Nancy Pelosi is not Fat-Shaming You

She might be contemplating opening and ice cream shoppe, though.

My mom, before she went to the Pentagon to write ethics regulations had to deal with a case where a patient wanted to bring suit against a doctor who had written on her chart that she was “obese.” Well, she was. That is the term. To her credit all mom had to do to get her to drop the case was explain that “obese,” is the medical term. The patient had understood it as an insult and didn’t understand why the doctor had written it on her chart. She felt that it was insulting and demeaning.

And to be entirely honest, that’s kind of fair. Yeah, the patient was a bit silly for trying to pursue such a case in the first place but that she realized her mistake I feel exonerates her. But this brings up several kind of interesting phenomena in medicine and the American culture of fatness and fat-shaming.

Before I get too far into this I want to make it clear I have and always have had weight problems. I oscillate from overweight to underweight and I have an eating disorder which makes me basically unable to enjoy food normally and can plunge me into fits of depression with no warning. Some of this is related to my autism and some of it is just your standard run of the mill American girl issues. I’m also one of those people who can gain and lose weight both fat and muscle at the drop of a hat. One time, I lost thirty pounds in a month and it takes me about the same time to get zee Arnold muscles. So when I talk about fat-shaming or thin privilege or medicalization of fat not only have I done my research, but I’ve lived it.

Ultimately though, what I want to talk about today is Nancy Pelosi supposedly “fat-shaming” Donald Trump. Guys. Guys. No. I’m sorry, but you can’t get mad at her for having ice cream one day and then accuse her of fat-shaming the next.

When doctors talk about obesity, morbidity, and mortality we’re not being dicks. (And yes, I get to include myself here because my PhD is in Palaeopathology and I do talk about obesity, morbidity, and mortality.) I get that “morbid,” also has a kinda … well … morbid lay definition, but in a medical context it’s just ‘regarding disease.’ So if something about your body is making you unwell then it is morbid. This doesn’t mean you’re a bad person for having a disease or being unwell, it just means you have a disease or are unwell. HOPEFULLY you have a doctor who will attend to you in a reasonable and empathetic manner. But the term “morbid,” in medicine is not meant as an insult. It’s just what we use when we’re talking about disease.

Now, medicine does have a bit of a history for using some silly or outright problematic terminology. Off the top of my head there’s “hysterical,” “juvenile/sub-adult,” and “senile.” “Hyster,” refers to the uterus and … yeah it’s bad. Let’s just say, vibrators have a very weird origin story. (And if you really want a horror show look into the history of gynaecology. It’s basically a long series of non-consensual invasive pelvic exams for women of color.)

The “juvenile” or “sub-adult” debate is pretty specific to palaeopathologists, forensic pathologists, and osteoarchaeologists, but … there’s issues. To REALLY shorthand it humans experience a relatively prolonged adolescence which these terms do not really adequately define and particularly “sub-adult” suggests that non-adults are “less than.”

And then … “senile.” Ah, “senile.” Not sure EXACTLY when this term was discontinued as an age group — and yeah, that’s what it used to be, everyone over about 50 was “senile,” — but I shouldn’t have to explain how this is problematic. And so I won’t.

The point is, there’s a long history of medicine using maybe not the best words for stuff. The idea that doctors should humanize their patients and show empathy is pretty new. Obstetric violence is a thing that still occurs pretty regularly all over the world. Just imagine that. There are doctors that see no problem with humiliating and actually hurting their patients. That may be a bit extreme but even doctors who really mean no harm make mistakes. When my mom transitioned to full-time regulatory work both writing regs and enforcing them (regulatory law is a bit weird) she got a lot of push-back from doctors who usually didn’t mean any harm but didn’t understand why they needed to respect patients’ humanity while conducting treatment or research.

In regards to fat this is especially difficult for a number of intertwined reasons.

The CDC puts the rate of obesity in the US from 2017–2018 at 42%. That’s a lot of fat people. From a quick internet search the UK’s rate is about 26%, France is about 11% and Japan … Japan is 3%. Operation Golden Arches has failed, my dudes. Back to the drawing board. Maybe something with sesame flavoured ice cream this time.

American obesity is due to the promotion of sugar in our diet for capitalist interests both directly driven by sugar companies and sort of accidentally created due to corn subsidies, a culture which promotes all things big, and epigenetic factors stemming from poverty and in many cases racial inequality and racially motivated violence and terror. And to be honest, this is really a partial list of all the causes. You could also add our car culture, a number of culinary traditions, and of course the availability and price of food staples and grocers in disadvantaged communities.

