An Ethnographic Study of the American Fat-Admiring Community

AN ETHNOGRAPHIC STUDY OF THE AMERICAN FAT-ADMIRING COMMUNITY

By ASHLEY N. VALDES

UNIVERSITY OF FLORIDA

2010 TABLE OF CONTENTS

ABSTRACT……………………………………………………………….……………..……….3

INTRODUCTION………………………………………………………………………………...4

LITERATURE REVIEW…………………………………………………………………………6

METHODOLOGY……………………………...……………………………………………….13

FINDINGS……………………………………………………………………………………….15

CONCLUSIONS………………………………..……………………………………………….20

BIBLIOGRAPHY………………………………………………………………………………..21

APPENDIX A – INFORMED CONSENT FORM……………………………………..……….24

ABSTRACT

This paper is an ethnography of the American fat-admiring community. Fat admirers (FAs) are individuals who prefer overweight and/or obese sexual partners. Big Beautiful Women (BBWs) are the object of FA’s affection; they range in size from overweight to obese. This study explores two main ideas: terminology and classification within the group, and the group’s interactions with the medical community. Based on 13 semi-structured interviews, 7 key terms used in the community were identified and described. Anecdotal evidence of mistreatment of FA/BBWs on the part of the medical community was also collected.

This study was conducted using semi-structured interviews with 13 interviewees (11 interviewed separately, and 2 interviewed as a couple), who were present at a convention for Fat

Admirers and Big Beautiful Women. Although there are homosexuals in the FA community, as well as reverse-role couples (Female Fat Admirers and Big Handsome Men), all the interviewees were heterosexual and belonged to the FA/BBW pairing.

This exploratory study revealed key terms and the impact of labels in the FA/BBW community. Also mentioned were concerns about size discrimination, the Fat Acceptance

Movement, and the mistaken labeling of fat-admiring as a fetish or paraphilia. Interviews also provided the basis for further work in dealings with the medical community. Many interviewees mentioned the Health at Every Size Movement, and derided the notion that obesity alone, in the absence of nutrition and exercise factors, is solely responsible for many diseases and medical conditions. Further exploratory work should be conducted to understand interactions of

FA/BBWs with the medical community in order to bridge the communication breakdowns that interviewees often mention when conversations with doctors turn to weight.

INTRODUCTION

In the past half-century, we have seen a shift in American culture towards “thin” as the ideal body type. Multiple studies (Brumberg 1985; Killian 1994; Gremillion 2002) exist that examine the relationship between American cultural ideals of beauty and the psychosomatic response from the female public in the form of eating disorders. The focus on “thin” has both a cultural and medical component. “Thinness” has been reified medically; there are adverse health consequences to obesity with concomitant increased costs to health care delivery. The government has issued measurements of Body Mass Index (BMI) to calculate approximately healthy weights for people of different heights, ranging on a scale from below 18.5

(underweight) to 30 or higher (obese). According to this scale, 31% of the American population was categorized as obese as of 2000. The Center for Disease Control and Prevention (CDC) estimates that $78.5 billion was spent on healthcare for obese adults, half of this expense being covered by Medicare and Medicaid. Obesity is also tied in causality to cardiovascular disease, diabetes, and other illnesses (Centers for Disease Control 2009).

If all the compiled research points to obesity as a detriment to good health, why is the percentage of obese Americans so high? There are social, economic, and biological factors to consider. For impoverished families, fast food restaurants offer cheap, calorie-dense food with little nutritional value (Hill & Peters 1998). There is also the tendency of neighborhood racial composition to play a role in prevalence of obesity (Boardman et. al 2005). Individuals may also inherit genes that cause them to become or remain overweight (O’Rahilly & Farooqi 2006). But, we have failed to consider the segment of the population that wants to be fat: an American subculture known as Fat Admirers (FAs). FAs are a group that embraces obesity as both a sexual preference and a way of life. They are largely unstudied; no formal research on their subculture

is available. The only research related to the topic are studies of fat preference in nations where this is the norm. The country of Mauritania is one such example, where nubile girls are forced to gain weight to be marriageable (LaFraniere 2007). The particular interest of American FAs is their presence in a culture that views being overweight in a decidedly negative light.

