I’d like to take a break from romance novels and podcasts to talk a little bit about a recent experience. It has been sticking in my mind for the past few weeks, and I haven’t been able to get over it.
I am being tested for sleep apnea. I’ve been told I snore off and on since I was a teenager. Both my parents are on CPAP machines. It is not surprising that I, too, might have an issue with sleep apnea. For a while now, I have suspected it, yet I’ve been reluctant to look into it. I am waking up with headaches, waking myself up with gasps of air, feeling tired, and dreading sleep. Even my sister, who can sleep anywhere with any distraction, says that she can’t sleep to the sound of my snoring.
The reason behind my reluctance can be summed up in one clear thought.
“I refuse to let my fatness make me Darth Vader before the age of 40.”
Sleep apnea is closely associated with being overweight. So close that fat people without snoring problems have been sent to sleep studies, and thin people with apnea problems are still told to lose weight. (citation: What’s Wrong With Fat?)
I saw it as an embarrassment and a personal failing. Even though my life was on the line, I was only convinced to get tested for it recently, at the age of 32, and only because it is affecting my personal relationships. Darth Vader is really not sexy, but neither is snoring so loud I’m sleeping alone. (And also death, I guess.)
I have been working really hard on not avoiding medical treatment just because I am fat.
In the past few months I have 1) successfully stood up to my endocrinologist, who wanted to talk about weight each time, even though I am working with nutrition and eating disorder professionals and 2) found a primary care physician after a three year gap.
It is really hard to go to a new doctor (or current, insensitive doctor) when you know they are going to weigh you, tell you your weight (which is an emotional trigger for me), and then give you that serious, puppy-eyed look over their glasses, right before opening their mouth to have the exact same exchange you have with every other medical professional.
Medical professional: Sooo, you are fat.
Medical professional: You should really lose weight.
Me: Do you have any concrete, workable professional advice that has any scientifically proven, lasting success in weight loss, or give me anything other than the extremely general and unhelpful advice of regular exercise, whole foods, and vegetables?
Medical professional: …..Uhhh….exercisewholefoodsvegetables.
I get upset. They can tell I am upset. And then the medical professional feels extremely awkward and doesn’t look me in the eyes the rest of the appointment.
Do you understand the undertone of this exchange, and how damning it is? The medical professional basically said to me,
You are killing yourself with weight on your body, and you have the power to change it, so it is your fault you are this way, even though I, a medical professional, a supposed authority on health, have no idea how to help you, save to offer really vague platitudes you have heard all your life. I feel morally obligated to call you out on your weight even though I am presenting a problem with no actual solution.
In essence: you are fucked.
It’s taken me a long ass time to stop internalizing and shaming myself for these one minute conversations, and I still am affected by it. Doctor’s appointments, especially new ones, make me nervous, since the weight thing always comes up, and it always has the potentiality to crush my self esteem for a good week or more. I’ve often wondered how accurate their blood pressure readings are, since I’m always stressed out when I walk into a doctor’s office, waiting for The Talk to happen.
This time, I walked into the sleep apnea consultation prepared.
I reminded myself of my self worth, no matter what it says on the scale. I reminded myself of all the things I have read, and done, and learned in my lifelong journey as a woman with non-acceptable weight.
I met a very pleasant, pretty, normal-BMI-ranged female nurse, who asked me some questions and answered some of my questions.
Here is part of our exchange.
Nurse: If it turns out that you don’t have sleep apnea, there are still measures you can take to alleviate snoring. You can visit an Ear Nose and Throat doctor. The last option is nose surgery, but that’s pretty invasive, so we don’t recommend it unless as a last resort.
Me: *thoughtfully nods.*
Nurse: There are other measures you can take *a bit hesitantly* like losing weight. Have you tried losing weight?
Me: *25 years of weight loss attempts, successes, failures, embarrassments, fads, counseling, money spent, books read, research studies that debunk weight loss myths, crying in the changing room because I couldn’t fit into regular clothes flashes through my mind.*
Me: *I can’t speak, only give her an incredulous stare and nod yes.*
Nurse: have you thought about bariatric surgery?
Me: *still can’t speak. Violently shake my head no.*
Nurse: *clearly uncomfortable now* okaay, thought I’d ask…
That being said…
Let’s briefly examine the fact that in one breath she said that nose surgery is an invasive last resort, and in the next she offered up surgically altering my stomach and intestines.
As a former OA member, I have heard enough horror stories about surgical solutions to weight loss to last a lifetime. As a person with binge eating disorder, I have no delusions of outside physical forces stopping me from eating more.
Let us review once again why I’m sitting in that doctor’s office. Eating more or less is not the point. Weight loss is not the point. The point is I want to be happy and healthy and OH YEAH SLEEP WITHOUT DYING.
Guess what, people without weight problems have sleep apnea, and people with weight problems don’t necessarily have sleep apnea.
So how did I get into a situation where a medical professional is trying to give me one-second advice on the incredibly complicated issue of food + genetics = weight?
