Fat Bias Kept Me Sick — But Not In The Way You Think

Seven years ago, I found myself at the base of a mountain in New Hampshire. A group of us were going on a moderate hike ― me, my then-spouse, my father, and some family friends. The hike would end at the top of the mountain, where we would be rewarded with a gorgeous view and a picnic lunch. It was a hike that said family friends had done many times. Aside from myself and my ex, everyone here was over 60.

We walked through lush woods along a gently sloping trail that grew steeper. Did I mention that I have asthma? I do, and while this was part of the reason for my anxiety about this hike, it wasn’t the core of it.

Although I exercised regularly, I just wasn’t “good” at inclines. I got winded quickly. Oddly, I didn’t blame the asthma for this. I blamed myself. I blamed my fat body.

I’d spent weeks before this particular trip amending my usual gym routine to include ever-increasing inclines on the treadmill, trying to build my stamina for the climb. It didn’t matter. Twenty minutes into the hike, I was badly wheezing.

I lagged behind the group. Eventually, one of the family friends fell back and paused with me. He put a hand on my shoulder, looked me in the eyes, and quietly asked how I was doing. I didn’t answer. His kindness and subtlety almost made me sob, as if everyone in the group and, for that matter, every person passing us on the heavily trafficked trail, wasn’t aware that I just couldn’t do this.

As we turned back, I used my rescue inhaler, as I was doing five or six times a day. It was my only asthma medication at the time. I was relieved, but also miserable, because I had failed to do something that people decades older than me seemed to do without a problem.

Why had I failed, in spite of my preparation? There was only one answer, although it wasn’t one I wanted to admit to myself: I was fat.

This is the point where most readers will assume they know where I am going with this inspirational story. I had a “wake up call” on that mountain. I knew I needed to change my lifestyle or be doomed. I did these things and lost X pounds and climbed that mountain a year later, triumphant, healthy, moral, pure, no longer fat.

Nope, nope, nope, nope.

The missing information? I’ve been a vocal advocate for fat positivity for over 20 years. I had stacks and stacks of research and experience that told me my problem was not so simple. Fatness is not a universal indicator of bad fitness, no matter what conventional wisdom may tell us. Fat people run marathons, climb mountains and compete as Olympic athletes. And even if it was my fatness stopping me on that mountain, well, we still don’t have a safe and effective way of making fat people permanently thin, so it hardly seems worth trying to scale 90 percent failure rates for weight-loss diets, or the copious side effects, complications and nutritional deficiencies associated with weight loss surgeries. If my fat was keeping me from hiking, I figured, I’d have to learn to accept that.

I still didn’t think much about my asthma. I had medication for it ― or so I thought ― thus, it couldn’t be the problem. In fact, I’d had asthma for years before getting a formal diagnosis; I just thought my occasional gasping for breath was “stress,” or a lack of fitness, even though I exercised more consistently than anyone I knew.

I assumed that breathing hard was just part of being fat ― until one night my lungs seemed to close up completely. I tried to get to my car but finally had to call an ambulance to take me to the emergency room. After this event, my doctor sent me for testing and prescribed me medication. Two inhalers: one twice-daily medicine with a name I don’t remember, and a second for acute attacks. I took the first one for a year before stopping. It didn’t seem to help, and it made my mouth feel gross. My doctor said that was fine if I didn’t see any improvement with it. I kept the rescue inhaler.

For 10 years, this little orange-and-white tube was the only thread between me and another ER visit. I never went anywhere without my inhaler. I panicked if it wasn’t immediately nearby. When I swam laps in the pool at the gym, I left everything else in my locker but I set my inhaler down carefully, within arm’s length, at the edge of my lane, just in case.

In the meantime, no doctor ever asked me how the whole breathing thing was going. I came to think of my too-frequent rescue inhaler use as normal. No one asked, and I didn’t bring it up because, well, I was just so fat, right? This is what fat people are like.

This is the weight of the internalized fat hatred that even I, a person who has written hundreds of thousands of words on the subject over more than 20 years, was still shouldering. I believed I had trouble breathing because I was fat, because fat people are unfit, because fat people are sick. Because fat. 

