Journal articles on the topic 'Coronary heart disease Victoria Melbourne'

The Getting It Together Rural Health Promotion project was established by a group of community health providers in Gippsland, Victoria. The overall aim of Getting It Together was to extend and improve health promotion practice amongst participating organisations. This was achieved through collaboration around health promotion training and planning. Complementary strategies addressing Cardio-Vascular Disease (CVD) were developed across four Local Government Areas (LGAs). Central resourcing was provided for coordination of the project, and for marketing and network support tasks. The project was based on an integrated and coordinated health promotion model, which contained overlapping strategies combining to create a broadly based partnership of action. At the commencement of the project, health promotion workers from each LGA were provided with a three-day training course conducted by the Royal Melbourne Institute of Technology University (RMIT). Participants developed Action Plans based around the three driving strategies of community wide-strategies, targeted strategies and marketing. A special feature of Getting It Together was a common media strategy, to support and reinforce action at the local level. An overall slogan was adopted, 'Slicker Ticker - A Gippsland Healthy Heart Project'. Uniting themes included 'Stress Less Week' and 'Gippsland Get Up and Go'. Latrobe Community Health Service facilitated the project and senior managers from the partnering agencies formed a Steering Committee, which met at key intervals to monitor the project.

Objectives: Coronary artery disease (CAD), also known as ischemic heart disease or atherosclerotic cardiovascular disease (CVD), is one of the major causes of morbidity and mortality globally and has contributed to about 80% of sudden deaths. There have been advancements in the diagnosis and treatment of CAD, some of which are still going on to improve patient care, however, there is a dearth of information regarding the various challenges the patients go through after being diagnosed with CAD and so a qualitative study was conducted on cardiac patients in Mauritius to shine a light on the various aspects of life affected by CAD. This is the first qualitative study conducted on cardiac patients in Mauritius. Material and Methods: A phenomenological qualitative study was performed on 12 patients who were diagnosed with CAD, at the Cardiac Unit of Victoria Hospital, Mauritius. By the use of NVivo 12 (Windows) Plus software, after it was transcribed, codes/nodes and themes were generated. Results: Twenty-five different codes were inferred from the study done and from the respective codes, eight main themes were established. The main themes drawn from the study were as follows: Emotional factors, risk factors, optimistic factors, support, awareness of your health, consequences, lifestyle modifications, and the healthcare system. Conclusion: An event of CAD is an experience with multifaceted influences on innumerable aspects of the patient’s life. The study illuminated the immense sufferings and emotional bearings of those patients who were living with heart disease. They expressed their overbearing, insecurities, and a loss of control over various aspects of their lives. This study provided various thought-provoking themes that emerged after transcribing the qualitative interviews. It also highlighted the various challenges faced by patients and how the beliefs of patients with CAD were vital to sustaining them. Family support is a vital aspect in keeping the patient both motivated to follow their treatment and emotionally grounded.

IntroductionIt is important to ascertain the cost-effectiveness of alternative services to traditional cardiac rehabilitation while the economic credentials of the Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) programme among people with coronary heart disease (CHD) are unknown. This economic protocol outlines the methods for undertaking a trial-based economic evaluation of SCRAM in the real-world setting in Australia.Methods and analysisThe within-trial economic evaluation will be undertaken alongside a randomised controlled trial (RCT) designed to determine the effectiveness of SCRAM in comparison with the usual care cardiac rehabilitation (UC) alone in people with CHD. Pathway analysis will be performed to identify all the costs related to the delivery of SCRAM and UC. Both a healthcare system and a limited societal perspective will be adopted to gauge all costs associated with health resource utilisation and productivity loss. Healthcare resource use over the 6-month participation period will be extracted from administrative databases (ie, Pharmaceutical Benefits Scheme and Medical Benefits Schedule). Productivity loss will be measured by absenteeism from work (valued by human capital approach). The primary outcomes for the economic evaluation are maximal oxygen uptake (VO2max, mL/kg/min, primary RCT outcome) and quality-adjusted life years estimated from health-related quality of life as assessed by the Assessment of Quality of Life-8D instrument. The incremental cost-effectiveness ratio will be calculated using the differences in costs and benefits (ie, primary and secondary outcomes) between the two randomised groups from both perspectives with no discounting. All costs will be valued in Australian dollars for year 2020.Ethics and disseminationThe study protocol has been approved under Australia’s National Mutual Acceptance agreement by the Melbourne Health Human Research Ethics Committee (HREC/18/MH/119). It is anticipated that SCRAM is a cost-effective cardiac telerehabilitation programme for people with CHD from both a healthcare and a limited societal perspective in Australia. The evaluation will provide evidence to underpin national scale-up of the programme to a wider population. The results of the economic analysis will be submitted for publication in a peer-reviewed journal.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618001458224).

