A Victim of Obesity

I’m seeing a disturbing proliferation of victimhood these days. Every day the media broadcast reports about victims of crime – of scams, fraud, theft, murder – and victims of acts of God, like weather, fire, and floods. My heart goes out to those victims because I feel a kinship to them. I too have experienced violence, loss, trauma, and pain. But I am not a victim. I’m a survivor.

A DAY IN THE (VICTIM)HOOD

Before we get into the meat of this article, I want to ask you a question: are you a victim?

Don’t tell me the answer yet, but keep it in your mind while you read the rest of this article.

Victimhood can be alluring. It garners attention, assistance and pity that you can milk for the rest of your life if you play the role well. You don’t have to be responsible for rebuilding your life or restoring what you lost. That doesn’t appeal to me, though. It sounds boring and tiresome, and it discourages laughter, which I find even more healing than tears, so why does victimhood continue and even proliferate? Let’s take a closer look at how obese people like us become victims.

 

WHO ARE THE VILLAINS?

Every victim needs at least one villain. Who or what are your villains?

Me – I got a lousy genetic legacy. I inherited every strand of obesity DNA my mother’s gene pool had to offer (plus the ones for thin hair and crooked teeth). We won’t discuss the humor genes I also got from her, though. Humor doesn’t enhance my victimhood. But that’s okay, because I’m actually not a victim.

While we’re blaming obesity on our ancestors, we need to look at the flip side of the nature versus nurture coin. I got a raw deal there, too. Neither of my parents encouraged exercise or sports. In fact, they ridiculed physical fitness programs and encourage scholarship and mental fitness instead, so I ended up being a very smart, very fat intellectual. And that’s fine, because I have a college degree and an impressive resume as a result. And anyway, I’m not a victim.

Another popular villain nowadays is addiction. Addicts will do anything to support a drug or other destructive habit. We need ever-increasing amounts of our substance just to prevent withdrawal, never mind to get high. For my brother, the substance is methadone. For me, it’s food, especially sweet or salty or fatty or chocolatey or otherwise nutritionally evil food, and it’s even easier (and cheaper) for me to score a hit of my substance than it is for my brother to score some of his. Baskin Robbins, McDonald’s, Lays and Duncan Hines are just a few of the virtually inescapable pushers I know. It’s sad but true, but I can overcome it, because I am not a victim.

Let’s not forget our celebrity-worshipping society and the flood of images of impossibly buff men and skinny women that wash over us every single day. The media and the likes of Victoria Beckham, Kate Moss and Angelina Jolie constitute a vast and powerful band of villains. The siren song of “Thin Is In” sounds all around me, but it doesn’t matter because I can shut my eyes, turn down my hearing aids, and remember something important: that I am not a victim.

In addition to obesity, I suffer from another incurable, chronic, debilitating disease that’s scientifically been linked to obesity. The pain and fatigue of fibromyalgia and myofascial pain syndrome haunt me every day, with villainy that threatens to suck all the joy out of my life. But I’m not going to let pain get the better of me, because I am not a victim.

 

VICTIM OR VICTOR?

 

Now let’s go back to the beginning of this article, where I asked if you’re a victim. I want to hear your answer to that question now, after you’ve read the article. Think carefully before you speak.

Okay, here goes. Are you a victim? Really, truly, a victim?

No?

That’s great! Neither am I. Like you, I’ve chosen to win the weight loss battle, conquer the villains, and emerge the victor. I’m not going to settle for anything less than that, and neither should you. So grab your swords, my friends, and fight back now!

Why Does WLS Fail?

Bariatric surgery can fail. No one wants to talk about that, especially when we’re filled with hope about what bariatric surgery can do for us. Why does weight loss surgery fail, and what does that mean for each of us? 

In the bariatric community, we spend a lot of time debating about which WLS is the best – that is, which one yields the best outcome (my own definition of that is optimal weight loss with minimal complications). I think we can all agree that there’s no such thing as a perfect or one-size-fits-all bariatric surgery. If we’ve all fought weight battles long and hard enough to need or choose WLS, we can surely agree that obesity is tough to overcome. And that is, I think, the grounds for further agreement, about why WLS fails. 

Here’s my premise: weight loss surgery fails because of obesity. If you’re thinking you need not read further because you already knew that, please wait until I explain a bit more. And those of you snickering in the back of the room, simmer down. I’m a natural blonde (duh) as well as an old fogey who needs time to make her point, but like Ellen DeGeneres, I do have a point. 

