Entries Tagged 'health care' ↓

The Australian federal government is making baby steps in using ‘Web 2.0′ tools for consulting with the public on policy and ideas. One of these projects is yourHealth. They’ve not quite got the full idea of what it’s really about yet, but participation in their first efforts will be encouraging (see AcidLabs for a post on why).

Over at yourHealth, you can comment on blog discussion posts, and submit your suggestions for and stories of health care in Australia. One of the current blog topics is ‘How should governments, industry and community groups work together to help us combat obesity?‘. Unfortunately one fat-shaming response made it through the moderation, which is disappointing. Most of the responses seem to be from people who aren’t fat haters as such, but still do believe obesity is a serious health problem and should be ‘combated’. I think the blog could use some Health at Every Size/FA ideas, so if you’re an Australian citizen or resident, please comment on the blog and make your voice heard. You do need to register and confirm your email address, and your comment is limited to 5,000 characters. But this is an opportunity to let the government know that not everyone thinks that fat bodies are a problem that must be solved, and that there are other ways to improve everyone’s health without singling out fat people or focusing on weight or BMI.

You can also tell your health story or give your suggestion either as text or video – see the Contribute page for the links to all these.  How about some stories of how anti-fat bias from doctors negatively impacted your health, or how HAES or FA improved it? Or how anti-fat public health rhetoric is directly implicated in disordered eating? The discussion, especially on obesity, really needs voices from fat-accepting people.

Of course you don’t need to limit your commentary to fat issues, any health issue which is important to you can be discussed!

If you are interested in health care, you should be aware of how health care is sloooooowly (oh, so slowly) being transformed by new models of patient-doctor communication. An excellent blog which discusses these issues is e-patients.net. It’s run by people active in their own health care and who are passionate about educating other patients, doctors, health administrators, politicians and anyone else about how being such an active patient can greatly improve health outcomes.

For example, here’s Dave deBronkart’s short bio from the site:

Diagnosed with advanced kidney cancer (median survival 24 weeks), e-Patient Dave deBronkart rapidly learned to use every aspect of empowerment, technology, and participatory medicine to beat the odds.

I’m sure we all know doctors who still refuse to treat a patient as an intelligent person capable of being active in their own health care, and yet more who express concern about the idea that patients will believe anything they read on the internet and do themselves harm. There’s an excellent white paper linked from the site that addresses these issues: e-Patients: How they can help us heal healthcare. The paper found that this idea that online patient support and information sharing will harm people is simply not true.

Here are some other recent highlights from the blog:

Participatory Medicine as Revolution! Think Critically! Communicate!
This post examines health care using perspectives from Pedagogy of the Oppressed, a  famous book on education: “Participatory medicine cannot tolerate an absurd dichotomy in which patients are merely following their doctors’ decisions—a dichotomy reflecting the prescriptions of the dominant elite. Revolution is a unity, and doctors cannot treat patients as their possessions.”

Applying paticipatory principles to EHR/PHRs
e-Patient Dave original story of the health data transfer from his hospital EHR to Google Health PHR is remarkable in many ways and shows why participatory medicine could well be one of the fastest way to lower the overall cost of health care by helping fix some specific dysfunctions in the system. It took just one active and engaged patient to produce a remarkable change in the way interoperability between EHR and untethered PHRs is going to be defined at BIDMC and probably at HITSP, at a minimum.

In other words, one single real event, driven by a patient has given more effective feedback to improve the national standards than years of deliberations of the cream of the cream in HIT in their rarefied tower of knowledge.

There are some who express concern that electronic health records will be used against patients by government or health authorities. This is addressed in the post Please! No more magical thinking in HIT! – wherein it’s pointed out that patient participation is essential to avoid those fears. It’s no good implementing EHRs and thinking that will solve everything unless you actually ask the people who own the data–the patients–and get their collaboration and participation in creating The New Health. And patients want security, and full access to their own data to check that it is correct. I personally would like to see the option for people to not have their data included in statistics, and to be absolutely sure that if it is, all personally identifying information is removed, with full disclosure of what the data will be used for. And, of course, the option for someone to not have an electronic health record at all.

