When I was growing up, I was big. I'm not sure where exactly I fell in relation to other kids my age, because I rarely went to the doctor. That's what happens when you don't play sports and move every couple years, and thus don't have a good relationship with a doctor. But, I was definitely bigger than most kids. And I got teased for it. Throughout high school, I wore a giant, baggy jacket, because I was so ashamed about my body. As a sophomore in high school, I was asked by another student if I was pregnant. One of my friends desperately wanted me to go to the homecoming dance as a freshman so that I could have a Cinderella moment.
Point being, I know what it's like to have a low self-esteem.
But, as a doctor, I also know the harms of childhood obesity. I've talked about it before. So, I want young girls to get healthy and be at a healthy weight.
Problem is, weight is a very sensitive subject for adolescent girls. I saw a girl in clinic who completely shut down on me, to the point where we got a social worker to come talk to her, because I mentioned she was heavier than was healthy. It's not an easy subject to discuss, and I hate bringing it up, but I do it because it's in their best interest.
Well, a recent study has come out that may affect how I bring up the topic. This study took a group of girls and asked if someone had ever called them 'too fat'. They specifically asked about family members, teachers, and peers. Girls who were labeled as such at age 10 were significantly more likely to be obese at age 19 than those who were not, independent of what weight they started at.
Makes you wonder about all that media that girls consume now, doesn't it? How they are comparing themselves to the size 0 models in magazines, or worse, real women who are photoshopped to be unrealistic in proportions. Or how Ursula and the Queen of Hearts underwent a makeover to make them skinnier.
Yes, obesity is a problem.
But you know what? I was at my healthiest weight when I felt great about myself. It took me a long time to get there--years of affirmation by someone I loved. But I became happier with myself, accepting of myself, and started to walk around with confidence. And those extra pounds melted off.
So maybe the focus should be on body image, and not weight. After all, there is also such a thing as being too skinny.
Showing posts with label adolescence. Show all posts
Showing posts with label adolescence. Show all posts
Sunday, June 29, 2014
Sunday, June 22, 2014
The Elusive Good Night's Sleep
I know, I haven't posted the past 2 weeks. This is what happens when you have to move and lack internet for a week.
Sleep is a very important part of our lives. After all, we spent roughly 1/3 of our lives sleeping. There are several theories on why, exactly, we need sleep. My favorite is the converting of short-term memory to long-term memory. Essentially, if you don't get enough sleep, you won't learn anything new. But for now, I'm going to focus on how much we need and how to get that sleep. In fact, this was the focus of a recently published article that has caught the attention of many news sites.
It's more than just memory, though. Getting less sleep than you need can result in poor academic performance. According to a small study by the American Academy of Sleep Medicine, this effect is as much as binge drinking or smoking marijuana, independent of other risk factors such as psychiatric disorders.
Sleep has also been linked to weight, particularly in adults. A recent study published in Pediatrics shows that getting less than the recommended amount of sleep in infancy and childhood is linked to obesity by age 7. Indeed, even how much a parent sleeps can affect how much the child sleeps, and thus his or her risk of obesity later in life.
Finally, sleep is the time when many hormones are released. For children, the most important of these is growth hormone. That's right--if children don't get enough sleep, they might not grow properly. As an aside, the unbalance of hormones is likely part of the reason why lack of sleep can lead to obesity--the body produces hormones to increase alertness, which promote deposition of fat for future use.
So clearly sleep is important. But how much do we need?
The amount of sleep we need is entirely based on age. Infants sleep most of the day, while adults only need 8 hours or so. Infants also don't sleep at 'normal' times, because they are accustomed to being in the womb and rocked to sleep while mom was awake and walking, and awake when mom was resting. When adults don't get enough sleep, they tend to develop quick tempers and have low energy. When children don't get enough sleep, though, they tend to become hyperactive. Many parents have experienced this with infants that cry more when they aren't put to bed on time.
By two months of age or so, the circadian rhythm starts to develop. This is our body's innate way of telling time, and is based on light clues. In a completely cut-off environment, a normal circadian rhythm lasts about 25 hours. Of course, we don't live in a world where the day is 25 hours long, so this is where the light cues come in.
One of the first things we, as pediatricians, do when we hear a child is not getting enough sleep is to ask about sleep hygiene. Where do you sleep? What time do you go to bed? What time do you get up? What else is in your room?
