Dieting With An Eating Disorder History

When I started Nutrisystem 80 days ago, I had some nagging concerns about how to lose the weight I’d gained on chemo without going nuts and ending up in a bonafide eating disorder relapse.  I’m not sure that concern ever goes away.  I haven’t done any purposeful eating disorder behaviors since 1996-1997 (it was a process), and no purging since March 1996.  Yet, there were so many years of my life, starting at a young age, when disordered eating was the only way I knew how to eat at all.  It was what I was taught.

I’ve lost 43 pounds in 80 days. That’s faster than the advertised 1-2 pounds/week on the Nutrisystem literature (and any healthy weight loss plan). I’m not purposely eating less than I’m supposed to- and when I tally the calories, fat, carbs, fiber, and protein (which is more for diabetic/insulin reasons),  I’m not compelled to cut back to crazy low numbers.  There have been days when I don’t eat all I’m supposed to, but it’s because of headaches and the accompanying queasiness.  I think some of that is because of the sucralose/Splenda in some of the Nutrisystem products (they don’t use aspartame/Equal)- so this week I called Customer Service, and was able to arrange to send back all of  the Cinnamon Buns and some of the Honey Wheat Bagels (had to do with the 30-day exchange policy).  They are sending me some Granola Cereal- no artificial sweeteners, low fat, and good protein (for granola).  I really liked those Cinnamon Buns. 😦  But, I’ve had a headache every day since I started eating those with the last order. It has been a constant 6 day headache.  I’m still not sure why bagels need an artificial sweetener.  Sure, the yeast needs honey or sugar, but adding sweetness just to make them sweeter?  Yuck.  They did still work with the salmon spread I came up with, but I’ll just have to find a store bagel that has good fiber and protein.  But I digress.

I still have the body image issues. When I look in the mirror, I don’t see 43 missing pounds. I know my clothing fits differently (or in the case of 3 pairs of shorts, just falls off).  I know the ‘numbers’ say I’m losing weight, but I don’t ‘feel’ it.  My ‘old’ pajama bottoms fit again. My t-shirts fit better. My bra doesn’t make me look like the Michelin Man.  But, I’m still waiting for my rings to fit again.  And I’m waiting to see the change in my appearance.  I took ‘before’ photos, so I will have something to compare myself to.  I hope I can see it.

I’m not sure how to see myself normally.  That part of the recovery puzzle never did work itself out.  My dad asked me how much I plan to lose, and I don’t know. I told him I’d know when I got there (which can be a scary thing to think about- those with eating disorders are never happy when they reach one goal). I have a BMI number I want to get under, but it’s not anywhere near unhealthy thinness.  When I was in the worst part of any given eating disorder period, I thought that the low 70s was a perfectly reasonable weight to aim for, at 5 feet 6 inches tall.  I do know that anything below a BMI of 18 isn’t good- and for my body type, I don’t want to go below a BMI that is much higher than that. I know I have to be careful not to keep looking for some ‘magic’ number- and that I have to be vigilant about not getting into numbers games in my head.

To look at me now, ‘eating disorders’ (the ‘thin’ ones)  are not what someone on the outside would even consider being a issue of mine , but I’ve been nearly 100 pounds heavier than I am now, and 70 pounds lighter during my adult life (18 or older). Between the relapses with anorexia, I’ve also been a compulsive undereater- people don’t talk about that. It’s not quite as bad as the internal demands of anorexia,  but the focus on food and weight is still abnormal enough to affect functioning around food and eating; social events with food are very difficult, even though the diagnostic criteria for anorexia aren’t all there.

I ate a lot when I first moved away from home in 1985, and no longer had the imposed restriction of my mom, or the original ‘diagnosed’ anorexia onset in 1981.  I’d been through inpatient psych hospitalization, and was ‘allowed’ to eat.  That led to unhealthy eating, and what I don’t really call bingeing, but more like finally being set free from a noose of thinness obsession.  My metabolism had to be messed up from so many years of dieting and starvation, which just made the weight pile on faster. “Normal” intake equaled weight gain.  I got morbidly obese- which is like a death nell for someone who has been anorexic/bulimic.  I relapsed a couple of times before the last one in 1995. Each time got worse faster.  The last one was really bad. But only those who saw what I was doing knew that I was in trouble.  To most people, I was too overweight to even consider that I was starving.  I lost 50 pounds in 3 months, and a total of 120 in about a year.  Some of that was from diabetes before it was diagnosed (weight loss is a symptom of undiagnosed high blood sugars), and then after the diagnosis I became very obsessed.

