End the War on Obesity: Make Peace With Your Patient

December 31, 2006

Below in a very interesting article-

Comments anyone?

Ralph Giarnella MD

Southington Ct, USA

http://www.medscape.com/viewarticle/547543

End the War on Obesity: Make Peace With Your Patients

Bacon, MA, PhD

Medscape General Medicine. 2006;8(4):40.

Posted 11/27/2006

Your patients are desperate to lose weight. Given the

presumed health imperative, you feel justified in

supporting their goal. You encourage calorie

restriction and/or exercise.

The " weight problem, " however, never goes away.

Face the facts. We're losing the war on obesity. The

" commonsense " approach just isn't working. Weights are

increasing, particularly among dieters, and weight

preoccupation and eating disorders are also on the

rise.

Challenge your assumptions.

1. Weight has been greatly exaggerated as a health

risk.

Consider mortality. Except at statistical extremes,

BMI only weakly predicts longevity. Many studies

indicate " overweight " people live at least as long as

" normal " weight people.[1-3] " Overweight " may even be

ideal for longevity.[2]

Consider morbidity. Epidemiological studies rarely

acknowledge confounding factors like fitness,

activity, nutrient intake, weight cycling, or

socioeconomic status. Studies that do control for

these find increased morbidity disappears or at least

is sharply attenuated.[4]

2. Sustained weight loss is not a practical goal, nor

is it well established to improve health.

The vast majority of people regain lost weight,

regardless of whether they maintain their diet or

exercise programs.[5] And no one has ever proved that

losing weight prolongs life. Some studies actually

indicate that intentional weight loss increases the

risk of dying early from certain diseases.[6-11]

3. Health improvements can result from improved health

behaviors, regardless of whether weight is lost.[12]

Improvements in insulin sensitivity and blood lipids

have even been documented to occur in people who

actually gained body fat during an exercise

program![13,14]

There's an alternative to the war. The new peace

movement is called " Health at Every Size, " and it

acknowledges that health habits are more important

than the scale.[12]

Participation is simple. Quit hassling patients about

their weight. Stop prescribing weight loss. Encourage

people of all sizes to change focus from weight to

health. Support everyone in appreciating their bodies

and incorporating healthy lifestyle habits.

That's my opinion. I'm Dr. Bacon, Nutrition

Researcher, University of California, , and

Nutrition Professor, City College of San Francisco.

Sign Up now for a free monthly email that brings you

the top features from MedGenMed.

Readers are encouraged to respond to Lundberg,

MD, Editor of MedGenMed, for the editor's eyes only or

for possible publication via email:

glundberg@...

References

1. Durazo-Arvizu, R, McGee DL, RS, Liao Y,

Luke A. Mortality and optimal body mass index in a

sample of the US population. Am J Epidemiol.

1998;147:739-749. Abstract

2. Flegal KM, Graubard BI, on DF, Gail MH.

Excess deaths associated with underweight, overweight,

and obesity. JAMA. 2005;293:1861-1867. Abstract

3. Troiano R, Fronqillo EA Jr, Sobal J, Levitsky DA.

The relationship between body weight and mortality: a

quantitative analysis of combined information. Int J

Obes. 1996;20:63-75.

4. Campos P, Saquy A, Ernsberger P, Oliver E, Gaesser

G. The epidemiology of overweight and obesity: public

health crisis or moral panic? Int J Epidemiol.

2006;35:55-60. Abstract

5. WC. How effective are traditional dietary

and exercise interventions for weight loss? Med Sci

Sports Exerc. 1999;31:1129-1134.

6. on DF, Pamuk E, Thun M, Flanders D, Byers

T, Heath C. Prospective study of intentional weight

loss and mortality in never-smoking overweight U.S.

white women aged 40-64 years. Am J Epidemiol.

1995;141:1128-1141. Abstract

7. on DF, Pamuk E, Thun M, Flanders D, Byers

T, Heath C. Prospective study of intentional weight

loss and mortality in overweight white men aged 40-64

years. Am J Epidemiol. 1999;149:491-503. Abstract

8. Andres R, Muller DC, Sorkin JD. Long-term effects

of change in body weight on all-cause mortality. A

review. Ann Intern Med. 1993;119:737-743. Abstract

9. Yaari S, Goldbourt U. Voluntary and involuntary

weight loss: associations with long term mortality in

9,228 middle-aged and elderly men. Am J Epidemiol.

1998;148:546-555. Abstract

10. Gaesser G. Thinness and weight loss: beneficial

or detrimental to longevity. Med Sci Sports Exerc.

1999;31:1118-1128. Abstract

11. Sorensen TI, Rissanen A, Korkeila M, Kaprio J.

Intention to lose weight, weight changes, and 18-y

mortality in overweight individuals without

co-morbidities. PLoS Med. 2005;2:E171.

12. Bacon L, Stern JS, Van Loan MD, Keim NL. Size

acceptance and intuitive eating improve health for

obese, female chronic dieters. J Am Diet Assoc.

2005;105:929-936. Abstract

13. Lamarche B, Despres JP, Pouliot MC, et al. Is

body fat loss a determinant factor in the improvement

of carbohydrate and lipid metabolism following aerobic

exercise training in obese women? Metabolism.

1992;41:1249-1256.

14. Bjorntorp P, De Jounge K, Sjostrom L, Sullivan L.

The effect of physical training on insulin production

in obesity. Metabolism. 1970;19:631-638. Abstract

Bacon, MA, PhD, Nutrition Professor, City

College of San Francisco, San Francisco, California;

Associate Nutritionist, University of California,

Author's email address: linda@...

Disclosure: Bacon, MA, PhD, has disclosed no

relevant financial relationships in addition to her

academic employment, consulting services, and writing.

January 5, 2007

I think part of the problem with this truce is that it's based on weight alone,

and not body composition vs how the person performs in their daily tasks. The

overly fat and undermuscled both can be helped by changes in body weight and

aided by a doctor's encouragement and help to know what's reasonable and what is

expected, vs the barrage of misinformation easily found on informercials and

hearsay from the latest cabbage soup diets....

Why would a doctor not help someone who asked, if they were clearly not anorexic

and thus harming themselves? Isn't there some evidence that diabetes and other

diseases are less a hazard with as little as 10 lbs off the bodyweight? Joint

problems too are less a problem if the bodyweight is reduced...

And why would a doctor PRESUME that the person before him/her was DESTINED TO

FAIL based only on statistics? Not all regained their weight...and not all

regain ALL the weight either...and anything that gets people moving is a boon,

not a detriment!

Society has not declared such a truce. You can see the snap judgements anywhere

you see a heavy person walking through a public space or God forbid, EATING.

Discrimination against the overfat is still popular, in employment, and other

normal activities. Society also currently holds the severely undermuscled and

waif like in high regard, despite the obvious suffering and mental illness by

definition that accompany such wasting! Yet would a doctor not be remiss to

address the severely underweight too? Anorexia is a serious disease based on

lack of bodyweight, to call a truce on that would not be a service!

why then would a doctor declare a " truce " that society has not, in the face of

patients ASKING FOR HELP?

wouldn't that be like saying to a patient with a serious disease that since the

odds are you won't make it, i won't treat you or even talk to you about

treatment or survival? no doctor would do that, right?

Isn't it like presuming all children to be either gifted or stupid and treating

them all the same based on the fact that they are of a certain age?

I think the author of the article is wrong, the only point I agree with is that

addressing someone's weight SOLELY on the BMI and not observation and other

factors, say activity levels and what you can SEE, mobility, and other

clues....THAT is where they should stop addressing just weight. If the person

before you is fit, athletic, and clearly not overfat, then get off their case

SOLELY based on BMI tables.

But as the above other cases say, this is no time for a " truce " generally!

The Phantom

aka Schaefer, CMT, CSCS, competing powerlifter

Denver, Colorado, USA

End the War on Obesity: Make Peace With Your Patient

Below in a very interesting article-

Comments anyone?

Ralph Giarnella MD

Southington Ct, USA

http://www.medscape.com/viewarticle/547543

End the War on Obesity: Make Peace With Your Patients

Bacon, MA, PhD

Medscape General Medicine. 2006;8(4):40.

Posted 11/27/2006

Your patients are desperate to lose weight. Given the

presumed health imperative, you feel justified in

supporting their goal. You encourage calorie

restriction and/or exercise.

The " weight problem, " however, never goes away.

Face the facts. We're losing the war on obesity. The

" commonsense " approach just isn't working. Weights are

increasing, particularly among dieters, and weight

preoccupation and eating disorders are also on the

rise.

Challenge your assumptions.

1. Weight has been greatly exaggerated as a health

risk.

