OTC: Specialists in Obesity

Exercise and Heart Disease

From:  John Hernried, M.D.

          

I lost a good friend recently.  He was a man I admired for his  youthful outlook and spirit.  At 62, he loved nothing more than skiing. I hope to be as excited about skiing when I am his age.  Yet, he also told me about some alarming symptoms he had while skiing, including blacking out a couple of times during a run.  Even though he was a friend and not a patient, I put my doctor hat on and told him that I was concerned and asked him to see a doctor.  He promised after several further prompts from me not to ski until he was checked out.  For whatever reason, he decided to follow his own voice and ignore my pleas.  He died of a heart attack while skiing down a slope.  As a physician, I am frustrated that he did not listen to my warnings. His death was preventable.  As a friend, I am sad for the loss and I will miss him. I take some comfort knowing that he died the way he would have wanted..

Many people engage in strenuous physical activity after being sedentary for long periods of time.  This burst of activity can be the result of New Year’s resolutions , wintertime activities such as shoveling snow or skiing, or being lured into one of the specials at the local gym.  Yet, not everyone should automatically start up a program without seeing a physician.  When should you get checked out?

At OTC, as part of our new weight loss/exercise program called Re-Entry Plus, we evaluate each person prior to approving exercise.  For those who may have risk for silent heart disease, we ask that this be evaluated by a primary care physician or cardiologist before beginning exercise. 

How about you?  Should you see a physician before you begin to exercise?  My answer is when in doubt, consult your physician.  If you are curious you can take the test called the Par-Q on this link. If you answer yes on any of the questions, please make your appointment with your doctor and bring in a copy of the questionnaire.

The next time I am on the slopes will be very bittersweet for me.  My words could not help my friend, but I hope that they will help someone who reads this blog.

Glycemic Index: Friend or Foe?

From: John Hernried, M.D.

         

It has been quiet on the fad diet front.  I have not seen any evidence of a radical new wave since the “death of low-carb” (which is still alive and kicking by the way).  However, I am beginning to hear the overtones of a fad surrounding the glycemic index.  In general, the fad diet lifecycle starts with an unproven concept, hits the media and internet, is then embraced by the food industry who sells all kinds of products, and finally falls out of favor when everyone realizes it doesn’t work. 

The glycemic index is nothing new.  The idea is that certain carbohydrates have different effects on blood sugar and insulin levels and therefore appetite and weight. There is some science behind it in that in that the number is determined in a lab setting where patients are fasting overnight and are fed pure isolated food (like one potato or one cup of rice). 

However, when it comes to weight loss, I do not see it as a magic cure for several reasons:

1. The major reason is that we don’t eat a particular food in isolation. We eat a greasy hamburger (low glycemic index) with a soda (moderate glycemic index) and french fries (high glycemic index).  How do you determine the glycemic index when it is all mixed together in the stomach?

2. It complicates what should not be a complicated system.  Basically, fiber allows for a lower glycemic index.  Therefore, fibrous fruits and vegetables are the key to a low glycemic diet.  This is something OTC recommends anyway as part of a balanced diet in weight maintenance.

3. There is little evidence for the effectiveness for weight loss using the glycemic index in non-diabetic patients.  Yet, there are 87 books listed on Amazon promoting the glycemic index.

Save your money and don’t buy any special books or commercial foods advertising the miracles of glycemic index. If you want to try it, please memorize the glycemic index of each of these 750 foods listed on this link. Imagine the power of sharing this information at dinner parties!

Otherwise, just focus on whole grains and fibrous fruits and vegetables to maintain your weight and health. What could be easier that that?

Death By Fork?

From: Maureen Allen, M.P.H.

               

Recently, 40 year-old actor Chris Penn, younger brother of Sean Penn died. Cause of death is cardiomyopathy, a bad heart.

