#29: Beyond the Scale: LBQ+ Women and Weight
COMMUNITY VOICE: Jen Kober | HEALTHCARE EXPERTS: Jessica Halem, MBA; Shana Zucker, MD, MPH, MS | COMMUNITY REVIEWER: Karyssa Blair
SHOW NOTES
Let’s define our terms (so you don’t have to Google mid-episode):
LBQ+ women:
A catch-all for lesbian, bisexual, and queer women
This includes those who are trans or nonbinary, if they feel seen and represented in the conversation
“Sapphic”
Is another term we love that gets at the same community of people
BUT in medicine-land, it is less of an academically recognized term (and instead evokes soft lighting, tarot cards, Indigo Girls…)
Fat:
Used as a neutral, descriptive term by many in the fat liberation and body neutrality movements.
Not an insult. Not a diagnosis. Just a way of describing bodies without shame.
Why this episode? (aka: yes, we’re talking about weight. No, we’re not doing it that way.)
The literature says LBQ+ women are more likely to live in larger bodies than their cis, straight counterparts. This is something that many LBQ+ people know, but it’s rarely discussed.
And of course, it’s more complicated than the statistics or scientific evidence gets to show
We know that, societally, queer women’s bodies are often seen as “deviant”
Queer women are simultaneously too queer, too feminine, too masc – too much
Our goals:
We WILL be talking about weight, but we are NOT going to pathologize fatness, and we’re not treating this like a health crisis
We want to give people the language and tools to talk about body size, health, and identity — especially in medical spaces that usually miss the mark
Queer Women and Body Image
Once upon a time, the go-to image of a lesbian was a bigger-bodied butch (± cargo shorts, Birkenstocks)
For many queer women, living in a bigger body has historically been understood as a form of resistance – a rejection of beauty standards rooted in the male gaze.
There’s power in rejecting body norms that are tied so closely to the male gaze (or declaring it irrelevant)
This rejection of the “white picket fence life” had far reaching implications
Dr. Zucker and our community reviewer talk about how stepping away from “normative” standards opens up space to reimagine what beautiful, healthy, and sexy can look like
This is a theme present agian and again in our QHP episodes!
The year of our Lord(e) 2025: things have changed!
Now? It’s the “Year of the Lesbian,” (no, but actually) and the spotlight’s shifted towards a new thin, high-femme aesthetic — think Kristen Stewart, Phoebe Bridgers, Chappell Roan
The added media attention – and vsibility – is great, but…
Not if we only celebrate thin, femme women loving other thin, femme women.
True queer visibility means celebrating all kinds of bodies: strong, round, soft, butch, sturdy — not just the ones that fit the new mold.
Living in the In-Between
Many LBQ+ women live in a space that’s neither cis straight woman nor cis man — and their bodies reflect that
They may be strong without chasing the “toned yoga girl” ideal, or masc of center without aiming to look like a gym bro.
You can see this in-betweenness everywhere:
In the gym, where neither the straight male gaze nor the skinny femme gaze feels like a safe place to land
In fashion, where androgyny is only celebrated when it’s attached to thinness
But why does it matter?
Because acknowledging this in-between space gives language to a quiet but common experience for LBQ+ women: feeling like you don’t belong in places that are supposedly “for them”
It’s about how that exclusion impacts access to supportive health, fitness, and community spaces.
Naming the in-between opens pathways to creating environments where queer women’s diverse identities, bodies, and presentations are fully respected and affirmed.
The Clinic Room of It All
How weight often plays out in healthcare spaces
Weight is treated like a problem, something that needs to be “fixed”
Weight is often treated as the ONLY problem.
Other important health concerns like mental health, fatigue, and symptoms are overlooked
Patients may feel reduced to their body size rather than seen as whole individuals
The result:
Many queer women enter the doctor’s office already braced for judgment and stigma
This (understandably) leads to distrust, avoidance of healthcare spaces, and worse health outcomes – not because of body size, but because of how people in bigger bodies are treated
This is PARTICULARLY important for queer women
May have fewer “routine” reasons to get pulled into care (e.g. annual visits for birth control, etc)
Less frequent contact means fewer opportunities to build trust and get preventive care
So what does good care look like?
When to bring weight up
Talk about weight when it directly affects medications, is possibly tied to symptoms, or a diagnosis – not just because of the number!
Even then, good care doesn’t assume weight is the whole story, or the only reason for a symptom or abnormal lab result
And good care always respects patient readiness and preferences around discussing weight
Lastly: good care includes getting to know the patient holistically
Avoids assumptions
Inquires about the patient’s values and goals – what does “health” look like for the person in question?
Do you want more energy? Do you want to feel stronger (or in Jessica’s case, put your suitcase in the overhead bin on a plane)? Are we training for the lesbian Olympics?
