What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Friday, November 03, 2006

Childhood Obesity

Like most family physicians, I am sadly lacking in answers to the rising epidemic of obesity. The term epidemic is used, I am reasonably sure, because of the dramatic rise in obesity over the last two decades, and the corresponding pathologies that are a result, such as heart disease, diabetes, etc. More appropriately, I think, obesity should be categorized as a chronic disease state (if an adaptive state, it is a pathological adaptive state). Like hypertension and elevated lipid levels, these chronic diseases are asymptomatic until the late stages of the disease. More and more diseases are found to follow a similar pattern (including Alzheimer’s disease).
Recently, I contacted the “would be” premiers of Alberta for their suggestions on how to control spiraling health care costs. So far, I have received one automated “thank you” and one response stressing “preventative medicine”. Total silence from the majority; although in all fairness, most of them sing the praises of preventative medicine in their party platforms on health care.
The problem is when I graduated in 1962, we had a full course on Preventative Medicine with a corresponding huge text book, and in spite of everyone’s best efforts since, we are failing the course in the public forum. This is most evident with the problem of obesity.
Let us briefly look at what we think we know about obesity and in particular, childhood obesity.
At a recent conference on migraine headache and pain control, the researchers suggested that some people genetically have a “pain monitoring and modulating” center that can be moved “upwards” with opioids and other pain medications, which results in addictions. In other words, more and more drug is required to produce the same therapeutic pain relieve, because “sensors” simply “adjust”. Research articles suggest that this type of genetic predisposition can exist in at least 60% of obese patients as well, but of course, controlled by a different neural system. It is suggested that we all have a “set point” for metabolism that is largely controlled by metabolic “sensing” neurons in our brains. This is supposed to tell us when to eat, so as to keep our energy level and our total body fat level, at a constant. Confusing stuff ; but basically, there should not be the problem of increasing weight with age----unless of course, something goes wrong----and therein is the “chronic disease” aspect. As mentioned previously, some 60% or more of the population have metabolic “regulators” that have the capacity to change during early life (and to some extent, throughout life), so that with increased food and a sedentary life style, metabolic rates may actually go down, but the regulators tell you that you need more food! What a mess!!! In effect, you become kind of a food addict!
Now, from what I can gather, our regulating system is most vulnerable to this change during pregnancy (inside of our mother’s womb), the post natal, neonatal (the first year of life), and during childhood. Once our system has been upgraded to do the wrong things and lie to us, this basically becomes a permanent thing (for many people, it continues throughout their lifetime). This explains why people “struggle with their weight all their lives”. Obesity, once established in the adult, has basically become a permanent and chronic condition.
One of the articles I read said (because of the above fact), that obesity prevention, therefore, is probably the best treatment. Which gets me to the gist of this entry. Let’s see how we are doing in the prevention of obesity in children, and therefore in the entire population.
Apparently, the city of Toronto, in the summer of 2000, abolished half the playgrounds at city schools, supposedly because they feared injury to the children. Now, I always thought that running and walking was good exercise, and that falling down from ones own height was a fairly benign event. The research suggests exercise helps prevent the “deregulation” pathological process responsible for obesity, so why get rid of playgrounds? Could this have something to do with real estate values and not injuries? I’m sure they put in lots of swings, slides, etc. for the kids (how many calories do you burn doing that)? Or maybe some great “monkey bars” that are ten feet high (it gives me creeps to see kids climbing on the top bars), but take up very little real estate. And of course, computers in our schools are a must (probably replaced Gym class in many schools). I understand that in some U.S schools, the “virtuous” school administrators prohibited playing “tag” and other similar activities on the school grounds. “Hey, you kids, stop running. You’re going to hurt yourselves! Get in here and sit in front of a computer, or get up on those monkey bars”! And what is with all this junk food in our schools? One of the researchers stated that “intake of highly palatable diets override the basic static controls of ingestion because it is regulated by neural systems mediating reward and motivation”. I think he was saying that by allowing junk foods, as parents and as a society, we are CREATING obese kids. I’m not suggesting we prohibit the manufacturing of these products, but perhaps as parents we should exercise some authority. Parents seem to be able to get peanut butter out of the schools, why not junk food? Yes, it too is killing our kids!
So how are our governmental leaders doing? Yes, the ones that say preventative medicine is going to save our health care system. They could penalize the schools that have junk food by decreasing funding to the perpetrators, and increasing funding to those that have healthy alternatives. They could also tax the h-ll out of junk food. Maybe take that tax money and give it to the schools? Apparently one of the main reasons we have junk food in the schools is to increase revenue. Now that’s a good one! We negotiate a financial deal that puts money into the education system, creates food addicts that are going to drain the health care pot in the future, and will usurp money out of the education system! Harper tried to take a baby step in the right direction by giving tax deductions to kids that sweat, but ran into criticism from parents whose kids were taking “archery lessons”. Good grief!
And how is the medical profession doing in addressing this problem. We used to restrict weight gain during pregnancy to 20 pounds. Now we say “eat as much as you want, as long it is healthy food”(good luck!). Some women gain forty or fifty pounds with no information to the contrary. The breast feeding mother is told that she is eating for two, so don’t be concerned. Still, as previously mentioned, this is an extremely important time for programming the infant to be obese. Restraint in any form seems to be a “bad” word these days. The toddler’s mothers are told that they will “wear it off” when they start playing soccer and become more active. But they don’t become more active. They discover T.V.s and computers, and these serve as super “baby sitters”. And if they cry---feed them, and if they don’t like what you feed them, keep offering them “stuff” until you hit upon something they like. As parents, why do we harbor so much guilt that we can’t say “NO”. Or are we so self involved that we can’t be bothered to be a parent to our child/children? Or is it that we don’t want to harm their self image by saying “NO”?
Well, here is a news flash, most obese people struggle with their self image.
We are indeed a weird society. We talk “ad nauseum” about prevention, but think about bumps and bruises. Some efforts of pediatric prevention have been laudable (seat belts, helmets, car chairs, etc), but how can we sit back and do nothing about behavior that will sentence a large number of our children to diabetes, heart attacks, and strokes? Talk about child abuse! I firmly believe that there is therapy in restraint and the word “NO”.


