is Good For Your Health
By Lynn McAfee
From Radiance Winter 1999
Medical activists do not need to be experts in the
latest "obesity" research. They dont need to understand all the words in
the medical dictionary, or even most of them. Medical advocacy is about attitude, not
Being a medical activist involves working to improve
health care for yourself and for others, especially in the area of preventive care.
Illnesses diagnosed too late can result in debilitating conditions and fatalities. In
fact, many people feel that delaying or avoiding going to doctors is a major cause of
death for fat people.
Many of us find it easier to help others than to help
ourselves. I know I would break down doors to make sure a friend received an ultrasound of
her uterus (an important preventive procedure, especially for supersize women), but I have
let myself down by walking out of every gynecological visit knowing that my doctor had not
adequately felt or seen my uterus.
When we are too unsure of ourselves, too scared or
intimidated to advocate for ourselves, we need others to help us. I have a "health
care partner" named Janet. She is familiar with my medical history and is willing to
come with me to any especially uncomfortable doctor visit or medical test, and I do the
same for her.
Of course, even when we are acting as someone
elses advocate, all the old messages about "doctor power" surface. (Who am
I to challenge a doctor?) It is easy to get so caught up in the technical aspects of
medicine that we forget the value of our own experience as fat patientsour primary
credential as medical advocates in these very situations. We need to trust ourselves to
ask questions, evaluate the information weve been given, explore alternatives, and
make good decisions. Sometimes the best course of action is to get a new doctor!
Personal advocacy, if we were to all engage in it, would
have a powerful influence on how doctors, HMOs, and other health personnel and
organizations treat fat patients. For many of us, this is the level of advocacy that,
challenging as it is, feels doable. Some of us will find, as Peggy Neske did, that a
single instance of personal advocacy can push us beyond the personal. When she was being
treated for a medical problem, she realized that her local medical center was unfriendly
to fat bodies. Taking matters into her own hands, she drew up a list of
deficienciesfor example, the size of waiting room chairs and blood pressure
cuffsand called the hospital. She was connected to the patient advocate there, who
was happy to hear her suggestions and even asked for more. She suggested that Peggy join
the hospital community advisory board that was forming.
Some of you may want to move on to the larger commitment
of what I call organizational activism. Organizational activism involves interacting
singly or in a group with health care, medical insurance, or medical research
institutions. As organizational activists, our "targets" can be health care
providers (doctors, nurses, technicians, hospital administrators, and even medical
receptionists); institutions (clinics, hospitals, and county and state health
departments); or groups (medical societies, medical specialty associations, and medical
schools). As a beginning activist, you might want to start by focusing on an area that
directly affects you. For example, if you have diabetes, you could focus on educating
diabetes self-help groups in your area. We are often most powerful and persuasive when we
speak from our own experience.
At any level of advocacy, your goal should not be
to turn others into people who think like you. Define your goal carefully. Do you want to
help someone make an individual health decision? Do you want to work to change one
specific part of a health policy? Do you want just to be heard? As an organizational
activist, often the goal is to ask important questions. (For example, Why do groups like
the American Heart Association continue to recommend weight loss as a first line of
treatment in spite of its failure rate? Why doesnt the government fund studies that
look at other methods of health improvement for fat people?)
As the example of Peggy Neskes response to an
unfriendly health care institution shows, advocacy does not always have to be adversarial.
In fact, we are often most effective when we approach a problem with the assumption that
the individual or organization will be interested in helping. I often preface my request
or questions with a remark such as, "Im sure that you are not aware of this
problem" before I dive into what I need. I end with, "How can we make this
happen? What can I do to help you?"
It is also important to understand that no matter how
concerned and friendly the person you speak with seems to be, he or she is not as invested
in the issue as you are and might even forget about your needs after hanging up the phone.
Dont get angry. Most people are juggling too many duties in too little time, and
asking them to do something more is problematic. A large percentage of an activists
time is spent on follow-up. When working with an individual or a group, try to agree on a
reasonable timeline. Then follow up, follow up, follow up.
Having spent many years doing organizational medical
activism on my own, I strongly suggest having at least one activist "partner Im
fortunate to have the other members of the Council on Size & Weight Discrimination
available whenever I need them. Many times Ive called a council member up from a
medical conference and just screamed out my frustration for a few minutes. It helps me to
deal with the immediate problemslow progress on an issue or an offensive
remarkand often helps me identify why Im so angry. Often the reason is an
attack of low self-confidence.
I find it very important to analyze my mistakes and my
successes. One mistake I made in the beginning of my organizational activism was that I
kept trying to talk to only those people "at the top," those I assumed were
always the decision makers. Finding the right person to talk to is the critical first step
of any project. But sometimes it is more effective when someone on a lower rung of an
organization is fighting for you, either by presenting your ideas or by helping you to get
an appointment with the person who can really help you. Just the fact that I have to call
ahead and talk to a secretary about getting an armless chair for a meeting works to
educate someone who can be working for me behind the scenes.
An example of a failure I learned from is the wellness
center project for fat people at Graduate Hospital in Philadelphia that Id worked on
for a year but was finally unable to achieve. I was
stopped by one fat phobic woman, who stalled the project until the
hospital was sold and the board of directors that had authorized the project was gone. I
learned that good can come from my efforts even when the original goal cannot be reached.
In the case of this hospital proj-ect, because information about the project reached other
activists, several women are now working on wellness centers in other parts of the
country, and Ive been able to provide them with material Id developed for my
Perhaps the most important thing Ive
learnedand this is something that applies whether you are advocating for your own
personal health or working on a larger proj-ectis to concentrate on one point at a
time. I call it the Sound Byte School of Political Education. If Im working on
accommodation issues, I dont even mention that fat people can be healthy until
Im nearly at the end of the project. If Im working on the "fat and
unhealthy" stereotype, I immediately admit that many of us are not healthy. I
concentrate on making them admit that some of us are healthy, eat healthily, exercise
regularly, and so on. When the person or group I am meeting with starts to draw me off
target by speaking in stereotypes or generalizations, I say, "Obesity is much more
complex than we used to think, and very little is known about it yet. Even if it is
unhealthy, theres no successful way to make people thin now." Then I move on.
Fat politics are complicated, and the person you are talking to doesnt care nearly
as much as you do. Decide whether you are giving a lecture or trying to get something
done. Both things are important, but dont confuse the two.
At whatever level of activism you respond to the kind of
medical services you and all the rest of us fat folks receive, remember that your acts of
advocacy help us all. Taking control of health care can save livesincluding your
LYNN MC AFEE
is a medical activist. She is interviewed in this issue of Radiance.