fattypatties

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 fifth and final installment of five.

IDENTITY, STIGMA AND HEALTH AT EVERY SIZE℠

Erving Goffman is said to have looked through newspapers and magazines every day, clipping items that helped him shape his ideas about how people interact with each other. Several key elements emerged in his writing.

First, he noted that people anticipate how others will view them and seek to manage that view through action, gesture, dress and facial expression. He called this "impression management." He suggested that this thing we call our "self" is actually a multitude of "selves" that are created in the moment of interaction with other people who are also presenting their "selves" in an attempt to manage our impression of them. In essence we play parts like in a play and we change our behavior and our presentation based upon who we are with and how intimate we are with that person. Questions of trust, authenticity, desire and control inevitably become part of the mix.

It is this background that helped Goffman develop his ideas about social stigma. He defined social stigma as a "spoiled identity." He suggested that those who are stigmatized by others are limited in their ability to manage impressions. When we are stigmatized, those who would view us through a single lens do not let us show them multiple layers of abilities, character traits, desires, etc. To stigmatize is to control another and to prevent them from having a useful and fulfilling social relationship.

Here's how it works. If I am stigmatized and I do something that fits the stereotype of my stigmatized social identity, I am used to prove the truth of the stigma. If I do something that is different from the stigma I am regarded as being inauthentic, faking it or trying too hard. I cannot escape the stigma and show my authentic self, or manage impressions that move away from the stigma.

Most of what has been done about stigma since Goffman has missed the point. Efforts are made to help individuals who are part of stigmatized populations to cope with the stigma and rise above it. This usually only serves to reify the stigma not end it. If stigma is to end, it must be ended by those who are stigmatizing. It is telling that English is so convoluted at this point. We do not really have a word for those who stigmatize. Bigot, maybe, but that can evoke a history that one might not want to evoke. Stigma is often regarded as the "right" attitude to have.

For example, there is a kind of reasoning that suggests that stigmatizing fat is correct because fatness is a result of laziness and a lack of self-control on the part of the person who is deemed fat. Fat people are placed into a cardboard, flat group that assumes all individuals deemed a part of the group are alike and, indeed are lazy and lacking in control. These are the only things that matter about the fat person. A fat singer, a fat Ph.D., a fat scientist, a fat physician, a fat athlete and so forth cannot exist as just a singer, Ph.D., scientist, physician, athlete. The word fat as an adjective changes the identity of the noun into something less than human.

But most people do not regard this as bigotry. This stigma is regarded as not only good but as necessary to help the fat person become thin. The stigmatizer is seen as "caring" about the "health" of the fat person.

But the stigma translates into a self-fulfilling prophecy with discrimination leading to reinforcement of the stereotypes. Fat people are insured less often and therefore put off going to doctors and getting health care, which leads to them become sicker. Fat people earn less money, making it harder for them to adequately acquire clothing and other symbols that suggest competency or diligence. Fat people are pushed to social backstage, which leads other to assume that they are unhappy with their bodies. And, of course, almost all fat people have tried to get thinner, which reinforces this belief as well.

Here's the problem. Stigma limits the life chances of human beings. It doesn't improve health. It makes it worse.

Stigma creates stress and stress creates imbalances in our physical and emotional well-being. There is ample evidence that stigma is a predictor of ill-health and there is growing evidence that this may have to do with a physiological change that surprise, surprise, leads to all those conditions that are associated with and are supposedly caused by being fat.

So I could sit here and make a health argument at this point, citing articles and studies. But I want to make a different point with this post.

Stigma is also a bad things to do to another human being. It is controlling and limiting the freedom of people. It shuns and shames people. In a word, it is just ain't right.

So I'd like to suggest in this last installment that the reason to embrace Health at Every Size℠ is because it is a stigma-free approach. Instead of treating a person as being less than human because of their size (and by the way, this happens to people on the thin end of the spectrum as well, not too mention people are considered too short or too tall), HAES℠ celebrates all bodies. Instead of dividing humans into acceptable bodies and unacceptable bodies, HAES℠ opens the door to people being judged on what they do, not what they look like.

To me, this is the most important reason to embrace HAES℠. Health is relative and there can be much debate on what is and is not good for a person. But dignity, empathy and diversity are not debatable. So often fat people, even fat activists, get caught up in justifying their existence by outlining how healthy one can be and still be fat. But that is not the issue. The issue is that weight-focused health care is stigmatized health care.

My favorite slogan, which has been co-opted from the disabilities movement is "nothing about us without us." A real test of public health policy as well as personal health care is the extent to which the voice of the patient is heard. Fat people are silenced by medicalization of their natural variation.


So listen up world. We do not need help. We do not need a cure. We do not need to be changed. We are that perfection. We have dignity. We are human. It really is that simple.

And that, to me is the essence of Health at Every Size℠.

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.

HEALTH AT EVERY SIZE℠ AND THE LIFESTYLE POLICE --
(OR WHY HEATH AT EVERY SIZE℠ IS IMPORTANT TO PEOPLE OF ALL SIZES)

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.

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 third installment of five.

HEALTH AT EVERY SIZE℠ AND GETTING OLDER


When I first decided in late 2000 to quit dieting once and for all, I was chronically ill with what I thought at the time was lupus (and have since learned was probably sub-clinical hypothyroidism). For the most part, these symptoms were chronic but not debilitating on a daily basis. I had flare-ups but had settled into routines that seemed to work. I had some sort of pain almost daily but usually dull pain and with regular exercise and eating good food and getting plenty of rest, I felt generally healthy.

I spent the first couple of years re-learning my hunger and satiation cues. I had dieted so much that I literally did not know when I was hungry or what my hunger felt like. In the past, I depended on outside cues to tell me when to eat and how much to eat. This was a process of mindful eating and, frankly, trial and error. I often waited too long at first, feeling ravenous when I finally sat down to eat and then finding I ate so fast that I was full long before I realized it. I slowed down my eating, learned to savor food and learned how to identify hunger before it was starvation.

In December 2002, I got pneumonia and became very weak. It was months before I could walk without gasping for air. I found a great program that started me working out in water with paddles and eventually I was doing 20 minutes on the treadmill and weight training in the gym. I became stronger and my metabolic health was excellent (blood pressure, blood sugar, cholesterol, pulse rate, etc.). AND I didn't lose weight or gain weight.

By the Spring of 2004, I felt the healthiest I had in years. I was still dealing with arthritic symptoms and flare-ups but not as often and not as severe. When we went on the road in The Ample Traveler, I felt good and maintained that feeling for some time. I turned 47 that summer.

