Sunday, May 07, 2006

Heavy

We recently had a 400 pound woman deliver a baby. She needed a caesarean section, and they had to do it in the surgery suite used for bariatric (weight loss) surgery rather than the C-section room of labor and delivery because she was so heavy she would have broken the bed in the C-section room. The anesthesiologists and obstetricians were pretty worried, because obesity to that degree increases both the obstetric and anesthetic risks, but mother and baby did fine.

I was reminded of that delivery because of the recent news about the agreement to limit the sale of soft drinks in schools - a long overdue agreement, in my opinion. It's no secret that obesity is a major problem in America and some other developed countries, and anything that can combat it is good news to me.

I should confess that being overweight has never been a problem for me, so perhaps I have no business commenting on obesity. I know that it is a life long struggle for many people, and I feel sorry for them, because of their struggle, their increased health risks, and their being the object of many unkind jokes. On the other hand, there is a strong history of heart disease in my family, so I follow pretty religiously a low fat diet and know the difficulties and temptations of doing so. I haven't ordered french fries and similar foods in a couple of years, and even though I love ice cream, I'll only eat the fat free and low fat stuff; so it annoys me a bit when I see some pretty large people frequently order wing dings and fries, or a double cheeseburger, in our hospital cafeteria.

Oh well, I guess it's a personal thing, although there was a presentation at the conference I recently attended that showed that not only did infants of diabetic mothers have more problems than normal babies, something we've known for a long time, but infants of obese mothers had more problems too. And it's too bad that the current younger generation might be the first generation in centuries to have a lower life expectancy than their parents - all because of obesity.

22 Comments:

Blogger Flea said...

Yep, it's a big problem, but we fleas are on it, ND, never you worry.

best,

Flea

1:55 PM  
Blogger Dream Mom said...

I too, worry about the obesity epidemic, especially in children. I am fortunate Dear Son did not have weight issues, but I also worked hard to prevent it. I breastfed him, I made sure he ate five fruits and vegetables for as long as I can remember and still do today, although it's much harder at times due to his oral/motor issues. I met with a nurtritionist some time ago, when Dear Son had his GI issues (related to his gene) and she was discussing his diet and asked about soft drinks. I told her that Dear Son liked them but that I don't allow them for the most part. I make certain he has 3 cups of skim milk a day since milk is one of the few "complete" foods. I also rarely to never give him junk food of any kind, mainly because I don't keep it in the house and he rarely gets processed foods. As a result, he doesn't like junk food of any kind, including chocolate, so his Easter basket is sans candy. The nutritionist said she wished more parents would be concerned about their child's nutrition. It's not about me being a good mother, which I know I am, but it's about teaching your children good eating habits from the beginning and modeling them yourself.

As for the ice cream, I'll have to differ with you. We don't have it too often, but when we do, it's the full fat kind or home made with our family's own recipe. I try to serve it over some fruit or just limit the serving size to a half a cup.

As for adult obesity, it's hard work. I have to work very hard to stay in shape, doing cardio five times a week plus eating seven or more fruits and vegetables (see my reference to the Super Foods book in my profile) as part of a balanced diet to stay in reasonable shape. I can feel their pain; I try not to be judgmental though and stay focused on what I need to do to stay in shape.

As for the hospitals, it would help if they offered better and healthier foods for the children. I bring a lot of food from home for Dear Son when he's in the hospital because most of the kids stuff is such junk.

Good post, as usual.

2:10 PM  
Anonymous Shamhat said...

"it annoys me a bit when I see some pretty large people frequently order wing dings and fries, or a double cheeseburger"

I don't think eating "lowfat" food is the solution. I think it's portion size. It takes me 2-3 sittings to eat a typical restaurant take-out portion, but my overweight friends can eat the whole thing for one meal. Yet we would both describe our intake as "Chinese food" or "lasagna."

I remember a birthday party for one of my children during which the two overweight children asked for a second piece of cake before even taking a bite of their first, because the pieces I cut looked too small to them. The appropriate-weight children didn't even finish their first slice.

3:32 PM  
Blogger La Lubu said...

I'm with shamhat; portion size makes a huge (sorry!) difference. That, and I can't help but think processed foods vs. homemade contribute to weight gain too---processed foods tend to have more fat and sugar, and less fiber (which'll fill you up). And by processed food, I'm not just talking about "fast food", I'm talking about entire aisles of the grocery store given up to what we used to look down on as "tv dinners" back in the day. And the folks who buy 'em will say "but this is Lean Cuisine, it doesn't have all those calories".

