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Lifestyle and habits

Understanding the Causes of Obesity

MCNtalk has frequently blogged on the national obesity epidemic and approaches to a cure. This pair of articles in The New York Times, “Attacking the Obesity Epidemic by First Figuring Out Its Cause” and “The Numbers Behind an Urgent Fight” offer, in different ways, important insights as to the causes of the situation—and why it must be addressed.

The first article, addressing cause, compares the epidemic to smoking and calls for a multi-level, long-term approach: “…the solution to the nation’s most pressing health problem—the ever-rising epidemic of overweight and obesity at all ages—lies in the answer to this question: Why did this happen in the first place? That is the conclusion of an impressive team of experts who spent the last two years examining obesity-promoting forces globally. They recently published their findings online in a series of reports in The Lancet.

But as has happened with smoking, it will take many years, a slew of different tactics and the political will to overcome powerful lobbying by culpable industries to turn the problem around and begin to bring the prevalence of overweight and obesity back to the levels of the 1970s.

And why is the comparison to smoking so apt for an obesity study? As “The Numbers Behind…” points out, if the trend that, since the 1970s, has led to striking increases in the proportion of Americans who are overweight or obese is not halted, about three of every four Americans will be overweight or obese by 2020.

  • The added treatment costs of obesity, already at $75 billion in 2003, could exceed $66 billion a year, with an even greater cost in lost productivity of up to $580 billion.
  • For every five-point rise in body mass index, men face a 52 percent increase in the risk of esophgeal cancer and a 24 percent increase in colon cancer. Women can expect a 59 percent rise in the risk of both endometrial and gallbladder cancer and a 12 percent rise in postmenopausal breast cancer. 

Food for thought? The cancer statistics alone should be enough to keep one’s mouth from closing on a double cheeseburger and fries.

The Cough That Launched a Hit Movie

And now for something a little different…a movie review. Or, rather, discussion of the new movie Contagion in The New York Times.

As the article notes, “You have to applaud the effort, for the movie does indeed offer a procession of dead-on accurate scenes that not only could happen but, in many cases, have already happened. Still, the whole thing is an improbable caricature, with 100 action-packed Hollywood minutes veering far from reality. You can still be very afraid if you want, if a contagious apocalypse happens to be your thing. But it’s not going to happen this way.” That may sound like good news, but on the other hand The Times piece does walk the reader through how events do play out in widespread contagions. Read more…

Fatherhood Leads to Drop in Testosterone

Here’s an article in The New York Times that caught our eye, “In Study, Fatherhood Leads to Drop in Testosterone.”

Testosterone, that most male of hormones, takes a dive after a man becomes a parent. And the more he gets involved in caring for his children — changing diapers, jiggling the boy or girl on his knee, reading Goodnight Moon for the umpteenth time — the lower his testosterone drops. So says the first large study measuring testosterone levels in men when they were single and childless and several years after they had children. Experts say the research has implications for understanding the biology of fatherhood, hormone roles in men and even health issues like prostate cancer.

Now, what does this mean? A few interesting points:

  • “The real take-home message,” said Peter Ellison, a professor of human evolutionary biology at Harvard who was not involved in the study, is that “male parental care is important. It’s important enough that it’s actually shaped the physiology of men.”
  • The study, experts say, suggests that men’s bodies evolved hormonal systems that helped them commit to their families once children were born. It also suggests that men’s behavior can affect hormonal signals their bodies send, not just that hormones influence behavior. And, experts say, it underscores that mothers were meant to have child care help.
  • Scientists say this suggests a biological trade-off, with high testosterone helping secure a mate, but reduced testosterone better for sustaining family life.

The new testosterone study could offer insight into men’s medical conditions, particularly prostate cancer. Higher lifetime testosterone levels increase the risk of prostate cancer, just as higher estrogen exposure increases risk. Read more…

Who’s really to blame for child obesity?

From time to time MCNtalk has touched on the subject of childhood obesity. Per this article in The Philadelphia Inquirer,  the subject is meriting serious attention, with dramatic solutions being discussed.

Should morbidly obese children be taken from their parents and put into foster care? This was the question discussed in a commentary piece last month by obesity expert David S. Ludwig of Children’s Hospital Boston and lawyer Lindsey Murtagh of the Harvard School of Public Health. They explored this solution at a time when the rates of obesity in U.S. children over the last 30 years have tripled.

