Blue, white, red, yellow, pink, brown. These are the colors of the ties and strips of fabric around the scrub pants and tops indicating their size. At the start of medical school, I would squeeze into a red top and red pants: these were the larges. Maybe this categorization sounds trivial, but to me, it felt like a scarlet letter. This explicit color-coded system makes comparison all too easy, and I feel uncomfortable because I know exactly how many of my medical peers are smaller than me and I worry that such judgements are being reciprocated. Each time that my friends complain about not being able to find smalls and mediums, I reflexively cringe and want to simply retreat back into myself.
I’ve been uncomfortable and hyperaware of my size for years. Growing up in the South, everyone in my family, including me, was referred to as “big-boned.” Even my pediatrician used to joke that I had “thunder thighs” as a toddler because I always maxed out the growth curve. On the golf team in college, I became accustomed to ordering the biggest size clothing on the team and it always made me uncomfortable. It was slightly illogical because I was also the tallest and strongest on the team. Nonetheless, a lifetime of body-consciousness left me particularly uncomfortable in any scenario which drew attention to my size.
By the end of third year, I started wearing yellow bottom scrubs (XL) and red tops. This was a result of two factors: first, irregular eating patterns amidst a hospital work schedule had caused me to become larger, and second, I was tired of squeezing into the smaller bottoms. My friends did not have this problem — many even lost weight through medical school. They ate less and less because of stress, while I ate more.
During my third year of medical school, I started feeling increasingly uncomfortable with comments made to patients and to me about weight. I cannot count the times that providers of all levels commented that a patient should just lose weight or how they could just eat less. They would refer to patients as obese or even as “fatties” — an especially painful remark for me since I knew that my weight was similar to that of some of these patients. I was acutely aware of many of these patients’ struggles with weight management; rarely is it as simple as just losing weight.
One particularly egregious remark stays with me to this day. I was stretching my calves after a long surgical case, and I asked the other student with me if his calves were stiff, too. He responded that mine were probably just sore because I was fat. I was utterly speechless. Incapable of responding, I simply turned around and left the operating room. I never said anything to him about it, though in hindsight, I wish I had. His remark was both inappropriate and inaccurate; my calves were stiff because of the long operation, not because of my weight. Worst of all, this interaction confirmed my fears that others, even medical peers, were judging me for my size.
When I came back for fourth year, I moved into pink top scrubs and pink bottoms (XXL). I knew that I had gained weight and this was just another blatant reminder. Fourth year also introduced new situations and challenges. On the interview trail, for example, I worried about being judged for being bigger, especially as I often encountered the same thinner students and rarely saw people of my size. I feared that weight would be an unspoken characteristic upon which I would be judged — a fear that is supported by data in studies of graduate school admissions and radiology interview invites. I worried that my interviewers would view me as “lacking discipline” for being overweight or would assess me as unfit to be a surgeon because of it. In reality, I am strong, I get around the hospital just fine and most importantly, I still take care of the patients like everyone else. I do not deserve to be judged for something as superficial as appearance, though I know it is inevitable.
Rather than succumb to bitterness or despair, I have instead shifted my focus away from the color of my scrubs. They are, in reality, just scrubs, and their size does not reflect anything about who I am as a person or eventual surgeon. It is, however, time for the medical field as a whole to acknowledge its inherent size bias. Most of the students in my class would be considered to have “athletic” builds and low BMIs, but the general population, including the vast majority of my patients, are more comparable in shape and size to me. This relatability helps me to empathize with my overweight and obese patients and I always ensure that they feel heard and not dismissed or blamed for their weight.
In addition to removing biased recruitment practices, an easy change that hospitals could make to be more inclusive would be to provide students and employees with more diverse scrub sizes. In the women’s locker room, for example, there are often a plethora of smalls and mediums, but I regularly have to dig to find the last pair of XXL. I would even prefer a larger option sometimes, but I didn’t want to have to go into the men’s locker room to find them. This type of alienation is absurd — hospitals should at the very least provide a full range of sizes to accommodate a diverse body of providers.
Just as we do for so many other characteristics, we should treat ourselves and others with empathy in regards to size and weight. We don’t and can’t know the struggles each person faces in their day-to-day life and it is time that we stop stigmatizing our fellow medical providers for superficial traits like size and weight.
Image credit: Close up of a female doctor (CC BY 2.0) by shixart1985
Contributing Writer
University of Louisville School of Medicine
Alyssa Brown grew up in Chattanooga, TN. She went to Centre College for a B.S. in Biology and minor in History. She fell in love with surgery after seeing her mentor perform an anoplasty during the first year of medical school. In July, she finished her third year of medical school and wandered off the beaten path to get a PhD, before finishing her MD. She is receiving her MD degree from University of Louisville School of Medicine, and her PhD in Biomedical Engineering and Physiology at Mayo Clinic School of Biomedical Sciences. She is currently working on research projects involving pediatric ulcer disease, diaphragm sarcopenia, and benign breast disease. She currently works as part of the AWS Blog Subcommittee and AWS Instagram Subcommittee. When she is not being a black cloud, you will probably find her in the pediatric surgery OR, baking sweets and pastries that she saw on “Great British Bake-Off”, or off on an adventure. You can find her on Instagram @alyssabrown1013 and Twitter @Alyssa_B_MDPhD