Recently the TV news magazine 48 Hours did a show featuring a "new" (actually a variation on an old) surgical procedure for weight loss. The timing was very apt, because just after that, Karen Smith posted this to the fat-acceptance listserv. I am reprinting it here with her permission.(Karen's story is not one-of-a-kind--far from it. If you are considering weight-loss surgery of any type, or you know anyone who is, please do plenty of research first and find out what your doctor may not be telling you. NAAFA has a policy statement that contains some very useful information. They may also be able to steer you to some additional sources.)
Date: Sat, 9 Nov 1996 21:58:15 -0700 (MST)
From: Karen S. Smith
To: fat-acceptance@world.std.com
Subject: (Long Post) Complications of Weight Loss Surgery
Hello to the list, and thanks for all your cards and e-mails of get well wishes. I have been out of the hospital for about a week and am feeling a bit stronger, so I thought I'd write about what's been happening.As many of you know, I underwent an ileojejunoleal bypass in March 1982. While the surgery had many immediate nasty side effects (uncontrollable bowel movements, explosive and painful gas, nearly unmanageable odor problems, kidney stones, colon inflammation, intolerance for many foods and drink) perhaps the most ironic of all was that I only lost 90 pounds and within two years had regained it *all!* The surgery involved disconnecting nearly 16 feet of small intestine, leaving me with about 18" of small intestine which is actually hooked up and functioning....the rest was left "floating" in the abdominal cavity, in the event that the surgery itself failed and would be available to reattach if necessary.
Well, I managed those side effects for almost twelve years and although I was bitterly disappointed with the outcome, I was willing to make the best of things. I was, after all, in good health except for these side effects, and I was no longer insured and couldn't afford the surgery to reverse the bypass.
Fast forward to 1994. I began to suffer from something called dermatitis-arthritis bypass syndrome. Every few months, I would get a red pox on my arms, legs, and thighs and experience excruciating migratory arthritis for about 7 to 10 days. First one joint, then another, would stiffen and become inflamed and very, very painful. The syndrome is caused by bacterial overgrowth in the disconnected small intestine. You see, the bacteria present in the small intestine is not found anywhere else in the body, and it is normally removed from the body through the normal elimination process. However, the disconnected small intestine laying atrophied, but still kept alive by the surrounding environment in my abdomen, continues to produce this bacteria on some marginal level until it reaches a critical level.
This bowel, though, has no outlet, so the bacterial overgrowth dumps into my bloodstream, where it provokes an immune system response. These immune complexes (antigen and antibody bound together) circulate in the blood stream and are deposited in tissues and joints....this it what causes the inflammatory reaction, the arthritis. Treatment consists of hitting the bacteria with an antibiotic and taking anti-inflammatory drugs to ease the pain. This worked for about two years. Until August 1996.
In August, I began experiencing increasing arthritis pain. No longer did the arthritis continue its "hit and run" tactics of the past....it attacked many joints at once and did not disappear after a week or so. I completed three, 10-day courses of antibiotics, each one progressively stronger, to no avail. In September, I visited the doctor to have my annual blood work-up to see if all was well. All was not well.
The blood chemistry tests came back within normal limits. However, my liver enzyme count was over six times normal (normal is about 30...mine was 198). By this time, I was suffering arthritis pain in the ankles, toes, knees, and hips and my mobility was significantly impaired. My doctor prescribed a different antibiotic, 800 mgs. of Ibuprofen three times a day, and took more blood tests. A week later, my liver enzymes rose to 495 and I was diagnosed with autoimmune hepatitis. More anti-inflammatory drugs were prescribed, another, stronger antibiotic. I also received what I now consider to be a life-saving referral to an rheumatologist who began other bloodwork.
This treatment continued throughout October, with my arthritis progressively worsening. By October 22, I was wearing wrist supports on both arms and a knee brace, using a cane and a riser on the toilet just to get through the day. Then, the vasculitis struck.
The key word here is inflammation: inflammation of joints (arthritis), spontaneous inflammation on shins (erythema nodosum), autoimmune hepatitis (inflammation of the liver), inflammation of the blood vessels (vasculitis). My immune system was out of control. I developed a huge, horrific skin ulcer on my belly fold, and within five days it had grown from the size of the tip of your finger to the size of a grapefruit, gaping and infected. On Friday, October 25, I was struck with inflammation of the chest wall and accompanying shortness of breath. I could not lay down if I wanted to keep breathing. My arthritis was so critical by this point, my hands were clenched into claws and I was unable to bend any of my fingers. I was rushed to the emergency room with blood pressure of 176/125 and barely able to catch my breath, barely able to walk, with a gaping, oozing wound the size of a bazooka!!!! I hit the ER with high hopes, thinking that I would finally get the help I needed.
