Here is a bit of an article that ran in the news yesterday, wherein a couple of doctors were interviewed about the high cost of business for inactive employees. Watch how quickly it devolves into a blamefest for making the discussion about healthcare and the tremendous burden obese people place upon it…

Two Doctors Discuss One Big Problem

By Rob Reuteman (FOXBusiness)

How much does it cost a business if an employee is physically inactive?

Dr. Steve Aldana, a professor of Lifestyle Medicine at Brigham Young University, sat down with Dr. David Hunnicutt, president of the Wellness Council of America (WELLCOA), for a discussion on the costs of unhealthy behaviors in the United States. Aldana has published more than 60 research articles and has written five books on the connections between healthy living and disease prevention. He is a regular consultant to the Centers for Disease Control and Prevention, the National Institutes of Health, and the California Department of Health Services.

What follows are excerpts from the interview, which originally ran in the WELLCOA publication, Absolute Advantage:

Hunnicutt: How much does it cost if an employee is physically inactive?

Aldana: Basically, it’s estimated that sedentary living—the fact that we’re not moving around very much—costs us as a nation $150 billion. This is in 1987 dollars. That’s just due to healthcare costs associated with diseases that we get from not moving around. So that takes care of the first area.
When it comes to the second area, this is where the numbers get serious. In fact, 15% of all of the health-care costs we pay in the United States is due to sedentary lifestyles. Now, if employers want to calculate what physical inactivity is costing their company, I would suggest that they take a look at their total health-care expenditures for a year and take 15% of that. In reality, that’s going to be pretty close to the actual expenditures.
About 78-80% of the entire U.S. population does not get enough physical activity to get the benefits.

Looking at it another way, there’s about 20-25% that are actually moving around enough to lower their risks and to lower their prevalence of disease. The rest are not. So it’s the vast majority; and it has changed a little for the better over the last few years—not very much—a couple of percentage points.

Hunnicutt: What do we know about the cost of [overweight-ness] and/or obesity?

Aldana: When it comes to calculating costs, overweight and obesity are pretty much the same thing—they’re just varying degrees of the same thing. By the way, about 67% of the population is either obese or overweight, and that number has some consequences associated with it. In a nutshell, about 12% of total health-care costs are obesity-related.

But there’s more than that, and it’s really interesting. If you take, for example, someone who’s obese and someone who’s not, and they both have the same health condition or the same disease, it costs $1,200 more to treat the obese person than it does the person who maintains a healthy weight—even though it may not be an obesity-related condition. This increase in treatment costs occurs because it’s more difficult to treat obese patients.

It’s tougher to get IV lines in them; it’s tougher to do surgery on them; they have more complications. As a result, it costs $1,200 more on average to treat an obese person than it does to treat a non-obese person for the same condition.

Hunnicutt: So between physical inactivity and obesity, it could cost an employer as much as 27% of their total health-care claims?

Aldana: It’s worse. The piece we’re missing here is the diet piece. The diet piece plus sedentary living are both contributing to the obesity epidemic. That’s when the numbers start to get really, really concerning. Indeed, when you factor this variable in, you’re now looking at 35-40% of total healthcare costs. If you add in tobacco use, you’re now sitting at 65-70% of total health-care expenditures within your organization.

Hunnicutt: What do we know about the efficacy of interventions like physical activity?

Aldana: A good intervention is going to get those people who are not already exercising to either start thinking about and/or participating in some form of regular physical activity. It’s not going to be a huge impact because it’s very difficult to make that kind of dent in this problem. But, if we can increase physical activity among the general population, I think you’re going to see that a few small percentage points will make a huge difference.

* * *

Bottom line it for me, doc. Can I force my boss to build a gym at the office?

On the face of it, this just sounds like another article blaming obese people for the ails of the healthcare system. But, it’s worse than that. Can you imagine the firestorm that would ensue if a couple of doctors came out front and center and blamed cancer patients for the high cost of healthcare? After all, their meds are costly, and they require extensive (expensive) tests (and retests). And, you know, it could be argued that people with lung, throat and mouth cancer most likely brought it on themselves by smoking or chewing tobacco. In other words, they knew what they were doing could cause cancer, but they — GASP — did it anyway. Yes, let’s blame the patient. How about people with high cholesterol? Isn’t it true that *most* of them could control it through diet and exercise? I mean, step away from the pizza and burgers, and go to the gym, people! Right? How about diabetics? Should we blame them for the high cost of healthcare? After all, they need lots of expensive syringes, insulin and testing supplies. That’s GOT to be a burden on our healthcare system.

Can you see where I’m going with this? I guess I feel that there is a component to the conversation that is critically missing. As usual, Western Medicine is focused on TREATING the symptom, instead of looking for the SOURCE of the symptom. Wouldn’t a CURE be better than a treatment? I think it’s far too simplistic to say that people are fat because they work sedentary jobs. Look at the restaurants out there. What do they serve? Even their “healthy menus” aren’t perfect. Ever looked at the nutritional stats for a salad from CPK? It would give most people a heart attack to learn that a “healthy” salad on the menu is 2,200 calories! I guess what I’m saying is, blaming the patient does not cure the disease, anymore than blaming a victim will prevent the crime.

Look, I agree that healthy is better, but I hesitate to quote statistics for obese people and ignore the costs of other debilitating diseases. Otherwise, we’re just blaming people for things that may be outside of their own control.

