Yes, Doctor, I Know I’m Fat

After battling righteously with Covered California, I’m covered by Kaiser, and in January, I made my first official visit as an insured patient to meet my preferred provider (whom I had to pick from a website, making me feel like I had stumbled into alternate reality online dating) and to start being slowly ingested into the Kaiser system. (Also, I wanted some vaccines.) I duly went through my medical history with my new doctor, and I felt like we were getting on very well — she’s a DO, and has an approach to medical care that’s similar to my approach as a patient, in terms of focusing on preventative medicine and trying to reduce unnecessary treatments, tests, and procedures.

I had a feeling she might be a good match. This date, in other words, was going well. Until we got to the part where she told me that I should ‘really watch [my] weight.’ I had a momentary vision of sitting in an airport looking after a friend’s bags while she runs to the bathroom, but I knew that wasn’t what she meant. She meant that I’m fat, although she didn’t want to say it. Instead, she pointed to the BMI chart on the wall, stabbing her finger at where I was, and then dragging her finger over to where I am ‘supposed’ to be, which is some 50 pounds lighter than I currently weigh.

Although I spend much of my life thinking about fatness and culture and social attitudes and how to retort to people who say things about fat people that are uncool, and also medically unsound, I felt sort of trapped. There is something about a doctor’s office and the authority of a white coat that makes my words die in my throat, even though I’m normally a pretty outspoken, loud, shameless person. I have scripts in my head for exactly what I would say in situations like this, but of course I never say any of those things at the time incidents happen.

I wanted to tell her that I am aware I am fat and that I don’t care. That I am happy in my body and that it can do the things I need it to do. I wanted to tell her that I do not have an obligation to be healthy — and that, moreover, my weight is not an indicator of my health. I wanted to tell her that I don’t experience my weight as a restriction or something that interferes with my quality of life. Instead I awkwardly knitted my fingers around each other, twisting on the exam table to follow her condemning finger.

Instead, I told her that only through extreme caloric restriction and excessive exercise could I lose weight. And that I would have to continue that for life if I wanted to keep that weight off. I told her that that wasn’t a sacrifice I was willing to make — that I prefer being happy to being a raging asshole all the time. I didn’t tell her that studies show most diets fail, that yo-yo dieting is less healthy than just being fat in the first place.

She told me that ‘people, women especially, just need to be careful about what they eat.’ She told me about how she doesn’t eat any sugar, or grains, or potatoes, just fresh fruits and vegetables, lean meats, eggs, and cheese. She told me about how as a former athlete, she had a tough time transitioning to a lifestyle where she wasn’t consuming as many calories, and she needed to adjust and modify her diet to keep her weight under control.

I wanted to respond that if that was her priority and she found a diet that worked for her that she liked, that was fine, but that I wasn’t interested. Instead, I tried to move the conversation along to another subject, to something other than the fact that I am fat and she doesn’t like it. As a primary care provider in a medical system laden with fat hatred, a system that tells physicians to tell their patients to lose weight, she was toeing the party line — and she was doing what she thought was right for me, because she genuinely believed that my weight was dangerous, ‘especially with [my] family history of heart disease.’

As a patient, I felt a profound discomfort. I wanted to push back, to bring evidentiary support to the table to explain why she was wrong — but I knew at the same time that this would be unlikely to have much of an effect on her attitudes, given how deeply engrained anti-fat beliefs are in much of the medical community. And thus I remained silent, even though what had transpired had upset me, and when we were done I left the office to get my vaccinations, and then I went downstairs to the pharmacy to pick up my prescriptions, and then I left the building and I walked slowly back to my car in the strange heat and early wind we had in January, when the drought seemed determined to remind us that it had the upper hand by blasting us with gusts of air so hard they made the windows rattle.

I sat in my car for a moment before I turned on the engine, and then I drove to my favourite bakery and bought some cupcakes to share with myself and the housemates. My first bite was so sweet and tender and moist, so delicious, and yet, at the same time, it had a note of bitterness to it, too.