As you can see in the photo, Basie, our 9-year-old cat is beautiful. He is also snuggly and purrs a lot. Basie has asthma, which has gotten worse. He’s been a “good eater” for many years but during the pandemic, with someone at home all of the time, we did not do a good job monitoring his food intake. Basie would eat all of the time, if he could. Consequently, he is on a diet to lose 7 pounds. He has lost about 1/10th of a pound. 7 pounds is a third of his total body weight since he was weighed at his last veterinarian appointment. His vet has prescribed special food. I’ve been measuring it carefully. Basie complains loudly but he is getting used to it.

Having to lose a 1/3 of one’s weight is A LOT. As a comparison, if I had to lose a 1/3 of my weight to get into the “healthy weight” category for my height, I would have to lose nearly 60 pounds. Basie’s current weight makes his asthma worse and puts him at risk for diabetes. When I tell people that Basie is on a diet for his health, they don’t bat an eye. It makes sense that he needs to lose weight. When people see photos of Basie, they recognize what a beautiful creature he is.

Now, let’s talk about weight and people, specifically female people. How many of us have had our worth judged by our weight? How many times have we had our worth judged by our weight? I’d say that it would not be unreasonable to think a typical number is in the thousands.

How many of us have been judged for trying to lose weight or not trying to lose weight? Or trying and not being successful? How many of us have prioritized how losing weight can make us look more attractive versus physical or emotional health benefits?

There’s a lot of policing of women’s bodies and there’s a lot of reactivity about that. People can be repulsed by the sight of an overweight person and say something negative. When called on it, the response is often, “I just care about their health”. This response is bull shit most of the time. It’s just fat shaming. I’ve also seen reactivity when women tell someone that they are exercising and watching their diet, “BMI doesn’t really mean anything. It’s biased and a form of fat-shaming. You should never follow a restrictive diet. You need to love your body.”

I had a lot of shame with my body and being overweight from the time I was a kid to about age 48-ish. I had shame about my body and my weight even when I was not overweight. I had an audio-tape in my head that told me everyday that I was fat. By the time I was diagnosed with breast cancer at age 46, the tape only played when I was overweight. Having breast cancer provided me with a natural opportunity to re-visit my relationship with my body. I decided to make a concerted effort to try to stop the tape and over time, I learned to love my body and to appreciate what it allows me to do in my life. The daily tape stopped and although I still have to work on it, the shame is nearly completely gone.

Even when I had a negative body image, I was careful around my daughter to not talk about my weight, her weight, or the times when I was engaged in a campaign to lose weight. Once she became an adult, like 21 or so, I commented once that I was trying to eat less. (This was after my SCAD heart attacks in 2017, while I was completing cardiac rehab.) She said, “But Mom, you’re not fat.” I replied, “I like my body and I think I look good but my doctor thinks it would be better for my heart to weigh less.”

Like a lot of people, I put on weight in the first few years of the pandemic. I’ve tracked my meals with apps for years and although I did not follow plans perfectly (I tend to do a fair bit of late night snacking after a day of healthy eating), I was not really eating more than I did when I was younger, and weighed less. I am active and walk 3-4 miles almost every day in addition to hiking during the summer. I’ve done this for 12 years. Nonetheless, my attempts to lose weight in the last few years, have been difficult.

In the meantime, I’ve injured the ball of my right foot. I have Morton’s Neuroma, which is caused by a thickening of the nerve under the metatarsal bones. The nerve thickens like a callous in response to repeated pressure on the ball of the foot and then the bones hit the nerve. It causes extremely painful shooting pains in addition to soreness. The injury was caused by my stair training last spring and summer in preparation for our camping trip to Alaska (which ended up being postponed). So my right foot was getting pounded by walking up and down all of those steps. My first response was to change my shoes from hiking shoes to HOKA’s, which are thickly padded and made for foot rehab. That helped and then it didn’t. I stopped doing the steps. For hiking, I bought a second pair of HOKA’S, a different model, and then I switched shoes halfway through the hike. That helped put the pressure in a different place but I was not able to do some of the hiking, especially when it was rocky or there were lots of tree roots.

By December of this year, I was in pain my often than not and by last month, I could barely walk around the house. So I went to my internist, thinking that I could get a referral for physical therapy (I thought I just needed to stretch my calves and Achilles tendon). Instead, she diagnosed Morton’s Neuroma, which is not treated with PT, and referred me to a podiatrist. I was able to get into the podiatrist the next day and I am now getting treated with accompanying improvement.