Background Alternative evidence-based cardiac rehabilitation (CR) delivery models that overcome significant barriers to access and delivery are needed to address persistent low utilization. Models utilizing contemporary digital technologies could significantly improve reach and fidelity as complementary alternatives to traditional center-based programs. Objective The aim of this study is to compare the effects and costs of the innovative Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) intervention with usual care CR. Methods In this investigator-, assessor-, and statistician-blinded parallel 2-arm randomized controlled trial, 220 adults (18+ years) with coronary heart disease are being recruited from 3 hospitals in metropolitan and regional Victoria, Australia. Participants are randomized (1:1) to receive advice to engage with usual care CR or the SCRAM intervention. SCRAM is a 24-week dual-phase intervention that includes 12 weeks of real-time remote exercise supervision and coaching from exercise physiologists, which is followed by 12 weeks of data-driven nonreal-time remote coaching via telephone. Both intervention phases include evidence- and theory-based multifactorial behavior change support delivered via smartphone push notifications. Outcomes assessed at baseline, 12 weeks, and 24 weeks include maximal aerobic exercise capacity (primary outcome at 24 weeks), modifiable cardiovascular risk factors, exercise adherence, secondary prevention self-management behaviors, health-related quality of life, and adverse events. Economic and process evaluations will determine cost-effectiveness and participant perceptions of the treatment arms, respectively. Results The trial was funded in November 2017 and received ethical approval in June 2018. Recruitment began in November 2018. As of September 2019, 54 participants have been randomized into the trial. Conclusions The innovative multiphase SCRAM intervention delivers real-time remote exercise supervision and evidence-based self-management behavioral support to participants, regardless of their geographic proximity to traditional center-based CR facilities. Our trial will provide unique and valuable information about effects of SCRAM on outcomes associated with cardiac and all-cause mortality, as well as acceptability and cost-effectiveness. These findings will be important to inform health care providers about the potential for innovative program delivery models, such as SCRAM, to be implemented at scale, as a complement to existing CR programs. The inclusion of a cohort comprising metropolitan-, regional-, and rural-dwelling participants will help to understand the role of this delivery model across health care contexts with diverse needs. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN): 12618001458224; anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508. International Registered Report Identifier (IRRID) DERR1-10.2196/15022

Background: Acute myocardial infarction (AMI) accounts for 43% of deaths related to ischaemic heart disease, with ST-segment elevation myocardial infarction (STEMI) accounting for 25%–40% of all AMI presentations. Given the impact of these diseases, there is a strong prehospital focus on early identification, treatment and transport of patients with acute coronary syndrome. The main aim of the STEMI system of care is to reduce the time to reperfusion of the myocardium, thereby improving morbidity and mortality rates. Therefore, the identification of STEMI by paramedics can have a dramatic effect on patients' long-term health outcomes. Ambulance Victoria paramedics play a crucial role in the care provided to AMI patients across the state, with the assistance of a computer-automated interpretation of 12-lead electrocardiograms (ECGs) to aid STEMI identification. Objectives: This study's objective is to analyse the diagnostic capability of the computer-automated interpretation to diagnose STEMI in the out-of-hospital setting. Methods: Quantitative data from January 2018 to December 2019 was sourced from the Victorian Ambulance STEMI Quality Initiative. These data were periodically matched with hospital outcome and diagnosis data from the Victorian Cardiac Outcomes Registry to compare provisional paramedic diagnoses with the final hospital diagnoses. Results: Of the 5269 cases of suspected STEMI, 765 (14.5%) could be matched with outcome data. Of these 765 cases, 88.9% were correctly identified as STEMI. The remaining 10% were categorised as either non-STEMI or unstable angina. No data were available for 1.1%. Conclusions: The diagnostic capability of the Zoll Inovise 12L interpretive algorithm to diagnose STEMI in the out-of-hospital setting appears safe and feasible. However, because of limited data matching paramedic findings with patient outcomes in hospital, no hard conclusions can be drawn. Furthermore, there is no way to ascertain how many false positives the Zoll monitor is interpreting. Further investigation is required to assess the true diagnostic capability of the Zoll Inovise 12L interpretive algorithm.

