This month, I am participating in a ReVolution! -- Every Monday in January I plan to write a blog post here about my life and how Health at Every Size℠ has changed my life for better. This is the fourth installment of five.


John Kennedy did implement the President's Council on Physical Fitness, which offered students rewards for various achievements in phys ed. I remember winning badges for things like long-jumping and running 100 yards (I had the second best time in my school for a girl in 11th grade). But there was not a lot of rhetoric connecting the physical fitness program with specific diseases and the question of public health. Since the 1970s, "fitness" has become more and more about policing behavior and personal responsibility, not about the joy of movement or the achievement of milestones.

What shifted in the 1970s with the physical fitness craze that led to the 1980s shift into funding lifestyle programs rather than prevention programs, was a fundamental understanding of health. The Baby Boomers seemed to have got it into their heads (as a group) that they could control their health. Jogging became a national past-time. Gym memberships rose. The belief that it was a good idea to do some exercise every day for general well-being became a quest to ward off all diseases. If we just ate the right foods, got the right amount of exercise, didn't smoke, didn't drink, and was conscious about nutrition, we SHOULD NOT GET SICK. EVER!!!

Of course, what that meant is that the poor souls who do get sick are suspected. Catch a cold, you didn't build up your immune system. Had an accident, you didn't stretch well or warm up in exercising. Contracted cancer, well it was obviously something you ate. Have a heart condition, your diet must be laden with, well depending upon who is speaking, too much fat, too little of the right kind of fat or if you eat correctly then it must be your Type A personality.

What started off as a system of promoting general well-being became a blame-the-victim game that has basically divided the population into haves and have-nots of health.

And of course, couple this with fat prejudice (as well as other kinds of prejudice) and a ready-made excuse for bigotry is woven into the culture. Believe that all fat people are lazy, ugly or dirty (the usual bigoted indictments of "other" groups), that's okay, you just care about their health.

This mechanism is, of course, not limited to fat people. Everyone with lung cancer is suspected of smoking. Everyone with AIDS is suspected of sexual "perversion." Liver disease means you must have drank too much. And so forth.

The new part of that rhetoric is "costs" -- almost daily someone somewhere publishes a report that shows how much the bad habits of others are costing everyone.

At the heart of this rhetoric lies two assumptions that need to be examined:

  1. We have control of our health.

  2. We are personally responsible for our own health and no one else's.

I believe that these two assumptions are patently false, though each with a grain of truth (as most lies need in order to be believable).

It is true that we have influence over our health and if we do things to excess (including exercising too much or restricting our food intake and obsessing over it too much), we will hurt our bodies in the long run and as we get older in the short run. But we do not control our health in full.

One of the original fitness gurus, Jack LaLanne died last week at the age of 96. He live a long and exceptional life, but the fact is he still died. He didn't die healthy. He died. Of course, a lot of people are pointing to LaLanne's life as an example, but I suspect that genetics played a bigger role in his longevity than his supporters would like to admit.

Jim Fixx was one of the thought leaders in the fitness craze of the 70s. He was a well-known runner. He died while running at the age of 52 from a heart attack. In truth, given that heart disease ran in his family and his father died in his early 40s, Fixx may have added some years and even quality to his life through his running. But he died young just the same.

The point is that there are a huge number of factors that determine health: some are under one's influence, most are not. To decide that Jack LaLanne had the superior fitness program over Jim Fixx is to pretend that we are masters of more than we have a right to claim.

Who cost the health care system more? Fixx died young, supposedly sparing us from his old age and the care he would need. LaLanne needed heart valve surgery at age 95. Was he a burden to the system because he prolonged his life until his valve needed care? These are absurd questions, but they are the kinds of questions to which the lifestyle think and victim blaming of current rhetoric lead us.

That leads to why the second assumption is also bogus, but with a grain of truth. We live in our bodies and in those bodies only we know what it feels like. We know our pain and we know our joy in ways that no one else, even our most intimate of lovers can really know. We do owe ourselves care and loving ourselves is, in part, about taking care of ourselves.

But health is not singular. The air we breathe we share. The water we drink we share. Every plant and animal that becomes our food is affected by that air and water as well. We share the planet with bugs. Some of those bugs do us good and some of those bugs under specific circumstances do us ill. We like to think of our bodies are singular, but in fact we have colonies of other creatures who share our body and some of those creatures like the bacteria that lives in our intestinal tracks are necessary for us to function. Where do we end and the bugs begin? Where do we end and the air begins? Where do we end and the water begins?

