Jay's Story
Two Decades of Weight Cycling and an Unexamined Knee
Meet Jay
Jay drives a 2008 Toyota Camry that they’ve named “Betsy.” The car has over 200,000 miles on it, and while they’d love to replace it, they don’t have enough zeros in their bank acccount balance. They’ve become surprisingly adept at basic car maintenance out of necessity, keeping a toolbox and emergency supplies in the trunk. The car’s latest issue is a mysterious rattling sound that starts after about 20 minutes of driving. Jay has learned to leave early for appointments, knowing Betsy might need a “rest stop” to cool down.
Jay injured their right knee in a motorcycle at the age of 20. It took months of recovery and physical therapy, but they survived and didn’t have too many more run-ins with doctors until a decade or so later during a routine physical, required for their retail management position.
They felt healthy at the time, maybe a bit stressed from work, but nothing serious. The nurse took their blood pressure three times, eyebrows raising higher and higher with each reading. 145/95. The doctor called it a “wake-up call” and handed them a pamphlet about the DASH diet, explaining that losing weight would bring their blood pressure down naturally.
Jay Starts Weight Cycling
Determined to avoid medication, Jay threw themselves into their new diet. They downloaded a tracking app, threw out all their “junk food”, and started walking during their lunch breaks. Over six months, they lost 25 pounds, and their blood pressure dropped to 128/82. The doctor was pleased, making Jay feel like they’d finally “cracked the code” to health.
But the retail hours were long and unpredictable. Meal prep became harder to maintain. The tracking app became another source of stress. The weight crept back slowly – 5 pounds here, 3 pounds there. By 33, they’d regained most of the weight, and their blood pressure was back up. Not only that, but their most recent blood tests showed a high cholesterol.
The doctor suggested they “get serious” about their weight, totally uninterested in Jay’s previous weight loss efforts. So they turned to Weight Watchers this time, and several times after that. Eventually they switched to Noom. Each program worked initially – they’d lose 15-20 pounds, their numbers would marginally improve, but maintaining the strict regimes while managing a demanding job proved unsustainable.
Jay Develops Knee Pain
The cycle continued through their late 30s and early 40s: lose weight, improve numbers, regain weight, worsen numbers, try again. Each attempt became harder. Their knee, which had been occasionally achy since the motorcycle accident in their youth, started protesting more frequently. Exercise became more challenging. Each new doctor would look at their chart, see the pattern of weight cycling, and assume they just weren’t trying hard enough.
Jay is now 45 and caught in a frustrating loop. Their blood pressure medication has been increased twice. Their cholesterol levels bounce up and down with their weight, and their doctor keeps threatening them with a statin. Their knee pain limits their activity, making the whole “eat less, exercise more” thing even harder.
Each doctor’s visit feels like a judgment, with every health concern being redirected to their weight, regardless of the actual issue. Like their most recent visit, when they brought up their worsening knee pain. The doctor barely glanced up from their chart before saying, “At your weight, joint pain is to be expected.”
There was no examination, no questions about the original injury, no discussion of how the years of weight cycling might have impacted their metabolism or their relationship with food. Just another lecture about weight loss and a referral to physical therapy.
Jay Goes To Phyical Therapy
Jay’s first physical therapy appointment was a rushed 30-minute session. The therapist barely looked at their knee, instead focusing on their computer while asking questions about Jay’s weight loss efforts. The prescribed exercises felt like they came from a standard template – wall sits, straight leg raises, and step-ups. When Jay mentioned that the step-ups caused sharp pain, the therapist simply suggested doing fewer repetitions.
The exercises became a real source of anxiety. Each morning, Jay tried to complete their prescribed routine, but the pain got progressively worse with each day that passed. The straight leg raises caused a grinding sensation, and after doing wall sits, their knee felt unstable for hours. Unsurpsisingly, they gave up after a couple of weeks but now they feel guilty, wondering if they’re just not trying hard enough.
Jay is not sure where to go next. The physical therapist is expecting them to exercise their knee and won’t be impressed that they stopped. Their doctor just dismisses their concerns without even watching them walk or touching their knee. During their last appointment, Jay tried to explain how they can no longer kneel to tend to their lower garden beds or play with their dog, but the doctor was already writing the physical therapy referral while saying, “Well, you know what you need to do.”
Jay’s world is shrinking
They’ve given up on gardening entirely. Their dog, sensing their limitations, has become more subdued during their walks. Jay is considering buying themself a cane. Even grocery shopping has become an ordeal – they now plan their trips around which stores have specialised carts available, though using one makes them feel embarrassed and defeated.