Why is this important for fat people? Well, there’s already a revolution going on in health care for fat people, and it’s being driven by fat people themselves through online communication and information sharing. It’s all these fat acceptance blogs and mailing lists and forums. We share with each other information on health and fat to counter the poor reporting and biased studies. We share where to find fat-friendly doctors and warn about anti-fat doctors. We discuss Health at Every Size. All kinds of help, advice, and support for physical and mental health. Again slowly, oh so slowly, doctors and other health professionals are getting wise to the ways of HAES (much to the alarm of any other doctors who make money off “treating” fat people). There’s some top-down pushing from such people as Linda Bacon, and then there’s all push from the patient end of the stick – fat people refusing to see doctors who treat them badly, discussing HAES and weight-neutral health with the doctors who might be dubious but are willing to communicate, and support for doctors who are pro-HAES. (And yes, I do realise that there are fat-acceptance people who don’t consider HAES that great and have concerns about healthism, but this isn’t the post for it.)

Elelctronic health records are only a part of the new healthcare, and you could in theory have collaborative medicine without them. It’s this collaboration and conversation that’s driving change.

I would actually love to get an electronic copy of my entire health record which I could keep in the manner I deem secure. I’d keep it on one of those nifty IronKeys probably, with backups. If it was kept online, I think something like the YubiKey would be useful for secure passwords. I’m actually far more worried about the security of physical records – I know at my GP’s office, the records are on full display behind the reception desk. And an enterprising information thief would only need to crack one window to get in and at the records. But I digress. I prefer to be in charge of my own information. Having an EHR to which I could add corrections and clarifications, instead of relying on a busy doctor to write down “pernicious anemia” instead of just “anemia”. I’d probably delete “obesity” and just put “fat” as one thing I could do to resist the medicalisation of a body size[1]. The Dave deBronkhart I mentioned previously discovered that because of wacky insurance billing codes, he “had” all these medical conditions he previously never knew he had, which could have caused problems when new doctors were looking at his record, and so on. Getting a hold of his own data allowed him to publicise the problem and correct the record.

In conclusion, I think that pushing for this new model of health will ultimately benefit fat people. It’s a long road, given how many fat people themselves are convinced they hate themselves and deserve poor treatment. The fat-isn’t-actually-a-moral-failing-and-won’t-kill-you cat is out of the bag, on the internet, and you can’t undo it. Take charge of your own health care, whether it’s full involvement you want or you just don’t care that much and are happy to say so.

For an interesting documentary on what’s popularly called “Web 2.0″, specifically as it relates to government, watch Us Now. Us Now in high-def or Us Now in regular. Imagine what they’re saying, applied to health care. In fact, the bits on mumsnet.com are easily applicable. It’s about new models of trust and reputation – one woman mentions how they are tired of ‘ridiculous’ information on child rearing from doctors and social workers and they trust information from other mums far more, because they’re also mums. These days, if you are a person in authority and you say something ridiculous or dubious, anyone can go look up more information on the net, and connect with other people, other experts, and see what they have to say.

—–

[1] I can see where there’s some artificial inflation of ill-health-correlated-with-obesity statistics: I went to the hospital a few months ago because I was badly dehydrated from gastric flu. When I finally saw the doctor, he had put on my exam card “gastroenteritis” and “obesity”. My fat has nothing to do with my hospital visit, yet is recorded as such. Frak that. Now If I had proper electronic access to my own record I could go in and put a note on it to the effect of “how is this relevant?”. To do that on the paper record is a pain in the arse.

I thought this deserved its own post.

Today I went to the family planning clinic, which is run by awesome women. I am taking the mini-pill, which is progestogen-only. The doctors there informed me that women who weigh over 70kg (155lbs) should actually be taking two pills a day to ensure effectiveness. It’s in the new Australian medical guideline on contraception and reproductive health, so if your doc isn’t up to date, tell them to get hold of a copy.

