fattypatties

The Obamas are following the Clintons down the road of Health Care Reform and while I had hopes that it was not true this time and I've been impressed with how much further they have gotten, I'm have a feeling of deja vu all over again. I fear that if the stalled health insurance reform does ever get restarted again, it will end up being exactly what the monied interest in health care want: mandatory purchase of health care without or with few restrictions on profit-making at the expense of our health.

But what really is giving me the willies is last week's "Let's Move" campaign "targeting childhood obesity." Does anyone remember the timing of the "Shape Up America"? There stood Hilary Clinton standing behind C. Everett Koop near the end of 1994 while he announced that what America's health care needed the most was for doctors to tell their patients to lose weight like no doctor before 1994 had ever suggested to a patient that weight loss was a good idea. Wait. 1994! Hilary Clinton! Could it be that this was a smoke screen to take the focus off her and her husband's failure to fight the monied interest and give Americans a universal health care system?

Now we have a stalled health care reform that has been watered down to create the same racket we have with car insurance, except that living is something we have a right to and driving a car is a privilege (remember the Declaration of Independence? LIFE, liberty and the pursuit of happiness). So either way, I smell smoke and I see mirrors -- don't look over here where deals have been made with the profiteers. Let us misdirect your attention to the horrors of fatness. Except this time, we'll add the good old, "do it for the kids" line and that way you don't have to worry about the fact that after 16 years of telling Americans to diet and most Americans trying to diet, we still have fat people. What's worse, we managed to kill a bunch of people from the drugs and surgeries in the name of losing that fat along the way.

My more liberal friends are taking a gentle approach. They see something well-meaning-ed in Michelle Obama's motherhood and are gently asking her to consider alternatives. I'm not so inclined to let her off that easily. There's too much data and too much history and too much context to just assume that she is miguided. This is the same ole, same ole and I think it's time to shout from the roof tops: "The Emperor and (the Emperess, in this case) have NO CLOTHES!"

But I don't want to stop there. I do not like negative politics and I do not want to echo the Nopublicans in their negativity about everything these days. So on the off chance that Michelle Obama is sincere in her desire to make life better for the next generation and the generations to come, let me put 7 practical and feasible alternatives on the table that would be better at improving the lives of our children than putting them on a diet and making them exercise to the point that they forget how much fun it is to just play:

7 PRACTICAL IDEAS THAT WOULD MAKE LIFE BETTER FOR GENERATIONS TO COME

1. SAFER FOOD AND DRUGS

Our food system is superior in many ways, but the ever growing greed in food production is leading to more and more mishaps from contaminated food to preservatives that are bad for us to frankenfood to the lack of basic foods in poorer neighborhoods with less nutritious foods in their place. In fact, I suspect that many of the sins laid on the doorsteps of "obesity" have more to do with safety of our food than it does with how much we are consuming of it. In addition, more and more people are dying from their medications, including children. Reform at the FDA is needed and I haven't heard one word out of the administration regarding this.

2. SAFER PLAYGROUNDS AND STREETS

Children still grow up in areas where staying at home and watching television helps them live longer than being out in a playground or playing in the streets near where they live because it is dangerous to be in the streets. (Last time I checked, gunshot wounds or being assaulted were not good for your health.) Schools are closing earlier and earlier. In a world where ecommuting and working at home is more possible than ever, we are still insisting that the 9 to 5 work day is optimal and thus we have latchkey kids with no place to go and no safe adults to be near. This is not a matter of playing police. This is a matter of it takes a village to raise a child. Our communities are not child-oriented. They are profit-oriented. If we wanted to create a village where children could move, they would move. Children do not need to be told to play. When they are safe to do so, they move. And by the way, targeting fat kids is going to make this worse, not better. Bullying kids that are different is one of the ways that the streets are unsafe. Blaming fat kids for their health problems is going to fuel those differences and give ammunition to those bullies. In fact, it turns the federal government into one of those bullies.

