YES, deconditioning IS a medical condition

Bloggers Cynthia Yockey and Debra Heine, aka "Nice Deb", and blogger and talk radio host Barbara Espinosa at CPAC 2010.
Bloggers Cynthia Yockey and Debra Heine, aka "Nice Deb", and blogger and talk radio host Barbara Espinosa at CPAC 2010.
Cynthia Yockey after her first 5K on June 3, 2012.
Me, Cynthia Yockey, after my first 5K on June 3, 2012. Come to find that training on the elliptical does not strengthen all the muscles needed for jogging or running because for jogging and running the only thing lifting your legs is you. Oops. So I went to work and now I can easily jog a 5K in hilly terrain.

Dear Instapundit asks, “Is deconditioning a medical condition?

Yes, YES, a thousand times YES!

The insight that deconditioning is a medical condition is just as brilliant and apt as Hans Selye’s observation that stress is a medical condition. The diagnosis of deconditioning gets to the root of a syndrome of problems that otherwise would be given treatments that, at best, would not work, and at worst, would be harmful. That’s because if your problems have a common source in your body’s being extremely weak, no pill can cure that by making you strong.

Defining deconditioning as a medical condition gives a name to the syndrome of health problems that follow physical weakness. Suddenly a myriad of separate problems that have been tormenting you like a swarm of angry bees is a single problem with a simple solution: exercise. While the extremely deconditioned need to have expert guidance to begin to regain their strength, the moderately deconditioned probably can begin with a morning walk. (Going outside in the morning and into the light will be the most energizing time to walk because light shuts off melatonin, the hormone that makes you sleepy.) Since even just going for a walk builds strength and stamina, that means treatment is affordable for almost everyone–all you need are comfortable shoes, and in cold weather, a hat and coat.

I got into my deconditioned state because I’ve been virtually housebound since 1984 caring for chronically ill or dying loved ones: my late life partner of over 20 years, who had MS and was quadriplegic the last 10 years of her life and died in 2004; my mother, who died in 2006; and now my father, who is 96. In addition, I was fighting two deadly sleep disorders which weakened me and almost took my life in 2003.

I knew that to be able to recover from the damage inactivity and my sleep disorders had done to my body would require exercise. I started out walking. In 2007 I joined a gym and took classes.

But it wasn’t until November 2010 that I realized that deconditioning was the root of my problems of lethargy, stupors and inability to get my housework and yardwork done without frequent rest periods. My “Aha!” moment came when my then 80-year-old pal, Marge, from my cardio class, extolled the glories of the new resistance training equipment in the main gym. I had only been using the elliptical machines in the women’s gym, which had the main gym’s hand-me-down resistance equipment. It looked complicated and unappealing.

But the new resistance machines seemed inviting, so I decided to set a series of small goals. All I had to do for the first month was walk into the main gym, sit at each piece of equipment and figure out how to adjust it. This got me through my feelings of resistance, overwhelm and anxiety. I promptly discovered that resistance training felt WONDERFUL! It was like switching on a light in my brain. I quickly came to dread missing my workouts because it was so much easier to be orderly, organize things and put thoughts into action for the next few days afterwards.

So my routine for the last two years has been cardio classes for coordination, balance and social contact; the elliptical for cardio; and resistance training for strength and mental clarity. I also counted calories and lost about 65 pounds.

The result has been that I can get the dishes done in 20 minutes instead of a couple of hours. Ditto for scooping seven litterboxes. I have energy and stamina. I am amazed at how much I can get done now.

It may seem like the common condition of being out-of-shape is being unnecessarily medicalized and turned into an illness in order to create more victims.

No.

First, being deconditioned describes symptoms that go well beyond just being “out of shape.” For that reason alone, we need a term for those symptoms. People who lead active lives but seldom exercise may be out of shape. But people who have been housebound or bedbound almost certainly are deconditioned. Unless you work with the chronically ill and disabled, you may take for granted things like having the trunk strength to sit up on the edge of a bed without back support. But people who are deconditioned must exercise to be able to do that.