Background and objective Carotid artery intima media thickness (CIMT) is a strong predictor of Coronary Heart Disease (CHD) and independent phenotype of early atherosclerosis. The global variation of CIMT and its demographic association is yet unclear. We evaluated regional variations of CIMT based on WHO regions and assessed the differences by age and sex. Methods A systematic search was conducted on studies published between 1980 January up to December 2020. PubMed, Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase data bases were used for searching. Supplementary searches were conducted on the Web of Science and Google Scholar. Grey literature was searched in “Open Grey” website. The two major criteria used were “adults” and “carotid intima media”. The search strategy for PubMed was created first and then adapted for the Oxford Medicine Online, EBSCO, Taylor & Francis, Oxford University Press and Embase databases. Covidence software (Veritas Health Innovation, Melbourne, Australia; http://www.covidence.org) was used to manage the study selection process. Meta-analyses were done using the random-effects model. An I2 ≥ 50% or p< 0:05 were considered to indicate significant heterogeneity. Results Of 2847 potential articles, 46 eligible articles were included in the review contributing data for 49 381 individuals (mean age: 55.6 years, male: 55.8%). The pooled mean CIMT for the non-CHD group was 0.65mm (95%CI: 0.62–0.69). There was a significant difference in the mean CIMT between regions (p = 0.04). Countries in the African (0.72mm), American (0.71mm) and European (0.71mm) regions had a higher pooled mean CIMT compared to those in the South East Asian (0.62mm), West Pacific (0.60mm) and Eastern Mediterranean (0.60mm) regions. Males had a higher pooled mean CIMT of 0.06mm than females in the non CHD group (p = 0.001); there were also regional differences. The CHD group had a significantly higher mean CIMT than the non-CHD group (difference = 0.23mm, p = 0.001) with regional variations. Carotid artery segment-specific-CIMT variations are present in this population. Older persons and those having CHD group had significantly thicker CIMTs. Conclusions CIMT varies according to region, age, sex and whether a person having CHD. There are significant regional differences of mean CIMT between CHD and non-CHD groups. Segment specific CIMT variations exist among regions. There is an association between CHD and CIMT values.

Abstract Background Geographic differences and background therapy have not been explored in the global VICTORIA trial, which enrolled high-risk patients with recent worsening heart failure with reduced ejection fraction (HFrEF). Methods and results Among 5050 patients enrolled in 5 pre-specified geographic regions, 34% were from Eastern Europe, 18% Western Europe, 23% Asia Pacific, 14% Latin and South America, and 11% North America (Table 1). Patients from Western Europe were older, had more atrial fibrillation, and lower glomerular filtration rates. Patients from Eastern Europe had more coronary artery disease and exhibited more advanced symptoms (∼50% New York Heart Association [NYHA] class III), whereas those from Latin and South America were less symptomatic (∼70% NYHA class II). North American patients had the largest body mass index as well as more diabetes and hypertension. Levels of NT-proBNP at randomization and MAGGIC risk scores were highest in Western European patients. Evidence-based triple medication therapy was used most frequently in Latin and South America and less frequently in North America; conversely, cardiac resynchronization therapy and implantable cardioverter defibrillators were most frequently used in North America and least frequently in Latin and South America. The overall primary composite event rate (cardiovascular death or HF hospitalization) in the placebo arm was 36.6/100 person-years over a median of 10.8 months and after adjusting for the MAGGIC score. When examined by region, these event rates were nominally highest in North America and lowest in Western Europe. Conclusion Substantial regional differences exist in characteristics and treatments among patients in this global trial of patients with HFrEF and a recent worsening event. These findings demonstrate the continuing unmet needs and opportunities for enhancing care in HFrEF. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): VICTORIA was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA and Bayer AG, Wuppertal, Germany.

