If The Doctor Says A Health Issue is Caused By Being Fat

Doctors telling fat patientsI’m often contacted by someone who has just been diagnosed with a health issue, and their healthcare provider has blamed it on their size and, in most cases, suggested dieting. The person contacting me has been practicing Size Acceptance/Health at Every Size (usually after a lifetime of failed dieting) but they are wondering if maybe they should try dieting again considering this new diagnosis.

Of course I’m not a doctor and I’m not giving medical advice, but I always tell them what I would do. If it were me I would look at it in two parts. First – is it true that body size causes this issue. Second, if so is attempting to control my body size a good healthcare option?

Part 1 – Is it true that body size causes this issue

Determining this can be tricky because our medical system is so steeped in fatphobia that people extrapolate causation from correlation, and extrapolate correlation from nothing (I’ve had doctors prescribe dieting to me for a broken toe, a separated shoulder, and strep throat, so we have to assume that healthcare professionals may be viewing our health through an extremely fatphobic lens. Almost any fat person can tell you that “diagnosis fat/prescription weight loss” is a huge barrier to fat people getting competent healthcare.)

When it comes to health issues that can affect, or are affecting,  mobility plenty of this is just ableism re-packaged into fatphobia. The desire to manipulate someone’s disability – including and especially lying to them about the possibilities of changing their disability through weight loss – is a form of ableism that should absolutely called out and eradicated.

The question that I’ve found to get to the bottom of this is “does this happen to thin people” If the answer is yes (and it always is,) then I know that being thin can neither be a sure preventative nor a sure cure. (If the answer is “yes, but it happens more often in heavier patients” The follow up questions would be “based on what research” and “how much more often are heavier patients tested for this than thinner people.” )

Part 2 – Is attempting to control my body size a good healthcare option?

If I were to decide that my size is causing this issue, the next question would be “is attempting to control my body size a good healthcare option?”

There is not a single study where more than a tiny fraction of people have succeeded at long-term weight loss, and very often these “successes” lost only 5-10 pounds. Almost everyone who attempts to manipulate their body size (through whatever method, whether it’s called a diet or lifestyle change, or something else) ends up gaining back their weight, and the majority gain back more than they lost and end up at a higher weight (that was exactly what my dieting attempts led to)– so if we’re considering body size to be the “problem,” then attempting to manipulate my body size is the worst possible choice based on all the research, and my personal history with dieting. So that would be a no on the weight loss attempt.

I would ask my healthcare provider(s) what thin people are told to do for whatever this health problem is, and I would go from there in terms of choosing a course of action.

I think that doctors telling fat patients to attempt to become thinner (to solve health problems that thinner people also have) is not just lazy healthcare, it’s unethical, unsupported by evidence, incompetent healthcare and, if I can help it, I won’t put up with it.

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Is It Ok To Call Fat People Fat?

Actual SizeI frequently get asked something like “not everyone likes to be called fat, so when I’m talking to groups, or people whose preferences I don’t know, or if I’m writing about fat people, what terms should I use?”

It’s a good question, and there isn’t a single answer, but I’ll try to get the discussion started here:

When talking to someone one-on-one, you’ll want to use whatever they prefer – fat, curvy, plus-size, fluffy, whatever. Depending on your relationship, it may or may not be appropriate to talk about terms (ie: I’m happy to call you overweight if you prefer, I don’t personally use that term unless I’m specifically asked because it suggests that someone’s body is the wrong weight which I avoid since I personally practice body positivity…) You need to decide if it’s appropriate, and I would suggest (especially if you personally are not fat) that you err on the side of just using the term the person prefers unless you have a very close relationship with this person.

When it comes to groups or writing, there are words to avoid, and words that you can use. Let’s start with those to avoid:

Avoid words and phrases that pathologize body size either directly or by comparison, like:

Obese

The idea that our weight in pounds times 703 divided by our height in inches squared gives a health professional tons of information about our health and treatment options is pretty messed up, and that’s before you take into account the fact that the “obese” definition includes Dwayne Johnson (The Rock).  In addition to being an annoyingly useless abuse of mathematics,  it’s dangerous to those of us who fall under its numerical construct,, causing healthcare professionals to focus on height weight ratio instead of their actual patients, even making them believe that they can diagnose mental and physical health issues from a picture of someone they’ve never met.

