Minimal Comment Friday

1. Italian Town to Pay Residents to Lose Weight. Men get 50 euros for losing 9 lbs., women for losing 7. You get another 200 euros for keeping it off for 5 months.

I have to say, that’s a … creative approach. And at least it’s using the carrot (so to speak) instead of the stick. I must admit there’s even a part of me going, “Shit, I could lose 7 lbs. and keep it off for 5 months for $350.” The question is, what’s the fucking point? A) 7 lbs. isn’t going to make a damn bit of difference to my health — it’d barely make a difference to my pants size — and B) just like everyone who diets for any reason, I would most likely be even fatter in five years. Seriously, this town doesn’t have anything better to spend money on? Send it over here, y’all. The CTA could really use it.

2. The Institute for European Environmental Policy is calling for ‘car exclusion zones’ around schools, to force parents and children to get some walking in. I’m all for more walking (even though I think it’s complete horseshit that this could “counteract a weight gain of up to two stone over a decade”), but has it occurred to people that maybe the reason more kids aren’t walking to school is that there are no fucking sidewalks? I lived less than two miles from my elementary school, but that was in deepest suburbia, where the only route between my house and the school was on highways. (I walked home from high school once, because I’d missed the bus and couldn’t get a ride, and it was friggin’ terrifying. Crossing a 4-lane highway without a crosswalk or lights timed for pedestrians is not so fun.) Then we have the fact that we’re constantly told there are pedophiles lurking behind every tree, just waiting to snatch up our! children! if we let them go anywhere alone. And the fact that, for some reason that completely escapes me, people seem to think it’s child abuse to put their kids on a friggin’ schoolbus these days.

But no, people drive their kids to school because they’re lazy. Just like they let them play video games all day (which, btw, actually has zero correlation with obesity, according to Gard and Wright) because they’re indulgent and neglectful, not because Oprah told them their kids could be taken at any minute from their own front yard! And, uh, forcing everyone to park off school grounds and walk their kids in is totally not going to create traffic problems or anything. Awesome idea, guys.

3. On a less headshaking note, the government of Ontario deserves kudos for putting money toward improving health care for fat people — including making sure that hospitals have everything from large blood pressure cuffs on hand to doorways big enough to accomodate gurneys made for big people. The Toronto Star even deserves a small nod for acknowledging that this is an issue of dignity and human rights, not just of, “OMG, THE FATTIES ARE COSTING US MONEY!” There’s a lot of the latter shit at the beginning of the article, but then you have this:

“This is a very sensitive population, they’ve been marginalized forever and you have to provide the kind of medical and psychological care in an environment that really meets their needs,” [Arya] Sharma [scientific director for the Canadian Obesity Network] said.

“The program is based on the idea that obese patients deserve help for their medical condition just like patients who have any other kind of medical problem.”

Zany concept, huh? (I won’t even quibble about the “obesity as freestanding medical condition” issue. Focus on the “obese patients deserve help” part. We don’t hear enough of that.)

Readers, what else have you read today? Discuss.

37 thoughts on “Minimal Comment Friday

  1. Yeah, 250 euros for 7 lbs is pretty tempting especially since that’s the difference between a bit of water weight and a change of clothes for me — no actual weight loss required!

  2. Interesting, but bariatrics?!!!! is a little unnerving.

    Warning comments only for those feeling up to it. Raj Patel does make another comment about half way down the page (August 17, 2007 12:20 PM)

    http://society.guardian.co.uk/health/comment/0,,2150651,00.html

    Also, if you can be arsed, click on ‘The era of gentle exercise is over. It’s official: you’ve got to work up a sweat’ under -recent articles- on the left hand side of the page. There is also one about children needing fat in their diet, which was covered by Sandy S. previously.

  3. On point 2 can I just say that it’s a European suggestion and that at least in the bits of Europe I’ve known you don’t typically have to cross 4-lane highways to get from where people live to where they go to school, and pretty much all the roads have sidewalks. And your average school doesn’t have a carpark for all the parents anyway, so they already cause a traffic problem.