Abstract Background In patients with prior CABG requiring subsequent PCI there is uncertainty whether bypass grafts or native coronary arteries should be targeted. Methods We analysed data from 2,764 patients with prior CABG in the Melbourne Interventional Group registry (2005–2018), divided into two groups: those undergoing PCI to a native vessel (n=1,928) and those with PCI to a graft vessel (n=836). Results Patients with a graft vessel PCI were older, had more high-risk clinical characteristics (prior MI, heart failure, ejection fraction &lt;50%, renal impairment, peripheral and cerebrovascular disease), and high-risk procedural features (ACC/AHA types B2/C lesions). However, patients in the native vessel group were more likely to have PCI to a chronic total occlusion. The majority of graft PCI were to saphenous vein grafts (84%), with 10% to radial and 6% to LIMA/RIMA grafts. Distal embolic protection devices were used in 30% of graft PCI. Patients with graft PCI had higher rates of no reflow (6.3% vs. 1.5%; p&lt;0.001), coronary perforation (p=0.016) and inpatient stent thrombosis (p=0.028). However, 30-day mortality and major adverse cardiovascular and cerebrovascular events (MACCE) were similar. Unadjusted long-term mortality (median follow up 4.8 years) was higher in patients who had undergone a graft PCI (44% vs. 32%, p&lt;0.001), but following Cox proportional hazards modelling, PCI vessel type was not a predictor of long-term mortality (HR 1.13; 95% CI 0.96–1.33, p=0.14). Conclusions Early clinical outcomes and risk-adjusted long-term mortality are similar for patients with prior CABG undergoing PCI to a native vessel or a bypass graft. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Alfred Hospital

Abstract Background Takotsubo Cardiomyopathy represents an acute transient decline in left ventricular (LV) function occurring in the absence of obstructive coronary artery disease or acute plaque rupture. Therapeutic strategies vary due to a paucity of evidence-based guidelines. Purpose To evaluate clinical and biochemical characteristics, management approach and outcomes in a contemporary cohort of patients with Takotsubo Cardiomyopathy across two tertiary centres in Victoria, Australia. Neurohormonal associations were explored by characterising the prevalence of pre-existing endocrinopathies and malignancy. Methods We conducted a retrospective study of 240 patients with Takotsubo Cardiomyopathy diagnosed between 2008–2018, utilising data from electronic medical records. Results Patients were predominantly female (91.3%, mean age 66±12 years), smokers (48.3%), and hypertensive (55.0%). A small proportion (16.7%) had pre-existing malignancy (breast 30%, gastrointestinal 23%, genitourinary 19%, lung 9%, other 19%) or endocrine disease (12.5%), largely driven by thyroid disease (94%). Troponin rise was common (94.6%; peak troponin 6.4±13μg/L), though few presented with ST-elevation (21.7%). Psychosocial stress was prevalent (44.6%) compared with physical illness (39.2%) or an unidentified precipitant (16.7%). Management was heterogeneous. Many were discharged on aspirin (37.7%), dual antiplatelet therapy (34%) or statins (35.9%) in the absence of obstructive coronary disease or other clinical indication and were frequently continued beyond 1 year. ACE inhibitors or angiotensin receptor blockers were prescribed in 83.7%, beta blockers in 84.9% or both in 74.9% (continuing beyond 1 year in 60.4%). LV dysfunction occurred in 81.7% at diagnosis (mean LV ejection fraction (LVEF) 45±11%), recovering in 91.3% (mean LVEF 62±8%; 17.2% increase, p<0.001) on repeat echocardiography (mean 107±154 days). Follow up occurred in 81.4%, though most patients with normalised LV function continued heart failure therapy (83.6%). 