Episode 2: Fatphobia in Healthcare

The speaker starts by sharing a funny story about a communication mishap with an older woman on Facebook. They then discuss fat phobia in healthcare and share a friend's experience of being dismissed by a doctor due to her weight. They highlight the flaws in using body mass index (BMI) as a measure of health and the negative consequences of weight stigma, including eating disorders and weight cycling. They also mention the impact of weight discrimination on individuals' overall health. The speaker suggests that it is important to consider whether obesity itself or the discrimination associated with it is the root cause of health issues. Oh, my God, okay, I think I am recording now, it's on, it's going, how does yours look? Perfect. Okay, ready? All right. And this is Maggie, and I'm a physical therapist. Welcome to our second episode. Well, I do have a story for you that I had to save because I thought it was so ridiculous but funny, a little unrelated to healthcare, but it aligns because it actually involves back to when I was a student physical therapist, I had to go to like a rural town and do like a rural health rotation. So I packed my bags and I go and I met this occupational therapist. She was at the time probably, you know, I was like 24, and she was probably like my parents' age. She was an older lady. And this was, you know, many years ago, but our communication has strictly been over Facebook, including just her wishing me a happy birthday every year, which is, I feel like, exactly what I do with all my parents' friends on Facebook. They'll reach out and wish me a happy birthday. One day, though, over the last week, I accidentally sent her a recipe that I was trying to send to somebody else. And I don't know about you, but if I get a random message five years plus later after knowing the person with no context, no nothing, I probably ignore it, just assume it's a mistake. However, I sent her the recipe and she says, so now you cook slash bake? And I said, oh, whoopsies, didn't mean to send that to you. Ha ha. But there are some great recipes on there. You know, she goes, you're funny, no problem. I've been baking a lot myself lately. PBS weekends have great cooking shows as well. Take care and stay warm. Seems like you're on the East Coast. PBS, also age appropriate, no. Is that channel still going? Anyway, I was too, but I'm like, who is like, seriously? Yeah, oh, so you cook and bake now? Okay. But then anyways, I tell her where I'm living and working now. She goes, oh, I know an OT who works there, so and so. And I said, oh, I don't know them. And she says, I didn't think you would. Just another friendly, well-traveled single. Just another friendly, well-traveled single. I didn't respond, but I do identify as a well-traveled single. No, I mean, that's such a random way to subtly point out your marital status, that older people, it's just very on brand for. I'm going to put it on my Instagram, my Twitter, wherever. Maggie, physical therapist and well-traveled single. Yes. No. You know what? They should do that on the dating profiles. Oh, not only am I single, I'm a well-traveled single. One level above that is a friendly, well-traveled single. One level above that is a friendly, well-traveled single. You know what? She's trying to set me up with somebody probably. Oh, you're a well-traveled single, aren't you? I don't know. I don't know, Landa. For the record, I am not single, but she doesn't need to know that. I don't need to justify myself to her. Oh, well, actually, I'm not single anymore. First of all, I didn't want to be in the conversation to begin with, so I'm just going to see myself out. I mean, it was too weird. No, probably meet someone at church type of vibes. Well, yeah, I mean, that's my little tidbit from the week. I could never, I could never, but I just did not respond. Oh, bless your hearts. I never did notice that. I think we'd get like 500,000 signatures right away. I really do. Going in and being like, hi, I don't know what I was thinking, but I don't need another hoodie. I don't need any of this. I live in the southwest United States, and I bought a beanie for some reason. The weather's amazing here, but for some reason I need to keep my head warm. Yeah. Well, I love it, and I really do buy something every brewery that I go out of state, out of my, like, home state, because it's like a little destination. You go try beers and whatever kind of fried situation there is on the menu wherever you go. I have a little souvenir. Yeah. Like, oh, did you get that on Amazon Marketplace? No, actually, I got it at the brew tap next door. Yeah, that's actually where I get all my fits. Every restaurant is called brew house, public house, tap house, like unions. You've heard those something market, union market, public market, tap market. I'm just kidding, but they're out there. Well, shall we get into our topic for today? Okay, so not only do we just chitchat amongst ourselves on this podcast, we also talk about topics in health care as our first segment and medical anomalies as our second segment. So we're going to start with our main topic I'm leading today. I hope I can do as good as you did last time, Paige. I thought you told such a good story. I just loved it. And Paige will be covering our medical anomaly, obviously. So we are covering fat phobia in health care today. So absolutely. And I have to say my inspiration actually came from a post that I saw on Instagram from this kind of up-and-coming nonprofit organization called Impact in Health Care. They do a lot of social media, but they have posts about a variety of topics, and they kind of had a little segment on fat phobia. And so that in combination with, like, a recent story that a friend had told me about their experiences going to the doctor really made me want to address this. So maybe I'll start with my friend's story. I will not identify her. Maybe she'll listen to this someday, we'll see. But what happened is, you know, one day she had to go to the ED because she had an ovarian cyst. So basically that's just like a cyst that forms on your ovaries. And for most women it's pretty common. When they burst or twist or move, it can be super painful, so painful that you do go to the emergency room. So she had one burst, and she got medications at the emergency room, and she went to follow up with a doctor to be like, okay, what do I do about the cyst? I'm still having a lot of pain, blah, blah, blah. I've also noticed I have gained 10 pounds, 10 pounds, like, since the incident. So she's thinking something hormonal, which would make a lot of sense with whatever happened with the ovaries. So she goes to the doctor and tells the doctor about this weight gain and everything, and the doctor says, oh, have you tried Weight Watchers? Maybe you haven't tried dieting, or maybe you haven't tried hard enough. And it just felt like she really overlooked the clinical