Combo Regimen Best to Keep Obese Seniors Going

By Todd Neale, Staff Writer, MedPage Today

Exercise and weight loss both appear to help obese older adults maintain function, although combining the two provides the most benefit, a randomized controlled trial showed.

After one year, participants 65 and older who participated in both a diet and exercise program had greater gains in physical performance than those who did either one alone, according to Dennis Villareal, MD, of the New Mexico VA Health Care System in Albuquerque, and colleagues.

The combined strategy also resulted in the most consistent gains on several secondary endpoints, including strength, balance, gait, and quality of life, the researchers reported in the March 31 issue of the New England Journal of Medicine.
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GRAY MATTERS: The Consequences of Unequal Wealth Distribution

by Saul Friedman

Shirley Sherrod had it about right when she said,

“Y’all, it’s about poor versus those who have. It’s really about those who have versus those who don’t. And they could be black, they could be white, they could be Hispanic...”

That wasn’t exactly the whole truth, for she and her husband. Charles, were ardent, longtime civil rights activists who understood that years of racism, played a large role in perpetuating the ignorance and poverty in the south among blacks as well as whites.

(Racism is here defined as the belief among many whites, supported by the law, that Negroes were inferior. Only in America did the Supreme Court, in Dred Scott, hold that black slaves were chattel, less than human.)

Overcoming that sad heritage, Ms. Sherrod, who has spent a lifetime helping in the struggles of the poor of all shades put her finger on a fundamental human problem in much of the world, especially the United States - the unequal distribution of wealth among too many of us.

That is the subject of a new book that has become the rage among social scientists and activists in Europe, especially Britain. It’s called The Spirit Level: Why Greater Equality Makes Societies Stronger, written by British public health researchers Richard Wilkinson and Kate Pickett who have produced an unprecedented rediscovery of the causes of so much of today’s anger towards the institutions of government and finance.

The book was called to my attention by a Canadian reader, Dr. Rob Dumont, a PhD, from a prominent and wealthy family. In a reply to one of my pieces on poverty, he quoted from the book to tell me that according to its central thesis, the growing gap in many countries between the haves and the have-nots is responsible for more than the misery of poverty.

According to the book, such health and social problems as “Obesity, Mental illness, drug and alcohol abuse, homicides, imprisonment rates, lowered life expectancy, overconsumption of resources, teen pregnancy and the lack of social mobility,” all have in common strong links to inequality of wealth.

Interestingly, the authors, who have exhaustively documented their work, do not denounce the wealthy. Rather they point out that the most affluent citizens as well as the most wealthy countries also suffer from these ills. Their analysis mocks the American Declaration of Independence which proclaimed, “all men are created equal.” The original sin of slavery gave lie to that promise and the lack of equality has taken a toll in this nation even today.

As one knowledgeable Amazon reviewer, Dr. Nicholas P. G. Davies, a Briton, wrote,

“Inequality issues are often presented as being about the poor, but this book shows we are all poorer for living in more unequal societies. Inequality is as bad for the rich as it is for the poor. Society is poorer as inequality becomes greater.”

As Wilkinson and Pickett make clear with dozens of graphs, which rate the nations based on the problems that come with inequality,

“The impacts of inequality show up in poorer health, lower educational attainment, higher crime rates, lower spending of social capital, lower cooperation with and trust of government.”

One graph that shows the “health and social problems are worse in more unequal countries,” makes these points:

“The U.S, Portugal and the United Kingdom rate high in the amount of income inequality. For the U.S., low taxes (by international standards), a weak trade union movement, low minimum wage and a tradition of individualism have resulted in a high level of income inequality.”

Indeed, the U.S., with its obsession with the market economy, has modest social programs, Social Security and Medicare, while most of the other 20 nations listed are social democracies with a broad array of social insurance benefits, including universal health care. Canada is roughly in the middle of the pack, along with France, Spain and Switzerland. Japan and the Scandinavian nations have the lowest income inequality, offering cradle-to-grave social programs.

Some critics suggest that the book cherry picks its statistics and the alleged problems to prove their point. But who could argue with the graph that puts the U.S., the richest country, almost off the charts showing the relationship between a huge income gap – perhaps the highest among civilized countries – and such health and social problems as infant mortality, higher than most European nations, homicide and imprisonment rates (the highest in the world), obesity, child well-being (poverty among children has reached new heights) and drug and alcohol addiction?

