You Deserve Better: The Fat Doctor's Reassurance on Your Right To Healthcare

In a healthcare system that routinely dismisses, blames, and denies treatment to fat patients, it's easy to doubt whether choosing to stay fat is the right decision. But here's the truth: you deserve a doctor who listens, believes, and validates you—regardless of your size. You have the absolute right to refuse to be weighed, to refuse weight loss, and to demand treatment without prerequisites. The ethics are clear, even when the reality feels impossible. This episode is your reminder that you're making the right choice, and that the fight for dignified healthcare is both justified and winnable. 

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Chapters

• 2:44 What You Deserve From Healthcare
• 19:01 Your Right to Refuse
• 28:47 The Reality vs The Theory
• 35:55 Stop Dreading Doctor's Appointments

Transcript

Hello, and welcome to episode 32 of the Fat Doctor podcast, Season 5. I'm Dr. Asher Larmie. It is October the 1st.
I don't know about you, but every year for the past few years feels like it has been going on forever, and at the same time, feels like it's flown by. It's so bizarre. I'm just like, when will this year end? But then I realized that it's not like 2026 is magically gonna get any better. But yeah, we're in October already. See? There you are. I'm still in August. We're in October.
Here I am, getting ready to record some podcasts. It's the end of September at the time I'm recording this, so not too far away from when this episode airs.
I don't know about you, but I am kind of done with all of the agitation. My soul is agitated 24 hours a day, and that is mainly because of the things that I'm consuming. By consuming, I don't mean food, I mean social media, for the most part. I'm trying not to... it's hard to stay away sometimes. Just the news in general, and just information. All the information that I'm receiving is just agitating. So, I thought, in the midst of all of this agitation, I would just bring a moment of calm-meditated reassurance to your life.
I'm going to record this podcast for fat people. If you're not a fat person, and you're listening in, I just want to say thank you very much for being here, thank you for being an ally, thank you for supporting me, I'm so grateful for you, but this podcast is not for you. That doesn't mean you won't benefit from listening to it, because listening to a podcast with fat people will benefit everybody, but I am speaking to, specifically right now, fat people.
Whoever you are, fat people, wherever you are, fat people, I'm talking to you. And, in particular, fat people who have made a choice to take a step away from dieting, weight loss, and are choosing to just be fat, and stay fat.
It's a bold choice. It's one I made a few years ago, and I am glad I made that choice. That being said, sometimes it's hard. Sometimes I need a bit of reassurance. Sometimes I wonder, what am I doing? Is this the right thing to do?
So here we are, and I'm just gonna remind you that you are making the right choice. I'm going to specifically tackle it from the angle of health, of course, because that is kind of what I do. I'm a doctor. So I guess this will be through the lens of health and healthcare, but hopefully be a reassuring podcast.
I've got a list of things I just want to say to you.
The first thing is that you deserve a healthcare practitioner – a doctor, a nurse, a midwife, a physical therapist, a therapist, whomever, every single one of your healthcare practitioners – you deserve one who listens to you, who believes you, and who validates you.
That's the case for people of all sizes. That's the case whether or not you choose to pursue weight loss. That should apply as a blanket to everyone. It is a basic human right: a healthcare provider who listens, who believes, and who validates.
Someone who is actually willing to look beyond their own stereotypes, judgments, assumptions, beliefs, their own bias, and go, yeah, I'm actually going to listen to what you have to say, rather than assuming I know what's wrong with you. I am going to believe you when you tell me stuff, so if you're in pain, I'm going to believe you're in pain. If you tell me that you're tired, and that this is just more than just regular tired, I'm going to believe you. If you tell me you've tried something, I'm going to believe you tried it. I'm going to believe you, because why would you be lying? I'm gonna believe you because you have the right to be believed. You shouldn't have to defend yourself, you shouldn't have to prove yourself to me. You should just be believed. Just like that.
And validated too, because there is something very powerful when you as a vulnerable patient share what's going on with you, or this is what I think is going on, or this is what's happening in my body, and it doesn't make sense, and it's worrying me, it's stressing me out, I'm afraid. It's really healing, actually, to be told, yeah, that makes sense. Oh, yeah, I know exactly what you're talking about. Of course! That's as predicted. All of those things are super validating, so you deserve that.
You deserve a healthcare practitioner who not only listens to you and hears your story, but also examines you. Is willing to place their hands on you and do so in a way that is healing and not harmful. There is nothing worse than being touched – actually, as an autistic person, you could just put that as the end of the sentence. There's nothing worse than being touched. There's nothing worse than being touched by someone who is visibly disgusted by you, by someone who doesn't like you, by someone who doesn't want to, is being forced to touch you because it's their job.
