Friday, 17 August 2018

Active Jobs for Fat Bodies

Every Monday and Wednesday morning (though it used to be Fridays, too), I work up a sweat right after arriving to work. You see, I am an office manager for a tech startup in Silicon Valley. Part of my job is to ensure that our beverage fridge and snacks rack are fully stocked. I haul cases and cases of glass and plastic bottled beverages across two kitchens to fill the fridge at 8:30 am. I also keep our kitchens tidy and organized, surfaces clean and safe for food to be displayed and consumed. I run our food program which is a near impossible task when we have nearly 130 people insisting they only want “healthy” food options when the data shows me that they really just wanna load up on heavy proteins at lunch, and complaining about non-issues seems to be a competitive sport around the office.

I am easily the fattest individual here. I am also the queerest (as in the only non-heterosexual human at this particular location). Both of these facts are only slightly unsettling, but don’t typically bother me. I like my job, it’s different every day and presents limitless challenges and issues to untangle. I like startups because they are scrappy, like myself. I can use both my creative and analytical brains to accomplish a myriad of tasks and projects. I find this to be mostly fulfilling. I have no lofty aspirations or goals, I can’t even say that I’m terribly career minded. I know what I excel at what I can do, my experience is unparalleled, my professional reputation impeccable. This isn’t bragging, though. Manual labor is just as much a part of my job as event planing or security protocols. None of this is new to me what so ever.
Fat people often hold very physical jobs. Of the most physically demanding jobs in the U.S. most are held by people most folks would consider fat. This isn’t an anomaly, this is true as hell. Our heft and girth can assist in and protect us from our physical tasks and I would imagine sustain us, too, for the long haul. As the sweat is now mostly evaporated from my brow and neck and the chill of the air conditioner overhead has me reaching for my sweater, I can’t help but reflect on the minimal effort any employee here puts in to do anything at all in a physical way. Yet they will go on and on about their “Keto” this or “fasting” that, “clean” eating and protein shakes. *barf* It’s all bullshit and I know it is. It doesn’t mean they stop the toxic talk, though. I have had to put a few folks in their place whilst demonizing fat in front of me. “And what exactly is wrong with being fat?” I have said with determined and steady eye contact (intimidating no doubt). “What’s wrong with all of what I got going on?” as I gesture dramatically to my entire body.
They tell me it’s “unhealthy” to sit at a desk all day. Don’t I know it! But it’s not like that for me because I’m jumping up from my chair about 50-75 times a day to take care of these adult babies and their endless needs, wants, and complaints. It’s never boring! Ha-ha! I don’t mean to place a negative spin on my role or the people, really, but it is a mixed bag and I’m a very sarcastic human. Ha! I was just thinking this morning as people talked with me or were sharing space while I was sweating it out in the kitchen filling fridges, that it makes some uncomfortable. It’s almost as if they’d rather not know or see someone doing manual labor on their behalf, like only they benefit from it, so I get it, but also, they know me and have to interact me with me constantly. I have no doubt that most assume all the things about me due to my committed ownership of this fiiiiine fat body ‘o mine. They are wrong and it makes me laugh.
I once had a job as “Director of Happiness” for a startup (okay I’ve held that title twice), where my job was so physical, every single day, that I had to change the type of under garments I wore! I was just sweating so much it was uncomfortable (I’m not typically very sweaty, but who wouldn’t be hefting and hauling all day?!). At one point I even sprained my spine on the job. It was insane the amount of work and pressure on me in that place, but all of the vegans and juice cleansers weren’t ever trying to pitch in. So quick to shame or hate on fat folks, but you don’t see skinny-minnies doing these jobs! (JFC! Do NOT search google images for anything about fat people working or having a job! Your blood will boil!)
I love my body. I trust my body. My body has taken me places and allowed me to accomplish things no one thought possible, myself included. I may be forty, but I’m feisty as fuck with no intention of ever chilling out! Every fat roll and dimple has fired up its cells to allow me to move mountains by starting my own business from scratch, starting a fat positive event for the public, for dancing every year in the Big Moves show with my dance partner Tigress, to leave a waning marriage and to strike out on my own and rebuild a life of my own choosing and design. I have had struggles and injuries and hardships, but my body has been there and seen me through each and every phase of this wild ride called existence. I have no regrets!
Rad Fatty Love to ALL,


P.S. Check out and use the hashtag: #FatAndFree on Instagram & Facebook!

Check out the Fat AF podcast on your favorite podcast app for all things fat sex with me and my BFF, Michaela! (You can listen straight from the web, too!)

Donate to this blog here:

My blog’s Facebook page for things I share that aren’t on this blog (and updated daily): 

Or get the same “shared” content on Twitter: @NotBlueAtAll

Are you on MeWe? I started a fat-feminist group there called, Rad Fatties Unlimited, look for it!

I also have an Instagram, though I need to get back into posting there:

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.):

via I'm Not Blue at All

Thursday, 16 August 2018

Annual Big Moves Show: The Sweet Barre

Surrounded by fatness

This past weekend I had the privilege of being a guest performer in the annual Big Moves (dot org) dance show in Oakland, California. My dance partner, Tigress, and I have been performing in this show together for six years now. Every year is an emotional, and often physical, roller coaster. Luckily this year wasn’t so bad in the physical department and emotionally, well, I may write about it later but I’ve been pretty dead inside since March and it’s workin’ for me. *Shrugs* It was a great show, though! It always is. Just being backstage with these incredible performers has been such a gift and source of inspiration. As much as I do the show to give that feeling to others, I do it for myself as well.
In a world that tells me every second of every day that I am not worthy of love and empowerment, this show and the performers in it show me and remind me that isn’t so. Being surrounded by fellow fat activists is something I wish every fatty in the world could experience. Because you can just be yourself! You don’t have to defend or demand, there’s no need to hide or seclude yourself at all. Literally every person in the show already knows what all of those things feel like in a very real and visceral way.
Many of the people in the show I have known in some way or another for many years now. Performing in this show for the 6th year in a row is just mind blowing! Where did the time go?! Also, it still feels new. Okay, not all of it, but each performance is a new opportunity to show the world and more so the audience what fat bodies can do. Fat people can do anything! Period! Each year I look forward to the costumes and music and how it will all come together in the end and it’s all just a lovely organic process of a thing!
I don’t have much else to say about it, other than you should come next year! Or in October when they host their annual A Taste for Dance with a chocolate tasting/buffet! I sang in that show for the last two years…this year I am tempted to shoot for a solo dance number, but taking things one day at a time right now. You should still come! It is a special and wonderful show, each and every time! The powerful emotions you will experience are worth the ticket price alone! It is the most positive and empowering thing! But I digress…
So, here are some pics! Ha-ha!

