In the grand old South. 1950. When America was America. With two parents and six children under one roof. Carol was different.
Carol never got much parental support. She was busy being a tomboy out riding her bicycle while her sisters were gussying up to go out dancing. She was a late bloomer. Her younger sisters were “women” (in the biological sense, not biblical) before she was. She didn’t mature until about 13 or 14, which seemed terribly old for an all-American girl. The first 20 years of her life, she yearned for her father’s approval, to be seen as beautiful, like her two dotedon sisters. They were beautiful, as was their mother—petite and exotic, like delicate flowers. Carol resembled the women on her paternal side, big and strong like an ox—not a flower. She felt like a bull in a china shop, her mother and sisters being the china.
Her father was not an affectionate man. There were not a lot of hugs and kisses. But he appreciated how cute and pretty her sisters were. He looked at them differently, with pleasure that he was part of making such lovely little packages. His own mother, whom Carol more closely resembles, was not a warm person, either. It may be a leap to say her father was starved for love, and he projected that onto the daughter who most reminded him of the source of his pain. A leap maybe, but a reasonable one. He didn’t abuse Carol, but rather dismissed her—acted as if she were invisible. No loving glances filled with pride for the big girl who looked like his distant mama.
As Carol grew older, he verbally disapproved. Carol was his hippie child; she had unkempt stringy hair and adorned gender-bending boyish denim. She wore “man clothes.” Father did not approve. He gave her brand-new-used denim jacket from the ArmyNavy store to her grandfather. Not just to a man, but an old man. Not just an old man, but the husband of his own mother. Cruel? Perhaps. Critical? Definitely.
It was not just her fashion sense that was problematic. Carol’s father also disapproved of her weight. He had always disapproved of that, and Carol was constantly being hauled off to some kind of doctor in search of a cure for her body size. There were diets and pills, more pills, and more diets. Somehow her bike-riding tomboy ways just didn’t deliver the figure her parents wanted. She couldn’t possibly just be genetically more similar to the paternal side than her sisters—there had to be someone wrong with her.
Her first of many diets started at around age 10. There was a diabetic diet (she was not diabetic). Then a “lady doctor” gave her a whole bunch of pills. Speed? Of course. Ladies understand the needs of other ladies. That Carol was a carbon copy of her grandmother, even down to the distribution of fat on her body, was somehow lost on the medical establishment. Or maybe her grandmother needed pills. She was, after all, a lady too. Carol was
10 in 1960. Not the heyday of junk food, or video games, or flatscreen TVs. Carol ate healthy home cooking and spent all her free time outside. She grew up in the country. It wasn’t a cushy life. And even if you think 1960 was too soft, her grandmother, with the same distribution of fat, grew up in the early 20th century, where there were hardly abundant MickyD drive-throughs, much less cars.
Did Carol get fat from penny candy after hauling wood, tending to the animals, walking miles a day, and doing physical labor from dawn to dusk? Probably not. Biology counts. It really does. But her grandmother was always on a diet too, at least during Carol’s life. In fact, all the women in her family, large or small, were on diets, all the time. Not just Carol. It just so happened that only Carol, well, and her grandmother, were large.
Her teen years took place during the late 1960s, when America had become someplace entirely different. Approval, in the form of free love, was available everywhere. One of her beautiful sisters also thrived in that era, though Carol didn’t know it at the time, nor would she have believed it if she had known. The good china rarely gets touched.
Carol was set to lead a bohemian life. She associated with cool people during the coolest period in history. Her friends from up north were living a communal lifestyle, united with people from England who had taught at the hippie-glamorous Summerhill (the first “free,” as in freedom, school ever). She was ready to join their brigade. But instead, she sought approval and married at 21. Like her sisters, she did the “right” thing, at least in the eyes of her family. She settled down. She also settled for a sweet good-old-boy with solid roots. It was unfair, to both her and him, and perhaps even more unfair to their three children.
During Carol’s marriage, she gained weight. Though she had always been sturdy, now she was fat—a bequest from the modern scientific marvel that is the birth control pill. The pill gave her 100 pounds, which was intolerable, so she went off it. She also wanted to have children; though her motivation was not entirely pure. Her sisters had children and she wanted what they had— more approval from her father.
