Much has been going around today about the most recent "winner" on the Biggest Loser. Rachel won the contest, with an ending weight of 105 pounds--equivalent to a BMI of 18 for her height, which is underweight. There are plenty of good discussions I won't try to repeat, including this one, where the writer says that the message is "if you are fat, you should do whatever it takes to not be fat anymore".
That message is absolutely true, and permeates everything in our society. We had a lively supper discussion this evening, including my 14 year old daughter. I don't want to throw around "eating disorder", because that represents a diagnosis. But I will throw around ideas like "disordered eating", "unhealthy weight loss", and "obsessive relationships with food and or exercise".
Let's start with the science. One place obesity researchers turn to is something called the National Weight Control Registry. This is comprised of a group of people who lost at least 30 pounds and kept it off for at least one year. Now, this is certainly a bar lower than that achieved by contestants on The Biggest Loser, but plenty of the people within this registry have experienced such weight losses. Almost all of them report having eaten less and exercised more as part of their weight loss strategy. But let's take a look at what makes them the most successful. (Yes, it's a news outlet. If I link you to a journal, most of you will get stuck behind a paywall. Some trust must ensue.)
They never cheat, even on holidays and special occasions. Count calories constantly. They weigh themselves every day. Exercise every day, equivalent to nearly 30 miles a week. Eat up to 300 calories a day less than others--meaning less than other "thin" people. These are just the averages, so plenty of people are above that.
Like I said, I'm not going to toss around the idea of "eating disorders", but that seems a bit on the obsessive side to me. Maintaining a weight loss doesn't mean being active and seeking out healthy food. It means thinking about your weight ALL THE TIME. Even when you've already reached that Holy Grail of "Healthy Weight".
Is this what we want? We certainly advocate for people to lose weight. Since these strategies are some of the only ways to maintain that loss, it would seem it is what we want. However, these characteristics--obsessive restriction of food, obsessive exercise, obsession with weight--are hallmarks of eating disorders. It is, of course, much more complex, but my point is that perhaps we should consider whether the behaviors that lead to long-term weight loss "success" are potentially damaging to mental health.
What's more important is that these behaviors will often be overlooked by medical professionals, as was recently discussed with regard to adolescents. I could show up at my primary care doctor's office with a dramatic weight loss, perhaps 50 pounds, getting myself down into the overweight category. I would be congratulated on my success. Almost any obese person who did that would be. We forget to ask the question of "how did you do that?"
As for our supper discussions, we talked about how this "extreme" approach, being thin at any cost, is more than just an idea held by a few trying to succeed at the near-impossible task of maintaining weight loss. It is the only idea promoted.
My daughter has a friend who, after trying many different ways to lose weight, and still being told by her doctor that she is overweight, has now decided to limit herself to weight-loss shakes. Her doctor is probably right, based on current definitions, but I seriously doubt this was his or her intended behavioral change. Consider what this child's day is now--constantly thinking about what she eats.
As a real sign of the extreme as the new normal, my daughter's PE class is the INSANITY Workout. I'm completely serious here. Where we live, most teenagers arrive in high school with virtually no physical education under their belts, a casualty of high-stakes testing and intense focus on academic skills. If a child arrives in 9th grade with no math skills, the school holds some responsibility for that. And we divide them up by skill level, ensuring that kids have a chance to succeed at an appropriate level. Not so with PE. After years without PE or other physical training, these kids are doing INSANITY. On top of that, a kid starting with a 15-minute mile--not a crazy speed for an overweight kid who has spent the last ten years relatively inactive, doing 3 hours of homework of night--has to get that down to about 8 minutes in order to get an A. In a matter of 9 weeks.
Oh, and the kids all get weighed before and after.
The expectations simply can't be achieved in a healthy way. Don't get me wrong--I want kids to be a healthy weight. I want them to eat well and be active. But I also want them to enjoy eating well and feel the benefits of being active. An ounce of prevention is absolutely worth a pound of cure. But once they've reached the point of being overweight, we don't just give up them, do we? Do we try to teach them reasonable, healthy behaviors, at the risk of them never achieving a "desired" weight? Or do we push them to extremes to reach that weight?
Obviously, I believe in the message of health and healthy behaviors. But the environment we live in, one comprised of The Biggest Loser and INSANITY and gorgeous women like Jennifer Lawrence being Photoshopped to remove nonexistent flaws, what do you think will win out?
