I raised this question on an Internet Discussion Board and asked people who considered that they were overweight to contribute. I received the following replies and these are reproduced below with the permission of the writers and in their own words.

Notes:

The contributors come from mostly English speaking countries with the majority coming from the USA, Canada and the UK.

Some of the comments relate to services which are specific to the country of the contributor.

The Population of the Bulletin Board is approximately 34,000 active and registered contributors with many more unregistered readers.

The weights of the Contributors fell within the range 81 kg – 227 kg (180 lbs to 500 lbs / 12 stone 12 lbs to 35 stone 10 lbs)

All Contributors were aged over 18.

Contributions were collected during January /February 2009

The term BBW is an abbreviation of the term Big Beautiful Woman and generally refers to females over 81 kgs (180 lbs / 12 stone 12lbs) The male equivalent of this is a BHM – Big Handsome Man.

The term SSBBW is an abbreviation of the term Super Sized Big Beautiful Woman and generally refers to females over 137 kgs (300 lbs / 21 stone 6 lbs. The male equivalent of this is a SSBHM – Super Sized Big Handsome Man.

The abbreviation WLS refers to Weight Loss Surgery in all its variations.

Contributor 1

That repeatedly trying to take my blood pressure with a too small cuff will only result in pain and bruising, not in a BP reading. To keep different sizes of speculum, as it’s embarrassing when I am told that they need a longer one for me, but don’t have any, resulting in smear test not working. That, as I’m 44 and not stupid, I probably KNOW what healthy eating is. That only having scales that go up to 20 stone, yet trying me on them, is only annoying and embarrassing. That someone can be 18 stone and fitter and healthier than someone of 9 stone. That we should be told by them that Chiropody is free on the NHS, for diabetics. This should apply to any services available to us. That we are sometimes too big to even wear one gown the right way round and another back to front… so get some that are just bigger!!

Contributor 2

That they realize that chairs with arms in a surgery is not only painful its embarrassing and is enough to put people off going to the Dr for routine check ups etc and means they will only go when problems get so bad it leaves them no option. That being asked if you are fat for a reason or just that you are a pig isn’t constructive, and yes I was asked that by a Dr once! That not every medical condition is caused by being overweight! Equipment that will take larger weights is a must, scales, toilets – as well as all the things xxxx said! Working elevators are a must when you have to go to different floors for tests/ treatment etc. Dont ask me to to walk up three flights of stairs then look surprised when I can’t catch my breath and my BP is up! Don’t patronize us we are fat not stupid, helpless or worthless….

Contributor 3

Dear God, please tell them that supersize does not necessarily = low self-esteem and sad lives lived in quiet, lonely desperation. I realize that’s not health-specific, but I’ve confronted that from do-gooders in my own family twice in the last month and I’ve had it up to here.

Contributor 4

As xxxx said, have a chair in your waiting room I can sit in! And another in the examining room. Not every fat person has diabetes, and if I tell you I’ve recently had my glucose tested and it was fine, don’t secretly add it onto other blood tests you’re running (causing me an extra charge my insurance won’t pay for!) just because you don’t believe it. (May not apply with the NHS, I guess.) An electronic scale that goes up to 1,000 pounds can be had for a couple hundred dollars (or whatever the pound equivalent is). Suck it up. That we likely know more about dieting than they do, as we’ve probably done it a whole lot more than they ever have. That their failure to accommodate larger sizes is detrimental to health in that people often avoid the doctor because of discomfort/discrimination they encounter there, making it less likely things will be caught early. Scolding and shaming are likely the least effective ways to elicit compliance. We need a health partner, not a parent.

Contributor 5

Look at me as a human being that needs your help, not just a patient.

Contributor 6

Consider the fact that fat may not be my fault, and your job is to treat it as a symptom, and not a diagnosis.

Contributor 7

I feel so doggone lucky with my doctor. She is very fat-friendly, which encourages me to have regular checkups. All things being equal, she would prefer that I weren’t so fat, but all things are rarely equal. She admits that I am much healthier than many of her thin patients, who assume they are healthy simply because they are thin, and therefore abuse their bodies. We seem to agree that informed obesity management works very well for me. And starving myself and fighting my body for the rest of my days simply to be thin would probably be counterproductive in the long run. A positive attitude works wonders, and methinx fat and happy is much healthier than thin and miserable. I wish more doctors understood this.

