One minor issue: so far as I know, polycistic ovarian syndrome can cause weight gain and make weight loss very diffictult, but it isn't caused by weight gain.
posted by Nancy Lebovitz at 3:55 AM on October 19, 2022 [2 favorites]

I’ve got friends with EDs, and some of them are fat. Since I love talking about food and cooking and all that, I’ve had more than a few conversations about their different experiences with how they’ve sought treatment and what they’re doing to recover. A friend told me that I seemed like a safe person because I was so enthusiastic about a nice sandwich in front of her one time that she wanted to tell me not only was it a nice sandwich but she was going to take a picture to send to her therapist. I provided an extra pair of jazz hands in the picture.

The thing is, they all have horror stories about doctors, but my fat friends have unbelievable horror stories. A friend I will call Teacup was diagnosed with orthorexia, which is where you make increasingly convoluted and restrictive rules about food. She is also fat and has done the yo-yo dieting thing for years. Apparently, after working with a dietician she ended up so dissatisfied with the resulting recommendations that she “went rogue” (her words) and eventually ended up anemic and a host of other symptoms. When she was being treated for her anemia, she got IV iron (highly recommended) and as the nurse hooked her up, he evidently said “well, it’s not like you should be eating steak, right?” She told me this story while she laughed. I was incensed. The guy was literally treating her for the effects of her ED, right there on the fucking chart and everything.

Losing weight absolutely needs to stop being seen as a solution to medical problems. I’ve got a doctor’s appointment in a week and a half and I “need” to have lost about twenty pounds since last year that I flatly have not. I’m going to tell my doctor she needs to treat me at the weight I am, and that’s that. Atypical anorexia, as described in the article, sounds to me like a diagnosis invented to put fat people into a special box and thus allow them to be treated unequally, understudied and underdiagnosed.
posted by Mizu at 4:46 AM on October 19, 2022 [44 favorites]

The world really needed this article -- more to the point, I did. People need to understand this more widely. When I was a girl in the '90s, well-meaning health class PSAs and lessons pointed to the dangers of anorexia and bulimia, but the images and the stories they told accidentally taught a different, false lesson: eating disorders worked. You could deal with the devil and he would deliver. Subsequently, I thought I wasn't "good enough" for an eating disorder even when I was exhibiting actual disordered eating.

It took until I was an actual whole grown professional to stop this nonsense. I was on my way to work when I nearly fainted in the middle of a crowded Red Line train, which would have caused the dreaded "medical emergency" delay and made half of Boston hate me for the morning. I managed to get to the next stop and hit a bench for a while. At urgent care, it turned out to be hunger and low blood sugar, which honestly hadn't occurred to me because I thought I had had "enough."

(And I've said it before: I think the prevalence of gendered insults like "dizzy" and "airhead" for women, especially in the '80s, tracked with a rising population of women who were having trouble concentrating or standing up for long because they were starving.)
posted by Countess Elena at 4:55 AM on October 19, 2022 [52 favorites]

Oof, yeah I've never had a doctor praise me more then when I was at the height of my ED.
posted by Bemused Recluse at 6:07 AM on October 19, 2022 [17 favorites]

I read an article about 2 years ago

about a woman who had a giant abdominal cancer tumour (3kg or 4kg when it was finally removed)

and she could eat very little because the tumour got in the way

and every time she went to the Dr

they told her that she was lying about how much she could eat

because "look how fat your stomach is!" [Her stomach looked fat because of the massive tumour]

and they refused to do tests because clearly she was just a lying fat woman
posted by chariot pulled by cassowaries at 6:45 AM on October 19, 2022 [34 favorites]

This is kind of me (not quite), and I'm caught between two competing pressures: a genuine medical need to lose weight (diabetes) against receiving treatment for disordered eating. I don't have an eating disorder according to my therapist (my disordered eating doesn't quite rise to that level) but I could very easily develop one and the weight loss treatment I was receiving was giving me an eating disorder, because they had all these tools for losing weight (like tracking every calorie, keeping a food diary, doing this exercise book that was supposed to deal with my presumed overeating as a kind of self-therapy) that were very triggering for me.

