The first time it happened, it was my mother. What perfect betrayal, like burning down the house where I was born. She grew tired in secret of the long, curved line of her belly, pendant in sweatpants and spreading over her lap when she sat. She hated huffing and puffing up the stairs, and she worried she’d become diabetic. So she underwent a radical form of weight loss surgery that eliminated over half of her gut — and taught me a powerful lesson in how intolerable it was to be like me.

Four kids and a minivan — nobody expected her to bother about her looks anymore. She didn’t tell anyone she was going to do it; she only told me I’d have to look after my younger siblings on the eve of the surgery. She made up her mind and didn’t want their judgments or their approval. The week before was an orgy of overeating that I recall as a conveyor belt of food. Carbonara thick as oil paint on piles of handmade noodles. Pot roast in flour-thickened gravy, potatoes enough to starve the Irish again, followed by bacon sandwiches that blurted mayonnaise from every side when she bit into them.

Even then, she barely cleared the insurance company’s weight requirement. Her doctor told her to make that last week count. Her best friend joked that she must be going in to get her tits done. She laughed and went under the knife at 4’11” and 285 pounds, nearly as wide as she was tall.

My mother was the first woman I knew who moved out of her own body.
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But what she really wanted was to not be like me anymore.

I went to support groups with her, in the year after the surgery. I didn’t go for the endless stories of these recovering fatties who had traded the feeling of being squeezed by the outside world for being strangled to thinness from within. I didn’t go for the stories of divorce so utterly rote and predictable that I struggled not to laugh. Men often marry fat women for very specific reasons. Conditions change and those men split like bananas. I went along because everyone there had once looked like me — and some of them had very nice clothes. They’d trade with one another, a 16 for a 14, a 12 for an 8. They shrunk before my eyes like icicles in spring. The tables marked 26/24/22 filled up and there was no one else to take those elastic dresses and 3X yoga pants. I showed up with a roll of garbage bags.

Why Don’t We Hear Fat Women’s #MeToo Stories?

More than once I inherited someone’s favorite outfit in its entirety, replete with the story of how it made her feel. I would wear that outfit later and remember that she wanted to stop being this so badly that she let someone cut out a large section of her intestines. She had an anchor-shaped scar across her entire abdomen. She vomited every day and shit herself at least once a week, but at least, thank god, it was all worth it because she wasn’t fat anymore.

There were other people I knew who moved out of their bodies, and I could understand why: They knew they had to go. They were being evicted anyway; blown knees and exhausted pancreas pushing them toward desperate measures. Weight loss surgery seemed a fair price if the alternative was death.

But in nearly every case, the alternative was my life.

I used to joke with people that I was my mother’s before picture, in the ubiquitous and devastating tradition of photos taken to reveal dramatic weight loss, the punchline for every ad that sells weight loss to women. Beforewe had shared a silhouette, titanic ass and olympian hips, a pear-shaped and pendulous swing we rode through the world. After I had trouble believing we were the same species, let alone iterations of the same bloodline. Long legs and short arms; freckles and the same crooked pinky finger. But disparity of scale suggested two different climates; two long-separated branches on the tree of life.

Before, my mother had dealt with the way people refuse to take fat women seriously. She had endured the infantilization and desexualization, and she was ready to trade it in. Two days after the surgery, she ignored her doctor’s orders and tried to chug a coke. I watched her stand over the kitchen sink with brown foam pouring from her nose and mouth, knowing herself chastened not by a paternalistic and fatphobic doctor for once, but by the physical reality that her new stomach was the size of a Dixie cup. A month later, I watched her black out after eating a Starburst; the sugar dumped into her bloodstream so fast that it acted like heroin when it hit her vitals. She traded the agony of perception for daily physical torment. After years of trying and failing at diets that never worked for anyone, she chose the nuclear option. She weighed her options and chose this over living a life like mine.

For me, it’s only the surgery that achieves the sharp sensation of abandonment, rejection, and betrayal. I’ve seen friends through every diet, every justification of denial, misery, and elimination. A friend or a cousin will one day lose the ability to converse about anything but carbs or sugar or whole foods or animal products. I’ll stop listening and start nodding. I know they’re trying to move out, move away. They cannot bear to be what we are anymore.