And they managed to do it in a way that was completely non-judgemental and cool, as in “Hey, did you know this?” rather than “You are OBEEEEESE so you have to take two pills HAR HAR” attitude so many of us fat women have experienced. Family planning doctors are the best. There were two attending my appointment, as one was training to be full-time at the clinic. The trainee doc was pregnant and very sweet, and the other one was a Hell-Yes-I’m-A-Feminist. Awesome.

Anyway, if you’re fat and taking hormonal contraception you might want to discuss it with your doctor. I don’t think you can take double doses of the combined estrogen/progestogen pill because of the side effects of estrogen. If you’re OK with taking medication on a schedule the mini-pill might work better for you. The progestogen-only implants like Implanon are supposed to be OK for fat women, but you might need to get it replaced a little earlier than usual. And apparently you’re not supposed to use Nuva-Ring if you are over 90kg/200lbs. Hopefully you can find yourself some great doctors at a friendly clinic like I did!

I’ll spare you my list of excuses for not updating this blog more often. Suffice to say I’ve had a lot on my plate. (Well, I would, wouldn’t I, what with being such a fatty and all. )

I’ve been on thyroid medication for some months now. Since I was apparently untreated for so long it’s going to take a while to feel the full effects, but for now I am feeling a bit less fatigued. Walking isn’t a tiring chore anymore, but I’m not ready to do an aerobics class or anything yet. I seem to have lost an interesting amount of weight, probably nearly all water weight, seeing as how edema is a big component of hypothyroid-related weight gain. The large lump in my throat is gone.

And interestingly, I don’t need to take as much asthma medication. It’s getting briskly cold where I am, something that last year would have had me taking four clicks per day of the highest dose 500/50 Seretide (Advair Diskus in the US, I believe) plus plenty of Ventolin (albuterol). This year, I take two clicks per day of the medium dose 250/50 Seretide and haven’t needed Ventolin at all. Last year, I had an allergist tell me that my asthma was probably mostly caused by my weight. …Right. I suspect that the hypothyroid and adrenal-fatigue state I was in was causing some kind of reactionary inflammatory process.

The mild insulin resistance I showed up with has also disappeared. Seems that too was a thyroid/adrenal related reaction from my body, not Impending Fatty Diabeeetus. I think all my hormones are finally falling back into normal alignment, some not as quickly as others, but it’s happening.

And so a big fat to all those doctors who told me all my problems were caused by my fat and didn’t bother to investigate further.

In the course of investigations for possible thyroid problems, I found out I had B12 levels near the lowest end of the lab range. Since I have discovered the best thing to do with one’s lab results is to not simply accept that anything in range is “normal” but to do some research, that’s what I did. (Generally if your lab results are in normal range and you feel well, then that’s fine. Except for kidney results – you can feel pretty good right up until near failure. Look after your kidneys!)

I discovered that there are several forms of B12, and if you have a low B12 level, you should also get the following tested:

• Holotranscobalamin (HTC) (active B12 what gets into your cells)
• Methylmalonic Acid (MMA) (raised if B12 is too low for you)
• Homocysteine (ditto)
• Full blood count (to check for megaloblastic cells)

I convinced my doctor to order those tests, even though she was pretty sure that my low B12 was simply due to being vegetarian. For whatever reason, the MMA isn’t covered by Medicare here so I skipped it and its $245 charge. However, my homocysteine came back raised and my HTC came back rather low, and with a note from the pathologist on the results that I should be tested for intrinsic factor antibodies and parietal cell antibodies. Which my doctor also ordered, and the results came back positive for parietal cell antibodies. This means I can absorb less than 1% of all the B12 I consume, and I need B12 injections for the rest of my life. Many sources (including my doctor) reckon that you only need one shot every three months, but there are lots of other legit medical sources that say anything from once a week or whenever you feel a bit run down. It took some arguing but my doctor agreed to give me one shot a week, as I have neurological symptoms.

