Category Archives: healthy habits

cool, data saving lives, entrepreneurship, healthy habits, quantified self

Step Jockey – real world calorie indicators

  • terrific behavioural intervention
  • funded by UK Dept of Health

http://www.springwise.com/london-begins-labeling-physical-world-calorie-loss-indicators/

London begins labeling the physical world with calorie loss indicators

StepJockey is a project that raises awareness of the benefits of taking the stairs through smart labels that detail how many calories can be lost by climbing them.

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United Kingdom 27th November 2013 in Government, Health & Wellbeing, Life Hacks.
Some people are fitness freaks and some are couch potatoes, but it actually doesn’t require rigorous exercise to stay in good shape. We previously wrote about Coca-Cola’s Work It Out Calculator — which details the small tasks that cancel out the calories in its products — and now the UK’s StepJockey is a project that raises awareness of the health benefits of actions such as taking the stairs, through smart labels that detail how many calories can be lost by climbing them.

Funded by the UK Department of Health, the startup believes that walking up and down stairs, rather than taking an elevator or escalator, can improve cardiovascular fitness and even help people lose weight. StepJockey’s research suggests that stair climbing burns more calories per minute than jogging and even walking down them is more healthy.

The team is currently crowdsourcing data about the country’s stairs, encouraging fans to type in the location of the office building or public staircase they want to measure and count how many steps there are. The site — or free iPhone app for smartphone users — then calculates how many calories are burned by using them. Users can then print off or order posters to hang next to the stairs, giving passersby that extra bit of encouragement to avoid the easy way up. Each poster features a QR code and NFC tag, enabling those with smartphones to log, track and share their calorie burning with friends.

According to StepJockey, the signs were developed using the principles of behavioral science, and tests proved that the nudge to take the stairs improved usage by up to 29 percent in some cases. Are there other aspects of the real world that can be improved with the addition of similar labels, offering useful data and digital interaction?

Website: www.stepjockey.com
Contact: www.stepjockey.com/contact-us

Spotted by Murray Orange, written by Springwise

complex adaptive systems, healthcare, healthy habits, policy, quotes & aphorisms, rapid learning health systems

Gamification in health…

  • people are more open to learning from a game than a powerpoint or clinician
  • fun, competition, and social networks all have positive affects on health and fitness behavior
  • “Practitioners still haven’t internalized the idea that we need to help people do the right thing. Not just by giving them the opportunity, but making them want to do it.”
  • “Designing engagement into social games is largely about manipulating dopamine response. Gamifying health allows us to hack into our natural feedback loops by engineering ways for us to get more dopamine for demonstrating good behavior.”

 

Source: http://www.medcrunch.net/whats-fun/ (via RWJF)

Gaming for Patient Treatment – What’s Fun Got to Do With It?

by  on Nov 6, 2013 • 8:48 pm

“People rarely succeed unless they have fun in what they are doing.” -Dale Carnegie

The Theory of Fun is an organization devoted to social experiments in fun. In one experiment, they turned a staircase next to an escalator into a piano to see whether people would still opt for the less physically challenging escalator. Not only did people choose for the fun piano staircase; they also went up and down the stairs multiple times (see the results here.) Playfulness has increasingly become incorporated into patient engagement and adherence. Additionally, creative tactics like video games that use fun, competition, and your social networks have shown positive affects on health and fitness behavior.

RM2 Customer 1 Gaming for Patient Treatment What’s Fun Got to Do With It?Paul Tarini, team leader for the Robert Wood Johnson Foundation’s Pioneer Portfolio, reported in 2010 that the collision of games and healthcare was inevitable. Featured that year at the Games for Health conference in Boston, MA, were dancing games for patients with Parkinson’s disease, or alternatives-to-smoking games on iPhones. Since, we’ve seen an unveiling of companies that develop games benefitting all sorts of conditions from anxiety and depression (SinaSprite byLitesprite) to games for kids with cancer (Re-Mission2 by Hopelab). The results have been significant and have illustrated how patients feel more inclined to accept and learn from a game about their condition than from, say, a PowerPoint or clinician. In Re-Mission2, results showed how players adhered to their treatment longer and more consistently after interacting with the game. Even more impressive, players had higher levels of chemotherapy in their body and so were literally responding to treatment better.

Michael Fergusson, founder and CEO of Ayogo Games, a social gaming production company based in Vancouver, believes games are the key to patient engagement and adherence. Practitioners, Fergusson says, “ still haven’t internalized the idea that we need to help people do the right thing. Not just by giving them the opportunity, but making them want to do it.”

Prescribed Fun: The Trick (or Science) of Adherence and Engagement

The World Health Organization (click for report) has said that people around the world will benefit more from adherence than from new therapy. Esther Dyson, an active investor in the digital health movement, has said, “It’s colossal stupidity that people aren’t healthier, because we know how to do it.” Yet, we don’t. Our own inability to do what we know we need to is the cause of many health care problems.

