This is the Weight and Healthcare newsletter! If you appreciate the content here, please consider supporting the newsletter by subscribing and/or sharing! Today I’ll start with a few scenarios. Note that they include weight loss talk so feel free to skip the bullets.
Thank you for talking about this. I am so, so, so tired of doctors assuming they know anything about what I actually eat or don’t eat. They never even ASK about my food intake before telling me to stop eating in one way or another.
My iron stores got so low before I figured out I have celiac, they worried I had some kind of rare cancer… I had to go through a (traumatic) bone marrow biopsy. Only to find out that because I was eating so little (because everything made me sick— which doctors didn’t believe, because a fat person could NEVER go without eating!), I had a ton of nutritional deficiencies. But the iron was the lowest and most dangerously low.
I say “I figured out I have celiac” because I did. No help from doctors. Out of desperation, I requested testing twice and was refused because of my size. (People my size can’t have celiac!) It would be years before I could find someone to take my request seriously, and I was RIGHT.
Years of poor nutrition, poor concentration, brittle bones, and menstrual issues… and no one even asked about my nutrition. If I talked to them about my food intake, they didn’t believe me. No matter how much I did or didn’t eat, it was always too much.
I’m so glad you figured it out. I feel like we keep finding we have zero support and a black hole we can fall into every 5 minutes. So, so tired of providers. So, so ready to do something else than have to keep such close track. The fatigue of being dehumanized at this rate by this many people needs to be talked about.
I am so tired. I have to spend so much energy being hyper vigilant just trying to survive the healthcare system that I feel like I don’t have time left for much else. It’s traumatizing at every turn. It’s so exhausting.
I don’t understand “treatments” like Wegovy. It just tells your body not to release hunger cues, so you don’t eat, but your body still needs food, right? I know on busy days at work or when I’m doing something really fun (like going to Disneyland) I WILL get dizzy and possibly even nauseous if I don’t eat. Are these folks not feeling those symptoms or are they just supposed to go on tired and dizzy?
Exactly! I had to get multiple people to advocate for my medical support at hospital yesterday and I’m out now. Why didn’t they listen to me? I’m starting to get fairly willing to challenge every step of care. How is it even care when I am doing all the work ?!
God is that a good question. I spent so much of my young - and adult - life just blindly accepting what I was told by doctors and not questioning or advocating for myself. On the one hand, I'm super proud that I don't give a crap anymore and I push back ALL THE TIME to make sure I get what I need. But it is EXHAUSTING. It just shouldn't have to be this hard or this much work.
Come to think of it, my doctor has NEVER asked how much or what I ate, nor did she refer me to a dietician or any type of nutritional assistance. Just that my lack of “enough” physical activity surely wasn’t “cutting it”. *shudder*
And when they do ask, they come to weird conclusions. Mine latched onto putting honey in my tea as the culprit for my weight. Because thin people never put honey or sugar in their tea, apparently.
I tried working with a nutritionist in my doctor's office once (because she was also a GP - or maybe a PA, I can't remember - my visits with her could be covered by my insurance so it was affordable) and I tracked tracked tracked so diligently and followed every single thing she wanted me to do....and lost virtually no weight over three months. She kept saying "it's important to truly log every single thing you put in your mouth" every week when we met and I'm like, lady, are you looking at my printouts from MFP? I clocked the *literal* SINGLE BITE I took of cake at my mom's birthday party! I tracked the Halls lozenge I had yesterday! I AM TRACKING EVERY. SINGLE. THING. In her mind, if I wasn't losing any weight it was clearly because I was lying or not following directions, not because what she was recommending was just not working for my body. It was so demoralizing.
And to your point, despite being a nutritionist, we never talked about actual nutrition. Not macros, not nutrients, nothing. It was entirely focused on my ability to lose (or not, as it happened) weight. Which, in light of this discussion, I am now retroactively pissed about!
My mom loved the Atkins diet and said she always felt so good on it, and I wonder how much was just that she was finally eating a decent amount of calories. She had the typical chronic dieter complaints: muscle and joint pain, constantly cold, low energy, etc. (Not a rec for Atkins, btw--it worked as well as any other diet, which is to say not very much for not very long)
Those also sound like symptoms of celiac, Hashimoto’s, and other autoimmune issues which could have been improved by lack of gluten (and/or all grains, depending on an individual’s reactions)… all of which can be exacerbated by chronic dieting and malnourishment.
There was an interesting article I read years ago and can’t find it now where some researchers correlated undiagnosed celiac disease with health improvements while on atkins and low carb diets… as in, people swearing the temporary weight loss made them feel good, but it was actually inadvertently treating a gluten intolerance.
