I Want to Move It, Move It?
Maybe someday I’ll be this awesome.
Last week, I was invited to go to an archery range with a new friend while I was in Seattle. I didn’t know what to expect. I was nervous; arrows are rumored to be pointy, and I’m not always known for my physical grace. I shoot handguns a few times a year, but this is completely different.
I ended up having a great time! We shot for about two hours. It was calming to focus on exactly how to hold my body for the next shot. When I got a good shot it was exciting, and every few minutes someone yells “Clear!” and I’d walk down to the end of the lane and pull my arrows out of my target (or from near my target). I loved focusing on where my arms were, my posture, my footing, and exactly what level of strength balance were required. I had a pretty righteous crick in my neck from sleeping in hostel beds, and it felt great every time I pulled the bowstring back and brought my shoulder blades together. It may not have been awfully strenuous, but I was moving for the whole two hours. I’ve looked up an archery range close to me, and I look forward to visiting it soon.
Movement and activity are important for health. Traditionally, we look at movement and activity as exercise- often a punishment for the outrageous sin of eating. When we remove the goal of weight loss, movement and activity are important for other reasons. Regular physical activity improves mood, blood lipid levels, sleep, blood pressure, blood sugar levels, and energy levels. We breathe better and our cardiovascular system responds quicker and recovers faster. When you find something you enjoy, it is a great stress reliever, too.
I haven’t always loved going out and doing physical things, because exercise felt like a chore for so long. A few years ago, I removed the ‘should’ from activity. It took a while, but I started wanting to fit some activity into my life. I feel better when I move. I have less pain, breathe better, and recover faster when I have to hustle somewhere. Also, I’m having a lot of fun!
Joyful movement is all about finding something you love. I love swimming, elliptical machines, biking short distances, weight lifting, chasing my friends’ kids, and I just may love archery now, too. I have a game on my phone, Ingress, that means I walk around for hours stopping near public art and landmarks looking suspicious (It is a sort of highly technical multi-player, never-ending version of capture the flag that uses Google’s maps and your GPS).
Jimbo Pelligrene found something he loves!
I’m still discovering things I like to do, and how to fit them into my schedule, especially as my schedule is so variable. I like working out at a gym; not everyone does. I got a deal online for a month’s membership and some personal training sessions at a local gym. I’m looking forward to getting to know their machines and find out how I can improve my ability to “throw things around.” I love my strength. While you can almost always find me in a dress, and often find me in heels and makeup, I still love the opportunity to help carry a couch, or climb a tree, or move some boxes.
I have friends who love to dance, love to run, love yoga, love to garden… When you remove the temptation to judge activity solely by its calorie-burning attributes, it really is all about what you like.
Movement has also been an opportunity to pay attention to how I feel. For a looong time, I assumed that I got winded before my muscles ever even noticed what was going on, and my feet hurt, because I was ‘out of shape.’ Turns out, I have asthma (I thought I got rid of it as a kid), a pretty impressive heel spur, and a decent case of plantar fasciitis (Those translate roughly to “perpetually walking on spikes”). I got an inhaler, and it works like magic! I have orthotics coming in next week, and I can’t wait to be able to step up my game, physically. I’ll have to figure out how to fit them in my dressier shoes, but I expect to feel quite a bit better on my feet. That means I can do more walking with less pain, which is so great when I like to play Ingress and wander around on foot for hours. Paying attention to yourself as you become more active means you can understand your own needs better.
What do you like to do?
Back from the HAES® Training
The training was amazing. Linda Bacon and Lucy Aphramor were brilliant. There were over 50 people at the training, and about half of them were dietitians. There were people from as far away as Australia. Everyone in the room believe that fat people have the same health goals as thin people. We covered a few things I have thought about before in conjunction with Health at Every Size®, but never quite connected in the same way.
We talked about how health is multi-dimensional- there is physical health, emotional health, spiritual health, social health- you can’t hold one above the others and expect to feel well.
I mentioned First, Do No Harm in my previous post. I’ve talked in classes before about the futility of prescribing weight loss to patients, as it almost inevitably results in weight rebounding and worse health than just being fat. I’ve talked about how our current medical model creates a barrier to treatment. However, Linda and Lucy clarified and condensed these issues. These are all issues of medical ethics. Providers, by and by large, get into the business to help people. But when providers are taught to prescribe weight loss, and that weight is a result of laziness and a lack of willpower, they are harming the vast majority of their patients. That is simply unethical. If providers knew and shared the facts about long term weight loss attempt results, we wouldn’t recommend it anymore, and more and more, people wouldn’t consent to trying it.
In the next few months, I’m setting up a forum to create a conversation between fat patients in Denver and Denver care providers. Hopefully we can address some of these barriers to quality care.
We talked about the fact that being fat can exacerbate some conditions. Being fat can impact joint pain, diabetes, and heart disease. However, is weight loss necessary? Experiencing one of these conditions doesn’t make weight loss any more reasonable of a goal. Also, there are things that you can do for any condition that doesn’t include such drastic measures with such poor results. While it is clear that eating a varied, enjoyable, quality diet and physical activity can improve diabetes and heart disease regardless of weight loss, joint pain is harder to assess. Eating low-inflammatory foods and getting enough sleep can improve joint pain, and sometimes physical therapy can improve symptoms, without weight loss. Thin people with diabetes, heart disease, and joint pain are given suggestions to improve their health that don’t include weight loss.
The last thing that I took away from this training a reminder of the community available to me. I was reminded of the HAES Community, where you can find researches, authors, activists, care providers, and more in your community. I heard more about ASDAH, who actually owns the HAES trademark. They have another listing of health professionals that work within a HAES mentality. They hold annual conferences, do lots of work in the community, and have excellent educational resources on their site. I heard of local HAES activists, and left having met many many awesome people.
Fat Discrimination, Part II
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.
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
The Fat Midwife 
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