Speaking of the health care system...

My area of nursing is in hospital case management. In my job, I track outcomes. Not just patient outcomes, but hospital and physician performance outcomes. There are a set of quality indicators that we track, which are similar to the ones that Medicare is tracking on hospitals nationwide.

Anyway, I was at a conference today, and the speaker was talking about these quality initiatives and outcomes tracking for grading physician performance. Of course, these quality measures are based on the treatment of chronic disease, as in heart failure, heart attack, diabetes, etc. At first, the speaker was focusing on "inpatient" care, but then started to talk about routine care in the clinic setting. Again, focused on the "evidence-based" treatment of diseases like diabetes.

Then, I heard what I thought was a possible "breakthrough" in the health care paradigm!

One doctor spoke up and said that treating a chronic disease like diabetes has nothing to do with quality care. The speaker asked what he meant by that. The doctor replied that if he were truly providing quality care, he would be more concerned with the PREVENTION of diabetes, rather than the CARE of diabetes.

Yippee! There are some that get it. Now, if they just "got" the Zone...

CranberryCat,

That is truly amazing and encouraging ! What was the reaction of his/your collegues to that ?

Although I could be accused of painting a "dark picture" constantly of the state of affairs of how medicine is practiced in America [ perhaps true - but just as "fair and UNbalanced" as how it is practiced : 95% INTERvention and 5% PREvention ] - however - as the cost of health care has started to put pressure on the "system" from all directions - [ It's just simply TOO EXPENSIVE and no one at the moment can figure out what to do about it ] - there has been slowly but surely developing a perception of the "unified" cost of obesity as it has reared it's ugly head in a NUMBER of diseases, and, there is a small but growing ember that obesity is a VERY PREVENTABLE DISEASE and the "prevention" methods ARE VERY INEXPENSIVE - that is - EDUCATION PRIMARILY.

NOT EXPENSIVE DRUGS AND MEDICAL PROCEDURES !

The awareness is just starting to creep in that a HUGE cost to the health care system could be sharply reduced with very [ relatively speaking ] inexpensive methods.

{ Hey kids - how about a government subsidy to the Zone Diet !!!!}

For the moment - there is some hope for the future.

... from the "END"Zone

E.Wally

ewally@verizon.net

E. Wally,
The reaction in the room was one of agreement from most everyone, that the emphasis should be placed on prevention.

But, in reality, it just isn't done that way.

We are hammering on the health care system, but that is only 1/2 of the problem. The other half has to be the individual willing to make the changes necessary to live a healthy lifestyle.

Unfortunately, you and I are only preaching to the choir.

There are a vast majority of Americans who are perfectly happy eating an Americanized diet, and would never consider changing. Even those doctors who have made attempts to educate, really only REACH a very small percentage of people who are willing to change their lifestyle.

The one doctor who spoke up at the conference yesterday stated that her focus is on prevention of diabetes, and when asked if she has been successful, unfortunately she admitted "NO". If she had the Zone as one of her tools (and I don't know her, so don't know if she does or not), then maybe she would be armed with the tools, but she still would need to have patients who are willing to comply.

Yes - I don't know which end of the "horse" you attack the problem from : even if the medical community, specifically your general practitioners where 90% of someone's medical care makes initial contact, HAD THEY BEEN EDUCATED as to using PREVENTION as part of how they practiced medicine - AND - in fact, PREVENTION and NUTRITION had been a significant part of their most extensive education - how incredibly difficult would it be to just "turn the tide" of American EATING HABITS !!!!!

************[What follows is actually the TITLE of an article in The Lancet medical journal - not my writing - the full article can be found at : http://www.zonediet.com/RESOURCES/F...**********


This is where Fighting Obesity Will Involve Politics As Well As Medicine

By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
September 29, 2005


Review
LONDON, Sept. 30-Winning the battle of the bulge, which is now a worldwide conflict, will take more than simply convincing patients to eat less and exercise more. It will also require winning a political war against the food industry.
That is the take home message hammered home again and again by writers of a review article in the October 1 issue of The Lancet.
In many countries, excessive calorie intake -- encouraged by the restaurant industry’s aggressive marketing of large-portion meals loaded with fats, sugars, and salts -- has overtaken lack of exercise as the leading contributor to obesity and overweight, according to David W. Haslam, M.D., of National Obesity Forum in Hertfordshire, England, and W. Philip T. James, M.D., of the International Obesity Task Force in London.


