Discrimination, tall people and BMI

Not that I am obsessed with BMI or anything.  I was delighted to read in the Reflections on Body Image report out yesterday, that BMI is under review by the Department of Health as an "indicator of health".  It is not and never was and shall never be a measure of physical or mental health and should never be used as a diagnostic tool on its own.

It was a tool refined by Louis I Dublin as a measure of mortality rate statistics for use by the Metropolitan Life Insurance Company to calculate rates for life insurance.  It is presently used by insurance companies worldwide as an exclusion criteria for many health conditions and, in some cases, exclusion from any medical coverage at all.  This means that Soane Tonga'uiha, the loose-head prop for the Northampton Saints, would be unable to get coverage in the USA, as his BMI is 34.7



Not that I am going to tell him..............

Imagine my delight when Extralongtail told me today that as BMI is an areal rather than volumetric measure, it discriminates against tall people.  I did ask her to explain further but she informs me that she needs to go out for a sustaining lunch before attempting to explain this:

BMI and insurance premiums.

The Body Mass Index has its origins in the mid-1800s, when Belgian statistician and “social physicist” Adolphe Quetelet devised it to describe "a normal man". The original Quetelet index was merely a means of working out the average build of a typical male human.

Enter Louis I. Dublin, who over one hundred years later would oversee the development of height and weight tables in his capacity as vice president of Metropolitan Life Insurance Company. These tables were based not on medical information but on actuarial statistics. The charts depicted the mortality rates of men based on height and weight, which was (and is) important data for an insurance company for rating life insurance policies.

In 1998, the U.S. National Institutes of Health brought U.S. definitions into line with World Health Organization guidelines, lowering the normal/overweight cut-off from BMI 27.8 to BMI 25. This had the effect of redefining approximately 25 million Americans, previously "healthy" to "overweight".[13] It also recommends lowering the normal/overweight threshold for South East Asian body types to around BMI 23, and expects further revisions to emerge from clinical studies of different body types.

In the United States, where medical underwriting of private health insurance plans is widespread, most private health insurance providers will use a particular high BMI as a cut-off point in order to raise insurance rates for or deny insurance to higher-risk patients, thereby reducing the cost of insurance coverage to all other subscribers in a 'normal' BMI range. The cutoff point is determined differently for every health insurance provider and different providers will have vastly different ranges of acceptability. Many will implement phased surcharges, in which the subscriber will pay an additional penalty, usually as a percentage of the monthly premium, based on membership in an actuarially determined risk tier corresponding to a given range of BMI points above a certain acceptable limit, up to a maximum BMI past which the individual will simply be denied admissibility regardless of price. This can be contrasted with group insurance policies which do not require medical underwriting and where insurance admissibility is guaranteed by virtue of being a member of the insured group, regardless of BMI or other risk factors that would likely render the individual inadmissible to an individual health plan

The Lobbying Disclosure Act of 1995 requires lobbyists at the federal level, including Congress, the White House, and federal agencies, to submit biannual reports describing the organization they lobbied for and the amount spent on lobbying activities. However, the lobbying reports do not specify the legislation discussed or the positions advocated by lobbyists. Thus, it is not possible to determine the extent to which health policy decisions were affected by lobbying. The Lobbying Disclosure Act could be strengthened by requiring more detailed reporting, such as specifying the legislation discussed and the positions advocated by lobbyists, say the authors of this new study.

Health care organizations lobby lawmakers in order to influence health policy decisions. Such decisions affect virtually all aspects of health care, including compensation for goods and services, licensing and oversight, and research priorities. The investigators found that a total of 1192 organizations were involved in health care lobbying. Individual organizations with the highest lobbying expenditures included the American Medical Association ($17 million), the American Hospital Association ($10 million),Pharmaceutical Research & Manufacturers of America ($7 million), Schering Corporation ($7 million), Health InsuranceAssociation of America ($7 million), Blue Cross/Blue Shield ($6 million), and Eli Lilly & Company ($5 million).

Reports on the finding by nonprofit Center for Responsive Politics that insurance firms and allied organizations have spent $66 million lobbying the United States Congress in 1997. List of the top 16 insurance lobbying spenders; Insurance industry as the second biggest lobbying spender among industries.

