To think a doctor telling you that you need to lose weight isn't "fat shaming?"

[FrankieDoyle]

Genuinely interested in opinions.
I follow a plus size Instagram blogger/influencer who normally posts about fashion, inspirational quotes etc.

Today she posted about a trip to hospital that she had. The doctors there were apparently unhelpful and told her that they couldn't operate on her because, amongst other reasons, her weight. They told her she would need to lose weight before they could consider it.
I think she's about a size 26-28, from her posts about her wardrobe where she's mentioned the size she wears.

So she posted a video stating that she was sick of being fat shamed, something needs to change, and the doctors don't take her seriously etc.

It got me thinking that actually I disagree with her viewpoint that it's "fat shaming" to inform a patient that they need to lose weight? The doctors have to check that it's safe to perform an operation on someone don't they?

I say this as an overweight person myself (currently a size 20 but following a diet plan and trying to lose weight. )

Maybe I'm wrong I don't know, but it seems unfair to criticise doctors on a public platform with thousands of followers, simply for doing their job.

I understand some doctors can be patronising or seem to focus on a person's weight, and that can't be a nice experience. But I really disagree that it's "fat shaming" actually I quite dislike the phrase being used to criticise these medical professionals.

@itsgettingwierd

Great post I believe.

It still confuses me how they'll recognise anorexia as an ED caused by poor MH but will not recognise use that overeating is the same - just an opposite effect.

Then being overweight causes further MH difficulties.

But it’s not a direct parallel is it?

Obese people aren’t purposely eating in order to get fatter in the same way anorexic people restrict their eating in order to lose weight.

Also, where many anorexic people look at their emaciated bodies and often still feel they are too big, do obese people look in the mirror and see themselves as too thin and needing to get bigger?

I don’t think they have the same issues with control and body dysmorphia.

Therefore, I don’t think they’re comparative.

It is not fat shaming to be told they cannot operate on you safely. The NHS is crap at helping people lose weight and perhaps it is not their job, but its hard for people in this position. But no, I have had to lose weight to have an op before, that is just what it is.

In this age of internet and information literally everywhere, do people really need someone else to tell them what food is low calorie and what food isn't? I mean, I reckon most reception kids know that carrots are healthy and Big Macs aren't! I think that weight loss groups can be helpful, but expecting a dietician to tell you what you should and shouldn't eat to lose weight is really quite shocking.

I don't know. When I was recently referred to the dietician, she was very focused on losing weight and just wanting to refer me to Weight Watchers, even after I said no. I wasn't asking about losing weight. I was asking about specific nutrients and managing comorbidities, because I want a more varied diet than leafy green vegetables (which I spread consume quite a lot of,) but it seems that some foods which are particularly good for e.g. Iron, aren't good for cholesterol and things like that. I still don't have the answers to the questions I asked, and she's still keen on referring me to WW. So for me, the dietician was a waste of time because I was specifically not asking about weight loss, and the appeared to be her only focus. And it's about the only appointment I've had which hasn't resulted in a customer satisfaction survey, either. (No, I wouldn't recommend this practice to most of my friends and family, because most of them don't live round here, so what would be the point?)

@Vates

I am a size 24-26 so true fattie here. I don't think it is shaming to be honest but approached with care. My GP who has treated me (severe mental health problems) since 19 only tried to tackle my weight problem once and she was incredibly sweet but honest about it. Unfortunately I don't want to live (and living a long life would be my personal hell!) and love food more than people (food is nicer than you're average person) so there's not a solution as far as I can tell. But Society in general definitely has a problem with fat shaming. My god, the incidents for me between the ages of 16-30 destroyed me, my confidence and my whole life. BTW, at size 20 people will definitely still look down on you! I think the shaming needs to stop.

Please get some proper help for your mental health so you can live life again, you sound like you are giving up, there are good things out there x

Some good points on here regarding how to help people lose weight saying it in a helpful way . However as part of my job, I have to tell people that that can't have an anaesthetic because they are too big and their risk of dying is too high. This is always delivered in a kind way but its a black and white decision . Its not my opinion or judgement .

@thestrawberrygirl

I'm in Italy, my Dr tells me on every visit that I'm overweight and must lose some. I'm 167cm and 72kg, I agree with him, I really need to, it's his job to tell me. I'm also told often my my DH, in laws and friends I need to and it's not offensive in the slightest to me, they simply care about my health and the impacts of being overweight on the rest of my health. It's a very accepted thing to say here and not labelled fat shaming, which I find ridiculous and might explain my shock at the size of some very young women on my last visit to UK. I don't recall young women being so large when I lived there 25 years ago. While we're on the subject, I'm two sizes smaller in UK clothes than I used to be despite being fatter, have they change the sizing?

I'm also in Italy and agree. And yes, for some reason companies selling us a size 16 and pretending it's a 12 makes us feel better about needing the 16. It's a dangerous precedent and they're all doing it.

@Lairymary

My husband is friends with someone who is a GP, she is rather large and I occasionally wonder how she delivers the "you need to lose weight" chat without getting embarrassed

I'm a doctor but not a GP. I'm a bit fat. In the past, I've had to have those conversations (not in my current job).

