Archive for December, 2011

The Best and Worst of 2011

December 30th, 2011

So, it is time to recognize the best and worst stories on obesity in 2011. (Why this is important to do just because we have to buy a new calendar isn’t quite clear to me but everyone seems to be doing it).

The selection really wasn’t too hard. First place for best development goes to the Centers for Medicare and Medicaid Services for adding intensive behavioral counseling for obesity to the benefits for Medicare beneficiaries.

Second place honors go to the Canadian Obesity Network for their Images Gallery, a creative step to generate positive visual images of persons with obesity.

There were more candidates for the worst developments in 2011.  However, the winner for the worst development goes to Dr. David Ludwig for his article sanctioning state removal of obese children from their families on the presumption that the parents are deficient and the child may have to have bariatric surgery years in the future.

Second place was a toss-up between Congress declaring pizza a vegetable and Washington Post Eugene Robinson’s saying New Jersey Republican Governor was not qualified to be President because he is obese. The award goes to Eugene Robinson because he should know better; we have lower expectations for Congress.

Here’s hoping for more good stories and fewer bad stories in 2012. Have a Happy New Year!

Obesity In Ireland

December 28th, 2011

Obesity is a problem in Ireland with a prevalence similar to that of the United Kingdom and northern Europe.  On our trip this summer, my wife and I could not help looking for the similarities and differences in the approaches to obesity between our two countries.

This exercise was more than just a bus man’s holiday. Both of us had family from Ireland who came over during the Great Famine (1845-1850).  During this period, one million people died of starvation and disease and another million emigrated. The population of Ireland has never recovered. 

The presence of the famine is quite real in Ireland. Not only are there replicas of the “coffin ships” which brought the Irish to the United States and Canada under horrendous conditions. But there are several monuments, including this one in County Mayo, to the victims of the famine.

 

But the most sobering reminder is the presence of hundreds of famine houses throughout the south and west, where the famine was most harsh. These are stone houses, usually with the roofs caved in or now covered with metal sheets. Some seemed to be converted to barns but most seemed untouched since the family left…or died.

 

To leap from viewing these relics of famine to discussing the problems of obesity seems like an enormous leap in 160 years or so. It is a testament to the improvements in agriculture, food science and transportation that famine is so remote. A telling illustration of where we are today was the display of the BMI chart in the windows of many pharmacies we passed, such as this one. No doubt the diets rich in Guinness and potatoes

 

Famine may be a remote threat to Ireland today. However, television news had extensive reports of the famine in Dafur, as well as appeals for contributions.(Television also had numerous reports of a gentleman who was suing to receive bariatric surgery. He had failed to meet the weight requirement of the National Health Service but was suing because quality of life was not one of the criteria to be considered. Obese Man Tom Condliff, 62, Takes PCT To Court To Persuade Them To Fund Gastic Bypass Surgery | UK News | Sky News. He lost the case.) 

The Irish government put together a comprehensive national strategy in 2005. Obesity – the policy challenges; Obesity – the policy challenges: executive summary. The very first recommendation is that “The Taoiseach’s (the prime minister) office should take the lead responsibility and provide an integrated and consistent proactive approach in addressing overweight and obesity and to the implementation, monitoring and evaluation o f the National Strategy on Obesity in conjunction with all government departments, relevant bodies and agencies, industry and consumer groups.” The strategy goes on to make specific recommendations for high-level government action, the education sector, the social and community sector, the health sector, the food commodity, production and supply sector,  and the physical environment sector. The 2005 recommendations were reviewed and evaluated in 2009. Report of Inter-sectoral Group on the Implementation of the Recommendations of the National Task Force on Obesity They reported significant progress on 32% of the recommendations. Not too bad given Ireland financial crises. 

There are two aspects of this plan which are important. First, everyone has skin the game. Every sector is tasked with making a contribution to an improvement in the obesity epidemic. But importantly, the top political leader, took responsibility for leading a united effort. Second, they monitor and report on the progress of their recommendations.

 Related to that is the broad absence of “blame” in the Irish approach to obesity. We had the opportunity to discuss this with Dr. John Devlin, Deputy Chief Medical Officer of the Department of Health and Children.

The Irish approach has been to skip arguing over who or what is to blame for obesity and to get all the players to make practical contributions to making improvements in their domains. It took a while to imagine discussions of obesity without the “blame factor.” It seems virtually every conversation in the United States about obesity has to do with who is to blame: the individual, the parents, the environment, television, schools abandoning phys ed and bringing in bad foods, food company marketing, especially to children, genes, your mother, etc, etc.

This “blame factor” may be easier to reduce in a society more homogenous than our and less litigious. But whatever the reason, one has to think that this obsession with who is to blame has done nothing but frustrate reaching solutions. It may be a bit of ethnic pride but the United States could learn a lot from the Irish approach: have the top levels of government lead all sectors in reaching practical.