LOBBYIST EMPLOYERS - FINANCE & INSURANCE*	Jan - Mar 97	Apr - Jun 97	1997 Total
Adam's Marketing Associates, Inc.	$45,942	$45,942	$91,884
Aetna Inc.	$9,919	$8,006	$17,925
AFLAC	$7,899	$7,899	$15,798
Alliance of American Insurers	$34,635	$34,635	$69,270
Allstate Insurance Company	$33,800	$68,619	$102,419
American Agents Alliance	$7,770	$9,785	$17,555
American Council of Life Insurance	$76	$25,036	$25,112
American Express Financial Advisors Inc.	$3,000	$3,000	$6,000
American Express Travel Related Services Co., Inc.	$13,250	$15,412	$28,662
American General Finance	$5,054	$7,362	$12,416
American Insurance Association	$81,781	$50,646	$132,427
American International Group, Inc.	$5,391	$30,106	$35,497
American Share Insurance	$12,027	$11,017	$23,044
American Stock Exchange	$0	$0	$0
AON Corporation	$0	$0	$0
Associated Electric & Gas Insurance Services Limited	$0	$0	$0
Association of Banks-In-Insurance	$6,062	$6,055	$12,117
Association of California Insurance Companies	$141,584	$146,395	$287,979
Association of California Life and Health Insurance Companies	$99,705	$109,614	$209,319
Association of California Surety Companies	$4,875	$10,787	$15,662
Aurora National Life Assurance Company	$15,996	$15,000	$30,996
Avco Financial Services	$4,570	$3,769	$8,339
AXA Global Risks (UK) Limited	$1,539	$0	$1,539
BankAmerica Corporation/Bank of America NT&SA (a wholly owned subsidiary of BankAmerica Corporation)	$118,137	$75,398	$193,535
Beneficial Management Corporation of America	$4,911	$10,675	$15,586
Blue Cross of California	$64,160	$141,853	$206,013
Boxers and Wrestlers Benefit Fund of Southern California	$0	$0	$0
California Administrative Services Organization	$3,210	$6,605	$9,815
California Association of Exclusive Insurance Agents, Inc.	$0	$3,000	$3,000
California Association of Health Underwriters	$10,650	$10,650	$21,300
California Association of Life Underwriters, Inc.	$33,125	$32,168	$65,293
California Association of Professional Liability Insurers	$0	$0	$0
California Association of Thrift & Loan Companies	$23,750	$0	$23,750
California Automobile Assigned Risk Plan	$5,371	$353	$5,724
California Bankers Association	$146,022	$216,911	$362,933
California Credit Union League	$62,032	$69,914	$131,946
California Financial Services Association	$9,195	$9,736	$18,931
California Independent Bankers of the IBAA	$0	$0	$0
California Insurance Guarantee Association	$5,000	$6,353	$11,353
California Insurance Wholesalers Association (CIWA)	$16,250	$8,125	$24,375
California Investor's Mutual	$3,025	$3,000	$6,025
California Land Title Association	$26,192	$21,269	$47,461
California Public Securities Association	$21,455	$18,512	$39,967
California Self-Insurers Association	$9,873	$10,699	$20,572
California State Automobile Association and California State Automobile Association Inter-Insurance Bureau	$178,986	$120,589	$299,575
California Surety Federation	$6,750	$10,125	$16,875
California Workers' Compensation Institute	$4,538	$0	$4,538
Central Mutual Insurance Company	$0	$0	$0
Charles Schwab and Company, Inc.	$3,000	$18,087	$21,087
Chase Manhattan Bank, The	$0	$25,121	$25,121
Chicago Title Company, and affiliated Title Insurance Companies	$6,719	$6,699	$13,418
CIGNA Corp. on behalf of CIGNA Healthcare of CA., Inc. and Pacific Employers Insurance Co. and its affiliated entities	$85,000	$15,000	$100,000
Citicorp & Subsidiaries	$13,496	$19,068	$32,564
Claims Benefit Insurance Administrators, Inc.	$0	$250	$250
CollegeFund-Partners in Education, Inc.	$0	$0	$0
Collegiate Capital Group, LLC	$2,000	$10,000	$12,000
Colonial Life & Accident Insurance Company	$6,000	$6,000	$12,000
Commonwealth Land Title Insurance Company	$0	$8,000	$8,000
Continental Casualty Company	$82,554	$83,995	$166,549
Cooperative of American Physicians/Mutual Protection Trust	$6,845	$16,292	$23,137
Council for Affordable Health Insurance, The	$0	$0	$0
Dean Witter Reynolds	$0	$0	$0
Delta Dental Insurance Co.	$0	$0	$0
Doctors' Management Company, The	$15,081	$15,000	$30,081
Dun & Bradstreet	$0	$60,000	$60,000
Escrow Agents Fidelity Corporation	$6,062	$6,080	$12,142
Fannie Mae	$11,442	$5,509	$16,951
Farmers Group, Inc.	$127,455	$65,586	$193,041
Federal Home Loan Mortgage Corporation (Freddie Mac)	$31,844	$41,095	$72,939
Federated Investors	$13,461	$9,465	$22,926
Federated Mutual Insurance Company	$3,325	$11,548	$14,873
Federation of Exchange Accommodators, Inc.	$7,856	$8,448	$16,304
FGIC Capital Market Services	$0	$0	$0
Fidelity Investments Public Sector Services Company	$0	$0	$0
Fireman's Fund Insurance Company	$21,269	$15,414	$36,683
First American Financial Corporation, The	$20,103	$10,069	$30,172
First American Title Guaranty Company	$0	$0	$0
FMR Corp.	$0	$0	$0
Fremont Compensation Insurance Group	$30,045	$30,045	$60,090
Funeral Security Life	$0	$0	$0
Funeral Security Plans, Inc.	$6,900	$8,137	$15,037
G.E. Capital/Monogram Retailer Credit	$0	$0	$0
Gerald J. Sullivan & Associates, Insurance Brokers	$3,644	$7,292	$10,936
Goldman, Sachs & Company	$12,590	$9,360	$21,950
H & R Block	$45	$135	$180
H.F. Ahmanson & Company, including its subsidiaries	$1,500	$1,500	$3,000
