Me, Hiding My Fat
My gastroenterologist prescribed me a dietician for guidance doing the Low FODMAP’s diet to help with SIBO (small intestinal bacterial overgrowth). Normally, I would handle a diet plan myself, but I wanted to do it right, and every website seemed to differ on what low FODMAP’s meant. Also, I did not expect to wind up dealing with body shaming.
I made an appointment with a local dietician. It went terribly. Somewhat foolishly I made a follow-up appointment because I thought anyone could have a rough day. I didn’t want to judge someone based on one meeting. These are moments I look back on and get frustrated with myself. As I near forty, it’s time to learn that my time is valuable and I can usually trust my first impression. The woman was not having a difficult day; she is just not the right person to guide me in any direction.
Where Things Went Wrong
After listening to her story of Lyme disease and SIBO and how she saved herself, she put me on a scale and gave me the fat pinch test. I have not had a fat pinch test since high school when the belittling gym teacher at our school, who was more jock than coach brought us into his office one by one to pinch our fat. School pictures of all the cheerleaders hung on the walks and shelves—a statement that shows I was in high school years before #metoo. No one enjoys having their fat pinched, but neither incident really bothered me. I’m aware that is one of the easier, albeit imperfect, ways to gauge body fat. It’s what this dietician did with the information that I have a problem with.
She told me that I needed to lose weight because it is my fat, not my SIBO causing all my autoimmune issues. She explained that fat creates inflammation in the body, and I needed to get rid of my fat to solve my problems. On this point, she is not incorrect. There is a link between overeating, fat, inflammation, and overactive immune response. There is also a link between undereating, being underweight and lack of immune response. Like much of life it is about balance. When I developed autoimmune issues eight years ago, I was absolutely not overweight. Fat did not create my problems. After six months of having SIBO I had put on twelve pounds. SIBO was certainly creating multiple problems for me.
Then she told me that I “hid my fat well, but that I had no idea how petite I really was.” She was going to help me lose the fat hiding my truly petite frame.
“I’m fine with losing weight,” I said, “but I’m here to learn about Low FODMAP’s.”
“Do you want to do Low FODMAP’s?” she asked me.
“No, but I want the SIBO to go away. So I’m willing to do it.”
To which she responded, “Low FODMAP’s is hard. I wish the doctors would stick to doctoring and let us handle the nutrition.” I sat baffled. That’s like cutting off the hand that feeds you. She knew my doctor has specifically recommended her.
In the next breath she insisted I was taking my thyroid medication wrong. After ten minutes searching the internet while I sat there explaining that my thyroid numbers were under control she learned that I’ve been doing it right for eight years. Guess we should leave the doctors to the doctoring.
I left feeling pretty crappy. I’d put on twelve pounds in the first six months I had SIBO before I started treatment plans for it. I wasn’t feeling good about that. It was weight I wanted and needed to lose. But for me, more important than the weight loss was getting a handle on the SIBO, since SIBO can make eating and absorbing nutrients nearly impossible, but weight gain excessively easy.
At our next appointment she had partially crafted a low fat, low cholesterol, high FODMAP’s diet for me to follow in order to lose weight. When a dietician is not familiar with over ten year old research indicating that foods high in cholesterol don’t cause cholesterol in the body and that we need fat in our diet because fat in food does not create fat in the body, I start to loose faith. I not an expert about diet and food, but I know that. It was big news in 2007.
She wouldn’t put Chilean Sea Bass on my meal plan because it was too fatty. There is something unhealthy about an individual who is afraid of healthy fats educating others about proper eating habits. I should have left then, but I stayed. I’d invested so much time I wanted to leave with something. It turns out I would be leaving with nothing. She had my plan filled with flavored yogurts (which are loaded with sugar—an item that actually does cause fat in the body and increases SIBO symptoms). Dairy is limited on Low FODMAP’s and yogurt is a no-no unless it is lactose free.
