Comments

All for it!
First comes compulsion to eat too much.
Then it comes... compulsion to drink too much.
then even worse...
You have to be carefull about undue cruelty, because it requires a hard look in the mirror. But people who enjoy (somewhat)their jobs may not even need hobbies - especially the more damaging ones. Maybe except reading and writing...

Posted by gerson barbosa at January 9, 2009 11:41 AM

Tom - rarely do I find myself disagreeing with you strongly, but here goes. Childhood (and adult) obesity is a very serious problem. Schools are neither the cause nor the solution to the problem. PARENTS are responsible for their children. I AM responsible for my children. I don't need a BMI from the school to know if my child is overweight or not. Kids generally eat 5 out of 21 meals in school, none in the summer. Children will follow the lead of the parents. Parents set children's eating habits and exercise levels. Period, end of story. Schools should teach nutrition and unhealthy food should be out of the schools (which means adequately funding school lunch programs so that schools don't have to sell popular snacks and pops to generate revenue to cover their meal programs - another real problem). So, Mr. Speaker, I move to table the amendment. No more pawning off our own responsibilites to schools and teachers. They aren't making our kids fat, we are!

Posted by Bruce at January 9, 2009 11:41 AM

This is a fabulous topic Tom. I know a little about healthcare and although I don’t have the evidence (I’m sure I could find it) I’m pretty confident in saying, in the UK at least, that nurses are the highest profession of smokers. Many senior managers, nurses and other clinical staff in healthcare are overweight. I also believe there is evidence that doctors have more alcohol related problems than many professions. I saw a surgeon interviewed on a health promotion video a few years ago who admitted on camera that he was overweight, drank too much, ate unhealthily and didn’t exercise. He understood why people don’t always take notice. As he put it “I am fairly intelligent, I’ve passed all the right exams and look at me”. I think the man was being very honest and realistic. It’s very easy to look at others lifestyle and be critical. Let he who has not sinned cast the first stone etc.

Having said all that …

Maybe doctors, nurses and other health professionals should not be allowed to lecture the public about healthy lifestyles unless they themselves meet some agreed criteria on lifestyle and weight. That’s not Draconian at all – it’s no brainer common sense.

I am not as knowledgeable about the education system but as a parent I’ve had three children and now two grandsons. I have to say the thought of an obese teacher lecturing my kids about obesity is a bit rich.

As an aside – surely there’s an interesting equivalent in the current financial crisis. Business has more accountants than ever and yet we all end up in the s**t. The same role model behaviour rules apply in that world too doesn’t it?

You indeed must be the change you wish to see in the world. And for me the family is the place where the role model behaviour should start - I am with you Bruce 100% - don't blame teachers - first look in the mirror.

This is where freedom of choice meets risk and we all have to make our minds up where we sit.

Yours affectionately,

Trevor
12 pounds overweight, former smoker, occasional red wine lover, less-than-perfect, role model but now obsessive marathon trainer :-)

Posted by Trevor Gay at January 9, 2009 11:54 AM

Tom, Tom, Tom,

Could not agree more with Bruce1 - schools need to be very good at teaching - which they are not - and parents need to parent. But I want to go a step further - we need to be careful about causality - and how we apply it - I would argue that even today we have little compelling proof on the weight - health relationship lots if inferences being made from very little - or very bad data. I grew up in a time when we talked about body type in somewhat different terms and acknowledged that different shapes were acceptable. I am not making the case for being over weight being a good thing - and yes we should want our children to be active and healthy and strong - but that does not support a single measure - BMI being used as a label.

I will close with an observation from the world of sports. One could make a strong case supporting the view that the second best basketball player of the Jordan era had a BMI of around 34 - well into the obese range - anyone want to guess who I am talking about

Posted by Bruce Humbert at January 9, 2009 12:06 PM

Gentlemen, I completely agree that families are the first-line bearers of responsibility. But if collective family "effectiveness" does not lead to the right societal answer [less childhood obesity], while societal costs of the problem shoot through the roof, then we must, perhaps alas, ask "outside" institutions to step into the breech. I.e. the likes of the Massachusetts initiative. And in turn if we must ask these public institutions to step in, then we hope they'll do it as effectively as possible. Which leads me to this Post. ...

Posted by tom peters at January 9, 2009 12:13 PM

BMI is an imperfect measure. But the stats on the likes of child-onset diabetes and the human eyeball, or at least my human eyeballs, suggest that there is a problem of epic proportion--even if Mike Leavitt overstates.

Posted by tom peters at January 9, 2009 12:19 PM

"Bust fat docs!" I laughed. About 10 years ago I was diagnosed with Type 2 Diabetes. And yes it was because I had become a lard butt. But when I went and checked in with my GP, he says "The first thing you have to do is lose weight." And I looked at him - he was about 50 pounds heavier than I was, his neck was pouring over his shirt collar, and he was panting from his walk in from the next room - and I said "Maybe I should go on the same diet you're on." I found a new doc and lost the weight.

I agree with the comments about the importance of family leadership. But let's face it - more than 50% of children have family situations that provide no guidance. Mt daughter is a teacher and I can't believe the stories she tells me about parents and students. When I read Tom's article about MA sending home a Health Report Card, I had a picture of a mom sending out for an extra large pizza with extra cheese so they could discuss the report over dinner. Schools can help set behaviour patterns. Schools influence attitudes and actions. I don't think it's realistic to expect parents to take the lead in this issue.

Posted by Brian at January 9, 2009 12:23 PM

Tom – I’m with you where ‘family effectiveness’ doesn’t work and the 'institution' however defined has to step in. Then we can expect role model behaviour. Not least, professionals are paid to provide role model behaviour surely …. families on the other hand do it free of charge through love ... and sadly sometimes fail.

Posted by Trevor Gay at January 9, 2009 12:26 PM

"Maybe I should go on the same diet you're on."

Wish I'd been there!

Posted by tom peters at January 9, 2009 12:39 PM

I think Tom should lose weight and become a high school principal in an at risk school.
Then he can try out his managment/leadership ideas in a far from perfect situation and become healthier to boot.

Posted by zed at January 9, 2009 12:44 PM

Please let's not forget that many parents are simply unable to feed their children a healthy diet. All the healthy stuff is expensive and stores that might sell healthy foods for less, like Wal-Mart, are not in walking distance. In a city like Detroit and other urban areas, mass transit is lacking and many people are without cars. (I heard recently on NPR about an initiative of young people here that includes farming within city limits. This was great to hear!)

So, what in poor neighborhoods? Mostly dirty liquor stores where respect for customers is all but non-existent and prices astronomical. These stores sell sodas, lunch meat, processed cheese, junk food--including monster size boxes of candy to be consumed individually, hot dogs, and other fatty food products, but NEVER a single vegetable. By the way, the fatty foods are less expensive. Considering these things, it is clear to see why the obese level in some areas are particularly high.

Some kids only see a healthy image in school or at the doctor's office whenever they go, if ever. Yes, parents are responsible for their kids’ diets, as my mom was for her 12. We rarely ate fried foods, never had a lot of junk food around, and had a salad replete with many vegetables, including three different kids of peppers with dinner nightly. But let's not forget the responsibility of us all to uphold parents and the community around them. This includes the measures spoken of in this post.

Posted by Judith Ellis at January 9, 2009 12:54 PM

Great, and really needs to be pushed further. The food most schools serve is poor. Keep pushing this.

Posted by MarcC at January 9, 2009 1:20 PM

"I think Tom should lose weight and become a high school principal in an at risk school.
Then he can try out his managment/leadership ideas in a far from perfect situation and become healthier to boot."

I have a close friend who has changed the world in tough schools. In that setting, leadership-by-example is as important as on the battlefield. I make this comment because the above comment implies that such ideas as leadership-by-example are pie in the sky.

Leadership by example? Frankly that is the only true tool any of us have, as parents, teachers, or, yes, car salesmen.

Posted by tom peters at January 9, 2009 1:22 PM

OK - what I'm saying is for you to lead by example.
You have great ideas, but can you implement them yourself?
They are pie in the sky unless you yourself can actually use them.
Can you succeed in an environment where no one would care who you are?
I guess I'm just sick of people coming up with stuff schools need to do other then teach the three R's.

Posted by zed at January 9, 2009 2:03 PM

Tom:

Yes, something we should do.

What is stumping me about your post is the HIGH focus on food, and the NON-focus on physical fitness.

To see a reduction in fat, you need to see action on both these fronts.

And, while we pay a lot of attention to changes to the food we consume that has happened over the last 20 years, e.g. corn syrup, trans fats, larger portion sizes, we ALSO need to pay attention to the fact that the PE curriculum was cut during this same time period! In other words, kids are doing less PE now per day than they were 20 years ago.

So, I say yes, do all the stuff you recommend. AND add in more PE. For the kids, the teachers, everyone.

Posted by Dave Hardwick at January 9, 2009 2:06 PM

If we could possibly provide enough funding, and design an effective enough system, to change an archaic institution such as the American education system - we could spend half as much and teach twice as many families to do it right as an alternative. What I'm saying is that as hard as it would be to do anything effective in schools, it would still be easier and more effective to do it in the homes.

I also humbly disagree that this is even remotely as important as terrorism. The only way we could possibly say something like that is because it's been so long since September 11th, 2001. I 'guarantee' (oops, never do that) that if three suicide bombers coordinated an attach today in the three busiest shopping malls in America, we wouldn't give a hoot or holler about childhood obesity. That doesn't mean we'd be correct necessarily but it would provide a different perspective.

As big a problem as obesity obviously is, and I absolutely hate that fact, it cannot compare to the loss of freedom we would suffer if we couldn't go about our lives as we do - even recognizing already how Sept 11th has affected our lives. Can you imagine it 10 or 20 times worse? Remember how we viewed potential acts of terrorism on September 12th? Is there another wave? Is it tomorrow? Is it in my hometown? Will it be chemical, biological, or radiation this time?

I live in Oklahoma City (which I realize give me NO special credentials) and remember EXACTLY where I was when I FELT and HEARD the percussion from the Murrah Building bombing by our America's own homegrown domestic terrorist. God help us if we get so complacent that we forget what kind of threat that will be to our lives if such an event were to become commonplace!

I have to say thanks for all the other entries whether agreeing or disagreeing with Tom's comments and the article posted.

Posted by sgtboz at January 9, 2009 2:21 PM

"nothing is more practical than a good theory" - attributed to Kurt Lewin.
Joke? - no way!
The more a situation is tough, the more new ideas are necessary.
According to the Wikipedia, the maximum efficiency of an internal combustion engine made of steel is 37%, and the avg is 18-20%.
That is, we waste as heat 80% of what our cars use up.
The solution would be to use another idea, like electricity etc.
The reality is very nasty, but ideas are the only way to start a change.

Posted by gerson barbosa at January 9, 2009 2:23 PM

A quick point about BMI: most top class athletes (esp. gridiron and rugby players) are theoretically overweight or even obese. This is because they train to put on body mass, convert it to muscle and use it in their sport, while retaining fitness and health.

I worry that some people will appreciate that BMI is nothing other than an indication. Many, however, will see it as a "rule" and exceptions will be unfairly castigated. One size does not fit all.

BTW: if we're going to use BMI to indicate possible obesity, why not for anorexia as well?

Posted by Mark JF at January 9, 2009 2:31 PM

.
Want to talk about alcohol: declare your usage and any previous problems.
Want to talk about smoking: declare your usage and any previous problems.
Want to talk about pre-marital sex: declare your experience and any previous problems.
Want to talk about any health issue (STD's, appendicitis, self-harming, ulcers): as above.
Want to talk about theft: declare your record, any remember that taking office supplies from work counts.
Want to talk about driving: how many points on your licence and how many bans have you had?
Want to talk about CEO behaviour: declare your CEO experience.
Want to talk about your President / Prime Minister / Chancellor: declare your experience.

This, "You can't talk about obesity if you're fat" line doesn't fly. It's like, "Unless you've experienced it, you can't talk about it" or "You can't tell someone to do something you haven't done yourself." Actually, I can. These old canards deny that I've got any imagination, empathy, similar experience, ability to understand, intellect or general understanding. Poppycock! (And does this mean I can't authorise someone to perform brain surgery on me unless I'm a brain surgeon myself?) Gerrouttahere!!! If you're overweight, you simply have to talk about obesity differently.

BTW, and slightly contradicting the above, anyone thought that people might actually listen better to someone who was overweight?

Posted by Mark JF at January 9, 2009 2:45 PM

HERE HERE, Mark JF.

I figure no one better to tell you to stay off drugs than he or she most addicted.

If he's being judgmental or condescending, that won't fly.

Otherwise, a fat guy telling me to lose weight is most qualified because of his experience. As with so much, it's about context and intent.

