I wake up and try to avoid mirrors. But when I pass one on my way to the closet, she's there in my peripheral vision: a 5-foot-6-inch 200-pound woman, a woman considered obese by federal standards.
My closet contains outfits in six sizes -- over the last 20 years, I have worn every women's size from 12 to 26, and my body frequently fluctuates between them, changing as much as 15 pounds in a single month. Sighing, I rummage through my closet for something to wear, because I don't know which of my four typical sizes I am today.
(The decision is complicated by the fact that I've removed the tags from my clothing, to spare myself from seeing the numbers on them.)
While getting dressed, I focus on clothes instead of the puckered, silvery stretch marks that appeared with my children. I hold up my clothes to briefly marvel at how large they are. I often have to try on my outfits two or three times before something fits correctly.
I don't want to relinquish the smaller clothes just yet, because then I'd be resigning myself to eternal largeness; I don't want to get rid of the large clothes or even the middle-sized outfits, because I need them and shopping for clothes is usually torturous. I stand in front of my closet thinking these thoughts for the millionth time. This is how every day begins.
Fat? Who says?
In determining that obesity is a serious national problem, the federal government lowered its guidelines for obesity last year, so that more people are classified as obese.
The federal Centers for Disease Control and Prevention use a height-to-weight ratio to categorize people as overweight, obese, or morbidly obese. But the Surgeon General lowered the thresholds in 2002, so while I wasn't obese in 2001, this year I am -- even though my weight hasn't deviated more than 15 pounds.
While eating disorders, a more sedentary lifestyle and bad nutrition are important factors in many cases, scientists have isolated 250 genetic causes of obesity, a figure cited by the University of Pennsylvania Medical School's Weight and Eating Disorders Program.
The CDC estimates that 50 percent of Americans are overweight, with 27 percent of that figure (roughly 14 percent of the total population) being obese.
More recently, the Harvard School of Medicine released numbers showing that as many as 60 percent of Americans are overweight and 30 percent are obese -- data that suggest being overweight is becoming the rule rather than the exception.
Pennsylvania is our nation's third-fattest state (tied with North Dakota and Kentucky), with 59 percent of residents qualifying as at least overweight if not obese, according to the Kaiser Family Foundation.
Although Colorado has the lowest estimated prevalence of adult obesity in the nation, at 14.9 percent, the increase over the past decade is striking. Between 1990 and 2001, obesity among Colorado adults more than doubled. Currently more than 450,000 Colorado adults are categorized as obese, according to the Colorado Department of Health and Environment.
A great personality
For my 14th birthday, my mother bought me a book called Flatten Your Stomach. When I was 16 and already wearing a size 36D bra, I was mocked and repeatedly told by boys at Swissvale High School that I had "a great personality" but was only "liked as a friend."
Out of nowhere, a well-meaning high-school English teacher gave me a girdle one day after class; she suggested it could help me.
At 18, when complaining of stomach cramps, I went to a Wilkinsburg gastroenterologist who took one look at me and curtly explained that once I lost weight, my pains would go away. (One week later, in the emergency room, I was diagnosed with mononucleosis.)
While top-heavy since the age of 11, I never wore a size larger than 14 in high school. I now see photos of myself as a teenager, and don't necessarily look at that girl and think, "Wow, she's a big girl," but apparently that's what others saw. I remember how I suffered and wonder why.
Being fat is invisible
It seems that people like me are so big, we're invisible.
Wal-Mart's 1999 employee benefits booklet lists the following charges as "not payable for treatment or services": medications and diet supplements related to diet programs; appetite and weight control; and treatment of obesity or morbid obesity, including gastric bypasses and stapling procedures -- even if the participant has other health conditions which might be helped by the reduction of weight.
The American Obesity Association (AOA) estimates on its Web site, www.obesity.org, that more than 80 percent of employers have policies similar to those of Wal-Mart, one of the country's largest employers.
The AOA site offers help for those who must appeal a health insurer's decision not to cover such sources. Two letters published there are from morbidly obese patients whose doctors stated gastric bypass surgery was medically necessary for their survival, but whose insurance companies refused to cover the procedure.