Any thinking American can verify the sad truth in another graph that shows these health and social problems are worse in more income-unequal states. With the rise of unfettered rapacious, anti-labor capitalism, which touted sweatshops and child labor, income inequality rose to criminal levels.

And today, as you might expect, the southern states, namely Mississippi, Louisiana, Alabama, Texas, Tennessee, Kentucky, West Virginia and Florida “have high levels of income inequality and much poorer outcomes in the health and social areas.”

These states also have the highest levels of poverty and the lowest levels of education attainment, and in the last couple of years, income inequality has become worse throughout the United States, especially in the industrial north, as a result of the 2008-9 recession which has increased home foreclosures, personal bankruptcies and the numbers of Americans – nearly 50 million – struggling against poverty or near poverty.

Yet at the same time, the rich are becoming obscenely richer. Michelle Singletary, reported in the Washington Post last month that while the average income for the top one percent of earners rose 281 percent, or $973,000 per household, in the last decade, the bottom fifth saw their incomes increase 16 percent, or $2,400 per household.

Former Labor Secretary Robert Reich, who wrote the forward for the American edition of the book, noted that today’s CEOs are paid more than 350 times that of the average worker. Surely we’ll see the results of such inequality in health and social problems in the next few years.

In his inaugural speech, President Obama said, “The nation cannot prosper long when it favors only the prosperous.” But that’s exactly what has happened as bankers have made huge profits and gotten scandalous bonuses while real unemployment reaches towards 15 percent.

Franklin Roosevelt fought the economic royalists of his day to help Shirley Sherrod’s Georgia get electricity and survive the Great Depression with the Tennessee Valley Authority and the Works Progress Administration. What has Obama done?

One can blame the Republicans or the U.S. Senate, but where is the leadership of the President? It won’t do to give Ms. Sherrod a job. Platitudes like, “I feel your pain,” are not true. It might help to use the powers of his federal government to put Americans to work. But as she said,

“Folks with money want to stay in power and they’ll do what they need to do to stay in power...It’s always about money, y’all.”

Find out more about Spirit Level, at the excellent British web site, The Equality Trust, which supports the messages in the book.

Write to saulfriedman@comcast.net
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Get Moving! Exercise can Enhance and Extend Your Life

Regular exercise is essential to healthy aging. It lowers risk factors linked to the development of chronic disease, such as, obesity, high blood pressure, diabetes, and high levels of triglycerides. In turn, physical inactivity has been linked to the development of heart disease and stroke. The American Heart Association (AHA) cites physical inactivity as a major risk factor for developing coronary artery disease. The Centers for Disease Control and Prevention (CDC) highlights regular physical activity as one of the most important steps to take to prevent serious health problems that can occur with age.

Different activities lead to different health benefits. Some forms of exercise, such as strengthening exercises, improve flexibility and balance. Aerobic exercise increases cardiovascular fitness and endurance. Examples of aerobic activities include brisk walking, bicycling, jogging and dancing. CDC’s guidelines recommend that older adults 65+ who have no limiting health conditions participate in moderate-intense aerobic activities for at least two and a half hours every week. It also recommends including muscle-strengthening exercises, such as, lifting weights, working with resistance bands, heavy gardening, or yoga on two or more days every week. Strengthening exercises can increase a person’s flexibility and balance, which reduce the likelihood and severity of falls.

Recent Exercise Statistics for Adults 65+

Statistics published by CDC in 2009 indicate that older adults in the age range, 65 to 74 years old, exercise more than those 75+. In addition, the statistics indicate that older men exercise more than older women.
The statistics state that 38.5 percent of men, 65 to 74 years old, exercised regularly and 31.1 percent of women in the same age range exercised regularly. The numbers decrease for adults 75+. 23 percent of men 75+ exercised regularly and 14 percent of women 75+ exercised regularly.

Learn More about the Benefits of Exercise

To learn more about the benefits of exercise and tips for incorporating exercise into your life, visit these resources:

• How much physical activity do older adults need? (CDC)
• Physical Activity (AHA)
• Physical Activity for Older Adults: Exercise for Life! (American Society on Aging)
• Exercise for Seniors (Medline Plus)

