Tuesday, 31 January 2017

The Fat Shaming of Miss Universe Canada

no-fine-printSiera Bearchell represented Canada in the Miss Universe Pageant.  A reporter at a media event recent asked her “How does it feel to be so much… larger than the other delegates?”

She has been publicizing the fat shaming that she receives, and recently posted “I have a vision to redefine beauty. I have a vision in which women around the world will recognize that true beauty, validation and self-worth start from within.”

I applaud her for what she’s saying and doing (and for not going with the extremely damaging “I’m not fat” defense.) And I encourage her to really mean it by including every body in her work. Too often when people talk about body positivity or redefining beauty, they have limitations and exclusions in the fine print – only certain skin colors, only certain shapes, only certain sizes.  If we are redefining beauty then our redefinition has to include and center the voices of:

  • People of Color
  • Fat people (with absolutely no limits or caveats about size or “health”)
  • Trans and non-binary people
  • Disabled people/people with disabilities
  • Non “hourglass” bodies
  • People who don’t meet current cultural stereotypes of attractiveness
  • People who don’t care about (or can’t afford) clothes that are “in fashion”
  • People who don’t want to (or can’t afford to) wear makeup
  • People who live at the intersections of these identities

We need to be done with concepts about “body positivity” and “beauty” that come with a bunch of exclusions and limitations (based on things like racism, healthism, ableism and sizeism, and classism.) I hope that Siera Bearchell will be part of the no fine print movement that we need to be.

miss-canada-2 miss-canada

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Monday, 30 January 2017

We Are Not Too Much

the-questionThe phrase “You are too much!” is usually used when someone goes out of their way to help you, or says something really funny, or does something out of the ordinary.  “You are too much!” is typically a good thing, a compliment.

In our culture fat people hear that we’re too much all the time, but absent the complimentary nature. It’s not just those who describe our bodies as fleshy castles or whatever ridiculous fat bashing BS they’re saying.  It’s ingrained in the language – overweight, extra space, plus size.  The (massively mistaken) idea being that there are people who deserve to live in a world in which they fit, but at some point (a point which is pretty arbitrarily assigned and different based on who you talk to, or what plane you’re on) we lose that right.

I’ve talked about this phenomenon, including the fact that it’s acceptable for hospitals – which were built and stocked by people who knew full well that fat people exist – are allowed to simply shrug and tell me that they don’t have beds, or blood pressure cuffs, or equipment, or chairs, or crutches, or wheelchairs, or whatever, that fit me. In a fat hate forum someone said that my saying that fat people should have beds that fit us in hospitals shows that we want the world to “bend over backwards for us.”

I’m here to suggest that we do not have to buy into, or feel bad about, this bullshit argument.  The question shouldn’t be “why does that fatty have the audacity to suggest that those who provide medical care to the community should have equipment to treat her?”  The question should be “How come I can go into any hospital and expect that they’ll have equipment to treat me, but fat people can’t?”  A nice follow up question would be “How can I help correct that?”

We are not too much.  The world is not yet enough.

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Friday, 27 January 2017

Justice for Debbie Johnson – City Council Woman and Upskirt Photo Victim

debbie-johnsonDebbie Johnson is a City Council member in Port Wentworth, Georgia.  She is also a Black, plus size, woman – in fact, she is the first Black woman in the council of all white men. In 2015, during a closed session meeting Ernie Stanhope, another member of the city council, took an upskirt picture of her and shared it around with men including the city attorney and the mayor (who is aptly nicknamed “Pig.”) Then Eric Steely, a political opponent of Ms. Johnson, upped the ante by posting it to Facebook complete with lies and derogatory statements about her. None of the men told her that the picture was being circulated.

The picture went viral and ended up on the front page of the local paper, and on the evening news. That led to a police investigation in which the mayor (who, seriously y’all, goes by “Pig”) chose to obstruct the investigation by refusing to reveal who took the picture. He finally gave up Ernie Stanhope in a follow-up interview. He said “If this does get out, I ain’t gonna be the one that’s gonna be held responsible for it.” Well said, Pig.

Ernie Stanhope sat with his legs wide open and tried to suggest that it was her fault that he took the picture because she was sitting with her legs wide open.

City Attorney Eric Gotwalt brought his own attorney to the proceedings and when asked about the picture requested to take a break. Then it appears he tried to claim that his looking at the picture was an act protected by attorney client privilege.  When asked if we was representing the mayor or the city he responded “I think we represent both.”  He thinks…I’m sure that’s confidence inspiring for both the mayor and the city.

Eric Steely lied about the picture’s origin and then tried to suggest that it was Ms. Johnson’s fault that the picture existed saying: “I could constitute that as a deliberate attempt at public indecency.” Though it’s not clear by what authority he might “constitute” that.

The investigator then asked “What purpose would it serve for her to do that?”

Eric went with the “she was asking for it” defense, claiming “I could sit here and say she has some kind of perverted sexual fantasy and that satisfied it.” Of course that means that Eric’s response to finding out about what he considers to be a sexual predator out there exposing herself is to post an upskirt picture of her to Facebook, captioned with lies and derogatory statements. What a fine upstanding citizen he is.

Ms. Johnson wants to pursue the matter but District Attorney Meg Heap refused to press charges. Ms. Johnson describes it as being repeatedly violated, at every Council meeting. In discussing Meg’s refusal to press charges Ms. Johnson points out:

I’m a black woman that was violated by all white men. What if it had happened to her and it was Black men?  If Black men were violating her? They would be underneath the jail.

I appreciate her pointing out how systemic racism and privilege are at work here. As a Fat Activist I wonder, too, how this might have played out had she not been plus size?

Mayor Pig said ““When I started thinking, I said well again, Miss Johnson being a big woman can’t cross her legs and the picture says it all. ”

This is an example of what we talk about when we talk about intersectionality as coined by Kimberlé Williams Crenshaw. Ms. Johnson is being violated and oppressed by white men at the intersections of being Black, plus-size, and a woman.

She is being represented by The Claiborne Firm, which takes on civil rights cases including, according to their website “cases under the federal civil rights statute after excessive use of force by law enforcement officers and denial of medical care by corrections officers and private contractors.”

Her attorneys are asking for our help:

Call City Hall: 912-964-4379

  • Demand the removal of City Attorney Eric Gotwalt and his firm
  • Demand the resignation of  (seriously can’t believe I’m typing this) Mayor Pig Jones

Contact District Attorney Meg Heap: 912-652-7328 mdheap@chathamcounty.org 

Share this information with your community.

You can find more information about the case here and in this video:

http://ift.tt/2jEGdVr

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Wednesday, 25 January 2017

Kitties and Puppies

Pile of Cute

I’m still dragging after this weekend, so instead of any actual content, please enjoy this picture of lazy critters. Maybe I’d be better rested if there was room for me on that couch.

Also, shout out to Erin Lynn Jeffreys Hodges, who is awesome!

 




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A Woman's Place is in the Resistance

How much things can change in just a week! Since Trump's inauguration on Friday, America has been going downhill far more rapidly than I ever thought possible. How is it that one man can undo so much of what was achieved in the last 8 years?

To comfort myself I repeat an old teaching: The world only spins forward. The long arc of history shows our progression and looking back we'll see what's to come, the next four years, as a blot of ink on another-wise bright page of progress. We've accomplished so much in the last 100 years it's stunning, and one Cheeto-Skinned fascist can't undo it all. Millions of people came together on Saturday for the Women's March to say NO to what's come before and YES to a better world for themselves and their children's children's children.

I say yes to compassion, love and empathy for all people, but I embrace Punch a Nazi Day because punching a Nazi is always in self-defense-just make sure they're an actual Nazi, not just someone you don't disagree with.

I say yes to slowing, stopping and if possible, reversing climate change. It's not an alternative fact that the world is getting hotter, the oceans more acidic, the seas rising. We must stop it or another mass extinction is on the horizon.

I say yes to healthcare for all, clean water and air for all, housing and food for all. We could do this already but some of us are greedy. We need to mobilize and fix the systems, build our own gardens, plant our own trees. It's clear that the governments, in the pocket of the corporations, wont be helping.

Act locally and think globally.

Resist.



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Low Prenatal Weight Gain Does Not Prevent Blood Pressure Issues in "Obese" Women


One idea often promoted by care providers is that keeping prenatal weight gains to the minimum possible or losing weight in pregnancy will prevent blood pressure issues (Gestational Hypertension or Pre-Eclampsia) in "obese" women.

