Re: Fat Acceptance

This post is in response to the article I posted last week from CNN.

I found this article to be particularly interesting primarily because I could identify with the story of the woman's overweight daughter. But I would also like to insert my opinion on the matter.

I've always been "well-built" and stocky. I've always liked to describe myself as a bowling ball: small, but hurts when you drop it on your toe.

I was a little on the chunky side for most of my life and always struggled with my self-esteem. As I began to accept that being chubby was my fate, I became more and more complacent with diet and exercise.

However, when I began to truly LOVE myself to the core, that's when I began to care more and more about my health and fitness.

I think there is a fine line between accepting yourself and loving yourself. When you love yourself, you genuinely care for your body's well-being and take steps to improving the way you treat your body. Sometimes the result is weight-loss, sometimes not.

This is why there is such a challenge for health care professionals (public health professionals included!). Too many people are in acceptance mode, which I feel results in behavioral complacency. In health behaviorist speak (and according to the Transtheoretical Model), we would call these folks the "pre-contemplaters" (reference: Prochaska and DiClemente's Stages of Change Model). We want those pre-contemplaters, especially those with heinous health behaviors, move into contemplation, preparation, and action modes. How can we do this when we're now telling people it's okay to be fat?

I think everyone can make changes and improvements to health behaviors. I also think there are positive and negative ways to go about making changes, for example, there are positive and negative motivations for making changes. Negative motivation: to look like a super model; Positive motivation: to feel good physically, mentally, and spiritually. I think that by achieving self-love, our internal compasses will direct us all toward positive health behavior change.

Social Media: A Health Educator's Friend or Foe?

I am truly overwhelmed by the social media frenzy and the advances in new technology. More so, there’s the whole subset of “vocabulary” that needs to be learned to effectively stay in the loop. Sometimes I want to throw my hands in the air and give up on trying to stay in touch with it all, but then I realize by being culturally relevant, I become a better health educator.

Now the question is: are social media like Facebook, Twitter, blogging, and texting my friends or foes? I think if social media can be harnessed and used appropriately it can be a very effective health education tool. However, like your mother always told you “Everything in moderation.” I think if overused or used improperly, we could have a global disaster on our hands. Okay, maybe that’s an exaggeration. But the results wouldn’t be good.

Example 1: The CDC on Twitter

The Centers for Disease Control and Prevention have multiple sub-centers/departments on Twitter, tweeting updates to their followers. This is a pretty effective way of keeping the general public (at least those on Twitter) updated to any breaking public health news like a new publication or report or “Hooray! It’s International Eat-Your-Veggies Day!” But probably the section that may have the most purpose with Twitter is the Disaster Preparedness section of the CDC. Twitter is potentially a good channel for communicating information (albeit, brief) on preparing yourself for, well, disaster. One situation where this may have back-fired, however, is with the swine flu. Tweeters panic and make assumptions since there’s no way to get the whole story due to the 140 character limits. Plus, there’s no room for a post-script “Don’t Panic.”

Example 2: Online Forums

Gobs and gobs of research have shown that social support in its various forms is an effective way of managing chronic disease. If you Google Scholar or do a PubMed search of “Social Support and Disease" you’re bound to be overwhelmed with the search results. Online support groups, such as those for type 2 diabetes or breast cancer, have had great impact on mental and physical well-being of their participants. You might even know someone who participates in one and can attest to how much they love their online support system. Some benefits of online support groups are:

1. Common interest. Not feeling alone in your suffering is a good thing.

2. Anonymity. Participants don’t feel judged by people who already know them and have preset opinions.

Some health issue support groups, however, aren’t destined for greatness. Studies have found that support groups of teenagers suffering from anorexia or bulimia are counterproductive because the teens share their “methods” for staying thin. I give an “A” for effort, though.

Example 3: Texting Health Messages

I hate texting. I’m so glad I’m not a middle or high school teacher because I’d probably hate it more. I think we’ll have an emerging pandemic of “texter’s thumb” on our hands (no pun intended) in the next few years. And I think it teaches teenagers bad grammar and inappropriate use of the acronym. However, realizing we live among the “text generation,” I think it can be an important avenue for health messages. I’m currently working on a project that works with multiple sites doing diabetes self-management studies. One of our studies is using text messaging as a means of reminding participants of upcoming doctor appointments, medication reminders, healthy eating tips, and the list goes on and on. I’m very interested to see the results of this study. Several studies have already been done (mostly international) that have found text messaging (or SMS) to have a positive impact on certain behavior changes. However, several studies have also been deemed “inconclusive,” so more research needs to be done in this area.

Okay, so I haven’t covered all forms of social media. I tried to be objective, but let’s face it, I’m a fan of you, social media. Let’s be friends.

"I'm healthy! I went to college!"

Back in May, a report was released by the Robert Woods Johnson Foundation that ranked states according to the gap between college graduates and non-college graduates who rate themselves in “less than very good” health. Meaning, the states ranked the highest had the smallest gap in self-reported health status between those with college degrees and those without. Top-ranked states were Delaware, Hawaii, and Maryland. Lowest-ranked states were California, West Virginia, and Kentucky.

Click Here to download the report.

This report is chocked full of other data about self-reported health status among American adults, but I want to focus on the relationship found between education and health status. What they found was that as education levels rise, health improves.

As someone who’s been in the health field for years, I can look at these finding and say “Well, duh!” But is it all that intuitive? Let’s deconstruct it:

College Education > More Knowledge > Awareness of Health Risks > Healthy Behaviors > Reporting Good Health

OR

College Education > Higher Income > Ability to Regularly Access Health Care Services (by health insurance or out-of-pocket expenses) > Reporting Good Health

OR

Both?

I think the gap between college-educated and non-college-educated folks is somewhat a combination of the two models proposed above, but I think the main factor is probably linked to income. We know that people with higher education levels get paid more (check census data: http://www.census.gov/hhes/www/macro/032008/perinc/new03_000.htm)

I would venture to say that most Americans have access to basic health knowledge. Most children learn basic health behaviors all through primary school, from teeth-brushing to healthy eating. And there are so many public service announcements and news reports related to health nowadays (providing you have a television), so the basic knowledge is there. However, people who make more money are more able to access healthier foods (fresh veggies cost more!), physical activity (e.g. gym membership), and regular health care.

One thing that concerned me about the release of this report is that the chairman of the commission that put out this report said that in order to improve our nation’s health we need to improve education quality and education attainment. I’m all for improving the nation’s schools and giving every child the opportunity to go to college if they want, BUT…

-Do we really know that education actually precedes health status? I mean, which came first, the chicken or the egg? Maybe kids who already value health and consider themselves to be healthy, physically and mentally, go to college. Many college-bound kids are able to stay on their parents’ health insurance during their college years and maybe they see health insurance and regular health care as important. Who knows?

-Maybe before correcting the educational system in the US we need to fix the health care system. We ought to consider striving toward getting every person, regardless of age, equal access to health care. We’ve missed the boat on folks who will not go back for an education, so why not seek to meet their current needs? In the coming years, people over 80 will become the fastest growing age group in America and people over 50 will represent 35% of the population. Let’s meet the ever-increasing need for access to health care.

-Keeping in mind, access to health care and education alone will not fix the problem. Both issues need to be tackled to move toward improving the health status of the American people.