But just because our culture and history caused it or just because there’s so many overweight and obese Americans does not mean that fat suddenly isn’t unhealthy. It still is. (And I know what you’re thinking; it’s not the only thing that’s unhealthy. Yes, hold your horses. We’ll get to that.)

Obesity raises your risk of all manner of cardiovascular issues including heart disease and stroke. It also raises your risk of osteoarthritis AND cancer. If you are in a position that you can get to and maintain a healthy weight and body fat percentage it’s a really important part of staying healthy. This is just a thing. Now, you don’t want to be underweight either because that also has cardiovascular, neurological, and skeletal implications, but Americans are far more likely as a group to be overweight than underweight.

When you stop eating your body has to get its nutrients from somewhere or you will die. So it will start cannibalising non-essential tissues. The entire point of fat and the reason stressed populations tend to gain fat easier and have a harder time losing it is so that if there’s a famine you can live off that fat for a bit. You never want to just completely stop eating, but the existence of fat and the reason it’s such a pain to get rid of is evolutionary. Once your body gets through its fat stores it will go after the muscle and then the bone. This last stage HURTS. I’ve been there. It’s what made me realize I had a serious issue. So I’m never going to tell you that you all need to be super-de-duper thin, but if you have the option to maintain a healthy weight you should do it.

Now, once again, I do need to cast a little side-eye in the general direction of the medical community. There is a tendency for doctors to dismiss particularly female patients and people of colour who are overweight. Like I said, a lot of health issues can stem from too much body fat. And you can even be of a healthy weight and have bad cholesterol. So these concerns aren’t coming from absolutely nowhere, but losing weight isn’t a magic cure for everything, isn’t necessarily preventative of everything, and shouldn’t be a prerequisite to receiving healthcare. I have to say I get really angry when doctors turn away patients saying “your problem is due to your weight; lose it and you’ll be fine,” particularly when there exist medical problems which will cause weight gain or bloating.

So … with all this in mind, let’s talk about Nancy Pelosi’s comment.

She didn’t say anything inappropriate or even classically inaccurate. Hydroxychloroquine is contraindicated for individuals who have or may develop heart issues. That’s Trump. That’s Trump particularly because he is obese. And yes. He is obese. Trump had the White House doctor release to the public that his weight is 239 lbs and his height is 6'3". Neither of these things is accurate or factual. Barack Obama is 6'1". We know this because Obama is honest and not terribly bothered about his height. Here’s the Obamas and Trumps standing together.

Anyways, yeah Obama and Trump are roughly the same height, but if you llok closely you’ll note that Obama’s eyes are slightly higher than Trump’s meaning Obama is probably at least half an inch taller. (I’m also amused that Michelle is considerably taller than Melania.) This all puts Trump at *maybe* 6'1" but probably more reasonably 6 feet even. He’s certainly not 6'3".

Regarding his weight, this one’s harder to prove and in fact I can’t. There is a possibility however slim (no pun intended) that Trump did actually weigh in at 239 lbs. I think that’s absurdly unlikely, but it is possible. The thing though — and I’m not breaking new ground here, I think this broke on twitter of all places — the BMI charts put you in the obese category if you’re 240 lbs and 6'3". Trump at 6'1" weighing 239 lbs is still obese, but by over-reporting his height and likely under-reporting his weight it seems like he’s just overweight.

Now, if we’re being real, humans are super variable and regardless of height and weight one person’s overweight is another person’s healthy. In my vast swings of crazy body type I have had moments where I was super muscular with a low body fat percentage. At these times I was tipped into the overweight category. I did not have excessive fat at all, but I was so muscular that my BMI was at the tipping point. And that’s because BMI is not adjusted for muscle or people with giganticus skeletons like myself. (For the record right now I AM legitimately overweight and could really stand to lose a few pounds, but it’s also pretty easy for me to build muscle and that’s how I got myself into this weird situation.)

This is also why there are weight categories for martial arts. I try to stay in the middle weight range because I can smash the tiny girls who really belong in feather weight and got classed up, but if I have to fight with the heavy weights … well, they’re not fat, but they’ve got more muscle than me and will kick my butt. In karate I can sometimes make it work ’cause I am lightning but in judo it is pretty sad. Although, I suck at judo in general. It’s just generally sad.

But yeah, Trump isn’t heavy because he’s running about with extra muscle, he’s heavy because he’s fat. Sorry. I know that’s not funny, but this guy thinks that exercise makes you die fast. He is NOT muscular.