Lack of light triggers the release of melatonin, a hormone that helps us feel sleepy and fall asleep. If your room is filled with light, even lights from computers, iPads, televisions, etc, you could inhibit your release of melatonin and have a harder time falling asleep. So, one of the first things we recommend is to get those computers and televisions and whatnot out of the bedroom. Even if you don't use them right before bed, the lights that stay on can influence your melatonin production. You can also condition yourself unintentionally into not associating the bedroom with sleep, but rather with activity.
Getting up and going to bed at the same time every day, even on weekends, can also help your body just get used to going to sleep at the same time. I realize this isn't ideal for adults, but there's no reason kids shouldn't have a consistent bedtime.
Finally, as we get older (by early elementary school), our sleep cycles become more consistent and average out to 90 minutes each. Waking in the middle of a sleep cycle can be very disorienting, and can make you feel tired all day. So, bedtime and alarms should be planned so there is a multiple of 90 minutes in the sleep time. In other words, you should try to ensure you are getting 6 hours, 7.5 hours, 9 hours, or 10.5 hours of sleep (depending on age, with younger kids needing more sleep), rather than 8, 10, or 6.5 hours.
This is only an introduction, and I'm sure I'll talk about it more in the weeks to come, but to not bore you too much, I'll leave it there for now.
Have additional questions? Leave them in the comments!
Sleep is a very important part of our lives. After all, we spent roughly 1/3 of our lives sleeping. There are several theories on why, exactly, we need sleep. My favorite is the converting of short-term memory to long-term memory. Essentially, if you don't get enough sleep, you won't learn anything new. But for now, I'm going to focus on how much we need and how to get that sleep. In fact, this was the focus of a recently published article that has caught the attention of many news sites.
It's more than just memory, though. Getting less sleep than you need can result in poor academic performance. According to a small study by the American Academy of Sleep Medicine, this effect is as much as binge drinking or smoking marijuana, independent of other risk factors such as psychiatric disorders.
Sleep has also been linked to weight, particularly in adults. A recent study published in Pediatrics shows that getting less than the recommended amount of sleep in infancy and childhood is linked to obesity by age 7. Indeed, even how much a parent sleeps can affect how much the child sleeps, and thus his or her risk of obesity later in life.
Finally, sleep is the time when many hormones are released. For children, the most important of these is growth hormone. That's right--if children don't get enough sleep, they might not grow properly. As an aside, the unbalance of hormones is likely part of the reason why lack of sleep can lead to obesity--the body produces hormones to increase alertness, which promote deposition of fat for future use.
So clearly sleep is important. But how much do we need?
The amount of sleep we need is entirely based on age. Infants sleep most of the day, while adults only need 8 hours or so. Infants also don't sleep at 'normal' times, because they are accustomed to being in the womb and rocked to sleep while mom was awake and walking, and awake when mom was resting. When adults don't get enough sleep, they tend to develop quick tempers and have low energy. When children don't get enough sleep, though, they tend to become hyperactive. Many parents have experienced this with infants that cry more when they aren't put to bed on time.
By two months of age or so, the circadian rhythm starts to develop. This is our body's innate way of telling time, and is based on light clues. In a completely cut-off environment, a normal circadian rhythm lasts about 25 hours. Of course, we don't live in a world where the day is 25 hours long, so this is where the light cues come in.
One of the first things we, as pediatricians, do when we hear a child is not getting enough sleep is to ask about sleep hygiene. Where do you sleep? What time do you go to bed? What time do you get up? What else is in your room?
Lack of light triggers the release of melatonin, a hormone that helps us feel sleepy and fall asleep. If your room is filled with light, even lights from computers, iPads, televisions, etc, you could inhibit your release of melatonin and have a harder time falling asleep. So, one of the first things we recommend is to get those computers and televisions and whatnot out of the bedroom. Even if you don't use them right before bed, the lights that stay on can influence your melatonin production. You can also condition yourself unintentionally into not associating the bedroom with sleep, but rather with activity.
Getting up and going to bed at the same time every day, even on weekends, can also help your body just get used to going to sleep at the same time. I realize this isn't ideal for adults, but there's no reason kids shouldn't have a consistent bedtime.
