Fat, pain, power and the clinic

I have a touch of osteo-arthritis (OA) in my right knee. Sometimes I get a small amount of pain. I understand OA as a degenerative condition and that I will likely become increasingly disabled as times goes on. My doctor referred me to physiotherapy where I learned some tricks for strengthening my knee to hold off the degeneration, and for pain management, and I've been going to the OA gym, organised by the physiotherapy clinic near where I live, which runs a course for people coming to terms with the condition.

I'm writing about this here because I had been unaware that knee OA is one of those things that inspires a lot of fatphobia from health professionals. Whether or not being of a heavy weight exacerbates knee OA is up for debate, I think, because OA also occurs in non-weight-bearing joints, and weight loss, which is next to impossible to sustain in the long-term, does not necessarily ameliorate the pain. The other thing is that thin people get OA too. But 'lose weight' or 'maintain a healthy weight' are part of the mantra of knee OA. My doctor and physiotherapist have been fine and respectful, but the OA gym, also managed by the National Health Service, has been another story altogether.

There are general problems in the space that relate to a kind of clinical arrogance. We 'patients', there are seven of us, are older, don't necessarily speak English fluently, look poor, struggle to communicate, have other health issues, and look like the bottom rungs of a social status chart. The two people teaching us are limber young jocks who appear to have no empathy, don't understand people who aren't jocks, and perhaps have never had an injury. They use their own bodies as models for what we should do, but their bodies are nothing like ours. They say things like: "I'm going to show you these exercises and if you don't do them at home every day you are wasting my time." One of them has made not-funny jokes about people who try and cheat the exercises, as a kind of warning for us not to cheat, the assumption being that we would cheat, and that cheating – or finding other ways to do things – when you are in pain is a bad thing.

It's the fat stuff that interests me. I am the fattest in the group and a lot of the fat talk is directed at me. For example, the physiotherapist asked the group if anyone had ever heard of BMI (Body Mass Index), and fixed me with a long stare as she asked it. I thought the question was ludicrous and stared back, gaining me the unspoken label of uppity fatty in the process. The same person complained about doctors who "are too frightened to tell their patients that they are obese. I'm not like that, I'll tell people when they need to lose weight." I wondered if she would ever tell me directly to lose weight, and what that conversation might look like. The other women in the class concede to the fatphobia, all agreeing that they should lose weight, regardless of how much they weigh, the men seem to ignore it all. One woman said that she had lost a lot of weight and that she still gets pain, but this was not explored.

There's ageism and disablism in the room too, with uproar when one of the physios suggested that a way of managing knee pain could be to get a walking stick. No! No! No! We are too young for that! We don't want to look like cripples! Me, I'll take the stick, I'm old enough, crip power.

It is hard to know what to do. Speaking up in a group where people are generally hostile to the idea of fat and where I may as well be speaking Martian is too risky, especially as I have already felt labelled as a troublemaker for not being compliant and self-hating. I have a packet of readings that I'm thinking of offering to the Physios, though I think this will be read as an aggressive action. I suppose I'm holding out for the opportunity for feedback. But even then my identity as an activist, or as a person with any intelligence or agency is invisible in the OA gym, the institutionalised fatphobia means that I am interpreted as a problem, no matter what I do. The others may be extraordinary people with fabulous skills, but you would never know it, we are collectively patronised and treated as people with nothing to offer. I don't know if my knee is benefiting in any way from this experience, but for me it has greatly illuminated some of the ways in which clinical power operates, and the misuses of that power.