Press Release For Thursday July 5, 2012

MDPrevent & Consumer Reports Agree 
On The Need For Preventive Medicine

MDPrevent Offers The “Prevention Attention” 
Advocated For By July 2012 Issue

MDPrevent, a primary care medical practice focused on preventive medicine and wellness offers the full range of preventive medicine and wellness services desired by patients.

Delray Beach, FL July 3, 2012

According to Consumer Reports on Health (CR), “Immunizations, cancer screenings, lifestyle counseling, and other wellness measures can save lives. But your doctor may be falling short when it comes to making sure you’re up to date on the services you need.” CR cites a January 2012 study published in the American Journal of Preventive Medicine to support is conclusions.

CR is spot on. In 2011, Medicare implemented new coverage for Annual Wellness Visits (AWV) as part of a growing menu of preventive services. As with many other preventive services, the AWV requires no co-payment or deductible.  Yet, in 2011, only 6% of patients received this service from doctors who performed it and many did not receive the proper service. Why? As CR writes, “wellness gets squeezed” because “it doesn’t pay for doctors” to do it, for many doctors “its awkward territory,” and “most doctors don’t have the time.” Wellness, according to CR, when even done, is typically not the “focal point”; rather, “wellness gets squeezed into visits when people have a problem.”  

Working within Medicare’s guidelines for AWV, MDPrevent, a primary care, preventive medicine, and wellness center was launched to fully address the wellness needs of Americans. MDPrevent’s innovative medical practice combines in one location the expertise needed to provide the full spectrum of wellness services. With a team consisting of a physician, nurse practitioner, nutritionist/registered dietitian, health psychologist, fitness and yoga instructor, and health educator, MDPrevent can uniquely help patients enjoy life to the fullest, free of disease.

The MDPrevent model is sure to become the future of integrative medicine enabling patients to draw on the full expertise and guidance they need from their primary care office to avoid, delay, or mitigate chronic diseases and improve their current quality of life.

As one part of MDPrevent’s offerings, it custom developed the LEAN program, a medically supervised 12 week personalized lifestyle modification program that includes initial medical assessment, coupled with private consultations with a nutritionist/dietitian, psychologist, fitness and yoga instructor, and health educator, and rounded out with a final medical assessment. Patients then continue with private consultations as needed or join support group and educational group sessions. The program aims for slow, but steady and sustainable lifestyle modification and weight loss by focusing on healthy living and well-being. In addition, MDPrevent is also a Certified Diabetes Education Center catering to the nutritional and educational needs of diabetics.

MDPrevent was founded by Dr. Steven Charlap, a pioneering physician with an MD from New York University, an MBA from Harvard, and general surgery training. In 1989, he founded HealthDrive, which grew it to be the largest U.S. medical and dental practice serving the extended care industry. Over twenty years, HealthDrive cared for over 5 million seniors and Dr. Charlap witnessed first-hand what happens to people who don’t take adequate care of their health, are institutionalized and become dependent on the kindness of strangers. According to Dr. Charlap, “It is sad to see people end their lives in a nursing home. You realize that in such a setting relatively little can be done to improve health at that point. Even more frustrating was that one couldn’t even try because Medicare and Medicaid basically shunned preventive services.”

In 2010, after Dr. Charlap learned that Medicare was initiating coverage for wellness services that can positively impact people’s lives while saving Medicare money, he founded MDPrevent to create an innovative preventive medicine, primary care, and education center focused on providing community based services to help people change their lifestyles to avoid and mitigate chronic diseases. Dr. Charlap states, “The scientific evidence shows that the longer you live, the healthier you’ve been.” After extensive research and consultations with the experts in the field of primary prevention, an interdisciplinary dream team of Preventioneers was assembled.

Testimonials from patients include comments like, “I finally have my head on straight” or “it’s changed my life.” (See www.mymdprevent.com, Testimonials). According to Dr. Charlap, “I see the smiles on people’s faces when they complete a session for the day. They feel empowered and for the first time in a long time, in control of their health and their weight. I know we are really on to something that can change the future of healthcare.”

About MDPrevent

MDPrevent is a new concept in primary care that seamlessly integrates primary care, preventive medicine, and wellness. The healthcare practice helps American’s prevent problems before they happen, reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare and most major insurances) The Annual Wellness Visit includes a comprehensive health risk assessment, biometric measurements, review and analysis of prescription, supplement and vitamin use, nutrition review, and development of a five- to 10-year prevention plan.

