Thinly Minted

This is Taylor.  She recently posted a video of herself on YouTube (and it quickly went everywhere, sent to me by many readers, friends and family) decrying the Girl Scouts because the organization failed to notify her and her family of the fact that transgendered girls are allowed to be members of Girls Scout troops.  Because of her outrage, she is calling for a boycot of the annual cookie sale.

The ludicrous quality of this girls complaint seems to have registered on her, her family and probably her lawyer since her video has "gone private" as of today, meaning you have missed an opportunity to appreciate it.

I encourage readers to see Lisa Belkin's blogpost today Girls Scout Video: What were her parents thinking? where she lays blame squarely on the parents for raising an intolerant, pugnacious, offensive and "sanctimonious" daughter.

I for one, cannot wait for my neighborhood Brownies to peddle their cookies.  I might even buy a box of Samoas which I have always boycotted for their lousy taste.

Helping Fat People

This is not funny

When I was a rookie fellow in adolescent medicine in the Bronx in the 1980's, I was assigned a new patient, a "morbidly obese" fifteen year old who weighed over 200 pounds at about 5'2".  He moved with difficulty and he smelled even from across the room.   My assignment was to engage him in a program of weight management through diet and exercise.  He lived close to the hospital so we had weekly appointments.   After a few months of watching his weight increase, I decided to alter my therapeutic goals for him.  The purpose for our visits became simply managing his hygiene.  He and I bonded and he started to groom himself in a more age appropriate way.  I did nothing for his weight.

So now, I wonder if he is still alive, almost 30 years later.  I wonder if he suffered a heart attack or stroke, if he has diabetes, if he can walk at all or if he smells bad again.   If he's alive I  wonder if he was ever offered surgery to help manage his weight.

Nowadays, this young man would be evaluated for many problems beyond the not insignificant social ostracism he was experiencing.   With a BMI exceeding 35 he would be worked up for metabolic syndrome.  Experts disagree on what the components are, but they are some combination of large abdominal girth, elevated triglycerides, blood pressure, and fasting blood sugar.  He would also be evaluated for sleep apnea, gallbladder disease, Type II diabetes, thyroid disease and substance abuse. 

Current insurance companies might require my patient to undergo six months of medically supervised diet and weight managment.  Nowadays, if he continued to gain weight he might be a candidate for weight loss surgery. A recent article in the New York Times profiled a young woman with marginal success after laparoscopic adjustable gastric banding, the simplest and possibly safest of the procedures available to obese teens.  Her story underscores the continued efforts required by a multi-disciplinary team to promote the life-long lifestyle changes required to be successful at keeping the weight off. 

Many US childrens' hospitals are currently participating in a multi-center study of the efficacy and safety of "lap-band" surgery in adolescents.  Here is a quote from the website of the New York-Presbyterian Children's Hospital:

Our investigations evaluate the safety and success rates of laparoscopic adjustable gastric banding surgery in treating adolescents who are obese. There is substantial evidence worldwide that attests to the safety and efficacy of laparoscopic gastric banding, and we are now documenting its role in the adolescent population.

In addition to evaluating the general body changes that occur in the months and years following adjustable gastric banding, we also study the metabolic effects of banding in growing teens. It is our hypothesis that gradual, steady weight loss will not result in nutritional deficiencies, but rather will result in long-term and sustainable weight reduction.

In spite of this progress and the mounting number of success stories, most primary care providers, pediatricians and family medicine doctors, are reluctant to refer patients.  Susan Woolford and her colleagues at the University of Michigan studied hundreds of such primary care providers and concluded that "some severely obese adolescents may desire and potentially benefit from bariatric surgery, but referral for the procedure may depend heavily on the attitudes of their primary care physicians."

With one in three US gradeschool  children overweight, and epidemic numbers of adults with complications of obesity looming, it behooves all of us to look at all the many ways available to tackle this problem.  For some who are beyond a certain BMI, surgery is a life-saving option that deserves exploration.
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Mamaroneck Tigers Hit New Hampshire Primary

 I just heard about an extraordinary opportunity for local Westchester kids from the Mamaroneck High School.   Sixty four lucky students are off to the races!

The New Hampshire primary races that is.  Under the guidance of the AP Government and Politics teacher, Joe Liberti, they are going to be helping to get out the vote for three days this weekend.  Regardless of their own political persuasions or uncertainties, they will stretch their thinking and experience civic duty first hand.  

Activities include meeting with the director of field operations for Newt Gingrich and attending a panel discussion sponsored by Politico.  Best of all, those of us here at home will be able to share in the adventure because they will be creating a ten minute video of their experience.