Photo Credits: Dotty Lynch

We are pleased to provide the post in Irish:

Is fadhb Otracht in Éirinn a bhfuil leitheadúlacht cosúil leis sin de na Ríochta Aontaithe agus dtuaisceart na hEorpa. Ar ár turas an samhradh seo, ní raibh mo bhean chéile agus mé ag lorg cabhair na cosúlachtaí agus na difríochtaí sa chur chuige a otracht idir an dá thír.Bhí an cleachtadh seo níos mó ná fear bhus ar saoire. Bhí an dá linn teaghlaigh ó Éirinn a tháinig os cionn linn an Ghorta Mhóir (1845-1850). Linn na tréimhse seo, fuair duine amháin milliún duine de ocras agus galar agus ceann eile milliún ar imirce. Riamh Tá daonra na hÉireann a aisghabháil.Is é an láithreacht an ghorta fíor go leor in Éirinn. Ní amháin go bhfuil macasamhla de na “longa cónra” a thug na hÉireann chuig na Stáit Aontaithe agus Ceanada faoi choinníollacha horrendous. Ach tá roinnt séadchomharthaí, lena n-áirítear an ceann seo i gContae Mhaigh Eo, chun an íospartaigh an ghorta.Ach is é an meabhrúchán is sobering láthair na céadta teach gorta ar fud deisceart agus san iarthar, áit a raibh an gorta is harsh. Tá na tithe cloiche, de ghnáth le caved na díonta i nó anois clúdaithe le leatháin miotail. Roinnt chuma a thiontú go sciobóil ach an chuma untouched an chuid is mó ó d’fhág an teaghlach … nó a fuair bás.Chun breathnú ar na léim ó iarsmaí den ghorta chun plé leis na fadhbanna an otracht is cosúil cosúil le léim ollmhór i 160 bliain nó mar sin. Is fianaise ar na feabhsúcháin sa talmhaíocht, eolaíocht bhia agus iompar go bhfuil an ghorta chomh cianda. Ba léiriú ag insint an áit ina bhfuil muid inniu a chur ar taispeáint ar an chairt BMI sna fuinneoga na gcógaslann rith muid go leor, ar nós an ceann seo. Níl amhras ar an aistí saibhir i Guinness agus prátaí

D’fhéadfadh a bheith ina bhagairt Gorta iargúlta ar Éirinn sa lá atá inniu. Mar sin féin, bhí tuairiscí nuachta teilifíse fairsinge na gorta i Dafur, chomh maith le hachomhairc i leith ranníocaí. (Teilifís Bhí tuairiscí iomadúla de fhear uasal a bhí agairt a fháil máinliacht bariatric. Gur theip sé chun freastal ar an riachtanas meáchan na Seirbhíse Náisiúnta Sláinte ach bhí agairt mar nach raibh caighdeán na beatha ar cheann de na critéir a bheidh le breithniú murtallacha Man Tom Condliff, 62, Takes CCP Chun Chúirt a áiteamh orthu a Ciste Máinliacht Seachbhóthar Gastic |. Ríocht Aontaithe Nuacht |.. Sky News Chaill sé an cás)

An rialtas na hÉireann a chur le chéile straitéis chuimsitheach náisiúnta i 2005. Obesity – na dúshláin bheartais; Otracht – na dúshláin bheartais: achoimre feidhmiúcháin. Is é an moladh an-sin den chéad uair “Ba chóir an Taoisigh (an príomh-aire) oifig a chur ar an freagracht ceannais agus cur chuige comhtháite agus comhsheasmhach réamhghníomhach i ngleic le róthrom agus otrachta agus le cur i bhfeidhm, monatóireacht agus meastóireacht ar an Straitéis Náisiúnta ar Mhurtall i gcomhar le fáil gach roinn rialtais, comhlachtaí agus gníomhaireachtaí ábhartha, tionscal agus grúpaí tomhaltóirí. “Téann an straitéis maidir le moltaí sonracha a dhéanamh le haghaidh gnímh rialtais ard-leibhéil, an earnáil oideachais, an earnáil shóisialta agus phobail, an earnáil sláinte, an tráchtearra bia, a tháirgeadh agus a soláthair san earnáil, agus an earnáil timpeallacht fhisiciúil. Rinneadh athbhreithniú ar na moltaí 2005 agus a mheas i 2009. Tuarascáil an Ghrúpa Idir-earnála ar Chur i bhFeidhm na Moltaí an Tascfhórsa Náisiúnta um Fhoircheasacht Thuairiscigh siad dul chun cinn suntasach maidir le 32% de na moltaí. Níl sé ró-olc a tugadh Éirinn ghéarchéimeanna airgeadais.

