The Tyranny of Healthcare Guidelines

I recently suffered a catastrophic knee injury (I tore my meniscus in multiple places, though I don’t have a good story to go with it) that is precipitating a total knee replacement. I am a fat person who has had severe arthritis for over a decade, and I am lucky enough to have an orthopedist that is doing the surgery without requiring me to lose a (frankly ridiculous) amount of weight. But when I announced my impending surgery to my group of friends and family, I heard from multiple people with the same story: they need a joint replacement but are being asked to lose upwards of 100 pounds first. I watched my mother go through something similar before she was able to get her first knee replacement, and when she was finally able to have her surgery, it changed her life.

So I had to ask myself, are there actual guidelines for an optimal weight for joint replacement surgery? According to the American Academy of Orthopaedic Surgeons:

So if in effect there is a lack of actual guidelines when it comes to joint replacement, what is motivating physicians to require patients to lose large amounts of weight before surgery? As far as I can tell, it is 100% about physician preference. It is well documented that many physicians have an anti-fat bias. The assumption that fat equals unhealthy is still pervasive in healthcare. In looking around for some kind of guideline for physicians, I mostly found older blog posts by surgeons advocating for weight loss.

Current research, including research conducted about 6 years ago, suggests that fat patients and “normal weight” patients have similar outcomes in pain relief and function. A review article from the University of Alberta published in 2021 goes a step further, saying that “losing weight before surgery doesn’t lead to better outcomes.” And in fact, waiting for surgery worsens the condition of the patient. Bottom line: surgeons who require their patients to lose weight first are doing harm.

The best thing a patient can do if they are up against this particular roadblock is to shop around for another surgeon. It is clear to me from just a little reading that there is evidence to support patients at all weights receiving joint replacement surgery, and that hopefully means overall attitudes are changing.

Signal Boost: Maintenance Phase Podcast

Debunking the junk science behind health fads, wellness scams and nonsensical nutrition advice.

Do you like well-researched podcasts about wellness? Are you a methodology queen? Do you want to sometimes laugh out loud in an inappropriate place like on a train or library? Then Maintenance Phase is the podcast for you. Aubrey Gordon, otherwise known as Your Fat Friend and author of What We Don’t Talk About When We Talk About Fat, and Michael Hobbes, writer and podcast co-host of You’re Wrong About, walk their audiences through a connect-the-dots journey through science and policy to figure out how we all got to where we are in the world of wellness and nutrition.

I could do a whole blog post about pretty much each episode. When I need my fat liberationist fires stoked, I make sure to put on a new episode or at least an episode I haven’t heard yet. I’ve gotten into the podcast a little late since they got started in October 2020. There are currently 25 episodes available for your consumption (no calories involved). Gordon and Hobbes have a great rapport together, and their energy, while sometimes chaotic, is infectious. They are uniformly well-researched and tell a wonderful story, whether it’s about Oprah and the Wagon of Fat episode or celery juice and master cleanses. I learn a lot from listening to the episodes and can identify with a lot of the experiences that Gordon, fat-lady about town, had. But this podcast definitely isn’t just for fellow fats; anyone who wants to learn more about some of the latest and greatest health and nutrition fads of the recent past should give it a listen.

Wearing a Bathing Suit is a Radical Act

There’s not much I enjoy more than going for a swim: ocean, pool, lake, whatever. I’m a water baby. But once you’ve had the experience of a random person shouting, “Hey, it’s a beached whale” at you, putting on a bathing suit becomes a much different prospect.

Each time I put on a bathing suit, it is a radical act. Showing ANY part of my fat body without shame is radical, but a swimsuit leaves no place to hide. It’s all just out there, for anyone to see. And when it comes to fat bodies, there seems to be no shortage of people who are not ashamed of offering their commentary loudly and publicly. I hate that I have to psych myself up each time I go swimming, which is something I do twice a week for both my physical and mental health. I’m a much better person if I’ve been able to be in the water. But there’s always that moment, that terrifying moment, when I leave the locker room and wonder if this is the day that someone is going to say something awful. And I get it, putting on a swimsuit is fraught for LOTS of people, but putting on one while in a fat body is a particular culture phenomenon that invites commentary.

So what do I do to get past the fear and anxiety?

First, I look around. I’m pretty fortunate in where I go to swim regularly that there is a mix of bodies out there. The time of day makes a difference, too. I tend to go in the morning when there are fewer parents with their children or people trying to get in a workout early before starting their day. So, it’s mostly retirees and me. And mostly, I can usually find someone who’s body is enough like mine that I don’t feel like I’m out there on an island by myself.

