Tuesday, 27 September 2016

Raising Body Positive Kids in a Body Negative World

The world is messed up you are fineI’m honored that this post is part of BEDA’s Weight Stigma Awareness Week, please check out all of the awesome work that they are doing.  

I was at an event recently where we were doing icebreakers. The “light hearted” question we were all supposed to answer was “what advice would you give your 10 year old self?” The other women said things like “you can be anything you want!” and “you’ll never use algebra so don’t worry about it so much!”  Everyone was smiling and laughing so when I said, completely seriously “Don’t diet.  Don’t ever, ever diet” it kind of stopped the show. But it started a conversation about the ways that a sizeist world had messed us all up around our relationship with our bodies.

In my work as a speaker, writer, and blogger I’m most often talking with adults who are trying to overcome a history of body image issues and chronic dieting that often goes all the way back to childhood and is perpetuated by our current thin-obsessed culture. When I do speak to and with girls, sometimes as young as third grade, I hear about the extreme pressure to be thin and the fat shaming (both often coming from adults) that is leading to a world where 1 out of 4 children had dieted prior to turning 7, and a staggering 80% of American girls aged 10 have been on diets. Also concerning was the finding that one-third of boys and the majority of girls ages 6 to 8 wish their bodies were thinner, and where the American Academy of Pediatrics reported that hospitalizations of children younger than 12 years for eating disorders rose by 119% from 1999 to 2006. (Children UNDER 12)

One of the things that can help kids deal with this is adults who not only model healthy behavior, but who also point out what is happening and give kids some ammunition against a world where they will be encouraged to judge themselves and each other harshly, and where predatory industries see them as a target demographic.

Role modeling can be tough.  Often adults who have been raised and conditioned by society to have crappy self-esteem and body image are trying to raise kids with high self-esteem and body image, and that can be very difficult to do. I think that one of the best things that we can do for the kids in our lives is to work on ourselves, starting with the way that we talk about ourselves.  

Here are some things that I wish more adults had done when I was growing up:

  • Stop negative body talk, all of it, right now. Start with your own body. Kids believe what we do more than what we say, so if we talk badly about our own bodies, but then tell kids who look like us that they are beautiful, they are going to see right through that. Decide that you are going to talk about things you like about your body, celebrate exactly what you look like and what your body can do. Don’t say negative things about other people’s bodies.  When you watch the Oscar’s, encourage kids to focus on the performer’s accomplishments and not on how they look.
  • Have books and art around that highlight and celebrate a variety of bodies – people of different sizes, shapes, colors, dis/abilities, ages, and more.. http://ift.tt/1N08uMb
  • Talk about health in terms of health and never in terms of weight or body size.  Let kids know that bodies come in lots of sizes and all bodies are good bodies, and let them know that, while there are things that they can do to support their health, it is not a barometer of worthiness or entirely within our control.
  • Make health about fun, not about restriction and punishment.  Talk about what kids can DO to support their health instead of suggesting what they should restrict or not do.
  • I have a talk I give to all ages called “The World is Messed Up, You’re Fine” and I think that’s an important message to give kids.  Let them know that a lot of times adults, including adults we’re supposed to trust, do super messed up things, often meaning well but messed up nonetheless. When it comes to body size and health right now the world is pretty messed up -people insist that bodies are good or bad depending on what size they are and there’s a lot of prejudice, negative body talk, and bullying that happens around size.  There are even some doctors who believe this, and even think that they can make guesses about how healthy someone is by what they look like.  The truth is that people come in lots of different sizes for lots of different reasons and all bodies are good bodies.
  • Be honest – explain the concepts of oppression, and privilege and activism in an age-appropriate way. Yes, in our society people who look a certain way may be treated better, and if you think that’s wrong you can fight to end it.  You can also talk about weight and health – explain that there are some people who may want the best for them, but they are unfortunately ill-informed about the truth about the diversity of body sizes that exist and how health works (maybe start with the story of Galileo.) You can also bridge this lesson to talk about other types of oppression – racism, ageism, ableism, homophobia, transphobia, classism et al,  areas where they have privilege and how they can use that privilege to help (age-appropriate intersectionality FTW!)
  • Point out the ways that the industries profit from us hating our bodies and trying to achieve some stereotype of beauty that is unattainable and arbitrary.
  • Never encourage kids to diet. Nothing good comes of it.  Research from the University of Minnesota found that: “None of the behaviors being used by adolescents for weight-control purposes predicted weight loss…Of greater concern were the negative outcomes associated with dieting and the use of unhealthful weight-control behaviors.”  Encourage kids of all sizes to appreciate their bodies and see them as amazing and worthy of care. Then work to make sure that they have the resources to take good care of 

