obesity, public health, etc

a hopefully non-judgmental thread to discuss anti-obesity public health measures, the evidence for them, and other assorted issues, continued from the unfortunately-titled earlier thread

re: that system talked about on the other thread, there's some more results on pubmed when you search for 'traffic light' obesity

http://www.nhs.uk/Livewell/Goodfood/Pages/food-labelling.aspx#Tr

The issue of obesity and public health breaks down for me this way.

Obesity is not a communicable disease. Strictly speaking it is not a disease at all, but merely a precursor or a risk factor for disease. And, if anything, American society seems to be converging on treating obesity as evidence of an egregious moral failure, much as we have in the past looked upon drunkards, people with sexually transmitted diseases, or more recently, smokers. Which isn't helpful at all.

I am aware that ill health in general has social costs as well as personal costs, but some social costs are inherent in ALL cases of ill health, so this seems to me to be a weak justification for any measures apart from the basic effort at public education drawing the connections between obesity, poor eating habits and problems like diabetes and high blood pressure. That education effort has already been made and if anything, the media have enthusiastically taken up this message, inflated it to enormous size and distorted it out of all recognition, so that the message now reinforces the general public prejudice more than it informs anyone of the facts.

Because public education seems to have passed the point of diminishing returns, it seems to me as better left to a private discussion between the person and their doctor. But I'm fine with trying to educate doctors to disentangle the plain facts from their own prejudices around the subject, so they don't just mirror the attitude of socety, but can discuss it dispassionately.

there's a lot i disagree with there but i'm afraid to get into it

I think an issue is that in our current food climate it's hard not to get into unhealthy habits. Things on the level of public policy- those traffic stop labels, doing something about all the corn syrup- are more promising to me than efforts to educate individuals by wagging fingers at them.

I saw a pretty good documentary called "The Men Who Made Us Fat" - I think it nails it down pretty accurately.

It started all the way back in the 70's - tsk tsk Nixon, George McGovern, Ancel Keys.

https://www.youtube.com/watch?v=E6nGlLUBkOQ

I thought this was pretty interesting, too... this is about how obesity is now very prevalent in developing countries. I didn't know this, but Mexico is now considered the world's fattest country.

https://www.youtube.com/watch?v=mGL3iT5MMdQ

Big takeaway: big food corporations are raking in a lot of money on making us fatter

But then I get into thinking: would we be able to feed the world without all this cheap grain and sugar??

yes, on lentils

treeship where do you draw the line of finger-wagging? is it bad to encourage people to exercise?

Exercise does very little to combat obesity.
If people want to exercise, do it for fitness - stress relief, balance, strength. To lose fat it's not very useful, though.

Disagree with that to some extent. Building lean mass in the course of losing fat will make it easier to keep fat off in the future, as will simply staying active.

Small things like stand-up desks/10k steps per day/etc., even without traditional 'exercise,' appear to have a very positive effect on long-term health (for overweight/obese people and non-overweight/obese).

Encouraging people to exercise is fine. Framing exercise as a method to 'cure people of obesity' is far too narrow a way to talk about it and comes at it from a negative, rather than a positive perspective. Exercise is not like a medicine you must swallow to cure you of a problem, it's a central component of maintaining good health. And, ideally, it should be inseperable from your normal way of living your life, like walking to the store or playing active games you enjoy.

wait idgi

burning more calories and ingesting fewer calories is a surefire way to improve your BMI, no?

and i think for obese people exercise IS like a medicine, the same way mindfulness exercise is like a medicine for mentally ill people

So, if exercise is a medicine, are you qualified to prescribe it?

my mom, after 30+ years of obesity, has just been diagnosed with diabetes

apparently her future is strongly tied to the amount of extra fat she carries around her core - the more that's there, the worse the diabetes will get, and the less that's there, the more manageable it will be

she's exercising regularly now, and she treats it as an intervention for her health problem

how exactly is this unhelpful to her?

i don't think it's surefire, is the thing

https://www.youtube.com/watch?v=JsR1x1-99GE

now who's coming from a negative perspective, aimless?

yeah, anecdotal, but i've found exercise very (very) effective in combating obesity. a extra calorie burned is just as effective in weight loss as a calorie cut from intake. do both, and i get twice the benefit of either in isolation.

i mean, at my heaviest, i've been able to burn more than 700 calories by walking quickly over hilly terrain for an hour. put in two hours, and i'm burning a pound every couple days. add significant calorie restriction, and i was able to average about 5 lb/week lost.

course i was younger then...