One of the most dreaded complications of pregnancy is blood pressure issues like GHTN and PE, and obese women really are at increased risk for these complications. It is understandable that care providers want to try to prevent that if at all possible.

However, here is a recent study that shows that losing weight and very low gains in pregnancy did not lower the rate of Gestational Hypertention (GHTN) or Pre-Eclampsia (PE) in obese women.

This is important because, as we have discussed before, more and more providers are zeroing in on weight gain in pregnancy as a way to try and prevent complications in higher weight women.

There have been studies which found that lower weight gains were correlated with lower rates of pre-eclampsia, and higher gains with higher rates of pre-eclampsia. However, this doesn't mean that deliberately restricting weight gain prevents PE. As Nohr 2008 states:
Any causal interpretation of the association between total weight gain and these complications is limited. For preeclampsia, high total gain most likely reflects pathologic fluid retention as part of the disease.
In other words, just because very low gain is associated with less pre-eclampsia, it does not follow that making women gain very little weight during pregnancy will prevent pre-eclampsia. Instead, higher weight gain is usually simply a side effect of pre-eclampsia due to the fluid retention and swelling common to pre-eclampsia.

Despite this, many caregivers imply that women can prevent pre-eclampsia by controlling their weight gain during pregnancy. Some are resorting to "scorched earth" tactics, including some truly frightening and extreme nutritional advice, or by encouraging women to lose weight during pregnancy.

This latest study shows that blood pressure issues in pregnancy can't be reliably prevented by having obese women gain minimally or even by losing weight while pregnant. 

Care providers should not be putting higher-weight women on extreme restrictions while pregnant, nor should they be expecting them to lose weight.

Too many care providers see weight gain within recommended limits as a surrogate marker of a woman's nutrition and exercise habits. Women can gain "appropriately" and still have terrible nutrition, and women can gain above or below the recommended limits and still have great nutrition and habits. Discussions about weight gain in pregnancy need to move beyond the scale.

While it's perfectly appropriate to inform higher-weight women of the most optimal prenatal weight gain range to shoot for and to give them reasonable counseling about how to do so, it's much more important to emphasize great nutrition and regular exercise. Then trust the woman's body to gain what it needs to gain for that pregnancy.


Reference

Am J Perinatol. 2014 Dec 8. [Epub ahead of print] The Influence of Gestational Weight Gain on the Development of Gestational Hypertension in Obese Women. Barton JR, Joy SD, Rhea DJ, Sibai AJ, Sibai BM. PMID: 25486285
OBJECTIVE: The objective of this study was to examine the influence of gestational weight gain on the development of gestational hypertension/preeclampsia (GHTN/PE) in women with an obese prepregnancy body mass index (BMI). 
METHODS: Obese women with a singleton pregnancy enrolled at < 20 weeks were studied. Data were classified according to reported gestational weight gain (losing weight, under-gaining, within target, and over-gaining) from the recommended range of 11 to 9.7 kg and by obesity class (class 1 = BMI 30-34.9 kg/m2, class 2 = 35-39.9 kg/m2, class 3 = 40-49.9 kg/m2, and class 4 ≥ 50 kg/m2). Rates of GHTN/PE were compared by weight gain group overall and within obesity class using Pearson chi-square statistics. 
RESULTS: For the 27,898 obese women studied, rates of GHTN/PE increased with increasing class of obesity (15.2% for class 1 and 32.0% for class 4). The incidence of GHTN/PE in obese women was not modified with weight loss or weight gain below recommended levels. Overall for obese women, over-gaining weight was associated with higher rates of GHTN/PE compared with those with a target rate for obesity classes 1 to 3 (each p < 0.001). 
CONCLUSION: Below recommended gestational weight gain did not reduce the risk for GHTN/PE in women with an obese prepregnancy BMI. These data support a gestational weight gain goal ≤ 9.7 kg in obese gravidas.


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Tuesday, 24 January 2017

When We Talk About Weight Loss Research

credible hulkOne of the reasons that I’m no longer interested in attempting weight loss is that my review of the literature informs me that it simply has no basis in evidence as being an effective way to either lose weight or become more healthy (which are two separate things).  When I say that, people often object insisting that there are studies where people have lost weight.

The problem is that any old research where a couple of people lost weight won’t do (go ahead, review the literature.  I think you’ll be shocked to find how often the average participant lost a few pounds, gained back half of it before they stopped tracking, and then the authors declare the study a success.)

The research we would need for weight loss to meet the criteria of an evidence-based medical intervention is twofold.  First, we would need a study where the majority of the participants lost the amount of weight that we are told we need to lose to change our health and maintain that weight loss long term (over 5 years).  If we had those studies – and we don’t –  we would then need some proof that weight loss actually caused health improvements – and this study already brings that into question.

This rules out the National Weight Control Registry because they’ve chosen to study 10,000 people who experienced weight loss while completely ignoring the up to 800,000,000 failed attempts that happened in the same time frame.  Then they just look for things that the 10,000 have in common. So when they say things like “eating breakfast contributes to weight loss” what they actually mean is that they asked the 10,000 people who succeeded what they did, and a majority of them said that they ate breakfast.  Note that they didn’t ask how many of the up to 800,000,000 people who did not lose weight also ate breakfast – that would be important information to have since if a majority of the people who didn’t lose weight also ate breakfast then breakfast may have absolutely nothing to do with it.

Imagine if I got together everyone who had survived a skydiving accident when their parachute didn’t open and started looking for things they have in common.  Even if every single one of them wore a green shirt and had oatmeal for breakfast, I cannot say that wearing a green shirt and eating oatmeal will allow you to survive a skydiving accident, nor can I ethically start Ragen’s School of No Parachute Skydiving “free green shirt and oatmeal with every jump!”  When your entire sample is a statistical anomaly, your research is useless. When all you’re looking for is random coincidence among a select group of outliers, you’d be better off using your research money on lottery tickets.

Other times, people bring up studies where phase 1 was weight loss and phase 2 was maintenance, the study lost between 40% and 70%  of participants during or after phase one, and then the researchers continued on as if the remaining people were the complete study group.  Not ok. Why did all of those people quit?  How will their experience be accounted for? Often the remaining subjects start gaining back the weight they lost so that at the end of phase 2 the average participant has gained back half of their weight with a net loss of less than 10 pounds.  Or they only follow up for a year or two when we know that most people gain their weight back by year 5.

People list study after study and all of them have one or more of the above problems, which I or someone else in the discussion points out.  At that point, the person listing the studies often gets frustrated and says something like “Why don’t you like my studies?” or “You just don’t want to believe.”   If they examined it, I think they’d find that their frustration isn’t with me, it’s with the fact that they’ve been sold a lie and they bought it at full retail price.

I certainly know that frustration, when I did my first literature review of weight loss research I expected to find that all diets worked – I was just looking for the “best” one, the one that had the most solid success.  I was so shocked at what I found that I read through all of the literature again.  I simply couldn’t believe that this thing – weight loss – that had been marketed to me more aggressively than anything else in my life had no basis in evidence.  I couldn’t believe that doctors had been giving me an intervention which had been shown repeatedly to almost always end in failure, and the majority of time had the exact opposite of the intended result.  When I found out that there weren’t even any studies that showed that weight loss caused changes in health I was just stunned.

It took me a lot of time and a lot of work to accept the truth.  It was hard to find out that I’d been lied to (on purpose and inadvertently), it was hard to find out that the thing that I’d been promised would solve all of my problems was never going to happen.  In many ways, at least for me, Health at Every Size was about giving up, but that’s what I do when I find out that I’ve been harboring a mistaken belief.  That’s what scientists (well, good scientists) do when their research does not support their hypothesis (however strongly held or widely believed it might be.)  They don’t suspend the rules or research and logic and argue for a belief that they can’t support with evidence.

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Monday, 23 January 2017

Cheap Fat Jokes Are Not Political Commentary

Talking NonsenseOn Saturday millions of people around the world marched in solidarity for progressive, feminist goals*. Enter Mike from Mike’s corner who decided that the best thing that he could contribute was a crappy fat joke:

march-meme

Facebook post from “Mike’s Corner” It’s a picture of a protest march that says “IN ONE DAY, TRUMP GOT MORE FAT WOMEN OUT WALKING, THAN MICHELLE OBAMA DID IN 8 YEARS

This is obviously crap, and I’ve been asked to talk about why so that we can decide how best to respond.  There are several things happening here.

