Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

First diabetes educator license is issued in Kentucky

Kim DeCoste (photo via AADE)

Kentucky is the first state to issue a diabetes educator license, according to a press release from the Kentucky Board of Licensed Diabetes Educators.

Kim DeCoste of Richmond, a registered nurse and chair of the Kentucky Diabetes Educators Licensure Board, is the licensee.

"I am proud to represent diabetes educators throughout Kentucky as the first person to receive a license,” DeCoste said. “Kentucky’s legislation assures that the qualifications of diabetes educators have been thoroughly reviewed and that individuals are appropriately credentialed. Improved consumer safety is vital as diabetes care becomes increasingly complex.”

The release said Kentucky passed laws in 2011 to require licensing of diabetes educators in an effort to improve the quality of health care in the state, which has a high rate of diabetes. Ten percent of Kentucky adults, or approximately 370,000, had been diagnosed with diabetes in 2010, according to the latest Kentucky Diabetes Report. An additional 233,000 Kentucky adults have been diagnosed with pre-diabetes, and research from the federal Centers for Disease Control and Prevention has indicated that approximately 27 percent of people with diabetes have not been tested or diagnosed.

Because diabetes is controllable if diagnosed early and managed well, diabetes educators play a vital role in working with people who have or are at risk of developing diabetes and developing a plan of care, the report says.

The American Association of Diabetes Educators define a diabetes educator as “health care professionals—registered nurses, registered dietitians and pharmacists, among others—who specialize in helping people with diabetes understand how to best manage their health.”

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.

Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44^th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.

Kentucky, in Diabetes Belt, needs to do more to keep percentage of residents with costly disease from rising, advocates say

By Dr. Gilbert Friedell and Isaac Joyner

World Diabetes Day is Nov. 14, and we urgently need to address this plague right here at home. Diabetes is a major public health problem — an epidemic — in the United States. One out of 10 people over the age of 20 now has diabetes, primarily Type 2 or “adult onset” diabetes, and the disease is rapidly increasing. This increase has been particularly striking in the several Southeastern states comprising what the federal Centers for Disease Control and Prevention calls the “Diabetes Belt.”

PERCENTAGE
OF ADULTS

In Kentucky, one of eight people now has the disease — a frightening fact. Even more frightening: one-fourth of those with diabetes do not know they have the disease! If this epidemic is not interrupted, by 2050 about one out of three people in this country will have diabetes. For minorities, that figure will be closer to one out of two.

Diabetes itself poses a significant health problem, but the real burden of the disease is its complications. The high blood-sugar levels characteristic of diabetes, plus the effects of high blood pressure and elevated cholesterol levels, damage both small and large blood vessels. Over time, those with diabetes frequently go blind, have a toe or foot amputated, lose kidney function and frequently die of a stroke or heart attack. These complications are BAD: blindness, amputations and dialysis.

The cost of diabetes is staggering. In 2025 its annual direct and indirect cost to the country is projected to exceed $500 billion. Here’s what we need to do about this epidemic.

First, we need to focus on primary prevention of the disease, and that means stressing proper nutrition and regular exercise. Early childhood is the time to begin good dietary habits, and the conscious selection of food for school snacks and lunches provides an excellent opportunity for establishing these habits.

With young people and adults, a structured program of weight loss and exercise can prevent the onset of diabetes among about half of the overweight population that has elevated but not diabetic levels of blood glucose.

At the community level, we need active engagement by local health departments and officials interacting with the population. We recommend the creation of broad-based Community Diabetes Control and Prevention Councils, with health providers, business leaders and teachers, along with diabetes patients and their advocates.

At the state level, we need mandatory screening of all adults, and mandatory reporting of all new cases of diabetes to a state diabetes registry. Strong support from the federal government must be provided for these efforts, and for local health departments.

Diabetes prevention will require a significant change in the behavior of patients, health providers, communities and government. This will not be easy, but the current fragmented way in which we deal with diabetes is not working. It is long past time for greater public recognition of the grave threat that the diabetes epidemic poses — and for a rational, coordinated response to it.

Gilbert Friedell and Isaac Joyner, of Lexington, are co-authors of The Great Diabetes Epidemic: A Manifesto for Action.