Not so fast, fatty.
At more than 300 pounds, she decided it was prudent to lose some weight first. But who can lose weight? Of course the grapefruit and cabbage soup diets weren’t particularly effective, so Carol settled on a more radical “cure.” Carol opted for another modern scientific marvel: intestinal bypass surgery. It was the first weight loss surgery available, and only at exclusive locations. Success! She lost 100 pounds in one year, and got pregnant immediately.
An intestinal bypass, or technically a jejunoileal bypass, was a surgical weight loss procedure performed from the 1950s through the 1970s, in which all but approximately 12 inches of the small intestine (normally about 25 feet long) were detached and set to the side. The list of complications with this procedure is long and disturbing. They include: malabsorption of carbohydrates, proteins, lipids, minerals and vitamins; extreme digestive problems; hair loss; gallbladder disease; bowel obstruction; cirrhosis; arthritis; kidney failure; peripheral neuropathy; pericarditis; pleuritis; hemolytic anemia; neutropenia and thrombocytopenia; inflammation; severe pain; anemia; edema; bacterial overgrowth; as well as diarrhea, typically 4–6 times a day. Oh, and death.1
The “multiple complications” associated with intestinal bypass led to a search for alternative procedures, one of which was gastric bypass. Many patients who had the intestinal bypass had it converted to a gastric bypass within five years (assuming they had it late enough in history, and lived that long). “The jejunoileal bypass is no longer a recommended Bariatric Surgical Procedure.”2
No kidding.
Weight loss surgery has changed quite a bit since the 1970s. Completely new procedures have been introduced in nearly every decade since. Surgeons are still working to find a procedure that is safe, has long-term success, and does not cause severe complications down the road. So far, no procedure has accomplished this. It’s telling that old procedures are dismissed, and newer procedures are not around long enough for long-term studies. Something “better” comes along and the old procedure is acknowledged to be unsound—but the better system has no track record.
Issues around weight loss surgery are complex and controversial. There have been suggestions of cover-ups in research and misleading data. Most research on surgery only reflects the first two years post-op, including the reports by the Journal of the American Medical Association.3 This is particularly significant because that time period cannot accurately take into account the further surgeries needed to repair complications, which are far more dangerous than the initial surgery. And it does not speak to the profound impact of the nutritional deficiencies common in patients over the long term. Malabsorption can cause the breakdown of all body systems, including the brain. The data also ignores the fact that in the long run, most people gain much, if not all, of the weight back.
Despite this, weight-loss surgery is nearly becoming commonplace. In the 1990s, only around 12,000 procedures were performed each year. Now the number of patients undergoing surgery is over 200,000 a year. The medical establishment is making enormous amounts of money on weight loss surgery; the industry is presently valued at over $10 billion per year. (ObesitySurgery-info.com; S. Szwarc; P. Ernsberger; V. Snow. et al; Kalorama Information).
Carol had that first child and two more children with the intestinal bypass in place. Each one of those children took every ounce of nutrition she was able to process. By the third child she was barely a shell—though she was skinny. She went from 323 pounds pre-op to 128 pounds after her last child was born. Mind you, she also went from a healthy 323-pound person to a sickly 128-pound person—though she was skinny.
She did not want the last two pregnancies; they were accidents. She did not want to be in the marriage, for that matter; she and her husband were too different. She tried various kinds of birth control, but that was unacceptable to her husband. He was a religious man and wanted more children; he believed God wanted them to have more children. More children would likely have killed Carol. He didn’t mention what God said about her life. Whatever God may have said, Carol said there would be no more children. She wanted to live to raise the ones she already had.
They separated.
While she was on her own, she realized, much to her surprise, that she had the kind of body she had never had before. It may have been a sick body, but by conventional standards, it was also hot. She had a period of, let’s call it, “exploration.” Or we can say she was promiscuous. It didn’t last long. She soon met a man, and within a month she moved across the country—to the wilderness and an entirely different kind of life—to be with him.
Carol has had three major relationships in her life, and during them, has run the gamut of sizes. With her first husband, she went from being very large to being very small. Her second husband met her when she was small, but the bypass was killing her and she had to have it reversed—leaving a beautiful corpse was not a priority for her.