Consider mortality. Except at statistical extremes,

BMI only weakly predicts longevity. Many studies

indicate " overweight " people live at least as long as

" normal " weight people.[1-3] " Overweight " may even be

ideal for longevity.[2]

Consider morbidity. Epidemiological studies rarely

acknowledge confounding factors like fitness,

activity, nutrient intake, weight cycling, or

socioeconomic status. Studies that do control for

these find increased morbidity disappears or at least

is sharply attenuated.[4]

2. Sustained weight loss is not a practical goal, nor

is it well established to improve health.

The vast majority of people regain lost weight,

regardless of whether they maintain their diet or

exercise programs.[5] And no one has ever proved that

losing weight prolongs life. Some studies actually

indicate that intentional weight loss increases the

risk of dying early from certain diseases.[6-11]

3. Health improvements can result from improved health

behaviors, regardless of whether weight is lost.[12]

Improvements in insulin sensitivity and blood lipids

have even been documented to occur in people who

actually gained body fat during an exercise

program![13,14]

There's an alternative to the war. The new peace

movement is called " Health at Every Size, " and it

acknowledges that health habits are more important

than the scale.[12]

Participation is simple. Quit hassling patients about

their weight. Stop prescribing weight loss. Encourage

people of all sizes to change focus from weight to

health. Support everyone in appreciating their bodies

and incorporating healthy lifestyle habits.

That's my opinion. I'm Dr. Bacon, Nutrition

Researcher, University of California, , and

Nutrition Professor, City College of San Francisco.

Sign Up now for a free monthly email that brings you

the top features from MedGenMed.

Readers are encouraged to respond to Lundberg,

MD, Editor of MedGenMed, for the editor's eyes only or

for possible publication via email:

glundberg@...

References

1. Durazo-Arvizu, R, McGee DL, RS, Liao Y,

Luke A. Mortality and optimal body mass index in a

sample of the US population. Am J Epidemiol.

1998;147:739-749. Abstract

2. Flegal KM, Graubard BI, on DF, Gail MH.

Excess deaths associated with underweight, overweight,

and obesity. JAMA. 2005;293:1861-1867. Abstract

3. Troiano R, Fronqillo EA Jr, Sobal J, Levitsky DA.

The relationship between body weight and mortality: a

quantitative analysis of combined information. Int J

Obes. 1996;20:63-75.

4. Campos P, Saquy A, Ernsberger P, Oliver E, Gaesser

G. The epidemiology of overweight and obesity: public

health crisis or moral panic? Int J Epidemiol.

2006;35:55-60. Abstract

5. WC. How effective are traditional dietary

and exercise interventions for weight loss? Med Sci

Sports Exerc. 1999;31:1129-1134.

6. on DF, Pamuk E, Thun M, Flanders D, Byers

T, Heath C. Prospective study of intentional weight

loss and mortality in never-smoking overweight U.S.

white women aged 40-64 years. Am J Epidemiol.

1995;141:1128-1141. Abstract

7. on DF, Pamuk E, Thun M, Flanders D, Byers

T, Heath C. Prospective study of intentional weight

loss and mortality in overweight white men aged 40-64

years. Am J Epidemiol. 1999;149:491-503. Abstract

8. Andres R, Muller DC, Sorkin JD. Long-term effects

of change in body weight on all-cause mortality. A

review. Ann Intern Med. 1993;119:737-743. Abstract

9. Yaari S, Goldbourt U. Voluntary and involuntary

weight loss: associations with long term mortality in

9,228 middle-aged and elderly men. Am J Epidemiol.

1998;148:546-555. Abstract

10. Gaesser G. Thinness and weight loss: beneficial

or detrimental to longevity. Med Sci Sports Exerc.

1999;31:1118-1128. Abstract

11. Sorensen TI, Rissanen A, Korkeila M, Kaprio J.

Intention to lose weight, weight changes, and 18-y

mortality in overweight individuals without

co-morbidities. PLoS Med. 2005;2:E171.

12. Bacon L, Stern JS, Van Loan MD, Keim NL. Size

acceptance and intuitive eating improve health for

obese, female chronic dieters. J Am Diet Assoc.

2005;105:929-936. Abstract

13. Lamarche B, Despres JP, Pouliot MC, et al. Is

body fat loss a determinant factor in the improvement

of carbohydrate and lipid metabolism following aerobic

exercise training in obese women? Metabolism.

1992;41:1249-1256.

14. Bjorntorp P, De Jounge K, Sjostrom L, Sullivan L.

The effect of physical training on insulin production

in obesity. Metabolism. 1970;19:631-638. Abstract

Bacon, MA, PhD, Nutrition Professor, City

College of San Francisco, San Francisco, California;

Associate Nutritionist, University of California,

Author's email address: linda@...

Disclosure: Bacon, MA, PhD, has disclosed no

relevant financial relationships in addition to her

academic employment, consulting services, and writing.

January 6, 2007

states:

" I think part of the problem with this truce is that it's based on

weight alone, and not body composition vs how the person performs in

their daily tasks. "

, we are in complete agreement on this issue. Among other things

I am a licensed life and health insurance agent. One of the

perpetuators of the bogus " BMI " driven height/weight " obesity " charts

is the insurance industry. Heavily muscled individuals are dinged for

being " too heavy " for their height. However, with some companies it

may be possible to get a reduction in one's premium by getting a

physcian to validate one's general health through documentation of

low body fat, blood pressure, heart rate, etc. My company's

considering such exceptions, but it has to be on an individual basis

due to the industries' heavy reliance on the " law of big numbers " to

use statistics to determine rates. As an agent I have already

encountered this with a couple of my athlete/clients. We do our

underwriting in the field to determine rates, so I am trying to get

the company to develope a way for " big " athletes to apply for an

exception based on a physical.

Basing one's health insurance premiums on just height to bodyweight

is very unfair to the small portion of the population which is often

the most health conscious and the healthiest. But talk about fighting

city hall...

W.G.

Ubermensch Sports Consultancy

San Diego, Ca.

>

> I think part of the problem with this truce is that it's based on

weight alone, and not body composition vs how the person performs in

their daily tasks. The overly fat and undermuscled both can be

helped by changes in body weight and aided by a doctor's

encouragement and help to know what's reasonable and what is

expected, vs the barrage of misinformation easily found on

informercials and hearsay from the latest cabbage soup diets....

>

> Why would a doctor not help someone who asked, if they were clearly

not anorexic and thus harming themselves? Isn't there some evidence

that diabetes and other diseases are less a hazard with as little as

10 lbs off the bodyweight? Joint problems too are less a problem if

the bodyweight is reduced...

>

> And why would a doctor PRESUME that the person before him/her was

DESTINED TO FAIL based only on statistics? Not all regained their

weight...and not all regain ALL the weight either...and anything that

gets people moving is a boon, not a detriment!

>

> Society has not declared such a truce. You can see the snap

judgements anywhere you see a heavy person walking through a public

space or God forbid, EATING. Discrimination against the overfat is

still popular, in employment, and other normal activities. Society

also currently holds the severely undermuscled and waif like in high

regard, despite the obvious suffering and mental illness by

definition that accompany such wasting! Yet would a doctor not be

remiss to address the severely underweight too? Anorexia is a

serious disease based on lack of bodyweight, to call a truce on that

would not be a service!

>

> why then would a doctor declare a " truce " that society has not, in

the face of patients ASKING FOR HELP?

>

> wouldn't that be like saying to a patient with a serious disease

that since the odds are you won't make it, i won't treat you or even

talk to you about treatment or survival? no doctor would do that,

right?

>

> Isn't it like presuming all children to be either gifted or stupid

and treating them all the same based on the fact that they are of a

certain age?

>

> I think the author of the article is wrong, the only point I agree

with is that addressing someone's weight SOLELY on the BMI and not

observation and other factors, say activity levels and what you can

SEE, mobility, and other clues....THAT is where they should stop

addressing just weight. If the person before you is fit, athletic,

and clearly not overfat, then get off their case SOLELY based on BMI

tables.

>

> But as the above other cases say, this is no time for a " truce "

generally!

>

> The Phantom

> aka Schaefer, CMT, CSCS, competing powerlifter

> Denver, Colorado, USA

>

> End the War on Obesity: Make Peace With

Your Patient

>

> Below in a very interesting article-

> Comments anyone?

> Ralph Giarnella MD

> Southington Ct, USA

> http://www.medscape.com/viewarticle/547543

>

> End the War on Obesity: Make Peace With Your Patients

>

> Bacon, MA, PhD

>

> Medscape General Medicine. 2006;8(4):40.

> Posted 11/27/2006

>

> Your patients are desperate to lose weight. Given the

> presumed health imperative, you feel justified in

> supporting their goal. You encourage calorie

> restriction and/or exercise.

