I was sitting at the doctor’s office today getting the results of a sleep study. I have mild sleep disruption and I was given two treatment options; CPAP machine and weight loss. I looked the doctor and directly asked “is it proven that losing weight will in and of itself help my sleep apnea?”
“Well” answered this sleep apnea expert “let me explain. There are several factors that contribute to narrowing of the airway during sleep. Anatomy, like a deviated septum (which I have), chronic sinus issues (which I also have), allergies (which I also have), genetics- some people have narrow airways, larger tongues, and so forth, and weight. There are other issues that can contribute too. Can I tell you that if you lose weight your sleep apnea will go away? No, I cannot.”
That’s not a smoking gun and I am not pretending it is. What I told the doctor is that I am overcoming severely disordered eating and that it is dangerous for me to diet. I explained to her that one of the reasons I am “overweight” (which is actually a totally bullshit term anyway) is because I spent most of my life dieting. I wish her eyes were blank. Instead, I’m sure I saw her dismissing what she perceived as my line of bullshit.
Stop Prescribing Weight Loss: It May be More Harmful than you Know
I was upset on my ride home. Not because I’d been body shamed without science to support it, but because she had blindly recommended I go on a diet. She does not know my history. What if I’d battled anorexia or bulimia? What if it was severe and nearly killed me? What if it’s only been in the last five years that I’d begun eating? What if my body dysmorphia was so damaging I was suicidal? What if it took in-patient treatment and a decade to get better and I’m still fragile? What if I’d lost my job or dropped out of college because my mental health was so affected by the societally imposed and non-scientific message to “lose weight”? What If I had lots weight -I kept losing weight-and kept gaining back everything I’d lost and more (like nearly every single human who diets)?
What if I was never anorexic or bulimic or “so bad” I needed to be in-patient anywhere? What if I secretly threw up after each meal or never threw up but berated myself so badly I believed I was worthy of all the worst things in the world- because I “couldn’t lose weight?” What if I believed my morality, worth, and all sense of purpose hinged on my ability to stay at a hundred and forty two pounds for my whole life? What if I’d never been a hundred and forty two pounds as an adult?
What if I married a guy who was awful to me because I believed being a size 18 made me unworthy of being treated respectfully? What if I was stuck living a life that made me miserable -constantly trying to make up for the space I was taking up in this world by pleasing every person I laid eyes on- because I believed what the doctors, nutritionists, and magazines told me; that I am a fat, lazy slob who can’t even bother to skip the chocolate cake to save her life?
What if I was so down on myself that I did not believe I deserved to live- that I was a waste of life on this precious Earth? Then, without knowing any of that, my doctor tells me once again that my problems will be solved if I lose weight. And what if I don’t know the truth? What if I trust that they know what they are talking about?
What if I go home and that was the last straw? Maybe I marry the asshole, make myself vomit, or cut myself. Maybe I overspend hurting my financial security or eat every “fattening” food I can get my hands on to punish myself.
Doctor, Please Stop Prescribing Weight Loss Until You Know My History and Social Circumstances
Doctor, you don’t know my history. Please stop prescribing weight loss until you know my hsitory. You don’t know what I have been through. So please, before you recommend losing weight as a treatment do some research about whether or not diets work (they don’t). Do some research about whether dieting, even when “successful” keeps the weight off or makes people fatter (spoiler, it’s the latter).
Doctor, if you really care about my health care about my whole health. Care about the words you are saying to me and what they mean. If you aren not trying to shame me, get me out of your office quickly, or write me off, please consider all of me and understand that whole health has nothing to do with the number on a scale. Learn that BMI was never meant to be part of a conversation with a doctor.
Before you say such hateful and hurtful words and pretend they are about my health and wellness please know my history. Know what those words will do to me. And if you don’t know, don’t say them. Please stop prescribing weight loss without knowing my history.
Those words could -quite literally- do me in. They could alter the course of my life in a way you’d be sad to learn about. I know you think it’s the good and right thing to do -to “get me to lose weight”- and that you think patients who come in 50 pounds lighter are the success story, but I ask you to take some time to know what you are saying before you do. Learn the statistics; that 90 percent of people who lose weight gain back all the weight they lost (and often times more). Look at what Canada is doing now. Understand that if it’s my health you care about you have to consider my whole personhood before you say things that you may not understand are awful.
Please Consider this Message Before Your Next Prescription
You can dismiss this message. You will have plenty of company and rally cries. Clinicians, some nutritionists, and people in the “health and wellness” industry will come beside you to say that you are right, that losing weight is the most important thing and until that happens nothing else matters! You can justify each other’s damaging “prescriptions” easily.
Or, you can consider this request. You can trust that it comes from lived experiences, knowledge, and yes, science. Slowly, you can start to seek new information- about whether BMI is useful in healthcare, and if it’s not, how does that change terms like “overweight”? You can look into how “overweight” people fare with disease recovery (better). You can use your wonderful training and education to look at a prescription of weight loss to see first, if it does no harm. You’ll have to be ready for a paradigm shift. You’ll have to face things that you might not want to.
From a patient who has worked really hard to get better, I assure you doctor, I am worth the time it will take to learn this- just like the rest of my fellow humans.
Edited to Add: I am scheduled for surgery to fix my deviated septum this spring. My ENT thinks this is the cause of my Sleep Apnea, along with some other anatomical laryngal issues (I was born with) that hopefully won’t require fixing.Thank you so much for reading! Follow Pondering Jen on social or sign up for our newsletter to stay connected!