Hanne Blank’s FAT

Elizabeth Reis

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Dr. Hanne Blank Boyd is a writer, editor, and consultant whose published work lies at the intersection of bodies, selves, and cultures. Publishing under the name Hanne Blank, she is the author or editor of ten books that include Straight: The Surprisingly Short History of Heterosexuality (Beacon Press), Virgin: The Untouched History (Bloomsbury), and most recently FAT (Bloomsbury, 2020). Formerly on the faculty of the Women’s and Gender Studies department at Denison University, she lives in Decatur with her spouse, a liberal distribution of dogs and cats, and ever-expanding collections of books, fountain pens, lipstick, and yarn. You can find her on Twitter at @hanneblank; she publishes a Substack at https://hanneblankboyd.substack.com/

FAT is a brilliant short book that blends Blank’s own experience of living as a fat person with the history of all things having to do with fat, including our compulsion to contain and control it. She examines the concept of the calorie, for example, and the history of the BMI (body mass index), as well as the emergence of the fat acceptance movement. She also critiques the diet industrial complex that she herself confronted as a child. As I read the book, I had questions and wanted her to elaborate. Here are some highlights from our conversation:

Lizzie: We hear so much about how unhealthy it is to be fat, but that point of view obscures how medical providers and institutions discriminate against fat people in all sorts of unhealthy ways. We’ve all heard stories about physicians overlooking serious medical conditions because they couldn’t see beyond the patient’s weight.

Hanne: There are thousands of horror stories out there about this. I’ve never met a fat person who didn’t have a tale of medical awfulness to tell. It’s been a factor in my own life. I have polycystic ovarian syndrome (PCOS), which went undiagnosed until I was in my 30s despite a classic presentation, at which point I was told to lose weight and it’d go away. (Surprise! It didn’t! Because it doesn’t work like that!) Also, at one point I had to have emergency surgery because my GP wrote off recurrent abdominal pain as “food sensitivities” that she thought were “probably beneficial in the big picture” because I dropped 75 pounds in less than 6 months–because I could barely eat because eating anything triggered terrible pain. As I discovered when I finally landed in the emergency room, I had very bad gallstones, one of which had lodged in my common bile duct, and a whopping infection had developed. Had things gone south from there, I easily could’ve died of sepsis. When I confronted my GP about this after my surgery, she said that she’d realized that it was possible I had gallstones, but “you were doing so well with the weight loss that I figured if it ain’t broke, don’t fix it.”

There is also an issue here of healthcare practitioners falling victim to severe logic errors around fat and disease. With the caveat that there’s still much we don’t know about how bodies work, the relationship between fat and health is not a one-to-one correspondence. Fat is rarely disease-causative. It is rarely injury-causative. We do not have evidence of a link between fat and the development of specific diseases, the way we do with, say, cigarette smoke being carcinogenic, or lack of vitamin D causing rickets. We also don’t have evidence of fat causing specific injuries. Sure, a fat person may experience greater forces of stress on a knee, for instance, due to greater weight. But fat by itself can’t cause a dislocated kneecap. Yet we have been taught to believe that fat causes both illness and injury, all by itself.

Lizzie: You have some very snappy come-back lines for when someone says something insensitive to you about being fat. I’ve heard from my disabled friends that they frequently hear the same hurtful comments. When someone said to you, “I would kill myself if I were as fat as you,” you retorted, “Why wait?” What motivates this hostility and callousness that so many people seem to share regarding fat people?

Hanne: Power, status, and the fear of losing them or being tainted by proximity to those who do not have them are the motivators here, so far as I can tell. It’s a similar dynamic to what lies behind racism, ableism, ageism, etc. People who are raised in a kyriarchy are repeatedly taught (tacitly and explicitly), from infancy onward, who the powerful and high-status are and what their attributes are. They are taught that being one of those people is the best thing you can possibly be and that having that power and status is what makes life worth living. The next best thing is to attain close proximity to that kind of power and status. We are also taught what attributes can get a person into that kind of proximity to power and status, and that having those attributes is thus also something that makes life worth living.

Those who don’t have those attributes, who neither have primary power/status nor proximity to it? That’s scary and dangerous and not fun and we’re taught to avoid it however we can. We’re also taught to avoid being in solidarity with those who don’t have those attributes, because solidarity with those who have been written out of the power/status equation means that attention, care, and other important resources are flowing in the “wrong” direction. That would threaten to upset the whole power/status paradigm in which resources and access to resources always flow upward to those with the greatest power/status. Can’t have it go the other way, everyone will want some!

This is why I have no compunctions about telling the “Oh my God I’d kill myself if I had to be like you” folks not to wait on my account, because I have hope that maybe it’ll shock them out of their unexamined complicity for half a second. I mean, a girl can dream.

p.s. This dynamic is also the reason that people have such a hard time believing that fat people can be romantically and sexually attractive. Expressing attraction to traits that do not serve the power/status hierarchies is stating that those traits (and people who have them) have worth and value. And, as I note above, we can’t be having with that or it betrays the arbitrariness of the status quo, which makes it vulnerable. Better to resist that temptation to experience feelings that might lead to solidarity with the less- or un-powerful, the low- or no-status, because you a) jeopardize your own power/status and b) threaten a paradigm run by people with lots of power and status who can and will obliterate you in order to obliterate that threat.

p.p.s. And yet these attractions still exist, far more widely than anyone typically likes to acknowledge.