OK, let’s continue. Some disappointment or failure can be attributed to the inadequacy of a bariatric medical device or surgical procedure or surgeon or patient, but underlying all that is the basic reality of obesity: it’s a chronic and currently incurable disease, caused by a mixture (unique to each patient) of genetics, behavior, environment and biology. Weight loss surgery may address some aspects of those factors, but not enough to cure obesity. So it fails because of obesity.

In the past, I’ve given a lot of thought to how genetics, behavior, and environment have contributed to my own case, but no more than a passing glance at the biology of it. I’m the daughter of a gifted scientist who passed on not one single gene of scientific aptitude to me (instead, I got his nose and the name McMillan). 

I realize that saying that WLS fails because of obesity is like saying the ocean is wet because it contains water, but as with many obvious facts of life, it’s easily overlooked. We go into WLS believing or at least hoping that surgery will fix enough of what’s wrong in us to help us lose weight and maintain that weight loss, but we need to remember that no WLS will cure our obesity. We need to remember that our obesity is at least partly caused by factors that are invisible to us. 

Those factors were invisible to me until a few months ago, when I was asked to write a magazine article about some recent research studies that found a link between obesity and fibromyalgia. I’m uniquely qualified to write that article because I’m a veteran of both wars. 

When I began researching the article, I was astounded by the dense mountain of information: scientific data, theories, probabilities and conjectures that I’d heard little or nothing of before despite my exalted status as the World’s Greatest Living Expert on the Adjustable Gastric Band. I’ve had WLS, talked to dozens of bariatric medical professionals, attended three bariatric conferences, read countless books, articles, blogs and reports, but suddenly I felt like a babe in the bariatric woods. Why hadn’t either of my bariatric surgeons (never mind my primary care physician) mentioned any of this to me? Are they unaware of it? Are they hiding it from me and the rest of their patients? Is there a conspiracy afoot?  

This information is of enormous importance if only because it knocks a big hole in the old-school blame-the-patient approach. The paranoid in me wonders if the information is hidden to protect an industry or to further a political cause, but I put those thoughts aside and instead considered the very real possibility that bariatric surgeons are well aware of the obesity mountain but are practicing a form of medicine that circumvents it. They don’t climb the mountain and they don’t hike around it. They cut right through the middle of it. 

THE OBESITY OCTOPUS

To explain myself now, I’ll have to resort to another simile. In a sense, bariatric surgeons treat obesity by stuffing a many-armed octopus in a sack and bludgeoning it with an axe. I’m not criticizing the surgeons. Surgery of any kind requires a breathtaking degree of confidence, skill, and audacity. Although surgery doesn’t address every waving octopus arm, it is the only effective long-term treatment for obesity available in the United States today, and I’m very grateful that I was able to have WLS and lose my excess weight as a result of it. At the same time, I sometimes worry about the future. This spring, treatment of a medical problem required removal of my band. I’ll soon have vertical sleeve gastrectomy surgery, but what if obesity takes over my life again in spite of my band and all my hard-won lifestyle changes? Are researchers working on an obesity cure now that can help me with that in the future?

WHAT CAUSES OBESITY?     

It turns out that researchers have indeed been busy searching out the causes of obesity in the hope of finding a better way (or ways) to treat it, prevent it, and/or cure it. 

As I mentioned above, several studies have reported a link between obesity and fibromyalgia. It’s easy to get caught up in a chicken & egg debate about that – does one disease cause the other? I don’t want to go down that road right now. Instead I want to talk about some factors that are associated with (and may be contributing to) both conditions. They are: 

Non-restorative sleep – Sleep affects the production of hormones (leptin, grehlin, cortisol) that are key to the experience of hunger, appetite, and satiety. Poor sleep tends to decrease leptin (satiety hormone) production and increase grehlin (hunger hormone) production. It also seems to increase sensitivity to pain. If you have sleep apnea or another type of sleep disorder, or even subclinical sleep disturbance, it’s likely that your physical hunger is increased and your sense of satiety is decreased. The adjustable gastric band can intervene on your behalf, but it doesn’t correct the hormone production problem.  

Neuroendocrine dysfunction – the nervous system (neuro) and endocrine system (glands) control all physiologic processes in the human body. The nervous system works by sending messages through nerves, as if it’s a hard-wired telephone system. Nervous control is electrochemical in nature and is rapid. The endocrine system sends messages by the secretion of hormones into the blood and extracellular fluids. Like a radio broadcast, it requires a receiver to get the message. To receive endocrine messages, a cell must bear a receptor (a receiver) for the hormone being sent in order to respond to it. If the cell doesn’t have a receptor, it doesn’t “hear” or react to the message. 

