Tips for Suriving a Broken Ankle

Before and after

My right ankle, before and after

So, you’ve broken your ankle. Do you live alone? Eeeesh. Do you enjoy exercise and outdoor activities? Ughhh. Do you prefer to plan your own meals and have control over the day to day minutiae of your life? Oy. Do you dislike asking for help for every little effing thing? Oh lordy. Brace yourself. You’re in a lot of pain and haven’t even thought about how much your life is about to change. Take a deep breath and consider this advice from a person who was NWB (non weight bearing) for 8 weeks. It will be okay. But for right now, this is your life.

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Ask someone to get you fuzzy crutch covers IMMEDIATELY. One rugburn on your armpit is too many. You also will want to cover the handles to prevent blisters. (You will still get some blisters.) You can buy some, or use some towels or old t-shirts. It doesn’t matter what you use, just cover that rubber.

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This isn’t you.

Learn how to actually use your crutches. Get a doctor or nurse or physical therapist to show you how to use your crutches properly. Make sure they’re the right height and that you’re putting most of your weight on your hands, not armpits. Find someone to explain how to go up and down stairs properly. Stairs are the absolute worst.

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Get yourself a knee scooter post haste. Crutches are the devil. Two weeks after my surgery, I crutched into a McDonalds to use the restroom. It had been raining and the floor in the entryway was wet from people’s stupid wet shoes. I wasn’t even thinking and crutched right in there and completely wiped out, landing on my splinted foot. This hurt a LOT and could have jeopardized my entire recovery. (Thankfully, the screws held!) A graceful and experienced crutcher may look cool gliding down the street, but I promise you it is NOT WORTH THE RISK. Get an Rx for a knee scooter and ride that damn thing with pride.

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Scooters also need fuzzy covers.

Sure, you look like a child with your backpack and sneakers (you should be wearing sneakers now – preventing trips and falls is very important) but who cares. You’ll be much more comfortable and much more stable. You’ll even have a hand free to carry things for yourself, which is very important.

Practice patience. Oh, baby this is a hard one. It’s multidimensional too. You need to be patient every moment of every day. Nothing will be quick for you anymore. Grabbing something from the fridge during a commercial? Nope. Running upstairs to get that one little thing you need? Nope. Taking a quick shower? Nope. Running a quick errand on the way home? You are not about that life. You are the turtle. Be the turtle. Every move you make is measured, thought out, and slow. Rushing is for other people. You have to become a zen master. Going to be late to work? Accept it. Not quite enough time to cross the street before the light changes? Wait for the next cycle. Need to put your boot on but the sock is still in the dryer? Chill. If you rush, you will hurt yourself. It’s not worth it. Patience.

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Along those same lines, remember that this, too, shall pass. Your NWB days will end. It seriously sucks, but it is temporary. Be patient. Be patient.

Don’t get over confident, there, buddy. The minute you start jumping on and off your scooter or crutching at high speeds over uneven terrain, you will fall. Seriously. Use both hands on the scooter when you’re going backwards. Make sure your crutches have made solid, stable contact with the ground before swinging your body forward. GO SLOW. Hubris leads to re-injury.

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Learn to ask for help. Sometimes it feels really awful to ask for help. On Labor Day I got a ride to a matinee showing of A Walk in the Woods. I should have realized the theater would be PACKED with the elderly and their many walkers and wheelchairs. The handicap accessible seats were all taken, and every other available seat was up or down stairs. Since I was using my scooter and didn’t have my crutches, stairs were not an option. I was trying to figure out what to do when an elderly woman with a cane got up out of her handicapped seat and and insisted I take her seat. I immediately refused. I was absolutely mortified, but she hoofed it up the steps with her cane and woudn’t take no for an answer. When I told my coworkers about the incident, they had a completely different take. They said, “She must have been really excited to have been able to help you out. You probably made her day!”  It took me a moment, but when I thought about it, I could see that being the case. This was really helpful for me to realize as I struggled to ask for and accept help. My friend James wrote a great post about that. Read it. You will need to ask for and accept help.

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You will also need to stop feeling awkward about how often you say the phrase “thank you,” because it will be every other word that comes out of your mouth. These days, I say it at least nine times during every single interaction I have.

Learn to receive help graciously. This is one of the hardest parts about being laid up with a broken leg. Suddenly you can’t do anything for yourself. If you’re lucky, you will have people helping you. But the downside to that is that you have people helping you. Like when someone graciously offers to go grocery shopping for you and buys all the wrong things. (Regular Cheerios are NOT just as good as Multigrain Cheerios, Mom!) Or people sweetly offer to bring you food and keep bringing you pizza. I now know how it feels to be so freaking grateful for pizza and also so goddamned sick of pizza at the same time. It’s a strange feeling.

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One of the things I struggled with the most before my knee scooter was the fact that I couldn’t carry a plate or a glass of water on my crutches. This meant that I couldn’t serve myself food. This meant that one of the most basic functions of being an independent adult – feeding yourself – was completely in the control of other people. In my case, for two weeks after my surgery, the people in charge were my parents. And let me be clear here: surrendering that level of control to your parents as a 30-year-old independent woman is INFURIATING. Yes, my parents were so incredibly generous and helpful and basically saved me during those first few weeks after my surgery because I had no one else. I am so, completely grateful for everything they did for me. But it was still really freaking hard not to lose it that time that I asked my dad for some food because I was really hungry and he said “No, it’s too early for dinner. We’ll eat later.” And I was like “AW HELL NAH, DAD. I AM A GROWN WOMAN AND I AM HUNGRY AND I WILL EAT NOW.” Except I had just had surgery, didn’t have the scooter, and I couldn’t get my own food. He refused to bring me food and I started to cry and he got upset that I was upset and that was probably one of the worst moments of this whole entire experience. Once I got my scooter, I had a free hand to carry things. It was a game-changer.