I always acknowledged that I could be healthier and it was easier said than done.

People received it quite well and often lost significant weight.

That's the approach my GP has, too.

Coming from someone who is very overweight, it's definitely not fat shaming. Is it unpleasant to hear? Yes. Is it frustrating that whatever medical procedure is required is contra indicated by her excess weight? Undeniably. Is it even unfair? Yeah probably a bit.

It's many not very nice things, to be sure, but fat shaming it is not.

This might have already been said, but I think a lot of the issue stems from doctors or generally healthcare practitioners declaring that every single issue that a fat person may have is a result of their weight. Not even bother to run investigations or consider any other alternatives because they are just purely focused on weight.

It still confuses me how they'll recognise anorexia as an ED caused by poor MH but will not recognise use that overeating is the same - just an opposite effect

You must be very confused indeed because fat does not equal the opposite of anorexic. Most people who are overweight do not have any kind of eating disorder and its not usually caused by poor mental health.
Most people are fat because they eat and drink a bit too much and don't take enough exercise. It really is as simple as that for the majority.

I wish people would stop pathologising everything, its so unhelpful. To pretend that 65% of UK adults have an eating disorder caused by mental health issues is astoundingly silly.

It would be wrong for a doctor just to assume that whatever health problems an overweight patient has are just the result of their weight, and to refuse to investigate further. Which does sometimes happen. However, many operations are more dangerous for overweight people, and I don't think it's unreasonable or 'fat shaming' to refuse to carry out the surgery unless or until the patient loses weight (assuming of course that the surgery is not urgent).

The thing that gets me the most is that medical people/well wishers who initiate this kind of conversation never acknowledge that losing weight is a longterm process, and that you aren’t necessarily going to have visible change immediately. I’ve also found that they rarely want to hear about the changes you’ve already made.

It’s one thing to say that losing weight is necessary before an operation, but the likelihood is that by the time the patient has reached that stage, they’ve been told about their weight repeatedly, and likely had some of their symptoms dismissed due to the weight. So I’m sympathetic to the situation. The medical profession really needs to rethink how it addresses it’s patients as a whole, there seems to be a lot of dismissal because patients aren’t experts when they are in fact the only people who truly understand what’s happening in their bodies

The thing that gets me the most is that medical people/well wishers who initiate this kind of conversation never acknowledge that losing weight is a longterm process, and that you aren’t necessarily going to have visible change immediately. I’ve also found that they rarely want to hear about the changes you’ve already made

Well, why would they state the obvious? They, you and everyone else knows its a long term process, it doesn't need to be spelled out!
And they don't want to hear about the changes you've already made if they haven't made much difference...they aren't too relevant.

@SoreusBacchus

It still confuses me how they'll recognise anorexia as an ED caused by poor MH but will not recognise use that overeating is the same - just an opposite effect

You must be very confused indeed because fat does not equal the opposite of anorexic. Most people who are overweight do not have any kind of eating disorder and its not usually caused by poor mental health.
Most people are fat because they eat and drink a bit too much and don't take enough exercise. It really is as simple as that for the majority.

I wish people would stop pathologising everything, its so unhelpful. To pretend that 65% of UK adults have an eating disorder caused by mental health issues is astoundingly silly.

I sadly have to agree. It did provode me with some more exvuses of why I possibly couldn't lose the weight.

Of courses some people have mh issues etc, but I agree that lots of us simply got on too well with food and then learned to swim in denial. And yes. As some pp mentions, very little overeating can ampunt 5o considerable weightgain over the time

I am in two minds about this. I am hugely overweight. I am aware of this. However, I also have chronic (often debilitating) pelvic pain. Everybody I have spoken to, including the gynaecologists at the hospital, admit that they think it is endometriosis and possible adenomyosis. And that this is probably also the cause of my infertility (and multiple early miscarriages).

However, they refuse to treat me (a laparoscopy) until I lose weight. But I am chronic pain, in all probability caused by a condition that is in no way caused by my weight. I am stuck in a cycle of being in pain every day, unable to exercise as much as I would like because of the pain, and hormonally all over the place. Yes, I am chronically depressed. Because I am in chronic pain. And because my desire to be a Mum is overwhelming and apparently fat people don't get to be parents (or at least no support towards being able to conceive).

I would happily, willingly (and have offered to!) sign a waiver and pay privately for any surgeon to do the operation needed for me to end the pain I am in. I understand I have more risks than someone of a lower BMI. I accept this. I understand that the surgery may be more complex, and that I may need to have an ICU bed ready in case something goes wrong. I am prepared to pay for that. I understand that due to my weight the risk that I may die in surgery is increased. I will sign away their liability. I am happy and willing to do this.

Not one surgeon will touch me despite all of this. If I was a particularly complicated case, if I smoked, even if I was a drug user, if I was very young or very old, NONE of those things would rule me out of the thing that I need to be out of pain. It is only weight that they are allowed to use as a reason to refuse outright without looking at any of my other medical data (pristine in my case, I am a picture of health!)

