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

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 : )

Soda Tax.

Firstly, a huge thanks to those following my blog -- I appreciate it! I get extremely giddy over new followers, so thank you! And keep the comments coming, I love the questions and commentary. :)

And on to soda tax. VERY interesting idea. I think I may like it.

Kelly Brownell, professor of psychology and director of the Rudd Center for Food Policy and Obesity at Yale University, argues that in order to produce a real change, there needs to be a shift in the economic balance between healthful and unhealthful foods and to curtail the all-pervasive marketing of junk food. This would include a tax on soda, he states. Brownell is a go-to guy on topics surrounding the obesity debate and the media [1].

Brownell is also co-author of the book entitled, "Food Fight: The Inside Story of the Food Industry, America's Obesity Crisis, and What We Can Do About It" (Note to self: order this on amazon.com ASAP!). His suggestion of taxing sugar and high-fructose corn syrup beverages surfaced in April when it was published in the New England Journal of Medicine. While this idea isn't a new one to Brownell, he claims it's now feasible due to the economic recession in America [1].

The details? Brownell proposes an 18% tax on soda. He states that with such a tax, fewer Americans will consume soda, and weight loss nationwide can be expected. Starting at the state-level, Brownell forecasts involvement on a federal level, much the same way as tobacco taxes [1].

The tax money can then be used to fund obesity-prevention programs and subsidize the farming of healthful fruits and vegetables, just as the government currently subsidizes corn that's processed into high-fructose corn syrup [1]. Does anyone care about the obesity epidemic enough to DO anything about it? Appears so. The Centers for Disease Control (CDC) held a three-day "Weight of the Nation" conference in DC last month. The conference brought together academics, scientists, physicians, and public health officials from all over the world to discuss the current obesity epidemic in America. Specifically, research presented at the conference estimated the 2008 cost of treating obesity-related ailments in the US at $147 billion [1].

Brownell is quoted in saying [1]:
"Until healthful foods routinely cost less than unhealthful ones, getting people -- especially low-income people -- to eat them will remain a challenge." -- I agree.

"...Unless limits are placed on the marketing of unhealthful foods, the whole anti-obesity effort hardly stand a chance." -- Probably so.

"The public-health approach to fighting obesity must shift from treatment of those who are already fat to preventing others -- especially kids -- from getting that way." -- Interesting. Worth a shot, anyways.

The columnist, LaRue Huget, counters with the argument that diet and weight should be a matter of personal responsibility, not government concern [1]. While I wish I could agree, I don't. Just because something ought to be, certainly doesn't mean it's a reality. And certainly this is true for leading a healthful lifestyle and maintaining a healthy weight. If obesity weren't an epidemic, I could possibly wish on a lucky star that Medicare would be in existence in 45 years' time. Ha! Brownell goes on to say, "When people move to the U.S., they gain weight. Have they become less responsible? We have more obesity this year than last. Are we all less responsible? [1]." Hmm. Wise man, that Brownell, don't ya think?

Regina Benjamin, a highly accomplished and well-regarded physician (who happens to be overweight) has been nominated for surgeon general. What does this message send? Brownell explains that Benjamin is an "excellent role model because she does struggle with her weight. Her nomination underscores that there are better ways to judge a person than by how much she weighs." Great. But, how much is too much? At what point does a weight "struggle" turn into a weight "problem"??

[1]. LaRue Huget, Jennifer. Can We Fight Obesity by Slapping a Heavy Tax on Soda? The Washington Post. August 11, 2009.

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.

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.