Remember that laundry list of complications? Carol had many of them: malabsorption, electrolyte imbalances, several types of anemia, gallbladder disease, diarrhea. She can’t even remember them all. What she can remember is her husband pressuring her to get pregnant, and when she did, the doctors pressuring her to have an abortion. But her spouse was a very religious man, and life was life, even if it meant her death. She had had that bypass for six years, and for six years, she was sick. Every day, all the time. Sick, but thin. With sallow skin and circles under her eyes. But thin.
When she was pregnant, the docs wanted her to have an abortion to save her own life. As they explained, babies are parasitic. Everything goes to them first. By her third pregnancy her doctor was insistently distressed. Carol had to be hospitalized through a good deal of the pregnancy, and still her daughter was born a month early. Carol had low oxygen in her blood, anemia, and she was too weak to care for herself. She spent her time in the hospital being force-fed. Regardless, they needed to take the baby as soon as they could.
Carol is a big person, with big bones, a big head, and a 128-pound body after the pregnancy. Atop that 128-pound body, that big head looked like it might just fall right off. Not the picture of a beautiful corpse.
In sad irony, to this day, the only picture her mother displays of Carol is when she was 128 pounds. Emaciated. Sick. But beautiful—at least according to her mother. They are very close now. Time does heal many (though not all) wounds. But the distortion runs deep. Her mother, quite literally, was comfortable with Carol risking her life to be thin. It was bizarre, says Carol. Maybe it’s not bizarre; it’s probably common. But it is pathetic.
She ultimately had the bypass reversed under a doctor’s “recommendation.” Meaning, he recommended that if she wished to live, she would have it reversed. The critical issue for her at the time was malabsorption, but does it really matter? Whatever the particulars were, it was going to kill her, and she opted for living.
Though the procedure has changed since Carol had hers, she would never recommend any type of weight loss surgery. In fact, she describes it as “barbaric.” Of course she is biased, as she was sick for years to the point of near death. But as reasons go, that’s a pretty good one to justify a bias.
As soon as it was reversed, she went right back to being very large. This did not sit well with her second husband, who tried to control her eating and will her to be small again. But it wasn’t will, but rather the lack of a functioning small intestine, that had made her small. He tried to control everything, not just her weight. Control was his distorted demonstration of love. So much for marriage number two.
Her third husband met her when she was large, and she’s still large—with a nice, big, small intestine intact. She was the first large woman he had been with. But their connection was deeper than body dimension, and they quickly became best friends. Perhaps it took her as long as it did to find someone who loves her as she is because that was lacking in her childhood. She seems to think so. It took her 40-plus years, several surgeries, and many miles to find him, but they have been together ever since—almost two decades. Some things are worth waiting for.
Thankfully, and surprisingly, 20 or so years after the bypass reversal, Carol is pretty healthy. Her blood work is completely normal. No high cholesterol, no type II diabetes, no high blood pressure. No nothing, at least nothing directly related to her present state of being fat. Her current doctor never mentions her weight; it’s not medically relevant. Not every doctor has recognized that irrelevancy. Before this doc, she saw a lady, some 12 years ago. It was a regular checkup, there were no issues. The doctor had never met her and had no reason to draw any conclusions. The first question: “What’s up with this weight?”
“I don’t know, what’s up with this weight?” She got another doctor. What’s up with those lady docs?
When it comes to weight, people can argue “what ifs” and “possibilities” all day. But sick is sick and healthy is healthy. There are tests for these things now. That’s the beauty of modern medicine, less guessing. Carol is 60. She certainly could develop high blood pressure by 80. Who couldn’t? Well, dead people couldn’t.
After the bypass reversal she gained the weight back gradually. It took a few years; it came back in two stages. First, she went up to about 260. That weight worked for her. She taught aerobics at that weight. Then about ten years ago, she was diagnosed with fibromyalgia, and she’s since gained another 100 pounds. She would prefer not to have that extra hundred; she finds it hard on her joints. But there is no practical way to lose it. She’s in pain now, so it’s harder to move. But that pain is from fibromyalgia, not fat.
Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and tenderness in the joints, muscles, tendons, and other soft tissues. Fibromyalgia has also been linked to fatigue, sleep problems, headaches, depression, and anxiety. The cause is unknown. Possible causes or triggers include: physical or emotional trauma; abnormal pain response—areas in the brain that are responsible for pain may react differently in fibromyalgia patients; sleep disturbances; and infection, such as a virus, although none has been identified.4
It seems that a good number of people who have had weight-loss surgery, and/or have gained and lost, and gained and lost, a great deal of weight, have fibromyalgia. That is not a scientific conclusion. It is a conclusion after observing a lot of people who have gained and lost, and gained and lost, a great deal of weight. Carol does not necessarily see a connection, at least not for her. After her reversal, she was vital. She lived off the grid, hauled her own water and wood, and helped to build her home. She was a highly active person. She points out that skinny people get fibromyalgia too. But she also recognizes that the years of illness may have contributed. Get on it, scientists.
Carol’s two promiscuous-ish periods occurred while thin and fat. One of each. It would be nice to be able to say she was treated exactly the same, that the men were “fat-blind.” Not the case. She got a great deal more attention at 128 pounds. But it wasn’t attention she enjoyed. It was a shallow attention. Her husbands are men she fell in love with, who fell in love with her. “They loved me and loved me well; they loved me for who I am.”
The shallowness she encountered when small was an eyeopener. It’s easy to speculate about why she got more attention while thin. Maybe it’s as simple as most men prefer thin women. But these were men looking for a good time. Yes, more men were looking for a good time with a thin woman. But the men who wanted a relationship, who wanted to share a life and to give and receive emotional love, picked Carol for who she was in her entirety. So maybe it’s not such a terrible thing that she had fewer choices as a fat women. The choices seemed to be more substantial and worthy of her time, her energy, and her caring. It is not uncommon for those who are considered conventionally “beautiful” to be emotionally wary, pessimistic, even jaded and cynical. Being beautiful has its advantages, one would imagine, but it certainly doesn’t guarantee anything when it comes to meaningful relationships.
When she was larger, Carol says, she was more self-conscious of the fatness of her body than any man was critical. It was invariably her issue. Granted, they knew she was fat when they got involved, but so did she. Now, in retrospect, she struggles with something else: the warped image she had of herself, and the loss of her young body that she never knew to appreciate. So many of us had no perspective on our young bodies, the bodies that shamed us that we so desperately wanted to change so we would be acceptable people. Those bodies were—fine. More than fine. They were lovely, strong, youthful, vibrant, and yes, beautiful. And we simply had no idea.
If you could only hear the wistful tone in her voice, the mournful sadness with a touch of romanticism, the bit of hope that somehow, someday, this will be realized. If only. “I wish that I remembered my young body. I really do, because for so many years, when I was younger, and trying to become comfortable with my body, I didn’t look in the full-length mirror. I only looked in the mirror that showed my face. I have a beautiful face. You know what they say: ‘You have such a beautiful face.’ It means: ‘Don’t look down.’” Indeed. Carol, and so many others, lost big parts of their lives wallowing in the self-flagellation of fat torture.
Carol’s children are two boys and a girl—actually grown men and a woman now. Her first son takes after Carol; he’s a “big boy.” The second is rail-thin, like his father. And her daughter is inbetween—she has more weight on her than some people think she should have, but she looks just liker her grandmother. Carol raised them differently than she was raised. She didn’t make them clean their plates, for one. They had choices. They were involved in decision-making. Needless to say, they weren’t put on diets or given pills, and they are much more well-adjusted for it. Her daughter, slightly larger than some people think she should be, has no body image issues. She is unfazed by those “some people,” and not a bit self-conscious. Her son, who is large, like her, struggles. He has “trouble” in his personal life. He is not so comfortable in his own skin. It’s not that he has poor self-esteem, but his own feelings of worth don’t change the shallowness of other people, and that hurts him.
With her small, medium, and large children in tow, they were once leaving a restaurant when some boy yelled out: “Oh look, it must run in the family.” Carol responded: “Yes, young man, it does.” She wanted to say: “Does stupidity run in yours?” Truly, though, what a stupid comment. What doesn’t run in the family? Is being like ones’ relatives an insult? Are we genetically flawed because our lineage includes some trait not currently prized? Would we be better people if we could control our genetic destiny? It may happen soon enough, but for now, yeah, it runs in the family. What’s it to you?