KET offers program about diabetes prevention and control

KET's "Connections with Renee Shaw" is offering a program about diabetes prevention and control on KET2 Friday, Nov. 8 at 5 p.m. and KET Sunday, Nov. 10 at 1:30 p.m.

This programming could not be more timely, since Kentucky, along with parts of Appalachia and the Deep South, is part of the nation's Diabetes Belt. Diabetes rates are 11 percent or higher in many counties, and as much as 25 percent of Kentucky's Medicaid budget goes towards treating the complications of type 2 diabetes, according to the program guide.

Experts will discuss statewide education and prevention methods and the changes individuals can make to avoid diabetes.

This show will explain the difference between type 1 and type 2 diabetes, the function of the pancreas and insulin, and the role that diet and exercise play to help control diabetes complications and even prevent the onset of diabetes.  It will offer personal stories of people who are living with diabetes, explain the concept of pre-diabetes and how to prevent it, and discuss specific ways we can help resolve this growing problem.

Program guests include Dr. Raymond Reynolds, professor of internal medicine, endocrinology fellowship program director, and director of the Barnstable Brown Diabetes and Obesity Center at the University of Kentucky; Theresa Renn, coordinator of the Kentucky Diabetes Prevention and Control Program; Tami Ross, a registered dietitian, certified diabetes educator, and nationally recognized speaker and health and nutrition writer; Stewart Perry, a Lexington insurance broker who has been living with Type 2 diabetes for more than 20 years and is a policy advocate on the state and national level for the Kentucky Diabetes Prevention and Control Program and the American Diabetes Association.

November is National Diabetes Month; here are some tips to stay healthy and keep the disease from stealing your vision

November is National Diabetes Month, and if you're one of more than 370,000 Kentuckians with the disease, in addition to watching your diet and keeping track of your blood sugar, it’s also important to have regular eye exams.

A comprehensive dilated eye exam can catch
diabetic eye disease early, before symptoms appear

Diabetic eye disease is the leading cause of vision loss among working-age Americans, says a release from the National Institutes of Health.  Diabetic retinopathy is the most common form of this disease, affects=ing more than 7 million Americans, a number that is expected to reach 11 million by the year 2030.

Since diabetic retinopathy has no symptoms until it reaches an advanced stage, it is important to get regular dilated eye exams so it can be detected early, says the release. Fortunately with early detection and timely treatment, the risk of severe vision loss from the diabetic retinopathy can be reduced by 95 percent.

If you have diabetes, controlling the disease will reduce your risk of developing diabetic eye disease. It’s now a good time to remember these health tips too:

• Get a comprehensive dilated eye exam at least once a year. 
• Tell your doctor if you're feeling down or if your eyesight changes.
• Control your blood sugar, blood pressure and cholesterol levels.  
• Take your medicine even when you feel Ok.
• Be active for 30 to 60 minutes on most days of the week.
  
• Eat healthy foods like:
• fruits, vegetables, fish, lean meats and poultry, dried peas or beans, lentils, and low-fat or skim milk and cheese
• whole grain foods such as whole wheat bread and crackers, oatmeal, brown rice, and cereals
• food prepared with little added fat, oil, salt, or sugar
• smaller servings of meat, fish, and poultry
• larger servings of fruits and vegetables. 

Click here to learn more about diabetic eye disease from the National Eye Institute. Click here to learn more about preventing and managing diabetes from the National Diabetes Education Program or here for additional tips on staying healthy with diabetes.

Diabetics have increased risk of complications from flu

Certain groups of people, including diabetics, are at risk of serious flu complications each year, according to a report from the University of Alabama at Birmingham.

More than 500,000 Kentuckians, over 11 percent of the state’s population, are living with diabetes, wrote R. Stewart Perry and Larry Smith, co-chairs of the American Diabetes Association's national board of directors, in an op-ed piece in The Courier-Journal.

“Diabetes can weaken your immune system against the flu, and it also puts you at an increased risk of flu-related complications,” Fernando Ovalle, M.D., professor of medicine in the UAB School of Medicine and senior scientist in the UAB Comprehensive Diabetes Center, said in a news release. “The weakening of the immune system makes it harder for your body to fight the flu virus. Being sick can also raise your blood glucose and prevent you from eating properly. You are also at risk of flu-related complications like pneumonia.”