I understand that risks are higher, and that doctors and other healthcare professionals MUST, as part of their duty inform patients of the increased risk of morbidity, delayed wound healing etc etc. And that the patient must sign to say they are aware of that and be given the option to wait, lose some weight and come back with the lower risks. But right now, my life feels not worth living. My mental health is in tatters, BECAUSE of this condition that they refuse to treat. If I had to choose between killing myself because I am in pain, and dying on the table trying to become pain free for the first time in 17 years (!), I know which I would choose. And I would celebrate the surgeon who chose to give me that chance, not sue them.

If I had to choose between killing myself because I am in pain, and dying on the table trying to become pain free for the first time in 17 years (!), I know which I would choose. And I would celebrate the surgeon who chose to give me that chance, not sue them

I think you're failing to realise that if a surgeon operated on you even though their clinical judgement says it is dangerous to do so, and you die, they will actually have killed you. A waiver is not going to help them live with that.
No surgeon will do an operation that they believe has an unacceptable level of risk.

@SoreusBacchus

The thing that gets me the most is that medical people/well wishers who initiate this kind of conversation never acknowledge that losing weight is a longterm process, and that you aren’t necessarily going to have visible change immediately. I’ve also found that they rarely want to hear about the changes you’ve already made

Well, why would they state the obvious? They, you and everyone else knows its a long term process, it doesn't need to be spelled out!
And they don't want to hear about the changes you've already made if they haven't made much difference...they aren't too relevant.

Because they’re supposed to take an interest in your health, is it really that difficult to think about? Because asking people if they’d considered their weight and if they’d made any changes would come across infinitely better than just saying “you need to lose weight” at every appointment. It’s hardly as if the current methods are successful.

Because they’re supposed to take an interest in your health, is it really that difficult to think about? Because asking people if they’d considered their weight and if they’d made any changes would come across infinitely better than just saying “you need to lose weight” at every appointment. It’s hardly as if the current methods are successful

We're talking about surgeons and anaesthetists at a hospital. They don't care if you've considered it or what changes you've made already, it's not relevant to them. They are concerned if your current weight makes surgery inadvisable or impossible, and what the next step is.

Your weight is your responsibility, not everyone elses.

As you age it’s an actual effort to stay a healthy weight. I was always naturally slim and ate what I wanted without a second thought but now heading to my late 40s I intermittent fast most days and do an hour of cardio daily to stay size 10. I can see why people don’t do it.

I’m a retired anaesthetist. Obese patients are at serious risk during anaesthesia and during the post op period.
As part of informed consent, I always had to warn patients in advance of this.
I remember one morbidly obese woman, where I struggled with an extra long spinal needle to find her intrathecal space through the inches of fat, as she was unfit for general anaesthetic.
Three years later, she was listed for another procedure. I picked up her notes, saw my previous op sheet, and quailed at the thought of struggling with her again.
I walked into the anaesthetic room - and thought I’d got the wrong patient, looking at the slim woman waiting for me.
She burst out laughing and said “You didn’t recognise me, did you! I listened to your warnings last time, and I’ve lost five stone.”
We ended up hugging and I told her I was hugely proud of her.
Giving patients the facts about the dangers of obesity, in a respectful and nonjudgmental way, can be life changing. It is certainly not “fat shaming” - a ridiculous term.

@Flatdisco

It's not actually proven weight has a negative impact on health but doctors have been taught this is true and have no reason to learn off their own backs so keep spouting this as truth.

Of course being overweight has a negative effect on health, have you not heard the stories of overweight people being more at risk from dying than those with a healthy BMI? All the photos of supposedly healthy people who have passed away who are quite obviously not perfectly healthy due to their size.

Add to it increased risks of certain cancers, heart disease, diabetes, joint problems to name but a few.

In my GP surgery , the nurses and some Gp's seem petrified to use the 'F' word
When I was diagnosed with Diabetes the nurse kept stuttering trying to tell me I need to lose weight, I joked and said 'yep I know I am fat' and she said I am so sorry but we are just not allowed to tell anyone they need to lose weight.
A reasonably intelligent person without any medical issues should be able to recognise that being overweight is not healthy or helpful in their long term life...I am overweight and have a medical condition that could make it harder to lose weight but I know that what I put in my mouth does'nt help!
Reverse shaming a medical professional for daring to advise her is disgusting in itself as they will have to explain and potentially be the subject of an investigation should she die on the operating table.

I think doctors are damned if they do and damned if they don't in this area. My colleague's mum is very overweight, she has bad knees, gets breathless very easily and had been told that she is pre-diabetic, all of which would improve with weightloss and/or a healthier diet. However, she maintains that no doctor has ever told her she should lose weight for her health so she won't do it. My colleague's aunt apparently used to be concerned for her and try to encourage her but has now given up. Should a doctor have told her to lose weight? Would she actually do it if they did? (Is it really true that they never have!?)

She sounds an idiot ... of course that's not fat shaming ... they are concerned for her health