Make It Make Sense

I never set out to be a fat activist. Most of the time, I do not even think about my weight at all.

I have joked with close friends that I have the opposite of body dysmorphia. I am fully capable of going after the hottest guy in the room, stripping naked to jump into a lake, or ordering a hot fudge sundae with extra fudge without the slightest awareness that any of it might be considered socially unacceptable.

Then occasionally I will catch a photograph of myself and briefly think: Who is that?

For a moment, I see what the rest of the world sees. A nearly 300-pound, middle-aged woman (still super cute though) staring back at me.

I might feel a flicker of shame. Promise myself dietary changes and to quicken the pace of my daily nature walks.

But within a day or two, I am back to my old ways, finding joy in taking a slow stroll in nature to practice some mindfulness, eating consciously, not restrictively. Having recently recovered from a torn Achilles tendon where I could barely walk for the better part of a year, I feel gratitude for simply being able to walk again. Now that I find myself moving more, I know my weight will fluctuate a bit, like it has done all my life; reset and recalibrate moment to moment.

I have never considered my weight a tragedy or a personal failing. Sometimes it has even felt like an asset. I have had women burst into tears when I walk into an exam room and say, “Oh, thank God. A midwife who actually looks like me.” I have had people from high school reach out years later to tell me that they looked up to the way I always carried myself with confidence, and spoke up for what I thought was right while being in a bigger body. I have been told it gave them permission to do the same.

My body has never stopped me from caring for patients, succeeding academically, or building meaningful relationships.

But throughout my career in healthcare, an unspoken friction has lingered in the way other clinicians, mostly leaders, have responded to me. I suppose if my presence felt inspiring or comforting to some people, it likely felt challenging to others. The difference was that now, as a professional, the people being challenged by my presence could potentially hold power over me and my livelihood. Being fully myself suddenly carried significant risk.

The first time I felt that friction threaten my ability to succeed was during nursing school.

I became pregnant during my final semester while simultaneously starting two clinical placements: one in Labor and Delivery and one in Leadership. I wanted to keep it private at first, to prove myself before my body became visible in a way others could no longer ignore.

My Labor and Delivery preceptor, Jennifer, was kind but worked me hard, and I was grateful for it. She taught me fetal monitoring, how to support physiological labor, and how to care for patients in the operating room. I thrived under her guidance.

My Leadership placement was with a woman, I forget her name, let’s call her “Sharon.” She spent much of her day in meetings, so she split my leadership placement between following her and shadowing the House Supervisor. I attended staffing meetings, watched units scramble to cover sick calls, responded to hospital emergencies, and observed the constant balancing act of hospital capacity.

When we would go unit to unit, nurses would encourage me as a nursing student and try to persuade me to enter their specialty. I had been working in professional environments since the age of 14, so I was sensitive to subtle social cues about when to lend a hand and when I would be most helpful getting out of the way.

One afternoon, someone brought sandwiches for the leadership team. She handed me one and said, “Of course I got you one. You’re part of the team.”

I remember that moment more clearly than I probably should because when I looked over, Sharon was glaring at me after muttering something under her breath. The rest of that week felt tense. She seemed constantly irritated with me, making small cutting remarks that left me confused and off balance. I had no idea what I had done wrong.

Eventually, I called my advisor at school for guidance, and that’s when she told me Sharon had already contacted her earlier to complain about my performance as a student. According to Sharon, I wasn’t “engaged enough,” and I was suddenly in danger of not graduating. At the exact same time, my Labor and Delivery preceptor was giving me top marks and scheming to help me get a job.

So I tried harder. Graduation was within reach, and I had a baby on the way.

I brought Sharon back a gift from a weekend trip to the coast; an iron mermaid statue because she loved mermaids. I asked for feedback directly and tried to understand how I could improve. But her answers were vague and impossible to act on.

I wish this had been an isolated experience.

Years later, after becoming a midwife, I got my first job within that same hospital system where I completed my nursing clinicals. My boss seemed pleasant enough at first, but she was never particularly interested or invested in me. She had been excited to hire a former patient and friend of hers at the same time as me; I was more of an afterthought. I arrived eager, dependable, and ready to learn. But as we worked together more regularly, it almost felt as though she made a point of discussing diets, body image, and appearance around me specifically. I could tell something about me made her uncomfortable.

After a while she started finding fault with how I advocated for myself and the other midwives on our team. I wasn’t trying to ruffle feathers, just help protect the mental health of my colleagues. She intentionally passed me over for a position I was next in line for, lied about me to higher-ups and other midwives, and eventually made it impossible for me to work there any longer.

Then came my most recent experience with an employer who used AI to “fix” my professional headshot. She enlarged my smile into something almost cartoonish, as if competence needed cosmetic approval. I knew immediately I did not fit the smoke and mirrors of the woke, girlboss, “white wellness” aesthetic she was selling.

Within the first 90 days, she abruptly ended my contract. In the blink of an eye, all the trust and important work I was building with my patients was gone. Cut off. She justified this by highlighting a few very fixable errors in my charting. She never gave me feedback or an opportunity to fix it. I was told that I could benefit from some more support and mentoring, but that support was not something she would offer me. In contrast, my straight-sized colleagues, with as much experience as me, were given support, mentorship, and reassurance that their jobs were secure.

