Transcript:
This is Maureen Farrell and Heather ONeal and this is The Milk Minute. We’re midwives and lactation professionals bringing you the most up-to-date evidence for all things lactation. So you can feel more confident about feeding your baby, body positivity, relationships, and mental health. Plus, we laugh a little or a lot along the way.
So join us for another episode. Welcome, welcome, welcome. Well, welcome. Welcome. This is how we’re going to do it now. Just like you’re sitting around a campfire, we’re going to all hold hands now and we’re going to sing kumbaya and we’re going to start that because we’ve got some stuff to talk about.
Welcome back to The Milk Minute. Anyway, I am here today to take you on a bit of a journey with me. But let’s do a question first before I like even introduced the topic, okay. Because I feel like once I start, I can’t stop. This is going to be one of those where there’s no slowing this train down. Yeah. Okay.
Today’s question is from Amber Livingston and she asks tips on how to dry up fast? Yeah, we got them. We have them. So first of all, the question is always, do you need to dry up fast? Right? How slow can we do this? Frankly, even if like you wean your baby suddenly, like let’s try to wean your body as slow as we can, but we do have a great episode on weaning that I want to point you to, first of all. Heather’s going to get the number, hold on.
My fingers are blaze. Anyway, but I do want to say the biggest way that you’re going to dry up is by stopping milk removal. But we have to balance that with engorgement, milk stasis, mastitis. We talk about all of that and exactly how to do it and what you’re comfortable with in episode 76, Weaning history, psychology and practical tips.
But I will mention a couple of the practical tips here. One is cold compresses before and after any expression. Supportive bras, not tight. We don’t bind the breasts anymore. Just keep your bras really supportive and eliminate extra stimulation. So no nipple play during sex, no hot showers directly on your breasts.
Don’t let your baby twiddle your breasts if that’s a situation that’s happening, because it usually is depending on the age of your baby. And you could consider some over the counter medication like Sudafed or Benadryl. Sudafed really has a better track record for it and you could take pretty much the maximum dosage of that for a few days.
Yeah. And also you can make a really, really strong Sage tea or peppermint and just continually drink it. Yes, but as Maureen has said in previous episodes, spearmint will not work because that is actually a wet plant and it is not drying. So it has to be Sage or peppermint. Right. And more than anything, I want you to really monitor your breasts for signs of infection and get antibiotics as soon as possible if you see that. Yep. Alrighty, good luck.
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We love you; we love your babies and we love this product.
Okay. Well, Heather and listeners, I would like you to know that this episode is going to be emotional and might not be something that you’re ready to hear, and you might need tissues and you might need private space and you might need to stop and come back to it but here we are. Warnings out front. I am going to talk about being fat, being fat while breastfeeding, body positivity, self-love, fat acceptance, like lots of talk about being able-bodied or disabled or values around that. It’s going to get a little complicated and a little messy and it might be something you’re not quite ready for, but I’m going into it with you, Heather. You have to. Yeah. And I just want to say if you’re a healthcare provider, please stick around.
Yes. Of any, any kind of healthcare provider. I will be the first person to tell you that I’m nervous about this episode, because I’m a little bit afraid that I’m going to hear some things that maybe I’ve done in the past with patients, not on purpose, but probably some things that I have done that were maybe not so great when it comes to helping people breastfeed or labor or birth, or well-woman care with somebody that doesn’t necessarily consider, like, how would you say that?
Like straight provider bias. Oh, are you saying like, as a straight sized person? Oh let me tell you about it. So, yeah, so I don’t even know, honestly, I don’t even know the terminology that is okay. I just was corrected the other day when I was referring to a person with autism and they said, oh, sorry, it’s person first.
They prefer you to say an autistic person. Yeah. And that’s a trend that we’re seeing across a lot of spaces where we want to put the person part first and not the, the other part you’re identifying them by. But doesn’t, when I heard that, I was like, doesn’t it make sense if you want to put the person first to say a person with? Yeah, I it’s, I don’t know.
It’s confusing. It is confusing and that’s okay. And we’re here to be honest and make mistakes. And I want to say from the get-go, like, I am not an expert in this, except in that this is my lived experience. And I’ve certainly read a lot of research around it, but I am not like a PhD in the fat revolution movement and fat liberation and body positivity and whatever, but those people exist.
Okay. So there are resources out there if you listen to this episode and you’re like, whoa, I, as a person need to dig into this. I as a healthcare provider need to dig into this. Those exist and I’ll try to put some links for you in the show notes. Are you ready? Okay. I think I’m ready. Okay. Okay.
I’m just going to start by saying this. I am fat. Okay. I’m already uncomfortable.
Yeah. And I bet you’re tempted to be like, no, you’re not fat. Like you’re beautiful. Guess what? I said, I was fat, not ugly, you know? And a lot of you at home probably have that response because that’s what we’ve been raised to think. That fat is a bad thing. Oh, I think that’s universal no matter what size you are.
Sure. It is a cultural belief here and across many places in the world. So that’s why I started with that statement because I’m setting a tone. Okay. Fat is not a bad word. Because our value as human beings is not determined by the size of our bodies or the ability of our bodies or even our health status.
So I’m almost okay with trying to wrap my head around like of course, you know, fat is beautiful and all sizes are beautiful cause I’m there. Like mentally I’m there, I’m with it. I can appreciate beauty in all shapes and sizes. But when you said the ability of your body, I was like, oh no, this I’m all of these things.
Like I directly tie my worth to my looks and my ability to do things and to do. I’m like a do-do person. And sometimes we can get there when it concerns other people, but for ourselves, we’re like, oh, I skipped right past self-love. Shit. And I have to say, they’re probably tied because I can see a pattern already in talking in the short amount of time that if I’m not able to do something for whatever reason, maybe I’m too busy with the kids or I’m busy with work and I don’t complete something, I beat myself up about it. But then my next thought is always, and I didn’t work out. It’s always together for some reason when it goes down the line of like, I didn’t complete enough today and I’m fat. Right. Right.