Overweight

To me this is offensive because it suggests that someone’s body is wrong.  It’s body shaming. Over what weight?  Saying that someone is “overweight” is saying that:

  • There is a weight that they should be.
  • They are more than that weight (with the connotation that this is a bad thing.)
  • It’s somehow our job to decide how much other people should weigh.

And that’s crap. People are lots of different sizes for lots of different reasons and it’s not our job to tell them that who they are is somehow too much person.  People come in different sizes and unless they ask us for an assessment of their body against some measure, then it’s not our place to say that they are “over [some arbitrary] weight.”

Normal Weight

“Normal weight,” along with the two terms above, form the basic classes used in the (totally bullshit) Body Mass Index Chart. There is really no such thing as a “normal weight” this is just a term that was created as a base from which to pathologize other body sizes.

Healthy Weight

Again, not an actual thing. Remembering that health is not an obligation, barometer of worthiness, or entirely within our control, the truth is that people of all sizes have health issues, and there is no weight that you can reach that will make you immortal unless and until you get hit by a bus. The conflation of weight and health is at the root of so much fatphobia, including and especially fatphobia in healthcare.

What If I’m Talking or Writing About Studies That Use These Terms?

If you are discussing studies that use terms like “obese,” “overweight,” or “normal weight” then put them in quotation marks and include a content note like “These are terms used in this study, we do not agree with these terms as they pathologize body sizes and are inaccurate.”

So What’s The Deal With Using Fat?

Fat is used by many people (including me, for the reasons I outlined in detail here,) but may be triggering for others – especially in setting like eating disorder recovery.  In other situations, it can be useful to use the word fat and explain that it is just an adjective like any other. The problem is that people have heaped negative connotations on it because of fatphobia, and the fact that we search for euphemisms and talk around the idea of being fat (ie people will say “You’re not fat, you have fat,” but they would never say “You’re not thin, you have thinness” or “You’re not brunette, you have brown hair,”) is indicative of the problem. So, learning to use fat as a neutral descriptor can be a part of dismantling size-based oppression. But it’s probably best if that work is led by fat people (as opposed to thin people telling fat people what to – and what not to – call ourselves.)

Using “fat” may not always be appropriate, so you can also use many other neutral terms that people, including fat activists and clinicians who work with fat folks, use. (Remember, no community is a monolith and so there will be fat people who like and dislike each of these terms.)

Person/People of size  – For a person of size, it is more difficult to find clothing that fits their body and personal style. People of size are demanding better fashion choices.

Larger body – For those who live in larger bodies, weight-based oppression among doctors can compromise their healthcare.

Heavier body – Having a heavier body can mean being the victim of bullying.

Bigger Body – Living in a bigger body can mean being discriminated again on public transportation and commercial airlines.

Plus Size  – Being a plus-size athlete may mean that you have to deal with stereotypes and fatphobia just to run the same 5k as everybody else.

So that should get you started. Are there other words that you use or avoid? Feel free to keep this discussion going in the comments!

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Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

Fat Is Not A Violation

    

 

         

    

     

Did you appreciate this post? If you like the work I do, you can support my ability to do more of it with a one-time contribution or by becoming a member.

Like this blog?  Here’s more cool stuff:

Wellness for All Bodies ProgramA simple, step-by-step, super efficient guide to setting and reaching your health goals from a weight-neutral perspective.  This program can be used by individuals, or by groups, including as a workplace wellness program!
Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

 

 

 

I’m Not Fingernails, But I Am Fat

Pink Background, a black and white image of thin woman in a dress and heels leans on a table and waving. Black text says "Wait, Come back. You forgot your bullshit." someecards user cardYou’ve probably seen the meme on social media:  “You are not fat. You have fat.  You also have fingernails.  But you are not fingernails.”  I’ve seen this in plenty of versions and I think it’s problematic on a lot of levels. It’s come up in a number of conversations recently and so I’m re-posting my response.

First of all, as regular readers have probably already sussed out, I would be much more comfortable if this was written from the perspective of how someone feels about/for themselves instead of dictating to others how we should feel (ie: “I’m not fat, I have fat” instead of “You are not fat, you have fat”.)  People are allowed to look at their bodies this way because, hey, underpants rule.  That said, I think it’s an idea worth some exploring.

