So let’s return to the reasons for my hatred of western med. As already mentioned, western med is not friendly to fat people and the shame and guilt dished out often cancels out any perceivable benefits. But let’s also layer in the massive migraine headache that is the American “healthcare system.” Now, I work at a modest nonprofit job; this gives me the actual privilege of getting fairly affordable and reasonable health insurance. It also means, though, that I can afford an HMO, so all roads for my health care are “managed” by a primary care physician. Though I’ve had this coverage for years, I have never met the doctor that I googled and listed as my primary care doctor several years ago during open enrollment so…the air hung heavy with excitement. At least for two weeks.
“Dr. Wu is running behind…”
Dr. Wu. Through her picture online, I inferred she was nice and smart. Something in her smile said, “I know things.” The double win seemed to be that she is neither white nor male, giving me the impression that she might (might) be less patriarchal and also possibly more open to the newer research around obesity. I didn’t hold my breath too hard but I had more hope than usual. She also had really excellent online reviews that spoke of a caring bedside manner and deep and trustworthy competence. Wins all around for a name I highly expected to know only in the context of my insurance card.
But in May 2021, fatigued and feeling legitimately ill, I scheduled that appointment with Dr. Wu. The time had come for our meeting. And then it went. I showed up to my appointment on time on that blistering Thursday in July only to be informed that, “Dr. Wu is running behind…you can wait right over there,” by the bemused, round, but very knowledgeable (you could just sense it) receptionist. “How long is the wait do you think?”
“Well, let me check,” she nearly screamed through her N-95 and the glass partition. This seemed bad. “She’s running two hours and 45 minutes behind. Can you wait?” What the everliving fuck? What kind of job lets this happen? It was 3:45pm. “Ooooh no I’m so sorry, I can’t,” I managed as my brain exploded in slo-mo. Can anyone appreciate just the energy it took to get me into that building, only to be told to literally sit in a COVID-19 collection tank for almost 3 hours?? No thanks. “How about a reschedule,” I asked as the receptionist was clearly getting over my absurd level of reason exhibited in my rejection of Dr. Wu and her truly criminal lateness. “Sure, sure. Okay…uhh, let’s…see…her next open appointment is…wellllll,” she muttered as the number of clicks of her mouse indicated she was scrolling through months of time. “October 3.” And there it is. “Do you want that one?”
uuhhhhhmmmm…nooooo. As the sociologist brain in me ran through all of the social wrongs in this situation, including but not limited to the fact that this experience is actually a privilege for almost most Americans who would’ve gladly waited that 2.45 hours and then paid out of pocked it for it, my Dr. Wu was taking on a different persona in my head. Seriously, who runs that late? An overworked HMO doctor at the very least, that’s who. But no, I couldn’t wait until October 3.
“Ooh, no,” my white privilege lied. I could’ve sat in that chair and waited but I was already salty about having to be here at all. “No, I have some concerns that I need some input on as soon as possible. Is anyone else available sooner?” I asked, sliding the insurance card through the little peep-hole in the partition.
“Yes…you’re insurance covers the whole practice so…you got options.” I LOVE OPTIONS. ” Do you have a preference, woman or man.” I waved away preference. Bye bye, non-white female Dr. Wu. I knew exactly what was coming.
“Dr. C is open next Wednesday.” Now, Dr. C’s name is Polish; I know this because that is my people and without seeing his name, I knew, exactly what this situation was becoming.
“Done…what time?” …will my institutionalized fat-shaming session begin.
“Any time you want, starting at 7:30.” I opted for 7:30am despite my average bedtime just several hours before to avoid whatever this 2.45 hours late scenario might be in this entire practice and, frankly, to get this over with, hopefully without much memory of the experience. I had to fast for the blood tests so…the clinic is literally 5 minutes away from my house. I’d take a nap. “Well…you won’t be sorry. Dr. C’s been my doctor for 30 years,” she casually dropped, passing my insurance card back through the partition with a stab.
“oh yeah…that sounds…ideal.” How did I even utter that response? An old white dude available all day for multiple days next week. With my broke-ass HMO. Sounds like a winner.
Dr. C and the Case of the (un)Expected Outcome
The long and short of the first visit with Dr. C was that it was exactly as I imagined it would be. After the cursory initiation of the scale and blood pressure check (surprisingly low!), Dr. C. walks through the door exactly as I thought he might. Doughy looking, fair-faced Polish family doctor sort. I’m not calling him Dr. C for discretion; his name has several y’s and z’s strewn recklessly throughout. It’s not worth the effort of typing it correctly when it intuitively looks and feels just wrong.
“Well,” he says, “your vitals look good but..you know…there’s the weight to consider.” Here we go. Activating chip on shoulder. Game on. I came out swinging with every counterpunch to his next 15 condescending questions like but not limited to: 1) do you exercise 2) ever heard of weight watchers 3) your portion sizes might be too big 4) how often do you drink a whole 2 liter bottle of coke? 4b. you know sugar isn’t an everyday thing? 4c.) have you thought about cottage cheese instead of ice cream for dessert? Omg, NOOOO, I’ve never heard *any of that* before! (I sarcastically spat back my head).