Everybody I dealt with was very kind - I have actually never had a doctor be unkind to me about my weight though I have experienced doctors focusing on my weight when something else was the problem - but they were driving me into at least orthorexia if not full-on bulimia out of an assumption that I had gained weight 100% from not paying attention or maybe not understanding basic nutrition facts, neither of which is my issue, quite the opposite actually.

Luckily I have a therapist for unrelated reasons who also specializes in eating disorders, so I was able to just talk to her about it instead of seeking out a new provider. She told me to stop the weight loss program, which I've done, and she's walking me very gingerly through dealing with my feelings around eating and my body. I have been slowly losing weight as well but it's really really hard, not even because of the therapy but because I'm post-menopausal and my body just gloms onto every ounce of fat it can get.
posted by joannemerriam at 6:52 AM on October 19, 2022 [12 favorites]

Every fat person knows this. EVERY fat person knows this. I am glad to see it hitting the mainstream but maybe if one (1) medical professional had listened to a fat person in the history of the world we would not, in the year of our lord 2022, be writing "when you're fat, disordered eating is actually PRAISED and ENCOURAGED" as though it's news.
posted by babelfish at 7:10 AM on October 19, 2022 [48 favorites]

Aubrey Gordon and Michael Hobbes talk about this on their Maintenance Phase podcast all. the. freaking. time.
posted by Halloween Jack at 8:04 AM on October 19, 2022 [15 favorites]

In the last year I've been on one of those drugs, dropped 25%, but more importantly been relieved of the bottomless, endless hunger that has held a part of my brain hostage for well over 40 years. The whole experience -- of not having my day ruled by trying to ride a bonk and the various ways that goes badly, of eating a lot less and actually feeling full, and of being smaller have really been a huge mind trip. For one, it's now very clear that weight is not under voluntary control (as if the 90% failure rate wasn't enough to make that clear).

The biggest mind trip is realizing how very strongly I've internalized the many stupid things about eating, and fat, and what we assume about people based on their size, that society drills into women, and all of us. It's just ... deep and vast.
posted by Dashy at 8:14 AM on October 19, 2022 [4 favorites]

chariot pulled by cassowaries: I have a similar story about my dad. He was a smoker, and after he quit, he gained a bit of weight. Later on, he lost so much weight during a short amount of time that it became a concern, and went to the doctor. This doc thought nothing was wrong, even though my mom could feel a hard lump in his abdomen, and praised him for losing the weight. Thankfully they got a second opinion and the stomach cancer was found. Said cancer was already pretty advanced, iirc, but he ended up getting good enough treatment that he could make one final trip to see family in the UK before relapsing.

Miss you Dad, and thanks Mom for seeking out that second opinion, so he could live a bit longer.
posted by May Kasahara at 8:21 AM on October 19, 2022 [11 favorites]

The thing that always makes me furious, is that public health scientists have known for DECADES that obesity at a population level is caused by things OTHER than individual food choices.

For instance, there is a pretty unassailable body of data across multiple interdisciplinary fields showing that obesity levels have risen as a result of the massive amount of chemical toxicants present in our air, water, and plastic products . And we even know the epigenetic mechanisms!

If your weight is directly related to the amount of lead your mother was exposed to when she was pregnant, why are we still prescribing diets as a cure?

How are individual people meant to counteract the effect of insecticides used in the global food chain?

If the thing that's making you and your family fat is the tap water you use to shower, drink, and cook your food, how is 'cutting out carbs' gonna help?

There is a scientific consensus on this stuff! It's not a conspiracy theory, but a whole enormous area of super-official public health research! And yet: the same old myths about individual's making bad choices get paraded out by doctors and politicians, every time. Despite the fact we also have decades of data showing dieting doesn't work!

It makes me so damn mad.
posted by EllaEm at 8:25 AM on October 19, 2022 [28 favorites]

I don't have an eating disorder and fall more on the side of overweight than obsese, but I want to gripe about my doctor telling me I should go on a "low carb" diet and use a calorie counter during my pregnancy because otherwise I might develop gestational diabetes.

