Thursday, January 19, 2006

Diet revolution, part IV

Amber Waves, June 2005: Obesity Policy and the Law of Unintended Consequences

Amber Waves is a publication of the U.S. Department of Agriculture's Economic Research Service, whose job is not to look out for your health. The USDA supports agriculture; they're dedicated to making sure that US food producers can sell things.

And thus, I'm not sure whether this journal article is just an appalling piece of agricorporate propaganda*†‡, or an accurate reflection of the futility of trying to change gluttonous habits, or both.

Either way, it's some serious obfuscation of the role aggressive marketing plays in the fattening of America.

* Suspicious:
Numerous studies, though ongoing, largely conclude that aggregate cigarette advertising has a small or negligible impact on overall cigarette smoking.
† Highly suspect:
The American Dietetic Association says that each additional 3,500 calories a person consumes results in an additional pound of body weight. That implies that a person who gave up 100 calories (equivalent to a piece of toast) each day for a year would end up approximately 10 pounds lighter at year's end.
‡ Coincidence? The biggest processed food companies are owned by tobacco companies....

Wednesday, January 18, 2006

Diet revolution, part III

It's a simple plan. It, like anything else in life, is not guaranteed. Here it is anyway.
  • Count calories.
This is unglamorous, but it's physics. Fewer calories in and more calories out is all there is. Gather data, determine basic calorie needs to maintain current weight, then set a reasonable daily caloric target to achieve a reasonable pace of weight loss.

Never, ever, ever substitute marketing claims ("low fat!" "low carb!" "healthy whole grains!" "wholesome!" "vitamin-enriched!") for calorie count.
  • Measure.
We got into this mess in part because our idea of portion sizes is so far out of line. We need to take our brains back from the restaurants and marketers and learn how to perceive the food correctly.
  • Trust the math.
Realize, accept, and make peace with mathematically-determined portion sizes. That is the amount of food we need, even if our bad habits tell us otherwise.

Rely on the numbers and use them to learn new and better habits.
  • Make conscious choices.
There are no "forbidden foods", only trade-offs we make to achieve our daily caloric target. Instead of feeling deprived and resentful, we are empowered to make these choices. We need to pay attention to the real consequences of each choice, and be aware of which decisions support our weight-loss goals and which ones sabotage us.
  • Question "convenience".
Things marketed to us as convenience often aren't. The time it takes to stop at a restaurant or a drive-thru or to assemble a processed food from a kit often are not meaningful savings over the time it would take to put together our own real food at home.
  • Be wary of processed and restaurant foods, even in small doses.
Make sure that the additives and artificial flavors aren't stimulating cravings or reinforcing bad habits.
  • Learn to love whole, natural foods.
One of the scariest things about artificial marketed foods is that they teach us the wrong things about what food is "supposed" to taste like. We then reject reality because it doesn't taste fake enough.

Reclaim the flavors of grape, orange, cherry, cheese and meat! Say no to the Kool-Aid- and Cheeto-ization of our everyday diet!
  • Learn, get angry, stay angry.
Practically everything about the American diet has been engineered by corporations. The urge to eat harmful foods, the gimmicky diets that don't work (and the deliberate undermining of confidence in simple calorie-counting), the reluctance to exercise, the frantic drive toward elusive convenience, the fallback onto artificial supplements for ourselves and our children, and much, much, much more, are all dreamed up in marketing departments and inflicted on us for nothing more, nothing less than profit... with our enthusiastic participation. Recognize it and reject it.

Monday, January 16, 2006

ICU psychosis 101

ICU psychosis is a disorder in which patients in an intensive care unit (ICU) or a similar setting experience anxiety, hear voices, see things that are not there, and become paranoid, severely disoriented in time and place, very agitated, or even violent, etc. In short, patients become temporarily psychotic. — et al.
Causes of ICU psychosis (partial list):
  • Sleep deprivation, exhaustion
  • Disruption of day/night schedule
  • Constant interruptions
  • Unfamiliar surroundings
  • Disruption of regular routine & activities
  • Sensory deprivation
    • Windowless rooms
    • Little human contact
  • Sensory overload
    • Hallway and neighbor noise
    • TV
    • Flashing monitors
    • Beeping alarms
  • Loss of control over surroundings
    • Lights on/off
    • Windows open/closed
    • Door open/closed
    • Access to food, drink, belongings, lip balm, etc.
  • Pain
    • From medical condition
    • Post-surgical
    • Needle sticks, injection with stinging medications
  • Discomfort
    • Furniture
    • Sleeping positions
    • Room temperature
    • Tubes & wires
  • Hunger, thirst
  • Lack of hygiene
  • Poor caregiver communication
    • Slow response to call button
    • Failure to explain procedures
    • Refusal or inability of caregivers to honor requests
    • Nurses' need for doctors' approval, and slow response thereof
  • Inability to communicate
    • Due to medical condition or breathing apparatus
    • Due to declining mental state
  • Medication problems
    • Disruption of regular medications
    • Especially psych medications
    • Reactions and side effects of new medications
    • Interactions of old and/or new medications
  • Powerlessness
  • Immobility
    • Due to medical condition
    • Due to monitors, IVs, other tubes
    • Due to fatigue or atrophy
  • Lack of personal privacy
  • Indignities
    • Exposure
    • Detailed monitoring and measuring of bodily functions
    • Requiring assistance with bodily functions
    • Loss of control of bodily functions
    • Catheters, etc.
  • Fear, anxiety, depression
    • About medical condition
    • About ongoing or upcoming procedures/treatments
    • About anything/everything on this list
    • Exacerbated by disruption of psych medications
  • Compounding confusion, agitation
    • Caregiver frustration
    • Self-injury or interference with needed treatments
    • Possible physical restraints
    • Family and friends "siding" with caregivers "against" patient
Compound all this by the patient being disabled: say, blind.