Posted by sgtboz at January 9, 2009 2:49 PM

Great discussion. A few points. I don't ageee with Leavitt either. BMI not perfect, but "not bad" either; most kids aren't big time jocks--high BMI is good indicator of blubber. Re fitness, amen--and because of litigation fears, some schools canceling recess. Ye gads. Agree, that we promiscuously throw all problems on the back of schools. Want Draconian, as I understand it in some cases parents going to jail if kid continuously truant. Ye gads, I guess--can you legislate good parenting? Am appalled by "nanny state" like many of you. Re anorexia, at least some countries--I think Spain was frirst are not allowing models to parade in public if BMI below a certain. Is this good or bad. Beats me, I'd vote for "sorta good." Etc. Etc.Etc. Etc.

Posted by tom peters at January 9, 2009 3:11 PM

What worries me - a lot - is smart people who like simple answers. For years as a marketer I believed in Maslow's need hierarchy - only to find out later that it has never been proven/validated and that indeed there are numerous papers out there showing that consumers do not behave at all like Maslow's pyramid would suggest.

Variance is a great thing - it makes us interesting and different. It is what makes markets and opportunities. Suggesting that there is a measure that can define good and bad is a big step - worthy of a lot of work and research. Meeting the eyeball test is what gets us in trouble - a lot at times. And since no one bit - the basketball player is was referring to was Charles Barkley - he played at a high level for a long time weighing well over 250 pounds and standing by all accounts at something short of his "given" height of 6'6" - more like 6'3 or or 6'4".

We know so little about genetic influence on health (and many other things) but are so willing to accept an arbitrary standard like BMI.

I would feel a lot better if someone could give me some data on the correlation between lifetime health costs and BMI.

Finally I am troubled by Ton's observation that since parents won't do this then the schools/teachers should/must - Tom, our schools can't teach, why do you think they could do this well.

Posted by Bruce Humbert at January 9, 2009 3:17 PM

It's not an "either or" scenario. Complex problem requires a complex solution. Parents must take responsibility. And, schools need to educate children...including education on good nutrition. A simple thing like bringing back mandatory PE classes would certainly help. Even though I can remember dying a thousand deaths when it came time to - gasp - undress in front of the other 7th grade girls. At least we were forced to get up and move around.

As for the argument that poor people don't have any choice - I'm somewhat sympathetic, but...I remember growing up a "fat kid" was the exception, not the rule - rich, poor and middle class.

...and don't get me started on luggage size & weight limits and airline passengers...;-)

Yours,
A former "skinny" who is now perpetually losing the same 10 pounds over and over.

Posted by Mary Schmidt at January 9, 2009 3:34 PM

When did you grow up, Mary? In the 40's? I grew up in the mid 70's and there were fat kids in my school and in schools where I competed, totally unassociated with body mass attained from athletics. These were singing competitions. Maybe this was the time when we started super sizing fast foods, as if the portion already was not bad enough.

There seemed to be fatter kids in certain areas, just as there were typically more health problems associated with foods in these same areas. The point made about poor kids is that there are few choices at home. If the schools do not offer healthy meals, they may not get them. In fact, if schools did not offer meals to some kids, they may not even eat. This is undeniable.

Posted by Judith Ellis at January 9, 2009 4:11 PM

Leave the fat kids alone! Get off their case! Preventative health care is to be encouraged - more activity, good food at canteens (Jamie Oliver has tried to actually change that in some schools in UK and found it a daunting task). This idea of role models for kids is bunk! Pure bunk! Jamie Oliver discovered that to be FACT when he just tried to change one tribal habit - yeah he only tried to change what the kids ate for lunch. To bring about this type of social change then TP has to do more than simply write posts or make dramatic speeches about the topic. This type of social change requires actions on many fronts (for sure and certain govts can not simply use its legislative powers to manufacture the right outcomes with this type of social re-engineering). The type of 'social re-engineering' that TP seems to be calling for here depends upon changing mindsets, ways of thinking, current habitual behaviours, and ways of being in the world. If any of you commenting here are prepared to do that then you may eventually succeed but be prepared for a long hard trek - Gandhi was prepared to act and he stayed the distance. So unless you are Gandhi like please just leave the fat kids alone! These fat kids are probably already victims within their hood because of the way they look and because they surely suffer from low self-esteem. They are probably already being bullied at school. They do not need to be further humiliated by their govt nor their school teachers.

Posted by Richard Lipscombe at January 9, 2009 4:42 PM

Should there not be any standard, no measurement? Yes, while there will be those of us who are overweight and healthy and those of us who are underweight and healthy, should there no basic standard of what best constitutes a healthy body mass?

It also seems that there has always been a range included when talking about weight and this range included height. But to say that professionals should just simply speak of things differently about a subject because they are themselves lacking in disciples is unacceptable. This line is hogwash, pun intended:

"If you're overweight, you simply have to talk about obesity differently."

If you're overweight and you're a trainer, dietician, or cardiologist, LOSE WEIGHT! You are no example, especially for kids. If you are overweight, I do not want you as my trainer or dietician, no matter how enlightened you are or how well you speak on the issues. If you are not well informed on the issues of physical training and dietary, I do not wish to have you either. But it is indeed very possible to have both of these in a single professional.

As far as perceptions go, I will say this: Cultures most certainly vary on this, especially as to what is more aesthetically pleasing, but mostly with regards to women. A thick woman (never fat :-)) can be sexy. But a fat man is never thick. A fat man is just fat and rarely considered attractive. Health, of course, is another matter.

Posted by Judith Ellis at January 9, 2009 5:17 PM

Judith says: "A fat man is just fat and rarely considered attractive"

Todd Rundgren says: "Love between the ugly is the most beautiful love of all." (See "Does Anybody Love You" on any Todd 'best of' album.)

I'm with Todd.

Posted by Mark JF at January 9, 2009 6:02 PM

Judith,

I am frankly shocked and going to assume you are kidding. What is "overweight" - who decides? - who sets the standard? and why is there a standard?

If you had made these same comments about skin color I suspect you would have been banned from the site...

I repeat - show me some data linking BMI and health - or health costs - and be very sure you can show the causality - one of the hardest things for researchers to prove...

I have lived through the butter is bad, olive oil is bad, caffiene is bad - wine is bad scares.

Finally - and then I promise to shut up. I do know that there is a correlation between height and life expectancy - it has been show that tall people on average do not live as long as short - shouldn't we be worried about our kid and grandchildren getting to be too tall?

Have a great weekend.

Posted by Bruce Humbert at January 9, 2009 6:08 PM

As it turns out, people with more surface area
(be they too fat or too tall) have shorter life expectancy than people with less surface area.
This is because they are more likely to be knocked into traffic on a windy day.

Posted by zed at January 9, 2009 6:28 PM

Bruce - The issue with regards to standards focuses on health. If I am 5" 1' female who weighs 300 pounds I would undoubtedly not be in the best physical health and probably will be in need of knee replacements sooner than one who weight say 110 pounds. I would undoubtedly need to lose weight to improve my health and pressure on my bones and organs. Would you agree? If I'm a 7" 1' male who weighs 200 pounds I might be on the slight side and I may be healthy or. But what is for sure is that there will be less stress on my knees and organs from being overweight. Would you agree?

Why is it that we do not wish to set guidelines as to what is acceptable or not? It is ridiculous to have debates that say it’s okay to be obese. IT’S NOT OKAY TO BE GROSSLY OVERWEIGHT! IT'S SIMPLY NOT OKAY! Weight cannot be compared to height. One is given; the other is consumption. While we cannot change our height we can most certainly monitor what we consume.

Believe me; I understand the issues associated with food and emotions. I am the heaviest I have been after losing two brothers and a mom consecutively over the last three years. Prior to my loved ones deaths, I ran 6 miles six days a week and was rather meticulous about my diet. I have been less so over these three years and have picked up weight. Over the past 2 months I have resumed by workout regiment and have begun eating healthier. The weight is dropping.

Regarding skin color, I guess it is equivalent to height; it is not a choice, except for those who bake in the sun or in the tanning booth. I am, however, interested in what you might think with regards to skin color. There was a time where there was a distinction of color with regards to house and field niggers, both were nonetheless niggers. But this too was a choice of the slave masters who themselves created the distinction by raping women and girls they enslaved. No choice there.

Posted by Judith Ellis at January 9, 2009 6:46 PM

The statement that Mark focuses on was meant to be facetious, as love is in the heart of the lover. A woman who is thick is fat but considered alluring so, but a man in the culture in which I spoke is just fat and not pleasing. Who says that life is fair?

I am now reminded of the Victorian period where the more rolls women had the more pleasing and alluring they were. I guess issues of health did not matter as much as life expectancy was so short. "Eat, drink, for tomorrow we die."

Posted by Judith Ellis at January 9, 2009 7:07 PM

Judith,

I think you assume too much. I will say it again - we have NO DATA to tell us what the most healthy BMI is - and we used to be more willing at accept the fact that there were different body types and that they had differing height-weight ratios - that has all been lost and we have apparently decided to let BMI be our standard.

All I am trying to say is that this is complicated and poorly understood - deciding that one number is "good" and that all other numbers are "bad is scary too me. Yes I am "overweight" - and would love for the "excess" pounds to magically disappear - but my younger brother - who was at a "normal" BMI had a heart attack two years ago - did not drink and had a relatively low stress job compared to what I do. He has cost his health care provider several hundred thousand dollars more in his life than I have.

Again I am not saying I have any answers - my problem is with people who think they do - when they lack any data to support their theory.

Reread your original post - it is judgemental - as is your second - NOBODY has shown the overweight are inferior to the non-overweight in the kind of way you imply.

Finally do some research on height - you will be surprised to find out how much control we actually do have over this variable - for example - children with employed fathers are on average taller than children with unemployed fathers at age 12.

Posted by Bruce Humbert at January 9, 2009 7:17 PM

So if you are a kid and are satisfied with your current height (you don't want to grow any taller), you should try and get your father fired?

Posted by zed at January 9, 2009 7:25 PM

or if you are a kid and get cut from you basketball team because you are too short you have one more thing to be pissed off over at your worthless slug of a dad :-)

Posted by Bruce Humbert at January 9, 2009 7:30 PM

Here in Palm Springs in the winter "PS I Love You" we are forever lean & youthful & beautiful so it is hard for me to keep up with this rant. :>)

Seriously though I am "naturally" lean @ 5% bodyfat year round - not 7 or 9 or 11% but 5 per hydrostatic testing & the "Tanita body fat scale" (link @ my name below). Not said to impress but to impress upon you that like me one should be too lazy to be fat with all its excess baggage!

Am such because I've read every nutrition & exercise book invented since spam - educate the little porker kids who educate porker parents!

Forget the BMI & put those little porkers on the Tanita & under the kleig lights each morning to shock & awe them back to reality! Oink oink!

Don't get me started on the Democrats & unions' robbery of tax payers to create mini school prisons in Detroit, Baltimore, Albuquerque, D.C. & elsewhere!

Here it is a big deal that $4,000 per year is charged for a fabulous Catholic school eduction; whereas Detroit is $9,000 per year per student for a mini Alcatraz! DC $10k! Go Ms. Rhee - fire those nefarious brothers & sisters!

Posted by Contraire at January 9, 2009 7:44 PM

Bruce - You're a funny man. What about the knee replacement analogy or the fact that a grossly overweight person would be hard pressed to take a walk in the park? You don't need science for this; it's obvious. I've witnessed the struggle.

There is nothing wrong with judgement in and of itself! I am unmoved this label. There is also nothing wrong with stating the obvious, especially in the light of there is nothing wrong with being grossly obese.

Being really fat is no fun! Not because it is ugly as Mark suggested, but because it causes unnessary health issues such as shortness of breath and inhibits quality of life--unless taking a walk is not desirable or physical execrise necessary.

My mother was not overweight but she had diabetes and simply would not eat properly. She insisted on her sodas and desserts. She could have lived a healthier longer life had she consumed less of these things. But this was her choice.

Do you know anyone who is grossly overweight? Ask them about their health and inability to do simple stuff. But to listen to you, such a person would not like to take a walk in the park without stopping every few minutes to catch his breath.

I have not asked you to go back and read your statement with regards to skin color or mine with regards to niggers. I assume you want to move off of this comparison. OK. We can do that.

Posted by Judith Ellis at January 9, 2009 7:51 PM

Many competitive employers will NOT hire smokers now because of healthcare costs - and it is the same regarding obese people - too much risk in employing them long term.

Ever notice how quite lean all the Costco associates are versus Wal$Mart people? The Costco types move around a lot in those giant warehouses!

PS - the 'n' word here must be denied - someone went too far & this from someone who has a black PhD law professor brother-in-law & we are always talking race. The 'n' word doesn't fit this thread nor the rape mention - shall we report all the brothers that rape & fill our prisons to a disproportionate measure & link it to obese kids?

