Fat Folx: You Are Not Responsible for the Re-education of Health Trolls

Last month I wrote a couple of blog entries about my experience living in a larger body, specifically about dealing with my somewhat clueless doctor and a ridiculously out-of-line massage therapist. These experiences resonated with many of my readers and I received quite a bit of appreciation from people who have experienced or witnessed fat bias and health trolling. Among such wonderful feedback, I also received this public comment from a somewhat estranged family-friend that was rather troubling. 

I love you and we are miles apart on this topic. I agree with much of what you say regarding the bias, but my training in Exercise Physiology (and my own history with weight gain and loss) is not on the same page with much of what you say on the physiology side of things. This topic and your history are complex, but I think we should chat sometime, so I can better understand your perspective and also offer you another viewpoint. 

I could hear the swish and flap of red flags waving as he breathed these words of concerned curiosity on my Facebook post. His commentary smacked of self-importance and the politely repressed anticipation of proving me wrong in the name of Science and the spirit of Dialogue. 

I was almost tricked into thinking this person actually cared about what I had to say and was interested in dialoguing further because while we may not see eye to eye, his response ended with an invitation to discuss these differences further. But if he was truly interested in understanding my perspective, wouldn't he have privately messaged me instead of very publicly performed his dubiousness surrounding my thoughts on being fat? Why perform this public display of dissent among so many affirming comments and shared stories?

As I composed my message to him, I realized that I had absolutely no interest in discussing any of this further with him nor to educate him about fat bias, mental health, and Health At Every Size. If my assessment of his personality and this situation was correct, he just wanted to tell me that I'm wrong and he's right and prove to me that he knows better than me. Here is how I responded:

I appreciate your offer and hope it will hold until I have the emotional energy to have that conversation. To be completely honest, I am just not in a place to fairly listen to the other side right now. Also, I feel like I've had the other side crammed down my throat for my entire life. However, if you can offer any readings you find helpful, I'd probably better be able to digest those. If you're truly interested in the viewpoints I mentioned, I'd recommend reading Anti-Diet and looking up the Minnesota Starvation study, as well as the 4th edition of Intuitive Eating. I also have an academic paper that has been recommended for sharing with health professionals. 

I figured if he was dedicated to showing me his truth, he could point me in the direction of the readings he found the most informative and maybe I would take a look. I doubted very much that he was as interested in understanding the work my perspective is rooted in; nonetheless, I offered him titles of the texts I've found most influential in my 2021 quest to deprogram myself from body shame and Diet Culture.

I sidestepped his passive-aggressive demand that I defend my experiences and I called his bluff on wanting to understand my viewpoint. I've been doing the work; if he wants to dive deeper into the beliefs, history, science, and studies of weight, diet, and exercise, then he is going to have to do his own work. So when he responded that he does not have any specific readings or research to recommend and that he does not have the desire to read anything, I was not surprised. A little disappointed, but not surprised.

It's so easy to fall into the trap of defending our experiences as people living in larger bodies in a world that is designed for those living in average bodies. 

But how can we begin to explain the isolation we feel when we have to wedge our substantial hips and bottoms between the constricting arms of waiting room chairs, wait as nurses search for the bigger blood pressure cuff that will actually fit around our biceps, and wince when we see the markings in our charts labeling us as "morbidly obese"? 

And how can we convey the frustration and anger we feel when we are constantly told that everything that ails us would be cured if we were not fat: that our pain, injuries, and illness are our own fault; that character flaws like weakness and lack of willpower are the reason we are fat.

We are constantly told that, if we just tried harder, we could fix all of our problems by shrinking ourselves. 

But we are people, not problems to be fixed. 

We are not broken, our healthcare system is.

We don't need to be fixed, the healthcare system does.

We don't need to be fixed, our society does.

My Massage Therapist Went Too Far (but not like that)

This past December I booked myself a 90-minute massage to help with muscle tension and swelling due to chronic illness and, of course, the stress of pandemic-life, parent-life, and just general life-life. I've had a monthly membership to a massage chain since I began my teaching career in order to help me manage stress and tension; over the years, my needs have changed some to deal with injuries and chronic pain, including some membership hiatuses due to finances, surgeries, and the pandemic. Suffice to say that this was my first massage in quite some time and I no longer had a go-to therapist, so I booked with someone new to me.

Historically I have been a fan of deep-tissue massage, but since being diagnosed with RA I've been rethinking this and wanted to try a firm massage instead. I hoped that it would be less painful in the moment and more emotionally relaxing, with the same longer term effects. My therapist was a very friendly man, tall and living in a larger body, who happened to be blind. I was intrigued to experience his massage, hoping he would be better able (than a sighted therapist) to use his sense of touch to respond to my body's tension (and writing this I have to pause and acknowledge that this assumption of mine may have been ignorant and driven by stereotypes that assign sensory superpowers to those who may have a single diminished/missing sense). Also, the fact that he is blind is relevant because he could not see me and therefore could not automatically judge my appearance.

