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Tuesday, April 20, 2010

Too Fat to Fight?

See this news story: Are school lunches a national security threat?

WASHINGTON - School lunches have been called many things, but a group of retired military officers is giving them a new label: national security threat.

That's not a reference to the mystery meat served up in the cafeteria line either. The retired officers are saying that school lunches have helped make the nation's young people so fat that fewer of them can meet the military's physical fitness standards, and recruitment is in jeopardy.

A new report being released Tuesday says more than 9 million young adults, or 27 percent of all Americans ages 17 to 24, are too overweight to join the military. Now, the officers are advocating for passage of a wide-ranging nutrition bill that aims to make the nation's school lunches healthier.

In light of my previous post, we should examine our complete diet, not just school lunches; but I doubt that we can be that introspective.

As for exercise, notice how much opposition came from the Republicans in this last health care bill because it supposedly provided funds for playground equipment (and as though that would be a bad thing).


Debra said...

Hey, Okie, I read through the article.
I noticed that... BOTH sides are name calling a lot of the time, and that the name calling often refers to... being crazy or not.
So.... what gives ?
We discussed this in an off-handed way a little while ago.
WHY is there so much polarizing over the question of being sane or not ?
Is this a smokescreen for something else ?
I have this theory...
Money, its plusses and minuses, has driven us collectively crazy.
Like... with our noses to the ground permanently to figure out if it's.. being "wasted" or not.
With all the obsession about money being wasted or not... look at what's going on about the.. WATER, the RESOURCES that are being wasted... I see a lot LESS preoccupation with THOSE being wasted on a grand scale...
Does that look sane or what ?
Not under my telescope.
No way.
This is not a national issue either.
It is a Western Society issue.
It's going on in France too.
A long time ago Cotton put up an open letter to Obama by a guy commenting on the...agroindustry business, and what it's doing to us.
Of course... I am a pseudo Luddite.
With a computer, and Internet I can ONLY be a pseudo Luddite...

JP said...

The problem isn't with the caloric intake as much as it is the neighborhoods.

Design neighborhoods so that you have to walk more and your obesity problem will diminish.

Oh, and Debra, only people can waste resources and be preoccupied with money.

That's why people are really the problem. Remove people and the problem goes away. ;)

Debra said...

Absolutely right, JP.
People's ATTITUDES are the problem.
But... I still think that we've got to find something besides money.
Maybe I'm just a pseudo Luddite dreamer ?

JP said...

Debra says:

"But... I still think that we've got to find something besides money."

We have found something besides money. We now have credit cards. ;)

Where did your anti-money stance come from? I'm just curious.

Debra said...

I don't know.
But I know that money has become the measure of all things these days. And that is BAD for us, as human beings.
I know that there are people who believe like I do, too, and they are trying to use their neurons to imagine a world without money.
I'm not smart enough to do that.
But... I think that if we ALL got together, maybe we could be smart enough to figure out how to go about it. A good way to use our neurons.

JP said...

Dominaton of Money. It's a natural stage of a culture.

From Spengler's civilization model:

"1. Domination of Money ("Democracy"). Economic powers permeating the political forms and authorities"

This period of time was from 1800 to 2000.

And now, for the next 200 years, the West can expect:

"2. Formation of Caesarism. Victory of force-politics over money. Increasing primitiveness of political forms. Inward decline of the nations into a formless population, and constitution thereof as an Imperium of gradually-increasing crudity of despotism"

The West (as an Civilization-idea, i.e a FRACTAL) is going under, so to speak. No more sub-fractals can really be expected from it.

I think you are on the bandwagon of those who want to start a new culture, a new FRACTAL, Debra. ;)

Dink said...

Man, there've (word?) been some great post and comments since I last checked in...

"Because of the small size of the brain, exact brain structures could not be distinguished, but something in the brain did light up."

How could a dead brain show changes? Curiosity before pride...

"Design neighborhoods so that you have to walk more and your obesity problem will diminish."

I dunno. When I was a kid in San Diego I walked a lot. Kids in Seattle now don't. Its hilly here, its rainy and cold often, video games are pretty cool, the kids and parents are bombarded with tales of child molesters and skin cancer. Complicated.

"No more sub-fractals can really be expected from it."

