Race, Obesity and Willpower

Alice Randall has an op-ed in the New York Times that touches the third rail of weight, race and body image, Black Women and Fat.

I’m not going to take the easy shot at her focus on behavior change and healthy eating. America as a whole needs to reject the junk diet that is killing us. Personal responsibility is crucial, but not the whole story. It’s not just willpower.

I’m returning to an earlier post here for a look at other factors that are steering us to ill health–

“Are we just losing our willpower year by year?

About a third of people in nine states were obese in 2009, a dramatic increase from 2007, when only three states had obesity rates that high, a new survey from the Centers for Disease Control and Prevention shows.

USA Today has a frightening map of obesity rates by state and year, and the CDC has the same map with more detail.

Were we all more virtuous thirty years ago, or has our environment changed? Certainly there are more temptations to be sedentary, and activity is being squeezed out of our daily routine. Cuts to public transit, to physical education in public schools, and lack of walkable communities all play a role. But what is happening to our food?

Between 1970 and 1990 the use of high-fructose corn syrup increased 1000%.

Corn is subsidized by the government, but people don’t eat that much fresh corn. The money is in the refined product. It’s cheap, it’s plentiful, and it’s not only a sweetener, it’s a preservative. The industry says there’s no difference between one sweetener and another, but recent research suggests otherwise…

In the 40 years since the introduction of high-fructose corn syrup as a cost-effective sweetener in the American diet, rates of obesity in the U.S. have skyrocketed, according to the Centers for Disease Control and Prevention. In 1970, around 15 percent of the U.S. population met the definition for obesity; today, roughly one-third of the American adults are considered obese, the CDC reported. High-fructose corn syrup is found in a wide range of foods and beverages, including fruit juice, soda, cereal, bread, yogurt, ketchup and mayonnaise. On average, Americans consume 60 pounds of the sweetener per person every year.

“Our findings lend support to the theory that the excessive consumption of high-fructose corn syrup found in many beverages may be an important factor in the obesity epidemic,” Avena said.

Correlation is not causation, but a grocery list of new, refined additions to our diet and an increase in obesity and diabetes is suspicious.

As bad as this is, it could get worse. A study shows a link between high fructose corn syrup and the growth of cancer cells. Business journalist Dana Blankenhorn asks if corn syrup will become the new tobacco.

High Fructose Corn Syrup (HFCS), a corn-based sweetener developed in 1957 and engineered into a wide range of food starting in 1975, looks headed to becoming a major health concern of this generation.
In the process Archer Daniels-Midland may become a one-company “big tobacco.”

And just as tax money intended to supply our soldiers with food in WWII was diverted into big tobacco– resulting in addiction and lung cancer for many veterans of that war, industry lobbyists succeeded in changing regulations so that food stamps could be used for soda. It’s a diversion of money that is supposed to be used to aid farmers and improve nutrition for low-income people.

What would ADM do with all that corn syrup? One answer is found on the ingredients list of almost any processed food– it’s in thousands of foods we don’t even think of as sweet. Read the label. And there’s another business plan. Send it to the second most obese nation–Mexico.

Mexico lost a trade dispute that had protected its domestic sugar production, and a flood of cheap corn syrup from the USA will displace sugar in their soft drinks. Meanwhile, some health-conscious Americans are buying Mexican soda sweetened with sugar to avoid the scary HFCS.

I have to say that this just plain sounds like evil product dumping. Nothing good will come in the long run if we export something that Americans have come to believe is unfit to eat. There is even evidence that people of Native American descent have a higher risk of health problems from a diet high in refined carbs. Ten percent of Mexicans are indigenous, and the majority of the population have mixed ancestry.

So we’re talking about dumping a cheap sweetener that Americans are getting leery of on to a poor nation whose people may be especially vulnerable to the health risks.

Why are our tax dollars subsidizing corn anyway? It’s not the most nutritious food crop. Why can’t Archer Daniels Midland GROW SOMETHING ELSE?

Obesity and being overweight are complex problems, with many causes. Willpower is one factor, certainly. But human nature can’t have changed so drastically in thirty years that we’ve all become gluttons. What has changed in thirty years is our environment, many small losses of activity and nutrition, many new chemical pollutants in our air and water. We’re all subjects in a global experiment in unnatural living and the results are starting to come in.

