DebraSY

Posts Tagged ‘Public Policy’

At the Risk of Getting Too Political

In Weight-Loss Maintenance on July 20, 2011 at 9:28 am

At Big Fat Blog, from time to time, political arguments erupt in the comments, and then shut down quickly, over which US political party is the most size accepting.   The arguments are quashed, generally, by the Libertarians who point out that both the left and the right view fat as a moral issue.  The right sees obesity as a failing of personal responsibility, whereas the left sees it as metaphor and consequence of society’s greed and overconsumption.  The Libertarians then make an unsubtle marketing plea, since they see themselves as the original torch bearers (and remain more consistent and stalwart than the upstart tea partiers) of “keep government out of our lives.”

Well, I am on an email list for an online, left-leaning news analysis publication called Truthout, and, truth be told, I don’t click through very often.  But, for obvious reasons, this article, Are Chemicals Making us Fat?, caught my eye.   Could it be that the left is coming ‘round?  

It’s a rather simplistic article, written as though this conversation is brand-spanking new “Researchers have called these chemicals endocrine disruptors. . . But a new, more relevant term for these chemicals has emerged. They are now also called obesogens.”

Has emerged?  Bruce Blumberg of the University of California at Irvine takes credit for coining the term obesogen, and his research using that word seems to date back to the mid-2000s, but the conversation regarding endocrine disruptors and obesity has been going on for decades.  (Our conversation at this blog, which I extended not once, not twice, but three times, is one of the most fun conversations on the topic.)

I am uncomfortable with the Truthout article for a number of reasons.  I don’t like how it conflates and confuses obesity and diabetes, as though they are conjoined twins.  This is a common practice now, and a panic-laden term “diabesity” has “emerged” to express this concept.  Generally, if blame is Read the rest of this entry »

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The Plate

In Weight-Loss Maintenance on June 6, 2011 at 11:01 am

It’s the topic of the day (or recent bygone days) at many blogs and websites:  The new US dietary guidelines replacing the old Pyramid, aka “My Plate.”

Knowing full well that I’m howling in the wind, I just blasted off the following missive to the “Contact Us” email address.

Warning to my size acceptance friends, restriction talk, could be triggering.  I also apologize for using the “O” word.  Had to consider my audience, and “fat” wouldn’t fly with them.

No Salutation.  Email address is Support@cnpp.usda.gov

Thank you for your hard work to date.  Here are suggestions for the new plate, which is better than the pyramid, but still inaccurate.  I hope you will integrate them into a new improved plate in the future:

1.  Refined grains have no place on the plate, they should be off the placemat in a distant place (that may look like an ice cream stand or some such) called “now and then treats.” 

2.  Replace the “grains” category with “nutritious starches.” Corn, legumes and baked potatoes are better switched out with the whole grains, not with the green leafies, etc.

3. Change the Dairy glass to “Dairy or Alternative” and link to your alternative section.

I’m not an RD, but I am an eight-year radical weight-loss maintainer (27% of my body’s highest established weight), which is probably more rare.  I think most RDs would agree with my adjustments to your plate. The milling and baking industry and dairy farmers might have a bone to pick, but you serve the broader citizenry, yes?

Regarding your weight-loss advice:  it is outdated and based in the cultural mythology that weight loss is routinely permanent.  Empirical science does not support this.  You would do more to promote health if you shared that weight maintenance is noble, challenging and rare enough in itself.  Most adults over 30 gain 1 to 2 pounds per year.  Preventing that would be helpful.  People should live joyfully most of the time, eat healthfully most of the time (following the revised plate I’m suggesting), exercise most days, then treasure the body that happens, regardless of its BMI category.  Read the rest of this entry »

Let Us Name the Enemy

In Weight-Loss Maintenance on June 3, 2011 at 6:32 am

In the forums over at Big Fat Blog, there’s a discussion going on about the 15 South Florida OB/Gyns (out of 105 that the Sun Sentinel surveyed) who limit their practices to women who weigh less than 200 pounds (and additional practices that set other, slightly higher weight limits, 250 lbs., e.g.). 

Dr. Yoni Freedhoff has also blogged on this news,  which is proving itself worthy enough for west-coast coverage

The offending doctors claim they’re discriminating because their equipment or exam tables are inadequate and that fat patients are at higher risk for complications and should go to specialists. 

