Seniors need strength training, too

Many people think that beyond a certain age, you become too weak to strength train or benefit from it. But research shows the complete opposite. Without adequate muscle exercise, most adults lose 20 to 40 percent of the muscle they had as young adults. With too much muscle loss people have difficulties performing daily activities that allow them to live independently.

Experts say that even small gains in muscle – too small to see – can make significant differences in how seniors live. Strength training can affect whether an older person can get out of a chair without help. It can also influence their sense of balance, risk of falls and fractures, and the ability to climb stairs or carry groceries. Strength training can even make bones stronger and weight control easier.

One recent study of seniors showed that after six months of strength training, strength in a variety of muscle groups increased 31 percent for the duration of the two-year study. Other studies show benefits for the frail elderly living in nursing homes. People who had formerly needed walkers to get around could use a cane instead.

I extrapolate and believe that we 50somethings should do resistance training as primary prevention. And I do.

Hold That Stretch: Warm-Up Is Challenged

Now a major study is stirring renewed discussion about when stretching is and is not beneficial.

The study, a review of six decades of research by the Centers for Disease Control and Prevention, found that stretching does little to prevent injury during exercise when done outside of a warm-up. In some cases, the increased flexibility that stretching promotes may actually impede performance.

The researchers analyzed 361 scientific articles on stretching published since 1946. The findings, in the March issue of Medicine and Science in Sports and Exercise, suggest that athletes who devote pre-exercise time to stretching may be better served with a warm-up that prepares the body for activity and regular exercises that build strength and balance.

"The idea of loosening your joints up and muscle stretching makes sense, but the problem is that it really hasn't been shown to prevent injury," said Dr. Stephen B. Thacker, director of the epidemiology program office at the C.D.C. and an author of the study. "If you put on your sweats and simply start stretching, your muscles are not necessarily warmed up."

Warming up, which typically means raising the body temperature enough to send the blood flowing through the muscles, requires more intense activity than stretching.

"For your muscles to function at optimal capability, they should not be too loose nor too tight," said Dr. Lisa Bartoli, an attending physician in physical medicine and rehabilitation at the Beth Israel Medical Center in Manhattan. She likened warming up the body for exercise to taking modeling clay from a refrigerator. "You warm it up and work it a little bit," she said. "And then you can stretch it."

Like many sports physicians, Dr. Bartoli tells her patients that rather than stretching before physical activity, they should do the sporting activity at 50 percent of the target intensity.

The argument against stretching does make some sense. You need not take a joint to an angle that you will not be using. Too much laxity may make injury more likely (by preventing resistance to injury).

I like the recommendation of warming up. I notice in golf that a slow warm up leads to better golf swings on the course. I notice that prior to my weight lifting sessions, a moderate aerobic activity of 10-15 minutes helps me get ready for action.

Going on vacation. Will resume blogging either Sunday or Monday. Playing golf and giving health care thoughts a rest.

Have a great weekend!!!

Wow - sometimes research provides good news. FITNESS: Study finds no evidence stretching prevents injuries

People who stretched were no more or less likely to suffer injuries such as pulled muscles, which the increased flexibility that results from stretching is supposed to prevent, researchers found. And the injuries found in the study typically happened within the muscle's normal range of motion, so stretching them would not have made a difference, Thacker said.

Other research has found that warmups, which increase blood flow through the muscle and make it more ready to respond to exercise, can reduce the risk of injury, Thacker said. Being in good shape also helps. Strength and balance training reduced injuries as well, he said.

Sounds good - warm up, stay in shape, do not worry so much about stretching.

I might love this diet. Can a high-carb diet help you lose weight?

American Dietetic Association spokeswoman Cindy Moore agreed and said with low-carb diets hogging the spotlight, “it may be a reminder that we can lose weight in a variety of different ways.”

Foods on the successful diets included high-fiber cereal, vegetarian chili, whole-wheat spaghetti, many fruits and vegetables, and skim milk. Daily calories totaled about 2,400, similar to participants’ usual consumption.

The control group also received prepared meals with similar calories, but the foods included sausage, scrambled eggs, macaroni and cheese, French fries, whole milk and fewer fruits and vegetables.

The successful diet was not tested against Atkins and other low-carb regimens, which contain more fat and fewer carbs than the control group diet.

There is more than one way to skin a cat, and more than one way to lose weight. This way looks interesting to me. I hope we read more about this new diet.

You probably saw this on TV or read this in the newspapers. The Post-Atkins Low Carb Diet

The level of saturated fat that is permitted in the Atkins diet is still more than in other low-carbohydrate diets, and 60 percent of calories are still supposed to come from fat, although trans fats are not permitted. But setting a limit brings the diet more in line with others, like the South Beach Diet.

The diet industry is still riven by arguments over the best way to lose weight, but many mainstream researchers say that if low-carb diets have moved people away from refined carbohydrates like sugar and white flour, they have accomplished something important. And some acknowledge that a low-carb diet fills many people better than a low-fat diet, helping to keep them on the diet.

Weight loss surgery has a major "upside". Morbidly obese patients who have major weight loss have wonderful health and social benefits. Despite the danger, for many patients the risk is clearly worthwhile.

We must always remember the risk though - Mass. Panel to Probe Obesity Surgery

Massachusetts health officials announced plans Tuesday to assemble a panel of experts to examine the dangers of obesity surgery, less than a week after the state's third death in a year linked to weight loss operations.

