I think maybe there is a step before offering options. What I hate, a woman with a 30-40 year history of working with my diabetes is medical people coming in telling what I am (morbidly obese type 2 diabetic - I weigh around 235). Ask what I have been doing about my health and my diabetes. I am one of the experts in the room.
Then you offer options because if they are already doing what you're offering maybe you can work together with idea of how to move forward.
This is an important point and I appreciate the rant! I was trying not to be redundant - this point is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
Agreeing with the other commenters: I need my providers to ASK what I've been doing before they even come at me with wanting to make suggestions. I have decades of nutrition experience, and a lifetime of debilitating food intolerances (celiac, soy allergy, corn allergy, dairy allergy, and the list goes on quite a bit from here) so anyone telling me to "eat better" had better be asking when they can come over and act as my personal chef in the same breath.
And on the flip side, don't assume that I'm inactive or I don't want to be active just because I'm fat and sitting in a wheelchair. I use the wheelchair to get to my appointments and do boring errands to conserve energy so I can go home and do FUN activities like gardening, pedaling my e-trike, renovating our home, and having sex with my spouse. I'm not wasting my precious energy on performing able-bodiedness for a healthcare provider.
These scripts are good, but I think they should come AFTER touching base with a patient and asking them how they're managing their health and what they're looking for out of the appointment.
Because honestly, even if a provider is prepared with a lengthy lecture about my problematic body, I still don't have to consent to hearing it. I may have already seen my lab results in the patient portal, and by the time the long wait for a follow up has passed, I've already made some changes I'd like to test for the next 6 months (because I'm an informed patient with research experience AND the desire to read way more research about my conditions than my providers ever would), so I have no interest in hearing the boring old reruns of an assumption-laden lecture about my body.
To Mary: I applaud you for being open to learning about the research that your education failed to provide you, and for asking for input to improve the care you offer patients. I admit that you not being "fully on board" with treating higher weight patients the same as thinner patients makes me cringe and hope that you aren't my provider, because I live with complex PTSD and a permanent unfixable spinal cord injury due to doctors' fat stigma interfering with their ability to provide me with evidence-based healthcare. I do hope that you'll read the comments (not just here, but on other relevant posts Ragen's written) and take our experiences to heart.
Hi Jen, Sorry for the confusion, I was trying not to be redundant - I believe what you are suggesting here is is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
Nope, my bad - I should have been more clear. I've edited the piece to reinforce the need to read that linked piece before launching into these scripts!
I’d rather they ask if I want to have that conversation at all. Frankly, I’ve avoided doctors for decades because I simply am ok with myself and don’t want to go through a big rigmarole telling them I’m not interested and to be quiet and not bring any weight, diet, or exercise talk into the room. I am still looking for a way to cut them off at the pass before I even step foot in a room with them and have to give my personal lecture why I am not interested in any talk into this area. It is alway felt as fat stigma to me and I have worked hard to come to an inner place where I just accept myself and my body. I feel focus on these subjects at all brings up disordered behavior and shame and guilt, as well as internal pressure to be people pleasing. I can’t seem to find a weight neutral provider available to me and basically I’ve been avoiding the whole experience. How do I head them off at the pass and say this whole topic and discussion is not allowed by me?
When I see a doctor, I often bring a piece of paper with the reason for my visit and any relevant medical info. If I have any reason to believe the doctor will try to diagnose my condition by telling me I’m fat or try to treat my condition by telling me I should stop being fat, I also write on the piece of paper, “I’m aware some of my health conditions are associated with higher weight, but I’m not seeking weight-loss advice at this time.” I’ve also sometimes sent a letter to the doctor with this info before my first visit. This does not work all the time, but it cuts down on how often I have to head off a weight-loss / diet / exercise conversation during the visit. If one starts, I immediately say “I’m not here for advice about weight loss, please let me know about other ways to treat this condition,” and repeat it until the provider moves on.
I'm sorry that you are dealing with this with providers - you deserve so much more.
Sorry for the confusion, I was trying not to be redundant - the point about asking before you start the conversation is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
I also have some printable cards with phrases that you can use and/or that you can hand to a provider. They include both phrases and links to research.
Yes I would also echo what the other commenter said and **it's so frakking easy** to do. Before suggesting...just ASK if that's something that I'm doing / already doing / have tried / etc.
The number of times it's been suggested to me to try things **I am already doing regularly** or to cut out things **I never do anyway** is frankly ridiculous.
And so then we can go from a convo that could actually be productive around whether something could be increased in frequency or intensity if I'm already doing it or whether we need to explore something else and for things I'm not doing the WHY actually frakking matters.