He began the pre-massage consultation by asking me about my body history (surgeries, injuries, and whatnot) and what areas of my body needed the most attention. Once I was on the table and the massage began, he figured out pretty quickly that I am very tall and living in a bigger body. He worked his way down my back and found the extreme tension in my lower back and was surprised at how bad it was; he asked me if I wear properly fitted bras. His wife, he told me, was a 34 HHH, so he knew all about the importance of well-fitted bras and the necessity of replacing them frequently and so on -- for back health. I tried to take his mansplaining in stride; despite my knowledge of bras and having my own boobs to take care of, I also realize that there are many women in the world who do not know what to look for in a well-fitting bra or that larger breasts can put increased stress on back muscles. At the same time, I am also aware that bras are often designed for the male-gaze with no concern for comfort, as well as the arguments against wearing bras at all. Like many women during the pandemic I have eschewed bras almost altogether and, when I want to wear a bra, I exclusively wear bras without underwire or molded cups. But I didn't tell him that because I didn't want his opinions on my choices and I know that my back issues have nothing to do with my fairly average-sized boobs. Instead I let him prattle on about his wife, their marriage, and their little spats over the course of the pandemic.

Have I mentioned that I do not like to converse during massage? I'm one of those uppity bitches who is happy to exchange pleasantries and information and then I just want to enjoy the peace and quiet of not having to care for anyone else intellectually, physically, or emotionally. I just want my own time. Of course I will speak up about my massage needs, if pressure is too light or deep, that sort of thing -- but I really don't want to chat about personal things. 

Then he hit my sacrum and hips where I carry much of my weight and so began his many stories about his own experiences with diet, depression, weight loss, weight gain, and gastric surgery. I was polite and tried not to engage. I told him that I'm recovering from disordered eating. You would think that would be a signal to end or at the very least redirect the conversation, but it was not. He just kept sharing.  Obviously what worked for him -- a man with his own particular health history and genetic background that has nothing to do with my own -- should work for me, right?

We've all met these people. Maybe we were those people once. "I did X and lost Y weight and now I feel great and so much healthier and happier." The thing is diets don't work; people always regain the weight unless they restrict their food for the rest of their lives. Diets and gastric surgery work great, until they don't. And then people end up gaining more weight than they lost because their bodies are fighting against starvation and want to make sure they're prepared for the next famine. I learned all of this throughout 2021 during my personal quest to deprogram myself from Diet Culture, also known as Wellness Culture. As I lay there, I endeavored to tune out all of his well-meaning bullshit and enjoy my massage.

Later that day, my husband asked me how my massage was. I responded that it was one of the best massages I ever had, but the therapist talked way too much and was super focused on weight and Diet Culture and I now knew way too much about his marital relationship. 

But that night, as I was going to sleep, I could still hear his voice in my head.

And the next morning, when I looked in the mirror, I didn't look as good as I did the morning before.

And later that next day, I caught myself calculating how much of what I'd eaten to determine if I "deserved" to eat again.

And then I considered passing on a dessert treat that I really wanted, all because I didn't like how my body looked in my clothing.

And over the course of several weeks, one of the best massages I'd ever had turned into one of the worst massages I'd ever had. It reactivated that insidious voice of Diet Culture judging my worth and attractiveness based on the flatness of my stomach and how streamlined my figure appeared. My curves and rolls again became something wrong, problems that needed solving, totems of asexuality, proof that no one could possibly desire me. Over the course of a 90-minute massage, an entire year of personal growth had been called into question. An entire year of healing had been two-thirds of the way undone. The voice of Diet Culture had been re-amplified in my internal dialogue and it was devaluing me, belittling me, making me second-guess my hunger signals, ruining the pleasure to be found in food, and robbing me of the joy my body holds.

What a bunch of bullshit. How had I let some guy mansplain to me about boobs and my own body? He doesn't have boobs. He doesn't live in my body, he hasn't birthed children, he doesn't have my same chromosomes and hormones, he doesn't have chronic pain and illness. What the actual fuck?

Why didn't I stop him in his tracks? When he didn't get my hint when I mentioned disordered eating, why didn't I tell him point-blank that I don't want to talk about this stuff, that I do not agree with his thinking, and that it is doing the very thing a massage should never do: stress me out! 

At first, I thought that once he voiced his opinion, he would be finished; his point made. I tried my best not to engage while still being polite (because I, like many women, were taught to be quiet and polite and non-confrontational by my foremothers -- problematic!). Then, when he continued, I just hunkered down and tried to focus on getting through it. And when it became clear that this emotional assault wasn't going to end until the massage did, I tried to escape by completely checking out and retreating into my own mind. But the emotional assault didn't end when the massage did because my own toxic inner-narrative was unleashed and it took me weeks and weeks to get back to peace with my own body.

