Sunday, May 25, 2014

Be a "healthy" weight at all costs. . . .

Oh I am angry. . . . .

Isn't that usually when I blog - when I am angry/upset/sad. . . . well this time I am angry.  Mostly at myself - but also at society, healthcare professionals, just the way it is. . . .

So here it goes.  Anyone who knows me knows that I am a registered dietitian, and have been for about 15 years.  I have worked mostly through the health department as a WIC/Maternal Infant Health dietitian, but I have also worked at several hospitals.  Obesity has always been an interest of mine - especially childhood obesity for several reasons.  First - my mother - even though she came from an active family and she herself was an active child - has suffered from obesity her entire life and I have seen what that struggle has done to her.  How people have treated her because of her obesity, how her weight has kept her from getting well deserved promotions and raises, how her battle against obesity (which included bariatric surgery) has ruined her health and left her heavier than ever.  Second, my own struggles to be my IBW along with three very hard pregnancies that resulted in 50 weeks of bedrest have left me with a BMI of 38 - well in the severely obese range.  Thus, I am doing a continuing education module called, "Underage & Overweight.  America's Childhood Obesity Crisis - What every family needs to know."  It is a great module.  It kind of, for the most part, follows my own personal stance of "if you eat right and stay active than your weight is going to be what it is going to be," along with, "focus on health, not weight."  The book talks about the changes in childhood obesity in the last few decades, study after study that shows calorie intakes and energy expenditures over those decades, study after study. . . . and I am left with two thoughts - first is, "dang, I have been right all along," and second, "WTF have we all been doing to ourselves all these years!"

So - here it goes.  First - overweight does not mean unhealthy.  Normal weight does not mean healthy.  These are things I have thought to be true for MANY years but these were things I thought I was wrong about.  Things that society and other health care professionals have told me I was wrong about.  My BMI is above 25 so I must be unhealthy.  My client's BMI is above 25 so they are unhealthy.  I hate f-ing BMI and always have.  It is a number that really means nothing.  Body Mass Index. . . . deals with body density, not body fatness.  Something I tell my clients EVERYDAY - but every insurance company, growth chart, and medical professional puts so much on that flippen number. . . and it is just that - a number.

So, I'll say it again, being overweight does mean someone is inactive and 3000 kcals a day of Doritos and Mc Donalds, while drinking 2 liters of soda pop and kool ade.  At the same time just because someone is normal weight it does not mean they are healthy, it does not mean they have three high calcium foods a day and eat five fruits and vegetables a day while getting in their 60 plus minutes of rigorous activity, and it does not mean they have a healthy relationship with food.  We, as a society, need to change this conception and stop putting so much emphasis on weight - instead we need to put it on being healthy!

This module I am studying discusses the increase in obesity over the last few decades - focusing mainly on childhood obesity but also talking about obesity in general.  It has been noticed that people/children of today actually consume less calories and fat than the did 20 years ago.  Let me repeat that - children of today consume less calories than they did 20 years ago.  A third time - our kids are eating less calories today than they did 20 years ago.  There goes the thought that we are eating more calories now than we have been and that is why we area a "fat" country with "fat" kids.

The module goes on further to recite study after study that discussed that the reasons we are gaining weight is because a - we are eating less calories than we need thus our bodies are in boarder-line starvation mode and b - we aren't as active as we once were.  It states that if you are active in "starvation" mode than one of two things will happen, 1 - you will lose a small amount of weight before just hitting a point of maintenance until you stop starving yourself which will then cause your body to quickly gain the weight back or 2 - your body will force weight gain even if you are eating less and exercising because it is a protection mechanism.  We have all seen people lose a tremendous amount of weight eventually gain it back, or heard people say, "I exercise and eat right but I can't lose weight."  In the medical profession we tend not to believe them.  We tend to think they are under reporting calories and over reporting activity because if they are eating as little as they say they eat and are doing as much as they say they are doing then they would be "thin", right?  WRONG!

We - as health care professionals - push to have a "healthy" body weight.  We focus on the healthy BMI range of 18-25, because we are told that is healthiest.  Our insurance companies are even having higher premiums for individuals with BMI's higher than 25.  Forcing people to go to drastic measures and even having surgeries to get to that point so they can be "healthy".  We have been told over and over that if your BMI is above 25 then you are overweight and you have to do something.  Well guess what, that is a pile of shit!

