Tag Archive | fat discrimination

Amy, What About That Ted Talk?

I’ve had a bunch of people ask me about this video.  Peter Attia talks about fat stigma, diabetes, and alternate theories of why people are fat.

There is pretty good science about the idea that there are reasons that lead to obesity other than the “two whole cakes” theory, which states (approximately) that all fat people are somehow sneaking two whole cakes daily. He talked about one of those suggested reasons. The idea is that insulin resistance causes obesity, not the other way around. This is promising. I love that people are looking at their preconceived notions about fat people and talking about them publicly.

I also support the fact that he pointed out that there are a good number of obese people that are metabolically healthy, and thin people with metabolic syndrome. These are often tied to diet and exercise, hence why I follow a HAES® mentality for those that WANT to improve their health. 
Those messages I support.

However, for those people who are fat and metabolically healthy- that means that they aren’t showing signs of insulin resistance. I think that needed to be more than a passing note in his lecture, because if they aren’t showing symptoms of insulin resistance, then why are they fat? I fall into this category. 

I have trouble with his messages of “I eat like this, and I lost a bunch of weight,” and the idea thinner is tacitly better, and realistically achievable. Not everyone loses weight with improved diet and/or activity. I also think that health is multi-dimensional, and sometimes the best thing for someones overall well-being isn’t improving their physical health at the expense of their social, emotional, and/or spiritual health.  This approach does not so much fix the stigma fat people face, but changing the bar by which we judge fat people-  if they’re insulin-resistant, and doctors say it is ok, then they’re not terrible people?  But those other fat people…

I don’t agree with a moving target for stigma.

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Back from the HAES® Training

Lucy Aphramor, Amy, and Linda Bacon

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

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.