My Fetus is Against the Patriarchy

At 32 weeks gestation, it recently occurred to me that in addition to shelter and food, the kid is going to need some sort of clothing.  We were in Richmond, VA last weekend and hit up some thrift stores for cheap baby threads.  Incidentally, if anyone is in Richmond, I recommend Diversity Thrift, which benefits GBLT-friendly HIV organizations (a direct counter to the philosophy of the Salvation Army) and has baby and kids’ clothes for 25 cents. Twenty-five cents, people!  On top of that, we are planning a major tie-dying event, so slightly stained items were desirable.  We may have gone a bit crazy, but anyway, the kid will have plenty to wear.

On our shopping trip, there were some prime examples of problematically gendered baby clothes:

Boys are all about danger and trucks and football!

And girls are all about shopping!

A common critique of gendered baby clothing is that girl clothes focus on looking cute and boy clothes focus on actions and non-aesthetic attributes (such as strength and intelligence).  But don't worry, value based on your attractiveness is now equal opportunity: 

"Does this diaper make my butt look big?"  

Seriously, people?  This is not cute, this is not harmless, this is not a joke.  This is introducing body hatred to BABIES.  It is not ok.

(I understand that babies can't typically read.  However, I would argue that 1. Our baby will be a genius, and can probably already read, and 2. emblazoning a child's torso or butt with such slogans will inevitably affect the way literate people interact with him/her, and allow the message to be sublimated).  

It feels very…greedy to say that this is why we aren’t telling people the sex of the baby.  But it's more than that.  It isn’t simply that we don’t want to receive clothes like this for gifts.  It isn’t just that we don’t want to dress our child in this absurdly gendered clothing.

The fact that baby clothes like this exist shows that these sexist, body-shaming, consumerism-frenzied, and generally problematic ideas in our culture are being delivered directly to people small enough to wear a 0-3 month onesie.  And I am not sharing the sex of my child because I want him/her to be sheltered from these gendered expectations for as long as possible.  At least until, you know, birth. 

Sorry again for the lack of updates – the thesis is finally done!  I graduate on Sunday! If all goes as planned I will have a baby in 7-12 weeks! (Holy shit, how did that happen?)

So yeah, there has been a lot going on.

But before I catch you up on that stuff, I wanted to take a moment to reply to some great comments I got on the last post. 

Lou de B made some great critiques that I would love to address.  Here is Lou’s comment, reposted for archival purposes:

Ok, but here is the thing. First the disclaimer: I am a linguist, not a medical Dr. I am overweight so this is not a thin person ranting at fat person thing. I have a long line of short tubbies above me on my Mum's side. But...

you cannot deny that obesity is a bigGER problem in the US, Aust etc than in - say - I dunno, Siberia. And that we just happen to be those that eat HUGE servings and a load of crap. In the US (I've been a dozen times or so) I have so much trouble remembering to ask for small everything so I get something equal to large in Aust. I am not kidding. Some of those coffee or drink cups are buckets. Not cups.

IF people are not drinking gallons of sugar etc AND they are still overweight, then sure, they can be healthy. I bushwalk, climb, canyon etc as do many friends who are overweight and fit. But if I'm drinking gallons of soft drink (you call soda) then my Dr should tell me to stop it. It isn't good for my health. Or my joints (which is where I'm having trouble).

This is not to deny other issues. I read The Beauty Myth at Uni and Real Gorgeous by Kaz Cooke etc. I'm very aware of the role of the media to distort images etc. But being overweight DOES lead to an increase in some conditions AND we did not evolve joints etc to be that size.

Feel free to rip all this apart. I know you know more than me!! And I ought, I guess, just read your thesis when it's done.

So let’s break this down point by point (mostly because my brain used up all its transition sentences over the past 9 months).

