Solve the obesity crisis to ensure our country’s financial stability

If I was Surgeon General, I would follow the lead of our country’s first Mom.

This is serious folks.

We, as an American society, need to solve the obesity crisis.  Not just for our physical health, but for our country’s financial stability.

Reducing the spiraling costs of health care is wanted by all.  So far, prevention of the diseases which contribute most to our health care costs, (heart disease, cancer and orthopedic issues, to name just a few) has been given only lip service, by our future supplier of health care–the American government.

It turns out that the mechanisms to reduce our most costly ailments are the same as those that mitigate obesity. It is like simple math. (If a=b, and b=c, than a=c.)  If lifestyle choices reduce obesity, and less obesity means less consumption of health care for heart disease and cancer, than better lifestyle choices means less health care consumption.  Bunches less.   (See, simple math was not so useless.)   It is for this reason, that I believe the most productive way to reduce health care expenditures is to reduce obesity.

Right now, the government and third-party payers are using other means to wrestle the rising costs of health care.  Dr Berwick and his like-minded academics from cocoons like Cambridge plan to reduce costs by rationing care.  Presently, we have the increasingly used covert rationing techniques, like using “doctors in cubicles” who, without seeing the patient, deny tests and procedures.   But soon, there will be no way to avoid overt rationing.   Others think that reducing doctors’ compensation will reduce costs. It will, but the price of this strategy will be reducing access to care for the majority–the VA, Great Britain and Canada are illustrative examples.

My vision is that we can conquer the obesity epidemic.  Doing so will improve our country’s health, productivity and likely lead us out of the health care morass.

Here are a few components of my plan…

First, some important assumptions:

  • High calorie food and drink are not going away.  Fast-food restaurants with drive-thrus are here to stay.  Coke, Pepsi and the infinite concoctions of sweetened fluids are staying as well. Very easy access to high-calorie inexpensive food is a certainty in the future.
  • Automation in the work place will continue to make it more difficult to burn calories at work.  The professor and the judge are right about this.
  • We will continue our evolution into a car-dominated society.  Outside of the unusual places where vegetarians and granola-munching dominate, like Boulder and Bend, it will become increasingly harder to navigate by foot or bike.
  • Society is unlikely to tax junk food like we do for cigarettes.  Although, the benefits of financially discouraging junk food consumption seems obvious, implementing such a tax is implausible and politically untenable.  For example, which foods get labeled junk and which do not, would prove to be a circus.  Baked chips versus regular chips, dark chocolate versus milk chocolate are just two of many vexing examples.  Further, the influence of our snack-food companies, like Coke, Pepsi and Frito-Lay would surely unleash their political fury against such a “regressive” tax, as they would call it.
  • Public education campaigns can work.  As a society we have convinced parents that it is dangerous to lie babies on their backs.  Also, the benefits of eliminating smoking in public places has taken hold even in the heart of a tobacco growing community, Glasgow, KY.  I believe with enough effort, reducing fat-creating behaviors is achievable.

These assumptions provide the background in which we will have to work out solutions.  A multi-prong attack on fatness will be needed.  (Please, feel free to add another prong.)

Prong 1: Hit em early.

Generational change will be needed.  As such, changing fat-creating behaviors needs to start early.  Pediatric leaders will need to make obesity education and treatment as high a priority as vaccinations.  Excessive calorie intake needs to be targeted at a young age, like measles mumps and other infectious diseases. Surely, obesity is worse than pink eye.  For example, kids naturally stop eating when they are full–this behavior needs to be carried forward, aggressively.

Prong 2: Educational reform.

Educational leaders need to passionately move forward in teaching children about the new world of available calories and challenges to finding places and time for exercise.  No longer should lip-service be paid to gym and nutrition classes.  Physical education should morph into exercise time.  Invoking the excuse that there is not enough time in a school day for exercise needs to be banished.  Oodles of data show that exercise actually enhances learning.  Junk food should be removed from schools.  There is plenty of room for fame and fortune for those who can make inroads here.  Maybe even a Nobel prize.

Prong 3: In treating obesity, adult doctors are guilty of passivity.

