But What About REALLY Fat People

Ragen Chastain Class III - SUPER OBESE Photo by Richard Sabel

Ragen Chastain  Class III – SUPER OBESE Photo by Richard Sabel

Often I get comments that say something like “but what about people who weigh [usually some random amount of weight that seems really high to the commenter from 300 pounds to more than 1,000, or some life circumstance, illness, or disability that seems like a big issue to them], surely in these situations weight loss, including drastic measures (like stomach amputation or an at home stomach pump) should be taken.” or “Studies show that very fat people tend to die younger, what do you say about that?”

Let me start by saying that I am a “REALLY fat person”.  I am Class III – Super Obese, as fat as you can get on the BMI charts. When I first found that out, I ran to the mailbox for weeks hoping to receive my cape and secret decoder ring.  I’m still waiting – it turns out that it doesn’t come with a secret identity but it does come with a bunch of shame, stigma, and concern trolling.  I want my  freaking cape, but I digress.

As far as studies that say that very fat people (Class II and Class III) die earlier, that’s not as cut and dried as it sounds.  To clarify some things: this “class system” of obesity is based on BMI and its many, many problems.  Class III Obesity is defined by the World Health Association as a BMI of 40 or above. To use me as an example – I am 5’4 so anything over 232 pounds makes me Class III Obese.  I weigh 284 pounds. If I weighed 2,284 pounds I would be in the same class in study’s conclusions about weight and health, lifespan etc.  This does not exactly smack of stringent science.

It also doesn’t take into account that there are health issues and medications that cause weight gain and may also shorten lifespan as a side effect, or treat illnesses that shorten lifespan.  Nor does it take into account that many people who are super fat spent most of their lives dieting and, considering statistics on weight regain and the dangers of weight cycling (aka yo-yo dieting), it’s entirely possible that this lifetime of dieting is the source of their current size, their health problems, and a possibly shorter lifespan.  It doesn’t consider the dangers of being under the stress of constant stigma and shame and how that can affect someone’s health (Peter Muennig out of Columbia found that women who were concerned with their weight had more physical and mental illness that those who were ok with their size, regardless of their size.).

It doesn’t take into account the difficulties super fats can have getting proper healthcare – doctors who don’t listen to a word we say and suggest stomach amputation as a cure for everything from strep throat to near-sightedness, the dangers of being put on drugs for health issues we don’t have based on the idea that we might get them someday (I once had a doctor try to prescribe blood pressure medication before having my blood pressure checked – it was 117/70), and other issues including not being able to get proper treatment because machines aren’t built to fit us.  Then there are people who avoid healthcare because of the shaming, stigmatizing, bullying experiences they’ve had,  the fact that medical students don’t practice on fat bodies in gross anatomy classes and the first time surgeons see the inside of a fat body it will likely be when that body belongs to a sick patient, the fact that when we are sick, super fat people can be under-medicated because the amount of medication is based on someone much smaller, or over-medicated because the amount of a medication doesn’t necessarily depend on body weight etc.  So acting like body size=early death and the only solution is thinness is a massive oversimplification.

I also think that the larger someone is, the higher the temptation to suggest that whatever issues they are dealing with would be solved if they were just smaller. In truth, neither how fat a person is, nor the abilities and disabilities they may live with, change the fact that weight loss almost never works.  In fact, weight regain is the most common outcome of intentional weight loss attempts, so  even if someone is arguing that high body weight is dangerous, the worst advice they could possibly give is to try to lose weight. In study after study after study weight loss has not been shown to be successful at changing body weight or making people healthier.  In fact, the only thing that weight loss interventions are shown to be highly successful at is causing long term weight gain. Weight loss does not meet the criteria for evidence-based medicine, and a fatter patient doesn’t change that simple fact.  So even if someone thought it would solve all health problems if everyone was thin, we don’t know how to get it done.  But we could stop stigmatizing fat people, thereby solving many of the issues I talked about in the last paragraph, and we could do it today.   We’ll never truly know how much healthier fat people could be without all the shame, stigma, bullying, and oppression until we end it.

As always, people are allowed to make whatever choices they want about their bodies and health.  From my perspective a Health at Every Size approach makes the most sense regardless of size, health issues, or ability, based on the evidence – there are no guarantees and my health is never fully within my control but I think the evidence says that healthy habits give me the best chance at my healthiest body.

To me, Health at Every Size is about each of us prioritizing health for ourselves and then, if we want to set goals, setting them based on health/habits rather than body size.  And it’s about treating health issues with health interventions, not body size interventions.  So no matter what I weigh, I would set my goals based on what I want to be able to do within the parameters of my body’s abilities and disabilities and my situation, and I let my body weight do whatever my body weight does.

And no matter what I weigh, I would deal with any health issues using health interventions.  Let’s say I developed joint issues.  I would likely be told that weight loss would “cure” those issues.  You know what else would “cure” them?  Being able to fly – which is about as likely as losing weight, so I’ll start dieting to fix joint pain right after I jump off a roof and flap my arms really hard.  Or I could insist on being treated for my joint issues using interventions that are shown to actually help joint issues.  I know that those interventions exist because thin people get joint issues as well and they aren’t told to lose weight, but they are treated.

People of all sizes deserve to be treated with respect and those of us who are “really fat” are in no more need of concern trolling, stomach amputations, or at home stomach pumps than anyone else.  Everyone deserves access to foods that they choose to eat, safe movement options that they enjoy if they want them, affordable evidence-based wellness care and a life free from bullying, stigma, and oppression. Yes, even if we’re REALLY fat.