I'm not against the advice to be careful with diet during pregnancy because it's easy to think you crave something sugary (like fruit juice) because of the pregnancy when really it's because it's ultraprocessed and just cravable in general.... I'm not against reasonable advice like eat whole fruits and vegetables, avoid sugars and potatoes because gestational diabetes is a real thing that affects a lot of women.

What I object to is the "low carb" fad diet and extra concern based just on my BMI, and not any actual health indications that I was at risk for gestational diabetes. When I finally took the glucose test the results were normal and even on the better side of normal.

What I resent was the (thin, busy) doctor jumping straight to the advice about not eating fried foods and not eating pasta when she didn't even ask me what I was already eating. I know it's because she's busy and not an expert in this area but "talk to a nutritionist" would have been better advice, or better yet just bring it up as a general issue for all pregnant woman and wait until there's an actual indication (besides BMI) that it's an issue of special concern for me.

This is a problem with "one size fits all" doctoring because I'm sure there are cases where the advice is helpful. Anyway a comparatively mild story but just the idea of being told to go on a more restrictive diet and count calories more during a pregnancy bothered me. What if I did have an eating disorder?
posted by subdee at 8:36 AM on October 19, 2022 [10 favorites]

I listened to a podcast about this recently—maybe a back issue of You're Wrong About, I'm afraid I can't find it right now—and my version of this is that from September of 2021 to June of 2022, I couldn't eat. I got sick with nausea and vomiting in September, and never recovered. Over the next nine-ish months, while undergoing various tests and seeing a few different specialists, I lost about 140 pounds. I was always able to take in enough to keep from serious dehydration, but I was basically on a clear liquid diet the whole time.

At some point, I realized that my doctors weren't paying any attention to my weight. Their staff were weighing me at every appointment, but the doctors weren't looking at it. I started pointing it out to them, and they'd flip to that page on my chart, and say, "oh, my goodness, you have lost a lot of weight," but they didn't seem alarmed.

So, I escalated from there. I started saying, "If I had started out small or medium-sized instead of very, very fat, weight loss like this could be life-threatening." I'm not sure if they didn't believe me about how little I was eating, or what. I was scared, and I wanted them to be scared, too. Concerned! Alarmed!

Anyway, in June I started getting light-headed and shaky. And then I started almost passing out. And then it started happening more often. I ended up in the ER, where I almost fainted twice in the waiting room, and where they discovered my potassium was very low. I was admitted, underwent a bunch of tests that all ruled things out, they fixed my potassium, and I've been much better ever since.

The very low potassium was not the cause of my sickness in September. It was a result of not eating for nine months. My doctors told me that low potassium works like that—you muddle along for awhile, and then drop off a cliff. But fixing it fixed a lot of things, so there's an underlying mystery that may never be solved.

I do have gastroparesis, which is slow stomach emptying, which was diagnosed after I left the hospital. I'd been having some stomach problems since the fall of 2019, and gastroparesis does seem likely to have been the underlying cause of them.

Anyway, the whole point of this is: I was very, very sick, and my doctors seemed a little lackadaisical about figuring out why, and I think part of that is that I was so fat to begin with that they just didn't really notice my dramatic, alarming weight loss (ONE HUNDRED FORTY POUNDS IN NINE MONTHS! Half a pound a day for 270 days in a row!) and, possibly, they didn't believe I couldn't eat, that I was living on ginger ale, jello, popsicles, and broth like a person with the flu.

Years ago, a friend of mine's cancer diagnosis was delayed because her doctors didn't notice her sudden, unexplained weight loss, or thought it was benign.

Right before the pandemic, an acquaintance of mine dashed across the room at the first break at an all-day singing event to tell me about her bariatric surgery. "I can see you have the same kind of problems with food I had," she said to me.

Once I went to see a therapist about my generalized anxiety disorder and she assumed I was there about an eating disorder. The therapist I decided to see instead, and who helped me get my anxiety under control through CBT and encouraging me to see a psychiatrist for medication, observed near the time we were terminating that she found it interesting I'd never mentioned my weight in therapy as most of her clients did. I said, "Oh, yeah, it's really not a therapy type of issue for me."