The main goal of this research is to gain a basic understanding of FA/BBW culture. Using language as a barometer of cultural understanding, this work identifies key terms used in the community. Given the medical attention on obesity and the potential clashes that the medical community may have with the FA/BBW community, another stated goal of this research is to gather qualitative data involving FA/BBW’s experiences with medical practitioners regarding weight. Interviews within the community will also inform questions for further study.

This project is significant because while we know of economic, social, and biological reasons for obesity, we do not fully understand cultural reasons for obesity in America. This ethnography is a necessary step in beginning to identify this unstudied phenomenon. To gain perspective on interrelated problems, such as the prevalence of obesity in America and discrimination against obese individuals, we must first better understand the perspective of those individuals who value their excess weight as an intrinsic part of their sexual life. Also, this study can impact treatment plans for obesity. In appreciating the cultural value of obesity for members of this group, we can offer them better health care intervention and delivery regarding obesity. After identifying patients as FAs, doctors can pursue other areas of overall fitness for these patients that do not necessarily include weight loss.

This paper examines relevant literature regarding risk factors for obesity, followed by a description of the research methodology. Findings are presented in two categories: definitions of terms, and quotes and anecdotes from interviewees that describe issues that arise in the

community. Conclusions will include overall impressions of the community and future research based on these findings.

LITERATURE REVIEW

There is little to no formal, methodological evaluation of the fat-admiring community in the

Western world; hence, the exploratory nature of this research. The literature review for this research draws instead on three main ideas: the social and economic costs of obesity, the risk factors for obesity, and the Health at Every Size movement. Understanding the socioeconomic costs of obesity is a necessary precursor to relating to the types and sources of discrimination that those in the fat-admiring community are subject to. Risk factors for obesity give us a rough profile of the types of individuals that may be part of the fat-admiring community. The Health at

Every Size Movement (HAES) is an important concept in the fat-admiring community because it states that individuals can be healthy despite being obese, therefore dismissing the healthcare costs of obesity; which, in turn, is intended to diminish (often unsuccessfully) the social costs of obesity by dispelling the stereotype that obese individuals are a burden or drain on society.

Obesity is defined as having a Body Mass Index (BMI) of greater than or equal to 30. Often lumped in under the catch-all term of obesity are categories of “overweight” and “extreme” (or morbid) obesity. Overweight describes an individual with a BMI of 25 to 29.9, and extreme obesity is characterized by a BMI of 40 or greater. BMI is calculated as (weight in kilograms)/[(height in meters)2]. Different names for these categories are used by the World

Health Organization (WHO), which subdivides obesity into Class I and Class II based on BMI, and labels extreme obesity as Class III.

The 2005-2006 National Health and Nutrition Survey, administered by the Center for Disease

Control (CDC), showed that for Americans age 20 to 74, overweight rates had held steady at 6

near 35% of the population, but obesity and extreme obesity rose by 11.4 and 3 percentage points, respectively, since 1988. Another study estimates that approximately 130 million

American adults, or 64% of the population of adults in the US, are overweight. (Morrill and

Chinn 2004)

Being overweight or obese is more than a cosmetic issue in the US; it is associated with a plethora of physical health risks. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), cardiovascular disease, type II diabetes, high blood pressure, stroke, gout, sleep apnea, gallbladder disease, osteoarthritis, and many types of cancer are all associated with obesity.

Beyond the associations with physical ills, there are also detrimental psychological effects to contend with for those individuals living in societies where excess body fat is seen as unattractive, gluttonous, and/or lazy. In Richardson’s study of children’s reactions to handicap, a group of elementary school children were asked to rank pictures of children in order of who they liked best. The child with no physical handicap was always preferred, and the other drawings, which included a child with a facial disfigurement, an amputee child, and a child in a wheelchair, always had the obese child ranking last or next to last. (Dejong 1980) Dealing with the social stigma towards obesity can put obese people at risk for depression.

