Thursday 29 May 2014

Weight problem

I have a weight problem.  No, I'm not overweight.  I'm not underweight either.  In fact my BMI is a very healthy 22.4.  So what's the problem then?  Nothing . . . for me.  The problem is for everyone else - my weight has been stable for the past 20 years, and that pisses people off.

"Fuck you, Doc!  I've been trying to lose weight all my life!"

Yeah, that's exactly what I'm talking about.  My body just doesn't hold calories.  Oh, I may possibly put on a kg or two on holiday by, for example, eating 6 lobster tails at the seafood buffet one night (yes, really), but all I have to do to drop that weight is switch from sugary drinks to water when I get home, and I'm back to my usual svelteness within a few days.

Hmm, I can hear several readers' teeth grinding and . . . is that screaming?  Maybe I should stop.

No dammit, I know I'm torturing some of the more gravitationally-challenged here, but bear with me for a moment, because this subject is too important.  It turns out I'm not the only one with this sort of weight problem.  One of my readers named Lauren (not her real name) emailed me a link to a very interesting story written by a student at Yale University named Frances Chan (her real name.  No really, it is.  Seriously.).  Frances, studying at Yale University, recently documented her difficulty not with her low weight, but with her school's medical professionals' perception of her low weight.  She's been 90 lbs since high school, and she shares a slight frame with her entire family.   But after a trip to student health for a breast lump, she received a letter about a "concern resulting from your recent visit."  There is no better way to scare the shit out of a woman than telling her something like that.  Frances was appropriately concerned - was the lump cancer?  She was too young to have breast cancer!  What could they possibly want?

Fear not, the lump was indeed benign.  She was called back due to concern that she was too skinny.  The clinician then dropped a bomb directly on her head:
I would {be forced to} meet with her for weekly weigh-ins. These appointments were not optional. The clinician threatened to put me on medical leave if I did not comply: "If it were up to the administration, school would already be out for you. I'm just trying to help."
Not optional?  What??   Frances had been healthy her entire life - thin, but healthy.  But because this clinician thought she was too underweight, she was forced to meet weekly to get weighed like a boxer or a beauty queen.  Ok, bad examples.  But wait, it gets worse: in addition to her mandatory weekly weigh-ins, she was also made to see a nutritionist and a mental health counselor, have urine and blood tests done, and even get an EKG to test her heart.  Shockingly, all her tests were normal.  You know, because she was, and always had been, completely healthy.

Frances was told she had to gain 2 pounds or else risk getting expelled from one of the most prestigious universities in the world.  So what did she do?  She dutifully abandoned her normal, healthy diet in favour of the exact thing that every nutritionist in the world tells us to avoid - a high-carbohydrate diet, supplementing meals with ice cream and worthless empty calorie snacks.  She even resorted to taking the lift rather than stairs to burn fewer calories.

Her unhealthy efforts were rewarded with exactly the two pounds she desired.  Believing she had succeeded in fulfilling her quest and thinking her ordeal was at an end, she was told that she had to gain three more pounds

More ice cream?  Cake?  Doughnuts?  Oreos?

No.  Frances had had enough.  She abandoned her pursuit and decided to skip all future mandatory appointments.  Instead, she did what she should have done from the beginning - focus her attention on her studies rather than some bullshit witch hunt which tried to make a healthy person sick.

I understand and appreciate what Yale was trying to do.  Eating disorders are very prevalent among college-aged women, and they can be just as dangerous as obesity, if not more so.  But the way they went about it in Frances' case is all wrong.  Threatening expulsion for non-compliance was reprehensible.  And trying to force the girl to gain weight was simply ridiculous.

Frances' story angered me on several levels.  A well-timed phone call to her family verifying her usual weight could have prevented this debacle from the start.  Short of that, Yale should have minded their own goddamned business.  Forcing treatment on someone who doesn't want it 1) is unethical and 2) ostracises the patient, especially when that treatment is unnecessary. 

At the risk of sounding condescending (which is not my intention, I assure you), I'm proud of Frances for finally standing up for herself and refusing further compliance.  I do wonder how things turned out for her. 

Frances, if you are reading this, I sincerely hope the good-intentioned folks at Yale came to their senses and that you were able to resolve the issue.  If you were not, then yes I would like fries with that.

I kid, I kid.

Thanks to Lauren (still not her real name) for bringing this to my attention.  And thanks to Frances (still her real name) for speaking out.  To read Frances' original post, click here.


  1. I definitely agree. BMI doesn't account for build. Back in college my wife's BMI was around 16. No eating disorder and not too skinny, she's just built tiny. As long as she stays active she can eat and eat without gaining weight. All you need to do is look at her and you'll see she's fine, no scale needed.

  2. What happened to a patient's right to refuse? Privacy? Since when does HIPAA allow a practitioner to release info to the school (or work) without explicit consent?

  3. When I was in high school and college I did have an eating disorder. Fortunately for me, Karen Carpenter hadn't died yet and no one was concerned by my 90 pounds on a 5'/2" body. Take it from me, that kind of treatment would not have motivated me in the least to gain an ounce. A true anorexic like an alcoholic isn't going to be helped until they see the need for it. Treatment should only be forced on them when they are in immediate danger of dying.

  4. That sounds borderline illegal to me. Here in the UK that certainly would not be allowed to happen, and pretty sure the GMC (medics regulatory body) would have something to say about it to the doctor involved.

