Tuesday, 30 August 2016

Mammograms: Getting Called Back for Additional Testing


At some point in a woman's life, she should start having regular mammograms. When she should do this is a matter of some controversy, but sooner or later, most women will have regular mammograms every year or two.

But what happens when you get a call back after your mammogram telling you that you need further imaging? What can you expect, and how likely is it that you will be diagnosed with breast cancer? How can you handle the anxiety while waiting for further results? Where can you get further support and information?

Earlier this year, this happened to me. I had my regular mammogram and got a call back telling me they had found two suspicious areas and I needed further testing. It was very unsettling. Even though intellectually you understand it's not an actual diagnosis of cancer, it feels like a sentence of doom. Your anxiety levels go through the roof.

Statistically, only a few women who get called back for additional testing after an "abnormal" mammogram result actually have cancer. Most are just fine, but many of those called back have fears about what additional testing entails.

Let's talk about what diagnostic mammograms are, what additional testing may be used, what to expect during the appointment, how to handle the waiting, and the latest screening guidelines. Then I'll share with you my diagnostic testing experience.

First Step: Don't Panic

Although it's deeply unnerving to get "the call" telling you to get more testing, the first step is to stay calm. Don't panic and start mentally going to worst-case scenarios. As one resource notes (my emphasis):
If doctors find something suspicious, they’ll call you back – usually within just 5 days – to take new pictures or get other tests. Getting that call can be scary, but a suspicious finding does not mean you have cancer. In fact, less than 10% of women called back for more tests are found to have breast cancer.
Although your mind will tend to automatically assume the worst, take a deep breath. Remind yourself that even when extra testing is required, you have a 90%+ chance of not having cancer. 

It's normal to cycle in and out of various "what-if" scenarios in the time before your diagnostic test, but the important thing is to focus as much as possible on the other business of your life. There's no need to panic when you don't know if there's something to actually panic over.

It's understandable to do some worrying, but don't let it consume you. Hard as it is, try not to focus on the uncertainty; let the future take care of itself. Focus instead on the everyday tasks of your life.

Screening vs. Diagnostic Mammograms

An important aid in avoiding panic is to remember that there is a major difference between a screening test and a diagnostic test.

A diagnostic test tells you for sure whether or not you have a certain condition. To get that kind of certainty, diagnostic tests are very involved, expensive, and time-consuming. Because of the time and expense, it simply does not make sense to order them for everyone.

Therefore, a simpler and less-expensive test is used on everyone ─ a screening test. Screening tests are designed to test a wide variety of asymptomatic individuals to look for problems that might need a closer look. These tests are slanted towards what's called "sensitivity" ─ a high chance of finding any existing problems ─ so as not to miss any potential disease. The trade-off is that many people (including many who don't have the disease) will require additional diagnostic testing, and that testing process can be unnerving.

Diagnostic testing looks specifically for disease or a high suspicion of disease. It is geared towards "specificity" ─ accuracy in ruling out disease. If something pops up on the screening test that is unusual or statistically outside of the norm, that person is called back in for further testing. [Of course, anyone with a distinct symptom of a disease goes straight to diagnostic testing.]

This arrangement of starting with a screening test and only going to a diagnostic test for a few people is a smart way to save time and money in an era of limited medical resources. But because most of the public doesn't understand the difference between a screening and diagnostic tests, many people automatically assume that a call-back means they likely have cancer. It doesn't.

Handling the Anxiety of Waiting

Even for people who understand screening vs. diagnostic testing, call-backs can still feel quite alarming. Human nature makes us emotionally jump to worst-case scenarios. That's why you have to keep reminding yourself not to panic. The best thing to do is simply to focus as much of your attention as possible on the tasks of everyday living and not dwell on the fear. Find ways to redirect your anxiety.

Of course, just telling yourself not to worry may be counterproductive; it may be easier instead to let yourself worry but to limit the amount of time spent on it. If you find yourself being taken over with worry, try writing down your worries, putting them into an envelope (physical or mental), and taking them out to indulge the worry only at specified times. When you do indulge the worries, let yourself do it in depth. Think of every worst-case scenario you can, weep and wail, write your good-bye letters, plan your funeral, etc. But then at the end of the specified time, stop and put those fears away until next time. By indulging your fears periodically, you lessen their emotional dominance the rest of the time. It's the rigidly suppressed fear that tends to multiply. Let yourself express your worries but it may help to put some limits on that expression.

Another thing that can help is to journal about why you are so worried. Do some stream-of-consciousness writing to explore your fears. Often the answers seem simple when you start, but the writing process helps uncover more subtle reasons that can give you insight. Journaling won't make the worry go away but understanding the true source of the anxiety may help diffuse its power so it is less emotionally overwhelming.

It's only natural to worry, but try to keep the worry in perspective, try to understand it, and find ways to deal with it that keep it from taking over your life. Soon you will have the answers that you need and can either relax or start developing a positive plan of action. If you need additional support, don't forget that many cancer organizations have 24 hour free phone lines for information and support.

Follow-Up Testing: What to Expect

When you return for follow-up testing, what can you expect?

Basically, plan to devote about half a day to the appointment, give or take. Remember not to wear any powder or lotions to the appointment. Bring a book to help occupy yourself while waiting. The appointment will take several hours and quite a bit of this will be waiting.

You will start by having a longer and more in-depth mammogram. More images will be taken, using more angles, so they can really focus in on the area in question. Although longer than a normal mammogram, this process is usually less than an hour. Don't be afraid to ask questions about the process; technicians are limited in what they can say (and obviously can't give a diagnosis), but often can offer insight into what is being looked at and why.

Next comes the ultrasound. Although not mandatory, most mammography centers also do an ultrasound of the breast during follow-up testing. This process is also around an hour and will examine closely any areas of concern on the breast as well as lymph nodes underneath the arm.

Sometimes an MRI is also done. This is not considered standard-of-care and may not be covered by insurance so it is not part of most routine follow-up testing at this time.

You will be asked to wait on site while a radiologist reviews the results. This can take an hour or two more, so be prepared to wait, but you should get the results that day. The results are usually one of the following:
  • The suspicious area turned out to be nothing to worry about and you can return to your regular mammogram schedule
  • The area is probably nothing to worry about, but you should have your next mammogram sooner than normal – usually in 4 to 6 months – to make sure it doesn’t change over time
  • Cancer was not ruled out and a biopsy is needed to tell for sure
Remember, even if a biopsy is recommended, chances are you still don't have cancer. Often biopsy results are benign. This is hard to remember when you are told you need a biopsy but it's important to keep reminding yourself of this fact.

There are different types of biopsies. Most are done with a needle but some need a small incision. Biopsy results have to be sent away for analysis, which can take anywhere from a few days to a week or two. The wait is difficult. Find some emotional support but don't forget to keep your focus on normalcy during daily life.

If your biopsy results are benign, ask the doctor whether any follow-up is needed and when your next mammogram should be. Get the results and recommendations in writing for future reference.

If your biopsy results show cancer, then it is time to consult a breast specialist. People often report difficulty in recalling the information given at these consultations, so take a knowledgeable and supportive friend or relative with you to the appointment. Ask to record the appointment so you can refer back to it later. Take notes (or have your support person take notes) and ask for correct spellings of any words you don't know so you can research it further. You can find a list of questions to ask here.

Don't be afraid to ask for a second opinion about your options. You can you get completely different advice from another care provider so it really is worthwhile to get a second (or even third) opinion. You can also call the American Cancer Society for information and support at 1-800-227-2345. Many additional online resources for support also exist; don't be afraid to reach out to them. Many women find it helpful to be paired with someone who has been through breast cancer themselves and is trained in offering support to newly-diagnosed patients.

Reminder of Screening Guidelines

With all the anxiety that a positive screening test can generate, it's no surprise that many women opt out of yearly mammograms. They simply don't want to deal with the anxiety it produces. Others are concerned about over-treatment for non-aggressive cancers, false-positives, and the cumulative effect of the radiation from many mammograms.

Yet we know that statistically, mammograms save lives, especially as women age. So when should women start getting mammograms?

Unfortunately, even the experts can't agree on how often women should have mammograms. Some organizations suggest regular screening start at 40, some suggest 45, some suggest waiting till 50.

Once you do start regular screening, some suggest that every 2 years is enough, while others strongly push yearly screening. It's hard to know what to do.

