Putting the “Morph” Into “Dysmorphia”

I have never been able to look at myself in a mirror, then look at a crowd of people and point to one who looked like me.

For years, I would point to someone and ask whoever I was with “Is that what I look like?” It must have felt to them like I was fishing for compliments, because that’s usually what I got in return. What I really wanted to know was how I appear to other people, because I can’t tell.

What I did know was how much space I took up. I knew how far back the seat of the car should be. I knew looking at a chair whether or not it would be comfortable. Whether there would be enough room for me on a bench with other people sitting on it. Whether a particular pair of pants or shirt would fit me. Whether, if I parked my car in a certain place, I would be able to open my door wide enough to get out.

But things have changed.

I recently bought some new jeans, because the old ones were uncomfortably large. What arrived was a size smaller than I thought I had ordered, and I held them up and thought “I couldn’t fit one leg into these things.” And yet, not only do they fit, they fit loosely. I can park in smaller spaces and still get out of my car. I can sit in an armchair and cross my legs up on the seat and still fit.

You would think that would be a good thing, but what it means is that my dysmorphia is now complete. I have lost the one thing about my body I thought I knew – how much space I took up. When I look in the mirror, I don’t see that my body has changed, because although my face looks thinner, my proportions are still the same. When I look in the mirror, I have nothing else to compare myself too, so I can’t see that my body has actually gotten smaller.

It doesn’t help that I am still wearing a lot of the clothes I wore at my heaviest. My leggings, for example, wrinkle even at my widest points and no longer compress me at the waist, but they don’t fall off. I have a drawer full of t-shirts that have gone from painted-on to a bit loose, but they still fit. Almost 75 pounds down, I am still wearing the same underpants, although I am less prone to wedgies.

Part of me wants to believe that I will come to recognize this new body. Not just how much space it takes up, but its shape and texture. But when I do, will I love that body as well?

 

Weight Loss in the Time of Coronavirus

There’s a well-understood phenomenon that comes along with bariatric surgery called “dumping syndrome.” When a person who’s undergone bariatric surgery eats too many carbs, their body can respond with vomiting, diarrhea, extreme fatigue, rapid heartbeat, flushing, sweating, light-headedness, loss of concentration, and unconsciousness. It sounds dire, but it’s not life-threatening and usually just signals that you should knock it off, for crying out loud.

But then, along comes COVID-19, and all bets are off. Stress is at an all-time high as people are told to stay home, grocery store shelves are empty, infection rates and death tolls rise, and the truth about our poorly-managed healthcare system is revealed. Being unable to leave the house while simultaneously being bombarded with terrible news is a perfect recipe for stress eating, and stress eating is very often carb-rich. Snacks, baked goods, comfort foods – they’re mostly carbs, and therefore off limits for the bariatric patient. And yet, like everyone else, I’m only human and I only have so many outlets for relieving stress when I can’t leave the house.

Couple this with the fact that it’s spring. Here, it’s been raining for days, which means a lot of mold, to which I’m allergic. And when it dries out, everything is in bloom and spewing pollen into the air, to which I’m allergic. My nose is running like a marathoner and I’m sneezing constantly, and even though these aren’t symptoms of COVID-19, I’ve gotten death stares from people at the grocery store.

Which brings me to the point where I’m sitting on the toilet in some pretty acute distress, my forehead beaded with sweat, worried that the next time I sneeze I’m going to spew from both ends in a way that will involve a whole lot of cleaning up. And because it’s March 17, 2020, my mind does not go immediately to the tamale and beans I had for dinner last night. It goes to coronavirus. And the fact that my daughter, who was staying with us for the past few days and has only just gone home, has a compromised immune system.

It took me way too long to connect my symptoms to dumping syndrome, and once I made the connection, I immediately felt better. But it’s scary that this is what life looks like right now. Every time my nose itches or I feel a little warm (so, add climate change into this mix) or I have a tickle in my throat, I worry that I’m a plague victim, and a danger to the people I love most.

Like everyone else, I don’t know how long this is going to last, or what the world will look like once it’s over, but I do know that the only way to get through this thing will be to take great care of myself and the people around me. I hope you all can do the same, and that if you’re in a tight spot, there will be people there for you.

