Why I won't WLS

So I guess this is my version of a Fat Acceptance 101 post. A long talk with a friend over February break helped me sort out most of the thinking, and then an "I believe in HAES but I want WLS because I'm in pain and weight loss will fix it" post and the numerous pro-WLS and WLS-accepting replies thereto -- in a purportedly HAES online group -- motivated me to write it out.

When you strip away the siren song of a cure for whatever ails us (whether that be physical pain, mental pain, disability, etc), this all remains true:

1) Medical science has NO CLUE whether being less fat actually confers the health benefits medical science associates with being less fat, because very little research has been done that effectively proves causation rather than mere correlation. (In other words, we don’t actually know if being thinner is healthier than being fatter.)

2) Medical science has NO CLUE whether making a naturally/genotypically fat person into an artificially/phenotypically less fat person (whether via typical "diet and exercise" or more intensive surgical means) actually confers the health benefits associated with being less fat. (In other words, even if being thinner is healthier than being fatter, we don’t know if that is because of the thinness itself or because of other genetic factors. We don't know if becoming thinner through external means will make you as healthy as a person who is naturally thin.)

3) Medical science has not identified ANY weight loss interventions that are proven by good quality studies to be effective in the long term for more than about 5% of people. This includes WLS. (In other words, even if becoming thinner is healthier, WE DON’T KNOW HOW TO MAKE PEOPLE THINNER. This is key.)

4) Medical science does NOT fully understand the human metabolism and the complex mechanisms by which our brains, hormones, enzymes, digestive system, and other body systems regulate how our bodies use and store the energy we take in. (In other words, it’s no wonder intentional weight loss doesn’t work – we don’t even understand the body systems we are attempting to control!)

5) What medical science DOES know is that our bodies adjust how efficiently we use energy, when and whether to use energy versus store energy for later use, and so on, based on how much energy we take in, how much energy we expend, and who knows how many other variables. (In other words, our bodies are not the same as car engines. The whole “just eat less and exercise more” mantra is fundamentally flawed, because our metabolism is constantly reacting to changing circumstances and changing how it processes fuel accordingly.)

6) Because medical science does not comprehend how to adjust the human metabolism, WLS works on the same general principle as weight loss interventions (giving the body less fuel so that it uses energy from stored reserves, e.g. body fat) but depends on a physical impediment to the body’s intake of fuel rather than a behavioral impediment. (In other words, WLS is just a weight loss diet with a “gun to the gut” in the form of some sort of physical implant or mutilation of the organs that inhibits the body’s ability to eat much volume and/or to absorb the nutrition from what is eaten.)

Yes, it is logical that some of our afflictions may be caused in some way by our larger bodies, and the wear and tear to joints and body systems caused by asking them to work hard transporting our eloquent poundage through life. But given all of the above, it seems clear that this is moot. Intentional weight loss is not an option. WE DON'T KNOW HOW TO MAKE FAT BODIES SMALLER. Diets don't magically work just because we are in pain and are doing weight loss "for our health." Biology doesn’t understand intent.

If we want to feel better, we need to focus on things we can control: eating food that feels good and provides us energy, moving our bodies in ways that build strength and stamina, and getting psychological and emotional support to process the complex and difficult emotions that come with living in pain, living with disability, and being a member of a marginalized and oppressed group in society.

Keep your assumptions off my body

So over the past 24 hours, I've had a catastrophically yucky initial meeting with my (potential, violently rejected) new primary care physician, followed by (admittedly mild, but I'm sensitive to this sort of thing) Facebook drama. I posted on Facebook shortly after I left the office, because I was upset and distressed by the horrific 5 minutes I'd spent with the doctor. Unfortunately, in addition to several supportive comments, one friend (whose partner is a WLS "success story") posted a finger-wagging comment basically scolding me for overreacting, saying that it was probably appropriate for the doc to act as she did. Then, some other rad fatties and allies posted vehemently anti-WLS comments. Which felt good to read, but they in turn prompted the pro-WLS friend to spring to the defense of WLS. All of this in comments that started to feel like a flame war on my FB. It was to the point by this morning where each FB notification was making me feel sick, because I dreaded what it was going to be...

Finally, I decided to respond. But I'd been doing so much thinking that it became far more blog-length than comment-length. So I'm posting it here instead. I'm sure some rad fatties and anti-WLS people will think my position is not strong enough. While on the other hand, my friends and acquaintances who have positive ideas about WLS will probably feel I'm being unreasonable in my resistance. I can't please you all. I can only try to think this through and navigate it the best I can. I am torn, caught in the middle between the hordes and masses of society who think my body is an abomination, a disease to be "cured" by any means necessary, and by the small, quiet voices of fat acceptance and HAES and the tentative reaching instincts of my own body and soul, which tell me that fat is part of my biology and my identity and it's the world that needs to change, to stop treating me badly and seeing me as a problem and an intrusion.

