If I run fast enough

Since I discovered Health At Every Size^®, going to see the doctor has become a lot more fraught. I’m never sure what kind of reception I’m going to get. Will they mention the W word?

So far, I’ve been lucky. Or maybe I just have good doctors, who when I go in with a chest infection, don’t suggest it might improve if I were thinner. But even so, the journey to the doctors’ surgery is a maelstrom of anxiety. Will there be a confrontation? What will I say if they suggest I should go on a diet, get on a scale, or even that I should maybe consider bariatric surgery?

I rehearse scenarios in my head. Do I want to go with sarcasm? Passive-aggressive mock innocence? Throw the literature at them? Do I make them feel foolish? Do I frame it as a respectful discussion between equals? Do I just go at them with such finality as to invite no further input on their part?

By the time I get there, I’m ready. And it comes as almost a disappointment when nobody mentions my weight at all.

And then last week I found myself in a somewhat shakier position. There is a medication that I have to take than can have negative impact on kidney function, and so a few weeks ago I was booked in for my annual blood work check-up. Last week, I went for the results. This time around, the questions in my head were slightly different. How would I defend my position if my fasted blood glucose was high? If my lipids weren’t great? If my blood pressure was raised? I’ve been eating on the run a lot lately; intuitive eating has been a challenge. Probably less protein and more sweeties (that’s candy to you folks across the Atlantic) than I would normally choose. Plus, I’ve been more or less incapacitated by shin splints and Achilles tendonitis for quite a while now, so I’ve not been exercising. Fat and fit? Not me. Fat and couch-bound more like. Not to mention I was a heavy smoker before giving up just over 10 years ago — would my puffing history finally catch up with my arteries? So I was definitely worried.

What would happen to my smug superiority if my health were actually compromised by a condition that would most likely be attributed to my weight? Even though I’ve been fat and healthy for a long time. Even though thin people get diabetes, hypertension, and high cholesterol too. What would it mean for my Size Acceptance activism if I were diabetic?

I ran through how I would deal with each possibility. I’d say all of the above and more. I would ask them to give me the same advice that they would give a thin person with the same condition. I would ask them to support me more in sorting my musculoskeletal problems so I could get moving again. And I would remind them that even if they could conclusively prove that weight loss would fix all my problems, there is not a shred of evidence that any form of weight loss is sustainable long-term in more than a small minority of people and, conversely, that the process of losing and gaining weight over and over has definitely been shown to be harmful to health. And then they called me in.

My blood sugar was fine. My LDL-cholesterol (the bad type) was a fraction raised, but my HDL-cholesterol (the good type, the one that increases with exercise, the one that I was worried about) was also high. So overall, my cholesterol levels looked good. My risk index was 4%. He took my blood pressure. Astonishingly, following this whole rigamarole, it was squarely in the normal range. He was happy. And then he asked me to get on the scales. I said no.

This is the first time I’ve had to do this and my heart was pounding a little faster. Believe it or not, I don’t really like confrontation. “You don’t want to be weighed?” he asked.

“Not unless you have a good reason to weigh me,” I said. “If you were giving me a drug that required a weight-based dosage, for example. I don’t see why you need it. I’m fat. You have my blood work. I’m fine.”

“OK,” he said.

And that was that. A mini-victory. Later, it occurred to me that he probably thought I didn’t want to be weighed because I felt bad about my weight, rather than realising it was an intellectual protest at the ridiculousness of measuring health by a number on the scale. But it was a start.

For the next day or so, there was a pervasive sense that if I run fast enough, maybe my fat won’t catch up with me. That I had gotten away with it this time. That my fat had not caught up with me yet. I knew this was wrong. That all of the above arguments still held even if I did have high blood pressure or high cholesterol. That I was allowed to refuse “treatments” that didn’t work and that caused additional harm. That even if I was an unhealthy fat person, I was still deserving of the utmost respect and entitled to evidence-based healthcare. It occurred to me later that none of this worry was related to what if I was diabetic or had heart disease or was in any way related to my actual health. It was all to do with what if I was sick and fat? What would this mean for how I was looked at, treated, judged? Just one more way that weight stigma impacts on people living in a fat body; just one more example of how health is not about health at all.

Compared with some of the horror stories I have heard from other people, I have been very lucky with the care that I have received in the last few years. But I shouldn’t have to spend weeks preparing myself mentally any time I want to access a physician, simply because I wear the “wrong” dress size. One day, this will change. And I will continue to fight for that, whatever my blood work says.

And since I originally wrote this post, the wonderful Ragen Chastain has developed a set of postcards you can carry with you to use in situations like this. Find out more here.