If you haven’t already read Laurie Penny’s brilliant and unnerving account of her surreal evening as Milo Yiannopoulos’ guest at the Gays for Trump shindig he held in Cleveland earlier this week, stop whatever you’re doing and read it now. Then come back and discuss.
If you need more persuasion: It’s a sharp and scary analysis of “how trolls took the wheel of the clown car of modern politics,” as Penny puts it, and it’s full of weird details about the event and Penny’s strange non-relationship with Milo, whom she describes as “a charming devil and one of the worst people I know” and someone she simply can’t convince she’s not actually friends with.
Perhaps the oddest part of Penny’s piece, though, is her description of her encounter with a fellow we all know too well: Roosh Valizadeh, whom she describes all too accurately as a “headline-hunting nano-celebrity in the world of ritualised internet misogyny.”
“He asks me what I’m doing here,” Penny writes. “I ask him the same question.”
It’s a good question, given that Roosh is a raging homophobe who bans gays from commenting on his sites.
The interaction that follows is the most surreal episode in a deeply surreal evening. Roosh is tall and well-built and actually rather good-looking for, you know, a monster. I have opportunity to observe this because he puts himself right up in my personal space, blocking my view of the room with his T-shirt, and proceeds, messily and at length, to tell me what my problem is.
Number one: my haircut, and he’s telling me this as a man, makes my face look round. This is absolutely true. Number two: I seek to destroy the nuclear family, and disturb traditional relationships between men and women. This is also true, although I remind him that the nuclear family as it is currently conceived is actually a fairly recent social format. He insists that it’s thousands of years old, and asks me if I truly believe that it’s right for gay men to be able to adopt children. I tell him that I do. He appears as flummoxed by this as I do by his presence at what is supposed to be a party to celebrate Gay republicans. He’s here for the same reason I am: Milo invited him.
So, yeah.
For what it’s worth, I think Penny overstates Milo’s “weaponised insincerity.” He’s certainly a cynical enough opportunist, who jumped aboard GamerGate and then on the alt-right car of the Trump Train not because he gave a shit about any of the alleged issues involved but in order to promote himself. But he’s hardly the boy with the “fewest f*cks to give.” He actually gives a lot of f*cks, at least about himself. Like most narcissists, he’s acutely sensitive to slights and lashes out at anyone who pierces his vanity — much like his adopted “daddy” Trump.
But if you want to know how we got to this weird place we’re in now, Penny’s piece offers some invaluable insights.
@Joekster
You appear to have missed my point entirely, actually. What I am getting at is that this:
isn’t actually an option for a large percentage of the American population, because they can’t afford that kind of food, and/or can’t get to anyplace that sells it. They have nowhere to exercise because there are neither sidewalks nor parks where they are (and, FYI, encouraging people to take up an exercise regimen is no kind of public health policy; walkable cities are another matter). Leaving completely aside any disabilities and dietary restrictions, of course. That’s what I meant about it not being something that is subject to individual control.
I’m definitely of the mind that encouraging healthy behaviours that can lead to weight loss is superior to weight loss as a goal. If someone lives a lifestyle which results in obesity, there are no effective short term solutions that result in long-term weight loss.
Encouraging small, achievable goals, like a 20-40 minute walk each day, filling out meals with salad, and cutting soda pop out of my meals all helped me lose weight. Those little successes led to more little changes as well, eating healthier and boosting my exercise regimen.
Because I was altering a sedentary lifestyle and marginal diet, I lost weight. Even if I hadn’t lost weight, as a medical professional, you would agree all those things would improve my health outcome. Similarly, if I had been working out regularly, tracking my activity, and eating properly, and didn’t lose weight, would you agree that my weight might be the result of a medical condition or a genetic predisposition?
Plus, a sedentary lifestyle and poor diet is unhealthy for a thin person too. But people assume that fat people must live an unhealthy lifestyle while the lifestyle choices of thin people are not scrutinized. If exercise and diet are to be part of a check up, that should be the case for patients of all body shapes.