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Published in: on January 14, 2013 at 11:45 am  Comments (89)  

89 CommentsLeave a comment

  1. You are right but I can’t stop thinking about those people who can’t even get out of bed or move and have a very high percentage of body fat. I wonder if HAES can help them improve mobility and live normally (see Manuel Uribe who weighed 1,235 pounds but refused to have his stomach stapled and used the Zone diet-whatever that is).

    Anyway, what I am saying is that even I, who am opposed to such alleged ‘health practices’, even diets such as the Zone one, kind of find it hard to wrap my mind around the fact that these people can move and eat normally without some kind of help and without weight loss.

    I believe that is what those people were talking about.

    • Regan just pointed out very coherently and at some length that WE DO NOT KNOW HOW TO HELP THESE PEOPLE LOSE WEIGHT SAFELY. This is just as true for anybody weighing 2000lb as it is for somebody weighing 200lb. We do not know how. The evidence is in, and for every single intervetion the evidence says it does not work and/or that it is very dangerous.

      As it happens, I *am* bedridden. Not because of my weight – I have unrelated disabilities – but it means I can tell you a little of what HAES can offer to somebody like me. HAES can offer support for us to improve our body image. There is TONS of research that shows that people who are shamed and bullied end up putting on more weight…

      OK I’m going to think about this more because a lot of my “what can we offer?” things are not trivial to offer. I want to tell you about them anyway so stay tuned for a followup comment …

    • Hi Jo,

      Thanks for your comment, I do understand what you are talking about. For me I still go back to the fact that the statistics on diet failure do not improve as we get fatter – so no matter what benefits we feel someone might get from weight loss, that doesn’t make successful weight loss any more likely. I would never tell anyone what to choose but for me, I would choose a HAES intervention regardless because a weight loss attempt will most likely result in completely weight regain and is highly likely to mean that I end up heavier. It’s always possible that a person’s body size will change when they commit to Health at Every Size, but a body weight goal does not make sense to me based on the evidence. I believe in interventions that are proven to get the results I’m looking for. If I want to get stronger I work on strength – not body size, if I want to have greater flexibility I work on flexibility – not body size. I think the knee-jerk reaction that fat people who have mobility issues or disabilities should lose weight gets in the way of actual treatment, care, and accommodation. I also think that we should take care not to assume that a fat body is a sign that someone needs someone else to dictate to them what they should want. In general I think people should be supported in what their own goals are. That said, there’s no way to account for every specific situation – are there may be situations where mental illness of various types are involved which requires more specific solutions but I would still suggest that intentional weight loss isn’t one of them.

      ~Ragen

      ________________________________

      • Thank you Ragen for taking the time to clarify things. Indeed, I think that you cannot take one measure/size fits all approach. I’m still very new to HAES but want really badly to understand it and apply it to my lifestyle.

    • The thing is, these people likely have an underlying cause that makes them this heavy. I would tend to suspect endocrine and/or kidney problems at the top of the list. It doesn’t help to berate these folks, not that you are, but there are many people that do. Believe me, they already hate themselves quite enough without anyone helping them to do it.
      Lack of mobility is unhealthy for people of any body type, and there are a myriad of reasons why someone might lack mobility. But people of smaller body types are not berated for their immobility the way large people are.
      It always gets made into an issue of “defectiveness” rather than being seen as a real and genuine health issue. Therein lies the problem. Fat people = bad people, therefore really fat people must be really, really bad. This mode of thinking has never worked and never will. But until it is eradicated, nothing will change.

  2. Re joint issues: biomedical engineers need to work on designing artificial joints that can support very fat people and still last as long as the prostheses made for thin people.

    Doctors tell us to lose weight before allowing us to have joint replacement surgery, even though the weight will almost definitely come back and stress the artificial joint anyway.

    It’s not just the artificial joints themselves of course. Many surgeons claim that fat people are just too hard — or impossible– to operate on (unless it’s weight-loss surgery of course).I’m on a FaceBook forum for adults with hip dysplasia, and people constantly post about having to lose x amount of weight before Dr So and So will operate on them. They are in such terrible pain that they can barely walk, but somehow, they’re supposed to lose weight?! I will eventually need a hip replacement, and dread having this conversation with a surgeon.

    The fact is, there ARE very fat people and we deserve adequate health care, including joint replacements if we need them.

    • I was one of those people who could barely move due to a worn out hip. The pain was so intense that the only alternatives to surgery, in my mind, were using a wheelchair full time and if that didn’t work well enough, suicide. (I was not depressed, just in ridiculous amounts of pain with no end in sight.)

      It took a while to find a surgeon who would agree to operate on my fat self and the best offer I got was surgery only if I was under 300 lbs. He felt that the higher risk of infection would be mitigated enough if I lost 35-40 lbs. I felt that 1)weight based antibiotic dosing would be helpful and 2)I was willing to take the risk as opposed to the above alternatives.

      I was told to ask for WLS (my insurance doesn’t cover but he made me ask anyway, more than a little humiliating since my insurance administrator is my CEO), water walk for exercise (I managed 15 minutes then was in bed for 1.5 days), and restrict calories (I did this, but tried very hard to improve my nutrition while I was at it). Of course, about 1.5 year later, the 40 lbs I lost is back–and I have to lose it again if I want my other hip replaced.

      My surgeon did a great job but it makes me angry that I have to pass a “worthiness” test. I just want to be able to go to work (I’m really, really good at what I do), be mobile enough to take care of myself, husband and pets, and maybe get out and have some fun once in a while. I pay my insurance premiums and hospital bills (eventually), it doesn’t seem too much to ask.