Health Insurance Association of America	$18,750	$18,750	$37,500
Health Net	$81,964	$83,009	$164,973
Heddington Insurance (U.K.), Limited	$0	$0	$0
Highlands Insurance Company	$18,612	$8,275	$26,887
Home Warranty Association of California	$9,480	$24,970	$34,450
Household Financial Group, Ltd.	$40,316	$28,055	$68,371
Independent Administrators Association	$2,250	$0	$2,250
Industrial Bank of Japan, Ltd.	$0	$0	$0
Insurance Agents and Brokers Legislative Council	$0	$0	$0
Insurance Brokers and Agents of the West	$88,192	$82,848	$171,040
Insurance Brokers Society of Southern California	$0	$0	$0
Insurance Services Office, Inc.	$35,478	$34,629	$70,107
Investment Company Institute	$0	$2,814	$2,814
Koiso & Company	$1,076	$3,302	$4,378
Lehman Brothers, Inc.	$9,737	$15,336	$25,073
Lincoln National Life Insurance Company	$900	$400	$1,300
McLaughlin & Associates, Incorporated	$0	$250	$250
Massachusetts Mutual Life Insurance Company	$13,667	$10,250	$23,917
Maxicare	$6,000	$6,000	$12,000
MBIA Insurance Corporation	$232	$32	$264
Medical Insurance Exchange of California	$11,475	$11,475	$22,950
Mercury General Corporation & its subsidiary Mercury Casualty Company	$64,040	$63,039	$127,079
Merrill Lynch & Co., Inc., and its subsidiaries	$27,682	$27,108	$54,790
Metropolitan Life Insurance Company	$0	$19,039	$19,039
MGIC Investment Corporation	$2,563	$1,232	$3,795
Money Store, The	$135	$0	$135
Morgan Stanley, Dean Witter, Discover & Co.	$13,155	$8,803	$21,958
Mortgage Association of California	$5,200	$6,325	$11,525
Mortgage Insurance Companies of America (MICA)	$7,500	$0	$7,500
Multistate Associates Inc. on behalf of H.D. Vest	$5,000	$10,000	$15,000
Muriel Siebert & Company	$3,000	$2,000	$5,000
National Association of Bail Insurance Companies	$0	$15,000	$15,000
National Association of Independent Insurers	$14,095	$9,333	$23,428
National Association of Insurance Brokers	$0	$1,500	$1,500
National Association of Securities Dealers (NASDAQ)	$0	$0	$0
National Consumers Finance Company	$6,000	$6,049	$12,049
National Council on Compensation Insurance, Inc. (NCCI)	$16,357	$7,819	$24,176
Nationwide Insurance Enterprise	$10,222	$10,381	$20,603
New York Life	$7,500	$7,500	$15,000
New York Stock Exchange	$0	$0	$0
Norcal Mutual Insurance Company	$11,683	$11,475	$23,158
Norwest Financial	$0	$0	$0
Norwest Mortgage, Inc.	$19,660	$10,145	$29,805
Pacific Genesis Group, Inc.	$4,000	$16,000	$20,000
Pacific Life Insurance Company	$3,590	$8,906	$12,496
Pacific Rim Assurance Company	$4,474	$0	$4,474
Personal Insurance Federation of California	$78,552	$82,912	$161,464
Physicians Mutual Insurance Company	$1,500	$0	$1,500
Pipar Jaffray Companies, Inc.	$4,296	$2,565	$6,861
Presidio Capital Corp.	$3,494	$15,573	$19,067
Private Medical-Care Inc.	$0	$0	$0
Professional Insurance Agents of California and Nevada	$32,037	$39,669	$71,706
Program Beta	$0	$15,900	$15,900
Prudential Insurance Company of America, The	$0	$12,500	$12,500
Re-Insurance Association of America	$18,750	$12,500	$31,250
Reliance Insurance Company	$0	$225	$225
Safeguard Health Enterprises, Inc.	$7,500	$6,000	$13,500
Securities Industry Association	$16,498	$20,316	$36,814
Skandia International Insurance Corporation	$1,553	$0	$1,553
Society of Insurance Brokers	$0	$8,334	$8,334
Southern California Physicians Insurance Exchange	$11,475	$43,475	$54,950
St. Paul Reinsurance Company, Limited	$1,553	$0	$1,553
State Farm Insurance Companies	$100,792	$204,863	$305,655
Stewart Title Guaranty Company	$1,507	$4,852	$6,359
Surety Company of the Pacific	$23,323	$20,580	$43,903
Surplus Line Association of California, The	$51,750	$22,251	$74,001
Teachers Insurance and Annuity Association of America/College Retirement Equities Fund	$9,000	$9,000	$18,000
Terra Nova Insurance Company Limited	$1,553	$0	$1,553
Threadneedle Insurance Company Limited, The	$1,485	$0	$1,485
Title Loans of America	$19,500	$0	$19,500
Trans Union Corporation	$5,017	$10,177	$15,194
Transamerica HomeFirst, Inc.	$0	$0	$0
Transamerica Occidental Life Insurance Company	$5,590	$3,069	$8,659
Travelers Express Company, Inc.	$6,036	$4,000	$10,036
Travelers Group, Inc.	$0	$818	$818
Underwriters at Lloyd's, London	$7,493	$8,171	$15,664
UnionAmerica Insurance Company Limited	$1,545	$0	$1,545
United Healthcare	$13,750	$13,750	$27,500
United Services Automobile Association (USAA)	$21,045	$42,265	$63,310
Variable Annuity Life Insurance Company, The	$12,180	$9,087	$21,267
Ventura & Associates Insurance	$0	$0	$0
Viaticus Inc.	$5,000	$0	$5,000
VISA U.S.A. Inc.	$9,222	$9,434	$18,656
Vision Service Plan	$2,602	$2,570	$5,172
Wausau Insurance Companies	$0	$0	$0
Wells Fargo and Company	$58,870	$74,228	$133,098
Western Association of Venture Capitalists	$7,200	$7,200	$14,400
Western League of Savings Institutions	$64,694	$63,486	$128,180
Word & Brown	$750	$2,436	$3,186
Zenith Insurance Company	$50,022	$33,464	$83,486
Zurich Reinsurance (London) Limited	$0	$1,555	$1,555
20th Century Insurance Company	$20,343	$31,198	$51,541
21st Century Casualty Company	$0	$0	$0
TOTAL	$3,047,205	$3,308,687	$6,355,892