Ah, symptoms. There’s a lot of crossover with hypothyroidism, chronic fatigue, celiac disease, and mental illnesses. Brain fog, breathlessness (it’s a bit more like needing to sigh a lot than being puffed) and fatigue are the big ones, along with depression, tingling in feet and hands, muscle weakness, and as it gets more advanced left untreated, even dementia and multiple-sclerosis-like symptoms. I am still fairly sure there’s something thyroid or pituitary related going on with me as I have many distinct symptoms. It’s not unusual for people with one autoimmune condition to have others, either.

Pernicious (“deadly”) anemia, despite the name, is not really a blood disease. It’s a nutritional deficiency, but before vitamins were understood that’s how it was named as signs and symptoms were similar to other anemias. Dr Addison was the first to formally describe it, in the mid-1800s, and until about 1920 it was fatal (1-3 years life expectancy), when it was discovered that ingesting large amounts of liver relieved symptoms. The three doctors involved in that won the Nobel Prize for their efforts. It wasn’t until 1948 that B12 (cobalamin) itself was discovered, and ways to produce it from bacteria were developed.

The liver worked because B12 is stored in the liver. It holds about 2-3 years’ supply in humans, so it can take a while before a deficiency occurs.

Pernicious anemia is more common in the elderly, and there are some medical researchers who are convinced that it’s undiagnosed or undertreated pernicous anemia that is a significant cause of dementia and Alzheimer’s disease. B12 is a water-soluble, non-toxic substance (people with cyanide poisoning receive a 5,000 times larger-than-normal dose of B12 over an hour with no ill effects) and aggressive therapy seems to be the way to go with most with a deficiency. Like with the struggle to get proper diagnosis and treatment for hypothyroid, CFS, etc, many doctors are not terribly well educated on the topic and it’s sadly common for people with PA to suffer symptoms yet not be allowed a B12 shot outside of schedule. It’s mind-boggling, really. The way my own doctor reacted was almost like I was asking for heroin!

I’m on the waiting list to have an upper GI endoscopy, too, as people with PA have higher risk of atrophic gastritis, polyps, and stomach cancers. This will also include biopsies for evidence of celiac disease. (I won’t go into detail about my gastroenterologist appointment, save to say that they install lap bands and aren’t terribly fat-friendly.) The waiting list is up to six months, as despite the alleged enormous number of fatties, there’s only ONE endoscopy trolley rated for patients over 100kg available, in a population area of 450,000. If all those fat people are supposed to be so sick, then why isn’t the equipment a priority? I wonder how many fat people get sicker and sicker waiting for equipment to free up. As fillyjonk asks, tell me again about how it’s fat that’ll kill you?

Thankfully it’s not long until my appointment with a doctor known to be much more knowledgeable and sympathetic regarding issues like this. I’m hopeful I can get a good treatment and recovery plan.

For more information on pernicious anemia, the best resource on the internet is the Pernicious Anemia Society, a UK-based non-profit. It’s free to join and post on the forums, where there’s lots of helpful adivce and support to be had.

Wow, it’s been a while. A lot’s been going on, but at the same time nothing much, you know what I mean? I’ve been getting more and more tired and distracted and having some distressing memory problems, amongst other things.

After Rachel at The F Word posted a brilliant series of posts on hypothyroidism (Part 1, part 2, part 3, part 4, part 5, part 6), I finally got it together to compile a list of the symptoms I’ve been having (and blaming on various different things), and whaddya know, a match for hypothyroid. Except I can’t tell for 100% sure yet because the pathology lab is being an ass about actually testing my FT3 and FT4 levels despite my doctor telling them to do so, at my behest. Their reasoning? “As the TSH (Thyroid Stimulating Hormone) is normal, we see no benefit in testing the other stuff.” Frustrating. This lab uses an outdated range of 0.3-5.0, and in other countries the top end of the range is being lowered to 3.0 and even 1.5 for some. Even a rather conservative endocrinologist in this town, who has some of his lecture notes published on his website, states that a TSH of 2.0 or above is hypothyroid if symptoms are present. Which they are, and my TSH was 2.0 last time we checked. And thyroid antibodies are present, if a little under the lab range. And I came back alarmingly positive for thyroid inflammation. A bunch of other glandular stuff I got checked also came back with markers pointing to a thyroid and/or pituitary problem.

