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Is it okay to be fat?

http://www.hulu.com/embed/gpabQ23QRCHrDSAA80er1g

I just came across this Nightline Face-off episode on the concept of "fatness" as it relates to health, government policy, and cultural ideals of beauty. It was really interesting and especially relevant to conversations that have arisen in several different threads on the forums recently. Above you can watch a sort of 20 minute summary with a whole bunch of excerpts from the debate. You can watch the full debate on ABC's website, but it's quite a bit longer and I wanted to post something brief enough that people will have time to watch it and share their thoughts.

So, vegwebbers, what do you think? Is it true, as one panelist claims, that the notion of a person being fat and healthy is an oxymoron? Who (if anyone) should decide where we draw the line that distinguishes "healthy" bodies from "fat" bodies? What do you think about this idea of reclaiming the word fat so it's no longer a dirty word? What's your reaction to the panelists arguments about biological determinism (i.e. you're fat because your genes make you so) versus behavioral control (i.e. your eating habits determine how your body looks)?

One thing that struck me was that it was a debate amongst women. The moderator was female, as well as all four panelists. Uh huh. That's all I'm going to say about that.

On VW, we seem to have different definitions of "health," but I'd be curious to hear what a medical professional would outline as healthy in terms of...which factors? So many could be included. Maybe this is where it gets sticky.

You would be shocked to find out what a doctor considers healthy.  I can't go into much detail because of privacy laws, but I type for over a dozen doctors on a regular basis from several cities in the Mid West.  Generally they consider a patient healthy if they don't have any uncontrolled medical conditions that limit their activities of daily living (ADLs).  These so-called healthy people commonly have hypertension, hyperlipidema, COPD, type 2 diabetes, assorted cancers in remisssion, etc.  It also seems they are more likely to label someone as healthy who is overweight than underweight. 

I guess that makes some sense, since overweight is now our society norm, not underweight. How can regular people get the straight answers they need to keep themselves in top form when doctors cannot even agree upon a working definition of how our bodies should function? I think this is starting to really get to the root of the problem.

BTW, I would laugh really hard if you've ever typed any of my medical records!

I don't type for anyone in Indiane if it makes you feel better.  I've also never done GI, yet.  It seems that the medical school teach that chronic medical conditions are a natural part of aging and that "lifestyle" modifications are really only a first line of therapy before the drugs are brought out.  They define preventative health as things like vaccinations, routine screening tests (which don't prevent anything lol), sun screen, seat belts, etc.  Doctors are not taught that lifestyle can truly prevent and even treat most commen chronic medical conditions.  There is a lot of misinformation out there, and it's more than just the general public who is fed the lies.  Doctors act on what they are taught.  Who are they going to listen to, some strange patient or their medical texts/journals?  I just wish the pharmaceutical industry would get out of the journals and testbooks, but that's never going to happen. 

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I'm going to med school next year, and I really worry about this a lot. I don't want to end up being another rank and file doctor, dishing out medications like candy. But I know there's a system to follow, and individuality is not exactly taught. I do want to say that my GI doctor has been amazing. He has taken a holistic approach to my issues (and he's an MD, not even a DO), and we discuss things like diet and exercise. I don't know if he does this with everyone--he has said his day is mostly pretty boring, people in, people out, nobody wanting to stop and talk about their problems (before my EGD we screwed up his schedule because we talked for 45 minutes while the nurses sat and waited on us). He says most people want to come in, get diagnosed, get meds, and leave (basically, but I'm paraphrasing a lot--he's much more eloquent). So, there's a problem with patients not wanting to take more responsibility with their own bodies and health, too. The doctors don't want to sit and waste their time by explaining lifestyle changes to a patient if the patient has no interest in hearing it. It's a screwed system on both ends.

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I'm going to med school next year, and I really worry about this a lot. I don't want to end up being another rank and file doctor, dishing out medications like candy. But I know there's a system to follow, and individuality is not exactly taught. I do want to say that my GI doctor has been amazing. He has taken a holistic approach to my issues (and he's an MD, not even a DO), and we discuss things like diet and exercise. I don't know if he does this with everyone--he has said his day is mostly pretty boring, people in, people out, nobody wanting to stop and talk about their problems (before my EGD we screwed up his schedule because we talked for 45 minutes while the nurses sat and waited on us). He says most people want to come in, get diagnosed, get meds, and leave (basically, but I'm paraphrasing a lot--he's much more eloquent). So, there's a problem with patients not wanting to take more responsibility with their own bodies and health, too. The doctors don't want to sit and waste their time by explaining lifestyle changes to a patient if the patient has no interest in hearing it. It's a screwed system on both ends.

