Being Your Own Advocate at the Doctor’s Office

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Going to the doctor has always been a fraught experience for me. As a child, I was consistently in the highest percentile for weight-for-height, and my pediatrician expressed concern from the get-go. He would talk to my mom about my weight in front of me, and it is probably one of my earliest experiences with the feeling of shame.

As the years went by, my experience with doctors didn’t improve. I would fear going to get check-ups, bracing myself for comments about my weight and how I would need to “do something about it.” Even on the occasions when I would go to the doctor having lost weight, I would be anxious and fearful that my doctor would congratulate me and tell me to “keep doing what you’re doing,” as that meant I would have to continue to restrict, over-exercise, and obsess about my weight.

When my PCP retired about six years ago, I made the conscious decision to try and find a weight-neutral doctor. A fellow non-diet dietitian recommended a concierge doctor as someone who did not push back when she was told that discussions of weight would be off the table. I met with this PCP and explained to her my concerns and my desire to be treated through a weight-neutral lens. While it was clear that she typically practiced from a weight-normative perspective, she said that she understood and would not push back on me regarding weight matters.

Despite having this conversation with her at the outset, I still felt anxiety and dread for my doctor’s appointments going forward. Even though I knew she would not bring up my weight in a negative way or push me to lose weight, the 35+ years of fatphobia I had experienced in the medical space up until then was not so easily erased. After many years of therapy, I’ve come to understand that all of those negative experiences I had with my doctors were traumatic events and that these types of experiences have led to my profound distrust and anxiety regarding physicians.

It wasn’t until about a year ago that I was able to find a doctor who expressly practices Health at Every Size®(HAES), and this has made a huge difference for me. The fact that she truly “gets it” and treats me as a whole person (i.e., not just a number on a scale) has greatly reduced my medical anxiety. I don’t hesitate to reach out to her with my health concerns as I know she will give me sound medical advice that is not tinged with weight stigma. In the event that I need to see a specialist, however, my old fears return, and I have to figure out a way to ensure that I get good medical care.

Many of my patients in larger bodies can relate to my feelings around going to the doctor. Most of them dread going to see doctors because they know that the topic of their weight will inevitably come up. In many cases, these patients have put off getting help for health concerns for fear that they will be weight-shamed. One of my patients struggled with indigestion for months before finally seeing her doctor only to find out she had multiple ulcers. Unfortunately, this experience is not unusual for fat patients. These kinds of instances are often noted as “noncompliance” in medical charts, further promoting the false idea that fat patients are to blame for their health issues when it is really weight stigma at play.

Over the years, I have worked with a number of patients on advocating for themselves in medical settings. In most cases, these strategies are successful, leading to the patient receiving respectful, weight-neutral care. I thought it could be helpful to share these strategies with our readers.

One strategy that has proven to be quite successful for my patients is reaching out to the new provider via email or the patient portal before their initial appointment. I have a template email that I recommend for my patients, but of course it’s best to tailor it to one’s own particular circumstances. In this initial message, I recommend telling the doctor that you are looking for weight-neutral care and providing examples of what that looks like. Some examples are not prescribing weight loss as a health intervention, not weighing the patient unless it is medically necessary (e.g., for proper dosage of certain medications), and not telling the patient the number if they do need to get weighed. In addition, it can be helpful to tell the physician that you have been practicing the concepts of HAES and intuitive eating and that you are happy to provide them with resources if they are interested in learning more.

Sometimes even if you have messaged your physician directly, that message does not get relayed to the rest of the medical staff. This can result in the staff being unaware of your no-weighing preference and lead to an uncomfortable situation at the first appointment. To lessen the chances of this happening, some of my patients have reached out to the medical office manager or the primary care nurse at the doctor’s practice ahead of time to specify that they do not want to be weighed at their appointments. You can also ask them to note it in your chart that you do not want to be weighed so that the staff is aware.

In the event that you are unable to reach the physician or medical office manager before your appointment, many of my patients have found it helpful to bring “Don’t Weigh Me” cards with them to their appointments. These cards were created by Ginny Jones, the founder of, an online resource for parents who have kids with eating disorders. Ginny explains that in her own recovery from an eating disorder, getting weighed at the doctor’s office was always a major stressor for her. After investigating whether one needs to be weighed at every doctor’s appointment (hint: you don’t), she found that not being weighed at the doctor’s office greatly reduced her stress when going to these appointments. Ginny created small, wallet-friendly cards that you can use to facilitate the conversation with healthcare providers about not being weighed. Even if you don’t end up giving the card to your doctor, it can be helpful and empowering to look over it while in the waiting room prior to your appointment.

