By Andrew Walen, LCSW-C, LICSW, CEDS
I was scared this past week. One of my doctors suggested I get a liver sonogram, as he wanted to know if I had a fatty liver. He also ordered a blood panel to see how my liver enzymes are doing. Okay, I thought. I take a few medications, so this seemed like good preventive medicine to me. After the sonogram I got a short note from him through my online patient portal saying I had fatty liver and a slightly enlarged spleen and needed to lose weight.
Hold up, that’s it? No additional info? “Just cut calories and lose weight?” I wrote back. He said to talk to my general practitioner. My GP said the spleen was nothing to care about, but I should lose weight. Two doctors and two instructions to lose weight without a rational reason why.
This has been a drumbeat in my life since I was 10. Here in my late-40s, having recovered from a 20-year eating disorder and now 16 years into my professional career treating eating disorders, I have the wisdom to call bullsnot.
So, I did a little research and found that there are concerns for a small percentage of folks with fatty liver. Those who need to worry will have lab results that indicate a problem. I had one test that was in the yellow “high normal” bar graph, just ONE DIGIT from the desired green-colored section! My doctors didn’t even look at that before they said, “lose weight.” I got a third opinion and that doctor said the only time he worries about that value is when it’s three to five times normal levels and that’s typically only seen in alcoholics with fatty liver or those with severe health and nutrition related issues.
No need to lose weight. My health is fine. My liver is fatty looking. I’m fatty looking. Big freakin’ deal. But because I am fat, my doctors prescribed something that has no clinical worth, has a 95% futility rate, and is known to actual cause worse physical and mental health outcomes in the majority of humans.
I’ve seen hundreds of clients in larger bodies, some with anorexic behaviors, some with bulimic behaviors, and others with binge eating disorder. All of them report being told to lose weight. In the meantime, cancer has been overlooked, tumors ignored, and other diseases dismissed as too much self-diagnosis and internet research – all because of implicit and explicit fat-bias of the medical community who are sworn to treat these individuals.
This is not something we can avoid as people who are big, fat, obese, or whatever term you choose to use. The majority of doctors report they find “obese patients” to be lazy, stupid, and undesirable to treat. And there’s plenty of research to support that large-bodied individuals get worse healthcare. So, you have to be your own best advocate.
Your health is not your size. Your health is a combination of physical, emotional, and social determinants. I know I’m healthy because I try to eat intuitively, get exercise, take my meds, see my doctors when something’s not right, see my shrink, talk to my friends and family, and live my life filled with love, laughter, and music. Those are totally in my hands. Your health is in yours. Know the difference between a fat-phobic definition of health and real health.