Archive for the ‘Obesity’ Category

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Saving $1T by losing pounds

Saturday, April 16th, 2011

whole-grain cereal and a banana

Mark Bittman's "Opinionator" column in the New York TImes April 12, 2011, was right on. He called the $36B that Congress has been haggling over (like two small boys) small potatoes compared to what could be saved if we ate less overall and ate more of the right things. He quoted a number of medical resources, so I went back to look at the originals.

In the January 24, 2011 online edition of the American Heart Association's journal Circulation, a panel headed by a Stanford Associate Professor, Paul Heidenreich, stated that cardiovascular disease (CVD) currently accounts for more than one sixth of all US health dollars spent. They went on to predict that by 2030 the direct costs of care for all forms of CVD would triple from a 2010 estimate of $273B to $818B .

CVD includes stroke, heart attacks, congestive heart failure and hypertension among other entities and they are often highly correlated. In fact the INTERHEART study which Bittman quotes (and I found in a seven-year-old copy of the journal Lancet), says lifestyle-related risk factors such as obesity, smoking and hypertension account for roughly 90+% of heart disease.

We haven't even started on Type 2 diabetes (DM) yet and Bittman noted that problem will cost roughly $500B per year  by 2020. And almost all of the cases of Type 2 DM are preventable.

If we want to reduce the deficit, one way would be to reduce our weights and trim our waistlines. Sure, we wouldn't get rid of all CVD and Type 2 DM, but a large share of the $1.3T per year we will be spending on them by 2020-2030 could be avoided.

We're spending over $2T a year now on healthcare and those costs are going up and up.

So how can we save a major chunk of that huge sum? How about Dr. David Ludwig's ideas? He's a Harvard doc who has worked with Marion Nestle, the PhD dietitian I've mentioned before. He published a very recent article in JAMA (the Journal of the American Medical Association) with both straightforward and complex/innovate modalities to improve our American diet.

I read something about Dr. Ludwig and his earlier concepts in his Harvard bio and a WebMD interview. He's a pediatric endocrinologist working at Children's Hospital in Boston, founding director of its Optimal Weight for Life (OWL) program and author of Ending the Food Fight:Guide Your Child to a Healthy Weight in a Fast Food/Fake Food World.

In the JAMA article he talks about better funding for school lunch programs, making breads with whole grains (non-refined) and research needed to improve food preservatives that are healthier than the current ones. His own studies appear to show a correlation between lower calorie intake and eating whole grain products.

I see two difficult issues: getting people to make healthy foods choices and avoiding bureaucratic costs as the British experienced from their NHS shift toward paying physicians for preventive measures (NB. WSJ article from 4-16-2011 p. C3).

But what a great way to save us money that Congress might even agree on.

 

 

 

 

Posted in Complications of Obesity, Dieting, Healthy eating, Life extension, medically-oriented background info, Obesity, Weight Loss | No Comments »

Diet pills and supplements, part one

Saturday, April 9th, 2011

Take two and call me in the morning

I've never used diet pills and have avoided supplements that are supposed to help you lose weight, but there's a great new article on them. It's in a distinctly non-medical source, but was as useful as the medical sites I found and the medical newsletters I received, so let's start there.

The article is in Redbook which I can state categorically I normally don't read. But I got in the mail yesterday, unsolicited, a health-related newsletter from a major university and saw an article in it on diet supplements and weight loss. That started my online search that circuitously led me to the Redbook article, also available online  at http://www.redbookmag.com/print-this/diet-pills-yl?page=all

The piece says it will update you on five of the newest diet pills (I counted four, but who's counting?). They walk through the pros and cons of orlistat, available OTC as Alli, which prevents digestion of a share of any fat you consume. The manufacturer of this drug did a study (I prefer totally independent sources) and found increased weight loss in subjects who took the med. What's the con? Well if you consume more fat than ~15 grams per meal, you can develop diarrhea and you may not absorb your daily vitamin intake as well (A, D, E, and K are fat-soluble).

The next drug is Merida (Silbutramine) which acts centrally, i.e., in the brain, altering two chemicals that tell you when you're full. It also can raise your blood pressure and has been assocaiated with strokes and heart attacks. This one is only for the obese or those seriously overweight with other rick factors (e.g., diabetes), is expensive and your healthcare insurance may not cover its cost.

Then there's a duo, Glucophage (metformin) and Byetta (exenatide) that are mostly used for diabetics with weight control problems. Therefore they are usually covered by insurance plans. They also can cause nausea and diarrhea, but have been effective in some fairly long-term studies.

