Category Archives: Obesity-related diseases

Dr. Oz on the Real Threat to The Sopranos

Dr. Oz on the Real Threat to The Sopranos

James Gandolfini’s death is a reminder that everyone is vulnerable to heart disease

When I heard of actor James Gandolfini‘s untimely passing after a heart attack, I was reminded of a recurring theme in the television series he made so memorable. His tough mafia don character valued family above all, but was incessantly anxious about his ability to protect them and keep them well. Tony Soprano did keep his family safe—in his decidedly unconventional fashion. And Gandolfini, a husband and a father of two, looked after his own as well — until he left them altogether, claimed by a heart attack at just 51.

When it comes to our health, we are all like the much-missed Gandolfini. We will do anything for the people closest to us — anything, that is, except take the steps we need to maintain our health and allow us to spend as many years as possible loving and playing with the people we treasure most.

If even tough guys like Tony Soprano need to get checked out, the rest of us do too — whether we think we’re in good shape or not, and whether we’ve ever had chest pains or not, since plenty of people are pain free until the very moment their heart gives in. Some have argued that Gandolfini’s past substance abuse contributed to his premature death. Perhaps it did. But we shouldn’t ignore the more obvious risk factor: at just over six feet tall and around 272 lbs. (123 kg), he was an outsized personality in a dangerously outsized body. In a country that is simultaneously obsessed with bodily perfection, even as two-thirds of us are overweight or obese, weight has become an exceedingly fraught topic, and in the first hours after Gandolfini’s death, some commentators sought to sidestep the topic, wondering how a vigorous man with no known health complaints could have suddenly succumbed. But if we saw an anorexic teenager we wouldn’t pretend she wasn’t heading for serious health trouble, so why should we be so coy at the other end of the weight spectrum?

A key role in anyone’s weight gain may be stress—something that can be a defining feature of a celebrity’s day. Stress hormones such as cortisol can hijack our normal appetite sensors, pushing us to eat even when we are not hungry. This is particularly dangerous when the excess fat that results from overeating is belly fat, which squeezes the kidneys. Since it’s the kidneys that, in turn, regulate blood pressure, it’s no surprise that overweight people are at such high risk of hypertension, the leading cause of heart attack and stroke. Belly fat also harms the liver, prompting it to release more cholesterol. In many people, those changes can block the ability of insulin to break down blood sugar, contributing to diabetes, which wears away at our major arteries and leads to atherosclerosis, a condition often discovered after lethal heart attacks. Half of all victims die during their first heart attack because they do not know their risk factors or do not recognize the subtle warning signs that make their hearts vulnerable.

This awareness can be a life saver, and two of Gandolfini’s own Sopranos cast mates are living proof. Vincent Pastore and Frank Vincent both had heart artery blockages that resembled the type that may have killed Gandolfino. They both noted increasing shortness of breath, and although they did not realize at the time they were at risk of heart disease, they were brave and wise enough to seek help for their symptoms; each had life-saving surgery at my center during the run of The Sopranos. Shortness of breath is a telltale sign of cardiovascular trouble, since it results when the heart cannot even pump the blood out of the lungs, essentially meaning we are drowning from lack of oxygen. But most of us ignore this symptom and many people have no symptoms at all—until it’s too late. And that is why we suffer the loss of so many wonderful people like James Gandolfini.

It wasn’t easy for Pastore and Vincent to shed their afraid-of-nothing mobster characters and visit the doctor. In fact, when Pastore first met my colleague Michael Argenziano, he introduced himself by his Soprano’s nick name of “Big Pussy.” Dr. Argenziano had never seen the show and was caught off guard. Don’t worry, he assured him, we’re all afraid in situations like these. But showing up for treatment in the first place was a profound act of courage—courage that is fortified by our deep desire to protect our families.

Pastore and Vincent both agreed to speak openly about their cases because they hope their stories will serve as an important example. For those willing to follow it, here is my gauntlet for the brave:

First, if your belly looks like James Gandolfini’s, you need a check up. I am specifically asking you to measure your waist size at the belly button and honestly report if this number is more than half your height. Forget using your current belt size as a tool, since most men slip it below the belly fat pad.

Second, ensure that your baseline risk factors like hypertension, diabetes and cholesterol are under control. These are often corrected with lifestyle alone.


Third, shortness of breath from walking up two flights of stairs or any sudden change at all in your breath or stamina is worrisome. Think of it as the equivalent of having chest pain.


Fourth, what have you eaten in the last 24 hours? Fatty and fried foods cause spasms in blood vessels, which limits blood flow for six hours, at which point we often have another fatty meal. Most heart attacks occur on Monday mornings because of our dietary transgressions over the weekend and the stress of the upcoming work week. What you eat and do today will effect the chance of a heart attack tomorrow.

