Anti-Anti-Obesity

The anti-obesity campaign really irks me. If it was a healthy living campaign, focusing on healthy habits vs the numbers on a scale, then I'd be much more enthusiastic about it. Unfortunately, that is not what is happening. More and more the path is weight shaming and stigmatizing in the vein attempt to regulate our country's weight issues. The topic of weight stigma is far to vast for me to sum up in one post - especially since I'm exhausted and should really be asleep right now. Seriously, writing sentences that are comprehensible is really interesting with brain fog and neurological pain. So for right now I will focus on one area of this topic that is very important. Our youth.

Dina Zeckhausen is a psychologist and founder of the Eating Disorder Information Network. In an interview with CNN in 2013, Dina reported seeing kids in third and fourth grade who are already worried about being fat.

"There is so much emphasis on obesity," Zeckhausen said, "that there's a danger that we are going to produce a lot of anxieties in kids around weight."

See full article here

It seems like every other week (if not day) I'm hearing about some new way our communities are "fighting obesity" and each time it seems to be more infuriating than the last. Everyone has already heard about the "fat letters" sent out by some schools. Some say they're dangerous while others say that parents are being over sensitive. Honestly, if the schools were really trying to educate and advise families about health they would focus on teaching and focusing in healthy habits, not a number. Numbers do not indicate health.

There are many, many larger sized individuals who eat healthy, are very active, and have no health issues - except for what the scale says. Let me be clear, if someone (of any size) has a health issue, then treat that health issue. But that’s different than treating their weight as the issue. 

Carmen Cool, MA, LPC said it beautifully: “With all due respect, I need to disagree with you that we need this war on obesity. What we need, is to work together to end it. Not by making fat people thinner, but by recognizing and celebrating the truth of body diversity.  Weight is not the problem. The way we make assumptions about it is the problem. I want to live in a peaceful world. And a peaceful world starts with a peaceful self. Rather than fighting fatness, why don’t we help people of all sizes feel peaceful in the bodies they have.” 

see full article here: http://bedaonline.com/wsaw2013/weight-stigma-viewed-eating-disorders-lens-carmen-cool/#.UkJy_429LCT

I brought this up with my mom today and she immediately jumped in agreeing that it is ridiculous and dangerous. Aside from the obvious (obvious to my mom and I) health risks it poses, there is another very valid point she made regarding schools sending out "fat letters" that I had previously over looked - When there are students failing and struggling in reading and math, why would they focus on what the student looks like? Isn't that a bit of course? When there art, music, and science opportunities shut down by lack of funds why would the schools set their sites on the appearance of health (note the word appearance) with little to no regard for the individual student and their real health. Better yet, how is it even the school's place to decide who is healthy vs unhealthy based on a number? Oh, that's right, it's not.

If I am ever at a school (as a parent or otherwise) and I find out that the school has been sending anyone weight stigmatizing letters or promoting weight stigma in any way, I will be very upset. I will be beyond upset. I will be their worst nightmare.

DSM-5 Finally Fixes Anorexia Criteria!

This is long over due! The criteria for diagnosing anorexia has finally been broadened to include any weight - instead of the precious under weight "symptom". This help clear up the misconception that anorexia is a weight disease instead of purely a psychological one. With Weight Stigma Awareness Week in full swing I'd say this is a great time for the news! 

More than 55% of teen girls and more than 30% of teen boys report some kind of “disordered eating”. This means they exhibit symptoms like purging by way of self-induced vomiting, laxative and/or diuretic abuse, excessive exercising, restricting food consumption, binging, using diet pills, and even diabetics using insulin to regulate and manipulate their weight. 

“Before, patients were very sick before meeting criteria, and the evidence is pretty clear that if you interfere in anorexia before there’s been significant weight loss, the outcomes are much better and the illness is easier to treat in an outpatient setting,” says Kimberli McCallum, founder and medical director of eating disorder clinic McCallum Place in Saint Louis, in an article by Tara Haelle with Scientific America[1]. 

Before, many people fell into the EDNOS category[2]. EDNOS is the diagnosis given to any person exhibiting disordered eating but didn't fit exclusively into either the anorexia or bulimia category. 

So what was the problem with EDNOS? Usually the EDNOS diagnosis was not taken seriously by insurers, family members, or even physicians. This tremendously complicates treatment for an extremely deadly disorder. In fact, it's the most deadly eating disorder. 

