Chapter 7
Health
Fat, Sick, and Crazy
The Centers for Disease Control and Prevention reports that 57 percent of African American women over the age of twenty are obese.1 One in four Black women over fifty-five has diabetes.2 Heart disease is more prevalent among Black women than White women.3 Thirty-seven percent of Black women have high blood pressure.4 Women are more likely than men to experience major depression, but Black women are half as likely as their White counterparts to seek treatment.5 Persistent stereotypes help explain why the public processes these health challenges with more parts blame and exasperation than compassion, believing that Black women are simply fat, sick, and crazy rather than human beings in need of help.
It’s the Racism, Stupid
Too little attention is paid to the ways systemic inequity diminishes the physical and mental well-being of Black people, even though research suggests that living Black in America is a unique health stressor.
Black women face racism and sexism and often carry disproportionate responsibilities, which can place their bodies in a constant state of hypervigilance, anxiety, and worry. This results in real physiological damage, called “allostatic load,” the overburdening of bodily systems, including those regulating blood sugar, circulation, mood, and other processes.6
Researchers believe this helps explain several negative health outcomes for Black Americans, including high maternal and infant mortality rates and high rates of chronic illnesses like the ones previously mentioned.7 It also made Black Americans, including Black women, more vulnerable during the COVID-19 pandemic.8
According to the Centers for Disease Control, Black Americans were 1.1 times more likely than White Americans to contract the virus, 2.9 times more likely to be hospitalized, and 1.9 times more likely to die.9 And, because of other disparities, Black people were more likely be mentally burdened by the pandemic. A study into the effects of COVID on pregnant women, published by the National Institutes of Health, found that “Black pregnant women reported greater likelihood of having their employment negatively impacted, more concerns about a lasting economic burden, and more worries about their prenatal care, birth experience, and post-natal needs.”10
And a study published by the National Institutes of Health in 2012 revealed that “Black-white disparities in mortality persist after adjustment for socioeconomic status and health behaviors.”11 Even in the best of circumstances—when a Black woman has the access and ability to give her body the best care—her health outcomes are likely to be worse than those of her White sisters.
Racism is a public health issue that is too often overlooked in favor of chastising Black women doing the best they can.
Wake Up!
Sometimes bodies don’t need fixing so much as care. Even if they are sick. Even if they are disabled. Too often, the expectation that Black women live up to the strong Black woman myth means they are denied that care, but also fail to show compassion to themselves.
One day, when she was forty years old, Deborah Latham-White had an anxiety attack and felt as if she were dying.12
“My heart was pounding so hard, I assumed I was having a heart attack.”
That day she found herself sitting in the office of a mental health practitioner who suggested that she also get a complete physical. It revealed dangerously low iron levels. In fact, she was so anemic that she fainted outside the clinic. And doctors discovered something else, too—uterine fibroid tumors.
Deborah had been ignoring signs that her mental and physical health was fragile, thinking she could work through the many symptoms that had been plaguing her.
“The women on my mom’s side of the family always have hysterectomies by the time they’re in their early forties,” Deborah says. “I should have been listening to what my body was saying.”
Following weeks of improving health, she was finally able to have a partial hysterectomy. It took four more months to heal, giving Deborah time to question how she became so sick. The answer, in part, was that she had become, as Zora Neale Hurston wrote of Black women in Their Eyes Were Watching God, “de mule uh de world,” taking on everyone’s burdens to her detriment.
A change was in order.
While recovering, Deborah spent time doing more of the things she loves to do, including reading and watching movies. She started treating herself to what she calls “Queen Esther Days,” all about pampering. She started taking naps. And she learned how to say no.
“I changed how I responded to some people in my life. ‘You’re in a crisis, I’m so sad for you. I can’t help you. If I can I’ll let you know.’ I used to feel guilty when I would say, ‘No, I can’t.’ Now I can say, ‘No, I don’t want to.’”
Deborah says that it took “skidding like this healthwise” for her to realize that she is not invincible. And that was a hard lesson to learn within a culture that wants most for Black women to be self-sacrificing Mammies.
“We are taught to take care of everybody else. We are always giving our strength away. You know what I’m saying? We’re strong for our children. We’re strong on the job. We’re strong if we’re in church. It’s always an outpouring.
