Search Results for: cancer

Finally Seeing the Forest for the Trees

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Maura Kelly | Longreads | November 2017 | 15 minutes (3,727 words)

Growing up in suburban New Jersey, I never got the whole nature thing. In my middle-class town, surrounded by neatly engineered housing developments, the little “nature” I knew was unnatural. The grass of the boxy lawns, stripped of dandelions, shined a uniform pesticide green. The most memorable tree of my youth lived like a caged beast in an indoor shopping mall; Shel Silverstein would’ve wept to see it, imprisoned between the food court escalator and a fake waterfall with wishful pennies glittering on its floor. In my state, even the ocean was tainted; the beaches of the Jersey Shore were a riot of oversized umbrellas and slick men in banana hammocks blasting their boomboxes. One summer, so much trash washed up on the sand that it made headlines, hypodermic needles and all. The Garden State, so-called, but it wasn’t exactly Eden. Since I never went to summer camp, since my parents had no country hideaway, I was a kid who thought the Great Outdoors wasn’t all that great. A tree by any other name was just as boring as every other tree.

All that began to change slowly during my undergraduate years in a postcard-perfect New England town. There I began to understand how beautiful nature could be. I still didn’t want to commune with it or anything. (Camping seemed like a fantastically bad idea; why anyone would want to sleep on the cold hard ground in a place without a proper toilet was beyond me.) But the trees surrounding my campus and the mountains around my college town pleased my eye in a way that was new to me. There, in New Hampshire, I also went on the first hikes of my life. But despite my burgeoning Romantic sensibility, I saw those excursions up the mountain as little more than a chance to exercise while hanging out with friends. As for opportunities to stop and smell the pine needles, I was determined to avoid them. All I wanted was to rush to the top of Mount Cube and race back down again — fast enough to burn some calories — and I got annoyed when anyone tried to slow me down to ooh-and-ah over some dumb mushroom.

After college, I eventually arrived in that city of all cities, New York. I loved it. I couldn’t believe it had taken me so long to get there — to the center of the world, so it seemed, with all the great art museums, the great jazz places, the great movie theaters, the great performances of Shakespeare. The city helped me to notice an aspect of myself, the intellectual epicure, that I’d barely noticed before. It was a thrilling discovery. In New York, my brain was fed the richest of foods, my ambitions were fueled, my expectations for myself raised. By then, I’d lived in four other U.S. cities, and I felt sure I’d found the place that beat them all, where I’d stay forever.

The years passed and I had what I half-jokingly call “my nervous breakdown.” Half-jokingly, though it was no joke. A perfect storm of events — a break-up, a career disappointment, a professional trauma — knocked me down. I couldn’t eat or work, I could barely read or write, and I especially couldn’t sleep more than three hours a night. I couldn’t go out in public without disintegrating into tears — on the subway, in restaurants, at the gym, during a friend’s book party — triggered by the least little thing, like a long wait or a sad song. I was frequently overwhelmed by vertigo that felt as much physical as metaphysical. It felt at times as if I was slipping down some vast mountain into the abyss, unable to stop my steady descent, like a character out of some Edgar Allan Poe horror story. This went on for months and threatened never to end.

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When a Mother and Daughter Reverse Roles

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Marlene Adelstein | Longreads | November 2017 | 8 minutes (2,061 words)

Recently my boyfriend and I became completely absorbed in a PBS nature documentary about baby sea otters separated from their mothers in Monterey Bay, and the group of passionate scientists whose mission it was to rescue and rehabilitate them. One particular pup, a bundle of brown fur, dark soulful eyes and long whiskers, whom the scientists named 501, was weak and sickly and couldn’t groom or forage for food, crucial tasks its mother would normally perform. So the scientists took the pup to their research facility to nurse the orphan back to health.

At the rehabilitation lab, handlers wore dark ponchos and faceless Darth Vader-like welder’s masks so the otters wouldn’t become attached to them. Eventually the trainers brought in Tula, an older rescued otter, to act as a surrogate mother. Tula spent months teaching 501 essential otter skills, like how to roll, lick and rub her thick fur to keep buoyant and waterproof. After a few months, the trainers motored out to a protected cove on the Monterey coastline called Elkhorn Slough, a popular otter hang-out, and released 501 into the bay. As the pup swam off without her real mother, without her surrogate, and without her human mask-wearing protectors, I began to sniffle.

“Sweetie, are you crying?” my boyfriend asked.

“Me? No,” I lied as a wave of otter worry washed over me.

“The otter’s been trained to survive,” he said. “She’ll be okay. She was meant to live in the wild.” I knew all this but still, there I was, blubbering over a sea otter. How would 501 manage without her surrogate mother? Would she remember how to lick and roll? Would she find other otters? Would she survive?

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How Much is Too Much to Save a Dying Cat?

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s.e. smith | Longreads | November 2017 | 17 minutes (4,363 words)

The veterinarian looks anxious as she enters the room, clearly dreading the conversation she must have many times a night on the late shift at the emergency clinic.

Yes, your pet is dying. No, I’m afraid there’s not much we can do, she is bracing herself to say.

Her scrubs are a rich maroon, coordinating with the jewel-toned surroundings of the hushed exam room in the swanky clinic. Thick doors block the sound from outside, the interstitial space where they’ve left me alone in an echoing silence with a grim steel table and a box of tissues after the technician rushed my cat to the back, somewhere in the bowels of the hospital. The last time I saw her she was gasping for air, eyes huge, expression: betrayed.

I wonder if I will see her again.

It’s the largest veterinary clinic I’ve ever been in and it feels more like a spa, down to the powder blue polo shirts the receptionists all wear. The stack of euthanasia authorizations left out on the counter are the only sign this place is perhaps not what it seems. I have driven a long way to come here, because it is Easter weekend and my vet isn’t in the office, but this cannot wait.

Oddly, I find myself wanting to reassure the vet, to tuck her loose strand of hair behind her ear and offer her a cup of tea from the space-age machine out in the horrifically depressing lobby, filled with people sitting in little clumps with strained faces.

