Category Archives: nutrition

The Hospital of the Future is not a Hospital

Great insights into where capital is being invested in US healthcare…

http://www.healthleadersmedia.com/print/LED-305089/The-Hospital-of-the-Future-is-Not-a-Hospital

The Hospital of the Future is Not a Hospital

Philip Betbeze, for HealthLeaders Media , May 30, 2014

Pursuing expensive inpatient volume in the traditional sense is a strategic dead end. Any new construction undertaken by hospitals and health systems should be based on adaptability, patient flow, and efficiency gains—not bed count.

I’ve spent a good deal of time the past several weeks interviewing senior healthcare leaders for my story in the May issue of HealthLeaders magazine about the hospital of the future. But in truth, that headline might be a bit of a tease.

As it turns out, the hospital of the future doesn’t look much like a hospital at all. Instead, it’s a cohesive amalgamation of plenty of outpatient modalities that represent growth in healthcare. Inpatient care, increasingly, represents stagnation and shrinkage, in the business sense.

In the past, a story about the hospital of the future has meant investigating healthcare organizations’ access to capital, and their ability to fund expensive new patient bed towers with all-private rooms and top technologies, in a race to grab volume from competitors.

Under that operating scenario, the sky was the limit, in terms of what organizations were willing to do to attract volume.

That calculus has changed drastically.

In a recent survey on healthcare design trends conducted by Minneapolis-based Mortenson Construction, 95% of the healthcare organizations surveyed said most of the projects they are undertaking are predominantly ambulatory in nature.

“If, in theory, the [Patient Protection and Affordable Care Act] has now got 7 million people engaged in healthcare insurance who didn’t have that previously, the inrush of patients will be outpatient-based,” says Larry Arndt, general manager of healthcare in the company’s Chicago offices. “What’s not needed is bed space or heavy procedural space.”

A Strategic Dead End
The PPACA, employers, and commercial health plans have made clear that pursuing expensive inpatient volume in the traditional sense is a strategic dead end. That doesn’t mean new patient towers won’t go up, but it does mean their construction will be based on adaptability, patient flow, and efficiency gains, not bed count.

As few as five to seven years ago, says Arndt, a healthcare leadership team would take a capital improvement project through a planning and programming phase in which they followed a traditional approach. The team would utilize widely standardized metrics and program their building based on what they’re doing now, with no consideration of the future, Arndt says.

By contrast, within the last five years, more leaders have been embracing the concept of lean operational improvement.

In order to be competitive in a limited amount of reimbursements, they have had to become more efficient. So instead of the traditional approach of programming new construction based on how the organization operates today, instead, it attempts to map out its current patient flows and discover how to become more efficient. Only then will the team look at how to build around that improved and more efficient model.

Indeed, a whopping 22% of respondents to Mortenson’s February survey said they were “doing nothing” construction-related right now, and only 5% were planning for a traditional replacement hospital.

Instead, a majority said they are focusing new construction on building clinics that can feature just about any outpatient modality except surgery, Arndt says.

Healthcare Shifts to Outside
They’re focusing on combining dialysis, radiology and other treatments that can be provided in one location. And they’re funneling more of their capital budget to items that are outside the realm of new construction, like home health and what Arndt calls e-home healthcare—in other words, technological solutions that help patients access their caregivers outside of any facility.

“Our customer understands that healthcare is moving more toward healthcare outside a facility,” says Arndt. “That means more money is being invested in health information technology. Also, you see more constellation or satellite projects, for example, a small 15,000-20,000 square-foot clinic in a neighborhood. That allows patients to travel a shorter distance to a less congested environment, but yet allows connection to the bigger facility if needed.”

Modular construction is a trend that Arndt sees developing quickly. It’s in the process of designing a clinic for a client that will feature modular walls, to make it more flexible for the changes in care protocols that are assured, but that healthcare’s leaders aren’t sure how will ultimately affect their competitive offerings.

In one clinic, doctors want to be able to meet with patients in groups, for example. Modular walls mean physicians can occasionally meet with groups of patients instead of individually, or vice-versa. Their space is less limiting.

“The clinic can adapt,” says Arndt.

Prefabricating buildings is also gaining steam in healthcare, he says.

“Money is being invested much more wisely than it has been in the past,” he says. “For the design/construction field, we have to be more lean too.”

Part of that lean attitude means offering customers 3-D modeling that starts with design partners, such as the people who will be staffing the building, to optimize work flow.

Adapting Takes Time
“We can prefab things we couldn’t years ago,” he says. An example might be a bathroom “pod” that can be built offsite and installed on site. Full exam rooms can be prepared the same way, and models can be constructed to test care protocols with the team that will be working there.