It was easy to believe in Health at Every Size℠ under those conditions. When I wrote Taking Up Space with Carl, I was confident and had no doubt that this was a better way of living than the 30 years I spent fighting my body's natural tendency to be bigger.

I sprang my foot in 2004 and had nerve damage that left me walking with a cane, but even that didn't slow me down or shake my confidence. I had so much experience with chronic conditions at that point, that it became just one more thing to care for with my body--an annoyance, but my view of health had long since changed into an understanding of relative health rather than a set criteria. So I felt I was the healthiest I could be with chronic conditions.

Then I turned 50 and the "other biological clock" for women started. I became menopausal, I started having metabolic problems and I went through a rough period with Health at Every Size℠.

The same conditions that are supposedly connected to fatness are connected to aging, especially in women going through "the change." I began to doubt my choice to not diet and spent many days thinking through the whole process. I felt alone in some ways because I had fat-acceptance friends who were talking about how healthy they were and I knew I was not healthy. In fact, it felt like at the time that I was turning into the poster child for all the conditions that they were bragging they didn't have. For a while I kept quiet. I didn't write here and I didn't reach out. I didn't diet, but my reason for not trying to lose weight was that I was thoroughly convinced that it would not work, that I wouldn't lose any weight. I had been down that road and it made me sick and I didn't want to get any sicker. But I wasn't sure about the new road and whether I'd feel better.

I did reach out to some private groups eventually and I began to see that fat women who were going through menopause and who had type 2 diabetes and other metabolic problems were using HAES℠ to help them deal with their conditions. I started reading about these conditions and discovered that there were strong indications that the dieting I had done for 30 years as well as the aging process probably contributed to those conditions.

Let me be clear about another aspect of this. It didn't help that I had little access to health care due to no insurance and it didn't help that I am an underpaid teacher who has to work several jobs to supplement my income in order to be able to teach. Stress doesn't help. Stigma doesn't help. Fear doesn't help. Isolation doesn't help.

So about 2 years ago, upon realizing that many of my health problems, including the chronic conditions that started in 1997, were probably from hypothyroidism,I had another epiphany like the one I had in 2000. I had been misdiagnosed because of the societal and cultural attitudes about fat. In 1997, when I first got sick, I had chronic fatigue. I couldn't sleep well. I caught one infection after another. I was oversensitive to light and had rashes from exposure. I had an abnormal ANA count. I felt like I had the flu all the time with my joints and muscles aching. It wasn't hard to understand why the doctor thought it was arthritic and sent me to a rheumatologist, who, like most specialists, diagnosed me within her paradigm. Thus, lupus.

Except there was one symptom that I ignored and my doctors ignored: I gained 90 pounds in about 6 months. At the time, my paradigm and my doctors' paradigm was calories in/calories burned. I was eating less because I was too sick to eat much, but I went from someone who rode a bicycle everywhere she went (lived 3 miles from school, so at least 6 miles on school days, probably about 30 miles a week total) to someone who was bed-ridden. It seemed obvious that was the reason for the weight gain.

However, rapid weight gain is a symptom of hypothyroidism and no one even explored the possibility at the time. Hypothyroidism mimics lots of other conditions, especially so-called "check-box" conditions like lupus (positive diagnosis for lupus comes from presence of 4 out of 11 symptoms plus elimination of other possibilities).

So as I face an aging body, I've come to realize that my aging process is affected by several factors: hysterectomy (not ovaries) at age 38, untreated hypothyroidism, and years of yo-yo weight gain and pushing my metabolism and immune system to its limits.

In the past year, armed with this new understanding of HAES℠, one that doesn't depend upon me being perfectly healthy to demonstrate its effectiveness, I have become more pro-active in my health care.

First, I bought a wrist cuff to monitor my blood pressure. This has resulted in a significant reduction of my blood pressure meds and a personal realization that my blood pressure and pulse are heightened when I go to the doctor. I take my basal temperature in the morning to monitor the hypothyroidism. I check my blood sugar often. I am faithful in taking my medications and supplements, including menopausal support. I use assistive devices without hesitation because they improve my stamina and overall health.

And most importantly, I continue to practice intuitive eating and try to move my body as best I can. I do not diet. I do not weigh. I do not worry about my body size. The truth is that under thyroid treatment I think I may have lost a little weight (judging from how my clothes fit), but that is an effect of taking care of my thyroid and not intentional.

I am not the spring chicken I once was and I am angry that much of my health was taken from me by cultural standards and socialization that has made my aging more difficult. But the answer cannot lie in now buying into that thinking. I believe with all my heart that if I tried to lose weight now, I would make matters worse. I believe with all my heart that dieting is not good for the health. I believe with all my heart that I dieted my way into disability and early aging.

I believe with all my heart that if I had known and practiced Health at Every Size℠ when I was younger I would be a much healthier 50+ woman.

I tell my story often because I hope it serves as a lesson for others. I told Sarah on the podcast this week that I was excited to see so many young people involved with fat acceptance because they might be spared the years of dieting and the effects of that dieting.

I think that history will look back on this period as barbaric when it comes to dieting and weight loss. We have abundance and resources and instead of celebrating and sharing that abundance, we have created generations of people afraid of food, afraid of our own bodies.

I have come to realize how strong my body is. I have abused this body and fought this body for years and it perseveres and even improves with love and care. As I have researched what dieting does to a body, I have come to realize that I could be dead now from many of the things I did in the name of "getting more healthy."

So let me affirm, right here and right now, that I may not be the usual poster-girl for HAES℠, I should be, because HAES℠ has saved my life and has made me stronger. Health is relative and has a multitude of factors contributing to one's daily constitutions. But given what I've had to fight and what barriers I've faced and what damage I've staved off, I am healthy at my size.

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 second installment of five.

CORRELATIONS, CAUSES AND EFFECTS

So a lesson in the modern scientific method before I get personal:

The news media loves to report about scientific studies in absolute terms. Such and such "causes" cancer or diabetes or "fill-in-the-blank-scary-disease-or-condition." Most scientific studies do not purport to establish such a strong or absolute relationship. In fact, NO SINGLE STUDY CAN EVER ESTABLISH CAUSE AND EFFECT. Here is why:

Only in rare cases is the establishment of cause and effect so solid that it can be stated in an absolute. However, science can help make a case for or against cause and effect by applying the scientific method. If enough studies are done using solid scientific methodology, then a very strong case can be made that one thing causes another thing. But three conditions have to be satisfied in order to make that case:

The "cause" has to occur in time before the "effect."

