NAAFA Newsletter

Fall 2001

IN THIS ISSUE

Leslie DiMaggio Dies in Office

Untimely death of beloved chairperson leaves a void in our lives

Leslie came to NAAFA's Board of Directors in 1996. She served as Treasurer for a couple years before becoming the Chair. She kept NAAFA on a good financial track through a couple years when the convention revenues were lower than expected. She had gained expertise that was invaluable to NAAFA from her many years as a community volunteer, heading the Monterey County Court Referral Program for which she was named Volunteer of the Year; graduating from the Leadership Salinas Valley program; and being a successful small business owner.

In fact, many people first encountered Leslie when she owned the Grande Lady Boutique in Monterey CA and displayed her wares at several convention Trunk Sales. It was always a great experience to go shopping Leslie; she often found you the perfect outfit and became your greatest cheer leader along the way.

With her infectious laugh and her abiding sense of justice and fair play, it is hard to imagine that Leslie was not always comfortable in the role of a fat activist. But you could always count on Leslie to show up and do the right thing.

At the Memorial Day weekend, there was a celebration of her life at which people shared wonderful stories about Leslie. One of the vendors spoke about how supportive Leslie was when the vendor wanted to start a business offering beautiful batik outfits. Another person recalled Leslie as being the consummate Mom; the nice one you wished you had. A great story was told about how angry Leslie was at the organizer of a trade show for buyers from Big and Tall women's shops. He had booked a comedian who was notorious for peppering his routine with fat jokes. When Leslie protested, asking the organizer if he had a clue who the audience was, the organizer brushed her off. Not willing to let things go at that, Leslie organized BAT Women buyers to heckle the comedian off stage.

But I will always remember Leslie for showing up in support of the family of Anamarie Regino Martinez in Albuquerque, New Mexico. This was the little girl who the State of New Mexico took away from her parents because she weighed three times what the average toddler weighed and was 50% taller than average. The State felt the family was abusing Anamarie by force-feeding her. They had no comment about the child's height.

Leslie and I flew to New Mexico over the Labor Day weekend last September. Flying was not something Leslie enjoyed. (Indeed, she came close to being challenged to buy a second seat on Southwest Airlines.) When we got to Albuquerque, Leslie spoke so eloquently to the press gathered in the hallway outside the courtroom. A mother like Leslie is believable when she said, "It is impossible to force-feed a child that age. You either wear the food or clean it up off the floor."

The judge continued the case to later in the week in the hope that people who had come from out of state to testify would go home. Leslie stayed and bonded with the family in ways that few who were not parents could do. The family had never known that an organization like NAAFA existed to fight for the rights of fat people. Leslie became particularly close to Anamarie's grandmother, Margaret. And Leslie was overjoyed to be one of the first to report the good news from Margaret that the State had decided to return Anamarie to her family when it was learned that she did not lose weight on a 500 calorie liquid diet administered by foster parents. It was particularly meaningful to many of us to read on NAAFA's web site the posting from Margaret when she learned of Leslie's death.

Leslie and I were actually close in age. But I never met anyone like her. I could truly say to her, "I want to be like you when I grow up."

2001 NAAFA Convention: Thanks for the Memories!

San Francisco Human Rights Commission Approves Height/Weight Anti-Discrimination Law

These guidelines should serve as a model for other cities, states, and countries to follow in drafting similar legislation. A draft of the final wording can be found in the Compliance Guidelines To Prohibit Weight and Height Discrimination San Francisco Administrative Code Chapters 12A, 12B and 12C and San Francisco Municipal/Police Code Article 33. A copy of the draft is posted on the NAAFA website at http://www.naafa.org/fatf/sf_height_weight.html

A Call to Action

You can send this letter to the federal government

For all of us concerned about federal research policies related to obesity, the example in the press today may be the best, albeit most outrageous example yet, of the damage that is being done by the NIH War on Obesity. Particularly in light of the recent case of 3-year old Anamarie Martinez-Regino being removed from her home because her parents could not control her weight, the fact that the NIH has been subjecting healthy children to high-risk research to improve their "ailment" of having obese parents is chilling indeed.

According to an article 11-05-00 in the San Francisco Chronicle, the NIH just halted as unsafe a study being conducted on children by Jack Yanovski at the NIH's Institute of Child Health and Human Development. Yanovski's 15-year study of healthy children 6-10 years old was looking at the metabolic underpinnings of obesity. Children were regularly subjected to a barrage of tests, including x-rays, psychological testing, blood draws, and abdominal MRIs. One test involved having the children hospitalized overnight with several intravenous blood lines and required them to experience extremely high and extremely low blood sugar levels for hours at a time. The study was finally halted because it posed risks of "more than minimal pain, allergic reactions or, most problematic, dangerous blood clots of phlebitis." The article goes on to say that federal studies in healthy children are allowed only when there is minimal risk of harm, and then only if the research promises to help fight the child's ailment. This study considered the healthy children to have an "ailment" by virtue of their having obese parents. Yanovski defended the risks to the children as no greater than those children might encounter "while playing in traffic," according to the meeting minutes.

These were not lab rats. These were not even sick children. These were healthy children whose only crime was having fat parents. How much shame did the researchers heap on these fat parents for them to willingly subject their children to such horrors? Anamarie's parents are seen as criminals because they just couldn't stand to keep their daughter on a liquid fast diet. Their child was removed from their supposedly unsafe home and they had to fight tooth and nail to get her back weeks later! Yet the parents in Yanovski's study were no doubt convinced by the researchers that rather than abusing their children they were helping them.

It is neither the parents nor the children who are at fault here. This is the ultimate example of "blaming the victim." The fault lies squarely with researchers and a medical establishment that so abhors fat people that any treatment, no matter what the risk, is justified, rationalized, and promoted to parents and a public scared to death of being fat. Where will it end? Will they simply round up the millions of fat kids and send them to camps until they lose weight?

I would love to see a barrage of letters - Surgeon General David Satcher, the NIH Task Force, and every other federal agency and professional group promoting this obscene war against fat people - urging them to cease and desist before there are even more casualties. They must rethink their policies and their ethics - even hold public hearings on these issues. They must begin to listen to people outside the Beltway, outside the narrow circle of obesity researchers approved over and over again to do ever more high-risk research. This simply must stop.

