indigenous HAES

Whenever I have conversations about health disparities affecting Native people, the subject of diabetes has a good chance of coming up.  Not always, since it’s often about reproductive health (I don’t think I’ve mentioned it here but I’m a sex educator) , but fairly often.

I went to an amazing and inspiring presentation about language revitalization and the keynote speaker talked about what it “really means” to be Native.  It’s true that many of us* (not all, of course) grow up hearing “be proud to be Native!” but are never told what that means, but seeing our cousins, friends, etc. engaging in destructive behaviors–alcoholism, gang violence, etc.  This can contribute to the belief that being Native really means drinking, living in poverty, and being a stereotypical “lazy Indian.”

It’s also true that we have the highest rate of diabetes among all races, and that 95% (according to the American Diabetes Association) of Native people with diabetes have Type 2.  I’m not an expert on diabetes by any means, but I hear about it left and right from elders, medical professionals, etc.

I posted maybe a year ago about historical trauma and its effects on health disparities, and it comes up a lot in my college classes and fairly often in my job.  I can’t help but wonder, though, whether someone looks at me and makes judgments based on my body about the food I eat and whether it has given/will give/is giving me diabetes because omg deathfat.  Of course, it’s none of their business anyway, but being judged is annoying even when you know it’s unwarranted, shallow and inaccurate judginess.

So how do you overcome the assumptions of predominantly white medical professionals (who may or may not be totally excited about working in Indian Health Services clinics)?  How do you get your voice heard when it’s already being muffled by your race, gender, and size?  How do you explain that the reason why your blood sugars are normal and good “despite” your fat is that hey, fat cells do not automatically raise one’s blood sugar? Or that you are not actually in immediate danger of dying because you’re fat?  Wait, it’s almost like fat in and of itself doesn’t kill people!  Wait, thin people get heart disease too?  WTF??!?

Clearly my fat is leeching sugar and cholesterol into my blood ALL OF THE TIME and that is totes causing health problems because that’s how the obesity works.  How sad.

Ahem.

Whatever it “really means” to be Indian is subjective.  I would hope it doesn’t involve the stereotypes, the alcohol/substance abuse, etc. but everyone’s reality is different and while eating fast food every week may not be part of what it means to be Native, people who do so aren’t less Native.  People like to think that disease is caused by fat and that fat is a choice people make because they’re afraid that they will someday get fat and if they do, they gonna die.  My mom used to (and she hasn’t done this in a long time, knock on wood) “casually mention” how much weight her friends were losing just by cutting out soda, even diet soda! or by eating a handful of whole flaxseeds every day! or by using the Wii Fit! (this one was more recently), or whatever.  As I got older, I interpreted this as “you have my genes and you are fat and if these people lost weight then you can lose weight and I will be reassured that my genes won’t make ME fat omg-please-don’t-let-me-get-fat.”

It seems kinda similar to the way some thin Native people see fat Native people (and I am not comparing fat and alcoholism here, but also the way some sober Natives view alcoholic Natives) as “ruining our image for everyone,” like non-Indians are going to look at us and be like “OMG, a fat lazy Injun!  THEY ARE ALL FAT AND LAZY AND NOT TO BE TRUSTED, AHHHH!!!!” which is all kinds of fucked-up.  We are not obligated to be the sole representative of our race/tribe.  It sucks that a lot of people are forced into that role, but that’s another blog post.

Maybe that’s just my experience.  It’s more of an unspoken (or less spoken, not completely unspoken) thing, and I have no idea whether other fat Native women have experienced this or if just read too much into things/make shit up.  Whatev.

I will write something more coherent about this soon.

*disclaimer:  there are over 560 federally recognized tribes in the U.S. alone, and obvs. every tribe, band, family and individual is different so it’s a) difficult and b) inappropriate to make sweeping generalizations about Native experiences.

Advertisements

June 4, 2010. Tags: , , . FA, intersectionality. 8 comments.

Sarcasm: the emotional barrier of champions

Hey blog, it’s been a while!  It’s mostly been a while because I’ve been working nonstop for the past ~2 months and have finally got a break (and by break I mean I’m done working for the summer).  I should be blogging more regularly now, so yay.

My first job this summer was through the medical school at my university.  It was for Native high school kids who want to pursue careers in medicine.  This is awesome.  We need more Native doctors and I’m glad to help.

Well, a few weeks into this six-week program, a Diabetes Team from the local reservation came to talk to the kids.  I’m not going to claim that diabetes isn’t a problem in Native communities; it is, and that sucks.  However, I believe that IT IS NOT BECAUSE WE ARE ALL TEH FATZ.  The “team” consisted of two women (at least one of them was white, I’m not sure about the other): a personal trainer/fitness expert (or something) and a nutritionist.  They did the standard “exercise and eat healthy food and lose weight and you’ll greatly reduce your risk for the diabeetus” spiel, and they did not fail to mention that losing 10-15% of one’s body weight is, like, totally good for you.  (I posted last month about this.)

