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)

UK gets biggest-ever grant from National Institutes of Health to probe links between obesity and cardiovascular disease

The University of Kentucky has received its largest-ever National Institutes of Health grant to explore connections between two of the state's biggest health problems, obesity and cardiovascular disease.

Dr. Lisa Cassis
directs the program.

The university's Center of Biomedical Research Excellence "supports research of promising junior faculty focused on identifying mechanisms linking the epidemic of obesity to a high prevalence of cardiovascular diseases," a UK press release said. The faculty support helps the researchers compete for new NIH grants. In the first phase of the program, 90 percent competed successfully, and they published 500 study reports.

"Research to be executed under the present grant runs the gamut from laboratory research conducted at the cellular level, to bedside translational research conducted in pediatric and adult patients," the release said. "Projects focus on mechanisms for the development of obesity, the influence of obesity on recovery of the heart following a heart attack, obesity-induced inflammation, and how this influences the cardiovascular system, and imaging of heart dynamics and function in obese children."

A byproduct of cholesterol that acts like estrogen explains the link between high cholesterol and breast cancer

The link between high cholesterol and breast cancer can now be explained.

It is not the cholesterol itself, but a "byproduct of cholesterol (that) functions like the hormone estrogen to fuel the growth and spread of the most common types of breast cancer," researchers at the Duke University Cancer Institute report, according to Newswise.

Estrogen is known to "feed an estimated 75 percent of all breast cancers," Newswise reports. So basically, cholesterol creates a "byproduct" that acts like estrogen and "feeds" the breast cancer, the researches concluded.

This is the first time a link between high cholesterol and breast cancer has been explained, especially in post-menopausal women, according to the study, which also suggests that changes in diet or taking statins and other medication to reduce cholesterol may offer "simple ways to reduce breast cancer risk," Newswise reports.

Although studies have shown a connection between obesity and breast cancer, as well as high cholesterol and breast cancer, the reason for these connections had not been explained, said senior author Donald McDonnell, chair of the Department of Pharmacology and Cancer Biology at Duke: “What we have now found is a molecule – not cholesterol itself, but an abundant metabolite of cholesterol, called 27HC – that mimics the hormone estrogen and can independently drive the growth of breast cancer.”

The researchers also found that the more enzyme that makes the cholesterol byproduct that is present, the more aggressive the tumor.

When test animals took anti-estrogen drugs such as tamoxifen, or when they quit receiving the cholesterol byproduct, the cancer was inhibited, according to Newswise.

Nelson said in the article that there was also a potential association between the cholesterol byproduct and the development of resistance to the anti-estrogen tamoxifen. Data also suggest the cholesterol byproduct may reduce the effectiveness of commonly used breast cancer therapies.

These findings suggest that women who have breast cancer and high cholesterol who take statins will  have increased benefit, Newswise reports, because it will decrease their resistance to commonly used breast cancer therapies.

Further research will "include clinical studies to verify the suggested potential outcomes and to determine if this cholesterol byproduct plays a role in other cancers," McDonnel said.

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.

1 in 3 don't get potentially life-saving screening for colon cancer, second leading cause of cancer death in Ky. and U.S.

Federal officials said Tuesday that although detecting colon cancer early saves lives, only about two-thirds of Americans aged 50 to 75 have undergone recommended screening.

The U.S. Preventive Services Task Force recommends that men and women 50 and older get screened for colon caner, which is about 23 million Americans. However, only 28 percent of people who should be screened have ever done so and about 7 percent of people have received but are not up-to-date with their screening, says the federal Centers for Disease Control and Prevention.

Colon cancer is the second leading cause of cancer mortality in Kentucky and nationwide, and it affects men and women of all ethnicities. Kentuckians have a higher than average risk of colon cancer due to higher rates of obesity, diets high in fat, and lack of regular exercise.

"Despite research that shows colorectal cancer screening saves lives, screening rates remain far too low," CDC Director Dr. Tom Frieden said during a noon press briefing Tuesday. "Colon cancer is the second-leading cancer killer for both men and women. In fact, it's the leading killer of nonsmokers in this country, killing about 50,000 people a year," he said. The CDC report was published online Nov. 5 in its Morbidity and Mortality Weekly Report.

The number one reason people aren't being screened is because their doctor didn't recommend it, Frieden said, and the CDC is encouraging doctors to talk with their patients about screening. Certain preventive screening tests may be free under the Affordable Care Act, but be sure to check your individual policy.

"It is also important that individuals learn about testing options and get the test that's right for them," Frieden said. "But, we also know that not having health insurance greatly reduces the likelihood that someone will get tested and that's why increasing coverage is another way of saving lives."