WRONG, WRONG, WRONG!!!!
As a whole, I am sure ER doctors and nurses are fine, competent, people. However, I did not meet any of them. The ER doctor I encountered ordered a dozen tests and two chest x-rays to determine if I was having a heart attack. He ordered a big shot of Demerol to help with the pain (which helped me breathe slightly better) but at midnight, came back to tell me that there was good news.....my heart was fine...he was giving me a prescription for Demerol for pain and sending me home.
I stared at him in amazement....I said, "Sending me home to WHAT???? I can't lay down, I can't breathe, I can barely walk, my ankles are swelled the size of Montana, my liver enzymes are off the scale, my abdomen is oozing out my life's blood on your gurney here, my hands are frozen into little claws that no longer function, and you want to dull my senses further with Demerol and send me home to sit up in a chair all night???? Are you out of your mind????!!!!!!?????"
He obviously had never had anyone question him like this before, as he just stared at me and said, "You can't expect to be admitted on a Friday night with symptoms like these. Unless you are having a heart attack, a stroke, or a blood clot, I can't admit you."
One additional problem was that my primary care physician was out of town and the doctor on call would not agree to admit me....not surprising, since he was acting on the advice of the ER doctor, who by this time was very sick of dealing with me. I continued to argue with this odious doctor for half an hour, to no avail.
I went back home, sat up in a chair till 7:00 am, at which time I called the doctor on call who had refused to admit me. I carefully, calmly, through clenched teeth, explained all my symptoms and explained the treatment my primary care physician had been trying for almost two months, all the while becoming acutely ill. I finally asked him, "Just how near death do I *HAVE* to be to be admitted and get adequate health care?"
At this point, the beleaguered Doctor Montoya gave up, instructed me to come to the hospital where he would do a "Direct Admission" and give me an exam. From his tone of voice, I knew he was expecting to find my complaints trivial and overblown. I got there by 9:00 am and when he finished his exam, he began issuing orders, contacted the specialists I had been seeing, had taken a ream of notes and had changed his tune entirely. He had a plastic surgeon come in to look at my wound, and almost immediately began IV antibiotics and contacted my rheumatologist.
My rheumatologist arrived about two hours later and was appalled to see how my condition had deteriorated and ordered a number of tests which revealed that I had systemic vasculitis. By 11:00 pm I had been started on Prednisone and Imuran (corticosteroids and immunosuppressive agents).
I saw almost immediate results. Although the Prednisone gave me nightmares, by early the next morning I could move my fingers. The stiffness was slowly leaving my knees and ankles and I could bend my knees. My chest was still constricted, but I could at least halfway recline on the bed and still breath instead of sitting up hunched over gasping for breath. By Sunday evening, I was able to lay down, and by Monday, my chest pain was gone.
I went though many tests (including an excruciating colonoscopy) in the next few days, but by Thursday I felt well enough to go home. Home Health Care nurses visit me twice a day to change the dressings on my wound and it is looking better, and is slightly smaller (it measures 4" by 7"). It is the grossest thing I have ever seen in my life, but I am trying to deal with it. I cannot have any surgery until I am off the steroids, so am not making any decisions about it for now. My options are:
1) Have the surgery reversed and reconnect the small intestine.
2) Leave the present surgery in place and simply remove the offending small intestine which has no outlet.
3) Leave intestine in, but connect it to the bowel, giving it the outlet it needs but leaving my present surgery in place.
4) No surgery. Continue to treat the symptoms.
The problem is that most research shows that even if I do have some sort of surgery to reconnect or remove the disconnected bowel, there is a 40% chance that I will continue to have the symptoms. I will still have the autoimmune problems, and I will still have autoimmune hepatitis. The steroids and immunosuppresents have horrendous side effects, too, which must be considered. Nothing is without a price.
The good news is that *today* I am okay. I don't think about tomorrow any more. I am focused on today. This minute.
