M

y older sister, Jan, visited me in San Francisco last spring. “You look great,” I told her, noticing that her clothes were hanging loose; she’d been heavy most of her life. “I’ve lost 60 pounds,” she said, and I automatically congratulated her.

“I wasn’t trying,” she replied.

It hit me then that something was very wrong, first with her health, but also with the way I assumed that her weight loss was a sign of well-being. My own judgments and shame associated with being fat got in the way of seeing my sister. Looking closer, her face seemed strained, and despite the constant smile she turned on, she wasn’t well. She told me that she’d been in so much pain that she’d had little appetite for months.

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I asked Jan if she’d seen a doctor. She had, but it hadn’t gone well. The doctor she’d known for years had converted his practice into a concierge service, and she hadn’t wanted to pay the extra $15,000 to stay with him. So she’d made an appointment with an OB-GYN a friend had recommended. Jan’s eyes welled up as she described the visit.

She had run down her symptoms: vaginal bleeding, unexplained weight loss, and near-constant pelvic pain. She told me the doctor hadn’t taken her complaints seriously, dismissing her concerns and performing a routine examination.

“He didn’t do anything for me, and he didn’t find anything. He just saw me as a fat, complaining older woman,” Jan said. Demeaned and discouraged, she didn’t seek a second opinion right away. Instead, she explored possible causes of her abdominal pain, wasting months avoiding dairy and gluten and taking over-the-counter pain medications.

Jan’s experience as a fat 59-year-old woman is hardly unique. Several studies have shown that many physicians consider the time spent with obese patients a waste, and they don’t hesitate to broadcast their biases in the examining room. Fat people are less likely to seek medical treatment because they know the stigma and lectures that await them. My oldest sister, Cynthia, who is also heavy, recently visited a doctor for a rheumatologic problem and was curtly told to “lay off the hamburgers and Cokes,” even though she never touches fast food. On her next visit, she brought along her slim and athletic husband, and says she got better care by association.

Weight has long been part of our family drama. My sisters and I weren’t as trim and fit as our parents, who focused on thinness as the barometer of our worth. Our father is a pediatrician, and perhaps the sense of failure that many doctors feel when they see their fat patients in the office greeted him every evening when he came home to his kids. Our parents believed that making comments about our weight and putting us on diets would help — just the opposite of what the American Academy of Pediatrics today considers better wisdom for preventing obesity and eating disorders. Criticizing us for being fat, instead of encouraging us to be athletic, became a self-fulfilling prophecy. Jan, who’d been strong, bright, and athletically gifted as a child, the fastest skier and the best at team sports, became the heaviest of us four sisters.

During our visit in San Francisco, I encouraged Jan to see another doctor to get to the bottom of what was ailing her. A few months later, she finally got an appointment at an internist’s office. A physician assistant examined her. Jan arrived at the visit weak and wracked with pain. She came out of it in tears, with no answers and no relief.

“She wouldn’t give me anything because she thought I was just trying to get an opioid fix,” she told Cynthia, who had accompanied her. Did the physician assistant think Jan was putting on an act to cadge drugs because she was fat, that despite her detailed and articulate medical complaints — not to mention her obvious and tremendous pain — she fit some undisciplined, drug-seeking profile?

The physician assistant did, at least, send Jan to have some blood tests. When she had finished giving blood, she was so exhausted she couldn’t drive herself home.

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Very early the next morning, Jan got a call from the internist who, even though he had never met her, told her to go immediately to the emergency room. She was quickly admitted to the intensive care unit in critical condition, with a sky-high level of calcium in her blood. An MRI revealed an enormous mass in her abdomen.

When Jan was stable enough for surgery, the hospital’s gynecologic oncologist removed the largest endometrial tumor he said he’d ever seen, the size of a volleyball. It had peppered her pelvis with cancer, infiltrating her bladder and other organs. The MRI also showed spots on Jan’s lungs, likely signs that the disease was spreading even further.

In hindsight, endometrial cancer is an easy disease to Google. The first few hits reveal the signs and symptoms: unexplained weight loss, vaginal bleeding after menopause, pelvic pain. Jan had them all. I’m no doctor, and I know that physicians are not infallible, but it strikes me that those symptoms — the ones the patient came in worried about — should’ve raised red flags far more than the fact that she was overweight.

Jan went through a few rounds of chemotherapy and lost even more weight. She took some perverse pleasure at being able to fit into normal sizes and fashionable clothes for the first time in her life, not the unsophisticated, uninspired garments that most manufacturers muster up for plus-sized women. By then she’d lost about 100 pounds and, despite her conspicuous illness — the wig, the pallor, the fear in her eyes — people kept on complimenting her about her weight loss. They, too, saw only her size.

Jan died last Christmas Eve, six months after learning she had cancer.

Hers was an unusually aggressive type of endometrial cancer. Maybe she would have died just as quickly if she’d been thin. But I can’t help thinking that Jan might have had a better chance if her doctors had looked beyond her weight and their prejudices about fat middle-aged women; if she hadn’t been so reluctant to seek medical treatment because of the fat-shaming lectures she knew awaited her; and if she’d grown up thinking that her body was OK the way it was, and she should love it, move it, and take care of it.

Laura Fraser is a journalist and author of several books, including “Losing It: America’s Obsession with Weight and the Industry that Feeds on It” (Dutton).

