How to Hire a Doula

So, I’ve talked about why you should hire a doula.  But how to hire one?

Start looking by week 30 of your pregnancy.  This gives you time to do your research, find someone, and get acquainted.

Some doulas are trained and/or certified by organizations like DONA, CAPPA, or ToLabor.  If so, they should be listed with that organization.

Your friends, family, doctor, or midwife may have a recommendation.  What makes someone else comfortable may not work for you, though, so an interview is always in order.

Consider interviewing more than one doula, so you can contrast and compare styles and strengths.  Any doula should be willing to meet with you and talk over your plans and wishes before signing a contract.

One of the most important things to consider is how you feel around your doula.  You should feel safe and supported at all times.  

During your interview, ask how many births they’ve attended and how long they have worked a doula.  Ask for references.

Verify that your doula has a backup person in case of illness or emergency.  You should have the option to meet the backup doula as well.

Talk about your intentions for your birth. They can provide information, support and suggestions, but you’re steering this. If they get pushy about they think your birth should go, think about seeking help elsewhere.

Ask about how they communicate with medical staff.  There should be a goal of mutual respect, and they should be willing to work with medical staff, not take over.

Doulas generally don’t do any medical services. They shouldn’t be doing the things your OB/GYN or midwife does, like cervical checks, ultrasound, etc. That is outside scope of practice, and a potential red flag.

Ask about their experience with positions, comfort measures like massage and breathing strategies.  You’ll want to know that they can help everyone in the room remains calm and understands what is going on as the birth progresses.

Ask about what they do if a c-section becomes required.  Depending on the situation, a doula can still assist with emotional support during a c-section.

Ask if they have experience helping with breastfeeding or pumping (assuming you’ll be seeking that).

Find out what they do after the birth – do they help get you settled in at home? Do they do a follow-up visit?

They are there to support you, not make decisions for you. They don’t have the authority to act as an intermediary between you and the other birth staff, but they can help you by making suggestions as to how to get your point across or compromise when issues come up.  This is your birth, and your responsibility, but they’re there to help you!

In the end, find someone you’re comfortable with, that seems helpful and patient and knowledgeable.  Doulas are well worth the cost, and they’ll help you keep track of your goals and coping skills during your birth.

What do you suggest when choosing a doula?

 

Why do you want women to be uncomfortable?

I received a message this week from a woman who has recently gained weight for the first time in her life, and is no longer comfortable in her body.  She said a lot of things including, “why do you want women to be uncomfortable?”  She meant physically uncomfortable with their bellies or such, with the amount of space they take up and how it may restrict movement or comfort in chairs or yoga positions or such.

It sucks to be uncomfortable in your body.  I don’t want to downplay that.  But any significant body change requires adjustment, and part of that is to become comfortable with the change.

There are two kinds of comfortable- physically comfortable and emotionally comfortable.  I posit it is hard to be comfortable one way without being comfortable both ways.  If you’re constantly worried about X body part, you can be hyper-aware of it, leading to a sense of physical discomfort.

But being fat in and of itself is not necessarily physically uncomfortable.  My neck can get very uncomfortable.  I used to think my neck was uncomfortable and I couldn’t bend it very far because it was so terribly fat (emotional discomfort).  Turns out, my neck is often uncomfortable because the muscles get very very tight, and I can’t bend it very far because I’m pulled unreasonably tight half the time.  I can practically look behind myself after a good massage, no weight loss needed.  And as you can see, I can go further than touching my toes (I do the glamorous things, just for you all!).  I am comfortable in my body.

 

Yours Truly, legs straight, hands on the floor. Skirts are difficult, y’all.

Ragen Chastain can do the splits, is a professional dancer, and is training for a marathon December first1.

 

Ragen Chastain
photo from the adipositivity project

Being comfortable may be something you need to work towards.  As bodies change, needs change.  And bodies pretty much always change.  Weight gain or loss, age, pregnancy, illness, injury- any of these things can change the body and change comfort.

May I suggest a few things to help bolster comfort in your own body?

Move your body-  Take up space, stretch, take a walk, do yoga, go swimming, swing on a swingset, dance (by yourself in your room, or take a lesson!), play sports.  Use the body you have and feel its power.

