Tuesday, December 27, 2011

Not Me

After I got home from the hospital after my left thyroid lobectomy, I had a profound sense of not feeling like myself. Part of the reason for this was the way in which my body was controlled by others for the duration of my stay. Being in the hospital is not entirely dissimilar to being in prison. You can't leave until someone decides to let you go. People tell you to stay in your room, what you can do, where you can go, and what you can eat. They even watch and ask about every little thing you do including your ability to walk, talk, and what happens when you go to the bathroom.

Is it any wonder that I feel a bit disassembled as well when bits of me have been cut out and taken elsewhere. I believe that the body is an integrated whole which carries energy in every cell. When a part of it is damaged or removed, there is an energy disruption. The body knows something is gone and the energy flow has been altered. This is part of Chinese medicine, but it is also scientifically supported by problems like phantom limbs in which people still feel pain in now missing arms or legs. 

That being said, upon returning home, I was flooded with more profound feelings about losing parts of myself. I've written many times about the loss of identity that comes with losing weight and part of that is leaving behind the guarded, apprehensive, or restricted person that I was. When I was heavier, I avoided medical treatment. Subjecting myself to tests and then surgery "is not me". This behavior is outside of my character and I hadn't sought any treatment for about a decade, let alone had routine testing. My character is one in which I do not seek attention unless I have a problem. 

Just before entering the hospital, my husband and I went to a movie theater for the first time in over 20 years because I could now sit in a theater seat without fear of fitting or spilling into someone else's chair. We enjoyed the movie and it was a nice time, but, again, going to movies "is not me." I watch DVDs from the comfort and safety of my own home where I don't have to worry about how much space is allotted for my behind.

Yesterday, I went to a supermarket to do some routine shopping and, since it is near the holidays, there were a lot of kids around. One aisle that I wanted to walk through had three noisy kids around the ages of 8-11 jumping around looking at candy. I paused for a moment and felt a sense of apprehension. In the past, every time I saw a kid, I would try and avoid being seen because children were ruthless about making comments, staring, or saying rude things about my nearly 400-lb. body. As I stood at the end of the aisle, I realized I could walk down it without concern for mockery. I walked through and the kids didn't react to my presence. Again, walking by children without fear "is not me."

Over the past year in particular, there has been a huge transformation in how I live my daily life from small things to big things. I allow my picture to be taken and posted on Facebook. I eat in restaurants. I talk about eating and enjoying sweets without feeling self-conscious. People treat me as if I were just another person rather than some freak show to be handled carefully and with amusement. I walk for hours without pain or fear of future pain. I go to social gatherings without fear of embarrassment. I eat without guilt, but with self-control and moderation. My sister-in-law showed my picture to an acquaintance of hers and she went on and on about how "beautiful" I was. Honestly, I look in the mirror now and I don't know who that person is. I don't see her as me. 

This all sounds great, but, it is not me. People treat weight loss and lifestyle alteration as if everything were just one gain in quality of life after another, but I sometimes feel as if I am a big patchwork quilt with certain patterns and squares that have been a part of me for years and now a great many of them are being torn out and replaced. 

It doesn't matter that the new squares and patterns are nicer, prettier, and easier to live with. It is still disconcerting and makes me feel very separated from myself and not know who I am. A long time ago, I wrote about how I needed my husband so badly because he was a tether to who I was as my life became transformed and I've come a long way since then, but I still feel that he is the only one who knows "me" for what I really am. And I need him to tell me who that is because it's getting harder and harder for me to understand who I am with everything that has changed. 

It's not that I was my limits before, but rather that the type of person I was became defined by those limits both mentally and physically. I wasn't someone who willfully went out among other people and was a homebody because the cost emotionally and physically was too high. Social timidity and an avoidance of crowds were a part of me. I wasn't someone who spent money on clothes and restaurants, because there was no joy in such pursuits due to the emotional costs and uncertainty. Frugality and restraint with sensory experiences were a part of me because of my limits. I wasn't someone who allowed her picture to be taken or posted them willfully for others to see. My disgust with my weight and appearance made me humble and modest and banished all notions of vanity. 

I could go on and on, but the point is that my limits shaped my character and losing those limits is reshaping my sense of self. This isn't as hard a situation as some of my earlier identity struggles, but I still sometimes feel like I'm inside the "wrong" body and living the "wrong" life. I feel like I'm really not "me" anymore, and it's disconcerting. I have no desire to return to who I was, but I'm absolutely not sure of who I am. This will take more time and adjustment. 

Saturday, December 24, 2011

Normalization of Obesity

"Normalizing" has several different meanings and one of them is sociological. You can find many complex meanings, but one of the most simple ones is that it is the process of making something seem natural, logical, and commonplace. The word carries no value judgment about what is being normalized, and the act of doing so should be seen as a logical and expected part of the changes to culture.

That is not to say that "normalizing" is always a positive thing in the minds of everyone who witnesses it. One of the biggest examples of normalization which has been successful and ongoing over the past half century has been the perceptions of homosexuality. In my lifetime, I have seen the normalizing of it by society in action. What was once considered deviant and abhorrent is closing in on being considered normal and mainstream. For those (like myself) who believe that homosexuality is a biological inevitability and that sexuality is not a "choice", this is good news as we view it as the end of an unfair and oppressive environment. For those who have philosophical objections and believe a true choice is being made, this particular type of normalization is upsetting and unacceptable. They feel it is removing restraint from behavior that should be held in abeyance.

Normalization comes as a result of a great many factors. One is technological advances. Another is scientific discovery. Yet another is the evolution in philosophies based on education and integration of new ideas. Very generally speaking, there is a movement in most cultures toward more liberal thinking. That is, this is the direction until there is some shift back toward conservatism based on hardship. Those difficulties can be economic, medical (such as the outbreak of disease), or brought on my aggression (e.g., war).

All normalization is resisted by a certain segment of any society. When those views act in opposition to yours, it is easy to see them as small-minded, irrational, and selfish. When they agree with your views, they seem to be "right-minded". It's hard not to apply value judgments to both sides of the equation when it comes to normalizing of behavior, but it is important to understand and accept that the perspective of others has some validity. Dismissing alternate views out of hand lowers the quality of discourse and encourages rigidity on both sides.

With this in mind, I've been pondering both sides of the equation when it comes to the fat acceptance movement's efforts to normalize widespread occurrence of obesity. As someone who has spent her entire life overweight, and the vast majority of that life over 300 lbs., I know all too well the damage that is done to someone based on body judgment. I strongly believe that punitive attitudes toward fat people only do harm whereas people who fear the normalization of fatness as an endorsement of what they view as a "fat lifestyle" and what they often erroneously conclude is sloth and gluttony believe that social censure will increase the chances that people will not engage in behaviors that result in obesity.

Unfortunately, having lived a fat life, I also know that normalizing (as opposed to accepting, which is a whole other kettle of fish) obese bodies isn't necessarily a good thing on some levels. For one thing, accepting that being fat is expected, normal, and "usual" means that people will not attend to it based on health concerns. Despite all of the HAES propaganda, being obese (as opposed to merely "overweight") will eventually impact your health. You'll find that there are few fat advocates out there over 40, and even fewer over 50, who will latch onto the notion that being obese doesn't mean being unhealthy.

When I was younger, my body dealt a lot better with obesity than it has after 40. I'm now 47, and I have the joints of a person much older than me because of the extra pressure that has been on them for so many years. I'm not sure how anyone can say in good conscience that carrying 50-200 lbs. of extra weight will not take a toll on ones joints eventually. There is also the fact, and fat advocates are in denial about this, that pressure on the glands affects type 2 Diabetes development. Weight gain can bring on this condition and loss can send it into remission. That is not to say that one does not have to be genetically predisposed to develop it, but simply that it is a fact that weight affects development of such a condition.

Because of the health issues associated with obesity, normalization of fatness is a more complex issue than other social issues, trends, and concerns. On the one hand, fatness needs to be accepted because fat prejudice is unjust and highly destructive. I am certain that, had I not been tormented as a chubby child, I never would have grown up to be an extremely obese adult. It was the disapproval which sent me from overweight to class III obesity. Dehumanizing a group of people based on superficial characteristics serves only to create a loop of neurotic behavior which creates conditions that encourage eating disorders, including compulsive eating, overeating, and binge eating. As a psychological and social issue, fatness needs to be normalized and what I mean by that is that it needs to be regarded as a normal state for some people and they should not be treated with prejudice.

On the other hand, however, normalization which discourages people from dealing with their weight when weight will affect health (which is certainly the case for many people who are obese, especially in class 2 or 3 obesity), mobility, or quality of life (especially mentally) isn't such a great idea. While I fervently believe there are some people who were "born to be fat", it is undeniable that more and more people are fat and getting fatter compared to the past. If being fat were a normal human condition brought on by genetic predisposition, we wouldn't see the recent increases in the number of overweight people nor an increase in the amount of weight they gain. I realize that BMI was shifted to statistically move a great many more people into the "overweight" category, but that does not account for the dramatic increase in obese people and especially the super obese (such as I once was).

