Bracing for Impact

It’s been a rough week.

Actually the tale of just why it’s been a rough week has its roots in a trip we took to Santa Cruz a month ago, so I’ll digress there first.  For Z’s spring break, Sasha and Z and I went to Santa Cruz and Monterey.  The first full day we were down there, we hit the Santa Cruz Boardwalk, and had a fine time riding rides together.  Eventually, Z wanted to peel off and play in the sand, and I wanted to ride some adult “scary” coasters.  So I stood in line for 40 minutes to ride the Giant Dipper.  Finally my turn came, and I got in the seat… only to discover that the safety bar wouldn’t latch over my belly.  Because I am, in fact, too fat.  So I got instead to have the humiliating experience of getting back out of the roller coaster and walking away, under the eyes of all the other riders.  I think I made it about halfway out of the park before tears were rolling down my cheeks, and I went back to the car and spent the next half hour or so sobbing uncontrollably.

I’m used to the world being not quite sized to fit me.  In addition to being fat, I’ve got very broad shoulders, and since I was fifteen or so, even before I was fat, I’ve been super conscious of how much space I took up.  In aisles, in bus seats, on airplanes, and on and on, I have been daily reminded that I am a wider human than is designed for by code and custom.  And this has an accretive effect on the psyche.  But this incident was the first time that I was literally unable to access a thing intended to be experienced by people in my age range because of the dimensions of my body.

I want the world to change from how it is.  And I believe that it can, and that there are many, many people fighting the good fight to make some of those changes a reality.  But I also know that I have more control over my own body and life than I do over the world at large.  As surely as I want to put effort into improved access by design into the public sphere, I am also moved by this incident to attempt to change my body – in particular, to attempt to lose weight – because it’s possible that can happen faster.

I have a complicated relationship with my body.  There are times I revel in it, and delight in its wonderful sensations and experiences.  There are times I struggle to feel even a little bit at home in it.  There are things it does very well, some of which I definitely take for granted and should not; there are things it is uniquely challenged by, some of which are tiresome, frustrating, and infuriating.  What other people think of my body is in the main of no interest to me, and it is unfortunate and exhausting that ours is a culture in which many people feel free and entitled to offer unsolicited opinions about others’ bodies.  That said, my decision to try to lose weight is not coming from a place of shame, or out of a wish to please others aesthetically; it is out of frustration that my body as it currently is stops me from doing things I once could, and I would like to do those things again.

Right after we came back from the Spring Break trip, I was in the waiting room for a physical therapy appointment (recovering from a back injury) and saw a flyer for the Kaiser Permanente Medical Weight Management program.  My interest was piqued, and I called the number to get more information.  It’s a fee-for-service program not covered by KP insurance, but does offer physician support and claims to have an evidence-based approach.  I did a bit more digging, and some people’s reports of their experiences made me more interested, so I scheduled a slot in one of their introductory sessions, which happened this past Tuesday.

To provide some background, I also have a complicated relationship with food and eating.  For my whole life, many tastes, scents, colors, and textures have been unpleasant to me to the point that I have a strong aversion to them.  Under duress, I can force myself to eat things that fall into this category, but it’s always upsetting, and not in an “aww, I don’t wanna” kind of way – more in a “I am eating hot smelly garbage with a side of diarrhea” kind of way.  Conversely, there are foods that are so pleasurable to consume I have an addictive response to them.  This is not hyperbole; I spent many years addicted to and regularly using tobacco, and I can tell you from direct, personal, firsthand comparison that I have the same reward response from eating melted cheese as I got from having a cigarette after I was full-dress fiending for one.

So there are kind of three broad categories of foods for me – the vile and aversive, the meh, and the amazing-but-also-addiction-feeding.  I was able to kick tobacco 15 years ago by quitting it cold and suffering through the withdrawal, and I am going strong on that.  But I can’t just not eat.  And so three times a day (or more), I face the choice between those three categories.  All three are ubiquitous, and none of them are illegal or controlled or anything, so it’s small wonder that I keep going back to the things that mash the reward button.  I think any program that will be successful and sustainable for me has to account for this.  Moreover, I’m willing to bet that a nontrivial number of other fat folks out there have a similar process going on.  It’s not a matter of moral weakness, but a biochemical feedback loop.

Some of the testimonials I read about the Kaiser program seemed to indicate that they understood and dealt directly with the concept of food addiction, and so I was willing to take the shot on attending and even had some high hopes about it.  I had read a NIH study about the program and was a little disappointed that the long-term outcomes seemed to be only a 5% loss in weight at the 5-year mark, but hoped to discuss that more in the session.  Sasha kindly volunteered to come with me as moral support and advocate (in the event I needed it).

When the session rolled around, we got there and sat through a genuinely disappointing spiel.  The program manager, a distinctly curt and unpleasant woman who projects an aura of faint disgust with fat people, began the session, and then there were several physicians and coordinators who spoke.  There were two testimonials from participants, and frankly they were the only two people in the room with a shred of credibility, as they were people who knew what it is to live as a fat person.  The program entails a calorie-restricted liquid diet for 4 months, followed by slow reintroduction of self-prepared foods, weekly “support group” sessions, and physician monitoring.  The informational sessions are geared toward “helping people make healthy decisions” and presenting nutritional information and so on (as though this information has somehow escaped our notice up to now).  A subtle but pervasive air of pity and contempt was there throughout the session.

At the very end, perhaps sensing the extent of my discomfort at the whole experience, Sasha took the lead in asking some questions we had discussed before the session started.  The program manager was oddly defensive and dismissive about the NIH study, and seemed to be attempting to apply subtle social pressure to discontinue the questions; she was going around the room trying to hustle people into filling out their intake forms and clearly wanted to wrap up and leave.  Undaunted, Sasha asked about the use of body-positive language in support sessions.  The response from the PM was more than a little baffling.  She said that “we don’t really deal with addiction or anything like that; there are programs in the psychology department that might but it’s not our area.”  Uh, #1) way to not answer the question, and #2) thank you for pointing out that this program fundamentally won’t help me.  I guess.  I left that conversation with the strong impression that she was used to bullying fat people who already felt bad about themselves, and didn’t know what to do with questions from someone not in that vulnerable space.

After that very gross encounter, Sasha and I left and went to have dinner and re-watch Captain Marvel.  Said movie did in fact restore a great deal of my morale.  During the evening as I was unpacking the experience, a number of things occurred to us both.  A sense of moralizing was definitely present, and it was difficult to take seriously advice about how not to be fat from people who’ve never been fat in the first place.  The whole thing was very fatphobic and body-shamey; I am hard pressed to think of another situation classified as an illness where the HMO requires patients to pay 100% out of pocket, and it certainly smacks of bygone days when drug addiction was treated as a moral failing that should therefore be paid for by those weak enough to fall prey.  Sasha pointed out that this may also be a strong signal for Kaiser’s general sense of the program’s effectiveness; they tend not to want to pay for things that don’t work very well.

And then, Thursday, I saw this post on The Mary Sue concerning Avengers: Endgame and how they have a fat-shaming running gag.  I was deeply hurt and frustrated that the same studios that produced Captain Marvel, which helped me through a bad day specifically because of fatphobia, would themselves go for that cheap laugh at my expense.  Way to punch down, guys.  I was about ready to boycott the movie entirely, but a number of intelligent, nuanced, sensitive fat friends of mine saw it and said that while what The Mary Sue calls out definitely needed to be called out, it should not stop me from seeing it entirely.  So, I’m braced for impact, but I’m going to see it.  Still, Marvel, you’re on thin ice with me.  Do better.  I know you can.