 

Physical Therapy

Our daughter moved into her own place, and my husband and I have been making her room over into a guest room. The bed wasn’t as cushy as I’d like, so I put one of those memory foam mattress toppers onto it. This thing was a Costco special – fully three inches thick and, for a queen-sized bed, weighing about 20 pounds. As I wrestled it from its packaging and turned and twisted to distribute it over the mattress, I pulled something in my back and ended up in bed lying on a bag of ice for a couple of days.

About 17 years ago, I had a similar incident. I was sitting on the couch, sneezed, felt my back pop, and was immediately in agony. Back then, I went to my regular doctor. He prodded my butt, announced that I hadn’t done any permanent damage, told me it was probably due to my weight, and gave me nasal spray for my allergies.

I couldn’t stand for long. I couldn’t sit down. I couldn’t lie down. In order to bend over, I had to keep my right leg straight and extend it behind me. The only time I wasn’t in agony was when I was walking slowly, but I had an office job and two small children and so couldn’t do that all day. So I gritted my teeth, ate ibuprofen like candy, and bore with the pain.

I went to another doctor, and she said the same thing – “You’re too fat.” No offers to give me anything to alleviate my pain, no recommendations for ice or heat or stretching or goat sacrifices. Just an opinion about a tangential fact.

The frustrating thing wasn’t that I went to at least one more doctor who also told me it was weight-related. By that time, I had become resigned to living a life in pain and being unable to get medical help. The frustrating thing was that, as an office worker, I had a limited amount of sick time, and, since I was new at this particular job, no vacation time. Taking half a day off to see a doctor who didn’t even try to help, and having to cough up a $20 copay for the privilege, was a classic example of adding insult to injury.

This time around, I went straight to a chiropractor*. We talked extensively about my medical history. He asked me to stand and looked at me from many angles. He had me lie on my back, front, each side. He poked, pressed, probed and asked “How is that?” Finally, he did some adjustments and some deep tissue work, and I walked out of there feeling much, much better.

The entire time I was there, I fully expected him to say something like “I can work on you, but I’m not sure how effective it’s going to be, considering your weight.” Or “We can try to fix your back, but your best bet would be to lose weight.” When I went into the exam room and looked at the table, I thought There’s no way I’m fitting on that table without my hips hanging off the sides. When he took me into another room with a table specifically for lower-back stretching, I had a flash of fear that I would be too heavy for the table to work.

None of that happened.

This guy was polite, professional, competent, helpful. When I sat or lay on the tables, they didn’t even squeak, let alone groan with strain. I walked out of there feeling like I had been thoroughly listened to by a person invested in my well-being, and it felt a little surreal. Is this how it is for thin people all the time? And if it is, do you understand what a gift it is?

So now I’m angry on behalf of past me, who endured two years of unspeakable pain because the medical establishment couldn’t be bothered to look past an appearance they found displeasing to do their jobs, and I’m angry on behalf of everyone who is still suffering because of the judgement of medical professionals.


*The first time this happened, it was a chiropractor who finally figured out what happened. I blew a disc in my spine, and in the two years I couldn’t get treatment, the vertebrae on either side of it had fused, very slowly killing the nerve between them. Which is less pleasant than it sounds.

You May Not Be Fat, But You’re Still Fucked Up

Ever since I started these posts, people have been flocking to me, wanting to talk about their own experiences of weight. Many of them have BMIs* in the “morbidly obese” category (a BMI greater than 40), but just as many of them are what I think of as a “media-normal” weight, that is to say close to the size and shape that people in the media tend to appear.**

When thinner people want to talk about fat, the conversation always starts out the same way: “I lost a lot of weight, and…” But drill down on what “a lot of weight” is, and it almost always turns out to be 30 pounds or less. Don’t get me wrong – it’s fucking HARD to lose weight, and 30 pounds is a considerable accomplishment. Anyone who’s lost 30 pounds has a great deal more sympathy for those still struggling than people who cry about wanting to lose “that last 5 pounds” but have never had a BMI above “normal.”

What’s sad to me is that even those 30 pounds are enough to make many people panic, and to have friends and family begin the cycle of well-meant advice and snotty, skinnier-than-thou remarks. To these folks, those 30 pounds are often admitted to like a dark secret (as though people who saw you in the past could see how your thighs touched or your upper arms wobbled or whatever your hallmark of fat was), and I suspect the reaction they’re looking for is “NO! YOU?” That would reassure them no one could see the moral stain of excess weight. As though knowing they weighed more in the past would make me think any different about them than I do in the present. As though 30 excess pounds is the equivalent of murdering kittens.

