2013: Prevention as a Healthcare Policy in America

I am no expert in health care policy but I do know what it cost to be fat and sick. I know that if I did not have health insurance it would cost a lot more and I would be in much worse shape than I am now.  I think that healthcare policy requires a more comprehensive common sense approach only made complicated by the lobbyist for this industry.

I also know that in this country there is less emphasis on  preventative care and a major emphasis on medicinal maintenance when someone becomes ill.  There is a pill (and profit) connected to every conceivable condition – conditions that by and large can be avoided if we had a different relationship to food and health.  In 2009, health care accounted for 16% of America’s Gross Domestic Product (GDP) with the expectation that this will increase by nearly 10% by 2025.  We have a population that is living longer with chronic conditions driving up overall costs associated with health care.  Overall, we have a more obese and less healthy overall population in this country.  And the health care lobbying efforts have ensured that our leaders continue health care policy to place emphasis on maintenance rather than prevention.  

Prevention advocates argue that using such an approach in the context of healthcare policy would result in reigning in increasing healthcare costs and creating a more healthy society.  “The Trust for America’s Health reported that prevention programs could save the country more than $16 billion annually within five years, a return of $5.60 per dollar invested.  The Commonwealth Fund estimated that reduced tobacco use and decline in obesity would lower national health expenditures by $474 billion over ten years.” At a time where we are talking about reducing deficits and spending, this is an opportune time to really focus on this issue.

Unfortunately, though many Americans are indoctrinated to eat and drink to excess the wrong things, the real problem is that our policies and national leaders protect the very companies that benefit financially from our illnesses; this means the capacity to advocate for a sensible approach to health care policy against these powerful corporations is more than difficult.  For example, according to the Center for Responsive Politics, in 2005 there were 535 members of Congress compared to 2,084 health care lobbyist; this means for every member of Congress, there was approximately 3.8 lobbyist lobbying them on behalf of various drug and health insurance companies.  Further, according to OurFuture.org, in 2004 the health industry was credited with giving approximately $14M to 11 members of Congress who were created with negotiating the Bush Medicare Plan. 

So what are the costs associated with chronic disease in America?  Let’s take my personal favorite chronic illness, diabetes.

Diabetes

There are a total of 25.8 million children and adults in the United States which means that 8.3% of the population has diabetes with approximately 7 million undiagnosed.  As of 2010,  1.9 million new cases of diabetes were diagnosed in people 20 and over.  This is part of the reason why there has been a substantive increase in the number of diabetes related advertising and why we’ve begun to experience a sense of “normalcy” relative to diabetes.  Rather than focus on preventing Type 2 which is largely tied to weight, we are being socialized to learn to live with it.  There are approximately 79 million pre-diabetics in the United States; for diabetes drug companies and companies that produce lancets, blood glucose readers, and diabetes related products, that’s a lot of potential customers and money.

 After adjusting for population age differences, a 2007-2009 national survey data for people diagnosed with diabetes, age 20 years or older showed that 7.1% were non-Hispanic Whites, 8.4% were Asian Americans, while non-Hispanic Blacks and Hispanics made up 12.6% and 11.8% respectively of those diagnosed.

There are a host of other related conditions associated with diabetes including:

Heart disease and stroke

• In 2004, heart disease was noted on 68% of diabetes-related death certificates among people 65 years or older.

• In 2004, stroke was noted on 16% of diabetes-related death certificates among people 65 years or older.

• Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.

• The risk for stroke is 2 to 4 times higher among people with diabetes.

High Blood Pressure

• In 2005-2008, of adults aged 20 years or older with self-reported diabetes, 67% had blood pressure greater than or equal to 140/90 mmHg or used prescription medications for hypertension.

Blindness

• Diabetes is the leading cause of new cases of blindness among adults aged 20–74 years.

• In 2005-2008, 4.2 million (28.5%) people with diabetes 40 years or older had diabetic retinopathy, and of these, almost 7 million (4.4% of those with diabetes) had advanced diabetic retinopathy that could lead to severe vision loss.

Kidney Disease

• Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2008.

• In 2008, 48,374 people with diabetes began treatment for end-stage kidney disease in the United States.

• In 2008, a total of 202,290 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States.

Neuropathy

• About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage.

Amputation

• More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

• In 2006, about 65,700 nontraumatic lower-limb amputations were performed in people with diabetes.

Morbidity and Mortality associated with diabetes:

In 2007, diabetes was listed as the underlying cause on 71,382 death certificates and was listed as a contributing factor on an additional 160,022 death certificates. This means that diabetes contributed to a total of 231,404 deaths.

Cost of Diabetes

The total cost of diagnosed diabetes in the United States in 2007 was $174 billion, with $116 billion for direct medical costs, and $58 billion for indirect costs (disability, work loss, premature mortality). After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes.  Does anyone see the economic benefit for prevention here?