Aside from the change to the DSM-5 criteria regarding a weight requirement are other changes. Instead of the previous psychological markers of “intense fear of gaining weight or becoming fat,” it now reads “or persistent behavior that interferes with weight gain, even though at a significantly low weight.” And the criterion "at least three missed periods" has been completely removed. It has also added that while using BMI to help establish severity, “the level of severity may be increased to reflect clinical symptoms, the degree of functional disability and the need for supervision.” Additions of “partial remission” or “full remission” have also been added to prevent recovering anorexics from being rebranded with EDNOS. I know that, for myself, there have been several partial remissions. These remissions I experienced always had some other element that wasn't there the first time around. I suspect it's the same for many others. 

The real challenge is going to be physicians and families seeing an over weight child/adolescence lose weight and actually investigating the weight loss methods instead of just congratulating them. Being complimented and praised is so addictive, not only to children and adolescents, but to anybody. The truth is that there can be serious health complications going on such as dehydration, digestive issues, cardiac issues, kidney and liver issues, and difficulty concentrating.  

These changes will hopefully help health insurance claims as well. Many insurance companies automatically refused any patients for overnight treatment if they were more than 85% of their ideal weight. 

This should also help obtaining more reliable research statistics as well. Yay!

This is a win, guys!!!  

[1] http://www.scientificamerican.com/article.cfm?id=expanded-clinical-definition-of-anorexia-may-help-more-teens&WT.mc_id=SA_sharetool_Twitter

[2] http://www.something-fishy.org/whatarethey/ednos.php 

A Dangerous Blind Spot

As NEDAwareness week wraps up, I'd like to leave you with one last post. 

 *Note: I do plan to add other posts pertaining to this subject well after this week is over ;) 

There is a lot of attention on the current childhood obesity epidemic that seems to not only over shadow another epidemic, but fuel it altogether. 

In a CMAJ (Canadian Medical Association Journal) article from 2004, Dr. Joan M. Johnston addresses the push towards eliminating childhood obesity upon receiving a package as part of an obesity-awareness campaign for family physicians and pediatricians. 

She writes: "I am disgusted by the cavalier disregard for eating disorders exhibited in the medico-cultural war against obesity." 

This publication had ZERO mention of eating disorders. I don't know about you, but I'm pretty sure that BED (binge eating disorder) is infact an actual eating disorder. Am I wrong? Did this phenomenon occur purely out of poorly educated choices, or is this much more complex issue than the health industry would like us to think? It is beyond ignorant to think that anyone in America who is overweight (or has a child who is) doesn't already have a plethora of information regarding the issue or, even worse, doesn't already know they are over weight. Johnston later sums up this eating disorder blind spot by stating that "For such individuals, launching a frontal assault on the symptom (obesity) instead of dealing with the underlying cause (the eating disorder) may simply catalyze the transformation of their disorder into anorexia or bulimia nervosa." 

The quick fix of caloric intake vs expenditure will have devastating results. With out addressing the person as a whole and just focusing on the numbers we set up for poorer health. It doesn't take very long before you are so far down the rabbit hole that you realize the "control" you thought you had was just a mirage (remember: most EDs are not about the food or the weight,they are much more complex than that). 

Up to 20% of those lost in wonderland will die from their eating disorder. That is a number far HIGHER than the risk of death from diabetes or heart disease related to obesity. Johnston sums up with "By adding the official voice of family physicians and pediatricians to the consumerist messages already bombarding them about diet and exercise, we will be endorsing the exploitative purveyors of these messages. We will be telling our kids that they are not okay, and we will drive many of them into the waiting arms of anorexia and bulimia." Combine that knowledge with the fact that this was in 2004 and both the health-care industry and our government's attention to this issue has increased exponentially while still having this blind spot is terrifying.

In today's Huff Post Parents an article spot lights a school who sent home "fat letters" to all students with an elevated BMI. 

Seriously, I can't even go into detail about this article because it is so maddening. PLEASE follow the link and see for yourself. BMI and I have been long-time enemies. It is purely height in relation to weight and does NOT account for muscle mas or bone structure. In another insightful article, Time Magazine's website (Time Ideas) that was published last Thursday focuses on this issue and adds some great points: "promoting healthy eating, regardless of one’s weight or age, seems like a positive thing on the surface. But here’s the potential downside: We know kids and teens react differently than adults to external pressures like persistent messaging. Sometimes these pressures can translate into incredible waves of anxiety and fear. At the extreme, a healthy-weight youth could be pushed to monitor his weight more frequently or even begin an unsupervised diet — behaviors that might represent an impending eating disorder." As someone who started out trying be healthy and wound up almost dead, I can't stress the truth in this statement enough. There is no doubt that the current level of obesity in this country is alarming and needs to be addressed, I just feel that there MUST be a better way than how we're doing it now.