The death rate is significant. Patients need complete disclosure of the risks. But the benefits are great enough to make the risks worthwhile for many patients.

This article explains our portion control problem very well - Want to stay slim? Get a handle on America's out-of-control food portions

Many readers have a New Year's resolution to lose weight. You can lose weight just by dieting. However, increasing activity can help greatly. Need Exercise? Count on It

"You'll lose muscle mass, your metabolism will slow down," she says. "You gain a lot more things with exercise than just maintenance of weight. You get an increase in energy, an increase in metabolism; you decrease the chance of cardiovascular diseases; you get a reduction in blood pressure, things of that nature. If you don't work out, if you only consume as many calories as you burn, you're missing out on all that."

State legislatures have taken heed. They are passing positive laws to attack the obesity epidemic. Worried about obesity, states mulling laws for restaurants, schools and public employees

Under the laws that have passed, states will:

* Test the BMI -- body-mass index, a ratio of height to weight -- of students in six Arkansas schools, and send results home. Pediatricians say regular tests like this should be performed nationwide to track children at risk of becoming obese.

* Ban junk food from vending machines in California. New York City, in an administrative decision, banned hard candy, doughnuts, soda and salty chips from its vending machines.

* Require physical education programs in Louisiana schools, and encourage it in Arkansas and Mississippi. Though once a staple, such daily classes are now only required by state law in Illinois; other states let local officials decide or require exercise less often.

For even more information on obesity - here is the Surgeon General's web page on the subject - The Surgeon General's Call To Action To Prevent and Decrease Overweight and Obesity

I harp on fitness often. Personally I work out approximately 5 days a week, some resistance training, some cardiovascular work. This article speaks to young adults, but I suspect it is rarely too late. Treadmill Tests Gauge Future Fitness

The study involved about 4,400 men and women who were given a treadmill test when they were 18 to 30. Most of them were followed for 15 years after that.

Those who did not do well on the treadmill test faced double the risk of developing high blood pressure, diabetes or a condition called metabolic syndrome, compared with highly fit participants. Metabolic syndrome is a cluster of symptoms that includes high blood sugar, poor cholesterol levels, elevated blood pressure and a fat belly.

Some of the participants underwent a second treadmill test, seven years after the first one. Those who became more fit during those intervening years reduced by 50 percent their risk of diabetes and metabolic syndrome.

The study is published in Wednesday's Journal of the American Medical Association.

The findings ``confirm what common sense has always told us -- lack of fitness in youth is not a good thing for later life,'' said Dr. Teri Manolio, director of epidemiology at the National Heart, Lung and Blood Institute, which funded the research. ``It doesn't take that long for risk factors to develop and disease to develop.''

Fitness levels were determined by how long participants could walk on a treadmill without becoming fatigued and short of breath.

We should spend public health dollars on middle school and high school fitness programs. "Phys Ed" is not a luxury for students, but rather a most important class. It should provide life long exercise habits. This is important.

Do not drink excessively when running marathons. Running the Risk of Too Much Water: Hyponatremia Can Sometimes Lead to Death for Marathoners

If you run or bike long distances, please read this article.

So how can we get Americans to exercise? Maybe incentives will work - Bribing People To Exercise?

By exercising and staying healthy, Traci and Todd Gianvito have earned enough reward points to take a trip to Florida.

And, says Destiny Healthcare member Todd Gianvito, "We'll be going to Europe next year using the airline miles and using the vacation package for part of the trip."

Destiny Healthcare offers Traci and Todd incentives every time they visit a gym or work out. They even get points for taking CPR classes and doing charity runs.

"We'll get little incentive letters saying way to go, you're earning points and here are some free movie tickets -- which I think is cool," said Traci.

And it saves cool cash for their small midwestern healthcare provider and its parent company in South Africa.

"On the financial level, it impacts dramatically on healthcare costs, people are more prudent, they are more engaged in their healthcare," said Adrian Gore, with Discovery Healthcare.

What a logical, novel, and appropriate idea!!!!

So what are the costs and benefits of bariatric surgery? We just do not know - so Louisiana will find out! La. Testing Stomach Surgery's Cost Effect

Forty obese government employees will get weight-reduction surgery in a $1 million experiment to see whether it keeps insurance payments down over the long run by preventing other health problems.

The first job will be choosing the 40 from more than 1,000 people on the state's health plan who expressed interest in the surgery. The participants will be monitored for three years.

A few states require insurance companies to cover weight-reduction operations, such as those that clip the stomach to a fraction of its original size and bypass part of the intestine. This makes people feel full much more quickly, and digest less of what they eat.

The resulting weight loss can head off long-term illness related to being overweight. The operation is generally considered only for people who are ``morbidly obese'' -- at least 100 pounds overweight.

The Louisiana Legislature refused to require coverage of the operation after insurers objected that it would cost too much. The state health plan alone would spend an estimated $25 million in its first year if it had to cover all requests immediately, Executive Director A. Kip Wall told lawmakers this summer.

``The biggest obstacle is, for lack of a better term, pent-up demand,'' he said Tuesday.

Wall said the $25 million estimate was based on a quoted price of $25,000 per operation and the more than 1,000 letters his office got after sending a notice about the proposed test a year ago to the 250,000 people covered by the plan. Nationwide, prices range up to $40,000 per operation.

A $1 million contract was approved this month for LSU Health Sciences Center -- the state's major medical school -- to pick, treat and follow up with 40 volunteers for the pilot study.

Participants in the experiment will have to pay no more than the usual co-payment or deductibles. The amount would depend on which group benefits plan they are in.

