Monday, June 2, 2008

Fat is a symptom, not a disease, Part Four: Drug side effects

Many pharmaceuticals have weight gain as a well-documented side effect. The weight gain can be due to a variety of factors, including, but not limited to, lowering metabolic rates, causing hyperinsulimia (especially in anticonvulsants like neurontin and depakote), and many other biochemical effects that are not easy to put into layman's terms. To put it simply, these drugs work because they have a specific chemical effect, but they often react with other biochemical processes in ways that are either not anticipated, or are considered to be less important than the intended therapeutic effect.

To put it simply, a living animal is not a laboratory calorimeter, where calories in and calories out are a simple function. We are infinitely complex, and adding a molecule to the living system can help some problems, but modern medical science is not yet fine-tuned enough to successfully target one tiny process. Our SSRIs and other antidepressants are often like taking a blunderbuss to a rifle range--you will probably hit the target, but you'll hit a lot of other stuff too.

That's what progress is all about, though. A hundred years ago, you probably would have died if you had an acute gallbladder, while today a doctor plucks the quivering organ from our innards with a watchmaker's precision, making a cholecystectomy a very simple and survivable surgery, with smaller and smaller scars as tools and techniques sharpen. When I was a teen, I waited anxiously at a hospital in Milwaukee, five hours from home, for my grandfather's quadruple bypass to be completed. Today, he probably would have had stents neatly slipped into his blocked arteries, with only a pinprick on the surface of his skin to show for it.

Before we had antidepressants and other mental health drugs, we had some of the most inexcusably abusive quackery inflicted upon the mentally ill. Historically, mentally ill people were often just dumped in prisons and jails (and guess what--we're still doing it; ask any social worker). Some were treated to cruel, sometimes deadly exorcisms. Women were presumed "hysterical" and went to doctors for vaginal "massage" to induce orgasm as a treatment. Lobotomies became all the rage in the late 1940s, with frontal lobes scrambled with an ice pick through the eye socket. Asylums were often notorious for their squalid, cruel conditions, with many exposed by family members who were horrified at their relatives' treatment.

In the 1950s, the advent of psychotropic drugs was the first ray of hope for mentally ill people. I feel that we're finally seeing the tail end of the birthing pains of psychopharmaceuticals, with more solid research and standards being applied. The system is obviously not yet perfect, but important lessons have been learned, with our ancestors' brave--albeit not always informed--foray into citizenry as research subjects.

So, today, instead of a schizophrenic being shackled into a cold cell, at the mercy of potentially abusive captors, that person may be able to function normally with the help of a drug such as Risperdal. They may be able to work, have a family, and enjoy their lives. If the drug that enables them to function also causes them to gain weight, I question those who wring their hands over the weight gain. Surely the fact that they can live their lives independently is a pretty good trade-off for the potential stigma associated with the weight gain? And, if it is indeed the stigma the hand-wringers are concerned about, what is preventing them from working toward a better world, one where a fat person is not subjected to social stigma? Is their aesthetic sense so deeply rooted that they can't stand to see a happy person who happens to have a body shape that is not attractive to them?

Some of the best-selling drugs today are antidepressants, especially the SSRIs. They have helped millions of people become reacquainted with life, to poke their heads out of the steep-walled pit that is depression. Anxiety, another condition treated by SSRI, can be so disabling that its sufferers sometimes cannot even leave their homes. I think it is absolutely ridiculous that anyone would be so upset over the associated weight gain, when the drugs often make a person feel as if his or her life is worth living again. I'm tired of hearing the fatophobes shrieking about it, trying their damnedest to drag down those who have finally been able to stand up again, just because their bodies are different.

So tell me, fat-haters, are you really so shallow and juvenile that you would rather see someone institutionalized than fat? Hanging themselves instead of fat? I've really begun to wonder if the fat-hate is not just about fat, but about an excuse to be misanthropic to anyone who is socially vulnerable. After all, the mentally ill you used as a punching bag in ages past have now become functional fat people, so whom are you going to punch in their place? My suggestion to you is to find out why you need a punching bag at all, and then fix it, rather than continuing to delude yourself into thinking your victims deserve your abuse. Maybe you could even try one of the above drugs--it might even be good for you to see what it's like to gain weight without changing your eating or exercise habits.

10 comments:

Sarah said...

I've been on Lexapro since 2005. It has been a life-saver for me. Of course, my new lease on life is probably seen as negative by fat haters. I'm actually confident in my abilities and not afraid to go out in public anymore while being fat!

LavaLady said...

Thanks for this post. I have been taking a new drug to deal with my mood disorder, and have been thinking about my weight gain vs. my not wanting to kill myself all the time.

The fatophobes will never say never. They'd just say that I could start exercising more and eating fewer calories, and voila!, I'd be thin.

Yeah, right. Seeing as my (mostly) invisible illness has made just eating regularly a problem and I've still gained...

It does suck that I am both fighting a serious chronic illness and fighting fatophobia at the same time.

Thanks again for the post and this series!

Karen said...

Maybe you should start asking doctors where they want you on the Hilton/Hawking scale.

You can be more toward the Paris Hilton end - (conventionally) attractive, physically able, but mentally deficient.