Base conversations about activity (and maybe weight) around these goals!
TRANSCRIPT
Jen Kober: You can't chalk everything up to weight. Right? There's also other things happening. And I think that when all you do is drill into a person's head that their weight is their only problem. If you get it in your head that you're never gonna be healthy. You're like, "okay, well what's the point?" It seems very, it seems like a hurdle you're never gonna get over, and so you don't even try.
[QHP THEME MUSIC STARTS]
Gaby: Welcome to Queer Health Pod! My name is Gaby. I use she/her pronouns, and I'm a primary care doctor in New York City.
Sam: My name is Sam. I use he/him pronouns, and I also have the same job title.
Richard: And my name is Richard. I use he him pronouns, and I've worked in LGBTQ+ healthcare for over 20 years.
Gaby: And you are listening to Queer Health Pod, Season 3, episode 10: weight stigma for Lesbian, Bisexual, and Queer Women.
[QHP THEME MUSIC ENDS]
Sam: On today's episode, we're gonna be talking about Gaby's favorite topic: denim, hair gel, and jackets that are only practical in those rare two weeks when the seasons change. Wait, whoa, whoa. Wrong script. Sorry. I meant culturally loaded assumptions about body size stigma in queer women.
Gaby: . And yeah, I am super excited about this episode because I feel like LBQ+ women rarely get a spotlight put on the issue of body size.
Richard: Before we keep going, can you say what you mean by LBQ+ women?
Gaby: Yes, so: LBQ+ women is a term that I often use as an expansive, sort of like a catchall phrase, and when I write it out, there's actually a little plus sign after it. And to me it's a term that refers to anyone who is queer, who identifies as a woman. And :it may or may not include trans identified people. They're warmly invited to the conversation within this term, but ultimately, I think it really depends on whether somebody feels included by the conversations that we're having. Another catchall term that I really like is sapphic, but I didn't use it in this episode because it's very of the moment.
Sam: Sapphic is giving soft lighting, tarot cards, vegan – c-can I say vegan? –Indigo girls softly playing in the background.
Richard: I mean, that sounds like a perfect Friday night to me. It's very my college years.
Gaby: That is an existential crisis that we are going to save for another time entirely.
Sam: Richard's ideal college weekends aside, why is weight stigma, shall we say, a sapphic health issue?
Gaby: So just to start out by saying that, yes, on this episode we are gonna be talking about weight, but we're not going to treat it like a pathology, and we're not going to treat it like a health crisis. What we wanna do today is to address the elephant in the room, let's say the sapphic elephant in the room.
Richard: And the elephant is holding up a protest sign that says, "if you look at any kind of public health journal and check under L for lesbian, you'll read a lot on the same theme: that LBQ+ women as a group are more likely to live in larger bodies than their cis straight women peers."
Gaby: And there are studies out there that say things like lesbians are twice as likely to be categorized as obese based on BMI. And there are also studies like that for bi women.
Richard: To be clear, the BMI or Body Mass Index is a calculated number that medicine uses to categorize obesity and is a deeply imperfect tool and doesn't necessarily tell us a lot about someone's overall health.
Sam: Whoa, whoa, whoa, whoa, whoa. Let's back up this vegan U-Haul lesbian truck and unpack that. Are you starting this episode with the lesbian stereotype and backing it up with the scientific literature?
Gaby: No, no, no. Not at all. So the goal of today's episode is to really just talk about how weight is experienced by queer women, and talk about the experience of living as a queer woman in a larger body, which- it's often tied to stigma that's really anchored in both gendered and medical expectations of what a "normal female body" looks like.
Sam: Okay, cool. Makes a little more sense, but a vegan U-Haul doesn't make sense. And Gaby, you talked about how for many queer patients, especially LBQ+ women, there's so much going on with body politics, especially in the clinic.
Gaby: Yeah, so queer women's bodies are considered "deviant" for a few different reasons. First and foremost, they're women's bodies. Secondly, they're queer, and so they don't often align with traditional expectations of femininity or womanhood. So that's an added second layer. And then thirdly, for some queer women, there is that additional layer of living in a bigger body. And so again, in today's episode, I really want to explore the intersection between queerness, womanhood, and living in a larger body, because I think it's that intersection that we don't often get to talk about and we don't have language for.
Richard: And if it isn't abundantly clear, this is a deeply nuanced conversation.
Sam: So the goal of today is to give people the vocab and insight into all those different factors and the experiences that they play out, especially in medical settings. t alking about this not just as a health inequity issue , but also to talk about the power of being at home in your own body and the way that for LBQ+ women, that is specific and unique phenomenon.
