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Tag Archive: obesity

Leading Preventable Cause of Death in America



Obesity is now the leading preventable cause of death in America by some estimates.  Others call the leading cause of death, “dietary,  lifestyle and metabolic risks” but this is really just a politically correct way to say obesity.   The prevalence of obesity in United States is skyrocketing.  It’s not clear why Americans are becoming increasingly obese, but it is perfectly clear that it’s happening.  Using the standard definition of obesity of a body mass index (BMI) greater than  30, in 1985 no state had more than 20% of adults with obesity, and by 2009 9 states in the SE US had obesity rates > 30% and only the District of Columbia and Colorado had obesity rates <20%.   Compare the maps from the CDC web site of obestiy rates by state in 1985, 1994 and 2009.

Many states had no data in 1985, so you may think maybe the worst states did not report.  Probably not. Look at the data in 1994 when all states reported data.

In 1994 still no states reporting over 20% obesity rates.  Now compare to just 15 years later in 2009.

The change from blue to red is not a change in political parties.  Its us Americans getting fat.  This is a truly shocking increase in obesity in just 24 years, really a single generation.  In 2001 Mississippi became the first state with >25% of adults with obesity.  By 2005 Louisiana, Mississippi and W. Virginia had obesity rates >30%.  In 2009 only 14 states and Washington DC had obesity rates less than 25%.

This is far more than a cosmetic problem.  By some estimates obesity passed tobacco use as the leading cause of death in 2010.  This is largely because over the time frame from 1993 until 2008 the incidence of smoking decreased by 18.5% while the proportion of Americans who were obese increased by 85%.

Medical problems caused or made worse by obesity include many of the most common causes of death in America including  coronary heart disease, diabetes and some types of cancer, and stroke.  In addition obesity, especially morbid obesity, is associated with significant morbidity.  Osteoarthritis, congestive heart failure, lymphedema lead to marked reduction in a person’s ability to accomplish even the most basic of the activities of daily living.  The estimated cost of obesity in the US in is estimated at just over 9% of the total health care spending, or about 147 billion dollars in 2008 according to HealthDayNews.

So what can you as an individual do and what can America do as a country, to reverse this trend toward increasing obesity?  We know a lot more about what does not work than about what does.  It’s clear that fad diets just don’t work.  It’s also clear that there is more to obesity than just calories in and calories burned, but the answer for individuals and the answer for communities and the country as a whole are likely related to lifestyle changes as an individual and inducements to lifestyle changes as a community.

As a family physician I deal with individuals.  I have patients who are dying of obesity and I feel relatively helpless when I try to help them.  Bariatric surgery, either gastric bypass, lap-banding, or whatever the next better version of procedure may be is coming into its own as an option.  I have a few dozen patients who are great candidates for bariatric surgery, but the cost of $30-50,000 of more and the exclusion of obesity as a covered medical problem by most insurers makes almost none of them able to have this surgery.  Exercise and reduced calorie intake are the obvious answers, but changing eating and exercise habits as an adult are not easy, and many of my obese patients just are not successful in sustaining this type of change.

As a community, in any way you define community, there are things that can be done to make healthier choices about walking places, biking places, and getting incidental exercise easier to make.  Lighted sidewalks on busy streets, bike lanes on more roads, and building communities so that more jobs are within walking distance of home would induce more people to get out of their vehicles and walk or bike about.  These changes are expensive, and will compete with other infrastructure challenges for funding  I’m not optimistic that many established communities will commit to this type of change, but maybe some cities and newly developed communities can be healthier places to live.   The Walmart and Michelle Obama obesity partnership may be the type of thing that will help to some degree, but it will take lots more than that I’m afraid.

This medical blog would love to have a lively discussion of your best ideas on personal and community changes you’d like to see or accomplish.  Leave a comment.

Michelle Obama and Obesity

Walmart joining in the Michelle Obama obesity fight makes a formidable team.

Obesity is a gigantic problem in America. Walmart announced last week that they are going to focus on several aspects of making getting healthier food options at their stores more affordable and more decipherable.  In addition they are committing to placing stores in underserved inner city “food deserts,” areas where there is little or no access to full grocery stores and where residents are left buying unhealthy foods at high prices at small convenience stores. I don’t know if this program will make a difference.

The issues of obesity are complex and so far have eluded simple solutions.  Still with the nation’s largest food retailer pushing their suppliers to make mass market packaged foods healthier, and labeled more clearly can’t hurt.  Walmart has enormous market power with their suppliers.  They have been extremely successful in forcing conformity and getting price concessions in other lines of business, and I have little doubt that if they really want to they can influence food suppliers to produce healthier products at affordable prices for them to sell.  Maybe this will be a tipping point as Michelle Obama suggests.

