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War on Obesity


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 It must be repealed.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This is the main reason Obamacare needs to be repealed.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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What President Obama Forgot To Tell US

 Stanley Feld M.D.,FACP, MACE

Nancy Pelosi was correct. The only way we are going to know what is in the Affordable Care Act is to pass the bill.

The weeks before January 1st when the web site was going so poorly we heard a lot about the healthcare insurance companies taking a bath on Obamacare because of the skewed enrollment.

Only the sick and elderly were buying healthcare insurance from the health insurance exchanges. Young people were needed to buy insurance in order to keep Obamacare from the “death spiral.”

The sick and elderly were more likely to be hospitalized and run up a big hospital bill. The high bills would eat into the insurance companies profits. Young people were needed to stabilize the risk pool or insurance premiums would sky rocket because insurance company profits would fall. Insurance companies could go bankrupt.

The government’s expressed fear is the healthcare insurance industry would not participate in the health insurance exchanges.

President Obama offered to bail out the healthcare insurance companies if this was to occur.

This was another of President Obama’s deception.

It is similar to the deception “If you like your insurance you can keep it. If you like you doctor you can keep him/her.”

Last week we learned that the insurance company bailout was built into the original bill passed in 2010. The President knew about this bailout before Obamacare was passed.

Did the congressional members who passed the bill know about the built in bailout?

If they did they should all be voted out of office. If the Democrats needed to pass Obamacare did not know about the bailout they should have and they should all be voted out.

It should be recalled that this was a Democrat controlled House and Senate. There was not a single Republican vote included in the passage of Obamacare.

The American people did not know about the built in bailout at taxpayers’ expense.

Obamacare contains a "Reinsurance Program that caps big claim costs for insurers (individual plans only)." Robert Laszewski, a prominent consultant to health insurance companies, writes that in 2014, 80% of individual costs between $45,000 and $250,000 are paid by the government [read: by taxpayers], for example." 

Private insurance plans bought through the health insurance exchanges are not private health insurance plans. They are plans that are subsidized by the government if the insurance bill goes over $45,000.

Who pays this government subsidy?

The taxpayers, by having their taxes increased.

 Who makes the profit from this subsidy?

 The healthcare insurance industry makes the profit because the insurance policies have been priced at high risk (Increased deductibles, and increased premiums for consumers not eligible for government subsidies).

 "The reinsurance program has done and will continue to do what it was intended to do; help attract and keep more carriers in Obamacare than might have otherwise come."  Thus, Obamacare is being aided by having taxpayers subsidize big insurance companies' business expenses.”

Obamacare also provides the healthcare industry a greater subsidy. It is called the Risk Corridor Program”. The “Risk Corridor Program” limits the overall losses of the healthcare insurance industry to 2.4%.

This is the way the “Risk Corridor Program” works. The healthcare insurance company submits its expected costs to the government for a particular year.

If the expected costs of the insurance exceed 102%, the government will pay the healthcare insurance company 80% of the difference above 102% at taxpayers’ expense.

 Taxpayers' are unwitting generosity toward these "participating health plans" (plans sold through Obamacare's government-run exchanges):

 "[I]f the health plan has costs at 110% of the medical cost target [the costs that the insurer expects to accrue], it will be responsible for only 102.4% of the target (a 2.4% shortfall)-only about a quarter of its losses.”

There is little risk to the healthcare insurance company for being involved in the healthcare insurance exchanges.

The key point is President Obama had this written into Obamacare without telling taxpayers about it. I wonder if the CBO knew about it and calculated it into the original cost estimates of Obamacare.

“In this way, and so many others, Obamacare takes a major step toward the government monopoly over American medicine ("single payer") that liberals drool about in their sleep.”

The problems with a government controlled single party payer system are multiple. I have enumerated them in the passed.

I will summarize the problems:

1.Consumers are dependent on the government to make their healthcare and medical care decisions.

