Medical Community Logic
So, as I have written about a few times in the past month, I had some recent bad experience with my doctor and I've been trying to decide what to do.
I have an eating disorder. Technically EDNOS (eating disorder not otherwise specified) but it most closely resembles bulimia even though I don't physically purge at this point.
I have diabetes (along with other endocrine malfunctions) and so the guilt gets heaped on me double with my eating disorder. I have it under better control than I used to, but I'm food insecure, so sometimes when I'm having to ration food, the E.D. part of my brain starts praising me for not eating, repeating the old "hunger hurts but starvation works" mantra. Eventually, I stop feeling the physical hunger and become kind of detached from reality. When I eventually eat, it is generally not something approved by the American Diabetes Association. It might not even be in particularly large quantities, at least not for a person who doesn't have diabetes, but since I'm supposed to curb my carbs, it ends up spiking my blood sugar and elevating my A1C.
I wanted to freaking punch my doctor when my last blood test came back with slightly elevated triglycerides and she had the audacity to ask me if I had been "indulging in treats." I've told her I'm food insecure. I snapped at her that given that I'm food insecure, as I've already told her, any damn food is an "indulgence." No, I'm not sitting in front of the soap operas gorging on bonbons, which is, for whatever reason, what we fat ladies are always supposed to eat. I doubt I've ever eaten a dozen bonbons in my entire 53 (mostly fat) years on this planet.
I'm so numbed out by a lifetime of disappointment and abuse that I literally can't cry anymore. These days when something bad happens I say "well, here we go again" and I withdraw. Anger tends to be the only thing that prevents me from doing myself in. That and the fact that my son still needs me.
Honestly, I'm disappointed as fuck that with as progressive a state as Colorado is supposed to be, I have found exactly zero doctors in the Denver/Boulder area with a Health at Every Size approach. The doctor that I'm currently seeing (and I'm probably going to go back to my previous doctor) does not provide, as she claims, a "safe space" for larger people. Oh, on the first visit she acted like she's going to treat me with a semblance of humanity, but by the third visit, out came the old "my patients who have had weight loss surgery are all doing very well" hype. Yeah, providing a bench so bigger people don't have to squeeze into a small chair with arms does not make you size friendly.
Well, Lady, after a month of stewing over this shit, I've come to the conclusion that it is not this fat broad's fault that you suck at taking a larger person's blood pressure. My old doc may have been half-assed, but his staff was top tier. Even though my current doctor is very thorough, I can't stand her attitude. I think I'm better off with the half-assed dude. He only made me want to punch him about half the time.
I feel guilty about firing this doctor because if it weren't for her, I'd never have found out that I have a uterus full of fibroids and polyps, and it needs to come out because it increases my risk of uterine cancer. I wouldn't have mentioned the post-menopausal bleeding to my old doctor, mostly because I'm not comfortable discussing that kind of crap with men. Unfortunately, the doctor who will probably be performing the hysterectomy is a man, but the procedure he uses involves less invasive methods and therefore less healing time, which is an excellent selling point.
I don't know if I should tell my current doctor why I'm not returning, or if I should just ghost. I really don't much want to talk to her again. I doubt she'll learn anything from what I have to say anyway. She could have been a great fit, if only she'd actually lived up to her promise of providing a safe space for larger people and not been a lying liar shilling for weight loss surgeons.
The pressure on women to appear youthful, thin, and pretty throughout our entire lives is based on extremely sexist ideals, and even supposedly progressive women buy into these ideals without question. We are supposed to be a certain kind of pretty to please men.
Younger women tend to be more compliant than mature women, so women are supposed to aspire to look young, even if we were born during the Roosevelt administration. As it happens, I was born during the Johnson administration. So, expecting me to look like I'm an eighteen-year-old ingenue is unrealistic and offensive as fuck to boot. But, this leads me to my next point.
A smaller, more slender body type tends to be associated with youth and, therefore, vulnerability and compliance. Women are supposed to aspire to appear delicate and fragile rather than sturdy. As well, women tend to gain weight after giving birth. Mothers tend to give more attention to their children than to their husband. A woman who is focusing her attention on nurturing children rather than pleasing her lord and master is not to be desired. So, even if a woman has ten children (i.e. Catherine Dickens*), she is to aspire to have a maiden's body.
A larger body type has come to be associated with gluttony. Thus, a large woman is seen as focusing on feeding her own appetites rather than accommodating the desires of men.
(*Charles Dickens, amazing writer though he may have been, was more than a bit of a shit when it came to his wife, Catherine, whom he denigrated for having become fat in the course of their marriage, in which she gave birth to ten children. Dickens' eleventh child was the product of his affair with Ellen Ternan.)
The push for a chiseled, athletic body type in both men and women also has roots in the ideals of the Aryan Superman stereotype, such as in this image from the cover of a 1938 publication. Encouragement of an often impossibly slender and youthful kind of beauty by any means necessary is a holdover from the Nazi idea of a perfected (white) race. I am certain that weight loss surgery would be lauded by Dr. Mengele himself.
Conversely, this image of a middle-aged Jewish man with pronounced jowls and a double chin is touted as undesirable and to be eradicated.
Ageism is also inherent in the push to retain youthful slenderness throughout the entirety of one's life.
The medical community should be ashamed of themselves. Their intolerance keeps larger people from seeking care until their situation becomes catastrophic. The fact that only fat people who are sick tend to seek medical care allows the medical community to perpetuate the lie that fat = sick. Further, to treat an ill and frightened person who has come seeking help with shame and scorn is the opposite of doing no harm.
In modern times, poor people are more likely to be heavy than those in the upper class. Poor people tend to be unable to afford medical care and thus are only seen when their situation has become catastrophic, allowing doctors to argue that they have brought their misfortune upon themselves by not seeking preventative care.
The medical community likes to claim that weight loss surgery (stomach amputation) is a low-risk procedure. It is not. Here is some food for thought regarding weight loss surgery, courtesy of Big Fat Science. Few other elective procedures come with this much risk attached.
The medical community is not infallible. They also used to believe that trepanning and thalidomide were miraculous medical interventions, and look how well those turned out.
The medical community needs to embrace the Hippocratic Oath to "first do no harm," even if this means accepting that most of their patients will never be perfect. They need to treat all of their patients with compassion and respect, even the patient who is so addicted to nicotine that she can't stop herself from smoking although she has emphysema or has had part of a lung removed. (Both people I knew, as it happens.)
Even the alcoholic who can't stop drinking although he has cirrhosis of the liver.
Even the drug addict.
Even the fat person who actually does eat enormous amounts of food. Most fat people do not, in fact, eat more than thin or mid-size people. I've known a few thin people who could easily eat more than I do.
Even the diabetic who eats nothing but simple carbs.
People's behavior is more complex than just flipping a switch. There are psychological as well as physical components. And with fat people, trying to control their weight through deprivation dieting generally leads to--you guessed it--weight regain and then some. This post on starvation syndrome is worth a look.
Diets don't work, mutilation of a healthy digestive system is unconscionable, and people are the size they are for a variety of reasons. We need to reject the sexist, racist, classist, and ageist notion that Number Twelve should look Just Like You.
~The Cheese Hath Grated It~
Stress is worse than being overweight. They should prescribe paid vacations like they do in Europe.ReplyDelete