As I sit on your examination table, you start with, “I know this is a delicate subject.” Please, let’s not go there. Can we just have one appointment without revisiting this? The last time we discussed my weight, it left me in tears for hours.
But you bring it up anyway. “We need to talk about your weight.”
I’m here because my legs are acting up. One of them is swollen and painful, affecting my ability to walk and enjoy activities like going for a stroll with my partner or taking my dog to the park. I’m terrified it might be a blood clot, especially since I’m on hormonal birth control and recently traveled by plane. I explained to you that I’ve had larger legs my whole life, but this is a new, alarming issue. Sometimes my legs shake uncontrollably, and I lose my balance even when standing still. I am in pain and scared—what I need is help.
Yet, you focus on my weight.
Here’s what I want you to understand, doctor: This isn’t about me being “sensitive” regarding my weight; it’s about the fact that this conversation leads to subpar medical care. The last time we discussed this, we spent the majority of our appointment circling around my weight while only briefly addressing the actual reason for my visit: the swelling and pain in my legs. You pressed on my swollen leg, confirming fluid retention, and offered nothing else—no tests, no suggestions, no treatments. Because you wanted to talk about my weight instead.
This topic drives me to tears, not out of surprise or newfound awareness, but from frustration and anger. Do you know how many times I’ve had this talk? If I had a dollar for every time a doctor has sat with me and “got real” about my weight, I could buy a mansion with a pool and a media room. But here I am, stuck paying for yet another discussion on my weight.
I came prepared to discuss potential diagnoses I found through research, along with a list of questions, including requests for diagnostic tests like an ultrasound or a referral to a specialist. You suggested diuretics without any context, but I countered, “I don’t want to take diuretics without knowing the type of fluid involved; if it’s lymph fluid, they could make it worse.” You agreed.
I’m exhausted from being my own doctor.
You might be surprised to learn that I know I’m overweight. I’ve been aware of it for 36 years! I was conscious of my size when my pediatrician advised my mother to put me on a diet before I turned ten. I had it thrown in my face when a school nurse told me I’d be “so beautiful” if I lost weight. I was aware of it when my mother suggested I join her on an Atkins diet at seventeen, which led to gallstones that took a year for my doctor to diagnose, as she dismissed my symptoms.
I’ve felt this awareness in every Weight Watchers meeting, every flight where I struggled to fit into a seat, and even when a gastroenterologist compared my body to “an overstuffed suitcase.” I know! And I want you to hear me: I have accepted that I’m not going to be thin. This is my body. After years of dieting and attempts to lose weight, I’ve ruined my relationship with food and movement. I can’t even tell when I’m hungry or full anymore. I’ve spent countless dollars and shed endless tears, and yet here I am, facing this same conversation again.
It took immense courage to come to you for help. I dreaded this appointment, rehearsing how to steer the conversation back to my legs instead of weight loss. Last time, you compared my healthy stomach to a cancerous organ, which was a shock. Now, I’m just exhausted by the shame. I refuse to believe that every ache or pain is a result of my weight. I deserve compassionate, evidence-based medical care, yet you fail to provide that.
What do you expect from me? Do you want me to be shocked by the idea that I’m fat? Should I rush to the bariatric surgery center just to satisfy you?
It’s frustrating because apart from weight loss surgery, you haven’t offered any other advice. You haven’t even asked about my diet or lifestyle. You seem to think I’m unemployed, which is far from the truth. You drop the weight conversation on me and walk away. What am I supposed to do with that?
I fear that one day, my weight will lead to dire consequences—not because I’m “too fat to live,” but because I might suffer from a serious condition that goes unnoticed due to your focus on my weight. I imagine myself in this position, and you, with your sympathetic face, telling me I brought it on myself.
I also worry that one day I might succumb to the pressure and undergo surgery, hoping that it will make you and others see me differently. I could suffer complications, malnutrition, and worse.
All I want is for you to do your job. It’s irresponsible to let someone of my size walk out without a thorough examination. You’re more focused on billing my insurance for “obesity counseling” than actually treating me.
When I ask for evidence linking my weight to my leg issues, you admit it’s just a feeling. You inch closer, and I can feel the tears coming. Then you hug me. You’ve chastised me, ignored my concerns, and wasted my time—and now, a hug?
The next day, I see your notes: “Tried to discuss patient’s weight, but she is sensitive about it and prefers not to discuss.” Oh, come on.
In summary, navigating health issues while dealing with weight stigma can be an exhausting and frustrating experience. Patients deserve compassionate care that addresses their concerns without being overshadowed by their weight. It’s essential for healthcare providers to focus on the specific health issues at hand and provide the necessary support, rather than making assumptions based on appearance.
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