“I know,” I say as she sits opposite me, searching for words, and her shoulders slump in relief. “I knew the cancer would spread eventually, but is there anything we can do to make her comfortable?”

On my way in, struggling with the weight of my cat’s carrier and my bag, I passed a couple carrying one of those cardboard boxes they use to send cats home from the shelter, the takeout container that is supposed to presage many years of happy life together, cartoon kittens and puppies stenciled along the sides. It swung with a peculiar, empty lightness, bouncing in an almost sprightly way that felt at odds with the stricken looks on their faces.

There is a stark finality in the empty cat carrier.

You can take this, your cat won’t be needing it anymore.

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Language Acquisition

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Diana Spechler | Longreads | October 2017 | 16 minutes (3,875 words)

It begins at an outdoor café while you’re working for a month in central Mexico. From one table away, you zero in on his brown forearm, the two black cuffs tattooed around it. You want to touch those cuffs, encircle his arm with your hands. Soon you’ll learn the word esposas, which means both “handcuffs” and “wives,” but today you know only polite Spanish, please-and-thank-you Spanish. You smile at him until he approaches. When he asks if you have a boyfriend, you start to cry and can’t stop. You want to explain something to him — that you loved someone the way a dog loves her owner — but the only available language is snot. He holds a cocktail napkin to your nose. “Blow,” he says. For a second, you think he’s serious. Then you laugh so hard you feel something shift, the way the sky shifts from blue to pink.

***

His socks never match. His clothes and his dog are splattered with paint. His mother embroiders designs on his guayaberas and does his laundry. At night, he crashes wherever he is — on a porch, on a couch, by the lake in his pueblo. He takes you hiking to see the bursting white moon. He takes you to meet the shaman who can erase your pain with feathers. He takes you to see pyramids and an eagle carved into a mountain. He knows how to build a fire. He knows how to prepare a sweat lodge. He knows how to get people to buy him drinks. He knows how to wrap your hair around one hand and undress you with the other. During sex, he says all kinds of things you wish you understood. By the lake, you get so stoned together he stares at your face and asks if you’re Buddha.

“If I were Buddha, I couldn’t tell you,” you say.

“You have the face of Buddha.” He takes a drag, exhales a cloud, leans back on one elbow. “But don’t tell me. You are right. It is better not to tell me.”

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What Makes a Disability Undesirable?

(Ton Koene / VWPics via AP Images)

Who gets to decide if a disability is bad? This is one of the fundamental questions raised by a recent STAT feature on the genetic testing of embryos, which also looks at how that decision is reached. Andrew Joseph follows two women who knowingly pursue a pregnancy with an embryo that has a mutation that would put their child at a higher risk for certain cancers. It was the only viable embryo the couple had, so if they wanted a baby they didn’t have much of a choice.

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“No Fatties”: When Health Care Hurts

Illustration by Hannah Perry

Carey Purcell  |  Longreads  |  October 2017  | 4280 words (16 minutes)

Kasey Smith began gaining weight as a teenager. The numbers on the scale started increasing overnight, and no matter how few calories she consumed, they continued to go up. “It will even out,” she thought, crediting the change to puberty and hormones. But it didn’t, and her hair and skin began changing as well. “Something was definitely wrong.”

Each medical appointment, and there were many, concluded with doctors telling her to go on a diet. Smith (not her real name) remembers telling the endocrinologist about her frustrations with burning off the 900 calories she consumed each day and still gaining weight. “He looked at me and said, ‘Maybe you can cut back your McDonald’s to twice a week.’ I was stunned silent, and I went into the bathroom and broke down. ‘He doesn’t believe me. He thinks I’m just fucking with him.’”

As Smith’s weight went up, her food intake went down. Her mother signed her up for Nutrisystem, and her diet hung on the fridge for everyone in her family to see. Shame and humiliation narrowed her life down to three questions: what to eat, what not to eat, and how to burn more calories. She began to form dangerous habits, sometimes eating little more than lettuce.

Smith ultimately received a diagnosis of polycystic ovary syndrome, a hormonal disorder that can lead to excess male hormones, irregular menstrual cycles, and weight gain. She was prescribed Metformin and quickly began to lose weight, but the damage had been done. The 18-year-old developed anorexia, leaving for college at 130 pounds and coming back four months later and 30 pounds lighter, her hair falling out in clumps.

No one thought anything was wrong.

“I would go to the doctor, and there were no red flags. It was ‘You look fantastic!’ Not ‘This is alarming.’” Smith continued starving herself for another year until she ended up in the hospital, undergoing a colectomy to remove a foot and a half of her intestines, which had twisted as a result of her severe calorie restriction.

One year after the surgery, her worst nightmare returned: She was gaining weight. Celiac disease was the cause this time, but it wasn’t diagnosed until after Smith was in the habit of purging the little food she ate every day. She would regularly run in the park and pass out afterward. “I would starve all day, then I’d eat something at night, then I would purge it. In my head, I’m thinking, ‘I’m literally not consuming anything. The weight has to fall off.’”

She realized she needed professional help, and Smith found a therapist who specialized in eating disorders and began treatment at The Renfrew Center, a residential facility in Pennsylvania. She continues to struggle with discussing her weight at medical appointments. After she told her endocrinologist about her treatment at Renfrew, his reply was “I see you need to lose some weight.”

* * *

According to the National Association to Advance Fat Acceptance, one out of three doctors responds to obesity negatively and associates it with poor hygiene, hostility, dishonesty, and noncompliance, viewing fat patients as “lazy, lacking in self-control, non-compliant, unintelligent, weak-willed and dishonest.”

“Doctors may think they are doing their jobs by focusing on patients’ weights,” said Dr. Rebecca Puhl, deputy director of the Rudd Center for Food Policy and Obesity. But the effects of weight discrimination, both physical and mental, can be harmful to patients. “I do see this in health providers just as much as the general population, which is that maybe stigma isn’t such a bad thing. Maybe it will motivate people to lose weight. Maybe it will provide incentives for weight loss. But that is not what we see in research. We see the opposite — that in fact, stigmatizing people about their weight actually reinforces behaviors in health that increase body weight and obesity.”