It breaks my heart to hear how those people who’ve had a few excess pounds and shed them often talk about the unpleasant things they did to lose the weight. “I gave up all starches.” “I exercised three hours a day.” “I ate nothing but celery for a week.” “I fasted for 20 hours a day.” None of them say “And the whole time, I felt like Superman!” But they did it because they felt they had to suffer and sacrifice, not just to lose weight, but to atone for having gained it in the first place. And the more extreme and unhealthy their dieting journey, the more skinny people laud them for having endured it to re-enter the Company of the Comely.

Weight fluctuates for such a huge variety of reasons, from a slower metabolism due to aging, to the body’s need to conserve resources when it thinks it’s in crisis. People should be kinder to themselves about their bodies’ own changes. Love yourself, not by ensuring that you look attractive to someone else, but my making sure that you feel healthy, strong, and at peace. And if you feel those things at 30 pounds more, you’re fine.


*I use BMI here only because it’s a commonly-used metric. Please remember that both the entire notion of “body mass index” that supposedly measures your lean/fat ratio and the labels attached to various numbers on that index are utterly arbitrary.

**I say “tend to appear,” because we all know that anyone who looks “normal” on television or in the movies is likely a miniature stick figure in real life. I’ve seen Jane Fonda in person. She’s 5′ 8″ and weighs 4 pounds.

Thanks For Your Concern

“I just want you to be healthy.”

“You look so uncomfortable.”

“You’d feel so much better.”

I’ve heard it, usually coupled with some kind of advice that I’ve heard a thousand billion times before. Advice like “get more exercise,” “eat more vegetables,” and “drink more water.” I’ve done those things, and was probably still doing them. And I’ve lost weight. And then gained it back. And then lost it again.

And people say those things as though I might not have thought these things myself – as though I hate myself with such intensity that I’m committing suicide by cheese (although if I were going to off myself, that would be my choice).

But they’re not saying it because they’re actually concerned. They’re saying it to signal disapproval without sounding actually mean. “I just want you to be healthy” is code for “I feel disgust watching you eat.” “You look so uncomfortable” is code for “I feel uncomfortable when I look at you.” “You’d feel so much better” is code for “I’d feel so much better.”

But none of these barbs disguised as concern or advice help, because that’s not how it works. If it were as easy as “eat less move more,” everyone in a wheelchair or hospital bed would be obese, and everyone who ate vegetables and exercised would be skinny. But I’ve been obese my entire adult life (with occasional flashes of thin), and I know as well as you do that it’s so much more complicated than that.

Environment is a factor. Hormones are a factor. Psychology is a factor. Genetics play a part. If your family is heavy, you’ll be heavy. My mother’s family is from Scotland, and that side of my family is typically short and sturdily built. We totally look like the kind of people who can throw telephone poles and carry a sheep under each arm. My father’s side of the family are Mexican, and are generally taller and thinner. I started out with a 50/50 shot. Guess which I got (cue sad trumpet).

Long before I even considered surgery, I ate a healthy diet and got plenty of exercise, and seethed whenever someone expressed “concern” about my size. So I just stopped listening. I cordially invited those people who felt the need to comment to shut the fuck up.

If you were really concerned about me, you would tell me you love my dress. You’d tell me you read that story I got published. You’d tell me you think I’m smart. If you really cared about me, you wouldn’t want me to feel like crap about myself by not-even-subtly telling me that you feel bad looking at me. That’s your problem, not mine.

 

 

Clothing a Lava Lamp

Two months after my surgery, I have lost 40 pounds, and I’ve started The Pile – all the clothes I can’t wear because they’re now too big.

At my heaviest, I had three kinds of clothes – those that were slightly too tight, but I could still fasten, breathe in, and move around in; those that were big and loose and baggy (and therefore comfortable); and the Goldilocks clothes that fit just right. By far, this was the smallest group, and now, it’s even smaller.

Clothing you buy off the rack was designed to fit one specific shape of person, and odds are excellent it’s not you. It doesn’t help that for women, clothes sizing has come unmoored from anything as objective as measurements. The dresses I fit into have all come from the same brand, and range in size from 16 to 22. Apart from that brand, I’ve got 14s that fit. Most women I know would give up vanity sizing just to be able to go into any store and know that every garment of a given size will have consistent measurements.

