Saturday, January 24, 2015

Weekly Whine: Fat Shaming

A bit ago, I made a post about how some women can be very hostile towards other women just for being skinny, even if they are not at all obsessed with looks. I'm probably asking for trouble here, but there's more I'd like to say on the topic.

First of all, I want to apologize if I did not seem sensitive enough. I genuinely think women look good at any size, unless they are at some extreme, and I would never in a million years consider making a negative comment to another woman about her weight and I can't imagine the mindset of a person who would, so perhaps I don't realize how much crap overweight women have to endure. In that sense, when I make posts like these, it is eye-opening for me. Some people accuse me of always thinking I am right because I don't immediately change my opinion when someone disagrees with me, but I do genuinely listen to everything people on here have to say.

For example, one woman told about how she underwent chemotherapy and experienced severe nausea. She said, "for a while, I couldn't eat much without getting nauseous. I had that condition for over a year. It sucked. But would take that over the easy weight gain any time. Hands down. Not even a close call." It is definitely a commentary on how obnoxious people must be to overweight women if someone would rather lose weight from being horribly nauseated from cancer therapy than be healthy and overweight. Of course, women do unhealthy things to lose weight all the time. The commentor then went on to say that she "cried with joy", not because of a cure for her illness, but because she lost weight.

That sort of attitude, valuing pants size over health, speaks volumes about how difficult it must be to be an overweight female. Although I genuinely hope most women would not rather be sick than overweight. If they did, there are a few hot dog carts in New York that I think would be getting a lot more business.

The truth is, I think women are always going to judge other women (as a mother, I have received a very large amount of unsolicited judgment and critique on my parenting), and weight is something that is very visible, and easy to critique people on since it seems like it should be changeable, although any intelligent person would realize that that's not often the case. I don't know if society can change how we think about weight, or be less judgmental. However, I feel strongly that we should help women to realize that is never acceptable to make an unsolicited comment on another woman's body. (Or her parenting, for that matter.)


  1. I have a lot of trouble with this topic and find it hard to find a happy medium.

    On one hand I am a hairy-underarm, slut-defending feminist and believe anyone can do/wear/be whatever they want to and people should STFU about it.

    The other side of me is a doctor who can smell the lady in cubicle 7 from cubicle 4 and knows that she can't clean herself properly because of her size. ANd that she is eating herself to death, that her OA, HTN, T2DM and high Chol is due to her diet/weight and that she could probably shave half her medications by shaving a few kilos.

    I haven't been able to stop my brain from making snap judgements yet but it is definitely better at deconstructing those judgements seconds after they happen.

    Dr N

  2. After many, many attempts to lose weight, I finally succeeded, and have kept over 100+ pounds off for 6+ years, so I can look at this differently than some. Even those who do not say anything often treat obese people differently, as thought they are dumb. It is remarkable now when I go to the doctor for a problem, now it is not automatically dismissed as weight related. Random people in stores and offices treat me with more respect. I had not even thought about that until I noticed it happening! I am well educated, have always dressed well and have had an upper management job, but the difference in how I am treated is remarkable. I find that the little voice in my head is sometimes quick to judge others, even after this experience, and I have to consciously ignore it.

    I had a similar experience when using a wheelchair after a major injury. People in public places really talked down to me as though I were a child (or intellectually disabled). Makes you think.....

    1. @ Mary: I read your comment, and I want you to know, your pain resonated
      with me. - Paul

  3. A problem with obesity -especially morbid obesity- is that the common beliefs of its existence and cause are not routed in actual science. There's a lot of science that claims that weight == health, but a lot of it starts with that assumption, and there's other science that shows that a lot of health issues aren't related to weight at all. At best it's a hotly contested topic with a lot of conflicting research. At worst, it's a topic with a lot of bias.

    For umpteen years we were told that "if you diet and exercise you will lose weight and gain health" and it took until the 1990s before someone stopped and recognized that's a logic failure: you cannot claim that one result causes another result. Future studies found that you can gain health independent of weight.

    A lot of doctors insist that "being fat causes early death" but there's a lot of evidence that it's not being fat that's the problem, it's the doctor's attitude about fat people. It's a hard and bitter pill to swallow, but repeated studies show that the fatter a patient is the more scorn a doctor has for the patient, and the less the quality of healthcare. Anecdotally there are stories upon stories out there of fat people who can't get decent health care from doctors who cannot look past a patients body size. The situation is real, however. Take a look at Yale University's Rudd Center for Food Policy & Obesity which, in part, looks to help doctors recognize and overcome weight bias and stigmatizing behaviours.

