Quest for Thinness
My name is Rich, but I may be better known to some of you as richie79 of the UK who used to post prolifically here on Big Fat Blog and elsewhere in the Fatosphere for many years. Don't know if any of the old faces are still around but I wanted to share my wife Heather's story and felt this was maybe as good as any a place do it. If you believe otherwise, please let me know and I'll remove it.
In February 2005 a pretty girl with big brown eyes by the screen name of 'sweetheather86' sent me a 'smile' through a plus-size dating website of which we were both members. At the time I was at a low point following the failure of a previous long-term relationship. Heather and I hit it off almost immediately despite her being in the US and at 18, almost 7 years younger than I. Looking forward to daily emails from one another quickly progressed to a first nervous long-distance phonecall, nightly 4-hour chat sessions on MSN and before either of us knew it I'd booked a ticket to Boston. Two incredible weeks on from our first shy meeting at Logan Airport I knew this was the one person I wanted to spend the rest of my life with.
The only cloud on the horizon was the gastric bypass Heather underwent just two weeks after we first made contact. Even then I knew of the horrendous risks of these operations but although I had already fallen for her, didn't feel i knew her well enough to ask her to delay or reconsider it. She came from a long line of big women and had herself been fat throughout childhood, resulting in numerous failed diets and all the bullying and self-loathing that accompanies being a fat child / teen. At the time the media was full of stories of this 'magic bullet' and several of her family members had undergone the surgery with dramatic initial results. She told me that she wanted it done so that she could have all the things in life she had been convinced were not available to people of her size - someone to love her, a home and a family, access to nice clothes, and not to be abused and harassed in public. Tragically she later told me that she opted for the bypass as unlike the lap-band it was irreversible (the stomach is cut in two and 18" of small intestine removed and discarded) and therefore offered no opportunity to back out at a later stage.
Our relationship continued to blossom even as her health began to deteriorate. Each of us crossed the Atlantic to spend long periods together in one another's countries and during this time we crammed in as many activities, visits etc as many couples do in a lifetime. In September 2007 I proposed to her and she accepted tearfully and without hesitation; we were married two years later almost to the day and having obtained a spousal visa, in July 2010 she finally moved to Leeds in the UK to live with me full-time. By this point she had lost around 200lb and gained back almost 100lb of that. She was on a cocktail of drugs, could eat very little, suffered from constant dumping syndrome and was developing problems with joint pain, blood sugar and constant fatigue, all of which were exacerbated by a revision to the original surgery to repair the staples but which further reduced the range of foods she was able to eat.
In October 2010 Heather gave me the news that she was pregnant. Our joy at this was tempered only by concerns about her deteriorating health. Fortunately apart from having to be artificially rehydrated several times (she suffered from such debilitating nausea throughout the pregnancy that she was at times unable to keep down fluids) her pregnancy passed largely without serious incident. Our son Ben was born in June the following year; despite several attempts to induce her at term plus two weeks she never progressed to active labour and had to undergo an emergency Caesarean section on one of the hottest days of the year in an overwhelmed Leeds General Infirmary where she was treated like an inconvenience by several of the medical staff.
Her surgeon in the US had recommended a UK counterpart in our city who might have been able to help but NHS rules decreed she would first have to see a dietician. As was often the case I went along with her as she was rightly worried that this would be used as yet another opportunity to shame her about her weight; predictably the dietician told her that on her sub-1000 caloric intake it was 'impossible' for her to be maintaining at 320lb and that there must be something she wasn't telling her (because *everyone knows* that fat people always lie about their eating habits). This was followed up by a barium swallow which suggested she may be suffering from a stricture (narrowing) of the digestive tract and the prospect of further investigation, though subsequent events meant this never ultimately took place.
On the weekend of 8th February 2013 I went to visit friends in another city an hour away from home. Heather had encouraged this rare weekend away, as we took it in turns to give one another breaks from the stresses of young parenthood when possible. She waved me off at the train station with hugs and kisses and called to tell me goodnight later that evening. That would be the last time I ever heard from her. My attempts to contact via text and phone throughout Saturday went unanswered and, knowing how out of character this was, my friend drove me home. Unable to gain access to the house, which she'd locked from within the previous night, I frantically called the police, who broke in through our basement and found her collapsed in our bathroom. I was told that she'd been gone for some hours. Our little one was fortunately still upstairs in his crib and none the worse but for need of a clean diaper, a good feed and a cuddle.
Initially we thought the cause may have been related to a persistent headache she'd been complaining of but which her doctor had failed to take seriously. The results of the post-mortem however showed the truth to be far worse. Unbeknown to anyone she'd developed a fistula at the site of the gastric bypass surgery. This had suddenly ruptured causing, as the report put it 'destruction of chest cavity and diaphragm through discharge of gastric material'. I don't even want to imagine the discomfort my poor sweet girl likely suffered in her last hours, or to think that the surgery on which she'd once pinned her hopes of acceptance (and subsequently come to regret when she realised that her happiness was not weight-dependent) had been a ticking timebomb from the very outset of our relationship.
Heather was without a doubt one of the sweetest, kindest, most loving people I have ever had the privilege to know. In a world beset with so much cruelty and unpleasantness she was a revelation of tolerance and humanity. For the first time in my 33 years she made me comfortable in my own skin, gave me confidence to be myself and become a stronger person through my recent diagnosis with Asperger's Syndrome, a strength that only left me two Saturdays ago. Our long-distance relationship was forged in patience and anticipation of better days ahead, giving us a depth of connection that is all too rare and making us soul mates in every sense of the word. Heather loved me for my differences and quirks rather than despite them, as I loved hers and trusted her implicitly. In turn she told me that my unconditional love for her had finally given her the contentment and safety she craved when so much of her life had been marked by pain and unhappiness. She often said 'I'll always be your girl', over the years it became our little refrain that she would add to the bottom of cards and emails and tell me last thing at night. My life, Ben's life, those of all who knew her and the world at large will be all the poorer for her absence from them. Rest in peace forever sweetheart, know no more pain or torment, and I'll be counting the days till I'm back at your side.
(Cross-posted as 'Rich & Heather - Love Can Bridge an Ocean' to 'First Do No Harm' blog at www.fathealth.wordpress.com, WLS Uncensored Yahoo group and my personal FB page).
In today's weight loss products to stay the hell away from, I bring you Hydroxycut.
Taken off the market in 2009 because of complaints of liver damage, it was "reformulated" and became available again. Last week, a woman who had been taking it and was sleep deprived went into a delusional, homicidal rage and killed her daughter with scissors. The original Associated Press article, Nev. mom kills daughter, 6, with scissors is propagating as we speak.
Did this horrible tragedy have something to do with the weight loss drug, or was this woman just out of her mind to begin with?
Who knows, but between the liver damage, the loss of sleep and the possible delusions, I'm thinking this is a drug to avoid.
