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
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 firstname.lastname@example.org.