The Race to End Fatphobia
The picture above is one that I took several years ago in a Wal-Mart early in the morning, on my way to work in the local ER. The scooter jockeys looked to be likely ER customers in the not-distant future for any number of real or perceived maladies. When I took the pic I didn’t realize I was outing myself as a supporter of “ableist heteropatriarchal capitalism.” I just thought it was commentary on our soft times, and I thought it was funny. I still do.
Marquisele Mercedes doesn’t think it funny at all. She is “a writer, creator, and doctoral student from the Bronx, New York. As a Presidential Fellow at the Brown University School of Public Health, she works at the intersection of critical public health studies, fat studies, and scholarship on race/ism, examining how racism, anti-Blackness, and fatphobia have shaped health care, research, and public health.” She alleges a bad experience at age 13 in the ER as having been due to “fatphobia.” Mercedes states: “The truth is that fatphobia is a scientific invention. Fatphobia did not penetrate science; it is derived from science.”
“No Health, No Care: The Big Fat Loophole in the Hippocratic Oath,” proclaims Mercedes, and she says a lot of fun things like that in this essay, like “When you look at a fat person now, regardless of your own weight, you see a manifestation of ob*sity because of a social process called pathologization.” And here I had foolishly lumped in “fat” and “obesity” together all these years.
Or “It is proven that weight loss is a useless, hopeless endeavor. You are unlikely to lose weight in any permanent way and highly likely to open yourself to the myriad risks associated with weight cycling.” It goes on and on.
Right on, in fact to being a mandatory part of the UCLA curriculum for first year medical students. I remember feeling like trying to pass histology that first semester felt like a “hopeless endeavor” – and all the while I could have been learning important knowledge, like “colonialism” and “liberation,” or “Womxn and Two Spirit.” I have no idea what “womxn” are, but I clearly missed out on something important to treating patients equitably.
Did you think the head/neck section of gross anatomy was tough? Ha! Imagine having to learn “Combating Incarceration, Housing Injustice, and Environmental Racism with Community Organizing-Community Health Impact.”
That Mercedes’ bloated essay on fatphobia is required reading for the first year students explodes a lot of myths I had been indoctrinated with over the years. Blown-out knees, recalcitrant hypertension, renal failure, insulin resistance, depression, strokes, heart disease, low self-esteem, bigger grocery bills, having to buy an additional airline seat… none of that is caused by obesity, but is really my fault: Verbalizing concern to patients over “individual health behaviors, risks, and events like “poor eating and exercise habits, mental illness, and mortality because most weight stigma research is in support of ‘obesity prevention’ efforts” was apparently the exact opposite of what I should have been doing.
Offering a pill for every complaint, praising a 400-pounder’s healthy glow, and apologizing for the shocking state colonialism has left the climate in are apparently the best ways to prevent that next pulmonary embolus. This scenario will be a question on the next ABFM board exam, count on it.
I’ll never forget subbing in the wound care clinic. A patient had been going there for 2 years. He was morbidly obese and smoked and had a Venus stasis ulcer. I explained that losing weight and stopping smoking were the best way to get this to heal. He immediately complained to administration and I was admonished. Foolish me, him coming weekly was extremely profitable. If he chooses not to address underlying causes that’s his concern not mine.
But we can solve this all with just $12,000 of drugs per year for life for 40% of the population.