Health Care Opinions

Obesity: Are African-American women unintentionally sabotaging the government’s attempt to reduce the obesity rate?

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I am conducting a study on obesity, among African-American women that are over the age 18. In order to gather my data, I need participants. Please, please, click the link below, complete, and send.  There are only 36 questions. The survey takes about 5 to 10 minutes. It is, what I feel, a necessary and unique study.

Your responses are completely confidential. Once you have completed, it would help a great deal more, if you would pass it alone, and ask your friends and family members to take part. I am seeking about 200 responses.

KwikSurveys: Offical Free online survey & questionnaire tool..

Thank you in advance!

Evette

 

Epidermolysis Bullosa and this HEAT

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Oh my goodness, this weather is horrendous. Today, we have very high ozone levels in Charlotte. It is pretty severe. Last summer, we experienced our worst time, with my daughter’s health, which lead us to her diagnosis on 7/15/11. The palm of her hand had developed third degree blisters, within minutes, and we didn’t know why. She was screaming and crying, and in my mind, in horrible pain. By the time, we got her to the emergency room, we were immediately admitted, because (1) she appeared to have been purposely burned, and (2) this was our second admission for weird problems that were not normal or natural. Their first thought was to rule out child abuse, which is the worst thing ever to go through, even if mentioned as a protocol.

IS IT CANCER?

Because this was not our first time at this pass, I was ready to ask more questions, without sobbing uncontrollably. My worst fear was that my 6 month old had some form of weird cancer, and they were having a very hard time diagnosing her. I had begun mentally preparing myself for the absolute worst. This time, when the same inpatient pediatrician had come in, my baby was playing happily and was very content. Her behavior was normal. She was playing with the big ‘bubbles’ that had formed in the palm of her hand. I said to the doctor, we have been here so many times, we are seeing her pediatrician 2 and 3 times a week and that alone should let you know that my daughter is not being abused. My husband and I are bringing her to you, we are not hiding in the shadows. Therefore this time, I need for you to think like a doctor; I need for you to become nosy and inquisitive; become the researcher you were, when you decided to become a doctor. What can cause blisters that look like a third degree burn without pain? She is clearly not in any pain, at least now she is not. If it was a true burn, she would be hollowing now. I need for you to think. What can cause this, simultaneously, without an obvious reason?

She said she understood, and will make some calls. She was going to finally speak with a dermatologist, because whatever problems my daughter experienced related back to her skin. She came back, after speaking with a dermatologist and said that Gabriella may have EB, but the dermatologist needed to look at her himself. He came in later that night, and sure enough that’s what he felt was her diagnosis.

OH MY GOODNESS, IT’S THE HEAT

About two weeks later, on her other hand, her fingers had begun to swell, and then they just burst open, at the creases. The front and back creases on her little fingers were open. You could look down, and see her meat. We were being hit with a tsunami. It was so frightening. We did not know why she was suddenly getting so bad. This had never happened before. I didn’t find out until December 2011 that it was the heat that had wreaked havoc on our summer and my daughter’s skin.

After joining the support group, mid-August, my daughter had begun getting better. The fingers opening at the creases never happened again, nor the huge blisters. Her new finger and toe nails grew in properly, and had not fallen off again. Usually, they would grow back, and fall off. We had stopped seeing red spots on her fingers and toes, which was our signal that there was some irritation. The skin on her toes stopped shedding. July and August were the worst months, and then it was just over. It was like a bad dream, not our reality.

We went on to do three biopsies that came back inconclusive. The EB specialist in Chapel Hill, finally said to us that we may have seen the worst of it. He advised us that there is a type of EB that has a life span of only one year, and Gabriella my have just went through it, although the chances of that is as rare as the disease itself, but possible. He felt confident that we were probably not going to have any more problems, but still to check and protect her skin. If there were any more abnormalities to come and see him immediately. He also said that next summer will let us know if she has seen her worst. That’s when the dots connected that high heat (summertime) causes huge problems for EB children. It’s when they suffer the most. Wintertime is when the skin heals mostly, even in the worst cases; if there is a problem, they are not as severe as it would normally be in the summertime.