You need to reserch Dr John McDougall...that guy is awesome...just a heads up...Good luck with Med School

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Viruses don't work that way.  If it is the common cold/flu that cycles around seasonally, than you can take precautions to avoid it.  If it is say a new, aggressive virus, you will get it almost no matter what you do.  Those that are healthy may not have serious consequences.  Still, viruses, bacteria and other communicable diseases can be tricky.  Even very healthy people will surcome to things like staph.

Not that I am purposely pointing fingers.  I understand that society, poverty, ignorance and other things greatly effect how people  can take care of themselves.  However, I don't think that it is prudent to just ignore these issues and say that everyone has a different concept of health.  There are real divisions in terms of health.  Some people need only annual checkups, perhaps a few medications in their golden years and can work a full-time job until the age of retirement.  Others  have to see a doctor several times a month, get one or more operations in their life, take several medications throughout their life and have to draw on public assistance early in their life. 

If the virus has not mutated to be completely different, then our bodies can see it and think "hmmm, this looks like something I've seen before" and they can launch the B cells that were used in the similar virus the last time. Think of the H1N1 everyone is freaking out about--the reason older people are not dying in as high numbers as the young is because this virus ever so distantly resembles the 1918 flu virus, and they have some antibodies left over from that. Yes, there are *some* completely novel viruses, but this is very rare. Most are mutated slightly, and our bodies can recognize them as being somewhat familiar. There is a delayed reaction, but it's usually only a day or two, and we might barely feel the effects. This is where a healthy, ready and able immune system will come in handy. If we didn't have this resemblance recognition, every single little virus in the whole world would affect us until we'd built up antibodies to everything (but then the viruses are ever evolving, so this would imply that we'd be sick our entire lives).

I like your second paragraph. I think it's true that we all need to do what is best for our own bodies, but somewhere this is some wide range of factors that determine health. The problem is, who determines these, and how wide is the range? It kind of seems like a sliding scale, like a bell-shaped curve, instead of a switch of yes/no. On VW, we seem to have different definitions of "health," but I'd be curious to hear what a medical professional would outline as healthy in terms of...which factors? So many could be included. Maybe this is where it gets sticky.

new strains of the flu often have slightly different antigenicity, and the immune system has to go through B cell selection all over again. Even a single different glycoprotein will alter what antibodies can neutralize it. Influenza is particularly prone to switching its surface proteins, mostly because it's "messy" when it leaves a cell and might take different RNA with it than it came in with. So yeah, H1N1 has a very similar coat to the Spanish flu, but in most cases the annual "new" flu will make most people ill who come into contact with it. The reason for transient or mild illness is that the virus is simply not very virulent, or the innate immune system can deal with it pretty easily.

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Regarding medical views of 'health'... I think the problem is that our Western educational institutions (funded more each passing year by Big Pharm, btw, for whom 'health' is a non-goal -- if not an active enemy!) train medical staff to define health as 'the absence of overt disease/ disfunction'... Among the MDs I work with, it's the same as described above: the assumption is that 'least sick' or 'sick but able to function at some basic level, anyway' is a normal/ accepted/ desirable outcome... MDs get a billion more training hours on disease than on health/ disease prevention; so of course: what ELSE are they gonna focus on, as practitioners?!

I'm an occupational therapist, & work in rehabilitation facilities part of the time... I see folks recovering from devastating strokes, or amputations from diabetes complications, or weight-bearing joint replacements (where lifelong obesity undoubtedly played a role), being fed NOTHING not chock-full of saturated fat... I work on self-feeding skills in the dining room sometimes, and it hurts me to see the artery-clogging stuff on a stroke patient's plate, IN A REHAB CENTER! Like, of all the places where you'd expect folks to give you healthy food, it'd be in a medical facility, right?! (Nope!)