MDPrevent’s Preventioneers, or Prevention Pioneers, include MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, fitness and yoga instructors, and health educators, offer private consultations and experiential group sessions, medically supervised weight loss (with no pills, injections or surgery - paid 100% by most insurances if you qualify) and other classes on health, diet and nutrition, fitness and exercise, stress management, mindfulness, relationship and social network building, and other key elements of a healthy life. The goal: to improve life and smooth out the effects of aging by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, stroke, dementia and some forms of cancer. Learn more at http://www.MyMDPrevent.com. Read Dr. Charlap’s blog at mdprevent.blogspot.com

MDPrevent
5130 Linton Blvd. Suite H1

Delray Beach, FL 33484
(561) 807-2561

Doctors Need Help Tackling Their Patient's Weight Problems

An article appearing today at www.gantdaily.com  titled, Doctors And Insurers Are Key To Fighting Obesity, discusses the role that doctors must play in fighting the obesity epidemic.
Here is a quote from the article in reference to why doctors are not dong more.


"Many harried physicians are unprepared to advise people about how to change their behaviors, unconvinced they have time to do so, and therefore look skeptically at screening," said Dr. Robert Kushner, clinical director of the Comprehensive Center on Obesity at Northwestern University.

If doctors are overweight themselves, they’re less likely to recognize the issue in their patients, research shows. What’s more, doctors aren’t trained in medical school to handle weight issues. They also often aren’t convinced obesity treatments work, and many believe there aren’t good community programs to which they can refer patients.

 “The question is, how many programs are out there for primary care doctors to refer to in the community, and answer is – not many,” said Dr. Ned Calonge, a Colorado physician who is the immediate past chairman of the U.S. Preventive Services Task Force."

The writer reports these facts as if they are a revelation. They are not. In fact, they are at the very core of precisely why I founded MDPrevent.

People need a resource to turn to for weight help and by and large, doctors aren't a good one. But even doctors in the know can't do it alone. They need the help of others like nutritionists/registered dietitians. Yet, most nutritionists/registered dietitians are either hospital-based or working in solo practice. Very few are employed in physicians practice even though close integration with a doctor would ensure clear lines of communication. Even fewer nutritionists/registered dietitians work along-side a health psychologist and a fitness instructor. The combination of a primary care practitioner, nutritionist/registered dietitian, health psychologist and fitness instructor are at the epicenter of the solution to the problems that cause obesity. People need help with this disease and this type of dream team can offer such focused, integrated help.

The good news is that at MDPrevent it is not a dream because we have brought together these four quintessential provider types. We have also implored the government to fund our efforts to grow this model so instead of keep talking, writing, blogging about the problem, we can actually do something about it.

I hope the government is listening because the problem will not go away on its own and MDPrevent has a viable, cost-effective solution.

Surprise! You're Dead!

A number of my blogs evolve around weight and for good reason. A new study shows that carrying too much weight in the belly -- having an apple shape -- may increase the risk of sudden cardiac death.

Researchers at the University of Minnesota and the VA Medical Center in Minneapolis showed in a cohort study (an observational study that includes an analysis of risk factors and follows a group of people who do not have the disease, and uses correlations to determine the absolute risk of subjects achieving a particular outcome) that the risk of sudden cardiac death increased along with waist-to-hip ratio (WHR).

Here are two graphics to illustrate how one measure WHR.

 

Measurement of waist hip ratio: In a lean person (above, left), the waist can be measured at its narrowest point, while for a person with convex waist (above, right), it may be measured at about one inch above the navel. The hip is measured at its widest portion of the buttocks at left, and at the great trochanters (part of your femur that protrudes) at right.

According to Dr. Selcuk Adabag, the lead researcher, the WHR, when it comes to the risk for sudden death, was the greatest determinant, ranking even higher than body mass index and waist circumference.

The general rule of thumb for WHR is lower numbers are better.

A WHR of 0.7 for women and 0.9 for men has been shown to correlate strongly with general health and fertility. Women within the 0.7 range have optimal levels of estrogen and are less susceptible to major diseases such as diabetes, cardiovascular disorders and ovarian cancers. Men with WHRs around 0.9, similarly, have been shown to be more healthy and fertile with less prostate and testicular cancer.


The study showed that for individuals in the top quintile of waist-to-hip ratio (0.97 and higher for women and 1.01 and higher for men), the risk of sudden cardiac death was a relative 40% greater  compared with those in the lowest quintile (less than 0.82 for women and less than 0.92 for men).

The lead researcher speculates that the reason for this correlation may have to do with the inflammatory markers produced by abdominal fat. Those markers result in fibrosis in the heart muscle, which could ultimately lead to arrhythmias and sudden cardiac death. Abdominal fat is composed of the more harmful white fat cells.

So if you didn't have enough reasons, motivation, incentives until now to lose weight and get into shape, maybe avoiding sudden death may help?


Here's a WHR calculator so you can calculate your own WHR:


http://www.healthcalculators.org/calculators/waist_hip.asp

What Are We Waiting For?

I've participated in many discussions about why people would prefer to treat medical problems as opposed to preventing them. Opinions have ranged from that people are often in denial that something bad will happen to them to they think that genetics plays such a big role that it doesn't really matter what they do within reason. Others believe in the strength of our medical system so that if something bad does happen, the system will fix it. The most common opinion is that is just tough to change bad habits developed over many years and they will hope for the best.

