I have been a Fat Activist since the late 80s.
I’ve written about it. I’ve spoken about it at rallies. I’ve marched for it.
I have especially concentrated my attentions on health and medical care. I’ve been a part of and worked in the pregnancy and breastfeeding communities since 1983. I owned a Holistic Healthcare practice that welcomed and embraced people of size. I was a Licensed and Certified Midwife who had a tenderness for people with overweight or obesity. I proudly did well-woman care for women of size.
I’ve also been fat most of my life (“fat” is being used as an adjective, not pejoratively). Not just fat, but in common vernacular: extremely fat/super-sized/severely morbidly obese/Class V obesity/BMI over 68… most of my adult life.
My “Fat Activist” label has morphed into an “Obesity Advocate” one.
The Body Positivity Movement is still fairly new to me and I would describe myself as an Obesity Advocate with Body Positivity on the side. I am of the belief that everyone gets to make their own decisions on what occurs with and within their bodies… emotionally, medically, socially, etc. Judgement of another’s choices is counter to what I believe and practice in my own life. So is telling someone what they need to do in order to better themselves or prognosticating what will happen to someone if they don’t listen to you.
I speak from my own experiences. Please remember that I as share my thoughts.
What Being an Obesity Advocate Means to Me
Through my adult life, I have spoken up for people of size. When I see someone saying something to someone about being bigger than they are, I step in and tell them to tend to their own issues in private… that they are talking to a person, not a thing. I have been known to, depending on the energy hurling towards the person with obesity, tell someone to “Shut the fuck up.” It doesn’t always happen, but if they turn their hatred of fat onto me… whether I was in a super-fat phase or a thinner phase… I gladly take it so the other person does not have to. (I do this with and for Spanish-speaking folks, too. They are often reviled where I live.)
In San Diego in 1988, I met my first Fat Activists and they were wondrous! I learned how men spread their legs to get more space for themselves, yet a woman who has extra weight on her is supposed to shrink to a smaller size so he could have more room. I learned that my negative experiences at hospitals were not unusual, but quite the norm. The gowns were too small. Every illness or pain was explained away with, “You just need to lose weight,” as the solution and cure.
I was shown how the chairs in my life were too small and flimsy for many of us. I’d not really thought about how the arms on the chairs squished my thighs until I had marks on them, could be different. I didn’t understand that those of us with obesity (at the time called “morbidly obese”) could speak up and get things changed. Once I found my voice, I have not quieted down in the almost 40 years since.
When it came to the LGBT Pride Festivals, a group of us went to the board meeting and asked to be shown the chairs they would be setting out around the festival grounds. They brought out those flimsy plastic white folding chairs and I asked if they wanted to watch me fall on my ass right now sitting in it, or at the festival in front of others. Mumbling about, “What should we do?” we suggested standard metal folding chairs sprinkled around for us to use. That is what they did.
Over the decades, I have talked about these same issues with chairs for weddings, reunions, conferences, and concerts. It’s always nice to see the dawning of, “Ohhhh! We didn’t think of that!” come over their faces. Those with kindness, apologize and tell me they will get something sturdy and accessible. Those without kindness, grumble about having to make special accomodations for one small minority of people. Tough doo doo. If you didn’t think of it first, then you clearly need to be educated or reminded there are other people who live in your breathing space.
Medical Advocacy for People with Obesity
When I was 32 years old and in the ER, a student nurse masking-taped a small blood pressure cuff on my upper arm and watched as it ripped off, snorting and angrily going to get his supervisor. Apparently my continuous stream of, “It’s not going to fit. You need a large cuff. You might need a thigh cuff. It’s going to rip the tape,” didn’t sink in. A nurse came back with the large cuff, which still pinched a bruise on me, but got the blood pressure. No “I’m sorry.” No sympathy or compassion at all for how humiliating that was for me.
