She is Obese (January 2022)

This article is used with permission from my colleague Mindy Hoffman, MA, LPCC, NCC and I am honored to share this experience to all of you so we can do better as providers. Thank you Mindy for your bravery and please continue to use your voice and be you.

She is obese.

Those are the words I read from my visit summary after my physical on Friday. To make it worse, the word “obese” was written in red font. It hit me like a train. It caused old eating disorder thoughts to swirl in my head for about 24 hours. It made me feel like less of a person. I felt like I was doing something wrong and being judged.

The words obese or obesity are problematic and pathologize the size of bodies. The words are based on the BMI which measures physical appearance and not health. In fact, using these words increases fatphobia and weight stigma in our culture.

In the book Body Respect, by Lindo Bacon and Lucy Aphramor, BMI is used to see if someone fits in the category of normal, overweight, or obese. BMI is information relative to your weight and height and does not determine your health. They go on to say, “Using these terms medicalizes and pathologizes weight over a certain amount” (p.9).

BMI has a lot of power in the US medical system. Even as young children we know what our BMI number is and what category we fall into. In our culture, these categories alone are used to determine and define our health status. Many times, a patient may come in for an ailment and be told the solution is weight loss versus how a thin bodied person would be treated for the same ailment without mention of weight loss. Diet culture also attaches morality, shame, and that we are doing something wrong or right with our life depending on the BMI categories we have fallen into. For me, the word “obese” has not only been pathologized, but also means I am doing something wrong, there is something wrong with me, and I am not enough, and I am unhealthy.

I feel shame around being called obese.

Back to my doctor’s appointment. One important note, I declined being weighed at the appointment. Since my doctor didn’t have my weight, how did she determine my BMI and what category I should be in? It was a judgement call based on appearance and she chose “obese” to define my heath. Because “obese” is such a loaded word to me, it sent me into a spiral.

I live in a larger body and I identify as being fat. However, to me those are just descriptive words about my body, different from obesity and its connotations. Fat, unlike the term obesity, is not tied to my health or my relationship with food and movement. Fat is not associated with whether I am a good or bad person. I am fat. That’s the end. Just like other people are thin, tall, or short. Fatness is another facet of body diversity. Those of us in fat bodies deserve to be respected like anyone else and not have assumptions made about our health due to body size or labels.

Immediately after I read the bright red word, I reached out to several of my friends and mentors who are also eating disorder and HAES (Health at Every Size) clinicians for support. I took a screenshot of the sentence from my visit summary. Here are some of the responses I received:

“That’s fucked up!”

“…our medical system is fucked up. It’s just fucked up and unfair. Our society is just wrong, and doctors are the worst of them honestly! I’m so sorry you have to deal with this shit!”

(In reference to how my BMI was calculated) “She didn’t. She was guessing and being fatphobic.”

“What the STUPID FUCK is THAT?”

“You are ok, you are loved, you are safe. Those words are triggering but you are okay. Protect your recovery. Remember most doctors are incapable of the greater understanding of health at every size. You are strong.”

“You are also allowed to be upset! It’s a shitty situation. Honor your feelings and prioritize your recovery. I was just talking to a clinician the other day about how hard it is to live in our own bodies while working in the eating disorder field.”

“There is absolutely NOTHING wrong with your body Mindy. You have been taking good care of it in these last few years…feeding it when it’s hungry, moving it, getting good sleep, helping it manage emotions. There is nothing you are doing wrong. NOTHING. Doctors are unfortunately indoctrinated into a system that is very weight focused and biased. I know the word you saw felt hurtful, shameful, and implied you must be doing something wrong. That is your own internal weight bias talking. You see, we have all grown up in this nasty nasty system that is not rooted in true holistic health and wellbeing but rather in a narrow focus on weight. You are just perfect as you are. Nothing to change. Nothing to lose. You are well. You are present. You are healing. Coach will take all of these things away from you again.”

“Some of the worst offenders of perpetrating weight sigma are within the medical profession. Get angry, take action…but please don’t turn away from yourself. You bring healing and joy to others.”

So here I am, angry and taking action by writing. All I know to do is write it all out. I have done quite a bit of work about internalized fatphobia and weight stigma. My experience on Friday has taught me that I have a lot more work to do for myself and educating others.

Dr. Jennifer Gaudiani, in her book Sick Enough, informs us that patients can be in an active eating disorder and be at a normal weight. Their sickness may be missed. However, patients in larger bodies may be encouraged to diet and get caught up in weight cycles that are damaging to their health. One important note she makes is, “We must always resist our own learned, sizeist tendencies and continue to see the whole person in assessing their medical status” (p.90).

My doctor did ask questions about my mood, movement, food intake, drew labs, and other health metrics. My hope is that my health as a person would be based on all the metrics combined and not just on what a random number from the BMI categorizing me as “obese”. I don’t think healthcare providers realize how damaging their diagnosis and words can be. It makes me not ever want to go to the doctor again.

Robyn Goldberg, in her book The Eating Disorder Trap, comments, “Weight bias is not well understood amongst healthcare providers. They are often unaware that weight stigma is traumatic, and the stress an individual experiences as a result can cause disease, distress, and dysfunction” (p.60).

Like I said, this experience makes me want to skip out on going to the doctor. This could be very dangerous for my health and preventative care. I’m trying to see past the messed up system our healthcare professionals are trained and indoctrinated in and chose my values today. I know my own body and what it needs, how it moves, and how I feel in my body despite a BMI category.

I am so much more than my body. I am so much more than my eating disorder. I am so much more than my recovery. I am an amazing friend. I love others well. I am motivated, a hard worker, and I value my faith. I value connection. I love being in the mountains. They make my heart sing. While my journey is important, who I am is much more important. Weight and BMI have nothing to do with who I am. Weight and BMI are not the sole indicator of health.

Thank you for reading. This is a complex, nuanced, and different journey for each person no matter your body size. I welcome your thoughts, comments, and reactions. Please be respectful and curious.