From cancer.net, Dr. Connie Lehmen gives a summary of the controversy over screening guidelines:
At an absolute minimum, women should begin screening mammography no later than age 50 and get a mammogram every 1 to 2 years until at least age 74. All medical organizations agree with these minimum recommendations for screening...The areas of disagreement, and reasons for differences in the recommendations from different groups, center around the age to begin screening (40, 45, or 50) and the interval of screening (every year or every 2 years). These variations are due to different groups of people who interpret clinical trial data differently.
Bottom line, when you start and how often you screen really depends on your risk factors. Recommendations will vary from woman to woman.

How does "obesity" figure into recommendations? That's harder because it's not always clear. We do know that high-BMI women are less likely to get regular mammograms or follow-ups after abnormal mammograms, which may partially explain why we tend to be diagnosed at more advanced stages of cancer. Yet there is only limited research and recommendations specifically on the trade-off of benefits and risks of screening in obese women at different ages.

As women of size, it is clear that we are at increased risk for post-menopausal cancer ─ but authorities often neglect to mention that we are generally at decreased risk for pre-menopausal breast cancer (except triple negative breast cancer). But when does that initially decreased risk cross over to increased risk? Is it a hard and fast conversion right at menopause, or a gradual increase of risk as you approach menopause? I don't think anyone really knows for sure.

That means it's particularly hard to know what mammogram schedule a woman of size should follow during that in-between time in the 40s when women are peri-menopausal.

The short version is that mammogram decisions then really seem to boil down to your other risk factors (especially family history, breast density, and blood sugar status) and becomes a personal choice you decide in consultation with your healthcare provider.

Personally, not having access to much family medical history and having had a lot of fibrocystic lumps, I had a number of mammograms in my 20s and 30s. In retrospect, I think we did too much. After a lot of research, I opted out of yearly mammograms in my 40s, but did have a couple to establish a baseline. Now that I am past 50 I think it sensible to get regular mammograms (about every year or two) because high-BMI women really are at increased risk for post-menopausal breast cancer.

I still don't love mammograms but have found a center where the care is more sensitive and gentle than I've experienced in the past. It's still anxiety-producing but regular mammograms seem a sensible precaution at my age.

But that's just my choice, based on my own circumstances. Yours may be completely different.

My Experience with Call-Back Testing

Needing a follow-up diagnostic mammogram really threw me. It just goes to show that having intellectual knowledge about a subject doesn't always have a lot to do with how you react to unsettling news.

Even though intellectually I knew that I probably didn't have cancer, I'm very good at "catastrophizing." It took quite a bit of effort to reel back my tendency to immediately go to the worst-case scenarios. Reading up about screening vs. diagnostic testing helped me scale back some of my fears. Education can be a powerful counter to fear.

When the anxiety elevated despite my reading, I made an effort to explore it. Obviously I was deeply concerned about leaving my children motherless, especially because I still have a young one at home. But upon further reflection, I realized that my fear was made worse by the fact that my husband had just been laid off. My big concern was that if I did have breast cancer, we'd run out of health insurance and I'd bankrupt the family and cause us to lose our house. We also have two kids in college, another in high school heading off to college soon, and the young one in private school; I was worried that my medical bills would derail their educations.

For me, handling the anxiety proactively while waiting needed multiple approaches. Research helped reassure my rational mind that I had a 90% chance of not having cancer. Emotionally, taking the time to explore why the fear was persistent helped me understand and diffuse a lot of its power. I was then better able to just focus on the everyday tasks instead of spending my days in constant fear.

In the end, I didn't have cancer, just some "asymmetrical lymph nodes" that the radiologist initially flagged but ultimately considered normal. I don't even have to go back for more frequent testing, just the normal screening.

Whew, what a relief! But oh, how difficult that waiting period is. Especially coming during a job layoff and time of great stress at my own work.

Sadly, there are no magical answers to getting through it; for me doing research and exploring my fears was vital in staying sane. In the end, though, it really boiled down to gritting my teeth and focusing on everyday tasks so I didn't go crazy.

It's totally normal to be anxious while waiting. But if that anxiety gets overwhelming, consider what is effective for you to deal with the worry. Consider developing some additional tools to help.

Has anyone else gone through a similar experience? What helped you get through the waiting period?


Resources


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The Horror of “Obesity Autopsy”

Bad DoctorYes, the BBC is airing the autopsy of a fat person. No, it’s not ok. I can see the meeting now, someone stands up and says “how can we create programming that plays on and sensationalizes the social stigma against fat people, makes no medical sense, helps no one, and does tremendous harm?”  And thus “Obesity Autopsy” was born, eclipsing “Sharknado” as possible the most ridiculous idea to get produced and aired but, of course, far more harmful.

Let’s start with the basics. They have flown the body of a 238 pound woman, who died in her sixties of heart disease and donated her body to science, from California 5,000 miles to London so that Mike Osborn, a consultant for the Royal College of Pathologists, and Carla Valentine, an assistant pathology technician can perform an autopsy which will first be aired as part of a one hour program on BBC Three, an online service focused on the youth demographic, and then on a late-night slot on either BBC One or Two. The program will also include a panel of “obese young contributors,” who will explore the causes of obesity, and how it affects their day-to-day lives.

Before I get into this, let’s remember that fat people have the right to live and thrive in fat bodies without shame, stigma, bullying, or oppression and it doesn’t matter why we’re fat, what the consequences of being fat may or may not be, and if we could – or even want to- become less fat or not fat. Any suggestion otherwise will be some combination of sizeist, ableist, and/or healthist. The rights to life, liberty, and the pursuit of happiness are not size (or health) dependent.

Now that we’ve got that crystal clear, let’s start with the many ways that this is medically unsound:

First of all, the idea that one can extrapolate information about all fat people from the autopsy of one fat person is patently ridiculous.  This is taking what I’ll call the “Dr. Oz Fallacy” (wherein he tried to claim that all fat people have bad hearts based on the fact that the fat people who had come to him for heart surgery had bad hearts – as if the thin people who came to him for heart surgery were actually fine…) to whole new lows.

The autopsy can’t even tell us everything about this woman’s body (let alone everything about all fat people’s bodies.) For example:

It can’t tell us about her genetics in terms of body size or heart issues. It cannot tell us if her autopsy results are due to her body size, or something else entirely.  The  entire premise is completely bereft logic and I absolutely question the ethics of the pathologist and the assistant pathology technician participating.

It can’t tell us how she was affected by the culture of fat hate (Peter Muennig’s studies have found that the diseases that are correlated with “obesity” are also correlated with the stress of constant stigma, and that women who feel they are too heavy have more physical and mental illnesses than women who are fine with their size, regardless of their size.)

It can’t tell us if she was affected by the chronic dieting (and subsequent weight cycling) that is almost never successful and yet is prescribed throughout our lives to fat people by our healthcare providers.

It can’t tell us if she was affected by taking extremely dangerous drugs that doctors suggest fat people should take for a very tiny chance to get thin, despite the risk of death (often from heart problems,) or if she was affected by the tendency to prescribe to fat people what we diagnose in thin people.

It can’t tell us if her actual health problems were ignored by doctors who prescribed manipulation of body size instead of the evidence-based interventions that a thin person with the same symptoms would have received. It also can’t tell us if she avoided the doctor  or delayed seeking treatment because of their tendency to substitute shame and diets for actual evidence-based care.

It cant’t tell us if her healthcare was compromised by the epidemic of fat bias among doctors.  It can’t tell us if doctors would have worked harder to save her if she was a thin person on the table.

What it can tell us is that instead of using this woman’s donation of her body to science to advance the care that fat people receive (for example giving future surgeons a chance to work on a fat cadaver rather than seeing their first fat body when they are working on it) they are exploiting her life and death. I can’t imagine how I, or my loved ones, would feel if I donated my body to science and instead it was used in a mockery of science for television ratings.  It is inexcusable, it is unjustifiable, it is disrespectful, it is wrong.

And for everything this autopsy won’t tell us about this woman, it tells us exponentially less about every other fat person. And the people behind this are so utterly ignorant about that, that it’s embarrassing.  According to the Telegraph (not linking because of headless fatty picture) “Damian Kavanagh, the controller of BBC Three, said young people needed to be shown the impact of unhealthy eating.”

Body size is not the same thing as “unhealthy eating.” Fat people have behaviors around eating (and everything else) as varied as any other group of people. Speaking of questionably drawn conclusions,  I’m concerned about a panel of “obese young contributors  exploring the causes of obesity, and how it affects their day-to-day lives.”