One great accomplishment of our time was getting the lead out of our gasoline and cleaning up our housing. Another was getting cigarette smoking out of the workplace and educating people about secondhand smoke.

Fixing our national obesity and diabetes epidemic will take more than slapping a ‘natural’ label on a box of donuts. But for the most part we know what we need to do. My neighborhood farmer’s market is open tomorrow. They take food stamps, and not everything there is expensive. They are part of the solution. It’s a start.

MORE: Here’s a link to this week’s news on HFCS and cancer. Kraft and Coca-Cola are fighting a tax on soda. There’s no hope that one person can get around corporate lobbyists, but you vote with your dollar every time you go to the store. Yacht Club sells a nice sparkling water and it’s local.

DRUNKARD AMERICA: Michael Pollard in ‘The Omnivores’s Dillemma’ recounts a fascinating historical episode of widespread alcohol abuse and cheap corn whiskey. The dynamic is the same– lots of corn and the advantage of creating a processed, indestructable product that people will crave and buy—

As it is today, the clever thing to do with all that cheap corn was to process it — specifically, to distill it into alcohol. The Appalachian range made it difficult and expensive to transport surplus corn from the lightly settled Ohio River Valley to the more populous markets of the East, so farmers turned their corn into whiskey — a more compact and portable, and less perishable, value-added commodity. Before long the price of whiskey plummeted to the point that people could afford to drink it by the pint. Which is precisely what they did.

Prohibition was a disaster, but it was an attempt to solve a real social problem. One parellel here is that most people can handle alcohol in moderation, but most people can’t drink a pint of whiskey every day without becoming dependent or addicted. Most of us like sweets, but a highly refined sugar added to almost everything we eat is a diet that is addictive and unhealthy for anyone with a tendency to put on weight. When did you ever go to the store and buy a bottle of high-fructose corn syrup? The sixty pounds a year the average American consumes are added to other foods we buy. And some foods are so salted you don’t even know it’s sweetened unless you read the label.”

Alice Randall discloses that she struggles to keep her weight under 200 pounds. The photo of Josephine Baker as ‘fat’ is an example of the disconnect of image from the real lives of women. Josephine was a fit, athletic dancer with a beauty most of us can only aspire to, only in comparison to the anorexic fashion ideal is there anything wrong with her.

The combination of addictive eating and inactivity that is the norm of much of our population is a real threat to our national security and national health.

The answer is comprehensive change in our personal choices but also in our environment and culture. No easy road.

Documentary film-maker Byron Hurt shows us the challenges, the rewards and the urgency of addressing our health…

Hate to feel like I’m just a cut-and-paste blogger, so I want to mention that I enjoyed a local screening of ‘Soul Food Junkies’. Byron Hurt, the documentary maker, came to Rhode Island and showed his film at Miriam Hospital to health care workers, and later at an event open to the public at the Cathedral of Life Christian Assembly in Olneyville.

The film is an impressive balancing act– recognizing the centrality of food as culture, family and comfort– and the pleasure it brings. Also presenting the evidence that an un-balanced diet will take years off your life.

‘Soul Food Junkies’ was selected to show on PBS, date to be announced.

This short post is a taste, a larger portion will follow.

Too Fat for Love?

Kat Hudson on Salon has a beautiful post about learning to stop waiting for the day when she will be worthy…

In the past seven years, I’ve slowly gotten comfortable with myself. I know I’m not for everybody, but then again, who is? In learning to love my whole self, I’ve learned to love others, too. It is rare I find anyone physically ugly; I joyfully embrace all of our imperfections and differences. I see the spark of the soul hiding behind the eyes of all people and I fall in love a hundred times a day with everyone I see. Beauty is everywhere if you open your heart to see it.

There are so many kinds of beauty. Long ago I took art classes and discovered that when you look at a person with enough concentration to draw them, their beauty emerges. An older gentleman who lived in a little apartment near RISD was the model, so it was counter-cultural to find beauty in a person not young or buff.

I spend a lot of time with people who are physically challenged, but I’ve never met anyone I’d call ugly– barring behavior that is.

So much depends on self-hatred. It’s cost-effective to persuade people to whip themselves. Then they pass along the pain to others and restlessly buy stuff.

Women’s magazines come in two kinds. The kind that tells you that you bear the mark of original sin but check out the ads for mark remover, and the kind that has three weight loss diet plans and nine recipes for dessert in every issue. I used to appreciate the fact that men think they’re gorgeous no matter what they look like, but the commercialization of the body is getting to them, too. Like women need them to be more neurotic and self-absorbed?