Now, I’ve lost 43 pounds in 80 days.  I  let my doctor know (that’s definitely not something I would have done during the ED years).  I know that the huge reduction in insulin is probably also a factor in how ‘easy’ this has been (when nothing I did before Nutrisystem helped budge the chemotherapy weight).  I am eating more protein than before NS.  The glycemic index of the food is much better.  Even the ‘junk food’ on NS is formulated to be healthy.  The Cheese Puffs, cookies, pretzels, and candy bars are tasty enough to order after I reach my goal weight.  It’s hard to find 8 gms of protein and 6 gms of fiber in 1 ounce of regular pretzels.

I still have a problem with feeling full. I loathe that feeling.  There is a lot to eat on NS.  Most days, I don’t get it all in, but it’s not about the numbers game- it’s about feeling really uncomfortable.  Gas-X has become its own food group.  On ‘headache days’ (whether from sucralose or not- I have chronic headaches), it’s hard to pack in every meal.  But on days when I don’t have the headaches or other pain, I like the NS food.  NS food is quite good for ‘diet food’.  I go off plan now and then and have restaurant food (and it hasn’t affected my weight loss). Some people on NS (per the discussion boards) must stay very rigid so they don’t end up in long binge cycles- kind of like alcoholics can’t have a drop of booze.  I understand that from my years of working drug/alcohol rehab, but I have to be less obsessive, and go ‘off grid’ now and then to keep some sort of balance with the real world.

One of my other reasons for wanting to lose weight (besides the chemo weight) is that I’ll be 50 years old later this year.  I didn’t want to hit that milestone at such an unhealthy weight.  I want to stack the odds in my favor for the ‘senior years’ (geez, I’ll get my AARP card soon- when did THAT happen?) 😮 . I plan to eat restaurant food on my 50th birthday in November, and I can pretty well guarantee there won’t be a carrot on the plate 😀  And I will have cake.  I don’t normally enjoy restaurants (mostly from the heat intolerance and dysautonomia), but I’ve been told the sky is the limit by my dad, since a 50th birthday doesn’t come around but once.  I don’t feel like I’m almost 50… no husband, kids, etc- I guess I bypassed some of the other milestones in life, and have a different frame of reference for a lot of things.  But, I don’t want to be fat when I turn 50.

So, I’m doing well on Nutrisystem, but I don’t think I’ll ever feel like a ‘normal’ eater.  I think that the risk of anorexia is always there once it’s ever taken hold.  It takes over very subtly at first, and then everything crashes and burns.  Being aware of this has been helpful.  The ultimate goal of being healthy has surpassed the desire to be ‘skinny’.  That part of my brain has finally grown up.  But the part of my brain that remembers the horrible years of torment from anorexia, bulimia, and other variations of those doesn’t want to get ‘close enough’ to the edge.  Ever. It has scarred me in many respects.  I guess that’s probably good.  Now to get rid of the rest of this unhealthy weight, and then maintain it like a ‘normal’ person.  I’m more than half-way to my random goal, set when I started NS  (I had to put something down) but people adjust them once they reach their original goals all the time.  I’ll just have to see what feels right.

Running on Empty

The fall of 1981 was one of isolation, hopelessness, and being totally overwhelmed.  I was supposed to be having a wonderful time as a freshman at the University of Illinois- Urbana-Champaign campus.  I was 17 years old when I got there, and had become seriously anorexic the summer before when working as a nature counselor at a summer church camp I loved.  I wasn’t super skinny, but my mind was a total eating disorder trap.  Every thought included how to avoid eating, how to ‘get rid’ of food (I used laxatives- 10 of them 4 times a day), and how to avoid being noticed.  I bombed that last one pretty quickly.