Tá dhá ghné den phlean seo atá tábhachtach. Gcéad dul síos, tá gach duine craiceann an cluiche. Tá gach earnáil de dhualgas ag cur le feabhas ar an eipidéim raimhre. Ach tábhachtaí fós, an ceannaire polaitiúil barr, ghlac an fhreagracht orthu as iarracht aontaithe. Dara, siad monatóireacht agus tuairisciú ar dhul chun cinn a gcuid moltaí.A bhaineann leis go bhfuil an easpa leathan “milleán” sa chur chuige na hÉireann le raimhre. Bhí orainn an deis seo a phlé leis an Dr John Devlin, Leas-Phríomh-Oifigeach Míochaine de chuid na Roinne Sláinte agus Leanaí. Tá an cur chuige na hÉireann curtha ag argóint a scipeáil thar a bhfuil nó a bhfuil an locht ar otracht agus do na páirtithe uile a fháil chun ranníocaíochtaí praiticiúil a dhéanamh ar fheabhsúcháin ina gcuid réimsí. Thóg sé tamall a shamhlú gan an otracht plé Dealraíonn sé beagnach gach comhrá sna Stáit Aontaithe faoi mhurtall bhfuil a dhéanamh leis atá an locht “fachtóir milleán.”: An duine aonair, na tuismitheoirí, an comhshaol, an teilifís, scoileanna phys thréigean ed agus a thabhairt i mbianna olc, margaíocht cuideachta bia, go háirithe do leanaí, géinte, do mháthair, srl, srlD’fhéadfadh sé seo “fachtóir milleán” a bheith níos éasca a laghdú i sochaí níos mó ná ár n-aonchineálach agus níos lú litigious. Ach is cuma cad é an gcúis sin, tá ceann a cheapann go bhfuil an obsession le atá an locht déanamh aon rud ach frustrate réitigh a bhaint amach. D’fhéadfadh sé a bheith beagán de bród eitneach ach d’fhéadfadh na Stáit Aontaithe a lán a fhoghlaim ón gcur chuige na hÉireann: Tá na leibhéil is airde de rialtas mar thoradh ar gach earnáil a bhaint amach praiticiúil.

An rialtas na hÉireann a chur le chéile straitéis chuimsitheach náisiúnta i 2005. Obesity – na dúshláin bheartais; Otracht – na dúshláin bheartais: achoimre feidhmiúcháin. Is é an moladh an-sin den chéad uair “Ba chóir an Taoisigh (an príomh-aire) oifig a chur ar an freagracht ceannais agus cur chuige comhtháite agus comhsheasmhach réamhghníomhach i ngleic le róthrom agus otrachta agus le cur i bhfeidhm, monatóireacht agus meastóireacht ar an Straitéis Náisiúnta ar Mhurtall i gcomhar le fáil gach roinn rialtais, comhlachtaí agus gníomhaireachtaí ábhartha, tionscal agus grúpaí tomhaltóirí. “Téann an straitéis maidir le moltaí sonracha a dhéanamh le haghaidh gnímh rialtais ard-leibhéil, an earnáil oideachais, an earnáil shóisialta agus phobail, an earnáil sláinte, an tráchtearra bia, a tháirgeadh agus a soláthair san earnáil, agus an earnáil timpeallacht fhisiciúil. Rinneadh athbhreithniú ar na moltaí 2005 agus a mheas i 2009. Tuarascáil an Ghrúpa Idir-earnála ar Chur i bhFeidhm na Moltaí an Tascfhórsa Náisiúnta um Fhoircheasacht Thuairiscigh siad dul chun cinn suntasach maidir le 32% de na moltaí. Níl sé ró-olc a tugadh Éirinn ghéarchéimeanna airgeadais.