Simply saying to a patient, “try and lose weight,” is woefully inadequate.  Adult doctors need to be much more aggressive in their approach to fatness.  A high BMI is a high BMI. It is hard data that should be frankly discussed, like blood pressure, blood sugar and testosterone levels.  And, I am not just talking about Kentucky-level obesity, even “bike-jersey” fatness needs to be discussed.  Are you fat?  Put a bike jersey on and look in the mirror.  The answer will be obvious.

Lowering the threshold of discussing fatness is critically important, as catching any disease in its early stages makes therapy easier.  Obesity is no exception.

Prong 4: A massive public-service campaign needs to emerge.

So far, we have the pediatricians, educators and adult doctors on board.  Now we need the government.  Give the rationing a break for a moment, and let’s work on preventing the diseases which really impact our medical system. With the fury of the “got Milk” campaign, government needs to convince Americans (especially in places like Manchester, KY) that drinking sugary drinks, eating fat-laden snack foods and not finding a place and time each day to exercise is as bad as placing a baby on her back at night. “You don’t exercise?…Holy cow, that’s bad,” should be our country’s new mind-set.

Here would be one slogan,  “Exercise every day you eat!”

Prong 5: Reward objective evidence of wellness and fitness.

Although it would be controversial, it seems self-evident that thinness and fitness should be rewarded.  Twenty years ago, I remember that the sponsor of the Indy half-marathon–an insurance company–offered a discount for those that ran a certain time.  Drastic times call for drastic measures, and so it seems that those with normal BMI’s should pay less.  Sorry if this sounds prejudicial or caustic, but incentives are an important motivator, and none better than money.

Prong 6: Not finding a place or time for regular exercise needs to be unacceptable.

The message is that we no longer live in a world where kids walk to school and people burn calories at work.  It is a new world, where food is available everywhere. We are not devolving our cities backwards for pedestrian or bike traffic. Therefore, like brushing our teeth and hair are societal norms, so should finding time and a place to exercise.

Implementing such a radical new paradigm will require children.  Children can mold adult behaviors.  They brought us old folks Facebook and texting, so surely they can bring us the new social norm of daily life with exercise.  Our new America will need to look at those that run, ride or walk as the mainstream rather than the fringe.

Business leaders can also help with this new norm.  Forward thinking companies should encourage such a new paradigm.  Many already do.  Our new paradigm of exercise and eating right is good for business as well.

Such a message will take time and persistence, but it is possible.  Isn’t it?

Can we make the “program” the norm?

John Mandrola is a cardiologist who blogs at Dr John M.

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  • http://wellescent.com/health_blog/5_ways_to_limit_rheumatoid_arthritis_pain_without_pain_medication Wellescent Wellness Blog

    Education of children regarding diet and lifestyle is likely the area where the greatest gains can be made as young minds are more readily molded. At the same time, they can take home the messages to their parents. Once people leave school, however, they tend to be more set in their ways and far more effort is required to cause behavioral changes.

    As for getting people out and walking, we really need to make cities walkable for this to happen. We need to make distances to attractions and restaurants shorter. This involves reigning in tax policies that subsidize sprawling suburbs where the only option is to drive to get out and walking around looking at every other cookie cutter house quickly becomes boring. As someone with family living in rural areas, I see that they get out to walk more because it is more appealing to do so. Not everyone wants to go play sports so the key is making walking a part of our daily activities.

  • http://doctorsintraining.com Erin

    I’m with you! I know many other moms who are, too. We are the ones who get concerned looks when out running and swimming at 6 or 7 months pregnant, because we know that what we do and how we eat while pregnant influences genes getting flipped on or off (epigenetics i think it’s called?) to continue that healthy behavior in our baby. we are the moms who don’t withold sweets and junk, but firmly establish them as a “sometimes food” and educate our kids on when “sometimes” is. we are the moms who read, read, read everything we can on new health developments, spend extra for organic, hormone-free milk, fruit and veggies, and spend twice as much time in the store reading labels so we can avoid “corn sugar” (HA! nice try, industry), preservatives, and hydrogenated oils of every kind. i promise, we are out there and we are bringing on the prongs. :)

  • stargirl65

    We need to change the mindset of people.

