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Measuring Up?!

June 17, 2008

Yesterday I had to pick up a metformin refill, and couldn’t help but feel slapped in the face again by an NHS/Diabetes UK ad campaign. Not only was the pharmacy displaying one of the posters, a larger version had (probably coincidentally) been posted by the bus stop outside. Suggesting that people get checked for diabetes is certainly not a bad thing, but they picked one hell of a way to go about it.

The campaign’s title, Measure Up, kinda sets the tone. The posters offer a short list of other risk factors–one being ethnicity–but the main thrust is, indeed, the idiot’s version of Waist Hip Ratio. According to their info, women should not have waists bigger than 31.5″, while men’s shouldn’t be over 37″. Besides being based on a far-from-universal cultural assumption than men should be significantly bigger than women, this is unbelievably Eurocentric: yet another reminder that we non-Euro types just don’t Measure Up, and it’s probably all our fault.

Yep, I was diagnosed with Type 2 diabetes earlier this year, and I’m a big (to the British) apple-shaped American Indian woman. Even hideous scientific racists describe my folks as “Tall and broadly-built, robust,” with “a typically massive body build, and frequently tall stature”, even if they do feel a need to overstate common melanin levels. (They’ve even got an Appalacid subtype–who knew?) My body fat was not high before, but between the diabetes and medication side effects, I have lost enough weight that I’m losing some muscle mass now, and my cheeks are starting to sink in. This is not an attractive version of cheekbone definition, this is a version crying “famine victim!” which is all too easy to get with high flaring cheekbones. What subcutaneous fat I had is gone, to the point that veins are bulging out rather appallingly on my limbs. Who’d have thought that I’d ever start getting concerned about losing weight, given the crap we’ve all picked up from this society? Still, my BMI is likely at least 28 (I stay away from scales these days, as far as possible), and I am still officially “overweight”, verging on “obese”.

How do I Measure Up? Well, looking more closely, it seems that I should put the tape measure in the middle of the approximately two inch gap between my ribcage and pelvis. Checking a little while ago out of curiosity, my ribcage tapers down to about 40.5″ at the very bottom (from 45.5″ above the bust, which is not the widest part), and the top part of my hips came to 38″. It narrows down to about 36″ in the middle of that gap, and I can wear 34-36″ men’s jeans. My waist would just about Measure Up, were I a European man.

At least there is not as much emphasis as usual on this being something one can change, other than implied by the campaign’s title. I could probably get a smaller waist if I had some ribs removed*, but that’s about it. I guess I’m just screwed, being a member of a colonized non-White ethnic group which also tends toward robust build. Hmm, could this be a factor in West Virginia’s consistently ranking high in obesity stats, along with pretty much the rest of the South? There sure are a lot of us “invisible” Natives around, and I’m apparently close to average size for a woman from the Ohio drainage over the past 5000 years, at least. Just by looking now, I’d believe that’s still the case.

The WHR figures used in the U.S. do not apply well to non-White women in particular:

African American women had the smallest waist-to-hip ratio, with larger absolute measures for both the waist and gluteal C than the Caucasians or Mexican Americans. . .Native American women had an abdominal fat distribution pattern which was explained by more fat on the abdomen rather than less fat on the gluteal-femoral area. [This was in the Southwest. In the East, at least, a lot of us just don’t have the “feminine” hip and thigh deposits at all.] Native Americans had a different fat distribution from the other ethnic groups. Caucasians are not a good comparison group for African Americans or Native Americans because there are large differences as indicated by effect sizes in regional fat distribution.

I mean, you can tell this is so just by bothering to look at people. Knowing how that plays out back home, I had to wonder about differences here in the UK. With 20 seconds on Google, the situation does indeed look similar (backing up my eyeballing experience). From the official Health Survey for England – The Health of Minority Ethnic Groups ’99:

# Three of the groups of men with low obesity prevalence had a relatively high prevalence of raised waist-hip ratio (WHR): Indian (1.48), Pakistani (1.54) and Bangladeshi (1.33). Only Chinese men had levels of both obesity and raised WHR that were well below those of the general population.

# Among women, obesity prevalence was high for Black Caribbean women (risk ratio 1.60) and Pakistani women (1.61), and low only for Bangladeshi (0.63) and Chinese women (0.20). But women’s WHR in all six minority ethnic groups was well above that of the general population, risk ratios ranging from 1.37 for Irish women to 3.63 for Bangladeshi women.

By what standards do these qualify as “raised WHR”? Remember, for obesity, read “BMI over 29”. I have been denied some medical treatment by NHS doctors, including hormonal birth control, due to my supposed “seriously overweight” status–based solely on BMI, rather than on observation and the sense God gave a turnip. I have been made uncomfortably aware of having a different type of physique, and of being generally “too big to be allowed”, living here. I just take up more space than a Western woman is supposed to. This was far less noticeable living in an area with a very different ethnic makeup, in which my type of physique is not at all unusual.

