Archive for January, 2010

Is this a great country or what?

January 30th, 2010

So here is another take on the state of the union:  Increasing health care costs are fueling the country’s economic problems. Obesity is a major driver of the health care costs. The First Lady has launched a campaign against childhood obesity and is promoting gardens and local sources of fresh food. Persons who are overweight or obese get blamed (even the Surgeon General) and are discriminated against.

In the last decade or so, the federal government,  states, counties, cities, joined by major foundations and corporations, supported by numerous non-profit groups have pushed for recognition of obesity and steps to educate the public to its perils.

 So now, two restaurants are fighting each other in court over their themes, like Chili Chest Pain Fries. the Heart Stopper  and the bypass burger, employing décor of heart defibrillators, wheelchairs and dialysis machines  guaranteeing  that their menus will definitely lead to obesity if not outright kill you! Even free food for those over 350 pounds, see Delray Beach restaurant’s food is deadly — will lawsuit kill it? – South Florida Sun-Sentinel.com.

It isn’t just the bizarre, counter-pc approach of these restaurants that is troubling

If someone is fired from their job because their employer doesn’t like their size, there is virtually no recourse.  If you wanted to sue the restaurant or food chain or food company over its portion sizes, calorie content or food composition, you would be ridiculed for not ‘taking personal responsibility.’ The food industry would rush to legislatures to save the world from ‘frivolous’ lawsuits.  If you want to sue your school for what it serves your child, you would be accused on not being a very good parent. If you wanted to sue your insurer for not covering bariatric surgery or FDA approved drugs, you’d be accused of wanting other people to pay for your sins. If you wanted to sue to reduce food marketing to kids, forget about it too…it’s protected by the First Amendment. Yet, the doors of the federal courts are wide open to these restaurants suing each other. Where’s the Tort Reform Chorus? No doubt this will use up some serious judicial resources before it is over. How did we get here? More importantly, how can we move forward if legitimate, if novel, claims cannot even get in the doors of the courthouse?

Canada suffering through own obesity epidemic

January 26th, 2010

January 26, 2010

Canada’s Heart and Stoke Foundation sees “Perfect Storm” of obesity and hypertension.2010 report card – A Perfect Storm – Heart and Stroke Foundation of Canada See Dr. Sharma’s comments Dr. Sharma’s Obesity Notes » Blog Archive » Obesity Drives Hypertension Epidemic in the Young.

Is obesity leveling off and what does it matter?

January 23rd, 2010

Ten days ago, the media was touting new reports from the CDC that the obesity epidemic was ‘leveling off’ or  ‘reaching a plateau.’ The news was taken in some quarters with a sense of relief:”Whew, I’m glad that’s over.” Well, don’t get too comfortable. The reports have a lot more to say and overall, this is not a time for complacency.

What the reports actually say.

First, regarding adults, (Prevalence and trends in obesity among US adults, … [JAMA. 2010] – PubMed result), the authors note that the prevalence of obesity is high, exceeding 30% in most age and sex groups except for men 20-39 years old. Strong racial and ethnic differences persist with very high rates among African-American and Hispanic Americans compared to white Americans. Prevalence of severe or morbid obesity, called class 3, (a BMI of 40 or more) was 5.7% overall, with 4.2% for mean and 7.2% for women, including a rate of 14.2% among non-Hispanic black women. What their analyses found was that the earlier rates of increase were on the order of 6 to 7 percentage points. In the this analysis, over the past ten years, the rate of increase is 4.7 percent. Bottom line: rates are still going up.

Second, regarding children, (Prevalence of high body mass index in US children … [JAMA. 2010] – PubMed result) the authors found no statistically significant increases over the last 10 years among girls. Among boys, there is a different picture. Heavy boys between 6 and 19 years of age are getting heavier. Bottom line: the prevalence of obesity has tripled among school-age children and adolescents if you go back to the 1980s. It is high – 17%- and remains high.

So, is the epidemic leveling off? Answer: we don’t know yet. These analyses look at the last ten year trends and they are less than the peak periods of increase. Is this a pause on an upward track or the start of a decline?

