Dr. Isis has been away from MRU for the larger part of the last week. She's been home with family and visiting with friends. She has been staying in one of her favorite places in the world and in the town where her family is from. One of the things about going "home" is the feeling that Dr. Isis has to visit all of her favorite local restaurants and eat all of the local foods she loves and can't get at MRU. Dr. Isis really loves to eat and, I must confess, food at MRU is not on par with the places Dr. Isis has been in the last week. Not nearly on par.
Figure 1: Left Panel -- Food at MRU. Right Panel -- Food where Dr. Isis has been staying.
Well, today the amount of food Dr. Isis has eaten in the last week is beginning to get to her. My body just feels unwell. Today is Thanksgiving and Dr. Isis just needs to muscle through it and then get back to a hardcore routine of healthy eating, weight lifting, and running. And, trust me, Dr. Isis is going to have to do a lot of running to counter the aftermath of this week's indulgences.
Dr. Isis realizes that she has reached a point where she needs to say that enough is enough. Tonight Dr. Isis sat down to Thanksgiving dinner with the Isis family and began the yearly tradition and contest by which each member of the family attempts to eat until they are the last one to leave the table. Dr. Isis won't lie, she loves to eat. This year, for the first year ever, Dr. Isis outlasted the Isis children, all her baby cousins, the Isis women, Mr. Isis, and the Isis uncles and Brother Isis (all of whom are taller than 6 feet and easily more than two bills). This is the first time Dr. Isis has been victorious and she credits her win to the training she's been doing a la Takeru Kobayashi. Dr. Isis's reward for her win is kind of a general sick feeling.
Figure 2 : Dr. Isis's rendition of Dr. Isis after the Isis Family Thanksgiving Eat Off.
After Dr. Isis was done gorging eating she laid down to watch the Eagles lose win. She laid down on the couch to try to take the pressure off her lungs, leaned to the right to take the pressure off her vena cava, and saw the current issue of Time Magazine sitting on the coffee table. The cover headline reads:
So, I figured I'd give it a gander. As I read through the article, I learned that 67% of Americans are overweight or obese and 25 in 1000 have diabetes. Allegedly (although I sincerely have a hard time believing this) 96% of Americans cannot remember the last time they ate a salad and 40% of us do not exercise. Dr. Isis was thankful that her bad behavior had been limited to the past week, but the truth of the matter is that, for many, Dr. Isis's week of bad behavior is daily behavior.
But none of this is really news. In fact, the repeated cover stories about obesity in America seem to serve no greater purpose than to remind us of the problem in between bags of Doritos and cookies (I kid you not, as I write this Cousin Isis is sitting on the couch next to me eating a bag of Doritos). Still, it seems to take little more than the cream filling of the Oreo to make us forget the problem again. This is in the face of article after article that tell us that exercise and proper diet are effective immediate interventions (although we can debate the long-term sustainability of the intervention).
Figure 3: Wait! What? Who did you say is fat?!?
The scariest bit of it all is that our culture seems to be evolving from one which recognizes the problem, and chooses to ignore it, to one that has given up and accepts obesity as a disability. The Canadian Transportation Agency recently ruled that obese passengers, as a disabled population, are entitled to two seats if they need a little extra cushion for their...um...cushion.
Now, don't mistake the domestic and laboratory goddess. As someone who needs to run regularly in order to fit in the middle seat, Dr. Isis appreciates that maintaining a healthy weight can be challenging. However, deeming the obese permanently disabled flies in the face of current scientific evidence. We know that diet and exercise training can be effective in even the morbidly obese. While we may not entirely understand the changes in psychosocial triggers that cause us to overeat, we are making progress. And the advantages to losing just 20% of one's body weight are too huge to ignore (no pun intended).
In the meantime, we need to focus on initiatives that encourage a healthy lifestyle. Dr. Isis's health insurance plan gives her $200 every six months if she uses her local gym 8 times a month. This ends up paying for her gym membership and led her to lose the weight she gained with Baby Isis. It strikes me, working with human patients, that many of them have no concept of portion sizes or the nutritional content of what they eat or how to feed their children. I imagine that an investment in nutritional counseling could pay off many times the value of an airplane seat.