This may seem obvious, but establishing a time line is more difficult than it may appear. Just because something was observed in time before something else doesn't mean it occurred before. It just means a human paid attention to it. In medicine and health this can be particularly difficult because when a condition gets to the point of diagnosis it probably has been around for a while.

But this still remains one of the three criteria for making the case for cause and effect, so many things in health are never going to be established as anything more than related to each other.


A change in the "cause" must be met with a consistent and significant change in the "effect."

This is called correlation. It is probably the simplest and easiest criteria to establish in cause and effect because of the advances made in statistics in the 20th century. Basically, this relationship has to be tested with a sufficient enough data sample to produce results that cannot be explained by mere coincidence or random chance. So it has to be repeatedly demonstrated (which is why no one study would ever be able to solidly establish cause and effect) and that demonstration must be shown to actually be testing what it claims to test.

Small sample sizes, poor measurements or bad data collection means that correlations are not established. Data quality is very important. This includes how questions are posed. When money is involved (and it is always involved), one should take extra care to review how data collection occurred because this is where bias can be seen most often. Throwing out data that doesn't match, skewing questions and measuring techniques towards a particular conclusion and other types of biases can undermine the case made for correlation.


Once the first two criteria are established there must be NO OTHER EXPLANATION for what is being observed

That means that all other explanations should be considered and certainly that is the best reason why no one study or even a group of studies can "prove" cause and effect. All other explanations must be explored. This includes explanations about which the originators of the study can't or didn't think when they did the study.

Alternative explanations are the meat of science. It is where the debate occurs and out of it is how useful things get discovered and created. But it takes time and money to do this right, so this is where most things get subverted.

Each one of these conditions is necessary to establish a case for cause and effect. NONE of these things are singularly sufficient to establish a case for cause and effect. Yet day in and day out the news media uses the word "cause" when reporting scientific studies.

Why would news media so consistently get it wrong? Well, because, for the most part, instead of hiring a science journalist with a strong background in whatever field of science the news story comes, who can critically read the study and write intelligently about it, they just copy and paste press releases from research institutions. Often it is verbatim. So why would research institutions use the word "cause" so easily? Because, again, the person working in the public relations office is not concerned with science as much as they are with further funding and the word "cause" is often more exciting than the phrase "correlated with."

Cause is sexy. Cause sounds like a big discovery. Cause means something important has occurred with this study.

And, of course, there is also the problem in health of when do we move forward even if we can't establish cause. Epidemiology is the use of demographic information (prevalence and incidence of disease) to see patterns in diseases that allow health care workers to act effectively even if a cause and effect hasn't been firmly established. This works especially well with communicable diseases that are airborne or water-born because cutting off and quarantining the patient or the water source may in fact stop the spread of disease even if no one knows exactly which virus or bacteria is causing what. But there are definite limits to epidemiological methodologies. It does not work as well with diseases and conditions that have multiple factors.

What all this means is that you and I as both health care and media consumers have to be especially vigilant in receiving this information.

So what does this have to do with my life with HAES℠?

Before I understood these things, like many others in our society, I accepted what doctors and news media told me about my health and well-being. I figured that the system was basically honestly trying to help.

I have since learned that to be healthy I need to practice a healthy bit of skepticism. So short of becoming a biologist or spending all my waking free time researching this information, what can I do to ensure my own health?

This is my answer: Trust My Body!

Yep. And that was a big request from someone who spent a good 30 years trying to live up to an ideal that didn't fit my body. That was a big request from someone who's body is now broken from those years of trying. But I stand by it.

Science is useful but it is NOT THE ULTIMATE TRUTH. Science is a tool and like all tools, it can be used for good or for evil. Like all tools, it is only as good as the person's hands in which it resides. Like all tools, it is not perfect and can and will be improved through human effort.

Each of us has been issued a physical presence. This is a remarkable thing we have. It takes us places. It interacts with it's environment with or without our awareness. It is sensitive to and gives warning of danger. It feels pleasure as well as pain. It generally knows what it needs when it needs it and that need may or may not make sense rationally.

Health at Every Size℠ is an approach that has much scientific support, most notably, Linda Bacon's study that compared dieting versus non-dieting approaches. But like all science, Health at Every Size℠ should be studied with the skepticism and scrutiny that makes good science. In my own research, I have found that the relationship between health and size doesn't hold up to that skepticism and scrutiny well.

However, I am an advocate for Health at Every Size℠ for more than scientific reasons. My body clicks with this approach. When I was constantly dieting, I become sicker and, frankly, crazier with each dieting experience. There was no peace between me and my body. In the 10 years since I have been practicing HAES℠, I have discovered a trust in my body that has served me well. I don't fight it and even on days when I am ill and don't have the physical strength to be my most productive, I know that my body knows best.

So I invite you to learn to trust your body as well. It is a lifelong journey that begins with a simple premise: Only I know what I feel. But I assure you it is a better way to live.

Previous installments:
1. DIETING MY WAY INTO DISABILITY

“Of all tyrannies, a tyranny exercised for the good of its victims may be the most oppressive. It may be better to live under robber barons than under omnipotent moral busybodies." -C.S. Lewis

The problem in the US right now is that our choices seemed to be limited to robber barons and omnipotent moral busybodies. How I long for a freer world rich with potential and multiplicities.

Well the stupid embed code was messed up on the Colbert Report Word segment. So you will have to go see it here.

I have to admit there is something appealing to an exodus of tv pundits to their own country.

I have a lot of thoughts about Ayn Rand, government and the current state of affairs in our culture that I will save for future posts, but I find it interesting that there is a renewed interest in Rand's work.

I had other thoughts about an earlier work by Rand that might be of interest.

I've been a little out of sorts for the past three days. It's probably nothing. I worked on two big projects immediately after teaching a summer intensive course so I basically spent about 6 weeks running full blast with little rest. It is not unusual for me to deflate a bit after such a busy time.

But when I do, I get a little down about the world. I try to keep that to myself. After all, it is probably more physical than anything else. So why make a big deal.

But it is also a time of introspection and pondering about things. Yesterday, I watched a documentary called The Age of Stupid and today I watched a documentary called For All Mankind. An interesting pairing. The first is about global warming and how we are ignoring the danger signals and proceeding to a point of no return. The second was a look back at the moon landings, narrated by several of the men who have actually walked on the moon.

I am old enough to remember the moon landing and how positive it made me feel about the world and country I lived in. I was aware of other things at the time as well, though both my assessment of the moon and my awareness of troubling social stress like the Vietnam War and racial tensions were naive. I was 11 years old.