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In college my boyfriend's father almost died of congestive heart failure.  (He also has a vegy significant stroke history.)  By the time he was release from the hospital he had 2 heart valves repaired and quintuple (5) bypass surgery.  Guess what the first meal they served him in the hospital was?  A huge hamburger and french fries!  Crazy.

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In college my boyfriend's father almost died of congestive heart failure.  (He also has a vegy significant stroke history.)  By the time he was release from the hospital he had 2 heart valves repaired and quintuple (5) bypass surgery.  Guess what the first meal they served him in the hospital was?  A huge hamburger and french fries!  Crazy.

When Zack was in the hospital for his motorcycle wreck he refused to eat the food they served, because it was so nasty and there was 1 vegetarian option (and it was gross). So, I had his mom go out and get graham crackers and peanut butter, and that's all he would eat for the 3 days we were there. When we got home he told me to get in the kitchen and make him tons of food, and he really didn't start getting or feeling better until we got home and starting eating REAL food. I told the dietitian at the hospital that they were ridiculous, and they were going to kill people with their food instead of make them better. She sighed in resignation and said "I know. I just can't do anything about it." So sad.

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I've got an upcoming stay in the hospital planned and so yesterday while I was there for an appointment I popped into the cafeteria to see what the selections were like in case I didn't like whatever they tried to serve me. I couldn't believe how many menu options had bacon. BACON? In a hospital? It would be laughable if it wasn't so infuriating.

About whether or not it's okay to be fat: I became overweight while eating a crappy diet growing up and through my 20's. Now I eat a healthy diet, for the most part, and get way more exercise than I ever did, but the weight doesn't just fall off. I'm going to have to be very aggressive in getting rid of stored fat, but in the meantime, I know that despite having excess fat I'm healthier than I've ever been and I feel confident that I'm healthier than the average person who is thin but consumes fast food and animal products all the time. It just sucks that people look at me and think I must be an over eater with a terrible diet or that I'm lazy because of the way I look when I've not been those things for a long time.

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Its probably budget restrictions and/or contracts with food suppliers that make hospital food so unhealthy.  That is the same situation they have at schools.  Its worse at schools b/c they are also trying to make a profit off of it for underfunded programs. 

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Its probably budget restrictions and/or contracts with food suppliers that make hospital food so unhealthy.  That is the same situation they have at schools.  Its worse at schools b/c they are also trying to make a profit off of it for underfunded programs. 

Boom. Got it in one. The hospital has a contract with a company, say Sodexho, and Sodexho doesn't give a crap whether they're serving healthy food or not. They'll send the same food to prisons that they will to hospitals. I just wish hospitals wouldn't contract out their food service and actually take some responsibility.

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I was watching Food Revolution (that Jamie Oliver reality show) last night and he went to the school'sfood distribution center to see what was available. After seeing gigantic quantities of frozen, processed crap he asked if they had any fresh produce and the guy was like, "Of course, it's over here, but we don't have much because it's not what the schools are ordering." I think that if school and hospitals demanded better quality food the distributors would provide it. I think people are just lazy and don't like to buck the status quo. Like in sooo many other industries people just do what the people before them did.

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They bid for contracts from the schools.  Those that do it for the least win.  Unfortunately, that means processed foods.  Even if schools 'demanded' fresh food there is little chance they would get it between tight district budgets and the food companies needing to make a profit.  At one time, schools use to produce all their own food in the school in which it was being served.  Then it was one major cafeteria for all the schools in a distrcit.  Most schools don't even have kitchens or full-service cafeterias anymore.  The cost is too high to provide qualified staff (cooks make more than food server), facilities and raw ingredients. 

Jamie Oliver has a good idea, but is going about it the wrong way.  Its not about ignorance.  Everyone understands that feeding children bad food will lead to major health problems.  Its about budget priorities and a food industry that puts profits above consumer health.  Even if you were able to 'reform' a school, eventually they would have to go back to their old ways for these reasons.  He needs to stop blaming the individual schools and address the underlining problems through progressive reform at the State and National levels. Whereas, Michelle Obama's push to reintroduce Federal school lunch programs would have a profound effect on what is being served at schools.

