Episode 193 Transcript

SUMMARY:

  • Boundary Boss Live Training Announcement 0:00

  • Dealing with Anti-Fat People in Personal Lives 2:02

  • Supporting the Podcast Through Ko-fi 4:27

  • Fat in Healthcare: Introduction and Inspiration 5:36

  • Levels of Anti-Fat Bias in Healthcare 8:47

  • Statistics and Stories of Anti-Fat Bias in Healthcare 9:54

  • Impact of Anti-Fat Bias on Healthcare Outcomes 10:12

  • Personal Stories of Medical Neglect and Discrimination 19:41

  • The Role of Internalized and Externalized Anti-Fat Bias 30:37

  • Institutional and Ideological Anti-Fat Bias 32:13

  • Conclusion and Final Thoughts 42:57

Read the transcript alongside the audio.

Vinny Welsby 0:00

You're listening to the Fierce Fatty Podcast episode 193, fat in healthcare and ideological anti fat nurse, I'm your host. Vinny Welsby, let's do it.

Vinny Welsby 0:20

Hello. Welcome to the show. So pleased to have you here. This is your refuge from anti fat bullshit in the world. Come hang out with me. We'll have some good fatty times saying that, saying that this episode is kind of a trigger warning for anti fat bullshit stories of death by medical anti fatness. Sorry, sorry if you were coming here just for a fun time, but hey, listen, you might be in the US and listening to this on or near Thanksgiving. And if you are, and you are going to be spending time with people, even if you're not doing Thanksgiving, and you're a human that's going to be spending time with other humans who are not fat positive, who are into diet culture, into shaming fatness. Then I have a training that's happening on November the 20th, 2024 but there is a replay. So if you're listening to this after that date and the training sounds good, go and get the replay. I'll link it in the show notes, but it's boundary boss live, how to survive anti fatness over the holidays, something like that. I'm not looking at, I'm not looking at as we talk. But basically it's going to be, I'm going to be talking about how, how to deal with people in your life who are really fucking annoying, but you might love and maybe I don't know, maybe you don't, and you don't know how to deal with these people. So in my life, I previous to this work, when I first came into this work, almost everyone around me was really into dieting, really into talking about their diets, really into hating fatness. And, you know, hoped for me that I would be thin, thinner, and I was one of those people, too. And it's really difficult when you're newer to fat liberation, we tend to be surrounded by a lot of people who are who are like, you know, tell you that your body is bad, or talk about how their body is bad and they have a smaller body than you. Or they say, Well, I'm just worried about your health, or whatever it is, and it can be difficult to find our feet and to know how to deal with those. And just by the way, of what happened with me three categories of the people that I used to be around a lot. Either one, they grew with me. I set boundaries. We came to an understanding. We understand and love each other and know how to communicate without harming each other around anti fatness. Two, I have limited contact with those people. If I'm forced to see them for whatever reason, limited contact and I don't engage in Body Talk or three, they're cut out for my life and not saying that you need to do any of those things, because those things might not be appropriate for you or where you're at in your life and your circumstances, but that's what happened with me, and you know what? It's Vinny. I love the fact that I don't have to worry about the people they spend the most time with saying, oh my god, I'm so fat. Have you tried the new diet, you know, or whatever. I don't know why they would suddenly turn into an American. I don't know what type of accent that is. And being offensive to someone, yeah, apart from, you know, a random person on the random passer by being like, hey, diets, that happens sometimes. So you can't protect yourself from that. That happens sometimes, right? So anyway, yeah, if you want, if you're interested in that, go to the link in the show notes to either watch, if you're if you're come live, if it's before the 20th or watch the replay. And hey, I need to mention this, if you enjoy the show, then go check out ko fi. Ko fi, which is like Patreon, if you want to support my work. I have not had any new ko fi people within a while, you know what? And I was thinking, you know, I've not told you about it. I don't think also, my podcast is only out once a month now. So anyway, if you like my work, you want to, you want to sling me five bucks or not, whatever you. Kofi is a way to do it. Well, I guess with Kofi, if you don't want to say slim me five bucks, don't go there.

