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What I Discovered About Fat from a Lifetime of Trying to Be Thin

Promoting diets is about as sophisticated and effective as promoting sexual abstinence for teens.


Two years ago, I put a ladder on a slippery deck and stepped on it, and something happened that will surprise nobody but a woman utterly intent on fixing a rain gutter: it slipped off. I landed on one leg, fragmenting the knee joint. My husband hauled me to the beach and onto a boat and into a car, and ultimately I ended up at the best trauma center in the region, Harborview Hospital in Seattle.

During the aftermath of surgeries and narcotics, I got skinny, and then, over time, I gained back my normal weight, which put me at the low end of obese. During the first year after the repair, my knee had been feeling better and better, but as I gained it started hurting more. I talked to the doctor. “You did quite a job on that joint,” he said in a matter of fact tone. “At some point you’ll have to replace it.”

“But what about all of the metal?” I asked, gesturing toward my upper calf, where scars mark the steel plates that run down the top three or four inches of my tibia. “What about all of the screw holes?”

“Oh, we’ll just cut the bone off below all of that.” he said.

I had the same visceral reaction you’re probably having right now.

That isn’t happening, I thought. Two months later I elected an alternative procedure that I hoped would buy me an extra decade on the knee, a bariatric surgery that removed part of my stomach.

Any surgery has risks that have to be weighed against possible benefits, and for many heavy people the risks of stomach surgery would outweigh the benefits.  But for a number of reasons, I chose to make the gamble.

I’ve been “sturdy” all of my life: early maturing, strong and stout. Even at 5’4” I think of myself as a big person because in the second grade I was big—proud to outweigh and outrun most of the boys in the class, proud to have the largest feet. By age 16, though, I felt like a cow and had developed a sense of body-loathing that kicked off a four year struggle with bulimia. I recovered, but becoming a mentally healthy adult has required a truce with myself that involves relentlessly fending off the beauty myth and refusing to diet. To this day, dieting just makes me compulsive about eating, which is why, when I wanted to save my knee, I turned to the kind of people who had saved it in the first place, surgeons.

Over the next nine months, I lost about forty-five pounds, and my knee stopped hurting, which turned out to be an especially good thing when I injured the other knee and my bad leg had to function as my only leg for a while. Today I can walk and even run a little without pain thanks to remarkable people who spend their lives figuring out how our bodies work and how to repair them.

My surgeries changed me. The knee surgeries were, essentially, highly sophisticated carpentry--mechanical repairs, if you will. I feel a certain kinship with the antique chair in my basement that sports a metal hose clamp as a permanent part of one repaired leg. But the bariatric surgery was a different thing altogether, and it changed how I think about weight.

Most Americans believe that weight loss is a matter of will power. We hear it all the time—in the words of doctors who advise middle aged people to lose a few pounds; on sit coms where fat people play out stereotypes; in advertisements where buff means lean; and in the sometimes subtle but ever present denigration of fat people. People who are fat are lazy or weak, sloppy or indifferent. Implicitly, they deserve knees that hurt and blood sugar problems, even poverty, early death, and worse: rejection.

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