24 June 2016

Fat 101 for Nurses and Health Professionals

I went to see the nurse to get my blood pressure checked and to book a cholesterol test and I ended up with one of the worst clinical encounters I've had for a very long time. A doctorate in queer fat activism, a publishing track record and nearly thirty years of experience in collectively critiquing fat hatred is a pretty good foundation for getting your blood pressure checked whilst fat, one of the most basic medical interventions around, but it does not protect you entirely from feeling as though the rug has been pulled out from under you when a nurse pulls some fatphobic moves. I ended up with old memories of self-loathing, feeling destabilised and confused, and this from a clinic that says it is passionate about supporting people's health and wellbeing in its mission statement. I worry about the people who don't have my experience and credentials.

I have no intention of ever booking an appointment with that nurse again, but I have some pointers from this experience that may be of use to other medical practitioners.

How nurses and other health practitioners can support people of all sizes to have optimum health


Keep a set of weighing scales in the middle of the room like a monument to BMI. It makes it look as though this is the most important tool of measurement for you and reveals how little you know about body weight and health.

Smirk when a fat person declines to be weighed. Declining is a brave act of self-advocacy in the face of monumental pressure to capitulate to a system that does not have fat people's best health interests at heart.

Judge. Fat people can tell you are doing it, we have had a lot of experience of this.

Be surprised when you ask a fat patient about their life and they reveal themselves not to be the saddest sack of the universe, especially if you find out that they have more going for themselves than you do.

Gloat about your own thin privilege.

Get stressed or blame the patient when you struggle to find a pulse or do a basic check because you are not comfortable touching a fat person.

Treat patients as repositories of data for your poorly designed computerised records systems of questionable security.

Use any fat-sized medical equipment that has the name of a weight loss drug plastered all over it, especially if that drug has been implicated in the sudden deaths of fat people. Buy a large-sized blood pressure cuff, don't use one that is basically a giant advert for Reductil. How can your patients ever trust that you are not in the service of those brands?

"Take control," patronise patients with empty promises that "it will come together" to excuse your inability to listen to a person and support them with their needs that they have plainly stated.

Sneakily schedule blood tests for all the so-called fat diseases, which the patient has had before and for which there is no evidence that these diseases are a problem for them. Don't think your patient won't notice what you have done and know that you have been judging them the whole time. Don't be surprised when this patient does not go along with your great fatphobic plan. You may be tempted to stereotype fat patients like this as wilfully non-compliant and self-sabotaging. Don't do that.

Treat people as automatic fodder for the medical industrial complex. Maybe a medical solution is not appropriate.

Touch someone weirdly. Don't rest your hand on mine as you tell me about your ex-wife who was also a psychotherapist.


Remember that bodies come in all shapes and sizes and that this is human.

Listen to the patient. If they say their problem is stress, or anything else, do not assume that their problem is that they are morbidly obese(sic).

Listen extra hard if you have only just met that patient. Get to know them as a person.

If time is tight or the computer system determines what happens in the clinic, acknowledge that you are working within limitations.

Understand that being weighed is not a neutral act. Don't proffer it. Try and have some compassion and understanding for what scales might mean for a fat patient, even if your own experiences of being weighed are nothing to write home about.

Collaborate. Treat fat patients as people who are invested in their own healthcare, especially if they make an appointment out of the blue to get their blood pressure checked. This is proof that they care about their bodies.

Get consent. Share data with your patients without them having to drag it out of you.

Try and laugh when your patient makes a joke about being a zombie when you are unable to find their pulse because you are uncomfortable with handling a fat body. They are being generous and are trying to help you.

How to recover from a bad interaction with a medic

Remember it's more likely to be them and their system that is the problem than your fat body.

Talk to someone you can trust with your feelings, don't be alone with it. Perhaps resist posting on social media even if you feel alienated and upset, you may find that people's responses there are far from soothing.

Write down what happened, get it out of your head.

Make another plan for looking after your health.

Send the clinic some feedback if you feel up to it.

Make some tea.



Lemonbella said...

Thanks for this, had a similar experience at a routine blood pressure check. Nurse refused to re-take it despite me informing her that it is always up first time (and the check following me being weighed despite asking not to be, which is stressful. I was told I could not get my medication without the weight) and then lectured me despite a clear request from me that I did not want to discuss. Nurse couldn't be bothered to ask after my mental or physical health only the weight lecture. Awaiting outcome of my complaint, so really heartening for you to remind me why I stressed through making the complaint.

