Tuesday, June 12, 2007

Signposts to Sanity
This Scares Me

An occasional feature in which your ever lovin' granny points you at other people's really good stuff. Please note that the signpost chosen for today leads down a green and twisting trail, indicating a need to follow the twists and turns that the money takes.

Yesterday on Junkfood Science, Sandy Szwarc posted an article which frightens me. Doctors — forced into becoming lifestyle police. I am directly quoting her a great deal, because the way the pieces come together is important; since I don't quote her first mention of RWJF, I'll tell those of you who might not know that she is referring to the Robert Wood Johnson Foundation, the "philanthropic" arm (worth $8.99 billion) of Johnson & Johnson, the health care products company. And while you read this, keep in mind that the current Surgeon General has targeted obesity as a major health problem and has been issuing press releases touting disproven numbers of premature deaths caused by obesity and ignoring the fact that fat people outlive thin ones.
If government agencies and the American Medical Association get their way, doctors and pediatricians will be compelled to police the behaviors of children and families to make sure they comply with the obesity initiatives of the world’s most influential interest groups
As predicted here, they first recommend the definitions be changed so that children are labeled as “obese” and “overweight” using BMI percentiles*, rather than the long-standing recognition that such classifications are inappropriate for growing children and teens
Every well-child visit is now to include a qualitative assessment of eating behaviors, which must include identifying how often the family eats meals away from home, consumption of sweetened beverages, portion sizes, how often and what children and teens eat for breakfast, how much fruit juice is drunk, how many fruits and vegetables and foods high in fat or calories are eaten, and the frequency and types of snacks.
Labwork for these heavier children, even those without risk factors, is to include lipid (“cholesterol”) profile, fasting glucose and a slew of other biomedical tests.**
All children and teens, of “normal” BMI ranges should be assured to be in compliance with the obesity prevention guidelines as it delineated.***

Additionally, all children and teens with BMIs above the 85th percentile must receive special intervention by a primary care provider or healthcare professional trained in weight management**** and behavioral counseling.
But children or teens with any risk factors and who are not successfully losing weight, or all children above the 99th percentile*****, are placed in the “Tertiary care protocol.”

Tertiary care protocol

· Referral to a weight management center to include a multi-disciplinary team to institute diet and exercise counseling, a very low calorie diet, medication and surgery.******
Not one single clinical practice recommendation is based on credible science on childhood obesity, has anything to do with healthy eating, or has any evidential support. In today’s “pay for performance” world, however, doctors who do not comply with clinical practice guidelines — based on their patients meeting requisite BMIs, behaviors and health risk factor numbers — will see their private and public insurance reimbursements cut.*******
The unmistakable aspect of everything RWJF funds, unbeknownst to the public, is that the feel-good reforms are never for programs that actually care for sick people or children, but are always designed to coerce and move towards legislation that governs lifestyle issues, behaviors and societal values; and that increase the power and influence of governmental agencies and managed care, while undermining the choices of individuals and the judgment of doctors, parents and others directly involved in patient care. And with each one, computerized data collection is fundamental.
It’s interesting that the war on obesity is often compared to that against smoking, because the two targets share surprising similarities, and not just because they’ve both become among the most socially condemned in our culture.
Meanwhile, how many consumers know that Johnson & Johnson is the largest manufacturer of pharmaceutical nicotine products (like Nicoderm, Nicoderm CQ, etc.) in the world, which alone are a $500 million annual business for the company? I didn't and was also surprised to see how squishy the evidence on second-hand smoking being used
Johnson & Johnson, Inc., with $53.324 billion in annual sales, is also an international giant in weight loss and healthy eating products, selling nutritional supplements (McNeil Nutritionals, LLC), artificial sweeteners (Splenda), diet pills, employer wellness programs (J&J Consumer Companies, Inc. Vida Nuestra), and bariatric surgical devices and lap bands (Ethicon Endo-Surgery, Inc.). And just this past week, the President and CEO of RWJF, Dr. Risa Lavizzo-Mourey, finally stepped down from the Board of Directors of Beckman Coulter, Inc., a company with $2.53 billion in annual sales of biomedical laboratory tests — a position she simultaneously held while at the helm of RWJF, ensuring preventive wellness guidelines calling for excessive screening tests.
* By these standards, if I'm understanding this correctly , when Maya was four she would have been identified as obese, since she was so tall that she was off the chart for her age group. She was slender and tall.