Please note, I am not promoting obesity or a BMI of 38 like mine - but that "normal" and "healthy" BMI of 25 is not all it is cracked up to be.  First, a study did show that individuals who live the longest have a  BMI of 25.  That is fact.  That exact number lives the longest, but the next range of individuals who live the longest is from 25-30, with an average having a BMI of 27.5.  So why the heck are we pushing 18-25 if the range for healthy weight should be 25-30?  Study after study shows that individuals who are 20-40 pounds overweight don't have any less life longevity than those at their ideal body weight.  Again - why then are we pushing people to be at that lower weight with all this researched knowledge?  Plus, it has been noted that elderly individuals who are 20 pounds above there IBW are more able to recover from illnesses than those in the "normal" BMI range - yet again we push to be in that 18-25 range.  Can someone tell my why this is the case?  Finally, and this is the thing that gets me, the Framingham study.  Anyone who works in the medical field has heard of this study - it is a huge and very well respected study - well this study shows that men and women who lose weight have the highest death rates - even when the weight is voluntary and not caused by illnesses like cancer and AIDS.  Let me repeat that - individuals who lose weight have the highest death rate - higher than those who are obese.  This has been corroborated by other studies such as the Harvard Alumni study, MRFIT, CARDIA, and NHANES I.

WTF?!?!?!?!?  So all this time I have been trying the help individuals lose weight because I thought it was healthy for them and would lead to a longer, healthier life when really I was just increasing their chances of earlier death?!?!?!  I myself have struggled to be my IBW since I was 18 years old.  Increasing my activity more and more and decreasing my intake more and more - I did this because I thought it would mean I would be healthier and live longer. . . and now you are telling me that in doing this I am just sending myself to an earlier grave?

I turn to myself and I am even more pissed.  I look at my own body and just get pissed!  I am an obese dietitian.  Yep - a dietitian - someone who is supposed to be thin - and I am obese.  I have heard other dietitians make fun of fat dietitians, heard them say things like, "I don't even understand how they can be a dietitian and fat, if anyone should be thin it should be them."  I have read articles discussing how dietitians with BMI's above 25 should lose their license and not be allowed to practice because they are obviously unhealthy.  I have been ashamed of my body for many, many years because my weight is not 90-110 pounds - my ideal body weight range - and have felt very much like a failure because of it.  I have even went to doctors with my frustration and I am always told the same thing, "eat less and exercise more."  I have looked at them and told them, "I can't eat less and exercise more, if I did that I would be eating nothing and exercising non-stop."  Doctor's don't believe me.  Even in my quest to run a half marathon, where I was jogging 4 miles three days a week and 8 miles on my long run day I ended up gaining weight and in my frustration I went to the doctor and was told, "Eat less and exercise more."

That is bull shit.  I am obese - and I am obese because I was meant to be more than 110 pounds.  Yep - my body liked 135 pounds.  That was where my body was healthy.  That was where I had energy to be active and could eat a variety of foods.  I could drink milk and eat fruits and vegetables, but I was told I needed to lose 25 pounds.  I was overweight at 135 pounds and I was unhealthy at 135 pounds  - so I started doing something about that.  Eating healthier and exercising.  I got down to 128 pounds.  I actually felt good at that weight, but it wasn't 90-110 pounds.  I was still overweight and "unhealthy".  I continued to eat a variety of foods and exercise, and I continued to stay at 128 pounds.  For a year I worked hard and ate right, and at the end of that year I was still 128 pounds.  I felt good - but not the 90-110 pounds I "should" have been.  Something had to be done about that - so I did what many people do to lose that weight and be "healthy" - I did things that were un-healthy.

I see people doing it all the time and they get praised for it, but society and health care professionals.  I joke that, "I swear it is OK to be anorexic and bulimic if you are obese, I mean, you gotta do anything you can to be healthy, right, and obese is unhealthy so extreme measures are required!"  Heck - there are entire shows dedicated to individuals losing massive amounts of weight in a few months time - which losing that much weight in that amount of time really requires exercise being your full time job or doing very unhealthy things to do it.  I know people who pop diet pills like candy and do "cleanses" on a regular basis.  A 1200 calorie day is a day to feel guilty about and ashamed of, and every bite of food is an agonizing battle of adding calories in your head mixed with self-hatred and loathing.