1. Obesity is more prevalent in the US and Australia than in places like Siberia.

This is absolutely true.  According to data collected from 1994 to 2002, the prevalence of obesity (BMI >30) in the US is 27.6% for men and 33.2% for women (Baskin et al 2005, "Prevalence of obesity in the United States"). According to a 2005 paper (Thorburn, "Prevalence of obesity in Australia") the prevalence of obesity in Australia is 19% for men and 22% for women. I could not find data for Siberia specifically, but in Russia as a whole, in 2000 the prevalence of adult obesity was 16% (Jahns, Barturin, & Popkin, “Obesity, diet, and poverty: trends in the Russian transition to market economy”). 

2. The places where obesity is more prevalent have larger serving sizes and more junk food and soda.

I can’t find any articles to specifically support this, but based on my personal experience alone, I agree.  (I know that is really flimsy, but stick with me, I will do more research on this in the future.)

That being said, the implication here is that the larger serving sizes are responsible for the increased prevalence of obesity in the US.  There are a ton of differences between the US and Russia – we could really pick any of them and make an argument.  For example, it is colder in Russia than it is in the US.  Thermogenesis burns calories.  Therefore, the temperature difference could be responsible for the difference in obesity prevalence.  I’m not saying I believe this to be true, I am just saying that the causes of obesity are very complex and singling out any one thing is unlikely to be instructive.

3. It is possible to be fat and fit.

Yes, yes, a million times yes.  This is one of the concepts that a lot of people have trouble accepting, because we have been so conditioned to believe that fat = unhealthy.  Here is one of my favorite graphs that I found in my research (Matheson et al, 2012 “Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals”):

This study looked at four different healthy habits – eating 5 fruits and vegetables a day, getting moderate exercise, not smoking, and drinking in moderation.  Researchers grouped people according to how many of these healthy habits people had adopted (0 – 4 on the X axis) and then further divided people based on BMI (normal weight, overweight, or obese).  On the Y axis, you have mortality hazard ratio – the risk that someone will die prematurely compared to a thin person with all four healthy habits.

So, for people who have none of these healthy habits, we see that BMI matters – those in the obese category are 7 times more likely to die than thin folks with all four healthy habits, while those in the normal weight category are only twice as likely to die.  However, as people adopt more healthy habits, the difference between the normal weight and obese groups disappears. 

Remember, these people are not losing weight as they adopt the healthy habits, because they are still in the obese category.  Just having the healthy habits is enough to change their mortality risk, independent of weight loss.

I would also like you to look closely at the middle bar of each group – the overweight category.  As soon as overweight people have just one healthy habit, their mortality risk is actually lower than normal weight people.  (This is a whole separate rant for another day).

4. Some fat people are not fit – they have poor health habits such as drinking soda.

This is absolutely true.  There are also thin people who drink a lot of soda.  This is a poor health choice in either group.

5. Doctors should tell fat people with poor habits to improve their habits for the sake of their health.

Yes, I agree.  Doctors should tell their fat patients that drinking two liters of Pepsi a day is not a great choice.  But there are a number of caveats I would add:

• ·         The purpose of lowering the Pepsi consumption should not be to lose weight, because it is unlikely to be effective.  I know, I know, it seems like eliminating 830 calories from the diet would cause weight loss, but long term, a ton of research suggests that this isn’t the case (Mann et al, 2007 “Medicare’s search for effective obesity treatments: diets are not the answer”).  The leptin feedback loop is a squirrely little thing. 

• ·         Instead, the point is just to replace that space in your stomach with some fruits or vegetables.  We actually have proof that eating fruits and vegetables is good for you (it’s one of the healthy habits in the Matheson study above).

• ·         Suggesting that a patient stop drinking soda is something that a physician should do from a place of understanding of both the broad environmental factors that surround consumption in general and the individual factors that affect that patient’s life.  Pepsi’s 2012 advertising budget is $1.7 billion.  (That’s Billion, with a B!) I’m just some schmuck in a white coat and I certainly don’t have $1.7 billion.  Also, if my patient is the single mother of three kids working two jobs and drinking some Pepsi to stay awake through the third shift…nagging her would be poor form.  And by ‘poor form,’ I mean judgmental and insensitive. (Though plenty of doctors think nagging is their Hippocratic duty).

