Some links which I have found useful; I am not representing any of these groups.
By LINDSEY TANNER, AP Medical WriterSun Jul 2, 4:01 PM ET
Is it OK for doctors and parents to tell children and teens they're fat?
That seems to be at the heart of a debate over whether to replace the fuzzy language favored by the U.S. government with the painful truth — telling kids if they're obese or overweight.
Labeling a child obese might "run the risk of making them angry, making the family angry," but it addresses a serious issue head-on, said Dr. Reginald Washington, a Denver pediatrician and co-chair of an American Academy of Pediatrics obesity task force.
"If that same person came into your office and had cancer, or was anemic, or had an ear infection, would we be having the same conversation? There are a thousand reasons why this obesity epidemic is so out of control, and one of them is no one wants to talk about it."
The diplomatic approach adopted by the federal Centers for Disease Control and Prevention and used by many doctors avoids the word "obese" because of the stigma. The CDC also calls overweight kids "at risk of overweight."
Those favoring a change say the current terms encourage denial of a problem affecting increasing numbers of U.S. youngsters.
Under a proposal studied by a committee of the American Medical Association, the CDC and others, fat children would get the same labels as adults — overweight or obese.
The change "would certainly make sense. It would bring the U.S. in line with the rest of the world," said Tim Cole, a professor of medical statistics at the University College London's Institute of Child Health.
The existing categories are convoluted and "rather ironic, since the U.S. leads the world in terms of obesity," Cole said. "There must be an element of political correctness."
The debate illustrates just how touchy the nation is about its weight problem.
Obese "sounds mean. It doesn't sound good," said Trisha Leu, 17, who thinks the proposed change is a bad idea.
The Wheeling, Ill., teen has lost 60 pounds since March as part of an adolescent obesity surgery study at the University of Illinois at Chicago.
"When you're young, you don't understand what obese means," Leu said. "I still don't understand it."
The CDC adopted the current terms in 1998, using weight-to-height ratios and growth charts from a generation of children much slimmer than today's.
Children are said to be "at risk for overweight" if their body-mass index is between the 85th and 94th percentiles. They're "overweight" if their body-mass index is in the 95th percentile or higher — or greater than at least 95 percent of youngsters the same age and gender.
Many pediatricians understand the first category to mean "overweight" and the second one to mean "obese," said the CDC's Dr. William Dietz. He said the word "obese" was purposely avoided because of negative connotations but conceded that many pediatricians find the current language confusing.
Adding to the confusion is the fact that about 17 percent of U.S. children are in the highest category, and that almost 34 percent are in the second-highest category. That sounds like a mathematical impossibility, but it's because the percentiles are based on growth charts from the 1960s and 1970s, when far fewer kids were too fat.
In children, determining excess weight is tricky, partly because of rapid growth — especially in adolescence — that can sometimes temporarily result in a high body-mass index.
For children in at least the 95th percentile, high BMI "is almost invariably excess fat," Dietz said. But there's less certainty about those in the second-highest category. So to avoid mislabeling and "traumatizing" kids, the CDC chose to be diplomatic, Dietz said.
The committee, set up by the American Medical Association, involves obesity experts from 14 professional organizations including the American Academy of Pediatrics. Their mission is to update recommendations for prevention, diagnosis and management of obesity in children.
Final recommendations are expected in September, and the participating groups will decide individually whether to adopt them.
Dr. Ronald Davis, the AMA's president-elect, said it's unclear whether the expert committee can develop a consensus on the obesity terms.
"There are seemingly legitimate arguments on both sides," said Davis, a preventive medicine specialist with Henry Ford Health System in Detroit.
Maria Bailey of Pompano Beach, Fla., whose 12-year-old daughter, Madison, is self-consciously overweight, opposes the proposed change. She said their pediatrician has told her daughter to exercise more and see a nutritionist, but "hasn't told her that she's in a (weight) category."
"We're already raising a generation of teenagers who have eating disorders," Bailey said. "I think it would just perpetuate that."
Paola Fernandez Rana of Fort Lauderdale, Fla., has a 9-year old daughter who at 40 pounds overweight is considered obese. Rana said doctors "refer to it as the 'o-word' " in front of her daughter "in an effort not to upset her."
"They very clearly told me she was obese," Rana said. But she said she agreed with the term and thinks that at some point it should be used with her daughter, too.
"Obviously I don't want my daughter to be overweight, but ... in order to change the situation, she is ultimately going to need to hear it," Rana said.
Dr. Michael Wasserman, a pediatrician with the Ochsner Clinic in Metairie, La., agreed. Using the term "at risk for overweight" is misleading, creating the perception "that I'm only at risk for it now, so I don't have to deal with it now," said Wasserman, who is not on the committee.
"There's a tremendous amount of denial by parents and children," he said.
Chicago pediatrician Rebecca Unger, also not a committee member, said she likes using the term "at risk for overweight" because it gives patients hope that "we can do something about it."
