the HAES® files: If You Don’t Eat Wheat, Then Why Aren’t You Thin?

by Health At Every Size® Blog

by Stacey Nye, PhD FAED

I recently went to see Dr. X for my physical. Dr. X had just taken over the practice he shared with Dr. Y, who moved away last year. I have known Dr. X for many years and although he is a fine physician, he has never been known for his bedside manner.

As I sat down he greeted me with “So, are you still helping people with their weight?” I knew this was in reference to my psychotherapy practice treating people with eating disorders. He has even referred people to me, so I was surprised and a little taken aback by his characterizing what I do in this way. “I treat people with Anorexia, Bulimia and compulsive eating issues. I’m not a weight loss doctor.” I reminded him. He smiled at me as if I was a fool, but I let it go.

As we talked, he estimated my breast cancer risk. “Seventeen percent, slightly elevated”, he announced (apparently the average was 11%). I asked him how I could lower my risk.

His eyes lit up. “You could lose weight!” he exclaimed, looking down at my abysmal BMI, which he had also just calculated. He took some papers off a stack on his desk. I had eyed these when I walked in and tried to ignore them; pages copied out of the Wheat Belly book. “You should take a look at this,” he said. “I’ve been doing it for 3 years and have lost 25 pounds” he stated proudly. “It’s the greatest thing, and so easy. All you do is eat whatever is on this list and you will lose weight!”

Now I looked at him like he was the fool. Did he think I lived in a cave? Didn’t he know that I have heard about this before, from my patients, neighbors, colleagues, soccer moms and occasionally, even well-intentioned friends? Did he forget what I do for a living or was my initial impression correct in that he neither appreciated what I do, nor did he understand the HAES® paradigm from which I approach my practice? I was soon desperately missing Dr. Y as I was engulfed by weariness that I had to have this conversation. “Dr. X, I have numerous food allergies. I don’t even eat wheat,” I stated.

He stopped and considered this, regarding me with a slightly tilted head, like a dog that has heard a noise it doesn’t understand. “If you don’t eat wheat, then why aren’t you thin?”

What?! I thought; did he really just ask me that? “Because not everyone is meant to be thin,” I responded definitively.

He stammered a bit, and then picked up where he left off, as if what I said was barely relevant, “I never feel hungry. I find that I can eat fairly large quantities of food.”

I proceeded to spend a few moments defending my routine of health promoting behaviors. “I have a very healthy lifestyle. My blood pressure, cholesterol, and blood sugar are all in the normal range. I don’t smoke, I drink only occasionally, and I work out approximately 5 days a week. I have maintained my weight for over 10 years now, and while it is a higher weight than you would like, it is healthier than the yo-yo weight fluctuating I did before. I eat when I’m hungry, stop when I’m full, and have a healthy diet. Despite numerous food allergies, I manage to eat plenty of fruits, vegetables, lean protein, rice and potatoes. Although I have a sweet tooth, I don’t really feel the need to eat large quantities of food.”

This comment stopped him as well, but he recovered quickly, telling me about his other patients who had lost weight because he gave them these three magical pieces of paper.

“With all due respect,” I ultimately said, “I think I know more about nutrition than you do, and I’d like to end this conversation.” He finally conceded and went on to lecture me about talking on the phone while driving. Who was this guy? My doctor or my mother?

I went home and fumed. I took some comfort in the fact that years ago, a conversation like this would have devastated me. Today it just pissed me off. Somehow, up until now, I had managed to find doctors who treated my symptoms and didn’t prescribe weight loss as a therapeutic intervention. Others have not been as lucky. While the prevalence of weight discrimination among Americans continues to increase (Andreyeva, Puhl, & Brownell, 2008), anti-fat bias among physicians is also problematic (Sabin, Marini, & Nosek, 2012). Overweight patients routinely report being treated disrespectfully by health professionals because of their weight (Anderson & Wadden, 2004). One study found that 53% of overweight and obese women reported receiving inappropriate comments about weight from their doctors (Puhl & Brownell, 2006). As a result, obese patients either receive inadequate care (Puhl & Heuer, 2009) or avoid seeking routine preventive care (Wee, McCarthy, Davis, & Phillips, 2000).

