Wednesday, 30 November 2016

Underpants Rule

Underpants RuleThis is one of those annual tradition posts – it’s the Underpants Rule and it is pretty simple: when it comes to personal choices, everyone is the boss of their own underpants. So, when it comes to personal choices, you get to choose for you and other people get to choose from them and it’s not your job to tell other people what to do and it’s not their job to tell you what to do. To illustrate, if someone is considering saying something about personal choices that starts with

  • People should
  • Everyone ought to
  • What people need to do
  • We should all
  • Nobody should
  • You shouldn’t
  • blah blah things that have to do with underpants that aren’t yours blah blah

then there is a 99.9% chance that they are about to break The Underpants Rule. Of course telling you that you should follow the Underpants Rule is, in fact, breaking the Underpants Rule which is pesky, so let me instead make a case for the Underpants Rule and then you can make your own choice.

I chose a Health at Every Size practice (knowing that health is not an obligation, barometer of worthiness, or entirely within our control)  because I am a fan of research, logic and math.  I think that the research clearly shows that a HAES practice gives me a much better shot at supporting my health with way less downside risk than a weight loss- based health practice.

There are people who think the exact opposite of that.  I know that because they come here and tell me so – they say that I should make a different choice.  This blog is my little corner of the internet.  It exists only because I created it and I am thrilled to pieces that people enjoy reading it, that people get inspired by it, that it gives people information to make choices etc. I try very hard to make sure that I always follow the Underpants Rule and never tell anyone else how they have to live when it comes to their personal choices, and yet people come here and try to tell me how to live when it comes to my personal choices.  That’s annoying.

For this reason, I would never go onto someone’s weight loss blog and tell them all about Health at Every Size and quote research as to why I think it’s a better choice.  Those are not my underpants.

I do not enjoy (or believe them) when people tell me that I need to become smaller to be attractive.  Therefore I would never say that thin women need to become larger to be attractive.  Besides the fact that I don’t believe it, those are not my underpants. (Not to mention that the path to high self-esteem is probably not paved with hypocrisy so doing to someone else exactly what I don’t want done to me seems ill-advised.)

The “War on Obesity” is an underpants rule breakdown on a massive scale. A group of government, public and private interests (with various profit and political motivations) has chosen a group of people who are identifiable by sight and is now trying to tell us everything from how we have to prioritize health, to the path we have to take to become healthy, to how our bodies have to look.  Who died and made them Underpants Overlord?  Nobody. (And another year has gone by and I’ve still not received my official fat person pony.)

My metaphorical underpants and my actual underpants have something in common:  if I want somebody else in them, that person will be among the very first to know.  I have definitely not invited the executives at HBO, Kaiser Permanente, the government, or the diet industry into my underpants.

Over the years, there have been some misunderstandings about the Underpants Rule – mostly confusion about what is and is not covered, I wrote about the limitations of the UR here.

Now, I’m not telling what to do (cause, you know, Underpants Rule) but I’m suggesting that if you don’t like it when people attempt to be the boss of your underpants, then maybe take a pass on trying to be the boss of someone else’s.  I’m fairly certain that “Do unto others exactly what you don’t want them to do to you” is the brick rule or the pile of crap rule or something – at any rate a LOT of steps down from platinum and gold.

Remember, you are forever the boss of your underpants – occupy your underpants (with a nod to reader Duckie for that phrase)! I’m going off to see if there is a Guinness World Record for number of times the word underpants is used in a blog.

Underpants. Underpants. Underpants.

Underpants.

Under…

…pants.

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Monday, 28 November 2016

Corrections to E’s Story

I have to make a couple of corrections to this post from two months ago. First, C wasn’t sick for decades; it was several years, but not decades.

The second correction is a pleasant surprise: E is doing better. She’s regained some weight, she has a better attitude toward food, and she seems generally more positive. She’s still lost some memory and some mental acuity, and she still can’t walk, but I’m feeling more hopeful than I had been. Let’s hope the positive trend continues.




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External Version for Breech After Prior Cesarean


An External Cephalic Version (ECV, or turning the baby manually to a head-down position) is one option open to people whose babies are breech. However, if you have had a prior cesarean, you may be told that this is not an option for you.

The evidence does not support excluding those with a prior cesarean from an External Cephalic Version. It's time for obstetric societies to update their guidelines about this, and it's time for more providers to routinely offer ECV.

Background

The main benefit of External Cephalic Version is that it is often successful in getting the baby head-down, and a head-down birth is usually less risky than a breech birth.

Although many breech babies can be born vaginally just fine (especially those that meet certain criteria and/or are attended with alternate positioning), there are some increased risks to be aware of.

As a result, many care providers these days strongly prefer a cesarean or even schedule one automatically with a breech baby. Because some areas do not "allow" Vaginal Birth After Cesarean (VBAC), this can mean that all future babies must also be born by cesarean.

Therefore, getting the baby head-down via an External Cephalic Version can help prevent not just the first cesarean, but many automatic repeat cesareans and the serious complications that can happen with them.

Of course, like everything, ECV has both benefits and risks. The risks of ECV include premature labor, placental abruption (placenta detaching too early), hemorrhage, or fetal distress. Although real, these risks are relatively rare, usually less than 1%.

Obviously, sometimes ECV is also contraindicated. Most clinicians agree that ECV should not be attempted in the presence of pre-existing fetal distress, placenta previa, placental abruption, premature rupture of membranes, and certain uterine malformations. Low amniotic fluid levels may also be a relative contraindication.

A good review of the benefits and risks of ECV can be found here. Basically, ECV is able to turn babies head-down most of the time without many complications, and thus prevents many cesareans that would otherwise happen. This is important because cesarean rates are so high; ECV is quite an effective way to reduce the number of cesareans and probably many cases of resulting abnormal placental attachment.

Astonishingly, though, research shows that ECV is not used that much in many areas, despite its relative success rate and potential for lowering the cesarean rate.

Often, doctors don't even tell people that ECV is an option. They just schedule a cesarean and discourage people from exploring other options. One study from New Zealand estimated that only 26% of eligible patients with breech presentations were referred for ECV.

The situation is even worse if you have had a prior cesarean. For those with a scarred uterus, it's even harder to get an ECV because doctors have been taught that it's too dangerous.

The Controversy

People whose babies are breech and have a history of a prior cesarean are often told that ECV is simply not a choice for them because manipulation done during an ECV might make the uterus rupture along the scar from the prior cesarean.

The problem is that there is no actual proof that this is a substantial risk. No study has found this to be a problem, but just the mere fear of the possibility has led to its denial for this group. Currently, you can still find recommendations online that list prior cesarean (or any prior uterine surgery) as a contraindication to even attempting an ECV.

However, a policy of no External Cephalic Version for people with a prior cesarean is not supported by research.

There are a number of studies, including some very recent studies, that suggest that people with a prior cesarean SHOULD have the option to have an External Version if they want it.

The latest study (Weill 2016) had 158 women in the study group and found no increase in complications in the group with a prior cesarean. The success rate of ECV in this group was good (117/158, or 74%), and only 12 of these patients ended up with a cesarean during labor. That means that using ECV in the prior cesarean group prevented 105 automatic repeat cesareans. The authors summarized their findings this way:
ECV may be successfully performed in patients with a previous caesarean delivery. It is associated with a high success rate, and is not associated with an increase in complications.
Similarly, another recent study (Burgos 2014) found no increased rate of complications in the group with a prior cesarean. The authors concluded:
Uterine scar should not be considered a contraindication and ECV should be offered to women with previous caesarean section with breech presentation at term.
Another study (Abenhaim 2009) also found no increase in complications in those with a prior cesarean who had an ECV. The authors stated:
Concern about procedural success in women with a previous cesarean section is unwarranted and should not deter attempting an external cephalic version.
However, both RCOG (Royal College of Obstetricians and Gynaecologists) and ACOG (American College of Obstetricians and Gynecologists) still hesitate to endorse ECV after prior cesarean. They say that there is not enough research to prove that it is safe. They point out that many of the studies on ECV and prior cesarean are fairly small, which limits their power.

That is a fair point. It's true that most studies have been relatively small and we don't have a huge pool of data to pull from, but taken together the results are quite encouraging.