Many of the voices chiming in, both at Dr. Freedhoff’s site and BFB are jumping on the blame-the-lawyers bandwagon.  In other words, the enemy is our litigious society.  Doctors are afraid of lawsuits.  This makes me uncomfortable.  We common citizens should think HARD before throwing away our legal protections.  Conflict alert:  I am married to a lawyer.  I’m also the daughter of a lawyer, and the sister of a lawyer, and sister-in-law of a lawyer.  My family is lousy with lawyers. Though I am not one myself, I am fond of lawyers.  Even if I wasn’t, however, I think this blame-the-lawyers thing wouldn’t pass the smell test.

For one thing, the assault on “frivolous lawsuits”  strikes me as overblown, exaggerated and wrong-headed as the “war on obesity.”   The Duke Law Review has the best summary I could find of the “frivolous lawsuit” scare, and it makes a measured argument for how exaggerated it is.  Brief summary:  Those cases that are, indeed, frivolous are rare but over-reported in the news media, simply because they are more interesting than the millions of run-of-the-mill claims that get settled every day.  Moreover, often these cases are oversimplified in the mainstream media (imagine that!) and outright misrepresented by insurance spokespeople and the like who benefit by portraying them as “frivolous,” when a closer examination of the facts would reveal otherwise. 

Frivolous claims are not some great industry for legit or competent attorneys, because judges already have the power to throw out “frivolous” cases and even issue $anction$ against the attorneys who file them.  Some pro-business legislators have suggested that attorney’s “game the system” by filing frivolous cases on the notion that corporations will “settle” in order to avoid going to court.  That’s ridiculous and backwards.  Corporations keep their attorneys on retainer, so it’s no additional cost to them to go to court.  More often, corporations (including insurance companies) routinely deny claims, even when legit, because they know how difficult and expensive the claim will be for a lone citizen.  A claimant has a hard enough time securing an attorney for a good but marginal case; finding an attorney stupid enough to take a “frivolous” case and risk a judge’s $anction is enormously difficult.  Finally, if a claim does make it to a jury and receive what sounds like an extreme or “frivolous” judgment, often an appeals judge later lowers the award, but this fact never becomes part of the story that creates a particular case’s urban legend. Read the rest of this entry »

Hey, Everybody: Let’s Help Diane!

In Weight-Loss Maintenance on May 17, 2011 at 12:12 pm

First of all, thanks again to Dr. Sharma for hooking us in to the private world of obesity research where the erudite players who affect our lives talk about us.  Specifically, today he linked us to the Canadian Obesity Network Presentation Portal for the Second Annual Obesity Summit held in Montreal April 28 – May 1 of this year. 

Let’s give these CON-RCO people kudos for facility and detail.  If you click on the presentations, you receive a split screen with the speaker, in focus and centered, on the left and his or her Power Point Notes on the right.  How inviting!  Whatever trouble that took, please know it is appreciated!  Hooray.  

I scrolled through the selections to find some interesting conversation fodder, and my heels came to a screeching halt on page two, where speakers were talking about weight discrimination and bias.  I first was drawn in by this title:  So I am Biased, Now What Do I Do?  Michael Vallis, the co-director of the Capital Health Behaviour Change Institute and Associate Professor at Dalhousie University spoke well, and we may want to talk about him another day, especially how he seems to ice skate between talking about solving bias/discrimination and solving obesity – interesting and discomfiting.   He also talks about Motivational Interviewing, which we have talked about some in these pages’ comments.  As I listened to him I wore Hopefulandfree’s filter:  is this just sophisticated manipulation?  I don’t think he intends it to be, but I can see how it goes there.

But I digress.  TODAY, I want to talk about Diane Finegood’s talk, Weight bias and discrimination through a complex-systems lens.   About 22 minutes into the 26-minute speech, she presents us with a question, and with an earnestness that I think calls for reply.  I think we might be able to help her.

Diane Finegood is a professor at Simon Fraser University and Executive Director of the CAPTURE Project (CAnadian Platform To increase Usage of Real-world Evidence).  She’s also a radical weight-loss maintainer.   

Her presentation, in simple terms:  It ain’t easy to change a paradigm on a complex system, such as obesity bias as it relates to health care.  You’ll want to watch the whole thing, as she starts with a complex map of the issue and then reduces the problem downward several times to arrive at five steps.   The most important:  shifting the stinking paradigm.  This has to be done by attacking lower level issues – structural elements, goals, etc.  But at the very top is that paradigm, or root assumption.  She makes a stab at one-sentence statement to express what that paradigm should become, but she’s clearly uncomfortable.  Even her Powerpoint notes have a question mark.  Her attempt at a statement:

? “Obese people are no different because of their size.” Read the rest of this entry »

Obesity Public Policy Requires a Foundation

In Weight-Loss Maintenance on April 27, 2011 at 1:36 pm

There I was, noodling around in Science Daily, trying to take a break from contemplating why Dr. Sharma and his friends have lost their minds, when I happened upon this article on how discrimination makes you fat, which is no less depressing.  Sigh. The researchers excluded people who perceived themselves as victims of fat discrimination, nevertheless, we know that fat carries as much stigma and suffers as much discrimination as any other “negative” attribute, even among health professionals who should know better.  What is one to conclude?  Being fat, which leads to discrimination, will make you fatter.  Oh, that cortisol.  How we love it!

