Robert V. Taylor: Embracing Inclusion Banishes Fear

Robert V. Taylor: Embracing Inclusion Banishes Fear

Openly gay Air Force cadet graduates gift us with their pioneering courage! At personal cost, they point to the truth that the moral arc of the universe bends toward inclusion. Their courage is an invitation to trust in our own imagination and voice, embracing inclusion that banishes fear.

President Obama was the speaker at the U.S. Air Force Academy graduation in Colorado Springs, where these newly graduated lesbian and gay cadets took their rightful place alongside their heterosexual classmates. How fitting that the president who secured the end to LGBT discrimination in the armed forces participated in this historic moment.

For some of us, the fearless courage of the new cadets is a given because we have made strides to live authentic, integrated lives in which we claim the fullness of our humanity. In decades to come, people will look back at this moment and wonder why it was a big deal. It is a seismic moment, reminding us of the courage and self-love that it takes to step beyond whatever encloses us, keeping us from the fullness of our magnificence and well-being -- no matter who we are.

Like many LGBT people, my journey to coming out was a circuitous one. Living in South Africa in the oppressive apartheid years, it felt physically unsafe to be out. In the years that followed in my new home in New York, each step out of the closet to claiming my identity was matched with a half-step back. It did not always feel emotionally and spiritually safe to be transparent. The bad advice of those who loved me, expressing concern for my welfare and employment as they urged me to be circumspect, was like a sedative keeping me from being fully human.

In a transformative moment, I responded to the veiled threats of being outed and attacked for the sexual orientation that comprises a part of my identity. In my night sweats of fear about an imminent outing I discovered a wake-up call. No longer would I ever again live with the threat of denying my fullness. No longer would I freely give such power to others. Instead, I made a choice to claim my story, voice and love just as these cadets have done.

It was a new moment on the road to living an integrated life. My sexual orientation would be as fully embraced as my love of cooking, exercise and mystery novels. It would become a co-equal identifier along with my Palestinian and South African heritage, my experiences as an exile and an immigrant. They would co-exist in unexpected new harmony.

My own fears were not about the people I loved rejecting me. They were all fears about those outside of my immediate circle of trust and love, fears of losing a job and being rejected as a community leader. In naming and befriending my fears, their power to confine and define me was deflated.

The pioneering cadets who are out about who they are have probably not arrived at that truth without courage and struggle. The world needs their voices as much as the suspension of "Don't Ask Don't Tell" needs it in order to live into the promise of full inclusion without threat, fear or intimidation. Their personal struggles dealing with the dying remnants of homophobia as the institution they serve adapts to new realities will still be real. But they already know the enlivening freedom from fear.

Courage emerges from the self-love that demands your own well-being. These Air Force cadets invite others to give voice and imagination to the inclusive well-being of all.

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The Condition Nearly 1 In 4 Teens Are Being Diagnosed With

The Condition Nearly 1 In 4 Teens Are Being Diagnosed With

The number of teens in the U.S. with diabetes or prediabetes has skyrocketed in the last decade, jumping from 9 to 23 percent, new data finds.

Other cardiovascular risk factors, including high blood pressure and bad cholesterol, were stable during that period, but remain relatively high.

"This has serious long-term public health implications for this country," said Dr. Vivian Fonseca, president of medicine and science with the American Diabetes Association, who was not involved in the research. "We're likely to see a lot of people get diabetes and have cardiovascular events at a relatively young age over the next 10 to 20 years."

The new data, published online in the journal Pediatrics Monday, includes nearly 3,400 children ages 12 to 19 from the Centers for Disease Control's National Health and Nutrition Examination Survey, designed to track the health and nutrition of Americans.

The percent of overweight and obese teens did not change significantly from 1999 through 2008, hovering around the current estimate of 34 percent. The prevalence of prehypertension and high blood pressure also stayed relatively stable, at around 14 percent, as did high levels of LDL or "bad" cholesterol, at 22 percent. Low levels of HDL or "good" cholesterol stayed at about 6 percent.

However, the prevalence of prediabetes and diabetes jumped significantly, from 9 percent of teens in 1999-2000 to 23 percent in 2007-2008.

"I am reassured that at least we haven't seen a continuing rise in the rate of childhood obesity,” said Dr. Lori Laffel, chief of pediatrics at the Joslin Diabetes Center and a professor at Harvard Medical School.

