Content warning: frank discussion of bodies, weight stigma, weight loss
I didn’t write anything big last month because I was really freaking tired. Honestly, I’m still pretty freaking tired which is why you’re getting this: a relatively personal essay, because I’m mostly thinking about myself at the moment. As I mentioned in August, I had to go on a gluten challenge before being biopsied to test for celiac disease. This meant I was sort of poking my immune system every day—not only did eating hurt but every physical expenditure became more difficult.
My body is bonier and smaller than it was before the start of the gluten challenge. I was too tired to move much, so I’ve lost strength and mass. I also felt nauseous and bloated even more than normal, so I’m pretty sure I ate less. I got weighed at a doctor’s appointment yesterday and while I’m still within the official healthy range for my height, I was last at this weight after getting bad food poisoning back in June. I don’t feel like myself. It turns out I don’t have celiac, which I guess is a relief, but mostly I’m just stuck wondering what to do or why my body is hurting itself. And for now my body reacts poorly to wheat, so I guess I have to be gluten-free anyway.
Anyone who has ever felt at odds with their body knows that it messes with your head. There is the being too tired to see people bit, and the abandoning my normal routine bit, and the letting my house become more messy than it even is usually. My job has been accommodating—basically they let me leave early or come in late without question so that I can nap or do my work lying down/in sweatpants/with more breaks—but my brain has felt slow and frankly preoccupied with trying to understand what is happening to me.
In the last few years, I’ve started saying I was “built for aesthetic, not use.” I’ve mentioned before my height—I’m 5’11”, which makes me taller than the majority of Americans (though I’m not even the tallest woman in my extended family). That height + having facial features that mostly correspond with western beauty standards + being a skinny kid who is considered a slim adult = nearly two decades of having people tell me how lucky I am for the genes I got. I don’t disagree for the most part. These are traits that have given me advantages at various points. Once in high school someone told me I needed to marry someone hot to make sure my genes got passed on which is super weird but is part of a longer history of people just saying weird shit to me. Anyway. Apparently we think how people look is important. What I mean by “aesthetic, not use” is that my high arches mean my feet hurt a lot of the time and tend to cramp randomly, my long frame seems to be at the expense of flexible muscles or a stable low back, and it’s entirely possible that the thinness that people praise is just a side effect of being sick.
In early September, I went to get a massage to try to get myself back in my body. After a few negative test results and then the pain from preparing for the next test, I was feeling fairly shite. I didn’t know what was happening to my body, and frankly didn’t feel great about getting answers—I tried this nine years ago, going through the diagnostics, getting scoped, even having one doctor misread a test and seem to delight in telling me I’d never be able to eat vegetables or food with fiber again, only to be told that I was anxious. I’ve gotten better at asking for particular tests and advocating for myself but most of August and September was just feeling like I didn’t know what to do with my body. Between the inflammation caused by my body reacting to gluten and the secondary stiffness caused by not moving, I was not feeling great.
The massage therapist asked about my diet and exercise routine. I’m used to this, though there’s a part of me that hates doing it: I often feel like I have to prove my need for someone else’s help. Like I’m demonstrating what a compliant patient I am, with my daily walking, regular aerobic and strength exercise, and my healthy diet. I’ve been in and out of some form of physical therapy for the majority of my life at this point. This time, I mentioned that because I was doing my gluten challenge and was tired out, my muscles were extra stiff and there was probably more inflammation generally: I wasn’t moving much, and I could see that my ankles and face were a bit swollen. In explaining why I was doing the gluten challenge, I mentioned my difficulty digesting many carbohydrates and that I seemed to be incredibly sensitive to sugar. “That’s good,” she said, “we all eat too much sugar anyway.” “Yea,” I rather lamely replied.