And the point of all that is to say, the amount of stuff people think they can tell about a fat person just by looking could fill the Encyclopedia Brittanica, and a great deal of it is wrong, and the ways that it is wrong hurts fat people, adds to the stress of our lives, and sometimes kills us.

The podcast episode I listened to focused on the academic research of a fat graduate student, and I couldn't help thinking about how brave I thought she was. I've been striving to be size-inclusive and fat-positive for nearly 40 years now, all of my adult life, and I have been brave about this myself many, many times, and I've also been hurt about it many, many times. I'm glad it's getting talked about. I'm glad people are brave enough to put themselves out there in the face of the hatred and stupidity.
posted by Well I never at 9:14 AM on October 19, 2022 [44 favorites]

(Well I never, I bet you that was Maintenance Phase's "Eating Disorders" episode. It's still Michael Hobbes, which would be why you're thinking You're Wrong About.)
posted by sciatrix at 9:41 AM on October 19, 2022 [4 favorites]

Re: Maintenance Phase podcast episodes that deal directly with this topic, Eating Disorders (there's a transcript!), of course, as well as Body Mass Index, and Is Being Fat Bad for You?.
posted by spamandkimchi at 9:42 AM on October 19, 2022 [4 favorites]

This article is going to save lives.

Thanks for posting
posted by JoeXIII007 at 10:17 AM on October 19, 2022 [4 favorites]

(Well I never, I bet you that was Maintenance Phase's "Eating Disorders" episode. It's still Michael Hobbes, which would be why you're thinking You're Wrong About.)

Yes! Erin Herrop, the interviewee, was also mentioned in TFA.

Thank you. I could have found that if I didn't have my first cold in years (as of this morning PCR test results, not covid. Still unpleasant.)
posted by Well I never at 10:49 AM on October 19, 2022 [1 favorite]

Also, I apologizing for mis-gendering Dr. Herrop, who per the article uses they/them pronouns.
posted by Well I never at 10:51 AM on October 19, 2022 [3 favorites]

My mother (lifelong ED sufferer, never treated) had put on a fair bit of weight following menopause so her doctors saw her sudden weight loss as a good thing. "Hey, wow! It's so hard to lose weight after menopause."

And the nurses in my mother's ER where she'd been admitted for dehydration and severe malnutrition kept saying things like "oh, it's great that you're so tiny, so easy to move you in the bed!" And I know that nurses are underappreciated and unsung heroes who take endless shit but nonetheless I wanted to actually physically do them harm. SHE IS DYING FROM THE TINY, YOU FUCKS. IT'S RIGHT THERE ON THE CHART.

Just...burn it all to the fucking ground.
posted by We put our faith in Blast Hardcheese at 11:04 AM on October 19, 2022 [25 favorites]

i lost 50 pounds in about 18 months. it's the most i've ever lost and kept off. doctors--who have heckled me my entire fat life--told me that at my weight i should be losing more faster.

one doc put me on ozempic, which i tried because weight loss is a drug of it's own. it made me sick for 6.5/7 days. it was awful. i could not eat i was so nauseated. so for the 6 weeks i was on ozempic i lost 1-1.25 pounds a week instead of the .5ish i had been losing. to me, feeling that awful that long was not a good trade off for an extra half pound a week. my doctor did not agree and chastised me for stopping the injections.

my weight loss has stopped the last couple of months. i would like to lose 20 more (though science says i need to lose 140 more). i still have ozempic in the fridge and have considered taking it again. that's disordered as fuck y'all.

i am quite worried one day i'll get some kind of cancer and start dropping weight and be greeted only with accolades from my docs and then die a painful death because being thin is more important than anything else.
posted by misanthropicsarah at 12:13 PM on October 19, 2022 [8 favorites]

i still have ozempic in the fridge and have considered taking it again.

