Wednesday, October 20, 2010

Keep your assumptions off my body

So over the past 24 hours, I've had a catastrophically yucky initial meeting with my (potential, violently rejected) new primary care physician, followed by (admittedly mild, but I'm sensitive to this sort of thing) Facebook drama. I posted on Facebook shortly after I left the office, because I was upset and distressed by the horrific 5 minutes I'd spent with the doctor. Unfortunately, in addition to several supportive comments, one friend (whose partner is a WLS "success story") posted a finger-wagging comment basically scolding me for overreacting, saying that it was probably appropriate for the doc to act as she did. Then, some other rad fatties and allies posted vehemently anti-WLS comments. Which felt good to read, but they in turn prompted the pro-WLS friend to spring to the defense of WLS. All of this in comments that started to feel like a flame war on my FB. It was to the point by this morning where each FB notification was making me feel sick, because I dreaded what it was going to be...

Finally, I decided to respond. But I'd been doing so much thinking that it became far more blog-length than comment-length. So I'm posting it here instead. I'm sure some rad fatties and anti-WLS people will think my position is not strong enough. While on the other hand, my friends and acquaintances who have positive ideas about WLS will probably feel I'm being unreasonable in my resistance. I can't please you all. I can only try to think this through and navigate it the best I can. I am torn, caught in the middle between the hordes and masses of society who think my body is an abomination, a disease to be "cured" by any means necessary, and by the small, quiet voices of fat acceptance and HAES and the tentative reaching instincts of my own body and soul, which tell me that fat is part of my biology and my identity and it's the world that needs to change, to stop treating me badly and seeing me as a problem and an intrusion.

There's so much to respond to in what everyone said on my FB. I agree with the strong negative feelings that many of you have about these surgeries. On the other hand, I understand where my friend who said the distressing stuff was coming from (even though the way he said it really hurt!). I know several "success stories" for whom the surgery was really wonderful and they are feeling great / much improved / it was all worth it / etc. Which only serves to confuse me because I feel even more pressure to accept the pressure of medical professionals. However, I simply must stick to my own gut feeling/intuition/confidence that this is NOT the right path for me - at least right now. I won't say never, cause who knows?

What truly pisses me off about this doc is that, as I said in my initial FB status post, she had met me LITERALLY 5 minutes before stating that bariatric surgery was really my only option. She had not had me fill out any new patient paperwork. It's almost certain that had not reviewed my medical record extensively, if at all, given how overworked clinicians are these days and the fact that I had not scheduled a full physical, just a 15 minute appt. When she walked in, she asked, "What can I do for you today?" I stated that I am looking for a new primary care physician, and she repeated, "But what do you want today," or something. She didn't ask me any questions or move to initiate the getting-to-know-you conversation I was hoping for. So I said that I am looking for a team captain, that I see a variety of specialists for different concerns, including a naturopath, chiropractor, psychologist, occasionally podiatrist. I went on to express that I was seeing her because I am looking for a new primary care doc who will NOT insist on constantly recommending HMR (my medical group's in-house version of Weight Watchers) or bariatric surgery, as those recommendations aggravate my eating disorder and depression. I explained that I believe in focusing on changing behaviors, not focusing on weight (working my way into explaining HAES). But before I could elaborate, she said that that was just it, we can't change behaviors, and that for someone in my "category" the only viable option is bariatric surgery.

Really? You don't want to hear more about the eating disorder I just mentioned? But of course fat women don't have eating disorders, do they? If you have an eating disorder, it makes you skinny. After all, the same thing we diagnose as an eating disorder if you're below a certain weight (severely limiting calories, obsessively planning meals and reading nutrition labels, working out to excess, etc.), we prescribe to fat people, don't we! You don't want to know if I exercise or not, or what I eat, before making such a sweeping statement? But of course not; you know exactly how I eat (poorly) and whether I exercise (obviously not even a little) from looking at me, right? It may be - it probably is true - that I will never eat or exercise "perfectly."  But you don't even ask the questions??? It was blatantly clear that this woman thought she knew everything relevant about me just by looking me up and down. And so I told her, "ok, well that's what I needed to know. We're done here." She protested, "But don't you want a flu shot or a whooping cough booster?" "No, I don't want anything from you." Not exactly the ringing, persuasive speech I might craft if I were a character in my own movie... but I didn't cry. I didn't give her that. At least, not til I got to my car.

