Thicc Not Sick video

Just had to share this. Excellent work, Kristen Bartlett and Ashley Nicole Black! You hit all the top points we've been making for years, with humor and no holds barred. Great job! And thank you Samantha Bee for bringing their work forward to a national platform.

*Warning: Salty language and off-color humor, if you prefer to avoid that sort of thing

HAES Heroes: Joanne Ikeda

Joanne Pakel Ikeda

This post is to remember and honor one of our Health At Every Size® heroes.

Joanne Pakel Ikeda died on November 27, 2018 at age 74. She was a faculty member of the Nutritional Sciences Department at the University of California, Berkeley, for nearly 35 years. She helped students gain knowledge and skills in nutrition education and counseling.

She was well-known for her advocacy for the Health At Every Size model. In fact, she and Frances Berg coined the phrase. From her obituary:

Joanne was known for her role in the development of a new approach to weight management entitled Health at Every Size® (HAES). Mid-career she came to the conclusion that subjecting large people to food restriction, body dissatisfaction, and size discrimination was futile and only resulted in physical, psychological and social damage to these individuals. She and others determined that rather than focus on weight, the focus needed to be on health. Research showed that many large people could improve all aspects of health with lifestyle modifications unaccompanied by weight loss.

The idea to focus on health instead of weight was a radical, transformative notion in the field of nutrition and medicine and turned the field on its ear. While it has gained a great deal of traction, HAES sadly remains radical to many in those fields, but she never backed down. She was especially determined to protect children from becoming casualties in the “war on obesity” by promoting a Health at Every Size approach for them instead. Here is one of the posters she lent her support to.

Joanne fought hard for size acceptance for all ages and spoke at many conferences and other occasions about Health At Every Size. She worked with NAAFA (National Association for Fat Acceptance), which is where I met her. She helped establish ASDAH, the Association for Size Diversity and Health. She backed up her beliefs with action by testifying before the San Francisco Board of Supervisors about an ordinance banning size discrimination in employment, housing, adoptions, jury selection and other domains. That took guts.

Joanne did not just specialize in weight-related issues. She also studied the nutritional habits of various ethnic groups, immigrants, and low-income people in California and developed culturally sensitive nutrition education materials. She was a visionary in her field in many ways.

She accrued so many honors, I will only list a few here. She served as President of the California Academy of Nutrition and Dietetics, then was elected President of the Society for Nutrition Education and Behavior. She was co-founder of the UC Berkeley Center for Weight and Health. In 2018 she received the Helen Denning Ullrich Award for Lifetime Excellence in Nutrition Education.

I had the honor and pleasure of hearing Joanne speak in person and getting to chat with her afterwards. She was a warm, unassuming person, but she also knew her research and her points were evidence-based. She was very modest and humble but she also knew how to make a vehement rhetorical point when needed and wasn't hesitant to call out medical professionals on their assumptions and errors. She gave me lots of warmth and encouragement for my work on pregnancy in women of size, which was much appreciated as pregnancy is very much an overlooked area in HAES and size acceptance. As a parent, I particularly appreciated her advocacy for higher weight children in the midst of virulent anti-obesity public health campaigns.

Joanne Ikeda was a god-send to the size acceptance community and people of size, and we will sorely miss her presence and influence. Our hearts go out to her family and friends.

Resources

Obituary: https://www.legacy.com/obituaries/sfgate/obituary.aspx?n=joanne-ikeda&pid=190873802

Articles:

• https://blogs.berkeley.edu/author/jikeda/ 
• https://ucanr.edu/blogs/blogcore/postdetail.cfm?postnum=28960&sharing=yes
• How Diet Culture Harms Your Health - podcast and interview with Joanne
• https://sizediversityandhealth.org/haes-expert.asp?id=51

Lipedema, self acceptance, and trolls

Image from this article

This is a really interesting article by Courtney Mina about dealing with the fat hate that often accompanies being open about lipedema or being body-positive in any way online.

She posted some pictures of herself in only undergarments on Instagram, Twitter (#biglegs), and Facebook to see if people would continue to be body-positive towards someone with large legs. She was open with people about having lipedema, what that meant, and how it has affected her life, all while still being body-positive.

Gratifyingly, many people were body-positive and supportive of her. This shows that body-positivity campaigns are making a difference and the message is being heard. 

However, there were also haters. Some of it was the open, in-your-face really vicious hate so common on the internet (yep, I get it too). Ugh. But that's such an obviously biased and obnoxious response that you mostly just have to let that roll off of you. Some people are just trying to stir up trouble and some people are just outright misogynists. None of us should be subject to such hatefulness, it's wrong wrong wrong for sexism like this to be so prevalent and our society needs to target this misogyny, but some individuals are so hateful they are simply lost causes. I refuse to lose sleep over them.

Of course there was also the poisonous "concern trolling" ─ I'm-just-worried-about-your-health stuff. This is the kind of stuff fat people get bombarded with by people we care about (because obviously you are simply in denial if you are fat and not trying to lose weight). They can't see how much they've bought into harmful untruths about weight and health, and they find it difficult to acknowledge that there really are medical conditions that can cause fatness. They think that since their bodies work a certain way, all bodies must therefore work that way, even when evidence for a disease process is presented to them. They mean well, but it's still hurtful.

And of course, sometimes the worst people of all are the "plus-size police," the women of size who so hate their own bodies that they try to police other fat women's bodies too. The self-hate they have is just palpable and so sad. The absolute worst are the ones who are in the honeymoon period during or just after weight loss before the regain begins, or the ones who are chronic dieters. They are in the "high" phase of the dieting addiction and they want everyone to join them on this drug. No one is allowed to rain on their parade, gainsay their experience, or present an alternative approach like Health At Every Size®. Anyone who approaches it differently is just "in denial."

Sadly, even some in the fat-acceptance movement have wanted to deny the medical reality of lipedema, a medical condition that often leads to heavier-than-average legs, hips, and arms. It's as if they think that any acknowledgement of a possible biological condition underlying weight means we are making excuses for it to appease the haters, rather than embracing our size with acceptance. [Nope, you can acknowledge the biological causes and still be part of fat acceptance.]

I thought this post had many thought-provoking things to say. Definitely check it out. I was encouraged that many people were supportive of her, but I have to wonder how many were supportive because she is young and beautiful. There's a heck of a lot less supportiveness out there for middle-aged and older fat women, but I have hopes that this, too, will improve with time. Body positivity should not be only for the young and beautiful but for people of all ages and looks.

http://www.bustle.com/articles/102550-i-have-lipedema-posted-a-photo-of-my-big-legs-on-instagram-to-see-if

The Role of the Fatosphere in Responding to Obesity Stigma

Qual Health Res. 2011 Aug 2. The Role of the Fatosphere in Fat Adults' Responses to Obesity Stigma: A Model of Empowerment Without a Focus on Weight Loss. Dickins M, Thomas SL, King B, Lewis S, Holland K.  PMID: 21810992

Source: Monash University, Melbourne, Victoria, Australia.

Abstract

Obese adults face pervasive and repeated weight-based stigma. Few researchers have explored how obese individuals proactively respond to stigma outside of a dominant weight-loss framework. 

Using a grounded theory approach, we explored the experiences of 44 bloggers within the Fatosphere-an online fat-acceptance community. We investigated participants' pathways into the Fatosphere, how they responded to and interacted with stigma, and how they described the impact of fat acceptance on their health and well-being. 

The concepts and support associated with the fat-acceptance movement helped participants shift from reactive strategies in responding to stigma (conforming to dominant discourses through weight loss) to proactive responses to resist stigma (reframing "fat" and self-acceptance). 

Participants perceived that blogging within the Fatosphere led them to feel more empowered. Participants also described the benefits of belonging to a supportive community, and improvements in their health and well-being. The Fatosphere provides an alternative pathway for obese individuals to counter and cope with weight-based stigma.

New Health At Every Size Resource

I'm delighted to hear that ASDAH (Association for Size Diversity and Health) has started a new, very important blog, the Health At Every Size blog.  About time!

I'm sure my size-acceptance and fatosphere readers have heard about it already, but I wanted to make sure my birth-world readers (who may not be as familiar with HAES concepts) knew about it too.

