Fatsronauts 101

Fatsronauts 101 is a series in which I address assumptions and stereotypes about fat people that treat us as a monolith and are used to dehumanize and marginalize us. If there is a stereotype you'd like me to address, email me.

[Content Note: Fat hatred, dehumanization, gaslighting.]

#1: Everyone who is fat is fat for the same reason.

Nope! There are a whole lot of reasons that fat people are fat—and "overeating" is only one of those many reasons. In fact, "overeating" itself even has to exist in combination with some other factor(s), because "overeating," which I'm putting in quotes because that word can mean anything from "eating more than the recommended number of calories for a person without any other medical problems of a specific size and activity level" to "eating more than I think that fat pig should be putting in hir mouth," is generally something, using the same definitions, that a lot of genetically thin people do, too. It's just that they don't get fat from it, so they aren't said to be "overeating." Just "eating."

Some fat people have a genetic disposition toward fatness. Some fat people are recovering from eating disorders and/or yo-yo dieting and/or addiction(s) that fucked up their metabolisms. Some fat people have disordered eating. Some fat people have illnesses that themselves cause weight gain and/or require meds which cause weight gain. Some fat people have disabilities that cause weight gain. Some fat people have chosen, consciously or unconsciously, fatness as a coping mechanism in response to abuse and/or sexual violence. Some fat people are poor and/or lack access to fresh foods. Some fat people have simply never been taught good eating habits for their individual bodies and/or don't have the ability or opportunity to prepare the sorts of meals their individual bodies need. Some fat people's bodies have been affected by environmental toxins that have been found to cause weight gain. Etc.

There are a whole lot of reasons that individual fat people are fat. Most of us have some combination of these factors. For the majority of us, it is not as simple as: "I eat too much and exercise too little and thus I am fat."

And when thin people (or other fat people) make some "calories in; calories out" argument, or any variation thereof that implies all fat people are fat for the same reason, and all of us could be thin(ner) if only we reduced calories absorbed and increased calories burned, if only we tried harder, that's the same bullshit bootstraps argument that conservatives make about marginalized people all the time.

Paul Campos, who has written extensively about the OH NOES Obesity Crisis! and has debunked many of the myths surrounding fat and health, once wrote in a column for the Rocky Mountain News, which no longer appears to be available online:

This inspires me to point something out to my more liberal readers. Remember that particularly clueless right-wing acquaintance of yours? The one who believes that anybody in America can become rich, because he thinks about poverty in a completely unscientific, anecdotal way, which allows him to treat the exceptional case as typical? The one who can’t seem to understand the simplest structural arguments about the nature of social inequality?

The next time you see some fat people and get disgusted by their failure to "take care of themselves," think about your clueless friend.

The erroneous belief that all fat people are fat for the same reason, at the expense of acknowledging individual circumstances, is dehumanizing in the same way that blanket assumptions about any group is.

The only reason it's still considered acceptable, by people who should know better, to make such sweeping, dehumanizing statements about fatsronauts is because we still regard fatness as a behavior, and as an indicator of weak character, rather than as the neutral descriptor that it is.

Finally, there is this: Many fat people routinely speak up about the reality that our fat bodies aren't strictly a result of eating too much and exercising too little, and bravely tell the stories of our lives in which we share our personal circumstances, even knowing we will be mocked, dismissed, and disbelieved.

In order to continue to subscribe to the belief that fat people are all fat for the same reason, one must believe that those of us who speak to our own experiences which differ from that narrative are lying or delusional.

I, for one, am exhausted with the implication that I don't know my own body better than an observer who's invested in the idea that: 1. My fat is a problem; and 2. I'm not being diligent or honest about solving it.

Enough already.

If you're going to be an ally to fat people, Step One is acknowledging our individual humanity.

[Related Reading: On Fat Hatred and Eliminationism; Today in Fat Hatred; Proposed.]

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On Being a Thin Friend to Fatsronauts

[Content Note: Fat-shaming; body policing; bullying; gaslighting.]

Last night, in the comments to Big Fat Love, Shaker rvh asked, in response to a line in my piece:

"maybe your thin friends passive-aggressively use your weight to make themselves feel better about their insecurities"...

