Sunday, August 19, 2012

Need to Know: Obesity as a Threat to Our Future

On Friday evenings I often watch a program called Need to Know on public television.  This week’s episode, hosted by Scott Simon, dealt with the problem of obesity, first on the personal level, with the story of 10-year-old Carla, then on the public policy level, when Ross Hammond of the Brookings Institution was interviewed.  Carla, who lives in the South Bronx with her parents, is overweight and has been told that she is at risk for developing diabetes, an illness that runs in her family and has already killed one of her relatives.   

Children like Carla who live in low-income, predominantly minority neighborhoods have a one-out-of-two chance of developing diabetes at some point during their lifetimes, according to Dr. Alan Shapiro of the Children’s Health Fund.  Nationwide, children today have a one in three chance of getting the disease.  Correspondent and producer Sarah Schenck follows Carla as she enrolls in a health and fitness class and then proceeds to pass on what she has learned about diet and exercise to her parents.  In neighborhoods like Carla’s, sometimes called “food deserts,” nutritious food is scarce and expensive, while fast food is plentiful.  Opportunities to exercise outdoors are also limited.  Carla, a highly motivated and unusually articulate young person, seems to be making good progress toward her goals.

In the second part of the show host Scott Simon talked with Ross Hammond, a Senior Fellow at the Brookings Institution who is also on the editorial board of the journal Childhood Obesity.  As Carla’s story had illustrated, Hammond emphasizes that obesity has complex causes, including biology, the brain, and the person’s physical and social environment.  For this reason “it is very difficult to think of a single solution that will work for everyone.”  Instead, it is important to coordinate a variety of approaches to attack this urgent problem.   

According to Hammond, medical care for the overweight and obese can cost as much as 100% more than that for people of normal weight.  It is estimated that care for this group now accounts for 21% of all medical spending.  Obese patients require larger beds and special equipment in emergency rooms.  (I would add that very overweight patients in nursing homes will have the same needs over longer periods of time and that additional staff will probably be required as well:  think what it would take to turn a 400-pound patient over in bed!)  The best role for government, according to Hammond, is “helping to provide a playing field in which people can make appropriate choices and choose for themselves healthy options and have those healthy options be just as available, affordable, and convenient as unhealthy options.”  He calls obesity “a huge threat to our country.”

Monday, August 13, 2012

More Imponderables

Medical professionals generally would like people to take better care of themselves, to take more responsibility for their own health.  You can’t take responsibility unless you know the facts of the situation, yet some doctors and hospitals continue to place obstacles in the paths of patients seeking access to their own medical information.  I understand that privacy concerns necessitate the signing of a waiver and I have no objection to showing a picture ID, but even then my request is sometimes denied.  When a patient has had blood work, the actual numbers should be shown to him or her.  Some doctors provide interpretations of the tests rather the results themselves.  I remember the letters I used to get from one doctor, IN ALL CAPS, like a bulletin from the front lines.  Sharing and discussing the facts encourages cooperation between medical personnel and patients and may help to prevent erroneous diagnoses and the unnecessary treatments that result from them.

Recent discoveries in genomics have opened up new worlds of complexity in the study of the human body and made it even clearer than before that each of us is unique.  In spite of this, medical institutions in this country persist in trying to standardize treatment for all individuals in a particular category.  Medicare, which pays for my drugs, would like me to get off Premarin, which I’ve taken for more than thirty years and get on Estradiol, a newer and less tested medication.  They would also like me to swap the Synthroid I take for hypothyroidism for a generic.  (I tried a generic once before and it didn’t work the same.)  If a patient doesn’t follow orders when using a prescribed treatment, doctors call it “non-compliance.”  What should we call it when institutions want to take patients off prescribed medications that they have used successfully for years?  

Saturday, August 4, 2012

What I’m Having for Lunch: Layered Salad

This salad has a lot of variety in color and texture, as well as a mixture of sweet, spicy and nutlike flavors. 

Prep Time: 10 minutes                                                                                  Calories:  330
                                                                                                                      Protein: 26 grams
                                                                                                                      Fat: 19 grams

Layered Salad
40g lettuce (a couple of good-sized handfuls)
25g kosher dill pickles, 2 or 3 small
20g grape tomatoes, 5 or 6 small
70g cooked garbanzos, 3 heaping tablespoons
1 tsp. olive oil
a squeeze of lemon juice
garlic powder
65g (2-3 oz.) chicken, cut in small pieces 
   (pulled rotisserie chicken from the store)
1 tsp. lowfat mayo
curry powder
hot sauce
salt and pepper to taste
10g roasted pumpkin seeds (a very small handful)

1.    Wash the lettuce and allow to drain while assembling the other ingredients.  I always do this even when the package says it’s pre-washed.
2.    Wash the tomatoes and cut them in two if they are large.
3.    Spread the lettuce on a plate and sprinkle the tomatoes over it.  Place the garbanzos in the center.
4.    Sprinkle the garbanzos with garlic salt, the olive oil, lemon juice, and salt and pepper, if desired.  (This is the Italian-influenced part of the salad.  In Italy people eat lots of great salads with olive oil and garlic.)
5.    In a small bowl combine the chicken, mayo, curry powder, hot sauce, salt, and pepper. 
6.    Layer chicken mixture over the garbanzos.
7.    Top lightly with roasted pumpkin seeds.

Buon appetito!