Institute of Medicine: Obesity is not caused by lack of willpower

In a 48-page report, the Institute of Medicine “refutes the idea that obesity is largely the result of a lack of willpower on the part of individuals.” [You know the IOM, the same folks who brought you the “98,000 people are killed each year by medical errors” report, the accuracy of which has been challenged.]

According to a spokesman for the IOM, “"When you see the increase in obesity you ask, what changed? And the answer is, the environment. The average person cannot maintain a healthy weight in this obesity-promoting environment."

The report goes on to say, “People cannot truly exercise ‘personal choice’ because their options are severely limited, and biased toward the unhealthy end of the continuum."

Quoting further from an article about this revelation from the IOM, “The panel recommended tax incentives for developers to build sidewalks and trails in new housing developments, zoning changes to require pedestrian access and policies to promote bicycle commuting.”

"We've taken fat and sugar, put it in everything everywhere, and made it socially acceptable to eat all the time. We're living in a food carnival, constantly bombarded by food cues, almost all of them unhealthy," said David Kessler, former head of the U.S. Food and Drug Administration. Maybe Kessler should have done something about this when he was in charge of the FDA.

Are they serious?

Things like this really aggravate me. [Lots of things aggravate me.]

Everyone who drinks alcohol doesn’t become an alcoholic. The IOM says it's not willpower. How is it then that some who are exposed to the same environmental factors and food cues as obese people manage to maintain a normal weight?

How much did the IOM’s 48-page report cost and who paid for it?

Do you think building sidewalks and promoting bicycle commuting will really decrease obesity?

What do you think of the IOM report?

A version of this post appeared on Sermo yesterday. Most of those who commented felt that the IOM was out of touch with reality or al least, mistaken.

Words mean what I say they mean

Apparently a few years ago someone decreed that “non-compliant” was no longer a politically correct term to describe patients who did not take their medicines or follow instructions. The newspeak to use is now “non-adherent.” This was recently brought to my attention by cardiologist-blogger Dr. John Mandrola, who humorously blogged about his own non-compliant-adherent behavior after a hand injury.

I googled “non-adherent vs. non-compliant” and found references to the former used in medicine from as far back as 1998 but most hits were from this century. I could not identify the origination of the switch or why the term non-compliant was perceived to be judgmental.

I suppose compliant has a more submissive connotation, and God knows, we should not consider patients as subjugated, but adherent really means sticky as an adjective and follower as a noun. Is a patient who takes his meds “sticky” or a “follower”? The difference between the two definitions, compliant and adherent, is minor at best.

Who decides these things anyway? I don’t remember this being discussed anywhere.

This phenomenon is not unique to the US. Public health workers in the UK were recently informed that the use of the word “obese” could be viewed as derogatory by obese people. The workers were told “that patients may respond better if they are encouraged to achieve a ‘healthier weight.’” The full story is here and is worth reading if only for this amusing mixed metaphor uttered by an opponent of the UK advice, “If you beat around the bush then you muddy the water."

There is research on this subject. A 2012 paper from the journal Obesity [soon to be renamed “Healthier Weight,” I guess] describes a survey of a lot of people whose weight formerly would have been termed obese but now should properly be called unhealthily weighted. The term fatness was rated as significantly more undesirable than all others and excess fat, large size, obesity and heaviness were rated as significantly more objectionable than the remaining terms, such as weight problem, BMI, excess weight and the best of all, weight.

It’s not clear how just describing someone as “BMI” or “weight” will get the message across, but then I didn’t perform the study.

Question: what do you do with a person who needs to achieve a healthier weight but is non-adherent?

This post appeared on Sermo yesterday and attracted 28 comments. As you might expect, most did not like the idea of politically correct terminology.

Sticks and stones ...

The New York City Department of Education wants to ban some 50 words from appearing on standardized tests because the words might upset some students. The story apparently first came to light via the New York Post, but Google “New York banned words” and you’ll see lots of coverage and comment.

You can see the complete list here. To give you an idea, I’ve selected a few of the more interesting entries for comment.