This is very important. Some obese patients really cannot lose weight without surgery. I believe that it will save money, but we will wait and "let the data speak".

New Doctor, New Diet, but Still No Cookies

Theories abound as to what has propelled the South Beach diet to the center of the weight-loss universe since the book bearing its name was published in April. Is it the image it conjures, of bikini-clad models picking at tropical fruit salad between sun-drenched photo shoots? Is it the aqua shimmer of the book jacket, as eye-catching as the surf off Ocean Drive?

Or is it that Dr. Arthur Agatston, the cardiologist behind the latest low-carbohydrate, high-protein diet, is on to something?

Dr. Agatston — whose office is not in South Beach, by the way, but the older, tamer neighborhood to its north — is not far from that giant of diet doctors, the late Dr. Robert Atkins, in his belief that refined sugar and white flour are the villains behind the nation's climbing obesity rate. Like the Atkins diet, the South Beach diet strictly limits bread, potatoes and other carbohydrates, especially during a two-week initiation period, and allows the dieter to eat red meat, eggs and cheese.

But while the Atkins diet allows just about any fatty food that is not also starchy, Dr. Agatston advocates mostly unsaturated fats, like those in olive oil, nuts and oily fish like salmon. Butter is nowhere in the South Beach diet meal plans, nor is bacon or anything fried. The South Beach diet also differs from Atkins in that it allows carbohydrates — though only those high in fiber, like multigrain bread and wild rice.

Dr. Agatston's premise is that most carbohydrate-rich foods are so processed that they immediately turn to sugar in the body. That, Dr. Agatston says, forces a quick spike in blood sugar and nearly as quick a decline. The spikes lead to more hunger, he says, and — this is the part that many experts dispute — to inevitable weight gain.

"Nobody in the history of man ever ate complex carbohydrates like we have," Dr. Agatston said last week during an interview squeezed between a photo shoot and a meeting about his new heart-imaging center, set to open in December. He was late to the interview, so his wife, Sari, a lawyer who is helping with publicity, filled the time by talking about how even she, a bread lover, has come to accept whole-wheat pita instead.

The diet revolves around the glycemic index — the amount that a carbohydrate increases sugar in the blood compared with the amount that the same quantity of white bread raises it. The concept of the index as crucial to weight gain or loss has been around since the early 1980's, when it was used to help people with diabetes choose proper diets. But skeptics — including the American Diabetes Association, which has not endorsed the index — say a food's glycemic index fluctuates depending on how much is eaten and what other foods are eaten.

Foods with a low glycemic index, like lentils, soy milk and low-fat, artificially sweetened yogurt, do not raise blood sugar as quickly and sharply as high-numbered items like gnocchi, baked potatoes and pretzels.

High-glycemic-index foods cause the body to release a lot of insulin, which quickly lowers the blood sugar again and causes hunger to recur, the theory goes. Those with low indexes break down into sugar more slowly, for longer-term energy.

This article describes a very interesting diet. It seems to have significant rationale. Of course we need good prospective studies to be sure. I would probably pick this over the Atkins' diet given the information I currently have.

Wow, this is interesting. Forget the stretch

IF the first five to 10 minutes of your workout consists of stretching exercises to reduce the risk of injury, perhaps you should save yourself some time. Not only does such stretching fail to reduce the risk of injury, but recent studies have shown it also might hinder performance.

People who stretch before exercise have about the same risk of injury as those who don't, says epidemiologist Ian Shrier. Several years ago, Shrier reviewed half a dozen studies on the effects of stretching before exercise and found that not one demonstrated that it prevented injury. He published his findings in the Clinical Journal of Sport Medicine.

"At first people thought I was crazy," recalls Shrier, a physician at Sir Mortimer B. Davis Jewish General Hospital in Montreal. But his conclusions gained credence six months later, in August 2000, when Australian researchers published a large-scale study in the American College of Sports Medicine journal that reached the same conclusion.

That study involved 1,528 military recruits who followed the same exercise, weight and conditioning program. Half the recruits stretched before exercise; half didn't.

"A typical pre-exercise stretching protocol does not produce a clinically useful reduction in injury risk," wrote the authors. "If injury prevention is the primary objective, and the range of motion necessary for the sport is not extreme, the evidence suggests that athletes should drop the stretching before exercise and increase the warm-up."

Wow! I love studies that test conventional wisdom - and find it lacking. Interestingly, my personal trainer ask me to arrive early and do 10-15 minutes of cardiovascular warm-up prior to resistance training. He seems to have it right.

Exercise Is a Habit; Here's Why to Pick It Up This article reviews some very good studies on exercise benefits for women. It does ignore us men. I can only say, exercise is very good for us also!

Strength vs. Power

Admit it. You thought the terms were synonymous. Wrong, say exercise scientists. "Strength" is a measure of how many pounds you can move in one push or pull. "Power" measures how fast you can move a weight in a given amount of time.

The different properties are functions of the two kinds of fiber in skeletal muscles: slow-twitch fibers, which are mostly responsible for strength, and fast-twitch fibers, which supply power, says Scott Trappe, director of the human performance laboratory at Ball State University in Muncie, Ind.

Novices can build strength in major muscle groups by lifting about 60 percent of the maximum they can heft one time, performing eight reps each once or twice weekly, then working up, after a month, to three or four sets weekly. That's from a meta-analysis of 140 strength training exercise studies published this year in the journal Medicine & Science in Sports & Exercise.

