A Hypothetical Doctor’s Visit

Jasmine is waiting in the exam room and her chart shows that her weight today is up five pounds from her last visit two years ago, putting her BMI at 32. Her blood pressure was borderline high in contrast to the normal readings in previous visits. Although Jasmine’s labs were normal in past visits, they are out of date. When Dr. Johnson greets her today, Jasmine seems anxious and tells Dr. Johnson, “I almost did not come in today knowing my weight is up from the last time I was here and you suggested a diet. I feel like such a failure. However, I need help for my migraines, so here I am.” Dr. Johnson and Jasmine look at each other, there is a beat of silence, and they both sigh.

Dr. Johnson says, “You know, Jasmine, I have been reading the research on weight loss interventions and weight-cycling and I’m realizing that if the same thing happens to almost everyone, it probably is not the fault of the person, it is probably more about the process itself. So, instead of focusing on weight loss, I’m encouraging my patients to think about what makes them feel better in their everyday lives; emotionally and physically. For example, do you feel better when you eat more fruits and vegetables, drink more water, take a walk with a friend, meditate to relieve stress, and get enough sleep? There’s good evidence that those behaviors are going to make you healthier and feel better even if your weight does not change.”

Jasmine is a bit surprised by Dr. Johnson’s shift and says, “Well, typically, when my weight loss slows down or stops completely, I stop doing any of those things you mentioned that would help me feel better and be healthier.” Dr. Johnson says, “I understand, but we’re going to turn the focus from your weight to your health. Because those behaviors are linked to health, why not do them anyway?”

Jasmine smiles at Dr. Johnson and says, “It sure would be easier to come back and see you the next time I’m supposed to if I did not have to lose weight first.”

Dr. Johnson replies, “I do not want anything to stand in the way of you getting your medical care, including worrying that I might scold you. Now that we have a better plan, I am going to have the nurse retake your blood pressure.” Jasmine and Dr. Johnson then discuss treatment options for Jasmine’s migraines.

— from The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss published in the Journal of Obesity.

Quotes: Discrimination

I ran away from home. I ran away from St. Louis, and then I ran away from the United States of America, because of that terror of discrimination, that horrible beast which paralyzes one’s very soul and body.
— Josephine Baker

Discrimination isn’t a thunderbolt, it isn’t an abrupt slap in the face. It’s the slow drumbeat of being underappreciated, feeling uncomfortable and encountering roadblocks along the path to success.
Meg Urry

I am often asked why there is discrimination against women in science. And I have given it some thought. With prejudicial attitudes, you can’t really do much. You can point out when people discriminate and ask them not to.
Christiane Nüsslein-Volhard

I’d make a comment at a meeting and nobody would even acknowledge me. Then some man would say the same thing and they’d all nod.
— Charlotte Bunch

What are we having this liberty for? We are having this liberty in order to reform our social system, which is full of inequality, discrimination and other things, which conflict with our fundamental rights.
— B. R. Ambedkar

Dating!

I’d been married for years when I started this blog.  That may be why I don’t post about dating much.  But I ran across this blog post and it said a lot of things I agree with.

[It's] perfectly cool if you don’t find fat people attractive. Anyone who tells you that you are obliged to find any particular set of features attractive is an insecure git who needs the weight of numbers before they can relax.

You may be attractive to a small number of people. That’s cool.

The question is, are those people attractive to you?

If so, then awesome!  [...]

If not, then you have that icktacular quandary of deciding how much you feel like changing for them.

Because here’s the ugly truth and the truth of ugly: you’re not going to have a 100% success rate at attracting the people you want. You just won’t, not over the course of a lifetime.
[....]
“Normal” society, yes, rewards skinny people disproportionately. But it also rewards white people disproportionately. And straight people disproportionately. And men disproportionately. And if I’m not fucking careful, I can internalize those irrational hatreds and come to believe that there’s something wrong with me instead of society.

I know I’m not everyone’s cup of tea. That’s fine. I’m somebody’s cup of tea, and they’re mine, and that’s the important thing.

Last weekend I saw a fat woman with short gray hair wearing a t-shirt that said “I’m someone’s fetish”.

Now, “fetish” is a loaded term. It’s applied to characteristics or actions that society doesn’t think should be arousing. I’ve known people who identify as fetishists and those who reject the term. In this case, it seemed the woman with the tshirt was acknowledging that she was older and fat…and affirming that she’s a sexual person anyway. That’s pretty cool.

The blog post refers to a similar shirt too, so I went hunting. I found the one above in men’s and women’s sizes and another one in men’s sizes. Just in case anyone else wants one.