My roommate and I didn’t last long. She thought I was too quiet, and requested to move out (which she did).  Looking back, I can’t blame her; watching someone self-destruct and be so consumed by the eating disorder had to be miserable for her.  We both had double rooms to ourselves- which just meant more isolation for me.  Outside of classes, I spent a lot of time walking around campus, or taking the bus to various parts of town, and just walking.  When I was in the dorm, I’d look out of my 12th floor window, and follow the lights of cars as they drove through the countryside at night.  I played a Christian radio station for comfort, and just wondered if I’d get better.  Then I’d get scared that ‘getting better’ meant eating, and I’d fall back into the ‘starvation’ mode with even more determination.  Other than the background music, and the fighting in my head, most nights were eerily quiet.  Those who know the insulating effect of heavy snow, and how it mutes most sound, will understand what my head ‘sounded like’ for the many months I was there.

I’m not sure how I lasted as long as I did.  My weight was relatively stable, but the starving/bingeing/purging patterns were also how I was ‘living’.  I’d take 10 laxatives at breakfast, lunch, dinner, and bedtime with a 16 ounce glass bottle of Diet Rite cola.  If I ‘had’ to be seen eating at dinner (only meal where I’d be noticed- missing, eating, or acting weird), I’d have an apple or half of a baked potato. That would trigger intense guilt, and I’d run up the 12 flights of stairs to my room.  Then I’d get homework done, and go back to watching the lights of the cars in the night.

When I did try to get to sleep, it was another battle.  There were many nights when I’d watch one specific star as it moved across the sky out of my window.  Many times, I’d get up to go to the bathroom (spent a lot of time in there with 40 laxatives per day), and pass out before I could get back to my room.  I’d be sent out by ambulance, rehydrated, and sent back to the dorm.  They’d lecture me about how unhealthy eating disorders were, and I’d nod, then go back to my crazy routine.

What stands out the most from that semester, besides being so sick, were those nights of such ‘silence’ as I watched those car lights (and occasional police car’s red flashes ) move across the view I had from that 12th floor dorm room.  I’d wonder what those people were doing, and if they were in their own living hell.  I’d wonder if I’d ever get out of the mess in my head.  I’d wonder why I couldn’t just snap out of it and eat, without the blinding feeling of guilt for having fed myself.  It was like I was punishing myself for existing and having human requirements to survive.  But I had no good reason why.  I’d been born there (and placed for adoption), but the starvation (and diet contests) had been brewing for a few years- so the whole adoption/birthplace thing didn’t really pan out.  My mom had been constantly on me about my weight (when I wasn’t fat).  Maybe I just picked up where she left off.  I don’t know.  I eventually did ‘click’ with the explanation given by Peggy Claude Pierre- that the ‘negative mind’ was the one in control during eating disorders, and refused to allow the anorexic/bulimic to tolerate self-care and survival.

But those nights were so muffled and eerie.  I won’t ever forget those.  Or how scared I was.  And alone.  I had several people looking after me from their assigned ‘roles’ (therapist, resident director, resident advisor, and several dorm-mates), but nobody understood.  They each tried to help in some way, but I was on my own, with something I couldn’t handle. I refused to tell my parents (I saw that as failure, which wasn’t allowed).  So I tried to just keep going… but how long could I go on fumes?  Many days I had fewer than 300 calories.  When I binged, it was a disgusting amount of food, but it possibly gave me enough of a ‘boost’ to keep going. Laxatives don’t remove food; they remove water- so some nutrients got in… but I was running on empty, and running OUT of time.

And it was so, so quiet when I looked out at the world from that 12th floor dorm room window.

University of IllinoisOctober 1981

University of Illinois
October 1981

Eating Disorders and Suicide

This time of year stirs up memories of my first year at the University of Illinois (Champaign-Urbana campus).  I’d arrived there with anorexia well entrenched, after losing 45 pounds in about 6 weeks while working at a church summer camp as  a nature counselor.  I didn’t want to get to college ‘fat’.  And I didn’t (though I thought I was grotesquely huge), but I was already a slave to the eating disorder (ED) voice in my head that made eating absolute hell.  People who haven’t crossed the line to an actual eating disorder don’t get it. I don’t expect them to- and I’m thankful they don’t know what it’s like to have a war in their heads over the number of curds of cottage cheese that are ‘acceptable’.  Yeah- it gets pretty weird.