It seems as though, on the heels of the on-going series of articles in the New York Times, that anyone who has been interviewed by the Times could go back to them with this story urging the Times to do an expose on the ongoing conflicts of ethics and sorely misguided efforts of obesity researchers, using Yanovski as the lead. In fact, anyone who has press contacts, should free to send this letter to them to follow up this story.

I kept asking myself this week - What is it about fat people that fosters such blind hatred, such disregard for our basic humanity? When is the NIH going to study the damage of weight prejudice - in the culture, in medical care, in themselves? If the feds won't do it, when is some other organization/group of organizations going express concern or mount a dialogue on ethics. With all of the conferences being devoted to the so called "obesity epidemic" none of these issues are being seriously addressed. And it is high time they are. The harm being done is immeasurable - far worse than any amount of fat on any child's body.

I hope this travesty has one positive outcome - to continue to shine a light on dubious and damaging research and public health policies. To keep speaking up is the one thing we can all do. My thanks to all of you who may pass this message on, write a letter, or speak up at a meeting. It takes all of our efforts.

If you want to write to the Surgeon General, the addresses are:

David Satcher, Surgeon General
U.S. Department of Health & Human Services
200 Independence Avenue SW
Washington DC 20201
sgwebsite@osophs.dhhs.gov

A Plan to Give to NAAFA

Almost everyone has some sort of asset that is valuable to someone else. Why do you think garage sales do so well? Why is it that a car that doesn't even run can be donated to charity? (Not to NAAFA, but to larger non-profit organizations.)

Let's say you don't think you have money to spare for NAAFA. As an individual, you can help national NAAFA if you participate in your local United Way Campaign. Did you know that you could designate non-profit agencies outside of your region, like NAAFA, to receive your United Way contribution? Most Human Resource Departments oversee corporate contributions to the local United Way. There is a form you can complete at the start of the next local drive. You need only to provide NAAFA's tax I.D. number (23-729-6874), and your United Way donation will come to NAAFA to help us with our operating expenses.

When your chapter or special interest group holds an event, think about donating 10% of your profit to national NAAFA. You would not have found those supportive people if national NAAFA did not exist. And the beauty of making contributions to NAAFA is that you can direct how your money is spent. Do you want to have an activism event at the next convention like the Million Pound March? Help us find the perfect venue. Do you want better chapter relations? Help NAAFA fund a staff position to work on just that. Do you believe that size discrimination must be stopped in the school system? Help NAAFA fund a Speaker's Bureau to send speakers into schools on Diversity Day.

Gifts of cash are the easiest to understand. Every dollar you donate to a to a 501(c)(3) charity, like NAAFA, is deductible. The maximum allowable deduction for gifts of cash is limited to 50% of your adjusted gross income. Depending on your tax bracket, a donation of $100 could only "cost" $69 because of tax savings.

But there are other ways to benefit NAAFA while reducing your tax burden. Think about giving through Life Income Plans, giving through Living Trusts, and giving through Retirement Plans. You can enjoy the satisfaction of helping NAAFA survive to provide as much meaning to others as it has for you.

Whenever you contemplate donations to support a charity and provide a tax shelter for yourself, you must seek the advice of a certified financial planner or an attorney who can make the system work for you, your heirs and your favorite charity.

No matter how you decide to allocate your money, you must have some sort of will or trust in place. Your wishes will be followed exactly and, depending on how you set up your trust, you can avoid costly probate that would dilute the value of your estate.

In my San Francisco-Bay Area NAAFA chapter, one of our members had a will that stipulated all her clothing would be donated to NAAFA when she died. It wasn't clear whether she meant our chapter or National NAAFA. National decided our chapter could hold a garage sale and we would split the profits with 70% to local and 30% to national. The woman left a serviceable, professional wardrobe that netted over $500 for national. That's almost 1/3 of the cost of printing and mailing one of our bimonthly Newsletters.

Life Income Plans cover a wide variety of gifts of cash or other property. Whatever you set aside is to be managed by yourself or someone you designate for the rest of your life or the length of time of the trust. You receive income from whatever property or funds you've set aside for donation. When you die or the trust expires, the remainder of the assets are transferred to the charitable institution you specify. To use but one example, if you own your own home or income property; you could live in the home or earn income from rentals, get a tax deduction the year you designate the gift and avoid capital gains taxes by establishing a gift annuity or a fixed-income trust. I've seen brochures explaining all of these plans at my employer because I work for a non-profit corporation. If you don't have such an employer, you really need to see a Financial Planner to set up one of these plans.

A Living Trust is similar to a will. You set up a revocable living trust into which your assets are placed, such as real estate, jewelry, automobiles, collectibles, stocks and bonds. By providing that charitable gifts be made as a part of the final distribution of the trust's assets, you can be assured your charitable wishes will be carried out in a timely and efficient manner and will avoid probate. My brother died three years ago with a will but without a Living Trust. His widow has still not received all she thought she was entitled to, based on his net worth. My mother had a Living Trust and all her assets were distributed to her heirs within three months of her death without probate. We had some taxes to pay, but the State of California and the court system did not intervene.

Many of us who work have a Pension Plan our employer provides us, or a Retirement Plan to which we contribute. Your Human Resources Department has beneficiary forms to fill out which can be changed if your needs change. I have made NAAFA a 100% beneficiary of both because I don't need to leave assets to a young family. But I still need a will to state how much should be set aside to pay my debts and bury me!

Did you also donate to an IRA to reduce your tax liabilities during your working years? If you want a person and a charity both to benefit from your IRA donations, you must set up a separate IRA account for each. Additionally, if you are approaching the years of mandatory withdrawal from your IRA in excess of your living expenses, consider donating that excess to your favorite charity. There is an offsetting charitable income tax deduction that may equal the income tax that must be paid on the mandatory distribution.

We are all people of means. If you decide you can help NAAFA financially, please tell us about it. We want to be able to thank you as you so richly deserve. Thank you!