Unfortunately, they are wrong on many counts. Everyone knows someone who died prematurely and so we know bad things can happen to anyone. Genetics plays a relatively small role, less than 30% in our health. The health care system is strong on science, but weak on miracles. Letting your health deteriorate and relying strictly on health care providers is a risky bet. Habits may be hard to break, but they are not impossible to change. Support, guidance, and good knowledge can help.

I think the real problem why we don't focus on prevention is because there is a perverse incentive for the health care system to allow you to get sick so it can treat you. And by health system I mean pharmaceutical companies, health insurance companies (they charge premiums based on a cost plus basis), and of course health care providers, which include hospitals, doctors, and suppliers, who are generally only paid for treating a problem, not preventing it.

A number of year ago, I read an article about how the pharmaceutical industry hardly ever works on developing preventive medicines because it doesn't think there is a market for it.  Some may think that Statins, the cholesterol lowering drugs, are of a preventive nature, but they would be wrong. Statins are only prescribed (and at that, at an excessive rate) only when you already have elevated cholesterol. I don't blame the pharmaceuticals. Why create something for which there is little demand?

So we know the problem, what should we do about it?

My answer is education. education, education. Let's expose our citizenry to a series of self-administered quizzes about their health. Let's open their eyes to the consequences of their behaviors likely to lead to the development of chronic diseases. Let's require schools to school our children to a level where they can demonstrate a fundamental knowledge of what eating properly looks like, the importance of physical activity, and how to best manage stress.

Let's require that every insured patient submit to an annual wellness visit within 90 days of their insurance renewal to stay insured. Let's require during that visit a specific review of medical and family history and dietary, physical activity, sleep, and stress patterns. Let's also do a thorough review of medications and dietary supplements to make sure that they are being used sensibly.  In its totality, this visit will force, yes force, people to take stock of their health before something goes wrong. I believe that while all may not respond well to such a requirement, enough will benefit for it to make a huge difference.

As a society that insures every person over the age of 65, we can no longer afford to hope for the best when it comes to the future of our health care system. We need to get serious about propagating wellness and lifestyle modification and it all starts with education.

This week, Centers for Medicare and Medicaid Services (CMS) announced the first round of grants for its Health Care Innovations Challenge Program. There are certainly a number of meritorious applications among them that will improve our health care system. But sorely lacking among the first group was any real focus on education and primary prevention. Does our government appreciate that an ounce of prevention is really worth a pound of cure? One can only hope that in the next round, to be announced in early June, this absence will be remedied.

We will all be better served if we stop, or even slow down, the progression of avoidable chronic diseases among our populace.  For that, we need our government to help fund such efforts.

Better Than The Alternative

It's often been said that laughter is the best medicine. Humor can also be a great way to communicate bad news in a less offensive manner. I love this cartoon because it really summarizes the reality of the situation for people who live sedentary lifestyles or hardly exercise.

Study after study now shows the dramatic impact that moderate physical activity has on your health. It reduces heart attacks and strokes, improves cognitive function and memory, alleviates depression, prevents and reduces the consequences of diabetes, etc.  The flip side is that lack of exercise increases your risk for osteoporosis and dementia. Bad things happen to people who don't move!

So folks, what are you waiting for? If you don't like gyms, find a hobby that requires physical exertion. Take steps, park far away from your destination, mow the lawn, wash the car, wash it again, whatever you do just keep moving. Get up, get out, and live the one life you have to the fullest.

 You may find this cartoon amusing, but don't let it be you. 

You are only fooling yourself by pretending to exercise.

A word to the wise should be sufficient.

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Look In The Mirror. Part 2. Better To Buy A Bike!

Yesterday, I wrote about the dangers of using the services of a mobile testing company. As fate would have it, after writing my piece, I received a solicitation from one such company.

The solicitation included a marketing flyer, which on one side was titled, "6 Reasons for Regular Screening." Let's analyze their reasoning.

1. Your health changes over time.

Based on this logic, we should be doing all sorts of testing all the time because we never know when our health changes.  Applying this principle, this should include blood tests, ekgs, x-rays, CT scans, MRIs, PET scans, ultrasounds, cardiac-stress tests, spinal-taps, endoscopies, etc. If you agree with their thought process, why exclude more elaborate tests that are better detectors of problems. The answer is because most of the tests they do are unnecessary, because the tests are not free, because you can't obsess about your health by constant testing (a little neuroticsm is ok), and most importantly, because you are likely to get many false positives that will lead to further stress and unnecessary testing.

2. Your physician usually cannot order these screenings unless symptoms are present.

That's an easy one. Good physicians don't go on wild goose chases looking for problems. When they hear hoof-beats, they think of horses, not zebras, and they use the proper tools to diagnose the problem(s) the patient shares with them.