3. STOP POSTPONING PAYING THE BILLS UNTIL THEY GROW UP

Deficit spending is putting a burden on the next generation and the ones after that. I'm not just talking about government debt. We had a major meltdown of the "credit industry" 2 years ago and our response was to patch it up and keep it. We have been sold a pack of lies about credit, especially long-term debt. Debt used to be something we entered into until the crops were harvested and then we paid it back with an eye on savings in bumper crop years. Now we are told it is okay to buy our toys on credit. The wake up call is that some day it has to be paid. We hit the snooze button instead of making the hard decisions. That has delayed the collapse of an unsustainable system, not fixed it or bailed it out. All of these things means that it is just going to be a bigger problem for our children. If we really loved our children we'd be re-examining this entire economic system and making some deep and abiding changes in our economy.

4. SPEAKING OF DEBT, GET RID OF BORROWING FOR STUDENTS

Nothing screams "I hate my kids" more than student debt. We put pressure on kids to go to school. We design jobs so that a high school education isn't good enough. Then we make it impossible for them to pay for that schooling without first putting themselves in debt. They leave the starting gate with a burden to carry. This burden makes them wage slaves, pure and simple. Now we are adding to this burden by making it impossible for them to finish the "4-year" degree in 4 years. Overcrowding and cutting back on teaching continues to create a system where students will have to borrow more to finish that degree.

5. SPEAKING OF EDUCATION, MAYBE TEACHING SOMETHING OF VALUE

Student debt isn't even the biggest problem in education. With the "No Child Left Behind" legislation we have made schools less about learning and more about test-taking. Our educational system is creating automaton sheeple, not critical thinking citizenry who question systems in order to improve them. If we really wanted life to be better for our kids we'd teach them how to think about their lives and the social systems within which they live so that they could improve things. Nothing belies the fear that adults have of their kids' brains than the way we do education and nothing points out the lie of "doing it for the children" than this fear. If we truly want them to have a better life than we have, then we should prepare them to be reflective thinkers instead of sheeple.

6. STOP STARVING THE CHILDREN

The real tragedy of the "Let's Move" campaign is the extent to which America's children still are suffering from malnutrition, starvation and lack of food security. Children are dying from lack of food and we are emphasizing starving the ones who have food? How crazy is that?!?

7. REAL UNIVERSAL HEALTH CARE

It is long past the time for America to provide health care to its citizens. Children growing up under the "for-profit" health care system are not going to be as health as they would be if they were able to see a doctor without fear of breaking the family bank. There are plenty of preventative measures that will ensure they grow up health that have nothing to do with the size of their bodies that need to be available universally. The hodgepodge, committee-fied bills that are being "reconciled" in committee right now are not going to cut it without a public option. As long as health care is a "for-profit" enterprise, money is going to be more important than our children.

Let's be clear about some things:

I voted for Obama. I did not vote in 2000 or 2004 presidential elections because I saw no viable candidates for whom to cast my vote. I liked Obama's message of change and wanted to give him a try. I had hope that he might be different and I think there are some ways that he has been different.

But I am not as pleased as I hoped I would be and this latest campaign weakens my hope even more. This is nothing new. This is business as usual in Washington and all those things he said in his campaign about continuing down the path of business as usual will come true, even if it is cloaked in the language of change.

We pay a price for those things we believe that are not true. Taking public resources and emphasizing weight loss for children is going to have a heavy price tag. We are going to raise a generation who fear their own bodies, who stigmatize fatness and fat people and who will spend their adulthoods sorting out food issues instead of solving more important challenges. In addition, spending these public resources on this means that we take away resources from more important challenges facing us now. We pay now. They pay later.

We do need a change. The "Let's Move" campaign is not change.

I just saw this posted in a forum (I will refrain from attribution because I don't want to debate the person, but the ideas):

GOVERNMENT RUN HEALTH CARE:
The compassion of the IRS
the efficiency of the Post Office,
at Pentagon prices.

Without pointing out the immediate fallacy (no one is advocating "government run" care -- oops, pointed it out anyway) this is my response:

CURRENT AMERICAN HEALTHCARE:
The compassion of Wall Street,
the efficiency of American Auto Makers,
at Hollywood Blockbuster production costs

Medicine is never going to be a free market because the knowledge and care needed at the worst possible times in our lives is complex. Those charging for these services are always going to have the upper hand. Free markets allow for buyers to shop, to refuse to buy, to obtain the best knowledge. Without consumer protection and a power player in the market that evens the playing field, we are at the mercy of the sellers in the worst way -- the consequences of not buying is death, disease and disability.