What are you thoughts on this? Is it just “pig-piling” on easy targets?

The Not-So-Great Dr. Oz Has Spoken

My new(ish) blog buddy, Diane (fittothefinish.com) was on Dr. Oz today (Tuesday, 2/16) as one of his 100 People Who Have Lost 100 (or more) Pounds! it was his 100th show, so it was a big deal. In the past 4 months of reading her blog, I have come to admire Diane for her level-headed, sensible approach to weight management.

Don’t click the link until you’re done reading my page. It will send you away! (boo hoo).

I KNEW it was going to be a great show, so I immediately logged onto the FIOS site so I could remotely set the DVR to record it. Right when I got home from work tonight, I heated my 4, mini slices of Trader Joe’s Mexicaine Quiche, added a satisfying dollop of Greek yogurt, some hot chipotle salsa and a sprinkling of black olives, and pulled up a couch next to MexiKEN to watch the show. I told him we were going to see one of my online friends (and frequent commenter here on Barbie), and he was really amazed. “No way!” he exclaimed. “You KNOW her?” (Heck, yes!)

Anyway, the show opened with some exciting footage of 100 people who have lost a lot of weight. There was Diane! Yippee! I recognize her picture! And there was Dr. Oz doing the voice over, “Today, you’ll meet Dr. Oz’s 100 People Who’ve Lost 100 (or more) pounds the ‘old-fashioned’ way — they DIDN’T DO IT WITH SURGERY. They did it with hard work!“

Oh no…the (Not-So-Great) Dr. Oz has spoken.

How could this happen? How did I go from over-the-moon-excitement to abject-disappointment in 5 seconds flat?

Oh, I remember now…Dr. Oz made the same, ignorant assertion so many others do: He implied that people who choose weight loss surgery as a treatment for obesity have taken the easy way out.

Sigh. Here we go again.

Slightly deflated, but undaunted, I watched the first segment featuring Diane and 2 other people.

Each person gave 3 tips for maintaining a healthy weight and lifestyle.
Each person said things that pertain to people who have lost a lot of weight.
Each person said things that affect people like ME.

I don’t get it. Why does it MATTER how I LOST the weight? Doesn’t it matter how I’m KEEPING IT OFF? Doesn’t that count for something? Don’t I get credit for the fact that I have to do things the same way as every other person on the planet?

If everybody is looking for the EASY WAY TO LOSE weight, and everybody claims that weight loss surgery is the EASY WAY TO LOSE WEIGHT…then what is the problem? Clearly, those of us who have had surgery will tell you that there is nothing easy about surgery, but work with me here.

If we follow the logic through to its conclusion, then the argument looks something like this.

• People want to lose weight fast.
• People don’t want to work hard to lose weight.
• People want to find the easiest, fastest way to get thin.
• People believe that weight loss surgery is a fast and easy way to get thin.
• People say that weight loss surgery is cheating because it’s taking the easy way out.
• ERGO: Losing weight the fast and easy way is good, unless you do it the fast and easy way by having surgery.

My head hurts, and Dr. Oz isn’t helping.

Let me end with this: I am considered by many to be a fraud; a weight loss pariah. But, I’m okay with that. Wanna know why? Because, I’m the one that has to wear my skin and move my body and feed my stomach. No one else can do that for me. Ultimately, I made the choice I believed was best for my health; I chose gastric bypass surgery and I’m proud of it.

Come to think of it…”Weight Loss Barbie” doesn’t sound nearly as catchy as “Gastric Bypass Barbie”…

DISCLAIMER: I don’t hold Diane even REMOTELY responsible for Dr. Oz’s views on WLS. As a matter of fact, she has been a very vocal supporter of mine, and I KNOW she doesn’t share his opinions. Diane: YOU ROCKED THAT SHOW!

Reason to Fear or Reason to Fight?

A few weeks back on BariatricEating.com, I read an article which user KenM had posted back in August of 2007. It featured an extract from a discussion thread which had recently appeared on a listserv. After reading the posting (and subsequent discussion), I remember feeling a little freaked out by the content. I decided to mull it over and write something when I was good and ready. Apparently, I am good and ready now, so let me begin by framing the discussion:

The following text is edited down from an edited down version of a much longer thread that appeared on forums.aedweb.org. I have excised everything except the part written by Dr. Michael Myers, an obesity specialist from Cypress California who runs weight.com, (a site targeted to obesity, weight management, eating disorders and related topics.)

With that said, let me present the information for your review, and then I will make some observations. I’m sorry it is pretty long, but it is chock full ‘o startling, disarming and even scary stuff, which I think we should be aware of — but not fear!

BEGIN DISCUSSION THREAD:

Subject: Review of long-term effectiveness of dieting

After reading the [referenced] article, I was disturbed by the apparent bias evidenced by the arbitrary separation of weight management into subsets of diet, exercise, and behavior/lifestyle interventions.

