Quick appeal: Stories of weight discrimination and health care

This thread contained a number of stories of Shapelings’ experiences of discrimination from doctors – including stories of patients being directly and concretely physically harmed by a doctor’s failure to diagnose something properly due to weight bias.

Okay, so I feel like what I’m about to say is some kind of thick purée of every daytime television commercial ever, but still I press on: Are you between the ages of 25 and 60? Have you or has someone you love been hurt by a doctor because you’re fat? Are you in a position of enough safety that you can allow your name to be used? Please consider contacting Ginny Graves, who is writing a story for Healthon weight bias in medicine. She’s put up notices several places, she says, including First Do No Harm, but has not so far gotten any takers. So if you’ve already put up your story on FDNH and are willing to be identified in the article, you’re one of the people she’d like very much to hear from.

Please contact her at glgraves@comcast.net. And thanks!

The Vision Chart Effect

So here’s a blurb on a new study, courtesy of Washington Post’s “The Checkup.” It opens:

Women, want to enjoy good health in your golden years?

Ooh! I know this one! [thinks] YES.

Lose weight. Now.

Oh. Wow, that’s… um, directive. Not one to slice the bologna too thin, eh, WaPo? Attention ALL WOMEN! What? Yes, even YOU, the one whose BMI puts you in the underweight range. Want to be healthy when you’re old, woman? Lose weight. Now. It’s What Women Do, see.

Look, I don’t want prematurely to pile on Jennifer LaRue Huget, whom I don’t know from Eve. (I will note that a quick Google search suggests that she’s written two children’s books that miiiiiiiight just tap into the old mothers-are-the-ones-who-bear-total-responsibility-for-the-kids-and-I-can’t-therefore-fathom-why-they’re-so-UPTIGHT-laff-laff-chortle thing. But perhaps if I read the books I’d be pleasantly surprised. It’s happened before.) She was writing, probably under a deadline, on a study that was uploaded to the BMJ website LAST NIGHT. Plus, who knows what changes her editor made?

In any case, one can’t expect a short, punchy WaPo blurb to contain as much nuance as this analysis of the same study, which appeared today on… ummm… Washington Post’s “The Checkup,” and was reported by a Jennifer LaRue Huget:

The study controlled for socioeconomic status and for smoking, diet and other lifestyle behaviors that could affect physical and mental health. One caveat: Most of the women studied were white, so researchers aren’t sure their findings extend broadly across the general population.

Oh. The heck you say. Well, no, that’s really okay, because we’re all pretty sure that white women count for all women, right? So the opening command to lose weight probably still holds. Plus: look, it’s a WaPo blog. If one wanted in-depth and even-handed analysis like this:

Still, the study adds new fodder to the often-heated debate about how closely body weight correlates to health. While the common wisdom is that being overweight puts people at increased risk of life-shortening diseases such as cancer, diabetes and cardiovascular disease, others say no such cause-and-effect relationship has been scientifically established and that people can be very healthy even if they’re overweight or even obese. The new research is the first, according to its authors, to examine the role of overweight and obesity in overall health among women who survive to older ages.

…one would need to look here, in the coverage by WaPo’s “The Checkup,” by Jennifer LaRue Huget.

Okay, okay, I’m having a little joke. It’s ALL the same article! Ha! But seriously. [Puts on serious face]. Shapelings, I point this out as an example of a phenomenon I see in health reporting and advertising. I call it the Vision Chart Effect. The principle runs thus: In messages about fat, the text at the top is big, bold, and brief. Read down and it gets smaller and smaller, and lengthier and lengthier. Just like an eye chart! Witness:

UR FAT!

LOSE WEIGHT FOR HEALTH!

Look at these ladies! They’re thin!* And therefore healthier than you!**

*Not that we actually know any good way for YOU to get thin. Results not typical and so on.***

***-Incidentally, you maybe should know that this might not have fuck-all to do with overall health.

** – And by “you” I mean “white lady.” Frankly, if you’re not white we’re probably not talking about you in the first place.