Get lean - become serene & wealthy & happy!

Posted by Contraire at January 9, 2009 8:08 PM

Nigger is a word like any other word. How any word is used is what makes the difference. Context matters. Typically, I am opposed to saying the "n" word as a hollow euphemism that perhaps does not address the essence of its deragotory use, thereby somehow sanitizing it. Pray tell, what does the "n" stand for?

Posted by Judith Ellis at January 9, 2009 8:37 PM

I think many of you are missing the point. A 2007 U.S. Surgeon General’s report indicated that the new generation of kids will not live as long as their parents. In other words, we (society) are shortening the lives of our kids.

The problem is not open to debate—type 2 diabetes is affecting younger and younger kids…cholesterol lowering drugs are being prescribed to younger and younger kids on a regular basis…and on and on. The results of sedentary living and obesity of the young is now considered an epidemic by most medical researchers.

The problem has been identified, and it is real…it needs no further debate about its existence. What does need debating is how to correct the problem…this needs to be debated until solutions are in place—universally.

To this end I would throw in another contributing factor I think merits some consideration—the social responsibility of those who make the very devices that keep our kids chained to their computer monitors, X-boxes, Wiis, etc., etc. Like Tom, I have been a champion of innovation my entire life. I have seen and been involved in some marvelous innovations…and yet, I wonder…what hath man wrought?

Technology, highly successful marketing (especially to kids), and peer pressure, all have more influence on many of today’s families than parents can overcome. If you don’t agree, you can find a link to a good example of this on my latest post.

So, the problem has been identified—we are shortening the life expectancy of our kids—now, how can we correct this problem?

Posted by Bob Foster at January 10, 2009 1:16 AM

So I take it we are all comfortable living in a world were a young Charles Barkley won't be eligible for a basketball scholarship to Auburn because he is obese [Charles is reported to have played at well over 300 pounds and was known affectionately as the "round mound of rebound"].

Auburn can't/won't give him a scholarship because it would increase their insurance costs [or it would be a PR disaster to give him one because it is seen as "endorsing" child obesity].

If one takes Tom and Judith's proposition to be sound then the idea of linking college scholarships - athletic or other to a BMI standard is not far fetched.

Of course we have to set the BMI standard - Judith tells us it is "obvious" and the eye can easily tell us - and certainly in the case of her hypothetical 300 pound, 5'1" female - BMI=56.7. The current standard of BMI = 25 would suggest our subject needs to get her weight down to 132 to enter the top end of the normal range - and that would seem to be reasonable.

But by Judith's logic it would seem to me that their is a significant difference in stress on bones and organs for our subject at 132 pounds vs what there would be at 110 [BMI=22] so we will still need to find a way to incentivize our subject to get to 110 pounds so we will refuse to give her a job - or charge her an insurance surcharge - after all it is for her own good.

But why stop there - just think of how much better the world will be if we make a BMI of 18 our standard - our subject now weighs in at 95 pounds - and surely that is better for her than even 110 - much less stress on her bones and organs and now she will consume 10-15% few calories a year to sustain her weight - since calories convert directly to food consumption - her food budget will be lower - and the energy required to produce the food she eats also falls.

Another benefit of our new BMI standard of 18 is that we now find we can add an extra seat to a row of seats on airplanes - we can now seat 7 passengers in a row instead of our normal 6 - and boy are they more comfortable - because we have decided that we will price plane tickets based on BMI - and because we KNOW that lower BMI is better we are not bound to make the penalties for high BMI linear - we have a 100% surcharge for a BMI of 25 and a 1000% surcharge for a BMI of over 40 [essentially charging a single obese passenger for a full row of seats].

The logic of all of this is so obvious and compelling one wonders why we have not seen it sooner. The new world we envision with a BMI standard of 18 is much more sustainable - global warming is no longer a concern and our energy reserves/supplies have been extended by 50-100 years. Heck even streets seem less crowded and of course the cost of health care has dropped dramatically - perhaps half of what it is today.

But wait - in this new - more perfect world we have created there now emerges a group that says that if BMI = 18 is good - then BMI = 15 is obviously better [same basic logic that Judith endorses] and that we should launch a new program aimed at getting our children to this new - better weight - and we will begin with the schools and reporting BMIs on report cards - and demanding that our teachers be role models of this new wonderous standard - if they can't get to a BMI of 15 within 3 years they will be terminated.

And on it goes....

Posted by Bruce Humbert at January 10, 2009 7:27 AM

In the beginning of every year, I do an extended fast for spiritual and health reasons. For a month, I usually go without food for seven days every other week, drinking only liquids two weeks out of the month. Or, I eat one meal a day after 6:00 PM every day for a month. I have chosen the latter this year. (I also do a cleanse one day a week throughout the year, sustaining from food for the day.)

I have been on the fast now for 10 days and I cannot tell you the incredible feeling and energy I have, not to mention the satisfaction of the discipline required. My spirit is ebullient, my body feels great, and my mind is clear. My organs too seem to thank me. Whether these things are simply in my mind, can be argued. But what I can say is that my body is healthy and my spirit very much alive. For these, I am most grateful. But there is also something here that I must do. There are choices that I must make. I'm sure there are exceptions, but I do wonder about the consistent choices of excessively overweight people.

Science cannot prove or disprove many things, but we most certainly know when our body is not at its optimum. We most certainly know when we feel stuffed. We also know when our energy wanes or is sapped because of excessive body mass; a simple walk up a flight of stairs reveals this. Often time we ignore our bodies, as I have done. We also know when we should do thing differently, like eat less, as I have also done. But let's not fool ourselves into thinking that excessive fat is fun or healthy.

Science is not our only indicator; we are.

Posted by Judith Ellis at January 10, 2009 7:32 AM

Oh, and one more thing.

I forgot to mention that we have developed a genetic screener that we KNOW can predict adult BMI with 99.99% certainty, A simple test of the fetuses blood at around the 4th month will give us this information.

What should we do with this information?

Posted by Bruce Humbert at January 10, 2009 7:34 AM

Bruce - Your calculations are simply silly. It is not the letter of the law here; it is the spirit therein. Balance and moderation rule.

Posted by Judith Ellis at January 10, 2009 7:37 AM

1) I am utterly fascinated by this discussion. That is, that a discussion of obesity could generate such heat. (Call me naive, I guess.) (I do not pretend to be an expert, merely a civilian, but the notion that there is no correlation-causation between very excesive weight and health costs and lost productivity boggles the mind. I think it's looney, frankly--but look forward to discussing it with my M.D. and policy wonk friends.)

2) I do not like/am repelled by the "n-word" used in any context. I sometimes fear that as a white born in the South that the guilt I carry with me every day to this day leads me to be too politically correct on this issue. Erik and I think we will not remove the n-word posts here but offer fair warning that we will do so in the future regardless of context. I am simply offended by the term. I welcome your opinions on this issue and our proposed but not final resolution.

Posted by tom peters at January 10, 2009 8:36 AM

Tom,

Before you lay so much responsibility on us teachers, perhaps you should consider ways to increase our salaries. Do you really want the future of America being shaped by someone who makes about $30,000 a year? Perhaps the reason teachers are over weight is that they too are poor and can not afford to buy healthy food. Contrary to popular belief teachers do not make too much money, most of us make in the $30,000 to $40,000 range depending on location and that puts us just above the poverty level. Also teachers don't work just 9 months a year, the other 3 months we are busy getting ready for those students. And the 9 months we have students we are usually stressed out by the students, parents and people who think they know something about education and want to tell us how to do our jobs without ever having been in the classroom in our positions, that we build up lots of cortisol, which causes us to gain weight. Perhaps that's why most teachers leave the profession within the first 5 years.

Posted by Ed at January 10, 2009 8:44 AM

So Judith - which is it - "excessive weight" - or "very excessive weight" that we should be concerned with [and what defines the difference between the two]

My calculations may be "silly" but standards require objective [not subjective] measures what do you propose we use.

Personally, I am rebelled by the "f" word - thin people making judgements about the overweight and calling them "fat" is cruel and hurtful and should be stopped.

Posted by Bruce Humbert at January 10, 2009 9:13 AM

Tom - good decision - I agree with you and Erik 100%

Posted by Trevor Gay at January 10, 2009 9:39 AM

Tom - I vote no on the 'n' word use at all - it is racist coming from blacks, anyone - almost all the black community agrees with that - even hip hop & other music people stated such the last go round - plus no cop killing lyrics. That from my 2 time Fulbright scholar French surname black brother in law.

PS - appreciate the healthcare aspect of this - thanks. I use your healthcare material & WHO measures when I visit with my M.D. - "how sir are you not 34th & 42nd in quality & longevity" - makes for some lively visits. He mentions the obesity epidemic as part of it while I mention sanitation & medical record errors, etc, etc.

Posted by Contraire at January 10, 2009 10:34 AM

TP and Erik - I will, needless to say, abide by any rule that you set here. You can be assured of this. But as I have stated above the use of the word which you object to do not make the word less significant, nor does not using it alone rectify the historical content. I am less concerned about the word itself and more concerned about attitudes and policies that fostered such then and now. Being a white male or female from the North or South engulfed in guilt is useless and non-productive. What matters most is how we treat each other and how we work through such matters individually and collectively, historically and presently.

Regarding my use of the word here, it was very much intentional—obviously. I wanted to make a very strong point of the reason for variances in "skin color" not being one of choice with regards to black people in America, historically speaking. There was not a choice to birth a mulatto child; but there is more often than not a choice about what and how much we consume which often result in excessive weight gain. Historically, black women and girls had no control over their own bodies, let alone the "skin color" of the child they birthed. (In fact, do any of us, having been born, have such control?) The comparison of "skin color" with obesity made no sense to me.

Thank you, TP and Erik, for the forum. It's a great one. As stated, I will not deviate from your rules regarding the term of which we speak. I also want to make another point very clear. I very much appreciate the decision of not having such a word that is offensive to a great many people, both black and white, bantered about, as it may give rise to a great many offenses and it may be quite difficult to determine its use and context. But I trust our ability here to reject bigotry and hate and personally believe that EVERYTHING is a matter of context and the spirit of the message. That said, I hear you clearly and appreciate you both.

Posted by Judith Ellis at January 10, 2009 10:45 AM

I was once very overweight. Okay, twice. (Or so.) Well, I just told a lie. I was not "overweight"--I was FAT. Period. And it sucked. Only dealing with the "F-word" led to changed behavior.

Posted by tom peters at January 10, 2009 11:45 AM

Judith, I won't belabor this. Fact is I heard the damn word toooooo many times, doubtless thousands of times, as a kid. From doctors and lawyers and judges and shop owners and, yes, teachers ... and my fellow 7-year-olds. I just don't want to hear it or read it anymore. And I'm well aware that my doing so hardly reduces prejudice.

I think it was Bob Herbert who wrote a while ago how much he dislikes the word "authenticity." We all carry around prejudices or at least residual prejudices of all sort, I think he said--it's just that we've learned to be a hell of a lot more civil than we used to be. I agree with him. Drunks, in my experience, are often at the top of the "authenticity" scale; they let us know their true innermost thoughts--many of which are appalling; better a little more self-control and a little less authenticity in my view.

Incidentaly, where I grew up, outside of Annapolis MD, we pretty much put our Jewish bretheran, and even Catholics, into something like the "n" category; when I was assigned a Jewish freshman roomate at Cornell, in the fall of 1960, my parents sent me off to our Presbyteriam preacher for counselling. Of course JFK was on the campaign trail fighting the "he'll work for the Pope" prejudice at the same time.

Posted by tom peters at January 10, 2009 12:08 PM

Tom Peters, sir, I honor you. Thank you.

Posted by Judith Ellis at January 10, 2009 12:59 PM

Tom,

I would hope what I have said is not seen as an endorsement of being overweight - it does suck - and I have no problem with "nudging" people towards being thinner - lighter. My issue is with mandates and penalties - punishing - and government/teacher involvement in the process.

That being said, I still contend that we need to learn a lot more about the relationship between weight and health costs and health. I am a skeptic about medical "science" in general, much of what you say in your health rants I believe is true.

But I will also confess to being a bit perplexed by why you - and our President elect - and many others conclude that we know how to PREVENT health problems when we all know that we are not very good at CURING health problems once they arise.

I may be too much of cynic, but I am convinced that when the data is all in we will find out that we are over medicated - over treated - over diagnosed and that the net good done by our doctor friends is close to zero.

Posted by Bruce Humbert at January 10, 2009 1:17 PM

I never speak the word and rarely use it unless I'm writing and trying to make a specific point. I understand its import. Not being a fan of the word, I do not like to hear it in lyrics sung repeatedly or spoken readily by young African Americans as a term of endearment. There is nothing endearing about the term. But when I hear the word or see it written I tend to judge how it is used and respond accordingly.

