A little over a week ago I had an appointment with my doctor. Because weight does have an effect on medical issues it doesn’t surprise me that the topic of my weight comes up. I expect that my doctor will be honest with me so I expect this. But during this appointment it ended up being a non-helpful discussion where I felt patronized and dismissed. After thinking about it a few days. I decided to write a letter to express how I felt. I haven’t decided whether to send it or not. But it felt good to write.
I was in your office last week for my annual exam and to have a prescription filled. After the exam, the topic turned to my weight. I expected as much and was prepared to share with you things I’ve been working on. In the last 6 months I have been working hard to change some behaviors and thought patterns in order to lay a foundation for some life long changes to my body and health. Unfortunately I left your office feeling dismissed and shamed. After I have thought it about it for a few days I wanted to write and express my feelings about the interaction.
I am completely aware of the effect the weight has on my health. This has caused me a lot of anxiety, guilt, and shame over the years. For overweight individuals, going to the doctor often increases this anxiety as the first thing we do as we walk into the office is get weighed — and as it seems often our character is what is weighed next. After all – why don’t us fat women just “take care of ourselves” or simply do what our doctors tell us to do? It isn’t that we don’t want to. Because we do. We want it badly. We have spent thousands of dollars and uncountable hours trying to do just that. We have set goals, made charts, lists, calculated weight to be lost, prayed fervently, and talked endlessly with our friends and loved ones about our weight and what we are doing to fix it. We have attended meetings, logged meals, calories, and points. We have been exhilarated when the number on the scale goes down – even a little bit. We have been devastated when we have given our best efforts and that number didn’t go down. The truth is — the issue of our weight is foremost on our minds every single day. Either we are starting “another plan” or we are feeling guilty because we aren’t.
As I exited the exam room you gave me list of “good foods” and “bad foods” and your advice was to “simply not bring “bad foods” into the house.” I could have saved a co-pay and got the exact same advice from the latest copy of any women’s magazine in the grocery store check out. But most importantly — I already know what is on the list. I dare say most overweight women do. We understand the science of “calories-in calories out.” And if it really is as simple as that, then why is the obesity rate growing at the same time the diet industry is booming? And why is it so hard for us to do what is good for our bodies?
There are many reasons. Too many to go into here. There are physical reasons as well as psychological and emotional reasons. But what I want you to know is that your approach is not helpful. Shame is a very poor motivator. In fact, for me, shame is a trigger to overeat. I know you care about your patients health but it’s important for you to realize that our obesity has much more to do with what is going on in our souls than it does our body. Please be gentle with these souls. Instead of handing your patients a food list or a referral to a bariatric surgeon, and reinforcing their feelings of failure, let them know there is hope. Not hope that they will see a certain number on a scale – but hope that they can have healthy body, mind, and spirit. By all means, you should let your patients know the effect extra weight can have. I would expect you to say “your weight is affecting your condition of XYZ.” That’s just a fact and not a moral judgement. What I am suggesting is how you approach your patients in what to do about it.
There are therapist who specialize in emotional and disordered eating. There are books on making peace with food and how to be mindful and actually love and enjoy all kinds of foods. Foods that have no moral label of “good” and “bad”. Research them yourself and recommend them. Give your patients hope that there is physical movement they can enjoy instead of just finding “some kind of exercise you can stand”, as you said to me. Let them know that they can get in touch with their body and it will let them know what foods give them energy and what foods make them feel gross. Let them know that they are in charge! Not a list, a plan, a diet, or even you — they are. I think if you made a shift in how they talk to your patients about weight that you may just be surprised to see their weight drop and their overall health improve. Understanding and acceptance, along with your medical expertise, just may be the catalyst for real change for someone.