Woman uses her obituary to call out fat shaming doctors

[hazyshadeofwinter]

https://www.google.com/amp/s/amp.theguardian.com/world/2018/jul/30/canada-ellen-maud-bennett-obituary-fat-shaming

Just came across this... I've got some strangely conflicted feelings right now.

 

[stargirl]

unsure if i should laugh or be disheartened...

who seriously wants to be known for this past the grave? how embarrassing

 

[IcedLatte]

Agree re: conflicted feelings.

It's disheartening that this woman's cancer symptoms seem to have gone undetected until she was past the point of being able to successfully treat it.

However. Hooooowever.

Doctors do not simply refuse to treat patients 'until they lose weight'. Many cancer symptoms are not overtly obvious as being those of cancer -- family members of mine, for example, had symptoms that were frustratingly vague; inconsistent aches and pains, breathlessness, fatigue atypical to their normal energy levels, etc. All of those could be associated with being unhealthily overweight. It is incredibly easy to see how a doctor could strongly advise a patient to lose weight to see if these symptoms went away when the body was no longer being put under the stress it is when a person is obese (especially morbidly so).

Does that mean that some overweight patients potentially delay treatment by not benefitting from early detection? Unfortunately, yes. Doctors are not infallible gods. They are people who take symptoms at face value and make a sensible recommendation using those facts. What would the solution be? To give every overweight person complaining of bodily pains a full CAT scan? I am fortunate enough to live in a country with a national health service, and so was this woman; perhaps when one is in a privatised system paying for their own healthcare, one would feel more comfortable demanding further treatment. But national health services are incredibly delicate balancing acts of funding only necessary care, and the cost involved with ignoring how devastating obesity is on the body to avoid hurting feelings would be astronomical.

Let's not forget, Cancer Research UK in the past few months incited a great deal of hysterical criticism for fat-shaming when they published the following campaign:

Admirably, they doubled down on the campaign even after all of the internet dramatics, insisting that obesity IS a leading preventable cause of cancer, and that promoting this fact was perfectly in line with their mission. It's a terrible shame whenever a person dies, and I'm sorry to the family of this woman who lost a loved one. I have pity for them, I really do. But pussyfooting around the fact that her weight could very well have contributed to her death doesn't help to prevent future deaths. When it comes to cancer, there's one quote that has always struck a chord with me (particularly because of the family history with it that I mentioned above) - genetics can load the gun, but your lifestyle may very well be what pulls the trigger.

 

[smallthing]

Conflicted feelings here, too.

Is it incredibly sad that her condition went undiagnosed? Of course. Is it understandable? Yes. As @IcedLatte said, many cancer symptoms are ambiguous and can easily be attributed to obesity. I, too, live in a universal single-payer healthcare system and allocation of resources is an issue doctors must consider. Not to mention, weight loss is an apt recommendation for improvement of overall well being.

Something that the general public appears to be completely blind to, also, is the role obesity plays in major health issues. It’s confirmation bias on a massive scale. The number of cancer cases linked to obesity is an estimated 20%. Some quotations from the study I’ve linked (De Pergola et al., 2013):

“...cohort studies have shown that breast cancer risk was lowered by 50% in women who intentionally underwent weight loss higher than 10 kg after menopause...”

“Also, an excess of weight in teenagers was linked to doubling the mortality risk of colon cancer in adulthood.”

“A Canadian case-control study has found that those men whose weight increased by more than 21 kg after reaching adulthood had a colorectal cancer risk 60% higher than those with a weight increase of 1–5 kg, and the association was even stronger after excluding those patients with rectal tumours [26]. Endometrial cancer has also seemingly been shown to be directly correlated with weight gain during adulthood among Japanese women [27]. Additionally, diet-induced weight loss reduces colorectal inflammation and cancer-related gene pathways in obese individuals [28].“

A major risk factor for cancer is the presence of chronic inflammation, which can lead to oxidative cell damage, DNA mutation, and the formation of a “tumour environment” which allows vascularization and tumour metastasis. Considering obesity (any excess adipose tissue, really) is linked with chronic inflammation, the risk factors it presents for cancer - not to mention a whole host of other conditions - are quite clear.

The takeaway? Weight loss is an excellent health recommendation, at any age, for any overweight person. Should it eclipse more acute conditions like cancer? Of course not, but if we give in to this ridiculous fat positivity (not body positivity! It’s not body positivity if you’re destroying your body) movement, we’ll have an ever bigger public health crisis on our hands than we do already.

 

[temporally]

Ellen’s dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue.

Slightly OT, but the phrase “women of size” irks me. Seems like a feeble attempt to repackage gluttony as martyrdom.

 

[IcedLatte]

Slightly OT, but the phrase “women of size” irks me. Seems like a feeble attempt to repackage gluttony as martyrdom.

I hadn't even caught that! I misread it as 'women of her size'. Honestly, 'women of size' sounds ridiculous. Is this supposed to be the fat parallel to the term 'women of colour'? The oppression olympics strikes again, when the only oppressed minority in a fatty's household is the forgotten lettuce wilting at the back of the fridge

 

[Lioness007]

She was told by doctors repeatedly to lose weight. It is not fat-shaming if your illnesses are directly related/the cause because of being obese. Obesity is directly linked to heart disease, cancer, diabetes, etc. This has been proven time and time again. She went against doctors orders for what reason exactly? To prove a point?