    I don’t think it’s seen as a laziness thing though, more a convenience thing and a fear of traffic being too dangerous in this day and age. Hopefully schemes like this also come with increased numbers of school crossing patrols and the like.

    Oh, and I saw a much worse one today:

    http://news.bbc.co.uk/1/hi/health/6950856.stm

    Notably the quote from a professor which says:

    “People who are very overweight would have to do an hour of exercise a day just to maintain their weight if they aren’t going to change their diets,”

    I still haven’t stopped boggling at that one. I presume there was some more context to that than given in the article, but it’s just not true if they’ve already reached a weight that they’ve settled at.

    And finally “Hi”. A friend on livejournal pointed me at your blog, and I hope you don’t mind me coming over and commenting. I usually read it syndicated on livejournal, so don’t often read all the comments, but I’d just like to say I’m very glad to have found you and everyone seems very nice. Hope you have a nice holiday!

  4. While I wouldn’t say that everyone who drives their kids to school does so because they are too lazy to walk, my thin sister drives her daughters the ONE BLOCK to their bus stop. She says it’s because it’s too cold, too hot, too rainy, too windy … too “outdoorsy” perhaps … but I think it’s just because my sister isn’t ready for public viewing at 8am, and prefers to hide in her car.

    Then there was the article last winter about the busy Manhattan parents who send their preschoolers off to the 92nd Street Y in chauffered hired cars. Apparently, the back-up of Mercedes sedans and SUVs — with drivers in full regalia — is so bad that it causes traffic jams. The school’s director had (as of the January article) sent 3 letters to parents over the course of 9 months telling them to either park the car somewhere legally or drive around the block rather than double or triple parking while dropping these future Masters and Mistresses of the Universe off at nursery
    school. If you have TimesSelect access, you can read this amusing article here.

    I wonder if the recent problems at hedge funds will put an end to THAT particular problem.

  5. Plus, most of Europe is quite side-walk friendly. When i went to LA, i understood how hard it must be to walk in most of the city.

  6. The parts of Europe I’ve been to are sidewalk-friendly, but are even the suburbs and rural areas?

    FWIW, Eloisa, L.A. is especially bad, because it developed just at the time when the U.S. was having a love affair with the novelty of the car. Most major cities here are built on a pedestrian scale, at least… but very few other areas are.

  7. The Ontario government news makes me happy – I work in maternity care, and not having appropriate blood pressure cuffs (leading to artificially inflated readings) and too-small guerneys present a serious problem.The last thing they need anyone needs is a big announcement about “Where’s the LARGE CUFF?” (Many floors here have only one right now – it’s not a big deal to NEED the large cuff, mind you, it’s just that healthcare providers sometimes make it one).

  8. Definitely have sidewalks in the suburbs.

    Rural areas are less so, but have much less traffic. You’ll still mostly get pavements (sorry sidewalks) in much of the villages themselves, just not on the minor roads between villages. It’s possible you’d have to go well beyond walking distance to get to school anyway though, and then there’d be a bus, and it’d be pretty safe to walk to the bus stop.

  9. Where I live, the community buses any student who has to cross a highway. That is, they waive the normal mileage thing. When I was in high school, I walked two miles every day. (Every day, because there were toddlers at home, and no way was my stepmother packing up toddlers to give me a ride; something I didn’t really understand until I had one of my own.) I, honest and truly, walked in thunderstorms and blizzards and everything else, because the mileage cut off allowing you to ride a bus was 2.5 miles. It was all sidewalks and such, and it was very steep. You could file your nails on my calf muscles in those days.

    What I discovered when I moved to this school district though, is that they waive the mileage limit if you’re crossing more than two lanes, or two lanes with no sidewalk. If it’s real highway, not street. Which is good because highways. Scary.