But my GP, while excellent in many respects, is not terribly cluey about thyroid problems and seems extremely dubious that I have anything wrong going on because my TSH is “normal”, despite all the other signs and symptoms. Reading around the web, this seems to be quite the problem amongst doctors – the sole reliance upon TSH as a diagnostic for thyroid problems – and is causing a lot of people to go undiagnosed or undertreated and have a resultant poor quality of life.

I encourage you to go read Rachel’s posts on hypothyroidism and do some further research, if you think you may have a thyroid problem. The symptoms are a pretty close match with all the things doctors love to blame on being fat, and especially on being a fat woman: being fat (duh); fatigue; depression and anxiety; wonky periods (if female); joint pain; foot pain (including plantar fascitis); disordered sleep/apnoea; abnormal blood sugar; high cholesterol, and many more. It can even be mis-diagnosed as chronic fatigue, fibromyalgia, diabetes, kidney failure, PCOS, irritable bowel syndrome, chronic mental illness [*], etc. Left untreated, hypothyroidism can cause some of those serious conditions, as well as heart problems. And the main culprit is lack of understanding about the TSH lab range and what it can and can’t signal. I’ve come across a case study from a psychiatrist who has on several occasions tested people in psychiatric wards with severe depression and several suicide attempts, running a full thyroid panel and finding that while the TSH was in range the FT3 and FT4 levels of these patients were severely deficient. They were well enough to go home after getting thyroid replacement therapy. OK, I don’t mean to scare anyone, really, just illustrate that this is something a lot of doctors seems to know jack shit about.

Diabetes is the popular kid with medical professionals these days, and I often wonder how many fat people have been misdiagnosed and are subsequently receiving only band-aid treatment for their real problem. According to the statistics, hypothyroidism is actually far more prevalent than diabetes and far more underdiagnosed. And I wonder just how much undiagnosed and undertreated thyroid conditions contribute to the correlation between “obesity” and poor health. (Or any other number of conditions that fat people don’t get treated for because some doctors are too busy telling them to lose weight and everything will be fine.)

There is a lot of information on hypothyroidism on the web, and it can be difficult to sort out. And honestly, I reckon the F Word posts are some of the best balanced and researched. Here are some other sites I’ve looked at and my comments:

• Thyroid.about.com – there’s some useful information here if you can ignore the weight loss crap that’s prominent on the front page.
• Stop the Thyroid Madness – it’s very pro-Armour/natural thyroid, but it does have some interesting information on conditions associated with hypothyroidism, such as adrenal fatigue, and explains more about why TSH alone is a poor diagnostic.
• Thyroid-Disease.co.uk – a lot of info specifically for UK people, and some “alternative” stuff I’d personally ignore, but there are a few papers with comprehensive bibliographies and references from peer-reviewed and respected publications, which might help convince some doctors
• Thyroid Patient Advocacy UK – See previous.
• Thyroid Australia – You have to become a member to see a lot of content, but you can get some good info.

Regarding Armour/natural thyroid, the most sensible information I’ve seen has come from pharmacists (as is often the case): Some people do well on the synthetic T4 alone, others need a T3/T4 combo, and others still do best with natural thyroid, and in all cases it’s what relieves your symptoms that should guide your treatment. And make sure the pharmacist educates you on how to store your medication properly.

—-

[*] And people with some of these conditions also often have a hard time convincing doctors there’s something wrong, too.

The Australian federal government has set up a Preventative Health Taskforce. It’s to make recommendations on preventative strategies to combat the ‘burden of chronic disease currently caused by obesity, tobacco and the excessive consumption of alcohol’.