I taped the 48 Hours show on Thursday because I just didn't have the strength to watch it. I cannot bear to watch weight loss surgery promoted, any weight loss surgery, because it was after watching a talk-show about it that I decided to have mine. It brings back too many feelings and nearly overwhelms me. I see doctors and others promoting this mutilation without a word of the long term effects and with no warning of problems like mine.
I am only 41. I hope to overcome these problems, but right now it doesn't look too promising. The average life expectancy for patients who have had intestinal bypass surgery is about age 55. It angers me to think that I may not even have that long, and that my last years have to be so wretched. It is not fair....it sucks.
But, here I am. I am okay for now. I am still on-line, even though it is with a crappy Mac with no web-browser! :-) I'll keep taking the drugs and hope for the best...and I hope to keep telling my story to anyone who is contemplating these lousy surgeries, no matter how mad they get, until I'm not here to tell it anymore. And then all of you will have to take over and tell it for me. I am not being melodramatic....I am simply being realistic.
Sorry for the long post, but I wanted to get it all done in one sitting while I'm up for it.
I will post again with updates when I know anything new. Thanks again for all your support...it is much appreciated.
Karen Smith
Surgery for Weight Loss: Comparison of Risk and Benefit
by Paul Ernsberger, Ph.D.
from Obesity & Health (renamed Healthy Weight Journal)
March-April 1991, pp. 24-25As the eve of the 1991 NIH consensus conference on weight-loss surgery approaches, let us look back at the last NIH conference on this topic in December 1978. The panel gave its approval to intestinal bypass surgery, even though this operation was already coming under criticism for the long-term side-effects that it caused. As a result of recommendations by the consensus panel, intestinal bypass was accepted for health insurance coverage, which made possible tens of thousands of these operations. The legacy of the NIH panel's endorsement of intestinal bypass surgery is perhaps a hundred thousand patients worldwide, the majority of whom have suffered severe complications. Of the survivors, most now have had the operation undone. One can only hope that the legacy of this latest panel is more benign.
The panel members face a difficult task in evaluating the risks of the various surgical treatments for obesity. Nearly very surgical operation originates in a laboratory, where it is refined by extensive tests in animals. For example, coronary bypass surgery was the product of years of experimentation on dogs in which repeated measurements and detailed autopsies revealed potential complications and allowed surgeons to perfect the operation. In contrast, only three animal tests have ever been reported or gastric bypass or gastroplasty. In one test of gastric bypass in rats, many abnormalities were found at autopsy, including damage to the stomach, liver and pancreas from fibrosis (American Journal of Clinical Nutrition 40:293-302, 1984). We don't know whether these progressive abnormalities happen in human patients, because autopsy results have never been reported. Because of a lack of animal testing, the panelists will lack information on the biological effects of these operations.
Another difficulty the panelists will face is the bewildering variety of operations. As many as two dozen basic types of both gastroplasty and gastric bypass are in current use, along with several modifications of the original intestinal bypass. If we then consider variations on the basic methods, it can almost be said that no two surgeons do exactly the same procedure. The different types of operations differ in their safety and effectiveness. Operations such as gastric bypass that impair the absorption and processing of nutrients produce the greatest weight loss, and are most likely to produce lasting weight loss. With gastroplasty, weight regain is more common. After the most effective operation of this type, the vertical banded gastroplasty, 76% of patients failed to maintain weight loss after 30 months of follow-up (Surgery 98:700-707, 1985). In another study, 69% had fair-to-poor results in maintaining weight loss after 23 months and 22% suffered from obstruction of the narrow outlet from the stomach pouch (Mayo Clinic Proceedings 61:287-291, 1986). Weight regain after gastroplasty is usually the result of gradual stretching and enlargement of the stomach pouch or the narrow outlet from it. Because the stomach is almost infinitely expandable and adapts to increased pressure by growing larger, the operation is doomed to be eventually undone by natural adaptive processes of the patients' body. Although gastric bypass is more effective in maintaining loss of weight, there are more long-term complications, particularly nutritional deficiencies including anemia, pernicious anemia, osteoporosis, and neurological damage. These same complications were described 30 years ago as the long-term result of stomach surgery for ulcers. Consequently, these operations were long ago abandoned for treatment of ulcer. The stomach is not simply passive sac for storing ingested food, but plays a complex role in the processing of nutrients. Surgical procedures which interfere with the normal operation of the stomach inevitably cause multiple problems. Unfortunately, no controlled trials have ever been run which include physical examination of the patients for possible side effects by independent doctors not associated with the surgeon. In a rare instance of independent examination of bariatric surgery patient, a team of neurologists examined 500 patients who had received either gastric bypass or gastroplasty and found neurological complications (nerve or brain damage) in 5% of them (Neurology 37:196-200, 1987). The patients were usually examined within a year after surgery, so the incidence of long-term neurological deterioration could be much higher than 5%. Possible damage to organs other than brain and nervous system has not been put under rigorous independent evaluation.