    I had a patient come in yesterday for bronchitis. We had been trying to get a hold of him for 2 weeks. We called, left messages, and even sent a letter. He needed to come in ASAP as he now has diabetes and also very high TG. He is obese and inactive. He admitted he had received the calls and letter but just didn’t want to come in (until he got sick). Before we discussed anything he said that he refused to change his diet or exercise because he likes his foods and hates exercise.

    How do I get past this? Unfortunately he is NOT an exception to the rule.

  • Finn

    You’ve left out one thing: Ending government subsidies for growing the very crops (eg, corn and soy) that are used to make all those high-sugar, high-fat foods contributing to obesity. If the government wants to subsidize farmers, subsidies should only apply to fruits and vegetables that arrive in supermarkets as fresh or frozen unadulterated produce. I believe people will consume fewer sugary drinks and fatty foods when their prices are not kept artificially low through farm subsidies and price supports.

    One thing to add to prongs 1 & 4: public education campaigns, reinforced by pediatricians, to teach parents not to make their kids clean their plates at meals. Very young children naturally stop eating when they’ve had enough, but by the time they’re 5 or 6, they’ll finish everything in front of them because they’ve been taught that they must. This training to finish everything put in front of us rapidly overrides internal signals to stop eating, to our detriment.

    • gzuckier

      Amen to that. Add to the list cheese, which the NYTimes last month explained was being pushed upon us by the FDA (to the tune of triple the consumption we had in 1970) and is the largest dietary source of saturated fat. They even harangue Domino’s and Pizza Hut into adding more cheese, as if they were short on cheese to begin with.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    What about using cold hard cash? Pay folks for each pound lost with a bonus for maintaining their new wt. And, if the weight comes back, then it’s payback time!

  • jsmith

    Dr. Mandrola’s analysis is simply wrong. The idea that we can save HC costs by reducing obesity or smoking or whatever is intuitively appealing but unproven. If people don’t get sick from obesity, they will get sick from something else-like Alzheimer’s- and need very expensive treatment for that. Moreover, they will live longer, requiring more government assistance. Societies do not save money by making older people healthier. This issue has been looked into. See van Baal et al, Lifetime Medical Costs of Obesity:Prevention No Cure for Lifetime Medical Expenditure, Plos Medicine, 2008.
    I am all in favor of decreasing obesity to improve public health. Public finances will have to be improved by some other means.

    • http://www.twitter.com/alicearobertson Alice

      If people don’t get sick from obesity, they will get sick from something else-like Alzheimer’s- and need very expensive treatment for that. [end quote]

      But recent research on Alzheimers shows it can be glucose related and that exercise both physical and mental (i.e. getting off the TV and reading books, etc.) is very helpful in staving off this disease.

      • jsmith

        And if they don’t get Alzheimer’s they get cancer, or pneumonia, or heart failure or so dang old they need caregivers and then rehab from a hip fracture or whatever.Most people get expensively sick from one thing or another, Alice. No gettin’ around it.
        It’s better to get sick later rather than sooner. It’s just not cheaper.

        • http://Www.twitter.com/alicearobertson Alice

          Gosh….I am stoked….maybe we can regulate a czar who can run a government type of Hemlock Society, and we can all kill ourselves at age 70 and the government can save a bundle on social security, Medicare, etc. *wink*. Hey, maybe Paul Krugman can use that idea to win another Nobel Prize? Ha! Bucket List? Get busy, NOW! :)

  • http://brucesmallsurveys.typepad.com/ Bruce Small

    We have a rule in our house: No TV unless we are exercising (all the exercise equipment faces the big TV). It’s amazing what you can accompish with some common sense, and will power.

    • Anonymous

      Hmmm, do you connect the TV’s power to a bicycle trainer so that it can only be powered by someone on the bicycle on the trainer?

  • SarahW

    Oh good grief. People can handle their own lives and priorities; with regard to food and excercise, Recommendations are fine, and the place of physicians,

    but your obsession with monitoring and controlling other peoples habits for the good of the herd is as disgusting as any fat person ever will be.

    Keep your healthcontrol off my body. (My very slim, very fit body.)

    • gzuckier

      But you’re OK with the never-ending marketing machine monitoring and controlling people’s habits for the people’s detriment, because it’s profitable?

      • SarahW

        Of course I’m fine with persons excercising their own will and judgement. No one is a slave to marketing, except a fool. And fools have a right to be foolish.

