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.

“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.

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. 

 http://youtu.be/ZR3HMo-vzjE

 

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. 

 http://youtu.be/rvqcS6-7tNc 

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

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.

Double 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.

Why?

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.

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 8^th 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 5^th and 7^th 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.

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