Eating Ice Cream With My Dog (30 page)

“It’s not like he’s fat,” Lindsay had said to her cousin Jilly as they sat on the patio watching Jalen and Jilly’s husband, Peter, scrapping in the pool. “He’s not obese. Up until he hurt himself, he was always busy around the house or fixing cars or going up to the cabin.”

The term
type 2 diabetes
is a fairly recent one. The disease used to be known as non-insulin-dependent diabetes, adult-onset diabetes, and, originally, obese diabetes. The traditional association of obesity and diabetes is a tie as strong as the umbilical cord and, in fact, 55 percent of people suffering from type 2 diabetes are obese.
⁸⁰
If you read the barrage of antiobesity warnings, you’ll see that diabetes is at the top of the list of obesity-caused diseases. These warnings do not differentiate between overweight and obese, and they do not educate the public in the kinds of fat that make up both of those categories.

Lindsay was also right in that Ted wasn’t in need of a bariatric chair (that is, a chair designed for a four-hundred-or-more-pound body), but like a lot of men he was prone to a beer gut. Extensive studies have shown that an apple-shaped body is at a much greater risk for diabetes and clogged arteries, heart disease, and female cancers. Men are generally apple shaped (as am I, dammit), and this is reflected in the genders’ different statistics. Belly fat, known as visceral or deep fat,
⁸¹
collects and releases the fatty acids into the bloodstream, where they can clog arteries and interfere with the belly’s neighbor, the liver, which can result in higher insulin levels.
⁸²

Lindsay’s concern was bolstered by the strong heritability factor for obesity, and for glucose and insulin levels that can result in type 2 diabetes. Fourteen percent of children will develop type 2 diabetes if one parent is diagnosed before the age of fifty; if the parent is diagnosed after fifty, the number hovers just under 8 percent. If both parents are diagnosed, at any age, their children will have a 50 percent chance of developing the disease.
⁸³

Uncle Ted’s genes are identical to Lindsay’s father’s. She could be that one-in-seven offspring to get sick. These statistics are one of Lindsay’s reasons for wanting to lose weight and maintain an exercise schedule. She has done the waist-to-hip tabulation that can give a general sense of the risk of metabolic disorders and was relieved, for a change, that she is pear shaped.
⁸⁴
But relative risks and preventative measures were not on Lindsay’s mind on January seventeenth when the doctors kept her father, aunt, and cousins waiting all day for news on how Uncle Ted’s amputation surgery went.

Eight hours after he was wheeled into the OR, the Longhettis were finally informed that the surgery went well and were allowed to see him. They were surprised to find he was uncharacteristically cranky. He was in pain and he was scared of being moved from the hospital to a rehabilitation facility where he would be fitted with a prosthesis and undergo the initial physical therapy that would allow him to go home. “I’m a cripple,” he kept saying. “What can a cripple do?” Lindsay took a deep breath and began a mental list of the inspirational stories she would assemble for him, the exercise plan she would get Jalen to go over and do every day with him, the support groups she would find and get Aunt Carol to attend with him.

The situation was a call for action and, in a way, Lindsay was grateful for that. Action—research, questions, plans, therapies, sources, outcomes—is Lindsay’s specialty. Just as Jalen’s exercise addiction required therapy and group support, and her own rah-rah insistence that he get help mandated that she learn how not to indulge him, Lindsay needed forward motion in order to feel that life was taking place. Part of her success in balancing a nervy husband, graduate school, work, a home, and her big family and Jalen’s, too, was that Lindsay didn’t dwell on what she couldn’t do. She couldn’t go to Yale? Then go to Kent State. She couldn’t stand apartments? Plop a down payment on a house and not only stick to the savings plan but don’t be ashamed to pick up pennies on the street. That philosophy was what would rescue Uncle Ted. His depression would lift when they mapped out a recovery plan, got him exercising, got him interested in what he
could
do—hand weights, swimming, wall push-ups—instead of what he couldn’t do.

Which amounted to, after time and physical therapy, eat a sheet cake or walk barefoot.

