Soon after giving birth, Dr. MaryAnn Dakkak struggled to use her left leg and experienced numbness, weakness and pain. After visiting the emergency room about after an intense bout of pain, she felt frustrated when she realized that she'd have to leave without any answers.
“I had gone to the emergency room, had felt very dismissed. Nobody examined my leg. Nobody touched my back,” she tells TODAY.com. “It was very much ‘So you just had a baby. Sciatica (is common).’”
Dakkak wrote about her experience in an article for the Journal of the American Medical Association (JAMA) and how she hopes to reduce weight stigma in medicine.
“While I continue to work on the function of my physical body, another role I have is as a medical educator and faculty member,” she wrote in the article. “Creating and promoting a curriculum focused on understanding and disarming our learned biases are necessary to provide the best care to all patients, regardless of size.”
Dismissed for being postpartum and overweight
During the birth of her third child, Dakkak experienced a complication that contributed to hip pain and an inability to lift her left leg that worsened over the few months following birth. When she went to the emergency room, she asked for the doctor to examine her hip and back. Instead, the doctors implied that her weight and postpartum status meant that pain, numbness and tingling should be expected. Initially, Dakkak accepted this.
“It was like, ‘You’re postpartum. You’re really overweight.’ I was like ‘OK I believe it,’” she says. “I allowed it to be ignored because I had internalized the bias myself.”
The Boston-based family medicine physician knew that “a lot of people have neurological injury after birth and a lot of it is dismissed.” So, she called a friend, who is also a doctor, for a second opinion.
I allowed it to be ignored because I had internalized the bias myself.”
“My friend … tested my reflexes and I had no reflexes in my left leg,” Dakkak says. “(My friend) was like ‘What were you thinking? No obesity causes you to be unable to life your left leg.’”
Soon after, Dakkak met with a spine surgeon to schedule a procedure to treat her left leg pain caused by a herniated disc that “cut off my nerve root” in her spine. It’s not a typical presentation for a herniated disc, she says, and it’s even hard to see on an MRI, which is why a physical exam would be so important to get an accurate diagnosis.
“Luckily, because I know so many doctors, I was able to cobble together my own care team fairly quickly,” she explains. “One of my clinicians told me, ‘Oh my gosh, if you hadn’t advocated for yourself, you would have been permanently in a wheelchair.’ I would have been permanently unable to use my left leg.”
On top of everything she was experiencing, Dakkak fell down the stairs and broke her foot in two places prior to her surgery.
“I had my first two children in medical school,” she says. “I was excited to have maternity leave where I could take my baby on walks and do all the things that I see people do on maternity leave. And I did none of those things. Post-spine surgery I was in a wheelchair rolling around the house.”
After a few months of physical therapy and re-programming her nerves to prevent the pain from recurring, Dakkak improved.
“It definitely was not the maternity leave I had wanted,” she says. “After a few months I was able to walk on my own.”
Changing the way we think about weight and health
As Dakkak recovered, she considered her experience, what that meant for her, and how weight bias negatively impacts the care overweight and obese people receive.
“Everybody deserves a differential diagnosis no matter what they look like,” she says. “Something that especially obese women go through every day is being treated less than, not being taken seriously. (Many) of their complaints are just blamed on their weight without a full exam or a differential diagnosis.”
When she thinks of her weight now, Dakkak considers “functional goals” that she hopes to achieve. That’s also how she approaches weight with her patients. For Dakkak, she wanted to ride her bike a little longer, swim and play with her three children. Because of her weakened left side, she pursued gastric sleeve surgery this past February and lost about 40 pounds.
“Even after I got 20 pounds off, which was about a month and a half ago, I was able to bike longer, hike longer, walk longer without having spasms,” she says. “That’s how I measure my success. I don’t really care about my weight, and I don’t really care about any patient's weight. I really care about their ability to function in the world and meet their health goals.”
She says that research shows that physical activity “adds more to your health than weight loss” and that’s what she considers when she talks to her patients.
“We actually have fabulous evidence that losing weight when you’re a normal weight or even a little overweight adds no mortality benefit,” Dakkak says. “I really do try to nail down what are we losing weight for? I totally support weight loss in healthy consistent ways that get people to functional goals and physical activity.”
Dakkak says that for some conditions, such as diabetes and hypertension, for example, weight loss can help. But she never advises “weight loss for the sake of weight loss.” The bias against fatness is so great that it prevents people from even seeking care. She hopes this changes.
“A lot of the stigma is internalized by a lot of our patients, and we find they don’t go to the doctor,” she says. “Obesity is a risk factor —and should be treated as a risk factor — but it’s not an all encompassing diagnosis and it doesn’t cause all things. And I think it’s really an easy cop out.”