Contributor 8

Please think about medicine dosage based on body weight. it’s dangerous to constantly be taking not-quite enough antibiotics. Please have “hats” for collecting urine samples. I will need help getting up on the exam table, assuming it even can hold me. Lying “flat” on an exam/treatment surface is NOT comfortable or salubrious or effective…I will need bolsters/pillows. Don’t make any assumptions about birth control or STDs from my size. Expect I’ll need a talented phlebotomist. I might *not*, but that is your job to provide someone skilled at blood-taking, not me to put up with painful and ineffective jabbing Armless chairs – it can be more than just a comfort issue. if you are in some kind of pain already, then it can be just that much more worse/impossible. Bathroom design is crucial! and crucially more important in times of medical duress. handles/bins right next to toilets block usage as do the usual handicapped bars (not the wall ones, the ones right next to it sometimes)

Contributor 9

This just reminded me of another one–for heaven’s sake, do not assume that fat women don’t have sex and therefore might not be pregnant. More than once I have had x-rays and had to specifically ask for the lead blanket to protect my girly areas. It annoyed the heck out of me that they just assumed I wasn’t and didn’t bother to ask. My pregnancy might not have shown but why make assumptions when the effect to my unborn baby could be so serious?

Contributor 10

Bathroom design – definite hospital thing to consider! Wall mounted toilets and Supersized people are a no-no. Please provide me a bedside commode fit for a fat lady, or commode that fits over the toilet so I don’t feel like the toilet is going to fall to the floor with me on it. Same with the shower benches. The adjustable shower head and ADA handles are good, but if I need to sit in the shower, I’d rather not land up on my ass on the floor because the wall mount feels like it’s buckling under me. Gowns – I know the exist in my size, I got one on the first day, how about a note to housekeeping to put one in my clean linens every day Bariatric beds: maybe the bed can hold up to my weight and more, but the air mattress under me not inflating right because it’s straining under my weight, that’s disconcerting. Socks: I don’t have too fat of legs and cankles compared to my size, but stockings and TEDS and booties to fit my feet aren’t expensive, why not have a box in supply and ready to use? Armless chairs for reclining and using for therapy are good. Why not have them in a room for the fat lady? Not one person mentioned my weight during my recent stay. It was me who had to bring it up with the student nurse or the mechanical department when I asked them to shore up my toilet and my shower bench. It was me who had to ask for the larger TEDs, but my nurses always found a gown for me when I needed one.

Contributor 11

While I love my current doctors, in the past, I have had some real pips. One in particular made me pretty much hate the entire medical profession til I found my current docs. This moron blamed EVERY illness or problem on my weight, to the point that I refused to go see him unless I was desperate. I went in once for strep throat, and he said to lose 50 lbs. Another time (the last time I saw him) I went in for Swimmer’s Ear infection, and he told me to lose 50 lbs. That was it for me. I told him, after he wrote the prescription for antibiotics, that when I read the article in JAMA that thin people don’t get ear infections I would pay him. Never did write that check………..

Contributor 12

What I wish doctors knew was that there is a time and place for the “weight” discussion, and not to blame the weight for illnesses that are not even remotely caused by excess pounds.

Contributor 13

If you’re in the medical profession, get over your fear/loathing of fat, or stand the hell up and refuse to take fat patients. We can see it on your faces when you’re disgusted with us, and it’s just as unpleasant for us to deal with you as it appears for you to deal with us. This goes for your office staff as well. Don’t focus on my weight, but don’t ignore it. I know I’m fat. I am more than willing to discuss how my weight affects my health, but I’ll immediately discount everything you say if you immediately blame everything on my weight. If you have fat patients, become more knowledgeable about how obesity affects us. Don’t assume that every condition I have is because of my weight. Keep up with emerging technologies and information in regards to fat patients… there’s more out there than what you learned in med school. Don’t push us to lose weight. DON’T assume WLS is perfect for all of us because you read it in a journal, or your aunt’s neighbor had it. And DON’T KEEP PUSHING US TO GET WLS. It’s fine if you offer the information, but if we turn it down, we have reasons. Have accommodations for me. I’m not the only fat person you’ll encounter, so large BP cuffs, large gowns and, dare I say it, armless chairs. We’ll adore you for this. Know the weight limits on your equipment, and the equipment which might be used for testing your patients. And please, a little discretion and kindness if someone is too fat for XXX-machine – you don’t have to coddle us, but shouting out weight numbers isn’t helpful either. Help us to find suitable resources if testing is complicated by our size. Listen to what I have to say. I’m smart, and I do a LOT of research. Some of what I find may be nonsense, but some of it may not. Don’t pass off what I’m saying as crap just because I’m a patient… I’ve come up with some good resources/treatments in the past. Nurses – if possible, get experience/training on finding veins in fat arms. I’m more than happy to help you train people to do this if it will help the next fat person. Ask me – I like to help. Just because I’m fat, it doesn’t mean that I’m not extremely interested in and knowledgeable about my health. Don’t make assumptions about my habits or life because of my weight. Ask me if there’s something you want to know.

