Getting it all wrong

250px-Potato-ChipsI read two things today that were compounding my ongoing frustration with the focus on “obesity” rather than overall health.* One was this post from blogger and doctor Yoni Freedhoff, and the other about fast food kid’s meals from Center for Science in the Public Interest.

These, and many other things that are written with a focus on weight, really miss the point. The point to me being the nutritional quality of food we eat. Not that all food must be of high nutritional value, or consumed in the name of health. But focusing on how bad for health something is by how “fattening” it is, i.e. how many calories it contains, is missing the mark. The reason I, as a parent, limit the amount of fast food my daughter eats (even though she started out not really liking it much, she has grown into being a fan of fried chicken strips and french fries) is because of what it lacks, more than what it contains.

The problem for me, as a parent, is that many of the foods she claims to love (and these change) knock other foods out of her diet. Foods that are high in beneficial minerals like calcium, potassium, and iron, and vitamins like A, Bs, C and D, are not being eaten as often because she’s full from the other foods. Sure, there are vitamins and minerals in potato chips, but she has to eat many more of those to get the same amount as in a few pieces of raw pepper (which she sometimes enjoys). As a parent, I don’t want her to think that she can get what she needs from eating foods that are low in beneficial nutrients — especially since she prizes her ability to draw, dance and think well — and these things are connected.

I practice a very imperfect version of Satter’s Division of Responsibility in Feeding. I do let her decide when, and what to eat more than I would like to. She is always in charge of how much to eat of most things, except those things that are just so desirable that a natural stopping point is hard to find (such as potato chips). She will often not finish something sweet if she has had enough, but like many humans, potato chips are something she will eat just about forever (until her jaw hurts or her lips burn from the salt — and she prefers the less salty chips).

I am not worried about her weight or her size — I am worried that she learns to be a competent eater. I would like her to be able to eat what is served — this isn’t the case now — she doesn’t eat the school lunch served because she feels pressured to eat things she doesn’t like, and if she’s at a friend’s house, she won’t eat what’s served if she doesn’t like it. I would like her to be able to be tuned in enough to her body to eat at regular times — she would rather finish a drawing or keep playing with a friend than stop to eat, right up until she’s weak and crabby from hunger. We haven’t always done the best job of having regular meal and snack times — we always feed her breakfast, lunch, and dinner, with snacks in between if she’s hungry — but not at the same exact time each day. I just haven’t been able to do that — I’m working full-time, and I’m not the one to implement our food strategy much of the time. Her dad is definitely more of a “grazer” — he’s not interested in large meals, and prefers to snack throughout his waking hours — often nuts, fruits, small sandwiches/bread, salads, with some “snack foods” in there, too. He is always concerned that she eats — but not specifically so much what she eats. He doesn’t like her to eat much in the way of sweets — ice cream, chocolate, candy, but I don’t think he has the same sense as I do of what her overall nutritional needs are. Despite my efforts to tell him. I’m just too annoyingly close and too bossy to make an impression on this person who is the mirror image of my stubbornness. I’m the one who is fat, he is not, she is not. I worry about her getting enough of the stuff she needs to function well, now and in the future. I am fairly confident that if I did track what she eats over the course of 3 days, or a week, she would be hitting the marks, nutritionally. But I do worry that she eats too much sugar, salt and fat — not because these are bad things — but because they fill her up before she is able to enjoy foods that are better sources of vitamins and minerals.

But, as I mentioned, she’s not fat. So it doesn’t matter? She is apparently doing fine on the “calories in-calories out” equation, as far as Center for Science in the Public Interest is concerned. The problem I have with fast food being a normal, everyday deal, for my family, is that it isn’t the best way for us to eat. I don’t think it’s a particularly good way for anyone to eat everyday, not because of calories or saturated fat or sugar, but because of what it lacks.

So, why should I care what is served or advertised at fast food restaurants? Because, as a parent, it’s tiring to have to say no all the time. I don’t like to argue about food, or to have to make any food out as bad. I know saying no is part of being a parent, but I want to save my nos for the ones that really count. Having fast food be the norm, rather than home-cooked foods, fresh fruits, veggies, tasty stuff prepared with love, messes with the Division of Responsibility for me.