And let me just say fat is not a feeling. Right. And a lot of people who are not fat or smaller people, you know, it’s something we as fat people experience our small friends being like, oh my gosh, I feel so fat today.
And just saying, if you’ve ever said that in front of a fat person, consider apologizing and like, because it is not a feeling and it’s not like a bad thing that you feel, right. And it’s when we classify it that way, it puts again worth onto size and ability and all of that. And we’re not going to be part of ableism and part of marginalizing bodies.
I mean, yes, I hear you. And obviously I’m into it, but the shit runs so deep. Yeah. With me that it’s like, okay, yeah, we’re not doing that. I mean, we’re not doing that, but I’m going to go home and I’m going to continue to do it to myself. Right. All day. Right. So it’s just something that I want everybody to let all that settle in and let it set a tone for this episode and consider after you hear all of this, what you can do to be a part of the real movement of body positivity, that’s actually a political movement.
I will get into that more later. Okay. I want to talk about a couple of terms too, because I don’t want to be confusing to anybody. I also don’t want to be offensive to anybody. Of course, I probably will be at some point. If I am, tell me. I will post a correction and grow and change from it, same.
So often in the fat community, we kind of talk about body sizes on a scale or a range. And anybody essentially who can find their clothing size in just about any store we consider straight sized, like kinda like size 16 US and down. You know, if most of the places you go, they at least should carry your size. You know whether or not they’re in stock, like consider yourself straight sized instead of normal sized or skinny. We’re going to say that instead of normal sized or skinny.
But then as far as the fat community goes in an effort to acknowledge that fat bias is relative to your size. We often talk about it as you are a small fat, medium fat, large fat, or super fat. Infini fat, like infinity. Sorry. But that’s a kind of an effort for even within the fat community to understand that, like we do not all experience the same amount of bias.
Right. And that goes for body shapes too. But you know, my experience as someone who’s kind of in the medium fat range is going to be really different from a super fat person. Right. They’re going to experience more microaggressions, more flat-out aggressions than I am because our culture has this value based on size.
Okay. Next, I just want to set the tone that obese is a shitty term. Oh, yeah. Now this is where every healthcare provider that’s still listening is like, sorry, what? Like I thought that’s what we were supposed to use? Yeah. So obese as a scientific term is based off of BMI alone, which I will get into some of the problems of the body mass index as a determinant for health.
So problematic in itself. Also the root of the word comes from the Latin word, which I am not going to pronounce right. But it’s a dead language, obedere. Anyway, it means to overeat. And right off the bat that carries judgment about life choices, control over fat, control over weight gain, you know, people making the choice to be unhealthy or fat or whatever, and just carries a poor understanding of physiology and just, I think it’s inappropriate.
So I am wondering, just honest question, in the fat community, is it known that the word obese is linked with overeating or is it just a general feeling that every time they go to the doctor, they are made to feel as if they are fat because they overeat? So I think it’s a mixed bag whether or not people understand that, like that’s what that term technically means. More than anything though pretty much every fat person you’re going to meet hates that term because it is what is used to justify treating them poorly in the medical community. Right. First thing we hear off the bat. Okay. So you’re obese, you know, or obese 30-year-old, you know, you know, P zero, whatever. And you’re just like for fucking real?
Yeah. Is that the first thing you said about me? So it’s not just that, like that word sucks, but also people’s experience around that word is pretty generally traumatic. Well, I think that on, on the other end of a lot of healthcare providers, they not only don’t know that the root of the word obese, they probably don’t even know that that makes the fat community feel that way because they’ve, first of all, never bothered to ask, but also they’re in their mind, they’re thinking it’s more of a scientific term that is used to categorize people based on what, what kind of care they’re going to need next.
Right. Not to let them off the hook. I’m just saying for as much as, I’m saying there’s a lack of education around all of this, so I’m excited to learn more. Yeah. And, and also like we’re all individual people, right? Some people feel more comfortable with the term plus size. I think it’s bullshit for me personally.
I’m like, don’t use a euphemism. I know I’m fat, you know, I’m fat. I’m fat. It’s not a bad thing. You know? Some people would prefer the term overweight or large. So it’s kind of just like with everything, like healthcare should be individual. If we’re talking about people’s bodies, we should use the terms that they want. And also overweight compared to what? Exactly. What they’re supposed to be?
Or is it like a normal that we’ve all agreed on? Yeah. So, I mean, and, and you’re, you can see already, like if you just start thinking about this for five minutes, a lot of the flaws in all of this are really obvious, right? But you might be sitting there at home being like, okay, why are we talking about being fat?
This is a breastfeeding podcast. Well, even though I don’t like the term obesity, when I’m quoting scientific articles, I might use it. Like right now, “it is pretty universally accepted that obesity is considered an independent risk factor for not breastfeeding.” Oh my gosh. As if too much fat causes you to not be able to breastfeed.
Right. Well, I mean, I’m assuming you didn’t find any studies that show that. No. So let me tell you about it. So in 2007, a systematic review found that obese women plan to breastfeed for a shorter period than quote normal weight women and are less likely in general to initiate breastfeeding. And so when I look at that, I’m like, Oh, that’s because they don’t believe they can because they’re fat. Because somebody in their medical experience was like, well, you’re probably not going to breastfeed for very long.
Right. But understanding provider bias is really hard to get like statistical data on. But anyway, in this review they reviewed four studies that examined the onset of lactation and three reported a significant relationship between obesity and delayed lactogenesis. But we don’t have the information to tell us if that is a physiological thing, right.