By the beginning of the Spring semester, and returning from Christmas break, I was a mess. Being home for the holidays had been very difficult- I’d done what I could to avoid being around family by working at the University during a missions conference (‘Urbana ’81’).  Ironically, I worked in the food service area. But I had to be at home at some point (and in Florida with my parents for Christmas itself- that was a battle I lost).  Trying to hide an active eating disorder and starving/purging isn’t easy- and caused even more havoc in my mind.  I didn’t return to school at all well.  I’ve never been clinically depressed unless I’ve been starving/malnourished.  And I was a mess when I got back to my dorm.

I’d been seeing a therapist since I had arrived on campus the fall of 1981, as my resident director, resident assistant, and dorm-mates had found me wearing 6 pairs of socks and a winter coat in late August in central Illinois… humidity with the heat was probably stifling- but I was freezing.  The RD could actually feel the cold coming through the socks. SO she called 911 and I was hauled off. I was diagnosed with anorexia nervosa the next morning, and ‘ordered’ to start therapy or leave school.  I had no clue what to think about therapy, but I knew that going home wasn’t an option. It would mean I’d failed.  SO I went to therapy.

That therapist ( a very nice youngish woman) probably never heard me say much more than “I don’t know”- and I didn’t !  I had absolutely no insight, and no clue what could have gone on in my past to lead to the eating disorder.  By the Spring semester of 1982, I was really falling apart, and had a plan to kill myself.  My roommate had moved out long before (because I was too QUIET !!), so I could be isolated for quite a while before anybody would have noticed I’d been missing.  I had planned to take the tranquilizers (Thorazine- supposed to chill me out enough that I didn’t care if I ate) I’d been given at the university health system pharmacy,  and lock myself in my room, IN my closet (with the keys), and just wait.   I’d become fairly resigned to the idea that I wasn’t going to  live all that long with the anorexia (which had included periodic bingeing at that point, and daily purging via 40 laxatives spread out throughout the day), so it was more about just dealing with the inevitable.  I didn’t really want to die– I just didn’t know how to get out of the ED.  I felt trapped, overwhelmed, ashamed, and hopeless.

The emotional pain had hit the tipping point.  For some reason (like wanting to live maybe?), I spilled my guts to my therapist, who promptly had me escorted to the university health system (via the University Fire Department….. subtle), where I stayed until arrangements could be made to have me shipped to Forest Hospital in Des Plaines, IL.   It was a nut house.  Back then, there were no eating disorder ‘treatment centers’… if you had a nutty problem, you went to the nut house. That in and of itself was terrifying, but I was even more afraid of facing my parents- and being a disappointment- so a longtime adult friend and her daughter (former babysitter) came to get me…once the blizzard passed, some 3-4 days later.  The therapist and health center folks had wanted me out of there much sooner, but the weather was a big problem.  So, I waited at the health center ‘hospital’ as dorm friends came and went, both trying to cheer me up and also to say goodbye.

Suicide  attempt averted. That time. The next fall, I returned to the university, and the pressure build-up was almost instantaneous.  More on that later….

Gotta Lose This Weight

I’ve carried on about my frustrations with my weight gain following chemotherapy for leukemia (APL).  It’s no secret that I’ve got a history of eating disorders (just about all of them).  I’ve got to admit, I’m nervous about doing much restricting, as I don’t want to trigger that hell of anorexia again. I was told the last time around (1996) that I probably wouldn’t live through another relapse. As it is, some of my medical diagnoses weren’t identified until after that last relapse, and they’ve disabled me.

But I’m getting desperate.  I’ve got some diet journals to start using on January first… I’m not much into New Year’s Resolutions, but I do want to have this weight gone by my 50th birthday in November.  I hope I can lose the weight without losing my mind.  I have severe intolerance to heart rate or heat increases, so exercising isn’t really an option that will be of any major benefit.  I can stretch. That’s about it.   If the dysautonomia wasn’t an issue, the disc and joint disease is.  Sounds like excuses… it’s my life. I used to walk like a maniac, and loved it. I’d love it again if I could take my MP3 and hit the sidewalks.  No dice. I’d end up laid out on the side of the road.

