A weighty issue
Being comfortable with your body, feeling great no matter what your size, is not the same as denying the existence of medical problem linked to weight.
Perhaps in opposition to the nasty vitriol that is often directed at overweight women, it seems to me many now think it is inappropriate for their doctor to talk to them about weight.
One reason is the growing popularity of the Fat Acceptance movement. These groups and individuals, which primarily operate online, are generally about promoting positive body image and debunking stereotypes about overweight, which I’m totally thumbs-up for.
But some also have a dangerous undertone of denial about the very real harms being overweight is linked to.
It’s true, your weight is not everybody’s business. Your uncle should not bring it up over Christmas lunch. And I’ll buy whatever goddamn chocolate bar I want, judgy cafeteria lady.
But your doctor should bring it up, and should follow-up with you about it.
One extreme is the website Fat Friendly Doctors, which has apparently reached mainstream acceptance in the US.
This website describes “fat friendly doctors” as clinicians who avoid “making an issue of weight”, among other things.
“If a client asks not to be weighed, the request is acknowledged without complaint and taken into account automatically on future visits,” the website says.
Now, of course no-one would say it’s ok for doctors to be rude, dismissive or insulting to patients, but they do have a responsibility to raise uncomfortable topics or advise against a decision a patient is making.
Terms like “making an issue” and “without complaint” are highly subjective, particularly when the person might already be sensitive about their weight.
And when you read the descriptions people have sent in to the site of their own ‘fat friendly’ doctor, it seems the ideal doctor is one who never mentions weight at all.
“I have been seeing Dr **** for a number of years as my general practitioner. She has never once mentioned my weight, sought to blame any illness or condition on my weight or suggested dieting,” one glowing contributor writes about a Sydney doctor (I’ve chosen not to link to the site out of respect to the docs listed, who may not feel quite so pleased about the descriptions given of them).
Not all fat people are unhealthy (and in fact the stigma about weight can lead people to be less healthy as they shun physical exercise because they are embarrassed about their bodies), but the reality is overweight and obesity are linked to many illnesses.
Some of these “fat acceptance” blogs are able to deny the dangers of being overweight by cherry-picking studies that seem to support their hypothesis.
But it is true that while overweight and obesity have been shown to be risk factors for hundreds of different conditions, the evidence isn’t necessarily in that losing weight will definitely help all those conditions.
For example, our friends at The Cochrane Collaboration have found there is not enough evidence yet to say that losing weight will prevent you having a stroke, or dying from complications caused by high blood pressure (Although, dear reader, please note that this doesn’t mean that losing weight doesn’t help with these things, just that it hasn’t been proven yet).
However, they have found that it will reduce your risk of developing other serious conditions such as diabetes (and all the dangerous health complications that come with it).
The reality is that given the overwhelming evidence linking overweight and obesity with health problems. Being fat is bad for you. So it makes sense then that if you are overweight, when you go to your doctor they should raise it with you.
But how often does that happen? The Royal Australian College of General Practitioners recommends (pdf) docs measure the body mass index and waist circumference of patients who appear overweight once every two years.
But according to this study of patients from Melbourne general practices, your doctor is pretty much the last person who is going to bring up this subject.
It found that in the last two years only 29 per cent of people had been told they needed to lose weight despite 66 per cent being overweight or obese.
And who was doing the telling? It was almost always their partner (45 per cent), followed by family member (25%), and friend (16%). Their doctor came in last at 14 per cent.
Probably one of the biggest reasons this is not going on is the simple fact it is embarrassing for doctor and patient. Most people, bar a few exceptions, do not want to be fat. And most doctors do not want to upset patients by bringing up issues they don’t want to talk about.
But we aint making it any easier by insisting this is a no-go area. We don’t expect our doctors to be “smoking friendly” or “never-do-any-exercise friendly”, so why would we expect them to be "fat-friendly"?