After the jump, an American-style cornucopia of observations and theories about which Americans are overweight and why. I have been fascinated to read this mail and am trying to share some of the most interesting or representative parts.
First, why med students aren't fat, from a fourth-year med student from Indiana:
"1) From what I've seen, class is a massive factor when it comes to obesity. For us, it's actually frighteningly easy to quantify class when seeing patients -- we rotate through 4 different hospitals here and the term "Wishard Patient" is a well worn code among students/doctors/nurses/etc. Typically, it's used in the context of trauma (gun and knife club) but it's depressing how routine it is to see diabetic patients 50/100/150 lbs overweight in the populations that can least afford care. When working in a clinic for the local indigent population I saw a whole family where I'm certain every member was at least 100 lbs overweight, and a 14 year old girl already weighed over 250 lbs.
2) For some reason, there are very few fat medical students or residents. Undoubtedly some of this is class, but the number of overweight students is too low to be attributed solely to that. This actually kind of surprised me, because I've known my share of fat doctors. My dad was a physician and could have stood to lose 30-40 lbs for most of his life... But I'm constantly amazed at how fit my class is. I can think of maybe 5 people I'd call "overweight" (let alone obese) in a class of 280. I probably work out less than the mean, and I'm 6'2, 200 lbs, lift/run sporadically but play tennis once a week minimum. I have friends who literally look like they can bench press trucks. Some people just never NOT go to the gym, even on their most brutal rotations (sometimes that can mean 100+ hour weeks). That's really inspiring to me.
"But the moral of the story is why that's the case? Undoubtedly some of that is self selection, but I think a lot of it is that the medical hierarchy can be incredibly cruel to the overweight. I suspect it's much harder than an overweight candidate all else being equal to get admitted to medical school to get admitted (maybe even relative to other professional schools or graduate schools). I've seen superiors (staff, residents) just blatantly insult the weight of subordinates -- what comes to mind in particular is a staff physician constantly berating an extremely overweight resident to his face. And honestly, I sometimes wonder how patients would react to an obese physician -- is it tough to tell someone to quit smoking when you're a 100 pounds overweight? I'm not sure."
Are cars the problem, or suburbs? A view from Austria:
"Interesting last post about the perils of car culture. I think it's dead on, but I wanted to emphasize that it's not just cities that come out looking good. The lesson is closer to, it's suburbs that are bad.