Ask Aunt Fattie, Disability, Fat, Health at Every Size

Ask Aunt Fattie: What if I never stop gaining weight?

Dear Aunt Fattie,

I am deeply afraid I will never stop gaining weight.

I am 25 years old and 250 pounds. When I was 15 I was 150 pounds. Throughout my life I’ve averaged a gain of 10 pounds per year. Sometimes that has slowed down or sped up, but it always averages out. I have never successfully lost any significant amount of weight, even after 9 months of anorexic behavior that landed me in the hospital with severe hypoglycemia and malnutrition. The fact that diets have never ever worked for me, even in the short term, has made it really easy to give up dieting and in the past 6 years my eating habits and overall relationship with food has more or less normalized. I love fruits, veggies, whole grains, and lean meats, and although my hypoglycemia means I have to eat frequently, it also makes it very easy to maintain a balanced diet–if I’ve had too much sugar and not enough protein, or too much fat and not enough greens, I feel it immediately. Although I don’t do much in the way of deliberate exercise, I am a full-time pedestrian and walk everywhere, often while hauling several dozen pounds of books or groceries. I also have a very active food-service job that keeps me moving and on my feet for 20-40 hours a week. In other words, although I could always do more, I feel like I am living a lifestyle that is consistent with HAES.

I am satisfied with my lifestyle and how healthy it makes me feel most of the time. But every time I go up yet another size in my jeans, I get afraid. I no longer believe that fat is bad, or ugly, or dangerous, but I feel like there must be something wrong with me. Shouldn’t my weight at least be stabilizing? Or maybe fluctuating? It can’t possibly be normal just to gain and gain with no end in sight while leading an objectively healthy lifestyle, can it?

I have started to believe that there must be something medically wrong with me. Perhaps whatever it is that makes my body so resistant to weight loss is the same thing that makes me continue to gain weight. But I am so afraid to seek medical treatment, especially about something directly involving my weight. I know all a doctor is going to do is tell me I must be lying about my lifestyle and send me out the door with directions to the nearest Weight Watchers or Overeaters Anonymous meeting. Hell, I had doctors trying to “help” me lose weight while I was in the hospital for malnutrition. You’ll have to forgive me if my trust threshold for medical professionals is pretty low. I don’t want to fall into the diet trap again– it’s futile and miserable and crazy-making–and I certainly don’t need to be paying a doctor to lead me there.

And yet I’m afraid if I don’t seek help, and I continue to gain weight at this rate, I could end up wheelchair- or home-bound, possibly as young as 50 or 60. I am no longer willing to engage in self-destructive behavior for the hope of weight loss, but I am also unwilling to resign myself to a compromised quality of life. I am starting to feel both helpless and hopeless. Please Aunt Fattie, what do I do?

– Scared and Gaining

Dear Scared,

Of course I forgive you if your trust threshold is low – that’s a reasonable and adaptive response to a history of mistreatment. But unfortunately, this is one of those times when you probably have to go hunting for a medical professional that you can trust. It sounds to me like you’re asking a couple of different questions here, and one of them I just can’t answer: that is, whether it’s possible that there’s some medical issue that’s making you gain weight. Well, okay, I can answer that: yes, it’s certainly possible. (It’s also possible that you just have a high natural setpoint and haven’t reached it yet because of past dieting behavior, but you’re probably the expert on whether it feels like something is wrong.) But that’s as far as my expertise goes – I can tell you, for instance, that something like Cushing’s Syndrome can lead to rapid weight gain, but I can’t collect your 24-hour urine sample and test it for cortisol, nor would I want to. So you have to go doc-hunting.

More on that in a minute, but first, I think you’re also asking a question that’s more in Aunt Fattie’s territory, to wit: can I be worried about my weight gain and still believe in fat acceptance? And the answer to that is a resounding yes. You talk about practicing HAES because you love vegetables and walk everywhere, but while Aunt Fattie always encourages eating the food you find most nourishing and choosing the movement that most invigorates you, veggies and walking aren’t what HAES is about. It’s about looking out for yourself and your health, physical and mental, without judgment or obligation. That could mean veggies and walking, or it could mean cake and five minutes to yourself for once, or it could even mean another day of deliberate food restriction but with one micron less self-hatred. It’s a spectrum and a process. But one thing HAES always means is taking care of your body as much as time, finances, and energy will permit. That means that if you think something is wrong and you have the ability to go to a doctor, you deserve – more, you owe yourself – a competent medical evaluation.

