Fatphobia and Cancer

Around 2015 I started experiencing dizzy spells, especially when tilting my head back or reaching above my head. I brushed it aside at first, but at one point, it became so bad that there was a thumping in my ears that sounded like a helicopter was landing on top of me, and I almost passed out. Soon after that, a bump the size of an egg appeared on the back of my head at the base of my skull. I reluctantly admitted that it was time to visit the doctor.

As a fat, transgender, asexual person, medical appointments are usually a source of trauma, so a medical condition has to cause me more discomfort than the additional trauma I anticipate a doctor visit will bring me before I’ll go in. This is why it’s so frustrating when doctors dismiss my symptoms or imply I’m seeking attention rather than medical care. The doctor’s office is the last place I want to be, and a doctor’s attention is the last thing I want.

In the case of the dizzy spells, I told a Kaiser doctor my symptoms, and she briefly touched the bump on the back of my head before telling me it was a lipoma and nothing to worry about. She then added “obesity” to my chart, condescendingly advised me on an exercise regimen without ever asking me about my exercise habits, and told me about nutritional classes the hospital offered without ever asking me about my diet before sending me on my way. We spent more time on my weight than the reason for my visit, and she didn’t even address my symptoms, which a lipoma–usually slow growing, not sudden–isn’t supposed to cause.

I wasn’t able to stand up for myself in the moment. I felt too humiliated and angry. But I emailed the doctor later and called her out on her fatphobia, asked her why I was experiencing dizziness I’d never experienced before (and I’ve been fat almost my entire life), and insisted on a biopsy. The doctor apologized and scheduled the biopsy. One of the medical personnel who assisted with the procedure felt the bump and said I had cause for concern. When the biopsy results came in, they were inconclusive, so I said I wanted to get the bump removed just in case. Another Kaiser employee told me that I’d have to wear a drain for a while if I did and advised me not to get it removed. My doctor never contacted me about a followup of any kind.

Since Kaiser was my employer-provided health insurance, and I couldn’t afford to seek care outside Kaiser, I said, fuck it. I’ll just deal. I knew that would be a waste of my time. Why do I ever bother? This had pretty much been the outcome of every appointment I’d ever had before that moment, which is why I always put off going to the doctor and didn’t pursue preventative care or screenings.

When I sat down with my boss to fill out my paperwork for Kaiser health insurance, he told me that the doctors were likely to treat me differently because of my weight. This begs the question, if you know the insurance you offer employees will force them into fatphobic environments, shouldn’t you seek other insurance providers? Of course, with fatphobia being so prevalent, that can be challenging, and I found it humorous/uncomfortable/inappropriate that this man was warning me I might experience fatphobia at the doctor’s office, as if I was new to life in my body.

Fatphobia in medical settings by healthcare professionals has been well-documented and leads to worse outcomes for fat patients, a lower quality of care, and reduced access to appropriate care. As a result, research shows that “[fat] individuals are less likely to access healthcare, and are less likely to receive evidence-based and bias-free healthcare when they do engage (Drury et al., 2002; Aldrich and Hackley, 2010; Forhan and Salas, 2013; Phelan et al., 2015). For example, fat ciswomen are less likely to receive cervical cancer screening (Adams et al., 1993; Simoes et al., 1999; Amonkar and Madhavan, 2002; Carney et al., 2002; Cohen et al., 2007), breast cancer screening (Wee et al., 2000; Østbye et al., 2005; Zhu et al., 2006; Mitchell et al., 2008), and colorectal cancer screening (Ferrante et al., 2006) than non-fat ciswomen…Fat ciswomen with breast and cervical cancers are more likely to die from breast and cervical cancer than non-fat ciswomen with these cancers (Hunt and Sickles, 2000; Wee et al., 2004; Aldrich and Hackley, 2010)” (“Stigma in Practice“).

As a transgender person, I find places that do cancer screenings to be especially unwelcome and even threatening. Gynecology offices, for example, often have “women” in their title, pink throughout the building, and “women” in all their office literature. I could not feel more out of place. On the paperwork, there’s never a space for my gender, and I must choose something I’m not. But the paperwork is also not friendly to asexual people. During one visit several years ago, I put none on the question of what type of birth control I was using, and the nurse asked me if I was sexually active. When I said no, her demeanor changed. She became cold and hostile, and I wasn’t sure if it was because she thought I was lying or what. Now I realize it could also have been homophobia, and she might have thought I was gay based on my answers. When the doctor came in, she gave me that side-eye fat people are so used to, and her judgment and disapproval of my body size was evident in her facial expressions and body language throughout that excruciating appointment. Afterwards, I said, never again.

Unfortunately, because of my cancer and treatment, I’ll have to put myself in these unfriendly environments again since screening will be a frequent part of post-treatment life. Yaaaaaaay.

But it has constantly surprised me and my sister that I’ve experienced no direct fatphobia from my cancer care teams (with the exception of my first oncologist, whose treatment of me I do suspect was rooted in fatphobia). In fact, when I was going through the diagnosis process, doctors and nurses kept telling me that I was “young and healthy” save for the cancer. It was the first time a doctor had ever said I was healthy–I do appreciate the irony of being told this before also being told I had six months to live without treatment–and it actually made me angry because it highlighted the weight bias of previous practitioners.

My cancer care team’s equipment could accomodate me. They assured me that my cancer wasn’t my fault, and there was no way I could have avoided it. They didn’t advise or push weird diets but instead told me that the best food during chemo was whatever tasted good. I NEVER felt judgment from any member of my care team about my weight. I felt seen, heard, and cared for, and that allowed me to focus on surviving cancer.