 There are several things Ovalle said diabetics and parents of diabetics can do to give some protection from the virus:
 • Get a flu vaccine shot. The nasal spray vaccine is not safe for people with diabetes.
 •Talk to your health care provider about the pneumococcal vaccine. It will help protect against pneumonia.
 • Keep track of blood glucose. It can be affected by illness.
 • Wash your hands often with soap and water or an alcohol-based hand rub.
 • Try to avoid close contact with sick people.
 • Practice the good-health habits like getting plenty of sleep and exercise, managing stress, drinking plenty of fluids and eating healthy food.

 For diabetics who think they have the flu, Ovalle suggests these steps:
 • Contact a health care provider immediately. Symptoms include fever or feeling feverish or experiencing chills, cough, sore throat, runny or stuff nose, muscle or body aches, headaches and fatigue. In children, vomiting and diarrhea can be common.
 • Continue taking diabetes pills or insulin.
 • Test blood glucose every four hours and track results.
 • Stay hydrated; drink lots of calorie-free liquids.
 • Try to eat normally.
 • Weigh every day. Losing weight without trying is a sign of high blood glucose.

“Be vigilant and smart, especially when it comes to washing your hands." Ovalle said. "And if you every have any questions or concerns, contact your health care provider.” (Read more)

Clinics in 9 Appalachian counties will offer high-tech eye screenings to head off common ailment that blinds diabetics

Kentucky has one of the nation's highest rates of diabetes, but half the diabetics in rural Kentucky don't have annual eye exams – even though nearly 30 percent of diabetics over 40 have diabetic retinopathy, the leading cause of blindness among diabetic adults.

To stem that threat, units of the University of Kentucky are using a three-year federal grant to bring diabetic eye screening to diabetics in nine Kentucky Appalachian counties. Diabetic retinopathy can be treated, or avoided altogether, if the disease is detected early enough.

While studies have found that 90 percent of diabetics consult their doctor about their disease, about half the diabetics in rural Kentucky do not have annual eye exams. The grant will make technologically advanced exams available at clinics in Bath, Carter, Elliott, Estill, Jackson, Madison, Menifee, Rockcastle and Rowan counties, sending digital images of the eyes to UK's Department of Ophthalmology.

The specialists will screen the images for cataracts, glaucoma, macular degeneration, and other retinal abnormalities that can lead to vision loss and blindness. They will also enter the results into the patient's electronic medical record, for reference by other health-care providers. Currently, only a fraction of the results of community-based eye exams are imported into such records.

The partnership between the UK ophthalmologists, the university's Kentucky TeleCare, and primary care centers where the screenings will be done, is called the Appalachian Eye Network. It will reach nine counties with a combined population of 206,000. All the counties have diabetes rates higher than the national average. The project is expected to screen 4,860 people over the three-year term of the grant.

"Our goal is to reach patients with diabetes and those with high risk factors for diabetes who do not get annual eye exams and help uncover potentially devastating eye disease so it can be treated before the patient loses their vision," said Rob Sprang, director of Kentucky TeleCare. "I believe we have the opportunity to save people’s vision and change lives."

National Childhood Obesity Awareness Month: Policy changes underway in Ky. to lower its very high childhood obesity rate

September is National Childhood Obesity Awareness Month, and a number of policy changes are underway to combat the increasing trend of overweight children in America and Kentucky, where one in three kids are on their way to developing Type 2 diabetes.

Kentucky suffers from one of the highest childhood obesity rates in the country, tying Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent). It has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report by Kentucky's Task Force on Childhood Obesity.

The state's efforts to lower childhood obesity rates include two important studies for the Cabinet for Health and Family Services – "Shaping Kentucky’s Future: Policies to Reduce Obesity" and "Unbridled Health: A Plan for Coordinated Chronic Disease Prevention and Health Promotion." These reports contain policy recommendations for work communities, corporations, schools and the state itself to help Kentuckians eat healthy and exercise, The Foundation for a Healthy Kentucky says in a news release.

“Lowering childhood obesity rates is a positive lever for overall health change, reduced risk of chronic disease and an improved quality of life," said Susan Zepeda, president of the foundation. "Foundation polling and recent news reports signal growing awareness among Kentuckians of the importance of and the need for lowering our obesity rates."