I believed that, until last year.

After moving to a new state, I needed a new doctor. On my first visit, he glanced over my chart, looked at me with a combination of indignation and annoyance, and asked, “Why aren’t you on an inhaled steroid?” I shrugged. “How often do you use your rescue inhaler?” Four times a day, I said, giving the amount I was technically prescribed, even though my actual use was higher. I lied out of fear he would lecture me. Instead, he said, “I’m writing you two new prescriptions. I want you to stop using that inhaler.”

My horror must have shown in my face, because he explained, gently, “If you are relying on your rescue inhaler that much, your asthma is moderate to severe. I am giving you better medication. It will help.”

I didn’t believe him. I filled the prescriptions, along with my last refill for my old standby inhaler ― just in case. The idea of being without that inhaler even for a day chilled me with fear. I brought all my meds home. I put the new refill for the old inhaler on a shelf in my bathroom. I started using the new medication. And something incredible happened.

I could breathe.

It’s startling, how quickly some of us adapt to our own discomfort. I had lived with barely medicated asthma for so long, I didn’t know what breathing was actually like. After the medication switch, I ran up and down stairs for no reason other than to enjoy the sensation of hitting the top of the parking garage with air in my lungs. I walked briskly up hills in my new city. I did not enter a store or restaurant and see a second level with concern; I climbed the steps and arrived at the top breathing at a normal rate, like a normal person with normal breathing. It was incredible. It was like having a new body, except it was my same beloved and valued body as always. It was like having a new life.

It was also absolutely shattering.

Those weeks illuminated something: the extent to which my untreated chronic illness had affected my entire life and my ability to engage with the world for so many years. I realized that doctors had overlooked my symptoms and failed to treat me effectively.

This is true whether it happened out of simple oversight or full-on anti-fat bias, which is rampant among medical professionals, many of whom will not offer the same treatment to fat patients that they do to thin patients with the same problem, out of the mistaken and damaging assumption that fat patients are intrinsically noncompliant, or worse, not “worth” the cost and effort of treating.

But beyond that, I was angry and upset with myself. Because fat bias did keep me sick for a long time, but it wasn’t only the fat bias of doctors ― it was also fat bias hidden away in myself. I never advocated for myself on this issue. I let myself believe I was “unhealthy,” and so I failed to report my symptoms. This was a shock because I thought I knew better.

And at some point, I remembered that mountain hike ― and had the crushing revelation that I hadn’t failed to climb a mountain because I was fat. I had failed to climb a mountain because I had an illness.

I was fortunate because it turned out my illness was treatable. But I was upset that I didn’t stand up for myself. That I dismissed my own pain, that I didn’t recognize how much discomfort I was in, and that my fear kept me from demanding, with my doctors, that we figure out better treatment.

Stories about weight bias and missed diagnoses often focus on the justifiable and understandable rage in the aftermath. That doctor should have known! People die because of misdiagnoses by physicians working from prejudicial assumptions about the health of fat people. Fat people are less likely to receive life-saving cancer screenings, and often experience massive, mortality-impacting delays in accurate diagnosis because doctors (and even specialists) are often insistent that all of their problems are attributable to their weight.

What is sometimes overlooked is the fact that fat people themselves internalize the lowest expectations of their own health and don’t report symptoms, sometimes because we think we deserve them. Or at least that we don’t deserve to feel well.

We should be raging at the entire medical community for its failure to provide the same quality of care to fat patients, for putting fat patients in a position where they must fight to have their pain and illness taken seriously.  But we should also be vigilant and look inward at how living with external bias influences how we regard and care for ouselves — even those of us who know better, and even those of us who think we are immune by now.

Fat bias is an insidious poison, both physically and mentally, and none of us, not even the best role model you know, is ever fully inoculated from it.

Oh, and I haven’t been back to that mountain, haven’t done my victory climb, haven’t taken a photo to share with a teary Instagram caption about having remedied my failure with exultant success. I don’t need to. My victory was identifying the parts of my brain still trying to negative-talk me into self-loathing and then shutting them down. My victory was breathing. My victory was reclaiming my body, again.

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