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Thank you for this...I'm so so tired already of seeing articles about Ozempic, op-eds looking at it from every angle EXCEPT ones that don't think fat people should be required to seek these 'miracles' in the first place. With all the mainstream news I consume treating risky drug and surgical interventions as worth it, it really weighs on me not to see a counternarrative pushing back. Your work is such a service in that respect. Makes me feel less like I'm the delusional one among all these 'experts,' screaming into the void.
The growing attitude of "it's not your fault you're fat (but you still need to fix it)" is a predictable outcome of the ADA in 2013 deciding that large bodies are a disease. In the US at least, we treat people with chronic diseases *terribly*. We make very few accommodations and those only grudgingly. They're either faking it (if it's invisible) or a burden (if it's not). The whole point of a disease is to *get over it* and get back to normal. Normal meaning the rest of us can ignore it--regardless of whether it still affects you.
It also pushes forward a false narrative that the default body is a thin one. The only reason people are fat is that they have a disease. Disease must be cured. Disease must be caught early and treated aggressively in its early stages. Again, predictably, leading to recommending weight-loss drugs and surgery to fat kids before they have a chance to become fat adults suffering from chronic fat. Which, of course, isn't their *fault,* but they still need to fix it.
Even with the "no-fault" attitude, society still views fat people as disgusting, lazy, sloppy, and stupid. Only the explanation has changed. Not the way fat people are treated. Because we have these wonderful drugs and surgeries now so only the bad fatties are left.
Given what we know about epigenetics, I have to wonder how much of the increase in average body size is due to three generations or so of people weight-cycling for most of their lives. In addition to social stressors, better nutrition (compared to the early 1900s when the tables were made), and the changing definition of who counts as too fat.
People aren't made in factories (...yet). There is no default body. The sooner we acknowledge this truth, the better off we'll be, individually and as a society.
I once received a letter from a therapist taking a sympathetic tone that "being overweight is not your fault." She then went on to dole out the tired schpiel about how women who have suffered sexual trauma often gain weight so as not to attract the attention of men. I responded by saying I bought into that attitude for all too many years and it never did anything for me except make me try even harder to hate myself thin. I also said this was an odious, awful stereotype. There are too many things wrong with it to even go into.
I'm still getting over the emotional dysregulation from dealing with the pulmonologist I went to last month for (obviously) respiratory issues. At first I was really happy about the visit because she was able to tell me I have most likely been misdiagnosed with asthma and instead have vocal cord dysfunction, which is often mistaken for asthma. Ah, but she couldn't leave it at that. Nope, she had to tell me I was overweight and if I would lose weight it would help me with my respiratory problems.
First of all, I didn't reach nearly 60 years old by being entirely delusional. I realize I'm large. I can look in the mirror and see that. I am a former nurse and am well aware of all the conditions that are supposedly correlated with being the size I am. None of this is what I was there for.
I didn't know it at the time, but I'm now armed with information that can help me shoot down this unfortunate line of conversation in the future. I can say to the offending physician "Health Care Group X has an entire bariatric department dedicated to the eradication of big people. If I wanted to be eradicated, I would have asked for a referral to them. Since I am seeing you rather than them, it is safe to assume I am not here to be eradicated. Let us concentrate our time on your specialty if we may."
In a very chipper voice she informed me about the new miracle drugs, Ozempic and Wegovy. I shot that line down with "I was diagnosed diabetic at 49 years old. I know those are diabetes drugs, and there are good reasons why they are not first-line treatments for diabetes management."
Unfortunately I was left emotionally dysregulated and it's taken several weeks to get me back to a point of fragile peace with myself. At least she did give me a referral to a speech therapy clinic so maybe I can resolve this damn vocal cord dysfunction after decades of feeling like I'm choking to death anywhere from a couple times a day to several hours a day. Believe me, having dental work done with this condition is hell, and it probably interacts with my sleep apnea to create a vicious cycle.
The neat trick is they still manage to blame us when these interventions fail. Whenever patients regain weight, because of course they do, the explanation is always that patients went back to their old habits. My reaction to that old saw is always to wonder if the intervention is a miracle or not. Unless permanent weight loss is never really the goal...