What will happen to our consumer culture if enough people believe they are just fine the way they are? What if enough of us decide to wear what we look good in– regardless of this year’s fashion? Why be normal, when there are so many more fun things to be?

Plastic Surgeon General

Salon’s Dr.Ayala has a post on the weird assertion that the Surgeon General of the United States is not qualified because she is not a babe. What do they want, an aerobics instructor? Never mind that the first name that comes to mind for most Americans when you say ‘Surgeon General’ is the substantial C. Everett Koop. We remember Dr.Koop because he showed leadership in the AIDS crisis, and has dedicated himself to health promotion since.

President Bush’s Anthony Carmona was rather studly, so he served that function well, but hardly a peep out of him in all his tenure. He was rumored to have a habit of yelling at nurses, but his mild reproof of the tobacco industry was saved for just before the door hit him on the way out. I have a thing for David Satcher, he was quietly effective and a strong advocate for mental health parity, but not a publicity seeker and did not become a media star.

I have high hopes for Dr.Benjamin. I will be very happy if she speaks out about the ‘Lack of Aid’ crisis we are suffering now, when a large section of our population cannot access primary and preventive medical care. Dr. Benjamin, I wish you good health and won’t gripe if you schedule some time at the gym. But we need you to put in long hours and breathe life into an office that has been left empty too long. Beauty is as beauty does.

Lose Weight to Graduate

Lincoln University in Pennsylvania has dropped a required fitness class for students deemed obese.

That idea was wrong in so many ways. Where to begin?

First of all, the required class, ‘Fitness for Life’ would be known as the fat class. It makes fitness seem like some kind of remedial training. Who want’s to be ‘special’ in that way? Kiss of death.

Secondly, you can be fat and healthy, or thin and sick. It happens. Why use weight as the only criteria? Is health just a matter of being thin? That’s easy– take up smoking. Reach for a Lucky instead of a sweet. Problem solved.

Obesity is a health problem. It’s not the only one we face, but it’s highly visible. It’s easy to stigmatize fat people because it’s harder to spot other conditions. But you can be thin and in terrible shape.

For health promotion, I have a modest proposal for colleges. First, look at your cafeteria. Are you offering cheap, greasy food and wilted salad, or real food? How much of a priority is it? Second, look at your campus. Is it walkable? Can you make it a livable space where students will walk rather than jump in a car? Do they feel safe on campus?

Third, you need a fitness center that all the students will want to use, so it has to be cool. A Siberia for fat kids won’t do it. Even the kids who want to exercise won’t be caught dead walking in there.

And any student who has done the work and paid the tuition deserves to graduate. If you’re going to hold their graduation hostage– save them the trouble. Just make it a policy not to admit any students over the ideal weight.

Here’s a link to an earlier post, From a Fat Old Nurse, that includes the story of a nurse who was denied graduation by Salve Regina. Sisters of Mercy, where was your’s?

Pot Calling the Kettle Fat

This is from the Huffington Post, count the contradictions in two sentences and win a prize…

Conservative commentator Bill Bennett certainly didn’t endear himself to the residents of Chicago during a recent appearance on CNN’s “The Situation Room.” Asked for his thoughts about President Obama going to Copenhagen to personally lobby for Chicago as the sight of the 2016 Olympics, Bennett said that he was actually rooting for Rio, Brazil: “I’m actually for Rio. In Rio, it’s beautiful women at the beach, and in Chicago, it’s fat people eating.”

Bennett (not the slimmest man on television) saw one silver lining in Obama’s trip: “He is going to have to say some really very positive things about the United States while abroad, which is not something he has been doing.”

Now this is a chubby guy slandering an entire major US city as being fat, while criticizing the President for supposedly saying negative things about our country. He’s rooting for Rio over Chicago. Way to go, patriot.

Bill Bennett is a conservative opponent of health reform who can lose enough money on the slots in an evening to insure a dozen poor families for a year and has written several books on virtue.

Bennett grew up in modest circumstances and worked hard to get an education with the help of loans and scholarships. Prior to advocating for cuts in the federal student aid program he was able to attend Catholic school and two colleges to study Jesuitical Sophistry Philosphy and Law. He is not an elitist.