How does this work? I am asking because I wouldn't ever want to do it and I genuinely don't know what behaviour would fit into that category.

This is a particular issue for women, since "diet/weight talk" and body policing are so central to much of female communication—it's a source of solidarity or contention (or both) between mothers and daughters (and sisters, etc.), a means of bonding between female friends and colleagues, a competitive frame between women, a means of auditing inclusion and exclusion in female groups—and is thus the source of a lot of good feelings and bad feelings among women. It is not, however, exclusive to women. One of the worst examples of ongoing, explicit, and profoundly harmful body policing around weight that I know is between a father and a son.

First, a caveat: Fat people police one another, too. (See Brian's great post, "Fat Isolation," which addresses some of the ways in which fat people engage with fat-shaming narratives.) This post isn't about how fat people are perfect saintly victims of meany thin people: Some of the most vicious fat-shaming ever directed at me has been by fat people who just weren't as fat as me, and boy howdy was their fragile self-esteem wrapped up in simply not being the fattest person in the room. And fat people even have their own special narratives of shaming one another, like the old "at least I'm proportionately fat!" chestnut, used to shame anyone whose fat body is fatter on the bottom, or on top, or in the torso, or the limbs, or some variation on failing to be a perfectly plump version of a thin person.

But, what we don't have is thin privilege, of the sort that gifts one the luxury of never having to consider the ways in which our language, and our public participation in the culture of weight-obsessed "diet/weight talk" and body policing, can inadvertently hurt and dehumanize the (other) fat people around us. That's central to the question rvh asked, and that's the question I'm going to answer.

Sometimes, it's just a function of unexamined privilege. It may not be your conscious intent to use a fat friend's weight to counterbalance your own insecurities, but that can be an unintended communication in habits like constantly referring to yourself as fat, or saying you "feel fat," or announcing that you need to lose weight, or body policing other people in front of a fat friend.

If you're saying things that could quite reasonably make your fat friend think, "Jesus, if zie thinks that about hirself/that other person who is not as fat as I am, what must zie think about ME?!" that's a problem.

If you're saying things that oblige your fat friend reassure you, "No, you're not fat; you look great!" that's a problem.

If you routinely talk about "looking good" and "being fat" as mutually exclusive concepts, e.g. "Oh, I look terrible in that picture—look how fat I look!", thus implicitly conveying to your fat friend that zie can't be fat and look good at the same time, that's a problem.

And, if your fat friend points out one of these unintended communications to you, and your response is either gaslighting ("I didn't mean it that way; you're putting words in my mouth because you're just sensitive about your weight!") or trying to create some secondary beauty standard just for fat people ("It's not that fat people can't look good; you just good look in a different way, but you really know how to work what you've got!"), that's a problem.

One of the things that thin friends have done to me my whole life, often without any malicious intent, is treat my general (but not total) lack of participation in the unwinnable game of achieving the beauty standard, as either evidence of my having "given up" or the logical response given how far outside the privileged aesthetic I am. Why bother, when you so obviously can't achieve anything resembling beauty, anyway? Oof.

There is truth to the fact that deviating so wildly from what is culturally regarded as "objective" beauty failed to inspire in me any ravenous desire to attain status on my appearance (though feminism was frankly a greater disincentive; I was still a small in-betweenie when I formed boundaries around how much I was willing to conform to imposed norms). But thin friends have often unintentionally conveyed harsh messaging about how (un)satisfied I should be with my body, by remarking on how evident it is I don't care. A lot of backhand-complimentary messaging verging on "letting yourself go" memes.

That's a problem, too.

And if you react differently to a thin friend's self-policing than to a fat friend's, if you figure that a thin friend wants to hear, "Oh, I hate my body, too!" and a fat friend wants to hear, "Oh, but your face/hair/blouse is so pretty!" that's also a big problem. Not only does it convey that fat friends should hate their bodies, but hey here's a weak compliment, it also conveys to fat friends that the body policing which is an invitation for inclusion in a sisterhood among thin women does not extend to us.