The fat people who become obsessed with counting calories and steps, the ones who try to vacate their bodies a little at a time . . . I don’t worry about them. They’ll never make it. Sooner or later they all come back.

The ones who follow in my mother’s footsteps are the ones that really leave. They get something cut up and cut out, they install new hardware to stop them from eating the world. They pack it in and they don’t return. I stay me.

I’ll be polite to my fellow fatties when they fall prey to the pressure; I understand what they’re going through. Thin people talking diets fill me up with liquid murder. I cannot abide their careful warding, hanging up knots of garlic and crossing themselves three times when they see me coming. I will not listen to their terrified superstition or their smug pseudoscience when they tell me again and again what they are willing to go through rather than become like me. When their talk rolls around to calories and their moral obligation to hate themselves, I typically spread out as wide as I can. I can expand like a jellyfish; it is a particular advantage of the very fat. I conform to the shape of my container like a water balloon. Displaying maximum width, I’ll eat anything I can get my hands on while they talk. On one notable occasion I shut down a discussion on the evils of white rice by calmly eating a trick-or-treating sized bag of mini Snickers while nodding my fat head to show I understood.

In outraged weariness of being seen as a cautionary whale, I seek out ways to weaponize my own image. I haunt thin people at the gym as the Ghost of Fatness Yet to Come. It started off as a demoralizing phenomenon; I began by refusing to shrink away from the pained glances and open hostility I receive for having the audacity to live in a fat body without making a constant apology for myself. My gym in San Francisco is a caricature of bodily obsession. Its ad campaigns are notorious, and lithe trainers cruise the floor like sharks sniffing for blood. There are no other fat people there. An orca among eels, I cast my shadow over their swimming and striving, and they look upon me in naked terror. I am the reason they get up at 5 a.m. and wear a monitor that counts their steps. I am the worst thing that can happen.

‘It’s Because You’re Fat’ — And Other Lies My Doctors Told Me

One after another, the fat people in my life have left me. Not through diet or exercise, not through the much-vaunted “lifestyle change.” They get the surgery and they cross over to the other side. Many of them have been self-accepting, even fat-positive. They came through hell to love themselves and live in their bodies without apologizing. But they’ve gotten tired of haunting the gym. They get tired of people lecturing and begging. They get tired of men at the bar shouting “man the harpoons.” They get tired of their seatmates on airplanes asking to be moved. They get tired of hearing they were too fat to fuck, or that this dress does not come in that size. They’ve done the impossible math: one set of humiliations they’re willing to trade for another. They come to agree with our thin friends; this life is the absolute worst fucking thing that can happen to a person.

I made new friends with a fat girl. She is beautiful and smart and holds an enviable position in my community. I tried several times to engage her in the casual sorority of fat girls, to talk brands and clothes and share a little eye roll at the way things are. She rebuffed me in a kind but cold way, and I didn’t know why. I thought spitefully that she might be one of them, in long recovery from the knife and not yet passing for thin. Months later, she published her own story of dysphoria in a lyrical cry that broke my heart. I adjusted. I took another step in the direction the conclusion toward which most of my life has been leading me: No matter how much they hurt, the actions of others are entirely for and about themselves. They aim those harpoons at their own hearts.

My mother did not opt for invasive surgery to leave me behind. She did it because was tired of the inescapable fight that is life in a fat body. I am not the victim here. I am only a casualty.

Yet another friend went in for the surgery, early this year. I tried to look at her life without judgment, without centering my own emotions, and figure out why she would choose this. We’re old enough now that vanity itself does not seem like enough. Maybe she’s lonely and thinks this is the answer. Maybe she wants to travel without being a spectacle and an inconvenience. Maybe she just wants to live in another body before she dies. In the end it doesn’t matter. She’s doing the thing that everyone but me will understand. It’s what they would do in her place.

The first day I knew she was home and recovering, I briefly considered having a dozen donuts delivered to her door.

But I didn’t. Because there are worse things a person can be than fat.

The doctor had my empty skin in fistfuls, pulling my flesh together at the center of my body. The corset of his hands exaggerated my natural curves unnaturally, making me look wasp-waisted and wrong.

“Just look how pleasing she would be,” he remarked, surprising me with the third person. He was not addressing me, but looking past me in the mirror to meet the eyes of my then-boyfriend.

