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(ASH)

Hello, welcome to The Fat Lip, the podcast for fat people, about fat people. I’m your fat host, Ash, and today we’ve got a big blinking content warning before we even start. On today’s show I’m going to talk about death. Like a lot. I’m going to talk about what considerations there are when fat people die, about dignity in death for fat people, and about what your options are after you die. We’ll also be talking about weight and weight limits. This is intense stuff, especially in the middle of a pandemic, and 2020 has been A LOT already, so consider this permission to leave this episode for another day (or another year or another decade) until you’re ready to think about this stuff. And if you never can, that’s okay too! 

Okay, we will proceed now. And again, feel free to turn me off at any time if this gets to be too much. 

I decided to make this episode because with everything that 2020 has thrown at me, I’ve been thinking a lot about mortality. I don’t think I’ve ever been afraid of dying, but I do feel very anxious thinking about the people in my life who I will leave behind. And the reality is that there’s nothing I can do about that. I will die someday and my friends and my incredibly loving husband will be shattered by it. And I fucking hate that. The worst part about thinking of dying is that it will hurt the people I care about. But it is inevitable. So I’ve been thinking about what death will mean for me and for them and how my fatness will inform what happens. 

So I decided to do some research. And it occurred to me that this is something I’ve never really seen discussed in the fat community. I think we probably avoid this topic whenever possible because the outside world already tells us so often that we’re doomed to die. (As if we aren’t all, regardless of body size, going to die, but I digress…) 

And it’s also just really tough to think about and to talk about and the information isn’t just out there and readily available. Even in death fat people experience barriers to accessibility, and those barriers increase the fatter you are. 

Which is just wild, right? Everyone’s always telling us we’re going to die, and you’d think that if fat people were dying in these huge numbers the way the medical community and the public at large imply we are, that fat post-mortem and funerary information would be everywhere! And you’d think that the funeral industry would be used to handling fat bodies and all of the equipment would be more than ready to handle us when we die! 

Turns out that that’s not the case though. Which is so, so interesting to me. 

Anyway. 

So the first thing I wondered about was dignity in death for fat people. This is something that I do worry about when I think about dying. Not so much for me–again, I’ll be dead so I don’t think I’ll care how my corpse is treated–but I can’t imagine how absolutely devastating it would be to be the loved one of a person who has died and to hear disparaging comments about fatness from the people you have trusted to care for your fat loved one after death. 

Now I don’t know anyone in the funeral industry personally, and I’m sure that most of them are nice people, but what I know about being a living fat person is that a surprising number of otherwise “nice” people are incredibly fatphobic. So I don’t know what the solution to this is, to be honest. 

There is a channel on Youtube called Ask a Mortician which is run by a mortician named Caitlyn Doughty, and she actually did a video a couple of years ago called Dying Fat. I am actually leaning a little bit on the information she shared in that video here on this episode because she gives a very succinct look at what your post-death funerary options are as a fat person. But in the beginning of the video she said that her most asked question about the death of a fat person is whether or not their body will be treated in a dignified manner. I think many fat people, like me, worry that our bodies might be mistreated in some way after our deaths. But Mortician Caitlyn in her video assures us that fat bodies are treated with the same care that not-fat bodies are. 

Which is really great to hear. But also I am the type to need more assurances than that. So I think that if you’re the type to have a death plan (and from doing research for this episode I’ve learned that we should all really have a death plan) maybe part of that should be interviewing funeral professionals and choosing for yourself the person or people who will be handling your body when you die. 

What Mortician Caitlyn does say, though, is that it’s super important that, when you die, the people around you know to be honest about your size when they call a funeral director or whoever else might be handling your body after death. Whoever that is needs to be prepared with possibly a larger gurney, possibly extra people to help move you, etc. And it could be incredibly traumatic for your loved ones if the people who come to remove your body are ill prepared. Again, something to put in your death plan. 

Now there are many choices you can make about what happens to your body after your death. I think we traditionally (in the US anyway) think of funeral home care, but there are other options as well as some limitations for those of us who die fat. 

Let’s start with traditional funeral options and those considerations, though. For most of modern history in the US, most people have chosen traditional burial after death. For fat people, though, the standard burial funeral packages may need amendments. For one thing, some fat people will require bigger caskets than the industry standard. A standard casket measures 24” wide on the inside and can accommodate most people under 350 pounds. For those of us who are fatter than that, though, a larger casket is needed. Some funeral homes are now stocking larger caskets, but some must be custom made. They are available, though. There are caskets that can accommodate a body that is up to about 1000 pounds. 

