ACP Internist

Wednesday, October 7, 2009

QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"

ACP Internist's daily digest of internal medicine in the news continues with obesity programs, H1N1 updates and employees who fake calling in sick vs. those who won't when they really are.

Obesity
Schools, workplaces, food retailers and food and beverage makers are chipping in for the Healthy Weight Commitment Foundation, an effort to reduce obesity by balancing calorie consumption through physical activity. As just a few examples, food manufacturers will change product offerings, packaging, and labeling. Companies may provide exercise activities or facilities, offer weight management programs, and provide healthier foods in workplace cafeterias and vending machines. The Robert Wood Johnson Foundation, The National Business Group on Health and the University of California, Berkeley Center for Weight and Health will evaluate progress.

An internist is developing recommendations for physicians on how to guide and treat overweight patients on behalf of the STOP Obesity Alliance, a coalition of professional and labor groups, businesses, insurers and health care providers. The internist outlines his success in a case study.

H1N1 Flu
Health and Human Services Secretary Kathleen Sebelius further encouraged H1N1 vaccination, calling it "safe and secure" and adding that it's made the same way as seasonal flu vaccines.

Although H1N1 vaccination in the U.S. is slowly starting, states have ordered more than 2 million doses, mostly of nasal spray, for the first patients, according to Thomas Frieden, MD, director of the CDC. In Chicago, John Segreti, ACP Member, an infectious diseases expert at Rush University Medical Center, told Reuters his facility will distribute its first 2,000 doses to children and will wait for inactivated vaccine for health workers.

Emory University doctors licensed their interactive Web site to allow patients with potential H1N1 cases to self-screen using the same triage calculations their doctors and the CDC use. Questions about fever, symptoms and underlying health help patients determine whether they've got H1N1 flu, and what to do next--rest, call their doctor or seek immediate treatment. This site and related hot lines have been developed to keep people from flooding emergency departments. The materials, known as Strategy for Off-Site Rapid Triage (SORT) and Real-time Epidemiological Assessment for Community Health (REACH), were created and developed at Emory University. Ruth Parker, FACP, was one of the developers.

In case you missed it ...
The proportion of employees calling in sick when they're not hasn't changed among U.S. workers--at about one-third and holding--but fewer are getting fired for it, according to CareerBuilder.com as reported by Reuters. Of employers surveyed, 15% said they fired an employee for missing work without a legitimate excuse this year, compared to 18% last year.

The survey showed that most employers typically don't typically question absences (29% in 2009, 31% in 2008, 35% in 2007) and two-thirds of them let workers use sick days as "mental health days." The one-third of employers who do check on absenteeism require a doctor's note, call the person at home or have another worker call or drive by the employee's home. Employers cited stress and burnout from the recession as a reason they think employees fake illness.

The bigger fear is "presenteeism," those who show up to work no matter how sick they are. (They're also called "mucus troopers.")

Labels: H1N1, Nutrition, obesity, QD, Workplace issues

A reverse disparity!

Feeling bummed about the loss of your job or your retirement account? Good news! You may be less likely to suffer a retinal detachment. Scottish researchers have found that the risk of retinal detachment is directly related to wealth. "The rate of retinal detachment was 15.4 per 100,000 population among the most affluent patients, compared with 13.6 per 100,000 for the second-most affluent patients, 9.3 per 100,000 for the third-most affluent patients, and 6.9 per 100,000 among the least affluent patients," HealthDay reported.

They have no idea what might cause this disparity. (Or why it matters, we would add.) But the news provides a pleasing contrast to this recent depressing article in Slate which discusses the links between poverty, obesity and poor health.

Labels: disparities, obesity

Saving health and money

Last month, I asked for some data on the cost-effectiveness of preventive care. The American Journal of Public Health has obliged. In a new study reported by HealthDay, researchers evaluated the cost and health benefits to be gained by preventing several chronic diseases. They found that preventing a patient's hypertension would save $13,702 in lifetime medical spending, while prevention of diabetes would save $34,483, and preventing obesity would save $7,168. Unfortunately, those cost arguments for tobacco cessation programs turn out to be wrong: quitting smoking would result in an increase of $15,959 in lifetime medical costs.