For some patients, even doing the above is not sufficient to allay their fears. In these cases, I recommend bringing a supportive family member or friend to the appointment as an ally. Ideally, this person should be someone who understands HAES and will help you advocate for yourself if you face weight stigma. Even if this person does not end up needing to intervene in any way, just having them next you can be an enormous help. When our bodies are flooded with anxiety, it’s often hard to remember all of the details relayed to us by our physician, so having someone there with you to take notes or ask follow-up questions is a helpful strategy.

Sometimes even doing all of the above does not work, and patients are still subjected to weight stigma at the doctor’s office. In these cases, I remind my patients that they have the right to find a different doctor who will respect their wishes regarding weight-neutral care. Though weight-neutral providers are few and far between, if you can find a fat-positive network in your area, often there will be a referral list of recommended providers (and ones to avoid). For instance, I am a member of the “Boston Area Fatties Meetup” Facebook group (a fat-positive group in Massachusetts), where members can ask for recommendations for fat-friendly doctors and other providers. This group also has an excel spreadsheet of fat-friendly providers in Massachusetts which can be searched by type of provider and location.

Currently, the Association for Size Diversity and Health (ASDAH) is working on compiling a list of fat-friendly providers into a database called the Health at Every Size® Provider Listing Project. According to the ASDAH website, they are working to create a better and more comprehensive listing of healthcare providers who are especially sensitive to the needs of marginalized groups including “Black people, trans people and superfat and larger people.” ASDAH has also provided a timeline of the different phases of this project, and currently (March 2023) they state that they will be launching their “new and improved” listing beta. We will be sure to keep you posted when the HAES Provider Listing is available for use.

Randomly Targeted

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One of the best books that I have read for professional purposes is Aubrey Gordon’s “What We Don’t Talk About When We Talk About Fat.” Although I have listened to countless patients detail what it is like to have a large body in our fatphobic society, Aubrey’s book helped me to grasp more deeply the contrast between weight stigma and thin privilege.

Some of Aubrey’s stories are wild enough to strain credulity, such as a stranger approaching her in a grocery store and taking food out of her shopping cart without permission due to supposed concern for the author’s health, yet I believe her. A couple of years ago, a Black friend of mine explained to me that Blacks have been complaining about police brutality for decades, but it took the widespread prevalence of cellphone cameras and their resulting videos to convince white folks that the problem is real. His words hit me hard, I learned from them, and I do not need to see video of someone stealing fruit from Aubrey’s cart to believe that this happened to her.

The crux of the book’s fourth chapter, “On Concern and Choice,” is that some people express concern about someone’s weight for supposed health reasons, in part because they believe body size to be a choice – which, for the most part, it is not – something that one can manipulate if convinced that their current size is a problem. Furthermore, their expressed concern is really not about the person to whom they are talking, but rather an indication of the fears they have about their own bodies. In other words, if we acknowledge that body size is largely out of our control, then we also have to face the reality that our own bodies might change in ways that we do not want them to despite our best efforts to keep them the same. That prospect scares the crap out of many people, who find it easier to pretend we have more control than we really do.

This chapter resonated because it hearkened back to the allegations people have directed at me upon learning that I used to have a spinal tumor. Surely you have a family history of such issues, they insist. No. You grew up under high-voltage transmission lines. Wrong again. You overdid it in the weight room. Eye roll. The list goes on. As each assertion is met with a negative response, the concern on their face grows. It took me a long time to figure out what that expression is about, but now I understand that when the ideas that the tumor’s cause was my own doing or something unique to my circumstances are struck down, people then realize that the condition can develop in anyone’s body – most notably their own.

Humans, we are a funny bunch. Our antennae go up a bit higher when we feel like something might affect us rather than just other people, do they not? Think about horrible stories we read about violent home invasions in our community. While the crimes and our thoughts for the victims may be similar either way, contrast how you feel when an article concludes, “The police say the parties were known to each other,” versus, “The police believe the victims were randomly targeted.”

Be Your Own Best Friend

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It’s the holiday season, a time to spread joy and love to those around you.  Many times this takes place in the form of buying gifts, baking, and cooking for those we care about.  It often involves telling our friends and family how much they mean to us, how loved they are.  This is the time of the year when we show our appreciation and care for others.

So, in the midst of spreading all of this happiness to others, who often gets neglected?  You guessed it – you!  Not only do we often forget or put off taking care of ourselves, many of us are pros at talking especially harshly to ourselves.  Many of my clients have an inner monologue that goes on a continuous loop.  These thoughts include things like, “I can’t believe you missed that workout today – you are so lazy!” or “You have to stop eating like such a pig” or “You are a disgusting, fat person who has no self-control.”

Now, would any of us talk to our best friends the way we talk to ourselves?  Of course not!  Pretty soon, we wouldn’t have any more friends!  Then why do we think it’s okay to talk this way to ourselves?  Whenever a client tells me about her latest bout of self-hate talk, I ask her to think about what she would say to her best friend if the friend was saying these hateful things about herself.  Common answers to the above hate talk include, “You’ve been so tired and run-down lately, it’s probably a good thing you skipped that workout.  You need the rest!” and “You are not a pig!  We all overeat sometimes, and it’s not the end of the world,” and “You are a beautiful, smart, and loving person – self control has nothing to do with how wonderful you are!”

