5 Questions With Dr. Asher Larmie (aka FatDoctorUK)

Meet the Experts

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One of the things I’m really excited about with this newsletter is getting to know practitioners, researchers, and other experts in weight neutral healthcare! I’m honored to say that Dr. Asher Larmie (they/them) who you may know on social media as @FatDoctorUK is our first expert!

1.     Tell us a bit about yourself and your work

The work part is easy.  I’ve wanted to be a doctor since I was little.  At least that was my mum used to tell me, and if my hopes and aspirations just happened to match up with her own?  Well, that was just a happy coincidence.  Aside from 1 year where I was convinced that I wanted to be a Marine Biologist, most of my life has been about getting in to medical school.  And then about graduating medical school.  And then about advancing my career. I graduated in 2003 and became a primary care physician (GP) in 2009.  On the one hand, I love my job.  But on the other hand, I am not a fan of the medical profession, so it’s complicated.

As for me, I am many things.  To begin with I am fat.  So much of my life experience has been shaped by that.  I’ve also recently come to accept that I am non-binary.  Whilst this is a recent revelation, I’ve never identified as female and it’s only once I learned to accept my body that I could also accept that I didn’t need to force myself to be something I wasn’t anymore.  I’m pansexual and have been together with my partner for over 20 years. We have three kids, two of whom are teenagers.  And I love teenagers.  Honestly, my favourite part of the journey so far.

I am Jewish and SW Asian (Armenian). I used to say I was multiracial (which I am) until I realised that I am 100% each of those races.  I cannot split myself into lots of different parts, so I guess you could call me a hybrid?! I grew up in a home where food was always served with a side helping of guilt.  My family are all feeders, but they also prone to comment on your weight at the very same time as they ladled a double portion on to your plate! Like I said, it’s complicated.

2.     How did learn about the concept of weight-neutral, body affirming care?

From you and others like you!!! I turned 40 at the beginning of the pandemic.  At the time, we were being warned that fat people shouldn’t be seeing COVID positive patients, and as part of my risk assessment, I was asked to weight myself.  I did, and for the first time my BMI had tipped into the 40s.  According to that completely redundant and useless measure of health, I was 40kg “overweight”.  I had no idea about weight-neutral care at this stage so I panicked and did what most people do in my situation.  I went on a diet.

I was convinced that the three 40s were a sign.  I decided that I was going to keep a permanent record of my amazing weight loss journey by blogging about it.  I had grandiose dreams of becoming a world-famous weight loss doctor.  My first blog post was entitled “Weight Loss the Hard Way”.  Gross. I feel a bit nauseous thinking about it now.

About 4 months into my strict calorie restriction (I logged everything in a notebook) I became quite depressed.  This was partly to do with circumstances beyond my control, but I know that the diet had a massive impact on my mental health. It was in that moment, when I was ready to pack it all in and shut down my website, that a really good friend suggested I should write a post where I laid it all on out there and be real with people.  So that’s what I did.   

It was in that moment that people in the fat liberation community reached out to me and supported me.  They told me about people like Ragen Chastain, Virgie Tovar, Aubrey Gordon and Jessamyn Stanley. I learned about the Health At Every Size movement and went on a 10 week Intuitive Eating Course. I read “The Body is Not an Apology” by Sonya Renee Taylor, “Radical Belonging” by Lindo Bacon, and “Fearing the Black Body” by Sabrina Strings.

And as I learned and unlearned in equal measure, I realised that doctors were at the root of so much of fat oppression.  We are stigmatising, dehumanising and abusing patients on a regular basis.  We are denying people their basic human rights by putting weight limits on healthcare.  We are responsible for the poor health and sometimes even deaths of millions of fat people throughout the country.  And yet we are celebrated for this instead of being held accountable. And that is unacceptable.  I knew I had no choice but to seek out a better way, and it became clear right from the start that this was weight-neutral body-affirming care.

3.     How have you/do you apply those concepts to your work?

The answer is pretty simple.  I take fat out of the equation.  The issue of weight is not allowed to enter through my office door.  If the patient brings it up, I try to gently remind them that most of the things people believe about weight are not true, so we need to put that to one side for now. I take a thorough medical history, conduct a full examination, and request the exact same investigations in all my patients, irrespective of their size. 

I treat patients according to their symptoms, not their weight.  Where appropriate, I give lifestyle advice but I never mention weight loss because I know that this corrupts any advice that I give.  If a patient asks me about weight loss, I help them to make an informed decision by explaining the risks versus benefits, as well as all the different options for treatment including the option of no treatment.

One of the biggest issues we face in medicine, is time.  Especially here in the UK where healthcare is free, which means every single second counts.  I do not have the time to really get to know my patients and spend time listening to and advocating for them. Which is why I have decided to set up a practice as a weight inclusive health coach (I made that term up). 

I want to be able to support people outside the confines of the weight-normative, fat oppressive medical system, and it is not possible to do that as a doctor here in the UK.  I am hoping that I will be able to listen to, support, and advocate for fat patients who feel they have been failed by the medical profession.

4.     What’s one thing that you wish people who are still working from a weight-focused paradigm could learn/know?

That much of modern medicine is built upon the opinions and theories of doctors from the 19th and 20th century.  These foundations were steeped in racial bias, Christian hegemony and capitalist greed. Many of the early papers published about ob*sity were written by Puritans who believed fatness was a sign of moral decay, and eugenicists who associated fatness with the “inferior races”.  Our hatred and intolerance of fatness (our explicit and implicit anti-fat bias) has shaped not only the way we treat our patients, but the very evidence that we are supposed to put our trust in. 

When it comes to weight, none of us are critical thinkers.  We all blindly believe that fat is bad, so much so that multiple papers are published every month that state something to the effect of “fat is bad” without even bothering to reference their statement.  The audacity! This goes beyond confirmation bias.  And to add to this, there are number multi-billion-dollar industries that are fully committed to maintaining the status quo.  And those industries just so happen to sponsor all the research that goes into weight-normative medicine.

Anti-fat bias is extremely dangerous.  Not only do we provide suboptimal care for our patients in larger bodies, but we also prescribe weight loss routinely even though that has been demonstrated to be ineffective and causes more harm than good.  On top of this, fat patients have lost their trust and their ability to communicate with us.  So much so that they are prone to avoiding healthcare professionals because of fear of being mistreated again.

Anyone working from a weight-focussed paradigm is failing to work in their patient’s best interest, is causing a great amount of harm, and is failing to respect their autonomy.  Furthermore, we have a duty to provide fair and equal healthcare to all.  And there is no question that we are failing in that duty.

5.     How and where do we find you and your work?

Your best bet is to find me on my website www.fatdoctor.co.uk.  There you can read through my FAQ section as well as my blog posts.  There is also a link to my podcast, all my social media channels, and various ways that you can interact with me going forward.  I am also available to train healthcare professionals who are interested in learning about weight-inclusive care in more detail.

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More research and resources:
https://haeshealthsheets.com/resources/