Yeah? It doesn't taste very good, either. I mean sure, it'll do---it's edible. But eating all the "lowfat" or "reduced fat" or whatever won't give you that sated feeling that comes from a non-factory meal with full flavor. I think that's the premise behind the "French paradox", that smaller portions of rich foods, eaten as part of a lengthy, convivial meal, and lots of daily walking will keep you thin.

I remember reading some article a looonnnnggg time ago (I dunno, fifteen years or so ago, before "obesity epidemic" was part of our general lexicon), that said labor saving devices along with a changed daily routine (for example, no more walking to the grocery store, because grocery stores in neighborhoods have all closed, reopening as "superstores" out by highway interchanges) have contributed to weight gain in the U.S. There was a chart comparing the yearly calorie difference between using a manual typewriter vs. a PC, things like that. The point wasn't so much that the calorie difference itself was to blame (for the average person, it would have represented a five- to ten-pound weight gain), but that "convenience" devices conditioned people to do less---to expect to have to put less effort into any physical work. I think the article was onto something. The thin woman next door to me is only a couple of years older than me---but she has "batwing" arms that she says is the result of aging---I'm not going to argue with her, but I think her sedentary job can take more of the blame---my eighty-five year old grandmothers have arms in better shape than that! Muscle atrophy is no joke.

Our bodies simply weren't built for years and years of sit-down work. I'm hesitant to criticize folks over weight, because my job makes weight-maintenance easy (70-80% of an electrician's day is going up and down ladders; it's like all day on the Stairmaster!). But really---there's no getting around that our bodies need to do physical work, and not just for weight maintenance. It impacts one's mental health, too! (or, maybe that's just me---I get super-cranky without a regular workout).

But with that said, let's face it---there isn't really a whole helluva lot of cultural support for fat women who want to lose weight. Oh, lip service about how much more "attractive" they'll be (attractive? I thought this was about health?), but when it gets down to the real nitty-gritty? How often do you see workout clothes that will fit a woman over 200 pounds? How about exercise classes given in room with glass walls, so others in the club can watch---not very obese-person friendly. Fat people have generally been fat since childhood, and fat women especially are sensitive to others laughing and pointing and saying the rudest crap imaginable to them. No surprise they don't want to go to the gym.

Or the doctor. I have an aunt who is obese. She had some health problems recently, and finally saw a doctor, and to make a long story short she had her gallbladder removed, found out it was cancerous, and is going through chemo. And I can't help but think how long she must have had symptoms before finally seeing someone about it. And it's sad to think that for her, the greater fear was just the doctor's visit itself.

Food for thought.

7:05 PM  
Anonymous Anonymous said...

I've given this a great deal of thought. Over the period of 5 years (including a pregnancy, during which I gained weight normally) I have lost 60 poounds. I would like to lose about 20 more.

The single easiest thing I did was to stop eating any thing with TFAs in it. Then we cut out high fructose corn syrup. Now, I avoid sugars added into food. I'd rather add stevia.

What I found, for me, is that TFAs and high fructose corn syrup is like crack - I ate a lot more of TFA laden food. If it is real fat, I eat less. I'm more satisfied. NOw, I basically try to eat food as close to the way it was grown as possible. I also do much better on a high protein diet.

8:39 PM  
Blogger Dream Mom said...

Anonymous-I agree 100% on the high fructose corn syrup. I try to avoid it as much as possible and read every label; sometimes you have to buy organic things like ketchup to avoid high fructose corn syrup. Most ice creams have them too, except Haagen Dazs and Breyer's All Natural Vanilla. The entire Breyer's line used to be all natural but now all of it except that one flavor is made with high fructose corn syrup. Those are the only two that I am aware of but I haven't checked in some time because we don't eat much ice cream. The entire Haagen Dazs line is pure from what I have heard. The high fructose corn syrup is in nearly every salad dressing too-so you have to make your own or watch the labels.

I make most of our food from scratch and only eat the diet type dinners in a pinch, about twice a month. They taste terrible and are loaded with sodium. I agree with Anonymous too about the high fructose corn syrup causing cravings-if you eat a little your body just craves more. You have to read all the labels today.

I subscribe to Nutrition Action Newsletter too which I like because it helps separate the fact from the hype on a lot of food labels.

9:01 PM  
Blogger Ex Utero said...

My achilles heel is caffeinated soft drinks. I otherwise do pretty well. I eat a lots of fish, don't eat fries, eat sensible portions, etc. But when I write (e.g. manuscripts, blog entries whatever) my brain likes caffeine and sugar in large quantities and I swear I write better, more creatively if I have that cocktail.