We’ll never know what wonderful work James Gandolfini would have done if he had had a full measure of years. We’ll never know either the things he would have taught his young daughter, who will have her first birthday in October. We do know the steps that might have helped him live to have all those experiences, and they’re the same things that can help protect us—and our families—too.

Risk factors for obesity

Here are some of the things that make it more likely that you’ll get obese. It’s probably a combination of these that lead to obesity in most people. 1 2
Your parents and your genes

You’re at risk of obesity if one or both of your parents is overweight or obese. This might be because you share the same genes as your parents. Or it could be because family members tend to eat the same things and have a similar lifestyle. 3

The ob gene

Genes are in every cell in your body. They tell cells how to grow and what to do. The ob genetells the cells in your body that store fat to make a chemical called leptin. Leptin tells the brain how hungry or how full you feel. It also helps your body burn the food you eat to keep you warm.

Researchers think that some people who are obese might have a faulty ob gene. So these people don’t make enough leptin. This makes it harder for them to control how much they eat because they don’t sense when they feel hungry or full. This makes them more likely to be obese. 4
But this problem is rare. Most people with obesity don’t have this problem.
Comfort eating

You might eat too much as a way of dealing with painful or difficult emotions. Perhaps you eat when you feel unhappy or bored, even when you don’t feel hungry. This is often called comfort eating. It can be hard to break this habit.

You might also eat too much if you have a mental health condition, such as depression oranxiety disorder, or if you feel bad about yourself (have low self-esteem).
Other risk factors

Many things make it more likely that you’ll gain too much weight. If you’re overweight, there’s a risk you might get obese.

  • Your sex: Women are slightly more likely to be overweight than men are.
  • Your ethnic group: Women who are Mexican American or African-American are particularly at risk.
  • Age: Men and women are most likely to gain weight between the ages of 20 and 40.
  • Menopause: The changes in levels of hormones during menopause can make it easier to gain weight.
  • Drinking too much alcohol: Alcoholic beverages are high in calories.
  • Quitting smoking: Quitting smoking is good for your health, but you might gain weight afterward.
  • Being married: Married people are more likely to be overweight than those who stay single.
  • Having children: Women are likely to gain about 2 pounds each time they have a baby.
  • Poor education: People who do less well at school are more likely to get obese later in life.
Sources for the information on this page:

  1. Kopelman PG.Obesity as a medical problem.Nature. 2000; 404: 635-643.
  2. Hughes D, McGuire A.A review of the economic analysis of obesity.British Medical Bulletin. 1997; 53: 253-263.
  3. Flier JS, Foster DW.Eating disorders: obesity, anorexia nervosa, and bulimia nervosa.In: Wilson JD, Foster DW, Kronenberg HM, et al (editors). Williams textbook of endocrinology. 9th edition. WB Saunders, Philadelphia, U.S.A.; 1998.
  4. Flier JS.Obesity.In: Braunwald E, Hauser SL, Fauci AS, et al (editors). Harrison’s principles of internal medicine. 15th edition. McGraw Hill, New York, U.S.A.; 2001.

Wikio

Outside the Superstar Spotlight, Minorities Struggle With Obesity

By Lenny Bernstein
Tuesday, September 15, 2009

For a sports fan, this September is a bit like Christmas. The NFL season is starting, and the speed, power and grace of Minnesota Vikings running back Adrian Peterson is on display. At the U.S. Open, Serena Williams tore through the field as usual, before self-destructing. Baseball is heading toward the playoffs; the superhuman Albert Pujols has a shot at the Triple Crown. The majestic Michael Jordan was inducted into the NBA Hall of Fame, and it won’t be long before Kobe and LeBron are back on the floor.

Yet here is the irony I couldn’t escape as I sat in front of my television last week, taking it all in: The overall fitness level of the minority groups those superstars represent is appalling. By any measure that matters, blacks and Hispanics are in worse shape than whites — who, of course, are firmly in the grip of the obesity epidemic themselves.

According to the Centers for Disease Control and Prevention, 38.2 percent of whites over the age of 18 did no physical exercise (outside of work) in 2006. For blacks, the figure was 48.9 percent and for Hispanics it was an astonishing 53.4 percent.

The result of these disparities is sadly easy to predict. Fully 54 percent of African American women older than 20 are obese — not overweight, obese — by CDC standards. For Hispanics, the proportion is 42 percent, and for whites it is 32 percent. In combination with generally poorer diets and less access to medical care, that level of physical inactivity helps explain why minorities suffer proportionately more hypertension, Type 2 diabetes and heart disease. Their life expectancies also are shorter.

A larger percentage of African American and Hispanic children ages 6 to 19 are overweight than their white counterparts.

The reasons for this state of affairs are controversial and — as with all matters of race, income and personal motivation — a difficult subject. We’ll get to them in a moment. But I bring this up now for a number of reasons.