Two things seem evident to the domestic and laboratory goddess. First, the current medical system is ill equipped to deal with the crisis of obesity. Certified Asthma Educators have been immensely effective in teaching patience how to monitor their own pulmonary function, about rescue medication overuse, and the importance of controller medication compliance. The point is, physicians are poorly equipped to deal with the obesity crisis (did you know that only one medical school in the Big Ten offers a section to physicians-in-training in exercise and nutrition as a part of the medical school curriculum?) and the additional level of support could be immensely beneficial. Second, and I realize how controversial this statement will be as a write it, we have to be willing to take a certain degree of personal responsibility for this problem. Dr. Isis has been heavier than she is now and appreciates that she is responsible for the times her waistband expanded. She fears that labeling obesity a disability removes the personal responsibility from the diseases in the same way that the blind, deaf, and paraplegic are usually not responsible for their disability and are powerless to change it.
This is a hell of a problem, but one that Dr. Isis thinks science can find a solution to - as long as we are willing to hear the solution. But, in the meantime, Dr. Isis hears Grandmom Isis calling her for dessert.
Medicine & Health
Comments
I want your insurance plan.
In the meantime, there seems to be some pie left....
Posted by: unbalanced reaction | November 28, 2008 12:05 AM
Stupid reader did not tell me you had a new post...
First of all, the Transportation Agency was ordering the Airlines to conform with a Supreme Court Ruling against the specific policy that anyone (disabled and obese) had to pay for the extra seats. My understanding is that b/c the policy did not distinguish between obese and disabled individuals, when the policy was challenged (by a woman who uses a wheelchair and has rheumatoid arthritis) both groups were included. The ruling did not state or claim that obese individuals were disabled. That is an important distinction. For a more accurate account of the story I suggest a look at www.globeandmail.com
Posted by: ScientistMother | November 28, 2008 12:18 AM
a post on obesity on thanksgiving. i have two words for you, dr isis: buzz and kill.
but seriously, i agree with you. personal responsibility is in shambles in america. we need to get our act together and realize that we create our situation- even if only by reaction to outside circumstances- and have the power to change it. if i don't like the situation, i work to change it. sometimes the work isn't likable either, but you do what you have to.
i also don't put too much stock in what the scale says when i step on it. i'm horribly out of shape (by my own personal standards) but my bmi puts me at about the lowest risk. i gain weight when i exercise but i'm healthier.
Posted by: leigh | November 28, 2008 1:02 AM
It really, really bothers me when people try to talk about obesity in America without acknowledging the impact of poverty at all. Really, if you listen to the discourse -- and scientists are absolutely no better about this than the pop press -- you'd assume that this was a nation where the wealthy (or at least middle-class-and-up) are particularly fat and unhealthy due to excess recreational eating...when instead we are a nation where the poor are fatter and less healthy than those with a bunch of extra money for Ben & Jerry's infusions. This indicates to me that we as a nation have more serious issues than individual self-control or lack thereof. Sure, you can argue that the poor need to take responsibility for themselves just like everybody else, which I will agree is fair as soon as there is fresh, healthy food available for purchase in low-income neighborhoods, and ideally an end to government interference that keeps high-calorie, low-nutrient white-flour-transfat-and-HFCS concoctions so damn cheap.
Posted by: Kim | November 28, 2008 5:31 AM
The realities of obesity in America serve to remind me that early childhood interventions and neighborhood support programs are desperately needed. We cut physical education and gym in schools and we wonder why childhood obesity sky-rocketed? I also think it's worth screening people to let them know if they have the propensity for extraordinary weight gain as they age. A family member of mine ballooned after she got married. Looking at weight gain in my family's histories encourages me to be proactive about my 10-20 pound gains so I don't have get 100 pounds overweight before I try to do something.
Posted by: Academic | November 28, 2008 9:28 AM
This is a pretty fatphobic post, and also pretty uninformed on the social justice issues involved with living in a fat body.
