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When I Lose Weight . . .

When I lose weight, I'm going to . . .

buy some new clothes

take a vacation

go back to school

dance (in public)

find the perfect job

fall in love

go to my kids' school events

wear a swimsuit

go anyplace I want

learn a new sport

take long walks

leave an abusive relationship

treat myself to a new hairstyle, a manicure, and a pedicure; and . . .

like myself again.

    Pick one. Or several. Feel free to add your own. The possibilities are endless. Most of us who are "overweight" have had our own plans for resuming life where we left off some thirty, fifty, one hundred, or more pounds ago. Losing weight is a difficult and long-term process at best. We have made the attempt to lose weight countless times, only to find ourselves at the same size - and often bigger - months later.

    So what do we do in the meantime, while we wait for this magical moment when we are transformed into a "normal-sized" person? I don't know about you, but I'm tired of watching the years go by and missing out on so much. I'm an intelligent, loving, productive, cuddly, witty, and friendly human being. I have many interests and a good sense of humor, am environmentally concerned, sometimes politically correct, and don't spit or make bodily noises in public. So, what's the problem?

    Some days it can be hard to step out the front door. In our own homes, with people who love us, we're fine. Our families are like others . . . together we laugh, argue, watch television, prepare meals, cry, read, hug, juggle bills, celebrate holidays, and care about each other. But out in the rest of the world we sometimes encounter criticism, discrimination, discomfort, and humiliation because of our size. Not from everyone. But from enough people to make life pretty unpleasant at times. Fat people who don't have the comfort of supportive, loving families or friends can have a very difficult time of it.

     We live in a society where it is no longer acceptable to make fun of, or legal to discriminate against, people because of their sex, race, religion, sexual preferences, or disabilities. The clot who utters remarks about someone based on any of these attributes is generally the one who looks bad, not the person at whom the comments are aimed. Not even the taunt "Your mother wears army boots!" has any impact today . . . Mother very well may be a member of the armed services. Discrimination and cruelty against people who are large, however, are still common. People who convey this attitude often feel justified in doing so.

    Comedians take potshots at fat people regularly. David Letterman seldom seems to make it through a show without a sight gag or remark putting down large people. True, Letterman's humor is often on the tart side on just about any subject, but this is exactly the kind of commentary that reinforces a very hurtful attitude. On the bright side, however, his rudeness toward fat people is increasingly met with silence or booing from his audience.

    Letterman is hardly the only comedian to routinely insult fat people. Jay Leno is even worse. He recently appeared on his late-night show sporting a "fat suit" and playing into every fat stereotype he could, including shoveling food into his mouth by hand and smearing it all over his face and onto his clothing. Joan Rivers, Frank D'Amico (self-described king of fat jokes), Tim Allen, Andrew Clay, George Carlin . . . it isn't difficult at all to find comics who base at least part of their routines on body size remarks. Comedy club comedians are notorious for making barbed fat remarks or building entire routines on fat jokes. Woe be to any large person with the misfortune of sitting near the sage when one of these malicious bullies strides out. Is it humor if it advances stereotypes or is painful and humiliating to someone?

    Self-righteous crusaders accost large-size people openly in public for a variety of "offenses" - from eating to taking up space. One woman, Cheryl, told me of being berated loudly by a woman in a grocery store as she did her weekly shopping. "You fat pig! How dare you eat like this? Don't you have any pride?" her attacker demanded. This incredibly uncivilized woman began removing items from Cheryl's cart and piling them on a shelf. A crowd gathered as a loaf of bread, a box of pancake mix, and a bag of potatoes were confiscated. Cheryl, completely embarrassed and unable to respond, burst into tears, took her five-year-old daughter by the hand, and ran from the store. When asked what she wished she had done, now that she was far enough removed to think it over, Cheryl replied, "I wish I had been calm enough to explain to her that I was shopping for my family also, none of whom are fat." It is sad to think that this perfectly lovely, shy, sweet woman thinks she has to explain herself at all to a very rude, malicious attacker.

    Here's another example of stereotypes dying hard. A friend recently expressed frustration at eating with me. She said it was "a drag" because I eat so slowly and so little, obviously hiding my true habits from her. She just couldn't accept that I always eat slowly and am easily filled up by a couple of pieces of pizza. She seemed to expect me to eat like Beldar Conehead, consuming mass quantities of whatever food was handy. Yes, there are times when I overeat and times when I eat something outrageously high in calories. I enjoy food just like anyone else. But overeating is not the norm for me or most other people of substantial size.