The doctor looked at me and said, ‘Maybe you can cut back your McDonald’s to twice a week.’

As weight discrimination has increased in recent years — roughly 40 percent of adults report having experienced some form of weight stigma — so have obesity rates. A positive correlation between experiencing weight bias and developing eating disorders has been documented, and two studies have reported that overweight children are more likely to binge after being teased about their weight. Nor do these habits change as we age. In a 2006 study of more than 2,000 overweight and obese women who were part of a weight loss support group, 79 percent said they turned to food after experiencing weight stigma. Another common response: refusing to diet.

Johanna Tan encountered that stigma when she gained 80 pounds in three months after beginning the hormonal birth control Depo-Provera. Her doctor suggested weight loss, and she chose a weight loss clinic. In the weeks after undergoing her doctor-mediated diet of 500 to 800 calories a day, Tan began experiencing episodes of chest pain so severe she made more than one trip to the emergency room. Her general practitioner blamed her symptoms on her large breasts. “Never mind that my boobs have always been this big, and this was a new symptom,” Tan said, laughing wryly as she explained she had been performing special exercises and getting massage treatments to help ease the symptoms. But it wasn’t her breasts that were causing the pain, it was her gallbladder. Gallstones had blocked her common bile duct, and if left untreated it could cause acute liver failure. The cause of the gallstones? Rapid weight loss. Neither Tan’s weight gain nor her loss had been correctly assessed by her doctors. (Depo-Provera lists weight gain as a common side effect. When Tan voiced concerns to one doctor, she was told, “Everyone gets more hungry. You just need to not eat more.”)

The assumption that any health issues a fat person experiences can be chalked up to weight has not gone unnoticed by the fat community. Marilyn Wann was motivated to pursue fat activism after what she describes as her Really Bad Day, when a man she was dating told her he was embarrassed to introduce her to his friends because of her weight, and she was denied health insurance because Blue Shield of California deemed her morbidly obese.

“This double whammy of social and institutional exclusion based on my weight woke me up,” she said. “Until then, I had hoped to avoid the impact of anti-fat attitudes by avoiding the whole topic. But hiding and silence and avoidance didn’t keep the yuck from finding me. So I recognized that I had to come out as a fat person. The next day, I went to a copy store and made up business cards for my new print zine, which I decided to call FAT!SO? — ‘For People Who Don’t Apologize for Their Size!’ Immediately, my life became less stressful. Of course, I still encounter anti-fat attitudes and weight-based exclusions, but I have drawn a line between me and the hatefulness. It makes a huge difference.”

Wann still experiences bias, especially at the doctor. “I know before I enter the door that the whole system prioritizes its prejudice over my well-being,” she said. “The prejudice is what’s necessary to the institution as it stands. The medical establishment, the insurance agencies, public health agencies that are government-based have always advanced their agenda on the back of fat people. … The institutions of our supposed health systems — in the government agencies, in the insurance companies, in all of the medical practices — are saturated or have deeply ingrained anti-fat bigotry.”

Establishing the balance of information and compassion while discussing a patient’s weight is constantly on Rebecca Zuckerman’s mind. “It puts medical professionals in a weird catch-22,” said Zuckerman, a fourth-year medical student at the Pritzker School of Medicine at the University of Chicago, who understands the motivation of fat activists but whose education includes the negative medical impacts of obesity. “It’s something I’ve struggled with personally. You can only explain it and tell people their options. You can ask if it’s OK to talk about weight loss or give more information. If they say, ‘No, I don’t want to hear it,’ you have to respect that.”

Still, the intense schedule of medical professionals, who are often allotted only 15 to 20 minutes per patient, often results in less-than-ideal communication. It’s easier to reach for the quickest conclusion: telling the patient to lose weight. Says Zuckerman, “A lot of doctors and nurses experience burnout, and they start losing empathy and don’t view the patients as people anymore. Your hands are tied to stay within those 20 minutes. Everyone’s trying to make more money, and the doctors are a cog in the wheel.”

That’s along with pervasive stereotyping about fat people in the medical community. In a study of 318 family physicians, two-thirds reported that their obese patients lacked self-control, and 39 percent stated that their obese patients were lazy. Even health care professionals specializing in nutrition thought poorly of their obese patients: “Attitudes toward obesity and the obese among professionals,” a study in the Journal of the American Dietetic Association, reports that 87 percent of health care professionals specializing in nutrition believe that obese persons are indulgent, 74 percent believe that they have family problems, and 32 percent believe that they lack willpower. In 2013, the American Medical Association labeled obesity a disease.

The misdiagnoses that occur lead directly to poor health outcomes. Johanna Tan ultimately spent three years in pain, leading to four weeks of hospitalization, a series of invasive surgical procedures, and lengthy rehab — procedures that wouldn’t have been necessary had the gallstones been caught earlier. While she was enduring severe pain following her first surgery and struggling to complete her postsurgical rehab, the hospital staff accused her of being lazy. “I spent two weeks in hospital post-surgery,” she said, “copping abuse for being lazy and not participating in my own rehab, before they realized they fucked up.” Tan said the nurses were condescending, saying, “I know it hurts. It’s major surgery. You still have to get up.” The pain didn’t ease until her doctors realized they had missed some gallstones and had to perform a second surgery. Tan wasn’t able to walk more than 10 feet at a time for the first month following her surgeries. It took six months for her to be able to walk further than a block.

* * *

Fat patients also often find themselves facing off with doctors who refuse to write prescriptions or referrals until patients lose an arbitrary amount of weight, a common scenario for those seeking joint replacement surgery. Despite being in “crazy amounts of pain,” Melinda Belles-Preston was required to lose 30 pounds before receiving an operation on her hips. Losing between one and two pounds a week, a healthy pace according to the Centers for Disease Control, would delay her surgery by several months. Heavier patients see longer lags. A required loss of 50 to 100 pounds can postpone a procedure for months or even years unless the patient undergoes weight loss surgery. Without surgery, the time spent in pain is prolonged, opening the door to painkiller dependence. It took Belles-Preston roughly six months to lose the weight, and she was in pain the entire time.