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Find and revel in small moments of independence. Help is great and necessary, but sometimes you just want to do stuff by yourself. Some of the best moments of my convalescence were those that I spent alone. Like, really alone in my house for a whole day by myself. Sure, I planned ahead so that I had a fridge stocked with ready-to-eat meals, a few movies queued up on Netflix, and my scooter. (Praise be the scooter!) And on those days, I made myself eggs when I felt like it. I washed my own dishes. I shaved my other leg without anyone having to know about it. I did those things by myself, with no one watching or offering to help. It was beautiful.

(minus the dancing)

(minus the dancing)

Get out of your head. Having too much time to think is dangerous, and that’s what you have now. Way too much time to think. Try not to make any major life decisions right now. Your broken leg depression (situational depression is common for people with broken legs) will cloud your perception and poison your thinking about the state of your life. In addition to impacting your day to day concerns like eating and transportation, your injury is going to affect your relationships, your job/work, your social calendar, your creative outputs, and your community engagement. It may very well impact your sense of self. You might begin to wonder things like: “Am I still an outgoing, involved, busy person who does improv and loves hiking if none of those things are currently happening for me?” “Are my relationships as solid as I thought they were after spending an entire weekend without hearing from anybody?” “Are the melancholic, pessimistic jokes I use to manage my feelings starting to make other people uncomfortable?” “Is my life even going in the right direction?” “WHAT AM I EVEN DOING HERE?” … This shit is dangerous and it is real. On the bad days, try to remember that things are actually not as terrible as they feel. This is temporary. This is temporary.

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Therapy is awesome, though. But if you can’t drive and have limited transportation options and can’t get out of the house to see a therapist, you’ll have to figure out some other strategies. Reach out to people as much as you can. Even thought it’s super inconvenient and a huge pain in the ass, ask someone to get you out of the house at least once a week. Go to a restaurant. Listen to some music. Change up your surroundings, even if only for a few minutes. You can ask someone to call you to check in every day. If there’s someone else in your life who’s struggling right now, do what you can to try to help them out. Helping someone else is one of the best ways to get your mind off your own shit. Cross off the days on a calendar. Countdown to your next doctor’s visit. Plan something really fun and special for when you’re healed. Make sure you remember the end in sight.

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Make plans. I found it really helpful to think about and actually make plans for when I could walk again. For example, I’m going to dance at my friends’ wedding in a couple of weeks. I’m going to visit my parents in the city after that. Perhaps the biggest distraction/focal point has been planning a Christmas vacation with friends. After effectively missing summer (no swimming for me…) I am going spend a week on the beach in the Caribbean!!! The trip will be totally indulgent and fun, and I will have no regrets.

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Continue to be patient. It’s been almost 10 weeks since I broke my ankle. I am currently walking, albeit very stiffly and slowly, with a sport brace and sneakers. I am doing physical therapy and I can finally drive. All of this is excellent. And yet, I’m not quite myself again. My ankle is still swollen and sore most of the time. I still cannot carry anything heavy. I still cannot jump or walk quickly or wear normal shoes. I’m also still feeling sad and frustrated and all of the other things you feel when you’re not okay. To others, I appear to be through the worst of it, healed, back to normal. But there’s a lot more healing left to be done for my ankle, and also for my spirit.

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Remember, healing hurts. Continue to be patient and gentle with yourself. Continue to ask for help. Hang in just a little longer. We all must walk before we can run.

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Sizeist Microaggressions You Shouldn’t Have to Put Up With

“Microaggression,” according to Wikipedia, is a term was coined by Chester M. Pierce in 1970. Columbia professor Derald Wing Sue, who literally wrote the book on them, defines microaggressions as “brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color.” Some examples of racial microaggressions include statements like “But you don’t act like a black person,” or any of these others mentioned in this Buzzfeed list, or this list from American Psychologist, and this Tumblr.

Microaggressions are definitely real things that impact the lives of marginalized people of all categories. Most discussion of microaggressions focus on race, but they play a big role in size politics too. But because size is a dynamic element for most people (i.e. it might change), sizeist microaggressions tend to impact people of all sizes – those who are fat, and those who are afraid that they are fat or afraid of becoming fat. I’m personally getting really damned sick of them.

“You look great! Have you lost weight?” 

“You look so skinny in that picture!”

“God, I am a disgusting pig at this weight.”  “…You weigh less than me….”   “I mean, just because I’m not usually this weight. It’s different.” 

“But you eat healthy. I’m talking about the fat people who eat McDonalds.”

“Wow, you look great! You lost like a million pounds!”

“Just so you know, I used real butter in that recipe.”

“I used to be overweight, but I’m happy with my body now. If I was ever a size 10 again, I’d shoot myself.”

“But I don’t think of you as a fat.”

The important thing to remember is that  these micgroaggressions are committed unintentionally. For many people, these microaggressions come from the practice of fat talk – a self-deprecating way of communicating that people use to try to assuage their guilt over their eating/exercise habits, or demonstrate their social humility. It’s really unfortunate because people who fat talk think they’re only talking about themselves, and therefore only affecting themselves with their statements. They fail to realize that every time they criticize their own body or eating/exercise habits in front of other people, their words have the same impact of a microaggression.

It’s also possible that the person doing it just really has no idea because they just don’t think about weight stuff that often. For example, laughing at a fat joke on a TV show. While sitting right next to a fat person, totally oblivious to the impact of their complicit laughter on their friend next to them.

Microaggressions can result from the environment we live in too, like when clothing brands only carry up to a size 12. They can be actions rather than words, like when someone gives out free t-shirts as prizes, but only in sizes XS-L. They can happen in academia/research, like when you’re reading a book on organizational change theory and all of the examples are compared to weight loss maxims (“Just tell your team to put down the cookie, or better yet, remove all the cookies from the office!” – the cookie here being a metaphor for whatever “bad behavior” you’re trying to change).