I happen to believe that it should be universally and singularly funded so that we have one representative for the people who negotiates the purchase of services for all humans (this is the Canadian system and having been a part of it for several years, I found it to be working fairly well). But I'm a realist and I don't believe that such a system would be possible at this time. Too many stakeholders with too much to lose.

What is a close second is what is being proposed by Obama and is being semi-fulfilled by the various bills being considered in Congress: make one of the players in the market a force to level the playing field.

What I find most disconcerting is that many of the criticisms that are being leveled and fears being expressed about government involvement in health care already occur in our system, just through the private sector.

This is my top seven list of misconceptions:

1. Everybody pays for their own health care.

If you have insurance, you are paying for everyone else in the insurance system -- the concept of pooling funds to cover the risk for a few is the basic concept of insurance. Excluding millions of people from the pool isn't very smart unless the people you exclude from the pool are the ones most at risk, thus, insurance companies do not want you in the pool if you are a child, if you are an older adult, if you have a pre-existing condition, if you have are at-risk because of family history or personal behavior, and, increasingly, if you get sick.

2. No one should have to pay for those who do not qualify for insurance.

One of the reasons that health care entities charge so high is they have to cover the visitors to emergency rooms and facilities who do not pay either through bankruptcy or through simply not paying all or most of the bill. This not only costs the entity the money spent on the time and equipment to provide the service, but also the staff time on social services or collection services at attempting to get the bill paid. The net result of this is that those who have insurance pay more than they would otherwise because they are paying for these overhead costs.

3. Doctors and nurses should decide on care, not bureaucracies.

This ship sailed in the mid-80s. Your medical decisions are being directed by nameless, faceless decision-makers who "qualify" your care through your insurance company. If they refuse to pay, you most likely will not receive care. The job of the decision-maker is to find whatever reason possible to deny care in order to maximize profits. Most the reasons they find are NOT medical reasons. They look for some little thing in your application that they can use to cancel you policy (btw, they do NOT refund your premiums when they "discover" these discrepancies). The number one complaint that most medical professionals have regarding the current system is that they cannot spend the time or provide the best care to their patients under the current system. This is why nurses, especially, are solidly for health care reform. They see the results of this system every single day.

4. If the government becomes a major player, we will lose the efficiency of the free market.

We currently have the most inefficient and costly system in the developed world. Fully 25% of our health care "costs" are due to the enormous administrative burden of going through the qualification process the each insurance company has. Most doctors offices now employ at least one staff member who does nothing but paperwork and sit on the phone all day working through the bureaucratic mess of private insurance.

Our emergency rooms are places of the biggest medical mistakes because they are clogged with people who have no where else to turn for care. In inner cities, airborne communicative diseases spread faster because of these centralized places for the working poor to gather when they are sick to sit for hours and hours of exposure. We are one big disaster away from the whole thing breaking down.

The current system is extremely inefficient and is getting worse. We are starting to see the results. A recent book asserts that medical professionals are misdiagnosing about 15% of the time.

5. The current system allows the freedom to get medical care without interference from bureaucrats.

This one is especially used by those who would scare older persons with the so-called death clause. Well, every single HMO that I've studied or been a part of has "end of life counseling" already. I'm asked every time I go to the doctor or hospital about whether I've set up a living will. The current profit motive is going to push and push us to consider opting out of their paying for care at every turn. This is not a medical issue. This is not a moral issue (you know, care for your loved ones by planning ahead, it is the right thing to do), this is a profit issue (tell your doctor to turn off the machines so we can collect from you and never have to pay out). Personally, I'd rather have this be a matter between you and your attorney and not be asked when I'm sick, but if people are sure that this is a government thing, they need to pay attention to this long-standing practice by the HMO.

This does raise another issue that I think is more important. Does universal health care mean anybody can get any medical service they want covered. The answer is "no" and has to be "no" because otherwise we will be giving free reign to medical providers to invent crappy medical interventions. Oh yeah, we already have that -- its called "fee for service" and only a government player in the system is going to push for an incentive that doesn't include keeping us sick in order to get more money out of us. In truth, this may be the only thing HMOs have been good for in the past 30 or so years, but because of their own profit motives, they found out that they like us being sick too -- that way they can refuse us coverage when the moment comes while keeping our premiums.