“Going in nutrient-deprived and starved is probably not a good way to send someone into heart surgery or major any surgery,” Wann said; her tone made it clear she was stating what she thought should be obvious. “Someone who’s been losing weight may have worse outcomes than someone who’s stayed the same weight. … It’s amazing how someone can just look at you and decide how a random number of pounds can shift you from someone who doesn’t deserve care to someone who does.”

Pain management was barely discussed when Virgie Tovar, activist and author of Hot & Heavy: Fierce Fat Girls on Life, Love & Fashion, went to the doctor after being injured on an amusement park ride. Suffering what she described as “debilitating back spasms” that made movement “electrifyingly painful,” she was told she had to lose weight before anything could be done for her. “It was like this dogged commitment to not helping me until I was at a different weight,” she recalled. “Let’s say I lose weight at what is considered a normal pace that doesn’t endanger a person’s life. For me to get to the weight you’re talking about is like 10 years. So I just get to be in pain until I’m at that weight. And if I’m still in pain after a decade of weight loss, then you’ll think about taking care of this?”

Ideally, preventive care helps patients avoid catastrophic health problems, but it’s not always accessible to fat patients, whether because of issues with doctors, issues with technology, or both. Fat patients have been refused medical screenings, such as Pap smears, mammograms, and colonoscopies, that are considered routine and vital for thin patients. The American Cancer Society advises women to get mammograms yearly beginning at age 45 and colonoscopies every 10 years beginning at age 50, but fat people often struggle to find facilities that will perform the screenings and are told they cannot fit in the machines.

A required loss of 50 to 100 pounds can postpone a procedure for months or even years… It took Belles-Preston roughly six months to lose the weight, and she was in pain the entire time.

The importance of an MRI comes from its ability to provide higher-quality images. But the machines that provide those images are small, and other options, like CAT scans or ultrasound, don’t provide a comparable alternative. “All those scans need to penetrate the body to create an image. If a body is larger and has more fat tissue to penetrate, the image quality is poorer and blurrier, and it’s harder to make out structures,” Zuckerman explained. “It’s harder for skilled radiologists to diagnose things in patients who are larger for that reason. … The fact is, MRI machines are tiny. Some people literally cannot fit in them. So we do something else like an ultrasound or CT that is not quite as good. It’s better than nothing, but it doesn’t give us the image quality that an MRI does. You run the risk of missing something because the picture that you’re getting is not clear.”

The need for hospital equipment that can accommodate fat people has grown, and imaging devices are now available. This equipment is not available everywhere, however, and sometimes patients are referred to their local zoos. When Wann called the San Francisco Zoo’s medical department to ask about accessing its technology, the person on the phone sighed and said, “I wish people would stop saying that,” referring to requests to use the department’s CT and MRI scanners. While vet schools and zoos have larger-capacity devices, they can’t allow human subjects, and scanning humans in machines intended for animal subjects is banned by formal policies in most facilities. “That’s really beyond their certification,” explained Wann. They’re not licensed as an institution to practice medicine on people. Their entire institutional certification is being put on the line because our human medical system refuses to accommodate people above a certain size. It draws an arbitrary line and says, ‘Go beyond this line, and they’re monsters.’”

Without being properly screened, patients can’t be diagnosed. A 2008 review of previously published studies, 32 in total, reported that white, female, obese patients were less likely to be screened for breast and cervical cancer. A study from 2006 reported that only 68 percent of women with a BMI of greater than 55 were given Pap tests, while 86 percent of other women were tested.

In some cases, this is a result of fat patients opting out of health care entirely, even if they otherwise have the ability to access health care facilities and are insured: According to the International Journal of Obesity, 19 percent of participants reported that if they felt stigmatized about their weight by their doctor, they would avoid future medical appointments, and 21 percent said they would seek a new doctor.

“Fat people don’t go to the doctor often. They tend to avoid it,” writer and activist Kitty Stryker said. “A lot of fat people are ashamed of being naked. They don’t want to be touched. When I say I have a lower-back problem, I know they’re going to say, ‘Lose some weight, and that will go away.’ So what’s the point? Why bother continuing to try to get to the root of my health problems when I know the only thing they will ever tell me is ‘Lose weight’?”


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Patients often face added risk beyond concerns of being dismissed or the necessary treatment being denied: the possibility of weight loss treatments and procedures being strenuously suggested at inopportune or irrelevant moments. While the American Academy of Family Physicians recommends screening for obesity along with monthly sessions of counseling and behavioral interventions, the timing of these suggestions is crucial to the impact of motivational interviewing — and execution is often poor. Tan was mid-Pap smear when her doctor asked if she wanted a Weight Watchers pamphlet.

“The speculum’s already in and open. And she says, ‘I can tell you’re getting upset. Do you want me to continue?’” Tan recalled in disbelief. “I said yes because I didn’t want to have to make another appointment for my Pap smear. I was so mad, I was crying at this point. I couldn’t move. I couldn’t yell. She said, ‘I can tell I’ve made you upset, but weight is a serious issue.’”

Although familiar with the prejudice that came with her weight, Belles-Preston was still shocked when her general practitioner recommended weight loss surgery — while she was pregnant. “I walked out of the room. It was so incredibly offensive to me. I’m coming to you for medical advice about my pregnancy, and you’re talking to me about weight loss surgery, which is the furthest thing from my mind.”

“I have tons of resources and attitudes for confronting this kind of stuff, and it can still kill me,” Wann said as I marveled at her calm approach to discussing prejudice so severe it can result in death. “I understand not going [to the doctor]. I think it’s self-protective to some extent.… Every time I go to any kind of medical appointment I anticipate facing weight bias. I anticipate being denied the sort of services thin people would receive with no problem or being targeted for weight-based treatments that I don’t want and could harm me. I’m not interested in stomach amputation or stomach squeezing. I don’t think those are therapeutic practices in any sense. Every time I go see a doctor I’m aware they may casually say the only thing they want me to do is have my stomach cut off.”

