Preface: The alt-title for this piece is Chronic Pain in the Age of Ozempic. If you are looking for that singular connection, skip ahead to the last section followed by the list of references. If you are interested in a narrative that sets up the personal context of a health journey, please read on. Because a person’s life is much more than a sum of their ailments, and ‘health’ is more than an absence of disease or infirmity.
A Weighty Issue Across Continents
When I was a little girl growing up in India, I heard concerns, advice, and jokes about my weight. I was thin as a dry stick; I needed to be ‘cured’ of my picky eating habits; I should be tied to a post when the wind blew hard.
My mid-twenties brought marriage, immigration, and the start of an academic career in distant lands. These necessitated adjustments to new foods, family, and routines, which made my 5 ft 4 in (164cm) frame to cross the 50 kg (110 lbs) mark for the first time in my life. Thus began the upward trajectory of my weight graph, in unexpected fits and persistent starts, accompanied by a new set of jokes about Indian women’s weight after marriage.
South Africa provided an eventful near decade of life experiences, and an additional ten kilograms (22lbs). Transitioning from the commentary about being under-weight to being over-weight, I tried hard to balance my stressful schedule as a young-woman-immigrant-starting-a-new-life-and-career with different diets, every single one of which I hated since they left me tired, or hangry, or both.
Our workdays in Johannesburg normally started at 5.30 AM to reach the sprawling campus of Wits University before 7.30. We walked from the parking to our offices, to lecture halls, to meeting rooms, to the tearoom, to the library, multiple trips to the staff loos down long corridors, then back to the parking lot around 6pm. These walks amounted to four to five kms everyday, for five days a week.
My time in South Africa was an eventful decade of much learning and unlearning, full of joys and stresses. The worst of the stresses was to witness the Alzheimer induced painfully slow fading of my father back in India. Then, just before my father’s passing, my mother was diagnosed with stage four colon cancer. It became the only time I lost my piling pounds to touch the pre-nuptial numbers.
Managing this double whammy from across the oceans with a full schedule in South Africa manifested in a health scare of my own. Following an unexpected surgery though, my melted pounds unceremoniously resettled in all their favourite places.
My mid thirties offered the opportunity to pack up a decade worth of experiences, and the kilos, to move to Canada. This take-two of being a young(ish)-immigrant-woman-academic-starting-a-new-life-in-yet-another-new country-and-climate came with the added bonus of a cancer-ridden-brave-mother in India and a stressful long-distance relationship with my spouse (and dogs) in Johannesburg.
With so much happening in my life, and due to the genetic lottery, I had won (or lost), I was not surprised to be diagnosed with hypertension shortly after my move to Canada. As I worked long hours and over holidays to juggle my academic work, journal editing deadlines, and filial duties, my weight lurched from early to mid 60 kgs (130-140lbs). This time, I tried different physical fitness regimen in the little time I had, each one of which left me too sore, or injured, or both.
After six years of trying to manage my life threads unravelling on three continents, came the year of tumultuous upheavals in 2010. It was a steep emotional rollercoaster of a year, of rekindled hopes, deep personal losses, and chronic pain. At the start of the year, our dogs arrived in Edmonton ahead of my spouse who was going to spend his sabbatical year with me. It was a much-awaited reunion marred by the uncertainty of its longevity. A few months in, my spouse unexpectedly lost his brother and then my mother’s long battle with cancer came to its expected end. In early 2011, after spending my fortieth birthday together, my spouse had returned to Johannesburg, while I returned to working on the various stresses of my life with the help of my friends and our dogs, in the pleasant company of my slight plump which I had become quite comfortable with.
The Weight of the Weight
While spending the last three months of my mother’s life in India in 2010, I had experienced recurring pain in my lower back. I attributed it to the emotional and physical exertion of spending long hours by the hospital bed of my gently fading mother. By the time I returned home in Edmonton, the pain had increased both in its persistence and severity.
Guess what my family doctor’s only advice to me was? Lose some weight.
As a health-conscious vegetarian, I ate healthy, counted calories, and was as active as possible. A possibility which was now being limited by chronic back pain that traversed down to my right foot. My family doctor’s stance made me feel irresponsible – as someone who had brought the pain upon themselves.
I increased my time on the home treadmill, which only increased my back and leg pain. Putting aside my feelings of guilt and awkwardness, I went back to the family doctor, who prescribed a painkiller. Instead of decreasing the pain level, it increased my blood pressure to much higher levels.
With the encouragement of dear friends in the medical profession who were concerned that by now I was dropping my foot, I mustered the courage to go back to the family doctor and ask for a scan of my spine. He was visibly upset at my suggestion and instead prescribed a nerve pain medication, which gave me terrible nausea, stomach cramps, and weight gain, but no pain relief.
Swallowing my pride and the bile, after nearly six months of escalating pain, I went back to beg for help from the unmoving doctor. He stood at the door of the consultation room, and without even looking at me, gruffly announced that his assistant will send a referral to a neurologist, leaving me with all my unanswered questions, and the persistent pain. That was the last I saw of him.
