Obesity and Disability

Obesity and disability often go together. Which came first, the obesity or the disability? It doesn’t really matter. In my case, the chronic migraine led to the steroids and quitting work and lack of exercise which led to obesity. After a year on the ketogenic diet, I’m back down to just being overweight, but that’s the exception and not the norm.

This article in Vox sums up the predicament very well. In the author’s case, he was very active until an accident caused serious injury to his back and leg. Now he’s obese, but unable to be very active. And, we live in a world that isn’t very exercise-friendly to disabled people.

As I read the article, I thought about my own situation and those similar to me. I have chronic migraine, which is an “invisible disability”, more like fibromyalgia and chronic fatigue syndrome. They are real illnesses, but people don’t see disability when they see people with them. Nonetheless, there are real barriers to weight loss and fitness.

Fatigue is a real problem for me. I’m not talking about tiredness. I went to medical school and was a physician for 10 years. I know what it’s like to work for 36 hours straight. Yes, I can work tired. But, bone-deep fatigue is a whole other animal. One that they didn’t teach us about in medical school. I’m not fatigued all the time, but the day after a migraine (and sometimes for 12 hours or so before a migraine), I’m so fatigued that I can barely get up out of my rocking chair, much the less get out and walk a mile or two. And, knowing that my own medical training didn’t include much about chronic illness fatigue, I’m pretty sure that my medical team doesn’t understand it either.

There’s not much time for exercise. I know. Everyone uses that excuse. My issue is that I have migraine for 2-4 days out of every week. During that time, I am not able to do much physical work, like laundry, cooking, or cleaning. I might do some reading, knitting, or even paying bills if the pain isn’t too bad. But, during my non-migraine and non-fatigue time, I need to get the rest of life taken care of. That leaves precious little time for exercise. So, I do get some in, but it’s a couple of times a week at best. And, at times, there will be 4 or 5 days between exercise sessions. You should hear my body complain about that!

Healthy eating is very important for anyone with chronic illness. I have a bit of a leg up on that one because I took nutrition classes while I was in med school (I was one class short of getting a Master’s degree in clinical nutrition). I am also fortunate to be financially secure. I can buy fresh fruits and veggies even when they aren’t in season. We buy grass fed beef and free-range chickens as well as farm fresh eggs.

Eating healthy also requires energy, something people with disability, especially invisible disability, often don’t have. Processed foods are generally considered less healthy than fresh. But, I am fortunate to have a husband who can cook when I can’t. I plan the meals and, if I can’t cook, he’ll quite often cook what I was going to or make up something on his own. I will admit, though, that we eat take-out a good bit more than I’d like.

Because of my migraines, I did start a ketogenic diet a year ago. It hasn’t cured my migraines, but I have lost 60 pounds and I feel better. I don’t necessarily recommend this diet for everyone because it’s hard to stick with and I philosophically don’t support cutting out entire macronutrient groups. But, it has worked for me so far; we’ll see if the weight stays off.

It is increasingly important that we get rid of fat-shaming in our society. We don’t have a good idea of what works for weight loss in the long-term, particularly for those who are disabled. Instead, I agree with the suggestions given by the author in the Vox article. I would add, particularly, that medical professionals need better education about the lives of those with invisible disabilities in order to better support our attempts to live healthy lives. Most of us are doing the best that we can with limited time and energy (and, for many, financial resources).

Disability makes life more difficult, but not impossible. With support from our medical teams and society, we can be as healthy as possible. Life can be good. Let’s do what we can to make it that way.

Catherine