First it’s an attempt at humor based on stereotypes “ha ha fat women don’t usually walk ha ha” Just like people of all sizes, there are fat women who walk (and roll) and fat women who don’t but people who would make this joke are not likely to let the facts get in the way of their bigoted humor. There’s not much to unpack here other than to say that if someone thinks this is funny, they could maybe try to be less of a bigoted piece of shit moving forward.

There’s the issue of this being factually incorrect. Michelle Obama focused on kids (sometimes in ways that were horribly ill-advised) and didn’t have any programs about women walking.  I guess Mike is a fan of “alternative facts?”

The most dangerous takeaway that I’ve seen size bigots suggest is the idea that fat women delegitimize a protest simply by being there – as if the marches would have somehow been more legitimate had all the participants met Mike’s definition of “thin.” This isn’t original, the brain trust who created this meme was beaten to the punch by Ann Coulter (which is to say that this dude is getting his ass kicked by women from every direction.)

The size of the women (or people of any gender) who participated in the marches has nothing to do with anything, and yet fat phobia is so powerful in our culture that the first thing this guy decided to do was try to make a fat joke.  (I will say that I couldn’t find a single march whose platform included anything about size discrimination and so perhaps this will help us explain to organizers of future events why that’s important.)

When we respond to things like this, the most important thing is that we not reinforce the prejudices upon which they are built, or create more bigotry in the process. For this reason we want to avoid the mistake of responding about how fat the attendees were or weren’t, or using comebacks that are healthist and/or ableist.

If this appears in a space that you manage, I would suggest either simply deleting it or pointing out the issues as I have here. (If you’re interested in a discussion of moderating comments in personal online spaces as well as groups we manage online, I  recently wrote a piece for Ravishly about just that!)

If you see it in another space, you might leave a comment pointing out how widespread sizeism is, how messed up it is that women’s worth is judged by how closely we are able to approximate a stereotype of beauty, and how this meme proves the need for such marches.  You could also suggest that the person who posted it try to be less of a bigoted piece of shit moving forward.

If you have other suggestions, feel free to leave them in the comments.

*They are many things to talk about when it comes to these marches and how we can do better moving forward including how they could have been more inclusive of groups like People of Color, Trans and Non-Binary people, Fat Acceptance as a platform and more. These are important discussions that are worth having – cheap fat jokes parading as political commentary are not.

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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, 22 January 2017

Women’s March on Washington

I attended the Women’s March yesterday with one of my friends, and it was absolutely amazing. We knew it was going to be big when we got to the New Carrollton Metro station and there were people *everywhere.*  Signs galore, pink pussy hats as far as the eye could see.  Our train was jam-packed with people headed to the march, and we had some chants going on the train.  The next few stations we passed were also filled with people.

Estimates I’ve heard put the march at 500,000 making it the largest protest ever held in DC. Including sister marches around the country and around the world, it numbered in the millions.

The mood was hopeful and determined. There was a lot of cheering, and a lot of laughter.

I have a lot more hope now than I had throughout November and December.  This can’t be a singular thing. It has to be a beginning. We have to yell and scream and fight as loud and as hard as we can, and not give up.




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Saturday, 21 January 2017

Still Here, Still Fat, Still Awesome

Hey y’all!

I’ve got a few lovely messages this week from people asking me if I’m OK, as I haven’t blogged in a while.  So first up, yeah I’m good, thank you to all who asked.  Nothing hugely dramatic from preventing me from blogging, just a bunch of little things that add up, you know?  I’m never very creative in the hot months, as hot weather just saps any creativity out of my brain.

Add to that a shoulder injury that I incurred back when I was in New Zealand in June/July – I took a spectacular stack on some mossy concrete and sprained my right ankle in a magnificent fashion (pics below) and made my whole body hurt.  Once the ankle healed (remarkably quickly, thanks to the hot thermal pools in Rotorua I believe!) and the residual soreness of the rest of my body eased, my shoulder has continued to be a problem.  Got it checked, ran it through some time to heal, no joy, so back to the doc I went this week.  I’m waiting for the results of my X-rays and ultrasounds to see if I’ve buggered the rotator cuff, or whether it’s just bursitis.  As unpleasant as bursitis sounds, it’s the lesser of the two evils, because a buggered rotator cuff may mean surgery.  GAH!

13528043_10153763160742404_985516206062962668_o-1

And generally I’ve just been really busy!  The Christmas/New Year season, work stuff, friends, life in general.

But I am still around and still fat (yes loser troll, I am still fat, and still more awesome than you!) and still pissed at the way fat people, particularly fat women, are treated like we are sub-human.  I still have a lot to write about, just not a lot of time to do that writing.

I’m really glad people care and check in with me, it’s lovely!


Filed under: Uncategorized

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Friday, 20 January 2017

Laughter is the only thing that’ll keep you sane

Laughter is the only thing that’ll keep you sane
In this world that’s crying more and more everyday
Don’t let evil get you down
In this madness spinning round and round

– “Live Forever” by Drew Holcomb


Filed under: Mental health, Music

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One Last Time

Today I’m taking a break from my usual Size Acceptance and Health at Every Size writing to say goodbye and give my respect to President Obama.  I’ll be back tomorrow with my usual fare.

I’ve certainly publicly disagreed with the way that his administration has talked about and treated fat people. He wasn’t perfect, nobody is. But for eight years I’ve had the opportunity to live in a country with a leader I could respect, who worked to move us forward, make progress in civil rights, and be a mature, level-headed leader in the face of horrific racism and obstructionism. Thank you President Obama, I’ll miss you.

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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Thursday, 19 January 2017

Hatred in our Ranks: Why Lie About It?

Stream of consciousness ahead! I hope that all my readers can benefit from this post, but it is primarily geared towards conservatives and Trump supporters. Let’s open our eyes and be honest here. The left has its fair share of extremists, clowns, bigots, and violent and destructive folks. But I’m focusing on conservatives here because […]

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Fat Bodies Don’t Need Pity or Preaching

no-pity-no-preachingI saw a cooking show recently at a hotel and I made a note to blog about it.  It seems familiar so I looked back and, indeed, it turns out that it was a re-run and I had blogged about it before, so I’m re-posting it. There was a chef whose passion was “healthy cooking.”  She started out by talking about how many people in her family “struggle with their weight”, she teared up as she talked about how sad it was for her to watch.

Then, when she went in front of the judges with a soup that was, to me,  a horrific looking combination of black eyed peas and cabbage – pureed –   she suddenly got angry and went on a rant about how she was “fed up” how there is “no excuse for it.” Happily the judges were not into the attitude which neatly  summed up two reactions that people have to fat people that I find utterly inappropriate and unwelcome.

First – Pity.  Don’t want it, don’t need it, won’t listen to it.  There is nothing pitiable about my body.  As I’ve mentioned before I do not “suffer” from obesity, I do suffer from people’s attitudes about my body.  That’s a suffering that will end as soon as people acknowledge that bodies come in different sizes for different reasons, that there is no wrong way to have a body, and that it’s nobody else’s business at all.  When someone says that they pity me because of my body it indicates that they think there is something superior about their bodies. My body is amazing and I won’t allow it to be treated that way without sticking up for it.  People can keep their pity, and their opinions and assumptions of my body, to themselves.

Preaching is the second issue.  It seems like every time I turn around someone’s trying to score points by giving “tough talk” to us fatties.  Telling us that they are just fed up with us and our big, fleshy bodies like we should care how they feel.  Saying that the world needs to stop “coddling” us, asserting that the world would be better if we didn’t exist,  waging war on us for power, politics and profit.  Suggesting that the problem with fat people is that we’re just not bullied and oppressed enough.  Somehow certain that the reason we’re not thin is that 386,170 negative messages a year about our body are just not enough. That somebody needs to tell us we’re fat. If shaming fat people made us thin, we’d all be thin.

I reflect sometimes on how the achievements of fat people are made more impressive because we accomplish things under the crushing weight of near constant stigma and bullying. Despite the pitying, the preaching, and the constant drumbeat of “your body is wrong”, we keep rising above, keep fighting back.  Just getting out of bed when you know the work water cooler conversation is going to be about weight loss resolutions, or going to the gym when you know the junior high level fatphobia you might face, are gold medal sports some days and we just keep doing it.

So go fatties go! Everyone else can keep their pitying and preaching to themselves, we’re fine.