Of course, finding a competent evaluator is easier said than done, but it’s possible. It might be a long hard slog, but they’re out there – check the Fat Friendly Health Professionals list, and look at reviews on RateMDs. And don’t be afraid to fire and report people who don’t give you the respect you deserve. Think of it like hunting for any other vendor; you want to do your research, get quotes (though in this case it’ll be about emotional benefit, not financial cost), and choose the person you’re most comfortable working with. And if someone cheats you or betrays your trust, you let others know. This process is a pain, but once you find someone, you don’t have to worry about getting crap from your doctors anymore. And having an expert you really trust can do as much for your health as all the veggies in the world.

One final note: it’s possible that you will keep gaining weight, even if you do find a competent, trustworthy doctor. Just as I can’t diagnose you myself, I can’t rule out the possibility that you have a medical condition that’s not easily corrected. Either way, this may be a good time to let go of some of your fear of becoming disabled. Though it is always scary to think of our bodies as changing in drastic ways, becoming disabled is not the worst thing that can happen to a person. Many people who use wheelchairs, for instance, have joyful, rich lives – lives that are hard in certain specific ways, but not lives that they would consider worse than other people’s. To borrow a term from disability rights, we are all temporarily able-bodied; accepting your body with grace, as you are doing with fat acceptance, includes facing the fears you may have about what could happen to you.

If you’ve got your own questions on fat, fatphobia, fatshion, and fatiquette, send them to

31 thoughts on “Ask Aunt Fattie: What if I never stop gaining weight?”

  1. As a disabled woman, I have chronic pain every day, and I have for a couple years now. Many people expect that this makes every day difficult for me, and that I must teeter on the brink of depression. On the contrary, my life is joyful and fulfilling. I am happier now than I have ever been. Although I had to deal with many difficult emotions to get to this point, and dealing with them was frightening, it was worth it. There is nothing intrinsically depressing about disability. Disability is a construct; there are societies where it does not even exist. I have created my own standard of ability, and within my daily life, I am not disabled. Thank you for talking about disability in such an enlightened way.

  2. Scared and gaining, you sound like me ten years ago. I started gaining weight in puberty and just kept climbing. Dieting and exercise didn’t even slow it down. Toward the end, I was buying 2 to 3 completely new wardrobes in ONE YEAR, because the rate of gain kept increasing.

    I had a pituitary adenoma, as it turns out. A benign tumor on the pituitary gland. It’s relatively rare, and it took eight years of fighting with doctors to get it diagnosed.

    Once I started getting proper treatment, the weight gain stopped.

    See a doctor; be persistent. Ask to have your prolactin levels checked (it’s a simple blood test). Best of luck.

  3. Scared, how do your thyroid levels look? The first thing I think of when I hear “steady weight gain for years despite a reasonable diet and exercise” is “failing thyroid”. Mine gave out somewhat spectacularly when I was 10, and I wasn’t treated until I was 15 and didn’t get proper treatment until I was 26. (I had a nasty case, complicated by the fact that what I really needed was some counseling about what having a chronic illness would mean to the rest of my life.)

    One of the things that having too little thyroid hormone in your body does is drop your metabolism and mess up your body’s natural weight setpoint.

    I would strongly recommend finding a doctor who is willing to believe you when you self-report your food intake and activity levels. It might take a few tries, and doctor shopping is *not* fun. In the end, though, it would be worthwhile even if you find out that this is in fact normal for you.

  4. Scared, this is all good advice you are getting. If you go to your doctor with all your information and a litlte knowledge of what it could be (cushings, thyroid problem) they might be more likely to believe you. Make sure to bring up any other symptoms you seem to be having, even if it they seem totally unrelated. chances are they aren’t, and they might make the doctor more likely to believe you.