Richard: And in fact, we're gonna spend a good part of this episode talking about just that: the forces that shape queer women's experiences with their body image are complex. They include things like community norms and media representations that identify what a body “should" look like, and also how a rejection of the patriarchy can lead to a rejection of those mainstream skinny body ideals.
Sam: Put that in your U-Haul.
[TRANSITION MUSIC]
Gaby: At the top of this episode, you heard from our community voice, Jen Kober.
Jen Kober: Hello, my name is Jen Kober. I am a lesbian phenom of comedy. I tour internationally traveling and telling the stories and the jokes. And I am a she/her/hers kind of gal. Though I am very masc presenting, I would say much to my mother's chagrin.
Sam: Is Mother's Chagrin taken as a drag name? Also an excellent gay bar name.
Richard: For Jen, her weight has been part of her lived experience for as long as she can remember.
Jen Kober: I was always the biggest kid in the room. I mean, I was like an 88 pound first grader. Like, they were like, "What is going on?" Right? Like, I, you know, when I hit a hundred pounds, I was like, woo. And they were like, "No, you are, you are SEVEN. This is not what should be happen." Right. But I didn't know what was going on. And then my mother would always bug me about it, right? Like, "Put that down. You don't need another one." Like all of those nagging sort of food things. But I didn't really trust what she said much anyway, because she was very critical of everyone. And so I just assumed that being a fat kid was fine. I still did everything. I was on the basketball team. Wasn't like I was sitting out of things. I was very popular. People liked me, I wasn't sort of an outcast because of it. And so I really did grow up thinking I, I just wasn't shaped like other people. And so when I would go to doctors and they would say to me that, "Well, the problem is is you're obese. You need to lose weight." I'd be like, "yeah yeah, okay, but put that aside. I'm also having this go right." Like, I was very quick to shelf that as the reason, because it didn't seem like the reason to me.
Gaby: So this is Jen's story. She is obviously the main character, but it also isn't a one woman show. Weight may be this objective number in theory, but how we feel about that number is just so influenced by everything and everyone around us. And in Jen's case, the list includes internal family expectations, social messages, and later on medical pressure, all of which made it harder to love her body.
Richard: Jen's story shows how all these outside pressures can pull us away from the natural connection we have with our bodies because we're not born hating them.
Jessica Halem: Our personal relationships to our bodies has been deeply damaged by our culture and by the world around us. We have been cut off from being born in love with our own bodies.
Richard: That is the great Jessica Halem joining us today as one of our experts.
Jessica Halem: Hello everyone. My name is Jessica Halem and I use she and her pronouns.
Richard: You may remember Jessica as the community voice for our queer women's sexual health episode from season one, but she has a wealth of experience advocating for lesbian, and more broadly, queer women's health issues.
Jessica Halem: I have been and LGBTQ health advocate educator activist policy wonk really for over 25 years. And I'm so proud of the work. in the words of medicine, I've sort of lived in that side of patient advocacy. So I'm not a clinical person at all. I am a proud women's studies major from Sarah Lawrence College. I've spent now the past 10 years in academic medicine really trying to get at the heart of medical education of how healthcare providers, especially doctors, are trained, how they think about things so we can really get to the root of the problems. I also do fun things. As you can imagine, there's not a lot of money being a professional lesbian health expert. So I've had to do other things. Like I spent 15 years as a professional standup comedian. I traveled the United States performing in every pride that would have me and bar and college and bathhouse along the way. So, those were good days as well.
Gaby: That mix of advocacy and lived experience and fun actually gives Jessica this really deep compassion and commitment for thinking about how our culture disrupts our natural relationship with our bodies.
Jessica Halem: You know, when we are babies, we suck our toes. We're like grabbing our own feet, you know, we love our feet. We're born in love with our ability whatever we can do, running and jumping and laughing and whatever it is, how our body moves, what our body does, we're born in love with it and in awe of it and excited by it. And that's taken away from us, our natural love of our body and what, how it feels and what it can do, and what it looks like. It's so sad. And so for me, when you asked to talk about the role of weight and stigma and fatness and bodies shapes what's normal, what's not normal size, how bodies look, how they should look, how we assume they should look, it just brings up so much sadness about how we've been, how we've had that taken away from us.
Gaby: That loss that Jessica describes, that disconnection from the joy and awe that we're born with, that can be shaped by all kinds of external forces, and one that often intersects with body image in really complex ways is queerness. So we asked Jen in her words to tell us: how does being queer influence the way that she relates to her body?