I won't even start on the supplements in this post. What I do want to mention is that most of the medical specialists that Redbook consulted emphasize these drugs are not for the person who wants to lose five or ten pounds so they look good in party clothes or a swim suit. They're for the seriously overweight who preferably are under a doctor's care. And one medical expert said they only work if you are willing to make lifestyle changes.

Guess what? That means dieting and exercising.

 

 

Posted in Dieting, medically-oriented background info, Obesity, supplements, Weight Loss | No Comments »

Eating Disorders, Part one

Wednesday, April 6th, 2011

Drugs as food

I was reading the Wall Street Journal yesterday and saw an article titled "Food may be addicting for some." Thus far I've been able to find the Archives of General Psychiatry online and ran across a synopsis of the article that was perhaps more erudite, but less helpful than the newspaper article. I then read a "psychcentral.com" review of the study.

Let's start with the newspaper. It describes a study on a small number of subjects, 39 women, who had MRI brain scans after completing a short food addiction test that was originally designed to detect people with eating disorders. Fifteen of the women had high scores indicative of potential addictive eating problems; those same women had markedly different brain scan results than the lean subjects.

Okay, let's go back a ways. Last year in the journal Nature Neuroscience, Scripps researchers found that obese rats had brain alterations as compared with lean rats. The changes in the rats' brains were similar to those reported in people who are drug addicts. In short we normally get neural (brain-mediated) rewards for "pleasurable" activities. Similar rewards occur in response to addicting drugs.

The current study started with 48 healthy young women, some of whom were thin and some fat (or as, in our world of political correctness, we now term "obese."). They were enrolled in a "healthy weight maintenance' study.  Thirty-nine MRI results are reported, after the women were show pictures of chocolate milkshakes or a less enticing solution and some actually got either the milk shake or a tasteless control surrogate.

Then they had brain scans and the pattern of neural activation was much like those seen in drug addicts. Either food intake (or even viewing a photo of food) or drug use can stimulate the brains release of chemicals we find pleasurable.

"It ain't easy" for some to lose the extra weight

So what does this mean for society? Number one: not everyone can lose weight by following a deciding to diet. Number two: the omnipresent visual food ads can be detrimental to a segment of our population. Number three: I think organizations similar to Alcoholics Anonymous may be one aid to that group of the obese.

The lead author, Ashley N. Gearhardt, a doctoral student at Yale, who help devise the 26-question Food Addiction Scale, was quoted as sayying, "Some of them actually stop socializing because it gets in the way of their eating."

We've got a major problem here folks. I gained a few pounds on a 11-day trip to see old friends all of whom wanted to feed me wonderful meals. When I got home I went back to my usual eating pattern and the extra weight dropped off rapidly.

That's not going to be as easy for some and darn near impossible for others.

 

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Posted in eating disorders, medically-oriented background info, Obesity, our kids and their weight issues, Unhealthy eating | No Comments »

Doonesbury adds up the calories

Sunday, March 13th, 2011

Don't eat here

I was reading the Sunday comics in our local paper and did a double take at the message in "Doonesbury," always one of my favorite cartoons. Zonker is working at "McFriendly's" and there's an emergency staff meeting. Their boss, termed Mr. Big, is there and talks about the chain falling behind their competition.

What's going on is their appetizer special isn't offering enough calories compared to Applebee's appetizer sampler (@2,590 calories) and Chili's Texas Cheese Fries (@2,100 calories) with the latter offering a full day's worth of calories "packed into an appetizer {bolding taken directly from the cartoon}).

We don't eat fast food (once in a while while on a trip we'll stop at Subway which has nutrition info listed), but I decided to check into these incredible numbers.

Guess what; they're real. A variety of fast food chains (Applebees, Chilis, On the Border) and restaurants (Outback Steakhouse) offer appetizers that boggle my mind. Remember, these are appetizers, and even if one presumes they're shared with one to three others, if you follow them with a meal, you'll be so far over the dietary guidelines you might as well be on a spaceship.

I found a website titled "The 20 Worst Foods in America" and looked at a few items. Applebee's apparently offers (or, to be charitable, offered at sometime in the recent past), an onion appetizer called the "Awesome Blossom." This one had 2,710 calories, 168 grams of fat and 6,360 mg. of sodium (my goal is 1,500 mg of sodium a day or less).

No wonder we're tipping the scales at higher and higher numbers; no wonder two thirds of our population is overweight and/or obese.

Don't eat these things. Best of all, don't eat in these places, at least until they clean up their act.

Yet we're at fault, at least partially. We've allowed ourselves to be gulled by the big corporations' propaganda and find it easier to eat out than to cook from scratch.

