The Fat Chick Diaries

In this article from the New York Times, Julie Weed reports on a minor rebellion among primary care physicians, who are radically changing the way they do business so they can see fewer patients each day and spend the time it really takes to offer them quality care. It involves things like reducing office staff and going to web-based appointment management. It also means freeing themselves from the yoke of insurance companies, which have huge paperwork requirements (forcing doctors to hire office staff) and puny payouts.

This got me thinking. This movement is both small and young. The overwhelming majority of doctors still practice rapid-fire, assembly-line medicine, where nurses or medical assistants line patients up in rows of little examining rooms and doctors move along the hallway, popping into each room for as little time as possible, just long enough to order some tests (all of which must be performed off-site, natch), or make a diagnosis and write a script, dictate a few notes, and move on.

If you were one of these doctors, why would you take the time to dig deeper when you could just say, “It’s because you’re fat. Lose weight. NEXT!”

I’m not saying they’re right. I’m saying that type of environment breeds this type of behavior. Fatness is the low-hanging fruit. The easy explanation. And a harried doctor under pressure to move fast probably just can’t help herself after a while.

In fact, the more fat people a doctor has on her schedule in a day, the more money she can make. She can practically run down the hall, pausing momentarily at each door just to peek in and say, “It’s because you’re fat! It’s because YOU’RE fat! It’s because YOU’RE fat TOO!” That leaves a lot more time to ponder the real mystery cases– like when thin people develop medical problems they think only fat people get. Thin and got heart disease? Well, we’ll actually have to look into that, won’t we?

It’s in everyone’s interest to reform the way modern assembly-line medicine is practiced. But I’m thinking maybe it’s especially in the interest of those of us whose larger bodies offer doctors an easy way out.

I learned two new phrases today: “thin privilege” and “diversely-bodied.”

Things are busy, and I’m a bit behind in reading the fat-related articles from the New York Times. I just finished this one from way back on May 14. (See? I told you I was behind!)

The article is about the experience of fat people in yoga classes, and how separate courses for fat folks are springing up all over the country. It notes specifically the inhospitable climate in many regular yoga courses, due in part to the inability of many yoga instructors to offer appropriate support and pose modifications to accommodate the needs of people who, for example, have breasts and bellies to big to allow them to get into the standard child’s pose. That’s me, by the way– I do mine with my knees spread apart so my belly has a place to go. But then, I do my yoga at home with Megan Garcia’s wonderful DVD put out by the folks at Just My Size. Well worth the money if you’re a beginner.

As usual, the comments that follow the article run the gamut from enlightened and supportive to ignorant and hateful. A few suggest that fatties need to be in classes with thin people so we can have thin role models who did the hard work of losing the weight. This, of course, falsely presumes that all thin people are thin because they work hard at it, that all fat people are fat because they haven’t bothered to work hard at it, and that we’re looking to be (or need to be) inspired by thin role models in the first place.

But then there is this comment by Anna from Atlanta, which I just loved:

It’s amazing that a practice meant to bring about awareness can operationally be so closed! I’ve practiced yoga for many years and have always very much enjoyed the rare opportunities to practice in diverse communities…it brings a whole new level of joy into movement! But before reading this article, I had never considered the fact that diversely-bodied groups are so rare because lots of teachers don’t know how to adjust the full spectrum of bodies.

It’s “thin privilege” to be blind to the ways some are included and others excluded in this society….thanks for opening my eyes! In the future, I would like to train as a teacher, and I will remember this article.

We all struggle, and we can all benefit from enjoying and exploring our bodies…my practice helps me manage depression and be less aggressive toward myself. Until there are more integrated classes with well-trained teachers, I think it’s wonderful that there are separate classes for plus-sized yogis. If yoga is about accepting ourselves as we are and playing mindfully at our edge, then our community of practice can acknowledge its exclusivity (and the underlying issues that inform it) and work intelligently at becoming more inclusive.