      The other thing that drives me crazy is the irrational way we ration health care, sometimes based on weight, sometimes not. Dialysis? You’ll definitely be blamed and nagged about your weight but it’s readily available. Kidney transplant? Lower overall cost compared to chronic dialysis but none for you, Fattie. Super expensive ICU care? Again you’ll be fat shamed, but there’s a bed for you. Interventions that might have kept you out of ICU (or HAES research on metabolic health)? Not so “easy.”

    • Everybody deserves compassionate, respectful health care. If a person thinks they are going to be berated for their body type when they go to the doctor, it will make them less likely to go. Therefore, they are less likely to receive proper medical care. For all their schooling, doctors can certainly be stupid when it comes to this.

      • Hello! New to this blog, but enjoying reading it something fierce. As a studying doctor-to-be I just have to say that I am both heartbroken that these sort of issues aren’t brought up during our ethics courses but also spurred to change that.

        I hope to think I have taken a lot of what I’ve read here these past few days to heart and I will definitely be sharing with my classmates, and trying to induce discussion on this.

        I’m sorry, very sorry to hear about your experiences, I can’t say I know the feeling but it hurts me to hear about your treatment from people who are supposed to be professionals.

        Love from sweden.

        • Thank you!

        • De-lurking (on the blog, I did comment on FB previously) to thank Martina with all my heart.

        • Much respect, and glad you are studying to be a doctor. My son is as well. We need more people like both of you!

    • In one of my clinic rotations in school we had a patient who needed a hip replacement so bad that this person could barely walk, though was mobile enough to walk short distances. We were tasked with assisting the patient in losing the 15lbs that the surgeon said needed to be lost before he felt comfortable operating. I brought up how ridiculous I thought this was, but we had little sway with the surgeon. The patient also had Congestive heart failure and was around 75 yo. I remember thinking that THAT condition should worry the surgeon more than the patient’s weight. I also had little doubt that if the patient was wanting WLS, the CHF, high weight and advanced age would not be “obstacles” to “treatment”. It made me want to scream.

      I will say that with our naturopathic protocol, the patient did start feeling a lot better, though the required weight loss was not as fast as the other doctors seemed to expect. I cannot wait to have my clinic full and running.

      • Congestive heart failure = excess fluid in the body = weight gain.
        The focus on “skinny at all cost” helps nobody. You are so right that the CHF should have been of far greater concern than the patient being plump.

  3. Great reading, loved this comment “Let’s say I developed joint issues. I would likely be told that weight loss would “cure” those issues. You know what else would “cure” them? Being able to fly – which is about as likely as losing weight, so I’ll start dieting to fix joint pain right after I jump off a roof and flap my arms really hard”

    I laughed out loud on that one! I’ve heard this “cure” as well; and when I did lose about 70 lbs one time in my life when I was brainwashed by meeting everyone elses standards and did NOTHING in my life for about a year but diet & exercise (and dayjob), by starting to jog more I was told ” well, that will tear up your knees too you know” Gawd, people are so crazy!

    Thank God I’ve come around to letting all that go and found your blog to read :) Keep up the great work, we need ya!

  4. Ragen, I just have to say, I absolutely love that pic of you! You are so beautiful and I love what you stand for in size acceptance, especially those of us who are obese.

  5. Jo asked what we should offer to people who are obese to the point where it really is impacting their ability to do almost anything and who are housebound/bedridden due to their weight. As somebody who is bedridden myself, here are my suggestions. They are not easy things to do, they require time and energy and commitment, and I don’t know of any groups who are offering things like this to housebound/bedridden fat people. There damm well *should* be groups! Anyway, here’s my list…

    NOTE: This is not a magic list! It’s off the top of my head. It’s not complete. It’s probably wrong in lots of spots! I have not looked up the evidence for most of it! It’s just my *ideas*. I would adore suggestions, corrections, evidence, additions, etc.

    0. Basically I think people should be supported in whatever THEIR goals are. But I recognize that people may be in such a slump emotionally they have “given up” or may not have any idea what’s possible. The rest of these items are *suggestions* for things which *might* either be goals or might support people in reaching their goals. I have tried very hard to frame these as things to offer, not things to impose on anybody – they should be things which are easily available, and things which people know are easily available, and things which are also appropriate in all other social justice dimensions in which I am less conversant.

    1. How about supporting the fat person by offering medically-appropriate interventions: treatment for physical conditions they might have like arthritis, heart problems, apnoea, skin problems, etc. It is irrelevant whether their weight has “caused” or “worsened” these conditions or not, what is relevant is that they now have to deal with them. How about we offer to provide fat-positive advocates who can accompany people to medical appointments who can provide transport and then also advocate for evidence-based treatment and make sure that the medical people understand that they aren’t going to get away with “you’re too fat” as an excuse.

    Many of these conditions cause pain and fatigue and it’s really hard to want to move at all if you are in pain and exhausted! Treating these conditions is vital before somebody is going to feel well enough to do anything.

    Also you need to make sure that the treatments prescribed can actually be obtained – meds cost money, equipment costs money, etc.

    2. People who are bedridden or housebound may also need fat-positive appropriate attendant care to help them with things like washing and dressing and grooming. It’s really hard to feel good about anything or want to be near anybody if you are worried that you stink!