That said, certain medical tests are covered and recommended in the absence of symptoms because the evidence for thier prospective use has been carefully evaluated by the United States Preventive Sevices Task Force (USPSTF) and determined to be of good use. However, these tests are generally covered by insurance and can be ordered by your doctor.

3. Your previous results may have revealed important risk factors.

This is a doozey. It reminds me of my experience with the pre-diabetes. Do they think (or hope) you ignored the previous abnormal results, did not bother to consult a medical professional, and should now return for another test only to keep repeating the process of excluding a medical consultation?  Apparently so. Testing in the absence of follow-up is dangerous. Do not be a doctient, a person who thinks he is both a patient and a doctor and can self diagnose and treat.

4. Screenings can help prevent stroke.

Screenings do not help prevent stroke. They may detect your increased risk for stroke after which you can consult a doctor for preventive measures. The issue here is that in the absence of sign and symptoms of stroke related disease, such as heart disease, diabetes, obesity, high blood pressure, high cholesterol, atrial fibrillation, etc., the probability of having a stroke is extremely low. If you have these medical issues, you are at higher risk for a stroke and you don't need a test to confirm the risk. You should take action immediately to decrease your risk by changing your lifestyle and seeing your physician for medical intervention.

5. Screenings can detect serious risk factors in just minutes.

If you have nothing better to do with your life, then by all means go for these unnecessary tests in the absence of sign and symptoms because maybe, just maybe they may find some abnormality that requires action you should have already taken anyway. But don't worry, they will confuse you fast.

6. You may suffer from Peripheral Arterial Disease (PAD).

That's a true statement. You may suffer from hardening of the arteries and about a thousand other diseases. Again, PAD itself is associated with heart disease, diabetes, obesity, high blood pressure, and high cholesterol. If you eat what you want and barely exercise, there is a high probability you will develop PAD at some point in life. You don't need this test, and in the absence of signs and symptoms, that is why it is not covered by insurance.

Many insurances today, including Medicare, offer a full range of preventive benefits, including screening tests, that have, based on the scientific evidence, been to be found worthwhile. Don't succumb to fancy marketing and be sucked into getting unnecessary testing.

If you have any concerns about your health, speak to your medical provider as soon as possible.

One final note, a study just published in the American Journal of Cardiology, focused on men who had at least one parent who'd had a heart attack before the age of 55. The study found that despite this apparent gentic predisposition to heart disease, those men with a healthier lifestyle were less likely to develop heart failure over two decades.

"Healthy habits included not smoking, exercising regularly, keeping a normal weight and drinking alcohol in moderation."

Many screening companies use your family history to scare you into unnecessary testing. The bottom-line remains that testing doesn't prevent disease--you do by the lifestyle you live. Save your money on testing and buy a bicycle or some other piece of exercise equipment. It will do you more good.

Longevity and Weight: What's the connection?

For the past year, I have been meeting with, treating, and lecturing to over a thousand seniors. Although this is not a scientific conclusion, I notice that people in their late 80s and above are never markedly overweight and those who are markedly overweight often look older than they are. This is consistent with a study of Jews of Eastern European descent that are believed to have a longevity gene that confers the potential to live into their 90s and above. The study showed that despite sometimes living unhealthy lifestyles, none of those living into their 90s were overweight.

A study reported today further supports this conclusion.

First, let's review what is the Body Mass Index (BMI).  BMI is a measurement of weight classification calculated by factoring in your weight and height. It is an imperfect measurement because it doesn't differentiate between high body fat and muscle content. BMI has been used by the World Health Organization as the standard for recording obesity statistics since the early 1980s. (The formula is pasted at the end of the blog.) Here in the U.S., it is also the most commonly used measurement to determine underweight, normal weight, overweight, and obesity.

Generally a BMI below 18.5 is considered underweight, 18.5-25 is considered normal, above 25 to 30 is overweight, 30 to 35 moderately obese, 35 to 40 severely obese, and above 40 very severely or morbidly obese.  (It is used differently for children but I won't discuss that here. Write me for more information.)

In a new study,  Nicholas J. Timpson, PhD, of the University of Bristol, in England, and colleagues found that for every .8 (point eight)  increase in BMI, ischemic heart disease risk rose 52%.

 "These data add evidence to support a causal link between increased BMI and ischemic heart disease risk, though the mechanism may ultimately be through intermediate factors like hypertension, dyslipidemia, and type 2 diabetes," the group wrote in the May issue of PLoS Medicine."

Furthermore, they explained that "Observational studies, both prospective and retrospective, consistently link higher BMI to heart risks across different populations, but haven't convincingly demonstrated causality because of the possibility of confounding, reverse causation, and bias."


Everyone knows that being overweight is often associated with developing chronic diseases like heart disease, diabetes, stroke, cancer and dementia. However, this study is a big deal because it shows a direct correlation between weight and heart disease risks.

So it turns out that what I have been noting empirically, is in fact, scientifically grounded. The heavier you are over a BMI of 25 the more likely you are to die prematurely from ischemic heart disease, and I suspect, from other diseases as well.

