The obesity and BMI divide.

Paul Campos has a Daily Beast article ("Michelle Obama's Let's Move Campaign Is Helping Bullies") that puts it very succinctly what our bovine barnmate was trying to illustrate earlier: that contemporary discourse on weight-lose hinged on the Body-Mass Index (BMI) bordering on pseudo-science of pop-psychology, with all the trimmings of statistical conjuring and arbitrary standards buried in formality to make bullshit sound oh-so authoritative, medical but mostly pompous.

If you didn't get Cow's message earlier, here's Campos laying it out for you, which I doubt substantively differs much from Singapore although written in the context of America:

The Centers for Disease Control website offers these definitions of “overweight” and “obesity” in children: (emboldening by me)

· Overweight is defined as a BMI at or above the 85th percentile and lower than the 95th percentile for children of the same age and sex. · Obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex.

These definitions raise a couple of obvious questions in a nation that has been bombarded with claims that childhood obesity is skyrocketing. After all, by this standard, aren’t exactly 10 percent of children always overweight by definition, while another 5 percent are obese? And what’s the justification for these statistical cut-points, anyway?

The definitions were created by an expert committee chaired by William Dietz, a CDC bureaucrat who has made a career out of fomenting fat panic. The committee decided that the cut-points for defining “overweight” and “obesity” in children would be determined by height-weight growth chart statistics drawn from the 1960s and 1970s, when children were smaller and childhood malnutrition was more common. The upshot was that the 95th percentile on those charts a generation ago is about the 80th percentile today-hence, the “childhood obesity epidemic.”

These definitions are completely arbitrary. The committee members chose them not on the basis of any demonstrated correlation between the statistical cut-points and increased health risk, but rather because there was no standard definition of overweight and obesity in children, and so they invented one. In other words, the “childhood obesity epidemic” was conjured up by bureaucratic fiat.

The committee did this despite Americans being healthier, by every objective measure, than they’ve ever been: Life expectancy is at an all-time high, and demographers predict it will continue to climb steadily. This isn’t surprising given that mortality rates from the nation’s two biggest killers, heart disease and cancer, are at historical lows and keep declining, while infectious diseases are under better control than ever. There’s no reason to think that today’s children won’t be healthier as adults than their parents, just as today their parents are healthier than their own parents were at the same age, continuing a pattern that has prevailed since public health records began to be kept in the 19th century.

(Hat tip Kate Harding.)

How to tell the world you're an asshole

Oooh, who likes getting all het up and furious first thing in the morning? You had better if you, like me, get the Straits Times on subscription. In today's Life! section, a letter from Asshole Alpha:

Stay lean, SIA girl

I refer to the report, I Don't Mind A Fatter Singapore Girl by Jeremy Au Yong (Life!, Oct 9).

I do not mean to be disrespectful or discriminate but I honestly do not want to sit beside an overweight person during a long flight, especially when flying home.

Singapore Airlines did not become a leading airline just because the SIA Girl looks slim, clean and pretty.

She is just one of the building blocks that fit very well into the whole operations. When there is a lapse or drop in service quality, SIA has to correct and improve. In every successful business, there are certain identities and standards associated with it. These form its culture and infuse its soul.

It is easy to say you do not mind having a fatter Singapore Girl but it will be a problem for many.

Teo Yee Chee

Fatphobia: check. Equation of service staff's physical features with 'service quality': check. Commodification of service staff as mere 'building blocks': check. Cluelessly trumpeting the opinion that the other people should be in service to the pleasure of your unpleasant, privileged ass: check. (The one grain of truth in this letter: that many will share the same retrograde views that you hold.)

Hey, Teo, next time you might want to lighten up on the disingenuity, and just declare that you think fat people don't deserve to be treated like fellow humans. I have a lot of things to do and it would save everyone's time if I didn't have to point out the contemptible ridiculousness of your opinions before I told you to fuck off.

+++++

ETA: I haven't read the original Jeremy Au Yong article that this letter refers to, but I don't have high hopes for it.

Visiting the Doctor While Fat

It seems like everytime I have something to say, it's because I've read something excellent that Melissa McEwan of Shakesville has written (I do read other blogs, really). This time, it's her post on going to the doctor while fat.