Looking very quickly and non-analytically at the report and accounts for a quantity of the Top 25 Health Insurance companies in the US, there was a sharp jump in revenue for the financial year 1999/2000 in the majority of the companies. 

Just sayin......

Sources: Wikipaediea, Open Secrets, Centre for Responsive Politics,

Alien Abductions in Northern America increasing. Canada now empty

Canada

In 2003/4, the population of Canada was estimated to be 31,510,000.  It was also the year that WHO decided to do a BMI survey.  So to get an accurate picture of the nation's health with regard to obesity they surveyed 120,150 people.

The statistics read as followed

2.6% of the population aged 18-100 were underweight
46.7% of the population aged 18-100 were of normal weight
48.2% of the population aged 18-100 were classified as overweight (14.9% classified as obese with a BMI of over 30)

Quite what happened to the missing 2.5% of the population I am not sure.....

But panic not, another survey was taken in 2004 (to find the missing population?).  This was an unmitigated success as the statics read as follows:

59.1 % of the population (18-100) were classified as overweight (23.1 classified as obese)

Canada has apparently sustained more losses with 40.1% of their population now missing......

There are no figures after this date, so one assumes that Canada is now empty?

United States


And the plot thickens.....

In 2002, the USA apparently had 100% population


1999 - 2002 survey of 10,652 people

2.4% of the population (16-100) were underweight
35% were of normal weight
62.5% were classified as overweight (28.9% classified as obese)

2002 of 68,500 people surveyed in a national survey

5.2% were underweight (18-100)
35.7% were of normal weight
59.2% were classified as overweight (25.1% classified as obese)

2002 of  86,003 in the State of Georgia aged between 50 and 100

2% were underweight
40.4 were of normal weight
57.6% were overweight (23.3% classified as obese)


In 2004,   85,143 people were surveyed in 11 states.

