The other day, I was chatting with a woman while we were waiting in the grocery check out line. We discussed the loud rain outside and smart strategies to get into the car without getting drenched. As we chatted in this long line, we eventually got to the area with the magazines. She commented on how she wished women didn’t think they had to be so scantily clad on covers in order to get picked for movies. My feminist ears rejoiced and I nodded in agreement.
We discussed female actors we enjoy in movies.
Me: (Pointing to the People Magazine cover with Melissa McCarthy) She is such a smart actor…great comedic timing and multifaceted.
Line Friend: I don’t like her, she’s **while going from chirpy to hushed** fat.
Me: (momentarily paralyzed)
Line friend: I wish she didn’t make that new clothing line because that just encourages obesity. And laziness. If she was smart, she would just eat less and exercise more. Then she would be healthier. It’s not rocket science.
Me: That’s funny. I am a dietitian and in my work I have learned we can never know how much a person eats and exercises by looking at them. We also can’t tell how healthy they are by looks. I have met many fat women who can run 2 miles in the time it takes me to run one. And, by the way, nutrition science is just like rocket science yet even more complicated.
**mic drop**
Rather, I heard the cashier say “Do you have a VIC card?”
What does this woman in the check out line have to do with your PCOS?
Everything.
This anonymous woman demonstrated cultural beliefs about fat people: lazy, stupid, gluttonous and untalented second class citizens worthy of only tent-like clothes. Just by looking at Melissa McCarthy, this woman knew her cholesterol panel and SAT score.
What if this check out line woman was your doctor?
This is called weight stigma. Here’s a great PDF from the Binge Eating Disorder Association describing exactly what is included with weight stigma.
Eating
As I experienced the grocery check out line conversation, I thought of many of my PCOS clients. I’ve heard hundreds of women recite eating plans well below their nutrition needs full of wholesome health promoting foods only to feel like a failure. Even though they hard-core diet, the scale doesn’t budge. Family members, doctors, dietitians, clergy, therapists, and our culture say that is not good enough. If a person is not losing weight then they are not doing enough.
I want to scream from the mountain tops: STOOOOOOOP!
This way of thinking sends many of my clients with PCOS to reach for fad quick weight loss diets so extreme they are considered eating disordered. The scale may budge for a second yet extreme efforts always end up harming. These extreme measures led most to binge because of human physiology combined with high insulin levels. Ever feel like attacking a plate of brownies while cutting carbs? That’s oxaloacetate (from the Kreb cycle) and neuropeptide Y (a brain chemical) working with your hyperinsulinemia (feel like rocket science yet?).
Here’s a secret: healthy eating without scale obsession is possible. It may or may not change your weight AND it still makes you healthier. Here’s more on this.
Exercise
A woman with PCOS once told me the shame she felt when a man approached her in the weight room. He said, “I think it is so great you are here doing this.” My client looked around hoping she was the only one working out at 6 am and he was complementing her early bird arrival. Nope the room included a dozen other people. He walked away and didn’t make a peep to anyone else. Why did he single her out? She knew: she was fat. And, the shame washed over her as she decided to never go again.
Weight stigma keeps many women with PCOS from moving in a way that feels good and energizing. Plus, eating so little leaves the muscles rarely energized enough to feel like exercising. We know consistent movement helps manage high insulin levels and other side effects of PCOS. Instead of being a slave to the gym, consider how your body enjoys to move. I love My Big Fat Fabulous Life’s Whitney Thore’s Big Girl Dance Class and Debra Benfield’s Curvy Yoga retreats. More people are wise to including all sizes in gyms and yoga studios but there are not enough. While we work on changing cultural beliefs on movement, check out this inspiring video.
Doctor visits
Women with PCOS, you must be exhausted. First, you had to struggle for way too long to find your PCOS diagnosis. Then, since we have such little research, you were given little to no information on how to treat this crappy condition. Then, if your weight increased rapidly, your health care provider told you to stop gaining weight. Like you were living off Twinkies and Mountain Dew. Then when weight loss proved to be impossible or only through deadly pursuits, doctors told you to just Eat Less. Exercise More. No wonder you avoid doctor visits like the plague.
I am so sorry. I hate when you go to the doctor for strep throat you hear a weight loss lecture instead of what those of us in small bodies hear: “I just need a throat culture and you will be on your way.”
I am sorry that, we the medical and health providers, didn’t listen to what you were saying. Or not saying. That you already were working your butt off and doing as much as humanly possible. On behalf of health and medicine, I apologize.
Weight stigma keeps women with PCOS from going to the doctor. The eating and exercise assumptions along with cultural stereotypes we all hear in our heads are sugar coated shame injectors. And, not going to the doctor keeps you from the most important parts of PCOS treatment: knowledge and early detection. Many of my colleagues and I are working to unveil weight stigma among health and medical providers. I think they will see the light *fingers crossed* soon. Here’s some research so far. It’s a handy PDF you can send your doctor.
Or mom.
I am rethinking my conversation with my check out line friend. I think next time I hear the whisper “she’s fat” I will pause. Take a breath. Then say:
Hello, my name is Julie. And I am a fat activist.
