May 9th, 2008 by Dr. Val Jones in Celebrity Interviews, Health Policy
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This is a continuation of my interview with Mike Huckabee at the National Changing Diabetes Program conference in Washington, DC. In my previous post I asked Mike about his weight loss journey, and in this post I asked him some global questions about healthcare. My regular readers will appreciate that my digital voice recorder did not malfunction during this interview, though I did drop my Blackberry at one point out of sheer enthusiasm. Gov. Huckabee was the first to reach down and help me get it. What a gentleman!
Dr. Val: Your friend, Dr. Fay Boozman, said “We need to stop treating snake bites and start killing snakes.” Tell me what that means in practical terms.
Huckabee: Healthcare in America is reactive and is geared towards intervening in catastrophic situations, when what we should be doing is focusing on preventing them. The whole system is upside down. It’s like we’re focused on putting Humpty Dumpty back together again instead of keeping him from falling off the wall. Our healthcare system is based on a broken egg concept.
So the key thing that we have to change in healthcare is to focus our resources on prevention and a healthy lifestyle.
Dr. Val: You said that your hope was that “‘Healthy Arkansas’ will spread like a highly contagious but benevolent virus that could become the genesis of ‘Healthy America.'” Can you give me a virus update?
Huckabee: We did in fact launch “Healthy America” and it was the most successful Governors’ initiative in that we had more states participate in this than any other NGA (National Governors’ Association) initiative. Forty-three states launched state-based health initiatives for preventive health. Some were more aggressive than others.
We began the initiative because there was a new awareness of the need to change the healthcare model from intervention to prevention. The concept of Healthy America was to influence behaviors at work, at play, at home, and at school. These programs have been remarkably successful. For example, in the first year, the average productivity of state employees increased by $3400/year. And that’s not to mention the savings in healthcare costs. The average diabetic spends 8.3 days/year in the hospital. The cost of those days could pay for 7 years of diabetes counseling and medication. It’s as if the choice is between a new oil filter or a new engine – which do you think is going to be less expensive?
Dr. Val: Revolution Health is attempting to encourage behavior modification through social networking and online, physician-led programs. What do you think are the strengths and limitations of this approach?
Huckabee: First of all the strengths are more dramatic than you may realize. When we used the online approach in Arkansas, we did health risk assessments followed by online coaching for everything from smoking cessation to weight control. Online programs can be very successful because they’re instant and accessible 24 hours/day. The socialization becomes very important because peer pressure can be harnessed to challenge people to walk more steps or lose more pounds than the others in their group.
Online approaches aside, the key to improving health in America is to create an atmosphere of healthy behavior. This cultural change may take a generation to achieve, which is why most politicians don’t touch it. Politicians like to deal with issues that can be dealt with in an election cycle, not a generation.
However, America’s approach to littering, seatbelt laws, smoking, and drunk driving are four examples of real changes we’ve made in this country over time. The changes took place in three stages: attitude change, atmosphere change, then an action is changed.
Attitude change involves giving people information that changes the way they think about an issue. Atmosphere change means making unhealthy behaviors difficult to participate in (like taking away ash trays and putting up a no-smoking sign), and finally the government codifies into law the new behavioral norm.
The government is usually the last player, not the first, because people have to create the behavioral norm before the government can enact laws. If the government tries to mandate a personal habit, then the debate will not be over the merits of the approach, but over the personal liberties of people to do what they want to do. And in America, the government always loses that argument. So what you have to do is get enough Americans believing that taking care of themselves is the right thing to do, and then there will be the demand for government to put that into law.
We don’t have a healthcare crisis in America, we have a health crisis. And if we dealt with the health crisis we would resolve the healthcare crisis. The real reason we’re in trouble is because 80% of the money we spend on healthcare is a result of chronic disease. And that chronic disease is primarily the result of over-eating, under-exercising and smoking. It’s our lifestyle that’s killing us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
May 8th, 2008 by Dr. Val Jones in Celebrity Interviews
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I had the exciting opportunity to interview Governor Mike Huckabee at a recent conference for the National Changing Diabetes Program. As most of you know, Mike lost 110 pounds through lifestyle interventions and has kept the weight off for over 5 years.
