Wednesday, August 4, 2010

obesity, again

another article on rising obesity rates - http://www.nytimes.com/2010/08/04/health/nutrition/04fat.html?_r=1&ref=us.

what's a country to do?

for one thing, some soon-to-be unfolded efforts to tag foods in the stores based on a 0-100 scale (100 being excellent for health) may help folks make better dietary choices. and if that weren't enough, there's now more discussion on making developments - neighborhoods - more activity friendly, tho that's a way in the future dream. for the most part, getting mother nature to drop the temperature below 90 would be helpful but the reality is, no matter the outdoor temps, most americans simply don't move enough.

so, what's a country to do?

well, yesterday the voters of missouri resoundingly voted against the federal health plan that mandates purchasing a health insurance plan. that will be the crux of the many lawsuits aiming to gut the program. and i'm sure there are good, and bad, arguments for and against it. but i'm not so sure it's one that law alone should manage. of course, being a nation of laws, that's not an option unless this blog can convince my fellow americans to reconsider their opposition to a plan that will help keep costs down by providing some measure of health care prior to the end stages of disease, maybe mitigating the need for extreme measures. let me expound.

joe eats too much junk food, drinks too much beer, and sits around watching too much tv. joe's formerly fit athletic body is now fat and plaque-laden. he is totally entitled to his choices, his lifestyle, and i don't begrudge him that...until he goes to the doctor. whether or not he is insured, the drug, insurance, and medical conglomerates will prosper on his life choices, driving up the costs for all of us who may or may not be choosing similarly disease oriented lifestyles. why? because of basic economics: supply and demand. you see, joe has to have more and better drugs to manage his deteriorating body; his insurance is paying out more than he can afford to put into it monthly; and the medical community, short of hours and long on modalities, will make a killing on his conditions. thus, the costs are shared by those of us who hardly use or abuse the system both in drug development, costs, distribution, and reimbursement; in insurance premiums; and in the ever-constant struggle by docs to get reimbursed by the insurance industry, and to prevent lawsuits by providing best of care vs best of prevention, which combined drive up costs for all.

now i know the argument - and concur in its rationality - that ever since medicare and medicaid, government subsidization has driven the cost of health care beyond previous amounts. so, in the 1960s, your doc lived next door; today, he lives in the finest of mansions in the best of neighborhoods, regardless of his clientele. and that's one of those unintended consequences of good programs and bad policies. but here we are, and going back to the way it was - when docs took $10 for an office visit - is not an option. neither the docs nor their technologies can be bought for 1960s prices. so, what's all this have to do with obesity? wellllllll

we have a choice in this country: we can allow individuals to choose to live unhealthfully, or we can encourage and SUPPORT healthy living, as a nation. there are costs all along either path, so let's face that reality. if 25 states opt out of the mandate for health insurance, then, should someone from that state travel to my state and have an attack or injury or event requiring health care, which state is going to cover the costs? for all intents and purposes, even a citizen of missouri would be like an illegal mexican when it comes to health care: no contribution, my costs.

it behooves us all to be patriotic in our observance of healthy lifestyles. it behooves our leaders to consider rewarding such lifestyles and even punishing unhealthy ones. there are rational ways, dollar-ways, to make folks understand that their choices affect not just them but us. and that there are valid reasons as to why we can make reciprocal demands upon them to comply more with what are generally considered hallmarks of a healthy lifestyle. as such, we can demand that junk foods not be included in school lunches, at work site eateries, or interspersed in aisles and media so that the attraction is harder to avoid. (i say this knowing full well that the marketplace will think i'm a socialist. i counter by saying the nation's wellbeing should not be subjugated to the financial interests of a few any more than its security should be subjugated to the religious fanatacism of a few.)

and let's reward movement - encourage it in kids (how about neighborhood schools again?), in neighborhoods (sidewalks anyone? police walking the beat?), and in adults (workplace supports). and discourage sedentary behavior with financial and workplace disincentives. (what would you be willing to sacrifice in your lifestyle for a paid vacation day? better yet, would you be willing to engage in healthy choices for an extra few days off?)

this is not the answer to all questions in this issue. it's really just a provocation for you the reader to think about how we're going to handle this epidemic. i'm going to do a 15 minute indoor bike ride now. good nite.

2 comments:

  1. Speaking of eating, straight up, how important is timing of food and exercise? Example, this article: http://well.blogs.nytimes.com/2009/07/02/eating-to-fuel-exercise/

    I for one do better when I do cardio 1st thing in the morning w/out food. Also, I am rarely if ever hungry for several hours afterwards. Is that so terrible? Is the importance different if one is doing cardio vs. strength training? Also what started the idea of eating after exercise because your body burns more calories? I have a hard time buying into that.

    On a side note, have you thought of adding an "Ask Dr. Irv" section to your blog? I for one have asked you many questions and they don't necessarily correspond to the post I'm commenting on. Just a thought. Thanks for answering all my random questions. I do appreciate the insight.

    ReplyDelete
  2. dear reader

    thanks for your inquiry and your suggestion for an 'ask irv' section. i will investigate that and see how i might make that happen. (of course, anything can be done on the 'net, but i have to see if i can do this without it consuming all my time.)

    timing of intake is the new vogue concept in sports nutrition. we've long known and discussed type and amount of calories prior to exercise. much depends on what you can eat, like to eat, and when you like to do so before what kind of activity, recognizing that one should 'practice' as if preparing for what to eat prior to competition.

    the latest info coming out regards post workout nutrition. hence my previous mentions of low fat chocolate milk to replenish not just liquids but carb and protein for muscle rebuilding after RT.
    i think this is very consistent with what body builders and all mass/size athletes have done for years - getting in some easily digestible protein via liquid supplementation. for cardio athletes, however, the thinking has been to get in carbs; but even that's starting to change. several studies have looked at adding protein to the drinks athletes consume during cardio events to extend either duration or intensity; others have considered added protein for post workout meals as a way to enhance recovery. there's nothing as definitive as for RT but it's leaning toward protein having merit.

    now, you're asking from a different direction than that of an athlete; you're issue is calorie management, maybe wt management.

    cardio first thing in the a.m. may stifle appetite a while; however if you listen to your body well, it will demand compensation for the withdrawal of energy that occurred from your last meal the nite before to the post workout meal several hours later. oftentimes, this is done at the expense of wise portion or macronutrient choice. that is, you may end up over eating later or choosing hi cal foods you otherwise would not normally eat. thus, you may be fighting wt gain with your morning routine at the expense of all your efforts by not eating enough at the right time.

    but do not fret. every athlete is different and if you cannot run on a satisfied gut, then by no means change nothing - running is better than not running, for the most part.

    now, in conclusion, to address your hard time buying thing about eating after exercise. think about it - your metabolism is elevated after exercise, just as it's elevated after eating. if you don't eat, your body slows its metabolism to conserve energy. if you exercise and don't eat, your body will further conserve energy to prevent going into a severe drought of it. what's it do? it reduces muscle or lean tissue mass. why? because muscle is active tissue, needing calories to not only stay alive but to function well. without them, the body will attempt to achieve homeostasis by reducing those body elements that use energy - muscle. the other choice, of course, is to scale back on organ function; not a good choice if you ask me.

    therefore, not eating after exercise actually impairs one's ability to not only perform more or better activity; it impairs one's ability to maintain healthy body weight if not now while you're young but later when it's harder to sustain hi energy outputs and you have less muscle mass with which to do so.

    eat up....

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Dr.Irv