People | Bodies

When Someone Loses A Bunch of Weight, Maybe Don’t Lead with “How’d You Do It?”

Weight loss is not a life change that just happens with a snap of one’s fingers. There’s more to it than that, even when people say it’s just about “putting in the work.”

When I was seven or eight, my friend’s dad would only call me schmendrik. It’s a Yiddish nickname for someone who’s overweight. It also means, according to Google, fool or nincompoop.

I remember feeling one-dimensional whenever he spat that word at me, translating it as all that defined me. I felt the same as an adult, facing friends and family who wanted to help. They’d share unsolicited philosophy, suggestions, and information about weight loss and weight gain and exercise and “it really just comes down to putting in the work, Gideon.”

This is the common language we use to talk about weight, very frequently slanting toward losing it. After I did, going from 270 pounds at my heaviest to 157 pounds at my lightest, those same friends treated it as my accomplishment, asking: “How’d you do it?”

And I always found it difficult to answer. It’s not that I’ve forgotten climbing that mountain, rife with discouraging uphill schleps or disheartening plateaus. But a question like “how’d you do it?” confers upon me an agency that only feels partial or incomplete, and assumes that weight loss is a life change that just happens with a choice, a decision, a snap of my fingers. There’s more to it than that, even when they say it’s just about “putting in the work.”

That verbal habit, that weight loss is just work, is a symptom of consumerism, which preaches that health is a commodity. To attain it, invest in good shoes. Invest in good athletic wear. Buy organic. Buy fresh. Buy a juicer. Buy a gym membership. Buy fitness classes. Buy a cookbook. Buy an Instant Pot. Hire a personal trainer. We are what we choose to buy.

Self-determination, too, proclaims health is a choice. To attain it, walk the path of the righteous. Temper impulses. Shun unhealthy foods. Exercise frequently. Rest often. Heal wisely. Meditate. Disconnect. Want this. We are what we choose to be.

As such, obesity becomes something a person can change, and weight considered entirely within a person’s agency to control, to command. But it’s not.

Before my weight loss, I was among the approximately 40 percent of adults in the United States who lived with obesity. At my heaviest, my body mass index was above forty-three. And that meant the CDC classified me—and nearly eight percent of all Americans—as severely obese.

Nationally, many people living with obesity would rather not be. The National Center for Health Statistics reports that, between 2013 and 2016, nearly half of all Americans tried to lose weight. The top methods people reported attempting were exercising and eating less. There was also a correlation between trying to lose weight and a higher household income. But persistent ads and promotions tell us we’re just not trying hard or often enough.

It really just comes down to putting in the work.

The inclination toward victim-blaming is tied to rationalization, according to ConscienHealth founder and health consultant Ted Kyle. In 2008, he ended a twenty-six-year career in pharmaceuticals and has since chaired various health organizations, including the Obesity Action Coalition. “Bias toward people with health problems,” Kyle told me, “is particularly strong when we don’t have a lot of solutions available.”

And we don’t. It’s increasingly difficult to find fresh, healthy food across the country. Our medical establishment is averse to the preventive treatment of obesity. Doctors continue to give their patients advice that is impractical, given socioeconomic circumstances. Dr. Farah Husain, the division chief for Bariatric Surgery at the Oregon Health & Science University, told me obesity is not only hard to undo—maintaining it is a never-ending affair.

The inability to explain or fix any disease scares people. Kyle spoke of the stigmatization that comes with fear, recalling the initial and long-held reaction to patients with AIDS, who were often completely denied care. “The tendency to see health as something that people bring upon themselves is ancient—and even biblical,” he said. “People with disease were seen as unclean or receiving a punishment that they or their parents brought upon themselves.”

Schmendrik. Foolish, contemptible.

*

I’m laid off in the summer of 2013, one year into my first full-time job after college.

After exhausting other media opportunities, I begin applying at restaurants, where I’ve held odd jobs—from dishwasher to server—since I was fifteen. They keep turning me down. One manager tells me he can’t risk hiring me since he assumes (correctly) I will quit as soon as I find work back in media.

I grow depressed. I have nearly quit all forms of the exercise I’ve flirted with. I’m not eating well. I often turn to the promise of happiness at the bottom of a fast food paper bag. Anxiety keeps me from sleep. I scrape by, churning out short articles for low rates, and submitting resumés by the dozen.

Earning enough to afford living expenses consumes me—what I’m consuming doesn’t. By the fall, I’m at the 270-pound-mark, my heaviest.

