Nov 7Liked by Mara Gordon, MD, Virginia Sole-Smith
I loved this discussion. The reality is that it has taken me 20 years to develop the relationship with my doctor to get her to a state in which she acknowledges me as a unique human and not just a fat person. So I’ve been very fortunate to have one consistent doctor for 20 years. But when I see other doctors for whatever reason (strep throat to broken foot kind of situations) it is normal for the Dr to tell me to lose weight. I don’t have the time and energy to manage those interactions. I can just say ‘what else’ as in ‘great, thank you for telling me to lose weight, but should we put a cast or something else on my broken bone’. It is exhausting, demoralizing and dehumanizing. I am glad we have doctors like Dr Mara. It’s gonna be generations until medicine changes. One day the common advice we’ve been receiving our whole life will be akin to bleeding fevers. I’m so sad the amount of energy this continues to consume.
Wow! This was a great episode and had me really reflecting on my journey to practicing medicine in a size inclusive way. I’m a psychiatrist so it definitely looks a little different for me, but it is really important work! I definitely worry about how I’ll be perceived in talking with other healthcare providers about this especially if I’m in person as I’m fat myself. One of my attending from residency described practicing in a weight inclusive/HAES type frame as feeling like you are wearing a tin hat since the weight centric paradigm is so dominant. I can feel that way with my patients as well at times, but I definitely feel it’s important for folks to hear from a doctor that their body is not a problem to solve. I think as a fat person I sort of bristle at the idea that weight loss might be a good option for managing a health condition just given what we know about the risk for eating disorders, harm of weight cycling and the fact that maintaining weight loss is impossible for the overwhelming majority of people. That might be an extreme take and I definitely appreciate Dr. Gordon’s approach to this topic. I’m lucky to have a PCP who is proudly HAES and does not weigh me or blame anything on my weight. Currently have a visit scheduled with a new doctor and already anxious about how to advocate for myself with someone new. I feel like it says a lot about our healthcare system that I feel that way even as a physician. I also want to shout out that reading your piece in scientific American was a very important step in my journey! Thanks to you both!
About 5 years ago, I was diagnosed with prediabetes. I got the results in the app with no context. When I messaged my Dr to ask about it, a nurse replied with the instructions to "cut out carbs." I was so discouraged by her reply, the insensitive communication that I have still done nothing about it. The stigma is real. I felt/feel shitty about it and so embarrassed that I've told no one in my real life except my therapist. We need better healthcare. That dr has since left the practice and I'm on the hunt for a new doc, but that process is so mind-numbingly frustrating and disappointing that I haven't yet started. We deserve better than this and I'm encouraged by this convo.
Nov 7Liked by Mara Gordon, MD, Virginia Sole-Smith
I'm about to move and ugh, finding all new providers for everything is daunting! I know it'll take a while for a directory to be compiled but I'm so glad that a resource like that is being put together by AWSIM! I'm going to have to find new doctors really quickly one because of ongoing medications that I'll need to get new prescriptions for on my new health plan, but also because I'm moving while still in ongoing recovery from a shoulder replacement surgery and will want to connect with a local orthopedic surgeon and physical therapist to make sure I'm on track in the later parts of rehab. A little scary but I'm ready to go in and set boundaries even if I can't immediately find someone weight neutral.
I follow Dr. Gordon’s Substack and was so excited to see her here! I’m also on the hunt for a new PCP and I wish she weren’t 4 hours away. We have a medical school here, but from what I’ve experienced at my specialist’s office they don’t seem to have found the Medical Students for Size Inclusivity yet. I’ve searched a few of the online “fat-friendly providers” lists that exist, but there are very few in my area. It’s too bad more size inclusive doctors don’t/can’t/won’t include that in their online bios. It’s hard enough to find one when all you have to go on is school credentials and board certification. I hope that the louder we are in demanding what we deserve, and the more Dr. Gordon and her colleagues speak out, the sooner we’ll see the paradigm change. We’ve already lost too many generations to medical fat phobia.
I also was wondering, though it's probably too late to ask Mara, about the impact of "obesity-first medicine" which has been receiving some rather glowing editorials by doctors recently. It seems rather like the OPPOSITE of weight neutral health in many ways.
I loved this episode- the why don’t you just go on a few more walks/jump on a treadmill type of “laid back” comment and the whole “your high blood pressure would go away if you lost 10-15 pounds” is basically my villain origin story. I’m not proud that I have skipped annual physicals when I had gained “too much” weight but seeking healthcare can be very hard even in a small fat body.
My grandma rapidly lost weight before her cancer diagnosis in January 2021 and she died in March 2021 so I think there needs to be some awareness around rapid body changes but most people will notice their body doesn’t feel right. She knew in December (and maybe before, my dad always thought my grandparents might have kept their gut feelings to themselves).