One older review (Sela 2008) did a search of previous studies to pool the results. They found a total of 124 patients who had an ECV after prior cesarean. They added 42 patients from their own database. Adding in the 36 from the Abenhaim 2009 study, 70 from the Burgos 2014 study, and 158 from the Weill 2016 study, you get a total of 430 patients who have been documented to have an ECV after prior cesarean ─ all without any poor outcomes.

What this means is that there isn't ANY evidence to prove that ECV is unsafe in those with a prior cesarean. While the data pool is still somewhat limited, so far ALL of it supports ECV after prior cesarean.

Yet ACOG's recently revised 2016 guideline on ECV states, "Having had a previous cesarean delivery is not linked with lower rate of success; however, whether it magnifies risk for uterine rupture is not known." They cite only two studies from 1991 and 1998 and state, "Larger studies would be needed to establish the risk of uterine rupture." This ignores all the recent studies on ECV. This cavalier omission will continue to lead many care providers to continue to deny ECV to those with prior cesareans.

Although more research is needed, the bottom line is that the accumulating evidence certainly suggests that an ECV after a prior cesarean is not unduly risky and is a reasonable choice that should be offered to those who want it. 

A more reasonable view of the evidence has led the SOGC (the Canadian version of RCOG and ACOG) to state:
External cephalic version is not contraindicated in women with a previous Caesarean birth.
It's time for ACOG and RCOG to recognize that they are basing their guidelines more on fear than on the latest evidence and update their guidelines accordingly. Bravo to the Canadians for leading the way on this issue.

More research should be done ─ an excellent question is WHY hasn't more been done by now? My best guess is that it reflects the exaggerated fears of the care providers rather than a reasoned response. But given the absence of poor outcomes up till now, research on this topic should be expanded and in the meantime, ECV should be available to those with a prior cesarean.

In addition, it is time for more care providers to offer ECV as an option across the board. This is a sadly underused procedure that could certainly greatly impact cesarean rates and maternal morbidity, both by preventing the first cesarean and lowering the rate of automatic repeat cesareans that follow.


References

External Cephalic Version After Prior Cesarean

Aust N Z J Obstet Gynaecol. 2016 Sep 14. doi: 10.1111/ajo.12527. [Epub ahead of print] The efficacy and safety of external cephalic version after a previous caesarean delivery. Weill Y, Pollack RN. PMID: 27624629
BACKGROUND: External cephalic version (ECV) in the presence of a uterine scar is still considered a relative contraindication despite encouraging studies of the efficacy and safety of this procedure. We present our experience with this patient population, which is the largest cohort published to date. AIMS: To evaluate the efficacy and safety of ECV in the setting of a prior caesarean delivery. MATERIALS AND METHODS: A total of 158 patients with a fetus presenting as breech, who had an unscarred uterus, had an ECV performed. Similarly, 158 patients with a fetus presenting as breech, and who had undergone a prior caesarean delivery also underwent an ECV. Outcomes were compared. RESULTS: ECV was successfully performed in 136/158 (86.1%) patients in the control group. Of these patients, 6/136 (4.4%) delivered by caesarean delivery. In the study group, 117/158 (74.1%) patients had a successful ECV performed. Of these patients, 12/117 (10.3%) delivered by caesarean delivery. There were no significant complications in either of the groups. CONCLUSIONS: ECV may be successfully performed in patients with a previous caesarean delivery. It is associated with a high success rate, and is not associated with an increase in complications.
BJOG. 2014 Jan;121(2):230-5; discussion 235. doi: 10.1111/1471-0528.12487. Epub 2013 Nov 19. Is external cephalic version at term contraindicated in previous caesarean section? A prospective comparative cohort study. Burgos J, Cobos P, Rodríguez L, Osuna C, Centeno MM, Martínez-Astorquiza T, Fernández-Llebrez L. PMID: 24245964
OBJECTIVE: To determine if external cephalic version (ECV) can be performed with safety and efficacy in women with previous caesarean section. DESIGN: Prospective comparative cohort study. SETTING: Cruces University Hospital (Spain). POPULATION: Single pregnancy with breech presentation at term. METHODS: We compared 70 ECV performed in women with previous caesarean section with 387 ECV performed in multiparous women (March 2002 to June 2012). MAIN OUTCOME MEASURES: Success rate, complications of the ECV and caesarean section rate. RESULTS: The success rate of ECV in women after previous caesarean section was 67.1% versus 66.1% in multiparous women (P = 0.87). The logistic regression analysis confirmed this result (odds ratio 0.93, 95% CI 0.52-1.68; P = 0.82) adjusted by the variables associated with success of ECV. There were no complications in the previous caesarean section cohort. The vaginal delivery rate in the previous caesarean section cohort was 52.8% versus 74.9% in the multiparous cohort (P < 0.01). There were no cases of uterine rupture. CONCLUSION: Based on our data, we conclude that complications are uncommon with ECV in women with previous caesarean section, with a success rate comparable to that of multiparous women. Uterine scar should not be considered a contraindication and ECV should be offered to women with previous caesarean section with breech presentation at term.
J Perinat Med. 2009;37(2):156-60. doi: 10.1515/JPM.2009.006. External cephalic version among women with a previous cesarean delivery: report on 36 cases and review of the literature. Abenhaim HA1, Varin J, Boucher M. PMID: 19021458
AIMS: Whether or not women with a previous cesarean section should be considered for an external cephalic version remains unclear. In our study, we sought to examine the relationship between a history of previous cesarean section and outcomes of external cephalic version for pregnancies at 36 completed weeks of gestation or more. METHODS: Data on obstetrical history and on external cephalic version outcomes was obtained from the C.H.U. Sainte-Justine External Cephalic Version Database. Baseline clinical characteristics were compared among women with and without a history of previous cesarean section. We used logistic regression analysis to evaluate the effect of previous cesarean section on success of external cephalic version while adjusting for parity, maternal body mass index, gestational age, estimated fetal weight, and amniotic fluid index. RESULTS: Over a 15-year period, 1425 external cephalic versions were attempted of which 36 (2.5%) were performed on women with a previous cesarean section. Although women with a history of previous cesarean section were more likely to be older and para >2 (38.93% vs. 15.0%), there were no difference in gestational age, estimated fetal weight, and amniotic fluid index. Women with a prior cesarean section had a success rate similar to women without [50.0% vs. 51.6%, adjusted OR: 1.31 (0.48-3.59)]. CONCLUSION: Women with a previous cesarean section who undergo an external cephalic version have similar success rates than do women without. Concern about procedural success in women with a previous cesarean section is unwarranted and should not deter attempting an external cephalic version. 
Eur J Obstet Gynecol Reprod Biol. 2009 Feb;142(2):111-4. doi: 10.1016/j.ejogrb.2008.08.012. Epub 2008 Nov 18. Safety and efficacy of external cephalic version for women with a previous cesarean delivery. Sela HY, Fiegenberg T, Ben-Meir A, Elchalal U, Ezra Y. PMID: 19019528
OBJECTIVE: To evaluate the success and morbidity rates for attempted external cephalic version (ECV) in patients with one previous cesarean delivery (CD) and a breech-presenting fetus at term. STUDY DESIGN: This is a retrospective study of outcomes of ECV at our institution for all women with one previous CD and a breech-presenting fetus at term between January 1997 and June 2005. A literature review was also performed as a Medline search (1966-2006). RESULTS: ECV was attempted for 42 women with a breech-presenting fetus and previous CD. The success rate of ECV was 74.0%, and 84% of women with successful ECV delivered vaginally. All fetal and maternal outcomes were favorable. Only four Medline reports met our inclusion criteria, representing a total of 124 patients and a mean ECV success rate of 76.6%. Thus we assessed 166 cases of attempted ECV and find an average ECV success rate of 76.5% and favorable fetal and maternal outcomes. CONCLUSIONS: Women with a breech-presenting fetus at term and previous CD, who desire a trial of labor, should be counseled regarding the accumulating evidence about the efficacy and apparently safety of this procedure and may be offered an ECV attempt.
Eur J Obstet Gynecol Reprod Biol. 1998 Oct;81(1):65-8. External cephalic version after previous cesarean section: a series of 38 cases. de Meeus JB1, Ellia F, Magnin G. PMID: 9846717
OBJECTIVE: To determine if external cephalic version (ECV) is a reasonable alternative to repeat cesarean section in case of breech presentation. STUDY DESIGN: Retrospective study of 38 women with one previous cesarean section and a breech presentation after 36 weeks of gestational age who have had at least one experience of ECV. Statistics used the Fisher's test with significance when P<0.05. RESULTS: Version attempts were successful in 25 of the 38 women (65.8%). Seventy-six percent of the successful version women went on to have vaginal birth after cesarean section. A total of 19 successful vaginal deliveries occurred (50%). Success rate of ECV was lowered when breech was the indication of the previous cesarean section. The vaginal delivery rate was increased after successful ECV in patients previously vaginally delivered, but this difference did not reached significance (P=0.057). No maternal or neonatal complications occurred. CONCLUSION: ECV is acceptable and effective in women with a prior low transverse uterine scar, when safety criteria are observed.
Int J Gynaecol Obstet. 1994 Apr;45(1):17-20. External cephalic version after previous cesarean section--a clinical dilemma. Schachter M, Kogan S, Blickstein I. PMID: 7913053
OBJECTIVES: To describe our limited experience with external cephalic version from breech to vertex presentation at term, with the use of ritodrine tocolysis, in women who had undergone a previous cesarean delivery. METHODS: Eleven parturients after previous cesarean delivery underwent external version after 36 gestational weeks, utilizing tocolysis with ritodrine, after excluding cases of low-lying placenta, severe oligohydramnion or ruptured membranes. Patients were then followed until delivery and scar examination was carried out after vaginal delivery, or at re-cesarean section, according to mode of delivery. RESULTS: All 11 attempted versions were successful. Six patients subsequently delivered vaginally and five by re-cesareansection. None of the uterine scars showed any signs of dehiscence. Three of the five infants delivered by re-cesarean section weighed over 4000 g, whereas all of the vaginally-delivered infants weighed under 3500 g. CONCLUSIONS: External cephalic version to vertex presentation after previous cesarean section was successful in all 11 carefully selected patients. No untoward effects were noted, and no signs of scar dehiscence were found. The safety and efficacy of this procedure after previous cesarean delivery should be examined further.
Am J Obstet Gynecol. 1991 Aug;165(2):370-2. External cephalic version after previous cesarean section. Flamm BL, Fried MW, Lonky NM, Giles WS. PMID: 1872341
Approximately 100,000 cesarean sections are performed each year in the United States because of breech presentation. Numerous studies have shown that external cephalic version can eliminate the need for many of these operations. However, because of the fear of uterine rupture, these studies have generally excluded patients who have undergone previous cesarean section. To evaluate the validity of this exclusion policy, we studied patients with one or more previous cesarean sections and breach presentations near term. Version attempts were successful in 82% of 56 patients who had undergone a previous cesarean section. Sixty-five percent of the successful version patients went on to have vaginal birth after cesarean section. There were no serious maternal or fetal complications associated with the version attempts. We conclude that external cephalic version is a reasonable option in patients with prior low transverse cesarean section.



