as small as a world and as large as alone, I have just read the link you posted about fat...

3:51am May 16, 2014

Anonymous asked: I have just read the link you posted about fat people with ng tubes, i am the person who sent the original ask about why you have one. I am curious still though, you are obese? or at least very overweight, can't they give you less calories through your feeding tube so that you can at least lose some weight, why do you need to be fed if your body has so much reserves?

I’m going to humor you, even though your initial ask was rude as fuck. Hint for the future: If you want to be taken seriously, don’t mention someone’s facial hair and their fat in one breath and then imply they don’t really need life-saving medical treatment. Have a little respect.

So first off, I don’t have an NG tube. An NG tube is a tube that goes from someone’s nose, into their stomach. It works mostly for people who either refuse to eat, or who have swallowing difficulties. My mother (who is also fat) had an NG tube for awhile because she couldn’t swallow without choking.

What I have is called a GJ tube. The G part goes into my stomach. The J part goes into my intestines. It doesn’t come in through my nose, it comes in through a hole surgically implanted in my abdominal wall. GJ tubes are a way bigger deal to put in and take out than nasal tubes, and are only done when there’s an absolute medical necessity. They did their best to talk me out of getting one. Not because I didn’t need it, but because getting a feeding tube of this type is considered a big deal and they wanted to make sure I knew what I was getting into before I agreed to it. They actually thought death would be better. I disagreed, which is why I’m still here.

So basically, my esophagus and stomach don’t work very well. They move only very slowly. Food doesn’t get passed down to my intestines, and neither do digestive juices. Lacking anyplace else to go, the food backs up, goes into my lungs, and gives me pneumonia. Even if I don’t eat anything at all, my stomach acid will build up and back up into my lungs.

So at that point, given a stomach that flat-out doesn’t do what a stomach is supposed to do, you need a way to get the food into your body. Fat people aren’t magical. We can’t live off of thin air. And we can only to some extent live off our fat reserves, and only for so long (generally at that point the body goes into a nasty and dangerous death-spiral that involves consuming muscle and fat and all sorts of other things indiscriminately, it’s not recommended, I’ve been there). So fat people need food. And that means fat people without a functioning stomach need a way to get food into our body.

(Take out the word “fat”, by the way, and the medical indications are identical. Fat is only as relevant as your prejudices make it. Medically, all it means is that I’m less likely to die of total malnourishment in the meantime while all this is getting set up. But it doesn’t mean I can’t die of malnourishment before I ever become thin.)

So there’s two main routes for food getting into your body if you don’t have a working stomach: One is through your veins (it’s called TPN), and the other is through your intestines (it’s called a J-tube). TPN is the more dangerous of the two, so I have a J-tube as part of my GJ-tube. The G half of my J-tube isn’t for feeding, it’s for draining out all my stomach fluid so that I don’t inhale it and get pneumonia.

Both parts are absolutely crucial to my continued survival: The G-tube means that I won’t drown in my own fluids or get a nasty infection and die of that. The J-tube means I can get fed into my intestines and not die of malnutrition or other complications of starvation. Because everyone needs food. Fat people are not Breatharians. We can’t magically absorb nutrients from nowhere. (And anyone who is in any way sensible about weight loss will tell you that starvation is not healthy for fat people.)

I’m actually extremely careful with calories, because my nutritionist said that my goal should be to either maintain a single weight, or very gradually lose weight, but not to rapidly gain or lose weight. Unintentional weight loss is a symptom of two different diseases that I have (gastroparesis and severe adrenal insufficiency), and small amounts of weight gain in response to treatment can actually be a good sign, despite the fact that I’m technically overweight.

I eat between 1100-1300 calories a day. That seems to keep me either at a constant weight, or very gradually losing weight. I am actually not that interested in losing weight, I am more interested in maintaining a healthy amount of nutrition for my body, at whatever weight my body decides to become. I have long since figured out that my body has a mind of its own when it comes to weight – I have weighed everything between 105 and 245 pounds in my adult life, and very little I have done on purpose has made the difference there. At the moment, I have lost about 67 pounds in the last couple years, some of it quite precipitously.

What I take issue with is the idea that someone who doesn’t even know me, can look at me online and think they know the quick fix to the problem, and the problem being that I am fat. Honestly, with all of my health problems right now, being fat is not even on the list of problems I discuss with my doctors. It is far more important that I get adequate, well-rounded nutrition than what weight I am.

In fact, one treatment I am on may cause weight gain in the near future. Adrenal insufficiency is treated by steroids like dexamethasone and prednisone, and those steroids are linked to weight gain.

Health is not always about what size you are.

Right now, health, for me, means:

* My body is making cortisol, or getting some replacement.

* My stomach is not backing up into my lungs and killing me.

* I have a means to get food into my body, past the esophagus and stomach that aren’t working.

All of those things are life-threatening. By which I don’t mean, “This could be life-threatening at some point in the future, hypothetically, because society assumes there’s always a link between this condition and a danger to your life.” (Which is how our society sees being fat right now.) I mean, I would not be alive right now without aggressive medical intervention in the area of feeding tubes and steroids.

The idea that my weight ought to be my biggest health consideration in such a situation is just silly.

It’s also pretty silly to assume that a fat person can simply adjust the amount of calories they get, and become thin, with no unpleasant side-effects or malnourishment encountered along the way. Actually, reducing body size by reducing calories is a good way to become fatter in the long run, and there’s a good deal of science backing that up. Most diets are calorie reduction, and the overwhelming majority of those diets result in the body learning to hang onto every calorie and then make you fatter than you were before the diet. I have watched people do that my whole life, had it happen to me by accident (after involuntary starvation, not dieting), and am not interested in encouraging that cycle any further.

So my goal, as always, is to maintain my weight, and if it happens to drop a little here and a little there, that’s fine, but I’m not going to just keep cutting calories until I’m thin. And every nutritionist I’ve ever seen has backed me up in this view.

So unless you’re a nutritionist, gastroparesis specialist, and endocrinologist, all put together, you might do better to stop asking questions that really seem to amount to “I don’t understand, why aren’t you thin yet, you don’t meet my expectations of fat people’s biology.” I think the part that pisses me off is the lack of acknowledgement of the 70 pounds I’ve lost already, and the fact that losing 70 pounds was not, medically, a good thing, and the fact that even if I somehow wanted to making losing weight my biggest medical priority (which, with all my life-threatening conditions, it can never be)… you don’t go from 245 pounds to 130 pounds without a long period in between where you’re… still fat. I already went from 245 to 178 far too fast to be medically safe, and nobody wants to acknowledge that this even happened.

But seriously, if you want your questions to be taken seriously, you should ask with a lot more humility and a lot less presumption that you already know all about the biology and medical aspects of being fat. And not poking at people for having facial hair helps too.

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