After his death, a British news organization quoted a friend of Penn’s commenting on Penn’s many compulsions, among them binge eating. The friend described his last binge, the one he had the day before he died. His menu included a large steak, several chocolate milkshakes, several pints of beer and fish and chips. According to him, it was not an isolated incident. We may never know if Penn actually had binge eating disorder but it is no secret he was overweight.

Binge eating is an eating disorder described as frequent episodes of eating what others would consider large amounts of food without being able to control what or how much is being consumed. Some other behaviors associated with binge eating disorder are eating very rapidly, eating until uncomfortable, eating when not physically hungry and eating alone out of embarrassment and feeling ashamed once the binge is over. Binge eaters range from normal weight to severely obese. Anorexia nervosa and bulimia are more well-known, but binge eating disorder is just as serious, distressing and life threatening as the others. This is mostly due to the diseases caused by obesity.                       

February 26 through March 4, 2006 is National Eating Disorder Awareness Week. Binge eating disorder can be treated if the behavior of binge eating is part of the treatment plan. If you suspect you have binge eating disorder, talk to your doctor. It won’t be easy, but neither is living with guilt and shame. 

         

The Drudge On Obesity

From: John Hernried, M.D.

            

And naturally society is to blame for all the obese that walk among us. It seems that there is apparently just too much darn choice for Canadians and we just can’t help ourselves.

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This sarcastic remark by Arthur Weinstein, a writer for the Canadian Free Press and The Drudge Report infuriates me. It’s from an article he wrote “Obesity Isn’t Rocket Science.”   He is responding to a physician from the Canadian Institute for Health Research who said there is no easy fix to the obesity epidemic because it is a complex problem akin to “rocket science.” Weinstein believes individuals are entirely responsible for their behavior and government should have only an informational role in helping.   From a public health standpoint, providing information without policy is futile. If simply providing information was the public health approach to influenza and Tuberculosis both diseases would be epidemics..

There is nothing complex about choosing to snack on carrot sticks rather than eat a bag of potato chips. Her reference to the complexity of obesity as far as it is caused by eating non healthy is a slam against the citizens of this country…

The fact is, the disease of obesity is complex and we live in a toxic environment.  I often talk about my patients being great “savers.” Research on the incredible complexity of appetite and energy control in our brain, intestine, liver and fat will unlock new treatments to obesity.  For the time being , we who treat it know  obesity is exacerbated by the convenience and availability of cheap, high-fat and high-sugar foods

Finegood’s statements are a good illustration of how some, especially those on the left, view their fellow citizens. When given a choice, other than abortion of course, some people will make bad choices and therefore the solution is to take that choice away.

I keep thinking of the documentary, “Supersize Me” where children recognize Ronald McDonald but not George Washington or Jesus.  Kids receive 10 messages for fast food on a daily basis and parents have, at best, one attempt at a message.  To think that this is “fair and just” and “free will” does not make sense.

Obesity isn’t a left versus right disease. Promoting that thinking isn’t going to alter the grim fact that we are rapidly gaining weight and suffering the health, financial and emotional consequences.  There is common ground here, and it would be nice if Mr. Weinstein found it instead of inflaming his readers by choosing sides.

That’s Entertainment

From: Maureen Allen, M.P.H.

         

No wonder it’s harder than ever to lose and maintain a healthy weight. Eating is now something to do, a diversion, an activity. Hunger is optional. Places and things to eat are advertised and promoted like skiing or going to the movies. “I can read a book, listen to music or eat a pizza.” And in our perfect world, you can do them simultaneously.

Marketing creates needs for things. If we see something often enough we’ll soon not be able to live   without it. Costco is a goldmine for the impulsive shopper. You eat free samples while filling your basket with quasi-food items like 1 pound muffins and giant cookies. Nutrition be damned – it’s such a good buy!