Arndt’s customers, he says, can be categorized two ways. Either they’re thinking broadly about adapting to the future without knowing exactly what it’s going to bring, or they’re standing idly on the sideline until they understand better how the PPACA and other drastic changes in how healthcare is provided and paid for will affect their bottom lines.

Neither approach is necessarily better than the other, but waiting just puts off the action that needs to be taken. It can be a prudent approach, but even in healthcare, what works can change quickly. Designing, building, and adapting still takes time.

Don’t wait too long.


Philip Betbeze is senior leadership editor with HealthLeaders Media. 

Apples cocks up HealthKit slide at WWDC…

It’s already starting to seem a lot like HSG, except less credible…!

 

http://rockhealth.com/2014/06/digital-health-entrepreneurs-thoughts-healthkit/

Embedded image permalink

A digital health entrepreneur’s thoughts on HealthKit

Guest Contributor
June 03, 2014

Tags: 

This morning, Apple made its much-anticipated move into healthcare with HealthKit (aka, the formerly rumored HealthBook.) With a typically dissonant and ever-growing ecosystem of health apps, devices and data, digital health needs a major player to enter to integrate these products and tools. We’re excited about what the largest company in the world is capable of doing for digital health. Here’s some perspective on what a seasoned digital health entrepreneur had to say about today.

Aaron Rowe
HealthKit is really exciting. Putting all of this information in one place, in a gorgeous app that will reach a ton of people, could do wonders for public health. But it won’t do much good if the on-screen content is designed without input from people who deeply understand health metrics. It looks like Apple or one of its partners made some technical mistakes on a slide that was shown during the big reveal of their new health app.

The slide, which appeared toward the end of the HealthKit segment of today’s WWDC keynote, neatly displays four key metrics for diabetes management: glucose, carbs, walking, and diabetes medication adherence. The numbers and units that Apple used as examples to illustrate their vision don’t make sense. When you measure your glucose with a personal blood sugar meter, it is measured in mg/dL— but the example shown by Apple displayed these numbers in mL/dL. Whoops!

What’s worse, the app screen features an SMS-style message from a particularly photogenic doctor who says, “You’re making great progress with your diet and exercise. Keep it up.” While the graph above this message shows a steady and very unhealthy looking uptrend in the users glucose readings. The current reading shown on the app is 122 “mL/dL”.

“People with a fasting glucose level of 100 to 125 mg/dL have impaired fasting glucose (IFG), or prediabetes,” according to a National Institute of Diabetes and Digestive and Kidney Diseases website. “A level of 126 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes.

It strikes me as particularly unusual that Apple would make these mistakes, since they are known for their intense attention to detail. Perhaps this kerfuffle happened because none of the folks who were involved with the WWDC keynote know what medical details should look like—is there some disconnect within the group that is building HealthKit?  Have the designers who worked on this screen had enough contact with Apple’s partners at the Mayo Clinic or recently hired health experts? Not long ago, the Cupertino-based company onboarded several noninvasive glucose-monitoring experts from the wearable Raman spectrometer company C8 MediSensors and an early employee of Rock Health’s own Sano Intelligence.

I hope HealthKit will help patients understand and react to the results of every common blood test that is done in the home and medical labs–from cholesterol to creatinine. This could be one of the greatest ways in which Apple can make the world a better place. But they may need to sync internally to refine their understanding of these numbers, before they release this potentially lifesaving product into the wild.

Aaron Rowe is a research director at Integrated Plasmonics, a San Francisco startup that has developed a new class of spectrometer and surface plasmon resonance sensor chips. He and his colleagues are exploring ways to expand the scope of chronic disease management programs, enhance the success of new medications, and increase the usefulness of telemedicine by bringing a wide variety of in vitro diagnostics devices into the home and workplace. You can follow him on Twitter at @soychemist

 

Esther Dyson on the population health rampage!

 

http://www.healthleadersmedia.com/print/TEC-303509/Esther-Dyson-Launches-Population-Health-Challenge

Esther Dyson Launches Population Health Challenge

Scott Mace, for HealthLeaders Media , April 15, 2014

A tech investor with a proven track record of attracting innovation and money to a variety of endeavors is looking for a few good communities to compete for the greatest improvement in five measures of health and economic vitality.

Wellville

Healthcare ladies and gentlemen, start your communities.

That was the call on April 10 from angel investor and tech advisor Esther Dyson, whose population health dream has taken a big step toward reality with the launch of the Way to Wellvillecompetition.

