Teaching Professionals to Deal with Weight Bias Issues

When you REALLY need a doctor there fastEarlier this year, The Lancet published a six-part series on the obesity epidemic, recommended several changes,  including improved training of health care professionals, especially in the areas of counteracting bias and improving care-delivery strategies. It is sad but true that many health professionals have their own issues around weight and obesity, and sometimes patients are the ones who suffer for it.

Efforts toward change are being made. For instance, Elizabeth Harrington reported on a program sponsored by the National Institutes of Health (NIH) that will allow doctors to “virtual role play” and practice creating effective rapport with overweight and obese children. The program’s documentation says:

Even brief advice delivered well can have a meaningful impact, and yet, health care providers indicate that lack of efficacy and skill, impact, patient motivation, and educational materials keep them from routinely addressing obesity prevention and treatment in their practices.

The curriculum was developed by SiMmersion, a company that specializes in communications training. Participating doctors will talk with virtual actors, and little animated characters on the screen will “thumbs-up” them when the conversational flow is going well. There are three different scenarios to role-play: voicing concern about a child’s weight to a parent; speaking with the child about making healthy choices; and scheduling the follow-up appointments.

In January it was announced that, thanks to a government grant amounting to nearly half a million dollars, the program would be tried out by 100 different health care providers in the Minneapolis-Saint Paul region of Minnesota. Apparently it has not gotten off the ground yet, as the SiMmersion website makes no mention. The NIH has already paid the company pretty close to a million dollars each for programs that teach doctors how to talk to alcoholics and prescription drug abusers.

A Childhood Obesity Starter Kit

Elsewhere in the U.S., Healthy Jacksonville’s Childhood Obesity Prevention Coalition is offering a childhood obesity “starter kit” for primary care physicians. Among the several elements is an article from the American Academy of Pediatrics on the pediatrician’s role. It recommends, among other things, that children’s doctors should familiarize themselves with the cultural, socioeconomic, racial and ethnic groups their patients belong to, so they can recognize and empathize with the challenges that each child faces—especially when there are environmental determinants of obesity that can’t be controlled. As they put it:

An interactive, responsive dialog between pediatricians and families and children is important to help families move toward lifestyle change. The AAP Change Talk website, which includes training in motivational interviewing, may be used for primary care providers.

Healthy Jacksonville also offers a comprehensive plan for the management and treatment of overweight or obese children. It urges adopting an “empathic counseling style” to empower the patient and family to make changes in their lifestyles and behaviors. There is an “Encounter Documentation Tool” to record the details of the patient’s history and current condition. It indicates the special things to look for, such as difficulty in breathing, stretch marks, early onset of puberty, knee pain, and other conditions that particularly afflict the obese.

One section offers a brief introduction to motivational interviewing, along with some hints for opening the dialogue. For instance:

Always ask for permission to discuss nutrition, exercise, healthy eating, etc… Use open-ended questions to initiate conversation.

Another suggestion highlights the importance of encouraging patients to set their own goals, because to do otherwise is useless, especially if the clinician takes an aggressive attitude.

Source: “Global obesity response is ‘unacceptably slow,’ according to experts,” MedicalNewsToday.com, 02/19/15
Source: “Feds Spend $499880 to Teach Doctors How to Talk to Fat Kids,” FreeBeacon.com, 01/16/15
Source: “Physician Starter Kit,” hjcopc.org, undated
Source: “Management and Treatment Stages for Overweight or Obese Patients,” hjcopc.org, undated
Image by Elias Gayles

Professionals Struggle with Weight Bias Issues

Anguish sculptureThe destructive effects of fat-shaming have been observed in many ways. For instance, Sharon Begley reported for Reuters.com that physicians tend to spend less time with an obese patient, and don’t bother to offer counsel on achieving a healthier lifestyle, “perhaps believing it would fall on deaf ears.”

Medical personnel don’t even need to specifically verbalize their anti-fat bias, because it is all too easy to “telegraph” negative attitudes. Aside from being rude, this dismissiveness can cause tangible harm. Being treated badly can cause people to avoid doctors, and when they are reluctant to seek medical help or even have checkups, serious conditions like diabetes can develop unnoticed.