Jen Kober: I just always accepted that this is the kind of girl I am. I am the kind of girl that likes short hair. I'm the kind of girl that wants to be able to wipe her hands on her clothes. I am the kind of girl that likes to have a lot of fucking pockets for all the shit I like to have with me because I am very delicate. I'm a tender butch. I need chapstick and I need little tissues, and I need a Q-tip every now and then. And there need to be pockets for these things to fucking go in. I need my candy and a little bento box. I need order, right? I need little compartments of things. And that's, that's just the kind of girl I am. I knew that I was a girl who had just cut off all of her hair and was, you know, wearing black t-shirts and cargo shorts and Birkenstocks and, and, and what, okay, now, now what are we doing now? What are we doing? Where are all the cute little girls that look like girls? Where are they? Because that's where I want to go
Sam: To recap, in Jen's exact words:
Jen Kober: I just always accepted that this is the kind of girl I am.
Sam: Mom, dad, I, I love Birkenstocks!
Richard: We've known that for a while, sweetie. It was obvious.
Sam: Ugh. Thank you. Jessica, ever, the queer woman's historian reminds us a little bit about where that image, the archetype of a big, sturdy, butch girl with short hair, cargo shorts, and sensible sandals comes from.
Jessica Halem: Our community where when I was growing up and in the queer women's community, big bodies were celebrated. People with confidence were celebrated. A big butch daddy was celebrated. The big butch who sat at the end of the bar bought everybody a drink, right? I mean you know, for a body to manifest that, it's like, either I don't give a shit or my life is, like whatever it is.
Richard: I love this "I don't give a shit" mentality. To me, this is a complete reframing. Those who don't conform to mainstream body image ideals are participating in a physical act of resistance against dominant social norms.
Sam: To quote our elephant, "fuck the patriarchy."
Gaby: To me, it's really worth saying that it's, it's all wrapped up in finding the male gaze irrelevant. Like what kinds of self-love and body image can manifest when you don't care about looking like, I don't know, an extra on Baywatch, because the true audience for that is a gender and a sexuality that maybe you're not interested in.
Sam: What does it mean about your lesbian identity that you reached for Baywatch? But the idea you're talking about was echoed by our second expert voice.
Shana Zucker: My name is Shana Zucker. I use she/her pronouns. I'm a fat queer woman and I'm also a general internal medicine physician in Pittsburgh. .
Gaby: Dr. Zucker talked about how the process of accepting her sexuality changed her views on body image.
Shana Zucker: Coming to terms with sexuality like, when I was 16, I hated myself for this. and Like, because I had to hate myself and then choose to throw out the picket fence. I also then that, you know, it, it's everything cascades. I then threw out the, you know, size zero dream, because I was like, I don't I don't need this. I can shed this.
Gaby: Our community reviewer, Karyssa Blair, did note that it can go the other way. She said, in an email to us. "I deviated from heteronormativity after embracing my body as it is. My queerness was able to bloom after letting go of body image expectations and shame." So I guess either way, the point that we're making is that one form of “deviance” you know, the ways that we deviate really from society's mainstream expectations can enable a realization about other forms of that within our identities.
Richard: There it is again, that theme that we keep coming back to. How stepping away from the white picket fence version of life opens up space to reimagine what beautiful, healthy, and sexy can look like.
Gaby: I, I agree. I've really noticed this across so many of our episodes. Uh, let's say the episode in season one about intersex bodily autonomy, episodes on steroid use for GBQ+ men, all the way to this episode on Queer Women's Health. We're finding that untethering from normative expectations is a really powerful act of queer liberation. And as Jen points out, when you see this kind of untethering in aggregate in a community at large, it's not just a powerful way to resist normative mainstream expectations, but it becomes a really important way to normalize alternatives to those expectations.
Jen Kober: I was in Chicago and someone brought me to a lesbian bar and. I was like, "oh, there's a bunch of us." Right? Just to know that there were other people, you know, with the same sensibilities as me, with the same style as me, with the same sort of tastes as me, just knowing that that existed made me feel better.
Gaby: So what I find so interesting about this is how body image in the queer women's community has really shifted over time. There clearly used to be this dominant image, it's the one that Jen alludes to of the butch lesbian, somebody who's in a bigger body, who is masced, who is outside traditional beauty standards. But if you fast forward to right now, to the Year of Our Lord 2025, you'll know that there's been a real sea change in what a typical lesbian looks like.
Sam: Sorry, listeners, when she says Year of our Lord, she's not spelling it with an E, but so exciting. It is the year of the lesbian.
Gaby: Well, it's, it's kind of complicated because it's actually not just lesbians anymore, even though there are headlines going around saying, this was the year of the lesbian. There's lots of room for more nuanced identities in the mix. Which is something that I really love discovering when I was coming out and has become even more so since. It means that that stereotypical masc or that butch lesbian, which is this avatar in both Jen's and Jessica stories, has been replaced a little bit, not completely, but certainly in a significant way. And what I think is even more interesting is that the new queer women stereotype that comes in to replace it. Is very specific. It's this very thin, stylish, aspirational, Instagram ready, queer woman.
