Preaching to the choir

I have been thinking for a while now about fat acceptance and what it accomplishes. It is no small feat for a woman, fat or not, to make peace with her body and accept it no matter her size or weight. For a fat woman, peace often, perhaps usually comes only after years of struggle and failed diets and internalized shame and feelings of self-loathing. There is no denying that accomplishing this, that coming to accept and hopefully cherish one's body is not only desirable but far more healthy than living with the daily stress that self-loathing and the other accompaniments of hating one's body create. I support and embrace this goal wholeheartedly, having worked hard to get to that point myself.

But, it seems to me to be at best an uphill battle if I look outside myself and my very small circle. I am open about having long ago stepped off the diet train and about my embrace of HAES and of fat acceptance. I can say that I have made small differences in the people close to me because as I have changed in relationship with my body and with fat and body acceptance, those closest to me have also. But no matter what I do, no matter how open I am, have to face the reality that I and people like me make up the tiniest part of my culture. And I cannot see right now how to make significant impact on those whose attitudes need to be changed -- doctors and other health care providers, insurance companies, media outlets, airlines, stores and on and on. Because the bias is massive and pervasive and supported day in and day out with a constant drumbeat about how bad fat is and how much a drain on resources fat people are.

A lifestyle? Who knew?

Policymic, which says of itself that it is a site for "next generation news and politics" has run two articles in the last week that are actually take a critical look at the effects of bias against fat. The first one, "Can Fat People Be Healthy?" concludes:

whatever view you take of the relationship between obesity, genetics, and our environment, it's abundantly clear that weight gain is far more complex an issue than we often assume. By itself, extra body fat isn't necessarily unhealthy and getting rid of it isn't just a matter of self control. These are important points to keep in mind as we learn more about weight regulation and try to keep ourselves healthy as a matter of policy. 


Good statement. And then come the comments, which are less vitriolic than usually follow anything even remotely supporting body acceptance or HAES, but still we have the whole obesity as a choice thing. And this from the very first comment:

Obesity is not just an irrational lifestyle choice

Oh my god -- someone forgot to give me the memo on my weight being a lifestyle choice. Because who in their right mind would want to pass up the opportunity to be the target of vicious verbal attacks, bias even among health care providers, having to pay more for all kinds of things from clothing to health insurance, just to cite a few of the many "benefits" of this "lifestyle". Oyyyyyy!

Is Fat Still A Feminist Issue?

That is the headline for an interesting piece in The Scavenger this week. Susie Orbach's book, Fat is a Feminist Issue, was a controversial book when it was first published in 1978 and in fat acceptance circles remains so today. For me, it was Orbach's book that first got me to consider that my fat was might just be something other than a focus for my personal hatred and shame about and for my body, that maybe, just maybe there was meaning to be found in my body. Of course, when I read it, I was convinced that once I digested the message, that fat was in part a response to patriarchal oppression, I would find the pounds would melt away as i would no longer need them to make the statement for me. I got the message, my body stayed the same. But that book was important because it was the first step away from 30 years of dieting and weight cycling and toward acceptance of my body.

Charlotte Cooper, in her blog, Obesity Timebomb, has addressed the objections many have to Orbach's work. And I agree with many of them. Orbach does conflate being fat and compulsive eating and in fact kind of lumps all fat women together when she does. This is a common error in all writing about obesity that I have seen from psychologists. And I also disagree with Orbach that obesity represents, stems from an eating disorder, which is properly treated will get the fat woman to the slender body that is the natural state for women.

Another Unasked Question

Can anyone tell me what a "healthy weight" is? That term is tossed around as if it has actual meaning but I can't find it. Is a slender person who has type 2 diabetes  at a healthy weight? If so, then weight is not relevant to her illness. Is a fat person who has normal blood pressure, cholesterol and glucose levels healthy? Then one would have to assume that hers is a healthy weight. See -- it is a term that makes no sense because for the most part weight does not map to health.