• ·         Doctors should also tell their normal weight patients not to drink two liters of soda.  It’s not just unhealthy for fat people, it’s unhealthy for everyone. The other side of the ‘fat = unhealthy’ assumption is that thin = healthy.  But as we see in the above chart, thin but sedentary, drinking, smoking, and eating crap still makes you twice as likely to die prematurely.  Bringing the focus back to habits rather than bodies means bringing the focus back onto things we can actually control that are more likely to make a difference.

6. Though there is cultural bias against obesity, obesity is still legitimately linked to increased morbidity and therefore is a medical problem.

This is probably the part of Health At Every Size that I struggle with the most.  I feel like some of the more zealous Fat Acceptance folks try to argue that obesity has absolutely no corresponding health risks. 

Are all the studies of obesity and health risks done in an environment of unrecognized fat phobia so that all their results are suspect?  Yes.  Much the way those old fashioned studies about how the Negroid skull was associated with lower intelligence were conducted in an environment of racism – the world view of the scientists absolutely colors the results. 

Do almost all the studies of health effects of obesity fail to control for obvious confounding factors like health habits and socioeconomic status? Yes.

However, I still believe there are some negative health consequences of obesity.  The data on hypertension is pretty convincing.  Also, the joint issues you bring up are a great example.  That’s just physics – more weight on those joints causes more degradation.

But, as we have seen, the cause of obesity is outside of an individual’s control and weight loss efforts are unlikely to have long term success.  So yes, I think it is silly to say that obesity has no health consequences, but I also think it is silly to say that because there are negative health consequences people need to just try harder. 

Age is also linked to joint problems, cardiovascular disease, and cancer.  And physicians use this information when calculating a person’s disease risk, but no one suggests their patients try really hard to age more slowly.  And I’ve certainly never heard of a doctor refusing to treat the patient until they successfully get younger.

 

So yeah, I hope that helps flesh out my stance – I look forward to your responses/questions/etc!

Also, now that I have learned how to add pictures – here is a picture of me, planting some vegetables.  Which I totally plan on eating at least 5 of per day.  As soon as they grow up.  

The Thesis - Executive Summary

So sorry about the lack of updates.  I have been working on my thesis.  I thought briefly about posting the whole thing on here.  But then I realized that I don’t want to inflict that on anyone. 

Here’s the executive summary.

1. People seem to think obesity is a big deal.  Two thirds of American adults are overweight or obese – everybody panic!

2. Obesity stigma is prejudice against overweight and obese people.  It’s a real thing in the world, especially the world of healthcare.  It turns out lots of doctors think obese people  are lazy, weak-willed, stupid, annoying, incompetent, non-compliant, and generally icky.

3.  People justify these beliefs by claiming that obesity is under personal control.  See, it isn’t like race, because I am not white on purpose.  But being fat is a choice.  So if fat people didn’t want to be discriminated against they could just stop being fat.  (Kind of like how poor people should just work harder and pull themselves up by their boot straps.) 

4. Nope, turns out that obesity is not a choice.  Turns out nothing else you thought you knew about obesity is true, either:

            Myth: Obesity is primarily caused by poor individual choices about diet and exercise.

Fact: Obesity is caused by a complex interaction of genetic, microbial, neuroendocrine, environmental, social, economic, psychological, and cultural factors – most of which are NOT under personal control.

            Myth: Obese and overweight people could lose weight if they actually tried.

Fact: Diet and exercise do not work.  Not only are 95% of weight loss attempts unsuccessful at producing long-term weight loss, evidence also indicates that dieting often actually leads to weight gain, increased stress, and disordered eating behavior.

Myth: Obesity is a serious medical problem.

Fact: The lowest mortality risk is actually associated with BMI values officially in the “overweight” range, especially for non-whites. Few studies of the association between BMI and health problems bother to control for exercise or dietary quality.  The truth is, you can be fit and fat.