A colleague of mine suggested that I didn’t need to defend my good health, and that I may have done that because when we are a higher weight than our doctors think we should be, we feel the need to prove that we are practicing healthy behaviors in order to gain respect or acceptance. It’s true. Although I no longer seek to be thin for the sake of looking a certain way, I did feel the need to defend my fat body with good health. I see how this could be problematic, because even if I developed high cholesterol or blood pressure, dieting would still not guarantee long-term weight loss (Mann, Tomiyama, Westling, Lew, Samuels & Chatman, 2007) or improved health (Bacon & Aphramor, 2011).

I have decided that the next time I see Dr. X, I will educate him on the HAES® paradigm. I will remind him that I am the No Diet Doc, and I spend most of my professional time teaching people how to stop dieting. I will explain to him that the reasons I am not thin are complex, relating to genetics, my history of yo-yo dieting, my love for French fries and my aversion to sweating. I will ask for evidence-based treatment recommendations that don’t include dieting and weight loss – recommendations that he might give a thin patient. I will consider finding a new “size friendly” doctor if he ignores my needs. After all, everyone is entitled to shame free, blame free, and compassionate health care. Even if we do eat wheat.

 

References

  1. Andreyeva T, Puhl RM, Brownell KD. (2008). Changes in perceived weight discrimination among Americans, 1995–1996 through 2004–2006. Obesity (Silver Spring) 16: 1129–1134.
  2. Sabin, J.A., Marini, M., & Nosek, B.A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLoS ONE 7(11): e48448. doi: 10.1371/journal.pone.0048448
  3. Anderson DA, Wadden TA (2004). Bariatric surgery patients’ views of their physicians’ weight-related attitudes and practices. Obesity Research 12: 1587–1595.
  4. Puhl RM, Brownell KD (2006). Confronting and coping with weight stigma: an investigation of overweight and obese adults. Obesity (Silver Spring) 14: 1802–1815.
  5. Puhl RM and Heuer CA. (2009). Obesity, 17 (5), 941–964.
  6. Wee CC, McCarthy EP, Davis RB, Phillips RS. (2000). Screening for cervical and breast cancer: is obesity an unrecognized barrier to preventive care? Annals of Internal Medicine 132: 697–704.
  7. Chastain, R. Dances with Fat blog. http://danceswithfat.wordpress.com/
  8. Mann T, Tomiyama J, Westling E, Lew AM, Samuels B & Chatman J. (2007). Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer. American Psychologist, 62, 3, 220-233.
  9. Bacon, L. & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal 10,9.
  10. McKelle, E. http://everydayfeminism.com/2014/06/support-health-iwithout-fat-shaming/
  11. http://www.kantorlaw.net/Eating_Disorder_Blog/2013/May/Weight_Bias_in_Your_Doctors_Office_The_Problem_a.aspx

 

DrStaceyNyeStacey Nye is a Clinical Psychologist and Founding Fellow of the Academy for Eating Disorders. She does individual and group psychotherapy specializing in eating disorders, body image, depression, anxiety and women’s issues. Her practice is in Mequon. Check out her website at http://www.nodietdoc.com

19 Comments to “the HAES® files: If You Don’t Eat Wheat, Then Why Aren’t You Thin?”

  1. I went to my pain doctor a year or two, and she was shocked at my higher weight. She told me not to ‘overdo’ my eating disorder recovery. I was shocked and upset and composed myself enough to tell her that this reinforces a lot of fears larger people have about how they’re treated and that it was very hurtful to me.

    She apologized.

    I then was told that as long as I’m cheerful and the fat person everyone wants to be around, as opposed to the fat person everyone feels sorry for and avoids, that I’ll be OK.

    She then apologized for her earlier remark again.

    Then she asked me if I wore a helmet when passengering on a motorcycle. I was then lectured on the different stages of coming out of a head-trauma induced coma and that I’d never trust people or be the same again afterwards.

    I think she apologized a third time, but I was too dumbstruck to be sure at this point.

    So, now I’m thinking that a trend has started! Startled doctors making stupidly personal comments that don’t belong in a visit is a thing now!

    (The good part about the visit was that I was able to contrast my previous visits and realize newly that the positive things she’d said about me all had to do with my weight/appearance. So I learned something from it)

    • RDK-I’m horrified by what your doctor said to you! How insensitive and downright stupid! We expect our doctors to be kind and wise and certainly your doctor was neither. I cannot imagine that this doctor helps anyone, and certainly not you. Good luck fining a new one!

