Helpful Phrases at the Doctor’s Office

Ragen sells a handy “doctor’s office survival packet” that includes printed postcards outlining her all-or-nothing position that weight loss is impossible and weight regain is inevitable. It demands treatment that goes against medical standards and ethics, and assumes obesity has no effect on health and is itself untreatable. In all cases, Ragen requests a “thin person” treatment, even for conditions that almost exclusively affect obese people.

Source: Dances with Fat

To highlight why this is an issue, consider how it looks when applied to other major lifestyle-induced medical issues. Why bother quitting smoking if the majority of people don’t succeed on their first attempt? What is the “non-alcoholic” treatment for liver cirrhosis? Ragen’s advice makes about as much sense as Health at Every Smoke and Health at Every Shot.



45 thoughts on “Helpful Phrases at the Doctor’s Office

  1. “No, I don’t want to see the chest x-ray that I came here specifically to get because my chest hurts and I’m coughing up blood, it may trigger me. Lung cancer you say? Well those giant black spots on the xray could **hack hack** be from anything, its not indicative of my 2 pack a day habit. What would you do **cough, hack** to treat a non smoker with lung cancer? Stop smoking?!!?? You’re just smoke shaming me!!! How dare you! I’m off to bad mouth you to all my blog followers and I’ll have your license! Mark my words!”

    Yea…that’s how that would go. Crazy thing is that a lot of the treatment for these obesity diseases would be similar for a thin person. Diabetes? Change your diet, get adequate water and sleep, exercise. Heart disease? Adjust your diet, adequate water intake, non-strenuous exercise (but still exercise). I just feel though, that if you’re in your 20s or 30s (and possibly 40-50s) and need full joint replacements, barring some injury or accident, there is no side stepping the weight issue.

    • The plural of “anecdote” is not “data,” but health problems I’ve had that could be helped by losing weight, it’s not really mentioned or sort of danced around. I haven’t had the experience of going to the doctor with a sinus infection and being told I need to lose weight that many people in Ragen’s scene describe.

      I have known people whose doctors have pushed weight loss surgery as a treatment for chronic health issues like PCOS or type 2 diabetes, though.

      • A lot of “medical fat shaming” is entirely self-perceived. If a doctor mentions weight loss as part of treatment, people fixate on it and don’t remember anything else.

        Consider the story of Rebecca Hiles that has been getting a lot of attention recently. She was diagnosed with lung cancer in her early twenties after a six year battle with major health problems. A year ago she posted about her experience and described how diligently her doctors had worked to help her, treating her for every remotely likely diagnosis. At one point she had a “ziplock bag full of pills” and was hiding symptoms from her family and medical team. Eventually an ER doctor ordered a CT scan to check for pneumonia, and even though he saw nothing on it himself, he referred her to a pulmonologist who noticed a “tiny shadow of a thing” and scheduled an exam and then surgery to remove her cancerous lung.

        A year later, Rebecca rewrote her story as “medical fat shaming” because along the way some of her doctors recommended weight loss for things like asthma and GERD. In Rebecca’s mind, it means they were only seeing and treating her as a fat person, and it’s the only reason her cancer went undiagnosed for so long. In reality, lung cancer in someone her age is a literal one in a million zebra diagnosis (0.1 cases per 100,000 according to the National Cancer Institute). The average age at time of diagnosis is 70! Her doctors treated her respectfully and tried everything reasonable to help her. They recommended weight loss as a completely appropriate treatment for some of her diagnoses, but at all times she was given the “thin person” treatment as well. The only way her weight could have affected her diagnosis is by making her cancer harder to spot on imaging.

        When I see this story trotted out beside Ragen’s claims of medical fat-shaming, it just makes me question everything.

      • @ ironfact: My SO does this. He’s smoked since teen years. When I met him 3 years ago, I noticed that he had clubbing of his fingers (a strong sign of lung cancer, heart disease or other serious medical issues). I mentioned it, but he downplayed it. Fast fwd to earlier this year. He’s having chest pains, trouble breathing, other stuff. I finally get him to go to a doc and there is a cyst in his lung. In ALL of this, he never told any doc that he smoked, so they weren’t even looking for possible cancer issues. He was lucky that it isn’t cancer, and has quit smoking which resolved most of his symptoms. The clubbing will take time to go away. But had he just been honest from the start, it wouldn’t have taken months to get what he needed.

        Just as a note, most lung cancer can’t be seen on an xray unless its very far advanced, and usually a CT is needed. Even then it can be hard to spot.