Wednesday, February 5, 2014
Monday, January 6, 2014
The Self-Hatred of the New Year's Resolution
Today a friend sent me a link to a HuffPo article about states that could benefit from New Year's Resolutions to lose weight.
It was sent as a discussion point, not something she agreed with. But most people looking at it will probably nod their heads at the points that are made. These maps bother me. A lot. I believe they reinforce geographic stereotypes. Who lives in the South? Black people and poor people. And we all know black people and poor people are fat. And don't forget that fat people are lazy.
Another thing that bothers me is the presumption that "these states could benefit" from efforts to lose weight. Well, California, I'm sorry but you're not off the hook. The colors make it appear to go from "oh what perfect people" to "OMG they are all dying". But, really, it's 20% vs. 30%. Don't pretend Alabama needs something that those pale orange states don't.
The final thing that bothers me is that this is just plain not true. (News report and article.) The South doesn't hold all the fat people after all. More importantly, we are continuing to report using maps that are 1) not true and 2) reinforcing prejudiced views about obesity.
But the real point of all this, now that I've gotten off my chest the data flaws of our US Obesity reporting, is the point that "losing weight" is the number one New Year's Resolution. Of course it is. It's drilled into our heads from every direction--public health, medicine, the media, our own social networks--that we should be thinner.
As a rule, I do not make New Year's Resolutions. I won't go into why, lest you think I'm some crunchy granola hippie, which I'm definitely not. But New Year's Resolutions are usually about doing something that's hard, something that you believe will make you a better person. A singular focus on weight loss is not about being a better person, it's about self-hatred of the person you are. You can't change the external you, no matter how much you hate it. You can change the internal things you feel and the choices you make. Perhaps external changes will follow, but if they don't have you truly failed?
So, when you make those resolutions, think about what you are asking of yourself. Are you really trying to improve yourself, do something different or new, or take a step forward? Or are you trying to change something you dislike about yourself that you really can't control? Don't resolve to change an outcome, resolve to change a behavior or belief. Because resolving to change an outcome is going to fail, and we'll be right back here again in 2015.
It was sent as a discussion point, not something she agreed with. But most people looking at it will probably nod their heads at the points that are made. These maps bother me. A lot. I believe they reinforce geographic stereotypes. Who lives in the South? Black people and poor people. And we all know black people and poor people are fat. And don't forget that fat people are lazy.
Another thing that bothers me is the presumption that "these states could benefit" from efforts to lose weight. Well, California, I'm sorry but you're not off the hook. The colors make it appear to go from "oh what perfect people" to "OMG they are all dying". But, really, it's 20% vs. 30%. Don't pretend Alabama needs something that those pale orange states don't.
The final thing that bothers me is that this is just plain not true. (News report and article.) The South doesn't hold all the fat people after all. More importantly, we are continuing to report using maps that are 1) not true and 2) reinforcing prejudiced views about obesity.
But the real point of all this, now that I've gotten off my chest the data flaws of our US Obesity reporting, is the point that "losing weight" is the number one New Year's Resolution. Of course it is. It's drilled into our heads from every direction--public health, medicine, the media, our own social networks--that we should be thinner.
As a rule, I do not make New Year's Resolutions. I won't go into why, lest you think I'm some crunchy granola hippie, which I'm definitely not. But New Year's Resolutions are usually about doing something that's hard, something that you believe will make you a better person. A singular focus on weight loss is not about being a better person, it's about self-hatred of the person you are. You can't change the external you, no matter how much you hate it. You can change the internal things you feel and the choices you make. Perhaps external changes will follow, but if they don't have you truly failed?
So, when you make those resolutions, think about what you are asking of yourself. Are you really trying to improve yourself, do something different or new, or take a step forward? Or are you trying to change something you dislike about yourself that you really can't control? Don't resolve to change an outcome, resolve to change a behavior or belief. Because resolving to change an outcome is going to fail, and we'll be right back here again in 2015.
Saturday, October 12, 2013
Just how bad is obesity stigma?
So, yesterday a friend shared a story about the obesity stigma surrounding gay men. In it, he explains how the teasing he endured relentlessly, and the comments he continues to receive today are overwhelmingly about weight, not his sexuality.