Or did someone just not prioritize them as far as making the rounds because they figured they wouldn’t be able to do it anyway quote unquote? There were 15 studies that examined maternal obesity and the duration of breastfeeding and the majority of them found that these women were breastfeeding for shorter amounts of time than straight sized women.
Even when they were adjusting for as many of the different factors that could play into that as they could, as far as like socioeconomic status and bias and blah, blah, blah. But again, like not easy to control for those factors. So after reading that review, you know, the only conclusion you can really come to is that we have some evidence that there is a link between body size and breastfeeding, but we don’t understand it.
They could be biological reasons, physiological reasons, behavioral reasons, cultural reasons, provider bias, et cetera. We just don’t have enough information to tell us that. Endocrine reasons? Right? So many things. Question mark. Right. And the reality is that there’s not just one type of fat person, right?
There are so many reasons that the body stores excess adipose tissue, and it has frankly not been studied. And basically we have to have qualitative studies that help us understand this, because that is just increasing a health disparity for people with marginalized bodies, right. And in this marginalized part of society.
So then in 2011, there was like another review of literature where there were 12 studies assessing the association between pre pregnancy, maternal BMI and breastfeeding initiation. Again, it was found there was a link between that and delayed lactogenesis or failure to initiate breastfeeding. But it’s just a lot of these studies found that there were just so many confounding, like co-factors that we’re muddying this, right?
Like maternal smoking status, parody of the people giving birth, type of delivery, infant birth weight, just like there is so much that goes into this. Yeah. And that’s with every breastfeeding study really. But also, I didn’t hear you say anything about longevity studies or, you know, we don’t know what makes people fat exactly. So like, do they have an endocrine disorder that causes them to store more adipose tissue, which also interferes with breastfeeding? It’s not that the fat is causing the breastfeeding issue, it’s that, you know, the, the fat was there to begin with because of this underlying issue. Right.
And it’s, this is why you know, fatness is such a complicated medical issue because we simply do not have the research that explains it, frankly. And for so long, it was assumed that it was just a choice. Well, you’re making bad choices, you’re eating unhealthy foods and you’re eating too much. And all you have to do is eat better and exercise.
Folks, if you’ve ever had a doctor tell you to eat better and exercise to lose weight, frankly, they should be subject to a malpractice suit. Because if, “eat better and lose weight” was a medication, the effectiveness of it would be so low that it would be pulled from the shelves. I mean, it does not work even if they actually give you guidance for how to do that. Which how many times have you had a doctor?
Never. The one time my BMI was over normal for my height is the time that I was told to eat better and exercise, and I had a meltdown. Yeah. And you know, how many of you guys have then gotten a referral for a dietician or are personal trainers covered under your insurance? Gym memberships? I mean, fuck a bunch of that.
I just want to let you know if a doctor has ever said that to you, even if they gave you some guidance around it, they don’t understand weight gain. Because what we know is that for most people, it is not that simple. And even if you lose weight from lifestyle changes, it is not usually permanent. Hmm. So it is a really complicated situation and it is not your fault, even if you ate unhealthy foods, even if you eat too much, even if you need to exercise more, guess what?
Shit tons of skinny people do that too. I mean, and yet when they walk into a doctor’s office, their lived experience is so different. They’re screened for type two diabetes at a much lower rate. And so when we look at things like the statistics on how many, you know, straight sized people versus fat people have type two diabetes, guess what?
The group that is screened more often, has it at a higher rate. What do you think of the term skinny fat? I think it’s weird. I don’t. So I was just thinking you were saying, you know, straight sized people will go eat a bunch of crap and not exercise, but no one calls them out on it. And I was like, well, there’s been a couple of times that I’ve heard the term, oh, they’re skinny fat, like they’re skinny, but they’re fat on the inside.
And I think that’s just like another term putting some weird value on size, you know, because really what we’re looking at is both of those groups probably have metabolic disorders, right. Or something going on because no, you should not really be able to eat like 10 pizzas and never exercise and not gain any weight.
And you can still see a foot of daylight between their thigh gap. And you’re like, what, how? I mean, yeah, it’s, it’s very complicated and frankly, it’s just, we don’t have the answers here. So I just like, I feel like I spent this whole time just setting the stage for what I’m actually about to say. Oh boy. It’s okay.
All right. I have to move on. So I want to dig in a little bit to provider bias and medical bias when it comes to fatness. And I want to start by saying that BMI is bullshit. Yeah. I never gave a second thought about BMI until that appointment with my doctor one or two years ago where she was like, so your BMI is creeping up there above normal where we’d like it to be.
And I was like, sorry, what? It is? Oh my God. And she was just like, yeah. So you might want to lose about 15 pounds. I was like 15 pounds? And like, I’m sorry, that’s not a prescription. Lose 15 pounds. I’m like what? Well, if I lost 15 pounds, it’s part of the mathematical equation that would put me back into the normal range that would make their computer happy.
So can I take you on a little bit of a journey with BMI? I’m not going to like, okay. I could spend two hours on it, but I’m going to try to spend less than 20 minutes. Perfect. Okay. The person who created the body mass index said explicitly that it could not and should not be used to indicate the level of fatness in an individual.
He was a Belgium mathematician named Lambert Adolphe Jacques Quetelet. I don’t know. Anyway, he produced this formula basically to give like a quick and easy measure of the degree of obesity in a general population assist to the government in allocating resources. Okay. This was for like social services. He coined it, the Quetelet Index and basically it was never supposed to be applied to an individual.
Okay. It was supposed to quantify quote the average man which I will get into later. Then in 1972, a researcher named Ancel Keys, coined the term body mass index, kind of tweaked that a little bit and titled his paper, The Indices of Relative Weight and Obesity and, you know, publish that in the journal of chronic diseases. And there we have it.
