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American Medical News drew my attention to a recent study published in the International Journal of Eating Disorders. Among the surprising findings, 62% of women surveyed (all over the age of 50) said that their weight or shape negatively impacted their life, and 13.3% had eating disorders. About 7.5% of respondents admitted to trying diet pills to lose weight, while 2.2% used laxatives, and 1.2% vomited to reduce their weight (aka bulimia).
Eating disorder treatment facilities have noticed a surge in older patients, including one center that experienced a 42% increase in the number of women older than 35 seeking treatment at its clinics nationwide over the past decade.
Healthcare providers should be aware that eating disorders are not just a problem for young women. Women of all ages are now struggling with a rail-thin beauty ideal in a country of rising obesity rates, sedentary lifestyles, and ubiquitous junk food. And for older women with eating disorders, the health risks of osteoporosis, stomach ulcers, and cardiovascular abnormalities are much higher.
Perhaps primary care physicians should include an eating disorder questionnaire in their regular visits with boomers? We may be surprised by the prevalence of this issue, and I bet that many of our patients will be glad we asked.
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Many people assume that look-alike over-the-counter (OTC) medicines contain the same active ingredients as the more expensive brand name products. But that’s not always the case. Take lip medicines for example – many of their labels suggest that they treat cold sores (caused by the herpes simplex virus), but only one active ingredient has been proven to work. Docosanol is the active ingredient in Abreva, and has been approved by the FDA to shorten the duration as well as prevent the outbreak of cold sores (an estimated 20-40% of Americans are afflicted by cold sores).
In a recent survey (sponsored by Abreva), 66% of respondents said they believed that “look-alike” medications contained the same active ingredients as the brands that they were copying, and 93% said they purchased look-alikes solely because they were less expensive.
Unfortunately, you get what you pay for in this case. Even though the FDA may send out warning letters to manufacturers of look-alike products who print false healing claims on their packaging, those products often remain on store shelves. The manufacturer of Abreva (Glaxo Smith Kline) notes in a press release:
Several “look-alike” cold sore treatments tout healing claims, but contain the ingredient Benzalkonium Chloride instead of docosonal. The FDA recently issued a warning letter to a marketer and distributor of a product containing benzalkonium chloride that is making the claim on its product’s label that it heals cold sores. The FDA found that the active ingredient, benzalkonium chloride, is not indicated as a cold sore treatment and may not make cold sore healing claims because there is no scientific evidence to support claims that it heals cold sores.
Evidence suggests that Abreva shortens the duration of cold sores by about 18 hours, and may slightly reduce the risk of outbreak if the medicine is used at the first sign of pain or tingling. Whether that’s worth the price of the treatment is up to the consumer, but choosing a cheaper product with a different active ingredient is likely to be a waste of money.
The Abreva case serves as a reminder to check the active ingredients in your OTC medicines before purchasing what seems to be a cheaper, equivalent medicine. While generics are often a smart way to save money on effective medicines, look-alike medicines can sometimes be hiding fake cures in a convincing little package. Let the buyer beware!
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The American Medical Association (AMA) voted today to endorse taxation of sugary beverages as a means to raise money for anti-obesity programs. Interestingly, a recent physician survey at Medpage Today suggests that only 50% of physicians think that a soda tax is an effective public health strategy.
I am one of the 50% who feels that this policy will not be effective. In short, this is why:
1. You can become obese by eating and drinking almost anything in excess. Targeting sugary beverages is reductio ad absurdum. Did America become fat simply because of an excess supply of sugary fluids on grocery shelves? What about the super-sizing of our food portions, the change in workforce physical requirements, the advent of cars, escalators, healthy food “deserts” in poor neighborhoods, video games, and cutting gym class from schools?
Holding Coca Cola, et al. responsible for our own over-consumption of calories is both unfair and tantamount to spitting into the wind – something bad is going to come back at us. Consumers can easily get around the soda tax by buying sweet alternatives – which may have even more calories than soda. (Caramel latte anyone?) And then what? Are we really going to play public policy, food and beverage whack-a-mole?
Carmelita Jeter's Shopping Cart
2. You can be thin and fit while eating and drinking almost anything. Obviously nutrition science has shown that a diet rich in fresh fruits and veggies, lean meats, low-fat dairy, whole grains, and healthy fats is the best for our health. However, please consider that the world’s fastest woman, Olympian Carmelita Jeter, eats Hostess cup cakes, Teddy Grahams, Welch’s grape juice, whole milk, and Gatorade. How do I know? Because she posted a photo of her shopping cart on Twitter (see image to the left). I obviously have no idea how much of this she eats – or when she eats it – but if the world’s fastest woman is powered (to some degree) by “Twinkies” then I think we should all think twice about demonizing certain foods/beverages in our anti-obesity fervor.
3. You can’t regulate good behavior. Human behaviors that may lead to obesity are simply too complex to regulate. Who would want to live in a world where government becomes the de facto “Nutrisystem” for its citizens, mailing out pre-packaged, ingredient-controlled meals to 312 million people per day, three times a day, seven days a week? While that may save the post office from its imminent demise, we can neither afford to do that, nor do we need to.