Now, what drives fat discrimination?

Oh, damn, here I am again, thinking about Dr. Sharma losing his mind.  

If you haven’t been following his blog lately, this election cycle in Canada has somehow prompted Dr. Sharma to use his authority to advance hysteria, which feeds discrimination (and will make us fatter), though that isn’t his intent.  He and his partners in politics are bamboozled, in fact, that some of us have suggested they are employing “scare tactics,” since their treatments (in practice) are nuanced.  And yet, how will these words from the Canadian Obesity Network call to action ring in the ears of people who are inclined to discriminate and stigmatize?

“Obesity is the nation’s top contributor to disease, death, loss of productivity and costs to our health systems,” says Dr. Arya M. Sharma,  . . . “One in 10 premature deaths among Canadian adults aged 20–64 years is directly attributable to excess weight, and 60% of adults and 25% of kids are overweight or obese.”

Huh?  Confusing causation with association is the tactic of weight-loss profiteers and other fatphobes.  That statement is followed by hysterical statements about the multimillion-dollar costs of obesity based on studies that are far from flawless.

Obviously, Dr. Sharma and crew are hoping to drum up a sense of urgency, but that’s not at issue.  Everyone’s panties are bunched over obesity.  The call to action itself makes the point that “37% of Canadian adults and 35% of youths identified obesity as the number-one health issue affecting Read the rest of this entry »

Obesity Public Policy: Let’s Just Call it Confusitarian

In Weight-Loss Maintenance on April 15, 2011 at 12:20 pm

Thank you to Anonymous blog reader KX for submitting the following two-part essay for my consideration.  Amitai Etzioni on Obesity Public Policy Part One  and Part Two.   Do not be intimidated, my gentle readers.  In PDF form, part one, before notes, is only three-and-a-half pages and part two is two-and-a-half.

I read the essay(s) before reading the author’s bio (silly, ignorant me), but as I read I could tell that he’s an outsider to our issue.  He clearly doesn’t understand or divide out the players the way we might, or as I have.  He has absorbed our issue as any intelligent, disinterested person might and then proposed public policy recommendations in keeping with his particular theory and area of expertise. 

Amitai Etzioni is a respected public policy scholar who has been a senior advisor to the white house and held university professorships at some of this country’s most prestigious institutions (Columbia, Harvard, George Washington).  He’s been president of the American Sociological Association and the International Society for the Advancement of Socio-Economics.  In 1990, he founded the Communitarian Network, a not-for-profit organization dedicated to “shoring up the moral, social and political foundations of society.”  (The group also calls itself nonpartisan, but Etzioni’s jabs at Libertarianism would seem to betray that claim.)  He’s the author of more than 30 books, none on obesity from what I can tell.

In other words, he is the “guru” of a respected theory/platform, “responsive communitarianism,” and in this two-part essay, he applies his theory to obesity public policy.  It is worth a look from us, because it is most certainly getting a look from powers that can influence our lives.

The first half of part one is very hard reading.  He lays a foundation of assumptions:  Fat is BAAAAD!  Fat is expensive.  Fat kills.  His sources are ones that we in the fray have refuted or countered with alternative sources many times over. Read the rest of this entry »

Sanity Starts in the North

In Weight-Loss Maintenance on March 9, 2011 at 12:06 pm

I think Canada may have a fighting chance at keeping its “COACH” program from becoming another thinly veiled fat hatefest.  This is because Dr. Arya Sharma is calling out his forces, and maybe some balance and sanity will prevail.  Here’s the link to today’s post for you who are only now-and-again visitors to Dr. Sharma’s blog.  It is especially vital for you to visit this post if you are Canadian.  Click the button within his post that describes you, and enter the fray to reclaim your COACH program.

I considered clicking, even though I’m a US citizen.  I can mispronounce “about” to sound like “a boat.”  I can end every third sentence with an “eh.”  But I’m sure, eventually, I’d be outed, and it would be horribly embarrassing.

The COACH program seems to show some signs of innate sanity.  Its Readers’ Digest condensed description talks about “resources to manage . . . excess weight” not resources to lose weight.  It acknowledges that “eat less move more” is not a panacea. 