Do you have more examples of sizeist microagressions? Have you been committing them unintentionally? And if so, are you willing to make an effort to stop?

How to promote health without being healthist

Have you ever felt suffocated by the pressure to be healthy? To eat “clean food,” run 5ks, go vegan, lose weight, tone up, eat paleo, buy agave nectar, do Crossfit, meditate, track your steps, count calories, eat organic, go paraben-free, switch to coconut oil, try acupuncture, use a Himalayan Salt Lamp, or quit sugar?

Do you ever feel like a bad person for failing to meet this standard of health so clearly articulated on sites like Pinterest?

health on pinterestWhen it’s your job to promote health, it’s also your responsibility to be aware of the barrage of health messaging out there and of the way it can make people feel: confused, overwhelmed, frustrated, insufficient, lazy, incapable, flawed, ugly, less-than, defeated, worthless, or even hopeless.

I’m going to throw out a radical thought experiment. What if I chose to be unhealthy? What if I simply opted out our contemporary culture of wellness? What if I decided that I didn’t care about longevity or preventing disease? What if I wasn’t interested in athletic pursuits? What if I was happy with my life without any of that stuff?

Would that make me a “bad” person? Would that make me less deserving of civil rights and legal protections? Healthcare? Federal or state assistance? Education? Would it make me less deserving of respect? Kindness? Compassion?

What if rejecting the active pursuit of health and wellness was a valid choice? 

Believe it or not, I do think it’s a valid choice. This may be surprising coming from a public health professional. But I think it is especially an important perspective for health professionals to have. My job is to promote health and wellness as well as to prevent and alleviate illness, violence, and suffering in the community I serve. Convincing people to care about their health and wellness is part of my job, but it’s something that has to be done carefully and thoughtfully so that I do not fall into the trap of perpetuating an oppressive culture of “healthism.”

What is Healthism?

The term “healthism” can be traced back to a 1980 article by political economist Robert Crawford, “Healthism and the medicalization of everyday life”:

Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being. –  Inlt J Health Serv

Implicit in healthism is morality, a driving force behind public health since the Civil War. The sanitation movement of the 1860s and 70s was largely led by the social (and moral) reformers of the Women’s Christian Temperance Union, who fought unsanitary living conditions and prostitution in the same breath.

Sylvester Graham (of Graham Crackers) and later Dr. John Harvey Kellogg (of Kellogg’s Cornflakes) were practicing healthists in the 1880s. They believed in a connection between immorality and disease, and prescribed bland foods and abstinence (from masturbation especially) as part of a healthy lifestyle that would produce a “higher. purer, and nobler type.”

Petr Skrabanek, whose 1994 book The Death of Humane Medicine and the Rise of Coercive Healthism explored this issue, wrote that healthism begins when all human activities are judged according to their health impact, and deemed either “healthy” or “unhealthy”, “responsible” or “irresponsible”, “acceptable” and “not acceptable” based on this measure. Skrabanek goes further to claim that “healthism either leads to, or is a symptom of, incipient totalitarianism … Healthism justifies racism, segregation, and eugenic control; for the healthist, what is ‘healthy’ is moral, patriotic, and pure; while what is ‘unhealthy’ is foreign, polluted, and impure.”

In his review of Skrabanek’s book, Bryan Appleyard wrote:

Skrabanek has two arguments against healthism. First he insists that this kind of pressure and coercion amounts to a fascistic imposition on the lives and freedom of individuals.

And, secondly, he points out that most of the healthist assumptions are either not proven, wrong or highly biased. For example, he says that screening – a central doctrine of healthism – has been found to have no health benefits, but that this finding has been suppressed. And he regards the caring of the healthists as a hypocritical cover for crude authoritarianism.

‘As healthism is driven by power,’ he writes, ‘rather than by concern for the welfare of fellow men, it is devoid of any moral principles.’

, calls healthism “the new Puritanism“:

Healthism is an avenue for subliminal narcissism. There is something seductively deterministic and morally appealing about eating like a cheese-fearing vegan rabbit and looking better, living longer and getting 50 % of the insurance premium back thanks to Affordable Care Act’s Zen-sounding Wellness provisions.

In short, healthism is the new puritanism. The old puritans worked for God’s glory with a famed work ethic which, according to Max Weber, might have been the chiefly responsible for the success of capitalism.

The righteous, mirthless, po-faced, lycra-clad new puritans are forever punching numbers in to risk calculators and obsessing over arbitrary thresholds of LDL-cholesterol whilst watching the Dr. Oz show with the fastidiousness with which the old puritans internalized Leviticus, lest they miss another opportunity for a miniscule relative risk reduction.

Fall Ferguson, Assistant Professor of Health Education at John F. Kennedy University and current President of the Association for Size Diversity in Health says:

Healthism includes the idea that anyone who isn’t healthy just isn’t trying hard enough or has some moral failing or sin to account for … More subtly, healthism represents the widespread ethic of individual responsibility for health in our culture. In the debate over U.S. health care reform, we obsess over the health of individuals, whether it’s reshaping individual behavior to our liking or finding ways to pay for the expensive treatment protocols that we see as being needed because of people’s personal “failure” to care for their own health.

At best, “healthism” refers to a cultural preoccupation with health. At worst, it describes an ethical paradigm in which certain health behaviors are considered moral imperatives and a person’s value and character is judged based on their adherence to those behaviors. A person might also be denied services, benefits, and rights based on their adherence to those behaviors. This is highly problematic.

People engaged in the work of health education/promotion, public health, medicine, nutrition and fitness, etc., must be aware of the pitfalls of healthism, and try to avoid them whenever possible.

Why is healthism bad for INDIVIDUAL HEALTH?

