Women are more likely to be told to drop pounds than men with an identical body fat ratio.

From the very moment they sprouted, my breasts have been nothing but a burden. After puberty I couldn’t play sports (no bras ever fit). By the time I hit my 20s my breasts had grown to cantaloupe-size L cups. My shoulders and back ached constantly; the 10 measly chiropractor visits insurance covered each year provided only temporary relief. So I approached my chiropractor about breast reduction. It’s an invasive surgery, he said. “Losing weight is what will really help you.”

I was stunned. Just lose weight? That’s not how boobs work. That advice is the fat shaming version of “Did you try restarting the router?” It took years to grasp how common it is for medical professionals who we trust to dismiss fat people, like me. And women are more likely to be told to drop pounds than men with an identical body fat ratio, according to research in the Journal of the American Academy of Nurse Practitioners. Doctors and insurance companies advise people like me that getting lighter is the magical solution. No wonder it took eight years, three surgeons, two insurance companies, and one team of female doctors to get my medically necessary breast reduction surgery.

Six years ago this month I consulted a highly recommended local surgeon who considered me a good candidate for breast reduction, even at my weight. My insurance claim was approved, but then the surgeon’s office said he wouldn’t operate on me until I lost 35 pounds. They cancelled the surgery. I was devastated.

In 2016 I tried again, this time with a surgeon who’d work on me at my current size. Another impasse: He refused to remove the amount of breast tissue required by my insurance. “You don’t want to be too small,” he told me. “You won’t like it.” Internally, I raged. I want small boobs! I want a pain-free life!

Enough with men deciding what’s best for my body. My care team, I determined, should be all women. I found a female surgeon and attempted for a fourth time. My new doctor, Meghan Nadeau, agreed to do my breast reduction. But as she flipped through my chart, she reneged, citing my blood sugar. (I’d been diagnosed with type 2 diabetes only three weeks prior.) I gave up.

Then, this June, I threw my back out. My new chiropractor ordered me to begin the process again before irreversible damage to my spine set in. She wrote a letter for insurance. So did my endocrinologist, ditto my primary care physician. When I saw Dr. Nadeau again, not only had she spoken with the other women on my care team, but she was ready to do everything possible to get me approved for surgery. I cried eight years’ worth of emotions that week.

In August Dr. Nadeau liberated me from nearly six and a half pounds of breast tissue. The relief in my body was immediate.

Despite being deemed too high-risk my recovery has gone perfectly. My scars—the physical ones—are already starting to fade, though the emotional ones linger. Yet I’m free from the false truth that losing weight is the only path to health.

Reiny Cohen is a Seattle-based communications strategist.

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