It's very well documented that up to 50% of doctors harbour a widespread bias against fat people. And we also know that men have to be a whole lot fatter than women before they're classed as fat, so this is a problem that disproportionately affects the fairer sex (as if we didn't have enough to deal with). In fact, the folks at Shapely Prose have a whole blog dedicated to collating stories of doctors offering misdiagnoses and all around disastrous advice on account of fat: First, Do No Harm. The stories therein are all from women. Granted that could just be how the blog readers skew, but I find it rather telling nonetheless.

Not one to be left out, here's my story.

I have been on many diets. The first one I embarked on was shortly after I was tagged for the TAF club in primary school and my parents thought they should do something. The last one I was on is the one I want to talk about. Oh, there were many in between, like any good fatty I've gone through periods of "eating well", "lifestyle changes" and even the goddamn Atkins diet (I have never ever wanted a piece of toast quite as badly as I did back then, and I can't even tell about you the mental torture involved in avoiding a lovely hot bowl of chicken porridge when you're sick). But the last one, the last one was the one where I was going to do it right. I wasn't going to be part of the 95% that gain back all the weight and then more. I decided that I would pay for a program that was presided over by healthcare professionals. You may have heard of it - the Dr. Bernstein diet.

Sure, I did the research beforehand. I read the forums where people on "maintenance" talked about gaining back the weight (people I assumed were cheating and just wanted to maintain the veneer of doing well). I read about how some people experienced hair loss and how others stopped getting their period on the diet (but you are monitored throughout the diet by health professionals!). I read all about these things, but I wasn't going to be one of them, it was going to work well for me. Of course it was. I was going on a Diet. This was going to Change My Life.

The diet involved keeping your caloric intake between 400-900 calories a day. Only that's not how it was framed. Rather, there was a list of foods that you were allowed in the quantities they were allowed in. And there were foods on that list you were discouraged from eating too often (to give you some idea, you weren't allowed things like carrots and peas, and if you wanted an apple, it had to be a small one). I did really well on it, then I ran out of money and couldn't continue the program, and I wasn't comfortable restricting my food intake so drastically once I wasn't under the constant care of health professionals (you get to talk to a nurse for 10 minutes a time three times a week) so I went to the "maintenance" phase. I'd already lost 30kg, so I was feeling pretty good about myself. I still read as "fat" but was probably closer to "plump".

The maintenance phase is where you can start "eating sensibly". Which any good dieter knows involves small amounts of carbs and smaller amounts of fat and lean protein portions the size of your palm. Two months in, I started experiencing episodes of chest pain. Not scary heart attack chest pains, more like I was wearing a bra that had been crossed with a boa constrictor. So I went to my doctor about it and was diagnosed with boobs that were too big. *cough* So I was sent away with a prescription for some massage therapy and was told to work out to strengthen the muscles in my back and chest.

So I did. But the episodic pain kept coming and it was worse each time. Twice I went straight to the emergency room because all I wanted was morphine to stop the pain (and also my partner was pretty freaked out that I was having such severe chest pains). Each time a report was generated, sent to my doctor and each time I was told that they were muscle cramps (obviously the first thing the ED did was to rule out a heart attack). I kept working out (which really helped with carrying the groceries home, I can't recommend it enough if you are able to fit it into your life) and I kept going to those massage appointments that are far less pleasant than you imagine. In fact, they hurt like hell. But not as much as those waves of pain that kept hitting me at random moments.

Eventually I worked out that if I chewed over-the-counter painkillers that contained codeine it'd dull the pain enough that I could just sit around and ride it out without having to keep presenting to the harassed emergency department staff. All for having boobs that were too big. What a burden to bear.

Except it had absolutely nothing to do with my impressive knockers. And I assure you that they are quite impressive.

I'd gone to Canada over school break (God bless the universal health care availabe in Canada...) and I got the now familiar pain again. Only this time it didn't go away. I'd made it through an entire bottle of Mersyndol (not recommended) over three days and it was still there, and more insistent with time. I'd lost my appetite and I was impossibly itchy all over despite the absence of any dermal symptoms. Then one night, like a knife through the fogged pain-haze was a bright, white stabbing pain, unlike anything I'd ever experienced in my life. This time, I called an ambulance.