Touch your body- Moisturizing and doing my own body scrubs are some of the best things I can do to get comfortable in my body, and they make my body more comfortable!  Touch the parts of your body you are uncomfortable with.  It may take time, but you’ll get more familiar with your own body.  Solo sex is a great way to get comfortable with your own body.

Have someone else touch your body- Get a massage.  Hug a friend.  Curl up with loved ones.  Notice that they are just fine with your body.  Sex with a partner also helps!

Examine cultural messages- Notice where you are getting messages that your body (or part of your body) is a problem.  Is it a commercial? A magazine? A store?

Surround yourself with better messages- check out the writers and artists I’ve featured on the Brilliant People page, especially Marilyn Wann’s Yay Scale and Substantia Jones’ Adipositivity project (NSFW).

How do you get comfortable in your body?

  1. flexibility and physical endurance aren’t necessarily markers of being comfortable in your own body, but they can be

Plus-size Pregnancy Fashion

Lots of people have written about where to find plus size maternity clothes.  Where to find it, when to buy it, and how to work it into your budget.  I’m not one to reinvent the wheel, so here are some excellent articles from people with firsthand experience that cover the spectrum of plus size maternity clothes information:

Body Positive Maternity Clothing Advice by Alice at Offbeat Families

Overall great advice and awesome pictures.  Great shopping information and information on how to modify what you already own.  Not specifically a plus-size article, but I didn’t see anything that was bad advice for fat folks.

The Masterlist Plus-Size Maternity Resource FAQ by Kmom of Well-Rounded Mama

Take some time with this one.  It has great advice and the largest list of available retailers I’ve seen, including consignment.

Ample Mama

I came across Ample Mama, a company out of Canada offering plus size maternity clothes from 1x-3x.  They ship to Canada and the US, and seem to have a decent selection.

Plus Size Birth

Plus Size Birth has two great resources for plus size clothing information.  She has a great post about plus size maternity clothes, and a youtube video.

What was your experience with plus size maternity clothes?  Do you have a favorite store or trick?

Research Tuesdays: A Writer, I am Not

You know how some people write for pleasure?  They keep journals, and write short stories or novels or poems for fun? They participate in NaNoWriMo for kicks?  Yeah, I know those people, and I love them.  My NaNoWriMo folks, keep up the good fight!  But I am not one of those people.  Writing doesn’t come naturally to me, and it makes me super nervous.

One of the things I want to do most here is my research posts. I think it is really important to understand why different medical professionals recommend different courses of care. Academic, peer-reviewed study is a big piece of understanding why we structure medical care the way we do. It is also the best way to factually understand why and how we should change things to consistently provide better care.

I have high academic standards for information, and I know that there is a lot of skewed information out there, even in smart places like academic journals. I am not a writer by trade, and I’m still in school, and still steep on my learning curve.

I am getting a little stuck because I am so worried I’m going to get something wrong. As is the nature in any field, I am bound to be wrong eventually. Anything I say here needs to be verified. Please, check out my sources, and check out people who disagree with what I say. Please check with your medical professional. Keep in mind I am a student. I am not a midwife yet, and as a reader of this site, you’ll be the first to know when I am!

This is not so much a legal disclaimer as an ethical one. I wholeheartedly trust the resources I use. I will never publish anything if I’m not prepared to stand behind it. I want to keep this site as a portfolio of trust-worthy, backed up information so that people can trust me and the information I present.

But I am a perfectionist at heart, and lately I’m brought to an anxious halt by the idea that I might someday let you down. I write to the best of my abilities, with the best, most rigorous research I can find.

I love to learn more, so please feel free to send me studies, articles, and information, especially if you find it in opposition to what I write here.

Research Tuesdays will be back next week.

Research Tuesdays: Case Studies

Case studies are completely different from the way we often think of studies- large populations with quantifiable, calculable data.  But case studies are excellent for understanding new areas of information, and exploring what we may currently be missing in health studies by providing a snapshot of individuals or groups within a certain situation.  Here are two papers including case studies of fat-related health issues that are not currently receiving a lot of research:

Eating Disorders in Fat Teens

Fat people have eating disorders.  This isn’t often talked about because it is often difficult to diagnose eating disorders in fat (or previously fat people), because behaviors are initially seen as normal and even praise-worthy. 