Once a surgical technique has been developed in the animal laboratory, normally the next step is to run controlled clinical trials comparing long-term outcomes for patients and an untreated control group. Coronary bypass was tested in this way and it was proven that heart patients undergoing surgery lived longer than comparable patients getting only non-surgical treatment. No controlled clinical trials have ever been run for weight-loss surgery, except for one Danish trial of gastric bypass that showed that patients undergoing surgery experienced more health problems than comparable patients who were put on very-low-calorie diets (New England Journal of Medicine 310:352-356, 1984; Danish Medical Bulletin 37:359-370, 1990). Gastric bypass or gastroplasty does result in improved levels of blood pressure. cholesterol, and blood sugar. These reduced risk factors might translate into long-term disease prevention over the patients' lifespan if (and only if) their reduced weight can be maintained for life.
Do the benefits of weight loss exceed the risks of major surgery and the side-effects of tampering with the digestive system? In considering this question, the consensus panel must first ask whether weight loss is permanent. If a patient loses 100 pounds only to gain it back five years later, then her risk factors will return to dangerous levels. Because of the harmful effects of losing and regaining weight (the "yo-yo syndrome"), some risk factors, especially blood pressure, may be worse after regain of weight than they were at the start. When the risks of surgery and long-term complications are taken into account, then it become apparent that the net outcome for the patient who regains weight is highly negative. The typical patient receiving these operations is a woman in her 30's. To be certain of reducing her risk for heart disease later in life, weight loss must be assured for at least 10 years and preferably 20.
The consensus panel must also consider the benefit side of the risk-benefit equation. In order to evaluate the benefits of weight loss in extremely obese persons, let us start with the assumption that the poor health suffered by fat people can be completely reversed by weight loss. This may not be a valid assumption, especially because it is now dear that many fat people are burdened by a genetic defect that allows runaway weight gain. This same genetic defect may also lead to diabetes, high blood pressure and heart disease. Currently we do not know whether the health problems of the obese are directly caused by the fatty deposits themselves or whether they result from defective genetic machinery. If the latter is true, then weight loss will not completely erase the excess risk associated with obesity, because weight loss will not change a person's genetic makeup. Setting this argument aside, let us consider the actual risk faced by extremely obese persons. The median life expectancy from age 25 as a function of body mass index is shown in the illustration above (see original article). These data were taken from the world's largest epidemiological study, which tracked 1.8 million Norwegians for 10 years (Acta Medica Scandinavica Supplementum 679:1-56, 1984). Let us consider the lifespan of women, since 90-95% of all patients undergoing weight-loss surgery are female. Women who are neither underweight nor overweight have a life expectancy of about 79 years. Morbid obesity begins at a body mass index of 35. Women with a body mass index of 40 and above are shown at the far right. Their life expectancy is reduced by 5 years, which is equivalent in risk to light cigarette smoking. However, even these extremely obese women still have a longer life expectancy that normal-weight men. Several conclusions can be made from this graph: first, the typical "morbidly obese" woman in her 30's considering weight-loss surgery faces another four decades of life, which means that weight loss maintenance and surgical complications must be evaluated over the very long term. Second, given that the maximum benefit from weight-loss is a 5-year prolongation of life, the risks from surgery must be kept very low. Third, surgery should clearly be reserved for the most obese patients (body mass index over 40) and the ongoing trend for surgeons to make exceptions to the "100-pound rule" and operate on thinner patients must be deplored.
The challenge awaiting the NIH consensus panel is formidable. They will lack a base of knowledge of the biological effects and the medical consequences of these operations, especially over the long term. The vast array of variations of these operations complicates any evaluation. Operations that are more effective are also less safe; none of the surgical procedures seem to be both safe and effective. Risks and benefits must be compared over the remaining 40 years of life expectancy of the patient, but for many procedures patients are tracked for two years or less, and many times only weight loss is recorded without independent evaluations of the patients' overall health. Hopefully the 1991 panel will not repeat the mistakes of the 1978 panel, which failed to confront the epidemic of complications from intestinal bypass.