Some laughing gas and some more morphine later, I was discharged and told to visit the GP the next day. Knowing that this could not possibly be big-booby-itis, and knowing that my original doctor was unlikely to reverse a diagnosis she'd held onto for the past three years, I went to my partner's father's doctor (who came highly recommended). That doctor took one look at me and panicked. He quickly scribbled a report, told me that I was severely jaundiced and made me assure him that my next stop after leaving his office was a hospital emergency room. He told me to stay there till I was admitted.

For the past three years, I had been experiencing gall bladder attacks. This time, the gallstone had moved and by the looks of things (i.e. bright yellow) it had lodged itself in my common bile duct. I was in liver failure (also explains why I was so damn itchy, hyperbilirubinemia would do that to you).

I needed my gallbladder out, and to complicate things, the surgeon also had to look for the stone that was stopping up my pipes. I think I was given the choice between being sliced open end-to-end and a laproscopic procedure. I can't remember, at this point I was on a morphine and benedryl drip. There was something about having to wait longer for laproscopy, I think. So I chose to be gutted. A week later and there was still no improvement. That's how long it took the people at the hospital to realise that instead of being a lazy fatty who was not invested in getting better, there was a second stone that was missed.

I will have you know that once the second stone came out, I did all the rehabilitative things they had me do. Twice and with enthusiasm.

So there's my story. I'm fat, I have large boobs, clearly my body couldn't support it despite having supported it all this time. Obviously the diet I was on was an unmitigated good and couldn't have caused anything like episodic pain consistent with a gallbladder attack (P.S. this is actually the #1 reason for gall bladder issues in young women).

I'll leave you here for today, but do remind me to tell you guys about the time where I presented at a doctor's office because I had violent diarrhea for the past three-four days and was given the "you should lose weight" talk. Oh and that time I went to ask a "family health professional" about whether my birth control pill was adequate contraception for someone of my heft and got a long lecture about health and weight loss instead. And and and and and and and there is so much more where this came from. Buy me a drink and I'll tell you all about it.

No, really?

This Straits Times story carries the headline "Teens pressured to be thin".

In other news, water is wet.

Forgive my snark. It's good that the media is reporting the truth. It's just astonishing that this can remain a revelation, considering that more than half the adult population have themselves been teenage girls at some point. It's almost as if our experiences don't count until they're packaged in some Researchy Research to remove the taint of female subjectivity.

The article itself:

ALMOST nine in 10 American teenage girls say they feel pressured by the fashion and media industries to be skinny and that an unrealistic, unattainable image of beauty has been created, a poll showed on Monday.

The online survey of 1,000 girls aged between 13 and 17 for the Girl Scouts of the USA found that three quarters said they would be more likely to buy clothes that they see on real-size models than on women who are skinny.

But three out of four girls said that fashion is 'really important' to them.

'The fashion industry remains a powerful influence on girls and the way they view themselves and their bodies,' said Kimberlee Salmond, senior researchers at the Girl Scout Research Institute.

'Teenage girls take cues about how they should look from models they see in fashion magazines and on TV and it is something that they struggle to reconcile with when they lookat themselves in the mirror,' she said.

More than 80 per cent of teen girls said they would rather see natural photos of models rather than pictures that had been digitally altered or enhanced. Other top influences on body perceptions, aside from celebrities and models, are peers, friends and parents, the poll showed.

2010 New Year's Resolution: Stop pitting body shapes against each other!

www.nataliedee.com

More British women say they would prefer to look like curvy Kate Winslet than skinny Victoria Beckham.

According to Jezebel, in a poll of 2,000 British women commissioned by weight-loss company Slimming World, Kate Winslet came out on top as the star whose figure was "most desired". She got 16% of the vote, closely followed by TV presenter Kelly Brook with 15% and Halle Berry with 12%. Bringing up the rear were Kate Moss, Posh, and Jordan, with 1% each.

Slimming World also released a statement that said:

It shows a positive shift that women are more likely to see Kate Winslet and Kelly Brook as the ideal body shape rather than Kate Moss or Victoria Beckham.

It perhaps suggests that it is not being "skinny" that is most important to them anymore, it is being healthy.

