Friday, 16 February 2018

Lies About Health At Every Size

Public HealthI see a LOT of misinformation being spread about Health at Every Size, sometimes by well-meaning but misinformed people, sometimes by those intentionally trying to discredit the concept. So today I thought I would repost this to help clear up some of what I think are common misconceptions:

1. Health at Every Size says that if you love your body you will be healthy

First of all, “healthy” is complicated to define. More to the point health – by any definition – isn’t an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstance. To me, HAES on a personal level is about putting the focus on habits and behavior that support our personal health concept (rather that putting the focus on trying to manipulate our bodies to a specific height/weight ratio.)

It’s also about acknowledging that we don’t have as much control over our health as we might like to think we do, and creating environments that are conducive to health, and I don’t mean fat-shaming and soda taxes, I mean creating environments that are free from stigma and oppression, removing barriers to access and information, making healthcare accessible and affordable for everyone, giving people the option to appreciate their bodies and think of them as worthy of care.

Finally, everyone has the option (though, of course never the obligation) to love their bodies regardless of “health” or anything having to do with “health.”  People are allowed to having complicated feelings when it comes to their bodies and “health.”

2. Health at Every Size is only for fat people

Nope-ity nope.  HAES is practiced by people of all sizes.  The reason that it’s most often talked about in conjunction with fat people is that fat people are typically told that the only path to health is to become thin (despite the fact that there are thin people who have all the health issues that fat people are told to lose weight to avoid) and so while many fat people find it while looking for an alternative to the intentional weight loss recommendations that have been failing us our entire lives, HAES is an option for those who want to pursue health rather than body size manipulation, it’s also practiced by people of all sizes who want an evidence-based health practice.

3.  Good Fat People Practice Health at Every Size 

The good fatty/bad fatty dichotomy is the idea that fat people who participate in “healthy” behaviors or are “healthy”  (as defined by the person who inappropriately and incorrectly thinks that it’s their right to judge) are better than the “bad fatties” who don’t practice “healthy” behaviors or aren’t “healthy” (by whatever definition.)

The GF/BF dichotomy is wrong and it needs to die.  Each person should have the right to define and prioritize “health” for themselves, and to choose the path that they want to travel -those are personal decisions and aren’t anyone else’s business (those wishing to make a “but muh tax dollarz!” argument can head over to this post) Public health isn’t about making fat people’s health the public’s business, or about creating healthism in the name of health, or about using “health” as a thin veil for fat bigotry.

4. I disagree with the science behind Health at Every Size, therefore I am justified in treating fat people like crap.

Noooooooo. World of no. Galaxy of no. Universe of no. No. People are free to believe whatever they want about body size and health. None of those beliefs are a “get out of Sizeism free” card.  Fat people have the right to exist without shame, stigma, bullying, or oppression. Period.  What someone believes, or what is true, about Health at Every Size does not come into play here.

The seed for my HAES journey was reading the research about weight loss methods and realizing that there wasn’t a single study that would lead me to believe that future efforts at long term significant weight loss would have any different outcomes from my past attempts (which is to say, I had the same experience as almost everyone – losing weight short term and gaining it back long term, often plus more!)  Realizing that I had been sold a (massively profitable) lie about my size and health, I went looking for what the research actually said. And the research seemed pretty clear to me that, understanding that my health wasn’t entirely within our control, a focus on behaviors rather than body size was a much more evidence-based way to support my health.

There are people out there riding the weight loss roller coaster even though their experience, and the research, tells them that there is no reason to believe that attempting intentional weight loss will leave them thinner or healthier in the long term, because they want to be “healthy” and they don’t know that there is another option.  HAES is important because it provides a paradigm for personal choices and (perhaps more important) wellness care that doesn’t revolve around doing something that nobody has shown is possible for an outcome that nobody has proven is valid.

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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Sunday, 11 February 2018

Cinderella VBACs and Gestational Age

Image: Disney

"At my last doctors appointment I went in and asked my doctor if I could continue with the pregnancy past 40 weeks if I were still pregnant. He said No because the risk of uterine rupture goes up past 40 weeks."  source
"Gestational age greater than 40 weeks alone should not preclude Trial of Labor After Cesarean." ACOG 
Many women planning a VBAC (Vaginal Birth After Cesarean) are told by their providers that they will be supported for a VBAC, but their doctors often conveniently forget to mention ahead of time that they enforce arbitrary rules that require women to go into labor by 40 weeks or be forced into a cesarean, like the woman quoted above. Some even insist on a repeat cesarean by 39 weeks.