And who is at particular risk for diabetes in the UK, looking back? “African-Caribbean or South Asian people who live in the UK are at least five times more likely to have diabetes than the white population.” Hmm, and we Amerind types have “only” 3-4 times the rate back home, toward the lower end of that for Black people. Could this have anything to do with general stress levels for minority populations? I know mine have gone up, not in small part from getting stared at on the street, not to mention repeatedly getting to hear about being bigger than a lot of the British think I should be. Racism certainly is alive and well in the US, but it actually looks good compared to what I’ve seen in Greater London. That’s pretty scary. There has been less population diversity, and for a shorter time. My mom and I were both amazed at the difference in response from many West Indians once they heard (Southern) American speech coming out of our mouths; they were obviously expecting less xenophobic treatment. Not sneering or trying to pretend they weren’t even there probably helped, too.

In some cases, scratch the “non-White” bit; “colonized” is more than enough. According to MIND , “Irish-born people are statistically more likely to be socially disadvantaged, experience high levels of physical and mental health problems and long term disability, and are also grossly over represented as users of the psychiatric services. [6] [7] [8] Research also shows that Irish men are the only migrant group whose life expectancy worsens on emigration to England. [9]” These are Irish people in Britain, today. I knew that anti-Irish xenophobia was hardly a thing of the past in the UK, but that piece made for interesting reading. *** Kind of changes the perceived privilege of repeatedly getting mistaken for Irish on the street here, I must say.

Not to mention the privilege of pretty consistently being perceived as Hillbilly White Trash, back in the US. Southern Appalachia is still getting colonized, in search of natural resources and Lebensraum. This hurts people who really are White, rather than just Black people and Indians pale enough to pass for Irish. (For that matter, there are a good number of Black-identified people just about as pale, thanks to some historical factors.)

Not only does this “public service” campaign play into nasty societal attitudes about fat–and, as usual, ignore the fact that progressing insulin resistance will make you fatter, especially in the abdomen– it’s horribly racist. Yeah, some people will say that they’re just pointing out a correlation, but it cannot be done neutrally in this social climate. It would be just as honest, and appropriate, to point out the statistical correlation between diabetes and flaring cheekbones, lower nasal bridge, higher melanin levels, and epicanthic folds in the US; they could surely think of similar here. However, that would be more obviously racist, and more people would probably think to ask why every non-White group of people living in the West is really prone to chronic health conditions. Yet again, members of other ethnic/racial groups are just not trying hard enough to be “good”, i.e. magically change their basic physiques into something more characteristic of the Euro-derived people who Matter. Yet again, there is something fundamentally wrong with us because we’re not a certain type of Western/Northern European.

As if it weren’t bad enough that a lot of us are unattractive in a masculine-looking way**** by virtue of not being White Westerners, it’s also an unhealthy lifestyle choice by which we bring all kinds of health problems upon ourselves. This campaign certainly does reinforce that idea.

Sometimes I don’t know whether to laugh, cry, or start throttling people. I really don’t.

Edit: I ran across another intriguing study: Internalized racism, body fat distribution, and abnormal fasting glucose among African-Caribbean women in Dominica, West Indies. At least in this case, it did look like internalized racism will stress you out enough to cause elevated glucose levels, which will put some abdominal fat on you independent of BMI. It’s hard to interpret this one otherwise. Another one: Associations of Abdominal Fat With Perceived Racism and Passive Emotional Responses to Racism in African American Women.

————-
* This sounds pretty extreme, doesn’t it? One of my mom’s cousins–who did get talked into a breast reduction**–also had a doctor suggest that she had too many ribs which were obviously causing her no end of problems, but he’d be happy to remove the bottom two or three pairs. I wish I were kidding. Not too surprisingly, we’ve got the same type of barrel chest, and she’s living in a more Anglicized coastal area.

** Breast size has also been linked with risk of developing diabetes. It couldn’t be that Canada has a lot of big apple-shaped First Nations women whose backup reserves are stored in breasts rather than hips, who have a much higher risk just by virtue of being First Nations, eh? To quote a researcher, “While an elevated body mass index (BMI) and the distribution of fat around the abdomen are strongly linked to the onset of Type 2 diabetes, little is known about the impact of breast fat.” I guess it’s just the horrible fat, then.

*** It also contains such gems as:

For many Irish people, living in Britain can be just as difficult as it is for people from visible minorities, i.e., people from African Caribbean and Asian backgrounds. They have experiences of prejudice and discrimination, which are similar to people from Africa, the Caribbean and the Indian sub-continent, yet they are not considered to be in need of culturally-sensitive services.
The dominant understanding of racism in Britain is seen in terms of a black-white dichotomy. Irish people are often classified with the indigenous population or with other white minorities, as a result Irish issues often remain invisible.

and:

Many Irish-born people, on their arrival to Britain, despite being white and English speaking, experience culture shock, alienation and racism. A sense of loss and feelings of alienation are common experiences shared among all minority groups. As with other minority groups the combination of social and cultural needs increases the likelihood of mental distress. The colonial relationship between Ireland and England has shaped the beliefs and the behaviour of Irish people and contributed to feelings of inferiority which are easy to reject in Ireland, but more difficult to ‘throw off’ living in England. Such conflicts occur when Irish people are confronted by negative stereotypes. They are faced with the choice of either ignoring or confronting them. Either way can be a recipe for distress.