If you don't know about Health At Every Size (HAES) yet, the basic principles of HAES are:

1. Accepting and respecting the diversity of body shapes and sizes.
2. Recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects.
3. Promoting all aspects of health and well-being for people of all sizes.
4. Promoting eating in a manner which balances individual nutritional needs, hunger, satiety, appetite, and pleasure.
5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.

Here is a summary about the HAES Files from the HAES blog's first post (I've broken it up a bit):

The Health At Every Size^SM approach is about the ways that people of all sizes can maximize their health.

This approach does not mean to give up or to let everything go. It is an active process by which people work positively with their bodies and within their lifestyles to achieve a level of health which is reasonable and above all, sustainable for them.

It means managing health within a framework of a life well lived as opposed to weight centric, thin at any cost methods.

It means managing nutrition and fitness within a global health framework that would include managing stress, sleeping well, maintaining social connectedness and much, much more. This is not passive, and it is not easy. It requires a lifetime of careful work in learning which foods nourish you and which leave you feeling unwell; in learning what forms of exercise strengthen you and energize you and which forms leave you depleted and hurting; and in learning to make positive, gradual changes based on self-care rather than self-hatred.

The HAES Files will serve as a means to push for a shift in paradigm from weight centered to health centered...

We have asked each of our bloggers to challenge us on how we address weight and diet and nutrition and physical activity and stigma and discrimination and ALL that our culture has deemed to wrap in a so-called “obesity crisis.”

We are no longer content with sitting in the back of the room, listening politely as policy makers, the media, and the food, diet and health industry dictate how this is going to play out. We are done asking for a seat at the table, we are taking one.

AMEN to that!

For those who are new to the idea of HAES, here are some more resources on it.  There is also Linda Bacon's book, Health At Every Size, excerpts of which can be found here.

I look forward to many wonderful, informative, and empowering posts from this new resource.  Go ASDAH!

Belly Blog Carnival!

The beauty of my body isn't measured by the size of the clothes it can fit into, but by the stories it tells. I have a belly and hips that say, 'we grew a child in here' and breasts that say, 'we nourished life.'

- Sarah from I Am Beautiful: A Story of Women in Their Own Words

In January and February, I wrote two posts called Belly Thoughts and Further Belly Thoughts.  They were about belly ambivalance, specifically about how my generally good body acceptance was challenged by pregnancy and birth, and how I sometimes still struggle with that.

However, even as I explored topics of body ambivalence, I tried to end on a positive note with an acknowledgement and honoring of the work our pregnant bellies had done.  I wrote about honoring my belly, I posted some pictures of how my older children painted my belly in the last weeks of my last pregnancy, and I discussed how much those pictures meant to me.

That was my way of trying to bring the conversation back to a positive place, because even as I am challenged to fully love the changes in my body brought about by age and multiple pregnancies, I also do not regret having had children, not for a single moment.  My children are more than just compensation for the changes that have happened to my body.

As I've written before, I think it's a crime that there are not more images of women of size pregnant, birthing, breastfeeding, and parenting.  I certainly could have used some images like that when I was first pregnant and afterwards, and I know many other women of size feel the same.

Most of the information out there on fatness and pregnancy is very negative, and rarely do you see any pictures at all in the media ─ let alone beautiful pictures ─ of women of size in pregnancy and afterwards.  And we need images like those. 

And many of us, trained to be self-conscious or ashamed about our size, neglect to document our own pregnancies in any significant detail, whether that be with belly pictures, birth pictures, breastfeeding pictures, or parenting pictures.  Far too often we take the pictures, instead of letting ourselves be the subject of pictures, and that just adds to the lack of documentation out there....and the lack of documentation of our own lives.

And we need documentation.  We need to STOP being invisible mothers.  We need ─ and deserve ─ to be seen.  We deserve to take up space in the world as women and as mothers.

A number of you have sent me pictures of yourselves pregnant as a result of my post about the lack of images, and I think this is awesome.  Thank you to everyone who has sent in or shared their pictures with me.  I have so enjoyed them.

However, I've been a little reticent to use some of them on the blog because of the fear that a troll might take these pictures and abuse them.  Unless you have made it really clear to me that you are okay with your pictures being online forever like this, I usually haven't used them, just to be cautious.

But even as I worry about these things, I've decided it's really important that we declare our independence and post our pictures anyhow.  It's SO important that there be pregnancy and parenting images of women of size out there, showing that we do have babies, we do give birth, we do breastfeed, and we do parent.

We women of size are women, just like other women, and we have families, just like other women.  It's about time we got more documentation of that.  And it's about time we celebrated that more, instead of hiding whenever the cameras come out.  It's time we became visible moms.

So as a positive coda to my series on belly thoughts, I would like to propose a BELLY BLOG CARNIVAL. 

If you have had children, blog about your pregnancy belly and body, and post pictures too.  Document your experience in words and/or in pictures, and share your feelings ─ positive,  negative, challenges and all. 

If needed, please use trigger warnings out of respect for others, but I would ask that everyone try to end with a focus on the positive, if at all possible.  We can document our challenges, but let's also not forget to celebrate our bodies.  I especially welcome entries which celebrate their bodies in creative ways.

When you have posted your entry, send me a link to it (with a brief summary of what it's about). You can send it to kmom  [AT]  plus-size-pregnancy [DOT]  org.  Send it by March 31st, 2011.  Then I'll summarize everyone's posts together (with links) in one place here on my blog sometime in April.

If you don't have a blog and just want to share a picture, you can email that to me as well, along with permission to use the picture and whatever brief information  you want to appear with it. I generally discourage the use of real names, since this will be available online forever, but if you are absolutely positive you want this picture of you, identified with your name, available forever (the logistics are too much if you change your mind and want to delete it later), I will publish that as needed. Depending on how many I receive, I may put it in one big post, spread them out over a number of posts, or open a Tumblr account or something (if I can figure out how...I'm new to that!). 

(If you send me a picture, please remember to give me explicit permission to use your picture or I won't post it.  People often send me a picture but forget to add permission, and I don't have time to do follow-ups to get that.  In addition, if you'd like to include permission for me, kmom, to use your picture in whatever way I need for future posts, articles, presentations, publications, etc., I'd love to have that as well.  I'm always interested in adding to my gallery of plus-sized pregnancy and parenting photos to use as needed in my various projects. I welcome pictures from everyone but am particularly in need of pictures of any stage of pregnancy or parenting from women of color, and pictures from women of size during labor and birth.)

In summary, it's time to cap this belly discussion with a positive finale.  Over the next few months, expect to see periodic pregnant belly pictures on my blog from various women of size. We may even have related posts about belly casts, belly henna, belly painting, and other things we as women of size can do to celebrate our beautiful lush pregnant bodies. 

Bring on the bellies!!

*And isn't that picture from "Lyista" at the top of this post just the MOST gorgeous belly photo ever?  My thanks to her for sharing and for giving me permission to use the photo!

Further Belly Thoughts

About a month ago, I published a post called Belly Thoughts that was quite controversial to some people. 

I've been writing a follow-up for a while, but I've been working on a big project at work and have had sick/injured kids, so I have had a hard time finishing it. I have also been struggling to clarify my dismay and surprise over people's response to that post. Honestly, the response upset me and I thought it best to wait a bit before replying so I could make a more measured response.

But I think it's time now to continue the discussion.  Forgive me if it's a bit rambly.  It's just time to get it out there, imperfect as it is, so we can discuss it and then move on.

Trigger Warning: Frank discussion of body image issues and body ambivalence will follow.

First, thank you to those who commented, even if I didn't agree with you or like what you said.  Dialogue is important and it's not always a bad thing to hear dissenting voices.  It generates discussion and can clarify issues or further the conversation. Obviously, this topic provokes some strong feelings, and I think that's an important point to explore. 

One complaint that was made was that the post needed a Trigger Warning.  With some reflection, I can see that point. I thought about putting one in the original post, but I thought it was not needed because I felt I was pretty clear in the intro paragraphs what was going to be in the post.  However, I can appreciate that some people in their journey need a really clear and obvious warning about these things. So that point is noted and I have already gone back and added a trigger warning to the original post and to this one as well.  My apologies to anyone who I inadvertently triggered.