In 2008-2009 26.7% of adult Americans and 16.9% of children were obese.  In my practice I have to say that I see relatively few patients who are even close to ideal body weight.  This varies from state to state.  To see how your state fares check this animated map on the CDC site.   BMI is far from the whole story, but it’s a quick and dirty way to check to see if you are in a normal, overweight, or obese weight range.  Use this widget to check your BMI now if you like:

Getting the cost of fresh fruits and vegetables down as well as reducing the cost and increasing the availability of healthier packaged foods at one major US grocery retailer has to influence their competitors to follow suit.  Look at what happened when Walmart started selling $4./ month generic medications.  Target, Fred Meyer, Costco and many other retail pharmacies raced to compete.

I’m excited that Michelle Obama has taken on such an important problem as her area of influence as First Lady.  I’m happy that Walmart has chosen to try to be leaders in this fight for the health of Americans.  Will this really make a difference?  Who knows, but don’t underestimate the power of Walmart.  Most that have in the past are now out of business or chasing them to catch up.

This medical blog loves comments, so let me know what you are thinking.

High Fructose Corn Syrup: A Sweetener with a Bad Rap!

Brooke Douglas is back with her monthly nutrition advice for DrPullen.com   This month she shoots down yet one more myth, that high fructose corn syrup is somehow worse than sucrose, a.k.a. table sugar, as a sweetener in foods.  We get fat as a country because we eat too much and exercise too little, not because of this wicked ingredient hidden in our foods.  If you want to read more from Brooke, visit Nutrition Authority, and call her if you need personal nutrition guidance.

Why does High Fructose Corn Syrup spook ‘health-conscious’ eaters, parents and nutritionists alike?
By Brooke Douglas, RD, CD

If you have listened to the mainstream media you may have been misinformed. HFCS has been labeled “the Devil‟s candy,” a “sinister invention,” and “bad for you, crud.”

But is it really all that bad?

Simply stated, the answer is “NO.” Actually, most people fail to realize that HFCS is composed of the exact same sugar combination found in table sugar and honey (fructose and glucose) in virtually the exact same ratios. The name “high fructose corn syrup” simply distinguishes it from other forms of corn syrup, meaning it isn‟t any higher in fructose than sugar is. I say it was a bad name choice; maybe they should have named it, “Bob?” Regardless, many credible studies have been published clearing up a lot of the misinformation on HFCS. The American Medical Association concluded, “There is no difference in how the body metabolizes high fructose corn syrup, table sugar or honey. They are indistinguishable once they reach the bloodstream. High fructose syrup does not appear to contribute to obesity more than other caloric sweeteners.”
As a derivative of corn, this alternative sweetener was created in the late 1960‟s in order to be used in foods and beverages because of the many benefits it offers. HFCS is what makes our ‘moist’ breakfast and energy bars moist. It keeps food fresh, enhances fruit and spice flavors, retains moisture in bran cereals, maintains consistent flavors in beverages and keeps ingredients evenly dispersed in condiments. Over the last 30 years it has become a hard-to-avoid staple of the American diet. HFCS provides the sweet zing in everything from Coke, Pepsi and Snapple iced tea to Dannon yogurt and Chips Ahoy cookies. It also lurks in unexpected places, like Ritz crackers, Wonder bread, Wishbone ranch dressing and Campbell‟s tomato soup.

The news media and a myriad of web sites and blogs continue to mistakenly report that obesity and diabetes rates have climbed at a remarkably similar rate to that of HFCS consumption. Yet, the nutrition science community reports that if the consumption of HFCS has increased in America, then so has all the other food categories. In other words, we are eating more, 24% more total food intake to be exact. We are not eating disproportionately more HFCS; we are eating more of everything! HFCS can only contribute to weight gain when it is eaten as excessive calories, regardless of the food source. Replacing HFCS with sugar, in our processed foods, will not reduce obesity or improve health.

In fact, many parts of the world, including Australia, Mexico and Europe, have an obesity epidemic and rising rates of diabetes despite having little or no HFCS in their food and beverage supply. This supports findings by the U.S. Centers for Disease Control and the
American Diabetes Association that the cause of increasing rates of obesity and diabetes in America is not HFCS. Rather, inactivity and excessive calories, from whatever source, promotes weight gain and therefore, diabetes

Dr. Walter Willett, current chairman of the nutrition department of the Harvard School of Public Health stated “If there was no high fructose corn syrup in our food supply, I don’t think we would see a change in anything important. I think there is an overreaction to HFCS. There is no credible evidence to support the idea that high-fructose corn syrup is somehow responsible for the increasing trend of obesity and diabetes in America.”

Unfortunately, some people have found it easier to look for one single ingredient to blame, like high fructose corn syrup, for all of America‟s weight gain woes. Even former critics of HFCS have dispelled myths and distanced themselves from earlier speculation about the sweetener‟s link to obesity in a comprehensive scientific review published in the December 2008 American Journal of Clinical Nutrition.