12-month mortality was rare (7%) as was recurrence (5.1%). Conclusions Management of Takotsubo Cardiomyopathy remains challenging due to phenotypic diversity, variable therapeutic approach and unclear treatment duration. Pre-existing illness, including malignancy and endocrinopathy, may provide a substrate for the development of Takotsubo Cardiomyopathy or amplify cardiac adrenoreceptor sensitivity. Enhanced understanding of possible neurohormonal and cellular mechanisms may facilitate targeted management and preventive strategies. The role of antiplatelets or lipid lowering therapy is not supported in existing literature, however, as this study highlights, they continue to feature heavily in the Takotsubo treatment armamentarium. Further studies are needed to enhance understanding of underlying mechanisms and establish a standardised treatment approach with targeted therapy to promote LV recovery and prevent recurrence. Acknowledgement/Funding None

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. University of Western Australia, Special Collections.First Tuesday Book Club. ABC Splash. 4 Dec. 2012. <http://splash.abc.net.au/home#!/media/1454096/http&>.Foster, Dennis. Confession and Complicity in Narrative. Cambridge: Cambridge UP, 1987.Frank, Arthur. The Wounded Storyteller. London: U of Chicago P, 1995.Fraser, Jane. “CEO Says.” Fremantle Press. 7 July 2015. <https://www.fremantlepress.com.au/c/news/3747-ceo-says-9>.Garton, Stephen. The Cost of War: Australians Return. Melbourne: Oxford UP, 1994.HMAT Aeneas. “Report of Passengers for the Port of Fremantle from Ports Beyond the Commonwealth.” 20 Nov. 1915. <http://recordsearch.naa.gov.au/SearchNRetrieve/Interface/ViewImage.aspx?B=9870708&S=1>.“Interview with Ray Coffey.” Personal interview. 6 May 2016. Follow-up correspondence. 12 May 2016.Jenkins, Wendy. “Tales from the Backlist: A Fortunate Life Turns 30.” Fremantle Press, 14 April 2011. <https://www.fremantlepress.com.au/c/bookclubs/574-tales-from-the-backlist-a-fortunate-life-turns-30>.Keesing, Nancy. ‘An Enduring Classic.’ Australian Book Review (May 1981). FACP Press Clippings. Fremantle. n. pag.King, Noel. “‘I Can’t Go On … I’ll Go On’: Interview with Ray Coffey, Fremantle Arts Centre Press, 22 Dec. 2004; 24 May 2006.” Westerly 51 (2006): 31–54.Larsson, Marina. “A Disenfranchised Grief: Post War Death and Memorialisation in Australia after the First World War.” Australian Historical Studies 40.1 (2009): 79–95.Lindstrom, Richard. “The Australian Experience of Psychological Casualties in War: 1915-1939.” PhD dissertation. Victoria University, Feb. 1997.Loughran, Tracey. “Shell Shock, Trauma, and the First World War: The Making of a Diagnosis and its Histories.” Journal of the History of Medical and Allied Sciences 67.1 (2012): 99–119.Lucas, Anne. “Curator’s Notes.” A Fortunate Life. Australian Screen. <http://aso.gov.au/titles/tv/a-fortunate-life/notes/>.McLeod, Steve. “My Fortunate Life with Grandad.” Western Magazine Dec. (1983): 8.Munro, Craig. Under Cover: Adventures in the Art of Editing. Brunswick: Scribe, 2015.Murphy, Ffion, and Richard Nile. “The Naked Anzac: Exposure and Concealment in A.B. Facey’s A Fortunate Life.” Southerly 75.3 (2015): 219–37.———. “Wounded Storyteller: Revisiting Albert Facey’s Fortunate Life.” Westerly 60.2 (2015): 87–100.“NBC Book Awards.” Australian Book Review Oct. (1981): 1–4.PBL. Prospectus: A Fortunate Life, the Extraordinary Life of an Ordinary Bloke. 1–8.Repatriation Records. Albert Facey. National Archives of Australia.Roberts, Chris. “Turkish Machine Guns at the Landing.” Wartime: Official Magazine of the Australian War Memorial 50 (2010). <https://www.awm.gov.au/wartime/50/roberts_machinegun/>.Semmler, Clement. “The Way We Were before the Good Life.” Courier Mail 10 Oct. 1981. FACP Press Clippings. Fremantle. n. pag.Smith, Sidonie, and Julia Watson. Reading Autobiography: A Guide for Interpreting Life Narratives. 2001. 2nd ed. U of Minnesota P, 2010.Thomson, Alistair. Anzac Memories: Living with the Legend. 1994. 2nd ed. Melbourne: Monash UP, 2013. Tyquin, Michael. Gallipoli, the Medical War: The Australian Army Services in the Dardanelles Campaign of 1915. Kensington: UNSWP, 1993.War Service Records. National Archives of Australia. <http://recordsearch.naa.gov.au/NameSearch/Interface/NameSearchForm.aspx>.Williamson, Geordie. “A Fortunate Life.” Copyright Agency. <http://readingaustralia.com.au/essays/a-fortunate-life/>.