Let’s break the cycle of negative self-talk and start talking to ourselves in a more positive way.  When we are kind and gentle to ourselves, we are more likely to take better care of ourselves, too.  Imagine what a difference that would make!

He Said, She Said: Weight Management

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Weight concerns are one of the main opportunities for improvement that bring people to our practice. Our approach may ring true for you or elicit skepticism.  Either way, we invite you to share your reactions and questions on our Facebook page.  Also feel free to contact us directly if you prefer to voice your questions in private.

He Said

“Weight Management.”  According to my business cards, that’s what I do.  Because weight is such a loaded term that quickly brings to mind so many thoughts, feelings, and expectations, coming up with concise language that accurately reflects my approach is a challenge that I am still trying to settle.

Indeed I do help with weight management, but not in the direct fashion that some people might expect.  We know from working with patients, collaborating with our colleagues, and reading the research that weight-centered approaches to losing weight almost always fail.  That’s the irony: The more we emphasize and focus on weight, the harder it tends to be to keep weight off.

This fact is hardly a secret.  In October, I wrote about a conference I attended where presenters showed that over 20 diets resulted in the same pattern of weight change: sharp initial weight loss followed by gradual and steady weight regain.  A few years back, I had a telephone interview with a commercial weight-loss program that was interested in hiring me.  A study they had posted on their own website showed that approximately 85% (I forget the exact number.) of their clients regained their lost weight after one year, so I asked the interviewer what strategies they had developed since that study to help prevent this rebound.  She said they realized that clients are unable to successfully transition off of the commercial meal replacements and must stay on them for life.  This is very similar to the diet drugs on the market, which also must be taken for life or else the weight will come back, as well as commercial weight-loss programs where leaders tell clients they should be prepared to be lifetime members if they want to keep the weight off.  Sounds like a great business strategy.  As you can imagine, I did not get the job, which was fine by me.  Philosophically, we were not a good fit.

It may come as a surprise to learn that the healthcare community is still uncertain to what degree weight in and of itself matters in terms of health.  The folks who officially declared obesity a disease state this past summer can cite research supporting their view.  The “Health at Every Size® supporters, who argue that health and body weight are independent, have supportive research as well.  Personally, I have been talking about the concept of “Health at Every Size” for a decade, long before it even had that label.  As a guy whose BMI labeled me as overweight despite a very low body fat percentage, excellent labs, and solid athletic capabilities, I could see firsthand that weight was not necessarily a good indicator of health.  Lest you think that the unimportance of body weight is a fringe theory or an excuse that overweight individuals use to stay that way, my energy metabolism professor, a lean and athletic guy himself, taught us the same concept back when I was studying nutrition at a large state university.

Clearly, there is still much that we need to understand about how important weight is when it comes to our health, but how much does this question even matter?  On one hand, determining the importance of weight is of course important from a public health standpoint.  In order to best help people be healthy, we need to understand the factors at play as well as their roles.

Speaking pragmatically, however, the importance of weight is largely irrelevant.  We know from epidemiological data that overweight and obesity have become more prevalent, not more scarce, over the years.  Closer to home, even if you have not tried to lose weight and keep it off through various permutations of food restriction and/or overexercise without long-term success, you at least know several people who have.  When Joanne and I listen to our new patients share their histories, tales of weight lost and regained are par for the course.  Society as a whole has been acting under the assumption for decades that weight matters, yet this assumption has not helped us to get any thinner.  In fact, quite the opposite is true.

If we remember that weight-centered approaches almost always fail, the only alternative is lifestyle change.  Even more radical approaches, such as bariatric surgery and lifetime medications, have to be coupled with lifestyle change in order to be effective.  There is just no getting away from it.  Whether weight matters or not, or whether somebody wants to undergo a radical approach or not, the bottom line is that lifestyle change is still necessary in order to improve health.

What constitutes healthy lifestyle change is based more upon one’s baseline than it is on some idealistic vision of what one should be doing in theory.  The efforts and constructs of lifestyle change are usually limited by other factors (e.g. time, finances, personal preferences, etc.) rather than by guidelines, so in a sense guidelines do not even matter all that much when it comes to helping people in real life.  The idea is just to start wherever you are and move towards better health one small step at a time. 

More specifically, instead of gravitating towards a particular mode of exercise because it burns the most calories per unit of time, find ways of being physically active that are fun and agree with your body.  You will be happier and more likely to make the activities long-term habits.  Instead of counting grams and calories, restricting your intake, and cutting out whatever food group is being scapegoated this week, learn to eat mindfully and listen to your body’s hunger/fullness cues.