  10. Good to know, Eleanor. Unfortunately, a lot of the suburbs here grew up at the exact same time as L.A., when everyone thought cars were a miracle and couldn’t imagine there ever being a problem with a town built on the scale of a car.

    “New Urbanism” is gaining a lot of traction here, though, and it’s resulting in suburbs I might actually consider living in. For now, living in the city and driving about twice a week works for me.

  11. Since it’s Friday, I’ll just focus on the happy one.

    Yay Ontario! Way to treat fat people like human beings! *confetti*

    Sadly, I’m not even being sarcastic.

  12. I was happy to see the “kids need to eat fat” article, but it was kind of surreal to read. “Oh, hey, did you know kids are actually supposed to get bigger? And that that ‘growing up’ thing they do actually requires fat and calories? Crazy, huh?”

  13. I would have posted the “kids need fat” article, but the version of it I read (BBC) ended with a rant about how a high fat diet will still cause THE DIABEETUS, and I couldn’t even deal.

  14. The latest issue of Scientific American has me banging my head on the desk. To summarize: some new books/researchers argue that you can be fit and fat, but not everyone agrees, so you fatties better lose weight–and if you weigh more than you did at age 20, you’re fat (?!?). Oh, and losing weight will require “multiple drugs” used in combination.

    Can you hear my teeth grinding?

    At least they acknowledge that the “calories in/calories out” model is bunk.

  15. In terms of kids being driven to school – I think in the EU it’s a planning regulation issue that roads in residential areas, even in rural or suburban areas, MUST have sidewalks – farmhouses and remote houses in the countryside being an obvious exception.

    A major concern is traffic congestion. I cycle to work (I am still obese, btw), and I can attest to the fact that once the school year starts, the congestion in Dublin easily doubles, and so do journey times for cyclists (for car drivers, they triple or quadruple).

    I would like to point you to a strategy paper from the Dublin Transportation Office to encourage walking and cycling to school, in which kids fitness and weight does make an appearance, but only as one, and not the most important, of a number of policy issues, most of which are linked to transport policy and the environment:

    http://www.dto.ie/web2006/srts.pdf

  16. “People who are very overweight would have to do an hour of exercise a day just to maintain their weight if they aren’t going to change their diets,”

    Isn’t this actually the OPPOSITE of true? I think it burns a lot of calories just being us.

    I love it when people figure out that kids are supposed to grow. Reading articles that are all “these kids put on TEN POUNDS between the ages of 7 and 13!!!” makes me want to bang my head on a model’s scapula.

    As for the walking to school thing, I think you’re dead on, and that it dovetails with the playing outside thing, which my boyfriend and I have discussed a great deal — parents are afraid to let their children play outside, and that contributes to a sedentary lifestyle. Presumably, one day the irony of saying “sit on that couch until you lose some weight” will completely overwhelm the current adult population of the U.S., and the kids will be allowed to run around outside again.

  17. Quick question for LP (and anyone else) about the larger cuff: I’m a medical student, currently in a family medicine office with 3 exam rooms and 1 larger cuff. Sometimes I don’t realize I’ll need it until I try to put on the smaller one, or when I try take a BP with it and it won’t inflate right.

    In these scenarios, am I doing something wrong by saying something vague like “this cuff isn’t working, let me get a different one from next door”? I mean, I know the patient probably realizes that I actually need a bigger cuff, not just some magical “other” or “different” cuff, so am I actually being more insulting rather than less? Please enlighten me — I mean well, but I know I’m still kinda clueless here.

  18. LadyGrey: Would the practice be open to you presenting an informed suggestion that there should be one large cuff per sphygmomanometer? A significant percentage of the population – I believe the _majority_ of people, in America – require them, and they cost next to nothing in the grand scheme of things (especially when you count staff time in tracking the elusive single cuff down).

