Even as someone who might understand the arguments for this device, I’m appalled by the implied endorsement of debunked ideas about obesity, writes Anna Rawhiti-Connell.
One of the most frightening scenes in the Handmaid’s Tale is when June goes to Washington DC and, in line with tradition in the delightfully dystopian capital of Gilead, is fitted with a mask. She is muzzled. It’s something you do to dogs and ideally not to people.
It’s rightfully horrifying on the show because the idea of our mouths being forcibly shut or restricted is the stuff of nightmares. To restrict what goes in and comes out of our mouths is to silence us, starve us, suffocate us, and potentially kill us. It calls to mind examples of historical instruments of torture, restriction and repression like the “pear of anguish” or the scold’s bridle.
It’s quite understandable then that when the University of Otago tweeted about a “world first weight-loss device to help fight the global obesity epidemic” accompanied by a picture of a set of teeth locked together by “an intra-oral device that restricts a person to a liquid diet”, Twitter went bananas.
Informed by a growing understanding about obesity and the daily judgement and prejudice fat people face, the tweet got slammed faster than it would take me to slam a cheeseburger after freeing my jaw from medieval wiring.
In the back of my mind though, as I watched the tweets roll in, labelling this yet another example of fat phobia and fat shaming, lurked the only edge case I could think of. The edge case I’ve experienced and the possible edge case the university buried in the original press release. They state, in the 10th paragraph of the release that: “The tool could be particularly helpful for those having to lose weight before they can undergo surgery.” They don’t specify which surgery in the release, there are any number that might require weight loss, but allude to one kind of surgery in a follow up paragraph:
“While bariatric surgery plays a major role in the management of morbid obesity, it cannot be relied upon to manage this ‘global epidemic’. It costs about $24,000 and patients ‘live with the consequences of that for life, which can be quite unpleasant’.”
I take issue with the comment about the “unpleasant consequences” because while there can be some, they are vastly outweighed by the benefits and the long-term reduction in cost to the health system. It’s a bit odd to be seemingly putting people off this surgery in a release about a so-called alternative.
I know about these consequences and benefits because I had bariatric surgery in February 2020. It actually could be relied on a bit more in this country if it were funded better. New Zealand’s overall rate of public funding for weight loss surgery is half the rate of the United Kingdom and Australia. New Zealand has the third highest adult obesity rate in the OECD.
I had the surgery because my health insurance covered it, I was a Type 2 diabetic, morbidly obese and had been trying to lose weight since I was a teenager. I have already written thousands of words on the mental gymnastics involved, but let’s just say I was staring down the barrel of some serious health problems and I have made my peace with my decision. It has changed my life and I will beat you in any debate on the subject.
Before undergoing surgery you are, in most instances, required to be on a liquid diet. It’s intended purpose is to shrink your liver. The surgery is performed laparoscopically so your liver has to be lifted out of the way to get to the stomach. It’s a big deal amongst the bariatric surgery community, we frequently bitch about the “Opti” (Optifast – the meal replacement drink most of us use) phase because it’s ghastly. To be crystal clear, I wouldn’t wish a liquid diet on anyone unless it’s required for bariatric surgery. Done without the surgery as the end goal, it’s an unsustainable way to lose weight.
It’s also very hard. You get headaches, light-headedness, nausea and your bowels get fucked up. I was a truly disgusting human being to be around for the three weeks I did it, and had to do something of an apology tour after.
Most people will lose weight doing it because in total, three shakes a day equates to an intake of 600-800 calories, so there is a kernel of truth to the idea the university has alluded to about the psychological benefits of a kickstart. I was allowed to supplement my shakes with two cups of vegetables. I tried to make a “Big Mac sauce” from courgettes to go on my burger made from roasted carrots. Desperate times.
During this time of desperation, most bariatric surgery patients are also contemplating a huge life change, the fear of the unknown, an irrational fear of dying on the operating table and attempting to peel back the layers of deep, entrenched shit that is melded with our bones. We have to begin to unpick years of body hatred, self-hatred, blame, shame, skewed eating habits and myriad bags of emotional and psychological luggage we carry around that weigh three times as much as our bodies.
