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War on Obesity: Pre Diabetes Part 20

 Stanley Feld M.D.,FACP, MACE

This is a continuation of my War on Obesity.

The New York Times has criticized Donald Trump’s healthcare plan without even knowing what is in it.

I hope all the features of a healthcare plan missing from President Obama’s healthcare plan are included in President Trump’s healthcare plan. I believe Dr. Tom Price knows most of what needs to be included. He also knows that Obamacare is a disaster. It must be repealed.

I have written a series of articles outlining what should be included President Trump’s replacement healthcare plan after he repeals Obamacare.

I believe the critical element necessary for Repairing the Healthcare System is the development of a healthcare system in which consumers are responsible for their health and healthcare dollars.

This is the main reason Obamacare needs to be repealed. Obamacare makes consumers of healthcare dependent on the government and less responsible for their own healthcare.

Joan Colgin R.N. was Endocrine Associates of Dallas P.A.’s first fulltime Diabetes Educator. I nominated her for Diabetes Educator of the year some years back. She came out second to a woman who was trying to provide diabetes education to an indigent population. Endocrine Associates of Dallas P.A. was providing effective Diabetes Education on a one on one basis to consumers of all socioeconomic groups.

Joan provided Diabetes education to all people who were interested in learning to be responsible for the self-management of their Diabetes Mellitus. Patients live with their disease 24 hours a day and must learn how to manage it.

Endocrine Associates of Dallas P.A. was extremely successful in motivating people to be responsible for their own care.

Joan is presently the nurse member of the Texas Diabetes Council. Recently she asked me to publicize the CDC’s new position statement on Pre-Diabetes.

The National Institute of Diabetes (niddk.nih} published Overweight and Obesity statistics:

  “More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

 “ More than one-third (35.7 percent) of adults are considered to be obese.”

 “ More than 1 in 20 (6.3 percent) have extreme obesity.”

 “ Almost 3 in 4 men (74 percent) are considered to be overweight or obese.”


My personal observation has been that 80% of patients in the Cardiac ICU have Type 2 Diabetes. Almost all have Type 2 Diabetes that was just discovered on this admission to the hospital.

We know the complications of Type 2 Diabetes Mellitus take at least 8 years after the onset of the disease to occur.

The Cardiac ICU patients either had Pre Diabetes (asymptomatic) or undiscovered Type 2 Diabetes Mellitus (also asymptomatic) for at least 8 years prior to their heart attacks.

The CDC position paper can be extremely helpful in reducing the cost of medical care to our healthcare system if it is rolled out effectively.

Eighty percent of our healthcare dollars are spent on the complications of all chronic diseases. Type 2 Diabetes Mellitus is the most prevalent.

The summary of the position paper is as follows:

“What Prediabetes is Trying to Tell You”

Did you know that people can have prediabetes for years without any clear symptoms?

It often goes unnoticed until serious health problems show up, like type 2 diabetes or heart disease.

But if you find out you have prediabetes early, you could make lifestyle changes proven to help safeguard your health.

Knowing your risk is the first step. If you have any of these risk factors for prediabetes, don’t wait—talk to your doctor about getting your blood sugar tested:

  • Being overweight
  • Being 45 years or older
  • Having a parent or sibling with type 2 diabetes
  • Being physically active less than 3 times a week
  • Ever having gestational diabetes (diabetes while pregnant) or giving birth to a baby who weighed more than 9 pounds
  • Being African American, Hispanic/Latino American, American Indian, Pacific Islander, or Asian American 
  • Want to find out your risk right now? Take the 1-minute quiz at organd be sure to share the results with your doctor.

 The summary is all you have to know. is an excellent questionnaire that takes two minutes to complete to determine if you are at risk for Type 2 Diabetes.

The CDC division of Diabetes Prevention includes a detailed position statement entitled:

The Surprising Truth About Prediabetes

The first sentence says it all!

It’s real. It’s common.

And most importantly, it’s reversible.

You can prevent or delay prediabetes from developing into type 2 diabetes with simple, proven lifestyle changes.

 The reason for the statement is simple to understand. We are all born with an inherited genetic make-up. About 33% of us have the genetic make-up that predisposes us to Type 2 Diabetes Mellitus.

Obesity will bring out the tendency to develop Type 2 Diabetes Mellitus by causing us to be resistant to our own insulin.

Our body in response to exposure to sugar secretes our insulin. If we are resistant to our own insulin our sugar level will increase to the point of officially having Type 2 Diabetic Mellitus.

America has an Obesity Epidemic.

“More than two-thirds (68.8 percent) of adults are considered to be overweight or obese.”

Americans are constantly exposed to too many calories. The only way to gain weight is to eat more than you burn. The only way to lose weight is to eat less and burn more.

One third of those 68.8 percent of obese people will get Type 2 Diabetes unless they lose weight to prevent its onset.

Unless those people lose weight they will be destined to suffer the morbidity and mortality resulting from Type 2 Diabetes Mellitus.

The only one in control of a person’s weight is that person. This is the reason that individuals must be responsible for their own care.

The government cannot provide weight loss. The government can provide education and incentives for individuals to be responsible for their own care.

Preventing the onset of Type 2 Diabetes will precipitously decrease the cost of medical care.