      • I have to pop back in and defend her actual doctoring side of her practice. She did well for me when I was a non overweight BMI.

        And, she’s done well for others we know – but I can’t help but wonder how much more people who were larger would have been helped had she not been disgusted by how they moved or felt that they were just sad all the time.

        See, I didn’t realize that her admiration for ‘how I moved’, and her negative comments about compliance among other patience and how they moved all ungracefully (among other things) were actually coded things for liking that I was *thin*.

        She retired this year and I think she probably was past due for it.

  2. Well, good luck with that education project.

    When I was younger and less fat I thought I was pretty good at dealing with doctors. But wait until you have a higher-than-they-want BMI *AND* are getting older (gasp!), particularly if you are a woman. That’s a real double or triple whammy. If you are both old *AND* fat (not to mention female) then you’ve really “let yourself go” and “obviously” “don’t care about your health.” The lectures turn into outright bullying, and the ability to get ANY health advice whatsoever other than “you need to lose weight” continues decreasing to near zero.

    Just at the time of your life when it is relatively likely that a good relationship with a good health care professional might actually contribute to your actual health and longevity, the chances of having that decrease to near zero (if you are fat).

    I have all but given up on doctors these days. For years I was un- and under- employed and had no health insurance, so no access to health care. My whole focus was on getting a job with health insurance so that as I aged I would have access to health care. Now I have that job (with health insurance) but no more have access to actual health care than I did when I was struggling to survive on low wage, no benefits jobs.

    • Do I understand where you’re coming from! No, having health insurance does not give us better access to health care. Every time I locate a doctor who sounds like she might be able to help me, her practice is closed because she has so many patients. I have a decent nurse practitioner, but his tools are limited, though I am grateful he is calm and sensible. He was on vacation when my bloodwork came back so a doctor I have never met and do not know called me up to tell me I’m going to have a heart attack. My dental hygienist said I should have inquired as to precisely when. This woman heard not one word I said when I tried to explain my medical history and that a low TSH is typical of hypothyroid patients who are actually being treated. I am no longer going to engage in conversations with maggot-brained cretins; I have refused to do so for years regarding politics, and I now refuse to do so regarding my health, which I know a great deal more about than some jerk who is incapable of listening and learning.

      • Hi Dogtowner. I think all of these comments have made it abundantly clear that many of the physicians we entrust our medical care to can say the most idiotic (thanks Tiana) things. I think lessons in diplomacy are clearly lacking from most medical school curriculum. Thank you for your comments.

    • Hi rg. I believe that there are still good doctors out there who will treat all of us with the respect that we deserve. I encourage you to check out one of these lists of “fat friendly doctors”:

      the HAES®registry http://www.haescommunity.org/search_registry.php;

      http://cat-and-dragon.com/stef/fat/ffp.html

      Good luck!

  3. Stacey,
    I am deeply saddened by your experience with Dr X and others like him. As a colleague in the eating disorder field I too hear stories from clients that mirror your experience. Not just from their PCP’s but many of them from pain or orthopedic MDs who want to believe thin people don’t have back or pain issues which obviously is not the case. They also believe dieting is the answer to all that ails one. I love & respect your desire to educate Dr X about who you are and why being fat is okay & can be healthy. You are already showing him that though. If you still want to have that conversation please remind yourself that Dr X may (again) not hear a word you say and that’s not about you. I know that you know that too. He’s stuck in the medical model which often renders him deaf to common sense & other medical professionals who don’t have MD behind their name.

    • Thanks, Marjorie for your comment. You are probably right about Dr X not being able to really hear or understand my message. He prided himself for confronting me about my weight, correctly assuming that Dr Y never did. What he failed to realize is that I greatly respected Dr Y, and probably received better medical care as a result.

  4. Ugh! (Head in hands, ashamed of my fellow physician.) In addition to all of the resources you have have to educate him, consider sharing this blog post I wrote about weight stigma in healthcare: http://amihungry.com/weight-stigma-in-healthcare/ and tell him to call me if he has questions:)!

