11 replies to this topic

[stocks]

Such an explicit statement of the idea that some people are simply of better ‘stock’ than others would be unacceptable today. Nonetheless, the same idea is implicit in the logic of modern thinking on poverty and obesity. Wealthy people who cook decent meals with fresh ingredients are seen as being morally superior - they care about their health and their children’s health, and they care for the planet, too. Poorer people, who apparently only eat microwaveable meals or pizzas biked to their homes during an episode of EastEnders, are looked upon as sinful and slothful - they are, in Jamie Oliver’s immortal words, ‘white trash’ and ‘tossers’ who allegedly care little for their own wellbeing or that of their families. Today, the sense of a divide between rich and poor is articulated most frequently through issues of health and diet.

The search for some form of moral superiority, rather than a real concern with health, is the driving force behind the authorities’ War on Obesity. That is why a campaign ostensibly against fatness can easily shift its attention from feckless ‘chavs’ to working mothers: because it is underpinned by moralistic judgements about our lifestyle choices rather than hard scientific facts about our eating habits. First ‘white trash’ families and now mums who dare to work - the War on Obesity is a war against those who make the ‘wrong’ choices, who refuse to play by the rules laid down by the new elite, and who instead do things their own way. In this sense, the demand that we ‘eat healthily’ and have the correct body shape (whatever that might be) is at root a demand that we conform.

http://www.spiked-on.../earticle/3674/

[maineman]

SImply not true. It is just innacurate to say first that if you are poor "white trash" as you call it, then you are obese. This is a gross mistatement. People who eat too much are overweight. In some cities where there are inner cites, access to fresher food is wanting and those who are unable to move out of the poverty level and live there have less fewer shopping choices. Sadly, fast food, which is truly inexpensive, is more prevalent there. But that doesn't explain it. People are overweight in poorer countries where there are no fast food houses. But rich and poor alike can, and do, make poor choices when it comes to overeating, smoking and drinking. THese, however, are personal choices and each individual has the freedom to choose another helping, another beer or to light up. The "moral" dilemma is whether someone who is offering help to someone who is in a position of authority (doctor, nutritionist, "diet" expert, etc.) has any right to pass a "moral" judgement. If you want to be fat or drink or smoke that is up to you and should be nobody's business. If you want to do those things AND you expect free medical care, then we have an economic dilemma, not a moral dilemma. On the other hand if and when you decide you'd like to live a healthier lifestyle, then I, as a doctor, have the moral obligation to tell you the truth (which is why I get kind of upset about some of the so-called "health" BS posted here at times). THe "war on cancer" was not against cancer patients. At the time this concept was floated, cancer patients were treated worse than lepers and so were cut off from society and access to care. By bringing the discussion to the public and having quality presidential leadership who informed the public in the right way that this was a moral group effort, "cancer" was de-mystified and enormous progress has been made. In this country people's weight began to rise in the 1950s, once post deprssion and post world war 2 lifestyle limitations faded and prosperity returned. There was a brief dip during the "recession" years of the 1970s and since then we, as a nation, have been gaining weight. This, too, shall pass as more truthful information is passed along and the idea of health and fitness is embraced. The public dialogue is good. As Krishna said, "where the mind goes.... the body follows"..... But is wrong for anyone to say that those personal choices are "wrong", just as it is wrong for anyone to say that another's religion is "wrong". Personal choice is a sacred cow. mm ps...are these people white trash? Elizabeth Taylor (fat), Jackie Gleason (fat) Chris Farley (fat), Fats Domino (fat) Marlon Brando (fat)....

[calmcookie]

I don't think that many of the poor have any reasonable understanding of nutrition. I believe that they just don't know any better. I'm not sure who is fighting any kind of moralistic "war" or wanting people to "conform." Maybe some do. But my ONE AND ONLY reason for doing what I do is because of the tremendous suffering I've seen: Diabetic amputation, blindness, dialysis, infections, morbid obesity that robs people of every human dignity ... they cannot even wipe or toilet themselves .... they live in CHRONIC misery. My interest has nothing to do with morals but about attempting to help people avoid a life of terrible pain and hopelessness. I have sat beside the bed of dialysis patients who look at me and beg to die .... but they cannot even put an end to their own horrible lives ... and it goes on and on. I cannot bear it ... I feel their pain in every fibre of my being and I have to do something about it. But that is me ... crazy I suppose. C.C.

