The Fat Land

Obesity is a disease.

About 40 per cent of Canadian forces members consider themselves fat.

About 48 per cent of Canadian children seven to 12 years old eat junk food for an afternoon snack.

About 50 per cent of Canadians are overweight compared to 61 per cent of Americans who are overweight.

About 25 per cent of all Americans under 19 are overweight, a figure that has doubled in 30 years.

World Health Organization estimates that in the most industrialized countries; at least one-third of all disease burden is caused by tobacco, alcohol, blood pressure, cholesterol and obesity.

Compare this to developing countries of the world; underweight alone accounts for over three-million childhood deaths a year.

Some die because they have too much to eat; others die because they don’t have enough to eat.

“Fat Land: How Americans Became the Fattest People in the World,” is a book recently published by Houghton Mifflin and is written by Greg Critser. I saw the book’s review in the British Medical Journal (BMJ) and found the information interesting. Here are some interesting observations.

Critser blames the obesity epidemic on President Richard Nixon and his Secretary of Agriculture, Earl Butz, who in 1970s delivered everything that the modern American consumer had wanted – plenty of cheap, abundant, and tasty calories.

This was done by vastly increasing corn production and thus boosting the manufacture of high fructose corn syrup used in sweetening cola drinks.

New technologies converted cheap imports of palm oil, into a viable commercial fat, one fit for everything from frying chips to making margarine to baking cookies and bread and pies.

Food became cheap. We saw the introduction of “super-sizing” of portions (“value meals”) 12 ounce Cokes, the Big Mac, and jumbo fries.

Fast food companies penetrated school lunch programmes by providing foods high in fats and sugars.

By 1999, 95 per cent of 345 California high schools surveyed were offering branded fast foods as a la carte entrée items for lunch.

Social forces have also expanded our waistline.

We work long hours, spend lot of time commuting, we don’t sweat much at work, we snack a lot, children spend more time watching television, playing on the computer and the video games.

Physical education does not get a priority in schools, and the rates of childhood obesity and type 2 diabetes continues to increase.

What can we do about it?

Critser suggests reform of grade school lunch programmes, more physical education in schools and after school programmes, and involvement of parents of obese children in nutrition education.

What about obese middle aged and older men and women?

In a letter to the BMJ editor, a doctor suggests that obesity may be controlled in older people by more sexual activity which would replace gratification derived from eating and drinking, a sort of reversal of the libidinal shift from genital sexuality to the alimentary tract exhibited in advancing age.

Wow, not a bad idea! Have you tried it lately?

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High Blood Pressure

Hypertension (high blood pressure) is one of the diseases of mass destruction.

World Health Organization says that hypertension causes 7-million premature deaths worldwide each year.

It is estimated that 25 percent of the 42 million people with high blood pressure in the United States are unaware that they have hypertension.

Hypertension affects 22 percent of Canadians.

If untreated, hypertension is deadly.

Hypertension can damage your heart, brain, kidneys, and retina. You may have high blood pressure but may have no symptoms. It is a silent killer.

For close to 100 years, it is known that hypertension causes premature death. That is why it is important to have blood pressure checked on a regular basis.

Why is hypertension on the rise (pardon the pun!)? Partly because we are eating more and moving less. And we are living longer. Our blood vessels become harder and less compliant with age. When the blood is pumped out of the heart into less compliant blood vessels, the blood pressure goes up. So the heart has to work harder – and eventually it becomes tired, weak and fails.

Normally, systolic blood pressure should be less than 140 mm Hg (mercury) and diastolic pressure of less than 90 mm Hg. It is written as – systolic over diastolic (for example 120/80 mm Hg).

Blood pressure is lowest in the early morning, rises as the day progresses, and then dips down during the night and earliest hours of the morning.

Blood pressure also varies from minute to minute, depending on levels of stress and physical activity.

“White-coat hypertension” means a person’s blood pressure is up in the doctor’s office but not elsewhere.

Hypertension can be prevented and treated with lifestyle changes – with or without medication.

Eat a healthy diet, lose weight if you are overweight, do not smoke, limit alcohol intake, eat a low salt diet, minimize sugar intake, do regular exercise, relax and learn to manage stress with laughter and meditation.

Here is a medical joke to reduce your blood pressure. It was published in Stitches, a humor magazine for doctors.

A motorcycle mechanic was removing the cylinder head from a Harley Davidson’s engine when a well-known heart surgeon came into the shop. The doctor was waiting for the service manager to have a look at his bike.

“Hey Doc, can I ask you a question?” the mechanic called out. The surgeon was bit surprised but walked over to the mechanic.

The mechanic straightened up, wiped his hands and said, “So, Doc, my job is just like yours. Look at this motor, I open it up and take out the valves, fix them or put in new parts, and when I’m done it will run like a new one. So how come I work for almost nothing and you get the really big bucks when you and I are doing basically the same work?”