Your flaws are so big or multitudinous, we don't even know what do to with you. Often, thin women, in a failed bid at sensitivity, exclude fat women from self-policing with platitudes, instead of just not doing it at all. One of the least obvious but most common ways thin women hurt their fat friends is with pity.

Sometimes, it's evidence of an agenda. Most of us have thin friends who do this sort of thing out of thin privilege—simply not considering what it unintentionally communicates—and many of us also have thin friends (or family members, etc.) who do this sort of thing with an agenda. That is, they fat-shame with the desired objective of feeling better about themselves.

I have a thin friend who incessantly gripes to me about how "fat" she's getting. She will examine herself in a mirror, or look down at her leg while she's wearing shorts, or grab her flesh and say things like, "Look at this disgusting cellulite!" She then looks at me pointedly, waiting for me to "compliment" her by observing the manifestly obvious: That she is not fat.

(I trust I don't need to elucidate why obliging me to treat "You're not fat" as a compliment is no fucking fun.)

Or she'll grouse about having not accomplished some professional goal she thought she'd have accomplished by her current age, or about getting grey hair, and say, "Well, at least I'm doing better than X. I just saw her at the store and OMG she has gained SO MUCH WEIGHT." She then carefully scrutinizes my face, searching for evidence that I feel terrible about being fat, so she can feel better about herself because at least she's not fat and feeling terrible about it!

Inevitably, I disappoint her by saying instead, "Your body is strong and healthy, which is such a privilege for which to be thankful!" or "Oh, I'd love to run into her. She was always so nice/funny/smart/whatever."

I disappoint her by failing to give her the satisfaction of seeing me crushed at the implication I'm a monstrous wreck in comparison to her—an implication that cannot be overtly challenged, because, of course, she gives herself plenty of room to say, "That's not what I said! You're just being insecure!"

We are old friends, but I don't see her very much—for reasons that I'm guessing are obvious, but I will state it plainly nonetheless: My body does not exist to make other people feel better about theirs, and I do not consider my fatness the negative benchmark on a competitive scale.

You may be wondering how you're supposed to convey that you're unhappy with your body in a way that doesn't effectively imply there's something wrong with your fat friend's body. And the truth is: Maybe there isn't. Like other forms of privilege, thin privilege means that complaining of some aspect of that privilege, even if it is a legitimate complaint, can make you look like a real asshole to people who don't share it.

"My raise at work wasn't enough that I can buy the dream home I wanted, and I'm super disappointed!" is a valid thing to express, when you've worked hard and laid plans and been given promises by an employer who didn't deliver. But it's also something most of us realize isn't a concern about which we want to oblige consolation from our unemployed friend who's just lost hir home to foreclosure.

Body policing and "diet/weight talk" are so pervasive, and fat hatred so accepted, that it's not considered bad form for people with thin privilege to oblige commiseration from fat friends. (In fact, some thin people get miffed when fat people object to being drafted into such conversations: "I thought you of all people would understand!") The first step in avoiding trading on thin privilege is simply to acknowledge that even participating in policing, of self or others, can convey negative, judgmental messaging to fat friends.

Obviously, every friendship is unique, and some fat friends are completely comfortable discussing body image with thin friends. But that should not be assumed, even if fat friends have previously joined in weight talk and body policing. Fat people are expected, and often pressured, to join in, and can use that participation as a self-defense mechanism, even if it makes them anxious and unhappy.

(For me, as one example, I'm comfortable discussing body image with some friends, and not others, based on individual levels of empathy and sensitivity, and the quality of the discussion—attention-seeking negativity I can't abide, but straightforward or humorous self-evaluating is something I value with many of my friends.)

If you want to discuss body image with a fat friend, my recommendation is this: Talk to them explicitly about their comfort level with that subject. If you're not good enough friends to have that conversation, don't discuss it all.

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Big Fat Love

[Content Note: Fat hatred, body policing, food policing, bullying.]

I know I've said this before, though only on Twitter, but, because I'm seeing a disproportionate amount of shit being flung at fat people—and when it's remarkably more than usual that is SO MUCH SHIT!—as a result of HBO's garbage documentary, The Weight of the Nation, the first part of which aired last night and the second part of which airs tonight, I'm going to say it again: I like fat people.

