On Problems to Be Solved

So, the headline of this AP article is okay: “Europe plans free fruit, veggies for school kids.” Nothing wrong with that — in fact, I think it’s a swell idea. But you do know what’s coming next, right?

An estimated 22 million children in the 27-nation bloc of nearly 500 million people are overweight because of bad eating habits.

Right. So I guess the writer personally observed 22 million children to determine that their fatness is the result of “bad eating habits” — and indeed, that they’re actually fat, as opposed to just growing children whose BMI ranking could change substantially in two weeks’ time? ‘Cause otherwise, that sentence is ludicrous. Even a stone fatphobe with a modicum of journalistic integrity would write “… in part because of bad eating habits” — if nothing else, what about the ZOMG SEDENTARY VIDEO GAMES NEVER OUTSIDE factor? — or just end the sentence at “overweight” and allow people to draw their own conclusions. (Which, unfortunately, they totally would.) But no, 22 million children just have bad eating habits, period. True facts!

And it gets better. (The article’s like 200 words long, and still, it gets better.)

“You only have to walk down any high street in Europe to see the extent of the problems we face with overweight kids,” EU Agriculture Commissioner Mariann Fischer Boel said.

Problems you can see just walking down the street? Like what? Roving bands of tubby little thugs demanding protection money from local businesses? Pillaging and plundering? Bursting out into elaborate musical numbers on busy streets? What are these great societal problems that are obvious to any pedestrian?

Oh, right. The very existence of fat kids is a problem.

Fuck you, Mariann Fischer Boel. Children’s bodies are not a problem for the government to solve.

And that’s inevitably my problem with programs like this, and the way they’re sold to us. I am 100% in favor of free fruits and veggies (though I’m not naive enough to think those won’t be traded for sweets by fat and thin kids alike, I should add). Free fruits and veggies for everyone! Local, organic produce for all my friends! While you’re at it, bring back gym class and train future phys ed instructors to focus on encouraging the joy of movement instead of forcing everyone to move their bodies in exactly the same way, regardless of any pain (physical and/or emotional) it causes! Subsidize exercise facilities until they’re affordable for everyone! Create more bike paths! Clean up local bodies of water so everyone can swim for free! Build cities on the scale of human bodies instead of cars, and keep the streets safe enough for everyone to walk around! Ban high fructose corn syrup! Keep fast food and soda and junk food corporations out of the schools! Raise the minimum wage and shorten working hours so people have more time to cook and be active! KNOCK YOURSELVES RIGHT THE FUCK OUT creating an environment that makes it easier for everyone to eat a variety of fresh foods and get plenty of exercise!

But don’t tell me that’s going to make everyone thin — and really, really don’t tell me that making people thinner should be the main point of such a plan. It fucking infuriates me that with all of the many, many excellent reasons to do all the things I’ve just suggested, the only potential outcome that can muster the political will to enact any of it is weight loss. Fuck having a cleaner, safer, more fun environment that might lend itself to people generally feeling more energetic and vibrant (which might also lead to more productivity, for all the hardcore capitalists out there) — unless we can get rid of the fatties, it’s wasted money.

Lack of access to fresh fruits and vegetables is a problem to be solved. A polluted environment is a problem to be solved. Corporations weaseling their way into schools are a problem to be solved. Unsafe cities are a problem to be solved. Car-dependency is a problem to be solved. The need for many people to work every waking hour just to get by is a problem to be solved. The widespread belief that exercise is primarily a punishment for fatness or a talisman against it, not something enjoyable that generally makes people feel better, is a problem to be solved.

Human bodies are not a fucking problem to be solved.

Ask Aunt Fattie: My new potential beau hates his fat

Dearest Aunt Fattie,

I was recently excited to stumble across an online dating site which includes a body shape descriptor – I prefer larger guys and want both my own size and my preference in men to be stated up front. Not long after signing up, I found a cute, sweet-seeming fat dude who shared a lot of interests. I messaged him, of course, and we got to chatting.

