My 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.

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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  • Laura,
    Thank you for writing this article about your sister, Jan. I lost my sister, Patty, one year ago – very similar situation. I keep asking myself what I could have done. What did we miss? Well, truly we (her three sisters) miss her and will continue to do so for the rest of our lives. Patty was diagnosed in February and died in April. The speed of her demise was shocking. The feeling of helplessness was overwhelming. I still cry when I think of Patty – cried reading your article. And yes, Pat was overweight for several years but I cannot understand how her doctor missed her condition either. Again, thank you for writing about Jan. May you find some solace in knowing you’re helping others.
    Best wishes,
    Sandi Gauthier

  • Wow. What your sister went through is horrible. I am so sorry the two of you had to endure this. Doctors have lots of bias. They treat all women terribly, as if you are neurotic or something, but being overweight or poor is the worst. I wish medical schools would address this issue. It’s horrifying how many women with heart disease are dismissed as having anxiety or how cancers are dismissed as hypochondria. I encourage all women to google your symptoms and go into the doctor’s office with an idea of what could be wrong and demand the proper tests. Put up a fuss if you have to. It’s your life!

  • I am so sorry for all of you that went through that. God Bless you all. I just lost my sister the day after Christmas last year. She had complained so many tomes about abdominal pain and being constipated. She had two surgeries last year also. She went to her dr in October for bronchitis. He treated her and she didnt get better. November came and he sent her for an xray. He immediately called her and said she needed a ct scan of her chest. Dec 8 he wanted to see her right away so I took her. She had a huge mass in her lung that was pressing on her airways and was told they thought it had spread across her chest. She was sent to an oncologist. He sent her for an abdominal ct and we made an appointment for a biopsy for Jan 2nd. My sister never made it. On Dec 26th she said she couldnt breath. The rescue was called and they couldnt save her. The ct scam finally came nack after my sister passed. He whole body was ate up with cancer from her lungs to her colon. I will never understand how her doctor never found any of this until it was too late. She had suffered for years with RA but this past year she lost 50 pounds without trying and like I said had 2 surgeries. How could they have missed it?

    • My deep condolences to you, Tammy Hill. That is an awful story and – I don’t understand either. Especially given the weight loss which is such a classic symptom.

      It is hard to lose anyone but this makes it so much harder. So very, very sorry.

      Take care of yourself through this – your sister would want you to manage as best possible. But my heart hurts for you.

  • This story makes me so angry. I am an NP working with oncology patients and one paragraph into the story it was painfully obvious she had endometrial cancer that should have been diagnosed by the OB/GYN she saw initially. (Did he even do an exam? Many don’t.) She had all the classic symptoms (post-menopausal bleeding is NEVER, EVER normal) and she was also at high risk due in part to obesity. I too, have been the fat lady patient but also the healthcare provider and the obesity bias with healthcare providers is disgustingly real. If I had a dollar for every tacky comment I heard a provider make about an obese patient I’d be retired and living on an island somewhere. I am sure there have been plenty of those comments made about me behind my back when the provider left the exam room. Obesity is not a moral failing or a lack of willpower or laziness-it is a complex metabolic disorder and we are not helping patients by shaming them. Does anybody really think obese people want to be obese? Trust me, we don’t. On top of that, it is expensive and time consuming to plan healthy meals, eat well and exercise which compounds the problem for many people, particularly the working poor. This is not an excuse for people to avoid responsibility for their own actions, but hard facts that make the obesity issue even more difficult to manage for many people. You didn’t see people who weighed 400 or 500 pounds a generation or two ago. Overall, the American diet with high calorie and high fat foods (plus God only knows what other additives are in the food we eat from our water and soil) is slowly killing us all. We are not doing our obese patients any favors with ongoing lectures and may be causing more harm than good by causing them to avoid routine care and screenings that could be lifesaving. We need to work with patients to help them find interventions that work for them and not make assumptions based on our own personal bias. God bless you all and keep you well.

  • I am also a cancer victim who was fat. My symptoms were blamed on fat right up until my kidney tumor was palpable through all that fat. Had I not needed a physical for work and had the nurse practitioner I saw not decided to palpate my abdomen, I would be dead now. I had unrelenting back pain(fat), blood in my urine(unaddressed, attributed to “trauma to the urethra due to weight”), emotional lability due to cancer spreading to my adrenal gland(probably menopause or stress), shortness of breath due to my huge kidney displacing my internal organs and pressing my diaphragm into my lung on the right side(also due to weight and inactivity, though I was working full time, 12 hour shifts at times.) I respected and believed the medical professionals I saw. I believed that I just needed to work on my health. Exercise more, eat less. Problem was, I had a toddler to chase, an acre and a half of yard to maintain, a full time job as a nurse, and a host of other demanding jobs to do. I never had time to sit down and connect the dots myself. Looking back at it now, it is so very clear it makes me ache. I lost a kidney, an adrenal gland, my core strength, my job and my career because no one was willing to listen to me, and my cancer grew to stage IV before it was ever detected…accidentally. I am disabled because no one followed up and refused to believe anything could really be wrong with the fat woman looking for pity and pain medicine. Had anyone followed up, my cancer might have been found before it metastasized, and I might not worry daily that my youngest son will have to finish growing up without me.

    • An awful story that is so moving. What happens when health is supposed to be only a “personal responsibility.” And yes I am sure so clear in hindsight. You valiantly tried and didn’t get the good help you needed. Horrible! You were never the woman they branded you as and you know that now.

      Very best wishes to you . . . hope things go better than expected and while yes your worry is reasonable, hope too that you can prescind from the situation often and find frequent joys and pleasures too. But when you are not Superwoman and you can’t, that is normal too!

      I personally really like the book “Cancer Made Me a Shallower Person”. Escape is good.

  • In reading this article I felt as if I was reading an account of my daughter’s experience.She had exactly the same problem with the gynecologist and, like Jan went to another doctor too late. After surgery and chemo, Barbara also died after a short time.

  • Brought tears to my eyes. So sorry for your lose. Your sister’s story is an important one to tell. I will do my best to remember.

  • They are just as bad with other people. I’m 73. I get the senior screening, “did you fall in the last year?” Yes, I was on the trail and tripped in an exposed root. “I don’t mean that. Did you go to the emergency room?” No, I got up and went home with a scraped knee.
    I’m about 20 lbs over my optimal weight. Because I don’t have big thighs, they dont record it, even though my protruding belly is quite obvious.
    I think they are just under so much pressure to see too many patients in too short a time, that they don’t look beyond the obvious. Do you look like you’ll live and is there a drug or a surgical procedure for that.
    I feel bad for the doctors, but unless they are my age, I don’t trust how they’ve been trained. The best care I’ve had has been as a self pay, and I con’t do that unless I really have to.

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