i don't think it's surefire, is the thing

― antoine fuckwant (goole), Wednesday, July 24, 2013 1:00 PM (3 minutes ago)

well, nothing is. still a p good idea for almost everyone.

nice sig btw

A lot of the studies that claim that exercise doesn't lead to weight loss seem to be limited in scope -- they take a bunch of people and put them on exercise programs for relatively short periods of time, and also it often sounds like the exercise itself isn't very strenuous. The short time period is also problematic because you can wind up building muscle while losing fat and thus have the initial appearance of no progress.

you can wind up building muscle while losing fat and thus have the initial appearance of no progress

which is as good a description as any why weight loss is not, in itself, a partuicularly good goal to focus on. it has the benefit of being simple, but the drawback of being simplistic.

very strenuous exercise is not all that great for you, either. it stresses out your adrenal glands, raises cortisol levels, which can actually lead to weight stalls/weight gains.

Everything in moderation.

jesus why is having a body so complicated

is it too much to expect this thing to just run properly

run as in operate, that is. fuck actual running obv

I think there's probably a good amount of leeway between low-intensity exercise and exercise where you're actually doing damage with elevated cortisol.

hey, just offering another opinion since I can tell you cutting cals (which I took to the extreme when I was in college, eating about ~1,000 a day) and exercising (also took to the extreme at the same time) pretty much put my thryoid in the tank (I am hypothyroid). And now I am fatter than I was prior to that.

The easiest way to combat obesity seems to never become obese in the first place.

jesus why is having a body so complicated

is it too much to expect this thing to just run properly

It's not that complicated at all! It's all just pleasure in food, pleasure in activity, pleasure in having a balance of interests, until you start asking yr body to be something it's not: substantially thicker or thinner or a different shape in a basic way. Yes, if that's what you want more than anything, it's going to radically change or even disorder your life.

That is not necessarily applicable to obesity, however medicine is defining that right now, but maybe it could be.

yeah I mean the only thing that worked for me was both gradual, prolonged reduction of calories AND increased exercise. And there was a lot of trial and error (really, over the course of YEARS) and nuance to all of this for me in terms of what did and didn't work. For example there were certain things I found myself able to just completely give up (at least on any regular basis) -- french fries, donuts, soda, etc., and I just stopped keeping certain kinds of snack foods (chips, crackers, cereal) in the house at all, the ones I was most prone to overeat. At the same time, I had to let myself eat other things freely in order not to feel deprived. And with exercise it was a struggle to find a way to exercise that I actually enjoyed, and to really learn to exercise in an effective way. When I first started going to the gym I think I was doing things too low intensity to really lose weight (unless I would have done it like an hour or more every day) AND too low intensity to be enjoyable. But it also seems like I kind of had to get in shape to get in shape, i.e. to get myself into good enough physical shape that I could even enjoy higher intensity workouts. And I discovered things like basketball that made me actually want to get to the gym in the first place (although I've cut back on that as my joints have gotten a little creakier), and after warming up with shooting around and some drills I had gotten myself in the door and was ready to work out. I also found I like moderate weightlifting and bodyweight exercise, but really dislike running, so I try to build workouts where I get "cardio" by doing a series of weight exercises in relatively quick succession. And I found ways of getting a relatively good workout out of an eliptical machine by varying resistance, switching from forward to backward, emphasizing pushing/pulling or arms/legs. I'm kind of ADD, so I need a lot of variation to stay with a workout and I decided to accept that. I also hate workout "goals" and "systems", e.g. those checklist sheets that trainers give you, so I just decided not to use them.

This may be the wrong thread for this, and I apologize if so, but it's something that popped into my head recently:

If obesity is/isn't categorized as a disease, does that mean something like alcoholism or drug additction is/isn't a disease, too? Why or why not?

NB I am not a doctor and am guessing most ilxors aren't either, it's just something I wondered.

did anyone peek at the docu's I posted? I am very interested in that sort of discussion - the root causes of global obesity.

As for my OWN obesity, I am fairly certain it's linked to: my own mother's fat phobia, the low fat craze of the 1990's, pigging out on carbs in highschool, tanking my thyroid in college, getting my gallbladder removed shortly thereafter. Ever since I was 23 or so I've not been able to eat very much without gaining a lot of weight.

I've dropped 35 lbs in the last 10 weeks and exercising is a big, big part of that. I'm always surprised to hear suggestions that it doesn't really do much to cut down weight but in spite of eating less (mostly through skipping breakfast) my diet is not a whole lot better than it was before then.

