Dr. Nance (2:37)

Absolutely. So buckle up, because this first story sets the stage for every everything to come. Anna, you ready to dive in?

Anna O'Brien (2:45)

Let's do it. Hello, Dr. Nance.

Dr. Nance (2:57)

Hi, Anna.

Dr. Nance (2:58)

Welcome to the show.

Anna O'Brien (3:00)

I know I'm. I'm a little nervous because on this first episode, it's me.

Dr. Nance (3:06)

You know, I don't know any other podcast where the co hosts actually interview the other co host, so I'm excited.

Anna O'Brien (3:15)

Yeah, it's a whirlwind. I think that it is important, though, because I think it makes sense as to why I'm here. Right. Like, obviously, you make sense. You're a doctor, but why am I here? I ask that all the time.

Dr. Nance (3:29)

Well, I'd actually love to start with the why. Can you share your intention of sharing your story?

Anna O'Brien (3:39)

Yeah. So my intention with all of this, and even when this came across my plate as something potentially to do, it really is that I've been on a really long journey. Right. And I would say that in some ways, I'm not even at the end yet, but every step I've taken forward has significantly improved my life and for a really long time. And we'll talk a little bit more about this when I, you know, share my story. I was afraid to take the first step because of a lot of the noise surrounding me. And I think if I can encourage just one person to take a step towards feeling better and whatever that means for them, because it is incredibly personal, then it will have been worth it. And I think that women are, in a lot of ways, built to be afraid of medicine and doctors and seeking health and. And we're sold so many other solutions that aren't really solutions that I'm here to advocate and speak for the fact that there are doctors out there that care, and it may just take some work to find them.

Dr. Nance (4:42)

Well, that's a great way to start. So you mentioned that you started to notice kind of some changes in your body. When were you aware that your body was not the same as everyone else around you?

Anna O'Brien (4:58)

So the changes in my body really started to happen around puberty. I just started to gain weight, which was kind of unusual because I was always a really active kid. Like, they. They used to call the church doors the Anna doors, because I was running in and out of them all the time, causing trouble. And I used to do this dance where I would move my feet really fast because it just had so much energy. So it was puzzling to a lot of people. How was I gaining weight? And the first thing went to like, oh, she must be eating wrong. Right. So I remember around that time when I started to gain weight that my mom took me to this really shady doctor in the middle of nowhere. And I remember even as a little kid being like, this place is sketch. And went in. There was, like, one of those little windows that they pulled open, and I looked inside and the woman asked me, like, three questions. Not one of them was my age or my weight or anything like that. It was literally like, do you have a heart murmur? Do you have any of these other conditions? Diabetes, I think. And this is like, at 8 years old, shut the Door took me in. This older man gave me a speech about why I was awful because I was overweight. And then he wrote me a prescription for what I now know was fen phen. So at eight years old, I started taking Fen Phenomena and Wild.

Dr. Nance (6:21)

Fen phen is a stimulant that was a popular kind of diet drug in the 90s, but it had significant side effects, mainly cardiac problems. So it is no longer used to treat obesity.

Anna O'Brien (6:39)

Yeah, let's just say that that's. I mean, to look back at that now and even to have had to do some things on my journey because of that, you know, because now what we know what fen phen can do to the body. There were concerns about heart issues when I was pursuing other things down the road. So I don't know why that was okay. I don't know why it was so casual. I think I'm still coming to terms with why my parents thought that was okay to do. But regardless of it, I was put on that and I lost some weight, but not really. And I just remember during that period of my life that every once in a while I would get to eat normal food. So my mom, I remember, threw everything away in the house, had this big menagerie where everything that, in my opinion, at the time, tasted good was in the garbage. We were left with brown rice, flavorless chicken, shredded wheat and vegetables. That's it. And. And I remember, and I have this very vivid memory of when I was about, I wanna say, 10 or 11, I went to my friend Nikki S's house and her mom made me a cheeseburger. And I remember sitting there eating that cheeseburger, being like, this is the best thing I've ever had in my entire life, this cheeseburger. Wow. And this is, like, cheese. It wasn't even probably that good of a cheeseburger, but because I'd eaten such terrible food for, like, a while.

Dr. Nance (8:11)

Like, we're talking in now cheeseburger or.

Anna O'Brien (8:14)

Yeah, like, it was probably, like, McDonald's cheeseburger. But I just remember being like, oh, my God. I was like, my life has forever changed. Like, music played, lights flashed. Like, it was like this amazing thing. And I didn't die. There were no issues, and I just had a normal day. And I remember. I remember that up until that point, I had a really weird relationship between pleasing my parents and losing weight. Like, I felt every time I got on the scale that I was a little bit of a failure because I wasn't losing as quickly as they thought I should have been losing, taking fen phen. But I was starving and still very active. So what. What ended up happening is life was just kind of, you know, bleak. And so I stopped. I would say in a little bit, I stopped being as active because I had no fricking energy. And my body started to change because I wasn't the same active person I was before. And I started to put on weight instead of losing it. And I think at this point, a lot of the articles and stuff that came out about fen phen, you know, we all got off of it because it wasn't legal anymore. So basically, I gained a bunch of weight, and I kind of just accepted it. In my 20s, I moved on from my parents. I moved into a really amazing group of friends. And I think that every friend group goes through this. I mean, I hope they still don't go through it, but back when I was in my 20s, everybody went through it, which was like the collective culture where girls got together and dieted together. So we did the thing that everybody seemed to do, which was join Weight Watchers, right? You know, we all got together. We'd go to our group meetings together. We would support each other, we'd share recipes, weigh in. And. And honestly, I built my friendships around losing weight. And that's a really weird dynamic, right, where that success in losing weight was also like a success of friendship when it doesn't work for you. As simple as that. It's. It's almost like you're a failure in your friendship dynamic, which is something that I'm. Honestly, I don't know if I realized until I just started talking about this part of it. But, like, I think as we fast forward and I stopped losing weight, I lost about £100 that way just by literally getting active as part of this Weight Watchers group. And I would go to Soul Cycle with these girls. I would run to SoulCycle, do one to two Soul Cycle classes, and run back. I started walking to work. So I would walk from Brooklyn to midtown Manhattan, which is about a four mile walk, and I would walk there and back. And I started just becoming really, really active again. I never was like a binge eater or an overeater, so it kind of was like my activity just jumped up and that's where the weight went. But then it stopped. I had lost weight and gained weight before, but this was very different because I was gaining weight while still maintaining a really healthy lifestyle. So I was still going to spin class, I was still running, I was still eating healthy, I was still walking to and from work. So it didn't make sense that I was gaining weight back. I honestly didn't know what to think. I felt very cheated. I felt very angry because I felt like I did everything right and this is my predicament. So, like, what? What the hell? What the hell? And I did start to feel. And I don't think I've ever admitted this to myself until this podcast, which is a little bit wild, but I think I started to isolate myself because I was embarrassed that I wasn't able to keep up with my friends who were making. Oh God, already crying, who are making all of these amazing changes in their life. And I was making the same changes but not seeing the same success. So you begin to build this mental capacity of like, I must be lying to myself. I must be a failure. I don't want to have to have the conversation about why isn't it working. And I don't even know if my friends judged me in that way, but I judged myself in that way because I built my entire community and friendship around managing weight. And then I couldn't be successful in that friendship because I wasn't losing weight anymore. I even felt that way partially in my job. Like, it's. It's wild to think when I'm really honest with myself, how much that inability to achieve that goal really messed me up.

