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August 11, 2011 / missmarymax

“Healthy”: Fat and Thin

Trigger Warning: This post contains discussion of disordered eating, heart disease, brutal things people say to those with eating disorders, and brutal things people say to fat people.  Do well by you.

This is a story of two people.

First: a 16-year-old, female, thin.  This girl goes long periods of time without eating, then eats.  Ravenously.  It’s hard to say, based on her own description, whether she eats “too much.”  Too much, to her, is anything.  Sometimes, when she’s done eating, she throws up, or she spends hours on the treadmill, working off the calories she’s somehow let herself consume. Eventually, this girl is taken to a doctor.  That doctor, being an asshole, does not understand right away that she has a problem.  He instructs the girl’s parents to sit her down for meals. This response will appall every doctor she’ll see later, every medical professional who will see her pattern — starve, eat, starve — and recognize it, clearly, as an eating disorder.

This is the girl behind door number one.  Behind door number two is her father.

Her father, (no gender-twists for once), is male.  He’s in his fifties, and he is not thin.  Every day, he wakes up, rushes to work, rushes through work, forgets breakfast, forgets lunch, and ends up ravenous.  He goes long periods without eating; then he eats. Ravenously.  This is his pattern: starve, eat, starve, eat, starve.  This is the only relationship with food he knows.

The girl receives treatment for an eating disorder.  She sees a therapist, a dietician, a psychiatrist.  She enters residential therapy, spends three months out of state learning how to eat and how to feel.  She is told, again and again, that eating disorders are deadly, the most deadly of any mental illness, that this is why she must change. She grows terrified of her heart stopping, suddenly, the way they have told her it could. She loses sleep over the possibility. A few years later, she loses a friend (also thin, also young) to it as well.

The father, too, has a heart attack. Surgeons enter his chest and rewire his heart, bypass three clogged arteries, declare two others too far gone to save. He learns this is not a death sentence, but that he must not take it lightly. If he can change — here, now, fully — then he may live long and well for many years.

He will be told not to eat certain foods. Not to eat too much. He will begin following, rigorously, the diet prescribed to him by the hospital. He will lose a shocking amount of weight in a matter of months, and the skin will sag on his face in a way it never has. He will be congratulated by doctors as his weight plummets, he will become the star of his rehab. His pattern will not change — (starve, eat, starve). He will simply last longer between cycles. He will eat salads and yogurts for a week, instead of a day, then treat himself — ravenously — to the foods he craves.  He will do this to be healthy, to live. He will do as he’s been told.

Doctors will insist he do what they insist she stop. Because he’s had a heart attack. Because she’s risking one.

This is — no surprise — my story and my story of my father. Granted, there are many reasons our experiences are different. Recognizing my behaviors as eating-disordered, given that I was a sixteen-year-old White girl, did not require thinking far outside the prototype. My father, on the other hand, was older, he was male, he binged and starved but did not purge — through exercise or otherwise. All of these factors — combined with dangerously limited diagnostic criteria and public perception — played into the responses we received.

But there is one realityI truly believe only my thinness and his fatness can explain. And that’s the way medical authorities told him to restrict, advised him to, told him to exercise beyond the calories he took in, congratulated him on weight lost at shocking speed, reinforced his sense that gaining weight (not losing it) was dangerous.  That’s the way that — on a basis of BMI, bad science, and crap notions about health and weight — his team of doctors cultivated his disordered eating.

My father’s health has improved in the time since his heart attack. His blood pressure and blood sugar are the best they’ve ever been. I’m grateful to him for not landing back in the ICU, for the year-and-a-half in which I’ve not worried, as I hold his hand, that it’s for the last time.

 Still, I worry. I worry about the deprivation/ indulgence cycle that his treatment has exacerbated, rather than curbed. I worry about how much his “recovery” looks like my “relapse.” I worry how long he can keep up a status quo that tells him to check his desire rather than fulfill it.