First I’m concerned with the effect on these panelists. Even if one believes that “determining the causes of obesity” is a noble pursuit, it should follow that the pursuit should be undertaken with scientific rigor, not by asking fat people (who live in a fatphobic society and get messages like the one from Damian Kavanagh that suggest that “obesity” is the same as “unhealthy eating”) to speculate wildly – even if they weren’t handpicked to agree with the stigmatizing premise of this show.

I’m also concerned that they are asking about the effects of obesity on these kids’ lives, when it’s so common to try to convince us to blame on body size what is actually the effect of fat stigma.

Not to mention that even if this autopsy could draw medically sound conclusions about fat people (and let’s be super clear that it cannot) that wouldn’t change the fact that fat people should be able to live without sizeist, healthist, ableist, stigma, nor would it change the fact that there is not a single study where more than a tiny fraction of people have maintained significant long term weight loss, so if the suggestion is that being smaller would make us healthier than it’s as useful as telling us that being taller would make us healthier.

This show is an abomination that can only serve to disrespect the dead and stereotype and stigmatize fat people, and it has no place on the air.

If you want to give feedback you can Send them your thoughts using their online form

If you want to get more information and community support around making sure that stuff like this stops happening, join us at the Fat Activism Conference:

THE FAT ACTIVISM CONFERENCE:
TOOLS FOR THE REVOLUTION! 

This year we have a kick ass line up of speakers talking about everything from Re-Imagining Fashion from an Inclusive Framework” to “Activism for the Introverted and Anxious” to “Building Fat Patient Power While Accessing Healthcare” and moreThis is a virtual conference so you can listen by phone or computer wherever you are, and you’ll receive recordings and transcripts of each talk so that you can listen/read on your own schedule.  We also offer a pay what you can afford option to make the conference accessible to everyone. The Conference will be held September 23-25, 2016

Click Here to Register!

Like this blog?  Here’s more cool stuff:

Check out the Body Confidence Blog Carnival! Eleven days of awesomeness

Like my work?  Want to help me keep doing it? Become a Member! For ten bucks a month you can support size diversity activism, help keep the blog ad free, and get deals from size positive businesses as a thank you.  Click here for details

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

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

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

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

 



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Monday, 29 August 2016

Our Spaces, Our Rules

This week there has been a rush of people on my social media who have been shocked , shocked I tell you, shocked and appalled, that I wouldn’t allow them to post anti-fat beliefs and diet talk, and that I deleted their comments. I’m surprised that they are surprised – I am responsible for the spaces that I create and I’m not going to allow people to turn them into a cesspool of anti-fat sentiments, concern trolling, and weight loss talk.

 

After I delete something something like “I’m allowed to diet if I want to, because [I want to fit into different clothes, I want to stop being treated poorly, I think it will make me healthier etc]!”is a common refrain, and an accurate one – people are allowed to do whatever they want with their bodies, whatever their reasons. “I’m allowed to [talk about my diet/express my disagreement and concern for your choices/say whatever I want] on your Facebook wall” is an inaccurate statement as it’s my wall and I get to decide what goes there.

As I’ve been deleting and, when necessary, blocking people I’ve been getting a lot of feedback from people who say that they are grateful that they know I moderate my space, and that they never realized that they could delete things they don’t want from their own social media and they are finding it really empowering. So I decided to repost this today as a reminder:

No matter how much we love our bodies, fat people face a lot of stigma for our size, and thinness confers tremendous benefit. I can understand the desire to try to solve social stigma through weight  loss, or to try to lose weight to solve the issues with getting clothing in our sizes, or buying into the idea that manipulation of body size is the path to health. People are allowed to do all of these things.

For my part I think it’s important for people to have access to information not paid for by the diet industry, including information regarding their odds of failure so that if their attempts fail it softens the self-esteem blow.  People are allowed to believe that manipulating their body size is the key to being healthy and feel that they need to lose weight for health reasons. I think they should have access to true and correct data about health and weight.  I don’t think that they are required to do any research or justify their choices in any way, I just think that they should have easy access to the information.

To me social change is more important than social approval.  I think that the cure for social stigma is to end stigma, not to insist that members of the stigmatized group change themselves.  In my experience when you try to change yourself to change the behavior of others or gain their approval, you soon find it’s never enough -there’s always something else that somebody wants you to change. If I was offered a pill that would make me into the perfect stereotypical beauty I wouldn’t take it. That doesn’t make me worse or better than those who make different choices. Our bodies – our choices.

People are allowed to want to, and try to, lose weight. However, where people get tripped up is in the belief that they should be allowed to talk about that in Fat Activist, Size Acceptance, and Health at Every Size spaces.  Nope nope nope. It is ok to have spaces that don’t allow diet or weight loss talk, it is ok to have 100% body positive spaces, it’s ok to have a policy of “absolutely no diet talk” or “absolutely no negative body talk.”  The spaces that we create – be they our homes, blogs, Facebook Pages, Twitter, Youtube, Instagram, Snapchat or other social media – are ours.  They exist because we created them and we have every right in the world to moderate them.

I notice that often bullies are still using every schoolyard bullying technique that exists to try to question our right to moderate our own spaces.  From calling us “chicken,” to creating some twisted logic, to trying to make us believe that allowing them to bully us is somehow our obligation.  We get bombarded by negative messages about our bodies every single day, and we have every right to create spaces that support us and our choices, even if that means excluding people who want to be in those spaces but refuse to respect the rules of the space, regardless of their reasons or even if they have “good intentions.”  Our bodies, our choices.  Our spaces, our rules.

THE FAT ACTIVISM CONFERENCE:
TOOLS FOR THE REVOLUTION! 

This year we have a kick ass line up of speakers talking about everything from Re-Imagining Fashion from an Inclusive Framework” to “Activism for the Introverted and Anxious” to “Building Fat Patient Power While Accessing Healthcare” and moreThis is a virtual conference so you can listen by phone or computer wherever you are, and you’ll receive recordings and transcripts of each talk so that you can listen/read on your own schedule.  We also offer a pay what you can afford option to make the conference accessible to everyone. The Conference will be held September 23-25, 2016

Click Here to Register!

Like this blog?  Here’s more cool stuff:

Check out the Body Confidence Blog Carnival! Eleven days of awesomeness

Like my work?  Want to help me keep doing it? Become a Member! For ten bucks a month you can support size diversity activism, help keep the blog ad free, 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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Saturday, 27 August 2016

Dine in Los Angeles Style at Ford’s Filling Station

This is a sponsored post written by me on behalf of JW Marriott Los Angeles L.A. Live. All opinions are 100% mine. Friends! You’ve GOT to try Ford’s Filling Station at the J.W. Marriott...

Read more here!

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Friday, 26 August 2016

5 Steps to Craft the Life of Your Dreams

This shop has been compensated by Collective Bias, Inc. and its advertiser. All opinions are mine alone. #StoKColdBrew #CollectiveBias Friends! I have an amazing inspiring post in store for you that...

Read more here!

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Thursday, 25 August 2016

Exhibit A: Why I Hate Wife-n-mommy Culture 

I will, soon enough, be writing a whole bunch of posts as to why I hate what I term the wifenmummie (or wife-n-mommy) culture. I don’t have the energy to tackle that task right now, but I will give you an example of why I find it so outrageous. I was browsing my timeline on […]

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Shipwreck on Lesbo Island

You don’t get to puff yourself up that you’re building the future, then crow about choice when people challenge you on the future you’re building. I guess that’s as good a place to start as any. Saye Bennett wrote on her blog that she is “still skeptical” on the topic of bisexuality. Well, the post, […]

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Monday, 22 August 2016

Gym Fat Shames, Activists Shut It Down

WTF are you doingUsing the corporate logo, a Gold’s Gym franchise in Egypt posted a picture of a pear with the caption “This is no shape for a girl” to their Facebook page. There was an immediate backlash, which led to a bizarre non-apology apology that looks like it was written by Donald Trump’s full time “Apologizing for Stunningly Offensive Stuff” Team.

In my article for Ravishly I talk about the entire situation, including the franchises awful apology and corporate’s much better apology (thanks to the work of activists,) and the culture that created this and will keep creating situations like it until we fix it. You can check it out here:

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THE FAT ACTIVISM CONFERENCE:
TOOLS FOR THE REVOLUTION! 