Respectfully, to all the “naturalists” out there, the real science does not support the bad rap! Whether it is mercury concerns or ADHD theories, the science does not support singling out this one sweetener. Besides it takes our focus off the larger nutrition picture. „moderation not deprivation” AND spend less time sedentary! The small, smart choices we can make each day to promote good health quickly become good lifestyle habits!

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Earth Day and Medical Progress

I tried to come up with a post today to relate to earth day. I’m a conservationist, and was hoping to somehow relate Earth Day to something relevant in medicine.  My first find was an article discussing a letter in Lancet, a prominent British medical journal, arguing that obesity is a factor in global warming.  I thought of trying to write a humorous article somehow relating the NFL Draft today to the global warming issues of increased calorie consumption, but decided to leave that to Saturday Night Live.   I think the authors of the Lancet article were serious, but if not they are certainly buzz masters.  This has been a very popular reference with several Google pages of “hits” if you search for “obesity and global warming.”    The LA Times article is a fun read.  Check out the NY Times article:  For a World of Woes, We Blame Cookie Monsters

On a more serious note I found an article showing that E-visits for acne to dermatologists lead to similar outcomes as in-person visits.  This could reduce the carbon footprint of some types of healthcare provided, essentially telecommuting to the doctor’s office.  The devil is in the details, as at this time most physicians don’t have the technology in place to do these visits, the HIPAA issues are of concern, and we can’t get paid for E-visits, but it gives hope that this may be down the road for some types of care.

Maybe your focus today should include planting a tree native to your local area and eating an organic vegan diet for the day.

Exercise and weight loss. More tough news.

Exercise alone does not seem to be effective in preventing weight gain once a woman is already heavy.   The latest JAMA issue reports on a huge study trying to see if different levels of exercise prevent weight gain in women.  This study looks at the 34,000 women in the Women’s Health Study, a huge cohort of women which has already reported on aspirin use and other variables.  The results are not encouraging.  Regular exercise was only associated with lack of weight gain in women who were thin (BMI<25) at the start of the study.  Women who ranged from upper normal weight (BMI 25-30) to obese (BMI >30) gained weight even if they exercised regularly.  The only group of women who did not gain weight over the 13 years of follow up in the study were thin women who exercised regularly for 60 minutes daily of moderate to high intensity exercise.  This page effectively describes Aspirin side effects.  The take home messages of this study are:

  1. Starting early with prevention of obesity is key. Once overweight it is far more difficult to prevent further weight loss. Multiple prior studies have demonstrated how difficult it is to achieve sustained weight loss.
  2. Calorie restriction is needed to prevent weight gain once overweight. Exercise alone is not sufficient.

The conclusion of this study sums it up pretty well.

“In conclusion, in this large prospective study of women consuminga usual diet, sustained moderate-intensity physical activityfor approximately 60 minutes per day was needed to maintainnormal weight and prevent weight gain. These data suggest that the 2008 federal recommendation for 150 minutes per week, while clearly sufficient to lower the risks of chronic diseases, is insufficient for weight gain prevention absent caloric restriction.Physical activity was inversely related to weight gain onlyamong normal-weight women; among heavier women, there was norelation, emphasizing the importance of controlling caloricintake for weight maintenance in this group.”  JAMA. 2010;303(12):1173-1179

Obesity- Have both Doctors and Patients Just Quit Trying?

I know I’m worn down by the US obesity epidemic.  Many patients clearly overeat, others are also too sedentary, and some just seem to be obese genetically.  Regardless it seems that the only patients who really lose weight in my practice figure it out themselves.  I wish I had an answer for everyone who asks me about weight loss. Sounds like I’m not alone.  See Roni Caryn Rabin’s article in this week’s NY Times discussing the sad fact that US doctors and patients are not even talking to each other about obesity.  

 March 16  2010, 1:07 pm

Doctors and Patients, Not Talking About Weight

By RONI CARYN RABIN

Doctors recognize obesity as a health problem. So why is it so hard for them to talk to their patients about it?

A new report released on Tuesday by the STOP Obesity Alliance, a collaboration of consumer, provider, government, labor and business groups, suggests both doctors and patients are frustrated with the conversations they’re having about weight.

What are the common causes of preventable death in the US?

Most people can guess smoking is #1.

But can you guess #2

Think a minute and look at the rest of this post.  Comment if you are surprised. 

Even modest weight loss leads to improved heart health


Many may say “Duh?” when told that losing a bit of weight improves your cardiovascular health.  It seems intuitive, but it is not something that has a lot of good data to prove.  Here is an article about a recent study from Washington University in St. Louis that shows that modest weight loss in obese patients leads to improved heart and blood vessel function, even when the weight loss is fairly modest.  Improvements in both heart pumping function and carotid artery wall thickness.   (see full article)  This is good news.  Get fit and lose those pounds!