This is the reason a consumer driven healthcare system with consumers being responsible for their care is vital to a successful healthcare system.

I hope President Trump and all of congress is listening.

The opinions expressed in the blog “Repairing The Healthcare System” is, mine and mine alone.

All Rights Reserved © 2006 – 2017 “Repairing The Healthcare System” Stanley Feld M.D.,FACP,MACE

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War On Obesity: Part 19


 Stanley Feld M.D.,FACP,MACE

In February 2010, Michelle Obama announced her “Let’s Move” or “Healthy Food Financing Initiative” to combat childhood obesity.  President Obama announced that his administration would provide $400 million dollars toward his “Health Food Financing Initiative” run by Michelle Obama. Its goal was to bring grocery stores and healthy food retailers to underserved urban and rural communities across the nation. He would subsidize the purchase of healthy food for the under-served. 

What about the non-underserved communities and its obesity rates?

“The other elements include helping parents make healthy eating and lifestyle choices for their families; serving healthier food in schools; and increasing physical activity among the nation’s youth.”

 By August 2010 in a special session of congress the initiative grew to a $26 billion dollar subsidy distributed to the states.

The increase in funding for the initiative escaped public scrutiny.

“The Democratic congress passed a special session bill that epitomized everything people hate about Congress; a bill to help states was passed with $26 billion in money that was offset with strange accounting measures.”

This was shortly before the November 2010 elections. It was part of President Obama’s scheme to “redistribute wealth.”

Republicans and some Democrats reacted to the size of the initiative. President Obama’s administration moved money from other programs to fund the initiative and claimed the initiative did not increase the deficit.

Nancy Pelosi punted on Democrats’ and Republicans’ calls for debate before voting. The traditional media did not report the controversy.

“The two authors of the letter, Representatives James McGovern (D.-Mass.) and Keith Ellison (D.-Minn.), said, “This is one of the more egregious cases of robbing Peter to pay Paul.” 

The occasional public service announcements by Michelle Obama about the initiative are slick.


 Everyone agrees that obesity is bad for your health and bad for the skyrocketing healthcare costs. The nation’s perception about food and exercise must be changed. The poor and underserved are not the only ones that need to be educated.

America just keeps getting fatter. Obesity has continued to rise even after Michelle Obama started her initiative.

A comprehensive state-by-state report titled 'F as in Fat' shows that obesity rates continue to climb, along with diabetes and high blood pressure.


Two decades ago, not a single state had an obesity rate above 15%. Now all states do have an obesity rate of above 15%. 

“In the last 15 years, the report said, adult obesity rates have doubled or nearly doubled in 17 states. Two decades ago, not a single state had an obesity rate above 15%. Now all states are above 15%.”


The states with the highest levels obesity are states clustered near the Gulf of Mexico and Atlantic coasts as well as states along the southern Appalachian Mountains.

Alabama is the state with the highest obesity rate and one of the highest rates of Type 2 Diabetes Mellitus at 12.2%.

Twelve states with high obesity rates have had a significant increase in Diabetes as well as hypertension.  In Alabama, the hypertension rate is 33.9%. In Mississippi, the report found that 34.6% of adults have high blood pressure.

 Obesity among African American adults was higher than 40% in 15 states. Among Latinos, it was greater that 30% in 23 states. Latinos with obesity have a higher incidence of Type 2 Diabetes. The incidence is greater than 20% in most states.

In Caucasian adults, obesity rates were higher than 30% in four states. However, any percentage rate of obesity is going to lead to chronic diseases, increased complications of chronic disease and subsequently increased healthcare costs for that person and the state.

Michelle Obama’s initiative is partially correct. There are two vital conceptual errors. The emphasis is on kids in poor neighborhoods. All $26 billion dollars is going to be spent in under privileged communities while the epidemic includes all ethnic and socioeconomic groups.

Most importantly, the parents of the obese children are the drivers of food choices. The change must come from the parents. The parents must be taught to understand the risk of obesity and the consequences of that risk. There are many ways to accomplish this for less than $26 billion dollars.

Anita Dunn was President Obama’s communication director in 2009. President Obama called her one of the most valuable people in his administration. She left the administration and is now the head of SKDKnickerbocker a public relations and lobbying firm.

She has taken on Michelle Obama “Lets Move” initiative by managing a campaign for a group called “the Sensible Food Policy Coalition” The group includes General Mills, Kellogg, PepsiCo, Viacom and Time Warner.

Read that last line again. You get it?


It is easy to visualize why this group of companies would be opposed to eliminating empty calories from kids’ diets. It would mean a lot of lost revenue. Time Warner and Viacom would lose a lot of advertising revenue for its various TV channels advertising junk food to kids if Mrs. Obama’s initiative were successful.


“Consumer groups say the food lobby is aiming to capitalize on Dunn’s connections, particularly among Democrats more sympathetic to nutritional guidelines. The Center for Science in the Public Interest said Dunn and her firm “should be ashamed.”

Dunn dismissed the criticism.

“Without resorting to personal attacks, everybody should be able to work together towards a common goal here,” she said. “At the end of the day, combating childhood obesity is not a question of what gets advertised but a matter of more exercise, healthier eating habits and working together.”

