I'd never felt more embarrassed.
I'd decided to visit the doctor after weeks of complaining about abnormal symptoms, like swollen ankles, unrelenting aches in my lower back, consistent hot flashes, and rapid weight gain after significant weight loss.
I hadn't visited this particular doctor before. I chose her because she's a Black female physician with the same last name. Those determining factors seem superficial, but any sense of familial connection eases the discomfort of visiting a new doctor. Choosing her seemed right.
She listened patiently as I rattled off my ever-growing list of medical concerns. Then, she weighed me, asked me for my family's medical history, and promptly diagnosed me as obese.
The doctor never considered my symptoms outside of the number on the scale.
Instead, she reduced all of my aches, pains, and hot flashes to excess weight gain.
"You need to lose weight," she said condescendingly. "Your ankles are swollen from edema," she commented as she touched the water pooling in my ankles. "If you don't lose weight, you're going to have early osteoporosis. Your bones will break down."
She then recommended a list of nutritionists who would help me "temporarily eliminate carbs from my diet." She also encouraged me to hire a personal trainer and told me she'd monitor my 100-pound weight loss over the course of nine months.
Here's what she didn't do: Consider my symptoms as separate from my weight, gauge my weight as a symptom of a larger medical issue, or devote time to figuring out my medical ailment.
That's the problem.
Many fat women have encountered doctors similar to mine. Rather than diagnosing and treating the problem, physicians are treating fatness.
Researchers Rebecca M. Puhl and Chelsea A. Heur surveyed 2,449 fat men and women for a 2009 study. They found that 69% of those surveyed experienced bias from doctors while 52% endured recurring fat bias. As Puhl later told The New York Times, fat-shaming, especially by doctors, is "very harmful to health."
Dr. Natalie Boero, a sociology professor at San Jose State University, told Revelist that a focus on obesity is causing doctors to fail fat patients.
"We're so caught up in conflating weight and health, but there's plenty of evidence to show that weight and health are not correlated," she said. "Every illness that a fat person gets, you also see it in thin people."
Even though obesity is often credited for illnesses like heart disease and diabetes, Boero argues that has to do with the way doctors approach the treatment of fat patients rather than how diseases manifest in fat bodies.
"Whether I'm complaining about a symptom or not, every time I walk in the doctor, they want to test my blood sugar," she said. "You can bet the second, if it’s ever high, they will know that second. Who are doctors surveilling? Who are they testing?"
Fat-shaming patients has a deadly cost for fat people, and more specifically, fat women.
"We know that fat women who have good health insurance and access to medical care will avoid preventive care for fear of fat-shaming," Boero said.
Studies have shown that Boero's assessment is accurate. For instance, a 2006 study looked at the barriers preventing white and Black plus-size women from seeking adequate gynecological care. Over 90% of the women observed had health insurance that covered preventative care. The researchers examined women in different BMI categories to see how their weight impacts their seeking of care.
The study's results were alarming: Women who were medically classified as obese delayed their cancer-screening tests out of fear of being fat-shamed. This avoidance of the doctor increased as a woman's BMI increased.
"These barriers [included] disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional," the study's researchers concluded. "Obese women reported that they delay cancer-screening tests and perceive that their weight is a barrier to obtaining appropriate health care."
None of this surprises Boero who said that she, and her daughter, have been fat-shamed at the doctor.
"What do you say when a statistic comes out that says cervical cancer, a cancer that when caught early is very treatable, is more deadly among fat women?" she said. "Does that really have to do with fat? Or is that social? We really don’t ask these questions."
Boero said that doctors focusing on weight also distracts from social class and race as the greatest determinants of health:
"So often, when doctors bring up weight, they aren't actually treating what patients are complaining about. I went in for a sore throat, and I came out with a diet. I think it goes to our idea that somehow doctors are immune from or outside of these moral judgments. They're mired in them as much as anyone else — in fact, even more than everyone else."
However, Boero's own experiences with doctors proves exactly why they aren't removed from making moral judgments about patients.
She told Revelist that a children's hospital admitted her then 7-month-old daughter for a respiratory infection. They weighed her daughter and determined that she, a 7-month-old baby, needed nutritional counseling.
"She looks at me, she looks at my daughter who, at that point, is a Roly Poly baby. And she says that my daughter’s file has been flagged for nutritional counseling because of her weight," she said. "She starts asking how much juice I’m giving her. I’m not giving her juice at 7-months-old."
Boero asked the nutritional counselor to leave, but realized how frequent similar experiences are.
"This is the first contact parents get with this: Their baby is being [fat-shamed]," she said. "She came through the ER with a respiratory infection."
None of this actually improves the health of fat people, which is why it's ineffective.
"If you cared about my health as a fat person, you wouldn't fat-shame me," Boero said. "You wouldn't assume I'm in bad health, and you would actually look at what things are doable that can have lasting impact. You would make sure I could get care."
I sought a second opinion. My new doctor attributed all of my symptoms to several medical issues, including extremely low iron and vitamin D deficiencies.
None of my medical issues were caused by obesity. In fact, he told me weight gain is a side effect, not the problem itself.
Boero said being proactive in seeking second opinions is one of the many ways that fat people can get better medical treatment. She said that The National Association for the Advancement of Fat Acceptance (NAAFA) has online resources for talking to doctors. She also recommends setting boundaries with doctors before going in for appointments.
"Being educated about fat-shaming, sharing experiences on this, and emailing doctors [about health at every size] are great resources," she said. "I really think the best thing to do is contact the doctor before. Tell them that you want behavioral changes that can help, but you want them to treat your problems, not your size. [Tell them] 'I'm not really open to weight loss or prescribed weight loss.'"
My doctor's fat-shaming approach depressed me. It made me feel inadequate, small, and unworthy of medical care.
However, I realize now that being proactive about my health matters most. I hope other fat people, especially fat women, find doctors who care about their health — not their weight. Our lives depend on it.