5. Our society’s prejudice against fat people comes from our psychological need to protect ourselves from the possibility of bad things happening to us.  In our society, thin = beautiful, and therefore being fat is a bad outcome.  Rather than just feel sorry for fat people, we need to insulate ourselves against the threat they represent. We need to convince ourselves that the universe is a just place, that hard work pays off, that good things happen to good people and bad things happen to bad people.  Ergo, fat people must be bad. 

6. Obesity stigma is a problem because it is a prejudice just like sexism, racism, and homophobia and it has no place in a just society.  A full two thirds of the US adult population are victims of obesity stigma, so the effects are wide-spread.  These effects include psychological distress as well as more concrete discrimination in the areas of education, employment, housing, parental rights, and others.

7. Obesity stigma is a particular problem for doctors because it means we are violating the principles of beneficence and non-maleficence.  Our current treatment of obesity (nagging patients about dieting and exercising) does not work and is often actively harmful to patients’ overall well-being.  Fat patients find the experience of coming to the doctor to be so shaming (what with the nagging, lack of appropriate waiting room chairs, gowns, exam tables, and blood pressure cuffs, and mandatory weighing) that they avoid seeking care altogether.

8. For physicians and other healthcare providers, the solution lies in embracing the principles of Size Acceptance and practicing a medical model known as Health At Every Size (HAES).  HAES is a new approach to fat patients that emphasizes overall well-being rather than weight loss.  The core principles of HAES include, “accepting and respecting the diversity of body shapes and sizes; recognizing that health and well-being are multi-dimensional and that they include physical, social, spiritual, occupational, emotional, and intellectual aspects; promoting all aspects of health and well-being for people of all sizes; promoting eating in a manner which balances individual nutrition needs, hunger, satiety, appetite, and pleasure; and promoting individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise that is focused on a goal of weight loss.”

9. Health At Every Size interventions have been proven to be effective in improving psychological markers of well-being, decreasing disordered eating behaviors, and improving cardiovascular markers of health such as cholesterol level and blood pressure.  Furthermore, no randomized controlled trial of HAES has shown weight gain to be an effect, and several such studies have pointed to HAES leading to modest weight loss. (Not that we care about the weight loss, but just in answer to all the critics who think intuitive eating will lead to weight ballooning out of control - it doesn't.)

10.  In addition to using HAES interventions with individual patients, physicians should also combat obesity stigma in their roles as practice managers and community health advocates. (For example, resisting public health messages that participate in fat-shaming in the name of advocating for personal responsibility.)

11.  In conclusion, obesity stigma is bad, doctors have been responsible for perpetuating it, and now it is our responsibility to fight it.

Whew.  That is all.

Where I Stand Now

A tremendous amount has changed in the past year, and even more is going to change in the year to come.  And so it occurs to me that now might be a good time to take stock of my life, my writing, and myself.

I set out to write this blog about medical stories – you know, those anecdotes where doctor sees a patient and learns something profound about herself or the human condition or how to be a better doctor.  At the very least, patients often say funny and entertaining things.  But it turns out I haven’t seen very many patients in the past several months; most of the stories I have written have been about old patients or my own patient and family side of interacting with the medical profession.

It isn’t as if the patients I have had have been uninteresting.  I had one particular patient that presented a fascinating medical mystery and was a great character that I really clicked with.  I meant to write a post about him for months, but I never really knew what to say about it, there wasn’t really a point or a lesson to the story.  Talking about how well we got along seemed a little self-congratulating.  And also, the story of what happened to him wasn’t my story, it was his.

I tried to re-read Kitchen Table Wisdom recently and I couldn’t make it through.  It’s a book of essay/stories about healing, you would think it would be right up my alley, but I just found it annoying.  Because every patient story had to have a lesson or universal truth you could extract from it.  It just seemed so reductive and a bit contrived.  Sure, sometimes my patients remind me of things going on in my own life and that lends itself to good blog posts.  But should it?  Maybe if I were less self-involved, things wouldn’t have to relate back to me all the time.  Maybe I would be a better healer if I were focused enough on my patients that they reminded me of themselves. 

