on round numbers and iliac crests
I've always been impatient with mankind's affinity for round numbers. Nature doesn't count things, it doesn't measure things out in arbitrary standard units, and it doesn't use a base-10 numeric system, so I've always thought the bias towards anthropomorphic boundaries at units of 100, or 10, etc., with regard to diagnostic categories was basically BS and should be avoided if you want to see things clearly.
Well, it turns out that things really changed for me around the point when my BMI went from 40.0 to 39.9, when my weight went from 400 to 399 (and again in another way when it went from 300 to 299), and when my waist size went from 44 (generally the lower boundary for Big & Tall clothing sizes) to 42. Dang!
I really wanted to self-righteously tell everyone how this division between an obese BMI (30-40), and morbidly/severely obese (40+) was a lot of myopic hooey, but nature did not cooperate with me. A lot of things changed right around this boundary (which I just crossed). What I thought was a great opportunity for self-righteous pedantry evaded me.
For example, I haven't done it yet, but after I get my next set of labs drawn I am going to try going completely off any anti-diabetes medicine. I am just taking one pill now for Diabetes, so if I can get and stay off of this one (and still have normal blood sugar levels) I will have reached my most important goal medically, i.e., I will no longer be taking medicine for Diabetes.
A year ago I was on the max dosage for every safe oral Diabetic drug (I didn't take the new risky ones), and I was injecting myself daily with about 125 percent of the usual dose of long-acting insulin (insulin-glargine, aka Lantus) just to get sort of crappy semi-control of my high blood sugar.
Today, I eat what I want (fortunately I don't want simple carbs much these days) and sometimes I wonder if my blood sugar meter is working correctly when I check my blood sugar because I am usually smack dab in the middle of the normal range. I get blood sugar levels now that I honestly never thought I would see again in my lifetime, and without really trying (i.e., without exercising a lot of dietary discipline).
When did this happen? As I crossed what I believed to be a mostly-arbitrary threshold between a BMI of 40 and 39. Bariatricians use this boundary for all kinds of reasons--therapeutic choices, research, etc--and I have been robbed of an opportunity I was eagerly anticipating to tell them how myopic and deluded they are.
Also, this point is when I found that I can rely upon the notion that I will be able to comfortably sit in public seating of any kind (even those tiny seats in ancient Broadway theaters), when I can shop in regular (not Big & Tall) clothing stores, when I could start sitting on a standard meditation cushion on the floor to meditate, when I can ride a bike, when I can dress and tie my shoes in a standing position, when I can wear regular t-shirts (when my favorite sports team, corporate behemoth, dive bar, etc has a t-shirt I can now get one in my size), and when I actually started to feel and appreciate the support/padding in my shoes.
But, the oddest thing that has happened recently, something that I completely did not anticipate, is that I discovered my iliac crests and how they relate to pants.
The iliac crest is the upper part--the wings--of the pelvis, what people generally refer to as their hip bones (though the hip is a joint down and more towards the middle of the pelvis). If one is of normal stature and not really obese, this is where one rests their hands when having them "on their hips," and much to my surprise, it is where pants hang on the human body (normally, except for those low-rise hip-huggers that are, on the right person, awesome).
For as long as I remember I kept my pants up by either cinching them around the mass of soft-tissue in approximately the same area, or by wearing braces (though I didn't like them much). I wore elastic belts, often bought pants in stretchy material, and while underneath all that fat I may have been unknowingly using my iliac crests for part of the mechanical solution to keeping my pants up I didn't know I was doing it. Now, my pants are subtly just sitting on the crests, they stay up in any position (also a new experience), and I can wear non-elastic belts that still do their job. Even more shocking, I can wear pants without a belt at all and I am not constantly pulling them up.
This is absolutely amazing to me, the novelty has yet to wear off (after living with this realization for a couple of weeks now). This is fundamentally amazing to me perhaps because this was completely unanticipated, but also because it is more evidence that what I call the "freak show" of my life is switching to the interior from the exterior. And it happened right as I dipped below a BMI of 40.
Time and time again I will be standing somewhere and my attention shifts to my waist and hips and how effortlessly my pants stay up as well as how comfortable they are. It is not getting old.
The "freak show' refers to my experience of moving through the world as a massively obese man. For most of my adult life my primary identity has been as the big fat guy in the room. When I got into the sight of small children they would often stop dead in their tracks and stare in slack-jawed awe at me, pulling their parent's sleeve and asking "why is that man so fat?" Well-meaning rescue-trippers would try to help me up stairs, or into a seat, or ask me if I needed help carrying something. Ill-willed armchair judges of character would assume I am unwilling to restrain my appetites, or worse, that I was mentally defective. Everyone assumed I was sick, or felt bad (and most of the time they were right). This was my identity. You could help someone who did not know me identify me in a group with "the really fat guy." I was always the fattest person in the room.
I was the freak, the outlier, the occupant of the tail end of the bell curve. I couldn't rely on there being a chair I could fit into, or a table at which i could sit, when I went to unfamiliar locales. Also, I had no choice about revealing to anyone I met in person that I had a serious weight problem. You knew that when you saw me. My biggest concern, problem, object of shame, and feature of my identity (and freakish in it's novelty) was known to everyone, whether or not I wanted them to know.
Now, I have a choice whether to tell someone I have struggled with obesity. I'm still obese, significantly so, but a couple of days ago when I was watching the Yankees I realized I'm not as fat as ace pitcher Cece Sabathia. Wow, I am slimmer than a professional athlete (albeit an unusually corpulent one). Wow.
I still feel like my life is a freak show in a lot of ways (and I know you do too), but most of that freak is on the inside. I'm not that easy to pick me out of a group now. A new friend, whom I met in July, told me the other day that "obese" is not an adjective he would find useful in describing me to someone else.
next - typical