It turns out this darling chubby boy is quite swept up in self/fat-hatred, and while he’s open minded about the size of his partner, he has lost a fair bit of weight in the past year and hopes to lose a great deal more. He even went so far as to schedule gastric bypass surgery, but ended up deciding to “wait and see if I can do it on my own.”

So as a believer in fat acceptance, I feel torn about actually going out with this fellow. It’s early yet to write something off before it starts, and I feel like this guy would actually benefit from learning about HAES, if he was interested. But I have met and crushed on several self-hating fatties in the past, and I’ve found that their own body issues have ended up projected all over me (something I don’t quite have the Sanity Watchers points for).

On the one hand, I don’t want to have to argue anti-diet, HAES, fat-loving, etc, to a guy who possibly loathes his own adipose and blames it for his problems. But as a lover of big guys, I have to admit it is also going to be no easy feat to find a big, happy, self-loving, fat-accepting dude who can love me AND himself. So what’s a good strategy here? Hoping to convert the self-deprecating? Or waiting around until a single, fat, HAES/FA dude stumbles across my path?

- More Fat Fish in the Sea

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Another load from the Duh Truck

I just got this press release yesterday (article abstract here):

Piscataway, N.J. – June 2, 2008 – A major review in Clinical Psychology: Science and Practice reveals that research indicates people who are obese may be more likely to become depressed, and people who are depressed may be more likely to become obese.To understand the potential links between obesity and depression, researchers led by Sarah M. Markowitz, M.S., examined the correlational data that suggest a connection between the conditions and found evidence for causal pathways from obesity to depression and depression to obesity.

People who are obese may be more likely to become depressed because they experience themselves as in poor health and are dissatisfied with their appearance. This occurrence was particularly prevalent among women and those of high socio-economic status.

People who are depressed may be more likely to become obese because of physiological changes in their hormone and immune systems that occur in depression. Also, they have more difficulty taking good care of themselves because of symptoms and consequences of depression, such as difficulty adhering to fitness regiments, overeating, and having negative thoughts.

Treatments such as exercise and stress reduction can help to manage both obesity and depression at the same time. Potentially, dieting, which can worsen mood, and antidepressants, which can cause weight gain, should be minimized.

“The treatment of depression and obesity should be integrated,” the authors conclude. “This way, healthcare providers are working together to treat both conditions, rather than each in isolation.”

This is not the first time that a correlation between fat and depression has been posited, but it’s remarkable because the researchers actually seem to have noticed that the causality could run both ways. Instead of treating this as yet another danger of fat, they’ve (rather miraculously) said “wait a minute, maybe fat stigma is depressing. Maybe the stress of being fat in a hostile culture can either mimic or trigger clinical depression.” And how much do I love “experience themselves as in poor health”? They don’t actually say here that fat people ARE in poor health; instead, they acknowledge that fat people are constantly being told they’re in poor health, which as we know is a bigger health risk than being fat.

Once again I am convinced that FA is so much healthier for the general population than diet culture, no matter what our detractors might say. So fat leads to depression and depression leads to fat, huh? Well, what’s more likely to throw a wrench in that cycle — the people telling you that you will be ugly, unlovable, fatigued, ill, and not worth caring for unless you become smaller? Or the people telling you that you are worth caring for, worth nourishing, that you can participate in mood-elevating exercise for the joy of it instead of for punishment, that it’s possible for you to have a sense of health and well-being in your body, that your body is not a death sentence (any more than anyone else’s)? Our way might not wind up with fewer fat people, but we’re sure as hell going to have fewer depressed people. And isn’t that more important, really?

Well, that’s the problem — most people, including the researchers, don’t seem to think so. To be fair, the study is also remarkable because it calls for minimizing diets, “which can worsen mood” (ya think?). But what’s with the call to reduce antidepressant use? This is grievously irresponsible. Rio put it best, in her “Fat is a Symptom, Not a Disease” series:

I think it is absolutely ridiculous that anyone would be so upset over the associated weight gain, when the drugs often make a person feel as if his or her life is worth living again. I’m tired of hearing the fatophobes shrieking about it, trying their damnedest to drag down those who have finally been able to stand up again, just because their bodies are different.

