Tag Archives: death

Six Year Old Girl Dies–Diagnosed as Fat?

Sorry to start your week out with such a sad story, but I think it needs to be told. Late last week I became aware of the story of Claudialee, a six-year-old girl who passed away after being misdiagnosed with type 2 diabetes, when she actually had type 1 diabetes. There is a very detailed account of the story here.

I’m not going to go into every detail of this story, but I did want to point out a few things that stand out for me. One is that Claudialee has a family history of diabetes. Another is that the doctor diagnosed Claudialee as obese. It is clear that the doctor was deeply concerned about the young child’s weight–prescribing diet and exercise in an effort to get her to lose weight. It is also clear that the mother closely followed the doctor’s recommendations–carefully monitoring what Claudialee ate and making sure she got plenty of exercise.

What is not clear is why the doctor felt so strongly that this child had Type 2 Diabetes as opposed to Type 1. According to a source cited in the article (The National Institute of Health) at that age group, Type 1 Diabetes has an incidence of about 20 in every 100,000 kids, whereas Type 2 Diabetes has an incidence of .4 in every 100,000 kids or 1 in every 250,000 kids. What’s more, at that age, Type 1 Diabetes is a far more urgent problem than Type 2 Diabetes. So what led to the doctor’s misdiagnosis?

We may never know for sure. But it does invite one to speculate whether the child’s weight was a factor. Clearly, getting Claudialee’s weight down was a prime part of the prescription to the parent. And as the child’s weight went down, the doctor neglected to do some of the critical follow-up blood tests that would have indicated that something was drastically wrong.

The article states:

Because Mercado [the doctor] had locked in on type 2, she did not monitor her patient’s blood. She did not tell Irma [the child’s mother] to purchase a $20 blood sugar meter from the drugstore. She did not ask Irma about the frequency with which her daughter drank and urinated. And neither she nor Cabatic [another doctor] described to Irma the danger signs to look out for.

When asked in court, why the doctor seemed so certain that the child had type 2 diabetes when type 1 diabetes was so much more prevalent among children that age, she stood by her original diagnosis:

“How many type 2 infant diabetics have you treated?” a lawyer asked her.

“A lot,” she replied. “Maybe it’s geographical, because I work at Brooklyn as an assistant professor and also in wellness program where there are a lot of obese children, so we diagnose a lot of children with type 2 diabetes.”

Clearly there may have been other issues at play here. Claudialee was on Medicaid and doctors are paid significantly less for treating patients on Medicaid than they are for those with private insurance. The doctor was not board-certified, and the article points out that finding board certified physicians willing to work in clinics that take Medicaid can be difficult. And this is a single case where a single doctor has been convicted of malpractice. We will never know exactly what was in the doctor’s mind.

I but I personally found myself wondering if this doctor had ever previously considered that she may have a bias against fat patients–and maybe even fat children with low SES in particular. I wonder, had this doctor considered the potential for her own bias in this arena, would that child still be alive? Would Claudialee still be running around and playing today?

We certainly have plenty of evidence for a seeming “hysteria” around the issue of childhood Type 2 diabetes. A simple google search of “childhood diabetes epidemic” yields hundreds and hundreds of articles. This hysteria has spawned a number of shaming techniques aimed at children despite the fact that shame has been proven over and over again to be ineffective at treating obesity at any age, that shame is more likely to make kids engage in unhealthy behaviors, and that eating disorders are much, MUCH more prevalent among children than diabetes of any kind.

All I know for sure, is that stories like that of Claudialee get me even more fired up to fight against weight stigma in medicine. And that passion leads me to come to you with a plea. The Association for Size Diversity And Health and the Size Diversity Task force have embarked on a documentary film project to help doctors see and understand weight stigma and weight bias in medicine. This project is called the Resolved project. But this project needs a little bit of help from you. We are raising funds to finish the documentary on Go Fund Me here. Any help you can offer would be greatly appreciated. Even if you can only give a few dollars, that will help. And if you don’t have a few dollars to spend, would you consider sharing this with your friends and asking them to help? Let’s see if we can end weight stigma and weight bias in the healthcare industry for good. And maybe, just maybe we won’t have stories like Claudialee’s any more.

Love,

Jeanette (The Fat Chick)

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Boy Scouts, BMI and Managing Risk

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Would the BSOA deem Russell “too fat” to go to camp?

Yesterday, I read Ragen Chastain’s amazing post on the new policies implemented by the Boy Scouts of America regarding participation in events and BMI. In order for any Boy Scout to participate in a “high adventure” activity which includes a duration of over 72 hours and being over 30 minutes drive from emergency medical services, his parents and doctors must fill out a group of forms including Part C which has a whole lot of questions about BMI. In fact questions about height and weight are the first things listed on the form before listing any pre-existing conditions or other information about disease or wellness. Any scout with a BMI over 40 will be forbidden from participating in these high adventure activities (including the Jamboree). And according to the site:

The Jamboree Medical Staff will review all applicants with a BMI of 32.0–39.9 and consider jamboree participation based on 1) health history, 2) submitted health data, and 3) recommendation of the applicant’s personal health care provider. For applicants with a BMI >31.9, a recommendation of “no contraindications for participation” by the applicant’s personal health care provider does not necessarily guarantee full jamboree participation. The jamboree medical staff will have final determination of full jamboree participation.