The issue with normalization and obesity needs to be split between societal and philosophical acceptance on the one hand and medical attention which indicates it is to be viewed as an undesirable condition on the other. In societies in which fatness is seen purely as a bodily issue related to health (there are some, but just not in the West) rather than a moral or character failure, people address their weight the same way that they do other factors which affect health. If someone is anemic, has poor circulation, etc., the measures taken to look after their body given these conditions are not seen as oppressive or unfair. They are simply seen as what is necessary. The same applies to weight in such cultures. I know because I live in such a culture at present. Fatness isn't about morality or character, but about health. While I don't believe that anyone is required to be healthy, I do believe society should encourage people to act in a manner which promotes happiness and the highest possible quality of life. And if you are not healthy, you will not have a good quality of life. Do we want to normalize conditions which decrease quality of life? I don't believe this is good for society on the whole, let alone the individual.

Unfortunately, the prejudice and venom directed at fat people that society is currently indulging in is what encourages more extreme  and broad efforts to normalize obesity. The harder you push people, the harder they will push back. It is similar to the way in which the NRA pushes to keep extreme weaponry legal in order to make sure they can keep their hunting rifles and hand guns.

The answer is simple, but people are reluctant to take it because they have to change their personal slant to a more objective one. Stop judging and abusing people based on their bodies. Stop encouraging the false notion that health and weight are completely different factors for most people. Deal with this like adults without injecting value judgments or personal opinions. As is so often the case, I'm not holding my breath.

Friday, December 23, 2011

The Importance of Eating

I have spent the last 4 days in the hospital having half of my thyroid cut out because of a benign tumor. During that time, I knew certain things to be true about getting out of there as soon as possible. I also had experiences with food which were quite different than those in my daily life and that caused me to reflect on the mental progress that I have made.

Part of having surgery is that you can't eat for at least 12 hours before you have it. Because I've learned to be hungry and not panic (something which people who are compulsive eaters and obsessively think about food often do), this was uncomfortable, but not something I built up a great deal of tension about. In the end, I didn't eat for more than 36 hours and when I could eat, I was on a liquid diet for a further 24 hours. By the end of this period of time, I was pretty ravenous physically, but it was okay emotionally. 

I contrast this with how I dealt with feeling hungry in 2009 when I first started to change my relationship with food. At that point in time, I could hardly bear hunger for an hour, let alone more than a day. This was as much a physical situation as a psychological one. When your body's rhythms are accustomed to regular and copious feeding, you have "fat hunger" and breaking that takes time. In fact, it took me over a year to lose most of it, and two years for it to vanish entirely. There was also emotional panic about not having food plans in place and obsessing about food when I felt the least bit hungry. Hunger was something I had nearly zero tolerance for. Now, I can manage it, though not in a disordered "I'm going to starve myself" way. It's merely a "I can wait until I a reasonable time to eat". Do I enjoy being hungry? Not at all. But it no longer drives me crazy because of mental and physical conditioning to learn to deal with food and hunger in a normalized fashion. It's okay to be hungry for awhile. It's okay to eat. 

The thing I knew while I was in the hospital was that it was important to eat in order to be released in a timely fashion. I had no control over the content of what I ate, though it honestly was quite nutritious and well-balanced (this was not an American hospital as I live in an Asian country). The main difference between what I ate in the hospital and what I eat at home was that it was a lot more calories than I tend to consume, but I ate it all up anyway for two reasons. First of all, eating at a caloric deficit slows healing. Though I'm still working on losing weight and try to generally eat between 1500-1800 calories per day, I did not consider weight loss when eating at the hospital nor did I feel bad or guilty about it. I know they were feeding me in a way that promoted health, and even if it was more than I needed, I knew it was good for me. 

For many women who are trying to lose weight, they go around the bend mentally when they are not in control of their food and wouldn't knowingly eat more calories than they do according to their "food plans". I once read a comment out there in the ether by a woman who was so happy to fast before surgery because she was getting such a huge deficit, but became angry when she learned that they were using her I.V. drip to put calories back into her before the procedure. Her desire to eat less was so obsessive that she became upset at a procedure meant to stabilize her metabolically before an invasive medical experience. This betrays an extremely distorted view of food, calories, and biology which elevates deprivation and dismisses the value of calories to the daily operation of a healthy human body. Yes, calories were put into me as well. I know this because the I.V. bags had calorie values written on them and I saw them change bag after bag. However, it didn't trouble me.

I didn't even count the calories I ate, though I could have guessed pretty accurately if I had wanted to. Sometimes it is important to be careful about what you eat, but sometimes it really is not a primary concern. Healing was my concern. Well, that and convincing the hospital that I was able to swallow without difficulty and had a good appetite. The former wasn't 100% the truth, but the latter was absolutely true. I ate what I was given with interest and gusto. I deserved it, needed it, and enjoyed it.

One of the things which I realized a long time ago was that I wouldn't be able to have a normal relationship with food if I viewed it as the enemy or separated it into "good" and "bad". I ate white bread with jam. I drank full fat milk. I ate gelatin made with sugar and custard made with sugar. I ate white rice. It was good and good for me. I needed those extra calories, and not because I'd been fasting and on a liquid diet. There was no thought that it was "okay" to eat more because I'd been deprived for two days. My thinking was only that I needed to be fed fully to heal better. In fact, my subsequent plan for the coming week as I continue to heal is to eat more than usual. This isn't "to hell with my weight loss, I'm going to binge". This is, I need to eat more calories (near what is a maintenance level) to get well faster. 

Though it isn't all about food, food is an important part of healing. The other part of it is modest exercise. I know from experience that walking daily has kept me from catching a cold for nearly three years. It's all about having a strong body, and you need food and exercise for that. 

The idea of strength and the relationship food has on that has been on my mind as of late because of a death in the family recently. My mother-in-law died last month, and the beginning of the end was when she stopped eating. A friend of mine remarked independently when discussing her mother's death that, when people stop eating, they are pretty much finished. Eating is about life. Not eating means death. That's not a recipe for gorging or overeating, but simply embracing the fact that food is important for life and it's important to have a positive relationship with it. Part of that is not eating poorly or eating so much that your body is compromised (with mobility or health concerns), but part of it is also not vilifying eating or seeing it as something to be tortured emotionally about. 

Friday, December 9, 2011

How Soon We Forget

This morning I was walking to the local subway station with my husband and mentioning to him that two and a half years ago, such a thing was impossible for me to do without excruciating back pain and frequent stops to rest. This walk is approximately 8 minutes long at a reasonable pace, but I couldn't have managed it in 2009. Even in 2010, there were doubts about my long-term ability to walk without the threat of pain and I still had backaches in the morning when I woke up.

Though I spent about 20 years in great distress with my back which limited or eliminated my ability to walk, I now take for granted that I have back-pain-free mobility. The strange thing is that I've been in this condition for a short time, but have already blocked out the longer reality of my life. While I don't believe that it's useful to dwell on the difficulties of my past, I believe it is important not to forget what it is like to be so fat that basic locomotion is fraught with pain and difficulty. This isn't important to stop me from regaining the weight I lost as the psychological issues will prevent that from happening. It is, however, essential if I'm to retain empathy for those who still live in shoes very much like those I once dwelt in.

Recently my husband had his own experience with "forgetting" or at least failing to apply empathy to someone overweight when he has had ample experience to draw upon. Despite years of living without going to restaurants, being unable to shop with me, and having to do things in a particular way to accommodate my size, he failed to consider the problems of an overweight colleague at his volunteer work and may have inadvertently contributed to some stress for her. 

A somewhat large group of these volunteers were pondering how to get from point A to point B and a suggestion was made that they split a couple of cabs. There were 8 of them, so they could split two quite cheaply between them by piling 3 in the back and one up front with the driver in each of two cabs. My husband did the math and said taking a taxi sounded like a good idea rather than hiking the distance in the cold weather. The overweight colleague, who he reckons may be in the 300-lb. weight range, said that a walk sounded good. In the end, they all walked, but my husband was metaphorically kicking himself for not "getting it" as he believed he "should have known better".

This situation illustrated the inner turmoil and strife of the fat person very well. It also showed how hard it is for people who have never been that large to conceptualize the world in the same manner as a very overweight person. While this woman would have probably been fine in the cab as long as she could sit in the front with the driver, the situation is still rife with uncertainty and potential embarrassment. I'm sure she was nervously pondering the potential outcomes as the situation played itself out.

If one boisterous person playfully calls "shotgun", she is put in a position of competing for the front seat without drawing overt attention to her actual  need for that space or cramming into the back seat with two other people. Having to do either of these is humiliating because either would reveal her status as the person too big to fit and therefore either requiring the special accommodation or making others potentially uncomfortable with her size. There's also the possibility that, even if she sat up front, the seat position would have been too far up and then she would have to cram in or adjust the seat such that she obviously took away leg room for her compatriots behind her. And finally, even if the others recognized her need for the front seat, knowing they were acknowledging her weight (or guessing that that was the case) is still embarrassing. 