Another month passed before I got an appointment with the neurologist. I thought he was very friendly and has since been suspended for ‘violating appropriate boundaries’ with women patients. Based on a physical examination, he declared that I am displaying symptoms of pinched nerve(s) in my lower back. He did not think I needed an MRI or a change of medication. He also suggested reading resources to understand chronic pain as being more in my ‘head’ as a response to emotions, anxiety, or depression.
Guess what this neurologist’s only advice to me was? Lose some weight.
I was too embarrassed to explain my privileged yet exhaustingly complex life to him and was very grateful when the kind neurologist even passed on the name of a trainer, he regularly referred his patients to. I sang praises of this neurologists to concerned friends because after six months of repeated dismissal by the family doctor, the demeanor of the neurologist felt caring. At least he had accepted that the pain could be `in my head’.
After just ONE session with the trainer, my pain was bad enough that even my guilt of feeling responsible for it could not move me to see the trainer again. I continued with the ineffective pain killers, and the painful exercises, but still without a scan to investigate why I was in so much pain.
By now it was the end of October 2011 and time for me to take two long haul flights to South Africa for a conference presentation and my vacation. I had not seen my friends and family in SA for more than two years and my spouse for nearly a year.
A week before my flight, I emailed the neurologist to ask if it would be wise to undertake this nearly 40 hours-long-door-to-door-trip with so much pain. When he did not respond to my emails and phone message, I repeated to myself that the pain is more in my head and that he would’ve said something if it was a concern.
Torn between panic and excitement, I flew from Edmonton to London to Johannesburg, in severe pain.
A Terrible Turning Point
I was in agonizing pain by the time I arrived in Johannesburg and could not stand or walk without support. We got an emergency appointment with a neurosurgeon. The MRI scan confirmed that I had a herniated disc L5-S1. The neurosurgeon suggested surgery asap. I asked about recovery and rehab. He said it could take a few weeks to months. So, I asked him to help me manage my pain enough that I can fly back to Edmonton after two weeks in SA.
That’s how I got the first ever epidural of my life. On a live screen, nogal!
The epidural dulled the pain enough that I could do my presentation, visit with friends and family, and go on the week-long holiday booked in Cape Town with my spouse, all while dragging my right foot, popping painkillers, and leaning on my partner for support. I cannot explain in words the fright and despair I felt as I let go of the hand of my partner at the airport and clutched hard my walking stick for support to embark on my journey back home on two hellishly long flights.
The dog sitter had left by the time I arrived home in Edmonton late at night. The next day, Gauri and Appu were excited for their routine afternoon walk, which required me to drive them to a nearby off- leash trail. That’s when I discovered that I could no longer use my right foot to drive without pushing on my right thigh with my hand to press the accelerator.
I stupidly decided to drive and managed to make it to the walking trail with Gauri and Appu visibly relieved at the end of the not so smooth drive. They walked excitedly ahead, while I dragged on with the help of my walking stick for some distance. Soon my defiance had given way to palpable fear, so we cut short the walk and luckily managed to return home without any incidence, except the concerned looks from the two 100lbs dogs crouching low in the back seat.
Once safely home, I phoned my partner, had a good cry, dusted myself down, and called a cab to go to the women’s history event at the University of Alberta. Concerned colleagues saw me with the walking stick, heard my story, insisted on taking me to emergency, and stayed with me until I was seen to around midnight. The MRI showed that the ruptured disc bulge was blocking nerves, paralysing my right leg.
The goddesses of luck finally smiled at me with the allotment of the neurosurgeon. He was professional, patient, respectful, and ready for an emergency surgery the same day. I asked for a week to settle some of my most pressing duties, one of which was the Parkland Institute conference in which I was chairing a session. But most importantly, I needed that time for my partner to arrive from SA. The neurosurgeon warned me about the possibility of permanent damage. I told him I was willing to take the risk. He called me stubborn but let me make my own decision.
So, I cheerfully called my partner who was in the middle of marking 1200 final exam scripts for first year physics & engineering students. He finished his marking, got the senate approval for a one-year unpaid leave from his university, packed the contents of the apartment, got them moved into storage, all within forty-eight hours. Another forty odd hours later, he was by my side.
Dr. Richard Fox saved my leg and made me walk within hours of the discectomy. My partner’s unconditional support repaired our fraying relationship.
I worked for years after that to regain confidence in my body and, of course, to lose the weight gained during the gross neglect of the family doctor and the neurologist, with only partial success in both. My partner spent the next several years trying to rebuild a new community and life after the untimely end of his academic career which had defined him for three decades.
My spinal surgery had changed both our lives.
And now?
In the ensuing decade following the spinal surgery, we lost our beautiful dogs, moved from Edmonton to Vancouver Island, I had a couple more surgeries, and learnt various strategies to deal with chronic pain. Unlike the regret we feel (at least once a year) for leaving behind our snow-thrower in Edmonton, I was very happy to see the last of the home treadmill.