Since only the abstract of the study is free, I also didn't get to find out how one would successfully prevent all these conditions. The key to preventing obesity, especially, seems like a secret we would all like to know.

Labels: Diabetes, health care cost, hypertension, obesity, prevention, smoking cessation

Maybe it's not health care's fault.

The failure of the U.S. to match longevity statistics of other developed countries is well-known, but a column in today's New York Times offers a different explanation for the gap. To put it simply, it's lifestyle (particularly smoking) that sets us apart from these other countries, not the quality of our health care, according to researchers. "Dr. Preston and other researchers have calculated that if deaths due to smoking were excluded, the United States would rise to the top half of the longevity rankings for developed countries," the Times reports.

The good news is that many Americans have quit smoking in the past decade or so, so we should be seeing continuing gains in health. The bad news is that we're working hard to make up the difference by getting fatter.

Labels: longevity, obesity, smoking cessation

Mediterranean diet trumps low-fat diet for diabetes management

Researchers compared the effects of a Mediterranean-style diet versus a typical low-fat diet for diabetes management in one of the longest-term randomized trials of its kind to assess their effectiveness, durability and safety on the need for diabetes medications in overweight patients with newly-diagnosed type 2 diabetes.

Researchers randomly assigned 215 patients to follow either a low carbohydrate, Mediterranean-style diet or a low-fat diet for four years. Nutritionists and dietitians counseled both groups in monthly sessions for the first year and bimonthly sessions for the next three years. Patients on the low-carbohydrate Mediterranean diet avoided medication, lost more weight, and decreased some coronary risk factors. Results were reported in Annals of Internal Medicine.

After four years, 44% of patients in the Mediterranean-style diet group required antihyperglycemic drug therapy compared to 70% in the low-fat diet group. Patients in the Mediterranean diet group also experienced greater weight loss and an improvement in some coronary risk factors.

View Video

Labels: Diabetes, diet, obesity, weight loss

Medical news of the obvious

People choose high-calorie over healthier drinks, especially when they're on sale. Sad but true, it often costs more to buy healthy or organic products than their high-fructose, saturated-fat-bearing cousins. A New Zealand study, published in Nutrition and Dietetics, corroborates this notion, concluding that of 1,500 supermarket discounts on non-alcoholic drinks, only 15% were considered "healthy." Although, researchers noted, the difference may have something to do with there being signficantly more non-healthy drinks on shelves than the alternatives, no doubt a savvy move by companies that are interested in making a profit as opposed to feeling good about their customers' eating habits. It turns out that water, plain reduced-fat milk and plain reduced-fat soy beverages (the "healthy" drinks) aren't as appealing as sodas and flavored sports drinks--sadly, I suspect that price has very little to do with it.

Driving everywhere is making us less healthy. By how much? A Reuters feature reported that driving cuts the average person's 10,000 steps a day to as few as 1,000. Because it cuts into potential time for exercise, each 30 minutes of driving translates into a 3% greater chance of being obese.

Labels: exercise, medical news of the obvious, Nutrition, obesity

Another reason to skip the soda: Potassium depletion

Supporters of the recent Senate Finance Committee proposal to tax sugary drinks may want to arm themselves with the findings of a new study on soda drinking. The study, published online May 13 by the International Journal of Clinical Practice, presents some alarming case studies of cola-induced hypokalaemia brought on by chronic consumption of up to 10 liters per day of sugar-sweetened cola.

The study's findings suggest that "potassium deletion should be added to the long list of soft drink-related health problems," (obesity, type 2 diabetes, dental decay and metabolic syndromes, to name a few), said a related editorial. To illustrate, the editorialist relates a case from his own files in which a 51-year-old man with COPD, hypertension and idiopathic gastroparesis developed persistent hypokalaemia, generalized weakness and loose stools. After running through a number of possible causes, the doctor hit upon the problem when the patient arrived in his office with a two-liter bottle of Pepsi in tow; upon further questioning, the patient estimated his total daily consumption at 4 liters. He agreed to keep his intake to two liters, and saw his potassium gradually rise back into the normal range.