    Dr N is a classic example of doctors who pin health issues on weight. Type 2 diabetes is not -caused- by weight or what you eat; weight is a medical risk for diabetes because of insulin resistance. (A medical risk is not a cause. Being black is a medical risk for sickle cell anemia; nobody in their right mind says that being black causes ssa.) OA occurs in people of every weight and some newer studies show that it may be tied to consumption of saturated fat. Diabetes + HTN + Cholesterol sounds like there's a good chance of either "metabolic syndrome" (I will make a bet said patient is also hypothyroid) or PCOS, both of which are genetic, inheritable conditions that don't magically appear from what you eat. They can be -exacerbated- by it, but that's a different situation.

    As for fat people who "smell because they can't take care of themselves" -- I'm often amazed at how often doctors will make this assumption and not look for a real, identifiable cause. Often things like infections can cause unwanted body odor. And sometimes it's all in the head. 40 years ago, people complained that people of a certain race "had a bad odor." Today that target is fat people.

    1. I agree it's frustrating for doctors to blame medical problems on weight, and recommend that as the solution. But I have to tell you, as a skinny problem, the solution my primary doctor usually has for any medical problems I come to her with is "nothing". Or at least, nothing that ever works. Maybe doctors realize this and figure that weight-loss seems like an easy answer that's better than nothing.

    2. I know it's shitty to be judged for something that isn't your fault. I also
      see "the looks" that some folks give heavier people that must hurt a lot.
      As a person with Aperger's Syndrome, I feel judged too. The things that
      most of you take for granted, I have to give conscious effort to. Am I holding myself the right way? Should I put my hands back in my pocket?
      Did I talk too much? Was I trying too hard? My wife once jokingly said to me, no wonder you get so tired sometimes. You're wearing yourself out. It's a full time job, I told her. She laughed (with me, not at me).
      So, Dr. Fizzy, if I appear to be "too much" at times and ask you for
      feedback, I'm not trying to engage you in conversation. I simply just
      don't know. - Paul

    3. Fizzy, what medical problems are you bringing to your doctor where her solution is "nothing"? This is off-topic and I'm not necessarily expecting you to list your personal medical problems on a website for everyone to read, but I do want to point out that there are many, many conditions or physical discomforts that people identify as an "illness" 1) that are not really a medical condition, i.e. not a pathology, and 2) for which there is no EFFECTIVE treatment within the medical realm. This is true for a lot of non-specific presentations (e.g. GI issues, chronic abdo pain, low energy, etc). After an initial diagnostic work-up (the length and invasiveness of which -in my experience - is totally dependant on how insistent the patient is) fails to reveal a pathology, there is really is "nothing" medical to be done. We would save a lot money on unnecessary medications, and a lot adverse medication side effects if people could just accept that.

      - a primary care doc

    4. Without getting into specifics, it's just been G.I. issues or skin issues. They had a few suggestions that didn't help much or at all, and the problem either went away eventually on its own or I learn to live with it. I agree with your assessment about most things people go to the doctor for. Mostly it's back pain or viral respiratory illnesses, and what does a primary care doc do for either of those things that's really been proven to be effective?

    5. Honestly, nothing "effective", really. Viral illnesses will go away eventually with time (and I actually counsel people not to go to the MD for a simple viral illness), but back pain - or any chronic pain - is the bane of our existence. There is usually no good solution, if the patient fails conservative treatment with physio and NSAIDS. Patients either get sent for a lot of pointless MRI and spine sx consults (again, mainly due to patient preference, and lack of anything else to offer), which drives up medical costs and doesn't solve the problem - and in the case of back surgery, may end up causing more problems.

      With the issues you're describing, if the initial work-up is negative and the initial advise doesn't work, then there probably is no good "medical" solution, and patients are better off - as you did - just waiting it out or learning to live with it. Primary care is best when we do preventive care or chronic disease management for diseases with reasonably good evidence for management (like diabetes, HTN, asthma, etc). For the chronic, non-progressive sources of discomfort, patient insistence on "medical" treatment can do more harm than good.

      - primary care doc

    6. I didn't say the word cause because that implies causality.
      If I tell a patient that they can improve their OA/HTN/T2DM by losing weight, they assume that I mean it was 'caused' by their weight. I dont, but it is often very difficult to explain risk factors.
      Being able to say "if you lose weight, this will get better" is just as shaming to some as "you are this way because you are fat". Because they don't want me to bring up weight at all. Though to not bring up weight, I'm ignoring a treatment option that has less side effects than their 10 medications.

      I'm not saying it's easy, but by bringing up a legitimate, proven treatment option, I shouldn't be labelled a 'fat-shamer'.

      OA happens in all sizes but is also specifically linked to joints that have more weight/pressure through them, i.e. man who uses walking stick and then gets OA in that shoulder only because more weight is going through it. Losing weight will mean less stress to joints, less medications needed.

