Medical Trauma in Our Bodies
A Positive Medical Consultation That Changed Everything
Medical trauma lives in our bodies. It’s carried in our muscles, stored in our gut, and etched into our nervous system. You know the feeling – that immediate tension when you walk into a doctor’s office, the shallow breathing, the way your shoulders creep up toward your ears. This isn’t just anxiety; it’s your body remembering previous harm and preparing to protect you.
Many of you will immediately recognize this scenario. You enter a medical setting and your body instantly shifts into fight-or-flight mode. Your heart races, your breathing becomes shallow, and you find yourself unable to focus on even the simplest tasks like reading a magazine in the waiting room. Sound familiar? You’re not alone, and there’s a reason for this response.
Content Warning: This post contains discussion of medical trauma, weight stigma, and challenging experiences with healthcare professionals that may be triggering for some readers.
The Power of a Positive Medical Experience
Recently, I had an appointment at a gender identity clinic that completely disrupted my expectations. After years of waiting, I finally had my appointment at the Chalmers Centre in Edinburgh, and the difference was remarkable from the moment I walked in the door.
The building itself was inclusive – gender-neutral toilets, nothing offensive on the walls, an immediate sense of safety. The receptionist was kind and sensitive, explaining that the clinicians wanted to record my BMI and blood pressure, but making it clear that either option was genuinely fine. When I mentioned I’d do my blood pressure but not my BMI, she simply said, “Actually, you have to do them all together on this machine, so never mind, just go take a seat.” No judgment, no pressure, no embarrassment.
Throughout the appointment, my doctor was exceptional:
- She truly listened – actively engaging rather than just waiting for her turn to speak
- She explained why she needed to type notes during our conversation
- She never interrupted me once, allowing me to lead the conversation
- She involved me in all decisions about my care
- She continually sought consent throughout our conversation
- She recognized me as the expert in my own body
- She offered genuine options and choices without overwhelming me
What a difference an hour makes
At one point about a quarter of the way through our hour-long appointment, she said something I’d never heard before: “Look, we have an option here. We could carry on with the initial assessment, or there are some things that have come up already which I could probably address in the here and now. So do you want to deal with that now, or do you want to carry on with the initial assessment? And then I’ll bring you back to do the other thing. Which way do you want to go?”
Think about how revolutionary this approach is in a medical setting. Rather than assuming the doctor knows best, she acknowledged that this was my consultation, and I should determine what felt most important to address.
I left that appointment with a clear plan, genuine options, and for the first time ever, tears of joy after a medical consultation. When I told her I was going to cry happy tears, she immediately said, “Oh, I thought you were going to say you were going to cry. Because if you’re going to cry, stay, and we’ll figure it out.” The care in that response speaks volumes.
This positive experience stands in stark contrast to how most of us experience healthcare, especially those of us in fat bodies or with other marginalized identities. The standard medical encounter often involves:
- Judgment (whether spoken or communicated through body language)
- Disrespect for boundaries and dignity
- Assumptions about our behaviors and choices
- Dismissal of our knowledge about our own bodies
- Violations of privacy and confidentiality
- Treatment that prioritizes teaching or efficiency over patient comfort
I’ll never forget being in a breast clinic as a fat trans person – already an incredibly vulnerable position – when a surgeon walked in with three medical students while I was disrobed. He looked at me and said, “Have your breasts always been that uneven? Look at that,” and started pointing. This wasn’t just uncomfortable; it was traumatic. The message was clear: your safety, your dignity, your humanity is secondary to the teaching opportunity you represent.
These experiences aren’t rare exceptions – for many of us, they form the foundation of our relationship with healthcare. And each negative encounter reinforces the trauma response, making the next medical appointment even more difficult to face.