Second, using “deconditioned” as a medical term is highly motivating because it tells the people who have deconditioning how they can recover. It powers them through the initial discomforts that otherwise may discourage them from perservering. It switches on a light in the darkness. It tells people what they can do to get well. And there is absolutely nothing that motivates people to get busy achieving a goal than the certainty that they will achieve it.

About my “Donate” button: This week generous donors made it possible for me to make the down payment and first payment on the eight-year-old car I needed to buy to replace my 16-year-old car, which died in July. Until that happened, I had been in despair about how I could attract and earn the money I need to start my own business and create the projects in order to pay off debt and tax problems my father has due to helping me through my health problems. I am a writer and entrepreneur–I feel certain I have the ability to make a good living and get the debts and taxes paid.

But I was very frightened about how long it would take me to get the small amount of money for the next step in starting my business. I feel pressured about time because my father is 96–I have to become self-supporting while he is still alive. The next step for starting my business costs $900. I can’t leave my father alone to work outside our home to raise this money. I hope my dear gentle readers who can comfortably do so will donate. I thank all of you in advance and will report on my progress. This is fiscal conservatism in action.


Day Three, mostly cloudy

I am very grateful to all my donors–enough money came in for the car down payment and the first month’s payment, which is a big load off my mind. There also is enough for me to see a doctor who may have a handle on my idiopathic hypersomnia problem. I hope I have my dear gentle donors support for that. I have to get healthy enough to make the rest of the money needed to pay for the car.

This doctor is one of the top experts in the U.S. on Maharishi Ayurveda, the revived form of the traditional medical system of India. I went to a talk he gave a few months ago and learned that ayurveda has a paradigm for sorting out the cause of hypersomnia and treating it. I know a lot about ayurveda, but that was news to me. When the ground went out from under my feet for the last few days, for no reason I could figure out, it spooked me quite a lot. I have to be well enough to support myself before my father goes. He’s 96, so this is urgent and no one else has any answers. Plus, I credit Maharishi Ayurveda with a great deal of the progress I’ve made over the last year and a half. With recommendations specifically for me, I think I can improve much more quickly.

The other thing about the storm in my head over the last few days is that it seemed to be part of a pattern I have of getting a huge boost from Instapundit, my fellow bloggers and donors, having plenty to say, and then not being able to do it because of a bolt from the blue–just like after CPAC. Stuart Lichtman calls unconscious self-defeating habit patterns like this “blockers” and provides an exercise for clearing them and establishing successful patterns and good luck. What do my dear gentle readers think of my tracking my progress by writing my before-and-after experience of doing the exercise?

By this evening my clarity began to come back. I should be able to write tomorrow–first the plan I want to propose to my donors, then my thank-you notes, then the backlog of posts I’ve been wanting to write.

I am grateful for your support, understanding and patience.

Day Two: The Storm in My Head

I still haven’t written my thank-you notes to my donors and I owe you all an explanation, except that I don’t know for sure what is creating this feeling of a storm in my head — my idiopathic hypersomnia or a migraine, or a combination, or what. I just know it will pass.

Writing heartfelt thank-you notes is not a hard task. However, I want to include in my thank-you notes an invitation to be part of a project I’ve long wanted to do. And for that I need a lot of mental coherence so I can write out my plan and then explain it clearly.

One of the most difficult things to deal with about idiopathic hypersomnia is having the ground randomly fall out from under your feet like this.

I appreciate your kind patience.





Stumbling out of the gate

Thanks to links by Instapundit and Moe Lane and the donations I received, I was able to make the car down payment this morning. But I have to explain why I haven’t written my thank-you notes yet.

I was out of bed and out the door before 7 am this morning (Monday) for a mile walk in the early morning sunshine to help me be alert for the day. Light shuts off melatonin production so getting out in the sunshine early in the day is important for reducing the effects of my idiopathic hypersomnia.

Shortly after our veterinarian’s office opened, I took dear little Cleo’s body for cremation. Next I dropped off some items at Goodwill as part of my on-going de-cluttering. Then I went to the car dealer to make the down payment. Thank you, dear gentle donors!