Here's a resolution for the new year -- How about we stop holding up one body shape, whether it be a curvy or skinny one, as the one and only "standard ideal". How about acknowledging the fact that human bodies come in a variety of shapes and sizes. How about we ensure that no one should feel like they should work towards attaining another celebrity's body shape/size, simply because they are two distinct individuals with two different bodies!?

For the love of 2010, please stop this shit.

But happy new year anyway!

If We are First Taught to Mistrust Ourselves...

Nearly a month ago there was an article in the Straits Times about a woman who was literally set on fire at a slimming centre as part of a procedure. As in she was told to lie on a table, a towel soaked in rubbing alcohol was draped over her stomach and the beautician whipped out a lighter and set fire to the towel.

From the article:

Once the towel was set ablaze, Madam Lee felt a sharp pain around her abdomen.

"I can't remember much of the incident. But I was in so much pain, I couldn't even talk," she said.

Staff at the centre managed to put out the fire, and she was sent to a nearby clinic where she was given medication.

"One employee even asked me, 'Really that pain?'" Madam Lee said.

Her medical bill of $40 was paid by Geneva. She was given another $150 for follow-up medical treatment. When contacted, the owner of Geneva said the centre no longer performed the treatment.

So they set someone on fire, express disbelief that it had been an "uncomfortable" experience and give her a little less than $200 for her trouble.

A proprietor of another slimming centre, when asked for comment had this to say:

Ms Catherine Koh, the owner of Beauty Forever Sal0on, said: "Now that the market is bad, the centres will try to think of all kinds of ways to get customers, so customers have to judge for themselves what is safe."

In other words, we will continue to expose you to hazardous situations because you are willing to pay for it. The harm that befalls you can only be the fault of your poor judgement.

How did an adult woman allow herself to be set on fire? In her own words:

'They didn't really explain the procedure in much detail,' Madam Lee said. She did not probe further.

It was only when the therapist whipped out a lighter that she felt slightly alarmed. 'But the employee kept telling me that she was here with me, so I shouldn't be scared,' she added.

Why didn't she ask for the procedure to be stopped? Why didn't a grown woman, "judge for [herself] what is safe"?

How could she?

How could she when as a fat person she is told that she is unhealthy and at risk for all kinds of debilitating and life-threatening diseases even though she is able to walk long distances carrying heavy groceries? How could she when as a fat person she is told that she is smelly and takes up too much room even though she practices excellent personal hygiene and smells better than the skinny bloke on the MRT who is, incidently, using two seats? How could she when as a fat person she is told she is unattractive and unlovable even though she has a (presumably) loving husband and family? (I must add that it was her children's cruel comments that pushed her to seek slimming treatments, so I do wonder about how loving the enviroment is - that being said, friends and family of the fat get messages daily about how loving a fat person means encouraging them to lose weight...just 5% makes a difference!)

As fat people we are taught to mistrust our own experiences and subsitute it for all the negative narratives we are fed daily in many small ways about our personalities, habits and loved ones. As fat people we are told that by virtue of what we look like we are all manner of disgusting and abhorrent and that to earn, to deserve the space we take up in this world we have to prove that we're trying to be good, that we recognize we are fat.

We are asked whether we're really hungry, to think about why we're eating, as though we cannot trust what our bodies have to tell us. We are told that all we need are 800-1200 calories a day to function even though when we adhere to these diets (it's a lifestyle change, y'know) all we can think about is food and all we do is feel guilty that we're still hungry and unable to gather enough energy to hit the gym (or walk home from the bus stop, for that matter). We never realise that the problem is with the diet and not with ourselves because we have been taught that as a fat person our lived experiences are a by-product of dysfunction and that we must be punished, punished, punished into submission, into that unsustainable smaller size and punished again when it all comes back.

We live in this miasma of fat shaming that discredits us and forces us to question our own judgements. How then are we supposed to "judge for themselves what is safe"? How then are we supposed to figure out that we don't all deserve to be set on fire afterall?

Public Service Annoucement: "To have self-esteem."