How Medical Trauma Lives in Our Bodies
The effects of medical trauma go far beyond mental distress. When I enter a medical setting now, my body responds in predictable ways:
- Hypervigilance – constantly scanning for threats
- Ruminating and rehearsing conversations for weeks before appointments
- Fast, shallow breathing
- Muscle tension, especially in the jaw, neck, and shoulders
- Bracing posture – physically preparing for impact
- Digestive distress – the gut-brain connection in action
- Skin reactions – increased itching, scratching, flare-ups
- Emotional shutdown or overwhelming urges to flee
These aren’t character flaws or overreactions – they’re normal physiological responses to trauma. Our bodies are designed to protect us from threats, and after experiencing medical harm, our nervous system identifies medical settings as dangerous.
This trauma is particularly amplified for those of us holding multiple marginalized identities. As a fat, trans, neurodivergent person, each identity carries its own layer of potential medical trauma. And when these intersect with childhood trauma or other adverse experiences, the impact compounds exponentially.
What Evidence-Based Heart Health Without Weight Loss Looks Like
Robin left the appointment with prescription in hand but deeply conflicted. On one hand, they didn’t want a heart attack. On the other, they didn’t trust their doctor and hadn’t been given enough information to make an informed decision about statins.
Searching online only led to more weight-focused, stigmatizing information. Robin felt stuck between taking a medication they knew little about and risking their heart health. They wished they could find a doctor who supported their heart health without weight loss. Someone who would treat them like a whole person instead of just a number on the screen.
Furthermore, Robin couldn’t help but wonder whether there were evidence-based alternatives for maintaining heart health without the constant focus on weight loss. After all, they had tried dieting multiple times throughout their life with no sustainable results.
Weight inclusive healthcare
Imagine if Robin had encountered a doctor who offered cardiovascular care without weight loss prerequisites. This doctor would have started with reassurance: “Look, I’m not particularly worried about this. Your slightly elevated cholesterol isn’t anything to panic about, and it’s not your fault. You couldn’t have prevented it.”
This doctor would have acknowledged Robin’s anxiety about their father’s heart attack but would have calculated Robin’s actual cardiovascular risk, which would turn out to be a 2-4% chance of having a heart attack or stroke in the next ten years. This is an objectively low risk.
They would have explained the difference between primary prevention (for someone who’s never had a cardiac event) and secondary prevention (preventing a second event), clarifying that Robin’s situation is much less urgent than their father’s would have been after his heart attack.
Most importantly, this doctor would have shared crucial information that Robin’s actual doctor withheld:
- Dietary changes haven’t been proven effective for preventing heart disease. Studies consistently show any initial benefits disappear after 6-12 months.
- Weight loss has no benefits for cardiovascular risk. In fact, weight cycling (losing and regaining weight) actually increases heart disease risk.
- Plant sterols may help slightly reduce cholesterol, but they’re expensive, require special products, and only reduce cholesterol by up to 10% as opposed to 20-30% with medications.
- Movement, stress reduction, and sleep improvements may help slightly but won’t dramatically change risk factors.
- Medications like statins can reduce heart disease risk by approximately 25%, but this translates to a very small absolute risk reduction for someone like Robin (from 4% to 3%).
Informed consent
With this information, Robin could make a genuinely informed decision about their health. Maybe they’d choose medication, maybe not. Either way, it would be their choice based on understanding rather than fear and shame.
This approach represents basic medical ethics—informed consent, patient autonomy, and non-maleficence (do no harm)—not some extraordinary level of care. Yet fat patients have become so accustomed to substandard treatment that even basic respect feels revolutionary.
Additionally, Robin would understand that pursuing heart health without weight loss isn’t just a personal preference—it’s actually aligned with the scientific evidence. The focus on weight loss as the primary intervention for cardiovascular health lacks robust long-term support, especially considering that:
- Most people cannot maintain significant weight loss beyond 2-5 years
- Weight cycling (losing and regaining weight) may cause more harm than remaining at a stable higher weight
- Many thin people also develop cardiovascular disease, indicating that other factors are critical
Achieving Heart Health Without Weight Loss
Robin’s story highlights how health markers like cholesterol have become moral measuring sticks rather than neutral medical information. When doctors use terms like “good” and “bad” cholesterol or label patients “non-compliant” for making informed choices about their own bodies, they’re making moral judgments, not practicing medicine.
