Thursday, June 6, 2013

The Stigmatization of Fat

This post is about fat. No, not the fat in coconut oil and Kerrygold butter that we're told will 'clog our arteries' by the 'experts'. This is about the fat that people wear or don't wear, and how it changes the way that they're treated. This flight may contain ranty-ness, so please fasten your lap belts before takeoff.

Today, there was a post on Mark's Daily Apple about the stigma of obesity, and it's an issue that I want to write about. I know that I'm writing this from a position of privilege, that I've never been overweight and I've never experienced it myself. But it doesn't matter that it's not me. It's friends, family members, acquaintances, strangers, fellow members of the species homo sapiens who are treated as less than because of the shape of their bodies. It's not right.

 It makes me angry because it's a symptom of a culture obsessed with weight, diet, body image, and thinness. It's the same culture that drove me to spend an hour a day on an elliptical in a windowless college gym, to pound out miles on the pavement running. It's the same culture that leads people to go vegetarian in hopes of losing weight, drives people to binge-eat cereal in the middle of the night, or exercise compulsively. It's a culture that says that your body is who and what you are, that a perfect skinny body is good and virtuous and a fat body is fat and lazy and stupid, paying no attention to the person inside that body, and disregarding what it took to attain that body. We are so much more than our bodies.

It's the bias in medical treatment that really makes me angry. Nearly half of medical students show bias against overweight and obese patients. Patients go in with pneumonia, polycystic ovarian syndrome, strep throat, migraines--and if they are overweight, they may be told that they are sick because they are fat, and that the solution is to lose weight.

They are sick because they are infected with a virus, because they have hormonal dysregulation, or a neurological problem, not because they carry extra adipose tissue on their bodies. I don't mean to imply that doctors should be blind to weight, but rather that they should treat patients who are ill based on their symptoms, rather than assuming a conclusion based on appearance. I mean to say that doctors should treat all their patients as equal human beings, not as patients and sub-par fat patients.

A woman I know is in her residency at a hospital in the Bronx in New York. The Bronx population, statistically, is mostly minority, mostly lives under the poverty line, and has high rates of obesity--coincidentally, residents have some of the least access to grocery stores and healthy food in the northeast. She mentioned--in passing, because she thought it was funny--that some of the doctors refer to an obese patient as a "Bronx Medium," and a morbidly obese patient as a "Bronx large"--effectively dehumanizing them. The doctors are less inclined to suture an obese patient after surgery, because it takes longer and is somewhat more difficult because there is a thicker layer of adipose tissue. So, often, they don't suture. They use surgical staples, which cause much greater scarring. When a patient is fat, they receive a lower standard of care.

I'm in training to become an EMT while finishing coursework to enter a physician assistant program. So the anti-fat bias in medicine, and in our society, is one that I'll continue to see for years to come. I hope that it never stops making me angry, because if it does, I'll have accepted it as normal.

How does this relate to paleo? One of the things that I love about the paleo community is that it challenges the conventional wisdom (when it comes to whole grains, grassfed beef, hours of cardio). It can be countercultural. It doesn't shrug and accept the status quo. So we should question this particularly warped aspect of conventional society. We should know that there's more to a person than his or her body,  strive to be whole human beings, and treat others as such.

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