Nationally, the recent report "F as in Fat: How Obesity Threatens America’s Future 2013" provides recommendations that could improve health in Kentucky and across the country with funding and effective implementation, including:
 · All food in schools must be healthy
 · Kids should have opportunities to be physically active on a regular basis
 · Restaurants should post calorie information on menus
 · Only healthy products should be marketed to children
 · Transportation plans should encourage walking and biking
 · Everyone should be able to purchase healthy, affordable foods close to home

“Here at home, Kentucky will host the Southern Obesity Summit in 2014 and several organizations are hard at work to advance health policies that support sound nutrition and active living at work, at school and in our communities,” said Zepeda. “These efforts create opportunities to discuss strategy and create more awareness of the compelling need to reduce childhood obesity rates in the commonwealth.”

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

Kentucky has nation's first statewide, comprehensive plan for diabetes prevention; 10 percent of us have the disease

Kentucky leads the way in the fight against diabetes and towards improving health for future generations of Kentuckians by becoming the first state to legislatively require a statewide, comprehensive action plan for addressing this disease epidemic.

Over 500,000 Kentuckians, 10 percent of the state’s population, are living with diabetes, costing the state about $4.8 billion a year in direct and indirect medical costs, write R. Stewart Perry and Larry Smith, co-chairs of the American Diabetes Association's national board of directors, in an op-ed piece in The Courier-Journal. While it hasn't been widely reported, state policymakers recently tackled the issue.

In 2011, the General Assembly passed a law (KRS 211.752), sponsored by Sen. Tom Buford, R-Nicholasville, and Rep. Ruth Ann Palumbo, D-Lexington, directing the Cabinet for Health and Family Services to report every two years on the impact of diabetes on the commonwealth.  The report must include the scope of the disease, its costs and what state government is doing about it.

The law requires the Department for Medicaid Services, the Department for Public Health, the Office of Health Policy and the Personnel Cabinet to “collaborate to identify goals and benchmarks while also developing individual entity plans to reduce the incidence of diabetes in Kentucky, improve diabetes care, and control complications associated with diabetes,” Perry and Smith note.

Such reporting will encourage the development of prevention strategies that are more effective and efficient, representing an unprecedented, coordinated effort against diabetes, they write. Many other states are using Kentucky’s plan as a model for legislation. "We call on every Kentuckian to enlist in the effort to step up the fight against diabetes," they urge.

AMA calls obesity a disease; could spur coverage for treatment

The American Medical Association now recognizes obesity as a disease, which may make it easier for Kentuckians to fight the state's obesity epidemic by gaining insurance coverage for necessary medical treatment. Under the leadership of newly elected President Ardis Hoven of Lexington, the physicians' group voted to approve this new obesity policy June 18 during its annual meeting in Chicago. Click here to read the report by the AMA’s Council on Science and Public Health.

Kentucky ranks 10th highest in the U.S. for adult obesity, and the state's obesity rate is predicted to jump from 30 percent in 2011 to more than 60 percent in 2030. This year, $2.3 million is expected to be spent on medical costs linked to obesity, and that number is estimated to rise to $6 billion in 2018, says a report by the College of Public Health at the University of Kentucky.

Read more here: http://www.kentucky.com/2012/09/24/2349167/recent-report-on-kys-obese-future.html#storylink=cpy

Being overweight or obese greatly increases the risk of developing other chronic diseases like diabetes, stroke, arthritis, sleep apnea, asthma, heart attack and certain cancers or other complications like asthma, joint problems and psychological issues, says the report. Kentucky children also suffer from high rates of obesity, and if the current trend continues, one in every three American children will develop Type 2 diabetes.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue," AMA board member Dr. Patrice Harris said in a statement. Although Medicare and Medicaid do cover obesity treatment associated with another disease or disorder, they do not cover interventions and counseling about lifestyle changes necessary to fight obesity. The AMA declaration could lead to coverage and help increase funding for obesity research, reports Jacque Wilson of CNN. With the AMA now calling obesity a disease, "insurers can stop ducking their responsibility" in paying for obesity treatments, Dr. Virginia Hall, an obstetrician from Hershey, Pa., said in a Forbes magazine report by Bruce Japsen.

