Archive for the ‘Complications of Obesity’ Category

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.

The American Year of the Vegetable

Monday, January 3rd, 2011

Ever since we met our Chinese graduate student, back in 1999, I've enjoyed figuring out what the current Chinese year is. For instance, 2010 has been the year of the Tiger, while 2011, starting February 3rd will be the Year of the Rabbit.

vegetable medley

But an Opinion piece in the Wall Street Journal today was titled "2011: The Year of the Vegetable." I read that and my copy of the Harvard Heart Letter, which arrived in this afternoon's mail, and found they were both urging us once again to eat  more veggies (and, in the latter case, more fruits).The newspaper article's theme was slanted toward preventing childhood obesity and its many significant consequences, diabetes and joint problems among them.

As the writer of the piece stressed, it's not the kids fault. We as adults and especially as parents and grandparents need to provide healthy choices and strong roles models. Which is to say, we ourselves are responsible for the epidemic of obesity in our youngsters.

How do I mean that? Well to start with our kids should be given healthy food and see that we also eat those foods. Recently, in two iterations, Lynnette and I hosted young adult children of old friends. Their parents are a doc and a nurse who worked for me in the Air Force. One twenty-two year-old  man came with his college roommate for a six-day stay. His older sister, a senior in medical school, visited here for two days while applying for the local Family Practice residency.

Even more veggies

All three young adults ate everything we suggested, including Brussels sprouts (we microwave or steam them and they're a completely different vegetable than the over-cooked ones I had as a child).

I asked the two whose parents I knew, "How come you are so willing to try different foods?

Both responded, "Our mother, when we were kids, said we had two choices. We could eat what the family was having...or we could starve."

I know their folks and I'm sure they would never have allowed the kids to starve, but  they both got the message. "learn to eat everything."

The author of the Opinion article mentioned that only 26% of adults (this came from a recent Center for Disease Control & Prevention survey) eat three or more veggie servings a day. He added that some of those who claim to match that minimum intake would count a hamburger  topped with a tomato or lettuce as a veggie serving.

That means three quarters of us don't meet that standard. Why? Probably because as kids, we didn't acquire a taste for eating them in the presence of adults who did.

So it's up to us to help our youngsters learn what a healthy diet is. And we better start now, or we're, in a sense, dooming our offspring.

I know those are strong words, but think about what's happening with our children; many of them are eating the wrong things and exercising less than we did as kids. Will their lifespan be shorter?

It's time and past time to set examples.

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.

Dietary therapy in hypertension

Friday, November 5th, 2010

High blood pressure, commonly called hypertension by physicians and other medical professionals, is a major problem in the united Sates, Canada and Europe. The numbers are staggering; roughly 30% of the adult population in the US and Canada, over 405 in a survey done in six European countries.

Why is this connected to diet? The incidence figures have gone up over the past twenty years and are most likely closely tied to the increased weight in members of our Western civilization. The consequences of poorly controlled hypertension are dire: strokes, kidney disease, cognitive impairment and heart problems are all more likely in the hypertensive group.

So what came first, the high blood pressure or the increased weight? And what can we do about hypertension?

I read an article in thew June 3rd, 2010 edition of The New England Journal of Medicine (NEJM 362:2102-2112) and then read a host of comments to the editor that were published in October 2010.

The article itself was something I saw mentioned in the "Harvard heart letter." It seemed fairly straight-forward at first. The two authors, Dr. Frank M. Sacks and Hannia Campos have published lots of research articles together; one is a physician and a senior Harvard professor; the other a PhD and a member of the Department of Nutrition at Harvard. This time they focused on hypertension, beginning with a breif case study, then telling us the astounding figures about high blood pressure and it's consequences.

It isn't just a BP of 140 over 90 and above; any blood pressure over 115 is associated with all those medical problems. Worldwide, according to Sacks and Campos, that level of blood pressure, 115 and above, is the most important determinant of the risk of death. In the cardiovascular arena alone it's a major factor in over seven and a half million deaths a year.

