Tuesday, October 2, 2012

The new witch hunt. . . . . .

When I was younger I heard of the Salem Witch trials, where people went around and hunted down those who they believed where witches.  In my lifetime I have seen several other witch trials.  For a while it was those who were homosexual.  For a while it was those who smoked.  Now it is those who are obese.

I come at this blog from two different perspectives that have kind of merged together to give me my opinion on weight, health and obesity.  Those who know me know that I am a dietitian.  Yep - I graduated with distinction from Purdue University, had I had Purdue's equivalent of Summa Cum Laude.  I have practiced the field for over 10 years.  I know how bad obesity is for the human body.  On the other side of the coin I come at this as someone who has been overweight my entire life, according to weight charts, and now I am obese.

I will say first of all that being obese is not healthy.  It just isn't.  My biggest issue is just how much emphasis is put on those numbers - weight and BMI.  After reading about Jennifer Livingston and the email that was sent to her I feel I really need to write this blog.  I need to write it for those who struggle with weight and for those who have never had to struggle with weight.  I need to write this as a medical professional who sees that this country is heading down a dangerous path where people are going to be forced into costly and dangerous surgeries, and where inadequate health care is offered to those who are considered obese.

We, as a country, need to stop focusing on a number.  BMI, weight, ideal body weight - that is all a bunch of garbage in my opinion.  They are guidelines and should be used as that, not set in stone goals that everyone needs to focus on.   These are good tools to see how someone is doing - but they should not be used as the end all be all.

Here are a few things I have learned in my practice.  First - BMI fluctuates dramatically with small changes in height and weight (this is especially true in children).  I can't tell you how many panic-ed parents I would have to see who were told there 3 year old was fat and needed to be put on a diet because their BMI put them above the 95%-ile on a growth grid, and then when you analyze it you find they were about to shoot up in height.  

Second - obesity is more complicated that it just being a choice that someone has made (as the person who wrote to Jennifer Livingston stated).  Do obese people eat more than they should, well heck yes.  That is how your body has excess calories to store as fat.  We all know that, but at the same time it is more complicated than that.  Someone who is overweight may make very healthy food choices yet they can still be overweight.  Someone who is overweight my exercise on a daily basis and do their best to live an active life.  To be honest - with the exception of the morbidly obese people I have met, most of the people I know who eat like garbage and never/rarely exercise are super thin people.  A lot of people who are functionally overweight/obese have metabolisms set so low that it doesn't take much to exceed the calories they need in a day - even when they do exercise.  I can say from experience, it his hard to function on 800-1200 calories a day without being totally starved.

Going along with the above statement - "choosing" to not be obese anymore is more complicated that choosing to no longer take part in other unhealthy "choices".  You can wake up one day and decided to quit smoking or drinking, you can't wake up and say "OK, I am not going to be obese anymore" and the just not be obese.  Unlike quitting smoking or drinking - you can't just stop eating.  If you stop eating you die.  It would be like the alcoholic who continues to drink yet controls the amount he/she drinks.  It takes a lot longer than just deciding to do it.

Third - going back to numbers again - those numbers should be a GUIDE.  I am five feet tall exactly.  My ideal body weight should be from 90 to 110 pounds.  The lowest weight I have ever seen as an adult was 114 pounds, and you would think that is when I should have been my healthiest.  Well I wasn't.  My body hated being that weight.  Every time I stood up I would get light headed, and occasionally pass out.  When ever I was stressed my body would dump too much insulin into my blood stream and I would have a seizure caused by quick drops in my blood glucose levels.  I was the most un-healthy I have ever been in my life.  My body was happy and healthy right around 130 pounds.  At 130 pounds I "overweight".