Exercise was almost completely worthless for weight loss for me. I can eat way more calories than I can ever exercise off.

everyone's body chemistry is different. cutting out breakfast is a big portion of calories. that's an entire meal you're losing - do you not see that as a pretty big reduction in calories??

i don't think the term "disease" means much more than just "medical condition"

i've definitely reduced calories but not to the point of losing 3.5 lbs a week. i think my average breakfast was only like 300-350 cals anyway.

35 lbs in 10 weeks is kind of a lot

that's 11000 calories a week doggy

Eating and exercise don't exist in a vacuum. It's easy for someone to say I did this and got this result, but really there are so many confounding variables that can effect the outcome.

that is a lot, and just goes to show how just because one dude loses weight in 10 weeks exercising, he thinks everyone can.

thanks to the revival of this topic on ilx i've been on a diet and exercise kick too. about 35 minutes a day of training and cutting back to around 1500-2000 calories per day from 2500 or so.

i'm not expecting to lose more than a pound a week

imo frogs is exaggerating

calorie labeling at restaurants is helping me a lot, thank u state govt

yeah xp and I've also found for me at least that slower weight loss is longer lasting.

I guess I was. I started on May 7th so it's actually been 11 weeks. I don't mean to make assumptions about anyone else. I'm just saying that the cals in/cals out equation (factoring in BMR) has been really accurate for me thus far.

in reality though weighing nearly three bills to start with is probably the biggest factor here

more bodyweight does = more calories burned per hour, so there is something to that.

I've dropped 35 lbs in the last 10 weeks and exercising is a big, big part of that. I'm always surprised to hear suggestions that it doesn't really do much to cut down weight but in spite of eating less (mostly through skipping breakfast) my diet is not a whole lot better than it was before then.

― frogbs, Wednesday, July 24, 2013 2:44 PM (2 hours ago)

lol, me too. got my pma, reconfigured my diet and exercise routine on may 5th. as of today, i'm 11 weeks in. i only weigh myself once a month, on the 5th, but i'd lost 28 lbs as of june 5th, almost three weeks ago.

bet's over, final tally is 55 lbs in about 17 weeks, feels good :)

Good for you!

That "feels good" is the essential part.

frogbs is a big loser :-)

http://www.nytimes.com/2013/11/08/health/fda-trans-fats.html?pagewanted=2&_r=0&smid=tw-nytimes

not directly obesity-related but this is pretty good news

Leaving just the 35% of trans-fat intake naturally occurring in dairy and beef. Its a start.

http://junksciencearchive.com/nov99/transfat.html

http://www.cnn.com/2013/11/08/opinion/carroll-fda-trans-fat/

aaron carroll

NV's link by the way is to someone self-identified thusly:

"Mr. Milloy is a frequent advocate for free enterprise/free market principles and policies in conjunction with the Competitive Enterprise Institute and the National Center for Public Policy Research, both of which are supported by individuals, foundations and businesses."

For what it's worth.

http://newsatjama.jama.com/2014/01/15/jama-forum-do-employee-wellness-programs-improve-health-and-reduce-spending/

http://www.washingtonpost.com/news/wonkblog/wp/2015/09/18/rich-parents-might-look-down-on-fast-food-but-its-actually-their-kids-who-eat-it-the-most/

i'm struggling to figure out what to make of this

to my simple mind it suggests that the relative nutritional content of food prepared at home is different across income bands?

could be! honestly it's just shocking to see the data show that lower-income kids eat less* fast food than more well-off kids, because the opposite has just been so ingrained in the public health mindset for so long

*actually iirc the data this article describes show that poor kids eat a lower percentage of their daily calories as fast food, so maybe they're just eating more overall? could it be a matter of portion sizes?

poor kids are much more at risk of being underfed and hungry than being stuffed full of fast food on a daily basis. just ask anyone at your local food bank.

the data does show a lower percentage of cals for poor kids, but it's like 1.5%, not something that seems hugely significant.

so--roughly same amount of calories overall, and roughly same percentage of calories coming from fast food. so if there's a disparity it makes sense to look at the nutritional value of the rest of those calories.

it's funny, the article mentions food deserts as if the data challenges that concept, but if anything it supports it--access to fast food is pretty much universal, but when it comes to eating at home, rich kids (or their families) have greater access to supermarkets with healthier options, while poor kids may be stuck with markets/bodegas/etc. that are full of low-value processed stuff.

and it continues:

The average American scores only a 58 out of 100 on the Healthy Eating Index, a metric devised to health gauge the quality of any given person's diet. The average food stamps participant, however, scores only a 51 out of 100, according to one study cited by the review, and 47 out of 100, according to another.

