Healthy Weight Week: January 21-27

It seems as if our culture is obsessed with body weight. We are bombarded with reports of an obesity epidemic on one hand and on the other hand, we hear of models getting kicked off the runways for being too thin. The Healthy Weight Network asks us to observe Healthy Weight Week, but what is "healthy weight"? The first thing you need to know is your Body Mass Index (BMI). The Centers for Disease Control (CDC) provides a BMI calculator for adults (click here to calculate) and children (click here to calculate for kids and teens). Acceptable BMI for kids is about 15 and for adults, BMI should fall between 19 and 26. If your BMI is too low, try eating six healthy meals per day. If your BMI is over 27, the equation is simple: eat less and excercise more!

The economic impact of obesity to individuals and the nation is sobering. In 1998, national medical expenses for excess weight (BMI 25–29.9) and obesity (BMI greater than 30), accounted for almost ten percent of total U.S. medical expenditures, or $92.6 billion in 2002 dollars, according to a CDC study. The Yale University Rudd Center for Food Policy and Obesity reports that as much as 7 billion dollars is spent annually on advertising junk food directed at children. The Federal Trade Commission (FTC) reports that Americans spend 1 billion dollars on weight loss products annually. Salt Lake Tribune reporter Sheena McFarland chronicles her weight loss in her blog, The Incredible Shrinking Sheena. Obsession with being skinny carries a steep price, too. Brazilan model Ana Marie Reston, with a dangerously low BMI of 13.1, died in November 2006 due to complications of anorexia nervosa. The New York City Metropolitan Transit Authority (MTA) reported that sick passengers, most of them fainting from dieting, are the major cause of train delays in that city. Emergency responders state that people go three to four days without eating to try to lose weight. Don't waste your hard earned dollars on snack foods or weight loss products!

Tennessee, with the fifth largest obese population in the U.S., has developed the TennCare Weight Watchers Partnership Program to promote healthy behaviors among its citizens over age 10 with a BMI greater than thirty and to reduce costs of their Medicaid program. West Virginia, with 64 % of the population designated as obese, has followed suit. . Check out this nifty graphic from CNN to see how your state ranks in promoting healthy weight in all age groups. To maintain or achieve a healthy weight, set simple achievable goals and be consistent with one or two goals for a period of three to four months. Try these tips:

• Park a mile or two from work and walk to and from work every day. If you use public transportation, get off at a stop a mile or two from your jobsite and walk. Get out at lunch and take a walk.
• Choose fruit, nuts or popcorn over snack foods. You may think of nuts as being high in fat, but the fat in nuts is good fat. Nuts also have micronutrients not available in other foods. Drink water or tea rather than packaged drinks. It's good for the environment and good for your body!
• Take three deep breathes, change positions every hour and stretch.

Happy Healthy Weight Week and good luck with your goals!

Photo courtesy of Celeste33 at Creative Commons.

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Economic Impact of Birth Defects: Folic Acid Awareness

January is Birth Defects Prevention Month and the Centers for Disease Control and Prevention (CDC), in conjunction with the Agency for Healthcare Research and Quality (AHRQ) has published a statistical brief of the economic impact of birth defects. AHRQ has found that in 2004, US hospitals spent $2.6 billion treating birth defects related problems. The average age for hospitalization to treat a birth defect related problem is 17.6 years, compared to 50 years for all other hospitalizations. AHRQ reports that 50% of the costs are spent treating cardiac and circulatory problems. Heart defects have the greatest economic impact to families and the US. Between 1997 and 2004 hospitalizations for these conditions increased by almost 30%.

AHRQ sponsors the Healthcare Cost and Utilization Project (HCUP), an aggregation of health care databases and software tools developed via a partnership of Federal-State-Industry. These databases include hospital care data collected nationally since 1988 and facilitate research on health policy issues and health care practices at federal, state, and local levels.

