The Fat Doctor Podcast

Casey's story: When good intentions aren't enough

• Dr Asher Larmie • Season 5 • Episode 31

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 Casey is a passionate, well-meaning therapist who believes in weight-inclusive care but freezes when clients bring up medical concerns. They've learned about anti-diet principles through Instagram and podcasts, but lack the medical knowledge to counter doctors' weight-focused advice. When a client receives a devastating diabetes diagnosis with the usual "lose weight" lecture, Casey wants to help but secretly wonders if the doctor might be right. Add in family pressure about their own weight, hostile colleagues questioning their approach, and the constant fear of professional consequences - and you have a dedicated professional caught between their values and their limitations. In this episode, I explore why therapists like Casey deserve support, not judgment, and how we can bridge the gap between good intentions and confident, evidence-based practice in the fight for weight-inclusive healthcare. 

For anti-diet and healthcare professionals, it's time to stop second-guessing your weight-inclusive approach, and get the research, tools, and professional certification to confidently counter medical weight bias:
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Hi! Welcome to episode 31 of the Fat Doctor podcast. I always hate the first line of every podcast I've ever recorded, by the way. I just hate it, I feel so awkward before getting to the swing of things. But welcome! Come on in! Take a load off, sit down, let me make you a cuppa. I'm just kidding, I can't make you a cuppa, but I hope you have a nice drink.

Maybe I'm with you on your run today, or maybe you're in your car fighting traffic. I don't know what you're doing right now, but whatever you're doing, hi, welcome.

I'm Asher, a non-binary, transgender, fat doctor, who is trying very hard to challenge the medical profession and make it a safer place for fat people. One doctor at a time. Just kidding. It's episode 31, we're talking about Casey today.

For those of you who have picked up on the pattern, on the third week of every month, I create a character. Often they're a patient, or they're an amalgamation of patients, because I don't want to use one particular individual - that's completely and utterly wrong and unethical. So I sort of amalgamate patient experiences that I've come across over my 20-plus years of medical practice.

And we kind of have a little chat about them. And today, I'm going to do something slightly different, because Casey is not a patient. Casey is the well-meaning therapist.

Casey is non-binary, all my characters are non-binary, not because I have a non-binary agenda, or a transgender agenda, although I do rather want to have a transgender agenda. But because I like the idea of making them non-binary and giving them gender-neutral pronouns so that you can imagine them however you want to. You can put your own picture in your mind's eye. Make them what you want. So, Casey...

I'll tell you they're in their 30s. I'll tell you that they are fat themselves. And they are mixed race. Add a bit of something interesting to the dynamic. Maybe we'll make them queer as well, so they have a real understanding of what it feels like to be someone that holds more than one marginalized identity themselves. Right? They are genuinely passionate about health, exercise, anti-diets. Body neutrality, they have... you know, they really care about the stuff. I've got an Instagram account, it's lovely.

They work in private practice. And in doing so, they see a lot of clients that are struggling with body image, not necessarily the reason they come to see Casey, they come to see Casey for all sorts of reasons, but body image comes up a lot, unsurprisingly, if you're a therapist.

So let me tell you a little bit more about Casey's professional journey, alright? They went and studied, and they started their therapy with very traditional weight-focused training. I have not studied to be a therapist, I have not got a degree in psychology, I do not have a PhD in psychology. So, I don't know what one has to do in order to become a therapist, but I'm guessing that the training, even though it's not going to be that focused on weight, is still going to be weight-focused training. It's going to be weight-centric training.

So, they believed for all their life, A, because of what they were told in the world, and B, because of what they were told during their training, that it's better to be thinner. Being fat is bad for your health, and that part of improving a patient's health, or client's health, is to help them to get thinner.

But Casey had their own awakening about diet culture harm through their own personal experiences, and you can make up in your head what that personal experience was. I'm not gonna tell you. But they came to their own understanding and realization. They are very much self-taught on anti-diet principles through Instagram, through listening to podcasts like mine, obviously. Reading books, you know, they're self-taught, because they certainly didn't learn it in school, when they were studying. So, it's all self-taught stuff.

Casey truly believes in weight-inclusive care, but lacks the formal medical training, but that's formal training, because as I said, they're learning a lot of this stuff through Instagram, through podcasts, through books. There's nothing wrong with that, by the way. Absolutely nothing wrong with that. I don't want anyone to be under the impression that the only way to learn about something is to do some kind of degree, or course, or have some kind of professional certification. I do not believe that at all.