Naturally, I wouldn't really like every fat person, but in the interest of providing a tiny bit of counterbalance to all the people who blanketly hate us, without shame or censor, I want to say in opposition: I like fatties.

I like my fat friends. I like my fat family members. I like my fat colleagues. I like my fat acquaintances. I like my fat neighbors. I like the fat members of this community. I like your fat partners and your fat kids and your fat friends, too. I like the fat people I see walking their dogs. I like the fat people I see at the grocery store. I like the fat people I see at the movies. I like the fat people I see at restaurants, on the local trails, at the vet, at the corner store picking up milk. I like the fat lady who told me, when I went out shopping in a sleeveless shirt on a hot day for the first time in my life at 38 years old, "I like your shirt!" And I love my fat self.

And there are people reading this, privileged people, who don't understand what it's like to live in a body like mine, who are thinking: Of course you like fat people. You're fat.

Because they don't know. They don't know the self-hatred to which we are exhorted in big and small ways, and how it can turn into hatred of other fat people. They don't know the ways in which the shaming, the bullying, the body policing, the rank hatred, the disgust disguised as concern can make a fat person maintain a physical and psychological distance from other fat people, especially people just that much fatter, because we are keenly aware that proximity is guilt and grotesquery by association. They don't know the contemptuous stares of patrons at a cafe when two fat people walk in together, or, Maude forbid, even more of us, like some kind of freakish human herd that storms across the countryside devouring the resources that belong to decent folk.

They don't know how difficult it is to hate yourself as much as this culture tells us we should hate ourselves for being fat, but love other fat people.

The self-acceptance, self-confidence, and self-love that allows fat people to really embrace and adore one another are hard-won—and, because those precious commodities remain elusive for so many fat people, it is not by any means axiomatic that fat people like other fat people.

We internalize the same narratives of moral weakness, of inferior character, of laziness, slovenliness, gluttony, ugliness. We have all the same reasons to hate fat people (including ourselves) as people who are not fat—plus the additional reasons of futile self-preservation described above.

We are discouraged from liking one another.

Even though we are often each other's most reliable safe spaces, fiercest champions, least judgmental allies, dearest friends with the boundless capacity to understand the nature of fat hatred, to recognize the challenges of Living While Fat, we are discouraged from liking one another.

And, of course, everyone else is discouraged from liking us, too.

Well, fuck that.

My fellow fatsronauts: Maybe your parents police your body, maybe your partner comments on your eating habits, maybe your boss passes you over for promotions, maybe your coworkers make snide comments about your weight, maybe your thin friends passive-aggressively use your weight to make themselves feel better about their insecurities, maybe strangers say awful shit to you, and maybe you have days where it feels like you are truly, hopelessly, resoundingly unlovable, just because you're fat.

It isn't so. I love the fuck out of you.

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The Best Thing You'll Read All Day

Doctor urges new view of obesity:

"I think one of the biggest misconceptions when we talk about obesity in general is that obese people are obese largely because of their lifestyles and because of the way that they live," Dr. Arya Sharma of the University of Alberta, told CBC News. [Sharma is the chair of obesity research and management at the University of Alberta and medical director of the Weight Wise program at Edmonton's Royal Alexandra Hospital.]

Sharma points to studies where people's eating and activity are carefully monitored. They show that some people can eat an additional 1,000 calories per day and not gain a gram, while others would gain five to six kilograms over a six-week period.

"There's a huge variability in how people can cope with extra calories," he said in an interview with CBC News.

He says people who tend to pack on the pounds simply have bodies that burn calories very efficiently and store the excess as fat. "They just take their extra calories, they don't even burn them because they're very fuel efficient, they'll just store those calories and they'll put them away."

..."Some people are just naturally lean. They can have crappy lifestyles and it doesn't seem to affect them."

..."We keep hammering home the stereotype of the fat, lazy slobs who are eating fast food all the time who are not moving, not exercising or not taking care of themselves, making poor choices, when there's very little science that actually backs this up."

