Sunday Long Read: A Large Problem In Medicine

Here's a simple truth about getting a diagnosis from a doctor if you're overweight like me: the diagnosis is whatever the problem is, it's because you're fat. Our Sunday Long Read comes from Marquisele Mercedes in Pipe Wrench with her own lifetime of dealing with this, and if you're Black like us, that diagnosis of "Lose weight or die" has been beaten into us by docs every visit.

The first time I was penetrated I was thirteen, almost fourteen. The lights were on and bright. My gray sweatpants sat discarded on a chair with my stretched-out underwear. My mom was a few feet away, on the other side of a locked door.

Moments before it happened, I was asked in a few coded but unsubtle ways if I had ever had sex. I said no. I was reminded, in case I’d forgotten, that I was a “developed girl” and “developed girls” often got “certain kinds” of attention that encouraged them to do “certain things.” But I had not forgotten; it is impossible to be a young fat Black girl and forget.

I had come to the Pediatric Emergency Department at Montefiore’s Children’s Hospital with intense cramps. I’d been sitting with my mom in a tiny room for nine hours before I was wheeled away to see a doctor. A nurse told her to stand outside and instructed me to undress from the waist down and wait. When my doctor—a thin blonde woman—entered the room, she said hello with a big smile but didn’t tell me her name. She asked whether I was sexually active but didn’t seem satisfied with my answers. Then she told me to lay back, scoot my bottom toward the end of the table, and spread my legs so she could “take a look.” She didn’t explain what that meant or what she was doing or what she had done after it was over. I screamed for her to stop, shouted “No!” over and over. The speculum had painfully snapped inside of me a second time when she said “Wow, you really weren’t lying!” I could only sob with so much helplessness it made my throat rattle. When she finished, she said she would come back to discuss things with me, but she didn’t. I was sent home with instructions to take Motrin and “stay out of trouble.” The STI tests all came back negative.

A pediatric emergency physician looked at me, a thirteen-year-old fat Black girl, and was so certain I was sexually active that she performed a pelvic exam while I screamed and cried and repeatedly revoked consent—if you can claim I ever gave it in the first place. An adult looked at a child and saw a corrupted vessel, a body as full of overindulgence and promiscuity and unrighteousness as it was “obese.”

Does this seem like an unfortunate aberration? Maybe a doctor who’d had a long night in the ER? A bad apple? You are not the first to cling to the comfort of denial.

This is medical fatphobia.

Medical fatphobia refers to the specific ways that hatred and denigration of fatness manifest within medicine and the fields that medicine influences, like public health. It is the reason many fat people likely didn’t get or know to ask to have their COVID-19 vaccine administered with an appropriate-length needle, and why the American Academy of Pediatrics supports bariatric surgery for fat kids despite the incredible risks.

Mainstream writing on fatphobia usually gives in to the myth that there is something exceptional about fatphobic violence in healthcare. That fat people, in all our corpulent clumsiness, are just more likely to stumble across the assholes.

This is not true. It is a lie that has been actively propagated with the assistance of the many not-fat people who have shaped our collective understanding of how fatphobia operates. The truth is that fatphobia is a scientific invention. Fatphobia did not penetrate science; it is derived from science. Everything you know about “obesity,” about fatness, about fatphobia, about fat people has been — and is still — wrong.

 

I don't go to medical appointments as a rule because I already know what the diagnosis is: lose weight or die. My COVID vaccinations were the only time I've been to a medical facility in years. I know I'm in bad shape, but any doc is going to tell me "If you don't lose X pounds in the next year, you won't make it to the next one."

This article goes over every reason why.