This past week we heard all about how we are fatter even than we thought we were, because -- surprise surprise -- BMI is not a good measure of obesity. So now we are supposed to look at percentage of body fat and lo and behold this will result in even more people being considered obese, and thus candidates for any of the emerging and existing treatments which will allegedly make them slender and  "healthy". 

In an article in Time, Dr. Eric Braverman says:

“People aren’t being diagnosed [as obese], so they’re not being told about their risk of disease or being given instruction on how to improve their health,” 



Of course he is ignoring the fact that one cannot be diagnosed as obese because it is not a disease. And the fact that there is no means of losing weight that is effective for the majority of patients over the long term. And the fact that fat is not a marker for health any more than height is. But his article in PLoS One managed to add to the volume of cries and hand wringing about fat nevertheless.

Unasked questions

I am struck as I read many of the reports in the news about obesity and treating it by the number of important unasked questions. Over the next few days I will look at some of these from recent news.

Did you hear last week that bariatric surgery is the cure for Type 2 diabetes? It was covered by all the major news outlets and touted as being the best hope. There was no discussion about the mortality rate due to Type 2 diabetes or that fact that thin people develop it as well. As I listened to these reports. my attention was caught by the remark of one surgeon that improvement in blood sugar was seen immediately following surgery, before any weight is lost. Why wasn't this surgeon asking himself why that is, because to me it suggests that a common factor is involved in both those patients' fatness and their diabetes rather than the fat itself causing diabetes.  That seems to be a very important issue. 

Today I read in the Atlantic, "Is Bariatric Surgery the Solution to America's Obesity Problem?" and this very issue comes up in the article, though without the question, which to me is why push surgery when this very provocative finding seems that it might lead to a more productive, less mutilating treatment possibility.

For Therapists

Sharp eyed readers will notice changes to the list of books now on my desk as listed on the left. As a therapist I am very interested in how therapists respond to fat patients and how fatness is viewed psychotherapeutically. I have had some interesting experiences myself with therapists who made assumptions about me and the issues I wanted to work on based on my size rather than what I said. It is  interesting to me that the literature is relatively silent in the last 15 years or so on this subject. I have searched long and had to find pieces written by therapists about their reactions to fat patients and written by fat therapists about patients' reactions to them -- the picking are pretty slim.

One of the books I stumbled upon is Eating Problems: A Feminist Psychoanalytic Treatment Model. I am pretty sure that in some quarters of the fat acceptance movement my liking of this book would mark me as suspicious, especially given that the book comes out of the Women’s Therapy Centre Institute, sister to the Women's Therapy Centre in London with which Susie Orbach is affiliated. I am impressed that the articles in this book do not take what I would consider a fat negative posture at all, but offer the author's thoughts and experiences with patients -- anorexic, bulimic, fat and everything in between -- in light of feminist theory and with a deep understanding of cultural forces we must all contend with. The net result is an approach that offered me some fresh insights into my own history and some very useful material I can use with my patients.

When a body meets a body


When a body meets a body, no formal introductions are made. What are the feelings and ideas, conscious and unconscious, that go through our minds when we are looking at another person? As therapists, we focus on words but our bodies also speak. And, in a manner of speaking, there are actually always four, if not more, bodies in the room. Each partner in the analytic dyad has both a body as material entity and a body as it expresses and symbolizes psychic life. For each person, the expressive and symbolic meaning of her own body and the body of the other changes with changes in her self-state. (Anderson, F.S.(2007). Bodies in Treatment: The Unspoken Dimension p. 237)


My first analyst was a woman. I chose her because at the time, she was the only Jungian analyst within reasonable driving distance of where I lived. I was just 40 with two children and an unhappy marriage. I had in mind that I would someday like to pursue Jungian analytic training, but that was not my primary reason for seeing her. It was that I was 40 and I knew I needed to deal with what I wanted in my life in the years ahead. Things got off to a difficult start because she looked very like my mother so before we began there was something of a negative mother transference. She was slender and very well dressed, the kind of woman with whom I often felt clumsy and ungainly. 