To gain power, recommends the American College of Sports Medicine, perform weight-lifting sets that load weight on more than one joint, such as holding dumbbells while lunging or lifting a free bar while rising from a squat.

A good weight training progam will work on both strength and power. As we age we want to maintain power. Power requires strength, therefore work on strength first.

How do we deal with the obesity epidemic (and yes it is an epidemic)? Girth control The author paints a fair picture of our obesity problem. He concludes his essay with these perceptive points.

Among other remedies, Mr. Brownell favors taxing unhealthy foods (a definition, he grants, that won't always be easy to assign), with the funds earmarked for projects such as advertising healthy foods and lifestyles.

Despite my own use of "junk," I don't like the idea of labeling specific foods "bad" because almost anything in moderation is fine. And the hint of any tax raise makes my free-market knee jerk. Yet while I once considered Mr. Brownell a radical, the fatter we grow the less radical he seems.

Still, there will never be a substitute for personal responsibility regarding obesity or anything else. For a child, there will never be a substitute for a caring, attentive parent who is willing to endure occasional whining and weeping, a tantrum ? or even the ultimate guilt-trip trick, "But all the other kids' parents let them do it." Yes, and their children may die because of it.

As my mother has always said, if all the other kids are jumping off the building should you jump? We actually can control our behavior. And we should.

I love the feeling of a good workout. A knowledge and feeling that I have exerted makes me feel energized. This physician shares that feeling. Pain Gains

The Fat Environment written by Ellen Goodman is worth reading. Just click and read. It is very simple.

An effort to get America walking seeks to stop obesity in its tracks

Results from the Colorado walking effort are being submitted to scientific journals.

Over 16 weeks, 85 percent of all participants raised their activity level by a total of 2,000-2,500 steps a day, the researchers say. But it will take a year to see if they stabilize, or even lose pounds, and it will take several years to see if the weight loss is sustained.

Like the Colorado experiment, only a fraction of America on the Move participants nationwide will be enrolled in a supervised study. Others can follow the same recommendations independently by registering on the program's Web site.

James Hill, the program's co-founder, says it's the first effort at systematically studying "how you stop obesity from getting worse."

"Our idea is dirt simple," says Hill, director of the Center for Human Nutrition at the University of Colorado Health Sciences Center. "If it doesn't work, we're in big trouble as a nation."

Statistics suggest we already are.

Obesity-related ailments cost $117 billion to treat, and contribute to 300,000 deaths annually, according to federal estimates.

Two out of three adult Americans are overweight, the government says, and they're gaining nearly 2 pounds every year. A quarter of them get virtually no exercise.

This article talks mostly about walking. They believe (as do I) that the key to weight control is movement, not diet. Diet will follow nicely. Quit suing fast food outlets; quit taxing fat content; reward walking, or any other movement.

Tax Policy That Uses Economies of Scales

First of all, obesity often persists as a result of individual choice. It may result from a disease or an inherited condition. But most individuals have the power to affect their own weight through diet, exercise and other habits.

Second, obesity is easily observable. A few measurements are all it takes to place a person somewhere along the continuum from dangerously skinny to Brobdingnagian.

Third, an individual's obesity can affect many people. As a result, it becomes a societal issue as well as a medical problem.

Precisely identifying these effects can be difficult. At least one seems much more important than squeezed seats on airplanes, however. Obesity increases the risk of many medical problems. When someone has a heart attack, chances are either taxpayers or members of a private insurance plan will foot most of the bill. And, thanks to modern medicine, the obese elderly survive almost as long as their thinner counterparts.

Last month, a state assemblyman from Brooklyn suggested a tax on fatty foods to discourage their consumption. An economist might take exception to this plan, because the tax would punish even people who ate such foods in moderation. Of course, that has not stopped similar justifications for taxes on alcohol and cigarettes. Even if you have just one drink or cigarette a year, you still pay heavy "sin" taxes.

Two weeks ago, Kraft Foods decided to lower the fat content of some recipes and reduce the sizes of single-serving snacks. Again, this approach is slightly clumsy. Even if you're eating rice cakes, you'll gain weight if you eat enough of them. And though some Americans may be happy with a smaller packet of cookies, others may just buy two and finish them both. (Kraft said nothing about cutting the snacks' prices in line with the portions.)

Another kind of remedy might have more success. The problem is obesity, not fatty food or anything else that contributes to being overweight. So why not take aim at obesity directly?

Basic economics recommends taxing individual behaviors that hurt society. But taxing overweight people, perhaps by identifying them and then assessing them some social cost of obesity every year, sounds draconian and impractical.

A more palatable solution might be to collect a lump-sum tax from every American and put the proceeds into a reward pool. Each year, anyone who wanted to could go to an existing government office for a simple series of measurements. People who registered normal weights throughout the year would receive cash rewards from the pool ? much like a tax refund.

This system would still tax obesity, though it would not tax the heaviest people more than the merely rotund. Nor would it tax the middle-aged and disease-prone more than the roly-poly young. Nevertheless, the incentive to lose a few pounds might be quite powerful.

He almost has the right idea. I would rather see body fat used as a factor in insurance rates. Rather than a tax, I would like to see health insurance scaled for behaviors - including obesity. Nonetheless, this type of thinking is worthwhile. It encourages us to more explicitly define the problem.