Alcohol, tobacco, or drugs—I suppose they get enough about those topics after school anyway.
Birthday celebrations and birthdays—On the list because some religious groups do not celebrate birthdays. Being of a certain age, I don’t like these words either.
Celebrities—Is just the word “celebrities” to be banned or is it about mentioning the names of specific celebrities? Either way, I’m all for it.
Dinosaurs—We wouldn’t want them to learn about that subject or be tested on it now, would we?
Disease—Said to be banned because it might upset students who have family members who are sick.
Evolution—See Dinosaurs
Halloween—A dangerous topic for young minds.
Junk food—Interesting in light of all the talk about an epidemic of obesity.
In-depth discussions of sports that require prior knowledge—How would one ask about this on a standardized test anyway?
Sex—Take care of that on your own time.
War and bloodshed—So students can’t be asked about war on a test? That’s going to shorten history class a lot. And how are the kids going to learn about stuff like when the Germans bombed Pearl Harbor?
Weapons (guns, knives, etc.)—See sex

It looks like New York City has taken the “Nanny State” concept to new heights. What do you think?

This post appeared on Sermo yesterday.

Cell Phones, Germs and Nonsense

Scientific American reports a study from Turkey published in the American Journal of Infection Control found that about 1/3 of cell phones carried by patients and 20% cell phones carried by hospital staff were harboring pathogenic bacteria. Conspicuously absent from the report is any evidence that bacteria found on cell phones actually caused any illness among the patients.

This goes along with other such hysterical reports demonstrating that neckties, lab coats, scrub suits, money, computer keyboards and television remote controls have been found to be similarly colonized with bacteria without evidence of transmission of disease. Of course, lack of evidence of disease transmission did not stop some legislators in New York from considering a proposal to prohibit doctors from wearing ties.

I have no doubt that old-fashioned land-line hospital telephones are colonized with bacteria too.

Having been the prisoner of a telephone for over 40 years in the practice of surgery, I would welcome a ban on its use. Maybe we could use smoke signals but that would probably generate protests by Native Americans and environmentalists.

What many people apparently do not understand is that there is a difference between colonization by bacteria and invasion by bacteria. I suppose I risk causing nationwide panic by saying this but YOUR SKIN IS COLONIZED BY PATHOGENIC BACTERIA!!!!!! AND SO IS YOUR INTESTINE!

I look forward to future papers documenting bacterial colonization of doorknobs, pens, eyeglasses, air, water and fire.

Sexism and Surgery: A Surgical Leader Falters

A well-known academic surgeon was “hoist with his own petard” via an unusual commentary he wrote in his capacity as editor of Surgery News, the official newspaper of the American College of Surgeons (ACS). Lazar Greenfield, Emeritus Professor of Surgery at the University of Michigan and inventor of the Greenfield filter, a device used for prevention of pulmonary embolus (clots traveling to the lungs), was forced to resign his position as editor and also as president-elect of the ACS.

The entire issue of the newspaper containing the piece was retracted by the ACS but it can be read here. The editorial, an apparent attempt at Valentine’s Day humor, suggested that women experienced lighter moods after unprotected sex with men and extolled the virtues of semen as a substitute for chocolate as a Valentine’s Day gift.

Rather predictably, the editorial was not viewed favorably by a number of women. Personally, I thought it was inappropriate for an official publication of the largest surgical organization in the country, and worse, it wasn’t funny. In fact, I tweeted the following several weeks before the feces hit the fan and the story was finally noticed by the New York Times.

There have been a slew of comments ranging from Greenfield is the worst sexist since Andrew Dice Clay to women are too sensitive. So now a famous surgeon, known to have encouraged and mentored women entering surgery, is disgraced. And the ACS loses both ways because it took the leaders of the society way too long to resolve the problem and they lost a formerly respected leader anyway.

Bottom line. It’s 2011, and this sort of thing just doesn’t fly any more. I feel sorry for Dr. Greenfield, whom I’ve never met. He seems like a nice guy who made a mistake which proved fatal to an otherwise illustrious career. Too bad.