      And I'm sure the smell IS because of infections. Candida in between fat rolls (sorry, can't think of a medical way to put this) is usually the cause and while it will need to be treated with antifungals, hygeine and removal of layers of skin that sweat and rub will often reduce this issue. Fat itself doesn't smell, it's the sequelae of the extra weight.

      Dr N

  4. I'm not certain if we're referring to the same person, Dr. Fizzy, but I do remember
    a confrontation between yourself and a woman who was on chemotherapy. If I remember correctly, it triggered a lot of pain for both of you. You both seemed
    to be in too much psychic pain to stand outside yourselves and see the other
    person's pain. In effect, she seemed to be saying, I have real pain and real problems. How dare you complain about this trivial stuff ! To paraphrase your
    response back: You don't know me but only what I choose to share. How dare
    you make assumptions about me. I am in terrible pain too, everyday!
    After reading "Pee Soaked Heck Hole" and a later comment about your formative
    years in which you were picked on mercilessly, head to toe, was I able to put it all into context. Many moons ago, when I was single, I had a similar experience. Although it's all a blur to me now, I remember a particular personal
    ad (online) that got my goat! A pretty gal with a nice figure and an attitude to match. PHOTO A MUST!! she put in capital letters. She also included a grammar test: you should know the difference between their, there and they're. Yes, I knew
    her type and was anxious to chat with her to give her a piece of my mind! It turned
    out that I was dead wrong and had a very expensive date with her. No, it wasn't the
    cost of the dinner that was expensive but the lesson that I had to learn. I had
    prejudged her based on past experiences and her profile only confirmed it.
    I had added up 2+2 and was convinced the answer was 5!
    Case in point: McDonalds Shaming - I read the subtext of what you wrote.
    Please don't judge me for giving my kids a Happy Meal a few times a week.
    I'm doing the best I can. My whole life I've been judged harshly. Please don't
    add to it. Unfortunately, some of the comments to the thread were anger filled.
    Perhaps they read into it: are you saying that Happy meals are the same as
    the meals I feed my kids? If your way is as good as mine, I'm wasting my time
    putting forth this extra effort. I must be stupid then. Is that what you're saying?
    That is not what you were saying, but it's easy to understand how someone
    can interpret it that way. By the way, I'm not putting myself on a pedestal,
    Dr. Fizzy. If I didn't do it myself, and continue to do it, I wouldn't understand it.
    So, the next time someone responds with great anger to a thread or a comment,
    it may not be about you. It may just be that they personalized it and, at that particular moment, are in a great deal of psychic pain. As you rightfully pointed
    out, that skinny gal you see just may be a geeky girl with a weak stomach.
    - Paul

  5. As someone who lost 50+ pounds at middle age after being fat for most of my life, I tend to be judgmental of other overweight and obese folks. My attitude is, "I lost weight and you can as well."

    While I would never confront anyone face-to-face about the way they look, I would like to submit anonymously videos of the way they look walking away from me. Especially when they are wearing Spandex.

    Fat shaming? Of course - but just with my "inner voice". I was bullied about my weight and other things all through school. I have wonky knees today because of my life as a "fatty". My problem, not yours. Just as someone's overweight is their problem, not anyone else's.

  6. @ Liz Harris: Yes, that " inner voice" or as I call it, that record that keeps playing over and over again in our head condemning us for not living up to some "standard."
    It is my feeling that at some point you internalized society's contempt for the
    "extra luggage" you carried with you. Yes, to your credit, you lost 50+ pounds,
    but apparently the damage to your psyche didn't disappear with the weight.
    You stated, "after being fat for most of my life." Do you now blame yourself
    for this? I'll bet you dollars to donuts that if I could go back to your childhood,
    it would be very understandable as to why you carried that "extra luggage"
    for so long. It's time to forgive yourself, Liz Harris for a "crime" you did not
    commit. Perhaps if you can do so, you can forgive others for a "crime they
    didn't commit either. - Paul

  7. Not sure. I would vote that if someone is ill, morbidly obese & lots of problems, saying about how well some others were after having the bariatric surgeries, that's more on the side of health than anything else. There's a difference between judging someone and going hey this is something that works/worked for others for their health. I have a very large neighbor who couldn't make it 2 houses down without being barely able to do anything. This woman is a truly wonderful lady with 2 kids, been married 25-30 years. I'd like her to enjoy another 25 more. Big difference between wanting someone healthy and around vs. not.

  8. Moose, I regret that people have treated you badly because of your weight, and I am happy to see you do not let it keep you down, but saying that obesity is to diabetes as being black is to sickle cell anemia is just wrong. Sickle cell anemia is a purely genetic disorder, which happens to be found primarily in people of recent African descent, who happen to make up the majority of black people. If a person with black skin and sickle cell anemia has hsi skin removed and replaced with white skin, or is treated with chemicals that block the synthesis of melatonin, or stays entirely out of the sun so that his skin becomes lighter, he still has just as much sickle cell anemia. If a person with obesity and type 2 diabetes loses weight because of diet, bariatric surgery, exercise, or (in one case series) liposuction, their glucose control improves.