But I do remember that I had hope.

I'm not so hopeful any more.

In fact, my feelings about the world around me are usually a high level of skepticism coupled with an overwhelming sense of sorrow. I have found in the ensuing 42 years that the position of disbelief is usually the truest position to take. I just frankly don't think much happens at face value anymore. There is always an agenda.

Of course when Kennedy made the above speech there was an agenda then as well. And it wasn't the explicit agenda. The cold war was on. The race to the moon was as much about military and ideological dominance as it was about exploration and expansion. It was inspirational but it was also devious.

Still, I think the quality has changed some how. I don't think our "leaders," if you want to call them that, rarely bother to cover up their motives or seek to take any kind of high road. We live in an uninspired age.

Yeah, I had a little hope when Obama gave wonderful speeches. But his words have not been met with action. That is partly because Washington and maybe the country (who can tell with the media lies) is deeply divided. But it is also because Obama is a politician first and foremost. We do not need politicians right now. We do not need politics right now.

There are some who would write for the next line that we need reason, but I do not even believe we need reason.

We need soul. We need to understand our nature and the nature of our planet and to feel the damage that our greed, hate and callousness are creating. We need to breath with the earth and feel her pain. We need to get out of our cities and look at the stars and understand our place in the cosmos. We need to feel the full impact in our guts and know that something must change and must change soon.

If I were Mother Earth, I think I'd be putting my collective children into a major "time-out" right now. It isn't that there are not things to be done. We should be doing things. We should be changing things.


But we are not:



We continue consuming, drilling, exploiting, and "expanding wealth" as if no piper was coming to demand payment.

But the piper is sounding the warning and the payment is not far away.

WE could make different choices.

I say "WE" but more and more I feel disenfranchised from that "WEness."

I do not feel the power.

In fact, I see very little in politics or in society that is being devoted to anything more than posturing. Those few of us who want to really see change are co-opted by politics or ignored.

It was present in the Age of Stupid video. I do not live in a large house, drive a large car or consume at anywhere near the level of my fellow Americans. I do not have the smallest ecological footprint, but I do not have the largest either. Yet the filmmakers chose to illustrate how much Americans were out-consuming the rest of the world by putting various cartoon fat bodies up. Yes, no matter what I do for the ecology, the greenies don't want a fat American on their side. Obama's escalation of the War on Obesity represents politics as usual. It is popular on the left to demonize fat people while crying loudly about other "isms." Never mind, the inherent contradiction of promoting one form of hate while claiming to fight another. Never mind, the promise of a different kind of politics while still using "war" both literally and figuratively in just the exact same way as those who came before.


Being disabled doesn't help either. As someone who runs into barriers every day of my life, I am keenly aware that technological advances mean nothing without a will to act and build. The "WE" often does not include the weakest among us.

So when I say "We Choose..." I really mean our so-called Leaders choose. I don't mean politicians, btw, when I say "leaders." I mean the people with power, the Power Elite.

The Power Elite chooses.

Can something be done about all this?

Well, yes. The "can" question is not the "will" question though. WE can do a lot. WE can make up our minds to go to the moon and put the resources towards that end and then get there. WE can end war. WE can end poverty. WE can live more in harmony with our environment.

But WE will most likely not do so.

Unfortunately, the we in the next sentence does include me and you: WE will pay a price for ignoring the truth. We will pay that price even if we knew the truth and were not heard by the Power Elite.

I wish I had an answer for the rest of us. I wish I could figure out what exactly those of us who see the impending disaster could do to get the powers that be to change. But today, right now, I feel like a passenger in a car who knows we should be putting the brakes on and is putting her foot through the floorboard trying to make it stop when it is the driver who has to brake. My imaginary brake won't save us and we are going to crash. It is a slow-mo feeling of impending disaster and a strong sense of helplessness.

That sense of helplessness won't keep me from screaming: "Look Out! Stop!" But ultimately it is not my call. Ultimately some other people are going to have to do something different. Ultimately they will have to make a choice and the consequences of that choice will have a deep impact.

I do have hope. I have the hope of someone who knows what it means to hit a bottom and learn. I fear for us as a species. There was a saying among 12-step programs -- "Don't let your bottom be lower than death."

I believe in Mother Earth. I think she will find a way to restore balance. I believe she will re-order what needs to be re-ordered. I can hear her motherly voice. "We can do this the easy way or we can do this the hard way."

Please, let's choose the easy way.

So I'm excited that there is a new resource on the web for People of Size.

And I'm very exited to be blogging there:

Why Are We Letting Michelle Obama Off So Easy?

I'm going to try to blog over there at least once a month.

I highly recommend the website.

I wrote in Taking Up Space that I am a reluctant warrior in the War on Obesity.

I don't like the idea of being a professional fat person.

I don't like the idea of being a fat activist.

I don't like the idea of defining myself as "that fat woman."

There are a thousand things I'd rather being doing, thinking about, playing with.

So I took a break for a while. I stopped writing about it. I stopped hanging out in forums. I stopped interacting with the fat activist community on a daily basis.

Then last summer I found Face Book and there was all this beautiful fat positive, fat activism going on and I was back in touch.

Also, last year The Fat Studies Reader was published. I co-authored the final article in the book. Actually, I authored an article that got combined with three other articles into one article. The book is getting a lot of attention. I sense a change and that change is actually interesting for me personally because it is opening up academic spaces that I might could wonder into. I have re-discovered a love for teaching at CSN over the past two years and I am feeling positive about the future as a fat woman and as a writer and as a teacher and maybe even as an academic.

But two incidences over the past few days have got me thinking about this and reminding me why I really dreaded.

First, there was a misunderstanding on one of the FB groups I post to and I felt like once again I was being treated like the angry one. Then later an FB friend posted about how great community is for addressing fat hatred and then as several people (including me) responded with anger about hateful comments we were scolded for not being more tolerant. Tolerant of hate? Being careful to not make a bully or a bigot feel shame. Wow. I'm very confused.

There seems to be a fear among activists regarding anger that I frankly don't understand. It is like many of them are waiting for permission from the powers that be to critique the powers that be. I'm reminded of Audre Lorde's article about the master's tools cannot be used to dismantle the master's house.

My anger is part of the deal. And I have lots of anger. Anger at being pushed into corners I don't want. Anger at being told that it is my responsibility to break out of those corners without holding the people who pushed me there responsible. Anger that the people I turn to to help me push back are too busy criticizing me to be of any help.