 Ms. Dunn’s statement is lame. It should be about doing the right thing. Unfortunately neither Michelle Obama nor Anita Dunn is doing the right thing.




War on Obesity: Part 18


Stanley Feld M.D.,FACP,MACE

 There are many perverse economic incentives causing obesity in our society. A cultural change toward food has to occur in America in order to decrease the ever-increasing obesity epidemic. Obesity leads to chronic disease. Chronic disease leads to increased healthcare costs. Eighty percent of the healthcare dollars are spent on the treatment of the complications of chronic disease. 

It is time for action to neutralize the barriers that exist for people to overcome obesity in America. 

I do not believe therapeutic tricks work. I know short-term diets do not work. We tried a very low calorie diet program at Endocrine Associate of Dallas P.A. in 1985. The program combined behavior modification along with a very low calorie diet for obese Type 2 Diabetics. It worked short term but failed long term.  We discontinued the program.

I do not believe medication to decrease appetite works. Many of the medications are harmful to one’s health.  A shift in society’s thinking about food is necessary.

Mrs. Obama has planted a garden in the White House’s back yard. She has started a public service program that focuses on obesity in children. Her program should focus on the entire population because adults’ behavior influences childrens’ behavior.


Mrs. Obama’s initiative falls short. There has been no visible continuous follow-up. The media is the message. As our TV addiction grows so does our exposure to junk food advertising. It can be overcome by continuous news about her initiative.  

Mrs. Obama’s message also has some scientific errors. Her message pushes fresh vegetables only. Fresh frozen vegetables are just as nutritious as fresh vegetables and cheaper. The diet should contain food from all food groups.

In order to lose weight you have to eat fewer calories than you burn or burn calories more than you eat.

The public has to be taught the caloric value of food. The public has to be taught to evaluate the number of calories they burn with exercise in terms of calories. The public must learn that in order to loss 2.2 lbs. one has to burn 9,000 calories more than one eats. In order to loss 22 lbs. one needs to burn 90,000 calories more than one eats.

The solution to obesity is to get all Americans to do more and eat less. They must understand the relationship of calories in to calories out.

My son, Daniel Feld, sent me this You Tube from a TED meeting in San Jose presented by Chris Wang of Ideo. His idea is innovative.   

It is actionable solution. It can be fun. It could start a national trend.  It has educational potential. It is an enjoyable video. 

Unfortunately, few know that a baked potato contains 100 calories. The same potato made into French fries has a caloric value of 450 calories. Water is boiled out of the potato and replaced by fat. Fat contains 9 calories per gram.  Water has zero calories per gram.   

My son, Brad Feld, and the Foundry Group invested in the Fit Bit Company.  I thought he was nuts. He sent me a Fit Bit to critique and I became a Fit Bit fan

My first impression was it was an overgrown pedometer. It turns out it is much more. It provides an education that puts individuals in control of their intake and output. It is easy to underestimate intake and overestimate output. 

 Fit Bit also has a chance of creating the educational trend necessary to help conquer obesity. 

 Technology is the future!

 Meal Snap is an IPHONE application that estimates how many calories are in a meal. All you do is snap a picture with your IPHONE of the meal and Meal Snap estimates the calories in the meal.   

So how do you get started going from overweight to healthy,

Leo Babauta in his blog Zen Habits covers it well.

Essentially it is the same way one would eat an elephant. “One bite at a time.”

You need to make slow changes silently with full awareness of intake as opposed to output. I have described some innovative tools that can be used. Decreasing obesity can lead to healthier living.

It is the individuals’ responsibility to  “just do it.”  Incentive must be provided by the cultural change in society to help individuals make their own good choices.

President Obama’s healthcare reform act does not accomplish that. 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone













War On Obesity: Part 17

Stanley Feld M.D.,FACP,MACE

In a War on Obesity the media is the message. The media has to produce an effective message.

There is no need reciting the harmful effects of obesity. There is no need outlining the cost to the healthcare system. The rising incidence of Type 2 Diabetes Mellitus is a direct result of obesity.

The message about obesity must be crafted so it can become viral. Attempts have been made to craft such a message. The message has not been constant or continuous.

At the same time, the fast food and junk food industry’s message has be constant and continuous. Its message shows up on every sports event and every comedy show on television multiple times a day. The fast food advertising budget has not been reported. I would guess a thirty second ad during the Super Bowl cost more than the entire public service costs of promoting healthy food intake during a full year.

In 2009, Michelle Obama planted a symbolic 1,100-square-foot plot in a spot visible to passers-by on E Street. The garden was planted to encourage healthy eating.

clip_image001Double click to enlarge

Please note there is a lot of spinach planted in four large areas of the garden. There are also a lot of peas planted. Kale, chard, and collard also occupy a significant number of square feet in the garden. None of these can compete with junk food and fast food.

At about the same time the garden was planted, there was a media frenzy created around contaminated spinach. Where are the tomato plants? Where are the fruit trees? There is just a small area devoted to blueberries, raspberries, and blackberries. Where are the strawberries?

“Virtually the entire Obama family, including the president, will pull weeds, “whether they like it or not,” Mrs. Obama said with a laugh.”