    The stereotypes held against fat people are awful (as are stereotypes in general). We are often perceived to be lazy, sloppy, stupid, immoral, mean, asexual/oversexed, jovial/angry, ugly, and gluttonous. And we all, of course, have been blessed with "such a pretty face." At various times in my life I have exhibited any or all of these qualities. Who hasn't? But I am none of these things normally.

    Let's face it . . . fat people are often looked down on. Airlines, restaurants, theaters, and most places of entertainment generally provide seating that even average-size people find to be a tight fit at times. Decent clothing has, in the past, been next to impossible to find. And no matter how brilliant, charming and witty we are at social gatherings, the Mel Gibson's of the world can be expected to go home with the 5'11", 115-pound bimbette.

    In an article appearing in the New England Journal of Medicine in 1966, H. Canning and J. Mayer* concluded that even elite colleges and professional schools are less likely to accept fat applicants. Employers often refuse to hire fat people because "they don't fit our image" (Larkin, J.C., and Pines, H.A., 1979). Once employed, the large person generally makes less money and has fewer promotions (Rothblum, Esther D., et al., 1990). It has been estimated that businessmen give up $1,000 a year in salary for every pound they are "overweight" (Palmer, 1996).

    Some doctors are disgusted by fat people and refuse to treat them. Others can't seem to treat a large patient for any medical condition without laying the blame for the problem on "obesity" (Maiman, Lois, et al., 1979). An orthopedic surgeon once refused to acknowledge a debilitating back injury of mine, brushing it aside by saying, "Fat women often exhibit back pains in an attempt to get their husbands' attention." This came after I had been in excruciating pain for three weeks. He sent me home after denying me any further pain medications so I would "get tired of this game and give it up." This is definitely not an isolated incident. Both in my personal life and in researching this book, this type of experience with doctors in a common complaint cited in the majority of conversations by fat people regarding health care.

    A fat person can exhibit the exact same symptoms of flu as twenty other patients in a doctor's waiting room and be told, "IF you'd lose some weight you'd feel a lot better." This goes far beyond embarrassment. Refusal by a physician to look at symptoms with an unprejudiced eye can result in misdiagnosis and improper treatment.

    Discrimination and cruelty against fat people are so common that the majority of people in one survey of weight-loss surgery patients said they would rather have a leg amputated or be blind than be fat. The reasons given by these patients for this shocking preference have nothing to do with personal feelings about themselves but come from living with constant struggle in dealing with prejudice from all sides.

    In a similar vein, Martin Seligman, Ph.D., author of What You Can Change and What You Can't, says that "American women pursue an unobtainable ideal of thinness. Throughout the world, in every culture that has this ideal of thinness, depression is twice as common for women as for men, and there are more incidences of eating disorders."

    Is it only adults who are subjected to this discrimination and humiliation? Hardly. As difficult as life can be for adults dealing with a prejudiced culture, the most heartbreaking experiences are often what children must endure. Fat children are teased mercilessly on playgrounds and are left out of games. When these children turn to adults for help, they are told, "We'll put you on a diet, then it will be okay." As if the cruelty is their fault. Even within their own families, large children are often unaccepted and treated contemptuously.

    According to the Centers for Disease Control and Prevention in Atlanta, 61 percent of girls had dieted in the year previous to the 1992 study. Twenty-eight percent of boys had attempted to lose weight (Berg, Frances M., 1992). What are we teaching our children about themselves? They will have to struggle with these "lessons" throughout their lives.

    All of this must change. And changes are happening. There is a growing understanding in the medical community, and throughout the general population of the dynamics of body size and how size affects health and happiness. But before "overweight" people can demand acceptance from the rest of the world, we have to learn to love and accept ourselves. From that will come an end to size discrimination.

