Let's Talk About Lipedema and Weight Bias
We should be neutral about our bodies, but we still need to diet if we want liposuction for our Lipedema. Can we do both?
As someone living with Stage II Lipedema, I can relate to the everyday struggle of nitpicking my body, especially with the influence of societal expectations. And like many others, I've attempted numerous diets in hopes of shedding weight, only to encounter disappointment.
However, my perspective began to shift when I discovered I had Lipedema and reached a plateau of 230 lbs. I also started feeling ridiculed for living in a fat body, especially when I needed help for my body issues.
This realization opened my eyes to the experiences of fat or “obese” individuals (obese is a term used in medical contexts but is often disfavored by fat culture) and their encounters with diet culture, fat-shaming, and marginalization within the healthcare system.
Every woman with Lipedema I’ve talked to has been shamed, marginalized, and ostracized from our society, even to the point that they cannot receive adequate medical care.
It really hit home when I started getting fat-shamed by medical practitioners who wouldn’t give me proper medical treatment.
“Along with our body pains and the unique perspective that our ‘fat’ causes us a great deal of distress, insurance requires that we must diet and fail if we are to be approved for liposuction surgery.”
The more I dig, the deeper I go into anti-dieting, body inclusivity, body neutrality (not body positivity, which is a pendulum the other way and has its own issues), and, most importantly, being healthy at any weight.
Discussing our bodies and those of others can be challenging, as it often leads to offense and discomfort. Society has ingrained in us a sense of shame if we don't meet some elusive "perfect" size (what is perfect anyway?). As a result, conversations about our larger bodies are often avoided altogether.
Ideally, we should be comfortable in our bodies of any size. However, with Lipedema, we usually aren’t. Unlike fat women who don’t have Lipedema, our adipose tissue is diseased, causing pain, lethargy, decreased mobility, and decreased quality of life.
Along with our body pains and the unique distinction that our fat causes us a great deal of distress, insurance requires that we must diet and fail if we are to be approved for liposuction surgery.
To give you an idea of what we need to do to qualify for liposuction surgery, here’s a snapshot of the insurance coverage criteria we must meet to be considered for approval:
Typical insurance coverage looks like this above. Note under the criteria for diagnosis of Lipedema is the failure of adipose tissue to respond to bariatric surgery or medically supervised weight loss.
Insurance and medicine’s answer to high BMIs and “morbid obesity” is to put us on highly restrictive caloric intake through non-food, shakes, powders, and meal bars or to alter our digestive system surgically. These are high-risk treatments that have no effect on our Lipedema and further develop our complicated relationship with food and our bodies.
It would be fantastic if there were other ways to diagnose Lipedema without going to these great lengths to rule out overeating. Most Lipedema women I’ve talked to do not overeat. Instead, they undereat. And this is dangerous for our health. We can become anorexic and still be seen as “morbidly obese.”
Until insurance changes its policies for liposuction surgery, this is what we have to face. On the positive side, almost all of us have already tried to lose weight through dieting.
So, here’s my question: Can we both change our mindset towards inclusivity and neutrality of our bodies and fulfill insurance needs to show we are resistant to weight loss?
I’m gonna say…Maybe.
One of the many movements pushing back against diet culture, fat-shaming, and marginalization, especially in the medical system, is HAES, or Health at Every Size®.
HAES focuses on holistic well-being regardless of body size or shape. HAES rejects the idea that health is determined solely by body weight. Instead, it acknowledges that health is “multifaceted, encompassing physical, mental, emotional, and social aspects of a person's life.”
I’ve only recently been introduced to HAES, so I’m not an expert. Not even close. However, a good friend of mine is a dietician who has enlightened me about this new way of eating and health and accepting all body shapes and sizes.
My friend told me that many dieticians are jumping onto the HAES bandwagon. Some are even starting private practices to help (mostly) women reconstruct how they eat and live in their imperfect yet beautiful bodies, no matter their size or shape.
Below, I’ve reprinted what the HAES website promotes, and if you want to go to the website to read more about it, I have linked the sites for you below.
According to the Association for Size Diversity and Health (ASDAH), here are the Health at Every Size® Principles:
WEIGHT INCLUSIVITY
Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
HEALTH ENHANCEMENT
Support health policies that improve and equalize access to information and services and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
EATING FOR WELL-BEING
Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure rather than any externally regulated eating plan focused on weight control.
RESPECTFUL CARE
Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma and support environments that address these inequities.
LIFE-ENHANCING MOVEMENT
Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement to the degree that they choose.
With this concept, I’ve come up with some of my own viewpoints on how we, as women with Lipedema, can also Embrace Our Body and Health at Every Size.
Body Acceptance: Cultivate a positive relationship with our bodies. Emphasize self-acceptance and self-compassion, promoting the idea that all bodies are worthy of love and care.
Balanced Nutrition and Physical Activity: Even if we are required to participate in diet culture for the sake of getting our liposuction surgery approved, we can still develop healthy lifestyles through intuitive eating and joyful movement. This includes mindful eating, listening to hunger and satiety cues, and engaging in physical activities that bring joy rather than focusing on burning calories.
Health Equity: Recognizing that lesser access to resources, socio-economic factors, and systemic discrimination negatively impact health outcomes. Body inclusivity advocates for creating a more just and inclusive healthcare system that considers the diverse needs of all individuals.
Non-Discrimination: Opposing weight bias and discrimination. Instead, we work towards building a society where people are not judged based on appearance or size.
Benefits of Embracing HAES:
Improved Mental Health: We can improve self-esteem and body image by promoting body acceptance and shifting away from harmful dieting practices. This, in turn, positively affects mental health and reduces the risk of developing eating disorders.
Sustainable Health Habits: Focusing on health behaviors rather than weight. By adopting sustainable habits that support overall well-being, individuals are more likely to experience long-term health benefits.
Increased Physical Activity: Shifting the focus from exercise as a means of weight loss to joyful movement can make physical activity more enjoyable and sustainable. If you love dancing, gardening, or lifting weights, you will likely keep doing it for joy. This leads to increased motivation to stay active.
Inclusivity and Empowerment: Let’s celebrate diversity and inclusivity, recognizing that health is not a one-size-fits-all concept. This mindset empowers us to take charge of our health and make informed decisions that align with our unique needs and circumstances.
Remember, your health journey is yours to define and embrace.
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Take Care,
Michelle