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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Wednesday, 18 January 2017

Thankful Thursday (early!)

It's good to stop and smell the roses; have you ever done that? Literally stopped on your way to or from someplace to smell a rose? I have and it's a lovely thing to do. Around here we have wild roses in the summer and sometimes you can smell them from a block away, their perfume wafting towards you on a warm breeze. They're not large or showy like some garden varieties, but there isn't anything like their smell. I wish I could bottle it and keep some for a winter's day like today.

In that vein I want to take a second to count my blessings, for they are many! Sometimes I forget that, like when the grater goes by three times and my first thought is "Ugh! I have to shovel that?!" Or when I come home to dishes to do and a messy kitchen because the kids came home from school and threw their stuff everywhere.

So thanks, public employee, for scraping the snow pack off the road and making it easier to get to my appointment later! And for the extra cardio I'll get from shoveling the mess in the driveway.

Mmm breakfast.

These monkeys make me want to be a better person every day. They motivate me to change the world for the better, not just for them, but for their hypothetical kids and everyone else. We're all on this rock together.

This handsome guy. He's just the sweetest, kindest man. He listens when I'm ranting, hugs me when I'm sad, celebrates with me and encourages me and also isn't afraid to call me on my bull. He pulls his weight around here despite working weird hours and traveling more often now. He's an amazing father and husband and I'm thankful for him every day. I wouldn't be alive today if it weren't for him.

A forever shout out to my best friend, Erin, who is a new auntie again as of yesterday and has known me for the longest of anyone in my life who isn't blood related. Erin has a beautiful soul, generous and loving, and I'm in awe of her strength and the life she's built for herself.

Much love to my parents, inlaws, sister and aunts for all their love and support over the years. You are, and will remain, in our hearts.

Thankful for good tunes, celebrity 'likes' on Twitter (Sir Patrick Stewart, Bif Naked and Vincent D'Onofrio!) and free healthcare. Adieu!

 

 



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Terrible Trend – Private Message Diet Spam

pm-diet-spamI’ve been hearing more and more about a disturbing trend of people marketing their weight loss products through private message on social media.  It’s been happening for a while, but based on the number of e-mails I get about it it’s gaining a lot of traction.  Today Marjorie posted an example on my FB wall. In some cases a person joins a fat positive group and then starts private messaging people. In others they just look for fat people’s profiles and then spam them.

Let’s start with what should be blatantly obvious: This is disgusting.  This is harassment. This is objectively terrible. This should never, ever, happen.  While people who are the victims of this are allowed to handle it in whatever way they prefer, nobody is obligated to tolerate this in any way, nobody is obligated to look for “best intentions,” nobody is obligated to put up with this or hold back their profanity-laced rant.  And that would be true even if there was a chance in hell that their products would lead to long-term weight loss.

People are allowed to do whatever they want with their bodies.  People are, at least for now, allowed to sell weight loss methods that almost never work. None of that, in any way, justifies something like this:

 

Image may contain: text

Private message that says the following (all spelling and grammar from the original.) “Hi Ashleigh, I’ve just been here looking through your photos and I’ve noticed since after Christmas your face looks a little fuller, I don’t mean to cause offence this happens to a lot of people! I don’t no if you know but I work for [redacted] and we have some amazing products that will benefit you in loosing the weight.  If you would like to discuss more please reply to this message and we can get things sorted asap [smiley face emoji]  Thank you x

Nothing will ever justify this. (I’ll also point out that it’s creepy AF – why is this person randomly looking through someone’s photos and comparing face shapes between them?) If this has happened to you, the first thing to know is that THIS SHOULD NEVER HAVE HAPPENED TO YOU!  So what do you do?  Here are some options:

Ignore/Delete/Block 

Say nothing to the person, block them and move on with your life.

Reply

This could be anything from heartfelt paragraph about the dangers of fatphobia, and the chances that this person could be sending e-mail to people whose eating disorders will be triggered, to a fully annotated paper about Size Acceptance and Health at Every Size. Or you could just say “How fucking dare you? This could not be more inappropriate and you need to stop doing this right now!”

Report

Send their information to the company that they are representing.  Perhaps something like:

“I wanted to let you know that [insert name and social media link] is representing your company poorly by sending unsolicited messages like this [quote message.] Obviously you know that this is inappropriate, offensive, and in addition to being fatphobic could end up triggering eating disorders.  I hope you’ll address this before more people are harmed.”

You can also report them to the social media site that they used to send it.

Name and Shame

They are so comfortable sending this out, surely they won’t mind if you let other people know about this fabulous opportunity.  Take a screenshot and send it on its way on social media.

Again, you get to decide how you deal with this, all I care about is that you know that it is well and truly bullshit. If you have other ideas for responses, please feel free to leave them in the comments!

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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Tuesday, 17 January 2017

MasterCard Telling Our Weight to the Airlines?

travel-companiesIt was recently reported that MasterCard filed a patent for  “a system, method, and computer-readable storage medium configured to analyse the physical size of payment accountholders based on payment transactions, and allowing a transportation provider to apply the physical size of payment accountholders to seating.”

They are suggesting that they can guess your size, and the size of all of your family members, based on what you buy, and then report that information to transportation companies.  Their patent application states that this information might be used thusly: “for the comfort of their passengers, transportation providers should avoid seating physically large strangers next to each other”.

Riiiiiiight.  Also, in lieu of drink service, airlines will start handing out bags of magic beans courtesy of MasterCard. I seriously doubt that Mastercard is going to the time and expense of patenting this so they can give it away, so if this goes into effect (and they may not act on it, even if the patent is approved) we can assume that travel companies will be paying them for it, and passing that cost on to us – and by us, I mean fat people.

Let’s get real here. Travel companies decided to start a business that moves people from place to place. Then, despite the fact that people come in many sizes, they built their planes, trains, and buses to only accommodate people up to a certain size.  Now they try to charge people larger than that size up to twice as much for the exact same service (travel from place to place) in ways that are indefensible unless you think “we hate fat people” is a reasonable defense.  And now Mastercard is saying “Hey, let us help you out with that.”

Again, this is a patent that MasterCard has applied for –  they may not be granted the patent, and if they are they might not choose to use it.  But I’m not excited about doing business with a credit card company that is excited about helping transportation companies engage in sizeism.

Like this blog?  Here’s more cool stuff:

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

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

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

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

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



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Sunday, 15 January 2017

The double standard of not taking women seriously

In the Washington Post, a few days ago, Petula Dvorak wrote that next week’s Women’s March on Washington won’t be taken seriously unless we step away from “well-intentioned, she-power frippery” like the pink pussycat hats.

While she has a point that we need to focus on the serious issues, she misses the fact that we can be as serious as she wants and still not be taken seriously, simply because we’re women. Hillary Clinton was nothing if not serious during her campaign. She put out reams of policy documents, and she discussed the issues in nuanced detail. The whole time, she was criticized for not being warm enough or likable enough. There is no appropriate level of seriousness where a woman will be both likable and respected. It just doesn’t exist.

Women aren’t demeaned and brushed aside because of pink hats or signs with glitter.  Things that are pink and sparkly are viewed as trivial and infantile *because* they’re associated with women. Look at the snarky comments about Teen Vogue and the absolute shock that people who write about fashion and celebrities for teenage girls might also know a thing or two about politics.

Also, matching hats have been kind of a thing in the last election. Funny, I don’t recall anyone criticizing Trump supporters’ “Make America Great Again” baseball caps as insufficiently serious, even though no one could point to what they meant by great or what period of greatness they wanted to go back to. There’s nothing inherently more serious about a red baseball cap than a pink knit hat with ears, except that one is coded as masculine and one is coded as feminine.

For that matter, Dvorak alludes to the fact that feminists will be criticized no matter what we do or don’t do when she mentions bra burning.

Bra burning. That’s the trope that folks have been using to dismiss feminists for nearly half a century.

In fact, no bra was burned at Miss America protests in 1968 and 1969. Feminists threw false eyelashes, mops, pans, Playboy magazines, girdles, bras and other symbolic “instruments of female torture” into a trash can. But the Atlantic City municipal code didn’t allow them to set it on fire.

Yet because the idea of a burning bra was so lurid, it eclipsed the fact that in the 1960s, women couldn’t get a credit card without a husband’s signature, couldn’t serve on juries in all 50 states, weren’t allowed to study at some of the nation’s Ivy League schools, couldn’t get a prescription for birth control pills if they were unmarried, were paid 59 cents for every dollar that men earned and could easily be fired from a job if they got pregnant. Among other outrages.