From now until May 23, Dyson’s nonprofit startup, HICCup, is inviting communities to apply to be one of five contestants in a five-year-long competition to get healthy using everything from the latest fitness gadgets to reality TV. Dyson is HICCup’s founder and chairman of EDventure Holdings.

The 20-page application form is not for the casual applicant. Individuals or consultants need not apply – we’re talking community health organizations, other nonprofits or perhaps the local Better Business Bureau.


Esther Dyson’s Population Health Dream


Why bother? Several reasons. Dyson is an early investor in all sorts of innovative startups, with a proven track record of attracting innovation and money to a variety of endeavors over the past 25 years. She also is a great listener, having convened various listening sessions around the country last fall to get this latest idea off the ground.

Dyson’s fledgling organization, HICCup, found its footing in those sessions, and also a CEO, Rick Brush, who spent nearly a decade at Cigna, where he was chief strategy and marketing officer for the national employer segment and launched the payer’s Communities of Health venture.

Esther Dyson

Esther Dyson
Photo: courtesy of Joi on Flickr.

At one of those early scoping sessions, Brush asked the kinds of tough questions about what Way to Wellville should be measuring that landed the answers in HICCup’s FAQ and himself in the CEO’s chair, Dyson tells me.

A ‘Learning Lab for Health’
“What we’re trying to do is almost create a learning lab for health with subsidiary projects and contests along with the five-year marathon,” Dyson says.

Back to that lengthy application, which goes beyond asking about a community’s healthcare, straight to the health of a community, seeking such metrics as percentage of temporary residents, household income, poverty levels, and a slew of outcomes data – percentages of a community with diabetes, heart disease, asthma, smoking status, obesity and more.

Applicants also have to describe their top previous successes and failures trying to improve community health, healthcare financing innovations such as ACOs, patient-centered medical homes, population health, bundled payments, and so on.

In other words, it’s a lot of the things that HealthLeaders readers are currently embarking on both individually and collectively. And if the prestige of being selected for the first-of-its-kind national competition of sorts doesn’t intrigue you, there are a couple of other things to consider.

First is the cash prize at the end of the five years. HICCup itself won’t be rewarding such a prize, but hopes to raise $5 million for it. “Honestly, contestants are going to have to spend $15 to $50 million as a community to do this, so you’re not doing this for the prize, though of course it matters to some extent,” Dyson says.

Second, and more importantly, Way to Wellville contestants will become part of a larger community amongst the five competing communities. They will meet face-to-face in September at an annual conference, Next Step to Wellville, about a month after the five competing communities are selected.

The actual judging of who wins in 2019 has yet to be decided, but it will be a third party for legal and fiduciary reasons. Dyson emphasizes that the organization doesn’t have all the answers yet.

Metrics Matter
If you believe, like I do, that healthcare is closer than ever to some tectonic shakeups courtesy of technology, then Way to Wellville is likely to be a great observation post. Innovative medical hardware and software companies are already flocking to a variety of competitions such as this. Way to Wellville is just taking a bigger view of what kind of population health solutions will ultimately be necessary.

Expect also a lot of intermediate measurements and competitions.

“We’re hoping that some of these quantified self vendors will come in and donate devices to the communities and so we’ll have Fitbit and Fuelband contests,” Dyson says. “[Add to that] the county health rankings and all of these sorts of official measures, most of which are a year or two old, and we’re all going to get a lot more real-time data.”

“You can’t report transitions to diabetes every month,” Dyson says, “so there will be some health measures that are kind of yearly, but then there are, the outcomes measures tend to be slow. The input measures, like the percentage of school lunches that contain no French fries or something, you can measure in more real time.”

The $15 to $50 million table stakes per community sounds daunting to me. “It’s not the community goes and gets a $50 million grant from somebody,” Dyson says. “It’s more than they get a $10 million grant for, let’s say, heart health. There’s a $2 million program for food subsidies for fruits and vegetables. There are accountable care organizations that find an investor to improve the health so that their costs go down. There are social impact bonds.”

Philanthropists Wanted
“So it’s a combination of a large number of different kinds of funding from donors, from social investors, from vendors giving in-kind services or goods, and maybe in outer years, the school board raises a bond to do something with the school lunch. Each community is going to need to get money and support from a variety of courses in a variety of funds.

“We’ll be looking for people who want to invest in various ways of producing health. We’re also looking for donors [and] philanthropists.”

And of course, Dyson is reaching out to her famous set of angel investor friends. The goal, of course, is to go beyond that. Another way to maintain excitement on Dyson’s agenda is “a cheesy reality TV show” and perhaps a documentary.

