Fatist anyone?

[mr friendly guy]

I am with Mike on this one. The sandwiches do look gross.

I also find the giant coffins don't seem that powerful an image. Most probably because they didn't have a normal person next to it to give it the sense of scale.

[Rye]

How about outdoor funeral pyres, Indian style, then(and without the wife burning)? A concrete 'tub' where the coffin is lowered into, which has an open top and some gas burners to start the fire - an outdoor crematorium. Just don't use it on a windy day...

I think that burying them in a biodegradable box and planting vegetation atop the plot would make a lot more sense. That's how I want to end up.

I also find the giant coffins don't seem that powerful an image. Most probably because they didn't have a normal person next to it to give it the sense of scale.

Well, the fact they're more square instead of oblong, literally like a king sized bed instead of a coffin is what got me. When I think of a coffin, I think of the typical gothic dracula coffin, what you might see in a zombie or western film. Then you see that monstrosity and think about how fat a person must be to require it.

[Darth Wong]

I'm sure the horror of the XXL coffins would be much more obvious if they were photographed while occupied.

[spaceviking]

How big do you have to be to need a xl coffin, I have seen some pretty fat people in normal coffins and they were not exactly tight. That being said I think coffins and the whole funeral industry exists to play on the guilt of the dead’s family, you don’t need mahogany and gold caskets were not fucking Egyptian pharaohs.

[Setesh]

While maybe not exactly what the original post was about there is a tendency for doctors to blame body weight for a host of problems that are unrelated, or even the cause of the extra weight.

http://fathealth.wordpress.com/

"Chronic joint pain, its because your fat!!"
"Early onset arthritis runs on both sides of my family. And I've had juvenile arthritis most of my school age life."
"No, no, its cause your fat!!"

[Bradbury]

While maybe not exactly what the original post was about there is a tendency for doctors to blame body weight for a host of problems that are unrelated, or even the cause of the extra weight.

http://fathealth.wordpress.com/

"Chronic joint pain, its because your fat!!"
"Early onset arthritis runs on both sides of my family. And I've had juvenile arthritis most of my school age life."
"No, no, its cause your fat!!"

Ironic that you mention this, since they just (two days ago) released the findings of a study that showed the opposite, though it covered specifically older patients.

It seems that even if the original study showed doctors had less respect for overweight patients, they still treat them with the same or better quality care.

The new study, of nearly 70,000 patients, found that obese and overweight patients were just as likely to be offered quality medical care as normal weight patients.

The findings, published in the April 7, 2010 issue of the Journal of the American Medical Association contradict earlier work that suggested the obese might get substandard care because many doctors don't like treating them.

The findings of this study surprised the researchers.

"We were not expecting these findings," lead author Dr. Virginia Chang of the Philadelphia Veterans Affairs Medical Center told Reuters Health. "We were fully expecting to find that obese patients got lower quality care and were less likely to get recommended care."

Chang and colleagues looked at data collected by the Veterans Health Administration and the Centers for Medicare and Medicaid Services.

The researchers did not examine whether medical care reduced illness or death but rather whether the care was offered as recommended by accepted treatment guidelines.

They looked at quality-of-care measures for 8 common preventive services including diabetes management, flu and pneumonia vaccines, and cancer screening and concluded that there is "no evidence" that obese and overweight men and women get less care on common preventive services.

To the contrary, they may receive better care. Compared to their normal-weight counterparts, obese patients were more likely to get the flu vaccine, and breast, colorectal, and cervical cancer screenings.

Obese diabetics in the study populations were also more likely to be offered two recommended blood tests - cholesterol and other blood fats -- and the HbA1c test, which measures blood sugar levels over the long term.

The authors note that the quality-of-care measures were higher across all weights (under-weight, normal weight, overweight, and obese) for VA patients compared to the Medicare population.

Chang said her team divided overweight patients into three tiers of obesity to see if people at the extremes of obesity were denied good care. They weren't.

Whether the same holds true for obese patients under age 64 is not addressed in the Pennsylvania research. The authors point out that the findings might not hold because of social bias.

"Physicians may be less biased toward older populations," Chang said, adding that "cultural pressures to be thin vary by age and are completely different for young people."