Because of this stunt, she argues, feminists were painted as foolish and extreme, and attention was drawn away from the serious issues they were fighting to address. But, as she points out, no bras were ever burned. That didn’t stop bra-burning from being a go-to insult against feminists. If anti-feminists need excuses to dismiss us, and the impossible double standards of sexism don’t provide them with one, they’ll just make one up.

 

 




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2016 wrap up

And in such a timely manner, too.  As I said in my previous posts, I’m super busy this month with some theater projects, but I hope to get back on track with CPBS in February.  (This would be a great time for a guest post…. hmu with your pitch…)  In the meantime, I wanted to share my ranked list of 2016 films, as I have the past few years.

2016 was unique for me in that I took on (and completed!) the #52FilmsByWomen challenge.  You can check my final list out on Letterboxd.  I unfortunately didn’t get around to some of the feminist classics I was hoping to see (e.g. Cleo from 5 to 7, Jeanne Dielman…, and I’m a bit ashamed to say that I couldn’t make it all the way through Daisies or The Night Porter), but I did have some pleasant surprises in The Love WitchThe Diary of a Teenage Girl, Margaret Keller’s experimental films, Pariah, and The Fits.  Also, feminist film critic hot take:  Meshes of an Afternoon and Born in Flames are essential viewing.

I decided to keep the intentional diversity train rolling in 2017 by making it my goal to watch 52 films directed by people of color.  You can check out my list of films I’ve watched thus far, want to watch, and sub-challenges I’ve set for myself here.

Any way, on to my ranked films of 2016.  I didn’t get to see as many films as I did in 2015, so a lot of the Oscar frontrunners are conspicuously missing.  Overall I wasn’t blown away by 2016, but I am pleased with my top 10 and hope to make repeat viewings, especially with Hunt for the Wilderpeople.  I also ended up watching more shorts than usual, most of which I didn’t include.  I’m not sure how to categorize them versus feature-length.

  1. Moonlight
  2. Mustang
  3. Hunt for the Wilderpeople
  4. The Lobster
  5. The Witch
  6. The Love Witch
  7. Embrace of the Serpent
  8. Green Room
  9. The Handmaiden
  10. Under the Shadow
  11. Sing Street
  12. The Fits
  13. Lo and Behold: Reveries of the Connected World
  14. The Illinois Parables
  15. Two Trains Runnin’
  16. Love & Friendship
  17. Don’t Think Twice
  18. After the Storm
  19. Demon
  20. Keanu
  21. Maggie’s Plan
  22. Another Evil
  23. Sunspring
  24. Night of 1000 Hours
  25. The View from Tall
  26. Everybody Wants Some!!
  27. Imperfections
  28. Southside with You
  29. Pushing Dead
  30. Into the Forest
  31. The Intervention
  32. Afterimage
  33. M.O.P.Z.
  34. Hail Caesar
  35. This House Has People in It (not inclusive of website)
  36. White Girl
  37. Wiener-Dog
  38. Middle Man
  39. Midnight Special
  40. 1:54
  41. The Shallows
  42. Tallulah
  43. Operator
  44. Anomalisa
  45. Soul on a String
  46. Dog Days
  47. Bad Seed


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Friday, 13 January 2017

Common Sense Prenatal Weight Gain Recommendations for "Obese" Women


The 2009 IOM Guidelines for Prenatal Weight Gain
Coming up with official prenatal weight gain guidelines is difficult. There's always a trade-off involved ─ too much weight gain increases the risk for large babies, but too little increases the risk for small babies.

(The effects of weight gain on cesarean rates and pre-eclampsia are harder to figure out because of multiple variables that influence outcomes, so we will limit our discussion for a moment to the influence of weight gain on fetal outcomes.)

This weight gain trade-off has been particularly difficult to figure out in women of size. We tend to have larger babies on average and a very big weight gain seems to increase fetal size particularly strongly in high-BMI women. Nor do we need to gain extra fat reserves for pregnancy and breastfeeding. As a result, the Institute of Medicine (IOM) recommends less weight gain on average for "obese" women (see chart above).

While I don't hate these recommendations, I do have some concerns with them, particularly for women in the borderline categories (see discussion below). Women in these categories may be particularly at risk for poor outcomes, yet they are given the same stringent guidelines (and are often told to gain even less than the guidelines).

I also question how much control women really have over gestational weight gains. Sure, we have control over how much we eat and exercise, but that impact on gain is fairly minimal. There have been many trials of interventions to help obese women keep their weight gains lower; some have had minimal success (about 5 lbs. difference), but many have made little difference in weight gain and do little to improve other outcomes. Even with the best support, many women of size gain above the guidelines ─ not because they are lazy or out of control, but because the guidelines aren't particularly realistic for them.

I am also concerned about harassment and over-intervention in the pregnancies of women who gain above these recommended ranges. I have heard many stories of women of size who are harassed or even punished with early inductions or planned cesareans because they "gained too much."

So while I agree in general with the IOM that obese women don't need to gain as much weight in pregnancy as other women, I do have some reservations about the IOM guidelines and in particular about how they are implemented. But sadly, even these guidelines are not stringent enough for some providers.

Taking The 2009 Guidelines Even Further

Some caregivers believe the 2009 IOM weight gain goals didn't go far enough for obese women. In recent years, unofficial prenatal weight gain advice has gotten progressively more extreme. I call this the "anorexation" of pregnancy weight gain guidelines.

The following are real-life headlines from media articles over the years. Notice how the headlines have changed. They have gone from "obese women should gain LESS weight".....


...to "obese women should gain NO weight"


....to "obese women should LOSE weight" during pregnancy.


Disturbingly, many experts have taken an extremist tone in the media and sold these draconian measures as a public health imperative, which alarms me greatly. Many news articles have pushed this weight restriction agenda, assuring us that very little gain was perfectly safe and even healthier for the plus-sized mother and her baby. Here are just a couple of examples.

One article about the IOM recommendations prominently featured the following quotes promoting even lower gains in high-BMI women:
"I think 11 to 20 pounds is way too much for an obese woman," said Dr. Thomas Myles, a professor of obstetrics and gynecology at Saint Louis University School of Medicine who was not involved in the current recommendations. "I usually tell my [obese] patients that gaining less than 10 pounds and even losing up to 10 pounds is appropriate, whereas for overweight women, gaining 10 to 15 and even up to 20 pounds is appropriate," Myles said. 
Gaining a little less weight than the recommended amount, especially for overweight and obese women, might be better, [Associate Professor, Dr. Emily] Oken [of Harvard University] said.
Another article promoting zero weight gain in obese women featured the following quote from one of its leading investigators in its study's press release (my emphasis):
It may seem counterintuitive to suggest that women control their weight during pregnancy, but these women are already carrying between 50 and 100 extra pounds — and for them any more weight gain could be very dangerous,” said Vic Stevens, PhD, principal investigator who has studied weight loss and weight maintenance for more than 30 years.
Another recent article quoted Dr. Sigal Klipstein, Chair of the American College of Obstetricians and Gynecologists committee on Medical ethics. Even as she discussed the importance of treating obese women humanely during pregnancy, Dr. Klipstein stated:
Although women should not to try to lose weight during pregnancy, “a woman who weighs 300 pounds shouldn’t gain at all,” Klipstein said. “This is not harmful to the fetus.”
But is it really true that very small or non-existent gains are not harmful?

Risks of Too-Small Gains

Those who suggest that gaining little or no weight is optimal for women of size are ignoring all the contrary research.

A significant amount of research has shown that very low weight gains and/or weight loss during pregnancy in women of size carries real risks, including


Tellingly, virtually NO media articles acknowledge that low weight gains have risks or cite the research that shows this. That there are so many articles promoting restricted gain in obese women while completely ignoring the potential harms of such a policy suggests a health agenda that places ideology over evidence.

And now there is even more research suggesting that very low gains may be risky.

A very recent study (Durst 2016) showed that weight gains below the IOM recommendations in obese women led to increased rates of  small-for-gestational-age ("SGA") babies and pre-term births. Another recent study (Cox Bauer 2016) found that gestational weight loss (GWL) was associated with low-birth weight babies. These are a concern because too-small babies are more at risk for future health problems like metabolic syndrome and insulin resistance.

