Invisible Eating Disorders and Medical Fatphobia

So I did that thing I sometimes do and started babbling on Instagram after a weird thing that happened and tried to make sense of it as I wrote and hello confusing word jumble!

Anyway. It got me thinking. What was I trying to say and what important thing did I miss (this is often what I think after one of my Instagram rambles - seriously go follow me I'm a delight!). The thing is I do sometimes connect with other people in the fat/body positive space over there and it's nice not to feel like I am boring absolutely everyone like I often do when I try to write about this stuff here.

So basically what happened was:

I went to my asthma review. I know, going in, that two things are going to happen to stress me out: they are going to nag me about still needing to use my short term inhalers (because asthma isn't a chronic illness no siree oh hey I wrote about it here too in a slightly whimsical way!).

AND they are going to weigh me. I have no idea why they have to weigh me at this, all is I know is that I no longer weigh myself and there is no way in hell I am going to let them mess with my head by telling me how much I weigh. So I go in fully on the defensive, but trying to remain calm at the same time.

It goes okay-ish, in an ideal world I would not be weighed but this nurse is a little scary and maybe my imagination is getting carried away but I feel like she actually wrangled me by the arm onto the scale? LOL IT'S FUN! At any rate, I tell her that I do not weigh myself and I do not wish to be told my weight, and she at least respects that.

It's a digital scale so I don't bother getting on backwards and I just don't look down. There is no apologetic removing of shoes or belts, because at that moment, I (just about) give less than zero effs what those numbers say.

Then there's a whole thing where the doctor has to come in because I still use my short term inhalers (like I have been my whole life this was never an "issue" in America but anyway) and then he's on to the importance of "cardio" and basically I'm just smiling and nodding my head and trying not to boil over with rage.

I feel vulnerable. I feel like I'm trying to create this impermeable shield in case the fat shaming begins.

And here's the thing. I'm only a "small" fat. I'm pretty sure I'm comfortably outside my "BMI" now (BMI IS BULLSH*T BTW OK READ ALL ABOUT IT), but I am still the same size I was when I quit diets and took up with body positivity and intuitive eating, so I kind of know where I'm at.

I only mention this because I know I still have thin privilege, and I cannot imagine what a sh*t show of fat shaming doctors are for people bigger than me. I still get occasionally less than subtly told that the answer to anything that ails me is weight loss, and it's infuriating, but I have heard and read so many genuinely upsetting things about people in larger bodies not getting diagnosed with very serious and even fatal conditions because the doctor could not bring themselves to look past the person's weight.

This article in Self is a great piece about how widespread it is and how women in particular just put up with it (probably because it's really hard to defend yourself when you feel you are being attacked/fat shamed all the time at the doctor's. Basically you are just waiting to go home and cry).

Unfortunately, even though it has been proven time and time again that most standard diets do not work/result in weight gain/weight cycling upwards, we are still infantilized by the medical industry and made to feel that being fat is somehow a choice we really should be better at fixing.

It boggles my mind that the standard expectation of body size keeps shrinking when the population overall is yes, getting fatter. I am not saying people shouldn't try to lose weight if they want to, if health is a genuine concern.

But we are not being helped by the diet industry. We are just giving them money for a new book every year, the latest expensive ingredients, the latest exercise fads, and none of it is working, and somehow WE are the failures?

Why is the huge trend towards intuitive eating and HAES (Health at Any Size) among professional nutritionists and health coaches being so completely ignored?

It's possibly also worth noting that my baby rage monster was already beginning to simmer as when I was sitting alone in the waiting area, there was a poster opposite me of an outline of a human body, with correlating blurbs about how being overweight causes all of these different types of cancer.

I won't open that Pandora's box, but AGAIN the blind promotion of "LOSE WEIGHT OR ELSE YOU WILL DIE" messages being fed to us everywhere are often easily challenged or dismantled when we look at them more closely.

