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My Manifesto on Health Care for Fatties

May 14, 2013

I know I have one last installment in my Health at Every Size® eating series, but there’s something else I want to write about. That’s coming soon, I promise.

Today, I want to write about being afraid to go to the doctor. Only, it’s so much more than that. It isn’t just fear of the doctor dismissing my concern and chalking it up to my weight. It’s fighting against my own deeply-ingrained indoctrination that any kind of pain I might experience is my own fault. My own fault because I’m fat.

For the last few months, my back has bothered me. Really bothered me. Right along my hips, at the top of the place where my back meets my ass. When I stand or walk too long, the pain is nearly unbearable. It especially hurts when I’m standing slightly stooped — doing the dishes is the worst. I can’t do the dishes and wipe the counters down because by the time the dishwasher is loaded (we’re talking ten minutes tops here) I have to lay down to relieve the pressure.

I know I need to go to the doctor. I don’t have health insurance, so it’s easy to say, “I’ll go in October if it’s not better by then.” I Google “severe lower back pain” to try to ease my worry, but make it worse because everything that comes up is about multiple sclerosis. I tell myself that I’m just tired, this semester was particularly rough, and I’m stressed. My book comes out in six weeks. Maybe I’m holding anxiety in my lower back?

The truth is, I don’t want to go to my doctor and have her tell me that the problem is my weight. I’ve been as fat as I am now for eight years and never experienced back pain like this. Maybe it is my weight, or my weight is making it worse, but it isn’t only my weight. It’s my sciatic nerve or some kind of pinched disc or something.

What I hate the most, though, is that I have to fight against my own tendency to believe that I deserve the pain because I don’t have the self-discipline to lose weight. Of course supporting 300 pounds can hurt, right? Right? I have to constantly remind myself that I deserve to feel good. There are fat people everywhere who can do the dishes without breaking down into tears.

Here’s the thing: I can accept that my weight might exacerbate my back problem. The problem comes when I internalize my body’s limitations as a moral failing and start to decide that it means that I don’t deserve good health care. I mean, if I was naturally very thin, I wouldn’t decide that having osteoporosis was something I did to myself and hesitate to get treatment.

I feel like I need a manifesto — so damn it, I’m going to write one.

Fat people deserve comprehensive health care that doesn’t stop at the “well, you’re fat” line. Fat people deserve health care that addresses them as whole people and not just a collection of fat cells. Fat people deserve equal treatment by doctors and other medical professionals. No person should believe that they are somehow so “bad” that they don’t deserve to feel good. Every body is a good body, and every body deserves proper care. Fat bodies, thin bodies, broken bodies, whole bodies, tall bodies, short bodies — all bodies.

18 Comments leave one →
  1. May 14, 2013 10:06 am

    I have been where you are many times in my life. I’m actually there now–postponing a needed doctor’s appointment because last year I lost weight, and now that weight is back, plus some. How I feel is this: shame. My health issue isn’t a huge discomfort, so I have an easier time rationalizing it. We all need to get past that thinking, and share with our doctors that we need them regardless of where we are on the scale. It may take some bluntness, but we need to have these discussions.

  2. May 14, 2013 10:25 am

    Amen to your manifesto! I hope you are able to get treatment without hearing that the pain is due only to your weight. I hope the doctor will look at other potential causes. As you said, you can accept that it may exacerbate the medical issues, but it’s not the sole cause.

  3. Pyctsi permalink
    May 14, 2013 10:29 am

    My lower back pain is caused by having inadequate muscle development to support my boobs. There is a simple exercise that works to strengthen those muscles:

    Lie flat on the floor, keep your lower body against the floor and push your upper body up as in a push up (this may also be a yoga position)
    Repeat 10 times at an unhurried pace, do daily.

    This wont give instantaneous results but it might help if your problem is the same as mine. You should still see if you can get an appointment with the doctor to make sure it isn’t something that needs different handling.

    I also find that wearing a backpack to carry things helps as moves my balance and helps my back muscles. I also have a chair in the kitchen for when my back hurts, I just sit down and stretch the muscles until the pain stops (if you have space you could check your local charity shops for a cheap dining chair if you don’t have something suitable).