“We Love Colors” Tights

I finally got some “We Love Colors” Tights, and yes, I got them from Amazon.

“We Love Colors” tights in kelly green. Blue & white dress from Making It Big some years ago.

“We Love Colors” tights in kelly green. Blue & white dress from Making It Big some years ago.

I was very pleased that they’re bright and not sheer. They definitely jazzed up my dress and got a lot of happy comments.

Photo of my leg in the direct overhead light of our kitchen. Foot is wearing Keen's Rose Sandal.

Photo of my leg in the direct overhead light of our kitchen. Foot is wearing Keen’s Rose Sandal.

I got the size “EE”, which is for “5’5″ – 6’0″ and 320-375 lbs”. I’m 5’8″, so smack in the middle of the height range, and about 430lbs, so well over the weight range. They fit well, not too loose or too tight, and came up to my natural waist.

I did wear a panty girdle over them so I wouldn’t have to worry about keeping them up. I didn’t have chub rub, but I usually don’t unless it’s extra humid, so I don’t think the tights necessarily have special chub rub protection properties.

Need a laugh?

This video from The Doubleclicks gave me one today.

Growing up isn’t fast
In fact it’s so slow you don’t see it happen
I turned around one day to find
That I worked a job & I had to file taxes

But I still like fun
And I still like games
And I still want to know all the dinosaur’s names

Dinosaurs were just really really big chickens
Growing up is just becoming a really big kid

(Full lyrics & downloads here.)

So…Clothes

Fat woman with cellphone

Image courtesy of Rudd Image Gallery

The “What if you’re too big for Lane Bryant” post appears to be permanently hanging in the “Top Posts & Pages” list, I swear. Yes, I am still (mostly) too fat for LB, though I do sometimes get bras and tees there (and Seanan McGuire helpfully tweeted today that it’s “buy 2, get 2 free” bra time.)

In other clothes stuff…

I’m still getting things from Gwynnie Bee. On the good side, I’m learning things like “IGIGI 5x tends to fit me” and “Kiyonna 5X doesn’t fit me”.  On the bad side, some of the dry clean only items itch and several items I’ve had to hang to let the cleaner smell dissipate. Now I’m worried that I’m allergic to their cleaners.  Sigh.

Inspired by Anthea Butler’s tweet about the “Ordain Women” founder‘s excommunication from the LDS church including “underwear“, I did some googling.  As I am not a church member, I could not order or view the garments in the online store. However I was able to view sizing information in the “Help” on the LDS website.  It appears I’m too fat for the garments available. I don’t know if it’s acceptable for LDS members to make their own.

In cheerier news, my new Elomi bra really improves my posture.

I got some comfy Keen sandals for summer.

Finally, since realizing that yes, there are ingredients in sunscreen which can make skin more sensitive in sun AND my recent “fine in shade and itchy / inflamed in the sun” experience with sunscreen, I have accepted my fate. Some short-sleeve mock turtlenecks from OneStopPlus.com should arrive soon.

Healthy Habits Better Than Statins

You may recall a study from a few years ago about how certain healthy habits — consumption of ≥5 fruits or vegetable/day, regular exercise >12 times/month, moderate alcohol consumption, and not smoking — decreased mortality risk regardless of weight.

You may not have seen this part:

The results of this study reinforce the association between healthy lifestyle habits and decreased mortality risk regardless of baseline BMI. This finding is of great importance to both patients and health care providers, whose perceptions about BMI may lead them to believe only obese and/or overweight patients require regular counseling about lifestyle adjustments. Although the evidence suggests that patients across the BMI spectrum should adhere to a healthy lifestyle to optimize health, many patients with a normal-weight BMI may believe exercise and healthy eating, for example, are less important for them as long as they maintain a low BMI.

I’ve mentioned before that the emphasis on fat often leads thin people to assume they’re healthy.  Not necessarily — something the authors called out.

 In the pooled analysis that included all individuals in the cohort (normal weight, overweight, and obese), the adoption of each additional healthy habit decreased all-cause mortality between 29% and 85% (Table 2). To put this in perspective, statins decrease all-cause mortality by 12% in individuals at high risk for cardiovascular disease.  Given the tremendous benefits of a healthy lifestyle, policies and programs that encourage adherence to healthy lifestyles should be encouraged both locally and at a national level.

What can be done about this?  Encouraging moderate exercise & use of alcohol, abstaining from smoking, and eating more fruits and veggies.   The study authors also note that when primary care providers take the time to urge things things, it can be “effective in decreasing smoking, increasing fruit and vegetable consumption, moderating alcohol consumption, and increasing exercise frequency.”  (That’s more than they can say for weight loss.)

