Robin Zabiegalski: Vermont offers excellent transgender health care, unless you’re fat

This comment is by Robin Zabiegalski (she/them), a writer in Burlington who currently writes health, fitness and wellness articles for Health Digest. Their work has been featured in several digital publications and Seven Days.

Vermont is consistently ranked in the top five states for trans people, and we’ve earned that ranking. In 2013, Vermont lawmakers passed legislation requiring insurance companies to cover gender-affirming care. In 2019, they revised that legislation to include trans youth and expanded Medicare coverage for gender-affirming surgeries.

These laws demonstrate Vermont’s strong commitment to affordable and accessible trans health care. Unfortunately, these laws don’t actually help fat trans people.

I use the word fat as a neutral descriptor, the same way I use the words “short” or “tall.” I describe myself as fat because one look at me confirms that I am. I’m also non-binary. I was identified as female at birth, but I am not female. I’m not a man either. My gender is somewhere in the middle. Where exactly? I’m not sure and I shouldn’t be. Sometimes gender is more about knowing what you’re not than knowing what you are.

Like many non-binary people, I experience gender dysphoria, which the Diagnostic and Statistical Manual of Mental Disorders defines as “a marked discrepancy between their experienced or expressed gender and the one assigned to them at birth.” Part of my experience with gender dysphoria is breast dysphoria, a discomfort in my chest that has a significant impact on my mental health. Because of this, I want a masculinizing top surgery, a gender-affirming procedure that removes breast tissue and shapes the breasts to make them appear more masculine.

When I started researching how to get top-notch surgery in Vermont, I discovered that there is currently only one practice in the entire state advertising top-notch surgical services. A few more doctors are listed in UVM’s guide to gender-affirming care for Vermonters, but one of those surgeons is at Dartmouth-Hitchcock in Lebanon, New Hampshire, and the other doesn’t seem to be doing the best surgeries anymore.

So I contacted the only practice in Vermont that definitely does top surgery. I did it with great trepidation because I know many surgeons refuse to perform top surgery on fat people. One study found that surgeons cited many reasons for their refusals, including the increased risk of surgical complications and the need for “revisions,” additional operations to correct poor results from the initial operation.

Research confirms that surgery is more risky for obese people. However, much of the current research does not examine why obese patients have more negative outcomes during and after surgery. One possible explanation is that this has less to do with body size itself and is more the result of medical weight stigma, a well-documented phenomenon.

Research shows that medical professionals believe disgusting things about fat people, and this directly affects how they care for or don’t care for fat patients. Many medical professionals, especially surgeons, simply deny medical care to obese people by setting BMI limits for procedures. The outdated “body mass index” still informs the medical definition of “fat.” Although BMI was never intended to be used as a measure of health, has deeply racist origins, and is not an evidence-based indicator of individual health, it is still widely used to prevent people from getting medical care.

And that’s exactly what happened to me. The best surgeon’s office informed me that I would not even be able to get a consultation with the surgeon until my BMI dropped below 35. I would have to lose 70 pounds before I could even talk to the surgeon.

BMI cutoffs like those for upper surgery aren’t even evidence based. Studies have found that fat trans people do not experience complications more often than thinner trans people, and in fact do not need revisions more often. The latest research strongly suggests that weight should not be a barrier to having gender-affirming surgeries.

You might be thinking, “Just lose weight!” You wouldn’t be alone. Most people believe that dieting and exercise lead to sustainable weight loss, but science shows that this is not true. As well as my personal experience. I have lost and regained more than 50 pounds several times in my life due to eating disorders. Every time I lost weight, I gained it back as soon as I started eating normally.

The only way I was able to stay thin was through fasting and compulsive exercise. When I finally got treatment for exercise anorexia and bulimia, I gained weight and stayed fat.

Losing weight is not an option for me and therefore I cannot get top surgery in Vermont. I will have to travel out of state which adds significant travel expenses, especially since I will have to stay out of state while I recover. A carer will have to stay with me while I recover in a hotel instead of my home and it can’t be my partner as he will have to be at home with our 3 year old.

In one of the most “progressive”, “trans friendly” states in the country, my fatness still prevents me from receiving medically necessary gender affirming care. Is this how we want to care for our neighbors?

Did you know that VTDigger is a non-profit organization?

Our journalism is made possible by member donations. If you value what we do, please contribute and help keep this vital resource available to everyone.

Filed under:


Tags: fat, gender affirmation, health, Robin Zabiegalski


About the comments publishes 12 to 18 comments per week from a wide range of community sources. All comments must include the author’s first and last name, city of residence, and a brief biography, including affiliations with political parties, lobbying, or special interest groups. Authors are limited to one posted comment per month from February to May; during the rest of the year the limit is two per month, space permitting. The minimum length is 400 words and the maximum is 850 words. We require commenters to cite sources for citations and, on a case-by-case basis, ask authors to support claims. We do not have the resources to fact-check comments and reserve the right to reject comments based on matters of taste and inaccuracies. We do not post comments that are endorsements of political candidates. Comments are community votes and do not represent VTDigger in any way. Please send your commentary to Tom Kearney, [email protected]