Pleasing. I remember that word specifically, can still hear it: a word shared between men. Although it was my body he was manhandling, his work was clearly not about me, personally. It was about what I broadcast — the experience of my body from an external perspective. It was about the object I could become.

After a lifetime of obesity — I was fat since I was 4 years old — I lost a significant amount of weight in my early twenties, which took two years and a total reinvention of my relationships with food and exercise. I worked hard to lose the weight, of course, and my body was inarguably different. But I still wasn’t satisfied, still didn’t look as I’d imagined.

At 14, I’d printed photos of bikini-clad women and taped them into a notebook. It was the highly problematic “thinspiration,” a small act of masochism to bolster my daily journaling of bites eaten and steps stepped. The models strode down empty beaches with carefree smiles and almost every inch of skin exposed, their taut tummies and distinct thighs heuristics for perfection — never mind how carefully crafted those images might be, how fake their photographed laughter. Living life as a fat girl in classrooms, doctors’ offices, and school dances had only reinforced my suspicion: If I looked like that, everything would be different. Easier. Better.

At 24, my “new” body could fit into clothes whose tags bore single-digit sizes, but I looked nothing like those women when I wasn’t wearing them. What fat I had left pooled into sags of skin across my belly and inner thighs, which still rubbed together — sometimes painfully. Outwardly, I had achieved thin-girl status, as evidenced by all the strange and problematic things I suddenly began experiencing: Men who’d wanted nothing to do with me before began asking for my phone number; athleisure-clad women beside me in cafe lines commiserated idly about tempting bakery cases, their wares assumed verboten. But in my brain, I was still a fat girl, and my unclothed body corroborated.

Naked at the mirror, I’d pick up the deflated bag of my belly and let it fall, or hoist the flab of my thighs like loose leggings to see the strong muscle I’d developed underneath. I had come so far and put in so much work to meet our society’s ideal, and I couldn’t shake the feeling I was being denied something — something I’d earned.

So I called the surgeon’s office and made the appointment.

My phone rang a week before my surgery date, which was set for early December. It was my anesthesiologist. He wanted to triple-check my health history for the many risk factors of general paralysis; I’d be under for at least four, and up to seven, hours.

I’d planned to take the four-week winter break of my senior year in college to get through the worst of the recuperation. Along with all the risks of the surgery itself, a full tummy tuck involves weeks of brutal recovery; patients can’t even sit upright, let alone walk properly, for several days post-op. Bulbous drains are inserted bilaterally into the wound to catch the lymph and blood the body weeps for even longer, requiring regular, stomach-turning maintenance. The incision site can remain swollen and tender for months after the procedure, all to say nothing of the basic, gut-level grisliness of the thing: a hip-to-hip gouge, a triangle of flesh lifted from the abdomen like making the mouth of a Pac-Man.

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I gazed at the box of post-surgical vitamins in the early kitchen sunlight, peeked inside at the three large bottles filled with horse-sized pills I dreaded trying to swallow. The blend had cost me $90 and was heavy on the arnica. I was about to give my body a serious beating.

I can’t tell which of the many pieces in this braid of hesitation finally made me call it off, but I do know the decision cost me my non-refundable $1,000 deposit. (The total estimate escapes me, but it was in the five figures.)

I wish I could say my entire weight loss effort was healthy and body-positive, but it wasn’t. Indeed, much of it was rooted in a kind of obsessive-compulsive self-hatred that made existing through constant, low-grade hunger and climbing untold StairMaster storeys not just possible, but inevitable.

But whereas parts of my weight loss effort were distinctly unhealthy and dangerous—psychologically and physically—other parts, like establishing a balanced fitness routine, were good for both my brain and body. By contrast, this surgery could only diminish my bodily health — if not by some complication related to the procedure itself, at the very least by forcing me to give up exercise, which I’d ultimately grown to love and rely on for self-care, for the duration of the recovery.

This surgery could only diminish my bodily health.
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Paradoxically, this surgery meant to make a body look “fitter” requires that body to give up fitness pursuits to properly mend. Many patients find that by the time they’re healed, they’ve gained much of their lost weight back. It’s not an uncommon irony in plastic surgery; breast augmentations, for instance, carry the risk of loss of nipple sensitivity. The sexually-objectified body part becomes a more perfect sexual object, but loses its sexual potency for the woman herself.