But even if you know that you’re, say 5′ 7″ and weigh about 200 pounds and know your measurements, you’re not going to be able to breeze into a store and find a garment that fits and flatters. Everyone carries their weight a little differently. What’s worse is that as the weight comes off, it’s not like it comes off evenly all around. My face got thinner immediately. My calves and thighs got thinner because I exercise by running. My belly? Not so much. I worry that I’m going to end up like some kind of bug – a gigantic body being held up by tiny stick limbs. What kind of clothes fit Gregor Samsa?

What’s even more frustrating is trying on all the clothes in my closet that used to wear before I gained weight. Many of them don’t fit, even though I weigh less than I did when I wore them, because I’ve changed shape. I had some clothes I really loved, and now I’m worried that I won’t ever be able to wear them, because by the time things fit around my hips, they’re too big in the waist, or by the time I can button a shirt over my boobs, it’s huge and boxy around the middle.

The biggest challenge, though, is the changing size/dysmorphia/specific taste trifecta. I know the look I’m going for, but I have no idea whether, when I hit my goal weight, it’ll look good. I guess I’ll have to do what I’ve always done: I just assume I’m the most amazing looking person in the room.

 

But You Don’t LOOK That Big

As I’ve talked to people about my experiences with bariatric surgery, I’ve heard the same thing over and over – “But you didn’t look that big.” “I never thought of you as fat.” “I just thought of you as my normal friend.” It reminds me of things I’ve heard about other parts of my identity: “You don’t look Mexican.” “I never think of you as introverted.” “I just thought of you as my normal friend.” But just because you don’t acknowledge one part of my identity doesn’t mean I don’t live it. And when denial of the problem is the response to the fact of my surgery, it assumes exactly the thing I was trying to avoid: that I did it because I wanted to improve my appearance.

I’ve talked about the numbers, but if you’ve read my earlier posts, you know that just numbers don’t tell the whole story. The experience of living in a body that carries a significant amount of excess weight is constant, it’s difficult, it’s humiliating.

The insults and limitations start at the beginning of every day. I get up and go to my dresser or my closet, and think “What can I wear that is both comfortable and doesn’t make me look like I’ve given up on myself?” Women’s bodies vary so much in shape, and as we gain and lose weight, that shape can change drastically, so it’s not a matter of finding a style of clothing that works for me, it’s a matter of finding a single brand, manufacturer, or single item of clothing that reliably fits and is comfortable (I am of the opinion that clothing that fits correctly and is comfortable is automatically flattering. Feel good, look good.)

Now I’m dressed, and I face the challenge of breakfast. What to have? I could skip breakfast, telling myself that I’m sparing myself the calories, but I also know that one of the down sides of having a suppressed metabolism is that if I miss a meal, it may spur my body to either eat more at my next meal to “make up” for it, or to hang onto calories it would otherwise burn easily because it’s in starvation mode. So, skipping breakfast not a great idea. Most days I’d have tea (I don’t drink coffee, but I drink so much tea…) and toast, perhaps some fruit.

Now comes the challenge of incorporating exercise into my day. I would sit at my desk for a few hours working on stuff, and the longer I sat at my desk, the more guilt I felt because I know I should be getting my steps in, should be taking breaks to walk around, etc. But because I work from home, if I got up from my desk, I had a choice between go out for a walk or getting actual chores done, and there are always chores that need to get done. This is a reality for a whole lot of people – the time it takes to work out is a luxury a lot of folks just can’t afford. Similarly, if I’m out running around on errands and it’s way past lunch time and my toast and tea have worn off, it’s easy to make choices that aren’t the healthiest. Have you ever tried eating a salad while driving down the freeway? It’s worse than texting. But you can eat chicken fingers with one hand.

Dinner time is the next hazard. I have a family, and nobody has the time to make three entirely different meals and then clean up afterward. It means that there was not just food that wasn’t the best for me (tons of pasta) but a whole lot of it (because my family can put away a whole lot of pasta). Worse, there were a lot of days that we didn’t even start thinking about dinner until it was too late in the day to begin cooking, so we opted for take out – pizza, Indian, Thai, Chinese. And I would eat not just because I was hungry at the end of the day, but to be social with my family and to ease the tension and stress of the day. It wasn’t uncommon to get up from the dinner table with some variation of “I’m stuffed!”