How to Help NAAFA

Here are some of the non-financial things I came up with:

1. Attend as many Chapter events as possible. This can still be a problem for me, but here and there I will be able to attend. I also have multiple respiratory allergies that make it very difficult for me to go to people's house. That brings me to...

2. Make my home available for NAAFA Chapter meetings/events. That way I don't have to worry about animals, etc. And if it's at my house the timeframe is up to me.

3. Write E-mails and letters for NAAFA campaigns. Recently I wrote to my Congressman, Senator, and National Highway Traffic Safety Administration for the new seatbelt legislation.

4. Surf the net, and when I find fat-positive or fat-negative sites I notify our chapter and NAAFA.

5. Write E-mails and letters regarding those fat-positive or fat-negative sites.

6. Hang chapter information at work, supermarkets, and anywhere I think it will get attention.

7. Talk about NAAFA to my friends and family.

8. Send E-mails to my friends regarding NAAFA issues. All my friends and family got the seatbelt stuff.

9. Joined the NAAFA members' mailing list to keep myself updated on what other chapters are doing and any other info the rest of the world's NAAFA members have to offer.

10. And hopefully by writing this article, I have helped NAAFA by providing you with some ideas to become more involved.

Book Review: Bountiful Women

Bonnie Bernell comes at life as a fat person with a great attitude, lots of positive and helpful suggestions and just an overall feeling that life can be great as a bountiful woman. Through out the book she quotes different women and they tell how they've faced or overcome certain situations. For example, how some dealt with family or friends who were critical of their size. Or, how some women dealt with everyday type of things we face as fat women (airline seats too small or having to ask for a seat belt extender, chairs too small in offices, not feeling sexy or feeling as if because of our size we can't have romance). Not only does Bonnie tell us we CAN have full lives as bountiful women, but in telling us about the women and their experiences and how they handled it she gives us a lot of good practical advice and new ideas on how to handle those things. She does this without coming across as preaching or as if she's trying to tell us how to live our lives. It's almost as if she's having a conversation with the reader and telling us stories she's heard from other women or telling us what she's experienced herself.

The women she talks to range in age from their 20s to their 80s. One of the ladies in the book that sticks out in my mind is Ramona (I believe that was her name). She was asked to pose nude for a group of artists and she did it. Ramona talks about how she felt as a bountiful woman being looked at by these artists and then how great it felt to see the beauty they saw in her in their drawings.

At the end of each chapter there's a page with short little blurbs that list the solution to some of the problems Bonnie talked about in the previous chapter, or short encouraging comments. I really liked those. It helped to review the chapter just read, what solutions were offered and always had a positive upbeat message that our lives can be good....that our lives are what we choose to make of them.

Her book was easy reading and very enjoyable. Each time I put it down I walked away with a positive feeling and new ideas on how to deal with situations I might face. The overall message I took away from her book was that my size should not hold me back from having the life I want.

Book Review: Dispensing with the Truth

If you are a dietitian or a nutritionist, you will find the book, Dispensing with the Truth, by Alicia Mundy (St. Martin's Press), fascinating reading because it documents how the diet drug combination, Phen-fen, was approved by the FDA and then withdrawn from the market because of adverse side effects. This book confirms what I have suspected for too many years. Greed and avarice have become integral to the value system that drives decisions and actions even in the field of nutrition, which purports to be about keeping people healthy. The end result of making money justifies any means one uses to get it, including jeopardizing the health and welfare of thousands of women in this country.

If you think you can trust academic researchers, especially those from elite, well-known Universities, read this book. At it's best, it will make you very cautious about the advice you give to patients and consumers, and at its worst, it will turn you into a cynic wondering if you can believe anything you read in academic journals.

If you are looking for heroines, you will find one, albeit an unsung heroine who didn't even get her name on the research paper that published her findings. If you are looking for archenemies, they are there in droves: businessmen, government bureaucrats, academic researchers, physicians, and attorneys. But most of all, there are the victims of avarice and greed; the women who died simply because they wanted to be thinner. And the loved ones left behind in bewilderment asking the question, "How could this have happened?" Perhaps the best way to memorialize them is to read this book and make the promise, "Never again."

Memorial Day Regional Gathering

More and more people agree with the idea you can be fat and fit, judging by the growing attendance at the early morning movement classes led by Rochelle Rice, NAAFA's Vice-President. People are pleasantly surprised that Rochelle has adapted yoga exercises so they can be done while sitting in a chair. Laura Baker conducted the late-afternoon water aerobics classes. Water aerobics - what a God-send for those of us who want to move but don't like the feel of sweat!

A really moving workshop, "Help! My Friend Wants Weight-Loss Surgery," was facilitated by Dr. Deb Burgard and therapist, Bonnie Burnell. The pros and dreadful cons were presented by two sisters who have opposing views on the surgery. Other workshops dealt with holistic healing, diabetes management, fashion tips, fighting employment discrimination and how to take the NAAFA "high" home.

A NAAFA Trunk Sale is a difficult place to be if you have a hard time choosing between beautiful outfits. Whatever your pleasure - from casual to corporate career wear to lingerie to swimsuits to leather to sequins - you could find it at the Memorial Day weekend. I regret I didn't get back to jewelry table. It was also good to see the Hawaiian shirts for big, beautiful men on sale.

DJ Zulu provided the music for the two dances. He's been instrumental in the success of BBW Northern California events this past year.

The Westin has long been known in the Bay Area for providing great banquet food. This weekend was no exception. Who could forget comedienne Pat Marquez at the Mexican buffet? She performed at the convention in San Diego last summer. This time, we sent the kids out of the room so she could really rip out a rousing Las Vegas lounge act! The best meal was a toss-up between a pasta dinner and the farewell breakfast buffet.

An equal draw at that farewell breakfast was guest speaker, Pat Lyons. She presented data she gathered about how barriers to good health care escalating with size. Yes, WE know it's true; but let's make it official. Along the same lines, there was a focus group led by Judy Freespirit and Simi Litvak. They are gathering information about difficulties experienced by those of us who are super-sized in emergency room care. Their project, "Off the Charts," plans to train Emergency Medical Technicians and other health-care providers in how to deal with us. The project got a big boost when Kaiser HMO lost a court case about the inadequacies of hospital care for the physically challenged this year in Northern California.