Weight Bias in the Medical Professions

A definitive picture was drawn by Rebecca Puhl, PhD, director of research at Yale University’s Rudd Center. Almost a decade ago, she led an online study of 2,449 overweight and obese women, which involved “self-report questionnaires measuring frequency of weight stigmatization and coping responses to deal with bias, the most common sources of the bias, symptoms of depression, self-esteem, attitudes about weight and obesity, and binge eating behaviors.”

The participants were asked about their history with various categories and types of people such as sales clerks, restaurant servers, friends, employers, and more. The most frequent stigmatizers were family members and doctors. 69% of the respondents said they had experienced stigmatization from doctors, and 52% said it happened more than once. Only 46% had negative bias interactions with nurses. Mental health professionals were way down the list—only 21% of the women had felt stigmatized by something one of them did or said.

In other studies, weight bias has been documented not just among doctors and nurses, but among psychologists, dieticians, medical students, and fitness professionals as well. It is not uncommon for healthcare providers to regard obese patients as awkward, lazy, sloppy, unsuccessful, unintelligent, weak-willed, devoid of self-control, and even dishonest.

In inquiries conducted among doctors, obese patients have been characterized as less self-disciplined, less compliant, and more annoying than normal-weight patients. As patient Body Mass Index goes up, tolerance for the heavy patients takes a nosedive. Physicians admit that they tend to lose both patience and respect for the people who come to them for help, along with the desire to extend that help. It is not unusual for doctors to feel that seeing obese patients is a waste of their highly-trained and specialized time. What happens when healthcare personnel exhibit a biased attitude toward obese patients? Here are some of the negative results cataloged by Dr. Puhl:

Reactions of Overweight Patients

  • Feel berated & disrespected by provider
  • Upset by comments about their weight from doctors
  • Perceive that they will not be taken seriously
  • Report that their weight is blamed for all problems
  • Reluctant to address weight concerns
  • Parents of obese children feel blamed / dismissed
  • Your responses and feedback are welcome!

    Source: “Insight: America’s hatred of fat hurts obesity fight,” Reuters.com, 05/11/12
    Source: “Clinical Implications of Obesity Stigma,” uconnruddcenter.org, 06/27/13
    Image by Rod Waddington


    Halloween Roundup, Continued

    Happy Hoosier HalloweenHalloween isn’t here yet, so there is still time to consider new strategies. But maybe the super-size sacks of candy have already been bought. That particular type of early preparedness is definitely not a good idea, by the way. As we have mentioned before,  a very real danger exists that someone will start nibbling early, and the supplies will have to be purchased all over again by a parent who has already surreptitiously gained five pounds before October 31 even arrives.

    In that same post, we examined a few of the additives that are commonly found in commercially manufactured sweets. Talk about scary! The point is that it’s never too early to start absorbing better ideas for next year. Over time, Childhood Obesity News has collected a great many sensible thoughts and innovative notions.

    Rather than try to skip awkwardly over the whole messy subject, one excellent strategy is to dive into Halloween with both feet and (to mix metaphors as is appropriate on a Frankenstein-related occasion) with all cylinders firing. A family can enthusiastically adopt the non-candy aspects of the holiday and start weeks ahead to create a memorable celebration by concentrating on costumes and decorating, as outlined in “An Early Start on Halloween.”

    Can parents get away with this? All indications say yes. As we reported, a poll revealed that 90% of American kids said they would still love Halloween even without the sickening glut of sugary products. In the same post, we suggested different approaches that might be used with children of varying personalities and psychological quirks. We have also, more than once, officially frowned upon the modern custom of dressing up babies as edible treats.

    In the midst of a nation replete with overweight and obese kids, we suggested renaming the spooky holiday Enable-oween or Sabotage-oween. But it doesn’t have to be that way. Dr. Pretlow discovered a poll taken by dentists in which an astonishing 93% of the responding children said they would happily accept a new video game in lieu of a candy stash.

    In the post “Halloween Advance Strategy,” we suggested different ways of approaching or handling kids of various ages and in various family configurations. For example, when there is only one child, and that child is very young, those parents are in an enviably advantageous position to create a whole new dynamic. For kids of any age, we have suggested all kinds of alternate trick-or-treat prizes and even more avenues of distraction to de-focus attention from the candy angle.