Ok I am proud of myself for not typing this in all caps LOL but apparently I also needed to rant. :)
I mentioned this on the other comments but I wanted to give each person a response. The point about asking before you start the scripts is in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
Thanks so much for the response -- I know you've covered this part before & I think I just skipped over clicking through that link (sorry about that!). I should have said "I will echo what other commenters and Ragen has already pointed out..." :) I sincerely appreciate you responding and addressing with real, practical tools for healthcare providers that *want* to do a better job -- and making that easy for them to do. I apparently also just needed to rant and clearly that's what I think the comment section on the internet is for lol.... :D Thanks again for all of your work! <3
I definitely should have been more clear, I appreciate you taking the time to comment and point it out (and I'm always here for a rant!) Thanks a bunch!
Great answers as usual Ragen. I appreciate that Mary wants to learn because so many doctors have literally no clue how much they are harming patients over what they think are minor conversations. In the past year, I’ve had endocrinologist, gastroenterologist, cardiologist, psychiatrist, and neurologist bring up my weight without me indicating it was an issue I wish to discuss. I know people are quick to think “yes but it’s relevant to your health.” In at least three of those appointments it 100% was not. It feels like a doctor saying “wow, you’re fat,” and then expecting to have a productive medical exam after that. I like the question asking. I know doctors don’t have a lot of time, but wasting my time focusing on my weight infuriates me.
I really like the suggestion of asking, "What have your experiences been with these types of conversations with healthcare providers?" I feel like it meshes well with the ideas others have shared about asking what they have tried, or *if* something is a problem for them, or if they have a history of an ED.
Appointments go better if there's real 2-way communication. I should be able to tell a doctor my exact symptoms or how I've responded to past treatments, which can save a lot of time!
I am ob%se, but my weight has been steady for over 20 years at about 50 pounds less than my highest weight. Without going into all of the nuances of how that all came about - just that fact alone would be helpful information to elicit before a clinician assumes anything about my weight, habits, or interests about weight maintenance/change. It always feels like my little secret. I know what folks are likely assuming about me. The beauty of aging is that I care less about the thoughts of others. :)
I think maybe there is a step before offering options. What I hate, a woman with a 30-40 year history of working with my diabetes is medical people coming in telling what I am (morbidly obese type 2 diabetic - I weigh around 235). Ask what I have been doing about my health and my diabetes. I am one of the experts in the room.
Then you offer options because if they are already doing what you're offering maybe you can work together with idea of how to move forward.
Thanks for reading my rant.
This is an important point and I appreciate the rant! I was trying not to be redundant - this point is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
That piece is here: https://weightandhealthcare.substack.com/p/three-mistakes-providers-make-recommending
I edited the piece above to reinforce the importance of this, thanks for your comment!
Agreeing with the other commenters: I need my providers to ASK what I've been doing before they even come at me with wanting to make suggestions. I have decades of nutrition experience, and a lifetime of debilitating food intolerances (celiac, soy allergy, corn allergy, dairy allergy, and the list goes on quite a bit from here) so anyone telling me to "eat better" had better be asking when they can come over and act as my personal chef in the same breath.
And on the flip side, don't assume that I'm inactive or I don't want to be active just because I'm fat and sitting in a wheelchair. I use the wheelchair to get to my appointments and do boring errands to conserve energy so I can go home and do FUN activities like gardening, pedaling my e-trike, renovating our home, and having sex with my spouse. I'm not wasting my precious energy on performing able-bodiedness for a healthcare provider.
These scripts are good, but I think they should come AFTER touching base with a patient and asking them how they're managing their health and what they're looking for out of the appointment.
Because honestly, even if a provider is prepared with a lengthy lecture about my problematic body, I still don't have to consent to hearing it. I may have already seen my lab results in the patient portal, and by the time the long wait for a follow up has passed, I've already made some changes I'd like to test for the next 6 months (because I'm an informed patient with research experience AND the desire to read way more research about my conditions than my providers ever would), so I have no interest in hearing the boring old reruns of an assumption-laden lecture about my body.
To Mary: I applaud you for being open to learning about the research that your education failed to provide you, and for asking for input to improve the care you offer patients. I admit that you not being "fully on board" with treating higher weight patients the same as thinner patients makes me cringe and hope that you aren't my provider, because I live with complex PTSD and a permanent unfixable spinal cord injury due to doctors' fat stigma interfering with their ability to provide me with evidence-based healthcare. I do hope that you'll read the comments (not just here, but on other relevant posts Ragen's written) and take our experiences to heart.
Hi Jen, Sorry for the confusion, I was trying not to be redundant - I believe what you are suggesting here is is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
That piece is here: https://weightandhealthcare.substack.com/p/three-mistakes-providers-make-recommending
Hope that helps!
Thank you! That does make sense. I read it as a tailored response to Mary and the other link was extra credit. My bad!
Nope, my bad - I should have been more clear. I've edited the piece to reinforce the need to read that linked piece before launching into these scripts!
