Parents, overweight kids and a minefield of blame and judgment

When Dara-Lynn Weiss wrote an article for Vogue magazine last year about putting her then 7-year-old daughter on a diet, she created a firestorm of controversy. “One of the most (bleeped) up, selfish women to ever grace the magazine’s pages” is how Jezebel summed it up.

Weiss described policing everything that went into her daughter’s mouth, depriving her of meals as a punishment for overeating, and humiliating her in public.

“I stopped letting her enjoy Pizza Fridays when she admitted to adding a corn salad as a side dish one week,” she wrote. “I dressed down a Starbucks barista when he professed ignorance of the nutrition content of the kids’ hot chocolate whose calories are listed as ’120-210′ on the menu board. Well, which is it? When he couldn’t provide an answer, I dramatically grabbed the drink out of my daughter’s hands, poured it into the garbage, and stormed out.”

Ultimately her daughter lost 16 pounds, and mother and daughter celebrated with a shopping spree for new clothes.

If all of this sounds over the top, brace yourself because Weiss recently published a full-length book, “The Heavy,” that chronicles in much more detail her efforts to help her daughter lose weight. And I’m beginning to think she doesn’t deserve the vitriol that’s been heaped upon her, because it’s often incredibly difficult for parents to know how to address a child’s weight in ways that are constructive rather than shaming, bullying and falling prey to America’s collective horror of excess pounds.

Full disclosure: I didn’t read Weiss’s article in Vogue last April and the magazine’s website doesn’t appear to have it available for nonsubscribers. So I’m relying on excerpts, secondhand accounts and published interviews with Weiss herself.

What comes across is a mother who’s trying to make her way through an emotional minefield of food, obesity, other people’s judgments and expectations, and her own desire to help her daughter without being either too permissive or too rigid.

She tells New York magazine that she accepts much of the criticism that erupted in the wake of her essay in Vogue: “I am strict. I was abrasive at times. I made a million mistakes.”

She talks about the awkward position parents find themselves in when they have a child who’s overweight: “Parents of obese children have this extra standard that’s very uncomfortable: If you tell a child he can’t have a piece of cake you’re embarrassing him by drawing attention to his problem; the same limit-setting would be considered fine for parents of normal-weight children.”

She points out how hard it can be to tackle a child’s weight issues: “It’s so awkward to talk to a child about food and weight, that’s why so many parents don’t do it.”

She’s candid about her own issues with food and body image and her fear of passing them on to her daughter.

Elsewhere, she discusses the “darned if you do, darned if you don’t” dilemma foisted on  the parents of children who are overweight. “You can’t get it right, you can’t be perfect – you’re going to make some people feel like you’re denying your kid her childhood, while others are standing there staring at every cupcake she eats,” she tells Motherlode, the New York Times parenting blog.

She expresses frustration with school lunches and children’s party menus that often undermine parents’ efforts to help a child adopt healthier eating habits. She describes how some of the common advice – “make better choices”, “stop when you’re full” – was too unstructured to be helpful.

And she challenges people to examine their assumptions about overweight children. Her daughter wasn’t lazy and didn’t eat unhealthy food, she said in a recent interview with USA Today: “She was a child with an enormous appetite… She has a brother a year younger, same parents, same food, who doesn’t want to eat sweets.”

Public opinion polls and research seem to back up Weiss’s observations about how we view children and weight.

A study published last year in PLOS One, for instance, found that obese children are more likely to be stigmatized than middle-aged and older adults who are obese – and that obesity among children is more likely to be blamed on external factors such as parenting style or environment.

There has been public debate about whether extremely obese children should be removed from the custody of their parents. And a couple of years ago a legislator in Illinois went so far as to suggest that parents of fat children should lose their state income tax deduction (although he later backed down, saying he was only kidding).

At the same time, a billboard campaign in Georgia that used pictures of real children and messages such as “It’s hard to be a little girl when you aren’t” was widely criticized for its fat-shaming approach and the lack of evidence that this strategy even works; the billboards ultimately were taken down.

And a poignant story that appeared last month in the New York Times revealed that children often feel bullied by adults about their weight, sometimes at the cost of developing eating disorders and obsession with body image.

As Weiss told the Motherlode blog, “People are so critical of childhood obesity, and then you try to do something about it – to help your child – and they’re critical of that, too. Parents can’t win.”

Whether you applaud Weiss’s story or deplore it, it seems to have launched a conversation about parents, children and weight. Perhaps it can lead in a more rational direction that reduces the judging and the bullying in favor of approaches that are actually helpful, both for kids and their parents.

