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.

Fat Poz Zone

Howdy folks,

Just a friendly reminder that this is a fat-positive zone. Or - if you can't quite manage that - at the very least, a weight-neutral zone. No discussion of intentional weight loss is welcome here, even if "you're just concerned about my health." That's called Concern Trolling (1) and it's not welcome here.

But how can you support me, if you can't tell me to lose weight, or share your inspiring story of how you lost half your body weight and have kept it off for 10 years and will sleep better at night knowing you've done everything you can to avoid the cancer that killed your mother? Read on, friend... read on.

A) Encourage me in my efforts at adopting weight-neutral, HAES(r)-based strategies for managing and improving my health and encourage me in those BEHAVIORS rather than in some perceived or "should" weight-loss goal.

• Studies abound which show that the positive health outcomes commonly attributed to weight loss will be achieved regardless of weight loss, if the healthy behaviors (movement, nutritious eating, etc) are adopted. (2)
• Studies also show that when weight loss is the motivating factor to exercise/eat healthfully, motivation tapers and the behaviors are abandoned when weight loss is not achieved or plateaus. On the other hand, when "feeling better" is the goal, incremental improvements provide positive reinforcement on an ongoing basis. 

B)  Even if it seems like weight loss might be the only way to improve how I feel, or if you cannot bring yourself to believe that my weight is not a causal factor in how I feel, resist the urge to suggest weight loss. Long-term, sustainable weight loss is just not possible for the vast majority of people.(3)

• The reality that doctors and diet programs fail to acknowledge is that somewhere around 95% of weight-loss diets fail. So by having weight loss as a goal, I'm very likely to be setting myself up for failure. 
• Still believe that I should be striving to be part of that 5%? Fine. Keep it to yourself, and see Point 1 -- you can encourage all the healthy behaviors you think I should be doing, and you are welcome to think to yourself that they'll lead to weight loss if that helps you support me. (Though hopefully you'll go out and read the research for yourself so you can continue to support me even when I don't "succeed" at becoming thin.) 

C)  For me personally, the suggestion that I need to lose weight is particularly harmful due to my medical history.

• If you really care about me, you will resist the urge to suggest weight loss for the simple and very personal reason that I have a history of eating disorder and the suggestion of weight loss from people I care about is very likely to bring on a relapse. I am tired of throwing up, depression, anxiety, etc. Seriously tired.

Footnotes: 
(1) On Concern Trolls: 
http://danceswithfat.wordpress.com/2012/01/11/dont-cry-for-me-well-meaning-concern-troll/
http://fatheffalump.wordpress.com/2012/01/04/genuine-concern-vs-concern-trolling/

(2) On positive health outcomes independent of weight loss:
http://thinkmuscle.com/health/obesity-health-metabolic-fitness/
http://danceswithfat.wordpress.com/2011/01/19/why-health-at-every-size/

(3) On long-term, sustainable weight loss being highly unlikely for the vast majority of people:
http://thinkmuscle.com/health/obesity-health-metabolic-fitness/
http://danceswithfat.wordpress.com/2012/04/21/for-fat-patients-and-their-doctors/
http://danceswithfat.wordpress.com/2012/06/12/do-diets-fail-or-do-dieters-fail/

ED issues - do they ever go away?

I love how our Fat Acceptance community can come together to support each other when one of us is feeling less fierce than usual... I'm hoping to find a bit of that support today.

Trigger warning for eating disorder issues, ok, y'all...?



I am really struggling the past couple days with a strong urge to binge on sugars, fats, and carbs. All the stuff I've been taught my whole life is "bad" (which I've struggled, with limited success so far, to re-define for myself in a HAES and intuitive eating framework). I've struggled with a tendency to have disordered eating - and disordered thinking about eating - for what feels like forever. Certainly since middle school, when I'd make up elaborate lies about wanting something to do, being so bored, surely my mom wanted me to go to the store and get some milk or something just so I could go to the store to buy a candy bar and devour it in a fear- and forbidden-food rush of shame. (I wasn't allowed to spend my allowance on candy, cause, ya know, so fat.) I also got caught once stealing chocolate chips out of the deep freezer in the garage... and the shame, wow... I don't think I'd have been more ashamed if I'd been caught masturbating. (Yeah, no body issues there. Why should masturbation be a shameful thing either? But that's another story for another post.)

I think I'm being triggered these past few days because a) I've learned that I'm gluten-intolerant, which means I'm constantly telling myself "no" to things I want to eat, and restriction/the forbidden are huge triggers for me... and b) I had a conversation with a friend who is a 10-year WLS survivor with pretty much the best imaginable outcome. I forget how it came up, but I tried to neutrally respond saying I was glad she had such a good experience and was healthy. Somehow this turned into her recommending other mutual acquaintances I could talk to who also had good experiences, and wham - I was triggered.