Some folks objected to the Shamu word. That may have been a bad choice, but I was actually being ironic, and I think folks missed that. I see people on the feed mockingly use words commonly used to deride us (like "deathfat" etc.), so that's where I was going with Shamu, but the ironic intent may not have been clear enough. I was trying to point out the tremendous irony of worrying about what I'd look like at 9 months pregnant and then not looking pregnant at all. By using the term Shamu, I thought it made for a better, more pointed bit of irony. But alas, I think the term is so emotionally loaded for some that they didn't see an ironic use of it. I'm sorry it caused bad feelings for some.

One thing I think it's important to clarify is that what I was talking about was body ambivalence, not body loathing.  No, I don't always have perfectly happy loving feelings towards every part of my body 24/7 (who does?), but sharing that does not mean that I hate my body or am engaged in fat-based self-loathing. It only means that I have mixed feelings towards parts of my body sometimes.  It doesn't mean that I don't have good feelings towards my fat body at times, or that I've been hiding secret loathing behind a facade of fat acceptance.  It's just body ambivalence, not body hatred.

Perhaps I wasn't clear enough in the post that most of the time, I'm pretty at peace with my body ─ a lot more than a lot of the thinner women I see around me, in fact.  But not 24/7/365, and some parts are more challenging to love than others, you know?  I was just trying to be up front about that, because I think we NEED more of this kind of honesty, especially among mothers, and especially among mothers of size.  But it wasn't about hating myself, just my struggle to love the changes that pregnancy has wrought.

Before pregnancy, my most difficult part to love was my chest, because I'm very well-endowed and that has all kinds of physical and emotional burdens attached.  After pregnancy, once breastfeeding worked out, that actually was the part that experienced the most positive self-image improvement.  The part of me that had previously only been a burden before suddenly was responsible for nourishing and protecting my babies for  months ─ years ─ on end, and my babies certainly loved that part of me, so why couldn't I?  I just had a totally different take on my breasts after that, even as I still sometimes struggle with loving them fully.

My belly was a different matter, much to my surprise.  Before pregnancy, I was pretty much fine with my belly.  But I was really surprised how much challenge I had with it during and after my pregnancies ─ especially after multiple pregnancies.  It does take a toll on your body shape and your body image, and I was just trying to articulate how that challenged me in my fat-acceptance and body-acceptance process.

So folks, if you were worried about me loathing my body or that I was suddenly revealing secret reservoirs of self-hate, please be reassured that most of the time, I'm pretty self-accepting.  But I don't think it's a problem to share that I'm not always that way, or that certain things really challenge my body image more than others.  I think a combination of pregnancy and recent aging-related changes of perimenopause gave rise to more reflection than usual on that, that's all. 

One thing I was very much troubled by was the fact that some folks questioned whether my posts belonged on the Fatosphere.  That in particular really shocked me, considering all the work I've done in Fat-Acceptance over the years.  Heck, I've been in the Fat-Acceptance movement for longer than some of my readers have been alive.  I'm not just talking the talk, but have been actually walking the walk for many years, and have been writing, researching, publishing, and presenting at conferences on the topic of fatness and pregnancy for more than a decade.  I've been a quite vocal and active FA-advocate, and have been a member of NAAFA for years.  To be questioned in my own backyard about my "FA-ness" was quite distressing.

Let me be clear.  I don't see my post as contrary to the purpose of the feed at all, or to Fat Acceptance in general. The Fatosphere is SUPPOSED to be a place where we can work through a lot of our feelings, good and bad, about our bodies. In my view, it's not a "you can only express positive things about your body no matter what" place.

Certainly, I surely see a lot of body ambivalence on other blogs. Why would my blog be exempt from being able to talk about that? The fatosphere is supposed to be the one place where we CAN talk about these things without being judged. And yet, there I was, being judged for some pretty normal feelings, ones extremely common to mothers after pregnancy, and I wanted to talk about how that interacted with my self-acceptance beliefs. I see that as very much in concordance with what the Fatosphere is supposed to be about.

I'm also very frustrated with the idea that I can't express ambivalence about the droopy baby belly, the "flap" if you will. Nearly all mothers have some ambivalence about this ─ it's very normal in women of all sizes, and I think it's intensified for many women of size. Why is this okay for women of average size to talk about ─ but not for us as women of size?  We all have to process it; it's a very normal feeling.  Some people experience the belly flap more than others, but we all have to process body changes to some degree.

It's not like because we are fat-accepting, we have a magic shield against negative feelings from body changes.  We have these issues too, and it may be intensified in those with previous body image issues.  Even those of us who are pretty far along on the fat-acceptance spectrum can still feel challenged by these things ─ and that's okay. And it doesn't mean that we are now body-haters and full of self-loathing and about to sign up for surgery.  It means we're processing normal feelings.

My whole point is that the changes in my body (and specifically my belly) resulting from several pregnancies, lipedema, and age are challenging my fat- and self-acceptance in a way it's not been challenged in a long time, and I continue to struggle with that. I think being honest about these kinds of struggles is absolutely VITAL to the fat-acceptance discussion. What are we here for if we can't discuss that kind of thing?

I'm not telling others how THEY should feel about their bellies. If you came through pregnancy perfectly positive about your belly, more power to you. I'm simply trying to express that even in me, a VERY self-accepting and fat-accepting person, dealing with this pregnancy after-effect has been quite challenging, even years after my last pregnancy, and how surprising this has been to me as an activist.

I certainly think that postpartum feelings about your body (and the unique challenges that might bring to fat women) is an appropriate topic for my blog, don't you? I KNOW a lot of other women of size have struggled with the same feelings because they've written me about it. I was articulating my own struggles as a way to not only help me with my own ambivalence, but to help others explore their own.

It was such a shock to me, how pregnancy challenged my fat-acceptance in so many ways. For example, as I've written about before, I went from a take-no-guff-from-doctors FA person to a meek little sheeple who got railroaded and frightened into a whole bunch of unneeded and fat-phobic interventions in my first pregnancy. It took me quite a while to get past that, but working through that and empowering myself enough to question the doctors led me to create my website and my blog. The journey was worth it ─ but it didn't happen overnight, and it took a lot of emotional processing to get there.  Sharing that is helpful to other fat women struggling to figure out what interventions are needed in their pregnancies and which ones are questionable,  what choices they really have in birth, and cutting through the anti-fat rhetoric that surrounds so much of the information out there on pregnancy and fatness.

I think a similar journey is worth it on the whole belly ambivalence question too. Pregnancy (and especially post-partum) totally challenged my FA-ness, and I still work through it. I don't think talking about that is in opposition to the fatosphere at all. I think it will help other women on their journey, which is why I talked about it in the first place. People are at all different points on their journey to fat acceptance, and I think it's extremely helpful to see someone else struggle with that journey too. To have my FA credentials questioned because of that is extremely frustrating to me.

Another thing that frustrated me was that while I discussed my belly ambivalence very frankly, I also made a real point of bringing the question back to positiveness at the end of my post. I made a point of honoring our bellies anyhow, even in the face of ambivalence, and acknowledging the incredible work they did. I thought I made that point pretty strongly, using my words and my belly-painting pictures, because it's very much how I feel. So it's upsetting to me to have that conclusion ignored or negated. Yes, I talked frankly about belly ambivalence and the challenges I've experienced, but then I brought the discussion back to a positive conclusion. That's an important point that got ignored by some.

Furthermore, it makes me frustrated to feel censored in what I'm "allowed" to talk about as a "good" fattie. Ambivalent feelings are part and parcel of the journey to FA, even for people well along on that journey. Other people can talk about this on the feed (and do), but for some reason it created a lot of reaction when I did it. Perhaps it's harder to hear it in relationship to pregnancy (society really tends to discourage expressing negative or ambivalent feelings about pregnancy).  Or perhaps it's hard to hear someone who doesn't usually express much body-ambivalence actually express some.

But the whole point was that this is a NORMAL and VERY COMMON response to pregnancy and post-partum body image in women of all sizes, and that it's often intensified for women of size and we should be discussing that.

Expressing that doesn't make someone anti-FA. It just acknowledges a common feeling among many women of size, something many of the women in the comments commiserated with, you'll note.