This post discusses dieting and why people gain weight, and may be triggering for some.
An article in July 9th's International Journal of Obesity, Does dieting make you fat? A twin study, by Finnish scientists K H Pietiläinen, S E Saarni, J Kaprio and A Rissanen, supports what size acceptance activists have been saying for decades: dieting is linked to long term weight gain. Most of us have experienced it first hand and watched friends and family members deal with it as well.
I haven't read the article myself yet, as it's not available for free. However, Dr. Arya M. Sharma, Canada's obesity czar, discusses the study in his newest blog entry: Will Losing Weight Make You Fat?.
Dr. Sharma is not a HAES proponent. The title of his article implies his concern is that average-sized people who diet for cosmetic reasons are making themselves larger rather than smaller. I suspect that he still believes that people who are obese by whatever standards he uses (he isn't fond of BMI) should still use restricted eating to pursue weight loss goals, regardless of the fact that it's likely to make them even heavier in the long term.
Most people read reports on studies like this one and read articles like Dr. Sharma's and they come away with conclusions like these:
- Extreme dieting causes long term weight gain, but 'sensible' diets or 'lifestyle changes' don't.
- Some types of restricted eating cause long term weight gain, but others don't, i.e. 'ur doing it wrong!'
- Weak-willed people gain more weight back after losing weight because they go nuts overeating after periods of restraint.
Well, I've seen and heard about all kinds of people yo-yoing upward in weight in response to all kinds of restricted eating plans, including the ones that are considered sensible, including low carb and low glysemic index plans, and including 'lifestyle changes' that are ultimately unsustainable or that incorporate measuring and counting rather than responding to internal cues. I've seen it happen to some of the strongest people I know. Yes, I'm assuming causation here.
I'd like to put forward a different hypothesis. Here it is:
In many (perhaps most) cases, weight gain is caused not so much by eating too much or by eating the wrong foods, as by
- having an undependable food supply, and
- alternately undereating and responding to strong, physiologically-based hunger cues and cravings.
This can be caused by deliberate restricted eating, by chaotic eating, by food insecurity, or by any combination of the three.
I'm suggesting that failing to eat satisfying quantities of food regularly - at regular meal times or as regular meals and planned snacks - triggers fat storage. The body interprets it as environmental hardship. Skipping meals, ignoring hunger until it goes away (not just for an hour before meal time), and eating practically nothing for days, then eating a huge meal? This kind of thing mimics the food insecurity that humans would have experienced in primitive conditions. Of course, when you've been restricting your eating and then that big takeout meal comes along and you finally eat to satiety, your body is going to try to store it all as fat. Who knows when your tribe will have an opportunity to kill and eat another delux pizza dinner or three course Indian meal deal? It's easy to see why people would blame the weight gain on the type and quantity of food consumed right before it happened. But what if it's really due to the previous restriction and the chaotic eating pattern?
If a metabolically normal person who has been eating well all along has an unusually large meal, her body will be feeling confident about the continued availability of food, and it will just dispose of the extra calories and/or decrease hunger cues for the next few days. That's why naturally thin people and many non-dieters can feast occasionally without gaining weight.
This would also explain why poor people tend to get fat. They may get enough calories overall (for the most part, being fat does indicate that you're not starving) but they may not be able to eat satisfying meals regularly. Lots of people are poor enough to be food insecure while still, overall, getting enough to eat.
This jives with the Fat Nutritionist's emphasize on dietary structure and variety over content.
This could also be one reason why some food-loving, big-eating nationalities and ethnicities don't tend to get fat. They eat regular, satisfying meals and avoid putting their bodies into fat storage mode. At least, they have until recently. The obesity panic has an ever-widening reach and is starting to affect people who used to eat regularly and without guilt.
In short, I'm suggesting that the restricted and chaotic eating caused by our weight concerns - which are in turn inspired by fashion, the medical weight based paradigm, and the media's anti obesity panic - may actually be making us fatter, world-wide. If it's true, it's pretty damned ironic.
I went to dinner with a good friend a couple of months ago. She seemed antsy and restless while we were eating. Then, excitedly, she announced, “I’m on Weight Watchers!” Wait, what? She knows me well. She’s heard me rail and rant about the failure of dieting. She’s listened to me talk about FA. And yet she still had a thrill in her voice when she announced this to me. As I looked at her incredulously, she responded, “I know I only have a 5% chance, but this time I’m doing it for my health!”
As I stared at her in amazement, a light bulb went on in my head: “but it’s for my health” is often used as an almost mystical, magical talisman to ward off the gods of failed diets. There exists a belief that somehow, if a person changes their motivation, they’ll lose weight. I believe this myth is behind the entire Obesity Epidemic. I’ve talked before about the fact that we were starting to accept that diets don’t work in the early 1990s - until, that is, someone came up with dieting for health. Then, as a society, we once again embraced it wholeheartedly. It would work this time, because it’s “for my health.”
I collect stories of those who successfully keep the weight off: at least 50 pounds for 5 years. So far, in seven years, I have collected seven stories. Of those seven, five gained the weight while pregnant and one while in an abusive relationship. Before these events, none had ever had weight problems; none had ever dieted. Each of them went on one diet and lost the weight, never having to worry about dieting again. Of the one other, she lost weight because of a very potent medicine, and she believes the weight would come back on if she stopped the meds.
When they are talking about that 5%, they are not talking about those of us who dieted for years. They are not talking about us who started out fat. They are not talking about those of us with three (in my case) fat grandparents. They are talking about people who gained weight during a pregnancy, or a short illness, or a period of depression. They are talking about people who are naturally thin - people who normally don’t have to deal with fat and who just got fat for a little while. I have heard that if you have been on more than three diets, your chances of losing weight are astronomically low.
I have been rabidly anti-dieting, and now I’m trying to change that. I’m trying to have more compassion. I know how hard it is to be a size 26 in this world; I imagine being bigger is significantly harder. Even as a deathfattie, I have privilege compared to those who cannot fit in an airplane seat or buy clothes in a brick and mortar store. I am not walking in your shoes, so I can’t know what your life is like. Yet, I can't help but discourage it BECAUSE IT DOESN'T WORK!
I watch friend after friend diet for their health and end up unhealthier in the end - and usually fatter. To add insult to injury, instead of seeing the diet as a failure, fat people usually see themselves and their bodies as failures. Be honest. How many of you have dieted time and time again only to end up fatter and hating yourself for it? How many of you who are in that but-I'm-so-fat-I'm-unhealthy place BECAUSE you dieted?
This is the thing: we have a tendency to fool ourselves. We tell ourselves it's for our health. However, if that were true, then HAES would actually be a better option. We tell ourselves we only want to lose 10%. I have found (a phenomena noted in Hirshmann and Munter’s When Women Stop Hating Their Bodies) that I don’t want to stop until I’m what society thinks is perfect. A little weight loss almost always leads to the desire for more.