Drawing upon popular magazines, newspapers, blogs, Web sites, and videos, this essay compares the media framing of six, “fat” political figures from around the world. Framing refers to the suggested interpretations that are imbedded in media reports (Entman; McCombs and Ghanem; Seo, Dillard and Shen). As Robert Entman explains, framing is the process of culling a few elements of perceived reality and assembling a narrative that highlights connections among them to promote a particular interpretation. Frames introduce or raise the salience of certain ideas. Fully developed frames typically perform several functions, such as problem definition and moral judgment. Framing is connected to the [covert] wielding of power as, for example, when a particular frame is intentionally applied to obscure other frames. This comparative international study is an inquiry into “what people and societies make of the reality of [human weight]” (Marilyn Wann as quoted in Rothblum 3), especially in the political arena. The cultural and historical dimensions of human weight are illustrated by the practice of force-feeding girls and young women in Mauritania, because “fat” women have higher status and are more sought after as brides (Frenkiel). The current study, however, focuses on “fat” politics. The research questions that guide the study are: [RQ1] which terms do commentators utilize to describe political figures as “fat”? [RQ2] Why is the term “fat” utilized in the political arena? [RQ3] To what extent can one detect gender, national, or other differences in the manner in which the term “fat” is used in the political arena? After a brief introduction to the current media obsession with fat, the analysis begins in 1908 with William Howard Taft, the 330 pound, twenty-seventh President of the United States. The other political figures are: Chris Christie (Governor of New Jersey), Bill Clinton (forty-second President of the United States), Michelle Obama (current First Lady of the United States), Carla Bruni (former First Lady of France), and Julia Gillard (former Prime Minister of Australia). The final section presents some conclusions that may help readers and viewers to take a more critical perspective on “fat politics.” All of the individuals selected for this study are powerful, rich, and privileged. What may be notable is that their experiences of fat shaming by the media are different. This study explores those differences, while suggesting that, in some cases, their weight and appearance are being attacked to undercut their legitimate and referent power (Gaski). Media Obsession with Fat “Fat,” or “obesity,” the more scientific term that reflects the medicalisation of “fat” (Sobal) and which seems to hold sway today, is a topic with which the media currently is obsessed, both in Asia and in the United States. A quick Google search using the word “obesity” reports over 73 million hits. Ambady Ramachandran and Chamukuttan Snehalatha report on “The Rising Burden of Obesity in Asia” in a journal article that emphasizes the term “burden.” The word “epidemic” is featured prominently in a 2013 medical news report. According to the latter, obesity among men was at 13.8 per cent in Mongolia and 19.3 per cent in Australia, while the overall obesity rate has increased 46 per cent in Japan and has quadrupled in China (“Rising Epidemic”). Both articles use the word “rising” in their titles, a fear-laden term that suggests a worsening condition. In the United States, obesity also is portrayed as an “epidemic.” While some progress is being made, the obesity rate nonetheless increased in sixteen states in 2013, with Louisiana at 34.7 per cent as the highest. “Extreme obesity” in the United States has grown dramatically over thirty years to 6.3 per cent. The framing of obesity as a health/medical issue has made obesity more likely to reinforce social stereotypes (Saguy and Riley). In addition, the “thematic framing” (Shugart) of obesity as a moral failure means that “obesity” is a useful tool for undermining political figures who are fat. While the media pay considerable attention to the psychological impact of obesity, such as in “fat shaming,” the media, ironically, participate in fat shaming. Shame is defined as an emotional “consequence of the evaluation of failure” and often is induced by critics who attack the person and not the behavior (Boudewyns, Turner and Paquin). However, in a backlash against fat shaming, “Who you callin' fat?” is now a popular byline in articles and in YouTube videos (Reagan). Nevertheless, the dynamics of fat are even more complicated than an attack-and-response model can capture. For example, in an odd instance of how women cannot win, Rachel Frederickson, the recent winner of the TV competition The Biggest Loser, was attacked for being “too thin” (Ceja and Valine). Framing fat, therefore, is a complex process. Fat shaming is only one way that the media frame fat. However, fat shaming does not appear to be a major factor in media coverage of William Howard Taft, the first person in this study. William Howard Taft William Howard Taft was elected the 27th President of the United States in 1908 and served 1909-1913. Whitehouse.com describes Taft as “Large, jovial, conscientious…” Indeed, comments on the happy way that he carried his “large” size (330 pounds) are the main focus here. This ‹happy fat› framing is much different than the media framing associated with ‹fat shaming›. His happy personality was often mentioned, as can be seen in his 1930 obituary in The New York Times: “Mr. Taft was often called the most human President who ever sat in the White House. The