Not surprisingly, the laundry list of physical and psychological health risks associated with obesity correlates with a heavy financial burden on the medical system. This financial burden is composed of direct costs, such as treatment services or preventative medicine, and indirect costs, such as morbidity and mortality. According to a study from the CDC, medical expenses related to obesity “accounted for 9.1 percent of total U.S. medical expenditures in 1998 and may have

reached as high as $78.5 billion. Approximately half of these costs were paid by Medicaid and

Medicare.” (2009)

Predisposition of individuals towards being overweight or obese may rest with biological factors. The two main biological factors that affect obesity are genetics and illness. A popular theory about obesity’s root in biology is the Thrifty Gene hypothesis (Neel 1962). Often used to explain the predisposition of modern Native Americans to obesity, the theory was originally formulated to explain the cause of diabetes, a common yet negative medical condition. The theory states that in human populations, nature has selected for a gene that allows individuals to efficiently store fat in preparation for times of famine. The thrifty gene would be advantageous to hunter-gatherer societies, who suffered food insecurity. The main issue with this argument is that modern hunter-gatherer populations do not readily store fat on their bodies between famines. As for Native Americans, while suffering disproportionately high percentages of obese adults and adult-onset diabetes compared to other ethnic groups in the US, the overabundance of carbohydrates in the Native American diet and evolution of sedentary lifestyle may play an equal or greater role than the supposed thrifty genotype. (Szathmáry 1994) Additional research draws comparisons between the Thrifty Gene hypothesis and the theories about salt sensitive hypertension in African American communities, citing the alternate explanation that stressors of poverty in minority populations is more likely than genetics to be the root cause of elevated levels of obesity in these communities. (Stinson 1992)

Genetic illnesses, such as Prader-Labhart-Willi syndrome (PLWS), can cause obesity as well.

One of the symptoms of the disease is uncontrollable appetite. A study by Meaney and Butler

(1989) using skinfold thicknesses as a measure of fat found that, on average, males with PLWS have three times the body fat of their normal males peers, and females with PLWS have double

the body fat of other women. Other conditions such as hypothyroidism, or the cessation or suppression of function in the thyroid, can upset the metabolic rate of the body and lead to weight gain. Children suffering congenital hypothyroidism have a high risk of becoming obese adults because of the body’s inability to regulate its metabolic rate. (Wong, Ng, and Didi 2004)

Social and economic factors play a crucial role is determining an individual’s risk for being obese. Ironically, food insecurity is a leading cause of obesity in impoverished, urban areas of the US. Families living in poverty do not have access to fresh, nutritious food, either because their food budget precludes them from purchasing said food, or because they do not have readily available access to a store carrying fresh food. (Rundle et. al, 2009) In the former case, the cost of bringing food from rural farm areas to urban centers is added to the overall price of the product, putting the cost out of many families’ price range. In the latter case, the food that individuals have access to is either “fast food” or prepackaged food; both are more “energy- dense” than fruits and vegetables in the sense that they are heavily laden with sodium, fat, and excess calories, but they also contain fewer nutrients compared to less energy-dense foods.

(Cawley 2006)

Social environment, such as incidence of obesity in the immediate family and sedentary lifestyle, are important risk factors for obesity. Beyond genetics, children are particularly influenced by the health habits of their same-sex parent; risk for obesity is tenfold greater for a daughter whose mother is obese, and sixfold greater for a son whose father is obese. (Perez-

Pastor et. al 2009) Given that obese parents are often eating the same meals and keeping the same exercise habits as their children, this figure should not come as a surprise. Parents who control their child’s eating can also negatively affect their child’s health. As parental control over child intake becomes greater, the child loses the ability to regulate his or her own energy intake

and recognize satiety, thus putting him or her at risk for obesity as an adult. Dual-income households’ role in family risks of obesity may come as a surprise. Contrary to the evidence that greater socioeconomic status is associated with a lower risk of obesity, dual-income households tend to be at greater risk. While they possess greater income as compared to a single-parent household, they are just as likely as a single-parent household to serve prepared foods at meals.

