Dear Healthcare Providers

Dear Dr. K., Dr. M., Dr. P.,

When I was a kid, I thought I could never be like you. You who put my grandma on a waitlist to get better. She was almost there, but then she passed away because you didn’t see that there was something wrong with her. You who failed to see that my mom had a severe kidney infection and sent her home, only to have her come back in a few days in severe pain and needing to be hospitalized overnight. You who refused to see my godmother when she was pregnant because she was “too high risk”. You could have said your caseload was full but you belittled her and made her feel unfit until she ran out crying. You who denied giving me birth control because “the condom gets the job done”, ignoring the pain I was in when menstruating.

When I was sixteen, I started to make excuses for you. I acted like you did your best. That there were good reasons for you failing me. That you did what you were required to do. I like to think that you regretted the mistakes that you made, that you thought about what went wrong, but you clearly don't see it this way. I started putting you on a pedestal, thinking you were heroes that were doing more good than bad. I realized that I was called to the medical field because I wanted to help people the way you did. I wanted to be like you, but also change the field in a good way so that all people would be helped.

I decided to get educated. I started down the traditional path, but there was a lack of discussion about how to treat people properly, how to be compassionate, how to connect with people of different identities, so I changed my degree. I took the five base classes, and then looked to psychology to learn about human beings, their behaviors, their motivations, their needs. From there I was drawn to social justice, so I started working towards a minor in Gender, Sexuality, and Women’s Studies. In these courses, I immediately began to notice that the medical field was lacking when it came to treating people of various identities.

So, is fatness a feminist issue? YES!!! Bergan (2009) writes “As a man I'm a big dude….As a woman I’m revolting” (p. 141). Dr. K., did you see Regina as nothing other than her size? Aside from being pregnant at an older age, nothing was high risk about her pregnancy. You had no reason to make her feel bad about herself or guilty about her decision to have a child. Eugenics has led people to believe that there are undesirable bodies that should not reproduce (McPhail, 2016). Were you worried her child would be fat, so you made it clear that she was ‘too at risk’ for you to see her. If C had been born fat, would you have been one of the people who blamed R for her child’s weight? Freidman (2015) writes about child obesity as something that falls under the realm of child protection. If a child is deemed obese or overweight, the child is at risk of being removed from the mother’s care. If the baby was fat, would you have blamed R because she clearly made her child fat by being fat, and not considered some of the many factors that affect one’s body size? Would you have recommended that they remove a toddler from her home because clearly the mother made her fat? I have never seen R break down or doubt her ability to be a good mother, but your comments really hurt her. If it's brought up she will tear up to this day.

I know that as a physician you probably feel the need to help people fix their weight. You don’t want them to be unhealthy so you prescribe that they lose the weight, but frankly that’s not how the human body works. In an attempt to understand the implicit and explicit biases that physicians hold, Sabin et al (2012), used the implicit association test and self-report measures. Most of the physicians reported not feeling competent enough to treat obesity. Most showed a strong preference for thin bodies; however, women showed lower biases. You know I have taken the IAT a few times, but on the weight one I had a slight preference for fat people over thin people. There are a lot of fat, thicc, curvy, bootylicious people in my life who I love and respect. This result really made sense to me because I was told that there was nothing wrong with being bigger by some of my family growing up.

I may have these preferences being a woman of color and being around POCs all the time. In some non-Western societies, fatness is seen as healthy, fertile, and wealthy. In the United States of America, a slender body is preferred over a fat one (van Amsterdam 2013). Fujioka, et al (2009), examined the way black and white college-aged women perceived themselves in terms of their size. For black women, the more secure they were in their racial identity, the less desirable they viewed thin bodies. White women found thin bodies most desirable, and were less secure in their racial identity. Back to R though, I did wonder with this whole thing if maybe you had an issue with a black, fat, pregnant woman. It is known that historically, women of color were forcibly sterilized so that they would be unable to reproduce. They were also disproportionately targeted in these scenarios (Jolly 2016). Did you have an implicit bias that fat women or black women should not be allowed to reproduce? Did you feel neither should? Dr. K, I want you to take the IAT and check your positionality and privilege because you clearly need to treat your patients better.

Dr. P, you truly broke my heart. I know I was never your patient, but Ollie saw you wanting to get on testosterone. Their BMI was enough to be considered ‘obese’, and you said they had to go down one weight category to get on HRT. What would happen if Ollie, had come back into your office pregnant. They did not have bottom dysphoria so they were not planning to operate. Pregnant bodies are so gendered in our society. If you are pregnant, you are assumed to be a woman. It has been proven that bodies that do not adhere to society's expectations of the ‘perfect’ pregnant body face discrimination in our society. For trans* folks, especially fat trans folks, there can be a lot of shame and blame associated with pregnancy. This could be a result of the physicians’ biases, but physicians may feel inadequate to treat trans* folks (Sojka & Sanchez 2019). Dr. P, you can’t advertise that you're a champion for trans* healthcare, but discriminate against certain bodies.

Dr. M, you’re up. I saw you for the majority of my childhood. You saw my future plans change from ballerina to archaeologist to author and finally to physician. I always looked up to you, being a black man and becoming a physician in the 1970s could not have been easy. Being top of your class at Columbia, and choosing to go into private practice after years being a top pediatric surgeon was so inspiring. You telling me about the meaning of life and supporting me through hard times was the first time any physician showed any interest in me aside from the reason I was in their office. I never had any issues coming to you until I was in high school, and I just assumed you were right because you were the ‘expert’. What I never considered until recently was that I was gaining weight around this time.

