Size Obsessed: On Western Medicine’s Fetish With Weight
Photo Credit: Chris Abatzis
It starts with blood. Doesn’t it always?
Not a little blood, either, but the kind of blood loss that leaves a body exhausted and iron-depleted. Complete with cramps forcing you to call in sick from school and lie in bed doubled over in pain, curled against a heating pad, crying.
It starts with your trust in the medical establishment, with the belief that if you can just talk to a doctor, you’ll understand why your own body betrayed you. Instead, it starts with a doctor who doesn’t take notes, who doesn’t order tests. It starts with a doctor who looks you up and down and simply states, “You need to lose weight.”
Your periods are heavy because you are heavy. The doctors don’t want to test you because to them, losing weight is the only medicine you need. They repeat it so often and so loudly, you eventually believe them. And you go on diet after diet: restricted calories, eating nothing but cabbage soup for weeks on end, 800-calorie diets, coffee diets, Southbeach, no-carb, low-carb, no-food.
And you lose weight. So much weight. Only to gain it all back. Repeat, repeat, repeat until you see yourself as nothing but a failure, the sole responsibility for all the problems in your body.
Your metabolism goes out of whack, your thyroid stops working, you end up with critically low iron which renders you bedridden and still, the doctors say, “Well, maybe if you lost some weight.”
Or maybe not.
Maybe the doctor looks you up and down and says, “You need to gain weight.”
That you bleed all the time because you are too thin, despite having put on weight after decades of being the same size. Your doctors make up a term called “skinny PCOS” to explain it away and slap you on more birth control pills. There’s no further explanation required.
“A culture fixated on size as privilege will ostracize outliers first, then insiders.”
Then your digestion goes on the fritz. Your gut bloats from all manner of foods that were once friends, your stomach ballooning outward. Restriction begins, not from a desire to be thinner, but from a subconscious fear of losing thin privilege. Of looking pregnant as a consciously child-free woman. The body dysmorphia takes hold.
But restriction has a way of sneaking its tendrils into your mind; suddenly, you’re in the bathtub, the warm water confusing your stomach, eating a full pint of ice cream on your own. Crawling out, the weight of the sugar, chocolate, and chunks (why always chunks) pulls you to the floor, body betrayal, tears and fright.
Your doctor inspects your stool, tests your blood, and tells you what every other doctor has said: you’re too thin.
Instead of getting mad, instead of righteous indignation, you believe them. Too fat. Too skinny. You believe them because, in a twisted way, it makes sense.
When you hear weight so often scapegoated, you internalize it and misuse it. When Veronica broke her ankle, she began to fear her bones were frail because she’s always been ‘too thin.’ Was the break somehow her fault?
When Finnian couldn’t get out of bed because every step felt like torture, because they were too exhausted to do more than the bare minimum of daily care, they thought it was their fault. Finnian had undiagnosed thyroid diseases and critically low iron levels. But they believed the doctors who told them they’d be fine if they just lost weight. Maybe the doctors were right. Maybe their body was being punished because of its size.
For Veronica, clothes, medical devices, and medical dosages are typically too big — but she can’t complain about it because it will be perceived as bragging. Real discomfort masked by a single-minded society obsessed with a sexual ideal.
For Finnian, medical devices and dosages, clothing and seating are typically too small — but they can’t complain about it because asking for accessibility as a large person means inviting abuse in the form of admonishments to just lose weight.
As Ellen on TikTok indicates, when overweight, being out of breath is associated with your weight because your doctors constantly say so. This belief nearly killed her boyfriend when he was, in fact, out of breath due to a heart attack in progress.
And Ellen Maud Bennett died because doctors attributed her chronic pain to fatness, a gross oversight that meant Bennett had no chance of surviving her cancer. By the time someone finally took her seriously, it was too late.
This isn’t a journey toward health. This is a journey of learning to dismiss asshole doctors who see only size. This is a journey of standing up for oneself in silence.
We live in a power struggle. Veronica and Finn both hear the same from their doctors — weight comes first. It’s not about body size. It’s about policing people, especially FLINTA*, BIPOC, and disabled people.
A culture fixated on size as privilege will ostracize outliers first, then insiders. The scales of privilege focus on the smallest detail. Every body is under the magnifying glass. Nothing is ever good enough, not even slowly dying to be ‘perfect.’
Eating disorders are often dismissed in FLINTA* folks because of body size — thin women are often seen as doing something good for themselves because they are becoming more palatable to the societal gaze. Treatment is often delayed until they reach a critical point that falls outside of the societal ideal. Conversely, fat women are regularly dismissed as not having eating disorders, because if the damaging behavior is causing weight loss, it is seen as a good thing at all costs.
Make no mistake — this is a war on our bodies and only the most adamant effort of acceptance and self-championing will offer protection from the continuous onslaught.
Today, Veronica gives a doctor one shot before dismissing them. Her health deserves to be taken seriously the first time. More time invested in a dismissive doctor will not change their mind. Good care comes from you, first. No one will stand up for you like you can. No one will rescue you like you can. Becoming her own fiercest protector was the greatest lesson Veronica ever learned.
Today, after years of fighting to be heard by dismissive doctors, Finn is blessed with a primary care doctor who treats the total person, not the number on the scale. Because of this, their health has improved drastically — their thyroid is functioning normally, iron levels even, and they move through their days with energy and joy. This monumental increase in health and vitality came not from losing weight, but from the standard of care every person deserves from the medical establishment.
We’ve both survived the lifelong battles with the medical establishment that led to more severe health problems, mental health challenges, and years of recovery. And we’ve learned about self-advocating, caring for ourselves, and learning how to speak when no one else will speak for us.
But we shouldn’t have had to scrape and scratch our way to this understanding. Compassionate medical care shouldn’t come at the cost of chronic pain, mental health challenges, and self-sacrifice. People shouldn’t have to die to make doctors listen. Change must begin at the root — in medical schools, in internships, in the language of intake forms, in diagnoses, and with every time you say, ‘No, you cannot treat me this way.’
What To Do if Your Doctors Won’t Listen
If you’ve faced body-related discrimination in healthcare, we believe you. You aren’t alone and you are not the problem. Below are a few ways to protect yourself and contribute to changing the system:
Document everything.
Take notes during the appointment. Ask your provider directly, “Are you refusing to test me for illness because of my weight?” Right down their answer. This helps you remember what happened, but it also puts them in the position of having to state the truth — that they are discriminating based on your size. The system will only change when faced with its own dark truth.
Know your rights.
In many places, you have the right to file a complaint with your official medical board. This may different from country to country, so search “medical complaint board” in your area for more information.
Bring support, if you can.
Ask a friend or a family member to accompany you to appointments. Repeated discrimination can send one into fight/flight/freeze/appease, reducing your ability to process what is happening in each session. An advocate will help you document the consultation and identify any red (or green) flags.
Get educated.
Look into the Health at Every Size (HAES) movement where an entire network exists to help people find quality healthcare, whatever they weigh.
You don’t have to do this alone. None of us do. Supportive communities exist to help you navigate this ongoing battle, to remind you that you deserve to be treated as a whole human being, and to pressure providers to do better.
Because everyone deserves medical care that isn’t earned through a lifelong war.
Because we shouldn’t have to wear the scars to prove we’re worthy of health.
Because we deserve more than painful survival. We deserve care.