Dear Doctor: It's Not Me. It's You.

[Content Note: Diet talk, fat hatred, body shame, weight loss, weight gain, disordered eating, fat-related medical malpractice.]

Dear Doctor:

Breaking up is always hard to do. I can't believe it's come to that point. You treated me with such compassion and understanding when my mother died, talking me through the physical effects of grief, and helping me find the right antidepressant medicines for the short term and the longer term. For that I will always be grateful. And yeah, from the beginning, you gave me little suggestions like “eat a weight loss diet” and “how about losing a few pounds,” but you didn’t seem to push it. After all, I was physically active, and jogging on a regular basis, and my numbers (save for my underactive thyroid) looked pretty good.

True, you were ridiculously excited if I came in and my weight was 3 pounds lower than the last time. I didn’t have the heart to tell you that it was the difference between weighing me after my period vs. before. But I never thought it would go so wrong.

I think it goes back to that time I twisted my ankle rather badly. I had to give up running, on a temporary basis at least. Let me take responsibility for my actions: I did a poor job at finding replacement exercise. I felt pretty bad about putting on a swimsuit, for one thing. The long and the short of it is, I didn’t exercise, and my numbers didn’t look so great any more. I had new stress on my life, taking on the directorship of a program at my university. You pushed the diet talk more aggressively. Finally, after months of it, and because I felt I had to be the “good fatty” for you, I agreed to try one of the diet pills you wanted to prescribe.

I’ll never forget how your face lit up, how I so clearly crossed from Bad Fatty to Good Fatty in your eyes. You got misty-eyed and said you were glad I was doing this for myself. I replied something like “Well, no, I’m trying this because of your advice on my health.” But I don’t think you heard me, not really. You definitely did not hear me when I disclosed my history of disordered eating, because the drug you put me on, Contrave (which is a combination of the antidepressant wellbutrin and the anti-addiction drug naltrexone) is specifically not recommended for those with a history of disordered eating. But more on that later.

I actually liked being on Contrave—not for weight loss but for its mental effects. The combination left me more focused than wellbutrin alone, less likely to “dither,” as my mother would have said. It’s too bad it’s a “weight loss drug,” because I bet it could be used for its psychological effects alone, and be very helpful for some people. I felt confident enough put on a bathing suit for the first time in 10 years. I rediscovered swimming, which although I’m not so great at, I do enjoy.

I also tried jogging again, building up from walking, but I discovered something new: a sharp pain and bulging muscle in my right leg after running for about 10 minutes. I went back to you and asked about it, confident that since you are a runner you’d give good advice. You said it was “probably an injury” and recommended I slow down my raining and walk/run on even ground always. You also suggested switching to pool running for some workouts, and I did. And that was okay; pool jogging is fun! I tried this for a few months, then tried regular jogging programs again. Again, I was sidelined by pain in the same area and the same horribly bulging leg muscle.

When I tried to talk to you about it, you said it was probably an old injury. I asked about sports medicine or physical therapy. You shrugged, said it would probably not help, and said I could bicycle or do aerobics instead. Two activities I really don’t enjoy. You also decided that the 6 pounds I had lost on Contrave weren’t enough, and switched me to phentermine. Again, I mentioned having a history of disordered eating. I asked about going off of any antidepressant. You said, “oh, it has a stimulating effect. You won’t need an antidepressant.”

Now, I didn’t have a pharmacological dictionary at that moment, but as soon as I looked up phentermine, I learned that it’s basically speed. My blood pressure had been high, and yet you prescribed this. I had a history of disordered eating, and you prescribed a drug definitely not for those with this problem. Why?

Still, I tried to follow your advice. And you know what? I was a nervous wreck. Sure, I didn’t feel like eating much. But I was jumpy, couldn’t sleep, and my stress levels went through the roof. What the hell was I doing on this drug?

I quit the drug. I tried to walk a few times a week, but my interest in exercise was nil. I was depressed. I felt terrible about myself. And I dreaded going to see you because I knew I’d have to deal with diet talk.

Yes, that’s right. Your fat hatred made me not want to see you, to dread seeing you. Even for problems that had nothing to do with weight, because I knew weight loss would come up.

I finally came in for a physical. I was 10 pounds heavier than when we started. My test results were terrible. There were red flags everywhere. And your answer?