Fikkan and Rothblum (2012), discuss how physicians are more likely to suggest weight loss for women than for men. I remember when I was having bad side pains, you told me to take vitamins and laxatives to have regular bowel movements. When they didn’t go away, you asked how much I exercised. Physicians are more likely to diagnose women as obese, which is funny because BMI is not gendered. This clearly shows a bias that physicians have against fat women. Saguy (2012) talks about how this is a budding field of research and how there needs to be more done to understand the ways in which people can be less discriminatory toward fat people.

After learning this I made a decision: I am not going to be like you. Yes, I may want to be a physician, and yes, I may want to put my life on hold for twelve years to have the two letters behind my name, but I will not be like you. I will not measure a person’s worth based on their weight.

I was always told that I did not have the body that society wanted me to have. Being a dancer, I was constantly compared to other people and many of the parents told me they were concerned about my performance because of my weight gain. The funny thing was that year was my best performance at nationals, and my team qualified for worlds. Despite all of this, I kept taking laxatives daily, and spent six hours in the gym at a time.

I wish I could go back to that version of me and tell her all about the HAES (Health at Every Size) approach. This is an approach to health that is not focused on weight or BMI, but the overall health of the individual. This model has five main principles: weight inclusivity, health enhancement, respectful care, eating for well being, and life enhancing movement (ASDAH 2020). The idea behind this is that instead of focusing on weight, the person is able to live a healthier life by listening to their body’s needs.

Something interesting that you may not realize is that your diagnosis of losing weight or being healthier, is often inline with the HAES principles. Bacon and Aphramor (2011) discuss the well proven fact that dieting is ineffective. Weight cycling is more unhealthy for a person than if they were to stay one constant weight, whether fat or thin. This is so important because in the USA especially, there is an obsession with dieting and weight loss. One of the main contributors to this is capitalism. The weight loss industry makes over sixty billion dollars a year. It is no wonder that diet companies like Weight Watchers are constantly being advertised on television, magazines, social media, etc. Basically if society shoves dieting down our throats, we will feel ashamed of our bodies, and look to these companies to ‘fix’ them.

All my life, I was always so sure about everything I wanted. I knew I was going to college, would have a strong career, a loving partner, maybe a family, and I would have the means to take impromptu trips around the world. Five years ago, I was so sure that I was going to become a doctor. I have even sent my application out all over the country so that this could happen, but now I have had a lot of trouble accepting the fact that I am going into a really broken system. Whether you look at sizeism or some other -ism, there is always something controversial happening in our medical system. I always think about the new show “New Amsterdam” where the main doctor is making sure to put a stop to these things at his hospital. He will say things about not complying and be praised, but why is it a white, straight man that is challenging these norms.

I still want to be a doctor, but I cannot be the rigid carbon copy that the system will try to chug out. The medical field will undergo a big change for me to be able to be compliant. If i cannot ensure my whole hospital is up to my standards, I would take steps to ensure that my whole staff is trauma informed, is competent when it comes to the -isms, and knows that any sort of bias or discrimination will not be tolerated on my floor. I will not be compliant when higher ups request care that is not good for the patient. I will take a holistic approach to allow for all of my patients’ needs to be met. I will refuse to break the Hippocratic oath by being intentional in my care approach because I am not like you. I have never been like you, and I refuse to ever be like you.

Sincerely,

Alana Rae Martinusen

References:

Bacon, L., & Aphramor, L. (2011, January 24). Weight science: evaluating the evidence for a paradigm shift. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3041737/

Fikkan, J., & Rothblum, E. (2012). Is Fat a Feminist Issue? Exploring the Gendered Nature of Weight Bias. Sex Roles, 66(9–10), 575–592. https://doi.org/10.1007/s11199-011-0022-5

Friedman, M. (2014). Mother Blame, Fat Shame, and Moral Panic: “Obesity” and Child Welfare. Fat Studies, 4(1), 14–27. doi: 10.1080/21604851.2014.927209

Fujioka, Y., Ryan, E., Agle, M., Legaspi, M., & Toohey, R. (2009). The Role of Racial Identity in Responses to Thin Media Ideals: Differences Between White and Black College Women. Communication Research, 36(4), 451–474. https://doi.org/10.1177/0093650209333031

Jolly, J. (2016). On forbidden wombs and transnational reproductive justice 1: Feminism, race, transnationalism feminism, race, transnationalism. Meridians, 15(1), 166-188. doi:http://dx.doi.org/10.2979/meridians.15.1.09

Mcphail, D., Bombak, A., Ward, P., & Allison, J. (2016). Wombs at risk, wombs as risk: Fat women’s experiences of reproductive care. Fat Studies, 5(2), 98–115. doi: 10.1080/21604851.2016.1143754

(n.d.). Retrieved from https://www.sizediversityandhealth.org/content.asp?id=76

Rothblum, E. D., Solovay, S., & Bergman, S. B. (2009). Part-Time Fatso. In The fat studies reader (pp. 139–142). New York: New York University Press.

Sabin, J. A., Marini, M., & Nosek, B. A. (2012). Implicit and Explicit Anti-Fat Bias among a Large Sample of Medical Doctors by BMI, Race/Ethnicity and Gender. PLoS ONE, 7(11). doi: 10.1371/journal.pone.0048448

Saguy, A. (2012). Why Fat is a Feminist Issue. Sex Roles, 66, 600–607. doi: https://doi.org/10.1007/s11199-011-0084-4

Sojka, C. J., & Sanchez, S. (2019). All People Deserve a Voice in Reproductive Care: Trans-Inclusion in Fat Studies. Women's Reproductive Health, 6(4), 259–264. doi: 10.1080/23293691.2019.1653578

van Amsterdam, N. (2013). Big fat inequalities, thin privilege: An intersectional perspective on ‘body size.’ European Journal of Women’s Studies, 20(2), 155–169. https://doi.org/10.1177/1350506812456461