That’s why everybody uses the BMI scale. That one little thing, one, thank you, Ancel. Dang it. God dammit. So anyway, but as I mentioned, you might’ve gotten a clue when I mentioned the average man that this scale is pretty, pretty sexist and racist because it was basically just a group of 7,000 white men that he used to create it and has absolutely no bearing on other bodies and also 7,000 is a small sample size.
But then how come you can pick woman or man on the BMI calculators? It was a little bit; it’s been a little bit tweaked over the years. However, so like Keys, Ancel Keys like changed a little bit, but really like there was no data like added for women. There was no, yeah, it’s shitty.
It was not created for this. It was not intended for this. The population used to create it is like from Belgium. I mean, come on. This is like some men in Belgium maybe should be this size. I don’t know. But did it catch on like wildfire because researchers are always looking for a data point that’s easy to track? Because there’s so many confounding variables in lifestyle research that this was almost like the easy grab.
Right. Am I right? Yes. And I’m just going to say that it is still the easy grab, like associations, like the CDC literally say the BMI is a reliable indicator of body fatness for people when it is not. Like it makes no allowance for relative proportions of bone, muscle, or fat in the body. Okay. Like none of that is calculated into there.
A high BMI alone doesn’t actually make any determination about the amount of fat on the body. So using like a set of data from a small amount of individuals that are not representative of the global population and just like umbrella-ing it over everybody makes no fucking sense. Yeah, like statistically it’s bad. Logically it’s bad. Physiologically it’s bad.
And it suggests that there are distinct categories of underweight, ideal weight and overweight with like sharp boundaries, right. That hinge on literally like a decimal place. What? Well, I mean, I guess why does it matter that it sucks? Because especially here in the United States, our super shitty healthcare model and private insurance companies literally use it to fuck with your lives.
Like if you have a high BMI, guess what? Your insurance costs more, you have to spend more money. Your healthcare provider is going to see that and treat you differently. You’re going to get different medication recommendations, different healthcare screenings. I mean, every, it changes your entire medical experience.
And yes, there are some providers who can look at BMI and look at the whole person, but honestly most don’t have that time. Well, when you start putting people in boxes, you’re limiting their choices, period. Because I know a lot of birth centers are limited to accepting patients within a certain weight range. So you’re actually limiting people’s birth options in that sense.
I mean, so many things like that. I will also add that relying on this scale often means that providers don’t feel the need to use more qualitative methods to assess health, right? Like you said, they put you in a box, cool. You’re unhealthy. Well it’s a faster appointment in our 15-minute appointment slot and it’s like, okay, I’m supposed to cover all kinds of nutrition information and lifestyle changes and motivationally interview people to make these changes, but you have 15 minutes to do it, but you know what?
Your BMI is high, lose some weight, have a good day. I put it in the chart, covered my ass. Right. And it’s easy. I get it. It’s a number. It comes from a mathematical formula. It carries an air of scientific authority. But it’s basically like mathematical snake oil. Hm. Yeah. So to categorize people by their weight and claim that it dictates their health is nonsense, right? Like I’ve said, but it goes deeper. Right? And it essentially ends up meaning that then your health status determines your value. Guess what? Unhealthy people come in all weights, healthy people come in all weights and they’re all valuable. Your size doesn’t determine how valuable of a human being you are.
Your weight does not determine that. Your health doesn’t determine that. It’s all just really, I mean, when you get invited into a space to talk about it and you really sit down and give it space to breathe, you see how much it actually, how much comes out of it. Like even when I was shopping for us, both for our photo shoot.
I was hit with a fat tax on the clothing. Yeah. It’s literally more expensive to live as a fat person. I did not know that as a straight sized person, I went out and I was like, holy shit. Why the hell are Maureen’s clothes twice as expensive as mine? And we had talked about this with our merch store and how, when we set the prices for our t-shirts, Maureen was adamant that we make all the prices exactly the same, no matter the size, because it was bullshit fat tax.
And I was like, oh yeah, Maureen’s always fighting to fight, blah, blah, blah. That’s fine. But then it really didn’t hit me until it was like my wallet and I was trying to purchase the clothes. And I was like, I literally had to spend a hundred dollars more because of it. And I was like, this is fucked up.
And did you know that fat people get paid less? No, I did not. Yeah. That’s not where I was going next. So I’m just going to leave it there for now. Okay. So. I want to kind of walk you through what it’s like to exist as a fat person who’s having babies and trying to feed them, because I know a lot of you guys are healthcare providers. A lot of you are not fat and you’ve never existed in that space.
And that’s okay. You know, I can’t expect you to know things that you’ve never experienced. So I wanna, I want to kind of help you understand the amount of stress that it adds to exist fat. Close your eyes, take a deep breath and imagine. You walk into your first prenatal appointment with your OB and instead of congratulating you on your pregnancy and asking about how you feel, they comment on your weight and tell you your BMI.
I just can’t imagine. Imagine, perhaps one of your next appointments, you’re nervous obviously, because the last one went so well and a nurse takes your blood pressure and just looks at you and says, well, that’s a little high. And then your OB walks in and says, well, your blood pressure is high and it’s not surprising with your BMI. Obese people tend to have higher blood pressure.
And you know, maybe at your next appointment, your midwife sees you and you ask about breastfeeding and they say something like, of course I would love for you to breastfeed, but I have to let you know that obese women statistically have a lower rate of breastfeeding initiation and duration.
So it’s an independent risk factor for not breastfeeding. So what if we discussed formula just-in-case? And imagine then, after that appointment, you go out to lunch and you see a straight sized person with small breasts feeding their baby and you just think, “how am I going to do that with my body? If I lifted my shirt up, I would show so much skin. I don’t think I could show that much of myself in public.”
