Tag Archives: Prevention - Page 2

Obesity confusion

Posted by on June 10, 2013 Comments Off on Obesity confusion

We are agreed that obesity is a problem, for individuals and for society.

We are agreed that dieting alone will not help. The latest popular diet approach is part of the background noise not part of the solution. Here is some noise from my Facebook feed as I was writing this posting.

Obesity diet noise

Exercise and dieting combined would work, but is probably beyond the ability of many if not most people facing obesity. Indeed, starting any exercise program may be a challenge to both will and health of someone morbidly obese.

We know that bariatric surgery can work; however, it is invasive, expensive, and there are debates among specialists about what works sufficiently.

Indeed, after Governor Chris Christie of New Jersey announced that he had had a gastric band implanted, there was considerable debate about whether that was sufficient compared to gastric bypass surgery, particularly given the failure rate of the laparascopic gastric band or “lap band.”

There is open debate about whether obesity prevention measures are cost-effective.

As if the problem were not challenging enough, a study has shown that physicians fail to demonstrate to obese patients the empathy necessary to effect change.

Al Lewis argues that many of our workplace wellness programs are ill-conceived and ineffective.

The seriousness of the problem is underscored by a Metlife study showing that obesity contributes $1,723 per person per year to the Medicare budget, or 8.5 percent of the total.

We are not left with a solid place to make a stand against obesity. My plan is to walk a bit more and eat a bit less as I contemplate next steps. What are your thoughts?

Are we making progress or falling behind?

Posted by on May 27, 2013 Comments Off on Are we making progress or falling behind?

In health care we don’t need to look far for bad news. In the past week, I have read:

  1. The prevalence of diabetes has increases 75 percent from the early nineties to the late naughts. A more extensive discussion (may require free Medscape subscription registration) is at New Statistics Shed Light on ‘Worrisome’ Diabetes Epidemic
  2. Leapfrog Hospital Safety Scores ‘Depressing’
  3. Study finds jump in ER-related admissions

And certainly we could include partisan bickering in Washington among politicians more focused on the next election than any meaningful policy debate or measures.

However, the simple fact is that none of this matters. We have no choice. If we do not adequately address our health care needs, then we will no survive as individuals or as a society.

If that premise, the premise of this blog, is correct, then we must assure access to healthcare for everyone. We must get the public health epidemics of obesity, diabetes, and gun violence, among others, under control.

On this Memorial Day, as we reflect on how many Americans have given up their lives at a young age to protect the American experiment, let us consider our debt to them: we owe it to them to insure that our society does not fail and that individuals not on battlefields do not give up their lives at a young age because they ate too much or someone bought a gun out of fear.

We are Americans: we do not accept failure in ourselves. The rest is trivial distraction.

The latest in DME: an umbrella

Posted by on March 25, 2013 Comments Off on The latest in DME: an umbrella

When my wife moved to the States from Singapore, she was amazed to find that the umbrellas sold did not list their UV protection. Singapore is 137 km or 85 miles from the equator, and light skin is valued in Chinese culture. So protection from the aging and darkening effect of the sun’s rays has strong cultural underpinnings–unlike the US where there seems to be a tanning salon in every strip mall.

Normally we don’t think of an umbrella as DME (Durable Medical Equipment). However, if DME is home medical equipment you need for your health, then using an umbrella to prevent melanoma seems to qualify. As reported in JAMA Dermatology The researchers Josette R. McMichael, MD, Emir Veledar, PhD, and Suephy C. Chen, MD, MS of Emory University performed a simple, but well-designed experiment: they invited friends to join them in a parking lot, took 3 ultra-violet radiation (UVR) readings, and then opened umbrellas the friends had brought, taking two UVR readings, 1 cm from the individual, and 1 cm from the edge of the umbrella as shown:

Umbrella_uvr_measurement_20130304

There was wide variety in protection among the 22 umbrellas tested, ranging from a white totes® (77%) to a silver Coolibar® (99%). Fourteen were black in color.