"Big Food" is changing what they sell. 'Big Food' Gets the Obesity Message

Trying to stay one step ahead of the regulators, Kraft, McDonald's and Frito-Lay have all said they will work to reduce or eliminate artery-clogging trans fats from their foods. The Food and Drug Adminstration has not yet determined how much trans fat is acceptable, but yesterday the agency said it would require food makers to start listing the amount in their products on the labels. That is the least that can be done to help consumers avoid some particularly unhealthy fats that are ubiquitous in snack foods, baked goods and many offerings at fast-food outlets and family-style restaurants.

Skeptics worry, with good reason, about the depth and sincerity of the food industry's late-inning conversion to healthy eating. An industry that has prospered by selling high-fat, high-calorie or sugary foods in ever larger quantities will probably be loath to deviate too much from a proven path to profits. But any smart chief executive will feel the increasing pressure from public health officials to combat obesity and will heed recent warnings from Wall Street that big food companies with a high percentage of unhealthy products face major legal and financial risks. If the companies are really serious about refashioning and downsizing their products, they can give a major boost to the global fight against obesity.

I remain skeptical. I do not think that food composition is the problem as much as lack of exercise. When one examines the data carefully, our biggest problem is activity (or the lack thereof). But maybe this will help.

Loyal readers know my healthy obsession with fitness. Now the American Heart Association is encouraging all physicians to adopt a healthy lifestyle. They just may be on to something important. Physicians Urged to Promote Exercise to Patients, and to Set an Example

As well as recommending regular physical exercise to their patients to prevent and treat cardiovascular disease, physicians should "personally engage in an active lifestyle," according to a new report from the American Heart Association.

Writing in the June 23 rapid access issue of Circulation, a group of experts led by Dr. Paul D. Thompson of the Hartford Hospital in Connecticut note that people who get a lot of regular exercise appear to have half the risk of atherosclerosis as sedentary people.

In addition, regular exercise appears to lower the chances of a host of other chronic conditions, such as diabetes, depression and certain types of cancer.

Consequently, Dr. Thompson and his team suggest that doctors follow recommendations issued by the U.S. Centers for Disease Control and Prevention, which support at least 30 minutes of moderate exercise, such as a brisk walk, on most or all days of the week.

As the title says - Do as I do!!!!!

Obesity costs moeny. That is the conclusion of these business leaders. Employers Plan Obesity Fight, Citing $12 Billion-a-Year Cost.

A group of large employers headed by Ford Motor, Honeywell, General Mills and PepsiCo announced a campaign yesterday to encourage overweight workers to slim down as a way to improve both their personal health and the corporate bottom line.

Dr. Vince Kerr, director of health care management at Ford, said weight-related costs were adding $12 billion a year to costs of employers nationwide, including medical bills, reduced productivity, increased absenteeism and higher health and disability insurance premiums.

"Obesity is becoming as large a factor as tobacco once was," Dr. Kerr said. Weight-related ailments are taking "amazingly large portions" of the $3 billion that Ford spent on health care benefits last year, he said.

Michigan, Ford's industrial base, is among the worst states for obesity and tobacco use, Dr. Kerr said.

He said the company's employees mirrored the general population in the growing incidence of diabetes and other diseases that often overlap with weight problems.

Ford is a founding board member of the Institute on the Costs and Health Effects of Obesity, organized by the Washington Business Group on Health, a group of 175 large employers that provide benefits for 40 million people.

The institute plans to draw on research financed by the federal Centers for Disease Control and Prevention and the Institute of Medicine of the National Academy of Sciences. The centers and the Institute of Medicine have also joined the new obesity institute board.

When business decides that obesity eats into profits (pun intended), then they act. We need to restructure our work places. We need exercise time and space. We need to walk more and ride less.

Our 'lunch rooms' and restaurants need to quick 'supersizing'. We can do much as a society and as businesses to improve this problem.

I applaud this interest from business and look forward to some positive results.

A reader questioned our inactive lifestyle as a cause of obesity. This article certainly supports that concept - Battling the bulge in the burbs

?We shape our buildings, and afterwards our buildings shape us,? Winston Churchill once said. Today, there?s new meaning to Churchill?s often cited quote: A growing number of public health researchers blame our sprawling suburban landscapes in part for Americans? bulging bellies.

NO DOUBT you?ve seen the statistics on obesity in America. Perhaps you?ve seen them on yourself.

Arlin Wasserman, an anti-sprawl advocate formerly with the Michigan Land Use Institute, says that when he moved from his native Philadelphia, where he biked everywhere, to suburban Traverse City, Mich., he put on 35 pounds.

?The move to Ann Arbor, where I logged 15,000 miles a year driving, gained me 15 pounds, even though I was still biking to work,? says Wasserman. ?But the move to Traverse City gained me another 20.?

Americans are becoming less physically active, not so much out of laziness but because of changes in the ?urban form? that are dictating more sedentary behavior, according to a new line of thinking in public health.

Advocates of anti-sprawl ?smart growth,? like Wasserman, say the theory adds ammunition to the arguments against suburban development, which has been blamed for loss of farmland and open space, as well as increasing traffic congestion.

?It?s not just a matter of our having ?super-sized? our meals or that we don?t exercise enough,? says Thomas Schmid, a public health researcher at the Centers for Disease Control. We?ve also drastically reduced the amount of regular walking, biking or getting around under our own steam as part of our daily activities, says Schmid.

I have tried to add walking to my daily routine. This is often difficult. This concept does make some sense. Can you modify your routine to include more movement?