The whole weight loss component of the presentation made me uncomfortable, and the nutritionist had blocks of fake fat in the amounts of 1, 5 and 20 pounds.  The 20-pound chunk of fat was kind of like a front-facing backpack so you can totally know what it feels like to be 20 pounds heavier!  Because whenever you gain 20 pounds, you carry it with straps on your shoulders.  She had a volunteer go up to the front to wear the 20 pounds and proceeded to ask her, “how does it feel?  Is it harder to move around and do things?” (it was.) and asked the room “Has anyone here ever lost 20 pounds before?”  I bit my tongue instead of saying what was in my head at that point, which was Yeah, when I was depressed/had severe issues with disordered eating/was crash dieting and hated myself, thanks for bringing that up. The BMI was mentioned once or twice.

The students did sessions of Problem-Based Learning (PBL), which is apparently what they do in med school; they were given a medical case and had to see what was wrong with the person.  The very last one involved a woman who had pain in her mouth and dwindling eyesight and rapid weight loss, and it turned out she had diabetes.  I don’t remember her height, but she weighed over 190 pounds, to which one of the two boys in this particular group responded:  “DAAAYUMMMNN!!”

I felt a little uncomfortable, mostly because I weigh >100 lbs. more than this hypothetical woman, and I’m pretty sure their facilitator, associate something-or-other for the medical school, assumed for the few weeks we interacted with each other that I was about to die of fat.  This happens every time my friends/whatever people I’m with (like the students at work) talk about other fatties when I’m around; I can’t help but think “what do they say about me when I’m not around?  Do they not see that I’m fatter than [whoever they’re talking about]?  WTF?”  My default defense mechanism is sarcasm, but that doesn’t really seem to work when I’m confronting issues of fat, because I forget that people actually believe that fat people don’t deserve nice things, or that no heterosexual male would ever want to have sex with a Fat Chick, EVER.  Sarcasm tends to be lost on people who have been socialized to believe what you’re saying, or they sense the sarcasm but don’t understand why it’s there because these statements are OBVS TRUE.

At the end of the program, the kids did presentations about different health issues:  COPD, pandemic influenza, asthma and smoking, healthy aging, something I don’t remember, and “Nutrition and Healthy Lifestyles.”  The Nutrition group started out by saying (and I may be paraphrasing slightly) “it’s common knowledge that obesity causes a myriad of health problems” and encouraged everyone to lose weight if their BMI was in the “overweight” range.  Common knowledge is something that irks me, especially when used about something that ISN’T common knowledge–or, in this case, something that is widely accepted but not true.  It’s like saying “it’s common knowledge that fat people never exercise and binge eat 24/7.”  There are people who actually believe this shit, and if they happen to come across a fatty who does exercise and doesn’t gorge themselves constantly, it’s “oh, but you’re the exception!” and/or “it’s okay for you because you can’t help it!”

I’m at the point where I’m finally comfortable calling people out about fatphobia, but I’m not comfortable enough to do it in a serious way.  My response to a friend who has made an effort to eat healthily and exercise tends to be “I heard fat is the worst thing anyone could ever be in the history of everything.”  It’s taken her a while to get that I don’t want to hear about how she OMG gained five pounds and that is definitely the end of the world!!!11one, but it’s happening.

I use sarcasm as an emotional shield for a lot of things, which I realize is probably unhealthy but it’s how I do.  When friends or even acquaintances say or do things that make me uncomfortable I tend to panic and revert to sarcastically remarking, “Rape is hilarious!” (why do I have friends who make rape jokes?  sigh.) because if I didn’t have that defense mechanism I might start crying and screaming at them instead.

Other fat bloggers have explained the concept of intellectually understanding fat acceptance while emotionally holding onto the Fantasy of Being Thin or just thinking “if I were X pounds lighter/X dress sizes smaller, I could really start accepting my fat body!”–or the Fantasy of Being a Little Less Fat.  To be completely honest with you, it’s only been half a year (almost 7 months!) since I was intellectually introduced to the concept that OHAI, fatness isn’t the end of the world.  I totally got it and I was ready to jump on board with the whole FA thing and fuck diets and whatnot, but there are still times when I catch a glimpse of my body from an unflattering angle or something and think “how could anyone ever find this attractive?  I’ll probably die alone,” moments after I’ve looked at photos of gorgeous fat girls who are roughly my size.

I used to wish I was shorter, because at 5’7″ I’m too tall for the category of “spunky because they’re short and chubby” girls–Tracy Turnblad from Hairspray and the like.  Oh fucked-up body image issues, you are so odd.

So it’s really sad, but if I didn’t deadpan “fat people don’t deserve nice things” or something similar, I might slip and let myself go back to an emotional place that involves a lot of self-hatred because there was a time at which I believed this was true and I’ve had a hell of a time figuring out that it isn’t… if only it were simpler.

I’m working on it.

August 1, 2009. Tags: , , , , . FA, intersectionality, real-life wtfery. 4 comments.

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.