As parents, caregivers and educators we are always looking for ways to foster competence, character, contribution, and connection (four of the Seven C's crucial to resilience in our kids and ourselves-best described in Ken Ginsburg's book, A Parent's Guide to Building Resilience in Children and Teens).  I am hard pressed to think of a better way to do this.  I hope these students will come back with momentum and energy to rally local residents across the community to debate, discuss and ultimately vote.

For a more complete announcement of this and other interesting, progressive educational opportunities at Mamaroneck, click here.

image courtesy of crazyman7.narod.ru via googleimages

New Year's Resolution to Diet?

With 2012 only hours away, many are scrambling to assemble their resolutions and for millions of us, teens and adults alike, this list includes renewed efforts to improve diet and exercise more.  While obesity is a growing international problem, we all know that weight watching can lead to serious health problems, both mental and physical. 

Following are a few warning signs that a diet may be misguided or inappropriate:

• The desire to lose weight seems more motivated by emotional than health factors. “I’m not popular because I’m fat.” Or “If only I could get rid of my stomach I’d be happy.”
  
  
• A person signs on to a drastic change in lifestyle. " I’ve decided to become a vegan in 2012.” Not only is a vegan diet (void of all animal products, including cheese and eggs) very difficult to do in a healthy manner, it is usually high in calories and hard to maintain.  

• You are quite sure that your daughter is at a normal weight and do not think dieting is necessary or safe. If any degree of struggle or disagreement arises between you over this issue, it is best to turn to a professional who can assess the teen’s weight and health status and explore the psychological and emotional motivating factors in order to provide guidance.
  
  
• You see evidence that your teen, young adult or friend is using caffeine, laxatives, diet pills or is even vomiting to control intake and weight. These are obvious signs of an eating disorder, which can quickly become a chronic and recalcitrant disease. Intervene as soon as possible.
  
  
• You see a marked increase in concern over fat content of food, accompanied by scrutiny of food labels, avoidance of previously favorite foods, and “fear of fat.”
  
  
• You note an uncharacteristic and perhaps unsustainable level of physical exercise that accompanies someone's new resolution. In an era when most Americans are not getting enough exercise and spending too much time in front of various screens, there are still many who use excessive exercise as a tool for weight loss and body changes that may not be appropriate. 

These concerns apply equally to girls, boys, women and men.  The latest issue of Contemporary Pediatrics in fact, discusses "Disordered Eating in Boys," and points out that a desire to gain weight (whether in the form of muscle or bulk) can signal an unhealthy attempt at body modification just as much as a wish to lose weight might.

With respect to this resolution, there is no more apt wish than to  "Have a Happy and Healthy New Year."

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Home for the Holidays

Whatever we are asked to call this period of time at the end of December, whether it's religious or festive, in my family we try to make a bow beyond just the secular to both Christmas and Hannukah.  However, as the kids get older and the precious time together seems more and more compressed, we spend less and less time with the traditional prayers, stories, and services than we do with the catching up and laughing, making merry, reveling in the special lights, and treasuring moments together.

For a long time, I like many moms before me, have made a ritual of cooking and preparing and creating a vast reception for the hungry appetites I know will land on my doorstep.  So over the years, I have worked to accommodate the expanding dietary rules, limitations, limits, and experiments that my growing brood requests.  This year I scoured Epicurious.com as well as my shelf of cookbooks for the perfect dishes that would accommodate the vegetarians, the kosher-observant ones, the meat eaters, and the simple gourmets among them.   With apologies to the lactose intolerant in the group, the baked Alaska "took the cake" this year with its drama and elegance and in the end, once we got over our disbelief and anxiety, its simplicity.

But no matter how hard I try and no matter how grateful and simply full everyone is, coming home brings  certain culinary calls.  Among them are the local sandwich shops that generate a debate among sibs over which has the best wraps or cranberry sauce.   The homing phenomenon was clear late on Christmas Day when the tired and overfed group decided to honor a Jewish tradition and order Chinese food.   From the very busy and stalwart restaurant right around the corner, they ate one of our long time standards: Chinese cold noodles with sesame sauce.  One of my adult kids gratefully announced: "The great thing about cold noodles is that they still taste just like they did in sixth grade."  Nostalgia strikes again.

No matter how sophisticated their palates might have become through travels and experiences beyond imagining, the tastes, flavors and happy experiences at home mingle and linger a long while in our minds.  And that is the blessing of togetherness no matter what's on the menu. 

image from zazzle.com via Googleimages

One in three teens and young adults arrested?

Usually, I can trust the New York Times to report accurately and scientifically about stories and research they pick up in the media.  I have not been alone in the past few days in feeling shocked by the article, "Many in US are Arrested by Age 23, Study Finds".   They were quoting from a new study reported in the well respected journal Pediatrics  that looked at a national sample of adolescents and found that over 30 percent of "23 year-olds had been arrsted for an offense othern than a minor traffic violation."

