It’s about fat.

For a while now, Target in Australia’s “Options Plus” line has been filled with not-terribly-attractive clothes that are pale imitations of current fashions. My local Target has a very limited selection, but I’ve been to some of the huge Targets and the Options Plus area is still tiny compared to the 17 acres of “normal” clothes. The sizing of the clothes is very strange: while in most other stores like Myer, Autograph, etc, I generally wear a 22 on top and 26 on bottom, in Target some tops, a size 18 will fit me, others, a size 24. I don’t have a large bust to content with either. Sometimes a size 24 skirt will fit perfectly, while I can’t get a size 26 past my thighs. Buying some trackydacks recently, one style, a size 16 fit and another style’s size 24 was a squeeze. I’m pretty sure these all come out of the same factory in Indonesia or China, how hard would it be to make the sizes at least consistent? It’s not that it’s even a difference between stretch material and woven. The inconsistency goes across all garments.

Frustrated with the range in a big Target I was in recently, I was leaving the store via the not-plus section, when I realised that some of the size 18s hanging on the racks actually looked kind of large. So I tried on some cardigans, which is what I was shopping for. They all fit just fine. And because they were “Misses” sizing rather than “Womens”, they weren’t too long for me and didn’t have armholes that went down to my waist, and so on. A 16 in some styles even fit. I’m not sure how they’d go on a woman with a larger bust than mine, though. So if you’re in Target, do have a look at the size 16/18s in the other sections. About half of the stuff there goes up to an 18 and nearly all to a 16. I’ll have to try this out at other department stores.

City Chic seems to be having a sizing problem too. Last year I bought an awesome coat from them in XL, after trying on quite a few other coats in the same size. I am a bit smaller than I was this time last year (see my numerous posts on thyroid), so the coat wasn’t a good fit anymore. I went back to City Chic to try on some L coats. Which were too small. Tried on their XLs. Still too small. WTF? I know they’re juniors sizing, but this makes little sense. Maybe they changed production factories or pattern designers. I hate when this happens.

As for Autograph, I think their clothing is getting uglier by the minute. I actually have some items from there from two years ago which still looks great, but every time I’ve been in there recently, nothing has stood out to me. Forget My Size. They are embracing the Big Boxy look. It doesn’t help that they put size 12-14 models in their catalogues and are obviously pinning the clothes back on them and they’re STILL big ‘n’ boxy. With dowdy-looking mid-calf skirts. When they have skirts.

Thankfully the Australian dollar is climbing back up against the US dollar and I can start buying a few bits from B&Lu and so on again.

I think I’m just going to have to clear a space here in my house and start sewing again. Fat fashion retailers are failing us.

Both Marianne at the Rotund and Big Liberty have good posts up about Flying While Fat, and I thought I’d add my tips on flying in Australia and some (OK, one) international destinations.

The main domestic carriers are Qantas and Virgin Blue, supplemented by budget Singapore-owned Tiger Airways, Rex (Regional Express), and JetStar, Qantas’s budget subsidiary.

I’ve flown both Qantas and Virgin Blue often enough, and have never had any problems with respect to my size. I’m 155cm/5′ tall and about a size 26 at the hips and 22 on top. Recently very few flights I’ve been on have been full, especially at off-peak times, like daytime on a weekday.

Qantas: I fit into the economy-class seats on Qantas’s 737s, and it’s not painful to have the armrests down but it is more comfortable to raise them. The seats are the same width as on their 767s. The armrests do go up on most seats, and the seating charts available on the Qantas website indicate which. The only exception is that the armrests on the window side are not raisable. I usually need a seatbelt extender, though you get the odd plane where the seatbelts are longer for some reason. The Qantas flight attendants have always been perfectly polite about getting me one when I ask. I have not flown on a Qantas Dash-8 but according to their website the seats are the same 17.5″ width as other planes.

Business class seats on Qantas are about 30% wider and have more legroom, but cost three times as much usually. There is no economy plus on Qantas domestic, although sometimes they fly a 747 between east and west coast to move the planes around and you can luck out and get a whole row to yourself on those!

