If you are here for the Doctor’s Office Survival Kit, just scroll down!  If you are looking for more support, I have a video workshop called “Dealing With Fatphobia At The Doctor’s Office (with a pay-what-you-can option) and you can find that here!

Last week on Grey’s Anatomy (no spoiler) former Scrubs star Sarah Chalke guest-stars in a plotline about a mother who has to strongly advocate with her doctors because she believes that her son is sick and they don’t.  This was more than an acting job, it was taken from Chalke’s real life – and lots of other people’s as well.

These days doctors have very limited time with patients and when you’re fat many doctors simply diagnose you as fat and prescribe weight loss, no matter what you came in for.  I’ve been prescribed weight loss for a broken toe, separated shoulder, and strep throat.  People close to me have had sudden onset back pain, and an acute knee injury blamed on weight.  Getting access to appropriate, evidence-based, affordable healthcare can seem almost impossible.

I started getting much better care when I decided that my healthcare was going to be a dialog between my healthcare providers and me, rather than thinking that I had no right to ask questions, challenge advice, or request that I be treated based on my values. To be clear, we shouldn’t have to do this, and not everyone is in a position to do it.  I want to give us options to self-rescue from fatphobia among health care professionals, while being clear that we shouldn’t have to do this and that the ability to do so is an expression of privilege, and that other biases – like racism, homophobia, transphobia, misogyny, ageism and more will make this process even more difficult for fat people with multiple marginalized identities.

Over the years I’ve developed some strategies that help me deal with health care professionals who are harboring weight bias.  By far the one I use most often when I’m told that something is caused by my weight is “Do thin people get [this issue].” The answer is always yes so I follow up with “What do you prescribe to them? Let’s try that.”  I also talk about research, including asking the doctor how, when there isn’t a single study where more than a tiny fraction of people lost weight, and no study that shows they were healthier for it, does she think weight loss qualifies as evidence-based medicine?

I’ve had readers request that I make cards that they can take with them.  I decided that today is the day. They are below and you can print them out to take with you.

Some notes about the cards:

Of course feel free to re-word these into phrasing the feels comfortable for you.

Use your own discretion – you’ll need to decide if you think that the situation will best be handled by you giving the card to your provider, or discussing it with them, or both.  I highly recommend calling ahead and letting a new provider know that you practice Health at Every Size and asking them if that’s something that they can respect and work with, in order to smooth the way.

The tone and timing are also things to consider.  I try to have this conversation with new practitioners before they prescribe weight loss so that I’m not starting off with conflict but with discussion. With existing providers I might say something like “I feel like I’ve been having trouble getting my healthcare values across to you, I brought in this card to help us have a dialog.” or something that means that, but that you would actually say.

I recommend practicing before trying this with the doctor/healthcare provider – you can practice in the mirror, in your car, with a friend etc.  Practice can help you stay calm and get the healthcare that you deserve.

The doctor card says “I practice Health at Every Size…” because this is what I have found to be the most effective phrasing when working with healthcare practitioners.  It is imperfect in that some people do not consider themselves Health at Every Size practitioners.  I’m absolutely open to suggestions on this.

I encourage you to actually read the research that is referenced. All research has limits, this is a start for conversations.

Consider other resources you can pass along to your healthcare provider, this paper is incredible both in content and references, Linda Bacon also has a great list of other resources specifically for healthcare providers.

If you have other phrases, research, resources etc. that you’ve found helpful working with the doctor, please feel free to leave them in the comments!

Here are the cards (they are also available in Spanish, French and German here!)

Copies without my website info:
Doctor Postcard – Front

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Book and Dance Class Sale!  I’m on a journey to complete an IRON-distance 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!  (DancesWithFat Members get an even better deal, make sure to make your purchases from the Members Page!)

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 (still!) training for an Iron-distance triathlon! 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.

I was thinking about how the fight for same-sex marriage rights is being characterized as asking for civil rights, when I got this e-mail:

If you spent less time asking for fat civil rights and more time dieting and exercising you wouldn’t need to ask for fat civil rights.

Ok, let’s do this.  First of all I spent over 10 years of my life focusing on dieting and exercise above all else so I’m pretty clear on what that looks like and why I don’t do it anymore. But really I think that I know everything I need to know about the person who wrote the e-mail based on their assumption that if I didn’t need fat civil rights I would be fine to wallow around in my rights, not caring that others don’t have them. Gross.

