I in no way regret my decision to join the Navy to go to medical school. The opportunities I’ve been presented with, the financial security that I’ve got, and the community and support my school provides is amazing.
But there are some things about the whole system that are incompatible with my way of thinking. I’m putting this rant on my fitblr blog instead of my normal blog because this rant is primarily based in health and fitness, and how frustrating I find the whole thing to be.
For one, the emphasis on weight by the military at large. I’ve talked about this with other people in my class, and there seems to be a general consensus that health and fitness are more important than weight. If you can pass the PT test, do all the push ups and sit ups and run like a maniac, why should it matter if you weigh 164 lbs vs. 163 lbs. Why should it matter if you weigh 200 or 250 lbs if you look professional in your uniform and can perform similarly to everyone.
This is especially true when you consider that a woman my height CANNOT weigh above 163 lbs without being body fat tested. BUT but but, a woman my height can get a waiver approved to weigh as low as 95 lbs. How is a 5’6” woman at 95 lbs any more healthy than a 5’6” woman at 170 lbs? In my mind, it’s not. But the emphasis remains on being skinny over fit. A girl in my class binge eats to be above her weight limit on weigh in day. But she can barely pass her push-ups/sit-ups. She’s not strong enough. She’s weak because she’s so tiny. How is that better than starving yourself before a weigh in but still being able to pump out well over a good score? It’s not.
But the emphasis on skinny = healthy isn’t just a command instituted idea. It’s rampant in the mind’s of my classmates in a way that’s SUPER!! irritating. For example. Today, I was discussing with my roommate a friend of mine. He’s super sweet, very smart, always helpful, but he weighs quite a bit, probably well over 300 lbs. I think he lets this get to him because he doesn’t take care of himself in other ways. As in, sometimes he’ll only have his shirt tucked in halfway, or be all disheveled in other ways. To me, he’s subconsciously thinking “Ya know, I already look like shit, why bother?” That’s not true though. He doesn’t look like shit. He’s a good looking human being.
As long as you have confidence in who you are and pride in how you appear, it doesn’t matter what your body looks like. You will radiate a much different image if you show the world just how amazing you are. Tuck in your shirt. Comb your hair. Be proud of you. Your weight does not define your worth.
I’m telling this to my roommate, and she’s agreeing. I say the phrase, “As long as you have confidence, in how you appear, it doesn’t matter how much you weigh.” She agrees. An eavesdropping classmate jumps in, “Except for the fact that it’s SUPER unhealthy to weigh that much!” I say, “As long as he is happy with his life and his body, who am I to tell him to change?” She responds, “Uhh, you’re gonna be a doctor! It’s your job to tell someone if they’re killing themselves. You need to convince him to make a change.”
Yes. I’ll get right on that. While also convincing every patient with lung cancer to stop smoking. It’s difficult. No. It’s impossible. If a patient doesn’t want to make a change because they like how their life is, there is nothing that I can do as a physician. And the funny thing is, smoking is actually strongly correlated with lung cancer. Being obese isn’t correlated with anything once you account for all of the other confounding variables (cardiovascular disease, diabetes, etc). Yes, obesity is a risk factor for developing these conditions. But if you’re considered obese, and you haven’t got them, there’s really nothing all that different about you.
And the thing is, that even if it was something strongly correlated, like smoking, I still can’t make them change. And I’m sure as hell not going to let my patient’s choices influence my level of care for them. I will treat that smoker with lung cancer the same way that I will treat the child with a brain tumor. Because they’re both still people who deserve my respect and my care. They have families that love them and care about them. And people come from all different backgrounds and circumstances and who am I to let societies standard’s of beauty dictate my patient’s worth?
Finally, I would just like to say that it REALLY grates on me to see the double standards in this population. Because so many people in my class are naturally athletic and naturally skinny. They’re blessed with miraculous metabolisms, and they LITERALLY cannot fathom any differently. They don’t get it. They can’t imagine it.
Today, we had our PT test. One of the tiny skinny girls in my class, she went home and her dinner was pizza hut pizza and ramen. Her diet regularly consists of craft mac and cheese, ramen, fried quesadillas, pizza, bread sticks, fried BLTs, chocolate bars, peanut butter cups, whole boxes of cookies in one sitting, and sugary cereals. She doesn’t and has never weighed more than 110 lbs at 5’7”. She does not work out. Ever. The only time I’ve ever seen her eat a salad is when I offer up my left overs (and she has already finished one lunch and eats mine too).
We’ve talked about this. I can eat a salad every day for a year and maintain my weight. If I ate like her, I would weigh literally thousands of pounds. She knows she’s not healthy. She knows she’s lucky because of her metabolism. If you ask her, she’ll tell you that. When I complain about my metabolism she says, “Ha! You’re so lucky! You HAVE to eat healthy to look good. I eat whatever I want. You should see my cholesterol! It’s off the charts! I’m probably going to have a heart attack in my 40s!”
She knows. She knows how terrible her lifestyle is, but she isn’t inclined to change. She’s not alone. Another girl in my class, who happens to be in my carpool, made us stop at McDonald’s on the way home so that she could buy “Two cheeseburgers, chicken nuggets, fries, and a milkshake.” She’s a size two. This is her life. She makes fun of her average sized roommate for only eating salads and whole grain cereal.
So here they are. People in my class who are VERY aware that weight doesn’t equal healthy choices. Yet all they’re concerned with is weight. They would tell their obese patient they need to make some lifestyle changes because they’re killing themselves (when who knows what that person is eating every day, maybe they’re a vegetarian who hasn’t eaten a partially hydrogenated fat in 10 years). But because they themselves are skinny, they’re not willing to make the same lifestyle choices. Even though they’re arguably just as unhealthy. Or more.
I don’t like being vindictive. I don’t like wanting revenge. But honestly, I hope one day their metabolisms slow down and they learn what it’s like to have to watch every single calorie you put in your mouth. I hope they learn what it’s like to be shamed for how you look even when all you ever eat is healthy foods. I hope their doctor tells them, “Ya know, you should really lose some weight because you’re killing yourself because you’re a fat slob.”
Because until you’ve lived that, you can’t really know what someone is going through. And until you’ve lived that, you’re not qualified to tell someone they’re not good enough. You’re never qualified to judge.
And for god fucking sakes, you’re going to be a doctor. Don’t judge your patients. Don’t praise them for losing weight when they’ve been throwing up with a stomach virus for two weeks (true story). Don’t encourage them to stop eating (true story). Don’t make their lives worse than they already are. Do your fucking job. Be compassionate. Understand their struggle. Treat their illness and treat their minds. Treat them like you want to be treated. Treat them with some fucking respect.