I was put on Ozempic for diabetes and weight loss. It worked in both cases but also gave me ketoacidosis and kidney failure, which has led to chronic kidney disease long term. This was because I was throwing up everything I ate or drank, even water. In other words, I was starving and almost died from it. When I told the doctor how sick I was he just said that was how the drug was supposed to work and not to worry. He never asked about my nutritional intake at all. I ended up going to the emergency department and had a week-long stay in the hospital on a drip in order to flush the stuff out of my system. The thing that really got me was that at my next appointment with the doctor who prescribed it, he asked me what I thought had caused me to be so sick. As if I was making the whole thing up!!!
That's heartbreaking. I'm so sorry that happened to you. What your doctor did and how they treated you is unconscionable. Bordering on if not outright malpractice. It's one more example of the "thin by any means necessary" approach to healthcare referenced in the newsletter.
Every health problem a fat person has is blamed on their size and the inquiry stops there. Anything that has the potential to make a fat person thinner, whatever the side effects (up to and including dying, see: phen-fen among others) whatever the complications (managing CKD and diabetes in your case), is always the appropriate course of treatment. No metric of success is as important as weight loss. Nothing else matters. Nothing else counts.
Thank you for mentioning that forgetting to eat or never wanting to eat is not normal or good. As a fat person who feels that way 90% of the time (it’s a medical condition that I’m doing my best to handle), it absolutely sucks. I’ve been dealing with this for over 3 years and I just can’t express how much of a chore eating is BUT this is still better than being at war with my body like I was for decades because our entire society had convinced me that dieting was the ‘right’ thing to do. For me, those weight loss interventions were physical and psychological torture.
I found it interesting that the people most likely to say yes to the question of mentioning weight during a doctor's visit are the ones most likely to make money out of the “obesity epidemic” eg researchers. They are also the ones with the least evidence-based information
That was fascinating. I also found it interesting that one nutritionist said no and a nutrition "scientist" said yes. I think that part of what is missing in that specific conversation is what did the person go to the doctor for? Is it an annual check up? Maybe MAYBE you can broach the topic then. If they came in to talk about their weight, sure. But if I come in because my ear hurts or I have a sinus infection or my hip is bothering me, FOCUS ON THAT. Pretend I'm a thin person and do whatever you'd do for them.
BTW, for anyone interested in the article, that link didn't work for me - I had to google it and there was a little more to the extension on my end. I'm in the US and have no idea if that was part of the issue on my end, but just in case anyone else has the same issue I did:
Thank you for talking about this. I am so, so, so tired of doctors assuming they know anything about what I actually eat or don’t eat. They never even ASK about my food intake before telling me to stop eating in one way or another.
My iron stores got so low before I figured out I have celiac, they worried I had some kind of rare cancer… I had to go through a (traumatic) bone marrow biopsy. Only to find out that because I was eating so little (because everything made me sick— which doctors didn’t believe, because a fat person could NEVER go without eating!), I had a ton of nutritional deficiencies. But the iron was the lowest and most dangerously low.
I say “I figured out I have celiac” because I did. No help from doctors. Out of desperation, I requested testing twice and was refused because of my size. (People my size can’t have celiac!) It would be years before I could find someone to take my request seriously, and I was RIGHT.
Years of poor nutrition, poor concentration, brittle bones, and menstrual issues… and no one even asked about my nutrition. If I talked to them about my food intake, they didn’t believe me. No matter how much I did or didn’t eat, it was always too much.
I’m so glad you figured it out. I feel like we keep finding we have zero support and a black hole we can fall into every 5 minutes. So, so tired of providers. So, so ready to do something else than have to keep such close track. The fatigue of being dehumanized at this rate by this many people needs to be talked about.
YES!! I agree 100%!!
I am so tired. I have to spend so much energy being hyper vigilant just trying to survive the healthcare system that I feel like I don’t have time left for much else. It’s traumatizing at every turn. It’s so exhausting.
I don’t understand “treatments” like Wegovy. It just tells your body not to release hunger cues, so you don’t eat, but your body still needs food, right? I know on busy days at work or when I’m doing something really fun (like going to Disneyland) I WILL get dizzy and possibly even nauseous if I don’t eat. Are these folks not feeling those symptoms or are they just supposed to go on tired and dizzy?
Exactly! I had to get multiple people to advocate for my medical support at hospital yesterday and I’m out now. Why didn’t they listen to me? I’m starting to get fairly willing to challenge every step of care. How is it even care when I am doing all the work ?!
God is that a good question. I spent so much of my young - and adult - life just blindly accepting what I was told by doctors and not questioning or advocating for myself. On the one hand, I'm super proud that I don't give a crap anymore and I push back ALL THE TIME to make sure I get what I need. But it is EXHAUSTING. It just shouldn't have to be this hard or this much work.
Come to think of it, my doctor has NEVER asked how much or what I ate, nor did she refer me to a dietician or any type of nutritional assistance. Just that my lack of “enough” physical activity surely wasn’t “cutting it”. *shudder*
Thanks for sharing and I found that powerful to learn it’s way beyond me, personally.
