Month: July 2009

I ran into an old friend of mine today, a friend I hadn’t seen in several years. She gave me a hug and then stood back a bit to inspect me. “Wow, Rebekah.” she said. “You look amazing!” Then she asked, “How much weight did you lose?”

The comment was so unexpected, it threw me for a minute. I mean, I did lose a bit of weight my 2nd senior year of college–the same weight I’d put on my senior year of high school. Neither weight change was expected or intentional–and neither final weight was inappropriate. It just happened–I went from low normal to high normal and back again. No biggie.

At least, no biggie to me. I’ve always felt comfortable with my weight, whichever/whatever it might be. I thought my body was fabulous at 160 pounds–and I still think it’s fabulous at 145 pounds. I don’t feel any different because I’m 15 lbs lighter. I’m not particularly any more or less healthy than I was when I weighed more. After all, I’ve always been an appropriate weight.

I mean, sure, I’ve noticed the comments I’ve had in the last couple of years. Someone asks me if I’ve always been this little. Another someone says I’m disappearing. Someone else says they wish they were as “skinny” as I am.

I’ve blown them off as being symptoms of everyone else’s weight obsessions. Especially since most of the people making these comments are certainly not overweight. I’ve never seen anything out of the ordinary about my own body.

But Julie’s comment today makes me wonder. Maybe I do look different than I did two years ago. Maybe it did change my appearance a bit more than I thought.

The problem is, people seem to think my “skinny-ness” is something to aspire to.

Julie says she wants to take my example. The gal who asked if I’ve always been this “little” (How a 5’10” woman is “little” is somewhat beyond me) envied the weight that I maintain so effortlessly.

But the truth is, I’m not any different than I was 15 lbs ago, when no one was aspiring to be me. I’m not even physically different EXCEPT IN LOOKS. My health status is virtually the same, my risk of disease the same, my self-image the same.

15 lbs ago, I was at a healthy weight. Now, I am still at a healthy weight; albeit a different one. The only thing to recommend this weight over that one is that I better fit society’s “ideal woman”.

It’s been an informative experience for me–one that has convinced me that we are an overly weight-centric culture.

Many of my colleagues in dietetics would disagree with me. They would say that this emphasis on weight is good. After all, weight status and health status are linked.

Problem is, too few people understand that weight (just like most other indicators of health status) is a balance. Take potassium for example. Unless you have had renal issues, you probably are unaware of the important role potassium has in your body. Your body has a tight range of potassium balance that must be maintained. If it gets too high, your body shuts down. If it gets too low, your body shuts down. Likewise, too high a weight is unhealthy; and too low a weight is unhealthy.

Yet somehow our culture has taken to thinking that weight problems are just a one way issue. They think that lower is always better. Even the health industry has gotten in on this. Did you know that once upon a time, the “overweight” classification began at a BMI of 27? That’s because risk of chronic disease increases at a BMI of 27. So why do our current recommendations place the “overweight” designation on anyone with a BMI above 25? Good question. The data doesn’t necessarily support it. The World Health Organization decided that they’d do better with a bit of a “fudge factor” down–and Centers for Disease Control followed suit.

And then your average citizen, who doesn’t know that the category is already “fudged” down, lowers the category a little more. They reason that if 25 is overweight and overweight is bad, then they better stay as far away from 25 as possible. And so an eating disorder is born–or if not an eating disorder, then certainly an unhealthy attitude towards health, self, and food.

Did you know that the “healthiest” BMI might actually be somewhere between 22 and 25? People above and below that BMI are at greater risk. So, let me ask you–based on what I just told you, am I healthier at my current weight (at a BMI of 20.8) or two years ago and 15 lbs heavier (at a BMI of 22.9)?

Do you see what I’m saying? I’m actually farther from “the ideal” than I was 15 lbs ago. But public perception is the exact opposite.

Weight is a touchy issue–but I feel our culture has been addressing it the wrong way. We’re the most weight-obsessed culture on the planet–but the only thing its accomplished for us is an “obesity epidemic” and an increasing prevalence of “disordered eating”. By focusing on weight, we’ve created a culture with more weight problems than any other.