I felt foggy and sleepy when I got home and eating lunch didn’t help. No matter how much I wanted to be awake and spend the afternoon writing, I felt like there was a storm in my head and I was going to have to sleep. That’s the difference between needing a nap and having to sleep due to idiopathic hypersomnia. Even if I could have stayed awake, I would not have been productive. And my father wasn’t up yet, so I didn’t have to try to stay awake. I was out cold until I heard my father get up around 5 pm. (It is a cold, cold feeling of dread when he sleeps all day like that but sometimes he just needs that much sleep.)

So–I’m stumbling out of the gate. If I stay up into the wee hours writing thank-you notes it will make the next day or two very miserable. I am sorry for the delay but it makes the most sense to write them tomorrow when I’m feeling better.

P.S.

Master of tip jar fundraising, dear Stacy McCain, has given me sage counsel to write two posts a day and put a PayPal donation button at the end of every post. He is right. While the immediate need has been met, even though I’ve improved far more from my idiopathic hypersomnia than most do–it’s a deadly condition–even one or two sleep attacks a week make me unemployable by anyone except myself since putting up with them is not a “reasonable accommodation” required by the Americans with Disabilities Act. My father is 96 and I am working for room and board, which ends when he passes on. This means I have to create my own business to be able to support myself and I have to do it now before he goes. I think it will take six months to start generating revenue. That is why I will continue to rattle the tip jar: so I can pay the small expenses of getting on my own two feet financially.

 





Pray for Cleo

An elderly calico cat named Cleo.
Cleo

On Saturday morning, when I came downstairs, I found a splash of red blood on the floor of the den, then a trail of drops of blood or urine mixed with blood — evidence of a kitty with a bad urinary tract infection. It turned out to be Cleo, the 19-year-old kitty we adopted with her daughter, Ro-Ro, in May when their people moved.

Cleo weighed four pounds and change when she moved in, due to advanced kidney disease. We love her, but she is very frail. I think giving her antibiotic pills would traumatize her. I have an appointment with our regular veterinarian for euthanasia tomorrow. I’m watching over her now to try to determine if she can wait that long, or I should take her to the animal ER–and to get her loved up before she goes. She is a very sweet cat and we will miss her.

For everyone who will recommend getting another kitty right away: I agree. I learned this morning that a friend’s mother may have to move in with her. However, my friend is too allergic to allow her mom’s cat to move in, too. I volunteered to take the puss and provide visitation.

Update, 8/12: Cleo was in a cozy box on my lap as I wrote this, but got restless so I took her downstairs and put cat and bed in her cave under the kitchen table. I laid out clothes for my father for tomorrow then went into the kitchen and found that Cleo had passed away. I wrapped her little body in a towel and held her for awhile and said blessings for her soul. I should be writing thank-you notes now to all the people who have helped me, but my heart is very sore and I don’t think I can stay awake. I am deeply grateful, but I will have to write them in the morning.

Thrilled with Paul Ryan

I am delighted that Romney has chosen Rep. Paul Ryan as his running mate. It signals that he is serious about fiscal conservatism and restoring America’s economy to prosperity. Ryan is the balance the Republican ticket needed.

Dear Keith Koffler* of White House Dossier worries, “Are Two White Guys What the GOP Needs?“:

But there’s a potential downside with Ryan that Mitt Romney could have avoided by picking Hispanic Florida Sen. Marco Rubio, African American Florida Rep. Allen West, Condoleezza Rice, South Carolina Gov. Nikki Haley or any of the other half dozen or so women said to have been considered.

A presidential ticket is not just about competence and ideology. It’s a symbol to many Americans, an incarnation of their own hopes and dreams for the future. They want to be able to point to the candidates and tell their kids – whether they be little girls or children of color – “Look, you can be president too!” And they want to believe the candidates have experiences and backgrounds that will enable them to truly understand what they go through every day.

On this level, many of the swing voters Romney will need – moderates and even many Democrats – will be disappointed with this pick.

Actually, I think competence and ideology have the potential to generate a landslide victory for Romney/Ryan because people want jobs and a prosperous economy. Obama hasn’t delivered either. In contrast, Romney knows how to create jobs and Ryan is a budgetary wizard who understands the machinery of the federal budget. I think independents will see Ryan as someone they can trust to improve the economy.