SOURCES: Journal of the American Medical Association, April 7, 2010.

Emphasis mine.

[Setesh]

Ironic that you mention this, since they just (two days ago) released the findings of a study that showed the opposite, though it covered specifically older patients.

It seems that even if the original study showed doctors had less respect for overweight patients, they still treat them with the same or better quality care.

Note that they studied for preventative care on things like the flu which is not the form of discrimination the wordpress study was talking about. Also:

Whether the same holds true for obese patients under age 64 is not addressed in the Pennsylvania research. The authors point out that the findings might not hold because of social bias.

"Physicians may be less biased toward older populations," Chang said, adding that "cultural pressures to be thin vary by age and are completely different for young people."

While the study on wordpress used a variety of ages.

There its more that some doctors look at the BMI chart and declare "Your dangerously fat you need to lose weight, eat less exercise more. That'll fix you up." Without really examining them, or screening them for certain conditions because being overweight is commonly thought to cause the symptoms. Or trying to treat them as if they are at risk for diabetes even if they really aren't.

Sorry, but this is a problem that bugs me personally. I am 24lbs overweight according to the BMI chart, and every general check-up its the same thing. After running a battery of tests the doctor comes in "Your perfectly healthy, except your fat."

And my wife has her own woes found here

And just for the heck of it too thin discrimination here

[Darth Wong]

Wait a minute, are you seriously saying that it's somehow unfair "discrimination" if a doctor tells a fat person to lose weight? Does that mean it's unjust discrimination to tell a smoker to quit the goddamned tobacco too?

[Simon_Jester]

Wait a minute, are you seriously saying that it's somehow unfair "discrimination" if a doctor tells a fat person to lose weight? Does that mean it's unjust discrimination to tell a smoker to quit the goddamned tobacco too?

I think he's pissed off about a doctor telling him to lose weight without first checking how much actual fat he's carrying. Or, in his wife's case, blaming a medical problem on her being overweight without checking to see if there might be something else going on.

I can sort of understand being upset about that: being fat will screw up your health, but it isn't the only thing that can do it, and weight loss won't reliably cure everything wrong with you. A doctor who doesn't look past your BMI at all isn't doing his job, any more than a doctor who automatically diagnoses every problem as "you need to get more sleep" or "you need to take more vitamins" would be.

It's certainly true that sleep, vitamins, and weight loss are all good for your health, but that doesn't make them the cure for everything that ails you.

[Darth Wong]

Wait a minute, are you seriously saying that it's somehow unfair "discrimination" if a doctor tells a fat person to lose weight? Does that mean it's unjust discrimination to tell a smoker to quit the goddamned tobacco too?

I think he's pissed off about a doctor telling him to lose weight without first checking how much actual fat he's carrying. Or, in his wife's case, blaming a medical problem on her being overweight without checking to see if there might be something else going on.

How is that different from any other normal doctor behaviour? If I come into the doctor's office and I have flu-like symptoms and I'm coughing hard, he'll probably assume the flu is causing the cough. Sure, it could be that I actually have leukemia, but you go with the most mundane and obvious explanation first. Similarly, if someone comes in complaining of joint pain and they're carrying 50 or 60 extra pounds around all the time, you're obviously going to think that it's probably their weight problem and sedentary lifestyle.

I can sort of understand being upset about that: being fat will screw up your health, but it isn't the only thing that can do it, and weight loss won't reliably cure everything wrong with you. A doctor who doesn't look past your BMI at all isn't doing his job, any more than a doctor who automatically diagnoses every problem as "you need to get more sleep" or "you need to take more vitamins" would be.

It's certainly true that sleep, vitamins, and weight loss are all good for your health, but that doesn't make them the cure for everything that ails you.

No, but he's basically saying that a doctor, when faced with a problem and a textbook explanation for that problem staring him in the face, should ignore it and look for other problems which might not even exist. How many expensive random tests should he perform, pray tell?

[Simon_Jester]

How is that different from any other normal doctor behaviour? If I come into the doctor's office and I have flu-like symptoms and I'm coughing hard, he'll probably assume the flu is causing the cough. Sure, it could be that I actually have leukemia, but you go with the most mundane and obvious explanation first. Similarly, if someone comes in complaining of joint pain and they're carrying 50 or 60 extra pounds around all the time, you're obviously going to think that it's probably their weight problem and sedentary lifestyle.

