Saturday, 19 August 2017

Be Principled Without Being a Sucker

I’m still pretty sick over Charlottesville, and right now there’s a lot of argument about the principle of free speech as it applies to white supremacists.

The “Unite the Right” rally was initially moved from downtown Emancipation Park to a larger park outside of downtown for safety reasons, but the ACLU challenged that. On free speech grounds, they made sure that the rally went on as planned. If it had been a peaceful rally, that might have been fine.  But the intent was never a peaceful rally. The heavily armed white supremacist groups surrounded a church, trapping people inside.  They stalked and harassed people. They beat them with pipes, attacked them with torches, and ran over them with a car. Richard Spencer described the rally as “a huge moral victory in terms of the show of force.”

Essentially, a violent white supremacist group conned the ACLU into supporting them with talk of free speech and peaceful assembly. My understanding is that between organizers making violent threats and public discussion of plans to come heavily armed, this should have been apparent to the ACLU. But whether it was or wasn’t, Nazis and the KKK did a bang-up job of using the banner of “free speech” to threaten and assault a lot more people than they would have if their rally had been in the alternate park, which wasn’t in downtown.

The ACLU initially claimed that it was in no way responsible for the violence, but later stated that it would start looking more closely at rallies asking for ACLU support and would not represent protesters who want to carry firearms. This seems pretty reasonable to me. The First Amendment includes a right “to peaceably assemble,” not “to show up better armed than the local police and beat the shit out of counterprotesters.”

It also seems to me to be an indicator of a lot of larger problems. One that’s been discussed a lot is the way Donald Trump is supporting and encouraging racism, but the larger problem I want to talk about is more abstract.  It’s basically this: No principle, no matter how noble, is immune to being abused by manipulative people. Abusers and manipulators of all stripes, from a controlling partner to someone who doesn’t want to pull their weight at work or school to literal Nazis and Klansmen who want to literally murder every Black or Jewish person in the country, are all really good at taking good things and twisting them.

To me, this means two things. First, the fact that something can be abused can’t make it bad, because *everything* can be abused. Secondly, having good principles doesn’t absolve you from being smart and savvy about how you adhere to those principles. If, for example, you work for the ACLU and are asked to defend a rally, do your best to find out whether these are people who want to peacefully express their ideas (good, bad, or genocidal) or a heavily armed mob intent on violence.

Or, to put it in D&D alignment terms, because I’m a geek like that, it’s not enough to just be lawful. Evil people will get your support for their evil by appealing to your lawful principles. If you want to be lawful good or even lawful neutral, you need to think really critically about the motivations of people who are trying to appeal to your principles.




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Wednesday, 16 August 2017

Fatshion: Palm Springs Looks

Hey friends. How are you all holding up? This is a tough time for the US (not that this is new but still). The alt-right fascist push-back we get from any progress we make is disgusting but not...

Read more here!

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Saturday, 12 August 2017

VBAC Prediction Models: Actual Results are Better than Predicted

Original checklist by Melek Speros

Many women with a prior cesarean who want a Vaginal Birth After Cesarean (VBAC) are counseled that they are not "good candidates" for a trial of labor because a VBAC Prediction Model suggests that they have a very low chance of VBAC "success."

In particular, the MFMU VBAC Prediction Model considers weight a strong negative predictive factor for VBAC. As a result, many obese women are told that their chances for VBAC are very low, implying they might as well just sign up for the repeat cesarean now. Many doctors strongly discourage VBAC in women with a high Body Mass Index (BMI). Some hospitals and practices even have BMI restrictions on who is allowed to have a Trial of Labor After Cesarean (TOLAC).

Similarly, many women of color are discouraged from pursuing a VBAC because they are told that they have a lower chance of success. Imagine the negative pressure against VBAC when these two factors intersect in a high BMI woman of color!

However, a recent study from UCLA actually examined how predictive this model was in their institution. They found that it was highly accurate for women predicted to have a very strong chance of VBAC. But to their surprise, they found it was NOT that accurate for women predicted to have a low or moderate chance of VBAC.

The difference was particularly striking for those predicted to have a low chance of a VBAC. 57% of this group actually had a VBAC, when only 29% were predicted to have one, nearly twice the expected rate. 

Of particular note, the authors also documented that, unlike the MFMU prediction model, neither BMI nor ethnicity were associated with lower rates of VBACs in their institution. 

This is especially meaningful to the many women of color and women of size who have been actively discouraged from pursuing a VBAC because of the MFMU prediction model. It also suggests to me that risk perception and the way women are managed in labor (higher induction rates and a lower surgical threshold are common in TOLAC in high BMI women, for example) may influence VBAC "success."