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  • im so sorry. about ur sister.im in england iv lost 3 stone iv had dyspagia not being able to swollow food x was in hosp for 13 days did every test was under ent who said il be eating. still choke on all sift foods. im under another hosp had tests still cant find anything my throat and neck hurt all day i choke even wen im not eating i have nad srthritus in my joints iv found out i have a brain desease and stull o one knows why im a size 10 to 12. was a size 16 x

    • Margarete, very sorry things have been so difficult and mysterious. Clearly much is wrong and they haven’t figured it out. This is even harder than knowing what is wrong. Very best wishes that things improve for you.

  • I am so sorry to learn of the death of your sister.
    I too was diagnosed with Endometrial Cancer three years ago. I too am very obese. I live in Toronto. I was very lucky though. I have a wonderful female family doctor, who sent me to a male gynaecologist for a biopsy. I was not very good with the biopsies (I had 2 with him) and he was so frustrated with me he eventually sent to a woman gynaecologist. She was wonderful and let me have the biopsy in the hospital under local anesthesia. They results never confirmed cancer, but as I was still having some spotting, I had to keep going back for more biopsies. As my medical care was wonderful, and my Doctor was always following up, endometrial cancer was confirmed. I had a complete robotic surgery hysterectomy, and the pathology came back Stage 1. This meant no chemo or radiation. Thanks be to God. Of course I was worried that I was too fat for the robot, but learned that robotic surgery is wonderful for the obese. My family Dr. does not nag me about losing weight. She wants me to eat healthy, and swim. I return to my surgeon every 6 months for checkups. This will go on for 5 years. I wish all obese women were able to receive the care that I did. Was it because my husband was with me every step of the way? Every appointment. Every followup. A married fat woman? Imagine that!!!!

  • This is my story! Same, same, same!
    Difference is, I sought a second opinion because I knew something was wrong! I’m still here 11 years later, no thanks to my ex-doctor.
    I listened to my gut feelings. So sad for this person and their family.

  • As sad as this makes me I am not surprised. I have always been heavy and had to fight to be heard. 15 years ago my feel started to hurt and my toes went numb. It took another 10 years for me to find i had nueromas in both feet. The only thing that does surprised me is that they did not blame her cancer on her weight. My beat friend got that.

  • GRRRR! So many times weight gain is a SYMPTOM of something else going wrong in the body! Not the problem itself! It is a defense mechanism. Not a control issue.

    SO blessed to have figured out my husband’s and my own real problems and make targeted, life-changing changes!

  • What a tragic story! This simply should not have happened. Even if your sister might have still died (and she might not have too), the disrespect and neglect she suffered are horrific. My deep condolences.

    I am fat, and fortunate enough to have an excellent family medicine doctor who knows that, despite that, I am basically healthy. (She accepted me almost 20 years ago as a patient, though I told her on the initial visit I didn’t have it as a goal to lose weight.) I know she wouldn’t blow off such symptoms. She has respect for everyone (not coincidentally, I think, she also was one of the early doctors in our area to have HIV as a focus and be willing to treat and work with patients some doctors were not).

    But I sure know that many doctors DON’T have respect for the fat. It worries me should my current doctor ever become unavailable.

    Like your parents, my mother was well intended and focused hard on diets and preventing me from becoming fat. I do think that backfired and probably resulted in a higher eventual weight, but fortunately it hasn’t interfered with my having had a very happy life.

    I’m very familiar with getting compliments for losing weight where in point of fact the reason I’ve done so (rarely) has been as a reaction to deep life stress such a a breakup or a loved one’s terrible car accident (and whenever I’m back to normal, unfortunately, I put it on again – but still better to be at a better place). Those compliments don’t feel good!

  • My heart breaks for you Laura, I can only imagine what a loss you have suffered and how much your sister suffered….thank you for sharing your story and perhaps these words will precipitate change and possibly help someone else with their diagnosis. Your sister was very beautiful with a smile that would light up the darkest day.

  • Laura, I am so sorry for the loss of your sister. I hear stories of weight bias impacting patient treatment frequently in my office and each time it makes me furious. Your sister was treated unkindly and unfairly, not to mention unethically.

    In a way, I feel I know you. I’ve followed your work, and read Losing It when it first came out, I’ve been quoting it ever since. Your article touched me deeply and I am so sorry for what your sister, you and your family have been through.
    Karin

  • Even as a physician, I got shoddy medical care. For years I had complained to my skinny PCP of fatigue and breathlessness only to be written off as a menopausal, overweight woman. Work up and diagnostic tests were not ordered. I was told to lose weight and exercise more despite telling him that I could no longer exercise. Finally, when he was on vacation, I asked the nurse to put in an order for a chest x-ray under his name. When I saw it, it was one of those “Houston, we have a problem….” moments. The CXR was shockingly abnormal with bilateral pulmonary infiltrates and massive mediastinal adenopathy. My friend the radiologist threw me in the CT scanner immediately and then said magic words “lung biopsy”. Subsequent monitoring showed oxygen saturation levels plummeted on exertion. I proved to have advanced pulmonary fibrosis secondary to sarcoidosis which has placed a strain on my heart. When he got back, I told him to go look at my x-ray. I was not happy to be diagnosed with a slowly progressive, incurable disease of unknown origin but at least I knew that I wasn’t crazy or just lazy.

    Because of my own experience, I took extra time to listen to and work up other middle aged women, who had been referred to me by their PCPs (mostly to get them out of their hair). Not infrequently, I found things that the referring physician had missed. The added time and attention would wreck my office schedule and I was frequently getting out late. With managed care, nowadays, PCPs are on a treadmill being forced to see more and more patients in less time. No wonder some diagnoses are missed! But they do not need to put on the blinders of fat prejudice either.

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