I'm going to make some statements, and then get on with my day.

Fatness doesn't cause stigmitization.
Fatness doesn't cause discrimination in employment.
Fat people have friends. Oh, yes, we have many of them.

"Obesity also leads to heart-wrenching psychosocial problems, such as difficulty making friends, stigmatization, and discrimination in employment."
"We urge you to harness your imagination and commitment to reversing the obesity epidemic by signing an Executive Order that would create a Presidential Commission on Healthy Weights, Healthy Lives."
-- From Center for Science in the Public Interest's* Letter to President Obama on June 22, 2009.

It's like these people looked at the Fat Hate Bingo cards before writing this to see how high they could score.

I swear, it's starting to feel like they are advocating that fat people be rounded up into detention centers in order to "reverse the obesity epidemic" and save the "tens of billions of dollars in avoidable medical costs." Is there some sort of mass-hatred playbook that these people are reading from? Does it get passed out somewhere -- "The Complete Idiot's Guide to Scapegoating, Inciting Violence and Cleansing?"

"The increased rates of obesity will negate many of our nation’s investments in health-care and could actually condemn youths to shorter life spans than their parents’."
Really? Really??? Scare tactic much? And your proof for this assertion is... the mounting evidence that weights in the "overweight" range have the longest lifespans, and those in the "obese" range have longer lifespans than those in the "underweight" range?

If you have the energy and can spare a few milimeters of mercury in blood pressure, read the letter that CSPI wrote and too many people and organizations signed. And then come back here and tell me you aren't angry, too.

* For those of you not familiar with CSPI, they are often seen as the "food police" -- in both good ways and bad. They are watchdogs for the food industry, and do good work to highlight problems in food safety and dangerous weight loss products. They also use belittling and downright abusive language with regard to fatness and definitely don't mind being seen as bullies when it comes to "good" and "bad" foods. I did at one point subscribe to their printed newsletter, as it does contain some information I'm interested in (ie which brands of wheat bread contain the most fiber, which items in the supermarket contain the most of whatever nutrient I'm interested in getting more of, without the stuff I personally choose to try to avoid) but the way they talk about fatness was just too painful to read. Also, they don't seem to be open AT ALL to the idea that increasing stigma makes health worse. Their main target audiences appear to be people that they think, by sheer power of will, are keeping themselves from becoming fat, and politicians. Oh, CSPI, you are like a family member that I keep seeing even though I don't want to, and maybe I remembered what it was like to play with you as a kid, but you've just gotten so hateful I can't stand to be around you any more. If you stuck to what you are good at, and just left the "obesity" stuff alone, you would be such a force for good.

First, I want to link to this Health Care-related comic by Barry Deutsch of Alas, a blog.
Which pretty much sums up how I feel about our current system.
There's an interesting article in The New Yorker by surgeon and writer Atul Gawande called "The Cost Conundrum." Dr. Gawande was also interviewed about the piece today on NPR's Fresh Air. In brief, Dr. Gawande looks at a Texas border town with extremely high per-capita health care costs (without higher than average quality of care or health outcomes). The conclusion he comes to (and reading it, I could see his conclusion early on in the piece) is that doctors being financially invested in the system drive up costs by driving more business to their own businesses. Compared with non-profit systems (not government-run systems), these areas where the economy is dependent on health care as an industry have much higher costs and more unnecessary procedures, surgeries and care, without better outcomes.
Now, I know that what is an unnecessary procedure is in the eye of the purchaser. But some of the top providers of care in the country are not-for-profit, and have been able to keep costs down.
But reading Dr. Gawande's article, and hearing him a bit on the radio, made me think about weight loss surgeries and how they fit in with what Dr. Gawande is saying. Fat acceptance is a direct threat to the business of those who are profiting from providing the surgery. I would love to see the differences in weight loss surgery rates between systems that are for-profit and those that are not-for-profit.

Thoughts?

