Thanks for the specifics.
I agree. Doctor is an asshole.
Really, I canât even mention that there is an obesity problem?
I think the same thing can be said about some of the âone-size-fits-allâ parenting advice out there as well. I was reading some terrible parenting magazine once that had an article about language development that gave an actual number range of words you should be speaking to your child each day for them to develop language properly. For an study in an academic journal, that would be just fine, but practical advice for parents shouldnât be so focused on numbers. That was when I decided to stop reading parenting magazines.
Given that the topic youâre responding to is about how many hysterical, gross generalizations are made based on very little (or poor quality) data, if youâre going to start talking about a purported âobesity problemâ it would behoove you to have actually read the research. (Start by googling âobesity paradoxâ and Linda Bacon.)
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Second to rocketpj: Iâm against book burning, but I make an exception for âWhat to expectâ which is just horrible. Thereâs a section about in utero hiccups being a possible sign of problems with the fetus which is not only erroneous, but turns what should be an adorable moment of pregnancy into ZOMG EVERYTHINGâS GOING WRONG!
Our OB/GYN knew she had a couple of scientists to deal with when my wife and I went for pregnancy visits, so she didnât BS us much - I told her that if she forbade my wife from eating sushi, we would just go find a Japanese OB/GYN instead. I think madopal has a point up above: if we all wanted to be really, really safe and healthy we would follow the âpregnancy rulesâ all the time - no foods with relatively high risk of parasite/bacterial contamination, no/little alcohol, etc. etc. But pregnancy -especially first pregnancy - wakes people up to every little risk they take with themselves.
For perspective, my mother was told, by her male OB/GYN, to drink a glass of brandy every day to quell her pregnancy nausea. YAY 1970s!
On here, probably not without some flak. However Iâve been to a Wal-Mart a time or twoâŚand I know exactly what you mean.
Seventeen years ago her doctor told the missus that heâd induce labor if she didnât give birth when he thought she should (not all my children are adopted).
I said I would prefer to wait, especially since in our family history all the babies were born late by at least two weeks for as far back as anyone can remember. Some as late as six weeks.
The doctor looked at me and said âGestation period is not a heritable trait.â
I said, âI just told you that in my family, it apparently is. I can provide extensive documentation.â
He turned to my wife and said âIt is your decision. If you do not take my advice it will be your own decision that causes harm to your child.â
I said, âWait, thatâs not fair, and you are putting her on an express train to a C-section!â
He said, âIf that happens I will give you my personal apology.â
I do not feel comfortable relating the rest of this story, sorry. Suffice it to say that nobody died, although there was a remarkable amount of unnecessary pain and bloodshed, and the doctor has never given me the apology he promised.
The obesity paradox ⌠As I understand it is that overweight people are sometimes healthier than ânormalâ weighted folks with the same conditions (ie diabetes).
That doesnât negate the fact that there are plenty of reasons that being overweight is bad for health generally speaking. Nor that Americans especially are heavier and at a younger age than theyâve ever been before.
My father swears to this day that he lived through a bad car crash because he was not wearing a seatbelt. Doesnât make wearing one any less if a good idea.
This is a discussion about pregnancy. You also didnât âdiscussâ much of anything. Just some factually-shaky opinions and no data.
What does this have to do with pregnancy? Oh right. Ewwww, fat people!
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If you want to understand why you are taking flak for talking about obesity, look at what the article we are discussing says about weight. You are supposed to gain 25-35 pounds while pregnant.
If you walk in weighing 70 pounds or 200 pounds it makes no difference. If you are 4â8" or 6â2" no difference. No account for anything about you, just a weight range.
That is exactly what is wrong with virtually all discussions of weight. People actually use BMI to quantify the obesity âepidemicâ despite the fact that BMI relates weight to height squared and people expand in three dimensions. The only person I know over 6â4" who is not âoverweightâ is rail thin. We tell people that the ideal weight range is a BMI of 20-25 despite the fact that evidence shows that 27 has the lowest mortality and that being underweight is much more dangerous than being overweight.
And all of this is ignoring the fact that weight is a very lousy metric for health. Try to find a study linking high weight to health outcomes that factored out exercise, healthy diet, and all medical conditions that cause both weight gain and other negative health outcomes. People who are otherwise respectable walk around acting like being above a certain weight causes diabetes.
Also, I donât want to get on the âwe can only worry about one thing at onceâ bandwagon, but seriously, socio-economic class is so much better a predictor of health than weight that we should really be talking about the poverty epidemic. The abject stupidity devoted to the obesity problem has gotten some of us on edge.
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Except I was responding to a post that talked about an episode where a doctor was scolding a parent for an overweight child. All I said then was that a doctor should be the one person that can bring this subject up because there IS a problem with obesity.
