Recipes and Reform

Boy, do I have a treat for you all today! Go to Gina's WW Recipes for some WONDERFUL and EASY recipes to try! My patient load is light today and I was able to spend some time perusing her blog this morning, saving TONS of recipes I'd like to try! If you enter your email address into her FeedBurner, you'll never miss a great recipe delivered right to your inbox!

Today for lunch I ordered take-out from Chili's Guiltless Grill (our microwave at work is still on the fritz)...the Buffalo Chicken Sandwich to be exact. It was really good! I was feeling great about my "Guiltless Grill" selection until I learned of the sodium...over 2,300 milligrams! Ahhh! At least the sandwich was only 386 calories, 7 grams of fat, and contained 9 grams of fiber??? :-/ Disappointing, Chili's! Very disappointing! I've also been reading Gina's blog, which has probably made me hypersensitive about sodium levels...which is a good thing!!!!!

Today for a snack I tried the Kay's Naturals Honey Almond Protein Cereal (gluten-free). I love the crunch of a cereal, but would be interested to see if the crunch held when served with milk (I ate the cereal plain). Most gluten-free products are "airy" in taste, weight, and texture...and the Kay's Naturals products are no exception. Though I should mention, I am a fan of the "light-weight" nature of gluten-free products...less bloat, I feel. The Honey Almond Protein Cereal is lightly sweetened, nothing over-powering which I prefer. Again, the portion size is excellent and one serving contains 100 calories, 3 grams of fiber, and 9 grams of protein! Nice work, Kay's Naturals...I am LOVING your products! Thank you!!

And in the news...a feather in the caps of those like myself in prevention...

A new poll for American's Health and the Robert Wood Johnson Foundation shows the majority of Americans consider disease prevention the MOST important element of health care reform.

The US Department of Health and Human Services aimed to reduce obesity rates to 15% in every state before 2010 (baaahahaha!). However, the trend is showing movement in the opposite direction -- obesity rates continuing to rise. As of 1991, no US state had an obesity rate over 20%. Today, only Colorado has an obesity rate under 20%.

In playing devil's advocate I have to propose...DO we (as a nation) want to change, or are we just sick and tired of our ill-fate if trends continue? 

If you had to take a side in this debate, what do you feel is consensus for the nation as a whole: 

a) improve health through prevention (nutrition, exercise, and preventative health care)

--OR--

b) continue Western medicine of treating the disease and not the problem

Weight...or height?

Is trying to control our country's height just as plausible as trying to control our country's weight? Maybe so.

Economists estimate that excess weight accounts for 9% of the U.S.'s medical spending. And while there's no similar figure for height, it is clear that both obesity and short stature cause similar economic strain [1].

Whatever the reason as to why, higher weight and lower height are associated with chronic disease, low wages, and poor educational attainment. In the US, the shorter you are the higher risk you're at for developing coronary heart disease, diabetes, and stroke. Women weighing more than 212 pounds at 5'4" tall are paid up to 9% less for their work, for example. According to survey data collected from over 450,000 adults suggests that male college graduates are, on average, more than an inch taller than men who never finished high school [1].

Is the reshaping of America both a war against fatness and shortness? How can one increase stature?

Height is not only genetic, but nurture and nature-related. Exposure to malnutrition, infectious disease, chronic stress, and poverty can abbreviate children's proper growth and height. Promoting foods which are low in calories and high in micronutrients, such as fruits and vegetables, is one feasible option. Increasing and improving education as a means of decreasing poverty and environmental stress is another. And of course, access to quality health care providers to improve prenatal and postnatal care is imperative [1].

This information is simply food for thought...and a topic that peeked my interest. Or maybe we should just throw everyone on growth hormone and run a blow-out sale on bariatric surgery!!

Kidding.

Yesterday checked out like so...

Breakfast:
1 cup steel cut oats, prepared (2 carbs)
1 Tbsp pumpkin butter (1 carb)
1/2 tsp turbinado (0 carbs)
     Total: 3 carbs

Lunch:
1 slice Buffalo Chicken Lasagna (2 1/2 carbs)
1 2% string cheese (0 carbs)
apple (1 carb)

     Total: 3 1/2 carbs

Snack:
6 ounces fat-free yogurt (1 1/2 carbs)

Dinner:
1 serving Chicken Tamale Casserole (2 1/2 carbs)

     Total: 2 1/2 carbs (low)

Snack:
4 peanut butter crackers (1 carb)

10 more days of being a diabetic...I can DO IT!!!!! Though, I am yet to look up the carbohydrate content of the INCREDIBLE pumpkin spice cappuccino I mixed with Dark Roast coffee this morning. It was worth the splurge though, I swear!!