In any case, the surgery was an undeniably wild expense and put my body at significant risk that was in no way medically necessary. I could tell myself I was doing it “for me” all I wanted, but was I really willing to risk my life for something purely cosmetic?

Half a decade later, I’m still living in my imperfect, stretched-out body. Loose skin and stretch-mark trenches confess a complicated history, a life lived across the spectrum of size.

I won’t lie and say I don’t still think about it on occasion, that I never poke and prod my misplaced parts in frustration. Although my gym time is now (mostly) for my sanity as opposed to my vanity, sometimes, I still can’t get past it. I did so much work. I do so much work.

But most days, living in my imperfect body helps me realize how misguided that ideal was in the first place, how arbitrary those visually-based goals can be. I’m in the best shape of my life, eating food that makes me feel good, and always finding new ways to move; I’m strong enough to enjoy experiences — running 30-minute 5Ks, squatting under heavy barbells, hiking steep river valleys — that were out of reach when I was less fitness-focused.

I can’t deny that excess skin has made dating somewhat challenging — sometimes more so than it was to date fat, when my partners knew what they were signing up for from the start. But in some ways, it’s actually a helpful elimination tool (or, as I like to think of it, an asshole barometer). Given that I look significantly different naked than one might expect when meeting me clothed, I’ve taken to having a frank and open conversation ahead of business time — and if that honesty and imperfection gives a would-be partner pause, I’ve gained an invaluable data point as to whether I really want to sleep with them in the first place.

My Friends Would Rather Have Their Guts Cut Open Than Be Like Me
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The sex itself is also better, by the way. I find I’m less and less focused on what’s jiggling where, or on how I can better perform for my partner, the movie-reel play-by-play of what does this look like; how I might be, in my would-be surgeon’s words, more “pleasing.” Instead, I focus and insist on my own pleasure as well as theirs; I’ve stopped faking orgasms. Part of it is plain old growing up, but I also thank my decision to allow my body to be what I’ve made it — as opposed to slicing it into something the better to be served up to others.

But most importantly, foregoing plastic surgery has unlocked a new understanding of my relationship to my physicality. Accepting that my body will always be this way — “imperfect” — shifts the impetus of maintaining it from self-punishment to self-care. The effort of eating well and moving lots, I’ve learned, doesn’t have to be about excoriating excess flesh or trying to be smaller.

Instead, it can be a labor of love, a way to respect and retain this resilient machine that moves me through the world — that is my world, sagging and stretched and strong and only mine.

I was 18 the first time I met a fat sister-in-arms. It was my first semester of college, and we immediately gravitated toward one another, buoys in the choppy waters of an unfamiliar sea.

That year, we became closer than either of us expected. Both of us had been the fattest kids in our high school classes, held at a distance from classmates by virtue of our bodies. We’d both hoped college would be easier, but most of the time, it felt familiar: the desks that weren’t built for us. Classmates who stared openly at our bellies and thighs. The lengthy diet talk amongst classmates, bemoaning the fat on their slight frames, a hundred pounds lighter than our own. Professors’ penchant for using obesity as a metaphor for capitalism and excess. Our bodies were always unwelcome, a stand-in for some pandemic or a terrifying future.

In the face of all that, we made a radical decision: We decided to like each other, and we decided to like ourselves. We became two of the few fat people who no longer feared our own skin. There was such reckless joy in our time together, such fearlessness in our hearts. We learned of our thirst for understanding only as we slaked it.

Our bodies were always unwelcome, a stand-in for some pandemic or a terrifying future.
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This was when I learned to love and admire bright and shining fat people, the ones who vibrated with joy, who refused to reject their bodies as character flaws or moral failings. The ones who resisted diet talk, the conscientious objectors to bemoaning their thunder thighs and bingo wings, their rolling bellies and wide hips. The ones who wore clothing that was bright and tight, or billowing and dark — whatever they felt like wearing. The ones who happily, loudly loved their size. The ones we were becoming.

These, I learned, were my people.