I am a bit late getting to this important article - 'No Matter What the Data Say' . Sydney Smith (Medpundit's pseudonym) minimizes the effect of diet and blames our increasing obesity on lack of exercise.

A recent study of teenagers' habits over the past twenty years supports this observation. Nutritionist Lisa Sutherland of the University of North Carolina at Chapel Hill looked at data from the CDC's National Health and Nutrition Examination Survey and Youth Risk Behavior Surveillance System, and the Department of Agriculture's Nationwide Food Consumption Survey, all of which have been following our national weight trends, activity trends, and food consumption trends for several years. She found that over the past twenty years, teenagers have, on average, increased their caloric intake by one percent. During that same time period, the percentage of teenagers who said they engaged in some sort of physical activity for thirty minutes a day dropped from 42 percent to 29 percent. Not surprisingly, teenage obesity over the twenty year period increased by 10 percent. The logical conclusion is that it isn't junk food that's making teenagers fat - it's their lack of activity.

This isn't the first study that has suggested the importance of exercise in the obesity equation. Consider the Pima Indians. The Pima Indians of Arizona have one of the highest rates of obesity in the world, while the Pima Indians of Mexico have very low rates - even though they eat on average the same number of calories a day. The difference? The Mexican Pimas spend twice as much time engaging in physical activity as American Pimas. Or consider the study of British twins which showed less body fat in twins who exercised compared to their less active siblings. And then there are the weight loss success stories. Study after study shows that those who lose weight and keep it off are those who exercise regularly.

Medpundit makes a reasonable argument here. I have often argued that weight control requires attention to increasing caloric expenditure (more exercise) and decreasing caloric intake (careful diet). I am skeptical of dietary data. We generally rely on surveys for these data - and I am skeptical of surveys in general.

While I believe that too many teenagers and adults take in excessive calories, Medpundit makes an important point. If we get off our butts and move we can handle more calories.

Two of my favorite medical writers have addressed the Atkin's diet articles published last week. Pounds Lost on Atkins Diet May Quickly Return from the NY Times.

The studies, reported in The New England Journal of Medicine, compared the effects on weight loss and cardiovascular risk factors of the Atkins plan with the conventional low-fat, low-calorie diet recommended by most health experts. Both diets resulted in weight loss, but participants on the Atkins diet lost more weight, faster.

But it is too soon to jump on the Atkins bandwagon in hopes of achieving bathing-suit slimness by the Fourth of July. Yes, the diet does help obese people lose weight quickly, and those wanting to shed 10 pounds in the next four weeks could achieve that goal. But the research suggested that by Labor Day many, if not most, are likely to be back to their starting weight.

The first five to seven pounds lost on Atkins are not fat but water, released by the body when it gets little or no starch or sugar from food. So as soon as you are unable to resist that bun with your burger or summer's succulent sweet corn, a cooling ice cream cone, thirst-quenching watermelon or a bag of fries, those lost pounds are likely to come bounding back.

And Miracle Cure? Fat Chance from the Washington Post.

Losing weight takes commitment. About 40 percent of participants in both groups quit the studies before they ended, a fact that some scientists said could bias the results. What the findings meant to Gary Foster, clinical director of the University of Pennsylvania's Weight and Eating Disorders Program and lead author of one of the studies, is this: "No matter what diet you're on, doing it alone is tough work."

Calories count. The Atkins philosophy is that total calories consumed don't matter, provided carbohydrates are severely restricted. But in one of the studies published last week, participants in the Atkins group ate fewer calories than those in the low-fat group, although the differences were not statistically significant. "The law of thermodynamics still holds here," says Frederick Samaha, chief of cardiology at the Philadelphia Veterans Administration Hospital and lead author of the study. "Weight loss is still entirely an effect of total calories in and total calories out."

And read RangelMD for a further discussion of this tautology - The Atkins diet: A case in calorie restriction.

Pass the Butter, Please

Though the Atkins diet has been reviled by the medical establishment for decades as a bit wacky and even potentially dangerous, the two new studies and a third published last month suggest that the diet actually works better than standard low-fat diets in the short term, without any detectable signs of harm. It was a startling reminder of how little the experts know, in this obesity-plagued nation, about the best way to lose weight and keep it off.

I would argue with the last point. We do know how to lose weight and keep if off. The successful keys are portion control and exercise. What we do not know is how to succesfully get patients to follow the formula! Weight loss is achievable, but requires lifestyle changes. And lifestyle changes are not easy to induce.

So the NEJM published two articles today on low carbohydrate diets. If you read the popular press you will see various spins on the results. The AP reports - Atkins Diet Bolstered by Two New Studies

The research, in Thursday's New England Journal of Medicine, found that people on the high-protein, high-fat, low-carbohydrate Atkins diet lose twice as much weight over six months as those on the standard low-fat diet recommended by most major health organizations.

However, one of the studies found that the Atkins dieters regain much of the weight by the end of one year.

The Washington Post reports Atkins Similar to Low-Fat Diets Study: Long-Term Results Differ Little

"The findings say that no matter what diet you're on, doing it alone is tough work," said the study's lead author, Gary Foster, clinical director of the University of Pennsylvania's Weight and Eating Disorders Program.

Because the Atkins diet encourages consumption of foods high in saturated fat, including butter, cream and steak, there has been great concern that it may increase the risk of heart disease. But three months into the study, there were no differences in the two groups in either total cholesterol or low density lipoprotein (LDL), the "bad cholesterol."