    3. How about supporting the fat person with an offer of affordable evidence-based fat-positive counselling. This could deal with several separate-but-overlapping areas:
    (a) Dealing with being fat. This includes dealing with bullying, shaming, etc., that is rampant in our modern world. It’s not easy to deal with, especially when people try to tell you you’re “too fat” to join the fat-positive movement!
    (b) Dealing with any primary issues that the person has, such as past abuse, anxiety disorders, depression, etc. These issues may or may not have contributed and/or still be contributing to the person’s weight – it’s not really relevant. They are human beings and deserve a chance at being happy, the same as everybody alive.
    (c)Offering family counselling for everybody living in the house may also be appropriate – if the person is being shamed by their family (or whoever’s living with them) that could easily undermine their progress.

    3. How about offering to help those bedridden people to have a social life, whether it’s via the internet or via local people who will drop in and visit. I can guarantee you it’s really amazingly hard to have a social life when you’re bedridden or housebound – and I’ve been working on it for a decade! Imagine a wonderful world where people offered to drop in on housebound friends to watch a movie with them, chat about their dogs, discuss celebrities or football or their kids, or just to say “hey, how are you?”. Wouldn’t that be wonderful? It’s a lot easier to get over anxiety and depression if you have friends, too.

    4. Clothes! Have you any idea how HARD it is to find clothes if you’re over a size 30 or so? Especially as most housebound/beddridden people end up very poor. Let’s offer to help people with appropriate comfortable well-fitting clothes and shoes so that they can look their best and be as presentable as possible!

    5. How about we offer to make sure people’s homes and environments are appropriately modified with things like wider doorways and also fitted out with bariatric health equipment such as beds, commodes, scooters, etc., so that they are able to do things they want to do. Again, it must be affordable for poor fat people.

    Notice how now, if somebody *wants* to go out and socialise or do some home-based joyful moving, they have the opportunity to have friends to accompany them, appropriate stuff to wear, and whatever mobility aids they require. Plus counselling to help them get over any anxiety they will be feeling. The person may or may not choose to do this – it’s THEIR life and THEY are the boss of their own underpants, as Regan would say. But it’s really hard to choose to go out if you have no ability to do so. We need to make sure people are offered the ability to do so.

    I shall hop off my soapbox now!

    • Jeshyr, I LOVE LOVE LOVE your ideas!! I can’t even begin to tell you (well, you know, I’m sure) what a huge difference these things would make in my life! But how to make them happen… ?

      • I really really wish I had a magic wand, Joyce! I’m relatively lucky because my bedridden-ness is caused by disabilities other than weight and so I have less prejudice to deal with, and I live in a country that does OK with supporting disabled people, and I still have to fight so very very hard.

        One thing I did which may or may not be helpful to know is I phoned about 5 local religious places (churches, synagogues, temples, etc.) and said “Hey, I’m not your religion and I don’t want to be converted but I’m local and I could really do with visitors, can you help?” I started with a bunch of new visitors, and three stayed around for over a year! One of them still visits me nearly every week and it’s 6 years down the track – I’m friends with her whole family now :) It’s the only thing on the whole list I can think of a cost-free way to do unfortunately … but perhaps it’s something??

        And please know I’m sending you positive thoughts and love from Australia! Hang in there, the movement needs people like you.

        • Jeshyr, if I ever win a gigantic lottery jackpot, or if Mr. Twistie manages to sell some songs that go platinum, THIS is what I want to do with a big chunk of the money.

          A program like this would be an amazing help to thousands. I would set it up as a non-profit and do my damndest to make simple dignity a reality for people in pain.

          Filing for future reference now.

          • Sounds like you and I are of like minds on this (oh, surprise). Let’s find a way to work on this together.

      • “How about we offer to provide fat-positive advocates who can accompany people to medical appointments who can provide transport and then also advocate for evidence-based treatment and make sure that the medical people understand that they aren’t going to get away with “you’re too fat” as an excuse.”

        You may have just found me a niche in my social work efforts. I’m getting my MSW right now and this may be the subject of a paper or a project in the future.

        • That would be so wonderful, Helena! I am a pretty darn good self-advocate but it’s so very very very hard to stand up for myself about weight where I feel shame and guilt to start with :( I’m relatively privileged in that area too because I have a BSc and I’m passingly familiar with the relevant research and can sound “educated”, which all helps when you’re dealing with medical people. And even I could use an advocate! I can only imagine how much it could be of assistance to those who aren’t lucky enough to have the advantages I have.

          Best of luck with your MSW – social workers are so very valuable :)

        • What a wonderful way to put your MSW to use. I hope you are able to use it as a paper/project, and then be able to actually create a program to help people in this manner. :)

          • It’s most definitely an avenue worth exploring. I have always had a heart to help women with eating disorders and body image issues, so this might be the right arena for it.

    • Jeshyr, I LOVE these suggestions. You essentially are asking for the housebound/bedridden people to be able to have what everyone wants. You are asking that everyone be allowed to have quality of life and not feel ashamed for wanting it or risk being shamed for daring to ask for it.

      As a super obese person (5’4″ and over 400) who is not homebound/bedridden, I can still relate to many of these. Thank you for putting this list together.

      • You are 100% right about that. Like I said, I’m mostly bedridden but my bedridden-ness predated my weight (it’s unsurprisingly difficult not to put on weight when I can’t dammwell move …) so I have a lot less prejudice to fight.

        I believe, on a social justice level, exactly that: That everybody deserves quality of life because we are all human beings, and that nobody should be shamed or guilt-tripped for wanting to have that.

        I just wish we could figure out a way to make things better which was financially within reach – most of these things are way past anything I can organise for even myself, let alone anybody else! What is it that we can do to make life better for fat peolpe starting now?

