Wednesday, July 8, 2009

prioritizing problems

In health care, chronic diseases tend to travel in packs. Those with non-insulin dependent diabetes mellitus (commonly known as type 2 diabetes) are generally, without a doubt, overweight...if not obese. I could and would provide you with statistics, but it's pointless. Even in my infantile career...this fact is clear as day. So I'm talking with my co-worker today, discussing the role of each of our clinic's classes -- diabetes, lipids, prenatal, weight loss, DASH, etc. While we deal most with diabetes patients, overwhelmingly...patient's labs are not reflective of dietary and/or lifestyle modifications. Even with unlimited access to dietitians. Hmm.

Now, I'm not arguing the precedence of diabetes treatment, however, patient's just don't get it. Blindness, loss of limbs, and dialysis are just not realities to diabetic patients until it's too late. It's sad...and what's a dietitian to do? It is my job to prevent chronic disease complications and educate patients on prevention. Moving along. When I suggested an increase in the number of group weight loss classes, my co-worker disagreed. "Diabetes Self-Management must take priority ahead of weight loss." Hmm. Sure, I agree...but it's not working. I can ramble about carbohydrate counting and bedtime snacks day-in and day-out, but again...it's just not working. I propose weight loss classes but more specifically, lifestyle change classes. These people want to lose weight and may not have the support system or tools in which to get started. A mere 5% drop in body weight will help insulin resistance in our type 2 patients. Futher, patients view weight loss as 1) appealing, 2) comprehensible, and 3) tangible. One can see numbers on a scale drop and feel the self-satisfaction and pride in purchasing a smaller size pant. And while carb-counting may be intended to aid in weight-loss, health care providers typically get wrapped up in the "eat this, not that".

Granted, there are patients who strongly benefit from a good 90-minute crash course in carb-counting and diabetic meal planning, who walk out of my office feeling empowered, motivated, and prepared to fight the progression of their disease head-on. But sadly, those individuals are far and few between with the majority falling through the cracks.

The American Dietetic Association published a new research study looking at body size acceptance. The study was a 6-month randomized clinical trial with a 2-year follow-up period. The subjects were obese, Caucasian females aged 30 to 45 who were noted chronic dieters. A model used to address health at any size was used, versus a traditional weight-loss program. Variables such as satiety, hunger, and internal cues of hunger were addressed [1].

At the 2-year check-up, the health at every size approach produced long-term behavior change and improvement in all variable outcomes. The dieting group did not. Weight was maintained in the health at every size group while the dieting group had sustained weight loss for only a year before the weight was regained [1].



It is known that age, ethnicity, sex, and lifestyle make drawing absolute conclusions between health and weight nearly impossible, states Morgan Downey, policy director for the Stop Obesity Alliance [2]. While there is no denying obesity as a compounding factor of chronic disease, if American's could alter their thinking and "eat to live, not live to eat" (as my mother always says) and move more, one's weight would lose such emphasis in the health world.




As a dietitian, I obviously support the maintenance of a healthy weight. And if you're overweight/obese, you should lose weight...I should lose those fifteen dang pounds I harp about, darn it! However, dieting shows that sustained weight-loss is atypical. What can we do to permanently change our perception of how we eat and live in order to benefit our health? What I know is that I'm okay with my +15 so long as I live healthfully -- continue my healthy diet, continue my healthy lifestyle (drug-free, happy-go-lucky me), and regular moderate-to-vigorous activity. I am hitting the treadmill here at work today during my lunch hour. How 'bout that?

[1]. Bacon, L., Stern, J., Van Loan, M., and Keim, N. Size Acceptance and Intuitive Eating Improve Health for Obese, Chronic Dieters. American Dietetic Association. June 2005.

[2]. LaRue Huget, Jennifer. Eat, Drink and Be Healthy. The Washington Post. July 7, 2009.

I have a goal!