This is what author Henci Goer calls a "Cinderella VBAC." The doctor claims to support VBACs, but puts so many limits on VBAC labors that almost no one gets one. Examples: the mother must go into labor before 40 weeks, the baby has to be below a certain weight, the mother must not gain very much weight in pregnancy, etc.

In that way, caregivers can give lip service to supporting VBACs without having to actually attend very many. As a result, activists separate caregivers into "VBAC Tolerant" versus truly "VBAC-friendly" by their insistence on these type of Cinderella VBAC restrictions.

Gestational Age Cutoffs in VBACs

One of the most common Cinderella VBAC rules is a gestational age cutoff. At 40 weeks, many women are told the risk for uterine rupture goes up so a VBAC labor would be too risky and they must schedule a repeat cesarean. However the research on uterine rupture past 40 or 41 weeks is conflicting and women are not being permitted to make fully informed decisions.

Some studies do show a modest increase in rupture risk by gestational age. However, others do not. One of the largest and most powerful gestational age studies did not show a statistically increased risk of rupture past the due date. This study was done at 17 different hospital centers, over a period of 5 years, and involved 11,587 women who labored for a VBAC.

What muddies the research waters is that many pregnancies after the due date end up induced, and a number of studies show that induction of VBACs is associated with more uterine rupture. So are the ruptures in these studies truly being caused by going beyond the due date, or is it an artifact of the high rate of inductions and augmentations done in pregnancies after 40 weeks? Some studies control for this and others do not.

In their book, Optimal Care in Childbirth (pg. 118), Henci Goer and Certified Nurse-Midwife Amy Romano note that the majority of uterine ruptures in these gestational age studies are found in the induced groups, and especially in those induced with an unfavorable cervix.

Now there is a new study just out on gestational age and rupture. It also found that the risk for uterine rupture did NOT increase with gestational age.

In this seven-year Israeli study of 2,849 women, 0.56% of women had a uterine rupture during a "trial of labor after cesarean" (TOLAC). The rate did not differ significantly by gestational age (GA), and  90% of women in the study had a VBAC. If all the women at 40 weeks had been forced to have a repeat cesarean, that would have been a lot of unnecessary cesareans. This study adds strong support to the position that women should not have to have a repeat cesarean at 40 weeks. The authors conclude:
Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.
The latest guidelines from ACOG (the American College of Obstetricians and Gynecologists) note that gestational age beyond 40 weeks should not preclude laboring for a VBAC. This position is echoed by VBAC guidelines from other countries as well.

What About Inductions?

What about other options? To avoid going past 40-41 weeks yet still give the woman an opportunity at a VBAC, some caregivers will induce labor around the due date. They point out that in some studies the chance of a VBAC decreases after the due date so they hope that inducing at the due date gives the woman the best chance at a VBAC. They also point out that the risk for stillbirth, although quite low, does increase at some point after the due date.

However, induction at term has pros and cons. In most studies (but not all) induction of labor increases the risk for uterine rupture and decreases the chance of a VBAC. For example, the 2015 NICE guidelines from the Royal College of Obstetricians and Gynaecologists states:
Women should be informed of the two- to three-fold increased risk of uterine rupture and around 1.5-fold increased risk of caesarean delivery in induced and/or augmented labour compared with spontaneous VBAC labour.
In Optimal Care in Childbirth (pg. 118), Goer and Romano, noting that the majority of rupture cases that occurred after the due date were associated with induction, state:
These data suggest that women should not be induced for passing their due date. Induction both increases their risk of scar rupture and decreases the likelihood of VBAC. 
But how does induction of labor specifically compare with expectant management past the due date in VBAC women?  Recent research suggests that induction increases the risk for uterine rupture (1.4%) as opposed to expectant management (0.5%). In other words, caregivers' interventive management of women past the due date actually increased the risk for harm, not reduced it.