In my experience, most people who say they want to lose weight for their health, just want to lose weight. If it is really about health, how about trying HAES? HAES has been proven to improve health no matter where you start out.
If you are in that place of thinking that your health sucks because of your weight, I feel for you. If you need to try one more diet, do. If you can, keep reading FA stuff while you diet. If you can’t, come back if it doesn’t work. If you are thinking about some kind of WLS, I want to encourage you to throw yourself into HAES and FA for one year - just one year. Give it the best try you can. If it doesn’t work for you, go have WLS next year.
I’m not anti-dieting because I want people to remain fat. I’m anti-dieting because it doesn’t work. “But it’s for my health” doesn’t make the odds any better. Remember: you did not fail; the diet did.
I've been planning to put together a post discussing specifics of WLS risks, side effects, and complications as a follow-up to our recent series on FDA approval of the lap band for lower BMIs. I want to give definitions of the medical terms and provide links to studies. It'll take a bit of research and a bit of time to put together.
So for now, I give you this new emergency room poster, published by the American Society for Metabolic and Bariatric Surgery: Clinical Pearls for the Emergency Care of the Bariatric Surgery Patient (that's a link to the full pdf).
WLS is becoming more common, and as a result emergency rooms are having to deal with more WLS complications; serious and life threatening damage to patients' health. This poster is being provided to hospital emergency rooms so that they can recognize some of the most common issues. Let's take a quick look at what it has to say about these issues, shall we?
- Intra-Abdominal Bleeding: "Bright Red Blood Oral or Rectal, Melena, Bloody Drainage, Tachycardia, Hypotension, Fainting" - this can end in death
- Leaks and Sepsis: often requires surgery; can be deadly
- Obstruction: "Closed loop obstruction and internal hernias are a risk after gastric bypass and may be lethel if dead bowel. Bowel can become ischemic in six hours."
- Pulmonary Embolism: blockage of the main artery of the lung - can be deadly
- Vomiting ± Abdominal Pain: "Vomiting associated with abdominal pain needs prompt surgical evaluation and observation until resolved or surgical exploration." - this can indicate a life threatening condition
- Abdominal Compartment Syndrome: "Progressive respiratory insufficiency, Renal failure, Intra-abdominal hypertension, Associated with end-organ failure..." Yes, this can kill you as well.
And bonus! Here are illustrations of some of the things that go wrong with gastric bands:
People like to say that being thinner automatically gives you better quality of life. Increasing your risk of this list of things happening to you... that isn't an improved quality of life. It's an increased risk of death - and a barrier to living fully. Oh, sure, they can probably save you if you make it to the emergency room in time, one with competent staff that have access to this information and time to go through all the steps. But, how much extra risk are to taking on if you (for example) travel to a foreign country where you don't speak the language and where emergency room staff won't recognize these symptoms? What if you want to go on a backpacking trip, and could easily end up in a situation where you can't get treated in time?
These things don't generally happen to people whose digestive systems haven't been surgically altered. If you look at the poster, just notice all the reasons they might have to cut you open for a second, third, or fourth time. Every single one of those experiences would be traumatic, painful, and time consuming to recover from, with a negative effect on your family and work life.
As fat people, our size doesn't necessarily prevent us from travelling anywhere in the world, going on backpacking trips, skiing, scuba diving, skydiving, or doing anything else we put our minds to. If we're not disabled and can access equipment that fits and is up to spec, we can do those things if want. However, people who try to lose weight through WLS are going to have to be careful for the rest of their lives, because they're always going to have these increased risks. Fat bodies can be healthy bodies. A post WLS body is always going to have been damaged.
Allergan wants the FDA to approve the lap band for teens. From Allergan's 2009 Annual Report, page 7 (page 5 on Acrobat):
we were initially surprised by the weakness of the market and our sales of
obesity intervention products, particularly the LAP-BAND® Adjustable
Gastric Banding System...
In the United States, major regulatory files were submitted to the FDA in
2009: BOTOX® for chronic migraine, OZURDEX™ for a new indication
of uveitis and LAP-BAND® System for morbidly obese adolescents.
I don't even know what to say about this. Wait. Yes I do.
Teenagers, generally speaking,
• aren't done growing;
• have many, many years ahead of them to develop complications from nutritional deficiencies;
• haven't had kids yet, meaning that under-nutrition and deficiencies might affect future pregnancies
• think they're supposed to be perfect (and that "perfect" exists);
• are driven by a desperate need to fit in;
• are still learning how to think; and
• (as people have mentioned in the comments) can be pressured or even forced into surgery by parents and doctors.
And Allergan thinks it would be a good idea to tamper with their digestive systems in a way that will enforce semi-starvation and make a healthy diet difficult or impossible. "Oh," you say. "We're only talking about morbidly obese teenagers." And I ask you: are any of the points above less true of fat teenagers? No. No, they aren't.
I'd like to introduce you to Atchka, if you don't already know him. He's one of the founders of Fierce Freethinking Fatties and he's been more on top of the issue of expanded FDA approval for lap band use than we have at BFB, blogging about it on a regular basis since December, when he wrote an excellent background post detailing the dodgy way that the FDA came to approve the lap band for lower BMIs.
Now, check out this post on Allergan's plans. It notes that hearing dates are not yet set for approval of the lap band for teens. There's still time to do something about this one, folks.
Atchka is organizing opposition to expanded approval for gastric banding. He's set up a Facebook group to help keep people informed. This is a great idea. Let's back him on it.
Just for good measure, here's the homepage for the FDA advisory committees. It's the Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee that's been making recommendations related to the lap band. The contact information for the department that oversees the committees and for the Center for Devices and Radiological Health, where the Medical Devices committees are based, are located on the pages I linked to above. If you feel inspired to write a letter or make phone calls, those would be good options. Alternatively, you could aim straight for the top.
Secretary of Health & Human Services
U.S. Department of Health & Human Services
200 Independence Avenue
S.W. - Washington, D.C. 20201
Imagine that you're thinking about getting a lap band. Where would you go to get information about the side effects and the long term prognosis? Of course, you'd ask your doctors for advice. However, GPs might not be well informed and baratric specialists might be biased. It would probably be best to go to a university library and ask a medical librarian for help finding relevant journal articles. However, I think it's fair to say that most lap band candidates would research the procedure using Google.
How do people use Google? A study found that a third of users will only click the first link that comes up, another third will click within the first five links, and almost no one checks the second page of results or beyond. Because of this, Search Engine Optimization (SEO), which attempts to place sites at the top of search results, has become an important marketing tool.