Richard: Oy, are you gonna mention Cate Blanchett again?
Gaby: No, because first of all, you just did, and second of all, because she isn't actually gay. . What I'm really thinking of is people like Kristen Stewart, Phoebe Bridgers, Chappell Roan. And, and just to say like, these are real life people, but it is also what the queer women characters look like if you're watching movies or TV shows. And so when that becomes this default image of a queer woman, then I think the question becomes what happens to everybody else? What happens to queer women who are bigger bodied or more masc or just not part of that zeitgeist that I just described?
Jessica Halem: I do worry about the celebrity nest of queer women identity. I will call it out when we are celebrating too much high femme presenting, beautiful, thin, presenting, women loving other thin, beautiful, presenting women as lesbian visibility. For me, that's not lesbian visibility. Lesbian, true lesbian visibility. Queer women's success. I love the pop stars that are, you know, I love the Chapel Rowans, but for me, again, when a big sturdy dike comes out and sings a hit, you know, and we all dance to it, wild things, you know, that for me would be lesbian visibility, right? Like when we have lots of different kinds of bodies being celebrated and sexy, that for me is a, it would be lesbian visibility and would be a win. We have to show different sized bodies, sexy, healthy, in the world around us. We are not going to engage in healthy weight conversations as long as we are not celebrating large sized people.
Gaby: If we say that we're centering queer women in movies, TV shows and magazines, and we're not also representing the bigger bodied butch lesbian, if we're not celebrating sturdy, round bodies that deviate from the norm, then truthfully, we're only advancing a small portion of the community. And we're saying, only these bodies, only these queer bodies are worth celebrating.
Richard: This isn't just about who gets featured in a magazine spread. It's also about how desire is shaped, what we find attractive and who we think of as visible or aspirational. That stuff doesn't come out of nowhere.
Jessica Halem: I do think that there is a lack of a conversation about questioning, "Why do you feel this way? Why are you attracted to this?" It's okay to have a conversation about what you're attracted to and to be open about it, but it's not okay to not question where it comes from and what it's about. If you are a high femme presenting and you find yourself only attracted to other high femme presenting people, I think we, you deserve to know that there's a history and a politics behind that, that you should be aware of.
Sam: Those pressures we were just talking about: the celebration of thin femme queer women as the default image of queer beauty? That doesn't just impact desire, it actively pushes bigger bodies, more athletic builds, and more masculine presenting folks out of the frame.
Jessica Halem: That lesbian culture has so much sports in it, and then we get to this like, then the lesbian health problem is being overweight. Like, how do I hold both of those in the reality of lesbian health disparities?
Gaby: Just to connect the dots here a little bit more explicitly, homophobia, among other things, is the force that tells queer women that their bodies are too visibly strong, that they are too deviant from that waifish feminine norm, and that they don't belong in sports. And so you can imagine how this discourages people from being active writ large. Like, take the softball team of it all out of the picture. You're just gonna be turned off from doing anything that brings you that strong and yeah, maybe bigger build.
Sam: Like, for example, going to the gym.
Shana Zucker: When I imagine exercise, I imagine a gym and I imagine a bunch of straight dudes and like, that does not appeal to me. I do not want to be in that environment.
Jessica Halem: it's not even just being around men and your comfort around men. It's the double whammy of going to gyms for women, you know, and then being around a bunch of, you know, skinny bitches as we call them, right? I mean, it's just like, I, you know, I don't wanna be around straight women gaze either.
Shana Zucker: Is this why lesbians go the. woods? Because we don't wanna be around anyone?
Gaby: In Jessica's quote, there's this concept of the in-between that I wanna highlight because it's to me, a really core part of many queer women's experiences. So you're strong, but you're not chasing the thin yoga toned Peloton instructor body, but you're also not a cis guy getting strong in that way.
Richard: Like the Britney Spears song, not a man and not a straight woman.
Sam: Okay. You definitely were listening to the Indigo Girls 25 years ago, but: whatever. Sure. That's how the song goes.
Richard: Okay, fine. But Gaby, why did you bring that up?
Gaby: Because I think that that in-between space, to me, it encapsulates how many queer women live at the edges of traditional gender and beauty norms. They're navigating a world that doesn't fully see or reflect them, and where there aren't spaces made for them, which makes how they relate to their bodies and health deeply complicated.