The fall-out from all this is that right now, I don't feel safe choosing topics for the blog, and that alarms me. I was planning a big series addressing the risks of pregnancy in women of size, because the fat-phobic doctors contend that a pollyanna approach ("everything will be fine") to fatness and pregnancy is misleading and intellectually dishonest. Research is clear that there are more risks for certain complications in women of size in pregnancy ─ the problem is that doctors DISTORT that information and use it as a scare tactic or a way to pressure women into questionable interventions. I want my series to look at the research dispassionately, acknowledge what risks there are, make sure people understand these potential risks, discuss how we can be proactive to lessen those risks, and make sure people understand that, though there, these risks are still generally small ─ that most fat women will have healthy babies just fine.

But now I'm questioning whether I should even attempt such a series, whether this will be seen as too negative or not "FA enough" for some. Yet I think not doing that series would be a tremendous disservice to women of size.  The whole purpose of my website and my blog is honest and accurate information, not just rah-rah cheerleading and a polyanna approach.

Women of size NEED intellectually honest discussions about the research, good and bad, along with primers for understanding it and using it to help improve our outcomes and experiences.  We don't need more "everything will be just fine" or "oh my God you're going to die" extremism.  We need a more nuanced approach.

I just am frustrated with the idea that we should only be fat cheerleaders and never be allowed to go beyond that.  Fat Acceptance is a journey, and I think it's important that we be allowed to fully process our feelings, even the ambivalent ones, along the way, without people jumping to conclusions about our FA-ness. 

Okay, so now I've vented a bit and expressed my concerns too.  Feel free to discuss in the comments section.  Just please be respectful and polite, even if you disagree and need to argue a point, okay?  I'm feeling particularly tender and touchy on this subject right now and would appreciate some delicacy, even as I know that dialogue is important.

But I don't think the discussion ends here.  This is of necessity a rather negative post, and I'm okay with that up to a point.  I think the frustrations needed to be aired and perhaps some good will come of the dialogue.

However, I prefer to bring the discussion back to the positive whenever possible.  So I decided to put the negative things in this post and do a whole different post next time that focuses things a little differently, a little more positively without being false, that puts things back on a more constructive footing. 

I'd like to propose a Belly Blog Carnival next time ─ more on that soon!!

Belly Thoughts

So, for those of you who have been pregnant, how did you feel about your pregnant belly?  How did you feel during pregnancy?  After pregnancy, with the post-mummy tummy?  Years later?

I was reflecting the other day on my relationship to my belly, especially in regards to my pregnancies and births ─ how I've celebrated it in some ways, and how I've struggled with it in other ways. 

I thought about things that I expected to happen and how the reality did or didn't meet those expectations, things that surprised me, things that pleased me, and things that made me unhappy or which challenged my peace with my body. 

Thought I'd share some of those thoughts here.  Hope you will share your own experiences too.

Trigger Warning:  Frank talk about body ambivalence and negativity. Some folks may find this post challenging or triggering and may want to opt out.


Worrying About Shamu

My first pregnancy was a surprise.  I went from being told I would not be able to get pregnant without "help" to being pregnant a few months later without trying.  So I was totally not prepared to think about pregnancy bellies! 

I hate to say it now because it sounds so vain, but I was really worried about what I'd look like pregnant.  I was already a large person; I figured when I was pregnant I'd look like Shamu. 

Now, I don't mean that in a negative way; I was pretty at peace with my body pre-pregnancy, and I didn't really "fear" being huge in pregnancy.  But I was having a hard time picturing the giant basketball belly you see on skinny women added to my already sizable frame, you know?  And I wondered what I'd be wearing on that basketball belly (or if I could find anything to wear at all, considering that it wasn't easy to find clothes even when not pregnant).

I know a lot of other women of size wonder these things too, because the top post viewed on this blog (by a HUGE margin) is the one on plus-sized pregnancy photos.  There are so few pictures of women of size out in the media, let alone pregnant women of size.  (And fat pregnant women of color?  Nearly impossible to find. Gah!)

The most common search words people use when they find my blog has to do with this search for images of fat pregnant women.  Except the phrases are usually "overweight and pregnant photos" or "obese pregnant belly" or "obese pregnancy pictures" or "plus-size pregnancy belly pics" and things like that.  There is a tremendous desire for pictures of pregnant women of size because I think so many fat women have that "Oh-My-God-What-Am-I-Going-To-LOOK-Like" anxiety. 

The Shamu obsession, I call it.

The Not-Looking-Pregnant-Surprise

The ironic gotcha to all that worry is that once I was well into pregnancy, I was disappointed to realize that I didn't look pregnant at all. 

People kept looking at me and wondering where the pregnancy belly was, I could see it in their eyes.  Well, it was there ─ it just wasn't visible to the casual onlooker.  I have a big ole rack-o-doom and that tends to hide any belly popping out pretty well, plus my baby was facing my belly (occiput posterior) for much of the pregnancy, which means you "show" a lot less (cause the baby's behind is facing the other way!). 

I was so NOT showing in pregnancy that most people couldn't even tell I was pregnant until the baby was nearly born.  My classic story of this was when I had to move during my 8th month of pregnancy.  I showed up to my new doctor's office, told them I was transferring care there from another state ─ and they eyed me and asked me if I needed a pregnancy test!  I said, uh no, I'm 8 months pregnant already and if you need confirmation, you can come over here and feel her kicking!  They still looked dubious but took my word for it. I was so upset that they couldn't tell I was pregnant even at that point.

The only time anyone knew I was pregnant was just before I gave birth at 40 weeks.  I was in an elevator, going up to my last OB appointment, and a doctor on the elevator remarked on my pregnancy (he didn't know me; he was just being kind and making small talk).  I could have kissed him!!  Finally, FINALLY, someone saw I was pregnant.

So in the beginning, I was most worried about just how large I might get in pregnancy, only to have the ironic problem of no one even knowing I was pregnant most of the time.  Some fat women do look obviously pregnant, but some don't.  A lot depends on factors like the position of the baby, your shape ("pears" show more than "apples" or "hourglasses"), and your overall frame. 

If you are bothered by folks not knowing you are pregnant, the secret is to wear obvious maternity clothing, stand with your hand massaging your belly a lot, and talk a lot about your pregnancy.  That will make it clear to all but the most oblivious by-stander that it's not just fat but actual baby in there too.  (Sad we have to be so OBVIOUS about it, but hey, if it brings you peace of mind, go for it.)

The Hard-Belly-Surprise

The biggest thing that surprised me about my actual pregnant belly was that it was hard. 

I was used to my belly being a bit more on the soft and squishy side ─ not flabby but not rock-hard either.  But in pregnancy, my "bump" was quite hard and that really surprised me.

The not-so-lovely part of this was that the squishy parts then drooped down to the underside of the baby bump and I developed an "overhang" that I'd never had before.  Eywww.

Now, I'm generally a lot more self-accepting than most but even I had trouble being loving and accepting of the big belly droop that sent all my fat south for the winter.  Permanently. 

That was a not-so-pleasant surprise.

And it only got worse with each kid. 

Four of 'em.

The Postpartum-Belly Reality

I have to be frank about this ─ this belly droop thing has been hard to deal with.  Honestly, it's not a part of my body that I'm so at peace with anymore. 

Hard as it may be for some people to believe, I really was okay with my belly before babies.  It wasn't flat, it did have a bit of a roll, but nothing all that remarkable. I carried more of my weight in my boobs, hips, and legs.  I was okay with my belly.  I wasn't photographing it and sending it off to magazines, but I really didn't hate it and I really did enjoy the fact that my waist was so much smaller than my hips, giving me that va-va-va-voom hourglass vibe. 

But post-children ─ oy.  The va-va-va-voom factor?  It va-va-va-vrooomed off to another universe.  The belly droops down now in a way it never did before.  If I move in just the "right" way, I can hear the "slap-slap-slap" sound of my flesh hitting against itself.  It never did that before children!  Oh my gosh, I cannot tell you how much I absolutely loathe that.

And that hourglass figure?  Well, it's not a straight line but it's closer.  I gained a lot of abdominal fat in my pregnancies, and I dislike that for a number of reasons, both aesthetic and more importantly, because abdominal visceral fat is much more of a health risk.  I used to be very much a pear, or at least an hour-glassy pear with boobs.  Now I gained an apple to add to the pear with boobs, leaving me just fat all over.  That didn't make me very happy. I don't mind being fat, but I really liked actually having a shape.  Now, I feel more like a blob.