I was really into this outfit and asked Tigress to snap a couple of pics for me.

Before the first performance!

Was trying to get a flirty-ish sneak peek sort of pic, oh well. 

Tigress ironed-on those letters backstage before dress rehearsal…You know you wanna buy one! 

Tigress’ costume was so effing cute!

C’mon! Amazing!

I wore this old af Eshakti dress for the curtain call the first night.


This was also Eshakti, 3 years old, a hi-low plaid dress that I’d only worn once. I wore for the curtain call at the second show.
You can see more of our costumes here:
More pics from the show:
We danced together to Jesse J’s “Queen” and if you haven’t heard it or watched the video, please don’t deprive yourself any longer! danced solo to “Bounce” By Calvin Harris Featuring Kelis:

Nope, we don’t have video of our dance number…you gotta buy a ticket to the show for that! Ha-ha!

I am eternally grateful to have access to the things that I do and the fat community here in the bay area. I am truly blessed to have such incredible humans in my life. When everything else in my life feels terrible, they make me feel like I matter, and that is a rare and special thing. To not only bare witness to their talents, skills, and beauty but to also share space, conversation and community with them is something I never could have even dreamed of. To share a stage, to be in the same fight, if you will, for fat liberation, is indescribably awesome and inspiring! Each of us individually prove that fat people can do anything, but together we are unstoppable!
Rad Fatty Love to ALL,


P.S. Check out and use the hashtag: #FatAndFree on Instagram & Facebook!

Check out the Fat AF podcast on your favorite podcast app for all things fat sex with me and my BFF, Michaela! (You can listen straight from the web, too!)

Donate to this blog here:

My blog’s Facebook page for things I share that aren’t on this blog (and updated daily): 

Or get the same “shared” content on Twitter: @NotBlueAtAll

Are you on MeWe? I started a fat-feminist group there called, Rad Fatties Unlimited, look for it!

I also have an Instagram, though I need to get back into posting there:

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.):

via I'm Not Blue at All

Wednesday, 15 August 2018

Alone, Not Lonely

I had not spent much time alone, like completely and with intention, until I was almost forty. Even at that point in my life, I can’t say it was with intention, at least at first. Now I seek it out with all of the intention in my very soul. It is a special sort of solace I didn’t truly think existed. I think it is a lost art form in some ways. I had read so many books on Buddhism, zen, feng shui, meditation, mindfulness, being present, and blah blah blah. I spent a good portion of my life seeking outside of myself what was always right there within me.