    I think healthcare staff have a role to play in helping patients learn that a large cuff is to their benefit – a too-small cuff will overestimate blood pressure and can lead to misdiagnosis and inappropriate intervention including unnecessary medication. Gently letting people know this can give them the tools to protect themselves from incompetence in the future. At the same time, it’s completely inappropriate to yell down the corridor “WHERE’S THE LARGE CUFF??” where all the other staff and waiting-room patients can hear.

    The obvious solution is correctly equipping all clinical rooms in the first place.

  19. LadyGrey, I think what Lauredhel says is great — it would definitely be ideal if every room were equipped with a large cuff.

    To answer your more practical question, though, I think what you’re saying is basically fine. To me, the key is in how you say it. If your attitude is basically, “Hang on, I just want to find the cuff that will work for you and give you the most accurate reading,” I don’t think most people would be offended. But if you come off as embarrassed about having to get the larger cuff — even if all you’re worried about is hurting the patient’s feelings — that reinforces that it’s something the patient should find shameful. Make sense?

    I wonder how much of the correlation between obesity and high blood pressure has to do with too-small cuffs.

  20. “I wonder how much of the correlation between obesity and high blood pressure has to do with too-small cuffs.”

    Had exactly the same thought.

  21. Fillyjonk quoted and said: “People who are very overweight would have to do an hour of exercise a day just to maintain their weight if they aren’t going to change their diets,”

    Isn’t this actually the OPPOSITE of true? I think it burns a lot of calories just being us.

    For some of us, it’s true. I guess this is probably not the experience of most very fat people, but for me the level of activity that results in weight stability is a substantial amount of exercise, easily over an hour per day on average.

  22. Sharon, do you mean you’ve found that you gain weight if you do less than an hour a day of exercise, or just that that’s the amount you do and you don’t lose?

  23. I mean, I’ve got the metabolism of a polar bear due to dieting/ED, so I do half an hour to two hours of exercise a day and don’t lose. But it’s not because it somehow takes less energy to power a larger body; it’s because my particular large body functions much more efficiently than food availability realistically warrants.

  24. LadyGrey – I agree with what others have said, and it sounds like the way you’re approaching things is great.

    I know what you mean – it’s not always obvious which size of cuff I need right away, and sometimes I under or over estimate (in fact, sometimes extremely thin women require the “child size” cuff to get an accurate reading). Most women I have worked with are not embarassed when I need to grab a larger cuff – some in fact remind me, or request it. And they shouldn’t be embarrassed, because it’s really not a big deal. I was just making the point that being respectful about people’s feelings, AND making sure that you have access to the right size cuffs is key. There’s no reason, in my mind, why large cuffs shouldn’t be widely available.

  25. Situation in The Netherlands: yes, in the cities we have pavements/sidewalks practically everywhere, even in the suburbs. In rural areas there’s simply less traffic, like many have already commented. Also: in urban areas in NL there’s viaducts/bridges/tunnels for both cars and bikes/pedestrians if a highway cuts off a neighbourhood from the centre of the city (I hope that’s understandable English) although of course a tunnel isn’t always very safe (creepy people can lurk there …)

    Goldsmith said policy like this is mostly about traffic congestion. I think s/he’s right. Funny thing is, if politicians would just add everything up, we’d win on all fronts:
    1] people would move more (walking, bicycling) so they’d be(come) healthier (not necessarily thinner, if only everyone would realize being fat doesn’t equal being unhealthy, we could focus on “exercising” for health AND fun, both fat AND thin people)
    2] there’d be less traffic congestion
    3] there’d be less polution.

    Here in NL, lots of people use their bikes as means of transport (like me. And me like Goldsmith: still obese, btw, LOL!), but there’s still a lot of cars. I think a lot of people drive theire kids to school because of fear for the kids (creepy people, dangerous traffic, etcetera), they hate the weather AND they’re in a hurry. Take away the dangerous traffic, and maybe more people would be tempted to get up just a little earlier and take their kids to school, and then bike/walk on to work! Like I said: a win-win-win situation. But like Kate called out horseshit: if only they’d stop whining about “the weight gain”.