JetStar flies Airbus 320 and 330-200s. I’ve never flown with them but I have heard from people who have that it’s much the same fitout and service as Qantas.

Virgin Blue: Seating is much the same as on Qantas on their 737s and 767s, and also on the new Embraer 170/190 jets. The armrests go up again except for the window side. Embraers are 2 x 2 seating, so there are no middle seat worries. Virgin Blue flight attendants have also been super nice about getting me a seatbelt extender.

Virgin Blue’s Premium economy seats are not wider than regular economy. They just have a kind of console/armrest thing where the middle seat it, and slightly more legroom.

Seating tips:
For both Qantas and Virgin Blue, online check-in is available, and I highly recommend doing it as soon as it’s open, usually 24 hours in advance. Go for a row at the back of the plane, and an aisle seat is usually best as you can raise the outside armrest. They usually do seat assignment from front-to-back, so if the flight’s not full, chances are you will get an empty seat next to you. From what I’ve read from airline reps, they don’t have a compulsory two-seats-for-fatties policy as they know that nearly everyone who’s quite large buys two seats or goes business class anyway.

Rex is a regional airline and so flies turboprop Saab 340s. I couldn’t find any information on seat width, but other airlines with the same planes have 16″-17.5″ seat width listed on SeatGuru. The layout is also 1 x 2, so if you called to check whether the armrests went up, a seat in the single-seat row could work out for you.

Tiger - I’ve never flown with them. They’re a very budget airline - no business class, user-pays for everything. That’s about all I know.

Internationally, I’ve flown with British Airways on their 747s. Seat width is a standard 17.5″. The flight attendants were also very very nice and polite, and one on-the-ball fellow even brought me an extension without asking as I rolled my eyes upon seeing that the seatbelt was about 2cm too short. “Here you go, sweetie! Aren’t these seats just ridiculous?!” He also showed me the trick of putting the complimentary pillow on the tray table so my meal tray would sit flat, as my belly gets in the way of the tray table folding all the way down; and he also asked the person in front of me to put their seat back up so it was as un-uncomfortable as possible.

Again, online check-in is a good idea. Go to SeatGuru and check out the seat plans first. I was travlling with my boyfriend, and on most 747s there are a few outer rows at the back with only two seats in them. We picked one of those and while it’s a little bumpier down the back of the plane and you get people queuing for the toilet standing next to you - if you don’t mind that then those seats are a good choice.

British Airways Economy Plus seats are no wider than standard economy and may in fact feel smaller as they have the solid armrests that wedge you in.

I’ll be flying with Cathay soon, and I’ll be interested to try the new style of seating they have - it’s a “shell” seat and some people have said they’re terribly uncomfortable, complaining of too-thin padding on the seat and lack of leg-room as the seat slides forward instead of reclining, while others have loved them. I’m short enough that legroom is rarely an issue, and I’m well-padded myself, so we shall see how they are. They’re the same width as usual, apparently.

Happy trails!

I

A new post at Drug Injury Watch reports that the weight loss drug Orlistat (in Alli and Xenical), the one that makes you get the orange, foul-smelling liquishits if you eat more than a tiny amount of fat, is being investigated by the FDA for reports that it causes liver damage: Agency Has Received Case Reports Of Hepatotoxicity For Orlistat

Roche is of course claiming that it’s not their product, it’s that just that being fat causes liver failure.

The Australian Government’s Youth Forum is conducting an online consultation into body image in Australia, particularly as regards to youth. As part of this, they have put together a survey. If you’re in Australia, please take the survey and tell them your honest opinions. They are also calling for public submissions on the topic.

All the information is here:

Online Consultation on Body Image – calling for submissions

The link to the survey is about 2/3 of the way down the page.

Check out this cartoon at PhD Comics on how correlation and causation works. The confusion of which seems to be the cornerstone of any study even vaguely to do with fat people.

If you are interested in health care, you should be aware of how health care is sloooooowly (oh, so slowly) being transformed by new models of patient-doctor communication. An excellent blog which discusses these issues is e-patients.net. It’s run by people active in their own health care and who are passionate about educating other patients, doctors, health administrators, politicians and anyone else about how being such an active patient can greatly improve health outcomes.