Tá dhá ghné den phlean seo atá tábhachtach. Gcéad dul síos, tá gach duine craiceann an cluiche. Tá gach earnáil de dhualgas ag cur le feabhas ar an eipidéim raimhre. Ach tábhachtaí fós, an ceannaire polaitiúil barr, ghlac an fhreagracht orthu as iarracht aontaithe. Dara, siad monatóireacht agus tuairisciú ar dhul chun cinn a gcuid moltaí.A bhaineann leis go bhfuil an easpa leathan “milleán” sa chur chuige na hÉireann le raimhre. Bhí orainn an deis seo a phlé leis an Dr John Devlin, Leas-Phríomh-Oifigeach Míochaine de chuid na Roinne Sláinte agus Leanaí. Tá an cur chuige na hÉireann curtha ag argóint a scipeáil thar a bhfuil nó a bhfuil an locht ar otracht agus do na páirtithe uile a fháil chun ranníocaíochtaí praiticiúil a dhéanamh ar fheabhsúcháin ina gcuid réimsí. Thóg sé tamall a shamhlú gan an otracht plé Dealraíonn sé beagnach gach comhrá sna Stáit Aontaithe faoi mhurtall bhfuil a dhéanamh leis atá an locht “fachtóir milleán.”: An duine aonair, na tuismitheoirí, an comhshaol, an teilifís, scoileanna phys thréigean ed agus a thabhairt i mbianna olc, margaíocht cuideachta bia, go háirithe do leanaí, géinte, do mháthair, srl, srlD’fhéadfadh sé seo “fachtóir milleán” a bheith níos éasca a laghdú i sochaí níos mó ná ár n-aonchineálach agus níos lú litigious. Ach is cuma cad é an gcúis sin, tá ceann a cheapann go bhfuil an obsession le atá an locht déanamh aon rud ach frustrate réitigh a bhaint amach. D’fhéadfadh sé a bheith beagán de bród eitneach ach d’fhéadfadh na Stáit Aontaithe a lán a fhoghlaim ón gcur chuige na hÉireann: Tá na leibhéil is airde de rialtas mar thoradh ar gach earnáil a bhaint amach praiticiúil.

Creidiúintí Grianghraf: Dotty Lynch

Bariatric Surgery for Teens on the Rise

December 27th, 2011

A new study shows a dramatic increase in bariatric surgery for adolescents. The procedures have changed with an increase in gastric banding and a decrease in gastric bypass. Side effects and mortality remain small in this study of academic medical centers. Increasing utilization of laparoscopic gastric bandi… [Am Surg. 2011] – PubMed – NCBI

Allergan Slapped on Marketing Lap-Band

December 27th, 2011

After the FDA slapped Allergan for the marketing campaign of one of its vendors,  2011 > 1 800 Get Thin LLC 12/12/11, the Los Angeles Times took on Allergan to do step up to the real work of corporate responsibility. Lap-Band maker needs to step up – Los Angeles Times. A lot of health care professionals who have worked with the company would not disagree with this position.

Obesity holds back improvements in US health

December 27th, 2011

Improvements in nation’s health stalls; obesity blamed in part. The United Health Foundation has released its 22nd annual report on the Nation’s health, finding no improvement, attributed at least in part, because of the rise in obesity. The report indicates that, for every person who quits smoking, another becomes obese. America’s Health Rankings and United Health Foundation

Who Would Have Thought?

December 27th, 2011

Gee, teen-agers want to eat junk food? Eating advice of experts and parents rejected?

No way, right?

Well, if you were skeptical before about school meal reforms, this article will be right up your alley. It shows the ‘creativity’ of teenagers in frustrating the nutritional advice of adults.  L.A. schools’ healthful school lunches panned by LAUSD students – latimes.com

Behind Weight Watchers’ New Look

December 27th, 2011

Wired Magazine has an interesting article on why Weight Watchers Inc. changed to the new Points Plus 2-12 program. The article provides some interesting background on how science interfaces with a commercial operation like Weight Watchers. At the fulcrum is Weight Watcher’s Chief Science Office, Karen Miller-Kovach. I’m biased here. I’ve know Karen Miller-Kovach  since my earliest days in the field. The article quotes CEO David Kirchhoff stating that Ms. Miller-Kovach tells it like it is and has “no filter.” Well, I can attest to that. She is the real deal and brings great credibility to Weight Watchers Inc. and the colleagues who have enjoyed working with her. Weight Watchers Revamps Its Magic Formula | Magazine

New View on the Origins of Our Obesity Predicament

December 24th, 2011

As readers know, there is a certain disconnect about when the obesity    epidemic began. Personally, I am quite persuaded that the historical record for the increase in human weight and height (the two parts of the BMI formula) goes back at least 350 years. (See, The Techno-physiological Revolution). On the other hand, something seemed to happened in the United States around the 1970s to send the rates skyward. There are no end of theories, all of which have some plausibility. So now comes Melinda Sothern, a well-respected and highly published obesity researcher, with a new look at mothers in the 1950’s. (Ouch! That’s a little close to home.) Her thoughts in this article do meet up with current research on genetic and, especially, epigenetic factors influencing the development of obesity. 

Many knowledgeable researchers have avoided going into this territory, not because of the science but because of the fear of being blamed for blaming mothers. This is not an inconsequential factor as parents may defer medical care for fear of being blamed for their child’s weight problems. (See the Cleveland obese boy incident.)

Sothern’s experiences and scientific credibility gives impetus to seriously consider her thoughts on the origin of our current predicament, given in this article in The Republic, ’50s women may have triggered obesity epidemic | The Republic