Image result for alone not lonely

Okay, that may sound very corny and all, but it’s also very true. I grew up with two siblings that I shared a room with. Even in the few years that I was an only child, my mother would often instruct me to go outside to play. Sure, as a child, I loved solo imagination time. I created epic dramas with my Barbies and stuffed animals. I imagined myself a Cinderella type of character and would build castles in the air about the day I would be saved. I concocted secret witches brews in my backyard with mud and leaves and bottle brush blossoms. All before the age of six. Ha-ha! Once I had a baby brother, though, everything changed. I was obsessed with him and he was (is) the sweetest lil’ bro a gal like me could have. (We have a younger sister, but we’ve never been as close.)
I spent so much of my childhood seeking joy and company outside of my house upon the instruction of my mother. When I was home I was care taking and tending to my two siblings (my mother being physically present but mentally incapable of managing). As I got older I spent even more time out of the house and with friends. I never questioned or thought about it or an alternative, it was just life.  Later it was boyfriends and housemates until it was just my husband and me.
When I left my marriage I stayed very close to my husband, in proximity as well as emotionally. We were still best friends. And he lived in the same apartment building as my actual bffs. My new roommate and I got to know each other over time and eventually became close. I was new to dating and had a new career path and everything seemed so new and exciting. Yet I didn’t know who I was or what I wanted in life, let alone where I felt I fit in this world.
At the time I had a very close bff with whom I would text every day and hang out at least once a week. They insisted time and again that I needed to be okay with my own company, that I should somehow force myself to be good with just me. That made no sense to me then, and really forcing anything is rarely a good choice. I struggled from time to time when plans canceled or a rough patch would pop up and I needed support. I would muddle through and not really give much thought outside of the issue at hand.
When I moved back to my home town and all of it’s awful triggers, and far from pretty much everyone I know and love, I was also out of work and still recovering from a spine injury. Isolation hit me like a ton of bricks. If I left the house I would get triggered and have a panic attack. If I stayed home I would feel stir crazy and start to climb the walls or consider self harm. It was maddening in a very real fucking way! PTSD is a terrible thing to live with, and I had gone so long without any symptoms that being faced with so much all at once lead to a complete mental breakdown.
I was applying to jobs everyday, interviewing constantly, and losing my fucking mind at the same time. I ended up being out of work for one year and one month to the day. Once I had a steady schedule, a job I excelled at, and a team that supported me, I felt more myself than ever before! I had been out of work for long stretches before, but never on my own. I had a boyfriend at the time who seemed supportive but it was only words, I would later find out. And while I have always had a great support system in my friends and chosen family, when everyone else is struggling as well, it just doesn’t seem right to ask of them too.
Image result for on my own
I realized during this vast stretch of time on my own that it was the first time in my life that I’d truly and deeply had been alone. I was forced to process and deal with things that I’d never confronted before. I had no roommate, except for my puggo, and no one within 20 miles for comfort or whining or whatever else I felt I needed at the time. It was also the beginning of the end of a 4-year and completely sexless relationship (yeah, that…it never happened, not even once). Unwilling to let go of that very last tether, I simply held on until I could right myself and find my footing in the world again.
Then I finally couldn’t continue to settle for a smaller and less satisfying life than I had set out for myself when I left my husband. I broke up with said boyfriend. It took me a month of processing and mourning the relationship before I did what I knew I needed to. And then they talked me into giving them a second chance, something I hadn’t done before. Let’s just say I won’t be doing it again, either. Ha! So then that was it. I was truly and completely alone…only stoked about it!
For the first time in my adult life I had no paramours or beau, no crushes and no prospects. For the first time I wasn’t chasing or being chased and it felt surprisingly great! I’d been dating (or married) non-stop since I was 12 years old (technically 11, but only by a week). I decided to just fucking chill, ya know? And I relished in it! I read more, I hung out with coworkers more, I just felt more relaxed within myself and more my true self than ever.
When I was wrongly fired from that job (long story), I thought I’d be fine. It didn’t seem as scary as before and yet things felt way worse sooner than I could have imagined. Luckily my friends, former coworkers, and fat community held me up and encouraged me a lot. I was only out of work for three months this time and yet it felt even more desperate than the year previous. I had no safety net, no (selfish) boyfriend, no savings, and for the first time at that point no credit card to fall back on. It was the realest form of alone ever. I freaked out a lot.
To make some room in my non-existent budget I gave up the one thing that had been helping my anxiety so much, cannabis. There were days and nights that bled together and had me literally climbing the walls of my tiny studio/in-law unit. My puggo is a great comfort, but he can’t do it all, ya know? So this was just the toughest of times, and then the holidays hit.
I had never felt more alone in my entire fucking life until that x-mas, early evening. My nearest and dearest were out of town, my family estranged. I dove head first into a terrible bottle of red wine (brand was Bitch with a fab label, but do not drink that shit, trust!). I drank the entire thing in under an hour. Have you ever tried to fucking chug red wine?! DO NOT! I was not kind to myself that night. It was an old self destructive habit that crept up and snatched me, I swear! I guess I was just desperate to numb the pain, but there’s many more layers to it than that.
After sleeping it off, I decidedly pulled myself together and cooked myself a damned x-mas dinner, at 9 pm. Ha-ha! It was actually hella good. It was a Trader Joe’s Thanksgiving Casserole, I highly recommend it if you catch it. I ate that thing for a week, but I digress. I sat with my thoughts while the casserole was in the oven. I didn’t have any screens or even music on. I just sat on my bed and took a deep and hard look at my situation and myself and the life I wanted. It was then that I realized that being single was just alright with me. I had tried to date off and on after the breakup, but just lost interest.
That week between x-mas and new year’s was more of that same soul searching kind of thing. I decided to double down and really go all in on my job hunting. I know what I am capable of. I know what I can and have accomplished. I reminded myself of this and so did my bffs. My PTSD symptoms didn’t pop up this go ’round and I hadn’t had a panic attack in over a year. When January hit I was in full force and how! WHEW! I interviewed every single weekday for a 5 weeks solid and I mean in person and phone interviews, usually back to back. It was intense and exhausting and terrible but I did it and I found a job that fit!
Image result for bitch wine
Having a job, especially one that I feel challenged and stimulated, needed and wanted, makes all the difference in the world. For my mental health especially! Without the usual workday schedule and social cues that go with it, I quite literally fall apart. Now that I’ve been at this job for 7 months, I feel pretty great! Still not dating, still no crushes. I have people who are interested in me like that, but one has become a friendship (thank goodness because they’re awesome just not a romantic match for me) and another who I just don’t even know what to do about (they text me “good morning beautiful” every single day, but we’ve only had 2 dates in 3 months). It’s fine. I am good on my own.
Something shifted in me a couple of weeks after starting my current job. I don’t know what and I don’t know how, it’s pretty tough to explain honestly. I tell my friends and joke about being dead inside but my lovely dance partner explained that it doesn’t seem that way to interact with me. Which is a relief but also just makes describing how I feel harder. Like, I don’t get as excited or upset about anything anymore. I feel things, but not most things. Prior to this happening I was considering seeking anti-depressants for the first time in my life, in the hopes of regaining my energy to do life things like housework and errands. Then when this change occurred it just felt like a relief in a way. Now I’m pretty darn comfortable with it. It’s better than feeling all the things or depressed or anxious all of the time.
I’m still me. I’m still fucking awesome. I’m just calmer, I guess. I rarely even cry anymore, which kind of sucks. A good cry can be very refreshing, even cleansing, or so the Victorians believed. There have been moments when this dead inside thing did make things hard as fuck. I had a conflict with a friend and there were tears and when they hugged me and were just sobbing into my shoulder, I felt nothing at all and it was hella awkward. Yes I said all the right things, but I’m certain it was weird for them, too.
A few people in my life have mentioned to me that I am much quieter than they have ever seen me before. What’s to say? *Shrugs* Seriously, though, maybe this is some sort of new coping mechanism since the world is almost literally and completely a dumpster fire at this point in time. Things were bad before I started this job and have only worsened, and yet I don’t feel nauseated every time I log into my social media accounts like I did then. Meh.
I still feel really good about being alone, though. I seek it out now! It’s odd and not at all what I would have expected had you told me this even last year! I enjoy my own company, I seek out new things on my own, and I ride my own melt. Life is good. It’s not great, but I’m grateful for every breath I get in this world. I have lost people I cared deeply for, some I didn’t know well, others I knew for decades. Cancer is an indiscriminate bastard! I was lucky enough to not lose my best friend to cancer, it was in their body, but it was removed entirely. I thank the stars above every day for that!
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I do feel as though I’m gaining some traction, as hard as things have been and seem at times. Stability is a wonderful thing if you can find it. I think I have minimized, ignored, pretended, and hid my mental breakdowns far more than I realized these last few years. I’m learning to be more open about it and face what happened in a very real way. Like, I know what my issues are, I know how to talk about them and do often, but being able to actually say, “Yeah, I have really struggled with my mental health for the last 3 years and have had a few breakdowns in that time.” is very new as in the last two weeks. It’s not that I wasn’t aware, but somehow saying the words felt like burdening others. Over that! Ha-ha!
Thank you for reading. I have such a deep longing to write on the regular again. I just don’t know how to get it back. I will keep trying and you have my undying gratitude for paying any attention to this silly ol’ blog o’ mine. **Hugs**
Rad Fatty Love to ALL,


P.S. Check out and use the hashtag: #FatAndFree on Instagram & Facebook!