Some of the best professionals I've ever worked with have been the ones that were very much intuitive. Like, they knew this stuff without having to be told this stuff. I just had a sense of justice. And I truly believe that a sense of justice is, for me, the starting point. You know, it is the center of what makes a person a good practitioner of any kind, professional of any kind. Especially in healthcare. If you've got a good sense of justice, then you are already halfway there. And actually, maybe even further than halfway. If you care about people, you have empathy and justice, then you're doing really well. And that's... and Casey has those things, alright?

So, Casey is a well-meaning therapist. Casey feels very confident discussing body image, discussing diet culture, very confident as they should be. But tends to freeze a little bit when their clients bring up medical concerns, like, you know, my doctor says I need to lose weight for my blood pressure, or for my cholesterol, for my diabetes, or whatever.

Casey relies on phrases like... All bodies deserve respect. And they do. But can't necessarily counter medical arguments. Poor Casey! It's really hard, isn't it? Really hard. Because they want to, but they just can't. Well, why should they?

Casey secretly worries that they're doing harm by not addressing these health concerns, because they basically, they kind of freeze up, and they kind of sweep it under the rug, or they'll say something like, all bodies deserve respect, and their client's like, yes, thank you, and the validation is really important, and the care and the empathy and the sense of justice, all these things are super important, like I'm saying. These things matter. A lot.

But at the same time, Casey wants to support their fat clients but isn't necessarily prepared for medical pushback. And Casey's having a little bit of an internal struggle right now. You understand the internal struggle, right? They've had a few incidents of late that really calls into question themselves, their practice, and are we doing the right thing. Am I doing the right thing by my patients? Am I doing it by my clients? Am I doing the right thing by myself, as well, like, you know, for myself. So.

I had a client recently who was diagnosed, newly diagnosed with type 2 diabetes. Comes in absolutely devastated, like, bawling their eyes out. This, by the way, is based on me. We can just put... I'm just gonna be honest with you, the client is me.

So client, like, had felt the sort of threat of diabetes looming over their lives for a really long time. The client is young, the client went in to see their doctor for something random, the doctor said they were going to do a set of blood tests, then they got a phone call saying you need to come in to discuss your blood test.

Came in, the doctor, you know, looks up from the computer screen, takes off their glasses, looks at them and goes, I'm afraid to tell you you've got diabetes. Type 2 diabetes, then goes on to tell them about 10 minutes about how this is a weight-related condition. You know, that's caused by eating too much carbs and sugar, and can lead to heart attacks and strokes, and sight loss, and kidney damage, and kidney failure, and... you name it, you know. And the only solution is weight loss, and cutting down on carbs, and gives them the real sense, this poor client, that they're to blame, they're at fault.

The only solution is weight loss, and I'm gonna, you know, put you into the diabetic nurse, and we're gonna have to sign you, and we're gonna sign you up as diabetic now, and of course, the client knows now, you know, next time they're applying for travel insurance, they're gonna ask the question, are you diabetic? Yes, I am. So the insurance premium just went up, just doubled, instantly, just like that. You know, when they go to apply for a mortgage, they might get denied, or they go to apply for life insurance, good chance they're going to get denied, because they're fat and diabetic now.

And they're young, this poor client, like, is in their early 40s, we'll say. Maybe 41 and a half. Yeah. So this poor client is devastated, like, inconsolable, bawling their eyes out. Really, really sad.

And Casey really wants to support their client. Casey's also worried about getting diabetes? Because Casey is under the impression that being fat causes diabetes, because why wouldn't Casey think that? That's what everyone believes, including doctors. Including politicians, including the media, including everybody. Everybody says that being fat causes diabetes, so of course Casey's worried that being fat causes diabetes, so how to console this patient? This client, do... I don't know, therapists call them patients or clients? I don't know. I keep switching the two. I mean whatever the right one is, I'm sorry for getting it wrong.

But yeah, what to do? Casey's thinking deep down, like, I need to support my client, I need to be there for my client. And at the same time is thinking... But maybe the doctor's right. Maybe they do need to lose weight to manage their diabetes. You know, or, like, is worry genuinely worried? Doesn't want their young, you know, this young person to have a heart attack at a young age? Like, genuinely cares.

And so there's that conflict, right? And Casey realizes, I don't know what the actual evidence says. Maybe they listened to the Fat Doctor podcast at one point in time, and the Fat Doctor went on about the fact that being fat doesn't cause diabetes, but that's not enough. Like, okay, cool, like... somebody on a podcast said so, isn't enough to convince them that actually. No, you don't need to lose weight.