Both parties appealed the decision all the way up to state levels, and both parties lost. The AOA cites five states where legislation is under consideration that would force health insurers to cover treatment or services to prevent and remedy obesity: Georgia, Hawaii, Maryland, Montana and Virginia. Barring such laws, however, this condition continues to cost sufferers in a variety of ways.
Fat isn't cheap
It isn't cheap to be overweight. The size 22 chiffon gown I purchased at one Pittsburgh salon in 2001 cost $200 more than the standard size 14.
Considering the 22 is a mere two inches wider than a standard size 14 -- that's essentially an extra $100 for each extra inch of dress.
It isn't cheap to lose the excess weight, either. At McDonald's, you can buy a double cheeseburger (480 calories, 240 from fat, and containing 27 grams of fat) for 99 cents, or you can buy a Fajita Chicken Salad (160 calories, only 60 from fat and containing 7 grams of fat -- without any dressing, croutons or other toppings) for $3.99.
127 million Americans
To prioritize research funding for the prevention and cure of diseases, the National Institutes of Health (NIH) examine several criteria, including: how many people have the disease; the number of deaths and degree of disability caused by the disease; the degree to which the disease cuts short a normal, productive, comfortable life; the economic and social costs of the disease; and the speed at which the medical community must act to prevent the further spread of the disease.
The American Obesity Association argues that funding is disproportionately low for obesity, a disease that affects an estimated 127 million Americans -- more than 57 times the population of the Pittsburgh metro area.
Conditions caused by obesity, such as hypertension and diabetes, receive considerably more funding from the NIH than obesity itself. The AOA now works in cooperation with the NIH to see that obesity is considered a serious national problem that deserves funding.
30 pounds in 30 days
A typical day: When I walk out of my home, a flyer stapled to the telephone pole I pass on the way to my car proclaims, "Lose 30 pounds in 30 days ... Ask me how!" On the way to work, I pass six skinny joggers, 12 Port Authority bus-boards with skinny, beautiful women on them, and four billboards related to health and beauty featuring tiny women.
Throughout the day, I receive 36 spam e-mails suggesting I should lose weight. Every time I log into my e-mail, I am treated to a large banner ad telling me I can "look better naked" through a certain weight-loss plan (an ad I see a total of 28 times during my workday).
Four times throughout the day, I pass the hallway vending machine, where the healthiest treat is a bag of pretzels, ridiculous with sodium.
By the time I am ready for bed, I have been reminded in 19 different ways and around 130 times that I am fat; that fat people are unattractive and undesirable; that fat people should be made fun of and feel ashamed of ourselves; and that we need to lose weight to be accepted, successful, beautiful.
Paying double fare
We're getting bigger, but seat belts aren't. The National Highway Traffic Safety Administration's seat-belt specifications require auto manufacturers to install seat belts for people weighing up to 215 pounds, with measurements said to cover "95 percent of the U. S. population."
People in vehicles are required by law to wear seat belts, but many of us larger people don't; for us, seat belts are uncomfortable, restrictive, and even cause burns or bruises. Nonetheless, we aren't so big that we wouldn't be thrown from a car.
With political pressure applied by groups like the National Association for the Advancement of Fat Acceptance (NAAFA) and the Council on Size and Weight Discrimination, these specifications are now being re-evaluated, with Honda recently responding by making seat-belt extenders available, for an added cost, with newer vehicles.
Even less savvy about this issue, Southwest Airlines implemented a policy in 2002 that allows flight attendants (themselves subject to strict and arguably impossible weight guidelines) to arbitrarily determine whether a person is a "person of size," and force that person to either pay double fare for two seats, or eject them from the plane if they refuse.
"A body built for babies"
My mother and sister both wear a size 4, and everyone on my mother's side is slim. "You don't look much like your mother," cracked a portly dentist I never visited again.
My father, on the other hand, is robust; place a photograph of me beside any photograph of my paternal grandmother and aunt at the same age, and they're identical. The women I resemble are short with large breasts and the curves to go with them. "A body built for babies," my grandfather used to say with a wink.
Indeed, I built two babies, and have been "obese" ever since, never reaching lower than a size 14 with even the most rigorous of fitness programs, which I have since dispensed with due to frustration and a general lack of time, money, energy or inclination to make weight loss my major hobby.