The extra abdominal fat certainly wasn't from gaining "too much" weight.  I gained a total of 5 lbs. net (lost 10 or so and then regained 15) on average with each child.  I bounced around a bit between each but ended up at about the same weight I started my first pregnancy.  However, you'd never know it from looking at me.  I look quite a bit heavier now than I did before my pregnancies.  And that sucks, I have to say.

It sucks not because I'm fat but because I look a lot fatter than I really am.  I basically am the same weight as 16+ years ago....but I sure look a lot heavier.  I'm not thrilled with that ─ but the real reason it sucks is because I know from the research that abdominal fat really is more risky. Even though I didn't gain "too much" and even though my eating habits actually improved from pre-pregnancy....I look more at risk, and probably am more at risk.  Damn.

The Lipedema Effect

As a side note of interest, I should point out that the bellyfat gain is probably due to lipedema (warning: not a fat-acceptance link).

People with lipedema (not the same as lymphedema) have a tendency to gain abnormal fat deposits in the lower body, especially the legs, but sometimes also in the abdomen or upper arms. They often gain a lot of these fat reserves during times of major hormonal changes, like puberty, pregnancy, menopause, etc.

My legs look just like the picture here, my legs got bigger symmetrically, I have the classic "cankles" with the ring overlap at the bottom yet my feet are not affected, and it is extremely painful to have any pressure on my legs, especially my lower legs.

While the lipedema fat gain did happen a bit, it was not too bad with the first few pregnancies. However, in the fourth pregnancy (in my 40s), the combination of pregnancy plus perimenopause plus postpartum thyroiditis did seem to add an awful lot of fat, both around my ankles and in the abdominal area.

So while I'm technically at the same weight I started my pregnancies out with, my fat levels have definitely increased, and that's been difficult to be at peace with.

Now, the belly droop thing is pretty common among women of size after pregnancy.  Fat women often experience this, regardless of how much weight they gained, how they gave birth, etc.  (Some get it without pregnancy too, especially if they've had a lot of drastic weight loss/regain in their lives.) 

But mine may be worse because of my 2 cesareans, because many women (fat or skinny) who have had cesareans find they have a post-cesarean "shelf" or "flap."  I'm sure some would be there anyhow without cesareans, but most cesarean moms really do see a marked increase on the belly flap-o-meter, and I'm sure being fat and having lipedema and having had cesareans only magnified that lovely effect.  [Another *#ing gift from my cesareans!]

So all in all, I've had some real challenges to my body acceptance after four children.

Belly Ambivalence

I take some comfort in knowing I'm not alone in my belly ambivalence, though.  A lot of women have droopy bellies postpartum, a ton of stretch marks, and a different overall shape than before. 

A change that drastic ─ well, it's just not that easy to come to terms with, no matter how much you love your body in general, or how much you adore your babies and wouldn't trade them for the world. So having a hard time coming to peace with your body afterwards is very normal, as you can see here:

http://www.theshapeofamother.com/

Beware, though, this is not a body-acceptance or fat-acceptance site at all.  These women have all the self-hate of their bodies (and especially their fat bodies) that is so typical of women in our society.  Add in the wrinkly, saggy belly that is universal immediately postpartum, and the body hate talk there can be really strong at times.  So while the pictures at Shape of a Mother are great to see, you should know that the self-hate talk may be triggering for some. 

Personally, I still find the site useful, even though I find the self-loathing and pro-dieting talk frustrating. I try to remember that it does reflect the ambivalent feelings many women have about their bodies post-partum ─ magnifying whatever body image issues they already had pre-pregnancy ten-fold.  Plus I just don't know any other sites out there that have such honest pictures of postpartum bodies. So I value the absolute honestly of the pictures themselves enough to try and overlook the self-hate talk.

Here is the link to the category of pictures of pregnancy and post-pregnancy bellies in women of size:

http://theshapeofamother.com/category/plus-sized/

[Again, be warned that there's lots of diet talk and WLS (weight loss surgery) discussion there.]

Belly Honor

No, it's not easy to stay at peace with your body (and especially your belly) during pregnancy and post-partum.  There are many challenges to body image, and the natural changes that come with pregnancy can exacerbate the body image issues of even the most self-accepting woman.

Still, it's important to honor the vital work that our bodies did, to love every bump and curve for the job it did bringing a new soul to the earth, growing a healthy being and helping it into this world, and nurturing that new life afterwards.

I guess my main message on this is that it's normal and okay to be a bit ambivalent about your body shape and condition after birth (even long after birth).  Don't hate on it, recognize the important work it did ─ but realize that it's totally normal to have some ambivalence about it too.

Acknowledge that, and then take some time to honor your belly anyway. 

To honor my belly despite my ambivalence, here are some shots of me several years ago in my last pregnancy.  I was "overdue" and impatient to have the baby, but I'd been down the Seduction to Induction Road before, knew how often it leads to a cesarean, and refused to get lured into that trap again.  So I was waiting....and waiting....and waiting...and waiting.  Baby didn't come until nearly 43 weeks by LMP (nearly 42 by adjusted dates).  Augh!

So to distract myself and to have some fun in those last few days, I put on my oldest, ugliest painting clothes, gave my kids a bunch of washable tempera paint, went out into the back yard, stuck out my belly, and gave them a new and unique painting canvas. 

They were young; the resulting artwork is probably not beautiful to anyone in the world except me, but we had a BLAST.   

I remember that belly-painting session with tremendous fondness.  I hope they do too. 

So I honor my belly, stretched out and saggy and droopy as it was (and still is), for all the work it did bringing my wonderful babies to me, like this one, below. [Yes, she is the one in-utero above.]

It was totally worth it, every bit of it.  

Enjoy. And find a way to honor your bellies, too.

*Art Docent Hints: If you enjoy a good mystery and want to try and deciper the painting, look for the picture of the baby they drew.  Look for the green head with a brownish arm sticking out to the side underneath (the rest of the body is a bit amorphous, I'm afraid). Also look for the word "baby" on the side.  There was an arrow below it, pointing to the baby, but it got obliterated by an overenthusiastic toddler.  Then they filled in the blank spaces with random colors and swirls. The final result was a bit Picasso-ish, but hey. 

**Fetal Position Postscript: For the curious, yes, in this picture my baby bump is really quite visible, but then my baby in this pregnancy was in the most optimal position for birth, which is anterior.  That means the little butt was sticking out in front, making a nice big bump to paint on.  In my first pregnancy, when I didn't look pregnant at all, baby was posterior and in that position the baby butt doesn't stick out and make much of a discernible bump.  The difference? I saw a pregnancy-trained chiropractor and got some adjustments.  That made my last pregnancy SO much more comfortable, and it helped baby to be anterior after 3 prior pregnancies with a posterior baby!  Trust me, that's a MUCH easier labor!

Please Document Your Stories of Mistreatment

For years, I've made it a practice to document stories of fat-phobic treatment and weight bias in fertility, pregnancy, birth, and parenting. 

I do this for several reasons.

First, I find that many health practitioners simply aren't aware of (or don't believe) the extent of discrimination that exists out there towards women of size. Documenting actual stories helps them gain a better understanding of what some women of size have been through and why many are hesitant or negative about seeing a care provider. It also helps hold up a mirror (to medical professionals in general and to maternity providers in particular) to their own attitudes and practices, and helps them understand how bias -- even unconscious bias -- can slip through and how it impacts women.

Second, I think it's important that these experiences be documented simply because all stories of discrimination and bias deserve to be acknowledged.  Fat women should not have to endure egregious treatment like this, and our experiences of discrimination and bias should be heard and honored.  For too long, we've been told that such treatment is our own damn fault, that we're "too sensitive" about these things, or that we shouldn't be questioning it --- it's for our own good because we're so incredibly high-risk.  Documenting these stories makes connections with the discrimination suffered by other groups, shows that discriminatory practices have patterns, and that weight bias is a real form of stigmatization and discrimination.

Finally, I think it's especially important to document stories like this so that the fat-acceptance movement and the birth world start to understand and grapple better with the problem of fat-phobic treatment and discrimination during pregnancy and birth, an issue they tend to ignore.  Surprisingly, over the years I've found more respect and attention to the issue of size discrimination in the birth world than I have in the fat-acceptance world, which I always find puzzling and frustrating. Much of the birth world has a long ways to go, but some segments of the fat-acceptance world (those who don't want/have children, or are young enough that it's not on their radar) have an even longer way to go.  Documenting how egregious the treatment can be in pregnancy and birth is important because it helps establish that there really is a problem here that deserves attention, regardless of whether size discrimination affects you personally and regardless of whether you have (or plan to have) children or not.