Holiday food guilt? Not on the menu

Writer Ragen Chastain can think of several things that would be more fun than being under holiday surveillance by what she calls “the Friends and Family Food Police”: a root canal, a fishhook in the eye… you get the picture.

Chastain, who blogs at “Dances With Fat,” tackled the subject last year of holiday eating and the well-meaning individuals who comment, nag or react in other ways to someone else’s food choices, particularly if that someone is overweight.

She clearly hit a nerve, because the comment section quickly filled with stories about people’s experiences at the holiday dinner table.

One woman was scolded by a cousin for eating high-carb carrots. Someone else was told “You don’t need that!” when she reached for the bread.

For others, the guilt tactics were more subtle – for instance, people asking them if they’d lost weight, or commenting, “I’m really being bad, I shouldn’t be eating this” while downing a sliver of pie.

Maybe it’s the food, maybe it’s the family dynamics, maybe it’s the emotional expectations we have for Thanksgiving and Christmas. Whatever the reason, there’s something about the holidays that can bring out the worst in people’s guilt and disordered attitudes about eating. When I Googled the words “holiday food and guilt,” there were 7.9 million results.

If you’re on the receiving end of the guilt tactics, how do you cope?

Chastain, who teaches workshops on self-esteem and the Health at Every Size approach and has written a book, “Fat! The Owner’s Manual,” advises deciding where the boundaries lie and what the consequences are for those who overstep them.

She writes, “I give people clear information, and several chances, but I don’t keep anybody in my life who consistently fails to treat me with the level of respect that I require.”

This might mean, for instance, simply saying “yes” or “no” if someone asks whether you really need that second helping of mashed potatoes – and then proceeding to eat it. Or it might mean giving a pointed response when someone gets too persistent: “I have absolutely no interest in discussing my food intake with you.”

Although much of the food guilt is aimed at obesity, it’s a minefield for other people as well. Thin people can be equally likely to have their weight commented on at the dinner table, or urged to eat more. And for those dealing with or recovering from eating disorders, holiday meals can be doubly difficult. Not only must they cope with food, and lots of it, but they may also be subjected to intense scrutiny over how much, or how little, they’re eating and whether they’re sticking to their prescribed meal plan.

This isn’t to say people shouldn’t try to eat sensibly for the holidays. The amped-up food choices can be difficult for those who have diabetes, need to limit their sodium or cholesterol intake, or simply want to watch calories.

Some tips from the Duke University Health System: Sample a little of everything but balance it with more fruits and vegetables. Stock up on healthy snacks for when temptation hits. Eat before a party to avoid overdoing it. Drink moderately. Don’t be afraid to say no if someone applies pressure to eat more.

The real question about food guilt is whether it actually works. According to a new study by the Rudd Center for Food Policy and Obesity at Yale University, the answer is no.

Researchers asked 1,000 study participants to evaluate several public health obesity campaigns by rating how positive or negative the campaign messages were and whether they were motivating or stigmatizing.

The best ratings went to campaigns that promoted specific health behaviors, such as eating more fruits and vegetables, and campaigns that encouraged people to become confident and empowered. Those that ranked the highest didn’t even mention the word “obesity.”

The least motivating? Messages that promoted shame, blame and stigmatizing.

Someone who truly cares about a friend’s or relative’s health should discuss it alone, at an appropriate time and in a way that invites dialogue, rather than shaming him or her at the dinner table, says Chastain. “Guilt is not good for your health. So I hope that if you choose to eat it, you also choose to enjoy it.”

Fire all the fat patients

Ida Davidson, of Shrewsbury, Mass., started seeing a new primary care doctor but on the second visit, she was told by Dr. Helen Carter that she needed to find another doctor. The reason? Davidson weighs 246 pounds, give or take the occasional fluctuation, and Dr. Carter’s policy is to turn away any new patient who weighs 200 pounds or more.

Discriminatory? Davidson certainly isn’t happy about it. “I have never heard anything so ridiculous in my life,” she told WCVB-TV of Boston last week.

Policies such as Dr. Carter’s might not be common but they’re not unheard of. When the Miami Sun Sentinel conducted a survey earlier this year among obstetrics-gynecology practices in South Florida, 15 of the 105 clinics that responded said they refuse to take new patients who weigh too much.

It seems to be completely legal. After all, there’s nothing that obligates physicians in private practice to see any and all patients who come through the door.

But as stories like these pop up from time to time, medical ethicists have expressed uneasiness over such policies. At the very least, it violates the spirit of the medical profession, some ob-gyns told the Sun Sentinel.

“No doctor should be unable to treat patients just because they are heavy” was the assessment of Dr. Bruce Zafran of Coral Springs, Fla.

