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Carol Normadi is a licensed marriage and family therapist in Northern California who is co-founder of Beyond Hunger, Inc., a group dedicated to helping people overcome obsessive concerns with food. She has co-authored two books on the topic of food obsessions: "It's Not About Food: Ending Your Obsession With Food and Weight" (Putnam, 1998) and "Over It: A Teen's Guide to Getting Beyond Food and Weight" (New World Library 2001).
Normadi and Diabetes Health publisher Nadia Al-Samarrie live near each other, which led to a recent conversation between them about the stages that fat people go through in accepting and dealing with their weight. In some ways, those stages-denial, anger, bargaining, and acceptance-are much like those that grieving people experience.
Nadia: What do you think is the source of hostility toward people who are fat?
Carol: I think maybe it's suppression of the feminine, because fat is perceived as feminine. Yet fat, happily, is what gives us the ability to have a baby. You can't get pregnant if you don't have the energy reserves-fat-to support a developing child. When we as a culture went towards oppressing the feminine, we wanted to take off all those rounded places. That's one piece of it.
The other piece is that we as a culture try to define things in terms of good or bad, so religion, ethnicity, skin color, and fat are the areas where we place shame and judgment. I can't tell you how much hate mail people in the fat acceptance movement get when they put themselves on Twitter or a blog. They get tons of hate mail-really abusive stuff. We live in a world that is fat-phobic and prejudiced against fat. So, if you're dealing with a body that is " overweight," you're going to have some shame about it because that's what you've been taught.
Nadia: Let me play devil's advocate. If you have diabetes and are "overweight," you have to worry about certain complications. There are consequences that affect not only your own quality of life, but also society. If you're not taking care of your diabetes, someone else has to pay the bill for your neglect. This is where I think the topic gets really complicated. It's not just about your image and whether people like or dislike fat people. It also involves taking on the responsibility we all have for our own health.
Carol: Yes, everybody has responsibility for their health, and everybody has a responsibility to do the best to take care of their health, whether they are thin, or have a normal body size, or are fat. The difference is that because of society's prejudices, fat people carry around a layer of shame, and that shame gets in the way of taking good care of themselves. It's not that people who have larger bodies don't need to take care of their health just as much as people with smaller bodies do. It's that their shame often leads to self-destructive behavior. So, to get people like that to really show up and take care of their bodies, you have to first take care of the internalized shame.
Nadia: Could you say that not taking care of your body is acting out and is a form of anger?
Nadia: Can anger be an extension of denial? In other words, denial is where you don't see any need to cope with weight issues. But anger comes when you know you have to cope but don't want to?
Carol: Well, anger is a healthy response to being hurt or frustrated because you know you're expected to give up things you love. You know all the things you're supposed to do, and you resent them.
Nadia: Such as new considerations for your diet.
Nadia: And the social rituals you participate in.
Carol: Yes. Anger's a normal process. The thing is to have a relationship with your anger so that you can hear it and have other people hear it. But you have to learn how to express it without being self-destructive.
Nadia: Are there stages to working through denial and anger?
Carol: Yes. I think part of it is a matter of time. There's definitely a stage where you have to integrate your anger and get used to it and how you feel about it. I think that support is really important. If you see other people who are in the same situation who hear and understand you, and say, "Yes, this is really hard. I've been here," I think that's significant. That kind of support and information allows you to shift your thinking and focus on learning how to handle your anger and make a transition out of it. You may have a big burst of anger in the beginning, and it will continue as you hit walls along the way. But each wall you hit is part of the process of coming to terms with your anger, being able to acknowledge and express it, and finding people who can really hear you and empathize with you.
Nadia: Once people hear you and empathize with you, do you start bargaining? Is that the right term? Do you bargain with yourself?
Carol: Well, you bargain with God.
Nadia: What if you don't believe in God?
Carol: What I mean is that you are saying to yourself, "Okay, if I do this, I want the universe, or God, or my body to stop what's happening to me so I can get rid of this diagnosis." So it's your mind's way of trying to control what's happening to you. Remember, too, that all of the stages you go through may be linear, but you may not go through them in a linear way. You may move into denial, and then into anger, and then to bargaining, and then all the way back to denial in one day. So you can move in and out of the stages.
Nadia: Then bargaining is an attempt to control the outcome?
Carol: Right. You're trying to control the outcome, but can't. You can't control the diagnosis. The only thing you can do is things that support your body to be healthier. So, as you're trying to wrap your mind around having to do things differently-perhaps radically differently-you go into the bargaining stage. While you're there, you eventually come to terms with the challenge facing you. You understand that what you wanted to be under your control cannot be. But you also understand there are other things that can be under your control. That's when bargaining moves into acceptance.
Nadia: When you move into acceptance, is it permanent?
Carol: Not always. Bargaining is the place from where you can move forward into acceptance or backward into anger. You might go back to anger because when you bargain, you're trying to control the situation by offering a sort of bribe: "Hey, if I pray every night, or if I'm good to my mother, or if I run every morning, the diagnosis will change." But when that doesn't work and your body doesn't cooperate by accepting the bargain, you get angry at it and at the fact that you're going to have to give up certain behaviors.
Nadia: It seems that you can be shifting between all of these stages all the time. It's not like you have to complete one stage before moving on to another, or that you get a certificate for completing each stage.
Carol: Yes! Monday you're in denial, and Tuesday you're angry, and by Friday you're in acceptance, but by Saturday you're having second thoughts. It just takes time and an awareness of what you'll be going through.
(Editor's Note: This is the first in a series of interviews that Nadia Al-Samarrie will be conducting with Carol Normadi on the topic of people's attitudes toward food and weight and how they can think about them in more positive ways.)
Categories: , Author Carol Normadi, Beyond Hunger, Diabetes, Diabetes, Diagnosis, Fat, Fat People, Food, It's Not About Food: Ending Your Obsession With Food and Weight, Over It: A Teen's Guide to Getting Beyond Food and Weight, Overweight, Weight Loss
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