Imagine then you’re at another visit and you ask your care provider about breastfeeding and they say, well, I see in your chart that it took some time to become pregnant and you have a history of dysfunctional menstruation. Do you have PCOS? It’s possible you might not be able to breastfeed anyway. Imagine that at your birth, you’re told that you need an induction and an epidural just in case because obese women have a higher incidence of complications in labor. So imagine that you then go in for your induction as scheduled and experience the cascade of interventions that leads to a Cesarean surgery and you’re sitting there in recovery with your beautiful baby and it’s 3:00 AM and there’s no lactation consultant. And you can’t figure out how to position a baby on your body because your incision hurts and you can’t actually see your nipple because you have larger breasts and you don’t understand what’s happening.
And the nurse tells you if you don’t latch that baby soon, they’re going to feed it formula. Does that sound familiar in any way? Is that your experience? Have you maybe as a healthcare provider said any of those things, because you were supposed to?
I’ve had people we’ll ask me, what was her gestational diabetes screen? And I’m like, is she passed it. And they’re like, well, you might want to check a sugar on that baby anyway, just in case. Yup. Yeah. You might, as a pregnant person have your gestational diabetes screen three times because they don’t believe you could pass it because you’re fat. So I just have to say that is what provider bias looks like and all of that is also what happens in every other space that we exist in.
Seatbelts on planes aren’t big enough. The chairs that we sit in, literally don’t fit our body sometimes. Sometimes existing as a fat person feels like you have to apologize just for being there because you’re inconvenient because everything around you has to change to fit your body. Because you have to shop at a special store because they’re not going to carry higher than a size 16, because quote, there’s not enough of you to buy it.
I mean, you’re going around in life, accumulating these traumatic experiences and microaggressions. And this is something that we see in other marginalized communities as well. Right. We talked a little bit about this with Dr. Devane Johnson when we were talking about the black breastfeeding experience. We’re not starting from a level playing field.
Right. We’re not starting at the same place. And to this day, I have been unable to find any adequate research, which separates actual physical ability of fat people to breastfeed from provider bias. And often provider bias looks like your doctor, nurse, midwife, whatever, failing to even tell you that breastfeeding is an option. Interfering when things are going normally, because they expect you to fail.
This I’ve seen a lot, a lot. Yeah. Yeah. And anticipating complications that haven’t happened yet and then basically causing them to happen. And then it just further solidifies that provider’s feeling about that scenario, right? It’s like when you create a C-section by over intervention and then the baby crashes and you get the C-section done and you say, thank God the doctor was here to get the baby out. Not saying that C- sections are bad. I’m just saying that that happened. It happened, that happens. And frankly, that’s like the entire medical experience for people who are fat. You know, it looks like every ache and pain, nausea, runny nose, depression, broken toe, whatever being blamed on your weight.
If you are interested in learning more about this, there are so many stories out there of people who symptoms are continually dismissed until they lose weight. Going back after they lose weight to basically, you know, find out oh, all along, it had nothing to do with fat. Shocker. I in fact know a person who had symptoms dismissed over and over for being fat, was told she just needed to exercise more and her lung functioning would improve. It was just cause she didn’t exercise. Folks, she had lung cancer, she died. She was not treated for that cancer until it was stage four, despite having seen doctors about what she thought was chronic pneumonia or bronchitis or whatever, you know, and that’s not the only story out there.
And was that absolutely because she was fat? I don’t know. Was it a contributing factor? Probably. Probably because her doctor saw that and said, oh, you’re just out of breath because you don’t exercise enough. It is a really big problem. Well, it’s irresponsible as a healthcare provider to get tunnel vision in any way.
You have to keep your mind open to other differential diagnoses. Maybe what if it isn’t this patient’s fault? You know, like just always so quick to point the finger at the patient. And even if it is their fault, they still deserve like compassionate healthcare. Exactly. Like what do you care anyway? Yeah.
And, and really the reality is when you have this experience in a medical space, you don’t go back for care. Which is probably why breastfeeding rates decline for people who are fat. Right? Because if the lactation consultant looked and said, oh honey, those are the biggest breasts I’ve ever seen. I don’t know how you’re going to feed a baby with those.
Are you ever going to see an LC again? No. The minute something goes wrong, you’re not going back. Absolutely not. Especially if there is no other lactation consultant around, it’s not like there so many of us that you get to choose which one you vibed the best with. No. And, and, you know, then you go back to normal life where everything feels like you’re unwelcome.
I mean, let me tell you something. Companies that sell plus size clothing, literally hire smaller models who need body padding to model them. I mean, not every time, but that happens. I actually saw an ad the other day for a company that was selling like comfy sweats that were basically size like 5X but tailored so they didn’t fit people of that size. Sold to people who were about a size six. What? Right. Like it is so, and that’s like, we’re like assaulted with that every day. You know, people who are fat do not get hired as often for jobs. I’ve read a couple of different things here, but one source said that they earn an average of at least $2,000 less annually.
Another source said that fat employees earn an average of $1.25 less per hour. In 2003, there was some research done that found that more than 50% of primary care providers viewed their fat patients as awkward, unattractive, ugly, and noncompliant, and stated that they agreed with the statement that obesity is largely a behavioral problem.
I don’t know. I’m hoping that I’ve created an adequate picture for you of what stress this creates, because I want you to know that it doesn’t have to be this way .That we can work to dismantle this system. You know, literally healthcare providers can just decide that they’re not going to let somebody’s weight determine the way they get treated.
They don’t even, I mean, I know that you’re charting often requires you to take a weight but what if you just like made it up for a week? I mean, what if you didn’t take people’s weights? How would that change the way that you treat them? The way that you look at them or think about their health? You know, if I had gone to an obstetrician for my pregnancies, I would have been considered high risk based on my BMI.
