Tell Me I’m Fat

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Written by Victoria Krone, AM, LCSW, Clinical Director, SunCloud Health

A few weeks ago, This American Life, produced by Chicago Public Radio, ran an episode called “Tell Me I’m Fat.”  I was in my car, driving home from work, as the episode came on air: “The way people talk about being fat is shifting…maybe it’s time to rethink the way we see being fat.”  Initially, I took that to mean that this episode would challenge listener’s prejudices surrounding people of size.  That this episode was going to provide a more nuanced look at obesity—perhaps touching on the psychological and compulsive behavioral aspects that often go hand in hand.

The first segment of the show aligned with my expectations. Ira Glass interviewed a woman who described how she went from feeling ashamed of being a larger woman to embracing her size and loving herself.

The second segment; however, left me concerned about what some listeners might hear and take away from this show.  The central story in this segment, is that of Elna Baker—comedian, writer, and NPR staffer.

Here is a transcript from part of the episode:

Elna: I lost weight so fast– close to 100 pounds in 5 and 1/2 months– it was like going from one human to another. Here’s how I did it. I enrolled in a weight loss clinic. The doctor gave me a list of foods I could eat and told me I had to exercise daily. Your diet will be aided by medicine, he told me– potassium, serotonin, dopamine, a multi-vitamin, and then phentermine, which would help suppress my appetite. I look down at the little colored tablets. Skittles, I thought, only the opposite. I began my diet with a prayer for grace. I was Mormon then. I asked God to give me the same willpower Jesus had when he fasted in the wilderness for 40 days. I prayed for his self-control. Then I took the first pill, phentermine, which is similar to amphetamines– speed. I’d never done drugs before. Remember, I was Mormon. I’d never even tried coffee.  I didn’t know how a substance could alter your state of being.”

Before continuing with Elna’s story– a little more on Phentermine. Phentermine is a stimulant similar to an amphetamine (think stimulants like Cocaine and Speed). It acts as an appetite suppressant by impacting a person’s central nervous system.

The official Phentermine website indicates that 32% of phentermine users report experiencing rapid heartbeat as one side effect of taking phentermine, while another 22% reported “phen-rage” (extreme anger), and another 3% experienced psychosis.  The website also endorses that users may develop emotional and physical dependence on phentermine and develop the following withdrawal symptoms: nausea, vomiting, trembling, nightmares, changes in personality, irritability, weakness, depression….anything sound familiar?

Phentermine is a drug with addictive properties (withdrawal, reinforcement, tolerance, dependence), and the people who turn to it and find “success” with it are those who have replaced one addiction (to food) with another (Phentermine).

So, back to Elna’s story:

“Here’s something that surprised me. It wasn’t enough to take diet pills. It wasn’t enough to lose the weight of an entire adult woman from my own body. Once I did all that, I realized I still wasn’t actually thin. Not really. After dropping the weight, I had so much extra skin that I could lay on my side and pull it a half-foot in either direction.

For a long time, I tried to get the skin to go away with lotions and exercise. Eventually, I resorted to surgery– in fact, four different surgeries. They included something called a circumferential body lift. They made an incision around my entire waist, cut out a 6-inch belt of skin, and then sewed me back together.

I also got a thigh lift. They cut up my legs from my knees to my groin and took out as much skin as they could. Now I have a scar that runs completely around my waist, as if a magician cut me in half. I also have two scars running up my legs like inseams.

In order for my legs to heal, I had to sit alone in a room for a month without any underwear and my legs spread eagle. It’s OK. I made it through every season of The Wire. But it was a painful month. One night, I went to pee, and the incision along my crotch split open two inches, not unlike splitting the crotch of your jeans, except it was my actual crotch.

I called the doctor in a panic. He told me he couldn’t sew it back up together without a risk of infection. So I had to pack the wound with gauze and keep packing it. I tried to pack it myself, but I was too hurt to move. As I bent forward, I heard it split even more.