What do I suggest? Certainly you can work towards getting to a healthy weight–ideally at a BMI between 22.5 and 25. But health is more than just weight–and you’d do better to be focusing on other indicators. For example, you could start looking at some other health-related numbers: HDL and LDL cholesterol, triglycerides, blood sugar, blood pressure, and resting heart rate are just some examples of other numbers to be looking at. You could also focus on behaviors that effect health: exercise, fruit and vegetable consumption, whole grain consumption, saturated fat intake, etc.

In general, it’s time that we got out of our weight rut and started thinking about promoting health.

Where I got my numbers:

Body mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies. Lancet. 2009 Mar 28;373(9669):1083-96.

• Meta-analyses of 57 prospective studies exploring the relationship of BMI with death.
• Mortality (death rate) was lowest for individuals at a BMI between 22.5 and 25.
• Risks for death associated with heart disease increased at a BMI above 25.
• Risks for death associated with respiratory disease increased at a BMI below 22.5

When I spent a summer as a housekeeper at the Sawgrass Marriott, I learned a lot. I learned how to fold fitted sheets. I learned how to make a bed “from side to side”–only walking around the bed once. I learned how to fold towels into fans and points. I learned fold points in the toilet paper. I learned how to dry a shower curtain. I’ll probably never again use most of those things (except folding a fitted sheet–I use that one on a weekly basis!) But, from being on the other side, I learned how to be a good hotel patron. I learned to use the luggage rack instead of piling my luggage on a bed. I learned the value of a tip. I learned to NOT stash the little containers of lotion and shampoo every day–wait until the end of your stay, then stow them in your bag before you leave. I learned the value of the “Do not disturb” sign–and the importance of removing it after you’re done.

Likewise, I learned an awful lot about dietetics from my time at St. Elizabeth Regional Medical Center–but the stuff that will stick with me is what I learned about being a patient.

I learned that age isn’t about how many birthday’s have gone past, it’s all about the attitude you’ve chosen to take towards the life you’ve lived.

I learned that stupidity knows no age limit–and that it’s worth being avoided at all costs.

I learned that family can be a hindrance or a help to the healing process.

I learned that power of attorney is a VERY good thing.

But the message that sticks with me the most, the piece I feel compelled to share is: DON’T PUT OFF TAKING CARE OF YOURSELF.

I’ve seen way to many patients who were dying and didn’t have to be. They ignored their checkups, they ignored their bodies, they didn’t go to the doctor for years and years. And when they finally got to the hospital, it was too late. They had a terminal diagnosis and nothing could be done but to put them on palliative care.

Please don’t be that person. Even if you don’t think anything is wrong with you, you should go in to the doctor for a routine physical AT LEAST every three years. Women should have a gynecological exam and breast exam every year after the age of 21 or the onset of intercourse, whichever occurs first. After age 50, this should include a mammogram. Men should go in for a testicular exam every year. After age 50, both sexes should get colonoscopies every 10 years and fecal occult blood tests more often than that. You should have a fasting lipid panel taken AT LEAST every five years. And you should be regularly screened for hypertension (at every visit and at least once a year.)

And when your doctor tells you something? Take it seriously. When your doctor tells you to get your diabetes under control and refers you to a dietitian to have diet counseling? Do it. Even if there’s an extra cost, you’re worth it. I’ve seen way too many people who let their diabetes fly out of control and are now missing toes, feet, and even whole legs. Your doctor tells you that you need to lose weight. Get serious about making sustainable lifestyle changes. I’ve seen too many people who continued along their current course and now have complications that can’t be treated–surgery is too risky for someone their size.

These kind of patients tear me up. Not just because they’re in pain or because they’re dying, but because it was PREVENTABLE. They didn’t have to be in pain, they don’t have to be dying. They had a choice. But when they had the choice, they chose not to take it. Rather than staying on top of their health, they decided to just let it slide. And it slid to places they never wanted it to go. Please, please, please, don’t be one of those patients.

Make your decision now. Choose life.