Talk to me about fat.

Talk to me about obesity.

Is it really an epidemic that's sweeping the nation, as some folks would have it?

Is fat the last "acceptable" prejudice? 

Why do I ask? Well, I was noodling about looking for topics to inspire me for the Wichita Pregnancy Fitness Examiner blog, and I ran across a couple of articles talking about the Institute of Medicine (who?) issuing guideliness on how much an obese woman should gain during her pregnancy.

Instantly all kinds of bells and flags started going off in my head.

For a singleton pregnancy, they recommend 15 - 25 pounds for an overweight woman and 11-20 pounds for an obese woman.

Really? Really, IOM?

Of course, 'overweight' and 'obese' are determined by that old chestnut, the BMI scale, which is CRAP.

It's true that there are health risks in pregnancy if the woman is obese. Obese women are declared to be at greater risk or conditions and situations such as hypertension, gestational diabetes, caesarian section, and postpartum infection.

But non-obese women fall victim to these as well. And I can't help but wonder how many of these instances arise from other causes than the woman's weight. It is so much easier to point fingers at the most visible non-"normative" condition rather than dig deeper.

I found a March of Dimes article from 2004 that quoted Laura Riley, M.D. (Director of Obstetrics & Gynecology Infectious Disease at Massachusetts General Hospital, Boston, and Assistant Professor of Obstetrics & Gynecology and Reproductive Pathology at Harvard Medical School) as saying that in the pregnancies of obese women, the "fetus is at increased risk for neural tube defects, birth trauma, and late fetal death."   And it's still being cited.

Well, that's a hell of a stick to add to the flail that overweight women beat themselves daily with.

You know, I'm of two minds about this.

If folks are so worried about obese women, why not make it easier in this economy to be slimmer? Get the subsidy for fruits and vegetables going rather than the same goddamn Vitamin Wow for the corn farmers (from where we get high fructose corn syrup, which is Satan's sperm, I shit you not). Get some kind of watchdog on junk food advertising to stop the marketing of food as entertainment.

Conversely--the reason for the increased chance of neural tube defects? Not because being fat causes them--it's because due to the inability of ultrasound machines to achieve decent resolution through the body composition, defects are more difficult to detect. So, lazy fucks, build a better ultrasound machine.

The folks who are saying lose weight before you get pregnant are the ones I tend to listen to most. Why? Because this infers that people can and must plan their pregnancies. We have the technology now to decide when we want to be pregnant, or at least to decide when we don't want to be pregnant.  We know what causes this. 

We know what causes quite a bit now.  We can exercise, control our eating habits, and take prescriptions for a lot of things that people once thought were irrevocably locked to the human condition. 

Unfortunately, clear thinking about women, weight, and pregnancy  is not as easily managed.

I don't know if you've heard about the movie "Precious" coming out.  In a soundbyte, it's about an obese black girl in Harlem who's suffered incest and abuse and is pregnant with her second child.

My understanding is that the movie is not as harsh as the novel it's based upon--Push, by Sapphire.  Still, it looks pretty grueling.  I saw the first trailer a few days ago, and I believe I was shocked.

My shock didn't register at first.  What registered at first was surprise.  I mean, come on, this isn't the usual Hollywood fare.  On first glance, you might think it is--the usual story, like Dangerous Minds or Radio where attractive young PoCs are helped by Nice White (hot) Ladies or Nice White Men.  But take a look--you see any Nice White Ladies in this movie?  Are the leads hot fashionable young persons?  No.  As far as I can tell, this is a view of grinding poverty, issues of size and race and unempowerment. 

Maybe shock is not the right word, after all.  What happened, over the course of a couple of days, was recognition of something real.  And you know how often that happens in movies, right?

Here's the realness, for me:  Over the course of 12 years working for Dr. Tiller, we saw many, many, many girls like Precious.  Black girls.  White girls, hispanic girls, Rom girls.  Underage young women accompanied by their mothers; in some cases by their families.  In some instances these young women would have to obtain a judicial bypass as they could not tell their parents--in more instances than you might imagine, sometimes they could not reach either of their parents.  And yes, you would think we were helping them, and you would be right.  But the converse was true--they trusted us with their health, their secrets, their lives, their bodies.  That was grace such as I had never experienced before.

I am amazed that someone would film anything resembling the lives of the young women I have met.  I am amazed that this is not going to be about the power of Nice White People, or romantic love, or a montage of how Precious went to the Y and sweated off a hundred pounds.  What will it say about American movie-going society if this movie does well?