Lizzie: You mention here that you were in the last generation of kids being prescribed weight loss stimulants. What are your thoughts about the new weight loss guidelines from the American Pediatric Association (APA)?

Hanne: If I were even more cynical about the medical “care” created to be deployed on fat people than I already am, I would say that the APA has done a bang-up job of creating a set of medical guidelines that will ensure that children never, ever escape the clutches of the medical-industrial complex as adults. We know that the long-term realities of bariatric surgeries are serious and complex, and can include (but aren’t limited to) malnutrition, dumping syndrome, hypoglycemia, chronic vomiting, bowel obstructions, hernias, ulcers, perforations, pulmonary and cardiac problems, syncope, tremors, flushing, micronutrient deficiencies, folate deficiencies, alopecia, delayed wound healing, and so on.

These complications often require lifelong management, and it’s not always just a matter of “take some vitamins.” Even managing something as “simple” as iron deficiency anemia, which is very common in people who’ve had gastric bypass (up to 50% of people with Roux-en-Y and sleeve gastrectomy methods end up with it) may not be so simple as “just take an iron pill.” For those who can’t absorb enough iron through oral supplements, treating their anemia can involve trips to an infusion center for IV iron. I bring this up because it sounds simple, but in practical terms it’s terrifically disruptive: think about how much of your daily life you’d have to rearrange to go sit in an infusion center all afternoon on a regular basis. But I’m sure there are people out there prepared to argue some medical version of the old “nothing tastes as good as thin feels” cliché, something like “no amount of medical intervention is as inconvenient or unpleasant as being fat.” (Spoken like someone who has no experience from which to judge, I’d say!)

Sure, we all want to assume that children are resilient and they’ll be fine after whatever medical interventions we impose on them. We know that this is not the case because we have ample evidence that children are not always as resilient as we imagine they are, and that children can be harmed by medical care even when it is well-meaning and competent.

We also want to assume that doctors are well-meaning and would never do anything to harm a patient, especially a child. We know that this is not true, because we have ample historical evidence of medical wrongdoing, including wrongdoing in the name of benevolent care.

It’s easier to tell ourselves that we have a magic bullet to stop a horrible thing from happening to children than it is to admit “Wow, our culture’s broken and we need to try to change it so horrible things won’t happen to children so often” and then try to fix it. I get that. But fat isn’t smallpox and eradicationism is neither an effective nor an ethical approach in this case.

Lizzie: COVID-19 has brought new attention to fat people. On the one hand, so many people who were able to maintain their weight before the pandemic are now confronting their new and different bodies, which might make them more sympathetic to others. On the other hand, if obesity is listed as a risk factor for COVID, people assume that fat people are to blame for getting sick. We can’t get away from blaming!

Hanne: Human beings are fragile little creatures who desperately want to believe that we have the means to transcend our vulnerability and prevent our own deaths. We don’t. We never have. Good deeds and clean living have protected precisely ZERO human beings, ever, from experiencing the body’s inherent tendency to get sick or hurt. No one gets out of this alive.

This is a desperately hard thing to truly acknowledge and live with.

So we find things on which we can blame illness, injury, and death, as if this way we can forestall the inevitable. We impose corresponding regimens and limitations on ourselves. We also like to tell ourselves that *other* people may not be able to exert sufficient… Self-discipline? Sophistication? Power of will?… to do these things that will surely appease both entropy and fate, but we can and do and thus we are superior.

So are we going to blame fat people for getting sick with COVID? Sure. We blame fat people for everything else that ever goes wrong with them; why should this be different? It doesn’t matter that the blame is wrongly placed. It almost always is.

Lizzie: Would you be willing to share with our readers something about your new memoir?

It’s a work in progress called Flesh Wounds. I swore for decades that I’d never write a memoir, so that’ll teach me to say “never.” The book is about my processes of learning how to navigate life as a person whose body has failed society’s expectations and standards in multiple ways. More specifically it is about growing up and living as a person who is and has always been fat, to whom polycystic ovarian syndrome (PCOS) and treatment-resistant depression have been lifelong companions, and whose neurochemistry is clinically non-standard. For all these reasons my bodymind has been considered difficult, intransigent, unlikeable, demanding, unwanted, strange, and unlovely by others and often by me as well.

I have lived my whole life in an odd middle space where my bodymind isn’t and never has been well-accommodated…but also hasn’t always gone egregiously unaccommodated. Much of the time I fit the “normal” mold, or can make do with the things I was offered, enough to get by. But it’s always a struggle. It’s always been a struggle. Do I try to fit in? Do I say screw it and let the chips fall where they may? What’s the price, or the potential reward, for each? What about the parts of this struggle that are painful and inconvenient and humiliating, and the parts other people loathe and denigrate to my face? How to cope with that? What about the parts that make it impossible to do the things I want to do, or to be in the world in ways I would like to be? How do I build a sense of self or a sense that I am worth keeping alive when I (my bodymind) am so often the problem, the thing that doesn’t work right and doesn’t fit in?

There is no tidy transcendent ending to the story I have to tell. I’m mostly trying to illuminate this very common human experience of living in and with a bodymind that is, in various ways, often hard to deal with.

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Featured image caption: Photo by Anna Tarazevich. (Courtesy Pexels)