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My New Favorite Fat TV Character

Actual SizeMy sadness over the fact that Chrissie Metz’ character in This Is Us has decided to have stomach amputation (announced in an episode that I think they should have named “An Ode to the Stomach Amputation Industry”) has lifted a bit because I discovered maybe my favorite fat character ever on a TV Show.

The show is called Scorpion and it’s about a group of geniuses who work with the US Government to solve crimes (why did nobody tell me about this show before now?) The character I’m talking about is Sylvester Dodd, played spectacularly by Ari Stidham. (Note – I don’t know how Ari identifies size-wise, I think of him as a fat, he might not agree.)

What I love about the character is that he is a very multi-dimensional main character, the character is very physical and often given very physical tasks to do that are literally life and death and, with the exception of him being called “Big Fella” in a good-natured, non-judgmental way, his weight is never an issue (at least as far as I’ve seen.  Fingers crossed since we’re basically binge-watching this show right now.) The show isn’t perfect, it cam play on stereotypes and there could definitely be more diversity in casting, but I enjoy the show and it makes me so happy to see a fat character portrayed as something other than a self-loathing side kick.

If you have favorite fat and fat positive TV characters (ie: multi-dimensional, no diet talk, no weight loss talk, accepting/affirming of their size etc.) please feel free to leave them in the comments.

Like this blog?  Here’s more cool stuff:

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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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Report: Fat, Disability, SWAGGA, DaDaFest

Breast wigs, gold mini-mini fingerless gloves,
puce Air Force 1s, the essential parts
of my SWAGGA costume

I'm surfacing from an intense few weeks rehearsing for and being at DaDaFest in Liverpool. For those not in the know, DaDaFest is an organisation that promotes disabled and deaf arts. They host a biannual festival and are involved with lots of other things besides. Their website is a treasure trove. This year's DadaFest (theme: Skin Deep) is still underway, there are still things to see.

I was there for two reasons: 1. To participate in an event around fat activism and disability arts. 2. To perform SWAGGA.

It was really exciting to create public conversations about fat and disability. People who know me will know that I have been interested in this intersection since the early 1990s. I wrote an MA dissertation about it that later spawned a book and a journal article that has also prompted people to write and think about these connections and divergences. Elsewhere people have come to explore the subject independently of my work. It's a thing. But it's hard to create conversations because this is tender stuff and it involves negotiating fatphobia and disablism to varying degrees.

My friend the actor, comedian and activist Liz Carr and I have been talking about fat and crip culture for quite a while and we wanted to have a public conversation about it at DaDaFest. Because the festival is progressive and supportive about fostering conversations that expand ideas around disability, they encouraged us to go for it. Our conversation meandered around our friendship, the things we have in common as fat and disabled people, the things we don't have in common. It was satisfying, full of hope! We have a lot to learn from each other. We were joined during this event by Bethan Evans of the University of Liverpool and Stacy Bias, who have been working on a project about fat people and access.

The talks were set up to be livestreamed and archived online. There were technical hitches that meant we thought this wouldn't happen, but in the end they were recorded, although the image is blurry and the sound very quiet. Have a go at listening with headphones and the sound cranked up. If I ever get some free time I will transcribe it.



Followers of this blog will know that SWAGGA has been a life-changing experience for me. For those not in the know, SWAGGA is a dance project instigated by Alexandrina Hemsley and Jamila Johnson-Small who work together as Project O. They recruited Kay Hyatt and I in 2014 to develop and dance this piece. We have now danced it at a number of venues for many people. There is also a film, check out the trailer.

We swept up this little pile of
dancer's dirt before we could
practise. Dust and long golden
hair. Not ours.

I don't know when we will dance SWAGGA again, or if we will dance it again. Every time I come back to it I feel changed. Dancing at the Unity Theatre in Liverpool, a wonderful venue with a radical history, was probably the best performance of it I've ever given. I had a sense that I'd really cracked it this time, which of course I feel every time! But what was different was that I was able to relax into the performance. We rehearsed quite intensively the previous week, resolved some of the things that I found difficult about it, like the part when I get up off the floor, I was confident and I felt that we belonged at DaDaFest.

Over two years, nearly three, with lots of space inbetween for me to pursue other interests in dance, performing SWAGGA at the Unity felt a bit like a graduation. I've never been to dance school, I doubt that any of them would have me anyway especially at this time in my life, it's unlikely that I would be cast in a dance production other than this, or do well at an audition, or even be invited to audition. For lots of reasons, the dance world excludes fat dancers. My movement and engagement with dance, a lifelong ambition, has been a process of making space in dance for people like me, with the amazing and generous support of radical practitioners. What a trip!





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Sunday, 27 November 2016

On fatness, news, and fear mongering

There has been a lot of talk lately about fake news, or has some people refer to it, about propaganda. While concerns around fake news are valid and should definitely be of concern in the post-truth culture, I have similar concerns about the failures of mainstream media (real news), to report information in accurate and useful way for the public. We’ve seen MSM in the United States struggle with this with PEOTUS, who is unwilling to distinguish between a truth and a lie.

2016-08-13-18-55-13

And it isn’t only the MSM in the United States that engage in irresponsible reporting. Here in New Zealand, the media has once again failed in their reporting around issues of fatness, and failed to present useful information for the New Zealand public. In a story entitled, “Claims of a NZ obesity epidemic are ‘fearmongering’, says academic”, it is reported that a “dramatic jump in the number of children considered overweight or obese is expected to hit New Zealand within the next nine years. By 2025, it is expected about 32 per cent of children will be considered overweight or obese….By 2025, more than one in four Australian children will be considered overweight or obese.”

