A physician-to-be looks at Fat Pride

There is a movement called Fat Pride. Marilyn Wann, the author of a book of fat activist essays entitled "Fat?So!" is widely considered to be at the forefront. It supports taking back the word 'fat,' just as the gay rights movement has taken back 'queer,' stripping it of its shameful and painful connotations. As one of my fat activist friends explained to me, "I'm fat. So what? I could say I'm Rubenesque, or generously proportioned, built for comfort and not for speed. But to the rest of the world I'm fat. Why dance around it?"
At a medical school, of course, we are taught that fat (dietary or bodily) is anathema (for those readers who majored in biochemistry and haven't read anything but Cell since sophomore year, anathema means really really bad). Virtually every lecture touches upon it in some way, from last year's biochem lecturer who seemed almost pathologically obsessed with saturated and trans fats (she cut one of her favorite baked goods out of her life entirely when she discovered they contained what I believe was 2 g of trans fat per serving--but then I speak as the person who has a hang up about fiber, which is no less pathological, and has me tallying my 25 grams a day in my daily planner)...to this year's pathology talks on cancer, in which dietary fat intake presents significant increases in malignancy risk. Obesity is a risk factor for cancer, for heart disease, for type II diabetes...yes. This is true. But there are other findings which are not discussed, and furthermore--and more disturbingly, to my mind--there is an atmosphere of...distaste for the obese that permeates our education, and which has no place in the training of future caregivers.
For one (yes, I should cite the study. Go to pubmed, and I have no doubt you'll be able to find it. I know saying 'A study said' without further citation is the gravest sin a scientist can commit. Mea maxima culpa) when overweight but cardiovascularly fit, exercising individuals and 'normal weight' but unfit individuals were tracked for seven years in a longitudinal study...the normal weight couch potatoes were at a higher risk of death. Interesting. Granted, in a social milieu that fosters sedentary life and cheerfully offers to Supersize everything, poor eating habits and inactivity often come together and produce someone who is unhealthy--and who also happens, through the normal workings of thermodynamics, to be overweight. But are all overweight people snarfing deep-fried Oreos and calling Guitar Hero their 'cardio for the day'? Of course not. Look, Grasshopper, and you will see...shades of grey. Yes, I know I spelled it the British way. I like that way better.
As for the distaste for fat people--which we medicalize and sanitize by calling 'overweight or obesity'--that is a much more malignant issue. My medical school class is not a cross-section of society by any means, perhaps most especially (and I find this intriguing) not in terms of body habitus, nor in health habits. Almost a dozen of us--out of 124--ran the St. Louis Marathon last year; many others ran the half-marathon. Today in class, I watched the snacks people were eating: four apples, one bag of carrots/celery, one bag of trail mix, a banana, and numerous diet Cokes. And as for body size, well, we are FAR below the widely cited "1 in 3" obesity statistic. Approaching, in fact, 0%. Perhaps that makes it easy for us to think of the obese as "them": it's something that happens to other people, something from which we (with our daily workouts and carefully planned 1800 calorie, low fat, high-fiber diets) are saved by our superior willpower.
I worry about this.
I worry that this will create physicians who think that nagging, insulting, preaching or condescending will get people to lose weight.
I worry that this will create physicians who think 'fat people' are to blame for all their health problems and are undeserving of sympathy and empathy.
I worry that we haven't found a way to help people who want to lose weight but can't, and that this may be partly because we think fat is a moral failing.
I worry.

Things'll be different, baby. Promise.

So the new school year starts on Monday, and tomorrow we have our one and a half-hour 'second year orientation,' which the class ahead of us has said is basically 90 minutes of having the fear of God put into us...ie, this year we have real grades, this year even more is expected of us, no more messing around, no more procrastinating and trying to cram everything in two days before the exams, etc. A sort of preemptive strike against laziness; a preventive spanking.
Problem is: this is what I have going through my head 24/7, in stereo and at a volume setting of 11 (out of 10). Do I really need to have the shit scared out of me to do a good job? Especially when I'm already, so to speak, flowing in that direction? Now we have Honors, High Pass, Pass and...*Not a Pass* as grading options, rather than the previous Pass/Fail. Of course, I'm going to shoot for all Honors, but do I need to go to Gunner Attitude Boot Camp tomorrow to get ready for the coming year? Maybe I'll have a little Xanax before I go... Am I high strung? Pas de tout.