* * *

The effects of that bias were traumatizing and long-lasting for Tan. Triggered by her uncomfortable experiences in hospital environments, Tan’s first job as an audiologist after graduate school provoked frequent panic attacks because of its location at a hospital. “I used to have to go to work early so that I could tamp down the panic associated with being in a hospital at all,” she said. “This fear of hospitals hasn’t quite gone away. Most recently, a few months ago, we had to spend a few days in ICU as my partner’s dad passed, and just being back in ICU rattled me so badly it was a month before I could stop popping several Valium a day.”

It was the adversarial relationship she had developed with doctors and nurses that contributed to Tan’s panic. And she’s not alone. For many, thin means healthy and fat means unhealthy. So small and slender equates with good health and is encouraged by medical providers, often resulting in strained relationships with their patients.

The idea that the lower the weight, the healthier the person, escalated into life-threatening conditions for Smith, who was frequently complimented on how healthy she looked while she was starving herself. “When you’re restricting [calories] you can brag about it,” she said, recalling her preparation for the colectomy. “[Doctors] asked, ‘Are you eating well and exercising?’ I said, ‘I’m very healthy. I exercise all the time. I only eat vegetables.’ It’s a funny dichotomy. Just because the scale is low does not mean that you’re healthy. A lot of doctors forget to be careful of that.”

But as the number on the scale climbs, the less flattering characteristics — greed, lack of control, messiness, lack of self-care, laziness, automatic unhealthiness — are associated with fat people, only to be furthered by the media’s portrayal of fat characters, who are typically the butt of jokes or seen as slovenly and undesirable. Women are often the punch lines, much more than men. BMI standards also are more harsh for women than for men, which is apparent in the statistics regarding weight loss surgery: Obesity rates in America are split fifty-fifty between genders, but 80 percent of bariatric surgeries are performed on women. In a 2014 study from Kansas State University, 72.8 percent to 94 percent of overweight and obese men were satisfied with their health as compared with 56.7 percent to 85 percent of overweight and obese women. There’s a reason all the stories and sources here are about and told by women.

“The truth is that there are reasons why fit people live longer, better lives,” Tovar said. “It’s because the entire culture is constructed to benefit them.” Weight discrimination is associated with an increase in mortality risk of nearly 60 percent for both women and men.

Fat activists are working to provide recourse at the community level; patients share the names of fat-friendly doctors or establishments, and Wann uses her social networks to help people get referrals for doctors and other medical providers. She also assists people with planning responses to doctors and providers who inflict weight bias. Fat activist Stef Maruch maintains a list of doctors who do not inflict bias or are fat positive, and Wann encourages people to update it whenever they can. NAAFA also publishes brochures and tool kits to assist fat people in navigating bias and fighting anti-fat legislation. A monthly newsletter updates recipients with the latest research and provides referrals to practical tools like products made for people of size. After Hurricane Harvey devastated Texas, NAAFA released a special-edition newsletter and sent plus-size clothing and supplies.

Obesity rates in America are split fifty-fifty between genders, but 80 percent of bariatric surgeries are performed on women.

The organization has also updated the brochure it gives health care providers treating fat patients. It was last updated in 2011, and per the recommendation of one of NAAFA’s advisers, its language is being revised to be much more aggressive when discussing weight bias with medical professionals. “Up until this point we’ve been trying to inform and be a little bit gentle,” explained Peggy Howell, NAAFA’s vice chairman and public relations director, citing the research scientists, Ph.D.s, and professors in medicine, law, nutrition, social work and more who serve on NAAFA’s advisory board. “The advisers came back and said, ‘I think we need to take a different approach. I think we need to be more assertive about this. There are lots of studies that support that this bias does more harm than good to the patients.’” The nonprofit’s 2011 brochure states, “NAAFA is working to help ensure that health care providers provide the best possible care by keeping in mind the special needs of their fat patients.” The new brochure reads, “We currently live in an environment that stigmatizes anyone who does not meet the aesthetic or medically defined categories of an ‘attractive’ or ‘healthy’ weight… [it] creates and sustains fat phobia and oppression, which includes weight bias, prejudice, stigma, discrimination, bullying, violence, and cultural imperialism. … Sometimes the internalized biases of health care providers directly contribute to further stigmatization of fat people.”

There is some movement on the medical end as well, driven by health care providers seeking training and resources. The Rudd Center has developed educational videos, which have been tested and found to reduce weight bias. Viewing the two 17-minute films — “Weight Prejudice: Myths and Facts” and “Weight Bias in Health Care” — resulted in improvement in attitudes toward obese people. The Rudd Center has also created a media repository of 400-plus photos and more than 80 B-roll videos that portray children and adults with obesity in non-stigmatizing ways, intended as a resource of respectful, rather than stereotypical, images for the media as well as scientists and health professionals to use when making educational presentations.

“We’ve created online courses and all different kinds of resources to use to try to increase awareness about this issue and educate providers that this is more than a social justice issue,” Puhl said. “This is a full public health issue. The stigma is making their patients’ health worse.”

For many fat people, the response is too little, too late. “I would rather doctors have signs on their door saying, ‘I don’t treat fat people,’” Wann said. “It would save everyone time and money if they had a sign on their door that said, ‘No fatties.’ At least they would be honest and own their bias.”

***

Carey Purcell is a New-York based writer who covers culture, politics and current events from a feminist perspective. She has been published in The New York Times, Vanity Fair, Politico and other publications. She has been a featured guest on AM Joy and Good Morning America, and her writing can be read at CareyPurcell.com.

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Editor: Michelle Weber
Illustrator: Hannah Perry
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Ahead by a Century: A Gord Downie Reading List

Gord Downie performs at WE Day in Toronto in 2016. (Chris Young/The Canadian Press via AP)

I remember the day in 1987 when my then-boyfriend popped their first EP, “The Tragically Hip” into the cassette player of his dad’s Chrysler Cordoba. When “Last American Exit” came on, I loved it instantly. It’s been on my playlists for 30 years. I’ve seen the Hip at community colleges, hockey rinks, bars, summer festivals, and arenas. I’m part of a swath of Canadians for which the Hip’s music meant good times and Canadian pride; our stories, truths, and landscape writ large in songs with incisive lyrics and driving beats.