Still, there is a bigger inaccuracy here, and that is the idea that I am asking for fat civil rights.  That is a gross mischaracterization of the situation. Civil rights are not others to confer, they should never be subject to a show of hands vote.  It is particularly problematic and inappropriate to suggest that the “right” way to get civil rights is to ask others for them.

The rights to life, liberty and the pursuit of happiness are inalienable. For me, this includes the right to exist in my fat body without being an unwilling combatant in a war waged against me by the government because of how I look.  It means not hearing the repeated suggestion that the eradication of me and everyone who looks like me is a worthy goal to which I should agree and submit, whether or not I want to be eradicated.

I think that people get confused because often those who work for civil rights use the strategy of politely asking people to stop oppressing us.  It’s a technique that I use often, it’s effective, and I don’t apologize for it.  But please don’t be misled.

Whether it’s the right to exist in a fat body, the right to marry, or another civil rights issue, from my perspective we are never actually asking that people confer civil rights upon us.  Rather, we are demanding that people stop keeping  our rights from us through an inappropriate use of power and privilege.  If we ask nicely it’s a courtesy, because this is not really a request.

Speaking of requests, by request the Health at Every Size/Size Acceptance FAQs are now a permanent page on the site.  Check it out and feel free to ask your own questions in the comments:  https://danceswithfat.wordpress.com/faqs/

Like the blog?  Here’s more of my stuff:

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Here are some answers to questions that I often get about Health at Every Size and Size Acceptance.  Remember these are just my answers and I can only speak for myself.  If you have other questions that you would like me to answer and add to this blog just leave them in the comments and I”ll get on it! (This is a re-post by request. )

Aren’t Size Acceptance and Health at Every Size the same thing?

Nope!  Not at all.  Size Acceptance is a civil rights movement built around the fact that the rights to life, liberty, and the pursuit of happiness are not size dependent, which is to say that fat people have the right to exist in fat bodies without shame, stigma, bullying or oppression and it doesn\t matter why we are fat, what being fat means or if we could/want to become thin by some means.  Health at Every Size is an approach to personal and public health where the focus is put on behavior rather than body size, with the understanding that health is not a obligation, barometer of worthiness, entirely within our control, or guaranteed regardless of behavior. A full explanation is here.

Isn’t being fat unhealthy?

No. Weight and health are two separate things – there are healthy and unhealthy people of all sizes.  Health is multi-dimensional, not entirely within our control, and not a barometer of worthiness. The confusion of weight and health does a disservice to fat people because people (often including doctors) think that they can look at us and determine our health, it also does a dangerous disservice to thin people who are told that they are healthy simply because of their weight and that isn’t what the evidence shows. In fact, the evidence shows that people’s habits are a much better determinant of health than their size is.  Body size is not a diagnosis.  I call this a Galileo issue – “everybody knew” that the sun revolved around the Earth and so Galileo’s statement that the evidence showed that the Earth revolved around the sun was considered heresy.  Now “everybody knows” that fat is unhealthy and so statements to the contrary, even though they are fully supported by evidence, are considered heresy. That doesn’t make them any less true.  Even if fat was unhealthy, there are plenty of things that people do to prioritize their health that we don’t police (not getting enough sleep, not looking both ways before crossing the street, extreme sports etc.)  The idea that public health means making fat people’s health the public’s business is just thinly veiled fat bigotry.  Kate Harding has a fantastic post about this as well.

Isn’t Health at Every Size just giving up?

Health at Every Size is a choice to focus on healthy habits as a path to health rather than focusing on manipulating body size as a path to health.  Studies on long term dieting show that the vast majority of people regain their weight after 5 years, many regaining more weight than they lost – dieting does not meet the criteria for evidence based healthcare.  To me Health at Every Size is about opting out of a social construct, perpetuated by a 60 Billion dollar a year diet industry, that takes our money to solve a problem that nobody has proven is valid with a solution that nobody has proven is effective or even possible for most people.  Health at Every Size does involve giving up on some things, including the hope of getting the societal approval that comes with being thin.  But the cure for social stigma isn’t weight loss, the cure for social stigma is ending social stigma.  Health is a very personal thing – each person gets to choose how highly they want to prioritize their health and the path that they take to get there, and there are no guarantees.  For me it’s about the best I can do with the amazing and unique body I have which just happens to be a fat body.

How is it fair that my tax dollars pay for the healthcare of fat people?