Obsession is not healthy, even if it’s an obsession with health. Encouraging or condoning this kind of preoccupation or obsession in others can be seriously detrimental to their mental, emotional, and physical health. It’s what leads to disordered eating and exercise behaviors, as well as what some are calling “orthorexia nervosa” – a rigid fixation on food quality and purity. It teaches people to ignore their body’s signals – to “push through the pain” – resulting in injury. It robs people of time and resources that they otherwise could put towards fostering social connections, creative hobbies, community service, and other worthwhile pursuits that foster well-being and happiness.

Healthism also creates and encourages stigma, particularly fat stigma. By promoting this idea that “fat = always unhealthy” (which is just not true), fat people are singled out as failing to uphold their “personal responsibility” to maintain their health. As a result, they are labeled as “lazy,” “ignorant,” “lacking willpower,” “gluttonous,” “greedy,” etc.

Whoever came up with the idea of making dieting about health is simply brilliant. Now, society can be prejudiced, but it is ok because it’s about health. Now, you are not shallow if you focus all your attention on dieting, you are righteous. And, whoa be to you who do not diet – for thou art sinning! – Lonie McMichael in Talking Fat

If fat people are automatically “sinners” by virtue of being fat, then it becomes socially acceptable to insult them or shame them. In some cases it can even be seen as a moral imperative to insult and shame them, especially if one believes that will cause them to lose weight. But being fat does not necessarily mean someone is unhealthy. And not only is insulting and shaming people a generally shitty thing to do, it DOES. NOT. HELP. PROMOTE. WEIGHT. LOSS. In fact, it can result in weight gain. So, not only is it cruel, it’s detrimental.

laci green quoteWhy is healthism bad for PUBLIC HEALTH?

Another major problem with healthism is that it tends to focus the attention and resources of public health work on fostering individual behavior change, when we know that social determinants of health influence our health more than individual behaviors do. Public health professionals and health educators pay a lot of lip service to the socio-ecological model intended to address these social determinants.

S-E-ModelYet, due to the influence of healthism, health professionals tend to concentrate most of their efforts at the individual level. Fall Ferguson writes:

In my own field of health education/health promotion, there is a disturbing disconnect between the evidence about the social determinants of health and the profession’s focus on changing individual health behaviors. Even “ecological” approaches to health education, which are inspired by systems perspectives that highlight the interconnected web of health causes, tend to focus on the end result of changing individual behavior rather than collective solutions to health issues. A 2012 article in Health Education and Behavior reviewed 20 years of reported ecological health education interventions; the article acknowledged the field’s shortcomings in this arena, and noted that in addition to certain structural barriers, we may need to move past our own training: “health educators may not have the training or resources to successfully plan and implement institutional-, community-, or policy-level programs.”

Maybe it’s more than just our training that holds us back. Maybe we need to acknowledge our basic healthism instilled by our cultural milieu as well as our professional training. And maybe we need to unpack the privilege that has allowed us to focus so much attention on the role of individual behavior in health.

Why is healthism bad for SOCIETY?

Today we often speak about eating and exercise in terms of morality, often to the point of absurdity. Amy Schumer did a great job of calling out the way we self-flagellate for eating dessert in her sketch, “I’m so bad!”

But this is one symptom of a much bigger problem. Healthism is a social justice issue. To focus on wellness requires resources, namely money, access, and time. This is a matter of privilege. Who has access to organic foods in their neighborhood and who does not? Who can afford childcare in order to exercise and who cannot? Who has healthcare benefits and who does not? Who can devote time to their meditation practice and who cannot? Fall Ferguson writes:

It seems to me that healthism is reflective of deep privilege; it is (in my opinion) a classic “first-world” problem. Healthism can only thrive in a culture where the dominant groups do not have to worry about such things as famine, infectious disease, war, poverty, and hatred as factors that affect their health. It’s privilege that allows us to make health a “project” that we can judge others for not taking up.

Those with lower socioeconomic status do not always have the luxury to focus on their wellness, especially if they are struggling with the basics of Maslow’s Hierarchy of Needs, like safety, housing, and hunger. We cannot talk health behaviors as “necessary” or “essential” or “mandatory,” (as in, “eating GMO-free is basically mandatory”) when they are often beyond the reach of lots of people. We must not judge people for failing to prioritize wellness based on our assumptions about their lives and our paternalistic ideas about what is best for them.

We also must remain vigilant and push back against legislation and policies that discriminate against people based on their health. As Ragen Chastain, educator, activist, and fitness enthusiast, frequently reminds us: “the rights to life, liberty and the pursuit of happiness are inalienable and not size, health, or healthy habit dependent.

The good news? There are things we can do to help avoid the pitfalls of healthism.

Here are some tips for health professionals:

  • Do not focus your work solely on individual behavior change. Make sure that you’re spending equal, if not more, time and resources on addressing social determinants through policy and environmental approaches. If your wellness program is focused solely on individual behavior change and there is no additional support for addressing social determinants in place, you need to rethink your program.
  • When sharing health promotion knowledge/tips/techniques/advice, always start with a disclaimer. For example, “Nobody has any obligation to participate in exercise, however for those who would like to participate – or just learn about the benefits of physical activity- I’m going to share the following info and tips.” Remind people that their heath habits have no bearing on their worth, their moral “goodness,” or their human and civil rights.
  • Be reasonable with your goals and expectations. Not everyone has to have the body of an athlete. Not everyone has to eat like a “health nut.” When you share guidelines, make them reasonable for the average person. Remember that for some people, the absence of illness and suffering is healthy enough, and that’s their choice and it’s valid.
  • Do not impose your beliefs about health and morality on your patient/client/student by automatically assuming they want to lose weight or devote time and other resources to fitness, nutrition, wellness, or weight loss. Use motivational interviewing techniques to find out what their motivations are for seeking help and work from there. Find out what they believe and respect their goals and value system.
  • Understand that shame and guilt are NEVER good motivators. Under any circumstance. Not only do they NOT WORK, they have a negative impact on a person’s mental and emotional well-being and can actually discourage them from participating in healthy behaviors.
  • Help every person cultivate a positive body image. It will not “promote obesity,” I promise.

