When my mood dipped into this latest low on Sunday night, I thought the news of the local clinic closing had triggered it. Since then, I’ve heard a great number of my connections are having an especially hard time this week, both with physical and mental illness. So, it may be something in the air. Something cosmic. For me, the clinic closing is still a factor. Let me explain:
I’m fat. (This is all the explanation many of you will need.) My family comes in two types, fat and not fat. I got the fat genes. I’ve been fat, more or less, most of my life, from the time my pediatrician first said “chubby” and I understood what he meant. For the last twenty-four years, I’ve been a patient at our rural medical clinic, which has been staffed with doctors who don’t care that I’m fat. Yes, they weigh me on every visit (I understand you can request they not do this), and no one has ever made an issue of it unless I’ve brought it up first. Which I have done from time to time. I don’t like being fat. I have spent an inordinate amount of time in my life struggling not to be fat, partially because it doesn’t feel good to me, but probably mostly because I got the message early on that fat is the worst thing I could be. I wonder sometimes how I’d relate to my body size if I’d never got that message, but that’s neither here nor there. Every time I stop trying not to be fat because I recognize on an intellectual level that the message is bullshit and body modification through weight loss requires me to engage in activities that I don’t enjoy almost to the exclusion of everything else, I end up displeased with the result.
Going to the doctor is problematic for fat people. (If you’re fat, you no doubt already know this.) Many, many doctors are as fatphobic and have bought into as many myths about the relationship between fat and health as those not in the medical community. In fact, when studies show that body size is not nearly the determiner of health many believe, they dismiss the studies. They call such findings “The Obesity Paradox.” They cannot accept it’s not a paradox; they’re just wrong.
When I was in a college dance program, engaged in vigorous movement 4-6 hours a day, at a weight of 180 lbs, one doctor told me I had to be lying about my diet and exercise habits because “if you really moved that much, you wouldn’t be so fat.” A friend of mine has spent over a year in intense pain because a series of doctors told her it was caused by “excess belly fat” and she needed to lose weight. She finally found a specialist to order scans, which found a number of issues completely unrelated to weight. But when the scans got back to her regular doctor, they claimed they “couldn’t see anything.” Because of the way her insurance works, she needs a new referral every time she needs to go to the specialist, but her doctor won’t give her one even though the specialist diagnosed her. A close friend of mine died of ovarian cancer because doctors said her pain was about her fat until it reached stage IV. I could go on, but you get the idea. In my opinion, if there’s any relationship between fat and health, it’s more likely to be that fat people are so reluctant to go to doctors and be shamed and/or ignored that they put off checking out symptoms until they can’t bear them anymore. So I’ve counted myself extremely lucky to have doctors who treated me like a person rather than a sack of lard the last 20+ years.
And now that clinic is closing. Their last remaining doctor is staying in the area, but he’s going to be working in Surface Creek, which is about 30 miles away. I’m not attached to this doctor (though he was the one to diagnose my gallbladder), and, due to unreliable access to transportation as well as being unable to predict when a migraine so bad I need a medical intervention is going to hit, I’d prefer not to have to travel 30 miles. I might as well go to the ER in that case; it’s about the same mileage. The hospital runs a family practice with a woman doctor in the next town over, just 10 miles. I’ve decided to go there.
I’m scared. After 20 years of compassionate doctors who don’t make a deal about my size one way or another, I’m scared this one will. I didn’t grow up here, so things may be different in the younger crowd, but there are a lot of confident fat people in this part of Colorado. Size doesn’t seem to be much of an issue, but maybe for this doctor it will be. Maybe the hospital running the clinic has an agenda around the “War on Obesity.” And yeah, I’m at a point in my life where I can give a doctor who focuses on my size a piece of my mind, but I don’t want to have to do that. I want to be able to go and have a physical like a “regular” person. Most of all, I really don’t want to have to explain my difficult relationship with diet and exercise. That’s what this post was supposed to be about. I didn’t expect to take 1000 words to explain doctors’ treatment of fat people.