> The " weight problem, " however, never goes away.

> Face the facts. We're losing the war on obesity. The

> " commonsense " approach just isn't working. Weights are

> increasing, particularly among dieters, and weight

> preoccupation and eating disorders are also on the

> rise.

> Challenge your assumptions.

> 1. Weight has been greatly exaggerated as a health

> risk.

> Consider mortality. Except at statistical extremes,

> BMI only weakly predicts longevity. Many studies

> indicate " overweight " people live at least as long as

> " normal " weight people.[1-3] " Overweight " may even be

> ideal for longevity.[2]

> Consider morbidity. Epidemiological studies rarely

> acknowledge confounding factors like fitness,

> activity, nutrient intake, weight cycling, or

> socioeconomic status. Studies that do control for

> these find increased morbidity disappears or at least

> is sharply attenuated.[4]

> 2. Sustained weight loss is not a practical goal, nor

> is it well established to improve health.

> The vast majority of people regain lost weight,

> regardless of whether they maintain their diet or

> exercise programs.[5] And no one has ever proved that

> losing weight prolongs life. Some studies actually

> indicate that intentional weight loss increases the

> risk of dying early from certain diseases.[6-11]

> 3. Health improvements can result from improved health

> behaviors, regardless of whether weight is lost.[12]

> Improvements in insulin sensitivity and blood lipids

> have even been documented to occur in people who

> actually gained body fat during an exercise

> program![13,14]

> There's an alternative to the war. The new peace

> movement is called " Health at Every Size, " and it

> acknowledges that health habits are more important

> than the scale.[12]

> Participation is simple. Quit hassling patients about

> their weight. Stop prescribing weight loss. Encourage

> people of all sizes to change focus from weight to

> health. Support everyone in appreciating their bodies

> and incorporating healthy lifestyle habits.

> That's my opinion. I'm Dr. Bacon, Nutrition

> Researcher, University of California, , and

> Nutrition Professor, City College of San Francisco.

>

> Sign Up now for a free monthly email that brings you

> the top features from MedGenMed.

> Readers are encouraged to respond to Lundberg,

> MD, Editor of MedGenMed, for the editor's eyes only or

> for possible publication via email:

> glundberg@...

> References

> 1. Durazo-Arvizu, R, McGee DL, RS, Liao Y,

> Luke A. Mortality and optimal body mass index in a

> sample of the US population. Am J Epidemiol.

> 1998;147:739-749. Abstract

> 2. Flegal KM, Graubard BI, on DF, Gail MH.

> Excess deaths associated with underweight, overweight,

> and obesity. JAMA. 2005;293:1861-1867. Abstract

> 3. Troiano R, Fronqillo EA Jr, Sobal J, Levitsky DA.

> The relationship between body weight and mortality: a

> quantitative analysis of combined information. Int J

> Obes. 1996;20:63-75.

> 4. Campos P, Saquy A, Ernsberger P, Oliver E, Gaesser

> G. The epidemiology of overweight and obesity: public

> health crisis or moral panic? Int J Epidemiol.

> 2006;35:55-60. Abstract

> 5. WC. How effective are traditional dietary

> and exercise interventions for weight loss? Med Sci

> Sports Exerc. 1999;31:1129-1134.

> 6. on DF, Pamuk E, Thun M, Flanders D, Byers

> T, Heath C. Prospective study of intentional weight

> loss and mortality in never-smoking overweight U.S.

> white women aged 40-64 years. Am J Epidemiol.

> 1995;141:1128-1141. Abstract

> 7. on DF, Pamuk E, Thun M, Flanders D, Byers

> T, Heath C. Prospective study of intentional weight

> loss and mortality in overweight white men aged 40-64

> years. Am J Epidemiol. 1999;149:491-503. Abstract

> 8. Andres R, Muller DC, Sorkin JD. Long-term effects

> of change in body weight on all-cause mortality. A

> review. Ann Intern Med. 1993;119:737-743. Abstract

> 9. Yaari S, Goldbourt U. Voluntary and involuntary

> weight loss: associations with long term mortality in

> 9,228 middle-aged and elderly men. Am J Epidemiol.

> 1998;148:546-555. Abstract

> 10. Gaesser G. Thinness and weight loss: beneficial

> or detrimental to longevity. Med Sci Sports Exerc.

> 1999;31:1118-1128. Abstract

> 11. Sorensen TI, Rissanen A, Korkeila M, Kaprio J.

> Intention to lose weight, weight changes, and 18-y

> mortality in overweight individuals without

> co-morbidities. PLoS Med. 2005;2:E171.

> 12. Bacon L, Stern JS, Van Loan MD, Keim NL. Size

> acceptance and intuitive eating improve health for

> obese, female chronic dieters. J Am Diet Assoc.

> 2005;105:929-936. Abstract

> 13. Lamarche B, Despres JP, Pouliot MC, et al. Is

> body fat loss a determinant factor in the improvement

> of carbohydrate and lipid metabolism following aerobic

> exercise training in obese women? Metabolism.

> 1992;41:1249-1256.

> 14. Bjorntorp P, De Jounge K, Sjostrom L, Sullivan L.

> The effect of physical training on insulin production

> in obesity. Metabolism. 1970;19:631-638. Abstract

>

> Bacon, MA, PhD, Nutrition Professor, City

> College of San Francisco, San Francisco, California;

> Associate Nutritionist, University of California,

>

> Author's email address: linda@...

>

> Disclosure: Bacon, MA, PhD, has disclosed no

> relevant financial relationships in addition to her

> academic employment, consulting services, and writing.

>

January 7, 2007

I have two daughters who served in the Air Force and a

son who is in the Navy. In both the Air Force and the

Navy the BMI is used as the intial screening for

making weight. This is done on a yearly basis. If

an individual BMI is above the recommended number the

the airman or seamen undergoes body measurements which

consists of measuring waist, neck etc. If the

measurements fall within these guidelines then the

individual is fine otherwise they are on probation

and given a period of time to shape up. I am not

sure if skin fold thickness is use by either the Air

Force or the Navy.

Despite some of the the BMI's shortfalls it is still a

good screening test as long as the screener knows how

to use it and understands the exceptions (such as

muscled athletes), and knows how to deal with the

outliers.

Unfortunately as with many screening tools the BMI can

be misused by those who do not know how to use it or

interpret the data.

Athletes make up less than 5% of our population. For

95% of the population the BMI is still a good

screening tool.

Of the 3000 patients that I have in my active database

I can think of less than 5 who could be classified as

athletes for whom the BMI would not be a good

screening tool.

Ralph Giarnella MD

Southington Ct, USA

--- " W.G. 'Bill' "

wrote:

> states:

> " I think part of the problem with this truce is that

> it's based on

> weight alone, and not body composition vs how the

> person performs in

> their daily tasks. "

>

> , we are in complete agreement on this issue.

> Among other things

> I am a licensed life and health insurance agent. One

> of the

> perpetuators of the bogus " BMI " driven height/weight

> " obesity " charts

> is the insurance industry. Heavily muscled

> individuals are dinged for

> being " too heavy " for their height. However, with

> some companies it

> may be possible to get a reduction in one's premium

> by getting a

> physcian to validate one's general health through

> documentation of

> low body fat, blood pressure, heart rate, etc. My

> company's

> considering such exceptions, but it has to be on an

> individual basis

> due to the industries' heavy reliance on the " law

> of big numbers " to

> use statistics to determine rates. As an agent I

> have already

> encountered this with a couple of my

> athlete/clients. We do our

> underwriting in the field to determine rates, so I

> am trying to get

> the company to develope a way for " big " athletes to

> apply for an

> exception based on a physical.

> Basing one's health insurance premiums on just

> height to bodyweight

> is very unfair to the small portion of the

> population which is often

> the most health conscious and the healthiest. But

> talk about fighting

> city hall...

>

> W.G.

> Ubermensch Sports Consultancy

> San Diego, Ca.

>

> >

> > I think part of the problem with this truce is

> that it's based on

> weight alone, and not body composition vs how the

> person performs in

> their daily tasks. The overly fat and undermuscled

> both can be

> helped by changes in body weight and aided by a

> doctor's

> encouragement and help to know what's reasonable and

> what is

> expected, vs the barrage of misinformation easily

> found on

> informercials and hearsay from the latest cabbage

> soup diets....

> >

> > Why would a doctor not help someone who asked, if

> they were clearly

> not anorexic and thus harming themselves? Isn't

> there some evidence

> that diabetes and other diseases are less a hazard

> with as little as

> 10 lbs off the bodyweight? Joint problems too are

> less a problem if

> the bodyweight is reduced...