So Sacks and Campos looked at three major factors in this problem: eating a healthy diet, cutting body fat and decreasing salt intake. Once again a diet rich in fruits and veggies, along with low-fat dairy, fish, nuts and poultry were their answer. They looked at the DASH study (Dietary Approaches to Stop Hypertension)  and subsequent diet-therpay studies, mostly those with reduced salt being a major component.

Their conclusions were along the lines I had suspected: people with high blood pressure should reduce their salt intake, eat fish, nuts and legumes instead of red meat, consume more fruits and veggies insated of desserts, eat whole grain products, use healthy oils (olive, canola, soybean etc.) and stay away from juices as substitues for whole friuts.

Well, we do that now, I thought. Then I read the letters to the editor. I've already written a post on iodized salt, but another letter wanted Sacks and Campos to mention the benefits of more potassium in the diet, quoting a study that showed a 50% reduction in the need for BP meds with increased dietary potassium. That one I'd leave up to your own doc; I agree with the general premise...as long as you don't have significant kidney disease.

One of the other letters focused on dietary sugar and sugar-sweetened beverages, with a recent, but not randomized and controlled study, saying that cutting sugar intake lowers blood pressure. And one group of docs didn't seem to have the time for all that; they'd just start the patient on BP meds.

Whew! That was a bit of information overload. I think what I carried away was a lesson learned over and over; we're too fat as a civilization and eat the wrong things. That's unhealthy in many ways. It's time to make a change in both spheres.

Bill Clinton meets The China Study

Friday, September 24th, 2010

Back in July I wrote about The China Study, a book written by a PhD named T. Colin Campbell who advocates our switching to a plant-based diet. Both Dr. Dean Ornish and Dr. Caldwell Esselstyn have extended Campbell's work into the clinical arena. Their diet and lifestyle programs are being followed by many who've wished to reverse deleterious effects of the typical Western diet they'd followed for years.

Yesterday I got an email from a friend asking if I'd write a blog post on the subject and mentioning that former President Bill Clinton was now on the plan. This afternoon I Googled "Bill Clinton's Diet" and found articles and a video interview of Mr. Clinton with Wolf Blitzer. Clinton had coronary artery surgery and his stent had begun to clog up with new deposits of lipid-rich material. He wants to live to see grandchildren, so he's adopted the plant-based diet fully.

Mr. Clinton is eating veggies and fruit, drinking almond milk instead of anything dairy. He occasionally eats fish, but no other meat; he does add a protein powder to a fruit shake daily. Thus far he's lost twenty-four pounds and his image on the video I watched was clearly that of a much slimmer man than before.

I have to admit I'm impressed. Mr. Clinton stated that 82% of those who've followed a similar diet have "begun to heal." Those figures go as far back as 1986.

I think if I had coronary artery disease I'd be tempted to change my eating habits completely, as has the former President. At the moment I'm about 80 to 90% of the way there. I drink soy milk (in my  case because of lactose intolerance) and eat a lot more veggies and fruit and much less meat than I did up to May of 2009 when I went back on the diet and lifestyle plan I came up with in 1996. I did so primarily to lose more weight and I'm roughly 25 pounds lighter today.

But, in the absence of any clinical atherosclerotic artery disease, I haven't gone the next step. I still occasionally eat red meat, though much smaller portions than in past years (a quarter the size of the steaks I used to love). I had some Swiss cheese at lunchtime (about 2 ounces) and I do eat chicken and fish.

As more evidence turns up I may further alter my dietary pattern. For now, since I'm lean with a Body Mass Index (BMI )of 20.5 and haven't been pushed by chest pain or any other signs of blood vessels being clogged, I'll settle for my part-way-there status.

I do think all of us in the US and much of Europe, plus some in other parts of the world, need to move away from the Western Diet and need to get our BMIs down below 25. Now two-thirds of us in America are above this figure which marks the boundary of being overweight (anyone with a BMI over 30 is obese).

Thanks, Mr. President, for setting an example for us to follow.