picture. Like, okay, a month ago I was in the ED for a burst ovarian cyst. Since then I have gained a ton of weight, and I'm in a lot of pain in my abdomen. And you're asking if I have just not tried Weight Watchers. It just felt like she was totally ignored and just like, oh, just lose weight is the answer. And I kind of think, yeah. Absolutely. And so she sought a second opinion, and the doctor provided her with a diagnosis that required, like, an exploratory abdominal surgery. And she underwent the surgery, and they pulled out a blood sample, abdominal surgery, and she underwent the surgery, and they pulled out so many lesions and cysts that were causing all the pain. And they were like, wow, we cannot believe, I mean, it's believable seeing everything that came out, how much pain you must have really been in. And I think I saw something, you know, similar. There's posts about, you know, just, like, women in general, like, being overlooked and therefore their pain not being believed and therefore action not being taken on, like, their symptoms. But particularly fat phobia from medical professionals is a big reason that a lot of people go misdiagnosed or underdiagnosed, which is kind of what I wanted to kind of, like, segue into. So I found this fabulous resource from the University of Illinois Chicago's website, so I'll post that here. But basically, I just want to go through, like, all the things they were talking about, like, okay, why is weight so stigmatized, why is it problematic? And a few reasons they list out are, like, that actually a focus on a body size is rooted in racism. So, like, just the root of why we, like, stigmatize weight is rooted there. Measures called BMI or body mass index is flawed. Basically, this is a simple calculation of height and weight. So it absolutely does not take into account levels of muscle mass or different body proportions. So I'll get more into why body mass index is, like, problematic in a bit, but I think the literature recently really shows it is not a reliable measure of health. Okay, doctors overlook patient concerns and blame it on obesity and say, you need to lose weight and that will solve all your problems. Additionally, 90% of intentional weight loss fails. Like, 90%. It's huge. Exactly. Yeah, probably. It was just saying, like, intentional weight loss, like, people told to lose weight and trying to lose weight by various methods, 90% fail. And I think the failure is kind of classified as, you know, either not maintained after a certain amount of time or just not successful. Okay, other consequences they talk about are, you know, when we tell patients to lose weight, it could lead to food restriction, which is very harmful, proliferation of eating disorders, and also something they mentioned called weight cycling, which is, like, losing and gaining and losing and gaining and losing and gaining over and over again, you know, was not beneficial to health long-term. And they also mentioned that we also don't focus on the effects of weight discrimination on people. So, for instance, if you walk around in the world as a black person, you're having a different experience. If you walk around as a trans person, you're having a different experience. If you walk around as a heavy person, you're also experiencing discrimination. And so there was a lot of discussion on some of the resources about, okay, is it the obesity that is causing health issues, or is it the discrimination that's contributing to health issues? Because a lot of the things kind of overlap, right? Like racism can cause, like, those chronic health conditions, chronic stress. Okay, so if you're experiencing discrimination because of your weight, that can have the same stress effect. Additionally, they mentioned that if you are told by providers, like, to lose weight over and over, and they're dismissing or misdiagnosing you because they just think if you lose weight that you'll somehow be healthier, then you might not go to the doctor. Because... Because... And I did find a source that said genes, genetics, can play an 80% role in your weight. Like 80%. You have, like, a lot less control over it maybe than people think. Wow. Okay, hold on. You watch PBS? I'm like, wait a minute. I thought it was just Yolanda. It's just Yolanda. Yes. Absolutely. There's also more emerging research about the relationship between weight and trauma as well. And if we focus just on the weight, we're totally ignoring any psychological kind of, like, marriage with it. So there's a lot of issues with fat phobia. I mean, it really annoys me, and I get worked up about it. Just to provide, maybe I'll provide, like, a standard definition that's out there. So fat phobia, also known as anti-fat, is the implicit and explicit bias of overweight individuals that is rooted in a sense of blame and presumed moral failing. Being overweight and or fat is highly stigmatized in Western culture especially, and it's intrinsically linked to anti-blackness, racism, classism, misogyny, and many other systems of oppression. So I've been thinking so much about how people go places and maybe their body doesn't fit in, like, the chairs. So when you're working in a hospital and patients come in, depending on the size, there might not be large enough beds for them. There might not be equipment there to accommodate them. There might not be blood pressure cuffs of size for them. There might not be gowns that fit them. And just imagine how, like, unwelcome you would feel to be that. You guys see the entire population, and really hospitals should have the equipment to accommodate this population and provide a healing environment because probably they're already dealing with doctors trying to tell them to lose weight, and then they don't fit in the bed or they don't fit in the gowns. I mean, how terrible would that feel? Absolutely. So I ended up finding this really interesting article that I just felt like we would get along with the authors so well. They said, this is a paper written by two self-proclaimed fat authors, autoethnography. And autoethnography, I've never heard of this, allows a researcher to tie in personal experiences with a patient. And they say that autoethnography, and autoethnography, I've never heard of this, allows a researcher to tie in personal experiences with their article. So the article they wrote is not short of citations. It is, like, cited out of the wazoo. So they, like, have the research in there, but then between the chunks of fact and research, they outline personal experiences that kind of, like, give you a story to go with the research. It was, like, really a cool paper. It's an autoethnography. So the paper is called Stigma in Practice, Barriers to Health for Fat Women. So it is more female-focused paper, but a lot of the research is generalized to all populations. So they said, I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. I know. 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