Have you encountered healthism in your life or work? Have any other tips for how to avoid these pitfalls? Please share your thought and experiences in the comments!

Growing up in the Stratus

A lot of things are happening in my life this year. This year I moved to a new state to start a new job in a new town. This year I will turn 30. And this year, I am buying a new car.

Buying a car might not be a big deal for some, but it is for me because it means saying goodbye to the car I have been driving for 14 years – the car I have been driving since I was 16 years old.

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The Stratus

When I turned 16, my dad laid down the rules. If I was to get a car, it had to be American, it had to be bright colored, and it had to be big. (Bigger and brighter = safer, in his mind.) I found a 1998 Dodge Stratus that I really wanted. It was black with cool black racing tape on the steering wheel from its previous owner. To my teenage self, that racing tape was everything. Then my grandparents got involved. They wanted to give me a car as a gift and, as they put it, they “don’t buy used.” So, it was decided that 16-year-old-me would receive a new, bright red, 2002 Dodge Stratus as a present from my grandparents.

I was terrified – both of the responsibility of owning a new car, and of what my classmates would think. No one at my high school drove a new car. I was deeply afraid of being socially outcast for being a spoiled, rich kid. I was privileged, yes. Rich or spoiled? Not so much. But how do you explain that to classmates seeing you ride around in a new car? I begged for the used Stratus with racing tape that would blend in at the high school parking lot. I actually cried because I was forced to receive the gift of this new car. A few people were nasty to me, like I predicted. But my friends and my brother’s friends enjoyed the crap out of that car and it didn’t matter anymore. Since then, I’ve learned to accept my privilege and found personal ways to contribute to repairing the world. I am at peace with who I am and where I come from, and if that’s what turning 30 is all about, bring it on.

The Stratus served me well for 14 years. It was with me at college. It was with me when I moved back home to live in my parents’ basement and figure out what I was going to do with my life. It was with me when I moved to Boston for my first, real full-time job as a grownup. It was with me when I went to grad school and started my career in public health. It was with me this March, when I merged onto the Mass Pike leaving Boston to start my new life in western New York, which felt so much like that final scene from Six Feet Under that I actually listened to Sia’s “Breathe Me.”

I know it’s just a car. An inanimate object. A possession. And yet…

The Stratus was with me during my first experiences canoodling with boys in the backseat. It was with me on those completely irresponsible and dangerous drag races on the way to high school. It was with me on my first road trips with college friends, looking for adventure and mischief. It was there for me and my friends on day trips to the beach and to vineyards and hiking trails and concerts and amusement parks. It was with me during moments of pure joy, dancing and belting out lyrics to my favorite songs while my left hand surfed the wind. It was also with me during some of my lowest moments, driving home from a devastating encounter, or driving around to aimlessly to try to break the spell of a depression.

The Stratus was there when my little brother injured his hand at baseball practice and I had to drive him to the hospital as fast as possible. The Stratus was there the night my wonderful friends knew I had too much to drink and took away my keys. The Stratus made it possible to do things like visit my family, or head 30 minutes out of town just to go to the “good” Mexican place for a burrito. Freedom, in a nutshell.

The Stratus is where I discovered and enjoyed music. From 2002 to 2015, my surprisingly good speakers blasted the Offspring, the Cranberries, the Goo Goo Dolls, Aqua, Sum 41, All American Rejects, Gin Blossoms, The Shins, The Killers, Frou Frou, Lady Gaga, Amy Winehouse, Kings of Leon, Foster the People, Passion Pit, Freelance Whales, and Fun. The Stratus has seen at least 20 epic Bohemian Rhapsody sing-alongs, and one particularly memorable Panic At the Disco! front-seat sing-along that drove our back-seat passengers crazy.

The Stratus is where I listened to the NPR and learned about the world around me, and very far away from me. The Stratus is where I practiced answering interview questions. Where I rehearsed having difficult conversations. Where I collected myself before trying something new. Where I bonded with friends on long trips – just us, with everything to talk about.

After 14 full years, the Stratus isn’t looking so hot. It’s got some rust now, and plenty of battle scars. (After a certain point, you stop caring about the cosmetic stuff.)

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But it still carries my story, complete with artifacts from different times in this young person’s life.

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A remnant from back when being an Apple user meant something.

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HRHS parking permit.

Alma matter.

Alma mater.

The green is the permit for my first condo in Boston.

The green is the permit for my first condo in Boston, the yellow for G lot at Brandeis. Oh, G lot.

It’s really not about the car. It’s about entering a new phase of life. It’s about looking back and feeling grateful for where I started, how far I’ve come, and the amazing people I have met along the way. I am ready to embrace what my future holds with an open heart.

Then...

Then…

Now.

Now.

As for the Stratus, it has a bright future. I’ve sold it to someone who builds and races stock cars. As hard as it is to say goodbye to the inanimate companion of my young adulthood, I am comforted to know that the Stratus is moving forward too. And I am hopeful that when it finally goes, it will go out in a blaze of glory befitting the journey we have taken together.

Thoughts on “Fed Up”

wpid-fed-up-trailer-headerI finally watched Fed Up now that it’s on Netflix and here are some of my thoughts.

First of all, it’s about time a documentary took the food industry to task for their immoral lobbying practices. I do agree with the way the film compared food advertising and lobbying to tobacco advertising and lobbying. It’s deplorable. It was depressing to look at Michelle Obama’s “Let’s Move” campaign and see how it buckled under pressure from the food lobbies and reduced itself to an education/awareness/PR campaign instead of a multi-faceted public health initiative working at the individual, community, and policy-making levels. I believe policy reform is crucial; without it, any attempt to improve the state of nutrition in this country will fail.