The editorial also cites the intriguing case of a 44-year-old ostrich farmer who returned from a kangaroo-hunting trip in the Australian outback with profound muscle weakness and respiratory distress that required intubation and mechanical ventilation. It turned out that his serum potassium level plummeted when he upped his Coca-Cola intake to 10 liters (from his usual 4 liters daily) to combat his thirst on the hunt (From the study, "Coca Cola and kangaroos," Lancet, 2004; 364: 1190).

The editorial warns against relegating these cases as "outliers," citing some rather unsettling statistics. Worldwide consumption of soft drinks was almost 83 liters per person in 2007, with the U.S. level even higher at an estimated 212 liters per person. While healthy adults often can tolerate low potassium levels, not so for patients with heart problems, the editorial points out, and even moderate chronic cola consumption has been associated with chronic kidney disease.

The statistics should be a wake-up call for internists, especially considering the steady rise of obesity and type 2 diabetes. Most people know that sugary drinks are unhealthy, but public health initiatives have focused largely on children and teens. However, the editorialist urges, internists need to start asking their adult patients about soft drink consumption, along with questions about alcohol, cigarette and drug use.

Labels: chronic diseases, diet, obesity

Step away from the doughnut

Physicians--and everyone else in the world--know that diet and exercise are the pillars to weight loss. But a study presented Friday at the European Congress on Obesity suggests that diet is, by far, the main culprit when it comes to packing on pounds, and should be the focus of weight-loss efforts as well, Science Daily reports.

The rise of obesity in the U.S. since the 1970s can pretty much be blamed on eating more calories, the study found. In order to get back to those sleek '70s physiques, adults would need to cut about 500 calories a day from their diets, and children would need to cut about 350 calories a day.

The alternative is to add about 2 extra hours of walking time to your day (2.5 hours if you're a kid). Which doesn't seem very realistic. Exercise is, of course, wonderful for many reasons and should be maintained and promoted, the study authors said. But to really combat the obesity epidemic in the country, Americans have simply got to stop pigging out.

Labels: obesity, weight loss

C'est la vie!

A new report from the Organization for Economic Cooperation and Development reveals that the French spend more time sleeping (8.5 hours a day on average) and eating (over two hours a day, nearly double the time spent by Americans or Canadians) than any of the OECD's 30 member countries. It's one of the more intriguing of the evolving social trends identified in the OECD's latest edition of "Society at a Glance."

Being well-rested and amply fed apparently confers some signficant health benefits as the French are also noted as having one of the longest average lifespans of the 30 countries--88.4 years on average for women, second only to the Japanese, and 77.3 for men, two years less than the hearty Swiss and Icelandic men. (With all that time spent in bed, it comes as little surprise that the French also have one of the highest fertility rates of countries studied.)

Other interesting findings from the report include that Norwegians have the most leisurely lifestyle, with just over a quarter of their time spent on leisure activities. By comparison, Mexicans spend the least amount of their time (16%) on leisurely pursuits. Unfortunately, most people seem to squander what free time they have watching TV, which accounts for nearly half of all leisure time in Mexico and Japan.

A telling statistic, considering the obesity epidemic, is the small amount of time devoted to exercise. Spain ranks highest, but hardly merits bragging rights with just 13% of leisure time spend on physical activities. The Turks may be the most well-adjusted, choosing to spend 35% of their free time entertaining friends.

Labels: obesity, sleep, statistics

More bad news for the BMI

You may remember, awhile back, the study which found BMI wasn't of much use for athletes and college-age folks. Well, new research finds that the BMI-- created mostly from data on whites-- isn't a great measurement of obesity for non-whites, either.

The article in the British Journal of Nutrition compared DXA measurements to BMI for white, African American, Hispanic, Asian and Asian-Indian men and women age 17-35 years. Here were some results:

--The DXA estimate of percent fat for African American women was 1.76% lower than in white women with the same BMI. So, assuming you trust the DXA as more valid, the BMI for obesity in African American women should be about 32, not 30 as it is for white women.