The article concludes by listing the obesity rates for adults and children in communities around the country. The article is framed around the narrative that the sky is falling, and I am Chicken Fat, running around disputing the claim.

 

Let’s set the scene, shall we? I’m sitting in the lounge at the airport, waiting to fly up to Auckland. My phone rings, and caller ID tells me that it is the local paper. I answer and speak with a reporter who is keen to get my thoughts on a press release from the Royal Australian College of Surgeons. He wants my thoughts, and of course needs them ASAP, so I suggest he email me the media release and I will read it and get back to him.

 

Here is what he sent me,

 

ROYAL AUSTRALASIAN COLLEGE OF SURGEONS

MEDIA RELEASE

Obesity Epidemic Already Upon Us Say Medical Professionals

Thursday 27 October, 2017

The Royal Australasian College of Surgeons has issued a dire warning to Australians and New Zealanders about their countries’ weight problem, as alarming statistics highlight the prevalence of the problem in young people.

This warning comes as the Obesity Surgery Society of Australia and New Zealand (OSSANZ) holds its Annual Conference in Sydney starting today to discuss some of the more difficult areas of Bariatric Surgery and as the Committee of Presidents of Medical Colleges (CPMC) prepares to convene a National Health Summit on Obesity in Melbourne on 9 November to discuss ways in which obesity can be reduced.

According to projections, by 2025, more than one in four Australian children aged between five and seventeen will be considered overweight or obese. This is up from one in five at the turn of the century, with a clear trajectory towards a one in three figure.

The numbers are even worse in New Zealand, where the one in three figure will almost be reached by 2025, when it is expected approximately 32 per cent of children will be considered overweight or obese.

RACS Fellow and President of OSSANZ, Mr George Hopkins, said that the increase in Australia and New Zealand had reached crisis point.

“We often refer to the obesity epidemic as a ticking time bomb waiting to go off, but the reality is it already has. You don’t have to spend long in any public shopping centre to work out how widespread it has become,” Mr Hopkins said.

“This is having flow on effects for the rest of the health system. There are strong links between obesity and a myriad of other health problems, including type 2 diabetes, heart disease and certain types of cancers.”

“Furthermore, obese people have a 50 -100 per cent increased risk of dying prematurely compared to people of normal weight.”

Mr Hopkins works as a gastrointestinal surgeon in Brisbane, where he has performed weight loss surgery on thousands of patients. He says there had been a noticeable increase in the number of obese patients requiring surgery, but most startling has been the rise in the number of children.

“When I am required to operate on younger people it is usually after every other weight loss strategy has failed. Compared to when I first started working as a surgeon it is alarming how common it has become for people to require this sort of intervention at such a young age.”

“With so many people now overweight this is not just placing an enormous strain on individuals, but it is also creating an untenable situation for our health system. There is only so much pressure it can take before it collapses.”

“Childhood obesity is preventable, but something needs to change urgently. Weight loss surgery has proven to be an effective measure, but it should not be viewed as a silver bullet or a cure.”

“We need to look right across the spectrum for how we are going to tackle this crisis, from education, to nutrition, to promoting more active lifestyles. Those figures are damning, clearly what we are doing at the moment isn’t working.”

 

So I read the release, and Google to learn more about the Obesity Surgery Society of Australia and New Zealand (OSSANZ). Because this press release has been released on the first day of the OSSANZ’s annual conference in Sydney, and understanding the Obesity Surgery Society is central to understanding the press release. Unsurprisingly, I learn that the OSSANZ is an organisation that is comprised of obesity surgeons and works, among other things, “to form a closer association of the obesity surgeons of Australia & New Zealand for the advancement of the obesity surgery & management”; it is also part of the International Federation for the Surgery of Obesity and Metabolic Disorders, which itself is a “federation composed of national associations of bariatric surgeons”, because these national associations, like the OSSANZ, are everywhere.

 

My main reaction to the press release was that it made a lot of claims about rising rates of obesity in New Zealand and Australia, but did not direct the reader as to where one could go to find the evidence to support the claims made. So, this was my response:

Hi Nick,

As they haven’t referenced/cited where they are getting their evidence/statements, I can only really speak to the tone of the piece. Which is fear mongering; it feeds into the existing moral panic we are having about obesity.

And it’s especially dangerous when targeted at children. We are already seeing the effects of the war on obesity in kids – the hostility & bullying of fat kids (by both peers & adults) is increasing, as are the numbers of eating disorders being diagnosed in youth. Further efforts to fight obesity will only increase stigmatisation of children’s bodies. Fat kids are living in hell, and non-fat kids are engaging in undesirable behaviours to avoid becoming the fat kids.

What we need are approaches to health that are independent of weight. And we can do this. We can teach kids about health seeking behaviours, without it being attached to fear or shame about weight. We can assess and measure the health of a population in many meaningful ways without using BMI.

What we do, though, is use weight as a proxy for health. And that isn’t helpful for anyone, except those who make their living performing weight loss surgeries.

Cat

 

I specifically mention that I can’t comment on their claims about the numbers in New Zealand in 2025, because the press release itself doesn’t provide evidence or any citations for how those projections are made. I specifically mention that all I can speak to is the tone.

And yet.

And yet.

The piece itself – presents the claims of the press release without question, and presents me as Chicken Fat. Read the first two sentences from the piece:

 “A Manawatu academic has slammed a warning about a projected spike in child obesity as “fearmongering”. A dramatic jump in the number of children considered overweight or obese is expected to hit New Zealand within the next nine years.”

A bit later in the piece, we get this: “However, that projection has been criticised by Massey University human development senior lecturer Cat Pause, who says such messages are dangerous when aimed at children.”

I didn’t provide a criticism to the projection; I noted that it wasn’t supported by evidence. The only feedback I provided was to the tone of the release. And yes, it was fear mongering. Specific examples of the fear mongering in the release include (emphasis mine),

  • alarming statistics highlight the prevalence of the problem in young people”
  • “the increase in Australia and New Zealand had reached crisis point
  • “We often refer to the obesity epidemic as a ticking time bomb waiting to go off, but the reality is it already has”
  • “it is alarming how common it has become for people to require this sort of intervention at such a young age”
  • “There is only so much pressure it can take before it collapses

While I am annoyed by how I was misrepresented in the story (a common experience for Fat Studies scholars and fat activists – see this and this on suggestions for how to not get stitched up by the media), it is not my biggest concern. My biggest concern is how the information itself – the facts – was misrepresented. The reporter simply repeated the projections from the press release, without providing links to further evidence – or noting that the press release itself didn’t provide evidence or citations. Or even repeating the projections as claims made by this particular group (with a particular dog in the fight). It could easily read, “The OSSANZ claims that by 2025, 32 per cent of children will be…” And while the word projection is used once in the article, the presentation of the projections read like established facts,

  •  “By 2025, it is expected about 32 per cent of children will be considered overweight or obese, according to Australian and New Zealand obesity surgeons.”
  •  “By 2025, more than one in four Australian children will be considered overweight or obese.”

Most people reading the article will come away believing that these are realistic projections supported by scientific evidence. But are they? Without any reference to the evidence, we can’t know. There is no doubt, however, that these projections are great for the OSSANZ. Who benefits from obesity fear mongering? Obesity surgeons – bariatric surgeons – the professionals who can present themselves as the only ones with the answer to the problem (as Mr George Hopkins in the press release notes), benefit greatly from these projections. But where is the evidence? I’m not willing to give the benefit of the doubt to the OSSANZ, or even the larger Royal Australasian College of Surgeons. We have too long a history of being taken in by projections – of judgments – from obesity science; these past proclamations have done a great deal of violence to the fat community.

 

For example, in 1999, David Allison and colleagues published a paper in the Journal of the American Medical Association that asserted that obesity caused 300,000 deaths a year in the United States (while noting several times that this was probably a low estimate). It’s since been cited by over 2,000 other papers and that number (300k) spread everywhere. Picked up by policy makers, healthcare providers, and NGOs alike, it is still often used in documents. Allison and colleagues received a great deal of criticism for the methodology they used to determine this number, however. In the paper itself, they note “…our calculations assume that all (controlling for age, sex, and smoking) excess mortality in obese people is due to obesity”. This means that they concluded that all the fat people who had died had died of their fatness.

