Dec. 20, 2004

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U.S. Clothing Sizes May Cover Up Unnatural Concept of Body Size and Shape

It's the same in almost every shop I go to here in Lima, regardless of the cost of the clothing or the age of the clientele: not a single pair of pants fits me. Initially, I blamed this on my somewhat above average height, 5'8"; maybe if these pants were longer, I could wear them. Then, a week or two ago, I found some brands targeted for "taller" women and found, yet again, that these still didn't fit. I embarassingly couldn't even get them much past the knee.

Now, this situation would perhaps be understandable if I had 1) recently gained weight or 2) wore a size that made clothes shopping a bit difficult, such as a U.S. 14 or 16. But I haven't gained much if any weight--perhaps a preholiday pound or two--and all of my old size 4-to-6 clothes still fit. The problem, of course, is that these sizes, considered well within the small-to-medium range for the United States, are larges or extra larges here in Peru, where even the well-nourished, upper-class women look to me like middle schoolers. And women who fit the American average of 5'4" and 145 pounds would be considered obese and medically managed as such.

It's not that the idea of what constitutes a normal height and weight simply varies internationally. I've long known that ideal weight charts, for instance, differ considerably from place to place. While living in Scotland, with high rates of obesity and the highest heart disease rate in Europe, I was considered underweight. And I could never find any clothes that fit me in China, where an XXXL dress might have fit, had it been available. I guess these extremes at the time and in their context made sense to me. The Scots, for one, have a legendary high-fat diet (Mars bar fritter, anyone?), more extreme than many other cultures, making a relative surplus of body fat more the norm. And most Asians tend to be shorter and slimmer than their Western cousins.

The problem, of course, is that these sizes, considered well within the small-to-medium range for the United States, are larges or extra larges here in Peru, where even the well-nourished, upper-class women look to me like middle schoolers.

Peruvians, on the other hand, are quite diverse with respect to ethnic background--black, Asian, Indian, Spanish--and tend to vary quite a bit in body shape and proportion, much like Americans. I just assumed when I arrived that I would fit at one end of the spectrum or the other. To date, this assumption hasn't panned out for me, or for the other American expats I know. All of them are young, slim, and athletic, and have the same trouble I have in finding clothes around Lima. We discuss it nearly nonstop, in bars and at the gym and at home. How weird it is to feel this much bigger, with all that this implies, just by moving to another country. It's like waking up and finding yourself living in front of a funhouse mirror that distorts you to immense, seemingly unnatural proportions for you and everyone else to see.

But I question the idea that it's just Peru and its waifish women who are "distorting" my body image and that it's not my problem but a matter of geography making me and many others feel this way. I wonder instead if we've been deceiving ourselves all along. Maybe my friend and I are larger than average and are just unaccustomed to being held to others' standards. Certainly most clothing here uses European sizes (based on hip or waist size, depending on the product), unlike American sizes for women, which vary considerably by brand and have become increasingly "generous" over the decades. A size 12 in 1955, for instance, is often today's size 8, most likely a consequence of the skyrocketing average weight of American women and the rise in obesity.

The shift may be helpful for promoting body acceptance, not to mention selling clothes, but I have to wonder if we're not doing ourselves a disservice by continuing to promote a "normal" size and shape that is larger than average by the rest of the world's standards. Our current ideals--in diet, lifestyle, and other areas--have only produced a wave of heart disease, type 2 diabetes, and other health problems related to obesity in proportions unseen in many European countries, for example. Since we have a goal of conquering the obesity epidemic, perhaps we should stop ignoring what the rest of the world considers normal and more closely examine our own standards--for everyone's health, regardless of size.

--Tarayn Grizzard, a lactation counselor and medical student at HMS

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

Copyright 2004 by the President and Fellows of Harvard College