Our kids learn from our example, even when they appear to resist what we say, they often do what we do.

It's time and past time to walk (or drive) away.

Thanks, Garry Trudeau. You were right on target.

 

 

Posted in Obesity, tricks and gimmicks, Unhealthy eating | 1 Comment »

Which came first: the diabetic chicken, the obese egg or the depressed farmer?

Saturday, February 26th, 2011

The chicken and the egg

My wife is a Mental Health therapist, attended a conference recently & then got an email from the presenter which referred to a study linking diabetes and depression. I got the synopsis from the Web and then went to our local hospital library where I could get a copy of the article. I'll come back to it later, since it was a new twist on the familiar entity .

the depressed farmer

Firstly, in spite of my post's title, this is no joking matter. I found a World Health Organization (WHO) fact sheet dated January 2011 on diabetes: It's a worldwide epidemic with more than 220 million suffering from the disorder and its consequences including an estimated 3.4 million deaths a year. If you're diabetic your chance of dying at a given age is twice that of your peers. If you are diabetic for fifteen years, you have a 2% chance of being blind and a 10% possibility of having severe visual impairment. Ten to twenty percent of diabetics die of kidney failure and then, of course, there's heart disease and stroke and amputations from diabetic vascular disease.

Next I found a medical article with stark  statistics: in 2007 about 2.6% of the US population aged 20-39 had diabetes, 10.8% of those aged 40 to 59 and 23.1% of those over 60. Diabetes and its complications consume 14% of the US health dollar and we're fairly high up there in the list of countries having a significant prevalence of the disease. Lowest on the WHO list was Iceland at 2% and highest was Saudi Arabia with 13+% of those who are 20 to 79 years old being diabetic.

There is a strong correlation between diabetes type 2 & excess weight, especially among women. That association is 80% or higher in Europe, Latin America and North America according to still another article.

And, as you might expect, eating a healthy diet, getting regular physical activity, maintaining a normal body weight and not smoking are the basic of diabetes prevention. By the way, 90% of diabetics around the world have type 2 disease, resulting from the body's ineffective use of insulin.

So what's the new angle? I already knew that half of all diabetics die from cardiovascular diseases, incluing heart attacks and stroke. I didn't know the odds were considerably worse for women with both diabetes and depression. The article I had printed off followed over 55,000 women for ten years (1996-2006) as part of the Nurses' Health Study. There were strong correlations between diabetes and depression in this study performed by researchers from Harvard, the University of Singapore and two English medical schools. Another professor, this one from Indiana, stated that over the past twenty years they'd learned that people with diabetes are twice as likely to suffer from depression as those who don't have the disease.

The Harvard group, in another article, state that death risk is three times as great if a person has both diabetes and depression. The two diseases appear to be linked; the question of antidepressant drugs being associated with an increased risk of diabetes was raised, but causation is unclear at present.

So once more, eat well, stay slim, exercise and be happy; it's good for your health.

Posted in Complications of Obesity, Exercise possibilities, Life Expectancy, medically-oriented background info, Obesity | 5 Comments »

You and your not-so-little dog too

Tuesday, February 22nd, 2011

the way for both man & dog to lose weight

The Wall Street Journal has an interesting article about obesity in pets this morning. That made me recall Blue, the fifty pound beagle I once had and, more recently Suzie, a cocker-springer mix who, as she got old clearly needed to diet, and her pack mate Dewawho was jealous of the special foods Suzie got to eat.

I'll come back to them in a bit, but let me return to the article first and the lessons it presents for us both as pet owners and, in some cases, as participants in the epidemic of obesity. Many pets eat "people food" which in itself is a bad idea. The example I read about was a dog that got steak and chicken and ice cream; not surprisingly that dog also became obese.

For pets, as well as for humans, obesity leads to multiple medical problems. One pet insurance company (yes some people do get health insurance on their dogs and cats) paid $25,000,000 in 2010 in claims for pet health problems related to obesity. Another said five of its most expensive insurance claims relate to weight issues.

Okay, lots of us don't own pets (we no longer do), so why does this relate to us?

The problem here is too much of the wrong food and too little exercise. Does that sound familiar?

So now companies are rolling out new low-calorie pet foods and even exercise equipment. The article showed a pet treadmill and a "tread wheel" with prices ranging from $375 to $999.

How about a nice walk instead? And while you're walking your dog, guess what? You too will be burning calories.

One pet resort is offering a contest for owners and their pets to simultaneously lose weight. Another had a "Fit and Spaw" retreat last month. None of these places, I'd bet, are inexpensive.