This got me thinking--what's worse? What's the most painful? I've been through plenty of trauma in my life.* From severely ill children, abuse, loss of a sibling, depression, the one trauma makes the most impact on a daily basis, and always has, is that I am fat. As painful and difficult as everything else has been, I don't get blamed for them. On the contrary, people empathize--there is no expectation I can undo any of those. Even depression, in more recent years, is more widely understood. But obesity? That problem is one I should simply undo, that it is a trauma I deserve because I have brought on myself.
It's not that obesity stigma is worse than the pain of other losses and experiences, it's that obesity stigma is wholly different, not even comparable in it's effect. The umbrella of blame and the effect of the stigma has woven itself into every aspect of social culture. There is an "us" vs. "them" characteristic where the experiences rarely cross. If you've only ever been part of the "us" group, it's difficult to understand why anyone in the "them" group could say something like I did--that it's the worst thing I've experienced.
Let's be clear here--I'm a well-educated woman who understands obesity better than almost anyone in the country, and I understand obesity stigma nearly as well. I also understand myself better than most people understand themselves--years of therapy and many life experiences have given me insight many people don't have an opportunity for. But even for me, obesity stigma is something that hurts, not just that I see.
It culminated this week, soon after "Weight Stigma Awareness Week" with the birth of #FatShamingWeek. Of course, most people do not think this way. But enough do that when you put that on top of the "kind words" suggesting some weight loss "for your health", the constant images of beauty that involve only thinness, and an ever-growing array of diet products, and stir that up with the beliefs about being fat that fat people have about themselves. Well, it's a recipe for disaster.
How can fat be the worst thing I've ever experienced? Because I can reconcile all of the other things. I can understand what loss is, and I can recognize the things I've learned and gained from all my traumatic experiences. But it's a daily internal conversation with myself about what I'm supposed to look like and what I actually do, how I'm happy and comfortable with myself despite constant messages that I'm should change myself, that I'm an obesity researcher who wants treatment and acceptance simultaneously. The cognitive dissonance of being fat in this world is overwhelming. If someone like me can't figure out how to reconcile it, why should be surprised when others live a daily struggle--disguised as a struggle WITH their weight, but truly a struggle with the MEANING of their weight, and the meaning of their life.
This stigma is not bad--it's overwhelmingly, heartbreakingly, inescapable.
*I think it's important to note that I've also had lots of wonderful things, great luck and blessings.
This got me thinking--what's worse? What's the most painful? I've been through plenty of trauma in my life.* From severely ill children, abuse, loss of a sibling, depression, the one trauma makes the most impact on a daily basis, and always has, is that I am fat. As painful and difficult as everything else has been, I don't get blamed for them. On the contrary, people empathize--there is no expectation I can undo any of those. Even depression, in more recent years, is more widely understood. But obesity? That problem is one I should simply undo, that it is a trauma I deserve because I have brought on myself.
It's not that obesity stigma is worse than the pain of other losses and experiences, it's that obesity stigma is wholly different, not even comparable in it's effect. The umbrella of blame and the effect of the stigma has woven itself into every aspect of social culture. There is an "us" vs. "them" characteristic where the experiences rarely cross. If you've only ever been part of the "us" group, it's difficult to understand why anyone in the "them" group could say something like I did--that it's the worst thing I've experienced.
Let's be clear here--I'm a well-educated woman who understands obesity better than almost anyone in the country, and I understand obesity stigma nearly as well. I also understand myself better than most people understand themselves--years of therapy and many life experiences have given me insight many people don't have an opportunity for. But even for me, obesity stigma is something that hurts, not just that I see.
It culminated this week, soon after "Weight Stigma Awareness Week" with the birth of #FatShamingWeek. Of course, most people do not think this way. But enough do that when you put that on top of the "kind words" suggesting some weight loss "for your health", the constant images of beauty that involve only thinness, and an ever-growing array of diet products, and stir that up with the beliefs about being fat that fat people have about themselves. Well, it's a recipe for disaster.
How can fat be the worst thing I've ever experienced? Because I can reconcile all of the other things. I can understand what loss is, and I can recognize the things I've learned and gained from all my traumatic experiences. But it's a daily internal conversation with myself about what I'm supposed to look like and what I actually do, how I'm happy and comfortable with myself despite constant messages that I'm should change myself, that I'm an obesity researcher who wants treatment and acceptance simultaneously. The cognitive dissonance of being fat in this world is overwhelming. If someone like me can't figure out how to reconcile it, why should be surprised when others live a daily struggle--disguised as a struggle WITH their weight, but truly a struggle with the MEANING of their weight, and the meaning of their life.