As we see more and more crowdfunded efforts springing up in healthcare technology, Dyson’s approach has some similarities – with perhaps a crowd with deeper pockets, or at least one that’s been around the startup block a time or two.

Dyson hopes for up to 50 applicants for the five spots, and already has solid interest from several communities. Her population health dream is alive, and by this fall we should start to see some manifestations of it.


Scott Mace is senior technology editor at HealthLeaders Media. 

Eating more fruit and veg won’t stop obesity

 

http://www.theatlantic.com/health/archive/2014/06/eating-more-fruits-and-vegetables-wont-stop-obesity/371992/

Eating More Fruits and Vegetables Won’t Stop Obesity

People have been eating more fresh produce as the obesity epidemic has worsened. They’ve been eating more of everything else, too.

Why are so many people overweight? Part of the reason, some think, is because they don’t have access to, the money to buy, or the desire to eat fresh fruits and vegetables.

That’s the idea behind initiatives like the “One more a day pledge” (whose slogan sounds like the pledge-taker might already be choking on carrots: “I pledge to eat … and help my family eat … at least ONE MORE fruit or veggie every day.”[ellipses sic])

Produce is less calorically dense than grains, meat, and fat, so increasing its consumption might indeed make sense as an obesity-fighting strategy—that is, if eating more fruits and vegetables caused people to compensate by eating fewer cookies and french fries.

Unfortunately, though, we don’t really eat that way. We’ll have a tossed salad—and then a Chipotle Quesarito. At least, that’s what RAND health economist Roland Sturm found in a new paper he co-authored with Ruopeng An, a health policy professor at the University of Illinois at Urbana-Champaign.

“Conventional wisdom is an awful guide for policy,” Sturm told me. “The consumption of fruits and vegetables has increased during the obesity epidemic.”

Differences in diet, such as eating more Cheetos and fewer cucumbers, help explain why some individuals are more obese than others, Sturm said. But they don’t explain why obesity has grown across all populations in nearly all U.S. states over the past few decades.

The study, published in the journal CA: A Cancer Journal for Clinicians, found that while college-educated people are still less likely to be obese than their less-educated counterparts, they’re still fatter than they used to be:

Increase in body mass index over time for people of various levels of education (CA: A Cancer Journal)

And the BMIs of the uber-healthy Coloradans, who regularly appear on “healthiest states” lists, have been rising over time, just like those of Mississippians have:

Prevalence of overweight over time in California, Colorado, and Mississippi. (CA: A Cancer Journal)

Today, people eat about 30 more pounds of vegetables and 25 more pounds of fruit per year than they did in 1970, according to Sturm’s calculations.

Unfortunately, they’re eating more of everything else, too. The average adult consumed about 2,100 calories in 1970, but in recent years that number has risen to more than 2,500.

Average daily per capita calories, adjusted for waste (CA: A Cancer Journal for Clinicians)

Attempts to discourage the consumption of certain macronutrients also don’t seem to work. Historically, people have simply eaten less of the forbidden substance and more of the others. During the low-fat craze of the 90s, for example, fat consumption dipped, but carbohydrate intake skyrocketed. And after the Atkins diet took off in 2000, people simply swapped carbs back in for fat.

Change in macronutrient consumption over time. (CA: A Cancer Journal for Clinicians)

“Preventing obesity is not about eating more food, regardless of how many nutrients it provides,” Sturm and An write, “but consuming less energy or expending more.”

Past research on the produce-obesity issue has been mixed: A 2003 study of a large sample of children found that eating more fruits and vegetables had no significant impact on weight. Around the same time, a different study of middle-aged nurses found those who ate more produce were less likely to become obese.

Sturm emphasized that his study is different because it’s looking at top-level changes over time, not disparities between groups of people.

A recent Lancet study found that rich and poor countries alike are now struggling with obesity, and that there have been “no national success stories” in stemming the epidemic. So while it’s definitely a problem that, say, poor American women tend to be fatter than richer women, another frightening trend is the overall rise of large waistlines over time.

The case for eating steak and cream

 

 

http://www.economist.com/news/books-and-arts/21602984-why-everything-you-heard-about-fat-wrong-case-eating-steak-and-cream

Economist Book Review

The Case For Eating Steak and Cream

Shifting the argument

The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet. By Nina Teicholz. Simon & Schuster; 479 pages; $27.99. Buy from Amazon.com,Amazon.co.uk

“EATING foods that contain saturated fats raises the level of cholesterol in your blood,” according to the American Heart Association (AHA). “High levels of blood cholesterol increase your risk of heart disease and stroke.” So goes the warning from the AHA, the supposed authority on the subject. Governments and doctors wag their fingers to this tune the world over. Gobble too much bacon and butter and you may well die young. But what if that were wrong?