2.3% of the population (18-100) were underweight
41.8% were of normal weight
55.9% were classified as overweight.(22.4% classified as obese)



There was another survey in 2005/6, in which 66.6% of Americans were classified as overweight with 30.5% of the population been classified as obese.

(So the USA was missing 33.4% of the population then).



In 2007/8, WHO surveyed a total of 5,555 people in the USA - population estimated 301,139,947.

68% of the population was overweight (37.6% were classified as obese)

32% of the population missing.

Where have they gone?  Because it seems unlikely they have gone to Canada.......

In all seriousness, this short exercise was meant to show you that statistics, even those taken in the same year, are a nonsense really.  Variations in a general population of some 5% and the lack of a quarter of the population can lead to some serious "fodder" for the "obesity hysteria", so beloved of the diet companies.......

Anosognosia

It seems that anosognosia is the topic of the week and has been distracting me from the whole horror of Caloric Conservation.  I have covered anosognosia before but I have learnt a lot about it and had a bit of a brain whirl jump this week which has finally made me understand it.

So Laura started it with this blog.  A rash of comments followed and a debate about whether people with an eating disorder really do have anosognosia, how long it lasts and whether it is to do with the creative side of the brain.  I had found this website, about problem solving some time ago and it all seemed to fit.

There then followed a fiery debate about anosognosia on F.E.A.S.T.'s Facebook page, which descended into "Do, Don't" argument in the end.  It is very hard not to be emotive when talking about one's personal perspective on eating disorders.  It is vitally important to remember that everyone is different and has fallen down the rabbit hole for different reasons.  It is also important to remember that one's personal road to recovery is not everyone else's.

Then ELT produced a cracker of a blog last night.  I hope both ELT and hm will forgive me for copying and pasting here what I think sums up anosognosia in eating disorders perfectly.

“persistent lack of recognition of the seriousness of the current low body weight”

I would say this applies both to the person on one extreme who is literally unable to recognize their illness and to the person on the other end who recognizes they are ill but the need to appease their anxiety outweighs that proper response to that recognition. Either way, the “seriousness” is not receiving the weight that it should in the person’s head- b/c they either don’t see it at all, or they see it but can’t make it matter. Does that make sense?

If whatever is causing the low weight is getting the most internal support from a person, then that person is obviously unable to healthfully process the seriousness of their condition. Because healthful recognition and processing means seeing something AND being able to respond to it appropriately. Also, being able to look at the long-term consequences of something as opposed to being stuck handling things on a moment-to-moment basis only- when the momen-to-moment need to manage anxiety outweighs the long-term consequences, then I think there is lack of recognition and processing going on.

Ostriches and Rhinos

So the whole "Caloric Conservation Guidelines" from Sheppard Pratt blog last week has produced an enormous amount of debate, discussion and some frank revelations.  I have swung between comments on my blog and Laura's blog, listening to some stories with open mouthed horror:

Also bathroom breaks were scheduled each day. To use it any other times was very difficult. Twice they served fried chicken which gave my DD diarrhea. The second time she ate it, she pooped her pants while waiting for approval to use the bathroom. They had her remove her soiled underpants and wear jeans with no undies the remainder of the day. She was not permitted to go shower and clean herself until shower time the next morning.

hearing amazing insights from others:

 You know what, although what they did was cruel, they saved my life. And I owe them that. I'm alive today, I didn't want to live then, but I do now, and I'm glad they gave me the chance to discover this.


Oh no I didn't see it as punishment, just as an over reaction and it left me feeling nothing but an inconvenience to the staff because I wasn't allowed to move/breath/look unless told to. Wheelchair obstacle courses were frown upon as well, sadly.

hearing genuine fear:

"Naughty child makes a decision not to eat because he/she is a rebellious brat. Naughty child threatened with all sorts of punishments if he/she continues to refuse to eat (and to behave like a brat). Once naughty child decides he/she will start to eat again the threat of punishment is reduced or removed.

Yes, exactly this. I'm an adult (over 25) with entrenched AN and no parents/family who can do family refeeding with me... But I'm terrified of going into IP because of the strong possibility of demeaning/humiliating/degrading actions on the part of a treatment provider. This isn't my AN talking - it's a genuine, evidence-based fear.

I have received messages from all over the world on Facebook, been linked and reblogged, on Tumbler and Twitter and generally made a pain of myself bringing it to people's attention in every way possible.

But interestingly, I have the feeling that the medical profession are closing ranks.  They feel that this is a one-off (not true) and that people with eating disorders do require serious and harsh medical interventions (true) and that the patients are prone to exaggeration (maybe, but then again, maybe not).  Whilst I am not arguing that some interventions in eating disorders are invasive, painful and humiliating, as well as being life saving, this type of "Guideline" is open to abuse and can (and does) result in ritual humiliation of a mentally ill person, which is wrong.