As a midwife, I made sure my supplies were going to fit super-sized people. The blood pressure kit I bought had a large and a thigh cuff. It was still a few years before it was common practice to take the BP on the lower arm. I learned that trick from a Labor & Delivery Nurse who showed me BP cuffs can take the measurement around the ankle as well as the lower arm. Epiphany! Whenever I insisted the nurse take my BP on my lower arm, they argued with me about it not working and I said, “Try it and see.” Of course, it did work.
Once at the Endocrinologist, just last year, mind you, the assistant told me they had to take it on my upper arm. I said, “No.” Her supervisor came in and told me they had gotten a directive stating it was a requirement to get the measurement on the upper arm. I said, “I refuse to have my blood pressure taken then.” The look on their faces showed they were not ready for that answer! Two visits of refusing and voila! Suddenly they were granted a dispensation to take it on people’s lower arms. Sheesh.
When I was creating my holistic healthcare office, I designed it with large-size folks in mind. All chairs without arms. Speculums that would be comfortable and appropriate for super-sized women. The exam table positioned so they could rest their knee against the wall while being examined. Gowns that fit people up to 600 pounds.
Remembering, I missed getting hats for urine specimens. Getting a clean catch with thick thighs is tough to impossible. Hats allow the person to pee in it and then the urine is collected afterward. I have had to ask for my share of hats over the years. Even if they had to search the floor for it, I refused to try and do a clean catch without a hat. You don’t have to either.
Ah, Chairs
Chairs in medical offices and other public spaces are the bane of my existence. If the chairs all had arms on them, I would go to the receptionist and ask for a chair without arms. I didn’t care how many times they looked at my funny. I was not going to squish my fat butt and thighs into a chair that would probably bruise me. I’ve had them search high and low and they often couldn’t find a chair without arms. I then asked the receptionist for her office chair, please. Flabbergasted, they would hesitate, then wheel it right out for me.
I promise, I am always nice and very grateful. I thank them as I get what I needed and then again, when I was finished and leaving. Even when I refuse to try to wear a standard gown and will get covered by a drape… I am kind and respectful.
I’ve spoken to dozens of office managers to tell them they need to get chairs without arms and/or long, firm, ottoman-type couches for their waiting rooms and offices. I have also petitioned for doctors and midwives to get at least one exam table that lowers to knee height for someone to sit on, then raise the table up for the exam. Large and super-sized folks deserve to be comfortable and safe, too.
But is Obesity Advocacy the Same as Body Positivity?
Body Positivity is a social movement that promotes a positive view of all bodies, regardless of size, shape, skin tone, gender, and physical abilities. Proponents focus on the appreciation of the functionality and health of the human body, instead of its physiological appearance.
There are definitely crossovers. When I speak about how I feel about my own body and look at others’ bodies -no matter what they look like on the outside- I feel good about how I’ve reacted through the lens of my own life. I am continually on the lookout for how I can make people with obesity’s lives easier and more comfortable. This does not just apply to those with obesity, but people of color, differently-abled, neuro-divergent, the spectrum of genders, and the plethora of “others” around us, are also within my view. Is this seeing people for who they are? For me, it is.
Where we do not cross is when Body Positivity becomes superficial. Looking at someone through a tight screen of one’s own making is unfair and can be cruel. I watch as people who step out of the narrow line of definitions are mocked and hassled to conform to what the Movement feels is the right choice or kind of life. “Fat Phobic” is hurled as a weapon against anyone who might want to make a change that affects their appearance. The Movement doesn’t seem to give a whit why the person might want or need to make a change, just that they are not conforming to the message of the group.
I am uncomfortable when people are seen as one-dimensional and their other motives or actions are ignored. I believe people, all people, should be embraced for who they are… on the outside and the inside.
So when people in the Body Positivity Movement decide to take GLP-1s, the assumption is they are Fat Phobic, not accepting of their own bodies. That they are judging others and saying, “You are not perfect the way you are.”
But that is not the case with anyone that I have seen speak or read what has been written. What’s often missing is the person’s motives for taking the medications. (Not that it is the business of anyone else.) Healthy discussion, though, could help each side learn more about the other’s opinion. Why does everything have to be so polarized in our culture today? Isn’t there room anymore for lively discussions to learn about and share with each other?
