Obesity Is a Disease?

I'd heard that the AMA had reclassified obesity from "condition" to "disease" but this news stayed in the periphery of my mind until I read this blog post by a college friend, Danielle. (I must note that Danielle is one of my amateur running heroes and she helped me run to my current 5k PR in January.)

After I read her post this morning, my mind was abuzz. As someone who is most definitely not predisposed to thinness, due to genetics, growing up near the poverty line, and other biological, socio-economic, and emotional factors that contribute to weight gain and retention, I'm worried about the implications of this new diagnosis.

When I was living in Lancaster, PA, in 2010-2011, I started having some health problems. It got to the point that I, one night, around 2 a.m., I drove myself to the hospital because I fully believed I was having a heart attack. Turns out, my heart was fine but my anxiety level was through the roof. Prompted by this scare, I found a primary care physician and we began the process of trying to figure out what was wrong.

My symptoms weren't limited to phantom heart attacks either. I was tired all the time, missed my period for months on end, had constant, achy pain near my liver/gall bladder, in my knees, and in lots of other places as well.

Through a series of tests, I was diagnosed with fatty deposits on my liver, PCOS (poly-cystic ovarian syndrome), insulin-resistance, and anxiety/depression. So, I was prescribed birth control, anti-depressants, and Metformin (for the insulin-resistance). I spent the next six weeks barely able to function because the anti-depressants and Metformin made me so nauseous. I was able to stop the Metformin immediately, but there was a weaning off period for the anti-depressants.

Six months later, the birth control hadn't made any impact - I was still missing periods and growing a beard. At one point, I had an ultrasound and there was no evidence of ovarian cysts. I was still having the same aches and pains everywhere. Nothing was better!

When I look back on those months of tests and failed treatments, I remember my first meeting with my doctor. During that appointment, I came out with the big question no one wants to ask: Could all of these symptoms be a result of how overweight I am? Instead of engaging the conversation, perhaps burned out on giving advice that was never taken, my doc dismissed my question and wrote some prescriptions. I was so tired and anxious that I didn't keep asking. If a pill was going to help, I would try.

Two years and a lot of hard, sometimes tedious work later, I've changed my diet, made exercise a regular part of my life, lost over 70 pounds, and all of my symptoms are gone. Every. Single. One. Including the anxiety and depression and the sore knees (some anecdotal evidence that extra weight and a sedentary lifestyle were far worse for my knees than running ever could be).

I don't blame my doctor for being reluctant to start a conversation that probably goes unheeded by many, if not most, people, but I was literally asking her to hit me with reality and she chose to ignore my interest. Let me be clear: She absolutely is not to blame for my continued inaction but she might have made a huge impact by continuing the conversation I was trying to start.

So, maybe it's good that people can be diagnosed with obesity. Maybe it means that people will be able to get the treatment they need and it will be covered by insurance. Maybe it will make it easier for doctors to start the conversation that begins with, "You know all these problems you're having? A lot of them could be solved by getting rid of the extra pounds you've been carrying around."

I'm a little skeptical, though. Being diagnosed as obese will certainly be a wake-up call for some. But I have to wonder what kind of treatment people will expect. Don't we treat diseases with pills and procedures? Will people be satisfied with their new diagnosis when they learn that the best treatment is diet and exercise? Or will they expect a surgery or medication to fix it quick?

I have other concerns and questions, too. How will obesity be measured? If it's BMI, Lord help us all. Will all overweight/obese people be considered ill? Will treatment be required if one's weight is above an acceptable limit? Will this increase fat stigma beyond what it already is? And on and on...

I'd love to hear thoughts from my very small peanut gallery. What was your initial thought when you heard the news that the AMA considers obesity a diagnosable disease?

First Ever Gear Review: Nathan Minimist Hydration Pack

I am a guzzler. Even before I started running, I would drink between 64 and 128 ounces of water every day. Since I started, my minimum has increased to about 96 ounces on a rest day. I don't force myself to drink that much, it's just what keeps me happy.

If I'm running less than 10 miles in cool conditions, I don't carry any water. Any more than that and I want some with me. In warmer weather, I've started taking water for anything over six miles. I've carried water in all three of the half marathons I've run. The courses were all well-supported but after running the Georgetown 10-miler, which had abysmal course support for this back-of-the-packer, I'm a little paranoid about being able to drink when I want to rather than when the course dictates it. On race day, I bring my own water and drink the race's sports drink.

After the G10 debacle, I asked friends for advice on hydration options. I knew I didn't want to carry anything in my hand, even with a strap. Wearing a SPIbelt for several runs helped me realize I didn't want a belt-style hydration system. For me, a pack/vest was the best option. Most of the people I asked about this option suggested Nathan as a quality brand.

Minimist: behind me all the way!
Since I'm a recreational runner with a limited budget, I chose the Minimist, which is one of Nathan's most basic race vests. The website's description of the pack: "Just what you need and nothing more with featherlight fabrication, a 1.5 L bladder, zippered back storage, and front pockets for phone and essentials." The pack itself weighs 11 oz. I can't remember how much I paid, but I'm pretty sure it was around $50. It's currently $59.95 on RunningWarehouse.com.