President of March of Dimes, Dr. Jennifer L. Howse, has urged the US Food and Drug Administration (FDA) to support an increase in folic acid supplementation in foods to prevent neural tube defects such as spina bifida. The US Public Health Service advocates that if all women of childbearing age consumed more folic acid before and during pregnancy, 70% of neural tube defects could be prevented. This week, the National Council on Folic Acid asks us to observe National Folic Acid Awareness Week. Folic acid can be found in whole grains, citrus fruits and green, leafy vegetables and beans, but has been a supplement to most grain based products in the US since 1998. It is a B vitamin that can also be taken as a supplement. The NIH reports that researchers at National Institute of Environmental Health Sciences (NIEHS) have found that increased folic acid intake by pregnant women decrease the incidence of another birth defect, cleft lip and palate. At the other end of the spectrum of life, The Journal of the Alzheimer’s Association, Alzheimer’s and Dementia, published a study indicating that folate supplements appear to protect against the disease. Check out the Brain Healthy Diet recommendations from the Alzheimer’s Association! Look for research on the rising cost of this health problem from the Association to be released the end of February.

Photo courtesy of Merlix at Creative Commons.

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National Wear Red Day

The first Friday in February is the day we all get to wear something red to work. What? Is our work attire now being dictated to us? Are we still in America? Why red? "It's just not my color!" you say. Well, yes, we are still in America and no, wearing red on that day isn't mandatory. It is however a great way for us to show support for the women in our lives by reminding them to get heart healthy.

Typically women tend to be all about the heart; we get involved in matters of the heart very easily, want to know where someone's heart is on an issue, we give our hearts away...and on and on. But do we know the heart truth? That heart disease is the number one killer of women. It's true, check it out at the hearttruth website. So why red? Red symbolizes many things - danger, heat, power, love, etc. - it indicates courage and is often used to incite people to make quick decisions (think "buy it now" button). Women tend to be the caregivers and nurturers, often putting their own needs behind all the other responsibilities they have. Here's a chance for us to honor the women in our lives whose hearts have touched ours and encourage them to get heart healthy - quit smoking, start a fitness routine, eat a healthy diet, get screened, etc.

The National Wear Red Day is an awareness campaign to inform women about heart disease; the word is getting out but for the most part women still need to wake up to the reality of the risk they are at, it's not just a man's disease anymore. Help spread the word, sound your own "red alert" and wear something red on February 2nd 2007, and tell a woman whose heart you care about that you did and why.

Photos Courtesy of Darwin Bell and Peter Kaminski's photos

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Preventing Vision Loss from Glaucoma

More than 2.2 million Americans have it, and there are at least 65 million cases worldwide. The disease is glaucoma, an eye disorder that frequently robs people of their peripheral vision; left untreated, it can result in blindness. In fact, glaucoma is the second leading cause of blindness worldwide. Worst of all, at least half of those who have the disease are not yet aware that it has taken hold.

In order to raise awareness of the disease, the Prevent Blindness America organization along with several other leading eye care groups have dubbed January 2007 National Glaucoma Awareness Month. Prevent Blindness America is the number one volunteer eye health and safety organization in the United States.

Glaucoma is a disease that damages the optic nerve. The optic nerve contains all of the connections between our retina and our brain. The connection of our eyes to our brains is absolutely necessary for sight to occur. Without our optic nerves, we would never see the images that the outside world projects onto our retinas.

In most cases of glaucoma, damage to the optic nerve results from increased pressure inside of the eye. Yet, in the vast majority of these cases, the pressure inside of the eye increases slowly, over several years. Therefore, glaucoma is usually a disease with no symptoms at all, until partial or even a complete loss of vision occurs. Despite the advances of modern medicine, we still have no way to repair vision loss once it happens. This is why early detection and treatment of glaucoma is so critical.

Anyone can get glaucoma, from infants to the elderly. However, the risk of developing the disease increases with age. Race is another risk factor for glaucoma: Black Americans are four to five times more likely to develop glaucoma than most other ethnic groups; Hispanic Americans are also at increased risk. If a relative has ever been diagnosed with glaucoma, this also predisposes one to the disease.

In late 2005, the American Academy of Ophthalmology revised its guidelines with regard to screening for eye diseases that often present without symptoms:

If you are under 40 without race or family history as risk factors, you should schedule a routine appointment with an ophthalmologist once every five years. Between the ages of 40 and 64, appointments should be scheduled once every two years. At or above the age of 65, the recommended frequency increases to once per year.

