This made me think of the Tressie McMillan Cottom piece where she talked about her efforts to find an outfit to wear to the doctor's office that would get them to treat her well as a Black woman, and after years of trying all kind of fancy stuff and looking like a serious professional, the thing that did it was her Peloton century ride t-shirt.
I haven't been to the doctor since immediately pre-pandemic and I'm apprehensive about that. Largely around cholesterol, which I struggle with, and the pandemic has surely not helped my struggle. But I've definitely gained weight through the pandemic and I'm sure the two things will be raised together. I keep thinking "maybe if I spend a month trying to drive my cholesterol down, I can avoid that conversation..."
Thank you thank you thank you for this piece. Especially for complicating that it's not as easy as just saying no to weigh-ins, if you are saying no due to fatphobia. My brain thought *YES* and then immediately "oh no!" I have work to do!
I'd love more pieces (or recommendations of stuff by other people) of how to navigate medical settings when you're starting with a foundation of anxiety or distrust. I'm not comfortable disclosing my history of disordered eating or my sundry other mental/chronic illnesses and I'm doin just fine working on those on my own. But I know I do need care for other issues that might come up, and at some point general wellness and all that. But there are a lot of barriers, history of trauma, etc.
I've been thinking about this a bunch especially because right now in my area, the vast majority of doctor's visits continue to be remote - mine have all been on the phone. If there's something that needs to be physically looked at, you can go in, but all I've needed are prescription renewals, so I haven't seen my doctor in person for about a year. And if you're not there in person, they can't weigh you! I have hypothyroidism so I'm asked if my weight has changed, since that can be a sign my meds need to be adjusted, but that's it. I almost feel like phone visits have made me let my guard down. I don't know when I'll next see my doctor in person or if they'll want to weigh me when I go in, but I know I'm going to want to kind of hype myself up to refuse when it happens.
Thank you so much for this, Virginia. I absolutely have thin privilege and have been wondering if it would be helpful, in an effort to be a better ally, to decline to be weighed. Because of my history of disordered eating, I often close my eyes during the weigh-in (it's just an enormous trigger for me; I am actively working on my issues) and don't give a shit what the person weighing me thinks about that choice -- so it would be better for me to decline, and, you've helped me understand, better for others, too.
(The last time I had a physical, last summer, I weighed a bit more than is usual for me, and I went into a complete spiral in front of my doctor. She has been my PCP since I was 22 years old, 17 years; she knows all of my history, and when I told her what was happening, what I was feeling, she said, "Well, we should be as thin as we possibly can without making ourselves crazy." There I was sitting in front of her, clearly struggling HARD with "making myself crazy," thinking, this is your advice? I am, by all standards, medical and otherwise, thin -- and I'm still getting this garbage? It was the first time in all these years that she deeply disappointed me. And it was also my wake-up call that this must be what fat people deal with all the time. (I knew, but I didn't *know,* and I'm sorry for that, but now I am furious and am committed to doing and being better.)
I love any information you provide about being a good ally. I value being part of the Burnt Toast community because it has helped me hugely in my healing process, but also because it continually shows me ways that I can support other people.
Around me (Minnesota), it seems like a lot of doctors are starting to skip it a decent chunk of the time. Not all, of course, but some. Urgent cares and MinuteClinics seem to skip it entirely unless dosing a medication that requires it. My (sadly retiring) PCP wanted one when I came in for a physical after not coming for like eight years, but skipped it for all later appointments. Maybe it's because I'm obviously fat and they're just going "yep, obese". But, fingers crossed.
(I've always found it weird they get adults' height every time too. Adults' heights don't really change, and everything I can think of that would change your height also comes with a bucket-load of obvious symptoms)
Also lol at the "I just walked with my kids!" Every doctor has some one-quick-trick-it's-so-easy in their pocket. I've been told I will, somehow, accomplish dramatic weight loss if I just stop putting honey in my tea, and another told me to do Zumba for dramatic results (Zumba *specifically*, the aerobics videos I was doing weren't the right ones, apparently).
