Direct from the AMA morning newsletter, I am happy to share this news with everyone! By working together and pooling resources to educate as many mothers about this problem, we are finally seeing some improvement (albeit small) on the childhood obesity front (see below) We have a long way to go to "Turn the Tide" but at least we're heading in the right direction. Very exciting!!
On another note, sadly, 2 studies found that children with food allergies, or those seeking treatment for weight loss, reported bullying mainly by peers, including threatening the food-allergic kids with the food that they are allergic to.The studies found that the children who were victimized due to weight also reported parental bullying and continued bullying in school even after they lost weight! This is crazy! We must teach our children to love one another no matter what our apparent external differences may be. The world will be a better place when/if we do. Please consider talking with your kids about this asap! Thanks!
Obesity down among young children from poor families.
The New York Times (12/26, Tavernise, Subscription Publication) reports that research published in the Journal of the American Medical Association "has found modest declines in obesity among 2- to 4-year-olds from poor families, a dip that researchers say may indicate that the obesity epidemic has passed its peak among this group." The new "study, by researchers from the Centers for Disease Control and Prevention, drew on the height and weight measurements of 27 million children who were part of the federal Women, Infants and Children program, which provides food subsidies to low-income mothers and their children up to the age of 5." Heidi M. Blanck, one of the study's authors and the acting director of the Division of Nutrition, Physical Activity and Obesity at the CDC, said, "The declines we're presenting here are pretty modest, but it is a change in direction."
The Los Angeles Times (12/26, MacVean) "Booster Shots" blog reports, "The more than 26 million children whose data was included in the study were ages 2 to 4. The prevalence of obesity increased from 13% in 1998 to 15.2% in 2003, but declined to 14.9% in 2010; extreme obesity went from 1.75% in 1998 to 2.2% in 2003, to 2.07% in 2010."
Bloomberg News (12/26, Ostrow) reports, "Researchers attributed the decline to greater awareness of health problems caused by obesity as well as an increase in breastfeeding, which research has shown can reduce the risk." Blanck said, "We're optimistic that with recent investments and recent initiatives we'll continue to see these numbers decline." Also covering the story are Reuters (12/26, Pittman) and WebMD (12/20, Mann).
As many of my close friends and family know, I had the pleasure to work with Dr. David Katz of Griffin Hospital in Derby, CT this past year. The rotation was fabulous as I got to see true Integrative and Preventive Medicine in action. For those new to Dr. Katz, he is rock star in the Integrative and Preventive Medicine world.
Here's a quick bio (skip this paragraph if you want to get to the meat of the article): "Dr. Katz is the director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, CT; founder and president of the non-profit Turn the Tide Foundation. Know internationally for expertise in nutrition and chronic disease prevention, as well as integrative care models, Katz has secured roughly $30 million in research funding, and has published over 120 scientific papers, numerous textbook chapters, nearly a thousand newspaper columns, and 12 books to date. He is the principal inventor of the Overall Nutritional Quality Index utilized in the NuVal™ nutrition guidance program (www.nuval.com), currently offered in approximately 1,000 supermarkets throughout the United States. He has been recognized three times by the Consumers Research Council of America as one of the nation’s top physicians in Preventive Medicine; was a nominee for the position of US Surgeon General in 2009; and was the 2011 recipient of the Katharine Boucot Sturgis award from the American College of Preventive Medicine, the most prestigious award the College confers – awarded for illustrious career contributions to the field. Dr. Katz is a health editor for the Huffington Post, and Editor-in-Chief of the peer-reviewed journal, Childhood Obesity."
So needless to say, I was thrilled to work with him for 5 weeks. He publishes a weekly column in the Huffington Post and in his most recent column, he discusses the differences between irradiation (medical procedures that require radiation) and illumination (knowing whether or not the test is the best one for diagnosing and/or treating your medical conditions). Here's what he writes:
"My colleagues at the Huffington Post recently did a fine job characterizing the trade-offs that bedevil decisions about the use of modern medical imaging. On the one hand, sophisticated imaging with CT scanners can inform treatment choices, and save lives. On the other, rates of imaging have sky-rocketed over recent years, raising concerns about radiation exposure for patients and for doctors, that invention may be acting as the mother of necessity!