Perhaps social games can help. Social games are digital games played with your online social communities (like Facebook and Twitter). According to Ayogo Games: “Designing engagement into social games is largely about manipulating dopamine response. Gamifying health allows us to hack into our natural feedback loops by engineering ways for us to get more dopamine for demonstrating good behavior.”

A recent NPR article, “How Video Games Are Getting Inside Your Head – And Your Wallet”discusses how video game architects actively track children’s engagement with the game they’re playing. Inherent in any game design is research, tests, and analysis, all of which are imperative to making the game more fun, more engaging, and more likely to hold the player’s attention longer, and in some cases long enough to buy something.

The science of the brain and human behavior are integral to the success of a game. Many, especially parents trying desperately to get their kids outdoors, interacting with “real” things and “real” people, have more damning language about these studies than applauding. Indeed, most, when attributing the term “brain manipulation” to something, don’t have many nice things to say. Yet, looking at all this through a health care lens, if doing the same types of testing, tweaking and manipulation leads to positive and permanent change in health and fitness of an individual, it can’t be that bad, right?

Michael Fergusson believes this, and has created successful games where players’ health and behavior improve because of it.  One of Ayogo’s first health care games, Healthseeker, was for people living with diabetes, and the first health care game on Facebook. They had over 15,000 players. There were parts that were extremely successful, but other elements that weren’t. They reviewed the data and looked at what worked and what didn’t to see what design elements of the game brought players success in their health goals. What they found was players who consistently received incoming messages of encouragement from their online social networks had significantly greater chances of success. Putting friends and family into their application, Ayogo discovered, makes the game more meaningful. As a result, this design element has been brought forward into other game designs.

Team Fun 

“Man is most nearly himself when he achieves the seriousness of a child at play.” -Heraclitus

Outside of the digital space, Little Bit Therapeutic Riding Center provides equine facilitated therapy to children and adults with neurological, pyshological, and physiological disabilities. For the riders, working with horses provides an overwhelming sense of joy, and the therapy no longer becomes treatment-like. Instead, it’s fun and unpredictable. More, a rider’s experience of success is linked to the team supporting her efforts – her volunteers, her horse, and her instructor. Play, joy, laughter, excitement – they all have healing powers for our minds, bodies, and spirits – and the value of your community in sustaining all that cannot be underestimated, whatever the method.

“The experience of interacting with your own health can be dramatically affected,” says Fergusson. Because of this you want the design of the experience to engage as many people as possible so that embedded in the design, is an evolving conversation where people can learn together and improve the quality of life together. To this, Fergusson asks an interesting question: “There’s a question about who’s behavior you’re really trying to affect in social gaming – is it the person’s behavior or the community of that person?” Perhaps it’s both that need to change in order for engagement and adherence to really stick.

entrepreneurship, file note, healthcare, healthy habits, policy, rapid learning health systems, research methodology, technology

Healthy life years is the key selling proposition for funding NCD interventions…

Non-communicable disease presents an as-yet, unresolved health research challenge. But they may also lie at the heart of a similarly unresolved intergenerational, macroeconomic challenge.

To date, governments and academics around the world have sat back and carefully observed the epidemic of overweight, obesity, metabolic syndrome and diabetes overtake their communities.

The food industry has aggressively defended its turf, understandably resisting any calls for regulation in the absence of definitive evidence that these interventions will work.

Only the most courageous of politicians would ever embark on the regulation of such a powerful sector in the absence of evidence supporting efforts such as restricting advertising to children, mandating processed food composition, food labeling and taxing macronutrients know to be harmful.

So we find ourselves at an impasse that no one seems particularly able to break.

An emerging theme related to this issue is the idea that while the health system has succeeded in delivering extended life, it has not yet extended healthy life years. As such, the population still shudders at the thought of raising the retirement age past 70, even though average life expectancy now surpasses 80.

Non-communicable disease is considered a major driver of this divergence. As such, preventing non-communicable disease may represent an important challenge, not only driven by a health/moral imperative, but also for important economic reasons.

There are significant macroeconomic consequences of people not living most of their lives in a productive state of health. Most significant of these is the capacity of societies to sustain pensions when boomer-driven demographic shifts result in an increasing ratio of pensioners to tax payers.

This places life insurers, governments and superannuation funds into the medium- to long-term frame as key beneficiaries of addressing non-communicable disease.

This in turn makes them key targets for attracting investment capital to a venture addressing this concern.

Imagine a world where people lived healthy, vital, productive lives well into the 70s.

Too much?

Google have spotted this opportunity by investing $100Ms in a new start up called the California Life Company (CaLiCo). Its initial focus is on “ageing” with an early emphasis on genomics, epigenetics and a pharmaceutical fix.

I starting to think the answer is much simpler: Eat food, not too much, mainly plants. Move.

It’s about less, not more.

Establishing the evidence for this inkling, and then commercialising the insights gained is the inspiration behind Riot Health.