I felt for this woman when my husband told me this story because I've lived in that headspace nearly all of my adult life. I also felt for my husband who kicked himself a bit for not being more sensitive to her needs despite his years of experience with me. If I have already allowed the limits of my primarily limited life due to my weight to slip away, how could he be expected to keep them front and center?

Thursday, December 1, 2011


I finally got the results of my thyroid aspiration test and the tumor is benign. My worst fear appears not to be coming true. However, I still have to have the left half of my thyroid removed because it's big and isn't getting any smaller. I'm having surgery shortly before Christmas (thanks, Santa, for the early gift of a follicular adenoma), but at least this can be put to rest as an issue before I go home and live an insurance-free life.

One thing about this experience, among the many other things about it, is that it illustrates (yet again, really, this is a lesson I never needed to learn, let alone need repeated reinforcement) that losing weight solves nothing and you can't "earn" good health through virtuous lifestyle habits. Life has been a good deal harder at sub-200 lbs. than it was over 300. Crap still happens. More crap happens because I'm out there more and subjecting myself to medical tests. That's not my way of saying I shouldn't take those tests, but merely a recognition that I was happier when I was ignorant.

Another thing I can say is that at no time was my weight loss in my thoughts about this. Frankly, I was concerned about dying not continuing to lose weight. The surgeon says that enough of my thyroid will remain after surgery that I will not be hypothyroid so I'm not worried about it in any event. However, it would probably be prudent to monitor my weight more frequently immediately after surgery in case all of the slicing and dicing in the area creates an unforeseeable problem.

It was also of interest in terms of my weight loss to know that my thyroid function was not affected by the tumor. That is, I have neither high nor low thyroid function now. So, in the end, my weight was all about what I ate and did rather than my body itself. I already knew that. Now science has confirmed it.

Thanks to Rebecca for the kind note in e-mail. I'm sorry that I didn't reply, but I've been in a really dark place mentally throughout all of this. Functioning at all was difficult at times. I had to take it moment by moment until the outcome was revealed. I really appreciate your concern and that you took the time to write.

Tuesday, November 15, 2011

The Thyroid Test

I finally had the thyroid test done, and the results were not what I had hoped for. Half of my thyroid is enlarged and has a tumor on it (a "lesion"). Because of the bureaucratic health care system in the country I'm residing in, I have to struggle to get a biopsy done quickly. Essentially, I have to call for an emergency appointment along with all of the people who have a cough or stubbed their toes and believe they absolutely need to see a doctor.

This is very stressful for me, and the worst part of it at this point in time is not knowing exactly what my disposition will be and feeling that no one in the medical system is particularly interested in how leaving me in limbo about my status causes me difficulty. The doctors won't tell me anything about possibilities and say "they can't be sure". They're more interested in covering their asses than informing the patient and answer the questions with responses which are little different from a shoulder shrug.

I'm treating this at present as a condition to be treated rather than a death sentence or an imminent diagnosis of cancer. I know that many women suffer thyroid issues which do not result in cancer diagnoses, but my fears that, if I ever lost weight again and resolved most of my issues, "God" would give me cancer seem to be headed for some sort of realization. I know this is a pessimistic attitude born of years of suffering and feeling that I am destined to be unhappy. It does not serve me well, and I will fight it. 

Saturday, November 5, 2011

Bits and Pieces (and girly parts exam results)

While I seem to be pretty good at long, rambling psychologically-oriented posts, I'm not nearly as diligent about recording more concrete information. Essentially, I view the bits and pieces as less interesting than the deeper thoughts so I drag my feet on writing about them, but this blog is about my recording all of my progress, not just the thoughts which I think are especially interesting. Here are the odds and ends:
  • My mammogram and pap smear were completely clean. I gambled by not having tests for many years and won. Next time I get these tests, I won't have years of fear and uncertainty behind them.
  • Though my eating habits were never particularly bad (just too much of everything), they are better now in that proportionally I eat more vegetables and fruit than I once did. However, I'm still overly fond of carbohydrates relative to protein-rich food. This can cause peanut butter cravings, especially at night. 
  • I realized that the less other people define me by my weight, the less I do so. People who were once very fat and lost weight continue to say that it is about your attitude, but it is hard to ignore the fact that I feel like a normal human because people now treat me like one. Not having to constantly battle other people's reactions to you is a psychological burden of immense weight. Not having that complicate my life has been a huge relief.
  • I never judge myself or beat myself up for what I eat, even when I make what I feel in retrospect are choices which are  not conducive to achieving my goals. I do, however, regret those choices and wish I'd done better. I think that regret over poor choices is normal, as long as self-flagellation or scolding does not accompany that regret. Everyone drinks or eats too much (or poorly) on occasion and experiences regret. It is okay to feel this way as long as it is not a character-defining or "end of the world" experience. Understanding and reacting appropriately to this sort of thing is also a part of "normalizing". Note that I am not talking about building to a stage of denial of food pleasure, but rather about eating in an imbalanced fashion. I will always eat for pleasure. 
  • I'm in the baby-steps stage of dealing with self-stroking with food. At the moment, I'm trying to reduce the frequency with which I do this. As I approach a piece or dish of candy with the intention of just having a small nibble for pleasure, I try to pause and reflect on why I'm doing it. Is it a craving? Is it a need for quick energy? Is it hunger? Or am I trying to soothe myself with a small bite of something pleasurable? If it's the latter, I tell myself, "it's okay, I'm okay," and I don't have it. I sometimes forget or fail to reflect, but I'm cultivating this mental habit now. I expect it to grow and help me stop using tiny amounts food as an emotional palliative. 
  • I still believe I ruminate on food "too much". That is, it occupies my thoughts at times when I should be thinking of other things or does so based on thinking about diet or weight loss. However, it is much better than it used to be in terms of total time and the level of distraction involved. I think this is as much a function of routine as preoccupation and that I'll have to work harder to push my mental pathways in other directions if I want to stop.
  • (added later than the rest of this post) Last time I weighed myself (November 9), something I'm increasingly bad at and don't seem to manage even once a month, I was at 173 lbs. I realize that this may be a false low, but it is definitely lower than before.  

Monday, October 31, 2011

Self-stroking: part 2

Sometimes when I am feeling frightened or insecure, I ask my husband if he will always take care of me. He always tells me that he will. At those times, my fear is that I can't make my way in life and if I fall, I'm afraid no one will be there to catch me. I need to know that he will be there, just in case I fall.

On an objective level, there's no reason to believe that I am incapable of making my way in life. For 12 years, I worked full-time and was the primary support while my husband worked part-time and was a househusband. I also worked full-time at various other jobs concurrently with my husband working full-time. About 6 years ago, after about a year of undiagnosed clinical depression (or nearly so) I went part-time, he went full-time, and I took over the household work. I have far more of my adult life under my belt being responsible for myself, but I don't think my fears are really about money or jobs.

I think my anxiety about being cared for is more generalized and I think it stems from the insecurity I spent my formative years dwelling in. Though I had a roof over my head and there was food on the table, my parents were constantly speaking about us being on the edge of insolvency. Money problems were always on the table and nothing was ever hidden from my sister and I. What was more, my parents were very absorbed in their own issues. They spent their days arguing about my father's alcoholism, my mother's spendthrift nature, and complaining about whatever trivial issues perturbed them. Neither of them was an adult in any way.

I know it may sound like an exaggeration to say neither was an adult, but they truly were not. My father refused to do anything that required even minimal interacting with other people if it didn't happen in a bar or a garage. He wouldn't go into a bank, shop in a market for food, go to my sister's and my school, or shop for clothes (not even his own). He abdicated all responsibility and my mother used the power that came with that to indulge her shopaholism and to live beyond our means. She created a loop in which she medicated her unhappiness with food and spending money and, in turn, created her unhappiness by being fat and being forced into bill juggling and loan consolidation to handle her debts. Her failure to be an adult was not in her refusal to take on responsibility, as she had it all, but it was in her inability to control her temper and the way in which she battered my sister's and my esteem to elevate her own. She heaped responsibility on us too young, shared her problems with us when we were incapable of understanding them or helping, and verbally abused us. Her failure was in not acting emotionally like a grown-up to her children.

In retrospect, I know that my mother created all of my family's financial suffering through her issues with spending. She had a vision of the life she wanted to live, and part of that was "keeping up with the Joneses". She was devastated when her siblings, especially her 3 sisters, lived a material lifestyle that was clearly superior to hers. Had my mother practiced moderate fiscal control, we would have been alright. We wouldn't have been rich, but we could have been secure and stable. Unfortunately, both of my parents were more interested in using what money we had to do what they wanted (my mother to buy junk and my father to drink alcohol and smoke everyday) than in providing a stable life for their family.

I mentioned in the previous post that food was the co-parent in my childhood, and the support that I carried with me into adulthood. It is the way I "stroke" (comfort, validate, reward, etc.) myself. Unlike my parents, food never hurt me, abandoned me, or disappointed me. It always gave pleasure and asked nothing in return. While my parents were inconsistent and my mother so mercurial at random intervals that I was driven to extreme nervousness and tension at times because of my fear of her wrath, food was the "good parent".