So, I’ve got to cut back on calories considerably.  I have to be diligent. But I can’t go crazy with it.  I really just want to be more healthy- not ‘skinny’.  I don’t know how this is going to work.  But I’ve got to do something.

America’s Shameful Truth

To other countries, especially those we send financial aid to, it may seem unbelievable that ANY American lives in poverty, or has any problem getting enough food.  Looking at our obesity rates, it looks like we need to be sending more food overseas, and subsidizing treadmills here.  But it’s much more complex and complicated than what the surface image shows.  Malnutrition isn’t just about inadequate food, it’s also about inferior and altered foods.  Poverty isn’t just about living in recessed or depressed areas, but a result of the trashed economy.

Per the 2011 statistics from a hunger statistic website, 15% of Americans were living at or below the poverty limits.  (Roughly one in six Americans is poor). Those limits are low enough to make basic expenses impossible to meet. Poverty limits are, however, above minimum wage if someone has one full-time job. (Our minimum wage supports poverty).  The standard set by the government to define poverty is ridiculously low. And people are out there living below that limit.  I’ve visited areas in this country, with our tourist brochures of amazingly beautiful parks and tourist sites, and maps of the movie stars’ homes  in Hollywood, that consider a cinder block house with a tin roof to be a sturdy- and enviable – home.  I’ve seen them.  I’ve seen the barefoot kids with the hollow eyes. I was only 16 myself at the time, and it’s an image I won’t forget.

According to those same statistics, 50+million people in America don’t have enough food.  Often the foods that are affordable are nutritionally bankrupt. Fresh produce is a luxury and at the bottom of the grocery list, as it’s more important to get calorically dense items for each dollar spent. Much of that is junk food, so it’s very  possible to have someone who is visibly obese, yet deficient in many nutrients.  Over 16 million children in this country know hunger as a daily part of their existence.  How that will affect their physical development and well-being is better known than how it will affect the country as a whole, as their generation will be compromised in their ability to learn. That will result in kids who never fill their potential, or maximize their earning potential- and ability to get out of the cycle of poverty and hunger.

Americans are often portrayed as relatively wealthy and lacking nothing. When it comes to food, our obesity rates are horrible and getting worse.  With the economy being as bad as it’s been in the last several years, the effects of ‘not enough’ are hitting socioeconomic groups that had been very comfortable and stable.  Homeless shelters are getting more families with educated parents who simply can’t get work, and who have lost their homes.  Americans need help here ‘at home’, and all of the financial aid sent to other countries is frustrating when the statistics here are so unacceptable.  There are many who are very hesitant to ‘give handouts’ as it perpetuates a cycle of dependency in those of a mindset of entitlement.  That is different than people who legitimately can’t get adequate nutritious food.  Yes, there are Americans whose greed and inability to deny themselves nearly everything they want makes them look rich (but in debt up to their eyeballs). There are those who are successful, and doing well.  But there are far too many who actually have very basic needs that aren’t met. 

There are wonderful private charities that do what they can. There are rescue and homeless shelters. There are food banks and soup kitchens run by non-profit organizations. There are thrift stores that benefit programs for the homeless and poor. They all work very hard, and do a wonderful job- but the job is too big. Our own citizens are still in a world of hurt.  NO child in this country should leave home for school without a nutritious breakfast. No child should come home after school to the bleak fact that they won’t have anything for dinner.  More than sixteen million kids live in that pain. They don’t just have poor quality food, there isn’t enough of it.

I think it’s great that we help other countries. I think it’s important that we continue to do so- and yet we need to get our own house in order.  We need to walk the walk, and quit with the cheap talk.  If other countries sent people to document areas in the Appalachian mountains,  depressed rural communities, inner city school kids who are falling asleep because they don’t have the energy to stay awake,  or the people who would do anything for a job, but can’t find one- and see the reality of this country right now, they’d be sending us aid.