--For Hispanic, Asian and Asian-Indian women, the DXA of percent fat is higher by 1.65%, 2.65% and 5.98%, respectively, than for white women of the same BMI. Based on this data, the BMI threshold for obesity in Hispanic women should be 28, not 30.

--For African American men, DXA was 4.59% lower than it was for white men of the same BMI; for Asian-Indian men, it was 4.29% higher.

So the lesson here is, if you use a non-diverse sample to construct a measurement or screening tool, you limit its applicability. Hmm, sounds a little...obvious?

Labels: BMI, obesity

Athletes want to share the fat

Studies about weight typically focus on how to lose it, but a recent study in Spain reveals that fat is sometimes coveted in the world of professional sports.

Researchers at the University of the Basque Country hypothesized that top-flight soccer players are generally more satisfied with their body images than other young men, according to a news release from Spain's Scientific Information and News Service. Predictably, a control group of university-age men said they'd like more muscular bodies but another group of Spanish League soccer players said that while they always try to build muscle they'd also like to add body fat in order to look more like other young men their age. Goes to show that the grass is always greener...

Turns out fat can also help you look younger, according to a new study of identical twins. After age 40, twins who had substantially higher BMIs than their identical sibling also had much younger looking faces.

Labels: obesity, weight loss

Don't let Halloween go to waist

With obesity and in particular childhood obesity in the news so much, parents are finding ways to cut back on Halloween candy excesses, including exchanging candy for money or toys.

It takes about 3,500 calories to produce a pound of weight gain. Exercising off 3,500 calories produces a pound of weight loss. But how much candy makes up 3,500 calories?

Kid's Health, the well-respected, ad-free resource, offers an easy and kid-enticing game to calculate how much candy makes up a day's worth of calories, which they estimated at 2,000 for kids ages 8-12. Eight big candy bars is all it takes to get a day's worth of calories. By the same measure, 13 would produce an extra pound of weight. Keep that in mind when checking over the Halloween loot.

Labels: diet, obesity, weight loss

More reasons to quit smoking and lose weight

Smoking has already been shown to be a risk factor for rheumatoid arthritis. But a new study, presented this morning at ACR, expands the evidence against tobacco by finding that RA patients who quit smoking had significantly less disease activity than patients who continued to smoke. The research was based on a registry of 1,405 patients.

Being overweight, on the other hand, increases your risk for osteoarthritis. Swedish researchers compared BMI to likelihood of receiving a knee or hip replacement due to arthritis and they found that the more you weigh, the better the chance that you'll need a joint replaced. The finding held true even in the normal weight population, and when controlled for inflammatory and metabolic factors. The findings make it pretty clear that the greater joint load placed on the hips and knees of overweight people is responsible for the arthritis, said the study author. He recommended diet and exercise, although he wasn't terribly optimistic that patients would be leaping off their couches based on the study. "Maybe we need to work at this for 10 or 20 or 30 years," he said.

Labels: obesity, rheumatology

Government exercise guidelines

There are a lot of competing recommendations out there about how much exercise people need to stay fit. This week, the Dept. of Health and Human Services released what it hopes is the definitive word on the subject with its "Physical Activity Guidelines for Americans."

These are based on "the first thorough review of scientific research about physical activity and health in more than a decade," and crafted by 13 advisory committee members appointed by HHS Secretary Mike Leavitt.

Without further ado, some highlights:

For adults, 2.5 hours a week of moderately intense aerobic activities, like brisk walking or gardening, is enough to yield big benefits. The 2.5 hours can be spread out over the week, but you need at least 10 minutes at a time to get your heart rate up.

Vigorous aerobic activity like jogging or jumping rope buys time: adults need only 75 minutes/week to stay healthy. You know it's vigorous if you can only say a few words before having to catch your breath.

Adults should also do muscle strengthening activities (lifting weights, sit-ups, carrying heavy stuff) 2 days/week.

Older folks should do as much as they can to meet the adult guidelines, and also do balance exercises if they are at risk of falling.

Pregnant women should follow the adult guidelines, though vigorous exercisers should talk to their doctors about whether they need to modify any activities.