OUR PROTOCOL

We finally have a fantastic pediatrician, in Charlotte, that I am confident can handle any issues that may arise. Now, if she does not remind me, I go about life with my baby, without a thought of EB. However, she had to remind me last week, it’s getting hot. So, let’s make sure she has sunscreen, and bug spray that is deet free. However, do NOT take her out in the highest temperature, and if so, only if necessary. Make sure she has thin socks that will protect her from frictional rubs, in her water shoes or crocs. No, we do not wear any pair of shoes; we need breathable cloth shoes. or crocs,which are perfectly ideal. However, I found some cute water shoes that some EB children favors, at Target. I really like these, because she can run in them. She has also outgrown her bucket hat from last year, and I found a replacement at Wal-mart last week. With my small efforts to protect my baby, we are doing just fine. We are approaching our one year anniversary to this diagnosis, and it is hotter than it was last year, and I am thankful to say, so far so good.

There are other things that I still do as well. She only wears 100% cotton. I have found that other materials irritate her skin. She is moisturized from head to toe, after every bath. Every morning, regardless of the weather, I still check her hand and feet for any blistering or shedding or redness. I guess old habits are hard to break, huh? Nothing is certain, but God, so I pray, check, and keep moving. We are no longer held hostage to this disease.

When we are all skinny, then what?

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Achieving a perfect world, without flaws, is possible? Or are we just kinda sorta mixed up in a political and social inequality warfare?

I get that it is healthy to live a healthier life. Also, personally speaking, I feel fantastic, I look phenomenon, with each passing day. I also understand that the beauty I feel and see are not what society expects, due to my waistline. I have met some absolutely beautiful people, throughout my life. They were not fat, but had some extra cushion, yet the pressure of the society had told them they were a misfit, and needed to change their physical appearance. ‘Girl, you just need to lose 5 more pounds, then you can go and get that dress.’ Yet, they had successful marriages, and a supportive family. I have also known some very beautiful thin people. You know, the ones that everyone suppose to look like, and they were miserable. They masked it well, were very successful (let’s face it.. beautiful, physically fit people get the job first) but was sitting on someone’s couch once a week, and were heavily medicated. Their lives were a mess. Maybe, it is because they were tired of being used as the world’s example? Maybe?

PRESSURES

I have the pressure of being a great mom; a loving, supportive wife; an available daughter and friend; a great student and leader that contributes and is not complacent. Lastly, I have the pressure of the world to look a certain way; live a certain way; and be who society expects. Now, if I had to choose two out of three, the lateral choice would drive me crazy. I am not a celebrity, a famous writer, poet, or musician, therefore this type of pressure should not be given too me.

SOCIETY’S WISH

When we are all thin and look the same, physically. Then what? Will we then be placed on even playing fields, with the same opportunities? No, because then it will be something else. God help us, if we get trapped into another political warfare. The uniqueness of this world would be gone, as well. So how far are we, as people, expected to conform? Are we to change who we are, every time something needs changing? Can we ever be perfect? I am not sure that’s a reality. Perfection means no growth, stagnation.

I use this argument, because obesity is so much more than bingeing on bad foods. It infringes on cultural standards and beliefs; it is genetically devastating; a physical, mental, and emotional entrapment that cannot improve with society’s stereotypic behaviors. I hope my argument does not seem discombobulated. What I hope to show is the size and level of confusion and culpability.

There is not anything wrong with knowing and owning who you are. Sure, we should be healthy, but we cannot throw our identity away achieving a healthier lifestyle. The magic is in the teaching. We have to bring awareness, without placing blame, stripping culture beliefs, while providing knowledge.  I do not want to look like or become Halle Berry or Jennifer Lopez. Yes, they are beautiful, beautiful women that have had the same problems, in life, I have. That kind of beauty and success do not erase LIFE, and all that comes with it, and nobody can change that.

So, I would say, let’s get healthy, not skinny, and focus on becoming a better person. At least that’s what I am doing. I will keep working on my weight and waistline, until I identify with that girl in the mirror. This is when I know I have hit my weight loss goal.

