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Today I was using cooking spray (for non-diet ease of use purposes!) and I had a flashback to a doctor’s appointment before I learned the truth about the failure rate of weight loss.
The doctor had put me on a diet and I had been following it very diligently. In a repeat of what had happened with previous weight loss attempts (what I later learned was exactly what the research said would happen,) I had lost weight initially, but then plateaued and was starting to gain it back. So I was in the doctor’s office and this is the conversation that we had (CN for diet behaviors.)
Him: Your weight has gone up, have you gone off the diet?
Me: No, I’ve been following it to the letter.Him: If that’s true, then we have to figure out what you are doing wrong.
Me: (not yet knowing better) Ok.
Him: Are you eyeballing your portions instead of measuring?
Me: No.
Him: Are you snacking between meals and not including them in your calories?
Me: No.
Him: Are you sure? Not even just a few bites?
Me: No.
Him: Are you doing less exercise than you think you are?
Me: No.
Him: Are you sure? It’s easy to over-estimate?
Me: No, I use a timer.
Him:
Me:
Him:
Him (lightbulb moment): Do you use Pam?
Me: Yes, the diet says to use it instead of butter or oil.
Him: How long do you spray?
Me: Um…What?
Him: The fat-free serving size is only for a one-second spray, are you spraying longer than 1 second?
Me: I don’t know, maybe?
Him (relieved and authoritative): Ok, well try making sure that you’re only spraying the Pam for one second and we’ll see if that helps.
While it was clear to me that this was ridiculous (I had gained a couple pounds since the last visit, exactly how much Pam did he think I was using?) sadly it wasn’t my last diet attempt on the advice of a doctor. And while this was, to me, the most ridiculous conversation I ever had with a doctor about weight loss, it is, sadly, still one among many. I’m sure that these doctors were well-intentioned, but that doesn’t erase the harm that they did and, in some of my appointments, are still trying to do.
Beyond the bad advice is the issue with the way he questioned me - this kind of mistrust of what patients say is common - too often practitioners simply assume that patients are lying because of their misbelief that if the patient was following the diet/telling the truth then they would be losing weight.
It wasn’t until I did my own literature review (this was before I was even aware of fat activist and weight-neutral health communities that had been working since before I was even born) that I realized that the weight cycling experiences I kept having were exactly what all of the research said would happen.
I also learned that I wasn’t alone in getting bad advice, there’s actually research on this. Again, I’m aware that in many cases the doctors making these recommendations had the best of intentions and honestly believed that they would work (in many cases because they were just parroting back what they had been taught.) In other conversations they assumed that I was lying. In truth, doctors have a responsibility to practice ethical, evidence-based medicine and it is a problem that they are doling out diet advice - which does not remotely qualify. The deeper problem here is a system that teaches doctors to give us this advice - it compromises the health of higher-weight patients and the trustworthiness of healthcare practitioners.
If you are a healthcare practitioner who prescribes intentional weight loss, please consider this an opportunity to think about the training you received about intentional weight loss and whether or not that training actually serves higher-weight patients. It can also be a good time to identify biases you have - if your fat patients are regaining weight the assumption that they are simply doing the diet “wrong” or lying about it is not only rooted in weight stigma, but it erases the fact that the experience they are having is exactly what the research predicts will happen. There’s some research here if you want to dig in, or feel free to reach out to me directly if I can help in any way!
If you are a patient who has experienced this, please feel free to share your own experiences with this kind of advice in the comments.
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More research and resources:
https://haeshealthsheets.com/resources/
*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.
Omg memory unlocked! I remember being shamed for Pam before! That’s about when it started to crack for me… that doctors weren’t as smart and all knowing as they wanted us to believe. If half a second of extra Pam is what’s making me fat, then maybe, just maybe, I’m always gonna be fat. (This was after I would have little contests in my head to see how long I could go without eating, and didn’t understand why I didn’t get thinner. If that half a second of extra Pam for roasting zucchini is too much then, well… maybe my body isn’t the problem here.)
The absolute distrust (and sometimes gaslighting) doctors inflict on us is definitely my biggest source of medical trauma and a ptsd trigger. I was a sick kid and I went through a lot of medical trauma, but it was the distrust that really traumatized me. How am I supposed to trust them with my life if they can’t trust me when I tell them what I ate for breakfast?
Before I figured out I had celiac disease, one my my most debilitating symptoms was upper right side abdominal pain and an inability to eat fatty foods without making it worse and causing GI symptoms. Classic gall bladder. (Fried foods or anything with added oil would make me so miserable— hence the Pam.) I’d been restricting my fat intake to manage my gut pain for years before it got bad enough to finally ask for help. My doctor was understandably convinced it was my gall bladder (spoiler: luckily all tests were normal and no one pushed me to amputate a functioning organ— and now that I’m not eating gluten, I can eat oil in food again!) and he would of course shame me for being fat. Then a few months into all this, the doctor himself needed emergency gall bladder surgery, and he was telling me how great he felt, and how he was eating pizza the same day he had it out, so we should try to get mine out too. But then quickly switched gears and told me I needed to keep trying to lose weight, and that if I added dill pickles to every meal, the “acidity” would kick start my weight loss.
DILL PICKLES. I love pickles, so I was already eating them all the time.
And THAT is when I realized doctors don’t have a clue how to make people thin, and they will say ANYTHING to avoid treating fat people and get us out of their exam rooms as soon as possible.
I had lost a significant amount of weight (but still fat) and was seeking fertility treatment. The doctor said losing weight would help and that when I’m hungry I should drink water. This same doctor also found that I had a cancerous tumor in my uterus. The first oncologist I saw gave me a bariatric surgery pamphlet and said this was what I needed for treatment. Weight is linked to cancer, of course. Particularly estrogen related cancer. I went to a different doctor who assured me it wasn’t my weight and he treated me with medication and an IUD. 15 years later and still at a higher BMI, I’m cancer free. It’s the IUD, dummy. He suggested a dangerous and invasive surgery rather than a simple medical device that was standard for lower weight patients.