Friday, May 1, 2009

Pediatrics

I am currently finishing up my pediatrics rotation. While I absolutely love working with kids, the constant focus on The Obesity Epidemic has been infuriating and exhausting. I gave a presentation to the department today, and while I usually talk directly about HAES in these contexts, I just couldn't cope with that kind of hostility after over a month of it. So I spoke about a related topic -- treatment of Anorexia Nervosa.

I spoke about Family Based Treatment, and how it is the only treatment for AN that has reasonable evidence behind it. I discussed how FBT works. I talked about the absence of evidence that families of teens with AN are themselves pathologic. Many of the audience members had a big problem with this. The argument that most families have pathology, particularly if you put a big microscope under them, so you shouldn't use anecdotal evidence to villify families of teens with AN was not convincing apparently. Plus, you know, the lack of evidence.

Anyways, that was all fine. I can deal with that. But then, just as I'm finishing, one of the pediatricians says, "You know, I bet that this behavioural approach would work really well for obesity as well. You schedule meals at particular times, you watch the kids, and you force them to normalize their eating." An argument followed where I stated that there is no evidence that kids who are fat eat worse than their thin peers. The pediatrician and several others were simply like, "You're wrong." Fine. Even that I can deal with!

But just before the pediatrician left, I was making the point that there is a huge difference between AN -- a severe mental illness with a high mortality and even higher morbidity -- and obesity -- a supposed risk factor for illness that describes one end of the normal spectrum of human variation. And the pediatrician said, very confidently, that he didn't think AN was worse than obesity in the long run. Nobody else seemed to understand how profoundly offensive, never mind ridiculous, that statement is.

Sigh. There are so many days where I feel like I'm living in a parallel world, and I start wondering whether I really am the crazy one. I'm ready for pediatrics to end.

13 comments:

Nicole said...

Wow. Tough crowd! Have you seen the Academy of Eating Disorders guidelines for childhood obesity?

http://www.aedweb.org/media/Guidelines.cfm

Printing out some of those and leaving them lying around might not be a bad idea...

Thank you for fighting the good fight!

peggynature said...

That is so fucked up. But I'm glad you're still fighting your way through it.

You will get to the end and you'll be one of the people to help change everything.

Fantine said...

I admire you for having the guts to keep standing up for HAES in the face of so much willful ignorance. It's hard enough for me to stand up for myself just facing my regular treating physicians. You must get all the negativity I get times a hundred every time you address the subject to a group like this.

Keep fighting the good fight. It gives me hope to know there are future medical professionals out there who haven't been completely brainwashed on this issue.

Jill said...

I have an image of you in a group of Victorian medical trainees making presentations showing that masturbation causes no harm whatsoever, and being rejected as swiftly. Considerable hard was done by doctors' horror of masturbation and attempts to stop it, and now that we've culturally eased up on that, fat seems to be taking its place as a moral hazard.

Sometimes it can be cold comfort to have science on your side.

Jill said...

Of course I meant "considerable harm" rather than "considerable hard." :)

chartreuse said...

Thanks everyone for your support. It really means a lot to me.

Meowser said...

Ern...did this doctor know about the unusually high rate of suicide among people with AN? More people with AN deliberately take their own lives than actually starve to death. Know who else has an astronomical suicide rate? People who have had gastric bypass. Gee, you don't think starvation itself makes life frigging unbearable or anything, do you?

littlem said...

I have an image of you in a group of Victorian medical trainees making presentations showing that masturbation causes no harm whatsoever, and being rejected as swiftly. Considerable hard was done by doctors' horror of masturbation and attempts to stop it, and now that we've culturally eased up on that, fat seems to be taking its place as a moral hazard.I might be driven to make the analogy in a presentation.
But then, I've been described before as a confrontational smart-*ss.

(Here via peggynature's blog)

Evelyn Tribole, MS, RD said...

Chartreuse,

This is soooo disturbing, especially when you consider how strong the data are for kids and teens--dieting predicts future weight gain and eating disorders!

Here's a couple of citations:
Field, A. E. et al. Pediatrics 2003;112:900-906

Neumark-Sztainer D. et al.JADA, 2006;106:559-68

Here's a link to my slide presentation, which includes the above studies
http://tinyurl.com/o4r5jh

I truly believe that this "war on obesity" will lead to more eating problems---more eating disorders, especially binge eating.

Take care,
Evelyn Tribole, MS, RD
www.EvelynTribole.com

Anonymous said...

WOW. Just found your blog and as someone who work in a hospital setting I want to say YOU. GO. GIRL! I am so impressed with your courage. Can't wait to read more of your blog.

chartreuse said...

Thanks again for the comments! Evelyn, I'll be sure to check out those references.

deeleigh said...

Hi! I just followed Michelle's link back to see if you had posted since last time I was here. Of course "childhood obesity" is nothing compared to anorexia, healthwise! What a bunch of idiots. How can people who are so smart be so stupid? If there's ever, ever anything I can do to help, please let me know.

-Dee

familyfeedingdynamics said...

wow. That is tough. I totally agree. The "war on obesity" is awful and has lots of collateral damage. I am utterly convinced it is making things worse rather than better. I lecture to MDs about the feeding relationship and weight and how feeding to either push weight DOWN OR UP almost always backfires. I am convinced that the current medical approach to this problem is close to, if not malpractice. Argh.