Finally, as we get older (by early elementary school), our sleep cycles become more consistent and average out to 90 minutes each. Waking in the middle of a sleep cycle can be very disorienting, and can make you feel tired all day. So, bedtime and alarms should be planned so there is a multiple of 90 minutes in the sleep time. In other words, you should try to ensure you are getting 6 hours, 7.5 hours, 9 hours, or 10.5 hours of sleep (depending on age, with younger kids needing more sleep), rather than 8, 10, or 6.5 hours.
This is only an introduction, and I'm sure I'll talk about it more in the weeks to come, but to not bore you too much, I'll leave it there for now.
Have additional questions? Leave them in the comments!
Sunday, February 23, 2014
When Food Becomes the Enemy
This week is National Eating Disorder Awareness Week, so it feels fitting that this week's blog be about eating disorders. There are roughly 30 million people (10 million men and 20 million women) in the US who suffer from an eating disorder sometime during their lifetime. That's roughly 10%. The highest risk group are the 15-19 year olds, but those as young as 6 concerns over their body weight or shape.
What is an eating disorder? An eating disorder is an abnormal way of eating that leads to some sort of impairment and is usually related to concern over weight or body image. There are several types of eating disorders, all of which have slightly different characteristics.
Anorexia nervosa is one of the more common eating disorders. It is characterized by restriction of food intake, an intense fear of gaining weight, and abnormal body image (not feeling that they are underweight despite being underweight).
It is also the eating disorder with the highest risk of death. Due to starvation, the body's systems begin to shut down. One of the first signs of severe disease is the loss of menses (periods) in women. Other problems include muscle loss and weakness, changes in hair and skin, and changes in the heart muscle, which can lead to heart failure and death.
Anorexia is very much about control. These individuals will closely monitor how much they eat, may exercise excessively to burn additional calories, and tend to have other psychiatric disorders as well. Sometimes they are victims of abuse, and feel that anorexia is the only way that they can control their lives.
In some ways, anorexia has become glorified. There are "Pro-ana" websites out there, such as (TRIGGER WARNING) this one that promote anorexic behavior. There have been a number of celebrities with anorexia, including Karen Carpenter (died from complications of anorexia), Mary-Kate Olson, and Evanna Lynch (known for playing Luna Lovegood in the Harry Potter movies). Thankfully, most of these celebrities have sought treatment.
Bulimia nervosa is the other commonly known eating disorder, and is characterized by binging (eating large amounts of food), followed by behaviors to limit weight gain, such as purging (self-induced vomiting) or excessive exercise. These individuals are typically of a normal weight or slightly overweight (contrasted to those with anorexia, who are usually underweight). While anorexia is all about control, bulimia is more about loss of control, which leads to these binging episodes, followed by guilt, which leads to the behaviors to limit weight gain.
Bulimia comes with it's own host of health problems, most of which are associated with the purging: body chemistry imbalances (which can lead to heart failure and death), tooth decay, risk of tearing the esophagus, GI ulcers, and bad breath.
Note that not all people who purge suffer from bulimia; you can also be anorexic and purge.
Notable individuals who have suffered from bulimia include Demi Lovato, Katie Couric, and Lady Gaga.
There are other eating disorders as well, including Binge Eating disorder, which is characterized by binging without purging, and EDNOS or OSFED, which is a catch-all category for other forms of disordered eating that impair functioning.
The problem with all eating disorders, and the difficulty that lies in their treatment, is that we must all eat to survive, and those with an abnormal relationship with food have difficulty correcting it. It's not like smoking or drinking, where you can avoid the source of the problem with enough self-control. It truly takes a whole team to manage an eating disorder: a general physician to monitor overall health, a therapist to deal with the body image issues, and sometimes inpatient treatment to ensure that they don't kill themselves in the process of recovery (refeeding syndrome can be a problem in the treatment of severe anorexia).
If you or anyone you know has an eating disorder, seek help. NEDA has many resources available, and has a phone number and e-mail (located on the left sidebar below the menu) for anyone who needs help.
What is an eating disorder? An eating disorder is an abnormal way of eating that leads to some sort of impairment and is usually related to concern over weight or body image. There are several types of eating disorders, all of which have slightly different characteristics.
Anorexia nervosa is one of the more common eating disorders. It is characterized by restriction of food intake, an intense fear of gaining weight, and abnormal body image (not feeling that they are underweight despite being underweight).