For example, here’s Dave deBronkart’s short bio from the site:

Diagnosed with advanced kidney cancer (median survival 24 weeks), e-Patient Dave deBronkart rapidly learned to use every aspect of empowerment, technology, and participatory medicine to beat the odds.

I’m sure we all know doctors who still refuse to treat a patient as an intelligent person capable of being active in their own health care, and yet more who express concern about the idea that patients will believe anything they read on the internet and do themselves harm. There’s an excellent white paper linked from the site that addresses these issues: e-Patients: How they can help us heal healthcare. The paper found that this idea that online patient support and information sharing will harm people is simply not true.

Here are some other recent highlights from the blog:

Participatory Medicine as Revolution! Think Critically! Communicate!
This post examines health care using perspectives from Pedagogy of the Oppressed, a  famous book on education: “Participatory medicine cannot tolerate an absurd dichotomy in which patients are merely following their doctors’ decisions—a dichotomy reflecting the prescriptions of the dominant elite. Revolution is a unity, and doctors cannot treat patients as their possessions.”

Applying paticipatory principles to EHR/PHRs
e-Patient Dave original story of the health data transfer from his hospital EHR to Google Health PHR is remarkable in many ways and shows why participatory medicine could well be one of the fastest way to lower the overall cost of health care by helping fix some specific dysfunctions in the system. It took just one active and engaged patient to produce a remarkable change in the way interoperability between EHR and untethered PHRs is going to be defined at BIDMC and probably at HITSP, at a minimum.

In other words, one single real event, driven by a patient has given more effective feedback to improve the national standards than years of deliberations of the cream of the cream in HIT in their rarefied tower of knowledge.

There are some who express concern that electronic health records will be used against patients by government or health authorities. This is addressed in the post Please! No more magical thinking in HIT! - wherein it’s pointed out that patient participation is essential to avoid those fears. It’s no good implementing EHRs and thinking that will solve everything unless you actually ask the people who own the data–the patients–and get their collaboration and participation in creating The New Health. And patients want security, and full access to their own data to check that it is correct. I personally would like to see the option for people to not have their data included in statistics, and to be absolutely sure that if it is, all personally identifying information is removed, with full disclosure of what the data will be used for. And, of course, the option for someone to not have an electronic health record at all.

Why is this important for fat people? Well, there’s already a revolution going on in health care for fat people, and it’s being driven by fat people themselves through online communication and information sharing. It’s all these fat acceptance blogs and mailing lists and forums. We share with each other information on health and fat to counter the poor reporting and biased studies. We share where to find fat-friendly doctors and warn about anti-fat doctors. We discuss Health at Every Size. All kinds of help, advice, and support for physical and mental health. Again slowly, oh so slowly, doctors and other health professionals are getting wise to the ways of HAES (much to the alarm of any other doctors who make money off “treating” fat people). There’s some top-down pushing from such people as Linda Bacon, and then there’s all push from the patient end of the stick - fat people refusing to see doctors who treat them badly, discussing HAES and weight-neutral health with the doctors who might be dubious but are willing to communicate, and support for doctors who are pro-HAES. (And yes, I do realise that there are fat-acceptance people who don’t consider HAES that great and have concerns about healthism, but this isn’t the post for it.)

Elelctronic health records are only a part of the new healthcare, and you could in theory have collaborative medicine without them. It’s this collaboration and conversation that’s driving change.

I would actually love to get an electronic copy of my entire health record which I could keep in the manner I deem secure. I’d keep it on one of those nifty IronKeys probably, with backups. If it was kept online, I think something like the YubiKey would be useful for secure passwords. I’m actually far more worried about the security of physical records - I know at my GP’s office, the records are on full display behind the reception desk. And an enterprising information thief would only need to crack one window to get in and at the records. But I digress. I prefer to be in charge of my own information. Having an EHR to which I could add corrections and clarifications, instead of relying on a busy doctor to write down “pernicious anemia” instead of just “anemia”. I’d probably delete “obesity” and just put “fat” as one thing I could do to resist the medicalisation of a body size[1]. The Dave deBronkhart I mentioned previously discovered that because of wacky insurance billing codes, he “had” all these medical conditions he previously never knew he had, which could have caused problems when new doctors were looking at his record, and so on. Getting a hold of his own data allowed him to publicise the problem and correct the record.

