Oh, Fat

I have struggled for a very long time with just being comfortable being fat. No matter what I tried, I didn’t lose weight and the weight (ha) of feeling like a failure with no self-control was so great that I just had to finally be like, “Okay, fuck it. I’m fat. Regardless of what I weigh, I need to make some fucking peace with my body.”

I’m not fat because of some personal failing. I’m just fat.

Well, you know, I reached that place because I spent so long hearing about what a personal failing it was that I was fat–that I wasn’t trying hard enough or that I was lying or that no man could ever love me if I didn’t get the weight off or that God wouldn’t let me have kids until I was thinner or… or… or… It’s always something. Being fat is a moral issue.  If you are fat, it is because you are just not trying hard enough, and if you are just not trying hard enough, you suck and it is fine for everyone around you to try to shame you into getting into line.

For my own sanity and self-preservation, I just had to learn to harden my heart to that nonsense.

I come from big fat people. I am a big fat person.

My gynecologist is not perfect, but she is the first doctor I ever had who looked at my body and said, “Hmm, something’s not right here.”  It has been hard, after years of trying to just experience my body as neutral, to hear that my body was evidence of a problem. That’s not her fault of course.  It’s on me to learn to separate “body behaving strangely” from “Betsy failing morally.”

But I’m having a little trouble navigating it–the distance between “your body indicates a problem, i.e. a moral failing” and “your body indicates a problem, i.e. a symptom of something not working right with you.”

Even yesterday this was a problem, because in the year I have been to see her, I have lost no weight. I haven’t been concerned about this because I feel so much better than I did a year ago. I can’t even begin to tell you how different it is, just to feel like my body works in a way that it never has before.  It’s not like I knew before last year that this was how it could feel to be in a body because I didn’t have anything to compare it to, you know?  I felt the way I felt and I assumed that it was pretty much how everyone felt.

So what if I’m not losing weight?  Right?  I didn’t go to her to lose weight. I went to her to stop bleeding like a stuck pig almost non-stop.  Problem solved, underlying condition diagnosed, treatment started, great improvements seen, appointments made and kept.

Ta da!

I’m fine.

Except she makes me go back out and get on the scale so she could see for herself.

“It’s fine,” I say. “I didn’t come here thinking that my problem was that I’m fat. You’ve solved my problem.”

“But you should not be on the amount of metformin I have you on and not have dropped some weight,” she said, “it’s not about whether you want to or not, it’s about how the medicine at this dose works in a body where there’s not something else going on. You could just be weird. It could be nothing. But I don’t want to be the doctor who saw something strange and let it pass.  Let’s just get an endocrinologist to run some tests and take a look.  Could be diabetes, could be thyroid, could be something else, could be nothing.”

I’m having really mixed feelings about this, I have to tell you.  I’m really struggling to reassess how I understand myself in my body.  I mean, all that work to be like “there’s nothing wrong with you” was good. I mean, shit, I probably wouldn’t have gone back to the gynecologist after the scary dude if I hadn’t acquired a good dose of fat acceptance along with my desperation to fix my problems. But there is something wrong with me, even if it’s only the PCOS.  And there may be something more wrong with me, and how I look is the symptom that gave the doctor the idea to even check for PCOS and now to send me to the endocrinologist.

I’m not sure how exactly to understand that for myself.

I feel a little like every doctor I’ve seen, in my entire life, has lectured me about trying to lose weight or, when they finally gave up and believed me that I was trying and it just wasn’t working, they just shrugged like, oh well, you’re just fat.  When, really, I had something wrong with me, that it would have been nice to be treated for.  So, I feel a little angry, even though I know it doesn’t really go anywhere.  It’s just like a grass fire that would burn itself out by the time you got the hose going and over to it.

I feel like I’m taking a little too much glee in reminding my male relatives, who assured me that I was too fat to be loved, that I have a condition. Ha, and how fucked up and stupid is that?  It also doesn’t do me any good, but it makes me feel self-righteous and sactimonious and it’s very hard for me to resist that, at least until my mom starts blaming herself for not doing something sooner.