Obesity is a chronic, relapsing, incurable neurobiological and neuroendocrine disorder. As with anorexia nervosa and bipolar affective disorder, society is biased and incorrectly assumes that obesity is a volitional disorder, about as far from the reality as one can get. Once the obese state is established, the body vigorously defends the new higher body weight with changes in hunger and satiety. Additionally, there is a constellation of changes present in multiple organ systems affecting substrate oxidation to muscle energy efficiency. For example, in the post-obese state, there is an increase in the chemomechanically efficient isoform of the myosin heavy chain in muscle, resulting in increased efficiency and decreased energy requirements of skeletal muscles. Genetic characteristics of the obese include decreased metabolic flexibility, resulting in reduced ability to oxidize the fat that is so pervasive in our besigenic society.

Is there any wonder a short-term diet is not going to succeed?

Long-term dietary change, along with lifestyle and behavior modifications including stimulus control, self-monitoring, cognitive restructuring, stress management, contingency management, and physical activity, are the cornerstones of modern weight management. To arbitrarily eliminate any component is akin to only partially managing the condition. Unfortunately, all of these components require a substantial cognitive effort to overcome the biology of obesity. Maintaining this effort is difficult and lapses are bound to occur. Biology will frequently win battles along the way, but long-term success can be achieved.

Finally, there was a mention of surgical treatment of obesity. The current “gold standard” is the Roux-en-Y Gastric Bypass. Contrary to popular belief, its efficacy resides not in malabsorption of calories, but in its effect on the sympathetic and parasympathetic nervous system and changes in several gastrointestinal hormones including ghrelin, GLP-1, and PYY. In other words, a surgical procedure is inducing an endocrine change that may, one day, be accomplished by a pill and which may help overcome the biology of obesity. Thus, a short-term diet without long-term dietary and other changes will result in close to zero long-term effectiveness. This, however, should not be misconstrued as evidence that integrated, long-term weight management will not be successful in the long-term.

END THREAD

Barbie’s Observations

Diet, Exercise OR Lifestyle?

It IS crazy to think we can maintain our weight loss by just focusing on ONE aspect of the trifecta (diet, exercise, OR behavior/lifestyle modification), but then, what messages bombard us everyday in our cars and on our couches?

• Take this little pill and lose all the weight you want without diet or exercise!
• Drop the pounds while you sleep!
• Use our exercise machine and lose inches fast without dieting!
• Have the LAP BAND surgery in one hour and never watch your weight again!

If there’s one thing I’ve learned in my bariatric after life, you cannot focus on one piece of the sugar free pie and ignore the other two. It is abundantly clear to me that I will never maintain my 170lb weight loss if I don’t strike the proper balance of healthy eating, regular exercise, and DAILY support. It’s black and white to me, and I can’t imagine how anyone could think differently.

The Truth About Obesity

Obesity is chronic, relapsing and incurable. Well, isn’t that just the best news you’ve heard all day?

Doctor to Patient: I have some good news and some bad news: The good news is, I can help you lose a bunch of weight. The bad news is, it won’t be permanent, and you’ll probably gain it all back — and more.

That’s either a bad joke (or a Jenny Craig commercial.) Are you KIDDING me? You mean you’ll operate on me, completely reroute my plumbing, make my stomach 1 oz., tell me to eat slowly for the rest of my life — and then tell me I’ll most likely get fat again, and there’s little I can do about it??? It would be really easy to latch onto that news and assume the defeatist position that I’m just doomed, but, being the defiant girl that I am, I refuse to take “fat” for an answer.

Damn biology! Damn genetics! Damn chemistry!

Contract Terms

Short Term Investment + Diet = Bad
Long Term Commitment + Dietary Change = Success

We all remember what happened when we hit maintenance in the past. We got our gold star and promptly stopped going to meetings and following the plan. We sabotaged ourselves by returning to our old ways. Why? Because we were never committed to long-term success. We were focused on the short-term results, and that’s exactly what we got. We wanted to be Valerie Bertinelli, but ended up being Kirstie Ally.

Is WLS Even an Option?
On the one hand, surgery is a permanent commitment (once you plumbing is rerouted, you can never go back (and don’t argue with me about “revision” or “bariatric reversal” or whatever. You’re NEVER the same.) So, anyone that thinks the LAP band is a great idea because it’s “not so invasive” or “is reversible” or whatever is mistaken. You’re having surgery, your body gets altered/modified, and you’re in for the long-haul. This ain’t not quickie wedding in Vegas followed by a Mexico divorce. This is “Will you still need me? Will you still feed me? When I’m 64?” Yes, poppet, surgery is a Permanent Commitment. BUT, surgery is just the beginning. After all, you’re asleep for the operation! The true commitment happens AFTER you wake-up — and every day you wake up after that.

I’ve said it before: This surgery will NOT cure obesity. The article above confirms it. But it also says something vastly more important (and this is where I choose to focus my energy): “…a short-term diet without long-term dietary and other changes will result in close to zero long-term effectiveness. [But this] should not be misconstrued as evidence that integrated, long-term weight management will not be successful in the long-term.”

In other words: We are not a foregone conclusion, and we are not sentenced to return to a life of morbid obesity. It is (largely) in our hands. We have the power to control our weight loss destiny — as long as we remember to keep all three aspects of our lives in balance. Remember this formula for success (yes, there WILL be a test, and it will be pass or fail!):

Healthy Diet + Regular Exercise + Daily Support = Long Term Success.

Any questions?