Squeegeelicious, a BFB member, tried using a few search terms that a lap band candidate might employ to search the web for information on lap band risks, side effects and long term effectiveness using Google: "lap band surgery," "lap band side effects," and ""lap band long term." Here's a summary of her forum post (accessible to BFB members) on the topic:
Search Phrase: lap band surgery
Three paid slots came up at the start of the search, all trying to sell me the surgery. The top ten results included the Allergan home page and seven marketing sites for weight loss surgeons and industry organizations. The Wikipedia entry on the lapband, which lists risks and side effects but doesn't explain them or discuss how common they are (and is probably policed by Allergen and bariatric surgeons), was in the top five. The Wikipedia entry also fails to mention how common it is for lap band recipients to regain the weight they lost. The tenth site was Lap-Band Surgery talk, apparently the largest Lap-Band forum on the web. It's a bit more of a wild card, because it allows users to post about their experiences. A positive news article on the lap band also appeared on the first page.
Search Phrase: lap band side effects
Again, there were paid results at the top. Most of the results on the first page were industry sites - either overt or not - that minimized the side effects and blamed the patients for problems resulting from the surgery. The most authoritative-sounding results in the top ten were Allergen's lap band page and the UC San Diego Center for the Treatment of Obesity, which lists risks and side effects but does not explain them or discuss the prevalence. The UCSD page follows quickly with the 'risks' of being obese. There were also a few poorly maintained forums and blogs. The risk of weight regain was seldom mentioned, and when it was, patients were blamed. Rounding out the first page of results and providing the only real dissenting voice was a 2003 BFB article. None of the hits above mentioned the effects of the surgery after six months except in the vaguest of terms.
Search Phrase: lap band long term
The first page included (again) the Wikipedia lap band article and an Allergan page that cites a three year study with 299 subjects. The Allergan article does list all reported side effects, and a few I hadn’t heard of before. A second Allergen page lists the effects that one might expect in the first weeks after implantation. Not exactly long term, but it provides a link to ‘6 months & beyond.’ Clicking on that link, it’s really just fluff about adjusting to your new thinner body and diet. Then there is a link for Google news, with 14 results. To sum it up, there were 12 positive articles, one reserved and questioning article about the FDA’s approval of the BMI lowering, and one result about banking.
A few other notes
I checked to see how far down I would have to go before finding a link to a negative review of the Lap-Band. For the ‘lap band’ search, the 19th result was an LA times article about a wrongful death suit connected to the surgery. It is decidedly anti-Lap-Band. For the search ‘lap band side effects,’ the last result on the second page is an article with stories of the suffering that people have gone through with the Lap-Band. For the search ‘lap band long term,’ there is a link to the same BFB article mentioned earlier at result 58, then a Women's E-news article that criticizes the FDA's move to lower the BMI recommendations and cites long-term European studies buried at result 74. It’s a good article, and points out the conflicts of interest of the panel that made the recommendation to the FDA.
While the majority of the sites gave accurate information on risks and side effects, most did not explain them or give information on their prevalence. When they did, they cited short term studies. When voices outside of funded sites surfaced, they were overwhelmingly positive about the surgery, and the few questioners were nearly drowned out. The one long term study that I did find was overwhelmingly positive towards Lap-Band, which made sense when I dug a little deeper and found that the first author of the study helped develop the technique and is one of its biggest proponents.
If someone uses Google to search for information on Lap-Band surgery, they will overwhelmingly be given Lap-Band positive information. It's likely that the person conducting the search will be hearing the same biased information from their doctors, from T.V. news stations, and from popular newspapers, and there's very little here that will change their minds once the initial hook is set. If by chance they do come across a dissenting voice, it will be so much in the minority that it will be easy to dismiss as ‘fringe’ information.
As Dr. Linda Bacon is fond of pointing out, "follow the money." I’ve followed the money, and it all flows back to people who have a vested interest in selling this product.
(by Squeegeelicious; edited and summarized by deeleigh. Thanks so much for doing this work and writing it up, Squeegeelicious)
Keeping in mind that Google's search results are dynamic and optimized based on personal information - they change day to day and they're different for everyone - I repeated Squeegeelicious's searches. I'm sorry to say that the information that came up for me was even more disturbing. Allergen's pages detailing the risks of the surgeries had disappeared. I had to hunt them down in order to link to them, and I couldn't find the one that talks about a 3-year study with 299 subjects. If anyone has a link to that, please share it in the comments.
Anyway, this made me wonder if Allergen is updating their pages following the FDA ruling - or more disturbingly, if they're deliberately making their pages on the risks and side effects of lap bands difficult to find. Are other people getting Allergen's pages on the risks and side effects of lap bands?
In conclusion, reasonably savvy people should be able to get to a list of lap band side effects and risks using Google. However, the risks and side effects - the meanings of the medical terms - will not be explained, and it will be difficult to find out the truth about how common they are. Information about the high rate of regain after lap band surgery is even more difficult to find.
Are there any medical professionals out there who would be willing to add details about the meaning and prevalence of lap band risks and side effects and the rate of weight regain to the Wikipedia article, and check up on it regularly to make sure the information stays put?
Yesterday, I discussed some reasons why the FDA's approval of lap bands for people with lower BMIs is problematic, and I focused on medical blackmail and fat hate (both imposed and internalized) as issues that prevent people from making informed, rational decisions about weight loss surgery.
There are a couple of other factors that I didn't address directly, but it would be a mistake to think that they can't have a strong and sometimes dominant influence on decision making. I'm talking about doctors' advice and social pressure, both from peers and from the media. For people whose health may not be perfect, they become even more influential.
There's a lot of WLS marketing out there; a lot of positive buzz. The media loves a good weight loss story, especially if it involves some kind of penance: starvation, extreme and uncomfortable exercise, or (better yet!) actual cutting, which is ironically characterized as an "easy fix."
Since both they and, in the case of the lap band, drug companies stand to make a lot of money through weight loss surgery, doctors tend to be well informed on the (sketchy) conclusions of the short-term research that supports WLS and not so well informed on the research that hints at the its real risks and its increasing failure rate over time, both for weight loss and diabetes treatment. Their advice may also be influenced by fat hatred, the media, and industry marketing. In other words, it's likely to be biased. However, patients have reason to trust their doctors' advice. Doctors are experts on health, after all.
People who are only a few years past the surgery, who have had no immediate complications and are still alive, are often thrilled with the effects and have not yet had to deal with the long term problems. These people can be downright evangelical, and will encourage others to ask for the surgery. (My advice is to tell them "I want to hear your opinion about this in 5 or 10 years; then I'll feel better informed.")
If the media, your doctor, and your friends are encouraging you to get this surgery, you've been told that it will probably take you out of a group that's routinely disrespected and discriminated against, and you feel like your real life can't begin until you're thin, then it becomes difficult to say "no."