  5. I just want to echo to hang in there and try to find a good health professional. Money may be a concern, but see if you can find a compassionate GP, Nurse Practitioner or OB/GYN who may eventually refer you to an endocrinologist. Be as upfront as you can about your concerns with your health professionals — let them know you want to get to the bottom of what is happening — but that dieting is off the table. I think that some medical professionals out there are starting to get it — my last 3 main medical professionals in the last 8 or so years, including the one I saw when I was pregnant, were really great.
    Our bodies are amazing but imperfect.

  6. Another thing that can lead to consistent weight gain is diabetes. (and yes, the conventional diagnostic criteria say that only weight *loss* is a sign… it’s a serious problem since that is only the case for a type I patient. it can take a type II patient decades to damage their pancreas enough that they start losing weight like a type I patient.)

    A good doctor knows that there are *many* diseases that can cause weight gain like you describe. I don’t think we’ve hit on even half of them in the comments. It takes careful testing to figure out which one is the culprit for any particular person. If the doctor *just* wants to stick you on a diet, ignore them and find another. If they want you to keep a food and exercise diary, they do have good reasons… that data can make it easier for them to eliminate certain diseases and disorders from the list of candidates. If a food and exercise diary will be triggering for you, TELL THEM. Not all doctors have experience with eating disorders, so they might not know. (same goes for any other triggers you may have.) If the doctor will not believe you’ve had an eating disorder, run like hell.

  7. It’s highly unusual for anyone to gain 10 pounds a year, every year, from the time they’re 15 through the end of middle age. Most people level off at some point, especially if, like you, they are moderately active and not bingeing and not taking a medication that accelerates weight gain. You are not wrong to suspect that you might have some kind of metabolic disturbance. Unfortunately, there’s really no getting around the “seeing a health practitioner with a clue” thing to get to the bottom of it. It would be worth it to travel to another city, even, if you can’t find one where you live.

  8. Meowser, do you have a citation for your statement that gaining 10 pounds per year is “highly unusual”? I find it difficult to believe that supporting data could even be gathered, given how many people diet at some point in their lives and how many medicines do potentially cause weight gain.

  9. I mean it’s unusual to gain 10 pounds a year when you’re not on a weight-gaining medication. Certainly I gained weight at that level when I took Zoloft. The author of the letter didn’t say she was on such a medication, so I assumed that wasn’t happening.

  10. I’ve been lurking around here for a while, and one of the reasons I love this blog is that every so often it totally shifts my worldview. “Becoming disabled is not the worst thing that can happen to a person”? That… never even occurred to me. I like to think I’m fairly aware of my own privilege, but wow, it is pretty fucking ablist to assume that being in a wheelchair means your life is over. I know this was just an aside in the overall insightful, compassionate letter, but it’s a huge something new to think about for me. Thanks!

  11. Scared, I definitely think a trip to a caring, compassionate doctor is in order.

    However, I also wanted to mention this – I note that you’re 25. Acknowledging that the plural of anecdote is not “data”, I have known many people, especially women, whose bodies changed pretty dramatically during that span between ages 15 and 25.

    Most of us had reached our adult heights before that time, which is often what people think about when they talk about being “fully grown”, but just because we’re reached our adult heights didn’t mean we’d reached our adult bodies, if that makes any sense.

    Remember that weight/body size has a strong genetic component. Are there women in your family whose bodies are shaped like yours? If you’re on good terms with them, perhaps try to find out what sort of changes their bodies went through and when. Or even just do a bit of snooping in the old family photos, taking note of people’s ages in those photos, and compare them a bit to your photos at similar ages.

    I have to say, while I never really thought about it as such, I gained probably 90 pounds from age 15 to age 24, but then my weight stayed within a 10-15 pound range until I got pregnant at age 30. That was almost five years ago, and after some rapid-though-unsurprising fluctuations post-partum, once again my weight has held pretty darn steady for a good three years now.

    So while I think it’s a wise move for you to get checked out and make sure there isn’t some undiagnosed problem going on, it’s also possible that your body is just finishing the final stages of the shift from “adolescent” to “adult”, and soon you will be able to stop buying all new wardrobes every year (which, dude – I hear you. That shit SUCKED. My sympathies on that one).

