Fat shaming, medical blaming and being "right"

Those who haven’t seen me in a while are often pleasantly surprised these days when they do see me. I’ve lost a lot of unnecessary weight, have more physical energy and am much more clear headed than I was for years. This comes of beating diabetes.

I sort of feel gratified when people remark in my change of health and appearance, but I secretly also feel frustrated. For every person who expresses this happiness for me, there are three people somewhere judging a fat person. Maybe they are even some of the same people.

Even technology seems to avoid overweight people in images. My camera app on Apple devices will show all the matching pictures of everyone thin I know, but displays only the sign “updating” for hours when asked to match pictures of fat people, including me. I tried to find other images to go along with this article on Flickr and similar sites, but fat people, especially fat people looking normal and content, are strangely absent from the internet, despite being all around me in real life.

Now, I’m one of those lucky souls inhabiting a body with a brain that does structure, routine and healthy habits without too much pain and suffering. I sleep seven and a half hours, get up at 6 am, meditate, exercise, cook and eat healthy food, and all that. I’ve done it even while insanely busy with work and my kids’ medical demands, though that entailed a lot of stress. So, you might think I’d be one of those people self-righteously saying, “health is connected to healthy habits,” and therefore fat people deserve to be shamed.

But here’s the catch.

I was fat. And I had healthy habits—or at least I kept the habits I was told were healthy by the medical establishment. I exercised. I ate a “Mediterranean diet” with lots of organic veggies, legumes and whole grains. I never ate fast food and rarely ate packaged food. I hadn't had soda since I was a teenager. I thought positively, I grew my own vegetables, for crying out loud.

But in fact, I can name a dozen middle-aged, fat women I know personally who also have that sort of healthy lifestyle. In case no one has let you in on the secret, life and body shape aren’t fair.

People definitely didn’t immediately assume I was living like that when they looked at my body shape. The overriding assumption in society is that people who have a lot of extra weight are slacking off somewhere, either not exercising or eating too much or eating the wrong things

When I hear people comment on other fat people, I don’t have to speculate much on what the underlying assumptions are, because I shared them up until recently. I never went around openly blaming people for being fat, but I figured focus, effort and good habits played a large role. And by de fault that seemed to mean that those who were fat lacked good habits and self-discipline.

But they often have them in spades.

OK, let’s be clear. Not every fat person does. Many people are not focused, don’t put out daily effort and don’t have healthy habits. There are plenty of people who eat mainly fast food and junk food and that does contribute to weight and poor health.

But there are also fat people who are disciplined and focused. Some are healthy the way they are. Some aren’t.

I wasn’t. But that was because I had a chronic illness that made it so that my body could not process most of the food I was eating—specifically the parts that were various forms of carbohydrates (i.e. sugar). When you can’t process sugar well, your body starts cranking out a ton of insulin (unless you have type 1 diabetes). And tons of insulin makes you fat, even if you eat relatively little and get your exercise.

This is not the reason every fat person is fat. But it was apparently my reason. I was allergic to most of my food. I fixed that, got rid of the food that was causing excessive inflammation and massive insulin production, and that worked… for me.

I wish everyone could find a magic key to their health like that. OK, it isn’t nearly as simple as taking a supplement pill. A large part of my life now revolves around making sure I can always eat food that my body can process well, and in the modern world—so heavy on carbohydrates—that means cooking almost everything myself.

It is both hugely time consuming and very expensive, because mostly what I can eat is fresh meat and vegetables. I have to carry an electric cooler almost everywhere I go. Even a day trip is now an expedition, because I can’t just run across a place to eat or pack a few granola bars.

But still, I was relatively lucky in this. In my case, there is a solution. My last A1C was 5.0. I’m officially in the healthy range.

But I wouldn’t be if I ate so much as a whole grain bread roll or a bowl of beans. My blood sugar would shoot up and I’d feel sick for a few days. I know because I’ve accidentally eaten things I shouldn’t before I realized how exacting my body’s requirements now are.

That means I wouldn’t be in this healthy range if I’d followed the advice of the medical nutritionist my doctor sent me to. She advised me to stick to my Mediterranean diet to “make sure the disease progresses slowly.” The disease, which is considered incurable and eventually fatal, is not progressing slowly. It isn’t progressing at all, because I researched instead of just taking what I was told at face value and accepting that I was going to die slowly.

That’s how I found out about ketogenic, very low-carb diets. I’ve been following a modified diabetic version for a year and a half—with all the recommendations for balancing electrolytes and digestive health.

I wish every ailment had a hidden cure like that. But this doesn’t even work for every type of diabetes, at least not this well.

Even so, it is far from an easy fix. It can reverse all the nasty effects of diabetes, including eliminating neuropathy and improving the immune system. But it is an entire lifestyle change and for most people with type 2 diabetes it has to be permanent.

