285 pounds. Forty-three years old. Summer 2024.
“Have you thought about GLPs?” my primary care physician asked as she listened to my heart.
I laughed nervously. “No, but I am now.” Humor has always been my shield.
She didn’t flinch. “Your BMI is over 40. You’re at risk for all sorts of health conditions. Why don’t you look into our weight-loss program?”
My labs were fine. But that didn’t matter. My body size alone was enough to warrant a prescription. I left feeling ashamed, reminded once again that medicine sees fatness as a disease in itself — regardless of actual health indicators.
This wasn’t the first time.
In 1995, I was 14 years old and weighed 367 pounds when an endocrinologist bluntly told my mother that I would “likely be bedridden by 20.” He described my legs as “enormous” and referred me to bariatric surgery. Soon after, I underwent a stomach stapling procedure that left an eight-inch scar down my chest.
At the time, pediatric weight loss surgery was quite rare. But to my doctors, my fat body made it acceptable — even necessary.
The procedure turned eating into a cycle of pain and vomiting. Food lodged in the tiny passage created by the staples left me doubled over until I threw it back up. I became, in effect, a medically induced bulimic — praised, nonetheless, for my weight-loss “success.”
Within a year, I had lost nearly 100 pounds. Friends, family and even acquaintances congratulated me. No one saw the violence done to my body or the damage it did to my relationship with food. They didn’t know the surgery left me dependent on ice cream, crackers and mashed potatoes because I could easily chew that stuff down to a pureed consistency to avoid the pain that followed whenever food got stuck in my staples. After the surgery, and even still today, I can’t tolerate most fruit — too acidic — nor many vegetables — too fibrous. Stomach stapling didn’t make me “healthier;” it only made me thinner.
That surgery didn’t even “cure” me.
More than two decades later, in 2017, weighing nearly 390 pounds, I went under the knife again, this time for a sleeve gastrectomy. By then, I had surrendered to the diet industrial complex, a multibillion-dollar ecosystem built around the idea that fat bodies are inherently flawed. The pressure was relentless — to fix, shrink and manage a body that medicine had always treated as a problem to solve.
“From childhood to adulthood, I’ve been told that ‘something must be done.’ Rarely has anyone stopped to ask what living in this body actually means to me.”
And the scrutiny wasn’t limited to exam rooms. In restaurants, on airplanes, at conferences, strangers felt entitled to comment on my body. I’ve been mocked for eating a donut, told loudly in a food court that I was “killing myself,” and subjected to humiliating requests to be reseated on flights. I’ve even overheard cruel remarks in a language people assumed I didn’t understand. Those moments left wounds far deeper than any heat rash or bruise from too-small chairs.
Society’s obsession with fatness extends well beyond personal interactions. Fat people are consistently portrayed in the media as lazy, undisciplined or morally flawed. Research has documented how these stereotypes influence health care practices and workplace discrimination. This cultural narrative seeps into medicine, where clinicians — even those with good intentions — can unconsciously perpetuate stigma.
Today, at 44, I’m on Wegovy. Reluctantly. When I started, I told my doctor my goal weight was 250 pounds — a number that, at 5’10”, felt right to me.
Now I weigh 235, down 50 pounds in eight months. My doctor tells me to stay on it. And I’m not sure why I’m listening.
Initially approved to treat Type 2 diabetes, GLP-1 medications like Wegovy are now viewed as a breakthrough for weight loss, but for me, they feel like another chapter in the same story: doctors offering interventions driven less by my actual health and more by the fear and stigma that surround fatness.
Why do I take it? Because sometimes it feels easier to live with the physical and emotional side effects of medicalization than with the relentless judgment of others — and, most troubling of all for me, with my own internalized fatphobia.
Here’s the truth: Fat patients aren’t blank slates waiting for salvation. We know the statistics, the risks, the medical language. What we also know — often more than our doctors — is the crushing weight of fatphobia disguised as medical concern.
Photo Courtesy Of Georgiann Davis
Studies show that weight stigma in health care leads patients to delay care, avoid screenings and have poorer mental health outcomes. Weight bias, it has been argued, can also trigger stress responses, raise blood pressure and worsen metabolic markers. In other words, the judgment itself is harming our health.
And let us not forget that the use of GLP-1s can come with a whole new set of harms in the form of extreme side effects like chronic diarrhea, severe nausea and pancreatitis, all familiar side effects to those, like me, who previously underwent weight loss surgery that permanently altered our digestive systems.
While GLP-1s often lead to weight loss, research shows that the weight comes back when the medication is stopped. Similarly, long-term studies on weight loss surgery reveal that many patients eventually regain a significant portion of the weight they lost. This cycle of losing and regaining weight — often called weight cycling — has been linked to negative health outcomes, including increased risk of heart disease, high blood pressure and metabolic issues, some of the very conditions weight loss interventions are intended to prevent. And once you are caught in the cycle, which research suggests is triggered by social stigma surrounding fatness, it can be incredibly hard to break free.
Obesity medicine is booming in large part due to GLP-1 drugs. But if we don’t confront the bias that underpins it — the reflexive assumption that fat equals sick — we will keep reproducing the same harm.
Medical education is part of the problem. Physicians-in-training often harbor implicit anti-fat biases and receive minimal guidance on treating patients with respect regardless of weight. Moreover, BMI — a tool used ubiquitously — is a flawed instrument. It correlates poorly with health outcomes when considered alone, and often oversimplifies complex metabolic and social factors.
Although many people assume that a fat body is inherently unhealthy, research shows that body size by itself isn’t a reliable predictor of mortality risk. This is especially the case when other metabolic risk factors, like high blood pressure, diabetes or high cholesterol, are absent. Exercise physiologist Glenn Gaesser has long emphasized that it’s fitness, not fatness that better predicts long-term health outcomes. And the two are not directly correlated — fat people can still be fit and healthy, just as thin people can be unhealthy.
We must also not forget that fatphobia is rooted in racism, as sociologist Sabrina Strings outlines in “Fearing the Black Body: The Racial Origins of Fat Phobia.” The earliest traces of fatphobia weren’t about body size, but about white folks distancing themselves from Black people, specifically Black women. When medicine jumped onto the fatphobia bandwagon, the fear of Blackness morphed into an ideological fear of obesity, and false claims that body size and health are synonymous.
It’s time for change. Medical schools must teach that BMI is not a proxy for health. Doctors must be trained to treat fat patients as whole people, not as problems to solve. Health systems must recognize that weight stigma itself causes measurable harm, and implement policies to mitigate it. This means redesigning exam rooms with appropriate equipment, training staff on inclusive communication, and reevaluating the language used in medical records, prescriptions and treatment plans.
From childhood to adulthood, I’ve been told that “something must be done.” Rarely has anyone stopped to ask what living in this body actually means to me. Rarely has anyone asked how the shame of constant surveillance affects my well-being.
I may continue to take Wegovy, or I may not. What I do know for sure is that any decision I make about weight loss is shaped more by how society treats fat bodies than by concerns about my health. Fat people can be healthy. Fat people can be happy. But in a culture obsessed with shrinking our bodies, it’s incredibly hard to believe that’s true, let alone live as if it is.
I am more than the size of my body. Every fat patient is. Medicine needs to learn to see us that way, or exam rooms will continue to be places where our health and happiness take a backseat to thinness at all costs.
“Five Star White Trash: A Memoir of Fraud and Family,” by Georgiann Davis, is forthcoming from New York University Press. Georgiann describes it as an unflinching queer response to JD Vance’s ”Hillbilly Elegy,” in which she guides us through her extraordinary life filled with medical, familial and criminal fraud.
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