[maineman]

Juvenile diabetes will be cured by science, as has polio, etc. Our good friends who are cracking the genetic code and our good friends who are working with stem cells and our good friends at "big pharma" who are developing the vaccine, all working together will have this licked very soon. Diet plays no part in the etiology of Juvenile diabetes. No more kids on Insulin, dialysis, pumps, etc. Adult Onset Diabetes has 2 basic etiologies. One is a genetically predetermined decline in pancreatic function. Just like gray hair, menopause, etc. this is hard wired. Our good friends above are going to fix this, too, but don't hold your breath. This will take awhile yet. The second etiology is the one we are all talking about. When people eat more food than their metobolism (i.e. pancreatic insulin production) can handle, they develop adult-onset-like diabetes. Many of these folks can just eat less and exercise more and "solve" the problem. Some need extra help from medication or insulin supplementation, particulary if they are subject to declining pancreatic function. Thanks to our good friends in medical research we are learning new truths about metabolism every day. Harvard is busy testing everything at the healthfood store, subjecting it to the same high level of scrutiny they reserve for all their top notch study. Same for the Cleveland CLinic, who has taken the lead in they study of herbs and alternatives. But meanwhile the average person in this country already has sufficient knowledge to be well. Rich or Poor has nothing to do with it. Its all about being motivated and aware or being lazy and not motivated. While far from perfect, basic dietary guidelines that already exist, IF FOLLOWED, would not lead to obesity. And it does NOT cost more to eat healthy. In fact, it costs more to buy food in boxes, cans and shrinkwraps. At our hospital, the obese nurses get together and order lunch from take out evey day, pizza, heroes, donuts, etc. while the doctors all bring lunch in reusable lunch bags, usually yogurt, fruit, leftovers, whatever, and we all go out for a run. You think these fat nurses "don't know"? The best work we are doing right now is in the grade schools and at the pediatricians. We have a program in place that encourages the kids to act and think independently THey are asked to take the lead at home. Only from the ground up. And its working here already. As for the adults, all we can do is provide them the truth when they are ready to listen. There are some interesting work place initiatives going on, too. Several of our big empoyers (like LL Beans) are beginning to layer healthcare ... if you meet quarterly goals, like blood pressure control, lower cholesterol, weight, etc. your health care premium is reduced. Smoking too. This has been very interesting to watch...... positive so far. just some thoughts, mm

[stocks]

Then there is the case of the US report from the Centers for Disease Control and Prevention (CDC), published in the Journal of the American Medical Association in 2004, which proclaimed that obesity was causing 400,000 deaths a year. This immediately sparked calls for massive government intervention. However, the authors of Diet Nation note how the report was prepared, not by the CDC’s top experts on the subject, but by the CDC’s director and other researchers attached to her office. After what appears to have been considerable internal criticism of the report, another group of CDC researchers reviewed it, and their review eventually found its way into the public domain under a Freedom of Information request. This second report suggested that a more accurate figure for excess obesity deaths was about 25,000 – 94 per cent lower than the original estimate. Strikingly, the original report was produced under pressure to ‘get the right result’ because a range of groups had an interest in reaching the highest possible figure.

http://www.spiked-on...e/article/2782/

[maineman]

As discussed before, the beauty of scientific research is that information is chllendged in an open forum, results are tested and independent researchers attempt to verify data. The truth always comes out. Errors are made all the time. Statistical power may not be adequately reached. Subsequent data either proves and adds to or disproves prior data. The open dialogue is key. Most people work by those rules. THose who don't get caught or sued. FWIW this is not the case with alternative health folks who simply state that something might be affective, like a vitamin, an herb, a suppement, a "mix of diets" or whatever. No scrutiny, no research. And if, God Forbid, anyone challenges them, they cry anything from "spiritual exemption" or that "big pharma" is trying to snuff them out, or whatever. This is why Harvard and others chose to iniitiate theri own bias neuthral research. As for obesity, just go down to any mall, restaurant, main street america and all you'll see is obesity. If is extremely wide spread. As to how many people die directly from Obesity, that is not known. What is known is that if you live your life with a BMI over 28 and don't exercise, your risk of AODM and ASCHD are significantly hgiher, and they definitely cause death, and before death a lifetime of illness and many doctor visits begging us to put them back together again...

[PorkLoin]

Great thread and great comments. I need to read this stuff every day. If health is the new morality then I'm pretty doggone immoral and lucky not to have suffered...yet. Doug

[calmcookie]

Lucky not to have suffered...yet.