"Americans are pretty poor eaters, but SNAP participants have particularly bad diets," said Andreyeva. "They don't eat nearly enough fruits or vegetables, and they consume too many fats and sugars."

https://www.nytimes.com/2017/02/22/upshot/soda-sales-fall-further-in-mexicos-second-year-of-taxing-them.html?smid=tw-upshotnyt&smtyp=cur

seems like a big win for public health advocates. we can't know what the effect is on health outcomes is for years down the road (if ever, unless some pretty creative study designs are put forth), but this is good news

What is the greatest current public health issue? And why?

pre-thanks for the interview help

Gun violence is a hot one these days due to a recent Public Health Advisory from the Surgeon General. But this is US specific and I don’t know where you are!

What is the greatest current public health issue? And why?

― H.P

been a while since this thread's been revived, i've had a lot of evolving ideas about obesity and its significance over the past seven years, particularly as it relates to trauma and "weathering"

but idk if this is the right place for me to soapbox about that lol

as far as the greatest current public health issue, yeah that's a complicated one. as far as the us is concerned, in my opinion (i'm not an expert in public health, but i _am_ a healthcare data analyst and i keep up on this stuff professionally) the greatest public health issue is lack of access to healthcare. i mean, everybody knows this is a problem, it's _well_ documented that the american private insurance system is completely inadequate to serve the healthcare needs of the american people. i work for a private insurer and everyone i work with knows that too. duct tape. duct tape and baling wire and trying to surviving the increasingly unreasonable demands coming from the c-suite.

i don't know if people don't know, or if they just don't talk about, the completely devastating effects of covid on the delivery side of the healthcare system. you go in there every day and you watch people die of a completely preventable disease that wasn't prevented because of misinformation and disinformation. you don't have the resources to help people, they go out in the hall and they die there. and i see, you know, sometimes people think that the people who suffer from anti-vax bullshit are the loudmouth entitled/fragile rich white conservatives on facebook, and it's not. it's the same people who die disproportionately of _everything_ _everywhere_ and always have been. it's marginalized people.

the racial disparities in american healthcare have been known for decades and at some point we decided not to document them because they could be used to support racism. the data can and was being used to support racism. this is absolutely true. not having the data, though, not _talking_ about race and its effects on the quality of healthcare people in america get, has only served to perpetuate and entrench the problem.

of course a lot of people don't trust american healthcare, and i can't blame anybody for not trusting american healthcare. the same institutional medical system that gave us such fantastic hits as the tuskegee syphillis experiments? doctors lie, doctors ignore patients, doctors condescent to patients, _particularly_ patients who aren't cis white men. doctors gatekeep patients, doctors gaslight patients. as someone who's chronically mentally ill, i've not always been treated well by providers. my pain doesn't get taken seriously because you can't run a test for it. people have given me drugs to pacify me and they gave me more and more and didn't tell me about the withdrawal syndrome and... i could have died. i've seen people die. my ex-wife's brother, he was schizophrenic. his mom tried to take care of him for years, tried to help him live independently for years, while he self-medicated by chain-smoking and struggled and did without. and finally she said i can't do this anymore, i can't give him what i need. in a facility they will be able to help him better. it was a hard decision, but he deserved better, so she did it.

within a week he was dead. drug overdose. nobody knows or, frankly, cares how it happened. maybe he got the drugs from another patient. maybe one of the people there accidentally gave him too much. it doesn't matter. he was crazy. people couldn't see him without seeing the _burden_ he presented to them. why hold anyone responsible? after all, they were probably all doing their best. just like all of us.

i have a number of family members who are doctors, who are good doctors, caring doctors. i've had amazingly good experiences with the medical system. doctors, nurses, healthcare professionals and paraprofessionals - these are my people. this is where you go to try and make a difference, and this is also, you know, where the money is, and we all gotta get paid.

but nobody is _resourced_ to help people, patients aren't _getting the help they need_. it's hard to tell the difference between inability to help and unwillingness to help. from my perspective as a patient, it doesn't matter which. from a broader perspective, it's very easy to read inability to help as active malice, when in fact it's "only" a form of systemic prejudice and marginalization.

