News from the front lines of fatphobia
Your girl keeps getting asked about Ozempic
Hello everyone! It’s been a busy few weeks around here fighting the good fight against fatphobia in health care. Is everyone sick of talking about Ozempic yet?
Doesn’t seem like it. Seems like it’s almost every day that mainstream media outlets have a new story about Ozempic and medications like it. (Have to wonder who’s on Novo Nordisk’s payroll.) Luckily, it also seems like readers are interested in hearing from a doctor who doesn’t push weight loss, and I’ve been honored to be invited to talk about my work as a size-inclusive physician in a variety of different settings.
Here’s a roundup of some of my recent media appearances:
I was on an episode of NPR’s Life Kit talking about the relationship between body shame, size-inclusive medicine, and Ozempic. Not a topic for the faint of heart!
Credit: Nicole Xu for NPR
I also got to go on live (!!) radio with Connecticut NPR in a roundtable talk on their weekday talk show Where We Live.
For that appearance, I was on a panel with two “ob*sity medicine” doctors and a researcher who studies body image and social media. Honestly, the other doctors seemed quite compassionate and advocated for a much more comprehensive portrait of health and wellbeing than just reduction in body mass index.
But I did take issue with some of the metrics they used: talking about weight loss as a goal of treatment, and even the way they described their area of expertise as “ob*sity medicine.” (What would be a better term? Maybe just… endocrinology?)
After the live radio, we all chatted on Zoom, and one of the other doctors said, “We should all stay in touch and see if there are opportunities for collaboration!” It was just chit chat, but it did make me think: are we on the same team? In a grand sense, yes, we all want to do right by our patients. But we do have pretty different approaches, and sometimes it can be hard to tell the difference.
The language of body positivity gets co-opted so frequently, it can be hard to tell what it means. For example, almost every ob*sity medicine doctor I’ve ever spoke to says they advocate a shame-free, judgment-free approach. They say they treat the whole person, not a number on the scale. Yet they still weigh their patients. They still use weight loss as a sign of success.
And over in my world, I have completely stopped directing my patients to lose weight. Yet I can’t tell you the number of new patients who have shown up to my clinic, saying, “I saw you on TV! I’m here because I want a size-inclusive doctor. Also, can you prescribe me Ozempic?”
I don’t necessarily begrudge my patients for wanting to be thinner and wanting to find peace with their bodies — the diet industrial complex is powerful, after all — but I have to chuckle. I’m not sure you were really paying attention to what I said, I think to myself when this happens. Lots of people think I’m an “ob*sity medicine” doctor, which I definitely am not. But it can be hard to tell the difference, when everyone uses the same language.
I was also thrilled to get to speak with the brilliant philosopher Kate Manne for NPR about her new book, Unshrinking. Talking to her was so affirming and thought-provoking — and I had to cut most of it for the strict word count!
We talked about lots of different issues, but given that I’m a doctor and the piece was for NPR’s health section, we focused on fatphobia and health care. And boy, is there a lot to unpack there.
Here’s one of my favorite quotes from the interview:
Fatphobia wears a lab coat, because it's dressed up as medical fact in ways that I don't think reflect the complex relationship between weight and health. It gives it a kind of legitimacy that makes it very hard to push back against for people who are trying to resist it as a form of prejudice, as a form of bigotry. Many people, they hear behavioral advice [from a doctor, like being told to “exercise more!”] and hear it as being told to shrink themselves.
You can read my interview with Unshrinking author Kate Manne here.
Thanks for reading, and as always, I welcome your feedback and thoughts. Stay in touch.
I just found you via a recent NPR article. I posted quite a bit about my personal saga on Kate Manne's article about the Oprah special. No matter our understanding of our fat phobic culture we have to live in it, for me I HAVE to participate to LIVE. I'm 61 and have CKD from dehydration after living 30 years colon free. I have a high output ileostomy. I also have T2 that was previously in control with low doses of glip and metformin. Once I got CKD I had to switch to insulin due to contraindications. At 224 I was deemed too fat to live by the kidney transplant industry. Both the University of Minnesota and Mayo won't even do intakes for fat folks with CKD. Mayo just started a bariatric CKD program that requires bariatric surgery prior to getting on the kidney list. Luckily Hennepin County Medical center is more "liberal." Even they wouldn't list me until I got below 200 lbs and "got stronger." They never could define what that meant. I passed the heart stress test and passed a stupid 6-Minute Walk Test (6MWT). The nurse who gave me the walking test was shocked when she saw me. She'd been told I was morbidly obese and would likely fail. I didn't of course. But since I'm 5'3" my BMI was in the MORBID category along with people who weight 1200 pounds. I got under 200 on Ozempic. but I started bouncing back up when my hunger returned. I go to the YMCA 5 nights a week, after work, for 2-4 hours. I usually close the place down. 8 months ago I switched to Mourjaro and AFTER I could stop insulin I got down to 178. I've plateaued though. This was my set point when I was in my 20s. I'm 61 now. I can't imagine ever getting smaller. I've been fat since childhood, my high school weight was 175. I eat once a day and am definitely malnourished. My short small intestine doesn't absorb much. I have 4 different medical diets that all contradict each other - CKD, T2, weight loss and ileostomy. The ileostomy diet has to win because I've had terrible blockages from eating mushy green beans, broccoli and such. My Endo keeps telling me to get under 800 calories a day to lose weight. Since I'm post menopausal and have the slowest metabolism out there. (I shiver with chills when I eat since my blood rushes to my stomach!) I need far fewer calories than the standard recommendations. At 2000 or 1500 calories a day I gain weight. I was healthier at 224, but I couldn't get on the kidney transplant list. While 61 seems old to many, I work full time, have a husband and adult child, am involved in my community and I'm not ready to give in yet. I say I've been busy dying for 46 years, I was a teen when I got ulcerative colitis. I've fought far too hard to stay alive to give in. It doesn't matter that there are NO scientific studies indicating someone at my size would waste a kidney. In fact , the only studies out there say people my size LIVE LONGER on dialysis than skinny people. Meanwhile skinny people, including malnourished anorexics can get on the transplant list. For all I've been though - which is way more than this comment - I still don't have it as bad as POC have had for years. While the racist eGFR for POC ended last year. The institutional and cultural racism that make CKD a leading killer of POC. I HAVE to stay on MJ, I HAVE to stay "compliant," I HAVE to jump though every hoop they give me so I can last the 6 year wait for a kidney. I actually just went inactive on the list because my eGFR has climbed from a low of 7 to 30. But I still have CKD and I will need a kidney to live. Although I'm now inactive, I HAVE to "keep up the good work" and keep trying to reach the weight I was at in 3rd or 4th grade. It would be optimal you know, for me to get to 100 lbs. HA! HA!.
I forgot to mention my latest humiliation - not based in science! I got a dental cleaning last week. In BOLD red font and exclamation point my chart indicated I was Obese. It was bold and bright on my screen used by the dentist and hygienist. Of course my first thought was, "It's wrong. I've lost 25 more pounds since then." BUT it really shouldn't be there at all! It has no impact on my dental health. I'm sure it's tied to the myth that fat people eat candy all day and are so slovenly we don't brush our teeth or bathe. ARRGH!