I realize now that my husband has taken on some of the role of a "parent" for me. I ask if he will take care of me because I was never taken care of by anyone as a child and I need to feel cared for and secure. No, I was not abused physically, nor did I starve, but I never felt secure, loved, or worthwhile. Neither of my parents gave me those things because of their own damage and immaturity. I don't blame them for it and this post is not about holding them responsible for my problems. That being said, ignoring the connection would undermine my ability to heal myself. I have to understand the roots so I know where to start tearing out the damaging weeds of my problems and planting more psychologically healthy "plants". Too many people think that "blame the parents" is what excavating your childhood issues is all about and that it's about finding reasons to be mad at them rather than change your life. It is not. It's about finding out what went wrong so that you can figure out how to make it right. My parents messed up. I forgive them. However, if someone breaks a complex mechanism (such as the human psyche), it really helps to know exactly how and where they broke it if you want to repair the damage as quickly and effectively as possible.

While my husband is functioning in part in the role my parents failed at, I know that he can't do it all and that is where the "self-stroking" that I mentioned in the previous post comes in. It's not wrong for him to do some of it because, after all, we all validate, comfort, and soothe our mates. It's part of the role they play. However, the fact that being separated from him for a finite period of time is so difficult for me means that I need to develop certain coping skills in this regard. As I mentioned previously, I used to have food to stroke me in his absence, and now I don't, so I need other things.

After yesterday's realization, I figured out, much to my chagrin, that I still use food to stroke myself and not terribly infrequently. The main difference between how I used it before and how I use it now is that I use extremely tiny portions now. Instead of eating a bag of chips, I eat 2 or 3 nuts. I don't eat a whole candy bar, but might eat 6 M & M's or a mini-candy bar. The calories are low enough to not be an issue, but the comforting still goes on.

That is not to say that every small treat I eat is an act of food-based stroking. Sometimes, it's merely that I want to enjoy these foods. Sometimes, it's a craving for a dessert after a meal (which is common for me anyway). However, there are definitely times when it is an act of stroking. It's not compulsive, but it is an act that tells me that "I'm okay". The food tells me, I'm going to be okay. Everything will be okay. This connection was forged in my childhood, and now I have to work to unravel it. This is the next stage in the evolution of my relationship with food, and I am not looking forward to the emotional fall-out which is certain to follow.

My approach to this is going to be relatively unstructured. That is, I don't plan to forever give up treats or even to swear off of them on a particular day. Rather than take some sort of rigid or Draconian view of food (which I believe is ultimately destructive and untenable), I plan to practice concrete self-stroking exercises at times when I feel I'm grabbing a tiny bite of a treat for self-stroking purposes. I'm also going to try and develop conditioning techniques to self-stroke in a higher order fashion. This is not an easy transition for someone like me, because it involves positive messages about myself to myself. This comes with difficulty because of my feelings of worthlessness, fear of narcissism or self-aggrandizement, and modesty. My mother reinforced again and again that I shouldn't form too high an opinion of myself to make sure I never thought too much of myself. For instance, when I got excellent grades and pushed myself hard in school, she made sure to tell me that I was "book smart", but lacked common sense or other intelligence. Even when I excelled academically and should have felt I was smart, she let me know that I was dumb and shouldn't be too proud no matter what I accomplished. She bragged to her friends about my sister and I, then told us we weren't so hot.

I'm also not the type of person who subscribes to hollow affirmations of my own awesomeness. A lot of people practicing self-acceptance resort to pat mantras about how "good" they are, but this simply does not work for me. My issue is not that I think I'm a really "bad" person and need to tell myself that I'm a "good" one. It is that I feel that I'm in no way special and that my value is less than that of others because my needs are less important than theirs (my mother always told me that it was selfish to put myself before others). Without my husband telling me regularly that I'm important, I can't keep the idea in my mind. I haven't internalized the notion that I am a person of particular value to anyone but him. If I am not with him, I cease to be anything because I am nothing to others. If they see me as anything, it is my feeling that they only do so because they view me as useful in some particular regard. If I cease to be of use, they will not care for me because I'm nothing special to anyone but my husband. I believe that he is the only person who will ever love me, the only one who ever could.

So, what I tell myself in affirmation has to be specific, important, and have deep relevance to me. It can't merely be that I say, "I don't need this chocolate because I'm a good person". I'm not sure what I need to say, just that I need to say some things which strike at the heart of the shortcomings of my childhood. One of those things might be simply to say, "everything will be okay," whether I eat this or not. I doubt that that will be all it takes, but it's a starting point after so many years of my youth being spent being told everything was not okay and I was not okay. As I explore this, I will post more about the process.

Saturday, October 29, 2011


"Stroking", as it is referred to in psychological terms, can be a fairly inclusive term. It means comforting, soothing, rewarding, or validating yourself. Humans need it, more than they often like to admit. It's why we enjoy compliments or feel better after we get a good grade on a test. It's why people want to be an "inspiration" to others or receive positive and supportive comments on their blogs.

It is not a weakness to desire strokes, though people often view the need for them as a reflection of neuroses. The idea that we should receive all of our stroking from internal means is a reflection of the Western mentality that we should be 100% independent in all respects. Obviously, some forms of "self-stroking" are carried out as we grow older and find higher level means of feeling good about ourselves. People can feel good about a job they know they did well rather than rely on others to constantly tell them. We do grow more comfortable and capable of assessing our value in various respects and "complimenting" ourselves through time, but it's a peculiarly occidental notion that we should never need anyone else to be psychologically whole.

I will be the first to admit that I am extremely poor at "self-stroking". This is something that I have come to realize rather acutely over the last week or so while my husband has been abroad and I have been alone. He has gone on such trips before, and it has always been difficult for me, but this time has been much harder. I realized that this is largely because of my changed relationship with food.

My parents were not particularly good at raising my sister and I. They got married too young and for less than positive reasons. Both were psychologically damaged. My father was not demonstrative at all because he was so uncomfortable with his positive feelings. My mother offered conditional affection and had self-esteem issues which caused her to condemn, judge and criticize and she was prone to emotionally unstable reactions. Neither provided a very good environment for young psyches, and what "stroking" they offered was unpredictable and often related to concrete rewards, especially food. When you are very poor and can't express your feelings because of your own issues, buying your kids bags of chips, candy bars, and cheap sugary soda is the easiest path to giving them strokes at the lowest overall "cost" (psychological and otherwise) to yourself.

For my parents, food was a co-parent. When they couldn't say "I love you", food did it. When they wanted us to settle down or give us something to make us go away and leave them alone, food did the job nicely. I have come to realize that food took on a great importance because of the way they used it. It was the parent I carried with me into adulthood, fulfilling needs that were supposed to be filled by family.

One of the emotional transitions that I had to make when I changed my habits was transferring "stroking" myself with food to other things. This is not an easy transition. Most people know that they "reward themselves" (a shallow and inaccurate description of stroking) with food. They know they need to stop doing it, but they fail to recognize that they need to replace it with something else. While it'd be great if realizing you were doing something destructive meant you could simply choose to stop doing it, people don't work that way. You can't simply conjure up a means of self-stroking instantly to replace how you deal with food.

For me, a lot of the burden of giving me strokes has fallen on my husband. As time has gone by, I have attempted to cultivate a greater internal integrity in this regard. To do this, I've done more things which help me feel better about myself like working outside of my home and deriving satisfaction from my ability to do the job well. I've also focused more on productive behaviors and tried to gain satisfaction from accomplishing them. These include moderate exercise and writing for my other blogs (which are independent of this one and unrelated to body or food issues). I've also found that FaceBook can serve a small role in this process by acting as a social conduit. It can be gratifying to post about your life and have people express happiness at what you offer.

Unfortunately, the current progress of the internal stroking cultivation as well as the very weak stroking from other sources is quite inadequate. Either these sources are too small or the neural connections which are being built aren't strong enough yet to substitute for the far more potent strokes that I receive from my husband's presence and food. Though the ties to food as a source of stroking are much weaker than they used to be, they still whisper at me from the darkness and beckon me back. It's easy. It's instant. And, it is so satisfying on a sensory level. It also does not impose upon anyone else. I often feel terribly guilty because of the burden I place on my husband to support me.

The problem during my husband's absence hasn't been that I've gone running to the pantry for comfort, but rather than I've suffered terribly during his absence. I've had crushing sadness and the sort of depression that put me on the edge of being incapable of taking pleasure in anything. This has been hard on him because my pain manifests itself in accusations that he doesn't really want to spend time with me, didn't consider my needs before making his plans and that he is, at least in part, responsible for my suffering. This is not what I mean to convey to him, but it is how he feels. For me, this is all a reflection of my self-worth issues. I feel abandoned, and then I feel I deserve it. My anger and aggression as I act on my pain only confirms more fiercely that I am unworthy of love or care and my self-estimation plummets even lower as I hate myself more for how I act. Losing weight and adjusting my relationship with food has improved my mobility and external quality of life, but it has wrecked havoc with my esteem because I never derived my sense of value from my body. A better body didn't equate to happiness for me, just less unhappiness.