It is also a lot easier for those type 2 diabetics who were already eating a diet with lots of salads, home cooked meals and plain water. I’ve seen how much people who were addicted to junk food or even just people who never learned to cook for themselves struggle to make the switch. The battle is real.

And then again, there are many people whose health difficulties are different. Different types of diabetes may not respond the same way. There are many other reasons why people become overweight, despite healthy habits.

What I take from this is that we have to take a good hard look at the assumptions we make about others based on their health. Just as we don’t immediately assume every person with lung cancer must have been a long-time smoker, one really cannot know what causes the health problems we see in others are, even if they seem to be preventable.

There may even be a solution—such as my ketogenic diet—which the person doesn’t yet know about. It is often hard for me not to excessively “sing the gospel” about this whenever I meet people with the classic T2 body shape and warning signs. I do let people know I have the condition and that I have found a solution, but force myself not to push too hard. It doesn’t work for everyone for a variety of reasons, and really if it isn’t my body, I’m not entitled to a strong opinion.

I’ve seen many sides of this issue in the last several years. Having adopted kids with a serious neurodevelopment disorder that is entirely preventable and caused by prenatal exposure to alcohol, I often run up agains the question of whether or not to assertively point out that they are adopted whenever I encounter a new health care provider. Sure, that’s actually crucial medical information and they’ll get the memo eventually, but the fact is that if I don’t tell them right off and they see the diagnosis first, they are going to go through a period of making certain very negative assumptions.

And beyond even the level of physical health, my kids’ disability carries with it lack of impulse control, inability to grasp time and organization and difficulties in understanding cause and effect. They will struggle all their lives not only with the real consequences of those things but also with people’s assumptions about their motives. And by extension, I labor under the judgements of others about my “parenting” and why my kids “act like that.”

From being a person who thought I was right a good deal of the time, who thought fat people must be a bit lax and that punctuality, motivation and calm are all within an individual’s control, I have come to question just about everything I thought I knew for sure. I could wish I didn’t have to beat diabetes and parent kids with such tough disabilities in order to become less certain, but I don’t know if anyone could have explained it to me sufficiently without the school of hard knocks to hammer it home.

What do you think? Does hearing about the experiences of others regarding how wrong one’s assumptions can be about another person’s health and behavior second-hand make a difference?

Doctors, haters or churches: Who chooses for you?

I have always been “pro-choice” if I had to check a box. Not because I like abortion. I hate abortion. I had a “spontaneous abortion,” otherwise known as a miscarriage, that ended my hopes of having biological children and it is still painful fifteen years later. Desperate to have a family, I adopted two children, unwanted infants who might have been aborted but weren’t.

So, when asked, I’ve always said “I’m anti-back-alley-abortion.” I am for women having the choice, not because I think it is always justified and “for the best,” but because the alternative isn’t life. It’s more death. I always figured that's just the realistic, non-ideological way to go at the issue.

Photo of a bicycle at a high desert V fork in a dirt road - Creative Commons image by Gutifoll via Flickr.com

But a recent experience has given me a little different perspective.

It started six months ago, when I received a surprise diagnosis of diabetes, despite being considered a “health nut” by most of my friends. I ate meat about once a week, carefully rationed sweets, halved the sugar in recipes, never drank alcohol, exercised as a matter of course, spurned packaged foods and fast food, and ate lots of veggies and beans.

Because I am already visually impaired and diabetes threatens eyesight in the best of them, I was immediately terrified. I spent about four days wallowing in depression. Then I took the bull by the horns. It’s just how I do things.

First, I cut out all sweets and white flour. The diagnosis did explain a few things. I had been chronically tired for a couple of years and my immune system was tanking. My previous doctor had ignored the problems and treated only immediate illness. I got a blood sugar monitor and swore to “be good.”

But when I ate a bowl of beans or drank a swallow of carrot juice I was overwhelmed with dizziness and ended up needing a nap. Even complex carbohydrates were causing havoc and high blood sugars. I hadn’t been put on heavy medications yet, but the writing was on the wall. So, I dove into a couple of weeks of intensive research.

And as it turns out, I’m not the only one. Yes, there are a lot of people who become diabetic because of poor diet and little exercise. But there are also plenty of physically active vegetarians and vegans who become diabetic. And yet, “low fat, plant based diet” is still the unwavering advice given to all of them.

Studies comparing plant-based, low-fat diets versus low-carbohydrate, moderate-fat diets show that the latter is demonstratively better at lowering blood sugar and averting the problems of diabetes. Some doctors, especially in larger cities and those connected with research institutions, are catching on, and in many places recommendations for diabetics have changed dramatically.

I joined a tough-love online support group that schooled me on a low-carb, whole foods diet for reversing diabetes. Yes, it is technically ketogenic but modified in several respects to better suit diabetics.