CONTACT DR. MYERS
***************************************
Michael D. Myers M.D. Inc.
3801 Katella Avenue, Suite 301
Los Alamitos, CA (U.S.) 90720
Web Site http://www.weight.com
Michael Myers mmyersmd@weight.com
****************************************

Source: Read original article here

OBESITY IN THE NEWS:
Plate Weighing Scales to Help Tackle Child Obesity

(Yahoo! Singapore News)

PARIS (AFP) – – A new device aimed at discouraging eaters from bolting their food is a useful tool in combatting childhood obesity, according to a study published online on Wednesday by the British Medical Journal (BMJ).

Doctors carried out an 18-month assessment of a small computer-linked scale called a Mandometer, which has been developed by scientists at Sweden’s Karolinska Institute. The gadget entails an electronic scale which sits underneath the diner’s plate, weighing the remaining food as the meal is consumed. (Note: The woman in the picture seems to be receiving treatment for anorexia — NOT obesity!)

Sitting next to it, on the table, is a small screen which shows a graph indicating the rate at which the food is being eaten. This line is matched against an ideal graph for consumption, as programmed by a food therapist. Too much deviation from the “ideal” graph prompts the computer to make a spoken request for the eater to slow down. The idea is to train overweight people to eat less and more slowly, thus helping them to feel satiated. Researchers at Bristol Royal Hospital for Children and the University of Bristol in western England carried out a test among 106 patients aged between nine and 17 years. All were clinically obese, meaning they had a body mass index (BMI) of 30 or more. BMI is determined by one’s weight in kilos divided by one’s height, in metres, squared. Some of the volunteers were trained on using the Mandometer, while the others were given standard anti-obesity care. Both groups were encouraged to raise their levels of physical exercise to 60 minutes a day and follow a healthy diet. A year later, the Mandometer group had fallen 2.1 points in BMI on average, around triple that of counterparts in the “standard care” group. This improvement was maintained when the investigators carried out a follow-up test at the 18-month mark.

Portion sizes among the Mandometer group were also somewhat smaller by the end of the study, falling by 45 grammes (one and a half ounces). The volunteers’ speed of eating had reduced by 11 percent, whereas it accelerated by four percent in the other group. Levels of “good cholesterol” were also much better in the Mandometer group.

The authors, led by Julian Hamilton-Shield, say the Mandometer is a “useful adjunct” in treating obesity among adolescents, a health area where the options outside the use of drugs are few, and call for further tests. They point out, though, that Mandometer was not a “stand-alone” device in the experiment, as it was used hand-in-hand with education about nutrition and encouragement to do exercise.

COMMENTS:

My initial reaction to the title of the article and brief synopsis was abject horror (which is, I believe the intended response). How could you even consider connecting an innocent little child to a medieval torture device in the name of behavioral modification? How could it ever be deemed appropriate to subject a kid to outright food policing, simply by attaching a happy little video screen to it and calling it a game?

And then I read the rest of the article, and I realized that, while it does seem extreme, the idea behind the Mandometer is sound: If you can teach a child how to eat proper portions — and do it slowly — he/she will lose weight — AS LONG AS you combine this tool with education about nutrition and encouragement to exercise. What’s so wrong with that?

Let me share an anecdotal tale that just might put this into perspective:

When my daughter was in 3rd grade, her performance in school suddenly took a horrible turn for the worst — it took a nosedive, actually — and we were completely panicked. Evidently, there was something going on in Hannah’s head that we didn’t understand, and no amount of behavioral modification would help. Fortunately, our HMO insurance covered a doctor who specialized in diagnosing and treating things like ADD, ADHD, Dyslexia and Aspberger’s, so we were able to get some professional help. As it turned out, Hannah not only had ADHD (she scored something like 9 out of 10 on the list of things that are present in a person with ADHD!) — she also suffered from benign rolandic epilepsy, which is a nefarious little disorder that causes absence and black out seizures. In most cases, the patient outgrows the condition during puberty, and the seizures stop. While we are thankful that the disorder resolved (as predicted), I am sad to say, the damage to her psyche was done, so her confidence in her ability to learn was shot. Combine this with ADHD and you’ve got a recipe for disaster.

Never fear! This tale does not end there….Enter: Drake Institute — a center that specializes in the non-drug treatment of ADHD through brain conditioning. We learned about this place from advertisements on Dr. Laura’s radio show and scheduled an orientation with the doctor. So, how exactly is drug-free treatment accomplished? Why, by hooking the patient up to a video game and asking them to control the outcomes by affecting a certain BEHAVIOR. Hey, that sounds amazingly similar to the Mandometer! In Hannah’s case, it took about 4 months for her to train her brain to overcome the static caused by the benign rolandic epilepsy and ADHD and she suddenly understood what it felt like to focus — and succeed at studying.

Unfortunately, that is not where the story ends…as with the Mandometer, the machine’s efficacy was only as good as the continued implementation of new behaviors (modification). Thus, the minute Hannah STOPPED using the methods she’d been taught to focus, she stopped FOCUSING! It’s the same thing with that Mandometer — the minute the kids STOP eating well and exercising, they regain their weight!

And, isn’t that true for us WLSers? Haven’t we learned that the surgery is only a TOOL and NOT a cure for obesity??? A clever person might equate gastric bypass surgery with the Mandometer, if they really wanted to

Why? Because, as a person living a successful — though tenuous — bariatric after life, I can clearly see the connection between the implementation of a useful tool and the continuation of behaviors learned from using that tool. In other words, if I eat too much, too fast, for too long, it directly follows that I will sabotage my weight loss tool and regain my weight. If I stop exercising (or don’t do enough of it), it follows that I will regain my weight. If I stop attending support group meetings (and participating in online community forums), it follows that I will regain my weight.