Thank you for the cat videos, I need to click on more on insta!
Loved this episode. Dr. Gordon gave such thoughtful guidance, as always. And I'm thrilled to learn about that new organization for medical providers.
On the topic of cat videos—one of the best birthday parties I threw for my daughter in elementary school was an "internet cat" theme. We put up posters (pages of old calendars) of Grumpy Cat (RIP) and L'il Bub (RIP), and the party guests watched a great 60-minute cat video compilation video on YouTube. For favors, we did fun magnets and buttons with cat memes. Maybe we did cat ear headbands, too. And the pièce de résistance: a "litter box cake" (delicious but not for the easily disgusted by that sort of thing).
Thank you for this conversation. I am sharing with a lot of family and friends who are just starting to realize that maybe the advice they have been getting to “just lose weight” isn’t really fixing their problems.
I must have the most progressive doctors this edge of the south. (Yes, Washington, DC is the south although few Washingtonians want to acknowledge.) I have five cardiologists, one clinical trial team, and one primary care physician. No one has ever asked me to step on an office scale. I must weigh myself at home daily to monitor fluid build up in lungs and heart, but my cardiologist trusts me to simply tell him when there's build up. He asks how much I've gained over night. It can be as much as 10 pounds of fluid, which is dangerous, so I must be fastidious. I've gotten used to capturing my dry weight each morning without shame in seeing the number. I've learned to separate medical reasons from judgment and vanity. I credit my medical team. They've helped me experience living in this body in a whole new way, a far cry from dysmorphia and disordered eating. I suppose we're never cured from those ills, but these days I'm finding myself grateful for my body rather than resentful of it. Thanks Docs.
So curious about this with regard to pregnancy. I had a BMI of 29 when I got pregnant with my VBAC baby. I passed my GD test. The OB was obsessed with the idea I might still have GD and it was missed, because I was so fat. He ordered an A1c test. Then I had to do another fasting test just in case.
My BP was mostly fine except for the day they told me my health insurance (new employer) didn’t work and then accused me of probably having pre-eclampsia because my heart was racing (yours would too if you had to pay hundreds of dollars while waiting for the new insurance to kick in). Then I had to do growth scans just in case (they overestimated his size by about 2 lbs; I said for Pete’s sake I’m a 5’8” viking, I will push out an 11lb baby if I want, stop threatening to cut me open). I had a spontaneous labor at 39w with an 8lb13 boy. No issues, no problems, the easiest birth in the world, and perfect health.
Postpartum, all my vitals are great, blood sugar, cholesterol, heart rate, whatever. I’m doing physical therapy so I can get back to working out. As far as I can tell, the only thing the above accomplished was stressing me the hell out. It’s really unclear to me how any of that could possibly have counted as prenatal care. I guess YMMV may vary and I know blood sugar issues can wreak havoc with placentas. But mine was fine. It was beautiful.
Thanks so much for sharing this, Liz! I'd love to point you to a really interesting (and challenging!) interview I did with Dr. Anna Whelan, a size-inclusive high risk pregnancy OB.
I really enjoyed this episode! I’m so happy to see and hear about more doctors getting on board with weight inclusive medicine!! I feel fortunate to have a GP who practices weight inclusive medicine which was huge for me since it was with her that I was diagnosed diabetic. She recommended an anti diet nutritionist and because I was open to taking medication we’ve now tried several to find the one that best manages my blood sugar levels with the least amount of side effects. I still struggle with being sent to specialists as now because I have diabetes on my medical chart they tend to lecture me on managing my blood sugar, which I believe is because I’m in a larger body as my blood sugar is actually really well managed right now (hooray for me!!), it’s frustrating and never fails to annoy me. I just got a lecture from my eye doctor literally right after I’d gotten my 3 month blood work back and both myself AND my GP were feeling SO happy with where everything is! The anti fatness runs deep.
This was suuuuuch an enlightening conversation — I feel like her approach to weight and health (and especially the nonjudgmental, nondogmatic way she responds to patients who express interest in losing weight) is so informative to me as a trainer who struggles so much with some of these things! Mara is awesome and I can’t wait for AWSIM (!) to have a robust provider directory ❤️
I loved this discussion. The reality is that it has taken me 20 years to develop the relationship with my doctor to get her to a state in which she acknowledges me as a unique human and not just a fat person. So I’ve been very fortunate to have one consistent doctor for 20 years. But when I see other doctors for whatever reason (strep throat to broken foot kind of situations) it is normal for the Dr to tell me to lose weight. I don’t have the time and energy to manage those interactions. I can just say ‘what else’ as in ‘great, thank you for telling me to lose weight, but should we put a cast or something else on my broken bone’. It is exhausting, demoralizing and dehumanizing. I am glad we have doctors like Dr Mara. It’s gonna be generations until medicine changes. One day the common advice we’ve been receiving our whole life will be akin to bleeding fevers. I’m so sad the amount of energy this continues to consume.