“We’re never allowed to say, ‘Hey, I’m really tired. Hey, I’m hurting. I’m exhausted. You’re exhausting me. I need a break. I don’t want to do anything for anybody.’ We’re just geared to give.”
More than twenty years later, Deborah is happy to have survived her wake-up call, but for several of her friends, it came too late.
“In my personal sister-friend group, I’ve lost three friends. They died really fast. They were all ‘strong Black women’ who ended up not reading their own health signals. One of them had different health problems all through her life. She just finally wore herself out.
“I had a supervisor who had two thousand hours of sick time, who was doubled over in chronic pain. She said, ‘I can’t take off from work.’ When she finally does go [to the doctor], because it gets to the point where the pain can’t be managed anymore, she finds out that she has terminal cancer. She’s actually dying.”
Deborah says many Black women believe that if we aren’t there—at home, at church, in our community groups, at work—everything will fall apart. “I don’t believe that anymore. It’s not healthy.”
Privileging her health and well-being takes on particular resonance as Deborah ages. She is in her mid-sixties now and sees the toll that lifetimes of personal neglect can take on Black women. The Sapphire-influenced idea of the always-feisty older Black woman is a myth.
“I’ve really started to tune out what society says aging should be for me. Instead, I’ve been looking at people like my mother and her social circle and how they’re handling being old—their health issues, their finances, and things like that.
“Before, where I might have just gone to the doctor and been quiet and listened and said, ‘Okay,’ now it’s more like, ‘Wait, I need to ask you these questions. Do you mind if I write down what you’re saying or record it, because it’s a lot to be taken in?’
“I took an online course on aging. It just gave me an entirely different perspective on the subject itself. But it didn’t address Black people. That’s critical now, because a lot of Black women are not realizing the later years of our lives can be lived really differently.
“I’m not interested in being forty [again]. I was very different mentally at forty and physically. At forty, I was really strong; it almost killed me. I admit that. I had too much on my plate. [Even now,] I’m constantly in the door and out the door. I’m here. I’m there. I’m sure that that’s part of fitting that strong Black woman image. I don’t think you ever just totally break away from it. What you can do is manage it because it’s not only ingrained in your mind but it’s ingrained in the minds of other people.”
Carrying the Weight
At the center of discussions about Black women’s health is their high rate of obesity (based on BMI, which was never meant to be used as a marker for health and is not calibrated for Black folks or women14). According to Sabrina Strings in Fearing the Black Body: The Racial Origins of Fat Phobia, “The fear of the imagined ‘fat Black woman’ was created by racial and religious ideologies that have been used to both degrade Black women and discipline white women.” Strings adds that fatness has been aligned with savagery—with “coarseness” and “immorality.”15
Concern about fat Black women is less about their health and more that their fatness is viewed as a visual illustration of negative stereotypes. That is why when talk turns to African American women and fatness, the conversation tends to be punitive and tinged with ridicule instead of support for women who want to make lifestyle changes and “mind your fucking business” for the ones that don’t.
In 2011, actor Boris Kodjoe caused a Twitter storm joking about “300-pound women in thongs, gnawing on chicken wings while grinding on me” and lecturing his largely Black female fan base on health.16
“No more excuses! High blood pressure and diabetes do not ‘run in your family.’ Pork chops, mac ’n’ cheese, and tons of soda do! #stopitnow.”
He also shared a list of what he termed “fat excuses,” which included spending time watching the reality show Keeping Up with the Kardashians instead of working out.
Kodjoe may have meant well, but evoking the image of a chicken-eating Mammy Jezebel and blaming Black women’s rate of obesity solely on laziness and lack of willpower misses the mark. Erika Nicole Kendall, founder of the website A Black Girl’s Guide to Weight Loss, says these sorts of assessments “burn my toast. Oh, [they] burn my toast!”17
A compassionate eye toward Black women and an exploration of the systemic issues that underscore their physical challenges might open the door to improved health and reveal “we are not as complicit as people think we are.”