    On the exercise front: speaking from the experience of a person who’s worn a device registering my calories burnt for a while: saying
    “people who are really very overweight would have to do an hour of exercise a day just to maintain their weight if they aren’t going to change their diets”
    is just a load of crock as well. What this professor is of course implying is that we fatties eat SO much, we need that hour of exercise to burn the surplus of calories (“if they aren’t going to change their diets” – cause, you know, no fat person EVER eats a “normal” diet, right?)
    I bike about an hour a day (just to and from work), and I need a lot of food to maintain my weight (with a BMI of approximately 34 I need close to 3,000 calories according to that device, and yes, I’m a woman, and yes, by trying to eat approximately that amount of calories I have found out the device in my case is accurate. Now I’ve switched to demand feeding, and I no longer have to care!)
    So Fillyjonk, if you look at me (but then again, I’m just an anecdote) you’re absolutely right: we need a lot of calories just being us. BTW: some obesity researches say that women who have a BMI of 30 or higher (so “obese”) need at least 2,300 calories to maintain – so 300 more than your average weight woman (I don’t know the figures for men, sorry). Which means: if you think you should live on 2,000 – the magical number for an average hardly-active woman – you’ll be hungry (for me that meant: thinking my body wasn’t functioning right, thank God I know better now).
    But Sharon is also right,
    “I guess this is probably not the experience of most very fat people, but for me the level of activity that results in weight stability is a substantial amount of exercise, easily over an hour per day on average.”
    It just depends on how your body works – and perhaps how many diets you’ve been on, which can very strongly change your metabolism. No researcher EVER takes that into consideration, let alone s/he would consider that every person is unique and therefore has a unique body with a unique metabolism.

  26. Kate asked me: Sharon, do you mean you’ve found that you gain weight if you do less than an hour a day of exercise, or just that that’s the amount you do and you don’t lose?

    Both descriptions have been true for me at times, and I’ve also been in phases where I’ve been exercising on average 1.5 hours a day and my weight has gradually been creeping up. My body’s control system appears complicated, and seems to be affected mainly by food, exercise, sleep and stress. I always do demand feeding(*), and if exercise is set to “average >=1.5 hours”, sleep set to “plenty” and stress to “low”, then I maintain the same weight. Any other settings of those three and I end up gaining weight.

    (*) By demand feeding I mean eating when my body yells for food. This I do because I am not capable of ignoring hunger signals for very long, and for me the eat-what-I-like philosophy tends to result in a lot more happiness and healthier eating than a rigid thou-shalt-be-healthy philosophy.

  27. (I am sorry for the long comment – I think I just needed to get this story out, and the Blood Pressure cuff discussion reminded me of it☺

    Regarding the blood pressure cuff, I didn’t even know that they had a larger size cuff! This may explain what happened last year when I went to my local PP to renew my BC prescription (I had just been laid off and lost my health insurance, so PP was what I could afford at the time). I thought that the visit would be a fairly simple in and out deal – I would show them what I had been using, explain that it seemed to be the best option to continue with the same pill.

    When I explained my situation to the doctor, she gave me a strange look when I mentioned that my last physical had been fine – my asthma was confirmed by testing and I had sinus/allergy issues, but that I was generally healthy. I didn’t think anything of it at the time, until she strapped the BP cuff on. It was tight before she even started pumping and, with my chronic and bizarre fear that the cuff will get too tight and make my arm drop off (completely irrational, but I spend the entire event sitting perfectly still, terrified, and repeating to myself “It can’t hurt me – I’ll be OK”), I was fairly nervous.

    Naturally, my BP was rather high (it usually is, even when I was a very thin and very healthy little girl I remember my doctor warning my mom about it – both parents have high BP and I really don’t think that being scared the entire time they are taking it helps) and the doctor basically told me that I was so fat that she really couldn’t give me hormonal birth control. She also lectured me on my BP. When I mentioned my phobia of the cuff, she looked me straight in the eye and asked, “Really, are you a doctor? Because I am and I think that your BP is high because you are grossly overweight (I’m a size 16, btw) – you need to face that and stop making excuses.”