— Anna, Atlanta

Among the things I liked about Anna’s enlightened comment is that it taught me two new phrases: “thin privilege” and “diversely-bodied.”

Thin privilege if, of course, an adaptation of “white privilege,” which is a concept that covers all of the ways that white people, even those who work hard to eschew racism, still experience benefits of being white whether they want to or not. It ranges from having no dearth race-mates in positions of power and authority and the vastly different treatment white people receive when they come into contact with law enforcement (nobody gets pulled over for Driving While White) to being able to buy band-aids that match your skin tone. If you Google the phrase you’ll find extensive lists of examples of white privilege.

I’m a bit surprised at myself that it never occurred to me to use the term “thin privilege” to describe the range of privileges that accrue to thin people in society because they are thin, especially to thin women. Next time you go to the mall and see the number of clothing stores for thin women compared to those for fat women, even though the majority of American woman are considered fat, well, that’s thin privilege: a wider range of clothing options, including professional attire. Next time you watch the news and realize that Candy Crowley is virtually alone as fat chick in the world of television journalism, well, that’s thin privilege. Thin people make more money and face less workplace discrimination. Thin students never have trouble fitting into the desks at school. And let’s not even talk about airplane seats. That’s thin privilege. The scapegoating of fat people because certain health issues are associated with weight while thin people with unhealthy habits get a pass from society because they can’t be identified on sight, well, that’s thin privilege too.

This is a phrase I need to use more often. All of us do.

Like many of my sister fat chick bloggers, I have blogged about Governor Paterson’s fat tax. You can see my previous posts here and here. My beef has been not so much with the idea as with the abusive and misleading name given to the tax, especially since the majority of the fat people I know already drink diet soda.

I’m pretty new to this whole blogging thing, and I’m still in the process of exploring the amazing blogs out there that deal with fat issues. So forgive me if I’m the last kid on the block to clue in to this amazing resource: Junkfood Science. The blogger, Sandra Szwarc, is a thoroughly credentialed nurse among other things, and she knows how to bring the data. one of her favorite sports is taking down idiots who use outdated, debunked studies or unsupported myths to promote bogus ideas about diet and nutrition, and therefore often about fatness and health. She’s a mythbuster extraordinaire, and I can’t stop reading her stuff.

Here’s her take on the obesity tax, which she calls a fat discrimination tax. When I wrote about the tax myself, I said I didn’t think it was the fat people who were drinking the sugared sodas. She actually brings the data: the research shows not only that it’s not fat people, but rather young adult males, who drink the majority of sugared sodas. She also busts the governor’s people for using the now thoroughly debunked claim that obesity causes more than 300,000 deaths a year.

If you haven’t already, go take a look. It’s definitely worth your time.

Recently on Shapely Prose, Kate Harding posted about a study that shows that ovarian cancer survivorship goes up when fat chicks are dosed with chemo according to their actual weight, and not the weight that is deal for their height. The post also noted that fat chicks are not screened as often for other types of cancer as thin women. WTF is up with THAT?

All of this got me thinking. In my previous post, I noted that my parents are big into the beach, and as a kid I was taught to swim very young so they could drag me to the beach, pool, reservoir, lake, etc., without fear of my drowning. I was in the sun. A LOT.

I happen to be very fair-skinned. I also happen to have grown up during the time when nobody used sunscreen, and in fact it was widely believed that going out and deliberately getting a sunburn early in the summer was good for you, because it would fade and become your base tan.

So I kind of worry a little about skin cancer. Just a little, you know?

Friends of mine with similar complexions and life histories have told me they get regular screenings for skin cancer. They go see a dermatologist, who goes over their entire body inch by inch in search of anything they think might be cancerous or precancerous. A fair number of them have had things lopped off and biopsied.

