AMA Declares Obesity a Disease

From Medscape News Today 6/20/13

CHICAGO — Physicians voted overwhelmingly to label obesity as a disease that requires a range of interventions to advance treatment and prevention.

However, there was impassioned debate in the hours before the vote here at the American Medical Association (AMA) 2013 Annual Meeting.

Although policies adopted by the House of Delegates have no legal standing, decisions are often referenced in influencing governmental bodies. This decision could have implications for provider reimbursement, public policy, patient stigma, and International Classification of Diseases coding.

“Obesity is a pathophysiologic disease. There is a treatment for this disease; it involves behavioral modifications, medications, and surgeons. Obesity affects minorities disproportionately,” said Jonathan Leffert, MD, alternate delegate for Endocrinology, Diabetes, and Metabolism. “The scientific evidence is overwhelming.”

Melvyn Sterling, MD, said this brings to mind to the debate over whether hypertension is a disease.

“I’m a general internist, among other things, and I treat the complications of this disease. It’s interesting to look back in history at a time when hypertension was not thought to be a disease,” said Dr. Sterling, who is from the AMA Organized Medical Staff Section, but was speaking for himself. “Obesity is a disease. It’s very, very, very clear that even though not every hypertensive gets a stroke and not every obese person suffers the complications, that does not change the fact that this is a disease.”

Some Not Convinced

Others testified that the measure for determining obesity is imperfect and although it is an epidemic, obesity does not meet the criteria for disease.

Russell Kridel, MD, incoming chair of the AMA Council on Science and Public Health (CSPH), told Medscape Medical News that there is no debate about the importance and urgency of addressing the problem, but he doesn’t believe it qualifies as a disease.

“It’s more like smoking. Smoking isn’t a disease. Smoking can cause disease such as lung cancer and emphysema in the same way that obesity can lead to diabetes and hypertension,” he explained. “We’re really talking nomenclature here, not philosophy.”

He noted that behavior and dietary choices play a part in obesity. “Thirty years ago, we did not have the obesity problem we have now. If you look scientifically at what has changed, our diet has changed. There’s been no change in our genetic structure in the past 30 years.”

Dr. Kridel said he would like to see more attention focused on prevention and personal responsibility. The CSPH issued a 14-page report opposing the classification of obesity as a disease.

“We did not think the evidence rose to the level where obesity could be recognized as its own distinct medical disease state. Obesity is a very serious condition. It’s a scourge on our nation. It’s an epidemic. It’s a significant risk factor for many other diseases,” said Robert Gilchick, MD, speaking on behalf of the CSPH. “But that does not alone make it a distinct medical disease state.”

He explained that because body mass index, an imperfect measure, is used to determine obesity, people who are otherwise healthy are being diagnosed as obese.

“Why should one third of Americans be diagnosed as having a disease if they aren’t necessarily sick?” he asked.

One Third of Americans

According to the Centers for Disease Control and Prevention, 35.7% of Americans are obese. Obesity-related conditions, including heart disease, stroke, type 2 diabetes, and certain cancers, are some of the leading causes of preventable death.

In other AMA actions, a policy that supports banning the marketing and sale of high-energy drinks to anyone younger than 18 years was adopted.

Also accepted was a policy that supports letting students have sunscreen at school without restrictions. Currently, most states don’t allow students to possess over-the-counter medications in school without a note from a physician. Sunscreen is considered an over-the-counter medication because it is regulated by the US Food and Drug Administration.

Dr Elaine Rancatore in the NEWS

Good Medicine
Spring 2013
Vol. XXII, No. 2

Mother’s Cancer Inspires Nutrition Outreach: Elaine Rancatore, D.O.

Elaine Rancatore, D.O.After losing her mother to cancer, Elaine Rancatore, D.O., began educating everyone from high school students to senior citizens about the benefits of a healthful plant-based diet.

When Physicians Committee president Neal Barnard, M.D., recently gave a lecture on his new book, Power Foods for the Brain, in Broward County, Fla., Dr. Rancatore talked about the benefits of fruits and vegetables in preventing Alzheimer’s disease and demonstrated how to make the book’s Blueberry Breakfast Smoothie.

“There is no time to waste in putting this new brain-boosting diet into action. We should all encourage physicians, dietitians, teachers, parents, and everyone else to spread the word,” says Dr. Rancantore. “And let’s not forget to make these changes in our own homes—it will help ensure that we’ll have as long as possible to spend with those we love.”

A longtime Physicians Committee member, Dr. Rancatore has practiced emergency medicine for 18 years and knows just how serious and debilitating Alzheimer’s can be.