Gina, CandidRD, is having a great give away on her site. Go here for more information!

[1]. Engber, Daniel. The Fat and Short of It. The New York Times. October 15, 2009.

Food Stamps for Pounds!

A 14-year nationwide study shows the U.S. Food Stamp Program may help contribute to obesity among its users. The average BMI of a Food Stamp participant was found to be 1.15 points higher than nonusers. Specifically, women's BMI rose with food stamp usage, while men's did not [1].

People's BMI's increased faster when they were on food stamps than when they were not, and also increased the longer they participated in the Food Stamp Program. While the Food Stamp Program is intended to increase food security and combat hunger, there may be unintended consequences, such as obesity [1].

Based on these findings alone, the Food Stamp Program may have a significant impact on America's obesity rate with nearly 1 in 11 U.S. residents receiving food stamps in 2008. Because poverty and obesity are linked, the study accounded for income and a variety of other factors, including race and education [1].

Is this trend worsening? Yes. While Food Stamp Program participant BMI's have increased in the past, the rate is increasing. The average food stamp user's BMI rose 0.4 points per year on food stamps, compared with 0.07 points the year before they were receiving food stamps and 0.2 points the year after they no longer received food stamps [1].

While 2002 was the last year included in the study, participants were then receiving a mere $81 in food stamps per month. The study co-author of the study, Jay Zagorsky states, "I think it would be very difficult for a shopper to regularily buy healthy, nutritious food on that budget...Modifying the Food Stamp Program to include economic incentives to eat healthier might be an important tool for fighting obesity." It is true that calorie-dense, high-fat, processed foods tent to be less expensive and the least healthy of the available options out there [1].

So, the Food Stamp Program needs some tweeks. Maybe they should consult with WIC which recently removed juice (yes, even 100% juice) from their program. Just like with soda, juice is now being linked to excess weight gain among American's, and specifically among children.

Any thoughts on ways to better the Food Stamp Program? Should certain foods be excluded from the program due to their nutritional content...or lack thereof? Weigh in! Tax dollars making our nation more unhealthy should be concern for us all!

[1]. Food Stamp Use Linked to Weight Gain. Today's Dietitian. Source: Ohio State University. September 4, 2009.

Health care reform: are you blue or red?

Tonight I watched President Obama's health care reform speech. I have to say, I was moved. For those who did not or will not get the chance to see the speech, here's a brief recap.

Obama began by explaining the massive expense of US health care at 150% more than any other country in the world. Yet, we're not healthier because of this. And US health care is currently putting "undue" pressure on government health care programs such as Medicare and Medicaid. Insurance costs are rising at 3x the rate of wages, and our health care costs account for 1/6th of the US economy. Obama explains that his reform "builds on what works". The reform suggests further security and stability of health care for those currently insured and a slowed growth of health care costs for businesses, governments, and citizens.

For those with health insurance or receiving Medicare or Medicaid, the reform offers no change in coverage or provider changes. The reform would make it unlawful for insurance companies to deny coverage to those with pre-existing conditions, or dropping medical coverage for those who develop an illness. The reform proposes no "cap" on coverage for the insured -- for the year or a lifetime. Lastly, the plan would limit out of pocket expenses for those insured.

For those without health insurance due to coverage lost with jobs or those in small businesses, would allow for insurance "shopping" and price comparisons, creating a competition among carriers to lower expenses for individuals seeking health care. A not-for-profit sector would also be available to those without insurance, which less than 5% of Americans are expected to utilize.

For those that choose no health insurance when "affordable options are available", basic health insurance will be required. Obama stated, "consumers do better when there's choice and competition". This can create reduced costs for tax payers by not allowing the system to be worked over by the uninsured.

Large companies must offer insurance or contribute to health care coverage. It was noted that 95% of US businesses will fall exempt from this point.

Key controversies addressed:

- the thought to "kill off seniors" was denied and deemed a lie

- illegal immigrants WILL NOT be eligible under reform

- no federal money will be spent on abortions

And as for funding the health care reform...there would be tax increases for America's richest. There would be NO increase in the budget deficit and NO money used from Medicare. Malpractice reform was suggested as a means of funding, though specifics were not discussed. In brief, the plan is projected to cost $900 billion over the span of 10 years -- less than what was spent on the Iraq and Afghanistan war and less than the tax cuts imposed on America's richest citizens during the Bush administration (which are still in place).