Personally, my VBAC prediction scores were extremely low (22%!) due to multiple risk factors, yet I went on to have not one but two VBACs. If I had let negative predictions discourage me, I would have missed out on my VBACs and their easier recoveries, and I would have been exposed to increased risk for placenta previa and accreta by having additional scars on my uterus.

I know from my work with the International Cesarean Awareness Network (ICAN) that many women are told they have a poor chance at a VBAC and yet go on to have a VBAC anyhow. In fact, few women meet all the "ideal conditions" for VBAC success, yet most will go on to have a VBAC.

If you have been told that you are not a good candidate for VBAC because of your BMI, your race, or various other factors, remember this study and the anecdotal experience of so many women in ICAN. It's okay to consider risk factors, but don't let them overly influence your decision. Group risk factors don't predict what will happen with any one individual. 

No one can guarantee you a VBAC, but neither can anyone reliably predict who will not have a VBAC when given a fair and adequate chance to labor. As the authors conclude in the UCLA study:
As part of efforts to safely decrease cesarean rates in the United States, patients interested in TOLAC (and their providers) should not be discouraged by a low predicted success score.

Reference

AJP Rep. 2017 Jan;7(1):e31-e38. doi: 10.1055/s-0037-1599129. Validation of a Prediction Model for Vaginal Birth after Cesarean Delivery Reveals Unexpected Success in a Diverse American Population. Maykin MM, Mularz AJ, Lee LK, Valderramos SG. PMID: 28255520  Full free text here.
OBJECTIVE: To investigate the validity of a prediction model for success of vaginal birth after cesarean delivery (VBAC) in an ethnically diverse population. METHODS: We performed a retrospective cohort study of women admitted at a single academic institution for a trial of labor after cesarean from May 2007 to January 2015. Individual predicted success rates were calculated using the Maternal-Fetal Medicine Units Network prediction model. Participants were stratified into three probability-of-success groups: low (<35%), moderate (35-65%), and high (>65%). The actual versus predicted success rates were compared. RESULTS: In total, 568 women met inclusion criteria. Successful VBAC occurred in 402 (71%), compared with a predicted success rate of 66% (p = 0.016). Actual VBAC success rates were higher than predicted by the model in the low (57 vs. 29%; p < 0.001) and moderate (61 vs. 52%; p = 0.003) groups. In the high probability group, the observed and predicted VBAC rates were the same (79%). CONCLUSION: When the predicted success rate was above 65%, the model was highly accurate. In contrast, for women with predicted success rates <35%, actual VBAC rates were nearly twofold higher in our population, suggesting that they should not be discouraged by a low prediction score.



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Wednesday, 9 August 2017

“It’s Not a Diet It’s a Lifestyle Change” is Bullshit

Talking NonsenseYou’ve heard it. I’ve heard it. We’ve all heard it. Back in my dieting days before I did my research I believed it. The secret to lasting weight loss, they say, is that you can’t go on a diet, you have to make a lifestyle change.

This is total, complete, utter bullshit. It’s a lifestyle change alright – you change to a lifestyle where you’re dieting all the time, and it still doesn’t work.  One of the big issues that the weight loss industry has created is a world where any weight loss claim said with authority that sounds even remotely plausible is accepted and repeated as proven fact.  Even in the world of peer-reviewed research, incredible liberties are given to weight loss research when it comes to not have to support their assumptions with evidence.

I was on a panel at a very prestigious school for their Eating Disorder Awareness Week. At one point the school’s dietitian who was on the panel said that the reason people don’t maintain weight loss is that they lose the weight too fast, that you you should lose 1/2 pound a week and then you would keep the weight off. I wasn’t surprised to hear it, there have been versions of this going around since I was a kid.

I knew that the students at the school were super smart and data driven so I said “I must have missed those studies, , who conducted the research.”  She stammered for a moment, then said “Oh, there isn’t any research.” Had I not been there those students would have heard only from a professional dietitian employed by their school authoritatively telling them that they could achieve lasting weight loss by losing 1/2 pound a week as if she was stating a fact, despite having not a shred of evidence to back up her claim.

I think that one of the hardest things we have to come to grips with as we get off the diet roller coaster and start a non-diet path is the sheer number of times we’ve been lied to, and the extraordinary breadth and depth of people who have done the lying.  Some because they believe t the lies, some because they want to believe the lies (despite that fact that they’ve been weight cycling for years), some because they want clicks on their site and they know that anti-fat articles are always good for that, and many, many of them for profit.

I hear about far too many people who, on their death bed, regret having spent their entire life dieting. In order to break free of the diet and weight loss paradigm that holds us down we have to see it for what it is – a lie, created on lies, supported by lies, and perpetuated by those who lie for profit.  It’s a Galileo issue – the idea that anyone who tries hard enough to lose weight can do it is widely believed, supported fervently with religious zeal, and not at all supported by the evidence.