(Gable and Lutz 2000)

Cultural factors play a large role in obesity risk for a population. In some cultures, women are put through fattening rituals in order to be considered attractive and eligible for marriage. The

Efik of Southern Nigeria are one such group. When a girl is of marriageable age, she is put in a

“house of seclusion”, where she can only be visited by close female relatives. Her goal is to eat as much as possible during this time and to gain weight. She is also counseled by older female relatives about the responsibilities of marriage and advised on how to manage her future household and raise children. The seclusion can last from two weeks up to seven years; the longer a girl stays in seclusion, the wealthier her family must be to allow her to do so. Her length of time spent in seclusion reflects the status of the family and, if she is not already betrothed, may affect her desirability as a bride; the longer she remains in seclusion, the fatter and more desirable she becomes. In the event of a girl’s betrothal prior to seclusion, the cost of feeding and caring for her is usual shouldered by her future husband, and thus reflects on his status as opposed to that of her family. The ritual of seclusion generally concludes with female circumcision, signifying the girl’s entrance into womanhood. (Simmons 1960) The bride fattening ritual of the Efik places a great deal of importance on the condition of obesity; it signals a girl’s passage into womanhood, her status and the status of her family, and determines her attractiveness within the cultural group. It is also an important example of fat admiring in other

cultures. While the standard of beauty in the Western world remains “thin”, here we have clear evidence for the pursuit of a completely opposite standard.

Given the assortment of factors at work in determining obesity risk, it is crucial to keep in mind that any of a number of these factors could be at work independently of one another in a single instance of obesity. Obesity’s causes are complex, and exist at both the micro (biological) and macro (social, cultural, economic) levels. The medical community tends to package their advice in a simple “calories in, calories out” formula, and stress a combination of diet and exercise as the cure for obesity. But with a multi-billion dollar weight-loss industry flourishing in the United States, is losing weight is as clear-cut as doctors believe?

The short answer is that there may not be a “solution”, per se. The Health at Every Size

(HAES) movement, based on a book by physiologist Linda Bacon, has increased in popularity in the Fat Acceptance community. The HAES movement states that, instead of weight loss being the only method of becoming healthier for an obese person, that learning to eat according to the body’s natural cues and getting regular, enjoyable exercise can confer extraordinary health benefits. Weight loss is not the goal of HAES; rather, being active, eating sensibly, and accepting one’s own body are the main components.

The government took notice of the HAES movement and, in 2004, conducted an experiment through the US Agricultural Resource Service (ARS). The study, spanning two years, divided seventy-eight obese women into two teams. One team met for regular meetings that emphasized diet and exercise strategies and weight-centered measures of health, and the other team attended

HAES educational sessions. After two years, the control group had initially lost weight, but then regained the weight and could not maintain the health benefits they had enjoyed during their weight loss period. The HAES group, on the other hand, lowered their systolic blood pressure

and cholesterol levels and maintained these levels for the full two years, although they did not lose or gain weight. They also reported being happier with their lifestyle plan, compared to the control group. (ARS 2006)