-

the greatest public health issue? yeah i'm trans and yeah there's transphobia out there but i _haven't_ been gatekept, i _haven't_ been gaslit. my experience has been good. people have supported me, have had my back, from day one in the portland, oregon healthcare system. the problem to me is that system is inadequate to _everybody_. covid came down and operations all had to be rescheduled. to prevent COVID you couldn't do surgical procedures like you used to. i mean the problem isn't _trans_ surgeries particularly, that's just the one that affected me most. people had chronic health conditions that not just affected quality of life but had a strong risk of actually killing them, and the healthcare system, they had to triage, they had to triage hard. make those tough decisions. people talk about "death panels", fuck, in effect every doctor is a death panel, because nobody has the resources to help all the people who need help, who deserve help. decision makers in healthcare have to decide every day who lives and who dies, to an increasingly greater extent, to an extent i've never seen before in my lifetime. and you know, those of us who live through that, who see that, who see good people suffer and die every day, we have to live with that. we have to live with ourselves. do you know kevin carter? he took that picture, "the vulture and the little girl" ("she" was actually a boy, turns out). he took that picture, and four months later he killed himself. the child lived, for a while. his name was kong nyong. he died in 2007.

not just as a trans woman, but as a person in healthcare, i see sick people surrounded by vultures every day. i don't mean the rapacious for-profit healthcare system sucking the life out of people for profit blah blah blah. no. i'm talking _death_. the spectre of fucking death, and you know, most of us get away from the vultures, for a while. but they're always there. and i've never gotten used to them. i've just learned to not talk about them, because it hurts me to do it, and it doesn't help, nothing is done, _nothing is fucking done_. "it is what it is." i can't _fix it_. nobody believes, i guess, nobody believes they or anybody can fix it. and it's just, i guess, the new normal, it's just going to keep going on forever.

well, it's not. it's going to change, because that's inevitable, but in the meantime we pretend we don't see it, we don't talk about it.

-

i said i had chronic mental illness, and that doesn't get taken seriously. and trauma. god. nobody acknowledges the trauma. i go in for my latest round of DBT and my therapist is going through my diagnosis and we talk about whether i have PTSD, and i say well, kind of, PTSD is when the trauma is _over_. COVID was a collective trauma. It was worse for me than for a lot of people, probably, for a lot of reasons, but it affected _all_ of us, it's still affecting _all_ of us. The COVID worst-case scenario has happened. It's routine now for people to die of COVID, people who are immunocompromised, people who are vulnerable, and the people who die, they don't get help, they get blamed, they get held responsible for our own deaths. _That's_ the new normal. That's how it always has been. Obesity? All my life people have been saying obesity is sloth, was a vice, just like they used to say acedia was a sin, that being depressed was sinful. The data doesn't show that. You look at the data and it's correlated with trauma, with systemic oppression. Almost every trans person I know has an unhealthy relationship with food. I have an easier time than most, I do better than most. My mom was severely abusive, she was a dietitian who substituted food for love, and I still have it better than most people. Underweight, overweight, it doesn't matter. Sometimes it seems like half of us are emaciated and half of us are morbidly obese. That doesn't get _connected_ to anything, all my life that's been seen as an independent variable, and finally, finally people are starting to realize it's not like that.

Occasionally someone shares some old statistic that says that the average lifespan of trans people is 35, and that it's because we all die from suicide or murder. It's not true. It's patently not true. We don't _know_ for sure what the average lifespan is trans people is. We don't know how many trans people there are, who they are. A lot of us who are trans are afraid to say. A lot of us have been bullied and gaslit into denying our own reality. It still happens. It's just not as effective as it used to be.

So we don't know. We don't know how being trans affects someone's lifespan. For a lot of other groups, we do have a good idea. We can compare the information of demographic groups. Even if we don't necessarily have full racial data, we can compare infant mortality rate in Oregon to infant mortality rate in Alabama. The infant mortality rate at Alabama is at third world levels. Again, who do you think is being affected by this? Who do you think suffers the most? If we had the data, I have a damn good idea of what it would show. It would show a crisis in infant mortality among Black children. Nobody wants to _talk_ about that, though. Nobody wants to admit it, nobody wants to _collect the data that would show it_. Again, you know. I understand. Tuskegee is in Alabama.

I mean I can tell you. I can tell you about diabetes. My mom has had diabetes since the age of 32, gestational developing into full-blown. She's obese, been obese all her life. The diabetes is well-managed, well-treated. She's got an insulin pump that manages things well. No retinopathy. No need for amputations. Who goes blind from diabetes? Who loses limbs from diabetes? Hell, even more than that - what groups do you see who are obese? And what do people say about them?

If you're poor and fat, people say you can't be doing that bad. People say oh you're fat, you're gluttonous, you're greedy, you must be living the good life, you can't have it that bad. If you were doing that bad you'd have, I don't know, fucking kwashiokor or something, right? You wouldn't have that big fucking belly, right?