Her weight was extremely relevant in this case, and the whole "fat-shaming movement" is putting women at further risk because of its acceptance.

My heart goes out to her family, but people can be extremely blinded by their own ignorance. It is so important to advocate for yourself, and this is a sad outcome. It really is.

My uncle is a retired cardiologist, and he simply refused to treat patients that smoked, unless they sought help for quitting. Although it is an addiction, you are contributing to the cause and do need to take some responsibility for the outcome of your health.

 

[gracilis]

I sympathize with the woman and her family over the life-altering diagnosis and the woman's subsequent passing. I understand the anger and sense of injustice, of "why me?" that comes with such a diagnosis and how that could lead one to blame the medical system, shoot the messenger, self-victimize.

It pains me because it is a sensitive issue but at the same time I've dealt with people who want to just wallow and blame external factors for things that are either in their own control or no one's control.
On one hand, you want to scream to these patients "Just put on your damn big girl panties and do it!" and on the other hand you know they often lack the resources in some way (i.e. ignorance, motivation, self-efficacy, untreated trauma history...).

If the weight was a major issue there are so many ways to address it and I am certain most medical professionals would love to give her resources and help her problem-solve her issues. However, no one can do that when the patient construes resources and objective information as "shaming".

Yes, obesity is tinged with negative associations and the obese are stigmatized.
Yes, health is more than body weight.
Yes, shame is typically an unhealthy emotion that can lead to vicious cycles that degrade health (as in binge eating).

And...
Yes, obesity is heavily correlated with disease risk, including many forms of cancer.
Yes, obesity can be changed through lifestyle.
Yes, it is the doctor's job to not sugar-coat the information you need to make informed decisions about your health.

I hope damn well this woman's call to arms to "women of size" to advocate for their health is heard and comes to fruition, just in a near opposite way from what Ellen intended.

 

[coeurV]

Beyond obesity compounding and masking cancer (among a plethora of other ailments), there is such a thing as problematic non-compliance. There are patients who will take ages to consult, and are happy to make liberal use of physician time, but inevitably reject any and all recommendations because they don't align precisely with their expectations. Or worse, they demand treatments which are rendered hazardous or whose outcomes become extremely difficult to fulfill at their size.

For those unable to look out for themselves adequately (physically or for reasons related to mental health), obviously we can take it upon ourselves to escalate to another level of care. For people who outright refuse to help themselves, the system must eventually move on to those who will.

In medicine, there are frequently cases where one is required to declare their intention to care for themselves. For instance, (and in the context of obesity) people choose to undergo elective gastric bypass surgery as an effective means of losing weight. But they are also required to agree to sustained lifestyle and eating adjustments after the bypass surgery, because the procedure itself is not a fix. It probably isn't a surprise to hear most bypass patients eventually relapse and put the weight back on.

If someone demonstrates refusal to treat the most obvious maladies with the simplest solutions, does it not seem reasonable that it ought to make that person a candidate for exclusion of other services, at least until they demonstrate a willingness to do their part? Handing out procedures and tests (when results are likely to be obscured) like candy only exacerbates strained resources. And it certainly doesn't help the patient. I feel sad that her circumstances led to this. That she passed on with anger in her heart, but there is stating the obvious, and there's stating the obvious with the intent of weaponizing it for a demographic which already harbors the utmost skepticism towards the healthcare system. yes, fat may not be "the only relevant health issue". but it's often the most relevant pertaining to outcomes and standard of care.

 

[coeurV]

If the weight was a major issue there are so many ways to address it and I am certain most medical professionals would love to give her resources and help her problem-solve her issues. However, no one can do that when the patient construes resources and objective information as "shaming"

I couldn't agree more. There is a vast difference between shaming and pointing out an issue, yet the two are constantly conflated. IMO this is the product of "fat acceptance" activists demanding the profession be held up to the imaginary ideal of a "body positive" physician.. And once patients are taught to suss out providers via a battery of questions (which are shared ad nauseam on twitter/pinterest/various social media), it can only go downhill from there. When someone frames an interaction as a battle, rather than an opportunity to be actively involve in their treatment and empower themselves with the knowledge to make informed decisions, every fact or suggestion feels like a deliberate assault. When someone comes in wielding questions as a weapon, their opinion of the physician is lost long before they even enter the room. Now, negative sentiments towards a healthcare provider does/should not inform the obligation to offer the best solution(s) available. But unfortunately, a patient's opinion of their physician DOES directly impact the decisions they make, and therefore the outcome of their treatment (or lack thereof..). So how do we reconcile the two scenarios?

Interestingly enough, when counseling smokers I find it useful to draw comparisons. Whether it's my continuing struggles with weight, or my parent's aging and difficulty easing into "conservative" eating habits, it helps them to reframe their position and identify with the woes of the wider public, instead of the traditional shame associated with smoking cessation The same cannot be said for over half of the obese patients I've encountered. The idea that facts (even those delivered as delicately or obliquely as can be) are "microaggressions" for one portion of the population and not another is both ridiculous and frightening.