“Patients don’t just forget names and dates—they can often end up in situations that are harmful to their physical health,” she adds. “They may forget to turn off the stove, or they may get lost and end up walking in the street.”

In addition to her position at Baptist Health South Florida, Dr. Rancatore is a co-founder of 2R-Health, which was created to promote healthful nutrition and physical activity, to develop and encourage healthy habits in our nation’s youth, to stem the epidemic of obesity and chronic diseases, and to support and promote research in cancer prevention and treatment.

She also spreads this message as a media spokesperson for the Physicians Committee’s 21-Day Vegan Kickstart, which she has participated in several times.

Dr. Rancatore received her medical degree from the University of Medicine and Dentistry of New Jersey, New Jersey School of Osteopathic Medicine. She also recently completed Integrative Health Coach training at Duke University, which allows her to help patients make behavior changes that foster good health.

Quinoa and Roasted Pepper Chili

A bowl of spicy Quinoa and Roasted Pepper Chili guarantees to take the chill off a cold winter’s day. This vegetarian chili is loaded with fresh vegetables, pinto beans, and quinoa and gets its zing from poblano chiles.

Quinoa-chili-ck-l

Ingredients

  • 2 red bell peppers $
  • 2 poblano chiles
  • 4 teaspoons olive oil
  • 3 cups chopped zucchini $
  • 1 1/2 cups chopped onion $
  • 4 garlic cloves, minced
  • 1 tablespoon chili powder
  • 1 teaspoon ground cumin
  • 1/2 teaspoon Spanish smoked paprika
  • 1/2 cup water
  • 1/3 cup uncooked quinoa, rinsed
  • 1/4 teaspoon kosher salt
  • 1 (14.5-ounce) can fire-roasted diced tomatoes with chipotles, undrained $
  • 1 (15-ounce) can no-salt-added pinto beans, rinsed and drained
  • 1 cup low-sodium vegetable juice $

Preparation

  1. 1. Preheat broiler.
  2. 2. Cut bell peppers and chiles in half lengthwise; discard seeds and membranes. Place halves, skin sides up, on a foil-lined baking sheet, and flatten with hand. Broil 10 minutes or until blackened. Place in a paper bag; fold to close tightly. Let stand 10 minutes. Peel and coarsely chop.
  3. 3. Heat a large Dutch oven over medium-high heat. Add oil to pan; swirl to coat. Add zucchini, onion, and garlic; sauté 4 minutes. Stir in chili powder, cumin, and paprika; sauté for 30 seconds. Add roasted peppers and chiles, 1/2 cup water, and remaining ingredients; bring to a boil. Reduce heat to medium-low; cover and simmer for 20 minutes or until quinoa is tender.

Benefits of Yoga You May Not Have Considered

There are many reasons why one pursues the practice of yoga. Often times in the West, we are attracted to the physicality, and the potential benefits of yoga to our bodies. However, there are many other benefits of yoga that may surprise you if you allow the practice to become more in union with your everyday life.

1. Increased Compassion: The physical practice is a sure way to feel a greater sense of connection to all beings, human and animal alike. In fact, Yoga philosophy tells us that we’re all one, and understanding this concept allows the greatest of all self-realization.  Yoga teaches us to see ourselves in others, and when we are able to do that, true compassion can manifest.

2. More Mindful Eating: Often times with a yoga practice, our wants and desires change. This is often noticed in what and how we eat. You may decide to ditch the fast food and grab the leafy greens instead.  You may even notice yourself approaching compassion while eating, and may choose to attain a more ethical diet.  This can be evident in a vegan/vegetarian diet, shopping locally and/or organically, reducing or eliminating processed foods, etc.

3. Increased Strength:  Many equate yoga with increased flexibility. While you will gain increased flexibility with consistent practice, you will be surprised by the amount of strength that comes from holding and engaging in the multitude of sacred yoga postures. For example,abdominal strength comes standing balances, as the core must be engaged for these poses. Arm balances will strengthen the triceps and biceps, giving these muscles greater definition. Most standing poses improve leg strength, and practicing these poses will tone the quads and calf muscles.

4. Increased Confidence: The amazing thing about yoga for many practitioners is the feeling that they can accomplish anything. Yoga is about attaining what was once thought to be unattainable. This can be standing on your head, to decreasing negative thought patterns. Whatever it is that you are seeking, yoga will provide. You will see the perfect self that is YOU, and will quickly realize that confidence comes from knowing that all you need is within. Try standing in a Warrior Pose. You cannot help but feel strong and confident!

