#i have three tests next week and a spelling bee but instead I’m losing my shit over this | Explore Tumblr Posts and Blogs

rolypolywl · 5 years

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Hello, and welcome to Roly-Poly weight loss. I’m your host, Roly-Poly.

Welcome to day 27!

So before I jump into our topic, I wanted to do a check in. It is important to check in with your process and your progress every so often. It is one thing to make goals, and another thing to keep yourself on track for achieving them. Too often this is the problem with New Year’s Resolutions. By the end of January we’ve stopped thinking about them.

You might have forgotten, or fallen off the wagon, or not made as much progress as you would have liked, but a check in lets you refocus and restrategize. If you let things continue to slide, you’ll never hit that goal.

I forget where I heard it, but I loved this metaphor. If you drop your phone, you’re not going to decide it is gone and walk away, or that it is ruined and start stomping on it. No, you’re going to pick it up and go back to using it.

If you stop working out, start up again. If you break your diet today, start again at the next meal. If you stop losing weight, assess why and make a new plan. If your goal needs to change, adjust it! Don’t just leave the phone on the ground!

So, we are doing the same thing here. Time for a check in.

I’ve been doing this for just over two months, real time, and that’s awesome! The first month, I noticed some real progress. The weight was creeping off, but it was actually coming off.

This second month, that has changed. And I know that at the beginning of the month I had a wonky week, I expected that. But I expected it to be the exception, not the rule. So I thought through it, trying to find the differences in the two months.

And the difference I found was No Zero Day May. Without tackling my eating, which we are now starting, just doing this cardio exercise for 20 minutes 3 times a week clearly isn’t enough to make a difference.

And it isn’t just the weight. I was sleeping better and had more energy in May than I did in June!

So, I’m going back at it. My goal is to walk, trampoline, or bike at least half an hour a day for this month, and see if that gets me back on the losing track. I am also aiming for one of my life goals, which is to get back into walking 5Ks. And more than that, I want to actually be able to jog and eventually run them. This is something I thought a lot about when I did my goal journaling, as I talked about in week 5.

I have started a partial bullet journal - I’m very proud of it and I’ll likely share some pictures on my tumblr. But I’ve been doing a lot of thinking about what my goals are, both short and long term. And, as I said, this 5K one is one of my big goals. I have talked about, and will continue to talk about, the fact that I was walking 5Ks before. But I really mean walking, coming in at the end. I want to be able to job them!

So I’m also going to start a Couch - to - 5K program, and work my way up to jogging and running! I’m very excited. This is a three-times-a-week schedule, and I did my first one yesterday, so we’ll see how that goes!

Now, I was a little intimidated by most of the plans I looked at, because they were in, like, a nine and ten week time frame. So I just doubled it! I’m going to be spending twice as long on each goal, and giving myself permission not to have to rush.

If it takes me four months instead of two to get up to jogging/running, that is fine. But that also means that three times a week I’ll be - theoretically - making that half hour walk either a full hour or a jog/walk as I work through the program.

So look for those posts from me too!

I’ll also be getting back into doing 5K walks, so look for those posts too! I already signed up for my first one, in two weeks, so I’m committed!

Finally, this week I’m trying to get into the habit of logging my food. Not changing anything, just eating what I usually would, but keeping track of it. We’re going to start logging in earnest next week, but it is helping me to try to pick up the habit this week.

So, that is my assessment of my process and progress in the last two and a bit months, and my plans going forward. Please take the time periodically to do your own assessment and tweak as needed.

Okay, check in done.

On to the topic!

Which is sadly one I’m sure we’re all familiar with. Fat shaming.

But not the trolls on the internet or looks in public or comments at the grocery store kind of fat shaming. This one is far more dangerous and hurtful.

Doctor fat shaming.

I have been incredibly lucky, and so I didn’t really realize this was a thing, though I’m now looking back over my most recent new doctor to see if it might have been there without me noticing it.

