Health And Wellness

Am I Fat And Sick Or Sick And Fat — And Why It Matters

Photo: New Africa / Shutterstock
doctor measuring woman's waist

Sometimes, when I take my teenage twin cousins clothes shopping, they’ll want me to try something on with them. I will politely decline and tell them this particular store doesn’t make things in my size.

“But you’re not fat,” one of them will inevitably say, because they’ve been taught that “fat” is a bad word and they don’t want to identify their beloved cousin in that way.

“I am,” I say. “It’s okay. I’m not putting myself down. It’s just a fact.” 

This is the way I walk through the world, constantly aware of how my weight might be reflected in what I can and cannot do, and the assumptions that others might choose to make about me.

It’s unsurprising then, that health care professionals do the same.

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The shape and size of my body affect my healthcare.

I hate to say it, because overall I am grateful for the care I’ve received, and am also acutely aware of the privilege that being a white woman has afforded me in receiving this care (the racism issue in healthcare has been well-documented), but it’s part of my experience, nonetheless.

Being fat and also sick is hard, mostly because people often assume you are sick because you are fat, whether or not this is true.

I can tell you as someone with an autoimmune neurological disease, that people (mostly women) of all shapes and sizes are experiencing diseases like mine. I’ve spoken with many of them. But that doesn’t also mean that almost every doctor I’ve seen tells me that I could stand to lose some weight.

I get it. It’s not like I’m unaware that I am fat or that obesity poses a number of increased health risks.

One neurologist brought up my weight often when he reported on something I might try to help my symptoms. Always in a very matter-of-fact way that felt like he was just checking off a box on the pre-determined health report he was required to give his patients.

The printout he gave me after every appointment had tips on healthy eating and recommended exercises.

He even referred me to a weight loss specialist once, who told me she couldn’t really help because the medications she would prescribe to aid in weight loss couldn’t be used with someone with my health conditions, and the exercises she gave me flared my autoimmune neurological disease to the point that I had to go on a round of steroids just to get back to my baseline level of pain. 

I asked my neurologist once, “Do you think my weight is the cause of my illness?”

He raised his eyebrows up and down, something he often does when he’s thinking. “Well, no, I can’t really say that. But losing weight is always a good thing.”

“How would you suggest I lose weight?” I pressed.

After all, he knew that physical activity of any kind, a trip to the grocery store or a few flights of stairs, would cause my headache pain to spike and the pain in my limbs to increase.

Beyond that, I get lightheaded every time I stand. I’ve even blacked out on occasion. I’d already tried yoga at his suggestion, but the poses only increased my pain. What would he like me to do?

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“I honestly don't know,” he said, a bit defeated. “Perhaps you could try Tai Chi.

Don’t get me wrong. I know that I would feel better if I lost a few pounds. I know that carrying all this extra weight is hard on your body and that there are a number of diseases with increased prevalence in overweight people. But I am also saying that it isn’t simple and it really isn’t easy.

We have a cultural attitude that your weight is an issue of personal character. That all it takes to lose weight and “get healthy” is some kind of exceptional mental fortitude.

People who don’t work out, who don’t eat right, are weak and somehow inherently flawed. This is one of the most ableist attitudes I have encountered. I can assure you, through all of this, when just getting out of bed is a challenge, I am not lacking in fortitude.

Unfortunately, this attitude has bled into our medical system and it’s hurting an entire community of people.

I’ve heard so many stories of people, mostly women, especially women of color, who have felt as though they weren’t taken seriously because of their weight. Those doctors missed diagnoses or took longer to get to the root of a problem because weight was initially blamed. They feel unsupported or even at odds with the people most in a position to help them heal.

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That’s why I often preface a description of a new symptom or issue with “I know I am fat but…” as though, I need to defend my sickness, remind whichever doctor I am talking to that, yes, I am overweight, but I am also sick in a way that has nothing to do with my size, in a way that affects all different kinds of people every day.

That’s why when the spinal fellow who’s just diagnosed my increased back pain and leg numbness as a fracture in my sacrum, something he can’t explain, something he claims only happens to old women and marathon runners, tells me “You might want to consider losing a little weight,” I have to challenge him.

“Are you saying that my weight caused the fracture?” 

“No.” He shakes his head. “I honestly don’t know how you ended up with a fracture like this. It’s just more general health advice.”

That’s what I thought.

I refuse to use a stool when I sing in my worship praise team every weekend because I know that people out there in the congregation, who don’t me, who don’t know my struggles, will think I’m just too heavy to make this through a whole worship service — not that I am losing mobility in my legs or have a deep vein thrombosis causing pain and discomfort with any weight on my leg.

When I have to lean against a wall and rest, do people assume it’s because there is something wrong with my autonomic nervous system, or that I’m just too heavy and worn? What does it mean to look sick in the first place?

So I let myself suffer, a little stubbornly, a little needlessly, because I am afraid that the fat part negates the sick part and I don’t want to be another wobbling, walking stereotype.

There are so many of us out there, so many women especially those I know with chronic illness, who also struggle with feeling like the medical community isn’t able to serve them without bias. Maybe it’s silly to think these kinds of internalized biases won’t affect me and my care as well.

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Stephanie Harper is the author of the award-winning fiction novel Wesley Yorstead Goes Outside, as well as the poetry collection Sermon Series. I've also published essays and articles in a number of publications, including HelloGiggles, Healthline, HuffPost, Grok Nation, and more.

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