Sharma notes there are all sorts of benefits for the body to exercising and eating healthfully (if one is able), but that weight loss simply isn't one of them for many people.

Gee, that sounds suspiciously like what lots of fat people have been saying about their own bodies and lives and realities for years!

[H/T to Shakers Sarah and Wondering. Reminder: That many people don't choose to be fat does not render choosing to be fat an invalid choice. It is a valid choice.]

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How Remarkably Unremarkable!

by Shaker PlusSizedWomanist, a young, plus-sized woman of color and full-time college student studying nursing, who most definitely plans on incorporating HAES into every single care plan she makes.

[Trigger warning for discussion of body size and fat hatred.]

Below is the newest Call of Duty: Black Ops trailer, titled "There's a Soldier in All of Us." Now, normally, I wouldn't find this video remarkable, seeing as how I can't play first-person shooter games to save my life, but there is one specific part that stood out to me like nothing I'd ever seen:

Location: A war zone. Scene 1: View of helicopters flying in the background in a worn down area. Scene 2: A young black woman wearing a gray business suit is shown walking away from an explosion holding a semi-automatic machine gun, aiming at unknown assailants. Scene 3: Two men drop down hanging in suspension, shooting machine guns at unknown assailants and then drop down even further. Scene 4: A young woman wearing glasses and a purple button-up shirt shooting at a door to possibly open it and then moves to the side as her female friend kicks down the door and and a young black male wearing hospital scrubs throws a grenade into the room. Scene 5: A male construction worker in a helicopter shooting at unknown assailants, and a man in the building being shot uses a rocket launcher to bring down the helicopter. Scene 6: An older bald man hides behind a pillar, struggling to get a cell phone out as Kobe Bryant runs in, shooting at a military Jeep, causing it to explode. Another man springs up and shoots another military Jeep, and it also explodes, causing a running young man wearing a jersey to tumble forward in the blast. Bryant smiles at the sight and shoots out at another man, who is brandishing a shotgun. Scene 7: The camera goes into first person view through the eyes of the aformentioned shotgun brandishing man, and then goes to a view of Jimmy Kimmel struggling to get to his feet, aim a rocket launcher with the words "proud noob" inscribed on it, and shoots. Scene 8: A man wearing a diner employee outfit is shown walking away from an explosion, shooting two pistols to the side. The screen pans out to show the battlefield. It pans back in to the diner employee dropping his empty pistols, with the screen reading "There's a soldier in all of us." Scene 9: The cover of Call of Duty: Black Ops is shown.

Can you guess what scene stood out to me? You can't if you didn't/couldn't watch the video, because I left something out of my description.

Scene 4. Twelve seconds into this trailer. What makes this scene remarkable is the fact that this young purple button-up shirt wearing woman is a FAT woman. *gasp*

And no, I'm not talking about the BS "Anything over a size 4 is considered fat" drivel that America's Next Top Model and the like purports. No folks. I mean a VISIBLY FAT WOMAN is being shown in this video. Somebody get the smelling salts. I'm sure we're gonna need them.

Because guess what else? There was nothing derogatory mentioned about her. She was treated as an equal human being, as an essential part of the team effort to find whatever fictional video game perpetrators that stood in their way. Fat hatred has permeated our culture so much that to see fat people being shown as something other than the stereotypical headless fatty, or the fat person who is so deep in self loathing and self hated, the fat person who is continually apologizing for even THINKING of existing while fat; to see ANYTHING other than that is an amazing feat.

It is sad that this is something that extraordinary. But right now, I'm cheering my butt off for the badassery of this purple shirt wearing fat girl brandishing a shot gun, because she's showing what we all knew: Fat people are capable human beings.

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Commenting Guidelines: This post is not about the inclusion of accused and acquitted rapist Kobe Bryant and such discussion will be considered off-topic, not because his continued role as go-to advertiser isn't a legitimate conversation to have, but because it's not a conversation that can be had in this thread without derailing from its primary (and important) topic. Ditto on any other unrelated though legit convos, like violence as entertainment, etc.

Related Reading: Fat Ladies UK.