Blogger Procrastinatrix said...

Good post. This subject makes my blood boil. The words "child abuse" come to mind when I see completely complacent parents catering to their child's every whim.

3/11/06 3:47 PM  
Blogger michie said...

As per our previous discussion, I thought you made quite a few good points...

Phys Ed class has been greatly reduced for many years now in schools across North America. I wonder if this correlates at all with the increase in children's body weights and cholesterol levels over the past 15 years?! Now they're going to ban tag and other unsupervised sports at recess? (See: U.S. Schools Banning Tag at Recess). This is for the child's own good? Riiiight.

The junk food in schools thing has a lot to do with money. A lot of these companies pay big bucks to have their stores/products in schools and since the schools need the funding, they give in. Also, Rose actually went and talked to a school about healthy eating (and how it's cool) a few years ago after one student group stopped selling junk food and then lost so much money that they wouldn't be able to pay for their graduation. (Are the detail right Rose?)

I think a lot of the junk food issue is due to the abundance of and demand for instant, convenient, palatable foods... It's so easy for both parents and kids to give in. And then of course there's the issue of advertising to kids-- all the sugary cereals and chips and pop. It's crazy. Children are highly influenced by advertising, and parents are highly influenced by their kids (I forget what the advertising companies call this particular strategy). A lot of parents nowadays just give in to their kids out of guilt over not spending time with them, this includes sedentary behaviour-exacerbating items like computers and video games, and also horrible junk food.

"I know I work late every night this week... but on the bright side, I bought you a couple of new video games and dvds, and there's also pizza pops, doritos, coke and ice cream for you and your friends! Yay! And on Friday night I'll be home at a decent time, and we can order in KFC and watch some TV together!!!"

I've often thought that if Health Canada had Coca Cola's or MacDonald's advertising budget, it would be a good start on this prevention thing...

It's definitely a complex issue. Good post!

4/11/06 3:26 PM  
Blogger Al said...

And is it my imagination or is most of the junk food advertising done at a time when kids are watching television or during those two hours before their usual bedtime (or is there such a thing nowadays?) We now know that the tobacco companies have targeted our kids for years. I don't have any doubt that the same is true of the junk food manufacturers. And since the eating habits of our youth, "programs" our eating habits for the rest of our lives, this may be more serious than the smoking thing!

4/11/06 3:48 PM  
Blogger Procrastinatrix said...

Junk Food companies do purposely target children-because children play a big part in influencing what the household spends its money on. Loud colours, flashy commercials etc. Plus the branding of junk food? for example, associating McDonalds with Disney toys, or Muppets. We wanted to go to McDonalds as kids to get those little muppets in the car toys. The other day at bulk barn I saw this candy that was in a clear plastic molar where on one side there were little candy white molars and on the other side was red syrup to indicate swelling or infection. The little white candy teeth were to be dipped into the red "pulp". They were called "toothache" candy. A parallel product with green syrup was right beside it called "rotten teeth".

I sometimes feel guilty lashing out at the huge consumption of junk by kids. Being raised in a household saturated with food business advertizing (my father worked at Neilson's before it became cadbury's, sara lee and Campbell Soup Co), I should be obese. I grew up on junk food and candy,chocolate, croissants, cake, popsicles, ramen noodles, chunkey soup, swanson dinners-a lot of super refined and processed food. Not that my mom didn't cook, but because it was around I figure I had a higher percentage of it. I guess the difference between then and and is that we were really active kids. We did dance, baseball, biking, *Gulp* TAG, etc. We rarely played inside.

I agree with a junkfood tax with one caveat. For those families who rely on fastfoods (urban deserts and the like, there are many people who can't get to a good grocery store or just don't know the basics of good nutrition (it IS cheaper)) and tend to be of lower income might be hit hard by this kind of tax. My proposal is that we charge by the Kcalorie;)

6/11/06 7:38 PM  
Blogger Al said...

As the literature suggests, some 60% of people may have "regulators" that adjust to dietary intake. Obviously, Procrastinatrix, yours didn't get influenced. I do think that in certain ethnic groups that this can happen in later life as well-----so beware!!!
I'm not a big fan of: "they eat junk food because they don't know any better" and they don't have access to a "good grocery store. The poor neighborhoods 70 years ago had gardens in their yards instead of grass or weeds. The "lack of education" thing is over-rated and the "lack of motivation" thing is understated. In my practice, my patients would get 100% in a health questionaire eg: better to eat hamburgers or vegetables, better to smoke or not smoke, better to be obese or normal weight, etc. About 20% lived up to their level of knowledge which reflects lack of motivation.
Thanks for the comments.

6/11/06 9:41 PM  
Blogger Salome said...

Among the eight components of a CSHP model are Physical Education and Family and Community Involvement. GAO studies show that the program strategy identified by experts as most important to prevent or reduce childhood obesity is "increasing physical activity," and that parental and social support for physical activity is associated with increased physical activity. http://www.phentermine-effects.com

23/10/08 2:45 AM  

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