Doug

Yes Doug, that is the big problem ... people just don't understand the consequences, UNTIL IT IS TOO LATE. I once had a diabetic patient who I had been trying to help, for years, but it was only AFTER his foot was amputated that he looked at me and said "okay, I'm ready to make some changes." When people have no understanding of how the human body functions, then they have a hard time believing that food or gentle activity can make any difference. It is simple human ignorance and SO EASILY REMEDIED - with just a small effort.

Prevention is unpopular .... but waiting for the reality of consequences is a terrible waste. I see it every single day.

No one thinks that illness will happen to them. It's always a shocking wake up call .. and usually too late.

Best to all, C.C.

Edited by calmcookie, 30 July 2007 - 08:48 AM.

[stocks]

What do these four “public health” problems—smoking, playing violent video games, overeating, and gambling—have in common? They’re all things that some people enjoy and other people condemn, attributing to them various bad effects. Sometimes these effects are medical, but they may also be psychological, behavioral, social, or financial. Calling the habits that supposedly lead to these consequences “public health” problems, “epidemics” that need to be controlled, equates choices with diseases, disguises moralizing as science, and casts meddling as medicine. It elevates a collectivist calculus of social welfare above the interests of individuals, who become subject to increasingly intrusive interventions aimed at making them as healthy as they can be, without regard to their own preferences.

This tendency to call every perceived problem affecting more than two people an “epidemic” obscures a crucial distinction. The classic targets of public health were risks imposed on people against their will, communicable diseases being the paradigmatic example. The more recent targets are risks that people voluntarily assume, such as those associated with smoking, drinking, eating junk food, exercising too little, watching TV too much, playing poker, owning a gun, driving a car without wearing a seat belt, or riding a bicycle without wearing a helmet. The difference is the one John Stuart Mill urged in his 1859 book On Liberty: “The sole end for which mankind are warranted, individually or collectively, in interfering with the liberty of action of any of their number is self-protection.…The only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant.” Mill’s “harming principle” is obviously important to libertarians, but public health practitioners also should keep it in mind if they do not want to be seen as moralistic busybodies constantly seeking to expand the reach of government.


If not, I’d suggest that the public health perspective leaves out some important considerations. Maximizing health is not the same as maximizing happiness. The public health mission to minimize morbidity and mortality leaves no room for the possibility that someone might accept a shorter life span, or an increased risk of disease or injury, in exchange for more pleasure or less discomfort. Motorcyclists, rock climbers, and sky divers make that sort of decision all the time, and not all of them are ignorant of the relevant injury and fatality statistics. With lifestyle choices that pose longer-term risks, such as smoking and overeating, the dangers may be easier to ignore, but it is still possible for someone with a certain set of tastes and preferences to say, “Let me enjoy myself now; I’ll take my chances.” The assumption that such tradeoffs are unacceptable is the unspoken moral premise of public health. When the surgeon general declares that “every American needs to eat healthy food in healthy portions and be physically active every day,” where does that leave a guy who prefers to be fat if it means he can eat what he likes and relax in his spare time instead of looking for ways to burn calories?

It’s true that, as the anti-smoking activist William Cahan pointed out on a CNN talk show several years ago, “People who are making decisions for themselves don’t always come up with the right answer.” They don’t necessarily make tradeoffs between health and other values in an informed or carefully considered manner. Sometimes they regret their decisions. But they know their own tastes and preferences, and they have access to myriad pieces of local information about the relevant costs and benefits that no government regulator can possibly know. They will not always make good decisions, but on balance they will make better decisions, as measured by their own subsequent evaluations, than any third party deciding for them. Leaving aside the question of who is better positioned to decide whether a given pleasure is worth the risk associated with it, there is an inherent value to freedom: When it comes to how people feel about their lives, they may well prefer to make their own bad choices rather than have better ones imposed on them.

http://www.reason.co...how/119236.html

[calmcookie]

Stocks, I agree with you - that nothing should be "forced" on people (except for going to jail if they kill or do other obvious crimes against others). But I cannot stand over regulation and big brother's hand in every tiny aspect of my business. What you do IS your business, no one elses .... but just know what might happen. Know the probabilities. Then, do what you wish.

I only think people have the right to be AWARE of the consequences of some health habits. What they do with that awareness is completely up to them.

Best, C.C.