Sabrina Kelley, now 55, went straight from puberty to menopause while still in her teens, when she had a pituitary tumor removed. Despite eating healthily and being a varsity cheerleader, tennis player and runner, Kelley gained weight inexplicably. Then, in college, she went from a size 10 to a size 18 in less than a year.
“The doctors persisted in telling me about obesity, diabetes and hypertension among Black women and told me to exercise more and drink more water,” she says.
After four years of misdiagnosis, and after seeing five endocrinologists, two nutritionists and an internist, she was finally diagnosed with Cushing’s disease. A pituitary tumor caused her to produce excess hormones and gain weight.
Women have used #diagnosisfat and #fatphobia to call out medical providers who misdiagnose, ignore and stigmatize them because of their weight instead of treating them for blood clots, fibromyalgia, heart disease and more.
Between the discrimination, working and going to school, insecurity about her appearance, and symptoms of the disease, Kelley was hit hard by depression.
“I would come home from work and just lay in the middle of the floor and cry because I was really coming to the end of myself. I just felt like if something doesn’t give ... I was very suicidal,” she says.
“There are other [ways] you can tell this is secondary weight gain. But [the providers] missed them. They only saw a big Black woman who didn’t want to be healthy,” says Sylvia Gonsahn-Bollie, M.D., an award-winning physician and dual board-certified obesity specialist.
'The doctors persisted in telling me about obesity, diabetes and hypertension among Black women and told me to exercise more and drink more water,' she says. After four years of misdiagnosis, and after seeing five endocrinologists, two nutritionists and an internist, she was finally diagnosed with Cushing’s disease. A pituitary tumor caused her to produce excess hormones and gain weight.
While it may be true that CDC data shows that Black women have the highest rates of obesity in the United States, at four out of five, Dr. Gonsahn-Bollie wants to shift the conversation to solutions.
“All of these statistics just get massaged and repeated, so they almost become a pronouncement, without looking past them,” she says.
Keisha Ray, a 36-year-old assistant professor at the University of Texas Health Science Center at Houston, was twice misdiagnosed because of her weight. At 19, she was told by her doctor that losing weight would help regulate her periods. Five years later, extreme pain ruined her family vacation, and an emergency room visit uncovered a severe condition. It was unrelated to weight.
On a different occasion, although Ray prepared healthy meals and exercised regularly, she gained excessive weight in a few short weeks. Again, doctors told her to diet more, an inadequate solution to a problem that was never properly addressed.
“Eventually, I had a physician who gave me actual diagnostic tests and found biological abnormalities that explained my symptoms and required medication and surgery,” says Ray.
It’s bad enough that weighing in can elicit strong emotions like anxiety, guilt or shame, but health care providers, like anyone else, can be biased toward race and weight. Unfortunately, for the patient, the stigma can last a lifetime.
Dr. Gonsahn-Bollie urges her colleagues to revisit the way they assess obesity.
“The newer data says that BMI [body mass index] tends to overestimate obesity in Black women. It needs to be adjusted for race, ethnicity, age, biological sex and metabolic health conditions like hypertension, diabetes and high cholesterol. We also need to look at waist circumference and body composition,” Dr. Gonsahn-Bollie says.
But that’s only the start of the conversation.
In her March 2022 article in Physician’s Weekly, “The Obesity Disparity in Black Women: How to Be More Inclusive,” Dr. Gonsahn-Bollie suggests physicians not internalize the statistics as Black women wanting to have obesity. Instead, she advises them to take an implicit bias test, such as the Harvard Implicit Association Test, examine their racial and weight biases and be more inclusive.
It’s bad enough that weighing in can elicit strong emotions like anxiety, guilt or shame, but health care providers, like anyone else, can be biased toward race and weight. Unfortunately, for the patient, the stigma can last a lifetime.
“That [stigma] headlined every health care document about me, whether it was the 18-year-old obese Black woman, the 29-year-old obese Black woman, the 53-year-old obese Black woman. It’s constant,” says Kelley.It’s not your imagination or your fault.
For generations, Black women have experienced discrimination in health care. Dr. Gonsahn-Bollie recalls that her own fear of gaining excessive body fat was based on her grandmother, who arrived in the United States from Liberia with hypertension and diabetes and almost blind from glaucoma due to a lack of medical care. The doctor was afraid she would develop the same health conditions if she gained too much weight.
“I saw how she was treated as a Black woman, an immigrant and someone who was overweight. That’s probably what I internalized, even more so than my experience, when I gained the extra weight. I felt like a failure, because this was the thing I had been trying my whole life to avoid,” she says.
Every woman, every person, has their own happy weight, and that is decided by you.
Dr. Gonsahn-Bollie admits that for a long time, her self-esteem was tied to her weight, until she embraced the fact that her beauty and skills extended far beyond a number on the scale or a dress size.
“I had internalized a lot of the bias myself, on myself, and what the expectations were of me as a young Black physician who’s supposed to be exemplary in health, in my opinion,” she says.
For nearly a decade, women have used #diagnosisfat and #fatphobia to call out medical providers who misdiagnose, ignore and stigmatize them because of their weight instead of treating them for blood clots, fibromyalgia, heart disease and more.
Finally, in November 2020, the American Medical Association recognized racism (systemic, cultural, interpersonal and other forms) as a serious threat to public health, progress in equity and appropriate medical care. The AMA also noted that patients will be reluctant to seek medical care if they sense that providers stigmatize them. The added stress and lack of trust can lead to more weight gain, more serious health conditions and less equitable treatment.
In health care, every patient must be assessed individually; the details matter and paint the bigger picture more accurately when they are considered and acknowledged. Assumptions and quick conclusions can steer those who most need help in a very dangerous direction.Focus on wellness.
“Every woman, every person, has their own happy weight, and that is decided by you,” says Dr. Gonsahn-Bollie. She wants her patients to look for wellness in non-scale victories to silence the societal noise that prevents us from knowing which size and shape make us feel most like the “it” girl in our bodies.
To steer the conversations with patients, she asks:
- Do you feel more energetic?
- Are you choosing foods that love you back?
- Are you eating because you’re physically hungry, or are you trying to fulfill emotional needs with food?
- Do you have fulfilling community and spiritual connections?
- Are you sleeping well?
- Do you feel sexy?
- Are you having sex?
And it seems to work. They tell her they feel seen and heard; and as one patient says, “I don’t have to wait to be a certain size or act a certain way to be beautiful and healthy. I can start feeling that way now.”
For more information about being healthy and well at any size, visit The Association for Size Diversity and Health, and If Your Doctor Mentions Your BMI, Say This…
