As a pediatric endocrinologist, I am on the frontline of the childhood obesity epidemic. In fact, I am now seeing 100-pound two year olds and 150-pound three-year-old kids in my clinic and I am concerned. The obesity epidemic is perpetuated by a processed food-culture that lacks healthier local whole foods.
Diets dominated by processed foods (refined carbohydrates with high fat- and/or high-sugar content and artificial ingredients) over whole foods (fruits, vegetables, whole grains) spur more obesity and diabetes, and have even been shown to negatively change gene expression of the offspring during pregnancy. All-processed ingredients reflect the balance of desirable factors in the modern way of life such as shelf life (long), taste (sweet), texture (fat) convenience (high), and price (low) — all profitable, all less nutritious, and all with a mass-marketed, generic, “cultureless” appeal that reduces emphasis on local cultures and flavors.
The recent rise of social networking is testament to the fact that people are hungry to connect and yearn to be culturally inspired. Culture (art, food, music) deeply connects people and transcends time, politics, and poverty because it is the language of being human — and something that never changes. Medical research as well as the positive embracing of First Lady’s “Let’s Move” campaign demonstrates an open mind to the idea of a healthier culture and readiness for change. In fact, many of the families that I meet in my clinic are interested in considering whole-food choices, but lack knowledge and guidance.
Food-culture change offers the best hope for transforming obesity and what Americans eat. Oprah’s recent vegan-whole-food-challenge show on February 1st is a step in the right direction and will help to propel the emerging whole-foods movement. Columbus, Ohio is emerging as a center for local whole-foods activism and food-culture change. Just in 2010, the Mid-Ohio Regional Planning Commission released the Central Ohio Local Food Assessment and Plan — the first plan of its kind in the nation — and received an $885 million US. Department of Housing and Urban Development (HUD) grant to create an urban foodscape in one of Columbus’ most blighted neighborhoods. Read more »
I recently read an article by Heather MacDonald entitled “Public Health Quackery” that has not left my thoughts since. The truth in regards to what determines health is being argued in the article.
At the heart of the article, MacDonald seeks to contrast the traditional science approach with the miasmatician approach to the fundamental question of the role of individual behaviors vs. socioeconomics on the determinants of health. MacDonald summarizes the miasmaticians’ beliefs of health determinants as being exclusively influenced by socioeconomics thereby dismissing any and all influences on health by individual behaviors.
Her primary argument in favor of the traditional science belief in individual behaviors as determinants of health is as follows: Traditional science bases assumptions of truth on data that is valid by scientific standards vs. miasmaticians’ assumptions of truth from biased, “flimsy” data. In other words, “quacky” ideas come from “quacky” data thus are not likely to be true. Read more »
When it comes to understanding medical information, even the most sophisticated patient may not be “smarter than a fifth grader.”
In one of the largest studies of the links between health literacy and poor health outcomes, involving 14,000 patients with type 2 diabetes, researchers at the University of California San Francisco and Kaiser Permanente found that more than half the patients reported problems learning about their condition and 40 percent needed help reading medical materials. The patients with limited health literacy were 30 to 40 percent more likely to experience hypoglycemia — dangerously low blood sugar that can be caused if medications are not taken as instructed — than those with an adequate understanding of medical information.
Now, federal and state officials are pushing public health professionals, doctors, and insurers to simplify the language they use to communicate with the public in patient handouts, medical forms, and health websites. More than two-thirds of the state Medicaid agencies call for health material to be written at a reading level between the fourth and sixth grades.
A new federal program called the Health Literacy Action Plan is promoting simplified language nationwide. And some health insurers, doctors’ practices, and hospitals have begun using specialized software that scans documents looking for hard-to-understand words and phrases and suggests plain-English replacements. Read more »
When I was in the 8th grade and honored at the “A” team honor roll breakfast, the speech was one that I never forgot: “Attitude is Everything.” Essentially, having a good education and good grades give you the tools to be successful, but having a great attitude toward any challenges ASSURES that you will arrive at that success.
Being a pediatrician AND an endocrinologist, I am blessed to work with many graceful children and their families who face medical endocrine challenges with great attitudes. I can recall numerous examples but will share one of my favorites: A now 11-year-old vibrant female with hashimotos thyroiditis who was diagnosed at 5 years old. Initially, she required frequent lab checks for medication adjustment (~5-6) which then decreased to ~2-3 annually thereafter for further medication dosing adjustments of synthroid replacement as she outgrew prior lower doses.
Her attitude towards her lab draws has always stuck with me because surprisingly she actually looked forward to them AND to her endo visits! She and her mother would always go out to eat and spend special quality time together whenever she had to have a lab draw. They would always choose Mexican food for these special outings, and in fact would limit all Mexican food intake, making it that much more special. Read more »
A common question that I get as a practicing physician with a public health background is: “Why is healthcare reform so complicated?” I feel that the question of who’s responsible for healthcare payment is not always an easy one to answer. An example from my most recent weekend on call covering an academic pediatric endocrinology practice demonstrates this point:
“Bill” is a 16-year-old African American male on state Medicaid insurance with type 1 diabetes since the age of 10. He is followed regularly every three months by another colleague in the endocrinology clinic. Review of his last several clinic notes on the electronic medical record reveal that he has been in moderate control of his diabetes on NPH/Novolog twice-daily insulin regimen. Approximately one year prior he was changed to this insulin regimen due to concerns with missed insulin shots on another insulin regimen that provided superior control but which required four shots of insulin daily rather than the two shots daily on his current regimen. Read more »