This post can be found at my new website, www.thefatmidwife.com
Lets do some good old fashioned soul-baring, inspired by The Militant Baker.
I have Polycystic Ovary Syndrome. It can mean a lot of different things to different people. To me it means I keep a closer eye on my heart health and blood sugar, both of which are currently normal. It may have contributed to my current size. PCOS correlates to the depression that I have dealt with off and on since I was a teen. I was told I may be infertile when I was diagnosed at 15. I was diagnosed when my mom and I realized my periods weren’t becoming regular as a teenager.
With a little care, I’m lucky that I am as healthy as a horse. The jury is out as to whether fatness is a cause or effect things with PCOS, and frankly I only care about it academically. That same big horse is already out of the barn, and a fancy chestnut mare is she. Turns out, I’m probably not infertile. However, I’m all over the jump-straight-to-spoiling role of auntie, so I won’t be testing that theory.
Other people may see actual cystic ovaries (although this is not guaranteed), heavy or absent periods, thyroid issues, thinning hair and acne and other skin issues. Symptoms vary from person to person. Symptoms may show up at puberty, like mine did, or may show up later in life.
The biggest part of my PCOS that I deal with daily is the beard… I started growing facial hair at about 17. I’ve been super self-conscious of it since then, but turns out people generally don’t notice. Or they’re too polite to say so. Even so, I’ve tried almost everything to get rid of it. Most things I’ve tried have caused more skin irritation and acne than hair removal. I now reap the benefits of a laser hair removal groupon I used few years ago, and a constant supply of tweezers stashed strategically in the bathroom and in my purse. I’ve also made more peace with it and don’t worry about it as much anymore.
Female facial hair can be a sign of hormonal imbalance, but it can also be normal human variation. I don’t discount the fact that the men in my family are impressively hairy. There are women who embrace their facial hair. I think that is awesome. While I like my face smooth, I don’t pretend that the preference is not a cultural thing. Mariam and Balpreet both look great.
I am pursuing personal training for a bunch of reasons. In order of importance, these reasons are:
- I really, really like moving things around and being freaky strong
- I like being able to walk, scurry, sprint, ride my bike, swim, and play on swing sets without getting winded
- I like being flexible and bendy
- The apocolypse
- It will likely improve my cardiovascular fitness and overall health
Keep in mind I, personally, find all these things important. You may enjoy (or tolerate) physical activity because of all, some, or none of these reasons. Or you may not. I love a Health at Every Size mentality and will continue to talk about it (a lot), but health is not a moral imperative. Health is not a ticket to basic dignity and respect. I’m at a place where I’m doing things that I enjoy, that improve my health. This does not make me better or worse than anyone else.
It does, however, make me do ridiculous things like meet with a personal trainer. Rob and I introduced ourselves yesterday, and we sat down at my local hamster wheel to fill out the appropriate paperwork. We talked about goals, what I’ve been doing for fitness lately, why I’m coming to this gym (online coupon for a month’s membership and 4 personal training sessions). And then we get to the fun part. I’m far enough removed from my dieting days that my weight and such are more of a passing curiosity than a cause for panic, so we measured my weight and body fat percentage. He wrote down the numbers and said, “Of course, we’d like to see your body fat percentage around [number redacted] percent.”
“Well, that’s a relative “we”. See, I’m here to work on these goals, regardless of any changes in weight or body composition.”
“But diabetes, cardiovascular disease, mortality….”
We went a couple rounds, with me citing these studies, and him citing his book of clients. I’m thrilled for his clients. They have achieved something that they wanted. But only one client he showed me had maintained the weight loss past five years, which seems to correlate with the statistics I cited in our conversation. Her goals are not my goals, and those odds are not odds I’m interested in.
We stopped debating when I said, “Here’s the deal. If I lose weight, you get a giant gold star and a letter from me for your book. If I don’t lose weight, but I do gain strength and reach my other goals, then we still both win.” We came to a truce and he sent me out for a warm-up of my choice. I like the elliptical machine.
We then did barbell squats, leg presses, leg extensions, and wall sits. And by we, I mean I. He pushed me to do reps, and we laughed as my legs shook. We gossiped and talked a little smack. It was glorious. I’m sore today, but I can’t wait to go back next week, after doula training. While Rob and I don’t see eye to eye about weight, I have an ally in my corner because I was able to advocate for myself and put down boundaries about what I wanted out of my personal training.
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).
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?
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.
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.