The challenge, of course, is finding the sweet spot between damned if you do, damned if you don't. Being overly cautious about medical testing -- imaging or otherwise -- could mean missing out on the very test you need to answer a critical question, or guide a crucial therapy. Being overly accepting of every application of modern medical technology might well mean it does you more harm than good -- making you glow in the dark, rather than illuminating the source of your troubles.
Up to a point, getting such decisions right requires trust in your doctor -- because they are decisions your doctor has been trained to make. Often that trust will be warranted -- and ideally it is in your case. Ideally, your doctor is not only highly educated, but equally intelligent and genuinely caring. With my many colleagues in mind, I can certainly say this is true much of the time. I can also say it isn't invariably true, and even the best of us have bad days. So I invoke my favorite Reaganism: Trust, but verify.
Verify you are getting the tests you need, and only the tests you need. Challenging such decisions is not an insult to your doctor. Simply, it is an affirmation of the fact that you, literally, have skin in the game: It's your body and your health on the line. Take nothing for granted.
In her Huffington Post column about diagnostic imaging, Emma Gray makes the following, reasonable suggestions. Before getting any type of scan, ask: How will this improve my care? Are there any alternative imaging exams that don't use radiation?
I like these tips, but I would like to go further and generalize them. Radiation is not the only hazard of medical testing -- any test can do harm of some kind. That's acceptable if, and only if, potential harm is much outweighed by potential benefit. To ensure that, always ask these questions before any test:Wwill the results of this test directly affect your decisions, or my options? Will this test provide a definitive answer, or is it preliminary to more tests? Is this test the safest way to get the information we need? Would you have this test if you were me?
If you can bring yourself to ask these questions about medical testing as a matter of routine, they should serve as a fairly good filter, letting only genuinely useful testing through. But with a little help from your inner statistician (yes, s/he's really in there!) you can do even better.
The goal of medical testing is to figure out what is going on (and then, what to do about it). That, in turn, is really dependent on establishing two things: What does this patient have and what doesn't this patient have? Testing is about confirming a diagnosis (ruling it in) and excluding all the rest (ruling them out). Ideally, it leads to ruling out everything so you can get that proverbial clean bill of health.
There are two, simple statistical concepts you should (and can!) master so that you can help guide testing toward ruling in what it is and ruling out what it isn't. The concepts are sensitivity and specificity.
In life, sensitivity is noticing and reacting to every little thing. It's not much different in medicine: It's the capacity of a test to detect a condition when it is really there. In the two-by-two table below, it is [a/(a+c)]. (Imagine a 2x2 table described as below, it would not copy into this post)
The table summarizes the universe of diagnostic possibilities into four quadrants: disease is present and the test finds it (cell a); disease is absent, but the test says it's present (false positive, cell b); disease is present and the test fails to find it (false negative, cell c); disease is absent and the test says it is absent (cell d). Sensitivity is, in essence, the percentage of the time that disease is present (cell a plus cell c) that the test finds it (cell a); thus, [a/(a + c)].
Here's the surprise: Although sensitivity is the measure of how reliably a test finds a condition that's actually there, it's the property a test needs to rule disease out! Here's why:
If a test is highly sensitive, it will almost always be positive when disease is truly there. Therefore, if a test is highly sensitive, it will almost never be negative when disease is truly there. A highly sensitive test will almost never be negative unless disease truly isn't there. And thus, a negative result on a highly sensitive test reliably rules out disease. The corollary, of course, is that a negative result from a test that is not highly sensitive -- whether or not it is highly specific -- does not reliably rule out disease!
Imagine the stunned expression on your doctor's face when s/he says: Llet's get this test just to make sure you don't have X ..." And you reply: "I trust, then, that this is a highly sensitive test for X?" I would love to be there when it happens!