Yesterday on my walk I came across four young men with book bags near the high school having a good time. (I typically stop and talk with young people just about stuff in general; most times I have never seen them before.) One of the young men wore a jacket that read "State Property." It was a bit disturbing, so I asked him about it.

The conversation went like this:

"Hey. How was school today?"
"OK." (They never seem to say more than that initially.)
"That's a nice jacket.
"Thanks."
"But what does it mean?"
"What...State Property?"
"Yes."
"It's a record label. Oh...you thought...."
"Yes, I thought you were wearing a jacket that glorified prison-life?"
"No ma'am. I'm going to college."
"Oh, that's great! And you?"
"Me too."
"Me too."
"Me too."
"Great! You can do anything. Have a good day."
"Ok. You too. Thank you."
"No, thank you. You have made my day."
"Really?"
"Yes, really."
"That's dope."

I left. I didn’t even ask him about the meaning of "dope." I assumed it meant cool. But it did leave a lingering thought about word usage for young people. As I continued my walk I could not help but to wonder about the record label. Why chose such a name that obviously has such a negative connotation?

By the way, these young people were all fit, handsome, and well-spoken.

Posted by Judith Ellis at January 10, 2009 2:13 PM

To put a positive note in this fascinating debate - my son probably has way more nutrition knowledge aged 8 (quite a lot from school as well as home)than I ever had at his age. His attitude on environmental issues also is a reason for optimism

Posted by PaulH at January 10, 2009 3:39 PM

To me this post and its consequential comments is interesting because it is about freedom not fat kids or offensive words per se. Perhaps the biggest challenge facing America and its citizens in 2009 and beyond will be to remain a free and open society. The biggest threat to that is the continued acceptance of 'political correctness' within American society and its rigorous application to Americans lives. If politically correct notions of who is fat and who is not or who is allowed to utter certain words and who is not are to end up becoming LAW or even part of the simple by-laws of commenting at tompeters! then in my humble opinion America and Americans will lose much more than they gain.

Posted by Richard Lipscombe at January 10, 2009 3:47 PM

Ah, thank you for that, PaulH, and bravi to you and your wife; you have done well--indeed!

I agree with Richard's basic premise re: freedom, while fully understanding the need for both checks and balances.

America is now in a balance phase, one of finding stability, on a great many issues after being severly checked.

Posted by Judith Ellis at January 10, 2009 4:16 PM

"I am utterly fascinated by this discussion. That is, that a discussion of obesity could generate such heat."

I'm not surprised at all Tom. This subject is something we can all relate to. The subject is not complex - it’s simple. OK I may reluctantly accept the SOLUTIONS may be complex ...... although I don’t think they are actually.

This subject makes an emotional connection with people. Why should anybody be surprised at emotional reactions to something so close to our hearts – literally :-)

A brilliant discussion – thanks everyone – more learning

Posted by Trevor Gay at January 10, 2009 4:37 PM

Bob - I missed your comment again. But believe me if I missed your relevant point in my comments before, I most certainly receive your very astute comment now. Thank you very much.

By the way, I did check out your blog, which I often do anyway; the video is quite alarming. I did not find it adorable or amusing. Kids will have compulsions about a great many things, including food, if they are not taught well and monitored.

Posted by Judith Ellis at January 10, 2009 4:47 PM

Thanks Richard - you express the core of my concern far better than I do/did

Judith - the problem begins when we say things like "i believe in freedom, but...."

The devil is in the but...

Posted by Bruce Humbert at January 10, 2009 5:02 PM

Richard, surely agree with you on the law part. And I've had some horrible experiences with my kids--virtually lifetime stigma/"record" for calling some "outcast" a "moron"--something we did 10 times a day when I was a kid; we ended up getting the VT ACLU involved and they scared the crap out of the local school board.

On the other hand, there is an other hand in my view.

Women were treated like dirt when I was a kid, or, rather, demeaned, etc, etc. I'm very glad 98% of that has evaporated in the name, mainly, of PC, including the meeting opener which was invariably as smutty a joke as one could emit; or the Playboy centerfold I'd use in Pentagon briefings as a showstopper in the middle of a presentation, as well as the demise of the "n-word."

Well, I was royally pissed off 15 years ago when people would get after me for using the "f-word" a dozen times in a presentation; "I'm an old Navy guy," I'd say. "That's the way I talk." In particular, folks from the South who were "religious" would jump on me in feedback. I'm delighted to say that I yielded to pressure, and cut out 99% of such stuff; and am appalled that I ever did it. (I haven't used the f-word in a speech in at least 10 years, and would probably barf on the spot if I accidentally did.)

Legislate it? God forbid, literally. In about 1990 I gave the biggest donation in history to the ACLU explicitly and exclusively for First Ammendent defense. (Not biggest in history in general, but biggest ever specifically for the First Ammendment.) Hence, my credentials are impeccable when it comes to protecting speech.

A little bit of political correctness goes a long way; law-driven PC speech guarantees et al is frightful!!!

(I can of course smell the ACLU remarks about to come. All I can say is that I desparately loooooove the Bill of Rights; and I loooove in particular the First Ammendment; I long ago decided that free speech was the cornerstone of our democracy, or in fact any democracy.)

Posted by tom peters at January 10, 2009 5:07 PM

Bruce - I think I have heard your declaration on the freedom of fat. Do you perhaps have yet another amendment?

Posted by Judith Ellis at January 10, 2009 5:25 PM

Re political correctness - using a 'Judith' expression I would say ‘words matter.’

I occasionally see re-runs of 1970’s TV sit coms. here in the UK such as “Love Thy Neighbour” or Till Death Us Do Part” etc. In 2009 I hang my head in embarrassment and shame. I am actually horrified we allowed such filthy, disgusting and frankly racist language on our TV screens ... and in the name of comedy for God sake! Duh!

I am not a prude and I am not necessarily the greatest fan of political correctness. However, I say political correctness has had a valuable and very positive influence over the last 30 years - certainly in the UK.

Sometimes what we see as ‘acceptable language’ is just plain not acceptable.

Posted by Trevor Gay at January 10, 2009 5:36 PM

I love the liberal thoughts that "20 lbs." needs to be lost or "losing the same 10 lbs. over & over" - hilarious. It is really 35 & 20 since most obese are in denial.

Then there is the matter of muscle loss as part of that weight which makes it almost impossible to keep the fat off next time! Once all those fat cells are created the science of it is that they crave to be replenished after shrinking down for awhile! Oink oink you porkers - celebrate with a 12 pack of glazed donuts! Thanks for the added healthcare burden! 5% & serenely yours, :>)

Posted by Contraire at January 10, 2009 5:55 PM

Trevor - I feel the exact opposite; although I have never seen the shows to which you refer, I get the gist. When I look at reruns of shows like Good Times, What's Happening, The Jeffersons, and Sanford and Son, I am not offended in the very least. But we could not watch any of these shows growing up; we could only watch The Waltons, The Brady Bunch, and Little House on the Prairie - one hour max and that was strictly monitored.

There were such families in our church as those above. But there were also those families like the Huxtables on The Cosby Show. With such a massive church, it was a community of all kinds. The problem is when we pigeonhole any people and say that they are all like this or that. Such is never the case.

By the way, All in the Family is one of my all-time favorite TV shows, if not my very favorite. It most certainly was not PC, but, oh, so masterfully written, produced, and acted. This was also a show I came to love much later in life.

Posted by Judith Ellis at January 10, 2009 6:18 PM

Oh...would Rerun on What's Happening be considered slightly overweight? Or, are we not suppose to have such judgments?

Posted by Judith Ellis at January 10, 2009 6:32 PM

Hi Judith – I’m not of course familiar with the US TV Shows but I very much hear what you say.

My ‘cringing’ is of course here and now in 2009 …. I guess when I was a teenager and watching these TV shows at the time I laughed along with the crowd. I think PC has helped to get rid of this sort of bigotry though and happily we see nothing like this nowadays – that is progress as far as I am concerned. I am very proud of multi-cultural Britain in 2009 and respect for all is essential.

Thanks for the feedback. As the time approaches midnight here in Britain I guess to carry on the thread of our discussion I should bid farewell today with those immortal words ‘Good night John Boy’ :- )

Best Judith

Posted by Trevor Gay at January 10, 2009 6:36 PM

Goodnight Trevor. I see you know some things about American TV. :-)

Posted by Judith Ellis at January 10, 2009 6:50 PM

Judith - there you go again - using the "f" word....

Yes I am obsessed by the idea of freedom - I believe that more freedom is ALWAYS better than less. Tom is to be commended for his willingness to put skin in the game with his ACLU donation - I disagree with them often (always?) - but they ask questions that need to be asked and answered.

I am also sensitive to the idea that with freedom comes responsibility. Throughout this discussion all I have asked for is some data to show me causation [which is different - very different from correlation].

So Judith here is my promise to you - show me the data that persons of my BMI [35] cost more and how much as a percent of the average and I will sign up tomorrow for paying that penalty/ surcharge in my medicare premium - if the data exists to support this it is only fair that I do so....

Deal?

Posted by Bruce Humbert at January 10, 2009 6:55 PM

I think of just one word..."Exercise". I remember in grade school having to work my butt off doing exercises that increased strength and heart rate. No one could be exempt, even my heavier friends had to participate, no excuses. Is exercise, not just gym time, a part of any schools curriculum.

Yes parents have responsibilities, but instead of just telling me about the problem begin to implement just one of the many possible solutions. Diet and exercise.

Posted by Bruce-Wisconsin at January 10, 2009 7:04 PM

Bruce - You're becoming a bit of a bore. But I must admit to smiling at the presidential debate tactic, "there you go again."

Bruce-Wisconsin - I'm with you: "Diet and Exercise"

Posted by Judith Ellis at January 10, 2009 7:46 PM

Judith,

You win - my calculations are "silly" and I am now a "bore" - I wilt under the power of your logic and facts.

I leave you with this - it is not mine - so google to find the source if that is important...

"For every problem there is a simple and obvious and wrong solution"

Cheers!
bruce

Posted by Bruce Humbert at January 10, 2009 8:03 PM

If at first, second, third, fourth, fifth, sixth, seventh, eight... time you don't succeed in convincing another...

STOP TRYING. YOU WILL PROBABLY NOT SUCCEED. CONCENTRATE INSTEAD ON YOU.

Bruce, your efforts may have been laudable but utterly useless to me beginning more than a few comments back. (I say this as they were addressed to me.) But I am glad that you have now stopped trying. This will do you good.

Why do men so often think primarily in terms of winning and losing in these discussions? This would not be the first time that a man has said such a thing here: "you win." Why must there always be a competition?

Another thing that some men have tended to make reference to in such discussions is "logic." I have studied logic and ontology on the PhD level and I, for one, do not rest my laurels on either branches of philosophy.

Posted by Judith Ellis at January 10, 2009 11:10 PM

The Japanese have already figured out how to deal with the problem we are discussing...

http://www.csmonitor.com/2009/0107/p09s01-coop.html

I just can't wait for this to catch on in the US.

BTW Judith - just because I addressed my comments to you should not be taken as me having any hope of changing your mind - I recognize a "true believer" when I hear/read one. The Kuhnian in me just has to keep trying to solve problems :-)

Posted by Bruce Humbert at January 11, 2009 8:00 AM

Now this is REALLY FUNNY: "BTW Judith." Am I as omnipresent as the wind? Perhaps as consuming as fire? :-)

You have given a link here, Bruce, and I shall read it.

Posted by Judith Ellis at January 11, 2009 8:06 AM

Tim Tebow, Heisman Trophy recipient and MVP of BCS Championship in US college football three nights ago. Bench presses 225 pounds 25 times and has a maximum press of over 400 pounds. Undeniably a healthy physical specimen based on his on-field exploits. Weighs 238 pounds at 6'2". BMI 30.6. Classification: Obese

Thought this might "lighten" up the thread.

Posted by David Porter at January 11, 2009 10:46 AM

Luckily Bruce there are enough checks and balances in your US democracy as there are here in the UK democracy to ensure we do not end up with ‘silliness’ such as the obesity police.

I take issue with the reporter about universal health care and the myth you folks seem to have in the US that universal health care equals ‘bad.’ Far from it I would say. Our UK National Health Service (NHS) outscores the US system on all indicators for UNIVERSAL health care.

This hot chestnut crops up in this forum regularly and many know I am a staunch defender of universal health care systems such as ours in the UK. I readily concede there is some superb healthcare in your system in the US that beats our healthcare system …. BUT if we compare apples with apples and not apples with pears then there is no doubt the US healthcare system falls way behind our UNIVERSAL system.

Journalists such as the one in that link should really do their research before making derogatory, incorrect and sweeping generalisations about universal health care and also this silly idea of ‘nanny’ state – it’s just not true.