Check out the Fat AF podcast on your favorite podcast app for all things fat sex with me and my BFF, Michaela! (You can listen straight from the web, too!)

Donate to this blog here:

My blog’s Facebook page for things I share that aren’t on this blog (and updated daily): 

Or get the same “shared” content on Twitter: @NotBlueAtAll

Are you on MeWe? I started a fat-feminist group there called, Rad Fatties Unlimited, look for it!

I also have an Instagram, though I need to get back into posting there:

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.):

**I’m in love with my new glasses from, they just arrived yesterday, but I’ve wanted them for over a year!

via I'm Not Blue at All

Sunday, 12 August 2018

The Turkey Awards: Obesity Eugenics via Fertility Treatment Denial

We've been talking about Obesity Eugenics, when authorities try to keep people of size from reproducing through negative media campaigns, scare tactics, risk hyperbole, apocryphal stories, push for normal BMI before conception, and pressure for sterilization or termination. This incredibly insensitive and discriminatory movement is the winner of not one, but two Turkey Awards. It's time to call out these egregious practices.

If you aren't familiar with them, the Turkey Awards are the "prizes" I hand out to highlight fat-phobic treatment of people of size from care providers, biased attitudes or studies from researchers, or troubling trends in the care of fat pregnant women these days.

Last year's Turkey Award was delayed so I'm doing two years in a row now. I've already done the first half; attention to the Obesity Eugenics Media Campaign. Now it's time to highlight the egregious lack of access to fertility treatment for people of size.

In past years, we've talked about:
We've already seen in the previous Turkey Award that many care providers believe that "obese" women have no business being pregnant. As a result, there has been a concerted public health campaign in recent years to reduce pregnancies in high BMI women. Today we talk about one of the most widely accepted and insidious ways the medical establishment promotes Obesity Eugenics ─ by denying access to fertility treatment.

Lack of Access to Fertility Treatment

Headline from The Hamilton Spectator, 2011
Denying access to fertility treatment via BMI restrictions is a widely-accepted practice in the medical community. It is driven by risk hyperbole, economics, and weight bias.
“Fat women only have babies because we can’t stop them; we’re certainly not going to help you conceive.” – Family Practice doctor to woman dealing with infertility
In many fertility clinics these days, women above a certain BMI are not permitted to access fertility treatments. In many clinics the cutoff is a BMI of 35, but in the U.K., the limit is usually a BMI of 30. Here is one story of a woman denied fertility treatment and pressured for bariatric surgery because of her weight.
The first thing out of the gynaecologist's mouth was “How much do you weigh”. 135kg [297 lbs]. “Do you realise how obese you are?” I then told her I have been working hard to lose weight through diet and exercise, thinking to cut her off before she got into her fat-bashing rant. As I explained that I had lost 15kg since January, was doing 90 minutes of cardio at the gym 5 times a week, and eating a low GI, low-fat, low-carb diet. She rolled her eyes at me in disbelief. Her reply was, “You are too fat for a baby. You need to get down to 65kg [143 lbs.] before I will help you”. At that point I should have stood up, told her to go f*** herself and walked out but I was stunned. I guess she took the stunned silence as agreement because then she whipped out the lapbanding pamphlet and told me I had to have weight loss surgery. 
Stories abound of women denied fertility treatment because of weight. One woman was told by her Reproductive Endocrinologist (RE):
Pregnancy is supposed to be beautiful and natural and it can be neither at your weight. I suggest you lose 100 pounds then come back.
Here is a story from the comments section of the defunct blog, My OB Said What?!?:
I...had an amazing RE last time, but she has since retired and the only one in town will not treat me due to my weight. He will not do any infertility treatment on you unless you have a BMI under 30!! Really? Because last time I got pregnant with injections and IUI [Intrauterine Insemination] I was 330!!! I had an amazing pregnancy and a healthy baby! Why is okay that...because I have a medical issue and disease I do not deserve to have children. UGH! I can’t even start on how this way of thinking pisses me off!!
Another woman in the same story wrote in the comments section:
We have a good ob/gyn...but we cannot find a reproductive endocrinologist who will even agree to see us.
BMI limits on fertility treatment is one of the most accepted ways doctors try to keep obese women from reproducing. It's another step on the path towards Obesity Eugenics.

The PCOS Conundrum

It's true that heavier women have higher rates of fertility problems. However, it's important to note that just because you are larger, it doesn't mean you will have trouble having a baby. Lots of plus-size women have babies without help. That includes me; I was told I would probably not conceive without fertility help, but conceived four children naturally with no problems. So don't just assume (or let your doctors tell you) that if you are fat you probably won't be able to have kids.

But it's important to acknowledge that some high BMI women do have more difficulty conceiving a pregnancy. Doctors often blame higher levels of estrogen, but the bottom line is that many fertility issues in women of size can be traced back to PolyCystic Ovarian Syndrome (PCOS), which leads to higher levels of estrogen.

In PCOS, women have a hormonal imbalance, probably because of underlying insulin resistance due to impaired insulin signaling. They have too much estrogen and testosterone, but not enough progesterone. As a result, the body ovulates sporadically, weakly, or sometimes only rarely. Ovarian follicles containing eggs either don't finish ovulating or ovulate only weakly. The ovarian cysts that are a byproduct of this process give off excess hormones, and can cause distressing symptoms like excess facial and body hair, thinning scalp hair, cystic acne, body tags, darkened skin around the back of the neck, armpits, etc. It also leads to reduced fertility.

In PCOS, the woman often experiences erratic menstrual cycles, which make it difficult to become pregnant. She may not ovulate regularly, or if she does, she may ovulate only weakly. If she does manage to conceive, she may have difficulty sustaining the pregnancy because of low levels of progesterone to support the the early weeks of pregnancy. In other words, the problem may be conceiving a pregnancy, or a high miscarriage rate afterwards, or both. While there are some women with PCOS who have the ovulatory phenotype and do not have problems conceiving (I'm one of these), many women with PCOS have fertility issues.

