Thursday, January 24, 2008

What does it all mean?

A reader named Moira wrote in on another thread, and I thought her comment deserved its own post:

Hi. My name is Moira, and I couldn't help noticing your comment that the BMI for overweight was lowered to 25 and obesity at 30. I've also noticed in my line of work that doctors lowered what the accepted upper limit for blood pressure should be as well, from 140/90 to 130/80. And just the other day I was called full figured for the first time in my life. What does it all mean? Is there someone out there who wants me to believe that every one of us has a problem needing intervention when we might just be fine as we are?

In a word, yes I do think that. Think about how other criteria have changed over the last decade or so, too, from cholesterol guidelines to blood sugar guidelines to weight guidelines. Ask yourself if it's really credible that most adults in the U.S. need to be on medication for cholesterol, high blood pressure, and other issues. Then ask yourself the classic question in any criminal case: Cui bono? Who benefits?

Big Pharma benefits, that's who. The health care industry benefits from the medicalization of all kinds of things, from childbirth to body size. Maybe it's useful to see the current anti-obesity hysteria as part of this overall trend toward pathologizing normal human variances and processes. After all, as soon as you identify a "normal" range of anything, you automatically create an "abnormal" range as well.

What do you all think?


Carrie Arnold said...

Nail, meet hammer.

You're dead on, Harriet. There's now a category called "pre-hypertensive" which "may benefit from medication." There's also plenty of pharmaceutical companies that would benefit from YOUR being on medication.

See here's the thing, Moira: no one profits from you accepting yourself. That's why there's so much resistance: people have too much stake in wanting you to fix yourself, to change. But when you accept *who you really are*? The only person who profits is YOU.

Harriet said...

I've heard doctors say that statins (cholesterol-lowering drugs) should be in the water like fluoride, that everyone can benefit from them. Absolutely nutty. Sandy Szwarc over at Junkfood Science ( has pointed out the fact that aging makes many of these numbers go up, so by lowering the threshhold you create a natural market for your meds as the population ages. A devious strategy indeed.

littlem said...

Nail. Hammer. Bang.

That is all.

Dreaming again said...

I am friends with several doctors, and know several doctors (I have 9 of them on my own team). Not a one of them would approve of treating pre hypertention with blood pressure medication ...and all of them think the pharmaceutical companies are out of line in promoting such.

However, a patient who gets into that pre hypertensive state, MUST start to watch their blood pressure, or they are at risk for high blood pressure developing. And ... there Is a high correlation between blood pressure and heart attack.

I also have yet to meet a doctor who sees one blood pressure reading that is high and medicates. It took 6 months of my mom's being high and over a year for mine ... with every effort for change in stress levels, and exercise to bring it down (dietary factors were not deemed a cause)
but rather genetics.

Statins will never make it into the water, it's an off handed comment. They are simply too dangerous of a drug for certain subsets ... people with muscle diseases ..children ... and pregnant women ... and way too many people cannot tolerate them and have to go through more than one to find one that their body can tolerate.

It might be wishful thinking that they can simply add it to the water like floride, or folic acid to bread ...but it wont' happen, and no one is really niave enough to think so.

They know that statins have caused serious enough muscle damage in too many people to ever really do such a thing. That's why the warning is on every single commercial they air.

It's not just the pharmaceutical markets lowering the numbers.

It's a fine balance here we're treading ... there are those out there trying to make fat a dirty word ...and all who are fat will automatically die of all these horrible diseases ...

but then ...there are those of us ..who ..really are fat ..who really DO have horribly high cholesterol
high blood pressure
plaque in our arteries
high blood sugar/ insulin rates
and are going to die if something isn't done

my problem is ... the high cholesterol
high blood pressure
high insulin
didn't come from what I ate

it came from starving myself ... trying to get skinny again.