The quality of American crops/food products is also an issue. GMOs- or genetically modified organisms- are what make up the vast majority of corn, soy, and canola crops in the US.  Few processed foods don’t include one or more of those crops. A lot of rice is also genetically modified. This is done to increase the yield per acre, so for financial gain, even though the studies on rats have shown tumor growth and organ failure, and human studies were never done. Monsanto (a pesticide corporation) is the manufacturer of these seeds used in our food supply. A bug killer company makes  the building blocks of our food.  Any product made from their corn, soy, or canola crops are also genetically modified, so high fructose corn syrup, corn starch, soybean oil, soy protein, etc are also ‘contaminated’ by the GMO process.  Many countries will not let GMO products into their borders, or ban the growth of them there.  The US government doesn’t care about the human effects of GMOs.  Bovine growth hormones, used to increase milk production in dairy cows, is also of questionable safety.  Artificial sweeteners also have links to Monsanto.  There are ‘organic’ options- but unless a product is labelled ‘USDA Certified Organic’, it’s possible that a GMO seed was used, but grown without added chemicals.

So, we continue to send billions of dollars to countries that aren’t solid allies. We cut back on nutrition programs here. People (and the politicians) fight about ‘handouts’ while kids go to school hungry, and don’t see dinner. Our obesity rates soar, partly because of disordered relationships with food – but also because nutritious food can be inaccessible financially. Junk is cheap.  Families are in shelters because jobs aren’t there to make rent or mortgage payments possible. It’s sad.  The ‘new’ American dream has been greatly altered from the post-WWII dreams of owning a home and living with minimal debt (and that debt was for needs– not wants).  It’s a new definition of survival.  Yes- the vast majority of people in the US are making it- however well or poorly. But there are millions…MILLIONS… of US citizens who are malnourished from hunger.  I don’t have any solid answers…but I do think that our priorities need to shift from such a ‘fix your neighbor’ mentality, to ‘save our skin’ outlook.  Maybe not permanently, but until we get a handle on our own horrible social and economic issues here.

America is hurting. Add to that the divisiveness of our politicians,  the more extreme members of political parties (to the point of hatred and absolute repulsion for the other ‘side’), and the relationships between ordinary citizens based on the same hatred, and the idea that anything will be solved seems unreachable.  I know that people from 23 countries have read my blog posts.  I wonder how many of those countries know how crazy things are here, and how many of OUR citizens are in need of help.

Letter to My Oncologist

First of all, I can never express enough gratitude and appreciation for what you did to treat the leukemia I was diagnosed with in 2010.  I’m thankful to God for your skills and incredible knowledge that helped to save my life.  Your awareness of the latest treatments for acute promyelocytic leukemia is wonderful .  I’ll always be thankful for that.  I often wish I had the chance to find out more about Iran from you. I’m sure you could tell me things that I’d never know from a book or documentary.  Because of you, I’m more interested in TV shows that focus on Iran, as I have respect for you and your skill as an oncologist; I want to know more about where you’re from. 

But I feel so misunderstood by you when it comes to losing the weight I gained during chemo.  Every single appointment revolves around my weight, and I’m really sick of it.  I’ve told you about my history with eating disorders, and while I’m aware that you don’t specialize in them, you must be aware of the nature of EDs.  The only time you backed off was when I was in tears trying to explain that I KNOW I need to lose weight. Nobody beats me up more than I do over my weight.  It is painful to hear it from someone who doesn’t know me aside from the leukemia.

Did you have to openly chastise me in front of the med student?  Up until then YOU had said that the weight gain was a side effect of the chemo. When I said ‘chemo weight’ and you told me “don’t you blame the weight on the chemo” when the med student was there, it was confusing and shaming. Was that for the med student’s benefit?

When you thought I was depressed, as in clinically depressed, you backed off. I’m FRUSTRATED.  You backed off that day when you saw I was upset.  But yesterday, when I had no outward signs of being bummed out, you started in again. I’m not going to keep showing up to hear about my weight  from a doctor who doesn’t deal with weight issues.  Not gonna happen. You deal with the cancer. Period.

