Thanksgiving Thoughts

In Weight-Loss Maintenance on November 24, 2010 at 8:59 am

Before I leap into three days of family revelry and cranberry sauce, I will give thanks here for something that only my friends in this readership can appreciate.  (Whether we’re maintainers, size acceptance proponents or both, our families don’t “get” us entirely, do they?)

Today I give thanks that Joseph Majdan was brought into the world and chose to use his formidable brain and heart in the healing arts.  Here is an excerpt from his essay, Memoirs of an Obese Physician, in which he bravely addresses his fellow Wearers-of-the-White-Coat, and firmly but gently calls them to task for their unprofessional behavior.   It appears in the recent Annals of Internal Medicine.   Again, I cannot get you through to the full article, but this account by Stacey Burling in the Philadelphia Inquirer provides most of the heart-breaking details.

 All of us have our stories of humiliation and shame.  We’ve been bullied.  We have memories of playground nicknames (Sappopotomus was my least favorite).  We recall times in which our opinions were marginalized, simply because we were (or are) fat.  Vesta keeps the First, Do No Harm blog chugging along with stories devoted strictly to marginalizations from the medical community alone. 

But we can, to some degree, escape those indignities.  We can choose a new doctor (and often we should).  Doctor Madjan spent a lifetime in that viper pit, delivering kindness and care despite the shameless, blatant snubs of his colleagues.  “One patient told me of her request to her physician to be referred to me. The physician responded, “Why do you want to go to him? He’s fat.” She came to me nonetheless. Other physicians openly told my friends that they would never refer anyone to me because of my obesity.”

Now, after losing a great deal weight (one more time), he comes forth with this brief but pointed essay that ends by calling doctors to treat their obese patients with dignity, and to not assume that they are lazy.  He expresses an urgent need for more research.  (Do I hear an AMEN?!)  And he calls for accountability.  “Equally important, attending physicians should be brought before professionalism committees for callous treatment of both their obese colleagues and patients.”   

My Thanksgiving prayer this year is that this man’s message gets through to the people who so desperately need to hear it.  How silly that the only reason it may be taken seriously is that it is wrapped in a size small (maybe a medium) labcoat.

  1. What a fine man! His story deserves to be widely disseminated.

    One cannot overstress how much disdain and yes, hatred, are directed at the “overweight”. Sadly, the hatred is as strong within the overweight community as outside it. I am constantly amazed at the level of self-hatred I find amongst weight-loss bloggers: they always, always blame themselves. If the only overweight/obese people I knew were WL bloggers, I would have to describe them (based on their own self-descriptions) as disgusting, lazy couch potatoes whose idea of a balanced meal was a couple of Big Macs with fries and a super-sized Coke, followed by half a chocolate cake for dessert.

    I can no longer read such blogs because
    a) they bring out my own latent self-hatred; and
    b) though I know lots of people of all sizes, I have never met anyone with such terrible eating habits. My idea of a binge is eating a cookie (or gasp) two. And yet I have struggled with my weight ever since the day I realized that I was heavier than most of my peers. Furthermore, when I look around myself at other overweight people in my entourage, I only see ordinary people, eating ordinary quantities of food. And no, honestly, I don’t think they’re all hiding away at home stuffing their faces with Twinkies.

    I am eternally grateful to have found a GP who, though very slim herself (despite having had three children), has never, ever chided me about my weight. She has always been incredibly supportive, through all my physical trials and tribulations and heartily congratulated me on my efforts to stay in shape despite my physical limitations. Would that all doctors had her generosity of spirit.

  2. Amen to that! I read the full article, and the hatred poured upon him by fellow doctors was just shocking! I’ve been very fortunate to have not experienced any serious shaming from doctors, yet I still find myself dreading visiting the doctor and avoiding it whenever possible. I know others – my parents included – have had such bad experiences that they postpone doctor’s visits to the point where it leads to complications that could have been avoided had they sought help earlier. I have to wonder how much of the poorer health that has been observed amongst obese people (in those studies that do show this) is for this very reason, rather than that obese people are intrinsically of poorer health. Not to mention that the causation could be reversed (poor health leads to obesity rather than vice versa).

  3. God, I just want to give that guy a hug.

  4. It isn’t really obesity that is hated and feared. It’s what obesity represents (metaphorically) in our society: a lack of control over one’s own life. Poor people and those who cannot afford medical insurance are also despised, and their misfortunes and tragic circumstances are also viewed as self inflicted. Psychologists, for instance, and MDs who provide *care* think nothing of charging over a hundred dollars an hour for a consultation with a patient who makes, say, ten bucks an hour. And if that patient doesn’t have medical insurance or a big enough income, at least in this country? Well, then…No appointment for you, no expensive cancer treatment for you. Just die, okay? Get it over with, and don’t make the rest of us pay. You see, fat people and poor people are not seen as PRODUCTIVE and EFFICIENT and CONTROLLED and SELF DIRECTED. Most people are treated like things, like machines, in our culture. As long as they have money and a socially approved appearance, then they will be valued, kept on display or used for consumption. (Our pretty myths of course deny the commodification of human beings. God how we love our myths.)

