Tuesday, September 29, 2009

Memo to the Lean, Mean, and Superior

 If this is your first visit to this blog, please note that the first two posts present a plan for health care reform that allows you to "own your own health care" without reliance on the government, your employer, or your insurance company and are the basis for all that follows.

Today's post addresses an issue that has unfortunately come to be considered relevant to health care reform.  As a health care practitioner I am  concerned with our society's rush to blame those Americans who are overweight for much of our escalating  health care costs.  I hope the following essay puts a more appropriate perspective on this. 

                             MEMO TO THE LEAN, MEAN, AND SUPERIOR

 Wherever we are, whatever we’re doing - walking along the reservoir in New York’s Central Park, enjoying a sunny day on Chicago’s beautiful lakeshore, or sun bathing on Venice Beach in Los Angeles – my husband and I can never help but notice the smug look on the faces of the tall, toned, and beautiful runners as they sprint past us on their daily jog.  Their skin glistens with what for most of us – the less fit masses - would be the smelly sweat of strained effort, but for them is the glow of the sweet serum of superiority.  Of course, reason tells us that the fit are most definitely fitter than the unfit.  And if the unfit – the obese, the overweight, and the flabby - assume the habits of the fit, if they eat healthy foods and become more active, these efforts should make each a healthier person.  But it won’t make any one a better person.  You can be the perfect weight for your height, even with your shoes on, fully-clothed, and your keys in your pocket, but be mean to your children.  You can be tantalizingly toned but be cheating on your spouse.  You can eat 10 servings of fruits and vegetables daily, of five different colors, and never visit your mother in the nursing home.

We need some perspective here.  None of us will get diseases caused by second hand fat.  We can drive down the street without fear of being hit by an obese driver. I know we are
very concerned about the added costs of health care caused by obesity, but, we spend a lot on sports injuries, and on rescuing mountain climbers, skiers, and hikers. And many of us have diabetes, heart disease, knee problems, and asthma without being a pound overweight.

Just a short time ago headlines proclaimed that the next generation’s life expectancy will be reduced for the first time in centuries because of the increasing numbers of obese.  This is quite a distortion.  Yes, if there are more obese and the obese die younger, the average life span will decrease.  But the longevity of those who remain slim will not be compromised by those who do not.

Perhaps it’s time to give the obese and the overweight a break.  We have been relentlessly haranguing them to lose weight and shape up. We have been bemoaning the drain they are on our health care spending.  We have been heaping advice upon them as to how simple and easy it is to lose their extra poundage.  Don’t eat anything with sugar, fat, or cholesterol (i.e. everything you like); reduce the quantity of what you eat (i.e. go hungry); exercise moderately to vigorously for 60 to 90 minutes every day (i.e. go jump in a lake).  Pretty soon overweight Americans will be loathe to venture out on our streets, walk in our parks, or swim on our beaches for fear of being captured by the mini cam of 
a fabulously fit news team who will broadcast close ups of their ample abdomens and bountiful backsides on the six o’clock news. We’re almost at the point of legislating what people are allowed to eat.   Prohibition may be on the way back, but the stills will be filled with potato chips.  The corpulent will be knocking three times on the doors of “Eat Easy’s” that feature foods fried exclusively in trans fats. .

Guidelines for healthy eating are good.  Awareness is good.  Losing weight, though, is much more complicated than just following some good advice.  We all have different metabolisms, different genes, different personalities, and different motivations.  We need to concentrate on health, not weight, and rely on common sense, not headline generating studies.  The simple truth underlying all of these headlines is that statistics can say almost anything we want them to.  

We don’t even distinguish between the moderately overweight and those who are obese, or recognize the natural weight gain that can accompany aging.  For many women, some extra weight after menopause can actually be beneficial.  Fat cells provide a natural source of estrogen that may help prevent some types of heart problems and the potentially permanent disability resulting from hip fractures.  Maintaining an active lifestyle is probably just as important for your health as maintaining your ideal weight.  In fact, some recent studies indicate that middle aged women who are overweight but exercise are healthier than those of ideal weight who do not.