Oh yeah. You would have had so many extra tests; you would have had extra ultrasounds. You would have probably been talked into an induction at 39 weeks. Yeah. And the minute anything looked like it went wrong, they would have talked you into an epidural to make sure that was placed because they don’t want to do a spinal under an emergency on someone that has extra adipose tissue on their back because they don’t want to fail at it and then not have adequate anesthesia.
And would I be breastfeeding after all that shit? Maybe not. I mean, come on. Would anybody? Know that traumatic births affect whether or not you breastfeed. Right? It just. So, I guess I want you guys out there to hear if you are fat and you are breastfeeding, or you are pregnant, that your size does not determine your ability to feed your baby. We frankly do not fully understand the relationship.
And I suspect that much more of it than we understand is about provider bias. Oh, for sure. It’s gotta be a huge part of it. And provider bias for an individual’s entire life, not just in that scenario. Provider bias from the time you go to your pediatrician when you’re in kindergarten and how you get treated and your expectation for how you should be treated and what you feel like you deserve.
And when you should speak up and ask for help and when you should get a second opinion, right. And, you know, I wish that all of you out there could feel free and celebrated and liberated from the oppression that you face because of your body. It’s hard. It’s really fucking hard. Fat shaming is embedded in every part of our culture.
I mean, literally like antagonists in children’s movies are often fat. I mean, Ursula, Jabba the Hutt, Augustus Gloop. I mean, seriously, that fucking song. I just, it’s crazy how ingrained it is. And did you know also body size is not like a protected class when it comes to legal issues? Michigan is the only state that has a law forbidding employers from penalizing fat people in the workplace.
I don’t even know. I feel like this one-off, all of the issues, this one wouldn’t be that hard to fix. I yeah, because I, I don’t know. It’s I just, you know what though? Here’s, I’m going to try to, it’s hard to move to a positive place. I’m going to try to do it right now. Okay. The thing is that all of us hold power here, because the way that we treat ourselves and the way that we treat the people we come into contact with matters.
That’s part of our culture, right? And we can actually start affecting changes simply by changing ourselves. Yes. There is a big political component in this. There is a big body positive movement that is all about that and that you guys should look into. And let me just say, body positivity is not a skinny white chick on Instagram you know, holding the one fat roll she has being like body positivity. No, it is radical acceptance that value is not based on size, ability, nothing of that health, right? It’s the radical acceptance that our bodies are equally valuable. That’s a really hard thing for any human being to do. Yeah.
And you know, I have to say, I feel as if my whole life I’ve been kind of trained for a certain expectation. I always had a proclivity for being like a waif, you know, like a taller, very skinny, no boobs, no butt, nothing. Like you know that classic question that they ask guys, “are you a boobs, butt, or legs guy?” And every time they would look at me, they’d be like, I’m a legs guy. And I’m like smart, because that’s all I have.
So every guy that ever told me it was always, oh, yeah, legs. And I’m like, great, because I don’t have either of the other ones. And I just kind of feel like when you have that in you for so long, that the expectation is that’s who, that’s what your identity is. And then it changes in the birth space. Oh yeah.
And in pregnancy. Pregnancy. Our bodies change so much during that process. And the interesting thing about fatness is that you don’t necessarily have to be born into it. It’s not like race, it changes over time. Yeah. And many people who have been straight sized their whole lives might suddenly find themselves fat.
Right. And, but also trying to breastfeed and also trying to diet and doing crazy things. Diet culture is a whole other podcast. For sure. But I lost my value in my postpartum period because I was no longer skinny. Right. Absolutely. And I that’s fucking ridiculous. And basically nothing that I did successfully, I took joy in because the underlying tone of how I was speaking to myself was, “it doesn’t matter that you’re doing a good job. You’re not doing enough because you no longer have value as an attractive person.” Like that’s fucked up to even say out loud. Right. But that happened. It’s happening still to me. And I’m doing all of the therapy and all of that, but I can’t actually imagine if that was my situation and my fully ingrained belief from the very beginning and how the world was externally treating me but in a negative way.
Yeah. Like all of my positive reinforcement kind of came from my crazy curly hair that all fell out after I had a baby and my height and being in shape. Yeah. And being motivated to like complete things like, oh, she’s an overachiever. So when you become postpartum, you pretty much lose all of that because you’re exhausted, all your hair falls out.
Like it’s all great though. People that are like full of that radical acceptance are like able to enjoy their babies. I mean, and that’s really where self-love becomes kind of revolutionary. Right? What if you were just happy? Right. In that moment and not worried about whatever the fuck you were worried about.
Okay. Well, I’m going to have us all start right now. Okay. Okay. So I’m fat. Most days I’m okay with that. How did I get here? It does start with believing fundamentally that bodies come in all shapes and sizes, and that does not denote their value. It starts often, not with positivity, but neutrality. It starts with interrupting negative statements.
Right. Because everybody out there has looked in the mirror and thought, I look fat. I, you know, my hips are too big. My boobs are uneven, whatever. So it starts with interrupting those thoughts and just being like, you know what? I woke up today, my body’s here. It’s breathing today. You know, it exists. I’m doing X, Y, Z.
I, you know, I’m standing up, I’m sitting down, I’m laying down just making statements about your body that don’t have value. Right. And just, you know, I’m walking down the street, not like, gosh, I’m so out of shape because I’m so fat and I can’t walk down the street. It’s just kind of changing the way that we speak about ourselves.
This is fake it till you make it. And it’s also grounding technique. You know, I went through a period of my life where I had PTSD really badly, and my mind would go to like this crazy place. And it would be like that car is red. My feet are on the ground and I would literally have to ground myself just to have a next logical thought.
So getting to that place, I think is really important for having some kind of a logical thought about your body and what it’s capable of. Yeah. And when you’re comfortable with that, when you feel like, you know what, I’m pretty successful at stopping these negative thoughts? I don’t, you know, it’s not like the first thing I go to every time.