Somehow the wheels have come off, to use a phrase that comes from a totally different arena.

As a civilization we're eating too much, too frequently, too many of the wrong foods and getting far too little exercise. And guess what, now it's showing in our furry companions.

I seldom walked Blue, didn't do enough physical exercise myself in the days when he was part of the family, and both let him eat, and not infrequently ate myself, too much of the wrong things. With later pets I talked to our veterinarian and started a low-calorie diet that made sense for Suzie, an elderly dog with heart failure. That included carrots instead of dog treats. Her pack mate Dewa, younger and slimmer, wanted some of the carrots too and continued walking with me on a regular basis, including several mountain trails.

While this was happening I got back on the more veggies and fruits trend and pushed my exercise. Now dog-less, but slender, I'm continuing to eat more sensibly and exercise regularly.

So maybe this is a lesson for all of us; some have traditional pets, some have critters that don't fit the paradigm (chubby goldfish?), some of us currently have no pets.

All of us can look at our life patterns; eat less, eat the right things, do more.

Posted in Complications of Obesity, Dieting, Exercise possibilities, Healthly lifestyle, Healthy eating, Obesity | No Comments »

They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at www.dietaryguidelines.gov if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the Huffingtonpst.com website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.

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Posted in Food-related disease, Governmental Efforts, Healthly lifestyle, Healthy eating, medically-oriented background info, Obesity, our kids and their weight issues | No Comments »

I've got (Circadian) rhythm

Friday, January 28th, 2011

"to sleep, perchance to dream..."

I was thinking about sleep patterns the other day. We're both trying for eight hours of sleep a night and I achieve that goal most nights; about twice a month I'll wake up at 3 or 4 AM and find myself unable to fall back asleep. Lynnette has that happen more frequently than I do.

So are short sleep nights important? I think it depends on how many you have.

The Center for Science in the Public Interest publishes a "Nutrition Action Health letter" that I just started a subscription to. CSPI has been in operation for those forty years and this was an anniversary/retrospective newsletter. In their January/February 2011 edition was an article titled "Unexpected: Surprising Findings From the Last 40 years."

One of those (actually many of those were of interest, but one I followed up on today) was "Too Little Sleep can lead to Too Much Fat." This discussed studies done by Kristen Knutson at the University of Chicago.

When I Googled Knutson and her work I found she's an assistant professor of medicine at the University of Chicago's medical school. She's actually a biomedical anthropologist with a PhD from the State University of New York (SUNY). and did her Master's work at SUNY also.

"Her research focuses on the association between sleep and cardiometabolic health in various populations."

That was cut and pasted from her U of C Department of Medicine (Section of Pulmonary Disease/Critical Care) bio. I also found an article she published in the Achives of Internal Medicine in 2009 where her group found a correlation between reduced sleep and hypertension.

In this current piece, Knutson noted that a a long-term study (16 years) of >68,000 women showed that those who slept less (under five hours a night) were a third more likely to gain significantly (more than 30 pounds) than those who slept seven hours or more a night.

So she recently conducted a much shorter study, getting volunteers and using a sleep laboratory for a month-long period. The research subjects were allowed to sleep four hours a night in one arm of the study and Knutson found they then had higher levels of a hormone that increases appetite and lower levels of another that decreases appetite than when they slept nine hours.

Another part of her study had the subjects, confined to the sleep lab, allowed to snack. When they were allowed to sleep less than six hours they ate more than when they slept over 8 hours.

Hmm, that's intriguing as is her quote from a meta-analysis (a brief definition of that is a statistical combination of a number of studies), that short sleepers are more likely to develop diabetes. That meta-analysis was published in 2009 in the Achives and in 2010 in another medical journal.

When I put those issues together (high BP, obesity, diabetes), I see the Metabolic Syndrome a fairly recently defined entity that goes along with increased cardiovascular risk.

So try to develop better sleeping habits if you're consistently on the short end of the scale (pun unintentional).

They may save your life.

Posted in Healthly lifestyle, medically-oriented background info, Obesity | No Comments »

When all else fails

Tuesday, December 7th, 2010

Most of my posts are written for those of us who are of normal weight and want to stay there or those who are overweight and would like to lose a few pounds or twenty or forty. As of this morning, for example, I'm twenty-four pounds under my May 2009 peak and sixty-five under my obese 1970 lifetime maximum.

It's the holiday season with Thanksgiving and Hanukkah and Christmas thrown in to a jumble of other parties, gourmet club dinners, symphony events and theatre events. I'm at my upper limit of 153 pounds and have to really watch carefully to avoid all the temptations.