    • When Ragen complains about being prescribed weight loss for a sinus infection, her doctor may have refused antibiotics because s/he determined her condition to be viral, not bacterial (most antibiotics are ineffective against viruses). Perhaps in the course of that visit, weight loss was recommended, but Ragen chose to put her own special spin on it. In all of Ragen’s stories, there is usually one tiny nugget of truth surrounded by several layers of fantasy.

  2. The thing that really bothers me is the first one. It’s your LIFE on the line, put some fucking effort into making it long and healthy. Don’t just be like, “But Jane gained it all back!” So? You are not Jane. You are going to eat greens and drink water and walk around the block after dinner. No one who ever accomplished anything started off that way. “But NO ONE’S company makes it!” “But NO ONE gets into Yale!” You know, a lot don’t. But who’s to say that with intelligence and drive, you can’t be in the group of people who made it?

    TL;DR: At least try, you fat fuck.

    • This is so true. The defeatism is really sad. For most overweight people, measurable health improvements are experienced with just a 10% weight loss. But I feel like the Ragens of this world think that if they don’t instantly look like a supermodel after dieting for 6 weeks, then there is no point to losing weight.

      • Also, the Project Harpoons of the world telling fat women that we have no value as human beings unless we’re thin. Everyone from the diet industry to fitness communities on Reddit tells people that they are not “done” until they’re un-fat. No, that’s not how it works. Losing weight is a lifelong process and a battle, not a project with a beginning and an end.

        This is where actual HAES, not the mutant monster it’s known as online, is useful. You can say to someone, “Fine, don’t look at the scale, but I your physician will weigh you, and you should take a brisk walk for 30 minutes every day because it will help your mood and your general health.” Meet people where they are. Go from there. Instead, we have an all-or-nothing way of looking at people. “The Biggest Loser” is one of the worst things to happen to fat people since airline seats.

      • I have an issue with Project Harpoon (not just for their terrible photoshop skills) and forums like FPH & 4chan for being on the other side of the extreme when it comes to fat logic and body positivism. If they’re not trying to make a difference, what the hell are they doing? Being disruptive? Seems like a big waste of time and energy to me. Trolling will never make a difference. Honestly stings – even hurts really bad sometimes – but that’s what we need to encourage is truth and support.

      • @42 BMI…well, yeah…weight loss does have a beginning…and at some point, when you get to where you’re supposed to be, it transitions into maintenance…so that’s the end of loss and the beginning of the lifelong habit of maintaining the loss. Please stop framing it as a “battle” or a “struggle”…I smartened the F up at age 38, lost 70 lbs in 8 months simply by eliminating processed foods and exercising for 30 minutes a day…and have maintained the loss for nearly a decade by continuing those habits…it’s not a struggle. It’s life.

      • You’re completely misrepresenting Project Harpoon here. PH was simply a joking reaction to HAES activists’s aggressive campaign of ‘fat women (not men apparently) are beautiful and better than thin women and we deserve to be pandered to!’ If you can’t take it, don’t dish it out.

        And mil, 4chan is on the other side of the spectrum because this all comes from the /fit/ness board. They are trying to make a difference, but their goal is to be fit and not be average. Furthermore, there are a lot of females on /fit/ who do no appreciated being constantly skinnyshamed and insulted by these delusional hags. They have just as much right to express themselves as you do.

    • Yes, I could not make it past #1. It really highlights the difference in their “mentality” as opposed to normal, healthy people, that this excuse would even “seem” valid to them.

      It is YOUR life and YOUR health, who cares what other fucks were willing to do or not do to re-claim their health.

      I dated a woman who told me a story about a woman in her 90’s who had hiked the Andes in her late 80’s and came to speak at her women’s group. The woman gave a presentation of her journey, and at one point a woman in the audience gasped: “I can’t imagine being able to hike mountain passes in my 80’s!” to which the old woman replied instantly: “Then you won’t!”

      IF you accept sickness and unhealthiness, and look for others as an excuse why not even to try, then that is exactly what you will have.

  3. Just take the first statement: “Show me a study where the majority of participants succeeded at the amount of weight loss you are suggesting.”

    Even if only 5% of people succeed, let’s think about this.

    Suppose you have a disease that would kill you, and there’s a treatment that costs nothing and has no negative side effects that could cure you. It only has a 5% chance of working, but if it works, you’ll know it. Wouldn’t you do it? If the answer to that is yes, why shouldn’t someone with the fatal disease of Obesity try to lose weight. It costs NOTHING and has NO NEGATIVE SIDE EFFECTS.

