Wednesday, February 22, 2012

Open letter to "fat" kids

Dear Beautiful Little Person,

I hear someone's been telling you you're fat. It might have been someone at school, or your brother or sister, or your parents. They've probably also been talking about how much exercise you do and what you eat. They've almost certainly been telling you what shouldn't be eating. Most of them are probably genuinely concerned about your health.

But here's the secret - it's your body. It's an amazing, strong and beautiful body. It can do all sorts of cool things. And because it's yours and yours alone, it's amazing and wonderful in its own unique ways. If you look after your body, get to know it really well, teach it new tricks and give it every opportunity to show off the tricks it knows, it will look after you. And it will look after you, and be able to learn new tricks, regardless of what shape it is, or what it is or isn't able to do compared to other people. This is what exercise is really about. Doing what you and your body love to do. Your body has different needs to everyone else's. It might need more rest than other people. It might prefer to go crazy for half an hour, or it might prefer a long walk. The new tricks you teach it might be cartwheels, or spins in your wheel chair, or playing handball. Get to know what you and your body love doing together, and do it as often as you can.

People also make a big fuss about food. There's a reason for that - it's important to be good at eating. But being good at eating isn't about what you shouldn't eat, it's about what your body needs. Just like exercise, different bodies need different food. It can be really hard to work out what your body needs, so a good place to start is to try to eat as many different kinds of food as you possibly can. That's hard when you're a kid - lots of kinds of food taste yuck when you're younger, and seem to taste better as you get older. While you're waiting for broccoli to start to taste good (and it really does!), keep trying different foods, and remember the ones you like. The more variety you eat, the happier your body will be.

As you grow up, try to pay attention to how foods make you feel. Which breakfasts make you feel good at school, and which ones leave you starving even before recess? Do some foods make you feel terrible a couple of hours later? (Drinking fizzy drinks gives me a headache about 2 hours after I drink them - I don't know why, but I mostly don't drink them anymore!) Eat the things that make you feel good, give you energy and have a huge variety of good stuff in them. Then you'll be good at eating, and you'll be looking after your body.

Your body is beautiful and wonderful and powerful exactly as it is. It doesn't matter what shape it is. It will change shape over and over again through out your life. That's not what matters. Look after it, don't compare it to other bodies and enjoy it.

Monday, February 20, 2012

What's an insurance company to do?

It looks like the Gillard Government might get their health insurance reforms through, and there is the standard "Our models are better than your models" stoush. Labor are claiming that 27,000 people will leave private health insurance as a result and Libs claiming it'll be 1.6 million. Whatever, private health insurance is largely a matter of philosophy - some people believe it is essential, others see little benefit in it. Personally, I'd much rather pay a higher Medicare levy so everyone gets the same access to health care, but we all know I'm a raving, bleeding heart lefty.

However, it seems both major parties agree that private health insurance is a Good Thing. Given that's the assumption they're working from, rather than fighting over how many people will drop out as a result of increased costs, why not consider options for offsetting the increased costs due to not subsidising rich people? One way to do this is to look at the costs of various kinds of medical care. An obvious candidate for this is obstetric care. I couldn't find any data on obstetric fees, but I had 3 children over 5 years and my fees tripled in that time. At the same time, many private OBs ceased practising in less affluent parts of Sydney. Newspaper reports and my OB suggested this enormous increase was due to insurance. If insurance has become that impossibly expensive, it's time for the Government to look at the causes. Without turning this into an epic, I'd suggest universal disability insurance would go a long way to addressing this problem. OB insurance is heavily affected by tragic outcomes during birth. If something goes horribly wrong, even if the OB wasn't actually negligent, everyone wants to see the family looked after financially. This is an expense that should be borne across the community. No doubt there are plenty of other areas of medicine where costs are artificially inflated for whatever reason. Don't misinterpret me here, I am not suggesting that health insurance companies should be working to reduce these costs. I believe the US has adequately demonstrated how disastrous that path is. But I do think this is what we have a Health Minister for.