It’s me! I’m the unhealthy thin person! Well, not exactly thin (any more), but pretty “average” sized in any case. I get maybe 1/4 of the exercise I should, have pretty poor nutrition. Wanna guess how often I get unsolicited comments on my health from anyone for any reason? Literally never.
@joekster
But why focus on obesity at all? If there are problems with lifestyle and you’d like to help people understand how to live a healthier lifestyle, why not focus on that? I just don’t feel like obesity needs to be brought up at all. All obesity is is a number on a chart derived from junk pseudo-science that’s long been shown to be inaccurate as an indicator of health in individuals, yet it drives all Healthcare decisions made for people in the “wrong” range because health insurance providers care more about statistics than what actually works.
Sorry for the rant. I do not have the luxury of being unemotional about this topic. I’m pretty sure if I don’t figure out what’s actually going on with me soon I’m going to die from this disease that no one cares to diagnose.
With everything below, please let me know if I use too much jargon and need to translate anything. This is a topic that I personally get excited about.
@Dalilama: I did take the point, but I was still trying to make the point that leftwingfox and wwth just made for me :). Sorry for talking past you a little bit.
You are correct as to infrastructural issues regarding healthy lifestyles, but small steps can still be taken. Regarding diet, fresh produce is very difficult to come by in the inner cities (especially the ‘food deserts’), but even steps such as eating chicken instead of beef or going for frozen vegetables instead of canned veggies (canned vegetables have a very high sodium content, which spikes blood pressure) make a noticeable difference. If even frozen foods aren’t available, then I work with my patient to figure out what is available, or I send them to opt he nutritionist (I face time pressures as well). Regarding exercise, I suspect that a large part of why Europeans are healthier than we are and pay less for healthcare is the simple fact that European cities were built before the automobile. I hear that in most of Europe, it’s quite possible to walk or bicycle pretty much everywhere you need to go without losing much time (if I’m wrong in this, people from Europe should feel free to tell me).
Another problem that I’ve run into a lot with my population (geriatric) is that many of my patients do not feel safe leaving their homes. Something I’ve found myself doing for many of them is writing for pedal machines: it’s something they can do while watching TV or reading the paper in their own homes, the Walmart version costs about $30, and it’s covered by at least some forms of Medicare (although figuring out which forms in particular is easier said than done). About an hour a day on these things provides cardiovascular benefits, assuming your heart rate gets up to the required levels.
Now, will any of these steps provide the health benefits attainable using resources available in the suburbs? Probably not, but they help. I’m a proponent of individualizing health care as much as possible, and I think it’s downright irresponsible that physicians don’t take the time to find out enough about a patient’s social situation to do so. The guidelines I mentioned serve me as a starting point, not the conclusion.
@leftwingfox, wwth: you’ve both said exactly what I was trying to get at. I am convinced that an obese person who exercises and eats veggies is healthier than a thin couch potato who lives on chips, soda, and pizza delivery. The mistake I see many of my colleagues making is using obesity as a marker for poor diet and lack of exercise. It’s easier to measure, but has about the same validity that using ‘cishet male WASP’ as a marker for ‘misogynistic racist homophobe’ does. The problem is, many don’t take the time to go from the symptom to the cause, and focus on the weight rather than lifestyle issues as a whole.
@leftwingfox: your final point touches on something that I wanted to emphasize: obesity does correlate with many different diseases. What many people forget is that correlation does not mean causation. So far, the only diseases where causality has been demonstrated to go directly and solely from obesity to disease are where the disease is mechanical in nature, such as degenerative joint disease and obesity hypoventilation syndrome, and I understand the latter is still being debated. On the other hand, there are a number of diseases associated with obesity where the causality goes the other way, and where treating the disease helps the patient loose weight. Examples of the latter include celiacs disease, hypothyroidism, and obstructive sleep apnea.