mantle of office did not hide his winning personality in any way” (“Taft Gained Peaks”). Notice how “large” and “jovial” are combined in the framing of Taft. Despite his size, Taft was known to be a good dancer (Bromley 129). Two other words associated with Taft are “rotund” (round, plump, chubby) and “pudgy.” These terms seem a bit old-fashioned in 2015. “Rotund” comes from the Latin for “round,” “circular,” “spherical.” “Pudgy,” a somewhat newer term, comes from the colloquial for “short and thick” (Etymology Online). Taft was comfortable with being called “pudgy.” A story about Taft’s portrait in the Smithsonian’s National Portrait Gallery in Washington, D.C. illustrates the point: Artist William Schevill was a longtime acquaintance of Taft and painted him several times between 1905 and 1910. Friendship did not keep Taft from criticizing the artist, and on one occasion he asked Schevill to rework a portrait. On one point, however, the rotund Taft never interfered. When someone said that he should not tolerate Schevill's making him look so pudgy in his likenesses, he simply answered, "But I am pudgy." (Kain) Taft’s self-acceptance, as seen in the portrait by Schevill (circa 1910), stands in contrast to the discomfort caused by media framing of other fat political figures in the era of more intense media scrutiny. Chris Christie Governor Christie has tried to be comfortable with his size (300+ pounds), but may have succumbed to the medicalisation of fat and the less than positive framing of his appearance. As Christie took the national stage in the aftermath of Hurricane Sandy (2012), and subsequently explored running for President, he may have felt pressure to look more “healthy” and “attractive.” Even while scoring political points for his leadership in the aftermath of Superstorm Sandy, Christie’s large size was apparent. Filmed in his blue Governor jacket during an ABC TV News report that can be accessed as a YouTube video, Christie obviously was much larger than the four other persons on the speakers’ platform (“Jersey Shore Devastated”). In the current media climate, being known for your weight may be a political liability. A 2015 Rutgers’ Eagleton Poll found that 53 percent of respondents said that Governor Christie did not have “the right look” to be President (Capehart). While fat traditionally has been associated with laziness, it now is associated with health issues, too. The media framing of fat as ‹morbidly obese› may have been one factor that led Christie to undergo weight loss surgery in 2013. After the surgery, he reportedly lost a significant amount of weight. Yet his new look was partially tarnished by media reports on the specifics of lap-band-surgery. One report in The New York Daily News stressed that the surgery is not for everyone, and that it still requires much work on the part of the patient before any long-term weight loss can be achieved (Engel). Bill Clinton Never as heavy as Governor Christie, Bill Clinton nonetheless received considerable media fat-attention of two sorts. First, he could be portrayed as a kind of ‹happy fat “Bubba”› who enjoyed eating high cholesterol fast food. Because of his charm and rhetorical ability (linked to the political necessity of appearing to understand the “average person”), Clinton could make political headway by emphasizing his Arkansas roots and eating a hamburger. This vision of Bill Clinton as a redneck, fast-food devouring “Bubba” was spoofed in a popular 1992 Saturday Night Live skit (“President-Elect Bill Clinton Stops by a McDonald's”). In 2004, after his quadruple bypass surgery, the media adopted another way to frame Bill Clinton. Clinton became the poster-child for coronary heart disease. Soon he would be framed as the ‹transformed Bubba›, who now consumed a healthier diet. ‹Bill Clinton-as-vegan› framing fit nicely with the national emphasis on nutrition, including the widespread advocacy for a largely plant-based diet (see film Forks over Knives). Michelle Obama Another political figure in the United States, whom the media has connected both to fast food and healthy nutrition, is Michelle Obama. Now in her second term as First Lady, Michelle Obama is associated with the national campaign for healthier school lunches. At the same time, critics call her “fat” and a “hypocrite.” A harsh diatribe against Obama was revealed by Media Matters for America in the personal attacks on Michelle Obama as “too fat” to be a credible source on nutrition. Dr. Keith Ablow, a FOX News medical adviser said, Michelle Obama needs to “drop a few” [pounds]. “Who is she to be giving nutrition advice?” Another biting attack on Obama can be seen in a mocking 2011 Breitbart cartoon that portrayed Michelle Obama devouring hamburgers while saying, “Please pass the bacon” (Hahn). Even though these attacks come from conservative media utterly opposed to the presidency of Barack Obama, they nonetheless reflect a more widespread political use of media framing. In the case of Michelle Obama, the media sometimes cannot decide if she is “statuesque” or “fat.” She is reported to be 5’11 tall, but her overall appearance has been described as “toned” (in her trademark sleeveless dresses) yet never as “thin.” The media’s ambivalence toward tall/large women is evident in the recent online arguments over whether Robyn Lawley, named one of the “rookies of the year” by the Sports Illustrated Swimsuit issue, has a “normal” body or a “plus-size” body (Blair). Therefore, we have two forms of media framing in the case of Michelle Obama. First, there is the ‹fat hypocrite› frame, an ad hominem framing that she should not be a