You suggested bariatric surgery.

Now, I am not a medical doctor, but I looked up bariatric surgery on my phone, in your office, and asked if it was really for me. I pointed out that I wasn’t in the weight range for which it’s really recommended. I asked about the considerable risks. You said that I could try something else for a while—maybe eliminate all fat from my diet and see how that worked. I asked about going back on an antidepressant. You never responded to that question.

I’ll never forget that day. Because I also brought up pain while urinating and my suspicion of having a bladder infection. You looked at my test results and confirmed that there were white blood cells in my urine, but…it was probably just from having eaten a fatty meal.

To be clear: I asked you about a bladder infection and you reiterated that I should try a non-fat diet.

That’s when I left your office for the last time.

An urgent care doc confirmed the bladder infection and after antibiotics I felt much better.

I was also doing some thinking.

I hated to leave you. Once upon a time you had been a caring doctor who seemed to listen. But once I stepped on your weight loss train, nothing could make you get off from that track. You didn’t listen. At all.Again, you prescribed a non-fat diet for a bladder infection. You had become one of those doctors that fat people tell horror stories about.

I was trapped in one of those doctor-patient relationships that ultimately kills fat people. It took me a while to realize this, as depressed and unhappy as I was, but I finally recognized our relationship for what it was: deadly.

It was time to go.

I know it’s probably tacky to talk about my new doctor here. (And I recognize how privileged I am to be in a position to be able to GET a new doctor.) After asking friends for recommendations of physicians who weren’t fat-phobic, I’m so far pretty happy with my new doc. He’s not a fan of diet pills, and listened carefully when I talked about a history of disordered eating (and he wrote it down, which I can’t recall you ever doing.). He listened to my discussion of stress and depression and agreed that going back on my old antidepressant would be a good idea. He listened carefully to my description of what had happened to my leg when running, asked about my flexibility, and came to a totally different conclusion: I wasn’t stretching enough. He talked about blood flow and unstretched muscles, and took the time to recommend a stretching program, as well as a local yoga class that specifically focuses on stretching and flexibility. He also looked at my shoes, talked with me about my stride, and recommended a place to get effective consultation on my running shoes. My numbers were terrible, but instead of saying I should give up fat, he suggested I try the exercise modifications, focus on stress management, and come back for a second round of tests in two months.

I’ve started the increased stretching, and man, has it made a difference. The antidepressant is helping me stay focused. I’ve gone back to the pool, am walking almost every day now, and even started a slow walk/ jog program. I got out my old weights and started a little strength training. And I feel so much better, because a key part of managing stress for me is getting lots of exercise. I don’t do it to lose weight, but to take care of myself. And for the first time in a long time, I feel like I am worth taking care of.

Here’s the thing, doc. I’m a feminist with lots of knowledge about fat hatred. I spent years overcoming my negative self image, and frankly I’m not all the way yet. And even so, you were able to pressure me into going along with your (futile and counterproductive) weight loss “program,” because I felt like it was necessary to get decent care from you. What's it like for people who aren't conversant with HAES (Health At Every Size)? By almost every measure, my health got worse: my cholesterol and other numbers, my blood pressure, my anxiety, my stress levels, and even ultimately, my weight that you care so much about. Far from getting better care from you, I couldn’t get you to see my health as anything other than completely centered on weight loss.

I know you probably won’t see this. But I’m hoping other people will. Maybe even some of those doctors who think that treating fat people this way is somehow promoting “health.” I would ask them: What would you rather have: a patient who is fat but whose stress is managed, whose blood pressure is good, whose lab results are in the desired range… or, a patient who loses some weight but who reports worsening stress levels and whose blood pressure goes up? When a fat patient discloses a history of disordered eating, do you assume that means they overeat? Or do you understand that fat people could have been anorexic and/or bulimic? When they report a sports injury, do you take it as seriously as you would in a thin person? Or do you assume they probably shouldn’t be doing that activity anyway, because they’re fat?

Anyway, Doc, I’m sorry it had to end this way, because I think you actually do care about your patients. I’ll always be grateful for the care you gave when my mother died. But I just couldn’t go on like this.

It’s really not me. It’s you.

Sincerely,

Aphra

[ETA: Commenting note: I am not soliciting healthcare advice in this post, and would be grateful if comments did not include such. Thanks.]