This post is a natural extension of my last post on self identity. Of the many components that make up our self identity, our body is often the one we most strongly identify with. Much of the course of our life is informed by the physical characteristics of our body; its age, shape, size, color, and overall health. We use it to communicate with others and manipulate our environment, and how others judge and interact with us is very heavily influenced by our outward appearance.

Although we intellectually understand that our body will change as we age, it often comes as a shock when it actually happens.  In my mind, my body is the same as it was at around age 20 – young, slim, and fit.  The truth is that time and the stress special needs parenting have taken their toll.

The response to chronic stress varies greatly from one individual to the next.  Some people lose their appetite, while others like me tend to reach for comfort food.  When Sarah was very young, we were frequent visitors at the local emergency room.  (I’m pretty sure we had a punch card: come in 10 times and the 11th is free.)  On the way home I would invariably detour through the nearest fast food drive through.  Add in chronic sleep deprivation and a busy work schedule and some days it’s almost impossible for me to make healthy meal choices.  I strive to build in time for exercise when I can.  Now that we have full-time nursing and respite care, I’ve resumed going to a yoga class.  The real stimulus behind this blog post was the eye-opening experience of buying yoga clothes for the first time in 10 years.

They don’t fit into little
pretty places. These hips
are free hips.
They don’t like to be held back.
These hips have never been enslaved,
they go where they want to go
they do what they want to do.
These hips are mighty hips.

~Lucille Clifton~

Despite the misconception that having the perfectly proportioned body is purely a matter of will power, one’s body shape and size are largely determined by factors outside of our control. Genetic inheritance is an obvious contributor.  As I’ve gotten older, I can see that the distribution of fat on my body (abdominal girth with skinny calves and ankles) is almost identical to that of my mother and maternal grandmother.  A number of genes have been identified that regulate the perception hunger and satiety and predispose some groups of the population to obesity.  There are other less well recognized factors that affect one’s weight.  For example, the type of bacteria in your gut can effect how efficiently you digest nutrients predisposing you to being either lean or obese.  Chronic partial sleep deprivation (regularly sleeping less than 6 hours per night) causes alterations in appetite regulation, insulin resistance, and blood sugar regulation leading to increased food intake and decreased energy expenditure.  Increased cortisol production from chronic stress can, in turn, alter production of other hormones that regulate appetite leading to obesity.  There is also emerging evidence that maternal stress during pregnancy can lead to ‘fetal programming’ which may influence the ultimate adult weight of the fetus.

The body can be a great source of suffering or a direct path to awakening and there are many Buddhist practices focused on the body. Mindfulness of the body is the first of four foundations of mindfulness that lead to awakening as taught by the Buddha in the Satipatthana Sutta. The Buddha said,

There is one thing that when cultivated and regularly practiced leads to deep spiritual intention, to peace, to mindfulness and clear comprehension, to vision and knowledge, to a happy life here and now, and to the culmination of wisdom and awakening. And what is that one thing? Mindfulness centered on the body.

On the other hand, it is best not to be overly attached to your body because it tends to change over time and is prone to injury, illness, and death.  The Buddha encouraged his disciples to consider the stages that a decaying corpse goes through – from the initial moments after death all the way through to when the bones turn to dust, and to imagine that it is the monks’ own body decomposing.  In a previous post I investigated the practice of contemplating the asubha, or non-beautiful elements of the body, such as blood, urine, and pus.  The Buddha encouraged his followers to consider the various parts of the body as if they were reviewing different types of grain in a bag…

Just as though there were a bag with an opening at both ends full of many sorts of grain, such as hill rice, red rice, beans, peas, millet, and white rice, and a man with good eyes were to open it and review it thus: ‘this is hill rice, this is red rice, there are beans, these are peas, this is millet, this is white rice’; so too he reviews this same body…

The body is the vehicle we use to navigate through life.  Just as the car you drive reflects your personality (Prius, Hummer, Maserati), your body is also a part of the complex composite called self.  But, your car is not your self and neither is your body.  A car develops wear and tear with time and use – small scrapes and dents, a vibration that wasn’t there last year.  It periodically needs an oil change and new tires.  It might be damaged in a wreck.  The body is similar: take care of it but don’t become overly identified with it because it will not stay the same.