    In case anyone doubts that sugar can be deposed from its accustomed throne, Dr. Pretlow recommends paying attention to a study establishing that kids’ two favorite things about Halloween are the trick-or-treat process and the dressing up. Actual consumption of candy came in third. An interesting detail is that kids who have had cavities filled are more likely to agree with the proposition that candy is harmful. Experience is still the best teacher of all!

    To round out the collection, a fanciful fiction called “My Halloween, by Curly” illustrates how an alternative holiday can be created by rejecting the old paradigm and inventing a whole new one.

    Your responses and feedback are welcome!

    Image by Theresa Thompson

    Communities Wrestle with Weight Bias Issues

    What's your anguish, baby_Remember when the state of Georgia wanted to do something about childhood obesity, and put up cautionary billboards as a public service, and got hit by an anti-fat-shaming backlash? Defenders vouched for the images’ acceptability by referencing the anti-skin-cancer billboards of Australia, in which warnings to use sunscreen and protective clothing were paired with photos of surgery being done on melanoma victims.

    Another argument seems to have been that the grownups, whose images appear on various anti-obesity posters, billboards and other advertisements, do not feel shamed. But opponents countered that the comparison could not be made, because children and adults are different. A typical objection was that depicting fat as a negative quality must necessarily imply hatred for overweight people. Observers with a certain mindset will interpret any mention of obesity as hostility and scorn.

    Last year Israel was the fifth worst country in terms of childhood obesity but a billboard campaign in Tel Aviv was accused of cynicism, a lack of compassion, and even criminality. Its creators were labeled as promoters of guilt and shame who make kids hate themselves.

    Four months ago, Marion, Ohio got into an uproar when a group called Pioneering Healthy Communities (PHC) put up billboards. The pictures showed stomach flab and the captions were “Marion, we have a problem,” and “1 in 3 of OUR 5th graders are OBESE” (and exposed to less-than-meticulous grammar). Such controversies sell newspapers and cause a lucrative clicking of webpages, but do they contribute to ending child obesity?

    PHC is certainly trying. The organization is funded by the Robert Wood Johnson Foundation and also, for specific projects, by the Marion Community Foundation. Its origin story, as related by Marion Online News, goes like this:

    In February 2011, twelve community leaders spent three days in Washington D.C. where they learned strategies to help Marion have healthier children and adults. This was the beginning of PHC Marion, a community coalition working to promote policy, systems and environmental changes…The MCF has provided funding for Healthy in a Hurry corner store, community gardens, signage for bike and walking routes, physical activity programs at Summer Feeding Sites, and bike safety days.

    Your responses and feedback are welcome!

    Source: “Does Billboard Ad Campaign Targeting Childhood Obesity Go Too Far?,” TheBlaze.com, 01/09/14
    Source: “Obesity Awareness Billboard Called ‘Fat Shaming’,” myfox28columbus.com, 06/25/15
    Source: “PHC Marion explains billboard campaign, their mission and work,” MarionOnline.com, 06/26/15
    Image by ayustety

    Obesity Will Cost the Future

    Day of the Dead SkullsIt seems like every time you turn around, another bleak prediction appears. In 2014, The Lancet revealed that about 2.1 billion of the Earth’s inhabitants—about one-third of the entire population—were overweight. And of that number, about 670 million qualified for obesity status.

    Earlier this year, the same journal published a six-part series on the obesity epidemic.  Working with numbers that went up to 2010, it was determined that only one out of every four nations had healthful eating policies in place, and none of them had experienced a declining obesity rate. Zeroing in on the U.S., the researchers who put the series together learned that American kids currently consume a lot more calories, on average, than they did 40 years ago.

    This extra consumption works out as an extra $400-worth of food being consumed per child per year, adding up to an extra $20 billion in annual sales for the US food industry.

    The practical significance of this figure was voiced by the World Obesity Foundation’s Dr. Tim Lobstein, who said, “Fat children are an investment in future sales.” Aggressive marketing by corporations obsessed with profit is seen as a huge problem. St. Francis Xavier supposedly said, “Give me the child until he is seven and I’ll give you the man.” Or maybe it was St. Ignatius. Either way, the food industry has grasped the basic principle and is holding on tight. David McNamee of MedicalNewsToday.com says:

    Taste preferences and brand loyalty are established during infancy, so the industry pushes highly processed foods and sweetened drinks on children from a young age.