As a result of these changes, weight loss does oftentimes occur, and when it does, it tends to stay off, but it may or may not be the magnitude that you, your friends, your parents, your partner, a BMI chart, society as a whole, etc. would like.  Therefore, part of establishing a healthy lifestyle means learning to love and accept yourself the way that you are and severing any link you may have between weight and self-worth.

It is really about putting forth your best effort to be healthy while still maintaining balance in your life.  This is what I help people to do; that is what I mean by “Weight Management.”

She Said

Well, we are closing in on the end of 2013. Inevitably, after the ball has dropped and the New Year’s celebration has ended, many people start to think about their New Year’s resolutions.  What’s at the top of the list for most people?  Weight loss.  Every January we become inundated with new patients looking to us for help with their weight goals. Most of them have tried every diet and eating program in the book (losing and regaining many pounds in the process), but they are certain that this time things will be different. This time I will find the perfect diet, most people think to themselves.  This time I will have more willpower, and I will lose the weight for good!

I truly understand why so many people want to lose weight.  Every day we are bombarded by messages about our weight. Whether it is from doctors, the media, family, friends or partners, the message seems to be that it is desirable to be thin and it is bad to be fat.  Those who try to lose weight through dieting are to be admired, while those who are fed up with diets are viewed as weak-willed and lazy.  Fat is not only disliked but also feared.  According to a 2006 study by the Rudd Center for Food Policy and Obesity at Yale University, nearly 50% of the 4,000 people surveyed said they would rather give up a year of their life than be fat.  The same study found that 15-30% of the respondents would rather become unable to conceive, be depressed or become alcoholic than be obese. 5% would rather lose a limb. 4% would rather be blind.

Given most people’s dislike and, in some cases, fear of fat, it makes sense that weight loss is on the forefront of many of our patients’ minds.  But as much as I understand our patients’ feelings, focusing all of our energy on losing weight and fighting obesity by dieting restrictively and exercising excessively hasn’t helped anyone reach and maintain their goals.  I mean, if these methods really worked, would we still have a billion dollar weight-loss industry?  Of course not.

It is time to take the focus off of weight and put it on health.  As I’ve blogged about many times before, health and weight are not synonymous.  Numerous studies have shown that when talking about health, it is lifestyle behaviors that make the difference, not just weight loss.  When patients come into my office with the sole goal of losing weight, I try to help them shift their view to one that is health-focused rather than weight-focused.  By implementing healthy lifestyle changes such as eating intuitively, being more physically active, and dealing with stress appropriately, one’s weight will often settle into a “healthy weight range.”  This weight range might not be what the media or the BMI chart says is desirable, but it is one that is sustainable and will result in the best health outcomes.

To a large extent, our individual genes determine where our weight will settle.  There really is not much we can do about that.  But what we can do is work on becoming the healthiest person we can be, regardless of what we weigh.  By honoring our body’s hunger and fullness cues, being active in a way that is enjoyable to our body, and accepting and appreciating our body where it is now (not 20 pounds less than now), we will truly reach our health goals.  Now that’s a resolution worth keeping.


Fitspiration or Fat-Shaming?

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In fat-shaming news, Maria Kang, a 32-year-old fitness fanatic and mother of 3, posted a photo of herself and her three sons (then aged 3 years, 2 years, and 8 months) on Facebook with the caption “What’s Your Excuse?”  In the photo, Kang is wearing only a sports bra and tiny workout shorts, showing off her toned and sleek body.  Clearly, the photo and caption are meant to be “fitspirational” to all of the new moms out there who haven’t yet made losing weight their top priority and to show them that even with 3 kids under the age of 3, you too can have the body of a fit model.  Needless to say, the internet has been ablaze with both positive and negative feedback on the image.

I actually saw this woman on the Today Show this morning, and she was rather unapologetic about the message her photo is sending.  She reiterated the fact over and over that the photo was meant to be inspirational, not a knock against fat people.  That may have been her intention, but honestly, the caption clearly implies judgment against those who “haven’t lost their baby weight yet.”  That perhaps if these overweight women just tried a little harder, they too could bounce a quarter off their abs.

Kang, who is a former personal trainer and beauty queen, clearly has always been in good shape.  Given this fact, it’s not surprising that she was able to “bounce back” to her original shape after her pregnancies.  But the fact is that she is in the minority.  The average woman in the U.S. does not look like Kang and even if she were to put in all of the extraordinary time and effort to achieve Kang’s physique, it is very unlikely that she would be able to maintain it.

So, yes, I do believe that this image is fat-shaming. Instead of sending the message that if you just try hard enough, you can have a hard body after baby, how about telling new moms that they are beautiful and that they should appreciate what their bodies can do for them (e.g. give birth!).  Now that would be inspirational.