Richard: In this section, we explore body image for queer women. There's a rich history of celebrating big, confident lesbian, bisexual, and queer women's bodies, the butch stereotype as an act of queer resistance against the male gaze and dominant ideals. But today, mainstream queer culture often highlights a newer stereotype, the thin, high femme lesbian, this shapes who is seen as desirable and aspirational, and who gets left out pushing bigger, athletic or masculine presenting queer women to the margins. To truly celebrate all queer women, we need to expand our ideas of beauty and desire to include diverse bodies, identities, and expressions.
Gaby: Also, we go to the woods because we finally get to use our carabiners for their God intended purpose, actually, their LORDE intended purpose.
Sam: Hmm. Amen. but how did they get the U-Haul there, Gaby?
Gaby: . Absolutely no idea. I'm a passenger princess in my marriage.
[QHP TRANSITION MUSIC]
Richard: So far, we've talked about the cultural forces that shape body image in the LBQ communities, but these ideals don't just influence attraction or confidence. They also follow people into the clinic room.
Shana Zucker: I'm a queer person who goes to the doctor in a fat body, and the entire time I'm just filled with this anxiety of when are they gonna say it? When are they gonna say it? How are they gonna say it? When's gonna happen?
Sam: Ooh, let's unpack the word fat for a second. Dr. Zucker uses it in a way that many people in larger bodies do: As a descriptive term that's been reclaimed, not an insult. It pushes back on the idea that fatness is automatically bad or shameful, and instead it treats as just one of the many ways that a body can be.
Richard: Which is more than we can say about most healthcare spaces as Dr. Zucker highlights. People living in larger bodies anticipate weight-based stigma. They walk into clinics already braced for harm.
Jessica Halem: That rupture happens so deeply upon walking in the door in my time with medical professionals, And I know you're looking at my weight and I know that I'm thinking about my weight. And I know that the weight is it's a very heavy, piece of the air we breathe together as in medicine and patients. And I think it's holding us back from having real conversations about how to be healthy and what we need to be healthy.
Richard: Medical stigma about body size is the kind of harm that can shut down a trust between doctor and patient, and without trust, people just don't go to the doctor.
Jessica Halem: Whenever I see the headlines that say we have an obesity problem in the United States, I, I immediately rewrite that. Headline and saying we have a healthcare access problem for people who live in big bodies. That's it.
Shana Zucker: I know people who avoid the doctor because they didn't, they don't wanna face that conversation of, " I don't want another person, a person with a fancy coat and a degree to tell me I'm fat." , and just like these really dismissive things that, that, sow mistrust and sow avoidance and then just lead to problems further down the line, exacerbations of issues that could have been controlled if someone didn't think to themselves, "oh geez, I don't want to go to the doctor. They're gonna make me feel bad."
Gaby: And for queer women that push away from care can be even more consequential because queer women compared to straight women often just have fewer reasons to go in and see the doctor.
Shana Zucker: When I think about a straight woman who is in a bigger body and goes to the doctor and is shamed by the doctor, she's like, "Wow, this sucks. And I also still need my birth control, so I'm still gonna go back." Whereas you have like this crucial contact point with a queer woman who might not be coming back for that care.
Richard: That moment really highlights the layers of mistrust and invisibility that queer women so often face in healthcare.
Gaby: And that mistrust only deepens when other parts of someone's identity, like race, physical ability, or gender conformity intersect with queerness.
Sam: Let's get back to Jen's story, which shows just how many of these dynamics play out in real life.
Jen Kober: I was 400 pounds when I was 20 years old, and so it was a problem. They ran all the tests. Sure enough, I'm super diabetic. I'm, you know, I, they immediately put me on insulin then. And, and once they did all that, then weight started really coming down.
Sam: So in Jen's case, her weight was connected to a medical condition, but this is not true for many people living in larger bodies.
Richard: And honestly, fixing the medical problem didn't make her feel better. Like so many queer women living in larger bodies, Jen just faced years of being treated like a set of symptoms.
Jen Kober: When I got the insulin, then I started playing that game where you like try to out eat the insulin. I was doing, I was a little Claus von Bülow there for a little minute, right? It was nice to get the high from like almost passing out and then jolting yourself with the fucking sugar, you know what I mean? Like just, oh, like three Krispy Kreme donuts. Just pounding them and just feeling that rush hit you was really, it was quite addictive. And so I did that for a little while. And then the pandemic hit. And I just did not give two shits. I woke up, my sugar was like 300 when I woke up. And I'd go eat a bowl of ice cream like it was. I just stayed sugared up. I was just pissing out sugar all day long. And oddly enough, I was still losing weight, but felt awful so people were like, "Oh, you look great," right? Even though I looked like shit because my face was all sunken in it was just terrible.