My challenge to them is:  If they are ignoring this particular transgression, are they condoning this practice?

For FB

Friday Video

Because we all need reminding

ECHO Feast Maudsley Carers conference

is going to be on November 23rd and 24th, in Nottingham at the Bestwood Lodge Hotel.   Wheels are in motion, speakers being booked, registration forms sorted out and a mass of email communication between the organising committee (Fiona Marcella, Erica, Helen, Laura and me).  I have somehow ended up in sort of charge of this whole thing (Head Girl) and was trying to find some inspiration on You Tube - a sort of "How to make herd cats" or somesuch.

Instead, I found this and felt it much more appropriate.....

Lost, frightened, hungry and tired

Our newest addition to the menagerie.  He/She (?) walked into my kitchen this morning, completely unafraid.  It is a racing pigeon that has got lost and is a bit bewildered so is now sunbathing on the roof of the shed, having been given a bit of wheat.

The dogs, who are sunbathing outside the back door, are keeping a wary eye on our new friend.  They were so shocked when it walked into the kitchen, right between their paws this morning (all birds within 50 miles normally flee in terror....) and I think they think it is some sort of "Superhero", as it has no fear of them or us "two legs".

We shall keep an eye on it for the next couple of days and, if it hasn't flown off, try and catch it and return it to its owner.  In the meantime, we are trying to work out what to call it......

Crooked bottom punishment?

Got you attention?  Good.  Crooked bottom is an anglicised way of saying Sheppard Pratt.

I was sent yesterday a scan of the Sheppard Pratt handbook, given to parents of a 13 year old earlier this year.  It is a sort of "Welcome to, Treatment Plan, Optional Extras" type document which is bad in too many ways to mention.  Access to patients by parents and carers is strictly limited to 1 1/4 hours in the evening and 3 1/4 (non-consecutive) hours at the weekend.

However this shocked me to the core:

Caloric Conservation Guidelines


For many who have developed an eating disorder, giving up long-standing behavioral patterns such as avoidance of food intake or bingeing and purging is a difficult endeavour.  We have found that gentle incentives are useful in helping persons with these patterns to keep on track toward recovery.  The Caloric Conservation Guidelines involve the loss of certain privileges when certain goals are not met.  The following provides an outline of these guidelines

• if you are on nutritional rehabilitation, you will be expected to gain a minimum of 0.2 kg (slightly less than half a pound) each day.  On the days you do not attain this goal you will be allowed 5 minutes for the activities of daily living (ADLs) and 15 minutes to dress in the morning following weigh-in.  You must then report to the Dayroom
• Showers are not permitted on the days of caloric conservation.  This is to diminish calories-burning activity and to provide an increased level of observation.
• If you do not gain weight for three consecutive days, you may take a shower on the third day.
• Caloric conservation includes loss of telephone and visitation privileges for the day as well (see telephone and visiting hours for details)
• In addition to not making expected weight gain, one may be placed on caloric conservation status for non-compliance such as meal or supplement refusal.  Privileges for individuals, or the entire population, may be rescinded by staff if your behaviour or the group's behaviour impact negatively on the unit milleu.

This is wrong on so many levels.  So wrong.

• hypermetabolism
• hormones (menstruating females)
• it doesn't take into account that the hospital are in charge of calorie intake and they may not be feeding the patient enough.
• ADL - I am assuming that means clean your teeth, brush your hair, go to the loo, make your bed, etc.  Even for one who doesn't care about personal appearance, 5 minutes would seem to require extreme multi-tasking.
• weight goes up and down over the course of a week - Mother Nature doesn't do averages.
• denying someone a shower for three days, when they are mentally ill, may be in contravention of  the Human Rights Act.
• It is wide open to abuse by staff.
• Is it even legal to take the rights of one individual because of the action of another?  We are talking about a hospital here, not some English public school
• "Non-compliance"?  If a patient is severely distressed and anxious, surely it is the job of the HOSPITAL to find some way of ensuring nutrition is administered.  By implying that a patient is non-compliant, Sheppard Pratt are implying that the inability to eat is somehow a "choice" on behalf of the individual and does not acknowledge that the patient is severely mentally compromised.  I would love to see whether this kind of "punishment" (and don't even think about trying to persuade me that this a "gentle incentive" for a terrified 13 year old) for "non-compliance" is the norm in other mental health wards treating other mental health conditions.
• Please note that this is just an "outline of these guidelines".  I would love to see a copy of those full guidelines, as I suspect I am seeing the consumer friendly part of the guidelines here.