This year we have a kick ass line up of speakers talking about everything from Re-Imagining Fashion from an Inclusive Framework” to “Activism for the Introverted and Anxious” to “Building Fat Patient Power While Accessing Healthcare” and moreThis is a virtual conference so you can listen by phone or computer wherever you are, and you’ll receive recordings and transcripts of each talk so that you can listen/read on your own schedule.  We also offer a pay what you can afford option to make the conference accessible to everyone. The Conference will be held September 23-25, 2016

Click Here to Register!

Like this blog?  Here’s more cool stuff:

Check out the Body Confidence Blog Carnival! Eleven days of awesomeness

Like my work?  Want to help me keep doing it? Become a Member! For ten bucks a month you can support size diversity activism, help keep the blog ad free, 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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Saturday, 20 August 2016

Those Trump Statues

Trump Statue ResponseAn organization called Indecline installed nude Trump statues in cities around the country, including New York, San Francisco, Los Angeles, Cleveland and Seattle. The statues show Trump as fatter than he is, with a “very small” penis, and no testicles.

There has been a lot of controversy about whether or not it’s ok, since Trump is so terrible, to revel in the shaming of him that these statutes are intended to create. I’ve received hundreds of requests asking what I think about it. I have very strong feelings about this, and I want to be clear that, as always, I can only speak for myself.

Let’s start with the fact that I am adamantly against fat shaming, body shaming (including genital shaming,) and transphobia. It therefore follows, for me, that I don’t want to participate in fat shaming, body shaming (including genital shaming) or transphobia.

That being the case, no matter how much I hate Trump’s behaviors and beliefs, no matter how much I’d like to take every opportunity to hate him, I have to be honest with myself that these statues (from premise, to installation, to the behavior around him) are fat shaming, body shaming (including genital shaming,) and transphobic as hell.

But don’t take my word for it, let’s look at what the artist has to say about them (and the criteria he was given) for this piece called “The Emperor Has No Balls.”

The criteria was he had to be naked, they wanted it to be pretty life-like, they wanted him to be chubbier than he is in real life, not that we were fat shaming him in anyway, you know he’s not that fat, and I’m not a skinny guy. He had to be in a regal, presidential stance. He had to have absolutely no testicles, and he had to have a very small manhood. There were a couple little things I personally put my artistic twist into and that was the saggy man bum, I was very proud of that ass, and the mason ring.

Explain to me why, if you’re not fat shaming him in any way, making him “chubbier than he is in real life” was part of the criteria? If you’re not fat shaming him in any way, why is this guy so proud of making his ass “saggy”?

Let’s move on to the blatant transphobia and cissexism: Not all men have testicles or penises. The existence and/or size of testicles and penises don’t define men or manhood, and the size of them should never be used to shame anyone – not outright, and not as a metaphor, not in any way. Not ever.

And how about misogyny? Not all emperors are, or should be, men, and sex organs should have absolutely nothing to do with who is qualified to be a political leader.

There are people who look very much like that statue.  If I shame the statues, I shame those people as well and I model to other people that they should do the same.

The cyber bullies and harassers who attack me and others often use the excuse that we deserve it because they disagree with us.  If I suggest that it’s ok to shame Trump for his appearance because I disagree with his views, I am making the same argument as internet trolls (certainly not the kind of company I want to be in) and I am lending legitimacy to that totally bullshit argument.

I cannot credibly make an argument that fat shaming, appearance shaming, misogyny, and transphobia are wrong…unless it’s in the service of ridiculing someone I don’t like, and then it’s totally fine and should be encouraged.

From my perspective there is nothing, absolutely nothing, that Trump could do that would make it ok for me to shame him for his size, his appearance, or his genitals.

Maybe his privilege protects him from the worst of it, but it doesn’t protect the people who I hurt by taking part in this, nor does it protect me from the reality of being a hypocrite, and that’s exactly what I feel I would be if I participated in this – I can only imagine my complete outrage if someone did something similar to Hillary Clinton.

To be perfectly clear, I’ve definitely taken part in this kind of snarky shaming behavior in the past, it’s entirely possible that I’ll make them again.  I can only realize and admit my mistakes, and try to do better moving forward.

There are so many things to criticize about Donald Trump – he is a racist, xenophobic, Islamophobic, misogynist, anti-queer, anti-trans liar who actively incites violence and hatred in an attempt to gain attention and power. How is that not enough to criticize?  What the hell does it matter how big his dick is?  Who cares how he looks?

Even if it wasn’t hurtful to others (and I know that it is, because people are saying so,) why would I want to cheapen my arguments against him by participating in body shaming? Why would I want to distract from the actual horror of a human being that he is, and the nightmare that his Presidency would be, to engage in the very behavior that I speak out against every day. Why would I want to take the chance of making him into a sympathetic figure?

It’s Say Something Sunday, so I’m taking this opportunity to say, as clearly as I know how, that I am against fat shaming, body shaming, and transphobia. No fat shaming.  No body shaming. No transphobia.  Not even once.  Not even Trump.

THE FAT ACTIVISM CONFERENCE:
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This year we have a kick ass line up of speakers talking about everything from Re-Imagining Fashion from an Inclusive Framework” to “Activism for the Introverted and Anxious” to “Building Fat Patient Power While Accessing Healthcare” and moreThis is a virtual conference so you can listen by phone or computer wherever you are, and you’ll receive recordings and transcripts of each talk so that you can listen/read on your own schedule.  We also offer a pay what you can afford option to make the conference accessible to everyone. The Conference will be held September 23-25, 2016

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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!

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Ban the Burqa: How Men Ruin Stuff

So talk of the town is that France is once again banning the Burqa, or more specifically the burkini swimsuit, from public spaces. Supposedly it liberates women, condemns terrorism, and promotes French culture…or something. Yeah, I don’t get it either. My obligatory list of disclaimers: Countries have the right to control their borders and to […]

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Thursday, 18 August 2016

In Defense of Leopard Print – a Piece by Sonya Krzywoszyja

I’m not one to listen to much style advice, whether it is for clothing, makeup or accessories. I’m a relatively conservative dresser, although I can’t resist a sequin from time to time and have a deep, unchanging love of leopard print. I consider it a neutral.

I’ve often heard that people consider leopard print too “old” (which I don’t even get) or too “tacky” to be worn. Frankly, I aim to embrace the tacky and the tacky fab, and have even converted my younger sister to “cheetah girl” prints.

I wonder where this idea of leopard print being tacky, trashy and cheap came about. Characters on tv shows that are often seen wearing leopard print are usually represented as brash, over the top and loud women. Think Peggy Bundy, Fran Fine, Dolly Parton – huge hair, heaps of makeup and stiletto heels … But I don’t see a problem with having any of those character traits or looking anything like any of those three women. I kind of aspire to be like that. It’s vastly different from the anxiety-ridden, shy person I am.

Why is this look seen as “cheap” when another look isn’t? When in reality, as the divine Ms Parton has said:

It costs a lot of money to look this cheap.

Hello, awesome.

I don’t think that when women turn a certain age, they should immediately only wear dark colours, slimming outfits and cut their hair short. Sensible shoes, a string of pearls? Hey, if that’s the look you like, then go for it. But I don’t believe that once you hit some magic number, every previous style of clothing you loved has to be thrown out or given to Lifeline and you have to go out and buy an entirely different, “suitable” wardrobe.

“Mutton dressed as lamb” is a horrible, sexist statement. It invokes a desperate older woman trying frantically to hold onto her youth. Is there even a male equivalent? Maybe the old Lothario in the sports car with the chest hair and fake tan. But these men are seen with a least a degree of affection, the women are viewed with scorn and pity.

Why do we have to tone it down? Who says? Growing up is not the same as growing old. Some of my favourite style icons are/were older, louder women. Anna Piaggi. Isabella Blow. Every person on Advanced Style. I wish I could be that don’t-give-a-fuck right now. I hope by the time I’m the age of most of these women, I will be.


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Rules are Made to be Broken – A Piece by Sonya Krzywoszyja

fashion police

My friend recently wore a cropped top out. IN PUBLIC. And she didn’t get stared at. She didn’t get ridiculed. I was recently in Sydney and wore leggings as pants. IN PUBLIC. And I didn’t get stared at, I didn’t get ridiculed.

Ok, granted, my leggings as pants had a longish top over them and I only wore them to grab some stuff from the shop, but it felt, as silly as it sounds, like a radical moment.