This is not to say that induction and augmentation should never be used in VBAC labors. Sometimes induction is medically necessary. Used carefully, induction and augmentation can be used safely in some VBAC labors. It doesn't have to be all or nothing.

Some types of VBAC inductions probably carry more risk than others, though. Some research suggests that prostaglandin use, sequential use of prostaglandins and pitocin, the induction of women with an unripe cervix, and the induction of women without a prior vaginal birth may raise the risk for uterine rupture.

For sure, misoprostol (PGE1) is associated with much higher uterine rupture rates and should never be used to induce a woman with a prior cesarean. The risk with other prostaglandins (PGE2) is less clear, though most clinicians avoid them these days.

Currently, the most favored method for inducing a VBAC is by mechanical means, such as amniotomy (breaking the waters) or a transcervical balloon catheter, along with oxytocin augmentation if needed. These methods may be less risky than other methods of induction for VBAC moms, although they still carry more risk for uterine rupture than spontaneous labor.

In other words, all induction scenarios do not carry equal risk. The risks may not be as high for induced labors in women with a very ripe cervix or with a prior vaginal birth, but parents should remember that the risk is never zero.

Although induction tends to lower the probability of having a VBAC, many women are induced and do have VBACs. This seems especially true for women with a high Bishop's Score (indicating a ripe cervix) or a previous vaginal birth. Regardless, the majority of women who have been induced do have VBACs. In several recent studies, about one-half to two-thirds of induced labors ended in VBAC. That's a lot of repeat cesareans averted.

Induction is a decision that should not be taken casually but which can be a legitimate choice for some. However, induction is generally overused in VBAC labors, and is often undertaken without fully apprising women of the risks associated with it. But it does remain a viable choice and there are women who have had induced VBACs.

Summary

When a woman with a prior cesarean passes her due date, there are many courses of action that are possible. Every choice has benefits and risks. Although the vast majority of women with a prior cesarean will have good outcomes whatever they choose, there are unique pros and cons to consider.

The most logical choice is to let nature take its course and wait for spontaneous labor. Many caregivers are very supportive of waiting for spontaneous labor after 40 weeks in women with a prior cesarean, and many will wait until after 41 weeks or even later to start discussing alternatives, as long as mother and baby are doing well. Obviously, each case's unique circumstances must be considered.

On the other hand, a surprising number of caregivers still use gestational age restrictions and force either repeat cesarean or induction at 40 weeks. For some, this is out of fear of any possibility of increased risk of rupture or a fear of stillbirth. For others, it is out of a mistaken belief that after 40 weeks, there is little chance of a VBAC. A cynic would also note that since about half of women do not go into labor before their due date, gestational age restrictions also mean that doctors attend fewer VBAC labors, easing their schedules while still letting them appear to be supportive of VBACs.

Unfortunately, research does not offer 100% clear guidance on uterine rupture risk after 40 weeks. Some research suggests a somewhat increased risk, but a closer look suggests the risk is mostly in induced labors or the difference is quite modest. The strongest research does not show an increased risk after the due date at all.

Gestational age restrictions also bring up the question of ethics. Mandating a repeat cesarean or an induction at a certain gestational age is a high-handed and paternalistic approach. It infantalizes women and strips them of their autonomy to make their own medical decisions. It also ignores the possible harms associated with these interventions.

Instead, women should be counseled about the pros and cons of each choice. Caregivers may advise a certain course of action, but in the end the woman has the right to accept or refuse that course of action. Discussion of these issues should begin early in pregnancy, not at term, so there is plenty of time for decision-making. Remember, every choice has pros and cons.