Second, I summon up the courage of my inner older white dude. These are the dudes I see walking around the pool proudly with their bellies hanging over the tops of their suits. The ones who are smiling and chatting with everyone like they are everyone’s best friend. If those guys can own themselves that way, then I sure as fuck can, too.

Finally, I try to remember that I have every good reason to be at the pool along with everyone else. I know what my body needs, how much it can take, and how far I can push it. I know I get cranky if I can’t swim. I know my depression is worse if I can’t swim. A year+ in lockdown from the pandemic helped teach me that. So I have to actively make the choice that my health and wellness is more vital than potentially having to deal with one awful person.

I encourage all of you to be brave. Whatever radical act you might be facing, go for it. Your body is wonderful exactly as it is, and it helps you do so many things. You are a warrior!

I Met a Girl...

Broadway Cares/Equity Fights AIDS is a charity organization that I have supported from time to time. My favorite way to support them is to put money into an orange bucket at a live show. It’s a thrilling moment to get to look a hard-working actor in the eye, say thank you for their performance, and give something toward helping lots of people. Broadway Cares also usually holds live performances for donations. With live shows on hold because of the pandemic, neither way of donating has been an option.

This year, Broadway Cares has a virtual performance called Broadway Backwards, available through 11:59 PM on April 3. It focuses on how the isolation of the pandemic has affected the LGBTQ+ community. The Broadway Backwards performances gender-flip songs so that those originally scripted for men are sung by women, and vice versa. There have been several Broadway Backwards performances to raise money over the years, and this virtual version includes some of them.

Which brings me to Bonnie Milligan and “I Met a Girl”.

https://twitter.com/BeltingBonnie

The whole Broadway Backwards show is glorious and well worth the watch, but Milligan’s performance of “I Met a Girl” from Bells Are Ringing made me really take notice. So much so that when it was over, I turned to my wife and asked her if that really happened. Because here was a fat woman, wearing a dress similar to what I could probably find at my local Torrid, singing about having met a wonderful girl and falling in love. I saw myself on stage in a way that I have never seen before.

Bonnie Milligan, Debra Monk, and ensemble in Broadway Backwards.

This… this is why representation matters. Because I saw a fat woman enjoying her new-found identity and being supported by the people around her. I saw someone who looks like me loving her life.

Milligan’s performance starts around 39:35, but I encourage you not to skip past what comes before (and everything that comes after). Her performance gave me a certain kind of hope that is much-needed more than a year into this pandemic life. I’m the newest member of the Bonnie Milligan fan club for sure.

If you miss being able to see Milligan’s performance in the virtual Broadway Backwards 2021, you can find it here from Broadway Backwards 2019. If you are able, please consider donating to Broadway Cares/Equity Fights AIDS. On top of helping many AIDS and family organizations, donations are also going to help those in the performing arts who have been struggling due to job loss and having their careers put on hold. This year’s proceeds also go toward helping The Center which has been serving the LGBTQ+ community virtually almost as soon as their building closed.

Fat Cats

My wife and I have four cats between us, two that I brought into the marriage, one that she had before we got married, and one that we adopted together. They all eat the same thing. It’s just that one is bigger than the others. We call him a cat bear.

This is Plato.

As you can see, he is large. He’s basically the size of a small dog. He’s got a big belly. Our niece, visiting us from Texas, saw him and exclaimed, “Holy hedge, he’s huge!” And he is. I don’t mind people pointing out how big he is. I love my big boy. He is squishy and I love to snuggle him (even if he doesn’t always enjoy it). What I mind is when people ask me if he should be on a diet. Or if I’m worried about him getting diabetes. Or if I’m worried about him dying.

Because when those kinds of comments are directed at my cat, it tells me a lot. It tells me that the reach of diet culture and fat-shaming isn’t limited to people. It tells me that when those same people look at me, they are wondering if I’m going to die prematurely, without knowing anything about how I live my life. They look at my body, or my cat’s body, and make a determination about how healthy we are. It doesn’t matter that Plato eats the same thing as the other three cats, one of which is skinny, one of which is fluffy and round, and one of which is athletic and sleek. It doesn’t matter what or how much I eat, or what my activity level is. The very fact of my fat body is enough.

The next time you’re around a fat cat, or a fat person, just enjoy their company and keep your suppositions to yourself.

Let's Talk About "Fat"

Source: https://www.penguinrandomhouse.com/books/645819/what-we-dont-talk-about-when-we-talk-about-fat-by-aubrey-gordon/

Reading What We Don’t Talk About When We Talk About Fat was more than a revelation. I had been a fan of Your Fat Friend for some time, following her on Twitter and reading her essays on Medium. I had always found her work to be well researched and poignant, telling stories from her own life. So when her book came out, and I finally found out that her name is Aubrey Gordon, I knew that I was going to buy it and read it as soon as possible. Chapter after chapter, Gordon lays out what it is to live life in a fat body, how society has been conditioned and manipulated against us, and the myths surrounding our bodies. I found myself not only nodding along as I read but moved to highlight passages that were particularly resonant or hard hitting.