> >

> > And why would a doctor PRESUME that the person

> before him/her was

> DESTINED TO FAIL based only on statistics? Not all

> regained their

> weight...and not all regain ALL the weight

> either...and anything that

> gets people moving is a boon, not a detriment!

> >

> > Society has not declared such a truce. You can

> see the snap

> judgements anywhere you see a heavy person walking

> through a public

> space or God forbid, EATING. Discrimination against

> the overfat is

> still popular, in employment, and other normal

> activities. Society

> also currently holds the severely undermuscled and

> waif like in high

> regard, despite the obvious suffering and mental

> illness by

> definition that accompany such wasting! Yet would a

> doctor not be

> remiss to address the severely underweight too?

> Anorexia is a

> serious disease based on lack of bodyweight, to call

> a truce on that

> would not be a service!

> >

> > why then would a doctor declare a " truce " that

> society has not, in

> the face of patients ASKING FOR HELP?

> >

> > wouldn't that be like saying to a patient with a

> serious disease

> that since the odds are you won't make it, i won't

> treat you or even

> talk to you about treatment or survival? no doctor

> would do that,

> right?

> >

> > Isn't it like presuming all children to be either

> gifted or stupid

> and treating them all the same based on the fact

> that they are of a

> certain age?

> >

> > I think the author of the article is wrong, the

> only point I agree

> with is that addressing someone's weight SOLELY on

> the BMI and not

> observation and other factors, say activity levels

> and what you can

> SEE, mobility, and other clues....THAT is where they

> should stop

> addressing just weight. If the person before you is

> fit, athletic,

> and clearly not overfat, then get off their case

> SOLELY based on BMI

> tables.

> >

> > But as the above other cases say, this is no time

> for a " truce "

> generally!

> >

> > The Phantom

> > aka Schaefer, CMT, CSCS, competing

> powerlifter

> > Denver, Colorado, USA

> >

> > End the War on Obesity:

> Make Peace With

> Your Patient

> >

> > Below in a very interesting article-

> > Comments anyone?

> > Ralph Giarnella MD

> > Southington Ct, USA

> > http://www.medscape.com/viewarticle/547543

> >

> > End the War on Obesity: Make Peace With Your

> Patients

> >

> > Bacon, MA, PhD

> >

> > Medscape General Medicine. 2006;8(4):40.

> > Posted 11/27/2006

> >

> > Your patients are desperate to lose weight.

> Given the

> > presumed health imperative, you feel justified

> in

> > supporting their goal. You encourage calorie

> > restriction and/or exercise.

> > The " weight problem, " however, never goes away.

> > Face the facts. We're losing the war on obesity.

> The

> > " commonsense " approach just isn't working.

> Weights are

> > increasing, particularly among dieters, and

> weight

> > preoccupation and eating disorders are also on

> the

> > rise.

> > Challenge your assumptions.

> > 1. Weight has been greatly exaggerated as a

> health

> > risk.

> > Consider mortality. Except at statistical

> extremes,

>

=== message truncated ===

January 7, 2007

On Barry Ross's forum, I asked members to offer their 'epiphany' moments,

experiences which changed their perceptions on the way to train or coach

athletes. One member wrote the following:

" I was working with a 35 year old woman,not an athlete, but someone who

looked slim and fit, who was trying to start running and martial arts training.

We were working on her mental attitude, as she had been feeling depressed and

in a rut, and was tired all the time. Almost too tired to do any training

except stretching.

To get her back in touch (or so I thought) with when she had been at peak

fitness, I innocently asked her to " think of a time when " she was fit and

healthy and full of vitality.

There was this long pause, and then she burst into tears. It turned out that

she had NEVER felt fit or fully healthy in her entire life!

It was a stunner for me. Until that point I had no idea that there are some

people who have NEVER been fit and have no experience of what it feels like. "

Ken Jakalski

Lisle HS

Lisle, Illinois

January 7, 2007

Dr. Giarnella states, I am sure very accurately:

" Athletes make up less than 5% of our population. For

95% of the population the BMI is still a good

screening tool. "

What a sad commentary on the state of fitness in this country, that

such a large portion of the population is able to be accurately

screened using BMI as a tool. How many of these " non-athletes " are

fit? I know a lot of men and women go to the gym to acquire a modicum

of fitness and to look good naked that are not athletes. There are

also the weekend warriors who " play " on their days off. Assuming

these catagories constitute another 10% of the population, that means

85% of our fellow citizens don't exercise and are likely not very fit

at all.

What can be done to get these " coronaries in waiting " off their

collective fat asses and out getting some exercise?

W.G.

Ubermensch Sports Consultancy

San Diego, Ca.

>

> I have two daughters who served in the Air Force and a

> son who is in the Navy. In both the Air Force and the

> Navy the BMI is used as the intial screening for

> making weight. This is done on a yearly basis. If

> an individual BMI is above the recommended number the

> the airman or seamen undergoes body measurements which

> consists of measuring waist, neck etc. If the

> measurements fall within these guidelines then the

> individual is fine otherwise they are on probation

> and given a period of time to shape up. I am not

> sure if skin fold thickness is use by either the Air

> Force or the Navy.

>

> Despite some of the the BMI's shortfalls it is still a

> good screening test as long as the screener knows how

> to use it and understands the exceptions (such as

> muscled athletes), and knows how to deal with the

> outliers.

>

> Unfortunately as with many screening tools the BMI can

> be misused by those who do not know how to use it or

> interpret the data.

>

> Athletes make up less than 5% of our population. For

> 95% of the population the BMI is still a good

> screening tool.

>

> Of the 3000 patients that I have in my active database

> I can think of less than 5 who could be classified as

> athletes for whom the BMI would not be a good

> screening tool.

>

> Ralph Giarnella MD

> Southington Ct, USA

>

January 8, 2007

--- CoachJ1@... wrote:

> On Barry Ross's forum, I asked members to offer

> their 'epiphany' moments,

> experiences which changed their perceptions on the

> way to train or coach

> athletes. One member wrote the following:

>

> " I was working with a 35 year old woman,not an

> athlete, but someone who

> looked slim and fit, who was trying to start running

> and martial arts training.

> We were working on her mental attitude, as she had

> been feeling depressed and

> in a rut, and was tired all the time. Almost too

> tired to do any training

> except stretching.

>

> To get her back in touch (or so I thought) with

> when she had been at peak

> fitness, I innocently asked her to " think of a time

> when " she was fit and

> healthy and full of vitality.

>

> There was this long pause, and then she burst into

> tears. It turned out that

> she had NEVER felt fit or fully healthy in her

> entire life!

>

> It was a stunner for me. Until that point I had no

> idea that there are some

> people who have NEVER been fit and have no

> experience of what it feels like. "

>

> Ken Jakalski

> Lisle HS

> Lisle, Illinois

In line with your experience the following article in

today's New York Times will shed some light on the

growing problem. The sad lesson from the article

below is that overweight children are considered be ok

by their parents and their peers and the normal weight

children are considered to be too thin.

The article also further illustrates the problems

faced by this generation of children, namely, the lack

of opportunities of even simple Phys ed, and the

abundance of bad choices which abound both at the

school cafeterias as well as the local food vendors.

Ken, as one who is obviously involved with a High

School, could you comment on what percentage of the

student body at your school actually participates in

sports?

My observation has been that the peak of sports

activity for the majority of children is 12-13 years

old. At least in our community there is good

participation int the youth league's however once they

reach middle school (6-8th grade) and high school the

majority of children stop participating in sports and

only the " jocks " continue in any sporting activity.

The percentage of individuals who continue to

participate in any kind of active sport drops

precipitously after grammar school.

Ralph Giarnella MD

Southington Ct, USA

January 8, 2007

As Obesity Fight Hits Cafeteria, Many Fear a Note From

School

By JODI KANTOR

BLOSSBURG, Pa. — Six-year-old Karlind Dunbar barely

touched her dinner, but not for time-honored

6-year-old reasons. The pasta was not the wrong shape.

She did not have an urgent date with her dolls.

The problem was the letter Karlind discovered, tucked

inside her report card, saying that she had a body

mass index in the 80th percentile. The first grader

did not know what “index” or “percentile” meant, or

that children scoring in the 5th through 85th

percentiles are considered normal, while those scoring

higher are at risk of being or already overweight.

Yet she became convinced that her teachers were

chastising her for overeating.

Since the letter arrived, “my 2-year-old eats more

than she does,” said anna Dunbar, Karlind’s

mother, who complained to the school and is trying to

help her confused child. “She’s afraid she’s going to

get in trouble,” Ms. Dunbar said.

The practice of reporting students’ body mass scores

to parents originated a few years ago as just one

tactic in a war on childhood obesity that would be

fought with fresh, low-fat cafeteria offerings and

expanded physical education. Now, inspired by

impressive results in a few well-financed programs,

states including Delaware, South Carolina and

Tennessee have jumped on the B.M.I. bandwagon, turning

the reports — in casual parlance, obesity report cards

— into a new rite of childhood.

