Fat Acceptance, Weight Loss Surgery & Addiction

I was 300 pounds in my early 20s. I had spent years dieting only to gain more fat than I ever lost. My desperation to be happy left me no choice but to accept and love my body as it was, since it appeared I was powerless to change it. Though perhaps it would have been comforting to connect with a Fat Acceptance (FA) group at that moment in my life, in hindsight I’m grateful for the independent streak that kept me from reaching out to such a group. I don’t “do” moderation, so it’s likely I would have completely embraced FA at its most extreme, not just accepting but promoting fatness, and scoffing at any mention of Weight Loss Surgery (WLS), the holy trinity of food addiction ¹  (sugar, starch and compulsive overeating), and anything else that might suggest that there is anything to fix about being fat. ²

The latest-wave FA movement, Healthy At Every Size (HAES) ³, was born out of Linda Bacon, Ph.D.’s 2010 book by the same name. Lisa DuBreuil, LICSW ⁴, is a HAES proponent.  As a clinical social worker, DuBreuil counsels postoperative WLS patients who develop complications following surgery. Last week,  I ran across a post written by DuBreuil entitled “Weight Stigma and Weight Loss Surgery.” The piece is part op-ed, part memoir, and firmly anti-WLS.

In DuBreuil’s piece, one post-WLS complication sticks out as particularly worthy of further exploration: Addiction ⁵. To hear DuBreuil tell it, addictions rise up out of nowhere for many postoperative WLS patients. One might go into surgery a social drinker, only to develop full blown alcoholism a short time later. DuBreuil reports seeing the same type of scenario play out with drugs, anorexia and bulimia, compulsive shopping, and gambling. “People have lost (or almost lost) their professional licensure, career or a marriage due to their new addiction post-WLS,” she cautions.

Addiction is hard-wired in the sufferer’s brain. It’s not the kind of thing that develops overnight, and it’s certainly not something that happens as the result of having surgery. Addiction doesn’t develop spontaneously, like an infection; for those who have it, Addiction is deeply embedded in their mental and emotional landscape.

Addiction is powerful. It can manifest in odd and unexpected ways when the pressure’s on. If one’s primary addiction is disabled, secondary addictions often rush to the surface to try to compensate ⁶. A great illustration of this phenomenon is the use of  Antabuse, a medication that disables alcoholism. When an alcoholic is on Antabuse, drinking alcohol makes them violently ill. Many who’ve tried to get sober by taking Antabuse often find themselves compulsively overeating (mainly sugar and starch ⁷), smoking, and taking drugs at times when they would normally drink. With their primary addiction disabled – but the disease of addiction still going strong – other addictive vices rush in to compensate.

Those  who choose to undergo WLS often experience something akin to the Antabuse scenario: Denied access to their primary addiction ⁸and, most importantly, denied appropriate resources to recover from that addiction ⁹, secondary addictions rise up to fill the void. At times when they would have overeaten or eaten sweets, they now drink to excess. Maybe they smoke. Or they start popping pills. Some have risky sex with multiple, poorly-chosen partners.  The “lucky” ones might develop addictions to “healthier” things, like exercise ¹⁰.

The illness of addiction plagues many, if not most, obese people (myself included). When the holy trinity of sugar, starch, and compulsive overeating is the primary addiction, obesity emerges as a symptom. As with any other addiction, abstinence is the cure. Problematically, most Fat Acceptance literature lumps abstinence in with traditional diets, cautioning folks away from both. Those of us who have counted calories or weighed and measured food in an effort to lose weight know exactly how traditional diets end – badly, sadly, angrily, and fatter for the effort. But those of us who have met our addiction with abstinence have a very different, positive – some would say spiritual – experience. We are free of obsessive thoughts about food, free of shame and regret, free of spikes and crashes brought on by surges of sugar and excesses of insulin. We sleep better, breathe more deeply, feel at peace. And we achieve and maintain a healthier, more comfortable weight.

DuBreuil is on the front lines with WLS patients, many of whom imagined surgery would “fix” them. But surgery cannot undo addiction. There, in patients’ darkest, most confused and desperate hours, she compassionately counsels them from a HAES perspective. I imagine her encouraging them to love themselves, to seek help for their drug and alcohol or other (new) problems, and to put the unfortunate choice to have WLS behind them. If you’re destined to be obese, why not embrace it and focus on being as healthy as your obesity allows?

Because obesity is not our destiny. It’s not insurmountable.  Obesity is usually a symptom of an illness we have the power to cure.

The prevalence of obesity would plummet and the long term success of WLS ¹¹ would skyrocket if DuBreuil and others who work with the obese population could accept obesity for what it very often is: a symptom of addiction. DuBreuil notes in her article  that “pursuing weight loss leads to weight gain over time and makes people less healthy in the long run.” She’s absolutely, 100% right. Weight loss for the sake of weight loss just shy of always results in more weight gain, poorer health and, over time, incomprehensible demoralization. However, when we adopt abstinence as a regular practice ¹² in an effort to recover from the emotionally, mentally, and physically damaging reality of food addiction ¹³, our bodies are able to settle naturally into a healthy, sustainable weight. People respect and prioritize addiction recovery. The respect and support afforded recovery efforts versus diets increases the odds that  sugar & starch addicts will maintain abstinence and, therefore, a more comfortable weight long term.

But it isn’t the cultural norm to say that obesity is the result of an addition. That’s not the language we use ¹⁴. As such, the obesity issue and those of us carrying the weight of it don’t receive the respect or the resources we need in order to recover. Instead, we get inundated with diets, fads, fat farms and surgeries ¹⁵. In the end, we’re more obese as a population, more depressed, and feel progressively less empowered.

HAES facilitates community, encourages self-acceptance, self-love, personal empowerment, and improved health for obese men and women – all important steps in the right direction.  Sadly – for Fat Acceptance fans generally and DuBreuil’s WLS clients specifically – HAES’s exhaustive online resource list includes not one mention of the words “addict” or “addiction.”

I hope the Fat Acceptance movement continues to build strength and momentum. WLS patients specifically – and obese people generally – absolutely deserve and should  be encouraged to accept and love their bodies ¹⁶. I also hope that the next wave of the Fat Acceptance movement promotes frank discussions of  the holy trinity of food addiction. ¹⁷  All obese people, regardless of where we stand on WLS, deserve access to information about our illness, and the resources and support we need if we wish to pursue recovery.