I have always been an unfashionable weight. As a young child in the ’50s and early ’60s when chubby cheeks and dimpled knees were the rage, people would stop my mother on the street and demand that she feed me.
I was tiny, wiry and elfin and lived on a diet of salami, green peppers and cocoa with the occasional egg beaten into it as fortification. The sound track of my childhood was a constant pressure and harassment to eat more than I wanted.
In grade five, things changed. I was moved to a class where I had no friends and the only girl in the class who tolerated me, I did not really like. Yet, we would walk home together, running the gauntlet of the nasty boys who would taunt and chase us. We would head for the snack bar, and often have milkshakes. The addition of an entire extra meal’s worth of calories several times a week was not a good move. I also capitulated to my parents’ pressure and started eating more at home.
At the same time, I went into puberty very young. I remember playing horses in the park and looking down at my legs and seeing hair. I was surprised, but my first thought was that I was turning into a pony. My mother was also not really prepared for the sudden appearance of secondary sexual characteristics at age 10.
She told me I was fat.
In fact, when I look at the few pictures of myself from that time I now see a short girl with hips, a narrow waist, large boobs and acne. I went from being too skinny to being too fat in a year and a half.
Once I was in high school, my life became significantly better. I made friends and had a love life. I still considered myself fat, weighing around 135 lbs. It was the Twiggy era and that first celebration of the emaciated in fashion became my definition of what beauty was meant to be.
In my life I have dieted many times. I have lost cumulatively over 500 lbs. I have used almost every kind of diet. Weight Watchers, calorie counting and tracking, low carb/high fat, meal replacements, personal trainers and, as is true for 90% of people trying to lose weight, I can lose it but never maintain the loss. My metabolism slows down so much that I can eat 600 calories a day for weeks on end and stay at the same weight. When I am dieting, all I can think about is what I am eating, when I am eating, how much I can eat. It becomes an obsessive refrain in my head, and I can barely concentrate on anything else in my life.
The stigma attached to being a fat doctor is huge. As a resident, supervisors would comment disparagingly about my weight. Once when I was seven months pregnant, the chief of the department commented that I was letting myself go. He was shocked when I told him that at least some of my weight gain would miraculously drop off in two months time. I had a new patient once say to me “I heard you were the best doctor, but I wonder, because you are so fat, how can you even give anyone advice about anything.” This was decades ago, yet it still rankles. I don’t know why I even accepted her as a patient, but I did. I cared for her through infertility, childbirth, Hypertension, diabetes, cancer and death.
Just being a fat person in the world is terribly difficult. The side eyes of contempt, the shocked gasp when you sit on a plane, the implication that you are lazy and even immoral for simply existing in a larger body is only amplified when you are a physician. So many doctors have bought into the “just diet and exercise, and you will lose weight, and then you will be healthy,” fantasy despite every study on weight loss showing that weight is almost invariably regained and usually surpassed over time.
Now let’s talk about the near-death experiences. First there was my short but significant adventure with Fen-Phen. This highly marketed weight loss drug in the ’90s was supposed to be the perfect treatment for obesity. It was effective, had next to no side effects and was perfectly safe. I took it for only about six weeks, stopped it because I could not concentrate enough to drive and yet it left me with a calcified mitral ring which has affected my exercise capacity ever since. This has left me with a deep suspicion of obesity drugs. So much of the research is drug-company sponsored, so I will wait for a good while before I take a drug that will leave me consistently nauseated and with diarrhea.
Having reached an almost immobilizing weight and developed diabetes, I decided to have bariatric surgery. Having done my research, which turned out to be flawed, I went for a gastric band procedure. Prior to the operation, I was on a protein fast and lost about 40 lbs. After the procedure, I lost a little bit more but not very much and for two years it was like I had a very strict but extremely stupid food nanny. I would vomit often and violently and sometimes without warning. Potato chips went down very easily but meat was next to impossible to eat. I once ate a single oyster in a ritzy restaurant only to rush out to the street to puke in the gutter. It was demoralizing and humiliating. I then started developing intermittent obstructions where I could not swallow. Finally one night I was on-call in L&D and I could neither swallow water, nor lie down without vomiting. Finishing my shift, (yes, I know that’s crazy) I called the bariatric clinic and had a stat barium swallow the next morning, which revealed that the cardia of my stomach was trapped inside the band. I had emergency surgery to remove the band and they found that my stomach was scarred and partially necrotic. A few more days could have had disastrous repercussions.
The band removed, my weight began climbing again. This time I opted for the gastric bypass. The surgery was apparently quite complicated because of the scar tissue among other issues. The next day I had a massive GI bleed, leaving me hypotensive and palpitating. Another procedure, a few units of blood and I thankfully recovered.
I am grateful for the bypass. I have been post-op for 15 years and remain 40 kg below my top weight. I am sure that my diabetes or heart disease would have carried me off before now if I had not had it. At the weight I am now I can exercise and am fitter than I have been in years.
As physicians, we treat fat people abominably. We shame them, we attribute every symptom to their obesity whether it is true or not. We refuse to operate on them until they lose weight, even though they lose strength and muscle mass and become worse candidates for recovery because of the delay. We drink the Kool-Aid of every new weight loss fad that comes along, ignoring the conflicts of interest of the researchers. We do not attempt to develop ways to improve the health of fat people because we just want to pursue the Golden Goose of weight loss products, even if this is not always in their best interests. We should instead search for a Holy Grail of understanding the root causes and prevention of obesity and how to keep fat people healthy at the weight they are. If nothing else, we can treat fat people with respect!