The fact that it took an incredible amount of effort and a whole lot of luck to get the same treatment, grudgingly, that a straight-sized person would receive without question, is absolutely infuriating!
I love the suggestion about getting one of the anesthesiologists who does weight loss surgery to do her knee surgery; that’s a very clever way to say ‘if they can do it, why can’t you?’
It's great that you were able to help the patient navigate this, provide her with the argumentative ammunition that she needed and that she managed to convince the surgeon to provide the needed surgery .
And on the other hand, it makes me spitting mad that higher weight people have to go through this, have to argue relentlessly but positively just to get the care we need. Gaaaa
Congratulations to the patient and you for getting her the surgery she needs! Thank you for taking on this work and for everything else you do to improve medical care for fat folks.
I wish my sense of relief over the successful outcome weren’t so overshadowed by rage that the surgeon apparently had never even thought about taking a risk-benefit approach in these cases, recommended a treatment that would almost certainly fail, and a treatment that involved surgery, even as she argued that anesthesia posed too much of a risk to the patient to justify surgery.
But that “Huh” over the idea of consulting an anesthesiologist experienced with high weight patients especially makes me grind my teeth…even though it means she learned something. What do they do when they train doctors that makes these things so hard?!
This is a wonderful example of the work you do and the wonders of patient advocacy. I know for me, when a I had the experience of a doctor telling me I could not have a medical procedure until I lost a percentage of my body weight was devastating. I did not want to ever speak to that doctor again. I am impressed that you and your patient put those feelings aside to advocate for the greater good. May that doctor think twice before pushing GLP-1s and weight loss surgery. Perhaps they will share their experience with other physicians. We can only hope.
This patient advocacy work is so valuable and important, especially as a way of fat people supporting one another to access the care we need. It definitely helps me feel like there are things we can do to survive in this present system even with so much stacked against us, and that is so important in order to have hope.
My step dad got put on an incredibly restrictive diet (pre GLP1s) in order for him to have a HUGE hernia removed. The surgeon said he wouldn’t have enough skin to pull over the incision otherwise. Which I thought was total bullshit. I mean, how do you operate on skinny people then????
He lost a ton of weight, which just made his hernia look worse (and it felt worse too).
But before he had the surgery, he found out he had multiple cancers. Which is likely why he lost so much weight.
His surgeon actually apologized for putting him on the diet.
He’s gone now. But I wish like hell they had just removed the damned hernia and let him have that time without the pain and discomfort.
Excellent use of the evidence to get care for someone, which is so encouraging to see. I am sad that it took that much effort but glad the the surgeon was willing to challenge her own thinking (which is very rare)
Congratulations to you and your client for prevailing! I’m sure that the doctor had, in fact, never considered talking to an anesthesiologist who performed WLS. Why would they? There’s a script, and it goes: A fat person has health issue and needs surgery. Fat person is blamed for health issue and told to lose weight. If they object, reiterate that it’s THEIR FAULT. When they fail to lose the “necessary” weight, blame the fat person again. If they never have the surgery, it’s a win, because “risky” surgery never attempted makes less-risky surgery outcomes look even better. Also, you get to blame the fat person for “lack of willpower.” If they do have the surgery and it fails, blame the fat person again. If they do have the surgery and it succeeds, congratulate the surgeon for their extraordinary skills in dealing with such a “difficult case.”
The fat person is NEVER the center of their own story, except to take the blame. And WLS (and GLP-1’s as weightloss) exist to make fat people conform to the standards. Any temporary or even permanent consequences afterwards — including death — are the “just desserts” of being fat in the first place. (And those are the only desserts a fat person is allowed to eat for the rest of their lives.)
All of this is reminding me strongly of articles I’ve been reading elsewhere* about “social legibility”, and who gets to be believed as truthful in families, schools, the workplace, and larger systems. It serves to underscore that marginalizing or “othering” a person may differ in the topic, but remains remarkably similar in the means. Whether the person is “other” because their skin is a different color, or they are neurodivergent and think differently, or they have a different body size/mass/shape, this person is not deserving of the same rights and privileges, and their word — even about their own body and experiences — is deemed suspect, and unbelievable at face value.
Our whole damn culture is based on middle school playground rules, and the bullies are still on top. It’s so exhausting.
*Eva Redford here on Substack is one of several I’ve been reading on this topic.
The supplementary tables are what turn this from an argument into a tool: putting each responder-failure rate next to the trial it came from is what a denial conversation actually needs.
And the 55th-revision endpoint change only surfaces if you read a trial's history, not its abstract. What those two findings share is worth naming, though. The threshold framing and the mid-trial endpoint swap are the same degrees-of-freedom problem at different stages, one in how an endpoint is defined, the other in how it's presented. Put the SELECT attrition beside them, 89.5% gone by four years, and whatever endpoint survives is conditioned on the tenth of patients who stayed. So efficacy and trial conduct aren't two critiques here, they're one, and the responder distribution beats the headline average as the number to hand a patient.
The fact that it took an incredible amount of effort and a whole lot of luck to get the same treatment, grudgingly, that a straight-sized person would receive without question, is absolutely infuriating!
I love the suggestion about getting one of the anesthesiologists who does weight loss surgery to do her knee surgery; that’s a very clever way to say ‘if they can do it, why can’t you?’