I have asked for this examination twice– once from a general practitioner, and once from a dermatologist. In the latter case, this was the entire reason for my visit. Both times, the examination was perfunctory at best. I stripped down to my bra and panties, and the doctor quickly perused only those portions of my epidermis that were readily visible. The GP did this while standing two feet away. Can you really tell a good mole from a bad mole at that distance? The dermo did get up a little closer and used some sort of special scope, but he only looked at parts he could see while I was sitting down and wearing a bra and panties. If I had a cancerous lesion, say, on the back of my thigh, he never would have seen it. My experience does not at all resemble what has been described to me by my friends. It has occurred to me that it might be because to the average doc, my body probably isn’t as much fun to look at up close as, say, Heidi Klum, whose dermatological exams probably take at least half a day.

To his credit, my GP did identify a mole on my lower lip that he felt looked a little fishy, and had it removed and biopsied. Benign.

Here’s a little project for all my fat sisters: Before your next doctor visit, do a good, solid internet search about all the ways in which fat chicks don’t get the same kind of care from doctors as other people. Make a list. Bring it to your doctor. Make sure he or she is doing for you exactly what would be done for any other patient. If you’re skeptical, make them say it out loud. That’s what I’m going to do.

Brace yourselves, skinny New Yorkers, because this fat chick is getting back in the pool.

My parents are beach people, so when I was a kid, they put my brother and me into swimming lessons at the earliest possible age so they could take us to the beach and we wouldn’t drown. I spent an absolutely enormous chunk of every summer at either the local community pool, the reservoir, or the ocean. So much so, in fact, that I’m almost certain that at some point I will keel over dead from a melanoma. But I digress.

I love to swim, y’all. I love everything from lap swimming in a heated pool to just bobbing up and down in the ocean like a cork. But when I reached adulthood and I started getting fat, I became extremely self-conscious about my body and refused to be seen in public in a swimsuit for nearly a decade. In other words, I let society’s hatred of fat folks drive me away from something I really love.

Shortly after the turn of the century, I was working at a small liberal arts college in Ohio that happened to have a pool, which happened to be free of charge for faculty and staff. I finally worked up the nerve to go out and buy a swimsuit, and I got my fat ass back in the pool.

You know what’s weird? I can’t sink now. When I was a kid, the most fun thing to do in the pool was to go to the deep end and let all the air out of your lungs so you could sink like a stone, then see how long you could sit on the bottom of the pool before you had to come up for air. As it turns out, this trick only works for skinny people. Fat is very bouyant, and so I can no longer sink. Bummer. The good news, though, is that I have more or less become my own flotation device, and I’m almost certain never to drown. The backstroke is a hell of a lot easier now, because I don’t feel like I’m sinking all the time. It sort of makes me wonder how competitive swimmers with almost zero body fat manage to do it at all. Maybe it’s because they’re going so fast, kind of like Jesus lizards.

In any case, once I was back in the water, I was hooked. I swam laps several nights a week and got into really great shape. I even lost a few pounds, but only a few. When I moved to Long Island, the college where I had my next job also had a pool, free for faculty and staff, and I was able to continue swimming laps at night. In fact, it was necessary for my survival, since lap swimming is a great way to relieve stress, and the job itself was a neverending nightmare. Fortunately, it only lasted a little over a year, and then I was free. Unfortunately, I haven’t had decent pool access since that time, so I haven’t been in a pool in several years.

But that is about to change. Apparently, $75 gets me an annual pass to use any NYC rec center with a pool, and there is one with evening hours about a block away from where I work. Holy shit, y’all, A BLOCK AWAY!!!!!! I cannot believe my luck!

So listen up all you skinny New York lap swimmers: Get ready to circle up! If something about the sight of a fat chick in a swimsuit offends your delicate sensibilities, now would be a good time to practice averting your eyes and zipping your lips, because I’m comin’ in! Woo hooooooooo!

I do have a suit that fits, but just for this occasion, I may have to head over to Junonia and see what’s new in fat chick swimwear. I’ve bought my last three suits from them, and they’ve been fantastic.

This recent article from the NY Times on fat acceptance and the HAES movement just makes me want to stand up and cheer. Read and enjoy!

