Posted by: silverstar98121 | August 13, 2009

Fear and Loathing of Fat People

I am morbidly obese, according to the latest guidelines. My BMI is an astounding 48. I am 130-150 lbs overweight, depending on whose chart you use. It’s one of the reasons I didn’t put a picture of myself up on the website for a long time. I know how people judge you if you are obese. So I have been around the Fat Acceptance websites for years. And I believe in Fat Acceptance.

For me, Fat Acceptance has to do with not being discriminated against. In these United States, you can’t discriminate in hiring against a dwarf, or a one-legged person, but you can discriminate against a fat person. To me discrimination against fat people is just as unacceptable as discrimination against a person of color. But, you say, a person of color, or a dwarf, or a one-legged person can’t change, but a fat person just needs to change their eating habits and start exercising. Were it really so easy. Studies have shown that for the most part, people tend to have a set point, and to return to that set point again and again. Thus the stories of the people who have lost the same 50 lbs over and over. This is due to a mechanism that sets your weight higher after every period of low food intake. Originally a mechanism to protect people from famine, and prepare them for more years of lean during years of good crops, one thing that can set it off is dieting. Think about that for a minute. Every time you lower your calorie intake, the next time you go back to eating normally, or even at a higher rate than what you were taking in on the diet, you gain weight. I have seen patients in a nursing home gain weight on 800 calories a day. Which also explains why every time we regain the weight, we gain a little more.

If dieting is a risk factor for obesity, I have my mother to thank for starting

Me at 16

Me at 16

me on that road at the age of 13. She decided I was too fat, and put me on a 1200 calorie diet, about half what I needed at that age. But looking at the pictures from then, I wasn’t fat. I just had boobs and an ass, attributes my mother lacked.

Part of the reason that fat people can be discriminated against is our stupid healthcare system, that puts the burden of providing healthcare coverage on employers. Employers fear, because of all the hype about the health problems of the overweight and obese, that their insurance premiums will rise. And they will, because the insurance industry is not out there to help us get healthy, it’s out there to help Wall Street get healthy.

But how much real evidence is there that obesity really causes or contributes to increased health care costs or premature death or disability? Not much, as it happens. Yesterday’s edition of Junk Food Science looked at the importance of null studies, studies that find no correspondence between supposed risk factors and poor outcomes. The particular factor in play here was the role of belly fat in the supposed increase in rates of diabetes. None was found. Was that reported in the news? Hell no! Why not? Why, we might quit worrying about our belly fat and buying nostrums to get rid of it.

Even that gold standard of treatment for we who are morbidly obese, the gastric bypass, has not really demonstrated that it can improve health outcomes for the morbidly obese. As a matter of fact, because it induces malabsorption syndrome, many of the “survivors” have considerably more hospitalizations and poor health after the surgery. Even then, they usually regain the weight after 6-7 years, if they survive in the first place. Death rates post op are 3% in the first year and 6.4% in the first four years. Compare this to a death rate of  0.44-0.66% among “morbidly obese” adults overall.

If the norm is to regain the weight, even after this drastic surgery, why all the recrimination of fat people here* and here, even by those who have been or are, by their own admission,  overweight or obese? Why the “disgust” at someone who has to use a scooter in the grocery store, and whose belly hangs down to their knees? When I see that person, and I think there is one in every town, I think “God, they must have lost a lot of weight to have all that loose skin.”  I can’t look at them with disgust, or I would have to look at myself with disgust. And I gave that up a long time ago.

As to sitting next to us in an airline seat, and us encroaching on your space, I can only say that the most miserable trip I ever had was sitting next to a normal weight guy with extremely wide shoulders. I felt I had to bend myself in half vertically to accommodate him. We would all be better off if airline seats weren’t on the average, 17.2 inches wide. Compare this with theater seats that average 2o inches and compact car seats that average 22 inches.

In the mean time, I have been told I have a “beautiful heart” by an echocardiographer, I haven’t developed Type 2 diabetes, despite the dire predictions, and neither did my grandmother who was my height and weight. She lived to be 89, BTW. I take a minimal dose of diuretic to control my blood pressure, which has never been over 140/90. Most of my “health problems” are minor inconveniences, not life-threatening.

The only thing that might be improved by weight loss is my knees, and since they are already bone on bone, even that is doubtful. Of course, if I lost about 75-100 lbs, then they might do the knee replacements they refuse me now. On the other hand, the surgeries would run about $30,000, and for that they could buy me a new power chair every five years until I’m the age my morbidly obese grandmother died at. And I wouldn’t have to have revision surgery for them either. Another example of how the US healthcare system wastes money.

But my knees are bad from my obesity, right? Well, maybe. On the other hand, perhaps I have Ehlers-Danlos syndrome, of which I have many symptoms, and which causes early arthritis in hyperextensive joints. Which my knees have always been hyperextensive. Or maybe it has to do with spending 30 years on my feet, often on concrete floors, 8-16 hours a day as a nurse.

So, yes, I’m trying to lose some weight. Most people who lose weight lose about 10% of their weight before the body’s survival mechanisms kick in. In my case, that would be about 25 lbs. I might be able to get into my skinny jeans. But get down to my normal weight and stay there? According to the studies, not bloody likely. And I accept that.

*BTW, fat people who accept themselves are more fun because they’re not worrying about their weight, and bitchy from being on a diet.

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Responses

  1. Silverstar, I hope that I have not alienated you forever by my post. When I wrote it I was trying to explore the complex emotions I have about this whole subject. I believe that you are doing the best you can under an almost intolerable health situation.

    Let’s all agree that riding in airplanes is uncomfortable not matter who you are sitting next to! As they said about a hundred years ago, if man had been meant to fly, he would have wings.

