“Maybe you should lose weight?” How doctors gaslight women like me

by Miriam Swallow Adler

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Healthcare gaslighting (also referred to as medical gaslighting) is the manipulation of a person by healthcare professionals forcing them to question their thoughts, memories, and the events associated with how they physically or mentally feel.
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Losing weight would be good for me, no matter the psychological, emotional, and yes — physical cost. It’s basically the only medical advice I get thanks to healthcare gaslighting.

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I think I have an eating disorder (and thanks to healthcare gaslighting my doctors only made it worse).

I look over — I probably shouldn’t — and see the psychiatrist who’s assessing me scrawl down ‘ED???’ in big letters. As if that wasn’t enough, she proceeds to circle it, once, twice, three times. I guess that means it’s a big deal.

This is my third psychiatric assessment in as many weeks. I’m trying to get mental health support on the NHS, and if I didn’t need the help before — I most certainly do now. The assessments, in and of themselves, are traumatic. Every time I open my mouth, I feel as though I’m losing weeks of recovery. Floating backward in time.



We’ve gotten through the trauma bit; I cycled through the shit in a robotic monotone — mum, alcohol, abuse, fire, illness, the day the dog died, the mess of it all. So now, we’ve moved on to sleeping and eating. She might as well just ask — ‘On a scale of one to ten, how dysfunctional are you?’ — (not sure, can I ask the audience, or phone a friend?)

I just admitted to her that sometimes I forget to eat for like, three days. That, and I make myself regurgitate meals sometimes. Not often, but still. It’s a thing I do. I wonder — does disordered eating become an eating disorder? — apparently, in my case, somewhere between throwing up chinese food in the restaurant toilets and eating nothing but a couple of packets of thai sweet chili crisps over the course of two days. Hm, I thought that was just a student thing.

‘I only do it when I feel too full, when I’ve eaten a lot.’ I hurry to say. ‘Does that make you feel ashamed?’ she says with her eyes. ‘I just feel too full, like it’s up in my throat. I don’t stick my fingers in or anything, I just regurgitate what I can until I feel better. It’s like I’ve eaten too much, not in a moralistic way, just in…a biological way. You know?’ — I suspect she doesn’t know. It’s at least a six on the dysfunction scale.


Read more: Who decides when severe and incurable chronic pain is “intolerable”?

I’ve never been formally diagnosed with an eating disorder. I’m not on the cusp of danger — not dangerously thin. According to my BMI (which is a sham, by the way) — I am obese.

Strong-boned, stocky, rubenesque, plump, short, fat — ‘obese.’

I can’t help but think that my weight has something to do with why I’ve never been diagnosed. I have low self-esteem when it comes to my flesh prison, I miss at least 4-5 meals a week (10 if you count breakfast, which you should). Half of all the times I eat at a restaurant, I throw up in the toilets afterward because ‘I feel too full.’ My new thing is zero things — fanta zero, coke zero. I haven’t hit zero food yet. I sort of worry that it might be a matter of time, though.


Healthcare gaslighting: how all my symptoms are ‘apparently’ caused by ‘fat’

I’ve brought this up with my doctor. He knows that I make myself throw up. Yet he, and all of the other medical professionals in my life don’t seem too worried. Again, I’m not thin. Not even close. Still, this is me hurting myself. What else could it be? Well, if The Media™ is to be believed — this is self-love. Fat people are allowed to exist in this world if, and only if, they are trying their hardest to get thin. That includes radical methods — uneccessary operations, self-loathing, bands and balloons and a whole lot of pain. Otherwise, they deserve whatever shit’s coming to them. Lazy bastards. Staying fat is hurting yourself.

Unfortunately, my doctors seem to side with Big Brother on this one. I’m constantly pressured by medical professionals to lose weight. Never mind that I probably have an eating disorder, can’t exercise without injuring myself, and am already a fucking vegan — losing weight will apparently solve all of my problems — including a rare genetic disorder. I call bullshit. I call this healthcare gaslighting.

In fact, the only reason my unbearable chronic pain defied diagnosis for so long is because of medical fatphobia.

‘I’m in excruciating pain,’ ‘I dislocated my wrist — again,’ ’I hurt all over, and I can’t sleep’ — are all met with the medical mantra of ‘lose weight, and you’ll feel better.’

Of course, I was in pain, I’m fat. That’s what you get when you’re fat.

No, I’m in pain because I am accumulating soft tissue injuries faster than my body can recover, and you should have figured that out by now, you bastards.

Bastards. How many people are left to writhe in pain, left with worsening illnesses, and worsening prognoses, all because someone took a quick look at them and decided that their diagnosis was ‘fat’?



Also, just how many fat people have been congratulated for losing weight, when in fact, that weight loss was a symptom of something awful — an eating disorder, a digestive issue, cancer?

How many people will have died because of healthcare or medical gaslighting?

I understand why my doctors don’t care whether or not I have an eating disorder. It’s twofold. First I’m not thin. I am anemic, but never mind that. I’m not thin. I am not wasting away. They conclude that it cannot be urgent. Second, I’m not thin. Losing weight would be good for me, no matter the psychological, emotional, and yes — physical cost. It’s basically the only medical advice I get.


Why is my disordered eating not considered a problem? I demand it to be a problem! How far do I have to go for you wankers to worry about me? What’s the cut-off point, and is it measured in kilograms?

When will you recognize my self-loathing as a pressing psychological symptom, and stop assuming that it just comes with the territory? Why is it considered normal for fat girls to hate themselves? Why is every crash diet, missed meal and coke zero not met with suspicion, and alarm?!

Medical professionals, society, get your shit together. Enough with the healthcare gaslighting.

Friends, don’t congratulate your mates when they lose weight, ask them how they’re doing. The answer may surprise you.


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Miriam Swallow Adler - Bio Photo
Article by Miriam Swallow Adler

Miriam Swallow Adler is a tired young person who writes, sings, and illustrates things while moonlighting as an Oxford University student.

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