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I hope, if nothing else, it wakes parents up to what is being served in schools and angers them enough to demand a change. It kills me watching him replace processed crap food with fresh crap food (meat and cheese abound), but maybe it will get middle America to at least think about what they're putting in their mouths.

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I think, for both hospital & school food issues, the solution has to come from reorganizing the way we handle food subsidies in the US... as long as we're making the least-healthy food the 'cheapest', seems like the problem will continue. Since big ag will aggressively resist ANY such revisions, maybe shows like Oliver's do make a positive contribution, just by shining a light on the problem... if enough people understand how profoundly damaging our food 'norms' have become, and demand a better system, the public will (hopefully) be less subject to manipulation by ag lobbies/ PR spin favoring the status quo, at some point in the future when (hopefully!) it comes to the forefront of domestic policy issues.

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Don't get me wrong.  I don't hate Jamie Oliver at all.  He has noble aspiration but is going about it in the wrong way, IMHO.  Like you said, deal with the policies and reorganize our priorities.

Unfortunately, with all this blame the poor and minorities and fear of public spenidng on social programs that is gaining momentum, it may not happen anytime soon.  When the Republicans took over Congress back in the late 90s, it was on the presumption that the immigrants, the poor, minorities, single mothers, etc. were ruining the economy and country.  Though this is based on preconcieved notions and not any real data, people still bought it and still are buying it.  One of the first things that Rep controlled Congress did was eliminate the school lunch program, while slowly giving more money to corporations and special interest groups.  They toted the school lunch program as a waste of money, eventhough it was pocket change - about 1/2 million a year.  Now we have bad food for children and agribusiness is stronger than ever.  The same mentalitly that allowed that to happen then is coming back now.

It will take quite a bit of education to make people even realize that there is a problem.  Then it will take even more time to create a momentum to counter the status quo.

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i guess the best one can do in that climate is get the school district itself to change it. it explains why the wealthier school districts in my area always had the better cafeteria food =/

i remember when the governator did the whole 'healthy lunches' or whatever for california. they got rid of soda/iced tea, and instead we got cans of 100% juice (that had malic acid added, so it tasted like candy. really? kids WILL drink juice.), and i think we kept the gatorade stuff. the vending machines had "healthier" stuff (cheetos -> baked natural cheese things, brownie -> "all-natural" brownie, haha). Despite these changes, they still sold pizza & big cookies at lunch. Say what??
I remember that one school got a fruit vending machine. Personally, I'd be scared to get some mealy, bruised apple from there.

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Don't get me wrong.  I don't hate Jamie Oliver at all.  He has noble aspiration but is going about it in the wrong way, IMHO.  Like you said, deal with the policies and reorganize our priorities.

We were talking about this on the Jamie Oliver/Food Revolution thread.  One person can't do it all, they can only bring their training and background to a situation.  Jamie Oliver knows about cooking and publicity, so that's what he's bringing.  He's not a policy analyst.  However, great things can happen when there's publicity, so his doing what he's doing could afford someone who does make policy to do what they do to effect change.  No one person is going to change a system.  It's takes a team.  His goal is to change the part he knows about and to bring people from other areas into it, like finding funding to train school cooks and to get the school nutritionist on-board with healthier food.

It's similar to people criticizing Bono because he's working on African debt relief.  People diss him for not single-handedly fixing all the problems of an entire continent, but he can only bring a small part of it to the table and hope he inspires other people to bring other parts.

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A bit of progress...?!

"Stafford Teen's Food Push Goes National"
http://fredericksburg.com/News/FLS/2010/042010/04172010/541732

;)b

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i used to work in hospital food service (patient, not cafeteria). it's really depressing, but it's all in accordance with USDA. Obviously, it's the USDA that has to change.

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i used to work in hospital food service (patient, not cafeteria). it's really depressing, but it's all in accordance with USDA. Obviously, it's the USDA that has to change.

which won't happen anytime soon considering how corrupt they are... i mean seriously having monsanto and meat and dairy industry executives go back and forth from working for the USDA and back to their other job is pretty ridiculous...

i mean thinking of it in terms of accounting (what i know about LOL)... they don't let auditors prepare the financial statements of the companies they audit... it is obviously a conflict of interest, i don't know why government positions aren't thought of the same... freakin ridiculous

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