Disclaimer: health professionals are generally great and try their best, but most do not have adequate staff time to handle ICU psychosis, nor will they necessarily have an arsenal of valuable techniques for dealing with it.

Monday, January 09, 2006

Paying for college, or more to the point, getting college to pay for you

This weekend I attended a workshop for students and parents, put on by a member of the Federal Way school board, on the subject of small, private, competitive and generous liberal arts colleges.

Most of these institutions are located "back East" and most folks in the Northwest have never heard of them. But they're excellent schools, and they've got lots of money to spend and infinite flexibility in how they will choose to spend it. For a low-income student, this translates into a good chance at a free ride if they work hard in school and know the right places to apply.

Many schools now emphasize need-based financial aid, but one school's idea of "need" can be very different from another's. Public schools are required to adhere to the federal and state definitions of "need", which can be severe ("after your parents take out their third and fourth mortgages, the remainder that you'll 'need' is..."). But private schools can do whatever they want. Some private schools come up with their own extremely generous definitions of "need"; others offer huge merit scholarships to the students who really impress them (see also this article). Some do both.

Parents and students often have no idea, and assume they are stuck with the federal assessment. It pains me how many families don't even try, because they don't know.

The workshop teaches families how to find these colleges, and students how to make themselves into attractive candidates.

The basics:

Get the best possible grades, but more importantly, take the most challenging classes available. All that stuff about being a well-rounded student is only true if you have already demonstrated that you can handle the college's curriculum.

But don't give up if you don't have a 4.0... a B student with a tough high school course load is usually very attractive, and that's where the well-roundedness comes into play as well.

Refer to Barron's Profiles of American Colleges and or Guide to the Most Competitive Colleges, both available on Amazon.

Start with the lists of most competitive and highly competitive colleges, throw out all the public schools (they don't have any money), and build a list of ~20 schools of potential interest (overall, not just financially).

Big, famous schools that everybody has heard of will have huge pools of applicants competing with you for admission and money. Look for lesser-known but highly-rated gems where you'll be a bigger fish.

Look beyond tuition. Barron's has information about endowment, average grant/aid award, and percent of students receiving aid. This can be helpful in figuring out which schools on the list are potential best buys and cash cows.

Finally, open up a correspondence early on with any school you feel passionate about. Ask intelligent questions, and generally make yourself known to admissions officers, alumnae, even faculty. (The workshop leader related the tale of a young woman who started writing to her chosen college and meeting with its alumnae as a 9th grader; by the fall of her sophomore year they accepted her to the class starting 2 years hence... with a full scholarship and without her ever submitting an application!) Passion counts for a lot. Even a need-based program will probably happen to find a few extra dollars for a really compelling candidate.

Most importantly, don't assume you can't, and don't give up!

Tuesday, January 03, 2006

Diet revolution, part II

It's a little creepy to me how much the media looove gastric bypass surgery.

I got curious; I looked it up. Gastric bypass is normally described as something like "stomach stapling" (which has been around for years), where the stomach's capacity is reduced. I didn't realize that it also includes partial removal or bypass of the intestines, which causes "malabsorption". If the patient overeats beyond the stomach's capacity, the intestines' ability to digest is also reduced and excess food passes undigested. In other words, diarrhea. (I assume this is the "dumping syndrome" that is sometimes cryptically mentioned by the media; they don't describe it or explain its cause.)

What I'm wondering is how this is any different from a bulimic who uses laxatives to purge after a binge.

On the other hand, desperate times call for desperate measures.

I'm thinking there's some math that goes into a weight loss surgery decision. Diet and exercise takes time. If a person has serious weight-related health problems, it's possible that the time it would take to lose the weight the "right" way may be greater than the time they may have. Those people probably need surgery. But even in our obese society, those folks are still outliers.

Nobody targets a major advertising and media blitz at just a few outliers.

Pretty recently, I had hopes that weight loss surgery might rescue me from this problem of not having my head in the right place to lose it the right way. Just fix it once and for all. I was annoyed, but also relieved, to learn two things: one, surgery doesn't work unless you also get your head in the right place (hence the 50% failure rate), and two, I don't qualify. Yet.