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This is the face of someone who's just realized she's dying.

Oh, not the way you'd expect - not an injury, or a heart problem, or cancer (though that may be true too).

She's dying of weight stigma. It may happen fast - that's the cancer part - or maybe slow, but she's just realized that one way or the other, the most likely thing that will kill her in the end is the medical system's lack of care or interest in her - and people like her.

You see, she weighs over 300 pounds. 140kg. 22 stone, for any Brits out there. That's a lot, for anyone who isn't sure.

And what that means is that she doesn't have adequate access to healthcare. She can't have an MRI to diagnose the breast mass they can't biopsy any other way. She doesn't fit in chairs in doctor's offices or gowns at the hospital. Her blood pressure measurements are inaccurate because her arm doesn't fit in an automatic machine. She can't do continuous glucose monitoring because her arms are too fat for the sensors. She can't have surgery in some hospitals, and if she does she can't be adequately anticoagulated afterwards. Her birth control is less effective - but her pregnancies are high risk. Everything we as a society take for granted in medicine - it doesn't work properly for her. Because she's fat.

This time it's a breast MRI. She probably has cancer, but no one knows for sure. But even if it's benign, even if she survives this time, she's finally realized...

There will always be a next time. This problem is not going away and it's only going to get worse as she ages and needs more help. More healthcare. What will it be next? Anyone care to make a wager?

If shame was effective in causing weight loss, she'd already be a size 2.

She's exhausted. She hasn't slept well in 3 months - since the mass was discovered. She's been writing articles and interviewing for podcasts and committee-ing so that this doesn't have to happen to the next generation, because it's unlikely change will happen fast enough to help her.

She hopes she's not dying of breast cancer - but she knows she's dying of weight stigma, and that's bad enough.

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