Repeat Cesarean without labor
Pros: Convenience of scheduling; lowest risk for rupture; no uncertainty of labor
Cons: All the risks of surgery and surgical recovery (bleeding, pain, infection, blood clots); more breathing problems for the baby; more breastfeeding problems; substantial risk of life-threatening placental issues in future pregnancies
Expectant Management past due date
Pros: Spontaneous labor is usually easier/less painful and VBAC is more likely; baby is more ready for life outside the womb (less problems with breathing, breastfeeding, blood sugar levels, bilirubin levels); mother usually has an easier recovery
Cons: May labor and still end up with a cesarean; continuing the pregnancy entails the very small but real risk of stillbirth or uterine rupture; may still need to have induction of labor at some point, may have decreased chance of a VBAC (although this may be influenced by high induction rates later)
Induction of Labor at 40 or 41 weeks
Pros: Induction can be scheduled and planned for; most of the time induction still ends in a VBAC; induction means predictable staffing requirements for the hospital
Cons: Induction involves a harder labor and more need for pain relief; more risk for fetal distress; a significantly increased risk for uterine rupture; and typically a decreased chance for a VBAC. May still end up with another cesarean after labor
Clearly, there are no easy answers. No one answer is the right answer for all women and situations.

The most important take away here is that after the due date, women with a prior cesarean should not be forced into anything; they should have choices. The pros and cons of the various choices should be reviewed with the mother and the ultimate choice should be left up to her. 

At term, some women will choose repeat cesarean, some will choose induction, and some will choose to wait for spontaneous labor. All are valid choices.

The ACOG guidelines are clear and caregivers need to honor them. Gestational age past 40 weeks should not be used as a cut-off to keep women from laboring for a VBAC.

Women who want a VBAC should ask careful questions early in pregnancy about the guidelines of their providers, including whether there are gestational age cutoffs or other limitations on their options. Be proactive; don't wait until the last minute to find out. In some cases, women may need to switch providers in order to get a truly VBAC-friendly provider. It is possible to do so, even late in pregnancy, but the process is easiest when it's done early.

The time is at hand. All women deserve to go to the ball if they want to. "Cinderella VBACs" need to become a thing of the past.

Checklist originally from Melek Speros


References

Arch Gynecol Obstet. 2018 Jan 22. doi: 10.1007/s00404-018-4677-9. [Epub ahead of print] Trial of labor following one previous cesarean delivery: the effect of gestational age. Ram M, Hiersch L, Ashwal E, Nassie D, Lavie A, Yogev Y, Aviram A. PMID: 29356955
PURPOSE: To stratify maternal and neonatal outcomes of trials of labor after previous cesarean delivery (TOLAC) by gestational age. METHODS: Retrospective cohort study of all singleton pregnancies with one previous cesarean delivery in TOLAC at term between 2007 and 2014. We compared outcomes of delivery at an index gestational week, with outcomes of women who remained undelivered at this index gestational week (ongoing pregnancy). Odds ratios and 95% confidence intervals were adjusted for maternal age, previous vaginal delivery, induction of labor, epidural use, presence of meconium, and birth weight > 4000 g. RESULTS: Overall, 2849 women were eligible for analysis. Of those, 2584 (90.7%) had a successful TOLAC and 16 women (0.56%) had uterine rupture. Those rates did not differ significantly for any gestational age (GA) group. Following adjustment for possible confounders, GA was not found to be independently associated with adverse maternal or neonatal outcomes. CONCLUSION: Among women at term with a single previous cesarean delivery, GA at delivery was not found to be an independent risk factor for TOLAC success or uterine rupture. We suggest that GA by itself will not serve as an argument for or against TOLAC.
Obstet Gynecol. 2005 Oct;106(4):700-6. Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation. Coassolo KM, Stamilio DM, ParĂ© E, Peipert JF, Stevens E, Nelson DB, Macones GA. PMID: 16199624 
OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.



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Sunday, 4 February 2018

Immigrants and Bikes

I’ve seen the argument that DACA recipients are like “kids whose parents stole a bike and think they should get to keep it.” I think that’s a flawed analogy for many reasons.

But, let’s say that your parents acquired a bike in violation of some criminal or civil law. This includes kids whose parents stole the neighbor kid’s bike at gunpoint, parents who bought the bike not knowing that it was stolen, and parents who received the bike in compensation for work, were therefore supposed to pay taxes on it, and didn’t (some deliberately, some who honestly forgot or didn’t realize). The whole range of major to minor offenses, both criminal and civil, both deliberate and inadvertent.