I have done a lot of thinking on this in the last 24 hours and I've come to believe that my feelings on WLS and abortion are somewhat parallel. In both cases, I believe that everyone has the right to choose to go through that procedure, but it is emotionally complex and has long-lasting physical and emotional consequences and should not be taken up lightly. In both cases I would not personally choose that procedure but respect others' right to make their own personal decisions about what is best for their bodies and their lives. And just as I would be offended by a doctor who recommended abortion just because I was visibly pregnant and single, I am offended by a doc who recommends bariatric surgery just because I'm fat.

Pro-choice folks have the slogan, "Keep your laws off my body." While there is no law that one must have bariatric surgery (though it's getting scarier and scarier in terms of de facto weight loss requirements embedded in ability/non ability to access health care in this country), there is a TON of pressure out there, especially for folks like me who are in the very far right (not politics, math - on a graph, bigger numbers are to the right!) portion of the weight bell curve. So it may not be as catchy, but I say it with gusto:

KEEP YOUR ASSUMPTIONS OFF MY BODY. Yes, I mean you, Dr. And you, well-meaning friend. My body is mine. In this day when fatness increasingly IS a choice (if you believe bariatric surgery is a viable option, which so many seem to), it becomes increasingly difficult to stand up and say, "I am fat. I don't believe thinness is a choice for me. So I am going to live in this fat body" without getting some pretty forceful push-back.

Ok, now I have all sorts of interesting thoughts percolating about how just when we thought people might accept that diets don't work, and therefore fatness really is biological and not a "choice"... in walks bariatric surgery, and in just a few short years goes from experimental to frighteningly mainstream. Coincidence?

But that's a subject for another day... This post is already exceedingly long. Kudos and thanks, if you're reading this. You've made it to the END OF THE POST. Leave me a (positive, no meanies allowed!) comment and you get a gold star. :)


  1. Well said Amanda! I have never made the connection to abortion and WLS before, but it fits to an extent. Neither one are requirements, but you will find protestors shouting loudly for or against from the sidelines. Both of those procedures are such a personal and private decision to make, that one should weigh all the consequences and possible outcomes. In regards to WLS, I've said it before and I'll say it again (as a super fatty) Gastric Bypass may not effect you now, but it probably will later. You may be the successful one who undergoes this procedure and manages to lose weight without any debilitating side effects now, but as you near the end of your life....when you want to be able to absorb vital nutrients that will sustain your life, it will probably be harder to do. Can the world just stop policing my body please?

  2. Only thing I'm going to say (I don't think it's negative) is that you talk about HAES but that you still eat poorly. First part of HAES is "health." Not losing weight, or trying to, but eating well -- not poorly -- or even perfectly. Just trying to put good stuff in your body, again, NOT with an emphasis on losing weight. Cuz otherwise you're not doing HAES, right? Just try to treat yourself well with the food you eat, make sure it *nourishes* you, body and soul. Exercise? It's good if you can do it, but one step at a time. First try loving yourself with the food you eat, and that it keeps you feeling good, and doing the things you want to do. You don't have to be perfect, but you should try to eat well, for YOU. Even if you fail, at first just try. Over the weekend I ate Halloween candy and pizza. It's what I needed I guess (tho I felt pretty crappy after) -- it certainly wasn't perfect, but then you try again. I ate a good meal later, not worried about calories, but about simple stuff without tons of fake junk in it and too many ingredients. And I felt better. Screw weight loss surgery. Just feed yourself well and lovingly.