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Fat Ladies UK

So, Iain and I have been watching Law & Order: UK on BBC America, because, for evident reasons, US-UK mash-ups are rather popular at Shakes Manor.

It's actually quite a good show, and it's fun to see how some of the early episodes of the original Law & Order have been Britishized for a UK (and anglophile) audience.

One of the interesting things I've noticed about the show is its fat people.

Notably, it has them.

Particularly fat women. You can always find a fat guy or two in the US version—"Casting call for portly Italian to play butcher on national crime drama"—but fat women are few and far between, and, when they do show up, they are fat not because Fat People Exist, but because fat is routinely used as a lazy shorthand to convey negative attributes to American audiences.

"You can tell she's a bad mother instantly because she's FAT and wearing unstylish clothes!"—The writers of Law & Order. Etc.

But on Law & Order: UK, fat women are just another part of the population. Across four episodes, I've seen a fat female cop, a fat female witness, a fat female attorney, and a fat female forensics analyst (and possibly some I'm forgetting), all of whom were fat for no other reason than because Fat People Exist.

And not inbetweenie fat—not "Bridget Jones" fat. But actually fat. Like me kinda fat.

It was remarkable to see these women on my television. Which is terribly sad, really. That shouldn't be remarkable, since the existence of fat women (and men), even in New York, is not remarkable.

(Shh, don't tell Karl Lagerfeld!)

I felt good seeing women who look like me in a show I was watching.

And then I felt bad, thinking about all the reasons I have so few opportunities to see women who look like me, and so many women I adore, in US-made entertainment, except as cautionary tales and punchlines.

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"Feeding People Is an Act of Love, an Act of Kindness"

That I totes fancy Chef Tom Colicchio is, of course, not news, not even close, and not a secret, not even a little. As if there's still any wonder why, he continued his crusade against hunger this morning on CNN, and, despite the fact that this interview is part of a week-long focus on the "childhood obesity crisis," note that Chef Colicchio doesn't mention obesity once during this interview, nor does he even obliquely equate weight with health. He simply makes the point that fresh food with meaningful calories nourishes children's minds and bodies, making them better able to learn. And he doesn't put that responsibility on "moms," or "parents," casually ignoring the profound structural flaws that contribute to kids eating processed food at school and home. He flatly explains why a fast food hamburger costs less than a peach, and lays out why it's a social issue, a collective responsibility for the richest nation on the planet to nourish its children.

No shaming, no alarmism, no hyperbole. Just facts and compassion.

This is how it's done, right here.

[The transcript will be posted here when available.]

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There's Good News and Bad News. And Fat News.

(TW for discussion of depression)

I went to the doctor last Friday (I went to see a couple of my doctors, actually, but this post concerns my visit with my internist). She recently replaced another doctor who had been part of that practice for several decades, and had been the only internist I had seen more than once as an adult. This new one, Dr. L., has had the unenviable task of taking on a lot of patients who were very attached to the previous physician, and earning their trust.

I went to see her a couple of months ago for the first time, to request a blood glucose test. My paternal grandmother, whom I never knew but from whom I seem to have inherited some unfortunate tendencies, had Type II diabetes, an illness which my "lifestyle" is quite conducive to. By "lifestyle" I mean that I suffer from great fatigue, difficulty focusing on tasks, and a lack of motivation.

"Lack of motivation" is a generally misunderstood symptom of depression. It does not mean that I sit around thinking, "Oh, I'm so depressed; why bother to do shit I don't want to do anyway." It means not that I lack discipline, but that there is a mental disconnect between my conscious mind, which says I want or need to do X, and the part of my brain which actually initiates activity. It prevents me from doing things I would very much like to do, as well as things I need to do, rather than indicating simply a lack of interest in doing things which are not immediately rewarding.

If you want or need to go somewhere, whether somewhere you're eagerly looking forward to going, or somewhere routine, or to the dentist for a root canal which you may be much averse to but have nevertheless decided will leave you better off in the long run, and you get in your car, turn the key in the ignition repeatedly, yet the engine sputters but does not engage, this is not an indication that you don't really want to go anywhere. It's an indication that something is wrong with the equipment you need to transport you there.

