MEGAN TRASK (Front Desk Assistant, Sunshine Primary Care): I could tell from the minute she checked in that she was fat. Like, real fat. The craziest cankles I’ve ever seen.

IVY GREENE (Fat Lady): I twisted my ankle playing soccer on Sunday, and by Monday morning it was the size of a softball. I decided to try this new walk-in clinic to make sure it wasn’t broken.

GRACE STONE, RN (Nurse): When I called her name, she could barely hobble out of the waiting room. Poor thing. She was almost too fat to walk!

GREENE: I asked the front desk for crutches, but they said I needed a prescription.

NURSE STONE: While I was taking her blood pressure, I asked about her exercise routine. She listed a bunch of sports and stuff, but I wrote down “none.” I mean, come on. I have eyes.

GREENE: I told the nurse I jog three days a week, play soccer, lift weights, and take spin classes. She just giggled. Honestly, I’m used to it. It was kind of annoying when she took my blood pressure four times, though.

NURSE STONE: I’ve never seen a fat person with good blood pressure before. Or, I have, but it gets me every time. Like, how is that possible? Being fat is horrible for you. Anyway, I knew I’d get the truth when she stepped on the scale. But she could barely even stand.

GREENE: I couldn’t put any weight on my right ankle, so it was hard to stand still to be weighed. The nurse accused me of trying to “beat the scale.”

NURSE STONE: After I put her in the exam room, I pulled the doc aside and told him her vitals were all good. Except for the most important one – BMI.

FREDERICK McMILLER, MD (Primary Care Physician): I reviewed the patient’s chart in detail before seeing her, as is my typical approach in difficult cases like this one. Megan had listed the chief complaint as “fat ankles.” I knew immediately that the patient’s ankle swelling was likely caused by heart failure, diabetes, gout, or a combination of all three. It was just so tragic to see in a 33-year-old woman. The sequelae of female obesity are truly terrible to behold.

GREENE: When Dr. McMiller came in, he looked like he was going to tell me I had cancer. He started talking about heart failure, and I was so stunned I couldn’t interrupt. I kept trying to point to my ankle, but he just moved on to diabetes.

DR. McMILLER: The poor woman was shell-shocked. I don’t think anyone had ever told her she was obese before, or what the consequences might be. It’s a shame our culture is so lax about obesity detection.

GREENE: He just kept muttering “obesity” over and over like it was a death sentence. I finally worked up the nerve to tell him I had hurt my ankle playing soccer, but—

DR. McMILLER: Ah yes, the old “playing soccer” canard. I see it all the time. Obese patients often present with strong vital signs and good self-reported exercise habits, but we doctors know the truth. They’re dying slowly by their own hand. Or mouth, I guess.

GREENE: He ordered a million tests, none of which was an x-ray for my ankle.

DR. McMILLER: Her heart sounded good, but I was sure heart disease was lurking under all those layers of hydrated fat somewhere. So I ordered an electrocardiogram, diabetes A1C, a uric acid blood test for gout, and a chest x-ray just to be sure. She kept saying she wanted an x-ray of her ankle, but I couldn’t justify such a waste of precious medical resources. Her swelling and bruising was clearly a side effect of obesity-induced chronic disease. There was no other possible cause.

GREENE: I just wanted to get out of there. I asked about crutches for the walk home, but he gave me a bunch of weight loss pamphlets and a prescription for an appetite suppressant.

DR. McMILLER: Crutches! Can you believe it? As though the cure for obesity is less walking. I blame the media. No one ever reports on the importance of diet and exercise anymore.

GREENE: I skipped the tests. It took a few weeks, but my ankle eventually healed on its own. It still makes this weird clicking noise, though. I should probably get it checked out, but it doesn’t seem worth it, you know?

DR. McMILLER: I never saw her again. I assume she died of obesity shortly after our appointment. So sad.