The main goals of the treatment is to 1) reduce inflammation of the nerve and 2) reduce pressure on the ball of my foot. I’m taking a series of steroid shots to reduce inflammation of the nerve quickly. I’ve started wearing orthodics that shift my weight to my arches from the ball of my foot. I have selected shoes that all better for my particular foot problem. I met with a different podiatrist (a well-known evidence-based podiatrist) earlier in the week. He told me that for the short-term, my bare foot should never hit the floor, even in the shower. So now, I have shower shoes and house shoes.

What does this have to do with weight? Not surprisingly, carrying more weight puts more pressure on the ball of my foot when I walk or run. Carrying more weight also makes my heart work harder and I have a chronic heart disease. Yes, there is a bias against women and weight in our society and that affects the medical field. And yes, programs like Noom and Weight Watchers contain harmful elements. And yes, restrictive eating is a bad idea for some people. This is my body. Losing weight is a good goal for me, and I know that tracking what I eat, being selective about what I eat, and reducing what I eat can be a helpful combination for me.

Losing weight is not easy, especially after menopause. Research on weight loss suggests that diet is more important than exercise in dropping pounds. (Exercise has so many emotional and physical health benefits. I am not discouraging people from exercising.) I’ve long suspected that in following a weight loss plan like Noom or Weight Watchers (I’ve lost weight on both in the past), I’d have to eat less than the plans suggested. I’d been on both Noom and WW during the pandemic and even when I followed them, I didn’t lose weight. I’d never really considered weight loss drugs before but I thought it was worth exploring. I take a statin drug now for my cholesterol. Losing weight is really hard. Why do we think we’re “cheating” if we consider other options?

I had my annual physical last December with my new internist. (My long time internist, Dr. Hyde, is enjoying a well-deserved retirement). I brought up my weight. She mentioned her weight loss success by reducing late night snacking. (She is not overweight and looks no older than 40.) In other words, she made weight loss sound easier than it is for many people. I told her that I’d tracked so many consecutive meals on Noom, thousands, that the counter went back to 1. I’d exceeded the counting capacity of the program. I told her that I’d been keeping within my points on Weight Watchers. I said, “I’m giving this one more effort to be incredibly scrupulous and to make sure that I am tracking portion sizes correctly. I’ve lost a couple of pounds since Thanksgiving. But it is so difficult to lose weight since menopause and if there were weight loss drugs that I could take that didn’t have bad side effects, I would do it.”

She told me that I qualified for weight loss drugs. We discussed options. I expressed interest in the oral medication, Contrave, which is a combination of two drugs that have been around for a long time. The combination is associated with modest weight loss for about 45% of people and it is not contra-indicated for me in light of my cardiac issues. She told me to do research and to message her if I wanted a consultation with the pharmacist. This is a new process at my medical clinic. You meet with their pharmacist for a new prescription. So I set up a telehealth visit with the pharmacist after one of my healthcare team informed me that my insurance does not cover Contrave (it’s $500/month) so I could not get a prescription. I replied, “Can’t the pharmacist prescribe the generic forms of the two medications that make up Contrave?” The health coordinator replied that this was possible. I am perpetually stunned by the amount of medical knowledge that’s required to advocated for my needs.

To make a long story short, I got the prescriptions ($15/month) and completed my first week yesterday. Even on the starting dose, it seems to be making a difference. I’d been losing an average of 1 pound a week since Thanksgiving and lost 2 pounds last week. My portion sizes and snacking have decreased a lot. I have lost a total of 10 pounds and I am starting to feel the difference. I am hoping that all of my efforts to heal my foot injury will translate to wonderful hikes in Alaska this summer.

Like Basie, I am beautiful. My body is a marvel. I hope to lose more weight so that I can do more of the things that I like to do, like ceramics, cooking, walking, and hiking, all things that require my being on my feet.

I hope sharing this will help reduce some of the baggage around women and their bodies. Our bodies are beautiful. They keep us alive. This is my body. I do with my body what I believe is best for me. You have your body and you make your decisions for yourself. This is body autonomy and it’s a beautiful thing to support in one another.

Be well,

Elizabeth