On Wednesday night, President Obama, a fitness freak, delivered his long-awaited address on overhauling the U.S. health-care system, an effort that all sides agree must place greater emphasis on preventive measures such as improved diet and more exercise. And with summer ending, we’ll all soon be spending a lot more time indoors. If you’re like me, you’ll be packing on the winter pounds.

Yet the approach of autumn also brings us the first annual (and possibly the first-ever) “walk-off” against obesity. On Saturday, thousands of people in more than 50 cities assembled against this killer.

The event was organized by Ian Smith, who launched the “50 Million Pound Challenge” in 2007. If you don’t watch VH1’s “Celebrity Fit Club” or read diet books, you may not recognize “Dr. Ian,” as his fans know him. (I’d never heard of him until a colleague mentioned his name.) But among African Americans, the slim, Dartmouth-educated physician is well-known for creating a national organization that has confronted their health problems and enlisted tens of thousands in a bid to lose weight. The group has since branched out and is trying to appeal to all races.

“Listen, the swine flu isn’t going to kill a tenth of the people that obesity kills on an annual basis,” Smith said in an interview. “This is one of the biggest health concerns for America, and we can’t get people to talk about it. . . . The sense of urgency isn’t there.”

One of the walk sites was in Alexandria, where Mayor William D. Euille led a team of about 40 people for a 1.5-mile walk. Over the past four years, Euille, an African American, has lost 60 pounds from his 5-foot-9 frame and kept it off.

“I got tired of hearing and reading and seeing obese kids and watching primarily African Americans suffer diabetes and high blood pressure,” he said. “My role, being African American, and being leader of this city, [is that] I’m the best person to deliver that message.

“No more excuses,” Euille said. “It is as simple as just walking.”

Or is it? Here is where experts disagree, and close examination of cultural and environmental factors makes solutions more elusive than they first appear.

Yes, obesity is a problem for all races and ethnic groups in this country and, generally speaking, affects people of all income levels. But higher proportions of the poor, minorities and the less educated tend to be obese, research shows.

Start with the traditional African American diet, Smith said, one rich in salty, fried food, a menu that has been handed down over generations. Add a greater acceptance of plus-size bodies by both African American men and women, along with some women’s disdain for exercise, and the cultural factors are stacked against blacks, he said.

If you’re poor, you may be sacrificing leisure time and exercise to make ends meet. Your grocery store may be stocked with cheaper, less healthful food. You probably have less access to fitness facilities, your neighborhood may not have sidewalks, and the local park may be the place where gangs hang out or drugs are sold, rather than a safe haven for an evening jog.

If you think this is a bunch of liberal excuses, you should know that it is supported by research. David Marquez, an assistant professor in the Department of Kinesiology and Nutrition at the University of Illinois at Chicago, who studies the physical activity levels of Hispanics, cited research showing that many Hispanic women feel that working, caring for their families and running their homes leaves them no leisure time at all.

Older Latinas also suggest that the only appropriate exercise for women is walking or dancing, Marquez said. Which is why he is trying to launch programs that center on dance as the primary form of physical activity.

NiCole Keith, an associate professor of exercise physiology at Indiana University-Purdue University Indianapolis was a researcher on one of the few studies of exercise that controlled for income. Researchers gave poor and moderate-income blacks equal access to fitness resources and — surprise! — they exercised at the same rates. Keith says poverty and environmental factors are unquestionably part of the equation.

“If you live in a dangerous area, you cannot get out and walk and run,” she said. “If you say, ‘You can walk on your lunch hour,’ you’re making the assumption that you have a job with a lunch hour. And you’re assuming everybody can walk when many morbidly obese individuals simply cannot.”

In recent years, Keith has had some success persuading Indianapolis principals to open school facilities after hours in inner-city neighborhoods so that adults and kids can exercise. She and colleagues have led videoconference exercise routines for people too infirm or too large to get outside for a walk. They also have tried adding exercise rooms to public housing projects. Urban planners are being educated on the importance of sidewalks. And the American College of Sports Medicine’s Exercise Medicine Campaign calls on policymakers to require doctors to counsel patients on physical activity during primary care visits. “If facilities are available and affordable or free, people will go,” Keith said.

Comments: misfits@washpost.com.

Wikio

Obesity costs U.S. health system $147 billion: study

CHICAGO (Reuters) – Obesity-related diseases account for nearly 10 percent of all medical spending in the United States or an estimated $147 billion a year, U.S. researchers said Monday.

They said obese people spend 40 percent more — or $1,429 more per year — in healthcare costs than people of normal weight.

“It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation,” Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news conference at a CDC obesity meeting where the study was presented.

“Reversing obesity is not going to be done successfully with individual effort,” Frieden said. “It will be done successfully as a society.”

The CDC outlined 24 new recommendations on how communities can combat obesity in their neighborhoods and schools by encouraging healthier eating and more exercise.