The way I manage this is to say that she can occasionally — not more than once a week — have fast food in the form of chicken strips and french fries — she doesn’t care for soda or milkshakes. She can have potato chips if I remember to buy them from the grocery store. At the end of most days, she has a small serving of regular — not premium — chocolate ice cream in a cake cone at home. She’s presented with a variety of fresh foods prepared lovingly by her dad, mom, aunt or other adult for most meals. And, my biggest hope is that her relationships — with me, others, food and her body — remain good, strong and whole.

*There are many excellent critiques of “healthism” — such as this one by Shannon Barber, this one from the Health Culture blog, and an amusing academic fight in the Journal of Medical Ethics about whether or not being healthy ( and following a doctor’s advice) is a moral imperative.

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Rethinking Common Sayings – A semi-rant

The other day, thanks to exposure to the organization People First of Washington, I found myself re-examining the biblical and overused expression, “the blind leading the blind.” I am certain this metaphor has already been torn apart by others, wait, I’m googling it right now, here’s a link to Autistic Hoya on a list of Ableist Phrases. I came to this realization when thinking about “the obese leading the obese” (I do not endorse the use of “the obese” to refer to anyone) — but really, if I believe in self-advocacy, who better to lead than a member of the group that has been misperceived, misunderstood, misinterpreted? The role of an ally, or friend, or caring human, is to say, “we’re all connected, is there something I can do?” and the answer may well be, “no, leave me the fuck alone. You’ve already ‘helped’ enough.”

And, I suppose, I wonder, what is leadership, anyhow? The point of the expression “the blind leading the blind” is to say that they will both end up falling into a pit. But, is that true? In terms of leading, I mean — will people who have the same, shared set of abilities be worse at leading than someone with a different set of abilities? Or if a person is to experience lasting “help” for themselves, would they not be better “lead” or taught by someone with a similar set of abilities who has found their way in the world with those abilities?

I’m late to read the Wicked series — I read Wicked not long after it was published, but I’ve devoured books 2-4 in the series, not yet having finished Out of Oz — but the theme of leadership flows throughout these books. I find myself in a position of leadership sometimes, whether it’s at the helm of my family, or at work, or in the greater world. And I always struggle in each of these realms, in terms of how much to listen to my own guidance, and how much to listen to others. I try, as much as possible, to incorporate all the “data” I have, whether that’s likes or dislikes of my 8-year-old when planning family meals, or passions and ideas of the people who, while incredibly self-directed, report to me since I am their supervisor. Good leadership is really, I think, good “followership” — but with the incorporation of data from multiple sources, and trying to strike the right balance, and checking back in with the people impacted by the decisions to make sure that there haven’t been negative unintended consequences (really, checking in the first place to get advice, as well as following up afterwards.)

So, then, who better to lead a person who has impaired vision, to avoid falling into a pit, than another person with impaired vision, who has walked the same path, and can show the follower how to make their own way as to not fall into this same pit in the future, by knowing the path, or having the right kind of assistance, or advocating for having the fucking pit filled in so no one will fall into it?

Where this expression really falls apart is when it’s transferred from the realm of concrete abilities to the idea of the “uniformed leading the uninformed” — that is, if someone with a particular problem leads someone else with that same problem “astray” with incorrect information, or information that “works for them” but not for others. (Sorry for all of the quotation marks, I am trying to convey that some of these words are problematic.) Being unable to use ones eyes to see (that’s not the only way of seeing, I think) is not a metaphor. Part of this relates to how problems are framed. For example, with the “obesity epidemic” — the problem is seen as “obesity.” From the perspective from person whose body is larger than average, their body size may not be the biggest issue, or an issue at all. Charlotte Cooper writes about this from a “Nothing About Us Without Us” perspective. Critiquing the “Foresight, Tackling Obesities: Future Choices” report, Charlotte Cooper writes:

This class background is particularly problematic given that a large chunk of the report is concerned with the question of What To Do About Poor Fat People? As is so often the case in obesity research, the notion of nothing about us without us is irrelevant, fat people are absent and abstracted.

Okay, I think that’s it for this morning. Have to get breakfast ready, clean the house, parent, get ready for Passover. Please let me know what you think in the comments.