If you are Black or Latino or if you have had a relative with glaucoma, it is recommended that individuals under the age of 55 make a routine visit to an ophthalmologist once every two years. Between the ages of 55 and 64, appointments should be booked once per year. At the age of 65 and above, the recommended screening interval is once every six months.

What can you expect at these routine visits? Eye doctors will want to check for three things: damage to the optic nerve, loss of vision, and increased eye pressure. Perimetry is a procedure which involves staring straight ahead at a light, while attempting to spot other lights with your peripheral vision. Tonometry involves eye drops which numb the eye, followed by the use of an instrument which gently presses on the outside of the eye in order to estimate pressure inside of the eye. Doctors will also want to use eye drops to dilate the eye. In this way, they will be able to visualize your optic nerves.

Following a routine examination, should there be signs of glaucoma or increased eye pressure, your ophthalmologist may prescribe treatments in order to prevent damage to your eyes. Such treatments most commonly involve medicines, either in the form of eyedrops or pills. Laser sugery and traditional eye surgery may also be options, depending on the stage and type of disorder that may be found.

Prevent Blindess Image Courtesy of Prevent Blindness America

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Some Symptoms of Functional Thyroid Disease

Thyroid disease is an everyday reality for over 27 million people in the United States. Within this enormous group, it is estimated that more than half remain undiagnosed and untreated. Iodine deficiency causes significant thyroid problems for many more millions of individuals worldwide. It is for these reasons, in my opinion, that Thyroid Awareness Month is so critical.

Thyroid Awareness Month began in 1995 as a joint effort by the American Association of Clinical Endocrinologists and the American Thyroid Association. This year, these two organizations are making a particularly strong effort to increase awareness of the symptoms most frequently associated with thyroid disorders. It is in this spirit that I hope to engage our readers in reviewing some common manifestations of thyroid malfunction.

The thyroid gland is a small, butterfly-shaped gland located at the front base of your neck. The workings of the thyroid are often likened to the engine of a car: normally, the gland releases the just the right amount of thyroid hormone, which is required for the cells of your body to function. For fuel, your thyroid-engine uses iodine, which must be obtained from food or from supplements. Like the accelerator and the brake on an automobile, the thyroid takes direction from the pituitary and from the hypothalamus. These areas of the brain signal the thyroid gland to produce more or less hormone, depending on your body’s energy state.

Sometimes, the thyroid may not be able to meet the body’s demand for thyroid hormone. This condition is known as hypothyroidism; it represents an entire group of possible disorders. Some common symptoms of hypothyroidism are listed below:


§ Constant and Persistent Fatigue
§ Forgetfulness
§ Dryness of nails, hair, and skin
§ Constipation
§ Muscle Soreness
§ Fluid Retention or Weight Gain
§ Heavy or Irregular Menses
§ Cold Intolerance
§ Hair Loss


At other times, the thyroid gland overproduces thyroid hormone, even when the body clearly has enough. This condition is known as hyperthyroidism, and it also represents several potential disorders. Some common symptoms of hyperthyroidism are as follows:


§ Persistently Fast Heart Rate
§ Anxiety
§ Hand Tremor
§ Unintentional Weight Loss
§ Heat Intolerance
§ Hair Loss
§ Fatigue
§ Frequent, Loose Bowel Movements
§ Increased Sweating
§ Heavy or Irregular Menses


Notice that although these conditions affect thyroid hormone release in opposite ways, they do share some symptoms in common. Importantly, persistent or unusual fatigue is the most frequent complaint for both conditions. Additionally, abnormal swelling of the thyroid gland, known as a goiter may be seen in either condition.

Thyroid disorders can strike anyone, at any stage of life. However, they occur more frequently in women, and they tend to run in families. Please be sure to speak with a health care professional if you believe that you may be at risk for thyroid disease, and you are also experiencing symptoms. If you are already being treated for a thyroid disorder, please make sure that you understand and follow the instructions given by your health care provider.

After all, if your engine isn’t working right, how can you?