So tell me, fat-haters, are you really so shallow and juvenile that you would rather see someone institutionalized than fat? Hanging themselves instead of fat? I’ve really begun to wonder if the fat-hate is not just about fat, but about an excuse to be misanthropic to anyone who is socially vulnerable. After all, the mentally ill you used as a punching bag in ages past have now become functional fat people, so whom are you going to punch in their place?

Of course, if someone doesn’t need antidepressants, and can get by with a new attitude (*cough*FA*cough*), decent nutrition for a change, regular exercise, a supportive therapist, etc., I am all for that. I’m sure that not everyone who’s depressed over being fat is suffering from a neurotransmitter imbalance; many are just reacting rationally to a hostile environment. And even some of us who do have neurotransmitter problems can get by fine most days without drugs, and overall I’m in favor of that, at least for me (I just don’t have the free time to embark on the medical odyssey of Finding the Right Antidepressant, since the wrong one is often so catastrophic, and meanwhile I can get along without them). I am not saying that anyone who exhibits symptoms of depression should be medicated. But to halfway acknowledge with one hand that fat stigma might be the problem, and on the other hand to discourage medication because it might make people fat? That is egregious victim-blaming, tantamount to saying “well, people can be cruel, and the best way to avoid that is to fit in perfectly.” If people are left unmedicated, it should be because they don’t need medication or prefer to have it as a last resort — NOT because it might contribute to a body that invites stigma. I appreciate the desire to reduce the levels of body-related stress that fat and depressed people are experiencing, but refusing to treat the stress because it might exacerbate the stressor is just nonsense. It’s like handing out plastic surgery to combat teenage angst.

In any event, this is a good reminder: While you’re exploring intuitive eating and exercise for its own sake and all that physically healthy stuff you thought was off-limits because you were fat, don’t forget to keep an eye on your mental health too. It’s reasonable to feel burdened sometimes, by expectations and stereotypes and mistreatment, but if you can’t climb out from under the stress (about your body, or about anything in your life), don’t neglect self-care in that regard. In the U.S., many cities have women’s centers that offer sliding-scale counseling, if you don’t have access to a therapist. Remember that stress and depression, whether or not it can make you fat as these researchers claim, is certainly more unhealthy for you than fat itself.

Happy International No Diet Day!

Hey, it’s International No Diet Day! Of course, we strive to make EVERY day No Diet Day, but if you’ve been teetering on the edge, today is the day to try it out for 24 hours and see how you function when you make peace with food. Or maybe it’s time to spread the word to some friends, or post a flyer next to the stats for your office “Biggest Loser” competition. Or maybe it’s just a day to eat a big piece of cake.

Or, you know, maybe it’s a day to eat a big piece of tofu. Posting about this initially made me feel a little weird about my breakfast, which I am eating right now and which is cottage cheese and some very gorgeous fruit. But then I thought, hey, isn’t this just another reason to resent the diet industry? Dieting has reinscribed excellent food like fruit and cottage cheese and spinach into Virtuous Diet Food, to the degree where it’s hard for a proud fatty to eat it without feeling a little furtive, like she has to make excuses. To the degree where people who have grown up in diet culture actually assume they don’t like really amazing food, just because its good-for-you reputation must mean it’s officially No Fun. (Of course, it’s entirely kosher to genuinely dislike food that’s also considered diet food, but I know plenty of people who turn their nose up at anything that’s supposed to be “healthy” because it smacks to them of deprivation.) Or they eat it because they think they’ve gotta get some virtue down their gullets, instead of because it tastes amazing and gives them energy. Fuck that — INDD is a day when food has no moral weight. I love cottage cheese (and if you think you don’t, give it another shot without thinking of it as a Diet Food), and I love chocolate chip cookies, and I might very well eat both today. Though not at the same time. And neither will make me bad or good, or a Typical Fat Person, or a Traitor to the Cause, or anything except a hungry person relishing some tasty comestibles. For at least this one day, let yourself off the hook. Count nothing. Judge nobody’s food choices, including your own. Let’s have food mean nothing but “substances that provide energy and are also as delicious as possible.”