I was spurred to write this review when a friend saw my pack in my most recent race photo and asked how I liked it. As my list of pros grew longer, I realized I should review this awesome product that's made my running more enjoyable.

Here's a quick list of the things I like about the Minimist:
  1. Featherlight isn't an exaggeration.
  2. The pack fits snugly, comfortably, and doesn't move unless I move it.
  3. Adjustments can be made quickly and easily even while on the move.
  4. It has enough pockets to make up for the lack of pockets in women's running clothes.
  5. It holds enough water for me for 13 training miles even in hot weather.
  6. The open design would allow me to use a larger bladder without buying a new pack.
  7. As far as running gear goes, it's affordable.
I've loved this pack since the first moment I put it on. It took me less than a minute to adjust it to my frame. Filling the bladder was easy and nothing leaked.

I tested it on a long run just a couple days after I received it - my first 10 mile training run. When I got started, I noticed a few things that needed to be cinched down, took care of it while I was on the run, and from that point, I didn't have to make a single adjustment to the fit. The pack stayed exactly where I put it, too. Even when I'm wearing a tank, nothing rubs, annoys or chafes. Once I've got it on properly, I barely notice my Nathan is on my back. Even after completing a half marathon, when all I want is to remove my shoes, hat, clothes, etc., I don't even think to unbuckle my Nathan because it fits so comfortably. While I'm on a run, the best thing a piece of gear can do is perform so admirably that I don't notice it.

The pack has four pockets. Two of the pockets have elasticized top openings and fit enough fuel for me for a half marathon (usually some Clif Shot Bloks and Jelly Belly Sports Beans). There's one zippered pocket that's large and stretchy enough for both my phone and 5th Gen iPod Touch (no smartphone for me). The fourth pocket has a Velcro closure. I've used this pocket for my car key. On a recent run, though, my key fell out. If the key hadn't hit my foot, I wouldn't have noticed it was gone and I would have had to retrace at least two miles of a long run, so I'll probably avoid keeping my key there in future.

There is a fifth pocket that I would potentially use in races in which there are major delays between getting to the start and starting or getting to the finish and getting your stuff. It's a large zipper pocket in the main section of the pack. Any item you put in it would be resting between the water bladder and your back. It could be useful for a light jacket, flip-flops, astronaut ice cream, or anything else that can be packed flat, is light, and you wouldn't mind carrying however far you're running.

So far, this pack's water-carrying capacity has been large enough for me to get through my longest training run of twelve+ miles. (I always keep some sports drink and food in my car for after long training runs.) It's also been a great resource in my halves, so I can decide when I want to drink instead of depending on the course or slowing down at water stops, though, as I mentioned, I do supplement my supply with the course-provided sports drink.

As I get to longer distances, I'm considering buying a 2L bladder. Because the pocket that holds the Minimist's bladder is open, I would be able to use a larger bladder without buying a new pack. It might stick up a little but that wouldn't bother me. In marathons, it might even be possible to have someone meet me mid-course to replace a depleted bladder with a full one.

There are only a couple things I'd change if I could:
  1. There is a clip for the hose on the upper chest strap but, even when it's clipped in, a good bit of the hose is left dangling off into space and joggling around. I troubleshoot this problem by tucking the nozzle under the shoulder strap but that's a duct-tape fix at best. I'd prefer the clip for the hose be on the shoulder strap. (EDITED [6/21/13]: I've since learned that the tube can be cut to the desired length, if you remove the bite valve and cut with sharp scissors. Of course, this assumes that the bite valve is simple to remove. See #4 below. [6/22/13]: With some elbow grease and trust in the quality of the product, I was finally able to separate the hose from the bladder and clean both. I also cut the hose to a better length.)
  2. I don't like red. Oh well. I rarely have to look at the pack while I'm on a run and most products of this type don't come in a wide variety of color choices. (This one is available in white but the vendor I purchased from didn't have that option. Even if they had, I wouldn't have chosen red.)
  3. The Velcro closure pocket isn't terribly effective at keeping things in. It's the tiniest of the pockets, though, and my stuff for a run can easily fit in all the others.
  4. Cleaning the bladder itself doesn't seem difficult but you're supposed to be able to separate the hose from the bladder and I have yet to be able to pull hard enough to make that happen because I don't want to damage the bladder or hose. My solution thus far has been to hang the bladder to dry after each time I use it, to empty the hose as much as possible, and to run clean water through before I drink from it.
Bottom Line: I would recommend this pack to anyone who doesn't care too much about bells and whistles but wants a simple, affordable, comfortable solution for carrying a lot of water a long way without using your hands or wearing a belt. I plan to continue using mine for a long time to come.

Tip for hot weather: Before my most recent half marathon, I filled the bladder with ice before I added water. Despite the heat and a two-hour wait from wake-up to race time, my water was cold for the first hour of my run. And, as an added bonus, the cool bladder was against my back, like an ad hoc ice vest. I wouldn't recommend freezing the bladder but I do fill it and keep it in the fridge the night before a long run.

How do you hydrate during a long run?