Carl Sagan once wrote, "We are star stuff." We are the elements and we will return to the elements. All matter does.

This inter-connectivity means that some health problems are better solved at a level different than the individual. Politics, pollution, climate, economics, personal relationships, stranger relationships, historical and sociological contexts affect our health and well-being.

We cannot calculate the cost of the contraction of disease without making some really big and fallacious assumptions. We are assuming that whatever condition or disease that is being examined is preventable and that the incident of that disease could have been prevented. This is always an estimate and it is always speculation.

Calculating the cost divides us and presents some of us as a burden to others of us.

And calculating the cost assumes a set price for our health that is never negotiable or questionable. Health "costs" do not occur spontaneously out of the mouth of some god somewhere. "Costs" are "charged" by people for services supposedly delivered to other people. Want to reduce costs? Charge less or pay less for medical services.

So how does Health at Every Size ℠help us with this understanding of health and the current lifestyle police mentality that essentially want to fault and make victims pay for their "crimes" against the healthy.

The Association for Size Diversity and Health offer 5 Principles of HAES℠:

  1. Accepting and respecting the diversity of body shapes and sizes.

  2. Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.

  3. Promoting all aspects of health and well-being for people of all sizes.

  4. Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.

  5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.

Accepting that people are diverse is a good beginning. Jim Fixx was a different person from Jack LaLanne. Both of these men were a different person from my great-grandfather who lived to be 99 years old, weighed 300 pounds when he died and probably never ran a mile in his life (though I'm quite sure he did his share of physical labor on the farm).

Personally I'm glad the world is full of diversity. I'm easily bored and without the wonderful diversity among us, it would be a really boring place.

Health and well-being are multidimensional and we sometimes choose one thing over another. I like playing poker. But I hate second-hand smoke. Even so-called non-smoking poker rooms are full of smoke because they are rarely cut off from the rest of the casino. I could not play daily, but I enjoy it enough to take the smoke every once in awhile. The exposure is limited but I know it is damaging just the same. Life is full of dimensions and complexities and no one can really draw a straight line of cause and effect with most health-related experiences.

The principles laid out are simple. They suggest that promoting well-being should be about acceptance not creating restrictive and constrictive rules that probably will not have the intended impact.

At the heart of these principles is a belief that all people deserve to be given a chance to show what they are made of -- all people deserve dignity.

The lifestyle policing and cost analyses come from a position of power and control. They are not about good health but about passing the burden on to someone else. They are about blame.

So perhaps you think that because you are average size or smaller this is not an issue for you. Well, the lifestyle think is what drives health care costs. Pre-existing conditions are a brainchild of this way of thinking. Dropping your insurance when you get sick is "only right" in a world where people are to blame for their illnesses. More and more companies are demanding fitness tests of their employees. Better not get too many colds because your boss might decide you ate too much candy or didn't work out enough and compromised your immune system. He will be able to fire you because you are costing the company too much in labor costs and insurance costs for having that cold.

The really sad part of this myopic view of health is that the real problems of pollution, poverty and daily stress are not being addressed. By ignoring the real problems we are making them bigger. You may be worrying about losing weight today, but ignore pollution and global warming and your children may be worried about how to find food for you in your old age.

Adopting a Health at Every Size℠ view of the world can contribute to a broader understanding of health and the major factors that contribute to health as well as creating a more just and sound basis for addressing those factors. Allowing fat people (or any group) to be scapegoated in the name of cost-cutting and blaming will open the door to anyone being blamed for their illness or disability.

First They came... - Pastor Martin Niemoller

First they came for the communists,
and I didn't speak out because I wasn't a communist.

Then they came for the trade unionists ,
and I didn't speak out because I wasn't a trade unionist.

Then they came for the Jews,
and I didn't speak out because I wasn't a Jew.

Then they came for me
and there was no one left to speak out for me.


Anonymous said...

Pattie, you already know I love you, but I thought I should say it again. This post says just about everything I could ever want someone to say about health.

Figure8onaDate said...

Well said! Thank you for taking the time to do this series.

Nancy Lebovitz said...

In regards how bad the "responsibility" thing has gotten: A friend of mine had pretty serious surgery for shoulder pain-- fortunately, the surgery went well. He's happy now with a metal plate on his spine and excellent shoulder mobility.

However, I wasn't sure why he needed the surgery in the first place, and when I asked him (more than once, which may have been a little obnoxious), he told me it had been degenerative disk disease. I said "Oh, fuck!", and he said "THANK YOU!" because everyone else had said, "What did you do to yourself?"