By age 18, my knees hurt. I didn’t know why, and they didn’t hurt a lot, but they did hurt a bit most of the time. As someone who took a lot of dance classes and played my share of netball, it was annoying, but not something I thought much about. After all, I reckoned, bad knees run in my family. But by age 20, the pain had gone from a bit annoying to definitely annoying. I decided, for the first time, to see a doctor about it.
She was a brisk woman with close-cropped grey hair, who glanced at me and told me my knee pain was due to early-onset arthritis as a result of my being overweight. My blood tests were negative for rheumatoid arthritis — but that didn’t matter, she told me. The only way to stop my pain from getting worse was by losing weight. So with the resigned sigh of anyone who has grown up fat, I accepted my fate. I was arthritic, at 20.
By 22, things were worse. My knees had gone from hurting a bit most of the time to spontaneously collapsing in blinding pain while I was doing innocuous activities like walking down the street. I went back to the doctor — a different one, because I just saw whoever was available at the student clinic. He asked me about my pre-existing medical conditions. I explained that my arthritis was a result of being overweight. He looked at me incredulously. “That’s not a thing.” No one gets non-rheumatoid arthritis in their twenties as a result of being overweight, he explained.
Instead, he decided we should figure out exactly why my knees were spontaneously collapsing. He sent me for an MRI, and I had a consultation with a specialist surgeon. “Patellae chondromalacia,” the surgeon declared. He showed me the shadows on my scan, which indicated rough patches on my knee caps. It was probably hereditary, exacerbated by my weight.
“Ok,” I said. “So what can I do about it?”
“You’re just going to have to manage the pain,” he explained. “And once it gets to be too much, you’re going to need your knees replaced. And that will probably be before you’re 30.”
[quote position="full" is_quote="true"]I had eight years before I turned 30. It felt a bit like a death sentence.[/quote]
Resigned, I accepted my diagnosis. I said goodbye to yoga and dance, which aggravated the condition, and started wondering about how much two new knees might cost, and how I’d get around on crutches. I had eight years before I turned 30. It felt a bit like a death sentence.
At 24, my new housemate decided she was joining our local gym, and in a moment of optimism, I decided to go with her. This gym offered a free short session with one of their personal trainers to help newbies learn the ropes. “I’ll put you with Hao,” the receptionist said. “He’s got a physio background; he’s good with injuries.”
Hao was intimidating — really tall, super buff, thick Chinese accent that was hard to understand at first. “It says here you’ve got an injury,” he told me. “What is it?”
“I’ve got patellae chondromalacia in both knees,” I replied. “It’s-“
“Oh that,” he said, interrupting me. “I can fix that.”
What?
Hao explained to me that what I had was a pretty standard sporting injury that is usually treated successfully using exercise — a fact that none of my doctors had mentioned. I’d probably injured myself as a result of all that dance and netball I did as a teenager, and it might have been exacerbated by my family history of dodgy knees. It’s normally caught early and treated early — it’s very rare for it to get to the point of causing knees to collapse, but that can happen in serious cases with no treatment. “Work with me for 10 sessions,” said Hao. “If you don’t notice a difference, I’ll give you your money back.”
Well, after 10 sessions I noticed a pretty significant difference. After six months, the pain that had plagued me for six years was entirely gone.
[quote position="full" is_quote="true"]When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl .[/quote]
I can’t help but think that there’s a whole lot of physical pain I could have avoided if any of the medical professionals I saw had considered the fact that I might have a sporting injury. And I can’t help but wonder if the reason they didn’t has to do with my weight.
When doctors looked at me, they didn’t see a girl who danced, cycled, and played team sports. They saw a fat girl — and they based their diagnosis on stereotypes about what that meant. I’m 29 now, and my knees no longer hurt. I don’t need to have them replaced — but if I’d listened to the weight-prejudiced opinions of my doctors, I might have.
This story is hardly unique.
Research shows that doctors have less respect for patients with higher body-mass indexes, which can lower the quality of care those patients receive. As one study put it:
“Many health care providers hold strong negative attitudes and stereotypes about people with obesity. There is considerable evidence that such attitudes influence person-perceptions, judgment, interpersonal behavior, and decision-making. These attitudes may impact the care they provide.”
