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.

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)

Japan approves a high-fiber version of Pepsi as a fat blocker

Let's start here: Way too much of Kentucky is way too fat. And, let's add this, we drink lotsa sugary beverages. Why, our intake of Mountain Dew alone is legendary. So, here comes some news out of Japan which may have particular interest to Kentuckians: This week, Pepsi will start marketing a new product called Pepsi Special that is special indeed, since it has the blessing of that country's National Institute of Health and Nutrition as a "food for specified health use." That use, you ask? Fat blocking. Let me at it, you say? Hold up, we caution. Pepsi Special is, in a nutshell, Benefiber Pepsi.

According to reporters at the The Atlantic magazine, wheat dextrin is the same additive in Pepsi Special as the one that's sold as Benefiber in the U.S. It's a soluble fiber that "absorbs water as it moves through our intestines and promotes movement of food through the bowel, and contraction of the bowel wall itself." In a 2006 Japanese study, rats that ate wheat dextrin absorbed less fat from their food because, notes the magazine, "It essentially moved right through them."

So, is any of this actually good for you? Dextrin "may increase micronutrient absorption, stabilize blood glucose, lower serum lipids, may prevent several gastrointestinal disorders, and have an accepted role in prevention of cardiovascular disease," experts say. But you still have to restrict your soda intake for any of this to matter. (Read more)

Anthem funds program to fight childhood obesity in Louisville area

A $35,000 Anthem Foundation grant to the American Academy of Pediatrics will allow a program that fights childhood obesity in Louisville and northern Kentucky counties to continue, reports Darla Carter of the The Courier-Journal. The grant provides free YMCA memberships and fitness and nutritional guidance to families of 9- to 17-year-olds with weight issues who have been referred by member physicians. The foundation is a philanthropic arm of Anthem Blue Cross and Blue Shield in Kentucky. 

Wellness programs looking good as business investments

Businesses should like these numbers a lot: Invest $1, get $3 back. That's the latest math on the return on employee wellness programs and experts are saying that may just be the start for the financial returns they can expect from targeted prevention efforts. Mark Green of The Lane Report writes that no less of an expert than Dr. William Frist of Nashville -- doctor, policy specialist, former U.S. Senate majority leader and venture capitalist -- has said: “No question in my mind, if we are to invest a dollar to have the greatest value in terms of outcome and results, we should put that dollar in prevention and wellness."

Frist, reports Green, "is a strong advocate of wellness -- as a business practice to adopt and a business sector to be in. Individual doctors, hospitals and the entire healthcare industry need to get involved, he said." Frist broke down for Green what factors most determine how long someone lives: “The numbers break down 30 percent genetic, 5 percent environmental, 15 percent socioeconomic, which is surprising to a lot of people, and then 40 percent behavioral: wellness, prevention. And then what is left (10 percent) is who your doctor is, what hospital you go to, what your emergency room is.” Those numbers  are important to Frist because to impact longevity healthcare spending over time, he said, resources should be on the 40-percent sector: behavior, wellness and prevention. Think smoking programs, weight loss, exercise, nutrition, seatbelt use. (Read more)

Doctor's rejection of the willfully obese makes exercise expert ask: Who's responsible for your health? Who should pay for it?

Bryant Stamford, professor and chairman of the Department of Kinesiology and Integrative Physiology at Hanover College in Indiana, wrote in his weekly exercise-and-health column Thursday's edition of The Courier-Journal:

"I caught an interesting news story on TV about a physician who refuses to treat obese patients. That was the headline. In truth, when she was interviewed she made it clear that she had a number of obese patients and she was treating them," if they were willing to lose weight. She referred the other obese patients to physicians who specialized in care of the overweight.

Stamford asked: "Is this approach the rationing of health care? It’s rationing it to those who take responsibility for themselves by managing their weight. . . . I don’t support withholding health care to anyone, and that includes the obese and smokers. But it does raise the issue of who is responsible for your health. We spend far more on health care than other industrialized countries, and we are bankrupting our health-care systems, including Medicare and Medicaid. Why? We follow a health-destroying lifestyle, then we expect to jump into the health-care system and have it perform miracles. And, more often than not, it does, but it costs a fortune for each patient. Does this make any sense?"

He points to ways in which some countries have decided in what order people get heart surgeries -- those who smoke are not first in line. What it could mean in the future for us?  "I believe the writing is on the wall. ... If you engage in health-destroying behaviors, you will be required to pay a lot more for health insurance. It’s the model for life insurance, and there already are rumblings around the country supporting a move in this direction. Stay tuned." Read the column here.

Calorie counts on your Coke and Pepsi machines coming in 2013

Coca-Cola, PepsiCo and the Dr Pepper Snapple Group, for starters, will start displaying calorie counts on vending machines in an effort to encourage consumers to make lower-calorie choices, starting in 2013. The plan, explains Time magazine, falls in line with the Patient Protection and Affordable Care Act’s requirement that vending machines and restaurant chains with more than 20 locations display calorie information. The labels will be marked "Check Then Choose" or "Try A Low-Calorie Beverage." The industry initiative, called the Calories Count Vending program, will begin its launch in city buildings in Chicago and San Antonio, where government employees are participating in a “wellness challenge.” The nationwide rollout will begin next year.