Just watch Rep. Ryan dissect Obamacare right in front of Obama and Biden. Obama glowers, looks daggers, then falls back on his trademark contempt as a bluff in lieu of having an informed rebuttal. Ryan’s performance is dazzling:

H/T: Joe Wiesenthal at Business Insider.

I’m thinking Joe Biden is not looking forward to the debates between the vice presidential candidates.

What I wish Ryan and the Republican Party would do, however, is look at the presidential race as a sales presentation rather than a will battle. The job of a salesperson is to overcome the objections to a purchase by a prospective buyer and make a sale. So, regarding issues such as entitlement reform, Republicans call for entitlement reform in a way that makes sense to Republicans but which frightens the bejeebers out of independents and persuadable Democrats. That why the Democrats’ commercial showing a Ryan look-alike throwing a wheelchair-dependent granny off a cliff resonated with their base. Sneering that their fears are baseless does nothing to dissolve their fear–in fact, it validates it.

Photoshop image of Paul Ryan holding up his budget plan but his title has been replaced with a joke title, "How I Plan to Murder You."H/T for photo: Ace from Ace of Spades HQ and @johnekdahl.

Democrats win elections by answering the question, “What will become of me?,” even though their answer is founded on smoke, mirrors and unsustainable spending.

What Romney and Ryan must do when they are selling their entitlement reform plans is to answer the question, “What will become of me?” After all, our entitlement programs, Medicare and Medicaid, are for people who cannot work due to frailties of age or disability. These people are not slackers. And the costs of medical care and longterm care can quickly wipe out the assets even of prosperous, prudent people.

What Republicans have with fiscal conservatism is the golden ticket to prosperity–but people must be able to see the benefit in their own lives. Generally, Republicans leave that part of the sales presentation out since we think it is so obvious it doesn’t need explaining. But it does. And God forbid that Romney and Ryan repeat what McCain did, which was to try to sell the electorate on the glories of economic pain now for a distant better future. The more Republicans inspire people about the golden ticket, the more people will get busy making the most of themselves and the less pain will be required to get our economy thriving again. That’s the winning message for Romney/Ryan.

*I ADORE Keith and went fangirl bonkers on him at CPAC 2012 when he asked a question in one of the panel meetings and I realized I was practically sitting next to him.

Update: Dear Stacy McCain was at the Romney/Ryan rally in Manassas, Virginia, today. I urge you to read his report because he captures the enthusiasm of the crowd for these candidates–an enthusiasm that Obama/Biden no longer generates. And for a bonus, he has the video of Hitler finding out that Romney has chosen Ryan.

Update: Dear Stacy McCain correctly predicts on Twitter that if my dear gentle readers hit the tip jar, I will make Paul Ryan a sammich–with my personal favorite, a Brandywine heirloom tomato that I’ve grown myself!

Update: Dear Michelle Malkin also is thrilled with the selection of Ryan and she features a short video of Ryan explaining how his plan will save Medicare, which I urge you to watch. It goes a long way toward answering the question, “What will become of me?” But conservatives need to remember that saying “the free market will make healthcare cheaper and better” is a meaningless statement for liberals/progressives. It’s the equivalent of saying, “Then a miracle occurs.” And it suggests that people will be dickering with their doctors, as if people will joyfully embrace the prospect of, say, heart surgery with anything less than all the trimmings.

My moment of commitment

Andrew Breitbart is shown arguing with Leftist media gadfly, Liz Glover, who is accusing him of homophobia while he has his arm around blogger Cynthia Yockey, A Conservative Lesbian.
Because conservative donors sent me to CPAC 2012 in February, in this photo (and at Mediaite, a video), I am standing with Andrew Breitbart, spoiling the Leftist narrative of gadflies, Liz Glover and Tommy Christopher: Liz was accusing Andrew of being homophobic while he had his arm around Cynthia Yockey, A Conservative Lesbian. Oops!