Brain Function Differs With Weight, Body Shape from MedPage Today

By John Gever, Senior Editor, MedPage Today
Body mass index and the distribution of fat were both associated with cognitive function in a large study of postmenopausal women, researchers said.
In women with a low waist-to-hip ratio -- denoting a "pear-shaped" body -- increasing BMI correlated significantly with poorer cognitive performance, according to Diana R. Kerwin, MD, of Northwestern University in Chicago, and colleagues.
Meanwhile, the "apple shape" with fat concentrated at the waist made higher BMI predictive of relatively better cognition, the researchers found.
The mechanism is unclear, Kerwin and colleagues said in their report online in the Journal of the American Geriatrics Society,but the association suggests the relationship between body fat and brain function is more complicated than earlier studies had suggested.
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Chronic Health Conditions Hit Native Elders Early

New Report on Native Elder Health Finds Asthma, Diabetes, Obesity Prevalent in Native Elders Years Before General Population

Native elders are aging earlier than other elderly groups, according to a new Center report that provides the first comprehensive information on American Indians and Alaska Natives (AIAN) elder health in California.

Using the 2005 and 2007 California Health Interview Survey (CHIS), the report provides omnibus data on native elder health on topics ranging from demographics, obesity, alcohol and tobacco use, as well as cancer screening, mental health, health insurance and more.


The authors, Center researcher Delight Satter and Center Associate Director Steven P. Wallace, found significant health disparities between AIAN elders and other senior racial and ethnic groups on issues ranging from diabetes and cancer screening to the high risk of falls.

The report, which follows a fact sheet on native elder health published earlier this year, provides evidence to show that native elders are developing chronic conditions earlier than other racial and ethnic groups.

Among the findings:

Diabetes

One-quarter (26 percent) of AIANs aged 55-64 have been diagnosed with diabetes compared to 12 percent of whites.

Asthma

One in five AIAN elders ages 55-64 have been diagnosed with asthma (20 percent) compared to 9 percent of Latinos of the same age.

Obesity

Nearly one-half (44 percent) of AIAN elders age 55-64 are obese, compared to 38 percent of African-Americans, 34 percent of Latinos and 25 percent of whites.

“Chronic health problems for Natives are cresting ten years earlier than the general population,” said Satter. “While researchers have heard anecdotally about this phenomenon for a long time, this is the first data in California that shows the drastic early aging that is afflicting the native community.

“Hopefully the data will also be a rallying call to health experts, advocates, policymakers and the native community to support the programs and policies that contribute to healthier aging.”

Although national health status data exist on the AIAN population as a whole, there is a severe lack of state-level and sub-state level data focused on the health of AIAN elders. This report presents the first comprehensive population-level health data on California’s Native Elders.

This report was funded by the California Wellness Foundation, the California Area Indian Health Service, the Mayo Clinic Spirit of Eagles and the UCLA Tribal Learning Community and Educational Exchange.

Read the report: Health of American Indian and Alaska Native Elders in California


UCLA Center for Healthpolicy Research

Women’s Health in California: A Snapshot

A new fact sheet from the UCLA Center for Health Policy Research provides a useful overview of some of the biggest health challenges for women in California, including high blood pressure, diabetes, smoking, overweight and obesity and cancer screening.

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Psoriasis Comorbidity Increases over Time - MedPage Today

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By Charles Bankhead, Staff Writer, MedPage Today

Patients with psoriasis have multiple comorbid conditions that tend to worsen over time, data from a review of medical records showed.

At baseline, psoriasis patients had significantly higher rates of hypertension than non-psoriasis controls (14.9% versus 11.9%, P<0.0001), cardiovascular disease (CVD)(3.9% versus 3.1%, P=0.0151), depression (3.7% versus 2.8%, P=0.0077), diabetes (6.3% versus 5.0%, P=0.0471), and hyperlipidemia (15.2% versus 11.5%, P<0.0001).

Psoriasis patients also had a numerically greater prevalence of obesity (0.6% versus 0.2%), and the differences between the two groups increased during four years of follow-up, researchers reported at the American Academy of Dermatology meeting here.

Differences increased the most for depression, hyperlipidemia, and obesity.

"The trends [are] all going directionally in the same way, and the point spread between the groups continues to widen over time," Alexa Kimball, MD, of Harvard, told colleagues.
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Overweight Middle-Aged Adults At Greater Risk For Cognitive Decline In Later Life

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from Medical News Today

The adverse affects of being overweight are not limited to physical function but also extend to neurological function, according to research in the latest issue of The Journals of Gerontology Series A: Biological and Medical Sciences (Volume 65A, Number 1).

The publication presents a collection of ten articles highlighting new findings related to obesity in older persons.