Among my favorite Hip songs, “50 Mission Cap” honors Bill Barilko, whose last goal won the 1951 Stanley Cup for the Toronto Maple Leafs. That spring, Barilko went missing on a fishing trip and the Leafs failed to win a cup until 1962, the year Barilko’s remains were discovered. Then of course, there’s “Ahead By A Century,” in which Gord asks us to embrace the moment, reminding us that “there’s no dress rehearsal, this is our life.” Part poet, part visionary, part activist, Gord Downie was a dervish on stage, growling those lyrics into the minds of audiences for three decades.

On October 17th, Downie passed away after battling glioblastoma for two years. In his moving tribute, Prime Minister Justin Trudeau said, “We are less as a country without Gord Downie in it.”

Perhaps the most remarkable thing about Downie is that he chose to spend the last two years of his life accelerating his contribution to social justice, working toward a better life for others, toward a better Canada. He used his profile and his songwriting to foster reconciliation between Canada and First Nations people by raising awareness of the atrocities and generational effects of residential schools. For his work, the Assembly of First Nations honored Downie with an eagle feather and a Lakota spirit name — Wicapi Omani — which means, “Man who walks among the stars.”

Here are five pieces about a man who used story and song to share his Canada and, through personal example, inspired and challenged us to be better as a nation.

1. “For Gord: 27 Short Essays About The Tragically Hip, Plus One Poem” (TheBelleJar, BuzzFeed, June 2016)

In this round-up, 28 fans share their earliest memories of The Tragically Hip and how Gord Downie and his lyrics became the soundtrack to important moments in their lives.

2. “Yer Favourites” (Eric Koreen, Hazlitt, August 2016)

After initial die-hard fandom, Eric Koreen gets turned off the Hip for a decade after getting fed up with a small, boorish, white male contingent of the group’s fan base, interested only in hearing the hits in concert — certainly not opening bands with thoughtful, though lesser-known songs. Koreen eventually reconciles the Hip’s dichotomous hold on Canada, in that they “combine the intellectual side of Canadians — that we’re thoughtful, smart people — with that humble, meat-and-potatoes side, too.” Koreen suggests his change of heart came as a direct result of Gord Downie, who he characterizes as someone who could “be frustrated by your country but not disown it; that you can be an intellectual and an everyman at the same time.”

3. “How I Learned to Love the Tragically Hip and Still Be Punk” (Damian Abraham, Vice, August 2016)

Damian Abraham, vocalist for Canadian hardcore punk band Fucked Up, recounts how he turned from lifelong Hip hater to friend of Gord Downie.

I met Gord properly for the first time in the summer of 2010 backstage at a Tegan and Sara/City and Colour concert. Gord was to join Dallas Green onstage to perform the song they did together on the latter’s Bring Me Your Love record, and I had brought my family with me to watch the show. My son was toddling his way around the backstage with us in tow when tumbled out in front of Gord. After helping him up and making sure he was OK, he picked up Holden’s flung and filthy soother and rushed over the sink to wash it. As he handed back the washed pacifier, I told him that he didn’t need to worry about doing that.

“Of course I did,” he responded.

Youthful exuberance can lead to rashness. In my rush to embrace punk and reject all that didn’t fit with my new world view, I ended up throwing out a lot of culture that I was thankfully able to rediscover later. Of all these bands, there are none I am more grateful to have awoken to the greatness of than the Tragically Hip.

4. “On the Tragically Hip, Blue Rodeo and a Shared Legacy” (Michael Barclay, Macleans, August 2016)

Jim Cuddy, of the legendary Canadian band Blue Rodeo, shares stories of times his band and the Hip crossed paths in their early years touring Canada.

We were supposed to be on right before the Hip, but the Eagles inserted some guy whose father owns the Knicks. It was a blues band, and he was terrible. But he had to go on then because it was his plane that the Eagles were flying on.

Then the Hip came on and they were on fire. Gord was in a big white outfit, totally drenched. At the side of the stage is Irving Azoff [longtime Eagles manager and former CEO of Ticketmaster and Live Nation] standing there with the Eagles, and he’s looking at Gord telling him to shorten the set, making gestures. It’s making me furious, because I know the Eagles only want to shorten the set so they can get on a plane and fly out, which they can’t do after midnight or something. So Gord’s doing his thing and continues on. Then the Eagles come on and do a miserable set, just sucking the joy out of the whole island. Afterwards I was sitting with Gord backstage and asked, “Didn’t that bug you?” He said, “Pfft, I never thought in my wildest dreams that I’d be playing and have Irving Azoff telling me to shorten my set.”

5. “Gord Downie opens up about battling cancer, says it’s ‘creating something'” (Peter Mansbridge, CBC News, October 2016)

In his first interview after his cancer diagnosis, Gord Downie talks with Peter Mansbridge about living with cancer.

When you see people now, you want to hug and a kiss. Why is that important to you now?

I do. Yeah. That was happening before, though, all this, strangely. My life was changing and I felt that everyone that hung in there with me, all these years, were still there — they didn’t write me off or anything like that. And they could have. So yes, hug and kiss. And my dad, Edgar, definitely kissed on the lips. And me and my brothers taught a lot of men how to do it.

Scientific Conferences Are Filled with Spies

AP Photo/Michel Spingler

Nations have long done battle with one another in different ways. These days, they spy from satellites, send viruses to corrupt government software, poach scientists and infiltrate academia. At The Guardian, Daniel Golden describes how international intelligence agencies send operatives to scientific conferences to gather intel, and how the U.S. has worked to convince foreign nuclear scientists to defect.