Kids are living in a world where companies will try, at every opportunity, to (as my friend CJ Legare puts it) steal their self-esteem and sell it back to them at a profit.  If we can help those kids develop their self-esteem and then hang on to it when the beauty and diet industries are trying to tear it away from them, we’ll give them a fighting chance to make a real change in their own world, and in the whole world.

Like this blog?  Here’s more cool stuff:

Become a Member! For ten bucks a month you can support fat activism and get deals from size positive businesses as a thank you.  Click here for details

Book and Dance Class Sale!  I’m on a journey to complete an IRONMAN triathlon, and I’m having a sale on all my books, DVDs, and digital downloads to help pay for it. You get books and dance classes, I get spandex clothes and bike parts. Everybody wins! If you want, you can check it out here!

Book Me!  I’d love to speak to your organization. You can get more information here or just e-mail me at ragen at danceswithfat dot org!

I’m training for an IRONMAN! You can follow my journey at www.IronFat.com

If you are uncomfortable with my offering things for sale on this site, you are invited to check out this post.



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Monday, 26 September 2016

Diet Culture: E’s Story

Does diet culture kill?

My sister E was the oldest of five children; I was the youngest. Growing up in a house where our father was at work most of the time, and our mother was tired most of the time, E did a lot of the work of raising me.

She was one of the most independent minded people I knew. She had friends and liked doing things with them, but she made her own decisions and they weren’t always what her friends would do.

She worked hard, but always on her own terms. She would use up all her vacation, and all her sick days, and she felt no guilt about it. She felt that there was no point working if you didn’t also have fun.

She’d say what was on her mind, pretty much unfiltered. Of course, she came of age in the 1970s, when “tell it like it is” was everyone’s motto. But she also knew how to sweet talk, and she could get me to do chores like no one else could.

But for all this independence, she had one weak point: she was a fat person. She was one of the most beautiful women I knew, but because she was fat, society put her in the “such a pretty face” category. She’s been on and off diets for as long as I’ve known her. They never worked long term, until about 11 years ago.

That’s when she had weight-loss surgery. I tried as best as I could to talk her out of it, but it didn’t work. She had so much self hatred because of her fatness that she wanted more than anything to lose weight and keep it off. She felt that she’d never have a husband unless she was thin, or at least thinner than she was. She knew that I was and am attracted to fat women, and was and am married to a woman much fatter than her. That didn’t matter. She just couldn’t imagine that there were others like me out there. Or maybe it didn’t matter what others thought: it was what she thought, and she thought the worst of herself simply because of her fatness.

I saw her a few years after the surgery at our father’s burial. She was a lot thinner than she had been, although not thin at that point. But she kept on saying how bad a person she was because she still ate more than she should, in her opinion.

At that time she was living near where my dad had lived, where it’s very cold in the winter, and she didn’t spend much time with other people. She talked about being depressed, and going for days without showering or bathing.

A little bit after that, she moved back to New Jersey, where we’re from. She was able to find a fairly nice place to live within her budget, and it seem like she had gotten her life in order. But she was still talking about not bathing or showering, and being sad. Another sister, C, lived nearby, and E had friends nearby as well. But she was still lonely.

C had been sick for decades, and last year, 2015, she died. After that, phone calls from E got fewer. In November 2015, E went into the hospital. She was diagnosed with an iron deficiency, got a blood transfusion, and was sent home with supplements.