Someone said that they are happy to be a fat activist. I'm happy that I've met some incredible people and that I've found some incredible support. But I have to tell you that even with all the good stuff going on, I'm still getting this lack of true community and lack of anything effective being done. Okay, I've written that and I don't like saying that. It isn't exactly true. But the sad part is that it is closer to the truth than the opposite.

I don't want there to be a fat community, per se. I want the need for that community to end.

I want there to be freedom. I want people to be able to be themselves without fear. I want people to have a healthy intolerance for injustice, for hatred, for wrong. I want being right to be respected. I want human rights to be respected. Mostly I want to travel and make art and write and play with animals and take great photographs and move freely in the world without fear. And I want that and more for you too.

The key for me is how to do that and once again I'm faced with the question as to whether activism is the answer.

I cannot escape my fat body. I cannot escape the hatred and stigma that is placed upon that body. I am a reluctant warrior in the war on that body. I have to defend. I cannot have what I want otherwise.

So, here's my answer for now (and I am really just coming to this conclusion as I write):

We have to find some new tools. There is no other way to do it. Failure is not an option. I cannot forget all this. So I got to find someone, somewhere who want to forge these new tools with me. It's an adventure. It's new territory (something I love to explore). I cannot go back to this without something new and I cannot NOT go back to it because I cannot live silently. Something, somewhere has to give and right soon.

The Obamas are following the Clintons down the road of Health Care Reform and while I had hopes that it was not true this time and I've been impressed with how much further they have gotten, I'm have a feeling of deja vu all over again. I fear that if the stalled health insurance reform does ever get restarted again, it will end up being exactly what the monied interest in health care want: mandatory purchase of health care without or with few restrictions on profit-making at the expense of our health.

But what really is giving me the willies is last week's "Let's Move" campaign "targeting childhood obesity." Does anyone remember the timing of the "Shape Up America"? There stood Hilary Clinton standing behind C. Everett Koop near the end of 1994 while he announced that what America's health care needed the most was for doctors to tell their patients to lose weight like no doctor before 1994 had ever suggested to a patient that weight loss was a good idea. Wait. 1994! Hilary Clinton! Could it be that this was a smoke screen to take the focus off her and her husband's failure to fight the monied interest and give Americans a universal health care system?

Now we have a stalled health care reform that has been watered down to create the same racket we have with car insurance, except that living is something we have a right to and driving a car is a privilege (remember the Declaration of Independence? LIFE, liberty and the pursuit of happiness). So either way, I smell smoke and I see mirrors -- don't look over here where deals have been made with the profiteers. Let us misdirect your attention to the horrors of fatness. Except this time, we'll add the good old, "do it for the kids" line and that way you don't have to worry about the fact that after 16 years of telling Americans to diet and most Americans trying to diet, we still have fat people. What's worse, we managed to kill a bunch of people from the drugs and surgeries in the name of losing that fat along the way.

My more liberal friends are taking a gentle approach. They see something well-meaning-ed in Michelle Obama's motherhood and are gently asking her to consider alternatives. I'm not so inclined to let her off that easily. There's too much data and too much history and too much context to just assume that she is miguided. This is the same ole, same ole and I think it's time to shout from the roof tops: "The Emperor and (the Emperess, in this case) have NO CLOTHES!"

But I don't want to stop there. I do not like negative politics and I do not want to echo the Nopublicans in their negativity about everything these days. So on the off chance that Michelle Obama is sincere in her desire to make life better for the next generation and the generations to come, let me put 7 practical and feasible alternatives on the table that would be better at improving the lives of our children than putting them on a diet and making them exercise to the point that they forget how much fun it is to just play:

7 PRACTICAL IDEAS THAT WOULD MAKE LIFE BETTER FOR GENERATIONS TO COME

1. SAFER FOOD AND DRUGS

Our food system is superior in many ways, but the ever growing greed in food production is leading to more and more mishaps from contaminated food to preservatives that are bad for us to frankenfood to the lack of basic foods in poorer neighborhoods with less nutritious foods in their place. In fact, I suspect that many of the sins laid on the doorsteps of "obesity" have more to do with safety of our food than it does with how much we are consuming of it. In addition, more and more people are dying from their medications, including children. Reform at the FDA is needed and I haven't heard one word out of the administration regarding this.

2. SAFER PLAYGROUNDS AND STREETS

Children still grow up in areas where staying at home and watching television helps them live longer than being out in a playground or playing in the streets near where they live because it is dangerous to be in the streets. (Last time I checked, gunshot wounds or being assaulted were not good for your health.) Schools are closing earlier and earlier. In a world where ecommuting and working at home is more possible than ever, we are still insisting that the 9 to 5 work day is optimal and thus we have latchkey kids with no place to go and no safe adults to be near. This is not a matter of playing police. This is a matter of it takes a village to raise a child. Our communities are not child-oriented. They are profit-oriented. If we wanted to create a village where children could move, they would move. Children do not need to be told to play. When they are safe to do so, they move. And by the way, targeting fat kids is going to make this worse, not better. Bullying kids that are different is one of the ways that the streets are unsafe. Blaming fat kids for their health problems is going to fuel those differences and give ammunition to those bullies. In fact, it turns the federal government into one of those bullies.

3. STOP POSTPONING PAYING THE BILLS UNTIL THEY GROW UP

Deficit spending is putting a burden on the next generation and the ones after that. I'm not just talking about government debt. We had a major meltdown of the "credit industry" 2 years ago and our response was to patch it up and keep it. We have been sold a pack of lies about credit, especially long-term debt. Debt used to be something we entered into until the crops were harvested and then we paid it back with an eye on savings in bumper crop years. Now we are told it is okay to buy our toys on credit. The wake up call is that some day it has to be paid. We hit the snooze button instead of making the hard decisions. That has delayed the collapse of an unsustainable system, not fixed it or bailed it out. All of these things means that it is just going to be a bigger problem for our children. If we really loved our children we'd be re-examining this entire economic system and making some deep and abiding changes in our economy.

4. SPEAKING OF DEBT, GET RID OF BORROWING FOR STUDENTS

Nothing screams "I hate my kids" more than student debt. We put pressure on kids to go to school. We design jobs so that a high school education isn't good enough. Then we make it impossible for them to pay for that schooling without first putting themselves in debt. They leave the starting gate with a burden to carry. This burden makes them wage slaves, pure and simple. Now we are adding to this burden by making it impossible for them to finish the "4-year" degree in 4 years. Overcrowding and cutting back on teaching continues to create a system where students will have to borrow more to finish that degree.