It may seem incredibly unfair to place this burden on my husband to those who are not living in my skin, but this is a reflection of my particular "sickness". My needs and the demands I place on him are no different than those of a someone who has a physical illness and needs support. The fact that they are mental changes nothing. As I have said before, if I were in a wheelchair and needed help, no one would blame me for holding him accountable for my hardship if he left for a week. We seem to think that mental issues are simply something people can choose to get over. If only it were that simple. I'm doing the best I can as quickly as I can, but it's not something I can magically grab out of thin air or pop a pill to cure.

The realization that I need to continue to develop more potent and various forms of self-stroking is a part of the solution. However, that is only a starting point. Developing them and not resorting to any form of instant gratification (like buying something) is not an easy thing. It's not only that I can't predict what actions will be effective (and I can't) but also that they lack the expediency of food. People often think that the desire for instant gratification is a reflection of childishness, impatience, and weak character, but, at least for me, it's a way of ending psychological pain. Without those emotional analgesics, I am left to suffer. The long term efforts to find and carry out higher order means of self-stroking heal the wounds at a glacial pace.

I am making progress toward being less reliant on my husband, but losing food as a way of supporting myself emotionally took away a lot. My improved physical condition didn't do much for my mental state because that was made when I was a child. My sense that I am worthless, despicable, and unlovable is recorded first and forever in my brain. Those recordings can be answered differently (refuted or supported), but they cannot be erased. I will always have to fight them. It's just a matter of finding other (effective) weapons than food.

Thursday, October 27, 2011

The Bleeding Obvious

Some time ago, I read an exchange between several people attempting to lose weight. One of them said that she couldn't get through the whole thing without having treats so she enjoyed a little everyday. To this, another said, 'if you can't get through the day without a piece of chocolate, you've got bigger issues.' I didn't say it, but I thought, "no kidding, Sherlock."

People who want to lose weight, but haven't had severe issues with food don't approach food the same way as those who have. Many of us are like alcoholics that were drinking several six packs a day. Getting down to one beer a day is a monumental accomplishment. In fact, as long as quality of life is not compromised by that one beer, there is no reason to extinguish it from our lives, particularly if having that one keeps us from having 12.

Perfectionists, absolutists, and people who measure their self-worth in body weight, calories or the nutritional composition of their diet are one of the single most destructive elements in dealing with obesity. For those people, "good" is never "good enough", and they cannot accept that any other viewpoints other than their own are valid. For them, the trivial, such as whether you have 4 Hershey's Kisses a day to help you mentally deal with the changes to your lifestyle, is a springboard for a smug sense of superiority. They are "stronger" than you because they don't need this little emotional crutch.

My response to this thinking is that if your self-worth and valuation of others is measured by the composition of your respective diets or a number on the scale, then you have bigger issues. Such a shallow definition of self will ultimately undo you far faster than a few bites of chocolate to help you get through the day.

Monday, October 17, 2011

quality of life

Quite some time ago, I was talking with a friend who has suffered from depression, at times quite debilitatingly so, during most of her life. She is one of the few people with whom I have discussed my weight loss clearly and frankly and we talked about how I made the mental changes to get where I have. I told her some of the things that I've written about in this blog, but the process has been so vast and complex that it was hard to encapsulate for discussion.

One of the things which we spoke about was the general notion of using psychological techniques or intervention to improve quality of life. I told her that this all started when I modified my emotional state a very long time ago. That experience, in which I went from someone who was prone to angry outbursts, haranguing my husband when we fought, and raising my voice to being relatively calm, constructive, and moving past the issue far faster, was an object lesson for other changes in my life including my current situation with food. I learned that you can forge a new mental pathway and build a bridge from who you are now to who you want to be. I think it was helpful that I benefited from this technique twice (the second time had to do with reducing materialism) in situations unrelated to food. I had a template for making mental changes over a long period of time and transforming who I was in a fundamental manner.

As we discussed this, I said that one thing I realized was that we all have the capacity to be happier and maximize our satisfaction with ourselves. People often view the person they are as inevitable and concentrate mainly on improving the mechanics of their life. They focus on objective aspects such as schooling, skills, money, and possessions. They see "improvement" as it is reflected in these things and reject that they can or need to improve their mental capabilities. I told her that I saw this as sad because I believe people can be much happier if they focus on making mental transitions rather than believing they are locked into their mindsets. My friend said, quite correctly, that most people don't realize that they can be happier. It's not even on their radar to strive for such an improved state of being.

A big part of the problem is that people are always telling us what is required to be happy, and we believe them. They tell us we need cars, houses, certain jobs, kids, spouses, or to look a certain way. No one tells us to be better people by not getting so pissed off at the guy who cuts us off on the highway. No one tells us that building empathy for our enemies can be a path to reduced personal suffering. What is more, no one tells us how to manage these things even if we want to.

A lot of what I've endeavored to do with this blog, and perhaps failed in my efforts, is to demonstrate that one can make the transition mentally and that psychological change is a slow process with many failures and successes along the way. If you make that journey, through self-reflection, deliberate, but slow behavior modification and discussion with yourself about your thought patterns such that you direct them more toward who you want to be, you can bridge the gap between who you are now and your ideal image of yourself. It's not about your body. It's about your mind, but I think a lot of people miss that message and just see what I'm saying as being about losing weight. If that's what comes across, then I've not communicated my message as well as I'd hoped. But then again, half of understanding is the message that I put out there, and the other half is what other people hear. I think a lot of people hear only what they want to hear rather than what I'm actually saying, and there's nothing I can do about it.

The Lady Bits Inspection

Today I had my second round of long-neglected medical tests. The first round consisted of a standard battery of tests on blood, urine, and stool samples as well as an EKG, blood pressure, and a cursory exam by a doctor ("open up and say, "ah"). The results of those tests were all in the normal range. The one disease that most obese people fear, type 2 diabetes, was not an issue. My blood sugar was normal and my HbA1C test was 4.4 (and 4-6 is "normal"). 

The tests I took today were for "lady's problems", as my mother would so quaintly put it. I had a pelvic ultrasound, a pap smear was taken, a mammogram, and a breast exam. The pelvic ultrasound revealed nothing but a benign cyst on one of my ovaries which I suspect has been there all of my life based on a certain pain I feel during ovulation. The doctor said it's no problem and is the sort of thing which changes in size based on menstrual cycles. The breast exam also revealed no abnormalities. The mammogram and pap smear have to be developed and examined by physicians and the results will come in two to three weeks, but my husband was in the room during the mammography and saw the images. While he's no doctor, he saw nothing strange on the images (no dark spots or shadows).

My sense is that all of the tests will come back fine. My last pap smear was about a decade or so ago, and I know how foolish it was to put off the test for so long. However, I'm a virgin who married a virgin and there's zero risk of HPV so I'm on the lower risk side for cervical cancer. Also, I've never taken birth control pills so there's little risk of hormonal contamination affecting my reproductive health.

The reason I resisted the test for so long was my weight, though not because of the weight itself. One of the last two pap tests I took resulted in a doctor trying to use an mechanical table to elevate me and I was too heavy for the motor to work. The doctor angrily asked me what I weighed and then scolded me because I might damage their table before scoffing in disgust and moving me to an old-fashioned table. She then hastily did the test and scurried away after an experience which she obviously viewed with distaste. I could not bear the humiliation again, so I put off the test until my weight was in a range that I felt would not yield a similar experience. 

I had another bad pap test experience at a clinic in which I struggled to get there with terrible back pain only to have the doctor refuse to give the test because the speculum wasn't big enough and caused me pain. I told her to just go ahead and do the damn test and get it over with and I'd put up with the pain for the brief time she did it. She said she had to order a bigger one rather than pinch and hurt me with one that was too small. I was extremely angry that she wouldn't do the test, and even madder that the clinic attempted to charge me for the office visit when the doctor was the one who refused to follow through and do it. I refused to pay and I never went back. 

This time, the experience was fine. The doctor was kind and the chair, which was different this time and incredibly comfortable, had no problems moving my 182 lb. body into position. A standard speculum was used with no pain or problem and, while not the most comfortable experience, it was not painful or negative. After reading so many horror stories on the internet from people who were harassed about their weight by gynecologists, I had myself practically whipped into a nervous wreck thinking that I might get derided for my BMI. No one said anything, though my husband did mention to the gynecologist that I had lost a lot of weight so that she would not be alarmed by the extra skin hanging off of my body. 

Having this generally positive experience is the first step in healing the damage done to me from my bad experiences in the past. When all of the tests are done and (what I am sure will be) normal results are in, I feel like I can start over with my relationship with the health care system. Part of what happens when you avoid getting routine care is that the longer you avoid it, the harder it becomes to face it. You develop a mindset through time that makes you think that going to the doctor will confirm your worst fears so you live in denial of the truth about your health. You believe that finding a problem on a medical test makes it real, rather than deal with the fact it was real all along. You imagine all sorts of things, and just keep avoiding "confirmation." If you did routine checking, you'd catch them at an earlier time, but the fear of humiliation and degradation keeps you away from that and the fear compounds as the years go by. 