I mean it astonishes me, astonishes me that people don't know about food insecurity. About what you do when you don't have enough. You take what you can get, when you can get it. That experiment they do with kids about "impulse control", that kids who don't take the cookie to get two later do better than the kids who can't hold off and take the cookie... you know what the real difference is? The real difference is that the kids who take the cookie have learned that people who promise them things are lying. That they fucking well better take the cookie while they can get it, that a bird in the hand, you know, that's literally something people say, that's literally _advice_ people _give_, but when poor people do it, well, it's not a virtue I guess, it's a _vice_. You take what you can get, when you can get it, whatever the cost, because you don't know when you'll have that opportunity again. That's the reality.

-

Back to outcomes, though. Disparities in outcomes. Two people get diabetes, and my mom manages the symptoms well, and, let's say, Gene-Gene the Dancing Machine, he doesn't manage the symptoms as well, and he has to have his legs amputated. Why? Why is he not able to manage his symptoms the way my mom is? I have a better idea than I used to. I'm here, I live in a city with great public transportation. I don't need a car to get around. I got money, on top of that, if I need to get somewhere and I can't wait for the bus, I can afford a Lyft. I also got multiple chronic health conditions. I had to change up my hormones. I was taking a hormone regimen that was really good, that was really working for me, and I had to change them up, because Pfizer doesn't make those hormones. Because you know, they say, this other kind will work just as well. Well, it doesn't work just as well. The change has been hard. I'm tired all the time. I ask my provider, hi, can I get some hormone labs done? I wanna know my hormone levels. And they say sure, just print this lab order. Because my prescriber isn't at the same facility as my lab, you see. My prescriber is out of network, because I can't find anybody in-network to prescribe for me. My insurer _says_ they have gender-affirming providers, and they do. They genuinely support me and always have. When I go to their provider lists to see who provides "gender-affirming care", it's a bunch of therapists. I don't want somebody who'll use my fucking pronouns. I want someone who'll prescribe me the girl juice. I can't find that. Nobody wants to do that. Doctors are afraid to prescribe, just like doctors were afraid to provide abortions before it was just outright made illegal here. Nobody understands that, either, nobody understands chilling effects. As long as it's legal, it's fine, even if you can't find anybody who will actually do it. That's not a problem. The inadequacy of the network isn't a problem. It's just about whether it's legal.

Sorry, this is turning into a long disorganized rant but fuck it, I'm gonna go with it, I need to say this shit. I of course don't have a printer for my lab order, but I figure, you know, I can submit it through the secure online portal. Every provider of mine has a secure online portal, and every one of them uses the same outsourced software, but I have to have a different login for all of them. Privacy reason. I understand that. I do that for a living, healthcare compliance. I get why it is. I also have a list as long as I arm of different healthcare providers that I'm trying to coordinate. I login and submit it and say "Hey, can you send this to the lab". And they say no, we've just outsourced our labs, we've outsourced them to LabCorp. Probably laid off everybody at the labs too. You know, everybody's gotta tighten their belts, healthcare is losing money hand over fist. It's funny, I think, funny how literally everybody is losing money and nobody seems to actually making money. I don't understand how that works. _Somebody_ has to be making money, right? I mean, you'd think one of the main features of a for-profit system would be that people would actually make profits, and for some reason that doesn't seem to be happening. Weird.

Anyway, they say, here's the phone number you can call to make an appointment. Oh, OK, great, because it's a routine lab and I used to be able to just do those walk-in. I guess I can't do that anymore.

I mean fuck it. At this point I'm just saying fuck it. I'm fucking injecting E whenever I feel like now. I don't know what the right dosage is, I don't know what my levels are, it's too much work to get my levels checked. I'm not up to it. I honestly, I honestly have wanted to go to DIY for a while now, to order grey-market estrogen. That way I can get the stuff I want. There's higher risk to that than there is to getting it prescribed through the official healthcare system, but it's probably lower-risk than me just fucking injecting E whenever I feel like it. But you know, I'd have to do that through cryptocurrency. That's too high a barrier. It's not ethical issues. Trans ethics is that you do what you need when you need to do with it and you live with the consequences. That's it. So I got no ethical problem with DIY. I just don't know how to do that, how to make that happen.

And this is, again, there's _no transphobia_ involved here. Everybody involved is absolutely trans-affirming, completely supportive, I'm not getting any pushback because they don't want to give hormones to me. Not an issues. It's just the way the healthcare system works, or "works", in America.