  4. May 14, 2013 11:26 am

    I want a manifesto too. I’ve started one several times just to erase it because can one person write something for a whole community?

    I hate going to the doctor as well. I have three non-weight related conditions that require regular doctor visits, but I have honestly come to think of doctors as the barriers to prescriptions I need. In all but one case, I diagnosed myself and came up with a treatment plan, they just run their tests and write the prescriptions. (I’m a little fed up with doctors today.)

  5. vesta44 permalink
    May 14, 2013 11:31 am

    This is a great post, Shaunta, and I love your manifesto. I’ve had that kind of back pain, in the same place, for the last 10 years or so. It’s been getting worse every year, and I’ve quit asking doctors what’s causing it or how to fix it because the only recommendation they will give me is “lose weight”. They say it’s my weight causing it, and if I would just lose a hundred pounds or so, the problem would resolve itself. Yeah, so not happening (what part of “I had WLS, it failed, and I’m fatter now” do they not understand?).
    That pain started out as the muscles in my lower back, just below my waist, cramping up. If I didn’t sit down and let the pain subside before continuing whatever I was doing, my legs would go numb and I wouldn’t be able to walk or stand – I had to sit down (or fall down, take your pick). It has progressively gotten worse so that now it’s not only the muscles in my lower back that cramp up, it’s also the muscles in my buttocks and thighs that cramp. I did finally get a prescription for tramadol (50 mg) for the pain, but like everything else I’ve been prescribed, it doesn’t even begin to touch that pain. So I figure out ways to do things that cause me the least amount of pain, even if it takes longer to do whatever it is (cooking, cleaning, doing laundry/dishes, etc). When it comes to avoiding pain, I can be quite inventive.
    One thing I don’t understand about this particular pain is why I hurt so badly if I lay on my back – the pain from laying on my back is as bad as it is when I’m standing/walking, so if it were my weight, you’d think laying on my back wouldn’t cause it (and the pain from that is so bad, that it’s difficult to stand up and walk afterward). That’s why I’ve never had an MRI done on my back – the one time I did go for one, I laid there for 45 minutes on that hard table and was in so much pain, I was crying. When they told me I had to lay there for another 45 minutes, I told them there was no way in hell I could do that and I wanted out, now. As it was, I had to sit on the table for a good ten minutes before the pain let up enough for me to be able to stand up and walk out of there (and that was 8 years ago). I’d have to do a seated MRI now and I’m not sure that would show anything, as my muscles don’t cramp when I’m sitting, it’s the only position that isn’t painful.

    • May 14, 2013 1:46 pm

      I have pain like you are describing and I’m considered uberfat (I’m 4’11” and probably 240-250 pounds….I stopped weighing myself when my back got really bad). Laying flat on my back is the absolute worst position for me because the nerves get pinched. At best my legs go numb….at worst I can’t use them. For my MRI I had to have a huge bolster under my knees to be able to do the scan, along with heavy duty narcotics plus muscle relaxers.

      I had a fracture on my L5 vertebra with pars defects, which created a slip in my L5/S1 joint (spondylolysthesis), and degenerating disc disease. I had an MRI that showed the DDD and the pinched nerve, but the X-rays in tandem with the MRI showed the whole story more completely. I ended up having spinal fusion surgery on my L5/S1 joint in January as I was getting signs of spinal cord injury (SCI). The doctor freed up a nerve that was absolutely smashed (his words).

      Back pain is hard with us fat folks….there’s the fat stigma from doctors, there’s internalized fat shame, there’s the fat stigma from physical therapists (or the disbelief when we’re actually strong despite injuries and maladies…my experience). It’s something that impacted my personal road to the recovery point I’m at now, and is actually why I blog about fatness, disability, and the intersections.

      I hope that vesta, Shaunta, and others are able to find a way to healing and coping that works for them.

  6. Val permalink
    May 14, 2013 11:47 am

    Great post – but I never hesitate to recommend yoga to everyone I know, especially for back pain! You don’t even have to take a full-fledged class; there’s plenty of videos on YouTube. A few deep breaths & gentle stretches can work wonders.