My Decisions to Gain Health Through Losing Weight
I’ve lost weight three significant times in my life. First using Fen-Phen and the second with a Roux-en-Y Gastric Bypass. (Those stories can be read in My Short History from Fen-Phen to Gastric Bypass.)
Now, I am on Mounjaro after a year of Trulicity.
Not one of these decisions was because of what I looked like on the outside, but what was happening to my body on the inside.
These words, “Proponents focus on the appreciation of the functionality and health of the human body, instead of its physiological appearance” resonate with me. I was not functioning and was most assuredly not healthy. How can one be functioning if they cannot walk across the room without stopping to breathe? What about when imaging shows your liver is covered in fat and you get the designation, “Nonalcoholic fatty liver disease” written in your chart? Or when your blood glucoses zip up the ladder with each meal and your kidneys begin to deteriorate with no symptoms whatsoever?
So many of the ills that happen within the body go unknown until things are really breaking down. Unless one goes to the doctor or care provider and gets labs and imaging, people might not have one clue anything is going on for decades.
And if there is one thing I do know first-hand and from my own years as a Fat Activist and Obesity Advocate, people with obesity hate going to the doctor. They don’t fit in the chairs. The gowns don’t fit. The provider blames everything on being fat.
Do you feel the same spiral I do?
Speaking Directly to Body Positivity Folks About GLP-1s
You do not know why someone might choose to take Ozempic/Wegovy or Mounjaro/Zepbound. You are not privy to their health status even if they have said their labs have been fantastic for years. People lie to conform. I did just that many times before I was diagnosed as a Type 2 Diabetic at 35 years old.
“I’m great! My labs are pristine! I’m fine. I am healthy as a horse.”
Then time caught up with me and I needed to do something to try and make time go backwards for my liver, kidneys, heart, and lungs. That’s when Fen-Phen came into the picture. When you’re told, “If you don’t do something now, you are going to die in two years,” you listen. Desperation kicks in.
I found myself in the same place again six years later and chose the Gastric Bypass to try again. It worked for awhile, but then I got fat and sick again. Fatter and sicker than when I started the process. I tried to get up and succeed, but kept falling down, failing all the “tools” that had been offered to me. I accepted I was a failure and had as comfortable life as I could.
Then COVID came and the echoes of “Let the fat people die” rang in my ears and I really gave up then. I spent two years with a DNR taped over my head, resigned that I wasn’t going to make it out of the house again.
When I had complications from COVID and was in the hospital April 22, 2022, that is when my life pivoted (again). Being told I was going to change my life or live in a nursing home slammed me against the wall of reality. Has anyone mentioned that to you?
Looking at my labs from that hospital stay, I’m shocked I was not sicker than I was. Now, after a year on Trulicity and now on Mounjaro, I am playing a desperate game of catch-up to heal what I can.
And I feel horribly guilty for not trying harder sooner. I feel horrid that I gave up so many times. I wear the yoke of responsibility for my own situation. The only salvation is that now I know obesity is a disease. It seems like a mirage, however. I have been told so many things before about why I was fat, it seems too easy to blame a disease. I have long believed my fat was a moral failing.
I’m 62 years old now. Would I have lived this long if I had not taken Fen-Phen and had the Gastric Bypass? I honestly do not think I would have. I feel I have leap-frogged over tragedy and am once again in the right place at the right time. Sure, I have life-long difficulties because of those first two tries at health, but I know they were a place for me to catch my breath, to see what life could feel like without carrying 350+ pounds everywhere, all the time.
So, my sisters and brothers in advocacy, please remember you never have the whole story, even with your closest friends and family. Being Health Phobic is just as unattractive as being Fat Phobic. Just because health gain comes with weight loss does not make a person guilty of betrayal.
No one owes you an explanation. You are responsible for your own life. We are responsible for ours. We all make different choices a thousand times a day… drinking different coffee, choosing a different color shirt, wearing bows in our hair… and what medications we choose to use to save our lives.
We’ll honor your choices. Please honor ours.