My turkey spectral pal's really awesome and very sad moving tale of her first encounter with pedestrian racism has really put me in such a horrible mood. I'm bowled over by the sort of shitty things parents, guardians and mentors can teach children in the name of love and the latter's self-interest. As I said in the comment section there, I'm reminded of my own experience in having to listen to the sort of bullshit about race and "bad animals" that my elders tried to inculcate in me, which for some reason never really stuck because I was and continue to be doubtful of authority figure and authoritative--and worse, authoritarian--tones.

Unlike many other people, I was always in the company of authority figures who fought a lot with each other, make all sorts of mistakes and cause all forms of hurt behind closed doors. That slightly dysfunctional background led me to understand intuitively that even purported role models are not always right. As my feline friend discovers, older people are not necessarily relevant in their 'wisdom'. By all means respect your elders as you should other people, especially with the common decency that we should accord all human beings (see: Human Rights), but screw that listen to your elders unremittingly bullshit.

This is going to be hard to accept, but even we on the barn makes mistakes for the simple reason that nobody's perfect. (Though, we're still pretty damn close to cutesy perfection, yo!)

So dear searching kid, teenager, jia-buey-tua (literally: eat no big) adult who feels different and alienated from the majority, please find delight in the fact that the sagely ones and even your media bigwigs might be wrong, but that you are capable of change and differing from them. Therein making you a little more real (human or otherwise), and a little more prepared for a life of infinite betterment.

Finally, I dedicate the following clip to Poultrygeist and all the other barnmates for showing us that one can actually wade through all the misogynistic, anti-gay, racist, et al bullshit to come out stronger, wiser and brimming with such admirable self-esteem. This is by yet another American comedienne, Margaret Cho, whom I mostly piggishly love, from her stand-up "Notorious C.H.O." (2002):

And I have a lot of self-esteem, which is amazing 'cause I'm probably somebody who wouldn't necessarily have a lot of self-esteem as I am considered a minority.

And if you are a woman; if you are a person of color; if you are gay, lesbian, bisexual, transgender; if you are a person of size; if you are person of intelligence; if you are a person of integrity, then you are considered a minority in this world.

And it's going to be really hard to find messages of self-love and support anywhere, especially women's and gay men's culture. It's all about how you have to a look certain way, or else you're worthless. You know when you look in the mirror, and you think: Urgh! I'm so ugly! I'm so fat! I'm so old!

Don't you know? That's not your authentic self?

But that is billions upon billions of dollars of advertising, magazines, movies, billboards, all geared to make you feel shitty about yourself, so that you will take your hard-earned money, and spend it at the mall, on some turn-around cream that doesn't turn around shit!

If you don't have self-esteem, you'd hesitate before you do anything in your life.

You'd hesitate to go for the job you really wanna go for.

You'd hesitate to ask for a raise.

You'd hesitate to call yourself an American. [BDP: please feel free to substitute this with your appropriate nationality.]

You'd hesitate to report a rape.

You'd hesitate to defend yourself when you are discriminated against because of your race, your sexuality, your size, your gender.

You'd hesitate to vote. You'd hesitate to dream.

For us to have self-esteem is truly an act of revolution, and our revolution is long overdue.

XOXO

What's in a number?

This Cow was uncomplainingly chewing her cud of chocolate croissant and marble cake at breakfast this morning when she read about the Health Promotion Board's National Healthy Lifestyle Campaign: Know Your BMI, Know Your Risks. HPB's press release reveals this campaign to be overwhelmingly about "obesity and overweight issues" and "weight management" and how BMI "is used as a measurement tool to classify a range of health risk categories". There's even a whole website devoted to this magic number.

There are many blogs and websites out there which explore the wider social context of, and experiences arising from the fixation of equating BMI to obesity to health or poorness thereof (Shapely Prose on our link sidebar is an excellent springboard). But this Cow fiddles around with numbers and statistical distributions for a good part of her waking hours, and something about the definition of the risk categories in the BMI, and the definition of obesity in general, strikes her as easy PR without proven improvements in public health outcome.