Cancer care, problematic as it can be, showed me what healthcare can be: a place of compassion that centers the patient with doctors who actively listen, trust the patient’s experience of their own body, and see every patient as a whole person worthy of respect and quality care. My oncologist frequently reassures me that what I’m experiencing is normal, goes over the mental health impacts of cancer and its treatment as a natural part of care, and affirms my individual experience. I’m used to healthcare professionals with fragile egos who feel challenged by an informed patient and seek to put patients in their place. Instead, my oncologist respects my intelligence, and because he does, we can have a higher level of conversation, and I can get a deeper level of understanding from his expertise. Cancer care has been a space of healing, not just trauma, and the trauma has come from the disease and its treatment, not my interactions with my team. Cancer care has been everything healthcare has never been for me. I don’t know if that’s encouraging or just fucking sad.

Fatphobia and weight bias beyond the doctor’s office is also infuriating but doubly so in the face of illness. People love to blame people for any and all misfortunes that befall them, not only because this makes them feel superior but also because this quiets the fear they have that such misfortune could happen to them.

There is no known definitive cause of my type of cancer, and though obesity has been listed as a risk factor for cancer in general (many argue those studies and their conclusions are flawed, by the way), it’s not a risk factor for my type of cancer. Even so, if you believe that a person deserves a disease and the suffering that comes with it if anything about them is a risk factor for that disease, then FUCK YOU.

In an article in Scientific American, Lindo Bacon*, PhD, and Amee Severson, RD, write, “From my (Lindo) decades of challenging the pervasive ‘fat is bad’ rhetoric, I know that every time I assert that the problem for fat people isn’t their bodies, but abuse from society, bigotry fights back. It’s not just the outright haters who populate the comments section, but worse, the self-righteous who see their stance as caring. It’s all about health, their argument goes, not bias. No, it’s not.”

Earlier in the article, Dr. Bacon and Severson write, “This hierarchy of bodies is nothing new, with roots in racism, slavery and every other attempt to rank bodies. We can no longer pretend that being less likely to be hired or get promotions, being paid less, receiving biased medical treatment, being socially excluded and bullied are attempts to help people ‘be healthier.’ These are the direct consequences of living in a culture that vilifies and fears fat bodies and that treats the people living in them as morally lesser beings.”

After I was diagnosed, a friend messaged me that they were buying a book titled The Obesity Code: Unlocking the Secrets of Weight Loss and asked if I wanted a copy. I didn’t have the energy to engage in more than a “No, thank you.” But OMFG. Even now, I just can’t even.

As a fat, transgender person, I have a complicated history with my body. It hasn’t always been a peaceful or positive relationship. In 8th grade, I signed up for track & field as an extracurricular. I had already internalized and struggled with the fatphobia around me, but one of the teachers over track made this worse by making comments about my body and how track was changing it. Her attention was condescending and unwelcome and in no way helped me come to terms with my larger-than-my-classmate’s body.

That summer I ran ten miles a day while only eating 800 calories and 2 grams of fat per day until my body literally gave out. With the help and support of friends, family, the media, and so many around me, I had developed anorexia athletica. As my body wasted away, I received more and more compliments on my body, one from my pastor (ick). This was both enraging and heartbreaking because people were essentially congratulating me on killing myself. I was waiting and hoping for someone to give me permission to stop and to tell me I was worthy and loved and respected as I was. No one did. It was glaringly obvious that my health was not the motivation for these encouragements and compliments on my weight loss. Anyone who was really looking could see I was quickly headed to death’s door. My mom and sister saw it, and I could feel it.

I’m grateful to my body for stopping me. I’m glad I learned young how dangerous others’ biases are and how easy it is for a desire for approval and acceptance to convince you to sacrifice your autonomy, your authenticity, and your health. NOTHING is worth that. Nothing. That lesson has allowed me to resist so many other invitations for self harm.

My body is amazing. It survived a thoracotomy with stage IV cancer. It survived six cycles of chemo. It survived me. My body is a warrior. My body, scarred and large and imperfect, is beautiful. My body is strong, even when it’s weak. I’m profoundly grateful to and for my body, and I won’t subject it to anyone’s ridiculous and destined-to-fail diets, restrictions, and standards.

My body is mine, not yours. So kindly fuck off.

On the flip side, another friend recently posted against fatphobia, and I felt so loved. I don’t believe in new year’s resolutions, especially since most center and glorify fatphobia and the diet industry uses them to exploit and demonize fat people for profit, but if there’s one thing I hope people have learned from 2020 and one thing they strive for going forward, it’s compassion. I hope, also, that hellish year and its aftermath has given people the strength to say no to those who worship and glorify hate in all its forms. When we stop supporting and internalizing beliefs and systems that destroy people, a world of possibility and wonder opens. It’s a world that exists at my center. It feeds my joy. Can you see it?

See also:

• WHAT IT’S LIKE TO BE A FAT BLACK QUEER FEMME–WITH CANCER: Talking with Walela Nehanda about the decolonization of body image through cancer by Taylor Crumpton
• My Cancer Pt. II, Medical Fat Shaming Could Have Killed Me by The Frisky Fairy

*Added 3/11/2022: Please read the following regarding Lindo Bacon. I find their behavior disgusting and their resistance to accountability troubling. Thank you to Marquisele Mercedes for bringing this to light and for your badassery. I’m sorry you experienced this.

• “I Will Never Work With You” by Marquisele Mercedes
• “Movements, Missing Stairs and Lindo Bacon” by Lindley Ashline
• “Holding Lindo Bacon Accountable for Repeated Harm in the Fat Liberation & HAES® Communities” from ASDAH