Some people need to lose weight.  I heard this in treatment, and I tried to buy it, as an explanation.  But ten years into recovery, it no longer makes sense. In the absence of my eating disorder, I maintain a weight with shocking ease. By my body’s standards, not the BMI’s, I settle into a place where I feel good and cared for– and I stay there by eating what I want when I want it, by walking quite a bit, and by generally forgetting to “work on” my body.

I cannot believe that what is right for my dad is so different than what is right for me. I cannot believe that, if his weight was meant to be as low as the BMI claims, as low as the doctors insist, his body would resist with this level of force. That he would speak of never feeling full, of cravings, of deprivation, or of shame.

My dad’s weight loss has genuinely changed the way people respond to him. (Thin privilege is no myth.)  Still, the medical professionals cannot see him as they saw me: as a person, whose body can be trusted rather than fought. Whose life means more than her numbers. Who is not healthier the less he is here.

Sick, isn’t it?

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10 Comments

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  1. Christine / Aug 11 2011 4:45 pm

    Another great post, dear cousin. I also agree to what you are arguing here, my grandpa had the same issue as your father, but after he retired things began to change. He started to regularly eat three meals and he even goes to a special work out session three times a week. I feel though, that one of the reasons he is not in the same position as your dad is the fact that he was, well still is, a doctor himself. He worked with children for a great number of years and saw many cases just like yours. He notices the similar patterns and is able to pave a new way for himself. I think that if the doctors saw the same pattern paralleled in your father, THAT is when they would be able to see the same thing you do. I think they don’t have enough general knowledge about both cases, or fields of study, to be able to catch it. And that is why your dad stays on his same path of starve, eat, starve.

    • missmarymax / Aug 11 2011 5:09 pm

      So true, my dear. I’m so glad your grandfather saw the risk. I think many of us have have blinders on that keep us from seeing how similar the patterns are. Even with people who have no heart disease or diabetes history, the response when they develop disordered eating or ED habits is so often “you look great!” or some other congratulatory bs, UNTIL they pass that point of “acceptable” weight loss. It’s frightening to think how impossible it can be to even reach that point, for certain people, and that we are still willing to accept these behaviors in certain populations, provided they have the type of body we think warrants them. Hope it’s changing, however slowly. Thanks for sharing, sweet.

  2. Hannah / Aug 11 2011 5:35 pm

    I just wanted to say that I work with MANY health professionals who have less insight into this than you do, who can’t see that a healthy weight and healthy eating habits have to go together.

    Part of why I love my job is being able to have relationships with patients and establish the kind of trust where they feel like they care discuss their health behaviors without being judged. I also love the fact that I get to work with medical students and they can see the power of these relationships. People aren’t used to being able to talk about what is realistic for them and what “feels right” for their body.

    So, thanks for talking about this and educating people like me, so that I can trurn around and educate the poeple that I interact with on a daily basis!

    • missmarymax / Aug 11 2011 5:52 pm

      Oh, Miss Hannah. MWAH. Doctors like you are why I don’t hate doctors. Thanks for the work you do, and the way you do it.

      • Christine / Aug 11 2011 6:04 pm

        I one hundred percent agree with this declaration of awesome.

  3. Katja Rowell / Aug 11 2011 6:46 pm

    this is a great piece, I just shared it. thanks!

  4. Scott / Aug 13 2011 2:51 am

    such a strong post Miss Mary, thanks so much for sharing ❤ I think you are SO right about not focusing on weight, as it is so individual. There is no way a BMI can fit everyone, simply no way. And it is so great to have people like you voicing this 🙂

    • missmarymax / Aug 15 2011 7:45 pm

      Thanks, Scott! In related good-to-hear-it news: I flippin’ love it when you comment. 🙂

  5. Abby / Aug 21 2011 8:27 pm

    I read this a few days ago and have been trying to think of some sort of intelligent comment to leave in response. However, all I can say is that I’ve read so many things on eating disorders, have written so many things on eating disorders, have rolled my eyes and felt misunderstood at those things I’ve read and been stereotyped with on eating disorders.

    This post–the articulate way you described exactly what I’ve felt a million times over–is one of the best things I’ve read. This is so, so excellent.

    Sorry for the lame comment, but that’s all I’ve got 🙂 Great post.

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