As my body found it could not trust me to feed it, and had no idea when it was going to get fed again ... it clung to every single solitary thing I put into it, and stored it, and it drove my insulin levels sky high, and my pancrease became overworked, and my cholesterol started to store when it shouldn't have ... and my fat cells went into starvation mode ...

and ... starvation ... caused all the issues they are blaming on obesity ... including ..the obesity itself.

Very few doctors recognise this (outside of the eating disorder treatment facilities)

I do have to fix it ... assuming it's not too late. Which, I'm not sure it's not.

What my body will do as it reaches a set point as I learn to eat normally ..we'll see ...

Harriet said...

To be fair I do think it's the pharmaceuticals companies much more than doctors. Many doctors I know are seriously irked at the drug companies and their antics. And I know that some of the intentions behind lowering those guidelines are good--to save lives.

But good intentions don't always lead to good outcomes. Take cholesterol, for instance. Drugs like statins lower cholesterol, but do they truly save lives? Is lowering the number the same as lowering the risk? That's still unclear. If a low number is good, does that mean a lower number is even better? That seems to be the thinking, and I fear it's faulty logic.

All the women in my family have high cholesterol. None of us has had heart disease. My grandmother lived to be 98. My mother's in her 70s. So far, so good. I was on statins for a year or so and did not tolerate them well. My wonderful doc and I have agreed for now, no meds, just keep on eating well and exercising.

High cholesterol is a byproduct of starvation--you're right about that. It's a symptom of the insult to the organism. Metabolism is a delicate mechanism that seems easily disturbed. I hope yours settles out again very soon, and that your health improves, dreaming.

Kate Harding said...

All the talk about cholesterol is prompting me to ask: Harriet, have you read Gary Taubes's Good Calories, Bad Calories? I finally just started it, after months of hearing about it. You can guess how I feel about the concept of "bad calories," and I've already written "Zuh?" in the margins a couple times, but overall, I really admire his research and reasoning so far, even if I have a bunch of questions for him. (And even if I have far less faith in the value of an Atkins-style diet than he does.)

All of which is to say, what he says about cholesterol within the first 40 or 50 pages blew my mind -- and he traces exactly how "cholesterol = heart disease" went from being a barely tested and frankly not very promising hypothesis to an unassailable fact, according to the government -- without any pesky studies actually proving it in between.

The parallels to obesity policy (which is, of course, related to this) are pretty stunning. I haven't gotten to his section on obesity yet, and I don't know how I'll feel about it, but it's already worth the cover price for the education in how bad science becomes public policy.

thoughtracer said...

Yes. Big Pharma indeed. It's a huge industry, and why else would limits on obesity and hypertension be lowering? Why else would they be using medications for off-label uses as often as they do, before even any clinical trials have been completed (most notably in the psychiatric world, where I work). It's a big issue.

Susan B said...

I just had surgery three weeks ago, and during my intake interview, the nurse asked if I was one blood pressure medication. When I told her no, she responded, "that's very unusual for someone over 50." Huh?

Harriet said...

Kate, It's one of those books I keep meaning to read but am kind of afraid to. I'll do it, though, on your recommendation, especially because I'm interested in the cholesterol stuff. Thanks.

Deja, really?? That's ridiculous. I'm 49 and I don't think any of my friends are on blood pressure meds.

Thoughtracer, you work in the psychiatric world? We should chat sometime about psychiatry in Our Town. :-)

Anniee451 said...

By jove, I think you've got it. You had me at the "medicalization of childbirth" by the way. Well said!

Anonymous said...

I do think there's an awful lot of "pathologizing" of conditions that probably don't need to be "pathologized." My mom went through menopause about fifteen years ago and was kind of aghast at the pill-pushing and the subtle suggestions she go on hormones (she was having no complaints, no problems with it - it wasn't bothering her one bit but her doctor brought up the issue of meds). Of course this was before they learned of the increased heart disease risk.

I am always leery when some kind of "life improving" (as opposed to life-saving) medicine is promoted; I wonder whether it will still be seen as safe and beneficial 20 years from now, or if we'll all have class-action cases against the pharma company that pushed it.