More Stories of Mistreatment

A few weeks ago, I re-posted an entry from My OB Said WHAT?!! about a fat woman being told that if she got pregnant, she'd get gestational diabetes, high blood pressure, and would probably "die anyway."  This is just one of several "gems" I've found like that on that site.

I was surprised to get a high number of comments from my readers relating similar discriminatory stories, stories I'd not heard before and didn't have documented. 

While I'm disappointed that these things are still happening in obstetrics and midwifery care even today, I'm glad to be able to document some more of these stories.

But I want readers to go further.  If you have a story like this, I want you to document it thoroughly, in multiple places. 

We must have a record of things like this happening if we ever want to see things change.

How and Where To Document Your Story

So how do you go about documenting your stories? 

First of all, you can always send them to me, at kmom AT plus-size-pregnancy DOT  org.  I like to keep a record of such stories; when sending your story, please give me your permission to use them as needed (i.e. on my blog, on my website, in presentations I make, etc.).  You don't have to use your own name; you can choose to be as anonymous as you wish.  Just remember to give explicit permission to use it.  [If you posted your story in a public forum like my comments section, I consider that explicit permission...you've already made it public.  But I still like to have formal permissions.]

Second, don't forget the blogs at:

• First Do No Harm, http://fathealth.wordpress.com/
• My OB Said What?!?, http://myobsaidwhat.com/

The First Do No Harm site documents stories of discrimination against fat people in the healthcare world, but sadly, they have very few entries under pregnancy, reflecting the lack of crossover between the birth world and the fat-acceptance world, I think. The stories here on my blog need to get repeated there. 

The My OB Said What?!? site documents stories of outrageous treatment in the birth world; it's not just limited to fat folk, of course, but it's important that the birth world hear of size discrimination and weight bias and how prevalent it is.  And it's important that they hear about these stories from someone other than just me as well.  I am one of the very few voices out there talking about this; it would be great to have other voices corroborating the stories of weight bias and discrimination out there.

So if you have a story of bias or mistreatment, I urge you to submit your story and document it in multiple places.  There really is a lack of understanding and acknowledgement in both the birth and fat-acceptance worlds that such discrimination really exists and is so common, so be sure to document it in multiple places. 

Documenting our stories is one way to start raising awareness about this problem and start confronting and challenging such treatment.  We don't have to suffer in silence anymore, and by speaking up, we can start changing the status quo.

Here are just a few of the stories from the comments section of my last post, edited for length.  I thank these women for sharing, and highlight a few of their stories here because not everyone reads the comments and might have missed some of these.  [A few have beeen edited or broken into more than one story for the sake of readability.]

• My last OB told me that I needed to lose 50 lbs during my pregnancy or else she was sure I'd need a c section and then a hysterectomy. I gained 4 lbs total, and my baby was 8lbs 6 oz. I will never see that doctor again. I refused to go to my 6 week check up because of some of the nonsense that went on during my labor/delivery.

• I was told during my second pregnancy (I was about 6 weeks in) that I would have to have a c-section because I am fat. No ifs or buts, I simply would have to. I ended up having a straightforward natural (2 hour) labour and delivery and without any mention of a c-section.

• I was told at the beginning of my pregnancy not to gain any weight AT ALL. And in fact to lose weight. When I asked why, he told me because otherwise, I was being selfish and putting my baby at risk. Thing is, I was stuck with him because I had no insurance at the time and the delivery (emergency c-section that I HAD to have) still gives me nightmares.

• That I must have so much fat inside my vagina that I would not be able to give birth without forceps or more drastic interventions....That my blood pressure would shoot up in the midst of labor (despite having been perfectly normal all through my pregnancy) and I would die without IV drugs. Now, with my kids around me and the bed they were born in just a few steps away, I can laugh about it. Then, not so much.

• My MIDWIFE told me that she couldn't feel my baby through all of my fat. Which is funny, because she would barely touch me. Her doppler couldn't find the heart rate because I was too fat too. Once she dropped me from her care, I interviewed several other midwives, all of which could feel the baby AND find the heartbeat.

• I was mostly able to avoid the scare tactics, thankfully, but during my cesarean, after my husband left with the baby, someone said "We should just do some liposuction while we're in here."

• In my first pregnancy, at 11 wks I started spotting heavily, and my GP sent me for an u/s to see what was happening. I ended up in the imaging department at our local hospital with a sonographer who was visibly put out with having to take care of me. At one point she told me to 'hold all that fat out of the way' so she could do her job, and how she wasn't sure she would be able to 'see anything through all the fat'. Not only was I beyond stressed over the possibilitiy of losing that pregnancy (which I did, sadly), but that 'professional' made me feel awful.

• I was a virgin at my second gynecological exam requesting birth control for the first time and the doctor told me I needed to lose weight if I ever wanted to get pregnant. She said she would not "let me" get pregnant at my weight and that it would be too difficult for me to carry a child at my weight. I changed doctors when I found out I was pregnant a year later while on the Progestin-only birth control pill she prescribed me (I did research and that pill has a way lower rate of working on bigger women... - she never mentioned that). I was actually in fear that she would suggest an abortion or something drastic because she was so adamant that I not get pregnant at my weight. I think she thought I wasn't going to be having sex anyway at my weight or something like that. I weighed about 290. I am now 38 weeks pregnant at 305 pounds and the baby and I are doing great. No GD, no high blood pressure. We've been fine. Looking forward to a healthy baby later this month.

• I've got a ton of horror stories. I moved to the SF Bay Area from Seattle when I was 28 weeks pregnant and spent hours on the phone looking for a doctor that wouldn't counsel immediate termination ("You or the baby will die, you are just too fat to carry to term."), "necessary" c-section ("Women of your size never have a natural labor. You will have to have a c-section.") or were anti-VBAC ...("Women with your BMI can't VBAC in our hospital. You won't find a better hospital in the area."). I wound up with a doctor that said she was comfortable VBACing who decided at 38 weeks that I needed an "emergency" c-section and called me in the middle of my grocery shopping about me "dying before the weekend was out" and generally pressured me into yet another c-section. Now I'm being told (by any doctor I can find) that a VBA2C is "impossible" at my size/BMI or at all.

• I was told by my OB at the first office visit (8 weeks) that I needed to lose 15-20 lbs. When I asked if this would be harmful to the baby, I was told that I could safely LOSE weight during pregnancy and it would have no effect on my baby because I had so much "reserves" the baby could survive from that. Luckily I knew that was BS and ate normally to sustain my energy, stamina, and that of my baby. When he balked about my weight at every subsequent visit, I flat out told him that I KNOW how unstable I feel during dieting, and there's nothing he could say to convince me that would be healthy for my baby, he shut up.
  

• On the day of induced delivery, my doctor (who had been cautioning me that I would "most likely" need a C-section because of my size) was afraid to break my water as I neared full dilation and effacement and called in the OB specialist again to perform the procedure. My doctor actually left the room during this procedure to scrub in and ensure there was an operating room available to do an emergency C-section. When the specialist was finished and labor progressed normally, my doctor was shocked. Within three hours, my 9lbs 1oz baby girl was born and proceeded to pee all over the doctor. Instant Karma.....gotta love it.

• I am pregnant with identical twin girls. I went to the perinatologist and he lectured me for 20 minutes. Telling me I was going to have GD and high blood pressure, and that I needed to lose 20 pounds during this pregnancy.

• I had an OB tell me (over the phone) that I wasn't "really" pregnant, since my BMI was too high for me to actually be pregnant. Her office then told me that they'd be happy to schedule me for a biopsy to determine what kind of tumor I had. I replied "The kind with two arms, two legs and a head." and hung up. (I was 28-ish weeks pregnant and had a number of ultrasounds under my belt.)

You can read more stories of size discrimination I've documented over the years here.  There are stories of fat women being pressured to abort --- simply because of their size.  There are stories of women being told that they will die if they dare to be pregnant at their size.  There are stories of women pushed to have cesareans they don't need (or intervened right into cesareans). There are stories of draconian diets and mega-interventions and abusive treatment, simply because of weight. 