I know that road - I have been there and to a certain extent I am still there - and yes - I am a dietitian.  I have had about a dozen glasses of milk in the last 20 years because I decided 20 years ago to no longer drink anything that contained calories.  I don't drink juice, any soda I drink is diet and my coffee is sweetened with stevia only, no cream here.  Tea is plain, and iced tea is unsweetened.  I have never been a sweets fan, so as much as I love to bake cookies and sweet breads I rarely eat them because I don't like them.  Even today - I consume two meals a day and no snacks.  I eat brunch and dinner.  On the days I work it is even less, I have a 190 calorie protein bar for lunch and a balanced, home cooked dinner.  I exercise daily - trying to jog at least one mile a day and I get in a mile walk at lunch.  I make sure the pedometer has at least 10,000 steps a day, because that is what I have been told is required to be "healthy".  I know my diet isn't balanced but I add a calcium supplement, multi vitamin, and fish oil daily to try to fill in any of the things I am missing.  Yet - with that - my weight continues to shift up about 10 pounds every year or so.  That 10 pound shift usually happens in a week. . . I will be stable and then just suddenly, for no reason at all, be 10 pounds heavier.  I know this because I still weigh myself three times a week.

I eat healthy and exercise regularly, yet I am obese and ashamed of it.  Embarrassed to be around other dietitians who are much thinner than I am because I must be doing something wrong. . . . I mean if I weren't doing something wrong than I would be 90-110 pounds, right?  WRONG!

I was NEVER meant to be 90-110 pounds, but was brainwashed into believing that was the case by society and medical professionals.  The photo of my great-great grandmother is on my shelf, a hard working farm lady who was probably 40-50 pounds above her IBW.  With her is my great grandmother, another hard working farm woman who is 20-30 pounds above her IBW.  I should have realized that genetically I was never meant to be 90-110 pounds. . . . NEVER.  But instead I did things to be "healthy", because overweight is unhealthy and normal weight is healthy.  I got close to it. . . 114 pounds was my lowest adult weight.  I even stayed there for a few years, even though I started having seizures.  Even though I was dizzy every time I stood up.  Even though my head, joints, and bones always ached. . . .I was almost healthy. . . just 4 more pounds and I would finally be in the normal body range. . . . I did that until the day came when I honestly thought I was going to die.  That was when I stopped and started eating daily again, twice a day actually.  Most of the aches went away.  The seizures stopped.  And the weight started to go up.

Today I am many, many pounds more than I was then.  My blood pressure is usually 90/60 - which is normal.  I still do have issues with low blood sugar, so I have to watch what I eat, make sure I don't overdo carbs and I have protein at each meal because I am a reactive hypoglycemic.  Something that was caused from my years of not eating.  I have chronic GI and stomach problems, something caused again from years of not eating along with years of laxative abuse.  My cholesterol is always very normal.  I jog daily.  I don't overeat.  To be honest, with the exception of the GI issues (again, caused from the things I did to try to lose weight) I am healthier than I have ever been in my adult life.  And I am obese.

My point to this rant is this. . . we have been lied.  We have been told that we are fat because we eat too much and don't do enough.  We have been told that if we lose weight we will be healthier and we will live longer and our lives will be healthier.  We have been told what weight we should be and that anything above that is unhealthy.  We have been told that it is OK to do extreme things to get to this weight - have dangerous surgeries - take pills - exercise beyond reason - limit our intake to starvation - it is all OK as long as we have a BMI below 25. . . . because that is what is healthiest and that is what will make us live longer.  Well I call bull shit on that.  We have been lied to, and study after study shows that.

Be active, eat healthy, enjoy eating, listen to your body's hunger and full cues,  and your weight is going to be what it is going to be.  Accept this and accept this in others.  BE ACTIVE, EAT HEALTHY, ENJOY EATING, LISTEN TO YOUR BODY'S HUNGER AND FULL CUES, AND ACCEPT THAT YOUR WEIGHT IS GOING TO BE WHAT IT IS GOING TO BE!  Healthy weight is different for each person and can not determined by a growth grid or a BMI number. . . .

That is my rant. . . .

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