Stand by.

healthy habits, nutrition

nutrition and exercise, not dieting…

Plenty of sensible lines, though nothing about fasting…

http://bigthink.com/experts-corner/why-dieting-is-the-worst-way-to-lose-weight

Why Dieting is the Worst Way to Lose Weight
by TOM VENUTO NOVEMBER 23, 2013, 6:00 AM

Dieting is the worst way to lose weight. Most people would say I’m crazy for making such an outrageous claim. However, by the time you finish reading this short article, I think you’ll agree with me: Not only that, my hope is that you’ll agree so much that you’ll join me on my mission against “dieting” — at least the way the multi-billion dollar weight loss industry has been pushing it on everyone for years.

So what on Earth am I talking about, “dissing” dieting like that? Haven’t I said it myself many times before that diet is the most important factor for burning fat and keeping it off? Actually, no. That’s where the misunderstanding is. What I’ve said is that if I were to put the many elements of successful fat loss into the order of their priority, nutrition would be at the top of the list.

There’s a big difference between “diet” and “nutrition”

You may see where I’m going with this now, but you also might be wondering if this is just semantics. Yes, it is. But that’s precisely why “diet” and “nutrition” are not saying the same thing. Words are loaded with meaning between the lines. Being successful is about understanding the power of words — and using the words that successful people use.

Few words are more semantically loaded than diet. Think about what connotations — and whether they are positive or negative. What comes up when you think of diet?

Restriction
Forbidden foods
Banned food groups
What you can “never eat”
Hunger
Gimmicks
Fads/trends (that pass or come and go in cycles)
Quick fixes (often unhealthy or dangerous)

The word “diet” was supposed to simply describe the way a person eats. “Diet” comes from the Latin, diaeta, meaning “way of life.” But in our technologically advanced, sedentary society today, and with the obesity crisis we’re facing, and the multi-billion dollar industry it has spawned, the word “diet” has become tainted . . .

Today, I think ‘diet’ carries too much negative baggage to use so loosely. The way I define it, a diet is any unsustainable change in your eating behavior to try to lose weight. When you say you’re going on a diet, you’re also saying that at some point you’re going off it. While you’re on it, you suffer all those negative associations I mentioned above.

By contrast, think about the connotations of the word nutrition. Do you think of anything negative? I don’t. I think of:

Vitamins
Minerals
Micronutrients
Fiber
Muscle-building protein (amino acids)
Unrefined foods, closer to their form in nature
Energy
Vitality
Health

Now think of the word program. A program implies that there is structure. So I define a nutrition program as a structured plan you can follow as a lifestyle, which nourishes you with nutritious food that helps you get leaner, stronger, fitter and healthier . . . and stay that way.

I propose we replace “diet” with “nutrition program” unless we are specifically talking about something short term.

I believe this distinction in words is crucial, but just to play devil’s advocate, let’s assume that diet and nutrition program mean exactly the same thing. There’s still a huge problem with the diet alone approach, and therefore, why 99% of the entire weight loss industry is wrong:

Diet is only one of the elements needed for a leaner, stronger, fitter, and healthier body. There are three other elements that most people are missing.

Dieting might improve your health. On the other hand, depending on your approach to “diet,” it might destroy your health. Dieting is not always healthy. Nutrition and training together is a sure-fire pathway to health.

Weight loss diets fail 80-95% of the time. Not because they don’t take the weight off, but because they rarely keep it off. Most dieters relapse. Drug addicts and alcoholics in rehab have a higher success rate than that.

Exercise and an active lifestyle are vital for long term weight loss maintenance.

The right kind of exercise is also vital for re-shaping your body . . .

Weight Loss Versus Body Transformation

There’s a world of difference between losing weight and transforming your body.

Dieting can’t transform your body. Only training can do that.

Dieting can’t make you stronger. Only training can do that.

Dieting can’t make you fitter. Only training can do that.

With diets, you might fit into smaller clothes. But you also may become a smaller version of your old self… a skinny fat person . . . weighing less . . . but still flabby (and weak).

The Muscle Loss Epidemic

With diet alone, 30 to 50% of your weight loss could come from lean body mass. And if you’re getting older, the prospect of losing muscle and strength should genuinely frighten you.

After age 50, you lose 1-2% of your lean muscle every year if you do nothing (if you’re not resistance training). After age 60, you lose up to 3% per year.

Let’s suppose you’re 50 or 60 and you’re thinking, “A few percent of my lean mass? What’s the big deal? I have no desire to look muscly.” I can understand that. Your goals and values do change as you get older. But I already realize that most people don’t want to look like bodybuilders. However, gaining lean muscle, strength and fitness will improve the quality of anyone’s life.

Maintaining the muscle you have must be a priority for everyone because losing lean mass every year means losing your mobility and losing your independence as you get older.

Stop the Diet Insanity!

