Does society want us healthy or just beautiful?

Is obesity a disease, or can big be beautiful and healthy?

photo credit: Dilona via photopin cc

In case you hadn’t heard, the American Medical Association classified obesity as a disease last week.

As CBS reported, “Medical therapies and procedures like the lap-band or gastric bypass surgeries are courses of treatment that may now be included in insurance coverage, based on the AMA’s decision.”

Does that sound like good news for the obese?  Maybe.  It sounds like even better news for the pharmaceutical companies who market weight loss drugs and the doctors who perform weight loss surgeries.

Will losing weight actually make people healthier, though?

Yes, there are certain health risks associated with having an elevated BMI, such as Type II diabetes and heart disease. More broadly, a higher BMI is associated with a greater risk of cardiometabolic abnormalities, as measured by blood pressure, triglycerides, cholesterol, glucose, insulin resistance and inflammation. Nonetheless, almost one quarter of “normal weight” people also have metabolic abnormalities, and more than half of “overweight” and almost one third of “obese” people have normal profiles, according to a 2008 study. That’s 16 million normal weight Americans who have metabolic abnormalities and 20 million obese (or 56 million overweight and obese) Americans who have no such abnormalities. (Abigail C. Saguy, read full article here)

I think medical procedures should be available to those who need them, but this decision from the AMA troubles me.  It seems like one more way that our society promotes appearance over substance.

We want people to be beautiful more than we want them to be healthy, and we equate thin with health.

Why can’t insurance companies cover treatments based on metabolic abnormalities, instead of BMI?  If the doctors believe gastric bypass would be an effective way to treat heart disease, cover it.  However, if it isn’t making one sick, why is obesity a disease?

Weight Loss is a $6.1 billion industry.Am I jaded that I think this decision was based on money?  There is so much money to be made in the weight loss industry.  $61.6 billion in 2012.  Most of that money is not spent in doctor’s offices or on pharmaceuticals.  Even less of it is spent on surgical solutions.  According to Marketdata Enterprises,

The number of bariatric surgeries is significantly less than reported by the ASMBS (bariatric surgeon’s national society). Surgeries peaked at 135,000 in 2008, according to government healthcare agency data (not 209,000 reported by the ASMBS). However, since then, insurers have gotten tougher on coverage and the number has fallen 15% to an estimated 114,000 last year. This reduced the size of the total weight loss market by $2.6 billion and translated into less business for bariatricians and VLCD programs.

Now that obesity is a disease, perhaps those numbers will change.

Does society want us healthy or just beautiful?It seems like we are still moving one step forward two steps back when it comes to body image.  We have campaigns to promote the idea that healthy beauty comes in all sizes.  Then we declare fat a disease.

Sorry, you’re not beautiful; you’re sick.  Poor pitiful you.  It’s not your fault; you have a disease.  Let me cure you, then you’ll be happy, healthy, and – most of all – thin.

Is tracking calories obsessive?

Sopia Loren:  Everything you see, I owe to spaghetti.My husband asked me the other day if I am “still obsessing over what I eat.”  I told him that if he meant am I still keeping the food diary, then yes I am still obsessing.

Even though I think it makes me look crazy, I bought a food scale so I could be more accurate in my record keeping.  I am not good with numbers, and my guesses at quantity are all over the place.  Sometimes I grossly underestimate; other times I think I’ve eaten way more than I have.

I think of myself as tracking calories, not counting them.  What’s the difference?  Mindset.  If I were counting calories, I’d be limiting my food intake.  To me, tracking them only means that I record what I eat.

Tracking calories is still working for me.  So is avoiding an excess of refined sugar.

As I told my husband, sugar is too delicious for it to be safe to say I’ll never go back to my high-sugar habits, but the reduced joint pain continues to motivate me.

Being pain free is much more appealing to me than either weight loss or being able to eat candy at will.

After three months of sweets as very rare treats, I can honestly say that sugar is not the temptation it was three months ago.  At Costco last week, I bit into a sample of a caramel something ice cream bar and found it sickeningly sweet.  I didn’t even want a second bite, and threw it away.

A few months ago, I’d have been debating the ethics of a second sample.

That’s not to say I have not enjoyed a cookie or three when my daughter bakes them, or that I have stopping making desserts myself.  (Although, right now, being summer, there is nothing better than bowls of berries with freshly whipped cream.  No sugar needed.)

My homemade granola and muffins aren’t sugar free, either, and I eat them almost daily.  There is a world of difference between a Pumpkin Walnut Oat Bran Muffin and a Baby Ruth, though.