Another popular assertion is, “Because of obesity, this is the first generation of children that will not outlive their parents” – ever heard anything like that? In 2002, the Houston Chronicle ran a story that included the dire warning of Dr. William Klish of Texas Children’s Hospital, “‘If we don’t get this epidemic [of childhood obesity] in check, for the first time in a century children will be looking forward to a shorter life expectancy than their parents.'” When pushed for evidence to support his statement, Klish acknowledged that he didn’t have any, but that it is based in his own intuition.

Similarly (albeit in a scholar journal, rather than the MSM), Jay Olshansky, David B. Allison, and colleagues published a piece in a 2005 issue of The New England Journal of Medicine that made a similar claim to Klish, “youth of today may, on average, live less healthy and possibly even shorter lives than their parents”. Towards the end of the paper, Olshansky and his co-authors acknowledge that their dire prediction relied on their “collective judgment” rather than empirical, scientific evidence. “It is important to emphasize that our conclusions about the future are based on our collective judgment”. When pressed for further explanation by a reporter for Scientific American, Allison responded, “These are just back-of-the-envelope, plausible scenarios…We never meant for them to be portrayed as precise.” (If you want to read the entire story in Scientific American, entitled, Obesity: An Overblown Epidemic? you can find it here and here).

 

Both of those talking points – obesity kills 300k people a year, and children will have shorter life expectancy that their parents – are still kicking around the Internet, government policy documents, and the scientific literature. MSM still repeats them when useful – and rarely does the use of either talking point include an acknowledgement that there is NO EVIDENCE TO SUPPORT EITHER. That these shouldn’t be taken as fact. As truth.

And there is also NO consideration given to the violence that is done by statements like these. Whether through government policy, structural discrimination, workplace programmes, or bullying/harassment enacted by family, friends, and strangers, make no mistake that those talking points bolster (and in many cases justify) the oppression of fat people.

In a democracy, a free press has the responsibility to provide the readers with factual information to inform their lives and decision-making. This requires not simply parroting back information found in press releases, especially where a conflict of interest may be apparent (like, obesity surgeons making predictions about how many obese patients there may be one day needing their surgeries, without evidence to support it). So for the Manawatu Standard to repeat those predictions, without providing any context to the reader, is incredibly irresponsible and gross.



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Yes, even if you had good reasons…

I’m still angry at the people who voted for Trump, maybe more than I should be. But, then, I read yet another conflict of interest, or see him tweet something stupid or hateful, and that anger feels pretty justified.

Some of my conservative friends are *really* tired of hearing about this anger. It’s not fair, they say, to lump people who voted for Trump for good reasons with those who deliberately voted to screw over minorities. To me, a lot of those “good reasons” seem pretty dubious, like wanting to criminalize some fictional epidemic of nine-month abortions, or believing that Clinton was more corrupt than Trump. But, let’s say a given Trump voter’s reasons were perfectly legitimate and compelling. They still knowingly elected someone who has incited violence, maliciously slandered minority groups, bragged about committing sexual assault, defrauded contractors, and promised to commit war crimes and discriminate against Muslims. And probably a dozen other horrible things I forgot about, because there are too many to even keep track of.

Regardless of what good they got, or hoped to get, they’ve already caused harm, to the tune of over 700 incidents of harassment or hate crimes reported to the Southern Poverty Law Center. I personally know three people who’ve been targeted. One got a Facebook nastygram about how he should die of AIDS, another had slurs yelled at him at his home, and a third had her home spray-painted wtih swastikas and slurs. There are children being treated for anxiety who never had symptoms before the election, because they’re afraid that they or their parents will be thrown out of the country. There are victims of sexual assault being retraumatized and reminded that they live in a country that doesn’t believe them or care what happens to them.

That’s just the start. It doesn’t include the people who will go without healthcare, or end up in poverty (or worse poverty) due to medical bills when the ACA is repealed. Many of those people will die. It doesn’t include the women who will die if Roe is overturned, from self-induced abortion, or pregnancy complications, or suicide. It doesn’t include war crimes, or Muslim registries, or mass deportation, or global destabilization if we back out of our NATO commitments.

None of that harm is in any way affected by the intentions of the people who voted for it. Whether their intent was to vote for fascism and oppression, or whether their intent was to bring jobs back to the Rust Belt, the impact is the same.

To me, it’s kind of like the trolley problem. You know, the train is rushing toward five people, and you can throw the switch to hit only one. Or it’s rushing toward someone you know, and you can throw the switch to hit five strangers. There are lots of variations.

If you voted for Trump, whatever you valued was on one side of the track, and all those people I mentioned before were on the other. You might be able to make a convincing case for why you threw the switch. Maybe Fox News convinced you that all those other people on the track weren’t really there, but that you yourself would be hit by the train if you did nothing. Maybe you felt that being careless with potentially classified information was a complete dealbreaker, or you believe that Clinton was personally responsible for Benghazi.

Whatever your reasons, good, bad, or indifferent, you threw the switch. Hillary Clinton didn’t make you throw the switch, nor did “PC culture” or “identity politics” or whatever else you want to blame. And now you want all the people you sent the train towards to pretend that nothing has changed. To trust you, the same as they always have. To pretend that they aren’t currently tied to the train tracks, or that the train hasn’t run over their foot already. And you’re so concerned about your own good name that you’re wasting time arguing with them about how their being on the tracks has nothing to do with you, rather than, I don’t know, untying some of them? Maybe driving that guy with the broken foot to the hospital? John Pavlovitz has good suggestions on where to start.




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Immigrants, I’m Sorry…

I’m sorry.  I didn’t vote for the monster that is our president-elect, but I considered it in the beginning. I quickly decided against that choice.   Why did I want to vote Trump? I was inspired by Brexit. I was inspired by the rhetoric of people such as Nigel Farage. I don’t like th EU. […]

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Wednesday, 23 November 2016

Handling The Friends and Family Food Police

Guilt Free EatingThis post is a danceswithfat tradition, offered for those who may have to deal with inappropriate friend and family behavior during this “holiday season” (whether they are celebrating any holidays or not.)

Ah, is there anything more fun than being under surveillance by the Friends and Family Food Police?  There are only a couple of things that I can think of – root canal, shaving my head with a cheese grater, a fish hook in the eye…

This happens to almost all of my fat friends, but to be clear it happens to thin people too – food judgment and shaming happens to people of all sizes and it’s never ok.

I think that we need to remember that fat hate and body shaming is modeled for people all over our culture, fear of being fat is a driver of a lot of behaviors.

First, I always suggest that you be prepared for boundary setting when you go into this type of situation.  Think about what your boundaries are, and what consequences you are willing to enforce.   So think about what you would be willing to do – Leave the event?  Stay at a hotel?  Cease conversation until the person can treat you appropriately?  Be sure that you know what you want and that you can follow through.

As an example, I’ll use that age old shaming question “Do you need to eat that?”

This is such a loaded question. What do they mean by “need”? Are they asking if my glycogen stores are depleted? If I am near starvation?  If my body at this moment requires the precise nutrients that are delivered by cornbread stuffing and gravy? Or do they feel that fostering a relationship with food that is based on guilt and shame is in my best interest?

This question is custom-made to make someone feel ashamed.  I think it’s asked for one of about three reasons:

Judgment

The person asking the question has decided that it is their job to pass judgment on your activities.  Being too cowardly to directly state their opinion, they use this question as a mode of passive aggression to “make you admit it to yourself”.  This is one of those situations where they would probably claim to be mistreating you for your own good, also known around this blog as “Pulling a Jillian“.

If the person asking this question truly cared about you and your health (however misguided they might be), they would talk to you about it in person, alone, at an appropriate time, and they would ask a question that invited dialog, not try to embarrass you in front of people while you’re eating what is supposed to be a celebratory meal. That right there is some bullshit.

Power/Superiority

Remember that some people never psychologically got past Junior High and nothing makes them feel so powerful as judging someone else and then making them feel like crap. Maybe because they are drowning in…

Insecurity

The person asking the question perhaps struggles with weight stigma, their guilt about eating etc. and since they feel guilty for enjoying the food, they think that you should feel guilty about it too, or they want to deflect attention from their behavior to yours.