The Last Straw
In wrapping up she said, “Okay, so this plan should give you 1550 calories a day.” That’s when I struggled to hold it together. “No way,” I stated emphatically. “I’m way to active. When I hold myself to an 1800 calorie a day plan I lose weight.” She insisted that was impossible and asked me what my physical routine was. I explained again that I worked in fitness and then reviewed my general activity level which made her enquire admonishingly, “Why are you so physically active?”
The sad part is that my weekly workout routine is not a weight loss plan. I meet the recommended hours of exercise each week for basic wellness. She should not discourage people from moving more for health and wellness. In a world where 3 out of 4 people don’t get enough exercise, she doesn’t understand how much movement we require for optimal health.
I’m not delusional; I have weight to lose. I’m also a woman, and sadly that means I’m always interested in losing weight. Practitioners need to be careful in a world where we value skinny as beautiful. I’m not frustrated by the fact that she wanted to lead me to weight loss. Doctors and practitioners need to be able to talk to patients about maintaining healthy weight and tools to do that. Those discussions need to be on the table. I’m frustrated by the lack of helpfulness for why I showed up and her tactics.
There is something insidious about using terms like “hide your fat well” and “you don’t know how petite you really are.” I don’t think most people look at me and think, “Maggie needs to lose weight.” Is that because I’m hiding my fat? Her comments suggest that no one is ever good enough. You can think you look good, but fat is hiding there, lurking in places people cannot see.
Types of Fat
She referred to visceral fat (the unhealthy fat that surrounds organs). This is less common in people who carry their weight in their hips and legs (which I do). In women it is something to worry about if your waist exceeds 35 inches (which mine does not).
Her tactics reminded me of when I was in junior high and my PCP decided I should get an annual skin check because I have a large mole on my back so I made an appointment with a dermatologist. When she walked in, she said, “You are clearly here for acne.” I wasn’t but I was mortified. I didn’t even have terrible acne, but I couldn’t see that then. I just left feeling disgusted about myself and embarrassed about my skin. In the case of this dietician, all she sees is fat. The dermatologist only saw acne. Neither one of them saw me.
Now I’m older. I understand that terms like, “you don’t know how petite you are” and “you hide your fat well,” are unhelpful, twisted terminology. I have a pretty good self-esteem, but I imagine some of those comments could really demotivate a person or get inside their head and work toward an unhealthy relationship with food.
Motivation through shame doesn’t work for me. Education, guidance, encouragement, feeling like someone is listening to my issues—those help me feel like I’m working with an individual who is going to get to the root of my problems.
In the end, I paid $8 for the Monash University FODMAP diet app. It’s incredibly user friendly and so far hasn’t pinched my fat. I’ve lost about half the weight I put on when I got SIBO.
Based on feedback from readers I wanted to add a little more:
First off, thank you for reading. Second, I did not write this so people would feel badly for me. That’s not the goal. I was more angry at the situation that saddened by her commentary.
Also, I truly believe there are good dieticians in the world. This is not a statement about all dieticians. In any practice there are good and bad people. I often say that good Pilates instructors are not competition for me. There is enough work to go around. Bad Pilates instructors hurt me though. They make people dislike Pilates. This is why recommendations from a trusted source is so important. But I was surprised because this dietician did come from a doctor I do like and trust.
What really bothered me beside the insidiousness of her words, was not being heard by a practitioner when I was working to advocate for my needs. It is hard to advocate for what we need when we see professionals. We get a little white coat syndrome. Here, I was being clear about what I needed and it didn’t seem to matter. This particular person had a limited scope and an agenda to push.
I came away discovering that part of advocating for our own wellness is to be willing to leave bad practitioners. That can be a pain. It feels like time has been wasted. Finding someone new could be a gamble and may take weeks. It’s frustrating, but it is better than working with someone who doesn’t see the individual sitting in front of them.
This was a life lesson: to advocate for good and proper care.
To read more about young girls and body image, click here.
When women body shame women: click here.
Is your body even and should you strive to make it so? Click here.
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