Not sure the above two items can possibly explain completely why last night I ate 2 corn dogs and a bacon-wrapped hot dog (after a full meal 2 hours earlier) and this morning a turkey sandwich and a muffin (both v. gluten-ous) and for lunch Taco Bell and then a 3-pack of Hostess orange cupcakes AND a pack of Twinkies. And why I'm feeling so much like a failure and so much frustration and some shame for eating all these things. I know I'll be kicking myself for DAYS as all this grease and sugar and most importantly gluten wreaks havoc on my poor tummy and gut. Why do I do this to myself? How can I give my body the food I know is good for it when intuitive eating says eat what I crave, and what I crave is sugar when my genes give me a high chance of diabetes and gluten which makes my tummy hurt? This is too hard to navigate.

Help me, wise fatties! What have YOU done to struggle through these issues and come out the other side?

Self care... it's a right, not a privilege

The New Year's Revolution Challenge for Thursday, January 20, is: 

Pick up the phone today and make that medical or self-care appointment you keep meaning to schedule!

When we don't feel good in our own skin, or we have had the experience of being humiliated, lectured, and scolded time and time again by medical professionals, or we feel ashamed of parts of our bodies, it's easy not to feel worthy of, or entitled to, medical care or self-care or those little physical luxuries like massage or pedicures. 

I'm here to remind you, and myself too, that we are all entitled to compassionate medical care and decadent pampering. Our bodies do not disqualify us! I have finally, after 10 years of searching, lined up a Primary Care Physician and a pedicurist (two of my most crucial care providers - more on why pedicurist is on that short list later!) that make me feel I can get medical care when I need it, preventive care before I need it, and regular pedicures so my chronic ingrown toenails are kept under control - and my feet look pretty and make me feel all girly and happy.

It actually takes two doctors to make one Primary Care Physician to see to my needs. First, there's my official PCP - a family medicine physician I'll call Dr. H, who practices at the local giant non-profit full-service medical clinic (think Kaiser, but local not national). Dr. H is a lovely woman, and seems to care about me deeply. I like her, too, and always ask about her kids and really feel I have a relationship with her. Unfortunately, I've been seeing her for years, and despite trying again and again to bring her up to my HAES standards, she can't or won't get on board. When I tell her about problems she doesn't know how to solve for me with a pill or a needle, she resorts to recommending weight loss because she's so desperate to do something to help me. I even had her talk to my HAES-expert therapist, and all Dr. H got from it was "Dr. B thinks you should exercise, too." Uh-huh... not exactly the full picture of Dr. B's explanation of HAES.

So why do I stay with her? Well... it comes down to the devil you know. I considered leaving - actually tried another doc - and the new one was WAY worse than the old. She actively pushed the issue of WLS! So I did some soul-searching, and decided that I just didn't have the sanity points in my life (or the money or the time to take off work!) to try meeting with a dozen - or a hundred - possible PCPs in order to find the one in a million who truly 'gets' HAES. Or more likely, is incrementally better than Dr. H but still not the HAES guru of my dreams. In the meantime, I've thrown away a person who truly cares about me and my health and happiness, who has a (admittedly major) blind spot but is otherwise really helpful and good to me.

The reason I'm able to settle for less than perfection in my official PCP is because I have another person on my team. I've been working with a naturopathic doctor, Dr. J-L, for the past six months or so. She, too, is less than my perfect HAES guru. (What can I say? I have high standards...!) But she's less indoctrinated in Western medicine, obesity-epidemic-booga-booga than a standard doc - to the point where she understands that a "morbidly obese" person such as myself can also have an eating disorder, and because of that understanding, she will not cross the line and give me weight-loss focused nutritional advice. In fact, she's so careful that several times I've had to explicitly say, "Please, go on... I'm totally open to your advice on nutrition. The only thing I don't want to hear is calories or pounds. General nutrition guidelines are welcome!"

So after one too many weight-loss discussions with Dr. H, and the terrible WLS discussion five minutes after meeting Dr. E (that's the new potential PCP I met with once - the 'E' is for evil!), I went to Dr. J-L and proposed a deal. I told her I'd like us to agree that as far as the two of us are concerned, she's my *real* PCP, and Dr. H is my Western Medicine Liason. We can't tell Dr. H this, of course. But I realized that if I 'manage' Dr. H by avoiding talking to her about things that will trigger her fears and stereotypes about "obesity" (back pain, knee pain, foot pain... things she associates with curing by weight loss, or has no good way to help with other than prescribing weight loss), she can give me great care on other issues, the kind Western medicine is good at (sinus infections, PAP smears, etc.). And now, I have Dr. J-L to help me with those issues Dr. H isn't so good at, so I had the luxury to do so.

The upside? Dr. J-L is helping me feel better on a day to day basis. Dr. H is there to prescribe me antibiotics when my sinuses go haywire. Everybody wins.

The downside? Dr. J-L isn't covered by insurance. Not even a little bit. And I have good insurance through work! And of course, I still don't have my HAES guru. Or rather, I have many HAES gurus, but none of them is my PCP.

But hey... it's working for me. At least until I come up with something better. Now if you'll excuse me, I need to plan my next pedicure.

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. :)