If I'm writing a grant, I can gain four or five pounds on the liquid diet and then I go back on diet drinks and loose it over the next two months in the gym.

Definately soft drinks are evil.

10:24 PM  
Anonymous Anonymous said...

Sedentary lifestyle definately leads to weight gain unless you deliberately do something else to offset it. i used to attend a large college where i walked to class (20 minutes to cross campus) and i maintained my weight fairly well, merely because of the walking. then i transfered to a smaller college, where it only takes 5 minutes to walk across campus, and i started gaining weight. students spend so much of their time sitting, to study, read, write papers, etc, and we don't often have TIME to exercise. now that i'm graduating, my main goal is to get back on my bike and spend time outside.

as far as natural foods go, i recently developed a major allergy to an unidentified substance. in the process of figuring out what it was, i cut out a lot of processed foods. now that i'm able to eat whatever i want again, i don't. example: instead of eating a single-serve cup of strawberry yogurt, i buy vanilla yogurt by the pint and eat about 3/4 cup with granola. it fills me up way more, has the same nutrients, and can replace a meal at times. not a lot of food, but it feels like it.

12:48 AM  
Blogger Navelgazing Midwife said...

As a woman grew up fat, fat, fat and who had babies when I weighed 220, 250, and 300 pounds (hospital, home, and car births respectively) and who has had a Roux en Y gastric bypass (5 years ago now) - I have researched obsesity almost as an obsession at times.

The other folks are right on when speaking about what these bodies are meant to do. The trekkers on the Lewis and Clark Trail ate an average of about 5000 calories and walked sometimes 20+ miles a day. (During high food volume times, the calorie content could rise to 12,000; lean times could see less than 500 - eating tallow, for example.) Before my gastric bypass, I was eating 8000-10,000 calories a day.

Major biochemical excuses/reasons push the morbidly obese to eat more and more. The fatter one is, the great the compulsion to eat. The ones we all in healthcare know about include insulin issues that cause instatiable hunger. Fat people tell me they are not diabetic and I say "yet." I'm sure I'm annoying when I speak loudly about insulin resistance, PCOS, and "pre"- diabetes in we fat, fat Americans. (I am still fat, by the way... losing 200 to weigh 200.)

Dopamine receptors in the brain also cause surges of compulsion towards eating as does ghrelin, the hormone that sits in the intestines/stomach - the hormone that rises incredibly the more weight the fat person loses, driving the need to eat higher and higher - causing not only re-gain, but additional weight on top of the original loss.

These are but three explanations we know about - there are certainly millions more that are being researched or still hidden from anyone's knowledge.

The fact is, of course, if we didn't drive, grew our own food, ate close to the earth, eliminated all processed everything, didn't sit on the computer, but helped our neighbor build his barn, walked to the river to obtain water, hunted elk on horseback and foot, etc. none of us would be fat.

But, alas, we don't live in that world. We live in this one.

Thank god for gastric bypasses that save lives.

(I have a special place in my heart for fat clients - having had everything from hangnails to hemorrhoids blamed on being fat. I doula lots of very fat women in hospitals - and midwife some mid-fat women at home. My office is set up for fat folks... tables holding up to 500 pounds, gowns for up to 600 pounds, a large Graves speculum to do Paps on fat women, step stools that hold 450 pounds, etc. All care providers will eventually need to be fat-friendly in their practices considering the enormous amount of people getting fatter and fatter.)

I keep struggling with food - even after all this time. It's just so hard sometimes.

7:56 AM  
Blogger NeoNurseChic said...

I gotta say that I'm pretty lucky that I haven't gotten heavy with the way I eat. I'm awful. I live alone, and I don't cook. My mom never really cooked much, and frankly I hate cooking for one. It leads to a lot of waste or a freezer full of stuff I'm completely sick to death of eating! So I do eat a lot of frozen dinners, processed foods, nothing sometimes, good once in awhile...

I find when I haven't been able to get food shopping for awhile, my body actually CRAVES fruits and veggies. I'll walk to the convenient store on the corner just to buy fresh fruit and yogurt drinks. No joke. Forget the potato chip cravings...give me FRUIT!! I think that's my body's way of saying I need to shape up the eating habits.