And even just, like, wanting to support client, as they go through the process of the diagnosis, and et cetera, et cetera, you know. If you're an anti-diet professional, you want to be able to say, yeah, no, I support you, I support your decision to not engage in weight loss. Also, to be able to spot, by the way, this is really common, how people with diabetes who have a history of eating disorders. Even if they choose to not pursue weight loss, which is great. Will often fall into the trap of changing how they eat, because that's what they've been told to do, and that will often trigger an eating disorder, and eating disorder is very common amongst diabetics.

So, maybe Casey has some concerns about this client, for that reason as well. All of these things are coming up just because Casey just doesn't have access to the information. Right? Tricky. And at the same time, deep down inside, Casey's worrying. This could happen to me. This is something I'm struggling with. This is something I've been warned about. Okay? At the same time...

Casey's family and loved ones, also family, right? They are really concerned about Casey's weight, especially since a few years ago, Casey made the decision not to pursue weight loss anymore. Like, that is a real issue for Casey's family.

Casey's got a mother who has been dieting her entire adult life, but probably even before. Casey suspects has an eating disorder, has always had an eating disorder. You know, their mum has an eating disorder, but it's never been diagnosed, this isn't anything sore, this is healthy behaviour that gets celebrated by doctors, you know, and healthcare professionals, and by everyone else, for having such control over the body and their weight. And so... That's really problematic. Casey has two siblings.

One of whom had weight loss surgery. Let's say 18 months ago. And so, there is a lot of talk about the surgery. There's also a lot of talk about the shots. Okay, you don't want to do surgery? What about the shots? The shots, the shots, the shots, the shots.

And sometimes Casey's family are subtle about it, but most of the time they're not. Sometimes they bring, you know, printed handouts to, you know, family get-togethers, they're constantly mentioning it, comes up in the group chat all the time, the shots. The surgery, the weight loss, the shots, the surgery, the weight loss, the this, fat, that fat, and it's just... It's background noise that just doesn't go away. And again, it's just really hard, isn't it, to stand on your own. And everyone around you is pushing in the opposite direction.

And they're really fucking tactless about it, and they're really mean about it, actually. They're cruel sometimes, and they don't care. Because they're doing it because they care... they tell you that it's about you, they're concerned, oh, I'm just concerned about your health, you know? And that gives me a reason to say whatever I want to say, do whatever I wanted to, and stigmatize you day in, day out, and harass you, and trample all over your boundaries, even if you're very clear about your boundaries.

Because I love you, and I just care about you. And isn't... I mean, how many people are listening to that and going, oh my god, that happens to me? Because it happens to me, or it used to happen to me. I'm quite lucky now that there's nobody in my life that gives me weight loss advice, but that certainly used to be. So yeah. And then there's colleagues as well.

So your client's bookcase, it's got the clients, they've got their family constantly harassing them. And then... and then... Poor Casey has this horrible colleague that they work with. Never got on with Casey, never quite took to them. Maybe it's because Casey's young, maybe it's because of the way Casey looks, maybe it's because of the way Casey presents themself.

This other therapist is not a fan. And at one point in time, during a practice meeting, actually openly questions Casey's approach, like, weight-inclusive approach, in front of all of their colleagues. So something along the lines of, like, aren't you worried about enabling unhealthy behaviours?

Enabling unhealthy behaviours. That's the... That's healthcare professionals' sort of speech for glorifying obesity, right? Like, layman's term, glorifying obesity. Professional term, enabling unhealthy behaviors. I'm gonna get mad at this hypothetical therapist who doesn't actually exist. It's about a meeting that never actually happened. But it just makes me angry.

Because supporting fat people to do something that actually is evidence-based. And, more importantly... is supporting your clients' sort of autonomy, right? Right to choose what happens to their own body.

How is that enabling unhealthy behaviour. Isn't autonomy, healthy behaviour isn't... aren't boundaries a healthy behaviour? Aren't... isn't the right to not to engage in something that is... there's no evidence to support it. Isn't that, like, healthy behaviour?

It's not unhealthy, it's healthy. In fact. When they say healthy behaviour, they just... they mean... you know, you're encouraging this patient to stay fat. And... I think we as professionals are taught that that is literally the worst thing that could happen.

Fuck autonomy! Like, fuck justice, and all of that stuff, agency, all these things that we claim to believe in and to uphold, and all this stuff. Goes out the window when it comes to being fat. It's like, all of these apply unless you're fat, in which case... all that gets thrown to the wayside. What's more important is becoming thin. So... God, these situations. I have been in these situations, and you freeze, right? You freeze in these situations, and you go...