To get you in the mood, here’s the Council on Size and Weight Discrimination‘s list of the top ten reasons not to diet.  (The links are added by me.)

10. DIETS DON’T WORK. Even if you lose weight, you will probably gain it all back, and you might gain back more than you lost.

9. DIETS ARE EXPENSIVE. If you didn’t buy special diet products, you could save enough to get new clothes, which would improve your outlook right now.

8. DIETS ARE BORING. People on diets talk and think about food and practically nothing else. There’s a lot more to life.

7. DIETS DON’T NECESSARILY IMPROVE YOUR HEALTH. Like the weight loss, health improvement is temporary. Dieting can actually cause health problems.

6. DIETS DON’T MAKE YOU BEAUTIFUL. Very few people will ever look like models. Glamour is a look, not a size. You don’t have to be thin to be attractive.

5. DIETS ARE NOT SEXY. If you want to be more attractive, take care of your body and your appearance. Feeling healthy makes you look your best.

4. DIETS CAN TURN INTO EATING DISORDERS. The obsession to be thin can lead to anorexia, bulimia, bingeing, and compulsive exercising.

3. DIETS CAN MAKE YOU AFRAID OF FOOD. Food nourishes and comforts us, and gives us pleasure. Dieting can make food seem like your enemy, and can deprive you of all the positive things about food.

2. DIETS CAN ROB YOU OF ENERGY. If you want to lead a full and active life, you need good nutrition, and enough food to meet your body’s needs.

And the number one reason to give up dieting:

1. Learning to love and accept yourself just as you are will give you self-confidence, better health, and a sense of wellbeing that will last a lifetime.

Ask Aunt Fattie: Do I qualify for HAES?

Dear Aunt Fattie,
I’ve been fairly thin my entire adult life – between 120 and 130 pounds (I am 5′ 6″) from age 20 until age 34. Then I met my husband, and because we both love food, we threw caution to the wind and ate whatever we wanted for 6 months, and I gained 30 pounds. I now weigh about 146 pounds. Of course, I’ve had to buy all new clothes, and a stranger stares out of the mirror at me when I look at myself. My husband and I have since begun a very strict meal plan that incorporates about 1500 calories a day of organic whole foods, whole grains, lean proteins, lots of veggies and fruit, no HFCS, no trans fats, no partially hydrogenated anything. We both feel great, but the meal plan is not translating into major weight loss for me (I’ve lost about 5 pounds in 3 months). I would like to stop hating myself, but I fear I don’t really qualify for HAES the way someone who’s had a lifelong struggle with weight does. Surely 145/150 is not my new “set point” just because I managed to eat my way up to it? Should I restrict calories more and try to get back to my old “set point”, 120-130? If not, how do I get used to the way I look now? I feel terrible about myself. Thanks for any advice,

Used To Be Thin

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Ask Aunt Fattie: Can I make my friend go to the doctor?

Dear Aunt Fattie,

I have a friend who is heavier than I am, and insists that there’s no point for HER to go to a doctor, because a doctor won’t help her, and she’ll just be wasting the copays to consult with them. She says that it makes sense for ME to go to doctors and take care of myself, because I’m less than 100 pounds overweight, and didn’t damage myself horribly while a child or adolescent.

However she was a horseback-rider as a teen, and has broken more bones than I can count. She seems to think this means she needs a doctor less than I do, because her case is already hopeless. At this point, she can’t sleep, because her arms fall asleep when she lays down, and she is having crippling back pain, and still says there’s no such thing as a doctor who can help her.

Screaming in Worried Frustration

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On “Personal Responsibility” and “Healthy Lifestyles”

All right, I’m way late in getting to the Yale study on discrimination that everybody was talking about last week, but it’s still worth a mention.

The hook most media outlets have been using is “weight discrimination is more common than racial discrimination,” which irritates me, because it plays into the “fat is the last acceptable prejudice” fallacy. So let’s make sure we don’t have any of that here. But let’s at least talk about this:

Losing out on a job or a scholarship, being refused a bank loan, getting poorer service in a restaurant, receiving inferior medical care, and being harassed by police were among the inequities listed by overweight people responding to a national survey whose results appear in the journal Obesity.