“I am reassured that most of the cardiovascular risk factors the researchers looked at have not increased," she continued. "But it is concerning that it looks like the rates of prediabetes and diabetes have more than doubled over that 10-year period."

Laffel said that the results should be validated and raise interesting questions about what, if anything, is driving the change in diabetes rates. For example, she said it is somewhat puzzling that obesity rates have stayed relatively stable while diabetes has increased, given the close ties between the two. Obesity increases the risk of impaired glucose tolerance, insulin resistance and the development of type 2 diabetes in both adults and children.

But overall, the new study does reinforce the link between obesity and heart-health risk factors.

About half of the overweight teens and more than 60 percent of the obese participants had at least one cardiovascular risk factor, a finding researchers call "concerning, given growing evidence demonstrating that cardiovascular risk factors present during childhood may persist into adulthood." The most common combination of risk factors among those teens was bad cholesterol and high blood pressure, or prehypertension, both of which can increase the risk of developing heart disease.

"This really speaks to the need for pediatricians to be vigilant about following screening recommendations, especially for obese and overweight teens," said study co-author Ashleigh May with the CDC's division of nutrition, physical activity and obesity, adding that 35 percent of normal-weight teens also had at least one risk factor. "We do see these risk factors are high for all youth, not just overweight and obese youth."

What the study points to, she said, is a pressing need for better prevention given that even moderate changes can have profound results. Studies have suggested that by eating less fat and fewer calories, and getting the equivalent of around 20 minutes of exercise per day, people can reduce their risk of developing diabetes by nearly 60 percent.

"We do know that we can slow or even halt the progression of prediabetes and diabetes," said Fonseca.

But the new findings raise serious red flags about what could happen without improved intervention and prevention.

"This is telling us that there is a very high prevalence of obesity-related problems in people in the age group 12 to 19. That's something we used to see only in people in their 40s," Fonseca said. "What this really means is that people are going to get serious health issues when they're in the prime of their lives."

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David Katz, M.D.: The Problem With Our Approach To The Obesity Epidemic

David Katz, M.D.: The Problem With Our Approach To The Obesity Epidemic

That's dam"m"ed, not dam"n"ed.

A CDC report issued today from the Division of Unintentional Injury Prevention reveals that drowning causes more deaths among children age 1 to 4 in the U.S. than any other cause except congenital anomalies.

This is a terrible, tragic, and obviously extremely important subject in its own right -- just not one in which I have any particular expertise.

Since my work doesn't relate directly to drowning -- other than having been a lifeguard and swim instructor earlier in life, and having taught all my kids, and many others, to swim -- I want to talk about my usual topic -- epidemic obesity -- because I think the two are more related than most people realize.

The Institute of Medicine recently released its report on what it will take to fix the problem of epidemic obesity. Timed to coincide with the Weight of the Nation scientific conference and mini-series on HBO, the intent -- well served, I think -- was to draw the nation's attention to the urgency of this issue more forcefully than ever.

The urgency relates to the dire human toll of rampant obesity and its consequences among children and adults alike. I have addressed this topic on any number of prior occasions, and I trust you don't want to hear about it again. There is a point at which doom and gloom simply cause us all to tune out.

The novel elements that figured in the programming this time around included, for one, a new perspective on the price tag -- the opportunity to save, or spend, over a half-trillion dollars on obesity between now and 2030. And, for another, a dedicated focus on the solution.

The solution is what the IOM report, "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation," is all about. There are, of course, plenty of particulars in the full report, but the authors distilled the gist down to these five bullet points:

• Integrate physical activity every day in every way
• Market what matters for a healthy life
• Make healthy foods and beverages available everywhere
• Activate employers and health care professionals
• Strengthen schools as the heart of health

That's pretty succinct, but really could be made more so. The solution to epidemic obesity and its unsustainable toll in both human and dollar costs is: Fix everything.

I don't disagree. We have epidemic obesity for many good reasons. Fundamentally, we have converted a world in which calories were relatively scarce and hard to get and physical activity unavoidable into a world where physical activity is scarce and hard to get and calories are unavoidable.

We've solved the age-old problem of food scarcity by devising, for our part of the world at least, food excess. We've solved the problem of over-taxed muscles by devising technology to do just about everything muscles used to do. We've solved the problem of food spoilage by devising highly processed foods that might literally have a longer shelf life than the person eating them.

