John C. Kirk (johnckirk) wrote,
John C. Kirk
johnckirk

Weighty matters

While I'm feeling in a slightly ranty mood, I've recently been thinking about the term "fatphobia", which I've come across in nou's journal.

Digressing for a moment, I'm not keen on dogs, particularly when they bark. When I was a child, I was basically terrified of them - the only exception was King Charles Spaniels, since they're small/snuffly/quiet. If a dog came anywhere near me, I would freeze to the spot, and if it started barking at me, or jumping up at me (even in a friendly way), I'd burst into tears. Nowadays I can control myself a bit better, having confronted the fear to a certain extent. The turning point came when I was about 15, and I was walking through a local village in my school uniform. There were a couple of boys who decided that it would be fun to scare us (me and the friend I was with) by setting their dog on us, so they sent it charging towards us. It was barking, and I didn't really think it was going to hurt us, but I was scared. On the other hand, I was damned if I'd let those two oiks see it!

As I say, I'm not too bad nowadays, but I still prefer to avoid dogs. There's a building near work that has guard dogs roaming around their yard in the evening, and unfortunately they can't tell the difference between someone who's trying to break in and someone who's walking past the gate (on the public pavement) to get to the bus stop, so they'll start barking and follow along on the inside of the railing. If I do need to work late (as I did tonight), then I normally give them a wide berth, either by crossing over the road twice (before/after the gate) or by walking along the left hand lane of the road, depending on how much time I have before the bus is due. Obviously I'll check for traffic before I walk in the road, but the point is that I'd rather take the small risk of being run over by a car that I can't see coming than take the large risk of having the dogs barking at me.

The reason I mention this is that I would describe my attitude towards dogs as a phobia. I know of people who have a similar reaction towards heights, or insects, or various other things. I suppose it's possible that someone feels this way about fat people, but that's not what the term is used to describe. For my part, I might be afraid of a particular fat person, e.g. if he/she was pointing a gun at my head, but that's all. I dislike the mindset that says "I am in group X, and if you disapprove of my lifestyle then that makes you X-phobic", since it just smacks of sloppy thinking. It's the equivalent of saying that "-gate" means scandal (Watergate/"Dianagate"), or that "-blane" means death (Dunblane/"paintblane"). Admittedly I have used the term heterophobia myself, but only when I was deliberately offering an inverse point of view to "homophobia", and I may change that the next time I update my website.

This is not to say that I necessarily endorse the behaviour that people are describing when they use the term "fatphobia". For instance, when I did a Google search on it, I found someone saying that they'd been refused a table at a restaurant, and the waiter told them that they didn't need to eat anymore; that is both rude and stupid. On the other hand, I also think that some people have a tendency to overreact to any perceived criticism. So, I prefer to avoid the category altogether, and just take things on a case by case basis.

More generally, I've been thinking about some of the health issues associated with being overweight. Personally, I'm feeling a lot better now that I've lost quite a bit of weight, e.g. I'm lighter on my feet if I run up the stairs. On the other hand, I stand by what I said last summer - if you're happy being overweight, then good for you, and I'm not aiming to criticise anyone here. On the health front, I have heard that there are risks associated with obesity, e.g. heart failure/diabetes, but I'm not a doctor, so I'm not qualified to debate them. What I have noticed during my first aid training is that there are some more mundane problems, and I think it's useful to be aware of them.

First, the disclaimers: copying the example from my post earlier today, I'm basically thinking about people like Hurley in Lost, i.e. [morbidly] obese rather than just a couple of pounds overweight. Also, for the sake of argument let's assume that any injury/illness is equally likely to affect people regardless of their weight.

Suppose that you slip over in the shower and break your leg, so you need an ambulance. At SJA we have various equipment that's helpful in this situation, but each item is rated for a maximum load. I believe that our division's carry chair can handle up to 16 stone, and the one I used at Buckingham Palace recently had an upper limit of 114kg (about 18 stone). Meanwhile, the trolleybed in our ambulance is rated for 25 stone. I would hope that they're designed with a bit of margin for error, but I have heard about a vehicle that broke its winch that way - they attached it to the trolley (with a 25 stone person on it), and it was supposed to pull the trolley up the ramp into the ambulance, but instead it got ripped out of the wall (path of least resistance?).

There are some heavy duty ambulances with special equipment, but if you're likely to need one then I'd recommend telling the dispatcher when you call 999, otherwise you'll have a delay while you wait for the first ambulance and then a second delay while they call for backup. For that matter, there are also manual handling guidelines that apply to ambulance personnel, and it may be that the standard two person ambulance crew (driver/attendant) can't lift a particularly heavy casualty by themselves, so they need to call in a second vehicle (or the fire brigade) for assistance. Again, it makes sense to arrange this all during the initial phone call, to save time later on - you don't have to make a big deal out of it, but just say something like "The casualty is male, aged 23, weighing approximately 18 stone", and then the dispatcher can decide whether the extra information is relevant or not.

Based on my own experience, I remember taking a fairly hefty casualty on a carry chair at the Notting Hill carnival last year - the chair was on the ground, but I had to support a lot of her weight myself. In theory we're supposed to talk to the casualty to reassure them, but in practice it was all I could do to avoid panting too obviously, and I didn't think that a comment like "My god, woman, how much do you weigh?!" would really help much. Anyway, the ambulance manual does stress that it's important to be in good physical condition, so I'd say that this counts as an indirect health issue, i.e. other people would be at risk of greater injury/death if all the ambulance crews were unfit. I've heard some people saying that "overweight =/= unfit", but I disagree - if you need to run up 5 flights of stairs with an oxygen cylinder then the less excess weight you have to carry, the better. There may be thin people who smoke 60 cigarettes a day and can barely walk, but that just means that being overweight is one way to be unfit amongst many, rather than that it's irrelevant. That said, I've worked with some women at SJA who are smaller than me but are also a lot better than me at first aid (a couple of them are now at university studying to be a paramedic/doctor), so it wouldn't be wise to restrict personnel to "6 foot tall rugby players only".

Regarding treatment itself, I think that most people are familiar with the Heimlich manoevre, i.e. the abdominal thrust. This isn't actually the first thing you're supposed to try if someone's choking, but it is a useful step. The basic idea is that you stand behind the casualty, put your arms around them, and join your hands at the front. However, if either/both of you have large bellies then that may not be practical, i.e. your arms literally might not reach. There are a couple of alternatives - you can do the abdo thrusts with two first aiders (one standing on each side of the casualty, linking hands at front and back), or you can brace the casualty against a wall and thrust up from the front. However, if you're choking on food in a restaurant (which could happen to anyone), I wouldn't like to rely on a random member of the public knowing about those techniques. Anyway, this is probably something that's worth learning about (e.g. from a first aid manual) if you think you're likely to need it.
Tags: dogs, fat, rant, sja, terminology
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