 

 

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Childhood experiences, intervening years, and all that jazz

jazzhand

The unbearable snazziness of one jazz hand being jazzy

Well, maybe not ALL that jazz.

I’ve been struggling a bit the past few days. After months of a tough-to-treat dip in mood that was the most serious depression I’ve had in a couple of years last year, 2013 has been decidedly better. But better isn’t always the same as great.

Work is super duper busy and hard. Fulfilling, and satisfying, but hard. I don’t have enough time to myself. My not-so-little-anymore girl is wanting more of my time lately, and I like that she wants it, and want to give it to her, but I’m torn. I’m also wanting, and needing, more physical activity than I’ve been getting. Add to that some challenges in my 20+ year marriage, and it’s a recipe for an unbalanced life.

I find myself noticing thoughts that had been happily absent lately, even during the lowest periods last year, about weight and appearance. I’m desiring reassurance of my innate adorableness*. I want to be reminded** that the people who I like find me delightful to be around, including as part of that being delightful, what I look like.

I’m also, frankly, struggling with using (larger-than-usual amounts of) food for comfort/analgesic purposes. For what may be the first time in my life, I don’t see this struggle about using food for comfort as a personal failing, or the answer to the question of “why am I fat?” I am feeling very connected to the universal challenge that people, when caged in by stress and demands and an inability to find relief in the moment, face — and the very strong desire for self-soothing. This isn’t as much about what I’m doing wrong, as it’s about finding ways to get my needs met that best fit into my life at the moment. And relying on food for self-soothing, at least in the way that I’ve been doing it, isn’t the best way for me in the moment.

Which brings me to what I really wanted to write about, which is this:

Adverse Childhood Experiences (ACEs) and their impacts on health in adulthood.

Here’s a link to an infographic about the study of the impacts of these traumatic events:

http://vetoviolence.cdc.gov/childmaltreatment/phl/resource_center_infographic.html

The relationship between having experienced these types of events as a child (and the cumulative effect of them) and health of the grown child isn’t spread evenly across conditions. For example, lack of physical activity, “severe obesity,” and diabetes don’t appear to be as closely associated with ACEs as alcoholism, drug use, depression, and suicide attempts, which are much more prevalent in people with four or more ACEs compared to zero ACEs.

Which brings me back to how I’m doing, and how I cope with feeling overwhelmed, tired, and stressed. Based on my early experiences and younger years, alcohol and/or drug use could have been a potential route to self-soothing. Depression is certainly something I struggle to manage. Perhaps, even though it’s not the best way to deal with challenges, turning to food for self-soothing rather than drugs or alcohol was the best I could do when I was younger, and remains a pattern that I still cling to. My desire to identify other self-soothing measures isn’t driven by a desire to lose weight, it’s driven by a desire to feel “healed” to the greatest extent possible. It’s possible that had I chosen drugs, alcohol and/or cigarettes as my preferred self-soothing go-to-mode(s),*** I would be less fat, and possibly even not have developed type 2 diabetes at age 25 (I’m now 44). However, my risk of early death, and the risk of not having the stable, solid, fulfilling life I have now, would be much greater. I think my personal suffering would have been worse had another coping path been the one I found myself on. And, quite possibly, greater suffering of the people I love, and who love me.

So, with gratitude, I look at where I am, and where I want to be, and I’m open to finding better ways to manage my stress. I’m already doing some of these — laughing, sleeping****, being social, trying to keep things in perspective, etc. I also know that doing a better job of feeding myself throughout the day, rather than relying on what food and drink I can scrounge up and then finding myself extremely hungry when I get home after work, will help with balancing out my overall intake throughout the day. And, now that I’m over the cold I had last week, looking for ways to get more active again.

Wishing you love, peace, and jazz hands,

Your faithful***** blogger, AcceptanceWoman

* I wonder — am I entitled to be reassured about the adorableness that I possess, not uniquely, but the universal adorableness that all (most?) of us have within?

