Posted by Pattie on 3/08/2006 05:10:00 AM

Top 10 Things I'm Tired of Discussing:

Number 4-- How fatness causes mobility problems.

Mobility problems are not caused by being fat. There are plenty of people with mobility problems who are not fat. Mobility problems are not caused by aging either. Lots of young people have mobility problems. Yet in just about every discussion that I've participated in regarding fat and health among fat activists, it seems important to someone in that discussion to "concede" the point that mobility is compromised by being very fat. It seems to be a "given" that no one really wants to examine out loud or question.

Mobility problems stem from the inability of the system of muscles, connective tissues, joints, bones and nerves not working together well enough to effect movement and carry one’s body. It does not mean moving slower than other people. It means that something in that system is either preventing one from walking and/or standing or making one be in pain when walking and/or standing.

There are a number of reasons why this system gets compromised. There are diseases that attack various parts of the system making for limited mobility. There is also atrophy of the parts through non-use. Disease can sometimes be cured and sometimes not. Atrophy is a matter of practice. The more one moves, the easier it is to move when no disease is present. Of course, there are reasons both physical and social that practice doesn’t happen.

Diseases and conditions not related directly to the skeleto-muscular system might weaken one's ability to move. Pain itself can contribute to atrophy when not moving is less painful than moving.

Lack of energy due to starvation can cause atrophy. Not only do we need energy (calories) to move, but we also need nutrients and calories for muscles to build when we move. Thus calorie restriction (dieting and famine) can create mobility problems.

Surgery is a common barrier to movement that leads to atrophy. It took me several months to recover from pneumonia back in 2003 because I was bedridden for so many weeks. Post surgery in 1996 also caused me to have limited mobility.

Social barriers like the harassment people of size experience at gyms, pools and on the streets may also limit practice and therefore limit mobility. Crime and fear in certain neighborhoods also limit practice. Because of harassment, poverty and stigma, many fat people are not active.

There is no doubt that larger people have more problems with movement. But accepting blindly that these limitations are "caused" by being fat is just one more example of not examining non-causal explanations for correlations. Ninety-pound little old ladies also have trouble carrying their weight if they are frail. In fact, one of the ways frailty is defined by not being able to carry one's weight.

Losing weight won’t necessarily cure mobility problems. The fact that most people practice moving atrophied muscles when they make attempts to lose weight probably accounts for a lot of the connection between weight loss and improved mobility. But Kelly Bliss, for example, has been helping very large people improve mobility without concentrating on weight loss for a long time now. The weight loss part is not the point, the moving of atrophied muscles so that they gains strength is the point of her workouts.

Losing weight to improve mobility is moot because weight loss is rarely successful. One must also keep in mind that reducing energy intake (which most people who try to lose weight do) will also reduce the fuel one needs to practice moving one’s body and improving strength and mobility. So dieting becomes a catch-22.

In fact, it turns out that large people carry their weight quite well. Of course, the authors of the study were concerned more with weight loss than with simply understanding what the large body is like, but the ability of larger people to move efficiently and mechanically different from smaller people suggests that the body takes care of mobility not matter what our size. It suggests that the problems larger people have with mobility can be explained by social and cultural problems rather than physical ones in the absence of disease.

So given all this, why are we conceding anything to fat haters regarding mobility? Why are even discussing mobility questions in the context of fat liberation?

I am tired of hearing about how it is okay for very fat people to try to lose weight in order to deal with mobility problems. I believe that any person who is not disabled by disease can improve their mobility through increasing the strength of that system of muscles, connective tissues, joints, bones and nerves, no matter what their size. Sure it takes more strength to move 800 pounds than it does to move 90 pounds, but I believe that movement (I am avoiding the word “exercise” because it evokes particular kinds of movement and any movement of the system helps improve atrophy) by any “body” at any size will be good for that person.

If you don't think conceding the mobility question has important political implications, let me suggest that you pay attention to what is happening to people who suffer from osteoarthritis in their knees in Great Britian. Despite evidence that knee surgery is an iffy proposition for which physicians have little ability to predict outcome and despite evidence that being fat is not a good predictor of the outcome of surgery, the National Health Service in Great Britian has decided to withhold surgical treatment on the basis of weight, requiring people to lose weight before they can have the surgery.

Similar restrictions have been debating in Canada and several HMOs in the US are refusing to cover knee surgery and knee replacements on larger people.

Knee surgery is not a cure-all, but it happens to be the best we have right now and people who are suffering are often willing to take a 50/50 chance on not suffering.

The question of mobility is a political question, a social question and a cultural question. Conceding that fat causes mobility is not only inaccurate, but it give fuel to the opposition.

Of course, all this has been pointed out on a number of occasions in discussions about fat liberation. It would be nice if we could stop worrying about what is wrong with fat people and start discussing what we can do to change the prejudices that lead to the political, social and cultural barriers that prevent fat people from moving freely and receiving good quality health care.

The mobility question boils down to this: Anybody at any size deserves the space and the dignity to choose to move their bodies free of harassment and fear.