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The Newest Eating Disorder: Orthorexia Nervosa

July 27th, 2009 by Nancy Brown, Ph.D. in Better Health Network
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Orthorexia is a term coined by Dr. Steven Bratman. “Ortho” simply means straight or correct, while “orexia” refers to appetite. Orthorexia nervosa refers to a nervous obsession with eating proper foods. While anorexia nervosa is an obsession with the quantity, orthorexia is an obsession with the quality of the food consumed.

Given how heavy people seem to be getting in our country, focusing on health should not be a bad thing. However, while it is normal for people to change what they eat to improve their health, treat an illness, or lose weight, orthorectics may take the concern too far. While it is normal for people switching diets to be concerned with what types of food they are eating, this concern should quickly decrease, as the diet becomes normal. Orthorexia, in contrast, is when a person is consumed with what types of food they are allowed to eat and feel badly about their selves if they fail to stick with their regimen.

People suffering with this obsession about what they eat may find themselves:
• Spending more than three hours a day thinking about healthy food.
• Planning tomorrow’s menu today.
• Feeling virtuous about what they eat, but not enjoying it much.
• Continually limiting the number of foods they eat.
• Experiencing a reduced quality of life or social isolation (because their diet makes it difficult for them to eat anywhere but at home).
• Feeling critical of others who do not eat as well they do.
• Skipping foods they once enjoyed to eat the “right’ foods.
• Feeling guilt or self-loathing when they stray from their diet.
• Feeling in “total” control when they eat the correct diet.

Often orthorectics will “punish” themselves by doing a penance of some sort, if this “fall from grace” does occur. While orthorexia nervosa isn’t yet a formal medical condition, many professionals do feel that it does explain an important health phenomenon. If you or someone you know suffers from something that sounds or feels like this description of orthorexia nervosa, you should go visit either a nutritionist or doctor.

References
1) Bratman, Steve. “Health Food Junkie–Orthorexia Nervosa, the New Eating Disorder.” 1997.
2) Billings, Tom. “Clarifying Orthorexia: Obsession with Dietary Purity as an Eating Disorder.” 1997
3) Davis, Jeanie. “Orthorexia: Good Diets Gone Bad.” November, 2000.
4) Fugh-Berman, Adriane. “Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating–A Book Review.” May 2001.
5) Dennis, Tamie. “Booster Shots.” Los Angeles Times, 7/09

Photo credit: Meg and Rahul

This post, The Newest Eating Disorder: Orthorexia Nervosa, was originally published on Healthine.com by Nancy Brown, Ph.D..

Healthcare Disparities: The View From Harlem, NYC – Part 1

July 22nd, 2009 by Olajide Williams, M.D. in Health Policy, True Stories
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Disparities in healthcare are composed of several interconnected layers – multiple layers joined together like the bricks of a divisive wall, separating better health from poor health.  And while we must acknowledge the pre-eminence of personal responsibility, we must also address the uneven distribution of mountains and valleys on the American playing field.

Disparity sometimes begins before one is born; before one is conceived – it may begin in-utero, with the absence of adequate prenatal care, with maternal co-morbidities and high-risk behavior, long before one is old enough to assume personal responsibility within an “inherited” landscape or community that is filled with steep climbs and dark valleys. Many of us are familiar with root causes of healthcare disparities – the four components or foundational bricks that sustain physical and economic health in capitalist societies.

• Educational status
• Employment status
• Insurance status
• Income level

Individual or combined deficits in these components typically lead to accumulating disadvantages within which good health is considered an outlier. It is often these environmental factors, and not genetic ones or racial ones that are largely responsible for the disproportionate morbidity and mortality we witness all over America – especially in Harlem – the site of my neurological practice.

A young child is born on Malcolm X Boulevard in central Harlem. He is the most beautiful baby I have ever seen. And yet, his passage into the world is not without hardship. His single mom, a sixth grade dropout, did not have health insurance even though she worked two minimal wage jobs.  She did not receive adequate prenatal care. Indeed, the only time she visited the hospital was to fix the broken bones in her face she sustained from domestic violence.  Fortunately, she escaped from that life by fighting back with everything she had. Even her child was born through conflict – amidst the peril of eclampsia. It was a stormy delivery in a safety net hospital. Luckily, she survived and the beautiful baby boy thrived.

The early years of the child’s life were spent with grandma, until she died when her grandson was only 9-years-old. Mom had nobody else to help her, and there were no breaks in Harlem. She could not afford the childcare she needed to keep her second job, which she fought so hard in vain to keep.  She became homeless. After squatting with her son in an old boyfriends house for a period of time, they finally moved into a housing shelter and were placed on a waiting list for section 8.

