Paper planes

This is one of those awkward posts that I don’t really know how to make, but I want to make it anway.

There is a movement, mostly online but in the real world as well, called Fat Acceptance. It’s generally speaking, a good thing. Fatness is linked far too much to ideas like lack of moral worth, or unattractiveness, or as a shorthand for “people that we don’t like” – Think Augustus Gloop, Vernon Dursley, or basically any Dickens villain. It’s unfair, and it has far-reaching consequences – Much like having a Geordie accent gives a lot of people the immediate idea that you’re going to be thick-but-friendly and probably inherently criminal, being fat can draw the stereotypes of slovenliness or greed. Doctors, also, famously, often attribute health problems to be caused by fatness, rather than being incidental to, or being an existing condition that’s affected by fatness, or fatness being a symptom of the existing condition. It’s infuriating to see other zebras, who are clearly hypermobile, being told that their initial problem is their weight, not their hypermobility.

(Not to forget that hypermobile people sometimes become fat due to being made sedentary by pain and having their diet restricted to high-calorie junk food by lack of mobility or gut problems)

One of the tenets of fat acceptance is “health at every size” (HAES), which reminds us that people can be healthy at, well, any size. To a certain extent, this is true. I know enough people who tip the scales as “overweight”, but upon losing weight they feel awful, no matter how carefully they do it. Likewise, if I’m more than a few pounds outside of a fairly tight range of weights (on either side) I either feel bloated and sluggish, or fatigued and sore. People can be healthy at many sizes, but not every person can be healthy at every size.

Some of the stereotypes attached to fatness are also attached to disability – The idea of being lazy, or of having “brought this upon yourself”, or of being unintelligent, or sexless, or of not caring about your appearance. I could draw an interesting Venn diagram there, and I bet that more things would fall into the overlap than into the discrete sets. So, of course, being both fat and disabled will draw a double-portion of unhelpful stereotyping.

There’s also a lot of natural commonality between fat acceptance, and body positivity in the disabled community (cripple acceptance?) – Both are to do with accepting having a body which society doesn’t usually consider desireable, both involve accepting the body’s limitations and modifying clothing or behaviour to make them more accessible (There’s a parallel to be drawn between anti-chub-rub thigh-guards, and jackets cut short to accommodate sitting in a wheelchair most of the day).

But one place where HAES and I disagree is on the subject of hypermobility.

Hypermobile people just have terrible connective tissue. Our collagen is soft and stretchy and doesn’t do a very good job of holding our bones together. As such, we have to be light. Not just “not overweight”, we have to be thin. If we want to put on muscle, we can’t put on too much muscle, because the weight of it will put too much stress on our joints. In the words of one consultant “You’re going to have to be the fittest person you know”.

Note that as well as overall fitness, we’re talking about total weight. It’s not rocket science – We only have a certain amount of connective tissues, and they don’t “scale up” neatly like muscles do when we get bigger. Much like putting a 5kg weight on a spring will stretch it out faster and further than a 1kg weight, or how a heavier weight will be more likely to rip through a suspended paper towel than a lighter one.

A doctor is not just being fat-shaming when they say that, in the context of hypermobility, a patient has to lose weight if they want to improve their quality of life. I’m not saying that there’s a moral imperative to be healthy, but I would strongly suggest that it’s always worth trying anything that’s not got a massive side-effect burden if there’s a chance of it improving things.

And that’s what’s toxic – We need to decouple the general “Health as moral imperative” and “Concern-for-health as shorthand for aesthetic qualms” and “Societal use of fatness as shorthand for all ill-health” from the very real reality of “More weight on damaged joints will damage the joints even further, quickly. Otherwise, the very reasonable cause of general fat acceptance can end up obscuring the also reasonable cause of “In the case of this specific illness, this medical advice should be followed”.

I wouldn’t say this, but I’ve seen other zebras say “I need to lose weight, for my joints” and be bombarded with messages of fluffy negtivity, saying things like “Your doctor is just fat-shaming you”, “The only reason to want to lose weight is because the media wants you to” and the downright untrue “Your weight won’t affect your joints”. And I don’t want my fellow zebras to accidentally make themselves more ill, when they wanted to try something to help themselves recover. Any attempt at showing solidarity to the original zebra (Even something as innocuous as “Good luck, hope that it helps, remember to exercise gently at first”) can get you piled on with cries of how oppressive you are and how much you’re hurting people by suggesting that having less weight on a painful joint will make it hurt less. I’ve also seen it described as disablist to say that one of the most effective palliative treatments for hypermobility is exercise, even though that’s just true. Your connective tissue won’t get stronger, but your muscles can, and strong muscles can stabilise lax joints better than weak muscles.

I worry for the community if magical thinking ever outweighs observation and experience. No ideology, however well-intentioned, is worth risking someone’s health for.


3 thoughts on “Paper planes

  1. I think honesty is the best policy, health-wise, but one also has to be realistic. Like many, after starting on lithium, I put on 3 stone in virtually no time. So now technically obese. But it’s a price worth paying compared with the risks of being unstable + bipolar. So instead of torturing myself with shame + guilt, I took my entire old wardrobe to Oxfam and just bought a new one that did fit.

    I don’t kid myself being obese is healthy. It’s not. But it’s part of being bipolar for me (at the moment). So I accept it rather than adding another layer of misery to those I have already!!

    • Exactly – This is exactly the sort of thing I’m in support of, people deciding for themselves where their priorities lie.

      My issue was EDS-specific, in that the truth of the matter is that being lighter and more muscular basically always makes hypermobility easier to manage, but that truth gets lost in the general message of “love your body as it is” – Fine if someone does love their body, but not if they are desperately trying everything to lessen the effects of EDS, but have been misled into believing that their weight won’t change it.

  2. Yes, to my mind, and what my trade as a health/science writer is all about, is to give people the best quality information possible, & then empower them to make up their own minds about the right way forward for them.

    Pandering to sensitivities, by fudging the truth – I am not interested in that really. Tact, by all means. But lies, NO!

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