Still another recent study (Hannaford 2016) shows that too-low weight gains, even in obese women, more than doubled the risk for too-small babies. The authors suggested that there may need to be a threshold of a minimum weight gain, even for very high-BMI women, which is a pretty radical suggestion given how many doctors are calling for zero gain or weight loss in this group.

But these new studies are far from the first to find reasons for concern. A brand-new meta-analysis (Xu 2017) of studies on weight gain below the 2009 guidelines in obese mothers found that low weight gain was associated with SGA babies in all obesity categories, not just in the borderline categories.

Yet another meta-analysis (Kapadia 2015) of studies on weight gain in obese pregnant women concluded that, because of its consistent association with too-small babies,
Gestational weight gain below the guidelines cannot be routinely recommended.
Too-small babies and prematurity may not be the only risks of very low weight gains; they may also be implicated in infant deaths.

A recent study (Bodnar 2016) found that weight loss and very low weight gains in Class I and II obese women were associated with a higher risk of infant death.

This is particularly important because research is very clear that SGA babies have a higher risk for stillbirth and neonatal mortality. In addition, some past research (Salihu 2009) shows that SGA babies of obese women are at particular risk for stillbirth.

Sorry, but SGA babies, prematurity, and infant death are pretty significant concerns. People like Dr. Myles, Dr. Oken, Dr. Stevens, and Dr.Klipstein who have been recommending weight gains well below the IOM recommendations have been playing Russian Roulette with the babies of their patients of size.

This is a common problem in medicine ─ taking a recommendation to extreme lengths without adequately studying its safety first.

Obese women as a group may benefit from gaining less weight on average than other women, but it does NOT automatically follow that even less is better

Sadly, while now there are years of data suggesting harms with very low gains and/or gestational weight loss, many experts are STILL telling women of size and their providers that "any weight gain in overweight and obese patients is detrimental to pregnancy outcome." Any weight gain, really?

This bias towards ever-lowered weight gain goals is so ingrained that it continues to deny the existence of any contrary evidence. The 2013 article quoted above advises OB-GYNs:
Weight maintenance and even weight reduction have not proven harmful in obese pregnant patients according to studies in the recent literature
Not proven harmful? This statement completely ignores numerous studies published before 2013 pointing out safety concerns with this advice (Bayerlein 2011, Bodnar 2010, Blomberg 2011, Vesco 2011, Dietz 2006, Potti 2010, Hasegawa 2012).

And now we have EVEN MORE studies showing that there are safety concerns, yet this low/no gain/weight loss advice continues to be given routinely by many providers who assure their patients falsely that there is no reason to worry.

But What About....?

Critics will undoubtedly point out that some of these same studies show benefits of lower gains such as a modestly lower cesarean rate or lower rates of pre-eclampsia. These are valid points. However, that's a whole different discussion because multiple variables influence these complications and it's difficult to tease out a causal relationship.

For example, caregivers are not blinded to their patients' gains. A bigger gain may mean a bigger baby. Fear of a big baby can strongly influence the perception of when a cesarean is "needed" and how many interventions like induction are used. Research shows that women with larger weight gains are induced at higher rates. Therefore it may not be weight gain that's the issue, but rather how the caregiver responds to the gain.

Pre-eclampsia is another situation where you can't jump to conclusions about weight gain. Women with pre-eclampsia typically have a lot of swelling, which means a higher weight gain. As Nohr 2008 states:
Any causal interpretation of the association between total weight gain and these complications is limited. For preeclampsia, high total gain most likely reflects pathologic fluid retention as part of the disease.
In other words, a higher weight gain doesn't necessarily cause pre-eclampsia, but rather it often results from pre-eclampsia. It certainly doesn't mean that a lower weight gain will prevent pre-eclampsia. We just don't know if deliberately restricting weight gain will lower the rate of pre-eclampsia in obese women.

However, it must be acknowledged that too much weight gain is probably also not ideal. Prenatal weight gain clearly influences fetal size, and higher gains seem particularly particularly potent for larger fetal size in high-BMI women. Postpartum, a larger gain may also be difficult to lose; multiple pregnancies with large gains can result in a net overall weight increase that might possibly affect the mother's health. So doctors have to find a balance between the very real risk/benefit trade-offs of too much or too little gain in pregnancy.

That's not easy, and I acknowledge that. But it seems to me that the debate is still very unbalanced, with too many experts still not willing to acknowledge the very real risks of too-small gains.

Deliberately ignoring contrary research is not an evidence-based approach. It smacks of a weight restriction agenda instead of a reasoned approach to best practices.

Summary

For too long, "experts" have been waging a campaign to lower the 2009 IOM guidelines even further for obese women. As a result, many care providers have used draconian pressure on women of size to gain very little or even to lose weight in pregnancy. But there are significant safety concerns with this approach, concerns that these so-called experts are conveniently ignoring.

The research makes several things clear:
  1. Very low weight gain or weight loss is extremely consistent with too-small babies in multiple studies 
  2. Too-small babies are at increased risk for adulthood diseases
  3. Weight loss and very low weight gains may also be associated with a higher risk for infant death and prematurity 
These concerns means it's time for caregivers to STOP promoting extreme weight gain limits and to START acknowledging that very low gains also carry risks. 

Now, it may be that in time, different weight gains will be recommended for different levels of obesity. That seems like a possibility that is worthy of further consideration.

For example, "overweight" women (BMI 25-29) and women with Class I obesity (BMI 30-35) seem to be the most negatively affected by very small weight gains, whereas some research shows that women with Class III obesity (BMI 40-50) and Class IV obesity (BMI 50+) are less affected on average by very low gains.

So there may be some gradations in recommendations in the future, and I welcome discussions about this possibility ─ but given the established risks and the meta-analysis of studies that showed increased SGA risks across all class sizes of obesity, it would still behoove us to be very cautious about recommending very low weight gain even in women with Class III and IV obesity. We simply cannot assume that restricting gains is harmless even there.

Common Sense Recommendations

To me, what's missing from prenatal weight gain recommendations for obese women is nuance. It's time to pull back from prenatal weight gain extremism and show some common sense. Here are the things I think caregivers should take into account when discussing pregnancy weight gain with women of size.

Women of size should be informed in a neutral way of the IOM weight gain recommendations and why they were made. A neutral discussion, with research citations as appropriate, goes a lot further to helping women make informed and empowered decisions. A decision about weight gain goals that comes from the woman herself, rather than being imposed by external forces, is a lot more likely to result in reasonable gains.

How the message is communicated is important. Women should be given reasonable nutritional advice and strongly encouraged to exercise, but risks should not be exaggerated. Lecturing, scare tactics, and condescension means that people will simply tune out recommendations. Treat women as competent partners in their own care and avoid judgment. Emphasize healthy habits rather than numbers on the scale.

Consider tailoring recommendations by BMI. Women in the borderline BMI classes are the most at risk for poor outcomes with very low gains; they should be encouraged to gain nearer to the top of the IOM recommendations. It may even be that women with Class I obesity (BMI 30-35) do best with slightly more gain (15-25 lbs.). Women in Class III (BMI over 40) and Class IV obesity (BMI over 50) can be encouraged to gain towards the lower end of the recommendations or even slightly lower (5-15 lbs.) but great care should be taken that this message does not translate into pressure for restricted intake or extreme measures. Do not assume that very high BMI women have adequate nutritional reserves to make up for a lack of gain; good nutrition is always the priority.

Do not promote actively losing weight in pregnancy. Research shows there are too many potential harms to recommend pursuing gestational weight loss. Some women of size lose without trying; this is not a cause for panic as long as intake is adequate and the baby is growing well. But actively encouraging women to aim for weight loss during pregnancy is different than coincidental weight loss, is likely to result in restrictive behaviors, and probably has far greater risk.

Consider patterns of gestational weight gain. Has the weight gain pattern been relatively smooth? Was there a very large gain in the beginning? At the end? Different patterns may indicate different concerns. Also, don't forget to take pre-conception weight into account; many obese women lose weight in the first trimester and slowly gain that back to a small overall gain. If the initial loss is not counted, it looks like the woman has gained more weight than she actually has. Look at the whole picture.

Do not harass women about weight gain. Weight-related harassment is obnoxious and inappropriate, but it is sadly all too common. Women should not feel afraid to step on the scale at appointments, yet they often experience harassment. Medical assistants should record weight without comment. Care providers can ask neutrally about gains and can work with women on monitoring nutrition and troubleshooting worrisome trends, but judgment and belittling will only backfire. If a woman gains outside of guidelines despite good nutrition and regular exercise, consider other possible variables. Assume that a woman's body will gain what it needs for a healthy pregnancy.