Finally, there are the ones where causality flows in a strange mishmash of different causes to different effects, where the exact role of obesity is still being researched. These include many cancers, diabetes (insulin resistant, of course) and the various forms of cardiovascular disease, stroke, venous thromboembolic disease, etc. basically, the ones responsible for killing most Americans.
One study I recall from medical school about diabetes that bears mention: back in the days when we split diabetes into ‘juvenile’ and ‘adult onset’ (I believe endocrinologists now speak of five different subsets of diabetes, but the point translates), someone did a twin concordance study of both types. In this sort of study, the investigators examine identical twins separated at birth and raised apart as a way of determining what traits are genetic, and what are not. For the purpose of this discussion, adult onset diabetes (now called type II diabetes) is the one associated with obesity, while juvenile onset (now type I) is not. What they found was that type I diabetes had approximately a 50% concordance rate, while type II diabetes had an approximate 90% concordance rate. It was a landmark study, both because it demonstrated that type I diabetes is not predominantly genetic, and that there is a real genetic component to obesity in general.
@ jokester
Mind if I ask a quick question? What’s your opinion on HIIT/Tabata?
It feels like it should be doing some good; but is it just a fad?
@kupo: sorry, I think you posted while I was typing a response. I brought up obesity mostly as a way of getting at how totally counterproductive fat shaming is, which PI mentioned now several pages ago. Not only is shaming in general morally wrong (at least, when we’re talking about something that inherently lacks a purely moral aspect), but fat shaming in particular is wrong from a pragmatic standpoint. Obesity is an inappropriate tactic, and people (at least, American people, can’t speak for the rest of the world) tend to respond to criticism by digging their heels in and doubling down.
Good luck with your health issues, and I am sorry you’ve had such a rough time of it. There are still caring, competent physicians out there, and I hope that you find one who can help you.
I really think that we, as a culture, shouldn’t focus on obesity, and should focus instead on the actual lifestyle issues and social determinants of health that are more closely related to hard outcomes.
@dlouwe
High 5! Can confirm, skinny as fuck. I have muscles I didn’t work out for. No weights, there’s just not much under the skin to separate it from the sinew. I’m always low key sick. I’m surprisingly strong, but that’s mostly cos it’s assumed that I can’t do anything, period. I eat sugar. I don’t mean sugary things (that too). Sugar and a spoon. Horrendous diet, meager exercise (and none of it planned), and general laziness
And yet, the ‘athlete’ comments ran wild in school. ‘Do you play basketball?’ ‘You must run track.’ Nope, but it never stopped anybody assuming I must be in the prime of fitness
@Joekster
I mentioned upthread 3 things I do, when trying to learn. Here’s another:
4)Nobody has time for your Gish Gallops or walls of text. Use fewer words. And more paragraphs. Stick to 1, maybe 2, point(s), settle it as quickly as possible, and drop it. If the subject comes back again, discuss it then. No need to argue every single thing at once. Take both your time and everyone else’s into consideration 🙂
@alan: my heads been stuck in geriatrics for the past year, so I hadn’t heard of HIIT yet. However, it appears to be similar to the theory behind the gym my wife has gotten into, Orange Theory, where you do short bursts of high intensity aerobics alternating with rest periods. My wife’s gym uses a monitor to track heartrate in order to help set goals. If it’s the same for hiit, then it’s a solid enough theory.
According to the AHA, your goal heartrate during aerobic exercise should be 50-85% of your maximum heartrate. Orange theory pushes you into the upper end of that zone, but stays within it. The trainers will tell you that that is the zone where you burn fat, and that’s true, but that’s not the real benefit. You’re burning fats in that range because that’s the range where your hearts demand for oxygen exceeds what your coronary arteries can supply, and so they aren’t able to efficiently use fats (efficient use of fatty acids for fuel requires oxygen), and instead of fully oxidizing fats to CO2 and water, they turn them into which during the recovery phase is shuttled back to the liver, where some of it is turned back into fat, some is fully combusted, and some winds up excreted in bile salts. Also, your skeletal muscles are doing a similar incomplete combustion of your bodies carbohydrate stores (skeletal muscle does not use fat during anaerobic exercise) into lactic acid, which is even more inefficient.
