Tag: Obesity

Weighing in on Paula Deen

Jan 19, 2012• 4

By Marion Nestle

The huge fuss over Paula Deen’s type 2 diabetes is understandable. She is, after all, the queen of high-calorie Southern cooking. And diabetes rates are especially high in the South.

Perhaps less understandable is the reaction of the American Diabetes Association. As reported in the New York Times,

Heredity, according to the American Diabetes Association, always plays some part. “You can’t just eat your way to Type 2 diabetes,” said Geralyn Spollett, the group’s director of education.

Wrong. You most definitely can eat your way to type 2 diabetes.

Type 2 diabetes is closely linked to overweight and obesity. No, not everyone who is overweight develops type 2 diabetes. But most people who have type 2 diabetes are overweight.

I’ve written before about obesity issues – mostly related to soda and diet soda (the message – even diet soda isn’t good for you – try to drink water instead) and also that even being a little overweight can still result in health problems. But a new study, coming out of the National Longitudinal Study of Youth, shows that obesity can also impact you economically with obese people earning less than the rest of the population on average.

Hopefully this information will help provide greater motivation for people struggling with obesity since sometimes it takes more than a simple understanding of health and self interest to sufficiently motivate people to take action. But it also raises questions about the reasons for average lower pay.Continue reading…

Can We Design a Heart Healthy Home?

Dec 9, 2011• 7

By SANJAY BASU, MD

There is increasing evidence that the quality of our homes and cities is a critical determinant of cardiovascular disease, diabetes and lung conditions. As urbanization and economic change occur globally, whether we live in a house free of dust in a city with open parks and traffic regulations, or in a dusty tenement building next to a major road, seems critically correlated with our likelihood for having shortened life expectancy, poor nutrition, heart disease and lung problems. In this week’s blog post, we look at some of the mechanisms relating the “built environment”—our human-made surroundings of daily living—to the risk of illness. We ask the question: can we do for our hearts and lungs what the Bauhaus movement did for functional design?

Indoor air quality

If Dwell Magazine had a feature edition on designing a healthy home, they’d have to tackle the major issue of indoor air quality. Much research on the built environment’s impact on health was revealed through a series of studies on asthma among children living in low-income public housing units in the United States. Poor indoor air quality resulting from dust and dirt in public housing units was a major cause of emergency room visits during the 1980’s and 90’s among these children, leading to new programs for housing quality checks and maintenance, which we featured in a previous post.Continue reading…

Farm Bill Needs a Major Overhaul

Dec 5, 2011• 2

By Marion Nestle

Q: What’s going on with the farm bill? Any chance for improving it?

A: I wish your question had an easier answer. The farm bill has to be American special-interest politics at its worst.

As Stacy Finz has been reporting in the main news and Business sections of The Chronicle, the failure of the recent super-deficit reduction plan also brought an end to a secret committee process for writing a new farm bill. Now Congress must follow its usual legislative procedures. The farm bill is again open for debate.

Advocacy is much in order. The farm bill is so enormous, covers so many programs, costs so much money and is so deeply irrational that no one brain – certainly not mine – can make sense of the whole thing.

It is all trees, no forest. The current bill, passed in 2008, is 663 pages of mind-numbing details about programs – hundreds of them – each with its own constituency and lobbyists.

The farm bill was designed originally to protect farmers against weather and other risks. But it grew piecemeal to include programs dealing with matters such as conservation, forestry, biofuels, organic production and international food aid.

Should Doctors Make House Calls?

Dec 4, 2011• 2

By Sanjay Basu, MD

In the olden days, doctors would travel from house to house when community members fell ill. Now, we usually expect patients to come to our office-based clinics. The modern model of care is certainly more efficient for us as physicians. But it’s also a barrier for patients to receive medicine; the highest-risk people usually make it to our clinics after being discharged from their first or second hospitalization, well after high blood pressure or diabetes has already taken its toll on their bodies. Our latest research suggests that we can statistically predict which people are most likely to end up having chronic diseases five or ten years from now. We can pinpoint these people right down to which house they live in. Such predictive models present a new opportunity to prevent disease before it becomes costly or deadly. In this week’s post, we look at a new idea for community-based disease prevention in medicine: the geographical mapping of chronic disease risks, and preemptive visits of healthcare workers to households where people are likely to become ill in the future.

The physician Jeffrey Brenner became famous for piloting a model of healthcare that would attempt to simultaneously improve services while reducing healthcare costs in his city of Camden, New Jersey. His model, recently profiled in Atul Gawande’s popular New Yorker article “The Hot Spotters”, was based on a simple observation: that sick people with poorly-treated diseases tend to be clustered in certain parts of the city.

The Politics of Prevention

Nov 29, 2011• 11

By JOANNE KENEN

If there’s one thing everyone in Washington can agree on it’s that prevention is good. And that’s about as far as the agreement goes.

As for the rest of it – who is responsible for prevention, how to define prevention, what is the government’s role in prevention, how much to spend on prevention and when to spend it – is not so clear, and wrapped up in the bitter politics (and difficult economics) of the day.

Then, there’s the question of the Prevention and Public Health Fund created by the Affordable Care Act to enable states and communities to try to prevent illness and promote longer, healthier lives. To backers of the law, the fund is an engine for public health, community transformation, and a pivotal part of the effort to create a “health care” system instead of a “sick care” system.

To foes, it’s a “slush fund”, a $13.8 billion monument to everything they don’t like about the 2010 legislation. It’s $13.8 billion that could easily end up on one of the deficit-cutting chopping blocks.

Denmark’s Fat Tax

Nov 16, 2011• 4

By Marion Nestle

The Danish government’s now infamous “fat tax” has caused an international uproar, applauded by public health advocates on the one hand and dismissed on the other as nanny-state social engineering gone berserk.