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New Recommendations for Prenatal Testing

When I was a student doing a clinical rotation through the obstetrics unit, one of my memorable patients was Baby Boy M. Actually, it was his mother, Mrs. M., who I can never forget, with her long red hair and intelligent eyes behind studious, dark-framed glasses. It fell to experienced staff members to inform her before discharge that her darling baby boy had Down syndrome, a chromosomal birth defect resulting in mental retardation, heart defects and distinct physical characteristics. She certainly fit the profile – she was 36 years old, gravida 4, para 4 (four pregnancies, four live births). Mrs. M. accepted the information patiently and with no trace of disappointment, the way mothers have been accepting grave news about their children since the origin of our species. Baby Boy M. and his mother were sent home, armed with referrals and resources. As a young girl in Pennsylvania, one of my neighbors was an adult woman with Down syndrome, who lived quietly with her aging parents, doing little chores around the house and yard. We all meet charming people with Down Syndrome and other birth defects throughout our lives and as we mature we accept them as being like everyone else, just different in some predictable ways. Looking at this picture of a beautiful little girl, it is easy to see that a child is a child is a child.

Some people do not feel up to the challenge of raising a child with birth defects. Certainly, the challenge of raising any child is daunting enough for most of us! The March of Dimes asks us to remember January as National Birth Defects Prevention Month. Their website provides a list of recommended Prenatal Tests and the timing for scheduling these. On January 2, 2007, the American College of Obstetrics and Gynecologists (ACOG) announced new recommendations for screening all pregnant women for Down syndrome. Genetic counseling and testing for Down syndrome has been offered to all pregnant women over the age of 35, as the incidence of the defect, caused by an extra chromosome in the maternal egg, increases with the age of the mother. The decision to have the testing was fraught with difficulty as an amniocentesis increases the risk of spontaneous abortion, or miscarriage. If the test is positive, the parents are faced with making a decision about terminating the pregnancy. As a result of the screening offered to older pregnant women, the incidence of Down syndrome has decreased. The new guidelines propose that less invasive testing be done – ultrasound to measure the thickness of the neck of the fetus (nuchal translucency or NT) and a blood screening test analysis of two proteins in the mother's blood called beta-hCG (human chorionic gonadotropin) and pregnancy-associated plasma protein A (PAPPA). First-trimester screening between 10 and 14 weeks of pregnancy detects about 80% of fetuses with Down syndrome. If the tests done in the first trimester of pregnancy indicate increased risk of Down Syndrome, ACOG recommends the parents be offered genetic counseling, amniocentesis and chorionic villi sampling (CVS).

Image courtesy of chokole.

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January is National Blood Donor Month

I wrote a report for biology class in eighth grade about blood, based on the book Blood: The River of Life. Maybe it influenced my career choice - the subject continues to fascinate me. How many people know that the phrase "I wouldn't touch it with a ten foot pole" stems from an ancient taboo about menstruation? When women were menstruating, it was forbidden to touch or even look at them. They were isolated in huts and meat was delivered to them via a ten foot pole. Blood is the very substance of life, and throughout human history we have both revered and feared it. Dr. James Blundell, an obstetrician from London, performed the first human to human blood transfusion in 1818 to treat a woman with post partum hemorrhage. Transfusion medicine has grown over the past 200 years into a subspecialty of medicine.

Today, blood transfusion is something we almost take for granted, but there is actually quite a bit of controversy surrounding this health matter. US blood banks no longer accept donors who have spent time in Britain or Europe in an attempt to prevent transmission of Creutzfeldt-Jakob disease (vCJD), the human form of "mad cow disease." The FDA continues to recommend that any males who report any homosexual activity be banned from making donations. Women with heavy periods are often anemic and people with low hemoglobin levels are not accepted as blood donors. Only people over the age of 17 and weighing more than 110 lbs. are eligible to donate blood. Other requirements for donors change frequently and the American Red Cross has up-to-date information about who is eligible to give blood and this organization reminds us that January is Volunteer Blood Donor Month. In 1997 World Health Organization (WHO) introduced proposals for unpaid, voluntary blood donation policies to be adopted internationally, and today, most blood is donated by volunteers.