Experts I talked with are not too optimistic. First, there is the perennial question of relying on the BMI. A recent paper indicates that more precise tools, like skinfold tests, would have predicted the obesity epidemic by 10-20 years. The timing of the rise in U.S. obesity varies with… [Econ Hum Biol. 2009] – PubMed result. Second, there isn’t a clear explanation of why the rates should be leveling off. We’d like to think people are changing their behavior but the evidence is there is less compliance with recommended dietary and physical activity standards than ever. Adherence to healthy lifestyle habits in US adults… [Am J Med. 2009] – PubMed result  Compliance with the DASH diet among persons with hypertension has slipped. Deteriorating dietary habits among adults with hyp… [Arch Intern Med. 2008] – PubMed result

The recession may be causing people to forgo buying more expensive but healthier foods Recession Weighs on Waistlines – chicagotribune.com. Many clinicians running medical weight management programs I have talked with report their volume is down 20-30%.

Hopefully, this is the beginning of a levelling or downard trend in obesity but we will not know for sure until more information comes in. In the meantime, we should consider that we don’t to be having phenomenal increases in obesity to justify more programs for treatment and prevention. An editorial  by J Michael Graziano on the two reports from CDC, states, “Even if these trends can be maintained, 68% of US adults are overweight or obese, and almost 32% of school-aged US children and adolescents are at or above the 85th percentile of BMI for age. Given the risk of obesity-related major health problems, a massive public health campaign to raise awareness about the effects of overweight and obese is necessary..Major research initiatives are needed to identify better management and treatment options. The longer the delay is taking aggressive action, the higher the likelihood that the significant progress achieved in decreasing chronic disease rates during the last 40 years will be negated, possibly even with a decrease in life expectancy.”  Amen.

January 23rd, 2010

January 23, 2010

Obesity by any measure found to increase risk of ischemic stroke Race- and Sex-Specific Associations of Obesity Mea… [Stroke. 2010] – PubMed result

Are we looking for answers in the wrong places?

January 23rd, 2010

In a cross-sectional and longitudinal study in Canada, nine known risk factors for overweight and obesity were examined. Only short-sleep duration, low dietary calcium intake and high disinhibited  eating were found to be significantly associated with higher BMI in both men and women. Short sleep duration had a greater effect than parental obesity, television viewing and physical inactivity. Population studies indicate that sleep duration has decreased over recent years. The authors note that affecting obesity by addressing  the traditional risk factors – reduced physical activity, high caloric intake and high fat intake – have not been very successful and that attention to factors which are not caloric per se may be worthwhile.  Risk factors for adult overweight and obesity in t… [Obesity (Silver Spring). 2009] – PubMed result

First Lady Weighs In on Childhood Obesity

January 20th, 2010

Remarks of First Lady Michelle Obama

Conference of Mayors

Washington, DC

January 20, 2010

Good afternoon everyone, it’s a pleasure to welcome all of you to Washington today for this year’s winter meeting.

Thank you, Mayor Kautz, for that wonderful introduction, and congratulations on becoming President of this fine organization.  I know you’re going to do an excellent job.

I see that Secretary Chu is here, and I want to recognize him for his outstanding leadership at the Department of Energy.

I’d also like to thank my hometown Mayor, Mayor Richard Daley; and past President of this organization, Mayor Joe Riley.

And most of all, I want to thank all of you for the extraordinary work you’re doing every day in cities and towns across this country.

As some of you may know, one of my first jobs was in a mayor’s office – working for Mayor Daley out in Chicago – and I saw firsthand the kind of challenges you all face.  Whether it’s handling a crisis in one of your schools, or dealing with cost overruns in paving your streets, or planning for that upcoming snowstorm, you have to be prepared for anything and everything.

And it’s not like you catch a break when you leave the office.  Whether it’s at church, or the grocery store, or the Friday night football game, I know that people don’t hesitate to come up and tell you about the problems they’re having, or what they think you could be doing better.  And they never hold back.

There’s a reason for that – it’s because you all govern where people feel it most.  You see people’s struggles up close and personal.  And what you see on the ground is often the first indicator of what’s happening on a national level.