On a sadder note, there was a memorial service to honor the memory of Leslie DiMaggio. She served as NAAFA's Chair for five years and was the first officer to die in office.

We also got to share wonderful news with Sondra Solovay, author of "Tipping the Scales of Justice." Her legal expertise was invaluable in getting the Supervisors and the Mayor to agree to amend charter of the City and County of San Francisco to add height and weight to the list of protected classes last year. She also provided legal assistance to the attorneys to keep Annamarie Regina Martinez with her family in New Mexico last September. It was that case which made her decide to become a practicing attorney. It is a grueling exam and while she attended the Memorial Day weekend, she found out she passed the California bar. We laughed and cried and cheered when we heard!

The event was a fabulous party and wonderful fund-raiser for NAAFA. Everyone got into the fund-raising spirit with the usual raffle prizes. But at this event, there were impromptu auctions of door prizes which were donated back. It felt like a PBS pledge, complete with a $100 challenge grant which was met by passing the hat for pocket change to equal the $100 donation.

Yes, I can safely say we're going to do this again; maybe even next year. Don't miss out on the fun, frivolity and fabulous times!

Progress in the Fight for Adequate Seat Belts

Seat belt activism helps educate police of unfairness and dangers

How about when a supersized housewife speaks? Do they listen then?

Apparently they do. I wrote a small one-page letter to my city's police chief to make him aware of Elizabeth Fisher's seat belt campaign, and suddenly I was not only phoned by the police chief, but the local newspaper, radio station, and NBC affiliate! "We" (the size acceptance community) were featured on the front page, no less, in living color in the Sunday edition of The Midwest City Sun! Over 100,000 readers suddenly became aware of Ms. Fisher's campaign, NAAFA, and size acceptance in general. It didn't stop there. Approximately 50,000 people listened in their cars; businesses and homes while KKNG 93.3 radio in Oklahoma City, OK interviewed "us" for the five o'clock newsbreak. An additional 135-140 thousand people became enlightened as they viewed their six o'clock evening news on KFOR TV, also in Oklahoma City.

Size acceptance was taken seriously, treated respectfully, and learned eagerly. I found all of the interviews to be friendly and allowed for my humorous personality to help us feel comfortable about "fat" talk. Although I had had media experience before, and knew most of the information about NAAFA and size acceptance, I felt a little shy about the petition. Thanks to Ms. Fisher's quick response, I was able to share "facts and figures" important to the seat belt campaign.

This media attention stems from the interest and support of "America's best police force" chief, Brandon Clabes. Chief Clabes, of the Midwest City, OK unit, asked my permission to forward the letter I had written to him to the media. While I don't necessarily WANT to be in the public eye, I figure that if I was given a big mouth to go along with my big body, I might as well use it to benefit the cause!

After all of this positive attention to our cause, I was inclined to meet Chief Clabes and thank him in person. Upon arriving at the police station, I immediately eyed a stack of National Safety Council brochures that read, "Air Bags and Seat Belts Save Lives". It urged, "Remember the most important safety step in any vehicle is for everyone to be buckled and for children to be properly restrained in a back seat - on EVERY ride." I guessed it was a good thing I had written about the lack of ability of fat people to use their seat belts since it was obviously taken so seriously.

Then the Chief greeted me with a warm hello. He was not at all what I expected. I had visions of an older pencil-pusher-type man with a beer belly and gruff attitude. Chief Clabes is a young 44-year-old, trim, and may I say, handsome, man with great personality. When asked about the officer's response to this campaign, he said that first and foremost was an overwhelming appreciation for the strength of character that it showed to step up and identify the issue and take a stance on it, for personal and professional reasons. "In our light, we feel like we're compelled to assist you in any way that we can. Obviously we have to address the state statute and ordinances regarding seat belt use·you realize just like we do that seat belts are made to save lives. But at the same time, we would endorse the campaign that you have in reference to the National Highway Safety Traffic Administration, to look at the standards and see if some revisions need to be made." He continued, "What you're doing now on the local level can be done on the state level and also the federal level. If other people in your situation will go to their local law enforcement, state law enforcement, and federal law enforcement agencies, and request assistance like you have, and get that support, maybe there will be some changes."

While he says that they are bound by the law, he does feel that officers can, and will, use discretion out in the field. "If the individual would explain to the officer the situation and there's not an alternative to the individual, hopefully the officer would use good discretion" he said. Further, "they're not out there to punish people, they're out there to save lives". Of course this entails fat people standing up for themselves and not letting embarrassment of size stand in the way.

One compromise we came to was that officers encountering a situation where the seat belt would not go around a person, could issue a warning, rather than a ticket, and take the opportunity to respectfully educate the person about seat belt extenders available from their car manufacturer. Another suggestion was that the officer write a ticket that could be waived when proof of an extender was shown to the court. Hopefully, this will only be a temporary fix and seat belts will come in larger sizes in the near future.

I also talked to Chief Clabes regarding treatment of fat people by the police in general. He assured me that they were professionals, and that serving their "customers" was a priority. "We don't discriminate by race, creed, color, sex, weight, or size", he said.

Chief Clabes, Elizabeth Fisher, and I encourage you to do in your area what we did here. Write anonymously if you are timid about revealing yourself and your size. Ask permission from those of us who don't mind "sticking our big fat behinds out there" to be listed as a contact person in the event your letter creates interest. Do it in whichever way is comfortable for you, but write, write, write! It doesn't have to be flowery or long or full of prose. As an old TV cop said, "just the facts, ma'am". 1. State the problem - seat belts are sometimes too small to buckle around a large person. 2. Ask for support - please see Ms. Fisher's site: http://www.ifisher.com/honda.htm and click on step one. 3. List a contact for further information - name(s), and how to best get in touch with them. It's that easy. But those three simple steps can reach out to hundreds of thousands of people. Fat people who haven't heard of size acceptance will be exposed to the support you and I are so fortunate to share. We owe it to others to share the NAAFA/size acceptance message. We owe it to ourselves to speak out for fat rights. Ms. Fisher and her campaign deserve respect and support from every NAAFA member. One person CAN make a difference·YOU can be that one!

Seat Belts: A Personal Story

NAAFA member addresses traffic police audience

When it was my turn to speak, I got up on a platform in the front of the room and sat in a chair. I had my seatbelt extender, which got passed around the room, my speech, and the microphone. I was nervous and my voice shook. The overhead projector light was directly in my eyes, but I carried on.

In the end, I think I made an impact on the people in the room. Beyond that, if they spread the word to their fellow traffic cops and, further than that, to their friends and relatives, I've made an impact on those people as well.

This is the text of my talk:

Hello, my name is Mara Nesbitt-Aldrich, and if you haven't noticed it yet, I'm fat. I also have some problems remembering words, so please forgive me if I seem to search for a phrase or a word. It's due to a crash I had two years ago.

I am sure you have all seen your share of collisions, and are well aware of the dangers associated with not wearing a seat belt.

This is my story. I grew up in New York City and went to a special school for smart kids and teenagers. I had an IQ of 153, and while I wasn't the best student in the class, I did OK. I never tested below the 95th percentile on any intelligence test, and was usually in the 99th + percentile. I did especially well in timed reading comprehension and proofreading. When I was 6 years old I was put on my first diet, and dieted my way up to my present size, about 400 pounds. But how and why I'm fat doesn't matter. I just am.

Almost two years ago, I got married. My husband and I decided to have the ceremony in Las Vegas, and have two receptions: one in New Hampshire and one in Portland. We also took a side-trip to New York City for a few days. I kept all the details for the ceremony, travel arrangements, receptions and side trips in my head. My husband called it "THE LIST". The only things I wrote down were the names and addresses of the people we invited. We had a lovely wedding in Vegas and reception in New Hampshire. We drove down to New York and on the drive back to New Hampshire we had a crash.

We were in my father-in-law's 1990 Ford Taurus, with me in the passenger seat. It rained a lot that day·3 inches·so we were only driving 50 or 55 on the highway. My husband Roger was belted and had an air bag. My seatbelt was too small for me to fasten, so I was unbelted.

A woman to our right lost control of her minivan, crossed over 2 or 3 lanes of traffic, hit an oil truck to our left and bounced into our lane. We hit her, and I flew forward and broke the windshield with my head. I regained consciousness about a half-hour later, when an EMT was shoving a board under my behind. I was taken to a hospital, observed for brain bleeding and released 6 hours later. My husband, who was belted and had an airbag, walked away from the collision with some bruises on his arm and chest.

At our wedding reception in Portland two weeks after the accident, I was bruised and swollen. I couldn't drink a champagne toast due to the heavy medication I was taking. I was unable to work for 6 months, and had 24-hour a day headaches. I noticed immediately that I was unable to remember certain words and many events and conversations. It seems that I have mild brain damage now. I was tested twice since the accident, and in several of the tests I scored in the 25th percentile, and the 12th percentile for processing information.

As you can imagine, this has changed my life. My memory is full of holes. I don't remember where I put things, I lose checks, I forget whole movies, and I deny having conversations. In other words, I can't trust my memory any more. I also tire a lot easier now and can only work part-time. I used to do a lot of public speaking, and I taught Yoga classes for 15 years until the accident. This is the first public speaking I've done in two years because I fear forgetting words and looking foolish.

The reason I wasn't wearing a seat belt when we had the crash wasn't because I didn't want to. I was not wearing a seat belt because the seat belt was too short for me. I have a DMV waiver in my wallet which says I'm not required to wear a seatbelt, but that piece of paper did nothing to prevent my head from being smashed.

What I need to be able to buckle my seat belt is a seat belt extender which looks like this. As you can see, it can be added or removed from the seat belt with one easy click. However, my extender works only in my car. Each car maker has their own configuration, which can change from year to year and model to model. It costs about $25, but manufacturers who do provide them often give them to customers at no charge. After I recuperated from the crash and started driving again, I spent 8 months trying to get a seat belt extender from Mazda, my own car maker. After dozens of phone calls and letters and a news story on our local NBC affiliate, I finally was able to fasten my seat belt. We were able to get an extender for my husband's Ford in one week.

Elizabeth Fisher, a computer programmer from Louisiana, also needs a seat belt extender for her Honda Odyssey minivan. Eighteen months ago she asked Honda to make seat belt extenders available for larger passengers. Honda told her no. When she persisted in her request for seat belt extenders, Honda officials cited company policy and told her there was NOTHING SHE COULD DO to get them to change their policy.

In Honda's letter to Elizabeth Fisher, they said their seat belts meet federal requirements. But what good is a seat belt that meets stringent federal safety guidelines, if it cannot be buckled? Elizabeth researched this federal regulation, written by the National Highway Traffic Safety Administration, and found that vehicle manufacturers are only required to provide seat belts that fit people up to 215 pounds and 6 ft tall. This regulation is based on height and weight data that is forty years out of date. It was also written before we knew that you are four times more likely to die in an accident if you are not wearing your seat belt.

There are laws in 49 states (all except New Hampshire) that require seat belts be worn, yet there are federal laws that tells vehicle manufacturers that they are not required to make seat belts that fit passengers over 215 lbs. There are millions of people in our country who may not be able to fasten their seat belts. This means that this is a bigger issue than one or two fat women who can't buckle up. The U.S. population is about 300 million, and if 215 pounds is the 95th percentile, that leaves 15 million people in that 5%. In today's population, the 95th percentile stands at 244 pounds, so even more people are at risk than the outdated figures show.

Fortunately many auto manufacturers do make seat belt extenders available to their customers. The new Ford van we bought recently has mention of extenders in their driver's manual. The car makers who will not provide them at any cost are Honda, Subaru, Kia, Hyundai, Porsche, Volkswagen, Audi, and Acura.

In an effort to increase seat belt use among larger passengers and drivers, a petition has been filed with the National Highway Traffic Safety Administration, asking that the existing federal regulation be amended so that any person who fits in a vehicle will be able to fasten their seat belt. In her petition, Elizabeth Fisher is asking that longer belts be made an option at the time of purchase, and that seat belt extenders be available for purchase for all models. A decision about this amendment may be made by the end of this month.

Hundreds of letters have been written to NHTSA in support of this petition for longer seat belts. Just this week Dr. Sue Bailey was appointed as Administrator of NHTSA. She feels so strongly about seat belt use that back in the '70s she had a mechanic install a seat belt in the bus her son rode to school in, and she herself will not ride in any vehicle where all passengers are not wearing seat belts. She knows that in a collision any unbelted passenger (including pets) can become a projectile which may cause the driver to lose control of the vehicle.

I hope that soon all manufacturers will be required to make seat belts available that fit any passenger who fits in their vehicle. In the meantime, it's important that larger passengers who are having trouble buckling up know that seat belt extenders are available for many vehicles just by going to the parts department at their dealership. I hope you will do your part to help spread the word.

When you stop a large person who is not wearing a seatbelt, let them know about extenders. If they are driving a car made by a company which doesn't provide extenders they could get a larger belt made by an auto upholstery shop for their safety. Many large people are embarrassed by their size but sharing this information with them respectfully may save their life.

Thank you very much and if you have any questions, I'd be happy to answer them.

UPDATE: In May 2001 I again addressed the Three Flags Group, this time to a group of about 450. I got some very nice applause from the audience, but the best part was that I added 95 signatures to Elizabeth Fisher's petition to the National Highway Traffic Safety Administration (there were reps from that organization at the talk too). Almost 100 police officers and local administrators were willing to put their names, addresses and phone numbers in plain sight to support our cause. I felt so good... it's rare that activism shows has proof positive in such a concrete way. I'm sure there will be more signatures coming from the Washington State Safety Board, which sponsored the Three Flags conference. I'll be forwarding them all to Elizabeth, and want to congratulate her on all her very hard work to make this important change for the safety of fat people.

Oh, by the way, the cutest uniforms were those of the Canadian Mounted Police! Good thing I'm married, I would have had to flirt with some of those guys!

Exercise: Easy for You to Say!

The research findings and policy recommendations regarding the benefits of an active lifestyle are as ubiquitous and nearly axiomatic as the recommendations for "weight management." Unfortunately, the reality is that all across America, millions of women and men are deciding not to go to the beach, pool, tennis courts, or local exercise facility because their bodies don't meet the current standards of beauty and appearance. Poor body image and shame keep many clothed, hot, and at home instead of out experiencing the joys of life.

It is noteworthy, however, that research studies looking at exercise interventions with large people often provide a built-in mechanism for social support and emotional safety, i.e., designing and administering the program specifically for them. Unfortunately, this is often not the case outside the controlled research setting where large people more realistically must confront the social stigma and humiliation associated with being large in a public exercise facility or setting. For many large people, the social and physical barriers to exercise add to the already considerable impediments expressed by most people who do not engage in regular physical activity (e.g. lack of time, distance to facilities, cost, and so forth).

With this in mind, I realized that I might attract fewer people to my health and fitness class by stating plainly in the ad that it was intended for "fat" people. Then again, fat people were the very folks I was trying to reach, and no other word seemed to convey that as efficiently. Ms. DT signed up for the class stating, "Here I am at 53. I'm middle-aged. I don't want to go to my grave hating my body and myself." Her feelings are fueled by a culture that is contemptuous of, and mean-spirited toward, large people. Ms. DT tries to walk 3 miles on most days; however, she is reluctant to do any other kind of activity in public. Even walking in her neighborhood is sometimes emotionally difficult because of verbal harassment from passersby. She loves swimming but goes to a nearby lake only a few times during the summer, and then only when no one is around. "I've spent obsessive amounts of time trying to disguise and hide," she says.

Many large people often don't get enough physical activity because it is a habit they haven't developed due to the shame and discomfort they are subjected to if they attempt it in public.

After an article about my class appeared in a local newspaper, one father wrote a letter supporting me in my efforts to provide a safe and comfortable exercise environment for large people. Mr. RR cited his 12-year-old "Rubenesque" daughter who loved swimming but would not take swim class at school because of the teasing. All the people in my class loved the water activity but had not been swimming for many years. For many large people, swimming pools are out of the question for two reasons: 1) public humiliation -- getting from the locker room to the water is emotionally impossible; 2) ladders -- most swimming pools are designed with vertical ladders or steps carved into the side of the pool wall. For many large people, sloping steps are the only comfortable entry into the water. I discovered this problem when the swimming pool used by the class was closed for repairs. Much to my surprise, all the other available swimming pools in the area had vertical ladders for entry and exit, but no sloping steps. This frustration occurred once again when a water aerobics instructor was invited to give a workshop at the university pool. One of the larger members of the class required assistance because the vertical ladder was not negotiable.

The members of the class also agreed that the local health/fitness facilities are taboo for them. One woman joined a local health facility only to be told that she was too large for a particular piece of exercise equipment. Indeed, the manager has the right to be concerned about the weight capacity of his equipment; however, the more salient question is, "Why do most exercise facilities not provide equipment designed to accommodate people of all sizes?" The spandex-clad, lean, hard-body culture at most exercise facilities is daunting for the general unfit population and especially so for large people. In a very real sense, health/fitness facilities are "preaching to the choir" and have created an exclusive atmosphere that is uninviting to those whom the healthcare profession admonishes most vigorously about needing to get more exercise.

Large people don't need to hear more about the benefits of physical activity --- they know this already. Rather, they need to have access to safe, comfortable, supportive activity environments, which currently are difficult, if not impossible, to find. We need to acknowledge the double bind created for large people by the health community's admonition to "get more exercise" without doing more to make physical activity less threatening, more accessible, and more comfortable for them. Instead of talking about why they need more activity, we need to talk about where and how. We need to create dedicated time and space where large people can feel comfortable and supported.

1. Writing letters to editors of local newspapers addressing the need for better access.

2. Writing letters to, phoning or visiting exercise facilities to discuss marketing possibilities aimed toward large potential customers.

3. Organizing as a group to create a class or group activity (e.g., swim, bike ride, tennis, yoga, etc.).

4. Renting activity space and time for "large body" exercise classes.

5. Talking to school physical education teachers and exercise facility instructors about providing a more supportive atmosphere.

6. Creating a "fat people's" swim time or water aerobics class with a fat-positive (or at least respectful) instructor at a pool accessible by public transportation (or with carpooling).

7. Encouraging health care providers to educate fat people about pain management, the best shoes for a fat person doing a lot of walking on sidewalks, and other medical and fitness-related information with the needs of a fat body in mind.

8. Advocating for an explicit commitment by those who encourage exercise to provide education both within the health care profession and also to clients about resisting the prejudice against fat people that permeates our society. This is crucial to fat people's health. It is an additional barrier fat folks need to overcome, one that is crucial to the health of fat people.

Defining "Obesity"

Standard dictionaries (e.g., Webster's) define obesity as "excessive bodily fat." Medical dictionaries are no more precise. For example, Webster's New World/Stedman's Concise Medical Dictionary defines obesity as "an abnormal increase of fat in the subcutaneous connective tissues." There are obvious problems with these definitions.

What is abnormal? What is normal? What is excessive? How fat is too fat? Because body fat is a continuous variable, with a typical bell-shaped curve within a population, where to draw the line between "normal" and "abnormal" is arbitrary. "Excessive" for one person may be just fine for another. Granted, the prevalence of so-called "weight-related" health problems is greater among fat people as compared to thin people. However, this observation is of limited clinical value. Consider the case of high blood pressure, which is often linked to obesity. Statistical analysis of the blood pressure-body fat relationship reveals that typically less than 10 percent of the variation in blood pressure in a population can be explained by variations in body fat. Furthermore, many cases of high blood pressure can be resolved with little, if any, change in body fat or body weight. The same can be said of many other health problems, including blood lipid abnormalities and glucose intolerance/insulin resistance.

Also, consider the medical dictionary definition verbatim. From a health perspective, subcutaneous fat is not nearly as problematic as intra-abdominal visceral fat. Body fat is a heterogeneous tissue. In fact, some studies have reported that thigh fat (most of which is subcutaneous) may be protective against cardiovascular disease. The irony cannot go unnoticed: "obese" thighs may actually reduce one's chances of dying from our nation's leading killer. Obesity also seems to protect against osteoporosis, a leading cause of disability among North American women. Therefore, "obesity" may not always be associated with negative health outcomes. In some instances, quite the opposite may be true.

The current use of the body mass index (BMI) as a measure of obesity (and overweight) is flawed. Adopted by most health organizations, the BMI is really just a height-weight chart in disguise. The BMI does not even measure body fat, certainly not regional body fat. Lifestyle variables are not considered. Furthermore, cut-points are rather arbitrary. A BMI of 25-29.9 is considered overweight. A BMI of 30 or greater is considered obese. But there can be little doubt that millions of Americans with BMIs greater than 25 have body fat levels that are "normal" for them, and which pose little risk to health (particularly those who engage in regular exercise and consume a healthy diet).

This is not to say that obesity is benign. Notwithstanding problems with defining obesity, "excess body fat" can impair health and well-being. In this regard, "excess" is from the perspective of the individual, not some arbitrary standard applied to a population.

In some instances, particularly for those at the extreme heavy end of the BMI/body fat distribution, and especially for those who have been very fat since a young age, genes play a dominant role. For these individuals, carrying what Knapp referred to as "dangerous weight," some weight loss may well be necessary to improve quality of life and reduce risk of many weight-related diseases. It should be mentioned, however, that physical health and cardiovascular fitness can be improved dramatically in very large people with relatively simple changes in diet and activity levels.

It is likely that the increase in average body weight of Americans over the past few decades is largely a matter of lifestyle (i.e., environmental factors seem to explain most of the "fattening" of America). However the health problems associated with obesity are very much the same as those associated with sedentary lifestyle and poor nutrition. It may be more efficacious to focus on behaviors rather than on body weight/fat. The scientific and medical literature is replete with studies to show that behaviors, such as physical activity and diet, impact morbidity and mortality to a much greater extent than does body fat. In most instances, then, it makes little sense to "treat" obesity per se. In other words, weight loss is probably not a useful outcome measure.

There is a danger in focusing on weight/BMI/body fat, particularly with regard to "normalizing" these physical traits. One reason is that the weight that is gained during adulthood is mostly fat, and when adipose stores expand, it occurs in part through an increase in adipose cell number. Thus the average middle-aged woman or man may have 10-15 billion more fat cells than she or he had 20-30 years earlier. Since fat cells cannot be lost via exercise, dieting or weight loss drugs, weight reduction efforts are likely to be unrewarding because fat cells can only shrink so much. In other words, a set-point weight that is largely under genetic control may shift up with age, owing to a "fattening" environment. Trying to "normalize" a person whose BMI has increased from 24 to 30 during his/her adult life is next to impossible. However, many health problems associated with "middle-age spread" (e.g., hypertension, blood lipid abnormalities, glucose intolerance, insulin resistance) can be greatly improved or entirely resolved independently of changes in body weight or body fat. In fact, a few reports suggest that exercise training may improve blood lipid profile and insulin sensitivity in the face of increases in body fat.

So body fat itself may not be nearly as problematic as we have been conditioned to believe. Our efforts to control it, however, may do more harm than good. Even if we can identify from epidemiological studies a so-called "ideal weight," it does not follow that this weight is best for everyone in the population. People either heavier or lighter than the "population-best" weight may be no better off if they changed their weight (either up or down as the case may be). In fact, most studies on weight loss indicate that losing weight, even among men and women classified as obese or overweight, and even if weight loss is intentional, does not improve, and may actually, worsen, longevity prospects. As the former editors of the New England Journal of Medicine cautioned, "Until we have better data about the risks of being overweight and the benefits and risks of trying to lose weight, we should remember that the cure for obesity may be worse than the condition."

Dieting and Weight Management

The short answer is: There is no evidence that any behavioral intervention results in long-term weight loss. So we don't have any weight management intervention to even debate about using. The persistent use of dieting interventions is a cultural, rather than a scientific, phenomenon. If we were following the normal rules about insisting that any treatment we prescribe has empirical support, no one would prescribe dieting.

Here is a longer answer: We do have plenty of interventions that result in short-term weight loss and long-term regain: e.g., temporarily restricting intake, basing eating decisions on rules (time of day, number of fat grams/calories, "legal" and "illegal" foods, etc.), and defining "success" as the achievement of weight loss. Is there anything about these interventions that could have value?