Legislators in other states, including New York, have

proposed them as well, while some individual school

districts have adopted the practice.

Here, in the rural Southern Tioga School District, the

schools distribute the state-mandated reports even as

they continue to serve funnel cakes and pizza for

breakfast. Some students have physical education for

only half the school year, even though 34 percent of

kindergartners were overweight or at risk for it,

according to 2003-4 reports.

Even health authorities who support distributing

students’ scores worry about these inconsistent

messages, saying they could result in eating disorders

and social stigma, misinterpretation of numbers that

experts say are confusing, and a sense of helplessness

about high scores.

“It would be the height of irony if we successfully

identified overweight kids through B.M.I. screening

and notification while continuing to feed them

atrocious quality meals and snacks, with limited if

any opportunities for phys ed in school,” said Dr.

Ludwig, director of the Optimal Weight for Life

program at Children’s Hospital Boston.

The farmers and foundry workers here in north-central

Pennsylvania have different ideas about weight than

those of the medical authorities who set the standards

(the percentiles are based on pre-1980 measurements

because the current population of children is too

heavy to use as a reference). Here, the local pizza

chain is called Pudgie’s. Nearby Mansfield’s fanciest

restaurant serves its grilled chicken salad piled with

fries.

Nearly 60 percent of eighth graders in the district

scored in the 85th percentile or higher in 2003-4;

more than a quarter had scores in the 95th percentile

or higher, meaning they were officially overweight.

As it is for adults, the body mass index for children

is a ratio of height to weight, but the juvenile

numbers are also classified by age and sex, and the

word “obese” is not used.

Holly Berguson, the homecoming queen at North Penn

Junior-Senior High School here, wears a size 20, a

fact cited by her many admirers as proof of this

community’s generous attitude toward weight, its proud

indifference to the “Baywatch” bodies on television.

“I don’t care how big I am,” said Holly, 17, who is

insulin resistant, a condition that often precedes

Type 2 diabetes. “It’s not what you look like, it’s

who you are.”

Part of the rationale behind the reports is that they

are an extension of the height and weight checks that

schools have traditionally conducted.

But here, the letters sent home with report cards have

been a shock. Many parents threw them out, outraged to

be told how much their children should weigh or

unconvinced that children who look just fine by local

standards are too large by official ones. Seventh

graders traded scores during lunch periods. And more

than a few children, like Karlind, no longer wanted to

eat, students and parents said.

This year, Pennsylvania requires body mass index

notification for students in kindergarten through

eighth grades. Holly will graduate before it is

required at the high school next fall. Her confidence

about her body — she is a lifeguard and wears a

bathing suit without embarrassment — says something

about how the perception of childhood obesity has

changed from earlier generations.

Among children, teasing and weight have always gone

together, but now, says Doris Sargent, principal of

Mansfield’s elementary school, there are so many

overweight children that “you can’t pick on

everybody.” Here, two kinds of children are teased

about their weight: the hugely fat and the thin.

Children who are merely big “pick on skinnier kids

because they don’t like their own weight,” said Cassie

, a wiry ninth grader at Mansfield Junior-Senior

High School who has been taunted as anorexic, as she

and her friends sat over a lunch of brown-edged

iceberg lettuce piled with artificial bacon bits and

neat discs of chicken parmesan in the cafeteria.

A few miles away, at North Penn Junior-Senior High

School, a cluster of bleary-eyed girls gathered before

the start of classes, complaining that the letters

chided them for a situation they were helpless to fix.

“It would be different if we had something to do

rather than eat,” said one, Shauna Gerow.

On a recent school trip to New York, the girls felt

like visitors from a different, chubbier planet, they

said.

“They’re all this big,” said Cassie Chase, holding her

arms close together, “and we’re all this big,” she

said, flinging them wide open.

The letters made some recipients feel the same way but

left them unsure what to do about it.

Sick, food services director for the school

district, has been phasing in healthier foods despite

budgetary obstacles and students who prefer white

bread over whole wheat. The school district has

revamped its menus, eliminating Gatorade and the

powdered sugar from the funnel cakes. But it still

sends a nutritionally mixed message: birthday cupcakes

are discouraged while cafeterias sell ice cream

sandwiches and Rice Krispie treats, which some

students buy five at a time.

The district’s cafeterias recently introduced kiwi and

field greens, which drew enthusiastic reviews, but

because of the high cost, they are now back to canned

fruit and iceberg lettuce. Officials, while trying

hard to address the concerns, acknowledge that change

may take several more years.

Along the same lines, all students receive some form

of physical education each year. But some students

live 45 minutes from school: by the time they get

home, it is too dark and cold to play outside. And the

administrators point out that many children with

weight problems also need tutoring after school, so

they have to choose between extra help and team

sports.

School administrators here say they do not have the

resources of their counterparts in Arkansas, which

slowed the rate of increase of its childhood obesity

using money drawn from a state tobacco settlement

windfall.

Nor can they afford exotic gym fare like the Pilates

and kayaking now offered in the Miami-Dade County

Public Schools, where high school students who had

scores in the 95th percentile and above have lost an

average of eight pounds a semester.

To successfully change students’ eating habits,

schools would need to counsel each child and provide

“really high-quality nutrition and physical activity

assessments,” said Schwartz, director of

research and school programs at the Rudd Center for

Food Policy and Obesity at Yale. “How often are they

eating fruits and vegetables? How much soda are they

drinking?”

Bové is the mother of three children who

attend the Blossburg schools. She clutched a picture

of her 9-year-old son, Christian, in a bathing suit,

to prove that he was not “at risk of overweight,” as

his 92nd percentile score had indicated.

The letter was inaccurate — and useless, Ms. Bové

said. “The school provides us with this information

with no education about how to use it or what it

means,” she said.

Ms. Bové is more worried about her daughter Alora, age

8, who has lately taken up carrot sticks and constant

weigh-ins. “She walks out of the bathroom saying, ‘I

weigh 68 pounds, and none of you can say that,’ ” Ms.

Bové said.

For the kind of young woman who counts every kernel of

no-butter popcorn, the index reports can be dangerous,

some experts said.

“A letter from school feels evaluative,” said M.

Vitousek, a professor of psychology at the University

of Hawaii and a specialist in eating disorders.

Declaring a weight healthy “without knowing the

background of how the kid got there, you’re affirming

kids who have actively done something to suppress

weight,” she said.

The practice of reporting body mass index scores in

schools has gone from pilot program to mass weigh-in

despite “no solid research” on either its physical or

psychological impact, and “no controlled randomized

trial,” said Ms. Schwartz of Yale. “Entire states are

adopting a policy that has not been tested.”

Individual school districts like Miami’s and New York

City’s are issuing personalized fitness reports for

students that list their abdominal crunches and the

pace of their one-mile runs along with their body mass

index scores.

The federal Centers for Disease Control and Prevention

is expected soon to issue a policy statement on the

reports, providing guidelines about their benefits and

risks, an agency spokesperson said. Meanwhile,

supporters of the reports said that some of the

problems experienced here — shocked parents,

uncomfortable revelations — are precisely the point.

“If families had an accurate perception of the issue,

we wouldn’t need B.M.I. screening,” said Dr. Ludwig of

Children’s Hospital Boston. “There are so many

overweight children that perceptions are getting

distorted about what’s normal and healthy.”

While the body mass index is not a perfect test, Dr.

Ludwig said it is an effective, low-cost screening

tool. He cited a 2005 study published in The New

England Journal of Medicine that suggested the current

generation of children might have shorter life

expectancies than their parents.

“The consequences of childhood obesity,” he said, “are

too great to ignore.”

January 8, 2007

Hi Ralph!

In a recent post you asked the following:

as one who is obviously involved with a High

School, could you comment on what percentage of the

student body at your school actually participates in

sports?

***

We have 570 students in Lisle HS. About 200 athletes compete in our sports

program, or about 1/3rd of the entire student body. You are indeed correct

in that, at least at our school, participation drops considerably once kids

enter high school. Part of this is just the 'selectivity' of some sports that

will 'cut,' like basketball, volleyball, and baseball.

One of the schools in our conference actually approved a 'no-cut' policy in

an effort to keep more kids out. That did not work very well, because it

created all kinds of additional problems related to staffing, scheduling of

contests, etc. Other schools like ours have tried things like organized

intramurals, but these programs have been more successful at the junior high

than high

school level.

Many kids get jobs as sophomores, and that also impacts on participation.

Your assessment of good

participation in the youth leagues and 'clubs' is also accurate. We are

similar in that the percentage of individuals competing declines as kids get

older.