Upon closer reading of the actual article in Pediatrics we discover that what the study looked at was  the "cumulative proportion of youth who self-report having been arrested or taken into custody for illegal or delinquent offenses (excluding arrests for minor traffic violations) from ages 8 to 23 years." 

According to WatchingtheGov.com "the study captured arrests for all offenses other than traffic violations, including underage drinking, shoplifting, truancy, robbery, assault and murder. Most teens who are arrested are cited for minor infractions and don’t end up imprisoned."

Lots and lots of kids are in and out of the legal system for offenses related to alcohol and marijuana. Is this the reason for what appear to be high numbers? The data did not separate out information by race or socioeconomic factors. How would it look if we could see it that way?  We know that young black men have a much higher chance of being arrested on similar charges than white teens and young adults. 

Commentary from the liberal  blogoshpere tends to blame the police, the criminal justice system, drug laws, and anti-adolescent bias in our culture. Look at this comment:
"The long term hang up of hair trigger arrests and kangaroo prosecutions is the (sic)we are creating a population of certified losers unable to ever recover. In other words, the cradle-to-prison pipeline is becoming more voluminous. People mired in this apparatus cannot get credit, cannot get employed, cannot get housing, cannot be admitted to practice a profession and are likely encouraged to continue in a life of crime to feed themselves."

For parents and pediatricians there are a number of important ways to think about this data. According to Robert Brame, the lead author of the study and a professor of criminal justice and criminology at the University of North Carolina,  "teens who wind up in trouble with the law tend to have early risk factors, such as having a troubled family, childhood behavior problems or difficulty in school."   Many of them are also mentally ill or have treatable problems like attention deficit disorder, anxiety and substance use.  It's the responsibility of the caregiver and the school to identify these students early on.

But we also know from nationally validated data that a lot of otherwise high functioning kids who star on our athletic teams and go to good colleges end up on the wrong side of the law whether they are caught or have such an encounter on their permanent record.  Sometimes it's an issue of  Halloween pranks, reckless driving, loud parties, and other "forgivable" things "teens just do," but it often is behavior that the law is managing because parents are not.  Communities, clergy, schools, parents and teens can work together to define the extent of kids' risky behavior and respond accordingly.  Responses can include programs for those who drink too much, community service for arrests, and other constructive ways of meting out justice.

No teen should be scarred for life, unable to get ahead and without a chance at restitution for behaviors that are commonplace. Nor should communities begin to accept that a criminal record is a right of passage as normal as a bar mitzvah, confirmation or a prom.  But I, for one, might be proud of my kid if he or she were arrested at an Occupy demonstration these days. 

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What does hockey say about us?

I was thoroughly mesmerized last week by the three part series in the New York Times by John Branch about the life and death of Derek Boogaard entitled "Punched Out: The Life and Death of a Hockey Enforcer."

First of all, the writing itself brought me to tears as I learned about Boogard's early years and the dedication of his parents that now seems almost pathological.  I imagined them driving him in the dead of night across hundreds of miles of Canadian tundra to participate in the national sport that they thought might rescue him from his gargantuan body and his young mind that could not succeed in a classroom as well as it did on the ice.

Then I was stunned by the ferocity and the ghastly descriptions of the brawls and the gladiator-like job of the enforcer, a player whose function is to literally take the gloves off and fight to frighten and intimidate the opponents.  Whereas there might be a graceful quality to hockey (one of my sons played high school varsity hockey and I can still hear the scrape and swish of the steel on the ice, but I can also remember the police presence at the games with particular opponents, "just in case.") and the elegance of a well played goal is undeniable, the presence and encouragement of the enforcer turns the game into a spectacle and a brutish game where violence an mayhem are encouraged. 

Finally, in the third article in the series I was saddened by the photos of his parents who perhaps thought they were doing the right thing; of his brother who protected and enabled his drug dependency for years; and by the shocking revelations that many of the players who sustain his degree of battering during their short lives are suffering from degenerative brain disease much like the football players we followed in the Fall.   So now it's winter and once again we are asked to ponder the morality, yes the morality of this sport that intentionally inflicts damage on young bodies and brains for the sheer enterntainment of it.

 Over the past few years as I have had the privilege of seeing athletes with head injuries and have been able to folllow them with sequential visits and Impact tests I have learned that many of these athletes are not playing for the joy of the sport.  Very often they are playing to satisfy a parental or family expectation or as a way of compensating for some perceived weakness in some other sphere of their young lives.   When they are finally pulled from the rink or the field because of injury many of them will confess to some relief at the drop in the pressure and the loss of fear of injury they experience.  As one reader wrote in the Times: "This series should be required reading for parents, coaches and children wherever hockey fever reigns."

For a previous blog post on a youth hockey team in Minnesota that is successfully encouraging more elegant and less dangerous play see this post called "Why I love Minnesota."

image from dialecticmagazine.com