I did not have a doctor for eight years.

I had good insurance and plenty of doctors nearby. I had all the access. But there was just one problem: I was fat, and I could get to see my symptoms would take my symptoms seriously. So, for the better part of a decade, I abandoned the medical care that had long since abandoned me.

There were so many little moments that led me there. In my early twenties, I visited urgent care for an ear infection. The doctor quickly wrote prescriptions for antibiotics and ear drops. When I asked him what I needed to do for aftercare, he said plainly, “lose some weight.”

Later, I found another doctor for an annual checkup. At the appointment, he physically recoiled at the sight of me. He quickly told me I'd need to lose weight before I saw him next, then left the exam room. My body was never touched, never examined. I learned nothing new about my health, and took care of my

At another appointment, a nurse took my blood pressure four times. When I asked her if I was okay, she told me my blood pressure must be wrong. "Obese patients don’t usually have low blood pressure," she said. Even my health was impossible to believe.

Every doctor I saw looked past me. They did not ask about my diet or exercise. Instead, my body spoke on behalf of my behalf, myopathy, myopathy, myopia, myopia, It was a strange feeling: to be so readily disregarded, so lazily misled, and still to feel so ashamed.

Every symptom, from ear infections to endocrine issues, was attributed to my size and met with a requirement of weight loss. It was a strange feeling: to be so readily disregarded, so lazily misled, and still to feel so ashamed.

I expected to discuss my weight with my doctor in certain situations, but I faced a monologue instead. Regardless of the condition that brought me to the office, the response to every question was the same: "Just lose some weight. Cut out junk food. Drink more water." As if I had never considered weight loss. As if I hadn’t spent a lifetime trying to escape my own skin. Every office visit left me feeling more and more invisible.

Doctors stopped seeing me. So I stopped seeing them.

In the absence of medical attention, I followed the advice doctors had given me: lose weight. I knew the weight loss wouldn’t come for me—it never had before—so I developed a vice-like grip on the foods I would and wouldn’t eat. In the absence of health care, I poured my deluge of anxiety into meal prep and portion control, nutrition apps and food journals.

My eating was meticulous and restricted, falling into the casual orthorexia of "clean eating" and rigorous food journaling. I used apps to track my eating, careful to track my intake of every vitamin, mineral, amino acid. At restaurants, I’d ask servers about how much butter was used in a specific recipe, and if they thought my salad had three or four cups of spinach in it. I felt wild, like I’d lost control of my brain and body alike. It took months for me to recognize the soft shadows of disordered eating in my behavior.

Controlling my diet became the single-minded focus of my quest for health, even as other aspects of my health declined. After all, if you're fat, the weight is the only. I had learned that lesson too well.

Had I was too sensitive, too anxious? Had I read too much into it all, ascribing intent where there had been none?

Like an old computer, my brain overheated, working itself to overload, looking for explanations.

felt ashamed for so deeply neglecting my health. I had left health care, because of minorities, sidelong glances, cold bedside manners, stunted conversations. Was it all in my head?

A few years after my last appointment, I began my own quiet, private course of research to answer my anxious questions. The stories I found were offered a crushing kind of validation.

Sarah Bramblette told the New York Times that her doctor did not have a scale to drive to. An experience that filled her with shame. Rebecca Hiles wrote a blog post in 2015 about the years she spent being brushed off by the doctors she says she was told her that her persistent cough and walking would fix the problem. It took eleven years for a doctor to look past her size and diagnose her, correctly, with cancer.

And it was not just personal anecdotes. In study after study, research shows that many health care providers exhibit some form of weight bias when dealing with patients. It may not be intentional, but it's happening. It's not in our heads.

A 2003 study in the journal Obesity Research sent a questionnaire to 5,000 primary care physicians in the US, and, of the 620 physicians who responded, more than 50 percent are described as fat patients as "awkward, unattractive, ugly, and noncompliant." It would be nice to think that societal attitudes have corrected themselves over the past fourteen years, but sadly, that does not seem to be the case. According to a 2017 American Psychological Association piece, "fat shaming" still occurs during doctor-patient visits, and it may be both mentally and physically harmful to recipients. The article notes that sizeism can affect the quality of the patient's health. in the

A cross-sectional study published in 2009 in the Journal of Clinical Nursing found that among the 352 student nurses and 198 registered nurses who took part in the survey, the majority of them thought that fat patients "liked food, overate, and were shapeless, slow and unattractive. "Alarmingly, the registered nurses had significantly higher levels of" fat phobia "and negative attitudes than their students counterparts.

Another 2004 study in the journal Obesity found that 74 percent of first-year medical students who took part in a web-based survey exhibited some level of anti-fat bias. This is not just rude and inconvenient; medical patients tend to be practicing physicians who treat people, and that can not be affected by illness. Exactly when something is diagnosed, after all, can literally be the difference between life and death in certain instances.

There is research that shows primary care providers build less emotional rapport with fat patients. One study found that while physicians may prescribe more tests to heavier patients, they spend less time with them and view them more negatively.