Whatever your parents did, you had no control over it. You may have known that something was shady about your bike, or you may have been blissfully unaware. You just got a bike. With that bike, you got a paper route when you were 10 or 12. From that paper route, you built up some savings. Later, at 16, you used the bike to commute to your part-time job at the grocery store. You kept saving and eventually bought an adult-size bike, which you still ride. You went to college or trade school. Your paper route and grocery wages didn’t pay for the whole thing, of course, but they helped. And that second bike saved you an awful lot of gas money while you were in school. Even if you’d paid for the second bike another way, you probably wouldn’t have had the confidence or skill to bike commute in college, if not for all that time you’d spent on the first bike as a kid.

You get a job and start building an adult life. Maybe you get married and have kids, maybe it’s just you and your cat. Maybe you buy a house.

One day, a government official comes to your door and tells you that because of the way your bike was acquired, it’s now forfeit. Your second bike, which you still have and ride, is also forfeit. In fact, all of your assets are going to be taken by the government, regardless of their relationship to the bike. You have a choice. You can leave your current hometown, job, friends, and family, and start your life over from scratch with nothing. Or, you can go to jail. Indefinitely. Eventually, maybe after several years, you will have the chance to explain to a judge why you should not have everything taken from you and get to stay where you currently live. Because you yourself aren’t being charged with a crime, you have no right to a lawyer.

Regardless of the crimes or civil offenses committed by the parents, or when the child became aware of them, is this a just and reasonable punishment? Because that’s what we do when we deport people.



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Monday, 29 January 2018

“Success” and Stomach Amputation

fat people have the right to existA popular online publication recently published a piece that purported to talk about the pros and cons of stomach amputation and stomach binding (also known as “bariatric” or “weight loss” surgery.)

There’s no way I’m giving it traffic, so there won’t be a link. And while people are allowed to do whatever they want with their bodies, including amputate or bind their stomachs (though that doesn’t mean it’s appropriate to discuss in every space,) it’s important that we talk about the realities of these surgeries. The story mentioned a failure rate of 1 in 10, which seems low based on the research, but perhaps that’s explained at least a little bit by what people consider a “success.”

One woman who says she’s “very happy” and has “no regrets” has had three of these surgeries. A lap band that had to be removed when “For five days, I wasn’t able to keep food down. At the hospital, I found out the lower portion of my stomach protruded through the band to the top, so I was basically choking on my stomach.” Next a gastric sleeve that caused “a lot of acid reflux” and “stopped losing weight around 220 pounds.” Then she went to Mexico and payed “$5,800 to $6,000” out of pocket (she notes that it’s half the price as the surgery in the US) because her insurance wouldn’t cover a third surgery. She currently weighs 180 pounds, has low iron and notes “I can’t eat really dry chicken. Certain textures are uncomfortable. Sometimes I get woozy from sugar.”

Another “success” story had to have her lap band removed and “The tubing on the band kinked, so the fluid in my stomach got in my lungs in the surgery.” Then she got gastric bypass, followed by eight plastic surgeries due to the discomfort her loose skin created.

Yet another chased her stomach amputation with two surgeries – hernia repair and emergency gallbladder removal.

Some people called their surgery successful because they don’t feel like they “take up too much space” anymore, their Tinder success increased, they are no longer interested in eating food, and that “unhealthy” food gives them “overwhelming nausea, ”that pizza would cause them to “throw up immediately and start getting cold sweats,” that they now have a single cookie for lunch. Others mention health improvements that many people have made without these surgeries.

Remember, those are the “successes.” The failures include a woman whose constant vomiting from her lap band triggered bulimia. Another had bulimia triggered by gastric bypass and still has to “puree a lot of my food to keep it down.” Others mention that they developed alcohol addiction.

The first thing I want to point out is who is missing in this article – the many people who gain all of their weight back, and the people who were killed by the surgery (even the Canadian Obesity Network admits that they kill more than 14 out of every 1,000 people – and that’s only the people who die quickly. When people die later due to complications, get blamed for their own deaths.

.I also have to point out that any of the people interviewed – whether they consider themselves successes or not – could have been killed by the surgery. While I’m glad that they survived it, the surgery is – at best – a crap shoot in which a very few don’t experience horrible side effects, some people are happy despite pretty horrible side effects, some people are unhappy about the horrible lifelong side effects, and some people die, and there’s no way to know which group you’ll be in until you are in it.

