To my fellow "genetically fat" folks:

TW: weight loss, weight gain, fatphobia, medical neglect, medical advocacy.

If you were overweight as a kid, and it just kinda got worse the older you got, and then you spent your adult life fluctuating between gaining and losing the same 20-30 pounds that didn't quite get you to the 60-100lbs you need to lose...

• Check your hormone balance.

• Get tested for food allergies.

• Get treated for "dopamine eating" if needed, whether you go the medication or therapy or surgery route.

• Manage your cortisol levels, again, however works for you.

If it's not any of those, at least you've ruled them all out. But it was literally all four for me.

• I needed to control my hormones with medication before I could see any results from exercise.

• I needed to eliminate five allergens from my diet, that were causing me to hold on to a very specific weight pattern even the exercise and hormone regulation didn't touch.

• I have AuDHD, and have two primary dopamine hit suppliers in my life - eating, and bargain shopping. And I am fully okay with letting the world know that I need pharmaceutical intervention to help me control these impulses. I can't do it without, my entire life without Contrave is testament to that.

• And my brain craves that dopamine hit the most when I'm the most stressed. See: being neurodivergent, undiagnosed for 40 years, in a neurotypical world that thinks you're also neurotypical and expects you to keep up. See also: undergoing multiple major surgeries in a short period of time. See also: adjusting to a newly significantly disabled body. See also: perimenopausal abdominal fat accumulation.

All things that it took 40 years, and my insistence on fucking around and finding out with my body, to get these diagnoses, figure out that's why I'm holding on to the fat, and figuring out what I need to do to finally shed the fat based on the real root causes.

The fatphobic people are wrong: I needed medical testing and intervention and a customized diet and exercise and medication plan that had never been suggested or offered to me by any medical professional in my life before this - I had always just been told to eat less of the fast food I didn't eat anyway, and get more exercise than the hour per day I already got. When that's the case, your weight is absolutely not your fault, you don't have any of the tools for the job at hand. And it's certainly no "moral issue."

But what is your responsibility is to be your own medical advocate, or at least to appoint yourself a trustworthy person as your medical advocate if you don't think you have the fire for it. It took putting myself on the Autoimmune Protocol and showing positive changes in my weight and pain levels to get the referral to an allergist. The hormones were a surprise, I just wanted to skip my period while I was camping. I basically had to go to my PCP with a hypothesis and my evidence for my argument, and ask for testing to confirm or deny, for every single contributing factor I could identify. It's a whole other kind of hard than the diet and exercise grind you're sold. Welcome to your Dr. House Era. But it is possible, and hopefully my list gives others a good starting point for their medical mystery solving. And hopefully your country's medical plan covers it.

Not wrong.