Belviq: The New Diet Drug

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I don’t know if the risk associated is worth an estimated 5% of my weight decreased in a year. Using the charts below, let us break these numbers down, in regards to Belviq:

BMI
Weight   Status
Below   18.5 Underweight
18.5 –   24.9 Normal
25.0 –   29.9 Overweight
30.0 and Above Obese
Height
Weight Range
BMI
Weight Status
5′ 9″ 124                    lbs or less Below                    18.5 Underweight
125 lbs to 168 lbs 18.5                    to 24.9 Normal
169 lbs to 202 lbs 25.0                    to 29.9 Overweight
203 lbs or more 30 or                    higher Obese

Belviq is for people who have a BMI of 30 and higher; overweight patients with a BMI of 27 or higher can also take this drug. This drug estimates a loss of at leat 5% of your body weight, within a year. So for instance, based on the chart above, 10.15 pounds of the 203 pounds listed in the above chart will be lost. It states on the FDA Approval Letter that this drug, along with reduced calorie intake, and increased exercise was more effective. This medicine is consumed twice a day, and has side effects and warnings, such as

  • Discontinue use, if 5% weight loss has not occurred by the 12th week
  • Valvular Heart Disease
  • Psychiatric Disorders

Unless there is a medical reason that prohibits a patient losing weight, with lower calorie intake and exercise, why would they take this medicine? Five percent of 300 is only 15 pounds, and I would have to ask if this drug is worth the risk? This is about 1 to 2 pounds loss a week. I can attest that this is achievable, with mild, but constant activity and increase in healthier foods, without medications. I eat whatever I want to eat, just in smaller portions, with an increase in fruits and vegetable as fillers. I get full eating heavier, healthier foods that do not add weight, when eaten in moderation.

If a drug needs to trigger your brain that you are not hungry, then why isn’t obesity taken more seriously as a mental disorder, widespread?Belviq was denied two years ago, because of concerns of the risks, although approved yesterday, without mentioning any changes. Was this drug passed to offer a ‘solution’ for obesity, without really being an answer? Was this drug placed in the market for profit? Was this drug approved, due to pressures of the government? I ask these questions, because it makes no sense how it would help me, for instance, lose weight that I am losing on my own. I have read trying to find the ‘ah ha’ factor, but I can’t find one. I am sure there is a reason that there has not been a  drug approved in 13 years, for obesity. I wonder if it has been so long, because weight loss happens only when the person is ready to commit, regardless of efforts from health care professionals?

This drug, with its FDA approval, can now be made available to all private and public insurance carriers. It is an oral tablet, therefore covered under the pharmacy benefit. I wonder how much this drug retails for. I am curious about the reimbursement factors of this drug, and the expected cost share to the consumers. However, I have been unable to find this information.

References:

Boyles, Salynn (2012). FDA Approves Diet Pill Belviq. WebMD. Retrieved from http://www.webmd.com/diet/news/20120627/fda-approves-diet-pill-belviq

Eisai (2012). Highlights of Prescribing Information. Retrieved from http://us.eisai.com/package_inserts/BelviqPI.pdf

Berlrot, B., Yukhanonov, A. (2012). FDA OKs first obesity drug in 13 years. Reuters. Retrieved from http://www.reuters.com/article/2012/06/27/us-arena-obesity-idUSBRE85Q1AA20120627

Arena (2012). Arena Pharmaceuticals and Eisai Announce FDA Approval of BELVIQ® (lorcaserin HCl) for Chronic Weight Management in Adults who are Overweight with a Comorbidity or Obese. Retrieved from http://invest.arenapharm.com/releasedetail.cfm?ReleaseID=687182

Hey… DON’T STARE!

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My daughter is 18 months old, and quite naturally, she will stare at someone new. However, I always say to her, don’t stare, but you can say hi. And because she is this bubbly, happy little person, she does not have a problem, throwing her hand up, saying very loudly.. HEEEEYYYYY, and will start a babbling conversation with you. It’s okay to just say ‘uh huh’, ‘I know’, or ‘for real?’ No matter how much, I say ‘hello’, she has chosen HHHEEEEYYYY! Then as we push-off or leave, I tell her to say bye-bye, and again, very loudly she yells BYE -BYEEEE, with this very proud wave she has concocted.

This is my first time at the wheel of motherhood, but it seems rude to stare at someone, regardless of the reason. Within the Epidermolysis Bullosa (EB) community, many of the children have scarred skin badly or covered completely with bandages, except their faces. I have heard many complaints, within our community how it upsets them to no end, especially the children. Listen, we would rather you not stare, and if you are curious, ask. Remember these are still children, and the look you give is heartbreaking, although you don’t know it. They can’t help it. It’s a genetic disease that has no cure, and unfortunately it is real.