I'm absolutely certain that if I regained weight and exceeded 250 lbs. again (or got near 400 as I was before), that I would find the experience of these health check-ups far more difficult and very likely traumatizing. People who have lost weight like to say that people treat you better because you change your outlook, but I will never believe that. I am the same except for my body. I was regarded as an object of disgust before, and now I'm treated like a human being. 

These tests, which I have avoided nearly all of my life, are the next leg along the path to "normality" that I'm attempting to tread down. It's extremely hard emotionally for me to do what I'm doing even though it's the sort of thing people without my fears take for granted as necessary and an undesirable but routine task. I asked a work acquaintance how she felt approaching her annual physical (which all people in the country I currently reside in can take part in for free) and she said she felt nothing at all about them. That is, she experienced no stress, anxiety or fear because she didn't form a set of neurotic responses from being treated poorly at such times. It was just what she did as part of her normal life to catch health problems and deal with them. This is "normal", and I have to desensitize myself to the experiences of having medical tests if I want to keep moving in this direction. I'm two steps in, and have one more to go when I finally take the thyroid test that was recommended during my initial check-up.

Friday, October 14, 2011

Is it mental?

One of my cousins was born with type 1 diabetes. That's the kind which reflects an innate deficiency in ones body's ability to regulate insulin rather than the type which is brought on by lifestyle. In terms of current thinking about health, it is the kind which one for which a person cannot be "blamed".

I didn't know this particular cousin especially well, but I did see him occasionally. He was about 5 years older than me and was always thin. He also seemed to have some emotional or mental difficulties. Though he wasn't in any sort of special education classes, he was not particularly bright and had some temper issues. He was capable of doing certain types of work and eventually married and had children.

Despite having grown up with his illness, my cousin was never capable of regulating his diet. In particular, he consumed candy bars and other sweets such that his diabetes was not under control. Though he never gained weight or got fat, his body was constantly being damaged by his diabetes as a result of a poor diet. In the end, he died young as a result of his inability to control his eating. He wasn't fat, but he literally ate himself to death.

There is no doubt in my mind that my cousin experienced a certain biological pressure to consume sweets. However, my uncle (not the father of this particular cousin) also was born with type 1 diabetes which he has kept under control for his entire life through medication and a controlled diet. The main difference between the two was emotional. One could not control his relationship with food and the other could.

The question that I'm throwing out there for myself after pondering their respective situations is whether or not the inability to regulate your diet when you have a life-threatening health issue is a question of mental health. Very often people approach diet as if there were a single "best" way to eat which would result in all people experiencing optimal health. Bodies don't work like that. There are people who can eat a candy bar (or two) everyday and experience no ill effects. There are those who can eat bread all day and those who can't tolerate a single slice. All processing of food by a particular body is individual with varying consequences.

This fact is one I realized long before I thought about my cousin's situation. Some time ago, I finally internalized the fact that there are people out there who can gorge on junk food and not get fat while I am likely going to have to be very careful about what I eat to simply avoid being morbidly obese. Some people will remain or get fat on 2000 calories. Some will stay thin on over 3000. That's the way it is and railing against it and the unfairness of it doesn't change the biological reality. Just as my cousin's reasonable desire to indulge in sweets that he likely saw his sister and others consuming resulted in his death, my diet, "healthy" or "reasonable" though it might be in some eyes, can result in a physical state which will make me miserable.

Getting back to the main point, however, if my cousin could not adhere to a diet which was stricter than most, was it a matter of mental health? Is the inability to control your behavior above and beyond what "average" folks are required to do because of your particular special circumstances an issue of psychology? My answer would be, "yes." Psychology isn't a matter of averages anymore than biology is. Maximum quality of life cannot be achieved by applying a template of actions or thinking patterns according to what everyone believes is best, but rather what is best for the individual. My cousin could not do what was best for him, even though similar actions would not have been destructive to someone lacking his health issues. If there had been behavioral intervention to help him master his destructive urges, he may have lived a lot longer.

There is a lot of debate about whether or not obesity is the result of a mental health problem and there are vociferous folks who rail mightily against the idea. However, I think context is very important. If someone washes their hands 30 times a day, do they have a disorder? They do, unless that person is a doctor who sees a lot of different people and washes his hands between patients and for regular routine hygiene. If someone becomes so fat that their mobility, joint health, or blood sugar are affected and their quality of life compromised by their weight and they cannot alter their habits to affect a positive change, is it a mental health issue? I say it is. If you can't make behavioral changes in your life to be happier, then it is a matter of psychology and it doesn't matter that only you need to make those changes. It's about mastering your own life, not living as an "average" person. That goes for everything, not just weight and food. If you can't control your temper, concentrate long enough to study, etc. and these conditions are particular to you, they are issues of mental health.

Note that I am in no way saying that these are psychological issues which must be dealt with. No one is obliged to deal with their particular problems at all. Just as I do not believe physical health is an obligation, I do not believe mental health is one either. People have the right to live as they please, even to their own detriment. However, I increasingly believe that thinking about our lives and choices in a relative fashion (i.e., "everyone does it and I should be able to as well") is a big part of what erodes quality of life for people. We often say fatalistically that "life isn't fair", but we don't internalize that reality and consider it when making choices in our lives. We still compare ourselves to others and feel that similar choices should yield similar results, and more so when it comes to health than many other areas. I think it's time to develop more sophisticated thinking in this regard and work out that "life isn't fair" isn't a pessimistic conclusion, but the starting point for understanding how to make the best choices for each of us as individuals.

Thursday, October 6, 2011

The Acquisition of Health

Unless you live under a rock, you have heard the news that former head of Apple Computer, Steve Jobs, passed away. I'm not going to turn this post into an off-topic homage to Mr. Jobs, despite the fact that I was once a Mac enthusiast and an Apple devotee and am still a dual-platform user (I use both Windows and Mac, favoring neither). There are likely thousands, possibly millions, of writers of all stripes who are doing just that, and I see no value in adding to the pile. Those who care, will say something. Those who do not, will close the browser window or tab.

What I want to talk about is Mr. Jobs's lifestyle. From all external observation and by reading what insider's said about him, he lived an exemplary lifestyle. He has been a vegetarian for nearly all of his adult life, practiced meditation, exercised regularly, and was trim and fit in appearance. Even after his liver transplant and treatment for pancreatic cancer, he walked every day and had incremental goals to improve his fitness and stamina. What is more, Mr. Jobs was someone who could afford the best medical care in the world and certainly received regular check-ups and attention for any and all health problems. Mr. Jobs did everything "right" in his life in terms of supporting good health, but he still died at the relatively young age 56.

Since fat people are constantly having their lifestyles scrutinized and they are blamed for any and all health problems they have, I think it is valuable to look at the life of someone who one might arguably be viewed as a paragon of lifestyle choices. People so often look at others and believe that, "if only" they did the right things, they would be healthy. It is absolutely true that there are lifestyle diseases which can be improved or eliminated if one makes choices which are more conducive to good health. However, we must accept that health is not something everyone can acquire with a "better" lifestyle. What is more, the degree of change necessary to improve health is not equal across individuals. One person may improve by making small changes and another may improve marginally making huge changes. Every body is different and it is only the illusion that we can control our destiny through making the "right" choices that makes people so keen to judge. If they believe Fatty McFats over there could be healthy by eating better and moving more, then they can believe that they can also acquire health by making the "right" choices.

Unfortunately, as Mr. Jobs's unfortunate and premature death illustrates, good, even stellar, lifestyle choices don't always result in the acquisition of health. We all have a different genetic make-up which influences how healthy we can be. Sometimes, it means we get cancer at a young age no matter what we do. Sometimes it means we get diabetes even if we eat well and are exercising regularly. It's important not to view sickness and disease as something people buy with their choices, and to understand that life and being healthy are a good deal more complicated than we'd like to believe.

Sunday, October 2, 2011

Finding balance, but still having extremes

These days, I'm so incredibly busy that I have little time to write about things which I believe are important to note on this blog. One of the things I hadn't had time to talk about was the recurrence over successive weeks of one evening of binge eating. I've written before that I had stopped binge eating for the most part, and when I did do so, it was nothing like before. However, I developed an almost routine return to compulsive eating over the past month or so. This situation, which has now abated, is important to remark upon because I want people to know that progress is not a straight line, and that this was not the end of the world or the beginning of the end of my ability to manage my relationship with food.

The fact that this occurred at all is no surprise. As I've written before, it is a biological impulse to gorge when stressed. All animals have this desire and it's one of the reasons that people often turn to food in modern life. We deal more with stress that cannot be relieved than ever before. Unlike the past when we could fight or run, we often have little choice but to stand and take it.

In my case, the stress has been brought on by various life changes. My husband has taken on more professional training work so he is around less. In the past, his commitment to these activities set off a rather scary disconnected binge incident, but this time I felt much better prepared to cope with his absence. And, honestly, I have been coping much better with it and feel less emotionally dependent on him than I have been in a very long time. However, all change is hard, and beyond his absence (which is a loss of a strong positive influence), I've been working a lot more and it has upset the schedule I have lived for awhile now. I am "catching up", so to speak, with the adjustments, but sometimes it feels like I'm tied to the back of a car and running as fast as I can as it pulls me along just a little faster than I can manage at my top speed. Occasionally, I fall (compulsive eat) and get dragged along the ground for awhile until I can scramble back up again (return to form the next day).

