sugar in the blood

weight loss, ambivalence, gays

Photo by Kira auf der Heide on Unsplash

First, I have a new story in Granta. It’s called “Stalin, Lenin, Robespierre,” and it’s the prequel to my story in Joyland, called “Warehouses” from the fall. I also have a story in the new issue of A Public Space (No. 31) called “That’s the Pain You Have.”

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This is an essay about my body.

As of this moment, I am 5’9” or 5’10,” depending on the doctor’s office (and inexplicably, the day). My weigth is less negotiable: 255lbs at both the doctor’s office and on my bathroom scale. I am a Type-2 Diabetic, and my a1C is 5.5, which, according to my doctor, indicates well-controlled blood sugar levels. I eat once a day. I drink about 32 ounces of a coffee per day, with Splenda, not sugar. I have no major allergies except coconut and lavender. I am astigmatic and myopic, and my vision is extremely poor without glasses. I do not wear contacts because I have a fear of bacterial infections and scraped corneas, and I was born with a congenital malformation of my urethra that required several surgeries when I was an infant. I have a very pale birthmark under one of my arms, I never remember which, and, as of about five years ago, a dark mole on my stomach that my doctor is tracking but finds mostly uninteresting. I have a mole on my cheek, a beauty mark of sorts, and one on my shoulder that sometimes becomes irritated from my clothes and I think about having it removed. I have never broken a bone or torn a ligament. I don’t have any major scars. I had surgery a lot as an infant, but my only other surgery came in my adolescence, when I had laser surgery to correct a weak muscle in one of my eyes and when I had a root canal. Once, my doctor told me that I had very large optic nerves and that they terminated in the wrong place. I have to get my eye pressure checked often because my father has glaucoma and large nerves are a risk indicator, but as they haven’t changed size in the last fifteen years, I think it just means that I have large nerves in my eyes. I am exceedingly ticklish. My family and my friends from Alabama have always told me that my hands are soft. My mother used to withdraw from me because she said my hands were eerily smooth, soft, and warm. She said it was like touching something alive. My friends just found it amusing. They have gotten rougher, at least to me, from racquet sports. But, I think there are people with softer hands. I meet them often now.

Late last spring, I finally switched from my GP in Iowa City to a doctor in New York. It only took a year and a half of living in New York to make that change. My doctor recommended that I see an endocrinologist because I was a diabetic and it is usually a good idea to have someone who specializes in that sort of thing when you have a hormonal disorder. I had never been to an endo before, and it felt a little like a personal failure that I needed a large care team for my, to my mind, very simple set of medical issues. High blood pressure (because black, not because fat) and Type-2 diabetes (because, well, fat). All my other molecules were in good shape. Except my testosterone was very low. When she told me that, I thought, oh, that certainly explains a lot. It wasn’t that I had no sex drive. I had recently started dating again. I had recently started to be interested in sex again. The two were not the same thing, but they were, as is often the case, somewhat related. I thought, oh, well, cool. She also said my Vitamin D was low, so I would have to supplement it, but the endocrinologist would help me with that. And if my testosterone stayed low after making lifestyle changes, they would shoot radiation at my head and look for a tumor.

My endocrinologist took my blood twice in a month, and deduced that my testosterone was still very low, but that my blood sugar was, to him, surprisingly stable and good. I was not surprised by this. I don’t believe doctors believe me when I tell them that I don’t eat very much or very often. I think they imagine that I am lying to them. Because I am fat. But it is the case that I do not eat very much or very often. I do not crave sugar. I do not consume vast quantities of carbohydrates. Still, each time he took my blood, he marveled at the tiny non-miracle that was my perfectly normal fasting glucose and my a1C of 5.7. Anyway, his larger issue—as has been the case with most of my doctors—was that he thought I was too fat and needed to lose weight. I felt and continue to feel largely ambivalent about the size of my body. This feels like a major win after three decades of warfare waged on my self-worth by a world that actively hates the sight and existence of fat people. I was raised among and by fat people, and still, at every turn, I found myself insulted and pinched and hostilely weighed and judged from every corner. And so to be in adulthood feeling ambivalent toward my human form feels like a big victory. So when my doctor began to problematize my weight, I said, oh, okay, well, I’d like to be more active, so I’ll do that.

