Killing Your Sacred Cows since 1992

I gave a kick-ass speech about size acceptance in my dreams last night. I was with a group of former co-workers having a drink. I mentioned in passing that I'd given up talking smack about my body and had pretty much learned to accept and even love myself and my fat. One of my co-workers asked, "But how?"

And I went off on a rant, and hit all the highlights pretty well:

-I stopped trying to suck in my stomach and pretend it wasn't there and started really looking myself in the mirror without criticizing.

-I learned to buy and wear clothes that weren't too tight (because many fatties refuse to buy clothing in bigger sizes when they put on weight) or too loose so that I had no shape, but rather sharp, tailored clothing.

-I realized that this was the size I was meant to be, and that all the women in my family are around my size, or bigger.You can chalk this up to similar eating habits, but multiple scientific studies with twins show that genetics is the hugest influence on ultimate adult body size.

-I've learned not to care if people think that I've just "given up" or have "taken the easy way out"; my mental health is just as important as my physical health, and constantly striving to be a size I'm not meant to be isn't any good for my mental health.

I was writing back and forth with an LJ friend about doing size-acceptance and fat-politics posts on LJ. You may have noticed that I haven't posted much to my "obesity propaganda" or related tags lately. This is partly because I've been thinking and processing but haven't been able to formulate a coherent post, and partly because I'm really damn tired of arguing about these topics on my own journal.

If I was posting my opinions and viewpoints as completely unbiased fact on a health-related journal, I'd expect to be challenged and wouldn't mind it so much. But I hate having the same clueless responses and repeated arguments on my journal, where I'd think it's obvious that this is my worldview and I really don't want to argue the basics of HAES.

Now, if you think that I've got some minor detail wrong, or you're questioning the way I'm wording something, that's fine. But if you disagree with the *basics* of "health at every size," then I'd just prefer you stay quiet and scroll on by, because I really don't want to argue about it any more. I know a fair amount of others who are pro size-acceptance or fat activists, and I know that most of them tried to be vocal at first but got worn down like I have by the "but everybody knows fat causes heart attacks" and the "but some sizes are JUST TOO BIG to be healthy!" comments.

I think that discussions of "health at every size" and related topics often get bogged down in discussions of where to draw the line. "OK," someone will say, "I think you can be healthy at 190 pounds if you exercise every day, but 400 pounds is JUST TOO BIG!" or "I realize some people are naturally thin, but a BMI of 16 is just too small to be healthy!"

My take on HAES is not about line-drawing. There probably is an unhealthy low weight, somewhere south of BMI 17, and probably there are sizes that are too big, somewhere north of 300 or 400 pounds, where it's impossible to be particularly healthy. But I'm not drawing that line, because I've had enough "us vs. them" mentality in my life already. I've seen fat people pointing at other fatter people and saying, "Well at least I'm not THAT fat." I find this kind of talk to be entirely unhelpful and actively hurtful, and I'm not going there.

To me, these are the basics of HAES:
1. People naturally come in a variety of sizes, are born with different amount of fat cells and with different metabolisms.
2. Most people have a "set range" of weight where they feel best, and it's very hard or impossible to change that by more than 5 or 10 percent permanently.
3. The best approach to improving health focuses on changing behaviors, one small step at a time, rather than focusing on numbers such as weight or BMI.
4. People can become healthier (NOTE: "healthier" not "completely healthy") without losing or gaining even one pound if they improve their eating and exercise habits.
5. Changing your health habits may lead to a small amount of weight loss, but some people don't lose much or any weight, and that's OK. You can often improve other measures like cholesterol, blood pressure, and resting heart rate by getting more exercise and changing the way you eat even if you don't lose much or any weight.
6. Weight and body fat are not the sole or even the most important issues when it comes to health. Getting adequate sleep, keeping stress under control, wearing sunscreen and getting skin cancer checks, getting regular pap smears, and practicing safer sex are all important to overall health, and should not be neglected in favor of obsessing over your body shape or size.

If you want to nitpick certain portions of what I've said or the way I've phrased them, I can understand that. But if you don't believe at least the basiscs of HAES as I've outlined them here, we're probably not going to have a constructive debate, because these are the bedrock principles of HAES as it fits into my worldview.