I dunno. History is interesting and can "rhyme", but we have some new twists to consider that previous generations did not have (access to information and communication, birth control, and mass lethality). I don't think we can really extrapolate what is going to happen with all these twisted variables to factor in.

BTW, where is your e-mail to so I can add you as an author? And you too, Edwardo.

Debra said...

WOW, look at all these prospective authors coming up !
I have ordered Barzun's book on the decline of Western culture. It is a big hodgepodge, apparently, and I am looking forward to picking juicy morsels out of it, and NOT reading it from cover to cover.
Since I think that our perception creates our reality, I am leery of saying that the West is going under, for evident reasons...

Debra said...

It looks like we agree on something here, dink... ;-)

JP said...

The "decline" of Western culture is simply the playing out of the final forms over and over again. A repeating fractal of thoughts.

What are the central ideas of "the West" or Faustian culture?

As opposed to other "major cultures", such as Greco-Roman Culture, Byzantine/Islamic (Magian)Culture, Chinese Culture, etc.?

Look at France, for example. It has played major roles in Greco-Roman, Byzantine/Islamic, and Western Culture.

Thai said...

Okie, nice post and amen

For once I think we agree on a great many levels of this fractal. Though I still think this issue will only be solved with more acceptance of personal responsibility. Remember, act locally to act globally? ;-)

And "yes", our diet is heavily influenced by those around us- no man is an island.

But if all your friends are smoking crack, are you really going to wait for them to stop before you stop yourself? This is lemming cliff diving behavior if ever there was an example.

... And I keep saying stop beating the obese up. They are simply the easiest group to beat up. The truth is there are a lot of other groups who spend a lot more money than the obese such as "the mentally ill", etc... many of whom are obese AND have tons of other issues to boot.

Kind of like the old insult: not only are you lazy, you're lazy, fat and stupid, etc...

And "no" JP, calories in are clearly the genesis of our weight problems- period. In the input/output nature/nurture like debate of western obesity, it is clear calories in who have emerged as the guilty culprits.

The lack of physical fitness is a separate and related subunit of the fractal we call "contributions to western obesity and poor health", but it is still a separate and less important cause of our obesity than its slug building block peers.

And this is not to dismiss the independent importance of physical fitness in overall health in any way.

As always, it is "all of the above" and very non-linear. ;-)

But I think I agree with everything else you say. Indeed, I really do wish you would send Dink your email and write a post on Caesarism as I'd love to explore this a little more.

It is clear medicine is moving in this direction from all I see around me.

Be well all

Thai said...

He he he...

Of course I forgot to add that using obesity as a means of avoiding selective service might be a lot smarter than it first appears. ;-)

Thai said...

Debra re: "... and they are trying to use their neurons to imagine a world without money."

From my perspective, this is the really sad part.

Of all the ways we could spend our time, this is not one I could ever dream of.


Dr John said...

What is the solution? Is there one? Just wait for famine?

Thai said...

You can see signs that totalitarianism is returning.

It will be interesting to see the form it takes in the US.

Citizens of countries like Germany, etc... have a strong sense of national identity and greater fondness for their government. It is not hard to see how this national character could be linked with the idea of a stern father and lead to what we once saw.

We have stern father personality types in America, but I almost never see them mixed with strong belief in the importance of the power of a strong central government, etc...

My limited experience tends to find stern fathers with free marketeers- e.g. "let them do what they will but they can also suffer the consequences", etc... If your experience of this mix of personality types is different I'd love to know otherwise.

... What form will it take in America?

The forms populism/totalitarianism might take can be very hard to predict.

Do you have any thoughts thinking about common character traits you see in your patients and scaling that to some kind of model on national character, etc...?

Thai said...


Dr John said...

Those are superb questions Thai. I am not sure I could come up with broad sweeping generalizations as to certain types of personality and particular beliefs in regards to govt. I would agree with your statements about peoples view of govt. I see lots of paternalism on both sides but in different flavors. One group preoccupied with substances that alter consciousness or sexuality often looking to enact laws to restrict behavior in these areas while the other insisting those along with health care are a right but smoking tobacco or eating trans fats are not. I see very few people taking the position "let them do what they will but suffer the consequences". This is me and a classically libertarian position and I have few friends.