But mostly, I feel kind of unsure about how to navigate this.  I want to feel good about myself no matter what and I don’t want to feel like my fat is visible proof that there’s something wrong with me, even if that is the case, I just am not sure that I do well at making the distinction between “something wrong with my body” and “something wrong with me as a person” very well.

But I feel like it’s also imperative for my health that I learn how to have an expectation of health–if a medicine is supposed to have the effect of making me lose weight and I don’t lose weight, it’s not “oh that’s fine because I’m fine with being fat.” It’s actually not fine, because it’s not working how it should. It’s actually not fine, because there may be something else wrong.

So, I want to feel good about myself, no matter what, and I want to learn to expect my medical treatments to perform how they should.

Ha, but doesn’t this take us right back to the whole “you’re just not trying hard enough.” thing?  When your doctor tells you to lose weight and you try to lose weight and you can’t, do you ever thing “Oh, the treatment this person recommended didn’t work–that might be an indication of something.”? No, after you think, “I have failed,” you think, “Oh, well, maybe I can’t expect the things my doctor recommends to work.”

So, I’m just saying, I don’t quite know how to strike this balance.

15 thoughts on “Oh, Fat

  1. You know, I’m glad your doctor is looking at other things. BUT, I’ve been diagnosed with PCOS for about fifteen years, and on a huge-ass dosage of metformin, and I haven’t lost a damn pound. I’ve had my thyroid and blood sugar tested, nothing else is wrong but the PCOS. But I think that some doctors are under the impression that metformin will absolutely cause weight loss, and it doesn’t. Not necessarily. Maybe not even probably.

    I’m a librarian, and it sounds like you’re in a related field. If you’ve got access to the Medline article database check out the PCOS research. If not, you can see the free version on pubmed.gov, it just won’t take you farther than the article abstracts. But that will, I think, back up what I’m saying. Metformin does not, in and of itself, cause weight loss in women with PCOS. But a lot of doctors are still under the impression it does.

    Hang in there.

  2. First, I was on metformin for a few years, at first I lost my appetite and, of course, some weight. After a few months, I got used to the drug, got my normal appetite back, the weight came back. Not all side effects last forever.

    Second, I’ve been dealing with thyroid issues since the late 1990s. Currently there is something majorly wonky going on with my TSH levels and I just can’t predict what this is going to mean for my dosing or how I’m going to feel. And while I keep telling myself that my self-worth is not related to my weight I can’t help but hope this might lead to some magical extreme weight loss. What I should be hoping for is that this leads to me feeling better, screw the number on the scale.

    And third…I’m a medical librarian too. You appear to have a niche following (and hi Rachel!).

  3. That’s what’s concerning her. I’ve lost my appetite, but no weight.

    My mom has thyroid issues, and my grandpa had diabetes, so it doesn’t seem unreasonable to me that there might be something else wonky.

    And holy cow! I am a little humbled to discover all these librarians following me.

    It must have been how Hemingway felt when he discovered good writers read him.

    Ha, just goes to show you, there’s never any moment when poking fun at Ernest doesn’t cheer me up.

  4. I think i said this when you were first out on here about the PCOS and commentors were all saying “good for you, now you’ll become skinny like my cousin Eunice who has PCOS and lost like a ton of weight when she finally got meds.”

    Because of my previous life in the infertility circles I know scores of women with PCOS–some of them in my own family–and none of them had permanent weight loss of more than 5lbs. So I echo what O.C. said above–I don’t think Metformin necessarily means what doctors think it means.

    But I feel very keenly where you’re at with the whole fat acceptance vs. medically induced weight problems. I’m right now at the point where my doctor is suggesting the addition of new medications. All of them cause weight gain and I don’t want to take them. All these years I’ve been fine with being fat, pushing the FA agenda and now that I’m looking at medically-induced weight gain (we’re talking up to 75lbs here) I’m not as fine with fat as you’d think. I don’t know what that says about me.