Nina Teicholz, an American journalist, makes just that argument in her compelling new book, “The Big Fat Surprise”. The debate is not confined to nutritionists. Warnings about fat have changed how food companies do business, what people eat, and how and how long they live. Heart disease is the top cause of death not just in America, but around the world. The question is whether saturated fat is truly to blame. Ms Teicholz’s book is a gripping read for anyone who has ever tried to eat healthily.

The case against fat would seem simple. Fat contains more calories, per gram, than do carbohydrates. Eating saturated fat raises cholesterol levels, which in turn is thought to bring on cardiovascular problems. Ms Teicholz dissects this argument slowly. Her book, which includes well over 100 pages of notes and citations, covers decades of nutrition research, including careful explorations of academics’ methodology. This is not an obvious page-turner. But it is.

Ms Teicholz describes the early academics who demonised fat and those who have kept up the crusade. Top among them was Ancel Keys, a professor at the University of Minnesota, whose work landed him on the cover of Time magazine in 1961. He provided an answer to why middle-aged men were dropping dead from heart attacks, as well as a solution: eat less fat. Work by Keys and others propelled the American government’s first set of dietary guidelines, in 1980. Cut back on red meat, whole milk and other sources of saturated fat. The few sceptics of this theory were, for decades, marginalised.

But the vilification of fat, argues Ms Teicholz, does not stand up to closer examination. She pokes holes in famous pieces of research—the Framingham heart study, the Seven Countries study, the Los Angeles Veterans Trial, to name a few—describing methodological problems or overlooked results, until the foundations of this nutritional advice look increasingly shaky.

The opinions of academics and governments, as presented, led to real change. Food companies were happy to replace animal fats with less expensive vegetable oils. They have now begun abolishing trans fats from their food products and replacing them with polyunsaturated vegetable oils that, when heated, may be as harmful. Advice for keeping to a low-fat diet also played directly into food companies’ sweet spot of biscuits, cereals and confectionery; when people eat less fat, they are hungry for something else. Indeed, as recently as 1995 the AHA itself recommended snacks of “low-fat cookies, low-fat crackers…hard candy, gum drops, sugar, syrup, honey” and other carbohydrate-laden foods. Americans consumed nearly 25% more carbohydrates in 2000 than they had in 1971.

In the past decade a growing number of studies have questioned the anti-fat orthodoxy. Ms Teicholz’s book follows the work of Gary Taubes, a science journalist who has cast doubts on the link between saturated fat and health for well over a decade—and been much disparaged for his pains. There is increasing evidence that a bigger culprit is most likely insulin, a hormone; insulin levels rise when one eats carbohydrates. Yet even now, with more attention devoted to the dangers posed by sugar, saturated fat remains maligned. “It seems now that what sustains it,” argues Ms Teicholz, “is not so much science as generations of bias and habit.”

Economist Daily Chart: Peak Fat

Worryingly, the study—led by the Institute of Health Metrics and Evaluation at the University of Washington—showed that children are fattening at a faster pace than adults. Last week the World Health Organisation set up a new commission to curb child obesity. But it will be some time yet before the world reaches peak fat.

http://www.economist.com/blogs/graphicdetail/2014/05/daily-chart-19?fsrc=scn/fb/wl/dc/peakfat

Daily chart

Peak fat

20140531_gdc156_0 Economist Peak Fat

WAISTLINES are widening everywhere. The percentage of adults who are overweight or obese has swelled from 29% in 1980 to 37% in 2013, according to a new study in the Lancet. People in virtually all nations got larger, with the biggest expansions seen in Africa, the Middle East and New Zealand and Australia. The chunkiest nations overall are found in the tiny Pacific islands and Kuwait, where over three-quarters of adults are overweight and over half are obese. And the world is unlikely to slim down soon. While the rate of increase has slowed in the rich world, it is still rising in poorer countries, where two-thirds of the world’s 2.1 billion overweight adults live. China is home to the largest number anywhere—335m, more than the population of America. This is not just because of its sheer size, but also because economic growth led to cellulite growth: a quarter of adults are now overweight compared with one in ten in 1980.Mexicans just outweigh neighbouring Americans. In both countries, two-thirds of people could lose a pound or two, though more Americans are obese. Agreeing on how to combat the problem is tricky, given that experts continue to bicker on what, precisely, makes us fat. Worryingly, the study—led by the Institute of Health Metrics and Evaluation at the University of Washington—showed that children are fattening at a faster pace than adults. Last week the World Health Organisation set up a new commission to curb child obesity. But it will be some time yet before the world reaches peak fat.

