“Ellen Maud Bennett died on 11 May 2018, because she was fat. Ms. Benett had been feeling unwell for several years and had repeatedly sought medical intervention… She was offered no support or suggestions about her ill health beyond weight loss. When the root of her malaise was eventually identified as an inoperable cancer, Ms. Bennett was given just days to live.”
This is the opening statement of a study published in the National Library For Medicine, which documented the medical struggles of ‘fat women'. Only, this struggle is not with being fat or obese, but with getting a diagnosis for other diseases as a woman who exists in a fat body.
'Gods', As Flawed As Humans
It's hard not to compare doctors and medical professionals with Gods when they do so much to help people and save lives. However, when it comes to treating ‘fat' bodies, we are often reminded that these Gods are as flawed and prejudiced as humans. I learnt this the hard way, when after months (years, actually) of pain, dysfunction, and poor physical health, I was returned home by multiple doctors who simply couldn't see beyond my weight. None of the 11 doctors I visited across Delhi and Patna bothered to see past my weight and look for disorders that weren't weight-related. Even with blood reports suggestive of something very serious, the only advice I was given was to ‘lose weight'. Finally, in Delhi, I asked a doctor, “Is it really the weight? Am I that fat that I am really the cause of all my problems?” I will never forget the face, the kind eyes, as he told me this: “No, I think you have a tumour, but maybe not cancer, we will have to get you tested ASAP”. He said this with all the calm in the world.
For 11 months, I went through 16 sonographies, 30-odd blood tests, and dozens of appointments with specialists. I waited in waiting halls enough to surpass my reading goals (I read 60 books that year, instead of the 52 I had promised myself). The pain never left my side though as I fought the blackouts, dizzy spells, and the dark clouds that would form over my eyes, brain, and soul.
When Doctors See What They Want To See
This doctor and his suggestion led me to question the very ethics of medical practice. Obesity is a serious problem and can lead to multiple health issues. However, most doctors in India have an inherent weight bias when it comes to their patients, especially women. My former gynaecologists made me go through nearly 10 ultrasounds to confirm that I had PCOS (which I did not, and I kept insisting I didn't have it) because in their words, not being skinny naturally meant having ‘fat'-related health issues or lifestyle diseases. Because if you are fat, you must have a poor diet consisting of junk and fried food. No matter the fact that I happen to be quite conscious about my diet. I cook all my meals, try to balance all nutrients. And so, this implication by doctors irked me deeply.
I dug deeper and came across women from various regions, ages, and backgrounds who had been denied proper medical care because their doctors couldn't see beyond their weight. I found their stories in the nooks and crannies of the internet, via Reddit or Instagram or online blogs.
Finally, last night, I spoke with my doctor, the one who had cared to look beyond my physical appearance: Dr Sanchayan Roy.
“Yes, there might be a subconscious bias that may lead to ignoring issues of larger bodies, but I cannot say it is intentional,” Roy says. He goes on to explain that “obesity definitely overshadows” individual symptoms and that a few medical professionals may give in to the presumption that a fat body necessarily has obesity-related issues. It's a double whammy for women, who often get a mixed misdiagnosis, centred around “periods”, that is, menstrual health, and obesity. These women are told that their issues are a function of their menstrual cycles, which, in turn, can be fixed by just being thin.
A Gendered Experience
When I asked Roy whether this bias, the fixation on ‘womanly' issues, existed for all sizes of women, Roy said something peculiar. “Men definitely are easier to diagnose, they are a lot more clear with their communications and forthcoming with all issues, even embarrassing symptoms, so fatter men are not as difficult to diagnose as women” (I was, at this moment, ready to lose faith in a doctor I had come to trust after a string of discomfiting medical experiences). But, he continued, “A lot of what the woman thinks of her issues is coloured by how her family or maybe a partner perceives them. If someone close to her readily dismisses her pain or minimises her issues, or lets her believe that all women go through similar pain, she may not feel that it is something major.” I sighed with relief at his addendum, because what he said was true. Roy emphasised that this ostensible lack of communication was gender-based and that women often did not open up to a male diagnostician due to cultural conditioning.
When I shared this experience on Instagram some time ago, a follower reached out to me with one of the most harrowing misdiagnosis stories. Her aunt had been going through intense pain in her breast, which didn't even let her move sometimes. Not surprisingly, the doctor told her to lose weight. Another told her that her heavy weight meant that she had heavier breasts, and that was the reason for the pain. Many doctors followed, and they all offered similar explanations. In 2020, she was diagnosed with breast cancer. The diagnosis came at the final stage of the disease, meaning, not much could be done by then to help her. “Is it possible an early diagnosis could have helped her? If the doctors saw beyond the weight?” her niece said to me. I wonder the same.
28-Year-Old Tanishka's Story
A close friend of mine, one of the liveliest, most fun people I know and, most importantly, an ocean of empathy, intelligence, and, as Gen Z say, “vibes”, lost so much of herself in the process of getting a reliable diagnosis. Here is 28-year-old Tanishka's story, in her words:
“I'll talk specifically about my back injury. I had been having pain for over a year [during 2022] before I decided to consult a doctor. I was already afraid of going to one because of how dismissive they are to bodies like mine. I consulted them only when the pain got really bad.
Three doctors told me it was nothing and that I'd have to reduce my weight. One assumed that I don't exercise; most do, and it is all quite demeaning.
Eventually, after a year, I had an episode [end of 2022] where a sharp pain made me collapse. I had to be hospitalised, and an MRI was done. That's when I learnt that a couple of my discs were damaged. The assumptions doctors had about me and my lifestyle and their diagnosis being limited to my size let this huge issue go unnoticed. I grew very scared to move and suffered a lot of trauma from the injury, which I continue to battle with. After the diagnosis, I didn't step out of the house for three months because I was so paranoid about feeling that pain again. I was on painkillers during these three months, when I should've been moving my body to heal. I've lost time and confidence and faith in medical facilities.”
Seeking Confirmation For A Disease I Didn't Have
The irony is that a long time ago, in 2012, I was put on a three-year course of life-saving heavy steroids. And, no prizes for guessing, they led to weight gain. Until then, as long as I was skinny, the medical fraternity had been all too happy to look at my problems, listen to my symptoms, and even brainstorm with an international colleague to save me.
All that changed as soon as my body started to grow bigger. Now, all my symptoms had to be double-, triple-, quadruple-checked with tests worth tens of thousands of rupees, all to ensure that my symptoms were real and not mere imaginations of a 'fat' woman. When I was 40 kilograms and said that I was suffering from acute pain in my stomach, bones or pelvis, the doctors were sympathetic and believed me. When I became a lot, lot heavier and complained of pain in my pelvis area, 11 different doctors across the best of hospitals and clinics in the country told me that because I was fat, I had PCOS. Other than my weight, there was no other evidence for it. Yet, I was forced to pay close to Rs 30,000-35,000 in a year to seek confirmation for a disease that I did not have. All reports said that I did not have PCOS, and yet, all doctors were convinced that my medical issues had to be ‘fat'-related.
No doctor ever cared to look at my body as a whole, beyond the layer of fat that envelops it. No doctor cared to look at my brain and get it scanned. Until finally, one did. And what if I had believed those numerous others earlier? What if I had gone on trying to lose weight, starved myself in my desperation to get skinny and ‘better'? How long - or late - would it have been before I would come to know of the pea-sized invader making me sick?
(Anwiti Singh is Assistant Producer, NDTV)
Disclaimer: These are the personal opinions of the author