Close Concerns Weblog

Don’t faint – Bush made the Nice list this holiday season

Bush is working to establish his legacy before leaving office in a few weeks and hopefully paving the way to huge leaps and bounds of change for the diabetes community in 2009. He recently doubled federal financing for community health centers nationwide, providing for the creation or expansion of more than a thousand clinics in medically underserved areas. These clinics, often the only dependable providers of basic services – and often the government’s safety net for diagnosing diabetes, in our opinion -  are seen as a cost-effective alternative to emergency room care. Many uninsured and underinsured seek care there instead of these clinics.

The recession of course has only magnified this problem despite the recent growth of the clinics. While the clinics previously tended to serve people of lower socio-economic status, more middle and upper-middle class professionals who have found themselves unemployed and uninsured have sought care from these clinics.  Patients are usually charged on an income-based sliding scale, with uninsured expecting to pay approximately $20 for an office visit.

President Bush supposedly began admiring the cost-efficiency effects of Texas community health centers and pledge to support them while campaigning in 2000. In his first year of office, he proposed to open and expand more than a thousand clinics over five years, a goal he saw accomplished.  “They’re an integral part of a health care system because they provide care for the low-income, for the newly arrived, and they take the pressure off of our hospital emergency rooms,” Bush said last year.

Democrats are rumored to say these centers will be part of a central deal struck between Congress and President-Elect Obama, however Obama himself has said little in terms of specific plans. Despite these discussions, staffing shortages have highlighted long-term concerns about quality of care, particularly management and care of chronic diseases. In 2008, the government finally began collecting data at the center for performance measures including diabetes control. We can’t wait to find out more what standards of care they are determining as “diabetes control” and how effective they are.

Even the experts can get it wrong - the high and low tech of healthcare innovation

Several new books have recently made a buzz in pop culture focusing on the high and ‘low’ tech of health care innovation. But seat belts everyone – even the experts can get it wrong. Exhibit A: a doctor not seeing the trees through the forest when writing a book as a high tech guide to new medical technologies (both up-and-coming and futuristic possibilities).

Dr. William Hanson comes from a high-tech background as an anesthesiologist and critical care specialist at the University of Pennsylvania. Yet, his book asserts that fluctuations in blood sugar cause diabetes. The NYT article attributes this to editor’s having problems keeping pace with Dr. Hanson, but is this so? It is shocking to see something like this, a book on “high tech” health care innovations be so low tech in terms of basic information. While the target audience of this book is more likely to be more educated and more familiar with diabetes, we all know that there are many doctors and endocrinologists – even those well-educated – who unfortunately aren’t up to speed on diabetes 101.

The reviewer from the NYT continues to discuss the carelessness and suggests “if your enthusiasm for the great beyond in health care can survive this caveat – and what is possibly a world’s record for misspellings of ‘principal’ in a single document – then this is the book for you.” (This follows a snide comment to guess whether descriptions of future technology contain similar crucial errors.)

hooray for IHOP

So yesterday was my birthday and Johnny took us all on a FULL day! We celebrated at IHOP for breakfast, Gilroy Gardens for the early evening, and Alembic on Haight Street (wow, it had just been written up in the NYT, but it was still nice and neighborhoody) for a late drink. I love all of these, but especially IHOP, it reminds me of when I was little (and before I had diabetes). There is an excellent IHOP on Lombard Street in SF, and afterwards you can take the kids up the wind-y street. So I have to say! IHOP is doing us all a big favor. Most excellent. They have carbs (and calories and fat and all that other stuff) listed on the menus for a lot of the items! AND THEY DON'T EVEN HAVE TO!! It's not like in New York, where my sense is that places are doing this a little grudgingly (begrudgingly?) ... we definitely love that too, but this was IHOP's own move and no one forced it! (In fact, the general manager told us that San Francisco may copy New York but it is sorrowfully behind in making it happen.) The carbs listed helped me SO much and after my waffle breakfast, thanks to exact carbs (54 after allowing for what Lola ate) and my CGM, my blood glucose didn't even go over 150! For an IHOP breakfast, that's pretty good. Plus I love the sausages and the kid menu and the "special treat" chocolate milk containers. Check out IHOP, it'll put you in a good mood all day ...

Obesity Tax Prompts Spirited Debate

We wrote previously about New York Governor Paterson’s proposed 18% “obesity tax” on regular sodas and juice drinks. The administration expects it would raise more than $400 million per year for health programs. But as expected, the tax has set off a spirited debate and opponents are coming out of the woodwork.

Nutrition experts expressed mixed views on the proposal: some compared it to the approach on cigarettes and smoking, citing it worth a shot to try to prevent obesity in children. Others, including Connie Diekman (past president of the American Dietetic Association), are more skeptical. “Taxing food doesn’t change long-term behaviors with respect to appropriate food choices.” These opponents cite the need for a broader approach centered on education. While we agree broad is good, we think this is an excellent start.