I believe at the beginning I said something to her to the effect that the issue of my weight was non-negotiable, a stance occasioned in large measure because of her resemblance to my mother and because I had worked so hard through my thirties to make peace with my body, to stop dieting and hating myself for being fat. In spite of that declaration or maybe because of it, after a couple of sessions, she told me of a dream she had had when she was in analysis, a dream she had had, she believed, for her analyst who, like me, was fat. In the dream, Jung told her that "every extra ounce costs a pound of consciousness." She told me her analyst had been grateful to her for telling her and had undertaken to lose weight because of that. I was not grateful. Not at all. I was angry. And hurt that she had so clearly not heard me when I said I was not willing to make weight loss a focus of my work with her. I know I wrote to her about my anger but I also know that my expression of it was pretty impotent. i wanted her to be willing to see me as I was, to sit with me as I was and allow me to open up to her and to myself my experience in my body, in my life. I needed to be able to speak and be heard without blame, the blame that comes with the belief that all I had to do to be "normal" was to eat less and move more. But that was not to be.

More Size Matters


"Thinness, exploited by advertising, [has become] a bogeyman, a judge, an accuser, an impossible standard, a drain on women's emancipatory goals. The advertised image of thinness, closely associated with beauty and "health" has become central to the notion of a "good woman" who is "trying her best"to look right, live right and be right. Although...advertised thinness on the surface promises that woman can "have it all"...its most powerful, secret message is to remind them of their subordinate status as women, still judged on the basis of their bodies. They must take up less space, fit into prescribed molds of standardized beauty, restrain their desires by discipline their hungry bodies. No one wants a fat woman, someone out of 'control'". *


I know that in citing anything psychoanalytic, I place myself outside the fold for many people in the fat acceptance movement. But for me, to disregard all of the contributions of psyche to the experience of being fat is to throw the baby out with the bathwater. I am after all an analytically inclined psychotherapist and I believe that fat is a matter of psyche, body and culture.

Yesterday I found in Medscape a good blog post on Adele and body image. The author of the post responds very briefly to a study --

According to a recent study in the journal Social, Psychological, and Personality Science, celebrities can serve as wellness role models. The researchers claimed that women who identified with a particular star actually experienced a self-esteem boost, and were motivated to take better care of themselves. So I relate to Adele and that bolsters my positive body image.


But the researchers go on to say that their theory holds true even if the size difference between the celeb and the viewer is quite pronounced, and I have a harder time with that. Buxom is a buzzword for now, but the Adeles are few and far between.


That in recent weeks we have seen Octavia Spencer applauded not just for her performance in The Help but also for her fashion acumen, also seen Melissa McCarthy on the red carpet, and Adele sweep the Grammies is nice, but as the blog post notes, rare events. And when considered in light of yesterday's post about the French so-called plus size model, a woman who is to all but the most critical eye not even close to being fat, the message to us remains the same -- to be fat is to fail to be a good woman. Or as LeBesco has said, "fatness marks the individual as a failed citizen in a number of ways: as not of the dominant social class,as an inadequate worker and consumer” and Adele and Octavia Spencer or Melissa McCarthy cannot change that.

Size Matters

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See this woman, Laura Caterall? Well a lot of folks are all aflutter because they see it as ground breaking that she is on the cover of the French edition of Cosmopolitan -- because she is a PLUS SIZE  model. That's right, at a size 14-16, she is considered to be plus-sized. I don't know about any of you, but I have never in my life looked like that, not even when I was a size 14-16. Maybe in France she is a size 16. But not in my world.







Again?

I have been surprised at how little attention the recent recommendation to the FDA that the drug Qnexa be approved. This drug was turned down two years ago because of concerns about adverse effects -- like birth defects, heart attacks and stroke. That decision seemed sound. But the expert panel, following testimony from Arya Sharma, M.D., obesity expert and consultant to Vivus the drug manufacturer, argued in its favor.

This drug, and all of its predecessors, produce only very modest weight loss, usually on the order of 10% of body weight. And that would leave most patients still well within the obese range and with the added not insignificant potential for serious side effects. One of the components, Phentiramine, was the Phen part of FenPhen and we know how well things turned out with that drug.