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• Overweight middle-aged adults at greater risk for cognitive decline in later life (scienceblog.com)

Overweight' Adults Age 70 Or Older Are Less Likely To Die Over A 10 Year Period Than Those Of 'Normal' Weight

from Medical News Today

Adults aged over 70 years who are classified as overweight are less likely to die over a ten year period than adults who are in the 'normal' weight range, according to a new study published today in the Journal of The American Geriatrics Society.
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• Overweight elderly 'live longer' (news.bbc.co.uk)
• Being Fat May Not Be All Bad -- If You're 70 (time.com)
• 'Overweight' Older People May Live Longer (inquisitr.com)
• Santa's OK! Over 70 and overweight possibly a good idea. (weightymatters.ca)

Did Americans get any healthier over past decade? - washingtonpost.com

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By MIKE STOBBE

About 10 years ago the government set some lofty health goals for the nation to reach by 2010.

So how did we do? By many measures, not so hot. There are more obese Americans than a decade ago, not fewer. We eat more salt and fat, not less. More of us have high blood pressure. More of our children have untreated tooth decay.

But the nation has made at least some progress on many other goals. Vaccination rates improved. Most workplace injuries are down. And deaths rates from stroke, cancer and heart disease are all dropping.

As we move into a new decade, the government is analyzing how well the nation met the 2010 goals and drawing up a new set of goals for 2020 expected to be more numerous and - perhaps - less ambitious.
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• U.S Life Expectancy Reaches High of 77.9 Years (wellness.blogs.time.com)
• Obesity Could Cut Womens Lives Short (healthadel.com)
• Why Is Exercise Good For You? (stepbysteptips.com)
• US health check for the past decade (americablog.com)

H.R. 3894: To amend the Public Health Service Act to authorize a community-based overweight and obesity... (GovTrack.us)

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To amend the Public Health Service Act to authorize a community-based overweight and obesity prevention program.

Sponsor: Rep. Kathleen Dahlkemper [D-PA3]

Full Text

Status:
Introduced Oct 21, 2009
Referred to Committee on Energy & Commerce

Updates

Announcement: NHANES 50th Anniversary and Conference

NHANES has long been a primary source of data on the nation's health. NHANES findings were used to set the goals and track the progress in reducing cholesterol levels, the prevalence of high blood pressure, and the risks of blood lead exposure in the United States. NHANES documented the rise in obesity and diabetes and produced the first population-based estimates of human immunodeficiency virus infection and osteoporosis. NHANES data also are used for the growth charts by which pediatricians and parents check children's growth and development.

A hallmark of NHANES is its partnerships with other CDC programs, the National Institutes of Health, other U.S. Department of Health and Human Services programs, and other government agencies to collect data needed for public health policies and practice. Additional information about the NHANES 50th anniversary is available at http://www.cdc.gov/nchs/nhanes/nhanes50th.htm.

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AMNews: Sept. 24, 2009, 2009. Health reform should include efforts to fight obesity, group says ... American Medical News

A coalition of physician organizations and other groups recommends doctor-patient conversations about weight loss and improved clinical approaches as ways to reverse the nation's obesity epidemic.

Patients counseled on weight loss by physicians are three times more likely to attempt dieting.

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Waist-Hip Ratio Good Gauge of Obesity in Elderly, Study Shows - Forbes.com

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(HealthDay News) -- Among the elderly, the ratio of waist size to hip size may be a better determinant of obesity than body mass index, say researchers from the University of California, Los Angeles.
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• Apple-shaped women risk asthma (news.bbc.co.uk)
• Wider Waist Boosts Asthma Risk (nlm.nih.gov)
• Obesity Can Cut Years Off Lifespan (abcnews.go.com)
• Obesity Shrinks Brains? (drsharma.ca)
• Obesity: A Dangerous Epidemic (healthnews.ediets.com)

Medical News: Rising Obesity Rates Increase Nation's Healthcare Tab - in Pediatrics, Obesity from MedPage Today

Reducing Obesity: Policy Strategies from the Tobacco Wars

To combat the epidemic of obesity, lawmakers can adapt policy approaches that have substantially cut tobacco use. A 10 percent tax on fattening food, identified based on a model used by the British government to determine the foods that may not be advertised to children, would reduce consumption while raising more than $500 billion over 10 years. Adding simple, "traffic light" nutrition labels to the front of each food package would change consumers' buying habits, as would listing calories on menus at chain restaurants. Consumption of fattening food would be further reduced by banning its advertisement in the mass media. Read More