If I have flu-like symptoms and a cough, yeah, it's probably the flu causing the cough.

But if I have a family history of leukemia, or if all my other flu symptoms clear up and the cough doesn't go away... well, then you do have to look deeper than the obvious explanation.

That's where "your medical problems happen because you're too fat" can become a problem: when you're dealing with the minority of patients for whom diet and exercise honestly are not helping. I'd expect that a good doctor would at least look into other explanations for the problem at some point.

No, but he's basically saying that a doctor, when faced with a problem and a textbook explanation for that problem staring him in the face, should ignore it and look for other problems which might not even exist. How many expensive random tests should he perform, pray tell?

On the first visit, normally? None.

If the problem keeps sticking around for long periods of time, or if there are big alarm flags in the patient's medical history... at some point, some testing may be called for. If losing weight is empirically not helping, then weight may not be the only problem at work.

[Darth Wong]

If the problem keeps sticking around for long periods of time, or if there are big alarm flags in the patient's medical history like "I was diagnosed with juvenile arthritis, I've had joint problems since I was seven and my knees kept bending backwards in gym class..." at some point, some testing may be called for.

Sure, but the reverse is also true. If someone has a textbook weight-related problem, and he refuses to try losing any weight to see if that will help his problem, then why should the doctor waste money on all kinds of testing to see if it's something else? You try the simplest and cheapest remedy first, before burning money on other stuff.

Attitudes like yours are a large part of the reason why medical costs are exploding out of control. People want all kinds of expensive tests with no regard for money, and they won't lift a finger to make things easier. If excess weight is the cause of a problem, it's the simplest condition in the world to check: all you have to do is lose some weight and see if the problem gets better. No drugs, no expensive tests, no hospital visits, no blood samples, etc. Even if the problem is something else, this is the obvious first experiment to try; if nothing else, you can rule out weight as the source of the problem. But noooo, that's "discrimination", right? Never mind the fact that it's a completely logical course of action, right? What a bunch of fucking whiners.

[Simon_Jester]

Sure, but the reverse is also true. If someone has a textbook weight-related problem, and he refuses to try losing any weight to see if that will help his problem, then why should the doctor waste money on all kinds of testing to see if it's something else? You try the simplest and cheapest remedy first, before burning money on other stuff.

Attitudes like yours are a large part of the reason why medical costs are exploding out of control. People want all kinds of expensive tests with no regard for money, and they won't lift a finger to make things easier. If excess weight is the cause of a problem, it's the simplest condition in the world to check: all you have to do is lose some weight and see if the problem gets better. No drugs, no expensive tests, no hospital visits, no blood samples, etc. Even if the problem is something else, this is the obvious first experiment to try; if nothing else, you can rule out weight as the source of the problem. But noooo, that's "discrimination", right? Never mind the fact that it's a completely logical course of action, right? What a bunch of fucking whiners.

Umm... I think you must be talking to someone else.

See, I favor trying the simplest and cheapest remedy first too. What I do not favor is continuing to push that remedy if it fails. If the patient does, by all evidence, go on a diet and start exercising and does not lose weight, something else is wrong and something more radical may have to be considered. Likewise, if the patient has a medical problem, loses weight in an attempt to cure it, and it doesn't go away, something else besides the patient's weight is wrong.


Looking at the comments Setesh linked to from his wife, if they are to be taken at face value, she has both these problems. She's overweight, seriously so, by her own admission. She goes to the doctor complaining of joint pain. The doctor (reasonably) tells her she needs to lose weight, to diet and exercise. She exercises and diets. Very little weight goes away.

She goes to the doctor again and says "doctor, the diet and exercise regimen isn't working." The doctor (fairly reasonably) says "try harder." So she does. Repeat several times. Finally she's eating minimally and still huge. Obviously something is deeply fucked up, and unless she's outright lying, it isn't as simple as "eat less and exercise more and you'll lose weight." She did, and to a significant degree, and it didn't work. I have no idea what her problem is, but the simple, cheap solution has been tried and failed.