And I, a young cancer survivor (well I was young at the time of diagnosis) was an average weight at diagnosis and had no real cause for my cancer other than bad dumb luck. I know, for a fact, that there have been no links whatsoever between Lymphoma and weight. And yet there, in a little box on the poster were the words "types of blood cancers". And who knows, maybe there are a few that have some fragile connection, but also....oh it just got to me.

Thin/average sized people get cancer too. PROBABLY just as many, if not more than, fat people. I certainly never noticed an uptick in body size on the cancer ward, and no it's not a chemo thing, I saw people from all stages of the disease in the appointment waiting area. I genuinely believe a large aspect of this hyper obsessed wellness culture has somehow permeated medical science.

I wrote about the blind ignorance of wellness culture and the harm it does to cancer patients here quite awhile back.

So to sit in an office when I feel like I have all of this knowledge and personal experience of the healthy mind and body that I firmly believe leaving diet culture and embracing body positivity, self acceptance and intuitive eating has brought to me after a lifetime of battling with my body and psyche, the PEACE of that, and be treated like a dumb chubby toddler who needs to jump around more is EXHAUSTING.

I was feeling pernickety to put it mildly. I mentioned I was thinking of taking up yoga again because I remembered when I did it regularly many moons ago that I felt like my breathing was better. The thin doctor cocked his head to one side and was like "Hm well yeah but really CARDIO and getting OUT OF BREATHE is what's best for you, really".

And to me, that just sort of represented everything that is wrong with the medical attitude right now. I had already told them I belong to a gym and (normally) do regular cardio, but me mentioning a new, more holistic, less calorie burning thing is just sort of dismissed/scoffed at, when yoga has been widely known to help people with asthma for eons. I'm tired gang.

I'm ready to leave the appointment now, and at this point it's just me and the asthma nurse. As I get up to leave, she says "By the way, just so you know, you have lost weight since last year." 

 I don't really say anything to that, at least, I don't feed into the diet culture b.s. any more and say "Oh yay, how much?" Because inside I am trying to stay calm.

My self worth revolved pretty strongly around my weight up until three years ago. Of course there is still a part of me that says "OH F*CKING YAY, GO ME!" inside. Of course she's still there. She's the same one who still thinks I might "accidentally" lose weight and would you look at that, by no effort whatsoever on my part, I have. I am living the diet culture dream.

I genuinely do not think I have lost much weight, I am still the same size I was when I quit diets/calorie counting. I think that my muscle mass increased for a while, but I haven't lifted weights for a couple of months now, so maybe it's actually lost muscle mass? It's not necessarily a good thing that the numbers on a scale decreased.

But once an eating disordered mind gets a whiff of that "Oh I SHRANK you say?" high, even a latent one, even one bolstered by the freedom of life outside that circus, it becomes a very delicate operation on my part to put her back in the box before she sees daylight again.

My eating disorder was never treated with therapy or told to gain weight, because she was invisible. She was inside a body that was mostly "average" weight wise, which was pretty infuriating to her to be honest. She flirted with excess thin-ness briefly, but it went largely ignored, other than a few remarks from friends to eat more.

There were no interventions. She was almost always in hiding (many are, but people in average or larger bodies with eating disorders mostly do not ever receive any kind of real treatment).

The only time my body obsessed brat of an eating disorder was allowed to breathe out in the open was when she got FAT after cancer/chemo steroids, and was very clearly expected (or she expected herself) to go back to how she was pre-cancer. It was the first time she tried actual diets, which must be ok because they are in books and everyone does it, right?

Yes, that one where you drink sugar water and oil all day was definitely medically SOUND. That one where you eat virtually nothing for five days a week but gorge at the weekends - yeah that's nothing like the binge starve cycle of a bulimic or anorexic mind set AT ALL is it?

She/I was VERY good at diets, the more extreme the better. She was comfortable with a pittance of food, because to lose weight you must suffer, it's just how it works, duh. Oh yeah and falling off the diet wagon and bingeing when your weight loss stalls, that is all too familiar too:

"You are such a perpetual failure, why can't you just be naturally skinny?" she sighs, and is rewarded with mass commiseration from women everywhere living their best lives on the diet hamster wheel, sharing memes about what "fat" failures they are - ha ha, good times..