The benefit of the HAES mentality in obesity treatment is clear. Why, then, is there such reluctance to accept that obese people can be healthy? Excess adipose tissue is not, in and of itself, a disease. Headlines of newspapers and magazines decry the “Obesity Epidemic”, but is it warranted to label obesity an “epidemic”? A small but growing number of academics oppose the use of the term to describe the national or global incidence of obesity. Because fifty to eighty percent of the variation in fatness in a population is genetic, and because there are currently no safe, long-term diet and exercise plans that result in a sustained loss of five percent or more of body weight, doctors may be giving their patients prescriptions that are impossible to follow when they demand dramatic weight loss in the name of health. There is even evidence that a small amount of excess weight may be healthier than being a “normal” weight under the BMI standards. (Gibbs 2005) In her article “Pathologizing Fatness”, Samantha Murray argues that the use of the word “epidemic” subsumes obesity and makes it into a pathology in need of treatment, all while dealing a blow to obese individuals by implying that their state of being is not only a health crisis, it is an aesthetic and moral affront to mainstream American culture. Facing such pressures, it is easy to understand the frustration that obese individuals feel at their inability to lose weight. They are confronting the state of their own bodies as diseased and immoral, according to Murray.

Given the myriad potential reasons for obesity, the growing body of evidence that is contrary to the traditional idea that obesity was always accompanied by poor health, and the popularity of the HAES movement within the Fat Acceptance movement, this work expects to find many

instances of conflict between FA/BBWs and medical practitioners. Another situation to be expected in interviews will be instances of discrimination towards FA/BBW and pressure from multiple sources on the overweight or obese individual to lose weight.

METHODOLOGY

This study was conducted using semi-structured interviews with 13 interviewees (11 interviewed separately, and 2 interviewed as a couple), who were present at a convention for Fat

Admirers and Big Beautiful Women (FA/BBW) and recruited via snowball sampling. Semi- structured interviewing was deemed the best choice for an exploratory study of this nature because it allowed participants to steer the conversation beyond the standard set of basic questions towards topics that were culturally salient or significant.

The interviews consisted of questions that included, but were not limited to: “How did you become involved in the FA/BBW community?”, “Have you ever been involved in the Fat

Acceptance Movement?”, “What are some names that you use to define/categorize people in the group?”, “Do you call people different things based on size, weight, or shape?”, “Have you ever had problems dealing with the medical community because of your weight?”.

Interviews were conducted in various public (though not crowded or noisy) areas of the convention hotel. Interviewees were only interviewed in convention-exclusive areas (i.e. no non- convention-attendees would have been present in these areas) for the comfort of the interviewee.

Interviews lasted from half an hour to an hour in length. Interviews were transcribed from digital recordings by the researcher.

Although there are homosexuals in the FA community, as well as reverse-role couples (Female

Fat Admirers and Big Handsome Men), all the interviewees were heterosexual and belonged to the FA/BBW pairing. While this study sample may not reflect the FA/BBW community at large,

it is an accurate reflection of the population in attendance at the convention; the researcher encountered no homosexuals at the convention, and only one Female Fat Admirer.

To understand the norms and rules of the culture, place findings in the larger context of the community, and supplement interview data with electronic ethnography, the study included time spent on an FA/BBW community internet message board. However, information gathered from the content of conversations or posts was not included as qualitative data. Use of message boards as a research tool followed the proposed guidelines for ethics in internet research (Eysenbach &

Till 2001) published in the British Medical Journal. For internet research, the group’s perceived privacy level was deemed “moderate”, as participation requires registration, but registration fields call for only an email address and screen name; the screening process for participation is almost non-existent. Community members did not need to sign informed consent documents or have issues with confidentiality or intellectual property rights because no qualitative or quantitative data was extracted directly from the message board. Again, the purpose of participation in the message board was validation or disproval of interview findings and cultural immersion for the researcher.

The researcher’s position was not disclosed while in chat rooms or on message boards, because such disclosure would negatively impact both the community and the research. The tendency for people to act differently when they are aware of a researcher present would have impacted the opportunity to learn about normal social interactions within the culture. Also, the presence of a researcher may have caused members interpreting the observation as voyeuristic to leave the message boards. All observations conducted using message boards were done so anonymously.

FINDINGS

Due to the exploratory nature of this ethnography, findings spanned two main categories: terminology and anecdotal evidence. Terminology includes weight range and non-weight terms, and anecdotal evidence delves into issues of prejudice, health, and strained interactions with the medical community.