Fourth - you never know why someone is overweight.  Never.  Maybe that person you saw just had a baby and is working on losing that weight.  Maybe that person you see actually just lost 100#'s and is working hard to lose more.  You don't know.  I know before I had kids it was much easier to lose weight.  I could spend 2 hours at the gym everyday.  It was much easier to keep calories super low and monitor what I eat.  After kids there are times where they day flies by and I realize it is 6 pm and I have eaten nothing.  Instead of just having a piece of chicken and dry rice I have to prepare a variety of foods for my children to try.  My, for a long time, was on preparing gluten free/casein free meals so my son could eat something.  There is no way I could spend two hours a day at the gym.  Finally, I know for me I spent 51 weeks on bed rest between my three pregnancies.  51 weeks laying there watching myself get fatter and weaker.  It was worth it, because if I hadn't done that I wouldn't have my four children, but it was hard and my body has not ever gone back.

Fifth - some people lose weight easier than others.  Yep - this is true.  I know, a calorie is a calorie and if you just cut back on what you eat and exercise more then you can lose weight.  That is true to a certain extent, but every body is different.  In general, those who are younger have an easier time losing weight.  In general, men have an easier time losing weight.  But on top of those things - some peoples makeup just makes losing weight harder or easier.  Some bodies, once a person starts cutting back on calories and increasing activity, automatically lower what they need to function on.  Thus, you can get a person who is eating less and exercising more and still gaining weight.  I know people who just decide to lose weight and they just lose it.  Small changes make a big difference.  I know others who work and work at it and still don't lose any weight.  I even know people who try to gain weight but just can't - no matter what they do.  Every body is different.

Sixth - no matter what there will still be some people who are overweight.  There are people - like me to be honest - who will never have a BMI less than 25.  Their body is not meant to be there.  It is not healthy for their body to be there.  I have a photo of my Great Grandmother and my Great-Great Grandmother (her mother) - they weren't morbidly obese but they were not small people.  They were active, hardworking people but their body was meant to be more stately than what a doctor's chart would have dictated they be.  This is what scares me about using that BMI as the end all be all for determining the health of a person - it should be a guide not a set in stone marker.

Here is what I think we should do - focus on health.  Eat right.  Yep - eat right.  Eat 3 meals a day.  Eat 5-7 fruits and veggies.  Limit simple sugars and high fats.  Try to eat fresh foods.  Get some calcium for your bones.  Then, exercise.  Get a good pedometer (the Omron HJ-112 is my favorite), and yes, make it a good one that doesn't count jiggles as a step, and make sure you walk at least 10,000 steps each day.  Make it a goal.  Find an exercise you like and do it 3-5 days a week.  Jogging, bike riding, swimming. . . be more active.  Have regular physicals.  Check your blood sugar levels, cholesterol levels, and blood pressure.  Use that along with your body weight/BMI to determine what your health is.  Try to stop smoking and drink only in moderation.  Focus on your health not the numbers on a scale!

Here is what really scares me - and this is a true story.  The former insurance company my husband had has implemented a new system this year (I still have friends who have this inusrance).  At the start of their year you were weighed and analyzed.  Each employee has six months to get their BMI down to the number they said you need to be at.  If you do not get your BMI down to that number then you have two choices - you undergo gastric bypass surgery or you have to take the more costly insurance that doesn't cover as much.  I have a friend who is about 50 pounds overweight.  She is very tall and large framed.  Even when she was thin she wasn't in that "BMI range" that the insurance wants her to be in.  She would look very unhealthy at the weight the insurance company demands her to be at.  So her six months are coming near an end and she has not lost those 50  pounds, thus she must either choose between gastric bypass surgery or the inferior insurance.  First - how is this legal to force someone to have a major surgery?  Second - losing 50 pounds in 6 months is a lot of weight - and in my opinion, very difficult to lose in a healthy way.

So this is the way I see it going.  People and the medical community will still focus on the number on the scale or your pants size.  Going out in public obese will be an ordeal - and God forbid an obese person try to go to a restaurant (I have already heard possible bills making it illegal to sell obese people fast food or junk food).  Instead of trying to get a population healthy we will be persecuting them and forcing them to undergo dangerous surgeries, or dropping them from health insurance all together.  I just see this going down a path that is just as unhealthy as the path we are on now. . . . 

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