The degree of difficulty on discerning someone’s intent in this sort of thing can range from “of course” to “who the hell knows”. Here’s the thing though, from my perspective it doesn’t matter why they are asking it:  I am not ok with being asked, and I get to make that decision.

So you’re at a holiday meal, you take seconds on mashed potatoes and someone asks the dreaded question:  “Do you need to eat that?” It seems like the table falls silent, waiting for your reply.  What do you say?

If it’s me, first I quell my rage and resist the urge to put them down (Yes, I do need these mashed potatoes.  Did you need to be a total freaking jerk?)

Second, as with so many situations where people lash out at you, remember that this is about their issues and has nothing to do with you.   If emotions well up, consider that you may be feeling embarrassed and/or sorry for them, and not ashamed of your own actions.

Finally I suggest you find your happy (or at least your non-homicidal) place, and try one of these:

Quick and Simple (said with finality)

  • Yes (and then eat it)
  • No (and then eat it)

Answer with a Question (I find it really effective to ask these without malice, with a tone of pure curiosity.  If you’re not in the mood to have a dialog about this, maybe skip these.)

  • Why do you think that’s your business?
  • What led you to believe that I want you to police my food intake?
  • I thought that you were an accountant, are you also a dietitian?

Pointed Response (be ready with a consequence if the behavior continues)

  • I find that inappropriate and offensive, please don’t comment on my food choices
  • What I eat is none of your business, and your commenting on it is not ok
  • I have absolutely no interest in discussing my food intake with you
  • I’m not soliciting opinions about my food choices.

Cathartic (but probably not that useful if you want to create an opportunity for honest dialog)

  • Yes, because dealing with your rudeness is depleting my glycogen stores at an alarming rate
  • If I want to talk to the food police, I’ll call Pie-1-1
  • I’m sure you’re not proud of the completely inappropriate behavior you just exhibited, I’m willing to forget this ever happened
  • Thanks for trying to give me your insecurities, but I was really hoping to get a Wii this year
  • No, but using my fork to eat helps to keep me from stabbing you with it

I don’t believe that guilt is good for my health and I’m definitely resisting arrest by the Family and Friends Food Police.

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Monday, 21 November 2016

Stuff you should read: I’m with the people making sanctuary.

From I’m with the people making sanctuary  at Morgan Guyton’s Mercy Not Sacrifice blog:

As these conversations and spaces have been rolling around in my mind, I’m realizing that I’m much more a part of the circle that I held hands in Thursday night at Tulane than I am in the same movement with the “Suck it up, buttercup” Christians. I’m just not in communion with people who ridicule “safe space” and want a hard and austere gospel to feel awesome about. So I don’t know what that makes me. But I’m with the people making sanctuary.

I honestly believe that’s the main point of the cross. Jesus made himself unsafe so that those who are unsafe could have a body to join. I’ve been looking at Philippians 2 a lot lately. I read there that the point of emulating Jesus’ cruciform nature is to become entirely other-regarding. Verses 3 and 4 are how genuine safe space is created: “Do nothing from selfish ambition or conceit, but in humility regard others as better than yourselves. Let each of you look not to your own interests, but to the interests of others.” That’s what being cruciform looks like in practical terms. And I’ve seen many people do it in the past two weeks. Most of them haven’t been Christian.

If I hadn’t already been done with the evangelical church before this point, the election of Donald Trump, the gleeful crowing afterwards, and the shrugging dismissal of grief, fear, and pain would have done it for sure.

Like Morgan, I’m with the people making sanctuary, whoever they are and whatever they believe.  I try to do it in Jesus’ name, but if it springs from their Islamic or Jewish or Hindu faith, or from no faith at all but basic human decency, I’m good with that.

A few weeks ago, I went to one of Franklin Graham’s Decision America rallies to protest his hateful comments about gay children, inspired by Kathy Baldock, who has done the same. I had what might have been useful conversations with some of his fan club, though I’m not sure I convinced anyone of anything.

I was also standing next to the atheist protesters.  While I was going for a “God is love” approach, with my “God loves LGBT kids too” and “Gay Children are Not Your Enemy” signs, they were in full-on “Religion is Bullshit” mode with “Nothing fails like prayer” and other more mocking slogans.  And yet. They also had stuff against conversion therapy, stuff about how it was normal and natural to be gay, but that prejudice has to be taught.

Before I left, I thanked them for being there and got a solidarity fist-bump.  It was strange and sad to be surrounded by what used to be my crowd, my tribe, and feel more acceptance from the people who think I’m a dumbass for even believing in God.  But I’ll take honest disagreement, even outright scorn, over honeyed words and the kind of “love” that drives people to suicide.

But I’m not alone.  When I first left the evangelical church, I felt adrift and cast off.  I didn’t quite fit with the Quakers because I missed the music and Bible verses, and because I didn’t consider myself a pacifist. I’m still trying to figure out what my spiritual home is as far as actually attending religious services goes.  Right now, splitting between Quaker meetings and the Episcopal church seems to be working for me.  But, for the whole scope of my life outside Sunday morning, my place is wherever people are making sanctuary, and are willing to let me join them.




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Q&A About Chrissy Metz and Contractually Required Weight Loss

know fat chicks

Design by Kris Owen

Chrissy Metz is one of the stars of the television show This Is Us.  As is all too often the case, she plays a fat character who is “struggling with her weight”  As is less common, the contract she signed to play the character includes a requirement for weight loss.  She says:

In our contract, it did state that that would be a part of it, to lose the weight in the trajectory of the character as she comes to find herself. That was a win-win for me. Because it’s one thing to try to do it on your own. But as human beings, it’s an ego thing: We’re more likely to do something for someone else.

I just have to be very clear. Whether or not I lose weight or stay the same, it’s purely a choice of mine for health. Not because I think that plus-size, curvy, voluptuous, big bodies aren’t attractive — because I think they’re awesome and sexy.

So I’ll just have to make sure that’s known, because I’m not selling out the big girls. I don’t do that. That’s not me.

As this has been posted to social media by frustrated fat activists I’ve been seeing a lot of questions about why this is a problem, so I thought I would give my thoughts as to the answers:

Lots of fat people do want to lose weight, why are you complaining that her character is one of those fat people?

It’s a problem because almost every fat character who we see on television and in movies is fully invested in fat-hating diet culture. Representation matters, and the fact that almost all media representation of fat people is based on negative stereotypes and diet culture is a problem.  It means that we don’t have role models who look like us (and like looking like us,) and that nearly every time that fat-positive fat people find out that we are actually going to represented (which is, in and of itself, pretty rare in television and movies) it’s not long before we find out that the we aren’t going to be represented at all – the only fat people who are represented are fat people who don’t want to be fat any more.

There are plenty of fat people who aren’t interested in weight loss and we would like to see ourselves represented as well. It’s not just important for fat people, but also for everyone we interact with, whose beliefs and opinions about us are shaped by our media representations as self-loathing stereotypes.

She said that this is about her health, don’t you want her to be healthy?

She is allowed to do whatever she wants with her body for whatever her reasons are, and she is allowed to believe whatever she wants about health.  She is allowed to try to manipulate her body size even though the evidence suggests that the most likely outcome of her weight loss attempts is weight gain. But let’s be clear that she didn’t say that she was losing weight for her health. First she said she had to lose weight per the contract that she signed to be on a television show.  Then, later, she said that it was about her health.

Also when she says “That was a win-win for me. Because it’s one thing to try to do it on your own. But as human beings, it’s an ego thing: We’re more likely to do something for someone else. ” it makes it seem like that’s some kind of factual statement when, in fact, there is no reason to believe that being forced to lose weight for a contract or for “someone else” will have any more chance of long-term weight loss than any other motivation (which is to say, almost no chance at all.)

What will happen if she doesn’t lose weight?

This is a damn good question. She says it’s about her health but what will she be doing to lose the weight – especially if it’s a contractual obligation?  It’s bad enough to eat less than you need to survive in the hopes that you body will consume itself and become smaller, but we also know that over and over again doctors and pharmaceutical companies have been completely fine with killing fat people in attempts to make us smaller so I can only hope that this doesn’t spiral into something horrific just so that television can create yest another shitty “before and after” weight loss as self-discovery fatty story. And even if she is able to lose weight short term, if she’s like the vast majority of people who regain the weight, what will happen then?