Because “a majority of sleep apnea patients are overweight.”
Guess what, a majority of America is overweight.
Can going through a complicated invasive surgery in order to lose weight in order to sleep better cure your sleep apnea?
Weight is an important factor in obstructive sleep apnea; however, there are other important factors to apnea including some of which are purely anatomical. Someone might have a severe receded chin, prominent tonsils or a deviated nasal septum. That being said if you’re only going to do one good thing in life, lose weight. It’s going to help your blood pressure, your joints, and increase your vitality. There’s no guarantee weight loss, in itself, is going to clear up sleep apnea, but it won’t hinder it, and it has many other benefits.
The National Sleep Foundation just recommended weight loss as a cure for sleep apnea the way that people talk about vitamins.
“Gingko biloba may help with cognitive function. Or, at the very least, it won’t hurt it…”
It’s weird that we switch from solutions to proselytizing for the religion of weight loss.
“Petting your dog creates endorphins that help reduces stress and lets you live longer. Or might not. There’s no way to tell. That being said, it’s fun and your dog likes it.”
Also, “if you’re only going to do one good thing in life,” don’t give to charity, or treat people as you want to be treated. Lose weight. That’s it. Instant sainthood.
“Have you tried losing weight?”
The outright hypocrisy of putting bariatric surgery before rhinoplasty is not particularly surprising to me. The thing that has been really killing me is the question above.
“Have you tried losing weight?”
I wanted to say, “Haven’t you??”
Who in this day and age has really never “tried” losing weight? We have ready food and office jobs and look at movie stars that spend four hours in the gym every day.
Who DOESN’T have an extra pound on two or on their body they’d rather not have?
There are probably a few people in my life who have never dieted, and never “tried” (whatever that means) to lose weight. It’s hard to tell, since body dissatisfaction has nothing to do with BMI. Some diets are coded as “cleanses” or dietary restrictions, and eating disorders are sneaky by nature.
But I do know that a vast majority of my acquaintance has tried or is trying to lose weight, some overwhelmingly so. Some are fad followers, some are clean eaters, some are serial dieters. Some are just unhappy and talk about going on a diet but don’t. Some are so consumed by their weight loss journey, every third sentence relates to where they are, what they are doing, what they’ve lost, what they’ve tried.
Put a dessert in front of two or more women, and they will start talking about weight loss. It’s one of those universals women feel safe to talk about in mixed groups. Family, children, TV, clothes, gossip, weight loss.
I have shied away from and even let go of friends with toxic diet and body obsessions. Personally, talk about diets is just another way to remind me that I am not accepted for who I am, and at this time in my life, I just don’t need that negativity.
However, I have had to come to terms with the fact there is no way to truly escape diet talk. So whenever I get into a situation where people around me are talking about this diet or that cleanse, I walk away or shut up.
Because diet these days is a religion, and there’s nothing I can say to change people’s minds about it. No fact from the articles I’ve read, no statistic will convince them. I could memorize and recite the entire book Health at Every Size, citations included, and it won’t change their minds. I can pull out the statistic that 97% of dieters gain back their weight and then some within 3 years, and the person talking with me with say,
“But there’s still that 3%, right? What do they do?”
They work really fucking hard, is what they do.
Periods of my life have been expressly dedicated to weight loss. And I did well. At different times I’ve lost 50 lbs, 60 lbs, 70 lbs. I didn’t eat with my friends, I didn’t go to parties, I didn’t drink, I didn’t date, I didn’t eat sugar, I didn’t eat carbs, I lived every moment in fear of the weekly weigh in. 0.5 pounds gained would make me tear up and go on a binge.
But yeah, I did lose weight and I kept it off…for a while. Long enough to count as a success in most weight loss studies (that usually don’t extend past eighteen months).
“Have you tried breathing?”
Let’s say for the sake of the argument that there are some people out there who have never tried to lose weight. What do you think are the chances that a 32 year old, 333 lb, middle class white woman in the United States has NOT? 1 out of 100? 1 out of 436? 1 out of 3,492,068?
It’s just fucking patronizing.
Here are some other questions she could have asked that have the same cultural significance:
- Have you ever heard a fat joke?
- Have you ever heard that being fat is a health risk?
- Do you know you are fat?
- Has a child or stranger told you you are fat?
- Have you ever seen the sassy fat sidekick in a movie not get a significant other?
- Have you ever seen weight loss success stories in the media?
- Have you ever heard that diet and exercise are the key to weight loss?
- Have you ever considered becoming vegan, gluten free, paleo or otherwise restrictive purely for weight loss reasons?
- Have you ever listened when someone told you how to lose weight?
- Have strangers, acquaintances, or medical professionals ever given you unsolicited weight loss advice?
- Have you ever had a physical exam?
- Have you yet internalized that being fat is your fault?
Well, then sit back and get comfy, cuz I’m going to tell you something that will BLOW YOUR MIND.