Troublingly, many of the ideas that doctors have about fat patients aren’t even grounded in medical fact. Indeed, too often it’s forgotten that the science around weight loss and health isn’t all that settled. Does excess weight cause you to live a shorter life? Maybe, maybe not. Countless studies by BMI category have found that overweight people actually have lower rates of all-cause mortality than normal weight people.
Some researchers think that if you adjust for the increased risks caused by weight cycling (aka. yo-yo dieting) and dangerous weight-loss drugs, you’d find the same mortality rates for normal, overweight, and obese people — yes, even very obese people. And even without the adjustments, the increased risk for very obese people is only small — not the “you’ll be dead before you’re 30” nonsense often pedaled by purveyors of weight-loss surgeries.
What about serious disease? There’s certainly a correlation between being overweight and some diseases, but multiple studies suggest that the weight might actually be a symptom rather than a cause.
Then there’s the idea that excess tissue “strains” the body. Eminent obesity researcher Dr. Paul Ernsberger has been quoted as saying, “The idea that fat strains the heart has no scientific basis. As far as I can tell, the idea comes from diet books, not scientific books . . . Unfortunately, some doctors read diet books.”
[quote position="full" is_quote="true"]So why, then, do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?[/quote]
What about dieting? Well, there actually is some scientific consensus there : Diets don’t lead to lasting weight loss—not even if you call them lifestyle changes. After an extensive metastudy of diet and weight loss studies, Dr Traci Mann concluded, “The benefits of dieting are simply too small and the potential harms of dieting are too large for it to be recommended as a safe and effective treatment for obesity.”
So why, then, do doctors insist on prescribing diets and weight loss as a treatment for anything and everything?
Sarah, 29 from Newcastle, Australia, had the misfortune of breaking both legs as a teenager, the result of a freak accident involving her legs falling asleep and then getting twisted to the point of breaking. Not long after learning how to walk again, she was involved in a serious car accident that left her with further damage to her legs. “I’m accident-prone,” she laughs. The multiple injuries have left Sarah with a build up of scar tissue that can make walking painful. But when she went to the doctor, her pain was blamed on her weight.
“My weight is a factor in the healing process,” she says, “But it wasn’t the cause of my injuries — and I’ve got police reports, x-rays, and specialist reports to prove it.”
Sarah changed doctors recently, and her new doctor decided to do a full medical history, checking the notes from all the physicians Sarah has seen. What she found shocked her. “She said there’s no record of my injuries with most of my previous doctors,” Sarah said. “They all had written that my leg pain was caused solely by my weight, and that meant I wasn’t getting any useful treatment for the pain. They just told me to diet.” Sarah’s new doctor promptly started her on a physical treatment plan designed for someone with compound injuries and severe internal scarring.
The difference has been immediate.
“Within two weeks I could walk nearly five kilometers. Before I started the treatment, I could only manage one kilometer or less before my knees were so swollen and painful that I couldn’t keep going,” said Sarah. “Getting actual treatment for my injuries, rather than just being told to lose weight and see what happens, has changed everything.”
Just to be clear, I’m not saying that eating healthily and exercising aren’t good for you. The problem is when doctors prescribe diets and weight loss to patients without fully considering their symptoms and other treatment options.
Stigmatization may also, problematically, stop fat people from seeking out medical care in the first place.
“I just don’t go to the doctor,” says Anita, a 28-year-old advertising executive. The last time Anita saw a doctor, it was a routine visit to discuss vaccinations and antimalarial medication for an upcoming overseas trip. The doctor prescribed the vaccines and asked a nurse to administer the jabs. It was the nurse who decided Anita had diabetes — without having spoken to her, or seeing anything pertaining to her medical history.
“He kept saying I would get a discount on the vaccines if I registered my diabetes,” Anita explained. “I haven’t got diabetes, but he wouldn’t listen. His whole attitude was like, ‘You know you’re fat, right?’ Um, yeah, I’ve noticed that, actually. Just give me the jabs.” The experience was pretty upsetting, and left Anita firmer in her resolve to avoid doctors wherever possible.
Still, Anita, Sarah, and I are relatively lucky; our experiences have caused us pain and humiliation, but no permanent damage. This is not true for everyone.
First Do No Harm is a website that chronicles the experiences of fat people with medical professionals — and it’s filled with harrowing stories.
