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Monday, November 23, 2009

Living While Fat - An American Crime

I am fat. I have been fat since I was 10. And while it was never a conscious decision about how to live, after years of personal struggle and self-realization I decided long ago to not let it get in the way of living fully. Which, by the way I do, probably way more than most skinny people.

Now I know that there are lots of people out there who are uncomfortable with the idea that someone as large as I can be professionally and personally successful, but I live to break the barriers of small-minded expectations. And although you may see me as fat on the outside, on the inside I have never been fat in the negative vitriolic way that we large people are expected to hate ourselves.

Which is why I’m still adjusting to the recent epiphany that fat people, like me, have become the latest government-sanctioned target for ridicule and bigotry in America.

It’s not like we haven’t been down the road of stigma and discrimination on a whole host of other issues in our ugly past before. Once upon a time Blacks were only 3/5ths the value of a White man and it was socially acceptable, and even fashionable, to call people Spicks, Fags, Kikes, Niggers, etc. It isn’t like fat kids have not been the joke of the playground since time immemorial, and it isn’t like adults supervising those playgrounds have not turned a blind eye to those particular rants – even in these days where there is sensitivity about bullying.

Is it not bad enough that people spit the word “fat” out as a curse word or derogatory marker? In this case, the word “fat” somehow emphasizes the terribleness of some other bad trait (e.g. “she is a fat slut” when really that slutty girl is not fat at all but a fat slut is worse than a regular old slut).

From my perch here in Tanzania it seems that what has changed is that fat is now an acceptable stigma for ADULTS and our very own GOVERNMENT to wield in America. And once again I am left wondering why it somehow makes us feel better about ourselves to put other people down for the things we fear the most. Like somehow the very presence of a fat person highlights all the insecurities we have about our own bodies – or something bigger - like the national debt.

And to make it worse, it is my own people – fellow public health professionals – that are leading the completely misguided assault on fat people. It seems that now that we’ve largely won the war on cigarettes the public health mafia needs a new place to turn their attentions.

Don’t get me wrong, it is not misguided to educate people about healthier behaviors and pitch to them the reasons why they should change, and to give them step-by-step guidance for how to make those changes. And it is not wrong to worry about the burden of obesity’s (as well as a whole long list of unhealthy behaviors) effect on our society. But in their overzealousness, my public health sisters and brothers are attacking the people who are fat rather than coming up with creative ways to deal with the undesirable behaviors or seeking to understand the true reasons why most seriously overweight people are overweight - which in my somewhat experienced opinion is really due to a complex mix of psychological and metabolic factors rather than simply too much McDonalds or Kentucky Fried Chicken.

Which leads me to why it is that I am up at nearly 2 AM on a Sunday night/Monday morning, writing about fat stigma, with my blood boiling and my face turning purple with rage. Well… it is the fault of the BBC. At 11 PM I listened to an interview with the head of student health from Lincoln University in Philadelphia describe why it is that the university plans to prevent almost 80 students with BMIs of over 30 from graduating unless they take a special fitness and health education class for obese students only. And to make it worse, arguing with an editor from the student newspaper who categorized the classes as offensive and inconsequential to the degree programs that students have completed, the BBC commentator countered that the university should even reconsider investing in fat students at all since probably not long after they graduate they will just get sick and be a burden to society, and therefore a wasted education.


When did it become fashionable again to deny a person an education because of their outside casing? Are students who smoke, drink, take drugs, have a family history of cancer, or have unprotected sex being subjected to special classes? Are they being told that because they may eventually be a burden to society they, too, should be divested of the degrees which they have spent four years earning?

I hope those students sue the ass off that school. I will be the first in line to contribute to the legal fund.

And this leads me to ask, whatever happened to loving the sinner but hating the sin?

The truth is that when stigma increases, the ability and willingness of people to seek help for that stigmatized issue decreases. I see it all the time in my work where people living with HIV in communities where stigma is high end up denying themselves access to treatments and support that might help them live longer and put others at less risk because the social risks of seeking help are too high. Where stigma decreases, communities are better able to cope. It is in communities where the partnership between people with the disease and their friends and neighbors without the disease work together that we have seen the best successes in curbing the spread of HIV.

It is frankly the same with fat people. The more the society around us seeks to stigmatize us, the less likely we are to feel comfortable interacting with the rest of the world, taking that exercise walk around the block, or seeking the medical assistance we need to stay as healthy as possible. Think about how unpleasant it can be to visit a new medical provider when you aren’t overweight. Then imagine what it must be like for someone who is significantly overweight to get weighed (and inevitably judged) by a stranger, be given a medical gown that doesn’t fit, meet with a new doctor who is more likely to lecture than counsel, and share your body – which you are not very comfortable in – with that lecturing stranger. It can be agonizing, demoralizing and stigma enhancing.