You’re the first to see the impacts of a struggling economy in the lines at your unemployment offices.  You’re the first to know that crime rates are rising when you get those arrest reports from your police force.  You’re the first to get a sense of job losses when CEOs tell you that they’ve decided to locate their operations overseas rather than in your hometown.

The same is true for issues affecting the physical and mental health of the people you serve.  That’s why I wanted to talk with you today about a problem that’s of great concern to me – one that I know many of you are seeing and hearing about every day in your communities…and that is the epidemic of childhood obesity in America today.

Over the past year, I’ve been thinking, reading and speaking a lot about this issue, but the statistics never fail to take my breath away.  Right now, nearly one third of children in America are overweight or obese – one in three.  And one third of all children today will eventually suffer from diabetes – in the African American and Latino communities, it goes up to almost half.

So it’s not surprising that a study published just this month found that obesity could now be an even greater threat to America’s health than smoking.  In fact, medical experts are predicting that this generation is on track to have a shorter lifespan than their parents.

Obesity is also one of the biggest threats to the American economy.  If we continue on our current path, in ten years, nearly 50 percent of all Americans will be obese – not just overweight, but obese.  So think about how much we’ll be spending on health care to treat obesity-related conditions like heart disease, cancer, and diabetes.  Think about all the missed days of work and decreased productivity we may see as a result.

And think about what this means for our quality of life – for how people feel when they wake up in the morning; whether they can make it through a day of work; whether they can do something as simple as walking to the store, or playing ball with their kids and grandkids.

And this isn’t some far-off, future problem we’re dealing with.  Many of you are already seeing some of the costs and consequences in the cities and towns you lead.

You see how kids in your schools are struggling – sitting on the sidelines, unable to keep up with their classmates, visiting the school nurse with weight-related health problems.  You see it in your clinics and emergency rooms, in waiting rooms overflowing with folks suffering from preventable obesity-related problems from asthma to high blood pressure to diabetes.  One mayor told us that obesity can even impact economic development and job creation because CEOs and entrepreneurs worried about high employee health care costs are sometimes reluctant to set up shop in areas with high obesity rates.

None of us wants this kind of future for our kids or for our country.  And I know that a lot of parents out there are worried right now.  They desperately want to do what’s right.  They desperately want to make responsible, healthy decisions for their kids.  But too often, the realities of modern life make it feel like the deck is stacked against them.

Many parents tell me that they want to prepare healthy food for their kids, but there aren’t any supermarkets where they live that sell fresh produce.  Or they’re tight on money, and healthy foods seem too expensive.  Or they’re tight on time – working longer hours, working two jobs – so they can’t pull off those homecooked meals around the dinner table.

They tell me they want their kids to be physically active, but their schools have cut gym and recess, and there’ve been cuts to sports and afterschool recreation programs too.  And the days of those tight-knit neighborhoods, where you could send kids out to play and tell them not to come back until dinner – for many folks, those days are long gone.  So many kids wind up spending their afternoons sitting in front of the TV or playing video games instead.  In fact, a study released today by the Kaiser Family Foundation found that the average young person in America spends more than seven and a half hours a day using some kind of media device.

And sometimes, parents just don’t have the information they need to make decisions they feel good about.  They’re inundated with news reports filled with conflicting information, and with food labels filled with ingredients they can’t even pronounce, let alone know whether those ingredients are healthy.

So really, with all the changes we’ve seen in our society – families having less time together, kids having fewer opportunities to be physically active, the rise of fast food – it’s no wonder that childhood obesity has tripled over the past thirty years.

And I know how stressful it can be for parents to contend with these forces.

Now, in my current life, I’m incredibly blessed, with more help and support than I could ever have imagined.  But I didn’t always live in the White House.

It wasn’t that long ago that I was juggling a fulltime job with the round-the-clock role of being a mom.  And there were plenty of times when after a long day at work, when the fridge was empty and everyone was hungry, that I just ordered that pizza, because it was easier.  Or we went to the drive-thru for burgers, because it was quick and cheap.  And I wasn’t always aware of how all the calories and fat in some of the processed foods I was buying were adding up.

