• Archives
  • Nov8

    At KevinMD, Dr. Joel Sherman writes smartly about why men avoid going to the doctor.  One reason: it reminds them of mortality. A second reason: a potential prostate exam. A third: they have to wait, a lot. Plus, telling a female receptionist about a male-related problem is not great.

    Note to middle aged men: erectile dysfunction is an early warning sign for heart disease, until proven otherwise.

    Men get more heart disease and die younger than women. Going to the doctor is usually an event (a screening exam, unable to move because of back spasm or broken limb) rather than a process (cancer prevention, for example).  Research on men backs this up.

    In my office, men often come in for lifestyle advice, weight loss help or nutrition consultation if they have a close friend or relative who recently became ill. Say, someone who had a high calcium score (over 400) or had a heart attack or prostate disease diagnosis.

    That’s especially true in men under 60; men over 60 know they need to protect their health. And they know that seeking help is an acceptable behavior, as is staying healthy.

    Sometimes another doctor requires them to come in, or a wife/girlfriend/mother/daughter/lover makes them. It takes courage to come in.

    45% of men don’t have a primary care physician, and 10% can’t remember when they last saw a doctor. 9% would avoid doctors even if they had blood in urine or semen.

    On KevinMD, above, a nurse writes about her husband: “He’s a little overweight (20lbs).  He says, “I’ll go when I lose weight”.

    It’s understandable that men feel that way.  But not necessary. What if it was a game, or competitive, or there were rewards involved, or it was actually fun?

     
  • Apr26

    The new reports on total body burden of mercury appearing to cause atopic dermatitis, or eczema, and of high mercury counts in Pacific seabirds reminds me of Matthew Davis, the previously healthy 6 year old whose daily tuna habit showed up as learning problems and disinterest in school.

    The Wall Street Journal reported it, and a whole generation of people happy to feast on yellow tail and unagi unhappy.

    Jeremy Piven’s recent mercury poisoning and exhaustion from twice daily sushi forced him to abandon “Speed-the-Plow” on Broadway.

    Last month, one of my new weight-loss program patients mentioned his fondness for sushi, not quite at Jeremy Piven levels. I suggested a blood mercury test, which identifies recent mercury intake not total body burden.

    It came back twice normal. Mercury is lipophilic, and is stored in your body fat…including your brain. And some people eliminate and detoxify it better than others.

    Now my patient is doing very well, motivated in part by the fact that he is accountable, he is working out and he is getting the right, individual foods for him, and not slowed down.  We’re off fish and will re-test in a few months.

    Fish are generally good food for people: the omega-3 story is powerful in reducing risk for heart attacks, lowering triglyceride levels, improving depression and mood and many more conditions.

    But please eat only low mercury sushi and sashimi.

     
  • Feb15

    Many studies now show parents underestimate their overweight kids’ weight.

    A New York pediatrician’s office shows that barely 10% of parents of overweight kids actually thought their kid was overweight.

    In contrast, fully 60% of parents of normal-weight kids knew that their kid’s weight was normal. Parents of overweight kids were off by an average of 45%tile.

    Parents of normal-weight kids who underestimated are more likely to be concerned about their child’s weight than parents who get it right.

    Parents most likely to make changes are those who knew that they themselves were overweight, had overweight kids over 8 years old, and those who thought their kid had a health problem.

    Obese children have a high risk of diabetes, high cholesterol and metabolic syndrome. These are all disorders thought only to occur in adults–like my patients–until several years ago.

    Bottom line: parents have a hard time discerning when their child is overweight, and it is different for adults than for kids.  For kids, use the BlubberBusters BMI for kids calculator: good, clear explanations and info.

     
  • Jan27

    I was interviewed recently by the American College of Physicians about best practices for physicians who find it uncomfortable to speak with their patients who want to lose weight.

    The resulting article focused on “motivational interviewing”: I just think about it as how to speak with patients.

    Here is a video on motivational interviewing about weight loss. The actors are clumsy and the advice is imperfect (artificial sweeteners are not the solution, there is no motivation elicited, the patient probably feels deprived, and the doctor is still directing instead of listening well). But this type of conversation is a first step.

    The real problem is that people don’t know how to do what physicians (may) tell them to do.

    The lack of training for physicians about what to say and how to say it doesn’t help. I got 4 hours of nutrition in medical school, and 2 hours in cooking school. None were about obesity.

    Finally, most physicians aren’t paid to have these conversations. They need to code a visit about weight management as something else, so they can be paid. I hope this changes with health reform. And it may.

    Motivational interviewing is a good tool–with enough time, compensation, evidence-based content and practice it will help. We can do it: POLST has done it for care near the end of life. Obesity could actually be easier.

     
  • Dec21

    Dr Molly Ferguson is a naturopath in Michigan who is courageous enough to discuss treating childhood obesity.
    Video: Treating Childhood Obesity

    Putting kids on a diet has long been terrifying to physicians because we are frightened about creating eating disorders (the other way!)

    But there is good data to show that the suggestions she makes: “eating the rainbow”, “eating fewer processed foods”, and “avoiding chemical additives” can have beneficial effects on kids’ health: improving immunity, increasing energy level at school, reducing hyperactivity symptoms.

    Is there a good diet for overweight kids? If there were just one, all kids would be on it.

    Childhood obesity has leveled off in kids ages 2-5, because Moms are super concerned, and have more control over what there is to eat.   The next frontier: kids ages 6-11 or 12.

    I think teaching kids about food and the basics of how to cook would transform family lives: treat Mom’s diabetes, and Dad’s cholesterol and heart disease, and Sis’ asthma.

    Eating and cooking healthfully to lose weight has worked for adults enrolled in Chef Clinic, and in adults who make big lifestyle changes.

    Should overweight kids be on a diet? And if so, what would one look like?