The prevention and treatment challenges posed by the global obesity epidemic are “overwhelming,”


[end of excerpt]

... so which end of the "horse" do you even begin to attack the problem from ?

... talk about an "immovable object" !

However - let's not just throw our hands up please, as much as it would be tempting to.

It is clear to me that ONE GOOD PLACE TO START would be MEDICAL SCHOOL :

Doctors educated prior to about 1960 were required to take ZERO courses on nutrition as part of their EXTENSIVE AND EXHAUSTING education !

AFTER about 1960 - ONE.

Don't you think that this says in a big way to a future doctor how important nutrition is and where it fits into their practice ?

... and the message is : IT DOESN'T

I truly perceive The Zone Diet, the "Zone" style of nutrition, the "Zone" approach to wellness, as an OASIS in the midst of the vast vapid desert called "the American Diet".


..from the "END"Zone [ some day ]

E.Wally

ewally@verizon.net

Here is another example of what our diabetic community is eating. This recipe is from "Diabetic Living Daily":
---------------------------------------------------------------------
Welcome to your healthy recipe of the day, from the editors of Diabetic Living Magazine and the Diabetic Living Diet. In partnership with EverydayHealth.com.


Berries with Custard Sauce
It's like a trifle without the cake! Instead of the sherry or orange liqueur that's used in traditional trifle, vanilla flavors our lightened custard dessert.

1/4 cup sugar or sugar substitute equivalent to 1/4 cup sugar
2 tablespoons cornstarch
1/8 teaspoon salt
1 3/4 cups fat-free milk
3 egg yolks, slightly beaten
1 teaspoon vanilla
4 cups fresh berries (such as raspberries, blackberries, blueberries, and/or halved strawberries)
---------------------------------------------------------------------

Any comments?

What stands out to me? (The sugar, the cornstarch)

The following illustrates how OBESITY has become a WORLD WIDE HEALTH ISSUE, how much of the blame falls on the food industry, and, what a difficult, difficult, fight it's going to be to bring under control – let alone reverse. Clearly, by direct implication, it is going to be just as difficult – if not SIGNIFICANTLY MORE SO, TO DEAL WITH ON AN INDIVIDUAL BASIS.

---------------- Which is what concerns us here !

This is one of the best articles I have read regarding the impact of the OBESITY EPIDEMIC. Unfortunately - for most people it will serve as an "eye opener" as to the extent of this problem: For example, are you aware that over 70% of the U.S. population is clinically overweight, and, in spite of government initiated efforts to at the least simply get this trend to level off - is getting worse, or, that according to a recent government sponsored study – just completed in summer 2008 – if, existing nutritional trends continue, ALL AMERICANS will be clinically overweight within 40 years !

ABOVE ALL ELSE THIS SAYS TO YOU AND ME :

That - whether we know it or not, whether we realize it or not, whether we like it or not - the "deck is stacked against" anyone attempting to maintain a sensible diet - and – THAT, is why it can very much "feel" like WE, or anyone, who consumes, or attempts to consume, food, that is GOOD for your health, in AMOUNTS that are GOOD for your health, at TIMES it is GOOD for your health - have something wrong - with – US !!!



The article in it's entirety appeared in the Lancet - one of the most respected medical journals in the world. The people who wrote the article and the many quoted are among the most respected in their fields. Keep in mind this is not coming from some crank with an axe to grind against the food industry.




Here goes :



Fighting Obesity Will Involve Politics As Well As Medicine

By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Rubeen K. Israni, M.D., Fellow, Renal-Electrolyte and Hypertension Division, University of Pennsylvania School of Medicine
September 29, 2005


Review

LONDON, Sept. 30-

Winning the battle of the bulge, which is now a worldwide conflict, will take more than simply convincing patients to eat less and exercise more. It will also require winning a political war against the food industry.