That’s one of those things where my response is simultaneously, “No shit, Sherlock” and “Thank Maude someone outside the fatosphere is finally saying it.” I never quite know how to feel about those.

Here’s the most exciting part:

Instead [of an increase in weight explaining the increase in weight-based discrimination] the authors point to media reports and the weight-loss business. Both frame obesity as a matter of personal responsibility requiring individual solutions, they say, citing other studies.

“Attributions about personal responsibility for obesity, whether perpetuated by media coverage or by diet industry marketing, could potentially contribute to higher levels of weight bias and perceived discrimination.” they write.

The authors call for national action to reduce weight discrimination.

I’m kind of stunned that a bunch of researchers not only noticed that discrimination against fat people exists, they correctly identified a major cause of it. (Did hell freeze over while I was neglecting the blog last week?) I am so fucking sick of the phrase “personal responsibility,” which always seems to be used by people who want to justify their prejudices, so I LOVE that they identify that phrase–and the thinking behind it–as the hate-fueling horseshit it is.

And that, I might add, is why this blog continues to work toward busting the myth that all fat people eat non-stop and never exercise. Sure, some fat people do, and they deserve the same respect as any other human beings, but as long as the culture keeps insisting that fatness is a failure of “personal responsibility,” I’m going to keep screaming that there are fat people who live “healthy lifestyles,” and thin people who live “unhealthy lifestyles” (see below for more on that odious framing) and you just can’t know how much “personal responsibility” any given person is taking by looking at them. So, you know, maybe you should shut the fuck up about “personal responsibility.”

Getting people to shut up is only a band-aid, of course, since the ultimate goal is getting everyone to take “personal responsibility” for making the world a kinder, more compassionate place. But you gotta start somewhere.

Speaking of phrases I hate, please check out Debra Sapp-Yarwood–known as DebraSY over at Big Fat Blog–going after the word “lifestyle” in a column for the Kansas City Star. (She reports that her suggested headline was “Why I Hate the Word Lifestyle and You Should too”–so naturally, they replaced that with a headline that makes no sense whatsoever.) Debra’s among the tiny percentage of people who’ve maintained a substantial weight loss for over five years, yet she is smart enough to know that doesn’t automatically mean “You can, too!”

Healthy lifestyle is often code language for the opposite of “fat.” It presents a false choice: If you choose a healthy lifestyle, you won’t be fat. If you are fat you must have chosen the unhealthy, fat lifestyle. How insulting!

Amen, Debra.

And now, Shapelings, over to you. Do you hate the phrases “personal responsibility” and “healthy lifestyle” as much as I do? And have you got any others? Rant away.

Linkies

Sorry I haven’t written much of substance here this week, y’all. All my righteous ranting energy went into this yesterday, and quite frankly, I’m just a little burnt out on absorbing fat hate enough to respond to it right now. Rest assured, I will recover soon and be back rantier than ever, but every now and then, I just have to take a break from it, or I will lose my fucking mind. The good news is, you guys seem to be doing just fine without me, so here, have some more stuff to discuss.

1) As an antidote to all the horror stories, Fat Lot of Good has an incredibly heartening doctor-visit story.

2) Aaaand back to the horror (H/T one of the Rowans):

To curtail Japan’s overweight population, the Japanese health ministry recently mandated that all waistlines among its 56 million workers over age 40 be below “regulation size” of 33.5 inches (for men). Any company failing to bring its employees’ weight under control–as well as the weights of their family members–will be fined up to 10% of its earnings by the government.

3) Pakistan is in danger of a food shortage, which is just awful, and I don’t mean to trivialize the very serious point of this article. But I must remark on one interesting detail:

The [World Food Programme] estimates that anyone consuming less than 2,350 calories per day is below the food security line.

Fascinating. (H/T Shapeling Jennifer.)

4) Stop the presses: thin people get heart disease, too. Another stab in the heart of the BMI, but wouldn’t it be swell if they called it something other than “normal-weight obesity”? (H/T Shapeling CJ.)