6. The current system is good for business

It is plainly not. Some of the business failures we have seen in the past few years have been in part due to the rising costs of health care coverage for employees and pensioners. The only business that the current system is good for is the HMO/insurance industry and the pharmaceutical industry. I mentioned in a comment on an earlier post, it is my belief that if we continue with the current system, we are going to see the United States lose ground in the world economy (and may be seeing this already). Outsourcing from other countries, moving of factories to other countries and brain drain exits of college graduates to other countries are all motivated in part by the rising costs of health care.

7. Our system is the best in the world, why mess with it?

Yes, we have more bells and whistles than most places. We do love our technologies. However, most of the time our technology drives up costs without producing much in the way of improved health. The fact is that we rank out of the top 10 in a number of health indicators such as life expectancy and infant mortality. When put in a per dollar perspective, we really suck. We spend more, receive less. We are not the best in the world and the best in the world are systems that have their governments involved in some way.

PREFACE

I knew it was going to happen...

The health care reform debate has finally got around to blaming fat people for the nation's health problems.

I've been avoiding thinking about this and writing about this because, well, it's tiresome. This is something that I see so clearly and it is obvious that the majority of Americans (and really the rest of the western world, or at least, English speaking world) just can't see. I hate the disconnect. I feel like I've seen and I've written clear and concise arguments over and over again only to have the exact same questions asked and the exact same rebuttals made. These questions and rebuttals are phrased in such a way that it is obvious the person posing them has not heard/read and/or understood a word on the clear and concise argument.

Ever spent time with a three-year-old who has discovered the word "why"? You speak and the response, no matter what you say, is "Why? Why? Why?Why? Why? Why?Why? Why? Why?Why? Why? Why?Why? Why? Why?" By the end of the "conversation" you are thinking "Why do I bother?"

Or in the words of Mugatu (Will Ferrell) in Zoolander: "I feel like I'm taking crazy pills."

So with this extremely impatient introduction let me make an argument for why the last thing health care reform needs to do is try to make people lose weight and why Health at Every Size (HAES) is the best preventative care option for containing health care costs AND making our country healthier.

TOP 7 REASONS FOR
MAKING HAES THE ONLY PUBLIC HEALTH POLICY ON WEIGHT

7. Almost every method for losing weight ends in weight gain.

There is no viable way for taking weight off and keeping it off for the vast majority of people. In fact, there is ample evidence (pun intended) that dieting and weight loss schemes may be one of the reasons that Americans are larger than they were 20 years ago.

6. Almost every method for losing weight has led to dire health consequences in long-term health outcomes.

Most weight loss schemes, including so called "sensible" ones often lead to poorer health outcomes for individuals who temporarily succeed at them. Drugs are often pulled off the market within a few years of introduction due to disability and death caused by them. WLS has some of the highest mortality and comorbidity rates of any surgery done on a regular basis. Severe calorie restrictions and various appetite suppression schemes cause all sorts of short-term and long-term health problems. Not only is there no proven way to lose weight permanently, there is no proven safe way to lose weight.

5. There is precious little evidence that being fat CAUSES any disease

Yes, there are correlations. But there are correlations between being male and certain diseases and no one is advocating castration for cures. There are correlations between being of African descent and certain diseases and no one is advocating skin lightening as curative. Three conditions must exist to show cause and effect:

First, the cause has to take place in time before the effect. Since figuring out when a disease started (diagnosis is always after the start of a disease), it is often impossible to know which came first, the weight gain or the disease.

Second, a change in the cause should produce a change in the effect. This correlation has been established on a population level. We have gotten fatter over the same period of time that we have, as a group, experienced more heart disease, diabetes, high blood pressure and so forth. But establishing the population correlation isn't the same as establishing individual correlations. For example, little evidence exists that losing weight in a particular individual leads to a change in their health conditions, especially when we consider the third condition to establish cause and effect.

Finally, NO OTHER EXPLANATION has to be available to explain the relationship between the cause and effect. So, in the case of weight loss, since most people trying to lose weight often change diet and/or their physical activity, the actual change in eating and/or exercise may be the more plausible explanation for changes in health associated with weight loss. Since precious few have actually studied or questioned the "cause and effect" aspects of weight with any kind of rigor, at this point we do not really know what the relationship between weight and disease are. We only know that over the past 30 years, people have gained weight and prevalence of certain health conditions have increased. We are far from establishing cause and effect and this is true no matter how many times people get on TV and say "obesity causes..."