Thus:  Behavior = Outcome

So, in the case of this article and the Mandometer, I think it’s pretty clear: Using a plate weighing scale to teach obese children how to eat correctly might seem draconian, but then, so does hooking your kid up to a video game with a bunch of wires so she can overcome ADHD, or, having surgery to overcome obesity.
Just something to think about….

By the way, an interesting aside: Though this article was written in Paris, the Mandometer IS actually being used in the US and was featured on CNN!

Mandometer Clinic USA in San Diego, CA

Now what do you say?

Radio Interview on WLVJ

Just wanted to invite you to tune in this Friday, October 2nd to hear my interview on WLVJ.

The station is based in South Florida, but is also broadcast over the web:

CLICK THE LISTEN LIVE LINK
or go here:
http://www.jamescrystalholdings.com/wlvj/

If you are on the West Coast (PDT), listen from 8 AM – 9 AM.
If you happen to be on the East Coast (EDT) that day, listen from 11AM – Noon.
If you end up being somewhere in the middle, you’ll need to do the math

I was invited to be on the HEALTHLINE radio program to talk about my weight loss journey, discuss my eating and exercise program and explain my current daily supplement regimen. I think we all know how critical this stuff is to living a successful bariatric after life, and I’m hoping my little “interview” will enlighten a lot of people out there who might be struggling with their own post-op journey. Maybe more importantly than even that? I want to straighten out anyone who still thinks obese people are lazy and surgery is the easy way out!

I hope you will tune in and give it a listen. It should be a good program, filled with good advice from the doctors who co-host the program. I am the first bariatric patient ever to be interviewed on their program, so I’m either gonna be a trailblazer (or a bridge burner — LOL) Let’s hope for the former!

Wish me luck!

Fitness Grants for Fatties:

Yeah, but would you take them up on the offer…?

In the news, Elgin (the fattest city in Illinois) is offering “Fitness Grants” to fat people as encouragement to battle their bulge. Not surprisingly, there aren’t many “takers,” but here are the program details:

Funding Opportunities

Activate Elgin, in partnership with the Kane County Health Department Fit for Kids initiative, is offering grant money to individual schools, businesses, community and neighborhood groups, and faith-based organizations throughout the Elgin area to encourage involvement in creating and/or implementing wellness programs. Application for mini-grants can be found by clicking the links below. In addition to the application form, you will also find a list of resources and suggestions to help you in planning your project. It is necessary to fill out all pages of the application. There are 48 total awards available, 12 in each of 4 sectors, and each organization may apply for up to $1,000 in funding in each sector. If you have questions about filling out the grant application or the award process, please contact Melissa Serritella, Activate Elgin Coordinator, at mserritella@elginymca.org. Completed forms may be submitted electronically to mserritella@elginymca.org; by fax, at (847)888-8152, Attn: Activate Elgin; or by mail, addressed to Activate Elgin: 50 N McLean Boulevard, Elgin, IL 60123.

So, I clicked the link to the “Worksite Application” because I wanted to learn more about the program criteria. I was curious to see if there would be mandatory weigh-ins or BMI formulations, but there weren’t. It’s basically a pretty straightforward process where you have a team organizer who is responsible for outlining the program and indicating how program compliance (and progress) will be measured. Hmmm…

Here’s what it says on the application:

• The qualifying organization must be able to show proof of program planning or implementation within the first month of the grant period and must hold at least one planning meeting per month.
• Applicant must designate a point-person, responsible for reporting progress.
• Organization must be willing to share best practices with other organizations.

There’s a spot on the form to state your particular need, describe the program, indicate the number of people who will be reached, show a program budget (for expenses like staff training, books/media, equipment/supplies), explain communication (advertising, sharing info, flyers), then evaluate how program success will be measured.

They even give ideas for programs that you might want to implement:

• Monthly lunch and learn sessions (grant pays for food, materials and trainers)
• Walking Club
• Healthy cooking workshops
• Discounted memberships to local gyms and fitness clubs
• Biggest Loser type challenge
• Working with food suppliers to promote “healthy snacks” in the cafeteria and vending machines
• Family picnic with healthy food options and activities that promote fitness (obstacle courses, bounce house, relay races, family fun run).
• Free cholesterol, blood pressure and glucose screenings
• Softball, bowling or volley ball team
• Smoking Cessation classes
• Healthy prizes and incentives for reaching goals and attending wellness events
• Posters, pamphlets, and small consumable supplies, like pedometers, strength bands and hand weights to help promote life-long physical activity habits.

When I first read the title for the article, I was suspicious, and thought it was just another governmental bureaucracy that would be based on bogus stats (like BMI ratings.) But, after reading it further, I realize that, while it could just be a boondoggle for people who want “free money,” I think it has the potential for being a great program that could help a lot of people. Unfortunately, you don’t become the “fattest city in Illinois” by being fitness conscious and health-motivated.