It is also the eating disorder with the highest risk of death. Due to starvation, the body's systems begin to shut down. One of the first signs of severe disease is the loss of menses (periods) in women. Other problems include muscle loss and weakness, changes in hair and skin, and changes in the heart muscle, which can lead to heart failure and death.
Anorexia is very much about control. These individuals will closely monitor how much they eat, may exercise excessively to burn additional calories, and tend to have other psychiatric disorders as well. Sometimes they are victims of abuse, and feel that anorexia is the only way that they can control their lives.
In some ways, anorexia has become glorified. There are "Pro-ana" websites out there, such as (TRIGGER WARNING) this one that promote anorexic behavior. There have been a number of celebrities with anorexia, including Karen Carpenter (died from complications of anorexia), Mary-Kate Olson, and Evanna Lynch (known for playing Luna Lovegood in the Harry Potter movies). Thankfully, most of these celebrities have sought treatment.
Bulimia nervosa is the other commonly known eating disorder, and is characterized by binging (eating large amounts of food), followed by behaviors to limit weight gain, such as purging (self-induced vomiting) or excessive exercise. These individuals are typically of a normal weight or slightly overweight (contrasted to those with anorexia, who are usually underweight). While anorexia is all about control, bulimia is more about loss of control, which leads to these binging episodes, followed by guilt, which leads to the behaviors to limit weight gain.
Bulimia comes with it's own host of health problems, most of which are associated with the purging: body chemistry imbalances (which can lead to heart failure and death), tooth decay, risk of tearing the esophagus, GI ulcers, and bad breath.
Note that not all people who purge suffer from bulimia; you can also be anorexic and purge.
Notable individuals who have suffered from bulimia include Demi Lovato, Katie Couric, and Lady Gaga.
There are other eating disorders as well, including Binge Eating disorder, which is characterized by binging without purging, and EDNOS or OSFED, which is a catch-all category for other forms of disordered eating that impair functioning.
The problem with all eating disorders, and the difficulty that lies in their treatment, is that we must all eat to survive, and those with an abnormal relationship with food have difficulty correcting it. It's not like smoking or drinking, where you can avoid the source of the problem with enough self-control. It truly takes a whole team to manage an eating disorder: a general physician to monitor overall health, a therapist to deal with the body image issues, and sometimes inpatient treatment to ensure that they don't kill themselves in the process of recovery (refeeding syndrome can be a problem in the treatment of severe anorexia).
If you or anyone you know has an eating disorder, seek help. NEDA has many resources available, and has a phone number and e-mail (located on the left sidebar below the menu) for anyone who needs help.
Sunday, February 16, 2014
Having Kids Young: A Saga of Teen Pregnancy
Teen pregnancy. It was a fairly commonplace occurrence back in the 'old days', when 12 and 13 year olds were married off and made to have children. Now, it's something that will get you, in many ways, ostracized from normal society. Because there are many issues surrounding this topic, I will focus on them one at a time. There are also a number of charged political issues surrounding this topic, most notably the idea that teenagers can make their own medical decisions with regard to reproductive health, as well as the availability and use of contraception and abortion, particularly in the teenage population. I will do my best to limit my bias in those topics, but discussing them at all presents a bias on its own, so I can't make every piece completely unbiased.
For today, we'll examine the trends in teenage births (in the US).
The data that contains the most time is that of the National Vital Statistics Reports, covering the time period from 1940 to 2000. During this time period, we reached a peak of teen births in 1957, with a rate of 96.3 per 1,000 births. That means for every 1,000 babies more in 1957, roughly 96 of them were born to girls aged 15-19. Up until 1965 or so, we were still in the baby boom--the same population that has now grown up and is currently entering or in retirement. The fact that 1957 was the peak indicates that the desire to have children was present even in the teenagers of the era, who were too young to participate in the war itself.
A few more statistics that might be relevant: in 1950, the marriage rate in the US was 11.1%; in 1960, it was down to 8.5%. I don't have the numbers for the individual years, but the peak of births may very well have corresponded with a drop in marriage rates (fewer people getting married --> fewer people having children in future). Of course, that data does not break it down into teens vs. older women, so it may not be relevant at all. In addition, it should be noted that a 'soft peak' in the overall birth rate was seen in 1957 as well (see 1958 data, page 76), as 1958 began the decline of the overall birth rate as well.