My worst experiences have been with gynecologists. When I entered menopause I was having weird bleeding problems, so I looked for a new gyn to work with me. The first one had a total fit about my weight (she herself was extremely thin). I'm new here on your substack and I don't know all the rules; is mentioning numbers not allowed? I'll say that my BMI at the time was 27. I went to a new gyn and said I didn't want to be weighed, and she became enraged and said she wouldn't treat me. Meanwhile, I'm still bleeding! Eventually I found a nurse practitioner who told me to go back on the pill for a year and then go off, and that took care of it. Was that so hard? At least I was old enough to stand up to these obsessive idiots.
I see that nurse-practitioner now as my primary care provider. I allow myself to be weighed, but when she walks in to the room and reads the stats, I say "Yes, I'm fat, I know I'm fat. There. You can put down that you 'counseled patient about her weight'". She just laughs and says "Okay." I hope she never retires!
I think it's important for parents to know that weight *loss* in kids isn't the only sign of an eating disorder or other illness that can be potentially detected by regular weight checks at office visits. *Failure to gain as expected* (i.e, falling off their growth curve in height and/or weight) is a red flag that something is wrong (so I'm a big fan of regular pediatric weight checks both to have lots of growth data points but also to catch signs of trouble as early as possible). Too many doctors take a "wait and see" approach in those cases, and it can be really dangerous. Waiting until a child has lost weight often means an eating disorder or other illness has progressed significantly and can be harder to treat. I know I'm a broken record on this topic, but I am so passionate about this!
Feb 22, 2022·edited Feb 22, 2022Liked by Virginia Sole-Smith
I really loved this one, thanks Virginia!
Side note - reading the bit at the end made me wonder: do they still weigh kids in schools? I'm in my late 30s now but I can remember this being an extremely trauma inducing experience back 25ish years ago when I was growing up. Hopefully they don't do this anymore!
Also, not to be a shill or anything (I have no affiliation with this company), but I've been a member of One Medical for my primary care for the last several years and it literally changed my experience of the health care system. I can't speak for all the providers they have, but the ones I've gotten have just been the best, even as a noticeably fat person. I've made recommendations to several friends in the last few years and all of them have raved as well. Downside is that One Medical only has offices in certain cities and near-in suburbs, but if you happen to be in one of their markets and are in need of a new primary care provider, check them out!
I'd be interested in hearing about how this differs for men and women? Seems as though all of the conversation around this topic is centered on people who identify as women, any male experiences? My instinct is that men aren't treated to the same scrutiny from their drs about their weight until it's much higher but I'm not sure if the facts back that up. Would love to hear from any people who identify as men.
This is super helpful to read. I fended off last year's conversation about the hockey-stick trajectory of my weight through my 40s (and a hell of a lot of grief and trauma, even before the pandemic) by opting out of being weighed and starting the appt by telling my provider about (a) the gym I'd joined and (b) my kid's ED. And it worked! But still felt shitty.
My 15-year-old's ED has made me a lot bolder about this stuff. Interestingly, as part of her recovery she was getting weekly weight/vitals checks at the pediatrician. Those have now tapered down to monthly, and she's allowed to do them in street clothes rather than changing into a gown. The nurses are *scrupulous* about doing blind weights, which I so appreciate. And then one night we go to the first driver's ed class and I have to fill in her weight on the stupid form for her learner's permit. (Her dietitian later suggested that my kiddo should just put down whatever number she feels like, rather than remotely worrying about accuracy.)
I'm going to the gynecologist next month (fun) and have been thinking about declining the weight check. I do have thin privilege and this is really helpful in thinking about how to have it be more than just an "I'll pass" conversation. Thank you!