I am fully capable of sitting for hours, thinking periodically, "I need to pee," then, "I really need to pee," and eventually, "Damn, I need to pee," before being able to jump start the part of my brain which engages with the task of getting up and walking the ten feet to the bathroom, and initiates the movement which allows me to do that.

The more complex the task, the harder it can be, because a more complex sequence of actions must be, in some sense, imagined and targeted before the actions necessary to bring them about can be initiated. Most people are unaware that this process even takes place, because in a healthy brain, it occurs swiftly and automatically. In my brain, it does not.

I also have difficulty disengaging from tasks. Physical tasks are self-limiting, because my normal state is one of fatigue, and it escalates rapidly with any exertion. I can get sort of "stuck", though, doing fairly simple things on the computer, because the fatigue factor is low and it can require more energy to disengage, or mentally change gears to engage another task, than it does to just keep doing what I'm doing.

One result of these and other symptoms of my depression is that I get no exercise and my diet is terrible. Much of what I eat is dragged out of the freezer and shoved in the microwave. Many days I eat pretzels, cheese and my staple diet cola for breakfast, because it's what I can manage. For a "healthier" breakfast, I'll have a piece of fruit with that — when I have any, which is only a few days a month.

I cook occasionally, simple things, and occasionally make a salad, but even chopping vegetables is often beyond me. Since I have no car and have been unable for some time to manage grocery shopping by a combination of walking and buses, I order my groceries on the net and have them delivered. Because of the expense, I do this only every 2.5 to 3 weeks, which is therefore how often I get fresh produce, and only as much as I am likely to be able to prepare and eat within a few days. So my diet, as I mentioned, is monumentally crappy.

I spent a lot of years fighting my limitations. That accomplished nothing of lasting value, and actually endangered my survival. So I've learned to do the best I can to work with them. It does not create a healthy "lifestyle" but it permits me to survive. This is why the scare quotes around "lifestyle". That word is generally used to refer to something seen as chosen, preferred, as if selected from a menu of possibilities (you know, like being gay. You know you just love it 'cause it's naughty!).

I did not choose to live this way. I generally refrain from speaking for others, but I can say with bone-deep confidence that no one would choose to live this way. Whatever minor advantages it may seem to have to someone who never has lived this way, are far outweighed by the disadvantages, and no, I and others are not too stupid or childish to figure that out. It is also not the result of weakness. No one who has lived it could doubt the tenacity and power of endurance necessary to do so.

I have also been on every class of anti-depressant, anti-psychotic, mood stabilizer and anti-seizure medication in existence, have been through cognitive therapy and several courses of electroconvulsive therapy (ECT), commonly known as electroshock. Only a couple of the drugs and the ECT provided any benefit, and it was short-lived. All of the preceding is meant to make clear that my "lifestyle" is not going to change.

I went to have my blood sugar tested because I like to see what's coming, even if I can't do anything about it. I prefer knowing what I'm dealing with. Not only was my blood glucose elevated (I'm "pre-diabetic"), my cholesterol and blood pressure are climbing as well. My doctor had briefly given me the usual recommendations about diet and exercise, which I listened to in silence, knowing she was obligated to provide me with that information, and after my follow-up visit two months later to check the progression of my various elevated numbers, (because this was the first time any of them had been elevated), had emailed me saying that medication was a possibility if lifestyle changes alone were insufficient.

Well, I gave that some thought. Dr. L. had engaged in no fat-shaming, no blaming of any kind, and seemed like someone with whom a patient could have a mutually respectful conversation. Also, Shakesville.

I spent the first three decades of my life hearing that all my problems, as well as those of the people close to me, were All My Fault. I saw, throughout my teen years, a series of therapists who were no help at all, who did not even provide me with a diagnosis, and generally treated me as if I were simply a rebellious teenager who wasn't smart enough to see that the person whose life was being destroyed by my inability to function was my own.