My life got better immensely and immediately when I stopped buying the lies that I could manipulate my body size, and that doing so was a worthy pursuit in the first place. When it comes to diet culture, that’s the only lifestyle change that I’m interested in.

Ready to put an end to diet culture? Then join us for the Fat Activism Conference:

Click Here to Register for the Fat Activism Conference

The Fat Activism Conference is all online, so you can listen by phone or on your computer wherever you are.  Plus you get recordings and transcripts of each talk so you can listen and read live and/or on your own schedule. The conference is happening October 6-8, 2017!

If you enjoy this blog, consider becoming a member or making a contribution.

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!

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



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Thursday, 3 August 2017

When Healthy Eating Is Anything But

Do I need to eat this-We live in a culture where people mistake the stereotype of beauty for everything from morality, to work ethic, to healthcare qualifications. One of the places this becomes the most apparent is in celebrity diet culture. There isn’t a single study where more than a tiny fraction of people have maintained any amount of weight loss long term (and even among those, the weight lost is incredibly small), but we’re supposed to believe that because someone is thin and talented, they hold the secret to weight loss and/or healthy eating — and let’s remember that these are most definitely two different things.

We also live in a culture that encourages us to have a seriously messed up relationship with food. Chips are a “guilty pleasure,” but baked chips are “guilt free?” Desserts are “decadent” and vegetables are “clean” (and I don’t mean given a good scrub in the sink).

I have seen “clean eating” defined as everything from a cock-full-o-meat paleo diet, to a vegan diet and plenty of eating plans in between. I’m “good” if I eat some broccoli, but “bad” if I eat it with cheese sauce.

Then there’s our society’s bizarre insistence that we make all food into a performance — from the obligatory “This is so much food, I could never eat all of this” we’re obliged to say when our plate comes in a restaurant, to our tendency to discuss why we are or aren’t eating a particular food (and I’m not talking about in the context of allergies or sensitivities). Or how many minutes on the treadmill we feel we have to do to “make up” for eating whatever we’re eating, how “good” or “bad” we are being with our food choices.

And we have these discussions with whatever rando strangers are also in line at Chipotle.

Combine those three things and you get the total cock up that is celebrity diet culture. In his piece “Clean eating websites like Gwyneth Paltrow’s Goop ‘indistinguishable from pro anorexia sites,’” Dr Christian Jessen wrote:

Click here to read my full piece!

Ready to wave goodbye to celebrity diet culture and all the nasty stuff that comes with it?

Click Here to Register for the Fat Activism Conference

The Fat Activism Conference is all online, so you can listen by phone or on your computer wherever you are.  Plus you get recordings and transcripts of each talk so you can listen and read live and/or on your own schedule. The conference is happening October 6-8, 2017!

If you enjoy this blog, consider becoming a member or making a contribution.

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!

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



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Wednesday, 2 August 2017

Do Body Positive Spaces Have to Allow Weight Loss Talk?

What Will you DefendThis question comes up a lot in a lot of different ways.  For our purposes today “weight loss talk” includes any discussion of the desire, reasons, and/or process by which someone wants to manipulate their body to be smaller.

So, that brings us back to our questions: Do fat positive spaces have to allow weight loss talk?

Short answer:  No.

Slightly longer answer: Hell no.

Long answer:

People are allowed to do whatever they want with their bodies – but that doesn’t make every choice people make appropriate for fat acceptance (or even the co-opted and watered down concept of “body positive”) spaces.

While no two oppressions are exactly comparable, as a woman who is both queer and fat, I liken this to someone who wants to have “reparative therapy” to try to become straight. They are allowed to do that, but they should not expect that discussion of their desire, reasons, or process of becoming not queer would be welcome in queer positive spaces. Similarly, it’s completely appropriate – and, in fact, absolutely necessary – that we have fat positive/body positive spaces that do not allow weight loss talk of any kind.

Social justice works in systems, and fatphobia is rooted in systems that include sizeism, healthism, and ableism. Health, ability, and body size are not obligations, barometers of worthiness, or entirely within our control. Insisting that they be prioritized and/or used to judge the goodness/worthiness of a body adds to oppression. The message that bodies are better if they are manipulated to be a different size adds to oppression. If we want to dismantle systems of sizeism, healthism, and ableism, then we need to vastly change the way we talk about size, health, and dis/ability and ending weight loss talk is a big part of that.

Ready for a world that affirms body of all sizes? Join us for the Fat Activism Conference:

Click Here to Register for the Fat Activism Conference

The Fat Activism Conference is all online, so you can listen by phone or on your computer wherever you are.  Plus you get recordings and transcripts of each talk so you can listen and read live and/or on your own schedule. The conference is happening October 6-8, 2017!

If you enjoy this blog, consider becoming a member or making a contribution.

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!

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



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