And when did marketing create the need for us to eat while driving? When McDonalds opened its first drive-through?   According to an article in the New York Times, the folks in Altamura, a small town in southern Italy, were ambivalent when McDonalds came to their town. They liked the jobs but not the golden arches erected near a 13^th century cathedral.  When a fourth generation baker felt it was an assault on the local culture, he set up shop next door hoping to benefit from the foot traffic.

His sandwiches made with foccacia, sausage, mozzarella and cardoncello, a local mushroom and a century’s old rustic bread were a hit. McDonalds began losing ground to the local fare and in a little under two years McDonalds closed up shop.

If they were awarding Olympic gold medals in Torino for good taste we’d have a winner.

How About a Side of Kanten With That?

From: Maureen Allen, M.P.H.

                     

It's only a matter of time until Tokyo’s latest diet craze hits our shores. And I mean that literally. Because it’s seaweed! The new diet food is Kanten - a gelatin made from ground-up seaweed. It’s promising to be the most popular Japanese export since Yu-gi-oh. Sound gross? Maybe, but it has no calories or fat and adds bulk and fiber to food. Think volume without the planning.

Kanten is available in threads or cubes at Asian grocery stores and on-line. After soaking it for about 20 minutes, it can be added to soups, sauces or desserts. Dieters lose weight without feeling hungry. If you’re fuller faster you’ll put down your fork faster too. Vegetarians prefer it to regular gelatin which is ground up animal hooves. Yum.

If Kanten’s not doing it for you, look no farther than California.  The Sonoma Diet and the Golden Gate Diet are gaining traction and their respective authors are hitting the airwaves. As you would imagine, wine is allowed everyday on the Sonoma diet. The Golden Gate diet contains no seaweed of any kind.

Still not inspired? Then how about the What Would Jesus Eat plan? God only knows what’s allowed on that diet.

The bottom line is most diets – even if they are quirky - will probably work as long as they are balanced and you stick with them long enough. The hard part is the weight management phase which lasts the rest of your life and doesn’t have a catchy title. Someone needs to write the maintenance manual. In all fairness, the Sonoma Diet does offer a life plan for eating and some of the others may also. But the true test of a diet’s success is long-term weight management. That’s where the rubber hits the road and the real work begins.

The Chinese Perspective of the U.S. Obesity Epidemic

One of the more fascinating views of the obesity epidemic came to my attention today.  It came from a Chinese news service (China View) and discusses the “corporate and industrial benefit” of the obesity epidemic.

The article started with a historical perspective. It said there have been changes in our work style and food technology that contribute to the epidemic.  However, their conclusions arise from a very capitalistic perspective:

"Put simply, there is a lot of money being made, and to be made, in feeding both oversized stomachs and feeding those enterprises selling fixes for oversized stomachs," … "And both industries -- those selling junk food and those selling fat cures -- depend for their future on a prevalence of obesity."

Wow!  To have a developing nation tell me that I am in this for the money is just shocking.  My passion for treating obesity focuses me on a complex disease without many allies.  Yet, am I secretly hoping to perpetuate the problem?

The answer is a resounding NO!  As a physician, I see the challenges and struggles of my patients—life-limiting disease, emotional turmoil and societal bias. I ask a lot of them to endure a strict diet, regular attendance and accountability to manage this disease.

The reality is that obesity is a significant disease that deserves attention and effective treatment.   This is my part in the battle, and I also appreciate the major efforts that are being developed for obesity prevention.  My utopian vision is “Star Trek: The Next Generation” where none of the characters had weight problems. I’m an optimist so I sincerely hope that it will not take this long.

But back to the article. I couldn’t imagine why it was written until I read the last paragraph:

“Nobody wants to sweat at work for 10 hours a day and be poor. Yes, you're obese, but you have a life that is much more comfortable.”

I did some further research and found that the rate of obesity in China has doubled.  Nearly 30% of the Chinese are either overweight or obese (a total of 200 million people), and their rate is climbing rapidly.  I suspect that China is still conflicted over their changing society and mourns the loss of an agrarian society.  Yet, their obesity rate is still far less than that in the U.S.  Rather than lashing out at us, they should focus on obesity prevention.  While I am proud of the work we do at OTC, I would be thrilled to never have to open a clinic in China. 