Beyond the sugar, there are still days I am not inclined to eat enough, and the diary reminds me to eat a handful of cashews or drink a glass of milk before I go to bed.

I’m still losing weight, slowly but steadily.  I lost three pounds last month, bringing my total to eighteen pounds lost.

Because I am tall, weight loss has to be more dramatic than that to be noticeable on me.  I haven’t even changed clothing sizes, although I can feel the difference in the way things fit.  My husband and my sister are the only ones who have noticed the change.

I’m fine with that.  It might make me self conscious if I felt like my efforts were on display.

Which begs the question – why am I blogging about it?

It’s been a month since I mentioned my progress, and I plan to continue to keep it at that.  I debated dropping it, but decided that would just make regular readers wonder if I’d given up.  Like my husband, you might be curious if I’m still obsessing over it.

I am.

How Many Weight Loss Rules Are There?

How many food rules can I break?Since I began the food diary two months ago, it has been hard to resist talking – and writing – about it incessantly.  I don’t think I’ve ever had to think so much about eating, so it is often on my mind.

True confession:  Left to my own devices, I’m an under-eater.

One of my dearest friends suggested this to me years ago, but I had a hard time understanding how I could be gaining weight by not eating enough.  My Fitness Pal warns me about “starvation mode,” but we’ve all seen photos of people who are truly starving.  They are not chubby like me.  I really do not believe I gained an extra thirty pounds by eating too little.

I think I gained it the modern way:  eating too much junk and too many calorie-laden restaurant meals as my metabolism was slowing down.  Under-eating some days and way over-eating others has probably been my norm for the past decade.

The first month of tracking, I lost ten pounds, most of it in the first couple weeks.  I think a fair bit of that was water retention.  Does sugar cause water retention?  I think it does, because when I cut the added sugar, my joints no longer felt swollen and achy and I dropped several pounds in a week.

(In case it isn’t obvious, I have no scientific training or medical knowledge, and nobody should take dietary advice from me.  Except my husband and children, who should.)

Then, I stopped losing weight.  I was also struggling to consume 1200 calories, much less the 1470 recommended for me, and felt miserable.  I wasn’t bothered that the scale wasn’t budging.  I was bothered that my digestive track wasn’t budging.

This is the primary reason I stopped eating meat years ago.  Apparently forcing myself to eat both eggs and yogurt every. single. day. has the same effect.  I decided to listen to my body and stop forcing myself to eat “high quality” protein.

Healthy eating is stressful.  All the best advice out there might not actually be right for any given person.  Apparently, I can only process so much protein a day, and most of it needs to come from vegetables and grains.

Sorry if that was TMI.

So, for the past two weeks I’ve been eating less animal protein and more of everything else, and I’ve lost a couple more pounds.  I’m not trying to eat low carb or low fat.  I am trying to eat 1200-1400 calories a day.

I’ve stopped trying to eat the five small meals a day that experts recommend, because it’s too much work planning that many meals.  I eat my three regular meals and, if my calorie count was low for the day, a bedtime snack.

If I crave chocolate in the afternoon, I do eat a square of dark chocolate.  If I want orange juice, I drink it, ignoring the juice-haters.  I have no forbidden foods.  I don’t deprive myself, other than relegating sweets to special occasions.  (Although I am not craving sweets, it does still feel like deprivation when I see others enjoying them.)

The nighttime snack (often cereal and milk because I need to get my calcium) helps ward off the junk food envy.  My family likes to eat chips or candy at night, and the sound of munching makes me want to crunch something, even when I am not hungry.  So a snack before bed works for me, even though I keep hearing that I should not eat at night.

I feel like the foundations of better health will be built upon breaking the rules.

At least, it will be built upon breaking expert rules, but they change their minds so often that I’m probably better off ignoring most of what they say anyway.

Thinking Thin: Sweets as Treats

God works overtime to prevent me from becoming vain.

I have lost ten pounds in the past four weeks.  The only garments which are noticeably roomier are my bras.

I have to remind myself that:

  1. I knew this would happen.
  2. Weight will eventually come off my belly, hips, and thighs.
  3. There are other benefits to the changes I’ve made.

As I mentioned a couple weeks ago, I’ve been eating more protein and less sugar.  Now that I’ve been tracking my eating habits for a month, it’s not as much work to get the protein.

The sugar still requires considerable restraint, but I think this is where I feel the biggest difference.