So let’s talk about all this “success.” Can you imagine the reaction people would have if after they got their tonsils out they had to eat pureed food and throw up all the time for the rest of their life? Or if they were likely to have to have 8 plastic surgeries (that their insurance may not pay for) after having their appendix removed? What about if their bunion surgery was considered a success even if it meant that they threw up immediately after eating pizza and got woozy after eating sugar for the rest of their lives, and  they got blamed if their bunion grew back worse than before in a few years? Or, imagine there was a surgery that actually did improve the health of fat people with absolutely no negative side effects, but didn’t lead to any weight loss – would they call that a success?

The fact that horrific lifelong side effects and possible death are considered to be perfectly reasonable outcomes of so-called weight loss surgery is an admission that healthcare professionals believe it’s completely ok to kill, or severely harm, fat people under the guise of “healthcare” as long as there is a chance we might end up thin.

And that’s not the only way that fatphobia plays into this. Notice how many of the things that are considered “pros” of the surgery would not be pros at all if we didn’t live in a fatphobic society. Is there any other surgery that doctors claim is about health, but sell using “more right swipes on Tinder” as a benefit? Have you ever heard a doctor try to talk a patient into surgery they don’t want by claiming that they’ll get more dates? It happened to one of my blog readers.  The problem is fatphobia and the solution is to end fatphobia, not to pressure fat people to risk their lives in an attempt to satisfy their bullies.

Far too often the medical centers and device manufacturers that profit handsomely from these procedures don’t give potential victims the complete picture – they trot out the few and far between “success” stories, downplay the risks, and somehow fail to mention the distinct possibility that you’ll die – or that the side effects will make you wish you were dead. They even lie about whether or not the surgery is reversible.

Christine had lap band surgery about 7 years ago. Her weight didn’t change but her health did, she says “I refer to my band as medically – induced bulimia.” She vomits every time she eats. She wants it removed, but the company that made it was sued and went out of business. Surgeons refuse to remove it because they claim that, since the vomiting is coming from the top of her pouch (and so doesn’t contain stomach acid,) it’s not a complication and thus doesn’t justify removal. She says “There was absolutely no problem whatsoever operating on a perfectly healthy fat person to make them smaller – but Oh hell no! we can’t fix the problem we created with our fat-biased, completely unnecessary procedure!!!”

Even worse – there are some doctors who are insisting the fat patients get this surgery before they will give them the same healthcare that a thin person would receive immediately. Thin people are not required to get a surgery that risks their lives and forces them to engage in behaviors that approximate an eating disorder just to get basic healthcare. Fat people shouldn’t either. (One of the most craven examples occurs when doctors refuse to give higher weight Trans people the gender confirmation surgeries they want, claiming it’s too dangerous at their weight, then suggest that those same people get…wait for it…stomach amputation surgery.  It’s disgusting.)

And as one of the comments in a Facebook thread about the original article said “Wow. I knew the risks with this surgery but it’s awfully sobering to read a giant thread of people who have died from it. So sad that as fat people it’s better for us to die skinny than live fat in this world”

You see, when you’re a fat person, you can’t trust doctors to see you as a human being worthy of care. We always have to remember that our doctor may be perfectly comfortable risking our life  in order to make us into a thin person who they would, only then, view as a person worthy of evidence-based non-lethal healthcare options. If we just want to get appropriate, evidence-based treatment (which is to say, the same treatment that a thin person would receive) in the body we have now, we have to do a ton of extra work, and even then it’s definitely not guaranteed.

People are allowed to do whatever they want with their bodies, including binding or amputating their stomachs. But nobody should be required to bind or amputate our stomachs just to be treated with basic human respect, or to get decent healthcare. And for those who have the surgery, whatever they are hoping to gain had better be worth dying for, because they very well might.

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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Sunday, 28 January 2018

Buy My Fatshions!

I’ve just listed some treasured fatshions for sale on eBay!
These items are new with tags, ModCloth and Eshakti
Just trying to get some grocery money.
Check out my items here:
http://ift.tt/2DRVAXY
(Please forgive the username, I’ve had it since the 90’s, it’s the title of a fave punk song.)

Feel free to ask me questions here. The gown I have listed I have two of, identical.