TOP TEN REASONS I AM FAT

10. The dog ate my diet sheet.

9. I lost my jogging shorts.

8. I have to cook for my family.

7. Dove Bars don't come in a no-fat, no-calorie version.

6. Oprah said it was okay.

5. Pritikin food tastes nasty.

4. Girl Scout cookies.

3. I wear this fat to keep the opposite sex away.

2. I gain weight just by looking at pictures of food.

1. Nobody doesn't like Sara Lee.

    None of these things, of course, has anything whatsoever to do with being fat. We have been programmed to find excuses for our size . . . as if we have to apologize somehow for something we have little control over. Can having a piece of cake after dinner really cause excessive weight gain? Does the equation "3,500 calories - 1 pound of fat" tell the whole story? If it were all that simple, how many fat people would there be? The truth is, we don't really know what causes some people to become fat while others remain average size. Some fat people get less exercise than some of their thinner counterparts . . . is that a result of, or a cause of, being large? Or does it have any significance at all? There are some very lazy average-size people out there and some very active fat people. Most of us - of all sizes - fall somewhere in between.

    Recent studies show that fat people, in general, don't eat any more or have any worse eating habits than our thinner counterparts (Brody, Jane E., 1987). One study focused on people in an all-you-can-eat restaurant. Fat people took no more food than did other people; neither did they select foods of higher fat or sugar content. Of course, there are fat people who consume huge quantities of food. But so do many "average-size" (and many thin) people.

    A friend of mine is as thin as a rail. He eats all day long . . . and we're not talking about carrot sticks and celery here. He consumes doughnuts, omelettes, french fries, buckets of fried chicken, cake . . . everything you could imagine. He exhibits the energy of a tree sloth and never participates in sports of any kind. I can't eat like that and have no desire to. I'm sure you know people of this type yourself.

    People probably become fat because of a variety of influences - heredity, appetite, lack of daily farm work to do, metabolism, and so on. Most of us got to where we are through any combination of these and other as-yet-undiscovered reasons . . . often coupled with a heavy dose of dieting.

    Despite all of the diet industry's efforts, our doctors' best advice, and our own multiple attempts at weight loss, we are a society of fat individuals. Even in this period of increased interest in physical fitness, the percentage of fat people is higher than it was even a decade ago. According to the latest, best guesses there are between 34 and 50 million adults and another 10 million children in the United States who are "overweight" by twenty pounds or more. That's just the ones they counted. You and I know there are lots more of us going about our lives and not participating in any fat census.

    Anyone who believes losing weight is a simple matter of eating less and exercising more has either never been fat or is one of the fortunate few (3 to 10 percent) who have been successful in achieving and maintaining a significant weight loss. We have been presented with no-fat, sugar-free, taste-free, slide-right-through-you foods and still we gain weight. We are offered a "delicious, filling shake for breakfast and lunch followed by a sensible dinner" and we continue to overflow our overstuffed couches.

    It seems that everybody is always on a diet, even though statistics tell us that over half of dieters will have regained the lost weight before a year is out. There is more at work here than a simple lack of willpower.

    A panel of experts at the National Institutes of Health (NIH) conference in April 1992 concluded that 90 percent of dieters regain most or all of their lost weight within five years. Others place this rate at 95 percent or higher. This leaves just 5 to 10 percent of dieters who lose a substantial amount of weight and manage to keep it off for at least five years. Everyone who begins a diet thinks he or she is going to be in that lucky, but very small, percentage.

    The panel stated that there was little doubt that excess weight increases risk for morbidity and mortality, but they did not find any evidence that losing weight reduces that increased risk. They did not see weight loss as having a positive effect on the incidence and severity of non-insulin-dependent diabetes mellitus, hypertension, and the risk factors for cardiovascular disease. But, considering the high likelihood that lost weight will be regained, it was not determined whether or not any permanent benefits could be accomplished.

    The NIH panel concluded that "the decision to lose weight should take into account the difficulty of the task as well as the potential adverse physical and psychological effects of weight loss regimens. These effects include the risk of poor nutrition, possible development of eating disorders, effects of weight cycling, and the sometimes serious psychological consequences of repeated failed attempts to lose weight."

    There is even evidence of significant health drawbacks to dieting. Epidemiologist Steven N. Blair of the Cooper Institute for Aerobics Research in Dallas conducted a survey of 12,025 Harvard graduates. The average age of the men in the study was sixty-seven. They answered questions about weight-loss dieting, heart disease, hypertension, and diabetes and revealed that men who dieted to lose weight had a higher incidence of these diseases than men who never dieted. This was true even among the leanest respondents to the survey. Of those who said they were always dieting, 23.1 percent had heart disease, 38.3 percent suffered from hypertension, and 14.6 percent had diabetes. Comparatively, non-dieters reported that 10.6 percent had heart disease, 23.4 percent had hypertension, and only 3 percent were diabetic.