Actually, what I said to my friend was: "You're a fat, fucking asshole."
Why?
And why read any diary with such an offensive opening?
Find out below the fold.
If you made the jump into this diary, you're probably wondering how I could have any friends. I'm lucky. I do. Or maybe that should be: I'm lucky I do. You decide.
First, the background. I happen to live in a part of the world where very, very few folks are overweight. We eat well; and exercise is every bit as important in our kids' lives as study and friendship. Americans, on the other hand, live in a land where anywhere from 30 to 50 percent of the folks are fat.
That's right, fat. That stuff hanging in folds or jiggling in the mirror isn't muscle, it isn't bone and it isn't healthy. It's fat.
Fat is a bad word in America these days. To call someone "fat" is to be hurtful. Once upon a time most people carting an extra 20% or more of their body weight in fat around did so because of some sort of metabolic or glandular condition. So calling someone "fat" was simply an insult about a physical trait pretty much beyond anyone's control.
These days folks just eat too much of the wrong foods and don't get enough exercise. So, sorry "no banana". Or should we say "no more giant bags of corn-chips". The "I was just born fat" doesn't cut if for most folks these days.
How about this little nugget? One in eight New Yorkers has diabetes. One in eight? Read the opening graph from a NYT piece in January this year:
Begin on the sixth floor, third room from the end, swathed in fluorescence: a 60-year-old woman was having two toes sawed off. One floor up, corner room: a middle-aged man sprawled, recuperating from a kidney transplant. Next door: nerve damage. Eighth floor, first room to the left: stroke. Two doors down: more toes being removed. Next room: a flawed heart...
How many New Yorkers with diabetes does that work out to exactly? 800,000. Remember that burgeoning US Latin American population? Figure one out of every two will get diabetes, one out of every three Americans, according to the New York Times.
So what's the connection to calling my friend a "fat, fucking asshole"? Again, a tiny bit of background. My friend is successful, in his early 40's, gave up all alcohol and drugs about seven years back, and then tobacco a few years ago. In short, he's made a lot of positive changes in his life.
Since he quit smoking he's been beating himself up about his weight. Beating himself up bad. For years. Finally, during lunch several months ago, he complained that his negative self-image had gotten so bad that it was ruining his life, every time he looked in the mirror, he claimed, all he saw a "fat, fucking asshole." My friend then startled us by claiming that he was "just going to have to accept his weight and learn to live with it."
Huh? Here he was, ready to start reconstructing his identity so that he would no longer "worry" about eating his way into an early grave.
Sorry. Friends don't let friends choose diabetes. So, I leaned over and said as kindly as I could: "The reason you look into the mirror and see a fat, fucking asshole staring back is because you are a fat, fucking asshole. Our health in this respect is largely a matter of choice. You just need to decide to accept the responsibility for what you do each day and what you put into your mouth." I then proceeded to outline two or three surefire methods of getting into shape.
How did he react? You can imagine. He stormed out of the restaurant spitting and cursing.
The exact chronology of events that then followed is unclear, but it seems he complained about my "appalling" lack of sensitivity to a few other souls who may or may not have allowed that I might just have a point. In any event, guess who started losing weight. Big-time and, dare I say it, he now looks wonderful.
He clearly feels better about himself; and now sees that he can establish some control over his lifestyle. Did my comments make a difference? Who knows?
Then I came across this item in the Huff Post today:
CHICAGO - Is it OK for doctors and parents to tell children and teens they're fat? AP
The article is a real eye-opener, even for fans of clean living like me.
Labeling a child obese might "run the risk of making them angry, making the family angry," but it addresses a serious issue head-on, said Dr. Reginald Washington, a Denver pediatrician and co-chair of an American Academy of Pediatrics obesity task force."If that same person came into your office and had cancer, or was anemic, or had an ear infection, would we be having the same conversation? There are a thousand reasons why this obesity epidemic is so out of control, and one of them is no one wants to talk about it..."
This passage really made me think. Don't we object to the military using all those polite euphamisms, like "collateral damage" when what they're talking about is blowing-up civilian men, women and children? In the NYT article we have adults getting toes sawn-off, but we're afraid to use factually accurate language with children. Doesn't this lead to more confusion? You bet it does. More from the same AP article:
Those favoring a change say the current terms encourage denial of a problem affecting increasing numbers of U.S. youngsters.Under a proposal studied by a committee of the American Medical Association, the CDC and others, fat children would get the same labels as adults -- overweight or obese.
The change "would certainly make sense. It would bring the U.S. in line with the rest of the world," said Tim Cole, a professor of medical statistics at the University College London's Institute of Child Health.
The existing categories are convoluted and "rather ironic, since the U.S. leads the world in terms of obesity," Cole said. "There must be an element of political correctness."
The debate illustrates just how touchy the nation is about its weight problem.
