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.

Eating: back to basics

I have a hard time making healthier choices without feeling like I'm caving to the pressure to weight-loss diet. I have a hard time turning down foods that taste exciting but don't do great things for my body without feeling the old ED voices coming up to haunt me, triggered by the slightest hint of restriction. So I've spent a lot of time living in a land of overindulgence, choosing the milkshake, the chips, the full-octane everything, resisting anything that reminded me of ways I was instructed to eat in order to lose weight. Unfortunately, that meant cutting out a lot of practices and foods that would probably help me feel better, have more energy, better digestion, etc. The diet voice was still in charge; I was reacting against it rather than living under its restrictive thumb, but it was still running the show.

I was starting to worry that "eat food, stuff you like, as much as you want" wasn't for people like me. That I was deluding myself that HAES applies to someone as far out on the 'fat' end of the bell curve as I am. But luckily for me, I have a whole heap of awesome people in my life who are generous with their time and willing to talk me off the cliff.

Talking with them, I was reminded that The Fat Nutritionist is talking to me, that HAES does apply... but when your (my) relationship with food is so broken, you may have to take some time and energy to break down what "stuff you like" and "as much as you want" really mean. (Spoiler alert: they do not mean "mostly stuff you were deprived of as a restrictive eater/dieter/child whose eating was controlled by others" and "as much as it takes to make you so full it hurts but at least you're not scared of ever being hungry again.") Edit: Oh, wait. Michelle totally calls that out here. Oh well... I got there eventually.

I was reminded to dust off my toolkit and pull out tools I have forgotten to use for a while (such as the fabulous Deb Burgard's "Every Body Part Gets a Vote"). I was reminded that it's OK to make choices that are conventionally deemed "healthy" and that making said choices doesn't make me a tool of the Dieting Industrial Complex. Yup, even if choices that may make my body healthier resemble choices one might make under the tutelage of a mother who wants desperately to protect her child from a life of fatness.

I was reminded it's OK to have full-fat dressing when I want it, but that it's also OK to dig deep and realize what I really want is a light sprinkle of oil and vinegar (hey, it could happen!) AND, more importantly, it's OK to have a salad because it tastes great and is full of yummy veggies and fiber, and go ahead and have cheese and eggs on it too because I'm NOT trying to eat low-cal or low-fat per se, just trying to have a nicer life and that means fueling my body well.

When a car isn't just a car

So a month ago I was rear-ended and my car was totaled. Luckily I am physically fine. A little sore at first but my chiropractor did a great job getting me back on track. Unfortunately, the car search has been incredibly painful as I struggle to find a car that will accommodate my fat body. I have been having dark thoughts about capitulating to mainstream medicine and looking to weight loss diets/surgery/etc.

This week, we got connected with an accessibility place that does van conversions. Not only do they have a minivan that accommodates my fat body in the driver's seat, but I'll be able to load my mobility scooter all by myself without struggle, and have a level of freedom and independence I haven't had for a couple of years!

The downside: the placement of the pedals requires my leg to be straight out from my hip, rather than lolling to the side like it usually does because of my big belly. The muscles in my inner thigh have to work pretty hard to keep my leg in this position, and after a longish (20 min?) test drive I was in a good deal of pain. Everything else about this van is better than any of the other vehicles we've tried, and after much talk and brainstorming we concluded that no other vehicle is likely to be able to fix this problem, nor is there an aftermarket modification that can be done to fix it.

Luckily, I have my resources. I consulted with dear Cinder Ernst the amazing exercise coach, and she thinks exercise can strengthen this muscle group to make the pain less over time. Friend Carole talked up the benefits of the increased independence and freedom this van will give me, and encouraged me to have faith that I can do the strengthening piece.

I go sign paperwork tonight. I'm gonna have a new minivan!

Still struggling to own this disability identity and not feel like I should "just eat less and exercise more" and undo my disability. That sh*t doesn't work - I know the research shows it - and yet the pressure is everywhere!

Trying really hard to turn away those dark weight-loss-focused thoughts and remember that my job is to eat food, stuff I like, as much as I want, and to take small steps with exercise.


So hard! When I hit a major bump in the road like this, especially one that centers around my body size, it is SO HARD to stay on target.

Puttin' on the Ritz

I grew up steeped in ideas about good foods and bad foods. Eating good foods (or even better, no food at all) made one a good girl, virtuous, and - eventually, presumably - skinny. Eating bad foods made one a bad girl, gluttonous, and fat with all the most negative connotations of fatness that society allows.

I've worked hard to unpack and (to some extent) unlearn these attitudes. I had a moment today when it really reared up. I realized I feel guilty/bad when I eat Ritz crackers. I remember being told they were full of fat and they were not something we ever had in the house growing up.

I wonder... are they really nutritionally that bad? I almost looked at the Nutrition Facts panel when the thought reared its head. But what would that prove? They are not made of air and cardboard, and they are a processed food, so a glance at the facts and figures is not likely to prove they've got the same nutritional content (or lack thereof) as a handful of celery sticks and shut up the guilt that way. Nope, that's staying within the problematic paradigm. It's not about whether they're "bad" or "good" at all. I've gotta use my intuitive eating and HAES skills and shut that sh*t down.

So...
Fact: In an ideal world, I would've brought a lunch, but I didn't.
Fact: The options to go out and purchase near work, and the time it would take to do so, did not work for me today.
Fact: I need to feed my body. Unplanned fasting is not an acceptable option for me.
Fact: I had Ritz crackers in my desk drawer because they're something I'll eat even when I feel crappy and/or don't feel like eating.

Therefore: Ritz crackers were the right choice given the parameters in place today.  

Take that, tape loop in my head!

Playing in my head...

I just had a lovely lunch with my boss/mentor and her 13-month-old boy. I had a vegetarian sandwich, because it was what I wanted. The intuitive eating voice in my head was proud of myself for getting what I wanted, and was grooving on the yummy mushrooms and melted cheese and various veggies. It also warned me that this was a very yummy sandwich but not much in the "stick with you" department, so I was thinking ahead to what/whether I had anything to snack on later in the day. All very sane and healthy (my definition of healthy, not corrupt "healthy=dieting").

But then there was the little diet devil on my shoulder telling me to feel guilty for all the yummy cheese (even though I had no meat, and very little bread!), and the dessert-wanting voice, not bad in herself -- wanting dessert is A-OK with me, or at least I want to get to the point where it is! -- but since the diet devil thinks dessert is bad, the dessert-wanting voice caved to the pressure and twisted herself in knots, arguing in a burst of spurious logic and ugly old definitions of virtue that "since I'd had a vegetarian lunch, it was OK to have ice cream now." If I'm going to have ice cream, I'd like to decide to because I want it, and it sounds good to my tummy/mouth/body - not because I've "earned" it by some bizarre deprivation-world logic. Sigh. But hey - the shake was quite tasty! And it did, in fact, settle well in my vegetable-occupied tummy landscape. So that's good, anyway.

I wish I hadn't had those couple of clutter-y diet thoughts. But really, I need to see that there's a lot more intuitive eating WIN than FAIL in today's lunch: I ate what I wanted to eat, instead of eating more/differently than I wanted in fear of future hunger, I got dessert because it sounded good but I also knew it would settle well and there was room in my tummy, etc. A couple of the messages my brain has on auto-play are bad, but the decisions made were right and in tune.