Researchers studying neuroendocrine interactions discovered (among other things) that in fibromyalgia and obesity patients, certain cells have damaged or malfunctioning receptors for the leptin, the satiety hormone. It’s the one that tells your brain you’ve had enough to eat. So one of the reasons you rarely feel satisfied by a reasonable amount of food (or in my case, an infinite amount of food) may be that satiety messages are going astray because your cells’ in-boxes are locked or absent. 

Dysregulated HPA is a factor contributing to both obesity and fibromyalgia. HPA stands for hypothalamus-pituitary-adrenal, three glands (part of the endocrine system) that are crucial to healthy functioning of many bodily processes. The HPA axis is a grouping of responses to stress. When you experience stress (whether it’s physical, like an injury or illness, or mental, like a fight with your spouse), your body produces a biomarker (messenger cell) that stimulates your HPA axis. Your hypothalamus (in your brain) then sends a message to your pituitary gland (also in your brain), where it triggers the release of ACTH (adrenocorticotrophic hormone) into your bloodstream and causes the adrenal glands (on your kidneys) to release the stress hormones, particularly cortisol. Cortisol increases the availability of the body's fuel supply (carbohydrate, fat, and glucose), which is needed to respond to stress. However, prolonged elevation of cortisol levels can cause havoc: muscle breaks down, your body’s inflammatory response is compromised, and your immune system is suppressed. If you’ve ever taken a corticosteroids medication like Prednisone to treat an inflammatory problem (like an allergic reaction) or disease (like lupus), you’ve probably learned the hard that it can turn you into a bad-tempered eating machine. 

Inflammation, as mentioned above, is another culprit in both chronic pain and obesity. A European study of showed that obese rats have chronic low-grade systemic inflammation that sensitizes them to pain. Immunological vulnerability is common to obese and chronic pain patients and contributes to pain, fatigue, sleep disturbance, and depression. All of those are factors that can prevent us from exercising and are associated with the neuroendocrine dysfunction described above. 

Mitchondrial dysfunction may also play a role in both chronic pain and obesity. According to Karl Krantz, D.C., “mitochondria are the power house of the cell. If energy is not being produced, logically it can lead to or contribute to chronic fatigue and pain.” A Finnish study of identical twins (each pair including a normal weight and an obese twin) found that the fat cells of the obese twins contained fewer copies of the DNA that’s located in mitochondria. This DNA contains instructions for energy use by the cell. The lead researcher of the study says, “If one were to compare this cellular power plant with a car engine, it could be said that the engine of the fat individual is less efficient.” So it’s no wonder that obese people are not able to burn or use all the calories they consume. Some medical professionals believe that chemical toxins (such as the preservative sodium benzoate, used in many soft drinks) and biotoxins (such as mold) can damage the mitochondria, increase inflammation, and aggravate both obesity and chronic pain.

 

WHERE DO WE GO FROM HERE?

Your own brain may in overload now after working its way through all the biological business I’ve ineptly but earnestly tried to explain. Even if nothing else is clear, I hope you’ve grasped the message that the causes of and factors in obesity are extremely complicated and well beyond the means of any currently existing medical device or surgical procedure to cure. I also hope you can see that blaming yourself for your obesity doesn’t go very far in treating it. You are not in conscious control of your neuroendocrine system. But neither are you entirely helpless. You have, or will soon have, a bariatric tool that when carefully used, can bring your appetite under better control and increase your sense of satiety. You can learn as much as possible about the factors that can improve your overall health and counteract the misbehavior of your nerves, hormones, and immune system. For example, I know for a fact that regular exercise helps me manage not just my weight but my depression and pain. You may feel defeated by the very idea of that, but according to an article in the July-August 2011 issue of IDEA Fitness Journal, as little as 5 to 15 minutes of exercise a day can yield health benefits and also increase your self-control when it comes to food choices.

At the end of the day, I still suffer from obesity and fibromyalgia, both puzzling and difficult to treat, but I try not to think of myself as a victim of those diseases. I can curl up in a chair with a box of chocolates and weep about my situation, or I can go on learning about my medical conditions and experimenting with ways to improve my health and quality of life. The author of one of the obesity-fibromyalgia studies, Akiko Okifuji, recommends that patients adopt healthier lifestyles and take more positive attitudes toward symptom management. That may sound condescending, but as Dr. Krantz wryly pointed out, “every person in America would benefit from that approach.” I know that’s easier said than done, but I’m willing to try it…are you?

Is there a link between obesity & fibromyalgia?

In 2009 and 2010, researchers published the findings of three studies performed at the University of Utah and the Norwegian University of Science and Technology that found a link between obesity and fibromyalgia. As someone recovering from obesity and suffering from fibromyalgia, I’m glad when data comes to light that might help explain, treat, or prevent these conditions. A link that might reveal a common cause sounded promising to me.

