Health is not the Goal
If I tried hard enough, I could start fixing the problem that was my body.
Back in my early twenties, I was training to run my first half marathon, and a friend who was enrolled in a nearby medical school came along for my first attempt to run eight miles. While we jogged at a slightly brisker pace than I expected, and while I quickly tired, we talked about the training he was getting to someday become a physician. We passed through sun-dappled shade and I felt a bit embarrassed; he had recently run a marathon, and this distance was no sweat to him. My legs were on fire and I was so, so tired. We still had three miles to go.
Bouncing along with post-marathon ease, eager to share med school insights, he asked me what I thought would be a doctor's goal for a sick patient. I pretended to be thinking, trying to catch my breath.
"Health," I said, breathing hard, my shoes pounding over the root-tangled trail. In my mind, any person who goes to the trouble of seeking out a doctor wants to put their body in peak condition. Health. Everything in working order. Smoothies and workout leggings. Muscle definition. Upbeat workout playlists. Beaming smiles of straightened teeth. A good shoulder-to-waist ratio.
I was 24. I was comfortable applying this ableist vision of bodily perfection to a hypothetical patient because I thought I could get there if I really, really tried. I'd never broken a bone, never had a kidney stone, never been hospitalized for an illness. I was just lazy and busy, that was all. Only character flaws stood between me and a yogurt commercial body.
I had also been absent for a few years from competitive sports. I had lost some weight while teaching abroad after college, but then I'd gained it back. I was now stress-eating in a boarding school dining hall, surrounded by glossy-haired, athletic teens. I stayed up late every night writing too much feedback on my students' English papers, which they promptly shared with the garbage. I could barely imagine how anyone with a full-time job had time to exercise. I knew my body was getting soft. I hated it more than usual.
The half marathon training was supposed to fix this. I wanted to return to the level of fitness I'd enjoyed in high school, when I rowed crew year-round and knew with certainty that even if I lived in a larger body of two hundred pounds, I had the fastest 2K time on my team. Athletic achievement had been my armor. I wasn't really fat if I was fast. Here I was again, not competing in a boat, but hoping to win something back with movement. "Health," I said again to him on the trail. But I meant "protection." I meant "a step toward achievable perfection." I secretly believed if I ran enough miles I could be happy with my body, that everything could be different.
If I could have waved a wand at that moment in my life, I would have magicked away forty pounds of my mass. I would have made myself slender. When my friend asked me that question about a hypothetical patient, I could only imagine going to a doctor myself with the hope of being a completely different person. If I had gone to a doctor at that time in my life, I would have approached him or her as if they were a witch, and I would have asked for help becoming a girl who enjoyed salads and didn't eat much else, someone who didn't think of food much at all. Someone who was safe from feeling bad about her body.
When I guessed aloud that the doctor's goal for the patient would be "Health," my friend said no.
"The goal is to get the patient back to where they were, right before whatever brought them to the hospital," he said. Particularly in an emergency medicine scenario or sick visit, it was most productive to address the most recent crisis. He was learning that a doctor stood the best chance of helping a patient by focusing on that final straw that brought them in.
I was flabbergasted. This seemed irresponsible of doctors. Why wouldn't they give patients a punishing regime of ways to do everything better? Why wouldn't patients demand to know all that was in their power to improve? Why wouldn't the doctor be as hard on the patient as the patient was on herself?
Then I asked my friend if we could slow to a walk. I just couldn't do the miles. My body had its limits, as embarrassing as it was to admit. He clarified that doctors didgive patients lots of information. What mattered, however, was giving the patient an idea of what was most important. What mattered was not ultimate perfection, but knowing at least one step to get closer to normal functioning.
When you're a young woman who is unhappy with the shape of her body, it is hard to consider incremental changes or even to consider the idea that you might not have to be unhappy with your body. It was hard to realize that I was not doing myself any favors by being hard on myself. I could only think in extremes. I wanted to be skinny. If I couldn't be skinny, I wanted to be athletic and know that I could run thirteen miles right now. I could barely accept, even as I huffed and puffed on that trail, that I needed more time to get to eight miles, let alone thirteen. It felt so urgent to get to thirteen. I wanted someone to confirm the laundry list in my head of behaviors that would lead me to Health, protection, perfection.
I did not show up to a doctor's office like the patient in my friend's hypothetical question. Maybe I should have. As I plodded along that trail, listening to my friend, I was living with a deep, distressing, and obsessive discontent with how I looked in virtually every piece of clothing I owned. Other than my difficulty running five miles at a brisk pace, I wasn't unhealthy. I just knew that I was big. I knew deep in my bones it wasn't okay to be a dress size 14, and that I was running out of time to make it okay because I was getting older and didn't have school sports anymore, and signing up for this half marathon felt like the first move of a neverending list of corrective behaviors that I would someday (someday!) master in order to discipline my body completely, by which I meant, make some of it disappear.
My answer to my friend, the deceptively simple and insidiously all-encompassing answer of "Health," shows how dumb we get to be in our twenties. "Health" to me then meant dramatic weight loss. It felt like a reasonable and valuable and even urgent goal. During that very jog, I furiously, desperately wanted my body to do more than it could do in the hope that I could make it an entirely new shape, to fight time and the new pressures of adulthood, to chase perfection. It had not yet dawned on me that adulthood was actually about functioning in my own life, rather than posing for a textbook. It wasn’t health I was seeking at that point. It was a mirage.
I wish I'd had the insight to correct my own fantasy. I held onto that magic list of behaviors which I imagined would get my body under control long after my friend pointed out that you can't fix every problem all at once, and that most adult humans can't -- nor do they want to. I wish I'd gone to a therapist instead of only going on runs. I wish I'd seen more fat women in films and television. I wish I'd had the language of body positivity and fat acceptance. I wish I'd known that health exists at lots of sizes. The straw breaking the camel's back might not have been a medical condition. It might just have been an idea: that my body, which took me wherever I needed to go and most of the time moved however I needed it to move, was ever a problem at all.