Race Plays Role In Diagnosis And Treatment - Kaiser Health News

CNN reports that African Americans and whites are treated differently by doctors. "While it's extremely difficult to tell in any given situation how much race -- consciously or unconsciously -- plays a role in a doctor's decision making, multiple studies over several decades have found doctors make different decisions for black patients and white patients even when they have the same medical problems and the same insurance." For example, "In a study conducted in 2007, Harvard researchers showed doctors a vignette about a 50-year-old man with chest pain who arrived at the emergency room, where an EKG showed he'd had a heart attack. Sometimes the researchers paired the medical history with a photo of black man and other times with a photo of a white man. The doctors were significantly more likely to recommend lifesaving drugs when they thought the patient was white than when they thought the patient was black" (Cohen, 7/23). In other news, "recently released statistics from the Centers for Disease Control and Prevention (CDC) show that minority groups experience obesity at even greater levels than their white counterparts," The Milwaukee Health Examiner/Examiner reports. "According to the July 17 issue of the Morbidity and Mortality Weekly Report, blacks have a 51 percent greater prevalence of obesity than whites. Hispanics also experience a greater percentage of obesity than whites with a 21 percent higher prevalence, according to the CDC publication." Read More

Planning Grants For Translational Research For The Prevention And Control Of Diabetes And Obesity

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) seeks to develop cost effective and sustainable interventions, that can be adopted in real world settings, for the prevention and control of diabetes and obesity. Research should be based on interventions already proven efficacious in clinical trials to prevent and reverse obesity and type 2 diabetes, to improve care of type 1 and type 2 diabetes and to prevent or delay its complications. The interventions proposed under this solicitation should have the potential to be widely disseminated to clinical practice, individuals and communities at risk.

This FOA invites research applications for planning grants or pilot studies for translational/dissemination research leading to full scale research in diabetes prevention and control as described in the program announcement, PA-02-153-Relevant topics include
1) methods to improve health care delivery to patients with or at risk of diabetes,
2) to enhance diabetes self management,
3) methods to develop strategies to promote healthy lifestyles to reduce the risk of diabetes,
4) methods to promote lifestyle change that will prevent or reverse overweight and obesity, and
5) new cost effective ways to identify people with pre-diabetes and undiagnosed diabetes.

Important considerations are cost effectiveness and sustainability of the intervention(s) proposed and the ability of interventions to be widely disseminated in settings such as representative health care systems, schools, worksites, or other community settings.

Proposals should test cost effective and sustainable strategies that go beyond research settings to achieve
1) control of glycemia and other risk factors for diabetic complications, including hypertension and dyslipidemia
2) alteration in life style to prevent or reverse overweight, obesity, pre-diabetes, or type 2 diabetes in at-risk populations.

Studies submitted to this program should focus on developing preliminary data demonstrating that the proposed approach is feasible and leads to reduced body weight and or improved glycemia. The interventions proposed must have the clear potential to be applied beyond research settings and to be widely implemented in existing settings in the U.S.

Proposals focused on minorities and other high risk populations disproportionately affected by diabetes and obesity are encouraged.

Latest CDC Data Show More Americans Report Being Obese

The proportion of U.S. adults who self report they are obese increased nearly 2 percent between 2005 and 2007, according to a report in today′s Morbidity and Mortality Weekly Report (MMWR). An estimated 25.6 percent of U.S. adults reported being obese in 2007 compared to 23.9 percent in 2005, an increase of 1.7 percent. The report also finds that none of the 50 states or the District of Columbia has achieved the Healthy People 2010 goal to reduce obesity prevalence to 15 percent or less.

Keeping Active, Not Smoking Can Reduce but Not Abolish CV Risks of Obesity

From Heartwire — a professional news service of WebMD June 16, 2008 — What people do, whether they smoke, and what they eat can mitigate the adverse cardiovascular effects of obesity, but they cannot do away with them altogether, researchers say. While other studies have investigated the relationship between fitness and fatness, this latest study also factors in dietary habits and smoking. "Our study confirms the findings observed in some epidemiological studies, that although physical activity is important, it does not abolish the excess cardiovascular risk observed among the obese," first author on the study, Dr Majken K Jensen (Aarhus University Hospital, Aalborg, Denmark), told heartwire. The results, Jensen continued, "suggest that both obesity and physical activity affect the risk of acute coronary syndrome (ACS) and that the lowest risk is observed among the leanest individuals who are the most physically active. The new information is really not on physical activity, but that we extended the investigation to include the role of obesity in combination with other lifestyle risk factors."