One comment I often get when I teach workshops or write blogs about participating in the discussion about our health, is that people aren’t sure if they are allowed to question their doctor/healthcare provider. I’ve had people suggest that if I don’t have a medical degree I don’t have the right to question a doctor. Except this is my body we’re talking about – my health. The issue shouldn’t be that I’m asking questions, it should be that my doctors don’t have answers.
I don’t think that body size constitutes a health diagnosis but if doctors are going to treat it that way, then we at least have every right to expect that they practice ethical medicine which includes evidence-based interventions and informed consent. Doctors who recommend weight loss as a path to health are suggesting that over 60% of the population undertake intentional weight loss as a medical treatment. So you’d think that if someone asked questions like “is there a single study that shows that this is likely to be effective” they’d have the answer at the ready. People are allowed to do whatever their doctor says without questioning, but you don’t have to have a medical degree to expect that your doctor can support his or her treatment plan with evidence.
I understand that doctors are under a tremendous amount of pressure, that insurance can make money and time spent with patient tighter, and that they don’t have as much time as they would like with their patients, I know that not all doctors are sizeists, and I mean them no disrespect; but that does not mean that they are above answering my questions, or that I give up my right to evidence-based medicine or informed consent.
In order for medicine to be evidence-based, there has to be a reason to believe that it will work, with an understanding of any potential harm it might do. These two things can and do vary greatly with the severity of the illness and the risk of the treatment. One balancing factor here is the concept of informed consent – doctors have to give the patient true information about how likely the treatment is to work, what the side effects may be etc. so that the patient can make an informed choice.
So if a cancer treatment cures people completely 5% of the time but 95% of the time the cancer comes back – often worse than before – then a doctor cannot ethically tell a cancer patient that everyone who tries hard enough with this treatment cures their cancer. But that’s exactly what they do with weight loss. Studies show that nearly everyone who attempts weight loss gains the weight back. That seems pretty obviously, yet doctors tell us that everyone who tries hard enough can lose weight and that weight loss is the key to health. And that’s despite the fact that there is good evidence that healthy habits, and not body size, are the best predictor of health (knowing that health is not an obligation, barometer of worthiness, completely within our control, or guaranteed in any circumstance.) (The research is here)
Here is a highly dramatized version of how this might play out:
Doctor: What seems to be the problem?
Me: I’ve severed my arm.
Doctor: What are you doing about your weight?
Me: Arterial blood is spurting out of my am, could we keep our eye on the ball?
Doctor: Have you considered bariatric surgery?
Me: Not interested in having my stomach amputated thanks. Do you really think weight loss will cure my severed arm.
Doctor: Weight loss will solve all your problems.
Me: Can you show me evidence of a weight loss intervention where the majority of people lost the amount of weight that you want me to lose, maintained the weight loss, and became healthier long term?
Doctor: No.
Me: Do thin people ever get severed arms?
Doctor: Yes they do.
Me: Ok, let’s treat my severed arm just like you would treat a thin person’s severed arm and then I’ll be happy to send you those studies if you would like.
Doctor: Treats my severed arm and sends me on my fat merry way. I have a re-attached arm and a renewed sense of empowerment.
We are each allowed to interact with our doctor in any way that we choose for any reason that we choose (sometimes we might choose to do activism, sometimes we might just want to get the diagnostics or medicine without any extra stress. Both are completely valid choices as is whatever else you choose.) You are allowed to believe whatever your doctor says and you also have the right to ask questions, especially when it’s your health on the line.
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