It's great that you were able to help the patient navigate this, provide her with the argumentative ammunition that she needed and that she managed to convince the surgeon to provide the needed surgery .
And on the other hand, it makes me spitting mad that higher weight people have to go through this, have to argue relentlessly but positively just to get the care we need. Gaaaa
Congratulations to the patient and you for getting her the surgery she needs! Thank you for taking on this work and for everything else you do to improve medical care for fat folks.
I wish my sense of relief over the successful outcome weren’t so overshadowed by rage that the surgeon apparently had never even thought about taking a risk-benefit approach in these cases, recommended a treatment that would almost certainly fail, and a treatment that involved surgery, even as she argued that anesthesia posed too much of a risk to the patient to justify surgery.
But that “Huh” over the idea of consulting an anesthesiologist experienced with high weight patients especially makes me grind my teeth…even though it means she learned something. What do they do when they train doctors that makes these things so hard?!
This is a wonderful example of the work you do and the wonders of patient advocacy. I know for me, when a I had the experience of a doctor telling me I could not have a medical procedure until I lost a percentage of my body weight was devastating. I did not want to ever speak to that doctor again. I am impressed that you and your patient put those feelings aside to advocate for the greater good. May that doctor think twice before pushing GLP-1s and weight loss surgery. Perhaps they will share their experience with other physicians. We can only hope.
This patient advocacy work is so valuable and important, especially as a way of fat people supporting one another to access the care we need. It definitely helps me feel like there are things we can do to survive in this present system even with so much stacked against us, and that is so important in order to have hope.
My step dad got put on an incredibly restrictive diet (pre GLP1s) in order for him to have a HUGE hernia removed. The surgeon said he wouldn’t have enough skin to pull over the incision otherwise. Which I thought was total bullshit. I mean, how do you operate on skinny people then????
He lost a ton of weight, which just made his hernia look worse (and it felt worse too).
But before he had the surgery, he found out he had multiple cancers. Which is likely why he lost so much weight.
His surgeon actually apologized for putting him on the diet.
He’s gone now. But I wish like hell they had just removed the damned hernia and let him have that time without the pain and discomfort.
Excellent use of the evidence to get care for someone, which is so encouraging to see. I am sad that it took that much effort but glad the the surgeon was willing to challenge her own thinking (which is very rare)
Echoing the comments stating the obvious fact that we shouldn't have to deal with this.
But mostly what I felt reading this is just how LOGICAL weight-neutral care is.
"Can you help me understand how this makes sense from a risk/benefit perspective?”- “It doesn’t.”
RIGHT! You and this patient are heroes for just calmly, clearly, and rationally presenting the truth.
If only all bias could be defeated in this way. Thank you for everything you do.
This post was amazing, just so amazing. And frustrating. And empowering. ❤️
Love and kudos to all of you. Slowly but surely.....
Thanks so much for sharing this story--both to you and to the anonymous patient. It gives me hope, one person at a time.
Congratulations to you and your client for prevailing! I’m sure that the doctor had, in fact, never considered talking to an anesthesiologist who performed WLS. Why would they? There’s a script, and it goes: A fat person has health issue and needs surgery. Fat person is blamed for health issue and told to lose weight. If they object, reiterate that it’s THEIR FAULT. When they fail to lose the “necessary” weight, blame the fat person again. If they never have the surgery, it’s a win, because “risky” surgery never attempted makes less-risky surgery outcomes look even better. Also, you get to blame the fat person for “lack of willpower.” If they do have the surgery and it fails, blame the fat person again. If they do have the surgery and it succeeds, congratulate the surgeon for their extraordinary skills in dealing with such a “difficult case.”
The fat person is NEVER the center of their own story, except to take the blame. And WLS (and GLP-1’s as weightloss) exist to make fat people conform to the standards. Any temporary or even permanent consequences afterwards — including death — are the “just desserts” of being fat in the first place. (And those are the only desserts a fat person is allowed to eat for the rest of their lives.)
All of this is reminding me strongly of articles I’ve been reading elsewhere* about “social legibility”, and who gets to be believed as truthful in families, schools, the workplace, and larger systems. It serves to underscore that marginalizing or “othering” a person may differ in the topic, but remains remarkably similar in the means. Whether the person is “other” because their skin is a different color, or they are neurodivergent and think differently, or they have a different body size/mass/shape, this person is not deserving of the same rights and privileges, and their word — even about their own body and experiences — is deemed suspect, and unbelievable at face value.
Our whole damn culture is based on middle school playground rules, and the bullies are still on top. It’s so exhausting.
*Eva Redford here on Substack is one of several I’ve been reading on this topic.
Congratulations on your article and victorious advocacy! Best wishes to your client, who also did an amazing job speaking truth to power!
The supplementary tables are what turn this from an argument into a tool: putting each responder-failure rate next to the trial it came from is what a denial conversation actually needs.
And the 55th-revision endpoint change only surfaces if you read a trial's history, not its abstract. What those two findings share is worth naming, though. The threshold framing and the mid-trial endpoint swap are the same degrees-of-freedom problem at different stages, one in how an endpoint is defined, the other in how it's presented. Put the SELECT attrition beside them, 89.5% gone by four years, and whatever endpoint survives is conditioned on the tenth of patients who stayed. So efficacy and trial conduct aren't two critiques here, they're one, and the responder distribution beats the headline average as the number to hand a patient.