I told him about counting macros and doing CrossFit; I told him about trying South Beach, Atkins, Nutrisystem (which worked, btw but is an absolute nightmare), and starving myself in 2016 to the point of hair loss and amenorrhea. It didn’t stop the barrage but I did everything I could to establish my theory: that this is not a behavioral or dietary problem BUT A MALFUNCTION WITHIN MY PHYSIOLOGY. (I’m screaming for the dumb ones in the back.) We we heading directly toward an impasse I could see and feel in my gut full of visceral fat when I offhandedly mentioned that, in 2014, I graduated with my PhD in sociology. He sat up in his chair, looked me square in the eye for this first time in 30 minutes and his tone changed. I was fascinated but not surprised. This is patriarchy at work.
In that one little phrase, two pivotal things happened. First, it established that I’m not an idiot and that an institution of higher learning has certified that (ps..knowing some of the people I knew in grad school who also possess this degree, this certification is about as useful in determining intelligence and skill as a handful of gummy bears BUT this is where its commonly understood meaning comes in handy.) Second, though, it jolted Dr. C out of his dogma for two seconds via some finely tuned cognitive dissonance for people who know the process of acquiring a terminal degree. He may disbelieve my stories of discipline and rigor in my dieting but there’s no way to deny that those exact same qualities, in addition to thick skin, determination, and frankly, the scientific method plus advanced reasoning and research skills are what it takes to muscle one’s way through that gauntlet. Because I had proven myself worthy in a similar arena, he could use the transitive property to discern that maybe, just maybe, this was not a behavioral issue. Maybe she has done her due diligence and it’s not working. Maybe there is something else going on. Silence befell the room. So now what, Doc?
“Okay…” he paused. “Let’s get the labs.” On top of labs he gave me a referral to every doctor and test on the list of possible factors: sleep, ENT, MRI for thoracic analysis, mammogram, the list goes on. I’m still, 3 months later, working my way through them. There’s a little piece of me that thinks he did this out of spite for my argumentative approach–she asked for labs…I’m gonna give her all the labs she can handle. It does not matter if it is or not; it got me where I wanted to go.
Thank god I had that PhD; I might still be trying to convince him that I know what calories are and that alcohol isn’t a food group (although it is a macro…who knew?)
Labs and the “IF” word
Just to finish out this part of the story, let me say that the labs came back and guess what? I’m not on my deathbed, shockingly. Test after test came back normal or just slightly off. Not a huge surprise given the significant amount of weight I’ve gained in a relatively short, stressful time. There was work to be done on this kidney issue and, another shocker, fasting blood glucose.
“You’re prediabetic,” Dr. C, opened with, walking in to my follow-up appointment. Good thing I speak labs because when I looked at the results myself, I thought he buried the lede there a bit. Yes, fasting blood glucose was too high. But no other indicator for Type 2 Diabetes was out of range. He gave me that diagnosis largely because of the weight on the scale. Ok fine. He’s an old white dude doctor. “Let’s walk through some of your options. I mean, we could discuss surgery if you want to go that way.”
Hell. to the. No. Once again, this is a physiological malfunction. OBESITY IS THE SYMPTOM AND NOT THE CAUSE. Why do I have to pay for the pleasure of educating my doctors? I need to get this on a t-shirt. You’d think the calories I burn just saying this over and over again have to add up eventually, you know? Except that we know this wouldn’t make a difference because weight loss is not a calorie-in/calorie-out transaction. (Nutritionists and trainers in the crowd, do you want me to talk slower on that one?)
“Oh no. No surgery for me. I’d love to work this out by repairing whatever has gone awry in here,” as I made a circle motion in front of my newly extra-padded torso. Something is not right up in here but with lab work looking this normal except for fasting glucose, I’m a healer. This bod will respond when given the right stimulus, I know it. Almost fully checked out because he opened with bariatric surgery as option one, and waiting for his referral to a nutritionist who will surely hand me the FDA food pyramid and ask me if I have ever heard of “quinoa” or “teff,” or if I ever made zucchini boats with stuffing made of meatless crumbles and vegan cheeze (real spelling). I mean…barf to all the above. What he said next, however, snapped me back. “Have you ever heard of intermittent fasting? Jason Fung?”
Oh, now this is interesting.
I’m mean, duh, of course I’d heard of this…because for 30 years I’ve scoured both conventional scientific literature and alternative medicine to find any light in the darkness. I’d done keto for about 18 months a couple years ago, to no weight loss avail, but keto was often paired with the discussion of IF. This was way alternative for this guy, who in that one question proved he had kept up on the weight management literature, at least within 5 years. Intriguing.
“Oh yes. I like his work a lot. I’m gonna have to do keto too, though, because I can’t manage it well if I’m eating carbs…I just feel hungry all the time.”
“Well, you know, a little hunger is a good sign.”
oh…there’s the fucking condescension and shaming...I had gotten hoodwinked by his momentary lapse in western med pedagogy. I was willing to forgive more easily because he did at least acknowledge my intelligence and name-dropped Dr. Jason Fung, the preeminent source of scientific research around obesity as a symptom of…the dysfunction of the endocrine system! Wait a minute…so fat people might NOT BE LAZY? What? So of course I took this to mean he prescribed me IF and I had said “keto” in front of him and he didn’t launch himself at me so… I ran with it. I hopped in my car which drove me to Starbucks for my last cold brew with milk for awhile…because tomorrow I’d plan my keto comeback, with an extra helping of Intermittent Fasting. And when that rando nutritionist online dare question my sanity, I could use the only benefit that western medicine inherently possesses:
“Oh, my doctor recommended it and he’s managing my program.” You white skinny bitch.