When we returned for our sophomore year, she told me the pressure had become too much. She feared for her partners’ shame, feared for more bullying from her tough love parents, feared for the jeering her thinner friends had to endure when they spent time with her.

So she got weight loss surgery.

I told her I was happy for her, and I was. She’d made a decision about how to engage with her own body. We’d often talked about how often our bodies were taken from us — from unsolicited diet advice to fatcalling, unwelcome comments about our orders at restaurants to bullying in the name of “concern.” Thinness was the only way she could truly end all of that.

My Friends Would Rather Have Their Guts Cut Open Than Be Like Me
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But her body wasn’t the only thing that changed. As she lost weight, so much more fell away. She gushed over her new straight size clothing, and relished the femininity she was now allowed by those around her. Her attention drifted to thinner friends. She grew out her hair and dyed it. At her thinnest, she started talking about how much she hated her thighs, even at the smallest they’d ever been.

That was how I lost her. She disappeared into the warm sunlight of thinness. I returned to the role I knew best: the fattest student in class. And I learned the quiet heartbreak of losing someone who truly understood what it meant to live in a body like mine.

There’s a quiet adjustment of expectations that comes with being very fat. You learn that you’re unlikely to be welcomed where your body can be seen: in sports, acting, sales, communications, politics. You might apply for a restaurant job as a server and be offered one as a dishwasher. You might audition for a play and be redirected to join the crew.

Sometimes people tell you kindly, sometimes cruelly. Sometimes you find out by seeing another fat person rejected in public, sacrificed as an object lesson. But no matter where you go, someone is always there to teach you a mandatory lesson: that your success will always be contained by others’ willingness to see your body.

In recent years, a handful of fat people have slowly but surely chipped away at the stone walls faced by fat people who want to be seen, who want to ascend to the heights normally reserved for those who have earned visibility through thinness. As an adult, I’ve seen two women my size become household names: actor Gabourey Sidibe and plus size designer Ashley Nell Tipton.

As a fat woman, these two had not just been breaths of fresh air, but indicators that more might be possible. That people who look like me could find their way into places we weren’t expected, and often weren’t welcomed. That people who looked like me belonged in front of the camera just as much as behind it. It is extraordinarily rare to look up to someone with a body like mine. It is rarer still for those women to be lifted up in media. That moment — of seeing and knowing bodies like mine in media — became a fleeting one.

What It Means To Become The ‘Fat Friend’
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Sidibe and Tipton both announced this year that they’d had weight loss surgery. Some — mostly thin body positivity activists — have congratulated Sidibe and Tipton for what they see as positive choices to benefit their health. Others — mostly fat activists — have responded with frustration or anger at losing two of the very few, very fat people who have ascended such great heights. These losses cut deep — not because of their individual decisions about their own bodies, but because it reminds fat people of how we’re seen, and often, how we’re forced to see ourselves. The ways in which we are expected to sacrifice our bodies for the comfort of those around us.

I am reminded of all of that, and of what it means to lose someone you’ve loved and looked up to — the familiar drift of formerly fat friends into thinness. I’m bracing myself for the crash.

But the longer I sit with the reality of losing two icons that have bodies like mine, the more I think of my college friend. I think of the ways in which her mother’s cutting remarks whittled away at her sense of self, the fear of facing an airplane full of disdainful passengers, the exhaustion of fending off strangers’ comments on her groceries at the store. She was constantly pitted against her body, made to choose between cutting out a vital organ, or continuing to live the tiresome life of a very fat person.

Her decisions are her own, as all of ours are. But often, weight loss was posited as the only way out of the heavy rainfall that eroded her sense of self: first topsoil, then clay, then bedrock. In the face of unrelenting bullying and rejection from all sides, fat people are told our only option is to forsake the only bodies we have.

I wonder about my friend, and what her body looks like now. Whether it has found its way back to its old shape, as so many do, or if she has stayed thin. I wonder if her mother still speaks to her so dismissively and unkindly. I wonder if she still feels the warmth of thinness on her shrinking skin, slipping into a new life like a witness under protection. I wonder if she found love with those who used to hate her. I wonder if she is happy. I wonder if she’s found the acceptance she was looking for.