And when they do ask, they come to weird conclusions. Mine latched onto putting honey in my tea as the culprit for my weight. Because thin people never put honey or sugar in their tea, apparently.
I tried working with a nutritionist in my doctor's office once (because she was also a GP - or maybe a PA, I can't remember - my visits with her could be covered by my insurance so it was affordable) and I tracked tracked tracked so diligently and followed every single thing she wanted me to do....and lost virtually no weight over three months. She kept saying "it's important to truly log every single thing you put in your mouth" every week when we met and I'm like, lady, are you looking at my printouts from MFP? I clocked the *literal* SINGLE BITE I took of cake at my mom's birthday party! I tracked the Halls lozenge I had yesterday! I AM TRACKING EVERY. SINGLE. THING. In her mind, if I wasn't losing any weight it was clearly because I was lying or not following directions, not because what she was recommending was just not working for my body. It was so demoralizing.
And to your point, despite being a nutritionist, we never talked about actual nutrition. Not macros, not nutrients, nothing. It was entirely focused on my ability to lose (or not, as it happened) weight. Which, in light of this discussion, I am now retroactively pissed about!
My mom loved the Atkins diet and said she always felt so good on it, and I wonder how much was just that she was finally eating a decent amount of calories. She had the typical chronic dieter complaints: muscle and joint pain, constantly cold, low energy, etc. (Not a rec for Atkins, btw--it worked as well as any other diet, which is to say not very much for not very long)
Those also sound like symptoms of celiac, Hashimoto’s, and other autoimmune issues which could have been improved by lack of gluten (and/or all grains, depending on an individual’s reactions)… all of which can be exacerbated by chronic dieting and malnourishment.
There was an interesting article I read years ago and can’t find it now where some researchers correlated undiagnosed celiac disease with health improvements while on atkins and low carb diets… as in, people swearing the temporary weight loss made them feel good, but it was actually inadvertently treating a gluten intolerance.
Wish I could find that article again.
I was put on Ozempic for diabetes and weight loss. It worked in both cases but also gave me ketoacidosis and kidney failure, which has led to chronic kidney disease long term. This was because I was throwing up everything I ate or drank, even water. In other words, I was starving and almost died from it. When I told the doctor how sick I was he just said that was how the drug was supposed to work and not to worry. He never asked about my nutritional intake at all. I ended up going to the emergency department and had a week-long stay in the hospital on a drip in order to flush the stuff out of my system. The thing that really got me was that at my next appointment with the doctor who prescribed it, he asked me what I thought had caused me to be so sick. As if I was making the whole thing up!!!
That's heartbreaking. I'm so sorry that happened to you. What your doctor did and how they treated you is unconscionable. Bordering on if not outright malpractice. It's one more example of the "thin by any means necessary" approach to healthcare referenced in the newsletter.
Every health problem a fat person has is blamed on their size and the inquiry stops there. Anything that has the potential to make a fat person thinner, whatever the side effects (up to and including dying, see: phen-fen among others) whatever the complications (managing CKD and diabetes in your case), is always the appropriate course of treatment. No metric of success is as important as weight loss. Nothing else matters. Nothing else counts.
Your doctor sucks and I am SO SO SORRY that happened to you.
Thank you for mentioning that forgetting to eat or never wanting to eat is not normal or good. As a fat person who feels that way 90% of the time (it’s a medical condition that I’m doing my best to handle), it absolutely sucks. I’ve been dealing with this for over 3 years and I just can’t express how much of a chore eating is BUT this is still better than being at war with my body like I was for decades because our entire society had convinced me that dieting was the ‘right’ thing to do. For me, those weight loss interventions were physical and psychological torture.
I just saw this article: https://www.abc.net.au/news/2023-07-14/should-gps-bring-up-a-patients-weight-in-consultations/
I found it interesting that the people most likely to say yes to the question of mentioning weight during a doctor's visit are the ones most likely to make money out of the “obesity epidemic” eg researchers. They are also the ones with the least evidence-based information
This is super interesting (and concerning!) You are spot on about the people who said "yes" giving the least evidenced-based reasoning. Ugh.
That was fascinating. I also found it interesting that one nutritionist said no and a nutrition "scientist" said yes. I think that part of what is missing in that specific conversation is what did the person go to the doctor for? Is it an annual check up? Maybe MAYBE you can broach the topic then. If they came in to talk about their weight, sure. But if I come in because my ear hurts or I have a sinus infection or my hip is bothering me, FOCUS ON THAT. Pretend I'm a thin person and do whatever you'd do for them.
BTW, for anyone interested in the article, that link didn't work for me - I had to google it and there was a little more to the extension on my end. I'm in the US and have no idea if that was part of the issue on my end, but just in case anyone else has the same issue I did:
https://www.abc.net.au/news/2023-07-14/should-gps-bring-up-a-patients-weight-in-consultations/102598856