In conclusion, I think that pushing for this new model of health will ultimately benefit fat people. It’s a long road, given how many fat people themselves are convinced they hate themselves and deserve poor treatment. The fat-isn’t-actually-a-moral-failing-and-won’t-kill-you cat is out of the bag, on the internet, and you can’t undo it. Take charge of your own health care, whether it’s full involvement you want or you just don’t care that much and are happy to say so.

For an interesting documentary on what’s popularly called “Web 2.0″, specifically as it relates to government, watch Us Now. Us Now in high-def or Us Now in regular. Imagine what they’re saying, applied to health care. In fact, the bits on mumsnet.com are easily applicable. It’s about new models of trust and reputation - one woman mentions how they are tired of ‘ridiculous’ information on child rearing from doctors and social workers and they trust information from other mums far more, because they’re also mums. These days, if you are a person in authority and you say something ridiculous or dubious, anyone can go look up more information on the net, and connect with other people, other experts, and see what they have to say.

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[1] I can see where there’s some artificial inflation of ill-health-correlated-with-obesity statistics: I went to the hospital a few months ago because I was badly dehydrated from gastric flu. When I finally saw the doctor, he had put on my exam card “gastroenteritis” and “obesity”. My fat has nothing to do with my hospital visit, yet is recorded as such. Frak that. Now If I had proper electronic access to my own record I could go in and put a note on it to the effect of “how is this relevant?”. To do that on the paper record is a pain in the arse.

I thought this deserved its own post.

Today I went to the family planning clinic, which is run by awesome women. I am taking the mini-pill, which is progestogen-only. The doctors there informed me that women who weigh over 70kg (155lbs) should actually be taking two pills a day to ensure effectiveness. It’s in the new Australian medical guideline on contraception and reproductive health, so if your doc isn’t up to date, tell them to get hold of a copy.

And they managed to do it in a way that was completely non-judgemental and cool, as in “Hey, did you know this?” rather than “You are OBEEEEESE so you have to take two pills HAR HAR” attitude so many of us fat women have experienced. Family planning doctors are the best. There were two attending my appointment, as one was training to be full-time at the clinic. The trainee doc was pregnant and very sweet, and the other one was a Hell-Yes-I’m-A-Feminist. Awesome.

Anyway, if you’re fat and taking hormonal contraception you might want to discuss it with your doctor. I don’t think you can take double doses of the combined estrogen/progestogen pill because of the side effects of estrogen. If you’re OK with taking medication on a schedule the mini-pill might work better for you. The progestogen-only implants like Implanon are supposed to be OK for fat women, but you might need to get it replaced a little earlier than usual. And apparently you’re not supposed to use Nuva-Ring if you are over 90kg/200lbs. Hopefully you can find yourself some great doctors at a friendly clinic like I did!

I’ll spare you my list of excuses for not updating this blog more often. Suffice to say I’ve had a lot on my plate. (Well, I would, wouldn’t I, what with being such a fatty and all. )

I’ve been on thyroid medication for some months now. Since I was apparently untreated for so long it’s going to take a while to feel the full effects, but for now I am feeling a bit less fatigued. Walking isn’t a tiring chore anymore, but I’m not ready to do an aerobics class or anything yet. I seem to have lost an interesting amount of weight, probably nearly all water weight, seeing as how edema is a big component of hypothyroid-related weight gain. The large lump in my throat is gone.

And interestingly, I don’t need to take as much asthma medication. It’s getting briskly cold where I am, something that last year would have had me taking four clicks per day of the highest dose 500/50 Seretide (Advair Diskus in the US, I believe) plus plenty of Ventolin (albuterol). This year, I take two clicks per day of the medium dose 250/50 Seretide and haven’t needed Ventolin at all. Last year, I had an allergist tell me that my asthma was probably mostly caused by my weight. …Right. I suspect that the hypothyroid and adrenal-fatigue state I was in was causing some kind of reactionary inflammatory process.