Tax dollars pay for all kinds of things and unless someone has a list of everything that their tax dollars pay for broken down by what they do and do not want to pay for, then this is just about prejudice against fat people.  Even if you believe that fat people cost more,  this is  a very slippery slope – should those of us who don’t drink get to opt out of our tax dollars paying for any alcohol-related health problems? Should vegans get to opt out of their tax dollars paying for the healthcare of non-vegans?  Should people who choose the Atkins diet get to opt out of their tax dollars paying for health problems of people who don’t eat low carb?  This whole argument collapes under even a bit of scrutiny.  Also, just to bring some facts to the table, the Congressional Budget Office, and anyone who has actually looked at the number,s has concluded that fat people are barely a blip on the healthcare cost radar.

How can you say it’s ok to be fat?

Because nobody needs anyone else’s permission or approval to live in, and be happy with, their body.  Fat people have the right to life, liberty and the pursuit of happiness and that includes the right to live life in the bodies we have without our government waging war on us or having other people tell us that we need to do what they think we should do in the hopes that we will look the way they think we should look. It is absolutely, positively, completely ok to be fat.

Remember in addition to any of the comments you might have, if you have questions that you would like me to answer, you can leave them in the comments as well! Answers to additional questions can be found on the official FAQ page:

https://danceswithfat.wordpress.com/faqs/

Like the blog?  Here’s more of my stuff:

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Dance Class DVDs:  Buy the Dance Class DVDs – Every Body Dance Now! Click here for details

I received the following e-mail today, I’ve received several like it and it’s been coming up in questions at my talks as well so I thought this would be a good day to talk about it:

I was on [a Size Acceptance blog] and I saw in the comments where someone who said that they are normal weight and new to HAES asked a basic question and the blogger told them to “just Google it” and said that she’s not responsible for educating them, and that it’s not the oppressed person’s job to educate their oppressor, and demanding that they admit their thin privilege.  I’ve actually seen this type of reaction a few times. Shouldn’t we be doing everything we can to help people who are just coming to Fat Acceptance and HAES?  Can you please put the smack down on this?

Let’s start here – there will be no smack put down. Those bloggers are completely within their rights to choose not t0 answer questions, and to direct people to whatever resource they choose.  They are absolutely allowed to write a blog and not answer questions about what they blog about, nobody is obligated to educate others in the way that the others want. Some people choose to do this type of education work and some don’t and those are both completely legitimate choices.

I believe that there is room in the fat-o-sphere, and in activism in general, for a lot of different people attacking size oppression, bullying, and stigma from many different angles.  I think that’s a good thing, and I’m not a fan of suggesting that all bloggers/activists should be the same or, even worse, that there is a “right way” to be a blogger, activist etc.

One tenet of anti-oppression work is that the oppressed are never obligated to educate their oppressors.  No matter how well intentioned someone is with their questions, or where they are in their journey, it’s not ok to insist that other people educate them.

The people being asked these questions can suggest whatever resources they choose. I don’t typically suggest that people “just Google it,” especially when it comes to Health at Every Size and Size Acceptance, since there’s no telling what they’ll find (including troll communities).  I’m also aware that there are some theories that would suggest that it’s best for thin fat activists to do work themselves and educate each other about size stigma and oppression.  People are absolutely allowed to do that, I personally think that there are too many discussions about fat people that don’t include us, so if it were up to me I would much prefer that fat people who are interested in educating those asking the questions be involved in these discussions.

I choose to answer questions, including basic questions about HAES and Size Acceptance.  The main reason I do this is because the first time I heard many of these questions was when I asked them, and someone took the time to answer them for me.  I’m able to make this choice because of the position I’m in due to a combination of things including my choices, circumstances, luck, hard work, and privilege, and I want to take advantage of those things and use them to their best outcome and, for me, answering questions from people who are at the start of the journey is part of that for me.

But that’s just my choice, it isn’t any better or worse than any other choice, and it doesn’t have to be anyone else’s choice.  The fact that you choose to be open about your Health at Every Size and/or Size Acceptance journey does not mean that you have to become a HAES/SA educator and answer every question you get.  You can refer people to blogs, books, other resources, to Google if you want to.  You can choose to fight your own oppression (or not) in whatever way you are comfortable and you don’t owe anybody answers, education, or activism on their terms.