Vinny Welsby 5:10

All right, but the podcast is funded by Kofi members to cover I don't make money from doing the podcast. I lose money, but the current donations that I have cover partially the costs for getting it edited, and then all the other admin work on the backside. So, so yeah, that's my anyway. Let's talk about fat in healthcare. I was inspired by this because I was talking with someone and they were telling me about this report that was done in BC, British Columbia, where I'm at, talking about racism, anti indigenous racism in healthcare. And so there was a report done, published too long, didn't read basic, not the report I didn't read. I'm saying too long, too long. TLDR, for you. So you you know, if you want to know the gist of the report, there's tons of racism in healthcare. Surprise, who knew? Yeah, everyone knew. Maybe not white people anyway. So this inspired me. The report inspired me to make this health one health episode, because I've got this picture in my mind of these stages. You know how like, I like visualizing things and making making the Instagram hosts, because I like visualizing things in simple ways. And I was thinking about the ways that fat folks are treated in healthcare, and it's also inspired me too. You know, I don't know if you remember, but in the summer, I made the fat at work report, which was this epic. You can go get it. It's free, epic report where 300 plus of you completed a survey telling me about your experiences of being fat in the workplace. 96.65% of you said you experienced anti fat bias in the workplace. So that's huge, gargantuan number, and I want to make that a one for healthcare as well. So I'm telling you now I'm making this podcast to force myself to do the thing I have ADHD, right? So sometimes I have these ideas in my head and I need to do something to force myself to do it. I've been thinking about it for a while, so I'm forcing myself to tell you about this survey. And the link to do the survey about your experiences, about being fat and engaging in healthcare, are going to be in the show notes. I've not yet created it, but I will by the time this episode comes out, and I would love to know your experiences. So this is going over the structural there's the structural way that that fat people engage in healthcare, and what is going on, what to expect. I mean, you know, if you're fat, if you're if you're a gender marginalized if you're if you're any type of marginalized person, you know what it's like to engage in healthcare is eye rolly. Not great. But I want to share some stories, talk about some stuff. Again, if this is not feeling good for you. Please skip this episode, because I'm going to talk about some shit shown links to everything that I'm talking about in the show notes. Yeah, so I've got this. I'm going to post this on Instagram, but I'm thinking about this, you know, zero to five point scale type thing, of how fat people are engaging in healthcare or accessing healthcare, and what happens normally and what needs to happen instead. So if we look at level zero, what happens is level zero is healthcare avoidance. So fat people can't or won't engage in healthcare due to previous bias, and shit experiences that we've had or delayed accessing healthcare, and the outcome of this is that health issues get worse. There's the treatment is delayed and potentially death. I'm going to go into all of the what actually the outcomes from having shitty anti fats, interactions with doctors leads to so first off, fat people are not even engaging in health care a lot of times because it's so traumatizing. Next level, one is initial contact. Initial contact. Often we are denied health care, full stop, just full stop. Told go away, lose weight, don't come back until you are this way. An example of this is IVF clinics. A lot of IVF clinics won't even talk to a patient if their BMI is over a certain amount, and that BMI is low, they just won't even. Let them book an appointment, so someone's got the courage to go and to try and access healthcare, and