Democratic Senator Tom Harkin, a member of the Senate Health, Education, Labor and Pensions committee and chairman of the Senate Committee on Agriculture, Nutrition and Foresty, said the report underscores why prevention and wellness efforts must be part of any plan to reform the U.S. health system.

“Report after report shows that if we fail to take meaningful steps now on prevention of chronic disease like obesity, healthcare costs will continue to spiral out of control,” Harkin said in a statement.

26 PERCENT OBESITY RATE IN U.S.

More than 26 percent of Americans are obese, which means they have a body mass index of 30 or higher. BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall becomes obese at 180 pounds (82 kg).

For the study, Eric Finkelstein of the non-profit RTI International and researchers at the CDC and the Agency for Healthcare Research and Quality analyzed medical cost data from 1998 and 2006.

They found U.S. obesity rates rose 37 percent between 1998 and 2006, driving an 89 percent increase in spending on treatments for obesity-related diseases such as diabetes, heart disease and arthritis.

Obesity now accounts for 9.1 percent of all medical spending in the United States, up from 6.5 percent in 1998.

“What we found was the total cost of obesity increased from $74 billion to maybe as high as $147 billion today, so roughly double over that time period,” said Finkelstein, whose study also was published in the journal Health Affairs.

An obese Medicare beneficiary spends $600 more a year on drug costs than a Medicare patient of healthy weight.

The CDC’s new obesity prevention strategies aim to address issues such as a lack of access to healthy food in poor neighborhoods and sedentary lifestyles that contribute to America’s obesity epidemic.

Frieden said soda and sugar-sweetened beverages “play a particular role in the obesity epidemic,” noting that Americans consume an extra 150 calories more per day in sugar-sweetened beverages than two to three decades ago.

He said adding a tax to soft drinks might curb consumption but that was not a position held by the Obama administration.

(Editing by Maggie Fox and Bill Trott)

http://news.yahoo.com/s/nm/20090728/hl_nm/us_obesity_cost_5
Wikio

Obesity costs U.S. health system $147 billion: study

CHICAGO (Reuters) – Obesity-related diseases account for nearly 10 percent of all medical spending in the United States or an estimated $147 billion a year, U.S. researchers said Monday.

They said obese people spend 40 percent more — or $1,429 more per year — in healthcare costs than people of normal weight.

“It is critical that we take effective steps to contain and reduce the enormous burden of obesity on our nation,” Dr. Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, told a news conference at a CDC obesity meeting where the study was presented.

“Reversing obesity is not going to be done successfully with individual effort,” Frieden said. “It will be done successfully as a society.”

The CDC outlined 24 new recommendations on how communities can combat obesity in their neighborhoods and schools by encouraging healthier eating and more exercise.

Democratic Senator Tom Harkin, a member of the Senate Health, Education, Labor and Pensions committee and chairman of the Senate Committee on Agriculture, Nutrition and Foresty, said the report underscores why prevention and wellness efforts must be part of any plan to reform the U.S. health system.

“Report after report shows that if we fail to take meaningful steps now on prevention of chronic disease like obesity, healthcare costs will continue to spiral out of control,” Harkin said in a statement.

26 PERCENT OBESITY RATE IN U.S.

More than 26 percent of Americans are obese, which means they have a body mass index of 30 or higher. BMI is equal to weight in kilograms divided by height in meters squared. A person 5 feet 5 inches tall becomes obese at 180 pounds (82 kg).

For the study, Eric Finkelstein of the non-profit RTI International and researchers at the CDC and the Agency for Healthcare Research and Quality analyzed medical cost data from 1998 and 2006.

They found U.S. obesity rates rose 37 percent between 1998 and 2006, driving an 89 percent increase in spending on treatments for obesity-related diseases such as diabetes, heart disease and arthritis.

Obesity now accounts for 9.1 percent of all medical spending in the United States, up from 6.5 percent in 1998.

“What we found was the total cost of obesity increased from $74 billion to maybe as high as $147 billion today, so roughly double over that time period,” said Finkelstein, whose study also was published in the journal Health Affairs.

An obese Medicare beneficiary spends $600 more a year on drug costs than a Medicare patient of healthy weight.

The CDC’s new obesity prevention strategies aim to address issues such as a lack of access to healthy food in poor neighborhoods and sedentary lifestyles that contribute to America’s obesity epidemic.

Frieden said soda and sugar-sweetened beverages “play a particular role in the obesity epidemic,” noting that Americans consume an extra 150 calories more per day in sugar-sweetened beverages than two to three decades ago.

He said adding a tax to soft drinks might curb consumption but that was not a position held by the Obama administration.

(Editing by Maggie Fox and Bill Trott)

http://news.yahoo.com/s/nm/20090728/hl_nm/us_obesity_cost_5
Wikio

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