Archive | June 2013

Fat Discrimination, Part II

Tools of the Trade

 

photo via: http://www.flickr.com/photos/lolitserica

You don’t have to read this post.  Just go talk to a fat person.  Ok, fine, read this post for a more concise version.  Then go talk to a fat person in your life.

Doctors, nurses, midwives and other health professionals can make taking care of myself a real pain in the butt.  People of size have to worry about two things when they see a health professional-  will they be able to treat me appropriately and will they be willing to treat me appropriately?

Depending on a person’s weight and size, a health professional may not be able to accommodate them.  Offices may not have chairs large enough.  If your chair is uncomfortable or impossible to sit down in, where should I wait?  Their blood pressure cuffs may not be large enough.  A too-small cuff will read incorrectly- readings will be higher than that person’s actual blood pressure.  I also know from experience that it is also painful.  Exam or treatment tables are designed to hold a certain amount of weight- that weight can be 250, 300, 400 pounds or more,  but a large person can’t always be certain that the equipment they’re told to sit on will support their weight.  For me, this is something I particularly worry about when getting a massage. Exam gowns are uncomfortable for everyone, but I promise they’re more uncomfortable if you can’t fit your arms though, or when the little sheet you’re supposed to cover your legs with doesn’t even cover across your hips.  Scales often top out at 350 pounds- how is a larger patient supposed to even know their size?  How am I supposed to trust a care provider to care for me, when they can’t acknowledge and care for the physical realities of my body?

After physical concerns, I have to worry about how a care provider will treat me.  There are so many personal stories about mistreatment. First, Do No Harm talks about the realities of patients seeking help and how they are treated.  But maybe you’re not persuaded by personal stories- let’s talk facts for a moment.   How care providers feel about my body impacts how they treat me.  Doctors spend less time with fat patients, offer them less options, and offer less education.  Doctors assume they are lazy, dishonest, and won’t be compliant with treatment. When asked to rate all patients, doctors acknowledge they just don’t like fat patients!  Don’t take my word for it, go read this article published in the American Journal of Public Medicine.

Fat patients sense this distrust and distaste.  They remember their mistreatment years afterwards.  It means that as a group we seek preventative care less often, including pap smears and mammograms.  When we do have health issues, we may wait until they reach emergency status, because as bad as it is feeling poorly, it is worse when you’re treated awfully about it.

This behavior makes it harder for fat patients to access even basic health care needs.  Care providers, including doctors, nurses, midwives, massage therapists, psychologists and counselors, nutritionists, physical therapists, social workers as well as others need to embrace some compassion and empathy for their fat patients, and treat us with the human dignity and respect we deserve.

Fat Discrimination, let’s talk about it

I had an amazing day at the HAES® training. I always wondered what kind of people earnestly say “I’m just so excited to be here!” People like me, I guess. I think there are over 50 people in this room, just eager for information about how to teach their patients, coworkers, and community how to better support health for people of all sizes. One trainer is from the UK, and participants are from as far away as Australia.

There are quite a few registered dietitians in the room getting their eyes opened about the kinds of bigotry and hurdles fat people face, in healthcare and the world at large. The gal sitting next to me went wide-eyed when I said that I can’t do things like zip lines or indoor skydiving because business owners don’t bother to make those activities available and safe for me. My money isn’t worth it to them.

I didn’t talk about the fact that I carry-on my luggage so that the airlines don’t lose my clothes- my clothes are far too precious to me to let them out of my sight, because they’re far less replaceable than straight-sized clothes. Or that I have to be conscious of how I am perceived in job interviews, or at the airlines, because I could lose a job or get booted from a flight. I didn’t mention that I got turned down for better health insurance last week. And that I have to call ahead to new doctors to make sure they’ll treat me like a human being instead of a disease, including having equipment that will accommodate my body.

People in the community call not having to deal with these issues “thin privilege”.  

The dietitian I was talking to said “well, you chose to go out and deal with these things anyway”.  Well, yeah.  I deserve to do fun things, have nice things, dress well, and be treated well.  The fact that that doesn’t happen is fully fixable, and I’m just angry enough to cause trouble until things change.

Headed to Health at Every Size® Training!

Today I start the Health at Every Size® fascilitator training, and I am super excited about it.  I’ll spend a week learning how to best teach people in my community (that means you!) about the concepts of HAES.   Until then, here is an overview.