That sounds so difficult.
Wow! This was a great episode and had me really reflecting on my journey to practicing medicine in a size inclusive way. I’m a psychiatrist so it definitely looks a little different for me, but it is really important work! I definitely worry about how I’ll be perceived in talking with other healthcare providers about this especially if I’m in person as I’m fat myself. One of my attending from residency described practicing in a weight inclusive/HAES type frame as feeling like you are wearing a tin hat since the weight centric paradigm is so dominant. I can feel that way with my patients as well at times, but I definitely feel it’s important for folks to hear from a doctor that their body is not a problem to solve. I think as a fat person I sort of bristle at the idea that weight loss might be a good option for managing a health condition just given what we know about the risk for eating disorders, harm of weight cycling and the fact that maintaining weight loss is impossible for the overwhelming majority of people. That might be an extreme take and I definitely appreciate Dr. Gordon’s approach to this topic. I’m lucky to have a PCP who is proudly HAES and does not weigh me or blame anything on my weight. Currently have a visit scheduled with a new doctor and already anxious about how to advocate for myself with someone new. I feel like it says a lot about our healthcare system that I feel that way even as a physician. I also want to shout out that reading your piece in scientific American was a very important step in my journey! Thanks to you both!
Wynne! Thank you so much for sharing this. We would be thrilled to have you think about joining AWSIM - we are eager for mental health allies.
About 5 years ago, I was diagnosed with prediabetes. I got the results in the app with no context. When I messaged my Dr to ask about it, a nurse replied with the instructions to "cut out carbs." I was so discouraged by her reply, the insensitive communication that I have still done nothing about it. The stigma is real. I felt/feel shitty about it and so embarrassed that I've told no one in my real life except my therapist. We need better healthcare. That dr has since left the practice and I'm on the hunt for a new doc, but that process is so mind-numbingly frustrating and disappointing that I haven't yet started. We deserve better than this and I'm encouraged by this convo.
I'm about to move and ugh, finding all new providers for everything is daunting! I know it'll take a while for a directory to be compiled but I'm so glad that a resource like that is being put together by AWSIM! I'm going to have to find new doctors really quickly one because of ongoing medications that I'll need to get new prescriptions for on my new health plan, but also because I'm moving while still in ongoing recovery from a shoulder replacement surgery and will want to connect with a local orthopedic surgeon and physical therapist to make sure I'm on track in the later parts of rehab. A little scary but I'm ready to go in and set boundaries even if I can't immediately find someone weight neutral.
I follow Dr. Gordon’s Substack and was so excited to see her here! I’m also on the hunt for a new PCP and I wish she weren’t 4 hours away. We have a medical school here, but from what I’ve experienced at my specialist’s office they don’t seem to have found the Medical Students for Size Inclusivity yet. I’ve searched a few of the online “fat-friendly providers” lists that exist, but there are very few in my area. It’s too bad more size inclusive doctors don’t/can’t/won’t include that in their online bios. It’s hard enough to find one when all you have to go on is school credentials and board certification. I hope that the louder we are in demanding what we deserve, and the more Dr. Gordon and her colleagues speak out, the sooner we’ll see the paradigm change. We’ve already lost too many generations to medical fat phobia.
Thank you so much, Bev!! <3
LOVE this convo.
I also was wondering, though it's probably too late to ask Mara, about the impact of "obesity-first medicine" which has been receiving some rather glowing editorials by doctors recently. It seems rather like the OPPOSITE of weight neutral health in many ways.
Yes - I have been reading about this paradigm. I think my approach is literally the opposite. I will write a substack post about it soon. ❤️
Hi Dr Gordon! Thank you so much for replying! I already subscribe so I so much look forward to seeing you write about this.
I loved this episode- the why don’t you just go on a few more walks/jump on a treadmill type of “laid back” comment and the whole “your high blood pressure would go away if you lost 10-15 pounds” is basically my villain origin story. I’m not proud that I have skipped annual physicals when I had gained “too much” weight but seeking healthcare can be very hard even in a small fat body.
My grandma rapidly lost weight before her cancer diagnosis in January 2021 and she died in March 2021 so I think there needs to be some awareness around rapid body changes but most people will notice their body doesn’t feel right. She knew in December (and maybe before, my dad always thought my grandparents might have kept their gut feelings to themselves).
Thank you for the cat videos, I need to click on more on insta!
Loved this episode. Dr. Gordon gave such thoughtful guidance, as always. And I'm thrilled to learn about that new organization for medical providers.