Then she rebalances her diet and (somehow) loses a lot of weight; I don't know exactly how this works. She eats a healthy diet, in reasonable quantities, and is still fat, but less so. And yet, despite her weight improving, her joint pains are getting worse, and spreading. But no doctor ever gives her advice beyond "You're too fat. Lose weight and it will go away."

I can only see two possibilities here. One is that she is outright lying about her medical condition; the other is that she can't get anyone to even bother to look at the possibility that anything but fat is wrong with her.

Maybe for all I know the former is true. But if the latter is true, then we are in fact seeing... loath as I am to say it, we're seeing actual discrimination: a fat person being unable to receive any medical advice other than "lose weight," based solely on her current weight, and without regard to any other factors like medical history.

Surely fat people should be able to receive some level of medical testing and treatment beyond diet advice, after making a good faith effort to follow the diet advice. Because to follow the "logical course of action" you promote, which is indeed the simplest, cheapest, smartest thing to do, I must be willing and able to "rule out weight as the source of the problem" sooner or later. Doctors who aren't willing to do this aren't doing their jobs properly, even if the basic advice "lose weight" is always good advice.

[spaceviking]

Why do you seem to be unconvinced that she is outright lying? These people are often food addicts; no one would be surprised by a doctor not giving a heroin addict benefit of the doubt. Also from what I have seen personally many overweight people are unaware of how much they are eating, and how insufficient their exercise is. They might work hard at their approved diet, but still unconsciously almost eat the entire communal popcorn/what have you bowl at the party, they may go the gym 12 hours a week but how much of that is chatting and barely moving on the treadmill.

Doctors dismiss claims of patients not because they are fatist etc, they do so because they are used to being lied to.

[Darth Wong]

Riiiiight ... some woman says that she cuts down her food intake and starts exercising, and yet she doesn't lose any weight, and we're supposed to believe that she's a paragon of honesty. Suuure.

Frankly, the minute someone says "I can't lose weight even if I do everything right", I assume that everything coming out of that person's mouth is bullshit. If you have trouble with controlling your food addiction, just admit it. Don't try to sell me these incredible lies about how your body can somehow violate the laws of thermodynamics.

[eion]

I also find the giant coffins don't seem that powerful an image. Most probably because they didn't have a normal person next to it to give it the sense of scale.

This is a little more illustrative I think. It'd be better still if they showed 2 average-sized people inside side by side.

[Simon_Jester]

Why do you seem to be unconvinced that she is outright lying? These people are often food addicts; no one would be surprised by a doctor not giving a heroin addict benefit of the doubt. Also from what I have seen personally many overweight people are unaware of how much they are eating, and how insufficient their exercise is. They might work hard at their approved diet, but still unconsciously almost eat the entire communal popcorn/what have you bowl at the party, they may go the gym 12 hours a week but how much of that is chatting and barely moving on the treadmill.

Doctors dismiss claims of patients not because they are fatist etc, they do so because they are used to being lied to.

I can't prove she's not lying. The reason I didn't assume so right from the start is that she's supposedly Setzer's wife, and I extended him the benefit of the doubt. He'd know if his own wife's claims to be eating responsibly and exercising are bullshit, I would think, and so I presume that he wouldn't link to them if they were. But since I am in absolutely no position to prove that one way or the other, I'm just going to drop the whole thing.

If she isn't lying I see why she's pissed off; I have no way of knowing whether she's lying. And, I admit, it sounds pretty shaky.

[Setesh]

Riiiiight ... some woman says that she cuts down her food intake and starts exercising, and yet she doesn't lose any weight, and we're supposed to believe that she's a paragon of honesty. Suuure.

Frankly, the minute someone says "I can't lose weight even if I do everything right", I assume that everything coming out of that person's mouth is bullshit. If you have trouble with controlling your food addiction, just admit it. Don't try to sell me these incredible lies about how your body can somehow violate the laws of thermodynamics.

If you think Snow's lying, fuck you and the horse you rode in on. Since moving in with me and me forcing her to eat regular well balanced meals (rather than a pint box of rice from a local chinese takeout if anything at all, then whatever her family had for diner) she is smaller than she's been since junior high.