It got to the point where our pediatrician kind of tapped me on the shoulder and said, “You know, you might want to consider making some changes.”

So we know that families could use a little help here.  But we also know that this isn’t a problem that can be solved from on high.  This isn’t something that will be fixed by just a bill in Congress or an executive order from the President.  And I know that the last thing you all need right now is a bunch of commands from Washington, or a ton of red tape that makes it hard for you to get anything done at all.

Ultimately, it’s going to take all of us – businesses and non-profits; community centers and health centers; teachers and faith leaders; coaches and parents; and particularly all of you, our nation’s mayors – all working together to help families make commonsense changes so our kids can get, and stay, healthy.

Now, I know that with the economy the way it is, a lot of folks are feeling stretched pretty thin right now.  And that’s particularly true of all of you, as you’ve had to make budget cutbacks that lead to all kinds of impossible choices and wrenching tradeoffs.

And there are some people who might ask you: How can you go and spend money on something like healthy school lunches when we’ve got overcrowded classrooms and outdated textbooks to worry about?  Or, how can you build parks, or sidewalks, or bike paths when we can barely afford to keep the community health center open?

These are fair questions.  But when you step back and think about it, you realize that in the end, they’re really false choices.  We’ve all heard from teachers and principals that if kids don’t have the nutrition they need to stay alert and focused in class, even the best textbooks in the world aren’t going to help them learn.  And we’ve heard from doctors and public health officials that if they don’t have safe places to play right now, then a few years from now, that community health center will be even more crowded and even more of a strain on your budget.

Ultimately, folks like you know that leadership is about having the foresight – and the courage – to make those sacrifices and investments in the short run that pay big dividends – often paying for themselves many times over – in the long run.  And that is precisely what happens when we undertake smart, strategic efforts to help our kids lead active, healthy lives right from the beginning.

That’s why Mayor Robert Cluck of Arlington, Texas – who’s also a doctor, by the way – has been working to get kids more physically active, giving out pedometers at the end of the school year so they can track their steps over summer vacation.

It’s why Mayor Darwin Hindman of Columbia, Missouri is building a system of walkways and bikeways in his city that will connect businesses and shopping centers to schools, parks, and neighborhoods.

Mayor Elaine Walker of Bowling Green, Kentucky has launched a website to encourage residents to exercise, helping them find parks and trail maps and information on upcoming bike rides, and walks and runs.

Mayor Rybak of Minneapolis brought in farmers markets to provide access to fresh produce in underserved areas.

Mayor Curtatone of Somerville, Massachusetts created a partnership with local restaurants as part of a city-wide strategy to fight obesity, promoting restaurants that have agreed to offer low-fat menu options and smaller portions.  And he and his staff view every decision they make, every project they manage, as an opportunity to take action for the health of Somerville’s citizens.

Mayor Mick Cornett challenged the people of Oklahoma City to lose a million pounds, and he created a website – thiscityisgoingonadiet.com – where people can learn how to lose weight and track their weight loss, and can share personal stories and tips with others.  So far, 40,000 people have signed up – and together, they’ve lost more than half a million pounds.

I’m pleased that the CDC is now offering grants to local health departments to fund more initiatives like this all across America.  We’ll be announcing the recipients next month, and I hope that many of you have applied.

And I want to recognize the U.S. Conference of Mayors for your leadership in supporting these efforts as well, including publishing an excellent guide for mayors on how to fight childhood obesity in their cities and towns.

It makes sense that this organization, composed of mayors across the political spectrum, would take the lead on this issue.  Because like much of what you do each day, this isn’t a partisan issue.  This has nothing to do with whether you’re a Democrat or a Republican, liberal or conservative.  It’s about the kind of future we want for our kids.  And it’s about whether we’re willing to use both our policies and our bully pulpits to build that future.