What is so often lost in conversations about weight loss surgery is the untold story of the constant pressure fat people are under to lose weight. Not just some weight, but as much weight as possible, as quickly as possible. And then we’re expected to lose more. For fat people in the spotlight — especially very fat people, very fat women, and triply for very fat women of color — that pressure warps and magnifies, fortified by so many people’s beliefs that we are entitled to others’ bodies, especially fat bodies, women’s bodies, and bodies of color.

Of course, all of us should be able to make whatever decisions we like with regard to our own bodies. And of course, I’m here for all of those choices. But for some of us, only one option is made available. And we are taught that it’s the only way to reclaim our own bodies, to succeed in our careers, to stem the tide of rejection visited upon us, and to gain the love and acceptance of those around us.

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I cannot claim to know the intricacies of Gabourey Sidibe or Ashley Nell Tipton’s life decisions. I cannot know how many jobs they lost for being too fat to be seen, and how that shifted their expectations over time. I cannot know how many colleagues spoke to them with syrupy concern or outright rejection. I cannot know the diagnoses or conversations with doctors that shaped their decisions. And I cannot — and will not — judge their decisions.

But I do know that the deck is stacked against fat people staying fat, keeping the bodies that have cared for us all this time. Our character, will, strength, worth, and health are all judged on the size of our skin. We are told that others’ behavior hinges on our size — that if we resisted our own bodies, they wouldn’t be forced to treat us poorly, mock us openly, or disregard our most basic needs. The only path to respect, we are told clearly and repeatedly, isn’t to request it from those around us, but to transform our bodies completely and immediately. For some of us, the only affirmation we receive comes when we lose weight.

As people living in fat bodies, our choices about our bodies are never fully our own — always swayed or sunken by the pressures of media, family, friends, doctors, strangers on the street. Everyone has an opinion on our bodies, and those opinions are asserted freely at every turn.

For very fat people, weight loss surgery is never as simple as a matter of health, and is rarely a decision offered freely to us amongst an array of options. Yes, I support the choices fat people make to lose weight. I just wish it weren’t the only choice available.

By age 18, my knees hurt.

I didn’t know why, and they didn’t hurt a lot, but they did hurt a bit most of the time. As someone who took a lot of dance classes and played my share of netball, it was annoying, but not something I thought much about. After all, I reckoned, bad knees run in my family.

But by age 20, the pain had gone from a bit annoying to definitely annoying. I decided, for the first time, to see a doctor about it.

She was a brisk woman with close-cropped grey hair, who glanced at me and told me my knee pain was due to early-onset arthritis as a result of my being overweight. My blood tests were negative for rheumatoid arthritis — but that didn’t matter, she told me. The only way to stop my pain from getting worse was by losing weight. So with the resigned sigh of anyone who has grown up fat, I accepted my fate. I was arthritic, at 20.

By 22, things were worse. My knees had gone from hurting a bit most of the time to spontaneously collapsing in blinding pain while I was doing innocuous activities like walking down the street. I went back to the doctor — a different one, because I just saw whoever was available at the student clinic. He asked me about my pre-existing medical conditions. I explained that my arthritis was a result of being overweight. He looked at me incredulously. “That’s not a thing.” No one gets non-rheumatoid arthritis in their twenties as a result of being overweight, he explained.

With the resigned sigh of anyone who has grown up fat, I accepted my fate.
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Instead, he decided we should figure out exactly why my knees were spontaneously collapsing. He sent me for an MRI, and I had a consultation with a specialist surgeon.

“Patellae chondromalacia,” the surgeon declared. He showed me the shadows on my scan, which indicated rough patches on my knee caps. It was probably hereditary, exacerbated by my weight. “Okay,” I said. “So what can I do about it?”

“You’re just going to have to manage the pain,” he explained. “And once it gets to be too much, you’re going to need your knees replaced. And that will probably be before you’re 30.”

Resigned, I accepted my diagnosis. I said goodbye to yoga and dance, which aggravated the condition, and started wondering about how much two new knees might cost, and how I’d get around on crutches. I had eight years before I turned 30; it felt a bit like a death sentence.

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At 24, my new housemate decided she was joining our local gym, and in a moment of optimism, I decided to go with her. This gym offered a free short session with one of their personal trainers to help newbies learn the ropes. “I’ll put you with Hao,” the receptionist said. “He’s got a physio background; he’s good with injuries.”