She was back in the hospital in December, this time with a gallstone that had migrated to her colon. They wound up removing her gallbladder. In January 2016, she was back in the hospital again, then again in March, and again in April. Since then she’s been in an infinite loop, going from the hospital to a rehab center and then to home, but never home more than a few days until she’s back in the hospital.

Her ailments, according to the hospital doctor who has seen her the most, come down to her not eating enough. Somehow last year, through a combination of her weight-loss surgery, depression, and drugs, she had attained the ability to starve herself. Put another way, she developed an eating disorder.

I went to visit her earlier this summer on our way to a family reunion, and at that point she was in a rehab facility. The problem was, though, she wasn’t getting better. She didn’t like any of the food offered to her, and wanted special food brought in like chocolate flavored Ensure. And sometimes she didn’t like that either.

Her mental confusion increased over that period. She could never understand why she was sick, why she kept going into the hospital, why she was losing her ability to walk and do things for herself.

Eventually E went back home, but this time she had an in-home aide to help her. And for a couple of weeks, it seemed like she was actually getting better.

But she wasn’t. She wasn’t doing the physical therapy, she still wasn’t eating enough, and she wasn’t on a path to independence. A family member decided that the in-home aide was too soft on E, and so she went back east herself to nurse E back to health.

Things didn’t go as hoped. E went back into the hospital a few days later, then to rehab, then back in the hospital. We still have hope, but she’s been in decline for a long time, and it doesn’t look good.

Is diet culture killing my sister? E was an independent woman, but she could never reconcile herself to being fat. When she found a way to starve herself, there was no turning back.




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Mutiny On Lesbo Island

Originally posted on Saye Bennett:
Note: This post is my long-overdue (sorry! ugh!) response to joannadeadwinter in our on-going conversation  about bisexuality. Specifically, this post is in response to her post, “Shipwreck on Lesbo Island.” Joannadeadwinter made so many excellent points in her most recent post in our discussion of bisexuality that I found myself nodding…

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Easy Vegetarian Enchiladas Recipe

This shop has been compensated by Collective Bias, Inc. and its advertiser. All opinions are mine alone. #CambialoConQS #CollectiveBias Hi friends! I am sharing a recipe passed down through my family...

Read more here!

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Sunday, 25 September 2016

Routine Planned Cesareans in Older Mothers Do More Harm Than Good


Many care providers push strongly for elective (planned) cesareans in older moms. However, a recent study challenges the wisdom of this common practice.

This extremely large study confirms that planned cesareans as a routine intervention for older moms is a bad idea. It increased their risk for infection, hysterectomy, kidney failure, cardiac arrest, and death.

This is an issue close to my heart as I was an "AMA" (Advanced Maternal Age, or 35 or older) mom for three of my four pregnancies.

In many practices, a woman like me ─ an older "morbidly obese" mother with a prior cesarean ─ would have faced intense pressure for a planned cesarean. I was fortunate to have care providers that didn't pressure me to have a cesarean just because of my age or weight. (Then again, I purposely chose providers who utilized a more low-intervention model.)

But the pressure for a planned cesarean can be quite strong on older mothers in many practices, especially if the mother is a first-time mom or received fertility treatment. One study found four times the rate of elective cesareans in older first-time moms. But why?

Some doctors see vaginal birth in an older mom as so risky that they prefer to just bypass labor altogether and plan a cesarean. Although the risk for stillbirth does seem to go up somewhat as women age, recent research confirms that this risk is quite modest (and not all research finds an increase in risk). Most healthy older women will do just fine.

Furthermore, a recent study confirms that the difference in outcomes between planned cesareans and planned vaginal births in older moms is quite small. Each choice has its own pros and cons to consider.

Risks probably increase as a woman ages; a woman of 54 probably has a much different risk than a woman of 41. However, many women with very advanced maternal ages have safe vaginal births too. Age alone should not be used as an absolute guide for a planned cesarean.

