My Doctor Held My Birth Control Hostage Until I Lost Weight
Ever since kindergarten, my weight framed every one of my doctor's appointments. It was a rhythm and routine I knew by heart. By second grade, there was the familiar belly-clenching breath as I stepped on the scale, the deep anticipation while watching the digital numbers dance on the screen, then finally came the invisible armor I'd put on to prepare for darts of judgments and guilt trips once those numbers finally settled.
I mastered the art of dissociation, but my first ob-gyn being lumped into this group of finger-waggy, weight-loss obsessed docs snapped me back into reality. When I was 15, I had built up just enough courage to ask about starting birth control. I did what I was told in sex ed: plan ahead and seek out safe sex methods to prevent unplanned pregnancy and STIs. I felt proud that I put this guidance into action, but that sense of personal achievement from being proactive and thoughtful about my reproductive health and future was immediately undercut.
“You really need to prioritize your weight instead of this kind of stuff,” she said. “I’ll give you a three-month supply, but you have to come back to prove that you have lost weight, or I won’t refill it.” My doctor dangling a birth control prescription as an incentive for weight loss was not a battle I was prepared to fight; there was no way I could have been ready for my medical provider to hold my sexual agency, body autonomy, and reproductive future hostage...all because of my weight and body size. Three months came and went, my weight remained the same, and I watched my prescription *poof* disappear. I was spiraling, and blaming myself for failing yet another weight loss attempt.
A few years later, when I was in college, I found myself facing another women's health medical mountain: my first pap smear. I always felt shame bubbling up in my chest when trying to schedule the annual routine appointment, and it was enough to keep me far away. But after hearing friends express how grateful they were to have caught something early because of it, I reluctantly got my exam on the calendar.
Walking into the exam room painted greige and adorned with crooked frames of coffee shop art, I hoped for a reprieve from all the times providers picked weight loss lectures over actual medical care. “I should have said this earlier, but we probably don’t even need to do a pap smear, you know…assuming you aren’t sexually active,” my doctor declared as she swung open the door. The form I filled out weeks before my appointment was on her clipboard—the same form that asked if I was sexually active, in a monogamous relationship, and if I had used contraception in those instances. The very same form that I had answered yes to all three questions.
A familiar shame washed over me. I immediately felt 15 again, floating outside of my body. I still remember the strange sensation of being both overlooked and inescapably observed and judged for existing in the body I have.
Over the years, I became accustomed to the unrelenting interrogation about my weight in healthcare settings. But I hoped it would be different when it came to preventative reproductive care and that my teenage experience with getting birth control was a fluke. Experiencing this, yet again, in a medical appointment where my reproductive care and sexual well-being were supposed to be the topics of discussion—not my weight—was devastatingly infuriating. Because here’s the thing: fat people have sex. When we erase fat sexuality, we are also inadvertently limiting—or flat-out denying—reproductive healthcare. This can lead to an increase in psychological distress, delayed diagnosis of reproductive health conditions, and eating disorder symptoms.
I know this all too well. My continued efforts to change my body following these experiences led me down a treacherous path. Every fad diet, weight-tracking app, and "thinspiration" activity ended with the same result: my weight aggressively fluctuating, always settling higher than before as I starved myself and then binged when my body couldn't handle restriction anymore. The eagerness to see my number on the scale would drastically drop, as the weight I anticipated never did. It wasn’t until I was 19, a sophomore in college, that I realized I had been struggling with an eating disorder for over 10 years, a diagnosis that short exams missed and biased medical care clouded. I had no idea that eating disorders impact people of all identities and body sizes, including people who looked like me.
My experiences are, unfortunately, not unique. Around 52% of women report experiencing weight bias as an obstacle to receiving preventive gynecologic cancer screenings, and, according to a recent survey, 35% of women have received weight loss advice from healthcare providers when seeking reproductive care, a recommendation that 83% found triggering or difficult.
Part of the issue is that experts aren’t really sure how weight impacts birth control use; there is limited research on the effectiveness of birth control on fat women, and they all contradict each other, which leaves significant gaps in our ability to understand and receive accurate recommendations. For example, some says that weight does not impact the effectiveness of hormonal birth control (like the pill, patch, vaginal ring, and IUD), but other studies push alarming findings that say emergency contraception, like Plan B and Ella, don’t work for women over 165 pounds, which according to the CDC, is below the average weight for women 20 years and older in the United States.
The only emergency contraception that's effective regardless of body size is the IUD, which we know is an incredibly painful option. It’s no wonder that fat women are 30% more likely to have an unplanned pregnancy and use contraception at a lower rate when our options are unclear and often overshadowed by weight judgments.
As a teen, my doctor instilled the belief that any birth control pill would never work for my body because I didn’t work hard enough to lose weight. I felt trapped, like I didn't have any choices and everything I had learned was reinforced: I was doomed to subpar weight-centered care until I made myself thinner. In an era where fundamental reproductive rights for women in the United States are under constant threat, weight-centered gynecological care will only further reduce the already-limited options. We might not have explicit control over the laws keeping women from making choices about her body, but we should certainly ensure that all health care, at its core, is inclusive of all bodies. No weight loss required.
If you are experiencing weight bias this is not your fault and your body is not a problem. You can learn more about weight bias at Health at Every Size (HAES), find a HAES provider, and through following fat activists on social media.
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