It’s interesting how differently I look at things, now that I’m on the “other side of the scale.” I would actually LOVE to be the one to organize something like this for my church. Now, if I can only figure out a way to get Chicago to fund my Southern California program…

Source: Chicago Area Local News: Elgin Declared Fattest City in Illinois

Life-changing surgery:

The decision to undergo gastric bypass

or banding doesn’t come easily

A recent article in the Central Illinois Herald and Review (Aug 2 ‘09) does an awesome job of explaining why WLS isn’t for everybody, isn’t the easy way out, and requires a deep level of commitment from anyone considering it.

Here are some of the most salient points from the article:

• “[They] would prefer everybody not to have surgery, [but instead] to exercise and lose weight.”
• “Those who experience success with bariatric surgery are highly motivated and must be willing to commit to the lifestyle changes the procedures necessitate.”
• “A lot of people come in without a doctor’s recommendation, so patients who seem to be looking for a quick fix are screened out.”
• “Bariatric surgery is not the easy way out.”
• “Surgery is not the first option.”
• “The problem is not losing the weight, the problem is keeping the weight off.”
• “…experts warned that surgery is not for everyone.”
• “Just because somebody is obese and wants surgery is not a criteria to do surgery. You really have to show consistent efforts and convince me, the insurance company and my team that you are willing to commit to this kind of surgery.”
• “Some patients who’ve had full-blown addictions to food get other addictions, so participation in a support group is highly recommended after surgery.”

It’s refreshing to see all of this in print because, as all of us post-ops know, surgery ISN’T for everyone, not everyone will succeed, and it is probably the hardest thing we will ever do in our lives. Period. If more people understood these very simple facts, then maybe those “Lap Band for Lunch” centers would have to close up shop and stop promoting WLS as a permanent fix to a very big problem. It’s just unconscionable that people can make money by irresponsibly perpetuating blatant lies about the realities of the gastric bypass/gastric banding after life. Then again, isn’t that what weight loss programs like Nutri-System, Jenny Craig and Weight Watchers do all day, every day? They peddle the dream, people buy it, and there’s no return policy at the end.

But, let me step down off my soap box for a moment and share a bright spot in the article. This one really made me smile, because I totally know the feeling!

One of the patients interviewed for the article reported that before her surgery, she was at beauty salon and overheard some women discussing gastric bypass surgery. She was stunned that they had had the surgery, because there was no indication that they had ever been obese.

“When you meet somebody that’s tiny like that, you just assume they’ve always been that way,”

Amen, sister. May we always remember where we came from, but never forget how hard we’ve worked to get where we are.

This is a touchy subject. On the one hand, everyone is entitled to prompt and reliable ambulatory care. On the other hand, I have to question if it is the taxpayers’ responsibility to fund the required heavy-duty equipment.

Clearly, it is embarrassing for an MO person to “put themselves out there” by calling for emergency services, especially when they are non-ambulatory without heroic aid and effort, but, I’m guessing it’s also embarrassing for the paramedic responders who have to “find creative solutions” to transport these big patients.  I mean, the MO individual probably feels like a beached whale, and the responders probably feel like using a crane and hammock to move the patient is denigrating. Clearly, there are NO winners with obesity. Not the patient; not caregivers and loved ones; not healthcare providers, and apparently, not taxpayers.

We’re way past assigning blame, so what is the solution? Read the article and feel free to comment. This issue is fraught with emotion, there’s no doubt about it. — Barbie

Midlands Ambulance Crews Strain to Help Obese Patients

By Michael O’Connor
WORLD-HERALD STAFF WRITER

Full Article

Four-hundred-, 600- and even 800-pound patients are presenting ambulance crews with some big challenges. As obesity rates rise, paramedics in Nebraska and Iowa are faced with carrying more obese patients. In turn, paramedics find creative ways to move them, and some fire departments are looking to borrow or buy specialized equipment.
Lincoln Fire & Rescue, for example, is considering putting a construction crane and a forklift on call for patients who are too big to get out a door or down steps. Firefighters had to use a tarp to haul an 800-pound patient a few years ago.

It’s another example of how obesity can strain the health care system, whether that’s hospitals or ambulance crews. The Nebraska Medical Center in Omaha in recent years has purchased heavy-duty beds and wheelchairs for obese patients.

Adult obesity rates in Nebraska and Iowa have been rising.

In 2008, about 27 percent of the population in the two states was obese. That’s up from 23 percent in Nebraska and 24 percent in Iowa in 2005, according to a report by Trust for America’s Health, a nonprofit group that focuses on preventive health.

Lloyd Rupp, a battalion chief in the Omaha Fire Department, said his crews encounter a 400-pound-plus patient every several days. Five to 10 years ago, crews would run into such patients every couple of weeks.

Paramedics in Omaha, Sioux City, Iowa, and elsewhere occasionally must call in an extra crew to help carry big patients, particularly up or down steps. Fire departments emphasized that even though large patients can be tougher to move, they are treated with the same respect as other patients. When paramedics don’t have specialized equipment, they have to improvise.
“That is the trademark of firefighters,” said Pat Borer, deputy chief of the Lincoln department. “They are resourceful.”

Bill Lundy, volunteer captain with the York (Neb.) Fire Department, remembers a call several years ago involving a man who had suffered a heart attack in his basement apartment. The man weighed more than 350 pounds, and there wasn’t enough room to get him and the stretcher up the basement stairs. There was also concern about whether the staircase could support the man and the firefighters carrying him.