    After a delightful few more minutes, she agreed to renew my prescription, but only if I promised to try to lose weight. She also “put a note in my record” stating that if I returned next year for a renewal and hadn’t lost at least 15 pounds, that I should be denied the pill. I rushed straight home and spent the rest of the day crying, curled up on the couch.

    Next time I have my BP taken, I will ask for the larger cuff. It may not help my phobia, but it is nice to know that I have an option.

    Again – I’m sorry for the slightly off-topic story.

  28. Your Ladyship, I agree with our esteemed host. I wouldn’t mind being told that the nurse had to get the larger cuff as long as I felt there were no moral judgement attached to it. (Tone of voice can carry volumes of unspoken words.)

    I had to have my blood pressure taken on Friday, and the nurse had to get another cuff. It was a gorgeous purple and I asked whether the sizes are color coded. She said that they are, so those if establishments who only get one or two of the larger cuffs got the color-coded ones, they could yell “where’s the purple cuff” and not raise anyone’s blood pressure.

    My BP, even after I agreed to be weighed (a usually very stressful thing for me, but, surprisingly not so much after finding Fat Acceptance) was declared “perfect” by my doctor.

  29. Toria, that’s terrible and borders on malpractice. Before you go next time, print out Sandy Schwart’s article that explains cuff inflation hypertension. You may also want to research White Coat Hypertension and have several articles about it printed out.

    I once had a run-in with a nurse practitioner who wanted to put me on a diet for my freakin’ allergies (telling me that I felt crappy because I was fat, when in reality it was a reaction to a work environment with 3 heavy smokers and no doors). I refused to see her from that point on, telling the appointment admin that “I’d rather be sick than see nurse Ratched.” She didn’t last there long.

  30. A size 16 is too fat to use the pill? I’m a size 20 (a short size 20 at that) and I’ve never, ever had a doctor or NP tell me that, and I’ve probably seen a dozen doctors in the last decade I’ve been that size. (Then again I have PCOS, so they want me on the damn pill, and with the bedridding cramps I get if I don’t take it, I’m sure not gonna argue with them.)

    That doctor is an ass, and should be reported to whoever is in charge of hiring there. Yeah, they might want to be circumspect about giving the pill to someone with hypertension (which I don’t have, FWIW), but it’s absolute lunacy to suggest that you have hypertension based on a single high reading just because of your weight, or to assume that no thin person ever has it or that a fat person who has it will automatically cease to have it with weight loss. In fact, Glenn Gaesser in Big Fat Lies has suggested that hypertension is far more dangerous for a thin person than it is for a fat person, and has studies to back it up.

  31. Thank you for the links, kate217.

    I was so upset and thrown off-balance by the Doctor that I didn’t think about how strange it all was until later (nor did I think to take down her name – she did a damn good job of heaping the shame on me). Both my Gyno and my old PCP never showed any hesitation about having me on the Pill. They talked about the side effects and risks, but neither suggested that my weight was a problem (re: the Pill, though my PCP was very helpful and understanding about my weight in general).

    The mildly amusing thing about the while story is that the Pill caused me to gain almost 30 pounds within two months of starting it. I’ve tried other formulations, barrier methods, and considered an IUD, but none are a good option for me right now (sorry if TMI).

  32. Sorry to come back to this late. UK doctors prefer not to prescribe the combined pill if you’re over about 35-37 BMI. They will however still prescribe the progesterone only or mini-pill. And modern versions of this (cerazette) are as convenient to take as the combined pill (ie you only have to be within 12 hours, not 3).

    I bike to work every day too, but should really walk it instead as it’s only a mile – the bike is just *so* much more convenient. Another obese biker. Had to get my bike shorts from the US though!

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