Given these facts, it’s sheer insanity that we have millions of people who want to lose weight — for health and for happiness — and the first thing or only thing they think of as a solution is DIET. They’re asking for deprivation, hunger, missing out on favorite foods, loss of muscle, loss of strength and eventually, loss of independence, putting a burden on other people to take care of them.

I’m not being melodramatic. I’m on mission to expose the mistakes of the dieting mentality and promote the benefits of the muscle-building, fitness and nutrition lifestyle.

The good news is, there’s a right way to burn fat and transform your body, but it’s not a one-trick show. You have to put several pieces together. This is total lifestyle change, so it’s not easy. But it is worth it.

This is as near to a miracle formula as you will ever find. It’s the 4 elements of the Burn the Fat, Feed the Muscle approach:

Nutrition program
Resistance (strength) training
Cardio Training
Mental training
Dieting is the worst way to lose weight

Not only that, here’s the nail in the coffin for 99% of what the weight loss industry is telling you: weight loss is the wrong goal to begin with. Burning the fat and keeping the muscle is the right goal. Even better, the right goal is to get leaner, stronger, fitter and healthier.

Train hard, and expect success.

© 2013 Tom Venuto, author of Burn the Fat, Feed the Muscle: Transform Your Body Forever Using the Secrets of the Leanest People in the World

Author Bio
Tom Venuto is a fat-loss expert, transformation coach and bestselling author of Burn the Fat, Feed the Muscle. Tom holds a degree in exercise science and has worked in the fitness industry since 1989, including fourteen years as a personal trainer. He promotes natural, healthy strategies for burning fat and building muscle, and as a lifetime steroid-free bodybuilder, he’s been there and done it himself. Tom blends the latest science with a realistic, commonsense approach to transforming your body and maintaining your perfect weight for life.

For more information please visit http://www.burnthefatblog.com/ and http://www.burnthefatfeedthemuscle.com/ and follow the author on Facebook and Twitter

data saving lives, healthy habits, nutrition, quantified self, rapid learning health systems, research methodology, technology

SMS provides for an effective weight loss intervention

 

Source: http://www.fiercemobilehealthcare.com/story/study-texting-effective-intervention-tool-weight-control/2013-11-21?utm_medium=nl&utm_source=internal

Citation: http://www.jmir.org/2013/11/e244/

Study: Texting effective intervention tool for weight control

November 21, 2013 | By 

Daily text messaging may be a useful self-monitoring tool for weight control, particularly among racial/ethnic minority populations most in need of intervention, according to Duke University study results published in a Journal of Medical Internet Research article.

“Recent studies show that racial/ethnic minorities are more likely than white individuals to own mobile phones,” states the article. “The high familiarity with and penetration of mobile technologies makes text messaging an ideal intervention platform among these populations.”

The purpose of the randomized controlled pilot study was to evaluate the feasibility of a text messaging intervention for weight loss among predominantly black women, who “have alarmingly high rates of obesity as compared with other gender and racial/ethnic groups.” The secondary aim of the study was to evaluate the effects of the intervention on weight change relative to an education control arm.

Fifty obese women aged 25-50 years were randomized to either a six-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (e.g., 10,000 steps per day, no sugary drinks) along with brief feedback and tips (26 women) or to an education control arm (24 women). The article states that weight was objectively measured at baseline and at six months, while adherence was defined as the proportion of text messages received in response to self-monitoring prompts.

At six months, the article reports that the intervention arm lost a mean of 1.27 kg, and the control arm gained a mean of 1.14 kg. The average daily text messaging adherence rate was 49 percent with 85 percent texting self-monitored behavioral goals two or more days per week. Moreover, about 70 percent strongly agreed that daily texting was easy and helpful and 76 percent felt the frequency of texting was appropriate.

“Given that the majority of evidence indicates that greater adherence leads to better outcomes, our study suggests that mHealth-based approaches to self-monitoring may enhance engagement and reduce the burdens commonly associated with other modes,” concluded the article. “Our intervention was relatively low intensity and has greater potential for dissemination compared to higher intensity interventions. As technology penetration increases in the target population, the use of this modality will become increasingly relevant and helpful as an intervention tool for weight control.”

Earlier this year, an article published in the Journal of American Medical Informatics Association revealed that mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in a weight loss program are more effective than traditional methods. The study involved a post hoc analysis of a six-month randomized weight loss trial among 96 overweight men and women, which found that physical activity app users self-monitored exercise more frequently over the six-month study and reported greater intentional physical activity than non-app users.

To learn more:
– read the article in JMIR

facts & data points, healthy habits, nutrition, policy, research methodology

A behavioural economist’s view on obesity…

This is a typically obtuse, academic view of obesity, breathlessly attempting to cite the immense complexity of the disease, capping it with a plea for more research dollars, or at least a reallocation of research dollars.

There are a couple of interesting snippets:

  • pets are also getting obese – 58.3% of cats were obese in 2012
  • lab animals too are getting obese – 11.8% per decade from 1982 to 2003
  • is this due to antibiotic-mediated changes to gut bacteria that not just change how we digest, but also how we behave?
  • socially mediated effects?