Bedtime. The final challenge. By bedtime, my lower back and left hip were so painful that I knew I won’t be able to sleep. I take ibuprofen, I take CBD, I put a couple of Salonpas patches on my lower back and hip. One doctor said I should stretch more because I hike without stretching first. Another just said to take more pain killers. Every doctor said “lose weight,” although not one would tell me how. It could be hard to fall asleep and impossible to stay asleep because the pain in my lower back was so great.

And then I would get up the next day and do it over again. And none of this includes doing things like shopping for clothes (I couldn’t walk into a mall, go into any clothing store, and count on finding clothes that would fit me), taking public transportation (being embarrassed because people would rather stand than sit next to me on the bus, and if they were standing and I was sitting, it wasn’t unusual to get hostile stares from them as though I were purposely denying them a seat), grocery shopping (the feeling of shame and self loathing as I put things like ice cream or potato chips in my cart, even if those things weren’t for me), or doing anything that required me to ask someone for help in person (it would be unusual to get the attention of a service worker, and when I did, they were almost never motivated to put much effort into helping me solve my problem).

So, while I appreciate that you didn’t see me as fat, I hope that you understand that I didn’t do this to change anyone’s opinion of me. That’s ultimately not my business. I did it because there were realities of my day-to-day existence that I didn’t want to live with anymore.

The Hard Part Isn’t What You Think

It’s been five weeks since my surgery. At this point, the pain from the surgical sites is gone (although that’s only been in the last week), and as of tomorrow, I’ll be able to eat regular food. I’ve lost just a hair under 30 pounds.

When I was first contemplating surgery, I understood that my eating habits would be changed forever, but I don’t think I really understood the mechanisms behind it. I knew that the surgery itself wasn’t going to be what took the weight off. It would be the diet and exercise that happened afterward. While that’s strictly true, none of it is happening the way I thought it would.

Won’t or Can’t

In the 34 hours I was in the hospital, they tried feeding me 3 times. Each time, I was able to take a few sips of water and about as much food as would fill half a baby spoon. That was it.

Over the next two weeks, I had nothing but liquids – protein drinks and shakes, three times a day for the first week, supposedly going up to five times a day the second. Except that I couldn’t. It would take me half an hour or more to drink the entire 8 ounces of liquid, and by the time I was due to have my next protein drink, I was still full from the last one. And being too full meant risking vomiting. My one goal through this whole process has been to never vomit.

Week 3, I graduated to “blenderized” food. “Blenderized” meant baby food consistency. Which meant a lot of actual baby food. If you add salt and spices, it tastes like food. I put a chicken breast in the blender with an equal amount of chicken stock, giving me about 32 ounces of chicken baby food. Here’s another issue: since I could only eat ~2 ounces of chicken at a time, I had enough for 16 meals. Even eating 4 meals a day, that’s 4 solid days’ worth of food, and who wants to eat the same thing every meal? If I put 2 ounces of chicken and an ounce of veggies in my dish, I was often still too full for my next meal. Sometimes, nausea from pain made eating hard.

Week 5, I progressed to “soft” food. By now, I can eat 4 ounces at a meal – four and a half, sometimes. Any more than that, and I can’t do it, and I’m too full for my next meal.

All this is to say, it’s not that I won’t eat, or that I don’t want to as in I have no desire for food (although that’s certainly true, for the most part). It’s that often, I can’t eat.

What does “rapid” mean?

All the literature I was given said “You will lose 10-20 pounds in the first two weeks, 30% of your goal in 3-4 months, half in 6. You will plateau in 12-18 months.” It seems pretty fast. I did lose 20 pounds in the first 3 weeks. And I hit my 30% goal about a week later. I credited the rapid loss to the fact that I was eating almost nothing but protein and vitamins.

I log everything I eat so I can ensure I’m getting enough protein – too little and you can lose muscle and your hair will fall out. I eat somewhere between 350 and 550 calories in a day (meaning I have never had fewer than 350, or more than 550). So I know exactly how much I’m taking in versus how much I’m putting out. Every day, I’m on the treadmill for between 30 and 60 minutes, although yesterday, I took my first hike since my surgery.

I stopped weighing myself every day after the first day I gained a pound relative to the day before. How can a person eat almost nothing and not only still function, but put on weight? Beats the fuck out of me. Years ago, I read an article dating back to WWII that detailed Queen Elizabeth’s very frugal diet (I presume to prove to people that the monarch wasn’t living opulently whilst her people were doing without) that said that the Queen’s diet amounted to about 750 calories per day. At the time, I couldn’t believe that anyone could function for a long time on that little. Right about now, I don’t think it’s even possible for me to take in 750 calories in a single day, and I’m functioning just fine.