You kind of stutter, and you don't get out what you need to say, and then you leave, and then, like, you're pissed with yourself that you didn't say the right thing, and... you know, it can really... it can be quite harmful, it makes me, certainly when this happens, it makes me want to sort of withdraw into myself, you know, because someone's questioned me, and I haven't been able to... give the answer they were looking for, so then they have the kind of air of superiority, well, I was right, you were wrong, you can't even defend yourself, kind of thing, and why should I have to defend myself, or whatever. I don't know, who... I just, as I'm thinking about it, like, I'm feeling flushed, just thinking about how horrible that situation is. So, poor Casey. Anyone else feeling really sad and sorry for Casey?

Like, they really just... they deserve... There is more than that. They deserve to... to be able to practice the way that they want to practice, and for sure. There are people out there that could really do with a therapist like Casey.

But yeah, Casey's struggling. And questioning, and wondering. And struggling to... to... to support their fat clients. But at the same time feel very unprepared for, like, these kind of medical or health-related concerns, this pushback. And I think the diagnosis case is questioning their own credibility.

Like, am I really like... am I right? Am I... am I sure I'm right? Like, I think I'm right, I'm pretty sure I'm right. And some days, maybe they're feeling really confident, maybe they've listened to a podcast, or they've seen something on Instagram, they're like, yeah! And then other times they're like, oh, maybe not.

And then, of course, there is the direct threat to Casey's well-being. Like, if... the other professionals in the practice decide that they can't support Casey's, sort of, beliefs, what are they gonna do? Fire them, or I don't know how it works, do you get fired? You're asked to leave, or stop them from doing it? Like, you know, there is the kind of, like, the bottom line thing. At the end of the day.

I often think this, but I... as much as I care about other people, I have to put my own needs first. I need to be able to, you know, pay my bills, and look after my own family, and support myself, and resource myself. Like, these are things that are really, really important, like, and I'm sorry, but they come... they are more important to me than anyone else, including all of you listening today.

So, the same thing applies to Casey. Like, they have to prioritize their own well-being, and their own bottom line. And of course, if they're worried about losing clients, or losing their job, then that is a real problem.

And I think Casey's heart is very much in the right place. And also that there are knowledge gaps, understandable knowledge gaps. And these are the people that, like, are really on my heart at the moment.

The people who, like. You know, when I think about... how... how we... how we're going to make as a medical profession, a safer place for fat people. How we are going to... how weight-inclusive medical practice is going to become the standard.

Because that's what I want. I want it to become the standard. Weight inclusive care should just be the standard, because it is, without doubt. When you look at the evidence, the better way of looking after people. It is the... it is... is just superior in every way. So, we need weight-inclusive medical practice to become the norm. We need weight-inclusive medical practitioners. We need the healthcare profession as a whole to be a safe place for fat people, and it's not.

It is a dangerous place for fat people right now. And so, when I think about, like, how is that going to happen. There are many, many ways to approach it, but one of the things we need is we need. We need the professionals who are gonna become leaders in their own field, right? We need... The people who are going to stand up and say, no. That's wrong, this is right, this is the way forward. Like, it... we can't... we can't... create systemic change until we have. The people in place to be... on the ground. To be able to enforce this change. Because I... doctors are not going to go willingly, and the weight loss industry is worth hundreds of billions of dollars. And so... it's not gonna be an easy or a smooth ride. There will always be forces working against us, as it were, so we need...

People in place on the ground right now. People like Casey, this well-meaning therapist, who really genuinely wants to continue practicing in a weight-inclusive way. And need support to do that. We need to be coming together and thinking about this, like, how are we going to... make that possible. You know? Like, as a group of people who are invested in this vision. I have a website, NoWay.org, it is... The website for the No Way Movement, and on there, I have... I'm gonna actually... I'm gonna Google it, I'm on my computer. NoWay.org, folks. And on there is...

What is the no-way movement? The No Way Movement exists to dismantle medical weight stigma by exposing the lies that underpin weight-focused healthcare, from biased research and industry-funded guidelines to media manipulation and political pressure.

We're working towards a fundamental shift in medicine, from weight-focused care to evidence-based, weight-inclusive practice, where every patient receives equitable treatment, regardless of body size.

And the crisis we're facing, we've reached a critical point in healthcare. Decades of prioritizing profit over people, with politicians and policymakers enabling systematic oppression of fat people. Has conditioned to society to believe that discrimination is medically justified.

The weight loss industry's relentless anti-fat marketing strategy has created a culture where healthcare professionals feel entitled to stigmatise. Traumatize and dehumanise the very patients they're meant to help. The recent aggressive promotion of weight loss injections... I'm gonna put this over here, because I keep looking at it, and it's out of sight.

The recent progressive promotion of weight loss injections with drug companies using corrupt and sometimes illegal tactics. To influence medical professionals. Shows just how far we've fallen.