It will allegedly ‘provide evidence-based advice’ on the above. Just putting fat next to smoking and binge drinking and it’s an EPIC FAIL right at the start. (see note at end for more on this)

The experts chosen to make up the Taskforce have short biographies available on the Taskforce website, but I’ve compiled some other important information the public might like to know:

Professor Rob Moodie – mostly involved with anti-drug and alcohol campaigns and global health. He is currently not a member of or involved with any organisation or company that’s notably or specifically with an anti-obesity focus (that I can find), but he has written articles like this one, Obesity – a market success, full of the usual OMG fat kids are reducing life expectancy! panic. As Chair of the Taskforce, he recently said “there should be five-yearly check-ups on Australians’ obesity rates, activity levels and nutrition”. WTF mate.

Professor Mike Daube – again previously mostly invovled with anti-drug and alcohol abuse policy, but also on the public record as getting all agitated about Too Many Fat People and thinking a ‘junk food tax’ will fix it.

Professor Paul Zimmet – involved currently and previously with a long list of think tanks and health policy organisations, etc, mainly to do with diabetes and obesity. Calls obesity an “insidious creeping pandemic” and “international scourge“. Pandemic. I do not think that word means what he thinks it means, what with it definitionally requiring a transmissible disease. More importantly, Professor Zimmet is also a currently a board member or scientific advisor for pharmaceutical companies that are developing obesity and diabetes drugs: ChemGenex, Apollo Life Sciences, and Dia-B. He is a member of Monash University’s Centre for Obesity Research and Education (which states ‘obesity’ is a disease) and several other organisations whose continued funding relies on the continuation of the idea that being fat is a horrible deadly disease.

Ms Kate Carnell – not much to add about Carnell beyond what’s on her bio there, but interestingly when she was CEO of the Australian Divisions of General Practice she stated the ADGP (now the AGPN) had decided that banning junk food advertising was not a practicable idea because the definition of ‘junk food’ was not clear. Has made general obesity-bad statements.

Dr Lyn Roberts – Can’t find any blatant commercial interests, but here’s an example of her (fairly standard, mainstream) stance on fat and health. I find it interesting the difference between the way she talks about fat and health compared to the dramatic language used by Zimmet: by no means fat-friendly but not using fearmongering as an argument technique.

Mr Shaun Ramsay – a senior manager at HCF, a private health insurance company. Previous to that, he was an executive for a large private hospital company. Is on the board of Research Australia, an organisation for strategic health research funding. RA is supported by a great deal of vested interests.

Professor Leonie Segal – A health economist. Not much to add, is on record with similar views as Dr Roberts above.

Dr Linda Selvey – a standard smattering of appointments to public health statutory bodies. Similar mainstream views on fat and health.

So there we have it. I suspect some people might say that well, pharmaceutical companies provide research funding! Where else are researchers supposed to get it? Sure, but it’d be nice if these interests were fully declared. And it would have been nice to see an eminently qualified researcher and academic on the Taskforce who was a proponent of Health at Every Size (yeah right, in your dreams) or at least had heard of it. They’re out there but they’re not one of the cool kids.

Not happy, Kevin and Nicola.

–

Note: Interestingly, people are all handwringing over a supposed epidemic of binge drinking (especially amongst young people) here. The available evidence on binge drinking shows that there’s been no real increase in binge drinking and alcohol-related violence is not rising. However, polls do show more people are worried about binge drinking and its effects and there’s been an epidemic of media sensationalism over those naughty naughty drunken teenagers, particularly those nasty slutty teenage girls/”ladettes” (how dare they try to have a good time). Sound familiar?

Also note: I don’t think that demonising smokers and heavy drinkers does any good. Teenagers drinking well beyond their limits on a regular basis even if it’s not an “epidemic” isn’t a great idea, but I think there are overarching societal problems that need fixing, not slapping taxes on alco-pops and various knee-jerk responses. You get the idea.