PS: I see references to statins a lot. They make money, despite side effects.  Not smoking? Doesn’t make money.  Exercise can make money, as can selling more fruits & vegetables — but not as much as a drug.  Hm.

Some Things I’m Learning

48 can be a little too young for menopause. Drat.

Occasional spotting can be a symptom of a problem. Well, that I knew. But it does lead into….

Vaginal ultrasounds don’t necessarily hurt.  But when the tech is having trouble seeing the right ovary, and keeps poking around trying to see it, fuck yeah, it’s going to hurt. For days.

Cervixes can have polyps! Cool! (I think.)

If you haven’t had kids, things like “uterine biopsy” can be bad news.  Why?  My cervix is, shall we say, not at all interested in this “open sesame” crap.

You can take tablets vaginally!  I did not know that, but you can.  Like, say, misoprostol.

Misoprostol causes uterine contractions, aka cramps.  It also “softens” & opens the cervix, like, for a biopsy. (Or, I would presume, an IUD.)

Even with misoprostol, my cervix is STILL not interested in playing nicely. It wants to be left the fuck alone, thankyouverymuch.  Perhaps I should name it Greta.

Don’t bother trying to go to work after said biopsy. Just no.

….yeah.  At the moment it’s been mostly gathering info, and so far no cancer has been detected.  So.  Joy.

 

Why Isn’t Obesity Research Better Known?

CBC has an article on the part of obesity research that doesn’t always get talked about.

Tim Caulfield says his fellow obesity academics tend to tiptoe around the truth. “You go to these meetings and you talk to researchers, you get a sense there is almost a political correctness around it, that we don’t want this message to get out there,” he said.

“You’ll be in a room with very knowledgeable individuals, and everyone in the room will know what the data says and still the message doesn’t seem to get out.”

In part, that’s because it’s such a harsh message. “You have to be careful about the stigmatizing nature of that kind of image,” Caulfield says. “That’s one of the reasons why this myth of weight loss lives on.”

Stigmatizing.  How is it stigmatizing to know that being fat isn’t something that can be easily changed by anyone?  One theory: accepting that most fat people cannot permanently become thin implies that fat people aren’t fat “for now”. They may be fat forever.  For the fat people who are rationalizing “I’m fat but I’m losing weight,” the idea that they may not be able to fulfill their fantasy can unfortunately cause another round of self-hate.  Realizing that thinness may not be as controllable as they thought could be scary. But — my understanding is that most obesity researchers are thin. So let’s try another theory.

Researchers may not be fat, but they know fat people, and are probably influenced by implicit and explicit biases.  Adding awareness that fat people will probably stay fat — even the fat people you like, that might become friends?   That’s scary.  It implies that fat people may not actually be sabotaging their weight loss, may not be at fault for weight regain.  Why, fat people may not actually be deserving of hatred.  What, then, of your attitudes toward fat people?  What kind of person are you?

Or, y’know, it might be that researchers are just concerned that if they stop promoting weight loss they they’ll lose their jobs and funding.  In the book Health At Every Size: The Surprising Truth About Your WeightLinda Bacon discussed the funding for her HAES vs weight loss study.

[...S]tatistics clearly show that when industry funds research, the published results are much more likely to show beneficial effects than research conducted without industry funding.

[...] I follow a strict policy of never accepting research money from private industry. Not that private industry would have been interested in funding this research anyway—I mean, there’s no profit to be made if we show people getting healthier with lifestyle change, without worrying about weight loss, or if we show that weight isn’t the be-all and end-all when it comes to health.

Consequently, I’m limited to public funding [...] Given that Congress shares the general perception that Americans need to lose weight, that’s where much of the nutrition money goes these days. Plus, many (all?) researchers who sit on the panels that review the grant requests are on industry’s payroll themselves. In fact, some in my field jokingly refer to a group of researchers from the Universities of Colorado and Pittsburgh and Columbia University as the “obesity mafia,” given their control over National Institutes of Health funding.

With my HAES study, I managed to wrangle a relatively small grant out of the NIH [...] I’d like to believe we got the grant because of the outstanding proposal. But I’m not that naïve. The reality, I think, is that I took my name off the proposal as the primary investigator and substituted Dr. Stern’s, who is better connected to the mafiosi.

(emphasis added by me)

Others have also speculated that obesity researchers are afraid of losing funding.  To quote Melissa McEwan,  “Boy, it’d sure be sad if they lost funding. Almost as sad as if I lose my life [because] a deadly ailment is misdiagnosed as fat.”  The emphasis on thinness as a measure of health and the societal biases against fat people conspire to prevent fat people from getting proper healthcare.