I used to think I was developing arthritis, because I often woke with the sensation of swelling in my elbows and hands.  They never looked swollen, but they felt it, and they ached.

Since scaling back the added sugars, the soreness and inflammation has stopped.  I remind myself of this when I want to eat a peanut butter cup or special dark nugget with almonds.

I have not completely eliminated sugar from my diet, nor will I.

Sweets as Treats:  Adopting a health mindset about foodI still eat at least two servings of fruit daily, and when my mother in law baked pineapple upside down cake, I happily ate one piece.  Only one.  Yesterday, I went all out and ate, according to My Fitness Pal, an estimated 600 calories of baklava for Easter.

The cake was worth every calorie, but, in all honesty, I should have cut the baklava in half.  I enjoyed the first few bites more than the last few, but I finished it anyway.

This is where I need to adjust my thinking.  I need to return to the mindset of sugar laden desserts as special occasion treats, not every evening indulgences.  I should stop eating if/when the taste isn’t as fabulous as I’d anticipated.  Those are the thoughts and habits I had years ago – when I was thin.

I plan to continue to eat home baked goodies when offered, to make them occasionally, to savor one piece or two bites, and to remember my old policy on sweets and treats:

If it’s not fantastic, don’t waste the calories.

No grocery store apple pie tastes like one made from scratch.  I’m almost always disappointed in cake.  Cool Whip is gross.  Cookies really do taste better fresh from the oven.  The first bites always taste the best.

Now I just need to convince myself that Ben and Jerry’s Chunky Monkey is not delicious.

Does anyone get enough sleep?

I’ve always been a huge fan of sleep.  Unlike the couple Hoagy Carmichael wrote about, I’m more likely to plead exhaustion and say good-night than to stay up til dawn gazing into my lover’s eyes.  There’s nothing romantic about being tired and cranky, if you ask me.

As a parent, of course, I’ve experienced sleep deprivation.  It is the great shared experience of mothers everywhere; we’ve all been there, done that, and would like to sleep it off somewhere.

Last week, I read an article about the effect of sleep deprivation on a genetic level.  700 genes were found to have disrupted activity when the study’s participants got less than six hours of sleep each night.

I’m not certain what that means, but no wonder new moms are exhausted.  Not only did you just create all those brain and kidney and skin cells, but now your own genes cannot even relax with a job well done.

Then there was an article about sleep deprivation leading to binge eating. 

I don’t binge eat.  It’s probably because I sleep eight hours a night and have happy genes.

Sleep deprivation is a serious problem, even for those without babies in the house.  Thirty seven percent of drivers admit they have fallen asleep while driving in the past year.

How much sleep do children need? | A Faded GingerIt’s also a problem for many children today.  I honestly think a lot of the behavior problems, specifically the tantrums and meltdowns and lack of ability to cope, and, yes, the inability to sleep soundly, I see in children are due to them being chronically tired.

They are not little adults.

If sleep deprivation messes with 700 genes, what must that do to a child with a rapidly growing body?

How much sleep do children need? According to the National Sleep Foundation:

  • Newborns need 10.5 to 18 hours per day for their first two months.  It doesn’t matter when.
  • Babies from three to twelve months need 9 to 12 hours each night, and two naps of 30 minutes to 2 hours.
  • Toddlers from one to three years old need between 12 and 14 hours of sleep per day.
  • Preschoolers aged three to five need only slightly less, 11 – 13 hours each day.
  • School aged children aged five to twelve need 10-11 hours of sleep each day.
  • Teens need at least 9 hours of sleep per day.

Do you feel like you get enough sleep?  What about your children – do they?

It’s not a cold.

On the radio yesterday, I heard yet another proclamation that I live in the “healthiest state in the nation.”

Bah-humbug!

Almost every time I leave my house someone asks if I have a cold.  “No,” I say, “I’m just allergic to Colorado.”

Technically, I know I can’t be, but that is how it feels, and, apparently, how it looks.  This altitude and semi-arid climate does not agree with my sinuses (or my skin – but my hair does well), and it seems my symptoms get worse every year.  Winter, being the driest season, finds me constantly congested and sneezing with lovely dark bags under my eyes.

I’ve had one steadily increasing sinus headache since returning from my Thanksgiving holiday back east.  Back east, where the air is thick and humid and people complain about it all the time, I don’t wake up with a blood crusted nose when I forget to coat my nostrils with vaseline before going to bed.  I never appreciated humidity until I lived someplace without it.  (Even so, I am still not a fan of sticky, sweaty summers.)