        • gzuckier

          Yes, and that foolishness jacks up healthcare costs. for everybody. (among all the other ways it makes life more crummy for everybody, including the nonfoolish).

  • http://www.nashandassociates.com Rachel

    I’m with you on this one!! It’s incredibly frustrating to eat right and exercise to stay healthy only to watch many of the people around me complain about illnesses/problems that are diet related! It’s even more frustrating when patients say things like Stargirl described. You know the fatty food is bad for you and makes you obese and causes diabetes, HTN, etc yet because it tastes good you refuse to take care of yourself?

    I agree that educating the youth is one of the best places to start this war on obesity. However, school lunch programs also have to get on board with this. It’s sending a mixed message when you tell children that fatty/sugary foods are bad yet chicken nuggets and sugary drinks are served for lunch by the school.

    I also love Prong 5! I’m not sure it would actually fly with health insurance companies but it is a great suggestion to at least get the conversation started. It’s infuriating that I pay the same for health insurance when I run regularly and eat my fruits & veggies as the person down the hall who smokes cigarettes and eats fast food for lunch.

  • http://Www.twitter.com/alicearobertson Alice

    I am happy you didn’t encourage more government regulation, and are insightful to understand the problems with Berwick’s romanticized rationing. Maybe the government should ration the crappy food our tax money buys?

    I will say though….I am bothered that one in eight Americans receive food stamps. I read a study that showed irresponsible choices in food are quite high when food stamps are used. I wonder why items like pop are even allowed to be purchased (it causes obesity….wrecks teeth, and it is related to diabetes, wrinkles and I hear it causes wars…ack..not funny…but the other stuff is true:) I know all the arguments about cost (I have six children in a one income household…and I am so thankful we have never had to use government aid….but, surely, the government has caused irresponsibility with no accountability). We see the schools are slowly changing…considering the vast amount of taxpayer money this is good and well. Let’s hope the prisons change to…maybe growing some of their own food (I have wondered why schools don’t do this. What a great, practical hands on project….instead of the whole school gathering a tree being planted).

    Anyhoo…i don’t mind tax money going to the needy, but wonder why there are no restrictions considering …it seems we are helping people eat themselves to death and costly health problems that are often avoidable.

  • labrat

    More of the same failed paradigm? That’s your revolutionary plan?

    There’s nothing new here, I was told to eat right and exercise in school 40 years ago.

    Diet and exercise!

    Diet industry – 40 Billion dollars a year!
    Exercise industry – 25 Billion dolllars a year!

    Scream it louder and shriller – yeah – that’ll work.

  • pcp

    Sorry, there’s no evidence that physician-initiated weight counseling produces any long-term results. I choose to spend my time asking the important questions (Do you wear a helmet when you bike and ski? Do you feel safe in your home? Do you have unsecured area rugs in your living quarters?) that enable me to get rich off P4P programs.

    • jsmith

      Bingo.

      • http://Www.twitter.com/alicearobertson Alice

        Yes, but you gotta quit poking the fat patients! :) . It tickles! Ha!

  • ninguem

    Wow.

    Eliminate obesity and solve our country’s financial state.

    Ethiopia will rule the world.

  • http://www.twitter.com/alicearobertson Alice

    Scream it louder and shriller – yeah – that’ll work.[end quote]

    Even if you are right the message is old..it’s more dire now with diabetes and other diseases being on the rise because we have chosen a fast food, cable TV lifestyle, instead of walking and books. Children are online, cellphones, or video games so much some can’t talk in full sentences.

    The screams will be understood when more doctors like Dr. Oz patiently, though firmly, show patients kindly what their future may be like without drastic change. We have tests today that can tell us what’s floating around our bodies that could possibly kill us.

    The message about burning more calories than we consume may still be the same, but it’s more specific, it’s more personal, it’s profound on that level because it’s more individualized with the use of testing. My father has had strokes in his brain the neurologist says was caused by high cholesterol years ago that went undetected. I don’t know if he would have heeded the medical advice that is given today, but I still think it needs said again and again and again. If one person responds and takes heed….it’s worth it.