Terminology

Defining group terminology was a major goal of this study; the language that a group uses to describe itself and others underpins the beliefs of that group.

The FA/BBW group has a unique set of terms used to describe community members. These terms have been divided into two categories: “weight range terminology” and “other terminology”. Weight range terminology (all given for a woman of average height, approximately 5’5”) is as follows:

Plumper – BMI of 26.5 to 30 (about 160 to 180 lbs). This term is also used to refer to young

BBWs, regardless of weight. The term “Chubette” is within this same weight range, but used exclusively to describe teenage plumpers.

BBW – BMI of 30 to 50 (about 180 to 300 lbs). An acronym for “Big Beautiful Woman”.

Many interviewees noted that BBW overlaps with other categories. Because the group stresses self-labeling over being labeled by others as a key component of self-acceptance, many will accept women heavier or lighter than this range calling themselves “BBWs”.

SSBBW – BMI of 50 and upwards (about 300 lbs and upwards). “Super Sized Big Beautiful

Woman” is the term used for those who join “The Three-Hundred Club”, those who weigh

300lbs or more. Although other weight categories were flexible, many respondents stressed that

SSBBW was reserved for women 300 lbs and above only; to label oneself an SSBBW at less than 300 lbs is viewed as insulting to true SSBBW. Women and men alike described this group as being the most sexually attractive to “hard core” FAs.

There is also an assortment of words that do not belong to the category of “weight terminology” that play an important role in identifying people and relationships in the community. These terms are described as follows:

Fat Admirer – a man who is sexually attracted to fat women, abbreviated FA. The female version of a fat admirer is abbreviated FFA (Female Fat Admirer). At a panel taking place at the convention where six fat admirers took questions from women asking about their sexual preferences and how they came to understand their attraction to fat women, all agreed that they had some issues with the term “fat admirer” not being a perfect description. One panelist in a later interview confirmed that the reason the term is used is because “it flows”, but that a more accurate term would be fat “desirer”, emphasizing the sexual nature of the attraction.

Chubby Chaser – a homosexual man who pursues overweight or obese men. Many heterosexual respondents were amused when people outside the community used this term to refer to them. All agreed it was a term used only in the gay community.

Stuffers – individuals who overeat for pleasure. The pleasure is usually sexual, and the goal is often weight gain. The stuffer is distinct from the feedee in that the stuffer acts alone.

Feedee/Feeder – a relationship in which one partner feeds the other for sexual pleasure. It is often compared to a submission/domination relationship, although there are disagreements as to which role the feedee occupies. It is taboo to mention in the community, due in large part to stories of feeders fattening women to immobility and then leaving them. To avoid this taboo, or to de-emphasize the submission/domination aspect, couples who engage in this practice may also

call themselves “Gainers” and “Encourager” (although these terms are used predominantly in the gay community). The feedee/feeder couple interviewed together noted that they were discrete in mentioning their activities to others, although they wanted people to understand that such a relationship could indeed be mutually beneficial and loving, as opposed to exploitative.

Quotes and Anecdotes

Due to the open-ended nature of the interviews, participants were free to broach culturally salient topics. The subjects that arose most frequently are presented here.

Participants shared stories of the importance of the community in their lives beyond the obvious social and sexual role it plays. The most striking came from a woman who described saving her money for a year to attend the FA/BBW convention. She described the meeting as an opportunity to “recharge my batteries” by being around other fat-positive men and women. Such recharging was crucial for her to remain positive about her body and herself.

Anecdotes about issues with discrimination based on weight arose in nearly all interviews.

Instances ranged from being mocked by strangers on the street to being ignored in restaurants or stores when they needed service. One interviewee shared an incident that had happened the night before the interview:

You get a lot of looks, stares, double takes. I don’t think they’re picking on me, but I’m not stupid. We were at a buffet, and we had to go through this really skinny area to get to it, and this girl… I walked by, and she looked at her friend and puffed her cheeks out. It was because of me… I can’t believe she did that.