Sam: As Dr. Zucker reminds us and often her patients, not all weight loss is healthy
Shana Zucker: it's like so upsetting every time when I'm talking with my patients and I ask if they've had any unintentional weight loss and they always laugh and say, "I wish." Not only have we caused people to ignore what is really an alarm feature for cancer and other illnesses, but that also that is something to be a point of praise. And so you know, it does at least give me an opportunity to like pause on whatever we're talking about and say we're gonna do a little quick sidebar. Now I wanna talk to you about healthy weight loss and unhealthy weight loss.
Sam: For Jen, things started to change when she found a provider who met her with curiosity and not prejudgments.
Jen Kober: When I finally got a doctor who was like “Oh, you're very active for someone of your size. You ARE moving very well for a person with extra weight on them. You do this and that." You know, okay, now let's talk. You know, it wasn't, it wasn't this lecture, it was this like: how can we help this? How, what, what's going on? When are you eating the bad stuff? What are you eating? Why are you eating it? You know, and started to kind of get to the root of those things. Now we're cooking with gas and the whole thing really started to change. I got on the Ozempic and that really evened me out and got me kind of in a better place.
Richard: I think the key here is that Jen found someone who really saw her and acknowledged the work that she was already doing, which is something that Jessica also mentions.
Jessica Halem: I wish a doctor would say, when you come in with a body that is in need of some form of repair, right? You did nothing wrong, you are not at fault. You are still whole and beautiful and perfect, but we can help repair some parts of this.
Richard: This approach took away the shame of "This is all my doing. This is my fault." And ultimately, let Jen open up and dig in to do the deep analytic work to understand what was really going on with her health.
Jen Kober: When your whole life, it's all been you're fat, you're fat, you're fat, you're fat, you're fat, you know. You're like, "Okay, what's new? Yes, I know I'm fat. Can we get to maybe something that's gonna solve this? Because I'm pretty sure fat is what we're sticking with at this point, you know?" I think that that's what the problem is with it, with doctors, is that they tended to chalk everything up to that and nobody kind of went past that with me. When you start figuring it all out and you're like, " well shit, no wonder, you know, I'm eating one meal a day at 3PM I'm getting like 3000 calories all at once, and then I'm sleeping the rest of the fucking day." Oh, you know what? Maybe that's the behavior that needs to change and maybe some sort of mental health could come in now and say, "Hey, maybe you're depressed . And that's why you're eating so much."
Gaby: I wanna be really intentional here in highlighting something about Jen's story, which is that it, it wasn't ultimately about the weight loss itself and really was more about how she was feeling in her body and really how all of this connected to the low energy, the depression.
Richard: It is also worth saying that mental health is crucial to consider, but it's not the whole story and we need to avoid making it a blanket explanation for any symptom.
Sam: And that's partly why one size fits all doesn't really work in primary care. Instead, we have to focus on what feels important to a healthcare consumer. How do THEY define good health? What are the symptoms that THEY are concerned about? Because as Jessica reminds us, there's a lot of things that can go on that list.
Jessica Halem: Am I smiling? I know that's important. Do I look healthy? You know, Do I have a glow? My eyes, my nails, and my weight?
Richard: And the really cool and fun part of medicine is that we can really dig in with people and ask them what they want and let them lead the conversation.
Jessica Halem: My problem with medicine has always been this idea that, you know, doctors are trying to get us to some version of a body or a life that they were taught was the way it should be. Instead looking at the person in front of them and saying, "this is who you are." I wish a doctor would say to me, "how can I support you in, in your own conversation about your weight? I know you're thinking about it. Everybody is, right? How can I support you, Jessica, what do you need?"
Sam: And for Dr. Zucker's patients, that means shifting perspective, helping people move away from rigid ideas of what exercise has to look like so that the conversation about movement feels relevant to their goals and needs.
Shana Zucker: There's so much work to do too in reframing, what does it mean to move your body? Does it have to be at a gym? No, of course it doesn't. But like, let's talk about what does we use this term exercise. I'd really try in clinic to use the word just moving your body and just reframe it in that way because I totally empathize with my patients who do not find such an environment appealing.
Sam: Often these conversations talk about strength and what functional fitness and health look like for someone.
Shana Zucker: When we talk about stereotypical images of queer women who doesn't love the butch with the power drill, there's something so powerful about being capable, being strong. And so if we can focus our conversation on strength...that you wanna have the strength to support your body, whatever it looks like, let's do that and come from a place of empowerment and power in your body rather than this place of shame and trying to become smaller and make yourself take up less space. Let's talk about taking up space, but with strength, power, and, and health in that way.
Gaby: I, I really love this quote. We spoke earlier in the episode about the butch body being this important physical act of resistance, and I think that what Dr. Zucker does in clinic reclaims that and realigns big queer bodies with strength, with resilience, and I mean, yeah, with fighting the patriarchy.