I wish I had a ready answer this afternoon for the nurse who asked me what my weight was! I was in for a breastfeeding issue with my baby in my arms and she was like "I'm not going to ask you to put her down." And I had JUST read this piece, Virginia, but I had no clue what to say so I just ballparked my weight instead of pushing back. 🤦🏻♀️
Feb 22, 2022·edited Feb 22, 2022Liked by Virginia Sole-Smith
You were excellent on the podcast. I loved the details from dieting fanatics from the past. The professor was really unable to take in your points, and his comments on lifestyle seemed very out of touch (strange, given his profession!). I did think the moderator was pretty good. And I am glad that you clarified that when a skinny person goes to a doctor with knee pain, her experience is VERY different from someone else in a larger body. And I was so glad they brought up Michael Pollan, given that you addressed him earlier! Thank you for sharing the link.
I love what you said about wanting to be an A+ patient. Ugh. As someone prone to rule-following and people-pleasing, who used to be a nurse, and is married to a physician, IT ME. Thinking back to my birth experience, in which my husband and doula were instrumental in advocating for me, one of the hardest parts of the experience was feeling like a “difficult” patient.
I’ve been putting off my physical for a multitude of reasons, but because I have thin privilege, concern about being weighed or being “counseled” about weight management hasn’t been one of them. (Although, as I type this comment, I realize my BMI would in fact prompt that conversation, so now I’m grateful to be armed with the power to decline!) Such a good reminder to me that, while I’m feeling resistance to making an appointment, so many barriers to accessing healthcare exist for folks who don’t have the privileges I do.
Also, I want to recognize and express appreciation for your inclusion of the few medical scenarios in which a patient’s weight actually does matter. To be clear, BMI is bullshit in terms of correlating with one’s general health. But earlier in my diet culture deconstruction journey when I was raging about BMI, my husband (an anesthesiologist) shared his professional perspective with me. There are a couple of areas within his practice in which it is really important to have that information in order to keep patients safe, and also, numbers are necessary when a doctor (who’s never before seen the patient) needs to come up with a safe plan in the few minutes they have together in pre-op.
THANK YOU SO MUCH FOR THIS. Just ordered some of those cards about not wanting to be weighed! I've tried saying no in the past and got brushed off with the "just don't look at the scale" comment you mentioned. Good point that not looking makes it seem shameful! I don't have a great doctor right now so this is inspiration to look for a non-weight-obsessed one!
This made me think of the Tressie McMillan Cottom piece where she talked about her efforts to find an outfit to wear to the doctor's office that would get them to treat her well as a Black woman, and after years of trying all kind of fancy stuff and looking like a serious professional, the thing that did it was her Peloton century ride t-shirt.
I haven't been to the doctor since immediately pre-pandemic and I'm apprehensive about that. Largely around cholesterol, which I struggle with, and the pandemic has surely not helped my struggle. But I've definitely gained weight through the pandemic and I'm sure the two things will be raised together. I keep thinking "maybe if I spend a month trying to drive my cholesterol down, I can avoid that conversation..."
Thank you thank you thank you for this piece. Especially for complicating that it's not as easy as just saying no to weigh-ins, if you are saying no due to fatphobia. My brain thought *YES* and then immediately "oh no!" I have work to do!
I'd love more pieces (or recommendations of stuff by other people) of how to navigate medical settings when you're starting with a foundation of anxiety or distrust. I'm not comfortable disclosing my history of disordered eating or my sundry other mental/chronic illnesses and I'm doin just fine working on those on my own. But I know I do need care for other issues that might come up, and at some point general wellness and all that. But there are a lot of barriers, history of trauma, etc.
I've been thinking about this a bunch especially because right now in my area, the vast majority of doctor's visits continue to be remote - mine have all been on the phone. If there's something that needs to be physically looked at, you can go in, but all I've needed are prescription renewals, so I haven't seen my doctor in person for about a year. And if you're not there in person, they can't weigh you! I have hypothyroidism so I'm asked if my weight has changed, since that can be a sign my meds need to be adjusted, but that's it. I almost feel like phone visits have made me let my guard down. I don't know when I'll next see my doctor in person or if they'll want to weigh me when I go in, but I know I'm going to want to kind of hype myself up to refuse when it happens.