That’s what Mayor Cornett did, when he started talking about the problem of obesity and lost 40 pounds himself to get down to his target weight.  And the people of his city took notice.  When he goes to restaurants now, everyone watches what he orders.  And a reporter quoted one of his constituents saying, “When the mayor pushes you to lose weight, that says something.”

That’s the kind of impact each of you can have.  That’s the power that raising awareness and setting an example yourself can have on an entire city or town.

And that’s what I hope to do during my time as First Lady.  That’s why, next month, I’ll be launching a major initiative on childhood obesity that mobilizes the combined resources of the federal government to work with partners across the country, including mayors like all of you, and others in the foundation, business and non-profit sectors.

The idea here is very simple: to put in place commonsense, innovative solutions that empower families and communities to make healthy decisions for their kids.

That includes increasing the number of “healthy schools” where kids have access to nutritious food; providing more opportunities for kids to be physically active; ensuring that affordable healthy food is available in more communities; and giving parents the information they need to make good choices for themselves and their families.

And going forward, I want to hear more from all of you about this.  We need your ideas and input.  We want to hear your thoughts about which strategies and programs are really working, and which aren’t.  We’re looking to you to be leaders on the frontlines of this effort across the country.

In the end, I know that achieving all this won’t be easy – and it won’t be quick.  This isn’t the kind of problem that can be solved in one year, or even one Administration.  But make no mistake about it, this problem can be solved.

We don’t need to wait for some new invention or discovery to make this happen.  This doesn’t require fancy tools or technologies.  We have everything thing we need right now – we have the information; we have the ideas; and we have the desire to start solving America’s childhood obesity problem.  The only question is whether we have the will.

Are we willing to work across party lines to give our kids a healthy future?  Are we willing to change our own habits as we work to change theirs?  Are we willing to make every decision about our schools, communities, and cities with the health and well-being of our children in mind?  In the end, are we willing to put our kids first?

I’m here today because I think we are – because I think we all know exactly what’s at stake here.  It’s what I think about when I tuck my girls into bed at night – how I want them to be happy and healthy and have every chance to follow their aspirations and ambitions.  I want them to have the tools they need to succeed in life: not just the education and opportunities – but the physical and emotional strength to seize those opportunities.  I want them to be able to engage in life with the energy, endurance, and focus they need to meet the challenges they’ll face along the way.

And I want them to have the blessing that my husband and I have, and that my mother has, of being there to see their own children and grandchildren grown up – and, God-willing, their great grandchildren too.

That’s what I want for them, and for every single child in this country.  And I look forward to working with all of you in the months and years ahead to give them that chance.  Thank you.

New Surveys Show mixed results

January 20th, 2010

A CBS New Poll conducted December 17-22, 2009 shows 98% of women and 91% of men consider obesity as a ‘very’ or ‘somewhat’ serious public health problem. But majorities of both men and women give the country a grade of “D” of “F” on making efforts to combat it. 89% believe obesity is something people can control but 60% do not favor a tax on junk food. 55% of Americans say they would like to lose weight, 40% would like to stay at their current weight and only 5% want to gain weight .  (In 1951, 17% wanted to gain weight.) Poll: Most Oppose Tax on Junk Food – Political Hotsheet – CBS News  Another survey has found that the number of people trying to lose weight has jumped from 54% in 1985 to 61% in 2009. The number of Americans who find overweight people less attractive has declined over 20 years from 55% to 24% but whether this is political correctness or a real change in attitude remains disputed. See, Survey: It’s OK To Be Overweight – CBS News . In a third survey, 79% of Americans say they are satisfied with their personal eating habits but 73% say most Americans have an unhealthy relationship with food. BioPortfolio News: GlaxoSmithKline Consumer Healthcare – Eight in 10 Americans Say They're…

Smoking Cessation can increase diabetes risk

January 8th, 2010

Can Smoking Cessation lead to increase in type 2 diabetes? Evidently the answer is yes according to Johns Hopkins researchers who studied a cohort of over 10,000 middle age adults. Smokers at risk for diabetes should engage in smoking cessation coupled with strategies for diabetes prevention. Smoking, smoking cessation, and risk for type 2 di… [Ann Intern Med. 2010] – PubMed result