5. SPEAKING OF EDUCATION, MAYBE TEACHING SOMETHING OF VALUE

Student debt isn't even the biggest problem in education. With the "No Child Left Behind" legislation we have made schools less about learning and more about test-taking. Our educational system is creating automaton sheeple, not critical thinking citizenry who question systems in order to improve them. If we really wanted life to be better for our kids we'd teach them how to think about their lives and the social systems within which they live so that they could improve things. Nothing belies the fear that adults have of their kids' brains than the way we do education and nothing points out the lie of "doing it for the children" than this fear. If we truly want them to have a better life than we have, then we should prepare them to be reflective thinkers instead of sheeple.

6. STOP STARVING THE CHILDREN

The real tragedy of the "Let's Move" campaign is the extent to which America's children still are suffering from malnutrition, starvation and lack of food security. Children are dying from lack of food and we are emphasizing starving the ones who have food? How crazy is that?!?

7. REAL UNIVERSAL HEALTH CARE

It is long past the time for America to provide health care to its citizens. Children growing up under the "for-profit" health care system are not going to be as health as they would be if they were able to see a doctor without fear of breaking the family bank. There are plenty of preventative measures that will ensure they grow up health that have nothing to do with the size of their bodies that need to be available universally. The hodgepodge, committee-fied bills that are being "reconciled" in committee right now are not going to cut it without a public option. As long as health care is a "for-profit" enterprise, money is going to be more important than our children.

Let's be clear about some things:

I voted for Obama. I did not vote in 2000 or 2004 presidential elections because I saw no viable candidates for whom to cast my vote. I liked Obama's message of change and wanted to give him a try. I had hope that he might be different and I think there are some ways that he has been different.

But I am not as pleased as I hoped I would be and this latest campaign weakens my hope even more. This is nothing new. This is business as usual in Washington and all those things he said in his campaign about continuing down the path of business as usual will come true, even if it is cloaked in the language of change.

We pay a price for those things we believe that are not true. Taking public resources and emphasizing weight loss for children is going to have a heavy price tag. We are going to raise a generation who fear their own bodies, who stigmatize fatness and fat people and who will spend their adulthoods sorting out food issues instead of solving more important challenges. In addition, spending these public resources on this means that we take away resources from more important challenges facing us now. We pay now. They pay later.

We do need a change. The "Let's Move" campaign is not change.

Mary Whorley at Whorley Dervish shared Rachel Maddow's School of Crock segment (those of us over 35 know the reference). She writes:

The Republicans were there so that Baucus would have plausible deniability along the lines of "the Republicans made me do it," which is politically less damning than "I did it for my corporate masters."

This is a game that has been going on in our two party system for years. The Republicrats owe their livelihood to big corporate interests (Read carefully -- I mean both sides of the aisle). Baucus did what he did because he was well paid:

The Montana Democrat is enjoying this largesse — some $3.9 million in contributions from the health care industry since 1989 — principally because of his place as chairman of the Senate Finance Committee. The panel is at the center of this year's health care debate, and on Wednesday Baucus released his view of how the medical system should be reshaped: an $856 billion, 10-year package of changes.

The stream of generous campaign contributions from doctors, drug makers, hospitals and other medical interests didn't stop at the chairman's door. It extends to the other members of the so-called Gang of Six, the two Democratic and three Republican senators who labored with Baucus since June to produce what he hoped would be a bipartisan bill. All have received above-average donations from the health-care world.

...

Among them, the six senators have raised $10.7 million since 1989 from the industries and people with the most at stake financially in the overhaul effort. That's an average of nearly $1.8 million apiece over that period, more than triple the roughly $560,000 average for all other senators and representatives.
Read More

So the acid test is here. Now that we have bills going to both chambers. There is a way for good health care reform to still pass. It would have to be fast and it would NOT be bipartisan. But it could happen. If the Democrats have the balls and really mean it, they can do it.

If they don't do this. If they pass the Baucus bill and not the house bill or something closer to the Baucus bill than HR3200, then they never meant it.

We need to hold the Democrats and Obama accountable.

Wendell Potter is my new hero. I saw him on PBS with Bill Moyer and now he has been featured on a NY Times OpEd. If you believe our current system works and that a public option isn't necessary, I suggest you read about Wendell Potter and also Linda Peeno.

Both of these whistle blowers tell eerily similar stories about the insurance industry. We are currently at the mercy of these megacompanies and their policies.

Here's a taste of their stories:

I just saw this posted in a forum (I will refrain from attribution because I don't want to debate the person, but the ideas):

GOVERNMENT RUN HEALTH CARE:
The compassion of the IRS
the efficiency of the Post Office,
at Pentagon prices.

Without pointing out the immediate fallacy (no one is advocating "government run" care -- oops, pointed it out anyway) this is my response:

CURRENT AMERICAN HEALTHCARE:
The compassion of Wall Street,
the efficiency of American Auto Makers,
at Hollywood Blockbuster production costs

Medicine is never going to be a free market because the knowledge and care needed at the worst possible times in our lives is complex. Those charging for these services are always going to have the upper hand. Free markets allow for buyers to shop, to refuse to buy, to obtain the best knowledge. Without consumer protection and a power player in the market that evens the playing field, we are at the mercy of the sellers in the worst way -- the consequences of not buying is death, disease and disability.

I happen to believe that it should be universally and singularly funded so that we have one representative for the people who negotiates the purchase of services for all humans (this is the Canadian system and having been a part of it for several years, I found it to be working fairly well). But I'm a realist and I don't believe that such a system would be possible at this time. Too many stakeholders with too much to lose.

What is a close second is what is being proposed by Obama and is being semi-fulfilled by the various bills being considered in Congress: make one of the players in the market a force to level the playing field.

What I find most disconcerting is that many of the criticisms that are being leveled and fears being expressed about government involvement in health care already occur in our system, just through the private sector.

This is my top seven list of misconceptions:

1. Everybody pays for their own health care.

If you have insurance, you are paying for everyone else in the insurance system -- the concept of pooling funds to cover the risk for a few is the basic concept of insurance. Excluding millions of people from the pool isn't very smart unless the people you exclude from the pool are the ones most at risk, thus, insurance companies do not want you in the pool if you are a child, if you are an older adult, if you have a pre-existing condition, if you have are at-risk because of family history or personal behavior, and, increasingly, if you get sick.