The Boy Scouts of America (BSOA) site, lists these reasons for the new restrictions:

“Anyone who is obese and has multiple risk factors for cardiovascular/cardiopulmonary disease would be at much greater risk of an acute cardiovascular/cardiopulmonary event imposed on them by the environmental stresses of the Summit. Our goal is to prevent any serious health-related event from occurring, and ensuring that all of our participants and staff are “physically strong.”

And frankly, all of this sent me scrambling for my manuals and training information about exercise in children. One question I had right away was, “Are they using data for all-cause mortality in adults and extrapolating that information for children?” Because, the data I’ve reviewed indicate that mortality among exercising children and teens comes from different sources that that of adults.

According to the Youth Sports Safety Alliance, the number one cause of death among exercising young athletes is Sudden Cardiac Arrest (SCA). During my fitness certification training, I learned that the number one cause for SCA is a heart defect called hypertrophic cardiomyopathy, a thickening of the heart muscle. Hypertrophic cardiomyopathy and other heart conditions likely to lead to SCA are often virtually undetectable from a standard physical exam. This is why many schools are starting to recommend and a few are beginning to require a EKG for participation in strenuous school sports. When SCA occurs, death often follows. Being close to a hospital only helps so much as mortality risk increases by 10 percent for every minute it takes to get to medical care. This is why there is a greater focus on CPR and Automatic External Defibrillators for helping to protect student athletes these days.

I am not aware of any research indicating that SCA is more frequent among overweight or obese young athletes. I am also unaware of any efforts on the part of the BSOA to ask that participants in high adventure activities be screened for hypertrophic cardiomyopathy or be given an EKG as part of the Part C form. Now, I understand that an EKG can be expensive to administer and read, but if the concern is really about the safety of the participants, it would seem that this is a more important test than BMI.

Another important risk for kids and strenuous exercise is heat stroke. And there is some research that indicates that heat illness is more frequent among overweight and obese football players than “normal weight” players. But many experts stress that exertional heat illness is 100 percent preventable. Most experts strongly recommend an acclimation process to help get student athletes ready for physical exertion. The super punishing, first day of practice workouts in full pads and gear is now frowned upon. I wonder if the Jamboree and other “high adventure” scouting activities really do enough to help scouts of all sizes acclimate to higher temperatures and altitudes or if they simply assume that as long as the kids are skinny, they will be safe.

Which makes me wonder. Where is the data? Show me the data that BMI has a serious impact on safety for children and youth who wish to participate in strenuous physical activity. Do not simply show me studies from adults and extrapolate down to kids. And if the health and safety of your scouts is of primary importance, why are you not requiring adequate screening for the leading cause of death among young exercisers? Are you building adequate acclimation days to make the camp safe for participants? Or again, are you assuming skinny = safe and healthy? And why are you making your most important event so strenuous that you have to worry so much about health and safety in the first place?

To borrow from a famous phrase from the film Jerry Maguire, “Show me the data!”

Love,

TFC

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Death and Taxes

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Well we’ve survived another U.S. “tax day”, so I thought I’d share a little post about inevitability. Most of us have heard this quote, “In this world, nothing is certain but death and taxes.” And while most of us understand the notion that taxes are inevitable (well at least unless you are a multi-billion dollar corporation) we have a little harder time with the whole death thing. We know on an intellectual level that everybody, including us, will die. Yet on an emotional level, many of us believe that if we eat enough fiber, do enough exercise, and stay thin, we won’t die.

Now don’t get me wrong. It’s perfectly reasonable to want to make choices that can potentially extend our lives or improve the quality of our lives. That makes sense. But I’ve often wondered at the emotional response to my acceptance of my own size. I understand that not everybody agrees with me. Some people think I should do anything and everything that just conceivably might help me at least for a short time to lose weight. But it’s the emotional involvement with this disagreement, the hatred and anger and spitting vitriol that comes with it, that sometimes throws me for a loop.

I recall sitting in a crappy and inadequate paper gown in a medical center where a doctor was nearly frantic in telling me that since I was fat, I was going to die. He wasn’t offering me any statistics or research indicating increased risk for mortality or morbidity. He was simply doing that finger wagging, nagging, since you’re fat, you’re going to die speech. And I replied, “well you know, I don’t have an M.D. after my name, but I’m pretty sure we’re all going to die.” Which gave me at least 10 seconds of respite before he started in on me again.

If you want to talk to me about increased risks for morbidity and mortality that may or many not be attributable to being fat, well okay. I’m armed. I’ve got data. Let’s rumble. But if you want to argue that all fat people are going to die, guess what. You’re right! All people, everywhere are going to die. Even if they eat whole grains, and their chi is perfectly aligned and they run a marathon every day-even if they are thin, they are still going to die.