I promised myself today I would get back on topic and stop blogging about the election for a while. So here’s a roundup of some nifty things I’ve come across in the fat blogosphere that are worth taking a look at. Not all of them are recent, but I’m new at this, so they’re all new to me.

This post from Shapely Prose is really just superb. It should really be required reading for any ignorant thin person and self-loathing fat person contemplating opening their mouths to talk about weight issues.

Next, babble has a big long list of places to go to ponder why diets don’t work. I’m glad every time I see this topic discussed because, after all, somebody has to counter the multi-billion-dollar diet industry. However, what I hate about articles/books/posts about how diets don’t work is that they rarely define what they mean by diet. Are these just fad diets with catchy names, like the Cabbage Soup Diet or the Watermelon Diet or even the South Beach Diet? Only crash diets with extreme calorie restrictions? Or are they talking about any attempt whatsoever to lose weight be altering food intake? Very few of these articles define specifically what they mean by diets. I’ve seen it reported in several places that eating several small, balanced meals per day is the most consistently successful way to lose weight by changing your food intake. Does this count as a diet?

Okay, this next one isn’t a blog post, but it’s still worth checking out. It’s an article from Newsweek online that I’ve been meaning to post and blog about. It discusses five financial costs of obesity. Some of the give are costs to society at large for having fat people in it, and some are costs to the fat people themselves, such as lower wages. Apparently, we make more than $7K less per year than our thin counterparts. I’m thinking of printing this article out and carrying it around with me so I can whip it out every time somebody complains that fat people are costing everybody else money. The next person I hear complaining that fat people are driving up the price of airline tickets or screwing up the cost of their group health plan, they can damn well explain to me where my missing $7K is. Think my fat costs you money? Well, your bigotry costs ME money. $7K buys a lot of airline tickets.

Finally, the most recent post over on Big Fat Blog, a post about the importance of real-world activism has generated quite a few comments, including this one by DebraSY, which says a lot of what I often find myself thinking. So much so, in fact, that I’m going to b-quote her here just so I can see it all again:

Those same people buy the mythology that we eat radically differently now than we did thirty years ago. We do, in fact, eat differently, but not as the established voices would have us believe. Thirty years ago, we didn’t think of a serving of meat as the size of the palm of one’s hand. Likewise, a “serving” of spaghetti was the size of the plate it was served on; not a half cup with a small scoop of marinara sauce. We didn’t eat hummus; we ate Velveeta. Sprouts? Who the Hell ate alfalfa sprouts? Thirty years ago, we didn’t feel guilty if we’d only eaten four vegetables on a particular day. There is also a cultural mythology that we were soooo much more active. I don’t know about you, but thirty years ago, after school, I was watching either the Brady Bunch reruns or Dark Shadows. Playing outdoors with my friends was sometimes “kick the can” or riding bikes, but more often it was “sit around and talk about other kids at school.”

The mythology now is that people choose a life of sloth and culinary indulgence, and choose to live in bodies that are socially unacceptable, rather than to live in sacred “moderation.”

Oddly, so many of the people who buy this mythology are, as you point out, fat. That’s why we must be very careful not to exclude people who are trim in our movement. A fat pride parade doesn’t work here. So many thin people see their fat relatives eating less than the rest of the family, or at least no more, at Thanksgiving and Christmas. They know that their sisters and brothers have not “chosen” to be social pariahs and are not, in fact, slothful. They see what they see, but they need reassurance that when their backs are turned they aren’t being betrayed by a big lie. They need to know who the real liars are: the weight-loss industry, the people who have books to sell, the college department chairs who put department funding before academic integrity.

