HemoDoc, From Doctor to Patient

Climbing the Sedentary Mountain of Apathy: College Students Are Exercising Less

By Peter Laird, MD

Exercise is one of the most important cardiovascular health interventions at any age and is an important adjunct for reducing the risk of CKD later in life. Diabetes, HTN and obesity are all related to the trend in American society to not engage in enough physical activity to maintain heart health. An interesting and yet disturbing study shows that physical activity actually declines for young adults while in college:

Physical Activity and Other Health-risk Behaviors During the Transition Into Early Adulthood:

Results

Overall, there was a 24% decrease in physical activity (equivalent to 1 MET/day) across the 12-year period. A significant three-way time X gender X educational trajectory interaction (coefficient= −0.189, SE=0 .09, p<0.05) emerged in the physical activity analysis; main effects in time² (coefficient= −0.114, SE=0.01, p<0.01) and time³ (coefficient=0.028, SE=0.01, p<0.01) were significant for binge drinking and smoking, respectively.

Conclusions

Physical activity decline was evident during young adults' transition into early adulthood, with declines being steepest among men who entered a college/university. Although there were increases in several health-risk behaviors during adolescence, individuals tend to grow out of binge drinking and smoking as they mature.

I read this report in somewhat of dismay remembering my own time in college where I ran cross country and track and engaged in my most physically active years, even more so than in high school where I played football in my senior year. As a child growing up in Alaska, we were essentially outside playing, riding bikes, hunting, fishing and playing neighborhood games with up to 50 other kids at the same time. We only stayed indoors on the very coldest of days even when we lived in Nome Alaska.

Today's children start out with a markedly reduced level of physical activity from the age of 12 and to witness a study documenting that this level of physical activity sharply declines during the college years does not bode well for reducing the number of patients entering the ESRD program later in life.  Sadly, there appears to be little that the health care industry can do to reverse this with the failure of dozens of programs over the last two decades. Society is no longer able to allow children to run around town unsupervised as we did just one generation ago if for nothing more than their own safety in this changing world.

The only hope in many ways is for parents to recognize the challenge to imbue their children with the opportunity and the desire to be physically active from an early age. Turning off the TV and video games is still under their control. Unfortunately, many parents today use these devices as a domestic baby sitter starting the process of sedentary lifestyles from an early age. School systems are discarding physical education programs in exchange for more computer time. High fructose corn syrup permeates not only our snack foods and sodas, it is also in many of our processed foods popular today. Perhaps it is too late to turn back the hands of time, but it is certainly not too late for individuals to take action. In many ways, society is nothing more than individuals setting priorities and acting upon them in the first place. Truly, it all begins at home.

Transplant Candidates Aided by Bariatric Surgery

By Peter Laird, MD

Many patients with end organ damage face the challenges of staying alive with only the hope that they will receive a transplant in time. For obese patients in need of a healthy organ to stay alive, many are without any hope due to weight restrictions for transplant candidates. However, with the advent of bariatric surgery for weight loss, some transplant centers are expanding the pool of eligible candidates by utilizing weight loss surgery prior to graft donation. In one remarkable case, a patient in need of a heart transplant underwent bariatric surgery while supported by an artificial heart.

Weight-loss surgery aids transplant candidates

Martha Magdaleno suffered from an enlarged heart that left her perennially breathless.

"I couldn't do anything, like shower," the 55-year-old mother of four in Inglewood said through an interpreter. "Even when I brushed my teeth, I would be out of breath."

Her condition grew so severe that, in 2006, cardiologists implanted an artificial heart to assist her failing organ and put her on the waiting list for a transplant. That pump died after eight months, and doctors had to replace it. . .

But Dr. Jon Kobashigawa, director of the heart transplant program at the Cedars-Sinai Heart Institute in Los Angeles and Magdaleno's cardiologist, was determined to get his patient back in shape for a transplant. He sent her to the Khalili Center for Bariatric Care in Beverly Hills, where Dr. Theodore Khalili performed a gastric bypass operation on her in early 2010. As far as anyone knows, it is the only time such weight-loss surgery has been performed on a patient with an artificial heart.

The risky procedure paid off. Magdaleno began losing weight, "about a pound or 2 a week," she said. By February, her weight had dropped to 165 pounds, and Kobashigawa placed her back on the waiting list. On a Sunday afternoon in June, she had a successful heart transplant, receiving a new organ from a 27-year-old man who died in an accident.

This procedure may become a standard treatment for ESRD patients who fail the initial assessment due to obesity. For patients to experience the full benefits of bariatric surgery, the patient must understand that it is a tool to combat obesity, but it is not a cure. Many patients will regain all or most of the weight lost initially if they do not change unhealthy habits and learn to eat well and exercise. Unfortunately, obesity is also a significant cause of ESRD combined with the co-morbidities most often associated with obesity, diabetes and HTN.

After observing several patients undergo bariatric surgery and the many complications that can occur, despite the utility of this procedure, the better part of valour is to avoid morbid obesity at an early age when life style changes have their most dramatic effects. Unfortunately, as efficacious as bariatric surgery is in the case of Martha Magdaleno, it will inevitably add to the financialy burden of a population already at the highest end of medical care utilization. That in the end may become the most important determinant of how often this combined surgical treatment will become.

 

Robert H. Eckel, MD on Lifestyle Changes to Combat Obesity

By Peter Laird, MD

One of the most important risk factors for diabetes, renal disease, cardiovascular disease as well as cancer is obesity.  Unfortunately, today's children are in the middle of an epidemic of inactivity and obesity which will reap serious illness outcomes much earlier than previous generations.  Adult Onset Diabetes is now routinely encountered in the pediatric population.  Robert H. Eckel, a professor from the University of Colorado and past president of the American Heart Association gives advice on how doctors can impact the obesity epidemic in this Medpage webcast.

 

Lifestyle Changes are the Key to Avoiding Diabetes

By Peter Laird, MD

America and many developed nations will see up to a third of their population develop diabetes in the next decade, truly creating world wide epidemic of renal disease, cardiovascular disease and blindness. The saddest note about this developing epidemic is that in most people, it can be prevented by lifestyle changes of more exercise, eating healthier and exercise.  All of this outside of the control of the physicians and rests squarely on the shoulder of the individual at risk.

 

Interventions based on lifestyle changes are effective but not necessarily easy to implement.  The problem appears in many cases to be the lack of discipline to continue a life long pursuit of health living habits.  Children today grow up in a video game atmosphere instead of the outdoor sports and entertainment that earlier generations were known.  High fructose soft drinks, just one a day greatly increases the risk of diabetes.  Unfortunately, high fructose corn syrup is also added to many foods. It is also implicated in inducing hypertension as well.  Nevertheless, simple dietary modifications and exercise can greatly abate this coming epidemic and the grief and suffering it will usher in around the world. The answer is to simply put the junk food and video games away and go outside and exercise at least 30 minutes 3-5 times/week.