Update: 5) The Rotund is looking for a co-blogger!

Update 2: Feeling burnt out yourself? Go watch A BABY OTTER DOING BABY OTTER THINGS.

Dear Monica Grenfell, STFU

I haven’t yet written about Chloe Marshall, the 17-year-old plus-size model who’s in the running for Miss England this year, only because I’ve had a zillion other things on my plate lately. Marshall’s a UK size 16 (i.e., US size 12/14), the biggest contestant they’ve ever had, and she’s already been crowned Miss Surrey. Woo hoo!

I would also probably have chosen not to acknowledge diet book author Monica Grenfell’s horrid opinion piece about Chloe in the Daily Mail, but so many Shapelings e-mailed me about it this morning, I would apparently be shirking my duties as a fat blogger if I skipped it. (Also, I kinda want the e-mails to stop. Not that I don’t love your missives, ’cause I do, but holy crap, this touched a nerve.)

So, Monica Grenfell comes off as a fucking idiot. That’s kind of all you need to know. She’s also a dietician. [Update: apparently she is not, though the article identifies her as one.] Now, I know some people around here are dieticians, are planning on becoming them, and/or have worked successfully with dieticians in the past, so you don’t like seeing them take crap. That’s totally fair. But let’s just say that when some of us say we wonder how many dieticians have eating disorders and/or a pathological fear of fat, we’re thinking of people like Monica Grenfell.

I hope she doesn’t win the Miss England title.

It would send an appalling – and very dangerous – message to other young women that it’s OK to be fat.

Chloe is a stark reminder that obesity is now virtually normal in our society – and we should all be hanging our heads in shame.

Because as we all know, shame is an excellent way to make people lose weight, and it’s worked fantastically well so far. Except for how the opposite is true. Facts, schmacts. Fat is icky!

It gets better.

At 5ft 10in, Chloe should have a body mass index, or BMI, (indicating her levels of fat) of 20. Hers is 26.03.

Okay, setting aside the fact that the “overweight” BMI category carries the lowest mortality risk, and people in it fare better than others when it comes to all sorts of diseases, the cut-off for overweight is 25. (10 years ago, it was 27.) We’ll also set aside the fact that several published reports have Chloe at 5’10” and 176 lbs., giving her a BMI of 25.3, not 26.3. Where the hell does Grenfell get off deciding Chloe Marshall–or anyone–“should” have a BMI of 20? Seriously, when your rhetoric makes a BMI chart look reasonable and fair when it comes to acknowledging natural size diversity, you need to check yourself, lady.

And it gets better still.

It’s a total fallacy that young girls are being pressured into near-starving themselves into being too thin.

Take a look around you and you will see that the total reverse is true.

Teenage girls aren’t in danger of falling victim to an epidemic of anorexia – but of obesity.

That’s right, folks. Teenage girls are under insurmountable pressure to get fatter. You heard it here first.

From a woman who gets paid to tell people how to eat.

The fact that Chloe Marshall exercises, eats a balanced diet, and knows from experience that she’d have to starve herself to be any thinner is meaningless to Grenfell, who says “I don’t doubt she is telling truth,” but then goes on to say:

Chloe claims she “crept up” to a size 16 after dieting to a size 12 on top and 14 on bottom. She’s kidding herself.

Her weight didn’t “creep on” magically – she ate too much food.

Every excess 1lb of weight she’s carrying – and I reckon she is at least a stone overweight – equates to five meals she didn’t need.

Hmmm. I do not think “I don’t doubt she is telling the truth” means what you think it means, Ms. Grenfell.

Also, how ’bout that, y’all? 5 meals=1 lb! I have heard a LOT of fucked-up dieting math in my day, but that’s a new one on me. (On the upside, all I have to do to get myself back under the “overweight” cut-off is skip my next 250 meals.)