Another mentioned that traveling to the convention exposed her to discrimination based on her weight: “Flying is a nightmare when you’re fat. You see the looks as you’re walking down the aisle; people are holding their breath and thinking, ‘Oh, I hope that fat woman doesn’t sit next to

me.’ Fat is the last acceptable prejudice,” she added. “You could never… make fun of someone because of their color, but it’d okay to make fun of them because they’re fat.”

There were also similar instances of family members judging FA/BBW community members on the basis of their weight or sexual preference. An interviewee described bringing his college girlfriend home to meet his parents for the first time. Not thinking that her weight was an issue, he neglected to tell his parents that she was over four hundred pounds. His father informed him that if he intended to marry the girl, that he should “wait until I die first.” Another interviewee shared this family story:

I remember one time, at a family function, they invited some neighbors down the street. One of the neighbors was really big; 500 lbs or more. Everybody was snickering afterward… they were like, ‘How do you have sex with someone that big?’ They couldn’t even imagine that fat people would be having sex.

The medical community was also brought up frequently in interviews when discrimination was mentioned. An interviewee lamented how difficult it was to find a doctor who would see her without blaming all her health problems on her weight. For most doctors she had met with, she described their mindset as follows: “You have a cold? It’s because you’re fat. Everything is fat- related. They don’t look past that.” Another interviewee related her frustration at her doctor brushing aside her concerns about having shortness of breath and blaming it on her weight:

The doctor told me I just needed to lose weight… and I needed to have physical activity. And I said, “But I’m in a gym, I go mountain climbing. I’m not lazy!” And he didn’t believe me, because I can’t possibly be in good shape if I’m at that weight.

A third mentioned a recent story that had been of interest on the community message boards:

There was a lady who was at… a world renowned clinic, and they were like, “Our MRI machine is not compatible for you,” but they actually told her that at the zoo, they could do it. Because hippos… can get onto those MRI machines. Tell someone to go to the zoo? That’s terrible.

Interviewees mentioned weight loss surgery frequently in the context of doctors and other medical practitioners suggesting the surgery as a “cure” for their weight, or that weight loss would be the cure for any and all of their health problems. One interviewee cited tragedy in her own family as in fueling her fear of the surgery: “I had three people who had weight loss surgery, and all three of them are dead. I was told to lose weight or I’d die, and then these people died trying. I felt trapped.” Another interviewee shared his frustration with his doctor telling him that his diabetes was directly related to his weight, and that weight loss surgery was the best solution:

My first appointment with the endocrinologist, she was prescribing lots of medications to get my blood sugar down quickly, which I appreciated. But then she went straight to my weight and recommended that I get weight loss surgery, which I wasn’t interested in. I wasn’t particularly interested in weight loss, period, because that’s a whole other cycle of dieting and regaining and all that… she would tell me that obesity causes diabetes, and I asked her why, and anybody I asked why, what’s the connection… There’s no idea, no clear answer. She looked at me and said, ‘Well, fat is like a bumpy road, and the blood traveling over it has a harder time…’ And I stared at her, and she kind of petered off.

Others mentioned the tenets of the Health at Every Size Movement as being crucial to their well-being. Four participants described conscious efforts to fit physical activity into their daily routines; three of them also mentioned their doctors’ disbelief that they had normal levels for blood pressure and cholesterol. Interview information related to HAES focused mostly on nutritious food and moderate exercise:

I stuck with organic vegetables, taking vitamins to protect my cardiovascular system. I try to do moderate exercise, things that are sensible for a person of my size. Certainly, I want to keep in good condition. Sensible daily activity, make sure that I’m rewarding my body with good, [nutritionally dense] foods. And trying to enjoy life as much as I can.

The research I’ve done on my own, trying to figure out what I can do to keep myself healthy, has paid off so far. I don’t want to go back to that cycle of damaging myself and damaging my body [with dieting].