Some of the numbers: Umbrella_findings_20130314

As is apparent in the account, the two readings (close and far) were highly correlated. The following scatterplot shows that as the values of each of the two readings are on the axes. The lowest reading shows the greatest protection, so umbrella 6 is the Coolibar®.

Umbrella_uvr_emory_20130304

As the earth warms, we can expect disturbances in the atmosphere that increase our exposure to UVR. Borrowing the style of the 19th century, carrying umbrellas, especially those designed to screen UVR, may be the best we can do.

What’s a woman to do? Or a man? Dairy and weight and bones and stuff.

Posted by on March 18, 2013 Comments Off on What’s a woman to do? Or a man? Dairy and weight and bones and stuff.

In many ways women’s health is more challenging than men’s.

Women over age 50 are much more likely to get breast cancer, or its precursors, such as fibrocystic breast disease.

Women get cervical and ovarian cancer–men don’t need pap smears or the equivalent.

Women are five times more prone to osteoporosis.

Many medical studies have disproportionately targeted men, although that is changing.

But let’s just consider osteoporosis for a moment. Some risk factors are:

  1. Unchangeable
    • Sex
    • Age
    • Race
    • Family History
    • Frame Size
  2. Hormone Levels
    • Sex Hormones
    • Thyroid
    • Other Glands
  3. Dietary
    • Low Calcium Intake
    • Eating Disorders
    • Weight Loss Surgery
  4. Steroid Prescriptions and Others
  5. Lifestyle
    • Sedentary Lifestyle
    • Excessive Alcohol Consumption
    • Tobacco Use
  6. Too little estrogen

This is but one ailment, but threading the needle is difficult. Consider that sedentary lifestyle and inadequate weight are opposites. If someone exercises and loses weight, the risk is increased. If someone does not exercise, the risk is increased. And the task is even more complicated. A recent study found that consumption of high-fat dairy is associated with increased mortality from breast cancer–so your doctor will probably tell you to stick to low-fat dairy to get additional calcium–be sure to ask.

Very often we hear that someone fell and broke their hip; less often we realize that someone’s hip broke, and they fell.

The International Osteoporosis Foundation estimates that 1 in 3 women and 1 in 5 men will experience a fracture from osteoporosis.

Osteoporosis affects more than 10 million Americans, accounting for 1.5 million fractures annually.

Calcium: Friend or foe? Part II

Posted by on March 7, 2013 Comments Off on Calcium: Friend or foe? Part II

Last time we looked at calcium supplements and cardiovascular risk. The indicators are strong that men should not be taking calcium supplements in the absence of a very clear, unambiguous reason to do so. Women at risk for osteoporosis, for example, need to discuss the relative risks and benefits with their physician. No treatment is without potential risks, so we need to make decisions based on likely outcomes and known risks.

Susanna C. Larsson PhD puts the issue of calcium in perspective:

Larsson_JAMA_Calcium_2013

In addition to the cardiovascular risks we have considered, there are elevated risks of kidney stones (renal calculi). Calcium is intimately related to the development of kidney stones, also called “calcium stones.

The U.S.Preventive Services Task Force has issued recommendations.

Annals of Medicine Calcium 2013

Here is what those recommendations ( I Statement and Grade: D) mean:

UPSTF grades

The best, meaning safest, sources of calcium are not supplements but diet. The Office of Dietary Supplements at NIH has issued a helpful Calcium Fact Sheet/a>

The recommended daily allowances for calcium are:

CalciumRDAs

And some of the best sources to attain that level of daily calcium consumption are:
NIHCalciumsources

Calcium: Friend or foe? Part I

Posted by on March 4, 2013 Comments Off on Calcium: Friend or foe? Part I

As I approached a certain age, my doctor said, “Oh, are you taking calcium supplements?” And, I asked him, “Isn’t arterial plaque calcified cholesterol? Is it really a good idea to flood my arteries with calcium?” He is a thoughtful person. “Maybe not,” he said, upon reflection.

The main therapeutic use of calcium supplements is to ward off osteoporosis. We are beginning to live longer than our bones were intended, and we are trying to avoid turning into boneless amoebae before we die. Knowing from childhood that “calcium builds strong bones,” we thought calcium supplements made perfect sense.