Whole, unprocessed food may be healthier, but processed food can last longer and is often cheaper and faster to prepare. Those qualities are important for all working women trying to make ends meet and feed their families, but they are especially important to Black women, who are more likely to work, to be single parents, and to live in poverty. In addition, some research shows that food deserts—urban neighborhoods and rural towns without ready access to fresh, healthy, and affordable food—disproportionately affect Black Americans.18
“How hard is it to get to where the healthy food is?” Erika asks. “When you go to your grocery store and you look in the produce aisle, are they properly keeping the produce? When you walk over there and you reach for an orange, do you see mold? Is the grocery store pleasant? Dirty? Do you see bugs there? Is your grocery store actually a glorified bodega? And when you get your food, how hard is it for you to get your groceries home?
“All of these are issues that heavily affect those of us with the least amount of money, and thanks to a history of racist policies in America, those of us with the least amount of money are Black.”
A 2012 study that revealed that two of every five African American women say they avoid exercise because of concerns about their hair caused no end of fat-Black-woman shaming.20 But the issue is not pure vanity, Erika says, pointing to America’s history of demonizing Black women’s natural hair. Keeping textured Black hair straight means keeping it away from moisture that could make it revert to its natural kinky state. Restraightening hair can take considerable time, and repeated use of blow dryers and hot combs is damaging. At the same time, Black women are chastised for spending money on weaves and wigs. What is a woman who has been told that her hair as it grows from her head is unsightly and unprofessional to do if not avoid activities that might affect her hair in a way that gets her penalized?
Of course, the entire nation—not just Black women—is struggling with rising weight and failing health amid a culture of sedentary jobs, increased workloads, long commutes, drive-thrus, processed food, and poor health care. According to the Centers for Disease Control, more than one-third of adults in the United States are obese, and related conditions—such as heart disease, strokes, and type-2 diabetes—are some of the leading causes of preventable death.21
Dr. Virginia Banks Bright says “there is little incentive” to truly educate the American populace, much less Black women, on healthy habits, because “far too many stakeholders are making money” from our continued sickness.22
“Pharmaceutical companies are making lots of money selling hypertensive drugs. And do you know how many people are on dialysis? They are running them 24/7 now. Dialysis companies are benefiting. Nephrologists are benefiting. Food companies are benefiting.”
Meanwhile, information about nutrition and fitness isn’t easy for the average person to get. Virginia says that there is not enough easily processed information for people to know what and how much they are eating. And, she adds, “We [doctors] do not receive a lot of nutritional training. We are not trained in how to eat.”
Nor do most doctors have time to give their patients proper nutritional counseling, concurs physician Elizabeth Ucheoma-Cofield.
None of this means that it is impossible for Black women to take control of their weight and health. Virginia lost seventy-five pounds and became a runner at the age of sixty after a lifetime of struggles with weight. Her wake-up call came when her weight put the health of her knees in jeopardy. Elizabeth lost the twenty pounds she gained after taking on a challenging job as a medical director and undergoing brain surgery.
Erika Nicole Kendall is among the Black women challenging the useless way others talk about Black female bodies and helping sisters get empowered, educated, and healthy besides. As with beauty, fitness is another area where Black women have created something new in the absence of others caring about what they need.
“We are going into our own communities. We are offering boot-camp classes. We are offering demos. We are offering conversation. We are hosting events where we talk about these things. A lot of the more popular YouTubers that do natural living and health and wellness are women of color.”
But the idea that Black women are indifferent to health and wellness means that our efforts are often ignored. Erika tells of attending an event where the owner of a fitness studio effusively thanked her for attending.
“He’s like, ‘Yo, I’m really glad to see you out here ’cause you know, Black women—they don’t work out like that.’”
That’s probably news to the more than one hundred thousand women who visit the site A Black Girl’s Guide to Weight Loss each month. Visitors include many non-Black women who enjoy the opportunity to congregate, learn, and offer each other support and encouragement. But the website holds a specific appeal for African American women happy to find a place online that speaks specifically to them in language that is frank and affirming.
“I talk about being poor and coming from a project in Cleveland and moving to the suburbs as a teen and then now living in New York as a professional writer,” says Erika, adding that many Black women not only can relate to her personal story but also appreciate her vulnerability. “Even if you can’t relate to the experiences, you can understand the humanity and that’s not something that we often see or are allowed to see Black women display in public media.”