Dr. Nance (12:59)

Well, I think which obesity as a. As a medical right and label carries an unwarranted moral judgment to it that does not apply to other medical conditions.

Anna O'Brien (13:20)

Yes, I think that there is a lot of stigma about obesity, and I think there's a lot of stigma about bodies in general and what visual cues they give us. So regardless of whether you're plus size or you use a wheelchair, people are going to assume an inordinate amount of things about you based on that visual picture. And as much as you may be different than that visual picture. You are never given the benefit of the doubt. In fact, you're always climbing back from a negative assumption. The hardest part about not losing weight for me was is that I didn't know what else to fix. And I think the automatic reaction to me was just to do more. But then what happens is, you do more. And, you know, I would eat less and less. I would work out more and more. And I. And I would say, honestly, running to SoulCycle, doing two classes and running back is probably not healthy behavior. It's just not. And there was one point in my life where I would have been proud of. That would have been like, look at all the exercise I was doing. But the reality is, it's like I was trying to compensate for what my body wasn't doing. And I thought, well, maybe if I just pushed harder, maybe if I just did more, it would change. And then when it didn't, I really did feel like a failure. I also felt like I was delusional. I think that's a really good word for. For my whole entire journey is like, maybe I'm lying to myself, right? Like, maybe I am eating all of these things. Maybe my calorie counting is off. Maybe I'm not exercising as hard as I think I am. Maybe I'm not going fast enough on that bike. So it becomes constant internal, like, what can I do more? Until you just break down and give up. And that's essentially what happened. I just finally was like, this is too fricking much. I'm done. And I started to feel just unconnected to my friends. So I dove into work. I would work constantly. I would sleep in the office. And in line with that, we were testing a new piece of software that was for content management for social media. We needed to test that software. I was like, well, I'll just make some Instagram content. We'll see if that does. Well, I don't. I don't really care. It's all about the job. And anyone who knows me knows that I am a somewhat recovering workaholic. I'm still working on it, but it is. It is who I am. So I became really good at regularly posting, at trying different things, because I was trying to test this software that helped brands and companies do that. Well, I worked really hard, and because of that, I inadvertently grew a following on social media just trying to test new technology. And it started off kind of slow. I remember I had, like 10,000 followers, maybe in the first couple months, and I was, like, blown away by that. I was like, I've made it big. But I had no clue what that would lead to. You know, you start with the 10K and then it's 20K and then it's 50K and then it's 100K and then it's, oh my God, 200,000 people follow me. But that also means that there is a lot of people who feel like they have a say in my life for good and for bad. Being in a bigger body is very polarizing. And sometimes that's just enough that just existing in a bigger body and not apologizing for it is enough of a reason to hate me. And one day I was a nobody. And all of the sudden I was like enemy number one to some people. And I think that's when I noticed actually, if I have to be incredibly honest, the time where I realized my life had been changed by this forever is I posted a picture of myself in a swimsuit, just a normal picture, just me on a beach. And Gillette, the company asked me if they could use it to just repost. And again, at this point, I didn't know anything about making money. I wasn't making any money. And I was like, sure, you can repost this, I don't care. They ended up using it. It ended up getting in the wrong hands and it became international news. People saying that a plus size person should not be used in advertising for a product like a razor. And it ended up to someone doing a podcast about whether or not plus size people should be in advertising. It was a very, very popular podcast. I'm not going to name it specifically, but they had a long about whether I should be seen or whether or not I should. People like me should be seen. And it led to me actually getting attacked on a sidewalk. And it's part of the reason I left New York. So I think that's. I think that's when it clicked that I was in a lot of ways powerful. Because if I could make somebody this angry, then, like, that's pretty powerful. But also I had to think about my life in a very different way. I had to protect myself and I had to learn to navigate in this world where people knew who I was and had an opinion about me. I also started to get very involved in the body positivity movement and this opened up a whole different world where my weight was seen in just a very different way for the first time in my life. So now I have this beautiful place in social media where people are like, you're beautiful, you're special. And we were talking about bigger bodies in a different way way. I had lived in this world where I had learned to accept negative, preconceived opinions of me and rise above them, which is again, a great skill, but not super healthy or amazing to live in. And now was presented with a world where I didn't have to prove anything, or at least it felt like I didn't have to prove anything. And that was, for lack of a better word, addictive. We were right in that crux of body positivity coming to light. So the acceptance of a bigger body was on the way of being more accepted versus less. And so there was a lot of advocacy, there was a lot of supportive people, don't get me wrong, still bad people out there saying mean things, that is the Internet. But it was definitely a better place. And that space gave me hope in a lot of ways. Hope that I could learn to live in this body and not necessarily constantly be focused on changing that body and the body. Positive community helped me stop measuring my value in a size and helped me start appreciating what my body was capable of. And I will always be grateful for that. That said, my time in that community did cause some harm. And I think that that's really hard to say because I don't want people to feel betrayed or hurt or like I'm biting the hand that fed me. But there's a lot of things in that community that make going to the doctor or even doing basic everyday things scary. There's a lot of discussion about how the medical community doesn't support fat bodies, which is true in a lot of instances, but it doesn't mean that all medical professionals are out to get plus size people. Also, there was a lot of discussion about it's okay to take a break, it's okay to be tired, which again, a valuable insight into life. But I began to feel like, oh, being tired is just part of a bigger body, being exhausted, being in pain, these things are just normal because I am plus size. So it began to write a script for me that this was just my reality and this is the reality I had to live in. And I just got, for lack of a better word, shitty cards and there's nothing I could do.

