Tag Archives: medicine

Proof Please

So very often these days we hear that the world has deemed to help the portly because they so desperately need help and the world is being nice–and stuff. Millions upon millions are invested in trying to prove that fat people are unhealthy, and if they would just eat a little less and move a little more, all their problems would be solved, everybody in the world would be healthy, and good, quality health insurance would cost everybody $1. The fact that despite the millions of dollars spent, nobody has been able to prove these or demonstrate any way to make this magical weight loss happen on all but a fleeting and temporary basis doesn’t seem to deter anybody from testing this hypothesis again and again.

And even when the proof is not available, or indeed the available evidence says that your “weight intervention” causes negative effects and makes people fatter current policy seems to involve simply ignoring those pesky little facts.

Take the current practice of weighing and measuring kids at school and then sending home “BMI report cards”. Despite showing again, and again and again that shame doesn’t make kids thinner or healthier, showing that shame causes kids to engage in more unhealthy behavior, that shame makes kids fatter, we still do this. Why? The National Eating Disorder Information Center issued the following statement regarding BMI testing in schools:

What the American Academy of Pediatrics (AAP) seems to be ignoring in its advocacy of weighing and measuring the height of schoolchildren is the risk it carries not just to increase body-based bullying from student’s teachers and peers, but the risk to children’s developing self-stigma and poor body image.

Body-based bullying continues to be the most common cause of bullying in youth. 29% of girls and 15% of boys are already teased about their weight at home. By grade seven, up to 30% of girls and 25% of boys are teased by other students. Poor body image has been found to stop youth from engaging in social, academic and physical opportunities. It limits willingness to express an opinion. In perpetuating focus on body shapes and sizes rather than on encouraging health providing attitudes and behaviours in children regardless of size, what are our schools (and public health) teaching?

However, it seems that plans to do BMI testing and BMI report cards in schools is continuing throughout North America.

This also reminds me of another recent situation I had recently reported. Blue Care of Michigan is still touting the positive results of their “enforced march” walking program for fatties despite the fact that there is no evidence at all that those who participated either lost weight, or had any positive health outcomes associated with the program. They apparently did nothing to track the original fitness level of the plus-sized participants and had no idea whether or not these folks were already active. They just told these people that unless they wanted to pay an additional $2,000/year they had to participate. They also forced those who participated to either be a member of Weight Watchers or wear a monitor which counted their steps during the day. Just like a prisoner, they were forced to wear a physical implement on their bodies that told their insurance overlords what they were doing throughout the day. Just because their BMI is over 30. They declared this project a success even though nearly 1/3 of the 12 percent of participants who bothered to respond to the survey said they hated the program and found it coercive. For more information, you may wish to read this article from my friend and colleague Jon Robison.

Throughout all this rhetoric about making fat people into “healthy thin people”. Throughout all this spending on proving that fat people can become thin people on more than a very temporary basis and that making fat people into thin people will make them healthy there is one thing continually missing and that thing is proof.

When the available evidence points to the opposite of the fat people can become thin people, or fat people can’t be healthy people or fat kids just have ignorant parents rhetoric, the powers that be either request more money to re-test the hypothesis or simply ignore the inconvenient facts.

You may have heard of iatrogenic effects in medicine. Dictionary.com defines them as: (of an illness or symptoms) induced in a patient as the result of a physician’s words or actions, esp as a consequence of taking a drug prescribed by the physician.

And good old Dictionary.com also defines iatrogenic as relates to social welfare: “(of a problem) induced by the means of treating a problem but ascribed to the continuing natural development of the problem being treated”.

Some experts have suggested that the “obesity crisis” is a textbook example of iatrogenic effects in both medicine and social welfare. But I wonder if the “obesity crisis” isn’t responsible for iatrogenic effects in the economy as well. If the response to the mounting pile of evidence that “diets don’t work” and “shame doesn’t work” and “fat people can be healthy” is always, “let’s pay for more tests” or “let’s do the weight loss junk but try harder this time” the obesity crisis will continue to be very, very expensive.

But I think the treatment for the economic effects of the hysteria surrounding the “obesity crisis” may be as simple as this. Demand proof. If your insurance company wants to put you on a walking program without doing an intake of any kind or presenting any data regarding the efficacy of the program, demand proof. If your kid’s school wants to measure their BMI along with everybody else’s and send home a BMI report card, demand proof that this makes kids happier or healthier. It’s not easy. It’s not fun. But the rights of fat people to enjoy life, liberty and the pursuit of happiness demands that we, the fierce fat folks, demand proof.

Love,

The Fat Chick

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When doctors are wrong.

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I recently watched this video–a TED talk–by Dr. Peter Attia. You may have seen it as it’s become quite a viral sensation over the last few weeks. But even if you have seen it, you might find it useful to watch again. So here it is:

While I don’t agree with absolutely everything Dr. Attia has to say, I do think he brings up a few important points. One issue is that some doctors, scientists, and other medical professionals are really starting to question the causal nature of the link between obesity and diabetes. I think this is an important area that will require a lot more study. And I think it is our job to continue to push for this continued study.

But one issue that I want to particularly want to highlight here is how hard it seems to be for doctors to admit they are wrong. Dr. Attia is clearly deeply moved. He feels a tremendous sense of remorse for how he treated that poor woman with diabetes. Once he realized the level to which he had allowed stigma to affect his treatment of this woman he was devastated.

Many of us would be quick to state, well he should be. He may have deeply hurt this woman. He may not have given her the best medical care. Many of us don’t go to the doctor because we are so afraid of being hurt just this way at the doctor’s office or the hospital. Some of us have died because of this.