  • Brenda

    Although I hate to be characterized as such, I am one of the dreaded “obese”. Out of a family of 10 brothers and sisters, I AM the only one who has had a weight problem. I have dieted and lost, and gained it back. I’m tired of fighting it because everyday I can tell I am losing the battle that I have fought since I was 13. I don’t eat fast food but on occasion, maybe a coke every once in a while, and I don’t sit around eating bags of chips. The insurance companies deny anything that has to do with helping one lose. I can’t afford a personal trainer, and chef but I know I can’t do it myself. The only medication I take is for blood pressure. I’d love to be thin and healthy but apparently it wasn’t in my cards.

  • http://www.drdialogue.com Juliet K. Mavromatis, MD

    Obesity is such a tough problem. Everyone (including me) has an opinion about it. Right or wrong, doctors do a poor job talking to patients about this because we perceive that we’re going to make people feel bad about a condition that society already stigmatizes. It is easier, and perhaps more productive, to talk to patients whose BMI is 25-30–and to help prevent the problem before it occurs. Most public health gurus do believe that obesity is the factor that results in our comparatively higher rates of chronic illness and poorer outcomes related to these conditions (and thus higher healthcare expense). I really believe that it isn’t mostly the content of food that matters, it is access to food. What’s with healthy snacks? Kids need to learn to feel and get through hunger…and “thirst.” Lets start by eliminating all snacks from school and sporting events. But home cooked meals and fresh ingrediants are good. Next, lets tackle portion size. My husband and I almost always split a main course or eat appetizers for dinner at a restaurant. As far as physical activity–lets make it easier for folks who work long hours. My guess is that they will be happier and more productive at work if they break-up their day with an exercise break. Not everyone can go to the gym at 530, and should it really be neccessary ?

    • Oh come ON.

      This is stupid. I’m sorry to be come across so bluntly – and realize persuasion doesn’t come from being insulting, really, but it IS wrong and seriously stupid.

      I and all my friends enjoyed little parties and cupcakes and treats at games, pretzels with cheese, hot chocolate, candy — and we were not fat. WE WERE NOT FAT. Treats do no cause obesity or else all of us would have been enormous porkers.

      Learning that treats are treats might be the better lesson, if one is to be taught (though a nice experiment might be to ban the high-fructose-C-S soda, and HFCS in snacks or treats.)

      Learning to eat when there is access to food all the time everywhere is how to manage life, not arbitrary restriction (unless by parents.)

      • http://www.drdialogue.com Juliet K. Mavromatis, MD

        Dear Oh come ON,
        At least I post with my name attached. Kids’ continuous access to food actually can be limited. This in school snack business, juice boxes for every whine, cup holders in every vehicle, is a relatively new phenomenon. Kids should be able to experience hunger. Parents should be able to tolerate whining. I agree that adult access to food cannot be limited. However, the hope is that is if adults have learned good habits as children they will be better able to limit their own access as adults. Sure, I eat double cheeseburger meals at McDonald’s and let my kids eat Jolly Ranchers and Doritos. But even “healthy” snacks one hour before lunch are nonesense. High fructose corn syrup, or honey sweetened, McDonald’s burgers or hormone-free, grass-fed, locally raised beef–with respect to an individual’s weight, it’s all the same. Calories in calories out.

        • Oh come ON.

          I’m sorry for the tone that probably did little to advance my point of view.

          However, I really have to disagree that access to snacks is “new”. We had snacktime at school and home. In my own and my siblings’ case, we were free range eaters, as my mother worked and did not set limits on snacking.

          In my I ate exactly as I pleased, and that sometimes meant a good deal of snacking between meals.

          Not all my friends had constant access to food like I did, but they did have access to plenty of food and plenty of treats on the usual occasions.

          I don’t know where you got the idea there was no snacking in school in the 60′s, but we did have treats regularly, with no compunction from the adults in charge.

          Calories in calories out is, I suppose, technically accurate, but “calories out” is the tricky part – it is subject to more factors than is generally admitted. Not all food calories taken in are absorbed, not all food energy metabolised in the same way and equally efficiently in all.

          I was ALWAYS slim, as were my siblings and my friends – and the eating habits of childhood have served me well enough, because I have at least a moderate amount of sense to know I can’t eat like a kid – I’m perfectly capable, childhood habits notwithstanding, to eat moderately and reasonably of heavy foods on special occasions, and eat very sensibly the rest of the time.