Women are taught to follow the “rules” of fashion. No white on the bottom half,, no horizontal stripes, heels with longer skirts, show one piece of skin, not all of your skin, bright lipstick should be a night time thing, etc etc etc. Fat women have to follow these rules as well, but they are also told they cannot wear the same type of clothing as slimmer women can – no crop tops, no leggings, nothing tight, no short hair (you must hide that double chin after all), etc etc etc.

When women break the fashion “rules” it can be seen as revolutionary. It is seen as a “screw you” to the dominant thinking of the fashion industry and the society influenced by that industry. Yeah, it might not change the world, but I think challenging people’s perceptions and preconceived notions of a woman’s body and the way it is clothed is no mean feat.

So, whenever I see a woman or someone who identifies as a woman flouting these rules and openly challenging the status quo, I give a little internal high five. Or a real life high five if I know them in person!


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Feminist, Fat and Fabulous: Dare – A Piece by Sonya Krzywoszyja

This fat woman has always tried to take up as little space as she could. She has tried not to draw attention to herself, good, bad or indifferent. She dressed in dark colours, she hunched her shoulders, she sucked in her stomach. This might have gone on indefinitely if it wasn’t for this fat woman making fat friends. Who taught her that she had a right to take up the space she inhabited, she had a right to wear whatever the hell she wanted, she had a right to walk tall and straight. She had a right to breathe.

Women in general try and take up as little space as possible. We’re taught we have to be good and meek and ladylike. We have to phrase everything we say as a question, just in case we’re wrong or if people disagree with us. We’re expected to cry if things don’t go our own way, or because the sky is blue. We’re looked at with disdain, but no surprise if we do happen to cry for some reason. If a woman draws attention to herself in some way, people shake their heads, they judge, they stare, they snicker.

I feel like this is doubled when the woman is a fat woman. How dare they be happy? How dare they eat? How dare they exercise? How dare they wear those leggings?

I dare.


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"Safe" Gestational Weight Loss?

Graphic from this misleading article. The article addresses
improving diet and exercise in pregnancy but doesn't mention any
of the studies that show risks associated with weight loss in pregnancy
While researching another post, I was angered to see that some providers ─ and media outlets ─ are still worshiping at the altar of weight loss in pregnancy for "obese" pregnant women.

Augh! I can't believe this is still being promoted, even after a number of studies suggesting there are risks to gestational weight loss.

I know, I know. Many care providers hope weight loss in pregnancy is the magical pill to automatically improve pregnancy outcomes in women of size and leave them forever skinnier afterwards. They see it as a theoretical win-win. But it just doesn't happen this way ─ and it is associated with significant risks. That is not a win-win situation.

Too many authors extol the possible benefits of gestational weight loss (GWL) while significantly downplaying or completely ignoring the possible risks.

I find this incredibly frustrating and irresponsible.

Ignoring the Evidence for Harm

In the article accompanying the graphic above, for example, the author never addresses the potential risks of losing weight during pregnancy. A fair and balanced article ought to look at both benefits and risks, but it doesn't.

The article suggests improving diet and exercise in pregnancy and notes some potential benefits from that. I don't have a problem with promoting good habits and agree that sometimes this may prevent certain complications, but the article makes the typical biased assumption that all fat women have terrible habits. This promotes the stereotype of the gluttonous obese person, which just doesn't match the life experience of the many fat people who have normal habits. So the article is problematic already for its automatic assumptions.

More importantly, the author never mentions any of the studies which have found risks associated with gestational weight loss. This is intellectually dishonest and shows an obvious agenda. The author implies that it's perfectly safe to lose weight in pregnancy, even though the issue of safety was not actually addressed in the article.

So what does the research say?

Over and over again, researchers have found that weight loss in pregnancy is associated with too-small babies and possibly prematurity.

In one study highlighted below, for example, "overweight" and "obese" women who had been diagnosed with gestational diabetes were enrolled in the California Diabetes and Pregnancy Program. Those who lost weight were compared with those who did not. 

The authors found that gestational weight loss was associated with some problematic outcomes, including more Small-for-Gestational-Age (SGA) babies and more premature babies. But this study is not the only one to find risks with Gestational Weight Loss (GWL). Here are a few more that have also found problems:
  • Bodnar 2010 - GWL increased risk for SGA and preterm births among obese women
  • Bayerlein 2011 - GWL increased risk for SGA and preterm births in all but class III obese women
  • Blomberg 2011 - GWL increased risk for SGA even among class III obese women
  • Catalano 2014 - GWL more than doubled the risk for SGA among obese women
  • Cox Bauer 2016 - GWL doubled the risk for low birth weight babies
As a result, one recent meta-analysis concluded:
GWL should not be advocated in general for obese women.
Yet there are still far too many doctors, midwives, and media articles promoting just that.

An Acceptable Trade-Off of Risks?

Critics will point out that gestational weight loss has benefits that off-set the increased risk of SGA and prematurity. For example, in the California Diabetes and Pregnancy Program study above, women who lost weight during the study experienced decreased risks for a big baby (macrosomia or LGA), cesarean sections, and NICU (Neonatal Intensive Care Unit) admission. The authors felt that this trade-off was good enough reason to promote continued inquiry into gestational weight loss, despite the increased risks for SGA and premature babies.

But these arguments have a huge fault in them ─ ignoring iatrogenic (physician-caused) variables. For example, when doctors see a large woman with a larger weight gain, they fear macrosomia and shoulder dystocia. As a result, they may disproportionately induce those who gained more weight and have a low surgical threshold for cesareans in this group. Thus, a higher cesarean rate in this group be more a reflection of their doctors' fears and intervention levels rather than an actual causal effect a larger gain.

Furthermore, a higher induction rate could also explain increased NICU admissions in this group, since induction places increased stress on the baby. Also, bigger babies receive more surveillance for possible low blood sugar, which often entails a trip to the NICU. So while the increased NICU admissions in the weight gain group cannot be dismissed, it may also simply be a surrogate marker for increased interventions in this group.

Only fetal size is directly linked to weight gain in pregnancy. Very high gains lead to bigger babies on average, and avoiding very high gains is probably a good idea. However, that doesn't mean that pressuring women to lose weight in pregnancy is better.

SGA has serious potential consequences, yet this is shrugged off as being fairly unimportant by many researchers. They feel it is worth the trade-off for fewer big babies. Culturally, big babies are the ultimate "boogeyman" in the obstetric world these days because OBs are often sued for birth injuries caused by shoulder dystocia. Yet drugging women, forcing them to birth on their backs in immobile positions, and rushing the baby out too quickly have a lot to do with shoulder dystocia and birth injuries. How sad that doctors would rather risk more SGA babies than learn how to deal more effectively with big babies.

I am alarmed at the number of care providers and researchers who consider SGA and prematurity a "minor" matter and a worthwhile trade-off.

SGA and prematurity are significant concerns for babies because they are at increased risk for fetal death, sudden infant deathcognitive delay, and poor neurodevelopmental outcomes.

SGA babies also tend to have more significant downstream health effects like metabolic disease, including insulin resistance, diabetesmetabolic syndrome, and cardiovascular disease. SGA and growth-restricted babies face life-long health risks.

It doesn't end there. SGA babies are clearly at increased risk for stillbirth. And there is now research shows that SGA babies of obese women are at particular risk for stillbirth. Stillbirth!

Additionally, recent research shows that obese women with gestational weight loss had higher risks of infant death after birth.

Yes, macrosomia has risks too, like higher rates of shoulder dystocia and birth injuries, and possibly higher cesarean rates.

However, some research suggests that SGA babies are worse off than LGA babies. And having a bigger baby on average may be nature's way of protecting the babies of high-BMI women, since stillbirth risks are lower among LGA babies than among SGA or average-sized babies in obese women.

Personally, if I had to choose, I'd rather gain a little more weight and risk a bigger baby than to lose weight and risk an unhealthily-small baby, putting it at risk for possible stillbirth or life-long health problems.

Yet researchers continue to shrug off SGA as a minor thing. The author of one study on limiting weight gain in obese women said, "What conclusions you draw depends on how you value the adverse effects." In other words, is a decrease in cesareans and big babies worth an increase in unhealthily-small babies?

I say NO. SGA babies need to be taken far more seriously as a downside to very low weight gains and weight loss in pregnancy, even if the price is a few more big babies or possibly even a few cesareans.

Or better yet, care providers could learn how to attend the birth of a big baby more safely.