The American Diabetes Association created a Diabetes Cost Calculator that takes the national cost of diabetes data and provides estimates at the state and congressional district level.  Factoring in the additional costs of undiagnosed diabetes, prediabetes, and gestational diabetes brings the total cost of diabetes in the United States in 2007 to $218 billion.  In my lovely borough of Brooklyn, in the 11th Congressional district where I live, the total cost of diabetes for people in Congressional District 11 in 2006 is estimated at $551,100,000. This estimate includes excess medical costs of $376,200,000 attributed to diabetes, and lost productivity valued at $174,900,000.  For the entire state of New York in 2006, the cost is estimated at $12,860,000,000. This estimate includes excess medical costs of $8,676,000,000 attributed to diabetes, and lost productivity valued at $4,188,000,000.  So clearly, this is a chronic disease that can wreck havoc on someone physically if they aren’t maintaining it, but the costs associated with this disease is astronomical.

I could have used cancer, heart disease, or some other chronic diseases in the same vein to prove what should be obvious to everyone.  It cost so much more to our government and our society to be chronically ill than to take a comprehensive policy approach to preventative healthcare in this country.  The Obamas have worked hard to create an awareness of this through Mrs. Obama’s “Let’s Move” initiative, but we have to do more as leaders.  As Americans we need to change our mindset and relationship to food and we need to demand that our leaders on both sides of the aisle engage in real leadership by reforming how health care policy is done in America.

So you’ve hit a plateau… NOW WHAT???

So you’ve gone through all the proper steps in your weight loss journey – you’ve assessed your weight loss readiness (check), you have found the time to exercise (check), you are eating right (check).  It’s all groovy, you are  managing your nutrition and health – then BOOM!  You hit a wall.  THE WEIGHT LOSS PLATEAU!!!! (wah!) That confounded weight loss plateau that all of us hit sooner or later and get frustrated about… but what happens here? Many of us revert, many of us fall back into old habits, sometimes out of fear, frustration, anger (insert emotion here).  Sometimes we indulge in treats to pat ourselves on the back for a good job.  So how do you know when you hit a plateau and what do you do when you hit it?

Let’s look at what a weight loss plateau is and what is means  for your body (and in keeping it real with ourselves, just to make sure you are actually hitting a plateau rather than cheating/patting yourself on the back.  What? Just saying).

My good friends at the Mayo Clinic  of course have the answers to these questions and more.  They are a great resource for you on your weight loss journey and you’ll notice, I reference them often.  Here, I am just asking the questions and they provide all the answers.

What is a weight-loss plateau?

A weight-loss plateau occurs when you no longer lose weight despite continuing with your exercise and healthy-eating habits. Being stuck at a weight-loss plateau eventually happens to everyone who is trying to lose weight. At that point, losing additional weight becomes more difficult. Although hitting a plateau is common, most people are surprised when it happens to them, believing that if they just maintain a reduced-calorie diet, they should continue to lose weight. The frustrating reality is that even well-planned weight-loss efforts can become stalled.

Akilah’s Editorial: If you are losing a lot of weight (50+ pounds) it is conceivable that you will hit a weight loss plateau more than once.  Your body is attempting to adjust to the new metabolic rate, the fact that your body may have become accostumed to exercises, etc.  So be prepared and know what to do.  How do you know what do you? Understand what causes the plateau…

What causes a weight-loss plateau?

The progression from initial weight loss to a weight-loss plateau follows a typical pattern. During the first few weeks of losing weight, a rapid drop in pounds is normal. When calories from food are reduced, the body gets needed energy by releasing its stores of glycogen, a type of carbohydrate found in the muscles and liver. Glycogen holds onto water, so when glycogen is burned for energy, it also releases the water — about 4 grams of water for every gram of glycogen — resulting in substantial weight loss that’s mostly water.

A plateau occurs because your metabolism — the process of burning calories for energy — slows as you lose lean tissue (muscle). When you lose weight, you lose both fat and lean tissue. (The notion that overweight people have a slower metabolism is a myth. In general, the higher a person’s weight, the higher the body’s metabolic rate.) Your weight-loss efforts result in a new equilibrium with your now slower metabolism. This means that in order to lose more weight, you need to increase activity or decrease the calories you eat. Using the same approach that worked initially will maintain your weight loss, but it won’t lead to more weight loss.

Akilah’s Editorial: In order to continue losing more fat, you will have to change your activity.  If you are into yoga, rev up your strength training.  Increase the time spent on cardio. Instead of working out 3x a week at 30 min, try 4x a week for 45 min.  Changes and increases in the types of activity you do will help tremendously… coupled with lowering your caloric intake will change how your body functions and if done healthfully get you through your plateau. I would recommend talking to your doctor and nutritionist about changes to your exercise and eating program.

How can you overcome a weight-loss plateau?

