How Can Pain Cause Weight Gain?  

For years the assumption has been that “obesity” leads to pain. Many patients have had the experience of looking for explanations of pain issues, only to have the problem never investigated and told to lose weight instead. Then years later, find out that their pain was actually the result of an underlying issue, made worse through a lack of early treatment. You might have seen a comic or visual joke involving a visibly injured patient and the doctor saying “have you tried losing weight?”

In my book, Young, Sick, and Invisible, I discuss how this same trope was directly responsible for my own autoimmune conditions being ignored long enough to cause long term and severe disability and damage.

In a recent post, I had responded to an intentionally insulting comment with a long explanation of how their assumptions about my use of a mobility aid and my weight was influenced by a series of misunderstanding about obesity, pain, and disability. Included among this explanation was the statement that “obesity” or rather weight gain, can often be a symptom of chronic pain rather than it’s cause.

In response to this statement I received a question, and while the phrasing made it clear the comment wasn’t actually a legitimate inquiry but another chance for the commentor to engage in fat shaming, the underlying question sparked my interest.

Heavily edited, the question was this:  

“I understand how obesity can contribute to pain by putting stress on joints, but I don’t understand how the opposite can happen. Can you Please explain it to me and help me understand? How does Pain cause Weight Gain?”  

To begin, the concept of “obesity” is widely misunderstood and is oppressive in and of itself. As a knowledgeable friend recently explained it –  The word is based on the Body Mass Index scale (BMI) where the ratio of height and weight was determined and everyone who scored within certain parameters was considered as having a healthy BMI while anyone whose BMI was above this range was deemed obese. A person who had very little body fat, but was very muscled, especially in relation to their height, would be classified as obese. In fact, since muscle tends to weigh more than fat, a body builder is more likely to be classified as obese than what most people consider to be representative of an “obese” person.

The concept that obesity is synonymous with fatness is a misunderstanding that has become accepted as a standard, and is used by doctors to excuse their own medical negligence when it’s the result of internalized biases regarding fatness.

What’s more, more and more evidence suggests that body fat percentage is not actually a reliable indicator of an individuals health, nor is there actually a reliable standard as to what fat percentage can be considered healthy and which is unhealthy. That rather fat distribution and percentage is really just a variation in body type much the same way that shape, height, etc. are.

The attempt to pathologize fatness ultimately makes as much sense as claiming that a certain eye colour is an indicator of overall health. Contrary to popular belief, just being fat is not in itself unhealthy.  A fat person can be just as healthy as someone who is considered slender. What is unhealthy is when there is a sudden significant increase or decrease of body fat percentage outside of regular growth and development. In the specific case of an increase in body fat levels, what is unhealthy is when it is spurred by malnutrition, stress, and immobility which in addition to spurring weight gain also have a measurable negative impact on blood pressure, blood sugar, and arterial plaque. Even in this case, it’s not the weight gain in particular that is of actual medical concern, but rather the specific effects on those measured stats.

The medically accepted myth that fatness all by itself is unhealthy is another example of the fallacy that correlation signifies causation. Additionally, this accepted fallacy has had significant impacts on our social understanding of body size and health. 

A more accurate way to look at the connection between a high body percentage and pain would be that it can contribute to pain when an underlying problem exists, and when the specific individuals natural body fat percentage is significantly lower than what it is now. There are many people out there who are fat, who not only experience no pain whatsoever, but also have perfectly healthy stats.

In fact, the social convention of proper weight is so distorted, that the little abdominal bulge many women spend years trying to eliminate, is actually not the result of fat but is actually their internal organs pressing up against their abdominal wall.

Weight on it’s own, doesn’t cause pain. Rather, in an event that someone has an underlying condition that may cause pain, carrying more weight than their body naturally would under optimal conditions, can put additional stress on the injury site and make pain more intense. The impetus for the pain however, is still the initial underlying injury or condition.

What many ignore is that pain and its related symptoms can actually be the cause of accelerated weight gain and that the best way to address both is to treat the underlying cause of pain and to treat the pain itself.

How can this be?

Continue reading “How Can Pain Cause Weight Gain?  “

How Can Pain Cause Weight Gain?  

