on intersectionality and HAES

I’m a little late, but there was some talk recently over at Fatshionista about diversity within the fatosphere, and after reading this post last month I shamelessly plugged this here blog and decided to start posting more… which hasn’t been working too well because I’ve been really busy, but I’m working on it.

As a Native deathfat, I’m especially “at risk” for type 2 diabetes based on the fact that I’m Native and Morbidly Obese Omg.  Medical professionals say that losing 10-15% of my body weight would reduce my risk.  For me, that’s 31-45 pounds, depending on the day.

Since I started reading about Health at Every Size (HAES), I’ve been thinking about this; if I practice HAES, which I do, it’s contradictory to want/try to lose weight to reduce my risk of getting diabetes, right?  But, says the thought at the back of my head, they aren’t saying I should be thin–just a little less fat.  After all, if I lost 31 pounds I’d still weigh around 280.  I’m aware that these concepts are inconsistent, but damn there’s a lot of pressure–especially when so many Native people are now trying to improve their health, which is a good thing but unfortunately equated with losing weight for a lot of them.

The race factor plays into this in different ways.  Some people think that so many ndns have diabetes because after frybread was invented we all ate too much of it (deep-fried dough isn’t great for you, I’m guessing).  Maybe a little simplistic, but it makes sense.  (For the record, I eat frybread maybe 3 times a year… om nom nom.)  Others, perhaps in the same vein in a sort of roundabout way, see diabetes–along with alarmingly elevated rates of alcoholism, suicide, depression, domestic violence, etc. among Native populations–as a symptom of historical trauma*, which is interesting.

“Compared to the U.S. average, American Indians are 770% more likely to die from alcoholism, 650% more likely to die from tuberculosis, 420% more likely to die from diabetes, 280% more likely to die from accidents, 190% more likely to commit suicide and 52% more likely to die from pneumonia or influenza.”  -Michelle Sotero, A Conceptual Model of Historical Trauma: Implications for Public Health Practice and Research

Alcoholism, suicide and domestic violence make sense.  Native women being 2.5 times more likely to be sexually assaulted than any other population in the United States can also be attributed to historical trauma.

Unfortunately, in the public health sphere, type 2 diabetes is tied to fatness even though there are plenty of fat people without diabetes and thin people who have it.  I haven’t been “diagnosed” with prediabetes, but in the eyes of a lot of people I’m at risk because I weigh over 175 lbs. and I’m Native and… oh wait, that’s it.  I have no significant family history of diabetes, and I’m young and fairly active.

Late last year, I was at a funeral and someone made a joke (heh, it’s what we do) about how in Native communities, something’s wrong if you’re too skinny. Which is kinda true; if someone who’s not fat but not naturally really thin suddenly becomes really thin, there’s probably a health problem going on there.  I found myself laughing nervously and avoiding the eyes of everyone around me, though, because that wouldn’t be true for me; if I were to lose a lot of weight people would probably congratulate me and encourage me to lose more.  Indigenous people have been assimilated to the point where we subscribe to society’s notion of beauty and health, at least the thin aspect.

I’m about to start my second week at a job with a 6-week summer program for Native high school students interested in careers in medicine.  It’s a great job and I think it’s really important to get more Native doctors working in tribal communities and urban communities with large Native populations.  It’s through the medical school at my university and has a focus on developing healthy lifestyles, which is great!  But once in a while someone will say something about how the OBESITY EPIDEMIC BOOGA BOOGA BOOGA is a huge problem for us as Native people.  When this happens, I generally bite my tongue and feel uncomfortable because calling the person out and trying to educate them about HAES is a little bit out of my comfort zone.  I’m an undergrad and not pre-med, and everyone else working there is pre-med or already a med student and the person talking about how fat Indians are pretty much in mortal peril (okay, slight exaggeration) was an authority figure.

I think it would be great to educate medical professionals serving reservations and POC communities in general–and, hell, everyone else!–about Health at Every Size.  I have issues with a lot of tribal health programs, including the lack of sex education, which IMO could prevent some of the gratuitous amounts of teen pregnancy (sex ed probably isn’t the cure because my 15-year-old cousin is pregnant on purpose–don’t even get me started–but it could definitely help) in our communities.  The local tribal clinic, not the one where I grew up but close to where I go to college/live now, is and pretty awesome.  They have a nutritionist and walking clubs and stuff, which is great and important, but from what I can tell a lot of it is geared toward weight loss if you’re fat and staying thin if you aren’t.

I don’t know, maybe someday my frustrations will be quelled when indigenous feminism turns into an actual movement and HAES is supported by doctors at tribal clinics, but for now I will plot and have conversations with people when I can/feel comfortable doing so.

*Historical trauma is the concept that Native people still have a lot of historically unresolved grief, which spans across generations and manifests in six stages:

1. 1st Contact: life shock, genocide, no time for grief. Colonization Period: introduction of disease and alcohol, traumatic events such as Wounded Knee Massacre.
2. Economic competition: sustenance loss (physical/spiritual).
3. Invasion/War Period: extermination, refugee symptoms.
4. Subjugation/Reservation Period: confined/translocated, forced dependency on oppressor, lack of security.
5. Boarding School Period: destroyed family system, beatings, rape, prohibition of Native language and religion; Lasting Effect: ill-prepared for parenting, identity confusion.
6. Forced Relocation and Termination Period: transfer to urban areas, prohibition of religious freedom, racism and being viewed as second class; loss of governmental system and community.

There has also been research done WRT Jewish people and the historical trauma resulting from the Holocaust.

June 15, 2009. Tags: , . FA, intersectionality.

5 Comments

  1. bri replied:

    I am so happy to have you participating in the Fatosphere and was rapt to add you to the feeds! It sounds like Native Americans face a lot of similar issues to that which Australian Aboriginals face. My husband and daughter (and extended family obviously) are Aboriginal and I have quite an involvement with the local Aboriginal community both personally and professionally.

    I am really looking forward to hearing more from you!

  2. wellroundedtype2 replied:

    Hi — your blog is awesome. Regarding the HAES/preventing diabetes stuff — here’s my perspective, for what it’s worth — if you do stuff that makes you feel good, and you end up losing weight, it’s still HAES. Many fat people wouldn’t mind, or at least have some mix of positive and not as positive feelings about, losing weight. I don’t think it’s an either/or.
    I am not Native American, but I really subscribe to the historical trauma explaination from a public health perspective (I have my master’s in public health). I also recommend the DVD series “Unnatural Causes” for the impact of national and regional policy on Native Americans if you haven’t seen it yet. It’s not perfect, but it gives a context for the increases in diabetes in Native Americans.
    Here’s a link to the web site:
    http://www.unnaturalcauses.org/
    Another interesting perspective is that of the research on adverse childhood experiences (ACEs) on health of adults, and the link to that research is here:
    http://www.acestudy.org/
    When communities are traumatized, families and children are traumatized, and there are generational ripples. My personal interest in ACEs comes from my growing up with an alcoholic dad and a depressed mom.

  3. Linda replied:

    @wellroundedtype2–thank you for the links and the insight! I went to a conference regarding historical trauma last year, and the keynote speaker presented the concept in a very intriguing way. I’d really like to do more research about this; I’m actually interested in going into the public health/health education field.

  4. Michelle Sotero replied:

    Hi, Linda! I am happy to see that you are interested in public health and Historical Trauma Theory. If I can help you towards your goal or in your research, please feel free to contact me. The field of public health needs more Native researchers and practitioners. Good luck!

  5. Sydney Bell replied:

    Hey…not stalking you, promise! Just found your blog today and really enjoying it. Keep up the good work!

    Syd

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