Because I know that people who show a concern for “health” always have everyone’s best interests at heart, it is my studied opinion that the mainstream media provides this effect as a SERVICE. A service to FAT PEOPLE. Isn’t that nice? Because apparently some fat people experience prejudice at the doctor’s office. To the point that they avoid going and getting regular checkups for things like vision. (A fact which could not POSSIBLY have any effect on overall health as one enters one’s golden years.)

Appeal: Examples of progressive religious people behaving badly (or goodly)

Shapelings, in a few weeks I’ll be giving a public lecture at my new academic institution. In the lecture I plan on doing a theologically-inflected Fat Acceptance 101. Or perhaps it will be a Theology of Embodiment 101 with a big helping of Fat Acceptance. I don’t know, because I haven’t written it yet. But it would help me out tremendously if you could post or send anecdotes/examples of lefty religious settings — especially white liberal churches who fancy themselves tolerant and welcoming — engaging in either fat shame or fat acceptance.

I wish I could give the pertinent details but I keep my online identity separate from my work identity. But do know that I thank you very very much for the help, and will credit anyone whom I quote or whose work I use, in whatever way you wish.

The Motherhood Post I’ve Been Promising

I spent most of the first year of my older son’s life in a haze, trying to navigate between his overwhelming need, my overwhelming desire to be a good mom, postpartum depression, doctoral coursework, sleep deprivation, and social isolation. This form of life was so new to me, and at times so desolate, that it took a long time to notice that aspects of it were deeply, deeply familiar.

Not my altered mother body that looked like it belonged to someone else; nor the way I was now smilingly by firmly shut out of mix-gender grown-up conversation, to be addressed only later, as an afterthought, with “And how is the baby doing?”; nor the intrusive sing-song-voice questions from strangers. Those were bizarre, unexpected and disorienting.

What felt familiar, though – as I eventually realized — was the combination of vast privilege, intense and anxious self-scrutiny, and utter lack of self-regard that I found now situated my life. Here, specifically, is how it finally dawned on me, one day when my son was out of infancy and I’d just come back from a Weight Watchers meeting. “Oh!” I thought. “Being a good mother is like dieting!”

At the time, I didn’t consider that in a “Holy shit, that just goes to show how they’re both ridiculous and futile enterprises!” I thought that I could marshall my discipline from dieting into discipline for good motherhood. But since I started giving up on both fantasies – the fantasy of being an acceptably-good mother and the fantasy of being an acceptably-pretty girl/woman – I’ve though a lot about how far the similarities really extend, and here’s what I’ve got so far:

First, there’s the fact that multiple oppressions help define the scope of an already-oppressively-gendered competition. The dominant culture’s possibilities for “pretty enough woman” and the dominant culture’s possibilities for “good enough mother,” are both fraught with racist, heterosexist, classist, and ableist assumptions. By the time the serious competition starts, many people are already ruled out and told, “You might as well not try.”

But if you are one who’s made it past the audition round – as I am, as a white moneyed able-bodied in-betweenie – then there are the methods, the expert books, the products to get you from “before” to “after”, the results-not-typical testimonies from people for whom a certain program worked, the manufacturing of insecurities so you’ll buy this book or that product.

And, of course, the self-denial made into virtue, where you get more applause and affirmation the more you sacrifice. Which is not to say the self-sacrifice should ever – EVER – make you truly unhappy. You can gripe a bit, sure, but when pressed you may only say how fulfilled and happy you feel at all the virtuous sacrifices you are making for what’s best.

There’s also an assumption that “responsible” eating/parenting requires retention of vast stores of information about every little situation, every bite, every nutrient, every variable that puts your body or your child closer to what’s best. What, you DIDN’T know that mustard has X points / that blueberries are a super food / that that toy was recalled last month / that Montessori education has the following positive outcomes / that the latest IOM or BMJ study says such-and-such / that it’s bad to be too hovering / that it’s bad to be too inattentive / that carbs are good now? / that carbs are still bad? What are you, selfish? Or just stupid and benighted, one of those sheeple who just parents/eats unthinkingly with no connoisseurship, health-consciousness, or taste?