The surgeon thought for a moment, then smiled, leaned over and said, “Try doing it while the engine is running.”

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Alcohol

“The premier now knows, or has been reminded, that misery is real and can and does happen to anyone. No matter how hard you work, how smart you are, how right you think, bad things happen”, writes Paul Sullivan, a columnist with the Globe and Mail and a reformed alcoholic for 21 years.

By the time this column appears, Gordon Campbell may still be premier of British Columbia. But almost every Canadian now knows who he is and what he did.

Was it a momentary lapse of judgment while under the influence of alcohol? Or an act of irresponsibility (while under the influence of alcohol) which could have endangered his and other people’s lives?

Let us briefly remind ourselves of the good, the bad and the ugly side of alcohol.

What is good about alcohol?

-Alcohol reduces sickness and death from coronary artery disease
-Makes the blood thinner
-Reduces the incidence of Alzheimer’s disease and dementia

What is bad about alcohol?

-Alcohol causes fetal alcohol syndrome in the new born
-Causes cirrhosis of liver, liver failure and pancreatitis
-Causes gastritis and bleeding
-Causes cancer of the esophagus, breast and other cancers
-And is very heavy in useless calories

What is ugly about alcohol?

-Alcoholism is considered a disease
-It is a compulsive addictive behavior
-It is a drug with complex behavioral effects
-It causes traffic or work related accidents
-It is a major cause of death and disability
-It destroys a person’s personal life, family life and capacity to earn a decent living

The good side of alcohol is sometimes abused by individuals who get addicted to it. Therefore physicians are reluctant to encourage or promote alcohol as a panacea for major health problems.

Critics of alcohol use say that much of the protective effect gained from alcohol use in coronary artery disease can be achieved by other means – exercise, diet, avoiding smoking, and control of cholesterol level.

What is moderate drinking? Is it one, two, or three drinks a day? It depends on how much you are used to drinking. Moderation for a non-drinker is different than for a habitual drinker.

What is alcoholism?

The term alcoholism first appeared in 1849 in an assay written by a Swedish physician, Magnus Huss, titled “Alcoholism Chronicus”.

Alcoholism means excessive and repeated use of alcoholic beverages. Ten percent of the population is dependent on alcohol.

“Alcohol is like love: the first kiss is magic, the second is intimate, the third is routine. After that you just take the girl’s clothes off” – Raymond Chandler (1888-1959).

So, let us be smart and say, “No driving after more than two drinks of alcohol!”

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Preventable Diseases

I call them the diseases of mass destruction!

What are they?

They are preventable conditions that are killing millions of people prematurely.

Why?

Because too many of us are living dangerously. Around the world, 56 million people die each year. About 40 per cent of these deaths are due to top 10 preventable conditions. These conditions have been identified by the World Health Organization (WHO) in its report released last year. Here is the list:

1. Childhood and maternal underweight rates
2. Unsafe sex
3. High blood pressure
4. Tobacco use
5. Alcohol use
6. Unsafe water, sanitation and hygiene
7. High cholesterol levels
8. Indoor smoke from solid fuels
9. Iron deficiency
10. Obesity

The World Health Report 2002 represents one of the largest research projects ever undertaken by the World Health Organization. In collaborating with experts worldwide, WHO has collected and analyzed evidence that will have implications for global health for many years to come, says the report.

What is the goal of the report?

The ultimate goal is to help governments of all countries to raise the healthy life expectancy of their populations – from the poorest to the richest. Everybody stand to gain another five years or so of healthy life, says the report.

Here are some other important points from the WHO report:
-Health problems of developing countries are worse. For example, at least 30 per cent of all disease burden occurring in many developing countries, such as those in sub-Saharan Africa and South-East Asia, results from fewer than five of the ten risks listed above.
-Underweight alone accounts for over three million childhood deaths a year in developing countries.
-In the most industrialized countries of North America, Europe and the Asian Pacific, at least one-third of all disease burden is caused by tobacco, alcohol, blood pressure, cholesterol and obesity.
-More than three-quarters of cardiovascular disease — the world’s leading cause of death — results from tobacco use, high blood pressure or cholesterol, or their combination.
-High cholesterol causes more than 4 million premature deaths a year.
-Tobacco use causes almost 5 million premature deaths a year.
-High blood pressure causes 7 million premature deaths a year.

If preventive measures are undertaken to combat these diseases of mass destruction then the life expectancy can be increased on average about five years in developed countries and 10 years in developing countries.

In Canada, healthy life expectancy could increase by 6.5 years, from their current 69.9 years to 76.4.

The WHO report says that the cost of inaction is serious. If nothing is done, then most of the premature deaths will probably double by the year 2020.

Inaction should not be on our agenda this year.

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