The mild insulin resistance I showed up with has also disappeared. Seems that too was a thyroid/adrenal related reaction from my body, not Impending Fatty Diabeeetus. I think all my hormones are finally falling back into normal alignment, some not as quickly as others, but it’s happening.

And so a big fat to all those doctors who told me all my problems were caused by my fat and didn’t bother to investigate further.

I finally have a diagnosis after finding a doctor who diagnoses the old-fashioned way, that is, according to symptoms and guided by lab results, as opposed to TSH lab test only. My TSH was rising anyway but it probably would have been about another 18 months until it went over the outdated range (which ends at 5.0), so the doctor I saw sees no reason why I should have to continue on being tired, depressed, hurty, etc, until then. I also have some mild adrenal issues, so she’s given me a small dose of replacement hormones to take for a month before starting thyroid replacement. I’m taking “natural” thyroid, though it’s about as “natural” as codeine given the amount of processing it undergoes, and I get it from a local compounding pharmacy which has an excellent reputation.

My doctor says I should be feeling quite a bit less fatigue within about two months, but an improvement on every symptom could take some time given how long this stuff has been going on - and it depends on the individual too. I am excited about being able to do stuff, and actually enjoy it instead of wondering how tired it’s going to make me. Eventually! And no love lost for all the doctors who didn’t bother to do anything except blame my fat.

Nooooooooooooo! Magda Szubanski, the great Australian comedian and actor, best known internationally for her roles as Mrs Hoggett in the Babe movies and as Sharon Strzelecki in Kath and Kim, is now shilling for Jenny Craig.

She’s long been a role model for fat women; someone brimming with confidence, success, self-esteem, and no evidence that she thought herself ugly or unworthy because of her size. I recall an Australian Women’s Weekly article from a few years back where she tells of her disdain for diets and how they don’t work. And she’s consistently rated as one of Australia’s best-known and best-loved stars for nearly a decade, so it’s not just fat chicks who love her.

Apparently, Magda has now crossed the arbitrary line of too fat.

Features of the campaign include:

Press releases resulting in newspaper and magazine articles where Szubanski claims she is “eating herself into an early grave” and realised she was “killing herself with fat”.
(Unless you are eating chicken that’s been left out on the bench in summer or lacing your peas with arsenic, I don’t think so.)

An ad talking about all the crazy diets she’s been on, and how Jenny Craig is different
(O RLY?)

Another ad where she talks about how she hates having to wear ugly fat lady clothes (FFS Magda, we know you have enough money to afford some Igigi, Anna Scholz, and Svoboda) and she is going on the Jenny Craig diet because she really wants to be “a fox”.
Yeah, it’s all about health!

Also there’s the “exclusive” tell-all confessionals on the tabloid TV show A Current Affair. You know, share in Magda’s special journey.

There’s no evidence whatsoever that Jenny Craig produces long-term weight loss. NONE. A thorough search of peer-reviewed scientific journals showed nothing that would cast Jenny Craig in a positive light and better than any other diet. There are a couple of reports that go up to one year, but that’s it. One of those reported that people who stayed in the “Platinum Program” for one year lost approximately 15% of their initial body weight (which is apparently enough to earn the researchers’ recommendation…WTF). But no one’s ever followed up beyond that year; you can bet your right arse cheek that Jenny Craig would be crowing about it from the rooftops if there was a smidgen of evidence that their program worked long-term, but they prey on all those repeat customers.

What’s the Platinum Program cost? $459 (Australian dollars). A MONTH. Yes, that’s right. FOUR HUNDRED AND FIFTY NINE DOLLARS A MONTH.

And the food is, frankly, awful. Highly-processed tasteless rubbish. I’m not opposed to processed foods per se, however I expect food to actually taste good, which Jenny Craig meals do not. Why punish yourself like this, Magda? What happened? And, cynically, how much money did they offer you?

(Note: This isn’t meant to be a personal attack on Szubanski. Just a frustrated “Why??” against the whole diet industry and its practices. And the performative nature of weight loss. Szubanski is free to do as she wishes, of course, but it’s always so disappointing when someone you thought was an ally turns around like that.)