And that's one. One particular drug. I take more pills a day than Ozzy Osbourne. Clinically evaluating me involves a high level of medical complexity. And I can't just get them filled at one pharmacy. Half of the drugs I take, my insurance won't cover them unless it goes through their special pharmacy. Because it saves them money. Never enough money, never enough money to go around. Do I know which drugs come from which pharmacy? No. Do I know which drugs are on autorefill, when they autorefill? No. I find out when I run out of drugs. This is not an ideal method of med management, particularly when it comes to drugs like lamictal, which need to be titrated up and down very gradually to mitigate the risk of a severe life-threatening side effect. I know this. I know _how_ to manage my medications. I don't have the time. I'm trying to work a full-time, extremely complex, frankly inhumane job. Managing my physical and mental health is pretty much a part-time job on its own. About 20 hours a week, it takes. I'm not doing it well. I'm supposed to get a colonoscopy. I've been supposed to get a colonoscopy all year. They gave me this kit, and it's inscrutable. I don't know how I'm supposed to get my shit into this thing. I'm supposed to get my shit into this thing and then mail it to them, except I guess not now, because the lab has been bought out. I guess I need to get a new lab order and a new poop kit.

I got a new glasses prescription in January. I got real good vision coverage through my employer. So I got a new prescription, except this time, this time I can't get my glasses prescription filled there like I used to. They don't have anybody working that side of things. You know, they don't have the money, they can't keep people working there. They say it's OK, I can just take the prescription and send it to the lab. I say well, I was getting it through you because most places can't fill my prescription. I go to you because I got astigmatism, I got prisms, these usual places, they can't do those orders. And they say oh, it's fine, just look something up on the Internet, there are plenty of places who'll take care of that for you.

I have not yet looked up a place on the Internet to do that for me. My glasses are probably four years old at this point.

I mean it could happen at any time. I could have cancer right now, I could get a colonoscopy or a poop test and whoops you have cancer, it's stage four, if you'd gotten it checked six months ago like you were supposed to we could've done something about it, but now? Not now. Now you're going to die from it.

I have pretty good idea why Gene-Gene the Dancing Machine lost his legs.

-

And again, I'm lucky, I'm covered. I got real good coverage. This job is fucking killing me, it's fucking killing me, but you know, at least they pay for all the mental health treatment I need from working this brutal, dehumanizing job. At least there's that. Not everybody has insurance. Remember Maggie Roche? Remember when she died in early 2017? 65. Too young. Too young. Breast cancer. You know, if she'd had coverage, if she'd had health insurance, they could've caught it, maybe she would've done better. She didn't. And you know, if they did catch it, what was she gonna do, start a GoFundMe for her medical expenses? That's our healthcare system right now, for millions of people. GoFundMe. Start a GoFundMe and hope you have friends with money. Nobody's gonna give your GoFundMe money to get _tested_ for breast cancer, mind you.

Even then, you know, I'm lucky. I live in Oregon. We got real good Medicaid coverage. I lost my job, I could get on Medicaid. I'd just have to fill out the paperwork, which gives me intense anxiety, which I have no idea how to do, but I could probably do it. I'd have anxiety about not working, providers would treat me like shit, I'd have anxiety about maybe never having a job again, but you know. Better than GoFundMe. I don't know how it would affect my existing medical treatment, though. I mean at least I wouldn't be responsible for them out of pocket, they wouldn't be excluded as "existing conditions". I guess literally Thanks Obama? I don't get an opportunity to say that very often, but I guess credit where credit is due. It's not much, but it's _something_. So who knows. Would my therapist still take me? Would I have to find a new therapist? You can't find a therapist around here. I'm lucky, lucky to have a therapist. A lot of the people I know, they can't get a therapist, they can't get treatment, so they self-medicate. A lot of them are addicts. Alcohol, drugs, you know, if they're lucky it's pot. Pot isn't nearly as dangerous as some of the other stuff. Nearly everybody smokes pot around here. I don't. I don't smoke, I hardly ever drink. I take more pills a day than Ozzy Osbourne.

And occasionally I need to get more intensive treatment. And again, when that happens, they triage pretty hard. I spent three months in bed last year, dealing with some pretty rough shit I had to go through. Three months and I finally said I can't do this anymore. I need help. And I go to the psych ER and they say we just want you to know we totally respect all gender identities here, what are your preferred pronouns?, and I let it go. I don't argue with that, because I don't want to be diagnosed with Mad Tranny Syndrome. I tell them my problems, I tell them I haven't been out of bed in three months, and they say "Well, it seems like you have pretty good insight into your condition, we think you can handle this." I don't think they even give me a pamphlet, though that's probably for the best. A pamphlet would be an insult.

Now, I already know what you need to do to get better treatment. I know that you _have_ to go through the ER. If you don't go through the ER, they decide you don't need help that bad, and they put you on a two month waitlist. That's what happened the first time I went through this two years ago. Being a lifelong patient, I've learned how to navigate the system pretty well. I got skills.