I read a recent poll that 4 of 5 mistrusted govt. in this country. I am never surprised how people who seem to support a general set of principles will suspend them whenever it suits them and ask govt to help them to whatever end they like. My brother in law for example is a fiscally conservative limited govt. kind of person. Ohio passed laws several years ago to prohibit smoking in private places with public access. Despite in general being completely against govt. intervention in most aspects of his life he supported this law simply because he and his wife do not like to go to any restaurant and smell smoke.

Despite my feverish attempts to explain to him that this was yet another step in the erosion of our liberties and it should be up to the owner to decide smoking policy, that was not enough. Mind you I do not smoke and hate the smell of it when I go out too. There was a much bigger issue at hand. Next it will be smoking in cars or anywhere. None of that matters to people.People may cloak themselves in high ideals but mostly at the core is often the desire to repress others or just act out of self interest.

What I see at the core of most systems of belief about the role of govt. is not a particular personality type but rather a process of thinking in regards to what level of risk and responsibility for ones own actions or personal discomfort one will assume and the willingness and or desire to enlist govt in support of a pre-existing set of personal beliefs.

Why these beliefs exist are very complex but as we can see we are seeing two increasingly fractured groups with many sub-groups who are increasingly at odds about what role govt should have in the individual and collective life of its peoples. I cannot reduce it to personality. Just like everything else in my business all my explanations are retrofitted and not very helpful.

I am afraid though.People often want to be free of risk and responsibility. It is human nature.(It is to a large degree why I see psychiatry as a very destructive social force.) Give them hope that this can be achieved and of course they will grasp for it. This is always the appeal of govt. It is also the seed of fascism in certain circumstances.

"Loss of freedom seldom happens overnight. Oppression doesn't stand on the doorstep with toothbrush moustache and swastika armband -- it creeps up insidiously... step by step, and all of a sudden the unfortunate citizen realizes that it is gone."

Thai said...


A stern free market father then ;-)

Certainly as legitimate a view as any other

Oh, re: starvation

Americans can be pretty dense, but I think even they will eventually realize what totalitarians, dictators, religious zealots and mass murderers have known since the beginning of time: we live in a non-linear (fractal) world.

To remind you of what I'm sure you already know: 25% of health care dollars are spent on 1% of people and 50% are spent on 5%, etc...

So as a morbid thought experiment I most certainly do not condone in the real world, if a Nazi walked into a room representative of 20 "health consumers" (I love that word) and simply shot the one person who consumes the most resources, 50% of health spending would cease to exist.

Or think how changes to the definition of disability have caused their rolls to grow such that 20% of all social security money now goes to pay for a small but rapidly growing number of disabled, etc...

FWIW, I think this single issue- changing the definition of disability- is the main explanation for social security's impending bankruptcy. All the other stuff is smoke and mirrors in my opinion as it is impossible for your money to grow with a 20% cut being taken out every year, etc...

So I can't say for sure that mass starvation will not occur- people can be dense. But we would have to be really really stupid an unable to cooperate to let this happen.

Re: fear

Dink once indicated fear but I have not sensed this in his comments in a long long time.

Remember, the bizarrest thing of all about credit cycles is that in reality, nothing is any different than it was before except our perception of things.

Dink said...

"It looks like we agree on something here, dink... ;-)"

You take that back immediately! And besides, our reasoning is wholly different so any similarity in conclusions is simply coincidence.

"What are the central ideas of "the West" or Faustian culture?"

Interesting topic. Separation of church and state is huge. Public education and meritocracy as an ideal. Freedom of press.

Cultural acceptance of irreverance I think may be the central thread. I think it held China back for a very long time (i.e. I won't suggest this innovation because it would hurt uncle's feelings). To expand, the quality of the product speaks for itself. I think its interesting that a subculture's first foray into mainstream society has been music or comedy (blacks, gays); catchy is catchy and funny is funny. Self-evident so no barrier to entry.

(wow, looking that last paragraph over I see that it was pretty sloppy. I'm going to leave it as-is since I think the gist comes across well-enough).

Capitalism and science have benefitted greatly from this irreverence; this respect of quality over source. Not that they're perfect, but they work well with irreverence and the evolution it allows.

"Dink once indicated fear but I have not sensed this in his comments in a long long time."