On another note the BMI chart says on it. "The body mass index is a screening tool; it is not used to diagnose any medical conditions but instead is used as one measure to assess a person's weight and his or her risk for developing certain medical conditions."
And current guidelines call for "Determining waist circumference and medical history risk factors for diseases and conditions associated with obesity."

As for "I can't lose weight even if I do everything right": Thyroid disorders, medication reactions, just naturally being a big person (and yes some people are just large and cannot lose weight and stay healthy past a certain point), Cushings syndrome, Hypopituitarism, Depression: just to name a few medical conditions that stop people from losing weight and in many cases cause their weight gain to start with.

[Bradbury]

Ironic that you mention this, since they just (two days ago) released the findings of a study that showed the opposite, though it covered specifically older patients.

It seems that even if the original study showed doctors had less respect for overweight patients, they still treat them with the same or better quality care.

Note that they studied for preventative care on things like the flu which is not the form of discrimination the wordpress study was talking about.

Umm... preventive care is studying quality of care. The wordpress-linked study examined physicians' respect based on BMI, not quality. I'd say quality of care is by far more important than if my doctor actively likes me. A lot of the complaints seem to be that since doctors discriminate based on their weight, they must be getting less care or more serious issues are overlooked in favor of diagnosing it as simply effects of obesity. The study showed the opposite.

But hey, if I misread and your problem is just that doctors are rude, then sure I can see that as troublesome.

While the study on wordpress used a variety of ages.

Yes, I mentioned that as a caveat when I introduced the article.

[Darth Wong]

If you think Snow's lying, fuck you and the horse you rode in on.

Oooh, the Appeal to Personal Anger. Such a devastating rebuttal to the fact that your wife is saying something that makes about as much medical sense as Looney Tunes cartoons. Because she's the only fat person who never lied to herself or her doctor about how much she was eating.

Frankly, the world is full of fat people who lie about how much they eat, to others and/or themselves. I don't hate fat people, but I'm sick of the ones who won't stop lying about how little they eat. Your body isn't magical, for fuck's sake: it can't manufacture mass out of thin air.

[adam_grif]

I wonder if anybody has thought of setting up a service where you put rich fatties into an induced coma for like a week and have tubes feeding them enough food to not die. You could make a killing! I'm sure is hideously dangerous, but that's what waivers are for.

[mr friendly guy]

No, but he's basically saying that a doctor, when faced with a problem and a textbook explanation for that problem staring him in the face, should ignore it and look for other problems which might not even exist. How many expensive random tests should he perform, pray tell?

How many expensive random tests should be performed? Well that depends on how good his lawyer is and how good yours are. I have been told in the US doctors go on a "fishing trip" with tests partly because of the letigatious nature of the society. I am generally one who orders less blood tests, but if I have a suspicion that something rare is going on, I will look for it.

But generally the approach to diagnosis is four fold
1. Common things being common - ie its a textbook example of it
2. Are there any "red flags" - that is something, a symptom or sign that screams its disease X
3. Anything that I can't miss - ie I would be sued if I miss it. A common example is when someone has a sudden severe headache, consider a subarachnoid haemorrhage, thus scan the head.
4. Consider the "mimickers". That is diseases that tend to present with vague symptoms or symptoms which at first glance could look like anything. A few examples are diabetes related diseases, TB (in third world countries), HIV and in the older days syphillis.

I wonder if anybody has thought of setting up a service where you put rich fatties into an induced coma for like a week and have tubes feeding them enough food to not die. You could make a killing! I'm sure is hideously dangerous, but that's what waivers are for.

Well aside from the problem with anaesthetic diffusing through fatty tissue (there is a reason why fat people worry anaesthetist) whats to stop them eating the same junk they did in the first place? Personally I suspect one can make more money if you run a health camp where fatties go to lose weight with good old exercise, diets (not crash course ones, just healthy meals) etc. Before you go into waivers, there is this thing called ethics. How ethical is it to do a dangerous procedure when less dangerous ones exist, and its not like the fat person is dying at the moment and needs it desperately.