    We get taught in our medical school that unless the patient has been sectioned, or otherwise incapacitated they are allowed to refuse treatment. This whole situation sounds completely alien to me!

  5. That really is awful. If my school ever did that to me, I would have to really think about whether or not I would want to continue going to that school.

    I have my own weight problem, that is a direct result of a serious knee injury that occurred a couple years back (my knee dislocated as I made my way down the steps to my concrete back patio. I tore several muscles around my knee, burst blood vessels, dented cartilage, and broke a small piece of the corner of my knee cap off, and fractured my femur, all from falling onto said patio. I have two small scars from the surgery too.) I was put on bed rest, and I went from 5' 2" and 130 lbs to 5'2" and 240 lbs in about 1-2 months. I have since tried to lose the weight I gained, but exercise causes me to become incapacitated from pain in my knee. I'm currently trying to lose weight through weight loss pills. But back to the point, if my school told me that I needed to lose my weight or face getting kicked out, I don't think I would continue to go - whether or not that school were some prestigious school.

  6. I would of flipped off and slapped that woman. Who she think she is by forcing a woman on something she clearly doesn't need?

  7. I'm usually not one to comment but this whole fat/skinny shaming stuff always manages to get me ranting.

    I like to think I'm a perfectly reasonable size, I'm 5'6" and 120 lbs- which even my family doctor says is a really good place to be. However I work retail, and although my home dept is I/A often I cover shifts in Plus Sizes.

    I have no problem with people's weight, I was kinda hefty up until middle school so I'm in no place to judge. My job is to help people, treat them how I would want to be treated if I walked into a store, etc. I would like to think I do a good job as well but...

    More than often I would have anticipated- I have had women refuse my help in that department because I am an 'einnie minnie' that 'doesn't understand' and clearly knows nothing about the troubles of bigger women!

    Part of me understands that they're probably treating me this way because they're used to society treating them so. It's probably more of a self defense strategy, but I really some comments I feel are very.... unnecessary? I hear 'do you even eat?' even more often than 'where is the bathroom?'. Sometimes I'll literally be eating on the floor (yeah we're not supposed to eat on the job but during longer shifts I sneak snacks- in reality am hungry like All the time).

    What I find most frustrating however, is that I can't even eat a lot of the food I would like to. Of course I don't feel like explaining this to every single person that walks into the department. I'm here to help you find pant sizes, not throw myself a pity party at your expense but...

    A couple of years ago I was diagnosed with Gilbert's Syndrome, which is just a fancy way of saying that my liver low-key hates me, beef, and other things livers are supposed to like. So basically if I don't eat the right salads, I turn yellow (I'm not making this up haha- the jaundice is real). Food tastes a lot grosser than it used to. Sometimes I want to eat food that I remember tasted great, and it really doesn't taste the same. I would gladly take a couple of pounds for the chance to enjoy food again any day.

    Anyway sorry for the long rant- the point is people shouldn't make assumptions about other people's weight. Heavy or einnie minnie, you never know what kind of underlying health problems people can have. The End.

    On a side note, this is the third day into binge reading your blog Doc, I'm really glad I stumbled upon it- these stories are true treasures!

  8. Firstoff, kudos to Frances; her weight is her business. I'm also curious about the end result, hopefully all went well.

    Magy, I understand where you're coming from. Unfortunately, larger women are often treated rudely in public, ofttimes by petite/skinny people. My wife has dealt with this her entire life. Even at a healthy weight, my wife is 5'11 and broad-shouldered. This leads to a lot of "big girl" and "is that a man" crap.

    I'm on the other end of the spectrum, a little past where Doc is. Most of my life, my weight was fairly consistent around 170. Due to illness, I lost 30 of those in about a week. Since then, I have been unable to put weight back on. Best my doctor and I have come up with is my metabolism is dialed in at 170, and refuses to adapt to my new weight. So thanksgiving dinner will make me gain a couple of pounds at most, and be gone in a few days. Not eating regularly results in a steady decline, which is coumpounded by having very little appetite most of the time. So it's easy to forget to eat. Thankfully, I found stability (initially) through medical marijuana, and more recently with Dronabinol.

    Please, no Jack Sprat comments.

  9. I was very, very happy to find that this story went public, and that in the process Frances "was contacted by other Yale students who had encountered similar travails."

    This is how you deal with abuses of power. You go public. There can't NOT be consequences for this sort of shit, or it perpetuates.

    I fully understand how difficult it can be: on the back of your mind you're always thinking "this is one of the best, most prestigious universities, I got this far, I can't afford to make them angry, I have to comply". Fear is always the great motivator in abuses of power, isn't it? It's also the same motivator in a plain old armed robbery. Kudos for Frances! I hope this story inspires others to stand up against any more heavy-handed idiocy!

    By the way, it's probably worth noting that she didn't just "go back to her studies", but rather went public with it. I.e., she didn't just ignore the stupidity in hopes it went away (as then Yale might REALLY have done what they had threatened, unchecked, and presumably "justified" on the bases of her missing "mandatory exams"); she fought it with public awareness. That might be worth adding to the main body of text somewhere.

    You don't lie down and take this kind of shit. You take your stand! You stop the bullshit train dead on its tracks, for you and for everyone else!


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