So, to summarize, it is difficult for people to make informed, rational, independent decisions about weight loss surgery because:
- Doctors sometimes withhold treatment pending major weight loss, effectively blackmailing people into WLS
- Because of internalized fat hatred, "Doing it for yourself" might as well mean "Doing it against yourself"
- Medical advice is commonly based on poor quality and biased research and may also be influenced by the profit motive
- Peer pressure from people in the "honeymoon period" after the surgery can be influential
- And of course, it's hard to resist the Fantasy of Being Thin.
(Did I miss anything?)
In theory, I think that people should be able to do what they want with their bodies. I really do. However, in today's social climate around weight - especially for women* - this is like legalizing heroin. It has the potential to do so much damage and ruin (even end) so many lives.
* According to this excellent article on Women's ENews, 80% of lapband recipients are women.
I posted a few days ago about the FDA officially approving gastric banding for healthy people with a 35-40 BMI. And, you may ask:
"Why would you be against that? Shouldn't people be allowed to do what they want with their own bodies? It's just a new choice that people are being allowed to make. Nobody is forcing anyone to get a gastric band."
Unfortunately, it isn't as simple as that. Here's why.
First, there's what amounts to medical blackmail; doctors withholding treatment until a patient loses a large amount of weight. How can anyone be expected to do that with an efficient metabolism forged by yo-yo dieting and health concerns that may prevent strenuous exercise? WLS, of course! This effectively forces people into weight loss surgery, and it's unconscionable.
However, even people who clearly want WLS aren't on anything like a level playing field.
Living in this society, we learn to have a violent type of hatred toward our fat bodies. I understand the impulse. I've been there. Who among us has not at one time or another felt complete and utter despair about his or her body? "This isn't what I'm supposed to be like! Why do I have this horrible, disgusting body? This can't be me." To someone in that state of mind, their body is separate and despised, unruly and out of control, something to fight and force into submission. When you're at odds with your body, hating it doesn't feel like self hatred and self harm feels like fighting the good fight.
Why do so many people feel this way?
We're told over and over again that the substance and appearance of fat bodies - any softness or fullness, really - is something to be ashamed of and evidence of weakness and inferiority. We're also told that it's all our fault, all due to eating too much. If you're thinking about your body this way, you just want to be able to stop eating. You think that you deserve to starve, whether by will power or failing that, by brute force. You really do want to hurt your body; to force complience. And the people in authority agree. Doctors, reporters, the media: they cheer and facilitate any self-destructive action taken in the name of weight loss, because weight loss can never be a bad thing! Why, it's the silver lining on the dark cloud of depression and even cancer! This is in spite of the fact that the widely accepted assumption that fat people eat more than thin people has no evidence behind it.
And I should probably note that yes, these
primitive bludgeons surgeries can sometimes help people who are very, very heavy, with compromised mobility, who just can't see any other way forward. But there should be a better way!
The question for fat people who aren't disabled by their size: Is the possibility of putting diabetes into remission (for the 8% of 30+ BMI Americans who have been diagnosed with it) enough to make up for vitamin deficiencies, brittle bones, neuropathy(!) and a heightened risk of suicide - not to mention the suffering related to the surgery and its intended effects?
It takes a special kind of blindness to disregard the problems with the evidence in favor of WLS: the short followups when the most widespread problem with the surgeries are nutritional deficiencies that become more and more harmful over the years; the high dropout rates, which are generally ignored (and I doubt the subjects who finish the studies are representative); the lack of meaningful control groups; the failure to acknowledge related deaths that occur more than a month or two after the surgery. (For examples, go to Junkfood Science and scroll down to the Bariatric Series on the right.) This shit is dodgy.
Gastric bypass has been around for 40 years and the lap band has been in use for almost 20. Why isn't the research on the long term effects of weight loss surgery more detailed and comprehensive?
Is it because the cost/benefit analyses being made by both doctors and potential WLS candidates are so loaded with societal baggage and negative emotion - not to mention profit motive - that the costs don't matter and any hint of a real health benefit is blown completely out of proportion? Is it because neither doctors nor surgery candidates really want to know the truth? Is it because the drive to make fat people thin actually has little to do with health and a lot to do with imposed and internalized hatred?
(Correction: Allergen had aimed to get the lapband approved for healthy people with 35-40 BMIs, but it seems that part of their proposal didn't actually go through. The New York Daily News article I'd linked to originally wasn't entirely accurate. The link below now leads straight to the FDA press release. Sorry about that. Slowing learning how to do journalism...)
The lap band has now been officially approved for people with a 30-35 bmi and a weight-correlated condition or risk factor.
I've been thinking for a couple of weeks that I should post something on this topic. However, I just hate dwelling on it. It's so fucking tragic. I get angry.
Smart doctors and scientists know that weight isn't just calories in and calories out, but we still love the idea of starving the fatties, and that's what WLS is all about. It's crude and barbaric, like an invisible and intrusive jaw wiring. Weight loss surgery is one of the only medical procedures intended to damage a healthy, functional system and it can be deadly, both immediately and in the long term. Lap band-related deaths are being investigated in New York and in in California. For those who survive lap band surgery, there are significant long-term risks and complications that are the rule, rather than the exception:
Swiss researchers, who published a study in the medical journal Obesity Surgery, found that the complication rate skyrocketed to 74 percent over a 10-year period. Complications include leakage and infection along the Lap-Band, frequent vomiting, dysphagia (an inability to swallow), surgical revision, band erosion and slippage or failure.
A 2007 study funded by Allergan and published in the American Journal of Surgery found that up to 76 percent of patients developed complications over three years. Over a nine-year period, one-third of patients had their Lap-Band removed.
Stomach acid produced from excessive vomiting can erode the band, just one reason for device removal.
This is despite the fact that the lap band is marketed as safer and less extreme than other forms of WLS. Oh, and it isn't even all that effective for weight loss.
In the end, I just have to ask why it isn't obvious to everyone that the trend of approving weight loss surgery for ever younger and lighter people is coming from a very dark place, both on the part of the doctors marketing and performing the surgery and the people requesting it.
I read about this "contest" in an email from OSSG-gone_wrong (obesity surgery gone wrong support group). One of the group members got the following email:
Enter the The Live My Choice Contest Program (Ends December 14th)
To raise awareness of the challenges those 100 pounds or more overweight face and to highlight the critical need to ensure access to treatment, Allergan, Inc. has launched the Live My C.H.O.I.C.E. Contest Program to provide three individuals with a LAP-BAND® Adjustable Gastric Banding System procedure, performed by a certified LAP-BAND® System surgeon of their choice, and one year of follow-up care, compliments of Allergan, Inc. The contest program is a part of Allergan’s public advocacy campaign, launched in May 2010, called C.H.O.I.C.E. (Choosing Health over Obesity Inspiring Change through Empowerment).