The thing is, I’m not healthy right now. As I mentioned in a previous post, I have spent the bulk of the last six years not moving. This came shortly after my last foray into weight loss, when I got sick of myself and joined Weight Watchers for a couple years. I followed the menus; I counted points and exercised daily. I lost weight…at first. I never achieved my “goal weight” (which in retrospect I think would have been much too low a weight for my frame), and after a while I started having trouble not gaining weight even on the weight loss program. Shortly thereafter, I went through the “this is bullshit” phase. I was tired of doing exercise I didn’t enjoy. I have never enjoyed exercise for its own sake, and it’s even more problematic now for reasons I’ll get to later. I don’t mind walking to get somewhere, but in my small town, there’s nowhere to go. The loop downtown and back is about a mile. Besides that, everything is out and back, which bores me. And I don’t often have a reason to go downtown. I was also tired of regulating my food intake, of modifying recipes to make them more “healthy,” of pretending the food was good and satisfying. Some of them were, and some of them were downright disgusting; I’d be lying if I said otherwise. I dunno, for people who eat a lot of “junk” food WW might be a guide to healthier menus, but I never have eaten lots of chips or drunk lots of soda and whatnot. So I didn’t have much to change nutrition-wise in the first place. Anyway, I’m not on board with labeling food “good” and “bad.” The body wants what the body wants, and sometimes it wants chips and ice cream, and fat people are allowed to have them. You don’t have to earn the right to eat anything by being thin.
I have become quite fat and less healthy than I’ve ever been (excepting when I was dying of anorexia, which I’ll also be going into later). Going for a two- or three-mile walk on the spur of the moment didn’t used to be an issue for me. Now, I get tired after a couple blocks, and in a half a mile I have to sit down and rest. Due to chronic sinusitis (and maybe my increased weight; I’m not ruling it out), I’ve developed asthma. I have two different inhalers, and I have to use oxygen at night, which I hate. I have myriad gastrointestinal problems no one can diagnose. I don’t feel good about any of this, and I think being fitter would be to my benefit.
Therein lies the problem, and it’s also linked to my current depressive state. A few weeks ago, after the blog post I linked above, a kind woman I know offered me a free membership at the local gym. I think she may be the co-owner, or is on amiable terms with the owner, who’s an ex. And I thought about it, and decided I’d give it a try. We met and she guided me through the machines, none of which were unfamiliar; I’ve done a little lifting long ago, and it’s not rocket science. The gym itself is entirely unpretentious. It used to be a laundromat, 800 square feet or so packed with equipment and surrounded by cinder block walls. I’ve only ever seen three other people there. No one poses or makes comments. They come in, do what they came to do, and leave. Utilitarian.
So I thought, “This is okay. I can do this. I can commit to twice a week.” My mood was in an upswing then. And I did do it twice a week for a couple weeks, and then my mom died, which threw me off. I went back to it for a week, and then this low hit. I haven’t been to the gym all week. I’ve stayed at home, being mainly sedentary. I haven’t even wanted to work in the garden. And it bothers me. In my head. In my mind. I believe I should be bothered by the fact I haven’t gone to the gym all week, so I am, if that makes sense. My body and emotions don’t give a flying fuck; they would like to stay in and watch TV, thank you very much. Meanwhile, my brain is giving me all these messages about being a lazy fat person, and “just pushing through the resistance,” and “you have to be disciplined about it,” and similar bullshit, which does not make my depressive state any better, I can tell you.