** Think of the additional time and expense of these evaluations and tests. If this is to occur at each well-child visit, how that adds up over the years. Fasting glucose tests, as those of us who have them can tell you, are blood tests, preceded by no food and minimal water for 12 hours. For young children who happen to be genetically larger? Be hungry, thirsty, and stuck with a needle? Whether your doctor thinks you need it or not? Let's see how fast we can make chubby children hate going to the doctor.

*** Children within the government's definition of normal are also to be subjected to evaluation of their eating and exercise habits? No children, no families, are to be spared the indoctrination that fat is evil? Aren't the five year olds who are dieting today bad enough? Shall we see if we can add more?

**** In other words, these kids, fat or just tall, will be placed on diets. When studies have shown that dieting before physical maturation not only leads to nutritional problems but also almost guarantees a lifetime of weight problems. When the Berkeley Nutritional Study "of women defined as clinically obese shows that nearly two-thirds of them went on their first diet before age 14 and, as adults, were more likely to be heavier than women who started dieting after age 14."

***** That's Maya, the four year-old who was so tall she was off the chart! To be placed in "tertiary care protocol"!

****** Medication. Perhaps another phen-fen that proves fatal? One that leads to "anal leakage"? Surgery. That's weight loss surgery (WLS), they are talking about here. On children. A surgery with a death on the table rate exceeded only by the quadruple bypass. With a death within 90 days of surgery rate of one in 50! A surgery that results in nutrient malabsorption -- on a developing child! That can result in brain damage! So, while we are looking at the prospect of WLS for children, let me tell you about my conversation with my brother about his bout with WLS. Now, Forrest was over 400 pounds and had a severely enlarged heart. His cardiologist told him it was WLS or he would be dead within six months. And, after the first surgery, he told me that he thought he had made the worst mistake of his life. At the time he told me this, he would have already been dead without it. Every bite he ate, he threw up. Since then he has had a second surgery which doubled the 20" of gut that he had still functioning to 40" (out of 28'), and he is doing much better. He still throws up often enough that his pre-WLS perfect teeth are rotting and he is losing them. Teeth that had never had a single cavity! He throws up if he gets post-nasal drip. He throws up if he eats one bite of bacon. The list of food that he has to avoid is incredibly long and, because he has only a one cup stomach capacity and food only has a two hour transit in his body, he has to pretty much avoid fruit, vegetables, and grains because they don't give him a high enough nutrient load for the bulk. He eats mostly meat. But not fatty meat! Not fats. He takes multiple calcium and vitamin tablets a day -- one of each every two hours. Also, since he has ADD, he must take a ritalin capsule every two hours. Any medication he needs, he has to take every two hours. What if something absorbs faster than that and he gets too much? And the cost of 12 pills instead of one! He does say that it's worth it to be alive, to see his grandchild, to live. But, he also says that if it had not been necessary to save his life, in no way would it have been worth it. Not to look better. Not to feel better -- because he doesn't. He just feels miserable in different ways.

******* In other words, doctors will be paid less if they don't follow these guidelines, no matter what their professional opinion of worth or harm they might do patients..

Sandy leads you to an excellent article on ED Bites, a weight site I was previously unaware of and have subsequently linked in my Size Acceptance blog roll.


J at www.jellyjules.com said...

Ugh, ugh, ugh ugh ugh.

My friend's friend just had the surgery, and now, only 6 or 8 weeks later, she's pregnant. I'm trying to figure out where the baby will get enough nutrition to develop normally? I guess Carnie Wilson did it, it CAN be done, but it doesn't seem like such a good idea.

And any doctor that told me Maya was obese would get a fat lip. End of story.

Kay Dennison said...

