I’m at the doctor’s office watching him study my chart when a frown crinkles his cheeks. He looks up, and I know what he’s about to say.
“According to the BMI, you’re obese.”
“Is that so?”
“You need to diet and exercise more,” the physician, who has a chiseled physique, scolds. “Given your condition, life will be much better if you trim down.” Before I have a chance to respond, he moves on.
What this doctor doesn’t know, and what I don’t have the heart to tell him, is that it’s nearly impossible to lose weight when your body won’t cooperate.
For the past six years, a brace has ensconced my left leg, forcing me to use a metal cane to get around. I’m disabled. This is my life. It’s a good one, and most of the time I don’t complain, even when I see the pity on people’s faces after they learn that a red pick-up truck careened into me. The spinal cord injury I suffered as a result will affect me for the rest of my life.
Before the accident, I was a varsity tennis player and member of my high school’s marching band. I bicycled regularly, ran with friends, worked out with my father, and was in the best shape of my life. Afterward, everything changed.
This is because staying fit is a rarely discussed challenge for many disabled people, even in conversations with supposed experts. According to the CDC, individuals “with mobility limitations and intellectual or learning disabilities” are far more likely to be overweight, with rates of obesity for disabled adults and children 58 percent and 38 percent higher than for their able-bodied counterparts, respectively.
For the sake of the ever-shifting disabled community then, we need to begin a conversation about this complicating reality and the social miasma it generates.
The difficulties of weight loss for the disabled
Higher obesity rates for disabled people shouldn’t surprise us. Certain medications keep weight on, pain often deters physical activity, and cooking when impaired can be a real struggle, making it harder to maintain a healthy diet.
With two titanium rods and eight screws in my back, even bending down fatigues me. Since my muscles aren’t innervated properly, balance is difficult, and the slightest of unanticipated weight shifts potentially dangerous. Plates, glasses, silverware rest in cupboards at different heights in different places around the kitchen. Just securing the groceries needed to cook in the first place usually means walking around a store with no place to sit down.
Often, take-out is the safest option.
Exercising itself is a struggle: Running or hiking — a favorite pastime for my peers — clearly isn’t possible, and sometimes when I try to go without the mobility scooter, a fall ensues. Parks and gyms also pose accessibility challenges. Many parks often have unpaved paths, inaccessible curbs or unnavigable topographical features such steep hills and unlevel woods. Gyms, meanwhile, typically provide safer environments due to requirements from the Americans with Disabilities Act, but many, including my own, remain inaccessible.
Shortly after my accident, I was gutted to find out that I couldn’t get to the work-out room of the local tennis club without taking stairs. Changing rooms can also be hard to manage, personal trainers rarely have much experience with disabled clients, and most gym staffers never consider how a disabled individual might need help to use their facilities.
Numerous friends have welcomed me to join them at more accessible venues. But then my personal pride gets in the way. I don’t want to be seen bumbling about on the treadmill, out of sync with everyone else around me. I’m afraid of becoming a spectacle — of showing them just how “abnormal” I actually am.
Getting in shape depletes my physical and emotional resources. Most of the time, I just can’t manage the loss.
Facile opinions on weight-loss have outsize impact on disabled people
In a world where ableism is a real threat, the last thing our community needs is to be judged for our weight.
Yet with each new article or report about obesity comes rejuvenated efforts to address the “epidemic” or “crisis” that larger people like me, disabled and able-bodied alike, perpetuate. Physicians with lackluster training in nutrition fat-shame patients who “delay or avoid seeking medical care” as a result, a problem that has been highlighted by body positivity activist Linda Bacon. Government officials also woefully misunderstand the situation, and countless studies have confirmed that most people believe those of us with bigger bodies should be able to summon the courage to lose weight on our own.
But while monomaniacal exercise and diet work for some people, they don’t for most: A staggering 95 percent to 98 percent of attempts to lose weight by the general public fail for reasons that “are biological and irreversible,” wrote Michael Hobbes in HuffPost last year. Relying on these two solutions as “the primary treatment for those in larger bodies, particularly those who also have disabilities, ignores the lived experience of the individual and is not evidence-based medicine,” said Louise D. Metz, a physician connected to the Association for Size Diversity and Health.
Bigger disabled individuals can fall prey especially easily to the personal failure model of obesity, and be recriminated appropriately, because we attract attention. Our bodies are doubly a spectacle, not only because of our size but because we move and function differently in the world, two realities that mutually inform and magnify one another.
A great many other do-gooders besides the doctor above, such as medical professionals, friends, relative strangers, are also quick to point out that my existence will be much improved, that my back will feel much better, or that my brace will last much longer if I watch my weight. But no one really explains how to do this, and I don’t ask, because I can’t kick the shame associated with being fat.
Where does that leave us?
In the end, two paths lie open to those who want to address the stigmatizing relationship between disability and obesity: the first recognizes that strategies for staying physically fit as a disabled individual, while not completely elusive, require far more time, money, and creativity. To start redressing this wrong, we must ameliorate obvious barriers: Make parks more accessible, gym environments more inclusive, assistance for cooking and ambulation more affordable, and wheelchair athletic leagues a normal presence in communities.
But at the same time, we need to educate health care professionals who should know better in the first place. “The research is damning,” Bacon points out. “If we really care about health, we should be fighting fat stigma—not fat.” This points me toward the other path, which sets fitness aside to reconfigure the dominant model of obesity as a badge of shame. I’m not the first to suggest this of course.
But until more people begin asking the question, “What unique perspective might the obese person have to offer?” no amount of fat activism will do a bit of good. Those with smaller body sizes, including doctors, need to engage with large individuals before casting judgment — or even worse, making themselves feel better with the vile phrase, “at least I don’t look like that.”
Life would be far better for people in my position if we manage as a society to walk, run, shuffle, limp, or wheel down both.
Pasquale Toscano currently lives in Oxford, England, but heads to London often for the theater scene. He will return to the US for a PhD program in early-modern English literature at Princeton University, focusing on representations of disability in drama and epic poetry.