Yes, the panel recognizes possible problems and suggests studying them following approval. Marvin Lipman, M.D. chief medical advisor for Consumer Reports, says:

Post-approval surveillance is not a very safe quid pro quo since this drug will be used by millions—perhaps with dire consequences. The components of Qnexa are known entities with impressive side effects.

Seriously, this panel of experts, knowing that millions of people made desperate to lose weight in any way possible because of the obesity panic will take them, is willing to risk lives for this drug's approval. To risk lives for a weight loss of 10%, weight which will rebound plus add more as soon as the drug is discontinued. Meanwhile, Vivus will make millions, perhaps billions of dollars before the drug is removed from the market, if it ever is.

A change of pace

If like me you are thoroughly tired of seeing images of headless fatties I have an artist to suggest to you -- Fernando Botero, a Columbian painter with a unique style and an appreciation for large bodies. I first became aware of Botero around 20 years ago when I was in New York to see an exhibit at the Met. In the center section of Park Avenue for several blocks I saw monumental bronzes and I was mesmerized. And had to learn more about this artist. Do take a look -- I think you will find delight in his figures like these two --

Fernando-Botero-Fat-Figure-Canvas-Painting-789-


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Close but...

Though I know that much of the Fat Acceptance community has very little good to say about intersection of psychotherapy and fat. And no wonder given what people like Yalom and Bruch have written. I stand a bit outside here and know that there is value to be found, as I myself did in my wrestling with Marion Woodman, in looking deeply into the emotional aspects of being fat. It was important for me to start from my place of deep opposition and slowly work my way through what she said, resisting and defending all the way until I could in fact find some common ground with her. I mentioned some of that in my last post. So I actively look for therapists who have written about fat. In my stack of books I am slowly wending my way through on the way to completing my own, is this one: The Overweight Patient: A Psychological Approach to Understanding and Working with Obesity by Kathy Leach. Leach is a practitioner of Transactional Analysis (TA) in the UK and has a special interest in working with obese people.

I have never been a big fan of TA. Like every other therapist I know, I read Eric Berne's Games People Play and found some the game metaphor interesting and even useful. But it never grabbed me as a way to work seriously with patients. Some of my less than enthusiastic response probably dates from working with a colleague heavily into TA years ago, but I would like to think I came to my stance based on more than my irritation with him.

Negative Mother Complex

I began this work as an argument with Marion Woodman. Using myself as a single case study, I set out to demolish her theses about obesity. Along the way, quite to my surprise, I found myself agreeing with some of what she said. I admit to feeling some ambivalence about it.  On the one hand, I see the complexes she emphasizes present in myself. There is no denying that. But Woodman presumes to be speaking about all fat women and within this assumes all fat women are compulsive eaters, all fat women are hiding in their fat, assumes all fat women can be thin and if they don’t want to be it’s a psychological issue, that fatness is the other side of the coin to anorexia. I know what she says is not true of all fat women. And I know that much of it is true of me. Woodman sees cause where I see co-occurrence. Having a negative mother complex, father complex and the rest are neither necessary nor sufficient to cause a person to be fat. But when they occur together with fat, they do indeed amplify pain and suffering. I know I am heir to a complex brew of genes and exposure to bacteria and viruses and hormones and who knows what else all interacting in a way we cannot yet define with how I feel, how I was been treated in my family and in the world, what I do with my anger. 

Tis the season

I think it must be due to the fact that it is Dec. 21 and only just this week cold here that it dawned on me fairly late that Christmas is almost upon us. Because in my mind it is just after Thanksgiving and I have plenty of time to finish my gift knitting, cookie baking, and gift wrapping. Gift wrapping? I haven't gotten paper yet! The tree is up and has lights but won't get decorated until this evening. I have a couple of posts in mind but they will have to wait until after the weekend.So, I am off to listen to a book while I finish my knitting. 

From my house to your house, I wish you the very best holiday.

January


Should Legislation Protect the Obese?