Once again, this woman is advising clients and selling books based on her “expert” knowledge about weight and food. A woman who claims the pressure on young girls to be thin is “a total fallacy”; that fat is not only acceptable but fashionable; that a fat woman who says she exercises, eats a healthy diet and has to starve herself to be thinner is simply in denial about having eaten too much; that anorexia is not a danger we should be worried about; that Chloe Marshall’s body demonstrates “a shocking lack of self-control”; and that a 17-year-old girl should have a BMI a full 5 points under the cut-off for “overweight” because, um, she said so. That’s who gets paid to tell people what “healthy eating” is.

“Dangerous nonsense” indeed.

Update: from Monica Grenfell’s website (via Shapeling A Sarah), here’s a little about her newest book:

CRASH DIET is Monica’s newest, most original diet book, which goes back to the basics of old-fashioned crash dieting to help you lose those ‘vanity pounds’ (the ones only you know are there!)

Monica Grenfell will tell you how to restrict calories to lose pounds “only you know are there.” I rest my fucking case.

Reality Check: Why Don’t Fat Women Get Checked for Cancer of the Nasty Bits?

The Rotund points out a recent Reuters article about how clinically obese women are less likely to be screened for cervical, breast, and colorectal cancer. And of course, researchers and journalists just can’t imagine why.

It’s not certain why obese women are less likely to get these screening tests, as few studies have been designed to look at the underlying reasons

Well, here’s one: Stigma and Discrimination in Weight Management and Obesity, by Kelly Brownell and Rebecca Pugh. A few highlights (with my emphasis):

24% of nurses said they are ‘repulsed’ by obese persons

Numerous studies2-6 document explicit negative attitudes about obesity among physicians, nurses, dieticians, and medical students. These attitudes include: obese people lack self-control and are lazy, obesity is caused by character flaws, and failure to lose weight is due only to noncompliance.

Among physicians, 17% reported reluctance to provide pelvic exams to very obese women, and 83% indicated reluctance to provide a pelvic exam if the patient herself was hesitant.12 Given that overweight women may hesitate to obtain exams and that physicians are reluctant to perform exams on obese or reluctant women, many overweight women may not receive necessary preventive care.

Efforts to reduce bias toward obese people have been limited. One intervention study17 attempted to reduce stigma toward obese patients among medical students. Before random assignment to a control group or an education intervention using videos, written materials, and role-playing exercises, the majority of medical students in the study characterized obese individuals as lazy, sloppy, and lacking in self-control, despite the students indicating that they had an accurate understanding of obesity’s cause. After the intervention, students demonstrated significantly improved attitudes and beliefs about obesity compared with the control group. One year later, the effectiveness of the intervention was still evident.17

Here’s another one: Barriers to routine gynelogical cancer screening for White and African-American obese women, by Amy, Aalborg, Lyons and Keranen.

The lower screening rate was not a result of lack of available health care since more than 90% of the women had health insurance. Women report that barriers related to their weight contribute to delay of health care. These barriers include disrespectful treatment, embarrassment at being weighed, negative attitudes of providers, unsolicited advice to lose weight, and medical equipment that was too small to be functional. The percentage of women who reported these barriers increased as the women’s BMI increased. Women who delay were significantly less likely to have timely pelvic examinations, Pap tests, and mammograms than the comparison group, even though they reported that they were ‘moderately’ or ‘very concerned’ about cancer symptoms. The women who delay care were also more likely to have been on weight-loss programs five or more times. Many health care providers reported that they had little specific education concerning care of obese women, found that examining and providing care for large patients was more difficult than for other patients, and were not satisfied with the resources and referrals available to provide care for them.

I find that bit about having been on weight loss programs five or more times fascinating. Because the logical conclusion is, these are women who know bloody well that diets won’t work for them–and also know bloody well that no matter what they see their doctors for, including a fucking pap smear, they’ll be told to go on yet another diet.

24% of nurses are repulsed by fat people. 17% of doctors don’t want to put a speculum up a fat woman’s vagina. (Do they enjoy giving pelvics to thin women? ‘Cause, ew.) A majority of medical students think fat people are “lazy, sloppy, and lacking in self-control.”

Yeah, it’s a total fucking mystery why fat women don’t want to have their most vulnerable body parts, the ones culturally designated as most shameful, poked and prodded by medical professionals. How could we ever begin to figure that one out?