So surprising that a behavioral economist’s view could be so dismal.

 

Source: http://www.nytimes.com/2013/11/10/business/the-co-villains-behind-obesitys-rise.html?_r=2&

The Co-Villains Behind Obesity’s Rise

Waltraud Grubitzsch/European Pressphoto Agency

Researchers have compared tissue samples from obese mice with those of normal mice to try to determine which behavioral or biological factors might cause humans to gain weight. Here, a 2012 experiment in Leipzig, Germany.

By SENDHIL MULLAINATHAN
Published: November 9, 2013

Why is obesity soaring? The answer seems pretty clear. In 1955, a standard soda at McDonald’s was only seven ounces. Today, a medium is three times as large, and even a child’s-size version is 12 ounces. It’s a widely held view that obesity is a consequence of our behaviors, and that behavioral economics thus plays a central role in understanding it — with markets, preferences and choices taking center stage. As a behavioral economist, I subscribed to that view — until recently, when I began to question my thinking.

For many health problems, of course, behavior plays some role but biology is often a major villain. “Biology” here is my catchall term for the myriad bodily mechanics that are only weakly connected to our choices. A few studies have led me to wonder whether the same is true with obesity. Have I been the proverbial owner of a (behavioral) hammer, looking for (behavioral) nails everywhere? Have I failed to appreciate the role of biology?

A first warning sign comes from looking at other animals. Our pets have been getting fatter along with us. In 2012, some 58.3 percent of cats were, literally, fat cats. That is taken from a survey by the Association for Pet Obesity Prevention. (The very existence of this organization is telling.) Pet obesity, however, can easily be tied to human behavior: a culture that eats more probably feeds its animals more, too.

And yet, a study by a group of biostatisticians in the Proceedings of the Royal Society challenges this interpretation. They collected data from animals raised in captivity: macaques, marmosets, chimpanzees, vervets, lab rats and mice. The data came from labs and centers and spanned several decades. These captive animals are also becoming fatter: weight gain for female lab mice, for example, came out to 11.8 percent a decade from 1982 to 2003.

But this weight gain is harder to explain. Captive animals are fed carefully controlled diets, which the researchers argue have not changed for decades. Animal obesity cannot be explained through eating behavior alone. We must look to some other — biological — driver.

Fittingly, the study is titled “Canaries in the Coal Mine.” Could our inability to explain animal obesity with behavior be a warning sign? Perhaps we are also overlooking biological drivers for human obesity. But what might these culprits be?

A particularly interesting candidate resides in your gut. Your digestive system is actually a complex ecosystem, playing host to hundreds of species of bacteria that do things as diverse as fermenting undigestedcarbohydrates and providing vitamins. They also regulate how much fat your body stores.

Not everyone, however, has the same gut bacteria. And, interestingly, the composition of this bacteria correlates with obesity. Of course, this relationship could be simple: the obese eat differently, and therefore they have different bacteria.

But a recent study in the journal Science showed that cause and effect could go the other way as well. Researchers harvested bacteria from pairs of human twins, where one twin was obese and the other was not. Then they transplanted these bacteria into mice. The mice who received bacteria from the obese twin gained weight, while the others did not. The mice did not eat more: Their metabolism changed so that they put on more weight even with the same caloric input.

What, then, determines your gut bacteria? It could be antibiotics or environmental toxins or how processed your food is. Another possibility is raised by a study in The New England Journal of Medicine that shows that obesity seems to “spread” across social networks, with people infecting their friends and neighbors. I had always assumed that was because birds of a feather flock together — and that is surely part of the explanation. But because gut bacteria can also spread among people in close proximity, perhaps the obesity epidemic really is, well, an epidemic?

I’m not arguing that behavior does not matter. Biology and behavior often interact; the spread of flu depends on whether we wash our hands. Similarly, the bacteria study found that the “obese gut bacteria” had an impact only when the mice were fed diets heavy in saturated fats.

Perhaps most interestingly, changing biology may even be changing cravings. Some biologists have hypothesized that our gut bacteria actually drive cravings for certain unhealthy foods. A focus on biology doesn’t mean a reduced emphasis on behavior, just a richer understanding of it.

These and other studies raise important possibilities, which deserve more research and attention. At the very least, we should invest as many obesity research dollars in uncovering and understanding these biological channels as we do in understanding behavioral channels. And this is a behavioral economist talking!

After all, this could radically change the way we think about policies to curb obesity. As one newspaper editorial pronounced:

“A little town in Sweden has put a local tax on fat men. It is declared that ‘the fat man stands accused by the very fact of his too solid flesh’ (vide “Hamlet”) ‘of gluttony and laziness.’ Millions of fat men throughout the world may rise up and denounce as liars the town councillor who drew up this cruel indictment and those who voted for it, but the gentler way of reproving them would be to point out the tritely recognised danger of generalisation in almost any statement of supposed fact. Not all fat men are lazy and gluttonous. Obesity is in many a congenital habit of body; in others a disease.”