To be frank, I am not even arguing on the minutia here.  I am arguing about standards of care for a mentally ill person that is being paid for by the insurance companies or parents.  I am sure I could come up with a whole load more arguments but I feel sick to the stomach re-reading this again and again.


If I heard of these conditions in a specialised eating disorders unit here in the UK, I would be scurrying off to the CQC immediately, waving the NICE Guidelines and the Human Rights Act.   


Now I am not sure about the US but I found a few documents that may be helpful:


http://www.med.upenn.edu/cmhpsr/BehavioralHealthReports.html

http://www.cchrint.org/about-us/declaration-of-human-rights/

http://www.aha.org/advocacy-issues/communicatingpts/pt-care-partnership.shtml

http://www.nationaleatingdisorders.org/uploads/file/NEDA%20WorldWideCharter%204Page.pdf

In my opinion, vulnerable, sick children are being denied basic rights as a punishment for non-compliance.  Is this healthcare?  Is this abuse?  Is this cruelty?  Is this legal?

What I can do is to try and shame Sheppard Pratt into changing this punishment regime immediately.  Please feel free to use this blog, link it, copy it, FB it, Tweet it, send it to your senator, your MP, your friends. 


To quote from NEDA's website the AED Worldwide Charter

Threats, coercion or punishments have no place in the treatment of eating disorders. 

Superior in every way

I am not prone to talking about things personal but I just wanted to say that my superior underwear has arrived.  Why oh why, weren't foundation garments with no clip, hooks, synthetic materials, narrow straps, underwiring or tight elastic invented before?  (And, why didn't I wait a week for the UK website to open?)

Thank you, L, for sharing your secret.  Upwards and forward, I can face the day.

Edit - I have to say I disapprove of the whole "These will smooth away your fat rolls" marketing but from the perspective of a breast cancer survivor with aquagenic urticaria, knitted, smooth, non-digging bras are like manna from heaven.

Sorry about no video - I was finding my inner feminist....

So the ATDT forum has been "hot" and humming with lively debate about various eating disorder issues, specifically relevant to the UK.  We started a lively discussion in April about the NICE Guidelines for eating disorders (would strong advise not reading the second link unless you have a good 5 hours to spare).  I am well aware that the guidelines are not perfect.  Unless you are boring like me and have read them a good many times from cover to cover, they aren't even adequate.  Most GPs never come across an eating disorder in their practice, so have no reason to familiarise themselves with them.  It is only complete word nerds like me, who need to give backup and information to parents fighting for treatment, that can jump in and out, copying and pasting the relevant "6.2.3.2.  Studies considered" with aplomb.

In their defence, they are the only Government-funded, official, comprehensive Guidelines for Eating Disorders in the world and I have heard international clinicians talking about them as a reference point for treatment.  I am justifiably proud of them, whatever their shortcomings. They are British guidelines and no "overseas peeps" is going to get away with criticising them without having read them and understood them.  Working from an abbreviated document doesn't cut the mustard with me. (Xenophobic, moi?)

We then moved our discussion on to a more personal footing when discussing the Beat carers workshops, which have been developed with the help of the inestimable Gill Todd and are based on the New Maudsley Method developed by Professor Treasure.

Lastly, we have moved on to debating what the New Maudsley Method actually is and explaining that this is a treatment protocol for carers, not for patients.  This meant I finally found a valid excuse to ring up Prof T and ask for clarification.  It was a blissful conversation that meandered through a whole host of different topics, ending up with farming - Mr Prof T is a farmer and I am now off to buy Dai Lewis, Hedge Laying video.

So why am I trying to find my inner feminist?  I was wondering whether I would have reacted so violently and shrilly, if the questions had not been posed by a man.  I suspect not.  Having older brothers, my natural reaction when questioned is to SHOUT and stamp my foot until either a) I lose my voice; or b) someone listens.

15 ways to parent a teenager.

I found this rather good list on the internet - "15 things to give up to be happy".  It makes a lot of sense.  However, I felt the need to reframe it:


1. GIVE UP YOUR NEED TO ALWAYS BE RIGHT

Teenagers are always right.  No need for you to put a spanner in the works...

2. GIVE UP YOUR NEED FOR CONTROL

Of course it's their body and no amount of you saying "You'll regret getting a tattoo, piercing your eyebrow, not wearing a coat" will seem like motherly concern or the wisdom of old age.  It is, of course, a control issue.

3. GIVE UP ON BLAME

 Just know that it is always your fault.

4. GIVE UP YOUR SELF-DEFEATING SELF-TALK.

Teenagers supply all the deprecation you need.

5. GIVE UP YOUR LIMITING BELIEFS

Yes, you really can pick up 20 wet towels from a bedroom floor without crying.

