Gwyneth Olwyn is the owner of Your Eatopia. She is a patient advocate and a member of Alliance of Professional Health Advocates.

Patient advocacy is an area of lay specialization in health care concerned with patient education, how to obtain care, and how to navigate complex health care provision systems. Patient advocates do not offer health care services.

You can follow Your Eatopia here on tumblr to find out when new blog posts are available to read at Your Eatopia

 

Medicare Payments to Primary Care Physicians a Big Issue

scienceofeds:

… the most important thing revealed by this data, I believe, is the enormously skewed reimbursement by specialty. It is an excellent window into the incredible differences in reimbursement for different specialties, with the ophthalmologists, radiation oncologists, etc. making huge incomes while primary care doctors (and nurse practitioners) are making $57 for an office visit. This is major. The fact that Medicare pays so fantastically much more for procedures (and, as a note, it is likely that all of the doctors, including the 202 family doctors in the highest-paid 2%, are getting it for doing a lot of procedures) leads to private insurers paying similarly more. And makes these specialties very attractive to medical students because they are lucrative (and often, though not in the case of many surgical specialties, involve fewer hours of work). Which leads to fewer primary care doctors, and a dramatic shortage in this country.

Medicare could change this. It could dramatically, not a little bit, change the reimbursement for cognitive visits to be closer to the payment for these procedures. If it did, so would private insurers. If the income of primary care doctors was 70% of that of specialists (instead of say, 30%) data from Altarum researchers and from Canada suggest that the influence of income on specialty choice would largely disappear. More students would enter primary care, and in time we would begin to see a physician workforce that would be closer to what this country needs, about 50% doctors actually practicing primary care.

This is a huge issue in Canadian healthcare as well. 

(Source: shrinkrants)

http://tumblr.scienceofeds.org/post/90520168508/it-always-troubles-me-when-people-in-speaking

scienceofeds:

It always troubles me when people, in speaking about mental illness, completely (or largely) disregard biology just as much as it troubles me when people disregard society and the environment. Both are important and neither can exist in isolation. Viewing mental illness solely as a product of…

When Science Becomes News, The Facts Can Go Up In Smoke

(Source: cognitivedefusion)

Personality disorder cognitions in the eating disorders.

scienceofeds:

[I cut a lot of convo; see cognitivedefusion’s criticism of the above graphic]

Yeah, I really appreciate what OP’s trying to do —- SO MANY people hear that you take antidepressants and are like, “Are you sure you need those? I’ve heard exercise can cure depression!” or “You’re weak if you need those; stop running from your problems” and those things are, like, instant portals to my inner reservoir of fury —- but I did balk at a lot of the things being presented as fact when they’re not actually very well understood at all. Shit is complicated, shit is ambiguous, shit needs a whole lot of further study.

Yes, I agree completely. And also a lot more transparency. 

Agreed on transparency regarding already reasonable body of research information (that is not widely disseminated, but is there nonetheless).

SSRIs are *believed* to inhibit the reuptake of serotonin, but you won’t find any conclusive evidence of that. In fact of the evidence out there, research has concluded that there is no link at all between any mental disorder and an imbalance of chemicals in the brain (whether the origins are made up to be about re-uptake or any other mechanism by which supposedly neurotransmitters might be “out of whack”).

And drawing sad faces on a bunch of pills and telling me that meds might get sad about any independent information suggesting that they are not what they claim to be, well let’s just say I am going to recommend that people recognize an anthropomorphizing marketing trick when they see one, and get some real trial data and population adverse event data to review instead.

(Source: edgebug)

Anonymous asked
i've heard A LOT that after recovery you're at your set point if you're MAINTAINING on 3000 calories a day.. is this true? i feel like i would be gaining forever.

scienceofeds:

youreatopia:

scienceofeds:

There is no single number that works for people regardless of their

  • height
  • weight
  • sex
  • physical activity
  • muscle mass
  • fat mass
  • duration of weight restoration 
  • ED history 
  • potential other comorbid conditions affecting metabolism/metabolic needs
  • lots of other things…

So the short answer is no. Will some people need to eat that much to maintain their weight? Yes.  Will all? Of course not.

Actually, the majority of women under the age of 25 do eat on average 3000 calories a day to maintain weight and health — those who are non-restricting controls in research trials, that is.

Like everything else to do with human beings, the majority of us fit in the average. There are those who are taller, those who are shorter but the vast majority of us are merely of average height. The same holds true for weight. And the same holds true for food intake on average according to doubly-labeled water trial data that confirm what individuals actually eat and not what they say they eat.