          I have to think other things have changed. I was not exceptional among my peers. We ate anything tasty any time we could get our hands on it – regular cookies and milk snacktimes from the most grudging of mothers, and we spent out little allowances on soda and candy and processed snacks.

          I wasn’t fat, they weren’t fat, and I’m not fat now. Treats at games and at school or church parties do no make kids fat. Not fat kids, not fat adults.

          Let parents be parents. Grown people are PERFECTLY CAPABLE of choosing foods, and they don’t need anyone’s social engineering to rescue them.

  • t petrusick

    I am a pediatrician , we have been doing BMI plots on children for several years (before I thought I could tell an overweight child when I saw one…I was wrong a lot went uncounseled). Addressing just overweight at two years has an impact without doing anything else. Parents at this age are worried about their childs decrease in appetite and showing them an over the limit BMI helps decrease the encouragement to eat more and eat inappropriate foods.

    FINALLY AS A PEDIATRICIAN WE WANT BABIES TO BE PLACED ON THEIT BACKS TO SLEEP you have mistated this two times in your blog.

  • Elizabeth

    One quick comment: You SHOULD put a baby to sleep on his back, not his tummy. I know that’s what you meant to say!

  • http://Www.twitter.com/alicearobertson Alice

    Danish say: Ah yes. Eat less. Exercise more. The first mom does not know what she’s talking about. Google: “David Brown Michelle Obama” to learn why.
    [end quote]

    Alice says David needs to read more before feasting on me. :) The Obamas enjoy junk food, and the President likes cigarettes. Yes, they exercise after those fat ridden, antibiotic burgers…with the corn syrup buns.

    What she promotes is just some hope and change that really is bunch of junk like the food they like. And David your post is only partially correct…better watch your popularity ratings as well as your waistline….some people have been known to have to eat their words….

    • http://Www.twitter.com/alicearobertson Alice

      Do I know what I am talking about? Not sure…a lifetime of additives, Diet Coke, Starbucks, and vaccines means I am a hormonal mess. What’s your excuse?:)

      So, I need to read a research paper to know Michelle can really down the junk food? Hmmm…..are they offering a grant for that? Nah…the Michelle Groupies are a creative bunch….I blame the liberal education for the voter’s indulgence in their unhealthy choice. The Obama’s wisely did their usual….do as I say…not as I do when it comes to education and food. But I still have hope.. there will be change:)

  • http://Www.twitter.com/alicearobertson Alice

    Ha! Sorry David that typo is pretty funny…hionestly, I know you are not a Danish…this iPad fills in words that make for good fodder….truly…no Freudian slip there…egads! I need a latte!

  • Alan

    The metaphor is not quite on spot. A crisis is a place to take action–to make a decision–not a problem to be solved. One could resolve a crisis, but that’s another idea. Unless incentives and institutions are re-worked, you’re going to have more of the same. Paradigm shift? Look at the way the medical-industrial complex is incentivized. How are you going to change it: top down or bottom up?

    In terms of ensuring financial stability, what is that supposed to mean? Is there evidence on the BMIs of the people who de-stablilized the system in the first place? Sorry to sound a bit cynical, but we’ve heard this tune before and it sounds like someone whistling dixie.

  • http://www.theblackribbonproject.org Beth Haynes, MD

    By socializing the payment of health care, it is now necessary to try and devise social solutions to what is really a matter of personal responsibility–which means using government force in attempt to alter and control behavior. This is having devastating effects on personal freedom as well as the cost and size of government.
    Don’t you think the fact that people are not financially on the hook for their poor choices (Americans only pay out of pocket 12 cents for every health care dollar they consume) is a significant contributor to the problem?

  • Anonymous

    All I know is that prior to the middle of the 19th Century, diabetes, heart disease, cancers, obesity, and depression were far less of a problem among the aged.

    Of course, in the 19th century and previously, people were a lot more active. A much higher percentage of jobs involved physical labor, and even getting around meant walking all over the place instead of getting in a car.

    • Anonymous

      even active people are developing all of the modern nutritional diseases these days.