Dr. Nance (21:22)

This is a great segue into a question about when you started to think about perhaps your, your size as a more medical issue. If there were something else beyond just your size that was causing you to feel tired and everything that you just so described.

Anna O'Brien (21:49)

I'm going to be really, really candid about all of this. This is a podcast, so we're just going to be real, right? I hadn't had a normal poop for years, and it was beginning to affect my ability to do basic everyday things. And I would get so exhausted on top of this. Sorry, I just said the poop. Because I was like. That was the thing that, like, broke the camel's back. But it would also be things, like, I would go and have a great day. Like, I did all of these things. I'm like, man, my body's amazing. I can do all of these things. And then I would pass out, and I would physically be unable to leave my bed. Like, everything in my body would just break down. And I would be stuck that way for two to three days. I would have gastrointestinal issues. I sometimes would be vomiting. I would be violently ill. I started struggling to get out of bed, just in general. And I kept pushing myself forward physically because around this point, I started to feel in my body really broken down. So as I'm in this community, I just kept thinking, oh, the reason my knee hurts is because I'm fatter. The reason my ankle hurts is because I'm fatter. The reason my thighs hurt are because I'm fatter. The reason I'm tired is because I'm fatter. The reason when I stand up, I almost pass out is because I'm fatter. All of these things just became related to the weight, and that's just how my body was. And so I initially pretended like a lot of those things didn't exist. I think when it became really clear, I have one moment. I remember that is the moment where I realized I couldn't live like this anymore. I was in Hawaii. We were filming swimsuits or something, you know, as one does as a creator. And I couldn't walk in the sand. It hurt so bad. And there's a video of me somewhere. I'd burn it if I could, where I fall into the sand, and I just cry. And then I scream, turn the effing camera off. I don't want anyone to see me like this. I'm so ashamed. And I just. I was this person who represented someone who loves their body, and I was at war with my body. And in that moment, I was like, I am such a liar. And I think that moment is where I was like, I need to make some changes. And I did not share that with the Internet right away. I never shared that specific moment with the Internet because it was too personal. I sometimes wonder if I've hurt People, as a creator in the potty positivity space, I parroted a lot of the same messages that everybody else did. You know, love your body, indulge in what you want. Life is short, you know, don't feel like you need to have this health standard. And that line of thinking at a very high level isn't wrong. Right. But I often wonder if I have driven people to not seek health. And I wonder if there's people who listen to me, who believed in me, who. Who followed me and are worse off because of it. And so part of the reason I share a lot about my health journey is because I have that guilt. And that guilt is going to follow me forever. And I did it unintentionally, and I did it because I. My. My. I myself was broken. But I believe that there has to be this space where we can acknowledge that bodies come in different shapes and sizes, while the same time acknowledge that just because your body doesn't fit a certain shape doesn't mean you should not care how you feel. It's a really complicated conversation, and it is very nuanced, and there are a lot of very angry voices in it. And I understand why they're angry. Right. I get that anger because I've been there. And I. In a lot of ways, in some ways, I'm still there. But the messaging is at times causing the same problems it's trying to prevent. And I don't know if I'll ever be smart enough or eloquent enough to fully explain that dichotomy, but it is a community that saved me, but also a community that broke me. And that is a really, really difficult thing to explain.

Dr. Nance (26:40)

I want to share with you something that my mentor told me a long time ago about why people seek help. And he's a joint replacement surgeon, right? So he deals with people who have terrible arthritis in their knees and their.

Anna O'Brien (27:00)

Hips all the time.

Dr. Nance (27:01)

And he asked me, he said, do you know when people come to me and they say, I want a knee replacement? I said, oh, when their X ray looks terrible and they're so much pain. And he said, it's not about the pain. People can handle pain. And people are handling pain all the time. It's when you are emotionally fatigued from the pain that. That is when they come to see me and they tell me they need help. And so you should feel no guilt in that. You felt like it took too long for you to seek answers and reach out for help. I would say that's the norm.

Anna O'Brien (27:55)

Thank you. Thank you. For telling me that, honestly. Thank you. It got to the point where I was afraid I was going to die. I know that sounds dramatic, but I was also having extremely intense periods. I was bleeding constantly. Like, I just felt like my body was on the verge of shutting down. And if this is what living was like, then I didn't want to live. And so at that point, it became a choice of, do I want to die like this, or do I want to try and make it better? And it took me a year of therapy to get to the point where I could mentally see a doctor because I was so paranoid from all the things I'd heard. And part of that paranoia came from an experience I had when I first entered the body. Positive movement, where I went to a doctor. At this point, I was still really active. I was running about three miles a day. I was smaller than I am currently and eating, you know, pretty healthy. So I went to the doctor. I walked in, she ran all my labs. There was no nothing wrong. I did not have, you know, diabetes, pre diabetes. At this point, nothing was wrong with me. And she tried to put me on diabetes medication simply because I was overweight, even though my blood labs did not indicate I needed it. Then she tried to sell me a program where I give myself a shot. Shot and eat 600 grams of chicken or something like this. Do you know what that is, by the way? It's like some shot you don't eat, and then you eat, like, a tiny amount of protein, and that's it. And she was like, I want you to do this for 30 days. And I literally was like, hail to the. No, no, no, I will not. Do you know what I'm talking about? Do you even know what that is?

Dr. Nance (29:47)

I. I have no idea what that is. I mean, nowadays, you know, with the era of ozempic, right, People think shots.

Anna O'Brien (29:54)

That's.

Dr. Nance (29:54)

That's.

Anna O'Brien (29:55)

No, it was not. It was unpicked.

Dr. Nance (29:56)

Don't believe that was the norm.

