Trademarking Health At Every Size

The Journal of Critical Dietetics has just published an article I co-authored with Jacqui Gingras called 'Down the Rabbit Hole: A Critique of the ® in HAES®'.

The article came about through discussions of what it meant that the Association for Size Diversity and Health (ASDAH) had trademarked the concepts Health At Every Size, and HAES.

As activists and scholars, we wanted to raise difficult and impertinent questions about who owns the movement, and about who watches the watchers. We have offered this paper as a means of creating dialogue about the trademarking. I think it also has relevance for discussions about professionalisation within grassroots social justice movements.

Critical Dietetics is an open access journal. This means that you don't have to pay to read the articles, although you do need to register on the site to access them (the other articles in this issue are really good too!). Go to the journal page to register and download the article (link at the beginning of this post). There is also space to comment on the Critical Dietetics blog.

Gingras, J. and Cooper, C. (2013) 'Down the Rabbit Hole: A Critique of the ® in HAES®', Journal of Critical Dietetics, 1(3), 2-5.

How I got into fat

Me, 1978 or so, looking into the future.

It's been a little scrappy around here of late and I'm sorry about that. I'm preoccupied with finishing my thesis, organising the Fattylympics, and keeping going amidst some slight burn-out. It could be worse but I haven't been in the mood for writing much.

I've been working on an autoethnography for my PhD. Ethnography is a kind of qualitative research methodology that involves looking at people. With autoethnography you are also looking at yourself.  If you want to know more about autoethnography, you could read Carolyn Ellis and Jacqui Gingras on the subject.

Because I think that context matters, I think that all researchers should reflect on who they are to be doing research, even – especially – the kind of researchers who produce pages of numbers about BMI. So I've been reflecting a lot over the four years in which I've been working on my PhD, and thinking about how I came to be here. With this in mind, I thought I'd share a little about how I got into fat. It goes like this...

I have been fat all my life, meaning that I have always been fatter than most of my peers. My family is pretty fractured and it's hard to tell how fat features there. Certainly three of my immediate family have had what they would think of as 'weight problems' and have 'done something about it,' and I have distant relatives who have been fat at various stages of their lives. I think I might be the fattest but it's hard to tell amidst all this shape-changing and self-regulation. I'm certainly the most self-accepting fat person in my family.

When I was about six or seven years old, my mum decided that something needed to be done about my body. Mum was a nurse, she was working as an administrator at a clinic at that time, and very much part of a culture of medicalisation. I think her decision to monitor the food I ate may have coincided with her own body-projects, it was certainly a part of her work of trying to pass as middle class. My first diet came at a time when we were living in a colonial ex-pat community in Hong Kong that included a lot of upper-middle and upper class people. I think she felt that she had to fit in with them, and that my fat body betrayed what she felt was the shameful truth of our class.

Mum and I dieted on and off for the next few years. Sometimes we'd follow a sheet that she brought home from work but mostly it involved periodic disapproval of what I ate and voiced anxiety about the size of my body, especially when clothes didn't fit me. In spite of all this I was a very active kid, I was a synchronised swimmer, and always running around, riding my bike, doing things. This continues to this day. So whilst I had this idea that my body was a problem, I also had an image of myself as active, someone who could do things.

I had no idea about fat politics as a teenager in the early 1980s in London, though I now know that a fat feminist movement had been active for at least ten years by this stage in other parts of the world. However, I had access to some things that enabled me to develop a critical understanding of my fatness. These things weren't directly about fat but they helped pave the way later on.

The first thing was feminism. I got interested in feminism as a young girl. In my family sex was never spoken about, and I was quite anxious by the time I reached puberty, I wanted information. I didn't know about libraries so I went to bookshops and read the sex education books there. Books on feminism were stacked nearby so when I'd read all the stuff about 'a man and a lady loving each other very much and making a baby' I moved on to much more interesting books about contraception, abortion, being lesbians, self-determination, and so on. I didn't know it but I was learning about speaking up, power, and possibilities for naming and exploring my own experience.

The next thing was a sort of queer punk. Whilst I was at school I got a Saturday job that introduced me to lots of people who were really happy to be freaks and who sneered at the straight world. Queer was not a term that had much currency at the time, but this group of people, including the heterosexuals, were very queer indeed. Some were performers, most were much older than me and everyone had lived exciting lives of one kind or another. People did things, they didn't wait for someone else to do it for them. Although everybody lived on the margins in some way, people lived creatively amidst rich communities of friends. There was always something to do, bands and clubs, I started going out and I never really stopped. At the same time I was reading subcultural literature, writers like Kathy Acker, David Wojnarowicz, William Burroughs, and this too gave me an idea that things could be different and that being different was no bad thing at all.

