competitive gluttony and obesity

Monday, July 6, 2015

The Fourth of July is all about celebration. There are picnics, parades, fireworks and sport. While baseball is the all American sport and the country rallied behind the Women’s World Cup victory, perhaps nothing epitomizes the American spirit like the Nathan’s annual hot dog eating contest. Gluttony may be a deadly sin but it is also major programming for ESPN, the network that live broadcast the competition and aired replays over its numerous outlets. The winner, Matt Stonie, ate 62 hot dogs (including buns) in the 10-minute contest, and to make certain that equality has arrived to competitive eating, there was a women’s division, with Miki Sudo crowned champion after consuming “only” 38 dogs. Unlike Wimbledon, there was no junior division.

It should come as no surprise that the American public embraces competitive gluttony. Two thirds of the adults in this country are overweight and one third qualifies as obese. Overweight describes excess weight that comes from muscle, bone, fat or water. The excess weight in obesity all comes from fat. There is no benefit to obesity. It increases the risk of high blood pressure, high cholesterol and diabetes leading to more heart attacks and stoke. The skeleton of the body is also not well adapted to carry extra weight and that leads to muscle and joint problems including joint and back pain, arthritis and degeneration.

There is no single cause for the epidemic of obesity and there is no single approach that can be recommended or prescribed for prevention and treatment. Some who are obese look for an “easy” answer in a pill or through surgery, but it takes a lifelong combination of diet and exercise to control weight. Food, especially empty calories, are readily available and these empty calories are especially prevalent in poorer neighborhoods where food desserts are the norm and healthy eating alternatives are not available.

 

When it comes to weight loss, it’s all about the math…sort of. A pound of human fat contains 3,500 calories. A calorie is a unit of energy. Eat more than you burn and weight is gained, eat less and the weight comes off. In obese people, that weight loss will likely come from fat, with a smidge of water loss thrown in. Cutting carbohydrates means forces the body to used stored glycogen for energy and that releases a little water that gets peed out. Add protein and exercise and there may be increase in muscle mass, which is a good thing, but that may mean that the weight loss slows just a little. As the body gets closer to ideal body weight, some of that weight loss will come from muscle, as the body tries to retain some fat, just in case famine strikes.

The body is a machine and requires a certain amount of energy intake to function. If there is a calorie deficit, the body uses its energy stores to make up the difference. Weight loss takes dietary control and all food is not created equal. A glazed donut from Krispy Kreme contains 190 calories, while one from Dunkin Donut rings at 260 calories.

It takes effort to lose a pound of fat. A mile of walking or running will burn roughly 100 calories. It doesn’t matter how fast that mile distance is covered; the calorie burned is the same. Moving faster increases cardiovascular performance and allows more distance to be covered in the same amount of time. More distance equals more calories burned. All things being equal, and if food intake remains the same, walking an extra mile a day (about 2,000 steps), will result in a 10-pound weight loss in a year.

Weight control is a national obsession but a frustrating one. Good intentions can be waylaid by a few moments of indiscretion. The few minutes at the Nathans’ hot dog eating contest that crowned Matt Stonie champion, cost him more than 15,000 calories or almost 5 pounds. And we celebrate gluttony for why?

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Fracture equals broken equals cracked

Monday, June 29, 2015

Words matter, especially in medicine. There are unique terms that help describe anatomy, physiology, disease and injury and it’s important that doctors speak the same language with their colleagues. It’s just as important that doctors translate medical speak into regular English, so that patients and families can understand their situation. For that reason, it is not terribly helpful when the media and press misuse medical terms that might confuse and mislead their audience.

This diatribe starts with the Sports Illustrated article that discussed the ability of hockey players to neglect injuries during their quest for the Stanley Cup:

  • Montreal’s Nathan Beaulieu – fractured sternum
  • Rangers’ Mats Zuccarello – fractured skull
  • Tampa’s Tyler Johnson – broken wrist
  • Ottawa’s Mark Stone – fractured wrist
  • Minnesota’s Jason Zucker – broken bone in his thumb
  • Ranger’s Marc Steel – hairline fracture in the ankle
  • Red Wings’ Jonathan Ericksson – broken big toe

At the bedside, patients and families seem to have the same concept when it comes to bone injuries. Routinely, there are questions. “I hope it’s only cracked and not broken” or “is it fractured or just broken?”

Let us be clear with the words… fractured, broken and cracked all mean the same thing. The integrity of the bone has been disrupted. One term does not imply a more severe injury and another does not presume that healing will be quicker or that surgery might not be needed.

When talking about fractures (the same thing as broken or cracked), there are other descriptive terms that are helpful in explaining the injury:

Is the fracture open or closed? The skin protects the body from the outside world. If the skin over a fracture is broken and the dirty outside work can communicate with the broken bone fragments and the risk of a bacterial infection increases dramatically. Often, this requires a trip to the operating room for the orthopedic surgeon to clean out the wound and prevent osteomyelitis, an infection of the bone.

Is the fracture comminuted? A bone can brake into two parts, it can shatter into multiple fragments or the fracture is somewhere in between. Comminuted equals more than two pieces and may signal a more complicated healing process…or not. Every injury is distinct and needs to be individually assessed.

Is the fracture aligned or is it displaced? If the bone fragments appear to be in reasonable position, they may heal nicely without much intervention. Sometimes, though, the fracture needs to be reduced or realigned to make it heal as close to abnormal anatomic position as possible. Knowing anatomy helps. Even though a fracture may appear to be normally aligned initially, the pull of muscles or gravity may cause the pieces to move.

Is the neurovascular status intact? Arteries, veins and nerves may be located near the fracture site and it’s important to know whether there is good blood flow and sensation beyond the injury. Looking for complications is the first step in potentially finding them.

And there are special terms used for certain bone injuries. Fractures may enter joints. Skull fractures may be depressed. The Salter Harris classification system is used to describe fractures that involve growth plate fractures in children. Compression fractures may occur in the vertebrae of the neck or back.

Each fracture has its own healing potential and treatment need. The goal for treatment is to return the bone to anatomic alignment and allow it to heal so that the body can be returned to normal function. If an ankle fracture heals poorly or is misaligned, arthritis may set in and cause problems to develop years later. Bones in the hand and finger cannot be allowed to have any rotation issue; otherwise the hand might not be able to form a fist. Bones that support the eye cannot trap muscle otherwise, the eye will not move properly and double vision might result.

The language of bone is important so that an injury can be described and explained in words. For that reason, it’s important that the doctor, patient and family know what words mean, so that they have the same game plan for care and the same expectation for healing. For that reason, the writers and editors of Sports Illustrated need to learn medical terminology, just like they learned the words used to describe the action on the field that caused the broken, fractured, cracked bone.

 

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