Like the blog?  Here’s more of my stuff:

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I got this e-mail today:  “Dear Ragen,  I hate exercise – like I seriously hate it.  I know that research shows that there are a lot of benefits but the thought of spending hours in the gym just sounds miserable.  Should I just suck it up?  What if I hate exercise?  Do you think I should do it anyway?”

This is a question I get a lot.  First, there is a mistaken notion out there that because I talk about my life as a fathlete and I talk about what the research says about fitness, that I am “promoting” exercise or I think that people “should” exercise.  Sometimes this happens because I haven’t written things as clearly as I should have, sometimes I think it’s because people have issues around exercise and just seeing discussion about it triggers them which is totally understandable given how much it gets shoved down our throats and the horrible experiences many of us have had (President’s Physical Fitness Test – I’m looking at you.)  Let me take this opportunity to clarify – I do not care if anyone else exercises. I am fully aware that there are people who don’t enjoy exercise, my partner is one of them, and I have no judgment about it at all.

The short version of why I don’t care is that the rights to life, liberty, and the pursuit of happiness are not exercise dependent, and other people’s prioritization of their health and the path they choose to get there are none of my, or anyone else’s business. The long version can be found here.

So if you hate to exercise, that’s completely cool and understandable, lots of people do.  Even if exercise has health benefits, that doesn’t mean that anyone is required to do it, or that exercising creates some sort of health guarantee wherein you are now immortal unless you get hit by a bus- that’s just not the case.  Besides, there are lots of things that are shown to improve our odds for health and we aren’t all obligated to do any of them. When we insist that people “owe” society healthy habits it very quickly becomes a slippery slope.  If we “owe” society exercise do we also owe it 8 hours of sleep a night?  A vegan diet?  A paleo diet?  To quit drinking? To not go skiing or play soccer or anything else that could get us hurt?  Who gets to make these mandates?  I recommend that people not try to tell others how to live unless they are super excited about someone else telling them how to live.

The reason I talk about the research around fitness is that I believe we are constantly lied to and I think we have the right to review the research ourselves. We are told that exercise will lead to weight loss when the research suggests no such thing.  Lied to that exercise won’t make us healthier unless it makes us thinner.  Lied to that we have to do hours of specific things in order to get benefit from it.  Those things aren’t true – the research shows that about 30 minutes of moderate activity about 5 days a week can have many health benefits for many people.  While that’s true, it doesn’t mean that we owe anybody exercise, and, again, it doesn’t give any guarantees when it comes to health.

So back to the original question:  If you hate exercise, you have lots of choices.  One choice is just not to do it.  Another option is that maybe you decide that you believe what the research says about the health benefits and you want those benefits so you find some forms of movement that you hate less than other forms of movement and do them.  You may believe what the research says and choose not to exercise.  You may decide that you think the research is crap.

Maybe you get a local pharmacy or clinic to take a baseline of your metabolic numbers, do the movement for a couple months and then see if there’s any change in how you feel or your numbers.  Maybe you work toward a specific goal (picking up a grand kid, walking to the mailbox.)  If you and exercise had a messy break-up, you can try to kiss and make-up.  Or not.  All the choices are yours and none of those choices are anyone else’s business.

I also wish people would stop encouraging us to set unrealistic goals.  I think that way too many athletes think that everyone must feel like them – since they love to exercise everyone else can learn to love it too!  I think that’s bullshit. I, for example, hate long distance running.  I’ve heard people talk about getting a “runner’s high” but the only runner’s high I ever get is when I get to stop running.

The dancers in More Cabaret, of which I am the director, discussed doing a 5k as a team bonding exercise.  I agreed to do it.  My realistic goal is that I will have fun with my teammates, complete the 5k, and be awarded a t-shirt (which they will not have in my size, giving me the opportunity for activism).  This is something that I can accomplish.  I do not have a goal of learning to love running – I’ve done a lot of it and since I still hate it, I choose to face the fact that it’s probably not in the cards for me.  The fact that some people love running does not indicate that I, or anyone else, must be able to love it.

If you hate exercise and you decide to do it anyway, you can try to make it suck less by picking activities you don’t hate (gardening? dancing in your living room?  video game that incorporates movement? window shopping?), changing activities frequently, playing music, watching televison, reading a book, talking on the phone (when I do flexibility training I often do several of those things at the same time to try to stave off the boredom) but you may never learn to love exercise, and what you choose to do about that is your business and nobody else’s.