Simple tasks have become complicated negotiations with pain. Getting in and out of Betsy requires a careful routine – easing out sideways, holding onto the door frame, waiting a moment for stability. They avoid anyhwere that requires them to climb a flight of stairs.
it doesn’t help that they live in the middle of nowhere. There’s no pool nearby for low-impact exercise, and the nearest gym with proper equipment is half an hour away by car. Their neighbor Sarah has noticed their decline and keeps suggesting her chiropractor, but Jay is struggling to make ends meet as it is, let alone pay for expensive alternative treatments.
Jay feels increasingly hopeless about their health. They’re tired of their body being treated as a problem to be solved rather than a complex system with a two-decade history of various interventions and attempts at improvement. They want a healthcare provider who will see them as a whole person, not just a number on a scale or a set of troubling lab results.
A different kind of care
What weight inclusive treatment looks like
A Better Way
Imagine a scene where Jay, bracing for another weight lecture, instead encounters a doctor who takes time to properly examine their knee. Dr. Lopez asks Jay to walk across the room, watches their gait, checks their range of motion, and most importantly – listens to their history of the motorcycle accident and the progression of symptoms.
Dr. Lopez explains that the old injury, combined with years of inadequate treatment and potentially harmful exercise advice, needs proper investigation. They order X-rays and discuss how chronic pain itself can impact overall health, including blood pressure and stress levels.
When Jay tentatively brings up their weight, instead of criticism, they receive validation. Dr. Lopez explains how weight cycling can be more detrimental to health than stable weight, sharing that the constant up and down worsens blood pressure, cholesterol, and inflammation levels. They discuss how the stress of perpetual dieting might have contributed to Jay’s health challenges as opposed to improving them.
The conversation about exercise shifts dramatically too. Instead of pushing through pain with prescribed exercises, Dr. Lopez emphasizes the importance of listening to their body. They explain that forcing painful movements could worsen their condition and that finding comfortable, enjoyable ways to move is more sustainable than following a rigid exercise plan.
Regarding their blood pressure, Dr. Lopez takes time to explain that relying on medication isn’t a personal failure but rather a tool for managing health – similar to how someone might wear glasses to see better. They discuss how reducing the stress of constant dieting and self-blame might actually help stabilize Jay’s health metrics more than another attempt at weight loss.
This kind of medical encounter has the potential to be a turning point in Jay’s story – one where they begin to understand that their health journey isn’t about fighting their body, but rather working with it and treating it with kindness.
How The Medical System Failed Jay
Jay has been repeatedly let down by the medical profession. In fact, it’s fair to say that doctors were part of the problem rather than offering the solution. The immediate jump to weight loss as a solution for high blood pressure. The dismissal of their knee pain as weight related without proper examination
Then there’s the harmful weight loss cycle of dieting and regain, which no doubt worsened their blood pressure and brought on their high cholesterol. Weight loss attempts, especially a low carb diet, are known to increase lipid levels.
These repeated failures on the part of the healthcare profession resulted in Jay’s world becoming smaller and smaller as their pain increased. Their doctor failed to take into consideration all of the environmental and social barriers at play. They just expected Jay to find a way, even when it was nigh on impossible.
The shame and self-blame reinforced by these medical encounters caused Jay’s mood to plummet, their self esteem to shrivel, and all but destroyed their faith in the medical profession.
Weight Inclusive Care Looks Like...
- A proper physical examination and appropriate imaging
- Understanding that stable weight is healthier than weight cycling. In addition, acknowledging the role weight cycling has played in the presenting problem, and looking forward, that weight loss is not the anwer.
- Acknowledging the harmful effects of weight stigma and the failings of a medical system that plays an important role in the systemic oppression of Fat people.
- A focus on pain management and functional movement rather than health metrics
- Destigmatization of medication use
- Recognition of rural healthcare challenges
Where To Next
Over the past few years, I’ve been advocating for weight-inclusive medical care, sharing evidence and experiences that demonstrate that there’s a better way to practice medicine. This passion has grown into a book I’m currently writing, where I dive deeper into these transformative approaches to patient care. Check out No Weigh for more information.
If you’re looking for medical care that treats you as a whole person, not just a number on the scale, I’d love to work with you. Book a consultation and experience the difference that weight-inclusive healthcare can make.
And for those wanting to learn more about the conditions discussed in Jay’s story, check out my in-depth masterclasses on high blood pressure and osteoarthritis. These on-demand courses break down the science and offer practical strategies for managing these conditions, all through a weight-inclusive lens.