Obama reached all (I hope). He presented several cases of individuals who had health care who have not received the treatment their condition required, or being dropped from their health insurance provider due to their health status or condition. Such instances are tragic and could happen to ANY one of us at any time. Obama closed with sharing thoughts from a letter written by the late Ted Kennedy suggesting health care reform for moral issues above all else.

While I am interested in hearing SPECIFICS on the funding, all-in-all I'm pretty happy with all that was shared. I have to say, whether or not US citizens agree or disagree with our president, there was a complete and utter lack of respect from Congress during the speech. It is despicable that people find that acceptable, or choose to contribute themselves. Health care is a complex topic with no clear-cut solution, but crude opposition rarely gets anyone anywhere fast. 

How do you feel about the suggested health care reform? I am interested to learn more and what role preventative medicine will play in the reform. Please share your thoughts -- are you more blue or more red? I think it's pretty clear where I stand : )

MD + RD = : )

The article, "Diabetics Be Aware: Doctors Are Not Dietitians," is brilliant. The title got your attention, didn't it?

Warning: stepping on soapbox today.

As a dietetic intern and diet technician in hospitals I felt like last man on the totem pole. The nutrition teams in hospitals have always felt like paper-pushers who crossed their T's and dotted their I's (I mean aren't all dietitians type-A freaks? - Ha!). Logistics and liability coverage only. Dietitians like myself are left feeling not only under-appreciated, but obviously under-utilized!

A newly diagnosed diabetic, for instance, may be getting their only nutrition education as they are being discharged from the hospital and wheeled out on a gurney. Literally. And if you think that's an exaggeration, I assure you it's not. I was the frustrated little intern running after that patient caring deeply for their disease state and prognosis.

I adore my current job and I can't help but make the connection between my job satisfaction...and the appreciation for dietitians among our providers! {{rainbows and clear blue skies}} Nutrition is a focal point of patient care at my clinics, ESPECIALLY among diabetics (duh, medical world).

So I get forwarded this incredible article today, written by a DOCTOR (Dr. Stephen Ponder)...who happens to be a type 1 diabetic AND an endocrinologist. The article proposes the vital role of a nutrition expert (dietitian) in the comprehensive care of a diabetic patient. I genuinely appreciate doctors and all that they do -- it's a ton! Yet, few doctors have the time or expertise to counsel a diabetic on proper diabetic nutrition. And MD's, for the record, "eat less carbs" won't do. It's not only incorrect information, but one must know WHAT a carb is to understand such a statement to being with.

The article states, "You should see a dietitian at diagnosis and periodically thereafter. Rememeber, doctors are not dietitians. I got little formal training in medical school on this subject. ...All diabetics need proper nutrition to maintain their health, not just pills or shots." [1]. Music to my RD ears.

Another important point to be made -- batting for the same team improves outcomes for all. Many of my patients are willing to hear me out (...and show UP to their appointment!) BECAUSE their provider emphasizes the role of nutrition in diabetes management. Having the MD's on board enables RD's to reach patients on a deeper level as the rapport begins building with the MD who coordinate the patient care.

Dr. Ponder is a type 1 diabetic working in pediatric endocrinology at the Children's Diabetes and Endocrine Center of South Texas at Driscoll Children's Hospital. Our team of RD's will be sending him a thank you card for his voice in support of nutrition and dietitians. Thank you!

P.S. Kristen (my ICU nurse friend in Chicago) -- don't forget to start your tube-feedings!!!!!!

[1]. Ponder, Stephen. Diabetics Be Aware: Doctors Are Not Dietitians. Caller. August 2009.

Tax the people, not the products.

I think this idea is more feasible than taxing products. However, I don’t advocate BMI as an indicator of weight status. So, what gives? I’m not sure. Weigh in, folks. Pun intended : )

Undoubtedly, taxing “unhealthy” foods will lead to a further socioeconomic gap between the rich and the poor as such taxes would more proportionately affect the poor than the rich. I’m way too liberal to support such a thing – sorry, Oklahoma and your redness. But how can we quantify an American “fat enough” to be taxed? Hmm.