Which means that when they send me home, when they triage me out, I know what I need to do for them to take me seriously. I cut myself. I haven't cut myself in 20 years. I'm really proud of that. It's really hard for me to keep myself alive, but I'm really good at it. I've really done well at that. That means not cutting myself. But 20 years, you know... I cut myself, and thankfully, thank God, it doesn't become a habit. It could have. I know how easily it could have, because it used to be.

And it works. I get into a different intensive outpatient program this time, not the one I've done the last two times, the one where they start off by saying that I shouldn't be ashamed of having mental illness, that lots of inspirational, successful people have had to deal with mental illness, that J.K. Rowling, for instance, had to deal with depression. They're not saying it to be transphobic. The handouts are just a decade old. The therapists there... you deal in intensive mental health treatment and you have to deal with a lot of trans people. A LOT of trans people. They're affirming and supportive and apologetic. You know, nobody has the money or the resources to update the stupid paperwork. Nobody's funding it. I mean it's _mandated_, Oregon has mental health parity laws, you have to cover mental health to the same extent that you fund physical health. It's just that nobody funds it. The state says it's the city's responsibility. The city says it's the county's responsibility. The county asks where the money is and nobody answers.

-

What's the greatest current public health issue in America? I don't know. Complicated question. Does any of the above help?

whoa

NEW: we may have passed peak obesity 🎉📈📉🙏

In what might be one of the most significant trends I have ever charted, the US obesity rate fell last year. pic.twitter.com/RttePO0EJQ

— John Burn-Murdoch (@jburnmurdoch) October 4, 2024

apparently 1 in 8 Americans have taken one of these drugs and seems like it may now be showing up at the population level? Kevin k what do you think?

I wonder whether people are shy about talking about using these drugs. I know just one person who I know to be taking them. Would never have guessed one out of eight.

same.

I'm trying to get started, my PCP has written me a scrip for "mounjaro" (fuck I hate that name), I think my pharmacy is waiting for my insurance to decide. It's $100/week without insurance, which I can't swing.

I'm talking to my liver doc about it because https://www.sciencedirect.com/science/article/abs/pii/S1871402123001455

Of course people are shy about talking about taking these drugs?! I know three people who have taken them.

Kevin k what do you think?

― 𝔠𝔞𝔢𝔨 (caek), Friday, October 4, 2024 6:51 AM (one hour ago) bookmarkflaglink

I think it’s great! there have been trials published over the last couple years that suggest they are beneficial — in terms of longevity and avoiding cardiovascular complications — in a wider and wider population. saw a report just the other day that the mounjaro “shortage” is no longer as well. hopefully the drugs will be more and more accessible

re whether it’s the GLP1s that are slowing the obesity epidemic, I’d have to read up on that specifically. 1 in 8 is a lot more than I’d have expected!

I wonder if that includes the older, lower potency oral drugs

re whether it’s the GLP1s that are slowing the obesity epidemic, I’d have to read up on that specifically. 1 in 8 is a lot more than I’d have expected!

However, GLP-1 users still need the gym. Studies suggest that the drugs cause significant muscle loss along with fat, leading to problems with balance and mobility as well as saggy skin sometimes dubbed “Ozempic butt”.

https://archive.is/XeZ0x

tradeoffs. living longer vs having a non saggy butt

live fast die young firm butt

https://www.healthline.com/health-news/how-common-are-glp-1-drugs-like-ozempic-13-of-u-s-adults-have-used-them

Xpost

-Friday Night Lights

full plates, clear plates, can lose

NEW: we may have passed peak obesity 🎉📈📉🙏

In what might be one of the most significant trends I have ever charted, the US obesity rate fell last year. pic.twitter.com/RttePO0EJQ
— John Burn-Murdoch (@jburnmurdoch) October 4, 2024

could be garbage data viz unrelated to the study but the chart shows the rate falling 4 years ago? but yeah fuck a tweet, why not link to something with substance?

@caek... or do you have a unvested interest in propped up phantom/shadow RSUs lmao

the ft article (paywalled) is https://www.ft.com/content/21bd0b9c-a3c4-4c7c-bc6e-7bb6c3556a56

here's the source https://www.cdc.gov/nchs/nhanes/index.htm.

this change starting in 2020 is fishy (did anything else happen that year?) agreed, but the article makes the point that it's a stronger trend in college-educated (i.e. ~rich) people, which makes sense if it's semaglutide-related.

I wonder if you can still build muscle at the gym if you take them - like a bodybuilder +_()+_()+_() or you just have to go pump iron to save what muscle you have