Here in the UK we have a universal system but we also have the opportunity to make a choice to have private healthcare as well. Only about 12% of our population take up the private option which must say something about our universal system.

best online viagra

I don’t want to create a whole new discussion on this matter as it was not the original subject of Tom’s post but please, please, please do not assume universal health care equals poor service nor does it mean nanny state.

Happy Sunday folks – I will now put on my crash helmet waiting for the bricks!

Posted by Trevor Gay at January 11, 2009 10:54 AM

C'mon, get real. The AVERAGE person with a BMI of 30.6 is not MVP of the BCS game!! The average 30.6 is probably on the hefty side and a lot of it ON AVERAGE is flab.

Posted by tom peters at January 11, 2009 10:54 AM

My bad. Thought this site was focused on excellence.

Posted by David Porter at January 11, 2009 10:59 AM

More thoughtfully. I live in one of the "fattest" cities in the US - San Antonio. I don't need to know when I am home from traveling because I simply look around the airport lounge when I arrive and see obesity everywhere. BMI is one measure, one tool for developing understanding. In my experience, the point is never knowing but doing. The degradation of the nuclear family, the requirement for two-incomes to survive, may all lead to kids seeking their human need for significance, love, connection through other vehicles - namely food. If I see a kid out playing vigorously in his/her yard, I almost look at it as an anomaly. Whatever our beliefs, the increased incidence of heart disease and diabetes in kids under 12 is a crisis. For behavior to change requires knowledge, yes, but ultimately will require a new level of connection to replace the needs kids are getting through food and sedentary behavior in front of the tv and video game console.

Posted by David Porter at January 11, 2009 11:18 AM

Are defensive linemen in the NFL the only generally accepted excessively obese professional athletes?

I am now thinking of the adorable defensive lineman, Refrigerator Perry.

Preferably, I like the "tight end" running backs: fit and fast. :-)

(Are preferences allowed?)

But I guess they all have their positions to play, body mass to pack on or shed.

Posted by Judith Ellis at January 11, 2009 12:02 PM

Just a wee and rather bizarre thought, but in all this debate about obesity, fat and BMI we've only mentioned and not really developed some thoughts on health and well-being.

I'd rather be a happy and contented person, a few pounds overweight, fond of a couple of glasses of whisky every now and again than a flat-tummied, BMI-perfect, organic, gym monkey, miserable sod.

And I'd rather risk dropping the occasional f-word into my speech than to rehearse and sanitise my every single utterance.

Posted by Mark JF at January 11, 2009 1:36 PM

I'd like to impose the 10,000 hour rule here - Tom & many others have spent 10,000 hours+ in perfect porker practice - thereby etching into their nervous system pork perfection & unwittingly preventing (even a glimpse of) lean & serene heavenly perfection - oink oink! :>)

Posted by Contraire at January 11, 2009 2:24 PM

Mark JF - you are as they say spot on - I am with you!

Tom will hate this - but as I am being bored by the Eagles-Giants game waiting for my beloved Steelers to take the field I did a few calculations...

For the 13 Steeler offensive players in the so called skill positions we have an average BMI 28 - with only two players - rookie QB Dennis Dixon and WR Nate Washington getting below the 25 threshold - they each are at 24.

For the 10 offensive linemen we have an average BMI of 38 - led by guard Chris Kemoeatu at morbid 43.

The four tight ends on their roster amazingly enough all came in right around 30 - they averaged 30.45

Kemoeatu is, as you may have guessed, of polynesian ancestry - and this leads us to an interesting question for Tom.

The link below suggests that there might be a need for a different BMI "standard" for polynesians

http://www.silkassociates.com/information.php?info_id=9

So do we have different BMI standards for different races...

I found some other data that suggests that the average polynesian male has a BMI in the 35 range - in contrast to the average for european males of around 25 - but polynesians of the same BMI will have lower body fat - more muscle and bone mass..

GO STEELERS!

Posted by Bruce Humbert at January 11, 2009 2:46 PM

As a less radical alternative could we just bust BAD teachers, whatever size and shape they are, and treasure the good ones, likewise? The latter are hard enough to attract and keep anyway.

Posted by Rob at January 11, 2009 3:28 PM

Very interesting stuff. Do we need different BMI standards for different races? Maybe. That's a great point. I'd like to see that discussion moved forward.

Posted by Aleksandar M. Velkoski at January 11, 2009 4:00 PM

Bruce - Just to lighten it up a bit (excuse the pun) you are not talking about ‘athletes’ with your ‘American football' – that’s just brute strength and no skill ... Now if you want to see real ‘football’ (after all we invented it) then take a look at my beloved Manchester United here in England.... Just jokin' folks … honest :-) – just thought I’d try to lower the temperature …

Posted by Trevor Gay at January 11, 2009 4:31 PM

"I'd rather be a happy and contented person, a few pounds overweight, fond of a couple of glasses of whisky every now and again than a flat-tummied, BMI-perfect, organic, gym monkey, miserable sod."

MARK, YOU WIN THE (MY) PRIZE FOR THAT ONE!

"And I'd rather risk dropping the occasional f-word into my speech than to rehearse and sanitise my every single utterance."

I HARDLY TIE MYSELF IN KNOTS CONTAINING THE F-WORD. MY TAKE IS, WHY GIVE GRATUITOUS OFFENSE TO ANYONE? I CAN SHOW EXTREME EMOTION, AND ANGER, WITHOUT THE ROUGH LANGUAGE I USED TO USE--I CONSIDER THAT A NON-TRIVIAL ACCOMPLISHMENT.

Posted by tom peters at January 11, 2009 4:46 PM

Trevor,

I will confess to being a fan of your greatest sport - but it is not soccer and unfortunately New Zealand is the best at playing it..

Real men required - not floppers - and I bet we have a few BMi's above 25...

Posted by Bruce Humbert at January 11, 2009 4:50 PM

Bruce - I guess you must be talking about Rugby - As the old saying goes "That game played by men with odd shaped balls" :-)

Best

Posted by Trevor Gay at January 11, 2009 4:56 PM

Yes Trevor - I would say

Go All Blacks!

But that is probably not allowed :-)

Posted by Bruce Humbert at January 11, 2009 5:12 PM

"I'd rather be a happy and contented person, a few pounds overweight, fond of a couple of glasses of whisky every now and again than a flat-tummied, BMI-perfect, organic, gym monkey, miserable sod."

Mark JF's comment asserts that one could not be both fit and happy. Ridiculous! It also asserts that one who is fit is unhappy because he is discipline, and one who is not disciplined is happy because he is indulgent. Not! There need not be an Either/Or. One can be both fit and incredibly happy. But I do wonder if one can be excessively overweight and happy. Hmmm? None that I know despite the smiles.

Bruce is most certainly an evangelist for fat. Like zealous evangelists who find multiple scriptures to support their "righteous" stand, he finds multiple findings to support his. But excessive fat is STILL not good. Any cardiologist or MD who specializes in diabetes will tell you this. The empirical approach is far better in fact finding; try disproving what is so righteously espoused.

By the way, I'll take DeAngelo William's "tight end" over Ted Washington's any day!

Posted by Judith Ellis at January 11, 2009 5:45 PM

I had intended to ignore Judith - but I must protest - I am not an evangelist for fat - or even for being overweight. But both are personal and we know very little about causation - the simple too many calories in has been proven to be just that too simple.

What I am an evangelist for is freedom - and personal responsibility - on all fronts. Right now we as a country could benefit most from a lot more of each.

And Judith your are obviously NOT polynesian - where fat IS seen as beautiful

But then again DeAngelo Williams is officially obese - BMI=32

Posted by Bruce Humbert at January 11, 2009 6:07 PM

Aleksandar – You bring up a good point. I remember when I was in college and went to see the doctor to check out vitals. I was told that my blood pressure was a little high but it was normal for me. For me? "What do you mean," I asked. She was not my doctor and I was seeing her for the first time. She informed me that hypertension in African Americans was typically higher. I was 19. After that I have worked to maintain healthy vital standards. Period. Regarding my weight, I have been fatter and thinner over the years, but always healthy and happy. Thank God.

Maybe there is a genetic component to these things things, but maybe not. It probably has more to do with the kinds of food consumed, though I do believe there are predispositions to some diseases. (Is fat a disease?) But what that means to me is that you have to work harder in certain areas. And, since we’re on this topic or race I have notices something with regards to Asians in America. I used to see very few overweight Asians. By and large they were incredibly fit. As of late, however, I’ve been noticing that the younger generations are as heavy now.

Is it Western influence? My thought is that it probably has more to do with the kinds of food being consumed by the younger generations. I also wonder if this kind of consumption will alter the health of Asian people.

Posted by Judith Ellis at January 11, 2009 6:25 PM

“Moderation in everything” is what my Grandmother used to tell us as kids. She was not small and not big. She enjoyed a drink, never exercised as far as I can remember - other than walking around our village - and she died at 94 - I'll settle for that. I don’t agree with the implication from Mark JF that being focused and disciplined to get fit, lose weight and exercise has any more likelihood of producing a miserable sod. The ‘miserable sods’ I’ve met vary in shape, size, age, fitness and profession. ‘Miserable’ is also a freedom I guess.

Bruce – getting back to the far more serious topic of Rugby, those All Blacks frighten me with that ‘Haka.’ I’ve been thinking about an equally aggressive English response and I offer you the terrifying spectacle of Morris Dancing as shown here. Please bear in mind my public health warning - only look if you are brave – this is scary – imagine this lot up against the All Blacks on the rugby pitch - scary or what Bruce? http://upload.wikimedia.org/wikipedia/commons/2/29/Morris.dancing.at.wells.arp.jpg

Posted by Trevor Gay at January 11, 2009 6:56 PM

Here is one of my favorite artists singing one of my favorite songs. I love this guy and his artistry.

He was most certainly obese and died a miserable death associated with his weight.

http://www.youtube.com/watch?v=0OMLoAtC9RY&feature=related

Posted by Judith Ellis at January 11, 2009 7:04 PM

Trevor my friend - the Morris dancers are doomed - I can remember the first time I saw the Haka - it was part of what made me a fan of the AB...

Ka ora'

And all the best to you.

And Judith - life is a journey and with any journey great discoveries are to be appreciated - I am now a fan of Iz - you have done a wonderful thing introducing a fat old man to a thing of enormous beauty - his voice and talent will live forever...

Off to iTunes to add what I can find

Thank you - it has been an enjoyable weekend.

Posted by Bruce Humbert at January 11, 2009 7:32 PM

Bruce - you will surely agree those Morris Dancers are some scary dudes though? :-)

Posted by Trevor Gay at January 11, 2009 7:41 PM

Israel Kamakawiwo' ole I have loved since the very moment I heard and saw him. On my blog I have written of him.

There were videos which included his songs without his fullness and these I did not wish to post. I wanted the man.

I agree, "his voice and talent will live forever." He makes me happy.

Many blessings to his.

All the best, Bruce. Have a great week.

Posted by Judith Ellis at January 11, 2009 7:41 PM

Trevor - it is the bells on the knees thing that does them in...

Posted by Bruce Humbert at January 11, 2009 7:48 PM

Get some Jamie Oliver in your life!

Posted by Patrick at January 12, 2009 3:15 AM

Judith: you completely mis-represent my comment when you say it, "...asserts that one could not be both fit and happy." No, no, no - that's simply not what I said at all! I offered 2 alternatives and you have incorrectly assumed that they are the only alternatives and it's either / or. I simply put forward 2 positions from many possible ones and offered my personal preference for one of them.

Given the choice, I'd like to look like George Clooney, speak like Charles Dance, have the intellect of Nassim Nicholas Taleb, the wealth of George Soros etc. In the meantime, I'm happier being me than being a gym monkey who happens to be miserable.

I suspect there is probably a link between, if not being super-fit, at least being healthy and being happy. One theme that hasn't been explored in this lengthy post is the psycholigical factors behind obesity (and anorexia): self-worth, depression, addiction / compulsion issues and so forth. For sure, parts of the western world need to address obesity but BMI seems too "one size fits all" and it needs a much wider plan that looks at exercise, nutrition, hydration, well-ness (physical and mental), education and balance.

Posted by Mark JF at January 12, 2009 3:41 AM

Mark - I hear you and I appreciate your comment in that it represents two sides instead of an alternative. OK. I recieve this. Thank you. But things are rarely "simply put" in discussions, as they include others who interpret your reading. The beautiful thing is that even mis-readings can offer something. As anyone, I want to be understood. But I also realize that others bring their perspective to what I write and this too is cool. A great many powerful books have been written on mis-readings, what the writer did not intend.