    Such large agencies as the World Obesity Foundation and the World Health Organization face issues they could not have foreseen four decades ago, like the paradox of undernourishment and obesity existing not only in the same countries, but even in the same populations.

    Obesity is a Low Priority

    Generally, national governments have more pressing matters to attend to than policing the food industry. The mellower ones allow their citizens freedom to eat and drink what they please, and even the tyrannical ones seem to have other areas they would rather be bossy about. Even when a government is benignly and legitimately concerned about the selling of obesity, it is more expedient to trust in the food industry’s “voluntary initiatives” (a.k.a. self-regulation). Manufacturers and advertisers promise to behave themselves and play nice. Governments pat them on their heads, sigh with relief, and move on to more pressing matters.

    Of course, this laissez-faire attitude has a price. Sooner or later, the medical costs of widespread obesity become apparent, and the number-crunchers who extrapolate current expenses into the future tend to produce figures that cause gasps of horror. The lead author of The Lancet series, Prof. Boyd Swinburn, discusses what needs to be done:

    The key to meeting WHO’s target to achieve no further increase in obesity rates by 2025 will be strengthening accountability systems to support government leadership, constraining the role of the food industry in the formation of public policy, and encouraging civil society to create a demand for healthy food environments.

    Your responses and feedback are welcome!

    Source: “A fat investment opportunity,” Moneyweb.co.za, 04/16/15
    Source: “Global obesity response is ‘unacceptably slow,’ according to experts,” MedicalNewsToday.com, 02/19/15
    Image by Eden, Janine and Jim

    Is Obesity Doom Escapable?

    Good News and Bad  NewsThe possibility that obesity is predetermined in the womb is disheartening. Even worse, it appears that fate is set for us by trillions of microorganisms. Because we serve as their luxury apartment buildings, they may cooperate in keeping us alive, but beyond that, they pretty much have their own agendas.

    A human host gets along best when her or his collection of microbiota combines the utmost diversity with a peaceful equality. When something causes an imbalance, and too many bugs of one kind proliferate, the symptoms show up in the human. Among those symptoms, according to this paradigm, are eating disorders and obesity. It is even possible that addiction originates with the activities of the gut bacteria. A field of science so relatively unexplored could have anything up its sleeve.

    This proposition is both bad and good. Bad, because we don’t get to choose the gut microbiome we are born with or acquire soon after birth. Its composition can depend on a lot of factors, none of them under our control. However, it begins to look as if quite a lot is under a mother’s control, so a pregnant woman with good intentions can exercise considerable power. We have spoken before of Columbia University’s Dr. Noel T. Mueller, who is very interested in the effects of the state of imbalance called dysbiosis. Apparently, dysbiosis can set a person on a bad trajectory, which is what counselors in other healing professions call a “path.”

    Dysbiosis Is Imbalance

    Scientists like Mueller worry that dysbiosis can set a child on a bad path—bad because it becomes increasingly difficult to course-correct as the person ages. It has long been known that once childhood obesity gains a foothold, over time it becomes more difficult to expunge.

    The same is true of the establishment of a sturdy microbiome. There is an “early-life window,” after which change becomes exponentially more difficult, although seldom impossible. But certain researchers are intent on discovering just how soon an intervention can be slipped through that window, if need be. In a wide-ranging interview published in the journal Childhood Obesity, Mueller said:

    The importance of this critical early-life window in shaping the gut microbiome is the primary reason why my work is currently focused on understanding the determinants of the maternal-offspring exchange of microbiota, and how we can leverage knowledge generated from this research to reduce practices that perturb the natural assembly of the gut microbiota.

    The best news is that is that bacterial diversity can, to a certain extent, be achieved. Even when a baby has not been blessed with a good healthy population of beneficial bugs right from the start, breastfeeding can compensate for a lot. Michael Pollan has explained the usefulness of the oligosaccharides in breast milk, which nourish a class of creatures known as Bifidobacterium infantis, about which he says:

    When all goes well, the bifidobacteria proliferate and dominate, helping to keep the infant healthy by crowding out less savory microbial characters before they can become established and, perhaps most important, by nurturing the integrity of the epithelium — the lining of the intestines, which plays a critical role in protecting us from infection and inflammation.