  9. Perhaps Moose overstated her case by using the sickle cell anemia analogy to make her point. However, it does not diminish the stress that she feels everyday for simply being different. I think it would be helpful if PCP's would be more sympathetic to the plight of those who are larger in size. It starts by establishing
    a relationship of trust. Seeing a person who happens to be heavy and not a heavy person is a good start. Secondly, understanding that fat is a protective layer, we
    ask: what is the patient protecting themselves from? Perhaps the extra weight
    serves them or served them at one point in their life. Feeling your concern for
    their well being, and not just seeing them as someone who needs to lose weight
    provides an atmosphere where they may be more willing to open up about
    something that shames them. It's also worth noting that one person's set point
    may be higher than another person's set point. Not everyone is designed to be
    skinny. Yes, it's easy to judge those who are heavier. After all, they did it to themselves, right? As I see it, it's a very sick society with people just looking
    for an excuse to hurt each other. Rather than take it out on others, some of the
    heavier folks chose to take it out on themselves. Please keep in mind that they're
    bombarded with the same images we all see day in and day out. The "beautiful
    people" we see on tv, billboards, the internet, you name it. Do any of you feel insecure looking at those images? Can you imagine the pain a larger person feels seeing those same images? Yes, they have desires, wants and needs just like
    the rest of us. For some of them, they know they are just that and will never be
    a reality. Isn't that enough punishment? For some, their weight has a medical
    component e.g, hypothyroidism, PCOS, etc. that can be treated with medication,
    and a change in diet. For more severe cases, a surgical procedure may be
    warranted. However, whatever the case may be, the stigma attached to being
    overweight, and not the health issues associated with it, remains the biggest obstacle for society. Hopefully, if we solve that obstacle, the other one will be
    easier to manage too. - Paul

  10. Thanks for this.

    I'm fat and always have been. A side effect of not dying thanks to high doses of corticosteroids since infancy.

    The only way I can lose weight is to go off my medications and severely limit my calories (to my BMR, nothing more) while exercising intensely for 5+ hours a week - doing this, I lose around 1.5 lbs a week. I *should* lose 5 by my calorie deficit, I just don't. And yes, I measure and track everything I eat and every minute of exercise.

    Because I'm doing interviews for med school, all my accomplishments may be secondary to my fatness if my interviewer feels like so many people do about fat people. I am, of course, doing everything I can to lose weight even though it causes pretty big health problems and is distracting me from classes because I need time to work out. I am anything but lazy or unmotivated, but that's all some people (including a lot of my future colleagues!) see when they look at me. They don't see someone with chronic illness who works hard to be as healthy as possible within the constraints of that illness, they just see some fatass who doesn't take care of herself, so I have to compromise my health to conform to the expectations of my future colleagues or I may not be able to get into the profession at all.

    I'm firmly in the "body policing is wrong" camp as well. People need to back off when it comes to this stuff. That includes doing away with the "REAL women have X" and "skinny bitch" comments and nonsense like that. It just further divides women.

    1. Give yourself a break. Based on the little I know about you from your comment above, your life is hard enough and has been all your life.
      Unfortunately, you're correct. Some people do see you as someone
      who "chooses" not to take of herself. That's not your problem. That's
      theirs. I know it hurts you, nonetheless, and I am very sorry society
      is still so backward concerning weight. You sound like a very classy
      gal to me, and I sincerely hope the interviewers are smart enough to
      recognize it too. Here's a suggestion and only a suggestion: perhaps
      you can share you story with the interviewer so he/she can understand
      all the obstacles you've had to overcome to get where you are right now.
      Personally, your story is a story of triumph, and if i was the interviewer
      I would be honored to have a person like yourself representing my school.
      - Paul

    2. I like this blog better before every time someone made a comment, this Paul guy came in and told them that they were a beautiful flower.

    3. @Anon 3:39 -- Well you've certainly solved the problem of too much kindness in the comments.

  11. To anonymous at 0650: I would not worry about it. There are a number of overweight and even obese medical students at the university where I work. Certainly the general prejudice against fat will make it harder for you than it might otherwise have been, but interviewers like to see applicants who have struggled against adversity. I was on tiny doses of steroids for a few years and was the fattest I have ever been, the effect is well known. On the positive side, it will help you filter the schools who choose shallow people to interview. In the grand scheme of things, the many other adverse effects you are suffering from steroids are more important than the weight (even though society as a whole will not respond that way) and all of that is dwarfed by the fact that you are alive and have a shot at pursuing an essential and rewarding career, thanks in part to the glucocorticoids which make your life difficult.

  12. Society's view on weight changes all the time :)