And, whereas we relied on people's intrinsic motivation to eat throughout all of history up until now, we have devised an industry dedicated entirely to talking people into eating more. Vast sums of money are exchanged both on marketing the dietary excesses that spawn obesity, and dieting programs that promise to fix it. An intelligent life form from elsewhere looking at this would surely conclude: We are nuts!

But of course, it's not all crazy. Some of it is just momentum. We've spent thousands of years working to overcome the challenges of too little food and too much physical exertion. We got caught up in these efforts and overshot the target! It's hard to reverse 12,000 years of human inertia, but that's what the IOM is recommending.

The IOM and I agree -- we need to fix everything. We need physical activity to populate our daily routines once again. We need healthful foods in reasonable quantities to constitute our diets once again. We need time for food preparation. We need to sleep better, and manage stress -- so we have the energy and equanimity to eat well and exercise.

But there are problems with a "fix everything" platform, no matter how defensible it may be.

First, no one is in charge of everything: food marketing, farm subsidies, sin taxes, school programming, school food, nutrition labeling, worksite wellness, transportation, and so on. And since no one is in charge of everything, calls to fix everything have the potential to lead nowhere -- because everyone assumes someone else should get it all done.

And second, even if we can figure out where the buck should stop, fixing everything can be quite overwhelming. And when we feel overwhelmed, we may not even bother to try. That tends to happen at the individual level, where people who don't feel they can succeed at eating well or being active simply abandon the effort. But it can also play out at the level of policy, where if doing it all is out of the question, the alternative all too often is doing nothing.

Since I have been wrestling with just such misgivings for years, I have settled on a particular view of what fixing everything looks like that I believe can help. Fixing everything is like building a levee.

I like the levee metaphor -- and have relied on it to guide my own health efforts, personal and professional, for years -- for three reasons.

First, the challenges we confront may be likened to a flood. A flood (800,000 items strong!) of highly processed, hyper-palatable, energy-dense, nutrient-dilute, glow-in-the-dark, betcha-can't-eat-just-one kind of foods. A constant flow of marketing dollars encouraging us -- and our kids -- to overconsume the very foods that propel us toward obesity and early-onset chronic disease. Wave after wave of technological advance, endowing us with devices that do things muscles used to do at work, and at play.

Second, a levee helps relieve the burden of a daunting task. Holding back a river is a daunting task. But no one person has to do all that! All anyone needs to do is stack a bag of sand. Stack one bag (or more than one) of sand, and you are part of the solution -- and thus not part of the problem. A levee is achieved incrementally -- and so, too, can we turn the tide of epidemic obesity.

And, finally, the levee illustrates a precautionary tale. Imagine the folly of putting one bag of sand along the bank of a flooding river and then asking: Are we dry yet? No one sand bag, no matter how good, can possibly contain a cresting river. No one sand bag can do what the whole levee can do. And similarly, no one program, or policy, or practice will fix obesity and related chronic disease for society. But we tend to think -- or at least wish -- it would. We are a quick fix, silver bullet, active ingredient kind of society.

But the active ingredient in fixing epidemic obesity is eating well and being active and everything that helps us get there. No one sandbag will do.

What are the sandbags in such a levee? I've written about them before, on more than one occasion, in both the peer-reviewed literature and here; cried out for them from any podium I'm granted; and established a non-profit foundation devoted entirely to making them available.

The levee is more than a good metaphor -- it's a method. There are no clear marching orders that correspond with "fix everything." But the marching orders related to levee-building are clear to the point of intuitive. Choose a bag of sand, and set it on the bank.

Which brings us back to the report on drowning. In the case of drowning, it's obvious we should not focus on lotions, potions, or pills. It's obvious we should not focus primarily on better ways to treat drowning when we have the option to prevent it. It's obvious the "fault" lies with an environment that makes drowning possible or likely, and not with the children.

With regard to obesity, we have overlooked all these same considerations. So it's time to start looking over the obesity floodplain we have been overlooking, and build the levee -- one sandbag at a time.

And in the interim, we need to recognize we are drowning in a flood of calories and labor-saving technology of our own devising, and willpower does not keep people afloat. Skill power does. Everybody can learn how to swim- and while waiting on the world to change, everybody needs to do just that.

-fin

Dr. David L. Katz; www.davidkatzmd.com
www.turnthetidefoundation.org

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