The contest ends December 14th. To qualify you must meet the clinical criteria for the LAP-BAND® System procedure: Body Mass Index (BMI) of at least 40; BMI of at least 35 with one or more serious comorbid conditions; or be at least 100 pounds over your ideal weight as determined by a physician. To enter the contest, submit a short essay or video at www.LapbandChoiceContest.com about how your weight has impacted your health and life, and why the LAP-BAND® System may be the tool to help you achieve your weight-loss goal. A family member or close friend may also enter the contest on a person’s behalf.
Individuals selected to receive a LAP-BAND® System procedure will publicly share their weight-loss journey in an effort to inspire others who are severely obese to reclaim their health and their lives. As part of this Contest Program, Allergan will provide all entrants the opportunity to receive free telephone consultations with a health educator who can provide one-on-one support, such as assistance in finding a local patient seminar, access to more information and resources regarding the LAP-BAND® System.
More information about the contest, including details on the rules and eligibility, can be accessed at www.LapbandChoiceContest.com.
You can read more about this travesty of a contest here.
The contest is over, 3 "contestants" have been chosen to undergo this procedure and 12 people who have already had the LapBand have been chosen to go to Congress and tell their stories about their weight loss and to
be the voice for others to help acknowledgment of obesity as a disease, NOT a choice, and acceptance of all treatments, including weight-loss surgery.
Um, yeah, there's just so much wrong with this that I can't even begin to enumerate it all. When I first read this, I was sputtering with rage and just didn't have enough swear words in my vocabulary for Allergan (although I went through every one that I had and made up a few, I can tell you).
"Obesity" is not a disease, nor is it a "choice" for most people. So far, the treatments the medical and pharmaceutical communities have come up with have created many more problems than they've solved, and, I would venture to say, have probably killed more fat people than being fat alone has.
But promoting actual healthy lifestyles, without mutilating functional digestive systems or restricting calories so that people become thin at any cost, doesn't make billions of dollars for the medical/pharmaceutical communities.
Is the medical/pharmaceutical community so hard up for patient/insurance dollars that they have to resort to a travesty of a "contest" in order to bring in more patients? The real tragedy here is that people think they're winning something that is going to improve their health, when in reality, what they've "won" is another diet where they'll end up gaining back what they lost and maybe more, not to mention the possible/probable complications that will last a lifetime and will outlast their insurance coverage. Doesn't sound like much of a "win" to me.
And this bullshit of asking Congress to declare "obesity" a disease? Really, Allergan? I'm sorry, but even though I'm fat ("morbidly obese" to you), I'm not diseased, I don't need "treatment" from you that isn't going to work and where the failure is going to be blamed on me. I don't need your shame and blame, nor do any other fat people, we're doing just fine without you, thank you very much.
A few days ago, AndyJo wrote a piece on a recent attempt to lower the FDA's BMI requirement for lapbands.
Well, it succeeded (thanks for the tip-off, AndyJo). The New York Times has published an article: Panel Votes to Expand Surgery for Less Obese.
Now, lapbands are likely to be approved for people with BMIs of 35-40 who have no health problems and for people with BMIs between 30 and 35 who have high blood pressure, diabetes, or other health problems that correlate to high BMIs. From the NYT story:
A study published in the New England Journal of Medicine this week showed that women with a B.M.I. of 30 to 35 had a 44 percent higher risk of death than women of normal weight, which is a B.M.I. under 25.
(Of course, this is the data dredge discussed in the last BFB post.)
Now men and women with BMIs under 40 may have a new way to increase their risk of death - the lapband!
Trigger warning: diet talk
Dieting. Food restriction; following someone's plan, counting calories, or cutting out certain foods with weight loss as the goal. Almost all of us have done it in the past; its long-term failure rate has led many of us to fat acceptance. Sometimes it seems like nobody wants to believe the truth: that it almost never results in significant, long-term weight loss. Not dieting, and not dieting combined with exercise.
Doctors don't want to believe that dieting doesn't work long-term for most people. The media certainly doesn't believe it. Most fat people don't want to believe it, even after they've dealt with it repeatedly.
Why? Because intuitively, we know that the energy in = energy out equation has to work at some level. Our bodies need food to fuel physical activity. If they're not fed enough, they will dip into their energy reserves; they'll lose fat (and muscle, and other types of tissue). Fact. We must be able to exercise some control over our weight by using this knowledge, right? Hollywood actors and pop stars obviously manage to keep themselves very thin - they can't all naturally be so gaunt.
Here's the lowdown. Studies have failed to support the idea that fat people and thin people have different eating habits, or that fat people burn fewer calories than thin people.
So, while it is theoretically possible to exercise control over our weight and even to become and stay thin, the habits that are necessary to do so are profoundly unjust and very difficult to maintain over a period of years, let alone decades. To maintain even a little bit of weight loss, it's necessary to eat less and exercise more than a person who starts out at the lower weight. To maintain the type of weight loss that actually takes someone from fat to thin takes a huge amount of effort and absolute control. It is NOT just a matter of "cutting down on the junk food" or "taking a brisk walk every day."
After an initial high energy panic stage, a body that's below it's set point - its natural weight - will fight with every tool at its disposal to regain. It will never fail to absorb the maximum number of calories from food. It will slow down all of its systems, causing us to feel cold all the time, to feel tired and irritable, and to have trouble concentrating. It will do everything it can to encourage us to eat more: chronic hunger, preoccupation with food, and a difficult to resist binge reflex. (In this context, bingeing isn't a mental issue. It's a physical compulsion.) Ancel Keyes saw all of this in his WWII-era starvation study.
The effort, control and endurance that it takes to maintain weight loss isn't compatible with most people's lives. It's just too uncomfortable. When someone who's maintaining weight loss decides that they want to feel better; wants to feel normal; to not be cold, hungry and moody anymore? That they'd like to feel full occasionally? That they need to give their body a break from all of the exercise? Or maybe they suffer an injury or give in to the binge reflex? The weight comes back on. Quickly or gradually, it's regained. Often, just to guard against future famines (because our bodies interpret diets as famines), we over-gain, past our old setpoint to a new, higher one.
And then - because there IS actually eating, even bingeing, involved; because we may have cut down on our physical activity - we blame ourselves. We blame ourselves, and everyone silently concurs. This is a bitter, painful experience and many of us have dealt with it over and over again.
But what about the few people who do manage to successfully maintain a significant weight loss?
DebraSY has been a BFB commentator for many years. She sometimes says that she's "failed at HAES." What she really means is that she's chosen the much more difficult and demanding path of weight loss maintenance. She respects the "no diet talk" policy in the fatosphere and she generally doesn't discuss it here, but she has started a blog where she does reflect on weight loss and maintenance, honestly and critically. I think that Debra's experience and point of view are a piece of the puzzle that's usually missing from our discussion. We've talked about people's experiences with weight loss surgery in the fatosphere in the past, at BFB and at Shapely Prose. Now, let's take a look at what unaided weight loss maintenance really involves, for those who can manage it.