Hao was intimidating — really tall, super buff, thick Chinese accent that was hard to understand at first. “It says here you’ve got an injury,” he told me. “What is it?”

“I’ve got patellae chondromalacia in both knees,” I replied. “It’s-“

“Oh that,” he said, interrupting me. “I can fix that.”

What?

Hao explained to me that what I had was a pretty standard sporting injury that is usually treated successfully using exercise — a fact that none of my doctors had mentioned. I’d probably injured myself as a result of all that dance and netball I did as a teenager, and it might have been exacerbated by my family history of dodgy knees. It’s normally caught early and treated early — it’s very rare for it to get to the point of causing knees to collapse, but that can happen in serious cases with no treatment. “Work with me for 10 sessions,” said Hao. “If you don’t notice a difference, I’ll give you your money back.”

Well, after 10 sessions I noticed a pretty significant difference. After six months, the pain that had plagued me for six years was entirely gone.

I can’t help but think that there’s a whole lot of physical pain I could have avoided if any of the medical professionals I saw had considered the fact that I might have a sporting injury. And I can’t help but wonder if the reason they didn’t has to do with my weight.

When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl — and they based their diagnosis on stereotypes about what that meant. I’m 29 now, and my knees no longer hurt. I don’t need them replaced — but if I’d listened to the weight-prejudiced opinions of my doctors, I might have.

This story is hardly unique.

Research shows that doctors have less respect for patients with higher body-mass indexes (BMI), which can lower the quality of care those patients receive. As one study put it:

“Many healthcare providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behaviour and decision-making. These attitudes may impact the care they provide.”

Troublingly, many of the ideas that doctors have about fat patients aren’t even grounded in medical fact. Indeed, too often it’s forgotten that the science around weight loss and health isn’t all that settled.

Does excess weight cause you to live a shorter life? Maybe, maybe not. Countless studies by BMI category have found that overweight people actually have lower rates of all-cause mortality than normal weight people.

When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl.
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Some researchers think that if you adjust for the increased risks caused by weight cycling (a.k.a. yo-yo dieting) and dangerous weight-loss drugs, you’d find the same mortality rates for normal, overweight, and obese people — yes, even very obese people.

And even without the adjustments, the increased risk for very obese people is only small — not the “you’ll be dead before you’re 30” nonsense often pedalled by purveyors of weight-loss surgeries.

What about serious disease? There’s certainly a correlation between being overweight and some diseases, but multiple studies suggest that the weight might actually be a symptom rather than a cause.

Then there’s the idea that excess tissue “strains” the body. Eminent obesity researcher Dr. Paul Ernsberger has been quoted as saying, “The idea that fat strains the heart has no scientific basis. As far as I can tell, the idea comes from diet books, not scientific books . . . Unfortunately, some doctors read diet books.”

What about dieting? Well, there actually is some scientific consensus there — diets don’t lead to lasting weight loss. Not even if you call them lifestyle changes. After an extensive metastudy of diet and weight loss studies, Dr Traci Mann concluded, “The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.”

So why, then, do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?

Sarah, 29 from Newcastle, Australia, had the misfortune of breaking both legs as a teenager, the result of a freak accident involving her legs falling asleep and then getting twisted to the point of breaking. Not long after learning how to walk again, she was involved in a serious car accident that left her with further damage to her legs. “I’m accident-prone,” she laughs. The multiple injuries have left Sarah with a build up of scar tissue that can make walking painful. But when she went to the doctor, her pain was blamed on her weight.

“My weight is a factor in the healing process,” she says, “But it wasn’t the cause of my injuries — and I’ve got police reports, x-rays, and specialist reports to prove it.”

Why do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?
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Sarah changed doctors recently, and her new doctor decided to do a full medical history, checking the notes from all the physicians Sarah has seen. What she found shocked her. “She said there’s no record of my injuries with most of my previous doctors,” Sarah said. “They all had written that my leg pain was caused solely by my weight, and that meant I wasn’t getting any useful treatment for the pain. They just told me to diet.” Sarah’s new doctor promptly started her on a physical treatment plan designed for someone with compound injuries and severe internal scarring.

The difference has been immediate.