I was also struck by the way the film gets at the issue of culture and environment – and how much change has happened to our culture and environment in the past 30 years. As a child of the 80’s, it’s interesting to learn more about the historical context of the “obesity epidemic.” I didn’t realize that I was growing up right in the midst of this new(ish) phenomenon. I think it’s human nature to assume that the culture and environment we grow up in just is. We tend to assume that things have always been the way they are.

It blew my mind to imagine a world pre-fitness culture where Americans didn’t all belong to gyms or own workout clothes or think of exercise as positive, healthy, and normal. It’s also interesting to re-examine some of my personal memories (for example, the debate about bringing Coca Cola vending machines into my middle and high school in exchange for a new scoreboard and who-knows-what-else) within the larger context of these sweeping changes that were happening across the country at that moment in time.

It’s strange to realize how different the culture and environment looks compared to what I experienced as a kid in the 80s and 90s. Now we have Crossfit bros and “fitspo” on Instagram and Pinterest. We have artificially flavored water-type beverages for sale as health drinks. We have energy drinks. We have Grub Hub and Foodler. Today we jump on weirdly specific food trends as though they could fix everything, like greek yogurt, acai berry, coconut water, kombucha, and coconut oil. At the same time, we lose our shit over KFC Double Down chicken sandwiches, Taco Bell Doritos Locos Tacos, and Cronuts. I never would have thought that fast food companies would ever be allowed into school cafeterias, and yet they have been. We must remember that this culture and this environment is something that can be molded and changed according to our values and goals, not something that “just is.”

I really appreciated that the filmmakers made a point to explicitly take the blame for obesity off of fat people. Although we can each try to improve our own health as we see fit, individual behavior change is not the solution to obesity in America. I was glad they touched on the psychology of addiction and the way environmental cues prime our brains to eat in harmful ways. I was glad that they talked about how dieting doesn’t work because it’s nearly impossible to do successfully in a long-term, sustainable way. I was glad they explained how being thin does not necessarily mean someone is healthy.

My only real gripe with this film was the disappointing way it talked about the role of exercise. While I appreciated that they showed a fat person who exercised regularly (fat people can be active too!), I had trouble with the way her failure to lose weight was equated with a failure to be “healthy.”

Some really promising studies have shown that exercise can improve health measures and reduce the burden of disease regardless of whether or not a person loses weight. So while I think it is valuable to point out that “calories in, calories out” is inaccurate, and while it is important to know that exercise does not necessarily result in weight loss, I am disappointed that they did not talk about the ways that exercise can improve a person’s mental and physical health and lower their risk for diseases often associated with obesity. Basically, the film made it sound like exercise was pointless because you’ll still be fat. This is patently false.

You can improve your health and quality of life by exercising, even if you stay fat. You can also improve your health and quality of life by eating better, even if you stay fat. This is the basic premise of the Health At Every Size approach. We need to avoid making people feel like they are doomed to be unhealthy and sick if they cannot lose weight – this can only result in worse outcomes for everyone.

This is all very similar to a recent article “You can’t ‘outrun’ obesity: Study says exercise doesn’t help weight loss.” I quote the brilliant Ragen Chastain:

What’s super messed up is that these doctors are aware that movement reduces the risk of developing heart disease, dementia, some cancers, and type 2 diabetes (the exact reasons that we’re given for losing weight,) and instead of saying “Hey, this seems like more evidence to suggest that maybe we should be more focused on evidence-based health interventions and less focused on manipulating people’s body size,” they are trying to downplay the actual health benefits because the evidence-based health intervention that they’ve found doesn’t make people’s bodies smaller…

The problem here is that we’ve become so obsessed with trying to get everyone into the same height weight ratio that we’ve taken our eye off the ball of giving people options and information that will support their actual health.

Most studies about weight and health don’t take behavior into account, which is weird because those that do take behavior into account find that behaviors, and not body size, are the best predictor of future health.  To be clear, health is complicated, multi-dimensional, not entirely within our control, not guaranteed under any circumstances, not an obligation or a barometer of worthiness.

A final thought is that I wish that the filmmakers had found a way to talk about the negative consequences of fat stigma for individuals and society in more of an intentional way. I understand this was probably outside their scope, but it is an important piece of the story.

Overall, I am glad this film was made and I think it could be a useful tool in creating change. We must remember that social change requires a multi-faceted approach. In Public Health we call this the Socio-Ecological Model.

S-E-Model

This model states that we need to make change at each of these different levels – including and especially the policy level. It also teaches that different strategies are warranted at each level. The Fed Up film did a great job talking about the kind of change that needs to happen at the policy level, which I think was the goal of the film. But when it comes to the individual level, it’s important to understand that being overweight does not doom a person to poor health always and forever. If the statistics in Fed Up are correct and approximately 95% of Americans will be overweight or obese by 2035, it is so, so important to give people hope.

As I said before and Fed Up clearly demonstrates, policy reform is absolutely crucial. But another piece of our overall strategy for change must be focused on helping individuals navigate the world they live in. By reducing stigma and focusing on the benefits of exercise and healthful eating for their own sake, we can help people live healthy, happy and productive lives – even if they stay fat.

The Thing About Being a Fat Health Educator

I am a college health educator and I am fat. I suspect that people do a mental double-take when I introduce myself as a health educator. My educated guess is based on the fact that fat stigma exists. In 2009, Salon published an article asking if Dr. Regina Benjamin, a renowned MD and recipient of the MacArthur genius award, was “too fat” to be Surgeon General. If folks are asking that about her, it’s not much of a stretch to imagine they’re wondering about me too. But here’s the thing. I don’t think my weight has any bearing on my qualifications as a health educator, and here’s a whole list of reasons why.

