uncontrollable bodies
it's about maybe being too fat for top surgery and how i feel about that
STRONG CONTENT WARNING for
EXTREME NEGATIVE BODY IMAGE TALK
FATPHOBIA
FATPHOBIC MEDICAL GATEKEEPING
FRANK DISCUSSION OF WEIGHT LOSS AND BMI
SOME WEIGHT NUMBERS.
HERE BE GREMLINS. BE YE WARNED.
Also, if you attempt to give me weight loss advice in the comments, I politely reserve my right to eat you.
Two months ago, I went to a top surgery consultation. Walking towards the strange little private hospital in a terrifyingly leafy and gated part of London, I felt like I was at the end of a journey past many obstacles: fundraising, getting a psychiatric referral, being fucked around by surgeons’ secretaries with the world’s worst organisation skills. Yes, my journey had been shorter and easier than many others, but it had still been tiring and difficult. But now, finally, I’d done it. It was over.
NARRATOR: haha. lol. lmao
Thanks for that. As you may be able to intuit from the title of this post and the content warnings, it was not over. The surgeon inspected my breasts (they are, apparently, ‘grade three’ - I did not ask if this was a good grade). He then asked me to step on the scales - “Can we just get an up to date weight?". I had already weighed myself - carefully, gently, reluctantly - several months before, duly made a note of the number, and put it in the surgeon’s patient questionnaire. But bodies, they will insist on changing. So when I weighed myself in the surgeon’s office, my weight had gone up slightly. Not significantly - not enough that I can honestly say I’d noticed - but up. The increase had taken me from just below the hospital’s BMI threshold to just over it - by 0.5. The surgeon was very apologetic - it’s not his limit. He let me cry for a little. But the hospital, apparently, would not book me in for a procedure. It’s a matter of insurance, apparently.
Is this one piece of information about me - this extra 0.5 units of unruly weight-to-height ratio - a reliable indicator of how safe I am to anaesthetise? If it is, nobody has explained it to me. Is BMI a reliable indicator of anything at all, apart from the statistically ideal size for a Scottish highland soldier in the 19th century? No. But none of this matters - it’s about statistics, and risk, and which kinds of risks are acceptable, and to whom. The line is drawn, and I’m on the other side of it.
It may have occurred to you that if it was only a small increase in weight that got me here, then I am lucky - a small increase in weight can be reversed, surely. Surely! I left the surgeon’s office agreeing that I would try to lose the relatively small amount of weight necessary to take me back down below the arbitrary safety line. I walked back through leafy north London to the bus in the rain, trying to keep it together. I had time; I wanted this; it was worth it. It would be worth it. To change my body, I just have to change my body. I could do it.
NARRATOR: they-
Thank you, I’ll take it from here.
From the ages of around 12 to 28, I was always trying and always failing to lose weight. Aged 28, sick of the daily misery I felt when I looked at myself, I decided that for my own survival, I had to choose to stop trying. I decided that I would never again set a new year’s resolution to lose weight, that I would consciously retrain myself to see my body and my weight neutrally, to accept its changes and fluctuations. I have written before about the tensions that arose with that resolution, when I realised how much binding my chest gave me joy, and started to feel that top surgery might also bring me joy. At the time I wrote that piece, the tension was on my mind, but it was somewhat academic - a tangle of thoughts to turn over, not an active dilemma. Unfortunately, someone somewhere is laughing at me, and decided to make it one.
I will simply come out and say it: for the past 2 months, I have tried to lose weight, and I have not lost any. A part of me wants to give you a detailed list of everything I have done, so I can say look, I did all the things I’m supposed to, it’s not my fault - but this is diet culture and fatphobia talking. I will say that I have tried. Some of the changes I’ve made - like changes in the ways and amount I move around - have felt positive; I have felt healthier. But they haven’t shifted my weight at all. It’s almost as if health doesn’t map to weight; who knew? (Everyone!). As I go longer and longer without losing any weight, it gets closer and closer to the cutoff point. Because my surgery needs to happen in the school summer holidays, I am bound by a time limit. If I miss this round, it will have to be next year. Can I stand keeping this doorway ajar for the next year?