At a health fair on Monday, I greeted passersbys with "How would you like to add more healthy years to your life?"  I thought this question will receive a resounding yes every time asked and it would allow me to engage the person in a meaningful conversation regarding the benefits of taking advantage of Medicare's smorgasbord of wellness and preventive services. I was wrong.

At least a quarter of the people said they were not interested. Perhaps it was my delivery or they were wary of what I was offering as too good to be true.  I really don't know the reason, but it amazed me anyway that anyone could answer that question negatively. I shouldn't be surprised.  Since the introduction of new wellness and preventive benefits in January 2011, less than 94% of eligible seniors nationwide have taken advantage of over $1,000 worth of these life-enhancing benefits. These services were implemented by Medicare to help seniors avoid chronic disease, prevent heart attacks, lose weight, and allow for early disease detection. Yet, few doctors are providing the service and few seniors are receiving them. What gives? Do they not know of the benefits or are they simply not interested?

I can't profess to know exactly what goes through seniors minds (even though in my past work experience I led an organization that cared for 5 million seniors), as I am a generation younger, but it still breaks my heart that they are not all willing to do whatever they can to live longer, healthier lives.

I can only imagine the fears they have of doing so-fears of developing dementia, fears of running out of money, fears of being institutionalized, or being left alone with the passage of friends and family. These can be legitimate fears as they can and do happen, but early planning can make a difference and I know plenty of seniors who continue to enjoy life into their 90s and beyond. I recently presented to three centenarians, the oldest 103. They all peppered me with questions.

Many seniors don't realize that the longer they live, the more good years they have enjoyed. A researcher at Albert Einstein College of Medicine also concluded that the longer you live, the less you spend on medical care. That may not make sense at first pass, but when you think about it, it begins to resonate. Living longer typically means you have less sick days and that means less visits to doctors, etc. Medical costs are a huge drain as we age and avoiding such expenses preserves our capital.

The bottom line is whether you do it for yourself, for some member of your family, or for any reason that motivates you, take care of your health (and weight) so that you can enjoy a long, healthy life.

BMI formula:

An Enemy of The People

It's been some time since I read Henrik Ibsen's An Enemy of the People, a novel about a town doctor decrying the health risks associated with the hot springs in the town which everyone thinks is otherwise healthy and is also key to their economic futures.

I belong to a group of health, wellness, and fitness professionals on LinkedIn. In response to a comment about who takes supplements, I weighed in about the tsunami of recent data that suggests that supplements may actually be harmful. Given that many members of the group sell such supplements, the reaction was swift and harsh. The doctors in the group who sell such supplements took an even angrier stance. It was as if I was threatening their livelihood, which I was apparently doing by speaking out against rampant supplement use.

I'm not surprised. We all know the effect that money can have on certain people. The arguments went back and forth with me asking for scientific evidence that their supplements work to prolong life and them countering it doesn't matter what the science shows as long as people say they feel better. Of course that led to a discussion about the placebo effect, but that resulted in my being lectured on people having a right to express their opinion. I agree that people have the right to express an opinion. I simply don't agree that they can state as fact that which lacks any supporting evidence.

However, what I found most interesting were the people who contacted me privately to say they agreed with me. Apparently, they were afraid to address the angry crowd directly.

Unable to refute me scientifically, the arguments turned more poetic with quotes from Robert Frost and some authors unknown to me.

Notwithstanding, by the end of the discourse, I was able to answer some people's questions, such how to treat a Vitamin D deficiency and perhaps, I was no longer the lone doctor warning the town of the dangers that lurked within. My day as an enemy of the people was done-at least for now.

Thoughts Are Not Facts

It is very hard to lose an argument in your own mind. That’s because there is no one to successfully argue the other side. It is not possible to live and not be exposed to events that are likely to cause stress. These events can include changing jobs, buying a home or car, getting married, having a child, losing a friend or relative, etc. Nevertheless, most people adapt to these stresses well and continue to lead useful lives. Some do not and the stress can become debilitating and disease promoting. Why? There are a number of reasons why each person reacts to stress differently. For most it is the contexts of which the stress occurs and other factors that mitigate or dissipate that stress. The key is not to see the source of the stress as the final arbiter.

When I was a third year medical student at New York University, I was assigned to the Bellevue Hospital Psychiatric Ward as part of my psychiatry rotation. One day, I was asked to process the admission of a man, whom I will call John, who was in his late-twenties, who presented himself to the emergency room as being depressed and suicidal. Accordingly, he was admitted to the hospital for a period of observation. When I did my admission evaluation with him, I asked him why he was depressed. His response caught me off guard and still resonates with me today, some 30 years later. He responded, “I always get screwed.” My initial reaction was that he was exaggerating but that he nevertheless believed it to be true. 