Hmm, why does all this sound eerily familiar? (Cue Deliverance banjos.) It also helps bring home just how desperate a shape some my ancestors must have found themselves in, to have seen passing for Irish as a status improvement in 17th and 18th Century Virginia and the Carolinas. Virginia got 15-20% of the Irish sold into slavery in the colonies from the Plantations. “[F]rom 1641 to 1652, over 550,000 Irish were killed by the English and 300,000 were sold as slaves”, roughly 60,000 of those ending up in Virginia, all before the worst time period. A good number of them did marry and/or get adopted into the Native population.

**** This is from the BBC. At least they’re open about this being a Western standard. I’ve repeatedly been amazed on the street here, with the extreme gender-based difference in walking style, and a heck of a lot of it seems to be a cultural difference. I don’t think I’m physically capable of walking without moving my shoulders at all, while maintaining any semblance of balance. If your actual ribcage–never mind your shoulders–is wider than your hips, you are probably not going to be able to cultivate the same “feminine” walk, even if you feel some strange urge to do so.

3 Comments leave one →
  1. urocyon permalink
    June 17, 2008 4:12 pm

    I forgot to mention the apparent antidepressant link to diabetes risk, which I have to suspect as at least a contributing factor for me. All my diabetic family members have taken antidepressants, to my knowledge. According to that article, “The investigators found that elevated depression inventory scores, which were present in 10.3% of patients on study entry, did not predict whether patients would develop diabetes during the study, but baseline antidepressant use did.” This is not necessarily so, as other investigation suggests.

    And more than one doctor acted like I was crazy (ha!), suggesting that the excess cortisol produced by a pituitary adenoma might be making me depressed. Cortisol will do that, just in response to stress. It will also trigger Type 2 diabetes; my current GP wanted to blame mine largely on the cortisol spike from that tumor, 15+ years ago.

    Just from what I’ve seen, depression and diabetes feed each other. Blood sugar control gets worse when you’re depressed, even if you try to take care of yourself, and the poor glucose control only makes you more depressed. I am trying to break out of that vicious cycle now.

    This relationship also plays into the ethnic angle, since minorities are more likely to suffer from lots of stress and depression, and to be labelled with mental health problems and given drugs for it.

  2. June 18, 2008 7:36 pm

    Interesting article. I can put your mind at rest on one issue, though: as a white middle-class woman, being fat is just as much of a crime.

    I’m 5’10”, broad-shouldered, and my hip bones protest at the idea that I should have a 32″ waistline…

    I had a pretty bad time with my diagnosis – I don’t want to say too much in gypsy_dreamer’s LJ because of someone who is reading it – and one of the things that annoyed me most was the attitude towards exercise. After a lot of digging it turns out that when the GP said ‘exercise’, she meant ‘gentle walking’ – automatic assumption that someone with my body shape is a couch potato who knows nothing about exercise. (I kept pressing for an exercise programme beyond ‘oh, just move around’)

    Stress is definitely a big factor. I halved my blood sugar yesterday (from near 15 to 7.6) by solving a particularly stressful and anxiety-inducing situation. If that’s not proof, then I don’t know what is.

  3. urocyon permalink
    July 11, 2008 2:14 pm

    Sorry for your comment getting hung up in moderation for so long, green_knight.:/ I didn’t see it sitting in the potential spam queue, and haven’t been in front of the keyboard much lately. Mea culpa.

    Yeah, having a high BMI is a major crime these days, no matter who you are. These kinds of measures particularly seem to be substituted for any kind of judgment within the NHS, from what I’ve seen. The point I was trying to get at was that it’s really easy to fall afoul, if the figures were formulated with a completely different group in mind. This would no doubt apply to Ingvar too, if he weren’t completely avoiding doctors. I couldn’t help but notice that neither one of us looked particularly big in Stockholm, and can only hope that they’re going by more reasonable criteria there.

    Sorry you had such trouble with your diagnosis. I knew I was lucky at the time, getting hold of a new GP who hasn’t said a word about my weight. When I registered at the last GP’s, the nurse just automatically ticked “sedentary”–I spotted that, and corrected as politely as I could! (That was the GP who got outright verbally abusive about my “obesity”, and wouldn’t prescribe more BCPs.) Interesting–I didn’t know that level of exercise was what they were talking about! I’d go absolutely bonkers if I didn’t get a lot more than that. I also loved the assumption that none of us knows anything about nutrition, and we’re all eating horrible crap. Bah to lousy assumptions.

    I understand about not wanting to say much in front of some people on LJ. That’s the main reason I got this blog going–important to judge the audience.🙂

    Yeah, I’ve also noticed a big day-to-day connection between stress levels and my blood sugar. That’s one of the reasons I’m trying to deal with my PTSD more now. Even if trying to work through some stuff raises the stress temporarily, it’s got to be better in the long run! I wish you luck keeping the stress down, just dealing with diabetes and the medical establishment.🙂

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