Samantha Bee did an episode of Full Frontal a few months ago which talked about this, and that is how I got clued in. You might have also seen it on Good Morning America.

Now, there are some great points from Good Morning America, and their doctor spells out something that needs to be shouted from the rooftops. “When I got board certified in obesity medicine, we learned the facts; that we don’t understand completely what causes obesity, but we know what doesn’t cause it. It’s not caused by laziness. It’s not caused by a lack of commitment.”

Unfortunately, they made one comment which I found to be true, if slightly missing the point. Or at least today’s point. Doctor Jen pointed out that physicians need to ask to talk to us about our weight, give explanations for why they are making the suggestions they are, and actually help us make a plan to change. But, she also notes that patients need to listen and understand that this is coming from a place of medical knowledge, not of societal meanness.

All of that is good and true, and we do need to listen with an open mind in those situations. But sometimes it *is* coming from a place of societal meanness. Earlier in that segment, before that advice was given, GMA had read a tweet from a viewer who, at 160 pounds and 5’8” oversaw that her doctor wrote obese on her chart.

Um, excuse me? Have you looked at a BMI chart? She is in the “optimal” range for her height!

That isn’t a doctor thinking that she needs to lose some weight for medical reasons, that is legit fat shaming. Samantha Bee gets more into this side of it. As she notes, “One study found that doctors spend less time with obese patients, and they may fail to give them medically necessary tests. Instead telling them they just need to lose weight. Doctor’s fat bias isn’t just rude, its medical negligence that can kill people.”

One of the articles she quotes is this one from the New York Times, and they have some shocking, and sadly relatable stories.

A 58 year old woman who had already lost 70 pounds was having hip pain and went to a doctor. ““He came to the door of the exam room, and I started to tell him my symptoms,” Ms. Nece said. “He said: ‘Let me cut to the chase. You need to lose weight.’” The doctor, she said, never examined her. But he made a diagnosis, “obesity pain,” and relayed it to her internist. In fact, she later learned, she had progressive scoliosis, a condition not caused by obesity.”

Another woman from that article “suddenly found it almost impossible to walk from her bedroom to her kitchen. Those few steps left her gasping for breath. Frightened, she went to a local urgent care center, where the doctor said she had a lot of weight pressing on her lungs. The only thing wrong with her, the doctor said, was that she was fat.”

Except, of course, obesity doesn’t cause a sudden inability to breathe. Turns out she had blood clots in her lungs, which is, you know, a life threatening condition that this doctor just ignored.

Healthline’s article on doctor fat shaming starts right off the bat with two women both told that their back pain was from their weight. It turns out one had injured her back several years before and the muscle was deteriorating (and all the exercise they told her to do to lose weight was making it worse). The other had ovarian cancer. Both conditions, it should go without saying, that have nothing to do with your weight.

This can also tie into eating disorders, which is an episode coming up, but as this patient notes, “Because I was fat when I first began dieting — and because I didn’t present as emaciated even after I was in the throes of anorexia — every sign of my eating disorder was overlooked.”

This also works in reverse, as some people with metabolic disorders who present as thin aren’t diagnosed because it hasn’t made them fat yet.

And the fat shaming doesn’t even have to be overt! A study was done on this and recently published.

Psychology Today quoted the Professor who presented it. “"Disrespectful treatment and medical fat shaming, in an attempt to motivate people to change their behavior, is stressful and can cause patients to delay health care seeking or avoid interacting with providers," presenter Joan Chrisler, professor of psychology at Connecticut College, said in a statement prior to the APA symposium. Chrisler added, "Implicit attitudes might be experienced by patients as microaggressions—for example, a provider's apparent reluctance to touch a fat patient, or a headshake, wince or 'tsk' while noting the patient's weight in the chart. Microaggressions are stressful over time and can contribute to the felt experience of stigmatization."”

