Sunday, February 19, 2023

Blood Sugar Hex Magic


Yes, it's a punny title, but I won't change it. 

It felt like magic when I began losing weight without trying. Several months out from COVID recovery, I'd changed exactly one habit: I was drinking an average of two liters of water per day. Before COVID I had a small water bottle for going out; by the time I'd sipped it dry I could usually find a place ot refill it. Now, I could down that thing in three gulps, and was instead bringing a full liter everywhere I went. I'd have to refill that as well. I assumed that my wholesome new drinking habit was the driver of the weight loss. 

I had to have pants taken in and shirts re-tailored. I bought a belt. Even my shoes fit a little looser. From July to November, I lost a dress size. By January, it was a size and a half. As of now, it might be two.

I won't lie: it felt great. I didn't have any other issues or symptoms, so I just kept on assuming it was all that water. It's no secret that I'm -- what are we calling it these days? Curvy? -- and it was thrilling to be dropping pounds. Who wouldn't want that, especially with very little effort? 

Most cultures these days seem to be weight-conscious. People will say it's about health but it's really not. It's straight-up "NO FATTIES" judgmentalism. If you're fat and healthy that's still insufficient. If you're thin and sick, you should handle that, but it's ultimately better than being fat. There are people who will argue with the idea that this is totally fucked up, and that's fucked up too. 

Taiwan is no different. Taiwanese society's obsession with weight isn't even unique: you'll find pills and horrible diets and people -- mostly women -- taking on unhealthy habits and getting surgery in every other Asian country and many, if not most, places beyond. Although the country of my birth is somewhat fatter on average, all of these things exist there too. If you needed any evidence that none of it works, there it is: the United States has the juice cleanses, the disgusting powders, the gross teas and the weird contraptions too, and Americans aren't getting any thinner. 

The main difference I've found is that Taiwanese standards for being thin are far stricter: you have to be a stick to even fit into the clothing sizes available. Large-size stores exist, but they don't work for me as I'm too tall for the hemlines and the cuts don't take curves into account.

People (usually women) who are average or even slender have told me that they're regularly called fat. One told me a guy walked away because he believed he should be able to wrap his hands around her waist and have his fingers touch, which is some eating-disorder level bullshit.  I've heard far too many people commenting on weight as though it's a moral failing in an infuriatingly matter-of-fact way, and include people who are simply not fat in that definition (not that it would be any more acceptable if they didn't). 

If you're a foreign woman, it's unlikely that you'll meet these size standards. Even thin Western women I know have said they feel like giants here. Trust me, it's even harder when you're a Big Foreign Sasquatch. In addition to local messaging, there's a big community of misogynist Western dudes who have the "no fatties!" mindset. Fortunately, they mostly ignore expat women they deem overweight. They don't seem to realize they're handing us a gift.

It's to the point that seeing a doctor can be an exercise in stress, when medical professionals ought to focus on treatment. It felt like being cursed, or hexed: presenting for care, being told to lose weight and possibly receiving substandard care from a doctor who assumed weight loss was the only possible treatment, feeling like trash about it, and avoiding seeking further care. People say being overweight can lead to lower life expectancy, but I wonder if seeking medical treatment less often, and receiving insufficient treatment when one does, might lead to medical conditions spinning out of control that didn't need to be life-threatening in the first place.

Although I don't really want to speak Mandarin when there's a contraption that looks like a wine key stuck up my vagina, I quit one English-speaking OB-GYN and sought out another, because her only suggestion for treating my cystic ovaries was to lose weight. Of course, the cystic ovaries probably contribute to the weight in the first place. 

When I got COVID, I asked for Paxlovid as I was feeling weird in the general heart area, which is generally not considered to be a good thing. I have a family history of heart problems (though as far as I know, I'm fine), but that wasn't enough. The telemedicine doctor said it didn't qualify. So I said "oh, but I'm fat!" and got the drugs: having a likely predisposition to vascular issues was insufficient, but weight was. The doctor also said that heart problems were associated with obesity, and I didn't have it in me to reply my family members with heart issues were not fat, with no exceptions. 

I don't want to single out Taiwan, though. Fat people are treated like crap by society and medical professionals around the world. A doctor in the US whom I saw because I tested positive for tuberculosis exposure (I never developed the disease) exhorted me to lose weight, in college, when I wasn't fat. The main difference is that in the US people will talk about "fatties" (or "fat chicks", because this is mostly aimed at women) in derogatory ways to no-one in particular. In Taiwan they'll be more straightforward about it, but are more likely to say it to your face. 