Calcium Source: news@Jama

I felt really validated when studies came out showing calcium to be a cardiac risk. The most recent was published online a month ago. The NIH AARP Diet and Health Study found a higher risk of cardiovascular events in men taking supplementary calcium. Why the risk did not appear to be elevated for women is a subject for further study.

Similar findings have been reported in the British Medical Journal: Heart and Education in Heart.
Calcium supplements: bad for the heart?
Heart 2012;98:12 895-896
As well as in other European studies:
2011_BMJ_Heart_Calcium

Where are those calories are coming from?

Posted by on February 28, 2013 Comments Off on Where are those calories are coming from?

Hint: it’s fast food. A recent Centers for Disease Control and Prevention (CDC) study found that over a 3-year period 11.3 percent of calories came from fast food.

That surprises no one. There were, however, two interesting points made:

First, while adults have decreased their intake of fast food, consumption by youth has increased. As consumption of fast food declines with age, it is not clear to me whether the decline is true progress or related to the aging of the population.

The second takeaway from the study is more intriguing, as shown in the following summary of study findings:

CDC_NatHealthSurveyNutrition_201302

I have highlighted the finding at the bottom of the graphic.

When it comes to fast food: the more you eat, the more you gain; the more you gain, the more you eat.

If someone told you that the more heroin, opium, etc. you consume the more you want, you would not be surprised.

Are you as surprised as I am to find a study that shows the same is true of fast food?

Since we regulate addictive drugs, there is an argument to be made that addictive substances consumed as food could be regulated as well. I do not know what that regulation should consist of, only that we have a tradition of regulating addictive substances, assuming that the individual is incapable of self-regulation in the face of addiction.

As is frequently the case, the questions that arise are more intriguing and clear than the answers.

Source: NCHS Data Brief ■ No. 114 ■ February 2013

The Safety of Our Children: Vaccinations

Posted by on January 28, 2013 Comments Off on The Safety of Our Children: Vaccinations

If there is one aspect of health we care most about, it is that of our children.

We are afraid to do the wrong thing, which might be doing something and might be doing nothing.

Vaccinations are the first major encounter our children have with the health care system.

By major I mean:

Under the recommended plan from the Centers for Disease Control and Prevention, children today are vaccinated against 14 infectious diseases, receiving up to 24 vaccines by their second birthday, and up to five in one office visit.

There has been controversy about the frequency of vaccinations, about the content of vaccines, and about the necessity of the vaccines at all in the absence of the diseases they protect against.

The last reported case of diphtheria in the US occurred in 2003.

The last reported case of polio in the US occurred in 1986.

I do not claim to know the incidence and severity of side effects and reaction to these and other vaccines.

Here is what I know:

  1. When a disease like smallpox was eradicated, the routine vaccination was halted.
  2. The diseases that we are vaccinated against have not been eradicated. We live in a small world: we travel to other countries, and others travel here. HIV/AIDS was brought here on a plane. We do not want to be like the Native Americans, wiped out by diseases from Europe because we were not vaccinated.
  3. The risk and incidence of reactions are minimal compared to the severity of an infectious outbreak.
  4. Science brought us the life-saving vaccines, not hunch or intuition.
  5. The Institute of Medicine of the National Academies has issued a report on childhood immunizations and found:
    1. the childhood immunization schedule is considered one of the most effective and safest public health interventions available to prevent serious disease and death. Furthermore, the committee’s review of the literature did not find high quality evidence supporting safety concerns about the immunization schedule.
    2. The committee’s efforts to identify priorities for recommended research studies did not reveal an evidence base suggesting that the childhood immunization schedule is linked to autoimmune diseases, asthma, hypersensitivity, seizures, child developmental disorders, learning disorders or developmental disorders, or attention deficit or disruptive behavior disorders.
    3. The committee found no significant evidence to imply that the recommended immunization schedule is not safe.

The bottom line: in all of our health care decisions we are playing the odds–life never affords us certainty. The odds favor vaccination according to schedule. Listen to your pediatrician–vaccinate your children.