Since I’m leading a weight loss group, I was inspired to read his new book, “Quit Digging Your Grave with a Knife and Fork.” I really enjoyed his witty and down-to-earth, positive approach to health. If you can imagine Dave Barry and Norman Vincent Peele getting together to talk about weight loss strategies, you’d pretty much have Gov. Huckabee’s book. I highly recommend it.
As for our interview, I’ll split the Q&As into two posts. This first post is about Mike’s personal journey, the second is about his view of healthcare. One thing’s for sure, after meeting Mike Huckabee in person, I can say that I’ve joined the team of folks who wear the “I heart Huckabee” t-shirts. He is a softspoken, kind-hearted, honest man with a quirky sense of humor and a gift for parables and analogies. Enjoy his thoughts below…
Dr. Val: It seems to me that your weight loss journey began the day when you sat in a chair at the State Capitol, and it broke under your weight (in front of a group of government officials). Do you think that successful weight loss usually begins with an “ah-ha moment” like yours?
Huckabee: I don’t think it’s always the case that people have that level of epiphany. Most people who are overweight know it – every time they bend over to tie their shoes and can’t, every time they need a seat belt extender on the airplane, etc. they realize that there’s a problem. Unfortunately, though, their response is often one of helplessness. They believe that they just have to live with their weight problem instead of believing they can do something about it.
Sometimes an epiphany can make people really angry, and cause them to say – “I don’t care what I have to do, I need to change.” Most people have made numerous attempts to lose weight and have tried many different diets, but they don’t understand the real problem. It’s a lifestyle issue, not a program issue. Diets fail because they have a beginning and an end. You’ve got to see this as change not so much of the menu but of your mind. Don’t focus on losing weight – that’s a big mistake. Focus on the things that make you healthy and then the weight takes care of itself. You may never be the skinniest person, but you’re better off healthy than you are skinny.
Sometimes I find that when people make weight loss their goal they lose weight but they’re not healthy because they haven’t done it in a healthy way. They haven’t combined activity with the weight loss. They’ve just starved themselves, and that’s not health.
Your health is like a dashboard. If the only thing you ever look at is your speedometer, and you don’t look at the oil gauge and the water gauge, you can get into serious trouble. You think, “hey, I’m going the speed limit” but that’s not the point. That’s how fast your car’s going, not how well it’s running. Health is the same way – you can’t just focus on weight, you’ve got to look at your cholesterol levels, hemoglobin A1C, blood sugar, and blood pressure as well.
After I broke the chair I went to see my doctor and he ran some tests that confirmed I was a diabetic.
Dr. Val: What did your doctor say to you at that point?
Huckabee: My doctor gave me a talk that changed my life. A lot of doctors simply say, “you’re a diabetic, here’s some medication, try to lose some weight and do some exercise.” But my doctor looked me in the eye and said, “you need to understand that if you don’t make a lifestyle change, you’re in the last decade of your life, and let me describe the decade…”
Quite frankly if he had just said that I was in my last decade I might have said, “Hmm, that’s not good, but you know what? I bet a drug company will solve this problem for me in the next few years. That way I can eat what I want and do what I want and just take a pill and everything will be fine.”
But that’s not what he told me. Instead he told me the truth, and he said “let me describe the decade…” And in great detail my doctor began to explain what diabetes would do to my body, organ by organ – my vision, my extremities, my heart. He made it sound like a slow, lingering death. And right then and there I vowed to come up with a different exit strategy for my life.
I gave up sweets and fried foods and began to exercise. You have to understand that this was a huge turning point for a southern boy. I used to say that exercise is for people who have nothing better to do with their lives than to get on a treadmill and play the role of a hamster. But I became one of those people that I used to make fun of – I’ve already completed four marathons. But most importantly, I haven’t needed any medications in 5 years and my doctor says that it’s as if I never had diabetes at all.
Dr. Val: You wrote, “If you really hate yourself when you’re fat, you’ll also hate yourself when you’re thin.” What did you mean by that?
