• Archives

  • Jun15

    Losing Weight Knocks Down Knee Pain…But How?

    Posted in: Aging and Costs of Aging, Arthritis, Obesity and Weight Loss, Uncategorized, Vitamins and Supplements, Wellness and Health

    If the US had the obesity rate it had in 2000 (not 2009), we might prevent 111,206 total knee replacements.

    If you have arthritis, you are twice as likely to be obese than if you don’t. About 50 million adults (22% of the US population) has arthritis—principally osteoarthritis, or wear and tear arthritis. Joint pain is the most common symptom.

    2000 median obesity among adults with arthritis: 33.2% (range 25.1% in Colorado to 40.1% in Ohio).
    2009 median obesity among adults with arthritis: 35.2% (range 26.9% in Colorado to 43.5% in Louisiana).

    Why do arthritic knees hurt? Is it because the knee bears 4# of stress for every pound of body weight? Is it inflammatory cytokines and adipokines that degrade cartilage? Is it something else?

    I’ve long been interested in improving quality of life in arthritis. A RC trial of omega-3s helped arthritic and neck pain; extra virgin olive oil has ibuprofen-like activity.

    Medical costs are estimated at $147 billion for obesity and $128 billion for arthritis each year, but the real, human cost which cannot be quantified is much greater.

    A systematic, careful, personal approach which looks at drugs and side effects, as well as diet and lifestyle, is what I recommend for my own patients.

     

  • May13

    The Cost of Calories: A Disruptive Technology

    Posted in: Aging and Costs of Aging, High Cholesterol, Obesity and Weight Loss, Wellness and Health

    Eating for health doesn’t have to be expensive. And it’s some of the best medicine: for weight loss, for pre-diabetes, for cancer prevention, for cholesterol control.

    Courtesy of MyMoneyBlog are easy ways to understand the cost of calories.

    In speaking with health professionals about what is new and next in nutrition, and the power of writing recipes on prescription slips, the subject of how much food costs does come up, but it’s usually the last question, after those about resources, food prescriptions and prevention.

    For the food-buying public, cost is usually the first question.  Getting real about the high price of cheap food is the biggest stumbling block for most people, and why not?

    The most precious commodity for many people is time, followed by immediate, check-to-check cost. Then food quality and nutrition.

    We spend almost as much away from home (48.6 percent) on food as we spend for food at home (51.4 percent), as of 2009.

    Cost from USDASaving health care dollars down the road often takes back seat to getting the kids fed, the car fixed and the job done.  Mark Bittman persuasively and lucidly writes that the U.S. can save $1 trillion dollars by reforming the American diet.

    We’re eating 23% more in the U.S. than we did in 1970. And that’s just quantity: quality of calories also makes a difference (cool interactive info-graphic here, from Civil Eats). And there’s no better control of quality than your own hands.

    Could cooking could be a disruptive technology in health care?

     

  • Mar1

    Diabetes Doubles! Food Can Help. Should It Be Reimbursed?

    Posted in: Aging and Costs of Aging, Diabetes, Wellness and Health

    Americans treated for diabetes doubled to about 19 million (8.5% of the population) in 2007 compared with 9.1 million (4.6% of the population) in 1996, according to the AHRQ, a federal agency.

    That doesn’t count the undiagnosed (7 million) and those with prediabetes (79 million).

    Health care spending on diabetes more than doubled to $40.8 billion (the ADA says this figure is low: total diabetes costs are $174 billion, they say, in 2007). U.S. Diabetes expenses 1996-2007

    But something odd happened: what it was spent on changed.

    The amount spent on on prescription medication in 2007 doubled vs 1996: 46.7% compared with 23%.  The amount spent on home health actually fell by nearly two-thirds: 9.5% vs 27.1%.

    Individuals with diabetes paid double too: $1048 in 2007 versus $495 in 1996.

    What do all these numbers mean? They mean diabetes is doubling, fast. They mean that payers are paying for medication–not home care, by a mile.  Actually, by billions of dollars.

    But I wonder if these same payers know the data about lifestyle program cost and prevention of diabetes.Diabetes Prevention Program

    This slide summarizes the results of the Diabetes Prevention Program. It tested metformin (a good, inexpensive medication)  versus diet and lifestyle in reducing diabetes, for a year.  Metformin reduced diabetes by 31%.

    Lifestyle did better. It reduced diabetes by 58%. Without any complications.

    They lost just 7 percent of body weight and exercised only 2.5 hours weekly, on average.

    It was an expensive program–about as expensive as medication, not including diabetes costs prevented–but the researchers brought the costs down: United Health is testing a version with the YMCA and pharmacists.

    More innovation! That’s the spirit! Should the right food be reimbursed?

     

  • Aug4

    Obesity: Follow the Money

    Posted in: Aging and Costs of Aging, Obesity and Weight Loss


    Adult obesity has nearly doubled in the U.S. in 16 years. Obesity-related quality of life has been nearly cut in half (using QALYs, which Eddie Lawlor and I showed had ethical challenges but predicted the health care financing problems we’re having now).

    And following the money gives a direct answer to this obesity problem. (see right, courtesy of wisegeek.com). Candy, pasta and bread are dirt cheap; fruits, veggies and nuts are not.

    Over the past  four years, the supermarket price of the most nutrient-dense (read: most nutritious, in a good way) foods increased 29.2 percent.  Those least nutrient-dense rose by 16.1 percent. Dr Dresnowski has been on this from early on.

    In other words, healthy food– fewer calories, more nutrition– is more expensive than junk food– more calories, less nutrition. Could the right financial incentives to producers and shoppers help?

     

  • Jul16

    Prevention Will Be Cheap. But Fun?

    Posted in: Child Obesity, High Cholesterol, Wellness and Health

    For 43 million Americans on September 23 and probably the rest of the U.S sometime in 2011, preventive services just got cheaper.

    No co-pays, no deductibles, no direct charges for stuff that works.

    Now, we must figure out how to make it fun, sexy and easy. For kids and adults.  But doctors getting paid to do it? Way fun.

    Which services?

    Blood pressure, diabetes and cholesterol tests; many cancer screenings; routine vaccinations; prenatal care; and regular wellness visits for infants and children; screening and counseling for obesity; and tests for HIV. Kathleen Doheny at WebMD has a comprehensible short list; healthcare.gov has a long one.

    These are mostly to diagnose disease, but the vaccines and obesity counseling are to prevent it. What about obesity?

    “The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults….and screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status.”

    Does this mean that the intensive Ornish program, designed for heart disease treatment and on the verge of approval by Medicare would qualify, but something milder, like Diet Plan of the Month, might not?

    If insurers cover weight loss counseling, there will be a lot more clinicians interested. And that will start the change in obesity treatment in health care.