Insurance reform?

I have been frustrated by the whole health care reform debate. Now that health care reform is "over" perhaps it is time to reflect a little. It seems to me that the debate was not so much about reform as about insurance. To reform the system would be to change the basic structure of how care is provided and what is paid for. Clearly we are not ready for that! When talk of looking at end of life issues conjures up discussion of "death panels" and adjustments of insurance coverage are defined as massive reform, I don't think either side gets it. As long as we do more and more complex procedures for more and more people who (by virtue of what we are doing) live longer and longer, costs cannot go DOWN. Now if we actually focus on prevention, keeping those same people from getting sick initially, THEN maybe costs can go down.

I believe insurance is the wrong model for health care. I have fire insurance on my house, collision insurance on my car, but I really do not want to use either of them. I don't know the statistics, but I'm sure almost everyone who has health insurance uses it every year. This is not insurance but pre-payment. To be sure, few of use could afford a serious medical evaluation without insurance, but why do we want it to cover everything? All we are doing is offering to pay someone else for for giving our own money back to us (less a substantial fee!). Can you imagine loaning money to the bank and they paying them to keep it for you? With the exception of catastrophic coverage, that is essentially what we are doing.

As a physician, I recognize that fewer people would see me if they had to pay out of pocket, and that is indeed one of the struggles of a primarily wellness business. the ones who do, however, are motivated to transform their lives. This is true health reform.

Tortoise and the Hare

You know the old story of the tortoise and the hare. The hare starts out fast, gets over confident and loses the race to the slow but steady tortoise. For many this seems to be the case in weight loss. It has always been alleged that fast weight loss is unhealthy. Although I have lost the reference, there as a recent study showing that actually rapid weight loss may be more beneficial in achieving both greater and more lasting results. This is only one study and hardly enough to draw conclusions. Nevertheless, rapid weight loss is not unhealthy per se. Unmonitored rapid weight loss and unhealthy eating is risky for sure. There have been many documented deaths from starvation diets, unwise use of over the counter appetite suppressants and the like. It should be noted there are far more deaths attributable to obesity and inactivity, but we all know that.

As a bariatric physician, it is my experience that rapid weight loss under supervision is quite beneficial. We observe our clients who get off to a good start are more likely to keep up their losses and less likely to drop out. getting up a full head of steam right out of the gate does help in my opinion.

Overall, my bet is on the hare, as long as we can keep him directed and not overconfident!

Too fat to fight!

A recent article on our bariatric society web site quoted top military officials as complaining about obesity in the 17-24 age range. Currently about 27% are too overweight to join the military. As an "old guy" from the Vietnam War era, I never even knew this could be a reason for rejection! I took my chances with the lottery and fortunatly did not get drafted due to a favorable number. How times have changed. The pedicatric obesity problem has gotten a lot of press as has the general population problem, but I'm not sure this particular age group ha gotten much press. This is the age where folks should be in their prime. This is the time to look back on when our health begins to fail: "If I were only 21 again!"

How can we help people see the course they have set for themselves? Children are dependent on parents, adolescents heavily influenced by peers, but this group is in the process of maturing fully. As a society we need to find ways to help with positive body image, mature patterns of eating and activity, and a sense that life is to be lived fully, not just observed on a screen. Yes, the business of life gets in the way, but all the more reason focus on staying healthy.

April Foolish Advice

With tongue fully planted in cheek I offer the following weight loss advice:

1. Use that newly released secret recipe that the medical community is hiding so they all don't go broke. It results in excellent weight loss and improved health (as long as you take it at least three times per day after 60 minutes of vigorous exercise)

2. Eat less and exercise more. That's all it takes! (Actually this is somewhat true but often results in weight gain on a practical basis. People find it hard and give up because it is not as simple as it seems!)

3. Want to lose weight, go to bed earlier.(Also some truth in this! Getting less sleep is associated with weight gain, but an earlier bedtime is usually not sufficient to result in weight loss on it's own.)