Of course, it’s good if awareness encourages overweight people to try to eat more healthy foods and fewer high-calorie ones and to become more active.  But it also can frighten many, currently in good health, into seeking quick fix diets or even surgery that can compromise their well being, both physically and emotionally.  We all know of someone who spends thousands of dollars on an expensive weight loss program, loses a hundred pounds, looks great, buys a whole new wardrobe, is ecstatically happy, only to be devastated and depressed six months later having gained it all back.  Quick weight loss programs work best for those who have recently gained weight due to a temporary lifestyle change, for example pregnancy, stress, or travel, that caused them to change their usual eating habits.  If over the course of thirty years you have gained sixty pounds, lose it all in three months on a rigid diet, and then return to the habits of the prior decades, it will all come back.  Permanent weight loss is a life long process.  Although health benefits begin immediately, the dramatic results we want reflected in the mirror are depressingly slow to be seen.

Profit obviously motivates those who sell quick weight loss schemes but the well meant advice from the media on how easy and enjoyable it is to assume a healthy lifestyle is also problematic.  One health reporter writes of the camaraderie of getting together with a group of friends every morning at 6 am to walk or swim for five miles, followed by a breakfast of green tea and a dry whole grain muffin.  She goes to the gym for her lunch hour and then has a delicious filling granola bar with an apple for lunch.  Dinner is a sumptuous lentil loaf accompanied by four different colored vegetables.  This may be admirable, but I can’t do it.  I don’t even want to do it.  And, of greater importance, it is not even necessary to do it.

I love eating sensuous delicious French, Italian, and Spanish meals with my husband, late in the evening, that include cream and butter and meat, even, sometimes, red meat. Needless to say, the next day goes much better if I sleep in and pass up the 6 am swim.  Yes, my indulgences are somewhat balanced by a job that keeps me on my feet most of the day, and by active past times such as gardening and cross-country skiing (which I consider to be fun not exercise).  If you like to run or work out at the gym that’s great.  But it just doesn’t work for everyone. A few months back a study indicating that moderately overweight people live slightly longer than those of ideal weight made the headlines.  Maybe the statistical benefit that comes from being a little overweight has something to do with enjoying life!

Americans can probably best manage their weight by balancing quantity eaten with energy expended and healthy choices with satisfying ones.  I know I cannot eat a big piece of chocolate cake every night, but I also cannot, in spite of the efforts of the “experts” to persuade me otherwise, be just as satisfied by a piece of carob cake made with nutrasweet and canola oil.  My personal solution is to have the real chocolate cake sometimes and not to waste my “satisfaction” calories on make believe desserts that taste awful!  I know I’m not going to run five miles a day or attend an exercise class four times a week.  But my husband and I enjoy a long walk or swing dancing with some tango thrown in after dinner.  These activities surely use more calories than watching TV.  Each of us must find our own balance of fun and fitness.

As a health care professional I have a responsibility to help my overweight patients achieve a healthier status.  Yes, it’s helpful when the media and the government make the public aware of healthy habits and the risks inherent in obesity.  But perhaps the slim and fit need to be more moderate in their zeal to rescue the overweight from their excesses.  It may be worth considering these words from the Roman Stoic Epictetus, written in the 1st century AD:  “These reasonings have no logical connection:  ‘I am richer than you, therefore I am your superior.’  ‘I am more eloquent than you, therefore I am your superior.’  The true logical connection is rather this:  ‘I am richer than you, therefore my possessions must exceed yours.’  ‘I am more eloquent than you, therefore my style must surpass yours.’ But you, after all, consist neither in property nor in style (Epictetus, Enchiridion).”  Updating this to the 21st Century AD, we might consider: The true logical connection regarding the superiority of the fit and thin is simply: “I am fitter than you, therefore I can do more push ups.  I am thinner than you, therefore I wear a smaller size.” I hope the many late night talk show hosts with their endless cache of “fat” jokes will take note. 

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