Contributor 14

I would add is for medical professionals to please keep in mind how scary a simple trip to the doctor’s office can be. Most of us have experienced the barely veiled looks of disgust or disapproval, or a complete lack of eye contact, and most of us have experienced feeling like a pain in the ass because we do have some special needs and requirements at the doctor’s office. If we’re there because something is wrong, we’re already frightened and worried, and to have to deal with being treated as though we’re somehow lesser humans when we’re in an already emotionally vulnerable state is even worse. For many of us, it takes a tremendous amount of courage just to pick up the phone and make an appointment, never mind walking into the office.

Contributor 15

I really hate it when doctors blame everything that’s wrong on weight. I have been to doctors for allergies, colds, flu and they say…lose some weight. I fell off the steps to my apartment and hurt my ankle and my doc suggested dieting options while I was in immense pain.

Contributor 16

Its not just doctors, I have found many nurses to be very insulting. I went to the ER last year because I was feeling so sick. After the nurse check my blood pressure, she decided to ask if I was on a diet. I said no, she then told me that when I start to diet and exercise more often I would lose weight and then I would get a boyfriend. I was sooo shocked and angry I was speechless, but my boyfriend was in the waiting room at the time!

Contributor 17

I have actually been told by medical practitioners to be quiet because THEY are the ones who went to med school. It’s xxxxxxxx – I know my body better than you, O Doctor to the Gods. It IS possible I know about something you don’t. Example (ok, this is a nurse or phlebotomist, but whatever): When I say to take the blood out of the back of my hand, do it. I don’t care if you don’t think it works. Yeah, keep shoving that fucking needle into all manner of locations in my body and subjecting me to pain ONLY TO TURN UP WITH NO BLOOD. Finally stick it into my hand and see that, oh, it works, and she’s not yelping, amazing!

Contributor 18

Sigh. When I say I’ve been over 300 pounds for most of my life, and over 200 pounds since age 11– listen to me. Don’t assume I am lying, because, no, it’s not a result of compulsive eating. When I say I don’t have x symptom or y disease/illness/etc.– don’t stare at me in awe. When I say I don’t want to lose weight, don’t scoff in disgust and label me truant.

Contributor 19

Some of us, as my medical file says are and can be in “remarkable health”. Please don’t pressure us to have WLS especially if you don’t know that the side effects can be much worse than being healthy and fat.

Contributor 20

“Salad” is NOT a treatment. Thank you.

Contributor 21

PLEASE just treat me respectfully. I am a human being. We can have the weight chat once, but not at every appointment. Make a note that we had the weight chat in my file, so that you are covered. Please don’t ask if I have “ever considered WLS” as if it were a new and novel idea. Of course I have, of course every obese person has. If you can’t do these things then please tell me and I won’t come back.

Contributor 22

Many times when setting up a first appointment with a new doctor I want to ask the receptionist if my being overweight will be a problem for the doctor, but I just don’t have the nerve. I wish I did.

Contributor 23

Here’s a couple of big ones (pardon the pun) GET A BIGGER CAPACITY SCALE. This accomplishes many things. You get an accurate weight, and we feel as if we’re not the alien that just landed on Planet Thinny. Having appropriate equipment will give the doctor and their stuff much credibility in our eyes. This very simple piece of equipment can help you earn our trust. BELIEVE US if we say your scale will not go high enough to weigh us. We KNOW when it won’t work. Do not say “oh, let’s just try” with a cute smile. This makes us angry. Most of us are aware of our approximate weight, and we’ll tell you if we aren’t. Some of us are uncomfortable with being weighed. Unless you need an exact number for dosing or other vital info – don’t push us to get on the scale. I know my fat body best – listen to me if I tell you something has changed, or something isn’t right.