Never again will I allow someone to tell me how to live in my own body. It may come
in the form of voicing their own opinions, relating their "success" stories, or giving me "helpful" advice, but I know now that I must be very careful with my body-love as it is a fragile babe in its infancy. I owe it to myself to nurture and protect my body-love as fiercely as I would one of my children. Next time I will say, I am in a vulnerable place when it comes to loving my body, and I do not want to discuss matters of size, diet, or exercise. Period. End of story.

Let's Get [A] Physical: Anti-fat Bias & Medical Professionals

on my way to the doc

I'm not the first person living in a larger body to leave my doctor's office feeling anxious and icky. Doctors are well known for their lack of understanding and empathy when it comes to matters of size. Diet Culture is so pervasive, so insidious, no one is immune to anti-fat bias -- even health professionals, no matter how good their intentions might be. 

I chose my doctor, nurse practitioner, and office staff because they are women of color working in a racially and socioeconomically diverse community. She was also cited by Noom (more on Noom another time, suffice to say I no longer support or recommend Noom to anyone because 1. They are a diet, no matter what they say and 2. My views on size and shrinking the self have changed drastically since then) -- which I was using at the time of my GP search -- as a fat-friendly doctor (not Noom's term, whatever they said I can no longer remember). This means that the office provides chairs that my ass can fit into and has large blood pressure cuffs in each exam room, things that make people living in larger bodies feel like normal people. 

At first, she and her NP were pretty decent about not overtly harassing me about my weight; however, as I have gained weight the past few years, there have been more suggestions about food restriction, exercise, and so on, including last week when I had my annual physical.

The past two times I have gone to my GP, both times for my annual physical, I have opted out of the weigh-in portion of my visit. Did you even know that was an option? I didn't until my 2020-2021 quest to deprogram myself from Diet Culture. I was so tired of overtly and covertly being told that there was something inherently wrong with me, something broken that needed fixing, because I am living in a bigger body. I learned that BMI is sham science and to question causation versus correlation when weight is blamed for health issues. Okay, so keep in mind that my doctor has no idea what I've weighed the past two years. She has no data, other than last year's bloodwork, upon which to base her conversation with me. And yet, she brought up food choices and intake -- not because of my health, mind you -- but because of my appearance. 

As she talked at me about lean meats and portion sizes, avoiding "junk" foods, and not buying these things so they're not in my house, I gritted my teeth. Has it ever crossed a doctor's mind that people are not necessarily fat because they eat like pigs at a trough (dehumanizing) or keep fun foods in their homes (weight is not about self-control)? I am overweight because of genetics, a history of food restriction since early childhood that messed up my metabolism and the always-accompanying disordered eating that comes along with that, poverty in my youth and access to food, trauma and the resulting influx of cortisol and other hormones, as well as several injuries/surgeries and chronic illness that have made it extremely difficult to engage in physical activity.

I am fat. I don't need to be fixed. I am still an awesome human worthy of love and respect.

So, I took a deep breath and defended myself: I'm a vegetarian (it's been twenty years); I am deprogramming myself from Diet Culture and disordered eating, I do not restrict my food and as a result I am not eating entire packages of cookies when I'm sad or stressed; yes, I have fun foods in my house because I like them, I eat them, and I have children who like and eat them; I will not restrict my eating ever again, I spent years doing that and it's done more harm than good, like disrupting my hunger signals; I am following the Intuitive Eating model and, yes, have met with a dietitian and am currently working through the IE workbook; I am newly diagnosed with RA and we're still figuring out my treatment, so I'm dealing with painful flares and swelling that make it impossible for me to engage in movement and activity with regularity -- especially because I have a history of pushing myself too hard and rendering myself unable to do anything for days after.

I now remember having a similar discussion with her last year after she suggested "weight loss" surgery, not stomach amputation but the gastric sleeve which is maybe a little better but also NO. I explained to her then that my issue was in my head, not in my stomach. That I was working with a therapist to deal with childhood trauma, unhealthy relationship paradigms, and the sudden loss of my mother. Why was I having to revisit all of this, and then some, again now at this visit?

No one should have to defend themselves and their actions to their doctor to prove themselves free of fault when it comes to their appearance and deserving of care when it comes to their health.

I left my physical feeling exhausted. It's exhausting to feel attacked. It's exhausting to feel the need to defend myself. It's exhausting to explain the effects of trauma, food restriction, and chronic illness to a person who has Thin Privilege and doesn't know what it's like to deal with chronic pain and mobility issues.

I think it may be time to find a new doctor. Again.