Time reporter Olivia B. Waxman asked whether this move will make a difference in calorie consumption. Early research didn't hold much hold, but later studies were more promising, she reports: "Studies have found that calorie information, when presented clearly — and at the point of sale — does tend to sway people’s eating and drinking behaviors. In a December study published in the American Journal of Public Health, for example, researchers at Johns Hopkins went to corner stores in predominantly black neighborhoods and posted signs with calorie information about sugary drinks (sodas, fruit drinks, energy drinks and the like) on refrigerated beverage cases. Overall, the study found, black teens — a population that is more likely to consume sugary drinks and is at higher risk of obesity than other groups — were 40 percent less likely to buy soft drinks when they saw the calorie signs. They were even less likely to buy them when the calorie labels put information in context: for instance, by noting that it would take 50 minutes of running to burn off the calories in one sugary drink. Those signs reduced soda consumption by 50 percent." (Read more)

UK and Purdue researchers find a compound in watermelon that fights 'bad' cholesterol and arterial plaque in lab rats

A study from the University of Kentucky and Purdue University showed that mice fed a diet including watermelon juice had lower weight, cholesterol and arterial plaque than a control group. The findings, reported in the Journal of Nutritional Biochemistry, suggest that citrulline, a compound found in watermelon, plays a role in cardiovascular health. "We were interested in citrulline because previous studies showed that it may lower blood pressure,"  Shubin Saha, a Purdue Extension vegetable specialist and study co-author, told Medical Xpress. "We didn't see a lowering of blood pressure, but these other changes are promising."

"The researchers fed two groups of mice diets high in saturated fat and cholesterol," MX reports. "Half the mice received water containing 2 percent watermelon juice, while the others received the same amount of water supplemented with a solution that matched the carbohydrate content of the watermelon juice. The mice that consumed watermelon juice gained about 30 percent less weight than the control group and had about 50 percent less LDL cholesterol - the so-called bad cholesterol. The experimental group also had about a 50 percent reduction in plaque in their arteries, as well as elevated levels of citrulline." Sibu Saha, a professor of surgery at UK, explained that the researchers are not sure at what molecular level the citrulline is working, but that is their next step.

Shubin Saha was excited about the dual benefit of the findings. "Twenty percent of each year's watermelon crop is wasted either because the fruit is visibly unappealing to consumers or because some growers find it too expensive to pay for harvesting as prices drop during the height of watermelon season." The wasted melons, he explained, could be put to use extracting these very beneficial compounds.  (Read more)

Do Kentucky families care about obesity? Louisville newspaper blog says yes; now comes the hard part

In The Prime, The Courier-Journal's collection of news, features, videos and blogs "that help you thrive as you age" has taken on a new crusade: obesity. It's a brave initiative in the blog's ongoing effort to get families on board with better health, better eating and longer lives. The blog started with a simple question: Do Kentucky families care about this issue? The answer is a resounding yes. Sharon Cecil, writing for the nutritional, medical, spiritual and fitness advisers on the blog board, explains that the group has done a year's worth of work and has now scheduled focus groups for more specifics. Stay tuned here.

Louisville cardiologist John Mandrola, meanwhile, takes on sugary drinks in the Sept. 22 blog installment of In the Prime. He astonishes with the simple fact that the average male teen drinks 357 calories daily from sugar-sweetened beverages. Not a useful nutrient in sight. And, he adds, if that male is pre-determined genetically to be obese, a Harvard study just found that could be even more susceptible to the harmful effects of sugar-sweetened beverages. The bad news only gets worse. (Associated Press photo)

Lastly, Cecil, a nurse, has high marks for the HBO series, "The Weight of the Nation: Confronting America's Obesity Epidemic." Go here to see all parts of that series.

HBO's 'Weight of the Nation' examines the obesity epidemic

A compelling four-part documentary delving into the obesity epidemic sweeping the country is being aired on HBO and can be watched free by clicking here. A reporter wanting to write a series of stories on the issue would find "weight of the Nation" a good reference.

The program is divided into four parts. The first segment, "Consequences," looks at the scope of the epidemic and the ramifications of being overweight or obese. "Choices" looks at the science behind how to lose weight, how to maintain weight loss and prevent weight gain. The third part, "Children in Crisis," looks at how the problem is affecting American children, exploring the decline of physical activity, school lunch, the demise of school recess and how marketing of unhealthy food targets children. The final segment, "Challenges," looks at the major forces driving obesity, including agriculture, economics, evolutionary biology, food marketing, racial and socioeconomic disparities, physical inactivity, American food culture, and the influence of the food and beverage industries.

