Fat and Queer and Getting the Healthcare We Deserve
Let’s face it: we all know our healthcare system is broken and in need of a major overhaul. I acknowledge this and also how there are people with more pressing issues than what my wife and I recently faced.
But, this is a story that needs to be heard, as well.
There has long been a bias in this country against fat people. There is also a bias against queer folk. Combine those two traits with an attempt to get pregnant and guess what? The ignorance and biases clamber off the chart.
After much soul searching and discussion over the course of a year, my wife and I decided we wanted to make attempts to become parents. We started our journey in January 2019 with an appointment at a well-known fertility clinic here in the Twin Cities. I identify as queer, and my wife as lesbian. And we’re fat. Overweight. Obese. Pick your word.
The doctor we spoke with let us know they preferred their patients attempting to get pregnant be under a certain BMI (Body Mass Index). I’m not going to mince words here: BMI as a lone measurement of health is total and utter bullshit. My wife has a higher BMI than I do, yet I am the one that has battled Type 2 diabetes the past four years. It should NOT be used as the sole measure of health.
BMI has become a way to discriminate against fat people in healthcare. There are doctors and surgeons who just won’t provide services for folks who have higher BMIs. This often denies potentially life-saving or life-altering care for larger-bodied folks.
Yes, there are health concerns for pregnancy and surgery that are related to weight. But here’s the insidious truth: From fertility clinics to gender-confirming surgeons and others, they simply don’t want to deal with fat people because it can mess up their statistics. That’s the underlying truth and real reason they use BMI as a measure.
Typical problems that arise before, during or after a pregnancy can happen to anyone, regardless of their weight or other factors. I’m pretty sure women were having babies long before BMI was introduced as a concept.
Short, tall, skinny, fat, black, white, Hispanic — anybody can develop gestational diabetes or preeclampsia. What is a must is having a compassionate physician who monitors these things regardless.
Getting back to our story, the doctor suggested my wife lose 30 pounds and then return to start the procedure. Since we were getting married in late March and hoping to start the process in April, this seemed perfectly doable.
Despite the stress of a pending destination wedding, my wife was diligent and over the course of two months, lost the recommended weight. When we returned home following the wedding, she set up a return visit to the clinic.
This is when everything went South.
The folks at the clinic, instead of being ready to start implementation procedures as they’d said previously, now wanted my wife to lose another 45 pounds, something that would delay us for another 4–6 months when you take into account safe weight loss rates. I was incensed. This wasn’t what they had told us previously. Thankfully, one of my coworkers is married to the worlds’ greatest obstetricians. From the start of our journey, she had suggested her husband. Unfortunately, he wasn’t in my wife’s health plan, so we were reluctant. However, we were completely frustrated by the process at the fertility clinic. I convinced my wife to go see him even if we had to pay out-of-pocket prices. This was the best decision we could have made.
Our doctor, whom I also knew socially, treated my wife with nothing but respect. In our initial consultation, he informed us of possible pregnancy complications because of being overweight and asked if we could accept the risks. We said yes. He said they’d monitor my wife closely throughout the pregnancy, and they did. Not another word was said about weight. We faced other challenges before being able to attempt our first implementation, but we were successful on our first try last October. My wife gave birth to a beautiful baby girl in July.
Our doctor and his staff treated my wife with complete respect in regard to weight and age, something several of my other friends couldn’t say about their OBs. I listened to their horror stories about being (sort of nicely) called old and/or fat every checkup. This had resonated with me and reinforced my decision to go with our doctor.
That covers the fat part, now let me shift to the frustrating part of trying to get pregnant when queer.
The biggest issue is education, as in healthcare folks don’t really have any. First, everyone assumes you are at a fertility clinic because of infertility issues. That is the default despite years of lesbians getting pregnant through IVF (in vitro fertilization) or IUI (intrauterine insemination). Additionally, gay men have used these processes with surrogate mothers. And still, the default is “oh, you are infertile.”
Um, no. We have a problem called lack of semen.
Repeatedly, my wife had to tell clinic officials, as well as representatives with her healthcare provider that her issue wasn’t infertility. Heck, we had no way of knowing that because we hadn’t tried. Over and over, she had to tell folks she was queer.
Typically, the problem was inferred heterosexuality. For example, a nurse practicioner kept mentioning postpartum birth control. My wife was like, “Yeah, not going to need that.” They mentioned success rates for trying to get pregnant for a second child naturally, aka, heterosexually. Ummm, still lesbian. There was mention of how sex could encourage the start of labor because of semen. Yep, still queer, and that semen was our missing element from the get-go!
Mention your queerness each time, and they’re nonplussed, it seemed. It was as if they didn’t know what to do with anyone who wasn’t heterosexual. Perhaps some culture competency training? I’d settle for notes in our chart! Infertility and heterosexual shouldn’t be the default.
It’s tiring and time consuming to always have to educate people. It’s time for healthcare providers to take it upon themselves to train people competently. Queer folk and others who have traditionally been treated poorly in our healthcare systems are known to avoid doctors at their own peril.
Doctors treating gay men need to provide information on PrEP, or pre-exposure prophylaxis, which people at risk for HIV take daily medicine to prevent HIV. Per the CDC, studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.
Transgender folks seriously dodge doctors because of the myriad issues they run across in the healthcare system. They often face discrimination and flat-out lack of education. Many health insurance plans fail to cover the cost of mental health services, gender affirmation surgery or hormone therapy.
And can we get rid of all doctors who think women are faking pain? It’s beyond the point in time where old-school doctors who tell women pain is “in their minds” need to take a seat. Stop telling women what they are feeling! It doesn’t take an in-depth Google search to turn up horrifying stories of women who continually told doctors concerns about pain only to have it not only disregarded but ridiculed … up until the woman died of cancer or something else that could have been prevented had the doctor merely listened and respected the woman.
My wife faced this, as well, although thankfully not at the level mentioned above. She needed surgery to remove a cyst before we could make an IUI attempt. An in-network doctor told her he didn’t remove cysts that small and disregarded the actual pain the cyst was causing her. I really lost my @!^&*!! over that one.
The fact my wife works in the same healthcare system as the doctor who refused to consider her pain was the only thing that kept me from putting that idiot on social media blast. One could say that all’s well that ends well, right? After all, we were successful in our implementation efforts, and we have a beautiful daughter.
It’s time to change things. It’s time for respect and education regarding folks who are overweight or queer or POC. It’s time to put an end to old practices. It’s long past time to listen to women.
I’m fortunate. I do have privilege in many realms. It’s also time for me to use that privilege for those who don’t have it. Unfortunately, although we know there is a problem, and we know we need action instead of talk, it’s likely up to us to get what we need.
My wife is a nurse who works in a large healthcare conglomerate. The frustrating part is when she tells me healthcare staff have yearly education on these topics. So it becomes a matter of corporate offices actually providing engaging education that is more about humanizing patients, listening to them and working for them than learning which chair patients can sit in or what blood pressure cuff to use.
And yes, it’s tiring for fat people, queer people, people of color and others to continually educate folks as to their needs, but this will have to continue. It’s hard to give personal details to doctors and nurses, but it’s absolutely necessary. We have to speak up, correct them when they’re wrong and demand the respect to be treated well.