Contributor 24

In some cases, I’ve been misdiagnosed or it has taken longer to get a diagnosis because a doctor assumes that something is being caused by my weight, when it’s actually completely unrelated. The thing that is especially stressful for me is when it comes time to draw blood. They automatically go for the back of my hand and don’t even bother to look for a vein in my arm. I hate that because a needle to the back of the hand becomes sore and painful for the rest of the day They really really really really really need to train phlebotimists and nurses on how to look for veins on a fat person. I’ve had nurses that had zero problems doing this and I’ve had nurses suck their teeth at me and use more force or pressure than they needed to out of frustration. I’ve had this happen so often I know exactly which vein they should use and tell them “This vein is good.” and point to my arm. I’m starting to think that if that vein takes any more pokes it won’t work, if that makes sense. That can’t be the only vein I have that is close enough to my skin for the needle to reach it. Bigger equipment: gowns, needles, cuffs, longer stirrups (I can only scootch down so far, any farther and the table will tilt), sturdy examination beds, armless chairs, digital scales that go past 350lbs.

Contributor 25

Medical professionals that blame every thing on our weight, or who won’t look past the weight to treat the actual problem are just exacerbating the problem. I don’t want to hear the question “So what are we gonna do about your weight?” unless I bring up the issue. Stop using BMI measurements to quantify health problems because it’s a useless tool. If a body builder has the same BMI as I do (I don’t have high bp or high cholesterol, or diabetes and I exercise regularly) and we look the same on paper…. Look me in the eye when you talk to me, and don’t use that tone of voice – they know what I’m talking about. I need a doctor not a parent. To therapists: don’t assume we’ve all been sexually abused as children or that we are automatically addicted to food. Actually listen to what we have to say. To OB/GYNs: don’t assume that fat women don’t have sex. When I ask for birth control I don’t want to hear “What do you need that for?” And don’t skip the questions about my sexual habits or answer for me when you do ask “Are you sexually active?” The answer isn’t always automatically “No.” And if a fat woman becomes pregnant don’t tell her she HAS to loose weight or that she should eat one meal a day. If she expresses concern about loosing her appetite “That’s a good thing.” Shouldn’t be the answer. Also please do not automatically assume a natural birth is out of the question for a fat woman just because a cesarian is easier for you. To all medical professionals: I know that medical degree means you know more than I do about how the body works, but it doesn’t mean you know everything. If you don’t know how to treat fat patients (and I’m not just talking about bedside manner) then admit it so I can find a healthcare professional who does.

Contributor 26

Fat bodies don’t bend and move the same way a thin body does. Please bear this in mind when devising or assigning therapeutic exercises.

Contributor 27

Dear Dr E.

Just because you duck your head and preface it with “I have to Ask”, mentioning WLS during my visit is not productive. You don’t have to ask, and if you want to have a real conversation about it, spend the time with me. Mentioning WLS or Banding in a 15 minute office visit is not the answer. I am going to tell you that NO I am not interested, but give me the opportunity to explain why. We need to put that topic to bed.

You may treat me with respect and we have a good relationship, but your nurse gives me the evil eye. She is curt and looks at me like I am a second class citizen. Your attitude is not the whole office attitude. I wish you would do a temperature check.

You and your staff need to be more familiar with the capacity, weight limits, and applications of your equipment. I should not have to tell the new nurse/temp that the small blood pressure cuff will give a bad reading, and hurt like hell. It should also not surprise them when I have trouble getting on the table. Offering a hand would not kill them.

When I asked you to get a bigger scale, you did it. Thank you for being responsive to my needs. The fact that it is kept tucked away in a corner and has to be taken out to weigh me it a bit odd. It doesn’t help that when it is taken care of its corner it is in a main passage of the office.

I will put up with a lot to get medical care, I always have, sometimes even with you I feel I get less than I deserve, and you are one of the better ones. I’m probably not going to complain but it keeps me from mentioning all the things I need to discuss.

Please understand that if I come in complaining about foot pain, knee pain, or anything that causes an impact to my mobility that it is a HUGE DEAL. Any mobility I lose for even a short period of time is life altering. For every day I am off my feet I lose ground, the balance of living life in a supersized body is upset. Make suggestions on what I can to to keep going. Would a cane help? A brace, a bandage? I need to keep going, keep moving.

I am your patient, I am unique, I am also supersized, there has to be something you can go to be more aware of supersized issues while at the same time understanding that I am an individual. I know it is not easy to do, but that balance has to be there or we I don’t get the medical care I need.

Sometimes I ask myself if you went to the medium sized people medical school and only learned how to treat medium sized people.

I like you, and do recognize that you have made the effort to understand some things, I think of you more as an incase of emergency. I really wish you were more of a partner in my care.

Sincerely,

The fattest person I have ever seen in your office.