** I’m not asking to be reminded here in this blog — I’m stating this because I’m noticing the desire for it.

*** To the extent that any of us “choose” these self-soothing modalities. Or any combination thereof.

**** Not at this very exact moment.

***** Faithful in spirit, if not in practice.

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Not sure which way I’m heading

I am questioning right now if this post belongs on the Fatosphere feed or not, because I’m exploring some thoughts that may be inconsistent with fat acceptance and size acceptance philosophies.

Is there ever such a thing as a healthy intentional weight loss?

Many outside of the Fatosphere and size acceptance circles believe so. Within the Fatosphere and fat acceptance philosophy, the belief is that no matter how well-intentioned, no matter how small the weight loss goal, no matter how sane and safe the methods used are, weight intentionally lost will be regained, and in the process, health in the broadest sense will be impacted in a negative way.

I am not sure I’m entirely on board with that philosophy.

I’m not advocating for widespread intentional weight loss. I am arguing for body autonomy, and the right for people to experiment with mixing up their health-related behaviors to achieve their own goals. I don’t think fat acceptance is opposed to body autonomy, but being anti-dieting does mean removing dieting from the tool kit an individual has at their disposal to work with to achieve their health-related goals. I’m not pro dieting, and I’m not aligned with the forces out there making money off of dieting. But I wonder about safe, sane changes to eating habits that might get lumped in with dieting.

I’m making many assumptions here. But let’s start with this made up case study. Let’s take for example someone with a family history of type 2 diabetes. Let’s say that over time, their weight has increased, due to many factors, but including some that have to do with being sedentary, and patterns of eating that are entirely normal in their cultural context. Let’s say that this person has had their fasting blood sugar tested annually. And let’s say that a recent fasting blood sugar test revealed an increase in the fasting blood sugar. And then when the test is repeated a few months later, it’s still higher than what’s considered normal. What’s the best course of action, within what this individual is interested in and willing to do? Let’s say this person decides to begin exercising, and to change up some eating habits, and also has the intention of losing some weight — not tied to some ideal weight, but would use that as one of a few outcomes to track the impact of her changes. So, over time, the change to eating patterns and to going from being sedentary to more physically active does lead to a return to the normal range of her fasting blood sugar. And, it has also led to losing perhaps 15 pounds. The new eating patterns and physical activity are feeling like a new norm, and not a constant struggle (but an occasional one), and there is minimal regaining of weight, and for a while at least, fasting blood sugar stays in the normal range. Let’s fast forward a few years, and perhaps all of the weight is regained, but the increased physical activity is maintained, but her fasting blood sugar again is up, and this time high enough to warrant a diagnosis of diabetes. Appropriate diabetes treatment is initiated, and there are again adjustments to physical activity and eating habits, as well as some medications added.

What role would I say the initial, intentional weight loss effort at the time of diagnosis of prediabetes played in the big picture for this individual?

I would say I don’t think it was harmful, given that it was driven by the individual, that the focus was on what she wanted to have happen, and with the hope that she did not tie her self-worth to the weight loss, or view herself as a failure for weight regain. That may or may not be what happens in the real world, but if that were so, I am left thinking that the intentional weight loss attempt wasn’t the wrong thing. It wasn’t the only possible response, but it was an okay one. Again, this is entirely made up — not a real person, so there are no real outcomes to report.

One of the problems I had with Linda Bacon’s book Health at Every Size: The Surprising Truth About Your Weight is that to me, it advocated the same behaviors that are encouraged with weight loss, but without tying these behaviors to weight loss. I don’t have a problem with it now, but at the time, I thought, why would I ever eat less unless I thought I would lose weight? These days, I can see that for me, there are benefits to eating less overall, and eating less of specific foods, whether or not weight loss happens, but at the time I read that book, it seemed hypocritical to me — like it was advocating dieting but not weight loss. Of course, right there in the book Dr. Bacon points out that it’s likely to feel that way when you first read it, especially if you still associate changing eating habits with dieting rather than action you may take as a form of self-care.

I am in favor of self-experimentation with physical activity and switching up what one eats. I can see that in some cases, this may lead to a decline in weight, at least in the short term.

