By Karen R. Koenig, M.Ed., LCSW
Conversations with health care providers about eating challenges and weight concerns can be difficult for you and your providers. Living in a thin-obsessed, fat-phobic culture, many of us are affected by weight prejudice.
We'd like to believe that doctors, nurses and other health practitioners are immune to such bias, but according to research and their own admissions, this is not the case.
Here are five simple tips to use at health care appointments that will help you get more out of your visits and move you toward improved health and fitness.
1. Share your eating and weight concerns honestly and openly. Talk about your diet and weight history. It's not shameful to say that you're an emotional or stress eater, that you never met a carb you didn't like, or that you feel too big to get out there and move your body the way you'd like to. It's not shameful to say that you've lost and regained 50 or 100 pounds. You've probably been on a gazillion diets and may have had several (lapsed) gym memberships. That's OK. The fact that you've made attempts over the years to become healthier is important for you to state proudly and is essential for your practitioner to know. The truth is that the deck is stacked against you. Scientific studies tell us that diets don't work long-term and you may have been depriving yourself of food for so long that your body has gone into caloric-conservation mode. Diets have failed you—not the other way around—and self-discipline is bound to fizzle when used repeatedly as the sole tool for managing food intake.
2. Speak up about your physical and emotional needs. Eating well and taking care of your body is more about self-care than about self-deprivation. It begins with identifying and verbalizing your needs. A good place to practice these behaviors is in a medical office. Are you comfortable in the waiting room and office chairs at your size? If not, speak up. Hate wearing a skimpy hospital gown? Ask the nurse if it's necessary to change into the gown. If you prefer not to be weighed or told your weight, tell the nurse. If the nurse insists you step on the scale, ask not to be told the number or stand turned so you can't see it.
3. Expect to be treated with respect and compassion no matter what you weigh. Regardless of your size, weight or the persistence and magnitude of your eating problems, you are entitled to be treated with respect and compassion by all health care providers. Fat stigma is no more OK than other slurs or prejudices. Mistreatment includes providers talking down to you, using a critical tone, telling you what you "should" or "need" to do rather than asking how they can help, or blaming and shaming you in any way for your eating or size. You have every right to tell your health care provider, "I feel misunderstood when you say that I just need to eat less," or "I wish you would stop implying that I eat a horrible diet, when I actually eat quite healthfully." If you had a heart murmur or a broken shoulder, you would expect respect and compassion. Your problems with food deserve no less understanding and attentiveness.
4. Expect to have your medical concerns adequately addressed. Your providers may try to blame all your health problems on your eating and sedentary habits and high weight. In truth, thinner people get sick and have medical conditions, too. Knee or back problems could get better if you weigh less, but there may be other causes for these problems as well. If you have a concern about heartburn, it's your right to have that problem addressed directly and not have the discussion morph into a lecture on why you need to eat less and move more. Feel free to tactfully interrupt a provider and say, "I'd like to get back to my problem with my heartburn," or "I'd like to talk more about what might be causing my heartburn and possible remedies." Remember, it's your body, your appointment and your agenda.
5. Be accountable and open to collaboration. Although it may pain you to admit to yourself and your provider that you stopped going to the gym six months ago, own up to your lapses. Be curious about what made you stop going and explain the reasons as best you can. Ask for help. Most health care providers want to help people. Tell them what might work to help you eat more healthfully and become more active. Tell them what hasn't worked and why, but recognize that it might work now with some tweaking. Be open to new ideas such as hiring a health coach or fitness trainer, consulting with an eating disorder therapist, joining an eating support group or making an appointment with a registered dietitian.
Keep a positive attitude and hope for the best with your health care providers no matter what bad experiences you've suffered. Offer second chances, but if you've tried to improve the quality of your relationship and it remains unworkable, move on. Give respect and expect the same. Most of all, don't give up on getting the help and treatment you need for optimum wellness and well-being.
Karen R. Koenig, M.Ed., LCSW, is a psychotherapist, blogger, educator and expert on the psychology of eating—the why and how, not the what, of it—with 30 years of experience teaching chronic dieters and overeaters how to become "normal" eaters and develop a positive relationship with food and their bodies. She is the author of six previous books on eating and weight. Koenig teams with Paige O'Mahoney to provide a cutting-edge approach for doctors and health care providers to treat patients with high weights and eating problems in a new book, “Helping Patients Outsmart Overeating: Psychological Strategies for Doctors and Health Care Providers” (January 12, 2017).