That editorial was written in 1923, for the paper known as The Paris Herald. Maybe the writer was on to something.

SENDHIL MULLAINATHAN is a professor of economics at Harvard.

This article has been revised to reflect the following correction:

Correction: November 17, 2013

Because of an editing error, the Economic View column last Sunday, about possible causes of obesity, misstated the source of bacteria that were transplanted into mice as part of an obesity study. The bacteria came from human twins, not from other mice.

 

A version of this article appears in print on November 10, 2013, on page BU6 of the New York edition with the headline: The Co-Villains Behind Obesity’s Rise.
healthy habits, policy

fat getting fatter

  • eat less and exercise more
  • Jim Clifton is Chairman and CEO of Gallup

Source: http://www.linkedin.com/today/post/article/20131122150210-14634910-america-s-biggest-fiscal-problem-the-fat-are-getting-fatter

America’s Biggest Fiscal Problem: The Fat Are Getting Fatter

November 22, 2013

Much of U.S. politics focuses on the fact that the rich are getting richer and the poor, poorer. But does anyone care that the fat are getting fatter?

The U.S. adult obesity rate so far this year is on pace to surpass all annual average obesity rates since Gallup-Healthways began tracking it five years ago.

Health costs are going to bankrupt us. At the current annual 6% growth rate, our total healthcare bill will go from $2.5 trillion per year — which it is now — to almost exactly $4.5 trillion in 10 years. If you add the stubs of the increases over the 10-year period, above the running $2.5 trillion our debt-burdened nation can’t afford, it totals a staggering $10 trillion.

To put this in perspective, the sum of our coming healthcare costs are three times the size of the subprime meltdown that brought America and the world to its knees. While we survived the subprime mess, healthcare costs will honestly break the nation.

Things look even worse when you compare America’s per person healthcare spending to comparable societies. We spend more than $8,000 annually per person, where Canada and Germany each spends roughly $4,500 per person, and the United Kingdom spends about $3,500, according to the Organisation for Economic Co-Operation and Development — and residents of those countries all live longer.

So is our American healthcare system superior? You tell me.

Americans obviously understand that this is a huge problem. Nearly a quarter of us say cost is the most urgent health problem facing the U.S., surpassing healthcare access for the first time since 2006. Obesity remains the No. 1 health condition named.

Keep in mind that all of the hoopla about the Affordable Care Act (ACA), or Obamacare, has little to do with reducing the bloated and growing $2.5 trillion expense. Obamacare attempts to address the insurance issue — who pays for what — but it doesn’t go after the core problem: Americans are too fat and unhealthy, and the vast majority of our health problems arepreventable.

That’s right — the Centers for Disease Control concluded a few years ago that of all of America’s chronic health problems, a whopping 70%, are preventable. And what is the common thread among these chronic diseases, such as diabetes and heart disease? Being obese puts people at higher risk for developing all of them.

Rather than go on and on about whether the ACA website works or not, or who wins and loses politically in 2014 and 2016 because of a disastrous rollout, shouldn’t the media be trumpeting this headline: 70% of Health Problems in America Are Preventable?

I just figured the overall weight of Americans, and it’s right at about 56 billion pounds if I assume 180 pounds per person. As a nation, in my view if we collectively lost about 10 billion pounds of excess weight, we might reduce our healthcare costs by a third. And we wouldn’t need all of these wasted political conversations, because we could balance the budget. Even better, the fix would be free — it wouldn’t require a new law, sequestration, or a shutdown.

That’s because the real fix doesn’t lie within political battles over insurance coverage. It lies within a sudden new culture of American fitness — and that begins with eating less and exercising more.

*****

Jim Clifton is Chairman and CEO of Gallup. He is author of The Coming Jobs War (Gallup Press, 2011).

healthy habits, nutrition

Katz: lifestyle = breakthrough medical cure = lifestyle = medicine

http://www.linkedin.com/today/post/article/20131124153502-23027997-lifestyle-as-medicine-at-a-fork-in-the-road-who-s-got-a-spoon

Lifestyle as Medicine: At a Fork in the Road, Who’s Got a Spoon?

November 24, 2013
 

Hippocrates recognized the power of lifestyle as medicine some 2500 years ago, testimony to his wisdom and prescience. As president-elect of the American College of Lifestyle Medicine, I celebrate the possibility of finding our way back to a future informed by such insight.

But for now, in the immediate aftermath of announcement, and on-going debate about just how many of us should take statins, let’s consider what Big Pharma would have to do to compete on an even playing field with the power of lifestyle.

Imagine, for instance, if the news were to break tomorrow – on the landing page of your favorite site, or front page above the paper crease for you traditionalists, in whatever news source you like best – that there is a new prescription drug. The drug is stunningly effective, and shockingly free of side effects. It is astoundingly safe – safe enough for newborns and octogenarians alike. It is available in bountiful supply, and remarkably inexpensive. In fact, you might be able to get it without spending any extra money at all – maybe even save money by taking it.