immediately it's like no, go away. You are denied basic healthcare. So level two, again, initial contact, the concerns that are brought up by the patient are attributed solely or mostly on weight, and you're denied evidence based healthcare told to lose weight, plus other interventions that are not evidence based, aka, told to quote, eat healthy and to quote, exercise more without knowing how much you actually exercise or what you eat. This is being treated poorly due to size, judgment and discrimination, so that leads to worse health, health outcomes and death. An example of this would be the IVF clinic, if you even get an appointment, won't offer health care unless the patient loses weight and blames weight on the reason why you're not able to conceive, and that's without testing. Is just looking at your body and saying, Okay, well, you know, you got an appointment with the help with the clinic, but the clinic is going to tell you, go away, lose weight. You CAN'T get pregnant because you're fat with literally just by looking using their eyeballs, no testing and no test is going to say you're too fat to get pregnant, because that test doesn't exist. So level three say you've got past those two, you've, you've, you've gone and seen someone, and now you're accessing health care. So at that point you could experience infrastructural and institutional inequity. So infrastructural is the actual structures within healthcare, so unable to access access equipment or treatment, etc. So this can cause delays in healthcare and worse health outcomes, or things like cut offs on procedures for BMI that are that are an institutional so a part of the hospital, this hospital system says we don't give gender affirming care to people over a BMI of this so institutionally, there's anti fatness, and that could be as well with the initial contact that institutional anti fatness. But if you're engaging in health care, pretty likely you're going to be coming up against both these infrastructural and institutional anti fatness, okay, level four accessing health care. So if you are able to access health care, you may experience sub par care due to stereotypes and discrimination. And the outcome of this is worse care. Well, worse health outcomes and death. And so this is the the the judgments that healthcare providers might be making about a fat patient, that they're non compliant, that they're lazy, that they're the what's the point? Because they're just going to, you know, be lazy and greedy and horrible. And one I've spoken about a lot, example of this is the HQ and one bird flu, you know, around COVID, when there was all I say, around COVID, COVID still thing, but the beginning of COVID, and everyone was like, Oh, my God, all fat people, they have worse health outcomes. And they said, hey, we'll look at the bird flu that happened there with with the bird flu, fat people had worse health outcomes. After they did a meta analysis of all of the data and looked at what was actually going on. If they found that fat patients would be being treated differently when accessing health care, and because of that, they were experiencing worse health outcomes. However, if a fat patient was treated the same as someone in a smaller body, they would have the same outcomes, and so then you've experiencing the sub par health care, and stage five is patient is unable to engage in health care or chooses not to in order to protect their mental and physical health. The outcome was care, was health outcomes and death, and we're back to the beginning, unable to engage in health care or choosing not to because it's not safe. And you could have already tried. We could have gone through this cycle many times, right? We could have tried to access health care and being cut off at level one, like, Nope, you're not even getting through the door. Or if you get to level two, you're getting through the door. But, you know, lose weight, because that's clearly what's going on. And if you get to level three, then it's, you know, shit care, right?