Yeah that head space is like totally normal and healthy (eye roll). But seriously, for so many of us, it  is the way things are.

The stress of the diet/ weight cycling life mimics/overlaps with actual eating disorders in myriad ways. Stress and depression from not losing or keeping weight off are also not "healthy"for us in the long run.

It's challenging and frustrating, but also, mostly, a million times better to live my life outside diet culture. Any time I have questioned what am I even doing/what is the point, I get a reminder, like a trip to the doctor where I am simultaneously exercise shamed and told I have lost weight. Isn't life weird.

I just don't understand why doctors/the medical profession are so insensitive and oblivious in
the way they handle this stuff sometimes.

So many people have eating disorders or have had them at some point. And if a patient asks not to be weighed/not to be told their weight, you would think, in 2020, it might occur to the nurse not to then tell said patient they have lost weight. It's just....ugh.

There is so much more I could talk about here, how people in bigger bodies are totally overlooked when it comes to treating their eating disorders because they are not thin, how they are told to diet their whole lives when that is probably the last thing they need.

How maybe, just maybe, there are other more safe and consistent ways for them to pursue health. Because diets don't work. Why is this so hard for the medical establishment to admit?

I know there are a million links in this post, but there is SO MUCH information out there for anyone remotely curious about this. I find it so frustrating that we still live in diet culture without questioning why, so blind to its harmful fallacies in 2020.

Even if you don't believe in body positivity or any of this stuff, I challenge you to just click on any one of the links I have shared, and maybe you will see what I'm talking about, just a little bit.

Right now I'm tired and I think need a little self care/regroup moment. It's okay to struggle with this stuff, truly, it's not all rainbows and Lizzo dance parties in the real world.

I think I'm as guilty as anyone of transferring my weight focused perfectionism onto this bopo life and feeling like I have to be okay all of the time and happy all of the time. I am much better off, truly, but the truth is it can be lonely and deeply challenging outside diet culture too, so forgive my ramble here.

But if it helps one person dealing with this it's worth it. And sometimes creating my own safe space is the only way to deal with it. So yeah, I'm off to finish season 2 of Shrill, it rocks. Thanks for reading.

Everyone watch Shrill! (on BBC iplayer in U.K., Hulu in U.S.) Also it's not always as gut punching as this (awesome) scene, it is mostly a comedy drama. But it does dispel a lot of fatphobic b.s. too.


  1. I'm so sorry your dr appointment was so sucky :( I avoid the dr office like the plague so I don't really know how general visits go. I only go to my pap smears, and not really that. I work at a senior center, which is mostly asian, and they seem to get cancer just fine with being on the thinner side so that poster trying to indicate that WEIGHT is the factor is just wth.

    1. Thanks, I feel like such a complainer lol! But as annoying as it was at the time, I am still super grateful it didn't result in me feeling crappy about myself and jumping back on a new diet the way I would have a few years ago. I know SOME cancers can be weight correlated, but even a lot of those studies don't have a ton of tangible evidence about the causality between higher weights leading to the cancer, it's also a fact that there are more larger people now too so I don't know what they do to balance that out. I for sure read that several of these studies were done by companies in the business of the diet industry too. It has really gotten out of control, this "obesity epidemic" stuff, and the way they are handling it just makes life more difficult for people in bigger bodies and does nothing to actually help them pursue healthier lifestyles in the long run imho because the focus is so weight correlated. I belong to A Facebook group with people bigger than me and smaller than me and there are plenty of people bigger than me doing WAY more exercise than I do, they are lifting badass levels of weights and doing amazing yoga positions in bigger bodies, but the health industry doesn't want to promote anything other than thin so we will never see them (tbf a few companies like Nike are getting better, but they still show very high achieving fat bodies, as opposed to encouraging everyone that a little bit of exercise makes a big difference, which is more important imo).

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