“I just care about your health”
Do you? Do you really? Alright then, let’s start by defining health. I’ll go first. Health is rather impossible to define. It’s easier to say what health is not than what health is. Health is not the mere absence of disease. Even the WHO agrees with that one.
Health is not just physical. It is emotional, mental, social, environmental and financial (to name a few). Health is not something we have any real control over, no matter what doctors have been led to believe during their careers.
Health is not static. It changes over time. It differs across cultures and communities. It is impacted by disease but it is not underpinned by it. Someone can have a serious illness or disability and consider themselves healthy. Someone else could have a seemingly minor complaint and consider themselves unhealthy.
In fact, you can ask anyone to define health and I bet you they will come up with a slightly different answer. Health is impossible to define, and if it is impossible to define then it is impossible to measure. So perhaps we should stop talking in terms and start talking about “health beliefs”.
Let’s face it, when doctors use the word “health” they are usually thinking in very narrow terms. Blood pressure, cholesterol and HbA1c seem to be the three most important elements of “health”. Perhaps some of us broaden our definition to include cancer risk or joint health. Some may even be brave enough to include mental health!
But instead of being specific, we use the word “health” because it’s convenient. It’s a type of get out of free card that say “I can be as shitty as I want to be but I’m doing it for your health so it’s OK”.
"The evidence says...”
Oy! ‘The evidence says’ people are the worst. Because there is a LOT of evidence that says being fat is bad for you. Of course, all of this evidence (and I mean all of it) is materially flawed. It does not consider fundamental confounders such as weight cycling and weight stigma. It’s about as useful as a chocolate teapot.
But it exists not only in the numerous medical journals where fatphobic papers that have no business passing peer review are published routinely, but in our social consciousness. We’ve all been taught that fat is inherently bad for your health. Any evidence to the contrary is simply dismissed. We call this cognitive dissonance.
But what does the evidence really show us? Firstly, there are a disproportionately higher number of fat people with certain medical conditions. Secondly, the relative risk of said conditions are higher among fat people. Thirdly, weight loss appears to induce a temporary improvement in certain health markers. And that’s about it.
Firstly, why are there a disproportionately higher number of fat people with certain medical conditions? Well experts argue all sorts of reasons. It’s the insulin pathway, or hormonal changes, or adpiokines and chronic inflammation blah blah blah. What they never seem to ask themselves is whether weight stigma itself is causing it. Even though we know the chronic stress from weight stigma interferes with the insulin pathway, alters hormones and increased chronic inflammation blah blah blah. The same goes for weight cycling.
Secondly, why do experts talk about relative risk and not absolute risk? Before I answer this, let’s talk about the difference. Relative risk reductions give a percentage reduction in one group compared to another. For example, if you take a statin, your relative risk of a cardiac event over the next 10 years decreases by about 25%. Impressive, right? But if your risk is only 4% then taking a statin only dropped it to 3%. Your absolute risk reduction is 1%. Far, far less impressive. Relative risk can be misleading and over-exaggerate how helpful something is, and is used to promote all sorts of interventions including weight loss injections and bariatric surgery.
Thirdly, a short-term reduction in blood pressure or HbA1c is not going to impact you in any way. High blood pressure and type 2 diabetes are asymptomatic conditions. The importance of managing these conditions lies in the long-term impact they have on our bodies, in particular our blood vessels. The damage they cause to our larger vessels (macrovascular damage) can lead to a heart attack, a stroke, or a limb amputation. The damage they cause to our smaller vessels (microvascular damage) can lead to a kidney disease, loss of vision, or damage to our peripheral nerves.
That’s why it’s much helpful to measure long term health outcomes than it is to measure short term health markers. Is there any evidence that weight loss improves long term health outcomes? Nope. There is evidence that weight loss worsens health outcomes (although this could be confounded by the fact that unintentional weight loss is a sign of advanced disease). There’s also evidence that weight gain over time doesn’t impact health outcomes. Explain that one if you can.
“Just look around you”
I don’t get how medical professionals can use anecdotal evidence to justify their beliefs and actions. We’re taught from day one to be evidence based. Why? Because we’re human beings and we’ve known about frequency illusion/bias or the Baader–Meinhof phenomenon for some time now.
Frequency illusion describes the process in which a person notices something more often after noticing it for the first time, leading to the belief that it has an increased frequency of occurrence. People sometimes talk about the ‘red car phenomenon’, which is another way to describe selective attention.
When you start looking for red cars on the road, you tend to ignore all the other cars. You’re focusing on the relevant stimuli whilst ignoring distractions. After a while all you see is red cars. Does that mean there are more red cars on the road than other colours? Nope. It’s an illusion – a form of confirmation bias.
Speaking of confirmation bias, it’s human nature to seek out evidence that confirms your beliefs and assumptions, whilst overlooking evidence to the contrary. We saw this in the early days of the COVID pandemic.
Doctors generally believe that fat people get sick, so they looked around the wards and saw a whole bunch of fat people. This confirmed their belief that fat people were more likely to get sick from COVID. Once we actually looked at the evidence and adjusted for other factors, we realised this wasn’t the case. But by then the damage was done.
Fat people were terrified of getting COVID and were also a lot less likely to seek medical attention if they developed symptoms, for fear of being blamed. And whilst we won’t know for some time whether this caused a delay in treatment and therefore impacted death and disability rates, previous pandemics have suggested that this is the case.
“I’m just doing my job”
Are you now?! And what job is that exactly? Doctors have four main responsibilities toward their patients. The first is to act in their best interest, and this is the one that doctors use to defend their fatphobia (see Reasons 1-3). But unfortunately for those doctors, their responsibilities don’t end there.
They must also do no harm. And I’m pretty sure failing to examine or investigate a patient because of their body size constitutes as harm. So does spending less time with them because you don’t believe them to be as worthy. Or mocking, poking, and prodding them. In fact, let’s all agree that shaming, humiliating and stigmatising a person is harmful and leave it at that, shall we?
And yes doctors do all of these things. The research exists and I suggest you google “medical weight stigma” for further information.
Thirdly there’s autonomy. Believe it or not, you have the right to decide what happens to your body and what you have to listen to. Can you believe that? Doctors don’t get to decide for you.
In fact, doctors have a responsibility to provide you with evidence based information of the risks, benefits, long-term implications and all your treatment options in order for your to make an informed decision. It’s called consent.
I’ve hear a lot of doctors lately saying “but what if that interferes with my own personal and religious beliefs” to which the answer is simple. Find another job. You learned about ethics in medical school – you could have dropped out then and saved yourself a whole bunch of time and financial debt.
Lastly there’s justice. Did you know that doctors have to make sure that they conduct themselves in a way this is fair and without bias? Yup, it’s written into our code of conduct. I’m just gonna leave this here without further comment.
“It’s my job to tell you the truth”
This is usually followed by “not to mollycoddle you”, or something to that effect. I can tell you right now that these doctors are beyond help. They got into medicine for all the wrong reasons. Chances are they have high levels of narcissistic traits. They love the power and the status but don’t actually care about the people they have been charged with caring for.
I’ve met a lot of these doctors. I can come up with several names for them but I’ll try to keep it civil. Suffice it to say that when they refer to “the truth”, they actually mean “my version of the truth”. And for reasons I have already covered, their version of the truth is nothing like the actual truth.
But that doesn’t matter because there’s no getting through to them. They lack compassion and are interested in serving their own needs rather than the needs of their patients. When you come across one of these doctors, do what you need to do to survive and then run away as fast you can. If you have the emotional strength to do so, report them. Otherwise find a different doctor, because chances are this one is only going to cause you harm.