On the flip side, specificity is the capacity of a test to exclude what truly isn't there. In the two-by-two table, that's [d/(b+d)]. The explanation is much as before, so I won't belabor.
Again, it is somewhat counterintuitive, but it's a test that is good at ruling out what isn't there that is needed to make a diagnosis! The logic is much as before:
A highly specific test is almost always negative when disease is truly absent. A highly specific test will almost never be positive when disease is truly absent. A highly specific test will almost only be positive when disease is actually present. And thus, a positive result on a highly specific test reliably rules a diagnosis in. Again, we have the logical corollary: A positive result from a test that is not highly sensitive does not rule a diagnosis in -- it merely suggests it. So before being treated for a particular condition, particularly if the treatment is apt to be unpleasant or dangerous, you would be well within your rights to ask: Was the testing this diagnosis is based on highly specific?
You are, I am confident, more than capable of mastering and using these simple, statistical principles. But I also recognize that some of you break into a cold sweat at the mere sight of anything that recalls high school algebra! For those in that group, here's your shortcut: SPin/SNout. Specificity to rule in, sensitivity to rule out.
There are more useful, simple statistical principles where these came from -- but they can wait for another day, and another column.
For now, we should recognize that medical testing used well should be illuminating. Used badly, it might simply be ... irradiating. Trust your doctor -- but on behalf of your skin, verify! Bring a few good questions -- and your inner statistician -- to your next doctor's visit to help ensure you stay in the sweet spot."
Hope this helps explain one of the ways doctors assess the risks and benefits of certain medical tests/procedures/exams. Remeber, an illuminated patient is the safest one.
Have a great week!
Try Activity Burst Everywhere (ABE For Fitness)! Developed by my current mentor, Dr. David Katz, a world-renowned expert of nutrition and physical activity and director of the Yale-Griffin PRevention Research Center where I am currently working, this website brings small bursts of powerful exercise to your office, home or hotel room...and it's FREE! The workouts can be done in business attire and are perfect for those of us who can't get to the gym or park to work out (first of all, you are not to blame given our increasingly "obesegenic" environment and secondly, you are definitely not alone!). Scientifically, small bursts of activity are just as effective as longer moderately-intense workouts! (Haskell WL, Lee I, Pate RR, et al. Physical activity and public health: updates recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007; 39 (8): 1423-34)
Dr. Katz's research on nutrition and activity bursts is internationally-acclaimed and evidence-based. It's making waves in schools (Activity Bursts in the Classroom - ABCs For Fitness) and now at home and work! You can peruse his website at www.davidkatzmd.com for tons of information on nutrition (including numerous books that he and his PhD wife, Catherine, have written over the years and info on the NuVal nutrition scoring system being used in various supermarkets throughout the northeast (and being piloted in Texas!)). He's also the President of the Turn the Tide Foundation, a non-profit dedicated to fixing the obesity epidemic. All in all, he's a Prevenitve Medicine superstar and has been featured on numerous talk shows (including Oprah and Dr. Oz!!!!!!!!!!!!) and was even nominated for the position of Surgeon General. I couldn't imagine working for anyone more exciting than Dr. Katz right now!
So, check it all out and get MOVING!
DISCLAIMER: The content of this website does not serve as medical advice nor does it substitute for a thorough medical
evaluation by a qualified health care practitioner. It also does not represent the opinions of any of the medical institiutions or practitioners mentioned.
Consult a physician or local health care provider before changing any medications, diet or exercise regimen.
Dr. Maltz earned a Medical Degree and Master in Public Health from the University of Texas Medical Branch (UTMB) in Galveston, TX. She completed a combined Internal and Preventive Medicine Residency at UTMB in June, 2011. She then completed a 2-year Integrative Medicine Fellowship at Stamford Hospital in Stamford, CT, during which she simultaneously underwent an intensive 1000-hour curriculum created by The University of Arizona Integrative Medicine Program founded by Dr. Andrew Weil.