She said that big bodies are awesome and sexy, why isn’t that enough for you?

It’s nice if she thinks that, but my fight isn’t just to be seen as beautiful or sexy, it’s to be seen as a human being and not a walking “before” picture. It’s about having the chance to get actual health care based on evidence-based interventions rather than being prescribed a bag of not-so-magical weight loss beans. It’s about fat people no longer being hired less and paid less than thin people with the same qualifications.  Being seen as sexy is nice, but what I’m talking about here is seeing people who look like me represented in media as fully actualized, non self-loathing human beings, rejecting diet culture and leading amazing lives.

But she says that she’s not selling out big people! She says it right there!

She may well believe that, and that’s great, but I don’t think her actions are necessarily in line with her goals here. If she really doesn’t want to sell out fat people she could say something like “I signed up to play a character with a weight loss trajectory and I agreed to be contractually obligated to manipulate my body size to portray that character.  I want to be clear that weight is not the same thing as health, and that neither weight loss nor health are an obligation, barometer of worthiness, entirely within our control, or guaranteed under any circumstances.  While I may choose to attempt weight loss, I understand that weight loss doesn’t make me better or worse than anyone else, and I also want to celebrate fat people who reject diet culture and live amazing lives in fat bodies.”

Once again, Chrissie Metz – like everyone – is allowed to do whatever she wants with her body for whatever reason she chooses, but that doesn’t mean that those choices don’t add to the diet culture that oppresses fat people. I wish her all the best and I hope that she will work hard to fully support fat people and to reject anti-fat culture even as she tries to manipulate her body size to fulfill her television contract.

Like this blog?  Here’s more cool stuff:

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

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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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Sunday, 20 November 2016

Moving through difficult times and a manifesto-in-progress

This time last month, I was chiding people on Twitter to not become politically complacent just because we’ll have a woman president.  Funny how your expectations can be pulled out from under you, isn’t it?  Not really funny ha-ha in this case, more funny sob-sob.  I can only imagine a lot of folks reading right now have been having similar reactions to the election of DJT, processing a lot of difficult emotions and wondering how to move forward as individuals, families, and communities.  

This time last month, I was trying to figure out how I want to wrap up the trope deep dive on fat man/thin woman romance storylines, but for the past two weeks or so, I’ve felt locked up.  Not only have I felt overwhelmed and struggling to prioritize, but I had a bit of an existential crisis over this blog.  (I’ve been having crises over lots of things, but I’m a gold-medal compartmentalizer and will focus on CPBS.)  If I’m being completely honest, this has been coming for a while.  I feel like I’m just hitting the same points over and over.  I’m not sure why I’m still at it.  Given that I’m feeling lost, for multiple reasons, I thought this would be a good chance to pause, step back. and think about my underlying reasons for continuing to write this blog, especially at this particular historical moment.  A Four of Swords post, if you’ll indulge a Tarot metaphor. (and if you are a fat-positive cinephile who reads Tarot: can we be friends please?)

Given the breadth and depth of issues that we as a country have to come to terms with, it felt/feels like cinematic representation of fat people is a topic that’s overly niche.  Thankfully, I received a jolt of inspiration from this thread on twitter from Ariel of Bad Fat Broads:

ariel-11-14ariel-11-14-2

I couldn’t have said it better myself, and definitely not in a handful of tweets.  The treatment of fat people connects to the treatment of other marginalized groups, and the fictional worlds that we see in films connect to how we understand the world we live in.  CPBS is inherently political.  My writing style tends to downplay that fact, I think, as I try to balance my critiques with giving you, the reader, space for your own reactions and analyses.  This is also the reason that I rarely linger on connections to my personal life.  But maybe that underlying premise gets lost.  

Problematic cinema doesn’t have the dire nature of situations like the Dakota Access Pipeline or the water crisis in Flint, Michigan.  However, even if art and entertainment don’t sustain us as organisms, they do sustain us as human beings.  How does it make you feel when you see a character in a movie that you relate to in a very specific and personal way, maybe an aspect of yourself that you don’t often think about or something you’ve never seen addressed before on film?  How does it feel when something very personal to you manifests on screen in an ignorant or cruel way?  And when that seems to be the only way you’re allowed to see it?  

And like any other institution in a kyriarchy, the film industry replicates the oppressive power dynamics in which it operates, leading to situations such as studios covering up sexual assault, racist casting practices, or workplace safety violations that lead to injury and death.  As with Ariel’s allusion to the concern about removal of access to health insurance, these dynamics play out in similar fashions across institutions.  Rape culture, racism, and worker exploitation are not solely found in the film industry, and neither is the marginalization of fat people.

These examples come from the act of making movies, but of course, this CPBS focuses on the movies themselves, specifically fictional narrative works.  As with all popular art, the politics of movies exist in a cycle with no easily defined beginning (if there is a beginning at all).  Specific ideas inform how films are produced, the films give audiences specific stories and images that normalize these ideas, some of those audience members make new films.  This cycle isn’t always a bad thing; my guess is you had your heart warmed this past Halloween at least once by a little girl in a Rey or Ghostbusters costume. Fictional movies can even be influential in changing how a society operates, such as Krzysztof Kieslowski’s A Short Film About Killing, which influenced the abolition of the death penalty in Poland.  CPBS is concerned with cinema as the outcome of established ideas about how people can be categorized, especially based on their physical attributes, especially especially who on the screen has the most adipose tissue.  If you didn’t know already.

But even if we don’t have cinema, in most situations, we have stories.  The stories that we tell speak to who we are.  There are explicit examples, of course, like stories containing moral lessons or commemorating historical events, but no story, and certainly no film, exists in a cultural vaccum.  Our stories contain patterns, which often turn into tropes or cliches, the kind of thing we see so often that our minds jump to an expectation without a second thought.  An example of this that I love is Richard Linklater’s Boyhood.  In this unique blend of a longitudinal case study and hangout film, there are two scenes where protagonist Mason (Ellar Coltrane) is engaged in risky behavior– playing with circular saw blades, and texting while driving.  Although the almost-three-hour movie establishes from the start that Mason’s life does not contain extraordinary conflict, as an audience member, I found myself growing very tense during these moments.  Why?  Because from the educational shorts I was shown in grade school to the moody indie dramas I snootily absorb as an adult, I have been conditioned to expect the direst of consequences from poor decision-making.  Even if a more conventional story beat isn’t created explicitly to warn of the potential dangerous outcomes of a behavior, it does speak to the standard desire for situations in movies to be at the extremes of human experience.  This is also true for characters, mired in their own cycle of expectations around what the embodiments of various tropes look like.  We conflate personality with physical features.   Who is the hero?  With whom are we invited to empathise?  Who is in the position of receiving our scorn?  Our pity?  Our revulsion?  A lot of the time, we know who these characters are without having to be explicitly told.  CPBS is concerned with the audience expectations that exist when a fat person is in a movie, and how films satisfy or subvert those expectations.

I’ve spent my whole life in the USA, and I’ve only been spending it since the early 80s.  I don’t know what it’s like to live outside this cultural and political context.  While I am critical of it on many levels, I have trouble imagining what the alternatives would look like, especially when it comes to art.  But I don’t believe that a truly just society would normalize the commodification of bodies; relative to this blog is artists’ bodies being objectified by the demand for profitable entertainment, instead of purely being implemented as a medium for expression.  Athletes in contact sports put themselves at risk of fatal injuries, intensified by the pressure to be stronger, faster, more intense, while the institution minimizes knowledge of the risk.  Sex workers whose labor revolves around performance are frequently subject to requests or demands that transgress their professional boundaries.  Transgender women are often used as joke fodder on the screen and often subject to violence and discrimination in real life.  People who work in arts & entertainment are subject to harsh criticism of their bodies, demands for regulation, perfection.  One doesn’t have to look further than the magazine rack at the average supermarket checkout lane to see that sensationalized narratives get written onto bodies as famous people shockingly gain weight, lose weight, age, get sick, or get pregnant.  Bodies are measured, judged, categorized, for their entertainment value, which often eclipses being seen as an equal.  Performance has paradoxical powers of distancing us from the people we are watching and giving us an opportunity to know their experiences.  CPBS is concerned with discerning how and when films invite objectification of or empathy for fat characters.  One work can even do both, depending on the approach of the audience.  Take for example Hamilton, the Broadway sensation that I respect but don’t have much interest in.  Many people of color feel empowered by seeing themselves in the kind of historical narrative they’re often excluded from, in a performance space that they are similarly often excluded from.  On the other hand, consider this weekend’s backlash against the Broadway cast for politely confronting the VP elect when he was in the audience, a man who believes in policies that would cause direct harm to the people he sees fit to provide him with an evening’s entertainment.