Debra is not a proselytizer and fundamentally agrees with fat acceptance, although many people may still find her posts triggering.
On her blog, Debra talks about the potential harm that can result from the diet mentality. She's also posted a critical discussion of "diet experts." These posts are pretty much straight-up fat acceptance.
If you feel okay reading about weight control, it helps to have the background she's laid out in her "about" and her first few posts: "The Unfairness of Weight Loss Maintenance", "Weight Loss Maintenance: the Job Description", and "The Slide Into Hell: Regaining Lost Weight." The truths that Debra discusses here are both familiar and revolutionary. THIS is what fat people keep running up against, and this is the truth that doctors, the media and the government want to deny. Unfortunately, their heads are in the sand; their hands are over their ears.
This is what reading Debra's blog confirmed for me: I'm not interested in emulating her. The price is too high. I've proven over and over again to myself that I have the persistence and insight to accomplish the things that I really care about. Weight loss maintenance is just not one of them. Frankly, if Michelle Obama, Jillian Michaels, the media, and the medical establishment think that's wrong, then they can go to hell. I'll take brisk walks and avoid junk food most of the time. I'll do the same things that a naturally thin person would to feel healthy and stay reasonably fit - that's HAES. But, I will not exist at the razor's edge of starvation and exhaustion in order to have a fashionable body and a doctor-approved BMI.
I'm here to say that it's entirely reasonable to say "no" to this, even if you think you might be able to manage it.
So how fat is your state? The Robert Wood Johnson Foundation and the Trust for America’s Health released another pointless report this week ranking the fifty states by fatness. The article points to an overabundance of food, aggressive food marketing, poverty, and low levels of education as significant causes, which I suppose is a slight step up from the usual disgust and personal blame. The education thing sticks in my craw though, because it implies that if we fatties only knew better, we just wouldn't be fat. Please, thin Americans, TEACH us to overcome our body's genetic tendencies. For the love of god, won't someone tell the fatties about calories in vs. calories out?? They just don't know!
Then we have this gem, about how, chemically, being fat means that you can't resist cupcakes as well as thin people do. Again, thanks, but your study involving ten whole fat people isn't really enough to convince me that the entire fat population's brains work this way, not to mention that you don't even really know what these results mean. My favorite part of the article is as follows:
Some of the most intriguing imaging studies have peered into the brains of people who have lost significant weight and kept it off through diet and exercise alone—although researchers say they're hard to find.
"They are very controlled individuals, and they are very rare. We had to fly some in from Alaska," says Angelo Del Parigi, a neuroimaging scientists who finally located 11 "post-obese" subjects who had dieted down to the lean range.
You don't say? People who have lost weight and kept it off aren't just coming out of the woodwork? Can we not maybe draw a conclusion here?
Finally, I'm sure you've seen some of the hullabaloo about the new diet drugs being tested and submitted for FDA approval. It looks like as of this morning the FDA has rejected Qnexa, which is shocking news in and of itself. Could it be that someone over there finally cares about side effects? Did they actually learn something from the whole Fen/Phen tragedy? If so, it's not stopping pharmaceutical manufacturers from trying again. Arena Pharmaceuticals is working on a drug called lorcaserin which, according to MSNBC shows "promise" and "little risk". It also shows little effectiveness, as study participants only lost an average of five percent of their body weight. That's about twenty pounds for a 375 lb gal like me. Given the risk for side effects, especially the ones they don't know about yet, I wouldn't say lorcaserin is a worthwhile bet. Seems to me that maybe we should divert those pharmaceutical resources to working on cancer or AIDS instead of trying to make the population slightly less fat and potentially harming them in the process.
But anyway...Happy Friday!
So an old friend of mine from high school gained a lot of weight and decided that gastric bypass surgery was the best answer to her weight-related concerns. She's been facebooking about it for months now and this week she finally had her surgery. I've been watching her progress with an uneasy curiosity since she announced she would have the surgery, wanting to tell her just how effed up I think the whole thing is but also recognizing that she is an adult and has to make her own decisions. Anyway, she has a blog where she has been documenting the process and I was just struck by this entry about how restrictive the pre-surgery and post-surgery eating requirements are. If you've ever spent one second of your fat life thinking "maybe I should consider that gastric bypass surgery", this will make you glad you passed it up. Check it out.
While blogging, I'm also having my "dinner". Tonight that is one cup of strained low fat cream of chicken soup. (Strained to get the chunks of chicken out!) My diet is extremely limited right now, which of course is to be expected. People are shocked when I tell them, but my tiny little stomach pocket just isn't up for too much yet! And since my understanding is that if I over do it the results will be quite uncomfortable for me, I'm not pushing it! (-:
The great news is that I am not feeling terribly hungry, and when I do feel slightly hungry, it is typically because it's time to eat something.
Here's the overall eating schedule that Dr. XXXXX requires:
2 weeks prior to surgery -- extreme low carbs -- max 20 carbs a day
day before surgery -- clear fluids only, plus Powerade with Miralax (bariatric colon cleanse)
day of surgery -- absolutely no fluids by mouth, later in the day got ice chips (was on IVs)
1st 2 days after surgery -- clear liquids only (broth, crystal light, sugar free popsicles, SF jello) -- in the hospital, they'd give me crystal light in medicine cups .... Here's one ounce of liquid, take 15 entire minutes to drink it.
Days 3-6 (where I am right now)-- Full Liquids (1% milk, low carb protein shakes, SF low fat yogurt, cream of chicken soup, plus all the things in clear liquids -- including SF jello, and SF popsicles) **now, the surprising thing here is the quantities... I should take a full hour to sip 8 ounces of whatever I eat/drink, yet I am to strive to consume at least 48-64 ounces of liquids over the the course of the day. Half should be clear liquids and half should be the full liquids, being sure to get protein in there.
Days 7-10 (begins Wednesday - woo, hoo!) -- Pureed/Soft Diet --- this is where my new magic bullet will be quite handy. See, my tiny new pouch isn't grown up enough to work as your stomach does.... using its muscles to break up and grind up the food we eat. So, for now, I gotta do that work before I eat something. Now, at this stage, I shall only eat 4-6 Tablespoons of food each "meal" and I should have 5-6 meals a day. I can add mashed potatoes, custard, and pudding, but I must be VERY careful to keep it really low sugar and really low fat. Otherwise, my tiny pouch will rebel and make me regret it. Other things, provided they are well cooked and blenderized, will be vegetables, scrambled eggs, LF cottage cheese, poultry, soups, applesauce, and stage 1 & 2 baby foods (but watch the sugar in those!). I must also be sure to remove all skins, visible fat, connective tissues, rinds, shells, seeds, etc.