Writing a blog makes you look a little self-obsessed by nature.  It’s a place for self-reflection, yet that reflection is all public. And really, self-reflection for public consumption is a strange phenomenon. 

I re-read all my posts so far and I realize that I have mostly been processing the same theme from every angle: the medical experience is dehumanizing.  I am so glad to have gotten a chance to process this, to move from analyzing my own experiences as a patient to integrating how I will do better as a doctor. 

Personally, having this time and space for self-reflection is a blessing. (Both the blog as a place to record my thoughts and having the past two years of relatively relaxed academic schedule to have time to reflect).  This time and space was instrumental in my re-defining myself as a healer, re-examining existing relationships and forming new relationships, and re-engaging with some of the “big issues” that had gotten shoved aside for lack of time.

But one of the most important transformations that I’ve been taking stock of lately is one that I haven’t written much about.  I’ve become an adult.  I’m twenty-seven years old.  The process feels a bit delayed to me.  I thought I was an adult at fifteen.  I thought I was an adult at twenty.  I thought I was an adult at twenty-three.  So maybe this is nothing new or special; maybe at thirty I will think how silly I was back at twenty-seven.  And I’m sure part of me will think that, because I don’t think I will ever be done growing. 

But I do want to acknowledge that an especially important transition has been happening over the past two years.  The major transition has been in the relationship with my parents.  I haven’t written much about this, because it has been incredibly difficult and feels very personal to be putting on the internets (even though I realize that functionally means sharing the information with about six people). 

But here is the shortest of short stories:  I got engaged to Benjamin and my parents lost their minds.  They strenuously objected and tried to break us up.  We got married anyway. 

This whole situation has exposed an area of my life that I don’t know I ever would have examined if I weren’t forced to.  I thought my relationship with my parents was good.  I knew we had some differences during the teen years, but I thought that we had a good relationship now and didn’t need to work on it at all.  But it turns out I had never actually separated from them in any meaningful way.  I was still looking to them for approval. 

The wedding situation became explosive because it was one of the only times in my life when my parents had actively disapproved of something I was doing.  Growing up, I was always looking for their approval.  I always wanted to impress them.  Nothing I ever did seemed to be enough; I distinctly remember my dad saying he was proud of me at my white coat ceremony because it was the only time I remember hearing those words. But nothing I did was ever met with active disapproval either.  Every accomplishment seemed expected rather than noteworthy, and every decision I made was merely interesting, never good or bad. 

Now, in the aftermath of this explosion, it’s really clear to me just how much I crave their approval, even as an adult. It’s also clear to me just how unhelpful that is to me having a good relationship with my parents, to my growth as an individual, to my marriage, and to adult functioning in general.  Seeing how much I want my parents’ approval also opened my eyes to how much time and energy I spend ferreting out approval from others as well. 

And ultimately, it is unimportant.  I don’t know how I came to this place, really.  I have always been so driven by external judgment that it would have felt impossible to accept that this is actually unimportant. But now, I find myself at peace with it.  It feels like a weight has lifted, like a requirement has been dropped.  It feels like getting to the end of the semester and having your professor tell you there won’t be an exam after all.

Approval-seeking is still my M.O. Unconsciously, I will slip back into this mode almost automatically.  It takes mindfulness to break out of it.  But now that I have given myself permission to do so, I feel stronger, more centered, more myself.  I look forward to seeing how this plays out in my role as a daughter, partner, parent, and healer.

Quick Updates

1.  I got my maternity leave details - they are simple pushing my start date back from 6/25 to 9/17.  So yay, I get maternity leave and don't have to worry about working when I am about to pop.  I will have to make up the three months later.  Also, this means I don't use up my vacation time, which is excellent because I am betting I will want some vacation.  The only bummer is that health insurance coverage does not start until the start date.  Welcome to the world kid, don't you wish you had been born in Australia?

2.  The day after my post about how I don't like to cook and am not good at it - I got volunteered to be the assistant teacher of a cooking class.  Woot.

On Cooking

I am not good at cooking.  I don’t particularly like doing it.  It’s not really my thing.