Moreover, all those little details have to coalesce into a Special Way of Doing Things. An eating program, a “healthy lifestyle,” a parenting philosophy. Nothing can work in practice if it doesn’t work in theory, because it’s the theory that distinguishes you from those poor slobs who just do whatever they want. You certainly can’t just eat on the fly, enjoying what tastes good and what makes you feel good. You have to have a special way you eat that you tell people about with a convert’s zeal. And you certainly can’t just parent on the fly. You have to have even the smallest decision be part of a consistent parenting ethic more substantial than “It was what happened to work right then, for me. For you it might be different.”

And oh God, the way we talk to each other when we’re trying to achieve the ideal. All the “I was bads” and “I did X even though I know I’m supposed to do Y” and “Help me keep my female relatives from sabotaging my plan!” and “My problem is that I just…”

And finally – and I’ve done this, and I hope we can help each other avoid doing this in the comments – there’s the fact that strangers will snicker into their sleeves at how trivial such concerns are. Look at these silly women, working themselves into a dither about calorie counts and organic sleepers. Of course, it’s also those judging strangers who are all too happy to blame you for your selfish eating/parenting, at times when your mere presence — whether as a mother of a child they find insufficiently silent and adorable; or as the possessor of a body they find insufficiently, um, silent and adorable -– gives them an ookie feeling.

Forgive me, I’ve been leading seminars and can’t help but throw out some discussion questions. What do you make of this? Do you see these similarities too, or am I overreaching, pulling a Roiphe, saying “Here’s my master theory for everything based on the experiences of me and my six friends!”? Have I and my mothering cohort been so formed by weight loss that we inevitably bring it to bear upon other areas of embodied life? Or is it the case that dieting, and self-effacing competitive mothering are both instances of some more general artifice that frames a certain sector of privileged women? Is there a way to talk about this that isn’t all WON’T SOMEONE PLEASE THINK OF THE POOR MONEYED WHITE GIRLS?!?! What are your perspectives — those who are mothers and those who aren’t, those who get entered in the pageant and those who don’t — on self-effacing hypervigilant motherhood and dieting?

Am I “worth it”? Well, yes and no.

Hello, Shapelings! This is A Sarah, reporting from amidst a sea of boxes. (Well, actually it’s more of a puddle of boxes at this point, hooray!)

As usual, a lengthy preamble and personal anecdote: As I’ve mentioned before, we recently moved to a different area of the country, and I’m just now starting my first faculty job. Because I’m young and female – and because I’ve been peppered with advice over the years about What! Not! To! Do! If! You’re! A! Young! Female! Faculty! Member! — I’ve been paying closer-than-usual attention to my self-presentation, knowing that my colleagues and students are forming first impressions that will be hard to undo later.

Attention to self-presentation, honestly, still fills me with anxiety and dread; I feel as though I’m always “on” and can never relax, and I berate myself whenever I do something that accidentally gives away power or otherwise gives the impression I wasn’t going for. That said, I have found that, this time around, I’m able to relegate some pieces of advice to the list of Things I’ve Decided Not To Care About Because They Aren’t Worth It To Me To Try And Change At The Moment.

So, for example, if it’s really true (as I heard once) that one cannot be young and female and warm and friendly in class and be taken seriously… well, then, too bad for me and my institution, because my default warmth and friendliness is not something I’m willing to spend time changing. For the record, I don’t actually think that rule holds true — though I can squint and see where it comes from. But my point is: even if it IS true that I must never smile while teaching? The amount of effort and emotional energy it would require for me to change my personality so thoroughly would leave me with nothing left for my students, my colleagues, my family, my friends, or my own well-being. Which would not be my fault, and which would suck. But people’s lives are complicated. One person may have the energy and circumstances and privilege that enable them to do something that would exhaust another person. Personality transplant, under oppressively gendered circumstances, in exchange for success in the academy? Not a tradeoff I can make. Someone else probably can; not me.