I can't say that I've resolved my concerns about overpopulation, eco-destruction, and unsustainable human tendencies. But I think your message about cooperation being the ultimate group selection did spark something in me. But like the cliffhanger endings of that old Batman show:

Can the cooperators create a viable system fast enough?


Will the non-cooperators outnumber the cooperators and ruin humanity's only chance?


Debra said...

Thai, on totalitarianism in the U.S....
When I came back to the U.S. two summers ago, we flew out of the Washington D.C. airport to a Western state and...
I realized in shock that the D.C. airport is a military installation.
It may not CALL itself a military installation, but... it sure as hell LOOKS like one, and that is what is capital in my book.
Totalitarianism has already arrived to the U.S. Not many people are seeing it, because many of them don't know what the U.S. looked like BEFORE this totalitarianism arrived.
When you are surrounded by something that looks familiar, it seems... NORMAL to you.
For the government.
I have an unfortunate perception of government which is founded on my personal experience.
The nature and function of government is NOT to protect the individual.
Government exists FOR THE SOCIAL BODY.
Not the individual. No way. Too bad this is not a both/and equation, instead of an either/or...
Now... I think that when you are going about your daily routine in your country, chances of seeing the government in your daily life are reduced.
But... there are some perspectives where it.. STICKS OUT. Where you can't miss it.
Putting one's trust in the government is foolish, in my book.
There are other places to put one's trust, but NOT in the government.
And the idea that the government is US ?
Poppycock. That sounds "Star Spangled Banner" but it does NOT pan out when you look closely at it.
Government is the ultimate instrument of social control. Like any other large scale institution, it exists to.. perpetuate its own existence. And it is entrusted with the ultimate power of social control WHICH MEANS REPRESSION. WE entrust it with that power.
I am NOT being cynical about this. (I think..)
I am being.. "realistic", if you like. Based on my personal experience.
The people who are griping about big government ?
I agree with them. I think that they are not as wacko as "we" are making them out to be. They have some very legitimate concerns in my book. It is too bad that many of them sound incoherent, because it IS possible to justify their positions with "reasonable" arguments. Like I did above...
It is the nature of man to want to have his cake and eat it too. Goes back to the Stone Age at least.

Debra said...

I forgot to add what I feel clinches the problem of government :
Give 'em (the government) an inch, and they'll take a mile.
This is behavior that goes back to the Stone Age too.
I occasionally have the feeling that the ordinary "law abiding" citizen in the U.S. feels that since he or she is obeying "the law", he will be protected from any illegitimate abuse from his government.
This attitude is extremely naive.
It rests on the ignorance of the law as an instrument of social control.
When we set up the law as the measure of all things, we ultimately put ourselves in the position of not being able to obey the TOTALITY of the law.
There will ALWAYS be a point in time where you will run afoul of the law.
Not because of YOUR nature.
Because of the nature of the law.
The LAW is also... TOTALITARIAN in nature.
(Because the law is LANGUAGE, and language itself has a..totalitarian bent.)
The best place to observe and understand this ?
In "The Merchant of Venice" by my dear William.
A true genius, that one. My.. idol, if you will. ;-)

Dr John said...

Thai, you assessment of the SSI disability problem is brilliant and I absolutely concur. Just in the 20 years I have been working the number and scope of those I see on disability for unclear reasons is astounding. The number of people on psychiatric disability has more than doubled since 1987'.

I saw a guy today. I have seen him at least 4 times on our psych unit and documented he was a malingerer. He always comes in wanting two things. Opiods and or Benzos and a place to stay. Last time he refused to leave until Medicaid reviewed his case and ejected him. He is not so impaired he does not know pts have "rights" to refuse discharge.

Today I saw him on consult. He is back to boozing and using any pills he can find. He is "suicidal" Between now and the last time I saw him he was given disability. I dictated a 3 page note I thought he was malingerer looking for drugs and a room and psychiatric TX was useless. He demanded to be sent to another facility where he had spent 3-4 weeks a few months ago. They did not care what I thought or even ask.

As long as he is "suicidal" and someone will pay, there is someone to deliver useless psych services that will cost tens of thousands of dollars and help nothing. The best thing in the world for the system would be for someone to walk into the room and put a bullet into his head.(I cannot do this as a Dr and responsible gun owner)

I have no motivation to try to intervene and stop this kind of abuse. I have tried for years. I open myself up for liability and no one cares.