At the park, dance class, with superhero princess, at work, but much less, at the computer.
Life is busy for me these days. Things are shifting and changing. As such, I'll be blogging less frequently here, and I'll be blogging more often at Angry Gray Rainbows. I haven't figured out yet what exactly I'll be posting here, and what I'll be posting there, but the posts I have that relate to therapy, healing, dancing, developing a "normal" relationship with food -- those will likely be there. I will likely still post here about more political topics, nerdy public health things and whatever else I strikes my fancy.
I'm so happy that Angry Gray Rainbows (the blogger) and Sassy Blonde have invited me to join them, and I think we'll make a harmonious team.
So, I'll see you less frequently here, and with some frequency there, as I can fit it in.

This morning, I came across this TED talk by Louise Fresco, "On Feeding the Whole World." I found it to be a great way of contextualizing the current agricultural moment, de-romanticising the the agrarian past, and clearly refutes the idea that someone obese people are in any way "causing starvation." She also highlights the idea that while for those who can afford it, "going artisan" is laudable, it won't solve the larger problems faced by current and future food needs.

http://www.ted.com/index.php/talks/louise_fresco_on_feeding_the_whole_world.html

 

My brain is in one of those "not able to process fast enough" modes at the moment (4:36 a.m. Pacific). Three articles are rattling around in my brain, running into my experience and training and lots of other stuff in there (hi, elementary school tormentors, how are you doing, jerks?!?).

Deep breath.

Doesn't "spurious confounder" sound like a phrase that ideally would be accompanied by "dangnabit!"

The spurious confounder in question? BMI.

I have often thought that it might be just such a critter. And I have agreement coming at me in the form of an article linked from Shapely Prose in [interruption for awake superheroprincess calling me -- okay back now, 9 a.m., better chance to be coherent] this post by Fillyjonk on The Nocebo Effect. Commenter Vixen pointed to a fascinating article on BioMed Central Public Health by Peter Muennig, Ph.D., MPH, Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York. In article, called "The body politic: the relationship between stigma and obesity-associated disease," Muennig lays out four hypotheses for how "the stress associated with social stigma and negative body image among obese persons explains some of the weight-associated morbidity that researchers had previous attributed to adiposity alone."

[Okay, based on that line alone, I'm ready to add Peter Muennig to my collectable set of my favorite "thinkers on obesity" trading cards. A few of the many guests at my version of Judy Chicago's The Dinner Party would include Katherine M. Flegal, Linda Bacon, Paul Campos, Gina Kolata and now, Peter Muennig.]

Addressing one of his hypotheses, Muennig states, "Consider that it is weight dissatisfaction that is driving the relationship between BMI and health, and that BMI is a spurious confounder." He designed a study to look at the difference between a respondent's desired or "ideal" weight and their reported weight, and then looked at the differences in days a person felt ill between those who had big gaps between ideal and reported weight, and those who did not. The study looked at responses to the Behavioral Risk Factor Surveillance Survey, a telephone survey conducted annually, and one of the bread-and-butter sources of U.S. health surveillance. (The BRFSS has many limitations, but I won't go into them here). What the study, covered in more detail in this article in the American Journal of Public Health by the same lead author, found is that the "difference between actual and desired body weight was a stronger predictor than was body mass index (BMI) of mental and physical health." This study found that in some statistical models, "a higher BMI is predictive of fewer unhealthy days than a lower BMI once the relative desire to lose weight is controlled for."
Yep.
And, then there's this:
That's right, it's worth repeating: for young guys, seeing onself as too skinny was also correlated with psychological and physiological morbidity.

From Muennig's conclusion, there is this gem:

I am excited to read this (I know, I'm such a public health geek) talk about the "net health benefits of public health communications campaigns." I'm thinking, how can I get President Obama to read this article? Especially with Thomas Frieden as new head of the CDC (I'm actually waiting and seeing on this, because there's almost no way he'll be more damaging to public health than the previous CDC director).

So, to article two (sorry it has taken so long for me to get here), the original article that Fillyjonk linked to from The New Scientist, their cover story on "How Beliefs Can Harm You" -- with the headline inside of "The Science of Voodoo: When mind attacks body".