4. When your doctor stops recommending rest and starts recommending diet and exercise, change doctors! (You may not lose weight but you will gain a co-dependant!)

5. You are a strong independent American and can do it on your own! Don't bother trying to get any help. (Actually 25% of people can lose 20 pounds on their own but most cannot keep it off.)

6. Join NASA, in outer space we are all nearly weightless!

7. Don't investigate any claims of pills or providers who promise miracles. After all, they wouldn't be allowed to say it if it wasn't true, right? (BTW, I have this bridge in Brooklyn you may be interested in....)

8. Wait for the weight to come off. It's bound to happen as soon as _____ (fill in in the blank) starts or stops. (BTW, about that bridge....)

9. Keep your tongue in your cheek. This will make chewing and swallowing impossible with resultant impressive weight loss.

10. Laugh it off. Actually some truth to this also. Stress is reduced by laughing, and you can at least lose that heavy mood!

Save your brain with the Mediterranean diet?

According to Gad A. Marshall, MD (Instructor in Neurology, Harvard Medical School, and Associate Neurologist, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston) two recent studies demonstrate a reduction in the risk of mental decline in people who follow a Mediterranean diet. In a study in New York City, risk this showed up as a decline in the risk of Alzheimer's dementia in those who followed a Mediterranean diet, exercised regularly, or both. The hazard ratios were 0.6, 0.67, and 0.64 respectively. The study was large, well controlled of confounding factors and followed people for over 5 years. It would appear that in this population the diet reduced the risk of dementia by about 30-40%! A similar study in France, which was smaller, showed reduced cognitive decline (better maintained brain function) but not reduced risk of dementia. This study may not have been powerful enough to show benefit in preventing Alzheimer's, but results are still encouraging.

It seems to me the more we learn about diet and exercise, the more benefits we find. Perhaps Hippocrates was on to something when he recommended healthy (presumably Mediterranean given his location) diet, fresh air and exercise!

An example of good parenting!

I was sitting on our front porch this evening because it was warm and beautiful. Lots of people were walking by, walking dogs, riding bikes etc. A mother with a boy about 4-5 years old passed. He was riding a bike which hit a bump and he went sprawling hands first onto the sidewalk. It almost looked like he leaped forward. He rolled over onto his butt and was clearly unhurt. He looked up at "Mom" for a reaction. I would expect to see her concern, maybe some sympathy, even offering a cookie or treat. Many times I've seen the "Oh, oh are you OK" response which usually just make the child cry. This Mom remained smiling. Her response was "So, did you catch the rabbit?" How inspired! He did look a lot like my beagle when she tries to jump something, only difference is no howl from the kid! I couldn't tell the mother what a good job she did, and I doubt she will ever read this, but at least I can tell someone. Hope it helps you keep your stumbles in perspective. May you "catch the rabbit!"

Wholistic, holistic or integrative?

There are a lot of terms around to describe the attempt to integrate body mind and spirit into health. Some of the more common terms are integrative, functional, mind-body, holistic and wholistic. None of these terms yet conveys anything very specific about the practitioner or style of practice. I'd say this is in development, but if so it has been for a long time! When I first became interested in "wholistic" medicine it was spelled with a "W" and done mostly in church basements. The "holistic" moniker has often been used by chiropractors and often includes nutrition, supplements and the like as well as manipulation. Integrative and functional are more recent terms used by a variety of practioner types, including a few of us bolder MD's. It implies bringing together multiple disciplines to improve health and/or treating function rather than disease.

As I reflect on my preferences, I find myself gravitating toward the older "Wholistic" for a few reasons. The concept of "whole" including multiple aspects of body, mind and spirit. I know the actual root of "holistic" is "hol," the same root as Holy. It seems to imply more focus on the spiritual. Although this emphasis is not a bad idea given the subordinate position the spirit is usually given, a more even emphasis is more to my liking. I think as a wholistic practitioner I should be willing to address body mind and spirit in any combination and not value one above another.

Comments?