I believe our physical education department does an excellent job creating

units that emphasize liftetime skills, health consciousness, and overall well

being. We are fortunate to have many resources for self-assessment and

individual goal setting, like the Polar heart monitoring program. Though I

don't

teach PE or health, I know that those who do take these units very

seriously. Lisle is fairly affluent suburban community west of Chicago, so I

don't

know to what extent socio-economics influences participation or health

awareness.

I'll see if I can come up with some data relative to BMI for our students.

Thanks for asking!

Ken Jakalski

Lisle HS

Lisle, Illinois

January 8, 2007

Below is another article in today's news that

illustrates the problems our generation of children

face.

Ralph Giarnella MD

Southington Ct, USA

SEATTLE

POST-INTELLIGENCER?http://seattlepi.nwsource.com/national/1110AP_Diet_Fat_Tweens\

..html

Sunday, January 7, 2007 · Last updated 9:26 p.m. PT

Study: Tween girls at risk for fatness

By LAURAN NEERGAARD?AP MEDICAL WRITER

WASHINGTON -- As if being a tween is not hard enough,

scientists now call the years between 9 and 12 a time

when girls are especially at risk of getting fat.

Girls are more likely to become overweight in those

preteen years than when they are teenagers,

researchers report Monday in The Journal of

Pediatrics.

The study did not say why that was and did not examine

boys to know whether they face a similar risk.

But it did highlight consequences of that adolescent

weight gain. Chubby tweens already were seeing their

blood pressure and cholesterol levels inch up, backing

up earlier research that fat's toll on the arteries

begins early. Also, being overweight in childhood

brought more than a tenfold risk of a youngster's

growing into a fat adult.

Parents should pay attention to creeping waistlines

and poor dietary habits, particularly in this age

group, said Dr. Simons-Morton of the National

Institutes of Health, which funded the research.

" It seems to be a particularly vulnerable period, "

said Simons-Morton, who heads obesity-prevention

efforts at the NIH's National Heart, Lung and Blood

Institute.

Some 17 percent of U.S. youngsters are obese and

millions more are overweight, a problem affecting all

ages. Overweight children are at risk of developing

diabetes and they grow into overweight adults who, in

turn, develop heart disease and other ailments.

The study tracked more than 2,300 white and black

girls starting at age 9. Researchers measured height,

weight, blood pressure and cholesterol every year

through 18. Participants were called in their early

20s to check their weight.

Some 7.4 percent of the white girls and 17.4 percent

of the blacks already were overweight by 9. Each year

through age 12, between 2 percent and 5 percent of the

remaining girls became overweight, reported

of the land Medical Research Institute,

the paper's lead author.

After the girls reached 12, new cases leveled off to

between 1 percent and 2 percent a year.

Other research has shown that the preteen years are

when youngsters switch from heeding parents' dietary

advice to eating like their friends do, Simons-Morton

said. Less physical activity plays a role, too. She

recalls from her own daughters' tween years long

sedentary hours on the phone and worries about getting

sweaty.

" It should be cool to be physically active, and

attractive, " she said.

January 8, 2007

It seems to be taboo, as I haven't read it anywhere, perhaps do to the

disease called political correctness that our food industry is all about

profit rather than nutrition.

I'm also sure, there would be a rash of descent if every school in the

Nation required every student to spend the first part of the day walking a

mandatory 2 miles as well as finishing the day with a mandatory 2 miles.

Of course, we can't do this because it might offend someone or, infringe

on free choice, even though not doing it infringes on all of our health care

costs.

Carson Wood.

Maine, USA

> --- CoachJ1@... wrote:

>

>> On Barry Ross's forum, I asked members to offer

>> their 'epiphany' moments,

>> experiences which changed their perceptions on the

>> way to train or coach

>> athletes. One member wrote the following:

>>

>> " I was working with a 35 year old woman,not an

>> athlete, but someone who

>> looked slim and fit, who was trying to start running

>> and martial arts training.

>> We were working on her mental attitude, as she had

>> been feeling depressed and

>> in a rut, and was tired all the time. Almost too

>> tired to do any training

>> except stretching.

>>

>> To get her back in touch (or so I thought) with

>> when she had been at peak

>> fitness, I innocently asked her to " think of a time

>> when " she was fit and

>> healthy and full of vitality.

>>

>> There was this long pause, and then she burst into

>> tears. It turned out that

>> she had NEVER felt fit or fully healthy in her

>> entire life!

>>

>> It was a stunner for me. Until that point I had no

>> idea that there are some

>> people who have NEVER been fit and have no

>> experience of what it feels like. "

>>

>> Ken Jakalski

>> Lisle HS

>> Lisle, Illinois

>

> In line with your experience the following article in

> today's New York Times will shed some light on the

> growing problem. The sad lesson from the article

> below is that overweight children are considered be ok

> by their parents and their peers and the normal weight

> children are considered to be too thin.

>

> The article also further illustrates the problems

> faced by this generation of children, namely, the lack

> of opportunities of even simple Phys ed, and the

> abundance of bad choices which abound both at the

> school cafeterias as well as the local food vendors.

>

> Ken, as one who is obviously involved with a High

> School, could you comment on what percentage of the

> student body at your school actually participates in

> sports?

>

> My observation has been that the peak of sports

> activity for the majority of children is 12-13 years

> old. At least in our community there is good

> participation int the youth league's however once they

> reach middle school (6-8th grade) and high school the

> majority of children stop participating in sports and

> only the " jocks " continue in any sporting activity.

> The percentage of individuals who continue to

> participate in any kind of active sport drops

> precipitously after grammar school.

>

> Ralph Giarnella MD

> Southington Ct, USA

January 8, 2007

--- Carson Wood wrote:

> It seems to be taboo, as I haven't read it anywhere,

> perhaps do to the

> disease called political correctness that our food

> industry is all about

> profit rather than nutrition.

> I'm also sure, there would be a rash of descent

> if every school in the

> Nation required every student to spend the first

> part of the day walking a

> mandatory 2 miles as well as finishing the day with

> a mandatory 2 miles.

> Of course, we can't do this because it might

> offend someone or, infringe

> on free choice, even though not doing it infringes

> on all of our health care

> costs.

>

More effective than " making " people do this would be

building communities that enable it.

Questions for consideration:

How walkable is your town?

How effective is public transit (which by definition

usually involves some walking to stations and stops)?

How many bike lanes, walking paths, and hiking trails

does your community have?

What about basketball courts, ice rinks, public pools,

public-use sports fields, playgrounds, and parks?

Does your community invest in its sports and

recreation?

Do people feel safe going out during the day or in the

evening? Do they feel safe sending their children out

to play or walk?

Do people want to go out because there is something

close to them that invites activity or congregation?

(For example, close to me is a park with an open air

ice rink -- it's like Grand Central Station most of

the time)

Are there sidewalks? Do they actually go anywhere?

Are there park benches and little chess tables and

public squares and other architectural elements that

encourage public congregation and public space use?

Are there places to walk to -- activities and

commercial enterprises that invite participation and

patronage from people of all ages?

Is it sufficiently inconvenient to drive that walking,

cycling, rollerblading, etc. is more practical and

preferable?

Is space laid out to emphasize the dominance of the

car or the pedestrian? (In many mall parking lots, you

take your life in your hands by crossing the pavement)

Is good healthy food easily available and

cost-effective?

Do you know where the stairs are in your workplace and

public spaces, and is it convenient to use them? Are

they prominently featured or are they hidden behind

the hot water pipes with the door locked?

Structural changes have enormous effects on people's

choices -- far more so, arguably, than telling them to

do XYZ. If we want our kids to walk to school, for

instance, then we need to make it practical and

feasible for them to do it. We need to both push and

pull them into activity.

Best wishes,

Krista -Dixon

Toronto, ON

January 8, 2007

> Do people feel safe going out during the day or in the

> evening? Do they feel safe sending their children out

> to play or walk?

> Do people want to go out because there is something

> close to them that invites activity or congregation?

There's a cultural element here too: in addition to the criminal

neglect of the siesta, we've failed to adopt the traditional evening

stroll found in Italy, the Passaggiata.

http://goitaly.about.com/od/italytravelglossary/g/passeggiata.htm

-- Roy

[Moderator: Please sign all letters with your full name and the city/country

where you live - thanks!]

January 8, 2007

The fitness industry has never been " healthier. " Please refer

to the following file which I recently uploaded to ST:

http://f1.grp.yahoofs.com/v1/wKKiRdR3XGj6kkszbne2AgJys8QvqVorr8tSv7um2

BW7FeuKkSbBfBbJSHlX6Zg6e9nesbDT_qLME1cqe4TL/Obesogenic%

20environment.bmp

The picture was taken from Lipman's presentation regarding

active travel (www.Sustrans.co.uk).

