the doctor/midwife to task on it then things often change.
the mailing list is here - http://health.groups.yahoo.com/group/ukmidwifery/
This won't be very constructive, but I feel the need to say this.
I'm a lesbian, a vegetarian, I dress awkwardly, my hair is multiple colours, and I get a load of shit for it here. Especially for the vegetarian bit but I digress. Yet when I go out with my sister, she's the one taking ALL the shit. Because she's fat.
My younger sister has a thyroid condition and her hormones are way too high. She's on meds that simply PREVENT her from slimming. The society's apparently very tolerant- they've gone over anything you could sue for and win- but, unfortunately, that doesn't include being fat (or hairy, or having buck teeth etc.).
I don't know anything about her doctors, though- but we're both insured in a private med company, so I figure they have to be nicer, since we pay them extra.
Just a quick update on size discrimination in the UK:
http://news.bbc.co.uk/1/hi/health/8314125.stm
I am just going to post my essay response for a class. This is all I have to say.
Meganaut524’s article, “Going to the Doctor Sucks, Especially When You’re a Fat Woman” poses succinct points from a very closed-minded and ignorant point of view about a woman’s over-dramatic problem of her embarrassment as a fat woman going to the doctor and her boorish about a new doctor denying her birth control pills because of her BMI. Although the article seems to pose valid points, underneath it is just an angry rant from a woman with low self-esteem who will exploit any small reason to make society appear as “women haters.” The author of the article is obviously oblivious to the core reasons why she was denied the birth control pills and unnecessarily angry at doctors who supposedly “judge” fat patients. To be completely honest, it was very hard for me to read this article straight through without scoffing or shaking my head.
The author of this article feels that the western health care system is conspiring against fat people because they have to be naked for check-ups and it’s humiliating. However, how else is one supposed to receive a check-up strictly for the purpose of making sure the body is healthy? She says that she is “reduced to a child; a complete moron who must not know anything about weight loss or nutrition or exercise…” But it is the doctor’s job to assess the status of a patient’s health. Being fat does not mean that a doctor will assume that you aren’t trying to lose weight or be healthier and they certainly do not consider fat people morons. It’s the job of the “self-righteous” health professionals to help you become healthy and there is no other way to do that than to tell you. Also, one does not become overweight over night so the author must have been spoken to before about her high BMI. Obviously the author hasn’t done anything to change that so why should she be angry visiting another new doctor?
The author also starts to bash the nurse at the student health center for recommending a nutritionist and a gym membership. The author responds by saying, “How the fuck does she know how I eat? I could live on salad and water for all she knows…I am already signed up for the gym and I just came from a workout there…” If the author lived on salad and water, she obviously would not be overweight and if one were to go to the gym consistently, one would also not be overweight. Doctors keep a record of weight for a reason—to see a progression in the health of a patient.
The author is then told by the nurse that, “Women with a BMI over 30 are advised not to take oral contraceptives in the UK, so you are going to need to choose another method of birth control.” The author says that it is “some kind of rule that completely discriminates against fat women.” Discrimination is not a word to be taken lightly. First of all, a BMI over 30 means that you are obese. Obesity causes an increase in cancer, health problems, and diabetes. Would you expect the doctor to lie to you and tell you that you are beautiful instead of try and help you become healthier? You dread the doctor because of your humiliation of who you are and what you've made yourself to be.
According to the National Institute of Child Health and Human development, women who are overweight or obese are more likely to get pregnant while taking birth control pills and 5% of overweight women taking the pill got pregnant each year vs. 3% of normal weight women. The author claims that the nurse is discriminating against her because she is fat, not because the effectiveness of the Pill is decreased, as well as other health risks. She claims that she was “stripped of her agency as an adult woman” and that she “was reduced to an alarmingly simple human being because she is fat.”
I think this article is completely irrational and ignorant and absolutely closed-minded. Her arguments, in the end, are unsatisfactory and not effective, making the readers feel irritable.
This is the most irrational claim of anything I have ever heard in my entire life. I apologize.