Because my discomfort is caused by dryness, it seems counter-intuitive to take antihistamines or decongestants.  Wouldn’t they be even more drying?  I resisted for a long time, but eventually began taking generic Benadryl at night.  I figured even if it doesn’t help with the congestion, it might help me sleep despite it.  I’m not sure whether it’s helping me sleep, but it’s not helping me breathe.

Yesterday, desperate from throbbing sinuses, I went to the pharmacy, where I pinky swore I am not manufacturing illegal substances in my basement, and bought myself a box of good old Sudafed, or, at least the generic version of it.  I popped two as soon as I got in my car.

Psuedoephedrine, you are my new best friend.  I hope I don’t get put on a list of suspicious persons before winter is over, because, really, I just want to be able to breathe through my nose and not have a headache that makes me want to sleep all day.

Pinky swear.

Who knows what to think about mammograms?

Over the past five years I’ve had eight sets of mammograms.

Why so many?

The first three of those years, after the screenings, I was called back for diagnostic mammograms.   Those target specific areas.  Since the compression is targeted, and seems higher, they hurt, really hurt.  The last time, the tech thanked me for not crying or cursing at her.  She said those are the usual responses.

The moments of pain are nothing, though, compared to the worry while you are waiting for that second appointment.  Even though I know – no, I don’t know, that is why I worry.  Even though I suspect that the extra mammo and ultrasound will reveal what I already know, that I have cysts, I still worry.

While I’m worrying, I question whether the tests are worth the anxiety they cause me.

My GP and my gynecologist, the one who just retired, never seeme to share that question.  They both embrace the mammo-every-year-after-40 policy.

I never feel fully convinced, but I don’t want to be negligent, so I go back every year for another smashogram.

I read an article the other day, that amplifies all my doubts over whether these mammograms are benefiting me.

I already thought that all the X-ray radiation to my breasts was not a good thing at all.  I spent my whole life refusing to have my teeth x-rayed  annually, but I’ve had my breasts repeatedly squashed and x-rayed over the past five years.

That doesn’t seem right, but I’m more afraid of dying from breast cancer than ending up with dentures.

However, when the New England Journal of Medicine starts saying that with mammograms, I’m more likely to be misdiagnosed and/or die anyway, then maybe I should stop the annual smash-and-worry routine.

Of course, other experts disagree.  The American Cancer Society continues to recommend annual screening starting at age 40.

I am almost resolved to discontinue the mammograms until I am 50, or at least to cutting back to every other year.  Every other year sounds like a good compromise, doesn’t it?

Then, another woman I know has a double mastectomy, and learns the cancer is already in her lymph nodes.  My resolve weakens.  I don’t know what to think.

Now is not the time to ask if she’d had annual mammograms throughout her 40’s, but I really want to know.  I want to know if she never had screenings, and if she had that the mammo would have caught the cancer earlier.  Or that she did have screenings and the radiation made it grow, even while the radiologist did not see it.

I want to know I’m making the best decision for my health.  I want easy answers, and there aren’t any.

And I am sad, so very sad, for another woman, another family that is afraid of what comes next.

Being a stand up kind of girl

Do you spend most of your day sitting down?  I do.

I don’t even have the excuse of working an office job.  I just spend a lot of time lounging around my house.  I read, I knit, I blog, I sit, sit, sit.  So when I read an article last week about the health risks of sitting more often than not, I took notice.

I couldn’t find the exact article, but this one is good.

The gist of it is that even if you exercise an hour a day, which I don’t, your risk of heart disease, diabetes, and, well, death, is significantly higher if you are sitting four hours a day or more.

Four hours of sitting each day is considered risky.

Four hours?  That sounds like someone who has been on their feet all day, doesn’t get to sit down until dinner time, then falls asleep in a chair while watching tv with their kids.

If four hours is risky, is there any hope for a couch potato like me?

Even my bicycle riding is a seated activity.

Momentarily alarmed, I have spent the last three days trying to stand up more often.  I ate standing up, even though this would make me a social pariah in France. (I’ve never been to France, but this is the sort of thing I think about while standing in my kitchen eating a bowl of cereal.)

I paced the kitchen waiting for the dogs to eat or come back inside.
I attended a child’s party and stood the entire time.
I read standing up, for a few minutes anyway.
I did not sit down during an hour long phone conversation with my mom.
I even remained fully upright while brushing my teeth, no leaning.