    The wealthy white MD actually believed he had it rough, he actually believed he SUFFERED, because people were mean and rude to him? Because they didn’t treat him like a wealthy white THIN MD? Oh please. There’s such a thing as perspective. Now that he is thin, and finally speaking up, his book is getting attention because it is written by a wealthy white prestigious MD. Who is a wealthy white prestigious MD whether he is fat or thin.

    Unless the good doc is out on the frontlines fighting for universal health care–and protesting loudly about the shocking inequality in health care (and widening disparities in health) resulting from socioeconomic, racial and ethnic disparities–then I cannot seem to muster up much enthusiasm for him and for his no-doubt profitable writing venture.

    Sure he advocates for obese people (umm, YAY!!!) but does his advocacy and compassion extend to obese people who are unemployed or uninsured, yet who would DARE try to make an appointment with him? Or does he save his indignation for the mistreated obese people who have the MEANS to pay?

  5. RNegade? You’re right of course, the poor do not get listened to. This is a problem that goes well beyond matters of obesity. Even the American poor are relatively well-off compared to the poor in many other countries.
    However, since this guy is a white, rich and now thinner doctor, he does have the ear of people who have more power in society, who maybe are capable of making a difference. I’ll take allies wherever I may find them.
    And yeah, I’ll bet he did suffer. Not all suffering in life is money-related. Fat people, even those of the highest social rank, are shunned and ridiculed. And if you’re beating your head against a wall, it’s still going to hurt whether the wall is made of dirt or of gold.

  6. Whoa, RNegade, I’m with Mulberry here. Your ire has taken a mis-direction, or has overreached. Your righteous indignation on behalf of the poor is noble, of course. But you can’t fault a man for gifts that he cannot help (his race), and for using his achievements to make a difference. Nor can you say he hasn’t suffered. It’s so obvious he has.

    For what it’s worth, there isn’t any book. It’s just a page and a quarter essay in what I think is a prestigious journal, and at the end he is quite harsh with his fellow White-coats. You and he are alike in many ways, too. Both of you are in the healing arts. Both in the delicate “changing skis” phase from weight-loss to maintenance. Both of you are almost too perceptive about the field you are in, and hurting because of its injustices.

    By way of full disclosure, I may have more (tender) skin in this than I recognize. Growing up, my father was a lawyer. During one of my yo-yo down phases weightwise, I had a boyfriend, whose father was some kind of laborer or some such (sensitive of me that I remember so well, eh?). At any rate, his father’s status made no difference to me. I just liked the boy, and I was bemoaning some common adolescent issue to him, and all he could respond was “Poor little rich girl. Pfft.” That was the beginning of the end of us. I realized that I could have no opinions, no pain, nothing to say, and certainly nothing to offer him. As far as he was concerned, I was just a silly, pretty girl and all my problems were solved by my father’s money (which, if you’ve read The Millionaire Next Door, you’ll know was probably a bit of a show). It is never good to be marginalized or to marginalize another. We need to celebrate one another’s gifts, and encourage their use toward good ends.

    RNegade, this Christmastide I’m keeping you in my prayers (and it’s not like I am a great religious person, but I think God hears the prayers of skeptics, doubters and other heathens too). I sense you’re wrestling some serious burn-out, and at a tender time in your weight “journey” (I hate that metaphor, but not as much as “lifestyle”) too. Hmmmm.

  7. Thanks for understanding (and prayers!) Debra. Yeah, this topic is probably not a good one for me to pursue in a public forum. I hesitate to write the following because it uses a lot of effort and many people arrive at the same conclusions. As in: There MUST be something I can do do turn things around! (Sound familiar?) If only I try harder then I will prevail. Ahem. I should have planned better…

    Backtracking a bit: I’ve been researching health disparities resulting from socioeconomic, etc, inequalities for the last few years of my education, seeing people die or become progressively sicker because the resources for health (not just for health care), are beyond the reach of so many. The recent Canadian study, which someone referred to in an earlier thread, for example, shows a greater correlation between diabetes morbidity and socioeconomic class than obesity.

    Many of the conclusions we are drawing about obesity and health do not control for socioeconomic status. In other words, even the studies of obesity *causes*, contributors (or factors) do not control for socioeconomic disparities. Lab mice don’t seem to have that problem, that we know of–although they may have other stressors we humans will never grasp–but people do face great inequalities, and being fat is only one of those. In other words, unless we control for socioeconomic factors (including stress/lack of stress related to those factors), the research data on obesity that we so anxiously read and covet may be mostly useless and misleading. (And a huge waste of time and money.)

    And, like you, I have a piece of skin in this fight. After 4 years of nursing school (and the accompanying loans, *sigh*), I entered the field just long enough to have my worst fears confirmed about prejudice and ignorance and discrimination in the health care system. I felt deep compassion and frustration, but it was still mostly intellectual understanding for me.