MedLine Plus reports that several screening options can be used alone or in combination, including the following: Fecal occult blood test or fecal immunochemical test every year. These tests can be done at home; Flexible sigmoidoscopy, done every five years, with home fecal tests done every three years; Colonoscopy done every 10 years.

All these tests are effective and one is not necessarily better than another, Frieden said.  The CDC says that as many as 60 percent of deaths from colorectal cancer could be prevented if everyone age 50 and older were screened regularly.

"The best test is the one that gets done," he said. For some people, however, colonoscopy may be the best option, Frieden said. "These are people with a strong family history of colon cancer or an intestinal condition such as inflammatory bowel disease, or people who have had polyps removed in the past. But for everyone else, and that's the majority of people, there is no proven benefit to one versus another," Frieden said.

Mayo Clinic experts offer advice on preventing and coping with osteoarthritis, especially in the knees

Experts from the Mayo Clinic offer tips for both those trying to prevent and those suffering from a painful condition that affects at least 27 million Americans: osteoarthritis.

It is the most common form of arthritis, which most almost everyone is bound to get if they live long enough. One particular form, knee osteoarthritis, may afflict as many as half of Americans at some point in their lives, says a Mayo Clinic release.

Obesity, joint injuries, joint overuse, a family history and aging are among risk factors for knee osteoarthritis. Dr. Aaron Krych, a Mayo Clinic orthopedic surgeon, says maintaining a healthy weight is one key to preventing knee osteoarthritis. “Every pound lost can result in up to a 4-pound reduction in the load on the knee,” Dr. Amin says.

Amin says other tips for prevention including doing exercises to strengthen muscles around joints and preserve your range of motion and using assistive devices, such as special grips to open jars and protect finger joints or a cane, to ease the burden on your knees.

It is also important to maintain overall fitness through low-impact aerobic exercises, such as bicycling and water exercises, said Amin.  If you're an athlete, learn techniques to protect your muscles and joints, he said.

For people already suffering form osteoarthritis, water-based exercises like swimming and water aerobics are good ways to get a workout while taking it easy on joints, said Amin. Tai chi and yoga are also good forms of exercise that can strengthen muscles and help maintain balance.

You can work with a physical therapist to develop a specific exercise program.  And, if osteoarthritis is making life difficult at home or work, making a list of those challenges and working with an occupational therapist can help, says Amin. It may also help to get proper cushioning and insoles for your shoes for both exercise and daily living.  Click here for more tips from the Mayo Clinic.

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.

Kids' excessive salty snacks are linked to obesity, high blood pressure; new limits on school vending items may help

As new research shows that America's child-obesity epidemic is linked to eating too many salty snacks,  new federal regulations could ensure that vending-machine snacks in Kentucky's schools are healthier and lower in sodium.

Spurred by children eating too much salt and being too fat, "blood pressure in America's kids and teens has gone sky-high," creating a young generation at risk for serious health problems, including heart disease, stroke, reports Brian Alexander of NBC News.

“Kids eat far too much sodium,” the study's co-author, Dr. Stephen Daniels told NBC. “And they aren’t adding it at the table, and their parents aren’t putting it into food; they’re getting it through processed foods.” The research, published Monday in the journal Hypertension, links this rising blood pressure to children's increasing bod- mass index and sodium intake.

The "Smart Snacks in Schools" nutrition standards, announced last month by the Department of Agriculture, require any food sold in public schools to meet calorie, fat, sugar and sodium limits. The changes shouldn't be very significant for Kentucky students because the state already prohibits vending machine sales during the school day. And, a few existing state regulations, like fat content, are tougher than the federal changes and will remain in place, Sue Bartenfield, nutrition program manager for the Kentucky Department of Education, told Stu Johnson of the Kentucky Public Radio bureau in Frankfort. The new federal limits on calories and sodium are tighter, and the federal law will also keep vending machines shut down for a half-hour after school, Bartenfield told Johnson.

Owsley men most likely in U.S. to be obese, Perry women most likely to die; Morgan women led nation in increasing exercise

Men in Owsley County are the fattest in the United States, and women in Perry County have the lowest life expectancy, 72, according to an NBC News report based on data assembled by the Seattle-based Institute for Health Metrics and Evaluation, which has developed a county-by-county, interactive map of obesity, physical activity, high blood pressure and life expectancy from 2001 to 2011.

In 2011, according to the map, 46.9 percent of men in Owsley County were obese. Women in the county were even fatter, at 53 percent, but that was well under the highest female-obesity county in the nation, Issaquena County, Mississippi, where 59.3 percent of women were obese.

Owsley was also the county where men were least likely to report that they get sufficient exercise, only 33.1 percent. But a nearby county, Morgan, was the one where weekly exercise increased the most in any U.S. county from 2001 to 2011 -- from 18.3 percent to 44 percent.