      • The counterargument is the party line. “Most diets lead to more weight gain. Do you really want me to have a 5% chance of improving my condition and a 95% chance of making it worse? Do you want me to die even earlier? WHY DO YOU HATE FAT PEOPLE AND WANT A FAT HOLOCAUST?!”

        Second half is only a slight exaggeration of the rhetoric of Ragen’s that made me say “wha?” and start giving up on organized fat acceptance.

      • It’s not just that dieting leads to weight gain. Remember that obesity isn’t actually unhealthy, because it’s “healthy habits” that determine whether you are healthy, not your weight. Also correlation never implies causation, so it’s just as likely diabetes and all other health problems associated with obesity actually cause obesity, rather than the other way around. And in any case, any negative health effects of obesity that can’t be explained any other way are actually caused by weight stigma and the stress of living in a fatphobic world, not obesity itself.

        The amount of doublethink necessary to accept all of this at the same time is truly astounding, but it’s exactly what Ragen’s “research” has discovered.

      • Right, I forgot that part of it! It really has been a while since I’ve been in those communities. Some conditions I’ve heard of it working that way…like, PCOS causes weight gain which makes PCOS worse and on in circles. However, fatphobia does not cause knee problems.

    • I don’t understand that whole ‘they couldn’t do it so why should I try’ attitude. I would never apply that logic (or lack there of) to any other aspect of my life. And at the end of the day, why should a lack of success on the part of a bunch of strangers have any impact on what I do with my life?

      So by this logic, the vast majority of members of the military are just genetically blessed? (I say majority cause I knew some fatties). It has nothing to do with the months of intense training and then the daily maintenance?

      • Don’t people in the military get discharged if they can’t maintain the weight they’re supposed to?

        I get what you’re saying, but it’s hard to come up with a good example of a group that’s consistently thin and fit that you don’t get tossed out of for being unable to maintain the needed fitness level and/or weight.

      • Yea, they do. And tgis isnt happening every day. But its not like that’s impossible. People go decades without this happening. Its not an instant “you didn’t make weight this month, get out” either. You have chances to readjust.

        I’m not trying to come up with anything. But if I was a 5’0″ overweight recruit, and got the weight off thru diet and exercise, and kept it off for a decade+ because I kept those same habits-well, I must just be genetically special then.

        An argument that already makes very little sense makes even less when you can point out large groups of people who do the opposite of your claim on a regular basis.

  4. Chicagosunroof wrote: Suppose you have a disease that would kill you, and there’s a treatment that costs nothing and has no negative side effects that could cure you. It only has a 5% chance of working, but if it works, you’ll know it.

    At treatment with only a 5% chance of working would not be approved by the FDA, particularly when in fact it ends up making most people worse in the long run. The scientific literature shows any diet plan works for six months. Nothing so far in any published clinical trial has worked for 50+ pounds long term. I don’t even think any study has met the 5% of people lost 50 pounds and kept it off mark.

    If it were a drug, not a single diet program ever marketed would ever get past the FDA. Exercise, however, if you could put it in a bottle, would have the status of a miracle drug. It makes almost everything better, including depression, diabetes, osteoporosis, risk of the common cold etc.

    I personally find doctors never mention weight loss to me. It may be in part because I don’t have any conditions that are caused/aggravated by excess weight. However, I think a large part of it is, in fact, that doctors familiar with the literature in the last ten years are discouraged; they don’t know what to say because they can’t actually say dieting works.

    Does that mean I agree with Ragan’s end conclusions, that obesity is not a problem and that people should stop trying? Not exactly. But I don’t think trying without realizing that most of these approaches don’t work is really productive. I think the solution is in part what Anonymous above suggests–significant long-term changes, such as giving up processed food. I’m working on the long haul. Anything I can do, no matter how tiny, which I know I can keep up for the rest of my life, is fair game. Anything that’s all about aiming for weight loss on the scale in the short term is out.

    • The 5% thing is actually a huge misrepresentation of a single study from the 50s. I think it has been covered here. That should never be used as an actual fact. It’s misleading & has no purpose other than to discourage people from seeking better health.

    • Um, this has nothing to do with the FDA, which doesn’t need to approve a lifestyle change. The weak statistic reflects the fact that 95% of people DECIDE to discontinue the habits they adopted to lose weight; then the “diet” or weight loss program fails. The reason so few succeed is because we are a lazy, entitled society who want immediate gratification, big results for little work, and large portions of mediocre food for $11.99.