After that appointment last spring, I went back to doing things I really love. Playing tennis. Playing table tennis. Going on long walks through Central Park and trying to get myself to be more active. I wasn’t trying to lose weight. That was not my direct goal. My goal was to be more active. Because I feel better when I am active. My energy is better, too, and so I can read more, concentrate more, and work longer. I genuinely believe that activity is a thing that makes my life just a bit better or more tolerable. And it was true that I had become very inactive over the last couple years. Teaching, writing, book tours, and then a horrible, long depressive fugue that lasted about two years—all of it took me out of the world and away from myself, and it was just hard to get back into a groove. In the same way that it was hard for me to find my way back to writing after a long time not. So I began to take weekly two-hour tennis lessons. I did two-hour table tennis whenever I had a spare moment. I listened to a lot of audiobooks on walks in the park. It was nice.

I did also lose some weight, but my doctor was not satisfied in this. He wanted me to try intermittent fasting. So I said okay. I cut out even more carbs and fasted. And that too made my life a little better. The weird GERD like symptoms I’d been experiencing due to puttng my one meal a day off until night time went away when I fasted. No food after eight. Drinking lots of water. Keeping active. Eating more vegetables. I love vegetables, so that was no great sacrifice. I lost a few more pounds in pursuit of things I was enjoying. I figured, well, I feel stronger and better and more intentional in my life choices. And I lost some weight so the doctor should be happy. We are both getting something out of this experiment.

The doctor was not pleased. He wanted more. So he put me on Ozempic. Against my will. That makes it sound worse than it was. He said, don’t you want to lose weight? And I thought, well, I don’t care. I am feeling stronger and better than I have felt in a long time. I feel perfectly content continuing on as I have. But that was not really an option. When you go to the doctor, there is some assumption of optimization where possible. And so he prescribed me Ozempic. I began to take it because I don’t like disappointing people.

Do you know how it works? I mean, not the biomolecular action. I don’t expect that you will know that. I mean, do you know how you take it? It comes in this long slender tube. It comes with these needle heads that you screw on and then you inject it into yourself, into an arm or your stomach or somewhere. You hold very still and depress the button and it makes this clicking sound as it pushes the medicine into you. The other day, when I took my dose, I realized I’d had a suboptimal injection. There was a little bump. When I touched it, I was shocked to find it very cold because the medicine had been in the freezer. It was so uncanny. A little cold knot right there on the surface of my stomach, amid all the warm human flesh.

I had very mixed feelings about taking the medicine. Extremely mixed feelings. There had been a lot of stuff in the news about it. A lot of things about celebrities taking it, and then that spawning a mimetic rush of other people requesting it from their doctors. Because of its “off-target” weight-loss effects. Then, when the medicine went into shortages due to wild demand, a set of moral panics began to arise. These were compounded when stories about dangerous side effects came out—stomach paralysis, horrible nausea, cyclical vomiting, etc.—and you can imagine how it all played out. I felt a version of the intense shame that often comes with a Type-2 diabetes diagnosis. A feeling of lousiness. A feeling of self-revulsion for having “made bad lifestyle choices.” As if your metabolic status were some sort of read-out of your virtue or your worthiness as a person. Many of these feelings come out of internalized fatphobia and the hostility of American Protestantism, where health is treated as a sign of the elect rather than a fluid and dynamic state. Your health is your health. We should not be stigmatizing or problematizing health, and yet we do. It’s almost as if with scientific advancement, we have somehow gotten around to blaming people for the ways that their bodies respond and react at a molecular level.

I don’t believe that states of health should be stigmatized. That’s maybe naïve of me, sure. But I have come to believe that those commercials where we showed people with tracheotomies and tubes from smoking were probably not the way to go, in the end. Do you know the commercials I’m talking about? In the 90s and 2000s, they used to play these commercials where people who had emphysema or lung cancer or mouth cancer had their bodies broadcast to the American public as a warning to not smoke or do tobacco, essentially using these people like a blood eagle on a Viking battlefield. I think perhaps we might have thought more deeply about the dignity of human life and might have gone another way in talking about the risks of smoking and drinking. But instead, we made a medical state into a moral state, and I am not sure that was a wise thing.