Obese and Invisible

From: Maureen Allen, M.P.H.

                              

I always read two parts of the newspaper without fail - the obituaries and the  classifieds. I’m neither morbid nor looking for a new job but habit compels me to those sections regularly. The Sunday paper is like hitting pay dirt with pages and pages of help wanted ads.

A few weeks back, there was an article on the front page of the job section about a federal law that prohibits discrimination in hiring. Among the reasons you can’t refuse someone a job are the usual suspects: race, sex, religion, age and country of national origin. The law says that you cannot ask questions of a job applicant to get the answers to those questions either.

That makes sense. If an employer wants to know someone’s sexual orientation they could ask questions about marriage or kids. They could ask where or if a person worships to determine religious affiliation. When I worked for the American Lung Association they asked me if I smoked because they did not hire smokers. Yes, we have a right to smoke but we don’t have the right to be hired.

In the article weight wasn’t listed in the litany of things you can’t ask a person about. But does an employer have to ask someone who is grossly overweight how much they weigh to discriminate against them? One look at the applicant is sufficient. An employer may view an overweight applicant as illnesses and absenteeism. Or worse.  They could plain old not like fat people.

The irony is that some overweight people describe becoming “invisible” the bigger they get. Many patients know the exact weight they hit when no one noticed them any longer. It’s long been felt that some victims of rape and incest actually use weight so as not to get attention from men.

W. Charisse Goodman wrote about weight discrimination in her 1995 book The Invisible Woman: Confronting Weight Prejudice in America.  When applying for a job a person is protected from intrusive questions that may hurt their chances for employment. But if you’re 100 pounds overweight, no questions need be asked.

Overweight and Healthy?

From: John Hernried, M.D.

      

There is significant debate about the danger of being overweight or obese in the absence of medical problems.  Many people say it is OK to be overweight and fit—that you aren’t at a significant risk for  disease.  This has caused many people to ignore their weight issues.

However, a recently published study in The Journal of the American Medical Association finds being overweight dramatically increases your risk for heart disease and diabetes after age 65.  The study followed 17,000 people who were “middle aged” meaning over 30 years old. The results were striking: Those who were obese but “healthy” in their middle years were 43 percent more likely to die from heart disease and 11 times more likely to die from complications from diabetes. 

It is important to reduce weight earlier in order to avoid heart disease and diabetes later in life.  I see a wide variety of patients at OTC with various amounts of weight to lose.  I am gratified knowing that I am helping them make a significant positive impact on their health by helping even the “healthiest” of our patients.

If you have a family member or a friend who is obese and under the false impression their health is not compromised, please, show them this article and tell them you care and want them to live a long and healthy life.  Often, an article such as this can be a kick start to making a significant lifestyle change.

New Year’s Resolutions

               

There’s nothing like opening your calendar to January and planning a new start. Many of us surrendered to the holidays after the first party in December. I know. I was at that party too.

So if you haven’t already made your 2006 resolutions or you want some fine tuning, there are a few things to consider before committing yourself.

The big enemy of any plan, whether it’s improved health or reading more, is vagueness. People will describe their behavior in terms of “good” or “bad” and it has no meaning. What may be a “bad” dinner portion for you may be just right for a linebacker after the big game. It’s all relative. So instead of making a resolution to be more something or better something, be specific about the behavior.

Don’t just say you want to read more. Choose a number of books will you read a month and how much time you’ll read on a daily basis. Instead of saying you’ll lose weight, say how much you want to lose, how many calories a day you will have and how much exercise will you need to achieve that goal.

Resolutions without details are just daydreams. And that’s fine if daydreaming is your New Year’s resolution.

From: Maureen Allen, M.P.H.