On the other hand, there’s apologizing. I tend to apologize too much. I learned early on that it was a way to keep people from being mad at me when I wanted something they didn’t think I should want or didn’t understand, or my personality didn’t appeal to them, or I was smarter than they found congenial. As an adult, this habit no longer serves me well; and it is of course a function of sexism that I ever acquired it in the first place. In my new job, am I willing to try and keep my gendered habit of apologizing in check? Well… yeah, I can do that. That’s an area where, for me, a modest amount of effort actually results in some noticeable change; but maybe more importantly, I actually find it life-enhancing to remind myself periodically that, no, I have nothing to be sorry for. I suppose it’s a kind of self-improvement (in the sense that it improves my life); but for me, it doesn’t require any kind of punitive understanding that I was BAAAAD before and now I’m trying to get GOOOOOD.

In a different category, I think, is dressing up for work. Which I’m also able to do fairly easily, and which I currently do, because it seems to go a long way toward causing people to perceive me as a competent colleague and teacher. Of course this ability — less so, I think, than not apologizing so damn much — is clearly a function of my class privilege and thin privilege. (I’m not thin, but it’s fairly easy to find US size 14 women’s business wear.) And so I sit uneasily with that, wondering what exactly I’m colluding with by dressing up, wishing that it weren’t so, and telling myself that old story about how I’ll do this to get tenure and then work to change things. But right now, dressing up is a tradeoff I’m willing to make, and I’ll keep reevaluating.

Anyway, making these kinds of conscious tradeoffs with respect to self-presentation — where I decide what things might make my life easier and better, without requiring of me huge amounts of energy or a script of self-loathing — has got me thinking about a little phrase you hear from time to time, usually when someone is trying to encourage you to devote huge amounts of your time and energy to the self-improvement scheme they want you to embark upon.

“You’re worth it.”

Like many Weight Watchers alumni, I once heard, and used, the phrase “worth it” in connection with dieting. I proclaimed I was “worth the effort” (not to mention the considerable financial expense and time drain) of staying on program. I’m “putting myself first,” I said. I’m “doing this for me.” I’m “taking charge of my life,” and so on and so on and on and on and on. And of course, all of these sentiments are just repetitions of what we all hear on diet commercials — albeit phrased, not in dainty “I” statements, but in brash imperatives, needling interrogatives, and pious testimonials. Put yourself first! Take charge of your life! I did it for myself! Aren’t you worth it?

And, Jiminy Christmas, what a ridiculously messed-up sentiment.

On the one hand, it’s ridiculous on the very face of it — in ways that we could all probably articulate without much trouble. I mean, really, Weight Watchers meeting leader? I’m “worth” the time and hassle of impressing people who wouldn’t like me otherwise (because, goody, they’re the ones whose favor I want!)? And I continue to be “worth” that effort even when the chance that it will have the desired effect is close to zero and it takes a major toll on my sense of well-being? I’m “worth” a self-defeating and time-consuming regimen undertaken for the purpose of gaining the approval of people who don’t see value in me as I am now? AWESOME, thanks!

But there are two deeper, and possibly even-more-ridiculous aspects to “You’re worth it” that I hadn’t really thought through before… both of which bear on self-presentation and intersectionality. So the idea I’m currently playing around with is the idea that, hidden in all the fake-empowerment “worth it” nonsense are two dangerous and disingenuous – and somewhat contradictory – sentiments that need to be exposed. Here’s my best first guess at what they are, but by all means let’s clarify them further in the comments:

Sentiment 1: Attention: Women In General. We, the spokespeople of the dominant culture, know best how you should negotiate the obstacles you encounter by virtue of being female in a sexist society.”

With the blanket assessment that weight loss — a very specific kind of attention to self-presentation — should strike you as being something “worth” your time and energy, these spokespeople presume to know your circumstances enough to dictate what kind of tradeoffs you should make in your life. Now: that’s temporarily leaving aside the fact that (as we all know) dieting almost never results in lasting weight loss!! But hey, you know, let’s say that it did. Let’s say dieting was one way to reliably improve your chance at being seen as more competent or attractive or valuable — within a system that codes women as being less valuable than men, less competent than men, and existing to look pretty to men.