  12. Okay, a summary of what people have suggested as possible reasons up to this point, and the medical tests you can ask for to rule these out:

    1) Cushing’s Syndrome – 24 hour urinary free cortisol survey
    2) Pituitary gland tumor – blood Prolactin levels
    3) Underactive thyroid – blood thyroid levels
    4) Type 2 diabetes – fasting blood sugar levels, 24 hour urine sample

    So, that’s two or three blood tests, and two urine tests you can go in and ask for. I’ve often found the best way to deal with my doctor is to go in with a firm idea of what I want, and what I’m after as a response, even if it’s just a repeat prescription for my thyroid or psych meds. [NB: small disclaimer – I’m an Australian in Australia, and deal with a different health care system to people in the US. Your mileage is almost certainly likely to vary].

    One other thing I’ve found by googling around – here’s a list of one hundred and sixty-one different conditions for which weight gain is a symptom. Obesity and Overweight are listed, but that still leaves your doctor with one hundred and fifty-nine of them to rule out.

  13. Thorn, great points.

    And Meg, that’s so weird — how can weight gain be a symptom of obesity? Still a useful list, though many of those conditions are quite rare.

    And since we’re talking about things like tumors, let me hasten to add that there are less catastrophic issues that can cause weight gain. I probably went up a size every couple of years with untreated PCOS, though that was complicated by dieting and disordered eating. Food intolerances and allergies could also contribute.

    Or, as Thorn said, you could just be growing into a body that’s going to end up bigger than you expected. Nothing wrong with that.

  14. Oh, and in re: Arwen’s “FJ, oops, Aunt Fattie” comment up there… it’s true that I’ve written the bulk of the Aunt Fattie posts so far (and posted them, which is why my byline’s up there), but I want to make it very clear that the disability paragraph is all SM. I only wish I were that conscious and sensitive about disability issues.

  15. Well, given the list includes things like Kleinfelter’s syndrome, which is easily ruled out if Scared is female (it only affects men), there’s a lot of stuff on it which can be ruled out fairly quickly and easily. I just like the fact there’s over a hundred and sixty different things which could be causing the weight gain, and the social default of “you’re just a glutton” is only covered by two of them. Says a lot about our society, doesn’t it?

    (Oh, and the list has weight gain listed as a symptom of anorexia nervosa… which will probably come as a shock to a lot of anorexic people out there).

  16. It’s true — Aunt Fattie is a collective effort, not just a name for FJ when she’s feeling cheeky! If you write to Aunt Fattie, you will get the full SP team weighing in on your problem.

  17. In fact, I’m probably going to input some questions and notes for future weeks, which means the posts will be under my name no matter who writes the bulk of them… so don’t go assuming this is all my project if you happen to see my byline!

  18. It’s true — Aunt Fattie is a collective effort, not just a name for FJ when she’s feeling cheeky! If you write to Aunt Fattie, you will get the full SP team weighing in on your problem.

    Well, so far, you just get 2/3 of the team, since all my lazy ass has contributed is, “Awesome! Post it!” But in theory, yeah, that’s how it works.

  19. On a note different than fat acceptance, I want to thank you (Aunt Fattie, sweet machine) for that last paragraph. I’m sitting here with tears in my eyes after reading it, because it really captured a journey I’ve been on – learning to accept disability, and learn to live with and even overcome the fear of what might happen in the future. I have retinitis pigmentosa, an eye disease. Right now, it means I have a little trouble with my peripheral vision and I have almost no night vision (dark areas/places, even inside, are a problem for me). But it also means I could go blind someday. I got diagnosed a year ago, and spent a long time in denial about this fact. Thank you for addressing the reality – that sometimes we have to accept the fear and the unknown and appreciate what we have now, and even what we’ll have in the future.

  20. I worry about this same issue too now and again, though my weight fluctuates a lot more than Scared’s seems to. And like a previous commenter, the disability paragraph was very, very helpful. Disability isn’t the worst thing that can happen to someone, and neither is weight gain. Though seriously, the buying of multiple wardrobes blows balls. As a fluctuator, I hear you on that.

  21. To add to what Thorn said, I’ve read in several places that we reach our adult weights at 25. So while it can’t hurt to get checked out, I don’t think you need to start worrying yet.