The first lady said that she had never had a vegetable garden. The idea of a garden came from her experiences as a working mother trying to feed her daughters, Malia and Sasha, a good diet.

Yet, when President Obama goes on the campaign trail, the photo-ops are usually taken in unhealthy greasy spoons. He does not set a great example to encourage a change in eating habits.

We are not told how these vegetables are included in the daily meals of the First Family. We are not taught anything about calorie intake of the first family.

There was a report of lead in the White House vegetable garden’s soil. This was not a good message. We immediately heard White House denials.

“The results prompted a number of headlines suggesting that the level of lead in the garden, 93 parts per million, was dangerous.

It was not. The level is well below the 400 p.p.m. considered hazardous by the Environmental Protection Agency, though not below the more stringent goals recommended by some countries like the Netherlands, at 40 p.p.m.

The head groundskeeper during the Clinton administration says that sewage sludge which contained lead was used once, in 1995.

These reports did not result in encouraging the population to change its eating habits.

The Centers for Disease Control and Prevention recently issued a comprehensive nationwide behavioral study of fruit and vegetable consumption. Only 26 percent of the nation’s adults eat vegetables three or more times a day.

These results fell far short of health objectives set by the federal government a decade ago. The amount of vegetables Americans eat is less than half of what public health officials had hoped.

“Dr. Jennifer Foltz, a pediatrician dedicated to improving the American diet, concedes that perhaps simply telling people to eat more vegetables isn’t working.”

“There is nothing you can say that will get people to eat more veggies,”

The consumption of salads during home prepared dinners decreased from 22% percent in 1994 to 17 percent in 2010. Only 23% of the home prepared meals contained one vegetable.

People know that vegetables can improve health and help with weight loss. The public service campaigns have been ineffective.


1. Vegetables are a lot of work to prepare.

2. Vegetables are wasted all over the country because they are expensive and often spoil in refrigerators.

3. The moment you have some fresh vegetables you have to schedule your life around eating them.

4. Vegetables have to be prepared properly to taste good.

5. Vegetables are expensive compared to fast food.

6. Americans want taste before health,

7. Americans want convenience before health

8. Americans want low cost before health

Why? Americans have the notion that government will pay for their healthcare when they get sick.

Melissa MacBride, a busy Manhattan resident who works for a pharmaceuticals company, would eat more vegetables if they weren’t, in her words, “a pain.”

“An apple you can just grab,” she said. “But what am I going to do, put a piece of kale in my purse?”

It is clear vegetables and healthy eating has been sold to the public the wrong way. Now, a food growers association is trying to get people to eat vegetables by packaging baby carrots as a junk food.


Heather Ainsworth for The New York Times

I believe President Clinton has figured out the right formula.

President Clinton was once so famous for his fast food diet that Saturday Night Live performed a sketch called "Clinton at McDonald’s." In the five minute parody, Clinton eats a fish fillet, a sausage egg and cheese sandwich, a chicken nugget, bites of a hamburger, a milkshake, and several french fries.

Since then he has suffered from coronary artery disease. He had a coronary artery stent. It failed. He then had triple bypass surgery. Recently, he became a vegan and lost 24 pounds. His interview with CNN is riveting. This type of public service campaign could change our nations eating habit and decrease obesity.

America must dedicate itself to fighting obesity to decrease healthcare costs. How many congressional delegates have a high BMI? The life style of the nation can be changed by examples such as President Clinton’s.

Otherwise, healthy lifestyles will remain a joke that cannot compete with the advertising campaigns of the junk food and fast food chains.

A victory over obesity is in the people’s power.


The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


War On Obesity: Part 16

Stanley Feld M.D.,FACP, MACE

The public’s perception is that obesity cannot be cured. In my opinion this is wrong.

I received two comments from readers after publishing War on Obesity: Part 15

The first;

Dr. Feld

Don’t you know that Obesity is a genetic disease? No matter what you do people cannot lose weight. If they lose the weight they will gain it back. A genetic disease cannot be cured.

Type 2 Diabetes Mellitus is also a genetic disease.


All obesity is not genetic. There are many diseases, situations that can lead to overeating. The majority of the obesity is due to environment factors.

Type 2 Diabetes Mellitus is genetic. At least 25% of Hispanic and Black people have a genetic abnormality making them less sensitive to insulin. (Insulin resistance). Insulin resistance increases as weight increases.

As the insulin resistance increases the person cannot metabolize glucose. Insulin is needed at the cellular level to permit the glucose to pass into the cell. The insulin resistance decreases the effect of insulin to permit this passage.

The person’s cells are starved of energy producing glucose. This causes the person to release stored glucose from the liver in order to overcome the insulin resistance. The very high glucose causes increased urination and increased thirst. The lack of glucose metabolism causes weakness.

Type 2 Diabetes Mellitus, the result of obesity causing increasing insulin resistance, can be asymptomatic for an average of 8 years.

The resulting high circulating blood sugar denatures proteins in the body. It causes blood vessels to decrease in diameter. Many people present with Type 2 Diabetes Mellitus at the time of a heart attack. Over the eight years of asymptomatic Diabetes Mellitus the blood vessels have been slowly constricting. This can result is a heart attack or stroke.