The documentary is on a detailed website that answers questions that range from "What is obesity?" to "How do I know if I'm overweight or obese?"

The project is a presentation of HBO and the Institute of Medicine in association with the Centers for Disease Control and Prevention and the National Institutes of Health, with support from the Michael and Susan Dell Foundation and health insurer Kaiser Permanente.

Lessons in battling obesity can be learned from the anti-tobacco movement, but there are big differences

To make real headway in battling the obesity epidemic, lessons can be learned from the war on smoking — though the two public-health issues have certain unique challenges. Judith Graham, reporting for Kaiser Health News in collaboration with USA Today, delves into the similarities and differences.

Her piece deserves to be read in its entirety, which can be done by clicking here, but here's a summary of her analysis:

Children are central. The majority of people start using tobacco as teenagers, with one-third of kids who smoke daily set to die prematurely of tobacco-related illnesses. Likewise, overweight children are at a greater risk of a vast array of health problems, including diabetes, liver disease and obesity in adulthood.

Protecting children as at the heart of both the anti-tobacco and anti-obesity efforts. "First let's protect our children," said Dr. David Ludwig, a child-obesity expert at Harvard Medical School. 

Changing social norms is the goal. While smoking in a hospital or airplane has become inconceivable, the same shift in social norms is required to fight childhood obesity. "Our (eating and physical activity) tastes, our preferences and our behaviors are learned and can be changed," said Dr. Jeffrey Koplan, former head of the Centers for Disease Control and Prevention and vice president for global health at Emory University in Atlanta. It won't be easy, but at least "we're dealing with a population that would like to be thinner and that works in our favor."

We can't "just say no" to food. "Tobacco we can get rid of entirely," said Dr. David Katz, director of Yale University's Prevention Research Center. "But we have to eat to live and make terms with food as the enemy."

That makes fighting childhood obesity much more difficult, since the message can't be "stop, don't do this." It has to instead be "make good choices, set boundaries," which is more difficult to convey and adhere to, Graham reports.

Our biology works against us. "While smoking is highly addictive, the biological responses attached to eating food are even more deeply rooted in human evolution," Graham reports. Evolutionarily speaking, humans are "built" to eat food when it's available and "we're very good at storing calories and defending calories once we've got them," said Dr. Stephen Daniels, chair of the department of pediatrics at the University of Colorado School of Medicine. 

Shame and denial are greater among the obese. A person's self-image is tightly tied to his or her body weight in a way that isn't true of smoking. That can provide a compelling reason to stop over-eating, but people don't tend to think of themselves as obese. "Obesity is seen as a pejorative term that people don't connect with," said Dr. William Dietz, director of the division of nutrition, physical activity and obesity at the CDC. "They think, 'I'm just 30 or 40 pounds overweight, but I'm not obese.'"

There are more food products available. "Tobacco is a single substance," Graham reports. "By contrast, the food and beverage industry is enormous and makes a huge array of goods that extend into every home, restaurant, convenience store, and grocery store in America."

There is no second-hand smoke equivalent. "The notion that my behavior as a smoker can have an effect on you and can make you sick was critically important in accelerating people's intolerance of smoking and their willingness to see the government take action," said Michael Eriksen, director of the Institute of Public Health at Georgia State University. "Your being obese does not affect me in the same direct way."

The role of the food industry is less clear. While Big Tobacco was able to be demonized, "with obesity (as compared to tobacco) there's a much more nuanced relationship with industry," said Dr. James S. Marks, director of the health group at the Robert Wood Johnson Foundation.

Couple loses combined 347 pounds in 2 years, pretty simply; similar success stories are always compelling

"When Art and Betty Halcomb look at each other, they still have a hard time believing how much weight they have lost," reports Nola Sizemore for the Harlan Daily Enterprise. Together, the couple has lost 347 pounds, a journey that started in April 2010.

Art weighed 384 pounds and Betty was 308. "We decided we were going to do everything we could do in a three-month period to see how much weight we could actually lose," Betty said. That included counting calories and daily exercise, which at first comprised for a half-mile of walking. Within two weeks, they were able to walk one mile.

"We did portion control with our meals, actually measuring out serving sizes," Betty said. "I was eating 1,200 calories per day and Art was eating 1,500 calories per day. We didn't limit ourselves to any certain foods. We wanted it to be a lifestyle change, not just another diet."

One of their major motivations was their daughter, Kristen Swanner, a two-time cancer survivor who has endured chemotherapy, radiation and a stem-cell transplant. To watch her "literally fight for her life and we were just throwing ours away, we felt so guilty," Betty said.

When they discovered Swanner was pregnant, after being told by doctors that she couldn't conceive, the couple had even more drive to shed the weight, knowing they were soon to be grandparents.

"Jesus says he wants us to have an abundant life," Betty said. "If we can do this, anyone can do it. Make that decision today to lose weight and live a more happier life. Don't give up — keep trying." (Read more)