Also, identifying obesity as a disease help reduce the stigma often associated with being overweight, Joe Nadglowski, president of the Obesity Action Coalition, told Wilson. "Obesity has been considered for a long time to be a failure of personal responsibility -- a simple problem of eating too much and exercising too little," he said. "But it's a complex disease. . . . We're hoping attitudes will change."

Mayors and AMA say food stamps shouldn't pay for soft drinks

Louisville's Greg Fischer is among 18 mayors asking Congress to ban sugary drinks from purchase under the Supplemental Nutrition Assistance Program, commonly called food stamps.  One day after their June 18 letter, the American Medical Association adopted a policy supporting the removal of sugar-sweetened drinks from SNAP.

In a the letter sent to congressional leaders, the mayors said it is "time to test and evaluate approaches limiting" the use of the subsidies for sugar-laden beverages to fight obesity and diseases linked to obesity, reports Jennifer Peltz of The Associated Press.

At its annual meeting, the AMA took several steps toward controlling the country's increasing obesity problem, including calling obesity a disease, an action that may prompt insurers to cover medical treatments aimed against obesity. “The AMA is working to improve the nation’s health care outcomes, particularly cardiovascular disease and diabetes, which are often linked to obesity,” said AMA President Dr. Ardis Hoven of Lexington. “Removing sugar-sweetened beverages from the Supplemental Nutrition Assistance Program will help encourage healthier beverage choices.”

This isn't the first attempt to ban soda from SNAP. The Department of Agriculture, where the program is housed, turned down such a request from New York City's Mayor Michael Bloomberg in 2010. The city had proposed a two-year experiment to see if a sugary beverage ban would reduce obesity among food-stamp recipients. But, the department rejected the plan and said a soda ban would “perpetuate the myth” that food stamp users make poor shopping decisions, The New York Times reported. Read about Kentucky's SNAP program here.

The soda lobby, the American Beverage Association, said sugary drinks shouldn't be singled out as a cause of obesity. It called obesity "a complex health condition that affects Americans of all income levels." Last year, more than 47 million low-income Americans used food stamps.

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

Study shows a 15-minute, moderate-speed walk a half-hour after eating can control older folks' spikes in blood sugar

It's no news that walking is good for your health or for preventing diabetes, but a new study published in Diabetes Care says a 15-minute, moderate-speed walk about 30 minutes after eating, which is when blood sugar spikes, is most beneficial for older individuals needing to control blood-sugar levels.

As you age, the process in which insulin converts sugar and glucose from your food into muscle cells, and the liver where it's stored for energy, doesn't work as well as it did when you were younger. Leaving too much glucose in the blood can lead to Type 2 diabetes and cardiovascular damage.

Exercise has long been known to helps prevent these effects. And while many individuals may not be able to get the recommended 45 minutes of exercise most days of the week, the study shows how you can be smart and get the most out of your exercising time. Compared to 45-minute walks in the morning and afternoon, the study says that only the 15-minute, post-meal walks managed to significantly reduce blood sugar spikes during the important three-hour post-meal window, reports Brian Alexander of NBC News.

This is the first controlled experiments of its kind and could be useful for pregnant women at risk for gestational diabetes who may not be able to exercise for 45 minutes,” the study’s leader, Loretta DiPietro of the Department of Exercise Science at The George Washington University, told NBC.

“This is not for weight loss, and it’s not going to increase your cardiovascular fitness very much,” DiPietro said. “It’s very specifically for glycemic control with older age.” But the study's findings benefit everyone because we all experience glucose spikes after eating, said DiPietro.

Remember to take precautions when walking at night, especially considering less than half of Kentucky adults live in communities with elements such as sidewalks or shoulders that allow for safe walking or bicycling.

Floyd County newspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

State Health Department gets diabetes prevention funding; will focus on prediabetes detection and lifestyle changes

The state Department for Public Health has been awarded a $134,380 federal grant to help reduce high rates of prediabetes and Type 2 diabetes in Kentucky.

“Diabetes is a tremendous public health concern that is both horrific for the individual, if unmanaged, and costly in terms of medications, various complications and long-term hospitalizations that are so often associated with the disease,” Audrey Haynes, secretary of the Cabinet for Health and Family Services, said in a press release.