      What is considered “active” today (2.5 hours of brisk walking or equivalent per week) was probably at the very low end of exercise volume and intensity in the 19th century. Today, only full time manual laborers or athletes are likely to approach the typical levels of exercise of people in the 19th century.

  • simon

    I just dread that they will put more on the docs…For instance, now I have to check the box that I did dietary counseling at each visit, as well as smoking cessation, depression screening, substance abuse, colon cancer and breast cancer screening etc., (and this is for a visit for a sprained ankle in 12 minutes). We do all these screenings, but there is a right time and place for each discussion.

    Also,does anyone suspect that if they don’t get their obese patients BMI down that someone will start withholding payments?

  • Dorothy Green

    “added sugars and omega-6 seed oils. Can’t say for certain which is worse. All I know is that prior to the middle of the 19th Century, diabetes, heart disease, cancers… were less of a problem”

    This is on the right track. A lot more is understood about nutrition now even though the experts disagree on some points, mostly amounts and kinds of fats. However, If you accept the science that shows our DNA has not changed significantly in over 10,000 years (Stephen Hawking, The Universe in a Nutshell) perhaps you can accept that the American Diet – with it’s high sugar (includes simple carbs), high fat (wrong ratio and amounts) and high salt content is the most significant factor in our healthcare crisis.

    90% of food dollars are spent on processed food. This unhealthy food is subsidized (corn feed, HFCS). More calories are produced and consumed than needed. Salt, fat and sugar are the substances now known to be potentially addictive, PURPOSEFULLY put into processed food in high amounts to make them hyper-palatable which then leads to obesity and or malnourishment (from eating too much in lieu of nutrtious food) which in turn is the highest risk factor in chronic preventive diseases that are now known to consume over 60% of our healthcare dollars.

    As an added point, the average American (that is total amount/by 300 million) consumes 200 lbs of animal protein a year. This represents 50% more protein than RDA. So even eating lean and light means somebody eats or wastes the fat (I don’t think it is used as a biofuel yet) and the extra fat from light dairy gets thrown on pizza. Bottom line, we eat too much cow and dairy.

    If there is a right to healthcare or even a moral obligation there must be concurrent responsibility to take care of one’s body and mind. This responsibility cannot be mandated, what people eat cannot be mandated and people cannot be mandated to exericse. These have to become part of our culture throught education, education, example, and example.

    The idea of using taxpayer dollars as incentives for people to lose weight or subsidizing food stamps to purchase soda and other unhealthy food really “pis–s me off”. Everyone needs to contribute to this effort upfront and personal and this would be a slap in the face and pocketbook of those who do take care and or pay their own way to change.

    We all have the potential to become addicted to food just as we have the potential to become addicted to other substances but food is the leader and must be dealt with now.

    It will take generations to change our eating culture even with the most expensive and highest quality preventive care. We need to 1) STOP subsidies to unhealthy food 2) tax (a reduction in sickness kitty tax – RISK) on the salt, fat and sugar in processed and restaurant food) coupled with a strong message about the risk. (it worked to reduce tobacco smoking from 65 – 20% ).

    Our budget is and will continue to be broke and or taxpayers will continue to shoulder the tremendeous burden of healthcare even with all the current healthcare reform measures(including not-for-profit insurance for basic care) unless there is a dramatic change in the American eating culture.

    Calculations
    Estimated of revenues from RISK of $.003/G on the fat and sugar and $.003/G for 100mg of salt in processed and restaurant food are in excess of 100 B a year – that’s a lot of salt, sugar and fat. What about bulk sugar, fats and salt. Well, gotta think about this. Michael Pollan has a good rule “Eat all the junk food you want – just make it yourself.”

  • http://www.twitter.com/alicearobertson Alice

    If there is a right to healthcare or even a moral obligation there must be concurrent responsibility to take care of one’s body and mind. This responsibility cannot be mandated, what people eat cannot be mandated and people cannot be mandated to exericse. These have to become part of our culture throught education, education, example, and example.[end quote]

    But….what if….those who accept government dollars were mandated to show responsibility and many foods disallowed? It seems to me junk food should not be paid for. The free lunch mentality from tax payer dollars should maybe have some accountability attached?