Meanwhile, fat patients continue to have their symptoms dismissed, their diagnoses delayed, and their treatment denied. Leaving many without hope and afraid of their own doctors. Our vision. We envision a world where fat patients feel safe and welcomed in healthcare settings.

A world where they receive equitable, evidence-based care regardless of body size. Where weight monitoring and unsolicited weight loss advice are eliminated from medical practice. Where healthcare providers are trained to recognize and address their own weight bias. And when no one fears or avoids medical care because of their body size.

The path forwards. This crisis is not normal, nor is it inevitable. The system can be changed. We can choose a better path. Evidence-based, weight-inclusive medicine where every patient receives equal care regardless of body size. Where symptoms are investigated, not dismissed. Where weight becomes a protected characteristic, not grounds for discrimination, where doctors are trained to recognize their bias, and fat patients are empowered. To demand better. It says, the lies have had their day, the truth. Will out. And that's what you see when you go to the No Way Movement website.

I encourage you all to join. Us, the movement. And I'm not gonna lie right now, the movement is me, and some wonderful members of my community. To build a healthcare system that serves all bodies with dignity, respect, and evidence-based care.

So, there are lots of free resources on this website. So, if you're a fat patient, or just anyone, really, and you want free resources, free, kind of, weight-inclusive resources, loads of free resources. Specifically looking at medical conditions, et cetera, et cetera, so head on over to the website for that.

As you probably all know, I'm writing a book. More about that over the next few months. And, the book is. Called No Way, Everything You've Been Taught About Weight Loss is a Lie, and, yeah. Over the next few months, I'm gonna really need your support. To help... get this book into people's hands. But we're not there yet.

Then there's also for anti-diet professionals who want to get their medical evidence and practical tools they need to practice weight-inclusive care with complete confidence. I am speaking to you right now. I have a program, I spoke about it last week, I'm sure the doors have opened now, and you can join the program, I hope. Some of you are joining the program, if you know an anti-diet professional that you think would be suited for this program, please signpost them to the No Way Movement website.

This program is for people like Casey. I designed it for the Caseys of this world, because the Caseys of this world deserve support. They are going to become leaders. Amongst the... within their profession. I genuinely believe that. The Caseys of this world. Are ahead of the curve.

And I want to support them. To be able to stand up to those shitty colleagues. And to the well-meaning family. And not stand up to the clients, because it's not what I mean, but to be able to support their clients. In a way, that feels good. And honours their own intuition, and just gives them the support and the backing to say, no, no, no, no, no. I'm right here, you know, so they're no longer questioning their own. Their credibility. Or their own integrity.

So, yeah, that's where I'm at right now. That's what I've been doing. Very excited about, where this is headed. I genuinely believe... I believe in this course. I really do. This is... years of... research and... reflection and refining the message. This is... You know, me, I've spent... a long time putting this together. I don't want to just... carve else it or phone it in, I wanted to do it properly.

There are literally hundreds of references, clinical references. Most of them are... horrible way, stigmatizing, offensive studies, but still studies that support. What I've been saying. And, yes. I'm very proud of it. I'm very proud of the work, and I'm very proud of what we are... trying to achieve. The No Way movement, you know, it's interesting. One time I started out, I was like, oh, I have to know exactly what we're doing. Like, I need a 10-step plan.

So that... and then... That's just how I am. I'm the kind of person that likes a 10-step plan. And then, either I had a 10-step plan and it didn't work out, or I was like, I have no fucking clue what the 10-step plan is. So right now, all I can tell you is I've created a movement. Or I'm creating. And creating movement.

There's a website, there's some free resources, I'm writing a book. There's, of course, a professional development, and... And then everything else is just gonna happen. That's what happens with a movement, right? And I am so... Like, up for listening to anybody and everybody's ideas about what... how, like, how to. Push this movement forward. I'm not trying to... control or micromanage this movement at all. In fact, would be very happy to hand over the reins of things to people.

So, if you have an idea, if you have a thought, a comment, a question. About the NoWay Movement. Check out the website, comment on the YouTube video. Send me a message, send me an email, send me a message through Instagram, I don't know. Message me. You can even send me a message through the. The podcast. Yeah, I've got a voice answering system, if you want to do that. But yeah, let me know. I'd love to hear from you. I read every email, and I respond to pretty much every email where possible. So please do get in touch.

Thank you very much for listening to me this month. I'm taking a week off now. I'll be back at the beginning of October. I don't know if it's one or two weeks off, but yeah, I'll be back at the beginning of October. And, you take care of yourselves in the meantime.

Thanks