5. Better (sometimes different) Relationships: With compassion, strength, and confidence comes the ability to relate to others in a more effective and genuine way. Often times, we see the principle of “like attracts like” when embracing yoga, so do not be surprised if your relationships begin to align with a more yogic way of being.

If you have a personal yoga practice, what surprised you when you were a new yoga practitioner?

Drop in Obesity: Why Antibiotics, Plastic, and Programs Might Matter

 

December 13, 2012 | By Amanda Gardner

You may have heard that childhood obesity rates are finally starting to drop a teensy bit after years of climbing ever higher. This is fantastic news for a nation that now counts 17% of its residents under the age of 20 as obese.

True, the declines have been seen only in certain areas of the country such as New York City, Philadelphia, California, and Mississippi.

And the drops are small (in New York City between 2007 and 2011, a 5.5% decline in the number of obese schoolchildren) and largely confined to higher-income, white kids who are less likely to be obese than poor, black children.

But the numbers do seem to be real. The one thing that researchers don’t know is exactly why the declines are happening.

No doubt, aggressive anti-obesity programs are the big reason, with some of the most encouraging trends seen in cities that have instituted comprehensive initiatives to fight the scourge.

Philadelphia, in many ways the poster city for this type of program and the only area which has recorded improvements across different ethnic and racial groups, has made major changes in school-food environments, including eliminating sugary drinks in vending machines, replacing whole milk with skim milk and removing deep fryers from cafeteria kitchens.

Corner stores in Philly are also in on the action with hundreds now offering fresh fruits and vegetables, low-fat dairy products, lean meats, and whole grains. Some have even taken on new shelving and refrigeration so as to be able to sell more healthy items.

New York City recently banned sales of sugary drinks in containers larger than 16 ounces and now requires chain restaurants to disclose calorie counts on menus.

“What they successfully did in New York and Philadelphia was tie together very comprehensive programs with public-policy efforts and all the other efforts going on in the community,” says Bob Siegel, MD, medical director of the Center for Better Health and Nutrition at Cincinnati Children’s Hospital. “They touched all the bases and they marketed it very well and had the education to go along with it.”

But are there other factors that are also helping to lower obesity rates?

For instance, efforts to curb out-of-control salt consumption may be paying off too. While more salt has not directly been linked with obesity (nor do we know for sure that salt consumption is down), research has shown that children who eat a lot of salty food also drink a lot of sugary beverages, a well-known contributor to obesity.

Also, “foods that have high salt content are often high in calories,” says Tracie Miller, MD, professor of pediatrics at the University of Miami Miller School of Medicine. So cutting down on salt also curbs calories.

Over the last decade, there’s also been a 14% drop in antibiotic prescriptions for children and adolescents aged 17 and younger.

Again, a direct link between antibiotics and obesity hasn’t yet been drawn, but one hypothesis is that the drugs might play a part in the obesity epidemic. One early study found that mice given antibiotics accumulated more body fat than mice who weren’t. Another study found that children who received antibiotics in the first six months of life were more likely than other kids to be heavier later on.

Interestingly, points out Ashis V. Barad, MD, chief of pediatric gastroenterology at Scott & White Hospital in Round Rock, Texas, the first six months of life is critical for “growing or creating the bacterial flora of your gut garden.” These billions and billions of organisms have an effect on food absorption and digestion.

Bisphenol A (BPA), a common chemical found in some hard plastics, linings of food cans, and other food packaging has also been linked to childhood obesity. Perhaps efforts to reduce the amount of BPA we’re exposed to are also paying off? In recent years, manufacturers have eliminated BPA from many products intended for children, like baby bottles. However, it’s seems unlikely that a chemical eliminated from baby products in 2008 or 2009 could have such an impact.

One big factor, at least in Philadelphia, may be the effort to provide better sidewalks, playgrounds, bike trails, and after-school activities, which promote physical activity, says Dr. Miller.

As part of its anti-obesity program, the City of Brotherly Love has created almost 10 miles of conventional bike lines, 9 miles of bike “sharrows” (markings indicating where bikes can safely navigate within traffic) and 1,800 bicycle racks.

All of this is in keeping with Michelle Obama’s Let’s Move program to increase physical activity (and improve nutrition) in children.

Of course, no one knows if these successes will be replicated elsewhere, or even if they’ll continue in these selected areas.

“This is very encouraging but I don’t take this message as ‘We’ve done it,’” says Dr. Miller. “We need to keep pushing and not stop because it’s easy to go back.”

“It’s extraordinarily complex how the [obesity] problem developed. It’s multifactorial and involves just about every element of life,” adds Dr. Siegel. “It took a lot of time to put these terrible things together with the environment and it’s just taken a lot of time to piece things together that work.”