Anna O'Brien (29:57)

This was like. This was before that. And it was like some crazy thing. And then you would reintegrate food. So I remember being terrified because she also sat me down and she's like, you need to exercise more. You need to do this. And I'm like, I'm running three miles a day. There is nothing more I can do. So I had had that experience, and now let's add to the table. I've gained back the weight, so now I'm 100 pounds heavier. What is that doctor gonna say to me now? If that was my last experience? What Is that doctor gonna say to me now? They're gonna say, you're trash. And now I've heard from everybody else around the Internet that when you get bigger, it just gets worse and worse and worse. And they're nasty and mean, and they do all these things. So my fear of the doctor was intense. So after a year of therapy, I kind of went through it. I saw a doctor through a process of extreme elimination. ZocDoc is amazing to get reviews on doctors, so you can at least get a gist of what people like and don't like about them. And so I read all of the reviews, and luckily, someone who was plus size had already seen this doctor and said that they were kind and compassionate and all of that. And I said, awesome. I'm going to go to this person that doctor, I can definitively say changed my life because they started the process for where I am now. And when I went in to see him, he sat down and honestly, I walked in with going back to shots. I said, just give me Ozempic. Just do it if it'll make me feel better. I can't feel this way. Because I honestly believed that the solution to my problem was that I needed to lose weight. So I had worked through therapy to accept that losing weight could help my health. I went through a lot of things to try to accept the fact that I was going to have to lose weight, right? And that that wasn't a bad thing, but it was about feeling better. So I went into this doctor and I'm like, just gimme the shot. And he literally looked at me and was like, how can I give you a medicine if I don't know if you're sick? And it kind of took me back. He's like, I'm not giving you anything until we read your labs. He's like, I don't know what's going on with you. And that is not a professional thing to do. Just hand over medication to a patient I've just met. So he ran some labs on me, and the first thing that came up is that I was in a really bad place. My instincts of the fact that I was on the verge of death weren't necessarily so wrong. I had major deficiencies in a lot of different vitamins. I had a lot of anemia, and I was losing blood. Additionally, I came back as positive for Hashimoto's. So I literally thought, okay, these are the answers, right? So put on the medication for, you know, get on Synthroid, which is what you take for thyroid disorder or Hypo or the what I should.

Dr. Nance (32:57)

Hashimoto's thyroiditis, you know, and it actually can. Can cause hyper or hypo, depending on its. It's your body's attack on your thyroid, which affects the production of the thyroid hormone. So a medication like Synthroid is given when you have abnormally levels of low thyroid hormone in your body.

Anna O'Brien (33:17)

