Fat

Like every woman in this culture, I have worried about my weight. My mother, round peasant DNA that she has, is a lifelong yoyo dieter, fads and breads were her downfall. And the three pregnancies. She was, unlike many thin obsessed women, actually overweight, even mildly obese. Standing at 4'11 1/2", there was little place for it to go. She didn't really believe in nutrition, fresh vegetables or spices. I expect she probably has some food issues from a childhood growing up in the depression, unacknowledged and purposefully forgotten, but still underneath.

My own worries are in that mindset. I was a slender child, but solid, not willowy at all. After puberty, no bust, slim waisted, wide enough hips, impossible to find dresses that looked passable. Did the usual chunkiness in high school, then slimmed down again taking dance classes in college. Carved myself down to bone and muscle in Basic when I was 26, periods stopped, and I was ill with bronchitis. Not an active choice, just running all the time. I would rebound to gain back about 20 pounds, which the ex thought made me look fat. At about 15 pounds more than that right now, I know this is a lie. I was up more than this, and did not feel healthy or comfortable. I came to Boston, walked my ass off. About 20 pounds of it. Gained back some. I will make no concerted effort to Lose Weight. I eat what I like, and try to improve the balance and reduce the straight sugar and fat, not for weight, but for my teeth and heart. I will not give it all up, because it gives me pleasure. Because resisting food temptation is not a human trait. I can accept that middle age will add some fat, and I'm fine with looking "ok for 50".

And obesity is a huge problem, one I see every day. I have gotten 500+ pound men and women situated on operating room tables. I have seen a 100 pound pannis (that apron-like flap of belly) hooked up to an anesthesia screen by sharp towel hooks (pt was anesthetized, and said flap was infected and dead) just to keep it from pulling her off the table. Just that took several young orderlies to accomplish. Removing that mass of tissue was a huge operation. Left to rot, it would have lead to a massive infection that likely would have killed her.

I have circulated many gastric bypasses. Obese women have more estrogen from the excessive fat, which increases their risk for all kinds of cancers. I have seen anesthesiologists struggle to get an airway in obese patients, where there was no visible neck. The obese do not breathe as well, they have orthopedic issues and difficulty staying clean, all surgeries are vastly more complicated when trying to wade through massive amounts of fat. Most cases of retained sponges and instruments are in morbidly obese patients.

All this is not to blame, since certainly there has to be a powerful genetic component. I could eat my fill whenever, and I would never weigh 300 pounds. My mother never ate very much, and she would never be 120 again. It is to understand why so many medical people hate taking care of the morbidly obese. We hurt our backs and cannot do a good job for our patient, we have to give them bad news way too often, anything we do means more complications and difficulties. We know it is complicated, but we also know that they are much more work, and to less positive effect.

I work with nurses who obsess about weight, diet talk abounds. And all from the thin to normal sized women. I refuse to be drawn, so I exclude myself from the talk, or make ill advised comments on why diets are a bad idea. Eat healthy, I say- you do not need to lose 5 pounds, I say- women who are healthy and a bit overweight are not at risk to their hearts, I tell them- I eat what I want because I do not have a car- which doesn't help at all. They do not hear, it is a habit of speech, like men talk about sports. I will not play "I am so fat...." Because I am not.

I wish my mother was happier about herself, at whatever weight, and more secure in her own body. I wish she'd eaten better, and spent less time dieting, and more time walking with me. Maybe we would have talked more. But not about fat.