The hemoglobin molecule is a protein within red blood cells (RBC). RBC’s carries oxygen to the tissues. Hemoglobin molecule with the RBC also gets deformed. It is converted to HbA1c. The measurement of the percentage of HbA1c in the circulation is an estimate of the average blood sugar over a three month period of time.

Each red blood cell lives for 3 months. New RBC’s are born every second. If they are born and live in a high blood sugar they become deformed. The higher the blood sugar the higher the percentage of HbA1c.

Normal Hba1c is up to 6%. The lower the level the less the chance there is for blood vessel narrowing and the lower the risk of complications such as heart attacks and strokes.

The cost of Diabetes Mellitus to the healthcare system is $217 billion dollars a year. The challenge is to decrease the incidence of Obesity. Decreasing obesity will decrease the incidence of insulin resistance. In turn the incidence of Type 2 Diabetes Mellitus and its complications will decrease.

The only way to decrease obesity is through public education program and advertisement, changes in the fast food industry’s economic incentives, and providing economic incentives to consumers to lose weight.

Consumers must be made to be responsible for themselves.

Decreasing obesity will decrease healthcare costs dramatically.

President Obama should be spending taxpayers’ dollars on this goal and not on pilot studies and bureaucracies destined to fail.

The second comment received illustrates that weight loss can be accomplished. A long time reader responded with the following note to my last blog.

I previously sensed he doubted consumers’ ability to control their own health and healthcare dollars.

Dear Dr. Feld

There is hope.  Yesterday I was at a client’s office when I met an old friend who serves as a security officer for the company.

I said, “John you look great” and he told me he had lost 85 lbs.  I said “wow that’s awesome”.  When we were away from other folks there I quietly asked him if something had precipitated the change and he said “yes, I was diagnosed as a type II diabetic and when I was diagnosed I had an A1c of 11.0%”. 

He said “the Dr. wanted to start me on Meds immediately but I said no meds, I want to try diet and exercise first”.  The Dr. was skeptical but let him have 3 months to try diet and exercise.  In the 3 months, John lost 70 lbs and his A1c was 5.5% when he next saw the Dr.  He has since lost 15 more lbs and he is now accountable for his health.

With no accountability, people will not modify their behavior.  Death is inevitable, the questions that we must answer are:

1. How much money am I willing to spend on delaying the inevitable?

2. Whose money is it going to be, mine or someone else’s?

3. Depending on the answer to question number 2, what’s the effect on the answer to question number 1?


It can be done with proper motivation. It is difficult to lose weight. Obesity does not cause symptoms. Type 2 Diabetes Mellitus can be asymptomatic for a long time. This patient did lose weight for his own health. Many people can be helped to lose weight.

As Ross Carlson said it is a matter of eating less and doing more.

Consumers are bombarded with the stress of daily life. Americans are constantly exposed to anxiety by the popular media. Local murders, national oil spills, two wars, auto accidents, other disasters, the threat of unemployment and increased taxes all heighten our anxiety.

Salty and fatty foods taste good and are cheap. These fast foods help relieve stress. Fast food temporarily ameliorates the epinephrine surge caused by stress.

If President Obama wanted to solve the rising cost of healthcare he should concentrate on changing the culture of food production and attitudes about eating and exercise.

He is giving this essential initiative lip service and little expenditure of money.

He should empower consumers to reverse this impending disaster.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


War on Obesity: Part 15

Stanley Feld M.D.,FACP,MACE

Cecelia and I went to flea market in North Central Texas on Memorial Day. There was a large crowd. I would estimate that more than 60% of the people were grossly obese and 30% were moderately obese.

There was a long line at the fast food restaurant.

Companies providing life and health insurance own nearly $2 billion worth of stock in the fast-food industry. The investments are in Jack in the Box, McDonald’s, Burger King, Wendy’s/Arby’s, and Yum! Brands, which includes KFC, Taco Bell, and Pizza Hut.

The life and healthcare insurance industries are not exhibiting the social responsibility they claim. They are in business to make a profit. The fast food industry is a profitable business. Why not invest in it?

President Obama ought to be investing taxpayers’ dollars for healthcare reform in convincing the public to not support the fast food industry.

The appeal of fast food is it is cheaper and more filing than fresh food such as fruits vegetables and chicken and requires no food preparation. The food also contains lots of salt and sugar which appeals to the tastes buds. Excess salt is a contributor to the onset of hypertension and sugar is empty calories.


Nearly half of all adults in the US have Type 2 diabetes, hypertension or hypercholesterolemia associated with an increased risk of cardiovascular disease, according to data from the National Health and Nutrition Examination Survey (NHANES).

Obesity is the underlying disorder precipitating these chronic diseases. If the U.S controls obesity it will decrease the incidence of these diseases and its complications. The cost of these diseases to the healthcare system is enormous.

Obesity and diet-related diseases are in fact far costlier than smoking, and they are just as preventable.

According to the latest statistics from the CDC, smokers incur health care costs of $96 billion a year in direct medical expenses.

Meanwhile, the annual health care cost of obesity in the US has reached $147 billion, and the medical bills for diabetes are at an estimated $217.5 billion a year!

Truly, the health care cost of smoking is dwarfed by the medical expenses caused by unhealthy food.