I’d rather they ask if I want to have that conversation at all. Frankly, I’ve avoided doctors for decades because I simply am ok with myself and don’t want to go through a big rigmarole telling them I’m not interested and to be quiet and not bring any weight, diet, or exercise talk into the room. I am still looking for a way to cut them off at the pass before I even step foot in a room with them and have to give my personal lecture why I am not interested in any talk into this area. It is alway felt as fat stigma to me and I have worked hard to come to an inner place where I just accept myself and my body. I feel focus on these subjects at all brings up disordered behavior and shame and guilt, as well as internal pressure to be people pleasing. I can’t seem to find a weight neutral provider available to me and basically I’ve been avoiding the whole experience. How do I head them off at the pass and say this whole topic and discussion is not allowed by me?
When I see a doctor, I often bring a piece of paper with the reason for my visit and any relevant medical info. If I have any reason to believe the doctor will try to diagnose my condition by telling me I’m fat or try to treat my condition by telling me I should stop being fat, I also write on the piece of paper, “I’m aware some of my health conditions are associated with higher weight, but I’m not seeking weight-loss advice at this time.” I’ve also sometimes sent a letter to the doctor with this info before my first visit. This does not work all the time, but it cuts down on how often I have to head off a weight-loss / diet / exercise conversation during the visit. If one starts, I immediately say “I’m not here for advice about weight loss, please let me know about other ways to treat this condition,” and repeat it until the provider moves on.
Hi Amy,
I'm sorry that you are dealing with this with providers - you deserve so much more.
Sorry for the confusion, I was trying not to be redundant - the point about asking before you start the conversation is covered in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
That piece is here: https://weightandhealthcare.substack.com/p/three-mistakes-providers-make-recommending
In terms of heading them off at the pass, this piece might be helpful
https://weightandhealthcare.substack.com/p/reader-question-how-do-i-get-a-fatphobic
I also have some printable cards with phrases that you can use and/or that you can hand to a provider. They include both phrases and links to research.
https://weightandhealthcare.substack.com/p/what-to-say-at-the-doctors-office
Hope this helps a bit.
~Ragen
Yes I would also echo what the other commenter said and **it's so frakking easy** to do. Before suggesting...just ASK if that's something that I'm doing / already doing / have tried / etc.
The number of times it's been suggested to me to try things **I am already doing regularly** or to cut out things **I never do anyway** is frankly ridiculous.
And so then we can go from a convo that could actually be productive around whether something could be increased in frequency or intensity if I'm already doing it or whether we need to explore something else and for things I'm not doing the WHY actually frakking matters.
Ok I am proud of myself for not typing this in all caps LOL but apparently I also needed to rant. :)
Hi Amanda,
I mentioned this on the other comments but I wanted to give each person a response. The point about asking before you start the scripts is in the piece I linked to where I said "Before you consider these scripts, I recommend checking out this piece where I talk about common pitfalls that happen when providers recommend behavior-based interventions to patients."
That piece is here: https://weightandhealthcare.substack.com/p/three-mistakes-providers-make-recommending
Thanks for the comment!
Thanks so much for the response -- I know you've covered this part before & I think I just skipped over clicking through that link (sorry about that!). I should have said "I will echo what other commenters and Ragen has already pointed out..." :) I sincerely appreciate you responding and addressing with real, practical tools for healthcare providers that *want* to do a better job -- and making that easy for them to do. I apparently also just needed to rant and clearly that's what I think the comment section on the internet is for lol.... :D Thanks again for all of your work! <3
I definitely should have been more clear, I appreciate you taking the time to comment and point it out (and I'm always here for a rant!) Thanks a bunch!
Great answers as usual Ragen. I appreciate that Mary wants to learn because so many doctors have literally no clue how much they are harming patients over what they think are minor conversations. In the past year, I’ve had endocrinologist, gastroenterologist, cardiologist, psychiatrist, and neurologist bring up my weight without me indicating it was an issue I wish to discuss. I know people are quick to think “yes but it’s relevant to your health.” In at least three of those appointments it 100% was not. It feels like a doctor saying “wow, you’re fat,” and then expecting to have a productive medical exam after that. I like the question asking. I know doctors don’t have a lot of time, but wasting my time focusing on my weight infuriates me.
"It feels like a doctor saying “wow, you’re fat,” and then expecting to have a productive medical exam after that." YES, this, exactly.
I really like the suggestion of asking, "What have your experiences been with these types of conversations with healthcare providers?" I feel like it meshes well with the ideas others have shared about asking what they have tried, or *if* something is a problem for them, or if they have a history of an ED.
Appointments go better if there's real 2-way communication. I should be able to tell a doctor my exact symptoms or how I've responded to past treatments, which can save a lot of time!
I am ob%se, but my weight has been steady for over 20 years at about 50 pounds less than my highest weight. Without going into all of the nuances of how that all came about - just that fact alone would be helpful information to elicit before a clinician assumes anything about my weight, habits, or interests about weight maintenance/change. It always feels like my little secret. I know what folks are likely assuming about me. The beauty of aging is that I care less about the thoughts of others. :)
Crucial read. Shifting to weight-neutral care is essential for building trust and improving outcomes. Thank you for sharing!