The fashion and fitness industries would have us continuously striving toward the mostly unattainable physical standard of a perpetually youthful, skinny, blemish-free exterior.  The body positivity movement emerging over the last decade is a reaction to the fat shaming that had become rampant in society. (Fatty-fatty two by four… sound familiar?) On the one hand, fat shaming helps no one and I applaud the body positive movement.  On the other hand, I am a doctor and I see the impact that an unhealthy diet and lack of physical exercise have on my patients.  Every year I admit several young teens to the hospital with new onset type II diabetes, a disease that only affected adults when I started training. We can’t ignore the impact on ourselves and our family – as well as the cost to society – that obesity, diabetes, and heart disease have.   The challenge is to find just the right balance between optimizing one’s physical health, while also embracing the body nature gave you.   It’s one of life’s paradoxes: accept yourself as you are, but also try to be the healthiest you can be.  Heart disease and stroke run in my family and I have to think about what is going to help me maintain my long-term health and capacity to care for Sarah. She will never be able to care for herself and the day will come when she will be dependent on strangers for care.  I’d like that day to be as far off as possible.

When the subject of fad weight loss diets inevitably comes up, I usually say that I’m on the Goddess Diet:  I eat as much as I can so my body will look like the Venus of Willendorf. The truth is that I enjoy exercising when I get the opportunity and I’m mostly a pescatarian with the occasional cheeseburger thrown in on days when the stress is just too much. When I start to feel bad about the pounds and bulges of tummy fat that I have accumulated over the years, I remind myself that every gram of adipose is an homage to the many sleepless nights spent battling Sarah’s seizures.  Every wrinkle and gray hair is a testament to the long hours I put in at work caring for sick children.  My droopy boobs are the result of a cumulative of two and a half years of breastfeeding my wonderful children. My chubby belly and skinny ankles are a memorial to my mother.  I have earned every single ounce reflected on the bathroom scale and I should glory in them!

Admittedly, this is a work in progress.

Body is something you need in order to stay
on this planet and you only get one.
And no matter which one you get, it will not
be satisfactory. It will not be beautiful
enough, it will not be fast enough, it will
not keep on for days at a time, but will
pull you down into a sleepy swamp and
demand apples and coffee and chocolate cake.
Body is a thing you have to carry
from one day into the next. Always the
same eyebrows over the same eyes in the same
skin when you look in the mirror, and the
same creaky knee when you get up from the
floor and the same wrist under the watchband.
The changes you can make are small and
costly—better to leave it as it is.
Body is a thing that you have to leave
eventually. You know that because you have
seen others do it, others who were once like you,
living inside their pile of bones and
flesh, smiling at you, loving you,
leaning in the doorway, talking to you
for hours and then one day they
are gone. No forwarding address.
~Joyce Sutphen~


This post is dedicated to my mother who left no forwarding address.
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5 Responses to Body

  1. Lynne says:

    Good advice, Doctor: accept yourself as you are but also try to be the healthiest you can be. The paradox of balance. It seems so simple but can be so hard. Thank you for your provocative post and best to you as you work to balance your latest challenges.

    • Vipassana Momma says:

      Thank you, Lynne, for being part of the group that helps me find that balance in several aspects of my life.

  2. I love this post — every single word. Thank you.

    I was effortlessly thin as a child into my young adulthood — barely any exercise and ate whatever I liked. I was a bookworm. I have struggled with the new me, 23 years after giving birth to first, Sophie, and then my two boys. I think the constant stress of caregiving, the surges of cortisol have changed my physique irrevocably. I’m learning to love it as it is, to exercise because it’s good for me, and to continue to enjoy food. Sometimes, when my daughter seizes, I describe it as a certain amount of ounces that have been applied to me. Dark humor, too. About everything. Namaste.

    • Vipassana Momma says:

      Special needs parents tend to feel quite isolated. It’s one thing to know intellectually that we aren’t alone in our experiences; It’s another thing to actually hear from others who are going through the same issues. We have a lot in common. I’m glad I know you.

  3. Debra Stevens says:

    And to mine, who left in December 1993
    Thank you VM

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