The best route to improve outcome may be to address fears and intervention levels around big babies rather than to make all fat women lose weight in pregnancy and risk too-small babies.

Take-Away Messages

Messages like this are irresponsible and need to stop
Websites that promote weight loss during pregnancy still abound in the media, and articles are still being published that say that weight loss in pregnancy is "safe" (I refuse to link to them).

And some doctors are still advising overweight and obese women to lose weight during pregnancy. Dr. Thomas Myles, a professor of obstetrics and gynecology at Saint Louis University School of Medicine, said in one article, "I usually tell my [obese] patients that gaining less than 10 pounds and even losing up to 10 pounds is appropriate."

Doctors and the media need to stop promoting weight loss in pregnancy for obese women. 

We've talked about this extensively before but despite the studies showing risks, the media and many providers keep promoting it. This is potentially dangerous.
Yes, some women of size naturally lose weight in pregnancy or gain very little. As long as they are not restricting calories to lose weight, have good overall nutrition, and their babies show normal growth curves, their outcomes are usually fine. I'm not worried about women who lose a little weight incidentally. Sometimes that happens in larger women and it's not a big deal.

Nor am I worried about care providers encouraging good basic nutrition principles and regular exercise in women (although I think they should do that for all women and not just fat women). Good nutrition is a basic and ALL pregnant women should be encouraged to work on it, though I would challenge providers to find a way to talk to their clients about nutrition and weight gain without condescension, moralizing, and automatic assumptions.

What I am deeply worried about is encouragement for women of size to intentionally lose weight in pregnancy, and the dangerous nutritional advice that is being given to some obese women in order to promote this dubious goal. 

For example, one doctor told his patient to "lose 1-2 lbs/week for the remaining 7 weeks of pregnancy...He suggests 1000 calories/day and 1 hour of heavy cardio exercise." Others have been told that they should lose 40 lbs. while pregnant, or that the baby will get all it needs from fat reserves so it's okay to lose weight. A few care providers are telling obese women to cut out entire food groups ("never eat carbs" or "cut out all fruit"), to go on SlimFast shakes, or to "eat nothing but vegetables" in order to limit weight gain.

Although most doctors are not this extreme, some women are being pressured into some dangerous nutritional stuff, all in the name of gestational weight loss. And women are being pressured into more interventions (like unnecessary inductions and planned cesareans) if they gain above what their care providers think they "should" be gaining.

Researchers MUST start recognizing the fact that their well-intentioned studies on restricted weight gain in obese women are, in practice, resulting in very harmful dietary advice and punitive practices for women who gain "too much."

Promoting gestational weight loss may be doing FAR more harm than good in obese women, especially those in borderline BMI categories for whom GWL is particularly risky. But even in "morbidly obese" women, there is enough evidence of possible harm that care providers should not be pushing for intentional weight loss in pregnancy.  

Instead, I urge care providers to focus on:
  • Reasonable nutrition
  • Regular exercise
  • Proactive care protocols 
In addition, caregivers MUST start looking at their own practice patterns in response to obese mothers' weight gain (especially induction for big baby) and how this impacts cesarean rates, NICU admissions, and morbidity in high-BMI women and their infants.

Here's what I want researchers and media to change:
  1. Stop promoting weight loss in pregnancy for obese women 
  2. Stop trying to sell gestational weight loss as "perfectly safe" and acknowledge the research that shows significant risks with it 
  3. Start recognizing that providers' responses to obese women's weight gain impacts outcomes, perhaps more than the gain itself
  4. Learn how to attend the births of big babies more safely 
Stop focusing so exclusively on the scale and start focusing on reasonable habits and reducing interventions as ways to improve outcomes in high-BMI women.


References

Obesity (Silver Spring). 2013 Apr 24. doi: 10.1002/oby.20490. [Epub ahead of print] Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus. Yee LM, Cheng YW, Inturrisi M, Caughey AB.  PMID: 23613187
OBJECTIVE: To investigate whether gestational weight loss after the diagnosis of gestational diabetes mellitus (GDM) in overweight and obese women is associated with improved perinatal outcomes...METHODS: Retrospective cohort study of 26,205 overweight and obese gestational diabetic women enrolled in the California Diabetes and Pregnancy Program. Women with gestational weight loss (GWL) during program enrollment were compared to those with weight gain...RESULTS: 5.2% of women experienced GWL. GWL was associated with decreased odds of macrosomia (aOR 0.63, 95% CI 0.52-0.77), NICU admission (aOR 0.51, 95% CI 0.27-0.95), and cesarean delivery (aOR 0.81, 95% CI 0.68-0.97). Odds of SGA status (aOR 1.69, 95% CI 1.32-2.17) and preterm delivery <34 weeks (aOR 1.71, 95% CI 1.23-2.37) were increased.  CONCLUSIONS: In overweight and obese women with GDM, third trimester weight loss is associated with some improved maternal and neonatal outcomes, although this effect is lessened by increased odds of SGA status and preterm delivery. We recommend further research on weight loss and interventions to improve adherence to weight guidelines in this population.
BJOG. 2011 Jan;118(1):55-61. doi: 10.1111/j.1471-0528.2010.02761.x. Epub 2010 Nov 4. Associations of gestational weight loss with birth-related outcome: a retrospective cohort study. Beyerlein A1, Schiessl B, Lack N, von Kries R. PMID: 21054761
...DESIGN: Retrospective cohort study. SETTING AND POPULATION: Data on 709 575 singleton deliveries in Bavarian obstetric units from 2000-2007 were extracted from a standard dataset for which data are regularly collected for the national benchmarking of obstetric units...RESULTS: GWL was associated with a decreased risk of pregnancy complications, such as pre-eclampsia and nonelective caesarean section, in overweight and obese women [e.g. OR = 0.65 (95% confidence interval: 0.51, 0.83) for nonelective caesarean section in obese class I women]. The risks of preterm delivery and SGA births, by contrast, were significantly higher in overweight and obese class I/II mothers [e.g. OR = 1.68 (95% confidence interval: 1.37, 2.06) for SGA in obese class I women]. In obese class III women, no significantly increased risks of poor outcomes for infants were observed. CONCLUSIONS: The association of GWL with a decreased risk of pregnancy complications appears to be outweighed by increased risks of prematurity and SGA in all but obese class III mothers.
Obstet Gynecol. 2011 May;117(5):1065-70. doi: 10.1097/AOG.0b013e318214f1d1. Maternal and neonatal outcomes among obese women with weight gain below the new Institute of Medicine recommendations. Blomberg M1. PMID: 21508744
...METHODS: This was a population-based cohort study, which included 32,991 obesity class I, 10,068 obesity class II, and 3,536 obesity class III women who were divided into four gestational weight gain categories. Women with low (0-4.9 kg) or no gestational weight gain were compared with women gaining the recommended 5-9 kg concerning obstetric and neonatal outcome after suitable adjustments. RESULTS: Women in obesity class III who lost weight during pregnancy had a decreased risk of cesarean delivery (24.4%; odds ratio [OR] 0.77, 95% confidence interval [CI] 0.60-0.99), large-for-gestational-age births (11.2%, OR 0.64, 95% CI 0.46-0.90), and no significantly increased risk for pre-eclampsia, excessive bleeding during delivery, instrumental delivery, low Apgar score, or fetal distress compared with obese (class III) women gaining within the Institute of Medicine recommendations. There was an increased risk for small for gestational age, 3.7% (OR 2.34, 95% CI 1.15-4.76) among women in obesity class III losing weight, but there was no significantly increased risk of small for gestational age in the same group with low weight gain. CONCLUSION: Obese women (class II and III) who lose weight during pregnancy seem to have a decreased or unaffected risk for cesarean delivery, large for gestational age, pre-eclampsia, excessive postpartum bleeding, instrumental delivery, low Apgar score, and fetal distress....
Obes Rev. 2015 Mar;16(3):189-206. doi: 10.1111/obr.12238. Epub 2015 Jan 18. Can we safely recommend gestational weight gain below the 2009 guidelines in obese women? A systematic review and meta-analysis. Kapadia MZ1, Park CK, Beyene J, Giglia L, Maxwell C, McDonald SD. PMID: 25598037
A systematic review was conducted to determine the risk of adverse pregnancy outcomes with gestational weight gain (GWG) below the 2009 Institute of Medicine guidelines compared with within the guidelines in obese women. MEDLINE, Embase, Cochrane Register, CINHAL and Web of Science were searched from 1 January 2009 to 31 July 2014. Quality was assessed using a modified Newcastle-Ottawa scale. Three primary outcomes were included: preterm birth, small for gestational age (SGA) and large for gestational age (LGA). Eighteen cohort studies were included. GWG below the guidelines had higher odds of preterm birth (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.07-2.00) and SGA (AOR 1.24; 95% CI 1.13-1.36) and lower odds of LGA (AOR 0.77; 95% CI 0.73-0.81) than GWG within the guidelines. Across the three obesity classes, the odds of SGA and LGA did not show any notable gradient and remained unexplored for preterm birth. Decreased odds were noted for macrosomia (AOR 0.64; 95% CI 0.54-0.77), gestational hypertension (AOR, 0.70; 95% CI 0.53-0.93), pre-eclampsia (AOR 0.90; 95% CI 0.82-0.99) and caesarean (AOR 0.87; 95% CI 0.82-0.92). GWG below the guidelines cannot be routinely recommended but might occasionally be individualized for certain women, with caution, taking into account other known risk factors.
Increased Risks for SGA Infants of Obese Women