On the topic of cat videos—one of the best birthday parties I threw for my daughter in elementary school was an "internet cat" theme. We put up posters (pages of old calendars) of Grumpy Cat (RIP) and L'il Bub (RIP), and the party guests watched a great 60-minute cat video compilation video on YouTube. For favors, we did fun magnets and buttons with cat memes. Maybe we did cat ear headbands, too. And the pièce de résistance: a "litter box cake" (delicious but not for the easily disgusted by that sort of thing).
Thank you so much, Oona.
Thank you for this conversation. I am sharing with a lot of family and friends who are just starting to realize that maybe the advice they have been getting to “just lose weight” isn’t really fixing their problems.
Just what I needed today. Thank you. And catfreakss. More butter is what I need right now literally and figuratively
I must have the most progressive doctors this edge of the south. (Yes, Washington, DC is the south although few Washingtonians want to acknowledge.) I have five cardiologists, one clinical trial team, and one primary care physician. No one has ever asked me to step on an office scale. I must weigh myself at home daily to monitor fluid build up in lungs and heart, but my cardiologist trusts me to simply tell him when there's build up. He asks how much I've gained over night. It can be as much as 10 pounds of fluid, which is dangerous, so I must be fastidious. I've gotten used to capturing my dry weight each morning without shame in seeing the number. I've learned to separate medical reasons from judgment and vanity. I credit my medical team. They've helped me experience living in this body in a whole new way, a far cry from dysmorphia and disordered eating. I suppose we're never cured from those ills, but these days I'm finding myself grateful for my body rather than resentful of it. Thanks Docs.
So glad to hear this. ❤️
So curious about this with regard to pregnancy. I had a BMI of 29 when I got pregnant with my VBAC baby. I passed my GD test. The OB was obsessed with the idea I might still have GD and it was missed, because I was so fat. He ordered an A1c test. Then I had to do another fasting test just in case.
My BP was mostly fine except for the day they told me my health insurance (new employer) didn’t work and then accused me of probably having pre-eclampsia because my heart was racing (yours would too if you had to pay hundreds of dollars while waiting for the new insurance to kick in). Then I had to do growth scans just in case (they overestimated his size by about 2 lbs; I said for Pete’s sake I’m a 5’8” viking, I will push out an 11lb baby if I want, stop threatening to cut me open). I had a spontaneous labor at 39w with an 8lb13 boy. No issues, no problems, the easiest birth in the world, and perfect health.
Postpartum, all my vitals are great, blood sugar, cholesterol, heart rate, whatever. I’m doing physical therapy so I can get back to working out. As far as I can tell, the only thing the above accomplished was stressing me the hell out. It’s really unclear to me how any of that could possibly have counted as prenatal care. I guess YMMV may vary and I know blood sugar issues can wreak havoc with placentas. But mine was fine. It was beautiful.
Thanks so much for sharing this, Liz! I'd love to point you to a really interesting (and challenging!) interview I did with Dr. Anna Whelan, a size-inclusive high risk pregnancy OB.
Check it out on my Substack, Chief Complaint: https://maragordonmd.substack.com/p/your-bodys-too-fat-to-carry-babies
I'd be honored if you'd give it a read.
I really enjoyed this episode! I’m so happy to see and hear about more doctors getting on board with weight inclusive medicine!! I feel fortunate to have a GP who practices weight inclusive medicine which was huge for me since it was with her that I was diagnosed diabetic. She recommended an anti diet nutritionist and because I was open to taking medication we’ve now tried several to find the one that best manages my blood sugar levels with the least amount of side effects. I still struggle with being sent to specialists as now because I have diabetes on my medical chart they tend to lecture me on managing my blood sugar, which I believe is because I’m in a larger body as my blood sugar is actually really well managed right now (hooray for me!!), it’s frustrating and never fails to annoy me. I just got a lecture from my eye doctor literally right after I’d gotten my 3 month blood work back and both myself AND my GP were feeling SO happy with where everything is! The anti fatness runs deep.
Thanks so much for sharing. I'm so glad to hear your PCP is size inclusive!
This was suuuuuch an enlightening conversation — I feel like her approach to weight and health (and especially the nonjudgmental, nondogmatic way she responds to patients who express interest in losing weight) is so informative to me as a trainer who struggles so much with some of these things! Mara is awesome and I can’t wait for AWSIM (!) to have a robust provider directory ❤️
Re cat videos: have you come across Mo the Cat Rapper? He is so wonderful. https://www.instagram.com/iammoshow?igsh=ZWxyOWpnYmlyN3c3
Thank you so much, Anna! That really means a lot. <3
I’m seriously going to re-listen to this interview periodically!
DELIGHTFUL