Kim’s public health blog

The Wall Street Journal (11/10, Dalton) reports that some countries’ governments have stopped focusing on individual discipline to combat obesity, and instead are working to make entire communities more healthy by reducing the opportunities to live unhealthily. Laura Kettel Khan, an obesity expert at the CDC, says that “people are finally acknowledging that the obesity problem is so pervasive that it isn’t just because people are making bad choices.” The Journal describes obesity programs across Europe and in the US, noting that these initiatives are taking off because obesity has become too expensive a problem to handle on an individual basis.

In a report issued by the  Institute of Medicine “It’s clear that smoking bans work,” said Lynn Goldman, professor of environmental health sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, and chair of the committee of experts that wrote the report.  “Bans reduce the risks of heart attack in nonsmokers as well as smokers.  Further research could explain in greater detail how great the effect is for each of these groups and how secondhand smoke produces its toxic effects.  However, there is no question that smoking bans have a positive health effect.” The full report is available on line and clearly supports the new legislative ban in smoking in restaurants in Virginia. .

Researchers at Fred Hutchinson Cancer Research Center have demonstrated that it is possible to successfully recruit and retain a large number of adolescent smokers from the general population into a smoking intervention study and, through personalized, proactive telephone counseling, significantly impact rates of six-month continuous quitting. The trial, funded by the National Institutes of Health, involved 2,151 teenage smokers from 50 high schools in Washington. Half of the schools were randomly assigned to the experimental intervention; teens in these schools were invited to take part in confidential, personalized telephone counseling designed to help motivate them to quit.  COMMENT. Despite the praise for the study, the difference in quit rates for test and control groups was only 4%.  This was despite a highly intensive effort.  No Cost[benefit analysis was done but it is highly unlikely for the process to work in the general population because of cost.

A study performed at  The University of Rochester Medical School   showed that when adolescents graduate to young adulthood, their preventive care tends to fall by the wayside. A recent study has found that young adults are much less likely to use ambulatory or preventive care, even though their mortality rate is more than twice that of adolescents. COMMENT: I have difficulty understanding why this should surprise anyone when the  various insurance programs, including Medicaid fail to pay for counseling by primary care practitioners. Further once the individual reaches 18 years of age eligibility for Medicaid vanishes.

In this week’s NEJM a team of prominent doctors, scientists and policy makers says ”it could be a powerful weapon in efforts to reduce obesity, in the same way that cigarette taxes have helped curb smoking.” Authors of the report include “the New York City health commissioner, Thomas Farley, and Joseph W. Thompson, Arkansas surgeon general.”  Comment: There is too much of a rush by public health behaviorists to rush into punitive measures to change population behavior.  There seems to be no sense that this leads toward Huxley’s Brave New World.

From the  Institute of Medicine: Local governments play a crucial role in the fight against childhood obesity by creating environments that make it either easy or hard for children to eat healthier diets and move more. A new report from the Institute of Medicine and National Research Council provides local officials with action steps that hold the greatest potential to reduce obesity rates among children, such as zoning restrictions on fast-food restaurants near schools, community policing to improve safety around public recreational sites, and publicly run after-school programs that limit video game and TV time.

The New York Times (9/2, Rabin) reported in Vital Signs, “Women can cut their risk of breast cancer by almost half if they watch their weight, exercise daily, breast-feed their babies and limit alcoholic beverages, according to a new report by the American Institute for Cancer Research.” For the study, researchers updated “a 2007 review of more than 800 studies, adding information from 81 new studies.” The researchers “estimated that nearly 40 percent of new breast cancer cases in the United States…could be prevented if every woman followed the recommendations.” Comment: This sounds fine but how often have we been able to change behavior?

In a study published in the current online edition of the journal Human Brain Mapping, senior author Paul Thompson, a UCLA professor of neurology, lead author Cyrus A. Raji, a medical student at the University of Pittsburgh School of Medicine, and their colleagues compared the brains of elderly people who were obese, overweight and of normal weight to see if they had differences in brain structure — that is, if their brains looked equally healthy. They found that obese individuals had, on average, 8 percent less brain tissue than people of normal weight, while overweight people had 4 percent less tissue.

The Los Angeles Times reports, “If people would just do four things — engage in regular physical activity, eat a healthy diet, not smoke, and avoid becoming obese — they could slash their risk of diabetes, heart attack, stroke or cancer by 80 percent,” CDC researchers found. “But less than 10 percent of the 23,153 people in the multiyear study — published in Monday’s Archives of Internal Medicine — actually lived their lives this way.” Further participants “who followed all four lifestyle factors had a 78 percent lower risk of developing a chronic disease than those with no healthy factors.”  Comment:  Ts is not much different to the Alameda Study on lifestyles published 35 years ago by Anne Somers et al, where they pinpointed nine behaviors, that if followed ensured 11 years extra quality life. Unfortunately the knowledge about behaviors has not translated into change,  Behavioral Medicine, like Economics, is a “Dismal Science” The major problem is that most people do not want some government agency to tell them how to live.  Further just as with other addiction than food, such as tobacco and alcohol, long term change is rare…

ABC World News (7/27, story 5, 2:05, Gibson) reported, “There’s a new study out today that shows that texting while driving is by far the most dangerous driving distraction. The 18-month study was conducted with long-haul truckers but researchers said the high risk associated with texting applies to all drivers.” Researchers found that while texting, drivers “are 23-times more likely to crash.” The Virginia Tech Transportation Institute, which compiled the research and plans to release its findings on Tuesday, also measured the time drivers took their eyes from the road to send or receive texts.