Firefighters unhinged an interior door, put the man on it and slid it through a basement window. Wendee Brown, an Omaha fire captain, said big patients often apologize for their size. “They are embarrassed,” she said. “You feel bad for them.” Moving big patients is tricky, she said. It’s hard to get your arms around an obese patient, making it difficult to get leverage. If a patient is weak or unconscious, it’s even harder.

A few years ago, a woman weighing more than 600 pounds who was dehydrated and weak had fallen out of a chair. Firefighters couldn’t lift her onto a stretcher, so they used a backboard, which is normally used for people with neck or spine injuries.

Brown said firefighters rolled the woman onto her side and slid the board under her. They lifted the board onto the stretcher, then slid the board out. Borer, the Lincoln fire official, said that several years ago crews used a 16-by-16-foot canvas tarp from a firetruck to move a patient who weighed more than 800 pounds. Firefighters rolled up the tarp edges to create handles and slid the tarp under the person. An extra crew was called in to help, and it took about 10 firefighters to carry the person to the ambulance.

Standard response in Omaha for a medical call is an ambulance and a firetruck, with a combined crew of six members. Rupp said that a couple times a year an additional truck with four firefighters will be called to help when a patient weighs more than 500 pounds and must be carried up or down steps.

Omaha might purchase a special ambulance to make it easier to transport obese patients. The ambulance would be used for all patients, not just those who are obese.

A standard ambulance costs $190,000 to $200,000. Omaha is considering paying $15,000 to $20,000 more for one that comes with, along with a winch, a reinforced floor and a bigger patient compartment. Rupp said the ambulance would be purchased when an existing ambulance must be replaced.

Some fire departments are considering purchasing heavy-duty stretchers, which can come with hydraulic lifts.

The Council Bluffs Fire Department purchased one four years ago. The stretcher can hold up to 1,600 pounds, compared with the standard 700 pounds, and is 29 inches wide instead of 23 inches.

The department uses it for patients who are 400-pounds-plus, and it’s getting more use lately— once or twice per month instead of every other month, said Rick Benson, a division chief in the department.
Contact the writer: 444-1122, michael.oconnor@owh.com

Copyright ©2009 Omaha World-Herald®. All rights reserved. This material may not be published, broadcast, rewritten, displayed or redistributed for any purpose without permission from the Omaha World-Herald.

Should We Impose a Fat Tax to Pay for Healthcare?

So, I read this article in the LA Times today, and couldn’t really decide how I felt about the concept. I mean, now that I’m no longer obese, and do not eat the types of things they are talking about taxing, why should I care? It’s the same as the “sin tax” on cigarettes. I used to smoke (20+ years ago), but you know what they say, there’s nothing WORSE than an ex-smoker! I hate it when people smoke by the exit door of my office building, on the streets, or even in their cars! But, should they be taxed more?

Is it fair to tax them more for what *we* deem is a “sin”? And, if so, is it then fair to go down that slippery slope and tax fattening food for fatties? Ahhh, but there’s the rub! It’s not just “obese” people who eat the fattening food. So, does that mean we “tax by the pound?” And would the revenue generated by the tax actually go where it’s “earmarked” (i.e., HEALTHCARE COSTS)? Furthermore, who will determine what is a fattening food, and what isn’t? I mean, salad dressing is fattening. So are bananas, in quantity.

And while we’re talking about healthcare costs, should obese people pay more, and thin people less? How about smokers? Charge them more, and non-smokers less? Second-hand smokers…? This gets messy in a hurry.

Anyway, read the following article and feel free to comment. It should really make you think (if nothing else!) — Barbie

Tough love for fat people: Tax their food to pay for healthcare
2:33 PM, July 27, 2009
When historians look back to identify the pivotal moments in the nation’s struggle against obesity, they might point to the current period as the moment when those who influenced opinion and made public policy decided it was time to take the gloves off.

As evidence of this new “get-tough” strategy on obesity, they may well cite a study released today by the Urban Institute titled “Reducing Obesity: Policy Strategies From the Tobacco Wars.”

In the debate over healthcare reform, the added cost of caring for patients with obesity-related diseases has become a common refrain: most recent is the cost-of-obesity study, also released today by the Centers for Disease Control and Prevention. It finds that as obesity rates increased from 18.3% of Americans in 1998 to 25% in 2006, the cost of providing treatment for those patients’ weight-driven problems increased healthcare spending by $40 billion a year.

If you happen to be the 1-in-3 Americans who is neither obese nor overweight (and, thus, considered at risk of becoming obese), you might well conclude that the habits of the remaining two-thirds of Americans are costing you, big time. U.S. life expectancies are expected to slide backward, after years of marching upward. (But that’s their statistical problem: Yours is how to make them stop costing you all that extra money because they are presumably making poor choices in their food consumption.)

“Facing the serious consequences of an uncontrolled obesity epidemic, America’s state and federal policy makers may need to consider interventions every bit as forceful as those that succeeded in cutting adult tobacco use by more than 50%,” the Urban Institute report says. It took awhile — almost 50 years from the first surgeon general’s report on tobacco in 1964 — to drive smoking down. But in many ways, the drumbeat of scientific evidence and the growing cultural stigma against obesity already are well underway — as any parent who has tried to bring birthday cupcakes into her child’s classroom certainly knows.