I will admit to being bitter about this whole weight loss thing. Not just bitter; I’m fucking pissed. Anger is a totally reasonable response to 25 years of guilt tripping over something I had no control over, and only made worse with all my efforts to change what is essentially me.
From my earliest recollection, I was told I was fat in first grade. Fast forward some decades, and here I am, trying desperately to stake some purchase in this world, to be okay with being okay, to drown out the nonsense that persists, despite everything.
I’m trying to say goodbye to the years of emotional labor, pain, and suffering that was me trying to appease the widespread rejection of my body size.
Anger is a stage of grief, right?
But I get it.
I can’t stop the machine in one day.
That perfectly pleasant normal-size nurse was just doing what she was taught to do, and she thinks she’s helping, bless her heart.
She feels a moral obligation to mention my weight, just doesn’t know how to address the elephant in the room.
So, I’m trying to be diplomatic here.
What could a medical professional say to a person like me?
What could come after “there are other less invasive methods, such as losing weight”?
- …such as losing weight. If you are interested in losing weight, please consult with your primary care physician about what would be the best weight loss plan for you.
- …such as losing weight. Here is a flyer with contact numbers of local dietitians if you interested in learning more about weight loss.
- …such as losing weight. However, everyone’s body is different, so it’s important to discuss your weight loss plan in depth with a professional. I’m not trained on nutrition so I can’t help.
- …such as losing weight. Weight loss, though, is not the one and only possibility, and considering the high risk of regaining weight, it might be better if you focus on eating healthfully, exercising regularly, and then focus on other non-weight related alternatives to making your nights as restful as possible.
- …such as losing weight. Have you tried losing weight? Yeah, me too. It’s a bitch. Ah well, it’s pretty much all predetermined by genetics.
- …such as losing weight. I don’t know your personal journey with weight loss, so you can take that with a grain of salt. The good news is that we can help you no matter what weight you are, that sleep apnea is not necessarily “caused” by extra weight, and it won’t be necessarily cured by losing weight. We don’t know why it happens, honestly.
- …such as losing weight. As if that’s an easy thing to do. Ha!
- …such as losing weight. The validity of weight loss as a cure-all health solution, however, has recently come under scrutiny, considering that most, if not all diets, eventually lead to gaining your weight back, plus some. Probably the healthiest solution in the long run is to never diet again, to be honest.
- …such as losing weight, taking allergy medications, avoiding alcohol before bed, quitting smoking, sleeping on your side, as well as various over the counter medicines and devices you could try.
- …such as lots of little things. We’ll brainstorm together and come up with a plan to test the efficacy of each option you try.
- …such as losing weight.
Don’t even get me started on her mentioning bariatric surgery to me.
Long story short, medical professionals: just don’t even fucking mention weight loss, okay? You have no solution, you have done no research, and this is not your fucking problem! Your overly solicitous concern with the amount of fat cells on my body is largely fueled by societal prejudice, and has little basis in scientific fact. The medical field as a whole has had a decided blind spot when it comes to obesity and the most basic of scientific principles:
Correlation ≠ Causation.
I have not yet read a single article that definitively says that obesity (fat cells on bodies) is the CAUSE of health risks (early death, etc.). Seen objectively, it’s almost ridiculous. What does extra weight have to do with the hardening of arteries and other things?
It’s just like when people say things like “I run every day, why am I winded whenever I go hiking?” or “I lift weights all the time, and yet I can’t jog for more than a minute straight.”
Because they are completely different actions, dumbass.
They are making jumps in logic they don’t even notice.
Running every day
= being fit
= overall good health and fitness
= being “a person who is fit”
= able to conquer everything fitness related due to previously mentioned personality trait.
When really, running every day makes you good at one thing: running every day.
The completely different set of muscles in your body unused to anything but a particular exercise will not listen to you when you say “how can I be this way? I’m a fit person!”
Fatness = bad health is just a monumental sized, completely universally ingrained jump of the same kind.
Even if the actual weight of fat cells on your bodies are the cause of a problem, do you have anything new, lasting, concrete, and reasonable to bring to the table as far as weight loss goes? No?
Then shut the fuck up.
I came in for sleep apnea. I’d like to be treated for sleep apnea, please.
What’s Wrong with Fat?, Abigail C. Saguy, PhD
Health at Every Size: The Surprising Truth About Your Weight, Linda Bacon, PhD
The Weight of Evidence: It’s time to stop telling fat people to become thin. Slate, Harriet Brown
Why diets don’t actually work, according to a researcher who has studied them for decades, Washington Post, Roberto A. Ferdman
Why you can’t lose weight on a diet, New York Times, Sandra Aamodt
The Most Important Piece of Nutrition Advice You Need, BingeEatingTherapy.com, Leora Fulvio, MFT
When Somebody Promises You Weight Loss, They Are Totally Lying, BingeEatingTherapy.com, Leora Fulvio, MFT
The Truth About the Fat But Fit Medical Study, ChristyHarrison.com, Christy Harrison, MPH, RD, CDN
Resources for Health Care Providers, LindaBacon.org, Linda Bacon, PhD