Then a magazine where I applied offers me a well-paying job in Washington, DC. I have no friends or family in the District and the job doesn’t enthrall me—but regular income and benefits mean that there is nothing to consider. I accept the job. The magazine doesn’t pay for my relocation, so I borrow money from family because I am lucky enough to have the privilege.

Then it happens as it’s happened before: a random crack and I injure my back.

It’s the summer of 2014 and I’m at the gym. I pay a monthly fee and show up once a month. I’d hurt myself similarly many times before. I can’t move much. It hurts on either side of my lower back where the buttocks meet the spine. It feels like a pinched nerve. Nothing alleviates it, save for lying on my back on a hard floor. Massage doesn’t assuage it. Pain killers don’t kill it. I’ve worked through shifts in this condition, serving tables or sitting at a desk. But things are different now. My insurance says I only have to copay. And my paycheck says I can afford that copay.

So in June 2014, I land in front of a specialist at the National Spine and Pain Centers in Virginia. She tells me the bottom two vertebrae in my back have denigrated. They’re both half their original size. She holds up X-ray images.

I ask about a cure and she shakes her head. There is experimental surgery but it costs tens of thousands of dollars, she says. I ask about insurance. She shakes her head. It’s not even proven to work, she reminds me, and concludes I should expect back issues for the rest of my life.

I ask her why and how this happened. The doctor points at my stomach and says, a lifetime of strain.

And if I didn’t have the stomach? I ask. She doesn’t answer. She says she’s unqualified to do so and recommends I ask my physician. But she lifts her eyebrows. Her gaze answers my question.

Of all the firsts I experience during this first year of my new life—a life with insurance, with resources, with the luxury of time—this is the most fundamental. Not only do I receive incontrovertible proof things have to change, but I also have the option of reacting to it appropriately. I have the means of putting in the work.

*

In a society plagued by weight bias, people affected by obesity internalize certain attitudes about fitness and health. When the people in your life and the commercials in your streams remind you incessantly that “something is wrong with you,” Ted Kyle told me, most people come to believe it.

Schmendrik. I sure did.

Though I blamed myself for my weight, I wasn’t sheepish about it. I figured I was unhealthy and determined I was choosing this path. Likewise, I was choosing any or all of the forty associated health complications that accompany it, which, according to the Obesity Action Coalition, include cancer, diabetes, heart disease, and stroke, to name a few.

Amassing health risks and self-destructive behavior, I smoked regularly and bit my nails. But no matter how badly I treated it, I figured it was in my power to change my body at any time.

It really just comes down to putting in the work.

“It’s actually very hard to reverse,” Dr. Husain explained. She told me the body adapts to deal with obesity, and that “once you get it, it’s hard to get rid of it. You have to treat it forever.”

In a society plagued by weight bias, people affected by obesity internalize certain attitudes about fitness and health.

Additionally, once you get rid of it, it’s hard to stay rid of it. A Huffington Post deep dive into obesity reports that even just a 3-percent drop in body weight triggered a 17-percent slowdown in metabolism. As reporter Michael Hobbes explained it, “Keeping weight off means fighting your body’s energy-regulation system and battling hunger all day, every day, for the rest of your life.”

Dr. Husain, who’s concurrently an associate professor at OHSU’s Department of Surgery, said the stigma of weight bias is pervasive among physicians. They tend to lean into antiquated notions, promoting food and sweat as the only paths to health. In July 2018, the National Center for Health Statistics reported that the richer a person was and the higher their BMI, the more likely they were to try to lose weight.

The most commonly reported methods were exercise and “eating less food,” followed by “consuming more fruits, vegetables, and salad.” But telling a person who lives in one of the growing number of food deserts across the country to “go find asparagus and broccoli” is a losing strategy, Dr. Husain said.

“Sometimes I do hit my head against the wall when I talk to providers,” she told me. “It frustrates me to high hell when we repetitively give patients advice that does not work.”

Consider the much maligned, but highly effective, treatment of obesity, bariatric surgery. People affected by obesity walk a hard and long road towards it—spending anywhere from six weeks up to twelve months at Dr. Husain’s clinic. Steps include a series of counseling sessions with a dietician, psychological evaluations to rule out food disorders, physical therapy, medical workups. It is not an easy way out.

Not to mention, all of those steps are necessary if insurance is going to be involved. This surgery isn’t cheap, with or without insurance. We’re talking thousands of dollars if insurance is game—tens of thousands if it’s not.