Okay, thank you. So I got put on Synthroid, I got put on all these vitamins. Immediately. Things started to improve to a point. I started having more energy. I started having less days in extreme fatigue. So I started to feel better. And I was like, this is it. I've solved all my problems. I started to lose weight just because my thyroid was now working. That's a problem. So I was like, everything's solved, everything's done, everything's great. And it was good for a couple months, but then a lot of the stuff started to come back. So I did get relief. It's just not in the permanency that I expected. So I started to have fatigue again. I started to have anemia that we couldn't get under control. And my doctor was like, I think something's wrong with your menstrual cycle. Your lady bit something. Something's not right down there. So he said, I'm gonna refer you to an OB gyn. I probably needed to see one anyway because again, I hadn't been in the doctor in a really long time. So he referred me to someone that was with my insurance. And I walked into the room, and he had just built this great perspective of doctors for me. So I went in with full hope and full glory, like the entire medical community has changed. Everything is great. We're respected and cared about now. Yay. And this woman was absolutely terrible to me. She would not give me the treatment that my doctor had requested. I'd have, because she said that I was just too fat for it. And she refused to give me a pap smear for the same reason. She said that the only thing that was wrong with me was that I was too fat. And repeatedly told me this to the point where I broke down crying in the parking lot outside. I messaged my doctor in the little portal, and I said, I guess I'm just too fat for a normal period. And he was like, listen, I have a friend. He's not gonna be covered by your insurance, but he's good. He will listen to you. And he's my friend. His approach to medicine is the same as my approach to medicine. And I remember walking to that office and being like, this is gonna be a train wreck again. I don't know if I can take it if this happens again. I just. I don't know if I can keep going. And he sat me down, he said, I'm not here to treat your weight. I'm here to treat your illness. Again, that same kind of messaging where I'm like, okay, this guy has got it. So he did all of the things and he said, I'm gonna biopsy you. You shouldn't be bleeding this much. You are on all of these iron supplements and you're still anemic. That doesn't seem right. So they ended up doing a biopsy. They did find a growth in my uterus. And it was inconclusive. The test was inconclusive. So we could have been cancerous. It could not have been. And he's like, we're going to have a surgery date for you in three weeks. You need to get it out. So like, I went in from hearing, nothing's wrong with you, you're just fat too, to hearing you have a growth and it needs to be removed immediately because we're concerned about its size. Finding out I had to pay out of pocket to receive basic care just because I was in a bigger body was so frustrating and so debilitating. Because at this point, I'd already spent so much money. I was driving to see doctors. It's like I couldn't catch a break. And then to be in a situation where someone literally refused to give me basic care that my primary care doctor had already requested because they were concerned something was going on is wild to me. Right. And that that was an acceptable answer and that was okay. And that that person felt entirely comfortable doing it. And then to have to pay out of pocket to get the basic standard tests that lots of people get all of the time and find out, oh, I do have a tumor was just so incredibly frustrating. Like, why did I have to pay to find out something that we pretty much already had a good inkling might be happening? Just because someone didn't want to believe it. Someone didn't believe that a plus sized person could actually have an issue, that it couldn't be anything other than my weight, there's no way. And I had to pay for someone to believe me. So I was scheduled for surgery three weeks later. I had to have some really tough conversations about anesthesia and what that meant in a bigger body. But again, because I had a doctor that actually was educated about plus size, he was able to find an anesthesiologist to work with him that had worked on bigger bodies before. And I was able to have a really successful surgery. Fortunately, when we came out of that surgery, it was benign, the growth, and it was removed. But there began to be questions about my estrogen levels. They weren't necessarily tracking high, but the nature of the growth made it feel like there was potentially too much estrogen in my body. So it didn't make sense, let's just put it that way. And there's several times in my journey where things don't make sense. So that happened. And again, when I had the tumor and I had that removed, that was really scary because we didn't know if it was cancerous or not. It really came down to, oh, this is. This is a hormonal thing. This is, you know, maybe related to your weight, may not be. But, like, you know, we've solved it, and we have precautions going forward. That's never going to be an issue again. You're going to feel less anemic. I was like, we've solved it. Everything's done. I'm great. Things are perfect. And then those problems didn't go away. I still have issues with anemia. I still have exhaustion. But every time you go into a surgery or a major treatment like that, you hope on the other side that that's the answer. And it is a little bit of a heartbreak every single time you get that diagnosis and you start that treatment and you think, this is it. This is the time where everything gets better and I can magically be this person that I have dreamed of being or have been previously. And then you find out you can't. And it's hard to keep faith that you'll get there. One of the hardest things about being on a journey to figure out your health, whether it's something like I have or a completely different condition, is that you feel insane 75% of the time because you don't have answers like, answers, even if they're terrible. Knowing what's going on or even the hope of knowing what's going on is the only thing that kind of keeps you alive. Some days there's still so much I don't have answers for. And sometimes it does feel like, am I going to feel shitty for the rest of my life? Is my health going to be unpredictable and uncontrollable and unexpected for the rest of my life? So when I stopped losing weight, it became really frustrating. So I ended up working on a campaign related to weight, and I met a doctor that I really loved who studied obesity. Conditions. And I decided to take a next step and try to figure out what was going on by going to see her. So I started driving to Houston once a month to see this doctor. And I did start taking Ozempic. But the weirdest thing happened through that process is, yes, I lost weight, but not as quickly as they would have imagined. But what did happen is I started to have just a complete reduction in pain and increased mobility. So I started becoming more and more active because the barriers to my activity had suddenly been reduced. So it didn't hurt as much to kneel, or all of my joints used to hurt really bad. So she began to see that that was a little weird. That was another kind of weird behavior. And this starts a kind of trend of things just being slightly off. So she submits a swab for genetic testing for what's called the rare obesity panel. Now, this panel is not the same as the obesity gene panel that you see a lot of people are doing research on right now. These are for conditions that are classified as rare. So, so, like the weird ones, my doctor basically sat me down and she said, listen, I've never had a patient have one of these genes personally, but it is something that we just want to eliminate because your body is not showing normal behavior. So went in, had my rare obesity panel done, and lo and behold, I come back with two genes. So essentially what happened when I got my genetic results back is they give you a little counselor that sits down with you and walks you through your genetic tests. And what they mean, one of the genes is a known gene. It has a lot of different things associated with it. And then additionally, they were like, oh, by the way, these are so rare, no one will ever research them. So good luck, have a nice day. Goodbye. Like, that's literally what they told me. And my doctor there was like, I'm not a geneticist, so we can try things, we can figure out what we can do, but I can't guarantee that it's going to work because at this point, we don't really know. I haven't seen this before. I don't have any previous experience to go off of. She talked to some of her colleagues at a variety of different places. No one had seen the combination of the two genes, so there was just really nothing to go on as part of what do we do? About seven years prior to this, I got an email from a woman, and she wrote me an email and was like, I think you have this condition called lipedema. And I was like, it is so uncool to try to diagnose somebody on the Internet. And I unfortunately talked mad shit about this woman behind her back. And I feel bad because at that point I just was sick of people telling me what they thought about my health. And so I totally tuned it out. I didn't really. I didn't even believe it was a real condition. I think I need to say that. I think I need to say that I thought it was something made up. Like, made up, like, you know, hey, you're delusional. I'm just going to tell you that this is your diagnosis so you stop bothering me like a pseudo diagnosis. When I started going through this medical process, that word came up again and I was like, the made up disease. They're just telling me that because they don't want to say, we don't know why you're fat. Instead of saying that, we'll give you a fancy shiny word, you'll feel better about it, but it's just because we don't know. And that's literally what I thought for a very long time. So when I went to the obesity specialist doctor, I did bring up lipedema with her, mostly because I had received that email before. I'd had other doctors allude to that potentially being a problem, but did not understand the condition enough to actually say for sure if it was. And I just wanted a diagnosis. Sometimes you just want someone to tell you, like, yep, that's it. So you feel a little less crazy though. So I brought it up with her and she was like, yeah, like immediately. Yeah. And then she's. And then I was like, you're just gonna say yes? And she's like, well, we'll do a couple things. But yeah, it was kind of one of those things where, like, it's pretty obvious I have it because I don't have any weight on my hands and my feet with how big I am. And because I have orange peel texture, because I have so certain ways of accumulation, because it's completely symmetrical, because it's in certain parts of my body, there's just a lot of things that indicate.

Dr. Nance (45:00)

So lipedema is, you know, most fat that accumulates in the body. We have peripheral fat. We have something called visceral fat, which is on the insides in our. In our organs. And lipedema is a condition where the fat gets almost clumped together in a way that it will never go away with diet and exercise. So it's a type of fat that is different from the normal fat in your body and doesn't respond to the typical ways, how fat expands and decreases. So it's primarily accumulates on the thighs, Sometimes it can accumulate on the arms, but the character of the fat is also different. So whereas most fat is yellow and spongy, lipedema is typically more hard and isn't as mobile as regular fat. Lipedema is a real condition. It is difficult to differentiate between what is lipidemia and what is just say fat as part of general obesity. But specifically, lipedema does not respond to the general ways of how to decrease fat. And so you may be doing a lot of exercising and a lot of dieting and you may never lose that fat.

Anna O'Brien (46:34)