One woman lost a lot of weight suddenly and was praised for it — with doctors missing the fact that it was a sign of the cancer that shortly killed her.
A man vomited constantly due to multiple sclerosis, but instead of viewing that as a medical red flag, doctors simply celebrated the 120-pound weight loss it caused. The vomiting led to permanent nerve damage, back pain, and tooth decay.
A woman had an emergency doctor declare that she didn’t need treatment for abdominal swelling after a serious car accident because she was just fat. She nearly died.
A woman went years just being told to lose weight to address her ongoing, multiple health problems. It turns out she has a rare neurological disorder; the diagnosis delay has led to permanent brain damage.
There’s another trove of awful stories on fat prejudice here. And of course Google’s got plenty more.
[quote position="full" is_quote="true"]Hormonal problems? Lose weight. Broken finger? Lose weight. Migraines? Lose weight.[/quote]
A consistent narrative runs throughout these stories. Hormonal problems? Lose weight. Broken finger? Lose weight. Migraines? Lose weight. Losing weight is the consistent — sometimes only — treatment offered for every ailment imaginable.
For many, changing the narrative around weight is literally a matter of life or death. So what can be done to address the problem?
The good news is that there’s some recognition within the medical profession that this is a serious issue which must be addressed. It’s been noted that medical students don’t receive nearly enough training on obesity, and efforts are beginning to try to change that. Researchers are also working on empathy programs and raising awareness about the impact of implicit bias against patients. All of this is a promising start.
At the same time, we can all become our own health advocates. If you’re a fat person, or someone you care about is a fat person, you can develop your critical thinking skills and challenge the classic “just lose weight” prescription if it doesn’t seem to fit the symptoms.
This isn’t easy. There’s an implicit power imbalance between patient and doctor that makes challenging their statements very difficult. By working to become experts on our own health and our own situation, we stand a better chance of being able to call out something that doesn’t feel right.
Doctors are highly educated people, but they’re subject to the same biases as the rest of us, and many of them don’t stay up to date with the latest research. That’s not good enough. If obesity really is a major health concern, it’s essential that doctors stay educated on recent studies and metastudies that look at how to get the best outcomes for fat patients. If doctors really do care about their patients, they need to start looking at the overall picture of a person’s health, not simply the size of their body.
Most of all, doctors need to stop prescribing a treatment that’s proven not to work for conditions that don’t warrant that treatment in the first place.
The medical profession needs to step up. It needs to accept that diets aren’t the universal treatment option for fat people. It needs to accept that fatness isn’t the universal cause of ill health in fat people. It needs to engage with the very real damage caused by its attitudes toward fat people, and with the substandard care delivered to many people as a result of their size.
It’s not exaggerating to say that lives depend on it.
This piece is published in partnership with The Establishment.
Ultrasound of human baby.Image via 
IVF animated process.Image via 
A couple speaks with a fertility professional.Image via 
Love, Mom.Photo from Heidi Johnson 
A teen boy having a hard time. 
Hands hold a digital representation of the brain.Image via 
Mother and daughter work a puzzle.Image via 
Man and woman connect under the sunshine.Image via 
The obituary paints a comic, if bleak, picture. 
A Facebook post about the obituary.
Why do some folks use social media but don't engage?
Psychologist says people who never comment on social media share these 5 positive traits
For over 20 years, social media has developed into a staple in many people’s day-to-day lives. Whether it’s to keep in communication with friends and family, following the thoughts of celebrities, or watching cat videos while sipping your morning coffee, there seem to be two types of social media users: commenters and lurkers.
The term “lurker” sounds equally mysterious and insidious, with some social media users writing them off as non-participants at best or voyeurs at worst. However, mindfulness expert Lachlan Brown believes these non-commenters have some very psychologically positive and healthy traits. Let’s take a look at how each one of these traits could be beneficial and see how fruitful lurking might be even though it can drive content creators crazy.
1. Cautious about vulnerability
Consciously or not, making a post online or commenting on one puts you and your words out there. It’s a statement that everyone can see, even if it’s as simple as clicking “like.” Doing so opens yourself up to judgment, with all the good, bad, and potential misinterpretation that comes with it. Non-commenters would rather not open themselves up to that.