The arbitrary cutoffs for “normal” cholesterol keep shifting lower, creating more “patients” requiring intervention, while the goalposts constantly move. Meanwhile, research shows that social isolation, economic deprivation, and chronic stress influence heart health far more than individual behaviors—but these factors receive little attention from healthcare providers.
Weight inclusive healthcare
Imagine if Robin had encountered a doctor who offered cardiovascular care without weight loss prerequisites. This doctor would have started with reassurance: “Look, I’m not particularly worried about this. Your slightly elevated cholesterol isn’t anything to panic about, and it’s not your fault. You couldn’t have prevented it.”
This doctor would have acknowledged Robin’s anxiety about their father’s heart attack but would have calculated Robin’s actual cardiovascular risk, which would turn out to be a 2-4% chance of having a heart attack or stroke in the next ten years. This is an objectively low risk.
They would have explained the difference between primary prevention (for someone who’s never had a cardiac event) and secondary prevention (preventing a second event), clarifying that Robin’s situation is much less urgent than their father’s would have been after his heart attack.
Most importantly, this doctor would have shared crucial information that Robin’s actual doctor withheld:
- Dietary changes haven’t been proven effective for preventing heart disease. Studies consistently show any initial benefits disappear after 6-12 months.
- Weight loss has no benefits for cardiovascular risk. In fact, weight cycling (losing and regaining weight) actually increases heart disease risk.
- Plant sterols may help slightly reduce cholesterol, but they’re expensive, require special products, and only reduce cholesterol by up to 10% as opposed to 20-30% with medications.
- Movement, stress reduction, and sleep improvements may help slightly but won’t dramatically change risk factors.
- Medications like statins can reduce heart disease risk by approximately 25%, but this translates to a very small absolute risk reduction for someone like Robin (from 4% to 3%).
Finding Your Way Forward
If Robin’s story sounds familiar, know that you’re not alone. Whether it’s cholesterol, blood pressure, blood sugar, or any other health marker that’s become weaponized against your body, you deserve evidence-based, weight-inclusive care that respects your autonomy.
Remember these key points about heart health without weight loss:
👉 High cholesterol is not your fault
👉 You couldn’t have prevented it
👉 Weight loss won’t provide long-term solutions
👉 Evidence-based treatments work regardless of size
👉 You deserve respectful, effective healthcare
👉 Addressing social determinants of health often has greater impact than individual behaviors
👉 Reducing stress may be more beneficial than restrictive dieting
Next time you’re told to “just lose weight” rather than receiving comprehensive care, consider using this script:
“I have researched the benefits and risks of intentional weight loss for high cholesterol. I do not wish to pursue this approach and do not consent to discussing my weight during consultations. I would like to discuss evidence-based treatments that work regardless of body size.”
You deserve healthcare that addresses your actual needs, not just another prescription for weight loss.
Where To Next?
For too long, fat patients have been forced to contend with a healthcare system that prioritizes weight loss over actual evidence-based treatment. But there’s a better way. By advocating for weight inclusive medical care, we can create an environment where all patients receive appropriate treatment, regardless of their size.
This is why I’m currently writing a book where I dive deeper into these transformative weight-inclusive approaches to patient care. And I want you to be a part of the process. High cholesterol is featured in Chapter 5, which is ready for your perusal. Check out No Weigh for more information.
If you’re navigating high cholesterol or other cardiovascular concerns and are tired of having your symptoms blamed on your weight, know that you’re not alone. Join our community in The Weighting Room, where you’ll find support, resources, and healthcare professionals who understand. Additionally, you can book a consultation with me.
Want to learn more about effective cholesterol treatment without weight loss requirements? Check out my comprehensive on-demand masterclass, free for anyone with a masterclass membership or available to purchase on demand.