Medical ethicist Dr. Arthur Caplan said doctors have a duty to provide care regardless of the patient’s health issues. “Simply saying ‘I’m not gonna take someone who’s obese,’ is, I think, not the way to approach the whole challenge of obesity, either for that person or for any American,” he told WCVB-TV.

Doctors who set weight limits for the patients whom they’ll accept into their practice say they have reasons for their policies. Some of the Florida ob-gyns told the Sun Sentinel that heavy female patients are more likely to have complications and are too much of a liability. According to news accounts, Dr. Carter decided to stop seeing patients like Davidson because three of her staff were injured while caring for obese patients. She also felt other facilities were better able to meet the needs of these patients.

Fair enough, but it makes one wonder where the line should be drawn. People who are aging or have higher-risk medical conditions also can be more prone to complications; should physicians stop seeing them? If it’s too much trouble for a medical practice to accommodate the special needs of overweight patients, should they also stop accommodating patients who are frail, who use crutches or wheelchairs, who don’t see well, who have low literacy or don’t speak English as their first language?

Although back injuries are a very real occupational risk for those who work in health care, proper training and equipment can go a long way toward making it safer to handle overweight or obese patients. And to simply dismiss overweight patients without first attempting to assess their willingness or ability to lose weight seems unfair (as well as an inaccurate generalization that these people couldn’t possibly have health issues or health-related goals other than their weight).

Sadly, numerous studies have documented that anti-fat bias is as prevalent among health care professionals as among the rest of the public. The typical medical school training also tends to be woefully short on education about nutrition and physical activity, with the result that many doctors are ill-equipped to effectively help their overweight patients.

So what – if any – should be the physician’s role in working with this population? A consensus report issued in May by the Institute of Medicine tackles this question and concludes that although policy and environment are significant areas that need to be addressed, doctors also play a key part in reducing and preventing obesity.

The report calls on doctors to be more systematic in assessing body mass index in their patients and talking to them about nutrition and physical activity. It recommends focusing on the patient’s overall health goals, not just weight loss, and providing advice and support to help patients meet their goals.

It doesn’t say anything about refusing to see these patients or delegating them to someone else’s responsibility.

Ethics aside, if doctors profess to be serious about reducing the incidence of American obesity, it’s hard to see how the “it’s not my problem” approach would meet this goal. An opportunity to forge a doctor-patient relationship with Ida Davidson and help her take care of her health was squandered here, and nothing positive was accomplished.

Linkworthy 4.0: The overdue edition

I’m way overdue for another edition of Linkworthy, my semi-occasional collection of links to interesting health-related stuff recently encountered on the web.

Besides, it’s time we all moved on from the Hatfield-McCoy post, which has accumulated several thousand hits since being published three days ago and is perhaps in need of a rest. (I’m just sayin’.)

Regional news first: The latest issue of Prairie Business Magazine includes a cover story about the use of high-tech diagnostic imaging, how the technology has evolved and how it’s being used in daily care. As a bonus, there’s also a story exploring the demand for doctors in rural health.

Did anyone catch the news earlier this week about a proposal by Michael Bloomberg, mayor of New York City, to ban extra-large soft drinks? On the surface, this might sound like a good tactic in the so-called war on obesity. Many people are questioning, however, the likelihood that a ban on large sodas will make much difference. The critics have weighed in here and here. The most colorful quote probably comes from the online commenter who opined that “we are like a bunch of lemmings headed for tyranny.”

Speaking of obesity, few people could have failed to miss the recent news about a study that discovered exercise does not in fact benefit everyone. Researchers analyzed six earlier studies and found that in about 10 percent of the participants, heart-related measures such as blood pressure, insulin level, cholesterol and triglycerides worsened with exercise.

The spinmeisters have been hard at work. Some are pointing out, and rightly so, that this was only one study – and a relatively small one, at that. Others worry that folks will use it as an excuse to avoid exercise. What this study really seems to be saying, however, is that we need to be careful about cookie-cutter assumptions that a particular intervention or lifestyle is always good for everyone, because often there are exceptions to the rule.

After blogging about three years ago on needle phobia, I heard from a couple of people who have this fear and who felt their anxiety often wasn’t taken seriously by health care providers. So I was intrigued to come across the news that MIT has developed a high-powered liquid injection device that squirts a thin stream of medicine directly into the skin.

According to the developers, it’s so fast and precise that it can barely be felt. But it’s a little premature to hope the device could be coming soon to a health facility near you. The injector device is still in the prototype stage and hasn’t yet been tested on humans. There’s also the not-insignificant matter of cost. Nevertheless, it’ll be interesting to see whether this Star-Trekkian concept catches on.