You can move on to some positive thoughts, right? You can move on to celebrating your body. Even if it’s like, seems like the stupidest shit. Like, wow, I love my eyelashes, you know, or look at my cute freckles or I have perfect skin, a lot of it, but perfect skin. You know what I mean? Like, or I like that one freckle on my hand. It doesn’t have to be anything big.
You don’t have to start with I fucking love my hips and they’re so sexy and I’m hot and I’m beautiful. That’s a really big place to start. At what point do you get to the place where you can take a compliment? That’s a great question, Heather. I’d love to know the answer to it. No, I mean, it’s, I think it comes with that though.
I feel like I’ve been much more able to accept that other people actually love my body when I do. And I’m really grateful that for the most part, the romantic partners I’ve had in my life have genuinely found my body sexy and beautiful, because that helps. Right. If you have people in your life who are telling you bad things about your body, you’re going to start believing them.
Even if they’re wrapped up in like a nice little shit sandwich, you know, even if they’re like, wow, you have the best skin. Yeah. I think that those pants are a little bit too tight on you, but oh my gosh, girl, if you just, if you got a size bigger, you’d look great. Thank you. And you’re like, I’m sorry, what the fuck?
Oh my God. But you know, when you’re doing this, you too can then extend it outward because I think many of us are guilty of having negative thoughts about fat bodies that we see. Why are they wearing that clothing? They shouldn’t wear that clothing, or it’s gross to see them sweating that much or whatever.
You know, we’re really taught to think these things about fat bodies that they’re big and gross, and we don’t really want to see much of them, but extending those positive thoughts, outward is going to help you feel better about yourself too. You know, if the best compliment you can give a fat person is that the clothes on their body make them look thinner or taller, you gotta work on that.
You know, we, I see this a lot in like makeover shows even like, even like the new Queer Eye, which is eons better about that shit than the old one, you know, you’ll still hear people being like, oh, this is very slimming on you. I love you Tan France, but work on that. Okay. Yeah. I have to say also, as a quick aside, I worked at a fine women’s boutique and wedding shop in high school and college and the owner of the company, it’s Coni and Franc. I love them. Coni talks about bodies objectively to size them correctly, to make them feel and look as good as she possibly can. That’s her job is to make people feel comfortable in their own skin, in the clothes that she’s selling them.
So I actually have to give her some credit for how I talk to people consciously in my appointments about like, there are certain times with breastfeeding where it’s like, you have a lot of breast tissue and that’s great. Here’s some good positioning that we can do for that. It’s like, this is this, and this is what we can do with this. And how do you feel about it? Do you love it or do you hate it? Because if you hate it, here’s some other things we can do. Always having options and never, the goal was never to like be a size four at Coni and Franc. It’s always like what kind of lovely jewels do we have in here for you today as a person and the bras that she uses, you can go and get sized for a nursing bra.
And the company they use is Dominique. And they’ve, they’re like, OG nursing bras. And actually they have a double D that’s their, their average size. Nice. So a D isn’t the largest size. It’s like the middle size. So they go all the way up to like an H I think. Right. So I love that that’s where she’s coming from.
She’s like, well, you know, the size I sell the most as a 22, which is accurate for this population. I mean, right. And that’s the crazy thing when people love to make arguments about, oh, well it costs more to make bigger clothes and blah, blah, blah, honestly, I call so much bullshit there. Like, guess what?
This is the size of the population. Change the way you’re using your patterns, make it more efficient, figure it out. Yeah. It’s not, it is not the job of the fat person to figure out how to make more money so they can buy the same clothes. Right. So from here we have many places to go. I want you all to know that how much fat is on your body is not the cause of lower rates or onset or duration of breastfeeding.
All of the studies correlate it, but it’s not causational. Right. They haven’t determined that that is actually the thing that is causing those breastfeeding rates to change. Well, isn’t obesity, quote, unquote, a correlation with literally every single thing out there? Diabetes and heart disease and cancer.
It’s like, because slap it on there, fat people suffer from every health disorder, just like everybody else, frankly, just saying, okay. Oh my gosh, by the way, did you see Jim Gaffigan’s new stand-up where he’s like, so we’re watching, you know, we’re, we’re listening to the CDC during the pandemic and they’re like, obesity is a risk factor for death by COVID and Jim, Jim stops it.
He goes, oh, big surprise. Fat people have a higher risk of something. And he goes, well, wait, how fat? I did see that one actually. Oh man. Anyway, love that guy. Okay. So I want you guys to know at home that we do have studies that show that people with less support and education about breastfeeding, strongly correlates to them having lower rates of onset and duration of lactation.
Right? And we know that provider bias and fatness, and therefore the care that you get is directly related. We also have studies that determine that your motivation to feed your baby from your body is possibly the biggest determining factor in your success. That does not mean if you failed, you didn’t want it enough.
That does mean that you have an awful lot of power. Yes, it does. We need to educate lactation consultants on how to better assist people with larger bodies and larger breasts. We need to educate doctors on the importance of supporting fat people in breastfeeding. We need to make sure our fat patients are aware that they’re at higher risk for provider bias.
And I want to end on a slightly happy note. Okay. There is a clinical trial currently being conducted in Mexico called maternal obesity and breastfeeding performance. This study is designed to test the efficacy of prenatal education and postpartum follow up on breastfeeding rates in healthy obese women who do not have compounding health issues that could impact their ability to breastfeed.
Essentially it’s controlling for provider bias. Yes. Wow. That’s really interesting and education too, you know, but also this means with all this power that Maureen’s telling you that you have because you have it and this perseverance that we have to succeed at breastfeeding, it means that if you have a bad experience or somebody gives you information that makes you feel like you have less power, you persevere and you ask a different person.