The public in general and FM sufferers in particular heard something else in those reports, thanks to eager journalists who jumped on the studies’ findings and mined them for their shiniest nuggets. The studies included mostly female subjects, so a distorted message was broadcast: FM is a fat woman’s disease, and if those lazy gals would just exert enough willpower to diet, exercise, and lose weight, their FM symptoms would lessen or even disappear.

I recently wrote an article about the obesity-fibro link for Fibromyalgia & Chronic Pain LIFE magazine. In researching the article, I learned a lot about the possible causes of both obesity and fibromyalgia, things I’d never heard before at all. Sufferers of both obesity and/or fibromyalgia often hear that their problem is all in their minds, but it turns out there’s a whole lot more going on than the patient’s conscious behavior…that the problem is caused or at least affected by biological and other factors over which we have no conscious control. If you’d like to read more about it, go to http://fmcpaware.org/ and click on the image of the magazine cover on the left side of the page (it’s a woman wearing a red jacket, holding a globe).

Seeing the world through fat-colored glasses

I'm sure you've heard the term, "seeing through rose-colored glasses." That would probably describe me, the eternal optimist. Many of us also see the world through fat-colored glasses, with lenses that look clear but drastically distort our perception of fat and thin. I've been going through a strange and frustrating period of seeing myself as fat every time I look in the mirror even though my weight has not changed. The other day I realized that my vision is also distorted when I look at other people, thanks to a lesson I learned from my friend Lisa B.
Lisa lost 114 pounds after having RNY (gastric bypass) in 2001. She was proud to be thin, and with obnoxiously big (her term) augmented breasts and movie-star smile, she was smokin' hot.
But eventually her stomach pouch stretched out, she ate more and more, and her weight shot back up, a 44 pound increase. In May 2009, Lisa had what's known as BOB surgery - band over bypass. Since then, she's lost 70 lbs. and is back to being that smokin' hot lady. Because I'm always recruiting before/during/after photos to help inspire other bandsters, Lisa kindly gave me permission to publish hers in the Bandwagon on the Road newsletter and in the 2nd edition of Bandwagon. When I first saw Lisa's after photos, I was disturbed and told her, "You look very scrawny. Have you seen your doc lately, and does he/she think your current weight is healthy?"
Lisa's reply was illuminating on several levels. She wrote (in part):
"I still see my surgeon every 3 months as well as my NUT and they both said that because I am small-framed, I am at a really healthy weight (I always thought I was big-boned, turns out I was just fat LMAO). All of my stats are where they should be...body fat percentage, waist-to-hip ratio, etc., and my labs are perfect each time too.
"This is the exact weight that my body stopped losing at 18 months ago and has remained at ever since...literally haven't fluctuated more than 2 lbs up. So my doctor said this is where my body is happy - this is my 'normal' now. He also said early on that if a "normal" (meaning never obese, I guess) person was my size their whole life, it would not be an issue...they would be considered a "naturally thin person," (you know, the ones we grew up hating lol) but since I have never been a normal size until now, I can expect people to comment that I'm too thin (rather than normal and/or healthy). Which did happen when I first reached this weight a long time ago...but now everyone around me is used to it - not to mention they see how much I eat (7-8 times per day) and what I eat (healthy food choices 95% of the time) and so they all know that clearly this must be my body's 'normal'."
Well, those 2 paragraphs gave me a brand new view of body image! And who am I to judge what's normal for another person? Lisa's words immediately reminded me of one of my coworkers at JCPenney, a “naturally thin” college girl named Hailey. Her mom is short and heavy while her dad is tall and thin, and Hailey looks nothing like her mom and quite a lot like her dad. She’s in good health, with beautiful skin, good muscle tone, thick shiny hair, clear eyes, lots of energy, and as far as I’ve been able to see, eats well (for a college kid, anyway). As much as I tend to focus on body size, I've never thought much about Hailey's body size or shape. Her prominent characteristics to me are her kindness, intelligence, sense of humor, and (in terms of appearance) her great sense of color in her clothing choices.
The other day a customer (an elderly man) said to Hailey, “Girl, you gotta put some weight on you,” and Hailey laughed and said, “I think this is the way my body is meant to be.” When I look at Hailey, I don’t think, “She’s too thin.” She looks normal to me. I've known her for 2 years, she's been thin the whole time, and thin is her "normal". So it’s really interesting that I looked at Lisa's “after” photos and thought, “She’s too thin”!
Why do I look at 2 thin, attractive, healthy women and think one looks normal and the other looks too thin? The only difference is that I know Lisa is a WLS patient, and with that ID tag on her, I assume a host of things about her, including a tendency of some WLS patients to develop anorexic behavior and become too thin. And we all know what happens when you assume, right? Assuming makes an ass out of you and and ass out of me. So shame on me! If Lisa walked into my JCPenney store tomorrow (which would make my day!), I'd just be blown away by her slim good looks and that movie star smile. "Too thin" wouldn't even be on the horizon!