Even if dieting “worked,” who are they to dictate which obstacles are most worth your attention right now? PARTICULARLY when the obstacles you have to steer your way around were PUT IN PLACE BY ONE OR MORE SYSTEMS OF OPPRESSION which… oh, hey!… they speak for! Bah. Spokespeople, you have no damn clue what I have to negotiate, any more than I have a clue what the woman next to me is negotiating or the trade-offs she’s able and willing to make. (Unless she tells me, in which case it would be nice if I’d shut up and listen and not pronounce about what she should do to become new and improved.) To the extent that I’m able even to influence the way I’m perceived by others: how do YOU know that my time and energy isn’t better spent on some other way of dealing with this shit? I’ll tell you what that time and energy is “worth,” thank you… IF I ever even decide that YOU are worth my time, which I just mightn’t.

Of course, it’s not reeeally all women who are “worth it,” is it? On a different frequency than the above announcement (directed, ostensibly, to women in general), comes this announcement to a select few:

Sentiment 2. “Attention, Very Specific Group of Women: See those unworthy people who can’t spend hours a day at the gym or hundreds of dollars on a weight loss program? Take my word that we can identify them by their fatness. Ew, right? What’s wrong with them, that they don’t have extra cash and time to spend working out? Show, with your thin body, that you’re someone who is “worth” money and time.”

Now, this one has of course bubbled up from the pits of hell. It basically says: Hey, you (presumed middle- or upper-class woman)! You are “worth it” exactly because there are others who aren’t, and you’re different from them. Anyone with eyes and discerning taste can tell the difference, amirite? Plus, all that money and leisure time that enables gym-going and calorie-counting and meeting-attending to be a viable option for you? You had it coming, because you are just soooooo worth it. Being worth it means you never have to consider that, maybe, just maybe, you got some of those perks by being born into them, and not through your own morally perfect decisions. So yeah, go ahead and draw ridiculous analogies — like saying that some people spend money on shoes (OMG SO SAAAD!), but YOU choose to spend your time on your health (as if you couldn’t also buy designer shoes if you wanted them!) No, it’s all FAIR AND SQUARE WHAT PRIVILEGE LA LA LA LA LA I CAN’T HEAR YOU!!!

As Paul Campos, among others, has noted:

“Americans are obsessed with fat because fatness has become a symbol for poverty, downward mobility, nonwhiteness and socially marginal status in general. Fear and hatred of fat has very little to do with the health risks associated with being “overweight” and “obese” (which are wholly imaginary and highly exaggerated, respectively), and everything to do with the symbolic meanings that thin and fat bodies have in this culture.

The fundamental strategy of the war on fat is to universalize the attitudes of middle- and upper-class white American women toward weight, food, dieting and exercise.” (emphasis mine)

(As if you really needed a current example of this very phenomenon.)

So I think that’s where a chirpy “You’re worth it!” eventually lands us. Any tension between the (faux-universally-applicable) first sentiment and the (very-specifically-targeted) second sentiment is resolved, if we translate it thus:

“I don’t know who you are or what your life is like. But I’m pretty sure that we, the spokespeople of the dominant culture, can pronounce authoritatively upon what you need to care about — and even on how you should best negotiate the oppressive systems we help sustain. And, in that vein, we have agreed that you should want to be a thin white straight cis femme moneyed woman, who takes what we say as authoritative, and who tries to improve herself for our sakes. You’re worth it! You’re welcome!”

That’s my best, and very wordy, guess. What do you think, Shapelings? Is this the real work that “You’re worth it!” is doing? Are there other things it’s doing? How do you decide whether and how to care about self-presentation? What’s the best way to think about being “worth it”? Alternately, feel free just to talk about how “worth it” you REALLY are — just because you’re awesome, and not because of the degree to which you meet someone else’s oppressive standards.

[cue Mister Rogers theme]

[No, really, we’re watching Mister Rogers at our house]

Friday Fluff, sort of. And sort of an open thread also.