Paul Ernsberger, Ph.D., Associate Professor of Medicine, Pharmacology and Neuroscience
Case Western Reserve School of Medicine
10900 Euclid Avenue
Cleveland, OH 44106-4982
email: pre@po.cwru.edu
NATIONAL ON-CAMPUS REPORT
Volume 24, Number 17
September 3, 1996
page 1
"No-Diet Days" fun carries a serious messageYou're walking across campus, not thinking about anything in particular, when you come upon something a little out of the ordinary...
Several students are yelling at bathroom scales and demolishing them with sledgehammers.
Puzzled, you keep walking-only to find another group of students burning what looks to be fake money and cursing under their breath.
For the last two years at Seattle Central Community College, such scenes have become normal-and much anticipated-parts of the school's "International No-Diet Days" program.
Held in conjunction with International No-Diet Day each spring, SCCC's two-week program goes far beyond the one-day event recognized around the globe. At SCCC, students have the opportunity to attend presentations or watch videos on body image and eating disorders, pick up helpful resources from an information table, or participate in an open mike event.
Or, says Student Organizations Coordinator Mary McGhee, the students can join in events requiring more active participation-like the scale smashing or the burning of "diet dollars."
The scale smashing is just what it sounds like, McGhee says.
"We put a scale down-we're very careful not to damage anything other than the scale, and the person smashing wears safety goggles-and the person takes a big sledgehammer and just lets go and whales on the scale," McGhee says.
The burning of "diet dollars," relates to the amount of money Americans spend each year on dieting.
"One of the students on the planning committee figured out that the diet industry takes in $130 for every man, woman, and child in America," McGhee says. For most people, she says, the investment is a failure. "So we said, 'Let's just burn those dollars."'
So the planning committee printed off "diet dollars" for the students to set aflame.
"And people really got into it. Some of the students would toss in a diet dollar and say something like, 'This is for the gymnastics coach who locked me in a sauna until I lost two pounds.' It was very cathartic."
While both events are designed to be fun, there's also a serious message, McGhee says-a message that also comes through in the other events in which students participate: accept yourself as you are, and accept others as they are.
"People are coming to the idea that your body may not fit the societal norm or the expectation that everyone will be thin," McGhee says. "But a lot of the students who saw fliers for the events or who saw the materials...this was the first time that such a concept was ever presented to them."
McGhee says No-Diet Days is a first step toward helping students who have wrestled with size issues, as well as students who might not realize that one size does not fit all.
"You can't change people's beliefs and attitudes overnight," McGhee says. "But this program gives people a chance to express their pride and acceptance real openly. And with other people, we're planting a seed, even though it may not bear fruit for a long time."
Contact Mary McGhee, Student Organizations Coordinator, Division of Student Leadership, Seattle Central Community College, 1701 Broadway, SAC 350, Seattle, WA 98122; Phone (206) 587-4134; E-mail: <marymc@wolfenet.com>.
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College, Chairs and 'Fat' Pride
by Lynn McAfee
I am the 500-pound, middle-aged woman you may have seen on campus over the last few years. I am a CGS student, and will graduate in another semester.
I don't think many people can imagine how difficult it has been for someone so physically different to be on this campus. While I have met a surprising number of people who went out of their way to understand me and appreciate my differences, the reality is that most people who pass me are frightened by my size and contemptuous of what they see as my self-imposed exile of fatness.
I have taught myself how to take the stares and comments because this belated educational opportunity is so important to me.
One night last semester, though, the combination of physical accommodation problems and the callous attitude of students finally drove me over the edge. On that night, you made me cry.
At the beginning of each semester I must make arrangements for special seating, because the fact is that I just don't physically fit in the student desks.
One night last semester, I had an exam in the Towne Building at 5 pm. When I arrived at 4:45, I found that someone had taken the table and chair I use out of the room.
Without this seating, I could not take my exam.
I found a desk that is used for disabled students several doors down from my classroom. Three students were studying in that room. When I asked the student sitting in the special desk to let me take it, he refused.