PCOS is one of the most common cause of fertility issues. Australian research suggests that up to 72% of women with PCOS have fertility issues, and PCOS often leads to long-term weight gain due to insulin resistance. While many people with PCOS are heavy, not all are, but the fertility effects of PCOS are independent of BMI. Thin women with PCOS experience fertility problems too, but they are able to access fertility help more easily than their heavier sisters.

There is an erroneous belief among some doctors that being fat or gaining weight can cause PCOS. This is an unproven assumption based on fatphobia and allows doctors to blame women with PCOS for their condition. It is far more likely to be the opposite ─ PCOS is most likely an inherited underlying metabolic condition that then triggers weight gain. One review states:
Familial aggregation of PCOS strongly supports a genetic susceptibility to this disorder.
Weight gain does tend to make PCOS symptoms worse, but it is likely the underlying condition that causes weight gain in the first place. Although it is not impossible to lose weight with PCOS, it is much harder. And not everyone who loses weight with PCOS finds that it helps their symptoms. Many people spend years yo-yo dieting because it is so difficult to lose weight with PCOS.

It is a cruel irony to then deny heavy women with PCOS access to fertility treatment. It is a double blow because they are the very ones who need help the most. It's simply a genetic condition that is inherited through no fault of their own, but they are being punished for that genetic inheritance.

Treatment Success Rates

Headline from The Globe and Mail, 2011
Many infertility doctors justify denying fertility treatment to obese people because they contend it is less likely to succeed at high BMIs, and the risk for complications if pregnancy occurs is too high. Let's take a look at these arguments and see if they hold up.

To be fair, there is considerable research that suggests lower rates of Assisted Reproductive Technology (ART) ) success in heavier women and a higher rate of miscarriage after fertility treatment, although not all studies agree. These results seem to confirm that health issues like PCOS play a strong role in infertility in obese women. But it doesn't mean that these women should be penalized for their genetic vulnerabilities.

It's probably true that a higher BMI has a generally lower success rate of fertility treatment to regulate menstrual cycles and help ovulation occur, but that doesn't always translate to actual live birth rates. When looking at live birth rates, some research has found very similar rates of ART success in obese women. One recent Israeli study found similar pregnancy and live-birth rates between all BMI groups and concluded:
The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF [In Vitro Fertilization] treatment denial.
When funds are limited, doctors argue that fertility treatment should be limited to those most likely to achieve a pregnancy. However, even when funds are available or people pay for their own treatment, many fertility doctors withhold treatment for people of size. It's not just about saving money.

Most tellingly, doctors do not deny fertility treatments to other groups (like older women) who may have lower success rates. Only obese people are penalized like this. 

This is a form of selective discrimination. If older women have access to fertility treatment, so should high BMI people.

What About Weight Loss Before Fertility Treatment?

Image from The Unnecessarean
One of the arguments for BMI limits in fertility treatment is that losing weight first improves outcomes. The British NHS Guidelines state that "most overweight women would only need to lose 5 to 10 per cent of their body weight before they would be able to conceive without needing treatment." The advantage of this is that it could save lots of money and increase success rates. However, the evidence is not so clear.

Some research does suggest higher rates of ovulation in obese women with PCOS who lose weight before fertility treatment. This is why many doctors require that high BMI people lose weight before treatment is permitted. They figure a low-cost intervention like this is worth trying before resorting to high-cost ones. That is a logical argument.

However, while weight loss may improve ovulation and pregnancy rates, does it really result in more babies? What is most important is the final outcome, i.e. live-birth rates. And not all studies agree that weight loss improves actual live-birth rates.2017 review found:
The existing data from randomized trials...have failed to document improved live-birth rates after the [weight loss] intervention compared with control groups.
A study in infertility clinics across several Nordic countries found statistically similar live birth rates among obese women (BMI 30-35) who were subjected to a very-low-calorie liquid diet for 3 months before In Vitro Fertilization (IVF). Another study found that an intensive weight loss intervention before IVF actually resulted in decreased IVF success.

An important 2016 study in the New England Journal of Medicine found that live birth rates were actually slightly better in the non-weight loss group that proceeded directly to fertility treatment than in the group subjected to a 6 month "lifestyle intervention" program (i.e. weight loss) before treatment:
...The primary outcome [live births] occurred in 27.1% of the women in the intervention [weight loss] group and 35.2% of those in the control group..In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization.
A follow-up of this study found that the lifestyle intervention in anovulatory women resulted in more spontaneous conceptions but made no difference in live birth rates.

The benefits of weight loss before fertility treatment are mixed. While some people of size do find increased success with spontaneous conception with a modest weight loss, other people of size do not. To blithely suggest that a 5-10% weight loss is all it takes to conceive is insensitive and unrealistic. It may help some; for others it may be a waste of valuable time. Weight loss can be offered to larger women if they are interested since it helps some achieve pregnancy, but the choice must be left up to them, not mandated.

Furthermore, time is a complicating issue. If women put off pregnancy to pursue weight loss, they are losing some of their most fertile years. It can take a long time to lose weight down to required BMI cutoffs. As one critic noted:
Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity...Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women.
Surveys suggest that very few women in their 30s are willing to delay seeking fertility treatment in order to pursue weight loss. They know that advancing age is a far more important risk factor than weight.

Others are unwilling to pursue weight loss because even a small loss often results in long-term weight gain rebound and they are unwilling to risk that, especially in pregnancy. A high drop-out rate in weight-loss-for-fertility programs is an additional problem, suggesting that many of these programs are not sustainable or practical.

As a result, there are some doctors who suggest an emphasis on good nutrition and exercise a few months before treatment is more effective than a weight loss emphasis.:
Lifestyle modifications, in particular a healthy diet and exercise during the 3-6 months before conception and during treatment, should result in better outcomes than requiring weight loss before fertility treatments.
This is compatible with a Health At Every Size® approach. Focus on lifestyle and habits, not the scale. Healthy habits are very important before pregnancy but they doesn't necessarily result in weight loss.

Perceived Risks of Obese Pregnancies

Headline from The National Post, 2016
Many fertility docs justify denying treatment to high BMI women because of the perceived risks of pregnancy at larger sizes. They are concerned that the risks of an Assisted Reproduction Technology pregnancy will magnify the risks of a high BMI pregnancy, creating an extremely unhealthy outcome. However, research shows that the two risks are generally not synergistic.