Although the risk for needing a cesarean during labor does increase as a woman gets older, the research shows that the majority of older women who are given a chance at having a vaginal birth actually do give birth normally. Giving birth under the care of midwives or in a non-obstetric unit setting may improve chances for a vaginal birth in older women who labor.

That is not to say that a planned cesarean is never appropriate in an older mom, only that the decision should be a nuanced one. Risks are higher in those with multiples, with those who have their first pregnancies after 40, and in those who required fertility treatments. Older women who have serious pre-existing health conditions, who have multiple major risk factors, or whose babies do not seem to be growing well have a much different risk profile than an older woman who is healthy, has no pregnancy complications, and has a healthy baby who is growing well.

It would be nice to see further research that provided concrete quantification of absolute risks at various ages in combination with various risk factors. That would be more helpful in guiding decision-making.

Still, all the factors must be considered and birth decisions should be made by the woman and her providers together. The decision should never be imposed on a woman by her provider; age does not negate a woman's right to personal autonomy in her medical decisions.

The bottom line is that routine use of a planned cesarean in older women simply because of age puts that mother's health at risk. Better to have the mother go into labor and see how labor goes. A cesarean can be done in labor if needed, but this very large study shows that routine cesareans for age leads to greater harm overall.

As the authors of the study conclude:
Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population.
For an excellent review of the overall research around pregnancy in ages 35 and older, please see this article.


Reference

Matern Child Health J. 2016 Jul 29. [Epub ahead of print] Effect of Planned Mode of Delivery in Women with Advanced Maternal Age. Lavecchia M1, Sabbah M1, Abenhaim HA2,3. PMID: 27473092
OBJECTIVES: The purpose of this study was to determine the prognostic value of planned primary elective cesarean section versus planned vaginal delivery in women with advanced maternal age. METHODS: We conducted a population-based, retrospective cohort study using the United States' Health Care Cost and Utilization Project's Nationwide Inpatient Sample to evaluate maternal outcomes in women with advanced maternal age delivering from 2003 to 2012. Healthy women who underwent primary elective cesarean section constituted a surrogate for low-risk planned cesarean delivery. Logistic regression was used to compare outcomes between women with planned cesarean and planned vaginal delivery. RESULTS: Among seven million births, we identified 442,067 deliveries in healthy women with advanced maternal age. The planned cesarean group comprised 7.96 % of women in the cohort. When compared to healthy women in the planned vaginal group, women in the planned cesarean group had a significantly higher mortality ratio (2.56/10,000 vs. 0.44/10,000, p < 0.01). The planned cesarean group was also at higher odds of numerous complications, including peripartum hysterectomy OR 1.81 (1.36-2.40), p < 0.01, cardiac arrest OR 5.39 (4.54-6.38), p < 0.01, acute renal failure OR 3.39 (1.78-6.46), p < 0.01 and sepsis OR 2.27 (1.25-4.14), p < 0.01. CONCLUSIONS FOR PRACTICE: Planned cesarean section is a key factor significantly influencing maternal morbidity and mortality in healthy women with advanced maternal age. When possible, planned cesarean deliveries should be avoided in this population.


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Saturday, 24 September 2016

Binge Eating Disorder

This post isn’t really about fatness, but I was thinking about binge eating disorder as a diagnosis. You can take a look at the diagnostic criteria here, but it seems to get into a thorny realm because one criterion is a sense of lack of control. To me, that sounds like saying “addictive behavior” while avoiding that phrase. It leads to some questions:

  • Is binge eating itself a problem, or just a symptom of a deeper problem?
  • Does this diagnosis really help people?
  • Is there an issue with the diagnosis being incorrectly applied to fat people?
  • The diagnosis also mentions distress, disgust, etc. If one binges without these feelings, does one have the disorder?

I don’t have a firm viewpoint, but I’d like to hear yours.




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September NAAFA Newsletter

I forgot to post the link to this month’s NAAFA newsletter last week; sorry about that. But here it is, and I’ve pre-clicked for you so that the link below takes you straight to the fat news. Enjoy!

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