Like the blog?  Here’s more of my stuff:

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The Book:  Fat:  The Owner’s Manual  The E-Book is Name Your Own Price! Click here for details

Dance Class DVDs:  Buy the Dance Class DVDs – Every Body Dance Now! Click here for details

Dancing with the Stars is back and I can’t decide if I’m more irritated about the gross misrepresentation of Contemporary Dance or the fact that it’s somehow become a weight loss show.  Since this is a blog about Size Acceptance and Health at Every Size, let’s talk about the latter and I’ll save my dance rants for the More Cabaret Blog.

The new season includes Wynonna Judd.  She is talking about getting healthy but many media outlets are discussing weight loss – “will she beat Kirstie Allies’ record?”  (Like almost everyone, Kirstie has gained the weight back.)

It makes me remember Kirstie’s season where they blamed all of her initial issues with dancing on her weight, and credited her dancing improvement to her weight loss.

This is a thing that we do. Have you noticed the way that we talk about the “miracle” of weight loss? It slices, it dices, it improves health, fashion sense, penmanship, and ballroom dancing!

This happens because our society’s preoccupation with thin has elevated weight loss from what it is –  a side effect that almost never lasts longterm – to this era’s snake oil. Weight loss happens in the short term for lots of people for lots of reasons.  Weight loss hardly ever lasts long term for anybody – only a tiny percentage of people maintain weight loss, regardless of the circumstances that lead to the loss or what they do in the long term.  And yet weight loss is constantly credited with all good things – forsaking all other reasons.

Someone starts practicing ballroom dancing 8 hours day 5 days a week with a professional ballroom dancer.  This person loses weight and their dancing improves. Who in their right mind credits the weight loss, and not the 40 hours of week of practice, for improving the dancing?

It’s the same when someone makes changes to the amount of movement they do and what they eat.  They lose weight and their health numbers improve.   Why do we credit the weight loss, and not the change in habits, to the health improvement?  Especially when research tells us that if the behavior changes are continued the weight will almost always come back but the health changes will remain.

Weight loss is a possible – but never certain – side effect, and typically a temporary one at that.  We need to stop suggesting that it is a cause, because it confuses people and leads to the mistaken belief that things that lead to weight loss are the same as things that lead to health.

That is why thin people get told to eat a predominantly whole foods diet and a variety of food in moderation, and fat people are told to drink 5 reconstituted soy protein shakes a day. 

It is why people measure the success of their movement program on weight loss, which is a shame since studies show that movement is fantastic for health, but lousy for weight loss.

It is why, when one of my blog readers returned to work after a bout of intense chemotherarpy, a co-worker actually thought it was ok to say “Wow, cancer looks great on you!”

It is why people glibly tell those dealing with anorexia – the most deadly mental illness – “I wish I could be just a little anorexic!”

It is what has created a “thin by any means necessary” mentality that makes me surprised that they don’t just hand out cocaine to fat people.  Then I realize that the diet drugs that get pushed at us, that not only don’t work long term, but have the pesky habit of killing people, aren’t far off.

We have made weight loss a thing of legend – the magic bullet that we are supposed to believe solves everything (including social stigma, which is convenient for those who enjoy stigmatizing us and don’t want it pointed out that the cure for social stigma is ending social stigma and not for the stigmatized to change themselves.) Weight loss is not the magical solution to all the things, let’s stop pretending that it is anything other than a highly profitable pipe dream.  Taking weight loss out of the health discussion removes a middle man that we don’t need, leaves room for conversations about actual health for those who are interested, and stops the mythologizing that lies to us and says that a side effect is a solution.

Then people can make their personal choice about how highly to prioritize their health and what path they want to try to get there within the realities of health.  They can make their choices and let their weight settle where it will instead of desperately trying to create a side effect that may actually lead them away from their goals.  Instead of forsaking everything for weight loss, let’s do ourselves a favor and forsake weight loss so that we can actually have a shot at everything.

Like the blog?  Here’s more of my stuff:

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CVS has implemented a so-called wellness program in which employees must go to a doctor to get their weight, body fat, glucose, cholesterol, and blood pressure measured, and submit those measurements to a third party healthcare company. They are required to sign a form saying that they are giving this information voluntarily, but if they don’t “volunteer” they are charged an extra $600 a year by CVS.

CVS says that they will never see the information. According to TODAY, CVS’s policy states:  “Going forward, you’ll be expected not just to know your numbers – but also to take action to manage them.”