"The weight loss may override the effect of the high-fat, high-cholesterol" Atkins approach, said the University of Cincinnati's Bonnie J. Brehm, who has been studying the Atkins diet in women. "These findings are similar to ours."

And this report from Medscape - Benefits of Low-Carbohydrate Diet Still Uncertain

The controversy over the benefits of low-carbohydrate diet continues, according to two reports and an editorial in the May 22 issue of the New England Journal of Medicine. A randomized trial showed no difference in weight loss at 12 months for a low-carbohydrate diet compared with a conventional weight-loss diet. Another study in severely obese patients did show a benefit, but the duration of the trial was six months. The editorialist helps to clarify the message.

"Despite the popularity of the low-carbohydrate, high-protein, high-fat (Atkins) diet, no randomized, controlled trials have evaluated its efficacy," write Gary D. Foster, PhD, from the University of Pennsylvania School of Medicine in Philadelphia, and colleagues.

...

"Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fat-restricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost. This finding should be interpreted with caution, given the small magnitude of overall and between-group differences in weight loss in these markedly obese subjects and the short duration of the study," the authors write. "Future studies evaluating long-term cardiovascular outcomes are needed before a carbohydrate-restricted diet can be endorsed."

So what does DB think? First, these studies do vindicate the concept that weight loss trumps fat intake. The most important factor in maintaining or decreasing lipid levels comes from weight. Second, one can lose weight on a low carbohydrate diet. But finally, weight loss remains difficult. Diets can start the ball rolling, but true sustained weight loss depends on lifestyle changes. No gimmicks need apply. We must all figure out how to control portion sizes indefinitely and increase our calorie expenditure (through both resistance and cardiovascular exercises).

I think we know this. Somehow exercising improves our mood - Scientists have a good feeling about exercise

Physical activity is known to exert a powerful "feel-good" effect, brightening mood and enhancing mental health ? in fact, regular exercise may be as effective as medication for some people with depression.

A growing body of evidence supports this boost to psychological well-being, but the exact mechanisms are not completely understood.

"We know exercise makes people feel better, but we're not exactly sure how," says Patricia Dubbert, associate chief of mental health at the VA Medical Center in Jackson, Miss. Dubbert is one of a growing number of mental health professionals who are prescribing exercise as a way to relieve stress and lift spirits.

This makes sense to me. I work out 2 mornings a week, and get to work in a great mood!

Regular readers of Medrants know that I strongly promote (and practice fitness). I believe that attention to fitness has many positive outcomes - including better health outcomes. Given that background, I love this idea - Tax plan to subsidize worker fitness: Health club membership would be in company health plan

Membership in a health club or an aerobic dance class could be a common part of company health plans if a tax proposal in the House becomes law.

The bill would encourage businesses to subsidize workers' workouts by letting the companies claim the contributions as income tax deductions.

The Workforce Health Improvement Program, WHIP, was drafted by a health club industry association, which sees the plan as a way to foster fitness - and, not incidentally, to get more members in the doors.

'What we are really trying to do is to extend the health benefits of exercise to as many Americans as we can,' said John McCarthy, executive director of the International Health, Racquet and Sportsclub Association.

The tax code currently lets companies deduct the costs of exercise facilities only if the facilities are at the work site, so generally only bigger businesses, with 500 workers or more, have them, McCarthy said. The proposed change would open the deduction to smaller businesses, he said.

PLAN WOULD ALLOW EMPLOYEE CHOICE

The plan would let employees choose how and where they want to work out, McCarthy said. "This bill supports all fitness suppliers - YMCAs, Jewish community centers, Jazzercise," he said.

However, WHIP specifically excludes private clubs owned and operated by their members, and facilities that "offer golf, hunting, sailing or riding."

While many could argue with the precise incentives here, the concept is a strong one. Giving tax incentives would work to encourage more use of fitness activities - clearly a desirable goal.

The Carbo War, Cont'd This article summarizes the controversy over low carb diets. It includes a common sense approach to dieting. I recommend this article strongly.

This rant does not qualify as news. The ideas are a rehash of many previous rants. Still I have not used this rant recently and I found an interesting new article related to it. A human time bomb

Worrall Thompson is the face of a new campaign to ?measure your mate?, which aims to raise awareness about the condition, known as insulin resistance syndrome (IRS). If your mate ? or any male who lets you wrap a tape measure around them ? measures more than 40in, they are at risk of IRS. The red-light figure for women is 35in.

IRS, which is also known as metabolic syndrome, glucose intolerance and Syndrome X, has been dubbed a ?medical time bomb? because it could lead to an explosion of disease in years to come. And not only among those facing midlife spread. Derriford Hospital in Plymouth last month reported that 30 per cent of 300 children between the ages of 5 and 16 were showing signs of it. Diabetes now affects about 4 per cent of the population.

The key to all this is the way that your body handles glucose. Until recently this was considered a specialised medical problem reserved for diabetics. But this comforting division is an illusion; our sedentary lifestyle, coupled with a taste for sugar and refined carbohydrates, is playing havoc with the subtle balance between glucose and insulin in our bloodstreams.