If you are obese, you will spend an average of 42 percent more on health care than someone of normal weight. This is just one of the reasons why I keep reiterating that someone needs to spend some time in the kitchen to prepare meals.

In response to my last post on consumer driven healthcare a fellow physician wrote;

Hi Stan,
You are assuming that patients, especially, will be willing to admit they might get sick and take steps to prevent it. I can’t even get overweight male diabetics to lose weight. All cigarette smokers know that smoking is bad for them.

I replied by asking “how much he was paying his overweight male diabetic patient to lose weight.”

When will President Obama listen? If he is listening he is not hearing. He is spending tons of money on bureaucratic infra structure that will not solve our healthcare problems or the costs incurred by those problems

The problem of obesity can be solved. It will take a societal change of cultural and attitude toward food and exercise. It will take innovative incentives. The ideal medical saving accounts provides that incentive.

The government has to develop incentives, and not penalties for the farm and food industry to reverse the production of obesity producing foodstuffs.

To some of us the incentive to stay healthy is enough. However, it is very difficult to eat healthy with all the advertising and food stimuli coming at us all the time.

My son Brad’s Foundry Group’s chief of technology officer, Ross Carlson, had an epiphany.

I saw Ross Carlson before he started his fitness program (see photo). He told me about his fitness program.

“ I’ve been hesitant to write this post for quite a while as it feels rather self-serving.  But as I’m ending phase two of my training program and now entering what I’m calling phase three I figured it was time for a little reflection.

Phase 1
If you’ve known me for more than 3 years you know I used to be fat.  Hey, let’s not dance around it, I was fat.

Fortunately for me I’d finally had enough and decided to finally get healthy.  This is what I call phase one of my fitness program or really fitness progression.

  I tend to be fairly obsessive with things I care about and fitness has been no difference.  My first goal was to lose weight – and a lot of weight.

I did two very simple things to accomplish this: I ate significantly less and exercised significantly more (that is to say I finally started exercising regularly).  I cut my daily caloric intake to around 1000 calories and added in cardio work, mostly cycling.  I continued on this program for roughly 10 months to reach my first goal. 

I guess it’s time for some numbers huh?  Wow, these are pretty scary: (I’m 5’11” by the way…)

Beginning: 235lbs | 40” Waist | 32% body fat | 32.8 BMI
Ending: 145lbs | 30” Waist | 8% body fat | 20.2 BMI

So in those first 10 months I lost roughly 90lbs total, 10” off my waist, 65lbs of fat (and 22lbs of muscle).  It was that last stat that made me begin phase 2 about 3 months ago.

Phase 2 and 3 are combinations of dynamic fitness training to increase muscle mass and cardiovascular fitness.

The key to exercise is to make fitness a way of life.

The key to decreasing caloric intake is to make eating less a way of life.

The key to weight loss is to exercise and burn more calories than you eat.

Nothing is new in the laws of thermodynamics. The patient must be responsible to and for themselves.

Final Thoughts
I plan on blogging more regularly about this subject now that I’ve finally published this post.  I hope to write about thoughts on eating, exercising, and my journey through all this.  If you’ve got questions or comments please let me know, they can be very motivating.  And if you’re considering doing something similar to this START NOW.  There is no better day than today to be healthy.

Oh, and now to leave you with a picture that I’m still scared by.  Left is old,
Fat Ross.  Middle is thin Ross from about 3 years ago.  Finally on the right is me a few days ago.  Just wait until you see me in 90 more days.


Hooray for Ross. Nice job. I am very proud of you.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


War On Obesity: Part 14


Stanley Feld M.D.,FACP,MACE

I wish everyone a HAPPY AND HEALTHY NEW YEAR!!

Cecelia and I just finished watching the movie Food Inc. It is a movie worth watching.

I was upset seeing the abuse of our food chain by big food corporations. There is little respect for America’s food safety.

America’s obesity epidemic is caused, in part, by the food industry’s ability to produce cheap food. Fifty years ago, when I was at Columbia College, the solution to America’s impending food shortage was debated. The predication was the nation was going to face a food shortage in the next 50 years.

Advances in genetics and farm technology solved the problem. However, the solutions to potential food shortages have led to unintended consequences. Our government has failed to enact and enforce appropriate food safety rules for the protection of its citizens.

Nonetheless, the federal government subsidizes the mega agriculture industry.

The government is supposed to be our surrogate for food safety. The Food and Drug Administration is powerless and uninterested in controlling the abuse of large food producers.

People want their food to be safe. If Americans their food to be safe they are going to have take control its quality and safety. It is has to be done one meal at a time in one community at a time.

Parent/Teacher organizations (PTA’s) through local school districts are taking actions in ways our federal, state and local governments have failed prevent our children from becoming obese.

My granddaughter lives in the Boulder Valley School District. The local school district realized that a good place to start changing eating habits of children is in the primary grades. It is being done by the use of organic, low fat, whole grain menus in the school lunch program rather than the traditional cheap fried fast foods.

Ann Cooper “The Renegade Lunch Lady” came to the school district to introduce her plan to improve school lunches.

The plan is simple:

  • All milk is Organic Valley from Colorado ranchers.