Not surprisingly overweight and obese teens are developing eating disorders, with studies showing just under half, to over half, of eating disorder patients have a history of above-ideal BMI, with diagnoses ranging from anorexia nervosa, to bulimia nervosa, to binge-eating disorder, to eating disorder- not otherwise specified (ED-NOS). This paper, presented in the Journal of the American Academy of Pediatrics, covers two case studies regarding adolescents with eating disorders that started at age 12, and went undiagnosed for two and six years, respectively.  The discussion section of the paper notes that these cases are not unique. 

Whenever weights are used in eating disorder criteria, it causes some patients to fly under the radar.  Behaviors are a far more accurate way to identify eating disorders, and fat folks are far from immune.  By far, the majority of eating disorders start from dieting

Fat Positivity improving Health Outcomes

This article covers health outcomes and stories of 44 fat advocacy bloggers.  The researches discovered that these people reported improved health, as well as ways to combat stigma and build community.  Stigma, essentially public disapproval or shame, is known to adversely affect health. These people found a way to cope with the stigma and stress of being fat in a culture that , and shared ways to improve health without weight loss. 

Dr. Samantha Thomas, a researcher involved in the study, said “Having that support and feeling empowered, people slowly found that their health behaviours began to change dramatically…People shifted their focus away from weight loss and more toward health. A lot of people started to take part in physical activity not as a way to lose weight but because they enjoyed it…It’s actually a massive shift in the way they looked at things.”

She also stated, “There are actually a lot of lessons for public health here.”

 

Research Review: Money as Motivation for C-sections

C-section rates are high in the US, and higher in fat women.

NPR just released an article talking about a study that proposes the United States’ high cesarean section rate is at least partially motivated by money.  This is plausible, as c-sections tend to bring in more money to a doctor and hospital, take less time, can be scheduled, and it is far harder to get sued for intervening than for not intervening. Interventions as lawsuit-prevention is a common theme among rates of other interventions, too, like episiotomies, pitocin, and epidurals.

My issue comes with their methodology.  Unfortunately, the actual paper is behind a pay wall.  NPR’s coverage of it stated that the study found OB-GYNs preform fewer c-sections on doctors than patients who worked in other fields.  I don’t doubt that.  It concluded that because doctors (as patients) are better informed, they receive fewer unnecessary c-sections (unnecessarians, if you will). They make the analogy that mechanics pay lower repair fees and have fewer repairs on their cars.  The idea is that OB-GYNs are less likely to recommend unnecessary costly procedures to people who will knowingly refuse them.

I think that this study may have faulty logic and may not give enough consideration to confounding factors.  People who are poor, not white or Asian, have lower levels of education, and are fatterhave higher c-section rates.  The study doesn’t seem to account for the idea that doctors are, as a whole, the opposite of that demographic.  Doctors have achieved higher levels of education, are statistically far more likely to be white or Asian, they may not be rich but they are more affluent than average, and doctors are less likely to be fat.

Thus, just by their demographics, doctors are less likely to have a cesarean section.  I think it is important to identify why doctors receive fewer cesarean sections, as c-section rates are too high in this country and globally (Pgs. 25-26).  But the answer is likely more complicated than just their expertise, and we should strive to remedy all the areas of inequalities around receiving the best care possible, not just the ones that are easy to identify.

Research Roundup

I’m starting a series of posts about current research around fat studies and/or birth.  I’ll feature the studies I come across along with a summary. 

Feel free to let me know about research you’ve found at: amy@thefatmidwife.com

Fat does not equal high risk pregnancy or birth:

Fat women are often excluded from birth centers because having a BMI over 35 is considered high risk, even if they don’t have complications like gestational diabetes.  This study finds that fat women who have already given birth and don’t have complicationsk (like gestational diabetes, preeclampsia, etc) do not have any more risk than thin women pregnant for the first time.
This study concludes that fat women may have lower risk pregnancies than previously assumed, and that BMI by itself is not a reliable condition for exclusion from out of hospital birth options.

Midwifery-led care provides better outcomes for women in a hospital setting:

This review involves over a dozen studies.  It only used studies monitoring midwives that worked within a hospital setting.  These midwives cared for their patients during pregnancy, birth, and provided aftercare.  Compared to regular gynecological care, positive outcomes for mothers included reduced epidural rates, fewer episiotomies, fewer instrumental births, and fewer rates of pre-term birth.  There were no risks or problems seen stemming from the midwifery care. 