Huckabee: Well, you have to be honest and tell people that their weight is a reflection of their personality. There is something inside of them that let them get completely out of control. It may have been a feeling of inadequacy, or some guilt – every person is different. But usually something is underlying the weight problem. It may be the fear of not having anything to eat next week. But something has to give a person that reckless abandon. Just because you change the physical aspects of your life, doesn’t mean that your emotional, mental, and spiritual aspects are going to change.
Dr. Val: How do you get to the bottom of what’s driving unhealthy behaviors?
Huckabee: I know that for me it was when I started to ask myself, “why is it that I’m triggered to overeat?” Some of it was childhood memories – it was the comfort that food brought. As a child, the few privileges I had were related to food. So food was always a reward. I received affirmation from dessert and would indulge myself to re-experience those childhood memories. I know that sounds awfully elementary but these things get imprinted on us. When we’re adults and someone is cruel to us or something bad happens, we affirm ourselves with food so that we can feel as if we’re a good person again. But once you come to terms with this, you regain control. You can tell yourself you’re alright and you don’t need food for comfort or affirmation.
**Up next, Mike speaks out about healthcare**This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
April 25th, 2008 by Dr. Val Jones in Expert Interviews
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In my quest to bring the best possible health advice to the Revolution Health community I am actively pursuing interviews with credible sources. At the top of the list is America’s #1 doctor, the Surgeon General. I recently had the opportunity to sit down with Vice Admiral Richard H. Carmona, M.D., who served as Surgeon General from August 2002 to August 2006. He addressed a range of health issues facing Americans today. I am posting the interview in segments; the following post is part of that series.
Dr. Val: Obesity rates continue to rise each year. Does obesity lie at the core of the chronic disease crisis and if so, what can America do to reverse this trend?
Dr. Carmona: Obesity is absolutely at the core of the chronic disease crisis. When we look at the relationship of obesity to other diseases that plague society today (such as asthma, cancer, cardiovascular disease, and diabetes) obesity increases the incidence of each of them, and can even accelerate some of them. Losing weight is not about trying to emulate models in fashion magazines, it’s about being healthy.
If we could only address one major public health issue as a nation, I would focus on the obesity crisis. Weight loss could have the greatest impact in decreasing the chronic disease burden in America.
Dr. Val: So what can we do about obesity?
Dr. Carmona: That question is simple on the surface but incredibly complex when you begin to analyze it carefully. First of all we have to identify the variables that contribute to this problem, because it’s a multi-factorial issue. The socio-economic determinants of heath are inextricable from the health status of individuals and communities. That means that if you’re poor and have less education, you’re going to experience health disparities. You can’t afford to buy healthy food, you don’t live in a neighborhood where you can walk at night and get exercise, and so on. So understanding all the determinants of health to address obesity is important.
Let me describe just one significant variable contributing to the obesity epidemic: the sedentary lifestyles of children. Thirty years ago it was commonly believed that physical education in school was not important, because kids played during all the hours that they are out of school. Parents reasoned: ‘Why should I pay a teacher to have my kids play ball at recess? I’d rather have her teach them math and science.’ So there was a sweeping trend to discontinue physical education at school. Now, however, kids spend too much time on playstations rather than on play grounds – or they watch over 4 hours of TV a day. They’re sedentary at school and at home.
Other variables that influence obesity rates in kids include the accessibility to fast food, the increased rate of single parenthood, and the change in cultural traditions around meal time. For wealthier families, easy access to large volumes of food of every possible kind can create an environment where people overeat.
The solution to the obesity crisis is not “one-size fits all.” The approach to obesity must be tailored to the cultural and socio-economic sensitivities of the sub-population that you’re trying to reach.
Ultimately we need to change behavior – walk a little more, eat a little less, buy some healthy foods. But targeted interventions must be culturally sensitive and socio-economically relevant. For example, the government is funding programs to make healthy foods more accessible to underserved areas, and physical activity programs are being reinstated in schools. But the effects of these programs are not going to be seen for many years because it takes time for the culture to catch up. Also, the approach must be comprehensive. If we were able to get all of our children enrolled in a daily game of baseball (to increase their physical activity), that would not solve the problem of fast food and video games.
There needs to be a community approach, so that no matter where the child turns they’re getting positive reinforcement of healthy behaviors. That’s part of what I’m doing with the national non-profit health organization that I’m president of now – Canyon Ranch Institute.