I see it as one country’s attempt to stave off rising obesity rates, and its associated medical conditions, when other options seem less feasible. But the policies appear confusing. Why Denmark of all places? Why particular foods? Will such taxes really change eating behavior? And aren’t there better ways to halt or reverse rising rates of diet-related chronic disease?

Before getting to these questions, let’s look at what Denmark has done. In 2009, its government announced a major tax overhaul aimed at cushioning the shock of the global economic crisis, promoting renewable energy, protecting the environment, discouraging climate change, and improving health – all while maintaining revenues, of course.

The tax reforms make it more expensive to produce products likely to harm the environment and to consume products potentially harmful to health, specifically tobacco, ice cream, chocolate, candy, sugar-sweetened soft drinks, and foods containing saturated fats.

Some of these taxes took effect last July. The current fuss is over the introduction this month of a tax on foods containing at least 2.3 per cent saturated fat, a category that includes margarine, salad and cooking oils, animal fats, and dairy products, but not – thanks to effective lobbying from the dairy industry – fluid milk.

What About Personal Responsibility?

Jun 24, 2011• 76

By JOE FLOWER

A reader writes to ask: What about personal responsibility? “I see no movement afoot to require the public to accept or meet norms of behavior that would reduce the need for medical treatment—smoking, excess drinking, use of drugs, over weight, etc. What ever happened to ‘You reap what you sow’?”

Good question. I answered:

Thanks for writing. This is a common concern. It’s often expressed something like, “Why are we paying for all this healthcare for people who won’t take care of themselves?” This seems, at first blush, an obvious question with an obvious answer. After all, as I constantly point out in what you read, vast amounts of healthcare dollars are spent to correct what we might call “self-inflicted lifestyle damage.” Why should the rest of us pay for that? Where is the responsibility?

On inspection, the question is more complex and the answer is not so obvious. Let me try to parse it out. I can think of four related aspects of the question.

1. Their health affects ours. My wife and I had a lovely dinner at a very nice French restaurant on the waterfront here in Sausalito last night. The staff was all French, with those endearing accents. The busboy who set our table, poured the water, took away dirty plates and all that, was Mexican. I talked with him a bit in Spanish about the nice weather. I have no way of knowing his immigration status. Now, if I had my ‘druthers, just as a customer, would I rather that he have good access to healthcare and healthcare advice, be up on his flu vaccinations, be aware of the importance of washing his hands frequently, or would I rather he be a seething mass of communicable disease, compounded by ignorance?

The McVictim Syndrome Could Kill Us

Dec 9, 2010• 57

By DAVID GRATZER, MD

Call it the McVictim syndrome. Too many pundits, public health experts and politicians are working overtime to find scapegoats for America’s obesity epidemic.

In his latest book, former FDA Commissioner David A. Kessler argues that modern food is addictive. In it, he recounts how he was once helpless to stop himself from eating a cookie. In a paper in this month’s Journal of Health Economics, University of Illinois researchers join a long list of analysts who blame urban sprawl for obesity. In November, former Carter administration advisor Amitai Etzioni argued that it’s so hard for Americans to keep weight off that adults should simply give up and focus attention on the young instead.

The peak of the trend: A recently released Ohio study, using mice, suggests “fine-particulate air pollution” could be causing a rise in obesity rates.

How long before we’re told that the devil made us eat it?

The McVictim syndrome spins a convenient — and unhealthy — narrative on America’s emerging preventable disease crisis. McVictimization teaches Americans to think that obesity is someone else’s fault — and therefore, someone else’s problem to solve.

The trifecta: Reform idiocy, Hospital CEOs and the Obesity Problem

Sep 7, 2010• 5

By Matthew Holt

It’s rare that you get such a delicious health care story combining human frailty, blindness and multiple stereotypes, but Julie Rovner of NPR found it. In fact I literally thought she’d been set up but she confirmed to me that it was true and put me in touch with the CMS spokesman who confirmed it. So remember, this really happened.—Matthew

An interim hospital CEO in Ohio Valley Medical Center, in West Virginia “found out” “advanced intelligence” from “word of mouth” sources in Washington DC that the “High Commissioners of the Healthcare Reform Bill” were going deny Medicare payments to any hospital of which than 5% of employees were 25% overweight.

This rumor prompted the said CEO to panic. Now before I tell you what he did, let me tell you a little of his story. To quote the CEO as he tells it:

I am five feet, 10 inches tall. The guidelines (he’s referring to standard BMI guidelines) suggest that I should weigh between 151 and 163 for my medium frame. If you add 25 percent to the upper limit, I would need to be no heavier than 204 pounds. I currently weigh 272 pounds, down from 335. I would have three years to lose 68 pounds

That is indeed some challenge. Not to mention that the hospital is in West Virginia (albeit the northern sliver between Ohio & Pennsylvania) where the obesity rate is among the nations highest—there’s a reason that Jamie Oliver took his childhood obesity crusade there. In fact Ohio County, WV’s obesity rate is 32% according to the rather fun County Sin Rankings site. And as obesity tends to mean a BMI of roughly 25% more than the outer band of the guidelines, it’s a fair bet that somewhere close to 32% of the workforce is obese. So getting that number down to 5% would be a major struggle.

The interim CEO also wanted to promote not only his own weight loss story but the laudable activities of his hospital’s dietitians and its weight-loss programs. Here’s his counsel to hospital employees.

I strongly urge you to take advantage of the programs OVMC and EORH are currently offering employees who are battling with excess weight. Mary Velez is doing a fabulous job with Weight Watchers programs, and in addition, I have also been offering a program known as “Diet and Fitness for Love.”

And who could be against that advice?