The reason his fat is relevant is at his age and body weight taking hydroxychloroquine could actually kill him. Pelosi said it with a mischievous smile, but she’s not wrong. Besides the fact that lupus patients take this and kinda need it to keep their debilitating immunological disorder from eating their neurological system Trump taking this could and in fact has inspired other people who really have no business taking this to take it. That’s really bad. If Trump has a massive coronary there’s like sixteen defibrillators and three cardiologists around at all times so he’s got a decent chance of surviving. Most Americans however, do not have a full time Secret Service detail complete with a dedicated and personal ambulance.

Additionally, Pelosi took an oath. She swore to

“support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion, and that I will well and faithfully discharge the duties of the office on which I am about to enter. So help me God.” Title 5, Section 3331

Part of this means she must — if she can — defend the line of succession. Trump has said he’s putting himself in danger. As much as it would be kinda hilarious if he accidentally gave himself a heart attack despite all the warnings, she cannot just sit back with a tub of ice cream and watch it play out. She has to say something.

So she did. And now y’all are mad.

Again, she did do it with no small amount of glee, but can you blame her? She is a grandma who put off her career until her children were all grown. She is now second in line for the Presidency and BOTH of the men in front of her are raging idiots who have utterly ignored their own oaths of offices, are acting like massive children in the worst way possible, and have directly contributed to the deaths of tens of thousands of Americans.

Donald Trump is trying to destroy the Constitution of the United States and the United States itself and she is honor bound to both prevent this and keep him from running with scissors. Can you truly blame her for finding the idea of Trump accidentally maiming himself through stupidity and inability to recognize his own poor health to be a little amusing?

I know, I know, she’s “fat-shaming,” and it hurts your feelings. But take it from a fellow fattie, this is not about … well … you. Do you have a private gym, swimming pool, tennis court, and track in your house? Do you have a professional kitchen downstairs with its own private herb and vegetable garden? Do you have a personal concierge doctor and multiple on call doctors whose job it is to keep you well? Are your groceries procured by the Secret Service from undisclosed and somewhat random grocers? No? Then you being unable to lose your weight or get to a weight you like or whatever is … well, it’s a little your fault, but unless you’re super rich you don’t have all the stuff Trump has so if you’re a little fat right now it’s far more understandable for you than for him.

If Trump wanted to lose a few pounds he easily could. You might have a harder go of it. But I doubt very much that you can easily get your doctor to prescribe and supply hydroxychloroquine. You are not President and you are unlikely to do something so monumentally stupid it results in a heart attack or death. I hope. I mean, I don’t know you, I’m just assuming if you read this far you’re either really bored or not dumb.

Now, I’m a pain in my own ass when it comes to exercise. I love it once I’ve done it because my body feels great afterwards, but getting me to lace up my running shoes or roll out my mat is an exercise in and of itself in futility. So I am absolutely not going to judge you if during the quarantine you’ve been a bit naughty. Hell, there’s a lot of people out there who for whatever reason gained weight and couldn’t get it off before quarantine. My mom was like that. And in my head my mom was the most beautiful person in the world.

Fat does not impact your worth as a person. It does not affect your beauty and whatever your weight someone loves you, someone finds you sexy, and outside of that you have value. Don’t ever let anyone tell you otherwise.

But, some people are healthy with a few extra pounds and some people are not. And no one who is obese is healthy. Again, obesity does not effect your value as a person. You’re still you. You’re still valuable. You’ve just got a disease and you need love and understanding and acceptance and control to overcome it. It’s okay to be obese as long as you understand that that much weight is not healthy and are willing to take what steps you can to improve your health. No one should pity you and no one should mock you. If they do they suck.

And guys, Trump has had everything he needed not to end up obese and to lose the extra weight when he started gaining. You do not have his resources. Many of you cannot even afford a private trainer. I certainly can’t. Again, he’s got an in house gym. I would kill just to have a single pair of dumbbells. Don’t compare yourself with him because you’re infinitely better.

Nancy Pelosi is not making fun of you. She’s not shaming you. She’s pointing out — accurately — that the President may be endangering his own life. Honestly, if you had an interaction with Pelosi she’s far more likely to offer you a scoop of chocolate ice cream than she is to make fun of your weight. Guys, this was not fat-shaming. It wasn’t even inappropriate.

Doctor of Palaeopathology, rage-prone optimist, stealth berserker, opera enthusiast, and insatiable consumer of academic journals.

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