Recently I’ve been thinking of body image issues. One of my regular podcasts covered the topic and I see it a lot when I watch My 600 lb Life (it’s my version of a 12-step program). For the patients, their first priority is getting the surgery, but once they start losing weight, their whole focus becomes getting skin surgery. I’ve also seen this on the newer show Skin Tight (that’s pretty much what the show is about). Many of these patients, even before they have the bariatric surgery to lose weight, are obsessed with being “normal.” More than a few of them refer to themselves as “monsters” or “grotesque.”
The patient who sticks in my head most clearly is Laura, a forty-something woman who was much more concerned about not-dying than her body image until after she lost a considerable amount of weight, and then, looking at her deflating body in the mirror, lamented that she still looked “ugly.” She wanted people to see her as beautiful on the outside too.
Another patient on Skin Tight (whose name I don’t recall) stated she still felt like a “freak” and tearfully told about being laughed at in the gym because of her loose skin. She was devastated that she had lost hundreds of pounds to be “normal” and because of the loose skin, she was now a different kind of freak.
It’s heartbreaking in so many different ways, but mostly because their self worth seems to be so closely tied to what everyone else thinks of them. They keep seeing flaws in themselves and in their bodies, and what concerns me the most is that even after losing all the weight, and getting all the skin removed, they are going to start seeing other flaws in themselves that need to be “fixed.” After the skin is removed, maybe their ears don’t look right; maybe their nose isn’t straight or their teeth, or their hair is too thin or too frizzy or too something. Once you go down that rabbit hole, it’s not easy to climb back out.
What is easy is to see how they ended up in that trap to start with. Let’s face it: when you know you aren’t normal, it’s easy to put up defenses and accept being “the fat one.” You learn to accept it when family and friends make concessions for your size or mobility: they set up the picnic table outside and instead of setting up a chair for you, they bring you the bench; instead of being a bridesmaid with the rest of your cousins, you get to be the greeter at the guest book; when we do a “girls’ night out,” they choose a bar that has “real” tables and chairs instead of the high bar stools you’re too fat to climb onto. You accept it, but really, what you want is to just be “normal and do normal stuff” like your friends do and like the rest of the world does.
The problem is that “normal,” aside from being completely subjective, is as elusive as the electronic rabbit the greyhounds are always chasing. It’s always just out of reach, but that doesn’t stop people from going after it. Part of that is the biological imperative that comes with being a social animal. Human society is structured around groups: families, clans, tribes, cities, states, countries. This is how we interact, proliferate and grow as a culture, but on the most fundamental level, this how we individually survive. A loner often does not survive as long and certainly not as easily as someone in a group. As children, we see very early that the kid who is different is left out and mocked. No one picks her for the kickball team; no one eats lunch with her; no one helps her with her homework and, perhaps most importantly, no one laughs and giggles with her. She is alone, because she is “different” and doesn’t somehow conform with the whole.
So the drive to conform, to be what society thinks of as normal, is an imperative survival instinct, but still watching these women grow tearful looking at themselves is beyond heartbreaking. They do not see their accomplishments and continued success; they see deformity. Yes, they do not look like everyone else’s idea of a normal person, but they completely throw out the strength it took to reach their goal. It takes great courage and strength of mind and body to make the significant changes they’ve made. Anyone who’s tried to change a habit (particularly a deeply ingrained habit) knows how hard it can be to consciously choose to do something differently instead of moving forward on autopilot and to make this new different choice over and over and over until it becomes the new autopilot setting. Moreover, these many of these patients have been given up as hopeless by multiple doctors, told to go home and just enjoy what they can out of whatever is left of their lives, because no one can help them.
So not only have they overcome their own bad habits (poor nutrition, overeating, lack of activity) to make multiple healthier new habits, but they have overcome the popular point of view that they are “hopeless,” “not worth saving,” and are “destined to fail.” That takes tremendous strength to work in the face of physical and social adversity, but they have succeeded. Instead of focusing on these achievements, sadly they focus on their flaws. They are so much closer to being normal than they have been in so many years (maybe all their lives) but they are still not there yet, and it’s obviously painful.
I am familiar with the sting of being different. I have been the kid who only gets picked for kickball because the teacher says so; I was the kid that gets laughed at and eats lunch alone. Although as a child, it was not so much because of my weight though I was always chunky: it was social status. I was the “poor kid” among the children of doctors, judges, accountants and other well paid professionals. I was also one of three minorities (including my sister) in the entire school. Obviously, I was different in a lot of ways (some of the kids used to ask me if I ate beans every day- not trying to be mean so much as just curious about Mexicans).
I came to accept being different. It wasn’t exactly easy and, at times, it REALLY hurt, but I came to enjoy being different. I liked the perspective it gave me. Living among “normals” and being educated in their system (I make it sound like they’re aliens, don’t I? Lol!!), I learned to see things from their perspective and it enables me to see other solutions to problems they sometimes miss. When people sometimes call me weird or imply it, rather than being offended, I confess I take a little pride in it. Weird is good, I often say. Different is good. I have family and friends who just accept my differences, so I have a “tribe” that I can call home, but when I’m out and about and people give me that “WTF?” look, I shrug it off. I embrace my differences and have learned it’s not going to kill me. It’s only an embarrassment if I let it be. Would I like to be thought of as beautiful? You bet! Would I like to be a size 6? Definitely! Hopefully, I will get there, but in the interim, I’m happy with the way I look (I think I’m kinda pretty, to be honest). I’m happy with the progress I’ve made health-wise. I’ve lost almost 150 lbs and still losing. I can do a lot more things than I used to and I’m looking forward to doing more. Does my baggy skin bother me? A little: I’m concerned that it may become a health problem or impediment to activities. Is it ugly? It’s definitely not attractive, but it’s a fact of life like poor eyesight, gray hair and arthritis. When I look in the mirror, I see me: someone who is secure enough with herself to embrace her life experiences and learns from them, rather than wishing I was part of the crowd, poor eyesight notwithstanding.