That’s why we need to reclaim the scientists. We need to attack the CDC when it issues an obesity alert (like an orange alert for the department of homeland security) to increase its prominence and funding. We need to demand that scientists start over from neutral, NEUTRAL, and to delve into why, why, why the average weight has increased by ten pounds in thirty years, and why, why, why the bell curve has flattened, creating more people who are “morbidly obese,” despite our extraordinary efforts to be “virtuous,” up to and including the surgical mutilation of our intestines, for God’s sake! On the other end of the bell curve are people who are dangerously thin — some triggered into eating disorders by a society that elevates weight paranoia to a religion, some besieged by immune defense disorders that do not make it possible to eat most foods. WHY? Our scientists must start from somewhere other than “lifestyle is the key,” as the Robert Wood Johnson Foundation would dictate with its near monopoly on funding of obesity research. (Robert Wood Johnson — founder of Johnson and Johnson, maker of the REALIZE laproscopic band.)

What has happened to mess with our collective weight in the past three decades? Is it environmental toxins? Fat-inducing hormones shot into the meat supply? New strains of viruses? A ridiculous concentration on sterilite surfaces? Or something else? Or a variety of reasons? Are these things affecting our genes, our endocrine systems, the composition of our gut flora, or something else? If fat is ASSOCIATED with certain disease, is it because of these outside factors. WE DON’T KNOW because the scientists can only get funding for “lifestyle” solutions that do not demonize business industry but include business and industry in the “solution” (a philosophy voiced by the Robert Wood Johnson Foundation spokesperson in a Newsweek artcle written by diet guru Dean Ornish).

If in the past three decades, the noses on people’s faces rotated left by 10% on average, we’d be researching the Hell out of anything that might have caused it. If some people’s noses had rotated upside down, right or left, and they couldn’t go outside their houses for fear of drowning in the rain, we’d be asking WHY! We wouldn’t be humiliating the people with nose rotation and further victimizing them.

In addition to putting the scientists in our sites, we need to put the legislators there. THEY need to know that the science of obesity is UNDECIDED, UNCLEAR, and until there are REAL answers, then legislation that further victimizes people who have put up with social pariah status is OUT OF THE QUESTION.

Care to know what I really think? (She descends from her soap box.)

Very recently, somebody I know referenced that scene in The Breakfast Club where Molly Ringwald insists she is not fat, and Judd Nelson replies, “Not at present, but I can see you’re really pushing maximum density. ” Then he goes on to explain that inside every thin person is a fat person dying to get out. Or something like that.

Well, as it turns out, inside some thin people there really IS a fat person trying to get out! According to the Washington Post, this is called being “secretly obese.” What it boils down to is this: some people who are skinny have health problems normally associated with obesity, even though they do not appear obese on the outside. As a result, they jack up everybody’s healthcare costs without being subjected to public shame because of it.

This pretty much splits all of humanity into four categories:

1. Fat people who are unhealthy and are the objects of scorn because, dammit, they’re costing us money!
2. Fat people who are healthy, who are either regarded as mythical creatures like mermaids or unicorns, or who are the objects of scorn anyway because nobody believes we’re healthy
3. Thin people who are healthy, who aren’t really part of this discussion (except when they’re the originators of scorn)
4. Thin people who are “secretly obese,” who aren’t the objects of scorn but should be because, dammit, they’re costing us money too!

If you ask me, that’s cheating. Perhaps everybody whose test results show them to be “secretly obese” ought to have a scarlet “O” tattooed on their forehead so they can become social pariahs and scapegoats for all of society’s problems just like people whose obesity is not a secret. Alternately, perhaps fat people who are in good health ought to be able to gather up some “secretly obese” people on a regular basis and unload upon them the pent up frustration that comes from being the objects of scorn.

Yeah. That sounds really good to me. After all, the reason people hate us because they think we’re unhealthy and costing everybody else millions in medical bills, right? Not because they just get their jollies dumping on fat folks, right? Because THAT would just be bigotry, and bigotry is wrong!