Carruthers

Wakefield, UK

>

> On Barry Ross's forum, I asked members to offer their 'epiphany'

moments,

> experiences which changed their perceptions on the way to train or

coach

> athletes. One member wrote the following:

>

> " I was working with a 35 year old woman,not an athlete, but

someone who

> looked slim and fit, who was trying to start running and martial

arts training.

> We were working on her mental attitude, as she had been feeling

depressed and

> in a rut, and was tired all the time. Almost too tired to do any

training

> except stretching.

>

> To get her back in touch (or so I thought) with when she had been

at peak

> fitness, I innocently asked her to " think of a time when " she was

fit and

> healthy and full of vitality.

>

> There was this long pause, and then she burst into tears. It

turned out that

> she had NEVER felt fit or fully healthy in her entire life!

>

> It was a stunner for me. Until that point I had no idea that there

are some

> people who have NEVER been fit and have no experience of what it

feels like. "

>

January 8, 2007

The problem of obesity, I think, lies in the whole setup of the

society. We primarily chase money and careers. Since the sixties,

Americans were able to work less in order to maintain the same

lifestyle. Still, most work more than 8 hours a day, just to achieve

the acceptable social goals: the house, car, clothes etc.

On the other hand there is the explosion of junk food industry. Now

you spend less time cooking. But even many so called health products

are ladden with preservatives and additives.

Then there is the modern medicine. If you are slobbing around and

getting all ill because of that, we will give you pills and keep you

going. Antihypertensives, drugs for type II diabetes, statins, for

instance, are becoming as common in households as candy. And if you

are still not happy - antidepressants will do the trick!

Then there is TV. How can you miss the latest on Dancing With The

Stars or whoever is kicked out of Big Brother or another survival

crap! Missing another serial killer investigation on CSI Miami is a

crime by itself. It looks, though, that there are more serial

killers than people who exercise around TV also reinforces bad

eating habits.

TV also creates regular exercise and diet fads. All kind of machines

are sold on the daily basis. I wonder if I can try and sell a walk

or a pushup! Or the idea to eat more veggies!

Ninety nine percent of people ahen asked about exercise will say

that they have no time for it. Though watching an hour of whatever

rubbish on the box is never a problem.

The solution... The lifestyle must be changed, and quite radically.

We can create diets that are easier to follow or exercise systems

less taxing psychologically. But only to a point. Work less. Watch

less TV. Spend more time cooking proper food. Find time to

exercise... I am not sure how enthusiastic I can get about all this.

[Mod: Please don't forget to sign your posts with your full name, city and

country - thanks]

January 8, 2007

Thank you for your response. As a small HS the sports

participation is probably much higher than the norm in

the biger schools. As a suburban school I suspect that

there is also a higher than average participation

since there are less students who have to work after

school.

In the City school where my daughter teaches High

School there are 3000 students and while they have a

full sports program I suspect that no more than 500

students participate in organized competitive sports (

there are only so many athletes you can put on a

basketball team no matter how big your school is). In

a city school with limited funds the sports are

limited to the tradition sports (no hockey, swimming,

lacrosse etc). I would guess that not ore 16% of the

student body participates in any sports.

Once these students leave school what percentage do

you think will continue to participate in any kind of

sport?

Ralph Giarnella MD

Southington Ct, USA

--- CoachJ1@... wrote:

> Hi Ralph!

> In a recent post you asked the following:

>

> as one who is obviously involved with a High

> School, could you comment on what percentage of the

> student body at your school actually participates

> in

> sports?

>

> ***

> We have 570 students in Lisle HS. About 200

> athletes compete in our sports

> program, or about 1/3rd of the entire student body.

> You are indeed correct

> in that, at least at our school, participation drops

> considerably once kids

> enter high school. Part of this is just the

> 'selectivity' of some sports that

> will 'cut,' like basketball, volleyball, and

> baseball.

>

> One of the schools in our conference actually

> approved a 'no-cut' policy in

> an effort to keep more kids out. That did not work

> very well, because it

> created all kinds of additional problems related to

> staffing, scheduling of

> contests, etc. Other schools like ours have tried

> things like organized

> intramurals, but these programs have been more

> successful at the junior high than high

> school level.

>

> Many kids get jobs as sophomores, and that also

> impacts on participation.

> Your assessment of good

> participation in the youth leagues and 'clubs' is

> also accurate. We are

> similar in that the percentage of individuals

> competing declines as kids get

> older.

>

> I believe our physical education department does an

> excellent job creating

> units that emphasize liftetime skills, health

> consciousness, and overall well

> being. We are fortunate to have many resources for

> self-assessment and

> individual goal setting, like the Polar heart

> monitoring program. Though I don't

> teach PE or health, I know that those who do take

> these units very

> seriously. Lisle is fairly affluent suburban

> community west of Chicago, so I don't

> know to what extent socio-economics influences

> participation or health awareness.

>

> I'll see if I can come up with some data relative to

> BMI for our students.

>

> Thanks for asking!

>

> Ken Jakalski

> Lisle HS

> Lisle, Illinois

>

January 9, 2007

I agree with many of the points listed below.

I am Registered Nutritionist in Ontario, Canada and a number of clients I see

want a quick fix without putting the time and effort into adjusting their

schedules to make wholesome meals and find time to exercise to see those

results.

Those of us in the health care industry have to make ourselves examples and help

to educate others that a healthy body weight and image can be achieved.

Tania Heinemann

www.yellowood.org

ON Canada

============

Re: End the War on Obesity: Make Peace With Your

Patient

The problem of obesity, I think, lies in the whole setup of the

society. We primarily chase money and careers. Since the sixties,

Americans were able to work less in order to maintain the same

lifestyle. Still, most work more than 8 hours a day, just to achieve

the acceptable social goals: the house, car, clothes etc.

On the other hand there is the explosion of junk food industry. Now

you spend less time cooking. But even many so called health products

are ladden with preservatives and additives.

Then there is the modern medicine. If you are slobbing around and

getting all ill because of that, we will give you pills and keep you

going. Antihypertensives, drugs for type II diabetes, statins, for

instance, are becoming as common in households as candy. And if you

are still not happy - antidepressants will do the trick!

Then there is TV. How can you miss the latest on Dancing With The

Stars or whoever is kicked out of Big Brother or another survival

crap! Missing another serial killer investigation on CSI Miami is a

crime by itself. It looks, though, that there are more serial

killers than people who exercise around TV also reinforces bad

eating habits.

TV also creates regular exercise and diet fads. All kind of machines

are sold on the daily basis. I wonder if I can try and sell a walk

or a pushup! Or the idea to eat more veggies!

Ninety nine percent of people ahen asked about exercise will say

that they have no time for it. Though watching an hour of whatever

rubbish on the box is never a problem.

The solution... The lifestyle must be changed, and quite radically.

We can create diets that are easier to follow or exercise systems

less taxing psychologically. But only to a point. Work less. Watch

less TV. Spend more time cooking proper food. Find time to

exercise... I am not sure how enthusiastic I can get about all this.

[Mod: Please don't forget to sign your posts with your full name, city and

country - thanks]

January 9, 2007

Hi Ralph!

As a small HS the sports

participation is probably much higher than the norm in

the bigger schools. As a suburban school I suspect that

there is also a higher than average participation

since there are less students who have to work after

school.

Interesting observations! I know that schools larger than ours offer more

activities (badminton, boys volleyball, etc.). This may influence the number

of participants. The work issue, at least from our perspective, is related to

the opportunities for employment. We have a few 'rural' schools in our

conference, and they don't have the high number of strip malls, fast food

restaurants, etc., that we have. Jobs are often related to kids wanting/needing

cars

and having to pay for insurance.

Ralph wrote:

<<<In the City school where my daughter teaches High

School there are 3000 students and while they have a

full sports program I suspect that no more than 500

students participate in organized competitive sports (

there are only so many athletes you can put on a

basketball team no matter how big your school is). In

a city school with limited funds the sports are

limited to the tradition sports (no hockey, swimming,

lacrosse etc). I would guess that not ore 16% of the

student body participates in any sports.>>>

***

I believe this would be accurate in terms of a large city school vs. a large

suburban school. There are certainly more sports offerings in our

neighboring suburban schools. It's not that Lisle is a small community (we

have

21,000) but we are basically landlocked, and a significant number of our school

age

kids are actually part of other school districts, even though they live in

Lisle.

This past fall we had twenty-three athletes on our cross country team--total

boys and girls. Area schools

much larger than us will have three times that number just on their boys or

girls teams.