The Ozempic moral panic is complex. But the most common narrative—at least that I see—is that people who take Ozempic “for weight loss” are stealing it from people who “really need it,” meaning, I guess type-2 diabetics. The active ingredient in Ozempic is a modified peptide called semaglutide. Its two main downstream effects are that it decreases blood glucose and also slows the progression of food through the digestive system, simulating satiety. These two effects, particularly the second, are what cause weight loss. And it is true that semaglutide was, for a long time, prescribed for controlling Type-2 diabetes. Semaglutide is available for weight loss under the name Wegovy. The issue that some people take is that the materials necessary for the production of Ozempic (semaglutide that is prescribed for diabetics) is being funneled either into Wegovy or that prescribers are prescribing Ozempic itself for exclusive use for weight loss rather than diabetes.

The issue I take with this narrative is that as a Type-2 diabetic, I was prescribed Ozempic not because my blood sugar was out of control (it was not), but because my doctor wanted me to lose weight. This is the case for many Type-2 diabetics, whose doctors feel that weight control is critical to long-term good outcomes. And for things like kidney health and heart disease. It feels insane to me that the people who “deserve” Ozempic are the diabetics because they “need it” for their sugar control while totally ignoring the fact that those very same diabetics are likely getting prescribed Ozempic for the very same reasons as the people who “don’t need it,” namely: weight loss. I actually don’t think that we should be creating classes of deserving and underserving with respect to medication. Particularly when those judgements are based on exterior things, like fame, wealth, privilege, or access.

When Mindy Kaling came under attack for taking Ozempic because why couldn’t she just exercise and diet and get surgery, etc., I marveled at the fact that people were viscerally upset that a person had gone to her doctor with a concern and had come up with a plan to address that concern. I think people seem to believe that weight loss is somehow cosmetic if one has enough money. And that it being cosmetic is somehow utterly decoupled from it also being a medical outcome. It just boggles the mind. The other thing is that when there came to be reports that going off Ozempic causes one to regain all of the weight one lost, people began to use this as a snide dunk. Like, “Just wait until they go off the drug and regain all that weight!” As though someone’s body reverting to a condition that they previously worked with a doctor to change, reverting, in essence, to their unmodified natural form, is somehow a punishment.

I am trying to understand how we as a society want to punish people for changing their bodies by wishing for them to be imprisoned in the body they tried to change, because that will show them. Let me try to explain it better: when a person who took Ozempic to lose weight and the public thinks they don’t deserve the medicine, there is a route to criticizing that person because they should just love themselves. And so the public begins to wish for them to return back to their original body, at which time, they point and jeer and, say look! see! You should have stayed fat and now you’re fat again! hahaha! It’s essentially using a person’s body as a punishment for not loving their body. It’s so carceral and insane that I can barely wrap my head around it.

I have talked enough about this. I do not want to talk about it anymore, and I already told an editor that I wouldn’t write about it, so I won’t. But you people need to release the cops in your minds.

Anyway, I have been on Ozempic for a while now, and I’ve lost a great deal of weight. Do I feel significantly different? Not especially. It is true that I am lucky to have experienced very few side effects of the medication. No nausea, no upset stomach, no other impacts to the other health indicators. Everything has been pretty much the same as before I started, except my body is physically smaller. The last time I lost a great deal of weight, people could not stop talking about it, pointing and saying how good I looked. Now I’m about the same size that I was then, except they seem to know better than to say anything about it. Though yes, the temperature of my reception by other people is noticeably warmer, but only in indirect ways. More people like my Instagram stories now, for example.

Yet, it is true that I have lost almost fifty pounds in six months. My clothes are much baggier, which is annoying to me personally. And it’s only when I touch certain parts of my body—the insides of my thighs, near to my hip bones, under my arms, my lower back, and other places—that I can feel a difference in the texture and density. I can feel more of myself, the deep structures of my muscle fibers and tendons, now. But it’s not like my body looks physically vastly different. It does not. I still look fat. I am still fat.

The other day, I had to go to the doctor for my three-month follow-up and as I was leaving, he asked if I needed any prescriptions. I said, yes, and mentioned that I needed a prescription of my beta-blocker. He squinted and asked why I was taking a beta blocker. I said because I had a panic disorder and my doctor five years ago put me on it and I’ve been taking it ever since. He said, no, you should take that. Beta blockers can inhibit testosterone and also make it harder to lose weight.