There’s something that comes to mind that Dr. Jon Robison writes in his article “10 Things You Can Do Right Now to Ease Concerns About Your Weight and Improve Your Health” that appeared in a special report from the Wellness Councils of America (WELCOA). (You can download the whole article here.) He writes:

Because the concepts that thin equals healthy and weight
loss equals better health are so deeply ingrained into
the fabric of our culture, after examining this different
approach people will often still ask this final question:
If I do all of this will I lose weight? The answer to this
question goes straight to the heart of the difference between
the Health-Centered and Weight-Centered Approaches.
The answer is that, if people follow the suggestions outlined
here, there are three and only three possibilities:
1. They will lose weight
2. They will gain weight
3. Their weight will not change
What is wonderful about this answer, unlike almost any other
answer related to this topic, is that it is undeniably scientific
and unarguably true. If people are above their natural
weight, they may lose some weight. If people are below their
natural weight, they may gain. If people are close to their
natural weight, they may stay the same. Which one of these
outcomes will occur is often not predictable. What is
predictable is that people will end up healthier and much
less concerned about their weight and their health.

I think my point is that if people do lose weight as a result of changes to physical activity patterns and eating patterns — whether or not that weight loss is maintained — is that bad? I think not. I do try to disconnect the concepts of health and weight loss and the behaviors that could lead to improved health with or without weight loss. I do think that on an individual level, if a person decides to make changes to their eating patterns and physical activity patterns, they will do well to keep Dr. Robison’s three potential outcomes in mind, and try to be as detached as possible from any particular outcome.

Photo of me looking pudgier than I have in a while, and smiling next to a dogwood tree.

This is me next to a blooming dogwood tree. Photo snapped by a 6-year-old.

For me, doing a variety of things to better control my type 2 diabetes has resulted in a weight gain that has stabilized. I’m getting about 3 hours of moderate physical activity per week right now, and I’m not cutting back on my food intake, although I’m experimenting with what and when I eat — and, yeah, I wish my weight was down back where it was when I began the medication changes I needed to make six months ago. But I’m also in pretty good health — although there are some things I wish were different that do appear to be related to weight gain. I’m considering trying some other routes to diabetes control that might make it easier to eat less overall, by my experiencing less hunger, but I’m certainly taking the best possible care of myself at my current size, and fighting hard against any internal or external pushes to devalue myself because I’m at a higher weight — whether this weight gain is temporary or here to stay.

 

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Trying to tune out the impending doom music and clear some brainspace

Up, DownTo begin, a warning:

In person, I am often told I am kind, warm, and sensitive, sometimes, to a fault. I have received feedback from people I work with and from friends that I’m not a douchbag. People, of a variety of ethnic backgrounds, class backgrounds, ages, size, tend to smile at me. When I’m meeting with people in person who I know are different from me (i.e. everyone) — I do try to read body language and non-verbal cues to see if I’m conveying that I appreciate the differences, and make “course corrections” — as well as apologize and listen — if I’ve made a misstep.

When I write, I lose the ability to “course correct” or modify what I’m saying in the moment. We all do, I suppose, but I think I come across as more forceful and way less sensitive in my writing. So I want to warn readers that I will be writing today about a couple of things I have not experienced first hand — bulimia and the experience of being African American and the racism directed at African American women in particular. I will also be mentioning dieting and the fever-pitch of publicity around the “Weight of the Nation” documentary.

I welcome feedback, comments, feelings, and will take comments to heart pertaining to what I’m writing if they come from an authentic place (i.e. not trolling, even of the “concern trolling” kind). It’s hard to be both bold and sensitive, but that’s what I’m aiming to do.

NYT, and “Why Black Women Are Fat”

The headline for that article is presupposing a question, and answering the wrong question. A better question, I think, is why did the New York Times, with a predominantly white readership, want to publish this article that stated “What we need is a body-culture revolution in black America?” When I read that line in the article, I thought, okay, the writer isn’t talking to me. I have no business dictating anything about cultural revolution in black America. I don’t even think I need to have an opinion about it. When we are talking about overall U.S. culture (which is, of course, made up of many cultures) I have many opinions. So, I was sort of puzzled about how to react. What I chose to do was to wait, and see what other responses emerged, from black American cultural sources (such as Ebony or blogs written by black women) and try to learn from those sources. Which I did. And I still felt like I didn’t have anything to contribute. I still don’t. In a golden rule sort of way, I thought about treating black women the way that I want to be treated. So, if an article were written about Jewish women and fatness, and it appeared not on a blog or in a Jewish newspaper but in the New York Times, I wouldn’t appreciate non-Jewish people participating in the conversation, during which anti-Jewish hate would be very likely to rear it’s ugly head, which is the least helpful thing and is doing more harm. So, I wonder, why did the New York Times publish this piece? I suppose it’s because I read it, and many others did too, and they are trying to increase their readership. Good job NYT. The question I would ask is, am I more likely to order a digital subscription now? The answer — no.