I have come to understand that my body wants to look a certain way, and is biologically predisposed to a certain build, a build called "voluptuous" and celebrated in other countries, a build that works just as hard at home and at work as the bodies of my skinny counterparts do.
10 vacation days a year
The United Nations' International Labour Organization (ILO) reports that Americans work more than people in any other industrialized nation.
Americans on average receive 10 vacation days per year, as opposed to the 30 received by Europeans; Americans must work for the same company for many years to receive a similar amount of vacation time.
Data from the U.S. Bureau of Labor Statistics indicates the percentage of Americans working 49 hours in a regular workweek rose from 8 percent in 1976 to almost 14 percent in 1998. Pending legislation might cause this number to rise even higher when several types of positions will no longer be eligible for overtime.
What professional person has time to prepare a healthy meal purchased from the grocery store when it's so much quicker to order out or swing past a drive-through during hectic lunchtimes spent satisfying a list of personal errands?
Two skinny parents
Our family heads over to Edgewood Towne Center. At Wendy's, my skinny kids are each eating a small Caesar salad and drinking Sprite; I have a salad and a diet soda.
I look over and see a thin dad and his thin wife, feeding their morbidly obese elementary-schooler a children's meal with a cheeseburger, fries and a "frosty." I am a fat parent with two skinny children, while these two skinny parents have produced a humongous child. I glare at these parents for serving this large child a meal made of saturated fat, and want to walk over and hug this young fat boy because I know how he's being treated at school.
Back at home, I watch Disney's Aladdin on the couch with my kids. At the story's beginning, the genie, voiced by Robin Williams, is expelled from the magic lamp, shoves his stomach way out and cracks, "Tell me, do I look fat in this?" My kids giggle.
Average size 16
The average size currently worn by an American woman is 16, but any woman over size 14 is considered "plus-size."
If you're a small woman, what are the stores named that target you? "5-7-9" and "Petite Sophisticate."
You're less sophisticated, apparently, if you're among the 51 percent of overweight women: Marketers herd you into a store called "Dress Barn Woman."
My family doctor notes my low cholesterol, my low blood pressure, low blood sugar, healthy heart and good lungs.
Concerned about a recent CDC study that proclaimed birth riskier to babies born to overweight women, I asked my doctor last month if I need to lose weight before becoming pregnant again.
"It can't hurt," she said. "But you are perfectly healthy and have already given birth to two healthy babies. So if you want to lose weight, lose it, but don't let obsession with your weight stop you from living your life."
Don't get to pick
While I'm putting my nightgown on, my 8-year-old daughter keeps me company.
She sits on the edge of my bed, swinging her tan, coltish legs back and forth. "Mom?" she asks. "Can I ask you a girl question?"
"Of course," I say.
"Are my boobs gonna be little like your mom's or huge like yours?"
She sees the same advertisements I do on television, sees the same tiny women on magazine covers in line at the grocery store, hears the same diminutive mavens of pop music on the radio wherever she goes.
"I honestly don't know, honey -- we'll have to wait and see."
"I hope my boobs are not big and fat like yours."
"Well," I explain, "you don't really get to pick. I didn't get to pick. It's just that my dad's mother and sister both have big boobs, and I look like my dad, so I grew big boobs. It just happened."
"But me and my brother are skinny like Daddy."
"Yes. You are both lucky, because you are skinny like your father."
She sighs. "If you and [her stepfather] have your own baby, will that baby be fat?"
"Maybe," I answer uncomfortably, my irritation increasing. "There's no way of knowing that."
"Well," she quips matter-of-factly, "I don't want a fat baby."
"How would you feel if I said, 'I have a baby with glasses, but I didn't want a baby who wears glasses, so I'm disappointed?'"
She gulps, pushing her glasses up her nose. "Sad."
"Of course you would. But that's not what it's like, and I would never really say that. You are a girl who wears glasses, and I love you. And I love your glasses, because they're part of what makes you, you. So no matter what my babies look like, I love them because of who they are. And that's how it will be with any more babies I ever have, no matter what they look like when they come out."
"Oh," she mutters awkwardly and unconvinced, slinking out of the room.
Forced to lose weight
A growing number of lawsuits involving overweight plaintiffs include people who were fired, passed over for promotion, denied employment, or persecuted for their weight.
