Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

50 Percent Of Physicians Disagree With AMA’s Soda Tax Endorsement

The American Medical Association (AMA) voted today to endorse taxation of sugary beverages as a means to raise money for anti-obesity programs. Interestingly, a recent physician survey at Medpage Today suggests that only 50% of physicians think that a soda tax is an effective public health strategy.

I am one of the 50% who feels that this policy will not be effective. In short, this is why:

1. You can become obese by eating and drinking almost anything in excess. Targeting sugary beverages is reductio ad absurdum. Did America become fat simply because of an excess supply of sugary fluids on grocery shelves? What about the super-sizing of our food portions, the change in workforce physical requirements, the advent of cars, escalators, healthy food “deserts” in poor neighborhoods, video games, and cutting gym class from schools?

Holding Coca Cola, et al. responsible  for our own over-consumption of  calories is both unfair and tantamount to spitting into the wind – something bad is going to come back at us. Consumers can easily get around the soda tax by buying sweet alternatives – which may have even more calories than soda. (Caramel latte anyone?) And then what? Are we really going to play public policy, food and beverage whack-a-mole?

Carmelita Jeter's Shopping Cart

2.  You can be thin and fit while eating and drinking almost anything. Obviously nutrition science has shown that a diet rich in fresh fruits and veggies, lean meats, low-fat dairy, whole grains, and healthy fats is the best for our health. However, please consider that the world’s fastest woman, Olympian Carmelita Jeter, eats Hostess cup cakes, Teddy Grahams, Welch’s grape juice, whole milk, and Gatorade. How do I know? Because she posted a photo of her shopping cart on Twitter (see image to the left). I obviously have no idea how much of this she eats – or when she eats it – but if the world’s fastest woman is powered (to some degree) by “Twinkies” then I think we should all think twice about demonizing certain foods/beverages in our anti-obesity fervor.

3. You can’t regulate good behavior. Human behaviors that may lead to obesity are simply too complex to regulate. Who would want to live in a world where government becomes the de facto “Nutrisystem” for its citizens, mailing out pre-packaged, ingredient-controlled meals to 312 million people per day, three times a day, seven days a week?  While that may save the post office from its imminent demise, we can neither afford to do that, nor do we need to.

People who believe that policy should drive behavior point to smoking bans that have cut down on smoking rates. While I agree that small improvements have been made in reducing smoking rates, roughly one in four people still smoke (depending on your source, this number could be as low as one-in-five), and one in every five deaths is still attributed to cigarette smoking. Hardly a resounding victory, alas.

But beyond the fact that policy changes (and the billions we’ve spent enacting and enforcing them) have resulted in a disappointing decrease in smoking rates, is the issue that cigarettes and food ingredients (such as sugar) are not analogous substances. While there is no safe minimum amount of cigarette smoke, our bodies need salt, glucose, and fat to survive. They cannot be cut out of our diet completely – nor should they. And the only way to force people to optimize their intake is to enact Draconian measures.

So instead of starting a food-fight, it’s important to accept the complexities associated with this particular health scourge and promote a broader, more-nuanced approach to wellness incentives. We have to attack this problem from the ground up, because a top-down approach requires our government to become an invasive, food and exercise nanny.

The good news is that one-third of Americans are not overweight or obese, despite our current “toxic” food/inactive lifestyle environment. Perhaps these thinner folks can be ambassadors for the rest of us, and reveal their secrets of healthy living despite our current limitations. Even with our best efforts, we need to understand that (like smokers) we will always have a segment of the population that is overweight or obese.

And as for the Olympians among us – they help to illustrate that obsessing over every morsel of food or cup of soda that we consume is not the way forward. Sorry AMA, I’m with Carmelita on this one.

Powered By Twinkies?

American Obesity And Sugar-Sweetened Beverages

We are a nation stricken with an epidemic of obesity, which contributes to the incidence of diabetes and heart disease. Each of these has been linked to consumption of sugar intake, and in particular, sugar-sweetened beverages.

There’s nothing evil about sugar — it’s just that too much of it in certain forms is bad for you. For the purpose of definition, sugar-sweetened beverages contain added, naturally-derived caloric sweeteners such as sucrose (table sugar), high-fructose corn syrup, or fruit juice concentrates. Read more »

This post, American Obesity And Sugar-Sweetened Beverages, was originally published on Healthine.com by Paul Auerbach, M.D..

Dr. Val On ABC News: Boys & Girls Clubs Combat Childhood Obesity

I recently joined SVP of the Boys and Girls Clubs of America, Judith Pickens, at ABC News to discuss the childhood obesity crisis and what can be done about it.

Find out more about Triple Play or download the parents game plan here.

The Boys & Girls Clubs Of America Fight Childhood Obesity

Dr. Val & Olympic Gymnast Shawn Johnson

Dr. Val & Olympic Gymnast Shawn Johnson

Because of obesity, this generation of children may be the first in US history to have a shorter lifespan than their parents. The CDC reports that teen obesity rates are growing exponentially, having tripled in the past 20 years. We also know that 70% of obese children become obese adults, and that 75% of our healthcare dollars are spent on chronic disease management – diseases that are 80% preventable with lifestyle modifications. Efforts to curb healthcare costs are unlikely to succeed without addressing America’s obesity epidemic.