“In severe instances of childhood obesity, removal from the home may be justifiable from a legal standpoint because of imminent health risks and parents’ chronic failure to address medical problems,” wrote Murtagh and Ludwig.

But, they added, “the decision to pursue this option must be guided by carefully defined criteria . . . with less-intrusive methods used whenever possible,” and the two are quick to point out that “morbid obesity” is the key point: Imminent risk – where children are really in lethal situations – is the only reason children can be removed from parental custody.

Bill Lawhorn, a supervisor of Court Appointed Special Advocates in Philadelphia, says that, in more than 30 years with the child-welfare system, he has never seen a case of removal based solely on obesity and that to do so would be a logistical challenge.

“Child welfare is hard-pressed to respond to adjudicate matters of abuse and neglect, let alone dietary concerns and lifestyle, or following through on healthy choices,” Lawhorn said.

Reporting laws in a handful of states, including Pennsylvania, could possibly make removals happen, though. Such laws require that doctors contact child services if they think chronic parental neglect has resulted in morbidly obese complications – like failing to comply with doctors’ orders for weight-related diabetes and sleep apnea.

But placing blame solely on parents would be shortsighted, according to Daniel Taylor, a pediatrician at St. Christopher’s Hospital for Children in Philadelphia and the founder of the Children’s Advocacy Project, known as Cap4Kids. Decades of societal neglect are actually to blame for our obesogenic generation, he said, citing the areas of food-industry regulation, investments in safe outdoor play, and portion-control regulation as elements that have been ignored.

Clearly the root causes need to be found and addressed; lifespans in the United States are seriously lagging behind rates in other developed nations, with obesity being one of the main culprits for the gap. Obesity and its complications are a major social, emotional, and economic drain on Americans. Perhaps removing children from their homes is not the actual solution, but it does frame the discussion in drastic terms: which is probably how it should be framed.

Companies Get Tougher with Employees Who Smoke

Smoking costs the U. S. more than $193 billion a year according to the Centers for Disease Control and Prevention, per this Bloomberg Businessweek article.  For employers, a smoker is 18 percent more expensive than a nonsmoker, says Cathy Tripp, a consultant at Aon Hewitt.

That cost gap likely will widen beginning in 2018 when, under a provision of health reform legislation passed last year, companies with health plans that spend way more than average will have to pay an additional federal tax. That may push some to reduce employee coverage. “Employers have two choices: cut benefits or cut the trend” of rising medical costs to avoid the levy, Tripp says. “It has made all of them a lot bossier when it comes to employee lifestyle choices.”

Health-care companies have been among the most active at tackling smoking. The Cleveland Clinic banned the use of tobacco in 2005 and stopped hiring smokers two years later. Job candidates, including doctors, must have their blood tested for nicotine. Says Toby Cosgrove, chief executive officer of the clinic network: “If we want to be a model of health care, then we as an organization need to show our patients what a healthy lifestyle means.” Read more…

Potato Chips Go To Waist

New research completed through the Harvard School of Public Health and published in the New England Journal of Medicine indicates that eating more potato chips and French fries is likely to lead to a bigger weight gain over the years than the weight change associated with eating more of other foods, as noted in this Wall Street Journal article.

The Harvard researchers looked at three separate long-term studies covering 120,877 women and men who weren’t obese and who were healthy when the studies began. (They were mostly white, educated and in the U.S.)

The study stands out because it quantifies how much weight a person is likely to gain or lose over four years based on one additional daily serving of a range of specific foods. Eating more potatoes correlated with a gain of 1.28 pounds, with French fries in particular associated with a 3.35-pound gain.

Marion Nestle, New York University professor of nutrition and public health, expressed surprise that potato products were linked with more weight gain than desserts like cake, cookies and doughnuts, which contribute the most calories to the American diet, other research shows. She says she suspects people who eat potato chips and fries also tend to eat too much in general, making these foods markers for a diet leading to weight gain.

Read more…

Louisville Confronts Obesity

The city of Louisville, Kentucky, is stepping up efforts to fight obesity, as noted in this New York Times article. More than six in 10 people in metro Louisville are considered “seriously overweight” and Kentucky ranks seventh in the nation for obesity. The rates continued to rise through 2008, while the percentage of the population reporting any physical activity outside of work fell despite public campaigns advocating more walking and biking.