Again, some of these things aren’t as overt as telling a patient to just lose weight, but it is still blatantly obvious to the patient that you think we’re too fat.

But, unfortunately, as these articles and segments cover, this problem goes beyond just the doctor’s personal fat bias.

For example, CT and MRI scanners. Most have a weight limit in the 350-450 pound range. This is treated for laughs in an episode of House, where he puts the fat guy in the scanner anyway and it breaks. Now they make scanners that can hold heavier people, but those are way less common than you think. Even “bariatric surgery” centers - you know, those places that give weight loss surgeries - don’t often have them.

“Yet CT or M.R.I. imaging is needed to evaluate patients with a variety of ailments, including trauma, acute abdominal pain, lung blood clots and strokes. When an obese patient cannot fit in a scanner, doctors may just give up. Some use X-rays to scan, hoping for the best. Others resort to more extreme measures. Dr. Kahan said another doctor had sent one of his patients to a zoo for a scan.”

If you think having a doctor tsk over your weight is humiliating, try being told you have to go to the zoo and use the elephant scanner.

Now, even if you can get a doctor to listen to you, and to figure out a way to diagnose what is wrong, you can run into complications with your medications.

There are several cases of doctors missing cancer because of fat bias, but even when it is diagnosed, there are problems. “Drug doses are usually based on standard body sizes or surface areas. The definition of a standard size, Dr. Hudis said, is often based on data involving people from decades ago, when the average person was thinner. For fat people, that might lead to underdosing for some drugs, but it is hard to know without studying specific drug effects in heavier people, and such studies are generally not done. Without that data, if someone does not respond to a cancer drug, it is impossible to know whether the dose was wrong or the patient’s tumor was just resisting the drug.”

There is also a problem with anesthesia. If an obese person can get their condition treated, and it needs surgery, they can run into problems. “There are no requirements for drug makers to figure out appropriate doses for obese patients. Only a few medical experts, like Dr. Hendrikus Lemmens, a professor of anesthesiology at Stanford University, have tried to provide answers.”

It turns out that some anesthesias should be counted by lean body fat, not total body fat, and using “average” person numbers leads to overdoses for obese people. This leads to complications after surgery. Oh, and you know why so many doctors won’t do knee or hip replacements in obese arthritis patients until they fall below some magic and arbitrary BMI line? Because they don’t want their percentage of complication-free surgeries to come down. Well maybe if you gave us the right doses of anesthesia we could help you with that!

Now, as we know, all of this medical fat shaming doesn’t help. Well science is finally on our side! “"Stigmatization of obese individuals poses serious risks to their psychological health. Research demonstrates that weight stigma leads to psychological stress, which can lead to poor physical and psychological health outcomes for obese people."”

One specialist noted, “"It's not unlike the way we treated depression 40 years ago. Only, instead of telling people to 'get over it', we say, 'just eat right and exercise.' We know there are economic, cultural, political and environmental elements causing this problem, yet our approach to treatment puts sole responsibility on the patient's behavior."”

So, what can we do about this? Most of us might be inclined not to go to the doctor at all. I’ve certainly fallen into this category. But, Healthline offers some other advice. “If a practitioner automatically advises weight loss, with no regard for symptoms or thorough examinations, one of my go-to responses is to ask them how they’d handle the situation if dealing with a thin patient. Would their diagnosis be the same? Would they prescribe weight loss rather than blood work, physical therapy, X-rays, or medication?”

You can also ask not to be weighed, or give them a letter at the start stating that you would like to focus on your health and not your weight. And, of course, if that doesn’t help, find a doctor who won’t fat shame you. More and more of them are being trained in this, and it is spreading.

So that’s it for today! Like I said, heavy topic but far too relevant to most of us.

This has been Roly Poly Weight loss. As always, I am your host, Roly Poly. Share your stories, with the hashtag #FatShaming. And please use this as a safe space to discuss your own experiences.

And please join me next time!

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