A debate on this point was in the NY Times last week. I'm still pondering it. On the face of it, it seems that it would go without saying that there should be legal protection against discrimination. And I certainly am not supportive of discriminating against fat people. So what gives me pause? I am leery of what could come along with new legislation. Like defining obesity as a disease. That would go against fat acceptance, at least in my mind. If we want to be seen as within the scope of normal, that is that weight has a range of variation, then it would not be a step forward to have obesity made a disease. And shouldn't employment be based on ability to do the job? Ca legislation be drafted that simply covers any difference without pathologizing difference? 

So what do you think?

Something to ponder

I finished Francine Prose's little book, Gluttony, in which I found much to think about. So think along with me --


Our obsession with living forever means that we are doubly affronted by the spectacle of the obese, whose flesh seems to be making a statement that the pleasures of the moment have been chosen over the promise of longevity. Doesn't that fat man want to live? The so-called glutton is a walking rebuke to our self-control, our self-denial, and to our shaky faith that if we watch ourselves, if we do this and don't do that, then surely death cannot touch us.


This has been something I have noticed for a long time, this belief that if we do everything just right -- meditate the right way, eat the right foods, think the right thoughts, exercise the best way -- then we will defeat death and live forever. Ernest Becker wrote about this in the 70s in his book Denial of Death. The basic premise of The Denial of Death is that human civilization is ultimately an elaborate, symbolic defense mechanism against the knowledge of our mortality, which in turn acts as the emotional and intellectual response to our basic survival mechanism. 



No Fat Allowed

Stacy Bias, on her blog Fat Girl Speaks, posts today about the long lasting effects of being kicked out of ballet class because she was too fat. I wonder how many of us longed for the pink tutu and leotard, white tights and delicate ballet shoes and heard we were too fat? 

I was one of those girls. When I was 9, I wanted to learn ballet. I begged my mother to let me take a class. She told me no, that I was too fat for ballet. So I got a book from the library, a book that showed the five basic positions for feet and hands. And when my mother wasn’t home, I would stand in front of the mirror and try to teach myself ballet. I wanted so much to be a graceful and beautiful dancer. But of course, there were limits to what I could teach myself. I practiced those five foot positions and hand positions again and again, trying to imagine myself a ballerina. What I saw in that mirror was my chubby body and lack of grace, just like she said.

Then, at my mother’s insistence, I took a course in ballroom dancing and etiquette. She was certain this was how I would become graceful and ladylike. I was terrible at dancing; I just couldn’t get the hang of following. I didn't know how to let the boy lead, to feel the music, let go, give up control and allow him to take charge of the dance. It is something I have yet to learn, though in my dreams I am able to let go, feel the music, and dance, my partner leading. And if I can do that in my dreams, perhaps I can do it in waking life.

Fat as sin

In the way that one thing often leads to another, the article I referred to the other day, which for those of you who are interested is "The Epidemic of Obesity in Contemporary American Culture: A Jungian Reflection", led me to two books considering gluttony as one of the seven deadly sins. And for those of you who want to know what those books are, here you go:

Gluttony by Francine Prose

Seven Deadly Sins: The Dark Companions of the Soul  by Anne Maguire

I started reading Prose's little book last night. Lots to think about in it as I develop my thought on what all of this means and explore the nature of the cultural complex we are all caught in. Here is a tidbit to reflect on:

Only during the last few decades has the legacy of Puritanism (operating in close partnership with the interests of capitalism) deftly lifted desire and gratification out of the equation, and replaced the notion that humans might like eating with the suggestion that we eat principally out of compulsion, illness, self-destructiveness, the desire for self-obliteration, to avoid intimacy and social contact, and so forth.

It immediately brings to mind the popular notion that slender people eat to live while we fat folks live to eat, and hence are gluttonous and sinners.

Politics

In addition to my personal interest in how we think about, talk about, and act on fat and fat people, I also have a professional interest, both as a psychotherapist and as a Jungian. When I started writing about this almost two yeas ago, I was surprised to find almost nothing in the Jungian literature about obesity. Since Marion Woodman wrote her book, The Owl Was a Baker's Daughter, published in 1980, the Jungian world has been silent on the subject. I have been able to find one article in Jungian journals since then. That alone strikes me as odd, given how prominent the concern about fat is in the culture as a whole.