    The men in the survey were asked to indicate their body shape throughout their lives. Those whose shapes had varied more had higher incidents of disease than the men whose weight had remained relatively stable. Other studies bear this out.

    Blair summarized, "The results appear to raise questions about research that has established obesity as a risk for heart disease . . . One of the fundamental tenets of the weight-loss industry is if you get people to eat less, they'll lose weight. And if they lose weight, they'll be better off. And there is no evidence to support either one of these."

    This "dieting doesn't work" concept is not a new idea. In 1983 Dieter's Dilemma by Dr. William Bennett caught my eye. After a quick look at the introduction I put the book back on the shelf. I just wasn't ready to accept what Dr. Bennett was saying. To me it meant giving upon someday having that perfect body. I had heard of support groups for fat people, but to my mind these people were just looking for an excuse to give up. I was just temporarily overweight and next Monday I was going to start the diet that would finally work. Every Monday. For years.

    Most of us want to live for as long as we can and enjoy life to its fullest. There are ways to be healthier and more active, no matter what your size. Fat and fit are not mutually exclusive terms. But the decision of what (if anything) to "do about it" is yours entirely.

    There are dozens of books on the shelf begging us to buy them and discover our innermost secrets and cravings . . . and offering yet another diet meant to "fix" us. Diet programs are available in every area of the country. If that's what you need, go for it! You must make your own decisions regarding your health. If losing weight is important to you, I certainly wish you every success. Everybody - fat or thin, tall or short - has to decide what is right for themselves. No matter what that decision, no matter what your size, you have every right to be treated with respect. By everyone . . . including yourself.

    I no longer care why I am fat. I've wasted too much of my life wondering about it. Researchers and geneticists can figure it out for me and let me know when the verdict is in. What I do care about is living in the hear and now.

    It took many years to come to accept that while I may want to look like Cindy Crawford and have a body Playboy magazine would beg to grace its centerfold (an offer which I would, of course, decline - yeah, right!), the best I may ever achieve is to be a Roseanne look-alike. And what is wrong with that? What I refuse to accept is the idea that because I am large I am not an important part of this world.

    We owe apologies and excuses to no one. Not even to the doctors and weight-loss counselors who demand to know why their diets didn't work for us. We don't need to apologize to people who have their sensitivities offended by the sight of us or to the airlines because our ample hips overflow their ridiculously narrow seats. If anything, these people owe us apologies . . . for putting us on diets that seldom work long-term and often add to our health problems, for mean-spirited prejudice that causes a great deal of pain, and for humiliation over problems we didn't create.

    Unfortunately, despite consistent findings in one study or after another indicating that people have little control over their body size, society still pressures us to fit in.

    Doctors continue to chastise us for our size and hand out the customary low-calorie diet sheets. Or, if they are really into it, they prescribe packets of powdered protein drink we are supposed to use to replace food in our lives. Despite the continued inability of the majority of dieters to lose weight and keep it off on any diet plan, diets are still the prescription of choice. Why is this? Is there a single other medical treatment besides low-calorie dieting with such a deplorably low success rate that is still being routinely prescribed? Outside of experimental therapies for the terminally ill, I don't believe so.

    But it gets worse. The pressure to fit into the tiny mold society demands becomes so intense that some people endure potentially life-threatening surgical procedures in the hope of losing weight. Thousands of surgeries are performed yearly that staple, bend, fold, and mutilate our stomachs or intestines. The sad thing is, these surgeries have no better long-term effects than any other method of weight loss. The list of possible complications that goes along with these surgeries is staggering.

    Those individuals who are most miserable and unable to cope with their feelings of shame and the lack of acceptance in their lives sometimes commit suicide. In the words of an infomercial diet cheerleader, "Stop the Insanity!"

            I've spent years counting calories. It doesn't do any good. It made me obsessive. I don't diet, but I've changed a lot of my eating habits. I'm not losing any weight, but I feel a lot better. I've done everything from diet pills again and again to trying every diet that has come out. I've had my jaws wired and I've fasted. I had my stomach stapled (a 97 percent exclusion) in 1982 and lost 130 pounds. I stuck to it. Then the weight loss slowed and I slowly began gaining. I was eating about 300 calories a day, starving myself, living on black coffee and water . . . and gaining weight.