    • Lung cancer has a 5% survival rate at 10 years, 10% at 5 years. More than half the people with lung cancer die within a year of diagnosis. Pancreas cancer has worse odds. Just because its an uphill battle doesn’t mean you shouldn’t at least try.

  5. Actually, anonymous, the gold standard for evaluating drugs is an “intent to treat” analysis. That means if 90% of the people taking the drug drop out because of side effects or noncompliance, laziness in taking the pill etc., their outcomes are still counted. The drug still has to work overall, statistically, even counting those people.

    And while I realize a lifestyle change is not a drug, in fact, many scientists and doctors expect lifestyle changes to meet the same criteria as drugs before they are proven. Diets just haven’t met that standard. It’s not that there isn’t a lot of evidence. I last searched the literature a couple years ago, but I don’t think there is anything new. The number of peer-reviewed, published studies that show a diet works in a randomized prospective study for losing 50+ pounds and keeping it off so far is, ta da, ZERO.

    In dieting, yes, the dropout rate is high. You can say that it’s because we’re all lazy and entitled, but in fact, that ignores some overwhelming biological facts–including increases in hormones that cause hunger after initial weight loss. I mean, whenever I’ve lost a substantial amount of weight on a ‘healthy’ balanced diet, I actually start waking up in the middle of the night dreaming I am shoving pizzas and ice cream sundaes into my gaping mouth. Sigh, yes, really.

    There’s a biological reality…it’s there and it’s real–in addition to all the societal and social pressures. We literally live in a society where one ‘ordinary’ restaurant meal is more than the average woman should be eating in a day; it’s hard to fight that, day in and day out, for years. One lunch where you just go out and eat an entree that’s not a goddman skinless chicken breast on salad hold the dressing and croutons and you’ve blown your calorie budget for the whole day.

    I am not saying Ragen is right. I’m saying that we should acknowledge that there is a core of truth to what she is saying. That’s why she has followers and money. Some of what she says rings true, and it strikes a chord. The problem is she’s taking a small truth and magnifying it so large. I don’t think saying fat people are just lazy and self-indulgent is an effective argument against Ragen.

      • Yes. Thank you.

        It’s easy as hell to overeat and slowly gain weight. In the first world, (particularly in the US) we are awash in high-calorie, flavor (salt, sugar, fat) laden “food-like products” that are engineered for profit first, health last.

        That being said, it’s also easy as hell to consciously stop overeating, count calories, and lose weight. (For the vast majority of people.) It’s just that as a society we’re accustomed to having what we want, when we want, in the size, shape, color and flavor that we want….

        That is the essence of the FA movement: Do not delay gratification. Eat what you want, when you want it. It’s not your fault.

        The crux of the problem is that many people (Americans) have no idea what real food looks like, and what a normal (healthy) sized portion is. They are educated primarily by their parents (bad habits replicated…) and assume that when you order a meal in a restaurant, that it is, in fact, an actual portion for one meal. More likely, it’s three or four portions – your total daily caloric intake.

        So the masses of uneducated hear “diet, self-deprivation, suffer” from one side, and “you’re fine just the way you are, eat what you want” from the FA side. The message that you can achieve a healthy weight and be fit – through very small adjustments in diet and activity – compounded over time – is lost. This is the real tragedy of FA – that their idiotic, delusional message that fate = healthy adds up to just so much more white noise clouding the issue.


    • Oh, will you stop. The vast majority of overweight people are overweight due to their lifestyle. No one’s calling them “lazy and self-indulgent;” the fact is that most Americans eat too much, eat too much of the wrong things, and get little to no meaningful physical activity…by choice. And most overweight people will freely admit that their weight is the result of their life choices. The 5% stat only reflects that VERY FEW people adhere to a significant lifestyle change that results in lasting weight loss. End of story.

    • I don’t understand what’s “hard to fight” about any of this. First of all, it isn’t healthy to be eating out all the time. Second, I love taking home leftovers. Most restaurant portions are equal to 2 meals. If you can eat that much food at one time without feeling sick, then you have accustomed your body to overeating.

      All of these things boil down to choices, Evelyn. If your health is bad because of obesity, then you are making poor choices. That’s no one else’s problem but yours. And the arguments against Ragen have nothing to do with her or anyone else’s health or weight. They have to do with her lying & manipulative behavior.