  3. To the previous anonymous poster, I don't think Amanda said she ate poorly or never exercised per se, but rather that's what the doctor assumed by looking at her, at least that's how I read it.

    Amanda, I agree with you about 90%, it is your body and you and only you should get to decide what to do with it, my only holdback is that I don't believe WLS patients are getting a complete view of the long term affects of WLS, I wish there was a way to guarantee that patients got ALL the information before agreeing to the procedure.

  4. "...But of course not; you know exactly how I eat (poorly) and whether I exercise (obviously not even a little) from looking at me, right?"

    To Anonymous 1 and 2 -

    I wasn't clear when I wrote that sentence. The parentheticals were meant to be what she was thinking/assuming, not what is actually true.

    I don't eat perfectly, but I've been working on intuitive eating for a long time. I'm also working with a naturopath who, among other things, is willing to give weight-neutral nutrition advice (though even that is sometimes triggering for me, so it's something I'm feeling out a little at a time). I don't move "enough" but I've been working on that, too, slowly but surely and around the chronic pain.

    But she (and SO many others, medical professionals or otherwise!) assumes I do NOTHING right, just b/c I'm fat.

  5. PS - Gold stars for Regina, Anonymous 1, and 2.

    Thanks for hanging out here with me.

  6. I am glad to hear that you stopped the conversation with your potential dr before the shaming began. I had a doc do something similar and I let him have it with data and he STFU! :)

  7. I think the doc probably didn't understand what you meant when you mentioned weight issues. It sounds like she assumed you were like most other fat patients: looking for some way to magically become thin. And yeah, the only 'viable' way to do that if you're very heavy is something as drastic as bariatric surgery. And of course you MUST desperately want to be thin at any cost and willing to take severe medical risks; after all, you're fat and have a pulse.
    She's probably never heard of anything like HAES or FA, and doesn't have any concept of fat people who are actually okay with their bodies and just want to stop being harassed about it and pushed into all sorts of medical weight interventions.
    The way I think about it is people like her seem to live in a sort of parallel universe where thin = healthy is an unquestionable fact of life that everyone 'knows'. You're not really speaking the same language as they are, and they don't realize it because they have no clue that any other language even exists.

  8. I'm very much with you about WLS. It's not for me. If someone else chooses it, it is not my place to tell them they've done something horrible. If someone close to me is considering having WLS, I will - if given a good opening - offer up resources for them to learn about the potential downsides of WLS... but from that moment on, I will shut my damn mouth and hope that if they go through with the surgery that they are among the lucky ones who get the most effect with the lowest rate of complications possible. And I will only offer up the resources if they express an interest in them.

    If it isn't my body and someone doesn't want my advice about it, I'm not going to force my beliefs on them.

    As for that doctor, it sounds like she had no intention of learning anything about you as an individual, and you certainly don't need that in a health care professional. I'm glad you walked out on her. You deserve someone who is going to listen to what you're saying and do a little research on your individual situation before making a drastic diagnosis/prescription.

  9. Well done you for putting the doc in her place. I was involved in an accident a few years back, and was seeing various consultants for a while, and the first question each time one consultant referred me to another was about the attitude of the new consultant to size. And then if I agreed to the referral, I always did the size acceptance speech at the beginning of the first appointment.

    Eventually I was a referred to a pain management clinic, to learn to live with the chronic pain. This involved joint appts with a physiotherapist and a CBT therapist, aimed at helping me move in a way which didnt make the pain worse, and not being afraid to do things in case it made the pain worse.

    Five minutes into the first appt, the CBT asks if I know anything about or have considered WLS. I am in high dudgeon and give them both my lecture on why I am not willing to consider it. ANd when I finish they both smile and say "good". Apparently they see so many people who have tried it as a way of dealing with pain and have just made all their problems a million times worse, and added some extra ones.

  10. Okay, for those of us who don't know, I figured out that WLS is weight loss surgery, used mostly here for bariatric surgery but also includes the lap band, but what are HAES, FA, STFU, and CBT?