If it is opened, don't. Opened Ozempic has a shelf-life of 52 days.
posted by Thella at 1:12 PM on October 19, 2022

Another one of those "well, duh" things for which it's good to have confirmation in black and white.
posted by The Underpants Monster at 1:17 PM on October 19, 2022 [1 favorite]

Thanks for posting this. I thought of bringing in my own experiences, but they are near identical to those above. Hugs to everyone. After I got my PTSD diagnosis, my interactions with the health care system have become better: all the doctors and therapists agree that my mental health comes before my weight. So that's something.
posted by mumimor at 1:22 PM on October 19, 2022 [4 favorites]

I am finding more healthcare providers who understand what it means when I step on the scale backwards, without my having to say anything.

But that's all the good news I got, I'm afraid.
posted by humbug at 1:34 PM on October 19, 2022 [3 favorites]

Ugh I had to deal with this during/after my pregnancy this summer. I hope I'm not making this thread to chatty by adding another anecdote.

After an 8 day stay in the hospital post c-section (pre-eclampsia complications, pneumonia, fun stuff) I finally get to go home with my healthy, bouncing baby boy. I've never had major surgery before, so I don't know what to expect in terms of recovery, but thankfully I have 12 weeks of parental leave to get better and be with my baby. As time goes on, I start feeling worse and worse. It doesn't seem related to the incision, that's healing nicely. My abdomen is in pain and it hurts to eat anything, plus I have constant diarrhea. My stomach looks bigger than when I was immediately post-birth. I go to a follow up with my OB and tell her all this and she says it's normal to have to "get used" to your new body and orders a c-dif test. It's negative, but I'm getting worse. I'm sleeping 18+ hours of the day, maybe getting 500 cals in and eventually I'm back to looking 8-9 month pregnant. I make another appt, this time with the practices' NP and finally just insist - my stomach did NOT look like this after I gave birth, this is not just me being fat, there is something wrong. She does an ultrasound and I have ascites. I get scheduled for a paracentesis the next day, they pull off over 3.9L of fluid and I get a call that evening that I have to head to the hospital immediately to start IV antibiotics based on the tests they did on the fluid.

I spend another 8 days in the hospital again. It turns out once they drained the fluid, I had lost 60lbs from the day before I gave birth to being back in the hospital 3 weeks later and I was critically malnurished. But I was still obese, so of course if I had a visible tummy, that was normal.

My sister, a doctor, visited with me in the hospital several times and after a nurse left the room, she would point out the way that they were making assumptions based on my weight. The one I really remember is nurses assuming I'd be a hard-stick - I'm a very easy stick, and if they had asked, I could point out the best sites for them.

As oft mentioned in this thread, Maintenance Phase is an amazing podcast. And like I've said previously, I wish more people in my life would listen to it. People who aren't obese. People like my boss who, on a trip to a conference, told me she was worried about my health. My health was just fine! My numbers always looked great, I was exercising regularly, etc, etc.
posted by lizjohn at 2:27 PM on October 19, 2022 [21 favorites]

Just a note about content for future readers of this thread who might have or be recovering from EDs: the article discusses disordered eating habits in detail and includes very clear descriptions of the physical damage anorexia can do to the body. That content might be unsurprising to some people, but I was not expecting it to be quite as graphic as it is. (It's a good article, though.) Please take care of yourself if you choose to read!
posted by chaiyai at 10:57 AM on October 21, 2022 [4 favorites]

lizjohn, thanks for sharing your story. I don't think it's too chatty. I think it's good for all of us to have a place to share these stories, and there are always people who are dealing with this who do not know they are not alone, whether that's healthy fat people struggling to get doctors, friends, acquaintances to believe they're healthy, or fat people with health conditions who cannot get the care their need because medical providers can't see past their weight.

It's good that articles like this are getting shared more widely. I've certainly seen changes in my decades of life. It's much more common now for medical assistants to ask if I'm Ok being weighed rather than to assume, or push if I say no thank you. More of the providers I see are able to accept that weight loss may not be an appropriate goal for me. The worst providers I've encountered in recent years are reaching the age of retirement. Things are beginning to shift, I think, and I hope.
posted by Well I never at 5:36 AM on October 23, 2022