Smallness and thinness have become such an ideal, that it has culturally impacted how we view people and their value—maybe even in the medical field

When I first got my period, I was disarmed. This force of clot wriggled out of me until the shock and pain assuaged and I stared at my thighs and hands. We’d been taught about periods, yes, but in such a clinical manner. Nobody warned me about the mess.

I tried to play it cool. I collected a napkin that we got for free when someone from a feminine hygiene company came to our school to give us a talk about periods and then pretended I knew how to put it on. That was the first day I bled. I then bled for 13 more days after. Nobody warned me about that either.

“I was having all types of body changes, experiencing things I had never experienced yet every time I went to the doctor, they couldn’t ‘find’ anything wrong… I started second-guessing everything”

I thought it was normal, considering it was my first. But when my next periods came or skipped or lasted over a month, I knew something was wrong. I consulted my high school nurse, who told me without even lifting her eyes from her phone that I needed to diet. I asked another school physician, and she said I needed to lose weight to normalize it and then sent me away within minutes.

I developed anemia as a result of the excessive bleeding and was told by the nurse who took my blood sample to keep trying to lose weight, even when I was already a varsity player and dropped so much weight from starving myself because of the body dysmorphia I had developed. Still, my periods were long and irregular.

I talked to the university health office, and they all gave me the same pointers. At my strongest and lightest, when I fit a size small and was heavily muscular, even when I complained and asked if they could check further, they just told me I was too heavy. I suspected something else was going on.

Despite this, my OB-GYN gave me the same instruction every visit: shed the weight. I had been on a diet and later stopped eating altogether. Years later, my psychiatrist told me that she suspected I had an eating disorder. Even when I would gently ask if they could check if there was something further, she committed to her suspicion. It wasn’t until I demanded a transvaginal ultrasound that we finally saw them: cysts, all over my ovaries. Polyps lit up the machine. PCOS had been ravaging my body for more than a decade, causing disruptive levels of insulin resistance, and making me retain weight no matter how little I ate. I sat at my OB-GYN’s office, devastated and angry. Why did it take so much convincing to look at my ovaries? Why couldn’t any physician in my life have helped me earlier on?

I realized this story wasn’t and isn’t unique to me, and unfortunately happens to many women everywhere.

Tale as old as time

Veronica, a senior research coordinator, shares her frustration, saying, “It’s so saddening and maddening how common [this] story is among women in general—our health concerns are never taken seriously. The idea is always, ‘Well if you just do what everybody else does, then you’d be fine.’ But I do what everyone else does, most times even more than they do, and I still am blamed for what I’m experiencing with no real reprieve.”

Veronica was waved off by many physicians in her life. She recounts, “I spent two years in my grad program feeling like I was going crazy. I was gaining weight despite not eating much/eating like I ‘should’ and working out a few times a week. I was having all types of body changes, experiencing things I had never experienced yet every time I went to the doctor, they couldn’t ‘find’ anything wrong… I started second-guessing everything. I went to get second and third opinions, continuing to visit doctors and nurses until someone told me I wasn’t imagining what I was experiencing, but for the most part, I was dismissed as ‘overthinking.'”

“I have had to demand answers for everything. When I started developing acanthosis nigricans under my breasts and on my neck, that was the only way I could get a nurse to take me seriously despite talking to her about my insulin resistance and changing body odors/body changes”

She adds that when she suspected she had PCOS and developed other conditions, that was the only time she was taken seriously, “I have had to demand answers for everything. When I started developing acanthosis nigricans under my breasts and on my neck, that was the only way I could get a nurse to take me seriously despite talking to her about my insulin resistance and changing body odors/body changes. Because I was never diagnosed officially, I didn’t get remarks about the diagnosis but most of the responses felt like ‘Here fine, you have it. Here’s your referral that you wanted so bad.'”

Bea, a children and women’s rights advocate, shares similar experiences. “I remember being particularly anxious during an annual physical exam at my old job because I was at my heaviest at the time. I was struggling with irregular periods and constant weight gain even if I was more active and had a more controlled eating [and sleeping] schedule. When it was my turn to see the doctor, I voiced my concerns about possibly having PCOS but she immediately turned me down… she basically told me that I needed to make a better effort with working out and eating less. It almost felt like I was in a debate trying to explain to her that I was doing all that I could to lose the weight but ultimately nothing was working, but we kept circling back to ‘you’re not doing enough.'”

Belle, a writer and expressive arts facilitator, also weighs in. “Earlier this year, I had to go through a pre-employment medical exam… [The physician] noted that according to my BMI, I’m obese. I disclosed to the doctor that I had PCOS, which explains my weight gain as this disorder messes with my hormones, metabolism, and insulin resistance. She said just diet properly and exercise.”

It’s difficult to pinpoint where this propensity to discredit the worries of bigger women in the medical field is most prevalent, but there are a few theories.

“Earlier this year, I had to go through a pre-employment medical exam… [The physician] noted that according to my BMI, I’m obese. I disclosed to the doctor that I had PCOS, which explains my weight gain as this disorder messes with my hormones, metabolism, and insulin resistance. She said just diet properly and exercise”

Breann, an OB-GYN medical professional, weighs in on the potential disconnect between generations in the medical field that may be fueling this mentality, saying, “I think the younger generation is more sensitive and understanding regarding weight. Rather than putting down or body shaming those who are overweight, the younger generation chooses to empower them. I do believe however that there should be a middle ground wherein we can stop body shaming while still maintaining a sincere concern for the patient’s welfare.”

