The New York Times continues its excellent healthcare reporting in tomorrow's paper, with a section on personal health called "Testing: A User's Guide." The paper reports on six illnesses/conditions (asthma, bone disease, cancer, heart disease, obesity, and diabetes) and what people can do to avoid them. It's notable, of course, that fully half focus on metabolic disease. These are short, punchy pieces but very actionable. We have admired Gina Kolata writing for many years and are thrilled she seems to be focusing more on healthcare. Our current issue of Diabetes Close Up highlights pre-diabetes and a conference that just ended a few days ago in Barcelona. One of the major themes of the meeting was waist circumference and how meaningful that is in relation to visceral fat, the worst kind of fat. Reading this piece in the NYT will be instructive to people, we hope - how easy is it to go pull out a tape measure? In fact, we're headed to our tool closet right now, how about you! Clearly not every tool is perfect, but we hope the tape measure wll be used more and more. See below for the original pieces...and thanks to the NYT for starting to run such actionable pieces.
May 1, 2007
How Does Your Waistline Matter? Let Us Count the Ways.
By GINA KOLATA
AT age 39, with diabetes and high blood pressure in her family, Linda M. was starting to worry about her weight and its health consequences. She was 5 feet 6 inches tall and weighed 170 pounds, which placed her in the overweight category, according to the standard definition. Although she was not officially obese, she said, “I realized I was not at my ideal weight.”
But Linda was in for a surprise during an appointment last fall with Dr. Judith Korner, an obesity specialist at Columbia University. Instead of weighing her, Dr. Korner whipped out a tape measure and measured her waist.
It was 35 inches, putting her in a danger zone, Dr. Korner explained. An overweight woman with a waist 35 inches or larger, or an overweight man with at least a 40-inch waist, is at increased risk for diabetes and heart disease.
“That was an education,” said Linda M., who did not want her last name revealed because of her weight. “I did not realize that my waist determined my future risk.”
Obesity specialists differ on what measurements are best.
Linda’s body mass index, or B.M.I., for example, was 27.4, far from the obesity category, which starts at 30. She would have to weigh 185 pounds to have a B.M.I. that high. (For comparison, a man who is six feet tall and weighs 221 pounds is considered obese.)
If a doctor were to use B.M.I. exclusively to evaluate Linda, the conclusion would be that her weight was not a serious health risk. She had only one risk factor for heart disease — a high level of triglycerides — and the guidelines for B.M.I. say that overweight people need two factors, like high triglycerides and a high cholesterol or blood pressure levels, to be considered at serious risk.
B.M.I. has limitations. Muscular men might have high B.M.I.’s, which make them seem fatter than they are. Old people often have deceptively low B.M.I.’s because they have lost so much muscle in the aging process.
In Linda M.’s case, adding her waist measurement to her B.M.I. indicates a high health risk, according to guidelines published by the National Heart, Lung and Blood Institute. For Dr. Korner, the test is useful in assessing if people like Linda M. — overweight but in a gray zone — face a true health risk? If her waist had been less than 35 inches, Dr. Korner would have been less concerned.
Dr. Ned Calonge, chairman of the United States Preventive Services Task Force, said the panel preferred B.M.I. measurements to determine whether people are fat enough to place their health at risk. For most adults, he explained, B.M.I. “is more feasible or has better validity than other measures.”
But, Dr. Calonge added, it is not enough to simply diagnose someone as obese. The goal should be better health.
And the problem with testing for obesity, using B.M.I. or anything else, is that the sort of counseling most patients get from their doctors has not been shown to improve health, Dr. Calonge said.
“You now have a, quote, diagnosis,” Dr. Calonge said. And there is at least fair evidence from research that intense and expensive counseling about diet and exercise can help people lose weight and improve conditions that place them at risk for heart disease. But, he added, “it is uncertain whether less intense interventions have any impact at all.”