Thank you so much for this, Virginia. I absolutely have thin privilege and have been wondering if it would be helpful, in an effort to be a better ally, to decline to be weighed. Because of my history of disordered eating, I often close my eyes during the weigh-in (it's just an enormous trigger for me; I am actively working on my issues) and don't give a shit what the person weighing me thinks about that choice -- so it would be better for me to decline, and, you've helped me understand, better for others, too.
(The last time I had a physical, last summer, I weighed a bit more than is usual for me, and I went into a complete spiral in front of my doctor. She has been my PCP since I was 22 years old, 17 years; she knows all of my history, and when I told her what was happening, what I was feeling, she said, "Well, we should be as thin as we possibly can without making ourselves crazy." There I was sitting in front of her, clearly struggling HARD with "making myself crazy," thinking, this is your advice? I am, by all standards, medical and otherwise, thin -- and I'm still getting this garbage? It was the first time in all these years that she deeply disappointed me. And it was also my wake-up call that this must be what fat people deal with all the time. (I knew, but I didn't *know,* and I'm sorry for that, but now I am furious and am committed to doing and being better.)
I love any information you provide about being a good ally. I value being part of the Burnt Toast community because it has helped me hugely in my healing process, but also because it continually shows me ways that I can support other people.
Around me (Minnesota), it seems like a lot of doctors are starting to skip it a decent chunk of the time. Not all, of course, but some. Urgent cares and MinuteClinics seem to skip it entirely unless dosing a medication that requires it. My (sadly retiring) PCP wanted one when I came in for a physical after not coming for like eight years, but skipped it for all later appointments. Maybe it's because I'm obviously fat and they're just going "yep, obese". But, fingers crossed.
(I've always found it weird they get adults' height every time too. Adults' heights don't really change, and everything I can think of that would change your height also comes with a bucket-load of obvious symptoms)
Also lol at the "I just walked with my kids!" Every doctor has some one-quick-trick-it's-so-easy in their pocket. I've been told I will, somehow, accomplish dramatic weight loss if I just stop putting honey in my tea, and another told me to do Zumba for dramatic results (Zumba *specifically*, the aerobics videos I was doing weren't the right ones, apparently).
My worst experiences have been with gynecologists. When I entered menopause I was having weird bleeding problems, so I looked for a new gyn to work with me. The first one had a total fit about my weight (she herself was extremely thin). I'm new here on your substack and I don't know all the rules; is mentioning numbers not allowed? I'll say that my BMI at the time was 27. I went to a new gyn and said I didn't want to be weighed, and she became enraged and said she wouldn't treat me. Meanwhile, I'm still bleeding! Eventually I found a nurse practitioner who told me to go back on the pill for a year and then go off, and that took care of it. Was that so hard? At least I was old enough to stand up to these obsessive idiots.
I see that nurse-practitioner now as my primary care provider. I allow myself to be weighed, but when she walks in to the room and reads the stats, I say "Yes, I'm fat, I know I'm fat. There. You can put down that you 'counseled patient about her weight'". She just laughs and says "Okay." I hope she never retires!
I think it's important for parents to know that weight *loss* in kids isn't the only sign of an eating disorder or other illness that can be potentially detected by regular weight checks at office visits. *Failure to gain as expected* (i.e, falling off their growth curve in height and/or weight) is a red flag that something is wrong (so I'm a big fan of regular pediatric weight checks both to have lots of growth data points but also to catch signs of trouble as early as possible). Too many doctors take a "wait and see" approach in those cases, and it can be really dangerous. Waiting until a child has lost weight often means an eating disorder or other illness has progressed significantly and can be harder to treat. I know I'm a broken record on this topic, but I am so passionate about this!
I really loved this one, thanks Virginia!
Side note - reading the bit at the end made me wonder: do they still weigh kids in schools? I'm in my late 30s now but I can remember this being an extremely trauma inducing experience back 25ish years ago when I was growing up. Hopefully they don't do this anymore!