This stigma is not bad--it's overwhelmingly, heartbreakingly, inescapable.
*I think it's important to note that I've also had lots of wonderful things, great luck and blessings.
Monday, September 16, 2013
Ignore Obesity Research in the News, Please
Today there is yet another study demonstrating a decline in obesity in children. Here is the actual study and here is a news report.
This follows reports from several weeks ago that obesity among preschoolers was falling.
This on top of the most recent F as in Fat report, which emphasizes greater obesity in the South.
Let's get a few things straight:
Reporting obesity prevalence based on self-report is bad science.
Reporting obesity prevalence based on non-representative samples is bad science.
All reports of state comparisons are bad science.
In the United States, no matter what anyone tells you, we do NOT have any idea what the actual prevalence of obesity is by state. We have ONLY ONE survey that allows us to make good estimates of total prevalence of obesity, and it will not allow state-level estimates. Most states do not have good systems to estimate obesity prevalence within their own state.
Please, for the love of the Flying Spaghetti Monster, just stop reading news reports about obesity prevalence. We have no idea if it's improving or getting worse.
I have no idea why the journals don't send me THESE articles to review, but I would definitely have them temper their language. I've kept a few from getting out there, but I don't get to review everything. Even if I did, I can't control the press releases. There is lots of good obesity research. Unfortunately, the news seems to only pick up the small fraction that is bad science.
This follows reports from several weeks ago that obesity among preschoolers was falling.
This on top of the most recent F as in Fat report, which emphasizes greater obesity in the South.
Let's get a few things straight:
Reporting obesity prevalence based on self-report is bad science.
Reporting obesity prevalence based on non-representative samples is bad science.
All reports of state comparisons are bad science.
In the United States, no matter what anyone tells you, we do NOT have any idea what the actual prevalence of obesity is by state. We have ONLY ONE survey that allows us to make good estimates of total prevalence of obesity, and it will not allow state-level estimates. Most states do not have good systems to estimate obesity prevalence within their own state.
Please, for the love of the Flying Spaghetti Monster, just stop reading news reports about obesity prevalence. We have no idea if it's improving or getting worse.
I have no idea why the journals don't send me THESE articles to review, but I would definitely have them temper their language. I've kept a few from getting out there, but I don't get to review everything. Even if I did, I can't control the press releases. There is lots of good obesity research. Unfortunately, the news seems to only pick up the small fraction that is bad science.
Friday, September 13, 2013
Low-Sugar Juice is Stupid
I've had multiple requests this week for donations to a local food pantry, which is great. But the featured request of the month is "low sugar juice boxes". I can't bring myself to donate anything because of this absurdity.
What is low-sugar juice?
What is low-sugar juice?
I would think normal people would put these
in that category:
Juicy Juice 100% juice “no sugar added”:
26g/8oz
Apple and Eve “1/3 less sugar”: 22g/8oz
(Made with vegetable juice)
Let's compare to the evil drinks:
Hi-C Fruit Drink: 28g/8oz
Coke: 27g/8oz
Or we could (OMG!) poison them with
chemicals and give them Splenda-sweetened drinks or (OMG even more!) diet soda.
Seriously? Can we just call a spade a
fucking spade? Juice IS sugar. Deal with it. Argue that juice is fine, and
serve juice. Argue that sugar is bad, and don’t. But don’t pretend like a “low-sugar”
name makes things any better.
If you are worried about adequate nutrition in your population, give them 100% juice drinks. If you worried about obesity (probably a bigger deal for poor North Carolina), give them water or something with an artificial sweetener.
There are plenty of reasons to argue for and against the juice box, and it's fine to want to get organic things (though I believe unnecessary). But you don't get to plop down "low sugar" and make things healthy. I'm not the only one who thinks juice and smoothies are as bad as other sugary drinks.
Even your organic, no-sugar added, hipster juice boxes are still just fucking sugar.
Tuesday, September 10, 2013
The Endless Stupidity of Wellness Programs
I could go on for hours about the ethical issues of "wellness programs" for employer-based health insurance. Most recently, Penn State began requiring employees to report a variety of health parameters in order to avoid a relatively large financial penalty.
Lost in that discussion was that North Carolina has just done a similar thing for their entire base of state employees (it does not require actually having a physical exam). The financial penalty is a bit smaller--on the order of $50--and requires completing a health assessment, attesting to being tobacco-free, and designating a primary care physician for everyone on the plan.