spokesperson for nutrition. This first form of framing, perhaps, is linked to the traditional tendency to tear down political figures, to take them off their pedestals. The second form of media framing is a ‹large woman ambiguity› frame. If you are big and tall, are you “fat”? Carla Bruni Carla Bruni, a model and singer/songwriter, was married in 2008 to French President Nicolas Sarkozy (who served 2007 to 2012). In 2011, Bruni gave birth to a daughter, Giulia. After 2011, Bruni reports many attacks on her as being too “fat” (Kim; Strang). Her case is quite interesting, because it goes beyond ‹fat shaming› to illustrate two themes not previously discussed. First, the attacks on Bruni seem to connect age and fat. Specifically, Bruni’s narrative introduces the frame: ‹weight loss is difficult after giving birth›. Motherhood is taxing enough, but it becomes even more difficulty when the media are watching your waist line. It is implied that older mothers should receive more sympathy. The second frame represents an odd form of reverse fat shaming: ‹I am so sick and tired of skinny people saying they are fat›. As Bruni explains: “I’m kind of tall, with good-size shoulders, and when I am 40 pounds overweight, I don’t even look fat—I just look ugly” (Orth). Critics charge that celebs like Bruni not only do not look fat, they are not fat. Moreover, celebs are misguided in trying to cultivate sympathy that is needed by people who actually are fat. Several blogs echo this sentiment. The site Whisper displays a poster that states: “I am so sick and tired of skinny people saying they are fat.” According to Anarie in another blog, the comment, “I’m fat, too,” is misplaced but may be offered as a form of “sisterhood.” One of the best examples of the strong reaction to celebs’ fat claims is the case of actress Jennifer Lawrence. According The Gloss, Lawrence isn’t chubby. She isn’t ugly. She fits the very narrow parameters for what we consider beautiful, and has been rewarded significantly for it. There’s something a bit tone deaf in pretending not to have thin or attractive privilege when you’re one of the most successful actresses in Hollywood, consistently lauded for your looks. (Sonenshein) In sum, the attempt to make political gain out of “I’m fat” comments, may backfire and lead to a loss in political capital. Julia Gillard The final political figure in this study is Julia Eileen Gillard. She is described on Wikipedia as“…a former Australian politician who served as the 27th Prime Minister of Australia, and the Australian Labor Party leader from 2010 to 2013. She was the first woman to hold either position” (“Julia Gillard”). Gillard’s case provides a useful example of how the media can frame feminism and fat in almost opposite manners. The first version of framing, ‹woman inappropriately attacks fat men›, is set forth in a flashback video on YouTube. Political enemies of Gillard posted the video of Gillard attacking fat male politicians. The video clip includes the technique of having Gillard mouth and repeat over and over again the phrase, “fat men”…”fat men”…”fat men” (“Gillard Attacks”). The effect is to make Gillard look arrogant, insensitive, and shrill. The not-so-subtle message is that a woman should not call men fat, because a woman would not want men to call her fat. The second version of framing in the Gillard case, ironically, has a feminist leader calling Gillard “fat” on a popular Australian TV show. Australian-born Germaine Greer, iconic feminist activist and author of The Female Eunuch (1970 international best seller), commented that Gillard wore ill-fitting jackets and that “You’ve got a big arse, Julia” (“You’ve Got”). Greer’s remarks surprised and disappointed many commentators. The Melbourne Herald Sun offered the opinion that Greer has “big mouth” (“Germaine Greer’s”). The Gillard case seems to support the theory that female politicians may have a more difficult time navigating weight and appearance than male politicians. An experimental study by Beth Miller and Jennifer Lundgren suggests “weight bias exists for obese female political candidates, but that large body size may be an asset for male candidates” (p. 712). Conclusion This study has at least partially answered the original research questions. [RQ1] Which terms do commentators utilize to describe political figures as “fat”? The terms include: fat, fat arse, fat f***, large, heavy, obese, plus size, pudgy, and rotund. The media frames include: ‹happy fat›, ‹fat shaming›, ‹morbidly obese›, ‹happy fat “Bubba›, ‹transformed “Bubba›, ‹fat hypocrite›, ‹large woman ambiguity›, ‹weight gain women may experience after giving birth›, ‹I am so sick and tired of skinny people saying they are fat›, ‹woman inappropriately attacks fat men›, and ‹feminist inappropriately attacks fat woman›. [RQ2] Why is the term “fat” utilized in the political arena? Opponents in attack mode, to discredit a political figure, often use the term “fat”. It can imply that the person is “unhealthy” or has a character flaw. In the attack mode, critics can use “fat” as a tool to minimize a political figure’s legitimate and referent power. [RQ3] To what extent can one detect gender, national, or other differences in the manner in which the term “fat” is used in the political arena? In the United States, “obesity” is the dominant term, and is associated with the medicalisation of fat. Obesity is linked to health concerns, such as coronary heart disease. Weight bias and fat shaming seem to have a disproportionate impact on women. This study also has left many unanswered questions. 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