Vinny Welsby 14:24

Oh, so I'm going to visualize this in an Instagram post, by the way. So poor outcomes of anti fat bison health, health care. Here's some stats for you. If you want some stats, we love, we love a little stat. Okay, so studies have shown that up to 70% of health care providers may hold negative attitudes towards fat patients. I feel like that's gonna that's conservative, don't you? Don't you? Yeah, you do, don't you? You think 70% is conservative? Yeah, and I think this is conservative too. 30 to 40% of fat patients experience bias from healthcare providers, including derogatory comments and some issues. Unsolicited advice and inappropriate assumptions about their health behaviors. And by the way, the we've got links for multiple studies for both of those lower quality healthcare, less likely to receive appropriate preventative care and more likely to experience misdiagnosis, delayed treatment and have their concerns dismissed or attributed solely to their weight we have increased mortality, the chronic stress induced by weight stigma can activate biological pathways that promote weight gain. Who cares? But more more weight equals more stigma, including elevated cortisol levels, increased inflammation and dysregulated metabolism. I'm quoting from an up worthy article here that links to a couple of studies, and they wrote a 2015, Lancet study found that doctors take less time with fat patients. By the way, almost all of these links contain o words, and even though they're talking about anti fat bias and how it's bad, they still spout anti fat bias, bullshit. Honestly, honestly, the amount of articles where it says, oh my god, anti fat bias is terrible. But you know, fat people, they are really unhealthy. He's like, what can you not say? Hello, you're writing an article about anti fatness, and you start off by right in there with the anti fatness, honestly. So every single one of these, these things, not every actually, there's like one or two that I'll tell you, the one that I know is good