· No more trans fats, highly processed foods or high fructose corn syrup, ever!

  • Rudi’s bread is used for all bread products.
  • Blackjack makes the pizza to Ann’s specifications (51% whole grain crust, etc.).
  • All pasta and red sauces are made in-house and organic.
  • Fruits and vegetables are organic and local whenever possible (all of September’s fruits were both!).
  • Improved salad bars with fresh fruit and protein items daily

The principal sent a note to the parents of the elementary school:

“The best way to support Ann and the commitment to healthy public school lunches is by encouraging your child to eat hot lunch – even if it’s just once a week.  The more money that goes into the system, the more Ann is able to change about the system.  You can check out her web site – she’s world renowned, works in D.C. with the USDA to improve the public school lunch standards nationwide, and is one of the top experts in this field.

If you have any questions, please do not hesitate to contact me.

Principal, Bear Creek Elementary School

Boulder, CO   80305”


If parents participate in the principal’s recommendation at a small supplemental cost a lot can be accomplished.

1. Obesity in kids decreased. Childhood Obesity is causing childhood Diabetes Mellitus, early coronary artery disease and other complications of Diabetes Mellitus.

2. The impact on the healthcare system will be a decrease in cost. Shouldn’t President Obama be concentrating on food supply value and safety? It could be done inexpensively and effectively.

3. Educated children will insist that the parents “eat healthy” at home.

4. A change in eating habits will force large corporations such as ADM, Monsanto and others to rethink their abuses of the food chain.

5. A change in eating habits will encourage large food chains such as Wal-Mart and Target to rethink their offerings in order to stay competitive.

6. America will have a consumer driven food reform program.

I think we are going to have to do it ourselves one meal at a time. President Obama might wake up and act on citizens’ requests, and not special interests.

It will go a long way to Repairing the Healthcare System.


he opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


War On Obesity: Part 12

Stanley Feld M.D.,FACP,MACE


Obesity is a major problem for the healthcare system. I am waging a War on Obesity. This article is Part 12 of my War on Obesity.

It is essential that a public service campaign at every socioeconomic level be mounted to explain the long term danger of obesity and how to combat its occurrence. Obesity is responsible for many chronic diseases and their complications. Its cost to the healthcare system is not sustainable. Diets might work short term. Lifestyle change is the only thing that will work long term.

The new administration should join me in my War on Obesity. It has been very responsive to the potential swine flu pandemic. The media has been very responsive to this important news story. Why can’t the administration develop a public service campaign to create an important healthcare story about the obesity epidemic? It might precipitate lifestyle change.

Neither President Obama nor the congress has suggested such a plan. The main message of my public service campaign would be:

2.2 pounds of fat equal 9000 calories

In order to lose 2.2 lbs weight you must eat 9000 calories less than you burn or burn 9000 calories more than you eat.

9000 calories is hard to lose and easy to gain

The federal government subsidizes school lunch programs in schools K-12. These school lunch programs were set up 50 years ago to counter malnutrition in under-privileged families. In 2009 the problem is childhood obesity. A new approach must be taken.

“The federal school lunch program, which subsidizes meals for 30 million low-income children, was created more than half a century ago to combat malnutrition. A breakfast program was added during the 1960s.”

The federal school lunch program is trying to produce healthy meals. They fail for two reasons. First, many schools do not control portion size. Second, those same schools still have snack bars, vending machines and à la carte food lines.

Federal rules that govern the sales of these harmful foods at schools are limited in scope and have not been updated for nearly 30 years. Until new regulations are written, children who are served healthy meals in the school cafeteria will continue to buy candy bars, sugary drinks and high sodium snacks elsewhere in school.

This is an example of a perverse outcome to a government mandate. The idea is good. The rules to execute the mandate are poor. The government will respond to people power (public opinion).

Public opinion can influence government policy and the media. If the people are passive they will have an environment that is good for vested interests. In the case of school food intake the vested interests are the candy, soda and junk food manufacturers and the school systems. The vending machines are a profit center for school districts that are underfunded by government. The profits are used to finance important school projects.

“Many states’ school districts have taken positive steps. But others are likely to resist, especially districts that sell junk food to finance athletic programs, extracurricular activities, even copier expenses.”

I did a Google search to see the breakfast and lunch menus of some independent school districts. Each has a disclaimer to avoid liability. Most provide between 650 and 1200 calories for lunch and 250 to 600 calories for breakfast depending on the portion size and the number of items a child can pick up.

Menus meet recommended dietary guidelines and may change due to product availability or other market changes. In accordance with Federal law and U.S. Dept. of Agriculture policy this institution is prohibited from discriminating on the basis of race, color, national origin, sex, or disability. To file a complaint of discrimination, write USDA,

Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Ave., SW Washington, DC 20250-9410 or call 202-720-5964. USDA is an equal opportunity provider and employer.

An obese child needs to burn 9000 calories in order to lose 2.2 pounds. An intake of 900 to 1800 calories for two meals is not going to help when a inactive obese child may burn only 1500 calories per day.

In an attempt to increase academic performance test scores, physical education has been eliminated from many school curriculum because of “school funding”. The lack of exercise increases the obesity epidemic.