Or you can be more toward the Stephen Hawking end - far from attractive, physically impaired (if they believe all disability is incurred by fat), but mentally impressive.

I dunno about you, but I'd rather be on the Hawking end than the Hilton end.

Karen said...

Maybe you should start asking doctors where they want you on the Hilton/Hawking scale.

You can be more toward the Paris Hilton end - (conventionally) attractive, physically able, but mentally deficient.

Or you can be more toward the Stephen Hawking end - far from attractive, physically impaired (if they believe all disability is incurred by fat), but mentally impressive.

I dunno about you, but I'd rather be on the Hawking end than the Hilton end.

redshira said...

There's also the fact that a lot of drugs cause weight gain but doctors won't admit it; the most obvious example is oral contraceptives, which can aggravate insulin resistance and cause massive weight gain, but the information leaflet says things like "It won't cause you to gain weight, but it may increase your appetite, so watch what you eat!" - thereby laying the blame on the patient. The female patient. Also, with drugs where weight gain is an acknowledged side effect, the attitude isn't one of "well, it might make you gain weight, but it won't be your fault, so don't worry", it's "it'll make you gain weight so make sure you work EXTRA HARD to avoid becoming FAT OMG".
I have PCOS, fibro, chronic myofascial pain and lipoedema (the lipoedema makes weight gain inevitable and weight loss quite literally impossible), and the Pill made me gain 120lbs over a total of seven months - 77lbs of that was in the first 2 months. Of course, the doctors insisted that all of it was my fault because I was eating too much. Then I couldn't lose it. You know how this sort of story goes. I am more than a little bitter, and very pleased you've been doing this series.

redshira said...

There's also the fact that a lot of drugs cause weight gain but doctors won't admit it; the most obvious example is oral contraceptives, which can aggravate insulin resistance and cause massive weight gain, but the information leaflet says things like "It won't cause you to gain weight, but it may increase your appetite, so watch what you eat!" - thereby laying the blame on the patient. The female patient. Also, with drugs where weight gain is an acknowledged side effect, the attitude isn't one of "well, it might make you gain weight, but it won't be your fault, so don't worry", it's "it'll make you gain weight so make sure you work EXTRA HARD to avoid becoming FAT OMG".
I have PCOS, fibro, chronic myofascial pain and lipoedema (the lipoedema makes weight gain inevitable and weight loss quite literally impossible), and the Pill made me gain 120lbs over a total of seven months - 77lbs of that was in the first 2 months. Of course, the doctors insisted that all of it was my fault because I was eating too much. Then I couldn't lose it. You know how this sort of story goes. I am more than a little bitter, and very pleased you've been doing this series.

Sarah said...

can't there be some in between, though? antidepressants have saved my life. i would never not take them because of the possibility of weight gain. but seeing it on my body is hard. it makes me feel like my body isn't my own any more. i'm grateful beyond words for the SSRI I take every day. but this post makes me feel like I'm a bad person for caring that I've gained weight. I don't hate anyone. I'm not a fatphobe. I'm just having a hard time right now.

spacedcowgirl said...

I totally agree with lavalady and shira; the fat haters seem to fall into two categories. The first knows that the weight gain just seems to happen and is not a result of changing eating habits, but have no problem making draconian recommendations about what you have to do to take the weight off at all costs. (Of course they have no intention of following their own advice--they're thin, after all. I sort of agree with you that it might be good for these folks to take a drug that causes weight gain so they might also gain a better understanding of how it really works and maybe stop acting like such assholes.) The second group is of course the people who think you're lying when you say you're active and don't eat that much. You really can't win with these people.

sarah, I for one certainly don't think it makes you a bad person to struggle with changes in your body, especially ones you don't have any control over. (I think the post addresses mainly people on the outside looking in, who either think they have all the answers for SSRI weight gain or would rather people be depressed than fat. Assholes.)

Anyway, I do think that putting your energy into learning to love your body at its current size is the best strategy. One superficial step might be to make sure you always have comfortable, attractive clothes that fit your current body and that you love (if you can afford to add to your wardrobe). But all that being said, I know that loving and accepting your body is hard work and much easier said than done. I'm sorry you are struggling right now, and good luck.

Heather said...

Latest Sarah,

Lexapro has done wonders for me. While you shouldn't feel *bad* for feeling this way, you should also examine why. Why are you disappointed in the extra fat you now carry? Societal issues? Why let someone else determine your self-worth for you? At the heart of being unhappy at being fat, is unhappiness with the self. When we throw off the shackles of berating ourselves for not being thin (which, incidentally, is less healthy than being fat), we can start focusing on more important matters, like our families, ourselves, our jobs, our hobbies.

Zilly said...

So tell me, fat-haters, are you really so shallow and juvenile that you would rather see someone institutionalized than fat? Hanging themselves instead of fat? I've really begun to wonder if the fat-hate is not just about fat, but about an excuse to be misanthropic to anyone who is socially vulnerable.

I think there is more to it than that. Fear probably plays a part. I know people who would rather be "beautiful" than healthy, and for whom "fat" and "happy" are mutually exclusive. The notion that it may be possible to get fat through any other means than lack of self-control terrifies them, so they choose not to believe in it. Even if it has already happened to them.