  1. Nutrition, fitness, and weight management are only one small part of a college health educator’s job. Depending on a college’s size and organization, they may not be in the job description at all. For example, my job description instructs me to spend at least 60% of my time on alcohol and drug abuse prevention, with a secondary focus on running our peer health education program. My next prescribed priorities are stress management, sexual health education, tobacco cessation, and sexual assault prevention. In my copious spare time (sarcasm alert) I attempt to cover the rest, including cold and flu prevention, cancer prevention, eating disorder prevention, and education around sleep, nutrition, and fitness.
  2. Not every health educator became a health educator because they’re a nutrition and fitness enthusiast. In fact, a lot of college health educators get into this field because of the badass health topics we get to cover: sex, drugs, and rock n’ roll. My academic interest in sexual health politics (the HIV epidemic, Roe v. Wade, etc.) are what led me to this field; learning more about other wellness topics in the process has been a bonus.
  3. You can’t accurately judge my health status based on my weight. Health does not equal thin. Plenty of thin people engage in unhealthy behaviors, and plenty of fat people engage in healthy behaviors. It is folly to assume that you know anything about a person’s health based on their appearance.
  4. Sometimes being a fat health educator can actually come in handy. Students struggling with weight, body image, or eating disorders sometimes feel more comfortable speaking with someone who they believe can relate to their experiences. Just as they might judge fat health educators as being able to relate to those experiences, they may judge thin health educators as being unable to understand their struggles. Clearly, you cannot tell by looking at a person whether or not they have struggled with weight, body image, or eating disorders, but it’s not far from the mark to assume that a visibly fat person has probably experienced fat stigma and can relate to what that feels like. The desire to receive help and support from someone who shares your experience or perspective is not unique to this issue. For example, many people struggling with substance addiction seek help from other recovering addicts. We see this in the sponsorship model in Alcoholics Anonymous and Narcotics Anonymous. It’s also not surprising that at any given time, 37%-57% of addiction counselors are in recovery themselves. I do not intend to equate the experiences of being fat and addiction because they are two completely different things. But sometimes it really helps to talk to someone who’s been there, you know what I mean?
  5. As a fat health educator, I know first-hand that nutrition, fitness, and weight management are not easy or simple – despite what some people would have you believe. I also know first-hand the unintended consequences of talking about weight management as if it were easy, simple, or even attainable for the majority of people. Those unintended consequences can range from frustration to self-hatred, from “fat talk” to dangerous disordered eating and exercise behaviors. As a result of this knowledge and experience, I am incredibly careful in my messaging around nutrition, fitness, and weight management. I avoid using calorie counts because those numbers can be triggering for people struggling with eating disorders. I stress Health at Every Size – a philosophy that promotes healthy eating and exercise behaviors for their own sake, regardless of whether or not they result in weight loss. I do not promote dieting, but I do promote making healthy dietary choices. I teach nutrition, fitness, and positive body image within a framework that supports an understanding of wellness as multi-dimensional – and I trust students to decide for themselves which dimensions they will prioritize.

It has been suggested to me that I should lose weight in order to be “taken seriously” as a health educator. This is so, so, so problematic on so many levels.

First of all, this is essentially saying that in order to escape the consequences of fat stigma, I should stop being fat. That’s a bit like suggesting a black person change their race in order to avoid the consequences of racism in the workplace, or that gay people stop being gay in order to avoid the effects of homophobia. With social stigma, the morally correct response is to fight to end the stigma, not eliminate the group of people who are stigmatized.

To be sure, being fat is different from being black or gay. I do not mean to equate these different experiences of oppression. Instead, I am suggesting that it’s not really helpful to think of being fat as something a person can necessarily change.

People do not always have control over the circumstances of their lives, especially in regards to health and disability, access to medical care, and financial security. Sometimes people may have medical reasons why they cannot lose weight. For others, the time, money, and energy it would require to lose weight may be more than they have to give. To assume that every fat person could lose weight if they chose to is a hugely reductive perspective, based in stigma, that denies fat people the right to their own individual stories, situations, and experiences.

To get more personal, I guess I could be classified as a person who “could” lose weight if I chose to. The thing is, I have made that choice in the past and it didn’t go so well for me. You can read all about in “My Breakup with Exercise.”

From my past experience, I know that In order to be a thin health educator, I would have to sacrifice to a degree that would have an overall negative impact on my life and personal wellness, as well as my job performance. For me, maintaining a low body weight is a mentally exhausting and extremely time intensive endeavor. It requires devoting nearly all of my free time to exercise and meal planning, to the extent that I do not have enough time or brainpower leftover to hang with friends, see shows, or work on creative projects like quilt-making, comedy writing and improv, and this blog.

The “decision fatigue” from focusing so much attention on food choices would also take its toll at work, leaving little decision-making power for my actual work. Plus, have you ever tried to go a whole work day on yogurt and salad? It’s not easy to keep that upbeat smile going when you’re hungry and irritable, and it’s definitely inconvenient when a serious one-on-one with an at-risk student is continually interrupted by your stomach growling.

However, with moderation, I can maintain a decent level of health without making those kinds of sacrifices. I may not be thin, but I can live a full life and perform my best at work.

For me, wellness continues to be a journey.

A Softer World

Each year I adopt new behaviors to improve different dimensions of my health and wellness. My priorities may change, but I will be continuing this journey for the rest of my life. My weight may or may not fluctuate as a result of my choices, but I refuse to think any less of myself for doing health education – or any work, for that matter – in a fat body.

So the next time you judge a health professional for being fat, take a step back and check your prejudice. It is up to all of us to create a future where professionals are judged not by their appearance, weight, race, ethnicity, religion, gender, sexuality, or gender expression, but by the quality of their work.