J Matern Fetal Neonatal Med. 2016 Jul 22:1-17. [Epub ahead of print] The effects of maternal obesity on perinatal outcomes among those born small for gestational age. Yao R1, Park BY2, Caughey AB3. PMID: 27450769
BACKGROUND:...Small for gestational age (SGA) neonates born to obese women may be associated with pathological growth with increased neonatal complications. METHODS: This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2011. Analyses were limited to births between 34 and 42 weeks gestation with birth weight ≤10th percentile. Results were stratified by maternal pre-pregnancy BMI class. The risk for stillbirth, neonatal death, neonatal intensive care unit (NICU) admission and 5 minute Apgar scores <7 were estimated for each obesity class and compared to the normal weight group. Multivariable logistic regression analyses were performed to control for potential confounding variables. RESULTS: The rate of stillbirth was 1.4/1,000 births for normal weight women, and 2.9/1,000 among obese women (p < 0.001, aOR: 1.83 [1.43, 2.34]). The rate of neonatal deaths among normal weight women was 4.3/1,000 births, whereas among obese women it was 4.7/1,000 (p = 0.94, aOR: 1.10 [0.92, 1.30]). A dose-dependent relationship between maternal obesity and stillbirths was seen, but not for other neonatal outcomes. CONCLUSION: Among SGA neonates, maternal pre-pregnancy obesity was associated with increased risks for stillbirth, NICU admission and low Apgar scores but not neonatal death.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):333-9. doi: 10.1097/AOG.0b013e3181ae9a47. Success of programming fetal growth phenotypes among obese women. Salihu HM1, Mbah AK, Alio AP, Kornosky JL, Bruder K, Belogolovkin V. PMID: 19622995
...METHODS: This was a retrospective cohort study using the Missouri maternally linked cohort files (years 1978-1997)...Fetal growth phenotypes were defined as large for gestational age (LGA), appropriate for gestational age (AGA), and small for gestational age (SGA)...RESULTS:..Neonatal mortality among LGA infants was similar for obese (6.2 in 1,000) and normal (4.9 in 1,000) weight mothers (OR 1.05, 95% confidence interval [CI] 0.75-1.48) and regardless of obesity subtype. By contrast, SGA and AGA infants programmed by obese mothers experienced greater neonatal mortality as compared with those born to normal weight mothers (AGA OR 1.45, 95% CI 1.32-1.59;SGA OR 1.72, 95% CI 1.49-1.98). CONCLUSION: Compared with normal weight mothers, obese women are least successful at programming SGA, less successful at programming AGA, and equally as successful at programming LGA infants.
BJOG. 2016 Feb 8. doi: 10.1111/1471-0528.13896. [Epub ahead of print] Comparison of methods for identifying small-for-gestational-age infants at risk of perinatal mortality among obese mothers: a hospital-based cohort study. Hinkle SN1, Sjaarda LA1, Albert PS2, Mendola P1, Grantz KL1. PMID: 26853429
OBJECTIVE: To assess differences in small-for-gestational age (SGA) classifications for the detection of neonates with increased perinatal mortality risk among obese women and subsequently assess the association between prepregnancy body mass index (BMI) status and SGA. DESIGN: Hospital-based cohort. SETTING: Twelve US clinical centres (2002-08). POPULATION: A total of 114 626 singleton, nonanomalous pregnancies. ...RESULTS: The overall perinatal mortality prevalence was 0.55% and this increased significantly with increasing BMI (P < 0.01)...SGA is less common among obese women but these SGA babies are at a high risk of death and remain an important group for surveillance.
  


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Still Skeptical: My Response To Joannadeadwinter

Originally posted on Saye Bennett:
This post is my response to joannadeadwinter‘s latest post Ooh, Look, A Bisexual! as part of our ongoing and respectful conversation about our views on the topic of bisexuality.  I wanted to say “thanks again” to joannadeadwinter for initiating this discussion and for her thoughtful, intelligent, insightful, and respectful interactions!  Everyone, please feel…

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Presence

I am finding more and more, at this nearing-the-middle stage of life, the value of listening. The importance of being present whilst in conversation. It’s no easy feat, the brain anxiously jumping from one thought to the next, often without any direction from our conscious self. “What time is it? Am I late? Are they talking about me? What’s that sound? My pants don’t fit right. Ugh! I don’t wanna go to that thing tonight. I gotta check on that meeting. Must do laundry! Did I remember to get milk at the store?” buzzing through your mind when someone is telling you about their day or dream or plans or whatever. It takes considerable effort, it seems, to actively listen and to be present. We often listen only to react or respond rather than to truly take in not just the words but the sentiment or feeling being conveyed in conversation. We miss so much as a result.

I’ve been thinking a lot about the difference between reacting and responding. I recently shared the concept/definition of gaslighting with a coworker and it blew her mind! (I especially love this article on the topic as it blew my mind when I read it last year.) How often do others approach us with the intent of getting a rise out of us or an immediate reaction? How often would it be better for all involved to pause a moment and to ponder before providing a response? Many who use gaslighting tactics are not aware of their manipulative actions but instead feel justified in their emotional appeals. It may seem surprising, but when revisiting my own past experiences with this new lens of perception, I can clearly see how many of these tactics have become social norms that even I have used without realizing.

Much miscommunication can be attributed to not being fully present or even because of modern technology as preferred method of communication. We miss out on body language and cues! What a loss!!! How many times has a text message left you wondering at someone’s intended sincerity or snark? Eye contact is huge! I have an odd sense of humor, I’d say, and so being in someone’s company physically can often help whatever absurdity or pun I’m attempting to convey.

I’ve been surprised by how much I’ve been enjoying reading Jane Austen lately. I snagged a great deal on Amazon with 8 of her works for 99 cents (total) for the kindle versions.  I’m halfway through Pride & Prejudice and just finished Sense & Sensibility last week. The formalities and restrictions of that era are entertaining, but I must admit to feeling a minor sense of longing for the skills and art of conversation as it was then. It was deemed of the utmost importance to improve oneself in order to be received as good company or society (lets not get into the whole “good breeding” and “fortunes” and whatnot LOL) or to be invited to social gatherings as such. As for my reading Jane Austen, well, I’d read Northanger Abbey years ago and when I saw the great price I thought I may as well dive right on in! Ha!

How different conversation is now! It’s no longer enjoyed as an art, in and of itself, but merely a burden for many to struggle through in order to not appear rude. I used to consider it a curse when so many strangers would tell me the oddest things about themselves out of nowhere. Once while in line at a deli, the woman behind me told me her entire medical history, unprompted. Now I see it more as a chance for human connection and often that’s all it’s really about. We all just wanna be heard, sometimes it doesn’t even matter by whom! We’ve all felt unseen or ignored, to reach out in order to relate can feel more meaningful than even the trivial subject matter at hand.

In a past career, in the corporate world, I was a big fan of this customer service video called “Give ‘Em The Pickle”. There was a part where Mr. Farrell told a story about a new server he had hired who seemed to only make her life harder by having a bad attitude about customers. He appealed to her, in order to improve things for all involved, to greet customers when she met them and upon making eye contact saying in her head “I Like You” and smiling. Within an hour everyone saw a difference! I think this works in life as well. Certainly we are not all meant to like everyone, but it helps especially when you’re feeling anxious or awkward or are afraid people won’t like you. It helps me be a more attentive listener when I’m uncertain about my own shit or my relationship with that person.

