Now that I have published my blog, I have been approached by several people saying, “Why Fat Geriatrician?  You aren’t Fat.”  First of all, thank you for reading the blog!  Second of all, thank you for your kindness–but I’ve got a BMI of 37.8.  Objectively and according to the WHO, I am “Severely Obese.”

So, here is my attempt at explaining why the name Fat Geriatrician appealed to me.

Fat and Old are dirty words in our culture.  We can still make fun of people who are fat and people who are old without really getting called out on it.  People assume that someone who is fat is also lazy, unhygienic, and dumb.  People assume that someone who is older is slow, feeble, and forgetful.

I see both groups as underdogs.  People fighting to be seen as who they are and not the label that society puts on them.  And boy let me tell you:

In the past few years I have come to own and embrace my size.  I don’t care about it in a vain way.  Once I embraced shopping in plus sized stores, I started jazzing up my look.  I added dresses, bright colors, and makeup.  I have never felt more fabulous or self-confident.

The only thing that worries me about my size is possible health consequences and early functional losses due to being overweight–hence starting an exercise program (see my first post).

But many people who are fat are not able to embrace their size or practice self-love.  Being obese is often complexly intertwined with other psycho-social issues.

The healthcare system can be especially judgmental (beyond health concerns) of fat people.  We are (unfortunately) becoming a majority of patients.  Medical school teaches cultural competency and has made judging certain diseases taboo (ex. HIV, alcoholism, depression).  However, doctors can still openly judge and shame obese patients–and call it counseling.

I’m constantly getting the side-eye from other doctors (who don’t know me well) about my weight.  I was shamed by attendings for my weight during my training.  I’ve heard physicians and surgeons make snide comments about the weight of patients.  And believe it or not, I was interviewing a trainee for a spot in one of our university’s training programs and this person had the nerve to give the bodycheck/eyeroll/snide remark trio to me about my weight.  If this person did that in an interview, imagine what they would do to a vulnerable patient?

Despite popular opinion fat people are not dumb.  We are actually highly attuned to this kind of behavior (I can say this as a member of the fat tribe).

There is research on weight discrimination in healthcare.  It has been found that more than half of doctors describe their overweight patients as ugly, awkward, and noncompliant with treatment.  Nearly one quarter of nurses admitted to feeling repulsed by their obese patients.  Patients pick up on this and do not come back. My working hypothesis about “noncompliance” in many obese patients is that it has more to do with a poor doctor/patient alliance than anything intrinsic to the patient. 

Hopefully I have convinced you that fat people are underdogs, especially in medicine.  Now let me convince you about old people.

One of the things I love the most about being a geriatrician is I get to work with a patient population who is not used to being seen or valued.  They are under-served, but not even on the healthcare system’s radar as being under-served because “50% of Hospital Length of Stay Days are for people age 65+.”  Access and appropriate care are not the same thing.

Anti-Ageism Rant:

Ageism is one of the only acceptable “-isms” left in America, and it is alive and well in the healthcare world.

I can’t tell you how many physicians have told me that they are experts in taking care of older adults (despite no training in aging) because they do it all the time?  The problem is they don’t do it well, and they don’t know it can be done better.  Older adults can also be ageist against themselves in a healthcare system–insisting that their symptoms are due to age.  They also rarely want to admit that they are older adults and that they could benefit from the expertise of someone in geriatrics.   We have a branding problem in our field.

One of my geriatric idols/attendings used to say “Older adults are the canaries in the coal mine for healthcare.”  He was so right.  As we age we become more vulnerable, and our fractured healthcare system that has been set-up for middle aged adults can be downright dangerous for older adults.  When something can go wrong in healthcare, it will go wrong for our older adult patients first.

So I have embraced a career of taking care of these underdogs and their caregivers.  It is more fulfilling than you could ever imagine to see someone who has been told, “oh you are just wetting yourself/forgetful/falling/etc because you are old,” and then making them dry/think clearly/stop falling by practicing good geriatric medicine.  It is life changing for the patient, and brings me so much joy as a doctor.

I also love geriatrics because we fear weight loss.  It is a harbinger of functional loss and declining health.  So I got to stop having the uncomfortable you need to lose weight discussions with patients who weighed less than I did.  Instead I get to give the “you can ditch your low salt, low carb, low fat diet–just please eat,” talks!  They are much easier for me as a fat doctor.

I think that being a fat “underdog,” and experiencing hidden prejudice in the healthcare system myself is a big part of what drew me to the field of geriatrics.  And therefore, it seemed very fitting to put these two ideas together in the name of my blog.

So there you have it!  Fat Geriatrician for the Win!

Hello World!

Welcome to Fat Geriatrician.

I am your host, The Fat Geriatrician.

Why start a blog?  Why call myself Fat Geriatrician?  Why in the heck am I thinking about a flamingo meditating on a lotus in the picture above?  I’ll try to tackle the first 2 questions in this post.

To answer those 2 questions, I’ll need to fill you in about a little group on Facebook called Physician Moms Group (PMG for short).  This is a group of over 70k moms who are also doctors (MDs/DOs).  In addition to being bad-asses and generally killing it at life (hahaha), we post about all kinds of things related to the Dr. Mom Life.  (We mostly post about how we don’t feel like bad-asses, and how we are are sucking at the Dr. Mom Life).  For the past 2 months Facebook has labeled me a conversation starter in the group.

I don’t know if I should be proud or horrified at all of the wasted time that represents.

Any-who, I recently made an anonymous post on the group (yeah, it didn’t even count towards my conversation starter status), and I got tons of responses.  One person (a conversation starter in her own right) even commented,

“All I know is that I am so darn proud of you! Also, I had a really hard day and you made me laugh so thank you! Maybe start a blog about your journey! You are a great writer!”

The then she quickly followed it up with,

“And to be clear I am not laughing at you… just you casually describing hanging off a bike in the dark as “a weird experience” and “I may have broken my vagina.””

Her comments were the inspiration for me to start this blog.  Instead of wasting my time with random (usually too long) posts on Facebook, why not collect everything in one place?

I bet you are wondering what could I have written about that made her respond like that?  Why did a total stranger tell me to start blogging?  I guess I’ll open myself up and claim that anonymous post here:

FYI–I did go spinning again after that post.  It took me 5 full days to recover enough that I could bend my legs again.  On the 6th day I went back on the bike.

Hopefully you are starting to see where the Fat came from in my name.  As a part of this blog, I will intermittently write about the struggles and humorous situations I find myself in because of my size.

In addition to defining myself (and being defined) by my size, I also define myself through my profession, Geriatric Medicine.  Hence the Geriatrician portion of my name.

I’m an academic geriatrician and clinician educator.  What does that mean in normal people speak?  I’m a doctor (MD) who specialized in caring for older adults (instead of pediatrics, cardiology, surgery, etc), and now I work in a medical school setting.  I teach other doctors how to appropriately care for older adults.

Insert first anti-ageism rant here:

Older adults are not just antique versions of middle aged adults! 

As you can guess, I’m passionate about my chosen field–so there will likely be many posts about geriatrics too.

I hope you’ll join me on my journey.  It won’t all be about being fat or being a geriatrician, I promise.  (Don’t forget the flamingo on the lotus!)