And this year it'll be different. Not so much with the studying (I studied a fair amount last year, and didn't generally put things off...just tried to stay on track, rather than trying to learn a semester's worth of material in three days like some people I know...who shall of course remain nameless), but with life. A balance. Social activities, studying, exercising, and perhaps most pertinent for those reading this: blogging. I'm going to update this site, if not daily, then at least 4x a week. Hopefully there will be hilarious hijinks to recount, poignant moments to share, and my strange mix of hippy-dippy idealism and cynical misanthropy to vent. Join the fun!

This first 'block' of courses includes
Pathology, ie: 'When stuff goes wrong,' or 'Looking at the process of disease' or 'The Microscope's Revenge: The Return of Histology--this time it's nasty.'

Pharmacology, or 'Yes, we can make even DRUGS monumentally un-fun. Who remembers what gets processed using Phytochrome 450? Or perhaps more trickily, what doesn't? Hands? Tell me the difference between adrenergics and cholinergics and be smart about it!'

and Otolaryngology, or "The only lecture you're really going to remember is the one about things kids have stuffed up their noses."

Pelvis and perineum, you say?

Yes, sex has officially become boring. Not just because it's been reduced to memorizing the branches of the pudendal nerve, the difference between the corpus spongiosum and cavernosa, and the inferior hypogastric plexus. No, (oversharing alert) I've also started to feel the effects of the massive quantities of Zoloft I'm taking, which means that while I'm not having panic attacks every day, nor considering jumping onto the Metrolink tracks, I am also somewhat lacking in the libido department. Granted, looking at all the photos of rectovaginal fistulas and elephantiasis of the scrotum in anatomy lecture may not have been the most...titillating, either.

Anne, I hear you saying, you write about anatomy all the time. We almost never hear about physiology or histology; sometimes you write about biochem or a selective, but rarely. Is anatomy really that big of a time-suck? Does it really weigh that heavily on your mind? To which I answer: yes, dear reader. Yes, indeed it does. And the bitch of it is, you really do need to know it. It's not like, say, some of the more esoteric histology and biochem lectures, where one could argue that the majority of physicians aren't going to need to know about post-transcriptional modification of mRNA in their practicing lives (if ever...ok, maybe at a bar trivia night, but then again, there was never a damn question at Lew's trivia night--In KC--that I knew by virtue of being a hoity-toity neurosci/German studies major. Mostly it was about sports, and weird/arbitrary 'pop culture'--so you know my scores were always in the crapper. Add to that the fact that it takes one--count it, one--Bud Light to knock me on my ass, and there you have it: the reason I never won 50 bar dollars. In Ithaca, on the other hand, the questions were of...ahem, pardon me while I have a snobby, elitist liberal moment here...a higher caliber, and the Telluride group always cleaned up nicely. I spent a bare minimum of my own money at The Chapter House. Good times).

In the course of my studying, I have come across a handful of words that I've fallen head over heels (make that cranium over calcaneous) for, and here they are:

acetabulum: where the femur (thighbone) articulates (connects) to the innominate (hip bone). Sing it with me...the thigh bone's connected to the acetabulum...

infundibulum: a cavity opening either into a tube or into the outside world; there is an infundibulum in the right ventricle of the heart, one in the fallopian tubes, and one in the shaft of every one of your little hairs.

Don't they just sound like Harry Potter words, like mad incantations? Can't you see Hermione Granger shouting, "Infundibulum!" and laying out a Death Eater? Can't you see what a huge dork I am, augmenting my dorkiness further by referencing a children's fantasy series in relationship to anatomy?