It occurred to me then that perhaps my testosterone has been low this entire time because I have been taking a medication for the sake of staying calm. He said, I should taper off and stop using it. Which necessitated getting a second prescription from my GP so that I can slowly wean myself off the medicine. The first couple days of getting Atenolol were, well, awful. My heart was beating slightly too fast all day. I felt anxious. My head hurt a little. I felt an intense pressure in my chest. But then, slowly, it evened out. I was halving the dose, so there was still something in my blood stream.

The issue is that I bought a Peloton last week, and it’s mean to be delivered later today. This is an issue because of one of the odd things about the beta blocker as a class of drug. When the medicine leaves your blood stream, for a period of time, it renders your body very sensitive to adrenaline. You are urged not to exercise and to limit activity for the period of time you are tapering. In this case, I am trying to do a two-week taper. So I cannot exercise. But this also includes other forms of activity that spike adrenaline or raise the heart rate. Jogging up the subway steps. Hurrying because I am behind on class prep and need to get down to office hours. Stressing about getting notes to my author. Opening my calendar and seeing the thirty meetings between me and spring break. Preparing to do interviews. Publishing a new piece. And, yes, exercise. But also. The rapidity of my pulse when I read the news. When I get into arguments. When something leaps out and startles me.

Over the last week, I’ve felt increasingly like Ralph Touchett from The Portrait of a Lady or Torvald from A Doll’s House. Something you may not know about me or that you probably already know about me is that I am a very anxious person. I am very prone to fear. And being startled. The other day, I saw a rat turn a corner in my building, and I gasped. I thought my heart was going to stop. And so I find myself in this odd position of being very afraid and also needing to be very calm despite being very afraid. And now I am waiting for a delivery of an item that I am going to use in order to exercise. So that I can maintain a degree of calm rationality. But of course I cannot use it because if I do, I could die.

How then does a person live—trying to avoid spikes in heart rate while also trying to be present and alive to what the world has to offer. Should I dig a hole and hop in? Should I just hope my heart holds out?

I suppose I should stop drinking so much coffee until I’ve successfully tapered off the medicine. But I won’t do that. No. Never that.

If I am so ambivalent about my body, then why buy a Peloton at all? Why investigate avenues of physical activity?

Well, I do have answer for that question. Not a very noble or very good one. But it is answer. Here it is: I would like to be able to socialize with homosexuals.

Walk with me on this.

The other week, I downloaded three dating apps. Tinder, Raya, and Hinge. I do this every eight to ten months. I download one or all three just to understand how gay men are living their lives. And every time I end up deleting them for more or less the same reason: that I feel alienated and bored. Gay men on these apps are: (1) always on the beach or a boat, (2) when they are not on a beach or a boat, they are in some sort of gym, (3) when they are not on a boat or a beach or in a gym, they are usually at some sort of outside gathering or in a dim restaurant. Those are the three phases of life for the contemporary homosexual who inhabits the dating app. They all have made-up jobs and spend all of their maximizing the exact amount they should increase their heart rate so as to attain a shape that will signal to the other homosexuals that they are a person who is sexually or morally desirable.

I do not have any desire to attract sexual interest from gay men. That ship has sailed. I am no longer twenty-eight. But what I’ve come to understand is that more than a set of methods to maximize their genetic gifts metabolically or physically, the culture of cosmopolitan queer life has accrued around the set of symbols and tableaux that have to do with exercise and beach-going. Even when they go to the park, they’re just in a tableau of the beach. I find it difficult to even speak to other gay men because I do not have access to the range of idioms of gym-going, beach-going, or club-going.

So I am acquiring a Peloton so that I can figure out how to speak to other gay men so that perhaps I will feel less alienated. I could watch the tv shows they watch or listen to the music they watch, but that is simply never going to happen. Exercise, I can do. Bravo, I cannot.

I suppose that when I was a younger person, I would have taken issue with the fact that cosmopolitan gay male life has these three zones and only these three zones and to exist outside of them is to be a spinster or unsexed. But I suppose, having lived for most of my homosexual life in the margins, I would like to try to be a little more available to my fellow homosexuals, and so I am exercising. Not to lose weight to become sexually available, but solely so that when I download another of these apps in ten months, I’ll have a picture of myself, sweaty, to post in my grid. And so that perhaps my life might become scannable to them, and that we might enter a phase of mutual legibility.