  5. Ooh! Katherine just reminded me of a comment I’d made on a PCOS related post on fathealth.wordpress.com…

    We’re told that PCOS causes weight gain, and makes it harder to lose that same weight, right? But research shows that it’s almost impossible for anyone who’s fat to lose a lot of weight! Huge weight loss just isn’t possible!

    So I wonder if there really is anything different about PCOS fat compared to “normal” fat. Or is it just that PCOS fat has gotten the attention of the occasional doctor, who noticed that a PCOS patient was doing the “right” things and not losing weight, then blamed that lack of weight loss on the PCOS?

    Maybe fat and PCOS have nothing to do with each other after all. And maybe fat is just fat. No “PCOS fat” vs. “normal fat”. I’d love to see research on this, but I’m not holding my breath.

    I do think I found research on metformin being tested as a weight loss aid on non-PCOS people, and it didn’t help. And you know it’s true because if it had caused even a little weight loss it’d be marketed from here to kingdom come as a weight loss medication.

  6. Aunt B,
    I think you’ve hit on something really important here that extends beyond weight. We’re taught that anything related to poor health is a moral failing. If you get sick a lot, you obviously don’t take very good care of yourself. The thing is, that’s so counter productive! It causes so much emotional noise that you can’t hear what’s going on with yourself or your body because your brain is busy screaming about what a failure you are. Sickness is a lot more complicated than that. It has some emotional components and some physical components and sometimes just plain old good or bad luck. Our response to sickness or weight (high, low or “normal”) or understanding any part of our physicality shouldn’t have to include hating or blaming ourselves because we are morally inferior. That only obscures the issue in such a way that makes it so much harder to understand or work with in any constructive manner.

    For the record, I am not a librarian… but some of my best friends are. :-) I do, however, have a small book problem… primarily involving storage.

  7. I was struck to see that you suggest that your weight is what led the Dr. to diagnose you with PCOS. But isn’t it the case that there is are other physical manifestations? Maybe she saw those.
    Still, I do get the problem you’re having. And I don’t think there’s any one good answer/solution for it. Maybe the best thing you can say is that you keep thinking it through.

  8. PCOS. But isn’t it the case that there is are other physical manifestations? Maybe she saw those.

    PCOS is a collection of symptoms, and any individual may have one, a few or all of them – I have the weight gain, horrific periods and cysts, but not the skin or hair problems, or (so far) the insulin resistance, for example.

    I gained a huge amount of weight before I was diagnosed with thyroid cancer and later PCOS (first 18 months of diagnosis: fat and lazy!) and this makes me weirdly ambivalent about my fat body. I don’t mind the fat itself – that’s neutral – but at the same time I feel like my body betrayed me. I was fat before the cancer, too – and was always a big, if not fat, kid – so it’s not like I was suddenly changed into a fat person. But weight can be a symptom of something wrong, or it can be just how your body works, and with all the emotion tied up in it, it’s hard to differentiate. Also, most medical staff being virulently fat-phobic makes it even harder!

  9. I just yesterday afternoon, while googling ‘arthritis forecast’ in hopes of getting one of those cute graphs which show how bad yr arthritis will be in that day’s weather, came across a slew of articles.

    They were from some pharmaceutical investment magazine talking about why you should invest in arthritis medications. Apparently they’ve forecasted (hence showing up in my search) that there will be a worldwide arthritis epidemic peaking in 2030. The articles go on to say this is a result of an aging population. The last paragraph is all about how fatsos get arthritis bcz they’re icky fatsos and if they’d lose just 15lbs their pain would be cut in half.

    Now as a person with RA I know how much of that was due to a naive understanding of what arthritis is. OA–osteoarthritis–is called ‘wear and tear’ arth bcz it is the one type caused by overuse and strain on a joint.

    There are 103 other types of arthritic conditions. Those have NOTHING to do with body size and are caused by a malfunctioning immune system.