AABB (which is not an acronym for anything) asks us to start out the year remembering the importance of donating blood. With the busy rush of the holidays, the supply of blood to save lives due to trauma or illness gets depleted. AABB states that one pint of donated blood can save three lives! AABB is seeking to standardize procedures for transfusion medicine in blood banks around the world. If you are anticipating surgery, you may want to consider autologous blood donation, or replacement blood donation, which is donating blood to yourself. There are professional donors who get paid for blood donations. As things stand now, blood donation is on the honor system; it is up to the donor to disclose their health history honestly. China’s Ministry of Health has adopted an aggressive policy to boost its supply of safe blood, and reports increasing its donated blood from 22% in 1978 to over 85% today.

If you don't know where to go to donate, AABB's website provides a nifty locator helper if you click this link.

Image courtesy of lordog.

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Some Cervical Disorders and Their Prevention

For women worldwide, cervical cancer is the third leading cause of death from cancer. In addition, cervicitis and condylomata can be significant problems for many women during their lifetime. Because January 2007 is Cervical Health Awareness Month, I thought it appropriate to review some aspects of these cervical disorders, with a focus on their prevention.

While the uterus is almost entirely made of smooth muscle, its lowermost portion, the cervix, is primarily composed of dense, fibrous material. This structural difference allows the cervix to play a critical role in pregnancy: the cervix remains tightly closed throughout gestation, thinning and opening at just the right time to allow for birth of the baby. Unfortunately, it is this unique makeup of the cervix which also predisposes it to disease.

Cervicitis is a painful inflammation of the cervix, most often caused by infection. The condition is common, affecting more than half of all women at some point during their adult life. Most cases of cervicitis are due to an overgrowth of bacteria which are normally present in the vagina. Sometimes, cervicitis can be caused by sexually transmitted diseases such as Chlamydia, Gonnorhea, Trichomonas, Herpes Virus, or Human Papilloma Virus. Painful intercourse, persistent vaginal discharge, and aching pelvic pain are some common symptoms of cervicitis. Many cases can be resolved with a simple course of antibiotic therapy.

Human Papilloma Virus (HPV) is the most common sexually-transmitted infection in the United States, affecting approximately one third of the sexually active adult population. HPV is transmitted through sexual intercourse. Although it usually causes no symptoms, certain strains of HPV can cause changes in the cells of the cervix, which may, over time, lead to cervical cancer. Pap smear screening has had a dramatic impact on the incidence of cervical cancer, as pre-cancerous changes can be detected and treated before cancer has a chance to develop.

HPV is also the cause of condylomata, or venereal warts. When these warts develop on the cervix, they rarely cause symptoms. However, when cervical condylomata are discovered during a pelvic examination, they indicate that one may be at a higher risk for developing pre-cancerous changes. Warts that develop below the level of the cervix are more frequently symptomatic, causing itching, burning, and discomfort during intercourse. Venereal warts that cause such symptoms may be treated with medicines, or with surgery.

Risk factors for the development of cervical disease include: having intercourse at an early age, having multiple sexual partners, and smoking. Prevention of cervical disease is therefore aimed at modifying these risk factors. Although condoms may help to reduce the transmission of HPV, the risk of spreading infection to sexual partners is still significant, since the virus often infects skin cells at the genital bases, which may remain in contact between partners even when a condom is properly used.

For the prevention of cervical cancer, the importance of regular pap smears cannot be overemphasized: if no previous changes have been noted, pelvic examinations should be performed once a year, beginning at age 18, or at the age of onset of sexual activity; if cervical changes have been noted, your health care provider will likely recommend more frequent follow-up.

On June 8, 2006, the US Food and Drug Administration announced a very exciting development: the approval of the first vaccine intended to prevent HPV infection. The new HPV vaccine has been designed to prevent infection with the strains of the virus that have been most frequently associated with the development of cervical disease and venereal warts. The HPV vaccine is currently approved for use in females from 9 to 26 years of age. This vaccine shows great promise toward reducing the development of cervical disease, especially cervical cancer.

For more information on maintaining cervical health, and on Cervical Health Awareness Month, please visit the National Cervical Cancer Coalition at: http://www.nccc-online.org/awareness.php.

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