Another thing to think about, though, is that often a larger-than-standard casket requires a larger than standard burial plot. Many cemeteries bury in a tight grid to optimize space, and a casket that is extra wide might not fit in their plots. You should look for a cemetery that has reserved space for larger caskets or that has plots that are a little more spaced out to allow for extra room. And unfortunately some cemeteries will require fat people to pay for two plots side by side. The fat tax persists, even in death. 

And actually, funeral costs for a fat burial can be quite a bit more expensive as well. Some funeral homes charge up to $3000 more than for a not-fat person based on the extra needs of a fat body–more personnel for moving and preparing the body, a larger vault for the casket, extra embalming costs, etc. 

So what about cremation? In recent years cremation is edging out burial in popularity in the US. And I think many people think of cremation as the cheaper option. This can be true, but also depends on when and how the body is cremated. Some people choose to still have a traditional funeral and have their body cremated after that. In this situation, many of the expenses of a burial funeral still apply. Only the cemetery and burial expenses are avoided. So cremation for a fat person could still come with those considerable extra costs. 

There is a cheaper cremation option though, often called “direct cremation.” With this decision there is no funeral home funeral, no wake, no visiting hours, and you never lie in a casket. After death the body is taken directly to a crematory and can be cremated in a simple cardboard container. Each country or state has their own requirements when it comes to direct cremation, so do this research when putting together your death plan as well. 

For fat people in particular, though, it’s important to contact the crematory before transportation to make sure that they are experienced in cremating fat bodies and that their crematory machines can accommodate a fat body. Some crematories are not equipped to handle very fat people. Another consideration is that very fat bodies require more heat over a longer period of time for cremation, so finding a crematory with experience in doing this safely is important. It might require some shopping around, but cremation of fat and very fat bodies is totally possible. 

And again, cremation of fat bodies often costs more. Some crematories charge between $100 and $500 more to cremate a fat person, again because of the extra personnel needed for handling and moving a fat body. 

There is a third option, though, depending on where you live. More and more states and localities have begun legalizing a process called alkaline hydrolysis (or aquamation or water cremation.) In this process, a body is placed in a pressure chamber with a mixture of water and potassium hydroxide, heated to 320 degrees Fahrenheit, and then heated under pressure for 4 to 6 hours. Essentially what happens is that the combination of chemicals, relatively low heat, and pressure breaks the body down into its chemical components. I don’t know if anyone else finds this stuff interesting, but I do. In the end this process results in two outputs. The first is a fluid that is rich in amino acids, salts, sugar, and peptides that can either safely enter the sewer system or be used in a garden or green space. The second output is the bone remains that are now soft, porous, and able to easily be crushed in the hand. Often these solids are ground to a fine white ash and the family may keep them just as they would flame-cremated remains. 

So the advantages of alkaline hydrolysis are many if your state or country has legalized it. This type of disposal uses only a fraction of the energy required for flame cremation and produces fewer pollutants. Currently 18 states in the US have legalized this process so if you’re interested, check into it in yours. 

But what are the considerations for fat bodies with alkaline hydrolysis then? Well from what I have been able to find, the only concern is whether your body will fit in the facility’s machine. Mortician Caitlyn says that standard alkaline hydrolysis chambers will accommodate bodies up to around 500 pounds. Some facilities do have larger equipment as well. So really if alkaline hydrolysis sounds like the option for you, it’s just a matter of making sure it’s legal where you live. 

There are of course other, rarer, options for what happens to your body after death. 

One option that I have always been curious about is donating my body to science. I have always had huge misgivings, though, because again it’s hard to trust that my body would be properly handled after i’m not around to protect it. But in theory it would be amazing for fat bodies to actually receive thorough study. We know very well that fat people and fat health are dangerously under-researched and it would be amazing to know that my body could help fat people even after I die. 

However. In researching for this episode I found again and again that most research facilities that accept bodies donated to science do not accept fat or very fat bodies. Some facilities say that they only accept bodies between 170 and 180 pounds. The highest limit I found was 250 pounds. Which is so discouraging. 

From what I read, most facilities say that fat bodies are too difficult to transport and store. I also read from one director of a medical research school that bodies donated to science are mostly used for first year medical students to dissect so they can learn what the inside of a body is quote “supposed” to look like and that ideally they need to see “perfect” bodies to learn. 

When I read that I found it incredibly telling. Like NO WONDER fat people receive such poor treatment from the medical community. They are literally never taught about fat anatomy. The medical community only values quote perfect bodies as educational tools. No fucking wonder. 

So in summary, if you’re a fat person who dies right now, there is little to no chance that your body could be donated to science. 