The quote from that article that stood out to me was this one: "One study found that women who believed they are particularly prone to heart attack are nearly four times as likely to die from coronary conditions than other women with the same risk factors." So, when we public health types are telling people that having a particular condition makes you more likely to get ill or die from illness, what impact is that having on health? Wouldn't it be better to use the placebo effect than the nocebo effect to encourage people to think of themselves in good health?

So, here's where it gets personal. This week, I saw both PhD Coachy and, for the first time since the beginning of the year (and since the miscarriage), Doc Thoughtful (my primary care doc). PhD Coachy has been recommending that I read (knowing my critical eye) "Feeling Good" by David Burns (or the "Feeling Good Workbook," depending on which one resonates more with me) and the concept that there are thoughts I'm thinking that I could address with more rational thought, and that this in turn can have an impact on mood and actions, well, it all makes sense and connects up well with the "beliefs can harm you" stuff above. I'm not advocating this book or approach for everyone, and seeing how poorly I was feeling emotionally over the past few weeks, I did have a conversation with Doc Thoughtful about potentially starting an antidepressant. But, sitting there in Doc Thoughtful's office, wiping some tears from my eyes as he asked how I was doing after the miscarriage, he asked me other questions. We went over my lab results, which were really good, my A1C was 5.7%, which is really good, and if I were an objective observer, I would have noticed it wasn't Doc Thoughtful raising concerns about weight, or telling me to do anything differently. He wasn't telling me to exercise more, eat less or differently (although we both agreed I would start taking my statin again to lower my LDL, which wasn't high but higher than ideal for a person with diabetes). We talked about which antidepressant I would take if I decided I wanted to take one. The one comment that he made that was a little cringe-worthy was when I mentioned the dance stuff I've been doing and he made some mention of "burning calories" (which made sense, given how much I had focused on weight during the visit), but I said, no, it was more for the mood-lifting and stress-reducing benefits, which led us to an interesting discussion about dance. So I left, without a prescription for antidepressants but knowing I could get one, with the knowledge that my blood pressure, blood sugar and blood lipids were in or near the ideal range. And, immediately prior to this visit, I actually did my first annual mammogram (I had done one before to rule out some worrisome lumpiness a few years back, so this wasn't my first one). It didn't hurt, and was maybe just a tiny bit uncomfortable for a few seconds. I ought to have felt proud of taking good care of my health.

Yet, I didn't feel healthy.

Especially when I returned to my work, which sometimes is about promoting awareness of health risks. Sometimes it's not about that, and often it's very positive. But what does the work I do to "raise awareness" do to people who feel healthy, and then are told that they are "at risk." I'll have to think about this more before I answer. I'm generally very, very tuned into the "harm/benefit balance" -- I know that this worrying that I do is prized by the people I work for and with because I'm tuned into things that they sometimes are not.

So, now to the third article, this one from Maclean's (Canada's newsweekly magazine) called "Size Isn't Everything." Here's one quote:
The article overall isn't necessarily fat-positive, but here's a statement I found intersting, "There’s one point, though, that’s impossible to argue: heavy people who improve their lifestyle are almost certainly better off, even if they never drop a pound." This doesn't address the idea that "heavy people" who are not stigmatized are also "almost certainly better off, even if they never drop a pound." Another study is cited in the article which "showed a marked improvement in risk factors for diabetes and cardiovascular disease, suggesting that losing visceral fat, not achieving a “healthy weight,” should be the clinical goal." As far as clinical goals go, that is an improvement. I got to the article from Dr. Arya Sharma's blog, as his "Edmonton Obesity Staging System" is mentioned (and he is quoted). I'm a little less in like with Dr. Sharma these days (strangely, he doesn't consult with me before forming his opinions), but I'm glad his views are getting play.

So, to end this very, very long post (if you've read this far, you're nearly there!), I'll go back to the personal. I am trying on Dr. David Burns' advice -- I will focus on doing what I can to control my thoughts. To that end, here's what I'm focusing on:
I am healthy
I am strong
I am caring
I am attractive

What conclusions are you drawing, from political to personal, from all of this?