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Recently I have found my thoughts haunted by the death of a woman I know only through the news. Paula Rojeski was nobody famous, just an everyday person living and working just a few hours away from my home in San Diego. But at some point the omnipresent local radio and billboard ads touting a Los Angeles-based lap-band surgery outfit apparently grabbed her attention. Maybe she was already feeling that her 180-pound body weight was an issue to be addressed via surgery, totally apart from those ads; I don’t know, the newspaper accounts don’t say. In any case, she wound up having the procedure done at one of the outpatient clinics associated with those ads.
Shortly after that surgery in September 2011, she was rushed from the clinic to a hospital and pronounced dead.
It’s sad enough that this turns out to be a “suspicious” death—the Los Angeles Times reported that this was the fifth death among these clinics’ lap-band surgery patients. But leaving aside the issues of safety related to these particular clinics, to the lap-band, or to bariatric surgery in general, why in the world did this poor woman feel the need to solve her weight issue with surgery at all?
I did not know Paula Rojeski, so there is no way for me to know her reasons. But if her experience of being “fat” in a society whose ostensible concern for health masks a nigh-phobic hatred of fat was anything like mine, I have some strong suspicions.
My experiences include being bullied by grade-school peers, shamed by family members, sneered at by strangers, and treated with unconscious cruelty by people I thought were friends. Medical professionals have scolded me for blatantly disregarding my health. Comedians and anonymous Internet trolls comment endlessly that fat people are lazy, ugly, undesirable, disgusting, and, above all, fair game for derision.
All of which hurts like hell, but the accusations of laziness especially rankle. I have put herculean amounts of time, energy, and money into dieting and exercise, under the supervision of all manner of medical authorities. I have succeeded in taking off literally hundreds of pounds, and even maintaining the loss for a year or more—the point at which, many weight loss experts assured me, I would be home free, habits and metabolism now transformed into this healthy new me.
Only each time it all came undone. Some life crisis would come along and demand my full attention, and thereby reveal that I had maintained the entire show only through an obsessive effort of conscious will. As soon as these crises distracted my attention away from weight control, the whole house of cards would come tumbling down. All the supposedly permanent behavior changes would drop away, the old hungers would awake with what seemed a new level of voraciousness, and within a year I would have regained all the weight and more, as well as gouging several more wounds in an already badly scarred self-esteem.
You go through a lifetime of wrestling with an issue, doing your best to deal with it according to trusted authorities, failing time and time again, and being shamed and blamed for those failures, and small wonder you start resorting to more and more desperate measures. Fortunately, by the time lap-band surgery and its riskier predecessors fen-phen and gastric bypass came around, I had already decided that the issue was not any fault of my own, but that by and large the weight loss authorities really hadn’t the faintest idea how weight and weight loss work. Yes, I know and have had fired at me ad nauseam the creaky truism “calories in < calories burned = net weight loss.” But that reductionist formula merely begs such questions as: Why do some people manage to keep weight off effortlessly while others have to fight tooth and nail to budge a pound and keep it budged?
Just this past fall, The Washington Post reported on a research study on a weight-control mystery that had been one of my personal demons: Maintaining a weight loss seems to get harder rather than easier. The researchers tracked levels of weight-regulating hormones in a group of test-subject dieters. They discovered that dieting caused these hormones to shoot up to levels evidently evolved to pack on and hold onto calories in the event of famine. Worse, these hormones stayed at those levels for over a year after the diet’s end. In other words, that irrational, eat-everything-not-nailed-down hunger that would wipe out even my proudest weight loss achievements isn’t in my head. It’s totally biochemical.
Weight control authorities could have been researching that issue a long time ago if they had actually listened to what fat people were telling them about their experiences trying to diet. Instead, they wrote our experiences off as rationalizations for noncompliance.
Especially now, when there is real reason for concern over increased rates of obesity in the population and governmental agencies of all sorts are jumping on the “War on Obesity” bandwagon, it is crucial that this aspect of the so-called “obesity epidemic” be addressed. How can you wage any such public health “war” with such glaring holes in the science of what you’re fighting? One of the primary weight-health assessment tools, the Body Mass Index, has been largely discredited as a reliable indicator of healthy weight, but it keeps being used even while excuses are made for its tendency to mislabel many healthy people as overweight.
But beyond that, our society’s entire attitude about fat is hobbling any chance at dealing with the issue rationally, and thus needs fixing. I can’t tell you the number of times I have had people insist, “It’s really all about health: It’s unhealthy to be fat and healthy to be thin,” yet when I push them a little ways, I start hearing things that sound more like moral judgments about appearance than concerns for health: Thin is pretty, fat is ugly; thin people are cool, fat people are lazy; thin means wearing the latest fashions, fat means wearing baggy clothes in a pathetic attempt to hide one’s body; and so on. I’m appalled at the number of times I’ve asked for people who exemplify an ideal weight only to have an underweight, over-airbrushed celebrity offered up. As for the concept that a person could in fact be healthy and fit while still carrying enough weight to qualify as “fat” by popular measures, the reaction I get is usually one of disbelief—even though there are studies to support that assertion.
I don’t see any of this changing any time soon on a societal level. The feminist movement has been chipping away at this subject at least since the publication of Susie Orbach’s Fat is a Feminist Issue back in 1978, and here it still is. But we can, individually and among our friends, families, congregations, and communities, help to foster more compassionate and truthful attitudes about weight and health. Some of this is already under way, especially in our congregations. For example, the youth group at my old congregation, the First Unitarian Universalist Church of San Diego, has been exemplary in modeling and living radical acceptance of people regardless of their size or shape. This is something that I, with my memories of being bullied for my weight as a child, find to be an amazing and blessed thing.
Meanwhile, I will continue my personal quest to find a healthy, sane weight management solution that works for me, without falling prey to any of the societal pressures and prejudices that keep trying to get their hooks back into me. And I’ll keep remembering people like the L.A. woman who ran afoul of the lap-band surgery, as a reminder that this really is a life-and-death issue—but not for the reasons some would think.