  22. Since i’m on a food allergies kick today ( see other comments), I want to reiterate the importance of testing out this possibility.
    Food allergies can do crazy things to us…. But many doctors never even think to consider them if you aren’t having the standard rash, itching reaction.
    My life/health (again more anecdotal data) changed dramatically after the discovery of a wheat/gluten allergy and it’s subsequent elimination from my diet.
    My allergic reactions included acne, extreme fatigue, thinning hair, sadness, and binge eating. It sounds as though your diet is nourishing and healthful, but perhaps one of the foods you are consuming is causing edema or improper metabolism? Just a thought, and something you could do on your own – without the help of a doctor, until you find one you like. Just eliminate a food for a week or so (since it can take up to 3 days for a food to trigger the allergic reaction) and see how you feel.

  23. Hi.

    This is totally just my own experience so, yeah, I’m not a doctor or anything.

    Since I was born I’ve been gaining 10lbs a year. I only remember as far back as being 80lbs when I was 8, and crying when I turned 11 and was 110lbs.

    I thought I was the only person this happened to! Wow!

    Now? I weigh less than my age plus a zero :) for two years now. It stopped going up when I was 30. I only went on one diet for one month when I was 19…and (I’m not bragging) I have no health problems at this time. Just so you know the background on my situation.

    So…while it is possible that it won’t stop, and you may have a medical condition…it’s also totally possible that while you haven’t stopped yet, you will. Naturally.

    Of course, knowing that doesn’t stop me from freaking out now and then and worrying that when I’m 80…well…yeah…I’m just a fan of my mobility, that’s all, so I get scared now and then.

    I think that’s normal.

  24. As I am autistic and have ADD I have to say thank you sweetmachine. Being disabled is certainly not the worst that can happen. I am even retired at an age of 35 and that is’nt so bad either. Actually I have never felt better then my last years.

    Btw: that site meg thorn linked – wrongdiagnosis – was like playing dr house :D

  25. Scared,

    Your post resonated with me because I had the exact same weight gain between 15 and 25. And the early years – probably 14 through 22 – were marked by heavy duty dieting. From what you’ve said, your diet efforts were even more extreme than mine, and that could be the problem.

    My cycle was that I would lose 10 lbs before summer and then gain twenty over the winter. When I stopped dieting, the weight came on a bit more quickly until I was about 245 at 25. (What happened after that is another story – but DON’T break your leg in the middle of winter in Maine).

    Check out all of the medical issues mentioned. It’s possible, however, that your early anorexic behavior might have messed up your metabolism. By “messed up,” I mean made it super efficient, so to prevent weight gain you need to eat less than you do and exercise more than you do. This isn’t a judgment on your lifestyle, which sounds extremely healthy. But I think maybe you’re body may be afraid that another famine is coming, and just won’t let you eat less without making you miserable.

    I really don’t think you will continue to gain weight forever if you continue your current lifestyle. I would be on guard about your activity level, though. If something in your life changes that makes you more sedentary (like you get a car), this might throw things out of balance.

  26. I just wanted to mention that getting a thyroid problem diagnosed is not as simple as a blood test. Many of us with thyroid problems have “normal” blood levels, but an underlying adrenal problem (that prevents thyroid hormones from getting into the cells and tissues), or some sort of tissue resistance. I was dx’d with thyroid problems a little over a year ago by a savvy, holistic doc who recognized that my clinical “presentation” showed my thyroid was involved with my symptoms, even though my blood levels were normal. I am on thyroid hormone now, and it’s starting to heal my metabolism.

    For more info, check out – lots of good info there on how to find a good doc and how to get diagnosed, and what other symptoms are involved other than uncontrollable weight gain.

    Good luck!

  27. A fasting blood sugar test is not enough to test for type 2 diabetes. Some people have a good fasting test, but their blood sugar goes way high one hour or two hours after eating. When it comes crashing back down most people feel desperately hungry. She may already be treating for this in her approach to hypoglycemia, but I would ask a doctor to prescribe a meter and test strips (available without a prescription but expensive) and check blood sugar after meals (and not just at 2 hours, at one hour as well).

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