When Swedish Fish Taste Like Fat Guilt
(NB: In this piece I discuss eating disorders and medical fatphobia. Please take care when reading.)
As Disability Pride Month begins, I’ve been thinking a lot about how little I know how to write about disability, especially as it pertains to myself. To be honest, I don’t even know if I should be calling myself disabled (which is, in itself, my internalized ableism telling me disability looks a certain way). What I do know is that I have chronic mental and physical illnesses that affect my day-to-day life. What I also know is that my body can do a great many things with a ton of privilege and that you couldn’t tell any of that by looking at me. That’s a set of statements I’m still untangling. What I really want to tell you is this: earlier this year, at a routine gynecologist appointment, my doctor suggested we do some blood work because it had been a few years since I got it done. The next day, just as I was prepping to start the after school program that I run as my full time job, she called me and told me something neither of us had expected: I had type two diabetes.
To say I was upset is an understatement. I sobbed to her on the phone. I cried through the after school program that day in front of the kids (thankfully they’re middle schoolers and mostly ignored me). I sent a tearful, panicky email to my therapist. Later on my way home, I sobbed to my parents on the phone in my car. I cried to my friends that night as I pushed the stir fry they had made me around my bowl.
I want to be clear about this bit before I go on: being diagnosed with diabetes or any chronic illness or disability is not a life ruiner. I did not cry because I was diabetic. I cried because I was embarrassed, because fat people are always told we’ll get diabetes and ruin our already ruined bodies even further. I felt like my body had betrayed me and proven all of them right. I cried because, as a person with an eating disorder history, I imagined a lifetime of low-carb and low-sugar diets and “wellness-focused weight loss” being pushed on me by even well-meaning doctors. I cried because diabetes drugs, particularly insulin, are outrageously expensive. (Did I know at the time that type 2 diabetes generally does not require insulin? No. Am I still sick about the price of insulin? Yes.) This is the reality of being a fat person at the doctor’s office. You know that when you are sick, you will be blamed every time. This only magnifies for superfat and infinifat folks (referencing Ash from the Fat Lip Podcast’s chart below), who often get turned away at the door or have their lives regularly put at risk by doctors.
I’ve known for a long time, intellectually, that fat people who are “healthy” are treated differently than fat people who are not (in this instance, I mean fat people with disabilities or chronic illnesses, because WOW health is complicated and I’m not qualified to unpack it). I’ve shouted from the rooftops that not only should weight not be an indicator of health, but health should not be an indicator of value. But when I was diagnosed with diabetes, I saw a really ugly part of myself come out, one that had prided myself for years on being a “healthy” fat person. One that had secretly smiled when doctors ran blood work and took my blood pressure and found that it was all normal and so they COULDN’T tell me to lose weight because my weight didn’t MATTER. (Ignoring the fact that many did tell me to lose weight while looking at my entirely “normal” test results). I held that knowledge close and used it to bolster myself, to defend myself from my own thoughts, even while having a panic attack in the waiting room of every GP I’ve seen for the last 10 years.
So when I no longer had that to hang on to, the fat ableist moral high ground, I crumbled. If doctors couldn’t even hold their fatphobia at bay when everything was fine, how would I ever get decent treatment when I showed up as a fat diabetic?
Here’s a tip in the days I learned after my diagnosis: don’t google type 2 diabetes. Don’t google diabetes in general. It’s the same thing I learned when I was diagnosed with sleep apnea early in 2020- it’s one of those diseases where weight loss is not just suggested but EXPECTED as a treatment. Specialized diets are not a niche holistic treatment, but the norm. Every website, every person you talk to, will give you a laundry list of things not to eat: fruit, milkshakes, bread, soda, pasta, you name it. These websites essentially walk an eating disorder right to your door and hand it the key. When it comes to diabetes and fatness, everyone’s a doctor. Not to mention I know many, many people in my life who wouldn’t dream of making fat jokes but will still joke about getting diabetes while cutting cake slices. But that’s because diabetes is what happens to BAD fat people, right?
Obligatory diabetes info moment: people of all body sizes and shapes get type 2 diabetes. My doctor told me there’s something like 19 types of type 2 diabetes, caused by everything from genetics to childhood pancreatitis to everything in between. Diabetes treatment has come a long way from what I remember from my diabetic grandfather and his bottomless bowl of sugar free hard candies and slices of cheesecake hidden from my grandmother. Medicines are more powerful, “diets” and “lifestyles” less rigid. I am trying to be less concerned with WHY I have it (it’s not because I’m fat! It runs in my family! cries the internalized fatphobia part of my brain) and more concerned with living a good life with it. And yeah, part of that good life is not being on a fucking diet or spiraling myself right back down into eating disorder behaviors.
In the short term, I got really, REALLY lucky. My gynecologist, Dr. K(an incredibly sweet and open-minded woman who I call “Austin’s trans gynecologist” behind her back because she sees, no joke, 99% of the trans and nonbinary folks with uteruses that I know) heard how panicked I was and called in a favor to a GP friend of hers who offered to take me as a patient and called me not even an hour later. This woman, Dr. C, reassured me on the phone that we could treat me with medication and promised me she would, under no circumstances, prescribe a diet or weight loss. The fact that both doctors work at local clinics and are covered by my insurance is the closest thing to a miracle my raised-Catholic ass has ever experienced.
It’s a great sign of how truly fucked up American healthcare is that even this is not a happy ending. My diabetes meds are $90/month with both insurance AND the manufacturer discount (without the discount, it is $250/mo and without insurance it would be $600/mo). Even Dr. C’s intuitive eating talks make me feel panicky and triggered. I live in fear of the day I move out of Austin and have to find new doctors or what will happen if I can’t afford my medication or what if my medication stops working or what if even more horrific inventions like the recent New Zealand jaw clamp device (please don’t look it up if you are a fat person or ED survivor, it’s awful, trust me) are invented or popularized. I’m scared the people in my life who have cheered as I accept my fat body will now look at me eating Swedish Fish and decide that I’m a hopeless cause who brought it on themself. I think about all of this every day and I have NO good answers.
One final thing to close this out- the first time I met Dr. C she very somberly explained to me that I’d most likely be on medication to manage diabetes and take a daily pill for the rest of my life, and that this was something many people have to mourn or get accustomed to. I, who has been on mental health medication to manage severe depression and anxiety for 10 years now, just laughed and told her “yeah, that ship has sailed”.
(Also sorry to my mom, who very kindly reminded me after I got diagnosed that I don’t have to tell everyone my personal business, for continuing to tell everyone my personal business always and forever).