- Susan Mason

    Dieting should work! Take in less calories than you expend and the pounds should flow right off. It's just common sense. If the weight loss slows down, drop the number of calories again or increase the activity level. It seems so reasonable. For a very few, it does work, just as purchasing a lottery ticket is the answer to instant wealth for a lucky few. Even when we know the odds are stacked against us, we still diet. Each one of us believes that somehow we will fall into that elusive group of successful losers if we just find the right diet, begin at just the right moment, and find the strength of a pre-haircut Samson within ourselves. It should be so simple.

    One of the most difficult things in the world for me to accept has been the final simple truth about dieting. It just doesn't work for the vast majority of people. After probably a hundred failed dieting attempts beginning at around age sixteen, including a stomach-stapling surgeries in 1978, I still want the fault to be with me, not with the diets. If it had been my fault in the past . . . my own weaknesses each time . . . then it would still be possible for the right diet to come along that would "click" with me. I would finally be "normal-size." It almost felt like grieving to have to put aside the hope that I have lived with for so long. But trying to lose weight seems like being in quicksand. The more you kick around and struggle, the deeper into it you sink.

    Am I giving up? Yes. I am giving up hating myself for being fat. I am giving up accepting the type of prejudice heaped on fat people by those with no kindness and not understanding. I am giving up on the idea that I must be thin before I can have an enjoyable life. Oh . . . and one more thing. I am giving up supporting Jenny Craig, the Slim Fast company, and Weight Watchers' executives and group leaders. You may be very nice people, but I have better things to do with my money and my life. (For more information about the diet industry, please see Appendix A.)

    Most of us have taken the pills, bought the diet books, joined Weight Watchers, been to at least one company like Jenny Craig, Inc., drunk the chocolate fiber shakes, had counseling, jazzercised, cried with Richard Simmons, followed diet sheets, learned biofeedback, tried twelve-step programs, stocked up on frozen diet dinners, and been on dozens of our own home-grown low-calorie diets. Some of us have had surgeries that do all sorts of strange things to our bodies, leaving us with complications and ugly scars; some people have even subjected themselves to shock treatments. We've lost hundreds of pounds in our individual dieting histories. And still we are fat. So now what?

    We are told by our families, our friends, our doctors, complete strangers, and society in general that we must lose weight. How? If wishes and dreams, threats and cajoling, encouragement and rewards, humiliation and pain, starvation, hard work, and deprivation don't work, what does? Permanent weight loss is a possibility for a few. Improved health and fitness, however, are attainable by virtually everyone.

    There are people who are in the business of catering to the large person's wants and needs. These are the people who should have our business. There are people, publications, and groups who work to end discrimination and enlighten the world as to the truth about the diet industry. These organizations and publications deserve our support.

    Most importantly, we deserve to be treated with respect, understanding, and common decency, just as all others deserve to be treated. If anyone - family member, friend, caretaker, or businessperson - has a problem with that, he or she should not be a part of our lives. Certainly not a part we allow to influence us with negative attitudes about our own self-worth or whose pocketbook we enrich with our money.

    That reminds me. This book is absolutely off-limits to anyone who cannot make a scale groan audibly or who doesn't love someone who can. The knowledge about to be entrusted to those of us graced with extra pounds will do others no good and may be more than they can handle. For everyone else, this book's purpose is to provide you with the information you need to be happier and more comfortable in this world.

    Life is right now, no matter what your size. This day isn't coming back to you ever again and no one is going to regret its loss as much as you. Don't put off doing the things you truly want to do and don't let anyone make value judgments against you. Demand respect from those not giving it naturally. Sign up for that class you've been waiting to take. Buy a terrific wardrobe that fits you now. You deserve to look wonderful. Flirt! Try that new hairstyle! Join a softball team! Do what makes you happy . . . and don't wait any longer . . . do it today!

            It's about liking yourself. You should never let size be an issue. You shouldn't wait till you are a certain weight in your life - going either way - to make your dreams come true.

- Phil

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Size Wise went out of print when its publisher, Avon Books, was purchased by another publishing house. It is no longer available through bookstores. If you are interested in obtaining a copy, check with Amplestuff or look for used copies on sites like Amazon.com.

*See bibliography at the end of the book for complete citations on this and other references.