All of that, though, is fraught and messy. It's not hard to imagine an inquiry into some area of health costs turning into a witch hunt and just making the whole situation worse, and I repeat, I don't want the health insurance companies themselves having opinions on how much health care should cost. So what's an insurance company to do to keep these 27,000/1.6 million customers? Well, if you can't reduce your specific costs, reduce your scope. Cover less. And here it gets really easy. Ditch the woo. Despite my total disrespect for private health insurance, we have the topmost, most expensive health care in the country (or close enough to it). This is a result of inertia after inheriting it from a previous employer. Here are some things it covers:

That's a bit fuzzy, it says "Naturopathy, Western Herbalism, Homeopathy, Iridology, Nutrition, Remedial Massage, Shiatsu and Bowen Therapy". Righto. I'm not entirely sure what "Nutrition" means here, because qualified dieticians are covered elsewhere. The sum total of evidence for the efficacy of these therapies would probably fit in the box that names them. This policy allows every single person covered by the policy to spend $700 per year on them. For our family, that represents $3,500 we could rip out of our health fund for therapies that either don't work, do actual harm, or work as well as Klinger's Keep Cool sugar pills. There's also this (included in the same $700 cap)


Whilst there is evidence for the efficacy of some chiropractic and osteopathy therapies, there's a whole lot of non-evidence based therapies provided under these banners as well. If we need to reduce the cost of health care, let's cut loose the stuff that has little or no evidence to support it. I've used acupuncture, and it worked, dammit! But if I want to go kick start my body's placebo effect, I don't think the rest of the community should be subsidising it. I can pay for my own woo.

While the individual costs for these services are an awful lot smaller than an average hospital admission, for example, they tend to be used much more often. Not least because they don't actually work. I was told by a physiotherapist that the nearly all complaints require no more than 3-5 visits to resolve. How many people have you heard describing months or years of chiro, osteo or other natural therapies? This study found that the average lower back patient made 10 visits to a chiropractor. That same study shows that chiropractic services are the most expensive way to treat back pain. If we want to reduce the cost of medicine, let's stick to funding evidence based medicine.

Every time my insurance company asks me about the service I got from a provider, they also ask me how they could provide a better service generally. Every single time I tell them to stop subsidising woo. Tell your insurance company too.

Monday, February 06, 2012

I am a looser

A week or so before school went back, when saying goodnight to Ben (aged 9) I saw he'd written "I am a looser" on his drawer. He's always been a "glass half empty" kind of kid, so I'd been expecting this kind of thing at some point. Still, my heart broke a little bit.

A bit of probing suggested anxiety about going back to school and being bad at stuff. The particular stuff he flagged was drawing, but I'm guessing it was sort of a generalised fear of publicly sucking. Still, drawing was an excellent example. Sucking at drawing is quite different to sucking at spelling. No-one hangs your spelling list on the walls in the classroom. In fact, even the person sitting next to you is pretty unlikely to look at your spelling. The things Ben sucks at are dancing, singing and drawing*. Everyone in the class is gonna know you suck at those things. Therefore, there was absolutely no point in attempting the whole "You're not that bad at drawing", because if he was already feeling bad, condescending to him, when he knows the truth, was only going to make it worse. Further, pointing out what he's good at doesn't help, because his talents don't stop it feeling awful when his stick figures are hung up next to a perfectly detailed scene.