Of course, not every woman of size encounters such egregious treatment.  Oftentimes the bias is more subtle than that, and sometimes arrives with completely good intentions from the provider....but it's still bias.  I encourage you to share those stories too. 

It's also important to note that some fat women DO receive truly size-friendly treatment during their pregnancies and births; if you are a woman of size already pregnant or just considering pregnancy, please don't despair.  It IS possible to get decent treatment, and of course not all OBs or midwives are horrible people or size bigots.

But size discrimination does occur and I believe it's becoming more and more common as the rhetoric in the "War on Obesity" heats up. So it's important to keep documenting and challenging these incidents, both subtle and overt, as often as possible.

Please, folks, take time to document your stories, in as many places as possible.

Health care professionals and the general public need to become more aware of the scope of the problem of size discrimination.  It's the first step towards change.

Long-Term Effects of Fen/Phen

I'm sure many of you have heard already that a new study came out, linking Fen/Phen to an increased risk of heart valve damage, even years after its use.

When I first started having children, I joined a lovely email support group for women of size who were moms or were pursuing becoming a mom. As a size-acceptance activist and as a mom, it was a wonderful source of support for me, yet also a source of frustration because it was not a diet-free list.

It was a challenge to try and gently bring some HAES concepts to the list, while also remembering that the mission of the list was not size acceptance and that weight loss talk was not against the rules in this group. This has been very challenging to deal with sometimes, yet it was a group of women I grew to care about, so I wanted to stick around anyhow.

Thus, over the years, I have watched so many of the latest diet fads, drugs, and procedures come and go while on that group. Shortly after I first joined, the Fen/Phen craze was reaching its height, and quite a few of the moms on that list were trying it.

They had only the best reasons at heart: they wanted to improve their health so they would be there long-term for the baby, they wanted to lose weight so they could keep up with an active child, they wanted to set a "good example" for their kids, etc. Many struggled with the popular culture belief that because of their weight, they might not be around to see their children grow up. How sad that moms are so uniquely vulnerable to weight loss scare tactics like this.

So some of them turned to Fen/Phen. I knew it was a disaster in the making, but I couldn't do anything about it.

But now there's proof that there was reason for concern. A new study shows that Fen/Phen actually caused far more harm than benefit, that women were more affected than men, and that damage from the drug may not show up for years after taking it. From the press release:

One of the "fen/phen" drugs once widely prescribed to help fight obesity has been tied to heart valve damage that develops years after a person has stopped taking it, a new study reports.

In the new study, published Nov. 5 in the journal BMC Medicine, researchers looked at 5,743 people who had stopped using fenfluramine more than a decade earlier but had damaged heart valves up to seven years later.

"Valve problems were common in individuals exposed to fenfluramines, more frequent in females, and associated with duration of drug use in all valves assessed," research leader Charles Dahl, from the Central Utah Clinic, said in a news release issued by the journal's publisher.

"We found clear evidence for a strong, graded association between duration of exposure to fenfluramines and prevalence of aortic regurgitation and for mild or greater mitral and tricuspid regurgitation," Dahl said.

"This is probably a conservative estimate, as another study has shown that there exists a 17- to 34-fold excess of clinically apparent (presumably severe), valvular disease in persons who had used fenfluramines for four months or longer," the authors wrote.

I don't know if any of the moms on our list who took Fen/Phen all those years ago sustained damage; many of those moms are no longer on the list. I hope anyone who did take the drug (and especially anyone who took it for more than a month or two) gets their heart function tested periodically because this study shows that the damage may take years to show up.

But this is what is so scary for me in watching all the diet fads, weight loss drugs, and weight loss surgery trends come and go. So often the long-term effects of these interventions aren't clear at first, and so many seem to turn up unexpected complications later on, some even life-threatening.

Now the big trend on the list is weight loss surgery, usually gastric bypass. I understand why these moms choose the surgery, and I understand the kind of miraculous weight loss and health improvements it seems to offer...at first. But over time, the nutritional deficits begin to pile up, the unexpected side effects accumulate, and the quality of life declines.

Weight Loss Surgery (WLS) seems like such a miracle cure on the surface, but I fear the long-term results for many women are going to be far worse than the Fen/Phen fiasco. And like the Fen/Phen thing, it will probably take years to show up and will be difficult to track.

How many women will get exposed to these risks in the meantime before they discover just how risky WLS is in the long run?

Is Weight Relevant in a Crime Story?

I saw a small news story recently in a major regional paper about a man arrested for murder. They gave some details about the case, how the body was found, the man's history of mental illness, etc. Normal reporting stuff.

Then, at the end of the article, they noted that the man weighed more than 400 lbs. They gave his height and weight, taken from the jail records.

My immediate reaction was.....What does this have to do with the case? Why is it relevant to be reported?

If the man was on the loose and they were asking the public to look for him, well, okay. Seems relevant then to have posted a physical description of the suspect on the loose.

But the man had been taken into custody already. So what about his weight had any bearing at all on anything?

Again, if a suspected criminal is at large in the community, physical description certainly seems relevant. Occasionally there may be some cases where weight might be relevant, such as reporting details about a crime which involved a struggle with a significant discrepancy in size between the perpetrator and the victim, etc. [I remember seeing a report from a trial with a scenario like that and thinking, well okay, maybe it's relevant here.]

But most of the time, I don't see how a person's weight is relevant to the reporting of crime cases. And yet, I've noticed it seems to be fairly common practice to include it.....if the person is fat. And especially if they are supersized.

And that leads me to my next point, the non-uniform application of weight reporting. If you consider weight relevant to crime reporting, then report everyone's. But the only ones I see being included are the ones where the suspect is significantly fat.

Why is a person's "obesity" status relevant at all? Given the level of bias about obesity in most people, including this information prejudices the public's perception about the suspect before they've even gone to trial.

As far as I'm concerned, all it does is further demonize obese people in the public's eye.

I don't think most newspaper reporters and editors are doing it consciously or deliberately....they probably are just reporting any details they see as being out of the "ordinary."

But they need to consider what effect their reporting may have, both on public bias about obesity ("supersized people are often mentally ill and/or dangerous") and on whether that suspect can get a fair trial.

The bottom line is whether any particular detail about the suspect is really relevant to the case or not.

In this case, the two main aspects highlighted were the man's mental illness and his size. Mental illness is a tricky one.....sometimes it's relevant, sometimes not. You have to be careful not to demonize or overgeneralize about it. Yet in this case, the man's mental illness probably played a strong role in the murder, so it seems relevant in that regard.

On the other hand, his weight does not seem to have played any kind of role in the murder, at least from the information publicized so far. So why include it?

I just can't see that it was justified or relevant at all.

Actionable Response

Well, that's just a pattern that I've noticed in papers for a number of years now. I don't see it all that often, but I do see it frequently enough to see a pattern, one that seems completely unnoticed by the writers and editors.

It really frustrates me that no one at the paper sees a problem with it. Surely the writer (or at least the editor!) would see that such things have no relevance to the report and might even cause harm?

When I see examples like this, I always think to myself.....I need to cut this out of the paper and save a bunch of examples up of it, then write to the editor (or ombudsman) of the paper, give my examples, point out the pattern, and explain why it's a problem.

So I'll write down the item or cut it out.....and then I lose it before I have enough good examples to show a pattern. My life is extraordinarily busy and complex, and this has just slipped through the cracks, given the many other priorities in my life. Yet this jumped up again recently and it's been bothering me ever since.

Yes, I could write and complain about this one example (and I may still), but it really is more powerful to show a pattern. Editors respond more decisively if a pattern of bias or misreporting can be shown. So I'd urge the rest of the folks in the fatosphere to start watching news media for examples like this, collect them, and then write in to the editors and protest it.

In the meantime, I have an article to dig out of the recycle pile and hopefully a letter to the editor to write. Chances are no one will notice the problem if no one ever mentions it. Time to get my butt in gear.

Comments? Do you see stuff like that in your local papers? Do you point it out to the writers and editors? If so, what kind of response have you had?

Fashion Newsflash: Fat Women Actually Have Sex!

I read with some amusement the recent press release about a study finding that fat women actually do have sex.

Gasp!!! Who'da thunk it??!!??