Vron McIntyre said...

Great post. I hope you're starting to feel better. I'm all too familiar with the blood pressure thing especially as I've had a lot of medical appointments recently, the "large" cuff is too small for my arm (by their own measurements) and they get wildly different results every time they try to use it on me. Its frustrating as I would like to know my BP but can't trust any of the results.

Dr Charlotte Cooper said...

Lemonbella and Vron, these incidents feel isolating but they are so so so common amongst fat people.

Paul Ernsberger said...

I own my own large cuff that fits my arm. I always measure own blood pressure before going to the doctor and I demand a recount if the readings don't match. The American heart association publishes guidelines for blood pressure measurement that every nurse knows yet never follows. Feet flat on the floor, back supported, sitting quietly for five minutes, no talking during procedure. Take the average of three consecutive readings.

Dr Charlotte Cooper said...

Thanks Paul.

Patty O. said...

Thank you so much for this post! I need to be reminded that it is okay--necessary, even--for me to stand up to my doctor and not allow him to patronize me or discount my symptoms as age or weight related. And I needed this reminder that I deserve to be treated with respect by health professionals!!

Melissa Schofield said...

This is a wonderful post. I am a nurse, and I am fat. When I go to my physician's office for a check up, the medical assistant (they don't have nurses at that office) always takes my blood pressure incorrectly. The needle drops so fast that I KNOW she is not getting an accurate reading. Of course, the blood pressure reading is always taken right after the weight. Like the previous poster, weight is required for me to refill my prescription. I always ask to have the BP retaken after 15 minutes if the first reading does not match what I am getting at home.

Also, it is possible to take the blood pressure in other places than the upper arm. It can be taken on the lower arm quite easily with a manual cuff. Some automatic cuffs are designed for the wrist! If you can take your blood pressure at home, I highly recommend it. You can buy an inexpensive manual cuff and stethoscope kit at many drug stores, online, at stores that sell scrubs, etc. Avoid automatic machines as they are more expensive and tend to only be available in one size. For the most accurate reading, have a friend take your blood pressure when you are relaxed. Take it several times over a period of a few weeks. Keep a record of the time of day, whether you were sitting, standing, or lying down, and the size of the cuff. Blood pressure tends to be lower in the morning and increases a bit as the day goes on. A cuff that is too small will give a falsely high reading. If you take blood pressure-reducing medication, keep a record of when your last dose was prior to taking your BP. Also, your sodium intake can really affect your BP. Just like you shouldn't get your cholesterol checked after eating high-cholesterol foods the night before because the reading will not be accurate, you also will not get an accurate BP if you have eaten more sodium than usual in the last day or two. Restaurant food often has a lot of sodium, even if you can't taste it. Other things that affect BP are your hydration level and your caffeine and alcohol consumption.

Having said all that, if you are consistently getting high readings when you are relaxed and using the correct cuff size, do something about it! Uncontrolled high blood pressure affects your whole body, not just your heart. It affects your brain, your vision, your kidneys, etc. etc. Take medication if your healthcare provider feels it is appropriate, but don't think that is the only solution. Work on stress management, including finding a way to move your body that feels good. I'm not talking about exercising for weight loss. I'm talking about movement just for the pleasure of it. Dance in your underwear. Stretch. Do yoga. Whatever. Try to reduce your consumption of substances that numb you to your feelings, because you are probably holding those feelings in your body. Find a safe way to feel your feelings and let them move through you and then move on. Do whatever makes you feel nurtured. For me, that means wearing loose-fitting clothes in colors I like, taking time to get some time outside (even if it's raining), and spending at least 15 minutes a day reading or crocheting. Try to reduce your screen time. Reducing your stress not only reduces your BP, it reduces your need to engage in not-so-good-for-you activities which contribute to increased BP.

If you feel comfortable, have a heart-to-heart with your healthcare provider about their attitude and the attitudes of their staff. Most of the time, their goal is truly to promote health. Remind them that shaming is not an evidence-based practice for health promotion! If your provider is not receptive, look for a new provider if you have that option. Your money talks!

Good luck! Advocate for yourself. It's good for you, and good for others who are getting the same treatment but not brave enough to speak up.


Dr Charlotte Cooper said...

Thanks for your thoughtful and helpful post.

NB. In the UK we have the NHS, not consumer-driven. Money talks, but it's a bit different here.