And, here’s the punch line. If you take this pill – which everyone else in your family can take along with you – once daily for the rest of your life, it would reduce your risk of EVER getting ANY major chronic disease – heart disease, cancer, stroke, diabetes, dementia, etc. – by 80%.

The only question here is which would be a better idea and the more immediate priority: calling your doctor to get a prescription for this wonder drug, or calling your broker to get some share of stock in the company holding the patent.

But, of course, there is no such drug. There never has been any such drug. And in my opinion, there never will be any such drug. But lifestyle is exactly that medicine, and we have known about it …well, since Hippocrates.

But we know about the power of lifestyle as medicine in the modern age in ways unavailable to Hippocrates. A seminal epidemiologic study published in 1993 in the Journal of the American Medical Association famously pointed out that the leading, actual causes of premature death in the United States are not heart disease, cancer, and so on – but the things that cause heart disease, cancer, and so on. Those factors sum up to a list of ten exposureswe each, overwhelmingly have the capacity to control in our daily lives. That list of ten is, in turn, overwhelmingly dominated by just the first three: tobacco use, dietary pattern, and physical activity pattern. Or, as I like to call them – how we use our feet, our forks, and our fingers.

That initial study spawned a whole branch of the epidemiologic literature, reaffirming over a span of decades now that lifestyle is by far the best medicine ever conceived – or, if neglected, a source of years lost from life, and life lost from years. Study, after study, afterstudy, after study, after study…has shown that feet, forks, and fingers are nothing less than the master levers of medical destiny. Add to these three the management of sleep, stress levels, and loving relationships in our lives, and the control over our medical destinies is astounding.

And, in tandem with the literature showing how these factors overmaster our fate with regard to chronic disease risk, there is a burgeoning literature showing that they have the capacity toalter gene expression, too. The Genomic Age has served up a powerful insight, albeit not the one we were expecting: DNA is not destiny. To a greater extent, dinner is destiny – because dinner, and lifestyle, can alter the behavior of our very genes. The nature/nurture debate is rather an unfortunate distraction, because we can, in fact, nurture nature.

Lifestyle is then, irrefutably, the greatest of all medicine. But as we learned from Mary Poppinsif not elsewhere, there is the separate challenge of getting the medicine to go down. Certainlythe last thing we need in this case is more spoons full of sugar!

Lifestyle is the greatest of all medicine, but it may feel in this morbidigenic, obesigenic world of ours that we can’t get it to go down, because we just don’t have the right spoon. It may feel that we can’t get there from here.

That is, in a word, wrong. We can get there from here.

Doing so begins by embracing the destination – by acknowledging that lifestyle is medicine we all want. Then, we have to acknowledge that we do indeed know just what destination we mean, that we know what healthy living looks like. We do – including diet – and if we could get past the distractions of competing dogma, we would have the destination clearly in our sights. I have written extensively about that destination before, in columns, peer-reviewed papers, and textbooks– so if you want more on the topic, just follow the links.

Finally, once the destination is clear – it’s a matter of following a route that leads there. And so we come to it: a fork in the road, where for far too long, a luminous opportunity for better health, and consequently better lives, has languished. A fork where health could remain alongthe road not taken, or find itself on a path of much lesser resistance. It’s time to choose.

Along one tine of our fork is perpetuation of the status quo, where we lose loved ones we don’t need to lose, long before their time. Or perhaps they lose us. It’s a road where we succumb to unnecessary miseries and lose both years from life, and life from years. And where we bequeath the same and even worse to our children – where they inherit along with our abdication an ever greater burden of chronic disease and premature death, at ever younger age. I think, and hope, this road is readily rejected.

Along another tine is a world that makes health more accessible, a better world. My career is devoted mostly to creating such a world. But it’s a long, slow, arduous process. This tine doesn’t lead to any immediate opportunity for each of us. Along this tine, some of us keep working, while the rest of us just keep on waiting on the world to change. It may happen, but I wouldn’t hold your breath.

And then there is the third tine, which leads promptly and without detour to the skill set we need to be the health we want to see for ourselves. It leads us to be the health we want to see for those we love. And of course, when enough of us have changed ourselves, it leads us tobe the changes we want to see in the world as well.

There is a place, an important place even, for lifestyle IN medicine – where health care professionals offer valuable guidance, and counseling that is both constructive and compassionate. But the power of this cannot compare to that of lifestyle AS medicine, where each of us pulls on the master levers of medical destiny every day. Think about the Blue Zones, those places around the world where people live the longest, healthiest, most vital lives. Those benefits are attributed to how they live and to their culture, not to the counseling they get from doctors. We are in control of how we live, if latently. We are in control of our culture-which begins at the level of household, where family values take hold. The cultivation of vitality could be a family value.