 

Steven Crowder, Cynthia Yockey and Chris Loesch at CPAC 2012 after Steven and Chris performed their new rap song, "Mr. America!!" HuffPo published a photo of me dancing to the music at the back of the room.
Steven Crowder, Cynthia Yockey and Chris Loesch at CPAC 2012 pose after Steven and Chris debuted their new rap song, "Mr. America!!" Because conservative donors sent me to CPAC, when HuffPo published a photo of me dancing while they performed, which Gawker and Mediaite picked up, all with the goal of portraying the Right as bigots, it blew up in their faces because Steven and Chris could reply that they were trashing A Conservative Lesbian. Gentle readers, donating to me pays off for the Right!

Dear gentle readers, I’ve done everything I know how to get through my challenges by myself. But now I’m in a bind that I can’t get out of on my own in time and it feels suicidal not to come clean about my situation and ask for help.

My problem is my 16-year-old car died in July. My plan for replacing it involved selling the two shares of Apple stock that I own due to having purchased one share the week that Steve Jobs was fired, plus selling some stuff on eBay (a mix of possessions and an item I thought I could get wholesale and sell at a profit). The eBay part of the plan fell through. A bunch of unexpected bills cropped up. Now I can either replace my old car, which was so unsafe I’ve already sold it to a junkyard, or cover the rest of the month — but not both.

The car dealer was in my father’s Boy Scout troop as a teen in the 1960’s, when my younger brother was alive and Dad took his scout troop hiking and canoeing in the wilderness. This was extremely rare in those days, but my father was raised to camping having spent his summers in his teens camping in Yosemite. All of the men who belonged to my father’s scout troop as boys and got to go on those expeditions still marvel at their luck and the influence my father had on their lives. That is why the dealer let me sign a post-dated check in July to replace my deathtrap with an eight-year-old car he had in stock after I proved I’d sent my Apple share certificate off for sale. So I have the car, I just can’t keep it unless I can cover that check.

I need to raise $1200. Please click the “Donate” button below and help me if you can.

My experience since becoming a fiscal conservative in 2008 is that conservatives will help others but want to know their money is going to someone who works hard and will make the most of every opportunity put in their hands.

So, for the first time, I’m going to explain the magnitude of the challenges I’ve faced. A lot of people in similar circumstances either kill themselves or go on disability. Or they die — I have been a caregiver for dying loved ones since 1984, a job so demanding that about 30 percent of long term caregivers die before the loved one they’re caring for. And in 2003, I was dying because my obstructive sleep apnea (OSA) had gone undiagnosed for decades. In 2004, when I was diagnosed with idiopathic hypersomnia, a rare and deadly condition with no cure, my sleep doctor told me he had never seen anyone who got as close to death as I did from OSA in 2003 recover enough to get their life back. This is because OSA causes hypoxic brain damage that affects executive function and working memory. Nevertheless, I made it my goal to get well, create a career and prosper.

Here’s a list of my health challenges, in order of diagnosis:

  1. Hashimoto’s thyroiditis (1995)
  2. Depression (1999)
  3. General anxiety disorder (1999)
  4. Obstructive sleep apnea (2003), which caused hypoxic brain damage affecting my executive function and working memory
  5. Idiopathic hypersomnia (2004)
  6. Obesity (my weight shot up in the 1990’s due to 1-5).

I also have a touch of arthritis but it is controlled by ibuprofen. For several years I had tachyarrhthymia, with a resting heart rate in the 120’s, and asthma, which caused a chronic, racking cough, but those went away over time after I started CPAP therapy in 2004 for my obstructive sleep apnea. CPAP therapy also greatly reduced my joint and muscle pain and stopped my chronic migraine headaches.

Regarding the obesity, my top weight was 217 pounds in April 2003. CPAP therapy also resulted in a fairly effortless loss of 10-15 pounds. In 2010, thanks to Instapundit and the rest of the right blogosphere coming to my aid when a dental emergency for my father meant we weren’t going to make the mortgage, there was enough money for me to see an oncologist-gynecologist and get a sonogram to determine the pain around my right ovary was due to obesity. I didn’t have cancer or need a hysterectomy, as I had feared.

Also thanks to my donors, I was able to follow the doctor’s orders to lose weight by buying a Bodybugg armband and wrist display. I’ve used them over the last two years to lose another 65 pounds, bringing my total weight loss to 80 pounds. One of the coolest ways I have to track my weight loss is photos of me with Andrew Breitbart — I’ll write a post with them soon.