Vinny Welsby 16:33

has BS in there anyway. Let me finish. Finish the quote. A 2015, Lancet study found that doctors take less time with fat patients and are more reluctant, reluctant to screen them for other health issues. It also found that health care workers tend to stereotype fat people as less likely to follow medical advice and stick to medications. A 2020 17 review of research from the American Psychological Association also found that medical discrimination based on people's size is a real issue, and fat patients are more likely to have undiagnosed medical issues. Quote, In one study of over 300 autopsy reports, fat patients were 1.65 times more likely than others to have significant undiagnosed medical conditions. For example, endocarditis. Ischemic bowel disease and lung carcinoma, indicating misdiagnosis or inadequate care and adequate access to health care, quoting from a Washington Post article, by the way, I've linked to things behind a paywall through archive.ph archive.ph if you ever hit a paywall, just put your link in there and it will, um, redirect you to for you to be able to read it. There's a Washington Post article doctors have fat phobia too, which does serious harm to patients, by Kate Mann, the illustration is really fucking good. There's an illustration done by Michelle condrich, and there's a patient sat and there's a doctor or healthcare provider in scrubs and gloves and a mask, and the patient's sticking out their tongue, and they've got that wooden stick on the tongue, and the little lights, you know the what's it called, fucking flashlight torch, if you're the British, the flashlight, which should be looking in the patient's mouth, is directed onto their belly. I thought that was a really smart image, so, and it looks like that the healthcare provider is looking in their mouth, but the flashlight is just illuminating the belly anyway. Couple of quotes from that piece. One study showed that fat patients were rated more negatively by doctors on 12 out of 13 indexes, including this patient would feel like a waste of my time, and this patient would annoy me. We receive fewer expressions of empathy and concerns from providers who build less rapport with fat patients and often hold hold that we are lazy and non compliant. Such views are not only false, they can contravene the moral principle that everybody deserves humane, compassionate medical care regardless of their weight or health status. Okay, we've got some stories from that worthy article. These are people's, you know, self reporting. So anyway, my little sister started to feel fatigued and dizzy at nine years old. She felt nauseated at the site of food and had abdominal pain that increased with physical activity. Mum got her to the ER and the doctors dismissed it, saying she's fat and probably is feeling ill after eating too much burgers, get her temp, do some exercise, and she'll feel better in no time. I didn't my mum didn't feel okay with the diagnosis, and took my sister to a second doctor, who also told her that she the child was fat, her sister's skin. Was starting to get yellow As the days passed and the abdominal pain was getting awful. So my mum, heaven, bless her, got her to the ER for the third time. She had stage four hepatitis and was about to die. She survived after a long and painful recovery, which involved being in bed for a whole year. Remember that we're speaking about a nine year old child. Luckily, they saved her liver, and she didn't. She didn't go through a transplant. But let this sink in. If it weren't for my mother, fatphobia would have killed her. Fat phobia kills kids and teenagers. Fat phobia kills innocent people every day. It treats human beings as lesser than others, and hurts them in the most vulnerable times. It's a real shame that we all have so much, so many stories to share about this issue, a real shame. There's a tweet from Everett Dion at free black girl. I discovered today that doctors have been gaslighting me for over three years. I have I've had a real medical problem that they've been attributing to me being fat. Fuming is an understatement. They've been overlooking a problem in one of my vital organs and saying it or saying all the symptoms were caused by the size of my body. If I've not gone to the doctor thinking I was having an asthma attack, the problem would not have been found. Another story a friend from college who had been going to the doctors because she was having trouble breathing, she was told to lose weight. Over the course of several years, she went back to the doctors time and time again, telling them that she'd been sticking to the diet, but because of her breathing problems, she had been unable to even walk more than 20 minutes at a time. The doctor got her into an exercise program and told her that she just needed to really try to lose weight, because that was clearly the reason for the breathing problems. By the time they found the tumor in her lungs, it was inoperable. She only if. Three months after diagnosis, she was 25 she'd had the tumor for over five years. The doctor was so focused on the fact that my friend was fat that they refused to look for underlying any underlying cause. They killed her. Someone responded weight first treatment kills. Fat phobia kills so other other outcomes from all of this bullshit is obviously death. There's a piece from from a website called stat. Stat is is exclusive biopharma health policy and life science analysis. Anyway, the the article is, my