Monday, January 8, 2018

Guest post: Weight loss surgery

Tuesday I sat through another hard sell for weight loss surgery. I'm so done.

I'm weary of doctors who won't hear my "no" and plow ahead extolling the virtues of procedures I have already investigated and decided are not for me. I would be at high risk of suicide if I allowed myself to be bullied into this. (That is not true for most people but would be for me.)

Today I felt calm enough to respond via email. To be sure, I responded plenty in the moment but everything I said was ignored or argued with and the doctor just kept going. My husband was present and he was shocked--as a fat man himself his doctors bring things up and then drop it if he says no. I talked with him about how hard it is to turn around and look for another doctor because I don't even know how THAT doctor will handle the sensitive issue of weight. If there's one thing I'd wish of doctors is that they come to appreciate how we've already survived a lifetime's worth of assaults on our self esteem based on our weight. Unless they've been there I don't know how easy that is to understand--but I wish they'd try.

I sent the following to Doctor M:

Subject heading was "Boundaries."

I understand that all doctors will discuss weight with their fat patients. I expect that it will be brought up. What I did not expect was the hard sell on weight loss surgery after I repeatedly indicated that I was not remotely interested in it and had firmly decided it was not for me for many reasons. You continued for something like 20 minutes AFTER I indicated that. But what is dangerous to my well being and survival was that you did so after learning I had spent months being verbally abused and was dealing with the resulting depression. Fortunately I've had years of therapy and could deal with the hurt, shock and distress I felt after having my boundaries violated.

It also concerns me that you'd dismiss the value of walking simply in relation to weight loss.

WEIGHT LOSS IS NOT A GOAL OF MINE. A Health at Every Size strategy of movement and eating healthy food IS. Obesity research has demonstrated that 95% of us regain. This is a feature not a bug.

Can you respect boundaries?


  1. Good for you for being able to stand up to your jerk of a physician, and I'm sorry that he/she is such a jerk. The medical profession has such an unhealthy obsession with weight loss, despite the very valid data you present about how very few people lose weight/almost everyone regains it.

    1. Thank you. It does get frustrating having the same conversation over and over again. I wish there was a checkbox somewhere that indicates "patient already had the conversation about weight loss surgery." And I fear that if weight loss is all they talk to patients about, there may be many fat patients who have given up on weight loss and don't know or believe that there is anything else they can do to have a positive effect on their health. He actually said when I wanted to talk about a brace for my injured knee that walking wouldn't help me lose weight! Like that's all exercise is good for. SMH...

  2. It is acceptable to badger and downright bully someone about weight loss as it is for no other health related condition-- and completely disproportionate. I would have never heard of a physician doing that about smoking, for instance. I wouldn't know where you would start at finding another doctor-- but this one is a real jerk. Even if it came from a place of "helping you", it was so disrespectful and overbearing that you're probably not listen to anything they say in the future-- if you are even their patient at all in the future. Which makes them stupid as well as rude.

  3. I am sorry you experienced that. As a doctor I apologize on behalf of my profession. Nobody should be bullied - they should certainly NOT be bullied by someone who is meant to represent their interests. Thank you for sharing your story. I hate to say it but do we now need a fat friendly doctor forum or something? Every doctor's office should be a place patients can feel safe and feel they have a teammate in their doctor - not a dictator. I am glad you have taken good care of yourself and have a supportive. Good luck in staying healthy in whatever method you choose!

    1. Thank you!

      A fat friendly doctor forum sounds like a great idea! It is a serious problem. I've read about doctors missing serious illness with a "just lose weight" bias. One woman saw several doctors with a worsening cough that just wouldn't go away and they kept telling her to lose weight. Finally she found out she had lung cancer. She lost a lung that could have been saved.

      I understand that doctors are human beings and can acquire all the biases and prejudices any other member of society might have. But these biases must be examined and compensated for if someone is going to be a good doctor.

  4. I would love to know what response you had from your email. I have found that those who have their minds made up before they walk in the room are difficult to sway. I want my concerns to be center and I will take yours under advisement. I work in Medical Research and sometimes know more than the doctor. It still doesn't stop some from trying to bully me. That usually is the last time I see than doctor. And I wait for the satisfaction survey with notes.

    1. Here was the response, which I held off on reading because I was so upset.

      "RE: Boundaries

      "I apologize if I spoke to you in a way that made you feel pressured or that made you feel like I did not suspect your boundaries.

      "We haven't seen each other many times and I did not have a recollection of a discussion about your objections to bariatric surgery.

      "I was attempting to fulfill my Hippocratic oath and fulfill my obligation to be a good advisor. I understand that in the short-term, weight loss may not be your goal but from the doctor's perspective, the long-term effects of your weight on your joints and vascular system are significant.

      "Will do my best to remember not to bring up this subject unless you want to talk about it"

      I'm still planning to look for another doctor.

  5. There was a great BMJ 'what you patient is thinking' article on this subject.

    1. That is great, thanks for the link.

      It feels like lectures on weight loss are some kind of hideous toll we have to pay before we can access health care. I feel as if everyone who reads the stats on weight regain immediately think "Right, fat people lack willpower. They should try harder."

      I have a strong family history of heart disease with both parents having passed away in their early fifties. Grandparents had strokes and heart attacks as well though a bit later in life. Despite a non-smoking vegetarian lifestyle at odds with my parents', I still had a quadruple bypass surgery at age 42, right in line with my mom's onset.

      When I woke up from surgery my surgeon stood over me and told me, still groggy, that if I didn't work to get to a normal weight I wouldn't make it to age 50. This plunged me into a serious depression.

      I turned 59 last month.

      I don't expect to live forever and I don't doubt the effects of fat ( see for a non-judgmental assessment of fat's affect on health) but I do believe that more yo-yo dieting is not in my best interest now that I have achieved a healthy relationship with food. Eating well and figuring out how to exercise despite my knee, is.

  6. That is a really great letter you wrote! Hopefully your doctor learned something.

    1. Thank you, from his reply it doesn't seem like he does.

      I'm wondering if I should write something to the HMO itself or if that would stigmatize me as a patient. I don't want to complain about him specifically but this isn't the first time I've had this lecture.

      One doctor who saw me after I injured the same knee for the third time also gave me a weight loss surgery lecture but he stood and delivered it with a raised voice and warned me that no surgeon in his department would operate on me (I wasn't asking for surgery). I couldn't even get a word in edgewise to tell him that my left knee is fine and that the one in question had been injured multiple times.

      My husband went to the follow up appointment after I had an MRI to see what was wrong with it (deep tear in meniscus among other things) and the doctor was so nice and respectful it was like meeting another person entirely.