The last point that I want to make about what I strive for in this film has already been alluded to, as far as parallels between struggles and keeping a realistic perspective on how cinema fits into a larger cultural landscape.  To refer again to Ariel’s tweets, people don’t exist as one identity, and bigoted mindsets aren’t usually contained to one specific group.  CPBS strives for an intersectional analysis, maintaining awareness of how other social categorizations exist in the films discussed, and how fatness exists in conjunction with these other categories.  Not only is this approach realistic to who people actually are, it helps to look at what it means to be a fat character.  For example, consider how fatness impacts gender, often counterbalancing traditional masculinity with the suggestion of domesticity and sensitivity, and subverting traditional femininity by prioritizing the pursuit of one’s own pleasure over self-restraint and adherence to standards.

Maintaining the progress that we and our forebears have made towards living free and dignified lives requires constant maintenance.  That includes being able to analyze the media that we consume, demanding that our culture recognizes us as fully human, and seeing others in that light as well.  It’s my hope that this blog will contribute to your engagement with those tasks in some way.



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It’s a cold and it’s a broken hallelujah

As a tribute to both Clinton’s loss in the election and Leonard Cohen’s passing, Kelly McKinnon, who plays Clinton on Saturday Night Live, performed Hallelujah. It was, of course, depressing, but managed to still be hopeful.  “I’m not giving up,” she said at the end.  “And neither should you.”  She also included a verse that I haven’t heard in other covers of Hallelujah, which fit perfectly:

I did my best, it wasn’t much
I couldn’t feel, so I tried to touch
I’ve told the truth, I didn’t come to fool you
And even though it all went wrong
I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah

Since Leonard Cohen passed, and Hallelujah was played all over, I’ve been hearing a lot of versions lately.  And I was reminded how much I flipping *hate* “A Hallelujah Christmas”. Taken by itself as a contemporary Christian Christmas song, it’s not bad.  Kind of blah and predictable lyrics, but the chorus of hallelujahs is pretty.  I can see why they wanted to use it as a Christmas song. But as a reworking of an existing song, it bothers me on multiple levels.

First, Hallelujah in its original version wasn’t a Christian song.  It was written by a practicing Jewish guy, and while it was full of religious imagery, none of it was New Testament or specifically Christian.  David writing Psalms, David and Bathsheba, Samson and Delilah.  So, turning it into a Christmas song seems really disrespectful.  Sure, making popular songs into Christmas songs is a venerable tradition, but the author of Greensleeves was probably a Christian.

“A Hallelujah Christmas” is also just not as good as the original.  There’s no metaphor, no symbolism, just a straight retelling of the Christmas story. It would’ve worked just as well with its own melody (and probably wouldn’t have botched the rhyme scheme).  So, it seems kind of sad to take a song that’s subtle and sad and angry and full of imagery and turn it into something tired and cliched.

It also seems like a cop-out to write something that’s almost a parody but not quite, reusing lyrics in ways that aren’t really interesting. Particularly taking an ironic use of “hallelujah” and turning it into a straight up “Praise God.” Not that there’s anything *wrong* with praise music.  I really like the Hallelujah chorus from Handel’s Messiah.  I also like the alleluia version of Amazing Grace.  But those don’t take a song that’s harsh and messy and complicated and dumb it down in the process of Christianizing it.




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Friday, 18 November 2016

Fashion for Good and Evil

Biscuit doesn't care about flatteringAlysse Dalessandro is the designer, entrepreneur, and general badass behind Ready To Starea body positive clothing company that sells clothes from small to 5xl all at the same price, using diverse models.  In short Alysse uses fashion for good – for empowerment and size diversity activism, and encouraging people to find and rock their own personal style, which is awesome.  She posted the following picture to Facebook, highlighting some wide-calf thigh high boots she found that her readers had been requesting.

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Because she looks so damn fierce, this post got shared around Facebook.  And that’s when it ran into people who use fashion for evil. When I say evil, I mean people who use fashion to put other people down,  judge other people, and try to enforce body-negative, anti-fat stereotypes of beauty, including and especially using the coded concept of “flattering.”

We tend to see these comments, well, basically anytime a fat person posts a picture of themselves wearing an outfit that isn’t all black and designed to be “slimming.” There are lots of ways that people make this mistake – and it’s a mistake that’s encouraged by a fatphobic culture – so I thought I would take some time today and dissect one of the comments that managed to commit all of the mistakes at once.

I’m a big girl myself and I think those boots are horrible and way too tight, I understand embracing plus size etc but them boots and the whole style makes me feel uncomfortable. It looks so unattractive. But I suppose as long as she’s comfortable and happy that is all that matters.

Let’s break this down:

I’m a big girl myself

Internalized fatphobia is real.  It happens when fat people live in a fatphobic society and accept the opinions and messages of their stigmatizers, bullies, and oppressors as valid. They take this to the next level when they choose to become a stigmatizer, bully, and oppressor by engaging in anti-fat sentiment, like this comment. Often they aren’t even fully aware of what they are doing or how it hurts people because fatphobia is modeled so ubiquitously in our culture as normal.

Consequently,there may be plenty of fat people who are willing to participate in fatphobia, but that doesn’t make fatphobia any more valid, or any less oppressive and wrong.

I think those boots are horrible and way too tight, I understand embracing plus size etc but them boots and the whole style makes me feel uncomfortable.

At this point I want to remind you that Alysse captioned her picture “Since everyone always asks where I got these boots – I found some similar ones!”  and did not caption it “Please take this opportunity to direct your fatphobia (internalized or otherwise) at me.”

Sounds like maybe this person doesn’t “understand embracing plus size etc.” It’s ok to choose to wear clothes based on whatever your reasons might be.  It’s ok to dislike someone’s outfit, but there’s really no need to say (or write) it out loud, unless you feel that it’s important for you to vocally police other fat people who refuse to bow to the strictures of diet culture and/or choose to dress differently than you.

If someone’s outfit makes us feel uncomfortable, that might be a good indicator that it’s time for some self-work, not a Facebook comment. Either way, if someone doesn’t ask for our negative opinion about their outfit, there is literally no good reason in the world for us to give it.

It looks so unattractive.

Again, if we don’t like it, we should feel free not to wear it, but let’s not pretend that we are the arbiters of what is and is not attractive.  And let’s not forget that “attractive” is another coded word that, when used about fat people, all-too-often means  “slimming” or “making one look as tall and thin as possible.”  What is and is not attractive is subjective, so unless there is a ceremony appointing us the judge of attractiveness (and if there is, I would hold out for a glittery gavel) our opinion of what is attractive is a great way for us to decide what to wear, and has nothing to do with what other people wear.

But I suppose as long as she’s comfortable and happy that is all that matters.

Note that the person feels free to criticize the outfit and call it “unattractive” as if that is fact,  but couches this – the only factual statement in the bunch – with “I suppose…”

If the commenter understands this – and I sincerely hope they do –  then they should also understand that there was no point to voicing the rest of the comment, other than to put another fat person down in the service of fatphobia, which is the last thing that we need.

It’s difficult to be live in a fatphobic society, and it’s easy to get caught in the trap of fatphobia (including internalized fatphobia.) So here’s one concrete action we can take: that if we see a fat person wearing an outfit we don’t like, it’s perfectly fine to decide that it’s not to our taste, it’s perfectly fine to take a pass on wearing it, but we can also choose to keep our negative thoughts to ourselves, thereby making sure that we don’t add to the epic load of fatphobic BS that we have to deal with already.

Like this blog?  Here’s more cool stuff:

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

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

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

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

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

 

 

 

 

 

 



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