Turns out, cooking should sort of be everybody’s thing, because everybody eats.  If cooking isn’t your thing, you end up eating a lot of EZ-mac and Chipotle.  I didn’t eat great when I lived alone – things certainly got repetitive and sometimes there was some emergency EZ-mac.  Ok, there was a lot of canned soup.

Choosing, preparing, and eating food has always been sort of stressful, actually.  In high school, my mom had what I would now call an undiagnosed eating disorder and there wasn’t a lot of edible food in the house.  (Though there was always a lot of spoiled, slimy, or mold-covered food that she felt too guilty to throw away).  So perhaps I did not have the sturdiest food-behavior foundation.

Then, when I lived alone, food choices always represented this three-way balancing act between cost, health, and time.  If it was healthy, it took forever or cost too much.  If it was cheap, it was full of processed sugars and simple carbohydrates and had never seen a vegetable.  If it was quick, it cost too much and had never seen a vegetable.  As a medical student, I was short on both time and money and felt like a hypocrite if I ignored my health. 

One of the best things Benjamin did when he moved in was start cooking me dinner.  I was trying to drag myself to the finish line of my semester fueled only on coffee and desperation, and he swooped in and steamed some broccoli.  I thought he was a god. 

And he still often does this.  Last night, a girl friend came over and we hung out and Benjamin made turkey burgers and oven fried potatoes and mixed vegetables.  It was amazing.

But I’m not really pressed for time so much these days.  I have my internship and my thesis, but it is nothing like the end of the semester crunch.  Or, you know, residency.  So I feel like I should still contribute to the household eating by occasionally preparing a meal.

And it is still stressful.  I still feel that juggling act between health, time, and cost (though I have both more time and money than I did before). But the new layer I have to deal with now is performance anxiety.  I want Benjamin to actually want to eat what I cook, and I feel self-conscious about my lack of culinary talent.  Perhaps it’s some internalized sexism that makes me feel that as the woman, I should be better at cooking than he is.  Or maybe I’m just a competitive person.  But in any case, I just want to be better at it than he is.  And I am just not.  The man has talent.  And I have...a semi-edible track record.  There was some artichoke pasta I made recently that he soldiered through but I just could not even stomach.

Tonight, I made this recipe: http://www.epicurious.com/recipes/food/views/Mashed-Potatoes-with-Carrots-and-Leeks-109125.  It’s really just mashed potatoes with leeks and carrots thrown in.  It tastes like mashed potatoes with leeks and carrots thrown in (nothing magical happens with them really) but it was pretty tasty once I got enough salt in there.

I was feeling very flustered and hypoglycemic the whole time I was cooking.  And I thought seriously about just asking Benjamin if we could divide up the food chores from here on out – I would shop and do dishes if he would cook all the dinners.

But I didn’t.  Because I don’t think partnership is necessarily about specializing and not developing diverse skills.  It’s about specializing in the moment – dividing and conquering everything that needs to get done that night and still being flexible enough to switch jobs the next night.  Deconstructing rigid gender roles should mean something more and better than “I always mow the lawn and my husband always cooks dinner,” it should make men and women more competent and flexible. 

So in the name of self-improvement and a flexible partnership, I will continue to struggle through preparing dinner once in a while.  And Benjamin will continue to struggle through eating those dinners.

At least until July, when I fully anticipate everything to go to hell.  

Race and the "Default Experience"

Following the Trayvon Martin story has gotten me thinking about race. 

First, I just want to say that I am probably not properly qualified to speak on any of these topics.  These thoughts are not the well-crafted ideas of someone who has a deep and nuanced understanding of race issues.  These are the fledgling ideas of a privileged white woman who learned the word “privileged” within the past year.  So bear with me. 

As a white blogger, I feel it is important for me to share these thoughts, rather than just, say, continue to whine about the uncertainty of my maternity leave status.  Because the black community doesn’t have the option of not being affected by this story. 

