I was prepared to write my knickers into a twist about this:
Until I actually read the article it referenced: http://press.endocrine.org/doi/pdf/10.1210/jc.2014-3415
There is no doubt that pathologizing fat has not helped fat people any more than stigmatizing it has. There is also no doubt that the medical profession, generally, has a huge case of The Blind Dumb on the subject of weight and cholesterol. Further, there is no doubt at all that Big Pharma is hard at work trying to keep it that way.
There are passages in the actual medical article, especially the stuff about using weight loss drugs (which, no matter how efficacious, are NOT going to work long-term, and may be very dangerous in the short term), is The Usual Blather. It’s awfully hard to figure out why the article was even written/published (be interesting to know who funded it…there seems to be a sort of double-speak in the Financial Disclosure section…), because there’s nothing new in it. As near as I can tell, all it really offers is some convenient lists and charts, and mostly rehashes old info. Its main thrust seems to be that some drugs for some of the conditions associated with obesity (including psychological issues) have the side effect of causing weight gain, and that it would therefore be good clinical practice to try everything else first. That, and to push phentermine and its various cousins. Down near the bottom of page 5, there is a passing acknowledgement that permanent weight loss is extremely rare and very difficult to achieve without bariatric surgery. Which is neither entirely safe, nor always a long-term success. They talk some about Orlistat and how few side effects it has, and note that it is the only weight loss drug generally available in Europe. Interesting thought, that, since European countries tend toward speedier and less insurance-obsessed drug approval processes than those in the U.S. Maybe we don’t want to be taking anything even the weight-obsessed French won’t prescribe?
And, of course, Orlistat does have one side effect: famously, it makes you poop yourself. It works. You lose weight like crazy, but what dignity you might gain by being thinner, you definitely lose in bowel control. There’s also the teeny, tiny problem that all that weight inevitably comes back, thereby straining the very system its loss was designed to benefit. I’ve also never heard anyone talk about the immune system issues tied to taking a drug that mucks up your digestive tract, which someone ought to look into, given our increasing understanding about how crucial gut bacteria are to immune function.
Nonetheless, the article does not advocate for postponing other critical medical treatments or procedures until patients lose weight, as the xojane piece suggests. That being said, the writer does have perfectly good reasons for finding it fear-inducing. I have been told by a reputable doctor that I had flu because I was fat. I have met a woman who was, I’m guessing, 200 lbs whose doctor would not sign off on desperately needed knee-replacements until she “lost all the weight.” I suggested that she get a new doctor. We weren’t close enough for me to expound on her doctor’s sadism, but I’ll say it here. Doctors have absolutely been taught to treat fat as a catastrophic disease in and of itself. Combined with the cultural conversation about fat people consuming more than our share of resources/space/tax dollars/air, and the other thread that sees fat as a function of laziness/stupidity/greed/all of the 7 Deadly Sins, and the third thread about fat being repulsive/contemptible/threatening/invariably disabling/low-class, its no wonder that docs are so often such assholes to their fat patients. When you add in a pharmaceutical industry much more interested in selling drugs, and its legions of charming, persuasive, sample-spewing sales reps, you get a five-strand knot of considerable complexity. It explains; it does not excuse. There is no excuse. There is a ton of research out there about the dangers of weight loss drugs and surgeries, questioning the purpose and efficacy of cholesterol-lowering drugs, and affirming that treating fat people like we’re a lesser species tends to make us get fatter. Because knowing that you can’t trust a whole profession that is supposed to be dedicated to your welfare isn’t going to leave you feeling battered and frightened and panicky at all. Nope. Nuh-uh. Not at all.
Doctors who see their fat patients as human beings aren’t worth their weight in gold, they’re worth their fattest patient’s weight in gold. They’re rare and wonderful creatures. And they are out there. We just have to look a lot longer and sometimes farther to find them.
Whitney Thore, the star of “My Big Fat Fabulous Life,” spoke recently of finally finding an OB/GYN who didn’t lead with her weight after years and years of one after another who walked into the room (where she had her feet in stirrups–an already terrifically vulnerable position from which to have a conversation) and started in on her weight immediately. I’m of mixed mind about the show. On the one hand, she’s parlayed a kickass youtube video into an income-generating career in which she has a platform from which to speak sense and sanity about fat life. Good things. On the other hand, reality TV.
I have the same mixture of feelings about S. E. Smith’s piece for xojane. The anger and fear are legit and righteous (https://fathealth.wordpress.com/. And calling the medical profession out on their prejudices is important and ought to be done more and more frequently and more and more loudly. For those of us who are middle-class, educated, cis-hetero, white, and insured, I think it is a particular duty, because if we’re dealing with this shit, then just think of how it is for women who don’t fall into those categories. All the knee-jerk fat-prejudice plus the huge range of stupidities and insensitivities to which those women are subjected almost autonomically. It’s abusive. It’s bullying. It’s ethically unacceptable. It’s mean. And considering how many fat people have abuse or assaults in their histories, it’s particularly vile.
But panic and approaching all doctors as though they were The Enemy isn’t going to help us, either.