Some doctors believe that fat women are at SUCH high risk that they can't possibly have a healthy pregnancy or a healthy baby. While that's simply not true, it is a strongly held belief of many fertility doctors. Toronto fertility specialist Dr. Carl Laskin says:
“To me, it’s a medical issue. It is not a discrimination issue. [Obese] women are running risks in pregnancy, and if they’re running risks in pregnancy, why should you be helping them get pregnant?” Dr. Laskin has a BMI cut off of 35. “Mine is a brick wall,” he said. "Other clinics will go as high as 40. Some have no cut off."
Bill Ledger, a professor of Reproductive Medicine at Sheffield University in the U.K., reflects the extremism of some doctors' beliefs:
Doctors shouldn't be helping women have a pregnancy that's at a high risk of going horribly wrong. 
Many reproductive endocrinologists (REs) feel that "it would be unethical to help a fat woman get pregnant."  From a comment left on my blog in a past post:
I just went to a gynecologist this past week ...I was told, quite directly, that she would not and nor would any doctor in my HMO take me on since my BMI would make the pregnancy too high risk to myself and a fetus.
An article from 2016 has the doctor throwing down the Fat Death Card (if you get pregnant you'll probably die so we mustn't help you):
One woman recounted a fertility doctor telling her, “Gals your size, OK, mortality rates are higher. So I go ahead and intervene, help you get pregnant here. Then you go down to (a birthing ward). And then, boom! Pulmonary embolism.”
Again, this goes back to risk hyperbole. People of size are more at risk for blood clots, some of which can go to the lung (pulmonary embolism), and that is potentially lethal. But the actual incidence of such incidents is quite low. Furthermore the risk can be lowered with good care by using blood thinners when indicated, not doing cesareans unless truly needed, keeping women as mobile as possible all throughout pregnancy and afterwards, and increasing postpartum surveillance for blood clots in women at increased risk.

Furthermore, the argument about risk is a spurious argument because it is not applied equally. 

Doctors justify denying fertility treatment because women of size do have a higher rate of pregnancy and birth complications, but they weaken their argument by not applying it equitably:
...the objection is that it excludes a specific patient category on grounds that are not applied to treatment of others with comparable risks.
In other words, there are many other groups (like older women, people with certain medical conditions) that have similar or higher risks for complications but these groups are NOT denied access to fertility treatment. Only fatness is penalized in such an across-the-board way. As one review put it:
...a higher risk than the mean IVF population does not mean that it is irresponsible to take that risk. It is a question of proportionality: a higher risk can still be acceptable in light of the gain a woman can expect from treatment. Through the same reasoning IVF is thought acceptable in other women who are at increased risk of pregnancy complications because of medical conditions. Women with diabetes mellitus have an increased risk of hypertensive disorders and congenital abnormalities, macrosomia, stillbirth and premature labour...Diabetes mellitus is, however, not an exclusion criterion for fertility treatment.
Another recent review agreed:
Given that patients with, for example, diabetes or previous pre-eclampsia, who are at higher risks than many obese women, are allowed treatment on the basis of individualized and well-informed decision-making, we think there is no justification for taking a different line with regard to BMI.
Although fertility doctors like to pretend that denial of treatment is based on their concern for risks, they don't apply these rules equally among groups. The same standards are not applied to other women at higher risk for complications; only the obese are targeted. 

Research also shows that while some risks are increased in people of size, the increase in risk is moderate, and many women of size actually have perfectly healthy pregnancies and births. Furthermore, group statistics cannot predict any one person's outcome. Denying fertility treatment based only on weight limits or BMI means that many pregnancies that would have had normal and healthy outcomes will never occur.

Some experts refute the idea that BMI should be used as a surrogate for unacceptable risk levels:
Dr. Cheung plans to argue that studies also show IVF does not pose unacceptable risks for heavy women, and that BMI alone is not a good measure of which patients face the highest risks. Age, he said, is "by far the strongest indicator" of success and dangers.
An article highlighting the Canadian debate agrees:
But to Dr. Yoni Freedhoff, a specialist in weight control at the Ottawa Bariatric Medical Institute, that’s part of an “insidious” health care practice. 
“It would seem to me that this ‘you’re too fat to have IVF’ policy probably is in part started as patient safety, but ultimately it reflects weight bias,” he said. 
Freedhoff, who’s advised assisted reproduction patients needing to lose weight, doesn’t dispute that excess pounds can cause additional risks. What he doesn’t understand is why weight might exclude women from fertility treatment, but other factors that have been shown to adversely affect pregnancy — such as smoking or advanced age — are not perceived as equally damaging.
Ethics and Eugenics Questions

Headline from The Independent, 2018
Infuriatingly, in some areas, helping an obese woman with fertility is seen as malpractice and authorities forbid or strongly discourage allowing fertility docs to treat women of size. According to guidelines in the UK:
Fertility clinics should defer treating obese women until they have lost weight through dieting, exercise or surgery, according to guidelines published today. Under the recommendations, clinics are advised to begin treatment on severely overweight women only once they have reduced their body mass index (BMI) to below 35. Women under 37 years of age should reduce their weight further, to a BMI of less than 30, the guidelines state.
Here's a story from a woman in Australia:
I’ve been to two fertility specialists and neither of them will give us any fertility treatment until I have a BMI of under 35 (99kg). Nothing to do with my chances of getting pregnant; they say it’s an ethical matter, that obesity itself is enough of a health challenge for the body without adding the impact of pregnancy. Getting an obese woman pregnant would be seen as doing harm. The second OBGYN informed me it’s a state-wide guideline according to the Fertility Council which covers public & private health.
Although there are fertility docs out there who believe that it's wrong to deny fertility treatment to fat women, BMI restrictions are common in many fertility practices and some government healthcare.

In New Zealand, Australia, and Canada, there are guidelines in place/ being proposed to prevent women over a BMI of 35 from accessing fertility treatment. In the U.K., women under the age of 37 must have a BMI of no more than 30. In the U.S., guidelines are more individualized, but many clinics have policies in place that bar fertility treatment above a certain BMI, usually 35.

