Mental Health and Obesity: When Being Fat is More Complicated Than That

Hi, my name is Lillian, and I am a compulsive over- and under-eating carbohydrate addict.

Seriously.

This is generally my opening at online Overeater’s Anonymous meetings. It is often an uncomfortable thing to admit to. It feels as if I make food choices to deliberately screw up my life and my health. There are two key words here: compulsive and addict. Both are directly connected to my mental health conditions, Bipolar II and PTSD. The symptoms of depression, anxiety, insomnia, hypomania can be triggered at anytime by situations and interactions with others. When these things are active, my eating and food issues generally get activated as well.

The roots and causes of my obesity and disordered eating are complex and convoluted. The road to recovery is not as simple as eating healthier and practicing self-restraint, despite what gurus, trainers, doctors, and scientists say.

All kinds of things can trigger a binge or make me resist eating for as long as possible: an anxiety or panic attack will make it difficult for me to swallow and cause a sense of nausea; conflict with people can trigger rage and instead of lashing out and hurting others around me, I’ll go for the food because it helps me to keep my mouth shut, my hands busy, and it will send me into an insulated world of carb-induced apathy. Then, of course, there are the hormonal moments where there is a system-wide ravening sense of hunger. These are the times when the compulsions inside of my brain and body take over and, even as I tell myself to make a healthier choice, the “need to feed” takes control.

I think sometimes that food and eating provide a sense of security, a touchstone of stability in an otherwise unstable world.

I grew up in a nomadic, emotionally detached, relatively isolated way of living. My mother likely had bipolar disorder herself with some schizophrenia thrown in for fun. Most of the time it was her and me, moving from place to place, to live near to or with other relatives of hers. there were her three marriages by the time I was six. The third lasted until I was ten, maybe 11, before I informed my mom what he’d been up to with me.

I suspect it was after that revelation, and the subsequent events, that my disordered eating began, or at least that’s when I remember it beginning.

Mom and I wound up living with my grandmother, who worked for Picadilly Cafeteria. In the mornings, before school I would usually eat a package of Dolly Madison Donut Gems – powdered sugar was my favorite. At school, I was the new kid, obviously part Hispanic and part White, in an inner city school in Houston. I was too light to fit with the Hispanics and too brown to fit with the Whites. I consoled myself with second helpings and two cartons of chocolate milk.

After school, mom and I would walk the city streets back to my grandmother’s apartment. My memory tells me that the apartment building she lived in had fast food accessible on three sides and no grocery store nearby. We would stop in at Burger King; I would order a Whopper Jr. meal.

Two or three hours later we might visit my grandmother during her lunch period. Since she worked at a cafeteria, those meetings would often include me eating again – either a full course meal or at least a side bowl of fried okra . . . mmmm, fried okra.

So, at one of the most unstable times in my pre-adolesence, food was the constant in an inconstant world.

Unlike other substances, like alcohol or drugs, and other compulsive behaviors like gambling and shopping, food and eating are EVERYWHERE and part of everything we do in our society. Every celebration, event, and occasion includes food, from religious gatherings, to business meetings, to wakes, and holidays. Food-enabling behavior is common among people who would never imagine pressuring an alcoholic to just try this new microbrew. On the flip side, have you seen the sidelong looks of disgust when a fit-looking person sees an overweight person eating anything other than salad?

In a world of fat-shaming attitudes from all forms of media and people around us, the medical profession seems to fail most profoundly in serving those of us who are seeking support and help to heal and achieve optimal health.

I am aware that the physical symptoms of the BD II and the PTSD interact with and are correlated to the fatigue and pain symptoms of the fibromyalgia I have experienced since I was in my early 20’s. Chronic insomnia, pins and needles in my hands, arms, and feet and a myriad of other “little” physical symptoms combine to make it difficult to want to get up and move, because I never know when what I do will set off another round of symptoms.

I was blessed to finally get medical coverage this year. The internist I got assigned to from the clinic nearest to my home, is a Resident, meaning eventually she will be moving on and I’ll either get a new PCP or hope to follow her to her new practice, if it and my coverage are compatible.