I felt so seen and validated, that my life hadn’t been as strange or as isolated as I had once thought. I was both comforted and horrified to know that I wasn’t the only one who had been tricked into thinking someone cared about me only to have them laughing about me behind my back to their friends or fetishizing my body for their own cheap thrills. Or that time I was on a tiny plane to Memphis for a work conference when the businessman seated on the aisle became visibly uncomfortable and more and more agitated until he finally alerted a flight attendant and was moved to another seat. I was far enough along on my fat acceptance journey to ask the flight attendant myself if he had requested to be moved because he didn’t want to sit next to me, and she confirmed that he had been moved for his own comfort. I nodded and tried to enjoy the new space that I had, but I couldn’t help crying a little. I had never come so close to actually being kicked off a plane, and if there hadn’t been another seat available (and he had decided to continue to raise a stink), I could have been.

Source: https://www.yourfatfriend.com/about

These were real experiences that happened to me, and I was convinced that they were my fault because I had been told my whole life that my body was my fault. And here’s Gordon telling me that it isn’t my fault, that in fact my body is not a problem to be fixed, and that I am not alone in having this happen to me. More importantly, here was Gordon telling everyone that these experiences are REAL and they happen every day. She talks about relating these events to thin friends and not being believed that they happened the way they did or that they happened because she is fat.

Ultimately, this is not just a book for fat people. I want to give this book to every thin person I know and exhort them to read about what my life is like sometimes, to learn that my body is not wrong the way that it is, and that walking around in a fat body is an act of rebellion. What Gordon’s book did for me personally is to kindle the fat liberationist spark in me that wants to fight against the systems and institutions that have made the discrimination against my body legal and acceptable.

I want to do a deeper dive into some of her content later, but I highly recommend that everyone read this book.

Athletic Wear for (Mostly) Every Body

Very occasionally a brand comes along that gets it right. Superfit Hero made a splash in my various online fat communities when they extended their plus size active wear up to size 7X. Finding appropriate clothing for a fat athlete is a challenge, to say the least, with most brands grudgingly offering a 3X. Even then, any brand that dared to do so was decried as glorifying obesity. But Superfit Hero takes it a step further.

Source: https://superfithero.com/collections/new-superhold-sets

Not only do they offer extended sizing for their clothes, they show people with fat bodies actually wearing those sizes. To be able to see how something my size actually fits a real person is not something that I get very often. Almost never, in fact. Every new item they offer comes in every size they offer, so fat athletes aren’t restricted to two or three basic colors. And this is my favorite feature:

Source: https://superfithero.com/collections/bras-tops/products/superhold-sports-bra-burgundy-blush

When you select a specific item, it shows you how that item looks in a variety of bodies. I mean, I have rarely, if ever seen that for a clothing company. Usually I just have to use my very extensive imagination to determine if something I’m going to buy is going to look good on me. As if that wasn’t enough, Superfit Hero has resources for fat athletes to find body positive fitness practitioners, as well as a private Facebook community for athletes and trainers.

Source: https://superfithero.com/pages/about-superfit-hero

Everyone should get to have this, the basic ability to buy clothes for their bodies. And not to be made to feel like they have to change their body to fit the clothes. More than that, everyone should get to have clothes that they can move in comfortably. I admire Superfit Hero for going as far as a 7X, but I’d be remiss if I didn’t say that even extended sizing doesn’t and shouldn’t end there. There’s always room to improve, no matter how right a brand is getting it.

Radical Self-Acceptance (and Drag Queens)

There are lots of things that people in fat bodies aren’t supposed to be able to do. And for every single thing that we’re not supposed to be able to do, there’s an example of someone out there doing it expertly (along with all the other people who are out there just doing it because they can).

One of those things fat bodies aren’t supposed to be able to do is get in drag and perform. And of course, there’s someone out there doing it more than expertly. Lots of people probably already know about Eureka O’Hara, but I was only introduced to them earlier this year when my wife and I devoured We’re Here on HBO. From the start, watching Eureka perform was ground-breaking to me. They used their size to their best advantage, and never shrank from showing off their body, including putting themselves into really the best corsets I’ve ever seen. They owned the stage in every performance, sexy and warm one minute and then doing jumps and splits the next. They’re running a marathon up there and looking GOOD doing it.