This scares me, too! I am soooooooo tired of our goverment thinking it is our nanny. I also am scared of the number of obese children I see. All I can say is that people need to reassess how they feed their children. For my two, McD's etc., was a treat or a quick fix when schedules got overloaded. We sat down to healthy meals AT the dinner table and talked -- just like my family did when I was a child. I don't think a lot of people do that anymore and I think that makes a difference. I got the impression that family meals had gone the way of all flesh when my kids were in school because their friends used to get such a kick out of having supper with us. AND the schools don't serve healthy lunches anymore. As much as I complained about the yucky cafeteria food growing up, it was healthier than it is now.

I wish I had an answer but it doesn't stop me from resenting being nannied. You can't save people from themselves.

Bridget Magnus said...

There has to be some middle ground between doctors who won't point out that maybe 100 pounds isn't a healthy weight for a 6 year old and this invasive piece of garbage.

By the way, I have no respect whatsoever for the AMA. These are the guys who think that damage caps will fix malpractice rates. And I have almost less respect for the pediatric board. Those are the guys who said a kid under 24 months should never ever be exposed to television at all (oh no! his big sister wants to watch educational programming!!), and if he gets an earache you should just "keep an eye on it" for 3 months (just what mom wants to do, "keep an eye" on a kid whose ears hurt all the time).

I have two questions about this really. First, who the heck is going to pay for all this? Because insurance companies generally don't pay for weight loss. They won't even pay for a regular office visit where you talk about weight loss in many cases. Second, what happens when some parents decide to decline "elective" weight loss surgery for their child? In some states it is not legal to "withhold medical treatment" from a child, so will these parents be called criminals and risk losing their kids?

By the way, here's the source document with the actual recommendations.

Kelly Bliss said...

Humm… the “War on Obesity” seems just as foolish and dangerous as a “War on Yellow Teeth”

What would happen if we tried to reduce the incidence of lung cancer and emphysema by focusing on the characteristic of yellow teeth instead of focusing on the behavior of smoking? What if we launched a “War on Yellow Teeth” to prevent lung cancer and emphysema? What if we defined the problem as yellow teeth? People who had yellow teeth would worry about their health and be made to feel bad about their yellow teeth. They would be told how their yellow teeth were costing billions in health care and insurance premiums. Many smokers would be targeted in this war as needing intervention. They would be given teeth whitening potions and creams, programs to whiten teeth, even surgical removal of the offending yellow teeth. After all, missing teeth and the resulting health problems are not as dangerous as lung cancer or emphysema.

What about those smokers who do not happen to have yellow teeth even though they smoke? Since their teeth are white, they would not be defined as having a problem. They would be ignored by the “War on Yellow Teeth” because they do not possess the characteristic that has been defined as the problem. They would not get support or education on reducing lung cancer and emphysema.

What about those people who did not smoke and just have yellow teeth due to genetics, medication, or other reasons? They would be targeted. As they worked to whiten their teeth, they would face frustration because they could not get their teeth white enough. They may damage their teeth with more and more extensive efforts to whiten them. And all along, they would be encouraged to continue. They would be pressured, and chided, and even have recommendations to have their offending teeth surgically removed in order to save them from the awful impending lung cancer and emphysema.

We are experiencing similar results in the “War on Obesity” as would occur in the above scenario about “War on Yellow Teeth”. In both cases, by targeting the characteristic (yellow teeth or body size), instead of the behaviors and actions (smoking or poor dietary habits and inactivity), we prevent a solution from being found. The resulting policies hurt the people with and without the unhealthy behaviors. The assumption that the associated characteristic causes the health issues skews research design and results in conflicting scientific conclusions.

We need to re-define of the problem in a way that promotes a solution for adults and children, of all sizes. I think that the real problem is: We need healthy eating and fitness activity for everybody of every size.
I propose that we end the “War on Obesity”, and begin a “Campaign for Healthy Eating and Fitness for Everybody of Every Size”.

Gina said...

That is truly horrifying!

Janet said...

Thank you for bringing such nice posts. Your blog is always fascinating to read.