Many of America’s large companies and corporations reward employees for healthful actions. A friend who recently visited was given a health coach with whom she speaks with over the phone on a regular basis. She’s started keeping food records and reporting them to the coach. After my initial reaction of, “Health Coach? Can I see some credentials?”…I saw our friend recording her intake, despite our not-quite-ideal intake each day. The incentive? Money! Talk about a win-win…or at least that’s how I see it. Same goes for working out. Record your hours in the gym and receive monetary reward for your efforts. Suh-weet. Similarly with husband’s workforce, those employees who fill out the Health Questionnaire are rewarded monetarily. And they’re on the clock while they fill them out – again, win-win! Here’s the real kicker: make and keep regular preventive doctor appointments and earn money for doing so (i.e. dental exams, colonoscopies, and mammograms). Sound insane? There’s companies out there paying their employees for maintaining their health. Hard to believe there can be such extremes in the world.

More and more companies are building gyms with employee-only access, free of cost to employees. Husband’s work is hiring a Certified Diabetes Educator (CDE) next year, even. Seemingly, if you want the support in weight-loss and health endeavors…they’re at most people’s disposal -- especially those in corporate America. If we could get cafeterias on board with palatable (maybe even delicious…), nutritious food, maybe we’d see some overall health benefits.

Anyways. Rant over. If the US were to tax the fat – what criteria would their “fatness” be based off of?

…Waist-to-hip ratio?
…A modified Metabolic Syndrome (2-3 qualifying criteria versus the current standard)?
…A BMI greater than ______? What do you think?

P.S. I still advocate a sales tax on sugar and high-fructose corn syrup sweetened soda!
P.P.S. Thanks for the blog topic request, Erin...it was a great one!

Obama and Healthcare Reform…

What does our president propose?

Well, firstly it’s important to understand that healthcare costs are the biggest driving force behind the federal deficit and thus, healthcare reform is Obama’s top legislative priority. Specifically, Obama is designing an overhaul to create a government-run insurance program to compete with private insurance programs in an effort to insure the 46 million uninsured Americans. With healthcare costs rising faster than inflation, the number of uninsured is guaranteed to climb without reform [1].

A recent Washington Post poll shows that public support for Obama’s healthcare reform has plummeted below 50% [1]. Big ouch. Nancy Pelosi, House Speaker, said there were enough votes to pass the bill in the House. This count was later questioned by Boehner.

Obama is pushing for the bill’s first version to be passed in each chamber of Congress before the one-month August recess. Republicans want a delay [1]. The month-long break is sure charge opposition.

Please comment -- what are your thoughts on Obama's proposed healthcare plan?

[1]. Whitesides, John. Obama Says Healthcare Crucial for Economy. Reuters Health. July 22, 2009.

100+: the fastest growing age segment!

That's right! The US and Japan lead the world in populations of centenarians as a population growing 20x the rate of the total population by 2050. In 1950, there were only a few thousand over the age of 100 while today there are an estimated 340,000 worldwide [1].

Why is this?

Demographers declare medical advancements and improved diets are to thank. How'bout it, nutrition!? Genetics, lifestyle factors, and doctors willing to treat chronic diseases aggressively are also key contributors to the climb in age [1]. There's so such thing as "too late" in today's medical field to reverse the progression of disease. Nope, nope, nope!

While Japan leads the projected number of centenarians at 627,000 by the year 2050, the US is not far behind. We come in second with an estimated 600,000 come 2050, which is up from the current 75,000 in the 100+ age segment [1].

What does this mean for Medicare and Social Security? Well, it means something better if we each do our part in preserving our health. The cost of chronic disease management is perverse...obscene, even. The reality is, the younger generations may be SOL when it comes to government assistance come post-retirement age. 401k anyone?

Though the average American lives to be 78, most Americans would like to live to 89. Twenty percent of Americans would like to live to 90 with 8% wishing to live to see 100 [1]. With those goals and aspirations, we'd better aim to better our health or else it could certainly feel like a really long life.

Well, I'll have you know, I take my health very seriously and I intend to preserve it to the best of my abilities. It's a personal aspiration of mine to live to be 100+. When I was growing up, every Sunday at church there was the cutest little old lady who used to handout candy to kids as they exited the sanctuary. Every week she was there. While I appreciated the candy, I had come to appreciate her over the years. It wasn't until after her passing that I learned she was nearly 103 years of age. She was mentally sharp as a tack, and physically well enough to never require mobile assistance. She even posed in a Harley Davidson photo shoot on her 100th birthday I later found out. Seriously though, what a woman!