WTF is “lifestyle change” supposed to mean anyway?

lifestyle changeIf you’re like me, you’ve heard the term “lifestyle change” thrown around quite a bit. For example, it was used plenty of times in the comments on my recent post, My Breakup with Exercise. People are always saying things like, “It’s not about dieting, it’s about making a lifestyle change.” But oftentimes one person’s “lifestyle change” is another person’s diet, and vice versa. So WTF does “lifestyle change” actually mean?

Growing up, I first heard my parents use the term to describe a family friend and the healthy changes she made many years ago. Even then I was confused because her story began with everyone’s favorite diet company, Weight Watchers. Even though she no longer follows the program, she continues to practice some of their tips and tricks to maintain her weight, like tracking what she eats, looking for foods high in fiber, etc. A relative told me about a coworker who “doesn’t diet” but just has “plus days” and “minus days”; if she had a “plus day,” she’d compensate by having a “minus day.” To me, this all still sounds like dieting because it involves monitoring your food intake, following food “rules” or restrictions, and placing value judgements on foods or eating habits as being “good” or “bad.” Of course, you might not agree, and that’s okay.

Although the intention is usually good, telling someone to make a “lifestyle change” is problematic because everyone’s understanding of what that means is different. For example, it could mean switching to sugar-free versions of your favorite foods, or it could mean never eating artificial sweeteners ever again. Those of us who struggle with weight and body image often understand the term to apply to eating and exercise behaviors, but for others it could refer to quitting smoking or taking up a meditation practice or switching to paraben-free bath products.

The beauty of the term, though, is that it can mean whatever you want it to mean — whatever makes sense to you.

At it’s most basic level, a “lifestyle change” means making changes to support one’s personal wellness. Did you know that there are actually seven different dimensions of wellness?

  • Physical wellness can include fitness, diet and nutrition, sexual behavior, substance use or abuse, medical care, and sleep.
  • Intellectual wellness can include the pursuit of knowledge, awareness of current events, and the expression or experience of creativity.
  • Emotional wellness can include stress management and relaxation, as well as self-awareness, self-acceptance, and mental health.
  • Social wellness can include interpersonal relationships, social justice, and community service.
  • Spiritual wellness can include your value or belief system (including but not limited to religion), and finding personal meaning, hope, and optimism.
  • Environmental wellness can include the protection and conservation of natural resources, as well as the health and safety of animals, humans, and our own bodies.
  • Occupational wellness can include job satisfaction, work/life balance, and financial security.

It’s helpful to consider of all of these dimensions because it reminds us that neither our worth nor our happiness nor our “wellness” is defined by our appearance, our fitness, or our diet. Part of figuring out what making a “lifestyle change” means to you is figuring out what dimensions of wellness you want to pay more attention to–recognizing that each are equally valid and important in your personal pursuit of health and happiness.

Last year I taught a course on leadership and we used a ranking activity to help students think deeper about their own values. (Mad props to Steve R. for the activity!) I modified it and I think this version could be helpful in terms of figuring out what “lifestyle change” you might be interested in. Below are 50 different things that could be part of making a healthy “lifestyle” change, in no particular order.

 Weight management

 Fitness/ Strength

 Smoking

 Religious belief & practice

 Community Service

 Finances/debt management

  Job satisfaction

 Inner Harmony

 Environmental conservation

 Social Justice activism

 Hope/Optimism

 Stress management

 Animal rights

Being active

  Nutrition

 Vegetarian diet/ vegan diet

 Mindfullness/ meditation

  Sleep

 Creativity/ Creative expression

 Sexual pleasure/sex life

 Family relationships

 Social life/ friendships

 Avoiding processed foods

 Career Advancement

 Romantic relationships

 Pursuit of knowledge

 Alcohol use/abuse

 Medical care

 Sexuality/ gender identity and expression

 Self-care/ Self-compassion

 Awareness of current events

 Political involvement

 Mental health

 Avoiding artificial sweeteners

 Body image

 Reducing intake of chemicals in bath/beauty/cleaning products, etc.

 Intuitive eating/mindful eating practice

 

 Self-acceptance

Avoiding artificial growth hormones in meat/dairy

 Drug use/abuse

 Community engagement

 

Experiencing new things/places

Eating less sugar/high fructose corn syrup

 JOY!

FUN!

 Eating whole grains

 Work/life balance

 Hobbies/skill development

 Gratitude

 Eating local/food sustainability

 

 Intimacy

Okay, here’s the hard part. Here’s the link to download and print it out: Defining your Wellness Values Chart

  1. Cross off the 10 that either a) you’re already satisfied with, or b) that are least important to you right now. (Remember that this doesn’t mean these things are unimportant, just that they are less important to you, right now, than the remaining 40.)
  2. Now cross off 10 more (30 remaining). Give yourself a time limit.
  3. Now cross off 7 (23 remaining). Take a quick break and then come back to it.
  4. Now cross off another 7 (16 remaining).
  5. Cross off 6 more (10 remaining). This is getting tough, huh?
  6. Cross off 5 more (5 remaining).
  7. Circle the most important wellness element to you at this point in time.

I just did this activity and it was really freaking hard, but I narrowed my top 5 wellness elements to: building fitness/strength, improving family relationships, self-acceptance, intuitive eating, and reducing my intake of chemicals, These are the areas I want to focus on to improve my overall “wellness.” So, for me, a “lifestyle change” means working out, accepting myself the way I am, finding more ways to make meaningful and positive connections with my family, listening to what my body wants, and staying away from processed foods and chemicalized bath and beauty products.

The thing about changing your lifestyle is that it has to be something you actually WANT to do. Wanting to lose weight because you struggle with body image is not the same thing as wanting to change the way you eat. For example, the person in that scenario might experience more success and actually feel better by choosing to focus on positive body image and building self-esteem.

Only you know what a “healthy lifestyle” means for you. And if you’re not sure yet, perhaps this activity will help.

Let me know how it goes! I am hoping to try this with my students next year, and your feedback will be super useful.