As it turns out, Carol has very little romantic experience with fat men. All of her husbands have been lanky. During her life adventures, she has found two fat men attractive. “Generally, I just haven’t found fat men sexy, but those I did were sexy because they were self-confident; flirting with a self-confident man is very sexy, it doesn’t matter if he’s big or small.” So it’s not the size of the body, it’s how he shows his assuredness. This is the same thing men continually say about large women. Is this true for just large people? Should the inner strength match the body size? Perhaps self-confidence is attractive in general, and it’s particularly important in those without conventional good looks? Or maybe strong people want the same in a partner? That sounds plausible. But really, who knows? When it comes to attraction, it’s probably best not to generalize.
Carol was disturbed by the notion that she may have been prejudiced against the looks of fat men. It is troubling to think that you might suffer from the same small-minded bigotry you so resent in others. But really, there is nothing wrong with preferences. We all have them. What is important is not to let social convention or perceived notions close off your options. After some deep thought, Carol determined it was not body size, but personality and attitude that were the keys. She felt better. In the end, looks have never sustained a relationship, at least not a happy one. Right?
Carol met her third husband at a party. They happened upon each other and spent the evening talking. She was about to leave with a girlfriend, and as she was leaving, he spontaneously kissed her.
Carol had not come to the party intending to leave with a girlfriend, she had been waiting for her young lover to show. She was 43 years old and involved in an affair of three months with a sweet young thing of 20. He was a beautiful boy, an intelligent kid, and they were having a really good time. But truth be told, she was not altogether comfortable with the age difference. The affair was secret. Perhaps it was a twist of fate when he called to let her know he wouldn’t make it because his car broke down. That is how Carol ended up with her evening-long conversation— and kiss. Carol believes everything happens for a reason. Maybe it does and maybe it doesn’t, but at that party, stood up by her pretty boy-toy, she looked into this age-appropriate stranger’s eyes and knew he was going to be someone important in her life.
It was actually a month before they bumped into each other again, and then again. They have since been together 17 years. The attraction between them was more than physical. He didn’t have a particular interest in large women; she was the largest for him. But that was incidental, and he never goes long without telling Carol how beautiful she is. They were married the year she turned 50. That was the year, happily, that her first grandchild was born, and sadly, that her best friend’s daughter was killed. It was also the year that her father died, as she held his hand.
Before her father died they did manage to make peace. A few years before he died, Carol was visiting. Where she lives, people wear sensible shoes. Her father was none too pleased with her footwear choice—it was not ladylike. Her mother, for the first time ever, intervened. To Carol it was a great moment: her father apologized. Maybe a year later, he was ill with end-stage kidney disease. They were making a quiet disconnected lunch. There were six kids in their family, with Carol being the oldest. Her mother commented on her pride for the children. Carol in turn said she was proud to be their child. Off in the background she could hear her father sniffing; no words, just a telltale sniff. Finally, Carol sat on her father’s deathbed. He was in a coma and very much at the end. They were alone. She took his hand and spoke of her grandchild and how she wished they could meet. She said she loved him and knew he loved her back. She promised they would take care of her mother. His breathing had been labored up to then and with her words, his breath slowed down to normal. At that moment all was settled between them.
When Carol’s father died her heart was filled with love for him. And he was beautiful
1 Lutrzykowski, M. “Vertical Gastric Resection (sleeve Gastrectomy) in a Morbidly Obese Patient with past Jejunoileal Bypass.” Obes Surg 17, no. 3 (2007): 423-5.
2 Griffen Jr., WO. “The Decline and Fall of Jejunoileal Bypass.” Surg Gynecol Obstet 157 (1983): 301-8.
3 Obesity Surgery Information Center. September 15, 2014. http://obesitysurgery-info.com/.
4 “Questions and Answers about Fibromyalgia.” National Institute of Arthritis and Musculoskeletal and Skin Diseases. July 1, 2014. http://www.niams.nih.gov/Health_Info/Fibromyalgia/.