Part of the problem is that between my work schedule and my own health, I'm really exhausted a lot of the time. I have a hard time going food shopping alone because of having to bring the bags in by myself. Maybe that's why it's a good thing I'm a neonatal nurse! God does have a plan for all of us... hahaha ;)

On the plus side of my horribly unhealthy lifestyle, I did just join the YMCA today! Mainly for the pool... I'm just finishing up about 5 months of physical therapy, and at this point I'm just going once a week. I know once I stop, there is no way I'm continuing those exercises at home unless I get back to the gym. I used to figure skate, and I miss being active! My activity is quite a bit limited compared to what I used to be able to do, but I can swim without any trouble at all, and this Y allows full members to work with a personal trainer for free for 12 weeks! They even have a smaller gym just for those of us who are new and not ready to tackle the big gym. That's nice for the shy and slightly self-conscious. :)

So I've gotta say - being thin doesn't mean healthy necessarily. I'm not much over 100 pounds, but I wouldn't describe my eating habits or my body as very healthy. I'm working on it, but it's not easy with my lifestyle and the way I feel! Eating healthy is important for those thin and heavy, and I definitely need to work harder at that. But at least I made a positive step and joined the gym. :)

Great topic!

4:03 PM  
Blogger NeoNurseChic said...

This comment has been removed by a blog administrator.

4:04 PM  
Blogger Janae said...

Today was my 6 yo son's physical. He's 47.5" tall and 47lbs. He looks skinny next to just about everyone his age. I asked my pediatrician if my son was skinny. My ped said that my son looks like what an average child should look like his age. Then it really hit me how bad the obesity epidemic is because I just figured my son was really skinny. He wears slims jeans because regular fit jeans are too big, even with the adjustable waistband. Would he being wearing regulars had he been born 20 years earlier?

9:15 PM  
Blogger La Lubu said...

Would he being wearing regulars had he been born 20 years earlier?

Yep. I had the same weight/frame as a child that my daughter does now; I wore regulars even though I was either the smallest or next-to-smallest in the class, but my girl wears slims. Most people tell me it's because she was premature, but I don't think so---her height is average. It's just that they're used to looking at heavier children.

10:28 PM  
Anonymous Ariella said...

This is a really interesting discussion. I'm a former marathoner and tri-athlete (NYC marathon 3x; Cape May marathon 1x; three half-triathlons around the Jersey shore) and I ruptured my ACL and tore my medial meniscus while rock-climbing about two years ago.

I went from being at the top of my game to being unable to climb the stairs. It was a HUGE blow. I had surgery and rehab, but the surgery didn't work quite right and I haven't been able to run since. I can use the elliptical trainer and I can work out with weights for strength (both upper and lower body).

And, I have gained a lot of weight. For me, I think I initially gained because I was accustomed to eating like I was going out and running 10 miles a day, or biking 25 miles a day, or whatever. But then, I was depressed by my lack of function and I kept. on. eating. I'm not making excuses by the way... this is my own fault.

Now, I'm back in rehab and my knee is slowly getting better. The swelling is going down, I have a better range of motion, etc. And I've also started to lose weight by just cutting out the junk food and sugar.

After this experience, I really have to believe that it's a combination of a mostly sedentary lifestyle AND the inclusion of so many processed foods that really spur people to gain weight. And since schools and parents are apparently incapable of teaching healthy eating habits, kids are left to learn on their own (or be lucky enough to know to stop eating when full).

I don't know what the answer is, but I am really sad when I see young children who have breasts at 7 or 8, or who enjoy sitting inside on the computer rather than running around outside.

8:52 AM  
Blogger Dream Mom said...

Janae-That's a great comment about whether or not your son would be wearing regulars if he were born 20 years ago.

Dear Son wore slim jeans all his life and yet he was still in the normal range on the weight chart for his age,just at the low end, 10th percentile yet he was at the 75 percentile for height. Most slim jeans were too big and would just fall off.

I work a part time job at a children's clothing store. I am amazed at how large the kids are today. While we sell a fair amount of slims, we also sell a lot of husky sizes for boys. I can't tell you how many times the mother will say that the weight is just "in his waist" and that he doesn't need it anywhere else. The one thing that I noticed in nearly every mother of a husky boy was that she didn't think her child had a weight problem. For the girls sizes, a size 10 in our store is a 25 inch waist. I had a 25 inch waist when I was 25 years old, not when I was 10 years old!

I can also tell you that there are a lot of parents that don't make sure their kids eat even five fruits and vegetables a day. They eat a lot of fast food.

And the children's hospitals, they are at fault too. In the one near our home, which is in a more affluent area, the hospital food centers around fruits and vegetables and is great. But when Dear Son is at the major academic medical center near the city, their food is nothing but processed food, fries and junk for kids. I had a hard time getting fresh fruit for Dear Son's breakfast or vegetables for lunch or dinner that weren't fried. And green vegetables, which is what I usually serve for Dear Son, were nearly impossible to get. And yet, this same place, had healthy restaurants in the lobby, for the adults. Hmmm....

