A Few Scattered Thoughts

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A few scattered thoughts as we settle into 2023 . . .

Caroline Garcia, a French professional tennis player ranked fourth in the world as of this writing, recently went public about her struggles with bulimia. She reportedly explained, “Everyone is different. Some don’t eat anymore, I was the opposite: I took refuge in food. These were times of crisis. You feel so empty, so sad, that you need to fill yourself up. It was the distress of not being able to do what I wanted on the court, no longer winning and suffering physically. Eating calmed me down for a few minutes. We all know it doesn’t last, but . . . It was an escape. It’s uncontrollable.”

She and I have never worked together, met, nor communicated with each other in any way, nor am I familiar with the particulars of her medical history and eating disorder history, so of course I am only speculating, but it sure sounds to me like she still has a ways to go in her recovery. For example, her discussion of “temptations” in the players’ restaurant suggests that she still might have some trigger foods and/or a dichotomous view of foods in which her mind sorts them into groups of good and bad.

Having said that, one of the positive steps she has taken towards recovery is allowing herself more freedom in her eating. For example, she is quoted as saying, “Now, if for two days, I want a pizza, I’ll take my pizza and it will stop obsessing me.” With every eating disorder – whether bulimia nervosa, anorexia nervosa, binge eating disorder, or anything else – removing restrictions is always part of the solution.

While I was lifting weights at the gym earlier this month, I overheard two high school boys questioning the bench press technique that their muscle-bound trainer was teaching them. Seeking a second opinion, the trainer asked another young man who responded to the boys, “This guy knows everything! Look at him; he’s a beast!” The boys were right to second-guess their trainer, whose directive to bounce the bar off their chest increases the risk of harm and decreases the exercise’s effectiveness.

The more macroscopic problem exemplified here is that some people continue to make the mistake of confusing appearance with expertise. Nearly a decade ago, I gave a presentation that I called “Looking the Part: Patients’ Size-Based Biases Toward Their Practitioners and How to Handle Them” at the 2015 Association for Size Diversity and Health (ASDAH) conference. As I prepared my talk, I found research indicating that patients make all sorts of appearance-based judgments about their practitioners. For example, patients indicated they were much more willing to discuss sensitive issues like their psychological, sexual, and social problems if their doctor was wearing a white coat. Research also shows that patients make assumptions about their caregivers’ abilities based upon age, gender, hairstyle, and even whether or not the practitioner is wearing a name tag. If some patients prejudge a practitioner’s expertise based upon something as silly as the presence/absence of a name tag, then it should come as no surprise that research shows that patients also make assumptions based upon a practitioner’s size.

Having been a personal trainer myself, I can tell you that clients and potential clients hold similar biases based upon a trainer’s size, physique, athletic achievements, and other factors, when really none of that has anything to do with a given trainer’s expertise and capacity to help the client at hand. My client load grew immensely after I rode my bicycle from Seattle to Boston because people assumed that I must be a great trainer if I could accomplish something like that. While I appreciated the uptick in business, the premise behind it was ridiculous, as I was certainly not a better trainer upon my return than I was before I left for my trip. If anything, I was probably worse due to the exercise science knowledge I forgot while I was away.

Trainers often – but certainly not always – have lean and/or muscular builds, but that does not mean they hold some secret that will help their clients to attain similar results. Because of their biases, potential clients tend to gravitate towards trainers who have the type of bodies they want for themselves, while other trainers, who might be great trainers in actuality but fail to look the part, starve for clients before ultimately switching professions. Furthermore, size-based bias also prevents some potential trainers from entering the field, such as a patient of mine who wanted to be a CrossFit coach, but she did not think she would be successful because of her body size.

The truth is that appearance and expertise are independent entities. Conflate the two at your own risk.

Back in November, I wrote a piece about a college buddy who recently died after being hit by a car. Shortly after publishing it, and thanks to some feedback that I received from a longtime friend, I realized that I made a mistake similar to the very one that I was criticizing. Whereas some people jump to blaming the victim without enough information, I did basically the same thing by blaming the perpetrator without taking into account the bigger picture.

We live in a society in which following the law is a suggestion that can be disregarded with little fear of consequence. Examples are numerous, but for the sake of brevity, here are a few that immediately come to mind: doctors who blatantly and knowingly commit insurance fraud yet are still impaneled; above-the-law politicians who are still in office instead of prison; maskless police officers, train conductors, and transit drivers who defied the mask mandate rather than enforce it; ubiquitous underage drinking; and dog owners who behave as if their pet is too special for the leash law.

My daughter used to like to watch cars and trucks, and I would see many drivers holding their phones despite the hands-free law that had gone into effect. Drive the speed limit and watch the line of tailgating traffic elongate behind you. Do pickup trucks even come with turn signals?

Sometimes I wish we had a list of the laws that we are actually supposed to abide by and those that are just for show so everyone could be on the same page. As it stands, each of us picks and chooses which laws to follow and those from which we rationalize our special exemption. The absence of both consistent enforcement and appropriate modeling from our leadership has neutered our system of laws. We tolerate this, and I have no idea why.

We also seem to be okay with huge billboards that are designed to literally distract drivers from the task at hand for the sake of capitalism. We could have floodlights that illuminate a crosswalk when a pedestrian pushes a button, but we do not. Instead of crosswalks, we could have underground passages or overhead walkways to avoid the risk of a car and pedestrian ending up at the same place at the same time, but such structures are rare. Instead of blinking little yellow lights or flashing red lights, we could have normal traffic lights that turn solid red for pedestrians in crosswalks, but I only see these at intersections where cars have to stop for each other anyway. Better yet, we could install the kind of solid red lights that have white strobe lights in the center for increased visibility, but these are few and far between. Guys, things do not have to be this way.

So, here comes my friend, a father of two young girls, entering a crosswalk unequipped with any of these aforementioned safety measures, on his way to meet his wife for dinner. And here comes the teenager – who has grown up and learned to operate a vehicle in a society that has normalized careless driving and repeatedly set the example that following the law is a personal choice rather than a requirement – who will soon kill him. Maybe it helps us to feel better to condemn the driver, to act as if their behavior is somehow an exception to the norm, and to claim that they alone are responsible for my friend’s death. The truth, though, is that we all are.

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