It is going to take a national educational program for parents and children understand the basic etiology of obesity and caloric intake and output to conquer the obesity epidemic. It is going to take a coordinated effort by local parent teachers associations (PTA) to eliminate vending machines and snack bars from the schools. It is going to take a PTA protest to reinstitute rigorous physician education in school districts. It is going to take “People Power” with educational help from the federal government.

The federal government has the ability to do this in a public service educational campaign. It could use the money for this campaign from the money it saved using my universal EMR and my ideal medical savings account rather than wasting it on ineffective new bureaucratic institutions.

If President Obama doesn’t do something, chronic diseases resulting from obesity are going to continue to drive healthcare costs through the roof.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.


War On Obesity: Part 12


Stanley Feld M.D.,FACP,MACE

During World Diabetes Day in Dallas Dr. Ken Cooper delivered a terrific keynote address concerning observational studies he has performed. He related fitness to obesity, the early onset of childhood type 2 diabetes mellitus, academic achievement and behavior.

Dr. Cooper is passionate about eliminating obesity in children. He presented us with astonishing statistics.

“Estimated obesity rates for children 6 to 11 years old have increased from 15.1% in 1999 to 18.8% in 2004. The Department of Health and Human Services estimates that 20% of children and youth in the United States will be obese by 2010.

Washington D.C. was first in the nation with 22.6% of children age 10-17 being obese. Texas was sixth with 19.1% of children aged 10-17. Forty two percent (42%) of fourth graders and thirty nine percent (39%) of 8th graders were obese in 2004. Seventy percent (70%) of these children will become obese adults and one in three will develop diabetes.

Type 2 Diabetes Mellitus is common in obese adults over the age of 40. A syndrome consisting of obesity, diabetes mellitus, high lipid levels and hypertension has been described and named “Metabolic Syndrome”. The incidence of coronary artery disease, strokes, end stage kidney disease and the complications of diabetes mellitus is high in patients with Metabolic Syndrome.

These illnesses are costly to the healthcare system. They are secondary to insulin resistance which is secondary to obesity. In order to save the healthcare system from bankruptcy we must have a national War on Obesity.

The obesity epidemic has spread to our children. It has led to an increasing incidence of type 2 diabetes mellitus in our children and earlier in life complications.

“It is estimated that 33% of children born after the year 2000 will develop diabetes with the incidence being higher in Hispanic and African-American children” “ It has been estimated Children developing Type 2 Diabetes before the age of 14 will have their lifespan shortened by 17 to 27 years. “

Dr. Cooper developed a Fitnessgram in 1982. It is composed a series of tests to measure fitness. He demonstrated, in 13,600 men followed for 8.6 years, that the less fit they are the higher the mortality rate. (JAMA, 1998).

He tested the fitness of over one million children. In California he tested fitness against reading and math skills in approximately 1.3 million children in grades 5,7,and 9.

He found; “only 25% of the students could pass all 6 of the Fitness tests. 43% could not walk or run 1 mile in the allotted time. “

As interesting and perhaps more important finding is that the higher the childrens’ fitness scores the higher the children’s test scores in reading and math using California’s standard test.

Children in the national school lunch program did worse in reading and math testing than children not on the free lunch program regardless the number of fitness standards achieved. The free food lunch program was not a healthy diet. The program has encouraged the obesity epidemic. I had not previously known of the school food programs relationship to scholastic achievement.

Public schools in Texas are obsessed with high achievement on the Texas Assessment of Knowledge and Skills test (TAKS). The obsession is related to school district funding, the no child left behind program and federal funding.

Dr. Cooper looked at the Math and Reading scores of 8189 5th and 7th graders and related it to the number of fitness standards achieved. Again the higher the fitness scores achieved the higher the math and reading scores on the TAKS test.

Miller in the Journal of Pediatric in 2006 looked at early onset of obesity and its effect on IQ and found;

A link between marked obesity in toddlers and lower IQ scores, cognitive delay and brain lesions similar to those seen in Alzheimer’s disease was observed.” 


Dr. Cooper’s take home point is obesity is the villain and fitness is the cure. Texas schools eliminated Physical Education in order to have more resources to teach children to pass the achievement tests (TAKS). This seemed backwards to Dr. Cooper. He thought it might be better to promote fitness and decrease obesity. This would lead to an increase in test scores and a decrease in childhood type 2 diabetes mellitus.

Dr. Cooper then petitioned the Governor of Texas a Senator and State Representative to introduce a bill to reinstitute Physical Education in the Texas school systems on the basis of this information. The bill passed but was not funded.

Dr. Cooper raised 3 million dollars in private contributions for his Texas Youth Evaluation Project. He has to date tested over 1 million children. Fitness scores varied from 32 to 8/100 for girls depending on age and 27 to 8.5/100 for boys. The older the children the less fit they were.

His plan is to relate an increase in fitness to a decrease in obesity, and childhood type 2 diabetes mellitus. He is also going to study fitness and its relationship to attendance rates, free lunch programs, TAKS scores, substance abuse, violence and truancy.

My guess is that fitness will have the expected effect on all these parameters. The Youth Evaluation Program is now being spread to many school districts throughout the nation. The federal and state government must support programs to fight obesity. The obesity epidemic is devastating to individual citizens and our society.



The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.