In addition to losing weight, I’ve gotten much more fit. I did my first 5K in June and now can jog a 5K (3.1 miles) easily in hilly terrain.

My financial challenges have come from items 2 through 5. I work very hard to think positively, but feelings of hopelessness and helplessness from the depression can grip me. The anxiety disorder complicates those situations because I get so frightened that I am too paralyzed to do anything because I can’t figure out what to do. Frankly, I think these problems will be cured by getting the skills and tools to succeed in my career as a writer and in my own business. I don’t need medication or pity. I need to create success. In the new direction for my blog, which I will explain soon, I will write about the exercises I am doing to cope with these blockers.

Regarding the hypoxic brain damage, I cobbled together my own program to try to heal myself and recover my abilities. That’s why I started to play to bassoon again in 2003. I started growing heirloom tomatoes in 2004 and joined a gym in 2007. I didn’t know the scope of my problem until the spring of 2010 when, suddenly, it was like the lights went back on in my brain. Mental images — the vision of tasks I wanted to accomplish — would pop into my mind when I wanted to plan something. Not only could I suddenly see the mental images of the steps of accomplishing a goal, I also could remember the steps to achieve my goals and pace myself to various milestones of my day — such as breakfast, lunch, dinner and bedtime.

Things really began to take off in the spring of 2011 when I learned about light and melatonin. I realized that neither blogging nor caregiving require me to get much sunlight and I never went out of doors in the early morning. Morning walks — now morning jogs — became an important part of managing my idiopathic hypersomnia.

This year I’ve discovered doctors and treatments that I think will heal me enough of the hypersomnia and brain damage that I will be able to work and support myself. Getting over my current hurdle of $1200 for my car will give me a foundation for generating the money to do this.

Unfortunately, I had a heartbreaking setback in February. Thanks to a link from Instapundit, generous conservative donors sent me to CPAC. I had a blast there and met people I really needed to meet. I also was in the right places at the right times so that HuffPo, Mediaite and Gawker collectively had their attacks on Andrew Breitbart and Steven Crowder blow up in their faces. I was joyful and brimming with posts that I still want to write, even if they are no longer timely. However, I came back home from CPAC so sleep-deprived that the next day I fell asleep sitting up in a chair several times while I was monitoring my father. I must have had several very long apneas during these mini-naps because by the end of the day, the light in my brain had gone out and there was only darkness and fog where my organizing ability, working memory and picturing power of the mind had been. I was devastated. I had no idea whether I could get well again, or, if I could, how long it would take. That’s why I’ve hardly written since CPAC. I had to put my attention on getting my health back.

I was still in darkness and fog in May when I forgot that I was making ghee and got involved in researching garden questions online. When I finally smelled smoke and saw two feet of flames coming up from the pot, thanks to my brain fog I forgot everything I knew about putting out grease fires, ignored the fire extinguishers in arm’s reach and got second degree burns that required an ambulance ride to the Johns Hopkins Bayview Burn Center.

Thankfully, in June the light began to dawn again. And this week I had an amazing breakthrough and got through a mountain of bills and mail clutter that has had me stumped for months. Now I feel like I can make it. I don’t think I could write this post asking for help if I hadn’t had that breakthrough to make me feel like I could ask people to invest in me and be able to make them proud and happy when they did.

Going forward, I have to put my attention on making money through a successful career that I can launch while continuing to care for my father. (I can’t work outside the home because I can’t leave my father alone for more than a few hours at a time.) Blogging is part of my plan to do that — I want to find my tribe. I’m also going to be writing about the system I am using to set and achieve my objectives and to clear my blockers — the habit patterns I have that obstruct my success.

Please, dear gentle readers, be sure to check in often from now on — and to join me! This is the new direction for my blog. Right now the best way for me to write about the glories of fiscal conservatism is to show with my own life how it gives me the chance to come back from death’s door, overcome seemingly incurable health conditions, pay off a terrifying amount of debt and taxes, and prosper — even after spending most of my life caring for dying loved ones, despite being extremely socially isolated, with no health insurance or savings, at the age of 58.