No Man Will Love You If You Are Fat 2

Disclaimer: TW for fat shaming. Also, the title of the post is not what I believe but a reference to a previous body image post where I mention that this is something I had been told frequently by people. 

Whenever people talk about eating disorders, they are usually thinking of the extreme ones like Anorexia and Bulimia.  Those are serious conditions that last a long time, and I encourage people to read up on them: especially the posts written by people who have suffered with them.

But limiting the discussion of eating disorders to just those two conditions is damaging in many ways to people who struggle with eating disorders that don’t fall into those categories.

I am thinking in this case of my own situation. I’ve talked about before about my struggles with weight and body image issues. What I never really explored is how my relationship to food is an eating disorder of its own. I don’t think it is one I could talk to a doctor about. Not because they wouldn’t believe me, but rather because it would be classified as not serious enough to worry about, or more likely as a lack of self-control.

I anxiety eat. This is especially the case whenever my anxiety is triggered by weight related issues. This can occur when someone, including myself, fat shames me, makes a negative comment about my body, etc.

It started back in high school with an obsession with forbidden food. My household was diet obsessed. Everyone in my family was concerned with weight gain and so food was watched, discussed, and analyzed obsessively. Discussions of what someone was eating, how much they were eating, when they were eating, were common and often negative. Added to that were self-depreciating comments, discussions of other people’s weight (like actors and performers), and fad diet books aplenty. My family was the very definition of fat shaming culture.

Food became something seductive, tempting, and evil; it became taboo. Especially unhealthy food. McDonalds, Coca-Cola, chocolate, chips, candy, and ice cream, all of it became a method of rebellion against the diet obsession of my everyday life. It’s not that the food was ever particularly good, the food we ate at home and eventually the food I started making for myself, was infinitely better tasting and better for you. There were two aspects of joy in the eating of the unhealthy food: The inherent anger and rebellion of “fine, you think I’m a pig, then fine I’m a pig” and the other was the affirmation of my own humanity even if I did indulge in food that was unhealthy for me or would result in weight gain.

Of course the down side was that the food really was unhealthy and so I would gain weight. The weight gain would in turn make me feel like a failure, as though I was unattractive, as though I was worthless. I would become depressed, and in searching for relief from that depression I would look for the release of unhealthy food.

It was a vicious circle. Eventually the response of seeking relief in the dubious pleasure of junk food became the ingrained response to anxiety of any kind, not just that triggered by body stress.  Pulling an all-nighter, being stressed about exams, money, work, any of those could trigger a need for indulging myself with food. Same with depression, which often manifests itself in me as anxiety; it too would trigger this uncontrollable need for food that I knew to be unhealthy.

Throughout my elementary and high school years, we were swarmed with public service messages about the dangers of anorexia and bulimia. That I did not progress to full blown bulimia is not in thanks to those PSAs but rather credited to my lack of a gag reflex. I cannot count the times when I would sit in the bathroom, lost in a miasma of body loathing, where I would surreptitiously try to shove a finger down my throat; luckily to no result. I could have probably found other ways to trigger vomiting in myself, but something always prevented me. The irony of my later Crohn’s flare did not escape me.

I soon noticed the pattern that immediately before visiting my family I would go on a binge,  and would continue it throughout the visit home. I would sneak food, either when out with friends, or at home. I would pilfer the freezer for vile old frozen chocolate, just because the desire for it would be so strong as to verge on addiction.

Then when I was away from the stress, the overwhelming cravings would disappear. Not to say that I would never indulge in a chocolate or fast food from time to time, but that uncontrollable desire to eat would be gone. Most of the time I would need to remind myself to eat. My cravings at that time were more frequently for healthy home cooked meals. I would snack on vegetable. A late night snack would be a lightly salted tomato, sometimes with some cheese.

When I left for university, I entered an atmosphere where junk and fast food were the norm. No one would look at me askance for having a burger or chocolate from time to time. In fact, occasional late night trips to McDonald’s became looked forward to outings. Miraculously, despite the atmosphere of binge eating, I began to lose weight. I didn’t crave the food in the same way, and instead became more interested in cooking for myself and exploring my culinary abilities. In fact, I was often times the source of healthier food options to many a dorm student.