2. No one should have to pay for those who do not qualify for insurance.

One of the reasons that health care entities charge so high is they have to cover the visitors to emergency rooms and facilities who do not pay either through bankruptcy or through simply not paying all or most of the bill. This not only costs the entity the money spent on the time and equipment to provide the service, but also the staff time on social services or collection services at attempting to get the bill paid. The net result of this is that those who have insurance pay more than they would otherwise because they are paying for these overhead costs.

3. Doctors and nurses should decide on care, not bureaucracies.

This ship sailed in the mid-80s. Your medical decisions are being directed by nameless, faceless decision-makers who "qualify" your care through your insurance company. If they refuse to pay, you most likely will not receive care. The job of the decision-maker is to find whatever reason possible to deny care in order to maximize profits. Most the reasons they find are NOT medical reasons. They look for some little thing in your application that they can use to cancel you policy (btw, they do NOT refund your premiums when they "discover" these discrepancies). The number one complaint that most medical professionals have regarding the current system is that they cannot spend the time or provide the best care to their patients under the current system. This is why nurses, especially, are solidly for health care reform. They see the results of this system every single day.

4. If the government becomes a major player, we will lose the efficiency of the free market.

We currently have the most inefficient and costly system in the developed world. Fully 25% of our health care "costs" are due to the enormous administrative burden of going through the qualification process the each insurance company has. Most doctors offices now employ at least one staff member who does nothing but paperwork and sit on the phone all day working through the bureaucratic mess of private insurance.

Our emergency rooms are places of the biggest medical mistakes because they are clogged with people who have no where else to turn for care. In inner cities, airborne communicative diseases spread faster because of these centralized places for the working poor to gather when they are sick to sit for hours and hours of exposure. We are one big disaster away from the whole thing breaking down.

The current system is extremely inefficient and is getting worse. We are starting to see the results. A recent book asserts that medical professionals are misdiagnosing about 15% of the time.

5. The current system allows the freedom to get medical care without interference from bureaucrats.

This one is especially used by those who would scare older persons with the so-called death clause. Well, every single HMO that I've studied or been a part of has "end of life counseling" already. I'm asked every time I go to the doctor or hospital about whether I've set up a living will. The current profit motive is going to push and push us to consider opting out of their paying for care at every turn. This is not a medical issue. This is not a moral issue (you know, care for your loved ones by planning ahead, it is the right thing to do), this is a profit issue (tell your doctor to turn off the machines so we can collect from you and never have to pay out). Personally, I'd rather have this be a matter between you and your attorney and not be asked when I'm sick, but if people are sure that this is a government thing, they need to pay attention to this long-standing practice by the HMO.

This does raise another issue that I think is more important. Does universal health care mean anybody can get any medical service they want covered. The answer is "no" and has to be "no" because otherwise we will be giving free reign to medical providers to invent crappy medical interventions. Oh yeah, we already have that -- its called "fee for service" and only a government player in the system is going to push for an incentive that doesn't include keeping us sick in order to get more money out of us. In truth, this may be the only thing HMOs have been good for in the past 30 or so years, but because of their own profit motives, they found out that they like us being sick too -- that way they can refuse us coverage when the moment comes while keeping our premiums.

6. The current system is good for business

It is plainly not. Some of the business failures we have seen in the past few years have been in part due to the rising costs of health care coverage for employees and pensioners. The only business that the current system is good for is the HMO/insurance industry and the pharmaceutical industry. I mentioned in a comment on an earlier post, it is my belief that if we continue with the current system, we are going to see the United States lose ground in the world economy (and may be seeing this already). Outsourcing from other countries, moving of factories to other countries and brain drain exits of college graduates to other countries are all motivated in part by the rising costs of health care.

7. Our system is the best in the world, why mess with it?

Yes, we have more bells and whistles than most places. We do love our technologies. However, most of the time our technology drives up costs without producing much in the way of improved health. The fact is that we rank out of the top 10 in a number of health indicators such as life expectancy and infant mortality. When put in a per dollar perspective, we really suck. We spend more, receive less. We are not the best in the world and the best in the world are systems that have their governments involved in some way.

Carl has a list of books he'll never write which includes one called the "Mononarrative," which would be about the trend in American public discourse that has been going on for 20 or 30 years. The idea seems to be that we should all be repeating the same narrative and that composing a text or subtext that doesn't confirm to this one, true narrative is unacceptable. It's not that everyone agrees upon the content of the mononarrative, but everyone seems to agree that there should be a mononarrative.

"Since coming up with the term, I've seen the expression 'monomind' in my readings," explains Carl, "and it parallels what I've been thinking very well."

Of late, Carl has been suggesting that there is a new discourse afoot -- he has called it the "No-No Narrative." Those in power no longer want anyone talking, including themselves. They just want to shut down discourse.

"The motto of the 80s and 90s was 'You're not supposed to say that,'" Carl further elaborates, "while the motto in this decade has been 'NO talking.'"

I couldn't help notice over the weekend how eerily similar the "spontaneous protests" popping up at town hall meetings on health care were to the "Brooks Brothers Riot" from the 2000 election. I went looking on YouTube for videos of both events and found that Rachel Haddow beat me to the proverbial punch:




I agree with Rachel's take at the end. The best way to fight this stupid form of shouting down politics is to point it out for the orchestrated power mongering that it is and make it so obvious that no one will want to do it again. Shouting down is not debate and shouting back isn't the way to create a debate. We must fight the no-no narrative by telling our own stories and by unmarking and taking away the incentive for this kind of government by riot.

And this is why Carl and I were happy Paul wrote the preface to our book:

America's Moral Panic Over Obesity

PREFACE

I knew it was going to happen...

The health care reform debate has finally got around to blaming fat people for the nation's health problems.

I've been avoiding thinking about this and writing about this because, well, it's tiresome. This is something that I see so clearly and it is obvious that the majority of Americans (and really the rest of the western world, or at least, English speaking world) just can't see. I hate the disconnect. I feel like I've seen and I've written clear and concise arguments over and over again only to have the exact same questions asked and the exact same rebuttals made. These questions and rebuttals are phrased in such a way that it is obvious the person posing them has not heard/read and/or understood a word on the clear and concise argument.

Ever spent time with a three-year-old who has discovered the word "why"? You speak and the response, no matter what you say, is "Why? Why? Why?Why? Why? Why?Why? Why? Why?Why? Why? Why?Why? Why? Why?" By the end of the "conversation" you are thinking "Why do I bother?"

Or in the words of Mugatu (Will Ferrell) in Zoolander: "I feel like I'm taking crazy pills."

So with this extremely impatient introduction let me make an argument for why the last thing health care reform needs to do is try to make people lose weight and why Health at Every Size (HAES) is the best preventative care option for containing health care costs AND making our country healthier.

