Sunday, February 6, 2011

The Obese Mind (MLAL)

Originally posted here

(This post is all over the place... My apologies in advance...)

It's flattering to hear people say things like "Look how skinny you are!" or "Oh my gosh!  You're going to wither away if you dont stop losing weight!" or "Dont lose too much weight!" or, my favorite, "You look great!".  But, when I look in the mirror, I see the same person I was at 240lbs.  That image hasnt changed.  Sure, I know I've lost 46 pounds.  I can feel it in my clothes (and in needing to buy new clothes).  I can feel it when I walk around.  I can tell by how much easier it is to bang out a 6 mile run, even in the winter, versus what it used to feel like when I ran a mile or two.  So, I know it's true.  I know I've lost weight.

But in my head, I'm still fat.  Really fat. 

This has really made me think.

If I had the opposite problem and suffered from anorexia or bulimia, this would be a problem immediately addressed.  I'd be classified as sick; the DSM IV lists this as an illness.  I could utilize my insurance and go for treatment.  Although binge eating is being considered for inclusion in the DSM, right now there is no over-eating disorder.  Does anyone else see a problem with this?  If you abuse your body to stay thin, you are sick and we want to help you.  If you abuse your body by being obese, we blame you.  You could stop.  You could lose weight if you wanted to.  You choose to be fat.  Many insurances dont even offer reimbursement for gym memberships (with usage of course!) and a fair amount dont cover consults with nutritionists.

I was talking to Peter about this and he said, "But you can stop.  You prove that."

Do I?  Really?

I'm not the only one confounded by the fact that obesity isnt included as a mental disorder.  It's being talked about and it should be.  One of the quotes that really struck me was "Consideration of the mental component of obesity should be a key target in the treatment of obesity to facilitate compliance and minimize relapse."  Can we have that in normal person speak?  We should realize that how overweight and obese people think plays a big role in how they eat.

I struggle.  Every. Damn. Day.  If my feelings are hurt...  If I am stressed...  If I am sad...  I want to go to the kitchen.  No, I feel like I NEED to go to the kitchen.  To rip the pantry apart and eat, eat, eat.  Sweet, salty, I dont care.  Just eat until I can eat no more.  Decimate the candy dish.  Drink the case of soda.  Is think it is safe to say that the above article may hit the nail on the hid by saying some causes of obesity can be linked to food addiction? Right on, doc.

Notice I say "some".  There is a huge debate (amongst docs and those of us in the overweight/obese camp too) about labeling obesity as a brain disorder or a mental illness.  Some people argue "I'm fat- not a nutcase!" while others are begging doctors to see their obesity as the outward sign of something wrong on the inside.  As Peter said while I ranted this afternoon, "There are too many causes of obesity to make it just a mental issue."  And he's right.  By making obesity in the simple "your BMI is too high" fashion a mental illness, we are missing the bigger picture.  Some people may be fat because of medication, because they simply like to eat and dont care if their weight balloons up, or because of a genetic issue.  Some women are heavier because of PCOS and thyroid disease and metabolic issues.  Some because they put on a lot of baby weight and never lost it.  Yes, there are plenty of reasons why.  Plenty.  As many as the stars in the sky.

But some arent.  Some eat because they are sad.  Because they are hurt.  Because they have no reason not to.  Sure, maybe some of the other things play in, too.  But there is a mental component to these people, and that cant be discounted.  

Would I have gone to the gym and changed my lifestyle if someone from my insurance company told me they'd foot the $50/month membership fee?  Probably not... If I'm honest, I'd have said "SURE!" and then, after a month or two, I'd have lost interest and given up.  Now, because I'm the one working out 3-4 times a week, I'm harassing my insurance company to see if they'll pick up the tab as a preventative treatment.  Obesity has a lot of health risks associated with it; among them high blood pressure and high cholesterol.  In the last 4-6 months, I went from having 3 prescriptions a month to 1 (and that's for my Hashimoto's which, in all likelihood, will never go away).  I went from needing injections that cost over $2K a pen just to ovulate and needing the intervention of an RE to try and get pregnant, to ovulating, menstruating, and (even though it ended in miscarriage) getting pregnant on my own.  I'd say these are some significant savings to my insurance company and well worth them picking up my $600 annual gym price tag.  On top of that, the long term outlook of someone within normal weights is significantly better than that of someone overweight or obese.  But my fatness wasnt a big deal...  My doctor mentioned that my weight was high (and that I would be better off losing some), that my BP and cholesterol were high, blah blah blah, here's a pill to help those and, if you'd like, we can give you a pill to help with your weight too.  I saw commercials for Jenny Craig and Weight Watchers and this miracle weight loss treatment.  How I, too, could be bikini ready in a few short months on this pill or using this machine or that one.

Because, really, being skinny or fat- we think it's all about how we look.  I want to look better.  I want to fit into those jeans or shop at that store.  I want to be pretty.

What happened to being healthy?  What happened to our doctors wanting us to be healthy (and not pill reliant)?  Why are insurance companies more than willing to cover a bevy of pills but not a gym membership?  Why will they cover god-only-knows the chemicals in some of those prescription diet pills but not consults to nutritionists?  (Let it be said that, while I am asking these questions of insurance companies in general, we do have coverage for nutritionists, mental health professionals, and (possibly!!) gym reimbursement, so I realize that we are very fortunate, but that isnt the case for a vast majority of people).

I remember going to the doctor quite a number of months ago.  My GP was out and so I saw the CPA who told me how she could help me get this great shake-detox-supplement thing to take off my weight.  It worked for her!  I took the card she gave me and looked it up online.  Really?  You're from my doctor's office and your pushing this non-FDA approved (not that that means anything), not really tested, drug-wannabe?  Really?  I blew it off and thought nothing of it.  Now, mind you, I love my doctor and I love the nurses who, when they gave me my recent blood test results, celebrated that my cholesterol was normal and that my sugars were healthy, but it still rubs me the wrong way that someone in their practice thought hawking that crap was okay.

I dont know what would have helped me.  I really dont.  For me, it was realizing that I couldnt go on this way... That I couldnt keep blaming something else for the simple fact that I ate too much and wasnt exactly eating the best things.  That Bobby and Maya were going to look to me for their example of how and what to eat, and I was a crappy example.  That I needed to "woman up" and be a better mother.  That I didnt want them having the same issues with food that I have.

It's hard because I think that people look at me now and think that I'm somehow cured.  That it was as simply and as easy as counting calories and exercising and, wow, look-ee there, she's lost weight!  But it isnt.  It's a constant struggle.  Not eating well- that's actually the easy part.  And the portion control?  Now that I know it, it's easier too.  And I dont feel sick after eating, so that's a great thing.  But the emotional part?  The part that "feels" obese?  The part that still aches to cram as much food in my mouth as I possibly can when someone hurts my feeling?  Still there.  I can have one cookie and walk away because I know now that I dont need to eat the entire box, but (for now at least) the feeling of "needing" food in my darker moments is still there.

And I fight them, every single time.  And maybe that means I've won the war and I really am "cured".  Or, maybe it means that I'm only winning the battles as they come.

But that's still something.

And I'll take it.