Most of us have probably heard about Munchausen’s disease, or Munchausen by proxy, in which people go to great lengths to fake illness in themselves or someone close to them. Now it seems there may be a new version of this behavior: Munchausen by Internet.

A rather chilling story from the BBC News Magazine details the behavior – and impact – of individuals who go online and convincingly pretend to be sick or to have someone in their family who is sick. Some of these hoaxes can be incredibly elaborate – for example, a woman in the U.S. who faked having cancer, HIV, anorexia and heart problems, and went so far as to post online pictures of herself in a hospital bed with an oxygen mask and feeding tube.

Many fakers seem to crave attention, and the Internet is the ideal medium for their manipulations, the article notes. “It gives the perpetrator a quick hit of attention, a feeling of being valued, but without really having done anything to deserve it. Just as online fraudsters dream of easy money, these people crave easy attention. And it is, perhaps, just another form of fraud – emotional, rather than financial fraud.”

Consider setting aside a chunk of time for the final piece in today’s series of links, an in-depth look at the huge global business of tobacco smuggling. Cigarettes are the most widely smuggled legal substance in the world, generating multibillion-dollar profits, fueling organized crime and corruption, and diverting much-needed tax revenue from governments.

Since 1999, a team of reporters with the International Consortium of Investigative Journalists has been examining this issue. They’ve just published a new series of reports, assembled by journalists from 15 countries, that takes a look at the influence of organized crime and terrorists groups as well as “the continued complicity of distributors, wholesalers, and tobacco companies themselves” in the illicit tobacco trade.

Most people are likely unaware of the impact of tobacco smuggling, its ties to crime and its impact on developing nations where cigarettes increasingly are being introduced and sold on the black market. This ambitious news project explains what’s happening and, more importantly, why it matters.

Why I won’t be watching ‘Weight of the Nation’

Count me out of the audience tonight when “Weight of the Nation,” the much-anticipated HBO documentary about obesity in the United States, makes its television debut.

If the trailers and pre-show publicity are any indication, “Weight of the Nation” stands a good chance of further fueling the stigma, stereotypes and alarmism about being fat, and ultimately doing little to solve the crisis it purports to address (although I hope I’m wrong about this).

Others have articulated this far better than I can. Here’s Fall Ferguson, a health educator with a law degree, with a list of 10 reasons to be concerned about the potential messages behind the HBO documentary.

Some excerpts from the list:

10. The misguided focus on obesity. The series identifies weight as “the problem” when the focus of our public health efforts should be health promotion and the prevention of chronic disease.

9. The appeal to fear. The publicity for the series (and I am guessing the actual documentary itself too) uses fear as a means of persuasion and motivation for change. Few things are as destructive to health and well-being as fear. I also question whether health professionals who use fear to influence people are behaving ethically.

8. Disservice to thin people. Thinner people may get the message that their lower weight means they don’t need to take care of their health or be concerned about preventing chronic diseases.

There’s more. Ferguson questions the message the documentary may send to children. She’s concerned it’ll add to the stigma that already surrounds being overweight or obese. She worries that the documentary won’t include alternative points of view or recognize the issues of body shame and eating disorders in the U.S.

The final point on her list? That “Weight of the Nation” will serve to escalate the cultural war on obesity while sidestepping a more critical look at how we frame this national conversation. “As a fat person, I am tired of being engaged in a war that I didn’t start and that uses my body as cannon fodder,” Ferguson writes. “As a health educator, I deplore the damage done to people’s health and self-esteem by our cultural war on obesity and I deplore the misinformation about health that masquerades as ‘public health messaging.’”

None of this is to say we shouldn’t be concerned about the quality and amount of food we eat or the environment we live in. We ought to be concerned because all of these things do matter to health. It’s frustrating to note, however, the way the message is so frequently shaped: that it’s all about the numbers on the scale and that if people could only lose weight, they would be healthy and their problems would be solved.

Here’s something else to think about: Has the war on obesity become so shrill that it’s counterproductive? A provocative new article by science writer Sharon Begley suggests it has. She writes that as long as we continue to stigmatize fat people and blame them for their weight, we’ll make little progress in more substantive changes such as altering the environment – and we’ll probably make the situation worse for fat children and adults.

Is it time to reframe the conversation? Perhaps so, because the current conversation doesn’t appear to be resulting in much progress. Maybe it’s time to recognize there’s more than one way of talking about obesity and that there are alternate points of view that ought to be heard.