I explained to him that Handicapped Services had placed that desk in the other room for me, and that I needed it to take an exam in 10 minutes. He still refused to give up the desk, and even suggested I look around in other rooms for a suitable desk.
I was stunned and angered by this attitude. Although I am not in a wheelchair, my size combined with a severe lung problem and arthritis makes walking quite problematic for me; I carefully calculate my breath and energy when I have to walk anywhere.
Just getting to classrooms is very challenging for someone with a disability; walking the halls looking for a desk takes more energy than many of us have.
I looked at that arrogant young man, and suddenly I was filled with a rage so intense that I knew if I stayed in that room for another few seconds I would hit him, so I left the room.
I stood outside that room after our interchange and remembered why I didn't go to college when I graduated from high school 25 years ago. My guidance counselor had told me not to bother to apply, because I was too fat.
He was right. Recent studies show that fewer fat people than thin people are accepted to college, and that fat students who are accepted receive less financial aid from their families than thin students.
As I stood in the hallway in the Towne building, I thought about all the times I haven't been able to go to concerts, plays, sporting events, and restaurants.
For a long time I had pretended that I didn't want to go to these events because I was too embarrassed to say, even to my friends, that I was too fat to fit into the seats.
I'm sure they knew, just as I'm sure that young man knew, that I needed special seating. If you're smart enough to get into Penn you should be smart enough to look at my butt, look at those student desks, and immediately identify the problem.
My friends didn't talk about the problem because they loved me and could sense my shame; this young man did not have such noble motives. He was just plain selfish.
I refuse to beg for the chance to take the Geology exam I studied so hard for. I refuse to beg for the space I need in this world. I was cheated out of my education when I was a teenager; I refuse to be cheated any longer.
I called the campus police and asked them to help me get my seating. When the officer came, I explained the situation to him. He disappeared into the classroom, and in a few minutes all three young men came out into the hall and began walking noisily from room to room, looking for another customized desk.
The finally found one and carried it into the exam room for me, complaining all the whole that I should have found it myself.
By this time, I was 15 minutes late for the exam. I later found out that missing the initial instructions caused me to lose several points on the test.
Apparently, it was so important to the three students' sense of self-esteem to keep the desk they already had that they interrupted their own studies to make the point that they owned that desk.
Their needs and desires came first. The desk had become a prize we were fighting over, not seating I desperately needed--the only seating on that floor adequate for my size.
They had options, I didn't.
If these same people had seen me walking down Locust Walk one day, I'm pretty sure they would have noticed my size and my limping walk; based on past experience, they would have said something to each other, or rolled their eyes, or shook their heads, or snickered.
My disability would have been noticed on Locust Walk. In that classroom, though, because I needed something they had, I was suddenly the world's largest invisible woman.
Most people look at me and think they know all about me. They think they know how I got fat, why I got fat and why I stay fat.
The reality is that no one knows that: not psychologists, not obesity researchers, not anyone. The only thing we know for sure is that diets don't work.
Becoming, and remaining, a person my size is a lot more complicated than even the experts used to believe.
Here's the one thing that you can know: you hurt me. You hurt me every day of my life.
You limit my opportunities by your prejudice and you demean me by your assumptions of superiority. You debase my very existence by actions and attitudes that perpetrate the sense of shame that all fat people are supposed to have.
It's not my body that causes me pain, it's you.
And fat prejudice hurts you almost as much as it hurts me.
Those of you who have taken the time to know me have found that I've lived a productive and interesting life. I was one of the original founders of Women Organized Against Rape; I was one of the first people in the country to write about the politics of body size; I had a successful business career for many years; I've been invited to speak about size prejudice all over the country, including a National Institutes of Health panel.
I've lived in a commune, marched in and even organized some of the demonstrations you study about in class, been lovers with prominent and attractive people (yes, even 500-pound women have sex lives--and certainly better sex lives than what I hear some of you thin women talking about).
Prejudice makes losers out of all of us. I can only choose not to be quiet about the prejudice, not to believe that I don't deserve to take the space I need, not to believe that physical disability makes me inferior, not to believe that only thin people are sexy or attractive or intelligent.
Thin people need to learn that it is not a just world, and that often it is only the biological luck of the draw that separates us.
------------------------------
Lynn McAfee is a Social Science major in the College of General Studies.
(reprinted from the University of Pennsylvania's Summer Pennsylvanian, June 2, 1994, volume XI, number 2, page 2)
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