    What I would like is for there to be as many places to get moving without being compared to the thin people, where the "trainers" know how to stop pain from happening (no it's not caused by the weight, but sometimes the weight exacerbates it), and trainers who don't use shame or yelling at you as a motivator, as there are gyms (spas, fitness centers, etc.) where you need to be thin before you go there in the first place.

    I was in my work's fitness center walking on a treadmill when someone came up and told me to push more and ramp it up. I told her if I did, she'd be calling an ambulance. I never went back. If she had just said, "nice to see you are here" or "keep going" or even just smiled at me, I would have gone back.

  11. HAES - Health At Every Size - just because someone is fat doesnt mean they are unhealthy
    FA - Fat Acceptance
    CBT - Cognitive Behavioural Therapy - available for lots of things, in my case to help me adjust to chronic pain and physical disability after an accident.
    STFU - Shut the (Fword) up I think

  12. "I simply must stick to my own gut feeling...." How can you do that if they cut out your guts? My g.i. dr. says that the brain in our guts is as important as the brain in our skulls. I think about (Marilyn Wann's term) stomach amputation as lobotomy.

    Congratulations on your self-preserving behavior. And I'm glad you stopped when you did. Had you continued you would have been educating her. Then she would have had to pay for the appointment and we all know she wouldn't have been willing to do that.

    And talking about gold stars -- you have a whole boxful coming to you!

  13. "But before I could elaborate, she said that that was just it, we can't change behaviors, and that for someone in my "category" the only viable option is bariatric surgery."

    Wow! So I have two things to say about what this doctor said: 1) she must be awfully cynical, and 2) she fits perfectly into her "doctor" paradigm within medical culture.

    It sucks, but mainstream medical culture views patients as outsiders upon whom one performs procedures. There is very little about wholeness and wellness that actually fits into that paradigm. You see on the fringes that there are a few daring change agents, but mostly these attitudes are so incredibly ingrained.

    Because patients are people (and not more "compliant" objects), they vary greatly in their behavior and in how they respond to others....not to mention treatments. But treating people like individuals means having faith in them and trusting them and letting them be fallible. This attitude is strongly beaten out of many, many doctors by the sheer overwhelm of the system.

    I could go on (perhaps I'll write a book), but I am glad that you did what you needed to do to keep yourself sane and advocate for yourself. You deserve to receive care from someone who can see you as more than a categoy.

  14. Amanda,

    I'm so impressed with your courage and your strength. It is so tough when feeling vulnerable to be bullied into accepting whatever a doctor says to do. Good for you for standing your ground.

    I recently had a similar episode. I had been seeing a doctor who admitted that my metabolic health was good and that my numbers (other than BMI) were pretty much all in the ideal range. I was symptom free and definitely exercised more than he did. So naturally he suggested I consider WLS as obviously the healthy eating and exercising weren't "working" (eyeroll). So I asked him why, given the fact he admitted I was healthy, I should risk surgery on perfectly healthy body parts? He tried to play down the risk factors--but I insisted. Why on earth would I do this, and how in good conscience could he suggest it.

    A month later, I was visiting my Mom and Dad and relaying the story. All of a sudden my Mom got really quiet. "Please don't have that surgery," she said. Apparently a very dear friend of my mom, who was the same age as me had gone into the band surgery perfectly healthy, got a staph infection and after a year of terrible suffering, she died. She left 3 small children behind with no mother. It was a chilling moment.

    I agree that people have the right to make up their own minds about their bodies. But I also agree with the posters who are eager for the full facts about WLS and the side effects to be revealed.

    As to the anonymous poster looking for size-neutral or size-positive exercise, there ARE options out there. Many of the local YWCAs are "safe". And with deep apologies for the plug, you may want to look at my site at which has a lot of info for fat people wanting to exercise.

    Okay, now my comment is as long as the blog post, but just to reiterate, Amanda, you rock! Thanks for listening!