After 1957, there was a steep decline in teen births, which was also associated with an increase in the percentage of these births to unmarried women. That is, prior to 1957, only 10% or so of births to women 15-19 were to unmarried women (so in 1957, 10 per 1000 babies was to an unwed teen). After 1957, as the birth rate decreased, the number of those to unmarried women increased. By the early 1980s, the teen birth rate was about 50 per 1,000 births, and half of them were to unmarried women (that is, roughly 25 per 1,000 babies born in the early 80s were to unwed teens).
In the late 1980s, we experienced an increase in the rate of teen births, which hit another peak in 1991 at 61.8 per 1000 births. Since 1991, though, teen birth rates have been declining, reaching an all-time low of 29.4 in 2012 (the most recent data available). Meanwhile, during that same period, overall births in the US have remained roughly the same, between 60 and 70 births per 1000 women since the mid-70s.
One more thing that is important to note; these statistics all refer to rates, not hard numbers. However, as the numbers from 2012 point out, we also experienced the lowest number of babies born to teen mothers in 2012 since the end of WWII. The year 1970 was the highest for the number of babies, at 644,708; for 2012, only 305,420 babies were born to girls aged 15-19.
However, note that all these statistics refer to live births by teenage mothers during the time period. It does not include abortions, miscarriages, or still-births. But those are a discussion for another blog.
So next time someone tells you that teen pregnancy is out of hand, it's worth it to refer to these statistics and point out that teen birth rates have been declining since 1991. The reason is likely multifactorial, and, once again, is a discussion for another blog.
Until next week!
For today, we'll examine the trends in teenage births (in the US).
The data that contains the most time is that of the National Vital Statistics Reports, covering the time period from 1940 to 2000. During this time period, we reached a peak of teen births in 1957, with a rate of 96.3 per 1,000 births. That means for every 1,000 babies more in 1957, roughly 96 of them were born to girls aged 15-19. Up until 1965 or so, we were still in the baby boom--the same population that has now grown up and is currently entering or in retirement. The fact that 1957 was the peak indicates that the desire to have children was present even in the teenagers of the era, who were too young to participate in the war itself.
A few more statistics that might be relevant: in 1950, the marriage rate in the US was 11.1%; in 1960, it was down to 8.5%. I don't have the numbers for the individual years, but the peak of births may very well have corresponded with a drop in marriage rates (fewer people getting married --> fewer people having children in future). Of course, that data does not break it down into teens vs. older women, so it may not be relevant at all. In addition, it should be noted that a 'soft peak' in the overall birth rate was seen in 1957 as well (see 1958 data, page 76), as 1958 began the decline of the overall birth rate as well.
After 1957, there was a steep decline in teen births, which was also associated with an increase in the percentage of these births to unmarried women. That is, prior to 1957, only 10% or so of births to women 15-19 were to unmarried women (so in 1957, 10 per 1000 babies was to an unwed teen). After 1957, as the birth rate decreased, the number of those to unmarried women increased. By the early 1980s, the teen birth rate was about 50 per 1,000 births, and half of them were to unmarried women (that is, roughly 25 per 1,000 babies born in the early 80s were to unwed teens).
In the late 1980s, we experienced an increase in the rate of teen births, which hit another peak in 1991 at 61.8 per 1000 births. Since 1991, though, teen birth rates have been declining, reaching an all-time low of 29.4 in 2012 (the most recent data available). Meanwhile, during that same period, overall births in the US have remained roughly the same, between 60 and 70 births per 1000 women since the mid-70s.
One more thing that is important to note; these statistics all refer to rates, not hard numbers. However, as the numbers from 2012 point out, we also experienced the lowest number of babies born to teen mothers in 2012 since the end of WWII. The year 1970 was the highest for the number of babies, at 644,708; for 2012, only 305,420 babies were born to girls aged 15-19.
However, note that all these statistics refer to live births by teenage mothers during the time period. It does not include abortions, miscarriages, or still-births. But those are a discussion for another blog.
So next time someone tells you that teen pregnancy is out of hand, it's worth it to refer to these statistics and point out that teen birth rates have been declining since 1991. The reason is likely multifactorial, and, once again, is a discussion for another blog.
Until next week!
Subscribe to:
Posts (Atom)