She adds, “Maybe it’s just because I’m a younger-generation physician, but I’ve personally never discredited my patient’s opinion.” It’s a possibility that these ingrained biases are generational, though nothing is certain yet.

The BMI debate continues

According to Breann, BMI (body mass index) “measures the ratio of an individual’s weight to their height. It determines if someone’s weight is within the normal range for their height, or if they are overweight or obese.”

It’s been used for decades by the medical field as a way to quickly gauge if someone’s body is in a “normal” range. Seeing where someone falls on the BMI scale helps a medical professional figure out what they may be at risk for.

“It’s still quite shocking that locally, some physicians still see BMI as a definitive scale for how healthy our bodies are. When really, the BMI metrics were designed for Western bodies and don’t consider other factors”

However, recent medical studies show that it may not always be accurate and/or may not be definitive, and therefore probably shouldn’t be relied upon as the sole indicator for health. Conclusions made based on this number may only paint broad strokes how “healthy” a person actually is. BMI as an indicator is being debated heavily.

“It’s still quite shocking that locally, some physicians still see BMI as a definitive scale for how healthy our bodies are. When really, the BMI metrics were designed for Western bodies and don’t consider other factors like body fat percentage, muscle mass, bone structure, and racial and sex differences… The only time I was in a ‘healthy weight’ range (according to BMI), I was battling an eating disorder,” says Belle.

Bigger doesn’t automatically mean poor lifestyle and choices

Culturally, many just write off those who are bigger. People tend to have preconceived notions about how healthy someone is and how much they care about themselves depending on how big they are, opening them up to comments about how “they let themselves go” rather than considering underlying issues, misdiagnoses, and a lack of medical care in general.

“I think there’s always a preconceived notion that people are more full-bodied because of how much they eat when that is far from the truth,” Bea says. “I honestly feel like it’s such a lazy way to approach healthcare because there are so many factors that contribute to weight gain… This is something I actually do not understand because assuming a person’s lifestyle according to their weight or size is so dangerous, it could lead to misdiagnosis and neglect of another underlying condition.”

Veronica agrees: “I sincerely do believe that my weight is a result of my underlying insulin resistance and hormone imbalances. I barely changed my lifestyle—I honestly became more active—when I started noticeably gaining weight. But because I’m still struggling to be taken seriously, the onus of losing weight and correcting everything is still on me, which is so damaging for my mental health.”

“I think there’s always a preconceived notion that people are more full-bodied because of how much they eat when that is far from the truth”

Smallness and thinness have become such an ideal, that it has culturally impacted how we view people and their value—maybe even in the medical field. Societally, bigger women are judged immediately just based on the space they take because they don’t align with the ingrained societal preference for smallness. Veronica encapsulates this perfectly, saying, “Our cultures value thinness, prettiness, proximity to whiteness because they all are ‘indicators’ of health, beauty, and wealth in a sense.”

Bea agrees, adding that religion has also played a huge factor, saying, “I feel like another problem is our culture subconsciously relying more on expectations and flawed ‘Christian’ values. I feel like when someone sees a woman who is bigger, they are instantly convinced that they’re not being responsible for their health and therefore not able to conceive children or even find a husband. I can’t count how many doctors have told me that I needed to lose weight because I might have a difficult time getting pregnant when I don’t even want kids.”

Moving forward and past medical fatphobia

Breann says that weight management is critical when it comes to health, but physicians should work alongside their patients while still caring for their security. “Weight management is an important aspect of an individual’s overall health. It is not merely an image. Healthcare workers need to find the balance of making the patient feel safe and secure in their own skin while addressing their medical concerns.”

This approach is what some women have been able to positively experience recently, like Belle, who says, “My doctor from Kindred explained that PCOS causes insulin resistance and delayed metabolism. She was very non-judgmental and kind in her delivery. She didn’t even bring up diet and exercise until I asked what to do. And even then, it didn’t sound restrictive. She used words like “lessen” instead of “avoid.” She didn’t say “exercise to lose weight,” but suggested I start strength training.”

While it’s sadly not every woman’s experience in the medical field, it’s refreshing to know there are professionals looking to be more sensitive toward handling matters of weight, mental health, and underlying issues beyond the quick assumptions they can arrive at just by looking at numbers on a scale.

While it’s sadly not every woman’s experience in the medical field, it’s refreshing to know there are professionals looking to be more sensitive toward handling matters of weight, mental health, and underlying issues beyond the quick assumptions they can arrive at just by looking at numbers on a scale

Weight-based discrimination is prevalent in many fields, but it’s particularly dangerous for medical professionals to hold on to these biases, as many patients don’t get the help they ultimately need and often develop further problems as a result. It can be maddening to have to demand care, and then to be met with annoyance when your suspicion has been proven right. It may be due to a host of reasons, such as it’s just how they were taught in medical school, generational gaps, or even an overload of patients that stretches doctors too thin, but this is still at the cost of the women suffering, who end up paying more than just doctor’s fees to navigate their medical woes.

Hoping and rallying for more understanding, sensitive, and inclusive practices is important. Belle summarizes it perfectly, saying, “[W]e need more inclusive and holistic healthcare educators so the next generation of doctors and medical practitioners can see their patients as people with feelings, and not just bodies with medical conditions.”