For generations, words like fat, obese and overweight have been thrown around like hand grenades. In medical settings, the damage dealt can last generations — and the victims are overwhelmingly female.
Hannah put up with the pain in her stomach for as long as humanly possible.
But after 12 months of agony she finally relented and went to her doctor for help.
It's something she rarely does. Not out of pride or stubbornness, but fear.
A fear of being judged or having her pain dismissed as a by-product of her choices, something that would simply disappear with diet or exercise.
However the constant piercing pain in her lower stomach — a suspected case of gallstones — was nothing compared to the verbal and emotional gut punch her doctor delivered that day.
"He turned around and looked me up and down and had the most disgusting look on his face," Hannah says.
"And he said to me, 'Well, you are the four Fs'.
"Fat, fertile, female and, most likely, flatulent."
Hannah was floored.
She held herself together as she dashed from the doctor's office to her car, searching desperately for a semblance of privacy.
She stayed there for the next hour, tears streaming down her cheeks.
"I just bawled my eyes out."
Her doctor told her that with a little exercise the gallstones would just disappear.
Twelve months later with no reprieve, she summoned the courage to return to a different GP.
He immediately sent her to surgery where her gall bladder was removed.
Hannah is speaking out about her treatment for the first time.
And she's not the only one.
The sound of Louise Cork's footsteps echo through the hospital corridor.
It's a setting that became increasingly familiar throughout her second pregnancy which, for a while, had all gone to plan.
But then a meeting with a midwife was anything but routine.
It was supposed to be a simple check on her baby's movements and fluid levels.
The words Louise heard left her in tears.
"Too fat to feel your baby."
"Overweight."
"Awful."
"Dangerous."
Louise was 37 weeks' pregnant and had gained around 2.5 kilograms throughout her pregnancy, which is less than the 5 kilogram recommended minimum listed on resources provided to women from birthing hospitals around the country.
"She made me stand on a scale and she lectured me about how bad my weight was," Louise recalls.
"I was already in a heightened, vulnerable state … and it really wasn't relevant to the conversation."
It was the first time any medical professional had raised an issue with Louise's weight throughout either of her pregnancies.
"I left in tears. It took away my power."
Louise filed an official complaint about her treatment after her child, a beautiful baby boy, was born with no complications.
She never heard back from the hospital.
"It made me feel like a failure. That was six years ago and I still get emotional about it now."
Harmful not helpful
The ABC has heard from more than 100 women throughout its investigation into weight stigma in medical settings.
Their reasons are different yet one thing is consistent.
Every woman felt judged by the size of their body and the standard of care they received changed as a result.
From her brightly lit practice in central Brisbane, Terri-Lynne South can't help but agree.
She says fat-shaming and weight stigma is "extremely prevalent" in medical settings.
"It's not helpful, and it's actually quite damaging."
In Australia, one in three adults are considered to be overweight or living with obesity, according to the latest federal government figures captured through a simple body mass index (BMI) test.
BMI is a somewhat acceptable measurement for large population groups but far less effective or relevant in individual settings.
Dr South, chair of the Royal Australian College of General Practitioners' Obesity Interest Group, says the language medical professionals use when talking about larger bodies matters.
She says that's because labels like overweight and obese, while technically accurate when aligned with certain diagnostic tools, have the ability to harm people rather than help.
Masses of them.
People like Annie.
Annie is a nurse. She went to a GP about an earache.
Her doctor told her what she needed to do was book in with a surgeon for weight-loss surgery and showed her a raft of surgeons in the area.
Emily's pregnancy was plagued with comments about her weight.
Her doctor refused to take her blood pressure with an appropriately sized cuff for her arm, resulting in consistently high readings.
It triggered an anxiety that led her to feel like she needed to terminate her pregnancy.
Tabitha went to her doctor because she was nauseous and vomiting, unable to keep any food down.
Her doctor asked if she was doing it on purpose to lose weight.
She was pregnant.
Zoe went to her GP for a mental health referral for suspected ADHD.
Her doctor put her on a set of scales, measured her weight and BMI and told her she was unlikely to be able to have kids.
Her husband filed a complaint and the doctor disclosed Zoe's BMI to him without her consent or request.
Chelsea hurt her back playing netball and could barely walk.
Her GP told her women — particularly obese women — exaggerate their pain and that if she "just lost weight" while immobile it would fix the problem.
She had multiple slipped discs in her back.
The O-word
Evie Gardner's story has all the same hallmarks of stigma and shame.
She says she has always felt judged because of the body she was born in, including in medical settings.
