Labeling Fat Patients “Non-Compliant” is Stupid and Dangerous
Hey look it’s me, in my natural state. Flipping everyone the bird!
I know I’ve blogged here before about the doctor I fired a couple years ago, the one who got upset with me when my perfect bloodwork results interrupted her lecture on how my dethfat was going to kill me any day! (I still have an image of a disembodied lump of adipose sneaking up on someone to throttle them.)
And I think I talked about her other bullshit: not believing me when I said I don’t drink soda, or at least not more than one can every couple of months. Or about her refusal to hear me when she told me I should food journal, and I told her, “I had an eating disorder, all that will do is send me into a spiral. I’m not doing it.”
But, I let her bully me into food journaling, and managed to keep from sliding into a total relapse into my old friend the Starve-Binge-Compulsively Exercise and Starve cycle. And when I showed it to her, she accused me of lying, then said if I actually wasn’t lying, she wanted to put me on metformin. And for me to continue to food journal.
When I told her, “No, I will not food journal anymore, and since I don’t have diabetes or even ‘pre-diabetes’, whatever that is, I do NOT want you putting me on metformin,” she accused me of being “non-compliant.” Shaking, I asked her to think about what she had just said, that I, the patient who is the model of compliance when it comes to antibiotics and my asthma medications, was “non-compliant” because I couldn’t do something 95% of the human race can’t do, and because I wasn’t willing to subject myself further to conditions I knew would trigger an ED relapse eventually. Well, a bigger one. I did relapse a bit, and then lied about how little I was eating, inflating the amount of food I recorded by one more meal and a snack a day.
She ignored me, and I never went back to her.
My Mom and my sister still go to her and love her. And I know why. They’re both good, long-suffering fat people who want desperately to be thin and will listen to her body-shaming bullshit and not recognize it for the abuse it is. They are more than happy to keep on with the Sisyphean task of trying to make their bodies other than what they are. I, on the other hand, am a Rebellious Fattie and refuse to go back to disordered eating, and refused an unnecessary medication that she wanted to prescribe simply because the odds are good it would have made me lose weight (along with pooping my innards out on a regular basis, one of the common side effects).
“You’re delusional about the shape you think you’re in,” she told me once, while I was exercising 1-2 hours a night 3-4 times a week (1/2 hr exercise bike, 1/2 hr -40 minutes weights, 1/2 hr swimming). I offered to bench press her if that would convince her. She said I wasn’t funny. I said I wasn’t joking.
The danger in labeling someone non-compliant comes when you use their weight, or their inability to lose weight, as an excuse to not treat their actual conditions appropriately, because they’re “non-compliant” and you, or someone else informed by those chart notes, decide not to offer them the best treatment options because of a belief that they won’t follow through on them.
Now, here’s the stupid part: 95% of the human race cannot lose a substantial amount of weight and keep it off for more than 5 years. This result is repeated constantly in the research. Constantly. We do not know how to make fat people thin any more than we know how to make permanently make thin people fat. We just don’t.
People bitch about “fat people costing more money because they have all these health issues.” Well, maybe they wouldn’t have “all these health issues” if we could get doctors to treat them appropriately, and also if the systemic fatphobia and body-shaming in the medical field didn’t drive fat people away from regular check ups and making appointments for minor things that may later become major, all because they don’t want to hear, “It’s nothing, you’re fat,” when they have pneumonia. Or doctors who prescribe exercise on a sprained or broken ankle, because “of course it’s just your fat, we don’t need to do X-rays.”
If you think I’m exaggerating, go to the blog, “First, Do No Harm” and read some of those stories. The pneumonia story was a friend of mine, who walked everywhere and ate like a bird, and yet, was still fat. Some of the bullshit that happens to fat people when they go to the doctor is fucking nauseating. Or better yet, listen to the first Polimicks podcast (psst, it’s on the sidebar to the right).
Because many doctors will brazenly refuse to treat fat people at all, or until they lose enough weight to satisfy Dr. Doucheface McFatphobe, many fat people quit trying to seek treatment until shit is really fucking bad and they end up hospitalized or with chronic conditions.
So, whose fault is that? Huh, assholes?
And while I advocate firing your doctor and getting a new one, some people can’t do that. Maybe that’s the only doctor in their town. Maybe their insurance only covers this doctor, this clinic… Maybe their HMO just randomly assigns doctors and they have zero control who they see.
Here are some great round-ups of blogs who post the research I’m too lazy to Google for your lazier asses:
Living 400 Lbs. has several great posts that mention current research. Go read.
The Fat Nutritionist is AMAZING.
And so is Dances with Fat.
Oh, btw, I’m taking part in a workplace-wide Kettlebell workout. I’m very excited, I’ve wanted to do Kettlebells for awhile now.
PS I know for a fact I “cost” my insurance/co-insured far more when I was thinner, in the throes of the eating disorder and compulsive exercising. I was constantly sick and hurting myself working out. Over a hundred pounds heavier now, I don’t have to go to the doctor nearly as often. It’s almost like I’m healthier at this weight.* Huh, go figure.
*I’m definitely saner.
Polimicks 
Do I have to tell you that this article could have been written by me, almost verbatim? I am blessed with having found a great and non fat-phobic doctor, but she is moving into research and away from seeing live humans.
Fat is not a disease. Fatphobia/Sizeism is.
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It always amazes me that mental health is so largely disregarded around issues of fat and physical health (with the exception of the whole “If you deal with your emotional problems you’ll stop being fat” thing… which yes, does work for some portion of the population, but not very many.)
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While I don’t get much of this because people never think I weigh as much as I really do (optical illusion?) I can say even mildly overweight people get this shit sometimes too. I get asked very seriously if I exercise at all when I complain about my asthma or my back pain. And then I remind them I have a fucking dog who I walk/jog with at least twice a day, and not just around the block either (they have already been told this before). The back pain one is especially frustrating because they just straight up chalk it up to being overweight and never look back. Good thing I figured out it’s from PTSD and tensing my muscles all the time. Thanks doc.
Also I like how you mentioned skinny people too. I have a few really skinny friends (and of course Don) who wish they could gain weight. But they really just can’t, at least not much, and not for very long. It really is something people need to shut the fuck up about and start accepting people the way they are.
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