This just in– We lost. I blame Bill Bennett. Why does he hate America?

To heck with Chicago– it’s not the real America anyway. Zealots erupt in applause when Rio gets the Olympics. That’s American zealots. They want us to fail.

From a Fat Old Nurse

Home with a cold, nothing to do but scan the news, and blog about how to fix this health care mess…

Part I– Money Corrupts

Congressman Patrick Kennedy has many faults, but I’ll always appreciate that he helped hold off Columbia HCA from buying Roger Williams Hospital in the late ‘90’s because by the end of the decade Columbia was paying huge fines for Medicare fraud and Roger Williams has had a little staff turnover.

The state law covering hospital mergers, the Hospital Conversion Act, prescribes many specific criteria that the attorney general and Department of Health director must use to determine if a transaction is appropriate under Rhode Island law and standards, including: whether patients — especially in traditionally underserved communities — can access affordable health care; whether essential medical services would remain available for safe and adequate treatment, appropriate access, and balanced health-care delivery; how much of the hospital market the new entity would control and whether the hospitals would continue to safeguard the public trust.

The law was first created when Columbia HCA — a large, for-profit hospital corporation with a less-than-stellar reputation — proposed buying Roger Williams Hospital, and permanently altering the voluntary nonprofit nature of our hospital system. Thankfully, this never happened. Nurses and other health-care workers, professional and labor organizations, and community-based health-care advocates worked together to win the passage of the Hospital Conversion Act, and Columbia HCA backed down.

That’s a local case of money corrupting health care. The Columbia connection comes back again in this story of how to grow an astroturf movement…

After six months and lots of money, Scott, founder of Conservatives for Patients’ Rights (and an ally of McKalip), has finally seen the fruits of his multimillion-dollar campaign against reform. Scott, a millionaire healthcare entrepreneur, predicted that when Congress reconvened this September the public option would be dead. “While Victory is near, we must not rest,” Scott crowed on CPR’s Web site. Scott himself never rested. He met with lawmakers, coordinated conference calls with conservative activists, wrote opinion pieces and spoke to the faithful about the evils of socialized medicine. Conservatives for Patients’ Rights targeted elected officials in 11 states with TV ads hoping constituents would pressure the lawmakers to oppose proposed changes. Sure enough, when the public option failed in the Senate Finance Committee Tuesday, Scott took credit in this video.

Scott came to the fight with a background in the business of healthcare; in the 1990s he was the CEO of the country’s largest chain of hospitals, until that company, Columbia/HCA, pleaded guilty to defrauding the government in 1997 and Scott was ousted (he was never charged in the fraud). Determined to reclaim some of his lost clout in the healthcare field and rehabilitate his image, in 2001 he started a chain of walk-in clinics in Florida called Solantic.

Walk-in clinics are one way people can access health care, and if they’re done right they can be a useful part of health reform. Where it gets dumb is when politicians claim that walk-ins and emergency rooms are adequate coverage. They’re good for dealing with the immediate problem, but without primary care they are just a revolving door.

Part II– Image is Everything

The Salon article gets really interesting regarding the weird hiring practices of Solantic…

Yet even before it was fully operational Solantic executives were accused of a pattern of serial discrimination in hiring, a pattern supposedly initiated by Scott himself. The suits alleged a standing policy not to hire overweight women, Hispanics with strong accents, older women and black women.

“One of the first things we needed was an R.N. [registered nurse] to help oversee the clinical part with me,” [Doctor] Yarian recalls. “There was this great young individual who had a lot of experience with clinic start-ups. She interviewed with me, and then with Karen. We both loved her. When I got on the phone with Rick, the first thing he says is, ‘What does she look like?'”

Yarian says he began describing her to Scott, at one point mentioning that “She’s a little bit overweight.”

“Immediately Rick says to me, ‘Fat people can’t work at our centers.’ And that sort of set the trend,” Yarian says. “I’d be interviewing someone and his first concern was what they looked like. He was always sending e-mails that people had to be fit and attractive. And no one was hired without his approval.”

Part III– Sisters Without Mercy, Newport, Rhode Island

Salve Regina University knew Sharon Russell was fat when they accepted her. They knew she was fat when they cashed her tuition checks. They refused to graduate her because she was fat. What were they thinking?