And I think on top of that too, I live a very public life. Everybody has the ability to see and comment on my life. So when I started talking about potentially having this condition, I received so much backlash that it must be just made up, which is crazy. Like I am an adult woman with an, with a good education and still when enough people tell you that you're crazy, you begin to wonder if you're the problem. So my obesity doctor did officially give me that diagnosis and was basically like, I'm out of my depth at this point. You need to go see a lipedema specialist. So we did some research, we picked a couple doctors which I then flew to LA because they were all in la, the ones that were pretty active in research. So I go to la, I go see this doctor and he's like, whoa, you got real bad lipedema. Like, it is real bad. You need to have surgery sooner rather than later. Now I've got to go back to that feeling about lipedema. I still, at this point, even though I was posting about it, talking about it, because I was trying to justify my body, but internally, deep down inside, I still was like, is this a made up illness? Is this a doctor in LA who wants to sell me plastic surgery? Because also that is what I heard from a lot of people online. I heard every single day about how I was taking the easy way out and that I was cheating and that I was going to this doctor to magically fix my problems rather than, you know, diet and exercise, calorie in calorie out solutions. And so I grappled with that even through the surgical surgery process. But I mentally decided if I knew I couldn't lose weight by making the healthy choices I'd made, then what was wrong with trying to get to a better body in this route? I just wanted to feel alive again because I think once you have a taste of that lifestyle and you're like, wow, if it was just like 25% better than this, then what, what are all the things I could do? Because I was still limited, right? So I was like, well, what if I can open up just more activity, more movement, more living. And I think one thing that has always bothered me, going back slightly to the plus size community, is they never talk about that loss of living. Let's throw all of the thing about healthy or unhealthy out, about bigger bodies. Let's throw all of that out. Let's say that there is literally no health difference. There is a loss of experience and a loss of living that comes from living in a bigger body. So we proceed down the surgical route. We get in for my first surgery and he goes, wow, your skin's really hard and fibrotic. He goes, stick. Still looking at you. I think I'm going to get in there and I think I'm going to need to take like, I think six liters or something. He gets in there and he ends up taking nine liters. And he said it was the most fibrotic he's ever seen anyone. So we're having a little bit of what that seems a little odd, but whatever. So we have the surgery. He removes way more. It says it's the most fibrotic patient he's ever seen. He said that my legs were literally like concrete under the surface. And I get through the first surgery and instantly my pain levels are entirely different. The first night in the recovery area, I'm dancing. I'm up on my feet dancing because they tell us we have to walk and the nurse has to be like, yo, calm down. And everyone tells me, oh, it's the pain meds. Once the pain meds come off from surgery and if you've elbow, no, never went back, I was just like, my life was instantly better and I was like, oh my God. And I still didn't believe that this was a medical definition. Deep in my heart, I still thought I was just fat, but that my legs were lighter and that's why everything was better. So of course I heal to the point where I can. For the next surgery. I have my second round of surgeries. My second surgery was really intense. You get a lot of hormone release. So I got depression, but it was like weird because I've never been depressed, so it's not something I have ever dealt with. And I, when I decided to have surgery, I decided I would be public about it, cover most if not all of it. So while I was recovering from surgery. I started having these really weird comments about bagels. And I was like, why? I don't understand why I'm getting all these comments about bagels. And so I had to ask what is going on in relation to bagels? I don't understand it. So previously to having surgery, we recorded a video where my doctor had asked me to keep walking prior to surgery, even though my pain had increased significantly because I'd gone off of the Wegovy, so I was no longer having any inflammation support. You also can't take Tylenol, so you're basically like Sol on any type of pain relief, but you need to stay active. So it's not a great time. It is not a fun party. You do not want to go to this event. So I was in New York and I was like, I really want this bagel because I have to walk. I'm going to make myself walk two miles to get this bagel, right? And I was like, I'll make it a fun little YouTube video for anyone who's dealing with chronic illness. They'll get it. Pain days are the worst. So I walk. And at various times during this walk, I have to stop and sit down because I'm in pain. And we get to the bagel shop. It is literally just before close, I order my bagel and I'm like, I'm so happy I did this. Look at me. I can do hard things. Which is something I really told myself a lot during this journey. You can do hard things. So I was, like, so excited. And I was like, let's just take a cab home so I can eat this laying down because physically, I don't want to move anymore. So we get our bagel, we get in the cab, we drive home. I get home to the hotel. I'm filming myself unwrapping it. And it's not the bagel I ordered. It's not the bagel I walked two miles. Now, to set context here, I'm having surgery in two days. I've been off of all of this medication that helps me stay regular in a lot of different ways. So I am a hormonal nightmare, right? I'm also in a lot of pain. So I just start bawling over this bagel, right? I just am, like, literally buckets of tears because I am. This is all the stress of my first surgery coming out. This is all the hormones that are rolling around in my body. This is. This is everything coming out. This is the pain I'm feeling because I, you know, it hurts. So I am crying over this bagel, and I was like, I just wanted this bagel, right? And then the next day I ordered the bagel, and that's the end of the video. And I'm like, I got it. It's fine, right? So they pick this video up and they make so many videos about fat girl cries over bagel, and they turn it into. A fat girl doesn't get what she wants, and so she cries. They erase the entire part about the fact that it had literally nothing to do with the bagel. The bagel was just the thing that I was crying about, but it was like, very. It's not about. And this is what people started to say. So people started commenting bagel gate and then started commenting. It was never about the bagel. So this turns into this whole thing where people are just talking about bagels vaguely around me, and I have no clue what's going on, right? And they knew I was in surgery. They knew that I was having this major surgery. And that's the thing they decided to go in on, is that I cried over a bagel. And I'm just like, y'all, I just had a major surgery. There was no compassion for me as a human being at all. And then I begin to wonder, you know, is it really worth going through this two or three more times? It's hard. Recovery is a process. Even with the great results I had from the first surgery, recovery from a major surgery is rough. So everything's kind of on pause, right? And I even pause move my surgeries a little bit later. And I honestly, my doctor's gonna listen to this and be like, you were considering not doing your other surgeries. I'm sure of it. But I was, because again, I thought I was delusional. I still at this point thought that this was a fake condition. Even though I was advocating for it and talking about it. I feel like such a scam. So I started to have really, really bad inflammation post the second surgery. And I've always had issues with inflammation. It's always been part of the journey. But it became really obvious through this because they just took 22 liters total. So 50 pounds out of my body, and I was heavier than the day I went in for my first surgery. And that was crazy. Like, that was unusual. So they had me go see a specialist in Tucson. Her name is Dr. Herbst. So Dr. Herbst is a board certified endocrinologist that is actually researching the genetics related to fat disorders, like lipedema, for example. Example. And if you know anything about Lipedema, she is the og. She's the queen. She's the queen. And I go and see her. I'm still having all of this inside. I'm still debating if I'm going to do the other surgeries. I'm like, is this worth it? Is this just cosmetic? I'm starting to have with the inflammation, a lot of exhaustion and stuff like that, which is natural with inflammation. So she does two things that caused the aha moment for me. She's like, I'm going to do some. I don't know the name of this, but it is a thing where they do thermal imaging to see how congested your veins are. So they take pictures and it shows almost like a heat map where your veins are enlarged and trapped. So she does thermal imaging of my body, lets me see it. And I can see everywhere that I haven't had surgery is bright purple on my hands, my feet, my face, and the places I had surgery. I have no congestion. So she looks at this thermal imaging and she's like, wow, you're super congested. We talk about some of the areas I have pain. We can see corresponding congestion in that area. She points to a bump on my arm, which I thought was a fat roll. I'm going to be very. Thought it was a fat roll right here, like where you can see kind of like a bump coming out of my arm. And she goes, I don't think that bump is fat. And I was like, oh, it's got. It's got to be fat. And she goes, no, no, no, no, that's not fat. So she pulls out an ultrasound and she shows me what's going on under there. And it is a vein that is, I guess, leaked and sitting under here. And this is the area I haven't had surgery out I'm having in January is just a giant pool of plasma that is just sitting in my body. And you can see it. It's wild. And that's when it clicked for me that this is a real illness, that this is a real thing, because I saw in my body the congested veins and I saw the pooling out in my arm. We also ultrasound a variety of different places that were not surgical yet and saw that all of the lower veins in the body have been compressed and they're not able to work and the blood is traveling through the top veins, which have now expanded and are getting gorged. So that's what's causing a lot of the pain and congestion in my body, is because my Blood is moving through one eighth of the veins. It should be moving through.