85% of all drivers say they are above average drivers. That’s an impossibility as the majority of us must be average drivers, by definition.

By all means, consider all the exceptional variation at either end of a bell curve, but be careful of falling into the trap of believing you are exceptional in the absence of evidence to prove that is the case.

I agree with your points but the question did not specify age, sex, or height, or any of the other variables that contribute. I believe you that 3,000 is the average that women under 25 consume (I’m assuming in North America?) but what’s the standard deviation on that number. 

But actually, where is that number coming from? All the healthy controls in studies on calorie intake in AN/BN eat less than 3,000. And I can’t find 3,000 in the literature or in government reports either. 

This suggests less (but they did retrospective interview, and people tend to underestimate). More details on that source. (It is just one source, of course.)

Also this (CDC 2012 report) (pg. 213).

My last response was not nearly clear enough: you correctly called me out on my bullshit-by-omission statement.

3000 calories for women under age 25 as an average daily intake is an extrapolation from research data.

G.

Anonymous asked
i've heard A LOT that after recovery you're at your set point if you're MAINTAINING on 3000 calories a day.. is this true? i feel like i would be gaining forever.

scienceofeds:

youreatopia:

scienceofeds:

There is no single number that works for people regardless of their

  • height
  • weight
  • sex
  • physical activity
  • muscle mass
  • fat mass
  • duration of weight restoration 
  • ED history 
  • potential other comorbid conditions affecting metabolism/metabolic needs
  • lots of other things…

So the short answer is no. Will some people need to eat that much to maintain their weight? Yes.  Will all? Of course not.

Actually, the majority of women under the age of 25 do eat on average 3000 calories a day to maintain weight and health — those who are non-restricting controls in research trials, that is.

Like everything else to do with human beings, the majority of us fit in the average. There are those who are taller, those who are shorter but the vast majority of us are merely of average height. The same holds true for weight. And the same holds true for food intake on average according to doubly-labeled water trial data that confirm what individuals actually eat and not what they say they eat.

85% of all drivers say they are above average drivers. That’s an impossibility as the majority of us must be average drivers, by definition.

By all means, consider all the exceptional variation at either end of a bell curve, but be careful of falling into the trap of believing you are exceptional in the absence of evidence to prove that is the case.

I agree with your points but the question did not specify age, sex, or height, or any of the other variables that contribute. I believe you that 3,000 is the average that women under 25 consume (I’m assuming in North America?) but what’s the standard deviation on that number. 

But actually, where is that number coming from? All the healthy controls in studies on calorie intake in AN/BN eat less than 3,000. And I can’t find 3,000 in the literature or in government reports either. 

This suggests less (but they did retrospective interview, and people tend to underestimate). More details on that source. (It is just one source, of course.)

Also this (CDC 2012 report) (pg. 213).

You are absolutely right that the question did not specify age, sex or height and I perhaps very wrongly assumed that the individual in question was quoting 3000 precisely because she is an average young woman with an eating disorder who has come across the material referenced on my site and what I read into the question may not be a fair assessment of the emphasis. I note that many are asking you repetitively of the validity of the guidelines outlined on my site because they trust your ability to uncover and call out bullshit.

This is what I see first and foremost in her (or his) question “I feel like I would be gaining forever.” What the individual is asking is framed by that statement in my mind. He or she wants confirmation that the re-feeding amount is temporary because they (getting tired of he or she here) wanted confirmation that they could stop if they were getting fat.

And you are right you cannot find 3,000 in the literature. I talk about that in my blog post on http://www.youreatopia.com/blog/2011/9/14/i-need-how-many-calories.html (with all the trial data I unearthed) and how the doubly-labeled water trials confirm what adult (beyond age 25) women eat is 2500 calories. The 3000 is an extrapolated number based on the average amount to which individuals under-estimate their intake on the much more widely applied self-report data that is the basis for all the government reports because there are no doubly-labeled water trials available to review for the female young adult age range. I explain my process in the sub-heading “the Under 25’s”.

I also address the fact that the science-based recommendation to raise the daily recommended intakes (in the UK) was stymied by special interest groups (read: weight loss industry) and that’s mentioned in the Usual Questions section on my site with links http://www.youreatopia.com/faq/specific-recovery-questions/do-the-minniemaud-guidelines-apply-in-my-case.html

So there’s that.