In April of 1988 Russell confronted the five nursing instructors from the college again. “It’s hard to explain how much fear they inspired in me. I had called another fat girl who attended Salve with me and asked her to testify. She had refused because she had been afraid to see those women again. And she had already graduated and had been practicing for two years! There was a great amount of fear. The class started out with sixty students; the drop-out rate was half.”

With the fear came anger, too. “I had paid big bucks for their abuse. My parents weren’t rich. Student loans and scholarships paid my tuition.” By the time of the trial in 1988, Russell had already completed a nursing program at St. Joseph’s in Hartford, Connecticut, and had a position at a hospital in Florida. “I had been working in the real world. No patient cares if you’re fat or not. They care about your skills.”

Part IV–Fit to Serve

What is the role of the Surgeon General anyway, and is Dr. Regina Benjamin qualified?

“I think it [her weight] is an issue, but then the president is said to still smoke cigarettes,” said Dr. Marcia Angell, former editor of The New England Journal of Medicine who is now a senior lecturer at Harvard University Medical School. “It tends to undermine her credibility.”

“We don’t know how much she weighs and just looking at her I would not say she is grotesquely obese or even overweight enough to affect her health,” Angell told ABCNews.com.

“But I do think at a time when a lot of public health concern is about the national epidemic of obesity, having a surgeon general who is noticeably overweight raises questions in people’s minds,” she added.

Will this answer the questions…

Benjamin founded the Bayou La Batre Rural Health Clinic in 1990 in the fishing village of Bayou La Batre, Alabama, and has served as its CEO since.

Like many of her patients, the clinic has suffered its own life-threatening challenges. It was heavily damaged by Hurricane Georges in 1998 and Hurricane Katrina in 2005. It also burned to the ground several years ago. But Benjamin rebuilt it after each setback and has continued to offer medical care to the village’s 2,500 residents.

Her commitment to them has meant making house calls during the rebuilding, mortgaging her house and maxing out her credit cards, Obama said.

“Regina Benjamin has refused to give up; her patients have refused to give up,” he said.

Many of her family practice patients are immigrants from Vietnam, Cambodia and Laos who make up a third of Bayou La Batre’s population, and many of them are uninsured.

Benjamin’s expertise goes beyond medicine; she earned a master’s in business administration in 1991 from Tulane University. But her focus has not been on making money for herself, she said.

“My priority has always been the needs of my patients,” she said. “I decided to treat patients regardless of their ability to pay.”

This practice of caring for poor people might be the real reason that Dr. Benjamin is being attacked. When Dr. C. Everett Koop, who was neither young nor slim, served as Surgeon General, he was greatly respected, and very popular for his leadership in public health. The post has become a more precarious and politicized place since Dr. Koop filled it, and Dr. Benjamin can expect to have every aspect of her life and career judged and misjudged.

But what qualities do we want in the nation’s doctor? Good looks and fitness? There’s lots of actors who qualify. Compassion and experience? I’d choose Dr. Benjamin for that. She has a fine resume and if the congressional process shows her to be who she seems to be she should be confirmed.

Part V– Looking the Part

The average nurse is middle-aged. We are an older workforce on average. Part of the problem is retention. Nursing is a high burn-out occupation. Part of the burn-out, I’m convinced, is the relentless corruption of patient care by the profit motive. Labor costs are minimized by stretching staff to the breaking point.

Stress leads to health problems in the people who provide health care, and not a few of us grab a cig or a donut when we shouldn’t. We’re all in it together. Health care workers have the same problems as other workers.

My doctor is lean and fit. He took time to talk to me about diet and exercise. I appreciate that, and that he supports health care reform.

My dentist is not as lean as my doctor. I go to her because of her competence and gentleness. If you want to keep your teeth, she’s the one to see.

If you ever need to check out a nursing home, don’t stop at the front lobby. That’s where they have the chandeliers and mahogany paneling and the fresh flowers. Don’t stop at the private rooms. Go all the way to the top floor where the sickest and neediest patients stay, and see how they are treated. See how the staff behave. Are they all having headaches, or do they take time to talk to the residents?

Glossy, for-profit clinics with buff-looking staff and a high profit margin are there for you right now, if you have the coverage. Rich doctors and attractive drug reps are making a good living.

You could almost forget that this is about sickness and health, life and death.

When the chips are down, I want to be able to count on people who have competence and compassion. I really don’t care what they look like. I want to know what they can do.