Little old loudmouth!

This content also appears at: http://www.reportingonhealth.org/blogs/little-old-loudmouth

This morning I decided I needed to let off some steam because I had far too many possible comments circling my brain to get them out in one session! Luckily, I was reading Virginia Hughes talking about a review of treatments for autism. After trying hard to get a very lonnng comment accepted and being told my email address was a crock, I decided I needed to join a forum where I could comment at leisure as a registered contributor. So, here I am.

As I've delved into the health field while doing an MPH, I've found I am quite passionate about a whole range of issues. I'm sure half of it is mere ego- but who cares in blogs? Aren't they a great spot to let the ego run free? My irrepressible impulse to write several pages of response to Virginia Hughes' blog entry is built on 35 years worth of thought about the origins of autism and quite a bit of empirical research, but many years ago. Meanwhile, I have kept up my reading on the topic of my abandoned PhD and I still feel that no one has exactly pipped me at the post and I want to let it all out!

I think I can explain why most autism treatments don't seem to work very well, as well as why traditional drug trials will never show the worth of various anti depressants for major depression. I'd really like to put forward my ideas on possible neurodevelopmental problems behind visual perceptual difficulties that autistic people suffer, especially in relation to social cues. For instance, the review of the work on mental rotation by researchers such as Soulieres et al, 2011, was quite logical and reasonable- but I think there is a totally different way to explain it which links to a lot more research on characteristics of ASD people. Hopefully, over the next few days, I'll be able to log in on the relevant websites and make some comments with my alternative explanations for the findings reviewed.

Then there's the topic of public vs. private payment/hospitals/clinics in health care. Australia has had a fairly good universal health coverage system for many years in Medicare, although lately the gap between the scheduled fee and what an individual doctor names as his/her fee has grown so much that ordinary people find it difficult to get appointments and/or pay at all. The government covers everyone for the scheduled fee, which varies with the length and complexity of the consultation. When the fee gets higher, I certainly visit the doctor less and I know many others are similar. The trouble is, if I give in and visit after some illness has become quite nasty (eg. I get a chest infection and my asthma flares up suddenly), firstly the doctor chastises me, then I have to have a swathe of tests, then I get medication and the illness lasts up to 4 times longer than it would if it hadn't worsened within the first few days. So this episode ends up costing so much that I go into debt with my partner and/or friends in order to pay for the treatment. So the system doesn't really work for certain classes/groups of Australians.

In the UK and USA, recent financial and political changes have meant the health funding in those countries is being cut across some areas. There is obviously huge debate about whether cuts should go ahead in health (could cuts be made in other budget areas?), and then which areas to cut first, should everything be cut equally, will private practitioners cut costs by shedding poor patients? etc The health systems in most Western countries do not set priorities across the board for treatment of certain conditions, ages or use of procedures (such as stenting the heart). Therefore, even with cuts, some specialties are going to go over budget by doing what they did last year, or overspend on questionably necessary procedures and underspend on vital ones. Of course, there is good old health economics weighing in with making assessments of years of quality life gained from treatments and arguments about what a quality life consists of and how can you value a life in dollars! I can have heaps to say on articles about these topics, but I keep using time that should be spent on other things!

Having been a researcher in eating disorders for many years (where most of my publications came from) I also find I have plenty to say about articles and media reports on young children hating their bodies from very young ages and on how "the media" and "advertising" are making kids sick!

I'd better button it up at this point as my partner is crying for stewed quinces and yoghurt, but I could rave on, naming endless topics I want to blether on about!

Lucky Spotrick got hungry, eh?!

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Too late I see we are too large

As everyone knows by now, health authorities across the planet have been getting in a terrible lather about increasing obesity. More people are becoming larger and their largeness is even larger than it was before!
I attended a charity event where people contributed delightful, multicoloured cupcakes for sale in a bid to raise funds for Australian Flood Relief.

[We've had shocking floods over a large proportion of the inhabited mass of Australia and that is a very big expanse of country to be under water. Some of it is still flooded after 3 months, other parts have had monster cyclones and been inundated again and again. People have lost the land their houses sat on, never mind the actual houses!]

Back to the topic at hand:

As I stood back after depositing my [dairy free] cupcakes on the sales table I observed the line-up of mainly women, many accompanied by youngsters in push-chairs. I was really quite shocked because just about every female over the age of 15 appeared to be overweight.

In contrast, I felt like a tiny, skinny little pimple on the face of the

earth. My GP has said I'm overweight for more than 12 months now, but I haven't made a major effort to do much about it. I'm just sitting on BMI= 25 and whenever I try to eat less and exercise more I lose track of myself while concentrating on something else- like study or having fun with friends; and then I end up eating as I always did, so the weight stays the same. At least it doesn't increase all the time these days! What's more, I'm revelling in having got rid of that horrible Black Dog of depression over the past 10 months and I'm not too keen on making anything I enjoy now into a negative experience. If I enjoy my food and don't balloon out, I'll just leave it be for a while.

However, what I saw with my own eyes was quite disturbing. I happen to know that people weren't nearly this big during the late 1980s and early 1990s because I really did measure them then! My work mates and I were doing research on women's attitudes towards their own bodies [you might call it body image]. We wanted to see how much of a role your actual size played in opinions about your body, eg. If you said "I feel fat when I look in the mirror", were you honestly overweight, or were you judging yourself too harshly? Of course it partly depended on weight, but in plenty of people real-world weight seemed to have very little to do with their miserable self-opinion. [I'm "Walker" among the authors]

When we measured height and weight, we found that about 20% of women were classed as overweight or heavier. That's one fifth of the population and when you looked at a crowd of people, it was believable. Eighty percent of women were normal weight or below, ie. BMI 25 and under, with mildly underweight around 18.5 to 20 and really underweight, continuing down to anorexic emaciation from 18.5 downwards. I met people whose BMI was only 13- just skin and bone, poor creatures.

Today, just before writing this blog entry I thought I'd better consult the current statistics so I could see what the government had been getting their knickers in a knot about:

Self-reported data from the AIHW (Australian Institute for Health & Welfare):

"Data from the 2004-05 National Health Survey showed that 47 % (7.5 million) of Australians aged over 15 years were overweight. Of these, one third (2.5 million) were obese.
Males were more likely than females to be overweight. Some 56% of males aged 15 years or over had a BMI of 25 or more compare to 39% of females [overweight and obese].
For both males and females, the highest rates of those who were overweight were aged 55-64 years, 68.5% and 52.2% respectively." [I am certainly not alone, with more than half of people my age overweight or obese by earlier standards]

Notice those stats are from 6- 7 years ago. There are more recent stats, but on much smaller numbers of people- so let's be kind and stick with the old numbers, because I haven't found a nice table with the new ones!

While searching for the above stats I came across the program of a conference in Australia during last week: The Australian Obesity Summit. In amongst the speakers I found the TV personality, Dr John Tickell, who is a doctor in real life and who runs expensive weight and exercise programs for a living. He always sounds (and looks) good but he hasn't shown me any longterm outcomes that stick with the ordinary adult in the community. It also struck me that nowhere in the conference program was there anything about people's attitudes and feelings, which are surely the factors behind the success or otherwise of a weight control program. He seems to recognise the magical value of food for women in the link, but I haven't heard what goes on in his sessions to confirm any psychological input.

In my webby travels I also came across the grim news that Australians are ranked third in the developed world's fattest population. What a [dis]honour.

Obesity: Australia ranked in global top three

And the delightful announcement that, yes -

Obesity Australia's biggest [sic] health challenge say experts

OK, so 39% of Australian women and even more men have their size rated above the norm- either overweight, obese or morbidly obese. Isn't it odd that men have a much higher rate of obesity than women, but women are the ones who worry about it AND get dumped on by men for being overweight. Hmm...pot calling kettle black here!

Sorry if you were at that function today, but I saw a room full of very worrying female bodies. Many of these overweight women were quite young- late teens to late thirties and I could see they had potential to become even larger because they were so much taller than the older women (like me). This photo was the only one I saw. I didn't take it, so faces are disguised to protect the innocent. I have no feelings either away as far as liking or not liking these people- it's just an illustration of what alarmed me.

Just for comparison, I'm only 150cm tall (about 5 feet) and my BMI is 25, giving me a weight of 56.2kgs or 8 stone-8lbs. Yes, I am verging on being too heavy for my height, and certainly a lot heavier than when I left school, a tiny, sickly streak of misery at about 32kgs [!! and never had anorexia nervosa in my life, just a bit weight-challenged as well as being height-challenged]. To see what I would have to weigh to be classified as obese (BMI 30 plus), I'll calculate a projected weight at BMI=31. That's 69.75 kgs [where would I put that??] or nearly 11 stone.

I can remember our chubby little admin officer at work in the Weight Disorder Unit was 12 stone and she didn't look good while she puffed going up stairs. To be morbidly obese I would have to weigh over BMI=34, so let's calculate for BMI 35. That would make me 76.5kgs and 12 stone on the dot. That's another 20kgs on top of what I weigh now, which is roughly 40kgs heavier than when I left school or more than TWICE my teenage weight. OMG!!

Thinking about the young women I saw today, some would have to be 100kgs or more as they looked very large, plus they were up to 1.80metres tall [nearly 6 feet]. That's a huge worry, plus I already worry about young friends who are already a bit overweight (from observation) and who tell me on Facebook what they had for dinner or lunch. Thinking to myself I cringe how close their size and eating habits are bringing them towards diabetes.

Ordinary people [and even some in health profession] seem to speak of diabetes far too casually. It fairly terrifies me and I think it would terrify them if they just contemplated it for a bit. I had the misfortune for my closest cousin to die at 19 from uncontrolled diabetes [I was also 19]. Sure, she overate when her parents weren't looking and hated having insulin and cortisone injections- but her mum had deliberately fed her to be huge (plus the younger two cousins). It was some strange neurosis borne of a poor family and the 1930s Great Depression. I also had two friends in their early 20s who suddenly got severe diabetes after participating in marathons and triathlons for a few years. Both were skinny guys who couldn't be told anything about looking after themselves, but they both became very ill and ended up on regular insulin injections. Such a shame- both had their PhDs by the age of 23 and had brilliant careers ahead of them but had to slow down when their diabetes hit and made them feel tired and ill.

This has been such a serious post- but it really struck me that the world has just been bumbling blindly into this obesity epidemic yet most individuals are completely unaware of the horrors that real obesity and diabetes can bring on a personal level. I'm not using scare tactics- it's really nasty to suffer the health consequences of obesity.

My idea of neighbourhood exercise and fitness programs part run by experts and volunteers may not be so pie-in-the-sky after all. However, in the real world we would have to do 1000% better than these hard-working guys: The Impact of a Community-Based

Heart Disease Prevention Program in a Low-Income, Inner-City Neighborhood by Jennifer L. O'Loughlin, PhD, and Gilles Paradis, MD, MSc, Katherine Gray-Donald, PhD, and Lise Renaud, PhD.