The impending doom music (dum dum dum) and what I’m doing about it

This week has been funny. I was really happy (in a cynical way) about Vice-President Biden and President Obama’s (limited) endorsement of same-sex marriage. Then, I started receiving lots of “Weight of the Nation” info and it started to drag me down. Luckily, work has been interesting, stimulating and busy. Too busy. And I rode my bike to work several days in lovely spring weather. Like my bike ride this week, the week itself has had ups and downs, wrong turns, and left me tired and sore. But overall, energetic and happy. So, the impending doom music, right. Here’s what I’m doing… I’m reminding myself that the framing is all wrong. ALL WRONG. Like the NYT, the producers of the documentary have answered the wrong question. The question is not “How do we win the war on obesity?” (Their answer: To Win, We Have to Lose.) The question is, as I see it, how can we achieve better health for all residents of our nation? To that question, the answer is not “To Win, We Have to Lose.” The answer is: we need to end racism and other forms of discrimination that are systemic, systematic and pervasive. We need to improve the standard of living for the poor and working class (some of the poor are not “working class” in the literal sense of the word — they may be children, elders, people whose disabilities — and the discrimination against them because of these disabilities — take them out of the workforce). We need to make progress on the social determinants of health — those things that lead to good or poor health — that don’t have to do with what happens inside of a doctor’s office. And we need to overhaul our health system.

When I hear the (dum dum dum) music, I think, they’ve asked and answered the wrong question. That helps me get through. That, and singing the “manah manah” song.

Another way of defining the problem

I’m not sure exactly who to tip my hat to, as it’s been a very hectic week, but someone very good pointed me to this book that came out in November 2011, that I can’t wait to read, “Weighing In: Obesity, Food Justice, and the Limits of Capitalism” by Julie Guthman from the University of California Press. The description on the UC Press web site includes this sentence, which sums up pretty well how I think of things: “Arguing that ours is a political economy of bulimia—one that promotes consumption while also insisting upon thinness—Guthman offers a complex analysis of our entire economic system.” I don’t like to use bulimia as a metaphor (again, Golden Rule, I don’t want people using diabetes or PCOS or just general fatness in that way), however, I agree with the political economy being one of encouraging a cycle of overconsumption and then compensation for it.

If I continue down this path — we are simultaneously pushed to eat more and not be fat, there are many responses and impacts on the system that don’t only result in fatness. These include, but aren’t limited to:

  • People who eat and then overexercise — causing injury, disability and sometimes death
  • People whose lives are impacted by having to constantly diet and “resist temptation” — huge psychological burden, social isolation, eating disorders
  • People who are marketed to, and whose children are marketed to, in predatory ways — malnutrition, cavities, disruption of parental roles
  • People who fight the marketing hard, and then fall prey to predatory weight loss or health improvement schemes — huge psychological burden, social isolation, eating disorders like orthorexia, financial burden

None of the above have a net positive result on health. If the problem is that people are eating too many calories, as programs like WOTN are proposing, needn’t we look to the source of the problem, the food industry and marketing industry? Not for the sake of making everyone thin (it won’t) but to say, from a perspective of what’s best for health across the population (including the people who aren’t fat), something needs to change. I’m not interested in fighting in, or winning, a war on obesity. I want to find and fight the root causes of ill health, and obesity is not a root cause. I want to get into the messy, long, hard work of truly agreeing on how we see the problem — and we are not there yet.

HAES is a very elegant response to the War on Obesity. It ends the purging side of the cycle, it turns the sharp swords of dieting and fat hate into the plowshares that help us plant seeds of peace and grow. (Yes, I had to look up what a plowshare was, but now it makes sense).