Dieting before and during pregnancy  bad for fetal development (in sheep):

This study overfed sheep and then restricted their diets and compared them to controls. They were then put on a controlled diet, and the embryos were transplanted into another sheep after a week of pregnancy.  This was to identify the effect of early weight loss on the embryos, especially their metabolisms. 

I’m intrigued by this study because I am wary of congratulating any woman on losing weight during their pregnancy and this seems to confirm it may have adverse effects. 

However, I’m not completely comfortable with this study, because they artificially fattened up sheep, which already puts stress on the body, and then attributed the fetal differences to the diets.
I think they may have involved too many variables.

We Just Don’t Do That Here

My friend sent me an article this week about body shaming- the way we talk about people’s bodies as ”good” or “bad”.
 
This spring, I had an awesome water exercise class.   Twice a week, I’d go frolic in a pool in the morning, and I’d shower off the bromine afterwards.  Like most people, I shower naked.  The showers at school are not private, so other people can see my naked, fat body.  Lucky them.

The weird part was, that one woman told me more than once while I was in the shower, “You’ve lost weight!”

People use “You’ve lost weight” as a catch-all compliment.  Generally when someone insists I’ve lost weight, I say, “I doubt it, and that’s ok.” Lather, rinse, repeat. My response is usually met by a double-down. “No, I really think you have.  Maybe you’ve just toned up.  I don’t know, you look good.” I tend to repeat things like “I work out to feel better, I don’t think that’s likely, I like my body as-is,” until they go away or change the subject.

However, this person did this while I was naked-unsolicited, and more than once.  That’s not acceptable.  We have a perfectly pleasant unspoken code that you ignore the fact that other people are naked in a locker room.  You don’t look, and you certainly don’t comment.  I let it go the first time, and after the second time, I stopped by their locker and tried to deal with this kindly and privately.

That went over like a fart in church.  
She said, “I was just complimenting you.”
(I understand that. It still makes me uncomfortable, and I’d appreciate it if you didn’t do it again.)
“Well, you don’t have to worry about it, I don’t like you *mumble mumble* anyway.”
She then flipped me the bird on my way back to the shower, and started yelling from beyond the shower wall as she walked by.

When I told friends this story, people were shocked- why would she react that way?

While I was surprised at the vehemence of her response, I wasn’t shocked.  People expect me to hate my body.  Combine that with asking someone to stop what they view as acceptable behavior, and having a hard time can easily end up turning to hostility.

A week or so later, I was waiting for a massage at the local steam bath (love that place!) and ended up striking up a conversation with another woman in the waiting area.  We talked about partners and houses, and where we’ve lived, and we ended up talking about her experience with breast cancer.  She had breast cancer over 20 years ago, and gained significant weight when she was on Tamoxifen.  She talked about trying to lose it, and how hard it was, and how she eventually just settled into her own body after a while, but at least she’s not obese.

I said, “I am,” and talked about how no weight loss program has a remotely reasonable 5-year success rate, how improving your diet and exercise show health improvement while weight loss may not, and how I’ve chosen not to yo-yo diet, or diet at all anymore.  I excused myself and had a lovely massage, and chatted about old and new birth control options with my massage therapist.

When I returned from my massage, the same woman and another woman started telling me about quinoa, kambucha, and other health foods that I should try, out of the blue.  I told them that I like quinoa, I’m interested in kambucha, don’t much care for coconut water, etc., etc.  I mentioned that I want to find some ethically sourced quinoa, since the native Bolivians and Peruvians can’t afford their own healthy crop, and I don’t particularly want to contribute to that.  Even so, I was caught in a continued crossfire of unsolicited diet advice, and it was uncomfortable.

These are not unusual moments in living while fat, but they are notable.

They are notable because these are the few times this happens to me anymore.  I didn’t become less fat.  I convinced all my friends, family, and coworkers that “We don’t do that here.”

We don’t put down our bodies, or other people’s bodies.
We don’t talk about food like it is our enemy. 
We don’t talk about your diet.
We don’t let our size limit what we want to wear.

It’s nothing against you, we just don’t do that here. 

It took a long time to get comfortable with it.  But “we don’t do that here” is not too hard. 

Neither is just stating your opinion.  When I was working with someone who was making fun of the idea of a fat woman in a bikini, I said “Oh, I’ve wanted one for a while! I’ve got my eye on a cute one with a Hawaiian pattern on it.”  Let them think about what they’ve said.