Let's set aside the fact that wellness programs don't work.
Obviously, I think requirements to report these things are wrong, but I thought I'd take out the "wellness plan" for a test drive.
I won't go into laborious details about the health assessment itself, because that's not what is most interesting. They asked my height and weight and waist circumference, the last of which I just guessed on because I don't typically keep a tape measure in my office. They asked about stress, drinking, tobacco, whether I take medications to sleep, details about my activity levels even I, an activity researcher, found difficult to interpret, and then a whole host of measures most people aren't going to know--blood pressure, cholesterol values, glucose values. Finally, they asked if I thought I would work on losing weight, eating better, and reducing stress.
So, I finish my assessment. Here's what I get:
First, take note of the little female icon. Just in case I forgot.
Okay, so I'm medium risk. Medium risk of what I'm not quite sure, but apparently something. Death? A cold?
Well, I don't want that! Surely they can help!
Well, if I scroll down, I get to learn the things I need to work on. "Work on"? Aren't I already working enough? And, hey, how do they know if I'm working on my depression or my "obesity"? Maybe I've worked my depression into submission and what I really need is to leave it alone.
Anyway, I'll bite. Let's find out how to cure my "obesity".
First, I suppose they need to tell me what obesity is. Because that's never come up before.
Holy shit, I have SO MUCH FAT that my health is in danger. Okay, even if that WERE true, healthy diet and daily Jazzercise notwithstanding, is that the most appropriate way to tell me?
Well, let's find an action plan. Because I don't want my health in danger!
Oh, nothing. Darn. Let's click around and see if I can find a back door in. Well, no plan, but more details on my condition.
Are those really warning signs of obesity? Because I'm pretty sure I don't have any of those. I know, I know, they are warning signs of obesity-related disease. But I do believe all of those can happen to anyone. And who puts the "right before you die" symptoms of a disease?
Okay, back to the search for my action plan. Ooh, here are my action steps!
Disregarding that half of these are indecipherable, they are called HOMEWORK!! Not "good stuff to do", but actual fucking HOMEWORK. I've already sold my soul to you, and you give me homework--without directions, no less?
But we're trying to cure my obesity, no? Ah, I found it.
Are those really all my options?
Maybe the health action details will help.
My "educational tool" consists of three bullet points, the first of which is to remind me it looks like I have a weight management "issue". My response to it goes from was this helpful (um, no) to "how likely are you to have bariatric surgery?"
Let me just get this out there. My BMI puts me in the obese category, but my health is great and I'm in fabulous shape. I need a lot of things--more time, more sleep, more money, better fucking health insurance--but I do NOT need bariatric surgery.
These people still haven't told me what to do. Oh, look, I found something. Well, I sort of did, because I can't find it again. But I did get a lovely screen shot.
Who looked at that and thought it was a good idea? Besides telling me absolutely nothing I didn't already know (or that every fat person also doesn't already know), it's like painful, dense text. For the record, the depression action detail looks very similar. I don't want to read it now. I'm pretty sure if you showed it to me when I actually WAS depressed I probably would've just cried.
Speaking of depression, let's see what tools are available to help me "work" on that.
None of those are relevant to me, and they know that (because I had to tell them that I am not menopausal and currently not pregnant and presumably they are aware I am not a child). The only POSSIBLY relevant thing is that incredibly depressing sad face in the sand. I mean, that makes non-depressed me want to cry. But I sure as hell don't need to know if I have depression. I do. I have--with a diagnosis--for a decade, and the State Employee's Health Plan certainly knows that.
So, my sum experience with the NC Health Smart "Wellness Program"? Buggy. Insulting in its treatment of obesity. Naive in its effort to address depression. (I can only imagine how the other conditions get treated. I wonder how many times people who report hypertension get told to avoid salt.) Seriously offensive in its approach--making caring for my health "work", using thinsplaining, and potentially dangerous in implying that I need to "work" on things that are already under fabulous control. Worthwhile primarily as a great way for the state to collect private health data about me, under threat of punishment.
We can only hope this effort--and the enormous amounts of money I'm sure went into it--will fall apart as quickly as the last wellness effort in NC.
Lost in that discussion was that North Carolina has just done a similar thing for their entire base of state employees (it does not require actually having a physical exam). The financial penalty is a bit smaller--on the order of $50--and requires completing a health assessment, attesting to being tobacco-free, and designating a primary care physician for everyone on the plan.