Mom was born poor; she had no successful role models; no good yardsticks with which she could measure herself against. Everyone around her seemed resigned to the status quo, which they would refer to as “the hustle”. She did not make it to high school; she fought for her minimum wage; she had no health insurance; and yet she worked hard to provide basic needs for her and her son. Each brick of disparity – educational status, employment status, insurance status, and income level – formed a wall so tall that it was hard to imagine how she would get to the other side.

Depression crept in – an irrepressible feeling of worthlessness and hopelessness. A feeling that no matter how hard she tried she would always fail.  Most of her girlfriends were already on the streets or in jail. Their children had dropped out of school to join gangs or resort to petty crimes. She promised her own mother long before she died that she would never resort to crime. She would fight a good fight for her son and herself. But depression dug deeper, breaking her will, piece by piece until she finally succumbed to the twin pressures of emotional and economic desperation.

We all have limbic needs. For some, these needs are nurtured by loving hands that paint lasting portraits of hope inside our souls. Expressions of hope hanging on the walls of our heart chambers: a mother’s attention; a father’s approval, a caregiver’s warmth, a schoolteacher’s encouragement. For other’s, there is insufficient nurturing – these limbic needs are not met; rather, they are torn down – left out in the cold, often on impoverished streets – unanchored, undermined, forced to adapt alone in a Darwinian society.

In my next post, I will finish this story. I will describe the boy’s life and his ultimate stroke in an attempt to show the interconnectivity of health and the four components of healthcare disparities.

30 Years Of Happy Meals

July 22nd, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Tips
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It’s always a bit of a landmark when something like the Happy Meal reaches a big milestone in years. This week marks it’s 30th anniversary of being introduced into our lives. That’s a lot of years, a lot of meals and a lot of small cute toys!

A meal in a box…who would have thought! I do remember when they first came out and parents with little kids flocked to them like flies to sticky paper. However, coming in at 600 calories for an average meal, packed a huge punch on the typical child’s health and waist band. Indeed, as noted by ABC News, childhood obesity has increased by 4x over the last 3 decades moving from only 4% the child population to 17%!!

The McDonald’s rep interviewed by ABC News mentioned that the “most popular” Happy Meal, the chicken nuggets with apples, is now only 360 calories. That is a great decrease by just shy of 50%.

Let’s not celebrate yet. What we need to consider is what proportion of a daily calorie amount this mean eats up.

Calorie amounts vary by age and gender. Here’s how it breaks down with recent recommendations from the American Academy of Pediatrics:

• Toddlers: 1000 calories a day
• 4-8 yr old girls: 1200 calories a day
• 4-8 yr old boys:1400 calories a day
• 9-13 yr old girls: 1600 calories a day
• 9-13 yr old boys: 1800 calories a day
• 14-18 yr old girls: 1800 calories a day
• 14-18 yr old boys: 2000 calories a day

Now, let’s look at some of the most popular Happy Meal calorie counts:

• Chicken nugget meal with Apple dippers & Apple Juice: 380 cals
• Chicken nugget meal with fries, 1% chocolate milk: 580 cals
• Hamburger meal with apple dippers, white milk: 460 cals
• Hamburger meal with fries, chocolate milk: 650 cals
• Cheeseburger meal with apple dippers, white milk:500 cals
• Cheeseburger meal with fries, chocolate milk: 700 cals

Finally, what percentage of a child’s daily calorie count will each of these meals snatch up for a toddler at 1000 calories a day?

• Chicken nugget meal with Apple dippers & Apple Juice: 38% Chicken nugget meal with fries, 1% chocolate milk: 58%
• Hamburger meal with apple dippers, white milk: 46%
• Hamburger meal with fries, chocolate milk: 65%
• Cheeseburger meal with apple dippers, white milk:50%
• Cheeseburger meal with fries, chocolate milk: 70%

What about if the child is a 5 year old girl requiring only 1200 cals/day?

The kicker here is that if we run these numbers for the teens, the percentages wouldn’t be quite as bad but teens go for the bigger meals which put them right back into these ranges in the end! (A Quarter Pounder alone is 400 calories! Check this list out for more details.)

Fast food such as Happy Meals is one of the big players in obesity in general for all populations. There are times we all have to grab and go because of work, travel and circumstances beyond our control. The key to not have the loaded calories make too much of a long term dent is to have a fast food plan and to work on being more healthy over all. Here are my suggestions:

1. Pick small portions and healthy alternatives at fast food places, and teach our children to do so as well. When in doubt, down size and pass on the fries or split them.
2. Eat healthy in general so the fast food day is the exception, not the rule.
3. Be as active as possible daily so your body and your children’s bodies have a way to burn the added calories.

McDonald’s job is to sell food and lure you and your kids’ through the doors. Your job is to keep your kids healthy and teach them how to be healthy life long. Have a Happy Meal once in a while…but do so thoughtfully and don’t delude yourself that these meals are anything close to healthy. The new packaging and food choices are just new hype for the same old unhealthy song.