Back when I took freshman psych in college, there was a chapter in one of the required texts called “Birth Control by the Toaster Method.” This was a loooooong time ago, so unfortunately I do not have the name of the author to cite. The purpose of the chapter was to point out potential flaws in data analysis, the most common being the tendency to mistake correllation for causation. The name of the chapter derived from an example in which couples living in certain country (I forget which) who owned toasters had fewer children than couples who did not own toasters. However, it should be obvious to all but the stupidest among us that the toasters themselves were not the cause of the drop in fertility (actually, it’s fecundity, not fertility, but that’s a pet peeve for another day). The relationship between the two was one of correllation, not causation. The underlying cause behind both was most likely income level– it was already well-documented that couple of higher socioecnomic strata have fewer children on average. They’d also be more likely to be able to afford a toaster.

I very strongly suspect, as do many others, that the same holds true for fatness and the diseases that frequently (but not always) accompany it, such as heart disease and diabetes. It’s not that the fatness causes the disease, it’s that the same thing that causes the fatness also causes the disease. For example, if you go through a long period of being sedendary and/or having really bad eating habits (I’ve done both in the past), you will probably pack on some poundage. You will also most likely put yourself at risk of developing diseases associated with bad eating habits and a sedentary lifestyle. In fact, the latter is true even for people who don’t get fat in the process. Moreover, it is supported by the increasing body of research that shows that fat people with healthy habits are healthier than skinny people with poor habits.

But where I’m really going with this post is this:

Recently I’ve posted a bit about the relationship between the built environment and fatness. Here’s a related article from Newsweek (another oldie-but-goodie) that talks about the unhealthy nature of the habitat we’re creating for ourselves and its relationship not to fatness, but to heart disease. Think of fatness as the toaster and heart disease as the fertility rate. It’s easy to see how people living in unwalkable, sprawling suburbs might wind up with both.

What is to be done? I wrote in a previous post about incentivizing the development of more walkable communities. However, the greater issue is demand. People move out to the sprawling ‘burbs in part because that’s the lifestyle they want. They want space. They don’t want to feel crowded. They value the conspicuous of consumption that a McMansion provides. These are all parts of the reason why families having fewer and fewer children are still buying larger and larger houses, with larger and larger yards. Perhaps the mortgage crisis will curtail this trend somewhat, but I doubt it will be enough to cause a radical cultural shift that will increase the demand for housing in compact, walkable communities. Good, strong leadership is needed. I don’t hear either presidentail candidate talking about this issue. Any ideas?

Ah, the New York Times, I love it so…

Today’s gem is yet another article on the increasingly large (obese?) body of evidence showing that you can’t count on physical fatness as an indicator of physical fitness, and it’s better to be fat and fit than thin and unfit.

It seems to me that the group of people to who whom the greatest disservice is done by the message that thinness equals health are the uhealthy thin people. They are allowed to assume that everything must be fine, because after all, they’re thin. A friend-of-a-friend of mine ate an entire pint of ice cream every single day for years, but never gained a pound. Putting aside for a moment the outrageous unfairness of that (I can gain weight just WATCHING him eat ice cream!), the real problem is this: He assumed everything was fine, and nobody suggested otherwise,– not even his doctor, who probably never asked him about his eating habits because after all, he was thin, so they must be fine, right? Then one day, he started experiencing sympoms of insulin resistance. He’s prediabetic now.

I’ve moved around a lot in the last decade, so I’ve had a handful of different primary case physicians. I’ve heard a common theme from all of them: Basically, if they had to pick me out of a crowd based on my medical test results (resting heartrate, blood pressure, cholesterol, blood glucose, etc.), they’d never be able to do it, because I have the numbers of a much thinner person. I’ve often been tempted to have them printed up on a tee shirt so people who see me and automatically think “unhealthy” will sieze up and fall over from their own cognitize dissonance. But the point is, they ALWAYS do the full array of tests on me, because they look at me and see me as high risk. If my FOAF’s docs had insisted on a fasting blood glucose test for him every year, or at least asked him about his eating habits (they ask me EVERY time, and probably don’t believe what I tell them), he might not be where he is now. That’s just wrong.

Bottom line: Unhealthy habits are unhealthy EVEN IF they don’t make you fat, and healthy habits are healthy EVEN IF they don’t make you thin. I am forever puzzled that this just will not sink in.