    For Scientific American, Claudia Wallis reported on the work of Rob Knight and Maria Gloria Dominguez-Bello (of the University of Colorado and New York University, respectively) who have tracked what happens in the birth canal.  She also inquired about the significance of a related Canadian study and learned:

    Babies drinking formula have bacteria in their gut that are not seen in breast-fed babies until solid foods are introduced. Their presence before the gut and immune system are mature, says Dominguez-Bello, may be one reason these babies are more susceptible to allergies, asthma, eczema and celiac disease, as well as obesity.

    But even a child who has started out along the path of dysbiosis can still reach for hope, as researchers learn how healthy balance can be attained later in life through diet or other means. This conscious building of a robust microbiome is called restoration, and Dr. Mueller, among many others, believes that “restoration approaches may hold promise for preventing childhood obesity in the future.”

    Your responses and feedback are welcome!

    Source: “The Gut Microbiome and Childhood Obesity: Connecting the Dots,” mchtraining.net, June 2015
    Source: “Some of My Best Friends Are Germs.” MichaelPollan.com, 05/15/13
    Source: “How Gut Bacteria Help Make Us Fat and Thin,” ScientificAmerican.com, 06/01/14
    Image by Mike Licht

    Are We Cursed with Obesity from Birth?

    baby-01McKinsey Global Institute issued a discussion paper titled “Overcoming obesity: An initial economic analysis,” some of whose details Childhood Obesity News has already recounted. It identifies obesity as a critical global issue, because almost 30% of the people currently inhabiting the planet are overweight or obese.

    It goes on to mention that obesity is the basic cause behind about 5% of the world’s deaths every year. The McKinsey interpretation of the state of obesity management is intriguing because the institute’s analysts place a great deal of emphasis on the newly-emerging field of microbial medicine. As an essay titled “Closing in on microbiome therapy” told readers of The Economist:

    There is growing evidence to suggest that autism spectrum and eating disorders, cardiovascular disease and metabolic conditions such as obesity and type 2 diabetes may all be associated with microbial imbalances in the gut…

    The composition of any individual’s gut microbiome is initially dependent on the circumstances of birth. Dr. Noel T. Mueller calls the gastrointestinal tract “one of the most complex microbial systems on earth.” Depending on the health of the microbiome, a baby can face physiological doom from the moment of delivery. All locations are not equal, and neither are all gene pools. Geography and ethnic heritage count for a lot.

    In our current state of knowledge, it looks like the activities of the microbiota are quite capable of producing chronic, low-level inflammation throughout the system. The theory is that such ongoing malaise can in turn initiate or exacerbate many different conditions from which the host humans may suffer or even die. All the intricate mechanisms have not been traced, but the overall picture seems to indicate that this is the case. Conversely, Dr. Mueller says:

    Greater bacterial diversity of the gut is associated with protection from various diseases, including those that are autoimmune in nature, like asthma, and those that are metabolic in nature, like obesity.

    How does a baby acquire such a desirably diverse assortment of bacteria? From its mother, of course. Dr. Mueller and his colleagues believe that delivery by Cesarean section can be detrimental, because the child is deprived of the journey through the birth canal, where normally it would be baptized by all kinds of microbial life. Breastfeeding is encouraged, because mother’s milk contains prebiotics that nourish the microbiome.

    It also appears that the decision about when to introduce solid food can be crucial, and this research team encourages the launch of meticulous studies to figure it out. Antibiotics are another hazard, and one to be avoided by a pregnant woman if possible, because the microbiome of the fetus will be affected. Post-partum, antibiotics can save a baby’s life, but can also set the child up for digestive chaos by devastating the inner microbial population.

    The Scientist reported on research which seems to indicate that the role of breastfeeding is immensely more complicated than anyone has previously suspected. It also appears that even more important than the mother’s vaginal microbiome is the microbiome of the placenta. In this barely explored field of inquiry, every discovery generates several new questions. Notes evolutionary geneticist Dr. Seth Bordenstein of Vanderbilt University:

    Based on the sum of evidence, it is time to overturn the sterile womb paradigm and recognize the unborn child is first colonized in the womb.

    Your responses and feedback are welcome!