They don't come right out and say it directly, but some of the subtext of the press release seems to be amazement that fat women are actually having sex, or perhaps even more amazingly to them, that there are men out there that want to have sex with fat women.

It's that same kind of reasoning that's been behind so many delays in the fashion industry for plus-sized women. They just don't seem to believe that fat chicks actually go on dates, go to the prom, get married, or have babies.

Bottom line, they seem to have difficulty believing that fat women have sex at all. Surprise!

The Plus-Size Fashion Vacuum

Because I'm middle-aged and grew up before the age of the internet, this plus-sized fashion vacuum hit me particularly hard, as I'm sure it did many others in the pre-internet days. [You young whippersnappers, you need to appreciate the wonders of having the internet as a resource!]

When I was in high school, I had a heck of a time finding nice clothes in my size, even though I was closer to "normal" sizes then (size 16 generally, sometimes an 18 or a 14).

My mom had to sew many of my clothes for me because most stores stopped then at size 12 or 14, and of the ones that went to a size 16......well, I just didn't fit their silhouette very well (too much of an hourglass instead of an apple).

I realize now it was a great act of love for her to sew for me like that (and what a blessing for me that she did know how to sew!), but her tastes and mine were not that close so it didn't always feel like a blessing. I really really wanted more fashionable clothes, stuff without polyester and elastic waists, you know?

I remember my shock and total disbelief my junior year when I actually found a prom-suitable gown in my size. I was thrilled. The clothing store employees kept throwing open the dressing room curtain to see if I was shoplifting because I stood there sooooo long, staring at myself in disbelief in the mirror. It was so beautiful, and I looked so good in it! You better believe I bought it!

Then I gained a bunch of weight in college (combination of undiagnosed hypothyroidism and PCOS, in which a strong weight gain in early adulthood is all too common) and it got even harder to find clothes in my size. I often resorted to running around in men's overalls because that's about all I could find in my size and non-existent price range. (They made clothing in larger sizes for MEN, but not for women, of course....but that's a whole 'nuther discussion!)

Yet imagine.....I still somehow managed to find a man anyhow, and we fell in love, overalls and all.

When Mr. WellRounded and I decided to get married, I went out to try and find a wedding gown......but there were none to be found in my size. Not ANYWHERE. Not in small towns, not in big towns, not even in a major metropolitan area.

I could go to a bridal store and hold up a dress against me and guess that it might look good on me and cross my fingers that when they were done it would fit me reasonably well......but I'd have to take a giant flying leap of faith and order it, pay for it, and then pray it actually worked. That seemed rather risky to me.

So I nixed that idea and contemplated getting married in my overalls. He loved me already in them, why not get married in 'em? Sadly, it looked like it might come down to that.

Finally, I decided, what the hell, it's my wedding, it's worth going into debt a bit. I hired my own seamstress, designed my own dress (neo-Victorian, thank you very much), and had it custom-made for me. I was back to having someone sew for me again, but at least this time I was calling the shots.

It worked out well but I was still ticked that I couldn't find anything in the stores, that I couldn't try out any designs ahead of time to see what worked best on my body, and that the fashion industry completely dismissed the needs of women of size at such an important moment of their lives. How dare they!?!

But the hardest part was yet to come.

The Plus-Sized Maternity Clothing Vacuum

Fast forward a few years, and Mr. WellRounded and I decided to have children. Took about a second to get pregnant despite dire predictions to the contrary (that's a whole 'nuther story too!).

So sooner than I began expecting, I went out looking for maternity clothes in my size....only to find that NONE existed. In fact, some clerks were openly hostile about having me in their maternity store at all. I remember going into a couple of them, only to have a clerk precipitously rush over to me and inform me that they didn't carry anything in "that" size in their store. When I asked them where I should go instead, they shrugged their shoulders and suggested buying a size larger in the plus-size stores.

They were really in a rush to get me out of their store; I think they didn't want to scare away the skinny women who might not want to be associated with a store selling "fat" clothes.

There was one clerk in one store that assured me that they had my size. Oh, my hopes were so high! I was beginning to panic about possibly needing to go naked during my pregnancy, and while I was pretty self-accepting, I wasn't too sure how the people at my job would feel about that!

She proudly hauled out one thing in an "XL" size (which generally fits about a 16/18, which I had long since left behind in teenagehood). Of course, it wasn't anywhere near suitable. She just assumed that an XL would fit anyone who was plus-sized. Ummmm, no!! There are different sizes of plus! So once again, I was without choices.

The long and the short of it is that I went through my entire first pregnancy without maternity clothes. None, zero, zip, zilch, nada.

How did I manage? Well, I did the only thing I could do. I went to the plus-sized stores (where I was already at the top of the size range, or close) and found the loosest clothes I could dig up, bought a few empire-waisted jumpers or trapeze tops, and then relied on loose-fitting tops and sweat pants with drawstrings I could loosen. Not the most professional-looking clothes for my job, but what else could I do? I had no other options.

By the end of the month eight, I was down to wearing 2-3 outfits, over and over and over again, each week the same exact clothes in order because I had so few choices. I was just lucky that I didn't have to work my last month (due to moving) because by then almost nothing fit....certainly nothing professional-looking. It was sweats and the biggest men's potbelly-friendly t-shirts I could find. It was really embarrassing.

That at least got me by to some degree for clothing, but I was really panicked about what I was going to do for nursing bras once the baby arrived. I could hardly find a regular bra in my cup size; how would I find one in an even larger cup size? With accessible flaps? OMG, I was really sweating that one.

I was lucky; a midwife at my doctor's practice had recently come across a brand-new business a few hundred miles away that specialized in hard-to-find nursing bra sizes. She had some flyers at the office and gave me one just before I moved. I was able to get some nursing bras in my size...miracle of miracles!.....just before I gave birth. Again it was by faith that the size would be right, because we had to do it all by mail....but at least I finally found something.

However, the humiliation of having to go through my entire pregnancy without maternity clothes really stayed with me. I knew I couldn't have been the only other plus-sized woman to have a baby in the history of the universe. Why wasn't someone, somewhere, addressing this?

I really caught on fire to try and change things and spread the word about the needs of plus-sized pregnant women.

It was shortly after this that the internet really started taking off, and I actually began to find a few companies here and there that did carry maternity clothes in my size. So I put together a FAQ on finding plus-sized maternity and nursing clothing.

I became active on the fat-acceptance bulletin boards, and would forward my FAQ when someone asked about maternity clothing for women of size. Within a short while, that got turned into my website, http://www.plus-size-pregnancy.org/, along with other information about being pregnant at larger sizes, and my particular niche of fat acceptance activism was born.

The plus-size maternity and nursing clothes FAQs are still there on my site, updated periodically (another update is due soon). Google makes it much easier to find such information these days, but it's still a good place to begin for someone just starting their maternity clothes search, or for women of size looking for more unusual maternity-related products like pregnancy support belts, birth balls that support larger sizes, nursing pillows that work for well-endowed women, nursing bras in unusual cup/band sizes, that sort of thing.

[I should probably mention that it's merely a clearinghouse for information on various vendors; I don't sell anything on the site whatsoever and I don't get kickbacks from any of the vendors in order to be listed there. It's a totally non-profit site.]

Still A Long Ways To Go

But while the internet has made a HUGE difference in finding clothing in larger sizes (including specialty stuff like wedding, costumes, and maternity), it still amazes me how many designer lines still don't design for us.

I think it all comes back to this idea that fat women don't have sex. Some folks in the fashion industry really seem to believe that fat women don't date, don't get married, and don't have babies.

Well, newsflash, designers!!! Fat women do date, we do get married, and we DO have babies. Yes, it's true.........fat women DO have sex!!!

Research even confirms this now, so maybe you can finally start believing it.

It's about time you designers and clothing store managers get on the stick and get more plus-sized choices out there.....for "regular" clothing, for fancy dress, for business wear, for weddings, for costumes, for athletic wear, and yes, for MATERNITY too!!!

Yes, fat women have babies too. And fancy that, we'd even like to have the option for maternity clothes for that time as well.

[Invitation to comments: If you have had a baby, how did YOU solve the maternity clothing issue? Was this pre- or post-internet?]

Note: It may take a couple of days for the comments to appear, but I'm very interested in your own experiences. Please do share.