By the way, my mother was an absolute stickler for quoting her. If you quoted her you needed to have gotten it right, including the spirit of her message and not the words alone. This is appreciated too. Understanding is important. So, thank you for the explanation. But I would also like to stress that there need not be extremities; there need not be one or the other from which to choose: excessively atheletic or incredibly lazy. One can find a healthy balance; there need not be an Either/Or. I concede that this was not your point. But it was, nevertheless, what I received from your comment. I guess it was, in fact, mine.

My mother used to quote a scripture to us often: "wherever you find yourself therein be content." But the overarching message was to make better choices and change perspectives in order to be so; the direct message that came through loud and clear was that some things you cannot change right away but work very hard in smart consistent ways to be a better person every day. (Find contentment.) She did this through love and kindness (and she was tough too; believe me!), teaching us balance by how she lived her life everyday in the choices she made and the words she spoke. Words mattered a lot to her. She was self-confident and humble.

With regards to desiring the qualities of another, I, for one, never have such a desire, whether physical, emotional, intellectual or spiritual. I am forever pleased with me and work daily to be the best person I can be. Appreciating, honoring, and respecting others is very important through acknowledgment and deference. But I never see myself as desirous of another. The very thought of desiring what is another's may indeed spur the kind of lack and obsessions you have just written of: obesity, anorexia, self-worth, depression, addition/compulsion etc.

Thank you for your comment and subsequent explanation, Mark --much appreciated.

Posted by Judith Ellis at January 12, 2009 6:58 AM

Check your BMI, I did, you then have information on which to base decisions

Posted by patrick at January 12, 2009 8:07 AM

Have PE every day instead of once a week in schools. And stop banning recess!

Posted by Greg at January 12, 2009 8:33 AM

Might I add.....Bust Fat Healthcare Providers?

This is a particular pet peeve of mine. If we don't model it, we can't sell it.

I'm one of them, and I walk the talk.

Posted by Marilyn at January 12, 2009 1:55 PM

You can have my cheesburger and fries when you pry them from my cold dead hands. This may be a foreign concept to some of you but this is still, in theory, a free country. Besides, if you really wanted to make a differenece, you could ban smoking and drinking.

Posted by Jim Outland at January 12, 2009 2:55 PM

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Jim – you may know on July 1st 2007, our UK Government introduced a new law in England to make virtually all enclosed public places and workplaces in England smoke free. This is not ‘nanny state’ behaviour by our government - it is just good sense. Smoking is a killer we can wipe out. I speak as a former smoker and I do not have a downer on smokers. Far from it – smokers have my utmost sympathy. I know how difficult it is to quit the habit. Nowadays it’s great to go into a pub or restaurant and not be inconvenienced and health-damaged by inhaling other people’s smoke. It is incredible that we have gone from a situation two years ago where pubs were foggy, unhealthy, polluted air-spaces to where we are now – a comfortable place to be.

Ban alcohol? – That will be trickier, and realistically, will probably never happen. Mind you …. I never thought the public would accept a smoking ban so who knows.

One person’s ‘nanny state’ is another person’s common sense. I am old enough to remember when seats belts were made compulsory in cars in England in the 1970’s. The ‘civil liberties folks’ in those days talked about that being a ‘restriction of freedom and individual choice’ – what poppycock. Sometimes we don’t know what's good for us and we have to be told.

Posted by Trevor Gay at January 12, 2009 3:56 PM

Well said Marilyn - keep 'walking' :-)

Posted by Trevor Gay at January 12, 2009 3:58 PM

There are many factors that lead to obesity.

Chronic stress elevates levels of cortisol. Sleep deprivation affects appetite and body chemistry. Can families change their schedules so that children have 10 full hours of sleep every night? Are families and schools willing to adjust when teens' circadian rhythms are keeping them awake until midnight and drowsy until ten in the morning?

As for food, it's how we eat as well as what we eat that affects our weight, and the well-off don't seem to have an advantage over the poor here.

Dr Theodore Dalrymple noticed that poor immigrants in the slums of London ate far better than the locally born for the same money or less, as they supported small shops full of fresh produce, legumes and rice. The mothers or grandmothers cooked meals that the whole family ate together, whereas the locals tended to buy processed food at higher cost that they ate by themselves. He said in all his years of house calls he never saw a local family eating at the table together.

Compare that with grabbing packaged food and wolfing it down in front of the TV or eating in the back seat of the car on the way to another after school activity.

Some primary schools have experimented with academic classes in the mornings, and games and cultural pursuits in the afternoon- a healthy mind in a healthy body approach. Are school boards and taxpayers willing to make those changes?

And how about society as a whole? Do we value a good night's sleep? Do we hold the family dinner hour sacred? Do we set aside half an hour a day for some brisk exercise that clears the mind and invigorates the body?

Yes Tom, what gets measured gets done, usually, but unless we're willing to encourage by example, an obesity report card just points out failure.

Posted by Lois Gory at January 12, 2009 4:29 PM

Lois a report card is just that a report, take from that feedback what you feel happy with, if you see it as failure, so be it, alternatively, see it as your personal manifest to do what you wish with it, but stop overworking health proffesionals on what is preventable.

Posted by patrick at January 12, 2009 5:10 PM

I stayed away from this for a bit. It amazes me. I have found no good argument here that obesity is not a huge health problem in the US and largely, avoidable. The argument using NFL linemen is absurd. And by the way, anybody check the mortality rates once they leave the game? I know it is difficult to maintain one's weight especially in this 24/7 fast food world. But really, we don't need BMI when a full length mirror and out of breath stair climbing provides some pretty good data. I am not suggesting legislation, I don't like infringement on anybody's rights unless they affect the rights of others. I dropped 40 pounds over the last couple years, and I can provide all kinds of reasoning for that, but when it comes down to it, I was tired of being fat. BMI does have its limitations when it does not take into account the athlete's muscle mass...but my guess is that doesn't apply to many of us. I am also old enough to remember all the arguments that tobacco was not a health issue.

Posted by Mike Neiss at January 12, 2009 5:13 PM

Here's an FYI about BMI

http://www.foxnews.com/story/0,2933,479254,00.html

Posted by zed at January 12, 2009 5:53 PM

I can't imagine how much trouble I will get in for this one...

First let me say I am a non-smoker. Did like a good cigar once in a while years ago - but have not had one in at least 10 years.

But I just don't understand why we have to go to the point of banning smoking in all bars and restaurants - what is wrong with clearly marking them and letting prospective customers know at the door - and yes I will sign up for a complete ban on "family" restaurants [defining those will be sticky] but why not find a way to allow a choice - and the freedom that comes with it.

I have seen several studies that question the impact of second hand smoke - yes I seek this sort of thing out. And we now raise so much tax revenue from smokers one could make the argument that we need more - not less of them.

Now if someone will just change the topic to global warming I can get my third strike and be out of here :-)

The Lonely Libertarian [AKA Bruce}

viagra to buy in new york Posted by Bruce Humbert at January 12, 2009 10:39 PM

Thank you, Patrick and Mike, for that--much appreciated.

Bruce - I like your tone. I smiled. But you have obviously not done enough research on the dangers of second-hand smoke; it might be very possible that public safety is a real issue here, therefore, policy necessary that protects the public.

A lot of policy may also be retroactive, as we have supported, even advocated smoking--even marketing it to minors, for so long, tax benefits aside. Perhaps you can begin your research anew by re-reading Mike's last line. Are you old enough?

Other lonely Libertarians, if only in views and not Party affiliation, may indeed be here too. You may not be so alone after all.

Posted by Judith Ellis at January 12, 2009 11:11 PM

The problem here is the argument. Smart, well-intentioned people like Mike Neiss, Trevor, and Judith don't realize the argument is not whether obesity is a health problem or not--it clearly is. The argument is whether or not anyone else-the gov't, the cultural nannies, the surrogate parents and do-gooder groups--has a right to tell anyone else, of any age, what to eat. Ban trans-fat? That is just saying "you are all too stupid to make intelligent choices for yourselves, so we will do it for you because we are the gov't and we know best." How the esteemed Dr. Peters can not realize that his view on the subject absolutely contradicts everything he supposedly stands for boggles my mind.

Posted by Useless Sam Grant at January 13, 2009 8:06 AM

Sam..I am not in favor of government action. I am in favor of people who are overweight pay much higher premiums for health care. Make your own choices...just don't expect the rest of us to offset your poor choices. Freedom of choice is what I am all about...but also acceptance of personal responsibility for those choices. Thanks....

Posted by Mike Neiss at January 13, 2009 9:26 AM

Useless Sam Grant - How apropos. (Just kidding--really!) I think Mike's statement says it all: "I am not suggesting legislation. I don't like infringement on anybody's rights unless they affect the rights of others." If I am in a restaurant and your smoking causes health problems for me, that's a problem. Your right negatively infringes on mine, while my right to be there does not upon yours.

Should there be no standard, for example, for harmful airborne dust associated with chemical plants that is hazardous to the health of a great many people living within certain proximity? Should there be no environmental standard--period? Is this government intrusion on the lives of citizens?

Is freedom thwarted when government steps in the above case? Get real! How about the contamination of drinking water due to hazardous chemicals? Is your water safe? Does demanding that businesses do something differently for the sake of public health infringe upon their right to do business? In this case, infringe away.

I shall wait for your answer, Useless, assuming that you will now join "the smart, well-intentioned people" who probably realize the argument better than you assume, seeing the real issue before us if we do not change: early deaths for kids who will not live as long as their parents from diabetes and a host of other deadly diseases.

Posted by Judith Ellis at January 13, 2009 9:39 AM

Mike.. I am for blowing up the entire health insurance system and letting people make all of their own choices. In over 40 years of being in the work force I have paid into the system 3 times more than my dependents and I have gotten back in benefits (conservative estimate - might be 4 or 5 times) I am tired of subsidizing the rest of you folks and doctors who manage their business based on what the policy will and won't cover - I have stopped getting "useless" but "free" blood work done twice a year - hate having my arm bruised by some poorly trained med tech...

And I assume that you would extend your argument to things like maternity benefits and genetic and inherited conditions - why should the rest of us pay for the choice of someone to have a child - or cover a disease/condition that exists only because the parents chose to inflict the high cost of caring for a "defective" child on the rest of us.

And Sam - glad you joined the fray - but don't jump to the obesity=problem conclusion so easy - the data is far from conclusive in spite of what the SWIP would like us all to believe.

The Lonely Old Fat Libertarian :-)

Posted by Bruce Humbert at January 13, 2009 10:07 AM

given a height of approx 5.70m I calculate that the BMI of this post is actually quite lean! - no that can't be right. Conclusion BMI is not a good index of long running posts!

Posted by PaulH at January 13, 2009 11:00 AM

I wonder if Bruce's mom would not have had benefits (did she have such?) if he would have arrived healthy. I wonder about the rise of birth defect without benefits for moms and the subsequent governmental costs without it. I also wonder about extremities, not in how much we eat, but in how far we go to attack every standard and system to make excuses for others, like those who will not control what they consume and execrise.

Yes, debate, conversation, sarcasm, and being cute may indeed work for discussion; they may even work to change minds and policy. But I do most importantly wonder if we can indeed stretch some things to the limit and in so doing actually break down a solid system of ethics. Birth cannot be more deserving of benefits, without which many of us would not be.

Posted by Judith Ellis at January 13, 2009 11:09 AM

I agree with John Bogle in that business has a responsiblity to the community. This responsibility has included healthcare. Shall the government now assume this role totally?

Posted by Judith Ellis at January 13, 2009 11:17 AM

False premise Judith - why can't we all be responsible for our own health care - save and invest our hard earned dollars and pay for our problems when they arrive (and arise). Here is a little experiment for you to try. Next time you go to the doctor tell the cashier you would like to pay in cash - that you are between health insurance coverage and want to pay the bill on your own. If your experience is anything like mine was a couple of years ago a $90 office visit with $20 co-pay turns into a $55 total bill.

And by the way - bringing my mother into this was way out of line - shame on you.

Posted by Bruce Humbert at January 13, 2009 11:33 AM

Bruce - I am sorry if I offended you with regards to your mother. This was not my intention at all. If you have read anything here that I have written I bring up my mother quite often. The point is to bring things home. It is very easy for us to talk in abstracts, but when the issues are brought home the responses are usually framed differently. This was my intention. I obviously failed. For this, I beg your pardon.

About twelve years ago, me and a friend, who designed the initial key pad for hotels entries, developed a very comprehensive plan to reduce the cost of medical billing, which would affect the cost of healthcare. This, we thought, would address, in part, the problem about which you now speak: healthcare costs and various forms of payment.

Our plan also addressed the necessity of reducing so many complicated codes which are essentially counterproductive to billing and adds to healthcare costs. We developed an online national medical billing system that did away with the complicated coding system. Believe me; I understand the complications involved in billing after having worked along a relative in her successful medical billing practice and trying to push our medical billing plan forward.

I have done many things and have had many failures, some successes too. Perhaps I should take this one up again.