This, I think, is my version of the slutty era, the ho phase, etc., mutual legibility. There is a thing, perhaps, to be said about cosmopolitan gay life with its run of trendy night spots, museums, and gym-going. Its tableaux of endless leisure on beaches and on riversides and vast horizons. Its sacraments of casual drugs, casual sex, and tonguing some twink in SoHo. One might, yes, ask a whole constellation of questions about why this and not something more wholesome and Quaker-adjacent. But I think I have outgrown even those questions. I have grown bored with quietly judging and being quietly judged. I think, at this age, when I can expect to live another thirty or so years, maybe I am too old to be sad about not being invited to the party. Perhaps, there is no party. Perhaps, I should just let myself be seen, and to see others, and just get on the fucking bike and take the slutty picture of myself sweating, to imbue such a picture with no more importance than I would a picture of a stack of books. Because in truth, even the marginal gays have their tableaux, their sacraments, and cathedrals. The poetry reading is no more holy than the dark room or the sauna. In my experience, it certainly is no less slutty.

For a long time, I called a feeling ambivalence when in fact it was bitterness or jadedness or a sense of rejection. I think gay men acted as an antennae or amplifier for all the things I already hated about myself, and I was using them as a means of self-mutilation. But now they’re just dudes, honestly. Inert aspects of the landscape. I used to feel horrified when men perceived me. Then, for a while, I felt only confusion, as in, why are you looking my way when I have nothing of any use to you and you have no use to me.

I don’t know what I feel now when men perceive me. Mostly, I think I don’t perceive their perceiving me. I think I stopped trying to imagine what other people imagine when they see me. When I stopped doing that, my mind got very quiet. And people could surprise me again. And I was able to go through life without feeling quiet so much tension or pressure. I was able to mind my own business. The result is that when a does perceive me and I am aware of being perceived, there is a moment of shock, recognition, and then, a question. I have come to appreciate the frisson that lies in that question—never the same question, though of course it always is the same. That question of what will come next from this mutual perception. Will there be anything? Will it be nothing? Will we just go one signifying at each other and then stop.

I started this essay in thinking about my body, taking an accounting of it. Trying to figure out where I’m at with it. Trying to set down the frank acts of it. It’s not lost on me that it began exactly the way many dating apps on board you: asking about your height and weight. Taking in the quantitative reality of your body. Then layering in all of the social and moral implications. Why did I do that? Why did I tell you how tall I am? How much I weigh? Why did you change your evaluation of me as you found out those numbers? Or did you change? Did I change? What is the effect of this disclosure? I know that for me, talking about my body has always difficult. Because the result of those bodily disclosures has always been rejection or judgement. It’s always been, how much do you weigh, then silence. How tall are you, then silence. How big are you, then silence. Black? White? What are you? Top? Bottom? Every time I’ve ever disclosed anything about my body, the result has always been silence, rejection, or judgement. I say it again because it’s just now occurring to me that any time a person has said something nice about my physical appearance, I’ve always assumed that there was some deeper, more brutal truth that they weren’t saying, and that the nice thing was always some half-truth or half-measure. And that every time I’ve looked at a picture of myself, I’ve always looked with a set of eyes that are not my own, a set of eyes that are looking for deceptions. Look how close up it is. Look how far away it is. Look how he’s turned this way to hide something, hide what, I don’t know. Even in pictures I took myself. With no deceptive intent. I’ve always read all of the images of myself as deceptive. That’s remarkable. My whole life, I’ve been harboring a tiny shadow self, someone who crawls out in the night and pokes holes in all my socks and dreams. That shadow self is typing this very paragraph, insinuating that I’ve tricked you somehow in writing this newsletter. But I haven’t. I wasn’t trying to.

Earlier, I said that the Peloton would arrive today. It did arrive. I was in the middle of a meeting, and it came in with four men who assembled it. So I am writing the end of this letter, with the bike in the other room, waiting for me, whenever it’s safe for me to climb up. I am imagining that the tiny shadow self who lives in me has already gone into the room to rig the bike somehow, to make it unsafe for me to use. He can’t help himself.

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