The HAES concept doesn’t erase that people of different size may face different health concerns.  It does acknowledge that long term weight loss is nearly impossible, and we need to address health concerns with people where they are, not when they reach an ideal body.  There are people who lose significant amounts of weight and keep it off, but that is a very, very small minority of people; different studies show no more than 2-5% of dieters are able to keep off significant amounts of weight for five years.  There is no weight loss method that has a decent success rate (which explains why nobody publicizes their results).  Weight loss attempts usually lead to regain, and often lead to weight gain above and beyond the loss.  This weight cycling is more damaging than just being fat.  In a culture where people often start trying to lose weight in childhood, it means that they are weight cycling again and again and again.

The obesity epidemic panic also does a disservice to thin folks.  Culturally, we assume that thin people are healthy, and don’t talk about how being inactive can impact their health, or that thin people need to be screened for the diseases and conditions that we associate with obesity, like high blood pressure, heart disease, and diabetes.   When we teach assumptions about what kind of people get these diseases, we harm those outside of that demographic by reducing their awareness of their own personal risks.  These assumptions are also found in health care providers, reducing the quality of care that both fat and thin people recieve.

Better than focusing on weight, what we can do is focus on health. While changing eating habits and exercising may not impact weight, they clearly impact health.  If we focus on changing eating habits, and creating opportunities for enjoyable movement, we see that regardless of weight, health markers improve.  This means lipid levels, blood pressure, resting and exercising pulse rate, blood sugar levels, blood insulin levels- all markers of physical health.  This is an approach that works for thin and fat people.

A big part of this approach is self-acceptance.  There is a lot of stress associated with thinking that you’re failing at losing weight.  That stress, combined with other life stresses, snowball into a lot of the diseases we currently consider ‘weight-related’*.

Many people have dieted and exercised in ways that have moved them out of touch with their bodies.  I have dieted and exercised in ways that got me way out of touch with my body.  But understanding what your body needs doesn’t go away entirely, it just gets shouted over so much it is hard to hear.

HAES promotes intuitive eating, the idea that when you remove foods from being off-limits, and pay attention to how foods make you feel, you will make far more healthy choices than when we are stuck in a good food/bad food dieting denial loop.   I know what foods make me feel good, what foods don’t, and when I want a little ice cream, I don’t finish off the carton because I’m afraid of my diet tomorrow, and that I’ll never again remember what it tastes like.

HAES also promotes enjoyable activity.  Find something you like doing, because movement, however you define it, benefits health.  Physical activity, whether difficult or easy, improves mood, sleep, and all the other health markers talked about earlier.

*See Robert Sapolsky’s book, Why Zebras Don’t Get Ulcers.

What is a Doula, and Why hire a Doula?

There are multiple kinds of doulas, but most simply, doulas provide support.  Birth doulas work with one mother throughout the whole birth, and have no other obligations or time constraints like nurses, midwives, or doctors.  They provide physical, emotional, and educational support.  Doulas work directly with the mother to provide natural pain and stress management.  They are available wherever a woman chooses to give birth.  A doula can complement a home birth, assist in a birth center, or help keep a hospital birth relaxed and make sure that the hospital staff knows your wishes.

Doulas are not only a source of strength to the mother.  If a partner is present, doulas provide support to their partner, too.  Doulas free up a mother’s friends and family to be supportive, instead of worrying about remembering what they’ve studied in a book or at a class.

Doulas prevent unnecessary interventions by supporting parents to be their own advocate.   Studies show that having a doula results in lower c-section rates, lowered instances of forceps deliveries, fewer episiotomies, fewer epidurals, and fewer uses of oxytocin (pitocin).  Doulas also results in more spontaneous births, shorter labors, better apgar scores, and higher rates of breastfeeding, both at birth and more than a month out.   Women who have used doulas report their births as less difficult and painful, and report a better experience overall.

Doulas may also have other complimentary certifications, like Lactation Consultant, Childbirth Educator, and Massage Therapist.

It is wise to start looking for doula services around 30 weeks.  This gives you time to meet your doula and make sure that they have a personality that complements yours, and make sure they have the training and experience to assist at your birth.

sources:

http://www.ncbi.nlm.nih.gov/pubmed/21328263

http://pediatrics.aappublications.org/content/114/Supplement_6/1488.full#xref-ref-4-1

http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2012.301201

http://www.cappa.net/Docs/CAPPA%20Labor%20Doula%20Position%20Paper.pdf

Chub Rub II

If you’re wearing shorts or working out, inner thigh protection is a little harder than putting on protective clothing.  I see this type of chub rub as a triage system.

First, try using something you already have at home:

Lotion/Oil – Your favorite body lotion or favorite oil (coconut is a hit) can create enough of a barrier to reduce friction between your thighs (or other body parts).  This method may not last very long if the lotion or oil absorbs quickly.