sister's cancer might have been diagnosed sooner if doctors could have seen beyond her weight. And so I'm pulling some quotes from there. My older sister Jan visited me in San Francisco last spring. The author is Laura Fraser, by the way, my older sister Jan visited me in San Francisco last spring. You look great. I told her, noticing that her clothes were hanging loose, she'd been heavy most of her life. I've lost 60 pounds, she said. And I automatically congratulated her. I wasn't trying. She replied. It hit me then that something was very wrong, first with her health, but also with the way that I assumed that her weight loss was a sign of well being. My own judgments and shame associated with being fat got in the way of seeing my sister looking closer, her face seemed strained, and despite the constant smile she turned on, she wasn't well. She told me that she'd been in so much pain that she'd had little appetite for months. I asked Jan if she'd seen a doctor she had, but it hadn't gone well. The Doctor she'd known for years had converted his practice into a concierge service, and she hadn't wanted to pay the extra 15,000 to stay with him, so she'd made an appointment with an OBGYN a friend had recommended. Jan's eyes welled up as she described the visit. She had run down her symptoms, vaginal bleeding and explained weight loss and near constant pelvic pain. She told me the doctor hadn't taken her complaints seriously, dismissing her concerns and performing a routine examination. He didn't do anything for me, and he didn't find anything. He just saw me as a fat, complaining older woman. John said, demeaned and discouraged. She didn't seek a second opinion right away. Instead, she explored possible causes of her abdomen, abdominal pain, wasting months avoiding dairy and gluten and taking over the counter pain medications. During our visit in San Francisco, I encouraged Jan to see another doctor to get to the bottom of what was ailing her. A few months later, she finally got an appointment at an internist office, a physician assistant examined her. Jan arrived at the visit weak and racked with pain. She came out of it in tears with no answers and no relief, she wouldn't give me anything because she thought I was just trying to get an opioid fix. She told Cynthia, who had a company who had accompanied her, did the physician assistant think Jan was putting on an act to CAD drugs because she was fat and that despite her detailed and articulate medical complaints, not to mention her obvious and tremendous pain, she fit some undisciplined drug seeking profile. The physician's assistant did at least send Jan to have some blood tests. When she had finished giving blood, she was so exhausted she couldn't drive herself home very early the next morning, Jan got a call from the internist, who even though he had never met. Met her, told her to immediately go to the emergency room. She was quickly admitted to the intensive care unit in critical condition for the sky, high level of calcium in her blood, an MRI revealed an enormous mass in her abdomen. When Jan was stable enough for surgery, the hospital's gynecologic oncologist removed the largest endometrial tumor that he said he'd ever seen, the size of a volleyball born. It had peppered her pelvis with cancer infiltrating her bladder and other organs. The MRI also showed spots on Jan's lungs, likely signs that the disease was spreading even further. In hindsight, endometrial cancer is an easy disease to Google. The first few hits reveal signs and symptoms, unexplained weight loss, vaginal bleeding after menopause, pelvic pain, pain. Jen had them all. I'm no doctor, and I know that physicians are not infallible, but it strikes me that those symptoms, the ones the patient came in worried about, should have raised red flags far more than the fact that she was fat. Jan went through a few rounds of chemotherapy and lost even more weight. She took some perverse pleasure at being able to fit into normal size clothes. I'm putting a quotation there, and fashionable clothes for the first time in her life, not the UN sophisticated, uninspired garments that most manufacturers muster for plus size women. By then, she'd lost about 100 pounds, and despite her conspicuous, conspicuous, conspicuous, conspicuous, conspicuous illness, the wig, the pallor, the fear in her eyes, people kept on complimenting her about her weight loss, they too, saw only her size. Jan died last Christmas Eve, six months after learning she had cancer. That's not the full article, if you want to read it. There's obviously some little bits of anti fatness in there and the O words, but I feel like it was written with compassion, and that's from 2017 and then this person has written a book about on this topic. One's called losing it. America's obsession with weight and the industry that feeds on it. I've not heard of that. Maybe I have let me, let me look at it. So I don't want to say, go read it, because I don't know if this is a safe person. No, I've not. I've not okay. I guess it is from 1997 No. Anyway, that story, another story that was gained a lot of attention, was of a Canadian person who in her obituary, let me just read it so Ellen Maud, daughter, Ellen Maud Bennett, daughter, sister and aunt, Ellen Maude Bennett, who passed away age 64 on May 11, 2018 was to most who met her an unforgettable character. I'm reading bits from the obituary. Worry, by the way, this photo was taken one week before her death, and the photo shows a

