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. 

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.

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. 

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?

Benign

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.