I hated that. For starters, there’s the idea that I’m lucky to have a body that won’t let me “be bad.” It’s a sort of health stance that is pretty much a fear of getting bigger, a fear of fatness. “But wait!” you might say. “I’ve heard that sugar is addictive! What about type 2 diabetes! What about all of the reasons to limit sugar in our diets!” Absolutely, there are valid health reasons to consider the composition of our diets and how we eat, but the assumption that an inability to eat sugar without becoming immediately nauseous is somehow healthy cannot be something we really believe. I don’t think being unable to drink a half a glass of orange juice on an empty stomach is a common marker of good health. One of the reasons I felt comfortable working with my PCP to try to figure out the diagnostics gauntlet I would need to run is because his reaction to my inability to eat sugar was sympathy. I was so conditioned by “wellness” culture to feel silly complaining about being unable to eat cake that I started to follow up my assertion with “I know it’s probably healthier not to eat sugar anyway” before he interrupted to assure me that it wasn’t normal and dessert is. I’ve heard variations on this theme before: when I assumed it was entirely my anxiety that made me nauseous and unable to eat that I was lucky to have the kind that made you eat less not more when stressed. Even being told, “Well, you look good!” when I try to explain how sick I feel, which I know is supposed to make me feel better, but always sounds like how I look is more important that how I feel. Which is to say: the relative thinness I’ve maintained through my life, a thinness that most people look at as a marker of health, might just be the side effect of illness. And there’s a chance that me getting better means gaining weight—and more than just what I’ve lost in the last few months. And I hate that that scares me, but there are so many messages out there that equate health, worth, etc with thinness.
Somehow, over the past two months of thinking too much about my body, I ended up listening to the entire Maintenance Phase back catalog. If you’re not familiar with this podcast, it’s basically two people discussing trends in public health, wellness, and our nation’s fixation on the “obesity epidemic.”1 Their recent “Soy Boys” episode is a great example of taking a medical urban legend and breaking down both where it came from and how the science doesn’t bear out (you should listen to it, but it gets into how we often confuse two things that have similar names but don’t behave identically in our bodies, like phytoestrogen vs estrogen). It’s been an interesting counterpoint. For one, I think it stopped me from falling down the miracle cures rabbit hole. I think I’m pretty smart and good at assessing risk and efficacy, but dealing with the US medical system is exhausting and most of the time I don’t feel like any one who can help is listening to me. “Gut health” happens to be our current wellness obsession—your gut bacteria might be why you’re fat, leaky gut syndrome, gut plaque, etc, etc, and because my symptoms are mostly GI with a smattering of lowkey inflammatory stuff (is it histamine intolerance? is my body bad at muscular recovery? why is my skin still breaking out?), I feel like the ideal audience. My targeted instagram ads include bovine colostrum, a million “greens” things (as gummies, shakes, powders), hormone balancing herbs, myofascial release. I actually find value in some of these techniques, like fascia-release for helping me to relax my muscles and combat some of my anxiety (my anxiety makes me tense which makes my muscles tight which makes me anxious and on and on). I just don’t see them as cure-alls.
The other thing, though, the big scary hard thing, is that listening to this podcast made me realize that I have a lot of internalized fatphobia. It seems like millennials are having this moment of collective realization that we grew up in a particularly gross period of diet culture. We were the nexus of the low-fat ‘90s (Snackwell’s devil's food cake is such a specific sensory memory with that kinda crunchy/chalky chocolate coating), low rise jeans, and people being shitty to Britney Spears and Jessica Simpson in like 2007. Diet culture is still a thing—we call it “wellness” now, and use terms like “clean eating” instead—but I was a teenager when the Fitness Pal app was gaining popularity, and my ninth grade health class had us tracking calories and doing public weigh-ins and body measurements. Sure, there was some bullying for being skinny (mostly from the teacher who had us doing calorie tracking) but I never actively tried to gain weight. I don’t remember ever restricting my eating in high school, but I was always very aware of my body. I think most of my friends were similarly self-aware. Arbitrary things people would say, like you were thin enough if you could still see some rib, or if your collar bones were visible, stuck in my brain as markers. When, at eighteen, I lost my modeling job in Paris for having hips that measured over 36” and a waist over 26”, I did try tracking my calories for a few weeks but ended up giving up. I knew enough to realize that my frame just couldn’t shrink to the parameters set for me and still be healthy. It was 2012 by then, and we were starting to fetishize big butts, so I glommed onto that narrative to give myself some relief. How dumb my agency was! I was a thin girl with a nice butt! They were missing out! As my body evolved, it just so happened to coincide with the changing zeitgeist. I was lucky.
