A Cursed Silver Lining

I started taking Ozempic for my diabetes.

A few years ago I took a few doses, but panic-quit after seeing the drug advertised for weight loss in a magazine. I canceled the magazine, too. The idea of losing weight was terrifying: I knew my restrictive eating disorder would be kicked into high gear whether I lost weight at all on the medicine. Instead, my endocrinologist helped me get used to mealtime insulin.

Over the past few years, my health has changed a lot. I was infected by COVID several times, and after the first time, I woke up one day feeling like my body was brand new and unfamiliar. The sudden drop from being chronically ill but managing into full-on disability has been full of fear, panic, desperation, and shame. My mobility changed overnight, and I believe I have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Managing my new health issues takes a lot out of me. Plus, signs of increasing insulin resistance have been very obvious: more patches of darkened, velvety skin on my body. I became tired of mealtime insulin shots and the comments from other medical providers about how much insulin I needed. I also saw a few bigger-name members of the fat community start talking about being on Ozempic — though they explicitly said they wouldn’t answer questions about weight loss. Still, it’s hard not to notice when people’s bodies change, especially in such a stigma-related way.

Ozempic and related drugs (Wegovy, Mounjaro) have been in the news lately as weight loss drugs. There have been shortages due to demand being so high.

Still, I decided to ask my doctor about it. She agreed that reducing my insulin use would greatly benefit me in the short and long term. I talked through the reasons, and honestly, my doctor suggested I should hold off on starting it because I have so many big feelings about it. But I pushed for it.

I can’t deny that a part of me has wished for weight loss, despite knowing what I do about weight science. I know the chance of someone my size becoming what the mainstream considers a “healthy weight” is less than 1%. I know that most weight loss is not sustainable more than a few years, and I know that when it’s regained, it’s usually accompanied by more weight.

I’ve spent over a decade learning the science we know (and don’t) about weight loss. I’ve also spent so much time in treatment for my disordered eating, therapy for CPTSD, and learning to see and unlearn internalized fatphobia. I’ve spent time in community with other fat people learning how to take care of a very fat body and how to find joy in it despite marginalization and oppression at large.

Explaining why I still am taking this medication and hoping for weight loss is so tender:

there is such a desperate panic to realize you may not fit into a car you bought, despite a lot of research and test drives to find a car that safely fits your body. Or of a partner who loves you but can’t move beyond their internalized fatphobia. Or of a peer who died after surgery to cut off a big belly — like I fantasized about doing for years. The panic of not being able to wipe well in a hospital’s tiny PICU bathroom, not designed for fat bodies, trying to take care of yourself enough so you can take care of your kid who nearly died. The terrible fear and anger of being denied medical care, over and over, by doctors who think we deserve the denials.

These all compound on top of the “milder” issues like access to clothes (from casual to professional), spaces like tables and booths in public places, and restrooms built to be accessible in mobility but not in size. Issues like fat people making less money and having a harder time finding a job because of social stigma, or of having our picture taken to mock us for using mobility aids in public, or being harassed online relentlessly.

None of this shit is my fault, but they’re all very fucking serious in how it impacts your life and well-being. Knowing all I’ve learned and unlearned, loving myself, and connecting with people who feel similarly doesn’t protect me from how other people can ensure my marginalization, isolation, and death. Hoping for weight loss is hoping to live longer simply by people being fractionally more willing to give me medical care. Hoping for weight loss is hoping for more safety in car rides. Hoping for weight loss is hoping for enough ease to make the hard times in life bearable.

I think part of why I feel so disconnected from the fat community these days is because it doesn’t feel safe to talk about these feelings out loud. For most of my life, I was the type of person who makes it unsafe. I brought so much trauma to the table that there wasn’t room for anything else. I’ve felt so wounded by fat celebrities who choose bariatric surgery and by smaller-bodied influencers that get to be beloved and uplifted despite leaving behind fatter fans in their collabs and collections. I haven’t been able to connect with so many others over the years due to the ways trauma isolated me through my own fear and panic.

I can’t and don’t blame anyone for being the way I have been. Starting to see things from the other side of trauma is still fresh. I still don’t have a reliable sense of handling hearing other people’s feelings on these tender subjects; some days I do, and others I’m right back in the thick of feeling panicked and afraid.

Despite my confidence that I never lose weight, my body is changing.

I can see differences: dark skin patches on my hands are fading. My blood sugars are lower, and I’ve been able to give up short-acting insulin for most meals.

And… I have a fold reemerging in my belly where I’ve had no fold for years. My cheekbones/cheek fat looks more pronounced. My belly doesn’t brush the steering wheel anymore.

But I’m being treated the same. The people who would applaud a weight loss still condemn me and deny me medical treatment. The people, some friends, that will feel hurt and betrayed will likely feel that way regardless of reasons why. And I understand it.

I’m terrified to weigh in or measure my shapes for clothing. I don’t want to face the desperate hope and desperate grief of discovering I’m right about losing weight. I don’t want to be torn in two by elation and heartache. I want and don’t want to be treated better because of weight loss.

I have been treated as irredeemably and dangerously fat as a 145lb size 12 up through 360lb size 32+. I know there is no weight in which I will be safe from fat stigma. There is no way to win this fight. I feel stuck being unseen — my eternal fatness being the silver coating of a mirror in which most others can only see themselves.