Many of you are in the same mode, I bet, but overall doing okay with your weight.

Then there's an entirely different group. I saw an article on Lap-Band surgery for those people who are obese and haven't managed with diets, counselling, support groups and perhaps even medication to lose the pounds they desperately need to shed.

Does this man need Lap-Band surgery?

Now I'm an Internal Medicine doc and a retired one at that, so I looked at the Mayo Clinic website, an Australian website, one for a nearby hospital and MedlinePlus, an online information source sponsored by the NIH and the National Library of Medicine. I wanted to know more about this surgical strategy for the obese.

First off it's not cheap with prices varying from $13,000 to $25,000 in the United States. Some people go south to Mexico where the prices are lower, but I wouldn't be likely to do that if I were seeking out this procedure.

It's done under general anesthesia using a laparoscopic approach. That means several small incisions are made in the abdominal wall and a small camera in inserted to allow the surgeon to see what he or she is doing. A band is then positioned around the stomach so that the upper portion of that organ forms a small pouch with a narrow opening to the rest of the stomach.

It doesn't require internal staples or cutting and, if the surgeon is experienced may take only 30 to 60 minutes. The 2,700-person Australian series I read about reported no deaths.

Lap-Band surgery has been restricted to the very obese with a Body Mass Index over 40 (mine is 20.5), or the fairly obese who have complicating diseases such as diabetes, heart disease or sleep apnea.

But, after the surgery people have to stick to a diet and should exercise. Plus there are complications with half the patients in one large series reporting nausea and vomiting, a third having reflux, a quarter of the bands slipping and requiring repositioning and perhaps 10% experiencing some blockage near the band.

The band is adjustable; the physician can tighten or loosen the stricture by adding or removing saline.

And this is the least invasive surgery for severe obesity. I also read where some proponents (and the company that makes the device) want to loosen restrictions on its use. They'd like it to be approved for use in people with a BMI over 35 or over 30 with complicating diseases. That would include over 25 million Americans.

I'll certainly stay out of that debate and stick to my diet and exercise concepts.

Posted in Complications of Obesity, Dieting, Governmental Efforts, medically-oriented background info, Obesity | 2 Comments »

The Fifth Taste

Friday, November 12th, 2010

Glutamic acid

I was reading an article in the Harvard's HEALTHbeat, one titled "An assault on salt?" and saw a reference to something I knew next to nothing about, umami--"the so-called fifth taste." That lead me to an April, 2010 publication crafted jointly by Harvard's Department of Nutrition and the other CIA, the Culinary Institute of America. That latter publication, "Strategies for cutting back on salt" is something I'll write about another time. In the meantime I decided to look up  more about umami.

I knew about the other four tastes: sweet, sour, salty and bitter, but had only heard the term umami used in context, not what it meant or how long it's been around. Apparently sweet, sour and salty were the original three recognized tastes, then a Greek philospher, Democritus deduced, probably after eating something he didn't like, that some foods are bitter. And things stayed that way, with four basic tastes (some would add spicy and astringent) until the late ninetenth centurywhen the famous French chef Escoffier invented veal stock.

About the same time a Japanese chemist, Kikunae Ikeda, while trying a seawees soup called dashi, sensed there was another taste. He wrote that it was the component that produced the flavor of meat, seaweed and tomatoes. Eventually, in 1908, he isolated a single chemical, a glutamate and later patented MSG. He used the Japanese word for delicious as the name for this new flavor and synthesized it; perhaps adversely affecting the seaweed industry in doing so. I got some of this from an online extract I found from a book titled Bozo Sapiens: why to err is human by Michael and Ellen Kaplan. I really enjoyed the short piece I read and ordered a copy of the book.

Subsequently scientists have found a receptor for umami; these cells don't have nerve synapses to other nerves, but instead secrete a neurotransmitter, ATP, that excites the sensory fibers which convey taste stimuli to the brain.

So like salt and sugars, food chemists can add umami to fats and induce us to want more and more. David Kessler, MD, JD, the former FDA head, is quoted as saying the standard joke in the restaurant chain business is, "When in doubt, throw cheese and bacon on it." Aged cheese has umami and bacon is said to have six different kinds of umami.

We just ate daikon and beets for dinner, both from our CSA, Grant Family Farms; we'll have grapes for dessert. If umami is a road to obesity and staying away from prepared foods the road to weight control, we were on the mark tonight.

Posted in Food Additives, Healthy eating, medically-oriented background info, Obesity, Weight Loss | No Comments »

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