Conclusions

Obese people within the community come from multiple backgrounds; many have been dealing negatively with their weight for years before accepting their bodies, and others fulfilled fantasies of weight gain that have culminated in obesity. Identification terminology is fluid; community members avoid making judgments and categorizations of others, because they are subjected to the same treatment in their everyday lives. This same self-categorization also helps with another important part of being a BBW, according to informants: self-acceptance. By knowing how much you weigh and what category you belong in, you are aware of yourself and your body, and have seized the opportunity to call yourself by the weight range term you most identify with, as opposed to being saddled with a category by others. A similar reclamation is occurring with the word “fat”, which was frequently used in interviews as part of the importance of reclaiming the word for the fat community to use as a positive descriptor.

Interviews in the community have shown that there is considerable friction with the medical community regarding health. Many reported being told by doctors that gastric bypass surgery was the only “cure” for their obesity; sensible nutrition and exercise were not even presented as options to these individuals, many of whom would be categorized under extreme obesity. Others found themselves frustrated when they tried to explain to their doctors that size was part of their sexuality and lifestyle choice, and that losing weight would adversely affect their happiness and quality of life. Other common themes were doctors not trusting the patient, doctors refusing to listen to the patient’s preferences, and prescriptions to lose weight without offering some sort of effective strategy for doing so. Further exploratory work should be conducted to understand interactions of FA/BBWs with the medical community in order to bridge the communication breakdowns that interviewees often mention when conversations with doctors turns to weight.

Despite sour interactions with their doctors, a number of people within the community are proponents of the Health at Every Size Movement. Many gave testimony about feeling better and more energetic after becoming aware of the nutritional value of the foods they consume, as well as integrating regular, moderate exercise into their daily routines. The effectiveness of HAES and other, similar programs in the community is promising because it has the potential to change the way that we approach the treatment of obesity. Shifting the focus from losing weight to living healthy, as the HAES movement suggests, may be the key to doctors being able to fight the war on obesity without making war on the obese.

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Appendix A - Informed Consent Form - IRB # #2009-U-515

An Ethnographic Study of American Fat Admirers

Please read this consent document carefully before you decide to participate in this study. Purpose of the research study: The purpose of this study is to better understand the Fat Admirer (FA) community, and some of the cultural reasons for obesity. I am collecting interview data to be able to create a cultural model of the FA community. What you will be asked to do in the study: You will be asked to participate in an interview about the general FA culture. The interview will be recorded using audio tape. The tapes will be used for transcription of interviews, and will remain in my possession. The tapes will not be released to the public at any time. Time required: The interview will last one to two hours. Risks and Benefits: There is minimal risk to you for participating in this study. One of the benefits of participating in this study is to the community as a whole. My intention is that data from this study be used to help the medical community understand how to best serve FA patients. Rather than emphasizing weight loss, doctors need to emphasize overall health (i.e. nutrition, exercise) for their patients. Compensation: There will be no monetary compensation. Confidentiality: Your identity will be kept confidential to the extent provided by law. Your information will be assigned a code number. The list connecting your name to this number will be kept in a locked file in my house. Your name will not be used in any report or publication. Voluntary participation: Your participation in this study is completely voluntary. There is no penalty for not participating. Right to withdraw from the study: You have the right to withdraw from the study at anytime without consequence.

Whom to contact if you have questions about the study: Ashley Valdes Peter Collings, Ph.D Undergraduate Student Assistant Professor Department of Anthropology Department of Anthropology 2800 SW 35th PL, APT 605D PO Box 117305 Gainesville, FL 32608 Gainesville, FL 32611 Telephone: 305-505-9060 Telephone: 392-2253 x239 Email: [email protected] Email: [email protected]

Whom to contact about your rights as a research participant in the study: UFIRB Office, Box 112250, University of Florida, Gainesville, FL 32611-2250; ph 392-0433. Agreement: I have read the procedure described above. I voluntarily agree to participate in the procedure and I have received a copy of this description.

Participant: ______Date: ______

Principal Investigator______Date:______