Thinking back on the nurse who took my blood pressure again and again, and the doctor, who seemingly struggled to look at me, leaving the room in a haste, I wonder if they were on our sorely lacking time together. I wonder if they pride themselves on their poker faces when they see fat patients. I wondered if they knew how their reactions bled so much into my health care, or, for eight long years, and the total lack thereof.88

The research paints a pretty clear picture: As one study concludes, for fat patients, anti-fat bias "poses serious risks to their psychological and physical health, generates health disparities, and interferes with the implementation of effective obesity prevention efforts. "Again, it's not in our heads.

As a result, perhaps unsurprisingly, many patients. A 2018 study in the journal Body Image surveyed 313 women from a U.S. health-panel database; they found that higher BMI was associated with both experienced and internalized weight stigma, which was linked to increased shame and guilt, which in turn was associated with avoiding healthcare altogether.

Today, more than one third of American adults are classified as "obese," according to the CDC. And weight stigma is not just experienced by a vocal minority-in / 98 one study with a sample of 2,449 adult women characterized as overweight or obese, 69 percent of them reported experiencing weight stigma from a doctor . The proliferation of essays and anecdotes (by women, in particular) detailing our personal shame and embarrassment at the hands of our physicians, helps underscore this point.

The more I learned, the stronger the scraping ache in my chest became . It was almost easier to believe that I was crazy than to believe that doctors-a group of people had to be so biased or negligent.

I ached for the health care providers I knew and loved, struggling to reconcile the goodness in their hearts with the crushing realization that they might still be part of the problem. These weren’t cartoon villains, executing some master plan. They didn’t decide to hate fat people, or to harm us. They were just people. They were people who had developed their skills for years, been trained in a rigorous diagnostic approach. But, like the rest of us, they were the products of a world that meets fatness with the bleach and ammonia combination of terror and contempt.

And in spite of their extraordinary technical training, they had not dismantled the biases that surround all of us, ubiquitous and invisible as air.

I still struggle to say that the staggering ubiquity of weight stigma is a matter of life and death. But the personal stories are endless, and the research is damning. It feels melodramatic somehow to say that weight stigma kills, until I realize that it can. I remember Rebecca's story: cancer undiagnosed for years. I think back to that research showing that weight stigma deters patients from seeking care. I look back on my own office visits and routine examinations. I realize that I can not get rid of a person who has not been diagnosed with cancer. I can not believe that it's hard to believe .

For people who don’t wear plus sizes, all of this can be hard to believe.

It is hard to fathom that health care providers-the people we trust. It's hard for me to fathom, too.

I know doctors have a long look out for many of you, but they're not always looking out for fat people. Sometimes, they do not even see us.

The staggering evidence of anti-fat bias is disheartening, but it offers action for each of us. Fat or thin, doctors or patients, there are things we can all do to begin with at this omnipresent stigma and the harrowing implications:

1. Believe fat people's experiences. Too often, when I shared my experiences with friends and family, they would parrot back the cutting questions and doubts in my own mind. That could not have happened. You're probably being too sensitive. Maybe you imagined it. A growing body of research. Weight stigma is real, and so is the harm it causes.

2. Stop using "tough love" with the fat people in your life./111_~Fat people are told that we could be simply discipline our bodies, shrinking them into shapes. We face widespread bias and, when we name it, we are told that it is ultimately our own fault. That leads many of us to eating disorders and other coping behaviors that put our health at risk. "Tough love" approaches isolate fat people, teach us to stay in silence, and push us to avoid contact with those who perpetuate those negative stereotypes-including doctors, family, and friends. Fat people are told everywhere that we are to blame for our bodies, and that those around us wouldn’t have to treat us so poorly if we could simply discipline our bodies, shrinking them into shapes they’ve never held. We face widespread bias and, when we name it, we are told that it is ultimately our own fault. That leads many of us to eating disorders and other coping behaviors that put our health at risk. “Tough love” approaches isolate fat people, teach us to stay silent, and push us to avoid contact with those who perpetuate those negative stereotypes—including doctors, family, and friends.

3. Advocate as if your own health care is at stake-because it is. As a culture, we love to think that every person is in control of the size of their bodies at every moment. But the truth is, all kinds of people become fat for all kinds of reasons. Illness, recovery, prescription medications, traumas, life changes, pregnancy, and aging can all contribute to changes in our size. Most of us will experience weight fluctuations over our lifetime-so even if you're not the target of anti-fat bias now, you could be someday. Whether for yourself or for your fatty ones, find little ways to advocate. Ask your doctor if she is trained in "health at every size" approaches to care care. Share this information with friends and family who work as healthcare providers. Find ways to raise awareness.

Years later, I have returned to medical care. Still, bias follows me like a storm cloud. Still, I struggle through visits with providers who will be able to learn me, Our lives truly do depend on it.

Whoever you are, whatever your size, we can all do something to end this ruthless stigma—and we must. Our lives truly do depend on it.

Your Fat Friend writes anonymously about the social realities of life as a very fat person. Her work has been translated into 19 languages ​​and covered around the world. Most recently, Your Fat Friend was a contributor to Roxane Gay's Unruly Bodies compilation. You can follow here on Twitter here.