TOP 7 REASONS FOR
MAKING HAES THE ONLY PUBLIC HEALTH POLICY ON WEIGHT

7. Almost every method for losing weight ends in weight gain.

There is no viable way for taking weight off and keeping it off for the vast majority of people. In fact, there is ample evidence (pun intended) that dieting and weight loss schemes may be one of the reasons that Americans are larger than they were 20 years ago.

6. Almost every method for losing weight has led to dire health consequences in long-term health outcomes.

Most weight loss schemes, including so called "sensible" ones often lead to poorer health outcomes for individuals who temporarily succeed at them. Drugs are often pulled off the market within a few years of introduction due to disability and death caused by them. WLS has some of the highest mortality and comorbidity rates of any surgery done on a regular basis. Severe calorie restrictions and various appetite suppression schemes cause all sorts of short-term and long-term health problems. Not only is there no proven way to lose weight permanently, there is no proven safe way to lose weight.

5. There is precious little evidence that being fat CAUSES any disease

Yes, there are correlations. But there are correlations between being male and certain diseases and no one is advocating castration for cures. There are correlations between being of African descent and certain diseases and no one is advocating skin lightening as curative. Three conditions must exist to show cause and effect:

First, the cause has to take place in time before the effect. Since figuring out when a disease started (diagnosis is always after the start of a disease), it is often impossible to know which came first, the weight gain or the disease.

Second, a change in the cause should produce a change in the effect. This correlation has been established on a population level. We have gotten fatter over the same period of time that we have, as a group, experienced more heart disease, diabetes, high blood pressure and so forth. But establishing the population correlation isn't the same as establishing individual correlations. For example, little evidence exists that losing weight in a particular individual leads to a change in their health conditions, especially when we consider the third condition to establish cause and effect.

Finally, NO OTHER EXPLANATION has to be available to explain the relationship between the cause and effect. So, in the case of weight loss, since most people trying to lose weight often change diet and/or their physical activity, the actual change in eating and/or exercise may be the more plausible explanation for changes in health associated with weight loss. Since precious few have actually studied or questioned the "cause and effect" aspects of weight with any kind of rigor, at this point we do not really know what the relationship between weight and disease are. We only know that over the past 30 years, people have gained weight and prevalence of certain health conditions have increased. We are far from establishing cause and effect and this is true no matter how many times people get on TV and say "obesity causes..."

4. We know that stigmatization contributes to ill health.

Any "program" that promotes weight loss is stigmatizing fat people. I know that is a radical thing to say, but it is true. Weight loss as a goal means getting rid of fat and it requires a demonization of fat in order to make it a goal. Fat carries stigma in this culture. Weight loss reinforces that stigma. Any public health policy that makes weight loss an overall PUBLIC goal is going to perpetuate stigma. That means even with accessibility, fat people will not receive the proper care they deserve either because some medical professional is going to concentrate on weight loss instead of the health condition OR many fat people, having been shamed or unwelcomed in medical settings is going to put off going to see a health care professional until it is too late. Thus, continuing to stigmatize fat is going to lead to worse health outcomes, not better ones.

3. We do know that exercise has a beneficial effect on individual health no matter what their size.

Health at Every Size promotes the idea that we should be pursuing health NOT weight loss. So here's where I know that the proponents of obesity as health crisis do not really care about the health of fat people and do NOT believe their own assertions about how to lose weight. Most HAES professionals advocate that to become healthy, all individuals should eat well-balanced foods with good macro and micro nutrients and should move their bodies more. Most weight-loss gurus recommend pretty much the same thing -- changes in eating and exercise to achieve weight loss. SO, if the weight-loss gurus believe that these lifestyle changes will lead to weight loss because of the physics of calorie consumption and conduction, why are they worried about HAES? If they are correct and we encourage persons of all sizes to eat well and exercise regularly, then fat people would lose weight, right? Does it actually require the fat persons active measurement of weight to lose the weight? No. If they are right, the weight would go down whether the person is weighing themselves or not. So if I were truly wanting to promote weight loss and I heard that a bunch of fat people were willing to exercise and improve their diets, wouldn't I be happy to just let them do it? Wouldn't I be elated that they got the message? But the opposite is true. Weight-loss gurus are threatened by the HAES movement. I believe that is because most of these people who say they are concerned about the health of bigger people have no such concern. What they want is more money, more prestige and more power for themselves. HAES as a health policy concentrates on providing encouragement for persons of ALL SIZES to take good care of their bodies. Fat acceptance means no more stigma of fat persons, which means that a fat neutral world would encourage healthier lifestyle practices.

2. HAES would mean better health for thin people too

By concentrating on weight rather than health, especially in children, the health habits of many so called "normal" weight and "underweight" persons are ignored. Since size = health indicator is so prevalent, the naturally thin persons often believe they are okay eating what they eat and not exercising. By paying attention to behavior instead of a physical characteristic, all persons will be encouraged to pursue healthier lives.

1. HAES will work to improve health where weight loss will not

There has been one study done in all the years of weight research that actually asks this question about success. Linda Bacon did a 2 year study running two groups, one that dieted and one that practiced HAES. The results were what any chronic dieter could tell you. Those who concentrated on losing weight were in poorer health at the end of the two years. Those who concentrated on improving health regardless of weight, were healthier. One study does not make a conclusive case, of course, but it certainly supports the need for further study and promises hope where most weight loss studies do not.

REAL PREVENTATIVE HEALTH CARE

The question of health care reform is a complex one and I agree that preventative health needs to be a part of the equation to cut costs and to ensure success. Our current system only encourages the financial health of a few at the expense of the rest of us. WEIGHT CANNOT be the ONLY consideration in this debate. In fact, so called "lifestyle" changes, cannot be the only consideration. In addition to a lack of access to health care, factors such as poverty, pollution, violence, food safety, drug safety, health care provider competence, effective vaccinations and stigmatization are just a few of the other things that need to be a part of this debate. HAES could be a key policy that would promote the end of stigmatization on the basis of size and the encouragement of a strong and healthy population. Weight loss, however, will be doomed to failure and in the end will add more costs rather than saving us.

If we want to succeed in creating true health care reform, we need to acknowledge and act upon fact, not fiction. Weight loss as a method of health improvement is a fiction, an often repeated fiction, but a fiction nonetheless. I feel compelled to repeat a quote that I closed with a few entries ago:

An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it. --Mohandas Gandhi

But I will add this quote as well:

The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible. -- Bertrand Russell