        • I’m not sure what we can do now, but you’ve given me some food for thought. I’d like to figure out what I can do for fat people in my area. I feel very fortunate that my circle of friends includes several beautiful fat people, but I’m always up for making more friends. :)

    • Thank you so much for the list, I am trying to educate myself as I am new to HAES and also cannot reach support groups and only find research/people who can help me on the internet (I live in Eastern Europe). It has helped me improve my body image overall and helped me get over my depression just to know that I have options.

      I cannot relate to what disabled people are going through but the stigma, fat shaming etc are still there. I’d love to be able to help people as I have seen what the diet industry has done to them and almost have done to me.

      I agree that people are grossly misinformed when it comes to weight, fat people, obesity, BMI and whatnot.

      It would be a dream for disabled people to be treated in the way you describe in my country, let alone disabled fat people. I guess the entire world is blindfolded when it comes to their needs but in some parts of the world nobody gives this problem a second thought.

      Plus, you have touched a sensitive point for me. It seems so absurd to be complaining because of this but my weight is approximately 186 pounds and it’s hard to find clothes in here (actually it is more of a humiliating, shaming experience as the salespeople treat me with contempt and whatnot).

      Other than that, financing what you just said (help for poor fat people) seems like something advocates would have to fight for really, really hard because the majority think that all bedridden/disabled fat people have brought this upon themselves and therefore it’s not their problem to help or care about this and money+support should go towards something else.

      Again, thank you for your response and I really admire you for not giving up and fighting for these causes!

      • Jo, thanks for asking the questions that made me think of those things!! And I am sorry my first response (above) was less gentle – it touched a nerve for me too.

        Good luck for yourself. I hope that the sales people remember that you are a person too and you should be treated with respect. I know you have to struggle a lot harder in Eastern Europe and I respect your courage. :)

        • Pet peeve alert. Not bringing this up to decry what you said AT ALL. Only mentioning it because I would love for everyone to really think about what it means.

          I really hate when folks say, “Remember that X are people, too.” Whether it’s fat people or whatever, the “too” is completely irrelevant. It indicates both a separatism as well as a subjugated status. Others already separate us out and condescend to us. We don’t need to do it to ourselves. So, my feeling is that we are not “people, too.” we are PEOPLE, full stop. Just my two happy cents. ;)

    • Just wanted to send {{{{{HUGS}}}}}, Jeshyr. I’m occasionally bedridden due to a combination of medical conditions, and, boy, is it ever Not Fun. The thought of being there all the time makes me want to get my butt together and look in on someone who’s stuck there all the time.

    • Wonderful suggestions! :-)

  6. I’m REALLY fat (5’4″ and 375-ish) and have issues that make it hard for me to move, so this post definitely got my attention. I’ve been following your blog for a month or two now, and it’s been getting me to think. I didn’t realize until today, though, that I’ve been kind of holding my breath as I read, full of reservations that maybe I’m TOO big for all of this to apply to me. In one fell swoop you’ve addressed all those BUTs in my mind. As I sit here having a good cry (with sadness it’s taken me this long to “get” it, relief at being validated as a worthy human being, and anger/frustration that so few people understand the concepts you are sharing), I’m wondering what I can do to get this message to my doctors and other caregivers — without getting the “you’re in denial” speech. I guess the only one who can advocate for me is ME, on a one-day-at-a-time basis. I hope you don’t mind if I refer people to your blog, as you have a gift for saying what I want to say so well! Maybe, with time and practice, I will find my own voice.

    Thank you, Ragen, for all you do!

    • Just wanted to send you a “hooray!” and a Virtual (((Hug))), Joyce! I know how hard it is to get over the shame and to start to speak up for yourself, esp with medical professionals, but it is totally worth it. If they are annoyed or put-out, that’s *their* problem, not yours. You don’t have to apologize for wanting to be treated with respect and dignity. No more shame! Yay for you! :D

    • (hands you a hankie and offers a hug)

      We all do it one day at a time, with help from the FA community, Joyce. Welcome.

      BTW, I’m liking your voice already.

    • I just really want to send you a virtual hug. So here it goes: *HUG* and *HUG* and one more for good measure… *HUG*

      I am not always my best advocate either. Do look at all the links Ragen has to actual research with which you can arm yourself for your next trip/visit from a caregiver. They are useful tools!

      You deserve to be happy. You deserve to be treated with respect. You deserve quality health care. I hope that you are able to obtain them!

    • Joyce, I’m almost exactly the same dimensions. I absolutely can commiserate. Let’s do this TOGETHER. *hugs hugs hugs*

    • Sometimes telling the caregiver (and it can be through handing them a note) that “I am here to discuss ____________.” if they bring up your weight can help. As in, “Well, first of all, you should lose weight.” “I’m here to discuss my throat, I’m prone to strep and it feels like strep.” “Oh.” (Actual conversation from urgent care.)

      • I am in the 310-315 range and never had any mobility issues until I took a extra job that required a lot of repetitive motion. Then I found out that I have 3 fractures in my shoulder and one in my leg from adventures from my misspent youth (failing down stairs leaving night clubs late at night and etc,)

        Most people refuse to believe my issues were not solely created by my weight.

        • Repetitive motion is murder on the joints. I have rotator cuff and wrist issues because of it.

