Fat in the Fitness World
What's Up?
What's Wrong?
What's New?

By Pat Lyons, M.A., R.N

From Radiance Winter 1991

I am a professional fat woman. I didn't long for this career as a kid-"Yes, teacher, when I grow up I want to be fat and talk about it!"-but this is where I find myself after cowriting a book first published in 1988, Great Shape: The First Fitness Guide for Large Women.   I am fortunate to be in a position to plant seeds of change in the healthcare system, the source of mistreatment and pain for so many fat people. I've been a nurse for 25 years and have been an advocate for respectful health care for all people-regardless of age, sex, race or income-for all that time. In the past few years, as a health educator and health promotion specialist, I've added size to that list.

I've talked with groups of 5 to 150 people and have seen eyes open (as well as jaws drop) as I proclaimed the simple fact that fat women need not be ashamed of themselves or live the lives of mournful hermits draped in black. "Have fun, be healthy, enjoy life, whatever your size" is my message.

Some people are ready to hear this message and rejoice. Others get angry, assuming that I'm encouraging women to "give up." It makes for interesting conversations, peaceful confrontations with health and fitness folks and sometimes tears of either laughter or frustration. Let me share a few stories with you so you can see what I mean.

Yesterday Alice, our Radiance publisher, invited me to participate in a segment being filmed for a Canadian TV program similar to "Sixty Minutes" that will focus on issues familiar to Radiance readers. The film crew was knowledgeable, sensitive and dedicated to presenting a fresh, progressive take on these issues. (After all, they were interviewing us, not Oprah.) We were filmed for one segment while walking around a local lake and talking about exercise and weight (microphones clipped under our shirts-boobs wired for sound). Back and forth we walked as the camera crew filmed. We got some very curious stares from other walkers and runners, who were no doubt asking themselves who we were and why someone wanted to film us. Should they recognize us? Were we famous? "Not yet," we giggled among ourselves.

One bold walker approached us to ask, "Are you filming a weight-loss program?" "No," we said. "This is not the before picture. This is after. This is now! We're filming a show about feeling good about ourselves as we are." Our questioner was a fat woman herself and gave us a look that said You're kidding. That we weren't sweating it out for size 10 jeans must have seemed strange to her. As she walked away she kept turning around to stop and watch some more, as if she couldn't quite believe we were for real.

We had told the film crew about the world's assumption that any fat woman who exercises is doing it for weight loss. We said that when more than two fat women were out together they attracted stares and even comments from strangers. Now it had happened right before their eyes, and they were including these incidents in their story.

Their assumption that all fat women want to lose weight and should lose weight, "if only for our health," is virtually universal. When fat people say they accept themselves and are happy, they are accused of lying, and when they decide to make health changes, such as walking more or eating less fat, it is assumed that their sole motivation is to lose weight. Unfortunately, for many fat people, when health-enhancing efforts don't result in weight loss, rather than question whether that goal is even possible for them, they feel ashamed.

A woman in one of the movement classes I teach said she'd virtually eliminated fat from her diet and reduced her cholesterol from 275 to 200, but had not lost weight. While this was a dramatic change-and in the long run could potentially reduce her risk of heart disease-she felt cheated. "They," meaning medical experts, had convinced her that eating less fat would produce weight loss, as if there were some way to guarantee this result. There isn't. Some people will lose weight, others won't. She'd started to exercise, and I had to tell her the same is true for exercise. Health improvements-such as lower blood pressure and cholesterol-can and do occur through increased exercise and better nutrition. But permanent, substantial weight loss is far more elusive. Yet this fact doesn't stop health and fitness professionals from relentlessly planting the goal of weight loss firmly in front of us.

My friend Laura went to a local fitness club that had instituted a special marketing program to entice large women to become new members. Skeptic that I am, I asked her if they had sensitized the instructors to the special needs of large women. Laura said she'd let me know.

The club offered appointments for new members with its professional staff. The first one Laura saw, a young woman in a skimpy leotard, asked, "What is your current weight?" "Two hundred fifty," Laura replied.

"What is your goal weight?" she continued.

"Two hundred fifty," Laura answered without hesitating.

The instructor looked at her slack jawed and sputtered. She'd apparently never met a fat woman whose goals were increased flexibility, strength, enjoyment and relaxation, not weight loss.

