Would You Rather Be Thin or Healthy?

Note: this has spoilers about an episode of the show House.

It sometimes takes me a while to catch up on shows, and a recent example is House. Although the show ended in 2012, I only started watching it this year. (For those who aren’t familiar with it, it’s about a brilliant but ego-centric and unconventional doctor who diagnoses unusual medical issues.) While I’m not sure I like the character House, the medical situations and issues around them are often fascinating.

This occasionally includes issues related to weight, and of those, the most interesting to me was episode 10 of season 5, “Let Them Eat Cake.” The reason that episode caught my attention was because it forced a patient to make an unusual choice.

Would she rather stay thin and be sick or gain weight and be healthy?

Dilemma in the show

The show started when a young, thin woman who was a fitness trainer suddenly collapsed. After investigation, House’s team discovered that she used to be a lot heavier but lost weight after bariatric surgery. But they still couldn’t figure out what was wrong with her.

The final clue came when she had a piece of chocolate cake and, for a short time, made a miraculous-seeming recovery. That allowed House to realize that she had a type of hereditary coproporphyria which could be treated by the patient returning to a high carbohydrate, high sugar diet. This would also require reversing her bariatric surgery and would lead to her gaining some weight back.

The other option was for her to go on drugs that would address her symptoms but wouldn’t fix the underlying medical condition.

The young woman barely paused to think. She chose to use the drugs and stay thin rather than risk being as heavy as she had been, even though she would have been healthier by going back to her old diet.

My own dilemma

The patient’s choice made me feel sad, but what made it even sadder was understanding why she decided to go with the drugs. After all, I think it’s what a lot of people would choose.

In a way, it’s a choice I made, too, at least for a while. However, my situation was much less straightforward.

In my case, when I lost weight, I stopped having my period. Much as some people might be happy about that, it meant my hormones were out of balance, and I started losing bone density. By my mid-30s, I had osteoporosis.

I saw all kinds of doctors over those ten or so years, and at least one of them wondered what would happen if I gained back a little weight. The problem was, since we didn’t know why my periods had stopped, we weren’t sure what would fix things. And I was very reluctant to gain back any weight without knowing if it would actually help.

I’d like to think that if I’d definitely known my hormone and bone density issues would have been resolved by gaining 15 or so pounds, I would have done it. But I don’t know for sure.

The problem in the end seems to have been my cortisol levels, which were all out of whack. Once that got under control, everything else normalized and my bone density started improving.

Ironically, I’m about 20 pounds heavier now than at my lowest, which I wouldn’t have been happy about fifteen years ago. I’m okay with it now, though, and I often wonder if my hormone problems might not have come up at all if I’d stabilized at this weight.

Why thin over healthy?

When thinking about why the patient in House made the decision she did, or why I made mine, it’s not that hard to figure out.

House himself highlighted part of it by commenting that his patient had chosen to stay “pretty”, thereby reinforcing the idea that only thin women can be pretty. (Based on House’s relationships in the show, it’s clear he believes this, though not everyone does.)

For those of us who’ve lost a lot of weight, we know how differently we’re treated when thin vs. healthy. We also know how much easier it is to find well-fitting clothes and generally navigate the world in a smaller body.

That doesn’t mean that being in a larger body should be avoided at all costs, and it certainly doesn’t excuse the behavior of people who practice weight shaming or discriminate based on size. But these things do happen, and it’s hard to think about deliberately choosing the harder route again.

Ultimately, this seems like more of a negative reflection on our society than it does on the patient’s choice. And while things may be somewhat better now than they were fifteen or twenty years ago, we still have lots of room for improvement.

Prioritizing health over weight

This has all got me thinking again about the way our society correlates health with being thin and sickness with being heavy. But they don’t always align that way, particularly when factoring in mental health.

I hope more people can start realizing that and recognizing that being healthy is a good choice, even if it means you won’t be thin. And that being thin isn’t necessarily the best option if it means you’re keeping yourself sick to be that way, such as with an eating disorder.

It’s a complicated subject, but it feels like there’s been some progress. I just hope we can continue that progress.