Fair Fat Female Forty Fertile

A few years back my gall bladder made itself know. The canary in the coal mine perhaps…tweeting calling skreeeeeetching to me that I was perhaps not in peak working condition. I don’t want that canary to die, so I must change the conditions.

In presenting to my GP I learned that there is a mnemonic taught to medical students for this very situation. The 5Fs of Gallstones.

Lets break it down (unlike the gallstones that taunted me):


Gallstones were thought to be more common in Caucasians.


describes being ‘overweight’ or ‘obese’…which translates into ‘not of an acceptable size’. Usually measured by the height-weight ratio: BMI. (bullshit medical indicator)


describes the sex of the individual. This relates to biology and physiology. Is impacted by hormones and cycles (within life stages and of life stages).


a measure of time since birth.


having had one or more children.

These measures of likelihood, presented in this mnemonic, can cloud the judgment of a medical ‘care’ provider. It is usually followed with blood tests and an ultrasound to confirm diagnosis (not so much to seek alternative possibilities). Interestingly, something like 10 -20% of the population has gallstones, and 80% of these people are asymptomatic. So..is finding gallstones in an ultrasound telling us the full story…or do investigations stop because gallstones are present? Then the 5F Patient is presented with a treatment: remove the offending organ and/or stop being such a pig.

Helpful, no?

This quantitative approach to medical advice means that bias is unavoidable and prejudices might mean a more serious condition is over looked. This is true for those who do not exhibit all the Fs, as they may not have gallstones considered. Family History would be more telling than Forty, but this mnemonic has not been updated, despite evidence to show that after fifty it does not stand, and that fairness is not a fair assumption.

Of particular concern is the bias surrounding weight. Assumptions are made about intelligence and lifestyle, and time does not allow exploration of the qualitative aspects that make the patient an individual.

The thing about each element in the 5fs is that none of them tell us about who the person is and most of these are factors can not change. The ‘fat’ is assumed to be a choice. But do they identify as fat.

Fat might be intended to be a measure of BMI, but stated thus carries weight (pun intended) and dangerous assumptions. It is assumed that she could ‘eat better and do some exercise’. It is assumed they are fat because they choose a particular lifestyle. This does not take into account the many factors that contribute to weight gain, and difficulties in losing weight. It does not consider the risks of losing weight quickly (though this is generally encouraged and applauded). And it does not consider how this person feels about their size. It assumes they should feel bad. ashamed. guilty. This person may not identify as fat. And yet, they are seen this way, and treated this way. And whilst the person may not use this word to describe themselves, it is known that having extra fat is correlated with increased risks. This is where the need for more understanding comes in. This presence of excess fat might be true compared to the general population (or the random line drawn denouncing unacceptable)…but what does it mean for this person. If their other health measures are good, and they do eat well and exercise, then the presence of fat is simply that. Just as being female is a fact, this does not tell us any information about who that person actually is. It gives important biological and physiological information, but can not tell us anything about the lifestyle, beliefs, philosophies, passions, traumas, medical history, medications, or personal circumstances.

There is more to this person than these 5 factors. Many other aspects make up this person and contribute to the symptoms they present to the GP with.

Effective medical care required effective communication. As long as this mnemonic is taught to medical students, we will see those of ‘unacceptable’ size being mistreated. This is across the board – in all stages of life and medical specialties. And appointments with doctors may need to be more than 6 minutes long.

and, in case you are wondering…I still have my gall bladder. I eventually (and independently) sought support from a nutritionist to review my overall health. That initial appointment lasted over an hour, covering all manner of things. Paired with my GP, I now have a team approach towards wellness. It involved a review of my diet – not in a judgmental way, but in a considered way, and some blood tests. I am being supported to make changes to my diet and increase movement, rather than shamed and left uncertain of where to begin. And it is not about weightloss. It is about wellness. Listening to my body and making gentle adjustments until that canary sings sweetly.

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