I left school and did A Levels and got into student politics. At the time this took the form of anti-fascist and anti-racist organising, I remember quite a bit of feminism in the mix too. The National Union of Students was still a radical body back then. We went on demonstrations and took part in discussions and conferences. Alongside this I was travelling on and off with my oldest brother who was what would now be called a new age traveller. So I had experiences of very marginal politics too, living on the road, trying to avoid arrest, a kind of practical anarchism.

Throughout all this my fatness was still seen as a problem, not only by me but by the people around me. I longed to be thin and still made attempts to lose weight, although this never came to much. I think I knew it was bullshit but I didn't have a way of articulating it until I saw members of the London Fat Women's Group talking on Wogan, a very popular early evening television talk show. This would have been in 1989. They were organising a conference, and they also made a short documentary about fat politics that was also shown on TV. I watched it avidly.

It took a while, a couple of years, for the things that the London Fat Women's Group were saying to sink in. I think I was still recovering, not just from growing up in a context of everyday fatphobia, but also other kinds of trauma. The last straw was being dumped by a boyfriend who wanted me to be thinner. I'd really had enough. But the appearance of those British fat feminists in my life showed that there were other ways of being, and my experiences as a girl and as a teenager enabled me to adopt it eventually. Given my context, it made total sense to me that fat could be a social and political identity and that there was incredible potential for the development of fat culture, collective action and intellectual activity.

I started to look out for other things. By my late teens and early 20s I had an experiential and theoretical framework for activism that made Shadow on a Tightrope and Being Fat is Not a Sin irresistible when I first came across them around 1990 or so. I started an ill-fated fat support group, did some postgraduate work about fat activism, started to meet people who were interested in similar things and who supported my fat identity, took part in a proto-fatshion modelling competition(!), wrote a book, and spent the advance on a trip to California to meet the dykes who put FaT GiRL together and attend the Dirty Bird queercore festival. Fat politics interested me initially as a solution to the years in which my body had been a battlefield, a place of restriction, blame, anxiety, but it soon became a much bigger project, something that could play off other life experiences. Fat as feminist, punk, queer, a place to which I could bring my politics, a way of understanding my life. There was no turning back.

References

Bovey, S. (1989) Being Fat is Not a Sin, London: Pandora.

Ellis, C. (2004) The Ethnographic I: A Methodological Novel about Autoethnography, Walnut Creek, CA: AltaMira Press.

Gingras, J. R. (2009) Longing for Recognition: The Joys, Complexities, and Contradictions of Practicing Dietetics, York: Raw Nerve.

Schoenfielder, L. and Wieser, B. (1983) Shadow On A Tightrope: Writings By Women on Fat Oppression, San Francisco: Aunt Lute.

Fat, pain, power and the clinic

I have a touch of osteo-arthritis (OA) in my right knee. Sometimes I get a small amount of pain. I understand OA as a degenerative condition and that I will likely become increasingly disabled as times goes on. My doctor referred me to physiotherapy where I learned some tricks for strengthening my knee to hold off the degeneration, and for pain management, and I've been going to the OA gym, organised by the physiotherapy clinic near where I live, which runs a course for people coming to terms with the condition.

I'm writing about this here because I had been unaware that knee OA is one of those things that inspires a lot of fatphobia from health professionals. Whether or not being of a heavy weight exacerbates knee OA is up for debate, I think, because OA also occurs in non-weight-bearing joints, and weight loss, which is next to impossible to sustain in the long-term, does not necessarily ameliorate the pain. The other thing is that thin people get OA too. But 'lose weight' or 'maintain a healthy weight' are part of the mantra of knee OA. My doctor and physiotherapist have been fine and respectful, but the OA gym, also managed by the National Health Service, has been another story altogether.

There are general problems in the space that relate to a kind of clinical arrogance. We 'patients', there are seven of us, are older, don't necessarily speak English fluently, look poor, struggle to communicate, have other health issues, and look like the bottom rungs of a social status chart. The two people teaching us are limber young jocks who appear to have no empathy, don't understand people who aren't jocks, and perhaps have never had an injury. They use their own bodies as models for what we should do, but their bodies are nothing like ours. They say things like: "I'm going to show you these exercises and if you don't do them at home every day you are wasting my time." One of them has made not-funny jokes about people who try and cheat the exercises, as a kind of warning for us not to cheat, the assumption being that we would cheat, and that cheating – or finding other ways to do things – when you are in pain is a bad thing.