There's so much to respond to in what everyone said on my FB. I agree with the strong negative feelings that many of you have about these surgeries. On the other hand, I understand where my friend who said the distressing stuff was coming from (even though the way he said it really hurt!). I know several "success stories" for whom the surgery was really wonderful and they are feeling great / much improved / it was all worth it / etc. Which only serves to confuse me because I feel even more pressure to accept the pressure of medical professionals. However, I simply must stick to my own gut feeling/intuition/confidence that this is NOT the right path for me - at least right now. I won't say never, cause who knows?

What truly pisses me off about this doc is that, as I said in my initial FB status post, she had met me LITERALLY 5 minutes before stating that bariatric surgery was really my only option. She had not had me fill out any new patient paperwork. It's almost certain that had not reviewed my medical record extensively, if at all, given how overworked clinicians are these days and the fact that I had not scheduled a full physical, just a 15 minute appt. When she walked in, she asked, "What can I do for you today?" I stated that I am looking for a new primary care physician, and she repeated, "But what do you want today," or something. She didn't ask me any questions or move to initiate the getting-to-know-you conversation I was hoping for. So I said that I am looking for a team captain, that I see a variety of specialists for different concerns, including a naturopath, chiropractor, psychologist, occasionally podiatrist. I went on to express that I was seeing her because I am looking for a new primary care doc who will NOT insist on constantly recommending HMR (my medical group's in-house version of Weight Watchers) or bariatric surgery, as those recommendations aggravate my eating disorder and depression. I explained that I believe in focusing on changing behaviors, not focusing on weight (working my way into explaining HAES). But before I could elaborate, she said that that was just it, we can't change behaviors, and that for someone in my "category" the only viable option is bariatric surgery.

Really? You don't want to hear more about the eating disorder I just mentioned? But of course fat women don't have eating disorders, do they? If you have an eating disorder, it makes you skinny. After all, the same thing we diagnose as an eating disorder if you're below a certain weight (severely limiting calories, obsessively planning meals and reading nutrition labels, working out to excess, etc.), we prescribe to fat people, don't we! You don't want to know if I exercise or not, or what I eat, before making such a sweeping statement? But of course not; you know exactly how I eat (poorly) and whether I exercise (obviously not even a little) from looking at me, right? It may be - it probably is true - that I will never eat or exercise "perfectly."  But you don't even ask the questions??? It was blatantly clear that this woman thought she knew everything relevant about me just by looking me up and down. And so I told her, "ok, well that's what I needed to know. We're done here." She protested, "But don't you want a flu shot or a whooping cough booster?" "No, I don't want anything from you." Not exactly the ringing, persuasive speech I might craft if I were a character in my own movie... but I didn't cry. I didn't give her that. At least, not til I got to my car.

I have done a lot of thinking on this in the last 24 hours and I've come to believe that my feelings on WLS and abortion are somewhat parallel. In both cases, I believe that everyone has the right to choose to go through that procedure, but it is emotionally complex and has long-lasting physical and emotional consequences and should not be taken up lightly. In both cases I would not personally choose that procedure but respect others' right to make their own personal decisions about what is best for their bodies and their lives. And just as I would be offended by a doctor who recommended abortion just because I was visibly pregnant and single, I am offended by a doc who recommends bariatric surgery just because I'm fat.

Pro-choice folks have the slogan, "Keep your laws off my body." While there is no law that one must have bariatric surgery (though it's getting scarier and scarier in terms of de facto weight loss requirements embedded in ability/non ability to access health care in this country), there is a TON of pressure out there, especially for folks like me who are in the very far right (not politics, math - on a graph, bigger numbers are to the right!) portion of the weight bell curve. So it may not be as catchy, but I say it with gusto:

KEEP YOUR ASSUMPTIONS OFF MY BODY. Yes, I mean you, Dr. And you, well-meaning friend. My body is mine. In this day when fatness increasingly IS a choice (if you believe bariatric surgery is a viable option, which so many seem to), it becomes increasingly difficult to stand up and say, "I am fat. I don't believe thinness is a choice for me. So I am going to live in this fat body" without getting some pretty forceful push-back.

Ok, now I have all sorts of interesting thoughts percolating about how just when we thought people might accept that diets don't work, and therefore fatness really is biological and not a "choice"... in walks bariatric surgery, and in just a few short years goes from experimental to frighteningly mainstream. Coincidence?

But that's a subject for another day... This post is already exceedingly long. Kudos and thanks, if you're reading this. You've made it to the END OF THE POST. Leave me a (positive, no meanies allowed!) comment and you get a gold star. :)