Monday, September 21, 2009

Pointing fingers: Taking the "easy out" with obesity

Dr. Ann Childers and I had an interesting twitter conversation (twonversation?) the other day. It went like this:

AnnChildersMD I once saw a child who, at age 6 years, weighed more than 90 lbs. She ate a high carbohydrate diet, and drank a can of soda every day. from web

staticnrg @AnnChildersMD Lots of kids do that and don't weigh 90 lbs. Not healthy, but there is more at play than just food w/ a 6 y.o. from iTweet in reply to AnnChildersMD

AnnChildersMD re: prior tweet Her parents were poor, and soda is cheap (except for the medical bills). Children drinking soda is accepted in our society. from web

AnnChildersMD Nearly all my obese patients drink sweetened sodas. Ones that don't are ex-soda drinkers, looking for a substitute. from web

staticnrg @AnnChildersMD How many of your "non-obese" patients drink sweet soda? Have you asked? Your tweets sound biased to me...are they? from iTweet in reply to AnnChildersMD

AnnChildersMD @staticnrg Personally, I am "biased" against processed and refined carbs. But there is plenty of "bias" in the scientific lit against soda from HootSuite

AnnChildersMD @staticnrg Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart Association from HootSuite

staticnrg @AnnChildersMD Yes, bad for all, but majority of those who do those "bad" behaviors are not obese. Why are we pointing at only the obese? from web in reply to AnnChildersMD

RT @staticnrg Why are we pointing at only the obese? {I was actually pointing at soft drinks <:-} from web

staticnrg @AnnChildersMD No, last night you first mentioned obese--I responded to that & asked if you asked slim patients about soft drink habits. :) from web in reply to AnnChildersMD

I realize Dr. Childers was well-meaning. I just don't think she and other doctors see what they are really saying. This conversation looks like Dr. Childers assumes only obese children drink "sweetened sodas" and slim children do not. I wish it were that simple. Now, I don't have a study to prove it, but I have observed in my 52 years a lot of folks who drink sweetened soda and are slim. I've also observed a lot of folks who do not drink sweetened sodas and who are slim, and others who are not.

I never drink a sweetened soda unless I'm sick, and was only allowed to drink them as a child about once a year. Oh, and a ginger-ale when sick then, too. I think we are too quick to point at food and drink as a culprit but forget that Grandma fixed sweetened tea, fried everything, potatoes, and more for meals all the time.

Yes, I agree these foods and sweetened sodas are not healthy. My parents were health nuts before it was fashionable, and I grew up eating healthy and drinking non-sugared drinks. Milk was skim, and we had eggs only once a week. Salad was a treat to us in the winter, but we grew the vegetables and lettuce in the summer. My mother taught school and my dad was a corporate manager. We were literate and they were wise. I believe my mother is the reason I kept my weight down even with Cushing's much longer than most. Sadly, that is not the case now, but I still eat like I should, not like I look like I do. My HbA1c is 5.4, and I work hard to keep it that way with high cortisol. (Ask @sixuntilme how hard that is!)

As I drift along in this post, my point is: Why ask only obese patients about sweetened soda? Slim patients have a lot of terrible habits, too. The tweets highlighted above show the point I'm trying to make. Obesity isn't the only problem caused by sweetened sodas. And there must be a factor at play other than the sodas when some can drink them and not gain weight while others drink them and do gain. Or even DO NOT drink them and still gain.

Of course, I must point out endocrine factors. This blog is full of them. Just the posts about bariatric surgery not working for those with endocrine diseases attest for that.

@jensmccabe has tweeted some very interesting things on epigenetics. I've poste a couple of things. Those need to be considered, too.

But my MAIN point in all this (and forgive my tired rambling) is that we are quick to point at the "bad behavior" of the obese without looking to see if that same "bad behavior" is duplicated in the non-obese population. It's poor science. You know what they say about "assume"...

Research is what it is. It's easy to "prove" those who are obese drink a lot of sweet soda. It's not so easy to prove that those who drink sweet soda are obese. Not to mention drinking diet soda may make one obese. How 'bout them apples? Uh...sodas...?

I'm all for eating correctly. I work hard at it. But I think we need to be careful when attributing behaviors to obesity and make sure they are ONLY obesity related. That's what I was trying to say, Dr. Childers.



  1. Nice post.

    That is one of the most rational debates/discussions about obesity that I have seen in a long time.

    The fact is that there is a prejudice against obesity.

    For most "Western" cultures, obesity is seen as a sign of poor health. Because of this, in our lizard brains, we judge obese people as being unhealthy and therefore unworthy as a potential mate.

    And sadly, our medical system is not much more evolved than this ancient prejudice.

    The fact that BMI is used as a health indicator should been seen as an indictment of our medical system.

    You are right when you say that there are thin people who drink soda. And there are probably people who drink soda and eat every day at McDonalds who are not only lean, but are healthy in every measureable way.

    And that's life.

    Some of us are luckier than others when it comes to food and our health/body composition.

    With all of that being said, soda provides no nutritional benefit. If we care about the health of ourselves and our families, we would never drink soda. It's garbage.

    But, it's garbage that tastes pretty damn good. I prefer root beer.

    So, we make decisions. We balance health & hedonism.

    Sometimes however, we lose our balance and sacrifice the our health to satisfy our tastebuds and our emotions.

  2. Yep, that's my point. It's garbage for everyone, not just obese folks.

    (So is a lot of stuff. Not just sweetened soda.)



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