The "binges" I had were on Thursday evenings, one of the two nights when my husband comes home quite late due to the work he's doing. I would eat up to around 2500 calories, which isn't a monstrous binge, but often what I'd do is eat according to my usual plan and habits to around 1500-1700 calories, then binge a further 800-1000 on things like pretzels, animal crackers, lean ham or chicken, and cheese. I felt like I just couldn't manage feeling hungry at the end of the day on such days, and just gave in and ate and ate to a point of fullness (not simply satiety). The thing is, I knew what I was doing and I did it anyway. This wasn't like the aforementioned incident where I was mentally split from my actions. I knowingly did this as a pressure release valve. It was the equivalent of people cutting themselves and knowing it is destructive but desiring the release enough to do it anyway. I knew it would set me back a day or two in losing weight, but the relief was so emotionally necessary that I did it anyway.

I decided after the second time that I needed to take control of the pattern that was emerging, but it had nothing to do with losing weight or fear that I was going to set off a new pattern of behavior in which I'd habitually overeat on a daily basis. Mainly, I was concerned with using food in this manner and creating a stronger psychological link between stress and eating. The actions weren't really the problem, but the repetition of them and the way in which they would reinforce and condition future compulsive eating patterns was.

To be perfectly honest, there is a bit of success that I took away from all of this, and, no, it was not that I stopped the pattern, though I did do that. The success was that I didn't freak out or think that I was going to gain weight because of this. It is an immense triumph to me that I was able to, for the most part, objectify the experience and treat it as a behavioral condition to be handled rather than lapse into an "oh my God, it's the end of the world" mentality. I knew that if I did it one day a week, I wasn't going to do it again for at least another week. I knew this wasn't going to be everyday, and I was confident that I could eventually get it under control. I also know that flagellating myself for this behavior or panicking would only make it harder to deal with.

The truth is that I'd be shocked if this pattern didn't re-emerge in the future from time to time, and I'm okay with that. It's not because I think compulsive moderate overeating in times of stress is a "good" thing which is to be blithely disregarded, but rather because I know it is a natural thing which many people do. It's not a cause for panic unless it becomes absolutely habitual, excessive, or overly frequent. If overeating is the one and only "solution", then it is a problem. If it is an occasional stress release valve, then it is natural animal behavior.

A big part of "balance" in all things is knowing that excess is as much a part of finding it as minimalism. Sometimes, you're going to do as little as possible and sometimes as much. Most of the time, you are going to stick around a range in the middle. That's what I'm looking for, not hitting some particular mark every single day under every conceivable circumstance. So, one of these days, I'm going to get into a stressful situation again and may find that I'm using food as a release valve. Some people get drunk. Some people get mad and scream at their loved ones who don't deserve such behavior. Some people sleep with strangers. Some people smoke pot. None of these things are "good" things, but if you expect to be "good" all of the time, then you're fooling yourself and setting a standard which most ordinary people cannot live up to. We're none of us paragons, and part of striking a reasonable balance in life is knowing that.

Friday, September 30, 2011

Expecting to be natural in an unnatural world

I've been told that modern dogs were bred from wolves, though I'm actually too lazy to research whether or not that is a fact. Whether or not they actually came from wolves is not really important, but I'm sure that domesticated animals, and the varieties of purebred dogs that people possess in particular, trace a genetic heritage to some wild species that was far more capable of looking after its interests than the current crop of creatures that have their poop scooped up by diligent and lawful owners.

Many things in modern life have been altered through time and technology while still retaining vestiges of their original biology. Many breeds of dogs would be incapable of survival if released into the wild, but they still respond in ways that their original nature dictates. We do our best to train the more unacceptable impulses out of them, and understand that we must overlay an artificial behavioral template on top of their desire to mark their territory, bite, or eat another dog's poop. We know that basic nature does not serve the modern domesticated dog (or its owner).

When it comes to humans, we seem to have a far less logical structure to our thinking. We live in a world that is very far-removed from nature then we talk about relying on our natural impulses to help us navigate it. The confusion is very pronounced when it comes to how we deal with food.

There are people who advocate eating by nature, as opposed to doing so in accord with artificial constructs such as planned meal times, calorie counts, or diet plans (and I use "diet" here as a  noun to mean - "what we eat", not as a verb referring to weight loss). They talk about how we should listen to our bodies and eat by intuition. I think if you're going to make such a recommendation, then you should be responsible enough to deeply reflect on what the nature of our bodies truly is as a result of our genetic heritage.

I'm no expert on evolution, nor on history, but I do know that humans spent a lot more time with insecure food supplies than secure ones. Even after agrarian lifestyles were implemented, it wasn't until food preservation techniques became refined and mass production common that the food supply was such that most people had food readily available at any given time. That means that the history of our biology as a species which is literally surrounded by food all of the time and capable of eating anytime anywhere is extremely brief from an evolutionary standpoint.

Most of the formative years of humanity were built around spending copious amounts of time and energy securing sustenance.  In order to ensure that we felt compelled to go find food, hunger had to evolve as a potently uncomfortable force. If we didn't feel hunger pain, we would just starve because it wouldn't hurt enough to push us to go out and gather or hunt for grub.

Our "nature" in regards to food developed in accord with dramatically different circumstances than those we currently live in. Bodies respond to food and hunger as if we were living in a situation in which food was hard to get and we needed to be strongly motivated to get it. Our impulses are in complete disharmony with our circumstances at present. Hunger pains scream, "find food, now," but the severity of those feelings came from a need to motivate activity or anticipate staving off those pains and to push us to action. They didn't evolve to drive us to wander into the kitchen and open a cabinet door and eat a snack.

So, talking about our "nature" or being "natural" about food only works if you are in a natural environment. We are not. We are in a highly unnatural situation based on technology and culture. Like the domesticated dog that can't fight for it's food to survive, we no longer have to expend energy to obtain energy. Like the dogs that we train to suppress their no longer appropriate nature in light of their residence in our homes and lives as pets, we also must be "trained" to deal with food in a manner which is no longer in accord with our basic biological impulses. Simply put, it is our nature to eat when hungry, but it is not natural to be able to do so.

The first step in dealing with the poor relationship people have with food, and this applies to everyone, not just fat folks, is to stop talking about what is natural and accept that we live in an artificial world with challenges to our nature. Just as we learned to hold our bladders until a toilet is available, we need to learn to hold our hunger at bay until we really need to eat. This is a task that should be performed by cultural norms, but the time period during which food has been a casual thing which is readily at hand, cheap, and of dubious nutritional value has been extremely short. In fact, it wasn't even a challenge my grandparents would have faced. Culture hasn't had time to catch up with this development.

Unfortunately, the way in which we deal with this particular challenge has been muddled greatly by various special interests fighting to further their agendas. Everyone has a viewpoint and they are interested only in defending or advocating whatever it is. Rather than deal with the issue, they simply want to be agreed with and we exist in a state of angry chaos when it comes to food. Additionally, the focus on behavioral extremes (excessive consumption or deprivation) and the insertion of value judgments into the equation serve to polarize and politicize the situation. Unless such emotionally-charged notions are set aside in favor of an rational and objective solution, culture will never find a way to balance our nature with the artificial environment that we will almost certainly continue to exist in.

The question of what is to be done is therefore up to the individual to build a life with this highly unnatural situation which creates a healthy relationship with food. And when I say "healthy", I don't mean merely to promote a healthy body. I mean "healthy" in an inclusive sense including that which promotes joy and mental well-being. Such a balance is possible, but you're not going to land on it "naturally", nor if your notions about food are focused on joyless and punitive ideas and idealized body concepts (such as thinness) or self-deception about the consequences of life at a high weight (such as claiming the development of Type 2 diabetes is unrelated to weight when it certainly is). If individuals, one-by-one, slowly and surely moved toward such a rational and balanced mentality, culture would catch on and catch up and there would be a critical mass that might result in an overall healthy, happy, and, yes, utterly unnatural relationship with food. It would be an artificial food culture for an artificial world. And there's absolutely nothing wrong with that.

But, I'm not holding my breath.

Tuesday, September 27, 2011

Health Test Results

Today I received the results of the first round of regular health check tests which I mentioned in the previous post. All of my results were within the range of "normal" except for one. That one was, quite predictably, my BMI which is 30.9%.

Personally, I'm not especially bothered that this number is highlighted in red to indicate that it is a problem because I planned to lose more weight anyway. However, I can't help but feel that the HAES (health at every size) movement would take issue with this. If all of my results are okay, why is weight even being tagged as an issue?

What I realize is that this isn't about any sort of personal choice on the part of the health care provider to point at my weight and say, "bad girl!". This is about bureaucracy and a system which looks only at numbers and reaches conclusions. With this type of health care, I'm essentially being judged by a machine rather than by human judgment. The machine prints out a report and if the range of numbers is outside of certain parameters, it prints it in red. If the number is high, it spits out particular advice. If the number is low, it spits out different advice.