In the mild climate of the island, I was back to walking outdoor for three to five kms, and a half hour yoga routine every day. My partner started growing seasonal produce. I also progressed from counting calories to distinguishing between green and red calories, and to keep my intake between 1800-2000 calories a day. Nevertheless, despite a few short-lived dips, I have had the same weight for more than a dozen years, which being in the early 70 kgs (160lbs) range, had graduated from ‘over-weight’ to the technically ‘obese’ category in the BMI index.
The gods of surgical interventions were not done with me yet, subjecting me to a carpal tunnel surgery in Feb 2023. It was a painfully slow recovery, but I was most relieved for not gaining more weight during the nearly nine months of nerve pain and disrupted routine.
Before I could offer my gratitude to the vengeful gods, I woke up one fine morning in late 2023 with excruciating pain in my left knee. My walks and yoga came to a grinding halt. Hallelujah still, as I now had an empathetic and thoughtful family doctor.
SHE did not dismiss my pain, or told me to just lose some weight, or that it’s in my head. She ordered scans right away and started working with me on pain management and mobility support strategies. The MRI scans show disc bulges in my lower spine and grade IV chondromalacia patella in both knees, which is medical-speak for “argh, enough with these painful manufacturing defects already, please!”.
So, what have I learnt?
I have been writing these narrative essays to share what I am learning about the world around me from the perspective of being a cis woman, an academic of colour, a beneficiary of the caste and class hierarchies, and an immigrant in a settler society on Indigenous lands.
Penning my life’s journey along my weight chart, I am learning about fat-shaming and fatphobia, and that neither are just about women’s looks or their health. As my brilliant colleagues wrote in an article about the limits of fat positivity: women’s health has been used to reinforce and maintain bodily hierarchies. They also remind us of the political dimension of our relationship with bodily fat, especially in terms of the structural and material oppression experienced by fat people, which are exacerbated along racial and class lines.
There is another interesting dimension of our perception of body size along racial/cultural lines. We know that the socially constructed ideal body image in high income western countries is now globalized through media and sociocultural internalization. As non-western countries consume this imagery, body dissatisfaction and cases of eating disorders are on the increase in countries that did not historically ascribe thinness to health or beauty. Nevertheless, studies have found that regardless of income and education levels, Black and Brown women (and men), even in high income countries, have a more forgiving relationship with body fat and are less likely to obsess over their weight. Some studies have lamented this acceptance and the approval of larger body sizes as a hindrance to the motivation for weight loss, while underplaying its role in reducing psychological distress, protecting self-esteem, and without questioning the unscientific basis of the Body Mass Index (BMI).
Through the lens of my chronic pain issues, I am learning how the globally pervasive bias against women translates into social and medical prejudice, causing harm and prolonging suffering. Despite many privileges, my personal experience of gender bias in pain management has profoundly affected the course of my life (and that of my partner’s). But I have also come across many health practitioners who try to rise above the prevailing sexism and racism. They make me cautiously optimistic about the medical establishment and the help it can provide in my ongoing health battles. So, although I have never had a phase of life when I was not told to gain or lose weight (which has translated to: there is no ‘normal’ for a woman’s weight and that pain is its corollary) I have worked hard to not view the body as an enemy or as a source of shame.
Unfortunately, my most recent health challenge is unfolding in the era of fat-busting wonder drugs such as Ozempic, which are creating new markets of consumers obsessed with their weight by elevating the usual banal fat-shaming to an unprecedented level. The age of Ozempic is making it harder to keep at bay the feelings of inadequacy and frustration at not being the ‘ideal’ shape or the ‘healthy’ weight. And, once again, for feeling responsible for my chronic pain.
So here I am, processing these complex intersections by reading and writing, and hoping may my pain be your voice.
Meenal (April 2024)
References
Angier, Natalie (2000). Who Is Fat? It Depends on who you ask. The New York Times. Nov. 7.
Moretti C, De Luca E, D’Apice C, Artioli G, Sarli L, Bonacaro A. (2023) Gender and sex bias in prevention and clinical treatment of women’s chronic pain: hypotheses of a curriculum development. Front Med (Lausanne). Jul 25.10:1189126.
Pick, Rachel (2023). Ozempic has won, body positivity has lost. And I want no part of it. The Guardian. June 8.
Rodier, Kristin & Heather McLean (2022). What Taylor Swift’s ‘Anti-Hero’ controversy can tell us about fatphobia in feminist politics. The Conversation. Dec. 13
Shanouda, Fadi and Michael Orsini (2023). Ozempic, the ‘miracle drug,’ and the harmful idea of a future without fat. The Conversation. Aug 20.
SPLC (2011). Size Bias As A Social Construction | Learning for Justice
Tagle, Andee and Clare Marie Schneider (2022). Diet culture is everywhere. Here’s How to Fight it. NPR. Jan 4.
Thornborrow, T., Evans, E.H., Tovee, M.J. et al. (2022) Sociocultural drivers of body image and eating disorder risk in rural Nicaraguan women. J of Eating Disorders 10, 133.
UNDP (2023). 2023 Gender Social Norms Index (GSNI) | Human Development Reports (undp.org)
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