To which I would respond, “Yes, that’s true.”

But I think it’s also important to see what this video has to teach us about doctors and what it might be like for them to understand that they were wrong about something. We look to doctors to fix everything. We ask them to make us well and to bring us back from the brink of death. It takes a certain amount of arrogance to hold a person’s beating heart in your hand and endeavor to fix it. And I imagine there is a certain amount of pain when you have to tell somebody or tell their family that you can’t fix it. You can’t make it all better. You are not god. And I’m not sure that the pain ever goes away.

Please understand. I am not making excuses for doctors who bully and stigmatize fat people. It is wrong, and it needs to stop. Now. That is why I am working so closely with the Size Diversity Task Force and the Association for Size Diversity And Health on the Resolved project. We need to share our stories. We need doctors and the public to understand that weight stigma is extremely damaging to fat people in medical settings and is sometimes even fatal. There was a period of years in my life when I was quite sick and might have died based on the assumptions that doctors had made about me. So I get it. This must change.

But I think, if we want our work to be effective, if we want things to change, we need to be perceptive and understand what it means to help doctors understand that they are wrong about this. We need to understand this–not so we can let them off the hook–not so we can let them down easy– so we can find the best path towards an actual solution, so we can understand why many doctors are so resistant, and so we can better understand why this is taking so long.

The issue of weight stigma in medicine is complex and nuanced. But I do know one thing. It will only change if a lot of us continue to work together to bring about change. I would love to hear your thoughts about this issue. And I would love to have your continued support to make the Resolved project a success! Click here for more information about how you can participate.

Love,

The Fat Chick

Like my posts? You’ll love my stuff!

Buy my book: The Fat Chick Works Out! (Fitness that is Fun and Feasible for Folks of All Ages, Shapes Sizes and Abilities)–available in softcover and e-book versions

Buy my DVD: The Fat Chick Works Out! (A Safe, Easy and Fun Workout for Klutzes, Wimps and Absolute Beginners!)

Buy a book or a DVD for a friend and save $5! Just enter FRIENDBLFT in the discount code box!

Check out my Training Programs–both in person and via Skype (Starting at just $25!)

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Caution: Medications May Cause Problems During Exercise

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In our current western culture, it seems that many–if not most of us are taking some sort of medication. In 2007-2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month. You may have thought about how these medications interact with one another. But have you thought about how your medications may interact with exercise? Both prescription and over-the-counter medications can have a significant effect on your workout. Here are some of the more common medications that can change the way you experience exercise.

May Cause Drowsiness: A whole host of medications from pain killers to cold medications (especially antihistamines) to blood pressure medicines can cause drowsiness. Often the medication will have a label that states this and recommends against operating heavy machinery. These medications may affect your balance and hand/eye coordination. So you should use care when operating treadmills, stair steppers, doing any sort of aerobics class and especially riding a bicycle. When trying a new medicine that “can cause drowsiness” you may want to use extra care when approaching your workout. And it’s important to keep in mind that taking two or more medications that can cause drowsiness can really increase the side effects.

Cipro: is an antibiotic used to treat respiratory, urinary and skin infections. This drug has also been linked (in relatively rare cases) to inflammation of the tendons in athletes. If you are on Cipro and you experience pain in your tendons or joints, you may want to tone down or even cut out exercise altogether until the infection has passed and your course of antibiotics is over. Remember to always follow your doctor’s directions with antibiotics and take the entire course that is prescribed to you.

Pain Killers: Keep in mind that pain killers of all sorts, from aspirin to opiates can mask some of the aches and twinges that warn you that there are problems in your body. While taking a NSAID can make an exercise session less painful, remember that pain can play an important role–letting us know when there are problems in the body. Don’t use pain killers to ignore pain signals that should be telling you to rest or to deal with the underlying cause of joint or muscle pain before it becomes a major injury that could sideline you for months.

Stimulants: In addition to caffeine, many medications can raise your heart rate during exercise. In particular cold medications (especially decongestants), allergy medications and diet pills can raise your resting heart rate and make your heart pump even faster during your workout. If you are taking one of these medications, you should monitor your heart rate during your workout and take care not to exceed the recommended maximum heart rate for your age and condition. You can find a handy maximum heart rate calculator here. Just please keep in mind that various conditions may change your maximum recommended heart rate. I’m not a doctor, so you may wish to check with your physician to see if any special restrictions or recommendations for maximum heart rate may apply to you.

Dehydration: Keep in mind that many medicines are somewhat dehydrating. It’s a good idea to drink lots of water before, during and after exercise in any case. But you may want to pay special attention to keeping fluid levels topped up while taking medications of any kind.

For more information about specific medications, you might want to refer to this chart. But keep in mind that neither the aforementioned chart nor this blog post are exhaustive guides to this topic. And as a further disclaimer, I am not a doctor. Your local pharmacist can be helpful for general information. For specific information about how medications and your condition are affected by exercise, don’t hesitate to call your doctor.

With the cautions listed above, you may be tempted to skip exercise altogether. But please remember, that exercise is one of the best prescriptions available for good health. With the prudent help of your medical team and a little bit of common sense, you should be able to enjoy the awesomeness of exercise for a lifetime.

Love,

The Fat Chick

P.S. Want to learn more about building a successful relationship with your doctor and creating an exercise program that’s just right for you? Why not pick up a copy of my book: The Fat Chick Works Out! (Fitness that’s Fun and Feasible for Folks of all Ages, Shapes, Sizes and Abilities)? It also makes a great gift!