Most of what you are reading in the public media is based on extremely distorted information, and better (and more honestly reported and less bias-edly interpreted) scientific results indicate again and again that body size is largely genetic, largely beyond our control, has in fact *barely changed* in the national and world population, and is not particularly unhealthy or a problem for individuals. People are NOT ignoring this shit - it's all anyone talks about these days, and people are eating far less than they used to. The social stigma against being fat is worse than ever, and no, that's not excusable and not for good reason. Also, as even WW keeps telling us, diets simply Do Not Work. Even if you pretend it's not a diet. (And WW is a diet.)
But hey, a lot of people stand to make a lot of money off convincing the public they need to diet and change their appearances, so you're hardly alone in not being informed about the other side about this. So this is just to say, there is another side to this.
Posted by: volcanista | November 28, 2008 10:11 AM
Academic, childhood obesity did not skyrocket. Definitions changed, childhood weights increased slightly on average, and then they stopped increasing. Years ago.
Kim, this is an interesting and more compassionate argument than I usually hear, and I have even said things like that in the past. Recently a large study showed, however, that poor people do not eat appreciably more "unhealthy" food (more fats, more processed food, etc.) than more wealthy people. They just eat less all around.
leigh, see, that's a great example. People's bodies are different and are healthy under different circumstances. BMI is pretty much crap, agreed! But there are healthy fat people and unhealthy thin people, and that's okay!
I have no problem with the airline ruling. Disability is not a black-and-white, either/or thing - people have disabilities in certain circumstances and not others. Not being able to hear is not a disability in circumstances where it's not necessary to do so; being fat is not a disability for most people under most circumstances. When the ability required is to fit into an impossibly tiny seat, however, that can mean a lot of people technically DO have a "disability." I resist painting the word disability with such negativity, such a shameful thing to avoid - able-bodiedness is not guaranteed to any of us at all times, and there should be no shame associated with being disabled, whether it's sometimes or all of the time. If the natural size range of people's bodies is not being accomodated by medical equipment, by airline seats, by anything else available to the rest of the population - that's a social justice issue, plain and simple. Moralizing about it doesn't change that.
Posted by: volcanista | November 28, 2008 10:19 AM
(Note that when I say "diets don't work," that's a long-term evaluation. People's weights fluctuate within a natural setpoint range, sometimes related to weight and activity, and for some of us, just randomly. And sudden changes in diet or level of activity DO cause changes in weight and body size. But it's temporary. Within 3-5 years, almost everyone gains back every pound, and for many people, repeatedly losing large quantities of weight leads to overall weight gain in the long run. And a lot of health problems.)
ANYWAY. I'll stop posting and wait to hear what people have to say after this, I promise! It's hard to sit through all the fat-hating talk at Thanksgiving every year, so my blood pressure is a little higher than usual on this subject. A big point I am trying to make is that eating intuitively, in ways that make you feel good, is the way to go. Eating is morally neutral. Good/bad food is a false dichotomy. Why can't people just enjoy Thanksgiving without all the guilt?
Posted by: volcanista | November 28, 2008 10:26 AM
Isis, if 96% of Americans can't remember their last salad and yet 67% are obese, then at the very least 29% of Americans eat badly but aren't obese.
If we're going to wag our fingers at anything it should be unhealthy habits, rather than body shapes that are very loosely correlated with those habits. And even better than finger-wagging would be encouraging people to take care of their health without equating health with weight and weight with personal moral failings.
Posted by: MissPrism | November 28, 2008 11:53 AM
Alright, MissPrism. I will grant you that at the heart of this is the issue that American diets in general are poor. However, I think it is more than a bit naive to say that there is no relation between dietary habits or physical activity and body size in the frankly obese.
And wasn't the point of my post that it is not effective to simply restate the problem. Instead we need to invest in initiatives that encourage a healthy lifestyle.
But, finally, I do consider living a healthy lifestyle to be a moral issue. As we are all pooled into insurance groups and are assigned premiums based on the health of the collective group, why is it irrational to think that one has a moral responsibility to that group? The idea that ones actions affect the individual alone is patently false. Body image issues aside, why is it offensive to ask people not to engage in behaviors that place a burden on the medical system and the financial well-being of the collective (I might also include cigarette smoking or riding a motorcycle without a helmet)?
Posted by: Isis the Scientist | November 28, 2008 12:11 PM
If people can't stop smoking on the basis that they might die, I doubt they'll be persuaded by the suggestion that they run the risk of losing someone else some money.