Scientific conferences attract people from all corners of the world and facilitate the exchange of information. Conferences are also one of the few opportunities for nuclear scientists from Iran to leave the country, so they function as what Golden calls “a modern-day underground railroad” for potential defectors. U.S. intelligence agencies routinely create their own sham conferences through an intermediary in order to isolate their targets and engage them one-on-one. The system has worked on many scientists. It’s fraught with many dangers: how to blend into a relatively small academic community and impersonate a scientist with actual scientific knowledge? How to get the target away from his guards without attracting attention? The larger question is whether this billion-dollar industry keeps the world safer.

“From the Iranian point of view, they would clearly have an interest in sending scientists to conferences about peaceful uses of nuclear power,” Ronen Bergman told me. A prominent Israeli journalist, Bergman is the author of The Secret War With Iran: The 30-Year Clandestine Struggle Against the World’s Most Dangerous Terrorist Power, and is working on a history of Israel’s central intelligence service, the Mossad. “They say, ‘Yes, we send our scientists to conferences to use civilian technology for a civilian purpose.’”

The CIA officer assigned to the case might pose as a student, a technical consultant, or an exhibitor with a booth. His first job would be to peel the guards away from the scientist. In one instance, kitchen staff recruited by the CIA poisoned the guards’ meal, leaving them incapacitated by diarrhoea and vomiting. The hope was that they would attribute their illness to aeroplane food or an unfamiliar cuisine.

With luck, the officer would catch the scientist alone for a few minutes, and pitch to him. He would have boned up on the Iranian by reading files and courting “access agents” close to him. That way, if the scientist expressed doubt that he was really dealing with the CIA, the officer could respond that he knew everything about him, even the most intimate details – and prove it. One officer told a potential defector: “I know you had testicular cancer and you lost your left nut.”

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Multi-Level Marketing’s Feminine Mystique: A Reading List

Women attend a Tupperware party, 1955. (Archive Photos/Getty Images)

The commodification of female friendship began in the living room, often with a small party or a conversation between neighbors. Then the goods came out: cosmetics, vitamins, jewelry. The multi-level marketing scheme was a suburban phenomenon, a way for homemakers to earn some money among friends. In the 1960s and 70s, Mary Kay, the pink-hued cosmetics company, dominated the market; in the 1980s, it was the Pampered Chef, with its kitchen tools and cookbooks; in the 2010s it’s LuLaRoe, a clothing company with coveted patterned leggings that are sold primarily through social media.

Today, multi-level marketing is booming online, with entire transactions taking place in the comments sections of Facebook posts, and aspiring entrepreneurs dispensing tips on YouTube about unloading their inventory. The products may vary, but the tactics don’t. Products are displayed, promises made. And whether a woman calls herself a consultant, a retailer, a partner, or distributor, there’s always a thinly veiled sense of desperation beneath the pitch.

Women who participate in MLM companies make a hefty up-front investment. To profit, they’ll need to recruit others to invest, and once drawn in it can be difficult to get out. Take a look at any website for an MLM company, and you’ll see sparkling promises of wealth for women. They don’t just sell products; they sell fantasies of empowerment, control, and financial freedom. Thanks to the stories below, it’s easy to understand how and why these companies target women, and what happens when they do.

1. “How a Single Mom Created a Plastic Food-Storage Empire” (Jen Doll, Mental Floss, June 2017)

It’s easy to associate Tupperware with beehive hairdos and grimy leftovers, but the company—pushed to success by social networker Brownie Wise—set the stage for today’s MLM culture. Doll tells the story of how Wise grew the company from a food storage novelty to an unstoppable national phenomenon. Why did hosting home parties as a Tupperware consultant appeal to so many women? For many, it meant a chance to work again, after the loss of employment after World War II.

Most of Wise’s Tupperware recruits fit neatly into the stereotypical role of a proper housewife. But, in reality, they surreptitiously represented a new kind of female empowerment. During World War II, many women had no choice but to enter the workforce. At its end, many of them had no choice but to leave it. Suddenly, selling Tupperware at parties allowed women to straddle both worlds. They were employed, yet they didn’t appear to challenge their husbands’ authority or the status quo. This pioneering entrepreneurial model allowed them to inhabit a workforce outside of the one the hustling salesman inhabited, and, in many cases, to do even better than he did. And that power relied specifically on a network of female friends and neighbors.

The parties weren’t just a way for women to keep occupied—it was a way they could contribute to their family’s bottom line. Most women who worked outside the home had low-paying jobs in fields like light manufacturing, retail, clerical work, and health and education. The money—committed dealers could bring in $100 or more per week—was a revelation. The opportunity for success was so great that the husbands of some Tupperware ladies left their own jobs to work with their wives.

2. “The Pink Pyramid Scheme” (Virginia Sole-Smith, Harper’s, August 2012)

For decades, Mary Kay has sold a two-sided promise to women: You can buy cosmetics for youth, but for actual power, you should sell them. When Sole-Smith became a consultant for the cosmetic brand, then nearly fifty years in business, she witnessed the revival-style tactics used consultants to recruit women. She also saw a flip side of the brand for women who found both friendship and financial peril in their new roles.

Lynne resigned from her directorship soon after, but she stayed on as a consultant. She had over $15,000 in credit card debt and a basement full of unsold products inching closer to their expiration dates. It took three more years to fully extract herself, paint over the pink wall, and get rid of the products. In 2011, her husband filed for divorce, citing as one of the reasons their “different attitudes towards money.” “He meant the whole Mary Kay thing,” Lynne said. “We just never got past it.” But it wasn’t for lack of trying. When her husband first began to talk about leaving, Lynne cleared every last Mary Kay product out of the house, selling much of it at a loss and throwing the rest in the trash. “I didn’t want him to see so much as a bottle of lotion and be reminded,” she said. “I didn’t want to be reminded either.”

But she hasn’t left Mary Kay behind entirely. The consultant who debuted with only two guests at Lynne’s party remains one of her best friends and is her son’s godmother. Lynne’s new career in real estate allows her to apply her sales knowledge, and the commission checks are at least bigger.

“Oh gosh, we were all so happy,” Lynne said as we looked at a picture of women in sequined cocktail dresses and layers of Mary Kay makeup smiling into the camera, their arms slung around one another. “I guess I didn’t know who I would be without Mary Kay to define me.”