The best thing about We’re Here was seeing the Eureka and her fellow Queens Shangela and Bob the Drag Queen, go into small towns across America and highlight the community. The show had all kinds of people—queer, straight, allies, amateur performers—transform themselves into a drag persona and perform for the town. Time and time again, we saw other people in fat bodies do amazing and fun drag performances and be applauded and supported by their communities. It was an amazing example of radical self-acceptance across the board. Watching each drag queen connect with their new drag daughters and bring out their best in each performance was moving beyond words.

There’s nothing that replaces the feeling of seeing someone who looks like you be entirely themselves. Unfortunately, the show had to be suspended because of the pandemic, so HBO did an episode highlighting the journey of each queen to becoming the performer that they are. It’s not surprising that David Huggard, who performs as Eureka, had a difficult journey and struggled with thoughts of suicide before finding drag. And then you see them perform with so much confidence and bravado, and you think that maybe you can do it, too. Whatever “it” is for you…

I’m hopeful that when it is safe to do so, HBO will put money back into the series and allow it to continue. Because it’s the kind of thing that helps expand perspectives, and that’s something that we really need.

Infinite Diversity in Infinite Combinations... Except for Fat

Copyright CBS All Access

I’ve written here before about how much I love Star Trek in all its forms. I cut my fandom teeth on the original series and was there all through Deep Space Nine and most of Voyager and even Enterprise. Now I’m all in on Discovery. It is beautiful to see all those humans and people from other planets all working together and serving together. It is the realization of what I think Roddenberry imagined when he started Star Trek.

Now that we’re halfway through the third season (Spoilers ahead)

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and there’s been a significant time jump, we’re more than a millennia from everything we know from the universe that has been established. So far we’ve seen a good chunk of the functioning society that exists in the 30th century. It’s a desperate time without the Federation to keep the peace and everyone is trying to scratch out an existence as best as they can.

But clearly no matter what has happened in the intervening 900+ years, all of the fat people have disappeared. If they were ever there to begin with. I mean, it’s statistically improbable that there’s NO fat people. Even if all of the systemic issues that perpetuate nutrition deficiencies and high-calorie, high-fat, low-cost foods in marginalized communities have been taken care of, fat bodies can and should still exist.

One of the images from the credits is the symbol for IDIC, or infinite diversity in infinite combinations. It was inspired by Roddenberry and became part of the Vulcan philosophy: “The glory of creation is in its infinite diversity. And the ways our differences combine to create meaning and beauty." (“Is There in Truth No Beauty?” ST: Original Series)

Roddenberry said “Until humans learn to tolerate -- no, that’s not enough; to positively value each other -- until we can value the diversity here on Earth, then we don’t deserve to go into outer space and encounter the infinite diversity out there.”

So, where are the fat people? The problem is that Star Trek is written by people that still have biases, who do not positively value everyone. Anti-fat bias remains rampant and has increased over time, while other biases have started to decrease. So even in while trying to imagine a society so far in the future that everything is new, and the writers can not only play in Roddenberry’s sandbox but potentially expand it in any direction, it is impossible for them to imagine fat people existing.

Until we can learn to positively value fat people, until anti-fat bias is totally eliminated (along with every kind of bias out there), until we can look at a person in a fat body and not see something that needs to be fixed, hidden, or eliminated, then we can’t move forward as a society.

Book Rec: Happy Fat by Sofie Hagen

Imposter syndrome is real and when I started this blog, a rather large part of me thought, “Who wants to hear from me?” There are lots of more informed, more active, awesome fat people to hear from. People with more experience. People with something to say . So it was beyond encouraging to read these words at the end of Sofie Hagen’s book Happy Fat:

“And then I can only hope you will engage with the fight. I hope you realise how incredibly valuable your input would be. How much we need as many people as possible to actively fight anti-fat bias.”

I am just a baby Fat Liberationist, but to have this veteran tell me that my voice in particular is needed in the fight? I feel like i can take on the world. And I feel reinvigorated!

The whole book is amazing and very worth the read. If you are an ally, there’s a particularly good chapter on How to be a Good Friend to Fat people. And those tips aren’t just for allies to fat people; they’re important for anyone who is trying to be an ally in any marginalized space. Hagen makes the point over and over again (a point that I’ve made more than a couple of times here as well) that the fight is intersectional, so our ally-ship needs to be as well.

Most of all, reading this book and finding experiences that I recognize within it, from this Danish woman living in the UK, made me feel like I’m not alone. And that’s the thing. When you’re walking around in a fat body and it feels like everything and everyone is against you, it is tremendously isolating. Even someone like me, who has built up an awesome fat community around me, can feel like I’m alone in this struggle. When I need to be reminded that I’m not, now all I have to do is look to my bookshelf.