I compliment people on what they do, not what they are.  For me, this means I compliment people on their style and achievements, which are things we choose, rather than on their body. 

It takes some effort, but changing these interactions with people means I spend less time worrying about body image issues, and some friends have thanked me for changing how they view their body, too.

 

I Have a Luscious Beard

Lets do some good old fashioned soul-baring, inspired by The Militant Baker.

I have Polycystic Ovary Syndrome.  It can mean a lot of different things to different people. To me it means I keep a closer eye on my heart health and blood sugar, both of which are currently normal. It may have contributed to my current size.  PCOS correlates to the depression that I have dealt with off and on since I was a teen.  I was told I may be infertile when I was diagnosed at 15.  I was diagnosed when my mom and I realized my periods weren’t becoming regular as a teenager.

With a little care, I’m lucky that I am as healthy as a horse.  The jury is out as to whether fatness is a cause or effect things with PCOS, and frankly I only care about it academically.  That same big horse is already out of the barn, and a fancy chestnut mare is she.  Turns out, I’m probably not infertile.  However, I’m all over the jump-straight-to-spoiling role of auntie, so I won’t be testing that theory.

Other people may see actual cystic ovaries (although this is not guaranteed), heavy or absent periods, thyroid issues, thinning hair and acne and other skin issues.  Symptoms vary from person to person.  Symptoms may show up at puberty, like mine did, or may show up later in life.

The biggest part of my PCOS that I deal with daily is the beard…  I started growing facial hair at about 17.  I’ve been super self-conscious of it since then, but turns out people generally don’t notice.  Or they’re too polite to say so.  Even so, I’ve tried almost everything to get rid of it.  Most things I’ve tried have caused more skin irritation and acne than hair removal.  I now reap the benefits of a laser hair removal groupon I used few years ago, and a constant supply of tweezers stashed strategically in the bathroom and in my purse.  I’ve also made more peace with it and don’t worry about it as much anymore.

Female facial hair can be a sign of hormonal imbalance, but it can also be normal human variation.  I don’t discount the fact that the men in my family are impressively hairy.  There are women who embrace their facial hair.  I think that is awesome.  While I like my face smooth, I don’t pretend that the preference is not a cultural thing.  Mariam and Balpreet both look great.

 

Scooters and Birthwork

I love riding my scooter.  My dad rides a motorcycle and I always loved riding with him.  A few years ago, I gave up my car (by “give up”, I mean totaled, and refused to replace). I’m not a terribly good driver, and it is much harder to get distracted on my scooter.  I chose a scooter partially because I have a tendency to wear skirts every day; I’m not much of a lady most of the time, but straddling a motorcycle in a skirt is a bit beyond my comfort level.  This leads to an interesting world in which some motorcycle riders acknowledge me as two-wheeled kin, and some don’t.  I love seeing motorcyclists and scooterists on the road.   To me, its a party where we all try not to get killed by drivers. And I always give a head nod or wave, either way.  It isn’t always returned.  I’m sure there is an argument to be made that a scooter can’t always go as fast, is a cop-out, and other reasons that motor cyclists might not openly recognize me.  And that’s fine.  While it is nice to see a head nod, wave, or two fingers flashed over a handlebar, the absence of recognition doesn’t make me go home and cry at night.

As I rode along a few miles from home, I was thinking about how this correlates to the birth community.  Some see it as an adversarial system, where OB-GYNs just want money for c-sections and their evenings free, and labor and delivery nurses are either overworked and surly or saints, midwives are angels, but home-birth midwives  might be irresponsible, and doulas take over the roles that friends and families should fill and just annoy the nurses.  And of course, they all have trouble working together.

I remember when I first chose to start down the path to become a midwife, I chatted with a labor and delivery nurse one night at a friend’s house.  I told her I was really glad to hear what she did, and asked her some questions about her experiences.  Eventually, she asked me what my plans were. When I told her I wanted to be a midwife, she laid into me saying that any time a woman had a midwife they always ended up in her care with interventions.  My decision was foolish, and harmful.  I was shocked at the vehemence.  I never ran into her after that night, so I never had the chance to understand the experiences that lead to her frustration with midwives and home births.

Her line of reasoning didn’t make sense, from multiple angles.  There are many midwives who work in hospitals, and there is plenty of evidence showing that home births and birth center births are effective for many women.

I don’t think either view has much merit.  In birth, no one has a direct ride to the front of the class. Each position has strengths and weaknesses.  Every care provider picked their occupation to help pregnant and laboring mothers.  OB-GYNs have a level of skill that is required for more complicated cases.  Midwives have skills to lead uncomplicated cases safely through pregnancy and birth.  Nurses provide care and  valuable monitoring and liaising with a hospital.  Home birth midwives fulfill a community need for supervision and guidance, even in the simplest of cases.  Doulas provide one-on-one support, hands-on assistance, and useful education.  They can all work together, within their own scope of practice, to create a community that supports parents at every level.

And maybe we can all go for a ride afterwards.

 

Adventures in Personal Training

I am pursuing personal training for a bunch of reasons.  In order of importance, these reasons are:

  • I really, really like moving things around and being freaky strong
  • I like being able to walk, scurry, sprint, ride my bike, swim, and play on swing sets without getting winded
  • I like being flexible and bendy
  • The apocolypse
  • It will likely improve my cardiovascular fitness and overall health

Keep in mind I, personally, find all these things important.  You may enjoy (or tolerate) physical activity because of all, some, or none of these reasons.  Or you may not.   I love a Health at Every Size mentality and will continue to talk about it (a lot), but health is not a moral imperative.  Health is not a ticket to basic dignity and respect.  I’m at a place where I’m doing things that I enjoy, that improve my health.  This does not make me better or worse than anyone else.

It does, however, make me do ridiculous things like meet with a personal trainer.  Rob and I introduced ourselves yesterday, and we sat down at my local hamster wheel to fill out the appropriate paperwork.  We talked about goals, what I’ve been doing for fitness lately, why I’m coming to this gym (online coupon for a month’s membership and 4 personal training sessions).  And then we get to the fun part.  I’m far enough removed from my dieting days that my weight and such are more of a passing curiosity than a cause for panic, so we measured my weight and body fat percentage. He wrote down the numbers and said, “Of course, we’d like to see your body fat percentage around [number redacted] percent.”

“Well, that’s a relative “we”.  See, I’m here to work on these goals, regardless of any changes in weight or body composition.”

“But diabetes, cardiovascular disease, mortality….”

I told him I understood his concerns, but that long term weight loss is not statistically likely.  And that my health can improve significantly from improved diet and activity that I enjoy.

We went a couple rounds, with me citing these studies, and him citing his book of clients.  I’m thrilled for his clients.  They have achieved something that they wanted.  But only one client he showed me had maintained the weight loss past five years, which seems to correlate with the statistics I cited in our conversation.  Her goals are not my goals, and those odds are not odds I’m interested in.

We stopped debating when I said, “Here’s the deal.  If I lose weight, you get a giant gold star and a letter from me for your book.  If I don’t lose weight, but I do gain strength and reach my other goals, then we still both win.”  We came to a truce and he sent me out for a warm-up of my choice.   I like the elliptical machine.

We then did barbell squats, leg presses, leg extensions, and wall sits.  And by we, I mean I.  He pushed me to do reps, and we laughed as my legs shook.  We gossiped and talked a little smack.  It was glorious.  I’m sore today, but I can’t wait to go back next week, after doula training.  While Rob and I don’t see eye to eye about weight, I have an ally in my corner because I was able to advocate for myself and put down boundaries about what I wanted out of my personal training.

 

Amy, What About That Ted Talk?

I’ve had a bunch of people ask me about this video.  Peter Attia talks about fat stigma, diabetes, and alternate theories of why people are fat.

There is pretty good science about the idea that there are reasons that lead to obesity other than the “two whole cakes” theory, which states (approximately) that all fat people are somehow sneaking two whole cakes daily. He talked about one of those suggested reasons. The idea is that insulin resistance causes obesity, not the other way around. This is promising. I love that people are looking at their preconceived notions about fat people and talking about them publicly.

I also support the fact that he pointed out that there are a good number of obese people that are metabolically healthy, and thin people with metabolic syndrome. These are often tied to diet and exercise, hence why I follow a HAES® mentality for those that WANT to improve their health. 
Those messages I support.

