I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)
Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.
Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more
What we’re hearing these days about carbohydrates – that we should blame them for the increase in obesity, diabetes, and heart disease – makes sense, but why did it take so long for this wisdom to prevail?
Part of the answer is political. The US Department of Agriculture has a big influence on what Americans eat. But where were the scientists? Unfortunately, much scientific research is funded by the government. If you want your grant renewed, you don’t threaten to bite the hand that feeds you.
So fat wasn’t the problem after all
The new wisdom about carbs is discussed in an LA Timesstory, “A reversal on carbs.” I was pleased to see clear acknowledgment that the advice to reduce fats in our diet resulted in increased carbohydrate consumption.
[T]he nation’s levels of obesity, Type 2 diabetes and heart disease have risen. “The country’s big low-fat message backfired,” says Dr. Frank Hu, professor of nutrition and epidemiology at the Harvard School of Public Health. “The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today.”
The chairman of Hu’s department says: “The good news … is that based on what we know, almost everyone can avoid Type 2 diabetes. Avoiding unhealthy carbohydrates is an important part of that solution.”
Unfortunately, while we were loading up on carbs, neuroscience discovered that they’re addictive. Avoiding them is not that easy, especially when they’re ubiquitous and cheap. Read more
When it comes to legislation that controls the health of its residents, New York leads the pack.
In 2006 the New York City Board of Health passed a law that required certain restaurants to list calories on their menus.
In 2008 Governor Paterson proposed a tax on drinks that contain sugar: the soda tax.
This past January Mayor Bloomberg announced a national campaign to persuade food manufacturers and restaurant chains to reduce the salt in their products. (It has to be a national campaign to be financially viable for manufacturers.)
In March a Brooklyn assemblyman proposed a bill that would make it illegal for restaurants to use salt when they prepare food.
And now Mayor Bloomberg has proposed a law that would prevent the purchase of soft drinks with food stamps.
The salt issue is controversial, and not the main point I want to address here. I do recommend, however, an excellent article by Gary Taubes called “The (Political) Science of Salt,” in which he says: Read more
An article in the Journal of the American Medical Association reports that the rate at which obesity is increasing has slowed down and may actually have plateaued. Is this good news? It would be if obesity was descreasing for everyone, at both ends of the economic spectrum. But what if obesity is decreasing for those who can afford healthy food and still increasing for those who can’t?
Research presented at the recent International Congress on Obesity showed that childhood obesity has stabilized or decreased in many countries over the last ten years. Rates are up in China, Vietnam and Germany, but have decreased or stabilized in Australia, Denmark, England, France, Greece, Japan, the Netherlands, Norway, Russia, Scotland, Sweden, Switzerland, and the US. In India, rates have stabilized for boys, but are still rising for girls.
When you dig a little deeper into the numbers, however, there’s a difference between the children of the rich and the children of the poor. An English study, for example, found that obesity was decreasing for 5-to-10-year-olds from higher socioeconomic groups, but was still increasing in lower socioeconomic groups. When the two sets of data balance each other out, it creates the appearance of a plateau.
Should parents use chocolate milk to bribe toddlers to eat their vegetables? Mead Johnson’s chocolate-flavored “Toddler Formula” has received a decidedly mixed reaction from blogging moms, ranging from outrage to gratitude.
But really, aren’t you worried that your baby might be suffering from a chocolate deficit problem? Don’t you love the idea of year-old infants drinking sugar-sweetened chocolate milk? And laced with “omega-3s for brain development, 25 nutrients for healthy growth, and prebiotics to support the immune system”? What’s next, genetically modifying moms to produce chocolate breast milk?
Obesity begins before the age of two
Almost one third of children in the US over the age of two are already overweight or obese. For low-income children the statistics are even worse. Michelle Obama is promoting her admirable Let’s Move Campaign. It advocates better product labeling, improved nutrition in school lunches, more opportunities for children to be physically active, and better access to high-quality food in all neighborhoods. Unfortunately that won’t be enough.
Studies show that attempts to modify behavior and nutrition, whether at school or in the home, have very limited success in preventing weight gain in children. The New England Journal of Medicinereports (emphasis added):
At as early as 3 years of age, obese children have elevated levels of inflammatory markers that have been linked to heart disease that is manifested later in life. To be a truly comprehensive and successful program … the Let’s Move Campaign must stimulate prevention efforts targeting the youngest Americans – those under 2 years of age and pre-schoolers. Indeed, prevention must start as early as possible, since school-age children already have an unacceptably high prevalence of obesity and associated medical conditions.
Marc Ambinder has written a terrific article on obesity for The Atlantic. It’s comprehensive and insightful, both objective and personal. Ambinder himself suffered from obesity until a year ago, when he went from 235 to 150 pounds following bariatric surgery. The operation immediately improved his severe diabetes, and within months it relieved years of suffering from sleep apnea.