Unfortunately, while Ted Longhetti and his doctors could take measures to treat his diabetes, the nearly canonical recommendations for prevention and treatment leave the Angry Fat Girls with as many questions as precepts.

Does weighing four hundred pounds cause insulin deficiency, or do some pancreases produce only enough insulin for, say, a weight of two hundred pounds?

How carefully has that 55 percent of obese diabetics been vetted for having diabetes in their family, for their lifestyles before and after diagnosis? Is it weight loss that brings blood sugar into manageable range, or is it the change of lifestyle? How many healthy obese people (that is to say, people who eat their vegetables, limit their cheesecake, don’t smoke, and get an hour of exercise in every day) develop the disease?

That January, Katie resolved to make her case to her insurance provider for gastric bypass surgery. She’d spent nine months jumping through their hoops, and she felt 2007 belonged to her. Katie describes her body as the “Big Apple,” and after falling off her summer food plan on which she’d gone from 427 to 398 pounds, she was as round as ever. She ate her way through the four-fecta of witch-shaped cakes, turkey-shaped cakes, Christmas tree cakes, and glittery happy New Year cakes, and then some. After all, on November first, the jack-o’-lantern chocolate cakes with orange frosting and licorice whip grins were one-third the price that they were the day before.

There’s almost nothing worse that we bakery-lovers could love. Not all sugars are created equal. There has been a great deal of talk in the media and nutrition circles about the perils of high fructose corn syrup, what Martha Beck calls “the sweat of Satan.”
⁸⁵
In the last thirty years it has gained preeminence as a sweetener because of its long shelf life. With corn plentiful and cheap, cane, fruit, and beet sugars fell out of commercial usage, but high fructose corn syrup is as different from those other sugars as aspirin is from heroin. Fructose metabolizes straight to the liver and apes insulin by releasing triglycerides that lead to high cholesterol and atherosclerosis.
⁸⁶

Katie and I were the smokers among the AFGs, and any conversation with her was interrupted with a shouted order for “large Diet Coke with lots of ice” or “Venti latte with skim milk, please.” We were also the two AFGs under psychiatric supervision for anxiety and mood disorders. Alcohol, tobacco, caffeine, and stress portend hypoglycemia as much as sugar does, and yet, as Katie met with surgeons and shrinks that January, her blood sugar and blood pressure were within normal range.

She might have gotten closer to the operating room had she been prediabetic or diabetic. A four-year study conducted by the University Obesity Research Center in Australia found that of the sixty obese, diabetic patients who were either assigned to a diet-and-exercise system or had laparoscopic adjustable gastric bypass, 73 percent of the surgical patients had diabetic remission, while 13 percent in the lifestyle control group experienced remission. After two years, the surgical patients lost 20 percent of their body weight and the control group under 2 percent.

The study, published in
The Journal of the American Medical Association
in January 2008, showed up in headlines around the world, each more misleading than the next: “Weight Loss Surgery Helps Treat Diabetes,” “Weight Loss Surgery Can Send Diabetics into Remission,” “Stomach Bands a Diabetes Fix,” “Obesity Surgery Can Cure Diabetes.” How many diabetics opened up their morning papers to be greeted with a moment’s promise that, somehow, the adjustable gastric Lap-Band would cure them? Even the authors of the
JAMA
editorial were extremely cautious about the efficacy of the surgery: “Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.”
⁸⁷
Still, the authors beg the question of whether it was weight loss or the extreme shift in lifestyle that resolved the patients’ diabetes.

In any case, with the American Society for Metabolic and Bariatric Surgery reporting 220,000 weight-loss surgeries performed in the United States in 2008,
⁸⁸
the number will only increase if the surgery is perceived to be a means of controlling diabetes.

And yet Katie, at 409 pounds, was turned down for gastric bypass surgery, for the second time, by Kaiser Permanente. She was in a towering rage.