  6. Funny how my experience is the exact of opposite of all these BS medical “fat shaming” fairy tales. I had medical issues that could be either caused or exacerbated by weight. I went to the doctor about it. All he wanted to do was hand me pills to treat the symptoms. Never said a single word about my weight(about 50 lbs overweight at the time). NOT ONE WORD. I went home and looked up the side effects of the pills and the condition(not condishun) I’d been diagnosed with, as it now had a name. I saw that weight loss could help, and the pills had side effects I didn’t want. So I said fuck the pills, and lost weight. Symptoms – gone. Within 20 lbs of weight loss, my symptoms were entirely gone. Lost the rest of the weight, never felt better. Never touched a single one of the pills. Went back to the doctor one time to confront him about why he’d give me pills instead of telling me to lose weight, and will switch doctors next time I need one(it’s been a couple of years now since this happened).

    • My husband is 5’9 and 150-160 lbs. He got a followup call after his last wellness visit from his doctor. She told him he needed to watch what he ate and exercise more (his cholesterol was up from the previous year). He didn’t feel fat-shamed.

      I also heard quite a few of my thin co-workers (after mandatory health screenings) say that they were given the 3rd degree about their results (glucose, triglycerides, cholesterol, smoking/drinking). It’s not like we’re just given a gold star and a lollipop for walking in with a normal weight.

  7. @John Galt, I also find most docs don’t mention it. I haven’t had any health issues connected to it, so maybe that’s why, but still, if there was an epidemic of docs shaming fat people I think I probably would have been hit a few times. Only time I got a tentative approach was from an intern fresh out of medical school who thought telling people to reduce their portions would be an effective strategy. That was an amusing conversation.

  8. On the subject of what the science says, and doesn’t say on the feasibility of long-term weight loss, here’s a study that I think is really awesome:

    Sadly, this link gives you only a summary and it costs $31 to read the full version. If anyone is really curious, it’s worth the money. The short version is that 500 overweight/obese menopausal women were divided into two groups. One group “the lifestyle intervention group” got regular nutrition and weight loss counseling, including a bunch of sane stuff like eating less at restaurants, reducing fried foods, cutting back on meat and cheese, moving more, and increasing fruit and vegetable consumption. The control group got “health seminars” on stuff like quitting smoking etc. but no weight loss advice.

    At six months, the “lifestyle intervention” group had lost an average of 17 pounds, versus about three pounds for the control group. At four years, the intervention group had lost an average of eight pounds, compared with no loss for the intervention group.

    The fascinating part of this study is that:

    1. It provides a realistic estimate about what you can expect from giving people regular and good advice on behavior changes ie. eight pounds on average over four years. That’s a realistic average based on the research. It is better than gaining. Of course some people did much better, and others did worse. and

    2. It tries to tease out which changes worked best in the long term. Cutting back on restaurants and fried food was helpful at six months but not at four years–maybe because the behaviors were harder to sustain. Of most interest to me, increasing fruits and vegetables was not the best strategy at six months but was one of the better ones long term.

  9. Oh, also a little gem buried in the charts:

    At four years, 15% of the intervention group had “substantial weight loss,” defined as at least 22 pounds. That compares with 6% of the control group. (Nobody told the control group they couldn’t try on their own to lose weight. They just didn’t get any help from the researchers.)

    Sadly, there aren’t enough long-term studies. But this one suggests a success rate of 15% at four years, with success being defined fairly modestly as 22 pounds or more loss. Not getting to “normal weight”–but just maintaining a substantial amount off. 22 pounds will make a big difference in your life and health even if you still are way overweight after losing it.

    • Thanks for posting that link Evelyn – drawing on my own N = 1 experiment, I’m coming up on 18 mos maintenance of my own modest 25-lb loss… Yep, I’m still fat – need to lose another 8 lbs to hit that “15%” mark, and another 20 to pass from “Obese” to merely “Overweight” on the BMI scale, but the difference in my Quality of Life is substantial.
      (I’m in that gray zone where friends & acquaintances say “You look good!” instead of doing that doubletake “You’ve lost a lot of weight!”)

  10. @Anonymous. Wow, we’re pretty similar in our stats, except you’ve maintained longer. I lost 20 pounds over the spring and early fall, and maintained it during October without losing more. I also have 20 pounds to pass from the ‘obese’ to merely ‘overweight’ on the BMI scale. As for me, I’ve been here many times, but it’s the first time it feels sustainable–as in, I have only made changes that I like enough to make permanent. Whether I make the 15% this time still remains to be seen, but I’m optimistic.

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