Obese "sounds mean. It doesn't sound good," said Trisha Leu, 17, who thinks the proposed change is a bad idea.
The Wheeling, Ill., teen has lost 60 pounds since March as part of an adolescent obesity surgery study at the University of Illinois at Chicago.
"When you're young, you don't understand what obese means," Leu said. "I still don't understand it."
Trisha Leu has "lost" 60 pounds during an "obesity surgery" study and she still doesn't understand what obese means? Maybe somebody should tell her that having 60 pounds trimmed off a teenager's body is the very definition of obesity.
So, I had lunch with this friend and others again this week. I complimented him once more on his improved appearence. He replied that he is still "running everyday". There's still some tension between us from our previous exchange.
In an ideal world nobody would be unhealthy. We'd respond to all those nicer folks who advise us gently to go to the gym or buy an exercise book. But the fact is for me and maybe my friend, I need to be hit square between the eyes with the truth before I pay attention, and typically more than once.
Like I said, I'm not completely comfortable with my role in all this. But if my friend does get healthy; and adds a few more years to his life, then maybe calling him a "fat, fucking asshole" really wasn't such a bad thing to do. I would never have used these words out of the blue, but for some reason serving them back to him just seemed right.
I don't think this is a one-size fits all issue, but the truth has to be at the center of every serious discussion. Often there is a solution if we can just get our minds around it. If just one person still reading decides to make some positive lifestyle decisions, then I'll feel this diary worthwhile.
Can we penetrate the fog of bs with polite words? I don't know; and I suspect not. I do know that denial is a killer. And if I have to make a decision between hurting someone's feelings or helping them get help I guess I know which way I'd go. You're entitled to disagree, no offense meant or taken.
Update: Kidneystones contacted his friend and made a follow up diary.
http://www.dailykos.com/story/2006/7/5/12556/98916
A day or so ago I posted a diary on health built around an exchange I had with a friend.
Just this evening I emailed him to fill him in and give him a chance to respond.
His reply below the fold.
I expect the only folks reading here are familiar with the diary so I won't dwell too much on that. I will, however, apologize for causing pain or giving offense in that diary. My friend and I belong to the same community outreach program and meet for lunch with others once a week or so. He emailed me this evening to pass along a link to the Tylenol liver damage story, so you can see we share a keen interest in health issues. Does that shared interest get me off the hook? Read for yourself.
From me:
Couple of quick questionsWas I out of line by calling you out on your weight?
Did my remarks motivate you in any way to take more action. (I'm well aware that you were already taking lots of action)?
Would you prefer I'd said nothing?
I hasten to add that the reason I ask is that I'm in the middle of a large discussion about how we deal with friends and their health issues and I've used our little blow-out as an example, no names, of course. The actual discussion is about destructive lifestyles and whether or not we should confront issues head on. Most of the participants are American. I'm arguing that with 1 in 8 New Yorkers diabetic ( 800,000 cases there alone) and one in every two Latinos expected to suffer the same fate, the last thing we need to do is pretend being extra large is normal.
There's an apology in here too.
I'll understand if you'd just as soon tell me to screw-off.
Not like you never have.
Cheers.
To which he replied:
Hi,Was I out of line by calling you out on your weight?
* Yes. to a degree, not saying the same to John G and Doug leaves your motives open to question.*
Did my remarks motivate you in any way to take more action. (I'm well aware that you were already taking lots of action)?
* Not really I was well aware of my weight.....doing what I can. *
Would you prefer I'd said nothing?
* Probably, over it now. However I know it is your personality to be very direct (and sometimes very argumentative) but "...really, you look like a fat pig" is pretty strong and obviously going to cause resentment.*
I hasten to add that the reason I ask is that I'm in the middle of a large discussion about how we deal with friends and their health issues and I've used our little blow-out as an example, no names, of course. The actual discussion is about destructive lifestyles and whether or not we should confront issues head on. Most of the participants are American. I'm arguing that with 1 in 8 New Yorkers diabetic ( 800,000 cases there alone) and one in every two Latinos expected to suffer the same fate, the last thing we need to do is pretend being extra large is normal.
* I can see your point, gentle reference to the facts may be helpful, but I just read a study where people only change when fully accepted as they are. "Only when people feel fully loved and accepted as they are, are they capable of hearing that they should change." - Byron Katie *
There's an apology in here too.
* It is appreciated/accepted. *
I'll understand if you'd just as soon tell me to screw-off.
Not like you never have.* ; o )
All the best*
I'm going to hit the hay. I still feel every bit as strongly about the insanity of our lifestyle choices. I'm not at all happy about the current dialogue, but accept that I'm not doing a good enough job of communicating with others. I expect I'm going to continue to err on the side of bluntness. I'll close here. No tip jar or further comment from me tonight.
"Only when people feel fully loved and accepted as they are, are they capable of hearing that they should change." - Byron Katie
May 2006 June 2006 July 2006 July 2007
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