 2. A single party payer system does not encourage consumers to be responsible for their health, healthcare dollars or medical care.

3. The inevitable cost overruns will result from government bureaucracy, regulations and inefficiencies.

4. The occurrence of fraud and abuse is inevitable. We have seen some fraud and abuse already.

Navigators are paid $48 an hour to help the poor enroll in Obamacare. One reader told me about a case were the navigator had to apply four times before the application was accepted without any errors.

This is only the first step in obtaining healthcare eligibility and then healthcare insurance.

4.  Government will be forced to limit access to care and ration care in order to keep the direct medical care costs down.

 5. All the secondary stakeholder costs are escalating as physician reimbursement is decreasing.

 6. Most importantly freedoms to choose your physician, your insurance and your treatment are being compromised at the expense of all taxpayers.

Something is very wrong with this plan.

This is all going to be done slowly so we do not notice.

America has been deceived. We are already feeling the effects of the deceptions.

There is more to come.

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

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  • Ryan

    You describe this thing very well . Now elections are coming on . Hope new govt do something in this case.

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Jerry The Diabetic Teddy Bear

Stanley Feld M.D.,FACP, MACE


The You Tubes are usually at the bottom of the email feed.



Last week two young entrepreneurs showed me a fascinating way to teach children age 3 to 8 with Type 1 Diabetes Mellitus how to take care of their disease.

The onset of Type 1 Diabetes Mellitus in young children is devastating for their parents. Many parents blame themselves for the child’s disease. The child is usually frightened and angry about having to take shots. They are also angry about the food restrictions and the fact that they are different from their friends. Often they become rebellious and try to avoid the shots or do not comply with the rules of food intake.   

Everyone has seen a 5 year old mesmerized by Leapster, an educational computer game. Children feel compelled to master Leapster. It keeps their attention for hours.  

Two recent college graduates Aaron Horowitz and Hannah Chung designed and are now marketing Jerry The Bear.

They participated in a wonderful program called Design for America program at Northwestern University while in college.

"Without believing in our ability to develop and implement innovative solutions that can address the world’s challenges, we will not even act.

We can’t innovate if we don’t believe that we can. We must work together with those from all different backgrounds and perspectives, we must work with our community, and we must support each other in our efforts improve the world around us.

Design for America’s vision is a world where people believe in their ability to innovate and tackle the most ill-structured challenges of our time.  

Design for America teaches human centered design to young adults and collaborating community partners through extra-curricular, university based, student led design studios to look locally, create fervently and act fearlessly. DFA currently tackles national challenges in Education, Health, Economy and Environment."

Aaron and Hannah produced Jerry the Diabetic Teddy Bear. After graduating college this year they applied and were accepted to a TechStars affiliated accelerator program in Rhode Island Beta Springs to further develop Jerry.

Jerry the Diabetic Teddy Bear is a fantastic teaching tool for young children. Young kids love their Teddy Bears. Jerry helps kids with Type 1 Diabetes adjust to their new lifestyle. By playing with Jerry children will learn to master their medical procedures.

Diabetic children will transfer the anger they feel at the onset of Type 1 Diabetes into an intense responsibility for taking care of their Jerry the Diabetic Bear.

The child with Type 1 Diabetes learns how to vary insulin doses and food intake through a computer chip algorithm game. The game teaches how to determine insulin dosage and food intake in order to keep Jerry the Diabetic Bear’s blood sugar as close to normal as possible.

In turn the child learns how to take care of his own Diabetes.  The child learns to be responsible for Jerry’s care and in turn his/her own care in order to remain healthy. Education must be made entertaining and purposeful. Jerry the Diabetic Teddy Bear is an effective educational vehicle that is simple and purposeful.

There is no reason that innovative teaching applications like Jerry the Diabetic Teddy Bear could not be produced for children with other chronic diseases such as asthma.

Design for America promotes the innovative thinking in young college students. It expands imaginative thinking in order to create new and effective products.