6. GIVE UP COMPLAINING

It's called nagging and doesn't work when earphones are plugged in

7. GIVE UP THE LUXURY OF CRITICISM

Nuff said?

8. GIVE UP YOUR NEED TO IMPRESS OTHERS

It's just deeply embarrassing for your teenagers when you try to make any kind of conversation with their friends.

9. GIVE UP YOUR RESISTANCE TO CHANGE

Watch TOWIE and don't comment.  It's perfectly good television.  What do you mean you want to watch "Chatsworth"?

10. GIVE UP LABELS

Expensive clothes and shoes are just going to be "borrowed" on a permanent basis

11. GIVE UP ON YOUR FEARS

The likelihood is that you will make it intact until they leave home.

12. GIVE UP YOUR EXCUSES

You are always in the wrong.

13. GIVE UP THE PAST

and just agree that their music is so much better and more meaningful than Dire Straits.

14. GIVE UP ATTACHMENT

After all your much loved, prized, lovingly cared for Valentino cardigan you bought with your first bonus in 1985 looks good as a piece of floor art......

15. GIVE UP LIVING YOUR LIFE TO OTHER PEOPLE’S EXPECTATIONS

See point 1

Farming in the run up to the Olympics

I can't not share this, just in from Farmwatch and the NFU.  Don't say you haven't been warned.

Don'’t let terrorists get your fertiliser

Don't think - act

An amazingly insightful blog post from the wonderful Carrie Arnold at ed bites, containing one of the greatest pieces of advice.

You can't think your way out of a disorder that you behaved your way into.

This insight is incredibly helpful for parents and carers.  You can't talk the patient out of the disorder that they behaved their way into.  All you can do is help them behave their way out of it.

Just a word

Mechugass (also Michegas, Michasgash, Mashuggas,)

What a great, great word.  Thanks LC.

What's the worst thing to ask......

when somebody is recovering from the hammer blows of cancer treatment?

Well, this is going to sound harsh but ringing up someone who is reeling from an operation and a cocktail of drugs and asking "Is there anything I can do?" is not a good question.  This puts the onus on the invalid to think of something for you to do, calculate whether they know you well enough to ask and then default to "Oh, thank you so much.  No, I'm OK.".

What can you do physically?

1.  Bring food for the deep freeze, wrapped, labelled and dated.  Leave on doorstep.  Toot horn and leave.  This is not about you needing praise.  This is about being a good friend.
2. Arrive with old clothes and send patient to bed, whilst you mop floors, load dishwashers and wipe down kitchen.
3. Take dog for a walk.
4. Take away their ironing and bring it back the next day - done.
5. Make their bed up with clean sheets.
6. Say "I am going to the supermarket - a quick trip.  What do you need me to get you or would you like to come too?" (Supermarket shopping in very tiring in the early stages)
7. Fill up the car with petrol/gas.
8. Tell them you are picking up their children from school/party/tennis match - asking them if they would like you to immediately invokes guilt.
9. Send a stupid funny card in the post.  It is lovely to get a letter.
10. Cleaning loos is optional.  Cleaning baths is not.

How can you help emotionally?

1. Understand that this is really, really scary, however much the invalid tries to convince you it's not
2. Understand that the invalid's sense of smell is heightened so too much CK1 can make them gag.  
3. Understand that this is bone-crunchingly tiring - falling asleep in the middle of a conversation is not rudeness or finding you boring.  It's just falling asleep.  
4. Listen (without feeling the need to comment).
5. Understand that losing your hair hurts - a lot.
6. Understand that this is not your drama.  Crying is NOT an option in the presence of the invalid.
7. Understand that the rest of the family is feeling tired, anxious and angry too - caring for someone is extremely stressful - especially if the invalid is a bad patient.
8. Know when it's time to go.  Keep it short and sweet.

Carers Workshop - Friday 29th June, London

Veronica Kamerling and Gill Todd are running a Carers' Wokshop in London on 29th June.

EATING DISORDERS  -  1 DAY CARERS’ WORKSHOP 

Friday 29th June 2012 

Time: 9.30am - 4.30pm 

Venue: The Fitzrovia Room, Park Crescent Conference Centre, International Students House, 

229 Great Portland Street London, W1W 5PN 

(Opp. Great Portland Street tube station and near Regents Park tube station) 

Cost: £80.00 per person.

Please make cheques payable to “Eating Disorders and Carers” and return with your completed booking form to: 

Veronica Kamerling 

5 Dorchester Way 

Greywell 

Hook 

Hampshire RG29 1BX

077333 260 475

www.eatingdisordersandcarers.co.uk

www.londoncarersgroup.org.uk