You can prescribe yourself lifestyle as medicine. You are the doctor in this case, for yourself and those you love. But as with all doctoring, it requires a skill set. If you don’t have it, you can get it. And frankly, there is no real alternative. No other medicine can do what lifestyle can do, and no one else can practice lifestyle for you. It’s your life, and only you can live it. If you empower yourself- if you acquire the requisite “skillpower” to take lifestyle as your medicine- it will almost certainly be a better life. Healthy people have more fun.

Lifestyle is the best medicine there is, ever was, and likely ever will be. At a fork in the road forhealth care, our economy, our culture, and what the future holds for our children and grandchildren- each of us holds the spoon that could get this medicine to go down.

healthy habits, nutrition

Eggers on fasting…

http://www.medicalobserver.com.au/news/a-fast-approach

A fast approach?

19th Nov 2013

Professor Garry Egger

CAN caloric restriction help individuals live longer?

Or does it just feel like it…

Two themes in nutrition have recently come together. The first, calorie restriction (CR), involves permanently reducing total energy intake by up to 30%.

CR has been shown consistently to increase the longevity of a number of different species of animal, as well as reduce weight.

The second theme, intermittent dieting (ID), or reducing energy intake on some days but not others, has spawned yet another diet craze that is dominating discussion at the dinner parties of middle suburbia.

Being battered and bruised by the numerous false starts in the dieting game, it’s tempting to pass off both of these as fads.

But the interest of some hard-nosed nutrition scientists makes a second look warranted.

Dr Eric Ravussen from the Pennington Institute in Arizona, is a world expert in energy metabolism and obesity.

For some time, he and several postgraduate students (including several Australians) have studied the mechanisms involved in CR.

The two forms of ageing

Speaking at a recent Australian and New Zealand Obesity Society (ANZOS) conference, Dr Ravussen described two forms of ageing: primary ageing, determined by genetics and natural factors; and secondary ageing, which is related to lifestyle and environmental factors.

Together these determine one’s maximum lifespan.

From animal studies it’s known that rats are able to run daily, live longer than those deprived of exercise.

But when a CR diet of about 30% total energy restriction is introduced, they live even longer.

Possible explanations for this are the reduced cellular oxidative stress from food, decreased DNA damage, decreased inflammation and auto-immunity, and increased metabolic efficiency.

For obvious reasons, such a study over a lifetime in humans has not yet been done.

Those that have been carried out opportunistically for short periods (such as during wars and in the human biosphere study) show a negative bounce-back in weight gain and health after the CR period.

Molecular changes

Physiological studies carried out by Dr Ravussen’s group, however, show molecular changes that are reflective of potential longevity advantages.

There’s also no doubt that weight loss follows such a regime — if it can be maintained.

A different way of restricting calories is through intermittent dieting popularised by the 5:2 diet and TV doctor Michael Mosley.

ID involves two days each week of energy restriction of 500 calories for women and 600 for men, with ad-lib intake over the remaining five days.

Exponents claim not just weight loss but reduced chronic disease risk.

And while there are not a lot of data to support the latter, there is good support for the former — strangely even with an increased overall food intake.

Dr Amanda Sainsbury-Salis from Sydney University’s Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders and author of The Don’t Go Hungry Diet, is currently doing the tests in mice.

While the results are not yet published, she does believe there might be something in the 5:2 diet and that the approach could be improved by using different degrees of energy restriction.

So far, studies with humans suggest weight loss may be more (and easier) with an ID plan like this.

A panacea in middle-age?

Given that most people won’t have the opportunity to calorie reduce (at least in a healthy fashion) for life, the question becomes, what advantage is there for someone trying the process in middle life?

There’s little doubt that (short-term) weight loss at least will be an outcome, but adverse effects, according to Dr Ravussen, include cold intolerance, decreased libido, constant hunger and reduced desire to exercise.

Reversion could also lead to increased difficulties with weight.

Based on animal studies, Dr Ravussen has calculated that a 50-year-old human could be expected to live a measly two months longer! So is it really all worth it?

If not weight, then what?

The use of BMI in diagnosis of metabolic disorder has come under question. Weight over height squared measures mass only and doesn’t take account of body fat. This then discriminates against mesomorphic body shapes – like some short male athletes – and the aged, whose height may decrease with age while weight remains stable. On top of this, BMI is not a consistent measure of ill health, as illustrated by the ‘obesity paradox’.

Garvan Institute researcher Dr Dorit Samocha-Bonet has shown that almost 50% of expected risk can be explained by other, easily measurable factors. The cumulative of risk for each is:

HDL cholesterol 26%
HbA1c 35.5%
Systolic blood pressure 43.2%
Triglycerides (Tg) 46.7%

According to Canadian lipidology expert J-P Despres, a Tg of >2.0 and a waist circumference greater than that recommended for ethnic groups (usually around 100cm for men and 90cm for women – called the ‘triglyceride-waist’), adds even more to diagnostic value. It may all make BMI less relevant at the clinical level.