Her readers know that Erika understands how challenging becoming healthy can be. She has lost a total of 176 pounds. More importantly, she changed how she treats her body: she learned to eat better and to move her muscles. Today, Erika has received certification as a personal trainer, with additional certifications in nutrition, weight loss, and women’s fitness, from the National Academy of Sports Medicine. She says that she is “very slowly taking the steps to pursue a doctorate in epidemiology,” to help better connect disparities in wellness to disparities in economics.
The results have been liberating, she says. She no longer has to grab the top of her car door to pull herself out of the driver’s seat.
“I remember the day that I could get out without doing that, and every single day since then I jump up. Whenever I have to stand up from sitting, I will just jump up just because I’m like, ‘I’m so glad I can do this now.’”
She can run. She’s more agile. Her balance has improved. And she’s strong.
“I have multiple bookshelves and I’m constantly rearranging my living room. I can do that by myself. My husband comes home and he’s like, ‘Did you have someone help you get the house like this?’ And I’m like, ‘Nope, did it myself.’ I feel good. I feel capable. And I think that’s the most important thing, that feeling of capability—the feeling that I can do it on my own. That’s so powerful. That’s a self-esteem booster right there.”
Self-esteem is not the enemy of good health. Despite propaganda that tells Black women they are ugly, they still can manage to love themselves. That is a blessing rather than a curse. A 2012 study revealed that although Black women are heavier than White women, they have “appreciably higher self-esteem.” It found that 41 percent of average-size or thin White women reported having high self-esteem, while that figure was 66 percent among Black women considered by government standards to be overweight or obese.
The correct response to this finding, Erika says, is not “How dare these Black women think that they are attractive” but instead to probe how damaging strict beauty standards must be that even the women who represent the pinnacle of beauty in America can feel bad about themselves. But asking that question requires probing the negative effects of patriarchy in America. And we don’t want to do that.
Many women in Black communities don’t grow up having thinness associated with beauty, Erika says. “We didn’t grow up feeling that we had to be bone thin in order to be attractive. We didn’t grow up being told over and over that you won’t get a husband if he can see a love handle. But my White girlfriends back home in Indiana? They absolutely received messaging like that. And they bent over backwards—and sometimes forward over a toilet—in order to make sure that they maintained that.
“I don’t think we got that message and I don’t think we need it. If we need anything, I think we need to understand that self-love is not just having a fresh hairdo, fresh nails, shoes, and a fly outfit. We need to understand that self-love should also incorporate taking care of our health. We can teach that without making it punitive, cruel, or insensitive.”
Instead, in Erika’s experience, what will help Black women collectively achieve good health is education, love, and support, and not just as these relate to physical fitness.
“We all need a mental escape every once and a while, and I think that having people around who understand, [who say] ‘Listen, if I don’t give her a break she’s going to snap. If I don’t help her out what is her future going to look like? What are her kids’ futures going to look like?’ A village is about more than [caring for] children. It’s about good friends. It’s about support. It’s about having loved ones who actually display love and are not just burdens or frustrations.”
Killer Secrets
In 2003, the California Black Women’s Health Project found that only 7 percent of Black women with symptoms of mental illness seek treatment.23 And, according to a 2009 National Institutes of Health manuscript, a 2008 study of African American women’s perspectives on depression found that many “believed that an individual develops depression due to having a ‘weak mind, poor health, a troubled spirit, and lack of self-love.’”
A member of the mental health profession currently working in higher education, Adrianne Traylor says, “I am cognizant of our community being left out of mental health discussions, not having appropriate access to mental health support, the cultural restrictions and barriers that keep us from seeking that support and that there are really not enough competent therapists to deal with situations that are unique to the Black experience in America. Finding a Black therapist to refer a client to is extremely difficult. Even when it comes to self-care, I think, ‘Who am I going to talk to? Who am I going to refer myself to? Who can I talk to who can really understand what makes my situation unique as a Black woman?’ We really lose out in the mental health equation—particularly when it comes to areas of depression, stress, and anxiety.”24
Members of the Black community often learn that mental health care is something they neither need nor can afford—economically, socially, or culturally. Black folks are encouraged to take it to the Lord in prayer, but Adrianne stresses that many mental health issues cannot be ameliorated by a pastor, a friend, or family. Some mental illnesses require intensive therapy or psychotropic drugs, and not getting that treatment can be devastating.