I was listening to Elon James White’s podcast, “Blacking it Up,” where he describes just feeling hopeless and confused about what to do.  An older woman called in and said she was just “broken.”  How do you react to concrete evidence that your society simply doesn’t value the lives of people who look like you?

I have trouble wrapping my mind around that, I have trouble engaging with it.  It’s too big, too scary, too unjust.  And I think this is why a lot of people just walk away from this discussion – or justify why Zimmerman’s actions were legitimate.  It’s a lot easier to deal with one kid who really was up to no good than it is to acknowledge that the society you live in (in which you may be personally very comfortable) is fundamentally dehumanizing, wrong, and unfair.

I’m not ready to bite off a chunk that large.  So, I have tried to stay aware of race in other ways.  Here are just two of the things I noticed in the past few days:

1. I volunteer at a sliding scale clinic and wellness center in East Baltimore.  Most of our patients are black, most of our staff and volunteers are white.  Today I was helping with a session on stress management and we showed a movie about the physical effects of stress.  The doctor they interviewed was a black man, but all the actors that they had demonstrating the effects of stress were white.  Moreover, they were all white men in ties.  The language the narrator used was generic, he would say “stressful jobs,” but the actor would be a white guy in a tie massaging his temples as he sat before a computer screen in an office.  Clearly, he had a very stressful pie-chart presentation to give.  Bummer. 

This is not the kind of stress my patients are dealing with.  My patients are dealing with losing their jobs for taking too much sick time after their daughter was killed and they took over raising their autistic grandchild.  My patients are dealing with having a stroke at 45 and re-learning how to walk.  My patients are dealing with being laid off from the job that was already barely getting them by.  And sure, on some level stress is stress and we can all relate to that experience.  But it’s always non-whites who have to do the relating.  Because my experience as an upper middle class white person is always the default experience, even in places like Baltimore where it is not the majority experience, either in terms of race or in terms of class.

When I can expect that my experience as a white person is the default experience, that is privilege.  When you are in a position to craft how you represent the default experience, and you perpetuate that privilege – is that racist? It’s not racist the way not arresting Trayvon Martin’s killer is racist, no.  But I think it’s probably a more subtle angle of the same beast.

2. Later, I was working on my thesis, which is about obesity stigma.  I was doing some research into the Body Mass Index and found that one of the problems with it is that the cutoffs for overweight (>25kg/m^2) and obesity (>30kg/m^2) is that they were developed based on studies of mostly white people.  Theoretically, the normal weight range (BMI 20-25kg/m^2) was chosen because it represents the range associated with lowest all-cause mortality.  But it doesn’t apply to non-whites. 

For African-Americans, the lowest mortality rates are found at BMI values in the “overweight” range.  This means the NIH has duped thousands of (probably) well-meaning doctors into nagging black patients to lose weight when they are already in the healthiest range. I myself have done this, I am sure, trying to be the good little medical student supporting lifestyle change.

Here we see the consequences of white being the default experience.  Studies are done on whites and results inappropriately extrapolated to every other race.  Even when studies on other racial groups demonstrate that there are differences, the guidelines remain rigid.  The NIH claims that “there are no studies that would support the exclusion of any racial/ethnic group from the current definitions of obesity.” 

I think this example is particularly interesting because it exists at the intersection of two different kinds of prejudice – that based on race and that based on body size.  (Please note that I am not stating that one is worse than the other or that they are comparable, just that both are coming into play in this situation.)  It isn’t overt racism – no one is using the N word or shooting anyone.  Instead, it’s just this insidious and officially sanctioned suggestion that black people should internalize discomfort with their own bodies, that they should conform to medical standards designed for white people. 

I guess I am frustrated and anxious to move on to the next step.  I’ve noticed this, so now what do I do about it? Even the relatively smaller examples seem too large to wrap my mind around when I consider how to eliminate them. 

So, in conclusion, I am frustrated that racism still exists.  I was raised by hippies and would say I am oriented towards activism (not that I am particularly good at it).  But I have a feeling that on this one, I have a lot of internal work to do before I start grabbing petitions or taking to the streets.