    Then my spouse was severely injured (a car hit him), and within a frighteningly short amount of time he lost his job, we lost our medical insurance, I became unemployable because I need surgery in order to work (need joint replacement in both hands), I can’t get surgery without being insured or having payment up front, the medical bills for my husband’s injuries have pushed us to the brink of losing everything we have ever worked for.

    Even with car insurance, do you realize how much (how little) $100,000 of *coverage* pays for when only two nights in ER and intensive care eat up almost a fourth of that, and then there are months of tests, treatments, appointments, and rehab that follow. Some surgeries can’t be considered at all, for him, even though it might help a lot, because there is no way to pay for it. Eventually, we found, even though you are still broken and need care to get back on your feet, the doctors will no longer see you because you can no longer pay. We can’t do a home equity loan without an income. We can’t sell at anywhere near a fair price in this market. Unemployment ran out. Our savings are gone. You need to be employed to keep good credit…

    Spouse finally returned to work on a limited basis, so still no insurance, and is in pain every single day. Without the surgery I need, I’m in physical pain every day too. My stomach is rebelling in pain, as well, from all the ibuprofen I take (or maybe an ulcer? who knows…)

    Yes, eventually our attorney will bring the case to settlement, years from now. It will be far too little too late. The maximum $100,000 coverage will have been spent on just the first few months of medical bills (well, plus attorney fees). The rest of the expenses…yeah. We are responsible. Somehow.

    You could not meet two more responsible, contributing members of society, yet there are no more social safety nets to prevent our slide into worsening disability and poverty. This is not a good time to have one’s hand out. Many people are in our sinking boat, many have already gone under. All of us, it is assumed, MUST have done something wrong to end up this way. We could overcome this adversity if we would only try harder. (Ring any bells?)

    Yes, I suffered humiliation and hurt and embarassment and discrimination because I was obese. Nursing school was especially challenging when I was carrying 120 lbs more than I am now. It was difficult and painful on many days, but I was still valued because I could WORK. Now, I can’t even get disability benefits because, well, I haven’t paid into the system enough to qualify! Most of my work during adulthood has been unpaid labor or volunteer, as is that of so many caring people in our world, and unpaid labor does not count toward qualifying for disability. Besides, I COULD work, but only if I can figure out how to pay for the surgeries and rehab I need on my hands.

    My point? I would gladly take those 120 lbs back, and add on another 100 lbs or more, if I could trade this current burden for that one.

    And yet I believe our struggles are all interconnected. Our culture treats people like objects, commodities, and if we don’t unite in our various struggles we will remain powerless to change course.

    But no worries. I’m sure it’s much worse in other countries than in the good old U.S., there are always others who are worse off, and besides, this kind of stuff won’t happen to you*. You are one of the special ones, the kind who take measures to prevent obesity, er, I mean destitution.

    *the generic “you”

  8. RNegade,
    The sad thing here is that just because many people have it worse does not mean you have it good. I think we agree on many things, such as obesity as more of a class issue. One book I would highly recommend to people interested in such issues is The Status Syndrome: How Social Standing Affects Our Health and Longevity, by Michael Marmot. I don’t recall any particular mention of obesity in this book, but the conclusions are more than applicable to it.

    As always, Debra, your compassion and sensitivity is much admired and appreciated.

  9. Oh RNegade, your story is shattering, and yet so common. I have no words of wisdom to give you–you are already one of the most articulate, intelligent people I’ve met on the Internet (truly, this site seems to attract as small group of brilliant people). But please accept my most heartfelt good wishes and hope that you and husband will find a way out.

    I don’t mean to rub salt in the wound, but stories like yours make me feel even more grateful for living in Canada. As someone who has had several surgeries (including a failed hip replacement, which was re-done successfully by a famous surgeon who apologized–profusely, I might add–I shiver to think where I’d be if I lived in the States. Thanks to universal health care (not perfect, but damn good), I continue to be a contributing, proudly tax-paying member of society. Thanks to universal health care, I can be self-employed in an interesting, well-paid profession. This would be impossible in the States.

    Here I sit in Canada, watching the US–a great and strong country–turning into a nation with such a gulf between the haves and the have-nots that it’s becoming hard to think of it as a true democracy. The dumbing down of the electorate is happening here in Canada (all you have to do is look at the tax-cutting buffoon who was just elected the new of mayor Toronto), but the US is light-years ahead, in the worst sense of the word. When the poor and destitute vote for the Republicans, you just have to wonder how much Kool Aid they’ve drunk.

    Rant over. Once again, my best wishes to you. I wish I could do something.

  10. Had a gut feeling there was some deep stuff at play with you, RNegade. I am so sorry. On the front page of the local paper today is the story of another responsible person being plowed under by the current system/economy. He described the feeling as the music stopped playing and suddenly he didn’t have a chair to sit in. We humans can be so shortsighted and cruel. Prayers. Prayers. Sometimes that’s what I’m left with. I wish they made me feel stronger, but they only seem to humble me. At any rate, you have my cyber support.

    Meanwhile, over the weekend, some twenty-something (who just lost weight) left me a message on one of my opening pages informing me that I have a bad attitude. How funny.

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