Key among the “interventions” the report weighs is that of imposing an excise or sales tax on fattening foods. That, says the report, could be expected to lower consumption of those foods. But it would also generate revenues that could be used to extend health insurance coverage to the uninsured and under-insured, and perhaps to fund campaigns intended to make healthy foods more widely available to, say, low-income Americans and to encourage exercise and healthy eating habits.

If anti-tobacco campaigns are to be the model, those sales taxes could be hefty: The World Health Organization has recommended that tobacco taxes should represent between two-thirds and three-quarters of the cost of, say, a package of cigarettes; a 2004 report prepared for the Department of Agriculture suggested that, for “sinful-food” taxes to change the way people eat, they may need to equal at least 10% to 30% of the cost of the food.

And although 40 U.S. states now impose modest extra sales taxes on soft drinks and a few snack items, the Urban Institute report suggests that a truly forceful “intervention” — one that would drive down the consumption of fattening foods and, presumably, prevent or reverse obesity — would have to target pretty much all the fattening and nutritionally empty stuff we eat: “With a more narrowly targeted tax, consumers could simply substitute one fattening food or beverage for another,” the reports says.

Of course, the United States also would have to adopt extensive menu- and food-labeling changes that would make “good foods” easily distinguishable from the bad ones subject to added taxes. Not to worry though: Several European countries, most notably Great Britain, have led the way in this area.

And here’s the payoff: Conservatively estimated, a 10% tax levied on foods that would be defined as “less healthy” by a national standard adopted recently in Great Britain could yield $240 billion in its first five years and $522 billion over 10 years of implementation — if it were to begin in October 2010. If lawmakers instituted a program of tax subsidies to encourage the purchase of fresh and processed fruits and vegetables, the added revenue would still be $356 billion over 10 years.

That would pay for a lot of healthcare reform, which some have estimated will cost as much as $1 trillion to implement over the next ten years.

There can be little doubt that lobbyists for the food, restaurant and grocery industries would come out swinging on any of these proposals. But the report cites evidence of a turning political tide for proposals that would hold the obese and other consumers of nutritionally suspect food accountable for their choices. A recent national poll found that 53% of Americans said they favored an increased tax on sodas and sugary soft drinks to help pay for healthcare reform. And even among those who opposed such an idea, 63% switched and said they’d favor such a tax if it “would raise money for health-care reform while also tackling the problems that stem from being overweight.”
– Melissa Healy

UPDATE: I got this email/video response from newsy.com and feel it’s worthwhile reading/viewing:

I read your recent post about “sin taxes” on fatty foods, which featured
your commentary, along with an article that compares fatty foods to
tobacco. In your post, you make a compelling point about how sin taxes can
lead to over-regulation in the name of the public interest.

It uses news coverage from multiple sources to examine the intersection
between America’s obesity problem and healthcare reform.

The video includes research from medical professionals and policy experts
to look at how our expanding waistlines affect medical costs. It uses this
information to scrutinize what role the government should adopt when
safeguarding the public good comes in conflict with individual rights.

http://online.wsj.com/article/SB124869340217883455.html

10% of Medical Spending Due to Obesity, Report Says.

I may not have wanted to hear it when I was obese, but let me tell you, this is just one MORE reason to cheer for my new, healthy body! I haven’t had a sick day in a year — and I used to get sick at least 4x per year, so I can see where this study is accurate.

Anyway, read the article and feel free to comment! — I’ve reprinted the whole article here, just in case the URL develops link rot at some point along the way

WASHINGTON — New research shows medical spending averages $1,400 more a year for an obese person than for someone who’s normal weight.

Overall obesity-related health spending reaches $147 billion, double what it was nearly a decade ago, says the study published Monday by the journal Health Affairs.

The higher expense reflects the costs of treating diabetes, heart disease and other ailments far more common for the overweight, concluded the study by government scientists and the nonprofit research group RTI International.

RTI health economist Eric Finkelstein offers a blunt message for lawmakers trying to revamp the health-care system: “Unless you address obesity, you’re never going to address rising health-care costs.”

Obesity-related conditions now account for 9.1% of all medical spending, up from 6.5% in 1998, the study concluded.

Health economists have long warned that obesity is a driving force behind the rise in health spending. For example, diabetes costs the nation $190 billion a year to treat, and excess weight is the single biggest risk factor for developing diabetes. Moreover, obese diabetics are the hardest to treat, with higher rates of foot ulcers and amputations, among other things.

The new study’s look at per-capita spending may offer a shock to the wallets of people who haven’t yet heeded straight health warnings.

“Health care costs are dramatically higher for people who are obese and it doesn’t have to be that way,” said Jeff Levi of the nonprofit Trust for America’s Health, who wasn’t involved in the new research.

“We have ways of changing behavior and changing those health outcomes so that we don’t have to deal with the medical consequences of obesity,” added Mr. Levi, who advocates community-based programs that promote physical activity and better nutrition.

About a third of adult Americans are obese, and the obesity rate rose 37% between 1998 and 2006, the years covered by Monday’s study.

Prescription drugs for obesity-related illnesses account for much of the rise in spending. Medicare spends about $600 more per year on prescriptions for an obese beneficiary than a normal-weight one, the study found.

Copyright © 2009 Associated Press