I finally got to reading that lone article recently and will critique it in some detail another time. One thing that stood out for me was the author's reliance on statistics and studies as reported in Truthout.org, a progressive, i.e. liberal, journalism site.

I consider myself a progressive and a liberal. As I reflected after reading the article, I realized that I had not thought much about the intersection of politics and the issue of obesity. I tend to see fat acceptance as progressive and liberal, radical even. But here I was faced with the reality that a source I generally agree with embracing spurious statistics and wholly aligned with the dominant paradigm about obesity as the great danger to life as we know it. I mentioned this to my husband, who is very active politically and also a progressive. His response was that he sees the left as believing that people can be perfected and that is how he sees liberals falling into this dominant discourse about obesity. With the right social programs and use of government policy, programs and influence, the argument would go, fat people can become slender people, i.e. more nearly perfect. 

Who eats fast food?

I am not surprised that this study has not received much attention, because anything that goes against the dominant paradigm will find it hard to gain traction.

Here is the study as reported by UPI:

People's consumption of fast-food becomes more common as their earnings increase from low to middle incomes, U.S. researchers suggest.


Senior author J. Paul Leigh, a professor of public health sciences at University of California, Davis, said the findings weaken the popular notion that fast-food is responsible for higher rates of obesity among the poor.


"There is a correlation between obesity and lower income, but it cannot be solely attributed to restaurant choice," Leigh said in a statement. "Fast-food dining is most popular among the middle class, who are less likely to be obese."


Leigh and co-author DaeHwan Kim, specialists in health economics, used data from the 1994 to 1996 involving nearly 5,000 people, which included data about food consumption patterns, including restaurant visits. The researchers found eating at full-service restaurants followed an expected pattern -- as income rose, visits increased.


In contrast, the study, published in Population Health Management, found eating at fast-food restaurants followed a different pattern -- fast-food restaurant visits rose along with annual household income up to $60,000. However, as income increased beyond $60,000, fast-food visits decreased, the survey said.


Leigh noted that the fast-food industry attracts the middle class by locating restaurants right off freeways in middle-income areas.


"Low prices, convenience and free toys target the middle class -- especially budget-conscious, hurried parents -- very well," Leigh said.



That's right -- consumption of fast food rises as income increases from lower to middle class. But do a Google search on fast food and low income and you will soon see that the connection between the two is firmly established in dominant discourse about obesity.

Take a look at how the study above was presented by one Utah newspaper:

Nutritionists and food policy experts said that doesn't let fast food off the hook -- and at least one of the UC Davis researchers agreed.

Nutritionists and food policy experts said that doesn't let fast food off the hook -- and at least one of the UC Davis researchers agreed.


"I'm sure that fast food in general has a big effect on obesity," said J. Paul Leigh, lead author of the study, which will be published in Population Health Management in December. "This research does not contradict that."


Even the lead investigator seems not to want to consider that fast food is not an important part of the equation. True, the study doesn't contradict the notion that fast food contributes to obesity, in fact it offers no information at all about causation!

It's also important to look at what other foods are available to consumers, Weinberg said. "Is your neighborhood full of 7-Elevens or is it full of Whole Foods?"


Judith Stern, a UC Davis nutrition professor and a nationally recognized expert on obesity, called for wholesome, high-quality foods to be available in low-income neighborhoods.


Stern acknowledged the difficulties facing low-income working people: "If you could cook at home, it would be cheaper. But where do you have the time?"

Again, look at the assumptions there -- people who buy food at whole foods are not fat. People who cook at home will choose "wholesome, high-quality foods" which of course means they are also not fat.

So where do fat people like me come from? I am well educated, middle-class, cook at home, almost never eat fast food, and my diet consists largely of locally sourced, organically raised "wholesome" foods that I consume in moderation.


© CHERYL FULLER, 2010. ALL  RIGHTS RESERVED.