The Ice Diet

Frozen food includes a caloric deficit when eaten – the energy to melt it down. In a 100 cal dessert, this can account for up to a quarter of the calories. Go figure

http://www.theatlantic.com/health/archive/2014/05/the-ice-diet/371614/

The Ice Diet

Eating ice actually burns calories because it requires energy for the body to melt the cube. One curious doctor suggests this can be used as a legitimate weight-loss tool.
Kevin Saff/Flickr

When he became determined to lose weight, Dr. Brian Weiner decided to change his eating and exercise regimes. “One of the first changes I made,” explains Weiner, a gastroenterologist in New Jersey and assistant professor at Robert Wood Johnson Medical School, “was to give up my beloved ice cream.”

Aiming for something lighter, Weiner replaced it with Italian ices. The cups at his supermarket listed their calorie content as 100—calculated by multiplying 25 grams of carbohydrate by four calories per gram. “One evening, in a burst of insight,” Weiner writes, “I realized that this calculation was incorrect. The manufacturer of the ices did not calculate the energy required to melt the ice, and did not deduct this from the calorie calculation.” By Weiner’s math, he was actually only consuming 72 calories, or “icals,” his term for the net caloric content of ice-containing foods after considering the calories that the body burns to produce the thermal energy that melts the ice.

Weiner reviewed the medical literature. “I found that no one has clearly identified this oversight,” he writes. “I could not locate references to considerations of the implications of the energy content of ice as food.”

After discussing the issue in detail with his son, an engineering student at Rutgers who vetted his father’s calculations, Weiner submitted his story as a letter to editors of the widely-read medical journal Annals of Internal Medicine. They published it. In the article, Weiner said the idea could be of real importance to people trying to lose weight. It’s meant as a supplement to overall diet and lifestyle that go into maintaing a healthy physical form. “While eating ice, you are serving two purposes,” Weiner explains, “you are burning calories and not eating positive-calorie foods.”

Now Weiner has also written an e-book, The Ice Diet. It’s free—part of his stated wish “not to get lumped in with the counter-productive fad diet (snake oil) promoters.”

As a practicing gastroenterologist, Weiner says he regularly avoids micromanaging food selection. He manages obesity as an illness and diets as part of a holistic approach to good eating. “I would usually cringe when patients brought up the weight loss diet of the day, usually some poorly documented and improbable strategy. I never thought I would be actively promoting and discussing weight loss diets.”

But now he is, so, what’s to know about using Weiner’s ice diet?

Samuel John/Flickr

When you eat a significant amount of ice, your body burns energy to melt it. Eating ice should, by the logic of this diet, also provide some level of satiety, if only so far as it physically fills space in the stomach and mouth.

By Weiner’s calculations, ingesting one liter of ice would burn about 160 calories, which is the energy equivalent of running one mile. So you get to eat and burn calories. Ever since the death of upward mobility, that has been The American Dream.

What’s more, it’s probably safe. “Ingesting ice at this level should not have any obvious adverse consequence in otherwise healthy persons,” Weiner, who trained at Johns Hopkins, writes. “For the vast majority of adults and children, there does not appear to be any contraindication to the use of the Ice Diet right now.”

One piece of evidence for the safety of ingesting substantial amounts of ice, Weiner notes, comes from the case study of the 32-ounce 7/11 Slurpee, from which he concludes, “The ingestion of one liter of ice per day appears to be generally safe.”

At some point beyond that liter, too much ice can be a problem. In the case of one obese person who attempted to eat seven quarts of ice per day, Weiner says, “Not surprisingly, this person suffered an uncomfortable feeling of coldness.” In his professional opinion, that much ice per day would, for most people, be a “toxic dose.” He recommends avoiding eating much more than the Slurpee-tested one liter of ice daily, “to avoid hypothermia or unusual cooling of the body. … Some organs do not work optimally when the body temperature drops too much.”

“For children using the Ice Diet, the amount of ice ingested should be monitored and related to their body weight and ability to report any problems that they might be having by ingesting ice.” Do not put ice into the mouths of children who can’t tell you if their brain has frozen.

For much the same reasons, use caution when using the ice diet during cold weather, Wiener says. Don’t eat ice on the ski slopes or while shoveling the walkway.

Don’t eat ice when you’re too hot, either. After running, for example, the body actually exerts energy through the active effort of dissipating excess heat that builds up during exercise. “If one were to ingest large amounts of ice as one was cooling off from exercise,” The Ice Diet warns, “some of the heat that had been generated by the exercise would be neutralized by the coolness of the ice, minimizing some of the energy burning benefits of the exercise.”