I probed deeper why he felt that way and he simply responded that everything went wrong for him and he was very depressed and wanted to kill himself.  I hoped we could do something for him but I wasn’t sure as a mere third year medical student how one deals with such a predicament. Over the ensuing few days, John underwent psychiatric counseling but still seemed to remain fairly depressed.  After about three days, he summarily informed me that he wished to go home. I dutifully advised the attending physician who felt that John was not ready. The concern was that depressed patients who contemplate suicide are more likely to perform the act once they are more energetic. Therefore, if John was really feeling less depressed, then he was in a particularly dangerous zone. When I told John the doctor did not feel it was time to go home just yet, John became quite agitated, arguing that he had brought himself to the hospital and that he now felt better and was insisting on going home. There was little I could do to assuage John who became increasing petulant. I went back to the attending physician and explained John’s reaction and the doctor remained steadfast in his opinion that John was not ready to be released. Over the next 24 hours whenever John and I spoke, he repeatedly expressed his growing anger about the doctor refusing to let him go home.

After a day or so, the doctor relented and agreed to let John go if he signed a form releasing the hospital of any liability for his medically ill-advised release. John angrily signed and I was asked to fetch John’s street cloths which the hospital had taken into storage. However, when I tried to do so, I was informed that John’s leather coat had gone missing.  I was afraid to tell John because of his now constant overtly manifested anger that he was without a coat in the middle of winter because the hospital had either misplaced it or had allowed it to be stolen.  Sheepishly, I approached John with the bad news expecting him to blow up at me. Then something eerily memorable happened. I told John and he did not react. I thought perhaps he had not heard or understood me and so I repeated myself. Again, he did not react. Finally, I asked John why was he not reacting and he responded, “I told you. I always get screwed.”

Is it possible that some people truly experience more than their share of bad luck? Is life for some a Greek tragedy where fate determines how they ping pong from one misfortune to another?

John thought so, but he was wrong. There is always a certain amount of predetermination in our lives. We can’t control who our parents are and the nature of the environment they create for us, including who we get for siblings. We can’t control the level of affluence we are born into and how that determines how we live, where we live, and what role money plays in our lives. We can’t control if we are born during a peaceful time or during a threatening war.  We can’t redo our childhoods regardless of its influences.

So what can we control? Just about everything else. Even though we may have certain genetic predispositions towards particular diseases, our lifestyle will to a great extent, scientists say 70%, will determine whether we develop chronic diseases like diabetes, heart disease, and cancer, the leading killer of Americans.  We may not be able to choose relatives, but we can to a great extent choose friends and significant others.  Louis Pasteur once said, that “chance favors the prepared mind.” While he was referring to the field of observation, his words ring true for virtually everything in our lives.

My older patients often tell me of aches and pains they suffer. Once I determine that the cause is not serious, I tell them the following. Life is full of aches and pains. It is what makes us feel alive. We can become victims and captives of such nuisances or we can ignore them and live our lives to the fullest. The twists and turns in our lives is what gives life color and flavoring. We can wallow about things that didn’t quite work out the way we wished. Or we can recognize that life may not be perfect but it doesn’t need to be to still be worth living and enjoyable.

 Two personal anecdotes bear evidence to the truth of these statements. One involved my first health care service company which I had founded with investment from others. The investors proved to be meddlers and I spent much of my waking time complaining about them rather than doing something about it. I thought I was stuck. Then one day after complaining about my predicament as had become my norm to an almost stranger (a friend of a friend), I got a wake-up call when he responded that I “sounded pathetic.” It was a rude awakening to say the least. I did not see myself as a whining, pathetic person, but that is what I had become. I had invested too much time and energy in what was wrong as opposed to in finding solutions. Those words changed my perspective and I took action that ultimately made everyone happy, including my investors.

A second anecdote took place more recently. Having grown up lower middle-class where money always factored into limitations and issues, I always thought that selling my company some day for enough money that would allow me to retire would be the highlight of my life. Little did I know the truth, but I found out. About three years ago, I retired after selling my company and I began to wallow in self-pity that I now longer had purpose in life. I had money, the freedom to pursue any hobby or activity, but yet I was miserable. I had always wanted to get more physically fit but I could not find the motivation to do so. I thought that if I only ran my old company again, all would be well. Well I got the opportunity and that reminded me why I sold it in the first place.  It was unfulfilling and I realized that my though process was flawed. It became clear to me that no external factor would be the genesis of my ultimate happiness.  I came to appreciate that happiness, satisfaction, and wellbeing had to be generated from within. Over the past year, I have discovered what it takes to be happy and healthy. It takes finding ways to help others. It takes finding meaning and pleasure in whatever we do whenever we do it. It takes being thankful for what we have and blocking out what we don’t need. It takes nurturing relationships with family, friends and strangers alike.  It takes realizing that “thoughts are not facts” and to spend less time thinking about what will make me happy and more time practicing it.