  7. As one of the super obese (5’4″ and over 400), I am so grateful that you posted this, Ragen. When I saw the title in my inbox, my heart beat a little faster and my mind began to race in contemplation of what you would say. Just as @Joyce Spear said, I had wondered if I was too big to be part of the “in crowd,” and just as she said, in one fell swoop, you brought us into the fold. Thank you for these words. I am taking them to heart and doing my part to apply HAES in my life. I can’t wait to get your dance DVDs so I can add that fun to my life. My goal is to become mobile enough to return to bellydancing without pain. You are inspiring me to push for that, and when I do, I promise to send you photos. :)

    • Hi There,

      I’m so glad that you liked the post, it absolutely breaks my heart that people are made to feel that their size makes them somehow too big for size acceptance – I just think – what the hell are we doing here? I’m excited about your goal to bellydance again and I would absolutely LOVE it if you would send me pictures. Big Fat Hugs to you!

      ~Ragen

  8. ” it’s about treating health issues with health interventions, not body size interventions”. I love this. As another Super Obese (forget the cape, I’d settle for the ability to fly ;); I still (yes, despite years of self-acceptance work) find it hard to want to head to any medical appointment. The stigma of going in there and knowing that I’ll have to at least speak up to not be weighed, make sure they use the right blood pressure cuff, hope they’ve left out the larger sized johhny….it’s stressful! If I knew instead that I could go in and just have my HEALTH assessed and not my BODY SIZE then a lot of that mental anxiety would melt away. Also, I love Jeshry’s suggestions for how to support anyone in getting the basic “comforts” of decent treatment, health care, and social support!!

    • Yup, I have a few conditions that have to be regularly monitored and somehow I end up seeing four doctors typically in a weeks time. So far, I’ve not been successful in not getting my GP to weigh me, even though I’ve tried all the things I’ve seen suggested. I don’t actually care about being weighed the first time, it’s all the subsequent times that really starts to get to me. (They are different doctors, but they all share a computer system.) Only one of the nurses can take a proper blood pressure, the others are like the keystone kops of blood pressure. By the last appointment, I’m kind of surly about it.

      • Perhaps you could simply refuse to get on the scale or take a blood pressure until they have the right nurse do it. Can you find a new set of doctors who will listen to you? They do need to know your weight because of dosing restrictions, but YOU don’t need to know it. When I was at the height of my eating disorder, I would always “weigh blind,” meaning that I instructed the nurse not to tell me my weight and I weighed with my back to the readout. Would this help you?

        • I do this at my doctor’s office. Her assistant covers up the numbers so I can’t see them then I step on with my back to the readout.

        • Be aware that stepping on the scale backwards can backfire on you. I’ve done this, and I think it created the impression that I’m “in denial” about my weight. It might be more helpful to work on getting them to weigh you *less.* (Once every month or two and any time they’re dispensing meds that are dosed based on weight should be *plenty.*) But that’s just my experience, and the doctor in question would probably not have treated me like an intelligent adult no matter what I did.

          If a nurse is doing blood pressure wrong and getting an incorrect reading, I would absolutely refuse to have my blood pressure done until someone who could do it correctly was available. (Last time I was at the doctor, a nurse scared me with a [really high number redacted], when the PA got a [normal blood pressure]. Though if you’re getting mismatches, it’s hard to tell who’s doing it “right.” I’d also refuse if the cuff was the wrong size.

          There’s no need for them to weigh you four times in a week, and I would refuse after the first one. There’s probably no need to get your blood pressure four times in a week either. If this frequency of appointments is going to be your norm, I would ask each doctor how often (in days, weeks, or months), they want a blood pressure or weight for you,followed by “Why?” if it’s “every time you come in, even if we have one from the day before” or if it’s really often. Then I’d keep track and decline the in-between ones.

          I know it’s convenient for them to run through their checklist and do every appointment the same whether they saw you yesterday or six months ago, but that’s not your problem, and you always have the right to refuse anything you think is unnecessary, unpleasant, or even just annoying.

          • Wow. I didn’t catch that this was 4 x a week. No, they don’t need to weigh you every single time. That’s ridiculous.

            • well, 4X a week weights might be ridculous… or they might be appropriate. Kidney failure and heart failure are 2 diseases that come to mind that can cause rapid fluid and weight fluctuations that might lead to interventions. I don’t know (or need to know) her health details, but there are some legitimate reasons to take a patients weight.

              • Weighing you 4 times a week may have nothing to do with your doctor’s personal preferences. I’m a medical student and I’m at an outpatient clinic this month and we have a bunch of things we do (including weight and BP at every visit) because otherwise the clinic gets dinged at the end of the month and gets lower reimbursements from medicare/medicaid even if the patients without those two vital signs aren’t medicare/medicaid.

                While I am all about quality improvement sometimes there are things that seem reasonable to an administrator that become downright outrageous when put into practice.

                I’m still working on internalizing HAES for myself. But I will get there and I will practice in a HAES appropriate manner. Thanks for the blog.

      • I refuse to be weighed because it will trigger bulimic behavior. My doctor is actually okay with this.
        I’ve had to tell several nurses how to take my blood pressure with a regular size cuff. Either flip the cuff upside down using it on the forearm, or use it down by the risk. Of course they can’t seem to be bothered to have a range of cuff sizes. Grrrr!