12:28 PM  
Blogger Janae said...

La lubu - I bet he'd be in regulars. I know I was, and I was like you - the smallest or next to the smallest in the class.

Dream mom - I could write a whole blog on trying to find the right slim fit pants for my son. It's not been an easy task finding something that fits his long and lean body.

I've a sister who spends a fair amount of time at the local Children's hospital with 2 of her boys because of their health issues (VACTERL and ACM I). It shocks me every time she says that they got food at the McDonald's that's at the hospital. What is a McDonald's doing at a hospital?! I verified on the McDonald's website that the restaurant is indeed inside the hospital. That is completely wrong, and I seriously wonder what in the world were the administrators thinking when they allowed a McDonald's inside the hospital.

4:40 PM  
Blogger neonataldoc said...

Thanks for all the comments. I pretty much agree with everything and La luba, I like the puns. Shamhat, I do think portion size is important but so is the type of food. A modest portion of wing dings and fries has a lot more fat and calories than a modest portion of bonelss chicken breast and rice. Dream mom, have you seen the number of fat calories in Haagen Dazs!? Edy's makes some pretty good light ice cream, very creamy. Give it a try!

8:54 PM  
Blogger Dream Mom said...

Doc-Regarding the ice cream-check my first post about limiting the portion size to 1/2 cup. Also, Dear Son and I aren't big ice cream fans. I could probably live the rest of my life without ice cream and still be a happy woman:)

Janae-The narrowest slim jeans I could find for boys were the Gap "Original" fit jeans. Try a 6 slim for your son-it will give him the waist size two to three sizes smaller (around a three or a size 4), plus fit narrow through the hips and thigh, and give him the length of a size six pant. I could pull most slim pants right off Dear Son so I had to look at a lot of stores to find a pair of slims that fit him.

10:05 PM  
Blogger Janae said...

Dream mom - After a long absence from shopping at the GAP, I re-discovered them this past fall. Yes, their Original Fit in slims are the only pants that fit my son. I recently purchased him some 7 slims because the sixes were too short. It's somewhat big around his waist, but the adjustable waist saves the day! Hopefully, the 7s will still fit him in the fall, but IDK since he's grown more than an inch in the last 2 months. He's growing up way too fast.

12:59 AM  
Anonymous Anonymous said...

"it annoys me a bit when I see some pretty large people frequently order wing dings and fries, or a double cheeseburger, in our hospital cafeteria."

-being a person who is slightly obese but one of the smallest people in my family, I can say that it doesn't help when people, whether they themselves are overweight or not, are judgemental like that. 1. What business is it of yours what I eat? and 2. If you said that aloud to me, it would make me feel like crap and that would make me want to eat more because I eat when I'm depressed.

8:38 PM  
Blogger neonataldoc said...

Anonymous: You have a fair point. It's probably not my business, but as a health professional, I can't help but get a little frustrated when I see people persistently do unhealthy things. And I would never say aloud to a person what I said in my post.

5:52 PM  
Blogger Demented M said...

I know this post is old, but I just wanted to add...

I have PCOS without any family history of diabetes, infertility, or menstrual irregularities.

I was overweight for the longest time and could not lose weight on a low fat/low calorie plan despite previous successful loss.

For a decade I complained to my doctors about my inability to lose weight. For a decade they told me to go to Overeaters Anonymous or TOPS and dismissed my concerns. Afterall, I was just a fat pig binging at Burger King. I probably couldn't even count calories correctly. Everyone knows fat people are stoopid and low class, right?

As it turned out, I had PCOS. I need a high protein, higher fat, no sugar/carb diet in order to lose weight. If I were to eat the way 'society' and most of medical science tells me to, it would eventually kill me. Carbohydrates do not do good things to my body.

Now I look at overweight women and I wonder if they have ever been screened and tested for PCOS. If their doctors even think or know to check. Or if we're all just fat pigs in their eyes.

PCOS is the most common enodocrine disorder in women yet it is grossly underdiagnosed. I think it's naive to think fat bias doesn't play into this imbalance.

I've since lost 50lbs working an enodcrinologist. Still could stand to lose more, but that will have to wait for now as I deal with other medical issues. I'm going to do my best to keep the weight off. I've always exercised, always been active, and now I eat low carb 24/7/365, but I can't guarantee I'll be able to maintain (or even continue) my loss. One bad asthma attack with prednisone along with my body's predisposition for adrenal suppression and I could be that 400lb woman in the hospital bed that you find so disgusting.

M

1:07 PM  

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