In 2009, Kentucky's rate for diagnosed diabetes was the fourth highest in the nation at 11.4 percent of the population, compared to a national median of 8.3 percent. The rate means an estimated 366,000 adults in Kentucky have diabetes. An additional 266,000 Kentuckians are estimated to have prediabetes, according to the CFHS website.

Prediabetes often leads to Type 2 diabetes, the most common type, within a few years, but lifestyle changes promoted by the federal Diabetes Prevention Program can decrease the risk of developing diabetes by almost 60 percent, according to a recent study published in the Journal of Preventive Medicine.

“We must act now to begin reversing the devastating impact of diabetes on our state,” Haynes said. “We are excited to continue our work with the Diabetes Prevention Program to help more Kentuckians start making healthier lifestyle choices so they can avoid developing diabetes and lead longer, healthier lives.”

The DPP specifically targets individuals with prediabetes and works with them to reduce their risk of developing Type 2 diabetes. The risk factors for both are: being older than 45, being overweight or obese, physical inactivity, having a family history of diabetes, ever having gestational diabetes, high blood pressure, abnormal cholesterol, having a history of cardiovascular disease and being African-American, Hispanic/Latino, Native American, Asian American or Pacific Islander. Click here to take the diabetes risk test.

The federal Centers for Disease Control estimates that national efforts to prevent Type 2 diabetes could save $5.7 billion in health care costs by preventing 885,000 cases in the next 25 years. Kentucky will focus on three diabetes prevention strategies that involve raising awareness among health care providers to improve detection and treatment of prediabetes and encouraging both state/local government and business to add lifestyle change programs to the list of covered services under health plans, says the news release. (Read more about diabetes and prevention in Kentucky).

First major study of diet and strokes links fried, sugary Southern diet, low on fruits and vegetables, to increased risk

Genuine Kentucky fried platter:
Cornbread, fried catfish, fried green
tomatoes, fried apples and fried okra
(Photo from Ramsey's, Lexington)

By Molly Burchett
Kentucky Health News

People with a Southern diet, or one heavy on fried food and sugary drinks like sweet tea and soft drinks, are more likely to suffer a stroke, a new study finds.

It's the first big look at diet and strokes, and researchers say it might help explain people in the nation's "stroke belt" or southern states suffer more of them, reports Marilynn Marchione of The Associated Press.

These findings have important implications for Kentuckians because stroke accounts for 5.5 percent of Kentucky deaths each year and more than 81 percent of Kentucky adults eat fruit and vegetables fewer than 5 times a day, which is a indicator of risk for stroke:

Heart Disease and Stroke Risk Factors from federal Behavioral Risk Factor Surveillance System national survey	Ky.	U.S.
Eat fruits and vegetables less than 5 times/day	81.6	75.6
Overweight or obese	69.1	62.9
No moderate or vigorous physical activity	55.8	50.5
High total blood cholesterol	38.5	37.6
High blood pressure	30.0	27.8
Cigarette smoking	28.2	19.8
Diabetes	9.9	8.0

"We're talking about fried foods, french fries, hamburgers, processed meats, hot dogs," bacon, ham, liver, gizzards and sugary drinks, said the study's leader, Suzanne Judd of the University of Alabama in Birmingham.  For the study, a southern diet also included jerky, red meat, eggs, and whole milk.


Fried foods tend to be eaten with lots of salt, which raises blood pressure and sweet drinks increases risk for diabetes- both are known stroke risk factors, Judd said.

People who ate about six meals a week featuring these sorts of "Southern" foods had a 41 percent higher stroke risk than people who ate that way about once a month, researchers found.

In contrast, people whose diets were high in fruits, vegetables, whole grains and fish had a 29 percent lower stroke risk, reports Marchione.

"It's a very big difference," Judd said. "The message for people in the middle is there's a graded risk" — the likelihood of suffering a stroke rises in proportion to each Southern meal in a week. 

These findings were reported last week at the American Stroke Association conference. The study was launched in 2002 to explore regional variations in stroke risks and reasons for them.

Stroke death rates in Kentucky vary widely among counties. Here's a county map of the rates, from KentuckyHealthFacts.org, which has a county-by county list:

The map shows stroke rates in ranges per 100,000 population from 2003 through 2007. Purple counties had rates above 69; blue counties ranged from 52 to 69; turquoise were 44 to 52; light blue were 31 to 44 (the number that is about the national average), and tan were 18 to 31.