Here in Tanzania I have become sick of opening up my MSN every morning to read another article about the fat tax on fattening foods, airlines denying seats to fat people with the happy approval of the rest of the country, or health insurance companies using fat as a preexisting condition to deny coverage to people who are even barely overweight. I don’t care if skinny Americans, are slightly put out by the very presence of fat people. For me their discomfort isn’t all that different than how some people 60 years ago didn’t want to have to ride the bus with Colored folks. Tough shit. The world is diverse, and not everyone can or should look like Heidi Klum.

Fat is a human rights issue. Stigmatizing me and my kind will not make America skinnier. It will just make us unhappier, more divided, and angrier. And by the way, none of these conditions are particularly conducive to weight loss.
**** Edited to remove a snarky comment about people doing coke to stay thin. I was trying to be ironic, but I think it just got in the way of my message.


Anonymous Anonymous said...

wow, you seem very angry at thin people. I am skinny and I don't snort coke. I eat lots of veggies and run a lot of miles. Not saying you don't or anything, (I don't know you), just saying that's the way I stay thin, not coke.

I don't agree with hating overweight people. But I do think our society (America) is actually way MORE accepting of people of all sizes than it used to be. In fact I think I've read that many people who are overweight don't even know they are (medically) considered overweight because so many more Americans are that it just now seems normal.

12:31 AM  
Blogger Mahlers On Safari said...

Dear Anonymous,

Angry at thin people? Not in the slightest. Almost everyone I know and love are thin. I completely support you in your vegetable eating and running. I think that is great.

Angry at Lincoln University (and the irony of them using the Lincoln name) and others who are hypocritical about risk behaviors - just focusing on this one (fat) when there are so many behaviors that put people's health at risk? And at how fat discrimination is completely accepted in our society? Yes. Absolutely.

But thank you for pointing out that the coke comment was a bit snarky. I debated leaving it in there and you've helped me to see that the piece will probably be better without it.


7:01 AM  
Anonymous Josephine said...

Thank you for such a great blog! The story of Lincoln University is just outrageous. Going through medical school I have so often been shocked with how bed-side manners are among physicians and nurses in contact with people that doesn't fit a the narrow path of the average, be it everything from wearing a headscarf, to overweight or smoking. If anything positive to be said about the AIDS epidemic then at least it sparked a whole new creativity around prevention. I really wish our fellows in the public health community could be better at remembering of all those lessons learned that when discussing smoking, obesity, road safety etc.

3:13 PM  
Anonymous Anonymous said...

I am skinny, and your friend, and I know you love me - and I love you. And - as ever - your blog was SPOT ON! I believe that our friendship - which goes back a few years now - is not based on either of our sizes, but is purely based on mutual respect & enjoyment of each others company (usually via phonelines and emails, but that's just a matter of geography). I couldn't agree more with your blog, and your anger running right the way through it.


3:52 PM  
Anonymous Jen in New York said...

What's interesting about this piece is that I used to feel the same rage towards the growing anti-smoker sentiment in the 1990s. I knew I had an addiction that ran far deeper than "well just quit then!" I had been raised in a culture where smoking was both pervasive and socially acceptable, and over time I felt myself become the target of hostility, mocking, and condescension.

CLEARLY smoking is something that is destructive (insane, really), both for the smoker and those around him/her. I have never had a quarrel with ANY non-smoking laws which apply to public places. Smoking, while I chose to do it, was my own bad habit and I knew better than to inflict it on the innocent people around me. Fine. Make a law. Tax the shit out of a pack of cigarettes. Raise my insurance premiums. I should not smoke. I get that.

But had someone said you me, "you may not have your diploma until you can prove you have not smoked a cigarette for X number of weeks," THAT would have been completely insane, and you can bet there would have been a major lawsuit. I'm with you there.

The obesity issue is, of course, more complex. I understand your anger and I think the stigmatization of obesity has always been part of our society. I also agree that it is fast becoming a human rights issue. But there are at least two main issues with which we must contend. One is the attitude of society in general, which is clearly unhelpful at best an destructive and demoralizing at worst. I believe that these destructive attitudes are the very things which open the door to such ridiculous ideas as denying a diploma to overweight students, and forbidding overweight women to adopt children.

The other issue is the practical matter of trying to reduce to cost of obesity to our healthcare system. Both the government and the health insurance companies are setting up new standards and laws aimed at promoting fitness, preventing and reducing obesity (no pun intended), and I wonder: is this so wrong? is it fair to the non-obese, some of whom work VERY hard to maintain a healthy and fit lifestyle, to have insurance costs skyrocket because of all the care that needs to be provided to the obese population? In the same way that non-smokers suffer the effects of smoking (both physically, in the moment of lighting the cigarette, and financially, in healthcare costs), don't the non-obese end up paying for obesity as well? And what can be done?