“Within two weeks I could walk nearly five kilometers. Before I started the treatment, I could only manage one kilometer or less before my knees were so swollen and painful that I couldn’t keep going,” said Sarah. “Getting actual treatment for my injuries, rather than just being told to lose weight and see what happens, has changed everything.”

Just to be clear, I’m not saying that eating healthily and exercising aren’t good for you. The problem is when doctors prescribe diets and weight loss to patients without fully considering their symptoms and other treatment options.

Stigmatization may also, problematically, stop fat people from seeking out medical care in the first place.

“I just don’t go to the doctor,” says Anita, a 28-year-old advertising executive. The last time Anita saw a doctor, it was a routine visit to discuss vaccinations and anti-malarial medication for an upcoming overseas trip. The doctor prescribed the vaccines, and asked a nurse to administer the jabs. It was the nurse who decided Anita had diabetes — without having spoken to her, or seeing anything pertaining to her medical history.

“He kept saying I would get a discount on the vaccines if I registered my diabetes,” Anita explained. “I haven’t got diabetes, but he wouldn’t listen. His whole attitude was like, ‘you know you’re fat, right?’ Um, yeah, I’ve noticed that, actually. Just give me the jabs.” The experience was pretty upsetting, and left Anita firmer in her resolve to avoid doctors wherever possible.

Still, Anita, Sarah, and I are relatively lucky; our experiences have caused us pain and humiliation, but no permanent damage. This is not true for everyone.

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First Do No Harm is a website that chronicles the experiences of fat people with medical professionals — and it’s filled with harrowing stories.

One woman lost a lot of weight suddenly and was praised for it — with doctors missing the fact that it was a sign of the cancer that shortly killed her.

A man vomited constantly due to MS, but instead of viewing that as a medical red flag, doctors simply celebrated the 120-pound weight loss it caused. The vomiting led to permanent nerve damage, back pain, and tooth decay .

A woman had an emergency-doctor declare that she didn’t need treatment for abdominal swelling after a serious car accident because she was just fat. She nearly died.

A woman went years just being told to lose weight to address her ongoing, multiple health problems. It turns out she has a rare neurological disorder; the diagnosis delay has led to permanent brain damage.

There’s another trove of awful stories on fat prejudice here. And of course Google’s got plenty more.

A consistent narrative runs throughout these stories. Hormonal problems? Lose weight. Broken finger? Lose weight. Migraines? Lose weight. Losing weight is the consistent — sometimes only — treatment offered for every ailment imaginable.

Losing weight is the consistent — sometimes only — treatment offered for every ailment imaginable.
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For many, changing the narrative around weight is literally a matter of life or death. So what can be done to address the problem?

The good news is that there’s some recognition within the medical profession that this is a serious issue which must be addressed. It’s been noted thatmedical students don’t receive nearly enough training on obesity, and efforts are beginning to try to change that. Researchers are also working on empathy programs and raising awareness about the impact of implicit bias against patients. All of this is a promising start.

At the same time, we can all become our own health advocates. If you’re a fat person, or someone you care about is a fat person, you can develop your critical thinking skills and challenge the classic “just lose weight” prescription if it doesn’t seem to fit the symptoms.

This isn’t easy. There’s an implicit power imbalance between patient and doctor that makes challenging their statements very difficult. By working to become experts in our own health and our own situation, we stand a better chance of being able to call out something that doesn’t feel right.

There’s an implicit power imbalance between patient and doctor that makes challenging their statements very difficult.
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Doctors are highly educated people, but they’re subject to the same biases as the rest of us, and many of them don’t stay up to date with the latest research. That’s not good enough. If obesity really is a major health concern, it’s essential that doctors stay educated on recent studies and metastudies that look at how to get the best outcomes for fat patients. If doctors really do care about their patients, they need to start looking at the overall picture of a person’s health, not simply the size of their body.

Most of all, doctors need to stop prescribing a treatment that’s proven not to work for conditions that don’t warrant that treatment in the first place.

The medical profession needs to step up. It needs to accept that diets aren’t the universal treatment option for fat people. It needs to accept that fatness isn’t the universal cause of ill health in fat people. It needs to engage with the very real damage caused by its attitudes toward fat people, and with the sub-standard care delivered to many people as a result of their size.

It’s not exaggerating to say that lives depend on it.