This is my moment of commitment, dear gentle readers. God willing, the Providence will move:

Until one is committed, there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative (and creation), there is one elementary truth the ignorance of which kills countless ideas and splendid plans: that the moment one definitely commits oneself, the providence moves too. A whole stream of events issues from the decision, raising in one’s favor all manner of unforeseen incidents, meetings and material assistance, which no man could have dreamt would have come his way. I learned a deep respect for one of Goethe’s couplets:

Whatever you can do or dream you can, begin it.

Boldness has genius, power and magic in it!

(W.H. Murray and Goethe: Usually the whole quote is attributed to Goethe.)

Please donate — it is urgent that I raise $1200 by Monday, August 13, to be able to keep my car. I thank everyone in advance, both for kind donations and for kind thoughts.

Weight loss advice guaranteed to make you fat

Over at PJMedia, physician Theodore Dalrymple asks a question that German immigrant and pediatrician Hilde Bruch posed and answered over the course of her career starting in 1935, when she founded a clinic for obese children at Columbia University’s College of Physicians and Surgeons.* The question is, “What are we to make of the fact that an affliction of the rich is now predominantly a problem of the poor?”

However, the main question Dr. Dalrymple asks in his headline is, “Is Obesity a Disease or a Moral Failing?

Dr. Dalrymple comes down on the side of moral failing.

I disagree. The research explained in the books I cite below suggests that the obesity epidemic has its foundation in bad advice from the medical profession based on ignorance of the endocrine system, sleep, exercise and what actually makes people fat. I think people will take personal responsibility just fine when they have better advice that is certain to get them the result they want.

Dr. Dalrymple also is dismissive of the idea that there are institutional causes of obesity. I disagree for the following reasons:

  1. The low-fat diet the medical profession has touted for weight loss and heart health is high-carb and makes you fat. This model must be discarded and replaced with the correct understanding of the roles that consuming carbs, exercise and sleep deprivation have on the endocrine system. People do take personal responsibility but the medical profession has to provide them with solutions that actually work.
  2. High carb foods dominate the offerings practically everywhere food is served: restaurants, shopping malls, you name it. The free market should fix this — supply will chase demand when people want healthier food.
  3. Exercise is not built into our daily activities as much as it used to be. You often have to work to find the place, equipment and time to exercise. Government will be involved in this solution because planning things like sidewalks, bike lanes and parks are part of the government’s job.

Here’s what I wrote as a comment:

Dr. Dalrymple, as other commenters have noted, you would benefit from reading Gary Taubes’ book, Why We Get Fat and What To Do About It. Taubes explains research showing the effect of eating sugar and simple carbohydrates on the endocrine system. Research shows that people who eat a lot of carbs can be starving while getting ever fatter simply because their insulin production is sending the food they eat straight to the fat cells instead of making it available for energy. They are caught in a vicious cycle. Worse, the low-fat/high-carb diets currently recommended for heart health exacerbate the problem. The more the public is educated about how the carb/insulin cycle affects them, the more motivated people will be to get out of it.

Unfortunately, as a solution Taubes recommends the Atkins diet, which can cause kidney failure, kidney stones, gout and osteoporosis.

Other diet and fitness experts educating the public about the role of the endocrine system in weight loss with more thorough explanations than Taubes provides and healthier diet recommendations include Jillian Michaels in her book, “Master Your Metabolism,” and Dr. Michael Aziz in his book, “The Perfect 10 Diet.”

By the way, one of Taubes’ major contributions to the field in “Why We Get Fat” is his history of which experts in charge of telling the rest of us how to live blew it so badly that they effectively are the creators of the obesity epidemic. This puts an entirely different light on the belief that the obese have failed in their own personal responsibility when you consider that the advice they were following to get or stay slim was instead absolutely guaranteed to make them fat and sick.

*Gary Taubes opens his book, Why We Get Fat and What to Do About It, with this information. I first started reading Dr. Bruch in the 1980’s when I was researching anorexia as I was trying to heal from having an anorexic lover when I was in college. I highly recommend her work.