  • http://www.twitter.com/alicearobertson Alice

    Some good thoughts there, Dorothy. “Eat all the junk food you want – just make it yourself.” [end quote]

    Dorothy made some good points. I will say I tend to agree with you about sugar. One of my children gave up sugar at age ten years old and her allergies stopped and she has probably been sick twice in six years. My daughter with cancer hasn’t eaten meat in four years….and desserts are not part of our regular diet.

    And if that’s not convincing there is research that shares that sugar decreases collagen…now that may scare some people. Hit them with vanity and you get their attention.

    David does this mean you don’t drink alcohol? I don’t….spent too much time in the UK…..oh that’s for another day.

    Anyhoo………this is where the Obamas are right about exercise. There is research (and that’s a loose term these days) that shows that the Amish women eat some pretty junkie diets, but remain healthy because they move their bodies all day long. The average Amish woman does do the 10,000 steps a day.

    I am not advocating junk food…..but exercise seems to be vital.

  • Dorothy Green

    Thank you for you comments. Alice,

    RISK could and should be designed so only healthy food is allowed to be purchased with food stamps, it is not fair to tax payers now knowing the health risks of too much sugar, wrong fats and salt. RISK revenue could be designed to enhance all existing programs (and there are many volunteer ones) to move to a healthier nation as well as to off-set taxpayers ever increasing contibution to Medicare.

    David – thank you for your points on processed vegetable oils and non- pasture animals. I understand the issues they too are appropriate for RISK. I have included them in a PPT presentation but though I would share just this much of my idea.

    You probably all know there are enough studies now on the American diet than in the tobacco smoking Surgeon General’s report in the 1960s. Most are on obesity but many are very specific to sugar, unhealthy fats or salt. Where is our Surgeon General on this issue anyway?

    There will always be exceptions cited like the Amish women who eat junk and exercise, like the guy who went on a Twinkies diet to lost weight and his HDL went up (note: he also took supplements, a protein shake, ate veges and counted calories) and like the smokers who don’t get cancer and COPD or heart disease but the evidence is there.

    RISK should be added to the debt reduction proposal. The revenue will be high to start (like the tobacco revenue was before usage decreased significantly). And it could be exchanged for at least another 1 percent of income tax from the lower two rates. If RISK declines than so would healthcare costs.

    The quote” eat all the junk food you want as long as you prepare it yourself” comes from MIchael Pollan. He has many books and many great ideas about changing our culture along with a lot of well known authors and activists.

    The only idea that is exclusively mine is RISK.

  • http://www.twitter.com/alicearobertson Alice

    the guy who went on a Twinkies diet to lost weight and his HDL went up (note: he also took supplements, a protein shake, ate veges and counted caloriese [end quote]

    Alice: I thought the guy said his HDL did not go up. I am rushed, so I don’t have time to look into it. He ate beans with fiber and protein and you are right it was something like 1200 calories a day….the archaic burning more calories than you consume still works.

    quote: The quote” eat all the junk food you want as long as you prepare it yourself” comes from MIchael Pollan. He has many books and many great ideas about changing our culture along with a lot of well known authors and activists. [end quote]

    Alice: I don’t know…….while reading his best sellers I certainly didn’t get that impression unless he was being facetious. He took great strides to say meal prep is an old art and we need to actually prepare our meals with real foods. Dr. Rozen (Dr. Oz’s) partner said to go ahead and eat a burger but not at the drive-thru (saying because of lawsuits they dump ammonia on the burgers to make sure the ecoli is removed). But to my knowledge neither of them would promote making Twinkies yourself! :) I think it’s a play on words. Also, I believe Pollan is a vegetarian. That’s what he said on Oprah’s show on eating healthy. Were there any Pollan eating a burger sightings?:) If so, we really need to talk to him about that…….*grin*

    I brought up alcohol because on David’s page he, rightfully, rants about sugar. But for consistency if you believe that you should not partake of alcohol….which I know they promote…but it’s been linked to breast cancer (not that David has to worry so much in that department….the odds are for him there), and other problems that go way beyond our waistline. Gotta love that research, particularly when it’s done by wine lovers! *VBG*

  • http://www.twitter.com/alicearobertson Alice

    Thanks……..but as I shared living in the UK means I saw more addicts than I want to remember. My mom and husband are from the same town, so all our relatives are there. Alcohol is one of the major food groups there.