    • May 15, 2013 11:59 am

      For anyone wanting to go the yoga route, I can’t recommend Heavyweight Yoga, by Abby Lentz enough. (I have no connection, I’m just a fan.)

  7. May 14, 2013 12:42 pm

    I have no job and no insurance, but I need to go to the doctor. But I’m stuck with my current GP, who plasters weight loss posters all over her wall, because who will take a new fat patient with no insurance and a history of mental health diagnoses?

    Fat often intersects with poverty, and it’s just about the worst thing ever.

  8. May 14, 2013 12:52 pm

    Your weight may be a factor, but you should still be properly assessed and receive whatever treatment is appropriate and may be helpful, just as a thin person would.

    My weight contributes to the joint pain I experience from a connective tissue disorder, but I should still receive physio, hydrotherapy, whatever help a thin person with the same condition would get. The doctor and physio should also not make assumptions about me, like telling me I am “so unfit and inactive” without even asking me how active I am or testing my fitness in any way.

  9. Elizabeth permalink
    May 14, 2013 2:22 pm

    I have back pain from sports injuries, so empathize with all other sufferers, but one thing that concerns me is if anyone is having back pain from kidney issues. When I had a kidney infection, my only symptom was fatigue, but back pain is a VERY common symptom. All back pain sufferers should be given urinalyses just to make sure their kidneys are okay.

  10. May 16, 2013 6:31 am

    Reblogged this on The Cheese Whines and commented:
    The “it’s your weight” diagnosis is a lazy diagnosis, and underlying issues are often overlooked until situations become critical. As well, who is it helping that people refuse to go to the doctor until situations become critical because they fear ridicule for their physique?

  11. May 16, 2013 7:00 am

    There are so many issues here, but the one I love the most is you’ve nailed the feeling of not deserving health care. I’ve ignored very serious medical problems because of self doubts – slightly different ones, like ‘am I just being a hypochondriac and will I be judged for wasting their time?’ – and the consequences have been bad.

    Here’s the thing – delaying treatment won’t make your back better, and it won’t make the internal voices go away. If you’re in so much pain that you cry when doing dishes, go and see someone! Maybe even frame it a personal growth project to deal with the angst. By fighting through the negative self talk and getting yourself to a doctor, you might help solve two problems at once – it will help you confront the negative self talk and it will get help for your back!

  12. gzcl permalink
    May 16, 2013 7:30 am

    You might have tight psoas. There are stretches which may help.

    • Goosepher permalink
      May 16, 2013 4:23 pm

      Agreed. Your weight itself is not the most significant issue, it is your inactivity (sorry, making assumptions). When sitting down all day your hip flexors (front part of upper leg) will get REALLLLLLLLLLLYYYY tight after a while. Once tight, it starts pulling on your lower back and causes that pain you described. I have this pain too, not from inactivity but from improper weightlifting. Google hip flexor or psoas stretchs to help reduce pain. Walking/running type movements and minimal sitting are the solutions to your pain.

      • Goosepher permalink
        May 16, 2013 4:26 pm

        Sorry for double post, but to add to this, in general a General Practitioner doctor is NOT knowledgeable about everything (including this) and will offer blanket prescription of “lose weight and exercise”. An orthopedist or knowledgeable physical therapist will recommend what i said above.

  13. May 25, 2013 10:06 pm

    Surprised no one has mentioned seeing a chiropractor. Although there are fat-phobic chiros out there too, as with any field, there are also very good ones who will really look deeper into your back issues and see if there are any mechanical and alignment issues that are affecting things. Seeing a chiro has been *tremendously* helpful to me.

    A lot of weight IS a stressor on the body, but knowing that isn’t going to make that weight go away anymore easily. Keeping the body well-aligned, loosening up the soft tissues around the bones, and strengthening the muscles that help support those bones is helpful for many folks in lessening pain. A combo of chiro, bodywork/massage/stretching, and yoga/weight training is good. You have to find the combo of this that works for you.

    I would also agree that ruling out other possible causes is important too. You want to make sure your kidneys are okay, that no bones are broken, no discs are slipped, etc.

  14. Banned From /r/bodyacceptance permalink
    June 1, 2013 7:16 pm

    Have you ever done any good posture work? The way you stand could easily be causing this pain.

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