For Madelyn Fernstrom, the director of the Health System Weight Management Center at the University of Pittsburgh Medical Center, the goal of a medical exam is not to document how fat someone is but to rule out rare metabolic conditions that might be causing the weight problem. An exam also helps to determine whether there are associated medical conditions that should be treated, like diabetes or high cholesterol or blood pressure.
As for Linda M., waist measurement made the difference.
“After that, I got myself in gear,” she said. “I tried to eat less sugar and healthier snacks; I was more conscious of what I was selecting.”
She lost 20 pounds and a couple of inches from her waist. Her triglycerides are lower, yet still a bit high. But, she says, as she sees it, with a smaller waist, “I’m out of the danger zone.”
May 1, 2007
Finding Whether Diabetes Lurks
By DENISE GRADY
MORE than six million Americans are walking around with no idea that they have an insidious disease with the potential to wreak havoc throughout the body.
The disease is diabetes, and it causes high blood sugar levels that can damage arteries and lead to heart disease, strokes, kidney failure, amputations and blindness. It is the sixth-leading cause of death in the United States.
The idea of so many people — roughly 30 percent of the 21 million Americans who have the disease — going without treatment is disturbing because diabetes can do so much damage. But in its early stages, people often do not realize they are ill, because the symptoms — if there are any — may creep up gradually or be attributed to overwork or aging.
“Certain signs are important,” said Dr. F. Xavier Pi-Sunyer, chief of endocrinology, diabetes and nutrition at St. Luke’s-Roosevelt Hospital in Manhattan. “If you have to get up a couple of times to urinate at night, and you didn’t before, that’s a suggestive sign. Also, vision blurring of any kind, suddenly beginning to lose a significant amount of weight without trying, frequent skin infections or vaginal infections. And this is nonspecific, but if you’re getting headaches and feeling kind of fatigued.”
Any of those symptoms should prompt testing for diabetes, Dr. Pi-Sunyer said. So should certain risk factors, especially if there are more than one. Aging and obesity increase the odds that a person will develop Type 2, or adult-onset diabetes, the most common form. Weight is a particular risk factor, especially if it is mostly in the belly — a waist over 40 inches in men or 35 inches in women. Blacks, Native Americans and Hispanics have a higher-than-average risk, as do people with a family history of the disease. Being sedentary may also increase the risk, though not all researchers agree about that.
People who appear healthy but have risk factors should be tested for diabetes every three years, Dr. Pi-Sunyer said.
The simplest means for earlier detection is a blood sugar test, measured after a person has fasted for at least eight hours. Readings above 126 milligrams of glucose per tenth of a liter of blood indicate diabetes; anything below 100 is considered normal. Intermediate levels reflect impaired glucose metabolism or “pre-diabetes.” People in this category need yearly testing, because up to 8 percent of them will become diabetic each year. About 54 million Americans are pre-diabetic.
Though many doctors in the United States like the fasting blood sugar test because it is quick and easy, some use another test, one that may pick up diabetes at an even earlier stage. This is a glucose tolerance test, in which the patient is given a fasting blood sugar test, drinks a glucose solution and then has another blood sugar test two hours later. People who test positive for Type 2 diabetes are generally advised to lose weight and exercise more, and some may also need drugs to help lower blood sugar. They will also usually be tested for conditions that often go along with Type 2 diabetes, like high blood pressure and high cholesterol and triglyceride levels.
A major study of people with impaired glucose metabolism found that among those who did moderate exercise, like walking for just 30 minutes a day, and who lost 5 to 10 percent of their body weight, there were 58 percent fewer new cases of diabetes than in a similar group of people who did not exercise or lose weight.
The study also found that a commonly used diabetes drug, metformin, could help lower the risk of the disease in pre-diabetics. But the drug did not work as well as weight loss and exercise, and it is approved only for diabetes, not for pre-diabetes.
In April a genetic test was introduced that can also identify people with an increased risk of developing Type 2 diabetes. The $500 test by DeCode Genetics cannot predict diabetes definitively, but it might motivate people with a high risk to exercise and lose weight. It can be ordered by doctors or from a company called DNA Direct.