If you do not know what a severely affected child looks like, imagine someone who has 3rd degree burns, everywhere. These children have not been burned; their skin is extremely fragile, and it is easy to experience tears and/or blisters, which is extraordinarily painful. There are children who have fused fingers. It looks like their hands are missing. They are actually there, their skin has just fused together.

Do you see why EB is the worst disease you have never heard of?

www.debra.org

www.EBfriends.ning.org

http://altinkeserlove.blogspot.co.uk/

There are children, like my daughter, who has this diagnosis, yet show very little to no sign of this disease; it isn’t uncommon. We are fortunate, but we will never forget about the other families, who are still actively fighting everyday for a cure or better solutions than a screaming child during bandage changes, while preparing for a pool salt or diluted bleach bath. Weird? Well, constant infection is a serious threat. If one goes undetected, it could be deadly. So, please don’t stare. Speak, ask questions, be informed, and know that you have just given a mom and dad a validation for getting up every day, doing what they must. We just want our children smiling, happy, and as comfortable as possible.

Be informed!

How much does your BMI cost you?

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I am seriously beginning to understand and know my friend better. I want us up close and personal. My body mass index (BMI) isn’t very cute, actually she’s quite fugly. However, there is beauty in her, I just need to dig dip and pull it out, because I know it’s there. Since beginning my weight loss journey, December 2011, I have decreased my BMI by 3.82. It sure doesn’t seem like much, but it sure wasn’t easy.

There are four categories, according to the CDC: underweight, normal, overweight, and obesity.  Each group is assigned to a numerical scale, which will correlate with a person’s suggested BMI.

BMI
Weight   Status
Below   18.5 Underweight
18.5 –   24.9 Normal
25.0 –   29.9 Overweight
30.0 and Above Obese

This number will also be used to decide statistical groups of high risk for diabetes, hypertension, heart disease, etc. This means that we are judged and placed in a group that may or may not seem positive and ill-defined, whether we like it or not. Whether I approve is a non-factor, because so many are trying to grasp and control the growing number of obesity. This number gives a starting point.

This is not the only use for this number. Employers and insurance groups are also finding use in this number. An individual’s premium rates can be determined by their BMI (Associate Press 2007). Using the BMI, an insurance group make decisions of whether you are a high risk person or not. And if you are not in the healthy weight group, then the assumption is that you are overweight, and could potentially need more health care coverage than others. Yes, you have now been reduced to a dollar, and this is not going to help your self-esteem, in the least bit, but it is a reality.

An employer who is self-funded has a tremendous amount of clout, in determining the structure of their health care policies. For instance, if you are a smoker, I have seen employer groups that offer health care policies for smokers and non-smokers, where the smokers’ premium rates are slightly higher. This same process, although not widely used, is an option for an employer group using the BMI.

Insurance rates are rapidly increasing, and until the last stage of the Health Care Reform Act in 2014, there isn’t anything that can be done. The rates may only increase by 10 to 15%, for example; however, if you are a family of 4 and your per pay period premium rate, for a PPO plan, is $450, it will increase by $517.50-540.00. This is a considerable increase, especially when you consider your deductibles and co-insurances. Now, consider a chronic illness, such as diabetes or high blood pressure, with a policy that has a lifetime max of $500,000. Depending on your level of obesity, the actual diagnosis, and severity of your diagnosis, you very well could exceed that half million dollars. Then what?

Body Mass Index and Average Premiums
Average Premiums ($)
BMI
Weight Status
Female
Male
Overall
Below 18.5
Underweight
$172/month
$157/month
$169/month
18.5 – 24.9
Normal
$180/month
$143/month
$164/month
25.0 – 29.9
Overweight
$211/month
$172/month
$185/month
30.0 and Above
Obese
$221/month
$187/month
$201/month
Percent increase in average premiums from Normal to Obese:
22.8%
30.8%
22.6%
Policyholders in the ‘Obese’ BMI category pay 22.6% more on average than those in the ‘Normal’ BMI category (Ehealth 2011)

With that being said, quite often there are incentives offered to lower your BMI and weight, by most employers and insurance groups. Although, the incentives are nice, I feel that mandatory training and education should come with it. The education should include food and nutrition, exercise tips and management, and/or behavior counseling.  At this point, the consumers have had time to properly invest in education and training, and if the decision is to not heed the assistance provided, then it allows probable cause to penalize (increase premiums) the consumers.