When I learned the results, I was not overjoyed or proud or whatever. I know some of the results could likely be better in the abstract (though there is nothing "wrong" with them now). For instance, my fasting blood sugar is 94. That is on the higher end of "normal", but is nonetheless normal. This number isn't on the high side of normal because I'm overeating or eating poorly. It's where it is because I haven't been sleeping well due to knee pain and my stress levels over the past 6 months have gotten higher and higher (due to taking on a new job and various other issues such as living close to a crisis zone). Insulin is affected by these factors in addition to diet.

The bottom line is that there are things I can do which would favorably impact these statistics and things I can't do. I can't instantly cure my knee, and, in fact, my efforts to date to improve it with self-prescribed physical therapy (exercise, bending, baths) have only made it worse and I'm abandoning that line. Right now, the pain gets better if I do nothing rather than do something. If I can't fix my pain, I can't fix my sleep problems.

The other thing which I think would improve my health is engaging in more vigorous exercise. While I walk and lift weights 5-7 times a week, I can't do strenuous aerobic exercise due to my physical fragility. Mainly, this is due to my knee, which barely tolerates the walking I do everyday. My back is generally better, but if I push it too far too fast, I will pay for it. Even now, I'm having some pain from various stretching exercises which create strain on my back. I can't change the fact that I'm unable to do more challenging exercise due to physical pain and damage.

My main concern about the numbers I was going to receive was that they would be poor and I'd feel that I was already doing almost everything I possibly could to have better health. I eat exceptionally well from a nutritional balance viewpoint. Sure, I eat a few treats a day, but I think only a nut job who derives all of his or her self-esteem and a sense of moral superiority from something as trivial as food choices would believe that a few bites of something sweet a day make a huge health difference. There's no way the equivalent of eating 3-5 Hershey's Kisses per day is going to have an appreciable impact on my health when my calories are kept consistently within a range of 1500-2000 the vast majority of the time and I eat a very good balance of nutritious food.

The tests I took validated my sense that I'm generally pretty healthy now, but I had an odd sense of foreboding even getting them because I know that a person can do everything right and still fail. Health is not something you can attain merely by connecting all of the proper dots. You can increase your chances, sure, but there are no guarantees. Each person works with particular predispositions. I'm genetically lucky in some ways since my body fat is hanging off of my behind and belly instead of collecting around my organs and in areas which tend to contribute to Type 2 diabetes. There are people at my weight or lower who have more problems, not because they are making poor choices, but because their body reacts differently.

At the moment, I'm still in limbo on the thyroid concerns that I mentioned in the previous post. I wasn't permitted to make an appointment for a test until after this first round of test results arrived. I still believe this is a precaution, but a seed has certainly been planted that I have cause for concern. I'd like to dig that seed up and throw it away before it grows any further, but I can't do that until I have another test.

Beyond the thyroid test, I've still got to have a pap test and mammogram. These are other tests that I've avoided for years because of humiliating and degrading experiences due to my weight. Last time I attempted to have such a test, the doctor put me on an electronically elevated table which would not move up due to my weight and angrily asked me how much I weighed and reacted with great and overt disgust that she had to move me to an old fashioned table to conduct the exam. Since then, I haven't gone back. Of course, I know that if I don't take such tests, I'm the one who will pay the price, but I couldn't bear to face it again after that.

Even at my current weight (around 185), I approach all medical experiences with trepidation. I am going to have all of the tests that I should have done completed despite my fears and anxiety. I'm scheduled to get the pap test and mammogram as soon as possible (around mid-October). I'm saddened that it took extreme weight loss to work up the courage to do what normal people do to maintain health and I'm angry that negative experiences made me avoid them for so long. As I've mentioned before, I often wonder if the higher mortality rate among obese individuals is related to not seeking regular health care due to the shoddy treatment they receive rather than obesity-related illness. If you don't go until something is seriously wrong, it is likely too late to deal with the issue.

For now though, I'm satisfied that I'm okay on the fronts which have been measured and relieved that doing everything I reasonably can just so happens to be "enough" for all of the machines to say I'm healthy.

Monday, September 12, 2011

My Secret Fear (Played Into)

I have had a secret fear related to my fatalism about life for quite some time, and I wonder if it stopped me at times from losing weight. That fear has been that, if I ever pulled me life together in any substantial way, that I would be struck with cancer and die. My feeling was that whatever force or forces of the universe  conspired to make my life to date as miserable as possible by having me born to messed up, poor parents and a biology which seemed to conspire to make and keep me fat would not "permit" me to be happy.

I realize that this is irrational, but there was always this nagging fear that if I overcame all of the emotional and psychological issues and became stronger and more capable, something bad would befall me to sabotage my happiness. I formulated the idea that my destiny was to be miserable and I think I often felt I'd rather be food-addicted and self-hating than risk whatever wrath was to befall me at the end of self-repair. This is the mindset that grew from the handful of cards that fate had dealt me.

Despite this nagging feeling, I've pressed on to be a better person in every way. I try to emotionally be better by dealing with negative emotions more positively. I've spent a good part of my life trying to turn my glass is half empty thinking around to at least a little more glass is half full thinking. I've tried to gently talk down the voice in me which is all too keen to tell myself that the sky is falling. The notion that I have fewer options in life and have to remain in a bad situation for fear of being worse off if I walk away from what I have has really been hard for me to talk myself out of, but I've made progress. I've learned to be less defensive and more open after years of feeling combative toward the world which seemed to lash out and hurt me at every turn. And, of course, I've dealt a lot with my food relationship and body issues.

So, I've made a lot of progress in my life at this point. That progress pre-dated this blog by many years. Psychological changes to my outlook in life, temper control, etc. are things which were not hampered by being very fat. One of the reasons that I don't look back on my life between 300-400 lbs. with regret as many people do is that I know how much I grew during that time regardless of my weight. In fact, I think it was part of the culmination of my mental growth that I was able to lose weight in the past two years. One could not have happened without the groundwork of the other.

Yesterday, I went for a physical examination. The results are hardly in as this was just the testing stage. No concrete results will arrive for two weeks as I'm living in a place with socialized medicine which is highly bureaucratic in nature. It rushes for no one. During the cursory exam, the doctor asked me if anyone had ever suggested I had thyroid problems. I said "no" (but later remembered that someone had suggested it in another exam about 8 years ago). He spent a few seconds feeling my neck and then suggested I should have it checked because he thought it was enlarged a bit. When I asked what it would mean if it were inflamed, he hemmed and hawed and essentially said he didn't know until they did an ultrasound, but they wouldn't give me one until I had a follow-up exam which wouldn't occur until I got the test results in two weeks. After that, I left for the next test in the battery I was being given, and a nurse came out and gave me a pamphlet on cancer detection.

Even though the doctor didn't use "the C-word", the nurse's delivery of such a document sent me into a state of numbness and fear. Here it was sitting right in front of me, my deepest fear being supported by medical professionals. I spent much of the rest of the day feeling as if destiny was going to be fulfilled, then I got angry.

The doctor didn't ask me any questions about anything related to thyroid conditions or my health aside from a few broad questions about diarrhea, constipation, smoking, medication, smoking, and alcohol. His exam was extremely cursory in every way because part of the socialized medical system in this country is a free annual health check-up. For the hospital to get more money out of me, I need to come for a follow-up (which I will pay 1/3 of the expense for) and do tests which are outside of the free regimen. While I don't think the doctor was intentionally recommending a test he felt was unnecessary, I do believe he was doing a sloppy diagnosis based on my age, weight (which he did not mention in the exam at all, but I'd be shocked if it didn't come up later in the follow-up), and a vague tactile exam of my neck.

The thing is that I was at the beginning of a cold when I went in for the exam. My throat was a little sore and a lymph node under the left side of my jaw was slightly swollen. The doctor never asked if I had a cold or was coming down with something and I never thought to mention it in the brief exam as I didn't think it had anything to do with anything. My husband later did research on enlarged thyroids and noted that colds can cause that (among many other things unrelated to cancer). The doctor should not have intimated that I could have a serious problem, which he did by telling a nurse to give a pamphlet about cancer, without at least asking about underlying conditions, but this is a bureaucratic type of health care and such behavior on the part of doctors is not rare. Dire and sloppy diagnoses have been given to friends of mine, and even to me on one occasion before, and they have been wrong.

If I hadn't had my fatalistic notions about my future if I lost weight, I don't know if I would have been more level-minded about what happened. I doubt that I would, but this experience has taught me that I need to continue to work on my outlook. Unfortunately, I also have to have a test on my thyroid in the near future because nothing will quell the nagging sense of fear that I could have a serious issue if I don't. However, after thinking it through and my husband's research on the topic, I'm pretty sure that I don't have thyroid cancer and that what I did have was a doctor who is part of a system which deals with people in what amounts to a cattle call system of health checks and who has a poor bedside manner as a result of both culture and a system, which is better in many ways than America's, but is still flawed.