Update: Read more from reviewers who posted today about “Weight of the Nation:” Mary McNamara, television critic for the Los Angeles Times: “Weight of the Nation” pounds away at obesity; Michele Simon at the Huffington Post, More empty recommendations on junk food marketing to children; Tom Conroy, Media Life Magazine, “The Weight of the Nation,” weighty; NPR, Pounding away at America’s obesity epidemic.

Fat kids: the blame and shame game?

Who knew an ad campaign promoting a healthy weight for kids could become the target of so much controversy?

The campaign, called Strong4Life, was rolled out last summer by Children’s Healthcare of Atlanta, Ga., prompted by concern for the future health of overweight children and data suggesting many parents fail to recognize when their child is overweight. Its newest addition is a series of billboards and ads containing photos of fat children, the word “warning” in red letters and messages such as “Fat kids become fat adults,” “It’s hard to be a little girl if you’re not,” and “Big bones didn’t make me this way. Big meals did.”

Public reaction has been swift, to say the least. It’s being blogged and talked about coast to coast this week.

Organizers of the campaign have said the shock tactics are deliberate. “We felt like we needed a very arresting, abrupt campaign that said: ‘Hey, Georgia! Wake up! This is a problem,’” Linda Matzigkeit, a senior vice president at Children’s Healthcare, told the Atlanta Journal-Constitution.

Few would argue we should all just look the other way when it comes to overweight children. But is an in-your-face approach appropriate? More to the point, does it work?

This campaign has drawn a lot of criticism, much of it well placed. (Read more here, here and here.) Public health experts who’ve weighed in say there’s little evidence that shaming is effective in getting either kids or adults to change their behavior. Some worry the harshness of the ads could make children and parents even more reluctant to seek help in losing weight. Others point to the complex influences on children’s weight – family income levels and lifestyle, food availability, the community environment, even the national school lunch policy – and the difficulty of applying simplistic solutions to childhood obesity.

But score at least a couple of successes for this campaign. It has highlighted, rather painfully, the fine line between attacking the problem vs. attacking the person who has the problem. It also has highlighted how difficult it is to have a national conversation about obesity without descending into shrill self-righteousness on one side and angry defensiveness on the other.

The firestorm surrounding the Georgia campaign actually is nothing new. Some years ago, a local medical clinic had to revamp its advertising for a pediatric weight loss program after hearing complaints from parents who objected to the imagery – a sad-looking child sitting alone while his peers played together in the background.

It’s not easy to know how to convey the message in a way that’s constructive. And make no mistake, “constructive” should be the operative concept here.

Since the goal of the Georgia campaign ostensibly is to prod parents of overweight children into taking action, it seems fair to ask: Are these parents genuinely in denial? There’ve been a number of studies examining parents’ perceptions of their child’s weight and most have found that families aren’t very good at recognizing when a child crosses the threshold for being overweight.

I had to look it up online: Among kids ages 2-19, overweight is defined as having a body mass index between the 85th and 95th percentile on the growth chart for children of the same age and gender. Obesity is defined as a BMI above the 95th percentile. I suspect many parents don’t know this formula off the top of their heads. Moreover, they may have trouble accurately applying it, especially for a child who’s actively growing.

Even when parents do recognize their child is overweight, they can be reluctant to add the obesity label (or any label, for that matter) to his or her medical record early in life. There also seems to be a persistent amount of misinformation about childhood obesity, one of the myths being that most kids eventually outgrow it.

It would seem that helpfulness and better information are called for here, rather than judgment or scare tactics.

And let’s not overlook another important fact: The medical community traditionally has had little to offer overweight children and their families other than the standard advice to eat less and be more active. Nor is there much evidence yet that interventions for adults, such as weight-loss surgery, are safe or effective for kids.

For the record, I dislike the Georgia campaign. Kids who are fat already know they’re fat; their peers are telling them so every single day. Harping on it may highlight the symptom but it does little to address the deeper causes. And if the ad campaign is meant to galvanize parents into taking action, why manipulate kids into the position of being a shameful symbol of parental failure?

If we’re going to recognize that the people who designed this campaign were motivated by concern for kids’ health, let’s also recognize that those who object to the ads are motivated too by concern for what’s best for kids. How about dialing down the rhetoric and meeting somewhere in the middle?

Image: Children’s Healthcare of Atlanta

The new fat index

Move over, body mass index. There’s a new kid on the block: the body adiposity index.

The body adiposity index, or BAI, was recently introduced in a study, published in the Obesity journal, as a better and more accurate measure of body fat. Unlike the BMI, which is based on weight and height, the BAI uses height and hip circumference to determine where an individual falls on the weight spectrum.