Refined carbohydrates are dangerous in the long term because they are too easily digested. The body turns all carbohydrates into glucose, which is then released into the blood. But while wholefoods, such as pulses, fruit and most vegetables, are broken down over several hours, providing a steady trickle of glucose, a sugar-laden fizzy drink, for instance, produces a glucose spike ? a sudden rise, followed by an equally dramatic fall. An occasional sugar spike is no big deal; but day after day, over many years, it can be deadly. As glucose levels rise, your body releases insulin to mop it up. After years of glucose peaks, the extra amounts of insulin have a diminishing effect. IRS then develops ? a pre-diabetic state with high levels of both insulin and glucose circulating in your blood. The result, among other things, is that hard-to-shift spare tyre around the middle and damage to blood vessels and the heart. In America the syndrome has been recognised as a medical condition, officially defined as having three or more of five conditions: abdominal obesity, high triglycerides (damaging fats) in the bloodstream, low levels of the good LDL cholesterol, high blood pressure and high glucose.

I rant about the metabolic syndrome frequently. We need to focus more energy on preventing the consequences of this syndrome. One can argue fairly persuasively that we should add waist circumference to our vital information on patients.

As I have discussed previously, waist circumference provides more information than body mass index (BMI). Athletes often have increased BMI, but excellent waist circumference. Waist circumference does a better job of predicting body fat percentage - which is the real risk factor.

Now we need to understand how we get patients (and sometimes ourselves) to prevent or treat this syndrome. The solutions will involve diet and exercise. Many believe that better understanding the glycemic index will provide great benefit.

SARS, malpractice concerns and too much traveling have decreased my diet and fitness posts. Today I will provide a very nice link on modifying our diets. Pecking at the Pyramid

Not a pyramid, but an hourglass.

That's the shape of the American diet, according to a recent report from the U.S. Department of Agriculture (USDA). Written by Judy Putnam, Jane Allshouse and Linda Scott Kantor of the USDA's Economic Research Service, the report finds that consumers eat mostly from the tip and the foundation of the pyramid, gobbling lots of food high in fat and added sugars (the tip) along with refined grain products, such as pasta, crackers and white bread.

At the same time, they skimp on vegetables, fruit, low-fat dairy products, beans, lean meat, poultry and fish.

Read the entire article. Please.

I have used personal trainers for 18 months. While they do cost significant money, I doubt that I would have achieved my current conditioning without a trainer. This article describes the benefits well - Friendly persuasion that works. The article discusses many pros but adds this "con" -

So, was it worth it? Absolutely. But it is also true that two months, no matter how intense, is not enough to get into great condition. It's a start, I hope, to a more regular workout.

If there is any room for complaint, it would be that for three days a week, there was no room for flexibility in my early schedule. I also should probably have taken much more care about diet so that I could shed more pounds.

I disagree about the flexibility comment. Having a fixed time to workout is a major advantage. Since prioritizing working out, I never miss these workouts unless I am traveling. Working out is too important to allow flexibility. Flexibility makes not working out too likely. Most of us need the discipline of scheduling.

10 pounds lighter, and safely past Super Bowl

The results haven't been bad: 10 pounds lost. Down to 214.

I would have liked to lose a bit more--12, 15 pounds--and probably could have had I suffered more. But I'm deliberating trying to long haul this process. I've been on those diets where you wake up hungry in the middle of the night, gazing greedily at the clock, waiting until the second hand sweeps the 12, ushering in feed time. It's hard to keep that up.

I did skip all starches for the first week--no bread, no potatoes, no nothing. I stuck to what could be called a modified Atkins--lots of steak, breakfast, lunch and dinner. It was fun eating so much steak. I was never hungry and I lost seven pounds. But I felt weird--almost a buzzing in my ears. After the weight-loss needle stuck for three or four days in a row, I figured, rather like a struggling radio station changing format, it was time to shift from All Meat All the Time to a more pleasing mix of other foods.

That's how it's been for the last 20 days. Lots of salads. Small meals--a glass of grapefruit juice for breakfast, a power bar for lunch. Even those vile Slim-Fast drinks. Going is slow, and the hard part is not to let disappointment sap my resolve. What trips people up about dieting, I believe, is how long it takes. They gain weight over months and years, and then want to strip it off quickly because dieting is such a chore. I've struck on two helpful metaphors I want to pass along.

The first came early in the month. I had lost a good amount of weight in a short time, then realized, sadly, that I still had a long way to go. "It's like walking to New York,'' I thought. "You head off at a good clip, make 25 miles a day, and a week later you're still in Indiana.''

We should all understand life as a marathon, rather than a sprint. Lifestyle changes only occur one day at a time. As I have attacked my New Year's Goals, I understand that I will need time to succeed. We succeed when we can delay gratification of our final results and revel in our small successes.

Companies fight employee fat: Obese workers have insurance costs up to $1,500 higher. Duh! Overweight patients and especially obese patients have greater health care costs. And they needed a study.

Medical costs rose as weight did, said the report in the January-February issue of the American Journal of Health Promotion. The average cost for those of average weight was $2,225. The lowest category of overweight was slightly more, at $2,388, but costs rose more sharply after that, reaching $3,753 for the fattest people.

The finding is in line with a report by the U.S. Surgeon General, which estimated the economic cost of obesity in 2000 at $117 billion. And it comes as the Centers for Disease Control and Prevention documents a rising level of weight gain. The worst fatness - extreme or morbid obesity - nearly tripled among adults between 1988 and 2000.

So I have ranted often, why should I subsidize the overweight and obese? Why should I not receive a break on my insurance costs for living a healthy lifestyle?

Some companies are starting to consider programs to encourage exercise and weight loss. Given the impact on health insurance costs, I would bet that developing such programs should save money! Why not have more company gyms - and even schedule exercise as part of the work day? While this might sound radical, someone should try this. I would bet that one could save on health care costs, without impairing productivity. </