And you find a new provider if you need to, if you can. You know, I’m so incredibly lucky that weight was not a required thing that I had to do with my midwives. Yeah. You know, I am so lucky that I had access to that. And I want you guys who are struggling with this at home to know that you have power, you have choices and you can succeed.
And if you are someone that used to consider yourself straight size, who now maybe doesn’t fall in that category anymore, you’re still the same person. And you still have that same value that you had before, whether you realized it or not. And guess what folks? Your body will change again. Yeah. And it’s just a body.
It’s what we live in. It’s what we’ve got. But we need to collectively find a place where we can love ourselves, love our neighbors, love all of these bodies and give them all adequate support. I agree with all of that. And I agree with your earlier statement that you do have perfect skin and the cutest freckles.
Thank you. Those are my starting points. Okay. Maureen loves to show up to photo shoots with no makeup on looking like the sun has just kissed her cheekbones and I love it. Oh goodness. Okay. Well I think that we need to give an award. Oh, a hundred percent. Yeah, absolutely. And by the way, thank you for sticking with this episode all the way through. This is a very important message.
And also if you feel brave enough, if a healthcare provider says some shit to you that just doesn’t sit right, come back around and be like, Hey, that doesn’t sit right with me. And I think we need to talk more about that until I feel okay about it. Before we move on with this healthcare discussion, can you please let me know what you meant by this?
It’s perfectly fine to do that. And you know, it gives the provider a chance to right it and if they can’t right it, get rid of them. We love you very, very much. And we love ourselves. Do we love ourselves, Maureen? Most of the time, yes. Most of the time. Yes we do. Sometimes we’re still working on it and that’s okay.
Yeah. We’re in progress. How about that? We are all there.
Hey, everybody, Heather here was some good news for you. If you’ve been wanting a lactation consult with me, but you’re not really sure how to go about it, I finally can take some insurance. So if you have Blue Cross Blue Shield, Anthem, or Cigna PPO, there’s a very good chance that you can get your visits a hundred percent approved with me.
So if you fill out the short form, it’ll take less than two minutes, in the show notes with your insurance information, we’ll know in as little as five hours if you’re approved and then we’ll throw you right on my calendar. And then we get to hang out and guess what? It’s not just one visit. I can see you prenatally.
I can see you before you go back to work. I can see you when you start solid foods. I can see you through weaning. I mean, we got this whole journey covered. So shout out to those insurance companies for valuing this as work, and I’m here for you every step of the way. So click the link in the show notes to learn more about my private consults and make sure that we can get you what you need.
I look forward to working with you. Bye.
All right. Who’s our award going to today? Okay. Today’s award goes to Taylor Schultz. She says we just hit eight months of breastfeeding. I only lasted a week with my first so this was a huge goal for me. It wasn’t easy and still isn’t, but we keep pushing forward. We currently have teeth and like biting mommy’s nipples, which is not fun, but we keep pushing. Cheers to all of us mamas for being amazing and doing the best we can.
And she posted a cute little picture with her and her babies. I like the older kid in the background. He’s a part of it. There’s always, here’s to the sibling that’s always in the back of the breastfeeding photos, cheesing. They can’t miss a moment. Still want to have that mommy time. We get it. Taylor, we’re going to give you the Booby Breakthrough Award, because it sounds like you’ve had some challenges and you just keep breaking through.
So congratulations on all of your successes so far, and we sincerely wish you a really wonderful journey to come. Absolutely. Well everybody, let’s go have a glass of wine, which is fine, by the way, if you’re breastfeeding. Go check out our episode on alcohol that we did way back in the day, which by the way, you little lushes is our most popular episode ever. Very pumped for the marijuana episode to come out.
Oh yes. Anyway, let’s not get ahead of ourselves. Thank you so much for listening to another episode of The Milk Minute. The way we change this big system that’s not set up for lactating families is by educating ourselves, our children and our friends. If you want access to behind the scenes, goodies, extra merch, special messages from us, you can join us on our Patreon for as little as $1 a month. Just head over to Patreon.com/MilkMinutePodcast. And if you’re not in a place where a dollar a month is feasible, totally fine. We would appreciate it if you would tell a friend who you think could benefit from our information. Thanks guys.
We’ll see you next time. Toodaloo.
Resources:
The Impact of Maternal Obesity on Breastfeeding- https://pubmed.ncbi.nlm.nih.gov/27638980/
Interventions for supporting the initiation and continuation of breastfeeding among women who are overweight or obese- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747740/
Maternal Prepregnancy Body Mass Index and Initiation and Duration of Breastfeeding: A Review of the Literature- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058894/
Overweight workers earn less: Study- https://www.linkedin.com/news/story/overweight-workers-earn-less-study-3578012/
āFat Chanceā Fat People get paid on average $1.25 less per hour- https://www.csbj.com/archives/fat-chance/article_35235ac3-9eaf-5a4d-8ea1-59398cae3116.html
Primary care physicians’ attitudes about obesity and its treatment- https://pubmed.ncbi.nlm.nih.gov/14569041/
Clinical Trial in Mexico- Maternal Obesity and Breastfeeding Performance- https://clinicaltrials.gov/ct2/show/NCT02756169
Top 10 Reasons Why The BMI Is Bogus
https://academic.oup.com/ije/article/43/3/665/2949550
https://pubmed.ncbi.nlm.nih.gov/17608952/
https://pubmed.ncbi.nlm.nih.gov/21434834/
https://www.everydayhealth.com/diet-nutrition/bmi/bmi-flaws-history-other-ways-measure-body-weight/
Heatherās Private Consults – I now take insurance!
https://breastfeedingforbusymoms.com/private-consultations/
Get Me Pre-approved to Work With Heather! Just click the link and scroll down to āCheck my coverage,” then go from there…
https://lactationnetwork.com/