I think our own motives often get in the way of connecting with others. We see others as being “in my way” or “taking up my time” without thinking about that other person’s perspective or intentions. I once asked a friend with some road rage (Love ya P!) “Where are you in such a hurry to get to? Aren’t we just going back to yours to watch t.v.?” he insisted it didn’t matter that we had no immediate deadline, he wanted to get where he was going unhindered and “EVERYONE NEEDS TO GET THE HELL OUTTA MY WAY!” Ha-ha! I always laugh when I think about that one! Hilarious!

I really wish communication techniques were taught from the very beginning of our schooling. Just think how much better things could be if it was just ingrained and a part of our normal socializing?! I spent so much of my life hiding/shrinking/mute in fear of all the things! I still fight those feelings occasionally. When I do have those feelings creep up again I try to push them out of my mind and remind myself that we’re all humans and deserve equal space and voice in life. Ha-ha! Sometimes it’s more of a stubborn internal argument while I’m on the train. I had a man-spreader sit beside me and it was just a big ole NOPE! Like, c’mon, dude! My fat ass and thighs aren’t giving way to nobody! Least of all, you, man-spreader! Ha-ha!

Truly, listening and being present for folks is so rewarding. In my new job (it still feels new, mostly), I have found people gravitate towards me because I have encouraged more than the typical “Good morning” routine. I have found friendship and connection with some so quickly that I hesitate because it seems scary to be so vulnerable, but it was actually the subject of vulnerability that bonded me with a coworker early on that has turned into a relationship that I look forward to coming to work to engage with. He recommended the book “Daring Greatly” by Brene Brown and the rest is history! Ha-ha!

*****************

I hope that perhaps some of this post has been of use to you, if not gently thought provoking. I’m finding myself in a bit of an odd state of mind lately, and as my writing style dictates, I do not always have full command of what comes out of my fingertips these days. When something comes to mind I try to get it down into words before it leaves me, but I’m afraid that often means I’m writing less and less about fat things. If there is ever anything you’d particularly like for me to address or discuss, do please comment or email me about it, it would make my day!

Rad Fatty Love,
<3
S

I’m looking for guest posts!!! Please consider submitting!

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the HAES® files: I Heart HAES-Informed Movement Specialists: One Woman’s Journey Home to Her Body

by Mikalina Kirkpatrick

I am a fat, white, middle-class, queer, married, 38-year-old, childless college student. I have been fat all my life. Looking back at childhood pictures, I am amazed at what was considered “fat” but I guess I was. Now as an adult there is no doubting it. I am what is deemed a super-fat person. Bigger than the sizes at the plus size stores, even. I have to buy my clothes from a catalog. Like many people who have been fat for most of their lives, I became divorced from my body at a pretty young age. I lived from the neck up. I ignored my body as much as possible.  Throw in some childhood through adulthood trauma, decades of binge eating and restriction cycling, a couple of injuries, years of living in intense body shame and all that comes with it, and the idea of ‘joyful movement’ as promoted by the Health At Every Size® (HAES) paradigm felt very foreign to me. I had incredibly strong blocks around movement. Just thinking about “exercising” gave me anxiety.

I’d like to share my story about how I moved from that place of anxiety and disembodiment to a place of personal empowerment. I have been able to experience some of the awesomeness that can come from living in a (super-fat) physical body. I got here with the help of what I like to call “HAES-informed movement specialists.”

I was introduced to HAES by Hilary Kinavey and Dana Sturtevant of Be Nourished at a retreat at Breitenbush Hot Springs in the Cascade Mountains of Oregon in March of 2014. What I learned sitting in that circle in that yurt began to change how I viewed my body and food immediately.  Once my eyes were open to the truth that lives in HAES, I knew I could never close them again.  I am so incredibly grateful that I have the privilege to build a HAES friendly support team. My primary care physician, my therapist, my acupuncturist, and my massage therapist and others have all helped me heal my relationship with my body by leaps and bounds. After a year of HAES informed therapy, and lots of healing with the help of my whole team, I was ready to try this joyful movement thing. But I needed help. Then I met Julie.

The first time that I sat in the studio with Julie, I was pretty nervous. I had heard she was amazing. I heard she made people feel safe. I also heard she lived in a normal sized body. Sure enough, when I showed up, I was greeted with a smile by a woman who could easily be on the cover of a yoga magazine. Julie started the class with us all sitting on our mats in a circle. She acknowledged her thin privilege. She acknowledged the sanctity and sacredness of every body exactly as it is. She talked about how she has come to learn that yoga can be an experience of meeting your body rather than trying to overcome your body.

With Julie’s guidance, I got to explore my body in a safe place with other people who were also used to feeling ostracized in movement environments. I was routinely delighted to find out what my body could do. And I was often frustrated to learn what it couldn’t. I tried to remember to let go of expectations and simply be with my body however it was. Over time, I started learning about my body. Now, I explore the world that is my inner thighs as I reach through to my feet, the feet that meet the ground, the ground that holds me every single day. When I sit in a side-bend and reach my left hand up over my head, I love the feeling of the long line between my hip on the floor and my hand in the sky, my ribs stretching like an accordion in between. Old patterns of judgment and self-loathing sometimes come up while I’m on the mat, and when they do, I have learned to meet myself with kindness and self-care. On those occasions I find myself dissociated, my head floating like a balloon, I’m able to use breathing and embodiment techniques to call myself back home to my body.

Six months ago I asked Hilary for a reference—I wanted to work with a physical trainer to see what else could be done for one of my injuries. She put me in contact with Susanne, a HAES-informed personal trainer who runs a beautiful movement space where I do strength training surrounded by crystals and candles. I clearly remember one evening, about a month into training, standing in my kitchen, I reached to pull something from a high shelf. I actually felt the muscles in my back and shoulders gliding over each other, working in concert to lift my arm. I must have stood there for five minutes, lifting my arms, circling them around me, just marveling in the feeling, the sensation of my body being a body, doing body things. Being treated like just another person wanting to learn about and strengthen my body has been amazing. There is no weight loss talk. There is no body comparison talk. No food police. No measuring tape. No scale. No goal weight. There isn’t even any “goal” talk, except to keep finding things that feel good. I often refer to her studio as one of my “safe spaces.”

Working with HAES informed movement specialists has been a total game changer for me. Re-learning movement in a safe and supportive environment has helped me create a relationship with my body that I never knew was possible. My body used to feel like an amorphous blob that I tried to avoid paying too much attention to. I wasn’t quite sure where I ended and the rest of the world began. Most of the time I felt numb. When I did get a sensation message from my body, it often terrified me. The feeling of my own heartbeat sent me into anxiety. Losing my breath at the top of a flight of stairs, I was awash in shame. I’ve learned to associate the feeling of losing my breath as part of movement. It happens to everyone. Not just fat girls.

I recently started going to the pool at my local community center. I took some swimming lessons to refresh my memory on the basic strokes and I found a love for Aqua Zumba. I bounce around in the water with twenty-something other women of all shapes, sizes, and ages. I didn’t check to see if anyone at the community center knew about HAES before I started going. My time with Julie and Susanne has helped me build the confidence I need to show up at a pool in a swimsuit and be 100 percent totally ok with it. Ok, 95 percent ok 95 percent of the time.

It’s not always easy living in my body. I still get triggered sometimes and feel like something is wrong with me because of my size, that I am a person in need of fixing. That my body is a problem to be solved. We all have bad body days. But I’m learning to take up my space. On the outside, my body looks pretty much the same as it has for the last several years. But on the inside it feels so different. I’m learning to feel the power and strength that lives within this body. It’s always been there. Activity has simply enhanced these qualities and made them more accessible to me. I am so incredibly grateful to Julie and Susanne for being such wonderful guides in my journey back home to my body through movement. I live here now, in this body, and I am proud of it. Everyone deserves the opportunity to find joyful movement and embodiment. And everyone deserves to have people supporting them along the way. The world needs more HAES-informed movement specialists. In school gyms, community centers, yoga studios, swimming pools, dance studios—every place where people go to learn how to move in new ways. Everyone deserves to have easy access to support for movement and activity that is weight-neutral, respectful, and life enhancing.

 


Mikalina Kirkpatrick is a writer and a student in the Portland State University Women, Gender, and Sexualities Studies program. She lives in Portland, Oregon.



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