Vinny Welsby 27:57

white woman with long blonde hair and smiling. Looking at the camera, she looks pretty vibrant, and it says she chose it for her obituary, because, as she said, I look so good for someone almost dead. She sounds funny. A final message Ellen wanted to share was about the fat shaming she endured from the medical benacle medical profession. Over the last few years of feeling unwell, she sought out medical intervention, and no one offered any support or suggestions beyond weight loss. Ellen's dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue. So listen here. Now, I know what some people might be feeling after we have to listen to those two stories. They're worried, oh my god, is that going to be me? And I want you to know that just by knowing about fat liberation and knowing that you deserve health care is almost like a a little bit of an immunization from anti fatness, not a complete one, because we're going to experience it, right? And at times we're going to be like, oh god, is this true? Do I do? Am I a terrible person that just needs to lose weight? But you've got this kind of foundation of knowing, huh, that doesn't sound right. And hopefully that turning into advocating for yourself and not saying that these people who you know, Ellen and Jan who died this, therefore it's not there for not, absolutely not. But maybe, if they had extra tools at their disposal, maybe the exact same thing would happen. Because, you know, doctors, you know, can behave like anti fat donkeys. But I want to just make you not take away from that that, Oh, my God, you. You are going to have the same experience. I mean, you might who knows what's going to happen in our lives, but by understanding we are worth health care and that losing weight is not going to cure your condition, we may be able to advocate for ourselves better. We may get better outcomes. We may not right. And the type of cancer that Jan had was a particularly aggressive type of cancer. I'm not sure about Ellen. We didn't have that extra information. But just because someone is diagnosed with cancer doesn't mean that they will die. By the way, Ellen died five days after her diagnosis, so thinking about all of this stuff, it makes me think about the image that I made, which is the levels of anti fat bias. And if you are familiar with it, it's the one, the thing that looks like a triangle, but I'm going to describe it out for you. There's a triangle, and it's split into four sections, four equal sections, and at the top one says intrapersonal or internalized anti fat bias. So that is your beliefs about fat people or fatness. And so if you're a fat person, you're going to have internalized anti fatness. That's going to look like negative self talk, agreeing with anti fat beliefs, trying not to be fat by dieting and taking drugs, etc. If you were in a smaller body, you're going to have internalized size privilege. So that's a belief that having a small, smaller body makes you morally superior than is due to the better choices and behavior that fat people fail to make, that you do make. So a lot of doctors will have that internalized size privilege and will have that. Well, it's easy for me to be this size. You know, all I do is, you know, with the same thing that a fat person does, lives their life, or whatever it is that they do, and are looking at Fat people like, why can't you just get your shit together, do what I do, do what I tell you, and stop being so XYZ, right? The next level on the triangle is interpersonal. So we're going down from the top of the triangle, and that's how individuals treat fat people. And so that's things like being fat shamed and rejected as a romantic partner, fat jokes, diet talk told to lose weight. And so interpersonal, if you're talking to a doctor, they could be giving you some of that interpersonal anti fat bias the next level. So we cut it in half, like the first two, they are like surface level. When I say surface level, I don't mean they're not that impactful. They are very impactful. But when we think about anti fatness, we think about how the way we feel about ourselves and how others treat fat people, and we don't necessarily think about what's below the surface, but we need to consider all aspects, all levels of anti fat bias if we're going to dismantle anti fat bias, and especially the bottom two. The bottom two are institutional and ideological. So institutional is the belief society holds about fatness and how it treats others or you due to those beliefs. And so these are things like being denied access to IVF, adoption, fostering children, employment, donating your body to science, buying a home, health and life insurance, Immigration and Citizenship, gender affirmation surgery, organ transplants, etc, etc. As if that list isn't enough, right? So institutional, I would lump in here as well. Is infrastructural, which is the structural way that you're denied, you know, not being able to find seats or MRI machine that fits, or a gown that fits, etc, in healthcare, so institutionally, healthcare practitioners are, wherever they're working, will have institutional anti fat bias, and finally, ideological, which is what I've titled the podcast, is talking about ideological, which is the idea that fat people are inferior, ethically, morally, and don't deserve dignity and respect. And it's a social culture and political belief, and that's the everybody knows that fat people are unhealthy, lazy and attractive, and we should just lose weight. And that is what I think, that is the basis of the issues with healthcare, is the ideological anti fatness that is woven into a healthcare provider's brain and all of our brains, right? And not healthcare providers are not special, but from before they've even started their training, throughout their training and throughout their career, they are taught to ideologically believe that fat people are inferior, and there might be some softening on that, and the softening is what we're seeing now with the organizations like Novo Nordisk, who are the manufacturers of azem Pick, who are trying to push. Narrative that it's not the fault of fat people, that they're fat and they're fat and lazy and greedy and disgusting. It's not their fault they have some type of problem, like it's a disease, right? That's a softening of the ideological anti fatness. It's the idea of love the sinner, Hate the sin, that fatness is inherently bad, but fat people can't help it. So let's, let's, let's treat them poorly with a smile on our face. So that's where we're at now that that that softening of of ideological anti fatness, which is not helpful, because the solution when you've got that softening of ideological anti fatness. When I say softening, I'm not sure if that's the right word. It's maybe morphing, changing. The solution is still to erase fat people, right? It's still to kill fat people. It's still to rid the planet of fat people. So we need to change that ideological anti fatness piece in order to change all of those other areas in healthcare, right? I feel like it's, you know, obviously we need to be able to access healthcare, but if we're stopped and, you know, have gowns that fit in wheelchairs and blah, blah, blah, all that stuff, but if we can't even get a foot in the door, because we know that we're going to experience interpersonal, anti fatness, institutional anti fatness. We're not going to get to the place where we can put on a gown that doesn't fit. And if we do get to that place, you know, we're wearing a gown that doesn't fit, we will already be harmed, be harmed by ideological anti fatness. So this is the one that, this is the article, the the the one link that I would say is is safe. It's from ama Journal of ethics, illuminating the art of medicine,

