Posts by Russell Brown
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I've been mulling over posting this for a day or so but I can't get it out of my head:
Cognitive Impairment: A Hidden Consequence of the Childhood Obesity Epidemic
The impact of obesity and metabolic disorders on cognition seems to be well established, but the particular impact on children is really upsetting. It compounds any existing disadvantage early in life. The NYU study above and this smaller one did find a direct and proportional relationship to overweight.
Admirably, the NYU researchers are acting on their findings:
At-risk kids receive user-friendly reports of their medical results along with information for the whole family about how to turn things around before the child develops type 2 diabetes. “The MRI studies should also help elucidate some of the pathways affected by insulin resistance and obesity, and lead to new treatments to help mitigate these risks,” Convit says.
This seems a good approach.
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Speaker: Talking past each other:…, in reply to giovanni tiso,
I’m not buying this. If “problem” is the same as a disease but without a definition, it’s just a sloppy way of saying disease. And I insist we should guard against sloppy use of over-charged language.
For my sins, I do seem to have started this by using the phrase "public health problem developing", in relation to Type 2 diabetes and child obesity. Somewhere along the way it appears to have switched to an argument about whether "problem" is a synonym for disease.
I do think that when the World Health Organisation is using words like "crisis" and "epidemic", "problem" doesn't seem to be a particularly over-charged word. But I don't think there's anything to be gained from pursuing the argument through any further iterations.
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Speaker: Talking past each other:…, in reply to giovanni tiso,
What’s the difference between a health problem and a disease?
I guess that "health problem" is descriptive where "disease" has a definition. The AMA has definitions of condition, disease and disorder, noting that "Condition is perhaps the least specific, often denoting states of health considered normal or healthy but nevertheless posing implications for the provision of health care (eg, pregnancy)."
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Speaker: Talking past each other:…, in reply to giovanni tiso,
And frankly I would have far less of a problem with the sugar tax if we were also doing all the other things that researchers and public health advocates have been suggesting for years, chief of which is giving poor people more money.
That would certainly be good.
But although the most deprived New Zealand households are hugely over-represented in the Ministry of Health's childhood obesity figures, they're still less than half the total. As the ministry says says, it "spans demographics".
So it think it does make sense to also target the sources of excess calories, although I'm not sure whether a sugar tax is the best way to do that.
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Speaker: Talking past each other:…, in reply to giovanni tiso,
It’s still not a condition, which is what saying it’s a health problem means.
I think professional acceptance of obesity as a health problem is very widespread. The more edgy argument is whether it should be called a disease. The American Medical Association officially deemed it a disease in 2013, although not without controversy. The principal objection was the inadequacy of BMI as a measure, but the delegates who voted also addressed another argument:
"The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes."
There are some pro-and-anti arguments collected here. Ironically (or sadly), almost all of the it's-not-a-disease arguments are overt fat-shaming of the just-pull-up-your-socks variety
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Speaker: Talking past each other:…, in reply to Rebecca Gray,
Kia ora tatou,
Thanks for your comments – I hadn’t decided til now whether to weigh in.Kia ora Rebecca. Thanks for joining it – I can imagine it has looked a little daunting at times!
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Speaker: Talking past each other:…, in reply to giovanni tiso,
Obesity is a huge health problem.
It is?
Two years ago the New Zealand Medical Association described New Zealand’s rapidly increasing obesity rate as “a public health crisis".
The World Health Organisation describes childhood obesity as “one of the most serious public health challenges of the 21st century.”
So yes, there would seem to be something to worry about.
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Speaker: Talking past each other:…, in reply to Deborah,
Please, stop using the word “obesity”.
The word is used in Rebecca’s original post and in both of the contrasting works she describes, and it’s universally used in public health. Using it in terms of a value judgement is clearly wrong and harmful. Is there an alternative word to use?
I’m in favour of a bit of regulation here, rather than the more diffuse mechanism of taxes and price signals. And a bit of regulation / public provision of walkable suburbs, playing spaces, reasonable employment with a livable wage, all the things that make it possible for people to be fit and healthy, rather than worrying about policing their size.
I think, in line with the original post, the discussion has revolved around policing food and drink manufacturers rather than people, but staying with that post’s overall theme, perhaps we should establish what our common ground is. It seems that the effectiveness of a sugar tax isn’t established and there is the obvious risk of further penalising people who already face disadvantage, so yes, perhaps regulation is the better option.
Although it wouldn’t be easy: perhaps a more serious attempt to signal nutritional information is one more immediate path. Even Nutrigrain’s rinky-dink “health rating” provided some motivation for Kellogg to improve its product. I’d endorse everything else you propose, although I don’t think seeking long-term social equity precludes focusing on the content of staple food and drink. Can we agree on that?
This isn’t simply academic for me. My mother has Type 2 diabetes and it would appear I’m predisposed to it. I’ve looked enough it its impact to not wish its effects on anyone.
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Speaker: Talking past each other:…, in reply to Danielle,
Is there a point at which you accept that “a greater risk of” is not the same as “a sentence to a blighted, impaired life”, or are you going to keep blockquoting me into submission?
No, I don't want to do that. I was trying to cite an example and I'm happy to clarify that and refer to instead to an increased likelihood of lifetime impairment.
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Speaker: Talking past each other:…, in reply to Danielle,
That is rather different from “a sentence to a blighted, impaired life”, which is what I objected to in your earlier post.
Among the things I had in mind was the CDC page on child obesity:
Health risks now
Obesity during childhood can have a harmful effect on the body in a variety of ways. Children who are obese have a greater risk of –
High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD). In one study, 70% of obese children had at least one CVD risk factor, and 39% had two or more.24
Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.25
Breathing problems, such as sleep apnea, and asthma.26,27
Joint problems and musculoskeletal discomfort.26,28Fatty liver disease, gallstones, and gastro-esophageal reflux (i.e., heartburn).25,26
Psychological stress such as depression, behavioral problems, and issues in school.29,30,31
Low self-esteem and low self-reported quality of life.29,31,32,33
Impaired social, physical, and emotional functioning.29Health risks later
Children who are obese are more likely to become obese adults.34,35 Adult obesity is associated with a number of serious health conditions including heart disease, diabetes, metabolic syndrome, and cancer.35,36
If children are obese, obesity and disease risk factors in adulthood are likely to be more severe.34,35.37
Discrimination is clearly the source of some of those risks, and I’ve tried to be careful in the way I’ve phrased things. I’ve tried to refer to the source of the problem, which is environmental. I get why you don’t let medical researchers write social policy – I see the issue with that in drug policy, which I know more about. (And I see the corrosiveness of stigma there too.) But I would love to see far fewer empty calories hidden in staple food and drink, because the consequences seem really bad.
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