Dr. Nance (58:12)

Probably ties back to your anemia.

Anna O'Brien (58:14)

Yeah, well, we're going to keep going down this because we're not done. So she's looking at all of this and she goes, let me take a look at your thighs. And she looks down at my thighs and she's like, oh, my gosh, it's like teeth. I've never seen this before. And this is where I just had surgery. So I produce very quickly, or at least we see from this all ultrasound, scar tissue. I produce scar tissue at a rapid rate because I had literally had surgery three weeks before. I should not have had the level of fibrosis that I had in my legs. And she literally, like, this is the woman that's seen every lipedema patient in the planet looks at it and goes, oh, my gosh, I've never seen this before. Which is not what you want to hear, by the way.

Dr. Nance (58:54)

Comforting feeling.

Anna O'Brien (58:55)

No, not a great feeling. And then she goes, I want to. I want to talk to you about your genes. And this becomes the first time I begin to understand what these genes do. So she pulls her computer aside, she sits me down, she said, I want to talk to you about your genes. And she goes, you have two very interesting variants and they're both related to the same thing. And she goes, they're related to aptosis. And I'm like, well, what the hell is that? And I will tell you, if you ever have a geneticist explain to you what something is, their dumbed down version will still be too hard to understand because I literally had to be like, can you give me an even dumber version? I have absolutely no clue what you're talking about, but from what I gathered, my dead cells do not properly leave the body and they cause havoc. So that would explain scar tissue forming. It would explain estrogen that was supposed to be taken out of the body not leaving properly. It would explain inflammation problems, not having, you know, clear routes to getting things out of the body.

Dr. Nance (59:58)

Well, you know what's interesting is, and it may be something different, but I don't think so, but apoptosis.

Anna O'Brien (60:06)

Oh, that's what it is. Yes. Okay, sorry.

Dr. Nance (60:09)

So apoptosis is the process in which a cell.

Anna O'Brien (60:15)

Yes, that's it. Sorry, I honestly don't know anything else.

Dr. Nance (60:18)

Clears the cells.

Anna O'Brien (60:18)

No, no, you.

Dr. Nance (60:19)

You were, you were actually explaining it perfectly.

Dr. Nance (60:23)

And it is normal for all of.

Dr. Nance (60:26)

Our cells to go through this process of dying and then regenerating. That's, you know, in our bone Marrow. Right. That's where we generate new cells. And so it is normal for our cells to die. There are other cells in our body. Primarily. It's called the macrophage, which.

Anna O'Brien (60:45)

She said that word. Right.

Dr. Nance (60:46)

The immune system.

Anna O'Brien (60:47)

This is how she tried to explain it.

Dr. Nance (60:49)

Yeah. That then gobbles up those dead cells, and then they. They go through, you know, the rest of your body, and they're. They're, you know, cleared. But a problem with apoptosis means that those dead cells don't actually get cleared in the proper way. And so probably all of the cellular material is then what is contributing to the fibrosis, which, for people who don't understand what fibrosis is, it's like a thickening and like a hardening of the tissues, almost like a woody characteristic, I guess, would be the best kind of way to describe it. Similar to scarring. Scarring is supposed to be a regenerative process. Right. It starts by. You have a cut, you recruit inflammatory cells. If you don't recruit those, and that's why it gets a little raised and red and swollen. That's actually normal. That's part of the normal process. And then over time, that scar starts to thin out, soften over the period of a year. So there's an evolution, and it's all based on individual cell mechanisms that help with this evolution. So it, you know, really does.

Anna O'Brien (62:08)

As I.

Dr. Nance (62:08)

As I said, a lot of it, I think, goes back to the. The genetics, which we're only at the point where we are able to identify a lot of the issues. Now the next challenge is to say, okay, so now what do we do?

Anna O'Brien (62:23)

Exactly. So essentially, this is the person that is most experienced in this, who has never seen this gene before, this pairing of genes, and they are both related to aptosis. There's limited information, I. E. There's no medical research written about it. It's either been hypothesized or tracked in some way, but it's not like it doesn't. There's no knowledge of, like, other than it's related to this function, what it actually does. So now we know that these genes caused all my symptoms. The weight stuff, the anemia, the lipedema, the tumor, the thyroid issues, but we can't really do anything about it. So the conclusion of my story now and then, it's kind of a sad conclusion, but at least I have a team of people looking into it, is that I am, as it stands right now, I don't want to say a1of1 because there's probably Somebody out there that's also dealing with this. But for most of the people I'm working with, I'm the only person they've seen with this. So this is all likely genetic, which was great to hear, but a little bit scary because it means it's more complicated. So we've begun the process of sequencing my genes to start. And I'm going to mess this up because, again, this is so out of my depth of understanding. But they're starting to try different pathways to try to understand how my body reacts. This makes sense. They keep saying we're going to run these pathways on it, and I don't know what that means, but it means that they're going to test and see, I guess, if. If they do this, does my genes do something different? I don't know. But the goal is to see what is happening with that. What was the update? I think apoptosis. I keep calling it aptosis and I have been calling it the wrong thing.

Dr. Nance (64:11)

So apoptosis, Apoptosis.

