Someone asked me recently, after reading the book, if I “support weight loss surgery as a solution to obesity.” After all, it’s the only weight loss method that “works,” in the sense that the data shows people usually do lose a lot of weight and keep it off much longer than they do from dieting. But I don’t support pathologizing fat bodies. I don’t support any system that requires people to take on the risk and side effects of a major operation in order to become socially acceptable. And I don’t support weight loss as a strategy for health.

Here’s what I do support: People. Who know their lived experience better than me. Who have the right to decide what to do with their bodies and deserve our respect for those decisions. #HAES hasn’t always done a good job of supporting fat people who decide to take this step. And it IS hard to frame bariatric surgery as being about anything other than weight loss since that’s the most visible result. But Gina’s story shows it doesn’t have to be. Her reasons for choosing the surgery are complicated, but they aren’t about wanting to be thin.

I hate ‘before’ and ‘after’ pictures. It was work to love myself before weight loss surgery and it’s work to love myself now. I am a ‘during’ at all times.

—Gina, page 173

I thought about this quote when everyone was showing their #10yearchallenge photos a few weeks ago, and it popped into my head again today while following some of the #nedaweek discussions. How different everything in our culture would be if we got away from #beforeandafter photos as markers of self-worth. If we stopped thinking of our bodies as available to trade in or trade up. We could make all sorts of decisions (including about body-altering things like WLS) from a place of true body autonomy. Because we are all durings, at all times.

There’s more on Gina, and the paradox of weight loss surgery, in Chapter 6 of The Eating Instinct.