Friday, March 18, 2005

One Size Does Not Fit All

For the purposes of this discussion, I want you to pretend the author of this article is a woman who is 4 feet, 11 inches tall, and weighs 170 pounds.

It's become fashionable recently to do things like fire smokers from their jobs, or propose "sin taxes".

Workplace Smoking Bans:

Weyco banned smokers from its payroll, began testing employees for nicotine and fired four workers who refused to take the test after the policy was enacted in January.


Today, it's smoking.

Tomorrow? Tomorrow, it's legislation to protect people from The Obesity Epidemic. If you're not within the national weight norms for your gender and height, maybe you'll be fined. Or maybe you'll lose your job. And I'll bet you won't get any assistance in helping you lose weight, because this is the Bush Ownership Society. You're On Your Own. But you'll be nicely penalized.

Now, the actuarial tables say that women who are 4 feet, 11 inches tall, should weigh something around 100 lbs.

So, turn and take a look at me. Of course, you can't, because this is the Internet. I'm overweight. But not by 70 lbs. More like 25-30. I'm not obese, though I might fit that formal height/weight definition. I feel good. I exercise every day and I eat a very healthy diet: no processed foods, little/no caffeine, and little/no alcohol. I don't get shortness of breath going up the stairs to my apartment unless something is dragging my metabolism down, like overfatigue or dehydration or something, and I can feel it when it does.

I have an Olympic gymnast's thighs - thicker! - and Tour de France calves. I can leg-press a small to medium-sized car. I have the shoulders of a man. A specific man, actually, my twin, a man who is about a foot taller than me. I measured, once, on a photo of the two of us.

Let's face it, I'm built like a tiny, somewhat curvy, top-heavy, tank. With big knockers.

I'm 4 feet, 11 inches tall. But I don't weigh 100 pounds.

So, according to the actuarial tables, you shouldn't hire me, or insure me, or take any other kind of risk on me. You should fire me or refuse me or fine me, until I meet the national health norm.

A one-size-fits-all law would say I need to lose about 70 lbs to fit a standardized idea of "healthy". A company adhering to one-size-fits-all federal or state guidelines might say to me, "lose 70 lbs or lose your job".

I don't need to lose 70 lbs. 30, max, to get back to my fighting weight, and I mean "fighting" quite literally.

But I'm screwed, because I don't fit "the standard".

Human beings are really standardized only to the extent that we are more-or-less suited for walking upright, have binocular vision, and are bilaterally symmetric (one of each limb on each side of the body, basically).

As for the rest of it - height, weight, muscle mass, fat, metabolic speed - we all vary significantly. The people who are best qualified to aim directives at each of us for the benefit of our health are those who know us as individuals, not statistical groupings or witnesses testifying before Congressional subcommittees. The people who have weighed, poked, prodded, drained, probed, and inspected us, personally, from stem to stern.

You know, our doctors.

Because MY doctor would say, "70 pounds?! You lose seventy pounds, and I'll put you in the hospital on an IV." For some other woman, 70 pounds might be just what the doctor ordered.

But that's the doctor's orders, working directly with a single patient, together, to achieve their best health and welfare.

Not a legislature's orders. Not an employer's orders. Because one size does not fit all.

Want to hear a funny thing?

All this time, I've been talking about abortion.

When a legislature promulgates a rule saying that women may only have abortions under specific conditions, no matter how hard they try, they will leave out case-by-case situations where they themselves would, if fully apprised of the circumstances, dash tears from their eyes and say, "yes, you should abort". They'll leave those out because you can't imagine every single variation on a theme.

It's One Size Fits All.

But One Size can never Fit All women across the United States. Because we're all different. Each one of us lives in a different economic situation, with different health needs or medical problems, different levels of social and familial support, different stressors, different risks, different advantages. We're all different. Not standard. You cannot foresee every single situation.

So, instead of putting the power to determine who does or does not have an abortion in the hands of the people most removed from the specific circumstances, and therefore least-qualified to decide whether you should have one, why not keep that power in the hands of those in the field? On the ground. In the trenches. The ones with the test results and medical history right in front of them. You know, doctors and their patients.

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