And now things are going even further. Some areas of the U.K. are proposing limiting fertility treatments to women whose male partners have a BMI over 30. The woman can have a "normal" BMI which would ordinarily get her IVF, but if her partner is fat, she doesn't qualify anymore. So not only can they deny treatment to fat women, but to fat men and any woman with a fat male partner.

Some fertility experts  recognize the major ethical problems with denying heavier people access to fertility treatment. An article about proposed BMI limitations on fertility treatment in Canada notes:
...It's ethically troubling," said the University of Manitoba's Arthur Schafer, director of the Centre for Professional and Applied Ethics. "In our society, the decision to procreate is left to the individual – so why would it be appropriate for the doctors to usurp those rights for women who are obese." 
Doctors would only be justified, he says, if they could "honestly, hand-on-heart say," that the safety risks are so great "that no reasonable fat woman would want to conceive a baby in this way." 
"I'm not sure the fertility industry or association can really defend a blanket exclusion on obese women having access to assisted reproduction."
Intersectional stigma applies here too. Another article from Australia notes that the impact of these policies is often discriminatory towards various racial groups and poorer people:
"They need to recognise that there's harm in doing nothing. Women who are unable to have children, there's a much higher risk of depression and anxiety and a doubling in the suicide rate. So doing nothing is not necessarily doing the best thing." 
The guidelines, he claims, can be classified as discrimination."Especially when you consider the low socio-economic group," he said. 
"The Indigenous patients have a lot higher incidents of obesity than the general population, so you're almost discriminating against those two disadvantaged groups in this particular policy. "Obviously that wasn't the original intent, but that is a potential end product of that."
Here is what one group of experts argues in response to the usual excuses for denying fertility treatment based on BMI (my emphasis):
Obesity is associated with a reduction in fertility treatment success and increased risks to mother and child. Therefore guidelines of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) suggest that a body mass index exceeding 35 kg/m2 should be an absolute contraindication to assisted fertility treatment such as in vitro fertilisation IVF. 
In this paper we challenge the ethical and scientific basis for such a ban. Livebirth rates for severely obese women are reduced by up to 30%, but this result is still far better than that observed for many older women who are allowed access to IVF. This prohibition is particularly unjust when IVF is the only treatment capable of producing a pregnancy, such as bilateral tubal blockage or severe male factor infertility. 
Furthermore, the absolute magnitude of risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment. We do not prohibit adults from engaging in dangerous sports, nor do we force parents to vaccinate their children, despite the risks. Similarly, we should not prohibit obese women from becoming parents because of increased risk to themselves or their child. 
Finally, prohibiting obese women's access to IVF to prevent potential harms such as 'fetal programing' is questionable, especially when compared to that child never being born at all. As such, we believe the RANZCOG ban on severely obese women's access to assisted reproductive treatment is unwarranted and should be revised.
Amen to that. Now if only the health authorities would listen. Unfortunately, they seem to be going in the opposite direction, getting more stringent in their weight-related restrictions, as seen in the U.K. limits on male partners too.


Headline from, 2017
A few brave medical professionals are speaking out about the discrimination happening in fertility treatment despite tremendous pressure from their colleagues. There have been a number of articles published recently in OB journals questioning the ethics of BMI restrictions but so far, none of the national guidelines have changed. And as noted in the U.K., things seem to have gotten even worse.

Bottom line, denying fat people access to fertility treatment is another form of keeping fat people from having children, but many doctors resist acknowledging the implications of these restrictions. They tell themselves they are protecting their patients with these guidelines. They tell themselves it's all about the risks, yet other groups with similar risks are not penalized. They refuse to acknowledge that they are infantilizing larger-bodied people and taking away their personal autonomy over crucial life decisions.

Authorities think that they are doing fat women a favor by insisting they lose weight before pregnancy, yet by insisting on such weight loss they deny women timely intervention when fertility treatments are most likely to succeed. The number of people who lose weight to a "normal" BMI and keep it off is quite small. When authorities insist on a much lower BMI as a requirement for treatment, they basically are keeping fat people from having children. Intentional or not, this is Eugenics.

Denial of treatment is based on weight bias, the assumption that all fat people voluntarily brought on their weight through poor health habits, sloth, and gluttony, and would perpetuate those bad habits to the next generation. Doctors assume that fatness is easily solved through altering health habits and exercising a little more willpower, but this argument does not hold up under scrutiny.

Research is very clear that most people are unable to lose weight and keep it off long-term, so denying treatment until someone reaches an "ideal BMI" or even a 5-10% reduction is unrealistic and delays fertility treatment until it may be too late. As some experts note;
Age trumps everything, so if your plan is going to make these women lose weight, the time that might take them if they’re older is going to be way more significant than any potential benefit in terms of weight loss.
Weight loss surgery does reduce BMI, but research shows significant trade-offs. There are reduced risks for gestational diabetes and large babies, but also increased risks of prematuritytoo-small babies, and possibly neonatal mortality. There are no easy answers here.

Potential health complications is a red herring argument. The underlying reason weight has been made an automatic disqualifier is because doctors see people of size as unfit parents who will create more fat people. Sure, there are some fat people who do have poor health habits but so do many thinner women, yet they are not kept from fertility treatment. If health habits were the main concern then EVERY patient should be screened for this and used as a barrier to treatment for all sizes, yet it's only targeted to obese people.

Furthermore, many fat people have medical causes for their weight such as Polycystic Ovarian Syndrome, lipedema, hypothyroidism, etc., and these conditions can impact fertility as well. To deny people with conditions like PCOS treatment is to penalize them for their genetics. People should not be punished for their genetic vulnerabilities.

People of size should be informed of the potential risks of pregnancy at larger sizes, but in a realistic way, not through scare tactics. People of ALL sizes should be encouraged to practice healthy habits and have great nutrition, and should be counseled about their individual risks. In most cases, though, the decision on whether to proceed with fertility treatment must be the person's. The government or a group of doctors has no business controlling whether or not a person has children. It infantilizes women and takes away personal autonomy to impose such rigid guidelines.

Denying fertility treatment based on weight basically keeps a whole group of people from having children and that's always a suspicious restriction that smacks of eugenics.

Those who would deny fertility treatment based on BMI are trying to be the gatekeepers of who are "allowed" to reproduce; this is another insidious form of eugenics and must STOP.