These silent users are connected to a concept of self-protection by simply not engaging. By just scrolling past posts or just reading/watching them without commentary, they’re preventing themselves from any downsides of sharing an opinion such as rejection, misunderstanding, or embarrassment. They also have more control on how much of themselves they’re willing to reveal to the general public, and tend to be more open face-to-face or during one-on-one/one-on-few private chats or DMs. This can be seen as a healthy boundary and prevents unnecessary exposure.
Considering many comment sections, especially involving political topics, are meant to stir negative emotional responses to increase engagement, being extra mindful about where, when, and what you comment might not be a bad idea. They might not even take the engagement bait at all. Or if they see a friend of theirs post something vulnerable, they feel more motivated to engage with them personally one-on-one rather than use social media to publicly check in on them.
2. Analytical and reflective mindset
How many times have you gone onto Reddit, YouTube, or any other site and just skimmed past comments that are just different versions of “yes, and,” “no, but,” or “yes, but”? Or the ever insightful, formerly popular comment “First!” in a thread? These silent browsers lean against adding to such noise unless they have some valid and thoughtful contribution (if they bother to comment period).
These non-posters are likely wired on reflective thinking rather than their initial intuition. Not to say that all those who comment aren’t thoughtful, but many tend to react quickly and comment based on their initial feelings rather than absorbing the information, thinking it over, researching or testing their belief, and then posting it. For "lurkers," it could by their very nature to just do all of that and not post it at all, or share their thoughts and findings privately with a friend. All in all, it’s a preference of substance over speed.
3. High sense of self-awareness
Carried over from the first two listed traits, these silent social media users incorporate their concern over their vulnerability and their reflective mindset into digital self-awareness. They know what triggers responses out of them and what causes them to engage in impulsive behavior. It could be that they have engaged with a troll in the past and felt foolish. Or that they just felt sad after a post or got into an unnecessary argument that impacted them offline. By knowing themselves and seeing what’s being discussed, they choose to weigh their words carefully or just not participate at all. It’s a form of self-preservation through restraint.
4. Prefer to observe rather than perform
Some folks treat social media as information, entertainment, or a mix of both, and commenting can feel like they’re yelling at the TV, clapping alone in a movie theater when the credits roll, or yelling “That’s not true!” to a news anchor that will never hear them. But contrary to that, social media is a place where those yells, claps, and accusations can be seen and get a response. By its design, social media is considered by experts and the media as performative, regardless of whether it is positive or negative. Taking all of the previously mentioned traits into account, one can see why they would prefer to “observe the play” rather than get up on the stage of Facebook or X.
On top of that, these non-commenters could be using social media differently than those who choose to fully engage with it. Using this type of navigation, there may be nothing for them to comment about. Some commenters are even vying for this for their mental health. There are articles about how to better curate your social media feeds and manipulate algorithms to create a better social media experience to avoid unnecessary conflict or mentally tiring debate.
If you go on a blocking spree on all of your accounts and just follow the posters that boost you, it could turn your social media into a nice part of your routine as you mainly engage with others face-to-face or privately. In terms of commenting, if your curated Instagram is just following cute dogs and all you have to offer for a comment is “cute dog,” you might just enjoy the picture and then move on with your day rather than join in the noise. These non-commenters aren’t in the show and they’re fine with it.
5. Less motivated by social validation
The last trait that Brown showcases is that social media users who browse without posting tend to be independent from external validation, at least online. Social media is built to grow through feedback loops such as awarding likes, shares, and reposts of your content along with notifications letting you know that a new person follows you or wants to connect. This can lead many people to connect their activity on social media with their sense of self worth, especially with adolescents who are still figuring out their place in the world and have still-developing brains.
Engaging in social media via likes, shares, comments, and posts rewards our brains by having them release dopamine, which makes us feel good and can easily become addictive. For whatever reason, non-commenters don’t rely on social media as a means to gauge their social capital or self worth. This doesn’t make them better than those who do. While some non-commenters could have healthier ways to boost their self worth or release dopamine into their systems, many get that validation from equally unhealthy sources offline. That said, many non-commenters’ silence could be a display of independence and self confidence.
Whether you frequently comment online or don’t, it’s good to understand why you do or don’t. Analyzing your habits can help you determine whether your online engagement is healthy, or needs to be tweaked. With that information, you can then create a healthy social media experience that works for you.