Health care for fat people is notoriously bad. Partly, some fat people avoid the doctor for fear of being shamed about their size or or out of fear of being publicly weighed. Also, some doctors are fat-phobic and provide substandard care for fat patients. There are also issues specific to being fat that some doctors aren't educated about, such as asking for larger blood pressure cuffs, because small ones can give false high readings in fat patients. I'm also including links about getting good care from mental health practitioners:

Big Folks Health FAQ, covering questions that include "How healthy or unhealthy is fat *really*?"
and "What advice do you have on dealing with doctors?" and "What if the doctor says my problem is weight-related?"

http://www.faqs.org/faqs/fat-acceptance-faq/health/

An opinion piece originally published in the New England Journal of Medicine suggesting that because most diets fail, doctors NOT advocate weight-loss for patients unless the patient brings it up as a concern, and urging doctors to be activists against size discrimination:

http://generous.net/health/nejm.shtml

Fat-Friendly Health Professionals List (several in the Ann Arbor area-- yay!)

http://www.cat-and-dragon.com/stef/Fat/ffp.html

Tips on how to obtain good health care if you're fat, including a link to a sample letter you could give your new doctor on the first visit:

http://www.cat-and-dragon.com/stef/Fat/ffp2.html

A non-dieting approach to dealing with diabetes:

http://www.radiancemagazine.com/issues/1995/diabetes.html

Guidelines for mental health therapists who treat fat patients:

http://www.naafa.org/documents/brochures/therapyguide.html

Know what you're up against. Study finds that many mental health therapists have hidden biases against fat people:

http://www.apa.org/monitor/jan04/weighing.html

Weight Watchers wanted to pay Renee Zellweger to lose enough pounds that she would officially be below the range they officially deem as being healthy:

http://www.bigfatblog.com/archives/001077.php#comments

From the comments:

WW claim they are promoting health. How can they claim this and pay Renee to lose weight?

Renee is 5'5" right? And the heavy weight [for the "Bridget Jones" movie] is 145 or so? She plans to drop back down to 106 lbs, right?

Take a look at WW's height/weight table. Look at the healthy weights for a 5'5" in person. 120 lbs to 144 lbs. Remember: Those are THEIR numbers!

What bothers me about Weight Watchers campaign is this:
Renee is being paid to drop her weight from a level that Weight Watchers themselves lists as just one pound above the healthy maximum for people bewteen 25 and 45 to a weight WW considers to be 14 lbs below the healthy minimum.

WW is paying her to diet down to a weight they officially think is unhealhty!
Is WW trying to send the message: Our numbers are upper bounds? (But we don't quite want to come out and say this... because.. well,...?)

My BMI is 21. Based on my reading this is 1-2 BMI points below the value that correlated with optimum longevity for groups of American women near my age.
Am I supposed to see the WW ads, hear WW is paying her and think: Oh... Renee is intentionally aiming for 17, I should too? BMI of 17!

Ed. to add: I don't think there's anything inherently wrong with having a BMI of 17 (slightly below the "ideal" range), anymore than there's anything inherently wrong with having a BMI of 32 (a few points above the cut-off for being labeled "obese"). But I do think that it's hypocritical of Weight Watchers to encourage someone to lose weight to the point that they are 14 pounds below what WW considers, by *their own policies* to be a healthy weight.

Paul Campos has his biases, but he's certainly passionate about debunking the hype about the so-called "obesity epidemic" and pointing out how much of our purported interest in people's health is really just distaste for the way big people look.

http://www.techcentralstation.com/052705E.html

excerpts:

re: The Centers for Disease Control recently revising figures claiming that obesity was responsible for anywhere in the vicinity of 300,000 or 400,000 deaths a year, numbers that were grossly exaggerated.


Campos: Well in one sense, the revision didn't surprise me. It didn't surprise me in the sense that if they were actually going to do an accurate and honest evaluation of the epidemiological literature, there was no way that the earlier 300,000 figure from 1998 or the 410,000 figure from 2004 could stand up to scrutiny.

The epidemiology on this issue is extremely extensive and what it shows is that there is no significant difference in relative risks or early mortality between the so called normal or ideal weight category on the one hand and the so called overweight category on the other. When you look at the obese category you do not begin to see significant increases in relative risk until you start getting to really high levels of obesity. What's more, you see similar levels of relative risk associated with only slight amounts of so called underweight that are similar to what you see with very high levels of obesity.

...

[I]f you actually look at the median weight gain in the population over the course of the last generation, it's probably been about eight pounds. The mean is higher than that because you have some real significant weight gain at the far right end of the tail of the bell curve. But the median is probably only about eight pounds or so. Such a weight gain, when you look at the actual epidemiological data, has absolutely no significance in terms of increasing relative risk for either mortality or morbidity in a way that any epidemiologist would ever pay any attention to it.

...

I really think that what's fueling this [obsesity panic] on a basic level are these anxieties about decadence and over-consumption and laziness and that somehow we've got something wrong with ourselves as a nation. And this is always being projected out on to this matter of weight.

It's a way of using ideology to turn an aesthetic and cosmetic preference into a medical matter and then to moralize that medical matter. So we are medicalizing and moralizing essentially matters of fashion.

The claim that weight is an important medical issue is not completely false, it's just largely false. At the statistical extremes of thinness and fatness, there's no question that weight has some relevance. But for the vast majority of people in this culture, and including the vast majority of people who are classified as weighing too much -- especially this completely phony overweight category -- it doesn't.