The overweight doctor with PCOS and the fatphobic healthcare culture

When I was 4-5 years old, one of my neighborhood friends was enrolled in ballet. I naively thought that it would be amazing to be in a class with my best friend. My parents reluctantly complied with the request, as my neighbor’s parents had volunteered to drive me and make the arrangements.

At the first class we were given the rules of the studio and handed a blue leotard. This blue leotard had long sleeves, and the fabric seemed like the inside of a magician’s bag. When I got home I immediately tried the leo on, because I was excited about this new adventure. Anyone who has tried on spandex, knows that you must shimmy into these things. I remember trying to push my arm through the sleeve, which resulted in the neck being overstretched, and then needing to roll the fabric over my arms, piece by piece until my elbow could move once again.

I ran into the living room of our duplex where my sister and mother were sitting. I made a comment about how I didn’t think the leotard was the right size. My mother sighed, as she often did, and commented that it wasn’t the leotard that was the wrong size. In those moments I became aware of the fact that I was different. I wasn’t what my mother, or society viewed as the perfect size. And if I ever forgot that I wasn’t in a body that was accepted, my mother, or children at school would remind me.

I played basketball and football with the boys at school. On multiple occasions I was berated because of my size, I was tall and chubby. However, when teams were picked I was at the top of the list, something I took pride in. I knew I had to prove myself more then the other players, because I stuck out, I was a non-blender.

One rainy afternoon we were playing football in the yard at recess. I was wide open, and the quarterback threw to a kid that was double teamed. I asked the boy why he didn’t throw to me, “I was wide open!” Another little boy yelled, “you sure are wide.” That was the last day I played football with the boys. My fifth-grade heart couldn’t take the continued ridicule.

As time went on, I found myself trying to overcompensate for everything. I wasn’t the desired kid my mother wanted, so I needed to get awards and a 4.0. I was going to grow up and do something great. I wasn’t the athlete people imagined, so I had to be the first girl to hit an out of the park homerun. I wasn’t accepted in any place in my life, because of the body that I existed in.

What do you think happens when someone isn’t accepted? They try to change themselves. I was on an alarmingly high number of diets before the age of 14. My mother made me do slimfast with her. I wasn’t allowed to eat anything except one meal a day. Of course, that worked for a while, and then I hit puberty.

My mother had never ending comments on what I should be doing and eating, all the while never supplying food that anyone would consider healthy. It is interesting that in this country many children are forced to struggle with food scarcity and obesity, all at once.

I “knew” I was unlovable unless I was what society considered a normal weight. For that reason, I struggled every single day of my life. My mother enrolled me in Jenny Craig when I was 14. I lost all the weight I needed to in 3 months, 80 lbs. She was so happy with how I looked, that I stopped eating the meals all together. With the positive reinforcement, came the desire to cut my calories further. By the time I went back to school I was having water, and a snack every day.

As many can imagine, this wasn’t healthy and I couldn’t focus in class, was still growing to my eventual 6’ frame, and certainly couldn’t participate actively in sports on 100 calories a day. I started eating again, initially little meals, but that translated into rebound weight gain.

Shortly after the weight re-gain, my pediatrician referred me to an endocrinologist. My Dad drove me to see him at the University of Wisconsin. I was at the awkward age that I made parents wait outside for the exam. The physician, who was an elderly man, came into the room and looked me up and down. He didn’t sit on the stool the entire 3 minutes he was there. He asked if I had extra hair growth. He asked if I had sudden weight gain? He then explained that I had PCOS, and it would be close to impossible for me to have children. He said I should start a medication, metformin, but it may not help, but he would send that into my pharmacy. That was the extent of the conversation. He left a 14-year-old girl, who wanted a family, thinking she would never be able to get pregnant.

During high school I was focused on getting into a good school, so that I could eventually be a doctor. This became my singular goal, because I had convinced myself that I could help people, and that I had a chance at being accepted and respected if I was in a caring position.

In college I had one glorious summer where I went to Weight Watchers and Curves. I worked out at Curves because I was too embarrassed to be seen by men. Afterall, I had been told by all the boys in my life that I was a great friend, but not worthy of a date. I lost 100 lbs. the summer after freshmen year and beginning of sophomore year. This was mostly because of my intense type A attitude that punished myself for every mistake I made, and every bite of food I had that wasn’t perfect. It really is amazing how you internalize the dialogue from your elders.
When I graduated from college, I was a healthy weight. However, my desire for perfection wouldn’t let me enjoy that moment. I still berated myself every hour of every day. Medical school and residency came and went, and then I had two children.

After my second child, I went back to my intense calorie restriction, and that coupled with breastfeeding, and pure barre, led me to lose 158 pounds. This was all within the first 6 months postpartum. I felt like I was out of control of my body, and this was the way I could attempt to control it.

Life and covid happened, and then one day in August, I decided I was going to lose weight in a healthy way, for the first time in my life. I allow myself to eat, I’m conscious of what I eat, but don’t deprive myself. My thoughts are also not constantly about food anymore. Why? Because I started a medication called Mounjaro. At this point I have lost about 80 pounds. Now, this isn’t just because of the medication, I do work out 4 plus times a week. I work out with a trainer. I drink a lot of water, and overall have made significant changes in my diet. However, for the first time in my life this medication as helped me quiet the negative food self-talk. I have become a better friend to myself.

When I became an OBGYN, I promised myself I would work on PCOS, polycystic ovarian syndrome, weight loss, and infertility. I want to make sure my patients have someone who cares about their successes, and still values them when they have failures. We all need people around us who care. I also realize how incredibly privileged I am to be able to have insurance, can pay for medication, and can afford appropriate food, which is something I didn’t have when I was younger.

Over the last several months I have seen people share their stories on social media and discuss how they have responded to GLP 1, injectable medication. This medication has been life changing for many. People are feeling like they have control over their lives. This has helped many of my patients overcome the insulin resistance that is associated with a diagnosis of Polycystic Ovarian Syndrome. PCOS is a complex diagnosis that is associated with metabolic syndrome and lifelong co-morbidities.

We need to make these medications more readily available, and we need healthcare providers to understand that obesity like PCOS, is a chronic condition. We need to use our tools to help patients who are struggling. Unfortunately, the feedback I have gotten over the years, is that the fatphobia in medicine, is so significant, that people are misdiagnosed, and often gaslighted by their providers.

I tell my patients that weight control, is a challenge you will have your entire life. This isn’t something that ends at the goal. It’s also something that is complex, and different for everyone. We need to do a better job supporting people instead of fat shaming them. We need to use medication as a tool to help, whenever it is appropriate. We shouldn’t be gatekeeping resources for an elite group, they should be readily available for people. This is one of the major ways we could help primary care providers avoid dealing with the other chronic conditions associated with obesity like hypertension, diabetes, hyperlipidemia, etc.

My weight has always caused me to be underestimated, and this has affected me throughout my life. I used to dream I was invisible, and I actively learned how to disappear in many cases. I don’t want my patients and their potential to go unfulfilled because of the fatphobic society we live in. People need to be empowered, and given the tools to achieve whatever their health goals are. My biggest ask; please start treating people like they have value, no matter what they weigh.

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