I was talking to someone the other day about massage, and how incredibly healing massage can be as long as you feel safe as a fat person, and you don't feel disgusting, which is often not the case. I've had a few massages I've paid a fortune for, and just been like, you clearly did not like touching my body. I mean, you get paid to touch bodies. I understand not everybody likes placing their hands on people's bodies. That's totally fine, but then just don't become a massage therapist. In the same way, if you don't like examining patients, probably don't become a doctor. Because it is a really big part of your job. If you feel uncomfortable placing your hands on a person's body, then notice you picked the wrong job, find another one.
People always say, oh, I'm squeamish about blood. Sure, that's important too, but that seems pretty minor compared to, I don't like touching people. I don't like listening to people, I don't like being around people. If you don't like that, then there's other jobs to be had.
Your symptoms are valid. They are valid. That's just it, and you deserve somebody who is going to say, alright, let's figure out what's going on here. Again, because it's kind of their job.
I'm going to talk about doctors specifically from now on. You deserve a doctor that doesn't default to weight loss advice. Imagine that. A doctor who isn't gonna just look at you, you walk in, they're like, right, the first thing I'm gonna tell this person is lose weight.
You deserve, when you start saying, you know, I've got pain, or I've got fatigue, or I've got whatever, that they don't just go, oh, that's because of your size. Do they actually engage their brain, do the thing that they were trained to do? We spent years in medical school. We started off with the basics, like pathology and virology and microbiology. We learned all about pharmacology, pharmacokinetics, and pharmacodynamics. We spent a lot of time learning anatomy and every single tendon, and muscle, and bone, and organ in the body. We looked at the different layers of the skin in great detail. We had to know where the epithelium and the endothelium met, how could you tell the difference? All this stuff. We had to learn that stuff. We didn't do it for shits and giggles. We didn't do it just so that people would call us doctor. We learned it so that we could use that knowledge and put it into practice.
We spent years going through each system of the body: cardiovascular system, respiratory system, alimentary system. We went through all of them and we learned about all the different things that could cause disruption in the body. Then we got our medical degrees, and then we went off into the big, wide world and went, whoa, actually, there's loads more to learn. And then we kept learning, and kept learning, and we continue to learn, and we specialize, and we get more and more, become more and more of an expert in our field. And we do all of these things so that we can figure out what is wrong and then try to fix it. It's kind of the point, right?
So when somebody comes to see me, and they have a symptom, I actually want to figure out what's causing that symptom and treat it. And assuming it's due to weight, and prescribing weight loss, it's lazy fucking medicine. Forgive my language. It's lazy medicine. It's like, you just can't be bothered. It's easy! I don't have to think now, I don't have to engage my brain, I don't have to use any of that knowledge and skill and expertise, I can just blame you, and send you on your merry way, and that's my job done, and I can take a bit of a break.
I get it, I get the temptation. Sometimes we all have days when we just want to phone it in and not do... but that's... again, if you went into medicine because you hoped it would be easy, that's a mistake. That was your mistake. I'm pretty sure people along the way would have told you it's not easy. So it's not like it was an easy mistake to make, and if that's what you were hoping for, an easy life, then again, wrong job. Find another one.
Because we have a responsibility to figure out what is wrong with our patients. And it's never weight. It is never weight. That's not the reason. Even if you want to argue that somebody's size is contributing to their symptoms, which I wouldn't, but even if you wanted to, it's never the actual reason.
Doctors, do better!
You deserve a doctor who treats you the way they should be treating all their patients. There are lots of studies that show... there was one really excellent study. They took a patient case history, a description of a case, and they didn't change anything in the case apart from the BMI. So we had someone who was thin, and someone who was fat. I think there were three, or maybe four. But the case was exactly the same.
They asked doctors, a whole bunch of doctors, to have a look at these cases and answer some questions about the cases. One of the things they found – they found many things – one was that the fatter the patient, the more the doctor attributed the symptoms to weight. And also, the less likely they were to treat them.
And I think that's really problematic, isn't it? When you are in medical school, they sit you down nowadays. It's all problem-based learning. I did a lot of lecture-based learning, but it's a bit better now. Let's pick a chronic disease. We'll pick high blood pressure, just for the sake of it. So you learn all about what we call the etiology, what causes high blood pressure, talk about the symptoms, the signs, and the treatments for high blood pressure. And then there's a standard protocol. You learn that in basics in medical school, then you go out into the big wide world, and then you actually have to deal with people with high blood pressure, and you learn how to treat it, and there are guidelines, and there are flow charts, and there are step one, step two. It's not difficult, anyone can learn how to do it.