"Deconditioned" is the newest buzzword on the marketing tongues of health and fitness clubs. They are searching for ways to attract us large people and our dollars. Some, like the club Laura went to, think they already know how to treat us, yet most fitness professionals have no experience with the issues that face a newcomer on the exercise scene, let alone someone who is much larger than other participants. And many fitness professionals are self-righteous about who they think can rightfully lay claim to the mantle of health and fitness.

If you are considering joining a fitness club, be sure to talk with the staff about their knowledge, experience and comfort in dealing with you as a large exerciser before plunking down any money. I've heard too many horror stories not to warn you to be a cautious consumer and to learn as much as you can about your own body. Trust yourself and stick to your own goals, not those set for you by overzealous instructors.

While I am critical of those fitness folks who see us only as a market, I am at the same time very encouraged by recent positive trends. Some of the strongest advocates of the approach we take in Great Shape-inviting large women to be active for the fun and pleasure of it, not as punishment for being fat-have been health and fitness professionals with average-size bodies but big hearts. They recognize injustice when they see it, are ashamed of the prejudicial attitudes of their colleagues and are working to roll out a respectful welcome mat for people of all sizes. In the past few months I've presented a staff training session to a local YMCA to help them make their club more accessible to fat people and have presented a paper at the annual AAHPERD (American Alliance of Health, Physical Education, Recreation and Dance) convention at the invitation of the National Association of Girls and Women in Sport. I have been received with respect and interest, and have sometimes been approached by people with eyes full of tears.

After my talk at the AAHPERD conference, several people rushed up to the stage. One young man, about 20, tall and thin, stood back from the rest. His eyes glistened. After a few minutes, I stepped over to him. "My mother and my sister are both very big, and both of them feel so badly about it," he said. "I watch them and see how much pain they are in and I'd like to help them. I have always been thin, have always been into sports and now I'm becoming a PE teacher, so I guess they think I don't understand them. What do you think I should do?" I was very touched by his caring. I told him that when he got home he could simply tell them he'd come to hear me speak and about how he felt about what I'd said. No advice, no lectures. No "You should go out and buy that book, Ma." I gave him a subscription card for Radiance and suggested he ask if they'd like him to give it to them as a present. Even if nothing else ever came of it, his mom and sister would know he loved them and cared about their feelings enough to come to a lecture on fitness for large women at 7:30 in the morning.

In talking with groups I've learned that I'm unable to predict their attitudes toward fat by their body size. Fat people are not automatically accepting of my words. Neither are women, even if they are working to improve women's health. What I'm saying addresses core life issues for so many. Thinness at any cost is so deeply ingrained in our society that saying I refuse to play that game sounds to some as if I'm advocating overthrowing the government! On the other hand, I frequently meet people with fat loved ones in their lives who are desperately seeking ways to ease their pain, people who believe in fair treatment for all and who are not afraid to stop someone from telling a fat joke with as much vehemence as they would stop a racial or homophobic slur. I am touched, encouraged and inspired by brave people of all sizes who are willing to stand up and be counted in the fight for human dignity for all. May their numbers grow.

For many of the years I've worked as a health education specialist, I myself bought the weight-loss message lock, stock and barrel. When I grow impatient with my colleagues I try to remember how much it took for my own attitudes to change, for me to believe the research I was reading and to trust my own experience.

I was a regular runner for seven years and changed my eating habits entirely when I began running. Even though I never came within 40 pounds of my so-called Ideal weight, I still thought it was because I was doing something wrong. It took a long time for me to accept that I would be fat forever and that I could still be healthy. I know it is hard for individuals and health and fitness professionals to make the transition from the universal weight-loss goal to one of health at any size, particularly if they haven't had the kind of personal experience I've had. But it is a change in attitude that I believe is absolutely essential if we ever hope to improve both the way fat people are treated by the medical system and how we as fat people treat ourselves. And without some changes, the health of fat people will only get worse.

Practically every fat person has a story of embarrassment or mistreatment at the hands of healthcare providers who blame virtually every health problem on weight. "Lose 50 pounds and call me in the morning" is the standard advice we expect, whether we go in for a sprained ankle or the flu. One woman told me she went to get glasses and was admonished for her weight! This kind of experience would be laughable if it didn't often result in tragic consequences -because fat people avoid or put off medical appointments. One woman I talked with had recently had a mastectomy. Even with this history of breast cancer, she still does not go for routine Pap smears, because of the humiliating way she was treated during an examination some years ago, when a doctor told her she was much too fat to have a pelvic examination.