Posted by Judith Ellis at January 13, 2009 12:09 PM

Bruce - With regards to the premise of your previous comment, women -- this includes mothers --- make some 30% less on average than men for the same job. What kind of benefits will "their hard earned dollars" pay for in comparison to men?

According to a NYT article of October '08 the game is already not fair:

"Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage."

Let's widen this gap even further by making women pay for their own health insurance totally in a job that their counterparts are paid more for doing in the exact same position. Again, how far will "their hard earned dollars" go? Not far!

Posted by Judith Ellis at January 13, 2009 12:39 PM

Ah Judith - again another false premise. Since you brought up the topic of my birth let's go back to that period of time.

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When I was born my mom and dad were responsible for all of the costs and paid them from their bank account to the doctor and hospital - but that was not a problem - they had nearly 9 months to save and plan for the event. The did have health insurance - but the way that worked back then was they had to get all the receipts together and submit a claim - and wait for their check.

Our family doctor had no receptionist - no billing service - no lab to support. He served roughly half the families in a town of 6000 in western Pennsylvania - made housecalls - and took Wednesday afternoons off. He also was totally irresponsible when my weight hit 220 in my senior year (I am 6' 3' so the BMI for that was 27.5) when he told me not to worry about it - that I was "big boned" (true story).

This "pay direct" system worked well for our family up until about the time I graduated from high school - I can remember my mom questioning how the new way - direct payment to the provider was better - she wanted to chose the provider and pay him/her directly - thought that gave her a degree of control over the process and the quality of service - and to this day I think she was right.

So I am a lone voice in the wilderness - both insurance based and government based health coverage (sorry Trevor) are fundamentally flawed.

Posted by Bruce Humbert at January 13, 2009 12:57 PM

I am not in favor of government control of personal habits. We all make choices. My point is that as healthcare providers we can't expect patients to do what we don't do or model. On many levels, both conscious and subconscious, patients are comparing what we say with what we do. Never forget that.

Whether we want to be looked up to or not, by virtue of the position we hold, our chosen profession, patients and students look to us for answers. It's that simple. Choose other types of work if you don't want yourself judged this way.

Posted by Marilyn at January 13, 2009 1:20 PM

Judith - WHEN did I mention women - my post spoke to the cost of having a child - last I checked that took two people and in many cases - not all or course - the payments for this come from a father's health plan.

My basic point is that I don't want ANYONE (man or woman) to pay for/buy insurance - I want them to pay for their own healthcare costs - and I don't want an insurance company or government agency to collect either a premium or tax to pay on their behalf.

A couple of years ago I tried to get some friends at McKinsey to do a study on the net benefits of health insurance along the lines of my earlier post. I would guess that for most of us the net benefit (sum of premiums paid by the insured and his/her employers minus the total net benefits received) is much less than zero - this is no more than a very inefficient system to transfer funds from the many (essentially healthy) to the few (the sick and injured)

Posted by Bruce Humbert at January 13, 2009 1:55 PM

I like the idea of some kind of measurement of weight, height and BMI - perhaps put on the report card with an average so that parents can see how their children are doing.
Also intrigued with the idea of role models being in decent shape - not "gym monkey' fit but not obese. Requiring a principal to be within a range of weight would have enormous impact.
I had lunch with a friend here in Canada running a $60M government budget to teach school children how to build habits to keep fit for life. One problem, my friend is a very tubby fellow which did cross my mind, but I did not mention.

Posted by Jacoline Loewen at January 13, 2009 2:05 PM

It's not a healthcare cost argument, either. That's a fallacy of the first order. Is there a limited "supply" of healthcare that forces the costs to rise if there is a higher demand? Come on, get real. You aren't paying higher premiums because your neighbor is overweight or smokes. You should pay more if you have children, drive a diesel auto, work in a coal mine, etc. if that logic train is followed.

And do you all really want to lay yet another self-image issue on overweight children by GRADING them on their alleged obesity? Yeah, that should help them lose weight. No emotional problems developing there, huh?

Posted by Useless Sam Grant at January 13, 2009 2:52 PM

Bruce - Repeating the words "false premise" does not make it so. I think that I have understood your points quite well. I have simply often not agreed with your comments or tone. Does disagreement a false premise make?

Considering being big boned, my 5' 10' frame could be considered as such. I was never skinny. But at my personal optimum for many years, I weighed 170, but wore a size 8, bench pressing with a spotter over 200 pounds. I will not dwell on those three now infamous letters, but my body fat was minimum. Perhaps I will return there.

I appreciate your personal story and understand that matters of image and weight for young people are not small things. I have an obese handsome nephew and a very tall 6' 1' gorgeous niece who's 16. Being gorgeous and a straight "A" student is secondary to her height. We trust this will change. And, no, she has absolutely NO interest in basketball.

Do men have babies? Who birth children?

Women!!!!!!!!!!!!!!!!!!!!!!!

Your idyllic situation where the healthcare of children comes out of the father's health plan seems a bit archaic in many situations in America. We would have to restore the nucleus family in this respect (I'm not against this), forbid divorce, insist that women marry men and forbid them to have children unless married. Is this your idea?

There are those homes where there are single working mothers raising children and there are also those homes with both parents raising children who are a part of the working poor; any assistance in the workplace with regards to healthcare insurance is helpful.

These are your words:

"I am for blowing up the entire health insurance system and letting people make all of their own choices... I assume that you would extend your argument to things like maternity benefits and genetic and inherited conditions - why should the rest of us pay for the choice of someone to have a child - or cover a disease/condition that exists only because the parents chose to inflict the high cost of caring for a 'defective' child on the rest of us."

What might the natural actions to your thoughts above be? Would calling for women, who have babies or not, to pay for their healthcare insurance when they make by average far less then men for the same job equitable? Do re-read my comments in light of your statement above.

I do appreciate your desire to return to simplicity with regards to direct pay but insurance is big business and it almost seems as monumental as halting or re-tracking globalization.

Peace out!

Posted by Judith Ellis at January 13, 2009 3:04 PM

I will try to be brief and wrap up my points - I think Judith and I have taken our discussion as far as we can.

Judith - the original false premise I was challenging was that we had only two options - insurance based or government based health coverage. I reject that premise and believe that a viable third option can and should exist and be discussed. By paying for one's own health CARE I am suggesting taking the insurance industry out of the equation. You note in your last post that they are a big business - but that is not proof in any way that they are of value and required - they add costs and inefficiencies which may in fact be making us less healthy.

The second premise was in response to your concern over the high cost of women's health INSURANCE relative to men - my only point here was that assuming that INSURANCE was a prerequisite for health CARE was an extension of the flaw that I saw in your first argument.

Finally, I am not saying there might not need to be some role for either government or private insurance going forward - but that we might be better off encouraging those with reasonable earnings and earning potential to become essentially "self-insured" - extending the idea of health savings accounts and removing the limits on contributions to these could be a first step.

Providing universal coverage for catastrophic conditions might also work - but has the potential for both fraud and abuse.

And of course we would need to cover the poor and unemployed through some sort of expanded medicare - but we also need to find ways to deliver better care in a more effective and efficient manner. The evil Wal-Mart is doing some innovative things with both prescription meds and walk-in clinics that are worthy of study and understanding - Walgreens is also in that game and others will likely follow - would be a good topic for Tom to look into IMO.

Posted by bruce Humbert at January 13, 2009 4:34 PM

Have been monitoring the ongoing debate between Bruce and Judith. This passion will surely leak into our headlines in the near future as people consider the role of government in their private lives. As with the bailouts, I must repeat my mantra, 'The nanny state will not be able to shield us from responsibility, personal or societal.' Practical experience has proven to me time and again that the government is not an efficient vehicle to provide any service.
But just in case I'm wrong, I've started concepting on a black market hamburger stand with high fat burgers. Maybe, mobile. On the back of a tractor trailer? Fat and Fast? What do you think?

Posted by Bruce Bortree at January 13, 2009 4:50 PM

Bruce - This is for you.

http://www.youtube.com/watch?v=9yiYbCJitvQ

Posted by Judith Ellis at January 13, 2009 5:37 PM

Bruce - I've just re-read you comment. If what you have outlined is what you have taken from my words we are in alternative worlds. Let's just enjoy the music, eh? Got any?

Bruce Bortree - I totally agree with your point on personal responsibility and that the government is not the most efficient usually. The government, however, does play a necessary role.

Posted by Judith Ellis at January 13, 2009 5:50 PM

Two for you Judith - the first I listen to often - on my Iphone and reminds me of why I care - want this for my children [3] and grandchildren [6]..

http://www.youtube.com/watch?v=c5IIXeR5OUI

The second you will recognize...
http://www.youtube.com/watch?v=_D17p0D-rks

Peace!

Posted by bruce Humbert at January 13, 2009 6:38 PM

"both insurance based and government based health coverage (sorry Trevor) are fundamentally flawed."

Hi Bruce - a quick response from me on ‘government base health coverage.’ I don’t have a problem with your criticism and I know government funded healthcare has flaws - I’ve always stated that. But I continue to challenge people on this Blog and other forums to show me credible researched evidence of a better system of UNIVERSAL healthcare coverage than the NHS in Britain. UNIVERSAL is the key word, where care is provided based on clinical need and NOT ability to pay.

I want to hear a cogent researched argument of how a system like ours in the UK is ‘fundamentally flawed’ when it provides the same guarantee of free healthcare care to my 80 year old Mom as it does to a billionaire (Mom is not a billionaire just in case you were wondering)

When someone shows me the evidence that an individual based, market-based healthcare system is better for the ENTIRE population and not just those who can afford it then I will be delighted to concede that a government funded system is ‘fundamentally flawed.’ Until that day Bruce you will not, I’m afraid, convince me that we would benefit one iota in the UK by scrapping our universal NHS.

It’s only anecdotal but a few people I correspond with regularly in the US tell me they are now actually quite attracted to a universal healthcare system. I am not stupid enough to believe it is anywhere near a majority view.

Also please don’t believe the crazy myths that ill informed journalists invent and then put around the press about our NHS in the UK.

Posted by Trevor Gay at January 13, 2009 6:41 PM

‘Useless Sam Grant’ - what a fabulous name – congrats Sir – I love that. And by the way thanks for calling me ‘smart and well intentioned.’ My kids will be impressed!

I am not … and never have been … in favour of governments telling me or my family what to eat. I don’t think they do that or ever will do that because we are adults with free choice and some intelligence and we wouldn’t allow it in our democracy. We don’t just wander around, robot like, just doing what governments tell us to do and we never have actually.

It's scaremongering for anyone to even remotely suggest that is what governments would ever seriously do and we all know it.

What I think governments can and should do is to present people with the best researched evidence and then allow people to make choices. I don't believe either in providing healthcare only to those who make healthy lifestyle choices thereby discriminating against people who make unwise choices. Where do we end with that scenario – do we not treat people who get injured playing football because that was a self imposed injury?

I wish we could get this thing into pragmatic, realistic proportion. No government will ever tell people what to eat for God sake!

Posted by Trevor Gay at January 13, 2009 6:58 PM

Jacoline - I agree with you completely. But two questions: 1) Is your friend not self-conscious in the least? 2) Who would hire such at that rate to do such a thing? Please!

It's as if we do not even want to acknowledge what is acceptable and what isn't. God bless your friend, but it's just not right for this person to be in such a role, especially when dealing with impressionable young kids--what a conflicting message!

Your story is like the parent who says "do what I say and not what I do." Yeah, right!

Posted by Judith Ellis at January 13, 2009 7:20 PM

Trevor,

I used to teach an MBA course in Strategic Management and on the first day of class i would write the following in big letters on the board.

R - C = P

I would tell them that was it - they knew everything they needed to know. R of course is revenue, C is costs and P is profit. For your health care system - and all non-profit operations P is set to 0.

So your national healthcare system operates on a simpler formula.

R = C, revenue and costs are equal - over the medium to long-term, perhaps we can have a wobble in the short-term, but over time we need to pay for what we get.

So my first problem Trevor is that you refer to your system as providing "free" healthcare - it is not free - it incurs costs and those costs have to be paid via revenues and we raise those revenues through fees, premiums, and taxes - in short someone has to PAY.

Next the problem I see that leads me to think the UK approach is flawed is that it introduces into the equation additional costs - these come in two forms, the first is terms of administration and record keeping, Hopefully you will agree that these are non-zero, and higher than they would need to be in a "pay your provider" model like we had in the US when I was growing up.

The second form that these costs take on is in terms of "over-testing" and over-treatment", By all that you have said and i have read to this point Trevor I am willing to concede that the UK system is pretty good at keeping these costs out of the system - we in the US are not as good - I posted earlier on the problem of matching treatment to what the plan permits - not what the patient needs. In my case the health plan that currently covers my wife and I allows four blood tests per year - a couple of years ago I annoyed my doctor by refusing to take all four - we negotiated a compromise at 2 after he conceded that he was only going by what my plan allowed.

