Thoughts on weight at the doctor’s office…

I saw my doctor last week for an annual physical – never a fun appointment – but even less fun than usual right now. In the aftermath of last year’s health drama, I expressed some concerns to my primary care provider about the care I’d received from their practice. I’d done some digging and found that if they had ordered certain tests sooner, or at all, there was a good chance they’d have found the mass on my ovary while it was smaller, before it would have cost me my entire reproductive system. And here’s the thing, while no one who knows me well would describe me as shy or retiring, conflict, and speaking truth to someone in an authority position in my life doesn’t come easily to me. I’ve been seeing the same physician and medical practice since I was a teenager, and my sense of her authority was only compounded by my training as a nurse to always treat doctors with respect (even when they’re wrong). We had an awkward meeting after I expressed my concerns, and then I hadn’t needed care from the practice (I get my hormones from a different practitioner) for almost a year. I was going into the appointment with some specific concerns and wondering if I would be heard.

I spent a lot of time obsessing over whether my doctor would actually listen to me, about how she’s handled certain health topics like my weight in the past, and just generally feeling anxious in the way that only someone who has experienced some recent medical trauma can understand. I also did some reading on advocating for yourself at the doctor, especially in regards to weight, BMI and health measures associated with weight. I investigated schools of thought like “health at any size” and “intuitive eating” and even made a pre-emptive appointment with a dietician who specializes in those schools of thought. I decided to try out one little tip, which was to ask that the nurse who weighs you not share your weight with you.

It started well. The nurse, though seemingly flustered by my request, said “no problem” and asked me to face away from the display on the scale. She locked in the weight and my height, and had me step off the scale. She then immediately directed my attention to the numbers, saying “this is your height and this is your weight.” Whoops. She didn’t notice that she’d just done the exact opposite of what I’d asked, and took me back into the exam room.

Next was blood pressure and pulse. In the last year or two my anxiety around medical appointments has skyrocketed, and my blood pressure and pulse at these appointments always reflects that. The nurse chided me for having “white coat syndrome”, asking why I was nervous because the doctors here were so nice. I explained that I’d had some bad experiences with the clinic and she asked me to clarify. I explained that because of lack of testing her beloved doctors had missed a tumor until it was so big that it had spread, and removing it meant a complete hysterectomy. She left, and the doctor herself came in.

We reviewed the things I was concerned about, and the questions I had, first and foremost about follow-up care and monitoring for future cancers, especially given that the hormones I take do somewhat increase my risk of breast cancer long term. I also told her that I wanted her to check, but I was 99% certain that I’d developed an incisional hernia where my incision from my surgery last summer never healed properly.

It was all well and good, until we got to the annual lecture about weight, diet, and exercise. Here’s the thing, I’m a registered nurse, and I’m quite well educated in what lab values mean. I’m also pretty educated about what makes up a healthy diet, and the importance of exercise. She could have simply told me she was concerned about a couple of things in my lab work, made a brief statement about the value of exercise, and left it there. But she didn’t.

Instead I got the full meal deal lecture. The same one I’ve gotten every time I’ve seen her since I was a teenager. I get it. I’m heavier than she would like. Frankly, I’m heavier than I would like. However, I’m also aware that I’ve just come out of three of the hardest years of my life health-wise, first with a two-year long major depressive episode, and then with the tumor, and subsequent two major surgeries and recoveries last year. I’m also aware that I take no less than four medications which all have weight gain and increased appetite as a side-effect. But I can’t say those things to her, because historically she doesn’t hear them. She’s a tall, skinny woman who went on a cycling trip around Europe for a summer vacation last year. Basically my polar opposite.

She asked why I don’t exercise much. I said, “I hate it.” She said, “Really? There must be something you like, what about doing one of those zumba classes?”

(Reader, I cannot express to you the horror I feel at shaking my jiggly, non-rhythmic midsection about in a room full of strangers at a zumba class!)

The kicker, this year, was that the lecture to exercise more and lose weight came AFTER she diagnosed me with a large incisional hernia. A hernia that will require surgical repair, likely more than a year from now, given current wait lists. A hernia that restricts my ability to do core exercises, any sort of heavy lifting, and is already causing discomfort when I walk. When I pointed this out to to her, she stuttered and started suggesting ways I could spend money I don’t really have right now on exercise that might work. Emphasis on might.

And here’s the thing, while I hate exercise, I’ve been slowly contemplating and getting ready to introduce more movement to my life. And then the hernia popped out fully a few weeks ago and starting causing achy and sometimes even sharp, painful discomfort. I don’t want to be a statistic of heart disease and diabetes, which I know is my doctor’s concern, but I’m also feeling flummoxed by the reality of my current place in time with my body the way it is. I’m looking forward to meeting with a health at any size and intuitive eating dietician coming up soon, and working with her and my therapist on some issues around food and satiation in my life.

Honestly, I know myself pretty well, and I can typically manage to work at change and or self-discipline in one area of my life at a time. I’m not a tackle things on many fronts kind of gal. I just wish my doctor would let me express some of those things, rather than giving a rather tone deaf lecture that displays her bias against ideas like “health at any size.”

Because that’s my goal – to be healthy. I want to be around to see my nieces and nephews have get married and have babies. I’m okay with whatever body shape gets me there, in a way that lets me play with those grand-nieces and nephews. For now, I’ll work on my diet and explore my relationship with food. I’ll include movement where I’m able, but I’m not going to focus too much on that at this time. And I guess I’ll continue to work on my ability to advocate well for myself, rather than feeling cowed by my doctor’s authority. I’ll get my chance to practice that one soon – I have a follow-up appointment in about a week and a half to discuss some tests I had done or need to have done, and the surgical waiting times for the hernia repair.

I want to close by sharing that in the last year I’ve been thinking, learning and reading a lot about what it means to be comfortable in my own body. Writers like Shannon Evans, Hillary Mcbride, and Jess Connolly have been my teachers from afar. I think about things like not dissociating from my body, not buying into patriarchal definitions of beauty, not sucking in my belly just to look skinnier, finding the definition of health that works for my body, rather than trying to make my curves fit into a skinny woman’s world. I think about the woman in my life who pays me a compliment by calling my curls “mermaid hair”. I think about the fact that I gain weight like a pregnant woman, and I think about how it felt to be asked if I was pregnant at a friend’s baby shower, because I was cradling my round belly to support my tender hysterectomy incision. I’ve slowly started to fall in love with this faulty, at times broken, body I’ve been given, and to name it beautiful. I’m thinking more about exercise and movement because I’m thinking about stewarding the gift of a relatively healthy body well. And I’m thinking continually about what it means to be called beautiful, simply because I am created in the image of a marvellous creator.