Thank you for this...I'm so so tired already of seeing articles about Ozempic, op-eds looking at it from every angle EXCEPT ones that don't think fat people should be required to seek these 'miracles' in the first place. With all the mainstream news I consume treating risky drug and surgical interventions as worth it, it really weighs on me not to see a counternarrative pushing back. Your work is such a service in that respect. Makes me feel less like I'm the delusional one among all these 'experts,' screaming into the void.
The growing attitude of "it's not your fault you're fat (but you still need to fix it)" is a predictable outcome of the ADA in 2013 deciding that large bodies are a disease. In the US at least, we treat people with chronic diseases *terribly*. We make very few accommodations and those only grudgingly. They're either faking it (if it's invisible) or a burden (if it's not). The whole point of a disease is to *get over it* and get back to normal. Normal meaning the rest of us can ignore it--regardless of whether it still affects you.
It also pushes forward a false narrative that the default body is a thin one. The only reason people are fat is that they have a disease. Disease must be cured. Disease must be caught early and treated aggressively in its early stages. Again, predictably, leading to recommending weight-loss drugs and surgery to fat kids before they have a chance to become fat adults suffering from chronic fat. Which, of course, isn't their *fault,* but they still need to fix it.
Even with the "no-fault" attitude, society still views fat people as disgusting, lazy, sloppy, and stupid. Only the explanation has changed. Not the way fat people are treated. Because we have these wonderful drugs and surgeries now so only the bad fatties are left.
Given what we know about epigenetics, I have to wonder how much of the increase in average body size is due to three generations or so of people weight-cycling for most of their lives. In addition to social stressors, better nutrition (compared to the early 1900s when the tables were made), and the changing definition of who counts as too fat.
People aren't made in factories (...yet). There is no default body. The sooner we acknowledge this truth, the better off we'll be, individually and as a society.
I once received a letter from a therapist taking a sympathetic tone that "being overweight is not your fault." She then went on to dole out the tired schpiel about how women who have suffered sexual trauma often gain weight so as not to attract the attention of men. I responded by saying I bought into that attitude for all too many years and it never did anything for me except make me try even harder to hate myself thin. I also said this was an odious, awful stereotype. There are too many things wrong with it to even go into.
I'm still getting over the emotional dysregulation from dealing with the pulmonologist I went to last month for (obviously) respiratory issues. At first I was really happy about the visit because she was able to tell me I have most likely been misdiagnosed with asthma and instead have vocal cord dysfunction, which is often mistaken for asthma. Ah, but she couldn't leave it at that. Nope, she had to tell me I was overweight and if I would lose weight it would help me with my respiratory problems.
First of all, I didn't reach nearly 60 years old by being entirely delusional. I realize I'm large. I can look in the mirror and see that. I am a former nurse and am well aware of all the conditions that are supposedly correlated with being the size I am. None of this is what I was there for.
I didn't know it at the time, but I'm now armed with information that can help me shoot down this unfortunate line of conversation in the future. I can say to the offending physician "Health Care Group X has an entire bariatric department dedicated to the eradication of big people. If I wanted to be eradicated, I would have asked for a referral to them. Since I am seeing you rather than them, it is safe to assume I am not here to be eradicated. Let us concentrate our time on your specialty if we may."
In a very chipper voice she informed me about the new miracle drugs, Ozempic and Wegovy. I shot that line down with "I was diagnosed diabetic at 49 years old. I know those are diabetes drugs, and there are good reasons why they are not first-line treatments for diabetes management."
Unfortunately I was left emotionally dysregulated and it's taken several weeks to get me back to a point of fragile peace with myself. At least she did give me a referral to a speech therapy clinic so maybe I can resolve this damn vocal cord dysfunction after decades of feeling like I'm choking to death anywhere from a couple times a day to several hours a day. Believe me, having dental work done with this condition is hell, and it probably interacts with my sleep apnea to create a vicious cycle.
The neat trick is they still manage to blame us when these interventions fail. Whenever patients regain weight, because of course they do, the explanation is always that patients went back to their old habits. My reaction to that old saw is always to wonder if the intervention is a miracle or not. Unless permanent weight loss is never really the goal...
“The practitioners’ blame, shame, and frustration toward their fat patients remain.” This had me snapping my fingers
So heartbreaking but informative. Thank you for all you do.