Rather than whine about the obesity epidemic in America we should be teaching children through entertaining and purposeful innovative educational ways to learn about food values, exercise and obesity.

This type of education should be universal if we are going to educate our population about the prevention and care of chronic disease.

This is a powerful way to reduce healthcare costs.

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

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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.



  • Jenn Graves

    I would love to know where you found the information on the amount of money used to fund Let’s Move ($400M + $26B). I’ve been ardently searching for this data, as I’m trying to get a handle on the overall costs of the “war on obesity” for a piece I’m working on, but have had very little luck. Thank you in advance!

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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












  • Daniel

    For years, my physician said “eat less, exercise more.” She had the mantra right, but never asked how much I eat or how much I exercised. More importantly, she never took her message the next step to help “activate” this message. It would have been helpful to hear concrete examples of what eat less exercise more looks like for a person of my age, height, weight. After hearing her simple mantra I would start to visualize giving up all the foods I like and exercising every day to try to accomplish her mantra… This was never going to happen.
    Your suggestion to get started by making slow incremental changes is right on! I eventually activated my own message to myself and slowly started cutting out little things that didn’t really matter (I stopped eating bread before dinner, I take only 3 bites of dessert to get the taste instead of finishing dessert every time, I take the stairs instead of taking the elevator when I can), and over the course of 2 years, I’ve seen significant improvements in my overall health.
    If the changes in food choices and lifestyle are too dramatic too quickly, people will resist the change because it is too unpleasant to give up what we enjoy and have gotten used to. If we make smaller more tolerable changes that can then become integrated into our lifestyle, then it becomes easier to maintain AND incrementally add the next slight change that can make an even bigger difference.
    Just my 2 cents. Thx.

  • LDEakman

    Stan – I think you should also emphasize reading labels on everyting you decide to put in your mouth. Melissa has taught me that value as it not only forces you to consider what but how much you’re taking in calories. One more point of emphasis would be the sugar addiction in our society. I’m seeing it begin to happen in emerging markets and it makes me more cognizant of our own sugar overload here in the States. A large part of the challenge with youth obesity has to be linked to sugar intake. Keep up the good work on the blog, hope to see you in Austin soon. Lindel

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Patients Own Their Disease.

Stanley Feld M.D.,FACP,MACE

It is important to listen to what physicians are saying. An article appeared in SERMO, a physicians’ social network, which expressed a physician’s frustration.

It is appropriate to publish some of that physician’s thoughts.

“I first heard this statement over twenty years ago, when I was an intern in general surgery, struggling to find my professional self.”

“My chief resident said; “The patient owns the disease,” “You’re not trying to make them suffer, you’re trying to help. They’re sick, you’re not.”

“The human body is unpredictable.  Disease complications happen.”

The author thought his chief resident was heartless and callous. In a way, he was but he was getting at the heart of the matter. What is the patient’s responsibility in the evolution of disease?

This physician took everything that happened to his patients personally.

The patient owns his disease. The physician does not own the patient’s disease. Lifestyle plays a large role in the cost of the healthcare system.

President Obama’s healthcare reform law ignores the central role patients play in the therapeutic equation.

Day after day in the Emergency Department, people who take no responsibility for their health confront me.  They smoke, they drink, they do drugs, they don’t take their medicines, they drive impaired and crash, and yet they expect me to make them well.

They visit at their convenience, complain about the wait, want their medicines for free, and then don’t pay their bills.

The concepts of health insurance, family doctors, and preventive care have been completely lost.  Everybody except the patient owns the disease.

There was a time that patients knew they owned their disease. They knew they were partners with physicians in the treatment of their disease. Patients had to do the best they could under their physicians’ guidance.

“Somewhere, somehow, things got turned around.  The patients no longer own their diseases.  They’ve given them to us – physicians and society at large.

We are held responsible for everything that happens to a person, regardless of how they conduct their lives or follow our instructions.