Health Minister Nicola Roxon said one idea put forward in a submission was an annual national fitness test where citizens would receive a financial incentive if they pass. Source

I know the Australia 2020 summit was basically a brainstorming exercise and is as to actual policy as grape chewing gum is to wine, but jeez. The fact that people think these things are a good idea continues to confound me. Will people with a disability or chronic illness get a pass or will they be expected to adhere to a fitness standard? After all, there’s that paralympian dude with one leg who can ski real fast, that means that all disabled people could do it if they just put their minds to it! FFS. Think, people, think! You can bet your left nelly that there’s no thought of a HAES style individual fitness level there. I’d get penalised in that kind of test for not being able to run so fast, but I can bench press a metric fuckton and impress yoga teachers with my sideways flexibility. I knew a young woman at college who could run 100m in 12 seconds but couldn’t touch her toes. She failed one of those general fitness tests, yep. The kind of thinking that leads a person to believe that something like that is a good idea that could be implemented nationwide may be well-intentioned, but it’s very narrow, ableist, classist, and, well, silly.

Lauredhel at Hoyden about Town posted some thoughts on stuff that seemed notably absent from the summit. I commented on something found in the quick summary report:

“Have health policy focused on prevention – across not just health, but across Government and the whole community, with “zero tolerance” of unhealthy actions”.

Who gets to decide what’s healthy and unhealthy? What would be the consequences of disobeying zero tolerance policies?

Seriously, WTF.

Surprisingly, the summary report doesn’t mention obesity, but it does mention things like a ‘fat tax’ on junk food, and making office buildings open up their stairwells so people can walk more, and incorporating 30 minutes of activity into every sedentary job. Bear in mind that these are nowhere near being actual policy proposals, really they’re just brainstorming, but I’m a bit disheartened (but sadly not surprised) at the lack of critical and lateral thinking going on.

Fat tax on junk food. Who gets to classify what food is junk? Low-carb diet fans would probably rate pasta as undesirable, low-fat diet fans would rate cheesy broccoli as a no. Personally I rate every item of Weight Watchers branded food as junk, but hey. More likely the ‘fat tax’ would be about hiking up prices on fast food franchise items. I really don’t like the idea, despite being a supposedly tax-’em!-lovin’ lefty. So $1 or whatever is added to the price of a Big Mac – but I can still buy a huge cheese, egg, cream and bacon laden carbonara from the Italian stand next to the McD’s in the food court, at its regular price? Will yaki gyoza (deep-fried meat dumplings) from the sushi place escape the tax while battered chicken strips from KFC get the hike? I could go to the market and buy Wagyu beef mince, olive oil, fancy rolls, fancier cheese,  pricey organic salad and make a burger that’s more fat and salt laden than any commercial burger. It just smacks of snobbery: a certain kind of interfering middle-class person who is aghast at what those poor people/children/etc eat and must set them on the path of righteousness.

Making office buildings open up their stairwells so people will walk more. I’ve got news for whoever thought of this one: they’re closed so that you can more safely escape in a fire or emergency, you twit, not because of some insidious corporate plan to hide the fact that manual escalation is in fact possible.

30 minutes of exercise required for every sedentary job. Well, it’s nice to encourage fun physical activity, but you know, I’m not confident this will actually do so. If you already go to the gym for a standard 30-60 minutes, as many of office workers tend to, can you get a note from the manager excusing you? Can I show a statutory declaration saying I don’t have a car, I already get plenty of walking time in, thanks? How on earth is this going to work? North Korean style where a severe person in a tracksuit shouts instructions via megaphone? The only way I can see it having a chance is that it’s not compulsory to attend, but it is compulsory for employers to allow you 30 minutes in addition to lunch/breaks, to go for a walk or whatever. 30 minutes isn’t actually that long if you have to include time at the start and end to get changed and have a shower (coworkers who come back from the gym without showering are gross). How many office buildings even have showers? For the love of Benji, people, use your noodle!