Physics writer Andrew Jones offers more skeptical calculations as to the caloric benefits of the ice diet, determining that eating a kilogram of ice would burn 117 calories. “To reach the 3,500 calories required to lose a pound of weight, it would be necessary to consume about 30 kilograms [66 pounds] of ice,” Jones writes. “Not exactly the most efficient diet plan.” That means, if you ate a liter of ice every day, you would lose about a pound of weight every month, all other things in life being equal. That’s not bad. And all other things wouldn’t be equal. Everything in your life would be different because you would be eating a liter of ice every day.

Also, of course, chewing ice can cause dental problems. Beyond full-blown cracking of teeth, the practice can damage the gums and enamel or injure the temporomandibular joint. To avoid dental damage, Weiner writes, “I would recommend that ice be allowed to melt in your mouth, as with ice pops, or consumed with the texture of shaved ice, as in the 7/11 Slurpee or the frozen margarita.”

Except don’t actually drink a liter of Slurpee every day because that sugar load would more than undermine this entire venture, and drinking a daily liter of margarita is this whole other thing. Weiner recommends making the process less onerous by making your own ice-pops using calorie free liquids instead of sugary concoctions or fruit juices. “For those with a larger budget, the Jimmy Buffett Margaritaville machine shaves ice into a very fine slurry, which can be consumed as-is or flavored with artificially flavored products.”

It’s that easy and, assuming the artificial flavoring you use is totally safe, you’re good to go. You don’t even have to worry about this fad diet becoming uncool. If anyone tells you it’s uncool, you can just cross your arms and say, “It’s objectively the coolest diet around in terms of temperature.” Pass the slurry.

Health consequences of GST on fresh food

Audio:

http://www.abc.net.au/radionational/programs/rnfirstbite/potential-health-impacts-3a-gst-on-fresh-food/5467836

Would a GST on fresh food make Australians sicker?

Saturday 24 May 2014 9:31AM

In response to last week’s Federal Budget, debate grows around whether or not the GST should be broadened to include fresh food. Calls are coming from MPs, former leaders and even the chief executive of World Vision Reverend Tim Costello, for an ‘adult conversation’ about a consumption tax on fresh fruit and vegetables. However, Australian research has shown a 10 per cent tax on fresh fruit and vegetables could have dire public health consequences.

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Credits

Presenter
Anita Barraud
Producer
Maria Tickle

Emeritus Professor Stephen Leeder AO – A Celebration!

 

http://sydney.edu.au/medicine/public-health/menzies-health-policy/news/pastevents.php

Emeritus Professor Stephen Leeder AO – A Celebration!

Thursday, 1 May 2014
MacLaurin Hall, Quadrangle Building, University of Sydney

Colleagues gathered to celebrate the remarkable career of Emeritus Professor Stephen Leeder AO.

Keynote presentations and discussion focussed on the following themes: Chronic Disease: An international epidemic; Medical Education; Public Health Education and Training for the 21st Century; and Health Policy.

Presentations

Chronic Disease: An international epidemic

Professor K. Srinath Reddy, President, Public Health Foundation of India (PHFI)

Professor Robert Cumming, Sydney School of Public Health, University of Sydney

Medical Education

Emeritus Professor John Hamilton AM OBE, University of Newcastle

Professor Bruce Robinson AM, Dean, Sydney Medical School, University of Sydney (see sound recording below)

Public Health Education and Training for the 21st Century

Dr Henry Greenberg, Special Lecturer in Epidemiology, Mailman School of Public Health

Professor Glenn Salkeld, Head, Sydney School of Public Health, University of Sydney

Health Policy

Dr Mary Foley, Secretary, NSW Health (see sound recording below)

Associate Professor James Gillespie, Deputy Director, Menzies Centre for Health Policy, University of Sydney (see sound recording below)

Dr Anne-marie Boxall, Director, The Deeble Institute for Health Policy Research (see sound recording below)

Ms Shauna Downs, PhD Candidate, Menzies Centre for Health Policy, University of Sydney

The Hon. Dr Neal Blewett AC (see sound recording below)

Distinguished Guest Speaker: The Hon. Jillian Skinner MP, Minister for Health and Minister for Medical Research (see sound recording below)

Sound Recordings

Chronic Disease: An international epidemic

Medical Education

Public Health Education and Training for the 21st Century

Health Policy

Dr Norman Swan in conversation with Emeritus Professor Stephen Leeder

Video Tributes

Professor Jeffrey D. Sachs, Director of The Earth Institute, Quetelet Professor of Sustainable Development, and Professor of Health Policy and Management at Columbia University

Simon & Trish Chapman

Flyer and Program

Event Flyer

Event Program

Corporate nanny is the one we should be fearing

 

http://sydney.edu.au/news/84.html?newsstoryid=13388

It’s the corporate nanny we have to fear



28 April 2014
Responsible adults should be left alone to make their own choices: so goes the customary argument against the nanny state. However, that ignores a very large elephant sharing the room with state and citizens – corporations.

