Tuesday, September 29, 2009

CNN clueless when it comes to... a lot of things

CNN.com headline: "Parents clueless when it comes to kids' growth charts". The article basically says that when doctors (et al) distribute pediatric growth charts to parents, the parents often don't understand the charts and that this "has implications in the war against childhood obesity". God forbid that parents' stupidity should get in the way of the war effort!

The thing is, though, that many parents (at least the ones I know) are perfectly aware of their kids' percentiles on the growth charts. In fact, if anything (from the perspective on a non-parent who has politely sat through more conversations on the subject than I would prefer) I would say that parents probably dwell on the percentiles a little too much. In several cases, it seemed that doctors deliberately caused the parents to worry about their very young children by going on and on about the percentiles (not just on the height/weight spectrum, but also in terms of the timing of certain childhood milestones). It is true that most of the parents I know do not have low income or low education levels, and therefore according to the article they are more likely than others to be able to understand the charts. But I'm not convinced that being able to understand the charts is really such a wonderful thing if it causes people unnecessary worry about their children. Maybe in this instance, ignorance is bliss.

Just have a look at this example of a pediatric growth chart. Notice that height and weight are on separate charts -- even as crude a measure of the height-weight relationship as BMI is not represented. Now suppose little Johnny is 2 years old and he's in the 70th percentile for weight on the chart. What is a parent to "understand" about that? *Some* child has to be at the 70th percentile -- 'cause weight, like height, exhibits a normal distribution -- so what if it's *your* child? Well, if he's also at the 70th percentile for height then maybe the doctor would let it go. But what if he's at the 50th percentile for height? Is he then "overweight"? And should you therefore put your 2 year old on a diet to slim him down?

The weirdest part of this article to me is the part where this pediatrician suggests that pediatricians talk to parents about height and weight in terms of clothing size because "It is real to them if they are having to buy clothes frequently or if hems always need shortening to accommodate girth." OK, remember we are talking about *kids* here. Now every parent who has to buy clothes frequently is supposed to panic and flip out and think that their child is abnormal and "at risk for serious medical problems"? I can just imagine what those conversations will be like... "Well, Mrs. Jones, the reason that you have had to buy new pants for your daughter three times this year is that she has a height problem. As you can see on this chart here, Susie is in the 85th percentile for height at her age, which means that she is overheight." What, you think that's ridiculous? Because height is mostly genetic and is just a natural parameter of human variation that is virtually impossible to control? And while it's possible that extreme tallness or shortness could signal an underlying health problem, which the doctor may want to check for, it is also entirely possible that there's no problem at all and therefore there's no reason to cause the parents to panic? Well, I couldn't agree with you more. Now, why is weight not treated the same way? Hey, don't ask questions like that -- don't you know we're at war?

Tuesday, September 15, 2009

Fat and the health care debate

Liberals: if you think that the solution to all our nation's health care problems, as well as the key to paying for a national health care plan, resides in getting rid of fat people, you are in good company: your president agrees. However, as much as I like Obama, he's just plain wrong about this. If he thinks we can "prevent obesity", he's got another think coming. And even supposing we could do that, if Obama thinks that eliminating fat people would eliminate all of our nation's medical problems and save us a trillion dollars, well, he's got even more thinking to do.

The facts are these: (1) You can't make fat people thin in the long term. (2) Making people thin doesn't necessarily make them healthy anyway -- in fact in many cases it does just the opposite. And (3) a national health care plan is going to be expensive, and rather than pretend like we can eliminate all the costs by forcing or guilting everyone into getting thin, we need to just suck it up and pay for the plan, even if that means raising taxes.

I have noticed a lot of anti-fat rhetoric associated with the health care debate. There's John Mackey's controversial WSJ editorial, and Michael Pollan's response in the New York Times, and Obama repeating his previous claims. And then there's Ashton Kutcher's statement on Bill Maher's show (which Maher of course did not call him out on): "Frankly, I don’t want to pay for the guy who’s getting a triple-bypass because he’s eating fast food all day and deep-fried snickers bars." (I should immediately point out that this quote doesn't single out fat people, just people who eat a non-Ashton Kutcher-approved diet. But I think it's not totally out of line to imagine a fat person as the stereotypical person that he had in mind with this statement.) But I've also seen it coming increasingly from ordinary people -- in debates on Facebook, for example, and in the comments that people make on some of the articles mentioned above.

Here is what I would like to say to everyone who favors universal health care: our message has to be consistent or we are doomed. It is totally hypocritical for a pro-choice liberal to declare that "a woman's body is her own" but then turn around and try to tell others what to eat and how much to exercise and how much body fat they are allowed to have. Universal health care means covering everybody, regardless of whose "fault" it is when they get sick. That is the whole point. If you keep talking about policing the way people live their lives as a way to drive down costs, you are playing right into the Republicans' fear-mongering about how Big Government takes away our freedom. We liberals need to get our thinking straight about this, or this whole health care thing is going nowhere.

P.S. Sorry for the comment moderation; I've been getting spam comments every day on my last post and I don't know how else to block them. I'll try to approve your comments quickly.

P.P.S. I just got wind of a new blog called Fat Habitat that may be of interest. It's about fat and sustainability. There aren't many posts yet (and the last one was pro-Michael Pollan before he made his recent anti-fat remarks, so it will be interesting to see how he's treated in the next post), but this will be one to watch.