Let’s consider some other examples – can you imagine Facebook memes that say “You are not brunette, you have brown hair” or “You are not tall, you have above-average height.” You’re not thin, you have thinness? When I’m flying in for a speaking gig I often tell the person who is responsible for picking up that I’ll be the short, fat, brunette -in the blue dress or whatever.  People often respond by telling me not to call myself fat, nobody in my life has ever told me not to call myself brunette.  Therein lies my problem with this – it seems to me that the reason to draw a distinction between being fat and having fat is that we are considering being fat to be a negative thing from which we want to disassociate, and/or we want to see it as so temporary that we don’t want to be identified as fat.

I don’t think the research suggests that most fat people will remove our fat.  Regardless, knowing that it’s possible that time and circumstance might change the size of my body, I don’t think that’s a reason to not identify the way that it looks now. I call myself a brunette even though it’s basically a certainty that I will someday have hair that is gray and not brown. So even though there’s the possibility that my body may someday not be fat (through illness etc. – it’s certainly not a goal of mine) I’m definitely fat right now. So why would I want to find a semantic way out of it?

The problem isn’t that fat people exist. The problem is the way that fat people are stigmatized, stereotyped, bullied, marginalized, and oppressed. I’m don’t think this can be solved by “having” instead of “being” fat. To me the fact that identifying a body as fat is considered an insult is a symptom of a problem, not the actual problem – so this can’t be solved through wordplay.  If brunettes were being oppressed I don’t think there is much to be gained by saying that I’m not a brunette, I just have brown hair.

Similarly, since fat people are being oppressed, I don’t think there is much to be gained by saying that I’m not fat, I just have fat.  Mostly because no matter how I describe myself, people can still see me, and these oppressions are based on how I look to others, not on how I describe myself.  I also understand that the word “fat” has been used as derisive and I understand that not everyone is into using it as a reclaiming term and everybody gets to decide that for themselves.  For me, using the word fat to describe myself without apology tells my bullies that they can’t have my lunch money any more, and avoids pathologizing my body in the way that terms like “overweight” and “obese” do.

It’s possible that people would give me slightly better treatment (however begrudgingly) if I said that I’m not fat – I have fat, or if I characterized myself as being “overweight” in a way that indicates that I believe there’s a problem with my body.  I’m ok with passing on that “approval”, because  I am far more interested in fighting stereotyping, stigma, bullying and oppression, than I am in trying to avoid it through wordplay or concessions that I can make to my oppressors.  Other people may see this differently and/or make other choices than I do and, of course, that’s completely fine. But as for me, I am fat because I have fat and I’m fine with that.

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Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

Weight Watchers By Any Other Name Would Still Be A Fraud

Deja Moo_When you know you've experienced this bullshit beforeWeight Watchers announced on Monday that they are changing their name to WW to reflect their focus on wellness and health. This is probably a clever move, though it’s not the first time they’ve made it. In 2015, they launched a program called “Beyond the Scale” that seems to be the same thing they are talking about now, minus the name change.

This idea that “everything old is new again” has been a long-running theme for the company. They have built their business model on getting repeat business from the clients they repeatedly fail.

You see, WW has never had success is creating sustained long-term weight loss. It’s a shameful track record — one they share with literally every other diet and lifestyle company that claims they can produce sustained, long-term, intentional weight loss. They know that most people lose weight short-term and almost all of them gain it back long term (with a majority gaining back more than they lost).

Moving forward, they will go by WW and will “focus on wellness.” They made sure to mention that they are still weight-loss focused, saying “We will never abdicate our leadership in the best healthy eating program for weight loss in the world, but we can be so much more today…” This isn’t their first foray into attempting to co-opt the language of Size Acceptance and Health at Every Size to sell diets — even as they’ve put out blatantly body shaming ads.

It’s easy to see the profit rationale for their hypocrisy. They get to continue selling their program to people, who they spent years successfully convincing to hate their bodies, and try to open up a new market amongst the people who have crawled and scratched their way up and out of the diet culture that Weight Watchers, excuse me, WW, immersed them in. So, it will likely make money, but that doesn’t make it right.

People are allowed to do whatever they want with their bodies  —regardless of the reasons, risks, or likelihood of success. And while I’m grateful that they seem to have stopped targeting children, that does not change the fact that it is impossible to sell weight loss from a wellness perspective. Here’s why…

You can read the rest of the piece here!

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Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

 

 

The Diet Industry Takes It All

Less ThanLately I’ve been getting more into Instragam (in the words of Sam Seaborn/Aaron Sorkin: Let’s forget the fact that I’m coming a little late to the party and embrace the fact that I showed up at all…”) I’m not sure how I got there, but I found myself on a page of things that IG seemed to think I would enjoy. Except IG was dead fucking wrong.