Children with TVs in their bedrooms are twice as likely to have extra fat, three times greater risk of heart disease and diabetes

Kids who have TVs in their bedrooms are twice as likely to be fat and nearly three times as likely to be at risk for heart disease and diabetes as those who don’t, according to a new study that elevates concerns about health and screen time. The research, published in the American Journal of Preventive Medicine, studied 369 children, 5 to 18, who have TVs in their rooms and watched more than five hours of television a day. They showed dramatic evidence of extra belly fat, bigger waists, greater risk of heart disease and diabetes and elevated triglycerides, or fat in their bloodstream, said Amanda Staiano, a scientist with the Pennington Biomedical Research Center in Baton Rouge, La. (Getty Images photo)

A 2010 study cited by Staiano indicated that 70 percent of American children have a TV in their bedroom. In the Pennington study, 66 percent of the kids had a TV in the room and the precise relationship between TV and health, as measured by height, weight, waist measurements, blood pressures, fat deposits and other exams, revealed the stark disparity between the groups with and without their own TV. (Read more)

British researchers say a simple calculation can predict likelihood of a baby's chance of becoming obese during childhood

If only we knew from the start which babies were predisposed to becoming diabetic and hypertensive and overweight . . . News out this week suggests we can. NBC News reports that British researchers have published findings in the journal PLOS ONE saying that a simple assessment can predict at birth a baby's likelihood of becoming obese during childhood. The formula, available as an online calculator here, estimates the child's obesity risk based on its birth weight, the body mass index of the parents, the number of people in the household, the mother's professional status and whether she smoked during pregnancy.

The hope is to help families will take steps to control the weight of babies and small children before medical problems arise. Philippe Froguel of Imperial College London, who led the study, explained that teaching parents about the dangers of over-feeding and bad nutritional habits at a young age is much more effective than having to teach children how to lose weight. Froguel's team developed their formula following 4,000 Finnish children since 1986. Childhood obesity is a leading cause of early type 2 diabetes, as well as various types of cardiovascular disease. (Read more)

One S.C. county serves as incubator for state's efforts to battle weight problems, with some good results

PE teacher Sharon Williams, right,
leads morning exercises before
classes start at Bells Elementary.
(The State photo by Tim Dominick)

With nearly two-thirds of South Carolina deemed overweight or worse, lucky Colleton County got picked to be a test case for doing better. That is, for improving its chances to beat the state's already overwhelming rates of diabetes, heart disease and stroke and for helping to lower the state's $1.2 billion dollar medical bill. Lucky, because in 2010, the county was awarded almost a half million Eat Smart Move More grant by the BlueCross BlueShield of South Carolina Foundation to see if it could promote health eating and more physical exercise countywide. Joey Hollerman of The State newspaper in Columbia, S.C., reports that "the results have been striking," though he notes that changing obesity numbers is "like turning an aircraft carrier, it's a slow process." Mostly, he's talking about attitude and perseverance.

How does the county-wide program work on a daily basis? First, of course, you have to have buy-in, which this county did. Hollerman explains that now when children arrive at Bells Elementary School in the county seat of Walterboro, "they go straight to the gym and walk laps before heading to classrooms. Worshipers at Power of Faith Delivery Ministry harvest collards as well as souls, and fried chicken is discouraged at church dinners. The local farmers market has a sparkling new home and a system set up to accept cards from the Supplemental Nutrition Assistance Program." The Let’s Go, Eat Smart program and exercise programs are posted in schools, workplaces, grocery stores and churches.

So how, if the numbers aren't clear yet, how to measure if it's working? Well, only one fried chicken basket showed up at a recent church supper and the member who brought it ended up apologizing for her breach. On the day the reporter visited only the elementary school only one child in the entire first grade tried to slip through without selecting a fruit or vegetable. He was sent back and grabbed a plastic container of grapes from the Go (instead of the Slow or Whoa) food options, Hollerman reports. There are also anecdotes galore, including those of children, once on insulin, who are now fine without it.

South Carolin's BlueCross BlueShield recently awarded another grant to Eat Smart Move More, in part to continue the work in Colleton County but also to for expand it to other communities. (Read more)