Well, that’s not entirely true. The alternate option is to donate your body to a forensic body farm. These facilities study human decomposition and teach forensic investigators how to determine how and when a person died. Which won’t exactly help living fat people. But it is an option if you’d like to have your body donated to scientific research. Most body farms, though, also have weight limits. Another thing to research for your death plan. 

But what about organ donation? Many fat people have been told over the years that they are not able to donate organs. Like everything in the medical community restrictions around organ donation seem to be based on BMI instead of on actual health, so you will find many organ donation organizations do place weight restrictions on donation. However, I do know that when my fat grandmother who was very passionate about organ donation died in 2002, they were at least able to use her corneas and skin.

And actually a new study on heart transplantation just came out a few weeks ago. It found that there were no significant differences in short-term outcomes, one-year survival rates or long-term death rates between patients who received a heart from a fat donor and those who received a heart from a not-fat donor. Which is infuriating–the transplant list for hearts especially is so long and so many people die waiting while fat donor hearts have been turned away. But now we know that fat peoples’ hearts are just as likely to be successfully donated as not fat people’s.

This is a huge discovery, and I hope that studies on other organs follow. And I hope that the donation organizations and the medical community start to open their minds and facilities to fat donors. So many lives could be saved if not for this particular kind of medical fatphobia. 

Okay, I think I covered most of the fat death bases here. I’m going to put a reference list on thefatlip.com so anyone looking for further reading can find it. 

In summary I think what is most clear is that no matter how fat you are when you die your final wishes can be honored and that with research and planning and conversations with your loved ones you can insure that you will have dignity in death. 

I was talking to a friend about fat mortality recently, and it occurred to me that fat people are often sold this story that we are somehow more mortal than not-fat people. We are told so often that we will soon die that I think many fat people worry about death a lot. We worry that we will be blamed or shamed for our own deaths. But the truth is that thin people are exactly as mortal as fat people are. We will all certainly die. No matter what we look like or how healthy we are. And there’s no shame in being mortal. There’s no shame in dying. No matter what anyone says, there’s no shame in being what was ultimately a pretty delicate creature who did their fucking best with the time they had on this planet. I for one won’t let anyone take your amazing resilience and ability to survive for however long you managed it away from you when you die, no matter how fat or not-fat you are. I hope you’ll do the same for the fat people in your life. 

Thank you to Starcrusher for the music you heard on today’s show. Hear more at cstarcrusher.bandcamp.com. 

Thanks also to our Patreon patrons. The patron of the day is Brenda who is my best friend’s amazing mom and who has done so much for me. Thank you so much Mama Brenda for supporting me and this show. 

If you would like to support the show for as little as $2 a month go to patreon.com/thefatlip to learn more.

Don’t forget to follow the pod on social media. All of those links can be found at the top of thefatlip.com. I’m most active on Instagram as always! 

Also! I’m doing a Zoom hangout on Sunday October 4 at 4pm central exclusively for Patreon patrons! If you’re a patron, come chat with me! And if you aren’t now’s a good time to join us! Again, go to patreon.com/thefatlip to learn more. 

Okay, that’s all I have for you today. Thanks for listening and I’ll see you next time. Bye! 

References

Aleccia, J. (2002, January 9). Donating your body to science? Nobody wants a chubby corpse. NBC News. https://www.nbcnews.com/healthmain/donating-your-body-science-nobody-wants-chubby-corpse-1C6436539

Alkaline hydrolysis (body disposal). (2020, June 27). Wikipedia. https://en.wikipedia.org/wiki/Alkaline_hydrolysis_(body_disposal)

Body Donation | Forensic Anthropology Center. (n.d.). The University of Tennessee Knoxville. Retrieved September 30, 2020, from https://fac.utk.edu/body-donation/

Doughty, C. (2018). Dying Fat: Your Funeral Options [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=71Z677IXUak

Epley, R. (2020, April 30). Donating Your Body To Science Can Help Save Lives — Unless You’re “Too Fat.” YourTango. https://www.yourtango.com/2019326931/why-fat-people-cant-donate-body-to-science

FAQs – Aquamation Info – An Eco-Friendly alternative to flame cremation. (n.d.). Aquamation Info. Retrieved September 30, 2020, from https://aquamationinfo.com/faq/

Forensic Body Farms: What You Need to Know. (2019, June 23). TalkDeath. https://www.talkdeath.com/forensic-body-farms/

HealthDay. (2020). Hearts From Obese Donors Still Safe: Study. US News & World Report; U.S. News & World Report. https://www.usnews.com/news/health-news/articles/2020-09-16/hearts-from-obese-donors-still-safe-studyLee, J. A., & Pausé, C. J. (2016). Stigma in Practice: Barriers to Health for Fat Women. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.02063