Then, Days 11-30 (almost 3 weeks) -- Soft Diet -- Pretty much as above, but adding a few starches like cereal, crackers, and adding soft fruits (have to remove citrus membranes) and low fat cheeses. The instructions say "small distinct pieces of food that is tender and easily chewed. Begin with ground or flaked meats and chopped or mashed foods".
Then, Days 31-45 (two weeks) -- we continue as above, but get to graduate to 6-8 tablespoons per meal, 5 meals per day. Also can add some things like brown rice and whole grain pasta.
Then, Six weeks after surgery -- Healthy, Lifelong Meal Plan -- add a few tablespoons of food per meal, then after another month, a little more. Ultimately, the plan for post bariatric surgery patients, is to eat 3/4 - 1 cup per meal, and eat 4 small meals per day. Dr. XXXXX disagrees with the snacking throughout the day theory. Essentially, we'll need to add more fiber here, but be intentional about high protein, low fat, and lower carbs. We are told to stay away from everything High Sugar. My understanding is that high sugar will result in dumping syndrome, and that I will not like that one bit. (-; A few people have said, "yep, you'll only do that ONCE".
A few other things for post bariatric surgery patients, that are a little odd, are that we can no longer drink from straws or have carbonated beverages. Those put too much air in our pouches, and make us feel full when we aren't. Also don't want those bubbles to increase the size of the pouch, that would be dumb after having surgery, no!?
Another quirk is that we are NOT to drink while eating a meal. Yes, we must drink 48-64 ounces daily, but we must stop drinking 30 minutes before a meal, and not drink fluids again until 30 minutes after a meal. Our little pouches (can you tell I've grown attached to my little pouch already? (-: ) will tell us we've had enough to eat and we would not have. Or, the food will slide right through with the liquids, and we won't get the nutrition we need. Either way, that's bad. SOOOO, no drinking at meals!!!
Oh, and NO MORE NSAIDS. I know, what's that, right? No more aspirin or anti-inflammatory medicines like Aleve, Ibuprofen. EVER. They're bad for our little pouches. They can cause bleeding and ulcers, and bad stuff like that. Oh, except the chewable baby aspirin we take for the first month after surgery to prevent blood clots....
We must also take vitamins for ever and ever amen. Chewable Multivitamins with Iron and chewable Calcium with Vitamin D. And B-12. Can be shots or sublingual... I'll find out a bit more about that when I return to the doctor next Wednesday.
The part that shocked me the most was that it should take you an hour to drink 8 ounces of fluid. An HOUR. Also, four cups of food a day? How is it remotely possible to get the nutrients your body needs on four cups of food a day? And no straws?! That...ahem...sucks.
Anyone have any other thoughts on this? Is there anyone out there who has gone through this and can comment?
I saw an ad for this show Mike & Molly during How I Met Your Mother last night. At first I was excited...look! Actual fat people on TV! Then I read the premise:
"Police officer Mike Biggs knows his way around the Streets—and the donut shop. As a cop, Mike’s not scared of anything—except dating, so he’s joined Overeaters Anonymous® to lose those extra pounds and gain some Much-needed confidence. When he meets Molly at a meeting, the attraction is immediate, and suddenly Mike is excited about the prospect of a new life. But now he must find the willpower to give up his beloved junk food for the apple of his eye."
Oh BARF. Anyone seen any more of this tripe? Comments?
Check out this article on Japanese attitudes towards weight. I feel almost like the author is saying "Gee, if Japanese women can lose weight and keep it off, what's wrong with Americans?"
They say the rates of anorexia and bulimia aren't any higher over there than they are here, but I have to wonder if that's because the idea of an average-sized woman not eating because she wants to be thinner is so widely accepted as normal. Certainly the act of specifically not eating or eating only vegetables when you are hungry for more is something of a disorder, whether it's officially anorexia or not.
Anyone have any other ideas about what might cause the disparity between our attitudes toward weight and that of Japanese women?
This article in The Vancouver Sun just floored me, and goes back to my comment on the Is it okay to be fat? thread. Exactly how much pain and suffering is society at large expecting us to have to endure to fit their narrow body ideals? If we're not being asked to run four miles and eat a scant 1300 calories per day a la Meme Roth, then someone is coming up with a procedure where a polyethylene patch is sewn onto a fat person's tongue to make it excruciating for him or her to eat solid food. Really? Is this something we need to do to people? Isn't the fact that any fat person is willing to undergo this type of procedure enough to prove that as a society we have kind of gone off the rails when it comes to body size?
This is the question posed in the Nightline debate linked to in withoutscene's posting below. The way I see it, when we ask "is it okay to be fat?", we're really asking a bunch of other questions:
- Is a person allowed to have and maintain a body that is larger than average?
- Is being fat a health problem?
- Is a person with a health problem allowed to choose to not treat that problem?
- Is fat caused by lifestyle choices?
- Is a person in a group health plan allowed to make choices that might cause them to need more health care in the future?
When you break it down to what we're really talking about, I don't see how any rational person could conclude that it is not okay to be fat. What are your thoughts?
This video over at ABC.com just makes me crazy. Dr. Richard Besser is attempting to give advice to a parent on how to deal with her eleven-year-old child sneaking food and instead of addressing the underlying causes and mentioning the potential for eating disorders, he recommends that the parent sit down with his or her kid and draw up a contract for changing her behavior. This is horrible, terrible advice, and I know because it's what my parents did with me. Did I mention I weigh around 400 pounds now?
Here's the thing: a child is not an adult. There's a reason we don't let children sign contracts, and it's because they're busy making mistakes and dropping the ball and acting on impulse...things that aren't really conducive to setting a goal and following it through. Why would you want to put your child in a position where she is likely to fail over and over? Furthermore, Dr. Besser makes a fuss about how the parents shouldn't be the food police, but that's the exact relationship you are fostering with this contract business, because someone has to be the enforcer and make sure the terms of the contract are being followed. Even if you're not being 'the food police', per se, you're at least being the food prosecutor. Is that really better? The bottom line is that it enforces the adversarial relationship that is already developing because she clearly feels like she has to hide her eating from you.
I swear, that letter could have been written by my parents. The part about "she wants to lose weight", is especially accurate because when I was a kid all I wanted in the world was to make my parents happy,and it was abundantly clear that all they wanted was for me to be thin. I have no doubt that there were loving reasons behind it, like wanting me to fit in socially, but all their campaign did was drive a wedge between us and eff up my relationship with food and exercise.
Here's the advice I wish my parents had gotten when I was a kid sneaking food into my room: listen to your daughter. Talk to her about what's going on and try to figure out what might be bothering her. Hug her...a lot. Remind her that you love her no matter what, and that you will always be there for her. That kind of thing will go a long, long way. In the end, the most important thing to remember is that your job here is about providing unconditional love and support. Leave the contracts out of it.