*This blog post was originally published at Dr. Gwenn Is In*

The Real Fantasy Of Star Trek Medicine: Doctors Without An Administrative Burden

July 15th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Policy
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One of my favorite summer activities is watching reruns of Star Trek Next Generation. It’s become somewhat of a summer tradition in my family the last few summers. Having become trekkies themselves, my kids were able to very much enjoy the recent movie, and get the history and lore behind it.

The longevity of the Star Trek enterprise is fascinating. Decades after it’s first launch, it still captures the imagination of inquiring minds and still provides endless hours of entertainment to viewers of all ages.

Even more amazing than the longevity of it’s run is the technology it represents. When the show first debuted, the sci fi components seemed truly out of reach. Today, much of the technology in the new movie and even some of the older shows doesn’t seem that implausible, especially when it comes to health.

Early Trek was a preview of our current Health 2.0 world. When first portrayed, that was not a concept any of us could grasp.  Think about it. In the original series, and continuing through to the latest movie, they used communicators in high tech ways with online computers to search data bases and emails and video calls to talk between doctors at different inter-stellar locations. The doctors even had high tech gizmos to look inside and offer a 3-d look within. All medical records were online and available anywhere. New advances in medicine came from experience, science as well as other cultures and the experience of the treating physician. Patients and doctors could review information online and use that to improve their own care.

What wasn’t so out of reach was the portrayal of the practice of medicine and the limitations of what the human physician could achieve. The bedside manner was always first and foremost the key element to a patient’s survival. The physician treated all patients, regardless of species, and had tolerance for different cultural beliefs in treatment. And, not all patients made it through their ordeal. After all, the doctor was “just a man, not a miracle worker”.

So, Trek’s docs were all health 2.0 with a healthy dose of health 1.0 in that they had these important features:

1. high tech gizmos and computers to diagnose and treat
2. traditional docs to take a history and offer counsel but computerized medical records
3. limits on what could be done
4. online communication with “Googling” ability
5. New advances and lessons from other species to tackle new issues and problems

Sounds a great deal like our health system, minus the insurance headaches, huh?

The practice of medicine is begging to be more health 2.0 but with doctors who very much want and need to be involved and keep their health 1.0 skills. Today we have gizmos that keep becoming more high tech…think robotic surgeons. Today we have doctors still driving clinical care with bedside manner still crucial to the success of an outcome. Today we still have limits of what can and can not be done, with a limit of human life, regardless of our efforts to prolong it. Today we have very robust online communication between doctors, between patients, between doctors and patients, and between everyone and the computer, but with an importance still placed on the face-to-face visit.

There’s one big difference between the docs on Trek and us…insurance. Because of that, what we see on Trek is still just a dream. Those docs can do their jobs so admirably and with great patient satisfaction because they are not burdened with an insurance system gone awry and not forced into cycles of defensive medical practices.

Until health reform sorts out how to allow us to have a patient-focused, physician driven system again, what we see on Trek will remain a dream. What’s sad and discouraging is that is this is one sci fi dream that is actually within reach. Don’t you think it’s time we stopped the insurance companies from preventing us from grabbing on?

*This blog post was originally published at Dr. Gwenn Is In*

HIV Screening Should Be Offered As Part Of Routine Medical Care, Even For Teens

July 14th, 2009 by Nancy Brown, Ph.D. in Better Health Network
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In 2006 the Centers for Disease Control and Prevention (CDC) estimated that 1.1 million people were living with HIV, 4.4% of whom were 13 to 24 years old, and 48% of those youth are unaware they are infected. Using the Youth Risk Behavioral Survey (YRBS) data from 2007, the CDC estimated that about 12.9% of high school students had been tested for HIV.

The good news is that the highest risk teens were the ones getting tested more often, but only 22% of the highest risk teens had been tested.

To decrease the number of undiagnosed HIV infections among adolescents and promote HIV prevention, the CDC recommends that healthcare providers offer HIV screening as part of routine medical care for all people ages 13 to 64. People at high risk should be tested every year, including:

• Injection drug users;
• Anyone who exchanges sex for money or drugs;
• Sex partners of people with HIV;
• Men who have sex with men;
• Heterosexual people who have more than one partner since their most recent HIV test; and
• Anyone who gets a sexually transmitted disease.

High schools can support that effort by including information about HIV testing in the health curricula. People familiar with the benefits and process of the testing and counseling are more likely to be tested.

For teens, I usually suggest they go to anonymous testing sites in their community to be testing, so that the test is not including in their medical record. The anonymity also gives them a little extra courage. The trick is that they cannot lose their test number for the two weeks they wait for results.

This post, HIV Screening Should Be Offered As Part Of Routine Medical Care, Even For Teens, was originally published on Healthine.com by Nancy Brown, Ph.D..