Let's set aside the fact that wellness programs don't work.
Obviously, I think requirements to report these things are wrong, but I thought I'd take out the "wellness plan" for a test drive.
I won't go into laborious details about the health assessment itself, because that's not what is most interesting. They asked my height and weight and waist circumference, the last of which I just guessed on because I don't typically keep a tape measure in my office. They asked about stress, drinking, tobacco, whether I take medications to sleep, details about my activity levels even I, an activity researcher, found difficult to interpret, and then a whole host of measures most people aren't going to know--blood pressure, cholesterol values, glucose values. Finally, they asked if I thought I would work on losing weight, eating better, and reducing stress.
So, I finish my assessment. Here's what I get:
First, take note of the little female icon. Just in case I forgot.
Okay, so I'm medium risk. Medium risk of what I'm not quite sure, but apparently something. Death? A cold?
Well, I don't want that! Surely they can help!
Well, if I scroll down, I get to learn the things I need to work on. "Work on"? Aren't I already working enough? And, hey, how do they know if I'm working on my depression or my "obesity"? Maybe I've worked my depression into submission and what I really need is to leave it alone.
Anyway, I'll bite. Let's find out how to cure my "obesity".
First, I suppose they need to tell me what obesity is. Because that's never come up before.
Holy shit, I have SO MUCH FAT that my health is in danger. Okay, even if that WERE true, healthy diet and daily Jazzercise notwithstanding, is that the most appropriate way to tell me?
Well, let's find an action plan. Because I don't want my health in danger!
Oh, nothing. Darn. Let's click around and see if I can find a back door in. Well, no plan, but more details on my condition.
Are those really warning signs of obesity? Because I'm pretty sure I don't have any of those. I know, I know, they are warning signs of obesity-related disease. But I do believe all of those can happen to anyone. And who puts the "right before you die" symptoms of a disease?
Okay, back to the search for my action plan. Ooh, here are my action steps!
Disregarding that half of these are indecipherable, they are called HOMEWORK!! Not "good stuff to do", but actual fucking HOMEWORK. I've already sold my soul to you, and you give me homework--without directions, no less?
But we're trying to cure my obesity, no? Ah, I found it.
Are those really all my options?
Maybe the health action details will help.
My "educational tool" consists of three bullet points, the first of which is to remind me it looks like I have a weight management "issue". My response to it goes from was this helpful (um, no) to "how likely are you to have bariatric surgery?"
Let me just get this out there. My BMI puts me in the obese category, but my health is great and I'm in fabulous shape. I need a lot of things--more time, more sleep, more money, better fucking health insurance--but I do NOT need bariatric surgery.
These people still haven't told me what to do. Oh, look, I found something. Well, I sort of did, because I can't find it again. But I did get a lovely screen shot.
Who looked at that and thought it was a good idea? Besides telling me absolutely nothing I didn't already know (or that every fat person also doesn't already know), it's like painful, dense text. For the record, the depression action detail looks very similar. I don't want to read it now. I'm pretty sure if you showed it to me when I actually WAS depressed I probably would've just cried.
Speaking of depression, let's see what tools are available to help me "work" on that.
None of those are relevant to me, and they know that (because I had to tell them that I am not menopausal and currently not pregnant and presumably they are aware I am not a child). The only POSSIBLY relevant thing is that incredibly depressing sad face in the sand. I mean, that makes non-depressed me want to cry. But I sure as hell don't need to know if I have depression. I do. I have--with a diagnosis--for a decade, and the State Employee's Health Plan certainly knows that.
So, my sum experience with the NC Health Smart "Wellness Program"? Buggy. Insulting in its treatment of obesity. Naive in its effort to address depression. (I can only imagine how the other conditions get treated. I wonder how many times people who report hypertension get told to avoid salt.) Seriously offensive in its approach--making caring for my health "work", using thinsplaining, and potentially dangerous in implying that I need to "work" on things that are already under fabulous control. Worthwhile primarily as a great way for the state to collect private health data about me, under threat of punishment.
We can only hope this effort--and the enormous amounts of money I'm sure went into it--will fall apart as quickly as the last wellness effort in NC.
JAMA Pediatrics has posted an interview with me and Daniel Callahan, about our perspectives pieces in this month's issue.
You can listen here.
You can listen here.
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