I see much of the same in my own 86-year-old Grannie. I'm sure you recall my boasting of her dance moves at my recent wedding reception...but here's a new story for you. On my way home from work last Friday I gave her a ring. I figured she would be heading downstairs to have dinner shortly (she lives in an independent living facility), but I tried her anyways. Turns out, she invited her "friend" Bill over (I use the term "friend" loosely. Grannie likes gentlemen, and has forever required several leading "friends" in her life. Bill just happens to be geographically desirable, however). They ordered in a pizza and were listening to music together. Maybe she was planning on showing off her dance moves, I'm just not quite sure. She did mention he was handsome. But, my point is...besides some short-term memory loss, the use of a walker (by choice), and some controlled hypertension, the woman is kickin' strong. You go, Grannie!

Aging can be a beautiful process, and I look forward to it...because I plan to do what it takes to do so gracefully. Kudos to those over 100 or well on your way...you're my inspiration!

[1]. Yen, Hope. Starting to Get Crowded in 10o-Year-Olds' Club. The Washington Post. July 20, 2009.

No $h*t, Sherlock!

Admittedly, this rant is biased...but also commonsensical.

In Medical News Today, an article was written discussing the importance of nutrition in the prevention of chronic disease. Well, duh. Unfortunately for me and my fellow RD's, we're S.O.L. until legislation changes.

But really, is it an over-sight? Are U.S. officials sitting back just hoping and praying that obesity will max itself out, and annual health care costs for chronic disease treatment and management secondary to obesity will eventually start to drop? Baaaaaahahhaa. I assure you, that's not the case.

Thanks, Doc.

Ninety-six percent of U.S. primary care physicians feel more emphasis needs to be placed on nutrition to treat, manage, and prevent chronic disease. However, M.D.'s cannot do it all. Only 12% of doctors are believed to present nutrition as a means of chronic disease management to their patients. Further, 80% of doctors reported "lack of reimbursement" as one of the top reasons providing nutrition services is not routine [1].

Keeping America alive and "well" (let's use that term loosely) has reached costs that we cannot entertain affording. Yet, we continue to superficially treat our people with "chronic disease management", spending trillions of dollars annual. Of our $2+ trillion in annual health care costs, 75% can be attributed to chronic disease management, according to the CDC [2]. Unless you are a renal disease patient (not receiving dialysis) or a diagnosed diabetic, you will receive NO insurance coverage for medical nutrition therapy as indicated by Medicare Part B [3]. Your insurance scoffs at the gravity of your BMI of 60 (a BMI falling into the 7th tier of "obesity"...if there should ever be such a thing ::hint hint:: -- doesn't "7th tier obese" sound a bit harsher than just "obese"??)...and rather than supplementing the cost to see a dietitian, would rather buy themselves a few years and then cover the costs of your bariatric surgeries, hospital stays, anesthesia, ambulance costs, [insert laundry list here]....

Nutrition is an over-sight in some ways, however, as other areas of health care have figured out that prevention is key!

According to the CDC [3]:
- For every $1 spent on water fluoridation, $38 is saved in dental restorative treatment costs
- A mammogram every 2 years for women aged 50-69 costs only $9,000 per year of every life saved
- For every $1 spend on the Safer Choice Program (a school-based HIV, other STD, and pregnancy prevention program), about $2.65 is saved on medical and social costs
- Implementing the Arthritis Safe-Help Course among 10,000 individuals with arthritis will yield a net savings of more than $2.5 million while simultaneously reducing pain by 18%

Glad I'm an eternal optimist, things are grim for the fatties.

"Change we can believe in" -- hook us up, Obama! Please?

What does ADA have to say about MNT reimbursement for weight management? Find out here.

[1] More Than 9 in 10 Primary Care Physicians Say U.S. Health Care Systems Should Place Greater Emphasis on Nutrition to Manage Chronic Disease, American Dietetic Association (2009).

[2] Chronic Disease Overview
[3] medical nutrition therapy: the assessment of the nutritional status of patients with a condition, illness or injury that puts them at risk. This includes review and analysis of medical and diet history, laboratory values, and anthropometric measurements. Based on the assessment, nutrition modalities most appropriate to manage the condition or treat the injury are chosen and implemented by the patient and nutrition professional.