The article includes explanations for the recent increase in obesity, observations on contempt for the obese (including “fat porn” TV shows), acknowledgement that weight loss is not simply a matter of will power, and an assessment of the political obstacles that make solving this important problem so difficult.
Sugary soft drinks are under attack from obesity experts, health commissioners, nutritionists, Congress, and President Obama. And the soft drink industry is fighting back.
Health experts have proposed a tax on soft drinks of one cent per ounce. That’s an extra 12 cents on a 12-ounce bottle of Pepsi, which may not sound like much, but it adds up. If a two-liter (67.6 ounces) bottle of Coke sells for $1.35, the price would go up 50 percent.
Health experts claim the tax could cut consumption by 10 percent and, they hope, reduce obesity. Even if the tax had no impact on weight gain, there’s the appeal of generating $15 billion a year in revenues.
Congress likes the idea of a tax on soft drinks because they could use the money to finance health care. The Congressional Budget Office did an estimate last December on a less drastic federal excise tax — three cents for every 12 ounces — and came up with a projected income of $50 billion over ten years. Currently there’s no amendment taxing soft drinks in either the House or Senate versions of the health care reform bill. But that battle isn’t over yet.
The Australian government is about to introduce a number of public health measures dealing with smoking, alcohol, and obesity. The measures are designed to reduce chronic diseases and make Australia the world’s healthiest nation by 2020.
Australia’s National Preventative Health Taskforce has published a report that includes 174 recommendations for preventing disease. Among the measures that could be implemented:
A 50% increase in the price of cigarettes
Cigarette packaging that allows only a bland box with the brand name and a health warning
A minimum unit price for alcohol and increased taxes
The elimination of alcohol advertising during TV sports events
The elimination of alcohol advertising before 9 PM, when more children and adolescents are viewing
Tougher restrictions on where and when alcohol can be sold
The elimination of TV advertising for “energy-dense”, nutrient poor (i.e., high empty-calorie) foods before 9 PM
Reduced taxes on health foods to make them more affordable
Tax breaks for gym memberships and for parents who enroll their children in sports activities
Additional stories related to health. Categories include: More articles on Health Care Reform, History of Medicine, Medical Journalism, Medical Technology, Medical News, Pharmaceuticals, Pop Culture, Social Media and the Internet, and The So-Called Obesity “Epidemic.”
HEALTH CARE REFORM
A ‘Common Sense’ American Health Reform Plan (The New York Times – Uwe Reinhardt)
After studying this nation’s perpetual “national conversation” on health reform for over three decades now, I am firmly convinced that any health reform that is the product of logical cerebral processes automatically misjudges what Americans appear to see as “simple common sense” in health care. The Experts vs. The Public on Health Reform (Kaiser Family Foundation)
In repeated Kaiser polls, we see a divide between what experts believe and what the public believes about some of the key issues in health reform. There is a wide gulf on basic beliefs about what is behind the problems in the health care system and key elements of reform.
I was planning to include a category called “The So-Called Obesity ‘Epidemic'” in the next Daily Dose, so I thought I should first explain what I mean by that.
Back in June, there was an article in The Washington Post called “Judging Fat People.” Here are some excerpts:
“Be honest: What’s your first reaction when you encounter an obese person? I’m guessing it’s not sympathy.”
Don’t think the fat person doesn’t notice. … [T]he stigma associated with being overweight or obese is enormous and has broad implications. … [S]ociety’s disdain for overweight people often contributes to their feeling defeated, to a sense of “nihilism” that makes them just want to give up any efforts to lose weight. …
As one whose weight has fluctuated over the years, I know that being overweight can stem from all kinds of circumstances, from emotional stress to the simple fact of being relegated to sitting at a desk all day. I know I feel crummy when I’m heavier than I should be, and I can tell when other people notice my weight, too. It would be nice if we could all cut each other a break.
The Medical profession
(Doctor’s firsthand account of the death of Neda Soltan)
(Mediterranean diet, Weight-loss surgery and cancer)
The medical profession
There is an amazing firsthand account of the shooting and death of Neda Soltan, the young Iranian woman who became a focal point for protesters after the video of her death was posted online. It’s by Arash Hejazi, a doctor who happened to be nearby and attempted to assist her when she was shot. He immediately realized that she had been shot in the heart and that there was nothing he could do to save her.
With his photo widely publicized, he feared he would not be able to leave the country, but he has returned to his home in Oxford, England. The article appears in The Times of London and is called “Doctor tells how Neda Soltan was shot dead by Ahmadinejad’s basij.”
Research shows that you can lose weight by dieting, but it doesn’t last. You regain the weight and, over time, your weight increases. Dieting is a huge industry, however, so you don’t hear the scientific facts too often. Most people have heard that a pattern of yo-yo dieting — losing and gaining — is unhealthy, but there are so many encouragements to diet that we ignore that information. What gets lost in all the promotion of weight loss is the importance of eating healthy food, not simply losing weight.