Fear of Fat

One of the aspects of weight maintenance that I didn’t expect is the persistent fear of fat.
When I say “fear of fat”, I’m not talking (right now, anyway) about the cultural phenomenon that makes us worship emaciated celebrities and scorn the obese ones. I’m talking about fear of fat on the local level, inside our own hearts and minds.
You’d think that my track record with my band would give me confidence. I lost all my excess weight, I regained 25 pounds, and then I re-lost those 25 pounds. I still have the basic tools I need to deal with weight gain: my band, my knowledge of how to use it, and my own inner resources (perseverance, intelligence, discipline). I’ve gained a boatload of self-confidence and feel strongly that I can accomplish anything I set my mind to. I can skate smoothly over the bright, shiny surface of my new life for days on end, forgetting that I was once fat, forgetting that I could become fat again. But sooner or later, something pushes my fear button and I hear Sting singing the melancholy song, “Fragile:”

If blood will flow when flesh and steel are one
Drying in the colour of the evening sun
Tomorrow's rain will wash the stains away
But something in our minds will always stay
Perhaps this final act was meant
To clinch a lifetime's argument
That nothing comes from violence and nothing ever could
For all those born beneath an angry star
Lest we forget how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are

On and on the rain will fall
Like tears from a star like tears from a star
On and on the rain will say
How fragile we are how fragile we are
How fragile we are how fragile we are

I don’t want to live my life with the fear of fat (or anything else) coloring my every thought, spoiling my pleasures, steering me away from taking risks that might yield wonderful things, inhibiting my to function like a normal (whatever that is), healthy person. On the other hand, fear of loss or injury helps me behave safely. I wear a seat belt when I’m in a car, I don’t exceed the speed limit when I’m driving, I lock my car before I walk away from it, I wash my hands, take my medication, and look both ways before crossing the street. Perhaps it’s a good thing to remember how fragile I am, so that dangerous impulses won’t send me and my bandwagon flying off the edge of a cliff, and so that I remember to thank God for the blessing of just being alive.
I was fat for a long, long time. Many of the important events of my young and middle adulthood were shaped, or at least influenced, by my obesity. Entire thought systems grew up around my fat, to explain it, justify it, banish it, nullify it. My daily habits, what I ate and how I moved, were coordinated by my fatness for over 30 years. I lost my excess weight in a fraction of that time, so it’s no wonder that my brain hasn’t quite caught up to the change in my body.
On the other hand, I arrived at my weight goal 2-1/2 years ago. That’s 30 months. If my brain devoted one lousy month to each year of twisted development, I could have been free by now! But it didn’t. I guess I was too involved with all these interesting and absorbing new activities: exercise, making new friends, clothes shopping, socializing, book and newsletter publishing, volunteer work, paid work. I forgot that Fat Jean was still inside of me, scratching her head and saying, “Hey, what’s going on here? Did anyone bring donuts?”
Although sometimes I wish I could find an exorcist to get rid of Fat Jean, I’m enough of a realist to sense that she’s never going to go away completely. She’ll be at my side as I step on the scales in the morning, whispering, “I told you so,” as I groan about a weight gain. She’ll be pulling on my elbow when I walk into a room full of people, encouraging me to investigate the food rather than introduce myself to a stranger. She’ll embrace me when I’m tired and sad, reminding me that true comfort is found only in chocolate.
Fat Jean is another reminder of how fragile I am. As much as I hated the obesity she led me into, I know that she’s not evil. She was doing the best she could to survive in difficult life circumstances, using some tools and skills I no longer need. The memories she holds are full of the strife and sadness that – along with many other factors – made me who I am today. That’s a strong, sensible, compassionate woman. I don’t need to dwell on Fat Jean, on what she reminds me of or what I fear, in order to benefit from the lessons she and I learned together. My plan is to do my best to balance the sad and fearful thoughts with joyous and hopeful ones. Yes, I know I already have the reputation of being the Eternal Optimist, but even I have to watch for the negative stuff that seeps through my walls from time to time. The Negatives are going to have to audition from now on to earn a moment on stage. If a Negative can teach me or remind me of something important, it can do its song-and-dance routine. If not, it’s outta here.