Anna O'Brien (64:15)

They want to see where else that's having issues, but they think that it's causing me to have stored estrogen. They think it's causing me to have that weird fibrosis that grows just really, really quickly, which explains why I kept gaining weight even when I was not having behaviors that would. Would drive weight gain. And it's also potentially a different way of getting lipedema because it's genetically related versus potentially hormonal. I mean, it's all genetically related, but it's a version that they haven't seen in this capacity. So it's an atypical case. I guess that's the easiest way to say it, and it is unresolved, but at least we know it's related to apoptosis. And anything I'm going to be doing at this point will help other people with issues with apoptosis in the future. Again, that's not a common thing, but hopefully, you know, finding a geneticist that actually will look into it is amazing because that's hard. I was told I would never find one. And then also having the resources to financially be able to afford all of this. And I think, you know, I hope as this series goes on, we talk about that a little bit, too, because a lot of these things are not accessible and not affordable and not covered by insurance. Definitely not covered by insurance.

Dr. Nance (65:36)

So how does it feel? I know it's been very, very recent. Knowing that your whole life, all of these struggles have been related to a genetic condition, something that you literally cannot Control and had nothing to do with a lifestyle choice or if you just had better habits.

Anna O'Brien (66:03)

I am still coming to terms with that. Even though I can only see the times in my life when I should have done better, I still, even with all of this, even though I now have accepted the condition, even though I now have this genetic insight and all of these other things, I still see every moment in my life when I could have done better. And there's still so much guilt and shame around choices that I thought could have been better. And I have been publicly pushing myself to make choices that I once perceived as bad because I think that I need to learn how to get over that shame, because it's not healthy to carry that burden. Even knowing it's not my fault, I still feel like it is. There is a community of doctors who still do believe that obesity is the individual's fault. And it's not like 10% of our population is overweight. It's like 60% of our population, all these people are getting overweight. What is going on? Our genetics could be changing our food could be changing our environments could be changing our socioeconomic situations, could be changing what is causing people to gain weight. So let's take the. The morality out of it completely. Like, let's take the choice out of it and say it's not a person's choice. So if it's not their choice, if nobody would choose this, we have to start looking at this as something that's actually a medical issue versus punishing people. I have gone at great lengths to share my medical journey, which at times I've really regretted, to be honest. Like, it's. It's hard. And even with some of the best doctors in the world voicing in on this, people still don't believe me. And sometimes I don't believe it, even though I do. Like, it's just. It's this. I can't explain it. When you. When you realize you're just this, your body is unusual, you're like, did they make a mistake? Did they. Was the genetics off? Was, you know, like, what happened? Right. I guess I just don't want it to be true. And I think the harder part about this is, like, I thought when I started the lipedema surgeries that it would just magically solve everything, or at least I'd get the body that I. I wanted and had tried for. And I will get that body for some time. But because of the way my body builds, fibrosis, it may not be for as long as I want it to be. And, you know, I'm going to keep trying everything that the doctors suggest to me and encourage me to do. But when I really think about it, it's like, share something really sad. And I'm sorry, I'm going to end this on such a sad note. But I was talking with someone the other week and they were like, you know, you're getting older. Are you concerned about not having kids? And I was like, I don't want to give them this. And the reality is I can. And that's a hard thing to think about, that your genes are bad. And I often, sometimes. And I'm sorry, this is so sad. This is so depressing. But I sometimes think about, like, am I meant to be alive? Because all these things don't work. And I know that that's just, you know, me coming to terms with this, right? And dealing with this. And like, obviously I live at the time, I do, because I am meant to be alive and I'm meant to probably do this, but I still feel every day conflicted. I don't know if that'll ever go away because there's nothing I can do. There's nothing I can do better. And that sucks. And as a type A person who just wants to optimize and fix. I can't optimize and fix this. Maybe I'll get lucky and someone will have a breakthrough, but maybe I won't. It's out of my hands. It's out of my hands.

Dr. Nance (70:27)

Well, if I could jump through the screen and give you the biggest hug. Because it takes true bravery to be this vulnerable, to be this public in order to serve the greater good by sharing your story so that maybe one person won't feel alone. And there are so many just themes that for people who may not necessarily have lipedema or a genetic condition or an autoimmune disorder, you know, just about what it's like living life with a chronic illness, what it's like feeling judged by your doctors, what it's like having to find new doctors that I think so many people will be able to resonate with and really feel like their own feelings have been validated.

Anna O'Brien (71:24)

I think if I could end on a positive note, because I just feel like I just cried at the screen for a little while. I cried at the microphone for too long, and now I need to turn it around. Even though everything has been a lot and it's, you know, I found all of this information out in about a year and a half, and that's. That's a lot in a very short amount of time. I don't regret doing it because if we go back to that first doctor's appointment before we knew any of the other things we know now, even just my initial blood work, I may not. I may not have made it through without some help. I would have been in the hospital and it would have been a much different journey. So even though the end result may not be exactly what I wanted, I live a more full life now because I allowed myself to hear hard things. And I think that's the thing I take from all of this. I don't regret it. I don't regret it. I don't feel like I wish I didn't know. Because at least now life makes a little bit more sense. And at least now I have resolved the issues I can resolve. Right. Sometimes there is no magical solution to health things. Sometimes it's about persevering and learning to adapt. And I think that's where I'm at right now. And so it's. It's kind of a hard situation to be in, to have to tell this story at this point, because the reality is there may never be a finite end to this. But at least. At least I know, and at least I have people around me who are supporting me. And I. I think that the thing that really clicked for me is I saw my parents maybe a couple weeks ago, and they were literally all on the weight loss train most of my life. And just having my dad look at me and finally go, I finally get it. He's like, I finally get it. And I'm sorry I didn't listen to you. And I'm just like, you know, maybe this story will help people see people in bigger bodies a little bit different. And again, it's none of my business what your health is. It's none of my business whether you're healthy or unhealthy. And the reality is, is I don't have the information to make that decision from someone. And if I can pass on a story that, you know, competes with the norms that we're taught, maybe. Maybe people will just be kinder to each other. That's the hope, at least. Maybe they'll be kinder to themselves.

Dr. Nance (73:50)

Well, I think that's a perfect way to wrap up. And I am so honored to share this platform with you and to get to be able to shine a light on other people's stories that are really going to make a huge difference.

Anna O'Brien (74:05)

I just can't wait. Like, going into this, I feel like it just is exactly what I wanted to do. Right. I exact. It's like I want people to feel less alone in these journeys, and I think we just have an amazing opportunity to do that. So I'm excited.

Dr. Nance (74:20)

All right, well, until next week.

Anna O'Brien (74:22)

Next week?