"Those experiences of weight stigma in medical settings are dehumanising and upsetting, but unsurprising."
Fat is a word she's happy to ascribe to herself, as is happy.
The word she doesn't use or own however is obesity.
In her world, the O-word, as she calls it, is seven letters with the power to do more harm than good.
Her experience inspired her to pursue a PhD in weight inclusivity at the University of Queensland.
"As a fat person, I think these experiences of weight stigma permeate every aspect of our lives."
While studying public health, the word obesity was thrown around like a hand grenade.
"Every cornerstone of public health [education] talks about the war on the O-word," Zoe says.
"My BMI is in the obese range, so as someone attending classes I was constantly being bombarded with messaging that obesity is bad, obesity is wrong — it hurt.
"That messaging was really intense for me and really harmful and it really affected by self-worth."
It's why Evie is researching ways to make the health system more inclusive for larger-bodied women.
She believes one step will be ditching the BMI and its labels.
The average person
Time and time again, the women who shared their stories with the ABC almost always pointed back to those three letters.
BMI.
Despite its prevalence, there's no doubting the fact the body mass index is an inaccurate measuring stick for assessing someone's weight and health.
It was devised by a mathematician in the 19th century to chart an average Western European's characteristics, using simple maths to assign someone to four categories:
Fiona Willer, an advanced accredited practising dietitian and lecturer in nutrition and dietetics at QUT, says those terms are particularly loaded in medical settings.
"It makes me really sad," she says.
"The truth is that many doctors still think that the weight on the scales or the BMI is something that is within people's volitional control — if they just try hard enough there'll be a lower number on the scales or smaller BMI."
Dr Willer says medical professionals still push patients to lower their BMI, despite irrefutable evidence it is "very, very hard" to do so with any lasting impact.
"Actually, when you walk through your doctor's door, your weight or BMI is the least interesting thing about you because that doctor can order more investigations to find out what you as a person, rather than you as a risk category, have potentially in store for you.
"They can look at your blood test results, your cholesterol levels, your blood glucose regulation, your hormone levels, they can look at lifestyle factors as well.
"All of those are way more predictive of actual health outcomes for you as an individual than BMI or categorisation by weight is."
The Australian Medical Association is far more circumspect.
It did not want to talk about whether weight-shaming was an issue or even prevalent in medical settings.
"Obesity is a very important healthcare issue that needs to be tackled at many different levels," president Dr Danielle McMullen says.
"Doctors are there to provide individualised, non-judgemental care and to support patients in managing their weight through education, lifestyle advice and discussion of treatment options."
Back in central Brisbane, Terri-Lynne South knows that non-judgemental care is out there.
She says a core group of professionals are trying and that there is reason for hope.
"We're trying to change the tide."
Why we speak
Kara Parker is the epitome of busy.
She somehow balances her career as a nurse with midwifery study and three busy kids aged 11, six and 20 months respectively.
Weight stigma has pervaded every element of her life.
Having endured years of comments and stigma, Kara had mini gastric bypass surgery last year and lost a significant amount of weight.
Yet she says doctors remain fixated on treating her as a BMI label rather than a human.
On her rounds, she privately advocates with her patients who she sees shamed over their weight on a daily basis.
She's brushed off the comments about her own body and size her entire life — but when they hit home with her children, things changed.
"My son, he's 11 years old and a very athletic child, he's literally got chicken legs.
"He's in the overweight factor [according to BMI] so he hates going to the doctor's because there was a paediatrician that told him he needs to watch what he eats because he's at that certain level."
Now, her sporty and determined first-born son watches what he puts in his mouth with a sense of fear.
Seeing the stigma she suffered now pass along generational lines makes Kara mad.
"The majority of my family, we don't go to doctors just because you get shamed as soon as you go in there," she says.
"I just get so angry with them."
'I try not to think of her'
Louise Cork knows the power of anger.
She still occasionally thinks of the lecture the midwife gave her six years ago.
Those words hold a power over her to this day.
But her treatment also proved an inspiring factor — she returned to university to study naturopathy and now runs a clinic in Ballarat.
Everything Louise does is inspired by her own experience.
"I see different people with different weight presentations all the time," she says.
"I have a health science degree now, but there are people that don't have that degree of knowledge of their body … who are made to feel like Louise six years ago when they go into these appointments, that there's something wrong with them, that they're a failure, that they're doing something wrong.
"We can do better and we should do better."
Credits
- Reporting: Daniel Miles with Eden Hynninen
- Photography: Daniel Miles, Alice Pavlovic, Dean Canton
- Digital production: Daniel Franklin
Posted, updated