So here’s what I’m wondering, as I type while meanwhile my younger son naps and my older son tells me “Mommy! Keep looking! Mommy!” because he’s sure that if I just watch this episode of Word World for the thirtieth time I will finally come to appreciate it as much as he does.

I’m wondering how best to introduce a thread intended to accomplish two things:

1) Provide an open thread, because it seems like it’s high time. At least, a number of Shapelings have had interesting links to offer in the comments, prefaced with an apology for being off-topic but rightly allowing as how there was no other place to put it. They are great links, so please put them here!

2) Gently suggest, without intending to be overly directive, that one possible Friday fluffy topic of conversation on said open thread might be your funny internet things that have stood the test of time? By way of background, in the last couple of days I’ve just for the first time been introduced to Auto Tune The News (over at Fetch Me My Axe) and and Homestar Runner (thanks to Fillyjonk via email) and now it’s clear to me that everybody else in the world knew about them a long time ago. So I am just personally curious about what else I’ve been missing. Not, of course, that it’s a duty of Shapelings to bring me up to speed on newfangled things like the Infermashun Sooperhighway and Home Pages and automatic horseless carriages and whatnot. Actually it was Fillyjonk who suggested it, and if SHE were writing this post she’d have zillions of links to things that would make you pee your pants in laughter. But she’s not feeling well (so do send her get-well wishes in the comments, if you think of it) and so you get me, and I have nothing to make you pee your pants, I’m sorry to say.

Well, Word World has just ended and my presence is now being loudly requested at the swing set. (Yes, our new house has a SWING SET! LOVE!) Oh, and hey, the younger son has just now woken up. Well, lovely. Okay, look, obviously my environmental conditions this afternoon didn’t end up allowing me to write anything coherent here; hell, I even resorted to the tired old writing-about-your-writing-process thing. (AND THAT WAS WHEN SHAPELY PROSE JUMPED THE SHARK! later generations would say.) But you all are really smart — surely there’s something here you can use as a spark for a conversation that’s actually, um, interesting. Go to it!

An Urgent Message To Shapely Prose Readers

Your attention, please. From Fox News’ Neil Cavuto (won’t dignify it with a link), by way of Talking Points Memo, by way of Jezebel:

Michael Karolchyk — who started the Denver Anti-Gym for the purpose of “getting clients in shape for sex;” who included in said gym an extra-special super-secret sauna for clients below a certain BMI; who idolizes Holden Caulfield (*snicker*… oops, sorry. (*snicker*…SORRY! I’M SORRY!)); who thought it appropriate to wear a “no chubbies” slogan t-shirt when appearing on national television; whose gym was shut down for not paying its taxes; who thereafter couldn’t quite muster the business savvy not to leave his clients’ documents (including credit card numbers) in a dumpster; and who giggles involuntarily if you walk up to him and say “boobies!”* — does not think Regina Benjamin should be the surgeon general.

I knew you’d want to know, so that you could adjust your opinions on the matter accordingly.

Anna N. at Jezebel reports:

Karolchyk says (based, again, on the scientific method of Watching Video Footage) that Benjamin is “lazy” and makes “poor food choices.” He asks if we’d want “the head of the Fed Reserve to be a guy in a cardboard box” or “Michael Jackson’s doctor” as the head of the DEA.

Folks, the comically un-self-aware man-child who is so desperate to feel young and vital that he appears to have willfully resisted outgrowing his years as a middle school bully is right. The mantle of authority is a privilege. Not everyone can enjoy a visible public platform from which to spout his or her opinions on stuff. That kind of space should be given only to those whose personal circumstances show them to be, not only thoughtful and of unimpeachable judgement… but also prosperous, lucky, and in the fickle general public’s good graces.

Thank you to Fox News, and Michael Karolchyk, for this reminder.

*-Astute readers may wonder how I know this. As a matter of fact, I know this because I have magic boobie-giggler vision: I can look at men and magically discern whether they snicker at the mention of boobies. This is a superpower akin to Karolchyk’s super-power of being able to look at people and magically discern how healthy they are. You call it pulling stuff out of one’s ass; Karolchyk and Fox and I call it penetrating insight. Potato, potahto.