Later, when that person clarified some specifics about the situation, I agreed that the doctor was overreacting. (I believe my quote was âDoctor is an asshole.â)
Iâm getting flak for one reason. I said there is an obesity problem and that triggered some anger.
BTW, I donât disagree with any of the specific points you make. BMI is horrible metric (especially for tall people ⌠at 6â2", Iâve been classified as overweight my entire adult life). Weight ALONE is not a sufficient metric for health. But, honestly, I canât think of any OTHER single metric that is a sufficient metric for health. But weight is a strong indicator of many health related issues (whether the weight is a cause or effect of a health issue must even be taken into account). And I never used the word obesity âepidemicâ. I said an obesity âproblemâ exists in this country. I stand by that statement.
Exactly. In particular, family genetics come into play, as well as ethnic group genetics. Your best clue on what to watch for in your own pregnancy is to learn everything you can about previous pregnancies on both sides of the family.
I know you didnât use the word epidemic and that you didnât say anything to support many of the foolish ideas about weight, and I know you werenât responding to the article, I was just using it as an example of the crazy ideas that are out there that are pushed on us - and they are pushed by doctors too. Iâm not trying to criticize you, just to explain (vent about?) why weight is such a touchy subject.
Like you say, doctors should be able to bring up weight where it is affecting someoneâs health, but because of the penetration that âfat is badâ has in our culture, we canât really trust them on the issue. You read a story about someone being unfairly hassled by their doctor and thought, âMaybe we should give the doctor some creditâ while others read it and thought, âYup, thatâs pretty much what I expect from doctors.â In this particular case I think I was extra-sympathetic to the original story because it invoked standard deviations.
But I also donât really buy the idea that we should use weight as a metric for health because, while itâs bad, everything else is bad too. We should accept the fact that we canât easily aggregate âhealthâ as a statistic, and, if we insist on doing so, we should use statistics more strongly tied to actual health outcomes (but no one wants to think of poverty as a health issue).
I think I understand where you are coming from. And I am sympathetic.
As an aside, I wonder how much of the âthatâs pretty much what I expect from doctorsâ is a outgrowth of the fact that doctors get so used to âdumbing it downâ that when they get a patient that can handle nuance and gray areas instead of just black and white ⌠they donât recognize that patient as such and keep it in the simple, âGo over this line and THERE BE DRAGONS!â
My wife spent time in both France and the U.S. when pregnant, and the enlightening experience clearly demonstrated the arbitrary and culturally skewed nature of medical advice. In France they told her: âDrinking wine is fine or even healthy, just donât drink too much. Try and limit your smoking to a few a day, but if it stresses you out to quit, donât worry about it. Unpasteurized raw cheese is fine, but whatever you do, DONâT EAT SALAD.â I guess they fear the risk of toxoplasmosis and other things that come from improperly washed vegetables. So she drank a little, smoked a little, ate cheese, raw fish, salad, whatever, and the baby was totally fine.
My best friend had to change pediatricianâs because he was getting a hard time for going Gluten free with their daughter. Heâs a celiac and itâs just easier and safer for everyone in the family to eat the same. But his daughter is as tiny as he and his wife is and the pediatrician was worried that she wasnât eating enough because she was too low on the chart.
So, that works great for the mother, what about for the child, who doesnât have any built up tolerance for caffeine?
I have not conducted any studies to back my wild speculation. I donât understand the mechanisms by which caffeine tolerance work or how they interact with the systems that protect embryos and fetuses from potentially harmful chemicals in the motherâs body.
I also assumed my complete lack of expertise was shared by the economist who was using study results rather than original research.
The authorâs research suggested that it was cutting down on caffeine, rather than staying below some absolute quantity, that avoided high rates of miscarriage. From this she concluded that it was quite likely a connection to nausea rather than the caffeine itself. I was pointing out that from our common experience of caffeine, it is not implausible that the relative level of caffeine has an actual effect - that âless-than-normalâ and âmore-than-normalâ could be amounts that have a real effect on the chance of a miscarriage. And remember that pregnancies work both ways - you need both a viable little one and a mother capable of carrying it, so a connection between a drug and a miscarriage rate may actually have nothing to do at all with how the drug affects the embryo/fetus.
Because of this, I thought she was hasty to conclude that cutting back on caffeine would not have a real effect on miscarriage rates. She may have additional knowledge or research not described that invalidates this argument.
Data point of one: my mother ingested high levels of coffee while pregnant with me (at least a pot a day). She has the gene that makes caffeine not as potent; in fact, she drinks it before bedtime to go to sleep. She passed that gene down to me, and I passed it down to one of my children. However, I am extremely sensitive to caffeine (my phenotype does not match my genotype). Based on this, one could surmise that a fetus does indeed have difficulty dealing with a caffeine habit while gestating. However, as prenatal effects go, itâs not that big a deal. Thereâs no Fetal Caffeine Syndrome, AFAIK.