If you are experiencing fertility issues, here is a brief set of links to resources that might be helpful:

*The full list of references for this post are far too long to include. Instead, here are a few key references and quotes. The other references are scattered throughout the article and have links to the original sources and studies. 

Studies Critical of BMI Limits on Fertility Treatment

Should obese women's access to assisted fertility be limited? A scientific and ethical analysis. Tremellen et al. 2017 Aust N Z J Obstet Gynaecol
Quote: "The absolute magnitude of the risks to mother or child is relatively small, and while a woman has a right to be educated about these risks, she alone should be allowed to make a decision on proceeding with treatment...we should not prohibit obese women from becoming parents because of the increased risk to themselves or their child...."
Should access to fertility treatment be determined by female body mass index? Pandey et al., 2010 Human Reproduction.
Quote: "Restricting fertility treatment on the grounds of BMI would cause stigmatization and lead to inequity...Time lost and poor success of conventional weight loss strategies would jeopardize the chances of conception for many women."
It is not justified to reject fertility treatment based on body mass index. Koning et al., 2017. Human Reproduction Open.
Quote: "Given that patients with, for example, diabetes or previous pre-eclampsia, who are at higher risks than many obese women, are allowed treatment on the basis of individualized and well-informed decision-making, we think there is no justification for taking a different line with regard to BMI."
Should overweight or obese women be denied access to ART?: Comment by: Ahmed Badawy, Middle East Fertility Society Journal, 2013.
Quote: "Those who are choosing to postpone childbearing for the weight reduction should balance the negative effects of aging versus obesity on fertility and perinatal outcomes... there is no strong evidence for the association between obesity and live birth in infertile women. Thus, there is insufficient proof to refute women fertility treatment on grounds of BMI."
We need to stop discriminating against plus-size pregnant women. Raina Delisle, Today's Parent, 2017.

Women with obese male partners will be denied IVF treatment, rules NHS group. Tom Embury-Dennis. Independent, 2018.

Should high BMI be a reason for IVF treatment denial? Friedler et al., 2017 Gynecological Endocrinology 
Quote: "The results of our relatively large retrospective study did not demonstrate a significant impact of BMI on the ART cycle outcome. Therefore, BMI should not be a basis for IVF treatment denial."
Randomized Trial of a Lifestyle Program in Obese Infertile Women. Mutsaerts et al., 2016 New England Journal of Medicine
...The primary outcome [live birth rate] occurred in 27.1% of the women in the intervention [weight loss] group and 35.2% of those in the control group (rate ratio in the intervention group, 0.77; 95% confidence interval, 0.60 to 0.99). CONCLUSIONS: In obese infertile women, a lifestyle intervention preceding infertility treatment, as compared with prompt infertility treatment, did not result in higher rates of a vaginal birth of a healthy singleton at term within 24 months after randomization.
Mr. Fertility Authority, Tear Down That Weight Wall! Hum Reproduction 2016 Dec;31(12):2662-2664. Epub 2016 Oct 19. Legro RS1. PMID: 27798043  Full text here
Discussion of the 2016 NEJM study above and subsequent subanalysis. Quote: "The impression from these epidemiologic studies and the smaller interventional trials is that obese women are damned if they do lose weight prior to pregnancy and damned if they don't. As the LIFEstyle study indicates, dropout rates with lifestyle modification are high (20%), the average amount of weight lost is modest (4.4 kg) and most women will not achieve the targeted weight loss (62%). Furthermore, women who participate, regardless of age, initial BMI and ovulatory status, will experience cumulative lower rates of a healthy baby... pending further studies, these cumulative data suggest that weight limits used to deny women access to fertility care are not only arbitrary, but discriminatory, and clearly not evidence-based.

via The Well-Rounded Mama

Tuesday, 31 July 2018

This Is My “After” Body

Before AfterI’m in the gym on the spin bike doing pretty hardcore intervals. There’s a dude in the room who keeps waving at me and giving me thumbs ups. Whatever. He’s finished with his workout before me, he cleans his bike then walks over to me. I gird my loins (I’m honestly not even sure what that means, but I feel pretty sure it’s what I did.)

“I’m so proud of you!” he gushes. I roll my eyes, but he is undeterred. “We’ve all got to start somewhere right? You won’t be a before body forever, keep going like this and you’ll have that after body in no time!”

Insert record scratch noise.

The way he said it was so practiced that I immediately felt like this was not the first time a fat person had been subjected to this little diatribe. For that reason, I really felt like I needed to shut this all the way down in a way that would hopefully ensure that he never says it again.

“Don’t make guesses about people based on how they look. I’ve been an athlete all my life, played sports all through school, and as an adult I’ve done competitive ballroom dancing, marathons, and a triathlon. This IS my after body. ”

He kind of stammered “I’m sorry, I just…” and then I put up my hand and used one of my favorite phrases in situations like this:

“I’m going to stop you there. I’m sure that you meant well, but that matters less than the fact that you are operating on stereotypes and commenting about my body without any kind of invitation. Don’t do that.”

He apologized and walked away.

As I continued my workout (which he had interrupted with his unwelcome wild guesses about my abilities and goals) I started thinking about how often fat people are only seen as “before” pictures, and I realized just how much this is my “after” body.

After all the failed diets (which, had I bothered to read them at that time, every study about diets would have predicted.)

After trying to end the fatphobia I experienced by trying to become thin (even though I know better – since I would never have tried to end the homophobia I experienced by trying to become straight)

After giving so much of my time, energy, and money to the diet companies who make more and more money every year selling a “solution” that is such a failure that they are legally required to tell us that it doesn’t work every time they advertise it.

After learning not to care about the opinions of people whose opinions don’t matter.

After hating and blaming my body for refusing to conform to some manufactured stereotype of beauty.

After discovering Size Acceptance and Health at Every Size.

After using them to heal my relationships with food, movement, and my body.

After shutting down some dudebro in the gym who thought he had any right to talk about my body.

This is my before body.

This is my after body.

This is my only body, and I will love it, care for it, give it my full-throated support, and wield it as a beautiful, unbreakable weapon against fatphobia.

If you value my work, you can support my ability to do more of it with a one-time contribution or by becoming a member.

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via Dances With Fat