The Elephant in the Room

Note: This post may offend.

I went to college in 2000 a bit overweight and with a history of some depression and anxiety.  Early into my freshman year, I got into a relationship that would last four pizza-filled years.  My “freshman fifteen” was closer to fifty and by sophomore year, I was nearly two-hundred pounds for the first time.

#tbt

#tbt

During my sophomore year, my depression became untenable.  I was crying constantly.  I did not want to continue.  My poor boyfriend had no idea what to do.  He was very loving and complimentary but also had issues.  As we bonded and “coped” with food, I gained more weight which fueled my unhappiness.

My situation eventually got so desperate that I sought help.  I went to a small music conservatory that was serviced by the health center at Northeastern University.  The doctor I saw listened to me describe my debilitating sadness and anxiety.  Somehow in the conversation, I disclosed what I understood of my mother’s mental health issues, including the medication she took.  The doctor said that I likely had similar brain chemistry and after a ten minute conversation, prescribed me the same SSRI.  She did not ask me if I was on any other medications that might be affecting my brain chemistry (aka oral contraceptives.)  We did not know each other.  The doctor did not know how complicated my relationship was with my mother and how difficult it was for me at that time to be told that I had the same issues as her.  One of the sources of my anxiety and depression was the feeling that, like my mom, I would never be happy.  This prescription compounded those feelings and set me on a course of inconsistent self-medicating and new fears.

In the same year, I had instability in my right knee to the point where it felt like it would buckle with every step I took.  I went to the same health center and the doctor had me stand up and take a few steps.  He said: “You have probably ground off all the cartilage in your knee cap by standing hyperextended.  There’s nothing that can be done.”

Nailed that diagnosis, Doc.  F*cking lazy idiot.

Nailed that diagnosis, Doc. F*cking lazy idiot.

At no point in either of these appointments did either doctor address the elephant in the room: my obesity.  The simplest explanation is usually the right one.  How could these medical professionals look at my body and not ask me what I was eating and if I was ever moving around?

Near the end of college, I lost about 30 pounds with Atkins and felt much, much happier.  My knee didn’t bother me and my depression was much less intense.  The underlying issues were still there but by taking control of my eating and having success, I felt in control of my life for the first time in a long time.

The next year (around the time the top photo was taken), I had gained the weight back and more.  I was in graduate school in New Hampshire and my depression was more intense than ever.  The last thing I wanted was to talk to another person who would confirm that I was on the same lifelong miserable trajectory as my mom.  I did not want to keep going.  Self-preservation thankfully won out and I went to the University health center.  This doctor listened and patiently deciphered the occasional word between sobs.  He asked me if I was on any kind of medication.  I had recently switched birth control but I assured him that it wasn’t the birth control that was the problem, it was me.  He wasn’t condescending but he urged me to discontinue the birth control and see if I felt better.  If I didn’t, we would move forward with treatment.

Within a day, I was fine.  Well, as fine as I had been in five years.  It was miraculous.  And I was furious.  What if all those years ago, I had simply discontinued my birth control?  Why didn’t that doctor address my situation similarly and save me so much grief?  Relief revealed the strength I needed to pick up and move back to California.

Six more years of yo-yo dieting, depression, anxiety, self-discovery and gradual progress got me to the start of this blog and the start of a completely different life.

I tell this story for context.  What I’m actually interested in discussing is the culture in which medical professionals do not address the most obvious cause of health problems: obesity.

Did I have irreparable cartilage damage?  NO!  I WAS TOO HEAVY FOR MY JOINTS.  Did I have a mental illness that required medication?  NOOOOO.  I was short-circuiting my brain several times a day with massive amounts of refined sugar and as I gained more weight I was destroying my self-esteem by living my mother’s life instead of my own.

Both of these “diagnoses” were wildly inaccurate but they came from doctors so I believed them and folded them into my identity.  They impacted my self-esteem and choices for nearly a decade.  Perhaps the first doctor felt that discussing my body would be too damaging for me to bear at that time.  Well, you’re a doctor.  Figure out how to talk about nutrition to a depressed young woman so you can help her.  That’s your job.

Now, it should go without saying that nutrition and activity are not the only solution, nor are they easy to address.  There are all types of situations in which therapy, medication, and other interventions are necessary and helpful.  Also, changing your eating is hard work.  Facing your fears and becoming active is hard work, especially if you’ve never done it before.  Untangling a lifetime of experiences and issues to face yourself and eventually love yourself is possibly the hardest work of all.

