When Food is the Enemy

When did food become our enemy

I see women in my practice every week who suffer from eating disorders (ED).   I never used to see men with  ED but that has changed. Still, the incidence is much less frequent than with women and, when it does present, it is often much less severe in nature. I used to see it more in gay men but now I see it far more in heterosexual men.  I also encounter it  more often as a condition on the disordered eating spectrum with most men regardless of sexual orientation,  rather than a full blown ED. 

In medical school I recall how many of the women I knew who would food restrict. I only knew of one male who would food restrict.   I actually got very thin myself, but quickly realized I needed food to stay awake most nights on call.

What’s on the menu?

It feels like we don’t know how to eat anymore. There is Keto this, low carb that, low fat vs clean eating. In the end we are at war with our bodies and food has become the enemy. When and why did food become a moral issue? I hear my patients say they were “so bad” because they had an extra piece of pie at a holiday dinner. It’s hard to imagine a world where we would accept the bodies we have rather than the bodies we wish we had. What will this imagined body bring us? Will it provide the elusive happiness we have been searching for?

Exercise is Healthy, right?

One of the latest eating disorders that has fallen on the more acceptable realm is ” Exercise Induced Bulemia.” Make no mistake it is still a compensatory way to maintain a lower body weight, but somehow it became socially acceptable to run, cycle or attend workouts at gyms that burn many calories. I frequently see women trying to keep up with their male partners. Sometimes it is the only way to spend significant time with them especially if they too have body image issues. Granted we are a more sedentary culture, but this is beyond going for the evening walk to move those stiff muscles at the end of the day.

Novel concept: eat when hungry

I am unsure of how to win this war on our bodies and the war on food. If my patient hates her body, I will ask her what about it she hates. She will usually say her double chin or her belly that hangs too low. What ever the “perceived defect” is, it likely originates from a place of self hatred. I listen and reflect back the negative and harsh feeling she feels at liberty to use against herself. Sometimes patients leave quickly if I won’t join them in this ritual of self hatred. Hopefully they stay and we can keep going deeper to understand this vicious attack on the self.

Thin Privilege

In recent times we are learning how certain groups are afforded more rights or privilege than others. As someone who grew up fat most of my life except for about ten years in medical school and residency, I know what it is like to be treated differently from thin people. I was also not a fat child or teen, but I ALWAYS felt like I could be thinner. I don’t think I know any women in or out of my practice that at sometime was not unhappy with her body. I see more women than men in my practice who are dieting or using extreme forms of exercise to maintain thinness. However, lately I see more men trying for that twenty something body well into midlife. Today’s discussion is not about trying to convince you that diets fail in 98% of people.  It is about how badly fat people are treated. It is also about the privilege I see afforded to thin people.

Seatbelt extenders are shameful

On airplanes seats are designed for thin people. At one time a major airline was requiring fat people to purchase two seats. I thought this was odd because up until age two a child can sit in a seat with the parent for free. Yet if you have an extra 20 pounds of fat you will need to purchase the extra room. What’s even more humiliating is having to ask for the seatbelt extender. You might fit in the seat but to safely sit there you will have to ask the flight attendant for the seatbelt extender. Why would anyone design a seat like that? Cars are not designed for seatbelt extenders. If you are a woman shopping for clothing in the plus size category, you will also  know that ten dollars gets added on for those sizes. As someone who sews, I highly doubt an additional ten dollars worth of fabric was used to make the garment and sewing a seam is sewing a seam.

Dieting makes us feel bad

Some of the most accomplished women in my practice “feel like failures” if their bodies have gained back the weight they worked so hard to lose. It is usually a repetitive cycle, they lose, they gain, they lose and gain time and time again. They only see that failure rather than their accomplishments as good friends, mother’s, doctors, lawyers, nurses etc. My job is not to stand in their way if they truly wish to diet to try to be thin. I am there to understand it with them. Why do they hate their bodies so much? What started the war with their bodies? Was it a mother who was always dieting? Was it something they learned?  Did a doctor tell them to lose weight?

It’s time stop hating Fat people

I am learning more about white privilege these days. I will admit I was unaware of how lucky I was to be afforded things others were not. I am now far more conscious of what I need to do to stop it in myself and my community. I know the time is also here to stop thin privilege as well. I am tired of seeing fat people ridiculed, passed over for jobs, labeled as lazy or unfit. It’s time to stop hating fat people.

Fat women hate Fat women too

I know I have had patients leave my practice because of my being overweight. Oddly the women who seemed upset with me were not the thin ones. It was the women who had body’s similar to mine. They wanted to see me as bad because I wouldn’t join them in hating their bodies. Thankfully through my own therapy I found a therapist who helped me stop the war with my own body. Each day I am grateful this body lets me dance, ride a bike, garden or walk. We must stop giving so much privilege to any group. For today I will think about ways I  might still conform to thin privilege, to be “the good fat person.” I would ask you to think about it too.

Fat Phobia

I am fat. I have been fat since I was in fourth grade. I got very thin in medical school mostly from not eating and dieting. The trouble was I could not keep the weight off. I felt like a failure when I gained back the weight. I weighed a whopping 142 pounds! Over the years and through my own therapy I realized I had to love the body that I had. That I was never going to be thin and that my constant rejection of my body would show up in other ways.

Weight Loss Rarely Lasts

What didn’t help was when my doctors would ask me, “have you ever thought about losing weight?” Are you kidding me?! I don’t know any overweight woman who has not thought about losing weight! Even the thin ones want to be thinner! I don’t know any woman who is truly in love with her body. In my practice so many women reject themselves and their bodies. I am also seeing it more now with men than I had in the past. There seems to be an association with thinness and happiness. Most of the doctors I see for any thing will typically counsel me at the end about weight loss. Thankfully, I have learned to tune it out. I know that weight loss only leads to weight gain and usually we add more back each time. I also know that after five years only 2% can keep the weight off. That is the same statistic as surviving pancreatic cancer. Why would I accept a prescription that has a 98% failure rate? A few years ago I had foot pain from what was diagnosed as a “stress reaction.”. The orthopedist told me I would likely improve if I lost weight. Well, that didn’t happen and HUZZAH my foot got better on it’s own. Guess that blew his theory out of the water.

Attacking our bodies is bad for our health

I am not going to pretend that my own negative feelings never come up now and again. What I must do is take on the battle of rejecting myself. This is what I teach my patients. It’s more about attacking myself rather than the actual struggle. When we reject our bodies it can show up as physical illness. It may show up as Lupus or another autoimmune disorder. Which by definition is the body attacking itself. I will teach my patient not to reject herself. Hopefully she will listen rather than believe I am “not on her side.”

Chickens are the best

This is a picture I would have hesitated to post many years ago because it does not depict a flattering image of myself, BUT this is who I am. I am fat and I love my chickens!