Sometimes, someone will surprise you, and not respond to treatment, or have something weird and wonderful going on in their blood test, and you're like, oh, wait, I didn't expect that. For the most part, it's pretty standard.
So why do we treat fat people differently than we treat everyone else? I don't get it. Why is there high blood pressure treatment, and then high blood pressure treatment for fat people is different? And by that, I mean when a thin person, or even just a slightly overweight person, a mid-sized person goes to the doctor, has high blood pressure, doctor's probably going to mention some lifestyle thing. Hey, you could do with a bit of exercise, make sure you're getting your omega-3s and reducing salt in your diet.
Vaguely helpful advice. There isn't that much evidence to support any of this advice, but I don't think it's terrible advice. There is some evidence that reducing salt can reduce your blood pressure, and exercise is never a bad thing, especially when it comes to cardiovascular health. Well, that's not true. Exercise can be if you're over-exercising, but just general exercise advice. Get your 150 minutes a week, or whatever we're telling people to do. Omega-3s, these kind of things, they're fine, it's great, good, fine. We probably should be doing that with everyone. I think that's reasonable. I don't mind doing that when I do it.
I don't assume that the person sitting in front of me doesn't know what I'm talking about. I might say to them, hey, do you know much about diet and lifestyle when it comes to cardiovascular health? What do you know about it? And if they go, yeah, I know that I need my omega-3s and so on, and they recite it for me, I'm like, great, I don't need to tell you anything then. But if they go, no, I have no idea what you're talking about, Doc, then I might tell them. I don't just shove that advice on them and assume that they basically don't know anything, because I think that's really rude and really presumptuous. People are smart, they read, and they figure these things out for themselves, so I check in first. But then generally a little bit of lifestyle advice never goes amiss in a new onset of high blood pressure, and then we start a treatment. Simple, right?
First of all, we establish whether it is high blood pressure. I forget that, but let's assume that we've made the diagnosis. Alright.
Why is it that when a fat person goes to see their doctor, instead of getting the usual exercise, fatty acids, omega-3s, a fat person gets: you need to eat less and exercise more. You need to consider bariatric surgery. You need to start a GLP-1 to lose some weight.
Sorry, what? What happened to the reduced salt? Oh, because weight loss, weight loss is important here. Nothing else, just weight loss. Is there any evidence that weight loss will improve your blood pressure? No. No, none whatsoever, actually. In fact, there's some evidence that persistent weight loss, so beyond 6 months, and especially weight cycling, can worsen blood pressure over time.
But there's no evidence that it improves blood pressure, and even in the short term, it only reduces blood pressure by a very small amount. We're talking an average of 3 to 4 millimeters of mercury, which isn't... doesn't need to handle that. It increases cortisol, increases inflammation, does all sorts of things, increases ADH, antidiuretic hormone, actually can increase your blood pressure if you're not careful, increases your stress levels. It's not good for your blood pressure. So there is no point to recommending it.
But more importantly, why are you giving fat people different advice? And then often it's like, try and lose some weight and see if that'll bring your blood pressure down. Oh, hang on. There's no evidence for that.
And what happens is the fat person leaves the office, and then either they try and lose some weight and fail, or they don't want to lose weight, or they're just like, oh my gosh, that was really quite traumatizing, I'm not going back. Now, maybe they don't go back for 3 months or 6 months, maybe it's a year, maybe it's 2 years, maybe it's 5 years, maybe it's 10 years, who knows? But in that time, they've had high blood pressure.
The term for that is therapeutic inertia. It's a fancy way of saying we didn't treat when we should have treated, and during that time that they weren't getting treatment, their risk factors got worse, or their health potentially got worse.
So you deserve a doctor that will treat you the same way they treat all of their patients, or they should be treating all of their patients, as per protocol, as per guidelines. And it's not okay. There isn't a guideline out there that says don't treat high blood pressure, just give them lifestyle advice and send them away. That's not part of the guidelines. So it's not okay that doctors are doing this.
You deserve a doctor that will tell you, in no uncertain terms, that your weight is not a reliable indicator of your health. That will tell you that your symptoms are valid. That will tell you that you deserve treatment. That is what you deserve, because those are all true.
And now, some reassurances. You absolutely have the right to refuse to be weighed. Always. You always have the right to refuse to be weighed. I was talking to someone recently who said, yeah, but then they refused to fill my prescription. They can't do that. That is ethically indefensible.