People who believe that policy should drive behavior point to smoking bans that have cut down on smoking rates. While I agree that small improvements have been made in reducing smoking rates, roughly one in four people still smoke (depending on your source, this number could be as low as one-in-five), and one in every five deaths is still attributed to cigarette smoking. Hardly a resounding victory, alas.
But beyond the fact that policy changes (and the billions we’ve spent enacting and enforcing them) have resulted in a disappointing decrease in smoking rates, is the issue that cigarettes and food ingredients (such as sugar) are not analogous substances. While there is no safe minimum amount of cigarette smoke, our bodies need salt, glucose, and fat to survive. They cannot be cut out of our diet completely – nor should they. And the only way to force people to optimize their intake is to enact Draconian measures.
So instead of starting a food-fight, it’s important to accept the complexities associated with this particular health scourge and promote a broader, more-nuanced approach to wellness incentives. We have to attack this problem from the ground up, because a top-down approach requires our government to become an invasive, food and exercise nanny.
The good news is that one-third of Americans are not overweight or obese, despite our current “toxic” food/inactive lifestyle environment. Perhaps these thinner folks can be ambassadors for the rest of us, and reveal their secrets of healthy living despite our current limitations. Even with our best efforts, we need to understand that (like smokers) we will always have a segment of the population that is overweight or obese.
And as for the Olympians among us – they help to illustrate that obsessing over every morsel of food or cup of soda that we consume is not the way forward. Sorry AMA, I’m with Carmelita on this one.
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This news flash from the land of no surprises… The Journal of The American Medical Informatics Association recently published a study analyzing physician use of online technology. They hypothesized that certain types of physician specialists (such as dermatologists?) would display higher adoption rates of Internet-based communication technology (including things like social media platforms, podcasts, health apps, and widgets). But instead they discovered that adoption of these technologies was correlated with male gender, younger age, and practicing medicine in an academic hospital setting. In other words, young geeky dudes are the ones who are most likely to use techie medical widgets. Who’d have guessed?
All kidding aside (and in case you hadn’t noticed, I’m a middle-aged, female physician who does not practice medicine in an academic setting. I have a blog, a podcast show, and was recently rated one of the top 10 MDs to follow on Twitter – so I must be a serious, category-blowing geek), this does have implications for healthcare. First of all, according to the US Department of Labor, ~80% of family healthcare decisions are made by women, and we consume a disproportionate amount of healthcare resources too. So in my opinion, healthcare technologies should be built by/for women and marketed to them more aggressively. Because if we’re trying to drive adoption of these things to streamline care, facilitate access, and reduce utilization, then we’ve gotta get the ladies on board too.
This study only confirms to me that we’re not there yet – guys are still more likely to use health apps/widgets, etc. But just as “progress” has been made in the video gaming industry (where only 12% of gamers were girls in 2001, that has grown to 40% in 2009) I think we can make similar gains in healthcare. And it’s for a much better cause than “getting really good at playing Grand Theft Auto.” Health apps have the potential to help people manage their diseases and conditions, avoid unnecessary trips to the doctor, and get them to the right healthcare provider at the right time.
So all you geeky (I say that with the utmost respect as a geek myself of course), male software developers out there – please befriend a few female physicians and work with us to get the tech trends moving in the right female direction. We’re all together in this game of life, right?
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Kellogg’s Special K cereal brand has long been known for its iconic slim woman in a red bathing suit. In a bold, Dove-soap-like new ad campaign, they have decided to feature “real women” – which apparently means women with larger BMIs – in red bathing suits. A Special K spokeswoman explains,
“We want to encourage a responsible attitude when it comes to body image and to show that losing weight isn’t just about the way you look or a certain size you need to conform to, but more importantly about the way it makes you feel.
The fact that we are using real women for the first time of a variety of shapes and sizes is the perfect way to encourage women to think differently about losing weight and not just focus on the numbers on the bathroom scales.”
While I certainly appreciate the intent, I think there may be an even better way of achieving the objective of avoiding an over-emphasis on the bathroom scale. Instead of normalizing and accepting overweight bodies, why not show what women of the same percent body fat look like? That might be a healthier way to help us wrap our minds around the fact that (for example) 21% body fat on one woman might look very different than 21% body fat on another… Of course body fat alone is not a perfect measure of health – cardiovascular fitness doesn’t always correlate with it. But it’s a potential new way of normalizing healthy bodies rather than accepting a new overweight standard.
In fact, with the upcoming summer Olympic games, it might be fun to show the many faces of fitness. Women athletes at the peak of their performance look very different from one another. How about putting them all in red bathing suits?
Anyway, I thank Special K for opening the discussion – and I encourage us all to strive for optimal health. But as a physician, I believe that we shouldn’t accept overweight bodies as a new health standard. Good health does come in many shapes and sizes, but not in high levels of body fat.