Must I Be Fat To Treat Obesity?
Newly-minted physician: I don’t think I can work with people with addiction.
Wise old physician: I’m sorry to hear that. You’re a good doc. If you don’t mind sharing, what made you reach the conclusion that you can’t work with this population?
New doc: I love working with them, but I see how they connect with you and the addiction counselors who are open about their own recovery journey. I have never struggled with addiction. How can they ever connect with me in the same way they do with you?
Wise doc: You’re right about that. Many people with addiction do feel that clinicians who are in recovery understand them better they feel they can connect quickly with us. But is that true just of addiction? Wouldn’t you say that it’s also true that people who struggle with any illness feel that other people with the same illness understand them better?
New doc: That’s true.
Wise doc: It’s true of depression and bipolar disorder, anxiety disorders and personality disorders.
New doc: True.
Wise doc: It’s also true of physical illnesses, especially chronic physical illnesses. Which is why support groups are even a thing.
New doc: You’re right.
Wise doc: So my question to you is: Must I be fat to help someone struggling with obesity? Indeed, if you think about it, if you have never been fat, can you truly understand the challenges an obese person must face every day — ranging from the difficulty bending down to tie their own shoelaces to dealing with the disapproving looks they get from people in all walks of life, whether the grocery store or an airplane?
New doc: That’s an interesting analogy.
Wise doc: But it’s true. As a family medicine physician, I try to help people with obesity, diabetes, high blood pressure and other chronic and acute illnesses in my clinic and in the hospital. Apart from my own history with alcohol, I have never really had any other chronic illness. By your logic, I should stop treating all those other illnesses, don’t you think?
New doc: But that’s different. Those illnesses don’t have the stigma that is associated with addiction.
Wise doc: Well, I would disagree. Obesity has a lot of stigma associated with it. As does smoking nowadays. As do many chronic illness with a strong lifestyle component. Besides, does it mean that you, who I suspect has never suffered from bipolar disorder or schizophrenia, cannot effectively help people with those illnesses?
New doc: Of course not! I think I get what you’re getting at.
Wise doc: You must realize, the shared addiction history only gives me a leg up in the speed with which a patient with addiction forms a therapeutic alliance with me. The quality and strength of that alliance depends on factors that are common to all effective healers.
I have learned a lot about addiction from clinicians in recovery. I have learned that yes, it is true that lived experience can help healers be more effective at their craft — primarily by creating a shortcut to the interpersonal connection that helps build the therapeutic alliance through which the healing is delivered. However, it is neither necessary nor sufficient to be an effective healer. What is necessary AND sufficient is a combination of the necessary clinical knowledge, an attitude of compassion and empathy, genuine listening skills and a real desire to help through healing. Lived experience is not necessary to acquire that combination. Without that combination, lived experience is worthless to an aspiring healer. Indeed, I don’t need to have a stroke to treat patients with post-stroke depression and I don’t need to be fat to treat obesity.
Apollo's Minion 
2 Responses to “Must I Be Fat To Treat Obesity?”
Thank you so much for sharing this. I have used a very similar analogy with my own clients who have been wary of working with me since I am not in recovery myself. I usually ask if they would only feel comfortable being treated for cancer by a doctor who has cancer. Almost every time the answer is no. Then we have the conversation about the things that make them wary of trusting me, which is usually fear that I will judge them for things that they have done in their addiction because I haven’t experienced them myself. I’ve had pretty decent success with building rapport after this type of conversation.
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Thanks for sharing your experience regarding this.
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