I only returned to mental health treatment in my thirties when it was clear that I would not live much longer without help. It was that which made me desperate enough to ask for the help I had always been told I did not deserve. I didn't find treatment which worked, but I did find a psychiatrist who treated me like a person with an illness who deserved whatever he could do to help, and that was enough to allow me to survive, although it has been touch-and-go at times. This doctor has been extraordinary, in my experience. I have had to deal with other mental health care providers as well, over the years since he became my doctor, which has only confirmed that view.

So I don't expect a lot, from anyone, including health care professionals. I learned somewhere along the way to say to people, "I won't accept that." I'm not sure I ever learned to say, "I expect this," or even just, "Would this be possible?" But I think the view insistently expressed at Shakesville that fat people are entitled to the health care they need, not only that which they earn by meeting the expectations of others, including health care providers, also influenced my decision to have a conversation with my new internist about whether medical treatment would be appropriate, given my unchanging "lifestyle".

So I went to see my doctor again. (She is aware of my history of depression, because I get all my health care from various departments of the physician's practice within my HMO, and they all have access to my complete medical record.) I told her that my diet is terrible and I get no exercise at all. I further told her that I have lived as I do for many years, well aware of the likely health effects, especially given my family history. (That diabetic grandmother? Also bipolar*. Thanks**, unknown Granny, for all the diseases!).

I told Dr. L. that realistically, none of that is going to change. I asked her if, given that reality, there was any value to my taking either of the medications she had suggested might be possible "if lifestyle changes were insufficient." She said matter-of-factly, "Well, medication is appropriate when lifestyle changes have been maximized." I said, "So there's no point in my taking any." She said, "Oh, no, I meant that if your lifestyle changes have been maxed out, and the condition remains, then medication is appropriate." So we discussed the nature of the medications she had in mind, and I left with two prescriptions. Deathfatz was not mentioned.

She knows how much I weigh. I was weighed each time I went, without fuss, and the result duly noted on my chart. Also, she can see me. I am "morbidly obese". But then, I'm generally pretty morbid. (Ha-ha! Little depressed person humor there! Yes, we have our own jokes, too. I will spare you them.) At no time did I get any fat-shaming, lifestyle-blaming, or air of disapproval from her. Most importantly to me, when I told her that I can't change the way I live, she took me at my word.

My allergist had previously tried to convince me how simple changes to my diet would be, based on how when he was divorced he used to just throw some stuff on the grill on the days when he had his kids. He's a nice man, really. His manner wasn't patronizing, and I actually appreciate his willingness to take the time to talk to me about something outside his own direct responsibility but which was intended to better my health, given that many people have doctors who rush in and out with barely a chance to discuss anything with them. But, doc, I'm not a divorced man who never learned to cook because a woman had always done it for him. I'm chronically ill. No, really. They are not similar conditions.

So telling a doctor that this is how I live, and that my own assessment based on the knowledge accumulated in living my particular life tells me that it's the best I can do under the conditions of my life, and having her accept my judgment on that point, and matter-of-factly go on to discuss what can be done, was . . . startling.

I have read the horror stories here at Shakesville and throughout the fatosphere, about health care professionals who appear to believe that fat people don't deserve to be healthy, and are by jiminy not going to get any help from them in becoming as healthy as they can be until they earn it by losing weight. I know I am really lucky to have the doctor that I do. Hell, I'm lucky to have the broad access to health care that I do, which is provided by a combination of Medicare and MediCal that I am very fortunate to have, and I don't forget that.

But having access to a building where health care is provided and a staff who provide it to those they feel are deserving (the right weight, the right gender, the right gender presentation, the right sexual orientation, the right religious beliefs, the right sexual habits — being the right kind of person, i.e., like me, the provider) is one thing, and having access to health care you can use, provided by professionals who respect the autonomy and judgment of the patient, is a whole other dimension. I have both, and I know that, in this respect, I am very fortunate.


*My depression is unipolar; unipolar depression is quite often also found in families where bipolar disorder is present.

**I couldn't resist the sarcasm, but obviously no one is responsible for the genes they have, much less who among their children and grandchildren inherit them, and given that these conditions certainly caused her suffering as well, unknown Granny merits only sympathy from me.

H/T to CaitieCat and eastsidekate, who jump-started my motor to write this post. :)

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