|Feeling the love with my cohort buddies. They|
know better than to talk about "fighting obesity" around me.
For one of my classes we were asked to evaluate a local public health intervention. I chose a program where doctors prescribe exercise to patients with health issues that can be helped with exercise. I picked this program specifically because a. I think if you can manage a condition with exercise instead of a drug, that's fucking fantastic and b. It was one of the few programs on the list that didn't explicitly make a reference to "fighting obesity." I am so tired of thin people talking about "fighting obesity." It sounds scary and violent, and just makes me think they're going to be waiting for me in an alley after class, ready to kick my ass for being fat. One of the interesting things about the war on obesity is that "obese" people (such as myself, though I prefer to be called "fat," thank you) are almost never included in dialogues about the "obesity epidemic." To me, that's along the lines of having a bunch of white people get together to talk about what should be done about racism, without including the voices of people of color.
I made explicitly clear to my group and our community partner that I think this program is fantastic, but that it's important that physicians not frame it in the context of fat shaming or pressure to lose weight as opposed to actually improving health outcomes, because frankly, that doesn't work. Nevertheless, in a discussion about how to measure if the program is actually working, BMIs came up. We talked about how BMIs are a poor measure of health since they don't include muscle mass, and therefore many athletes are considered overweight or even obese as a result.
"Nevertheless," our community partner said, "There has to be some cut-off point where it's just not possible to be healthy, like a BMI of 35 or 40."
"My BMI is 39," I replied. "I ran a 5K last fall, I exercise almost every day, and my bloodwork is perfect."
Her jaw dropped. "Well, um, maybe 50 then." Yes, because assigning an arbitrary weight cut-off point to "healthy" is totally productive.
When I tell people that in spite of my obesity that I am active and eat what I consider a healthy diet (ie, minimally processed protein, healthy fats and fresh produce) they often say things like, "well, maybe that's true for you, but you have to admit that most obese people probably aren't like you." Fantastic, I'm the model minority for fat people. I think people are missing a much more important message here- regardless of the etiology of individual fatness, there is the potential to be fat and healthy, and it's standing right here in front of you.
I've also had several people tell me that I'm "not fat" because I'm active and healthy. Wait, what? Do they even realize how invalidating that is? That's like telling someone that they're not gay because they don't "act gay." Even if I were thin, I wouldn't be any less bothered by the discrimination faced by people with non-thin bodies.
I make people uncomfortable, every day. I refuse to shut up about weight discrimination and how the "war on obesity" is doing it wrong. I am sure my thin colleagues are sick of hearing about it, but at the same time I can see how I am forcing people to see things from the perspective of a fat person, and that's fucking important. It doesn't mean that I'm not exhausted or depressed by having to fight my own goddam war on obesity everyday, especially when it's not what I came here to do. (It's become what I came here to do, to some extent.) When I moved from Chicago I lost an amazing community of body-positive friends who made me feel good about myself just the way I am. I actually felt sort of "normal" there. I am one of maybe two fat people in my entire public health program, because this is not a field that is friendly to fat people. I don't have any close friends here who have experienced first-hand how fucking hard it is. I often feel invisible and isolated and undesirable here, and it's a miserable reminder of what a lot of the country is like for people who don't conform to body standards.
Here is my public health suggestions for "fighting obesity" the right way:
1. Fix our food. Get rid of GMOs, factory farming, corn and soy subsidies, and subsidize small farms instead. Fund programs that teach people how to grow their own food, build community and school gardens. Promote the idea that vegetables can be fucking delicious instead of a chore to eat. Stop pushing ideas of nutrition that are fueled by corporate interests- people should not be eating more servings of grains than vegetables.
2. Fix poverty. Seriously, this is maybe the biggest public health issue facing us today.
3. Stop equating weight with health. Stop fat shaming and fat discrimination. Fat people know they are fat, we don't need to have our food and bodies policed by "concerned" assholes who make assumptions about our health based on our bodies, and are surprisingly unworried by the lifestyles of sedentary thin people. Making us feel ashamed of our bodies, or to eat or exercise in public is contradictory to messages that we need to eat better and exercise more to "correct" our fatness.
4. Increase access to inexpensive fruits and vegetables (the fruit stands that have been popping up around Chicago are a great idea) and a diverse variety of fun exercise that can be enjoyed by people of different fitness/ability levels.
5. Recognize that the stress related to the discrimination, bullying, and shaming of fat people might contribute to "obesity related health problems." In my classes I've learned that poverty, low social status, and being a minority are all serious risk factors for health problems like cardiovascular diseases and diabetes, which interestingly enough are diseases commonly considered to be caused by obesity. Furthermore, chronic stress is also related to weight gain. Funny how that works. The problem is, nobody is willing to admit that body-related discrimination happens, because fat people are "asking for it" by being fat. Despite the fact that studies have shown that fat kids have as bad or worse quality of life as kids with cancer. Obese children are 65% more likely to be bullied as "normal" weight kids, and often the solution presented is to put the kid on a diet instead of addressing the bullying itself. Is it surprising that this leads to negative health outcomes?
Do I know how to make all these changes happen? Not really. Policy and activism I guess. But my point here if that telling fatty to put down the fork is not going to fix the complex and society-wide issues that underly the "obesity epidemic." And maybe we should consider if obesity itself really is the problem here.
In the meantime, I'm looking forward to taking a break from public health next weekend, and going to dinner in Chicago with my ladypal Strick9, and being reminded that I'm not the only gorgeous, healthy, valuable fat person on earth. Because god, I miss that.