So if you want to focus on what is wrong in your life, no one can stop you. But that would be a shame because you would miss out on all the ways to find true happiness many of which cost nothing but a new perspective.

America Is In Midst of Obesity Epidemic; MDPrevent Offers Practical and Clinically Proven SolutionsDelray Beach, Fla - America is in the midst of an obesity epidemic. From infants to the oldest adults, we are a nation of bulging waistlines. The current rate of obesity is cited as representing 34% of the population, expected to climb to 40% within three years. The situation is so bad that despite Medicare’s financial woes, the Federal program felt compelled last week to begin covering 100% intensive behavioral therapy for obesity for qualified beneficiaries. Even the visit to determine if one qualifies is covered 100%. Numerous studies have linked obesity to heart disease, diabetes, cancer, and strokes, the leading killers of Americans. Among the populace there is a debate if obesity is a disease or a choice. A recent billboard in Indiana put up by a local hospital which stated that Obesity is a disease and not a choice garnered many negative reactions. It is difficult to believe that anyone would make a natural choice to be obese weighing its consequences. My name is Steven Charlap, MD and before I suggest solutions, let’s reviews what contributes to obesity. Obesity is the result of many factors of which any combination may be in play for an individual. On the clinical front, obesity may be the result of slowing of one’s metabolism due to such factors as insufficient thyroid hormone or an overabundant release of cortisol, a natural steroid that causes retention of water among other issues. Aging past 50 years old also can contribute as our metabolism, hormones, and digestive capabilities begin to lose certain functionality. Depression can also be a major cause of obesity. For some, other psychosocial issues may lead to obesity being the solution to a problem rather than the problem itself. For example, a recent study demonstrated a linear correlation between adverse childhood events, such as abuse or lose of parent before the age of ten, and unhealthy behaviors. Early childhood abuse can result in the gaining of weight as a protective shield of sorts. Identifying the root cause of one’s obesity is more important than rushing to judgment. Other causes of obesity include simply eating too much food. I am not referring to consuming too many fruits and vegetables; rather, I refer to unfettered access to foods that contain large amounts of processed sugar and flour. Fried foods high in saturated fats and any food containing trans-fats are among the guilty as well. The time of day food is consumed also makes a difference. Evolutionarily, when man did not eat during the first part of the day, the body assumed that food was in short supply and slowed down metabolism to retain as much of any food consumed later in the day. Also, the lack of food results in the release of neuro-hormones such as leptin and ghrelin. Leptin is an appetite stimulant that is activated after no intake of foot for a while eating and ghrelin, an appetite suppressant, is repressed under the same circumstances. Therefore, when a person finally eats, the stage is set for them to overeat and in particular crave foods with a high sugar content. This same hormonal process goes into effect when a person does not get enough sleep and so inadequate sleep, typically less than 7 uninterrupted hours, may also contribute to obesity. In his recent book Willpower, Robert Baumeister states that decreased blood sugar levels contribute to depleted neurotransmitters leading to poor decision-making. Exhausted capacity for decision-making leads to bad food choices later in the day, often including fast-food takeaways. It is claimed that sumo wrestlers gain their enormous girth by starving themselves all day, then consuming heavy fats and carbohydrates dinners and then immediately going to bed. Although I am unaware of any scientific evidence for this anecdote, it is consistent with what happens when one does not eat all day and overeats at dinner. For some people the cause of their obesity may be that they just love food so much that unlike their European counterparts who are said to eat to live, these individuals simply live to eat. Finally, some obese individuals and this is particularly true for children, have little choice but to consume obesigenic foods because their parents either are ignorant regarding the consequences of such diets, misinformed to believe that they can only afford to offer such unhealthy foods, or are hard-pressed for time to prepare healthy meals. Of course, schools offering similar fare such as pizza and French fries are major contributors to the problem as well. In fact, last week, some congressman tried to keep pizza on school menus claiming that the tomato sauce used to make the pizza qualified it as a vegetable. The french fries won as potatoes. Finally, food and supplement marketers, media reporting of inconclusive and mostly observational studies, coupled with well-intentioned but misguided populist bromides coming forth from media personalities like Dr. Oz, has completely confused the American population. For example, last week I spoke to a Medicare patient who came in for her 100% covered Annual Wellness Visit. AS part of her visit, I reviewed her supplements and vitamins. She brought them with her and included was Milk Thistle, which she was taking to promote liver health because she heard Dr. Oz say to do it. I suggested otherwise, in the face of the absence of her having any known liver disease. She also had a bottle labeled sleeping pills which actually contained diphenhydramine, an ant--histamine typically used to control cold, flu, and allergy symptoms. Again, my patient was immediately advised to stop taking it. In addition, she was taking Vitamin D and calcium from three different sources which were contributing to potential toxicity and she was advised to take only one. This experience has been repeated multiple times because patients have never had a good resource to identify what supplements if any, they really need. In a recent Time Magazine article, a writer by the name of John Cloud did his own social science experiment by taking some 3000 supplements over a 5 month period. He gained over ten pounds because of what he describes as the “licensing effect,” a misguided belief that while taking such pills he had the license to eat unhealthy and weight contributing foods regardless of the consequences. So what is America to do under the weight of this problem? The answer is obviously not simplistic or solutions would have been widely implemented already. As the United States Preventive Services Task Force recommends, the first step is medical assessment by a primary care practitioner to rule out an underlying clinical condition as the potential root cause of the obesity. Secondly, I recommend a consultation with a psychologist to rule out any psychosocial reasons for the excessive weight. If the trained professionals do not identify any medical or psychosocial reasons for the problem, then I recommend consultation with a registered dietitian and exercise physiologist to develop a nutrition as well as exercise plan. In addition to private consultations, I firmly believe that group sessions are critical to achieving meaningful weight loss. The dynamics of group interaction and peer pressure, as well as a nurturing, non-judgmental, and supportive environment provide the critical and practical information needed to change one’s lifestyle and achieve improved health and weight loss is a clinically proven approach. As referenced earlier, for Medicare beneficiaries, there is great news because Medicare now covers weight loss counseling by a primary care practitioner in a primary care setting at no cost to the qualified beneficiary. It is hoped that other insurances will follow Medicare’s lead and implement such coverage in the near future. So if you have Medicare and need to lose weight, MDPrevent can help. If you don’t have Medicare, we have a similar program offered at an affordable price. We call our clinically proven program LEAN (Lifestyle Education And Nutrition) Weight Loss. Our program was developed off a very successful program developed by the Veterans Health Administration which we enhanced. Our team of Preventioneers, so called because we are pioneering new approaches to prevention includes MDs, nurse practitioners, health psychologists, nutritionists/registered dietitians, exercise physiologists, certified yoga instructors, and health educators who are ready to help you. So if you are interested in learning how you can improve your health, take control of your weight, and live a more fulfilling life, call us today at (561) 807-2561 or visit us at www.mdprevent.net . About MDPrevent MDPrevent is a new concept in primary care and preventive medicine. The healthcare services and education company helps Americans reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare for seniors) or self-paid Total Health Assessments, and the development of a five- to 10-year prevention plans. Its MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, exercise physiologists, fitness and yoga instructors and educators also provide interactive group courses on health, diet and nutrition, fitness and exercise, stress management, relationship and social network building, and other key elements of a healthy life. The company also offers the LEAN (Lifestyle Education and Nutrition) program which helps people of all ages not only get healthier, but lose weight, while having fun and decreasing dependence on medications. The goal: to improve aging and well-being by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, dementia and some forms of cancer. Learn more at www.MDPrevent.net.