In Taiwan, my tailor and one doctor congratulated me on my weight loss. Foreign friends said I should get checked out as my water consumption was atypical, others didn't see a concern: drinking that much of a calorie-free substance is a common weight-loss tactic!

Here's the truly unhealthy part: I didn't want this to be a problem. Of course no one does, but specifically I was quite happy to continue slimming down. A tiny voice in the back of my head kept prodding me -- you know they're right. Water or not, my rate of weight loss wasn't normal or healthy. And yet, as much work as I've done to simply love myself and focus on being a person rather than a number on a scale, I wanted to keep losing it. Going to the gym hadn't worked. Eating better never worked either. Why not take this gift being handed to me?

It gets worse: walking around in my slimmer body, I didn't just feel better about myself, I felt healthy. After all, losing weight is healthy, right? Slimmer people are healthier, no?

This was in fact extremely dangerous. I was not healthy. But when society tells you that dropping a size or two is good for you, it's extremely hard to break away and say no, something's wrong.

I visited the US recently, and it took an old college friend to really hammer it home: I needed to see a doctor. Excessive water consumption and unexplained weight loss were the most common symptoms of high blood sugar and diabetes. Even then, thinking back on years in Taiwan being matter-of-factly told I was fat, with insane diets and life-consuming exercise regimes suggested as a "cure", I secretly hoped that I would be able to "keep" the weight loss.

And yes, I did find the anti-fat messaging in Taiwan more damaging. That could just be me: it's easy to ignore Internet chuds in the US screeching about "fat chicks", usually with some assumption that said fat chicks would be single forever. Who cares? I'm not single!

It's harder to not let oneself be affected by a straight-up proclamation that you are fat and that is bad. The advertising affected me more too. It's harmful enough that the US has re-vamped all its weight-loss marketing as "wellness" or "health" (I'm sorry but nasty drinks and no food are not healthy, period). In Taiwan, well, you are fat and that is bad.

For someone who's worked hard to break free of mindsets like these, it really shows how deeply this societal messaging runs, and how damaging it can be. I came very close to not seeking care because I thought of weight loss as an unequivocal good! 

I should have known better. You know who else lost a lot of weight because she was sick? My mother, just before the cancer came back. She's no longer with us.

I did make an appointment with an endocrinologist after returning to Taiwan. You know what it took to do that? A friend treating my new body as a warning sign rather than something to be congratulated. I should not have needed that hard a push. I also massively cut down my sugar intake and reduced my carbohydrate intake, although it's hard to sustain that with no clear diagnosis. It was especially hard as my first week doing this was in Mexico, where the chocolate and the churros are delicious. 

You know what? Even then, I fretted about it the day before and morning of, simply because I wasn't in a good mental place to be told yet again that I am fat and that is bad, with the implied message that I'm a moral failure, or lazy, or a bad person because I am fat, which is what I suspect a lot of people truly believe. 

Nobody should have to feel that way when doing something as normal as going to the doctor. Everybody, in every country, should feel empowered to present for care without judgment. 

This story has no ending, as I'm still waiting for my blood sugar results. I can't imagine I'll be told I'm fine. 

There is one happy conclusion, however: unlike so many doctors before her, the endocrinologist didn't say a word about my weight. I told her I'd had COVID about six months ago, and the symptoms began immediately after. I'd had my blood sugar checked before I got sick, and there was no issue. She pointed out that there is some evidence that COVID can actually cause diabetes in rare cases, so I was right to be spooked. She asked me if I had a family history of diabetes, which I do.

She did not exhort me to exercise or eat less. That's a good thing. There is no overweight person in the world who is unaware of it, who hasn't already been told this, who doesn't know. It's never new information. It's not helpful. 

She did her job: ordered the necessary blood tests and told me how to fast and eat before each one. We'll discuss the results next week. 

I only wish every other doctor in my life had approached it that way.

If I had to offer any general advice, it would be the same for Taiwan as for the US: stop. Just stop. Leave people alone. You don't know their lives, you don't know their health, and the "I'm just concerned about your health" concern trolling is actively harmful -- but you knew that. Treat health issues as health issues in and of themselves, and don't tie moral rectitude or assumptions about health to weight. Every single thing you want to say, everyone already knows, and it does not help. Listen to Maintenance Phase and just...stop.