I think this is at least a small part of what freaks people out so much about my decision not to actively pursue weight loss. Because at least in a small way, I’m not buying into their emotional fantasy, that if they do all the right things, they just won’t die. Here’s the thing. I’ve lost many who are close to me. And some of these folks did everything “right”. They ate well, they slept eight hours per day, they managed their stress, they went to the doctor and they simply got sick and died–sometimes quite young.

Am I suggesting that we should just ignore our health? Absolutely not! I am suggesting that there is no day in our life that is guaranteed. And I for one refuse to spend so much of my life trying to change one potential (and questionable) risk factor for mortality that I don’t have time to really live. If my days are limited on this earth, and they are limited, I want to do what makes me feel good and allows me to experience wonder and contentment and joy. Sometimes that’s taking the dog for a walk. Sometimes it’s eating ice cream. Because I’m grown up enough to understand that both walking the dog and eating ice cream are wonderful. And even giving up ice cream won’t allow me to live forever.

Love,

The Fat Chick

P.S. If you’d like to hear more about that story in the doctor’s office, you might want to check out this episode of the Right Now Show. And I’m pleased to let you know that the deadline for the RESOLVED project has been extended. So it’s not too late to create and share your video about your experiences with health care.

And if you’re interested in learning a little more about the joy of exercise, don’t forget to check out my book and DVD!

Weight Loss Surgery, Colon Cancer and Some Other Considerations

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Recently I read about a new study that links increased risk for colon cancer with weight loss surgery. I thought it was important to share this information with you, because it seems to me that information about the possible negative side effects of weight loss surgery is so often buried in the general media. And I think the positive effects of weight loss surgery are often blown out of proportion in the media as well.

That’s not to say that I have any interest in telling you what to do with your body. It’s YOURS. You should do whatever you think is best. However, with over 100,000 weight loss surgeries performed in the US annually, I know that weight loss surgery is big business, and therefore, there are large financial incentives for certain companies to suppress information about the potential unfortunate side effects from these surgeries. So I’d like to provide a few links to some of information about weight loss surgery that is not supported by those who profit from it. And hopefully I can help “balance the scales” a little bit.

To be clear, one of the potential side effects of this surgery is death. To be sure, there is a risk of death from any surgery. But there is growing concern that the risks of weight loss surgery are often underplayed and that the evidence often cited concerning the potential upside to weight loss surgery (including savings in medical costs and lives) is deeply flawed. It is also really important to understand that weight loss surgery is not a miracle cure, and it isn’t always the patient’s fault when things go wrong. It seems that weight loss surgery is often treated like other weight loss techniques in that success is usually attributed to the surgery and failure is usually blamed on the patient. Thus many who have negative experiences with weight loss surgery are often shamed and ridiculed and even asked to leave public forums where they might share their stories. That’s why I think it’s important to share this link to a site dedicated to those who wish to share their stories about complications arising from weight loss surgery. I think people who are considering weight loss surgery are provided with plenty of links to people often still experiencing the “honeymoon glow” of the initial weight loss. But I think if you are considering this important life-changing step, you should also have access to a few of the heartbreaking stories of those who have not had such a wonderful experience.

To reiterate. I am not telling you that you should or should not have weight loss surgery. It is your body and your decision. Clearly some people feel that the surgery has had a positive effect in their life and there are plenty of places where you can read about that. I know people who have had the surgery and are glad they did. But I have also known and cared for people who have died from these procedures. I know people who have had these procedures and didn’t feel they were told the truth about what to expect. I know people who felt that the potential downside was significantly underplayed and wish that they were given more balanced information before they had the surgery. I simply wish to provide a few links that will hopefully help provide that balance.

Love,

The Fat Chick

Right Now Show–Episode 003: Healthcare and YOU

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In episode 003 of the Right Now show, we explore the new initiative by the Association for Size Diversity And Health (ASDAH) called RESOLVED: addressing weight bias in health care. Jeanette DePatie (AKA The Fat Chick) shares some stories about her journey in healthcare and shares details about the RESOLVED project with the viewers.

For more information about the RESOLVED project, go to the ASDAH website. And to read another story about a truly frightening misdiagnosis of a fat person, click on THIS LINK.

And finally, if you’re enjoying the show, don’t forget to subscribe at: http://www.youtube.com/jeanettedepatie.

Thanks so much!

Love,
Jeanette
AKA The Fat Chick
http://www.thefatchick.com

P.S. This marks my 365th blog post! (One whole YEAR of blog posts=YAY!)

Don’t forget to enter your miles in the Fit Fatties Across America page on the Fit Fatties Forum. Let’s see if we can get out of Colorado and a little further down the road!

And if you’d like more information about how to pick a doctor that’s right for you, there’s a whole CHAPTER on that subject in my book The Fat Chick Works Out! You can buy a hard copy or an e-book, whichever you like!