3. “How Essential Oils Became the Cure for Our Age of Anxiety,” (Rachel Monroe, The New Yorker, October 2017)

When Monroe embroiled herself in the wild world of MLMs that sell essential oils, she found that it meant more than money for its sellers. Part of the appeal of grassroots-style selling came from consultants’ belief in their products. And when it comes to essential oils, it could feel like a matter of life or death.

Lara distributed a handout that listed various ailments and their oil treatments: eucalyptus for bronchitis, lavender for third-degree burns, cypress for mononucleosis, rosemary for respiratory syncytial virus. Diffusion “kills microorganisms in the air which helps stop the spread of sickness,” the pamphlet read. Oils “repair our bodies at a cellular level so when you are not sure which oils to use, don’t be afraid to use several oils and the body will gain a myriad of benefits.” Lara told the people in the room that doTerra had oils that were “very antiviral” and could knock out bronchitis in twenty-four hours. She shared essential-oil success stories—her migraines gone, her friend’s rheumatoid arthritis reversing, a colleague’s mother’s cancer in remission. A blond woman at the back of the room raised her hand. “Cancer?” she said, sounding both skeptical and hopeful. She explained that her sister-in-law had recently been treated for breast cancer, and was taking a pill to prevent its recurrence, but the side effects were terrible. The blond woman was hoping for a more natural solution.

“There is an oil for that,” Lara said cautiously. “There is some research. It is an option. It would not have those side effects.”

4. “The Truth Behind Rodan + Fields (And Its Takeover of Your Facebook Feed),” (Lauren Lipton, Allure, September 2015)

Women can become involved in MLMs for both friendship and financial gain. But what happens when everyone you know is involved in a sales scheme? After all, there are only so many showcases and special sales a person can attend, and for some, it might feel like an entire friend group has morphed into eager saleswomen. As Lipton learned, not everyone is thrilled about those endless invitations and events.

There’s a fine line between inspiring and annoying, and not all Rodan + Fields consultants tread it well. In fact, if you sell Rodan + Fields and think your friends might be dodging you, they probably are. “This is the suburban scourge,” says Rachael Pavlik, a Houston mother and the blogger behind rachriot.com, who says she goes out of her way to avoid anyone trying to sell her anything. “At first I would buy all of their stuff because I was kind of guilted into it….What is that? That’s not friendship.”

Pavlik is more outspoken than most. Most women we spoke to can’t bring themselves to hurt their friends’ feelings, so they roll their eyes privately, secretly blocking Rodan + Fields consultants who clutter their Facebook feeds and deftly fending off clumsy come-ons. One East Coast mother says she’s been approached multiple times by everyone from the woman who does her brows to childhood acquaintances she hasn’t seen for decades. Last year, an old high-school friend asked her to lunch — for reasons that soon became all too clear: “It wasn’t long into the conversation before I realized that this was a thinly veiled attempt to make me join her team,” she says. “She’s not trying to be friends with me; she’s trying to build her empire.”

5. “Multilevel-Marketing Companies Like LuLaRoe Are Forcing People Into Debt and Psychological Crisis” (Alden Wicker, Quartz, August 2017)

Wicker’s deep dive into the business practices of retailer LuLaRoe finds women grappling with everything from disappointment to financial disaster. On its website, LuLaRoe hypes not a company, but a movement—one that offers retailers a happy ending complete with balance, flexibility, and personal fulfillment. However, Wicker finds that the ending can happen quite differently for most consultants.

When consultants wake up to the fact they’ve been hoodwinked, many don’t warn their friends to stay away. That’s because if you speak out against any of LuLaRoe’s rules or mishaps, the community could publicly shame and harass you for being negative. “I can’t believe you call yourself a Christian,” one retailer wrote to someone trying to sound the alarm. “Where is the Jesus in you? I have to block you due to your constant-gross-delusional-uneducated opinions of LLR.” If you reveal you are struggling to make sales, you might be told to stop playing the victim, that you’re not putting in enough effort, to be more enthusiastic, and, of course, to buy more inventory.

“Success as a retailer results only from successful sales efforts, which require hard work, dedication, diligence, leadership, and perseverance,” says a LuLaRoe spokesperson. “Success will depend upon how effectively these qualities are exercised. As with any business, results will vary. In addition to the factors above, retailer success is influenced by the individual capacity, business experience, expertise, and motivation of the retailer.”

In other words, it’s not the system that’s broken — you’re just not trying hard enough.

Inside the Murky World of Essential Oils

Photo: Getty Images

Rub a little lavender oil on your pulse points for sounder sleep, one magazine suggests, while another recommends using a frankincense-oil blend in your skincare routine. In The New Yorker, Rachel Monroe dives deep into the world of essential oils, examining how the product has risen to prominence in an age where wellness and holistic healthy-living practices have been embraced by consumers.

In the U.S., the majority of this oil is sold by two companies, Young Living and doTerra, which follow a multilevel-marketing model with independent distributors, many of whom are stay-at-home mothers looking for social connections and a way to earn an income. Both Young Living and doTerra have had problems with preventing their independent distributors from making unfounded claims when selling their oils:

The Food and Drug Administration is charged with preventing sellers of alternative-health products from making unfounded medical claims. Without ample independent testing, companies can’t assert that their products prevent, diagnose, treat, or cure disease. They get around this by relying on abstract words like “vitality” and “balance,” and by talking in vague terms about general body systems or mild issues that don’t rise to the level of disease. Young Living and doTerra have attorneys on staff to insure that product descriptions are within legal bounds.

It’s much harder to police the millions of independent distributors. In September, 2014, the F.D.A. sent a sternly worded letter to doTerra, scolding the company for distributors’ claims about oils and conditions including cancer, brain injury, autism, Alzheimer’s disease, and A.D.H.D. The agency cited a tweet by a doTerra consultant using the handle Mrs. Skinny Medic that listed “oils that could help prevent your contracting the Ebola virus,” and a Pinterest post by Wellness Empress that recommended peppermint oil for asthma, autism, bacterial infections, and brain injury. (Young Living received a similar letter.)

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