  5. In spite of the idiocy you were faced with, I believe you performed fantastically. Well done. It’s definitely difficult not to become defensive when faced with blatant ignorance and bias, but I still think your responses were respectful as well as respectable. Being on the other side of the belief that we do not need to be thin to be either healthy or happy is going to guarantee that those on the other side will fight back with the non-facts they have been armed with through the years. Just like Marjorie Debevec-Marksteiner said, it’s not about you, it’s about them. Thanks for providing yet another example of a great way to handle those who continue to oppress us fat folk living the lives we want!

  6. Thank you for the reference to the fat friendly health care providers list. I do not have the kind of health insurance that allows me to pick any health care provider I want. I must pick from the list provided by the health insurance company — and I think their practice guidelines mandate that approved health care providers must bully fat people into becoming thin people.

    • rg don’t give up! If you can’t find any in-network physicians on those lists this page also has suggestions for how to ask the tight questions so you can find the best doctor to meet your needs.
      http://cat-and-dragon.com/stef/fat/nesbitt.html

      • I appreciate your hopeful optimism and willingness to encourage me. I really, really do. And I know that as soon as I say this I will be pigeonholed as a “yes-butter.”

        Perhaps things are different in different parts of the country. Is there really some part of the country where a non-patient, non-health-care-provider can really make a cold call to a doctor at his or her office and get a telephone call back from the physician? Not in my part of the country. You would get a receptionist who asks, “Are you a patient of Dr X?” and when the answer is no, you get 1 of 2 choices: “Would you like to schedule a new patient appointment with Dr. X?” or, “Dr. X is not accepting new patients at this time.”

        Believe me, I have even tried that (a series of “new patient” appointments). I went in with my list of questions I wanted to ask Dr. X to interview him/her to determine whether I wanted him/her for my primary care physician. I even declined the rather forceful instructions to disrobe before ever meeting Dr. X, because I wanted to have a CONVERSATION with Dr. X before DECIDING whether I wanted him/her to see me naked or not.

        Trust me, that did not go over very well. I now have a note in my chart in both of the clinics in my relatively small town indicating that I am “difficult” and “combative.”

        Lovely. The last time I tried to make a “new patient” appointment (3 months in the future, earliest that was available) the Dr. cancelled the appointment 3x in a row ON THE DAY OF THE APPOINTMENT and instructed me to call for a new appointment (3 more months hence). After 1 year of trying to get a “new patient” appointment which I never did get, BTW, I have now descended into staying away from doctors entirely and when I absolutely can’t possibly avoid it (such as, e.g., a bacterial skin infection that was growing worse and worse, and obviously not going to go away on its own or with the paltry anti-bacterial agents available OTC), going to an Urgent Care clinic (where I still get lectured about my weight, but at least I don’t have to wait more than a year to get in).

      • rg, I appreciate your frustration.I think all parts of the country are the way you describe. It can be tiresome at best to continue to put yourself out there and get the kinds of responses you are getting. Hang in there and don’t give up! Eventually your efforts will pay off.
        Urgent care is certainly an option, though I’m sure you know, not an ideal long term solution.
        Thanks again for the comments.

  7. I like to add something. Even ‘normal weight’ patients like myself ( BMI 23) are told to lose weight for medical conditions. I was told to lose 7 to 10 pounds to improve my GERD. I know the GERD won’t go away at a lower weight. I had ulcers when I weighed 20 pounds less and I got rid of them by eating better and therefor gain a little weight. The medical establishment acts like weight loss is the magical cure for nearly everything.

    • Marilyn you are right! My husband, who is a very healthy eater and quite fit, was told by our PCP to lose 10 pounds to lower his cholesterol. What was especially interesting about it was that this doctor, whom I liked very much, had never told ME to lose weight! He probably knew better than to say that to me. Plus, as I said above, I had/have no medical issues. Go figure! Thanks for your comment!

  8. Ugh! (Head in hands.) My colleagues have a lot to learn. Your experience and these comments break my heart. If anyone would like to put in a joint proposal to speak about this at the American Academy of Family Physicians next fall, let me know. I think some data and video testimonials would help. Only problem is getting the people who need to hear it to realize that it’s for them! (I posted a link to an article I wrote about Weight Stigma in Health Care two days ago but it apparently didn’t go through: http://amihungry.com/weight-stigma-in-healthcare/) I think the list about the problem would make a great outline for the presentation!

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: