I’m not sure how to start this post. This is a post about how, when you’re a fat person, the medical establishment and other large systems will always weaponize your fatness against you. This is a post about how the short-term disability/long-term disability (STD/LTD) benefits I supposedly had access to through my employer used my existing diagnosis of “morbid obesity” to deny me disability benefits.
There is a LOT to say about medical weight stigma, the insidious nature of diet culture, and fatphobia in medical care. Fat people experience discrimination in jobs, hiring, medical care, legal supports, education, and more. There are whole books and dissertations about these topics. Some of which I may delve into at some future point but, honestly, there are way better resources out there. Check out the Maintenance Phase podcast from Aubrey Gordon and Michael Hobbes. Read Da’Shaun Harrison’s new book Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness. Search for Kivan Bay’s #FatStudyGroup on Twitter or Imani Barbarin’s TikToks about the intersections of Blackness, fatness, and disability.
Anyway. I’ve been treated like a fat person my whole life- even when I wasn’t actually fat- but especially now that I am legitimately fat and have collected a number of vague diagnoses. I’m accustomed to the “diet and exercise” refrain I get from every doctor when I try to address my unrelenting fatigue, my digestive crises, or, now, the steamroller of Long Covid. My “obesity” has come up at almost every turn. [Side note: you should know that many fat people consider “obesity” a slur.] The neurologist I saw in March suggested obesity was causing some of the numbness, tingling, and other strange sensations I experience that I had never experienced before. The pulmonologist I saw in May (a guy I went to college with who knows me personally!) agreed that while obesity probably didn’t cause my shortness of breath, exertion intolerance, low oxygen saturation, etc that the weight I’ve gained is going to be all the more difficult to lose with my physical therapist prescribed maximum heart rate being set too low to allow me to exercise. All of that has SUCKED to deal with and has made medical appointments very anxiety-inducing for sure, but none of that really got in my head in a serious way.
That is, until my short-term disability claim was denied and the medical review cited my “morbid obesity” as the explainer for my issues. When I first initiated my STD/LTD claim in January 2021 after I literally shit my pants at work, I felt so much relief that I would be able to access some financial support to replace my paychecks which would allow me to take some time off. I assumed that because it was part of my benefits package, and because I was so clearly ill, it would be easy to access STD/LTD; looking back that feels incredibly naive. My original STD/LTD claim was denied on 6/28/21 due to, essentially, insufficient proof of my functional limitations. I called a disability lawyer for help and he told me to write my own appeal, submit all the records I have, and call him back if I was denied again (thanks for the assistance, man). I gathered all the records I could, wrote a lengthy appeal letter, asked my physical therapist to write and additional letter about my work limitations, and hoped for the best while expecting nothing. Despite all the hoops I had jumped, I could not have planned for the experience of reducing 18 months of Long Covid and post-viral syndrome into “morbid obesity”.
Here are some real quotes from the large packet I received explaining why, on appeal, the insurance company still could not approve me as disabled according to my employer’s policy:
- “C-reactive protein levels had been elevated, but they were often elevated in obesity, so it was not clear if they were elevated for any other reason than that.”
- “Six minute walk tests were reduced, but those were effort-based and walk distance results have been documented to have been shorter in obese individuals.”
- “You had elevated heart rate and blood pressure after a six minute walk test, but they were normally elevated initially right after walking and it was not clear that the results indicated anything other than deconditioning in a morbidly obese individual.”
- “Dr. M [my Long Covid doctor] stated that you had been unable to work full-time due to history of COVID-19, dyspnea, and cognitive dysfunction. The only clinical support was the reduced 6-minute walk test distance, which as already mentioned was effort dependent with norms based on normal weight individuals. While it was possible that some or all of your symptoms were due to long hal COVID, it was unusual for the symptomes to significantly worsen over time, as seems to have been the case here since you were working full-time with only a few absences per month until the beginning of 2021.“
Somehow, despite years of navigating anti-fat bias with my medical providers, reading this denial and having all of my symptoms couched in the size of my body is really under my skin. And this happens to fat people all the time. Given that the COVID-19 pandemic has been a mass disabling event creating thousands if not millions of newly disabled people, I anticipate this kind of weight stigma will continue to be used to deny fat people financial supports and other kinds of care.