Also, not to be a shill or anything (I have no affiliation with this company), but I've been a member of One Medical for my primary care for the last several years and it literally changed my experience of the health care system. I can't speak for all the providers they have, but the ones I've gotten have just been the best, even as a noticeably fat person. I've made recommendations to several friends in the last few years and all of them have raved as well. Downside is that One Medical only has offices in certain cities and near-in suburbs, but if you happen to be in one of their markets and are in need of a new primary care provider, check them out!
I'd be interested in hearing about how this differs for men and women? Seems as though all of the conversation around this topic is centered on people who identify as women, any male experiences? My instinct is that men aren't treated to the same scrutiny from their drs about their weight until it's much higher but I'm not sure if the facts back that up. Would love to hear from any people who identify as men.
This is super helpful to read. I fended off last year's conversation about the hockey-stick trajectory of my weight through my 40s (and a hell of a lot of grief and trauma, even before the pandemic) by opting out of being weighed and starting the appt by telling my provider about (a) the gym I'd joined and (b) my kid's ED. And it worked! But still felt shitty.
My 15-year-old's ED has made me a lot bolder about this stuff. Interestingly, as part of her recovery she was getting weekly weight/vitals checks at the pediatrician. Those have now tapered down to monthly, and she's allowed to do them in street clothes rather than changing into a gown. The nurses are *scrupulous* about doing blind weights, which I so appreciate. And then one night we go to the first driver's ed class and I have to fill in her weight on the stupid form for her learner's permit. (Her dietitian later suggested that my kiddo should just put down whatever number she feels like, rather than remotely worrying about accuracy.)
I'm going to the gynecologist next month (fun) and have been thinking about declining the weight check. I do have thin privilege and this is really helpful in thinking about how to have it be more than just an "I'll pass" conversation. Thank you!
I wish I had a ready answer this afternoon for the nurse who asked me what my weight was! I was in for a breastfeeding issue with my baby in my arms and she was like "I'm not going to ask you to put her down." And I had JUST read this piece, Virginia, but I had no clue what to say so I just ballparked my weight instead of pushing back. 🤦🏻♀️
You were excellent on the podcast. I loved the details from dieting fanatics from the past. The professor was really unable to take in your points, and his comments on lifestyle seemed very out of touch (strange, given his profession!). I did think the moderator was pretty good. And I am glad that you clarified that when a skinny person goes to a doctor with knee pain, her experience is VERY different from someone else in a larger body. And I was so glad they brought up Michael Pollan, given that you addressed him earlier! Thank you for sharing the link.
I love what you said about wanting to be an A+ patient. Ugh. As someone prone to rule-following and people-pleasing, who used to be a nurse, and is married to a physician, IT ME. Thinking back to my birth experience, in which my husband and doula were instrumental in advocating for me, one of the hardest parts of the experience was feeling like a “difficult” patient.
I’ve been putting off my physical for a multitude of reasons, but because I have thin privilege, concern about being weighed or being “counseled” about weight management hasn’t been one of them. (Although, as I type this comment, I realize my BMI would in fact prompt that conversation, so now I’m grateful to be armed with the power to decline!) Such a good reminder to me that, while I’m feeling resistance to making an appointment, so many barriers to accessing healthcare exist for folks who don’t have the privileges I do.
Also, I want to recognize and express appreciation for your inclusion of the few medical scenarios in which a patient’s weight actually does matter. To be clear, BMI is bullshit in terms of correlating with one’s general health. But earlier in my diet culture deconstruction journey when I was raging about BMI, my husband (an anesthesiologist) shared his professional perspective with me. There are a couple of areas within his practice in which it is really important to have that information in order to keep patients safe, and also, numbers are necessary when a doctor (who’s never before seen the patient) needs to come up with a safe plan in the few minutes they have together in pre-op.
Virginia, I just want to say I appreciate your work so much. <3
THANK YOU SO MUCH FOR THIS. Just ordered some of those cards about not wanting to be weighed! I've tried saying no in the past and got brushed off with the "just don't look at the scale" comment you mentioned. Good point that not looking makes it seem shameful! I don't have a great doctor right now so this is inspiration to look for a non-weight-obsessed one!