But that's by the by. The thing that I'm objecting to is the conflation of obesity with bad habits. I didn't say there was no relation, merely that the correlation is a very loose one, and that everyone wins if we remember that.
Posted by: MissPrism | November 28, 2008 12:34 PM
BINGO! The cheapest food available in the United States is fucking poison to human metabolism! And the reason for this is the federal Farm Bill.
The affluent can protect themselves from the effects of this government subsidized poisoning by purchasing expensive decent food and spending an hour or more a day at the gym. The poor cannot.
Posted by: Comrade PhysioProf | November 28, 2008 12:45 PM
I think Kim and PP have hit the reasons for most of the problem. You could also add a true lack of any nutritional guidance; I'm not sure there is a point in schooling where nutrition is actually discussed. There is also enormous pressure put on any nutritional guidelines released by the government by special interest groups.
Posted by: Nic | November 28, 2008 4:13 PM
MissPrism! *waves* I didn't know you read here, too, how exciting. I run into Shapelings all over the place. :) Hooray for the... feministosphere?
Okay, Isis, so it's been shown that being fat is largely inherited, but it brings with it some increase in certain health risk factors (also some decreased factors, which is why people with overweight BMIs live longest, but wev - for now I'll talk about the presumed increased risks. I'll also ignore that calculation of those elevated factors generally didn't correct for age). Assuming people can reduce those health risks through action, which is nowhere near as clear as your post made it sound**, but assuming that's true, people could do those things and reduce everyone's health care costs by reducing the amount of care the population needs as a whole. In principle. You're right there. Similarly, it would make sense that people should be aware of other inheritable risk factors - breast cancer risk, for instance, or alcoholism - and if they don't get screened early enough, or avoid a drop of alcohol their whole lives, they're costing us our damn money. Right? It's the same?
Why do we have health insurance if the point is only to help those who are already healthy? Do we have a moral obligation NEVER to get sick? Even if every illness were magically preventable with enough foresight? Some of us have, I don't know, UC, most likely because our Jewish background makes us 4x more likely to develop the illness. Maybe if I had known more about how to prevent an immune disorder at 10 years old, I could have done that and saved you some money.
Less sarcasm: Health is not a moral obligation. Nor is it a virtue. You're not more virtuous if you stayed healthier than me, just like how a person is not made more virtuous through self-denial (e.g. dieting) or self-punishmnt (e.g. exercise for the point of weight loss, rather than because you just like to move your body). Shit happens. People get sick, people get fat, people get addicted to stuff. Health care is meant to level the playing field - lucky folks to whom little shit happens have to pay more than their fair share, and unlucky folks with a lot of inherited fat and UC have to pay less than their fair share. That's why it's called insurance. In fact, hell, if it was all fair, we'd just pay our bills without insurance. Why should I be paying for someone else's wisdom tooth extraction, because they inherited crappy teeth? My wisdom teeth came in just fine. Those people have cost me money I shouldn't have had to pay.
** The myth that people can Do Something About Fat and reduce their risk long-term comes from studies funded largely by the diet industry and then misinterpreted and misreported in order to make a point that sells. I may not agree with Sandy's politics, and she is not bias-free, either, but she does present medical studies on this subject with either far less or just a far different bias from what we hear day in and day out about THE OBESITY EPIDEMIC BOOGA BOOGA. I don't know about what Dr. Isis studies, but I think most science benefits from listening to multiple points of view.
Posted by: volcanista | November 28, 2008 4:56 PM
Full Disclaimer: the 'advantages' of losing a mere 20% of my body weight would include not menstuating, higher altitude with ballet jumps (but no energy to dance), and perhaps being suceptible to floating away in large gusts of wind. However, I may be a bit prone to personal hypersensitivity to this subject, owing to having been a "Fat Kid(tm)".
If we are to focus on "personal responsibility", and we must judge anything, shouldn't we be focusing on the choices people make? Choices to overeat at Thanksgiving, choices to indulge in candy bars instead of a balanced breakfast, choices to forgo sleep and live with chronic stress loads which will weaken one's immune system? Choices that are not rendered irrelevant by being a runner, or by being "totally hot"?