She has been very open to supporting my efforts to get healthier and lose weight through changes in activity levels and nutrition, accessing mental health treatment and support, and trying to determine if there are now other underlying physiological reasons for the symptom changes I have been experiencing. She has agreed to delay prescribing medication for my Type II diabetes in favor of allowing me to implement lifestyle changes to see if I can control or reverse it.

Last week, due to lots of increased pain, numbing and tingling, I decided I wanted to see if she would be willing to order an MRI of my neck and lower back to determine if there might be some disc issues. Unfortunately she is out until the end of May on her hospital rotation. So, I agreed to meet with whoever was available.

The doctor I wound up with was young, gorgeous, and looked as if she’d never experienced weight or eating issues. She was very nice and sympathetic, but she essentially refused to expose me to the dangers of radiation, performed a brief, perfunctory physical exam, and told me that my symptoms are likely a combination of Vitamin D deficiency, my mental health issues, and being obese. She prescribed the Vitamin D, ordered a blood test to see if my iron was low, and suggested I consider weight loss surgery. She had her attending (supervising) physician come in to speak to me about it. This woman was my age or older, curvy in all the right places, put together and definitely looked in shape. Her approach was to appeal to my intellect, being rational and sympathetic, but it was definitely like having a conversation with someone who had an underlying sense of superiority that her knowledge of medical practice outweighed my knowledge and experience of me as a person.

It made me feel like crying. Essentially, I felt I was being told that I hurt because I’m an over-weight mental case and that losing weight is the only answer to how to heal. I find it very incongruous that I was refused exposure to the dangers of radiation but, knowing that I have fibromyalgia and PTSD, a traumatic, invasive surgery to permanently alter how my body’s digestive tract functions and disable my ability to digest fresh fruits and vegetables seems perfectly viable.

I am not my diagnoses; I am not my weight. I am not my eating patterns, compulsions, or addictions.

I am a human being doing the best I can day by day to live a life of acceptance and compassion toward myself and others. The best way to do that is to take care of my health in constructive ways—on a daily basis—and do better today than I did yesterday, letting go of the judgment of myself for perceived failings created by the false expectation of the members of society who feel best when making themselves feel superior and favored above others.

Lillian Moffitt is an exhausted mental mama making it day by day. She has two adult children, one five-year old and a granddaughter.

 

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4 responses to “Mental Health and Obesity: When Being Fat is More Complicated Than That

  1. I don’t like the way that “obese” is defined these days anyway – I keep thinking back to watching the Olympics these past few years, both winter and summer ones, and you know there are competitors within there that would be categorized as either anorexic OR obese, depending what they did. Models up until recently were supposed to maintain a size of 0-2, which would also be termed anorexic if I’m not mistaken. I myself am 4’6″, and had a horrific time in highschool because even though I’m fricking well below any BMI chart (it stops at about 4’10”), whenever we’d do the thing in class where you “chart your weight”, I’d end up being considered obese! (at 4’6″, back in highschool I ranged from 116-120, and my doctor flipped if my weight went down around 100lbs). But… regular society doesn’t consider that.

    Doctors don’t always get it either, I know. I never had a big issue with rheumatologists about this but every time I ran across a nutritionist in a hospital, for whatever reason, I’d get the third degree (and yeah, like the doctor you described, the nutritionists were invariably tall and ridiculously thin).

    …which leads to my hatred of nutritionists and the tons of ads on television about “hot to lose weight.”

    Yeah this is in response to what you were saying. I sympathize. Your picture to me does not say “obese”, though I realize the rest of your body may or may not have a different shape. I do think though that doctor should have listened to you and your concerns, rather than just dismissing them. PTSD is no joke – I have it so I know – and neuropathy symptoms (and there are various kinds of it, BUT NONE THAT I’VE EVER HEARD OF THAT ARE CAUSED BY OBESITY!).

    I hope you manage to find a doctor who does pay attention to you. Good luck!

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    • Thank you. It is what it is. I muddle along the best I can. I’m 5’3″ and have been running up and down the 260 ladder this year. 3x clothes are too big, especially up top, and 2x clothes aren’t always comfortable. Things that fit my waist are baggy in the legs. My stamina has increased due to increased walking, which is starting to create its own issues as I’ve already worn out the cheap shoes purchased a couple of months ago. It will work out, eventually.

      Like

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