As you may have noticed by now, I’m a fan of Robert Reich. He has an opinion column in the Wall Street Journal that pulls together much of what he’s been saying in his blog posts on health care, such as his insistence on the importance of a public health insurance option.
Health care reform
(Health care reform won’t make us healthier)
The medical profession
(Does the AMA represent doctors?; Does the public trust doctors?)
(The cost of healthy eating)
The doctor/patient relationship
(The effects of malpractice on doctors)
(Anatomically correct shoes)
Health care reform
Ezra Klein has an article in The American Prospect called “Wealth-Care Reform: Fixing our health-care system will make us more economically secure. It won’t make us much healthier.”
Health-care reform is, in practice, health-care-system-spending reform. Politicians promise that their plans will “bend the curve” and pursue “universal coverage.” They do not promise the plans will make everyone healthier, reduce infant mortality, or set targets for life expectancy. The health of the nation, as opposed to its ability to pay hospital bills, is hardly under consideration. …
“The irony is that we use health as a rhetorical trope a lot in the health-reform debate. … There’s a big payoff to pointing to health as a beneficial outcome from health reform. There’s not a big political payoff to advocating for enacting specific measures that would improve health.”
“Our agricultural policy is actually counterproductive for health. We subsidize everything that gives you diabetes and nothing that keeps you healthy. Every grain you can think of is subsidized, particularly corn, but are carrots subsidized? No. Is the advertising of carrots subsidized? No.”
“College graduates … can expect to live at least five years longer than Americans who have not completed high school. Poor Americans are more than three times as likely as Americans with upper-middle-class incomes to suffer physical limitations from a chronic illness. Upper-middle-class Americans can expect to live more than six years longer than poor Americans. People with middle incomes are less healthy and can expect to live shorter lives than those with higher incomes — even when they are insured.” … Our health is not determined by what happens inside a hospital ward or a doctor’s office. It is determined … by “where people live, learn, work and play.”
The question should not be how much health care we can buy. It should be how much health we can buy. Whether that health comes through a doctor’s office or a preschool is immaterial.
Health care reform
(Gawande radio interview; Public option)
Health news (Bayer and prostate cancer)
Social networking technology
(Doctors on Twitter and email)
Health care reform
National Public Radio has an interview with Atul Gawande about his recent New Yorker article. It’s 30 minutes and covers much the same material as the article. At the end, the interviewer asks Gawande what it was like to learn that Obama and his staff were reading and discussing the article. His reply:
Completely shocking. This is the dream you have, that anything you write is absorbed by the people who affect your life. And right now the folks in Washington are deeply important to us as patients and as clinicians, and so it felt like a victory. At the same time I also knew that the brickbats would come and I had better suit up.
Advocates of a single, national insurance system that would involve explicit cost controls and guidelines for care — that might put an end to such wasteful practices as over-testing — have been shunted aside. This is in part because Democrats quiver when Republicans call them “socialists.” But Republicans cry “socialist” even when Democrats promote weak reforms that barely nick the vested interests. That’s what’s happening now. No one has seriously proposed an overhaul that would achieve what a single-payer system has been shown to accomplish in most other countries: universal coverage with lower costs that delivers better results than we now get in the United States.
Financing was always going to be a problem. … [W]atching Baucus run for cover, watching Daschle do the old el foldo, I’m seriously pessimistic that anything out of Washington will meet the expectations of anyone in the country.
We spend a lot of energy on calories — counting them, avoiding them, feeling guilty about them. But what are calories, anyway? Well, they ARE energy. Specifically, calories are the energy we get from the food we consume. And that makes them a good and essential thing. Calories wouldn’t be a problem if we consumed them and then used them through physical activity. But when we don’t use as many calories as we consume, they accumulate and we gain weight.
When we count calories, we’re really counting how much energy we get from our food. One Twinkie has 150 calories. That’s the supply side. On the demand side, calories measure how much energy it takes to do things. If you raise a small apple one meter (39 inches), you’ll burn 2.4 calories. You’d have to raise an apple over 62 times to work off one Twinkie (and they usually come in packages of two). Read more
One group that opposes the nomination of Sanjay Gupta as the next surgeon general is the Center for Consumer Freedom (CCF), an organization that promotes the interests of the restaurant and food industries. Anyone who suggests eating less can expect criticism from an industry that wants us to eat more. Gupta took on the topic of obesity in 2006 with his “Fit Nation” campaign.
In the CCF we encounter two of my favorite and related subjects. One is the difficult balance between corporate and public interests in a free-market economy. The other is how the “personal responsibility for health” mantra works against our best interests. If you are personally responsible for your own healthy lifestyle, then the food industry is totally innocent of contributing to heart disease, high blood pressure, diabetes, and obesity. The slogan of the CCF is “Promoting personal responsibility and protecting consumer choice.” They’re a wolf in sheep’s clothing. Read more