So my point is that administrated plans - insurance or government - have administrative costs - some higher that others - but in all cases higher than would be associated with a simpler direct pay system.

My discussions on this thread have been aimed at removing costs from the system and making more funds available for care. The data that I have seen would suggest that the opportunity is huge in the US - perhaps 4-5% of GDP is being wasted in our approach vs yours - so at one level I very much agree with you - your system is very much better than ours.

My fear is that we would move to your approach under our new President and Senator Daschle - without "scrubbing" out the 4-5% we are wasting.

I have not been making up some of the things I have been posting - Uwe Reinhardt had an excellent series on health care issues in the NYT - a link to one of the articles is below - from there you can get to the rest of the series. Google scholar will take you to a number of articles by Professor Reinhardt on health care - one my favorites is on the impact of us old f**rts on costs - he found it is not a big deal.

Over the weekend while this thread was developing I emailed Prof R. on the BMI issue - he has not responded which is no surprise - perhaps Tom would have better luck

http://economix.blogs.nytimes.com/2009/01/02/us-health-care-costs-part-vii-reining-in-doctors-who-cost-too-much/

Posted by bruce Humbert at January 13, 2009 7:31 PM

Thank you Bruce - a great response and I will certainly follow up those articles from Professor Reinhardt.

As in most discussions I have about the relative merits of universal-or-not healthcare, you and I actually agree more than we differ.

By the way I did my MA Management (Healthcare) 1996-98 and if you had been my lecturer in the financial modules maybe I would have understood it better – you make it sound much more straightforward than I remember. I like your ‘simplicity’ needless to say – oh that all lecturers explained things as well as you do e.g. R - C = P

I concede we waste far too much money on administration and the ‘cost’ side of the equation and as I have said many times on this Blog our service is far from perfect in the UK - there is still plenty of ‘fat’ in the administration and management costs and nolt enough investment in front line care staff. I hope you will forgive me using the ‘F’ word yet again …. At least this time it’s in a less emotive context :-)

My struggle Bruce, quite honestly, is always to see how a non government funded system can provide universal healthcare that ensures healthcare entitlement to the poorest and the sickest among our society and I am sure you and I both want that in a cost efficient way. I believe the way we treat our most vulnerable, our poorest and our sickest is the best way to judge the government and therefore the people of any – i.e. “how much do we care.”

Of course I’m accused of being brainless and immature or words to that effect because I believe in socialist values and I plead guilty to that charge. I usually reply with this quote:

“When I give money to the poor I am called a saint. When. I ask why the poor are hungry, I am called a communist.” - Dom Helder Camara (1909-1999)

I am fundamentally opposed to profit being made from healthcare unless we can guarantee universal healthcare to all our people. Once we can guarantee that as a right to all then I have no problem at all with profit being made in healthcare.

Great exchange …and soccer still beats rugby :-)

Posted by Trevor Gay at January 13, 2009 8:18 PM

Trevor - how can you say this - nobody can deny they power of the Haka!

http://www.youtube.com/watch?v=qBQyxjP6hK8&feature=related

It is on my checklist of things to see before I leave this world!!!

Posted by bruce Humbert at January 13, 2009 8:46 PM

But Bruce - if you really want to see awesome scary stuff that would terrify the All Blacks take a look here and tell me you were not trembling in your boots as you watched it! :-) http://uk.youtube.com/watch?v=RZjLATAUwao

Coming up to 2 am Wednesday - time I was in the sack!

Posted by Trevor Gay at January 13, 2009 8:58 PM

But Trevor, that is exactly what has happend in some parts of the US. The mayor of New York City pushed through a ban on the use of trans-fats in all restaurants, etc. in the city. It is illegal to cook with certain types of oils in that city now. (Dr. Peters applauded this in his post.) In parts of California hot dog vendors who sold hot dogs wrapped with bacon have had their licenses revoked and their stocks confiscated--all for selling "unhealthy" food. An elementary school student (in Texas, I believe, but I could be mistaken) was suspended for purchasing a "controlled substance" from another student. The "controlled substance" was candy, which the school did not allow on the premises. The assault on freedom has already begun. In the name of lowering healthcare costs for "everyone" government and quasi-governmental institutions have decided to use the legal system to impose the "will" of the "people." And the "people" fall for that.

Posted by Useless Sam Grant at January 14, 2009 8:12 AM

The clear light of a new day has led me to drop my criminal ways and become a food control supporter. Given the government's need to control children's behaviour, we'll need 'food police'.
I envision Sly Stallone as "JUDGE SPREAD"...."Step away from the twinkie, son, and no one gets hurt!"

Posted by Bruce Bortree at January 14, 2009 8:16 AM

I love it Bruce Bortree! Too funny!

Posted by Judith Ellis at January 14, 2009 8:19 AM

Trevor - MAYBE these guys - but not just your every day MD

http://uk.youtube.com/watch?v=aGIPolcqQuc

Back to more serious stuff - I am with Useless Sam on being very afraid of the world that we are both creating and willing to accept. The trans-fats issue is a classic example of using "science" [some would call the science used junk science] to support an agenda.

We seem to be willing to give up a lot based on very little - here is what we know...

1. Efforts to show a DIRECT link between poor health and Trans Fats consumption have NEVER succeeded - and it has been tried - a lot.

2. The link that has been proven - and no one disputes this - is that trans-fat consumption increases "bad" cholesterol [LDL] TEMPORARILY - the effect is only permanent if trans-fat consumption continues at elevated levels. There is also data that shows that the same sort of temporary effect occurs on HDL - good cholesterol is reduced.

To get to a health scare we then need to add a linkage between high LDL and health - and we have a convenient one in the LDL heart disease connection - which has been found to be the case - but all of that data comes from studies that looked at PERMANENT increases in LDL.

I drive my doctor crazy every time he tests my cholesterol - as I noted on this thread earlier my BMI has been north of 27.5 since my senior year in high school - 45 years ago - and they are convinced that I will have a 'bad" cholesterol profile - but I consistently have LDL in the 90-100 range - HDL around 60 triglycerides in the 140 range. And let me be clear - none of these measures are my doing - they come from the genetic lottery.

My basic point throughout this thread is that things are very complicated - health is a result of a combination of factors - heredity - diet - environment - lifestyle - outlook [very under rated - seldom mentioned in the research] and probably a number of others we have yet to uncover. I get very nervous when people think that we have simple solutions that we need only implement to solve our problems. I know that correlation is not the same as causation - and how hard it is to prove causation in science.

Asking EVERYONE to give up something because someone might be adversely affected is serious business and we better be sure we have the data to support the action taken [I still get annoyed when I recall a plane flight years ago. The attendant told us all before take off that there would be no peanuts served (obviously this was along time ago when Delta served peanuts as snacks) since they had been told by a passenger that they were allergic to peanuts and that even peanut "dust" could bring on a reaction. I wondered then and still wonder whether the passenger was telling the truth or just trying to be a jerk]

Posted by bruce Humbert at January 14, 2009 10:04 AM

Phew - 148 comments on one topic – there’s a book here!

Bruce and ‘Useless Sam’ (BTW - I still looooove that name!) - I will be brief as I suspect this thread is nearing the end of its useful life. I’ve loved our exchanges thank you both – more learning for me.

I think my final word on this is that if we EVER allow any government to tell us what to eat in the UK I will personally write an email to every citizen in Britain using the words of a famous old front page headline from ‘The Sun’ daily newspaper in 1992 as follows:

“Will the last person leaving the country please make sure the lights are turned off”

Of course we should be wary of government interference but we have to make judgements about what is just acceptable direction and what is silliness because we just will not accept silliness.

I am very optimistic and confident that our young people will not be so stupid as to allow any government to make silliness become the norm.

Posted by Trevor Gay at January 14, 2009 5:46 PM

Trevor,

It appears you are correct - this thread is out of steam [gas?] but I have learned a lot - and discovered some new things - so it has been good to me...

I leave you - and the rest of our readers with one of my faves....

http://www.youtube.com/watch?v=c5IIXeR5OUI

Freedom is a precious thing - and hard to get back when it is given up - I hope my grandchildren will live in a world with more freedom than we have today.

And of course

Ka t? te ihiihi
Ka t? te wanawana

Posted by bruce Humbert at January 14, 2009 7:23 PM

Bellissimo, Bruce! This is one of my absolute favorites. It is on my blog permanently.

You might like this song incorporated by IZ into the earlier version I posted here.

But, for me, no one does it like Satchmo!

Thank you for your passionate voice here.

Best...

Posted by Judith Ellis at January 14, 2009 8:58 PM

Bruce, Amen to Mr Armstrong. I delight in the fact that New Orleans has named their airport after him as opposed to a politician. May that great city return to its glory.

Posted by tom peters at January 14, 2009 11:14 PM

Cheers Bruce - great stuff and amazing video ...keep takin' the pills and watch out for rampaging Morris Dancers :-) .. BTW ... At family party times and after a couple of glasses of Red Wine I do a pretty mean impersonation of Louis singing that very song ... He was brilliant - a legend and very popular here in the UK.

Best

Posted by Trevor Gay at January 15, 2009 3:25 AM

What a great man and great city! Viva la New Orleans, the home of not only the great Louis Armstrong but Antoine Dominique "Fats" Domino, Ferdinand "Jelly Roll" Morton, Joe "King" Oliver and Mahalia Jackson -- all great musicans, no politicians! :-)

Posted by Judith Ellis at January 15, 2009 6:46 AM

Ah Judith - so many great voices and talents from one city - I have not researched it - but cannot imagine that any one city has produced so many. The Marsalis family - the Neville brothers - Pete Fountain - Al Hirt - Harry Connick Jr - and more...

But as you might expect my love for the city centers on food - have never eaten better anywhere - Gumbo done right is a gift from heaven - and I have never had it done as well as in New Orleans and I cannot imagine a more perfect morning than sitting outside at one of the many wonderful cafes with a warm beignet and that unique New Orleans take on coffee.

No a place conducive to low BMIs ;-)

Posted by bruce Humbert at January 15, 2009 7:58 AM

Bruce - I was very much aware of those artists as well, but thought I'd stick with the "gods."

Without doubt, the food is second to none. "Fats" Domino didn't get his name from fasting. :-)

I recently read, Donna Brazile's book, Cooking with Grease. She talks politics, heading chapters with a great Southern Louisanna dish of her hometown. Donna creates a delicious delightful sometimes hearbreaking tale of political life on the national level through the aroma of her mother Jean's kitchen:

1. Jean's Kitchen: Finding the Right Pot
2. Blackend Fish
3. Red Beans and Rice
4. Crawfish Etouffee
5. Garlic Grits
6. Jambalaya
7. The Melting Pot
8. Smothered Chicken
9. Brown Gravy (Roux)
10.Crabmeat Lafitte
11.Stuffed Po'Boys
12.Creole Shrimp Bisque
13.Bell Peppers
14.Dirty Rice
15.Cochon de Lair (Roast Suckling Pig)
16.Oysters Bienville
17.Cafe Du Monde: Coffee and Beignets

Here is an example:

Chapter Sixteen

Oysters Bienville:

"Oysters Bienville is named for Jean Baptiste Le Moyne, Sieur de Bienville, the founder of New Orleans. The oysters are served in the half shell and topped with shrimp, mushrooms and grated Parmesan cheese and heavily seasoned. Throughout the Gore campaign (which she managed), I attempted to expand the Democratic base beyond its core-the oyster-by adding spices and novel ingredients-new voters and a broader message."

Donna laid a great foundation for the current Democratic base and shows us how she did so using the aroma, magic, and roux of her Southern Louisanna hometown.

Great book!

Posted by Judith Ellis at January 15, 2009 9:16 AM

"Leaders lead to the extent that they are role models for the change they aim to make and the values they aim to instill."
I'll try to give you the credit for that quote because I'm going to be using it a lot Mr. Peters.If put to the fire people respond accordingly. They do what is necessary to put the flames out. Thanks for putting the flame under the proverbial ass of health care.

Kellyann Curnayn RN, BSN

Posted by Kellyann Curnayn at January 15, 2009 1:04 PM

Quaity of care continues to go down on all levels. The businesses created through Conditions of Particiipation to receive Medicare continue to yield large amounts of revenue while health care is in 'Crisis'. I used your numberes Mr. Peters for the below article. Imagine micromanaging the floor traders on Wall Street the market would come to a hault. Well America Nurses were the
'floor traders'. Our work environment has been micromanaged to the point of paralysis.
http://www.centerforajustsociety.org/press/forum.asp?cjsForumID=1134&nav=publications

Posted by Kellyann Curnayn at February 14, 2009 10:39 AM