Several counties adjoining or near Owsley ranked almost as high in obesity, creating a cluster of high-fat counties in Central Appalachia. Here are the pertinent parts of the 2011 maps, with male obesity on the left and female on the right; for the interactive map, click here.

Female obesity rates by county, 2011

Male obesity rates by county, 2011

Parents should walk the walk, not just talk the talk, when it comes to healthy eating and exercise, study shows

A new study highlights the influential role parents have in shaping their children's eating and exercise habits. Children of mothers who encourage them to exercise and eat well, while doing likewise themselves, are more likely to be active and healthy eaters, says a Duke University study.

Both exercise and healthy diets are critical in fighting childhood obesity, a significant problem in Kentucky, where more than one in four kids aged 2 to 5 are already overweight or obese, says a report by the College of Public Health at the University of Kentucky.

At the same time parents are setting a good example for their children, they can keep themselves healthy; being overweight or obese greatly increases the risk of developing chronic diseases like diabetes, arthritis, heart disease and cancer.

The Duke study is a reminder that parents are influential role models in shaping their children's habits, whether that's good or bad. "It’s hard for parents to change their behaviors, but not only is this important for you and your own health; it is also important for your children because you are a role model for them,” said Marissa Stroo, a co-investigator on the study. “This might be common sense, but now we have some evidence to support this.”

To promote healthy dietary and physical behaviors in children, a healthy home environment and parental role modeling are important, the researchers say. They recommend limiting access to junk foods, providing access to fruits and vegetables at home, setting parental policies to support family meals and increased consumption of healthy foods, and encouraging children to play outside to increase their physical activity.

“Obesity is a complex phenomenon, which is influenced by individual biological factors and behaviors,” said study author Dr. Truls Østbye, professor of community and family medicine at Duke. “But there are variations in obesity from one society to another and from one environment to another, so there is clearly something in the environment that strongly influences the obesity epidemic.”

These findings are important because they show that being overweight doesn't just come from your genes, and parents can be actively involved in improving the health and well-being of Kentucky's children. In this study, Østbye and his colleagues examined the relationship between the home environment and behaviors related to obesity, such as dietary and exercise habits, among 190 preschoolers. The study was published online in the International Journal of Obesity. (Read more)

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

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.

Medicaid expansion would have 'a big health impact,' and critical-access hospitals need to change, rural-health expert says

Expansion of the Medicaid program under federal health-care reform would have a major beneficial impact on the health of Kentucky, a doctor who ran the state and national rural-health agencies told a rural-health meeting in Louisville Tuesday.

"Medicaid expansion has a big health impact," Dr. Wayne Myers, left, told those at "Doing Care Differently in Rural Kentucky," a seminar sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association in Louisville, just before the opening of the National Rural Health Association's three-day conference in the city.

Myers said that in the three states that expanded Medicaid eligibility since 2000, one life was saved for every 176  people added to the program, according to a study by the Harvard University School of Public Health, published in the New England Journal of Medicine. If that figure were extrapolated to the entire nation, the number of lives saved would be greater than if breast, prostate and stomach cancer were eliminated, Myers said.

Skeptics argue that Kentucky can't afford the estimated 6.3 percent annual cost increase for expanding Medicaid eligibility up to 138 percent of the federal poverty level, but Myers said, "It would be nice to shift that argument from dollars to health impact." He said that if the three cancers were curable with a certain amount of money, and you argued that the nation should not spend it because of the cost, "You'd have an uphill argument."


Myers also said Eastern Kentucky would be an ideal place for Medicaid and Medicare to start rewarding small, rural hospitals for increasing their role in health promotion and disease prevention.

The federal designation of "critical access hospital" has kept open many rural hospitals, which get greater Medicare and Medicaid reimbursements in return for limiting beds, procedures and patient stays, but President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted.

"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.

Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas, including Eastern Kentucky, are declining. "That's really scary," he said.

Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.

He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.

The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said.

"If it makes sense anywhere, does it not make sense in Kentucky?" Myers asked, reiterating the question to focus on the state's Fifth Congressional District, which he said has the nation's lowest life expectancy. When a questioner mentioned the district's congressman, House Appropriations Committee Chairman Hal Rogers, Myers suggested the program could be named for the Somerset Republican.

Other speakers at the seminar called for new approaches in rural health, despite obstacles.

"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.

He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."

Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.

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).

Common beliefs about obesity and weight loss found to be myths

Think going to gym class drives weight loss, or that breastfeeding protects a child from obesity? Think again, because these are among seven popular myths about obesity myths, according to an international team of researchers.

The seven popular but largely inaccurate beliefs, which lead to poor policy decisions, inaccurate public-health recommendations and wasted resources, were identified by the team led by David Allison, associate dean for science in the School of Public Health at the University of Alabama at Birmingham.