Kids and adolescents need an hour or more of moderate or vigorous exercise at least 3x/week. They should do muscle strengthening and bone-strengthening activities (eg: running and jumping rope) 3x/week.

These are minimum guidelines. More exercise than this is, of course, better.

Labels: exercise, obesity

Step awayyy from the buffet

Most everyone has heard that if you want to lose weight, you should take smaller portions, put your fork down between bites, chew slowly, etc. etc. etc.

But researchers have found that a bevy of other behaviors may cause people to gorge, especially at buffets (which, really, Congress should just outlaw until we get over this obesity crisis).

To wit, researchers found that overweight diners sat 16 feet closer to the buffet than normal weight diners. They were also more likely to face the food, use larger plates, eat with forks instead of chopsticks, and serve themselves right away instead of browsing the food.

One assumes that counseling people NOT to do these things has a shot at stopping them from eating quite so much. Perhaps something to pass along to your portly patients who are planning a trip to a buffet-laden place like Vegas. Or a cruise.

Labels: obesity

Patient weight loss tool

I've stumbled upon an online weight loss tool I really like, and some of your patients might like it, too.

It's "Calorie Count Plus", a food and activity tracker on About.com. With minimum effort on the user's part, the site keeps track of the daily calories you burn as well as those you consume, and will chart the results over time. (remember, this strategy works: an August study in the American Journal of Preventive Medicine found keeping a food diary can double the chances of losing weight.)

The site also has a feature where you can look up the calorie and nutrition information of the foods you eat, and it will give you a nutrition analysis and grade (A-F) according to how balanced your diet is. You can also keep a journal, participate in message boards and make "friends" through the site, if you choose.

My favorite feature: The "calories burned" counter resets to zero at midnight and updates throughout the day, using a projection based on your weight and height, plus any activities you tell it to include. It's kind of fun (and motivating) to watch that number climb.

Heck, I burned 10 calories just sitting here writing this blog post.

Labels: obesity, weight loss

ACP Internist hosted Grand Rounds on June 16, wrapping up the best of the medical blogosphere. Click here for the complete wrap-up.

Contact ACP Internist

Send comments to ACP Internist staff at acpinternist@acponline.org.

Blog log

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

db's Medical Rants
Robert M. Centor, FACP, contributes short essays contemplating medicine and the health care system.

Everything Health
EverythingHealth is designed to address the rapid changes in science, medicine, health and healing in the 21st Century.

Getting Better with Dr. Val
Getting Better is the continuation of Dr. Val Jones' previous blog at Revolution Health. It is devoted to helping people understand health issues from a balanced, scientifically sound perspective.

HealthHombre
A roundup of health policy news drawn from a database of hundreds of Web sites.

Interact MD
Michael Benjamin, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

Kevin, MD
The alter ego of Kevin Pho, ACP Member, is the closest thing to royalty in the medical blog world.

LSUHSC-S Medical Library Evidence Alert
Major guidelines, systematic reviews, meta-analyses and/or major reviews by national and international organizations.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by a doctor.

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ACP Internist

Wednesday, October 7, 2009

QD: News Every Day--obesity, H1N1 and faking illness vs. "presenteeism"

Tuesday, September 29, 2009

A reverse disparity!

Thursday, September 24, 2009

Saving health and money

Tuesday, September 22, 2009

Maybe it's not health care's fault.

Tuesday, September 1, 2009

Mediterranean diet trumps low-fat diet for diabetes management

Monday, June 1, 2009

Medical news of the obvious

Wednesday, May 20, 2009

Another reason to skip the soda: Potassium depletion

Tuesday, May 12, 2009

Step away from the doughnut

Tuesday, May 5, 2009

C'est la vie!

Thursday, April 9, 2009

More bad news for the BMI

Tuesday, February 10, 2009

Athletes want to share the fat

Friday, October 31, 2008

Don't let Halloween go to waist

Tuesday, October 28, 2008

More reasons to quit smoking and lose weight

Thursday, October 9, 2008

Government exercise guidelines

Tuesday, October 7, 2008

Step awayyy from the buffet

Tuesday, September 16, 2008

Patient weight loss tool

Contact ACP Internist

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