As a healthcare consumer I have a right to question providers about their statements and conclusions. They are not the experts on my body: I am. And I have to learn to trust my judgment about what is best for my health. That means I must inform myself and act on my own behalf. That is my part of the healthcare partnership. As a group, we fat people also have to begin to alter the traditional doctor-patient power relationship.

As fat people we must refuse to accept mistreatment. We must speak up for ourselves and report mistreatments we encounter to a provider's supervisors or to licensing boards and other watchdog agencies. If you can't do this yourself, solicit help from a friend or get in touch with NAAFA (National Association to Advance Fat Acceptance) and request help. When a doctor says the problem you are seeking help for is caused by your fat, you can ask what advice he or she would give a thin person with the same problem. There is no medical condition that only fat people experience. You have a right to the same treatment a smaller person would receive for your condition.

Medical providers must face the fact that their negative attitudes toward fat people keep them from practicing good medicine. Illnesses that have no relation to weight can be missed by a provider's unwillingness to look beyond fat as the problem. (I've heard stories of huge tumors being overlooked because the thought of palpating a very fat abdomen was abhorrent to the physician.) Providers must also stop hounding people to lose weight, because the pursuit of weight loss at any cost has caused both illness and death, where neither might have occurred from the weight alone.

The $33 billion that is now being spent annually on weight loss is not producing better health for our nation. At a time when public healthcare programs are going broke and 37 million Americans are uninsured, it is a scandal that weight-loss programs are experiencing unprecedented profits. It is no surprise to me that within the past two years in the San Francisco Bay Area some very prominent private hospitals that are experiencing difficulty staying afloat due to the healthcare crunch have started offering Optifast or Medifast programs. With the promise of high profit and returning clientele (since no method produces lasting weight loss), hospitals and private doctors are balancing their budgets on the backs of fat people.

A goal of health and a feeling of well-being whatever our size is a worthy one. We can stop this endless pursuit of thinness at any cost. The number of fat people in America is growing, due in part, I believe, to yo-yo dieting. Rather than insist on continuing the search for the right diet, which millions of citizens and an unbelievably high percentage of obesity experts are doing, we, as a nation, must instead look into our hearts for compassion. We must find ways to eliminate the social prejudice against fat. We must also find ways to help each other be as healthy as we can and enjoy our lives as fully as possible today. The cost is too high to wait any longer.

Fat people must also stop expecting miracles, for weight loss or any other concerns we have. All of us, whatever our size, must also stop expecting "perfect health" to be attained by counting on the medical establishment to deliver it. Health status depends on a combination of factors, including genetics, economics and access to care. But it also involves individual decisions about what we ingest, how we spend our time and how we treat ourselves. And, unfair as it seems, sometimes it is simply a matter of luck. We may do all the "right" things and still become ill.

Over the last year, as an interviewer for a special research project, I have talked to over 150 people with a kind of cancer that affects men and women of all ages and incomes, and from every walk of life. The interview consists of a lengthy questionnaire covering every conceivable exposure to carcinogens as well as numerous questions about life-style. After the interview is finished, the most consistent thing people say is, "I was perfectly healthy until I got this." The interviews often bear this out. Many had made numerous positive changes in diet, exercise, and so on and still had become ill. They are angry that their actions didn't inoculate them from disease. More than a few have looked into my eyes and said, "Enjoy your life now. You just never know when something like this will happen." On the days when I am frustrated to tears by how difficult it is to keep pushing the rock of fat acceptance uphill, I remember the words of these cancer folks. I remember that life is precious, that this moment is the only I can count on for sure. And taking care of myself helps me enjoy my life now. Besides, knowing myself as I do, even if I did decide to chuck it all and, say, open a flower shop, I know I still couldn't stay away from this fat business. I'd probably call the shop Fat Flowers. �

PAT LYONS, RN, MA, is a healthcare consultant living in Oakland, California. She is coauthor, with Debby Burgard, of Great Shape: The First Fitness Guide for Large Women (paperback, 1990, Bull Publishing).

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