You suggested I go to the YWCA to swim. Do you understand that heated pools trigger the dysautonomia?  I wear an ice vest to appointments, and that didn’t occur to you?  Well, I guess that’s understandable since you don’t treat dysautonomia.  You don’t know enough about me to know that I can’t walk unsupported for very far. I do OK in my apartment, but if I go to the store, I need the cart for support.  I was using a walker IN my apartment up until the day I was admitted to the hospital for that first admission when the leukemia was diagnosed. I had a partially torn ACL and medial meniscus in my left knee; you didn’t know that. It never got fixed, and I’m not sure how well it healed since it still hurts now and then. I was supposed to get a knee replacement done.

You asked about specific high calorie snack foods yesterday.  Do you have any idea how long it’s been since I had chips, cookies, cake, or candy in my apartment?  No?  I don’t either.  I don’t buy them.  The biggest treats I have are freeze dried apple slices that pack in a whopping 38 calories per bag.  Oh, that’s right- you told me to quit eating fruit.  Really?  Unsweetened fruit is a very basic food.  It’s on the diabetic meal plan I have that was set up by a registered dietician. I’m sure she got more nutrition education than physicians do (or her job wouldn’t exist). I’ve read about the basic nutrition classes that US med schools require. I’m not convinced that Iranian med schools demand much more with instructions to not eat unsweetened fruit.

I don’t need anybody to tell me I need to lose weight. Do you think I’m blind, or stupid? Or maybe you just think I don’t care and sit around eating bon bons all day. How insulting.  There hasn’t been a day in over 35 years when I haven’t considered my weight.  Are you even 35 years old?   I was badgered by my mom about my weight from the time I was six years old.  Then I took over, and equated my weight with my self worth for decades. It has been something that has haunted me for years, and I’ve worked hard to keep from letting it destroy my life. I don’t need (OR WANT) you to keep harping on me about my weight.  I know it needs to come off.

I’ve been an RN for 27 years, and a diabetic for 17 years. I know how being overweight is hard on a body.  I get it !  I’ve seen my regular doctor about it, and will see an endocrinologist next week. My blood sugars were never the same after chemo.  Is that my fault also?  I know that insulin is a problem when someone gains weight, and insulin stores fat.  I can’t not take it.  You don’t realize that I was 40 pounds lighter when I started on insulin; I wasn’t ‘fat’… somewhat overweight, but more than 100 pounds less than my highest weight. You don’t know about that, because you don’t do anything but tell me to lose weight over and over and over again.  You don’t know my whole medical history, or the daily struggles because of being disabled (I do pretty damn well, considering). You see fat and cancer.  Well, I’m in remission; maybe it’s time to have someone else follow me until the five year mark when I’m considered cancer free.  Someone else can do the yearly bone marrow biopsies.

Do you get after your obese staff members in the oncology office like you do patients?  Is that why nurses no longer go over the medication lists with me when I first get there, and why I found 16 errors on my list when I went over it today? Did the nurses leave?  Or are there techs in place of nurses now to save money?  I know that isn’t something you can control, but look around.  Don’t talk to me like I’m the fattest person you’ve ever seen.  I’ve been in your office and in the hospital enough to know that isn’t true.

I feel like less of a person every day because of my weight.  I know that’s not right, but it’s the truth. You aren’t helping that. You only let up one time (when I was in tears) because YOU had done so much to keep me alive and didn’t want me to be depressed.  It’s not about you.  I appreciate what you DID.  But what you’re doing is damaging.  I hate coming to appointments, and will continue to refuse being weighed at your office if I keep coming at all.  You did a great job with the leukemia while I was still being treated, but now, it feels a whole lot more like harassment.  Continuing to tell me repeatedly that I need to lose weight is so counterproductive I can’t even explain it.  It drives home even deeper that my weight is more important than anything else.  That is a great way to trigger something I never want to go through again. And something you really don’t know much about in my history.

I have to make a decision about whether or not I’m coming back.  I know my primary doctor can refer me to another oncologist.  I don’t want to keep seeing you three times a year just to be lectured about the obvious in a way that is demeaning and shameful.  Thank you for the incredible job dealing with the leukemia. But get back when it comes to the continued lectures about my weight.  I’m not going to do it.  When appointments are more of a sense of dread than they are productive, it’s time to hit the road.

Update: My primary doc is sending a referral request to another oncologist 🙂