  9. Really good blog post, Ragen.

  10. I’m not super obese, but the heathcare issue has always been something I’ve had a hard time with. Ever since I was a chubby pre-teen I’ve had doctors prescribing weight loss for everything (strep throat included, somehow weight loss would cure my chronic strep). I got to the point where I just didn’t go to the doctors anymore unless it was truly an emergency. When I was 17 my family was hit by a drunk driver, I hurt my leg which caused permanent nerve damage. While in the emergency room, after having my leg x-rayed, being exhausted, scared and emotionally drained I had a doctor tell me my injuries would have been lessened if I weighed about 50 pounds less. Thankfully my Dad spoke up for me and said if I weighed 50 pounds less I would have gone through the windshield and we wouldn’t be having this conversation right now (my hip caught the seat in front of me which kept me from going through the windshield).

    After my c-section in July I had a follow up appointment with the surgeons who performed my c-section and appendectomy. After checking out my incision and making sure I was healing properly the surgeon who performed my c-section told me to make sure next time I got pregnant I was at a healthy weight so I wouldn’t have to have another c-section. Both me and the other surgeon just stared at him like WTF is wrong with you. I looked at him and told him I was pretty sure the appendicitis was the reason I had a c-section and if the doctors had listened to me in the beginning about where my pain was located I probably wouldn’t have needed the c-section. The other surgeon agreed with me and told me my weight was neither a factor in the appendicits or the c-section and that women of every size deliver healthy babies so I should focus on my health not my weight when and if I chose to have another child. I could have hugged that doctor.

    • That doctor and your dad are worth their weight in gold. Wait – we’re not measuring worth by weight anymore are we??? Hm. Oh, hell. They’re just worth ALL THE GOLD IN THE WORLD!

    • Wait–your injuries would have been “lessened” if you had been a lighter weight. Well, there’s a bunch of happy horse crap. Different body types have different advantages and disadvantages. I think your dad was right.

    • Kudos to your dad for sticking up for you like that and kudos to that doctor for calling the other one on the carpet for that comment. We need more people and medical professionals like that in the world!

  11. To add to the chorus, I once went to a doctor — this was my first visit — about skin inflammation on my abdomen. Without hesitation, and BEFORE looking, he said, “You’ve got diabetes. That’s a fungal infection from the diabetes.”

    “What?” I said. “I don’t have diabetes. My sugar is perfectly normal.”

    Then he glanced at the skin and said, “Oh, you’re right. That’s not fungus.”

    TL;DR: I see a doctor for a skin issue. Doctor delivers diagnosis of diabetes because fat.

  12. I super, mega, unconditionally, massively, fatly ADORE this article. We superfatties are often treated like a dirty little secret of the fat pride movement. In our rush to legitimize fat bodies, I feel as though many of us tout with pride the studies that claim *moderately* fat peeps live longer lives. Do these studies say something about the shorter lifespans of superfatties? Shhhhhh! Actually, I’ve heard numerous times from loving and well-meaning HAES(c) researchers and practitioners that studies say it is only the superfatties that tend to manifest all the popularly-cited ill effects of fatness. See? Fatties *are* good people! (Well, except those *really* fat ones.)

    I’m always leery of shifting the conversation away from one group and onto another. This is why your post above is to me so brilliant and necessary. Politically and personally, I thank you, Ragen. <3

  13. I am thoroughly, unabashedly in love with every word you’ve written here, Ragen, and with every one of the comments. This community has turned my world right side up after so many years of it being upside down. You all are a giant, gargantuan gift to me. Thank you, God!

  14. About clothes. If you can please donate some to charities because fat people who are down on their luck have a even harder time finding clothes from clothes pantries.

    • When I do a closet cleanout, i donate all my used clothing in wearable shape to a local women’s shelter. A friend told me years ago that they never have enough clothes for plus sized women. If I’m feeling flush when I drop them off, I pick up a couple of three packs of plus sized panties too and throw them in.

      • Or for fat men.

        I had a client that came into my Rehab with just a Hospital Gown and slippers. He had lost all his property during a binge of drug abuse and they had to cut his clothes off in the emergency room.

        he never got enough clothes during his 6 month stay for a decent job interview.

        William

    • That’s an excellent idea, and something we can all do! *makes a note*

    • I’m going to be doing a closet purge soon, so this will definitely be kept in mind. Thanks for the suggestion!

      • Just a thought, but the word “purge” could be triggering to some folks here. I know that’s not what you intended. :)

        • I didn’t even think about it. I’ll keep it in mind. :)

  15. Why don’t medical students practice on fat people? Do they not have fat cadavers that they can study in dissection? If that’s the case, maybe we need to start leaving our bodies to science instead of being buried or cremated. (Although if I get hit by a truck and some professor says I died of being fat, I reserve the right to rise up and slap someone.)

    • Hahaha, I approve. I honestly don’t know, but I will ask my professor, but I think donating one’s body to science is an admirable thing either way. The cadavers we get are often quite old and have been ‘used’ for multiple dissections, since there are so few, never seen a larger one, but that might just be rarity and not conscious discrimination.

    • I’ve been told that the preservation techniques for the cadavers make them heavier and that fat bodies become too heavy to work with (which seems like a solvable problem to me but the person who told me this actually works in the field and acted like it was a legitimate reason)

      • Ragen, when working on my mortuary science degree, I helped prepare several cadavers for a local medical school. The bodies do become heavier after being prepped, but that should not stop the schools from taking bodies of various sizes.

        It may require some extra effort or modifications, but build bigger storage drawers, use extra people to move the bodies or have equipment with the ability to move bodies. It’s important for the people who are studying to become our doctors learn how to work with patients of all sizes.

    • I have actually looked into this. Most programs won’t accept a body over a certain height or weight. I’ve heard explanations that run from “doctors need to learn ‘normal’ anatomy first” (forgetting that normal just means average, and we are) to “bigger people won’t fit in the storage drawers.” Well, get some bigger drawers and start practicing on the type of people you’ll encounter after med school!