Now, a lot of people might, at this point, be saying, “Well, if you feel bad about not going to the gym, just go to the gym; what’s the big deal?” Or, “If you’re depressed because you haven’t gone to the gym, then why don’t you go to the gym,” which is essentially the same thing. And both of them, as well as being completely dismissive, totally miss the point. I’m not depressed because I don’t go to the gym. I’m experiencing a depressive episode, during which I literally am unable to go to the gym, and furthermore, I’m berating myself for my inability to do so. The fact that I have so little control over and so little say in what I am and am not capable of on any given day adds to the depression. You wouldn’t tell a person with two broken legs who felt bad about not being able to go to the gym just to suck it up and go anyway. It probably wouldn’t even come up, because broken legs, however inconvenient, are temporary (more or less), and that person would not be likely to have my same issues with physical activity in the first place.
For me, physical activity is a punishment. I don’t think it always was so. I remember playing on the monkey bars as a kid, learning to Skin-the-Cat and all. I remember learning to ice skate and liking it. I used to hang out with the middle school gym teacher when my mom stayed late at work, and swing back and forth on the rings like a monkey. It was when competition came into it, and I wasn’t good at it in the right way, that it became abhorrent. It’s not any strange coincidence that around the same time kids really started laying on the fat shame. Fat + bad at sports + being bullied for both = hating sports. Later, at the beginnings of my anorexic period, the self punishment through exercise escalated. When I felt bad or something bad happened, well, it happened because I was fat. In fact, I deserved it because I was fat. If I exercised more, if I weren’t so lazy, I wouldn’t be fat and would no longer deserve these bad things, so they wouldn’t happen. I would do endless sit-ups chanting “fat bitch” to myself. Of course, getting thinner didn’t take away the bad things or make bad stuff stop happening. So I decided I must not be thin enough and must not be exercising enough. I did it more, and more, and more. Even when I had mono. Even when I grew so weak I could hardly climb the stairs from the cellar where my stationary cycle lived to the first floor.
The treatment for eating disorders at this time was less than stellar. Right now, I even question calling them “eating” disorders, because SO much else in involved. No one cared much beyond making sure I cleaned my plate at every meal and restricting my activity level. No one delved into what this syndrome was all about; what I know, I’ve pieced together for myself, from my own experiences and those of others like me. No one ever taught me to have a healthy relationship with exercise. They barely touched on having a healthy relationship with food. They didn’t look into why certain personality traits and mental predispositions manifested in an overwhelming, morbid fear of growing fat. My psychiatrist at the time once told me, “You don’t have to worry about getting fat; people with this disorder never get fat.” If my 67-lb self saw my 250-lb self, she’d give up on the spot.
On top of all that, not forcing myself to exercise to death was such a vast relief, I can’t even describe it. Being given permission to stop, to sit down and be quiet, for an overachieving girl with demanding parents and a lot of expectations on her, it was like a drug rush. It still kind of is, to be honest. It’s the best self care I know. Exercise never feels like self care, even though I know in my head that it probably is at this point in my life.
It’s hard trying to explain this to medical professionals. The last time I was seen at the clinic, the PA, whom I actually quite like, was concerned about my cholesterol. I wish I’d had the presence of mind to tell him I had higher cholesterol when I was dancing, but oh well. He asked if I exercised. I tried to explain it to him. I told him I was depressed. He said, “Exercise will help with that!” which is not always true. I told him exercise is a punishment, that I used it when I was anorexic to punish myself for being fat. He said, “But if you were anorexic, you didn’t need to punish yourself, because you weren’t fat.” Something like that. I dunno; I let it go. Most medical professionals simply do not get that, for some of us, it will never feel good to exercise. I’ve heard story after story of people saying, “I used to hate exercise, but now I love it! I’m going to run a marathon!” and virtually none like mine. Yes, I used to walk at least three miles a day “for my health.” It never felt good. I hated it more and more every day. Why in the world would I want to continue with an activity I hate?
I want to be healthy. To be healthy, I CANNOT focus on weight loss. It frustrates me because I’m fairly certain that a certain amount of activity on a regular basis is necessary to physical health, and I can’t count on doing anything regularly. I also have to take it nice and slow, do what I can, when I can, and explore new ways of relating to my body. If I tell my new doctor this, will she hear me? It’s twisted enough in my own head.