Vinny Welsby 36:48

five ways healthcare can be better for fat people by Kristen, a, Hardy M, a, I feel like I I know of Kristen like we've probably message Kristen if you're listening. Hi. Love your work. So quote from this, fat suffering and death, much of the existing work on better accommodating fat people's knees within North American healthcare settings focuses on reducing stigma and addressing inadequate medical equipment, in some cases, inadequate equipment and surgery related issues can be a matter of life, of life or death. The Computed Tomography or magnetic resonance resonance imaging scanner that was not designed to accommodate the bodies of larger members of the population, the surgeon who never learned to operate on fat bodies because their medical school, medical school refused the donation of fat cadavers. By the way, most places don't take fat people for research or anything like that. If they're when I say fat people over 180 pounds, which is not fat, so all of the research is being done on thin people. Okay, refusal donation of fat cadavers or the loss of life due to impaired health and well being from bariatric surgery, these deaths are collectively uncountable. The results, however, is the loss of precious lives and the irreversible trauma to families, friends and communities. Other outcomes are not as often as deadly, but may result in significant damage to physical or psychological health when, for example, clinicians expressions of weight bias result in, quote, health care seekers of higher weight ceasing or contact with clinicians joint replacements in Healthy People being denied on the basis of BMI or eating disorders being induced or re triggered by the bigoted comments of those entrusted with healing to every survivor of medical weight bias is suffering in limitation of activities, economic impoverishment through imposed disability or other negative consequences, are lived experiences that come on top of the already serious health impacts of broader social and cultural fat phobia. Yes, yet these sequelae of encounters with medical fat phobia cannot be tackled, apart from their root causes, the dominance of thin centric ideology, but the pathologization of fatness a failure to foster the leadership of fat people and a biomedical health system that continues to elevate the powers of power of physicians over that of healthcare seekers fat and otherwise, ultimately, we cannot understand and effectively address the specifics of the induced suffering of fat people within or excluded from biomedical context without looking to the poor inequalities that ground and support them, to the power sorry, to the power inequalities that ground and support them. That's a good, that's a good, that's a good. It's not too long this piece, so you can probably read it in 10 minutes. So. Minutes. One minute. I don't know how long it'll take you to read, but anyway, that's from 2023 really great, really great. How am I gonna end this? Hey, Elizabeth, this is how I'm gonna end it. That's how I'm gonna end it. Listen. Some good news. Okay, some good news. So I train, I train organizations, right? I help individuals and organizations and learn anti fat but anti fat buyers. And I gotta tell you, I gotta tell you, things are changing 100% not have they're changing 100% but I 100% feel like they're changing really, really, really. So I've been doing this work for 10 years longer, I think probably I need to. I always need to go and check my LinkedIn to see how long I've been doing, doing this work. And I'm like, what Jesus would that be that long? I'm always like, Oh, it's seven years. And it's like, no, it's 11 years or whatever. I don't know. Let's just say 10, whatever. Anyway, 10 years ago, just absolutely not, absolutely not to get this was, this felt very like a very, very, very difficult topic to get people to get on board with whenever I'd be having conversations. By the way, this is my experience. Okay, so take that with a grain of salt, whatever it's called. But if I had conversations with people 10 years ago, and I was having conversation with people 10 years ago, hey, fat people are human. And, you know, wild things like that. What do you talk about? Vinny people are not human. Silly sausage. Anyway, I would, I would be getting a lot of pushback. I remember about seven years ago. So I used to be in recruitment, so I had a lot of contacts in HR, in Vancouver, many, many, many contacts. And I remember about seven years ago, and then again, about five years ago, reaching out to all of those HR people and saying, Hey, if your organization wants to include this in their dei planning. And no one was interested. No one was interested. Now, they're really fucking interested. Some people, though, there are still, there is obviously, obviously, there's still lot. No, I say some, there's still lots of people. And I'm talking about people who are leaders and maybe in the DEI world. But people are hungry for this now. People are like, yeah, fat people human. I'm a bored, and I think that we should be kind of fat people. You know, whereas five years ago, 10 years ago, it would be like, Are Fat People human? And there'd be a few people who were like, Yeah, but a lot of people were like, and some people like, but it only if they're healthy. So things, mine is my anecdotal, very kind of rough idea of feeling, of this, this work of we're getting to that point where everyone knows and you know, like, for example, I did a training with with healthcare providers a month ago, and I said to them, so how many diets you know? What do we know about diets? How many diets work? Basically, I said it in a in a more robust way, but how many diets work? And many of them said zero. And I was like, What the fuck? Huh? How do you how do you not know that diets don't work? This is amazing. Some of them were like, oh, you know, yeah, but what about this one? And so that basic thing of like, diets don't work. A lot of them know. But then there was still kind of, yeah, but my patients fat so and the fatness is causing the problem. So how do I get them to listen to me and not be fat anymore? You know, this is after the training, and I'm like, no, no. Anyway, they might not have been listening to the training and just randomly asked Anyway, whatever. I'm so thankful about that. It really, really, really, really, makes me excited about what the future holds for fat folks, knowing that things are maybe question mark, continuing to get better question mark. I'm even just saying that I feel scared, that I've just jinxed it, and, you know, I'm just delusional. I don't know again, if you wanted to come to that training, if you're if you're around family in the next couple of months, or if you're around anyone ever, just for the rest of your life, that talk shit about fat and fat, fat people and whatnot, and you want to know how to deal with them and some strategies and word tracks, all that jazz. Come along to my training. Link will be in the show notes, boundary boss live, or get the replay. If you enjoyed the show and you want to contribute to more cool, fat stuff, go to KO fi. You get. Some free stuff in return, and thanks for hanging out with me today. It was tonight. I like doing podcasts. I like, I feel like I'm hanging out with people, but, you know, I'm on my own. I just imagine, I know, we're in a big group together, listening, talking about fat stuff, and it's just me and my own. This is my fantasy. So yeah, thanks for hanging out with me today. Remember you are worthy. You always were. You always will be and stay fierce fatty. See you next time. A good boy.