One of the researchers talked to WebMD about why this method could be more helpful for assessing body fat:

The body mass index (BMI) does not accurately represent the amount of [body] fat,” researcher Richard N. Bergman, Keck Professor of Medicine at the University of California’s Keck School of Medicine, tells WebMD.

The new measure, called body adiposity index (BAI), does, he says. So far, he has validated the new measurement in Hispanic and African-American populations, and says more research is required to confirm how well it works in whites and other ethnic groups.

With BMI, he says, “you get a relative number” assessing body fat. With the new BAI, “you get a number which is the percent fat.” The new method, he says, is more accurate.

Here’s how it works: Take your hip measurement in centimeters and divide it by your height in meters times the square root of your height minus 18. The resulting number is your body adiposity index. The scale is the same as that for the body mass index – 18.4  or lower is underweight. between 18.5 and 24.9 is considered normal, 25 to 29.9 is overweight, anything over 30 is considered obese, and 40-plus is considered very obese.

The mathematics for the BAI seem rather complicated. Square root? I haven’t dealt with square roots since high school and I don’t like them any better now than I did back then. And the formula, or at least this early version of it, requires you to do the calculations in centimeters and meters rather than inches and feet. The body mass index, on the other hand, only requires you to divide your weight in kilograms by your height in meters squared – or cheat with one of the many handy online calculators that do it for you.

It has in fact been an ongoing academic challenge to come up with an accurate, consistent tool for assessing weight against the norm. The body mass index has been widely used for the past couple of decades and many Americans regard it as gospel, but it has its shortcomings. For one thing, it doesn’t account for individual variations in frame size. For another, it doesn’t distinguish between weight that can be attributed to muscularity vs. weight that’s due to fat. Nor does the adult BMI adjust for age.

The cutpoints are somewhat arbitrary as well. It’s not clear, for instance, the point at which women should be considered underweight. Varying expert opinions put the threshold at anywhere from 18.5 to 20. The division between normal and overweight also has been shifting. In 1985, the overweight threshold was 27.8 for men and 27.3 for women. In the late 1980s this was refined to allow slightly higher thresholds for people as they aged. The current cutoff point, however, is 25, which is stricter than the earlier criteria and has placed millions of Americans into the overweight category who weren’t previously considered so.

I suspect the new body adiposity index, while a useful tool, will have shortcomings of its own. Obtaining accurate hip measurements might be tricky, depending on where you hold the tape measure. For some people whose weight is carried primarily in their hips, the results could be somewhat skewed. The BAI also has been validated so far only among 1,700 people of Mexican-American and African-American background, so it’s premature to suggest it’s a good measurement for the population as a whole.

To complicate the picture, other research has found that the waist to hip ratio may be a better indicator of heart disease risk than the body mass index, at least among older adults.

So who’s right? All of these measures seem to be somewhat helpful for those who want to know where they are on the healthy weight spectrum. But it’s important to note that even the experts have yet to reach a consensus on what constitutes the ideal percentage of body fat for maximum health. Health encompasses more than what we weigh, and the numbers on the scale, the body mass index or the body adiposity index are only one piece of the whole story.

Photo: Wikimedia Commons

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Diet slackers

I’m not sure what to think about this: According to a newly released survey by Consumer Reports, there seems to be a gap between the healthy diet many people claim to have vs. what they actually eat.

When Americans were asked about their diet, nine out of 10 described it as “somewhat,” “very” or “extremely” healthy. But look at how they answered some of the other questions in the poll.

More than 40 percent said they drank at least one soda or sugar-sweetened coffee or tea each day. Only 28 percent said they limited the amount of sweets and sugar they consume; 26 percent said they limited their fat intake and 19 percent said they limited their carbohydrate consumption.

What about vegetables? About two-thirds of the survey participants reported they ate fewer than the recommended five servings of fruits and vegetables every day.

There also seemed to be a gap in people’s perceptions of whether they were overweight. About one in three who considered themselves at a healthy weight actually had a body mass index that put them in the overweight range.

The telephone survey involved 1,234 U.S. adults and was conducted in November. Overall, the respondents appeared to be trying to do the right thing, according to Consumer Reports:

Regardless of their weight, we found most people are trying to eat right. Fifty-nine percent said they were either “careful” or “strict” about their food intake, while only 23 percent said they pretty much ate whatever they wanted.

Thirty-eight percent described their diet over the last year as “extremely” or “very” healthy and 53 percent said their diet was “somewhat” healthy. Only 11 percent owned up to a diet that was “not very” healthy or “not at all” healthy.

Although studies have found that counting calories and weighing yourself daily are important strategies for maintaining a healthy weight, most of the people who participated in the Consumer Reports poll said they didn’t follow these recommendations. Only 15 percent said they tracked their calories, and 22 percent said they got on the scale each day.