***
The Surgeon General series: see what else Dr. Carmona has to say about…
Cost Savings Associated with Preventive Health
Consumer Directed Healthcare and Health Literacy
Complementary and Alternative Medicine
Preventing Chronic DiseaseThis post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 28th, 2008 by Dr. Val Jones in True Stories
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I lived in Texas from 1990 to 1994. I haven’t spent much time there since, although I’ve had my eye on Houston’s unfortunate distinction as “America’s fattest city” for the majority of recent years (though Chicago won the honors in 2006 if I recall correctly). Armed with this knowledge, I arrived in Houston today hoping that I wouldn’t let down the members of my weight loss group as I entered the “lions den” of poor eating habits and sedentary lifestyles.
I had missed lunch, and opted for an early dinner at the hotel restaurant. The menu surprised me in two ways: first, it featured quail and wild boar (this particular hotel chain is not known for culinary artistry – let’s just say that their recent “upscale service campaign” involved an email to me the day prior to arrival, asking if I might like anything special in advance of my arrival – like a 6 pack of Budweiser waiting for me on ice. I kid you not.) Second, they had made an attempt to highlight “heart-healthy food choices” on the menu. One item was identified as heart-healthy. Only one.
So I resisted the urge to try the local southern fare (fried catfish and hush puppies) and decided on the heart-healthy option. Here’s how the conversation went:
Server: “Welcome to XXX. May I start you off with something to drink?”
Dr. Val: [Shivering and somewhat surprised that the AC would be on so high] Well, yes, I think I’ll have some hot tea. Do you have green tea? It’s quite cold in here, isn’t it?
Server: “It’s not cold. The lights above will warm you up real quick.”
Dr. Val: [Looking up towards the track lighting above me, wondering if they could function as a sort of heat lamp.] “Oh, ok.” [Server leaves to put a tea bag in a mug of hot water and returns with it on a napkin.]
Server: “Have you decided what you’d like to order?”
Dr. Val: “Well yes. I think I’ll have the heart-healthy fish, but I was wondering if I could have a side of greens with that?”
Server: “What kind of ‘greens?'”
Dr. Val: “Well, maybe a green salad or some broccoli?”
Server: “Did you see the salads on the menu?” [I can tell she thinks I’m one of those “high maintenance Yankee women” as her voice begins to tighten.] “We have spinach salad or perhaps a Caesar?”
Dr. Val: [Now fully aware that I’m being irritating but desperately wanting to make a healthy choice.] “Yes but those are entree-sized salads and they have bacon, egg, and cheese on them. Do you have something more plain? Or maybe some steamed vegetables…” [My anxiety grows as she stares blankly at me].
Server: “Well did you see the string beans side dish?”
Dr. Val: “Yes, but they’re wrapped in bacon, and [trying hard to help her to understand my quandary] I was hoping to order something healthy… you know what I mean?”
Server: Blank stare.
Dr. Val: Nervous stare.
Server: Sighing, “well I can ask the chef to make the beans without the bacon. Not sure if he can do it, though.”
Dr. Val: “Oh that would be great, thanks so much!”
Server: [Fake smile, whisks menu from my hand, waddles toward kitchen.] 10 minutes pass.
Runner: [Appearing with a huge plate on his shoulder] “Did you order the fish?” [Surprised that anyone ordered the heart-healthy dish].
Dr. Val: “Yes, I did.”
Runner: “Ok, here you go.” [Places gigantic plate in front of me with a separate bowl holding about a half gallon of stir-fried green beans in oil. The fish has cream sauce on top of it, about a quarter inch deep.]
Dr. Val: [Remembering the phrase “Texas-sized.” I scrape off cream sauce and cut green beans into bite sized portions. I think to myself: how can anyone eat out in this state and hope to maintain a reasonable weight? I promise myself to go to the hotel gym after my meal…]
Yes my friends, the next 9 days at this conference are going to be interesting. I’ll keep you updated as I rekindle my cultural connections to Texas. And I have the utmost sympathy for Americans who live in places where eating out regularly can be hazardous to your health. Losing weight can be a fight, every step of the way, can’t it?This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 10th, 2008 by Dr. Val Jones in News, Opinion
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When I eat out at a restaurant I’m inevitably asked whether or not I’d like bottled water with my meal. My answer usually depends upon the city I’m in – New York water tastes great, so I ask for tap water in Manhattan. The water in DC tastes like a swimming pool (at best), so I usually order bottled water at Washington restaurants.