It's the fat stuff that interests me. I am the fattest in the group and a lot of the fat talk is directed at me. For example, the physiotherapist asked the group if anyone had ever heard of BMI (Body Mass Index), and fixed me with a long stare as she asked it. I thought the question was ludicrous and stared back, gaining me the unspoken label of uppity fatty in the process. The same person complained about doctors who "are too frightened to tell their patients that they are obese. I'm not like that, I'll tell people when they need to lose weight." I wondered if she would ever tell me directly to lose weight, and what that conversation might look like. The other women in the class concede to the fatphobia, all agreeing that they should lose weight, regardless of how much they weigh, the men seem to ignore it all. One woman said that she had lost a lot of weight and that she still gets pain, but this was not explored.

There's ageism and disablism in the room too, with uproar when one of the physios suggested that a way of managing knee pain could be to get a walking stick. No! No! No! We are too young for that! We don't want to look like cripples! Me, I'll take the stick, I'm old enough, crip power.

It is hard to know what to do. Speaking up in a group where people are generally hostile to the idea of fat and where I may as well be speaking Martian is too risky, especially as I have already felt labelled as a troublemaker for not being compliant and self-hating. I have a packet of readings that I'm thinking of offering to the Physios, though I think this will be read as an aggressive action. I suppose I'm holding out for the opportunity for feedback. But even then my identity as an activist, or as a person with any intelligence or agency is invisible in the OA gym, the institutionalised fatphobia means that I am interpreted as a problem, no matter what I do. The others may be extraordinary people with fabulous skills, but you would never know it, we are collectively patronised and treated as people with nothing to offer. I don't know if my knee is benefiting in any way from this experience, but for me it has greatly illuminated some of the ways in which clinical power operates, and the misuses of that power.

One of the most extraordinary experiences of fat embodiment in my life

The Hot Bath, where I had my treatment

I had one of the most extraordinary experiences of fat embodiment in my life on Saturday afternoon.

I went to Thermae Bath. This is the thermal baths complex in Bath, in Somerset. I'll try and explain this without being too confusing. Bath is a town. There are remains of Roman baths there, you can visit them to look but you cannot bathe in them. For a long time you could bathe in other baths in Bath, but then they closed. A new bathing complex was opened a few years ago. This complex comprises an inside pool, an outside rooftop pool, some steam rooms, and a hot bath where treatments are given. There is a separate building with a smaller bath. The baths are the only place in the UK where you can bathe in water heated by geothermal activity. Bath is also Britain's most well-known spa town, but that's another story.

(Quick and grumpy aside: If you are fat, the robes at Thermae Bath will not fit you, but the receptionist will insist "You'll be okay" without listening to you when you ask what size they come in. Although people of many sizes come and bathe at the baths, the robes only come in one standard size that does not cover someone of my size. This is extremely annoying, especially given that the complex has otherwise really good access for disabled people. I don’t know why they don't have some larger robes available. I have been to bath houses in Japan, a country where people tend to be much smaller than me, and I have been adequately clothed there, but not at Bath. Tip for fat people: bring your own.)

Thermae Bath at peak visiting time is not relaxing in the way that the brochure pictures promise. It is heaving with people who do not know about spa etiquette. So there is a lot of loud chatter, dashing around, and people seem unable to switch off and just experience the heat, the water, the ambiance. My girlfriend and I let go of our fantasies of having the place to ourselves and bobbed around in the warm water with everyone else. It was not a holy experience, but it was fun and relaxing in its own way.

The baths are a great place to witness yourself amongst a spectrum of bodies, to see the myth of bodily normativity at first hand, and to treat your own body with gentle kindness. Bobbing, floating, sweating, napping, all feel good. Going to the baths is not the only way in which I have learned to feel okay in my own skin, but it's part of the story. I would love to see a fat activist reclamation of David Walliams and Matt Lucas' hate-filled Little Britain stereotype Bubbles DeVere. I resent that mean appropriation of my fat, naked, spa-loving self!

The hot bath from outside

I also find the idea of spa treatments interesting because they inhabit a quasi-medical, or para-medical space. Often practitioners will have a professional qualification and will wear a uniform. Sometimes the division between acting medical and being medical is blurred, especially with treatments like colonic irrigation and botox (no thanks), and spa treatments can look very much like possibly-discredited treatments of yesteryear, electrified and radon baths spring to mind here. Negotiating medicalised space when you're fat is generally a complex and fraught experience, and sometimes the space of the para-medical spa treatment is anxiety-provoking in similar ways. Will the gown fit? Will the equipment fit? How will my body be evaluated? But spa-space can also be a much more free space because the authority of the practitioner is not as powerful as a common or garden health professional, here there is room for negotiation, their status can be more easily questioned, and this can embolden one to refute passivity more easily when dealing with real doctors and medics. Anyway, I think messing around with your body is a way of claiming your body.