I was looking at pictures from 2004, I was really skinny then! I think I have gained 10 pounds or more since then. I probably weigh the most now that I ever have, other than maybe when I got back from colporteuring in 2002. So I put myself on an exercise routine this week. I have a 45 minute, 3 mile power walk video that I really like, it's by Leslie Samson. Each mile is split up or you can do it all at once. So the last two mornings I have gotten up at 5:30 am to do two miles. When I get home from work it's hard to motivate myself to do any exercise, so I decided to try in the mornings. I would much rather exercise outside too. So in the evenings I am going over to David's parent's neighborhood and walking their sub-division with David's mom. That's probably another mile or more. I don't think I will do that every night, but at least a couple times a week. I also want to start playing tennis more. I am horrible at it, but since I have to chase the balls around so much I end up getting a pretty good workout! haha. My goal is to lose at least 10 pounds by the end of the summer, we'll see.

Light reading

July 8

Oh, I have so much to share with you, dear reader, but I have some fires to put out today, and so in the meantime, please enjoy this interview with the chef at Chez Roux, Albert Roux's new restaurant outside of Houston.
And while I'm at it, in case you missed it, my story on the cuisine of Puglia.

Thank you.

ask not what other can do for you, but ask what you can do for others.

If you cannot get the things you want in life, because you have no money, no freedom, no friends etc...
Maybe if you start focusing on what you have and not what you don't, you may get it..



but remember, its not only the outstanding things we need to remember, its also the small things in life we must be greatfull for.

Ancient Pringles

My parents are moving house. They're in the process of selling the home I, along with my two siblings, grew up in. It's a strange feeling.

Being a helpful (as well as emotionally attached) soul, I offered to come up and aid them with the inevitable clear-out. 'I'm not moving junk from one house to another,' said my Dad.

He's right. There are two decades of accumulated rubbish hiding in the darkest corners of the house. 'Useful' items once cherished have been stowed in the attic and forgotten about. Toys. Old school work. Clothes. All now smell old. Unloved.

The process takes three times longer than it needs to: the contents of each box, instead of being thrust into a waiting black bin liner, are examined. Memories come thick and fast and the occasional tear teases at dampening eyes. Childhood concurrently feels long ago and within recent memory.

But it's fun too. In one box we found this:



a tube of Pringles that had been opened and unfinished about ten years ago.

The lid was opened with trepidation. I feared a colony of mould that had somehow developed intelligence or sentience of some sort.

What was inside was far more disturbing.



Ten years and the Pringles looked almost fresh. I have no idea what they put into these things that has managed to slow the aging process to such a painfully unnatural degree but I'm sure Joan Rivers might well be interested.

For more dubious snacks, follow me on Twitter

how did you sleep?

How do you look when your sleeping??


Life is full of fun

Life is fun, when you allow yourself to enjoy it.
Be flexible and see the silver lining.


a gift is not just to be received, its also to be given.

read behind the lines

In the past, there was people i dislike because there were to fierce, and they never show they care.
they use to make us do things we find boring and they just keep pestering us...

but after it all, when we enjoy the fruits of our labour, then we recall that is because of this people that we have today... but what do they get???





To all the Cigku Kamal out there, I thank you.
Thank you for doing what you did, even when at times my behavior hurt you.
Thank you for believing in me even when i do not.
Thank you for planting the seed, so I can enjoy the shade....

Thank you.

Caring is sharing

If you can care for others, you are also caring for yourself.


Old Friends

a few nights ago, I got a call from an old friend from Primary school...
we set a time to meet for a drink... We got together and at the last minute, we got another friend out too.

Once, 2 Chinese and an Indian boy use to ride motor, play games, look at girls... Now meet as 3 grown man still friends. This is really something money can never buy.

Wash Your Hands

the public must learn to take care of themselves, at least wash their hands...

but how can we educated the public in a way that they will want to listen????

THIS is HOW!!!

Everything cost MONEY $$$, but how about Parents love?

To all parents out there, please enjoy this short film, and for all the children please remember those people at home.




I know the love you gave to your children is priceless...... Thank you and I will always love mine with my l

Why be a PILOT???

In the last IAG camp, I was amaze by the number of teens asking me about the path to take that may lead them to their dreams of being a Pilot.

i myself had not much information, so i did what was fastest.... "google it"
Then i came across this video from AirAsia.



Its funny and at the same time allows us to keep moving forward to achieve our dreams.
Stay focus and keep moving forward.