The fat-phobia thing: I didn’t think I was that bad because I can see diet culture shit for what it is, I know that a person’s body is not a reflection of who they are, and I know that many weight loss efforts are temporary and can sometimes trigger further long term weight gain. But I’m still afraid of my body changing. Aubrey Gordon, cohost of “Maintenance Phase” and a writer who came to prominence writing a column for Self under the moniker “Your Fat Friend,” talks frequently about how a lot of obesity epidemic fear-mongering uses this language of how much better the world will be when people like her don’t exist. That’s a horrific thought—that the world sees you as not worthy of existence. More damning for me was her describing how she has thin friends who will say all the right things but always confess that they could never be comfortable gaining weight. Back when I was a teenager, I fully believed that fatness was something that you could deal with if you tried hard enough. It took a few years to shift my brain from the mindset of holding an individual accountable for not fitting into the seat of an airplane to “why the hell can’t an airline be less hostile to people of different sizes?” Still, I struggle with idea of losing the privileges I get from thinness. Even as shitty as my experiences with medical providers have been at times, they would have been worse if I wasn’t small. Because at least I get perceived as compliant.
Because I remained pretty angular for most of high school, when I finally did get the small amount of softness and curvature in my form that is my adult body, it took some time to get used to. I had to rethink how to dress myself, yes, but also an entire narrative of who I was. Could I still be a little bit androgynous and masculine as my body started to present more feminine? Could I still cultivate whatever version of myself that I associated with that body? I think that as a scholar, I studied why we try to read an individual’s physical presentation as a stand-in for their personality so that I could untangle my own appearance from my selfhood2. Ideally, I can enjoy my appearance, but if it isn’t directly tied to who I am, I change it rather than it changing me.
I realize it sounds weird to say this, but it was briefly comforting to me, when I got back the visual observations from my endoscopy directly after it was performed, to have confirmation that even if my outsides appeared “healthy,” the inside showed the damage that was causing me pain. That for once, someone could look and see that there was something wrong. Yet, weeks later, when I learned that some of my issues might involve surgical intervention, I panicked. At the appointment where I was given my endoscopy results, I was briefly told I had a moderate case of a very common type of herniation that could be exacerbating some of my symptoms and that they could refer me for a surgical consultation. With no other information provided, I ended up on Google trying to learn more about why I might need surgery and how I could avoid it. I ended up so overwhelmed I triggered a panic attack and almost fainted in my living room. Not only because surgery kinda terrifies me, and post-op pain is real, but I’m vain. For some reason I fixated on the idea of these scars on my abdomen—I’ve since realized this will be fine and minor if necessary, but in the moment it felt like another way in which I was no longer in control of my body. Weirdly, having someone suggest I could get a tattoo to cover these hypothetical scars helped—I’ve never wanted a tattoo, but in this case it would be a way of regaining control. Already I am struggling with feeling my body change, inside and out.
There’s this common refrain in weight loss narratives about wanting to lose weight so that clothes will fit better, so it will be easier to sit in airplane seats, to exist in the world. My height is enough outside of the norm that finding clothes that fit is annoying (sleeves and pants are too short, but also, t-shirts and coats with shoulder seams never hit where they are meant to). I always try to get an aisle seat when flying so that I can angle my knees. Yet if there was an easy way for me to lose a few inches, I wouldn’t do it. Why? Because my height is seen as an asset, interesting, beautiful even. We’ve decided we don’t like fatness and find it ugly, but to seem less mean, we’ve broadly associated it, fatness, with being unhealthy and not caring for oneself. We concern-troll fat people about their size in the name of health instead of using the schoolyard taunts we might have as kids.
There’s no neat ending to this rant. Mostly just health stuff is hard to deal with socially and professionally when you don’t have a diagnosis and also America has a real problem with fatness. Listen to “Maintenance Phase” if you have an interest in public health or feel like confronting biases you suspect you may have. And health and beauty are not the same. Sometimes there are overlaps, but they are not a one for one, and that is fine. By divorcing health from someone’s personal preference about how bodies should look, our healthcare should improve. And stop trying to justify your physical preferences by saying they are markers of health. If you think they’re weird, interrogate them. If they’re not, just enjoy it.
See also Aubrey Gordon’s (one of the cohosts) book “You Just Need to Lose Weight” and 19 Other Myths about Fat People. Here’s an excerpt: https://www.self.com/story/aubrey-gordon-book-excerpt
SURPRISE. I haven’t managed to do this yet. How I look seems pretty tied up in who I am.
i love maintenance phase!! and omg another substack i cannot get enough of that talks a lot about not equating looks with worth is Jessica Defino’s The Unpublishable!! Reading it each week is like someone putting their hands on my shoulders and looking seriously into my eyes saying “you are not crazy.” Check it out if you haven’t run into it yet!