    But laypeople, journalists and most medical staff will read articles like those and the conventional wisdom will persist. Everyone will go about thinking that all people with arthritis got sick bcz they’re fattytwobyfours who are pig ignorant. Disease will continue to be marketed as a failure of individual will and discipline.

  10. Holla to the other librarians from an ex-!

    It’s difficult to separate the data from their interpretation when discussing the weight of the human body; moreso when it’s a woman’s body. The actual tools that we can use to measure and understand the data are already so layered with intention that its a real effort to see the data as just numbers.

    A body’s weight is only its relationship to gravitational forces. It changes according to the body’s input, output, and efficiency of internal mechanisms. It’s not easy to measure the change in internal mechanisms, which is why diagnosing has such a large margin of error. However, there are things we can measure that can help with diagnosis. They include the body’s input, weight change, and output. If the data are more accurate, the diagnoses are closer to correct. Medicine is a science that operates with a lot of hidden variables and an unreliable reporting method (the person who is the patient). Like other scientific observations, measuring the body and its changes is still the best way to understand it.

    It would probably help your doctor, who sounds like a thoughtful problem-solving type, to have really good data when she decides to tweak the chemicals she gives you to adjust your internal mechanism(s). Scales, weight-tracking spreadsheets, and calorie counting programs are used unfortunately to enforce conformance to a narrow acceptable range of body weight. Anything outside that range (we know) is seen as a moral, and not a mechanical, result. It’s awful, but shouldn’t stop someone who wants to contribute to his or her understanding of the body mechanism from using the tools.

    The hard part is separating the numbers from the morality. Its easier to do this if you have already done the work to climb out from under the definition of “acceptable”, which it sounds like you have.

    I hope you find the answers you need; it’s maddening to operate from inside a fog.

  11. This had been bugging me, so I started crawling Pubmed. Indeed, large dosages of Metformin can cause weight loss in women with PCOS.

    All of eight pounds. Whoop-de-damn-do.

    I tell ya’, on me eight pounds of weight loss doesn’t even change the ways my rings fit. You might as well call eight pounds zero pounds for all the difference it’d make.

    “Metformin and weight loss in obese women with polycystic ovary syndrome: comparison of doses.”
    Harborne LR; Sattar N; Norman JE; Fleming R

    The Journal Of Clinical Endocrinology And Metabolism [J Clin Endocrinol Metab] 2005 Aug; Vol. 90 (8), pp. 4593-8. Date of Electronic Publication: 2005 May 10.

    CONTEXT: Metformin treatment of women with polycystic ovary syndrome (PCOS) is widespread, as determined by studies with diverse patient populations. No comparative examination of weight changes or metabolite responses to different doses has been reported. OBJECTIVE: The aim of this study was to determine whether different doses of metformin (1500 or 2550 mg/d) would have different effects on body weight, circulating hormones, markers of inflammation, and lipid profiles. DESIGN: The study included prospective cohorts randomized to two doses of metformin. SETTING: The study was performed at a university teaching hospital with patients from gynecology/endocrinology clinics. PATIENTS: The patients studied were obese (body mass index, 30 to or =37 kg/m2; n = 41) women with PCOS. INTERVENTION: Patients were randomized to two doses of metformin, and parameters were assessed after 4 and 8 months. MAIN OUTCOME MEASURES: The main outcome measures were changes in body mass, circulating hormones, markers of inflammation, and lipid profiles. Results: Intention to treat analyses showed significant weight loss in both dose groups. Only the obese subgroup showed a dose relationship (1.5 and 3.6 kg in 1500- and 2550-mg groups, respectively; P = 0.04). The morbidly obese group showed similar reductions (3.9 and 3.8 kg) in both groups. Suppression of androstenedione was significant with both metformin doses, but there was no clear dose relationship. Generally, beneficial changes in lipid profiles were not related to dose. CONCLUSION: Weight loss is a feature of protracted metformin therapy in obese women with PCOS, with greater weight reduction potentially achievable with higher doses. Additional studies are required to determine whether other aspects of the disorder may benefit from the higher dose of metformin.

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