    • As a horror movie fan, I say this rules!
      And yes, I fully agree. After all, aren’t we fat folk supposed to be dying in droves because of our fatness? There should be plenty of us for med students to practice on!

  16. Super super fat one here. I’m one of those who is having trouble moving. I’ve always been fat, but I was also one of those people who walked and cycled everywhere as a youth, danced, did yoga, played tennis, and swam like a fish. I was very fat & fit. I did weight training, aqua aerobics and bellydance as an adult. I was also a yo-yo dieter starting from my first force diet at age 7. In my thirties I left dieting (and an eating disorder) behind… embracing HAES and learning how to trust my body with food. Yay, for me I also got the surprise blow of diabetes almost at the exact same time. I’ve been dealing with my diabetes for more than 15 years, using a non-diet approach – very attentive, attuned & meds. I have NO known complications and my tests are routinely excellent (knock wood, it’s a progressive disease). However, I took a bad fall in 2006 to my right knee and far worse fall in 2010. I have persistent swollen knees, as I blew out both of my upper bursa sacs. I had to give up belly-dancing in 2010 and now I’m finding myself in the very least fit I have ever been in my life. Do I still try to live a HAES approach? Yes, as best I can work that into keeping my sugar numbers balanced. Do I think it would all be easier if I weighed less? Of course! Do I believe that there’s anything out there besides forced starvation, and the psychological torture that goes hand-in-hand with it, that will get me there? No. Am ok with it? It’s a process of self-love to get there.

    • Hi, Singpretty. I don’t know if thus would interest you, but there are people who do belly dancing in chairs. Can you still do aqua aerobics? I started doing that a few months ago. ^^

      • @Bookeater, I love, Love, LOVE the idea of belly dancing in chairs. I remember when I first started learning, I teased my instructor about being able to shimmy while sitting and she didn’t believe it could be done. I proved her wrong. Now suddenly I want to find these people who do belly dancing in chairs. If you have any information, could you please share a link? :)

        • The http://www.chairaerobics.com site has a chair belly-dance video and other chair exercise videos. (I have not tried any of their videos; just googled.)


          The above is a wheelchair belly dance class.

          • Thanks for this info! :)

  17. I think you’d look awesome in a cape…

    Also, thank you for another great blog post.

  18. Absolutely love this. Especially the part about joint issues (as I am a fat woman with joint issues).

  19. I am so lucky. I’m in the Super Fat category (5’2″, 290 lbs).

    My first knee surgeon told me repeatedly that I needed to “lose some weight” and “wait a few years” before he would sign off on a knee replacement. (By this point I could barely walk 100 feet without significant pain.) My sister-in-law suggested I see another surgeon, who, after looking at my x-rays, offered to pencil me in the following week! (He told me, “I work with heavier people all the time and they respond just as well as everyone else to joint replacement surgery.”)

    I’ve had both knees replaced this year. No pain. I’m my orthopedic practice’s “star patient” and my physical therapists just released me into the wild with flying colors. I’ve started with a personal trainer to get my condition back, and he’s amazed at my progress. Why? I’m HEALTHY. Just fat. And because I was motivated and had a rock star for a surgeon, I’m on track to be back in shape soon as well. As I told my trainer, weight loss is a bonus, I want to be able to DO THINGS again.

    So keep looking. Good doctors and surgeons are out there.

  20. I think you meant World Health Organization (WHO), not Association. Not a big deal, just for future reference when you do your outreach work.

    It drives me insane that med schools don’t accept fat cadavers. What better way to learn how to work on people of all sizes? Find a way around the limitations of equipment etc., especially when cadavers for dissection are not easy to come by!

    Second, I hope the folks sharing weight bias stories will take them and post them over at the “First Do No Harm” blog. We need to formally document these stories. I send medical professionals to that blog all the time, and I pull from it too when doing speaking gigs on medical care for people of size. It’s SO important that we document and collect these stories, and they are handier in a central location like that. http://fathealth.wordpress.com/

  21. Whenever people in my life defend the show “The Biggest Loser”, I always tell them that losing weight hat quickly is unhealthy- no matter how much you weigh!

    • If the producers of “The Biggest Loser” went to Guantanamo Bay and tried to do that to the prisoners there, Amnesty International would be all over them like stink on a skunk. Because it is TORTURE.

      Yes, all you “The Biggest Loser” fans, you are watching torture porn.

      • *shudder* I’m a lifelong horror fan–seriously, my bedtime story of choice as a toddler was “The Raven”–and I loathe torture porn. I’m not a big fan of psycho-killer movies to start with, but torture porn of any kind crosses a line that touches too close to reality. I’ve seen too much of what people are capable of doing to each other in real life. I don’t need to see it in movies or on TV.

        All I can think of is that the people who like that shit have never been beneath its boot before.

  22. Ragen said: “I also think that the larger someone is, the higher the temptation to suggest that whatever issues they are dealing with would be solved if they were just smaller.”

    Do you mean that if I lost weight, I’d have a magic time machine that would take me back and prevent me from being hit by a truck? Ooooh, I want that!

  23. And actually, in England at least, people very often are denied WLS for being too obese, which people invariably find ironic and baffling, but which does make sense: the surgery is incredibly risky on people over a certain weight. It’s a much more firm link than that between obesity and ill health generally.

  24. Sorry, this is a reply to DeAun’s comment at the top that says she doesn’t think WLS would be denied on the grounds of weight.


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