Jessica Halem: I love lifting heavy weights and you know why I do it. I started to do it because I didn't ever want a man to jump up from his airplane seat to offer to put my luggage in the overhead rack. I wanted to be able to take my 50 pound carryon -- 'cause I only ever carry a carryon -- I wanted to be able to take my own carryon and look like a badass putting it into the overhead rack and taking it down. 'Cause I'm very short and men always jump up when I travel alone to put my luggage up. And I never wanted that. So I love the idea of goal-based exercise and really as queer women thinking about what is it, what is a good goal? And it's not about, you know, wearing a, a bikini on the beach. Is it about being able to defend yourself physically, feeling strong, to be able to feel safe walking down the street? I love that. Is it being able to run quickly, right?
Richard: Of course there are not-so-fringe benefits to improving your strength and stamina.
Jessica Halem: Lesbian sex takes a long time. God bless you if, you're quick, but like, you know, lesbian sex can go on for a long time. You gotta try a lot of different things. That takes stamina. That's a good thing. Good reason to go to the gym and work out, right? Build up your stamina in bed. You don't wanna, you know, lose your breath. You gotta keep going. Especially if you're the top, you know, you can't stop. You have to keep going!
Richard: Jessica reminds us: clear and compassionate conversations about weight are possible. It's about naming the facts and context, making space for timing and honoring the patient's story and readiness.
Jessica Halem: I wish that doctors named it and said it up front. I wish that I could walk into a doctor's office and the doctor would say, you and I know that this is a number and this is a conversation that, I have to have for other reasons. I wish you sort of peeled back the curtain and said, "Jessica, I need to talk about your weight. I need to know the number, and I need to know if it's changed for the following reasons: I'm thinking about your medications and dosages. I'm thinking about if it's changed and what's caused it, it could that be a sign of something else." I wish we talked about weight WHEN weight matters, and then we don't talk about it when it doesn't. So we say things like, "Hey Jessica, we did your blood work. We're thinking about pre-diabetes or diabetes. Weight is one of the factors that we need to talk about. Can we talk about that today? Is that okay?" And I say "today's really not a good day to talk about it. Is it an emergency?" No. Okay. Can we talk about it in three months? Right?
Richard: This is healthcare at its best: when it's truly a dialogue that's anchored in the patient's own decisions, preferences, and comfort.
Gaby: Today, we've explored how fatness and queerness intersect to shape not just bodies, but experiences with healthcare. From the anticipation of stigma in the exam room to the ways that weight overshadows deeper health issues, this episode talks about how vital it is for clinicians to meet patients with curiosity instead of judgment.
Richard: Jen's story shows us how individualized care free from assumptions can open the door to healing that goes beyond the numbers on a scale or a BMI.
Gaby: Cause at the end of the day, for so many LBQ+ women, reclaiming strength defining health on our own terms, it's really an act of queer joy, queer resistance, and queer resilience.
Jessica Halem: When I think about our community getting the care that they receive whenever I dream of a world in which LGBTQ+ people are happy and whole and cared for in relationship with medical professionals who have access to great information. Here's you guys with the medical information and the science and the, all that great, support and me with the need. And wouldn't it be great if we were in this partnership? I wish that you said things like, I care about your overall health, and this number is part of your story. It's your story. It's not the BMI story. It's not my story. Everybody's body is different. But it's part of your story, your relationship to your weight, and how it's changed over your lifetime.
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Gaby: QHP is a power sharing project that puts community stories in conversation with healthcare expertise to expand autonomy for sexual and gender minority folks.
Sam: Thank you to our community voice, Jen Kober, our healthcare experts, Jessica Halem and Dr. Shana Zucker. And of course we would like to thank our community reviewer, Karyssa Blair.
Richard: For more information on this episode's topic, check out our website at www.queerhealthpod.com.
Gaby: Help others find this information by leaving us a review and subscribing. We're on Spotify and we are on Apple.
Sam: We are on social media. Our handle there is at Queer Health Pod and reach out to us.
Richard: Thank you to Lonnie Ginsburg, who composed our awesome theme music, and to the Josiah Macy Jr Foundation who supported some of the tech we use to produce these episodes.
[QHP THEME MUSIC ENDS]
Sam: Opinions on this podcast are our own and do not represent the opinions of any of our affiliated institutions. Even though we are doctors, Don't use this podcast as medical advice. Instead, consult with your own healthcare provider and you cannot use QHP as a U-Haul code, but try it and let us know what happens.
Sam: Are you OK if I say "femme" instead of "high femme" because to me, they're the same?
Gaby: Yeah, sure
Sam: OK.
Gaby: They're not. That's fine. (laughter)
Richard: Incorrect, gay man!.