And that, of course, brings the biggest reason this could be stigmatizing: If the “everyone can be thin” drumbeat is a lie, researchers are complicit in this lie.  You’re not just kowtowing to Weight Watchers, Congress or the NIH when you continue to encourage “just eat less and move more” — you’re a fraud.  That might, indeed, be stigmatizing.

CBC: Obesity research confirms long-term weight loss almost impossible

The CBC has an article on what obesity research shows.

After years of study, it’s becoming apparent that it’s nearly impossible to permanently lose weight.

I’m not sure that’s news, but go on.

 For psychologist Traci Mann, who has spent 20 years running an eating lab at the University of Minnesota, the evidence is clear. … “Long-term weight loss happens to only the smallest minority of people.”

We all think we know someone in that rare group. They become the legends — the friend of a friend, the brother-in-law, the neighbour — the ones who really did it.

But if we check back after five or 10 years, there’s a good chance they will have put the weight back on. Only about five per cent of people who try to lose weight ultimately succeed, according to the research. Those people are the outliers, but we cling to their stories as proof that losing weight is possible.

“Those kinds of stories really keep the myth alive,” says University of Alberta professor Tim Caulfield, who researches and writes about health misconceptions. “You have this confirmation bias going on where people point to these very specific examples as if it’s proof. But in fact those are really exceptions.”

Our biology taunts us, by making short-term weight loss fairly easy. But the weight creeps back, usually after about a year, and it keeps coming back until the original weight is regained or worse.

This has been tested in randomized controlled trials where people have been separated into groups and given intense exercise and nutrition counselling.

Even in those highly controlled experimental settings, the results show only minor sustained weight loss.

When Traci Mann analyzed all of the randomized control trials on long-term weight loss, she discovered that after two years the average amount lost was only one kilogram, or about two pounds, from the original weight.

FYI, a PDF of Traci Mann’s study is here.  Most people — up to two thirds — regained all the weight they had lost, PLUS more.  Oh, and several studies indicated that dieting was actually a consistent predictor of future weight gain.

(File under: Things they don’t tell 8-yr-olds when putting them on their first diet.)

I was a bit puzzled at:

But eating right to improve health alone isn’t a strong motivator. The research shows that most people are willing to exercise and limit caloric intake if it means they will look better. But if they find out their weight probably won’t change much, they tend to lose motivation.

Is this a reference to (please choose one):

  1. People who improved their nutrition in an effort to lose weight and who stopped when weight loss slowed or stopped?
  2. That people are only willing to improve their nutrition if the carrot is “weight loss” and not “health”?

Because (let’s face it) option 1 is a classic bait-and-switch, and I know how demotivating that is to experience.

Mom/Teacher/Doctor:   “You should do this! You’ll lose weight!”
Me: *Does it*
Mom/Teacher/Doctor: “Why aren’t you losing [more] weight?  Oh dear. You’re probably healthier now!  So keep it up — maybe you’ll lose more!”
Me: *Sudden intense desire to commit matricide.*

I do love that the CBC quoted Traci Mann on what to do about this:

 Traci Mann says the emphasis should be on measuring health, not weight. “You should still eat right, you should still exercise, doing healthy stuff is still healthy,” she said. “It just doesn’t make you thin.”

And yes, that sounds like Health At Every Size®.

Secondhand Buyer Beware

Hopefully this isn’t really news to you, but …

I dutifully logged into eBay to change my password — granted my address etc are still in the hands of hackers, but it seemed the thing to do anyway, so I did — and started looking for clothing because, hey, why not? I have had good finds on eBay.

And I was thinking drawstring capris might be less risky in terms of “will they fit” since, y’know, drawstring.  Adjustable.

eBay listing for capris with price $34.95

eBay listing for capris

Looking at the description I saw they were from Woman Within. Only, y’know, for cotton/polyester knit pants, $34.95 seemed a bit … high. So I checked out OneStopPlus.com.

Same capris, $16.99-21.99

Same capris, $16.99-21.99

It’s very possible the eBay seller had bought them at a higher price and is trying to recoup it. But that doesn’t mean I have to help.

Quote of The Day: On Sex

[Warning: rape]

I had a conversation with a therapy patient of mine recently that spoke volumes to the problems of living in a rape culture that no longer wants to use the dirty word rape. She told me that she and her best friend (both 19-years-old) frequently endured sex with their boyfriends that involved heavy drug use, painful and coerced anal sex, utter boredom for the women, regular transmission of STIs, no orgasms for the women, and “sex on demand” whenever their boyfriends wanted to have sex. When I asked her if she ever felt pleasure during sex, or ever wanted to feel pleasure, she said, point blank, “I thought sex was only supposed to be pleasurable for the guys, right?” Right. 

