Friday, October 25, 2013

Fat enough. Coming to terms with weight when it’s less than ideal.

I don’t know which made me saddest—her sense of vindication when reporting the oncologist’s orders: “I don’t want to see any more weight loss”, or her distress that her weight was up 5 pounds. Or perhaps it was her pride in getting down to the lowest adult weight she has seen in many decades. Ahh, the perks of esophageal cancer!

She’s lived so tormented by her weight, berated by doctors and non-supportive family members to reach for something unattainable, to get thin, from the time she was a pretty, young, school-age girl. “You’re beautiful”, they’d say, “if only you could lose some weight.” Perfect labs and low normal blood pressure were not good enough. No, she didn’t look fat on paper.

And yet her obesity just might have been the source of her potentially fatal illness. There. I’ve said it. Admittedly, GERD, gastroesophageal reflux, is linked with many factors, and obesity is just one of them.  But after a decade living on antacids, popping Rolaids like LifeSavers—no pun intended—with a blood sugar approaching diabetic levels, she had gastric bypass. The GERD? Finished! Antacids were no longer a fixture like Kleenex and lipstick in her purse. Yes, she was free of heartburn and indigestion—and her blood sugars dropped to normal. With her 90 pound weight loss came a reversal in symptoms and the promise of a better life.

So it came as a quite a shock last year to learn that she had esophageal cancer. And hers, located at the very bottom of the esophagus near the stomach, was not a result of alcohol or smoking but from many years of damage from acid reflux.

GERD can lead to changes in the cells of the esophagus—between 5 and 10 % with GERD get Barrett’s.  And Barrett’s Esophagus can develop into cancer, with an overall lifetime risk of 5%

Could it have been prevented in her case?

Sure, earlier screening by endoscopy to evaluate progression to Barrett’s sooner could’ve helped. And being more proactive with a procedure called ablation to wipe out the changed “Barrett’s” cells would have helped too. 

As for weight loss?

It’s not that she didn’t try. Perhaps she was genetically meant to be a large woman with a high BMI. Still, she could have worked in more activity, walks at least, something, setting realistic, achievable goals. And stress reduction to prevent emotional overeating and anxiety-driven overeating.

Yes, those might have helped her weight and subsequent chronic reflux and possibly prevented her cancer. But in our society it would never have been enough. She would still be viewed as obese, with the stigma we project on that label. Doctors would still say her weight was too high, falsely envisioning the fast food drive-ins she never frequents. (Actually, her meals have been quite healthy and balanced for as long as I could remember.)

In spite of her post cancer, post surgical weight loss of more than 40 or 50 pounds—honestly I don’t know how much exactly—following the doctor’s orders and not striving to lose more weight is quite a challenge. Self-acceptance doesn’t suddenly appear at age 75 when it has been long absent.

So please don’t wait until changing is a matter of life and death. Seek support for working on self-acceptance. And try to see your weight as just a number—not a reflection on your character, nor your motivation, nor your fitness level or your health.

Thanks for reading.

And yes, I've written about this before with a bit of a different focus.


  1. It's so hard to just remember it's just a number. I'm working on just staying off my scale and not feeling bad about myself that I didn't lose as much weight as I wanted to with gastric bypass.

    1. Refocusing on what's really important is key! Stay off that scale!!!

  2. Sorry this isn't fully related but I have pretty much daily bloating and stomach discomfort and I read that that can mean you aren't digesting all of the nutrients in your food. Is that true? Do you have any tips about eating the foods I love (oatmeal, dense grainy breads, veggies, etc) that hurt my stomach because of the high fiber without having to take digestive supplements like Beano (I am a college student and they are expensive!)

    1. Uncomfortable fullness is quite common in those who are beginning refeeding. Food tends to move more slowly through the digestive tract when you have been under eating and there is a period of adjustment until things normalize. That said, you should discuss specifics with your MD and RD. Most colleges have these supports!
      Hope this helps.

  3. Back in the day, I wished for breast cancer. First, I'd lose weight and second, it would come with free breast reduction surgery of sorts. Then I grew into a big girl, saved up a bit of money and I'll get said surgery without the need for cancer. Might do nothing to my self-esteem but it will prevent toppling forward.

    I've been listening to the good old "If you lost a bit of weight, you'd be actually a pretty girl" since I was 12 or so, paired with "If you had a bit of strong will, you would indeed lose a few kilos." The most insane weight loss advice I got was "So why you don't stop eating, just get some daily multivitamin so that your hair doesn't fall out, until you're thin." Lately, my depression has been roaring wild so I almost stopped eating - most stuff tastes like cement and I have problems swallowing solids or ingesting larger amounts of anything; one can only go so far with thin gruel. Mommy is happy that I'm losing weight, that maybe, for once, I will be that pretty girl. Yay for toxic relationships.

    (I'm getting treated, no worries, but it goes slow and the depression brings up bad things.)

  4. I have enjoyed reading your blog. I have GERD, caused by a hiatal hernia. This is probably linked to binge eating. About a week and a half ago, I began intuitive eating because I am so ready for change. This has actually been a liberating process. I know that I can eat anything I want as long as I am physically hungry and was very surprised at how good that I have been feeling. The last three days I relapsed back to disordered eating but I know what my trigger was and I am working through those feelings. I am trying to learn how to take care of myself both physically and emotionally. I would be lying if I didn't hope that this will lead to some weight loss but I really want the focus to be on becoming a better me, physically, emotionally and spiritually.

    1. So glad the blog has been helpful! Thanks for your comment.