One Step Forward

For a few years I’ve been interested in Intuitive Eating and Health at Every Size, and for the last year I’ve been working to integrate Intuitive Eating principles into my life. My relationship with food has changed. A lot. Enough to convince me to launch a new self-care adventure. In order to understand what follows, I wanted to share the circumstances that led to a decision I made as well as what inspired me. Over the next six months, I’ll share how it all goes.

This journey started with a routine check-in with my doctor that didn’t go as well as I’d hoped. Since this happened during a pandemic, it’s understandable that most sane folks already feel a bit off-kilter on a daily basis. Anxiety is through the roof for good reasons: health concerns, work worries, money freak-outs, separation and isolation, limited resources, contentious politics, and intentionally conflicting news reports.  So, in addition to the normal high anxiety built into life these days, add stress about going into a medical clinic during a pandemic to mingle with potentially sick strangers wandering around inside.

The visit didn’t start well. I had to wait outside in hot weather, standing in a security line with people who refused to socially-distance. Once inside the door my level of freak-out ratcheted up because, while the clinic required several safety measures, clinic staff inside routinely ignored other visitors who disregarded those “rules” by removing their protective masks or invading the space of other patients.

When I successfully made it beyond the gatekeepers (security, payment, weigh-in that showed a small weight gain, a medical check-in with a nurse for my aching back), I waited a few minutes for Doc. The usually affable and smiling person I expected entered, looked at my medical record, frowned, gazed momentarily in my general direction, and grimly commented it’s time to talk about ob*s*ty. Your BMI has gone up and BMI is a very important measurement.

Until that discussion, I honestly believed the doctor saw me as an intelligent woman and a worthy-while-fat human being. By the time we finished a much longer discussion during which I questioned the validity of the BMI (designed for use in measuring large populations, not to assess an individual’s health), I had little doubt I represented a reprehensible majority of fat folks who clogged up the well-oiled gears of this mammoth medical corporation.  

Doc scowled and commented Ob*s*ty puts you at very high risk for heart disease, type 2 diabetes, and, of course Covid-19. Thinking this a discussion, I mentioned I used to teach statistics. Correlation between weight and those diseases doesn’t prove causation. In fact, I’m more concerned that science shows the importance of quality medical care and the role of stigma in health outcomes.

I didn’t mean it as an insult, but Doc’s response I’m talking about science, not stigma left little doubt I’d unintentionally hit a nerve. I tried to explain a bit about my 40-year dieting history. That is, successfully and repeatedly starving (and usually over-exercising) for about half that time, alternating with disordered eating that resulted in more and more quickly regaining any lost weight even though I ate less than before. Over and over again. Doc shook it off and insisted Caring about yourself is about not giving up. It’s about trying again. And again. And again. I listened, thinking this sounded very much like a prescription for dangerous yo-yo dieting so it couldn’t be standard for this by-the-book humongous medical business. I’m referring you to our healthy lifestyle program that’s all online now. You might learn something from it.

Now, I understand that it’s basic biology.[i] The body thinks famine (not ‘this idiot is starving themselves because they think it will make them healthy’) and everything slows down. I sighed at the realization that the “cure” for everything from my itchy eyes to my aching back is still weight loss. I thought about suggesting Doc tell me to get younger. That would definitely help. I didn’t make the suggestion.

Doc commented The program has a very good success rate. How good? I want to see data about weight loss retention at 5 and 10 years to show me something is permanent.[ii] But “medical science” apparently has a different perspective. Doc looked at me with a squint, so I could guess what came next. We track data for up to 12 months while people are in the program. Some lose 5 to 10% of their body weight.

I’m focusing on intuitive eating, I say. Doc responds, Well, whatever you’re doing is clearly not working. I just want you to live longer. Are you at least willing to attend? There’s no excuse; you don’t even have to leave the house. It’s all virtual right now. I was already inside my head when the word “compliance” popped up, so I missed the details. As soon as someone mentions compliance, my radar switches on. What I told myself Doc meant: If you end up sick we’re not going to give 100% because you don’t care enough to do what you’re told.

It felt like a life-and-death decision, so I agreed to register for and attend the orientation. (More about that another day, but at the orientation they said compliance is part of the program requirements with non-compliance noted in participants’ medical records.)

The upside: the experience helped me to recognize how my relationship with food has changed.

I climbed into the driver’s seat, turned on the engine and the a/c, buckled my seatbelt, took a few deep breaths, and checked in with my body. At that moment, after six consecutive nights of 5 or 6 hours of sleep, I definitely felt the fatigue and noticed a burning rawness, as if I had been attacked and singed by the flames of the experience, but aside from frustration with the impersonal medical system, I felt  disappointed with the doctor who didn’t have time to listen and didn’t want to hear, felt some residual shame from not having one of the 20% of the population’s slender bodies[iii], and some anger about all the failed diets that slowly drove up my weight. I wondered, would eating something comfort me? I sat quietly. A few years ago, I knew I would have driven to the nearest no-no store and gotten something decadent. This time, though, having given myself permission to eat whatever my body wants, I realized the good breakfast I’d eaten prior to the appointment stayed with me and I felt zero hunger. I asked myself what might help? What I longed to do: have a cry, and punch something inanimate repeatedly.

Lacking the inanimate object to pummel (though I really do want to learn how to throw a proper punch), I cried for a minute or two. After that I realized how disgusted I’ve grown with diet nightmares that end (95+% of the time) with dashed hopes, a lighter wallet, and feelings of complete failure (aimed at Self, not the Diet). I reminded myself that Diet Culture (now a $72B a year business) loves to lure people in under multiple guises (diets, lifestyle-, health-, mindfulness-, and wellness-programs are hot money makers right now) but Diet Culture silently cheers when people fail. Why? Well, duh. Out of the 48+ Million dieters in the US this year, repeat customers are how they earn the big bucks.

I attended the orientation with an open mind. The “lifestyle” program requires logging all food/drinks, strictly adhering to calorie counts, weighing/measuring food, drinking lots of water, exercising at least 300 minutes a week, and weekly (or daily) weigh-in. To me, these are all clear signs of a Diet Culture Program demanding total fixation on food. That strategy has failed me so often, I can’t bear to go back to that type of thinking. But after the orientation, the question that haunted me remained. What do I do? Deal myself in for a doomed diet and hurt my own body? Reject the inhumane and unproven strategy outright knowing it could have consequences? Blaze a different trail?

My decision: there will be no digging for the mythical slender old-lady inside me who longs to be set free. She quit tormenting me 20 years ago. The Real Me is smart enough to focus on finding contentment in each day, practicing gentle nutrition and joyful movement, working toward better sleep, expanding mindfulness practices, and the magic of gratitude. It’s not perfect, but it’s a perfectly acceptable start.

[i] And this ignores Set Point Theory.

[ii] So far, even surgical solutions aren’t looking promising to me in the long-term.

[iii]These are the people who wouldn’t survive a famine but remain the ideal for many reasons.

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