    Source: “How the world could better fight obesity.” McKinsey.com, November 2014
    Source: “Closing in on microbiome therapy,” economistinsights.com, undated
    Source: “The Gut Microbiome and Childhood Obesity: Connecting the Dots,”
    mchtraining.net, June 2015
    Source: “The Maternal Microbiome,” The-scientist.com, 05/21/14
    Image by Biagio Azzarelli

    Halloween Roundup

    Pumpkin CarvingThere is still time to plan for a reasonable response to the annual sugar festival known as Halloween. Childhood Obesity News has amassed a great number of hints and strategies that an overwhelmed parent or teacher might find useful to help do things differently in 2015.

    Rethinking Halloween with SAAD” looks at some goofy costumes for babies and discusses the idea of Sugar Addiction Awareness Day, and goes on to suggest alternatives to candy for trick-or-treat handouts. “Halloween Proximity Alert” introduces an idea pioneered in Colorado, known as Green Halloween, and talks about the movement toward eliminating celebrations in schools, or at the very least, toward refocusing such end-of-October observations on good health rather than candy consumption. It also includes a few other practical ideas for bringing a little sanity to the holiday, including preparatory exercise.

    Another seasonal post looks at the connection between allergies, addiction, obesity and Halloween. Here is the central idea:

    Apparently, Western medicine has made a devil’s bargain, trading a greater ability to control infectious diseases for a handicap in the form of debilitated intestinal flora that cannot handle processed grains, sugar, or fat, and that problem somehow leads to, causes, or facilitates obesity.

    Will Childhood Obesity Kill Halloween?” looks at the perhaps ill-considered decision made by the Obama administration to hand out candy while the First Lady was working hard to get childhood obesity under control in America. The same post describes new idea proposed in various communities around the country. “The Annual Childhood Obesity Challenge” suggests more trick-or-treat alternatives, along with ways of talking to children about the need for moderation. It also talks about the advantages of banding together with neighbors to effect change.

    A Problematic Holiday for Childood Obesity” emphasizes the obstacles the holiday presents to children who are already consciously struggling with problem foods, and offers more hints from experts on how to minimize the damage. “Last-Minute Halloween Hints” contains yet more thoughts on how to keep both kids and grownups happy in the face of the deluge of sweets. “Childhood Obesity Halloween Prep” goes into some detail about how families may cope.

    Basically, what we are dealing with here is a well-loved holiday, and no one wants to take all the fun out of it. The main thing to remember about trying to change the face of Halloween is that nothing can compare with an early start. The younger the children are, the easier it is to convince them that your definition of Halloween is the correct one.

    Your responses and feedback are welcome!

    Image by Kenny Louie

    The Message of WALL-E

    WalleWALL-E (released in 2008) won both critical and popular success, making good money and winning several important awards. It inspired the manufacture of action figures, a video game, and even a specialized Lego set. Although it is classified as a science fiction comedy, WALL-E’s dark themes encompass corporatism, consumerism, and ruination of the Earth to the point of uninhabitability. This animated feature film from Walt Disney Pictures portrays future humanity in a way that could be described as an epidemiologist’s nightmare.

    The megacorporation that owns everything strangles the planetary ecosystem with litter, then evacuates the remaining population to live for hundreds of years in a spaceship, waiting for a cleanup that will clearly never happen.

    Aboard Axiom, all the humans, even the ship’s captain, are so morbidly obese they can no longer walk. When one roly-poly character is knocked out of his chair, restoring him to his seat is a major undertaking. But mainly, the bloated specimens don’t care, because they float around in lounge chairs complete with feeding tubes and constant electronic entertainment laced with commercials for the drinkable potions that they subsist on.

    For A.V. Club, Sean O’Neal curated a number of media references suggesting that the movie was understood as showing prejudice against obese people who are “undone by their own unchecked consumption and aberrant laziness.” Described as discriminatory, disappointing, and even evil, it was hated by parents of children with eating disorders.

    A blog called “The F Word” said:

    WALL-E specifically singles out and targets obese people as the primary cause of mankind’s demise, further perpetuating the stereotype of the gluttonous, slothful fat person. Furthermore, the film suggests that, in their exaggerated laziness, obese people disregard not only personal health, but also that of the planet, and are held up as the cause for the destruction of the environmental landscape.