 

 

Rad Fatty Love to ALL,

<3
S

P.S. Check out and use the hashtag: #FatAndFree on Insta & FB!
And my hashtag #DateMyDamnSelf on Instagram if you feel so inclined

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And as always, please feel free to drop me a line in comments here or write me an email, I love hearing from readers. (Tell me your troubles, I don’t judge.): notblueatall@notblueatall.com



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Friday, 26 January 2018

Distraction in Action

The last few weeks I have been busy as a bee interviewing for all the jobs! I have also been spending a lot of time in my head, for better or worse. Mostly just processing things and supporting friends and doing my best to be better support to myself. I am in a good place, mentally and emotionally, even physically I feel pretty great lately. I have also gone on a few dates, even got stood up once. While I’m perfectly good with being single, and have immediate hopes or plans for changing that, it’s been a nice distraction from the day to day.

Because I don’t have a daily routine as a job would require, I haven’t been wearing makeup except for interviews and dates. I enjoy the process of putting on makeup. I like the time and attention of just focusing on one thing, and the end result is FABULOUS! I also enjoy the process of getting to know folks through dating apps. I know it’s not for everyone, but I find people interesting, for the most part.

I’m just me, interview or date or not. I don’t get nervous about such things anymore. I just show up open to whatever happens. I have my own set of personal rules in any scenario and they keep me safe and sane. I’ve enjoyed some great conversations and have learned a lot. Even when things don’t work out, I don’t take it personally. This is a huge step for me! Ha-ha!

I had been forgetting to take pics of my outfits before interviews and dates. Last night I had a 4 hour interview, followed by what turned in to a 4 hour date. One of my rules is to end a date on the 3 hour mark even if things are great. It keeps things exciting but not exhausting, often I don’t have to check the time and things wind down naturally. Last night that was not the case and I broke two more of my personal rules and I am glad that I did! (I don’t give out my number until the second date and I don’t get into someone else’s car until I know them and am comfortable with them.)

This time I remembered to snap a few selfies in between interview and date since I was keeping the same outfit on and my makeup didn’t require a touch up. I’m glad that I did! I might be in love with my double chin as a result! Ha-ha! This dress is my interview staple. It’s whimsical, professional, colorful and genuinely makes people happy when they see it. It’s from Eshakti and was my birthday gift to myself this past year. I get stopped on the street by strangers when I wear this dress, so it feels lucky. I had never worn it on a date until last night, though. It worked out great!

We met up at a loca museum and as we were winding down our art perusal, I asked my great date to snap a pic of me in front of The Gates of Hell, by Rodin. I LOVE THIS PIC!!! And I may now be a fan of Rodin. We found a bust he created that looked as if Patrick Stewart and Putin had a love child. Ha-ha! Also found a small but full body sculpture of Balzac that looked exactly like one of my all time favorite british actors, Matt Berry. It was a great date!

So great that neither of us really wanted it to end when the museum closed, so we headed to the cheesecake factory nearby for drinks…but then they insisted I eat and that they pay. I was very upfront about my feelings and situation (financially and being a feminist), but they instantly understood and genuinely wanted to just continue chatting. It was a blast! I’d never had someone open up to me so quickly! We talked about some heavy stuff, but we just clicked and that’s rad. I told them about my 3 hour rule and we both laughed when we realized it had already been 4. Rules are made to be broken, I suppose. We have another date next week to check out the second building of the museum we didn’t get to catch this time.

My interview yesterday also went really well. It’s hard to tell with these things, but I was able to offer some specific suggestions on how they might improve and streamline some of their current software and processes. They seemed impressed, but I no longer get any hopes up for jobs or dates. Ha! I loved seeing the office, though. They had this gorgeous saltwater aquarium in their waiting area I could have watched for hours. The culture there seemed like a great fit for me, but again, who knows?!

I don’t really have a point to this post, but just wanted to share what I’ve been up to and the ridiculousness of life and my adorbz double chin and that I’m still here. Thank you so much for reading. I had hoped to get some content suggestions through a survey but didn’t get but one response. So please comment! And as always…

Rad Fatty Love to ALL,

<3
S

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Thursday, 25 January 2018