As for "I can't lose weight even if I do everything right": Thyroid disorders, medication reactions, just naturally being a big person (and yes some people are just large and cannot lose weight and stay healthy past a certain point), Cushings syndrome, Hypopituitarism, Depression: just to name a few medical conditions that stop people from losing weight and in many cases cause their weight gain to start with.

Ok even though this is SD.net, being a doctor myself I am not going to bash you even though I find Mike's comments particularly funny. So I will offer some comments on the disorders you listed.

1. The thyroid disorders which cause weight gain are those causing hypothyroid, ie underactive thyroid and not overactive. Your symptoms will include things which "slow you down", at least thats how I like to remember it. So basically mental slowing, constipation (your bowel is slow), slow pulse, feeling cold even on hot days (you're slowing down your energy production), feeling tired. Oh, and you may have an enlarged thyroid gland, so it becomes obvious with a large lump in your neck.

2. Medical reactions - hmm. Unless you are refering to allergies which cause swelling, and consider that fattening I can't really think of anything specific aside from maybe chronic steroid use (not the anabolic steroids athletes take, but steroids to treat medical conditions). In any event chronic steroid use causing weight gain would start falling under the umbrella of Cushing's syndrome which I will touch on next.

3. Cushing's syndrome - well thin skin, moon facies, easy bruising, brittle bone, "buffallo hump". Oh, and did I mention it can occur with chronic steroid use. Which is why most doctors actually try to wean you off steroids except for some conditions most of the time.

4. depression - I am pretty certain its a worsening cycle, that is when you are depress you eat more hence gain weight. And if the weight bothers you then you will become more depress.

Now to lay it out all on the line, most of these disorders you listed are endocrine disorders. Ask your wife's GP to refer to an endocrinologist, or better yet, check for these disorders with a simple blood test (ok Cushings is more than just a simple blood test, but a screening test for cortisol in the morning would give them an idea to look deeper with things like suppression tests), however the other conditions could be suspected / diagnosed by blood tests. If you are from the UK or Canada it should be free, if you are from the US (your location lists Maine) it will no doubt cost you but as I understand it they shouldn't object if you are willing to pay.

[Setesh]

2. Medical reactions - hmm. Unless you are refering to allergies which cause swelling, and consider that fattening I can't really think of anything specific aside from maybe chronic steroid use (not the anabolic steroids athletes take, but steroids to treat medical conditions). In any event chronic steroid use causing weight gain would start falling under the umbrella of Cushing's syndrome which I will touch on next.

SSRIs (Selective serotonin reuptake inhibitors, Celexa, Paxil, prozac, zoloft, and Snow's personal drug of yesteryear Lexapro) are fairly common ones. Weight gain and drowsiness from metabolic slowdown are right in the side-effect list.

Speaking of Snow, she wrote her own response to this thread:

You know what I really love? People that think bodies are simple machines, and therefore know that I must have chosen to be fat. There's something about the self-righteousness of condescending assholes that makes me feel all warm and fuzzy inside!

You know, most people don't choose to be fat, you fuck. Sure, some people suffer from food addiction or are just plain crazy, but most fat people genuinely can't help it, and I am positively livid that you might suggest otherwise. Chances are, if I tell you all this, you'll think I'm making shit up.

I probably eat healthier than you. I can't stand fatty, greasy foods, and I haven't had fast food in long enough I could probably use a reminder about why I don't eat it. I try to manage low-impact workouts whenever I can thanks to what seems to be the start of rheumatoid arthritis, but mostly I just try to keep myself busy.

You do not know me. I do not know you, so I only can guess and call you a rampaging douchecanoe, but I don't know you and all I have to go on is that you have invalidated the experience of perhaps millions whose only crime was their genetic programming.

I was always hungry as a kid, and I was hyperactive, too. But, you know, I was kinda' hefty, and the combination? Well, it didn't go over well. I was shamed. Constantly. After a while, if people tell you something often enough, you believe it. So, I was fat, clumsy, and lazy even though I loved climbing trees and hiking through the woods and almost never hurt myself doing it.

Hm.

So after a while, I started acting that way. This is before I even hit puberty, alright?