Definitions of obesity based on percentile measures of a population distribution of height and weight are just that: percentiles. Percentiles are cut-off points which capture an arbitrary proportion of a population that fall above or below the cut-off point. A statement of fact, "X% of people are above Y kg in weight" tells you only that. What makes me healthy or not is a confluence of what genes I was born with and how I live, not my ranking in a statistical distribution that has not been shown to be clearly and simplistically linked to health outcomes. Since health risks and outcomes are affected by more complex factors and interactions than simple measurements of height and weight or the precise mathematical relationship between them that BMI represents, such measures on their own can't tell you much about an individual's health. "Do You Believe in Fairies, Unicorns, or the BMI?" has a more detailed analysis, and is written by an Actual Mathematician(TM)!

Distributions are characterised not just by their mean, but by the variation about the mean. And when distributions measure some characteristics of a population, they change over time. Focusing on one soundbite-y measurement may be convenient for the HPB, but surely an event that promises to "come alive with activities and entertainment for employees and families" has space for ideas on how to be healthy other than trying as hard as you can to not be in that X% that weigh above Y kg?

Fat Fashion is a Feminist Issue

Rendering populations invisible is a powerful silencing tool. It is a very handy way to make voices illegitimate, an easy way to discount the powerful truths being uttered by mouths you don’t even have to acknowledge are speaking.

The inestimable Melissa McEwan at Shakesville has written a post about shopping while fat and it resonated deeply with me. Not being able to find clothes that fit is a frustrating and energy consuming and demoralizing experience. Just recently I was trying to find a bridesmaids dress (the only criteria was that it had to be purple) in a shopping centre three-blocks-big that has been hailed since its grand opening as the fashion capital of Victoria. At 95kg and 167cm (I think that’s about right, I don’t make a habit of weighing myself) I can usually fit into the largest sizes stocked by straight-sized stores and the smallest sizes stocked by plus-sized stores. You know what though? Through the whole mall there was only one plus-sized store and it was stocked with only 2 items: strapless empire-waisted colour block dresses (to create an optical illusion, y’know) and shapeless over-large tunics (to hide your awful body, y’know). All the other stores from emergent designers to the names that draw celebrities to front-row seats at New York/Paris/Milan fashion week didn’t have clothes I could even try on. As in the garments were so small there was no chance of it making it past my substantial chest, or over my generous hips – even fully unzipped.

I’m not even that fat.

The bigger department stores embedded in the mall did carry formal wear in larger sizes (16-24) but you know what? They were so sombre and boring and tent-like that even my 72 year-old grandmother would eschew those styles for something that “wasn’t so old”. The message was clear – if you have to wear something you fatty-fat-fat-fat at least have the decency to wear something that hides your fat. It will make you look larger overall, but at least we won’t have to see any offensive jiggle-flesh or whatever it is you actually look like, because we designers actually don’t like to look all that closely. I’m not even inferring this from the styles available in the meagre selection us “bigger folk” get to paw through on our shopping trips. For reference, a quick Google of Karl Lagerfeld’s opinions of fat people (which I will neither quote nor link to, thank you very much) or Anna Wintour’s fabled disdain of fat (ditto).

Hiding us fat people away in sloppy garments is a way to make us invisible. Denying us vibrant colours (black is so slimming, y’know) is removing our visibility. Withholding from us the near-universal experience of a shopping day with friends by turning it into a day fraught with mental-health-minefields limits our social activities.

If you’ve ever sat next to a fat person on a plane or on public transport you would have seen them try desperately to make themselves narrower by folding their arms and pressing their legs together in an effort to not take up too much room – the psychological fallout from the constant messages that we need to hide, be hidden away, that we are taking up more space than we should really be allowed to. Maybe you haven’t noticed. Maybe you’re one of those people that look at the fat person on the chair and think “oh god ewww, I hope I won’t have to touch that if I sit down next to it” and not realise at all that we don’t much want to have our thighs touch yours either, thanks very much. (As an aside, I find the biggest offenders in the you-take-up-more-public-space-than-you-should are the men who sit with legs spread far apart. I’ve always wondered if it makes them feel like they have big penises. If any of you are reading this now, let me just say that it’s not fooling anyone.)

Sure the oppressions fat people face in their daily lives cannot solely be attributed to the dearth of flattering clothing in appropriate sizes. But it’s just one more thing we have to deal with and it’s one more way we’re made to feel invisible, less-than, not worthy of public space.

For more discussion of fat, fashion and being fat at the public, head on over and read the (highly recommended) folks at Fatshionista.