I also like that the acronym they chose, “COACH,” which suggests a helper, advisor.  I would change the words from Canadian Obesity Awareness and Control Initiative for Health (which, technically, would be COAHIC, anyway) to Canadian Obesity Acceptance and Commitment to Health.  For one, obesity has plenty of awareness.  Every idiot knows about obesity and has an opinion.  Control is, well, too controlling.  And often impossible.  What the developed world lacks is acceptance of obesity, and the understanding that it can co-exist with health.  Perhaps if the COACH founders had started with different wording for their acronym, then the idiots wouldn’t be trying to hijack the program today, and it wouldn’t be so vital that you Canadians go join Dr. Sharma and try to claim it back.

Meanwhile, how’s public policy south of the border shaping up?  Well, we’ve got Michelle Obama’s Let’s Move campaign.   Sadly, in the US, for some crazy reason, we have reached a consensus (enforced by “the American People,” excluding Democrats) that a society governed by the people for the people is inferior to a society controlled by the corporate elite to benefit the obscenely wealthy.  Therefore, for a government program to have any credibility, it must have corporate sponsorship.  Enter the Healthy Weight Commitment Foundation.  Doesn’t it just take your breath away to read this: Read the rest of this entry »

Not so Fast, FDA!

In Weight-Loss Maintenance on December 8, 2010 at 9:55 am

The buzz now, in size acceptance spheres and elsewhere, is the FDA’s presumed lowering of the BMI threshold for bariatric surgery involving laparoscopic bands. There is discussion among weight loss maintainers and maintainer aspirants at Lynn’s Weigh.   It’s interesting (but not surprising to readers here) that Lynn and many of her commenters are as uncomfortable with this presumed decision as the people discussing this issue at size acceptance sites, such as Fierce Freethinking Fatties and Big Fat Blog. I tried to enter the fray at BFB, and just made a mess on the comments page with my lengthy URLs, So I will give my thoughts (and links) here.

First, let’s clear something up.  It’s not a done deal.  The FDA rarely bucks a panel’s recommendation, but it can, and it hasn’t made a final decision yet.   It’s as though a motion has been made, and lacking discussion, it will pass in a few months’ time.  Maybe we need to enter the discussion.

In short, I think the FDA is being pushed too quickly, and with inadequate and premature evidence.  If it proceeds, then it does so on the recommendation of its Gastroenterology and Urology Devices Advisory Panel. While I’m sure these are fine people, it can be argued that the interests of bariatric surgery are well represented and consumer concerns may be, er, less so.

The panel of 14 includes general surgeons and other medical experts, as well it should, since it is charged with making recommendations on a variety of surgical devices for GI and urology procedures. But more specifically, at least five of the panelists are bariatric surgery True Believers:

  • Jon C. Gould, Chief of Minimally Invasive and Bariatric Surgery, University of Wisconsin
  • Thomas H. Inge, Director of Cincinatti’s Surgical Weight Loss Program for Teens since 2004 and has performed over 135 minimally invasive weight loss procedures for adolescents during that time  Read the rest of this entry »

On Science and Ethics

In Weight-Loss Maintenance on December 1, 2010 at 11:59 am

Note to casual readers – if you aren’t reading the comments, you are missing the best of this blog – the commenters are superb.  Now, in response to a brilliant observation on my last post from Debby, I found a worthy observation falling from my own fingertips:   

“My mission statement, as a blogger, and I probably ought to post it somewhere, is “tell a truth; advance compassion.” I can do that, since I’m not a scientist — I just observe them.  A scientist’s mission statement can only be “tell a truth; advance more research.” When they unwittingly adopt an agenda, such as “advance weight control for all,” then they betray their mission as scientists.”

Other people, say, public policy makers, rely on scientists to provide unbiased information so that they may make decisions about what to advance.  Biased information, by definition, is incomplete, and that will compromise decisions.  

I recently ran across an interesting scientific overview of ethics as they might apply to public policy and obesity.  Forgive the grammatical eccentricities.  I think it’s been translated from Dutch.

The scientists looked at various ethical frameworks that public policy makers might use to frame decision making with regard to obesity.  As I was reading, however, I couldn’t help but notice that the overview itself has been affected by bias.  I was stopped short at the background section, for example, where they give three sample ethical questions that public policy makers might ask when creating policy: 

“Is a campaign that stresses the importance of a healthy weight acceptable when it stigmatizes overweight persons? At what point does encouraging physical activity in the workplace become too intrusive in the personal life sphere? Is policy to inform people about health risks of obesity ethically sound when it does not reach people from ethnic minorities?”  Read the rest of this entry »