Everybody said that the only way you got fat was by eating too much and being lazy. So clearly, that was the case, right? Then why was I always hungry? I was shamed for snacking, for eating when I got hungry, so I spent more and more time tired and depressed. When you're hungry, you get tired and depressed. It's what happens!

The trauma didn't start happening until I was old enough that society was starting to see me as a "woman" and not a "girl". Want to know what's special? People seem to see women as "public property" almost. Women, men, everybody offered diet advice. Yes, thank you Lord Fuckbasket Douchgargle, I have never heard before someone suggest something so novel as eating less, and through some trick of fate I have never looked in a mirror to know I am fat! And you are certainly the first person to say any of this! I am in your debt. However can I repay you?

When I was sixteen, I started eating less. In general. I just coped with the hunger. I think this is about when depression really took hold.

By this point, I'd fairly steadily been on medication since I was seven, not that my medications had much to do with the depression, except that's what I was being medicated for at the time.

It didn't help. It was like being dead inside.

Let's zip forward again, about four, five years, and I'm on a new cocktail of medications. This chain of events here, I do not know how I survived. I genuinely do not know how I made it through.

So this new cocktail of medications, it had me losing weight pretty rapidly. That's actually a red flag. Rapid weight loss like you get with fad diets is not good, it does not stay off and your body does not react well to it. I had more or less stopped eating, maybe I'd eat something substantial every day, once, and then maybe a carrot later to stave off the worst pangs.

And my body? It didn't react well. The combination of medications wrecking my social and verbal filters and my starvation fucking my coordination and thought processes up...

Long story short, it was not good.

I moved to another state. I was forced off my medications, and for a while, I stabilized.

Then there was an anorexic roommate. The kind you can tell is anorexic, the thin kind that dumb fucks like you shout at to eat a sandwich. My little sister looks like that and probably eats more than you do, but no, this one was genuinely anorexic.

I tried to match her eating habits. It was hell, really, and I kept gaining weight. It started getting harder to move.

She moved out, and I must have still been convinced that I was overeating, because I kept eating less and less. I spent about a year surviving on less than a sandwich a day, splurging on a decent meal perhaps once a month. I ballooned. People accused me of snacking. I was lucky if I remembered to eat two days in a row.

This is when I was at my heaviest. I ate almost nothing, constantly looking at where to cut back because I was fat, therefore overeating, right? It had to be true, because everybody and their motherfucking cousin in Miami says so.

If you're starting to think I'm a bit bitter? News flash, Mycroft, I AM.

About two years ago, maybe a little more, I finally said enough of this. Time to start eating. And I did. A little at first, it was actually pretty hard. Then more.

I still forget sometimes, and I need to be kicked into it. I lost 60 pounds over the course of a year, and it's stayed off, and it keeps coming off slowly. A couple pounds here, a couple pounds there, but I don't know if I'll ever lose quite all of it.

I do not know how I survived. Thinking back, it was probably the occasional multivitamin coupled with the way my metabolism slowed down. Sometimes, I actually did pass out from hunger, up to six hours at a time. I claimed they were naps. You can feel it coming, you know, it's not like a fainting fit. It gets harder and harder to keep your eyes open, and you lie down and in five, ten minutes, you black out for a few hours and wake up too hungry to feel it anymore.

I've got huge bones under my skin, despite what some people believe is possible. Almost all my fat is in my midsection. Do me a favor and look up "visceral fat".

Then take a nice, big enema of SHUT THE FUCK UP.

[spaceviking]

If what Snow is saying is true she is the exception not the rule, though hearing about the sandwich a day suggests you don’t understand dieting. Reducing calories is one thing making your body think it’s going through a famine is another.

[Setesh]

If what Snow is saying is true she is the exception not the rule, though hearing about the sandwich a day suggests you don’t understand dieting. Reducing calories is one thing making your body think it’s going through a famine is another.

Didn't read that very closely, she knows that now, that's why she mentioned it as a bad behavior she picked up as a result of the way she was treated because she was fat. And she's not that much of an exception either. One of the first things out of peoples mouths when you've been dieting long term and its having little effect 'Diet harder' or 'you must still be snacking, eat less' which is what she did. And so do a lot of other people. A lot of eating disorders start for that very reason.