More recent developments underscore the tug of war over food and weight:

  • On one hand, Kentucky Fried Chicken has announced plans for its first non-fried menu while offering leaflets listing the calorie, fat and salt content of its entire line (as required by the new federal health act).
  • On the other hand, its corporate parent, Yum Brands, was quietly lobbying the state government to turn Kentucky into one of the few states that allow the use of food stamps in its restaurants, which include Pizza Hut and Taco Bell.

The city’s efforts to combat obesity, how and where it is spending money to fight it are instructive at a time when federal dollars are becoming more scarce and budgets are pinched. Cities are increasingly vying for nonprofit and government financing now available as concerns about the obesity epidemic have been underscored by Michelle Obama and others.

“For businesses, a healthy work force is more productive and less costly, so it became a competitiveness issue,” Jerry Abramson, the former mayor who began the Mayor’s Healthy Hometown Movement, said. “Every city was offering tax incentives, every city was offering real estate deals but not every city had the weight problem we do.”

In reference to a grant Louisville received from the Robert Wood Johnson Foundation to help the city’s efforts, Mary Lou Northern, senior adviser to Louisville’s current mayor, Greg Fischer, noted: “The grant made us think about the problem differently, that it’s not just about smart growth, it’s not just about transportation, it’s not just about parks or better nutrition, it’s about all of those things and more.” Read more…

Falling Behind: Life expectancy in US Counties

The University of Washington’s Institute for Health Metrics and Evaluation (IHME), as reported in this Seattle Times article (somewhat ominously titled “How long will you live? Depends on the county”), released a study today which has collected county-by-county life-span data for 20 years, comparing it to national averages as well as to other nations.

The numbers revealed gaps everywhere — between counties, between black and white residents, and between men and women.

The study (itself somewhat ominously titled)  “Falling Behind: Life expectancy in US Counties from 2000 to 2007 in an International Context” — found life expectancies in most American counties failing to keep up with gains in the 10 longest-living nations.

“We are finally able to answer the question of how the US fares in comparison to its peers globally,” said Dr. Christopher Murray, IHME Director and one of the paper’s co-authors. “Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That’s a staggering statistic.”

Some interesting points from the IHME’s website :

  • When compared to the international frontier [the ten nations with the longest life expectancies worldwide] for life expectancy, US counties range from being 16 calendar years ahead to more than 50 behind for women. For men the range is from 15 calendar years ahead to more than 50 calendar years behind. This means that some counties have a life expectancy today that nations with the best health outcomes had in 1957.
  • The researchers suggest that the relatively low life expectancies in the US cannot be explained by the size of the nation, racial diversity, or economics.
  • Instead, the authors point to high rates of obesity, tobacco use, and other preventable risk factors for an early death as the leading drivers of the gap between the US and other nations.
  • Change in life expectancy is so uneven that within some states there is now a decade difference between the counties with the longest lives and those with the shortest.
  • The authors propose that state and local policymakers use the life expectancy data and the county comparisons to tailor strategies that will fit the dynamics of their communities. This resonates with local policymakers, such as Dr. David Fleming, Director of Public Health – Seattle & King County. “It’s not the health care system that’s having the biggest impact on health; it’s the community,” Dr. Fleming said. “The average person in the US spends one hour annually in a physician’s office unless they are really sick. So until we start moving our interventions out into the communities where people live, we are not going to get ahead of these problems.”

Read more of the Seattle Times article or at the IHME’s site…

Under an Arizona Plan, Smokers and Obese Would Pay Fee for Medicaid

Arizona, like many others states, says it is no longer able to adequately finance its Medicaid program. As part of a plan to cut costs, the state has proposed imposing a $50 fee on childless adults on Medicaid who are either obese or who smoke.

In Arizona, almost half of all Medicaid recipients smoke; while the number of obese people is unclear, about one-in-four Arizonans is overweight, according to the Centers for Disease Control and Prevention. The state’s plan must ultimately be approved by the federal government. Monica Coury, spokeswoman for Arizona’s Medicaid program, discusses in this New York Times “Asked and Answered” piece.

As Ms. Coury notes, “We’ve talked about $50 once a year. We haven’t done the math, but it’s not about how much we would collect. It is totally about testing the efficacy of this strategy. Obesity is costing us billions in health care costs, so our thought is ‘let’s test some of these strategies.’”  Read more…