So who is addressing the obesity crisis now? One shining example is the Boys & Girls Clubs of America (BGCA). They recognized the impact of obesity on their club members and looked for ways to increase physical activity levels, encourage healthy eating, and repair self esteem in America’s underprivileged youth. After consulting with the Department of Health and Human Services (and obtaining funding from the Coca-Cola company), the BGCA created a multi-faceted initiative, called Triple Play, to combat overweight and obesity. The results are very encouraging.

After 2 years, an analysis of over 2,250 club members suggests that 90% of youth enrolled in the program met the daily, federal physical activity recommendations while a significant number improved their nutritional status, choosing to eat significantly more fruits and vegetables. Perhaps most interestingly, the participants also scored higher on tests of “self-mastery” which are correlated with self esteem and social skills. Overall, girls were impacted more strongly by the program than boys, though the reason for this is unclear.

I had the honor of moderating a panel of experts who discussed the impact of Triple Play on BGCA members. In attendance were Olympic gold medalists Shawn Johnson, Dominique Dawes, and Dr. Tenley Albright in addition to SVP of BGCA, Judith Pickens, former Club kid and Youth of the Year, Stacey Walker, and Chris Spain from the President’s Council on Physical Fitness and Sports. It was heartening to see that there are programs that can bend the obesity curve – because success in this area of disease prevention has been hard to come by.

I hope that healthcare reformers will carefully consider the impact of obesity-driven chronic disease, and look to program success stories like Triple Play as a means to affect long-term improvements of America’s health. Our kids’ lives and the future productivity of our country are dependent upon the implementation of prevention programs that work. Cheers to BGCA for leading the charge against childhood obesity!

Passion Meets Fashion: NHLBI’s “Heart Truth” Campaign Hits the Runway with Diet Coke

hearttruth

It’s definitely not your mother’s public health campaign.

When the National Heart, Lung and Blood Institute (NHLBI) launched the Heart Truth campaign seven years ago to raise awareness of women’s heart health their partners were your typical patient groups and professional medical societies.

Not anymore.  Today, their front row partner is Coca-Cola.  Diet Coke that is.

Dr. Val and I were among a small group of women’s health advocates who met last week to hear the latest on NHLBI’s campaign with Diet Coke and how the fashion industry is bringing an important public health message to women.

Diet Coke’s commitment to the Heart Truth campaign is unprecedented, one of the “largest public awareness initiatives we have ever undertaken,” said Celeste Bottoroff, VP Living Well, Coca-Cola North America.

Leading Diet Coke’s campaign?  Endless-legs Heidi Klum and other fashion-conscious women who have revamped the little red dress campaign into a national symbol with guts, curves and most importantly results.

“In 2002, only 34% of the women in this country knew heart disease was the leading cause of death among American women,” Dr. Elizabeth Nabel, NHLBI director, told the group. “But we’re making progress.  Today, as a result of the Heart Truth campaign and others like it, 65% of the women now know it’s the number one killer.”

Nabel led a discussion of the common myths associated with women’s heart heath and recalled her own experiences as a cardiology resident when women were caregivers who supported husbands, fathers and other male family members through heart ailments but often ignored or brushed aside their own symptoms for fear that treatment would interfere with domestic chores such as childrearing, cooking, and cleaning.  “Even when older women came in with heart problems, they weren’t treated as aggressively as men,” Nabel admitted.

“Most women still need educating,” she remarked.  “80% of middle-aged women still have at least one risk factor for heart disease.  And just one, doubles your risk of actually having heart disease.”

Joining Nabel were Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, Susan Bennett, MD, Clinical Director of the George Washington University Hospital’s Women’s Heart Program and Robyn Flipse, MS, RD, author and nutrition consultant to discuss the campaign’s most important messages.  First, heart disease is not a man’s disease, a point often raised by group’s such as those headed by Greenberger who cited research  indicating that only 17% of cardiologists and 8% of primary care physicians know that heart disease is the leading cause of death among women.

And it’s not just for the aged either. “When a 40 year old woman has heart disease it’s worse than a 40 year old man,” said Bennett recalling patients in their 20s and 30s in her practice.   “It’s never too late to change your lifestyle,” Flipse added.  “The body is very forgiving.  Even a 10% drop in weight can have a positive impact on blood pressure, cholesterol and other important risk factors.”

The Heart Truth campaign, thanks to the vision of Dr. Nabel and the willingness of NHLBI to partner with a highly visible, social icon such as Diet Coke is just what’s needed to cut through the feel good messaging that most public health campaigns resort to.  Having lived with heart disease my entire adult life (now well into middle age), it’s a welcome boost of energy and the visibility possible with this campaign is unparalleled.   Along with it comes some very important information that can save women’s lives.

Look for the heart truth emblem on 6 Billion Diet Coke cans, at community public forms, at American Idol, and fashion shows across the country. Diet Coke, with Heidi’s help, has even designed a new red dress label pin which strongly resembles an hour-glass.  And what woman doesn’t want that?

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »