What We Get Wrong About Trauma and Fatness

Losing weight will not heal us.

CW: Discussion of medical trauma, medical procedures, a critically ill child.

This will not be news to anyone, but: We’re in such a strange, hard place with the pandemic right now. We had our brief window of clouds parting/sun shining from mid-June to July, when I went to my sister’s blissfully normal wedding and ate indoors at restaurants and didn’t worry about taking my high-risk child along to the grocery store. And then Delta came and we went back to calculating the potential exposure risks of every activity; no to indoor dining; no to our town’s “Community Day,” even though they switched to open-top bouncy houses. No to flying across the country for my grandmother’s funeral. My kids are in school, but it’s still Covid School, with masks and distancing and mostly outdoor classrooms (and I’m profoundly grateful we have these options since so many places around the country aren’t able to do any of the above). We are so, so, so hopeful that kid vaccines are just a few weeks away but we also have no idea how long this stage of not-lockdown-but-not-normal-life will last.

Photo by Edwin Hooper on Unsplash

I have lived in this kind of limbo before.

During the first three years of her life, my older daughter underwent a dozen surgeries and many extended hospital stays—21 days, 32 days, 11 days, 38 days and so on. It adds up to about six months of our lives, spread over three years, spent sleeping on the hard blue caregiver sofa, showering across the parking lot at the Ronald MacDonald House, and eating in the hospital Au Bon Pain, with our baby, and then our toddler, immobile and tethered to any number of tubes and wires in a hospital bed. It was a harrowing and surreal time, when we were perpetually exhausted, afraid, and disconnected from the real world. I remember scrolling Facebook from her bedside one day and seeing half a dozen photos of people taking their kids apple picking and realizing: It must be Saturday. It must be September. It must be sunny outside. None of that existed for us. 

Something I learned, from living like this the first time around, is that this kind of trauma writes itself onto our bodies. This happens in different ways for everyone: More gray hairs, more headaches or other chronic pains, and of course, weight loss and weight gain. We respond to most of these changes—except, usually, weight loss—by trying to fix them. But we don’t blame ourselves for most of these changes, except, of course, for weight gain. When trauma underlies fatness, we see the fat body as proof that someone has not coped “well” with their trauma; that they carry unresolved issues; that they have resorted to food and a disregard for self-care because they lack other coping skills. 

Before Violet was born, I was thin. Not show-stoppingly thin, the way I was, thankfully only briefly, in my mid-20s, at the height of a disordered relationship with exercise. Just rather unremarkably straight-sized. I also didn’t gain much weight with that pregnancy, and lost most of it quite quickly in the first few weeks after she was born. Then, just as quickly, I began regaining it. By the time Violet was six months old, I weighed more than I had nine months pregnant. I moved into the “small fat” space and that’s where I now live. 

I want to say, very clearly: Fat bodies are not always traumatized bodies. Humans are a species with tremendous body diversity, and lots of people live in bigger bodies just because genetics shook it out this way. It is also normal for body size to increase with age and certain life experiences, like pregnancy, and we shouldn’t pathologize this benign reality of being a human. It is a manifestation of my own internalized fatphobia to explain my own fatness through trauma. But it’s also just what happened to me.

I sat in my daughter’s PICU room and ate chocolate croissants every day, sometimes twice a day, because I was bored and tired and needed both comfort and novelty. My husband forgot to eat and ran through the hospital campus every day, and trauma made him skinny. But I was too numb and exhausted to move. He has always coped with stress by escaping; I cope by nesting, hunkering down, being still. People around me often pushed me to do the other, even before my body started to change, but certainly after. I was encouraged to take more walks, get more fresh air, and make time for “self-care,” in the form of exercise. And that meant I had to also defend my decision not to do those things; to explain how, actually, I was terrified that if I left her hospital room, she might stop breathing. That this stillness was what I needed most. “If we were neutral about food and body size, then it would be like, okay, bring all the croissants and have as many as you want to comfort yourself and try to get through this really horrific time,” says Rachel Millner, PsyD, a psychologist who specializes in eating disorders in Newtown, Pennsylvania, and my guest on this Thursday’s audio newsletter. “Instead, we hold up some coping mechanisms as valuable, and vilify others, without seeing their wisdom.”

Photo by tabitha turner on Unsplash

I didn’t eat chocolate croissants forever. (I actually hated them, and everything Au Bon Pain serves, for a while because of their PICU associations, but now I love them again because, chocolate croissants!) They were a function of our deep crisis moments. But in some ways, the even harder times were in between those long hospital stays, when we would attempt to drop back into our normal lives. “You must be so glad to be home!” people would say cheerfully. They invited us to Normal Life Things, like drinks and barbecues. They didn’t realize that it was often so much scarier to have a medically fragile child at home, where we were solely responsible for her medication schedule and various tubes and drains, than to live in the PICU, which is a kind of prison but at least one staffed by people who know exactly how to repeatedly save your child’s life. 

At home, it was all on us. At home, my days began and ended with the alarm of her feeding pump demanding attention; in between my time was tracked in feeds and medication doses. At home, one day, the tube draining chylous fluid from her chest into a small plastic bulb popped a leak, allowing air to rush backwards up into her chest cavity. We didn’t have time to drive to the hospital. So I clamped the tube, cut it off above the leak and reattached the bulb, while my husband held our squirming toddler still and her heart surgeon guided me through the process over the phone with the same preternatural calm I imagine he uses with medical students because he knows if he displays any hint of anxiety, we will also panic and the patient is more likely to die. 

At home, every day, every outing, was a risk calculation: Can we fit this activity in between her scheduled tube feedings or will we have to syringe-feed her in the car or in a restaurant? Will everyone have a flu shot so we can go to the big family Thanksgiving? Can we trust the reading on the pulse oximeter or should we be in the car back to the hospital already?

And yet, some part of me still thought, in those years, that I should be using the time at home to “snap back.” To eat salads and go to the gym. I felt a little embarrassed about what I actually did to cope, which was to watch a lot of Gilmore Girl reruns, eat pasta, and do oddly absorbing, overly meticulous craft projects like making a dollhouse for Violet’s third birthday. I was still numb and also still nesting; our home had become a hospital, so I needed to make another home. I did not crave the cleansing release of a sweaty workout. I craved safety and comfort.     

I did find my way back to movement as a coping strategy and later just as a joyful thing to do. But my body has continued to change, and my thin body is likely gone forever. I had to mourn that, and adjust to a new reality. For me, that process became interwoven with the more extensive and ongoing adjustment process that all parents of medically complex kids undergo as we figure out what parenthood will mean for us. (Yes, Welcome To Holland both sums this process up perfectly and also doesn’t.) My parenthood is not what I expected. My body as a parent is not what I thought I needed it to be. But no part of this has been a failure. As Rachel said to me the last time I interviewed her about body changes and trauma: “Anything you needed to do to survive was ‘good for your health.’” 

In that conversation, of course, Rachel and I were talking about the pandemic and the collective trauma we are all now surviving. My pandemic has been, in so many ways, blissfully insulated by layers and layers of privilege, from real trauma. The threat is nowhere near as immediate as it was during Violet’s first three years. But in so many ways, where we are now—eight years after Violet’s first emergency surgery, five years after I repaired that chest tube—feels so fucking similar. The isolation of our PICU life was 2020’s long months of lockdown; the impossibility of sustaining normalcy in the time of Covid brings back our previous in-between times. I go on social media and see pictures of people going to concerts and taking their children on airplanes and to movies, and remember, none of that exists for us right now.

Photo by Tim Jamieson on Unsplash

One difference, of course, is that there are so many more people living this way now. Not enough, clearly, or we wouldn’t still be doing this. But most of my friends are doing the same kinds of constant risk calculations. They often land on different answers; some of them are dealing with even scarier situations than me, where there simply is no safe option for school or work. Some of them can accept more risk because they have protections we lack. But we’re all doing the same math, and feeling the same sort of burn-out, and the same fury when yet another article goes viral about how working parents (especially moms, especially moms in marginalized communities) are breaking under the weight of this whole thing without anything actually changing to make it better. 

And we’re all noticing how this long slog of trauma has changed our bodies, and, increasingly, our kids’ bodies—because they are living through this right alongside us. Lots of you have messaged to ask about the latest research documenting kids’ weight gain during the pandemic and yes, I have a piece coming soon that will dissect the science and give you more straightforward guidance on how to think about that data (no, anxious media headlines are not getting it right!). But what I keep circling back to is this: We not only assume that all fat bodies are proof of trauma. We also, erroneously, assume that making the fat body thin will heal that trauma. “That’s the part that’s rooted in anti-fat bias and untrue for the vast majority of people,” says Rachel. (See also her great Instagram post about this.) To let go of my trauma around having my baby almost die, I had to sit in a therapist’s office for months until I could finally say out loud to her, and then to my husband, and then much more generally, that I was sure it was all my fault. Then I could start doing the work of understanding that it wasn’t, and rebuilding my confidence in myself as a person capable of loving and caring for a child. (If your child has ever been critically ill and you need someone to tell you that it’s not your fault, you can email me at literally any time.) If, instead of seeking therapy, I had spent months dieting, I might have gotten thinner for a bit. But I would still be torturing myself by googling stories of crib death at 3am. It would not be any less horrendous to live like that as a size 10. 

Making a project of weight loss, right now, is unlikely to heal the collective trauma we’re all experiencing, or resolve any of our individual pandemic breaking points. It will not make the grocery store full of unmasked people more comfortable to navigate. It will not help your kids feel less anxious in school. It will not break the exhaustion of living this long in a state of hyper-vigilance. It will not make the grief of 679,000 Americans dead easier to bear. Weight loss as a response to trauma only ever reinforces our belief that all weight gain is, itself, inherently traumatic and pathological. But the ways our bodies change in the face of trauma are simply proof that we were there. And now we’re here.

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