And then the magic happened. After a week of rough transitional symptoms, I suddenly felt better than I had in fifteen years. I had energy! I could hike and exercise with ease. Various inflammatory conditions that I had though were just part of me—my severe menstrual cramps, the weird bumps on my arms, etc.—went away for the first time ever. And I lost the unhealthy weight I’d been carrying around.

It seemed like a miracle. Sure, the diet is a bit of a pain in our society, which isn’t set up for it. I have to carry my own food around and pretty much can’t eat out or use most packaged foods. But it isn’t miserable, by any means.

“Focus on flavor!” my support group advised. And I did. I found flavorful, pleasant things to eat that fit the diet. I no longer eat bland, unpleasant things or finish my kids’ leftovers just because I don’t believe in wasting. I eat only what I need and want.

I get a bit hungry before meals and never feel totally stuffed, when staying within the limits of this modified diabetic diet. But I also never have to eat a bowl of beans that doesn’t taste good to me just because I think it’s “healthy.”

I eat no sugar and only moderate amounts of sugar-free sweeteners. As a result, things like raw unsweetened peanut butter taste like a sweet treat to my adapted tastebuds.

But given that diabetes is a serious illness and the diet can cause electrolyte imbalance and even rapid weight loss for some, it is recommended that one proceed under a doctor’s supervision. So, I tried talking to my doctor about it. And hit a brick wall.

She insisted that I was “doing diabetes wrong” and that the proper course for me was to accept somewhat high blood-sugar levels and the slow health decline of “controlled diabetes.” I would never get better or feel good again, but medication would help to prolong my sight and my life somewhat. She prescribed medications with horrible side effects even though my health was dramatically improving. I refused to take them. She became hostile and refused to order the necessary lab tests to keep my protocol safe.

So, I switched to a different doctor, a process that took months. In the meantime, I saw a dietician who told me she couldn't “officially condone” my diet, given the regulations she worked under, “but it’s hard to argue with results.” Now, my long-term blood glucose tests claim I am no longer diabetic. But if I deviate from my diabetic-adapted diet my blood sugar skyrockets again, showing that the testresults only measured my good self-discipline, rather than the actual underlying condition.

The new doctor, however, had clearly talked to the old doctor and came on hostile and rude. The nurse was polite initially and then after going out of the room with the doctor, she was also hostile and thorny when she returned. This doctor also refused to do the needed monitoring tests and declared that I would come to regret not following their advice to return to my mostly vegetarian, low-fat diet, which had led me to diabetes in the first place.

Pizza-baked zucchini that turns out to be a very healthy choice - Creative Commons image by LuckyNessa via Flickr.com

Many rural or general practice doctors are still using the same diabetes treatments advised fifty years ago, and I couldn’t find a doctor in my local area who would even consider the efficacy of the low-carb diet that had given me my health back. Finally, I found a doctor who is open to the more recent research and who will take my insurance… in another state, over some high mountain passes, more than 120 miles away.

That was about when the Supreme Court leak happened, and a light-bulb went on in my brain. So, this is what “making decisions about your own body” means. This must be a bit what it feels like to be told that, “No, even though you might die, you can’t have this particular medical care because we don’t think it’s right.” Maybe it’s also how trans folks feel when trying to get transition care.

I’m this person facing a life-threatening health problem. I find a solution that works. I feel better. With the proper health care, I can conquer this condition. I can live again and there is no particular, studied, documented reason why my choice is bad. And yet, I’m told “no,” again and again, treated with hostility and discourtesy. I am forced to travel across state lines to get health care.

So, I’ve got to give some respect to those who have campaigned on reproductive rights and even on trans rights. Because there’s a part of it I get now that I didn’t get before this moment when something like that came and bit me too.

I have more reason to check that “pro-choice” box now. And I see that it is actually aptly named. It isn’t just about being against back alley abortion. It’s about the whole concept of people having the final say over their bodies and their health. Doctors should advise, yes. But they should also stay up-to-date as their field changes. When an individual is different from others, they must treat the individual, not the statistics.

And in the end, when a person makes a choice for their health and body, after listening to all the advice and considering all the factors, they must be treated with respect and given the care appropriate to that choice, even if the doctor doesn’t entirely understand. We can’t choose for someone else and there is much more under the sun than any of us can know with certainty.

From the other side of a health choice that went against the grain, I’m here to tell you to listen to your body. Follow what works for your body—not what is fashionable or intriguing or trendy or “natural” or feels good in the moment—but what gives your body sustained strength and health. Pay attention to that and find health care providers who do as well.

I just hiked up a mountain and back and felt great while doing it, after years of foot and leg problems, unexplained weight gain, difficulty exercising, chronic fatigue and other symptoms made me think I would never be able to hike again. Anything that makes a body get that much better is a wise choice.