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An Open Letter to My Health Care Provider About Weight

Dear Health Care Provider,

I’ve been thinking a lot about my last appointment and the question of being weighed. It’s something I thought about for a long time after the last time you asked that as well. In fact, thoughts about weight/size/weight loss and my health care come up frequently for me after appointments.

Your weight-centric care isn’t unusual. It’s very much the norm. The belief that it’s necessary to know someone’s weight, the use of the BMI scale, talk about the importance of weight loss, the use of obesity as a diagnosis – these are all common and typical interactions in any kind of health care office.

I happen to disagree with all of that. Therefore, it’s frequently on my mind after appointments.

To be clear, this note is not about justifying my stance on this. I don’t have to – I am an intelligent and educated adult who makes her own health care decisions, with input from my providers. If you haven’t noticed already, I’m not a passive patient. I know how to research, how to read and interpret scientific studies, I ask questions, I question things, and I decide what’s best for me.

This also isn’t to try to convince you to agree with my stance. You do you.

However, as my provider, it may also be helpful for you to know my stance and reasoning behind this as it effects my health care decision making and interactions with you. Plus, I’m a therapist and relationships and communication are life, ya’ll, whether professional like ours or personal. Seriously.

This is my stance – I follow a Health at Every Size and Body Trust/Respect approach to my health care. I don’t believe in diets, restricting food groups, calorie counting, or “earning food” through exercise. I do this for two main reasons.

One, because research has repeatedly shown for decades that these things (i.e. diets) fail 95ish% of the time and almost always lead to weight regain within 2-5 years. Dieting doesn’t work and weight cycling has been shown to be more damaging to physical and emotional health than maintaining weight, even at a higher weight. Also, these kinds of things lead to disordered eating and eating disorders, which are both rampant and severely underdiagnosed in our society, particularly among higher weight individuals.

Two, because engaging in those things in the past has seriously fucked up my relationship with food and my body. I’d rather be fat and happy and engaged in life than constantly trying to be smaller (only to fail), be miserable and obsessed with food fear.

I don’t believe a number on a scale provides useful health information. I don’t believe that number tells you much of anything about me. It cannot tell you how active I am. I cannot tell you how much I eat or what I eat. It can’t tell you what my social support is like, how happy I am, or what my relationships are. That number can’t tell you about the loss or trauma I’ve survived or the life I rebuilt out of that pain, again and again. It won’t show you my resiliency. It can’t tell you my sense of humor or the dreams I hold or the love I feel.

The fact that I am fat isn’t a secret. You can tell by looking at me. No amount of wearing the color black is going to hide it.

Any unexplained or rapid weight loss or gain can be observed and that’s basically all that’s needed to know to look for any connected health problems. The BMI is a bullshit scale that was never meant to be used as an individual health measurement. Why it is still considered a standard tool in healthcare baffles me. The only medical reason where specific weight might be needed is for very specific situations like medication dosing or anesthesia.

More and more research has shown that size and weight is not the deathly risk factor it has been touted to be. More recent research is showing instead that weight cycling and the effects of weight bias/weight stigma are incredibly harmful to physical and mental health, and in fact may be much more damaging to health that maintaining a higher weight itself. Most studies that did show higher weight to be such a threat to health and correlated higher weight to so many specific health issues did not control for weight bias/stigma or for many of the other societal factors (stress, socioeconomic status, access to healthcare, etc). That leaves those studies open to immense questioning.

Research is also showing that focus on health behaviors (activity, increasing fruits and veggies, managing stress, etc.) without focusing on weight or weight loss is actually much more beneficial and sustainable for health outcomes than pursuing intentional weight loss or focusing on weight. We can control health behaviors (to a large degree), but we have much less control over our body size than we’ve been taught to believe. Bodies have always been diverse in size and shape – they aren’t meant to all look that same or fit into a narrow range of numbers.

I have lived for 36 years in a body that has, in many ways, repeatedly failed me. I spent my childhood in physical pain. Without the spinal fusion and rods I got when I was 12, I would be completely disabled and unable to walk. My body failed to keep my babies safe and alive. My body doesn’t create and/or respond to insulin that way that it should. My thyroid stopped working properly in my mid-twenties. These are just a few highlights of my physical experience.

However, my body hasn’t failed me by refusing to be smaller or to fit society’s current definition of “appropriate” size and shape. There isn’t anything wrong with my size or shape.

There is, however, something wrong with the way that our society treats people who live in larger bodies. There is something very, very wrong with the rampant weight bias/stigma and fat phobia present in our medical profession as a whole. That is a significant piece of what is correlated to and/or causative of many of our health problems.

Essentially, when I say no to being weighed, to dieting, to talking about my weight, it isn’t done flippantly. It isn’t because I’m “being resistant” or “wanting to ignore ‘the problem.’”

I started saying no after decades of bias and stigma and shaming and shitty health care. When doctors learned that number, my quality of care too often took a nosedive. I started saying no after learning more and educating myself on actual unbiased research and science around weight. I started saying no after doing a LOT of work on my own internalized shame and bias.

I am not my weight and the number on a scale gives little to no useful information for my health. So, unless you legit need it for medication dosing or if I’m going in for another surgery (but for the love of Pete let’s hope not), I will always say no to being weighed.

I value my health, but in terms of how it helps me engage with life and the world and not at all in terms of this inaccurate idea that health can be determined by size or shape.

I value you as part of my healthcare team. I’m grateful for non-judgmental and open-minded care, for the way it isn’t assumed that every health challenge I have is due to my weight. I appreciate immensely that in general when I receive the same quality care that someone in a smaller body would receive. I appreciate the thought and attention given both in and out of appointments, and the willingness to be up front about what you know and don’t know. I always appreciate your openness to learn and to question your assumptions. I have immense respect for you and the provider that you are.

If you have any interest in learning more about what I’ve talked about here, I have included some of the resources in which I learned some of this research and information. If you aren’t interested, toss them.

You do you. I’m gonna do me.

Respectfully,

The woman learning to live, truly LIVE in her body as it is, regardless of what it looks like or what the fuck other people think about it.

*I’ll also note (because much of the research uses the term), I don’t agree with “obesity” as a medical diagnosis. It pathologizes body size and when the history of that diagnosis is explored, it is essentially a made up diagnosis to provide another way for pharmaceutical companies and medical professionals and insurance companies to make money. It also stems from incredibly fat phobic and biased origins and is very de-humanizing. Body size is not a disease.

Books:
• Health at Every Size and/or Body Respect (Linda Bacon)
• Intuitive Eating (Evelyn Tribole)

*There’s a ton of research in these books that I looked up and ended up going down a rabbit hole of studies and research.

Research Articles/Studies:
• How and why weight stigma drives the obesity ‘epidemic’ and harms health (2018)

• Weight bias and obesity stigma: considerations for the WHO European Region (2017)

• Obesity Stigma: Important Considerations for Public Health (2010)

• Weight Science: Evaluating the Evidence for a Paradigm Shift (2011)

Don’t Salt My Game Podcast Ep. 89: Blowing the Lid Off Weight Science (Laura Thomas, RD and Fiona Willer, RD)

*There are a number of non-diet, HAES dietitian podcasts that talk about all different aspects of the weight research/HAES/intuitive eating/etc.

*Also note, this is just a tiny piece of the info out there on this topic, a starting place to jump off and dig in. With minor effort in looking, you can find many wonderful non-diet, HAES health professionals talking about this, research studies, books, etc.

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