    And nowhere in my post did I once indicate or imply that I think gastric bypass is a good idea for anyone. I am in complete agreement with you about that surgery, and it appears to me that the discipline you have to impose about portion size and what you ingest after the surgery is why it is successful. If a person can have that discipline after the surgery, then why not exercise the same discipline before it, and not suffer the other side effects that result in such poor health following such a radical procedure?

    At any rate, I am glad you put your own picture up on your gravatar and side bar. You don’t just have a beautiful physical heart, you also have a beautiful spiritual heart.

    As I said on my own blog in my comments, it is obvious to me that I need to work on my own attitudes.

    Blessed be.

    • HMH, I was worried that I would alienate you with my post, but I just had to say something. No, you didn’t say anything to indicate that gastric bypass is a good option. Gastric bypass surgery is my personal bugaboo, because I have been told I had to have it to get my knees replaced. I never thought it was a good idea, and now there are studies to back me up. Gastric bypass, or even the less invasive lap band procedure, have more effects than just “portion control.” That portion control is enforced by such goodies as vomiting, dumping syndrome, diarrhea, etc. If you live through that, and your gut settles down, you usually regain the weight. Even on the smaller portions. Unfortunately, the time for portion control is before you get fat. Afterward, it’s a losing battle.

      • Good lord, it is worse than I thought. Nobody ever told me I needed that surgery, so I haven’t really looked into the side effects. It sounds profoundly horrible in all ways.

        In my personal experience, the first slug of weight I lost amounted to 22% of my body weight, and I promptly regained weight until the total amount I had lost was more like 10%. I held that weight for about 3 years before I started another round of calorie reduction. I have not done any research, but I’ll bet if they did study it they would find that it is easier to re-set the set point downward if one loses a small amount of weight (like no more than 10% of the original weight) and lets their body get firmly used to that place before one attempts to lose some more. Unfortunately, there is not a single “diet plan” or “diet service” (like Jenny Craig or all that crap) that encouragess such a modest goal. The “goal” in all those plans is what the establishment has dictated your “ideal” weight to be. When you drop that much weight that fast, the set point has not been adjusted lower at all, and your body is screaming to get back to the original one. History has shown that the body is VERY good at accomplishing that goal! That yo-yo effect is what enriches Jenny and all her friends.

  2. Here’s a great book I read this summer that really helped me (Silverstar’s closer-to-“normal”-weight sister) delete the “gotta lose weight” thoughts for now: Feed Me!: Writers Dish About Food, Eating, Weight, and Body Image by Harriet Brown

    • Hey, thanks, Sis. I’ll try to get that from the library.

  3. “Unfortunately, the time for portion control is before you get fat. Afterward, it’s a losing battle.”

    This is so not true, SS, and I’m very sorry you feel this way. But if you did lose that 10% and then, as hmh has suggested, give your body some time to settle into feeling that new weight as normal, that’s no small deal. That would be 25 extra pounds less on your knees. That’s almost two Sunnys!

    I don’t believe in diets. But relearning to eat well (which is I think what the book your sister has recommended is about) can help change the focus from losing weight to feeding yourself what your body really wants and needs. Another very good “non diet” book is On Eating. Very cheap at Amazon.com.

    I’ll be taking my copy of On Eating with me to the beach tomorrow.

  4. Great post silverstar. Am off to read HMH now….

  5. i have lived both sides of this issue – being classified as obese as recently as january, and now fighting my way back down to the middle of the ‘overweight’ range. while my weight never put me in the position of being disabled, it kept me from doing many things i wanted to enjoy…

    if weight/size are not a barrier to living your life in a manner you wish? why is that a problem? if it’s not a problem for you, then it sure as hell shouldn’t be a problem for me…

    what always aggravated me when i was on the heavier side was the ‘invisibility’ that came with it… people avoid looking at you, averting their eyes. perhaps it’s paranoia, but i always felt i was being judged – considered lazy, slovenly or reckless.

    nice rant, lady!

  6. My mother has been obese almost all of her entire life. We were lucky, she knew lots about nutrition and taught us how to eat a proper diet.
    I never saw her snack. I never saw her overeat. And she exercised.
    It never made sense why she was (still is) so heavy.

    I never did see anyone mistreat her for being overweight. Maybe it is because of where she lives, South Louisiana.

  7. A bit late getting ’round to reading this and commenting. Great post, btw.

    I will have to admit to having possessed some of the negative attitudes you describe in years past, mostly because we learn what we live and our peers while growing up can have, it seems, incredible influence (I guess it’s “mob mentality”).

    Nowadays, I’m less concerned about “weight” and more attuned to “healthy and fit”. I have little use for the scales and tables that the medical professionals trot out to confirm to me with visual aids that my BMI is, in fact, too large. Pfffft, I say. If I was to somehow achieve that magic 190 lbs (I’m about 230 lbs) that would put me on the upper edge of “acceptable”, I’d probably look like an Auschwitz survivor.

    I lost weight in the last months of my first wife’s life and probably more after she died. I probably got down to around 210 lbs, which is probably where I should be. Clearly, I’ve gained some back since, but I’m not too concerned about it. I eat pretty healthy, have really cut down on refined sugar, have quit coffee in favour of tea, don’t each much meat and don’t eat as much in quantity.

    I’m still fairly active around the house and yard (the paid job is largely sedentary) to the point where, as I close in on 50, I’m almost continually wracked with muscle spasms, stiffness and pain. Massage therapy and chiropractic is not helping, so I’ve started doing yoga.

    I don’t really know what to say about the whole discrimination thing. A lot of it is rooted in ignorance, I think. Education may help, but as you’ve probably observed, it is very difficult to change or modify entrenched attitudes.

    All we can do then is just try to live our lives and say eff ’em to those who would look down their noses at us.


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