What the hell does that mean? Who decides what constitutes “manage?” Are we headed toward compulsory dieting?  Compulsory medication?

Even looking past this gross invasion of privacy, telling employees to use their off-work time to go to the doctor, get their numbers, submit their numbers to a third party, and then “do something” about the numbers is about the laziest attempt I’ve ever seen at employee wellness.  There is no actual wellness in CVS’s program unless they think that shame and monetary penalties are the path to health.

I said this yesterday and I’ll say it again today:  When we reward and punish people for “health” and “healthy behaviors” we create an environment that ignores the complexities of health, dis/ability, and individual circumstances creating an environment of shame and blame that are the precise opposite of the goals of public health.

You know what has been shown to be seriously detrimental to health?  Poverty.  According to glassdoor.com, a CVS Cashier Sales Associate makes $8.19/hour.  That puts them at about 150% of the Federal Poverty line – and that’s if they’re single with no dependents and they manage to get a full-time schedule (Thanks to reader Lynn for pointing that out.)  If these people stand up for themselves and refuse to hand over private medical information, what effect does that have on their day to day lives?  Do they take $50 a month out of their grocery budget?  Do they skip going to the doctor? Is it fair that a CVS pharmacist can choose to protect their medical privacy for less than an hours of pay each month, but a CVS cashier would lose 6 hours of pay a month (and a much higher percentage) of their wages?

Not to mention that this inappropriately conflates weight and health in a way that is highly problematic while ignoring the fact that even if we believe people would be healthier if they were thinner, there isn’t any method shown to work long-term for more than a tiny fraction of people.  Other numbers can be heavily influenced by circumstances outside someone’s control.  Even if you believe that employers should take health measurements from employees and threaten that they are “expected to manage” those numbers, doing so is much more complicated than it sounds.

But maybe it’s not a gross overreach into their employees personal health information, maybe it’s a profit driver.  Per CNN Money, CVS has 163,000 employees.  If half of these employees stand up for themselves, that generates an extra $48,900,000 per year. Where does that money go?

This is not ok.  It is not ok to call handing over private health information “voluntary” when not doing it comes with a non-voluntary monetary penalty that could have consequences for employees’ ability to pay their bills.  I agree with Dr. Deborah C. Peel, the founder of Patient Privacy Rights, who said “Many employers want to do something for their workers, but very few of them are stupid enough to say give us the information and sign this form and say it’s voluntary,”

I’m standing up. I’m speaking out against this in whatever way I can.  I’m boycotting CVS until they end this policy.  I signed the petition on change.org. What about you?

Like the blog?  Here’s more of my stuff:

Become a member: Keep this blog ad-free, support the activism work I do, and get deals from cool businesses Click here for details

The Book:  Fat:  The Owner’s Manual  The E-Book is Name Your Own Price! Click here for details

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A recent study looked at he public’s willingness to accept legal strategies when it comes to public health interventions found that:

There was much support for strategies that enable people to exercise healthful choices—for example, menu labeling and improving access to nicotine patches—but considerably less for more coercive measures, such as insurance premium surcharges. These findings suggest that the least coercive path will be the smoothest and that support for interventions may be widespread among different social groups. In addition, the findings underscore the need for policy makers to involve the public in decision making, understand the public’s values, and communicate how policy decisions reflect this understanding.

I have a number of concerns around this, but first and foremost I think that we need to be sure that public health is about making information and options available to the public, while taking care not to make the individual’s health the public’s business.  When we reward and punish people for “health”  and “healthy behaviors” we create an environment that ignores the complexities of health, dis/ability, and individual circumstances creating an environment of shame and blame that are the precise opposite of the goals of public health. It also encourages people to deputize themselves into the “health police” which only serves to exacerbate these issues since, like drivers who think that everyone who drives more slowly is an idiot and everyone who drives faster is a maniac but their driving is perfect, these people tend to suggest that  “their” health practice is “Juuuuuust right.”

Before we break this down let’s look at some of the premises of this study.  The first issue is the danger of taking a vote on how we treat people in public health.  I’m not saying that studies like this shouldn’t be done, but I think we should be careful of how we interpret the results.  Public support for public health measures is not the same thing as evidence-based public health and even if 99% of people supported charging people more for health insurance based on how they look, that still wouldn’t make it right. The other questionable premise is the fact that this study mentions  a study from 2000 that showed the nation’s three leading causes of death to be tobacco use, poor diet and physical inactivity, and alcohol consumption.