So I had a treatment whilst I was at Thermae Bath. I'm almost embarrassed to say it because the name of the treatment – Watsu – sounds like so much orientalist mumbo-jumbo. I've since found out that it's a portmanteau of water and Shiatsu, a type of massage that emphasises pressure points. The evidence that Shiatsu is effective treatment for disease is unconvincing, but it feels really good. Watsu was invented by who else but a California hippy called Harold Dull in 1980, fact fans. Few people offer it in the UK because there aren't many pools appropriate for it. It can be very pricey and my session was no different, though I didn’t pay for it, it was a belated xmas present. I chose to have a Watsu session not because I am diseased, but because I wanted to be swished around in the water for an hour and can just about handle its inherent bourgie woo. I knew that Watsu would feel nice and relaxing but I wasn't expecting the experience to be as intense and strange as it was.

My session took place in the Hot Bath, a stunning pool at the centre of the building. I've included pictures of it here. When I looked up I could see clouds and sky through the glass roof. There was some music playing in the distance, and gurgles and pops made by the water, but the setting was incredibly serene, almost like a virtual reality environment.

My therapist was called C. It was just us in the pool. She told me what she was going to do and tied some floats to my legs. Two didn’t fit but there was no fuss and I am plenty buoyant anyway.

We did some breathing together, our bodies rose and fell in the water as our lungs filled and emptied with air. C invited me to lean back into her arms when I was ready. She took my head and swished me around, pulling and turning me. I looked up at the sky and then closed my eyes for the rest of the session.

What I saw when I looked up

I felt like a tadpole, something evolving from the primordial soup. Sometimes I was bobbed up and down and tilted out of the water. I was in constant motion, feeling the water swoosh past my limbs. I concentrated on my breathing and letting go of tension in my body, and of the sensation of the water around me, and of C's hands. She advised me earlier to be like a piece of seaweed, so I tried to do that. As the session went on, C incorporated stretches that would be impossible for me to do on land. She used her hands and feet, her whole body. I don't know how she did it, perhaps she grew some extra limbs. It felt amazing. At one point she stuck my head in a floating bonnet type thing (I still had my eyes closed so have no idea what this looked like) and pressed pressure points in my feet, hands and shoulders. At the end of the session she placed me upright against a wall in the pool and massaged my face. She gave me some time to come round. I said goodbye to the pool and stepped into a fluffy towel and had a rest on a recliner, under a blanket.

The whole session felt extremely intimate and special. I felt changed by it. I don't know if this was because I had been able to relax and trust that I would be okay, I think it may have something to do with surrendering to vulnerability in the water and allowing myself to be cared for. I have various histories of abuse to my name, which I have been thinking about a lot lately, and it felt mind-blowing to be held physically in this way. There is something about the way this takes place in warm water, too, which feels very elemental, and is somewhere I feel at home.

I was aware of how close our bodies were during the treatment and this could be disturbing if you didn't trust the person doing it. C's head was close to mine, I was in her arms almost all of the time, and my hand brushed past her breast and her armpit at various stages. There was intense eye contact. I was aware that my magical moment was work to her, and I thought about the treatment as being on a spectrum of embodied work that includes other kinds of massage and sex work. I felt like a John of sorts, but perhaps this is the only way I can rationalise this kind of gendered, paid-for, embodied experience.

I felt very moved that C was able to handle me. There's something really amazing when young and pretties (my girlfriend's term for normatively embodied people, perhaps those who have never encountered non-normative embodiment, or fear or deride it) are able to treat people with bodies like mine with respect. Being old, unruly, hairy-legged, ungroomed, fat, scarred, wobbly, messy, and all the rest of it does not always send people running for the hills – who knew?! It is absolutely brilliant when people who may not be in the firing line themselves step up and show that they have done their work. C looked after me and modelled ways in which I might care for myself. Thank you!

I thought of the journey I've taken with my body, how many fat people, people, would not be able to do what I did, and not just because of financial or other practical access reasons either. It was almost too enormous to think about, and I still feel that I could become a big blubbering mess if I thought about it deeply, so maybe I'll come back to that in a while, or take my time in picking it apart.

How did this all end? I walked back to the pool to see Kay, grinning, full of wonder, and with a profound sense that I'm alright, really.