The Politics of Turning Rape into “Nonconsensual Sex” by Breanne Fahs

Y’know, romance novels are often seen as pure pulp, but they do ground readers in the idea of mutual pleasure.  It’s not the worse way to set some expectations for sex.  (OK, the “never needing lube” thing can be problem….)

I’m glad that patient is in therapy.

Oh, and anal shouldn’t hurt.

 

It Came From The Search Terms

Seat belt extender, attached

Seat belt extender, attached

Once again, a post inspired by search terms used to reach my site.

how much does a woman who wears a 5x weigh

This probably depends on the woman’s height, amount of muscle, and how many limbs have been replaced with cybernetics.  Really, some of those are heavy.

what are the rules about having to buy an extra airline seat?

Depends on the airline – and you’ll probably want to call to book 2 seats.  Related posts are Day in the Life: Buying Plane Tickets and Flying While 400lbs.

alaska airlines seat size

Check out http://www.seatguru.com/

“do all overweight people”

I doubt it.

seat belt extenders walmart

No idea. I got mine from the dealer and Amazon.com.

im a 400 pound man is there a tool to help wipe bottom

If you’re reading this, I hope you look at the options at Amplestuff, Oversize Solutions, or Amazon.com. Amazon also has an option that works with toilet paper or a wet wipe, with a button release for sanitary disposal. There are also portable bidets available at Amplestuff and, again, Amazon.com. (This is FYI only, I don’t have actual experience with any of these devices.)

will i be too fat for the rides at disney world

I generally wasn’t, but it depends on your size & the ride. :)

Exercising for Strength

[Please avoid if references to calorie counting, restriction, or binge eating is a problem. This also goes for most of the links.]

Lately I’ve been reading two very different blogs for their exercise content.

One is Shaunta Grimes’ Tumblr, where she’s discussing her “100 Day Experiment” with Health At Every Size®.  Shaunta had begun her weight-accepting journey years before, but still counted calories and tried not go above 1800. Unfortunately she’d end up binging periodically.  During the 100 Day Experiement, Shaunta began eating at least what her body needs,  getting enough sleep, and exercising in slowly increasing amounts.  Shaunta began with exercising 10 minutes a day and has since added swimming & weight lifting.  Shaunta is thrilled to have more energy, be sleeping better, have less edema, and be stronger. She also hasn’t been binging. She has lost a small amount of weight but remains above 350lbs.

The other is 300 Pounds Down. Holly, the author, had weight-loss surgery in 2011 at 417lbs.  She’s lost 200lbs at the moment and intends to lose more (hence the name of the blog).  Holly began exercising for 30 seconds, increasing 30 seconds a day, working up to walking 5 miles a day.  An injury sidelined her walking, and then she began lifting weights with Crossfit.

Obviously these are two very different narratives.  But: both women began exercising while weighing over 350lbs. (Kinda like me.) Both began very gradually and increased slowly but steadily. (Yup.) Both women are getting stronger — and delighting in that fact! (Yup…)  Both have more energy.  Both are happier.  And both are encouraging me to continue my own exercise efforts.

I support bodily autonomy, including the right for each person to decide whether to exercise. I choose to exercise for my own selfish reasons. I support others in making their own choices. Both of these blogs have helped me to reflect on my own experiences with exercise and on my own victories, like “lifting 40lb boxes” and “better at carrying things upstairs”.

(And yes, I’m aware that Shaunta & Holly have very different blogs!!!  Shaunta, like myself, is a HAES proponent;  Holly has weight loss as a primary goal.  Shaunta is  deliberately eating more than she had before; Holly is deliberately eating much less & differently than before.)

Norwescon Panel Discussions

Like many fan conventions, Norwescon has lots of panel discussions.  There are many areas of focus, including not just sci fi & fantasy but science, space, writing, art, movies, indie filmmaking, gaming, costuming, music, and the culture of fandom.  This year, some of the panels included were:

  • Feminism in Fandom
  • Size Acceptance is for Every Body
  • Health At Every Size
  • Cosplaying while Fat
  •  The Bechdel Test
  • Escher Girls and The Hawkeye Initiative
  • Cosplay is Not Consent

I did not make it to all of these, but I do mention them as a sampling of things you might not think would land in a scifi convention.  The truth is that cons vary. If there’s interest, a con may include it.  Wiscon is a consciously feminist convention, but it’s not the only one to address these sorts of topics. Norwescon has been blessed the last few years to have the creator of Polimicks.com organizing the fannish culture panels.