That is the take home message hammered home again and again by writers of a review article in the October 1 issue of The Lancet.

In many countries, excessive calorie intake -- encouraged by the restaurant industry’s aggressive marketing of large-portion meals loaded with fats, sugars, and salts -- has overtaken lack of exercise as the leading contributor to obesity and overweight, according to David W. Haslam, M.D., of National Obesity Forum in Hertfordshire, England, and W. Philip T. James, M.D., of the International Obesity Task Force in London.

The prevention and treatment challenges posed by the global obesity epidemic are “overwhelming,” wrote Drs. Haslam and James. The statistics, which are compelling, include these:
• An estimated 1.1 billion adults worldwide are overweight, including 312 million who are obese. Ten percent of children worldwide are overweight or obese.
• The number of deaths per year attributable to obesity in the United Kingdom is 30,000. That figure is ten times higher in the United States, where obesity may soon overtake smoking as the main cause of preventable illness and death.
• It is estimated that obesity decreases life expectancy by 7 years for a 40 year old. The risk of death of every unit increase in BMI remains substantial until age 75.
• Excess body weight is the sixth most important risk factor contributing to the overall burden of disease worldwide.

The only region of the world where obesity is not common is sub-Saharan Africa.

The spread of fast food restaurants -- and their marketing tactics -- to developing countries is partly to blame for the worldwide obesity problem, the authors said.
“Given the fixed energy requirements of a population, the only ways to promote sales involved provision of products with higher content of fats, sugars, and salts in larger portions, making them available everywhere, and promoting eating and drinking on the move since this distracts the normal appetite regulatory response,” they said.

To help counteract this phenomenon, doctors should advise patients not to eat on their feet, the authors said. Patients should also be told not to eat while watching television, as TV also interferes with cognitive control of food intake.
The medical community’s ultimate challenge, however, will not be managing patients but taking on the food industry, the authors concluded.

“The industrial interests, with powers exceeding even those of the tobacco industry, are on the alert and often acting to slow the drive for change by intense political lobbying at the highest level and by engaging in tactics well rehearsed by the tobacco companies,” they said.

Dr.Sam Gidding, of the A.I. Dupont Hospital for Children in Wilmington, Delaware and a spokesperson for the American Heart Association, particularly agreed with the article’s indictment of the restaurant industry.

The industry’s portion sizes and advertising “encourage people to eat beyond a rational capacity,” he said. Without government regulation to set healthy portion sizes, the problem is likely to continue, he added.
“People have forgotten that gluttony is one of the seven deadly sins,” Dr. Gidding said. “This article reminds us of that.”
Drs. Haslam and James have received support from Abbot Laboratories and served as investigators in clinical trials of Abbot’s obesity drug Meridia (sibutramine).
Primary source: The Lancet
Source reference:
Haslam DW and James WTP. Obesity. The Lancet. Advanced online publication September 29, 2005



***********


In the preceeding is mentioned :

... excessive calorie intake -- encouraged by the restaurant industry’s aggressive marketing of large-portion meals loaded with fats, sugars, and salts -- has overtaken lack of exercise as the leading contributor to obesity and overweight, ...



As an example of this:

Do You Know How Food Portions Have Changed in 20 Years?

Anyone eating on the run or at restaurants has probably noticed that food portions have gotten larger. Some portions are called "super size," while others have simply grown in size and provide enough food for at least two people. With this growth have come increases in waistlines and body weight.


See if you know how much the portions offered TODAY have increased compared to the portions typically served only 20 years ago by quizzing yourself on Portion Distortion I (2003) and Portion Distortion II (2004). You will also learn about the amount of physical activity required to burn off JUST the extra calories found in today's portions.


We hope you find Portion Distortion insightful and fun. We also hope that next time you eat on the run, you will think twice about the food portions offered to you.


Link to Portion Distortion I http://hp2010.nhlbihin.net/portion/...n&number=1

Link to Portion Distortion II
http://hp2010.nhlbihin.net/portion/...n&number=1



... from "THE SAFETY OF THE" Zone

E.Wally

ewally@verizon.net