I also cringe every time the cut-off for some health marker is "lowered." Or the requirement of something - like exercise or eating servings of vegetables - is raised. My attitude is like, "I'm TRYING, okay? Don't keep pushing me to do more more more or I'm just going to give up."

And I've heard the offhand comment about "statins in the water system" said by some fairly well-respected doctors. Even as an offhand comment, it kind of horrifies me.

Harriet said...

Interesting way to think about it, ricki. "Life-improving" versus "life-saving."

Though as someone who suffers from panic disorder (which doesn't kill you, just makes you wish you were dead), I'm glad there are some meds out there to help with that.

It does seem that when we start messing around with the metabolism in particular we usually fuck things up.

Anonymous said...

Actually, having known people with panic disorder, I'd put those meds in the "life saving" category. Not that they'd die without them, but that their lives would be considerably more difficult and less pleasant.

I hope my comment didn't come off as too flip; I seem to do that sometimes.

I guess I was kind of thinking about the differentiation between Botox used to hide smile lines on 33 year olds, versus Botox used for people who have Bell's Palsy...Or like some of the "weight loss" drugs that were later found out to dangerously mess with the heart and lungs.

Anonymous said...

I am one of the many of millions of Americans that believe that we are at the very early stages of an obesity crisis. I'm a third grade teacher and a former obese man. I won't give you my numbers because I'm not here to brag about that. Let's just say that no matter what you hear from the media, it wasn't easy. It took a year of discipline and lots of exercise to achieve my goals. But it is possible, if done correctly, and it is so worth it. The reason I say all of this is because I see many children at the elementary level who are carrying at least 50 lbs of excess weight. Sadly, the numbers seem to increase each year. I love these kids and I wish that their parents will find the means to help curb the health and sadly, the social problems that are headed their way. I liken the adjustment of the BMI and blood pressure numbers similar to the way they both raise and lower the national speed limit. They do it to benefit the nation as a whole. Sweet lord this post was long. Sorry, I can't be more eloquent but I'm drunk.

Harriet said...

Alexander, you're posting to the wrong site here.

You're not going to find any support for what you're saying on this blog.

I don't know what you're drinking, man, but your knee-jerk acceptance of the party line on obesity won't find any converts here. BMI is nothing more than the ratio between height and weight--it's not a magic number, and it doesn't correlate for the most part with health or mortality.

I don't know what you think those parents should be doing if their children really are overweight. Putting their kids on a diet? Most diets backfire. Children should be taught from an early age to honor their true hunger, to eat when they're hungry and stop when they're not. All diets do is fuck up your body's own metabolism and homeostasis. And make you much, much fatter in the long run.

You say you're a formerly obese man. I bet you were on lots of diets in your life. I bet you were put on some diets as a child, and they didn't work, and you gained more and more weight. That's how it usually goes. Parents can serve a variety of good foods (NOT so-called healthy eating, but foods with protein and fat and carbs and, yes, sugar). Parents can model exercise for the pleasure of it, not as a weight loss tool. And parents can watch their children closely for signs of dieting, which is the number two risk factor for developing an eating disorder (number one is genetics).

Come back sometime when you're not drunk and maybe we can have a real conversation.

Anonymous said...

Alexander, how long ago did you lose that weight? Unless it's more than five years, you're not telling anyone anything new. Lots of people lose weight. And 95 - 98% of people who lose more than 75 pounds gain it all back (plus some) in 3 years. Formerly obese people don't exist long-term, so far as I can tell.

The exception might be normally thin people who develop binge eating disorders, who eventually stop binging and lose the weight. But that's far from typical.

Anonymous said...

Argh, my apologies, that comment was supposed to be from AnnieMcPhee! Look, I am all for giving "Alexander" another shot - we all post stupid shit when we're drunk. He just might be in the "educable" category. And he's going to need FA when he puts all that weight back on, plus interest.