For the past 2 months, I have tried to intentionally lose weight without opening up the part of my brain that used to make my life a misery. Before I shut away the possibility of weight loss forever, I used to wonder how anyone could make it through a conversation with me without becoming overwhelmed by their physical repulsion at my appearance. I used to marvel at the forbearance of everyone I spoke to. That’s a pretty extreme thought to carry around, and I managed to put it down by carefully excluding the prospect of weight loss forever. Letting that prospect back in has been terrifying. I have tried to keep my intentional weight loss safely contained - it’s temporary, it’s to get through some ridiculous gatekeeping, it doesn’t mean anything about me, it’s not like before…
But I have felt it creeping in. Sometimes there are cruel thoughts there - sure, you can cut your tits off, but you’ll still be fat! Those are easier, in a way, because I can take them head on. The harder thing is the grey joylessness that seems to have crept out and infected how I see myself before I even noticed it. The joy I used to find in thinking about my post-top surgery body has drained away. The joy I used to find in clothes has drained away. My body is an impediment, a stubborn, recalcitrant problem. And when I can’t find the joy any more, it’s harder to justify doing this to myself. Doubt creeps in about how much I really want this, if I can’t cope with losing weight to get it. I do little checks on myself to make sure. If I could magically remove my chest now, would I do it? Yes. If I were forced to choose between removing my chest and making myself thinner, which would I choose? Always the chest. It’s OK, I want this, it’s real. I can keep going.
The little thought experiments keep me grounded in the truth of what I think I want, but they’re also dangerous. They presuppose a sort of magical body-shopping which isn’t too far from the ideal future bodies diet culture tries to sell us. The idea that any available imagined body is mine for the taking feels like a dangerous one. But then again, this feels like it edges close to the TERF rhetoric about how trans people should know our ‘natural’ limits. What is it OK to want? What kinds of desire about my body are good, healthy, wholesome, supported? What kinds are representative of something bad, something wrong? I am trying to resolve all this in myself, its political implications, its emotional implications. And I am trying to lose weight, and my body is resisting me. And it hurts. I think that’s what I want to say most. It hurts.
It hurts to be trying to parse all this in a political environment where there is no space for ambiguity, no space for any false step. Can’t hack losing weight to get surgery? You can’t really want the surgery. Struggling with teasing apart dysphoria and fatphobia? It’s just like we said - you’re just a girl trying to escape a sexist body standard. Nobody has said these things to me, but they don’t need to. I know all the arguments; they are in the air. How much freer would I be to think it all through, if the cruellest parts of my brain weren’t given voice in the columns of national newspapers, in the judgements of the Supreme Court?
If I can’t get top surgery this summer, I’ll have to decide if I want to wait another year - subject to the same BMI demand, of course. I do want surgery, but if my body is going to resist losing weight so determinedly, can I keep trying to fight it for a year? If I’ve incurred this much psychic damage in two months, how much will I take in a whole year? What state will I be in if I make it to surgery in 2026 - a tiny amount lighter, sure, but how sane? What if I spend a whole year hoping and trying and still don’t make it? I have about another month to decide which is worth fighting harder against, the measurements of my body or the excesses of my mind.
It may be that I have to do what I did before, and close off a possibility. I don’t want to do this, but it may be that I have to. I am trying to prepare myself. Until recently, this felt terrifying, because abandoning surgery felt like I was abandoning so many other things - all the things I’ve been postponing until after surgery. After surgery, I’ve been telling myself, I will wear more flowers and glitter. After surgery, I will paint my nails. After surgery, I will ask more people to call me ‘he’ more of the time, and that will be OK, because I might have flowery clothes and painted nails, but my body will be different. After surgery, I will have ‘earned’ the right to ask for more, to present in a way that might confuse people, to transgress a binary by shifting my body along it. This is not a standard I would ever impose on anyone else, but it is the one I had imposed on myself.
And then last week’s news broke, and I realised that I’ve been kidding myself. Removing my chest will not ‘earn’ me the ‘right’ to anything. For the people who matter, I already have the right to paint my nails glittery and ask for ‘he’ pronouns at the same time. And for the people determined to keep me restricted and essentialised to a sex assigned at birth, it will make no difference at all. I won’t convince anyone to accept me who’s not already convinced. That doesn’t mean I don’t want surgery, because I do still, very much. But it does mean that if I can’t have it, I won’t be postponing things any longer. I will not be waiting to earn my place. My body will have its way.