But little did I realize that the water I’ve been drinking (whether from DC, NY or even from the bottle) has small traces of pharmaceutical chemicals in it. A new investigation conducted by the Associated Press suggests that most major urban water supplies are laced with tiny amounts of prescription drugs. How do the drugs get in the water supply?
Remember that water cycle you (or your kids) studied in grade school? Well, the “underground phase” is where the action happens. Drugs that we swallow pass through our bodies and some is released in our urine and stool. We flush that down the toilet and the fluid debris is treated in a sewage plant and then the water portion is released back into the water supply. Sewage plants and water filters are not designed to remove trace chemicals like heart medicines and anti-depressants, so they remain in the drinking water. Kind of disturbing, right?
Well, the good news (if there is any) is that the amounts of chemicals in the water are pretty small – we’re talking parts per trillion. Just to put that in perspective, that’s more than 1000 times smaller than the minimum amount needed for therapeutic effect from the fluoride added to the water system. And the concentration is far below the therapeutic threshold in the bloodstream for these drugs. But how do we know that tiny amounts of drug exposure isn’t harmful in some cumulative way?
Research into the potential long term effects of these chemicals in the water supply has focussed mostly upon the presence or absence of the drugs, and the concentrations at which they’re present. Animal studies (such as the “feminization” of fish exposed to environmental estrogens) and cell culture research suggest that exposure to larger concentrations of these drugs can cause negative outcomes, but to my knowledge there are no long term studies of the potential impact of very small concentrations on human health. But before we become outraged at this apparent lack of investigation, let’s think about why it’s so difficult to gather this kind of information.
First of all, concentration-wise, pharmaceuticals represent a small fraction of the thousands of man-made chemicals in the environment, including everything from pesticides to personal care products. So it’s very difficult to prove a cause and effect for any one drug’s influence – we are each exposed to a very dilute cocktail of chemicals in our daily lives, whether through the water we drink, the food we eat, or the air we breathe. How can we tease out the potential damage of one chemical over another?
Secondly, it’s pretty likely that any potential harm (from chemicals at such small doses) would take many years of exposure before a clinically measurable threshold is reached. It’s very difficult and expensive to study large groups of people over time – and it’s hard to know what their lifestyle choices may contribute to their overall chemical exposure. Over time people change jobs, change what they eat or drink, change where they live… the complex interplay of environmental factors make it hard to interpret exposures and effects.
And finally, how do we know what outcomes to look at? It’s possible that these small doses of pharmaceutical products could affect our bodies in fairly subtle ways – which again makes it difficult to measure. It’s hard enough to study cancer rates in populations, but how would we study differences in physical or mental performance? Or slight changes in mood or heart function?
Since there’s no easy way to prove a connection between drugs in our water system and our general health and wellbeing, we are likely to be left with far more questions than answers. I think we all agree that we’d rather not be exposed to trace amounts of any chemicals in our water supply, but unfortunately the cost of filtering all potential contaminants from the water is exceedingly high. Reverse osmosis (a process currently used to reclaim fresh water from the sea) can cost as much as $1-18/gallon depending on the system in place and the country using it. While reverse osmosis could guarantee a chemical-free drinking water supply, we couldn’t afford to supply it to all Americans. And in the end, it’s still unclear if solving that part of the puzzle would improve our overall health.
I hope that we’ll find ways to reduce the chemical load on our environment, and that advanced water purification technology will become more affordable in the future. Unfortunately, trace amounts of chemicals, drugs, and pesticides are more ubiquitous than we’d like to believe. The impact they may have on our health is difficult to measure, and largely unknown at this point. Perhaps the bottom line is that we’re all connected to one another through our environment – so that granny’s heart medicines may yet live on (albeit in trace amounts) in your bottled water. All the more reason for Americans to pull together to live healthy lifestyles, control our weight, and try to prevent the diseases that are requiring all these drugs in the first place.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