I weigh in on Mondays, and take my measurements so I can see not just how many pounds I’m losing, but how many inches. This past week, I lost a single pound, and gained 2.5 inches in my hips.

Half the game is 90% mental

Here’s the hardest part of the whole thing: Not losing weight, occasionally even gaining, is phenomenally discouraging. Downright depressing. And yet, I can’t angrily binge eat a pizza or down three Snickers in my car where no one will see me. If I eat the sugar, I’ll get violently sick. And at this point, the pizza would likely make me sick as well. Doing anything except taking care of myself will literally make me sick. And the only thing worse than being depressed is being depressed and sick.

Which means that the only thing I can do when I get depressed is to look at the horizon. I can’t afford to think short term anymore. Being discouraged now is just an emotional state. It doesn’t have anything to do with how I eat, exercise, take my meds.

It’s still early days for me, and yet, I don’t feel like the same person I was five weeks ago. We’ll see where that goes.

 

Part 5: Self Image

On October 22, 2019, I had a sleeve gastrectomy. I went into this process knowing that this would forever change my relationship to food and my body. This is part of a series of posts covering my history with food, weight loss, and my body. All opinions expressed in these posts are my own, and reflect my own lived experience. Nothing said here should be generalized, or taken as a suggestion for others. If you’re considering weight loss surgery, your first step is to reach out to your doctor.

My “Real” Family

Like a lot of children, I harbored the fantasy that the people I lived with weren’t my real family. My real family was kind and supportive. They valued the things I did and said, and liked having me around.

Because I read constantly, I had more than my own family and those of my friends to compare my life to. In fiction, everyone, no matter how unattractive, undeserving, or unlikeable, got partnered up with the person of their dreams. If it could happen in fiction, it was possible. People believed it could be true. Which meant that, despite the messages my family gave me, my ideal person was out there.

The hard part to keep in mind wasn’t that I could find my perfect person. It wasn’t even believing that this perfect person would like me. It was believing that I was deserving of a fulfilling relationship.

Where to Start?

Believing I’m deserving is complicated. If my only problem was being fat, I think I could have overcome that to be the kind of in-your-face, larger-than-life personality whose larger-than-life body was just part of the package. Sadly, my family was one of millions affected by the recession of the early 1970s, so I wasn’t just fat, I was also poor. My family is mixed race, and my parents were divorced before I even got to kindergarten. All these were strikes against me, and the ones that my family didn’t despise me for, the rest of my peers and neighbors did.

I was never mocked for my size in school, but I was mocked for my clothes – secondhand, and far out of date, sometimes dirty because my mother, a single parent of four kids who worked a day job and was also trying to finish up the college degree that four children started at age 18 had interrupted, couldn’t singlehandedly keep up with all the housework.

Worse, I was isolated from some of my friends, who weren’t allowed to come to my house because my mother was divorced. I have no idea what the parents of those kids thought would happen, but it was just another thing that marked me out as different. And every additional difference made me a little less deserving of the kind of life I dreamed of.

The Building Blocks of Self Esteem

Once I was too old to wear hand-me-downs, I had to figure out my own style. I did what everyone does – I spent my late teens and early twenties with bad perms, goofy outfits, and ridiculous makeup on my way to finding what worked for me. But the basis of finding one’s personal style is the belief that there’s something to work with – some good features to highlight, the possibility of hiding some flaws.

The first, and hardest, step was finding clothes that fit. When you’re larger than the largest size carried in most stores, your options drop off steeply. There have always been a few stores that cater to larger women, but not as many as there are today – and when I was in college, online shopping was still a distant dream. Clothes for larger women were usually for older women – the kind of gaudy floral prints your grandmother might wear, made into shapeless sacks. Finding a piece of clothing that both fit and looked good was a rare score. Slowly, I built a wardrobe that at least made me feel like a normal person.

Take Me As I Am

What I really wanted was what everyone wants – to have people think I looked good as I was. But that’s so complicated. Knowing I am fat, there’s a complicated logic that goes into feeling good. “If this person finds me attractive, my makeup and clothes must be fooling them.” Which means that I couldn’t be caught out with no makeup in sweatpants (she types while hanging out on the couch with no makeup and in sweatpants). There is also the deep knowledge that any photo of me will reveal what the naked eye doesn’t – that I’m fat. Pervading every clothing or makeup choice, every hairstyle, every carefully posed selfie is the central belief that to be fat is to be the worst, most reprehensible thing a person can be.

It has taken me nearly half a century, but I had finally made peace with the complicated mental gymnastics that go into being fat. With each grudging acceptance of the reality of my life – that I’m fat, that I’m a good person, that people find me fun to be with, that my children love me, that my husband finds me desirable – I could stand to look at myself with one less filter. Up to and including having a full-length mirror next to my dresser, so I end up seeing myself as I get dressed every morning. A sobering sight if ever there was one.

Which Leads to New Fears

Accepting myself has been a war I have to fight every minute of every day, and I don’t win every battle. But honestly, I feel that it’s a battle worth fighting. Learning to love myself as I am is the most important thing I can do not just for myself, but for my children who are bombarded with media messages that there is a “perfect” kind of person to be, and it isn’t necessarily the kind of person they are.

That’s why one of my biggest fears has been that people will see the changes to my body and think “oh, good, she’s finally doing something about all that excess weight.” And while that’s true, all most people are thinking is that I will become more attractive (or, at the very least, less unattractive) to look at. And that notion offends me.

Losing weight is hard. Harder for women than for men, and harder for people who have spent their lives dieting and thereby killing their own metabolisms than for people who’ve been thin most of their lives. But even with surgery that will boost my metabolism, I can’t continue to live the life I had before and still lose the weight that’s making my joints and back hurt.

I haven’t eaten more than 500 calories in a day since my surgery, and for more than a week before that, not more than 750. Because surgery has enhanced my metabolism, it means that I’m burning through a lot more calories than I was before, but taking in practically nothing. I feel weak sometimes, and a little dizzy. The pain from the surgery was excruciating for the first few days, and now, 18 days on, it has died back to a dull ache in one localized place. I still have to be careful about overdoing it, meaning that my family has had to pick up the slack for household chores. I will have to take specialized vitamins for the rest of my life, because I won’t ever be able to eat enough food or in the right proportions to stay healthy without them.

I wouldn’t have gone through the pain and expense and inconvenience to my family just so that random strangers will think I’m attractive. There is nothing the admiration of a stranger gets me, apart from attention that makes me uncomfortable. But even saying “I did this for me” leaves that nagging voice in my head: “You don’t deserve it.”

Next time, I’ll talk about the challenges in the run up to surgery. 

Part 4: All the Numbers

On October 22, 2019, I had a sleeve gastrectomy. I went into this process knowing that this would forever change my relationship to food and my body. This is part of a series of posts covering my history with food, weight loss, and my body. All opinions expressed in these posts are my own, and reflect my own lived experience. Nothing said here should be generalized, or taken as a suggestion for others. If you’re considering weight loss surgery, your first step is to reach out to your doctor.

Prurient Curiosity

There’s a class of questions everyone secretly wants to know, but is afraid to ask because weight and size are such fraught topics in our society. Those questions are all about numbers – how much did you weigh? How much did you lose? How much do you expect to lose? How long will it take?

Let’s start at the beginning.

When I first went to the doctor for a consultation, I weighed in at 243.8. For years, I had gone to every doctor’s visit and refused to be weighed. For most things, that datum isn’t relevant. I wasn’t surprised by the number, but certainly I was disappointed by it, although in a way, hopeful. My biggest fear was that I wouldn’t qualify for surgery. According to my doctor, the criteria was either a BMI of 40 or more, or a BMI of 35 or more and one or more co-morbidities – obstructive sleep apnea, high blood pressure, diabetes, high cholesterol (yes, no, no, no).  My BMI was 39.6. I was so relieved that I qualified, I nearly cried.

At that appointment, I was given a pre-surgery consultation appointment about 2 weeks later where I would receive my surgery date, get all my pre-surgery instructions, and get a list of the resources that would help me both before and after the process.

At the pre-surgery appointment, I was told that I needed to lose 5-10 pounds before surgery in order to shrink my liver (the stomach is under the liver, so shrinking it makes surgery easier and safer). And in the 2 weeks since my initial consultation, my weight had gone up to 245.4.

Ten days before my surgery, I started a liquid diet. Three times a day, I had a protein shake and a liquid protein drink. The shake was big, and could be really thick, so the ten days went by pretty quickly without my feeling very deprived. When I did feel sad, I could just look at the calendar and say “I can do this for another 5 days.” On the day of surgery, my weight was recorded as 238.7.

Where Do You Want to Be?

When I first considered this surgery,  it was because I had had back issues for years. I couldn’t lay in bed for more than a couple of minutes after waking, because the pain in my lower back (from the blown disc I talked about in Part 3) would become excruciating.  In the last year, I’d also had a problem with my left hip – it hurt when I lay on my side, or when I sat for too long. The doctor diagnosed it as bursitis. (I think if you’re old enough to have bursitis, you automatically have to put “the” in front of things like Google and Facebook.)

As I filled in the paperwork for surgery, I was asked several times what my goal weight would be. It was frustrating because even though the women recording my information were very encouraging and said “It doesn’t matter, we just have to put something down,” they didn’t give me any guidance. They told me what my BMI was, but not what a “healthy” BMI should be, nor what that would translate to in pounds. A “healthy” BMI is between 18.5 and 24.9, which would put my “healthy” weight between 115 and 154. That’s a 40-pound spread.

It’s really hard to know what your “ideal” look is, because even women of the same height and weight can have very different body types. With no guidance, I arbitrarily chose 160. I now know that the number you choose is important – it’s what the doctor will use to qualify whether your surgery and long-term outcome are a “success,” which is defined as keeping off at least 50% of your excess weight for 5 or more years. The success rate of gastric sleeve surgery is upward of 80%.

What Happens Next?

Doing a little math, we can see that my goal weight is 85.4 pounds less than my highest starting weight. I lost a few pounds before surgery, and as of right now, I’m down 21.6 pounds from that highest weight. It was easy, because for the first two weeks after surgery I was on a completely liquid diet, drinking clear protein drinks recommended by my doctor. Each packet of powder was to be mixed with ~8 ounces of water, and it was really, really hard to get that much stuff into my body. Surgery hadn’t just cut off a huge portion of my stomach, it had left my insides swollen and uncomfortable. Often in the first couple of days, I would take a sip of water and then struggle not to vomit. Over the next few days, drinking all my protein got a little easier, but that protein stuff is kind of gross.

Now, two weeks in, I am on “blenderized” food – any food that can be sucked up through a straw. At first I joked about putting pizza and burgers into the blender, but I had a huge secret.

I am terrified to eat real food. 

I’m still in that mindset of “my food choices got me into this in the first place.” To top that off, the advice given for life after surgery can be conflicting – I need to get a specific percentage of protein, carbs, and fat, I need to get at least 60-80 grams of protein a day, I have to drink 60 ounces of water, but I can’t drink either 30 minutes before or 30 minutes after a meal, and I have to eat 5-6 times a day, and I should make my meals last 30-60 minutes. I can’t eat cruciferous vegetables for a few months after surgery, I can’t eat red meat until at least 6 months after surgery….I am paralyzed.

Don’t Overthink It

I said this to the doctor on my first follow-up visit, and he gave a small laugh and just said “You’re overthinking this. Just eat food. Nothing processed, wait on anything with too much fiber, no simple carbohydrates.”

The best advice I was given came from the dietitian I had to consult before my surgery. She told me to eat slowly enough that I would be able to tell when I went from “I’m hungry and want more,” to “I’m no longer invested in this.” Not waiting until I was full, but waiting until the food was less important.

To this end, I bought myself a set of coffee spoons and dessert forks. I already own a fairly large selection of sushi plates and sauce dishes, as well as a food scale.

lunch plate

The remains of 2 ounces of cottage cheese and 1 ounce of unsweetened applesauce. 

When I talked to my doctor about using tiny utensils and plates, he sort of laughed at me, as though it were some kind of affectation. What this tells me about my doctor is that, while he sees and deals with the bodies of severely obese patients every day, he doesn’t have much insight into the mental processes of the severely obese. By taking tiny bites, I can tell exactly how I’m feeling as I eat, and can pay attention to the point where continuing to eat is no longer compelling.

It’s a challenge. I’m supposed to eat 5-6 times a day, but I can eat 4 times, tops. Even then, I’ll portion myself out 3 or 4 ounces of food and can’t finish it. I have no idea how much longer that’ll be the case, but I’m really, really hoping that the habits I’m establishing now will have solidified and be the foundation of how I eat going forward.

Next time, I’ll talk about the ins and outs of self image for the fat.