Avoid food extremism. Women of size should not be pressured to strongly restrict calories or to eliminate entire food groups. They should be encouraged to eat reasonable amounts from a wide variety of foods. Nutritional advice should be evidence-based, not from unproven diet trends. Caregivers need to find a way to talk to clients about nutrition and weight gain concerns without condescension or judgment. Work with women and listen to their feedback about their needs.

Individualize care according to the woman's needs. People of size are not all alike. Some fit stereotypical images of fast food consumption and binge eating, others have very healthy habits, and many fall somewhere in between. Ask them respectfully about their habits and concerns; don't make assumptions. Believe what they tell you and advise them accordingly. If habits need improvement, encourage small and reasonable steps and recognize positive achievements.

Remember that weight gains among high-BMI women are highly variable. Research shows that weight gains in pregnancy are less predictable in larger women. Some have very large gains, some have very small gains, and some lose weight without trying. Often the women who gain the most are those who have recently lost weight or who are chronic dieters/weight cyclers, those with lipedema, or those who have swelling with pre-eclampsia. Many factors influence gestational weight gain besides the habits of the women. Acknowledge that some weight gain may be out of their control.

Look more at how the mother and baby are doing than at the scale. Guidelines are more for groups than individuals. While research shows that very high or very low gains are generally best avoided on average, some obese women gain more or less than recommended and have perfectly healthy babies. Some gain a lot and have average-sized babies; some gain almost nothing and have big babies; some lose weight with no obvious harmful effect. Gaining outside the recommendations is not necessarily a cause for alarm, as long as the mother's intake is normal and baby is growing well.

Women should not be subjected to extra interventions if they exceed their providers' weight gain goals. Some fat women are being consciously punished for "too much weight gain" by being subjected to extra interventions like inductions or planned cesareans. However, some of these interventions may occur because of providers' underlying fears about big babies. Care providers must actively examine their own biases so that they do not unconsciously use increased interventions on those who gain more.

Most importantly, focus on nutrition rather than on the scale. Too many providers use weight gain as a marker of pregnancy status and ignore nutrition altogether. What a woman is eating matters more than how much weight she has gained. Women can be given a weight gain goal range, nutritional advice, and exercise opportunities, but nutrition should not be manipulated in order to achieve an arbitrary number. The scale is a poor predictor of outcome and should not be used as a surrogate for nutritional adequacy or fetal status. Focus more on nutrition and concrete signs of how the mother/baby dyad is doing than on numbers on a scale.

Care providers need to bring common sense back into prenatal weight gain guidelines and take a more nuanced approach with women of size.


References

Very Low Gain and Too-Small Infants (Latest Studies)

Am J Perinatol. 2016 Jun 29. [Epub ahead of print] Gestational Weight Gain: Association with Adverse Pregnancy Outcomes. Hannaford KE1, Tuuli MG, Odibo L, Macones GA, Odibo AO. PMID: 27355980 DOI: 10.1055/s-0036-1584583
...OBJECTIVES: We investigated how weight gain outside the IOM's recommendations affects the risks of adverse pregnancy outcomes. STUDY DESIGN: We performed a secondary analysis of a prospective cohort study including singleton, nonanomalous fetuses. The risks of small for gestational age (SGA), macrosomia, preeclampsia, cesarean delivery, gestational diabetes, or preterm birth were calculated for patients who gained weight below or above the IOM's recommendations based on body mass index category....Women who gained weight below recommendations were 2.5 times more likely to deliver SGA and twice as likely to deliver preterm...Obese patients who gained inadequate weight were 2.5 times more likely to deliver SGA. CONCLUSIONS: ...Among obese patients, a minimum weight gain requirement may prevent SGA infants.
Am J Perinatol. 2016 Jul;33(9):849-55. doi: 10.1055/s-0036-1579650. Epub 2016 Mar 9. Impact of Gestational Weight Gain on Perinatal Outcomes in Obese Women. Durst JK, Sutton AL, Cliver SP, Tita AT, Biggio JR. PMID: 2696070
...STUDY DESIGN: A retrospective cohort of perinatal outcomes in obese women who gained below, within, or above the 2009 Institute of Medicine guidelines and delivered ≥ 36 weeks. Additionally, outcomes, according to the rate of GWG (kg/week; minimal [< 0.16], moderate [0.16-0.49], or excessive [> 0.49]) were compared among women delivering preterm. RESULTS: Overall, 5,651 obese women delivered ≥ 36 weeks. GWG above guidelines was associated with increased cesarean section (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI]: 1.21-1.72), gestational hypertension (aOR: 1.58, 95% CI: 1.21-2.06), and macrosomia (birth weight ≥ 4,000 g) (aOR: 2.08, 95% CI: 1.62-2.67). GWG below recommendations was associated with less large for gestational age infants (aOR: 0.60, 95% CI: 0.47-0.75)...Minimal weekly GWG was associated with increased spontaneous preterm birth (aOR: 1.56, 95% CI: 1.23-1.98) and more small for gestational age (SGA) infants (aOR: 1.55, 95% CI: 1.19-2.01). Excessive weekly GWG was associated with increased indicated preterm birth (aOR: 1.61, 95% CI: 1.29-2.01), cesarean section (aOR: 1.39, 95% CI: 1.20-1.61), preeclampsia (aOR: 1.83, 95% CI: 1.49-2.26), neonatal intensive care unit admission (aOR: 1.33, 95% CI: 1.08-1.63), and macrosomia (aOR: 2.40, 95% CI: 1.94-2.96).CONCLUSIONS: Obese women with excessive GWG had worse outcomes than women with GWG within recommendations. Limited GWG was associated with increased spontaneous preterm birth and SGA infants.
J Perinatol. 2016 Apr;36(4):278-83. doi: 10.1038/jp.2015.202. Epub 2016 Jan 7. Maternal and neonatal outcomes in obese women who lose weight during pregnancy. Cox Bauer CM, Bernhard KA, Greer DM, Merrill DC. PMID: 26741574
OBJECTIVE: To evaluate neonatal and maternal outcomes in obese pregnant women whose weight gain differed from the Institute of Medicine (IOM) recommendations. STUDY DESIGN: Maternal and neonatal outcomes associated with weight change in pregnancy were retrospectively investigated in women with obesity (body mass index (BMI) ⩾30 kg m(-2); N=10734) who gave birth at 12 hospitals...RESULT: Compared with IOM recommendations, weight loss was associated with twofold greater odds of low birth weight infants and a mean decrease in estimated blood loss of 30 ml; excessive weight gain was associated with doubled odds of gestational hypertension or preeclampsia, fourfold greater odds of macrosomia and a mean decrease in 5-min APGAR of 0.09....
J Matern Fetal Neonatal Med. 2017 Feb;30(3):357-367. Epub 2016 Apr 28. Inadequate weight gain in obese women and the risk of small for gestational age (SGA): a systematic review and meta-analysis. Xu Z, Wen Z, Zhou Y, Li D, Luo Z. PMID: 27033234
...We conducted a meta-analysis of original researches with sufficient information about inadequate GWG in obese women stratified by obesity classes. SGA as the chief outcome was extracted and assessed in our analysis...13 studies (437 512 obese women) were included. Obese women who gained weight below the guidelines had higher risks of SGA than those who gained weight within the guidelines (OR 1.28; 95% CI 1.14-1.43). The same conclusions were also confirmed in Class I, Class II and Class III of obese women: Class I (OR 1.37; 95% CI 1.22-1.54); Class II (OR 1.38; 95% CI 1.24-1.54); Class III (OR 1.25; 95% CI 1.14-1.36). CONCLUSIONS: From our analysis, the guidelines of IOM can be applied to all the classes of obesity. More accurate boundaries for each obesity class should be established to evaluate the maternal and fetal risks. Diverse populations are thus necessary for more studies in the future.
Low Weight Gain/SGA and Risk for Infant Death 

