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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.

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“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).

  • This makes me so sad and angry. And it’s only one of multiple stories like this I have heard – the fat woman whose spinal cord cancer pain was dismissed as the ‘wear and tear’ of her weight. The fat woman whose breathing issues were dismissed as ‘You need to get more exercise,” only to lose a lung to cancer. As a fat woman myself I have taken to asking physicians who seem dismissive “what would you look into if I was a thin person with the same symptoms?” but I have the luxury of living in a large Canadian city and have options to seek other doctors if they respond badly. I hope physicians read this and examine their own prejudices and practices.

    • This is in reply to a Robert. In my case obesity was a life choice. I chose to eat poorly, and I chose not to exercise. I did this to my body. Does that mean I don’t deserve quality medical care? What about a patient with a faulty heart valve that doesn’t quit smoking? Don’t they deserve quality health care?
      What about an addict? That could be classified as a life choice. No one made them take drugs, yet everyone is trying their best to get those addicts cleaned up.
      Obesity is not a good enough reason to deny someone your best effort as a doctor. It’s not always a life choice. Sometimes it is a medical issue, and it’s not up to the doctor to prejudge which it is.

  • I have the same feelings about doctors. I could have toes hanging off my feet and lungs so congested you can hear me wheezing all over the city. But the first thing anyone wants to do when I see the doctor is weigh me.

  • I’m so sorry; your sister deserved to be treated like a rational human being. It’s inexcusable that no doctor ran tests and ruled out physical causes before brushing her issues off as just being due to her weight and age.

    That said, the medical establishment often doesn’t take women seriously, especially if you are older. I urge everyone to establish a relationship with an internist and a gynecologist as soon as possible. If you don’t like your physician’s approach or attitude, find someone else. That way if something happens you have a healthcare professional who knows you and will take you seriously. It’s especially important if you live in a city where you often have to wait a few months for an appointment.

    • Although it’s good advice to find an internist and gynecologist, it can take multiple tries. I have a high deductible health plan, and it cost me over a thousand dollars to visit several internists and find one who listened.

      I was sorry to see young doctors, fresh out of school, with patronizing comments and attitudes. I even told three young doctors that, from my perspective, the get to know you visit is an interview, and they failed, due to their attitude.

      I did finally find a good doctor, but most people cannot afford the price that goes along with this kind of search.

  • This brought tears to my eyes. I am sorry for her passing. There is malpractice done left and right. Often it is the patients who have to ask for the tests these days. These professionals are outdated and not compassionate.

  • I’m so sorry that you lost your sister. It’s my understanding that any vaginal bleeding after menopause needs to be investigated further through additional screening such as a pelvic and transvaginal ultrasound. Your story indicates that the gynecologist ignored your sister’s abnormal bleeding. I hope you follow up and as next of kin obtain her medical records. It may be worthwhile to file a complaint against the gynecologist with the state Board or perhaps, consider a malpractice claim.

  • I’m very sorry for the loss of your sister. I’m not a lawyer, but this sounds like a potentially strong medical malpractice case based upon what you’ve shared. No one should be subjected to grossly negligent medical care.

  • Dear Laura, I’m so sorry you lost your sister. Needless wasted time because of unprofessional doctors. I lost my little sister this past Valentines Day, wish she had treatment earlier too. Bless you

  • Ms Fraser, I am so sorry about your sister’s death and the suffering and stigma she experienced. Thank you for trying to help us to learn from her life and death.

  • I am sorry about your sister (we were the same age too). I had symptoms similar to your sister’s except for the weight loss. Despite being fat, was diagnosed with ovarian cysts and endometriosis, and round up having a hysterectomy at 55 after multiple cyst surgeries. Could doctors in different areas treat fat women differently? I’ve had pretty good care in the northeast (Massachusetts, Pennsylvania).

    • Nice to hear a happier story. Yes, there is still a lot of GOOD care. Thank goodness!

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