I believe this will be the new future. There’s promise in this practice. In addition, I believe the government should follow the same practice, with the health care reform act: educate, apply, and effectively enhance a chance for success in weight loss.

References:

Associated Press (2007). Shrink your BMI–and your insurance bill. MSNBC. Retrieved from http://www.msnbc.msn.com/id/17385151/ns/health-fitness/t/shrink-your-bmi-your-insurance-bill/

Ehealth (2011). eHealth Data Shows that Smokers and Overweight Consumers Pay More for Individual Health Insurance. Retrieved from http://news.ehealthinsurance.com/pr/ehi/ehealth-data-shows-that-smokers-221171.aspx

How do I go home skinny?

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I have read about the cultural differences, between African-Americans and European-Americans, of obesity. African-Americans do accept larger sizes, more so than European-Americans (Hancock, A., Smith, M., & Whaley, A. L. 2009). Quite often, we do not find anything wrong with being thicker in the waist. Our men, for the most part, aren’t turned off by a voluptuous, full-figured woman, or as they would like to say thick. Growing up as a child, the skinniest person in my home was my younger sister. She wore a size 0, until the age of 18 or 19. Why she was so small, we do not know, because my family worked overtime trying to fattening her up. Being fat in my family, or in my predominately black community wasn’t bad or a humiliating reason; however, you couldn’t be ashamed or afraid of the question, “honey, are you eating”, especially by our elders. They would go as far as trying to feed you themselves, because of the assumed lack of effort by your mother.

Because I was raised this way, it was difficult to feel that I was abnormal or that something is wrong with me. My dad told me all the time that I was beautiful, and worth my weight in gold, therefore it’s difficult to have a low self-esteem. That’s why I stated in one of my earlier blogs, I did not feel a need to change. I wasn’t sick with hypertension or diabetes or any other associated disease to obesity. I was healthy, for the most part. In fact, most people in my family are fairly healthy, yet fat. Of all the fat people in my family, we may have one case of diabetes, and she is a Type 1. She lost the weight needed to remove that diagnosis, although she never sought skinny. The two cases of high blood pressure, in my family, are of my smallest aunts. They are ‘normal’ size, and have been most of their lives.

In the rural parts of Arkansas, we have to work, and I do not mean clerking or typing. We worked the fields. There aren’t jobs in the Delta, so people had to chop cotton or pick sweet potatoes. This is serious hard labor, and we did it to make our ends meet. I, personally, cannot remember one person that lost weight doing this type of work. We worked from sunup to sundown, yet maintained our weight. Had we started losing weight, people looked at us like we were sick, because being fat wasn’t viewed as a negative. However, becoming to large, where it had begun to create immobility was a huge negative, because not working, and sitting around was a serious no-no.

This information, by no means, excuses our eating habits or waistlines, but does bring light to our mentality. The hardest part is learning how the rest of the world sees you, once you have lived outside of your community. For me, it was shocking and depressing. I come from a background, where you learned to work hard, and then reap your rewards. You don’t steal, lie, or cheat, but get your hands dirty, and all that you have earned will come to you. Statistically, since I began researching obesity, I have found that no matter how hard you work, if you are not a part of the social ‘game’ or look as society thinks you should look, you can easily be discarded. Trying to explain this to my family and friends, in the Delta, would sound like I am sharing a myth. It isn’t easily believed. My dad would ask, “baby, do they do their jobs or are they lazy?” It isn’t socially accepted being overlooked, because you are fat, in the world I grew up in.

To meet the level of success, I want, how small do I have to become? Then I will have to ask myself, how do I go home skinny? Everyone will want to feed me. I don’t think we are all meant to look the same. Skinny is not my goal, and I do not accept the readings and behaviors of negative thinkers about fat people, because I have value that is worthy, and I work hard. In addition, I have not had an overwhelming negative response; if it has happened, it was unbeknownst to me. In this case, I will gladly accept ignorance as bliss.

Reference:

Hancock, A., Smith, M., & Whaley, A. L. (2009). Ethnic/Racial Differences in the Self-Reported Physical and Mental Health Correlates of Adolescent Obesity. Journal of Health Psychology. October 2011, vol. 16, no. 7, pp. 1048-1057