I suspect fat-haters would call my criticisms proof that fat people hate exercise and such. Far from it. I rather enjoy it myself, but I definitely do not want to see anyone penalised or further ostracised for not participating in athletic or sporting culture. Hell, offer free yoga classes and dancing and swimming, give free fruit to kids at school and subsidise fruit and vegetables all you want, but for fuck’s sake, don’t make it about weight. Don’t make it a social imperative to meet some arbitrary standard of fitness or health. Don’t doom peopel to dysfunctional relationships with their bodies. Moving and eating should be happy activities, and genuine health comes from that – on an individual level.

If you hurry you can still get a submission in for the Australia 2020 summit. The deadline is 5 pm, Wednesday 9 April, and you can submit one online – maximum 500 words, no minimum.

You can view the document outlining long-term health strategy discussion points, and of course obesity is right in there, being blamed for causing chronic disease and such. No distinction is made between risk factors and risks.

Interestingly, the chart they include to show obesity and overweight prevalence shows a rise of only a few percentage points per category between 1995 and 2005, hardly a hand-wringing crisis if you ask me.

They ask the question

Why are healthy lifestyle messages regarding exercise, diet, smoking and alcohol abuse not being heeded more?

and my submission will be pointing out that fat people getting abused on the street and laughed at in the gym and so on would be but one of may reasons fat people may not exercise, and maybe thin people don’t exercise much because they’re getting the message that thin always = healthy. Also that the diet industry isn’t actually helping anyone gain health. That health at every size, not focusing on the BMI or number on the scale, is a much more realistic model for individual and public health. And so on, however much I can pack into 500 words yet remain focused on Fat People Are People Too, You Nincompoops.

If you’re an Australian citizen or permanent resident, I strongly encourage you to write. It’s short notice, but every bit helps.

And lo, yoga has another convert. Love it even when it’s difficult, unlike so mnay other activities. Pounding through crunches and other exercises at the gym? I found them boring and frustrating, generally since the expectation that one was doing it to be thin or buff or whatever. Yoga, on the other hand, there’s a point to it all, it feels like I’ve accomplished something rather than just completed obligatory busywork. There’s brain engagement.

I’ve been doing the programmes in the Megan Garcia book and DVD for a few weeks, and while good, the classes I’ve been going to really make it good. I’ve been trying out two teachers. One teaches a very relaxing, meditative class and the other class seems to be focused on body awareness and relaxation through more active poses adn sequences. I sweat more in the second. The classes complement each other and I’ll be continuing both because damn, they feel good.

The teachers are both wonderful. There’s been no body judgements and both instructors have always made suggestions for modified poses, and they do remind everyone that if it hurts or feels wrong, stop, breathe, relax. The more active class uses props (blocks, bolsters, etc) and the teacher has always been happy to show me pose modifications so my damn arm and shoulder don’t die. My left arm is quite strong enough to support me (around 270lbs or so, go left arm go) for downward dog and plank poses, but my right arm and shoulder give a big NUH UH to that, so I do those against the wall. And so on.

The gym I used to attend had a yoga class, but it was ‘yoga for weight loss’. No thanks.

The only problem: dust in the damn carpet. A yoga mat’s not much protection from allergens when your lungs are like mine and you’re mere centimetres away from all kinds of crap in the carpet. (HEPA nose plugs perhaps? Heh.) Oh and I breathe really noisily, thanks to a very deviated septum. It’s like breathing through drinking straws. SHHHHHHHHH, PSHHHHHHHH. And so on. The woman I was next to in class yesterday kept looking at me oddly, either she was pissed off because my breathing was disturbing her or she thought I was about to keel over.

Which brings me to point out that so far nobody has really cared about what anyone looks like in the classes. Everyone’s concentrating on something other than OMG Becky Look At Her Butt. I suppose there are classes where the Beautiful People go, but I reckon yoga classes run at community centres and church halls and such are probably going to be a safer bet regarding welcoming of all kinds of people.  (YMMV.)

I’ll add that I’m way fatter than any of the people in any of the plus-size yoga DVDs and books, and I’m not finding anything incredibly difficult or impossible to do even with modifications. I’ve always been fairly flexible, however, but I know now for sure that all those downers who reckoned yoga was only for thin or maybe a bit chubby people are totally wrong.