Obesity (Silver Spring). 2016 Feb;24(2):490-8. doi: 10.1002/oby.21335. Epub 2015 Nov 17. Maternal obesity and gestational weight gain are risk factors for infant death. Bodnar LM, Siminerio LL, Himes KP, Hutcheon JA, Lash TL, Parisi SM, Abrams B. PMID: 26572932
OBJECTIVE: Assessment of the joint and independent relationships of gestational weight gain and prepregnancy body mass index (BMI) on risk of infant mortality was performed. METHODS: This study used Pennsylvania linked birth-infant death records (2003-2011) from infants without anomalies born to mothers with prepregnancy BMI categorized as underweight (n = 58,973), normal weight (n = 610,118), overweight (n = 296,630), grade 1 obesity (n = 147,608), grade 2 obesity (n = 71,740), and grade 3 obesity (n = 47,277)...For all BMI groups except for grade 3 obesity, there were U-shaped associations between gestational weight gain and risk of infant death. Weight loss and very low weight gain among women with grades 1 and 2 obesity were associated with high risks of infant mortality....
Am J Perinatol. 2016 Aug 17. [Epub ahead of print] Morbidity and Mortality in Small-for-Gestational-Age Infants: A Secondary Analysis of Nine MFMU Network Studies. Mendez-Figueroa H1, Truong VT2, Pedroza C2, Chauhan SP1. PMID: 27533102
...Data from nine Maternal-Fetal Medicine Units Network studies were used and included nonanomalous singletons at 24 weeks or more and birth weight < 90% for EGA...Among SGA, the likelihood of stillbirth (8.8 vs. 2.5 per 1,000 births; adjusted odds ratio [aOR] 3.98, 95% confidence interval [CI]: 2.92-5.42) and neonatal mortality (14.0 vs. 5.5 per 1,000 births; aOR 3.18, 95% CI: 2.55-3.95) was threefold higher compared with AGA. For the subgroup of newborns of EGA of 32 weeks or more, SGA, compared with AGA, had significantly higher risk of stillbirth (aOR 3.32, 95% CI: 2.16-5.12) and neonatal mortality (aOR 2.50; 95% CI: 1.38-4.54). From 35 weeks onward, the risk of stillbirth among SGA is almost four times higher than for AGA. CONCLUSION: The risk of stillbirth and neonatal mortality is significantly higher with SGA than with AGA. Modification in practice or new management schema may be warranted.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):333-9. Success of programming fetal growth phenotypes among obese women. Salihu HM, Mbah AK, Alio AP, Kornosky JL, Bruder K, Belogolovkin V. PMID: 19622995
...METHODS: This was a retrospective cohort study using the Missouri maternally linked cohort files (years 1978-1997)...Fetal growth phenotypes were defined as large for gestational age (LGA), appropriate for gestational age (AGA), and small for gestational age (SGA)...Neonatal mortality among LGA infants was similar for obese...and normal...weight mothers (OR 1.05, 95% confidence interval [CI] 0.75-1.48) and regardless of obesity subtype. By contrast, SGA and AGA infants programmed by obese mothers experienced greater neonatal mortality as compared with those born to normal weight mothers (AGA OR 1.45, 95% CI 1.32-1.59; SGA OR 1.72, 95% CI 1.49-1.98). CONCLUSION: Compared with normal weight mothers, obese women are least successful at programming SGA, less successful at programming AGA, and equally as successful at programming LGA infants.
Low Weight Gain and Risk for Prematurity

Obesity (Silver Spring). 2013 Dec;21(12):E770-4. doi: 10.1002/oby.20490. Epub 2013 Jul 5. Gestational weight loss and perinatal outcomes in overweight and obese women subsequent to diagnosis of gestational diabetes mellitus. Yee LM, Cheng YW, Inturrisi M, Caughey AB. PMID: 23613187
...Retrospective cohort study of 26,205 overweight and obese gestational diabetic women enrolled in the California Diabetes and Pregnancy Program. Women with GWL [Gestational Weight Loss] during program enrollment were compared to those with weight gain...RESULTS: About 5.2% of women experienced GWL. GWL was associated with decreased odds of macrosomia (aOR 0.63, 95% CI 0.52-0.77), NICU admission (aOR 0.51, 95% CI 0.27-0.95), and cesarean delivery (aOR 0.81, 95% CI 0.68-0.97). Odds of SGA status (aOR 1.69, 95% CI 1.32-2.17) and preterm delivery <34 weeks (aOR 1.71, 95% CI 1.23-2.37) were increased. CONCLUSIONS: In overweight and obese women with GDM, third trimester weight loss is associated with some improved maternal and neonatal outcomes, although this effect is lessened by increased odds of SGA status and preterm delivery. Further research on weight loss and interventions to improve adherence to weight guidelines in this population is recommended.
BJOG. 2011 Jan;118(1):55-61. doi: 10.1111/j.1471-0528.2010.02761.x. Epub 2010 Nov 4. Associations of gestational weight loss with birth-related outcome: a retrospective cohort study. Beyerlein A, Schiessl B, Lack N, von Kries R. PMID: 21054761
...DESIGN: Retrospective cohort study. SETTING AND POPULATION: Data on 709 575 singleton deliveries in Bavarian obstetric units from 2000-2007 were extracted from a standard dataset for which data are regularly collected for the national benchmarking of obstetric units...RESULTS: GWL was associated with a decreased risk of pregnancy complications, such as pre-eclampsia and nonelective caesarean section, in overweight and obese women [e.g. OR = 0.65 (95% confidence interval: 0.51, 0.83) for nonelective caesarean section in obese class I women]. The risks of preterm delivery and SGA births, by contrast, were significantly higher in overweight and obese class I/II mothers [e.g. OR = 1.68 (95% confidence interval: 1.37, 2.06) for SGA in obese class I women]. In obese class III women, no significantly increased risks of poor outcomes for infants were observed. CONCLUSIONS: The association of GWL with a decreased risk of pregnancy complications appears to be outweighed by increased risks of prematurity and SGA in all but obese class III mothers.
Epidemiology. 2006 Mar;17(2):170-7. Combined effects of prepregnancy body mass index and weight gain during pregnancy on the risk of preterm delivery. Dietz PM, Callaghan WM, Cogswell ME, Morrow B, Ferre C, Schieve LA. PMID: 16477257
...METHODS: Using data from the Pregnancy Risk Assessment Monitoring System in 21 states, we estimated the risk of very (20-31 weeks) and moderately (32-36 weeks) preterm delivery associated with a combination of prepregnancy body mass index (BMI) and gestational weight gain among 113,019 women who delivered a singleton infant during 1996-2001...RESULTS: There was a strong association between very low weight gain and very preterm delivery that varied by prepregnancy BMI, with the strongest association among underweight women (adjusted odds ratio = 9.8; 95% confidence interval = 7.0-13.8) and the weakest among very obese women (2.3; 1.8-3.1)...Women with very high weight gain had approximately twice the odds of very preterm delivery, regardless of prepregnancy BMI. CONCLUSIONS: This study supports concerns about very low weight gain during pregnancy, even among overweight and obese women, and also suggests that high weight gain, regardless of prepregnancy BMI, deserves further investigation.
J Matern Fetal Neonatal Med. 2012 Oct;25(10):1909-12. doi: 10.3109/14767058.2012.664666. Epub 2012 Mar 12. Gestational weight loss has adverse effects on placental development. Hasegawa J1, Nakamura M, Hamada S, Okuyama A, Matsuoka R, Ichizuka K, Sekizawa A, Okai T. PMID: 22348351
OBJECTIVE: To clarify whether mothers with gestational weight loss (GWL) were likely to have adverse effects on the placenta. STUDY DESIGN: Subjects who delivered viable singleton infants after 24 weeks of gestation were enrolled. A retrospective analysis to evaluate cases of GWL in association with the findings of the placenta and amniotic membrane after delivery was conducted. After consideration of confounders, a case-control study with matched pairs (1:2) was performed. RESULTS: Of all subjects (5551 cases), 83 cases (1.5%) with GWL were found. Since the pre-pregnancy maternal body mass index (BMI) was significantly higher in cases, 166 controls with a matched BMI were selected. The neonatal birth weights, placental weights and the umbilical cord length in cases were significantly smaller than in controls (p < 0.05). Preterm delivery and small for gestational age (SGA) infants were more frequently observed in cases compared with controls [odds ratio (OR) 6.3; 95% confidence interval (CI) 3.3, 12.1, OR 4.3; 95% CI 1.9, 9.9]. pPROM were observed in 10.8% of the cases and 1.8% of the control (OR 6.6; 95% CI 1.7, 25.1). However, the frequencies of chorioamnionitis and the cervical length at second trimester were not different between the two groups. CONCLUSION: GWL is associated with SGA, small placenta, short umbilical cord length, preterm delivery and pPROM.


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