Ralph wrote:

<<<Once these students leave school what percentage do

you think will continue to participate in any kind of

sport?>>

****

I talked about this with a few of our coaches today. We believe that number

is probably between 1 and 3 percent for students in our school.

Thanks again for the questions!

Ken Jakalski

Lisle HS

Lisle, IL

January 9, 2007

I wonder if schools adopted an intramural league program where kids could

form there own teams and play against other teams within the school if that

would get more kids to participate in more physical activities. Kind of

like what colleges do. This may still cost too much money though if refs

have to be paid to ref the games. Do you think something like this could

work?

Krzyminski jr.

Idianapolis IN

>

>Reply-To: Supertraining

>To: Supertraining

>Subject: Re: End the War on Obesity: Make Peace With Your

>Patient

>Date: Mon, 8 Jan 2007 15:50:05 -0800 (PST)

>

>Thank you for your response. As a small HS the sports

>participation is probably much higher than the norm in

>the biger schools. As a suburban school I suspect that

>there is also a higher than average participation

>since there are less students who have to work after

>school.

>

>In the City school where my daughter teaches High

>School there are 3000 students and while they have a

>full sports program I suspect that no more than 500

>students participate in organized competitive sports (

>there are only so many athletes you can put on a

>basketball team no matter how big your school is). In

>a city school with limited funds the sports are

>limited to the tradition sports (no hockey, swimming,

>lacrosse etc). I would guess that not ore 16% of the

>student body participates in any sports.

>

>Once these students leave school what percentage do

>you think will continue to participate in any kind of

>sport?

>

>Ralph Giarnella MD

>Southington Ct, USA

>

>--- CoachJ1@... wrote:

>

> > Hi Ralph!

> > In a recent post you asked the following:

> >

> > as one who is obviously involved with a High

> > School, could you comment on what percentage of the

> > student body at your school actually participates

> > in

> > sports?

> >

> > ***

> > We have 570 students in Lisle HS. About 200

> > athletes compete in our sports

> > program, or about 1/3rd of the entire student body.

> > You are indeed correct

> > in that, at least at our school, participation drops

> > considerably once kids

> > enter high school. Part of this is just the

> > 'selectivity' of some sports that

> > will 'cut,' like basketball, volleyball, and

> > baseball.

> >

> > One of the schools in our conference actually

> > approved a 'no-cut' policy in

> > an effort to keep more kids out. That did not work

> > very well, because it

> > created all kinds of additional problems related to

> > staffing, scheduling of

> > contests, etc. Other schools like ours have tried

> > things like organized

> > intramurals, but these programs have been more

> > successful at the junior high than high

> > school level.

> >

> > Many kids get jobs as sophomores, and that also

> > impacts on participation.

> > Your assessment of good

> > participation in the youth leagues and 'clubs' is

> > also accurate. We are

> > similar in that the percentage of individuals

> > competing declines as kids get

> > older.

> >

> > I believe our physical education department does an

> > excellent job creating

> > units that emphasize liftetime skills, health

> > consciousness, and overall well

> > being. We are fortunate to have many resources for

> > self-assessment and

> > individual goal setting, like the Polar heart

> > monitoring program. Though I don't

> > teach PE or health, I know that those who do take

> > these units very

> > seriously. Lisle is fairly affluent suburban

> > community west of Chicago, so I don't

> > know to what extent socio-economics influences

> > participation or health awareness.

> >

> > I'll see if I can come up with some data relative to

> > BMI for our students.

> >

> > Thanks for asking!

> >

> > Ken Jakalski

> > Lisle HS

> > Lisle, Illinois

January 10, 2007

I wonder if schools adopted an intramural league program where kids could

form there own teams and play against other teams within the school if that

would get more kids to participate in more physical activities.

****

First, I think the more the merrier -- the more opportunities kids

have to get active, the better, so this is a great idea.

But that being said, there is a large proportion of kids/adults for

whom competitive sports are not appealing. This may be hard to

understand for the " natural athletes " and folks in the group who

gravitate towards group/competitive-based exercise. For some kids

there is nothing more fun than a pickup game of soccer or basketball.

For other kids, like me, it's a site of abject failure and trauma.

It's hard to express the depths of my childhood loathing for any sport

involving a projectile or team-dependent activity. I don't like

competition and I have no depth perception -- you can imagine the

hilarity ensuing when attempting to catch a ball (or, as an adult, car

keys flung by a husband who thinks it's a laff riot to watch me try to

grab them and end up stabbing myself in the eye ). For someone

without skills or aptitude, team-based sports not only mean that one

fails to execute the activity itself, but also endures the

disparagement of teammates who don't want the uncoordinated loser in

their group.

However, as a child, I absolutely loved individual sports/activities:

hiking, cycling, gymnastics, sprinting, etc. I was a little monkey who

was a kickass rope and tree climber (at least while my weight was in

the double digits, although as a grownup I have rescued a few errant

cats). Offering me team based sports would have done nothing to

encourage my regular activity, whereas cycling/walking to school,

walks with the dog, exploring nearby ravines with friends, etc. were

what kept me moving around on a daily basis. If I had to guess, I'd

say that implementing more individual-based activities along with

opportunities for unstructured physical play (e.g. tree climbing,

playgrounds) might make exercise more interesting and less traumatic

to nonathletic/noncompetitive kids.

It wouldn't take a lot of creativity or equipment either; in fact, a

large number of individual activities require far less investment in

equipment than team-based sports. Throw down some cardboard, grab a

CD player, and have the kids lay down the moves that they're probably

already practicing at home. Girls jump rope in surprisingly complex

patterns anyway, and boys will do it if you show them Rocky first.

Etc. etc.

Think about what elements the " losers " would need to get interested,

and you can probably put together something awesome that everyone

would enjoy.

Krista -Dixon

Toronto, ON

kristascottdixon@...

January 10, 2007

I think sometimes we need to do a better job of letting kids know that there

are clubs or organizations out there for individuals as yourself. There are

many cycling clubs, running, or even rock climbing clubs out there. It may

be limited in some areas more than others but there are tons of

opportunities out there. This would allow you to meet more people in your

community and be active. Teachers and coaches could recommend this and

hopefully recommend these type of activities.

Krzyminski Jr.

Indianapolis IN

>

>Reply-To: Supertraining

>To: Supertraining

>Subject: Re: End the War on Obesity: Make Peace With Your

>Patient

>Date: Wed, 10 Jan 2007 09:21:48 -0500

>

>I wonder if schools adopted an intramural league program where kids could

>form there own teams and play against other teams within the school if that

>would get more kids to participate in more physical activities.

>****

>

>First, I think the more the merrier -- the more opportunities kids

>have to get active, the better, so this is a great idea.

>

>But that being said, there is a large proportion of kids/adults for

>whom competitive sports are not appealing. This may be hard to

>understand for the " natural athletes " and folks in the group who

>gravitate towards group/competitive-based exercise. For some kids

>there is nothing more fun than a pickup game of soccer or basketball.

>For other kids, like me, it's a site of abject failure and trauma.

>It's hard to express the depths of my childhood loathing for any sport

>involving a projectile or team-dependent activity. I don't like

>competition and I have no depth perception -- you can imagine the

>hilarity ensuing when attempting to catch a ball (or, as an adult, car

>keys flung by a husband who thinks it's a laff riot to watch me try to

>grab them and end up stabbing myself in the eye ). For someone

>without skills or aptitude, team-based sports not only mean that one

>fails to execute the activity itself, but also endures the

>disparagement of teammates who don't want the uncoordinated loser in

>their group.

>

>However, as a child, I absolutely loved individual sports/activities:

>hiking, cycling, gymnastics, sprinting, etc. I was a little monkey who

>was a kickass rope and tree climber (at least while my weight was in

>the double digits, although as a grownup I have rescued a few errant

>cats). Offering me team based sports would have done nothing to

>encourage my regular activity, whereas cycling/walking to school,

>walks with the dog, exploring nearby ravines with friends, etc. were

>what kept me moving around on a daily basis. If I had to guess, I'd

>say that implementing more individual-based activities along with

>opportunities for unstructured physical play (e.g. tree climbing,

>playgrounds) might make exercise more interesting and less traumatic

>to nonathletic/noncompetitive kids.

>

>It wouldn't take a lot of creativity or equipment either; in fact, a

>large number of individual activities require far less investment in

>equipment than team-based sports. Throw down some cardboard, grab a

>CD player, and have the kids lay down the moves that they're probably

>already practicing at home. Girls jump rope in surprisingly complex

>patterns anyway, and boys will do it if you show them Rocky first.

>Etc. etc.

>

>Think about what elements the " losers " would need to get interested,

>and you can probably put together something awesome that everyone

>would enjoy.

>

>Krista -Dixon

>Toronto, ON

>kristascottdixon@...

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