Obesity and The Subjugation of Women

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No, I am not a bra burning man hater.

I was reading a fantastic post this morning by The Crazy Crone on weight and feminism that made me pause and think. Read her take here.

Since I am on the medical side of things as a physician:

I don’t think the clinical term obesity was intended back in the day to be used as it is today and, at least in my practice, it is not intended to be used as a derogatory term. It is purely clinical. Because it means what it does and weight is such an emotionally charged issue, no matter what term we use, I suspect people would feel the same. There are points where weight HAS to be addressed, such as in the context of severe arthritis or diabetes. The problem is that many physicians have not had weight problems (the selection process for medical school has a bias towards “attractiveness”) and they lack compassion and empathy when addressing the issue with their patients.

Yet there is way more to this issue than just doctors’ responses.

One of the terribly disturbing trends that I see now is that employers are doing much of the shaming. I don’t even have to bring it up.

The big push right now, at least in the US, is for employers to do biometric screenings on employees. I fill out countless forms every year informing employers what my patient’s BMI is as well as their waist circumference, cholesterol, blood sugar, and blood pressure so that they can “earn” a discount on their health insurance.

This bothers me greatly.

On some level, to keep insurance costs down, having a healthy population helps. Yet, I am not sure how shaming someone for a BMI over 25 is going to make them a better employee.

For instance, this week I had an RN from the affiliated hospital tell me that they were pushing everyone to have a certain BMI. They told everyone that they wanted to be the premier healthcare provider in the country and as such, in order for employees to maintain credibility, they have to be “skinny”. She shrugged it off as if it was no big deal but commented she needed to shed a few pounds. Her BMI was 25.5! What is worse is that she was not even using the medical system’s insurance. She was on her husbands and did not have to participate in the biometric screening for insurance purposes. The hospital was driving this independently, doing BMI’s during staff meetings.

The Abercrombie and Fitch of healthcare? I don’t know. Is it really about health or is it about the appearance of health?

I am not sure why having a bit of elevated blood pressure or some diabetes affects an employee’s ability to perform their job. Sure, make employees see their PCP and supply a piece of paper that says they have done this every year. Screening is good for early detection and intervention. Why do they have to invade privacy by asking for actual numbers that are not relevant to job function? Why can’t this remain between the patient and their physician?

To carry this further, as pointed out by The Crazy Crone, this undue focus on weight disproportionately negatively affects women. Most of my male patients couldn’t give a rip if their BMI is 25. But my female patients care. They care very deeply.

I don’t want to go so far as to say this is a vast conspiracy to subjugate women. Generally, those instituting these policies genuinely believe they are doing the right thing, but it does give me pause. How much more powerful would we be as women and human beings if we were not so distracted by trying to meet someone else’s often unattainable definition of beautiful or even “healthy”? If we loved ourselves more? If we loved each other more? If we had good self esteem and not self loathing?

Sure, we should be healthy. We should take care of ourselves and our bodies. Extreme obesity does decrease life expectancy and costs more healthcare dollars. Yet studies have shown, repeatedly, that people in the bit overweight category actually live longer than those of “normal” BMI. Check it out.

And that, my friends, is my own two cents worth.

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18 thoughts on “Obesity and The Subjugation of Women

    • Absolutely. But employers require that calculation. It has become the catch all. I have patients ask me all of the time what their BMI is. I don’t want to talk about that number. I want to talk about being healthy, the behaviors you need for being healthy. But even THAT is questionable. For instance, “Avoid butter! Butter is bad, margarine is good!” And then, “Ooops! Trans fats. So sorry about that.” It is frustrating and embarrassing being a clinician sometimes.

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  1. I agree that BMI is a frustrating measurement. My husband is a bean pole, I actually think he could stand to gain some pounds, but because he has so much muscle he’s considered overweight according to his BMI. So maybe he should just stop exercising and lose some muscle mass since fat weighs less? Total nonsense.

    I have a question though…… when you say that the selection process for medical school has a bias towards attractiveness, is this bias more so than the general bias that the world has towards attractive people? I think that attractive/thin (I put a slash there because oftentimes I think the two are interchangeable) people tend to have an easier time navigating through life in general, so I’m just wondering if this is more marked in the medical school context.

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    • Well, I don’t know that there are any studies to that effect. I just know anecdotally based on my own experience. There may also be other reasons for this. For instance, professional women tend to delay childbirth.

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  2. I think we do way, way, way, too much accepting. Love yourself. Nothing is ever your fault. Pathologize bad behavior. Daddy yelled at me so now I can eat myself into a monstrosity. Half the children I see (at least half) are overweight or obese. This was unheard of thirty years ago. I think we will soon be at a point where obesity is the norm and the gulf between healthy and unhealthy will be even wider. As is the gulf between those capable of sophisticated thought and those who are not. At times in my life when I’ve put on a few pounds I tell myself “you are a fat lazy fuck. Put down the fork and get running. Run til you stop being fat.” And that works great. We need more shame in the world. Buckets more.

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    • Right? That is probably coming. I am supposed to submit my BMI and other numbers but I choose instead to pay the higher premium for my insurance. I have that luxury. Most people don’t. I was talking to a woman in another healthcare system that has linked BMI to the actual premium. Not submitting the numbers but instead having it BELOW 25. She was commencing a two week liquid diet…

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