When I started working for a woman who could trigger my anxieties like no one else since my mother, it started me down a long spiral towards a lack of control when it comes to food. The fact that I was suffering, unbeknownst to me, through a period of depression as well, only made the situation more dire. Add to that being put on prednisone from time to time, and the result was a drastic increase in weight gain. With it came the self-loathing.  With the self-loathing came the sensitivity to comments as I had never experienced before.

Although I know without a doubt that my partner finds me attractive, I would take innocent comments from him badly. Although I would ask him to help me control my intake of unhealthy food, any attempt to do so would trigger a memory of the same type of comments coming from weight obsessed family.

I am getting treatment for my depression now, and soon, I will be starting to see a counselor/psychologist regularly to help deal with the emotional scars of the past. I hope that when that time comes, I will be able to lay to rest the anxieties that have been propelling me into this state. At the very least, I hope I will be able to control them and start back down to the pathway to healthier food habits. In the meantime, I work on controlling my anxieties and channeling my craving for unhealthiness in less destructive directions.

No Man Will Love You If You Are Fat 2

Where Ableism and Fat Shaming Collide

Earlier SpasticFantastic posted a great article calling out Takei on sharing an ableist joke for which he later apologized. The joke centered around a picture of a woman standing from a wheelchair, with the caption “A miracle has occurred in the alcohol isle”. SpasticFantastic did a great takedown of the problems associated with the image including the idea that lots of folk use mobility devices who don’t have complete paralysis, who may only use it occasionally, etc.

I am one of those people. My arthritis on most days manifests as stiffness and soreness, but otherwise doesn’t impact my ability to walk (I say walk and not mobility because I do have hindered mobility always). Other days however, every step sends a shockwave of pain up my body. My hip feels like it is dislocating every time it bends. On those days, at the very least I need a cane to maneuver and at worst I require a wheelchair.

My decision about whether or not to use an accessibility device should depend only on whether or not I need to at that moment and nothing else. Unfortunately, because I am also a fat girl, the decision also has to take into account how much fat shaming I am prepared to handle that day.

I’ve written about my anxieties surrounding my weight, and the way in which fat-shaming overlaps with my sexual assault. My weight has also been intimately involved with my disability. For many years, my condition was ignored on the pretext that it was caused by weight. The fact that symptoms persisted even at my lowest weights never seemed to register. Later when my various illnesses manifested themselves fully, I was left in a difficult position when it comes to managing my weight.

One of the medications I take frequently is a steroid which causes weight gain. My joint damage rules out any intensive forms of exercise, and my Crohn’s rather than my weight dictates what I eat. That said, despite my weight and my disabilities, I have healthy habits. Most of my food is made from scratch and uses little sugar or fat. I eat a healthy diverse diet. But that doesn’t matter ultimately because fat-shaming isn’t actually about health the way those who engage in it claim. It is about feeling superior to someone else and reminding women in particular that their bodies are public property.

Whenever I take steps to accommodate my disability, I find that I have to fight hard to assert my right to do so in the face of public scrutiny and judgement. I hear the snide comments and mocking laughter, I can see the smirks and not-so-hidden looks of disgust when I have to take the elevator one floor up. It doesn’t matter that stairs are painful for me, because obviously I am just being a lazy fat girl. The judgement makes me feel as though I have to perform or rather exaggerate my disability in order to get approval. This might mean highlighting my limp, or making obvious pain faces while rubbing my hands across my lower back. I have to put on an act in order to be granted approval for self-care.

The need to do this is encouraged by a social perception that bodies are public property and that society has the right in that case to grant my disability legitimacy. They, without any information about my pain levels, my daily struggle, get to decide on appearance alone whether or not I am “really disabled”.

Among these people are the folk who believe that my disability must be the result of my weight. The people who think that maybe I wouldn’t be so fat if I just walked instead of using a wheelchair at the grocery store. The idea that I am fat because I cannot walk never seems to enter their minds as a possibility.

And so knowing these judgements are being made about me every time I go out, every decision about whether or not to take advantage of mobility devices is painted with the difficult decision: which disability is more pressing today: my physical one or my mental one. And that is a choice no one should have to make.

Where Ableism and Fat Shaming Collide