Powder – Baby powder or cornstarch can stop your skin from rubbing.  This method can be messy, so you can use a washcloth or powder puff to apply.

Deodorant– Your deodorant can also work to ease the friction.  Just  apply the same way you normally do.

Silicone Lubricant – sounds silly, but the same silicone lubricant you may* keep bedside will reduce friction and is long-lasting.

If any of those don’t work, time to bring out the big guns.

Powder–  There are powders designed exclusively to prevent chafing, the most well-known being Anti-Monkey Butt Powder.

Monkey Butt Powder

Bar– These look like deodorant, but serve the express purpose of reducing friction.  BodyGlide is a prime example that I have used.

BodyGlide

Secret Shield is a smaller brand that I have heard recommended more than once.  It is available on etsy.

Secret Shield

Cream – Monistat Anti-chafing gel comes in a small tube.  It goes on clear and provides a slight barrier between the legs.

Monistat Anti-Chafing Gel

*(nay, probably should, but that’s another post)

Leave your recommendations in the comments!

Chub Rub Fixes

Whether working out, wearing shorts, or just wearing a skirt in summer, chub rub can easily occur.  Most often, this is when thighs rub and chafe, due to movement combined with heat and perspiration.  Chub rub does not discriminate, either.  Even many (most?) thin women’s thighs touch, and therefore rub.  It can be painful, messy, and some people worry that it is unattractive.  From reading around the internet, lots of people think that they suffer alone.  Not true at all.

Chub rub is fairly easy to deal with.  There are different methods to combat the pain of chub rub, but they can be generally broken down into two groups- clothing barrier and products.   Today we’ll cover the clothing methods, which are best used under skirts.

Pettipants/Bloomers

A traditional option.  Awesome if you love full skirts, petticoats and classic clothing!   These are also often the most widely available, available on Amazon and many other places.  There seems to be  a lot of overlap between the two terms, but here are two options: Pettipants , Bloomers

pettipants Bloomers

Lovees

For those that love lace, lovees is a shorts option designed to prevent chub-rub and still look good if your skirt blows up.

Luvees

Thigh Society

These look fantastic.  Thigh Society makes shorts made distinctly to prevent chafing, and in a wide range of sizing.

thigh Society

Allihalla

Alihalla has had some beautiful shorts for under-skirt wear, and they also stock beautiful underwear.  They are on hiatus through the end of the month, but check back then!

Bike Shorts

You can get cotton bike shorts from places like Amazon, department stores, or Target.  Stock varies widely by season.

Up Next, Part 2 – products.  Best for shorts and working out.

Fat Fashion

I I’ve been asked about where I get my clothes for a while now.  I usually wear dresses or shirt and skirts, and I like to dress up.  So here are some places I shop.

My number one recommendation would be to learn your measurements, know them by heart, and always order to your largest measurement.  You can always get things tailored down.  The exceptions would be stretchy material (you have a 2-or-so inch margin if you’re comfortable with a tight fit), and if your hips are your largest measurement, any flowy skirt will probably not be an issue.

I’ve called a bunch of these companies for sizing help over the phone, they’re usually very helpful.

There’s a mix of trendy and classic, cheap and kind of expensive ($100 dresses).  But, at least with these retailers, you really do get what you pay for.  If it is expensive, it will last you a looooong time – long enough to get tired of stuff!

So without further ado:

Classic:

Igigi  Kiyonna   Land’s End (COATS!, but their dresses are lovely, too)

Trendy:

City Chic   ASOS Curve   eshakti  (also somewhat classic, they include made to order options,  including customizable length, sleeve style, and sometimes neck line!)

Funky:

Re/Dress Domino Dollhouse Lucie Lu   B&Lu  Torrid

(Torrid is, in my opinion, a bit overpriced for the quality, so keep an eye on the sales!  Cute underwear and sexy stuff, too)

Basics: (t-shirts, youthful, cheap, on-trend)

Old Navy ( I wear between an XL and a XXL in almost all of their clothes, but they have a plus line, too)

High Quality Basics:  (Camisoles, sweaters, simple skirts, belts, tights…)

We Love Colors tights great quality tights!   Coldwater Creek  Talbots  Nordstrom  Sock Dreams (socks and more tights)

Here are some places for fat fashion inspiration: http://chubby-bunnies.tumblr.com/, http://deathfatties.tumblr.com/, http://fatshionista.livejournal.com/7561736.html

You may notice a few names conspicuously absent.  I don’t care for most of the easily available things at the big stores, but they have their purposes, including Lane Bryant’s bras and panties, which are reasonably priced and decently made.  Which is the nicest thing I think I can say about them…

Please leave your recommendations in the comments!