What all this boils down to is that neither the ketone bodies more lactic acid are particularly good for your muscles. They send off lots of signals, essentially complaining about how overworked and underpaid they are (if I may anthropamorphise), and your body responds by actually creating new blood vessels to improve blood flow to the heart and muscles. This in turn results in a lower blood pressure (because the same amount of blood is now occupying a greater volume of blood vessels) which in turn has a whole host of benefits.
I would place one caveat on this: make sure that you measure your reasting heartrate and your heartrate at maximal exertion prior to starting, and aim for that 50 to 85% goal. If you’re going above that for too long, you can actually damage your muscles. Also, everyone has a different resting rate, and as a rule, the more fit you are, the lower your heartrate is (because your vasculature is so well developed that your heart doesn’t need to beat as often to supply everything. Also, the heart muscle itself changes to pump out more blood the more you make it work). If you’re using a system that tries to get everyone to reach the same heartrate for the same amount of time, the less athletic members of the group will be getting less benefit from it, while the more athletic members may be damaging themselves.
Also, make sure you hydrate properly. With water and salt. Seriously. Every year someone drinks a gallon of water immediately after running a marathon, drops their sodium levels, and goes into seizures. You loose more than water in sweat, and you need to replace more than water. The best oral rehydration fluid I know (that’s cheap to make) is a 1:1 mix of Gatorade and water. Sure, there’s lots of sugar in there, but you’ll be burning all that off anyhow, and that has about the same concentration of sodium as normal blood.
Hope this helps.
@axcalibur: just read your response. I do tend to go into walls of text. There’s just so much to say. I’ll try to cut back.
I have noticed that physicians mansplain. A lot. Even doctors who don’t happen to have been born men. I think it has something to do with the way we enjoy knowing stuff that most people don’t, combined with a desire to share that feeling with the rest of the world.
@ joekster, it’s good to see that with ‘correlation does not equal causation’ you’ve found a way to phrase the issues that people have raised here about the obstacles that a focus on weight or BMI cause to promoting good health.
This phrase resonates with people who consider ourselves logical or scientific. Please follow it up with them with discussions about how the medical profession can act to change important non-medical factors like those Dalillama raises, or how a focus on weight alone can be harmful like kupo raises. Maybe even encourage a bit of contemplation about how one’s own communication style is impeding goals – you are trying it, so maybe they can too. 🙂
@croquembouche: I can’t take the credit: correlation does not equal causation was taught to me as on of the basic concepts of epidemiology. I’m sure most other physicians learned it as well, but many of us seem to need reminding.
I agree that we need to educate our colleagues as well. After all,mere in the USA, the medical profession is self-regulating, so there is no one else to do it. That also encourages mansplaining.
I do feel that we, as physicians, have a responsibility to push for programs that can address those social determinants dalilama mentioned, but I can understand how others may feel they have enough to do just managing their own patients. They have to do what seems right to them, and so do I.
I have to ask: what’s the name refer to? Dr. Google says that a croquembouche is a type of French pastry, but I don’t get the relationship to patriarchy. Is it a way of saying ‘the end of patriarchy’? You don’t need to answer if it’s to personal, just curious.
@ jokester
It does indeed; thank you.
What you say about hydration is especially interesting. I used to add a Berocca tablet to water (not sure of you can get Garorade here) but for various reasons I stopped doing that and just went to pure water. I have felt sick a few times on that. That’s probably the lack of salt you mention. I’ll get one of those double ended spoons (for measuring out an amount of salt and sugar), or I might just go back to the Berocca, I do like the taste.
I don’t actually measure my heart rate; I just have a timer app that beeps when to stop and start. But it’s interesting to know what’s (meant to be) going on.
@Alan: glad I could help ?
Milo is a classic narcissist.
Although I think his plan to hold a Gay Pride parade in the middle of muslim suburb of Stockholmn will be interesting viewing.