However, for those people who are fat and metabolically healthy- that means that they aren’t showing signs of insulin resistance. I think that needed to be more than a passing note in his lecture, because if they aren’t showing symptoms of insulin resistance, then why are they fat? I fall into this category. 

I have trouble with his messages of “I eat like this, and I lost a bunch of weight,” and the idea thinner is tacitly better, and realistically achievable. Not everyone loses weight with improved diet and/or activity. I also think that health is multi-dimensional, and sometimes the best thing for someones overall well-being isn’t improving their physical health at the expense of their social, emotional, and/or spiritual health.  This approach does not so much fix the stigma fat people face, but changing the bar by which we judge fat people-  if they’re insulin-resistant, and doctors say it is ok, then they’re not terrible people?  But those other fat people…

I don’t agree with a moving target for stigma.

 

But I Can’t ‘Move Joyfully’ Without Workout Clothes!

I know that many large women have trouble finding workout clothes in their size.  They either can’t find it or can’t afford it.

I remember wanting to start working out a few year ago, having nothing appropriate to wear, and going to Target, where the only pants and shirts I could find were just a smidge too small, but what else was I going to do?

Well, I’m older, wiser, and love online shopping.  Of course, I’d love it more if I could shop in stores, but I’ll take what I can get for the moment.

 

In stores, Old Navy carries workout gear through an XXL.  Their regular sizing is generous, and an XXL will likely fit through a 22/24, even though they’re marked as 20.  They have capris, yoga pants, sports bras, tanks, and t-shirts, and carry compression gear.  Online, they carry sizes 18W-30W in their plus section.  While the selection is a bit smaller and the fat-tax is pretty generous, they carry all styles of gear at decent prices.  I went on a spree a few years ago, so Old Navy is what I wear, and I find it pretty darn comfortable!

 

You’d never know it by their pathetic in-store offerings, but Target carries some decent women’s workout clothes online.  Unfortunately, their search function is difficult to use.  Some good sleuthing will find you good deals, though.

 

Woman Within has cemented a place in the online shopping experience.  It is great for basics, has excellent prices, and they consistently offer up to a size 40W.  Workout pants, skirts, shirts, comfortable swimsuits, and sports bras are available.

 

Junonia is synonymous with classic plus size activewear.  They’re a little pricier, but they’re known for quality and a variety of clothing to cover every activity from skiing to golfing to swimming to tennis to running.  Their sizing goes up to a 6x/40W in some pieces.

 

I’ve heard great reviews of Sparkle Skirts from the fitness group I’m a part of.  With pockets, compression shorts, and as finely obnoxious of a print as I could ask for, I’m excited to order one in the future.  Sparkle Skirts offers sizing up to a 3x.

Share your favorites, too.

 

Want to Move It, Move It?

Last week, I was invited to go to an archery range with a new friend while I was in Seattle.  I didn’t know what to expect. I was nervous; arrows are rumored to be pointy, and I’m not always known for my physical grace.  I shoot handguns a few times a year, but this is completely different. 

I ended up having a great time!  We shot for about two hours.  It was calming to focus on exactly how to hold my body for the next shot.  When I got a good shot it was exciting, and every few minutes someone yells “Clear!” and I’d walk down to the end of the lane and pull my arrows out of my target (or from near my target).  I loved focusing on where my arms were, my posture, my footing, and exactly what level of strength balance were required.  I had a pretty righteous crick in my neck from sleeping in hostel beds, and it felt great every time I pulled the bowstring back and brought my shoulder blades together. It may not have been awfully strenuous, but I was moving for the whole two hours.  I’ve looked up an archery range close to me, and I look forward to visiting it soon.

Movement and activity are important for health.  Traditionally, we look at movement and activity as exercise- often a punishment for the outrageous sin of eating.  When we remove the goal of weight loss, movement and activity are important for other reasons.  Regular physical activity improves mood, blood lipid levels, sleep, blood pressure, blood sugar levels, and energy levels.  We breathe better and our cardiovascular system responds quicker and recovers faster.  When you find something you enjoy, it is a great stress reliever, too.

I haven’t always loved going out and doing physical things, because exercise felt like a chore for so long.  A few years ago, I removed the ‘should’ from activity.  It took a while, but I started wanting to fit some activity into my life.  I feel better when I move.  I have less pain, breathe better, and recover faster when I have to hustle somewhere.  Also, I’m having a lot of fun!