I’ve not read that study so I don’t have a comment on the findings, but it is important to note that poor diet and physical inactivity are NOT the same thing as being fat/obesity, though the interpretations of the public health methods study seem to readily conflate the two which always brings scientific rigor into question.  Body size is not a behavior or a set of behaviors, it is not a diagnosis, it is not a disease.  This kind of thinking does a disservice to fat people by promoting weight stigma and suggesting that one cannot have a healthy diet and be physically active while still being fat which is demonstrably incorrect.  It also does a disservice to thin people suggesting that if you are thin your diet must be “healthy” and you must be doing the “correct” amount of physical activity which is also demonstrably untrue and dangerously misleading.  Public health interventions that are focused on body size are extremely problematic and wholly unnecessary to an actual conversation about public health. We’ve already talked about that. 

I think it’s fine to present people with information (including the evidence to back it up and the limitations thereof) and I think it’s fine to work hard to give people access to options like the foods they choose to eat, movement options that are both physically and psychologically safe, and affordable evidence-based healthcare.  I think that we should do that while being fiercely anti-shame in all of our messaging and  remembering that nobody owes anyone else “health” or “healthy habits” by their definition or any other, that health is multi-dimensional, complicated, and not entirely within our control, that the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent, and that nobody is obligated to choose to try for the longest life and ideally public health should be about giving everyone the same access to information and options and then allowing them to make their own choices.

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I am getting ready to take my first trip on Southwest Airlines in a long time.  They’ve recently changed their policy for fat flyers and I want to give them another chance.  I typically fit in a single seat but I’m traveling with my partner who needs a second seat and this gives me an opportunity to give their new policy a try.  Their new policy is that they would prefer people who need two seats purchase both of them in advance and then they will refund the extra seat after travel, but that “Customers of size who prefer not to purchase an additional seat in advance have the option of purchasing just one seat and then discussing their seating needs with the Customer Service Agent at their departure gate. If it is determined that a second (or third) seat is needed, they will be accommodated with a complimentary additional seat(s).”

My partner and I will be traveling to Austin in April and we’re planning to avail ourselves of the second option (not buying an extra ticket) and, if necessary, use it as an opportunity for activism.  I asked in a number of conversations  and communities with people of size if others had tried this and how it went.  I was a bit surprised by many of the responses I received from other fat people.  I was called an irresponsible trouble-maker, I was told that I shouldn’t be traveling if I can’t afford a second ticket, that I’m going to ruin it for everybody, that I should be bumped from my flight, that the policy is much better than it was, that I shouldn’t rock the boat, and many people told me that they are very happy to pay for the extra ticket since it gets refunded and I should be happy to do that as well.

Well, I’m not.

I simply don’t believe that fat people should be kept from air travel unless they have twice the money as thin people at the time of ticket purchase- I think that limits the opportunities of many fat people both personally and professionally because of their size and I consider that to be a form of size oppression that I choose to fight.

I think it’s nice that some people can pay for 2 seats every time they fly and wait for the refund with no problem and are happy to do it, but I don’t think that is everyone’s situation and I try not to be an activist only insofar as my needs are met.  I agree that the policy is better than it was, but I also try to be careful not to let better be the enemy of the equal.

Even if one is happy to pay double what a thin person pays at the time of ticketing, there are still issues with this. The fat person who is being flown to a job interview and has to tell their potential employer that their ticket will be twice as much up front as candidates who are thin. The professional speaker/consultant  who has to tell their clients that it’s going to be twice as much for their flight upfront than for a thin speaker/consultant.  The singer/comic/entertainer whose travel fees are twice as expensive up front as those against whom they compete for gigs.  The fat person who wants a job that requires travel by air and has to tell prospective employers that they will have to spend double the fees up front of a thin person competing for the same job, and that they will have to pay someone to deal with processing refunds, as they will be loaning the airline thousands of dollars every year.

Then of course there’s the simple fact that not every person who needs two seats can afford to pay double what other passengers pay and then wait around for a refund.  This is problematic both for the person who wants to book their travel well in advance and can’t afford to give the airline a long-term interest-free loan, and for the person who has to fly because of an emergency and can barely scrape together enough for one seat let alone two in the middle of an incredibly difficult time.