I really do believe the system will collapse in on itself in some way. How long can this way of doing things continue?

Thai said...

It can't and the bubble will pop

... FWIW I'm not sure homicide is necessary to solve the problem. True to Field of Dreams' "If you build it they will come", all we need is to stop building it/dismantle some of the most egregious nonsense and I'm quite confident the part which most offends you will go away and you will see the outlines of what drew you to the specialty in the first place again.

It is simply a law of nature: give something more energy and resources and it will grow. Cut these resources off and it will wither.

The key of course is to eliminate the most offensive parts of what we built while still retaining what we really need, and this is to some degree dependent on personal moral values.

FWIW, My model for all of health care (life really) is the tragedy of the commons" where "multiple individuals, acting in their own self-interest, ultimately destroy a shared resource even when it's clear that it is not in anyone's interest for this to happen."

I really do apologize for destroying it for you as I know I'm destroying it for myself.

FWIW, I honestly cringe 1/2 the times I fill those involuntary commitment forms out (there are a few I feel really good about). But my patients tell me they are suicidal (for the ? number time) and I have absolutely no way of predicting the future on this issue. And as I selfishly fear JP and Okie, I simply pass the buck to you. I do know this.

And so the can keeps getting kicked round and round, etc...

And yet I know my own retirement and health insurance in old age is being jeopardized (as it is for Okie and JP)

We need a grown up national dialogue soon as I know individually tackling this issue will do nothing but get you and I fired from our careers. Sadly I do not see anything on the horizon.

And so we might simply need to wait for the bubble to pop.

Either way, in the end, Stein's Law still applies. This bubble will pop and when it does look out.

Entire regions of the country will be taken down from its force.

Dr John said...

You have the best links Thai. Link me to a tutorial on how you embed a page to the words you type as you always do. I will give you a coupon for one free hour of useless "psychotherapy" with me. :)

Thai said...

FWIW, I've often thought of setting up a hedge fund in preparation for the eventuality of the health care bubble's popping.

I'm sure you read how John Paulson made billions in a matter of months betting against the housing bubble (no one in history of the world had ever made so much money so fast)?

Housing is peanuts next to health care.

As for making links, easy.

Fist open another tab in your browser with the address of a link you want to share. Go to this link and copy it.

Then type exactly as follows except ignore all "*" symbols as I have to add them in order to type the instructions and
1. the part where I say (add you link here) just substitute the link which you copied as above.
2. the part where I say (type whatever you want your link to say to people like me who will read your link)

*<*a href*="(add your link here)">(type whatever you want your link to say to people like me who will read your link)*<*/*a*>

I hope I did not make that too complicated

Thai said...

I meant to say do not type 1 and 2

Thai said...

But this is a random link if it helps

Just type creating html links to other pages into Google

Let me know if you need more help

JP said...

Thai says:

"And as I selfishly fear JP and Okie, I simply pass the buck to you."

Why would you fear me? I'm in the business of funding doctors for their time and opinions. I'm more of a profit center for doctors.

It's insurance companies and U.S. Attorneys who tend to dislike me.

What exactly is your job these days, Thai?

Thai said...

I meant "you" as a metaphor for the legal system that has become the med mal prison we made for ourselves (which does have a very legitimate funtion in my opinion)

I did not mean you or Okie personally. And even if either you or Okie were PI attorneys, I still wouldn't blame you personally as I think PI attorneys are as trapped in the system as anyone else.

As for what I do?

60% of the time I'm a practicing EM physician (with wacky hours hence can blog from home mid day) and 40% CFO of my EM group of 100+ providers which runs EDs for several different hospital systems.

... I'd prefer this last fact not be widely disseminated however.

Debra said...

I already addressed your last comments elsewhere..
I, at least am getting somewhere with the people who are suicidal and using pills.
But not alone, of course.
These problems COULD be handled much more intelligently and by spending a lot less money.
But... the money that is spent is also spent to legitimize the labcoats and their way of seeing things and doing business. (dixit Thai, and I'm sure he agrees on this one...)
It is spent to... maintain our OWN belief in the system in our OWN eyes.
How are your philosophy studies going, Doctor John ?

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