Joyful movement is all about finding something you love.  I love swimming, elliptical machines, biking short distances, weight lifting, chasing my friends’ kids, and I just may love archery now, too.  I have a game on my phone, Ingress, that means I walk around for hours stopping near public art and landmarks looking suspicious (It is a sort of highly technical multi-player, never-ending version of capture the flag that uses Google’s maps and your GPS). 

 

Jimbo Pelligrene found something he loves!

I’m still discovering things I like to do, and how to fit them into my schedule, especially as my schedule is so variable.  I like working out at a gym; not everyone does.   I got a deal online for a month’s membership and some personal training sessions at a local gym.  I’m looking forward to getting to know their machines and find out how I can improve my ability to “throw things around.”  I love my strength.  While you can almost always find me in a dress, and often find me in heels and makeup, I still love the opportunity to help carry a couch, or climb a tree, or move some boxes. 

I have friends who love to dance, love to run, love yoga, love to garden…  When you remove the temptation to judge activity solely by its calorie-burning attributes, it really is all about what youlike.

Movement has also been an opportunity to pay attention to how I feel.  For a looong time, I assumed that I got winded before my muscles ever even noticed what was going on, and my feet hurt, because I was ‘out of shape.’  Turns out, I have asthma (I thought I got rid of it as a kid), a pretty impressive heel spur, and a decent case of plantar fasciitis (Those translate roughly to “perpetually walking on spikes”).  I got an inhaler, and it works like magic!  I have orthotics coming in next week, and I can’t wait to be able to step up my game, physically.  I’ll have to figure out how to fit them in my dressier shoes, but I expect to feel quite a bit better on my feet.  That means I can do more walking with less pain, which is so great when I like to play Ingress and wander around on foot for hours.  Paying attention to yourself as you become more active means you can understand your own needs better. 

What do you like to do?

 

Back from the HAES® Training

The training was amazing.  Linda Bacon and Lucy Aphramor were brilliant.   There were over 50 people at the training, and about half of them were dietitians.  There were people from as far away as Australia.  Everyone in the room believe that fat people have the same health goals as thin people. We covered a few things I have thought about before in conjunction with Health at Every Size®, but never quite connected in the same way.

We talked about how health is multi-dimensional- there is physical health, emotional health, spiritual health, social health- you can’t hold one above the others and expect to feel well.

I mentioned First, Do No Harm in my previous post.  I’ve talked in classes before about the futility of prescribing weight loss to patients, as it almost inevitably results in weight rebounding and worse health than just being fat.  I’ve talked about how our current medical model creates a barrier to treatment.  However, Linda and Lucy clarified and condensed these issues.  These are all issues of medical ethics.  Providers, by and by large, get into the business to help people.  But when providers are taught to prescribe weight loss, and that weight is a result of laziness and a lack of willpower, they are harming the vast majority of their patients.  That is simply unethical. If providers knew and shared the facts about long term weight loss attempt results, we wouldn’t recommend it anymore, and more and more, people wouldn’t consent to trying it.

In the next few months, I’m setting up a forum to create a conversation between fat patients in Denver and Denver care providers.  Hopefully we can address some of these barriers to quality care.

We talked about the fact that being fat can exacerbate some conditions.  Being fat can impact joint pain, diabetes, and heart disease.  However, is weight loss necessary? Experiencing one of these conditions doesn’t make weight loss any more reasonable of a goal.  Also, there are things that you can do for any condition that doesn’t include such drastic measures with such poor results.  While it is clear that eating a varied, enjoyable, quality diet and physical activity can improve diabetes and heart disease regardless of weight loss, joint pain is harder to assess.  Eating low-inflammatory foods and getting enough sleep can improve joint pain, and sometimes physical therapy can improve symptoms, without weight loss.   Thin people with diabetes, heart disease, and joint pain are given suggestions to improve their health that don’t include weight loss.

The last thing that I took away from this training a reminder of the community available to me.  I was reminded of the HAES Community, where you can find researches, authors, activists, care providers, and more in your community.  I heard more about ASDAH, who actually owns the HAES trademark.  They have another listing of health professionals that work within a HAES mentality.   They hold annual conferences, do lots of work in the community, and have excellent educational resources on their site. I heard of local HAES activists, and left having met many many awesome people.