Her own family provided her with a strong example of this cultural challenge. Adrianne says she grew up surrounded by women who exemplified the positive aspects of “Black women always being strong and resilient and always being able to carry everything.” But as she grew older, “I saw the [unwillingness to pursue mental health care] weighing more heavily on the women in the family, because it seemed they were the ultimate repositories for sanity and intactness for everyone.”
When she was a teen, the house where Adrianne was born burned down. It was her grandmother’s home and had been the center of many family memories. The loss was devastating to Adrianne. “But I remember watching [my grandmother], who was temporarily living in this itty-bitty house out in the country, and on the one hand admiring her strength. She had lost everything—her physical mementos of her life with her husband—everything. She seemed so strong and seemed on the surface to be coping. But I wondered what happened when she went to bed at night. What did she do then, when no one was looking at her? I started thinking if we were wearing a lot of masks to get through our lives and whether they were helping or hurting us.
“As you become older and more aware of family dysfunction … it is an awakening. You’re oblivious to things as a kid and then your eyes open. You realize that the things that seemed like such strength could have really been someone doing what they could to hold things together.”26
Thirty-five-year-old Vivian St. Claire* is a high achiever, perfectionist, and inveterate “good girl.” She earned a PhD before she was thirty “because I was bored.”27
Vivian also suffers from clinical depression. And three years ago, she had a nervous breakdown, driven in part by her relentless drive to meet societal expectations.
Despite her academic and professional success, Vivian couldn’t shake the notion that she was a failure as a woman. A late bloomer in affairs of the heart, who was always more confident in intellectual pursuits than romantic ones, Vivian was childless and single, having just broken up with the man she once thought she would marry. “I never wanted to be the single Black woman, and I think that fear created that whole pressure.”
Her undiagnosed clinical depression began to spiral out of control as Vivian grappled with fears about her personal life, her weight, and other issues. She began taking Ambien to cure the insomnia it caused—Ambien, red wine, and occasionally marijuana.
“I would black out,” she says. “It was just all this very unhealthy mix of me trying to hide from a lot of different things. I know I was all over the place.
“Another part of my depression is I had a pact with myself: if I wasn’t married by thirty-five, I was going to kill myself. I very much planned everything out for my life. At thirty-five, my plans ran out,” she says. “That came out when I had my breakdown. My parents were in the room. While I was being evaluated, my mom was just sitting there silently crying.
“I would like to be more open with my struggle with depression—let close friends and things know,” says Vivian. But she admits her openness is tempered with the realities of being an academic hoping for tenure and a desire not to “embarrass” her parents. Although they were there during her breakdown, they still have not processed her mental illness.
“My mom is fine with it for other people, but not her children—even though her brother is a paranoid schizophrenic.” As her parents helped her complete paperwork that would commit her to the hospital, Vivian was surprised to hear her father answer in the affirmative when asked about mental illness on his side of the family.
“‘Oh, yeah, your Auntie So-and-So has this. Your uncle is paranoid schizophrenic and whatever.’”
Black families often keep mental health histories under wraps, treating suffering members like guilty secrets. Quoting author Nalo Hopkinson in the book Brown Girl in the Ring, Vivian points out, “We as a people—our secrets are killing us.”
It was a hard road back to mental health. Healing required that Vivian learn to be gentle with herself, to practice physical and mental self-care, to let go of her perfectionism, and to refuse to see her mental illness as a stigma.
“Today, I would say I’m the healthiest I’ve ever been—mentally and physically. I’ve come to a peace with myself. Yoga, therapy, being open about my mental illness and my medication, having coping mechanisms, and staying healthy—they are just part of my life now.”
Her voice catches as she describes her pride at making it through: “At this point, every day it’s a blessing that I’m happy, that I’m content with myself, and that I’m okay. I’m very proud of myself. I’m proud every day, because at least I keep holding on. It’s not so much of a struggle for me anymore.
“Putting other people’s pressure on me almost killed me. I’ve had to become comfortable with the uncomfortability of not being perfect. I’m amazed at the woman that I have become…. Sorry, I’m getting a little emotional, but it’s been hard. It’s been very hard. But I’ve earned a life beyond thirty-five years.”