If one of those doctors had told me to eat more healthily and become active, I probably would not have been ready to hear it.  I recognize that.  But I accepted what they did tell me so maybe I would have filed it away.  Maybe I would have come to a healthier lifestyle sooner if it had been suggested.  Especially if it had been suggested by every doctor I saw.

Everyone deserves love.  Everyone deserves self-love.  Everyone deserves a healthy, vibrant body to live their life in.  If someone isn’t healthy, if someone is obese, they absolutely deserve love and respect.  If they have health issues or low self-esteem and they’re obese, it is not unloving or unsafe to acknowledge that physical condition and address it.  It’s simple and vital.

Thoughts?

 

 

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6 thoughts on “The Elephant in the Room

  1. Thank you for sharing your story! I definitely agree that more doctors need to focus on holistic health and less on prescribing medications and quick fixes. Also, I’m pretty appalled that a doctor would be so quick to diagnose you in both cases!

  2. nichtisobel says:

    Beautiful, honest post. I don’t know what there is in here to offend. I know that many MDs feel all kinds or pressure from the HMOs and their brutal schedules to treat people like problems and that compounds the lack of holistic care. Often, though, it has to do with the doctor. My Kaiser OBGYN takes more interest in my whole-body health than my GP, although I literally owe my life to my GP in 2011 at age 38 for taking seriously my complaint about a week-long low-grade calf-cramp, which was, indeed, a significant case of deep vein thrombosis.

    Most HMOs think that psychological care should be short-term, and only cover 8-12 weeks of counseling. However, your GP can subscribe you intense psychiatric drugs only discussing your problems with you for five minutes, without even the basic follow-up psychiatric care needed to make sure the drugs are having their intended effect (and no side-effects).

    In these last ten years, since you’ve been in college, I know that the philosophy around holistic care has changed radically, and more and more doctors are taking the time to ask you how you feel, in general, and are perhaps less afraid to state the obvious.

  3. nichtisobel says:

    Oh, my DVT? Given that I presented none of the typical risk-factors for getting DVT, it was ruled that it was brought upon by my birth control. >:-\

  4. laura says:

    you forgot “everyone deserves tough love.” those who care will be honest and try to help no matter how hard it is to talk about. glad you finally found a doctor who could help. i had a similar experience with birth control and am still so angry that it wasn’t corrected sooner. best wishes. laura

  5. Andy Cantor says:

    Hey, this was a really great post. An important and complex issue which is all too often skirted around. It’s a tricky line to tread. I know many friends who are not dramatically overweight who have had their weight commented on in doctors offices for no good reason, but of course I’ve also most recently been getting to know the ‘backstage’ of hospitals where the word ‘obese’ is often heard, but rarely pointed out as being significant, even in cases where it probably is. (In a recent cancer case I saw presented at a meeting, the woman in the pet scan was clearly very large, but the idea that her weight might be a factor in her illness or well-being was never so much as touched upon. This was a young woman who would probably benefit hugely from losing weight, but that was simply not a part of the treatment plan.) I’m still learning, but I suspect as I become more familiar with the medical setting I will continue to see this pattern.

    As someone who has had completely reprehensible healthcare in the past (yes, often to do with that fucking awful miracle we call contraception) I’m determined to make my career about complete, sensitive, and useful patient education and advocacy. Your experience is far from uncommon and the healthcare system HAS TO CHANGE. Patient communication and follow up are too often appalling or absent. I could go on and on about this, but suffice to say that I think all of the points you make are good ones and I’m so glad you overcame the failure of the system and are living and thriving so well! Thanks for sharing this!

  6. Paul Lamb says:

    I’m not on any kind of birth control (being a guy), but I am pretty sure I have clinical depression. I thought my life would turn around — and I could feel some sustained happiness — after I lost 140 pounds (!) and especially after I took up running. I had a couple hours of euphoria and a few days of actual happiness after I completed the Portland Marathon last Sunday (my first marathon!), but the darkness is back and as black as ever. I told myself that if it did return after this biggest achievement of my life that I would see someone about it, so I guess now is the time for me to take some action.

    I’m glad you found your way to happiness.

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