    Some commentators speculated that children in the audience might receive the movie as an object lesson, and voluntarily reduce the time they spent in communion with rectangular screens. Kyle Smith, among others, noticed how the Axiom ambiance resembles the Disney theme parks:

    The meatball humans in WALL-E are like customers passively being served up a fake existence at the Magic Kingdom (which readily provides wheelchairs for not merely the afflicted but also the obese and the simply lazy), snorfling up the latest wows in an entirely artificial setting where every beverage and hotel room brings profits to the same corporation. And Disney paved over a few thousand acres of Florida wetlands to build Walt Disney World in the first place.

    Dr. Pretlow wonders if WALL-E is a farfetched prediction of the future of the Earth and mankind, or an accurate one. What do you think?

    Source: “Wall-E Plot Summary”
    Source: “Your guide to the WALL-E controversy,” avclub.com, 07/10/08
    Source: “Pixar joins in on fat-bashing,” The-f-word.org, 11/01/07
    Source: “Review: “Wall-E”,” kylesmityonline.com, 06/30/08
    Image by Pixar Animation


    WHO and Childhood Obesity in Europe

    WHO publicationSome European countries have reduced their mortality rates when it comes to diabetes, cancer, and cardiovascular diseases (including strokes and heart attacks.) This is a good-news highlight from the World Health Organization’s recent release, “The European Health Report 2015.” Unfortunately, the 150-page document also contains a considerable amount of bad news, which can be read in its entirety by downloading the PDF file.

    The Commission on Ending Childhood Obesity exists to provide the leaders of countries with guidance on policy options in order to treat existing childhood obesity and prevent more of it from developing. The goals include reducing the risk of morbidity and mortality and alleviating the psychosocial effects of obesity in both children and adults.

    In June, the Commission on Ending Childhood Obesity met in Hong Kong. Dr. Margaret Chan, director general of WHO, told the gathering that by 2025, there will be as many as 70 million overweight and obese infants and young children in the world.

    Tracking and Treating Obesity in Europe

    In order to monitor such factors as indicators on mortality and risk, health inequities, and general well-being, WHO hopes to build a single health information system for all of Europe. Currently, each of the 53 member states of the European Region has different resources and different ways of doing things. WHO promotes broad international cooperation in the sharing of knowledge and experiences.

    A difficulty that must be surmounted by any large-scale effort is the division of human suffering into two main causes — communicable diseases and non-communicable diseases. Obesity comes under the heading of non-communicable disease, but it contributes to premature mortality just the same. The European region has the world’s most elevated levels of tobacco and alcohol use. Equally as upsetting, the countries that make up the region have overweight and obesity rates that range from 45% to 67%.

    One of the report’s sub-headings baldly states: “Prevalence of overweight and obesity alarmingly high and on the rise.” One chart, for example, shows the prevalence of overweight and obesity among 11-year-olds. For this demographic, the countries in the worst shape are Greece, Ireland, Portugal, Poland and Italy. The report says:

    A recent survey conducted by the WHO Regional Office for Europe showed that more than 90% of countries reported having policies specifying requirements for a minimum level of physical education hours in schools and for the equipment needed for kindergartens and schools with exercise facilities. Only 20% of countries responding, however, reported having policies requiring bicycle lanes leading to schools and just 35% reported having measures to facilitate walking to schools.

    The website NurseryWorld, which takes a particular interest in children from birth to age 5, discovered from the WHO statistics that the countries with the lowest obesity rates in that age group are Kazahkstan (1%) and the Czech Republic (6%). Why? Rebecca Jones of Emory University’s School of Public Health hypothesizes:

    We think it is likely that, in countries with lower obesity rates, breastfeeding practices are playing a part as well as incorporation of nutrition education towards mothers and physical activity at young ages.

    But so far, that is only a hunch. WHO is working hard to promote better information-gathering and record-keeping in all 53 of the European Region countries, so that such promising leads can be more efficiently followed up on, leading to the widespread implementation of successful policies. The picture on this page is from an official WHO publication urging the utmost cooperation from all concerned parties.

    Your responses and feedback are welcome!

    Source: “The European Health Report 2015,” euro.who.int, 2015
    Source: “Interim Report of the Commission on Ending Childhood Obesity,” WHO/int, 2015
    Source: “If current trends hold, childhood obesity will hit 70 million by 2025, warns UN health agency,” UN.org, 06/22/15
    Source: “Research highlights severity of childhood obesity in Europe,” NurseryWorld.co.uk, 05/08/15
    Image by WHO


    Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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