It was a bunch of “before and after” weight loss pictures (of course they didn’t include the “after after” picture that will happen when almost all of them regain their weight in a few years.) People were commenting about how their “prayers were answered,” and their “hopes and dreams came true,” and a bunch of them said something about “celebrating” with many asking people to celebrate with them.

And that’s when I was reminded that diet culture conditions us to hope and pray and dream that someday we will be less than we are now, and to celebrate – and ask others to celebrate when there is less of us (for however brief that time may be.) Back in my diet days I remember doing this, and expecting people to praise me for it.

This is a dangerous message that harms us in so many ways:

Because, in a world with so much oppression and marginalization – where so many people are made less than they could be by structural and institutionalized oppression, where so many voices are hushed and unheard – diet culture tells us to spend our time, money, and energy trying to make ourselves smaller.

Because most people will lose weight short term, but almost all of them will gain it back long-term with a majority gaining back more than they lost, and will then be told to try again. That means that this focus of our resources on becoming smaller will likely last our entire lifetimes, as those who are trapped in the cycle will yo-yo diet from childhood until they die. I was recently told a story (with permission to share) of a women in the advanced stages of Altzheimers disease – she had forgotten who her friends and family were, but remembered that she – and everyone else – was supposed to diet and be thin. Diet culture was literally the only memory she had left. Fucking tragic.

Because when dieting doesn’t work people will turn to dangerous drugs and surgeries recommended by doctors steeped in fatphobia, which will cause some to slowly waste away to nothing while others will be not smaller, but dead.

If we let it, diet culture will use the empty promise that we could be smaller (and the messed up culture that convinces us that’s a good thing) in order to take everything it can from us – time, energy, and money that could be used to live our best lives in the bodies we have, to fight injustice and dismantle oppression.

I no longer have any interest in making myself smaller so that the empty space can continue to be filled up by the status quo. I already gave too much of myself to diet culture, too much of my voice, too much of my time, too much of my energy, too much of my money, too much of my life trying to shrink – to create a world where there was less of me. Never Again. Diet culture cannot and will not take any more of me, it doesn’t deserve any of me and it never did.  I’m using all of me to help create a world where oppression, marginalization, and suffering are the things that there are less of.

Did you appreciate this post? My work is paid for by the people who get value from it. If you like the work I do, you can support my ability to do more of it with a one-time contribution or by becoming a member.

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Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

 

 

 

A College Degree Shouldn’t Require a Weigh-In – But This One Does

WTFMorgan Stacy is in recovery from bulimia. She has been behavior-free for six months, which is major progress.

However, Morgan’s college is putting her recovery in serious jeopardy with one of their required courses.

Morgan is a student at Vanguard University, a four-year, private “Christian” school that receives state funding. At Vanguard, every undergraduate is required to take a class in which they must calculate their Body Mass Index (BMI), which is a ratio of weight and height. They are also required to measure their body composition via Biometric Impedance Analysis (BIA) and measure and calculate their waist-to-hip ratio.

In another lab, they are required to keep a food log and answer questions about their caloric intake like “what are you eating too much of?” Students are next given an assignment to determine the “factors” that “influenced your performance in these tests,” create a “body composition goal,” and then develop a plan for how they will achieve the results.

In addition to this class being utterly inappropriate (because a weigh-in shouldn’t be required for an English degree)  and fatphobic, it’s dangerous. The University has no way of knowing the circumstances of each student — who might be on the edge of an eating disorder, who might be in the throes, and who is trying to recover. For those of us practicing Health at Every Size and/or Intuitive Eating for whatever reason, these assignments go against our core beliefs and practices and can conflict with the recommendations of our healthcare providers.

That the class exists at all tells us that the University doesn’t understand the danger they are dragging students into. They have no idea how many students they have hurt, are currently hurting, and will hurt in the future.

Read the rest of the piece here!

My work is paid for by the people who get value from it (and not companies that are harm fat people for profit!) If you value my work, you can support my ability to do more of it with a one-time contribution or by becoming a member.

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Price: $25.00 ($10 for DancesWithFat members – register on the member page)

Non-Members click here for all the details and to register!

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com or on Instagram.

If you are uncomfortable with my offering things for sale on this site, you are invited to check out this post.