I made a concerted effort to stand up.  I still spent the vast majority of my waking hours seated.

If you don’t hear from me next week it is because I sat myself to death.

My only consolation is that I would be just as dead if I had been going to the gym for an hour each day.

Where have the old doctors gone?

Marcus Welby was on
before my bedtime.
How old can I be?

Yesterday I received a letter that my GYN has retired.  I’d only been seeing her a few years, but really liked her. She was a good listener, and believed me the first time when I told her where to find my cervix.  That sounds like a simple thing, but a lot of doctors don’t.  Exploring with a speculum hurts.

She was about fifteen years older than me, maybe, and nothing surprised her.  The two doctors who are taking over her practice look younger than me.  Judging by their photos, they are both in their thirties.

I’m not opposed to young doctors on principle, but I have not had good luck with doctors younger than myself. The last time I tried that, I ended up with lots of extra tests and appointments because the young doctor didn’t think anything I described or she felt seemed “normal.”  No, not normal for someone under 30 who has never had a baby, but for a woman in her forties, yes, it can be.  Sorry, things get messy and lumpy.  All sorts of things.

It ended badly, when she sought the opinion of an older doctor in the practice, who ended up telling her loudly in the hall that NO, you should not keep calling a patient back to re-check her breasts when multiple mammograms and ultrasounds showed NOTHING.  That SCARES patients.

I was glad I wasn’t the one who had to yell at her.

It’s not just the gynecologists and GPs.

Also, never seen an episode of Doogie Howser.
I think I had a collicky baby that year.
I’m not young, either.

The last time I was at the dentist he was trying to talk me into capping a wisdom tooth that does not hurt because he saw craze lines on the x-ray.  At my age, he thought, I should take preventative measures.   I thought I was politely declining treatment I did not yet need, and he angrily began telling me that I was foolish to dismiss the advice of an expert who had been practicing dentistry for six years.

Six whole years!  How dare I!

After he left, I asked the hygienist if he was always that aggressive.  She whispered, “No, I’ve never seen him that angry before.”

Maybe his student loans were stressing him out.

I’m only 45.  I wasn’t expecting this for another decade.  Where have all the older doctors gone?

Red Faced: the cause, not the effect, of my embarrassment

I’ve never been much for exercise. I don’t like to sweat, and I don’t know how to breathe. I know that sounds crazy, but it’s true.

I don’t breathe right. Mostly, I hold my breath. I also get confused about directions on how to breathe – when am I supposed to inhale? Should I be exhaling through my nose or mouth? I can never remember, then end up holding my breath while I think about it.  It just does not come naturally to me.

This is why I was the girl who either hyperventilated or passed out in middle school PE class every time we ran.

(The upside of passing out multiple times in PE is that you learn to feel it coming, so later, when you are pregnant, you will lean into a wall and lower yourself slowly to the ground, thus avoiding injury to you or your unborn child.)

So, I’m not a natural at exercise.  I can walk or ride a bike.

I love to ride my bike. It almost doesn’t qualify as exercise because:
1. I don’t make myself go fast.
2. It doesn’t require special breathing.
3. The wind mostly counteracts the perspiration problem.

Recently, however, I’ve developed another issue that is causing bicycling to fall into the exercise category.

My face turns bright red.

I can imagine Hitchcock’s face turning bright red.

By bright red, I mean cooked lobster. Fire engines. Stop signs.

This is almost as embarrassing as passing out in gym class.

I like to ride my bike to places. The library tops the list of places I like to go. It’s only five miles away.

It doesn’t help that there is a bit of hill just before the library, which means I’m also slightly out of breath when I get there.  Maybe more than slightly. There is not a lot of oxygen where I live, and remember I don’t breathe correctly.

The last time I went to the library, because my face was bright red and I was feeling the lack of oxygen, I decided I would sit on the comfy chairs while I cooled off. I was hoping to go unnoticed. No such luck.

This man just stood and STARED at me. I know I looked bad, but really? Move along, mister. I’m not a freak show.

I was waiting for him to ask if I was okay, or offer to call 911, so I could say I’m fine, but he just continued to stand there and stare.

I couldn’t take it. It was almost as bad as hyperventilating into a paper bag while classmates stared in horror.

I went to the ladies’ room to put a wet towel on my forehead.  That’s when I learned that eco friendly towels disintegrate when wet. I splashed some water on my face and went back out, face now bright red and dripping wet, checked out my books, avoided eye contact with everyone, and left.

How can I age gracefully when my body won’t cooperate?