Through her dialectical behavior classes, with the help of the therapist referred by her insurance provider, she was tutored in reacting to events and situations less hastily and less emotively. For a long time, the heading on her blog was a quote from Don Miguel Ruiz’s
The Four Agreements
: “Don’t take anything personally.” Ruiz’s admonition and the dialectical behavior skills she was schooled in were precepts she wanted to live up to rather than rules she managed to live by. It’s ironic, then, that one of her worst breakdowns started on a rainy Tuesday in January when she talked to her new therapist, the pre-weight-loss-surgery evaluator, about how important her blog was, how much comfort she took from readers’ understanding.

“People
get
what I’m talking about,” she told Dr. Franks.

“What do you write about?” he asked.

“Stuff,” she said. “My life.”

“What stuff?”

“How I’m feeling at any given moment, what I find funny or offensive. Stuff.”

“How are you feeling?” he asked.

She sighed. How many times did she have to tell him she lived in sadness the way a guppy lives in water, that she held a bowling ball of shame in her belly? “Okay,” she answered.

“It sounds interesting, your blog.”

“I’d really prefer you not read it. It’s private.”

“How can it be private if it’s there for anyone to read?”

“It’s my stuff. My readers share a lot of the same feelings. They write to tell me I’m okay.”

“But anyone could read it and write to you that you’re not okay. How would you feel about that?”

“Sad. But my friends would support me.”

“Do you feel like I don’t support you?”

What could she say? Dr. Franks was nice enough, but he was also one of the people who would be giving the go-ahead for her gastric bypass. And she wanted bypass more than anything in the world. She’d lost and gained 1,100 pounds in seventeen years. This third mountain of fat she had to pick her way down was too hard. She was profoundly, viscerally tired.

“Sure,” she said. “I’ve been open with you, and I wouldn’t have been if I didn’t think you supported me. But I’d like you not to read my blog.”

Dr. Frank read her blog. He read about her binges, her skirmishes with Kaiser over her gynecologist’s rudeness, her sarcasm about the presurgery nutritionist who made her make a list of all the “illegal” foods she struggled with and then go out and buy them in specific quantities in some bizarre attempt to make friends with waffles. He read about how she wanted to kill herself on Christmas when her brothers ganged up on her for overreacting when her mother made a motel reservation for her rather than inviting her to stay in her old bedroom. He read about how she’d gotten two kittens despite her landlord’s rules.

And then he told the committee that met to evaluate her candidacy that she wasn’t ready, that she was immature, unable to stick to anything, given to wild mood swings, and unlikely to follow their medical, nutritional, and psychological advice.

“We feel you need more time,” Laura, her nutritionist, called to tell her.

“Why?” Katie asked. “I’ve been through a year of meeting with you guys. I’ve jumped through all the hoops. What’s the problem?”

“There are a number of problems, but mostly Dr. Franks is concerned about your suicidal tendencies. You barely survived Christmas, he says. He doesn’t know how you’ll handle your family as you’re losing weight and they express their opinions about that.”

Katie sat utterly still in her Barcalounger as Apple pulled at the fabric with her sharp claws, something that usually drove Katie nuts.

“Christmas?” she said in that whisper that would be a choke if she spoke any louder. “We didn’t discuss Christmas.”

“You must have or else—”

“He read my blog. He fucking read my blog. He fucking read my fucking blog after I fucking asked him not to. I can’t believe this.”

“Now, Katie—”

“Nuh-uh.” Katie stopped her. “I’ve lived my whole fucking life with people like you saying ‘Now, Katie’ before they tell me I’m crazy or too emotional. He
read
my blog after I asked him not to. It’s like he broke into my house and read my diaries! I can’t believe this! There has to be some kind of law or rule or clause about prying.” She started crying then. “And it doesn’t matter, does it? Because all you guys have decided that because my family treated me like shit at Christmas and brought up old feelings of wanting to die, you’ll let me commit suicide with food that you say I’m supposed to come to terms with. Because I got really sad, you’re going to let me die, and they’ll have to take my body out with a fucking crane!”

Laura listened, making occasional murmurs of understanding. At the end of the tirade, when Katie had given in to sobs, Laura cleared her throat and said, “We think it would be a good idea if you took my six-month class in mindful eating.”