Are we a nation of diet slackers, then? There can be a tendency for people to portray their eating habits as good – even when they know they fall short – because they want to sound good for the poll taker. Sometimes people are in denial. And sometimes there’s confusion and conflicting definitions over what, exactly, is “good” and what’s not.

Are we dooming our health if we enjoy a daily cup of tea sweetened with a little sugar or honey? Maybe not; it all depends on the context of overall eating behavior.

“Careful” eating can be in the eye of the beholder. To some people, nothing less than puritanical rigidity will do. Others might define it as consuming fresh fruit and vegetables a few times a week or passing up an extra slice of pizza, while still others fall somewhere on the middle of the scale.

It doesn’t help that there’s been a proliferation of foods labeled “low sodium,” “low fat” or “lite,” leading consumers to believe they’re making a healthful choice when perhaps the benefit isn’t as much as they think. Alas, there’s also a great deal of conflicting information about food. First eggs were bad, then they were good, now they’re sort of good but in moderation. Margarine used to be good; now it’s not so good. Salad is good except when it’s loaded down with high-calorie dressing and toppings; then it’s bad. Nuts were bad and now they’re good but only in small quantities. It’s challenging for the average person to try to keep up.

The results of the Consumer Reports poll suggest the messages about healthful food choices are getting through to people, even if it’s mostly in the form of wishful thinking. (Find out where you stand by taking the Healthy Eating Quiz here.) What to make of the gap between self-perception and actual behavior is a little less clear. Maybe people are just fooling themselves. Then again, maybe there’s still a lot of confusion about the food information we’re receiving. No wonder if people still have some difficulty putting the best habits into practice in everyday life.

Photo: Wikimedia Commons

Noteworthy 1.1

I know I’ve said this before but I’ll say it again: So much to blog about, so little time. Here are some highlights from the many tidbits that have crossed my desk recently:

- Yahoo! recently issued its year-end list of the top searches for 2010, and pregnancy was at the top of list for health searches, followed by diabetes. The rest of the top 10, in order: herpes; shingles; lupus; depression; breast cancer; gall bladder; HIV; fibromyalgia.

Among the top searched questions on Yahoo! in 2010 was how to lose weight. A top obsession? Bedbugs, which came in at No. 7.

- Here’s an interesting report from LeaseTrader.com: In a rush by professionals to escape leases for high-priced cars, male doctors are at the head of the pack. LeaseTrader.com’s analysis looked at cars valued at $40,000 or more that were being dumped on the marketplace by customers who were downsizing their finances. Male doctors were ahead of lawyers and even financial executives in ridding themselves of expensive leases for Maseratis, Mercedes and BMWs. The report suggests that declining reimbursement and uncertainty surrounding the future of health care are prompting some physicians to cut back on their personal spending.

- Will Santa Claus be delivering the latest electronic gadget to the children in your household? Don’t let them strain their eyes by peering too long at digital devices, warn eye experts.

There’s actually a name for it: “computer vision syndrome,” or CVS, which includes back and neck pain, dry eyes and headaches. Some nuggets of advice: Use proper lighting, remind your kids to blink often and to give their eyes a rest every 20 minutes or so, and make sure they wear their prescription glasses if they have them.

- For all the national clamor about obesity, there’s one age group that seems to be overlooked - the 18- to 35-year-olds. The University of Minnesota is launching a new clinical trial to look at ways of using technology and social media to engage young adults. The CHOICES trial (Choosing Healthy Options in College Environments and Settings) will test a for-credit course model that uses web-based social networking to prevent unhealthy weight gain among 44o student participants.

It’s being offered at Anoka-Ramsey Community College, Inver Hills Community College and St. Paul College. Trial participants will be given cooking demonstrations, exercises for stress management, and other information and activities to help their improve their sleep, eating and physical activity patterns. Half the participants will be randomized into a control group with fewer interventions and no social networking. At the end of the two-year trial, results will be compared to see which group fared better.

The study is part of a five-year national initiative to test innovative, technology-based strategies for helping young adults avoid unhealthy weight gain. Six other studies, besides the one in Minnesota, are under way.

- There’s nothing like a mystery shopper to shed painful light on how organizations sometimes fall short in their customer service. A news release from the Baird Group, which is a member of the Mystery Shoppers Provider Association, offers an inside look at some of the discoveries that mystery shoppers make in health care: A receptionist yakking with a coworker while a patient stands waiting at the counter. Employees taking a smoking break under a sign that says “no smoking.” Staff members ignoring a patient or visitor who is obviously lost.