Here are the seven myths:

• Myth 1: Small, sustained changes in how many calories we take in or burn will accumulate to produce large weight changes over the long term.
Fact: Small changes in calorie intake or expenditure do not accumulate indefinitely. Changes in body mass eventually cancel out the change in calorie intake or burning.

• Myth 2: Setting realistic goals in obesity treatment is important. Otherwise, patients become frustrated and lose less weight.
Fact: Some data suggest that people do better with more ambitious goals.

• Myth 3: Gradually losing weight is better than quickly losing pounds. Quick weight losses are more likely to be regained.
Fact: People who lose more weight rapidly are more likely to weigh less, even after several years.

• Myth 4: Patients who feel “ready” to lose weight are more likely to make the required lifestyle changes, do health-care professionals need to measure each patient’s diet readiness.
Fact: Among those who seek weight-loss treatment, evidence suggests that assessing readiness neither predicts weight loss nor helps to make it happen.

• Myth 5: Physical-education classes, in their current form, play an important role in reducing and preventing childhood obesity.
Fact: Physical education, as typically provided, does not appear to counter obesity.

• Myth 6: Breastfeeding protects children against future obesity.
Fact: Breastfeeding has many benefits for mother and child, but the data do not show that it protects against obesity.

• Myth 7: One episode of sex can burn up to 300 Kcals per person.
Fact: It may be closer to one-twentieth of that on average, and not much more than sitting on the couch.

The research team also defined six “presumptions" that are generally held to be true even though more studies are needed before conclusions can be drawn, such as the idea that regularly eating versus skipping breakfast contributes to weight loss. Studies show it has no effect.

The same goes for the idea that eating vegetables by itself brings about weight loss, or that snacking packs on the pounds. According to Allison and colleagues, these hypotheses have not been shown to be true, and some data suggest they may be false.

The researchers also identified nine research-proven facts about weight loss. For example, weight-loss programs for overweight children that involve parents and the child’s home achieve better results than programs that take place solely in schools or other settings.

Also, many studies show that while genetic factors play a large role in obesity, “Heritability is not destiny.” Realistic changes to lifestyle and environment can, on average, bring about as much weight loss as treatment with the most effective weight-loss drugs on the market. (Read more)

Childhood obesity is linked to more immediate health problems than doctors formerly realized

While a plethora of research on childhood obesity has linked it to long-term health problems, a new UCLA study focuses on the condition's more proximate consequences, showing that obese children are at a greater risk for immediate health problems than previously thought. That's important for Kentucky, which ranks poorly in many health measures and is third highest in child obesity. (Photo by Tara Kaprowy)

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA.

Compared to kids who are not overweight, the study found that obese children have nearly twice the risk of having three or more reported medical, mental or developmental conditions. Specific medical conditions included bone, joint and muscle problems; asthma; allergies; headaches; and ear infections. Obese children also reported a greater tendency toward emotional and behavioral problems, higher rates of grade repetition, missed school days and other school problems, ADHD, conduct disorder, depression, learning disabilities, and developmental delays.

The study provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, a UCLA release said. Halfon said these findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for health conditions associated with childhood obesity. (Read more)

Military culling overweight and obese troops; Ky. recruitment drops

Between 1998 and 2010, CNN reports, the number of active-duty military personnel deemed overweight or obese more than tripled. In 2010, 5.3 percent of the force -- or 86,186 troops -- received at least a clinical diagnosis of overweight or obese, according to the Armed Forces Health Surveillance Center. The trend has prompted the Pentagon to re-examine its training programs, and it is now actively weeding out soldiers deemed unfit to fight. It is also a tidy way to trim the budget at the same time as federal cuts loom. (CNN photo)

During the first 10 months of this year, 1,625 soldiers were dismissed for being out of shape. That's  about 15 times the number discharged for that reason in 2007 at the peak of wartime deployment, CNN reports. Overweight are considered "substandard" fighting units and a threat to national security and the nation' ability to maintain an adequate defense. Obesity is now the leading cause of ineligibility for those wishing to join, say military officials.

Kentucky ranks 34th in state recruitment rates. The numbers -- as a percentage of the recruits per 100,000 youth aged 18-24 -- dropped steadily from 2007, when it was 2.53 percent, to 2010, when it was 1.94 percent. Perhaps the state's high obesity rate was a reason. (Read more)

Rural Obesity Prevention Tool Kit created to tackle epidemic: 40 percent of rural adults in U.S. are obese

When the Journal of Rural Health recently reported that 40 percent of adults living in rural areas are obese, compared with 33 percent of adults living in urban areas, the size of the disparity was larger than expected and previously estimated. In response to the severity and urgency of the obesity epidemic, the Rural Assistance Center of the U.S. Department of Health and Human Services has created a Rural Obesity Prevention tool kit which contains resources to help communities develop obesity prevention programs. (Read more)