It seems clear that temporary drops in weight followed by quick regain are ineffective, if not actually harmful. The vast majority of people (of any weight) do not seem capable of maintaining a regime of restricted intake forever. If this is a lack of willpower, then it is a universal human trait and the intervention of dieting is, at best, impractical.

But even if a person did maintain restricted intake forever to maintain a lower weight, remember that this is the very "capacity" that we also diagnose as a feature of anorexia nervosa. We know what trying to maintain restricted intake looks like; we see it in our eating-disordered patients every day as they subordinate the quality of their lives to the number on the scale. We know that simply restricting intake over time can induce an obsessive focus on food, irritability and cognitive inflexibility in people who have no history of psychological problems with food. We shouldn't prescribe a process for fatter patients that produces symptoms we diagnose as eating disordered in thinner patients.

Dieting "skills" directly undermine the body's self-regulation of eating by teaching the dieter to ignore hunger and satiety cues. Dieting undermines self-efficacy by causing compensatory eating that increases the dieter's fear that her appetites are indeed out of control and can't be trusted. Pitting her "will" against her body's attempt to regulate itself, the dieter feels the most in control at the beginning, when weight loss is the most dramatic. Later, when weight would in any case begin to plateau, the dieter is out of the "honeymoon phase" and facing the stresses of daily life, so that the link between feeling less in control and not losing weight is reinforced. Fraying motivation gives way to compensatory bingeing, for physiological and/or cognitive disinhibition reasons. The dieter experiences her body as out of control and bent on betrayal. Surely it is a cruel irony that large women, who already suffer the stereotype of having out-of-control bodies, are also the targets of an intervention that will reinforce that very self-perception. Further, on a physiological level, the restriction of intake that causes a temporary drop in weight may increase the body's efficiency at storing fat in the future, particularly for people who were already efficient at it in the first place.

The treatment of large women should focus on quality of life, individual assessment, long-term solutions, and self-defense skills in order to face a hostile culture. It should be weight neutral; that is, the therapist should not read any particular meaning from the person's body size, or assume the patient is eating in any particular way to be that size, and success should not be framed in terms of weight at all. The underlying assumption should be that bodies come in all sizes and degrees of efficiencies in storing fat. The focus is on the day-to-day self-nurturing that is necessary for a high quality of life, and there is implicit trust that whatever a person weighs when living in this healthy way, is their healthiest weight. Many of us are already using this definition of "success" with our thinner eating-disordered patients.

If there has been a long history of dieting, body image problems or disordered eating, the therapist should treat that issue the same way s/he would treat it for anyone. People who have been engaged in a power struggle around food need support to use nutrition information in a matter-of-fact way. Eating your fruits and vegetables, moving your body, and having friends are all aspects of daily life that are correlated with health and longevity, for people of any size. Some of the logistics of implementing these daily self-care and quality of life features will be different for larger people; e.g., addressing the paucity of accessible, comfortable, and pleasurable physical activity designed for larger bodies. The therapist can support long-term solutions by insisting the patient take the time to focus on what she finds most pleasurable, working with rather than against her body, solving problems, and building an identity as a person who nurtures herself. We have all the same tools to help fatter people with their emotional lives as we do to help thinner people, but we often overlook them in the glare of the spotlight on weight loss.

True weight neutrality is a difficult state to achieve, for both the therapist and the patient. The patient's weight might go higher, go lower, or stabilize during treatment. Any of these are likely to have meaning, and those meanings must be explored. But it is the renunciation of the pursuit of weight loss that I believe is critical for a good life, for women in general, and large women as well. Because there is so much magical thinking about what weight loss will do, it is a truly revolutionary act to let it go and trust your body, even your fat body. And yet this is precisely where the healing begins.

Most patients will not be ready for such a radical approach and experience stages of denial, anger, bargaining, and depression before they can accept this. They will want to diet to "just get started quicker" or "settle for losing just a little" as if weight could be chosen at will. We are used to this with our eating-disordered patients who are thin and want to be thinner. But somehow we think that it is different for large women; in other words, we accept the idea that it is terrible to be fat.

It is not terrible to be fat. It is terrible to be at war with your body. It is terrible to lack the skills to defend yourself (or even thrive!) in a culture that certainly does loathe fatness. One of the things we learn by treating thinner women with eating disorders is that they are trying to solve the problem of feeling vulnerable by eliminating any target of fat on their bodies. And we say to them, there are other ways to be safe enough, and we explore those ways. Why do we not remember this with our fat patients?

Letters to NAAFA

I went to high school with her in San Diego (a very weight-conscious place that a friend once referred to as "the land of bulimics") many years ago and have kept in touch with her, though I live in San Francisco. Long story short, in addition to having a complex about her weight (San Diego is a city where people have bumper stickers that say "No fat chicks" and surfer-barbie types are everywhere), my friend Amy also was in a car accident and a coma at age 16 and missed significant parts of her life. I think your events and network have really filled a void in her life that she really missed out on earlier, and they have gotten her out of her isolation and self-consciousness, and I can tell you I really see the different it's made! She is so much happier and I am so pleased to see it in her; and she wears her bag that says "fat chicks rule" in a city where anorexia is the norm! And she gets lots of compliments from other women on it. It's great!

So basically I just wanted to say thank you so much for being there for my friend and for enlightening social attitudes for everyone.

Melanie Doyle
San Francisco

Dear Melanie:
On behalf of the board of directors and the membership of NAAFA I would like to thank you for the letter you sent to the NAAFA office. It is wonderful knowing that NAAFA has effected not only the life of our member but the lives of her family and friends. Your friend (I know exactly who she is) is a great and terrific person. She has blossomed into an integral part of NAAFA a NAAFA event would not be a complete without her presence. I hope that you continue to support her and maybe one day you can join her at an event to see first hand what NAAFA has done for Amy and what Amy has also done for NAAFA.

Sincerely,
Maryanne Bodolay
Executive Administrator

ANNOUNCEMENT:
Dr. Glenn Gaesser Accepts Advisory Board Position

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