I was going to go with my go-to solution when feeling bad about not being able to do something - "If you want to be better at it, you just need to practise" - but he hates drawing. At which point, the answer become obvious. Ever since he was tiny, he's had no interest in drawing, colouring, or pretty much any visual art. Which, of course, is why he's crap at it. He's never done it. I explained to him that I could get him books that show the basics of drawing, and he could do lots of practice and his drawing would improve, BUT, he doesn't want to. Outstanding talent aside, the main thing that makes a kid good at something is interest in it. He was looking pretty skeptical, so I switched to his talents. He's good at science. He protested that he doesn't practise science, but he does, and has done since he could talk. He asks how everything works. He's been building and refining his model of the world since he was two. He's been practising incorporating new information into his models and beginning to identify dissonance for years. Kids that don't share his interest in that sort of understanding (possibly because they're too busy capturing the awesome beauty of the world), find science much harder.

After an hour or so of chatting, he was prepared to rub off "I am a looser" (once again, see footnote). It's quite empowering to realise that the main reason you're bad at something is that you're not all that interested in it. It's an unfortunate illusion created by those early years of school, that ability is innate. The practice is invisible, because it's just what the kids like doing. Kids see differentials in abilities, but they can't see the effort that went into it. If they focus on those examples, instead of the ones where they see the practice (like learning an instrument), it's easy for them to believe that if they don't pick something up straight away, they will never be able to do it. Ben has a tendency to ignore the visible practise, as did I when I was a kid. It took until I was much older before I realised that if I stick at things for long enough, I can be capable at them, regardless of whether I'm any good at them to start with. I believe many beers and games of pool may have finally illustrated this point to me. I'm hoping that I can keep this message explicit as the kids grow up, and make it very clear that if they are really bad at something, that's probably their choice, and that is a completely valid choice. There are only so many hours in a day.

Of course, he's still going to have to draw stuff. We talked a bit about how he can draw in a cartoon style that requires minimal effort, but looks both ok and intentional. Along with the deep and meaningful, he's gonna need some survival skills until he doesn't have to draw anymore.

* and spelling, as it happens, but that doesn't seem to stress him.

Saturday, February 04, 2012

4 year olds and belly dancing

There's nothing like starting your day with an ├╝ber tantrum from your 4 year old. I shared my exasperation with Twitter:

Honestly, there was screaming and gnashing of teeth for well over twenty minutes, because her brother had opened the flavoured straw she was holding. There was another, identical, unopened straw right next to her on the bench. It was, apparently, not an adequate substitute. When the screaming had finally abated, she reluctantly suffered through the identical straw and announced she was coming to belly dancing with me. She was still in her pyjamas and I had to leave in 4 minutes. Again with the totally rational requests. 

To her credit, she hustled and got dressed quickly and we only left ten minutes late. I love belly dancing, and I'd love to share that with Elissa. I tried to take her to some lessons last year, but the study made making it to classes impossible. She was very keen to go back this year, but my teacher didn't seem as relaxed about the idea as last year's teacher had been. So I was feeling more than slightly nervous, bringing my recently screaming banshee of a daughter into the class of a woman who was concerned she might disrupt the rest of the class. However, as 4 year olds are wont to do, she was the picture of delight. She did the stretching exercises with us, played with her toys a bit, and then danced her own dance in the corner until it was time to take off the coin belts. Nobody seemed perturbed, and she got lots of compliments. The relief was palpable. My day was looking up. 
Then we got back to the car park and I remembered the enormous huntsman I'd seen dart inside the front passenger door frame as we'd rushed to make the class on time. Have I mentioned I'm hopelessly arachnophobic? I have been known to call friends to my house to rescue me from spiders at 6am on a Saturday (eternal thanks Cate!). I'm very proud to say that I bought a can of spray from the chemist and dealt with the 8 legged horror (and many of his variably sized compatriots in other hidey holes in the car) on my own. Of course, this last part of the story has nothing to do with the point of this post - the best and worst of 4 year olds, but I felt the need to share. 

I kinda like four. The extremes are exhausting, but amusing too. Watching the bourgeoning capacity for logic, while weathering the episodes of total logic fail. Seeing the desire for independence translate into a real reduction in work for parents weary from a whole year of three. To quote Olivia's mother, Elissa, you really wear me out, but I love you anyway.