Would I, given the choice, have opted to have my jaw clamped shut to ease at least one element of the psychological torture I felt I was going through? Perhaps removing the temptation of eating a whole pizza would free up my brain to freak out about something else? Could I have been the edge case that trumped the wave of anger about this barbaric jaw clamping device?
I stood in my kitchen one night during the “opti-phase” and cried as I wrestled with that exact temptation. I feared never being able to eat a pizza again. I didn’t want to eat another vegetable or sip down the sickly sweet shakes no matter how much I pretended it was a Frappuccino.
But it’s in contemplating this very battle with Satan’s pizza that the wheels come off this idea of what might be the university’s edge case.
You will not meet a bariatric surgery patient, pre or post, who doesn’t talk about “head stuff”, mindset or the surgery being a tool. These are the phrases that bounce around support groups. They are given to us by the health professionals we interact with before and after surgery. The underlying implication is that while the surgery is the very best tool we have for a reset and a second chance at developing a different relationship with our bodies and the world around us, there is work to be done. It is not a quick fix. It requires commitment and a big shift in the thinking that brought us to their doors in the first place. I saw and still see a psychologist, a counsellor, a dietician and my surgeon. I involved my family and friends. I have chosen to be open about it.
The physical restriction created by the surgery gave me a flying start for sure – I could only eat a quarter of a cup of food for three months – but in all my dealings with the army of people involved in my care, the name of the game has always been about bringing me back to a place where I enjoyed food and ridding me of the restrictive diet mentality. To free me from a binge, starve, binge cycle. To deliver me to a promised land where I could question and understand the forces that work to completely fuck up our relationship with our bodies and the food we put in it. To equip me to unpick this stuff for the rest of my life from a place of peace and strength. That is the work you have to do and very often, the first time you realise it, is in those first few weeks on your awful Opti diet.
Beyond the lack of longevity in this study to truly test whether this “kickstart” is really all you’ve been waiting for on your road to peace and strength and the fact it ignores the aforementioned “work” that it really takes, the idea that physically restricting someone to a liquid diet by clamping their jaw shut ignores so many of the causes of obesity, it’s not funny.
The press release cites compliance as the main barrier to “successful weight loss”. Never mind poverty, living conditions, working long hours in sedentary jobs or the freedom given to Big Food Inc to load supermarkets with yet another stupid food mash up or plant a McDonald’s on every corner.
Never mind the increasingly individual and isolated lives we lead, away from communities, tradition and communal food sources.
Never mind the several multibillion-dollar industries that are designed to warp every single thought we have about bodies and profit from the wreckage.
Never mind the complex metabolic and hormonal science that now underpins most thinking about weight gain and loss.
The thing is, they tried wiring jaws shut in the 1970s and 80s as a weight loss solution and most people gained the weight back.
Even as I attempt to muster up the most generous read of this device as someone who might understand the edge case for it, a short term way for people to lose weight ahead of surgery, bariatric or otherwise, its tone, announcing the device as a way to “help fight the global obesity epidemic” and the suggestion it may “obviate” the need for surgery, reveals a whole lot of wonky thinking that needs to be put to bed.
It fails the sniff test because it endorses and celebrates debunked ideas about obesity and takes us back to the unhelpful position of believing that willpower and restriction are all that’s required to lose weight.
Even if you successfully lose the 6.3kg in two weeks as the seven trial participants did (all women, all of European ethnicity) and even if that kick starts you on a journey to making habit changes, you’re going to need a whole lot more than restriction and willpower to stay on a road that makes you feel healthy and happy.
Just ask any bariatric surgery patient. We got the gold standard of kickstarts and most of us still need ongoing care and guidance to remain in a place that allows us to counter years of screwed up thinking, the obesogenic environment we all have to live in, and the attitudes perpetuated by this jaw-clamping device and its hubristic reappearance.
Thankfully I am not muzzled as June was, nor are the experts on this complex subject. Something tells me they may have more to say on this matter. The jaws are unwired and the floor is open.
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