The Doctor Weighs In

"Most heart attacks in women are preventable," is the headline of an article posted on NBC.com.  The article describes a study, published in the Archives of Internal Medicine, that was done by the researchers at the Karoinska Institute in Sweden.  Dr. Agneta Akesson and colleagues looked at the diet and lifestyle patterns of almost 25,000 postmenopausal women.  At the time of enrollment none of the women had heart disease, diabetes or cancer.

The researchers asked the women to fill out "food frequency" questionnaires to identify how often they ate 96 different foods.  The researchers analyzed the data and found four major dietary patterns:

• Healthy - vegetables, fruits, and legumes
• Western/Swedish - red meat, processed meat, poultry, rice, pasta, eggs, fried potatoes, and fish
• Alcohol - wine, beer and some snacks
• Sweets - sweet baked goods, candy, chocolate, jam, and ice cream

Other information collected included family history of heart disease, education level, physical activity, and body measurements.

The women were followed for an average of 6 years.  During that time, 308 women had heart attacks.  The investigators found that two of the dietary patterns (healthy and alcohol) were associated with a decreased risk of heart attack.  Women who drank less than a quarter ounce of alcohol daily (that is just a splash in the bottom of your glass) and ate lots of veggies, fruit, whole grains, legumes, and fish had a 57% lower risk of having a first heart attack.  That is a whopping big difference.

If women added three other healthy lifestyle habits into the mix (not smoking, being physically active, and avoiding too much weight gain), they had a 92% lower risk of heart attack.  In other words, most heart attacks in women are preventable by making healthy lifestyle choices.

Now, it is one thing to say, eat healthy, drink in moderation, exercise and maintain a healthy weight.  It is quite another thing to actually do all of those things over the course of an entire lifetime.  On the other hand, if you look at the amount of money the US (and, indeed, the entire world) spends to treat cardiovascular disease, I believe you would find there is enough there to buy each and every person a personal cook and a personal trainer (I believe this is the secret to Oprah's weight loss and maintenance).

I say this tongue in cheek, but it does make the point that we aren't spending our "health" care dollars on the right things.  We spend generously to fix disease, but we are very stingy when it comes to funding health.   It is time to get this right.  There aren't enough dollars in any treasury to treat all of the heart disease we are going to see as a result of the global epidemic of obesity and physical inactivity.  This must be  a top priority of policy makers and health reformers.  Studies, like the Karolinska study, should be used to promote changes in public policy - such as healthy school foods, ensuring that all neighborhoods have access to fresh fruits and vegetables and that they have safe places where kids and adults can move their bodies (without worrying about getting shot in the process).

Every politician, health reformer, and policy wonk ought to know about this study and others that prove that healthy lifestyles mean fewer heart (expensive) attacks - not just in women, but in men as well.  The bottom line is most heart attacks are preventable!

by Pat Salber

Earlier this year, I wrote about the Food Industry Playing Games with our Children.  Now, thank heavens, HMO giant, Kaiser Permanente (KP), is countering with a food game of its own - a good food game. 

The Incredible Adventures of the Amazing Food Detective was developed by KP to teach youngsters (9-10 years old) about healthy eating and exercise.  Unlike other video games that have inducements to keep kids on the site, exercising only a few fingers at a time, Incredible Adventures only allows 20 minutes of play and then locks the young'uns out, encouraging them to stop playing computer games and go outside for fresh air and exercise instead.  Once locked out, they can't get back into the site for an hour. 

While playing the game, kids learn how to read food labels, how to measure the amount of sugar in drinks and other health skills.   Now that may sound pretty dull, but the site has woven this information into adventures that engage junior food detectives (from the site):

"There has been a mysterious outbreak of unhealthy habits hitting too many boys and girls. If we don't solve these cases, and fast, kids might not make the right food and exercise choices as they grow, and that could be trouble!

All junior food detectives will get secret training on how to eat right and exercise. You can investigate fun games like Whack A Snack, Soccer, and Zap the TV. Plus you can print out classified clues on ways to be healthy, then share them with your parents, teachers, and pals."

Now, as you know, I am not 9 or 10, so I am probably not the best person to evaluate whether the site can engage kids of this age -- and teach them healthy habits to boot.  If you have kids, know kids, or can get kids on the site, write us, let us know.  Can the Incredible Adventures website trump www.Tonythetiger.com" or www.bubbletape.com?  Let me know...

by Pat Salber, MD

When's the last time you seriously looked at the vending machines at work?  When you looked, what did you see?  I found candy bars, cookies (including the notorious transfat-laden Oreos), and grease chips (as opposed to "sun chips"). 

The first few times that I got the mid-day munchies at my new job, I made several trips to the break room searching for something to eat from the company's vending machine.  Nope, I said to myself, you can't buy corn chips, Oreos, or snickers--a dry, stale sweet roll is just not the way to use any of those precious 1200-1300 calories per day.  Come on now, isn't there anything remotely healthy or real in this machine?? - Apparently not. 

Back and forth I go, office to vending machine; vending machine to office.  Finally, the hunger pangs make the decision for me.  I will buy the least unhealthy thing in the machine - salted, greasy, (and stale) peanuts.  The little bag of "baddies" that I purchase for 65 cents is ingested in less than 2 minutes.

So, what to do?  As the brand-spanking new Chief Medical Officer of a Health Insurance Company, I know I need to do something.  But exactly what to do gets catalyzed at a health care conference I attended recently.  I chaired a panel on the integration of disease management and disability management, sponsored by Presagia, a leader in software to support this type of integration. 

One of the speakers on the panel, Bruce Goya, Universitywide Coordinator of Employee Support Programs at the University of California - a major employer in the state -gave a presentation in which he emphasized the importance of creating a culture of health in the workplace.  The light bulb in my head went on - big time. 

This is the answer to the vending maching problem at work.  Improving the vending machine selections in my workplace is not just about messing with people's snack choices, rather it is part and parcel of CREATING A CULTURE OF HEALTH.  A Culture of Health, I love it.

So, dear readers, here is a practical question.  If you got to choose what to put in your workplace vending machines to offer your fellow employees a healthy alternative to the usual vending machine fare....what would you choose?  Sunchips?  Protein bars?  Unsalted almonds?

Send me your suggestions.  I may not be able to change your company's culture of health, but you can help me change mine.