4. We know that stigmatization contributes to ill health.

Any "program" that promotes weight loss is stigmatizing fat people. I know that is a radical thing to say, but it is true. Weight loss as a goal means getting rid of fat and it requires a demonization of fat in order to make it a goal. Fat carries stigma in this culture. Weight loss reinforces that stigma. Any public health policy that makes weight loss an overall PUBLIC goal is going to perpetuate stigma. That means even with accessibility, fat people will not receive the proper care they deserve either because some medical professional is going to concentrate on weight loss instead of the health condition OR many fat people, having been shamed or unwelcomed in medical settings is going to put off going to see a health care professional until it is too late. Thus, continuing to stigmatize fat is going to lead to worse health outcomes, not better ones.

3. We do know that exercise has a beneficial effect on individual health no matter what their size.

Health at Every Size promotes the idea that we should be pursuing health NOT weight loss. So here's where I know that the proponents of obesity as health crisis do not really care about the health of fat people and do NOT believe their own assertions about how to lose weight. Most HAES professionals advocate that to become healthy, all individuals should eat well-balanced foods with good macro and micro nutrients and should move their bodies more. Most weight-loss gurus recommend pretty much the same thing -- changes in eating and exercise to achieve weight loss. SO, if the weight-loss gurus believe that these lifestyle changes will lead to weight loss because of the physics of calorie consumption and conduction, why are they worried about HAES? If they are correct and we encourage persons of all sizes to eat well and exercise regularly, then fat people would lose weight, right? Does it actually require the fat persons active measurement of weight to lose the weight? No. If they are right, the weight would go down whether the person is weighing themselves or not. So if I were truly wanting to promote weight loss and I heard that a bunch of fat people were willing to exercise and improve their diets, wouldn't I be happy to just let them do it? Wouldn't I be elated that they got the message? But the opposite is true. Weight-loss gurus are threatened by the HAES movement. I believe that is because most of these people who say they are concerned about the health of bigger people have no such concern. What they want is more money, more prestige and more power for themselves. HAES as a health policy concentrates on providing encouragement for persons of ALL SIZES to take good care of their bodies. Fat acceptance means no more stigma of fat persons, which means that a fat neutral world would encourage healthier lifestyle practices.

2. HAES would mean better health for thin people too

By concentrating on weight rather than health, especially in children, the health habits of many so called "normal" weight and "underweight" persons are ignored. Since size = health indicator is so prevalent, the naturally thin persons often believe they are okay eating what they eat and not exercising. By paying attention to behavior instead of a physical characteristic, all persons will be encouraged to pursue healthier lives.

1. HAES will work to improve health where weight loss will not

There has been one study done in all the years of weight research that actually asks this question about success. Linda Bacon did a 2 year study running two groups, one that dieted and one that practiced HAES. The results were what any chronic dieter could tell you. Those who concentrated on losing weight were in poorer health at the end of the two years. Those who concentrated on improving health regardless of weight, were healthier. One study does not make a conclusive case, of course, but it certainly supports the need for further study and promises hope where most weight loss studies do not.

REAL PREVENTATIVE HEALTH CARE

The question of health care reform is a complex one and I agree that preventative health needs to be a part of the equation to cut costs and to ensure success. Our current system only encourages the financial health of a few at the expense of the rest of us. WEIGHT CANNOT be the ONLY consideration in this debate. In fact, so called "lifestyle" changes, cannot be the only consideration. In addition to a lack of access to health care, factors such as poverty, pollution, violence, food safety, drug safety, health care provider competence, effective vaccinations and stigmatization are just a few of the other things that need to be a part of this debate. HAES could be a key policy that would promote the end of stigmatization on the basis of size and the encouragement of a strong and healthy population. Weight loss, however, will be doomed to failure and in the end will add more costs rather than saving us.

If we want to succeed in creating true health care reform, we need to acknowledge and act upon fact, not fiction. Weight loss as a method of health improvement is a fiction, an often repeated fiction, but a fiction nonetheless. I feel compelled to repeat a quote that I closed with a few entries ago:

An error does not become truth by reason of multiplied propagation, nor does truth become error because nobody sees it. --Mohandas Gandhi

But I will add this quote as well:

The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd; indeed in view of the silliness of the majority of mankind, a widespread belief is more likely to be foolish than sensible. -- Bertrand Russell