Many New Yorkers are opposed to the tax, worrying about decrease in sales at restaurants and bars and loss of jobs. The American Beverage Association has denounced the proposal, saying it would be paid for by “hard-working New York families” and that it would jeopardize jobs. The beverage industry accounts for 160,000 job in New York State each year, according to the group. A spokesperson described their reaction to the reason for the proposal by saying “If you’re serious about obesity, you’re not going to make a dent in it by singling out one product.” From our view, it’s important to start somewhere and we think this could catch on big-time. Taxing cigarettes, after all, has certainly had an impact.

Regardless of big names adding their weight to the debate, some small business owners in New York City, even in the neighborhoods with greatest rates of obesity, said the soda tax will have little effect on consumers’ decisions to purchase soda. Welll… we certainly think it is worth a try. We do think it’s likely at least some would turn to diet soda, and at a minimum, getting rid of the sugar is a win. Even better – and we hope this is next - would be subsidizing healthy choices like fruits and vegetables and paying to make them more widely available. Hey, maybe that’s what they can do with part of the $400 million – that’s a big number and should go a long way.

More on why childhood obesity is even more dangerous than we thought

A new report published in the December issue of Injury Prevention revealed a pattern of injuries: heavier children are more likely to hurt their arms and legs in a car accident. They are no more likely than others to be injured, but the risk of sustaining a serious extremity injury was more than 2.5 times as great for overweight or obese kids. The correlation persists even after adjusting for other risks such as failing to wear seat belts and riding in older cars (up to models from 1990).

The researchers reviewed records of 3,232 children ages 9 to 15 injured and suspect that obese children are more susceptible to bone fractures under any circumstances and perhaps the increased mass results in increased force of impact on the arms and legs. While there are no specific actions as a result from the study, this seems to add another assuring log to the fire building behind prevention efforts for childhood obesity.

 

Child obesity is “red flag” warning of heart disease

It shouldn’t come as a surprise, but kids – like adults – who are obese or have high cholesterol show early warning signs of heart disease. A study presented at the American Heart Association meeting that we attended recently in New Orleans showed the thickness of artery walls of kids and teenagers who are obese or have high cholesterol resembled the thickness of artery walls of the average 45-year-old. WHEW. This is not the first time kids have been studied (and only a mere 70 subjects) but it was the first time results have been correlated to adults.

Dr. David Ludwig, an associate professor of pediatrics at Harvard who was a co-author of a 2005 study predicting that obesity could shorten the average child’s lifespan by two to five years, said this study added significant hard data which has been lacking in the field. The lead author of the study, Dr. Geetha Raghuveer, described the results as a “red flag”.  It’s too early to tell if this generation of American children will suffer more heart attacks, strokes, or other heart problems (or at an earlier date), most researchers find the growing corroboration of links between childhood obesity and heart disease alarming. Most of the alarm comes from not only the length of harm to the body but also because at the stage in life, children’s bodies are still forming and physiological systems are still being fine-tuned. But Dr. Raghuveer says hope is not lost, and expressed hope for the opportunity to implement lifestyle alternations “be it exercise, be it diet, or perhaps medication. Perhaps it may be reversed.” This new data reflects a growing mass of data that reinforces the dangers of poor eating and sedentary behavior.

It will cost you more than calories to drink a regular soda in New York soon – 15% tax on traditional soft drinks coming soon

New York is expensive – and becoming more so if you like regular soft drinks (also known as non-diet sodas).  We salute Governor Paterson, who just proposed an ‘obesity’ tax of approximately 15% on non-diet drinks. This is part of a $121 billion budget unveiled Tuesday, in which Gov. Paterson described as “difficult” to make these decisions – but the obesity tax will help, expecting to generate $404 million a year. Milk, juice, bottled water, and diet soda are exempt from this tax.

So what’s the bottom line? Some people will choose to pay $1.15 for a coke instead of the $1 alternative diet coke. Some will switch drink preferences, and some will abstain from regular soda and the extra cost. Elie Ward of the American Academy of Pediatrics of New York State put it this way: “Raising the price of this liquid candy will put children and teens on a path to a healthier diet." We’re INCREDIBLY excited to see this happen as we think it will prompt much healthier choices, either due to learning about wellness or just tight pocketbooks. We look forward to covering the impact on obesity and whether it deters adults – not only the younger population – from purchasing regular soft drinks. And, at the end of the day, we notice it is New York again who is being progressive and stepping up to the plate to try new things to combat the rising obesity epidemic. Who else in the U.S. is willing to step up? Here’s hoping California is next …

Diabetes causes more amputations than landmines – are you scared yet?

Times Online from England published an article describing the overwhelming increase of diabetes as the reason for amputation of younger people’s legs worldwide – widely eclipsing land mines. Diabetes now accounts for 70 percent of all lower limb amputations, and Handicap International is now joining forces with the World Diabetes Federation campaign to reduce the incidence and improve the treatment of diabetes in developing countries.