Although “patient-centered” is the concept du jour, Kristin Baird, whose group works exclusively with health care organizations, says many organizations are “anything but.”

What qualities have she and her mystery shoppers seen in the best organizations? “What I see in these is a concerted focus on making service expectations real through communication, inspection, accountability and action,” she said.

- Finally, the American Pharmacists Association sent out some practical advice for people to manage their medication regimens during the excitement of the holidays:

If you’re going to travel, bring more medications than you expect to use and store them in their original labeled containers. Be aware that some medications, such as insulin, need to be kept cool. If you plan to be in your car for a long period of time, bring a cooler so you can store your insulin inside (but not directly next to ice). Some medications also might require special equipment such as needles or pumps, so be sure to remember all the prescribed parts of your routine.

If you’re flying, keep your medications in a carry-on bag. Check your airline’s regulations, because liquids in some quantities are prohibited on planes. A pharmacist can provide you with smaller bottles if this is an issue.

Have a plan for adjusting your medication regimen. And don’t forget to bring an up-to-date list of all your current medications and vaccinations. Although no one wants to end up in an emergency room or doctor’s office while they’re traveling for the holidays, having a complete and accurate medication list can help make it a little less stressful, both for you and for the providers who need to know about your current treatments.

HealthBeat photo by Anne Polta

Patients of size

To what extent are health care providers obligated to make special provisions for patients who are extremely obese?

My attention was caught last week by a lawsuit that has been filed against St. Joseph’s Hospital in St. Paul after a patient fell off a surgical table, sustained a head injury and later died. The family of Max DeVries, who weighed 300 pounds, maintains the fall could have been avoided if the table had been equipped with larger straps, and that the hospital was improperly equipped to provide safe care.

I’m not in possession of the facts, other than these, so I couldn’t begin to comment on the merits of this lawsuit, nor would it be appropriate. Moreover, it’s not entirely clear whether the issue is about safely accommodating larger patients or whether it’s about safe care, period.

It raises some interesting questions, though, about the responsibilities of health care providers toward patients of size.

From the Star Tribune article that reported the DeVries family’s lawsuit:

With growing obesity and about 30 percent of Americans obese, having adequate equipment for very heavy people has become an issue for hospitals and skilled nursing facilities.

In some cases, hospitals have bolted surgical tables to the floor to prevent heavy patients from tipping them over. How to care for overweight surgical patients has generated new operating-room products as well as medical journal articles and books in recent years.

There’s no denying that taking care of large patients has its challenges, as this case report from the U.S. Agency for Healthcare Research and Quality illustrates. Because of their size, they’re harder to transport in an ambulance or wheelchair. They often fit with difficulty, or not at all, in a CT or MRI scanner. It can be physically challenging to start an IV in one of these patients, or insert a chest tube or even conduct a basic exam.

Many health care organizations are trying to respond to these patients’ needs by purchasing sturdier equipment, developing procedures to lift and move them that are safer for health care workers as well as the patient, and training staff to be better prepared for treating obese patients.

Yes, it takes time and money to do this. The fact is, though, that health care organizations need to make an effort to provide safe, quality care to patients of size, whether providers like it or not.

Patients who are extremely obese are nothing new to the health care system. Human beings come in all shapes and sizes across the spectrum and at some point most will need health care services of some kind. In the past there may have been comparatively fewer patients who were in the 500-, 600- or 700-pound range. We’re noticing them now, and perhaps deeming them to be a problem, because there are more of them and because obesity has become so prominent on society’s collective radar screen. Health care also is much more interventional than it was a generation ago, making the mechanics of caring for very obese patients correspondingly more difficult.

Plenty of other patient populations pose some special difficulties too, however. It’s challenging to care for premature infants who are so tiny that they require specialized needles, tubes and surgical techniques. It’s challenging to care for patients who have disabilities or who are fragile and very elderly or who can’t communicate. Health care providers have accepted that many of these patients will have special needs that have to be addressed, and I’m not sure why extreme obesity should be any different.

Critics might argue that if you accommodate large patients, you in essence are condoning a so-called choice to be fat. The mechanisms that influence weight are complex, however, and lifestyle and calorie intake are often only one part of the equation. In any case, when a very obese patient presents at the emergency room or in the doctor’s office, it’s not a time to be moralizing or to insist the patient must shed 300 pounds before you’ll offer any kind of evaluation or treatment.

I suspect that over time, the health care community will probably develop more knowledge and technical skill for how to best meet the needs of large patients. But first there has to be a recognition that this is necessary and that it’s the right thing to do.

Photo: Wikimedia Commons