In 1991, three long decades ago, the National Institutes of Health’s Consensus Conference determined BMI largely governs eligibility for bariatric surgery (which is tantamount to insurance coverage). And BMI as a measure of health is itself based on centuries-old science. The rules are antiquated, but revising them requires cohesion the medical community hasn’t found yet, and it’s, of course, daunting to challenge the insurance industry on such matters.

“People work for a year” to get to a place where they’ll be successful with their surgery, Dr. Husain said, and then that’s just the beginning of a lifelong struggle against putting weight back on. Bariatric patients have to relearn how to eat, how to adjust to a whole new paradigm of nutrition.

Dr. Husain remembers walking into an appointment with a woman whose operation was successful, whose weight loss was “excellent, no complications,” and who started crying as soon as the doctor arrived.

“‘You took away my best friend. Food was my comfort, and you took it from me,’” Dr. Husain recalled the woman saying. “It changed my perspective about surgery and weight loss. It’s not all about the numbers, it’s about the human. It’s about preparing people mentally for how life can change and how they can adapt to that change.”

*

In the summer of 2014, I am likely to qualify for bariatric surgery with my top-line 43 BMI. It doesn’t matter. I’m ignorant of the procedure, its availability to me, or its actual benefits. My own weight bias catalogs it as a ‘lazy way out.’ It really just comes down to putting in the work, Gideon.

Gold’s Gym costs me less than thirty dollars a month through my job. At first, I exercise weekly, then a few times a week, then daily. My morning begins in a locker room and progresses into the office, where I am allowed to arrive later than early.

I learn about fitness. YouTube. Blogs. r/fitness. I read weightlifting burns a lot of calories and cardio is important. So I lift a lot and mount an elliptical regularly. I preemptively filter lifts dangerous for my back, or ones whose pain I have experienced firsthand. I observe and imitate. When intrigued or confused, I ask questions. Rare is a sweaty man unwilling to explain correct form.

I begin running. Outdoors. My first ever earnest attempt lasts “.1 miles” according to my phone. At that distance, I drop to my knees in front of the DMV’s best pho restaurant and throw up. I keep running. I buy workout shirts. I buy gym shorts. I buy underwear fit for fitness. I buy running shoes. I buy a bike. After moving farther from work, I begin cycling there. On the heels of my thirty-third birthday, I am running three-and-a-half miles every weekday.

I learn about nutrition. Netflix. r/loseit. r/eatcheapandhealthy. I read abs are packed in the kitchen: calories in, calories out. I read carbs are bad. I limit them. Paleo emerges as my North star, Atkins orbiting it. I promise myself I would never go on a diet. I prepare lunch before work and take my coffee black.

I track calories using LoseIt. It’s not perfect—nothing about weight loss is. I err on the higher calorie count. I buy food regularly, sometimes daily. Produce is tantamount. Refined or enriched carbs like rice, pasta, and bread become distant relatives, comforting in infrequent doses.

I experiment. I throw away failed endeavors. After spending months eating virtually nothing but red meat and raw vegetables, I wake up in a hospital. An internist jokes that my gallstones look like a pearl necklace. I am scared (mostly) pescetarian.

I drop sizes. 44. 40. 38. 36. I need new clothes quarterly. Underwear rides up otherwise. Sleeves hang too low. Oversized pants fold under the force of my belt. My wardrobe turns bare, its regular reincarnation too pricey for me to maintain.

I manage uncertainties and temper impatiences. I keep hurting myself. And I keep healing. I grow fond of the choices now afforded me, of the health options my job and salary and time and sick leave and insurance and doctors can provide. I have the privilege to do all this, to roll with the punches, to do the work the world has come to expect of a person with obesity.

*

People want to believe success is within their reach, in whatever form they cherish. They think, they believe, it really just comes down to putting in the work.

So they often presume agency on behalf of those who have lost weight, that goal codified into our screens and conversations: How’d you do it?

It’s the same agency we bestow upon CEOs and political leaders, superstar musicians and high-earning peers. How’d they do it? This thirst partly drives the flow of detailed accounts people share on r/loseit. I’d lurked it for years (and still do); methods vary, but common is the focus on method and consumption rather than the time and resource supporting it.

As much as I want to breezily respond to anyone asking with I worked very hard, it would paint an incomplete reality. Worse, it would exacerbate weight bias. Topping mountains is most commendable when all of us have a chance at climbing—but we don’t.

So I’ll try answering now:

Time was one thing, effort another, but most important was my freedom to spend both, to fail, and to try again. No injury affected my income and no medicine was out of reach. With rare exception, no exercise was undoable and no routine unbearable. If I needed something, I could get it. And if I wanted something, I could eventually afford it. I had the privilege to lose.