Also, let’s remember that this policy isn’t applied across the board.  First of all, the airline says that the armrests are the definitive border, but there are four armrests for 6 arms and so the airline has already created some issues with common space.  If someone takes up more than two seats because they have very broad shoulders or very long legs, they are not asked to buy a second seat, we’re all just supposed to be okay squishing in with them. At this time, I don’t take up two seats (it’s sheer luck – my fat goes front to back rather than side to side and I happen to have have narrower shoulders and hips) but I am constantly seated next to people whose arms, shoulders, or legs are in my space and I often wonder what would happen if I insisted that they needed to pay for a second seat based on the policy.

I have not yet found information on how Southwest handles bumps on overfull flights, but in general I believe that passengers should have the same experience regardless of body size. So if the flight is overfull, the policy to deal with that should have nothing to do with passenger size. Their policy should not be to bump fat passengers without compensation unless we give them an interest free loan of hundreds of dollars, while simultaneously giving compensation to thin passengers who they have to bump. It also shouldn’t be bumping passengers first due to physical appearance, rather than a fair and transparent system (volunteers, time of check in etc.)

I think it’s also important to note that it is the habit of airlines to overbook flights, so their policy is to sell more product than they have to begin with, and fat passengers should not bear the brunt of that. They should develop a system to let them know how many seats they need that does not require one group of people to pay twice as much up front as another group of people based on how they look, or to have one group of people have the highest chance of being bumped because of how they look. Anything else, as far as I’m concerned, is discrimination based on physical appearance and it’s not ok with me.

I believe in expecting the best and preparing for the worst, so in about a month my partner and I will go to the airport full of optimism that we will be treated well, and prepared if we are not.  Wish us luck!

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Reader Melissa clued me into Swedish Mannequins slightly larger than the typical size 4 that we see in the United States that have started a crapstorm of people falling all over each other to wring their hands and shriek about “promoting obesity”.

We’ve already discussed the thoroughly ridiculous idea of promoting obesity and it’s just as dumb now as it was then.

Also, I’m actually fat – right at this moment.  I’ve not the inclination toward nudism and over-sized burlap sacks chafe,  so I find myself with a need to buy clothing in my actual, right at this moment, size.  It would be just dandy if the mannequin modeling those clothes could even fit into the smallest size at the store, let alone my actual size.  I don’t believe that this would make me fatter, I do believe it would make me more likely to try on clothes that I ultimately buy while becoming less homicidal throughout the shopping process.

I think that it is vital that we stop calling these ideas, derived by rectal pull as far as I can tell, to be valid public health interventions just because they say “anti-obesity,” as if that’s some kind of magical password that renders science, research, logic, and basic human respect irrelevant and unnecessary.

Where is there good research to suggest that very thin mannequins lead to thin people or to healthy people (remembering, of course, that these are two separate things?)  Where is there good research to suggest  mannequins in a size 8 somehow cause people to become larger?  How is it logical that fat people will become happier, healthier and thinner as long as they never see people or inanimate objects who look like them?  Basically this entire idea – that the best thing we can do for fat people is purposefully create a world without positive representations of them –  is an unsubstantiated claim rooted in size bigotry.

Even if this research existed, the idea would still be problematic – is it ethical to try to make people healthier by creating a world that is designed to make them hate themselves and feel hopeless about their future unless they are able to change their body size? Then, of course, there is the added layer of the fact that the vast majority of those who try to change their body size fail? Among those who succeed, even if their physical health was better, would their mental health ever recover?

This is why I think it’s so important that we put representations of ourselves out there using the means that we have at our disposal – Facebook, blogs, forums, media appearances, wherever we can get ourselves out there.  It can also be extremely affirming to look at images of people who look like us to remember that what we are spoon-fed by the media is a stereotype of beauty that is artificially narrow and limited and, thanks to digital retouching, is unattainable by everyone – often including the people in the pictures.  Here are some places where you can check out awesome fatty images – if I’ve missed any (and I’m sure that I have) please feel free to add them in the comments!

The Fit Fatties Forum video and photo galleries (look around and feel free to add your own!)

The Adipositivity Project (NSFW unless your W is super cool)

The More Cabaret Gallery (FSFW – fairly safe for work)

Joyce Mudd’s amazing sculptures

This post (check the comments for lots of amazing pictures of fat people doing awesome stuff from belly dancing to hammer throwing).

Works of Peter Paul Rubens (NSFW)

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