I called my friend Andrea sobbing. She was at my apartment within five minutes. She came in holding a bottle of white wine and two Valiums– one for her, one for me. She had me lay back and pushed wads of gauze in my leg crease like she was putting the stuffing back in a teddy bear. But even surgery couldn’t remove the extra skin entirely. When I hold my arms and legs out, I still look like a flying squirrel.”

Elna’s narrative is recounted in a way that feels painstaking and exhausting—for narrator and audience alike.  It’s the type of narrative we endure with the expectation that a silver lining is around the corner—that this story will end with a resolution, lesson learned, advice for the audience.

Instead, Elna ended her story with an honest reality:

“Here’s something I never tell people. I still take phentermine. I take it for a few months at a time a year, or sometimes it feels like half of the year. I can’t get it prescribed anymore, so I buy it in Mexico or online, though the online stuff is fake and doesn’t work as well.

I have a shirt that says, “I’m allergic to mornings.” Everyone who knows me knows I have problems sleeping at night. I am usually up until 4:00 AM. I say I have insomnia. Really, I am awake because I am on speed. And I am on speed, because I need to stay thin. I need to stay thin so I can get what I want.

I know how this sounds. I know exactly how messed up it is. But I also feel like I can’t be honest with you, like we won’t really get anywhere unless I admit it. I’m taking it right now, by the way. I took it at 11:00 AM this morning. I will take another one at 4:00. I was on it to lose weight for my wedding. And now I’m still on it because I’m about to pitch a TV show in LA, and I need to lose even more weight.

Phentermine turns off the part of my brain that thinks about food. When I’m on it, I can legitimately say, I forgot to eat. I’ve thought before that it may be affecting my health. It feels that way. I’ve intentionally never googled the side effects.

I know that all of this is wrong. I don’t like what I am. But I’ve accepted it as part of the deal.”

And that’s how WBEZ ended Elna’s story.

I can’t blame them for the lack of a satisfying narrative arc—their job, as reporters, is to share the objective details of a story.  But I certainly hope they have taken steps to support their employee in getting the treatment she desperately needs.   Elna has a very serious eating disorder; and sadly, the physicians and surgeons she trusted to help her, only supported and furthered her disease.  Elna initially approached a doctor at a weight loss clinic and depended on this person, as a medical professional, to give her sound advice.   Instead, he handed her a script for a new addiction.

Elna says she is too afraid to research the health effects of Phentermine; yet we know, just from what she shared, that she has: sliced apart her body numerous times, put herself at risk of infection, regularly skips meals, has suffered emotional effects, completely disregards her body’s needs and hunger cues, and rarely gets a restful night of sleep.     As a professional who has worked with people with eating disorders for many years, I can also add to the list: she’s put herself at risk of getting Osteoporosis,  she is likely suffering from malnutrition, she has interfered with her body’s natural metabolism,  she’s likely to have Amenorrhea (absence of menstruation), low energy, and even impaired cognitive functioning.

Neither Phentermine nor weight loss have solved Elna’s problems—if anything, she describes herself in a darker place than before.   This is another example of why our fragmented medical system needs an overhaul; and why we need to begin treating people (not their symptoms) in a far more comprehensive way. The doctor who Elna initially saw, honed in on a “solution”—weight loss—without any evident attention to the underlying reasons she might be overweight.  Did the doctor run lab work? Did he rule out Thyroid disease? Did he take the time to determine her natural set point?   It’s especially unlikely that he referred her for a psychiatric assessment or that he required she work with a nutritionist (with knowledge of eating disorders) before prescribing Phentermine or suggest she engage in weekly therapy.

If Elna were given proper treatment with a team of specialists working together, it’s likely that she could have achieved a healthy weight without needing surgeries and without substituting one addiction for the next.   I hope this isn’t the way Elna’s story will end, and that after airing her truth so open and honestly, that those who are closest to her will help her to accept the treatment she so clearly needs and deserves.

No one should have to end their story: “I don’t like what I am, but I have accepted it.” Live Free.