  The weight on our shoulders is crushingly real, and forcing many good physicians to walk away from the thing they love most – taking care of others.”

He goes on to say;

I’m still shocked when a patient says, “You have to ….”  It’s endless – “refill my blood pressure and diabetes medicines, even though I don’t know their names or the dose. Patients demand I order an MRI for their two years of knee pain.”

“Say no, explain why, try to educate, offer alternatives, and the reply is  “If you don’t do it and something bad happens, it’s your fault.”

“You can’t tell someone that his or her symptoms are due to obesity, smoking or drinking – that’s judgmental.”

The author’s examples are endless. One last example sums up the dilemma facing healthcare in America.

“I once believed that every time I gave in to a patient’s pressure for an antibiotic for a viral illness, I was contributing to the emergence of super-resistant organisms.

“I believed that I could control the run-away cost of health care by judiciously ordering advanced studies only when absolutely necessary.  I tried to convince people that they owned the disease, that they had responsibilities to meet, that they couldn’t just demand everything be given to them.  And now I’m labeled a “disruptive physician”, because I generate too many complaints.

The increasing prevalence of obesity is a concrete example of the need for patients accepting responsibility for their disease.

Obesity is the cause of many disease processes. Obesity is not a random occurrence. It is linked to eating more than you burn. Potential patients are responsible for their obesity.

When obesity leads to the onset of Diabetes Mellitus, patients are responsible for controlling their blood sugar so they do not develop the complication of Diabetes Mellitus. The complications are heart attacks, hypertension, strokes, blindness, or kidney failure.

The government must provide and promote public education about obesity. Somehow, the appeal of overeating must be squashed and the virtues of exercise promoted.

Physicians and their healthcare teams are responsible for teaching patients how to control their blood sugar.

Eighty percent of the healthcare costs are the result of the complications of chronic diseases. Physicians must be encouraged, not forced, to set up systems of care to help patients become responsible for their chronic disease.

Where is the motivation for physicians in President Obama’s healthcare reform law? Where is the motivation for patients to become serious about intensively controlling their blood sugars in President Obama’s healthcare reform bill? New agencies are being set up to penalize physicians for not using resources to set up systems of care, resources which are uncompensated.

President Obama’s healthcare reform law does not promote patients taking responsibility for their diseases. The law contains nothing that measures patients’ performance. The law contains a lot of proposals that will falsely measure physicians’ performance

The law uses the term preventive care. It is meaningless without providing details. Prevention is immediately defined as providing vaccinations. Vaccinations do not define preventive chronic disease management.

If we are going to decrease the acute and chronic complications of chronic diseases, patients must comply with their physician’s recommendations.

Systems of care for chronic disease management have to be taught to patients and physicians. Medical schools have taught physicians how to treat diseases after its onset. President Obama should focus on setting up systems of public education before the onset of chronic disease.

President Obama’s healthcare reform act puts the burden of successful outcomes on physicians. Physicians do not own their patients diseases.

He should focusing on where money is wasted not building an infrastructure that will waste more money.

“Somewhere between the past paternalistic model of the physician-patient relationship and today’s give-them-what-they-want system, there has to exist a better paradigm.

As doctors, we need to resist the external pressures to make every one happy.  We must legitimize our expectations and have the backing of hospital administration when appropriate.

We should be empowered to refuse unnecessary, expensive, and often harmful demands. We cannot continue to abdicate the responsibility of our education and profession to political correctness.”

The Sermo physician’s statement demands physician leadership for constructive change. He says just say no.

It is difficult for most physicians to say no when they will be penalized by their hospital administrator or get sued under present malpractice laws.

Patients must own their disease!

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

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    Physicians and their healthcare teams are responsible for teaching patients how to control their blood sugar.But still i feel that some were it is patient duty to understand the physicians and co-operate with them

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    Patient understands their own disease and their capacity to work closely with doctors and health care team.

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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.

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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.

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