Corporate efforts to influence our choices dwarf anything even the most ambitious government health expert can dream of. The Department of Health and Ageing spent $51.9 million on advertising and related expenses in 2010-11. That budget, spread across everything from smoking to annual flu shots, can be matched by a single company promoting a single class of products. Last year, McDonalds spent $74.1 million on advertising in Australia, according to Nielsen estimates.

Perhaps the difference between the nanny state and the nanny corporation is that the government is trying to change us and corporations are not – corporations are just giving us what we want.

As responsible adults we know what’s best for us, so big business is on our side. While it’s true that advertising helps people buy the things they want at the best price, it also influences people to want things they would otherwise not want, and choose things they would otherwise not choose. It’s no accident that the psychologist primarily responsible for the modern theory of behavioural conditioning, John B Watson, spent a large part of his career as a successful advertising executive.

Head down to your local pub and order a middy to see the corporate nanny in action. The bar staff might tell you that you can only get a middy in “the other bar”. Or they might provide the helpful tip that a schooner is almost the same price. You will quickly get the impression that someone would prefer you to have a schooner.

If the nanny state made it hard for you to get a large beer, the benefits of the policy would have to be weighed against the cost to freedom. But when the pub makes it hard for you to get a small beer, freedom is apparently left untouched. Even if the nanny state legislated to ensure you get the option of a small beer, you can bet that someone would denounce this as an assault on freedom. This is just not thinking straight.

There are many proven ways to influence choice. If you want people to donate to a good cause at the same time as paying a bill, adding the information that 80 per cent of people donate has a measurable effect. Labelling a bin as “landfill” rather than “general waste” makes people more likely to use the recycling bin.

When governments do this, it is known as nudging, a gentle kind of nannying. Not everyone approves, because it is a little creepy to think of governments hiring psychologists to manipulate the unconscious parts of our minds. However, corporations are way ahead of government in nudge technology. Charging a little more money for a lot more stuff, as with the schooner of beer, can increase overall consumption.

The impact of a price rise on sales can be moderated by shrinking the packet and keeping the old price. A big serving on a big plate looks small, and a small serving on a small plate looks big – both useful effects when you want to influence what people order.

It’s a mistake to assume that only the state is trying to interfere with freedom of choice – corporations are in the same game. This effectively gives us a choice between two nannies, and there is good reason to be suspicious of the corporate nanny. Corporations have a responsibility to their shareholders to make as much money as they can, and it is well documented that adding fat, sugar and salt is one of the easiest ways to do that. At least the nanny state has some interest in our wellbeing, even if it is only to keep healthcare costs down. What is more, at least some of the time, the nanny state tries to give us freedom, not take it away.

Contrary to popular opinion, freedom and legislation are not engaged in a zero-sum game, where one can only win if the other loses. A good example is the recent stoush between public health advocates and the Australian food industry over food labelling.

It stretches credulity to believe that the current system is designed to make it easy for me to eat the way I want to eat. I have to take my reading glasses to the supermarket to find out which “percentage of daily recommended intake” corresponds to a “serving size”. A simple and informative front-of-pack star rating system was painstakingly negotiated by industry and health experts between 2011 and 2013, at the urging of the federal government. But the Australian Food and Grocery Council, the main industry lobby group, now argues that much more research is needed before any changes can be made, and that the cost of changing labels will be prohibitive.

I won’t be able to leave my glasses and calculator at home when I go shopping any time soon.

Government interference in how corporations label and market food is a prime example of the nanny state in action. But nanny is not taking away our freedom, she’s giving it back to us. Freedom is being able to live your life the way you want to live it, but you can’t do that when you’re being kept in the dark about the choices on offer, or nudged in the wrong direction by corporations.

A two-part symposium, Who’s Afraid of the Nanny State: Freedom, Regulation and the Public’s Health, presented by the University of Sydney’s Charles Perkins Centre and Sydney Law Schoolon 28-29 April 2014, will discuss the role and impact of government and corporations on our health and wellbeing.

Professor Paul Griffiths is Associate Academic Director for Humanities and Social Sciences at the Charles Perkins Centre, University of Sydney.