Pretending that everything is about personal responsiblity opens up a form of moral calculus that I think has rather bizarre implications. More importantly- this moral calculus is probably not useful at addressing the true roots of overweight and obesity. Pretending that excessive Thanksgiving dinners are sins that we pay for with Hail Marys of miles on the treadmills does not make for a rational approach to healthy weight.
Posted by: Becca | November 29, 2008 1:55 PM
i don't get the poverty-obesity rants. really. i grew up on food stamps and spent most of my childhood pretty underweight because we didn't always have enough food. this lasted through my teen years, when every doctor i saw tried some trick they surely thought was way clever to get me to say i had an eating disorder. i finally hit "normal" at 21, though i had been an athlete for years prior to then.
right now i manage to feed 2 people on under $30/week when my husband is home. we eat a lot of rice, beans, lentils, potatoes, pasta, etc. we eat frozen veggies that i buy for $1/bag when they're on sale. and i find meats on sale so we have a source of protein, but we generally don't eat much meat. i bother to take the time to do this and cook meals, instead of stopping by mcdonalds and buying 20something dollar-menu items a week. unfortunately this is not as prevalent a course of action as we would like.
i do think the food industry acts deplorably by stuffing this cheap, nasty, empty-calorie laden HFCS and partially-hydrogenated filler into all of their overprocessed, oversalted, oversweetened crap. but let's not talk about how we're all such victims, oh poor us, we have no choice in the matter. that's bullshit.
Posted by: leigh | November 29, 2008 3:41 PM
perhaps Leigh when you grew up it was eat or starve. Now, where I live, balancing a food budget can consist of buying expensive milk - or coke at half the price, or buying expensive lean cheese versus full fat cheaper cheese. Fresh food here is expensive. It does not surprise me at all that poor families battle twice as hard to get good nutrition and I feel for everyone who has a tight budget on which to feed their family.When I think back to the times when our only meat was mince night after night . . . only to go out for dinner at a friends house and be fed lasagne. Sigh.
Posted by: anon | November 30, 2008 10:13 AM
So, I'm not sure why anyone isn't addressing volcanista? I don't see why eating vegetables, lean protein and whole grains most of the time and dessert less of the time is a poor way to manage weight? I come from fat parents, from uncles who die early due to heart problems, diabetes and high blood pressure that was largely his doing. Their parents are thin-ish, healthy and all still alive and living on their own in their mid-eighties. So am I supposed to be thin or fat? I have thin grandparents and fat parents - I grew up fat, and still have to watch what I eat and exercise regularly to maintain (my still above average but not obese any longer) weight.
I think personal responsibility is a huge part of weight management. I didn't inherit fatness, I inherited poor eating habits and an addiction to food=comfort=happiness and a low exercise lifestyle that made me fatter.
I agree that there are a huge number of companies that want to sell me fast ways to get thin, and I agree that diets don't work. I am all for tolerance and not making anyone conform to the same beauty standard. But I am responsible for my choices and the consequences of my choices. No one else. I feel that "I'm fat because my parents are fat" is a bit of a cop-out. Know your history. But it doesn't have to be your future.
Posted by: LMH | December 1, 2008 10:00 AM
Easily more than two bills?! BITCH!
Posted by: Brother Isis | December 3, 2008 11:23 AM
Oh, get over it, Brother Isis. You're a bigger dude than the domestic and laboratory goddess and I did seriously out eat your sorry ass. Did you not see me eat a big bowl of turnips and turkey after dinner while we were watching Don't Mess With the Zohan? And eat three desserts? Really, you should be embarrassed by your poor performance.
Perhaps I will have to come back to Major Metropolitan City and let you lug my huge suitcase around some more so that you can toughen up, Buttercup. Then next year you'll be more fit to compete.
Posted by: Isis the Scientist | December 3, 2008 11:29 AM
perhaps Leigh when you grew up it was eat or starve. Now, where I live, balancing a food budget can consist of buying expensive milk - or coke at half the price
you think i pre-date coke?! LOL
and counter to that argument water is basically FREE if you're looking for any kind of liquid to ingest. this does not instill sympathy in me...
Posted by: leigh | December 3, 2008 6:59 PM