The WDF works to create partnerships in the developing world to help prevent diabetes with a noble goal – because earlier treatment of diabetes foot complications could prevent 85 percent of these amputations! What might be devastating to someone in a developed country is usually the sign that heralds the loss of a family’s livelihood and poverty becomes inevitable. In these parts of the world, artificial lower limbs are ok for walking but not adequate for hard manual work – and these patients tend to be middle aged with maximal domestic responsibilities and providing for several generations. In India, these patients aren’t overweight and obese like in America, but instead lean and strong agricultural workers.

Dr. Kalkunte Suresh, financed by the WDF, the WHO, and Handicap International, is leading a foot care division organizing local clinics to screen people for diabetes and the first signs of nerve damage that can desensitize feet and create vulnerability to minor or major injury. Dr. Suresh spreads the message of prevention and treatment of diabetes, and relies on channels of communication through well-respected locals (usually popular village postmen or bus drivers) to help educate fellow villagers about diabetes diagnosis, the need for foot care, and the importance of wearing shoes inside and out. These aspects of diabetes can be further spread by street performers using short acts and traditional songs, altered to educate on prevention and treatment.

Your love of junk food may be inherited – and our nation’s obesity epidemic is being passed on to the next generation

It’s something people have often dreamed of – an ‘excuse’, so to speak, to explain their cravings and need to consume more energy-dense food. This is junk food, that has more calories per weight. And a recent issue of the New England Journal of Medicine reports that children with a particular gene variant tend to eat more of it, although their metabolism is not altered.

Researchers stress that this is not an absolute guarantee that kids with this gene are more likely drawn to junk food, but rather a trait that is common. Others, including Dr. Goutham Rao at Children’s Hospital of Pittsburgh at the University of Pittsburgh Medical Center, were interested in the study’s findings that hint at behavior, because that is something that can be changed.

 

The study showed the number of calories consumed and measured what children ate on three different occasions when provided  a variety of options to eat, such as ham, cheese, raisins, grapes, cucumber, carrots, chocolate, water, orange juice, and bread rolls. Those kids with the variant gene consumed about 100 more calories – per meal – even though the actual weight of the food was nearly the same. Not impressed? Consider that the number of extra calories per meal would translate to an additional pound of weight nearly every two weeks.

 

Dr. Rao stressed the message to take from this study is that prevention, as we have focused on a lot in the past years, is extremely important. He recommends for parents to intervene if kids have a “predilection for seeking junk food. The emphasis should be on portion control.” He also reminds us that avoiding or restricting food completely gives the message that there’s something special about a food, which leads both kids and adults to overindulge when they do have access to the food. So instead of using this as an excuse – “I inherited my love of junk food” – let’s think of this as another motivation to keep portion control as an integral part of the healthy lifestyle we are all aiming to achieve!

New Physical Activity Guidelines for Americans – Get In Your Hour per Day, WHEW!

The U.S. Department of Health and Human Services has created the 2008 Physical Activity Guidelines for Americans as the first attempt on behalf of the federal government to describe the types and amounts of physical activity required for a healthy lifestyle. The guidelines, in a 76-page document accessible at http://www.health.gov/PAGuidelines/ and released in October 2008, describes the key guidelines of physical activity (definition: any bodily movement that enhances health, for children & adolescents, adults, and older adults). It includes a chapter for each of these three major age groups and explains how the guidelines specifically pertain to the group and demonstrates real-life examples on how to stay active.

The guideline recommends that children and adolescents should participate in 60 minutes or more of moderate to vigorous physical activity daily that is a combination of aerobic, muscle-strengthening and bond strengthening activities. For adults, the guideline states that adults need a minimum of 150 minutes a week of moderate-intensity or 75 minutes of vigorous intensity aerobic activity to achieve substantial health benefits.  Additional and more extensive health benefits increases with the duration of physical activity (300 minutes a week of moderate-intensity or 150 minutes of vigorous intensity aerobic activity). Similar to the younger age brackets, the guideline suggest that muscle-strengthening can provide additional health benefits. For older adults, the guideline suggest no more than 150 minutes of moderate-intensity activity a week with a focus on exercises that maintain or improve balance if they are at risk of falling. Pregnant women and individuals with disabilities are also recommended to participate in at least 150 minutes of moderate-intensity aerobic activity a week.

Not sure why you should be exercising? It kicks off by explaining the health benefits of physical activity, particularly focusing on the relationship between physical activity and health. The guideline also stresses the preventive effects of physical activity, which includes lowering the risk of developing chronic diseases such as coronary heart disease, stroke, type 2 diabetes, osteoporosis, among others. Also included are descriptions of how to perform physical activity safely to reduce risk of injuries or accidents. The guidelines suggest pace is important and people should start slow and add duration and intensity to their activity over time.

If you are anything like Kelly, understanding why we should exercise isn’t the trick, it’s being able to make the decision to prioritize behavior. 2008 has been disappointing on that front. Elsewhere on the team, others exercise daily and are a real inspiration to Kelly. One thing the new guidelines should at least do is prompt us all to consider where we are on the continuum.