I encourage any of us who have the energy to do so to raise our voices in our own settings, our places of influence, and say what we think the problem is. To say, this isn’t being framed right. To say, hey, did you notice there are more ads for weight watchers and other diets popping up right around this “To Win, We Have To Lose” rallying cry? To push back, in whatever way we can, against the music of impending doom while singing our own song of life, joy, love, peace and hope.

Okay, I’m off to deliver some gluten-free puffed rice cereal treats to a bake sale at my daughter’s school’s annual plant sale. That’s right, I’m trying to make fat all the people who can’t eat gluten, one tasty rice marshmallow butter snack at a time, while raising money for the cash-strapped school. I must be part of the problem. And, I need to pick up some vegetable starts while I’m there.

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Wrong diagnosis = wrong, harmful treatment

While looking for an image to illustrate this post, I ran across the one I’ve inserted here.

The data is from the NHANES, the U.S. National Health and Nutrition Examination Survey, a continuous program of studies designed to assess the health and nutritional status of a nationally representative sample of children and adults in the United States. Graphed is the distribution of BMI across the population, according to the NHANES, and how it has shifted over the past 30+ years.

FIGURE 1-1 Changes in the distribution of body mass index (BMI) between 1976-1980 and 2005-2006 among U.S. adults aged 20-74.I wanted to use this graphic to illustrate something — the distribution of weight in the 1976-1980 period, as represented in this graph, shows at least 50% of the population having a BMI of greater than 25, that is, in the “overweight” category or higher.

The dashed line graph, showing NHANES data from 2005-2006, shows approximately 2/3 of the population with a BMI greater than 25, which is what we’ve been hearing — that one out of every three adults in the U.S. is overweight or obese.

But, back to the 1976-1980 period, with one in two adults with a BMI greater than 25 — and the graph is of a “normal” distribution, a lovely bell-shaped curve, with a longer tail to the right than the left. This population distribution is one that would be expected in a population measure like BMI. The 2005-2006 distribution is flatter — more people distributed further to the right, and a longer tail.

It is hard, or really, impossible, to know who, living today, may have had a lower BMI were they the same age in 1976-80, and who is has the same BMI that they might have had then. It appears as though everyone has gotten fatter, but that isn’t the case — some people have gotten fatter, some have stayed the same — all but perhaps 1 out of every 4-5 people is still in the same pattern as was seen in 1976. (Anyone want to use some advanced algebra skills to determine the differences between the curves?)

If the way the problem is perceived is that no one should have a BMI greater than 25, then one half of the population in 1976-80 was “out of line” — how would one tell who is “naturally” in the BMI greater than 25 category, and who is “unnaturally fat?”

We can’t differentiate — we have no good way of knowing. We also don’t know when it comes to children.

I suppose I’m thinking about other differences, such as the distribution of height. Over the past century, we have gotten taller as a population, but in my family we haven’t gotten much taller than 5 feet or so. Are we abnormally short — pathologically short? The primary impacts of being shorter than average are those imposed by society, not a direct result of height itself. Or, if a child is born and develops into a very tall child, is that child’s height pathological? Are they to sleep standing up with bricks on their heads? Are they to be limited in the quality and quantity of food so they don’t reach their full potential in terms of height?

If the problem isn’t fatness per se — as many of us don’t believe that fatness is the problem — then what is? I don’t think it’s true that there isn’t a problem that is leading to those shifts in the population. I don’t think that fatness is the main negative outcome of the problem. Some of the people, perhaps as many as 1 in 5,  being fatter than they otherwise might be isn’t the main issue.

In my humble opinion, I think the problem is quite fundamental, and it has an impact on people across the BMI spectrum. I would say that the main problem is that there are more calories produced for consumption in the U.S. than can be consumed without creating health problems — and that there is a tremendous amount of advertising poured into our lives to encourage us to consume those calories. Fatness itself isn’t the health problem — the health problems that result from our food system impact people of all sizes. It’s not processed foods, or even food. It’s too much being marketed to us, it’s a consumer-based economy, it’s the push to somehow consume constantly what’s being pushed at us and then being blamed for our woes, be they health or over-extended credit or feeling “less than” for not participating in the whole consumer-driven culture.