If you’re at a plateau, you may have lost all of the weight you will given the number of calories you’re eating each day and the time you spend exercising. At this point, you need to ask yourself if you’re satisfied with your current weight or if you want to lose more, in which case you’ll need to adjust your weight-loss program. (Akilah’s editorial: You may have to do this several times before you hit your weight goal target depending on how much you are trying to lose.)  If you’re committed to losing more weight, try these tips for getting past the plateau:

• Reassess your habits. Look back at your food and activity records. Make sure you haven’t loosened the rules, letting yourself get by with larger portions or less exercise.
• Cut more calories. Reduce your daily calorie intake by 200 calories — provided this doesn’t put you below 1,200 calories. Fewer than 1,200 calories a day may not be enough to keep you from feeling hungry all of the time, which increases your risk of overeating.
• Rev up your workout. Increase the amount of time you exercise by an additional 15 to 30 minutes. You might also try increasing the intensity of your exercise, if you feel that’s possible. Additional exercise will cause you to burn more calories.
• Pack more activity into your day. Think outside the gym. Increase your general physical activity throughout the day by walking more and using your car less, or try doing more yardwork or vigorous spring cleaning.

The MOST IMPORTANT thing in addressing any plateau is NOT to go back into old habits that are harmful to your work and health.  If you are hitting a genuine plateau, that says you’ve come so far, why go back to bad habits.  Consider this a time to challenge yourself further, change your exercise, try jogging, train for a sprint triathelon, learn to swim, play tennis, do something that is better for your mind and body that will allow you to continue to meet your goals.

Good luck!

Finding Time to Exercise

Now that we’ve done the self-assessment to determine weight loss readiness here and you’ve determined that you are ready to shed the extra weight, let’s talk about another challenge that we often face in our weight loss journey…  Finding time to exercise (thank you Melinda Alexis-Hayes for the idea)…

Many of us often do not exercise because we say we can’t find the time for it or life is too busy right now (insert excuse here).  It’s time for a reality check…  You CANNOT lose weight and get healthy without exercise.  You can lose some weight changing your eating habits but if you want to see real change, you HAVE to incorporate exercise into your life on a regular – at minimum 2 hours a week – basis.  Optimally, you want to work out 5-6 times a week and incorporate strength training into the mix.

So, you know how much you are supposed to exercise, again, how do you get past the everyday of your “everyday” work, stress, family, obligations, etc.  What do you do in order to find the time to exercise? Well, here’s my list:

Put aside your excuses.  Just stop making them, put them aside.

Make it a priority. You make time to eat, sleep, and potty.  Exercise should be on that list of priorities.

Don’t get frustrated.  People always like to see immediate results and that’s not how it works.  You gained weight over time, you lose weight over time.

Wake up early. If coming home and working out seems to be inconvenient, then perhaps getting up early will give you the time you need to be good to yourself.

Do your chores! Yes, cleaning the house thoroughly (mopping, sweeping, scrubbing stoves and floors) burns lots of calories.  Washing dishes and cooking burns calories.  You could have a clean house and get your exercise in simultaneously!

Maximize time.  Want to watch television? Fine, but don’t just sit there.  Stretch, do your crunches, use hand weights, do planks, ride a stationary bike, whatever works for you, but get it in while you are watching that episode of Mob Wives, Basketball Wives, Housewives of NJ/ALT/NY/OC, A Tale of Two Wives…

 Or skip the tv and workout during lunch or before heading home after work.

Incorporate family time into your workout.  During the summer, my daughter and husband (and I) like to eat ices.  So we all walk 30 minutes to the nearest Uncle Louis’ frozen ice /ice cream shop and eat our ices walking another 30 minutes home.  Or when in a pinch, my kid rides her bike 3 miles while I jog trying to catch up (she is a sadist because she loves this).  Play tag, play hide and seek, not only will you bond with your kid, but get to burn calories.

Find a buddy. If you are like me, you would much rather workout solo than with people.  But some people really need a buddy and finding one creates co-accountability and support.

DANCE! Zumba, dancing, salsa, dancing with your kids, partner, etc…  These are all great ways of creating opportunities for fitness.  Or just dance with your daughter.  I grab brushes and my daughter and I sing and dance and sweat.  Then mommy gets to relax while mini me crashes for the night. 🙂

Avoid boredom! Netflix and your local library have fitness dvd’s that allow you to change up regularly so your routine aren’t so routine.

Get a trainer. If you are spending money on a trainer, he/she will hold you accountable for showing up.

Do it differently with the little things. Instead of taking the elevator at work or home, take the stairs.  Instead of sitting on the train, stand.  All of these little changes add up to calories burned.

Keep it short. Keeping exercise to 20-30 minutes a few times a week will allow you to get your workout in with less time.

Invest in equipment. If you think that you need a bowflex or something to help you get into the groove of exercising, I say go for it if it makes it easier for you.

Now, if you absolutely CANNOT find a way to fit in exercise into your life after this, then I don’t know what to tell ya… Good luck!