When I recounted this to longtime friends, I found myself doing what I always do first. I audited myself. I listed my possible failures. I tried to find the story where it was still my fault.

One of them finally looked at me and said, “I hate that you are taking all of this on yourself.”

That landed because it was chillingly accurate.

The outcomes have never matched the feedback.

Patients have come back to me for years, sought me out when I’ve changed jobs, and I am proud of how I’ve shown up and contributed to so many successes and great outcomes. The lived reality of my work did not match the institutional story being told about me.

Over the years, I turned all these school and work insults inward. I studied myself. Spent years in therapy and professional coaching. Read countless books on leadership and communication. I watched my nonverbal cues, I policed my tone, kept my opinions to myself, I shrank myself. I tried to become the version of me that would finally feel safe to other people with the goal of putting my head down and doing the work I was meant to do. But despite this, I remained a target, and lost myself in the process.

It took me years to realize these experiences were not isolated incidents, but part of a larger pattern that many fat clinicians quietly recognize.

There is growing evidence that fat clinicians and patients alike are often perceived as less competent, less disciplined, less professional, and less authoritative regardless of actual performance and competence. A 2021 systematic review and meta-analysis found that healthcare professionals across disciplines, including physicians, nurses, dietitians, psychologists, and therapists, demonstrated both implicit and explicit anti-fat bias.

These biases do not just exist in theory. Fat clinicians frequently describe being subjected to higher scrutiny, harsher evaluations, assumptions about laziness or lack of self-control, exclusion from leadership opportunities, pressure to overperform socially and professionally, and the unspoken expectation that they compensate for taking up physical space by being exceptionally accommodating, deferential, humble, or self-deprecating.

Socially, a fat woman who does not apologize for herself can quietly destabilize people’s expectations. Our culture is deeply invested in the idea that fatness should be accompanied by shame. When a woman exists outside of that script; when she is competent, confident, wears vibrant or stylish clothing, is creative, outspoken, sensual, ambitious, or visibly comfortable in her own body; it can trigger discomfort in people who have been taught that self-worth must be earned through thinness and self-denial.

Because how dare she refuse to perform the shame others expect from her?

After enough repetition, it’s hard to ignore the pattern.

If you think this is a reach; that I’m just a failed clinician with a chip on my shoulder; I hear you. Honestly, I wish everything I’m saying in this essay was bullshit, because then maybe I could have fixed it instead of living through it.

For over 10 years, I avoided sharing this publicly because I wanted to believe the best about people. Writing this feels intensely personal and deeply vulnerable. I don’t know many fat clinicians, and I don’t know how others perceive the way they’ve been treated in healthcare workplaces. The simplicity of this has been the most difficult. Not everything that rejects you is a misunderstanding. Not every environment is neutral. Not every “feedback” is honest. And many women in power are just better dressed versions of the same old gatekeeping.

What I do know is this: patients deserve providers who look like them. Representation matters. We need clinicians of all body sizes, races, genders, and backgrounds to stay in the field.

I am deeply grateful to Black clinicians and scholars who have named racism, discrimination, and inequity within healthcare systems. Their work created language and frameworks that allow many of us to discuss other forms of discrimination as well. I also want to acknowledge that I still carry substantial privilege as a white, cisgender, middle-class woman while Black clinicians continue to face racism, wrongful termination, surveillance, and discrimination in healthcare workplaces every day. That reality must be confronted directly.

We also know that size discrimination is deeply entangled with racism. Weight bias has historically been shaped by racialized ideas about morality, health, discipline, and bodily worth. Research shows that weight discrimination is now reported at rates comparable to racial discrimination, with more than 40% of higher-weight individuals reporting experiences of bias. Women of color often experience compounded discrimination, facing both racial bias and impossible “health” and beauty standards rooted in white supremacy and historical racism.

I am envious of clinicians who have had the luxury of focusing on patient care and honing their skills in stable environments with clear expectations and meaningful feedback. Others are forced to keep starting over under dubious circumstances, working for bosses who move the goalposts, offer no actionable guidance, and provide no consistent standards. Instead, there is ambiguity, dehumanization, and a steady stream of stories meant to justify treatment that never quite adds up.

There is no clean resolution here. I still love patient care. I still believe healthcare desperately needs clinicians with different bodies, backgrounds, personalities, and lived experiences. Patients deserve providers who look like them, understand them, and make them feel safe in the room.

But I also know now that many fat clinicians are surviving these experiences in isolation, quietly internalizing mistreatment that was never theirs to carry alone.

So if you are reading this and something inside you aches with recognition, please know you are not imagining it.

And if you know someone moving through this kind of silent professional erosion, send this to them. Reach out to them. Support them. We need community badly.

The cost of forcing fat clinicians out of healthcare is not just personal; patients lose clinicians who could have made them feel seen, safe, and worthy of care.

I survived this long enough to finally say it out loud. I know I am not the only one. And I KNOW many of us are done carrying this quietly.