I alone can’t say what the problem is. I only can feel one part of the proverbial elephant. The important thing is that those of us affected by the problem are the ones to define it. Diagnose it. There is nearly consensus on what the problem is by people who aren’t fat. It’s up to us to lead the way to an accurate diagnosis, or at least highlighting when the diagnosis is wrong.

Treating the wrong problem isn’t benign. It’s harmful. It violates the ethical law of “first do no harm.” We have seen time and again when people have been blamed for their own “sickness” — only to discover a shift in understanding that the person was never sick to begin with.

I am probably not quite saying what I am trying to here. I blame daylight savings time.

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What I sent to Disney about Habit Heroes

Here’s an excerpt from what I sent…
If I were to construct a game to encourage healthy habits in youth/teens, I wouldn’t focus so much on the habits themselves — in a “deadly sins” approach — but rather, what are the things that help people stay healthy — a positive, rather than negative focus.
For example:
Rewarding movement in a game with “muscle points” or “feel good points” or “years of life” points
Rewarding picking out the healthier foods from a landscape with “feel good points” or “healthy habits points”
Rewarding avoiding smoking with “feel good points,” “healthy habits points” or “years of life points”
Rewarding not giving in to peer pressure to bully someone earns “feel good points” or “healthy habits points”
Rewarding coaching younger children in being active (a sport or a game) earns “feel good points” or “muscle points”
Rewarding seeking out a friend to talk with when you feel low with “feel good points” or “healthy habits points”
Rewarding playing music, making art or another creative endeavor with “feel good points,” “healthy habits points” or “years of life points”
Rewarding doing well in school with “healthy habits points” or “years of life points”
 
There are certainly behaviors that if engaged in, lead to a longer, healthier life. While childhood obesity may seem to be a “big problem” — the more immediate, life-threatening challenges that young people face with include suicide, eating disorders and drug and alcohol use, as well as pressure to be sexually active before they are ready to.
 
If there is anything to be demonized — let it be isolation, bullying, peer pressure, cynicism — and feeling pressured to grow up faster.
I know what I wrote wasn’t perfect… I wrote it quickly. Looking it over now, I notice that there is of course the “good foods” vs. “bad foods” aspect I might want to reframe.
Rule #1 of public health education is this: Involve the people you are attempting to impact from the start… this includes assessment, understanding and diagnosing the problem, planning and implementing the “intervention” and monitoring and evaluating the outcomes.
Anyone who did any formative research around weight and children would learn that reinforcing stereotypes will only exacerbate the pain of the population they are trying to change.
As a so-called fat kid* (I was barely fat), I would have given anything for someone in a position of power to say that the first priority was for me to be loved and accepted and protected from harm. Then, to be provided opportunities to be active and to develop skills that would serve me well in my life. Not to be told the solution to all of my problems was to not be fat anymore.
This, I think, is the fundamental issue — are fat children really children, or are they are problem to be solved? If they truly are children, then like all children, they need love, nurturing, appropriate limits (including not harming others with physical, verbal or emotional violence), opportunities to learn and grow, supportive friends and family, an opportunity to discover the joy of movement, and certainly foods that help them grow healthy and strong as well as some foods that are purely fun. Just for fun, what if we were to try this first, before any other “intervention?” Or, better still, ask fat kids what they think — what would help them? Sure, some would wish to not be fat anymore — who wouldn’t want to be rid of the characteristic that makes you a target of hate — but others would ask just to be treated like any other kid who wasn’t fat. Skilled researchers would dig deeper than just “make me thin!” knowing that would likely be there. And I’m sure I would learn quite a bit from that quantitative research, probably some things that surprised me!
* I did have a therapist who I adored and saw for a long time look at photos of me as a kid with some surprise — she expected me to have been much fatter than I was, based on what I told her about the attitudes of my family and pediatrician. I vaguely remember her saying something like “you weren’t always fat” — I think she probably didn’t say “fat” but overall, she conveyed something like, no, your perceptions of yourself as having been fat from the get-go — that was formed by the people around you, not the reality of your body.

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