Plaintiffs who win their cases appear to do so under the Americans with Disabilities Act (ADA), the Rehabilitation Act, or state human relations acts. One case found on NAAFA's online database is People v. Corrigan, in which a mother was criminally prosecuted for felony child endangerment, based partially on the excessive weight of her child.
Several other cases concern airline employees who were forced to lose weight or resign; according to one case, as of 1991, the revised American Airlines weight limits for a 5'5" female flight attendant were 133 pounds for a 20- to 24-year-old woman, and 145 pounds for a 40- to-44 year-old woman.
Only in the state of Michigan, the District of Columbia, and in two California cities (San Francisco and Santa Cruz) is weight discrimination in employment practices prohibited by law.
How about these, Mom?'
At Kmart, we need to replace my daughter's summer sandals and several pairs of my underwear that were eaten by our beagle.
In the lingerie section, I am frustrated that all the prettiest panties are in sizes 5 and 6 while I wear size 9. My son holds up an obscenely large pair of granny-panties and yells, "How about these, Mom? They'll fit you!"
Insult is added to injury with another realization: One brand of size-9 ladies' briefs costs $9.99 for a package of three, while a three-pack of the same size in a brand called "Just My Size" (especially for fat ladies) is only $3.49. I begin to cry. My husband asks what's wrong, and I explain that I can either pay $20 for six pairs of panties, or save $10 by switching to the fat ladies' brand. All of these panties are the same size 9, and made from the same cotton and elastic.
My husband just sighs and hugs me. He is trapped and obviously uncomfortable, because if he says nothing, he's being insensitive and silently endorsing this disparity; if he says something, I might feel unattractive and unloved. So the man says nothing, just hugs his crying wife in the middle of a Kmart lingerie section.
My face buried in my husband's chest, I can hear what I soon see: a pair of thin teenage girls three aisles over, pointing to the plus-sized nightgowns and mooing.
A medically accepted disease
On April 2, 2002, the Internal Revenue Service (IRS) passed ruling #2002-19, which states: "Obesity is medically accepted to be a disease in its own right."
As such, taxpayers may now deduct "uncompensated amounts paid by individuals for participation in a weight-loss program as treatment for a specific disease or diseases (including obesity) diagnosed by a physician."
While your employer or your insurance provider may not be willing to help you with the costs of obesity, at least you can deduct the costs from your taxes with the applicable proof.
If you're overweight and too poor to pay for treatments to begin with, however, a tax measure that reimburses you for treatment costs hardly helps you.
Stupid, lazy, gluttonous
Many people look at me like they look at all large people, and think I'm stupid, lazy, gluttonous. Those who know me can attest I am none of those things. If I have a "great personality," it's been developed as a survival skill.
I admit my body would be smaller if in addition to being a full-time working mother, I had time or energy to exercise more, but I shouldn't have to apologize for my weight, and shouldn't be chronically disrespected and treated unfairly for it.
People shouldn't look at me and automatically assume that I'm fat because I chronically overeat, that my character is somehow fundamentally flawed, or that I have psychological problems.
It isn't as simple, for any of us, as "just putting our forks down." (In my case, I rarely consume more than 1,000 calories a day, which is but half the recommended calorie intake for an adult.)
All of us would choose to be smaller, and none of us needs to be told what pigs we are, or needs more hatred and ridicule. It may take a majority of fat Americans to get the issue addressed realistically, as a form of bias as serious as any other, which requires compassion, justice and reform.
How did your day go?
I stroll into my 6-year-old son's daycare during a flutter of activities.
Books, lunchboxes, jackets and colorfully scribbled art projects are flying everywhere as families regroup for the evening, trying to beat the 6 p.m. deadline -- after which parents are charged astronomically for lateness.
Four children and their mothers are all leaving at once, kids racing toward the door while their mothers call out for them to slow down and clumsily juggle their children's belongings. Soon enough, my son sits buckled in his car seat and we are on our way home. I ask him how his day went, and he looks thoughtful.
"I'm the only one with a big fat mommy, but I don't care and I love you the best anyway." I can only imagine the look on my own face when his eyes grow wide and he immediately apologizes for what he said.
"Sweetie," I answer, "you never have to apologize for saying you love me. I love you just the way you are, too."
Heidi McDonald is a contributor to Pittsburgh City Paper, where this article first appeared.
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