I think you make an EXCELLENT point about creating a supportive and accepting climate for people who may be too filled with shame to come out of hiding and really try to tackle their health issues. In the same way that we now see advertisements with a gentle, non-judgmental tone urging smokers to call a helpline, or send for information for smoking cessation programs, I agree with you that it's time for some more compassionate helping hands reaching out to the obese population. You point out that "Where stigma decreases, communities are better able to cope." That's really it, isn't it?

So how can we make it happen? What's the first step?

9:32 PM  
Blogger Mahlers On Safari said...

Jen in NY.

You wrote: "The other issue is the practical matter of trying to reduce to cost of obesity to our healthcare system. Both the government and the health insurance companies are setting up new standards and laws aimed at promoting fitness, preventing and reducing obesity (no pun intended), and I wonder: is this so wrong? is it fair to the non-obese, some of whom work VERY hard to maintain a healthy and fit lifestyle, to have insurance costs skyrocket because of all the care that needs to be provided to the obese population? In the same way that non-smokers suffer the effects of smoking (both physically, in the moment of lighting the cigarette, and financially, in healthcare costs), don't the non-obese end up paying for obesity as well? And what can be done?"

I understand the point you are making above - but the problem is that this same statement can be made about so many other issues. Many of the non-obese who work hard to mantain a fit lifestyle have other issues which cost our health system or our country in general. Some might have mental health issues that require them to spend years on therapy bills. Others will eventually develop chronic diseases just because they were predisposed to them for biological or genetic reasons. (What happens the day that health insurance companies start demanding genetic testing as a prerequisite for insurance coverage - because surely it seems we could be heading in that direction if the companies are left unchecked?) No one is pointing their fingers at alcoholics, anorexics or bulimics, some of whom are incurring livelong damage to their bodies.

Some will go on to become titans of Wall Street and fuck up our pension funds - which surely has just as many financial side effects on our society as being fat?

All I'm saying is that it is a slipery slope and there really is no fair way to point a finger at one group of people (over any other) and say... YOU. YOU are the ones that are costing our society so much.

My two more cents :)


8:07 AM  
Blogger supernana said...

Very interesting post. As someone who has been on both sides of the fat/skinny fence, I empathize with your anger.
I am, however writing because I wanted to tell you that I just spent the better part of my Sunday evening reading your entire blog. I am thinking of taking a job in Tanzania, a far cry from my current residence of Santa Monica, CA. You are very insightful and quite inspirational and I do hope that if I make out there I can have a chance to revel in more Hally wisdom. So thanks and keep it up.

9:19 AM  
Anonymous Alexis said...

Amen, Hally!

5:15 AM  
Anonymous verybadcat said...

Followed you here from Her Bad Mother.

I like your post, your message in general. I only have one problem, when you said that you didn't care if skinny people were uncomfortable with the mere presence of the overweight/obese and compared it to the Jim Crow laws.

At the point at which someone is taking up space in my airplane seat, or blocking my access to something, it has nothing to do with the REASON they are intrusive, per say, but they are being intrusive. I'm really, really tired of hearing this "it's okay to be fat" argument always including some dig at the skinny bitches that actually want to sit in the whole seat they paid for. Or that don't want to be snarled at when they ask nicely for someone to move.

Make peace with your body. I get that, I don't deny you that. I've been fat, my Mom is fat, my Grandma was fat and most of my relatives are fat. You don't make me sick, you don't disgust me. You're beautiful in your own way...

... as long as you are beautiful on the inside and not bitter with a chip on your shoulder.

Not you in particular.

Just saying- your right to be happy and be who you are- I believe in that strongly.

Until I spend three hours smushed up against the wall of the plane, avoiding overly defensive dirty looks.

10:25 PM  
Anonymous karla said...

Excellent post. And for all of those rallying the lose weight cry? Please, tell me, where is one journal article showing that one diet (just one) has lead to any form of significant, lasting weight loss. There aren't any. Not one. Not low fat... not low carb... not low calorie... not (fill in the blank). People of all sizes should be encouraged to adapt healthier behaviors, such as eating more fruits and veggies, and exercising... regardless of weight.

If you haven't, read Gina Kolata's fab book, "Rethinking Thin." I also love "Zaftig: The Case for Curves" just to see how ideal body image has changed in art. One more reco... if you have some extra bucks, check out the artist, Les Toil. Brian did a portrait of me maybe 9 years ago, and I love it. Well worth the bucks. :)

7:20 PM  
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12:07 PM  
Blogger Sherry said...

I am thrilled to have found your blog and this post in particular. I'm assuming you've recently read the Glamour magazine article written by a former anorexic who is 'disgusted' by fat people kissing, etc.etc.etc.

In my little blogosphere (I had the lapband about 8 months ago and have developed worldwide friendships with other 'bandster bloggers') we've been talking a lot about our own prejudices against fat people, where it comes from and how it changes as we become thinner. Maybe you'd be interested in reading some of that too.

In any case, I think you've made a brilliant case against fat discrimination and, in particular, using obesity for insurance coverage determination. Loved reading it!

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