Delray Beach, Fla - America is in the midst of an obesity epidemic.  From infants to the oldest adults, we are a nation of bulging waistlines. The current rate of obesity is cited as representing 34% of the population, expected to climb to 40% within three years. The situation is so bad that despite Medicare’s financial woes, the Federal program felt compelled last week to begin covering 100% intensive behavioral therapy for obesity for qualified beneficiaries.  Even the visit to determine if one qualifies is covered 100%. Numerous studies have linked obesity to heart disease, diabetes, cancer, and strokes, the leading killers of Americans. Among the populace there is a debate if obesity is a disease or a choice.  A recent billboard in Indiana put up by a local hospital which stated that Obesity is a disease and not a choice garnered many negative reactions. It is difficult to believe that anyone would make a natural choice to be obese weighing its consequences.

My name is Steven Charlap, MD and before I suggest solutions, let’s reviews what contributes to obesity.  Obesity is the result of many factors of which any combination may be in play for an individual.  On the clinical front, obesity may be the result of slowing of one’s metabolism due to such factors as insufficient thyroid hormone or an overabundant release of cortisol, a natural steroid that causes retention of water among other issues. Aging past 50 years old also can contribute as our metabolism, hormones, and digestive capabilities begin to lose certain functionality.

Depression can also be a major cause of obesity.  For some, other psychosocial issues may lead to obesity being the solution to a problem rather than the problem itself. For example, a recent study demonstrated a linear correlation between adverse childhood events, such as abuse or lose of parent before the age of ten, and unhealthy behaviors.  Early childhood abuse can result in the gaining of weight as a protective shield of sorts. Identifying the root cause of one’s obesity is more important than rushing to judgment.

Other causes of obesity include simply eating too much food.  I am not referring to consuming too many fruits and vegetables; rather, I refer to unfettered access to foods that contain large amounts of processed sugar and flour. Fried foods high in saturated fats and any food containing trans-fats are among the guilty as well.  The time of day food is consumed also makes a difference.  Evolutionarily, when man did not eat during the first part of the day, the body assumed that food was in short supply and slowed down metabolism to retain as much of any food consumed later in the day.  Also, the lack of food results in the release of neuro-hormones such as leptin and ghrelin. Leptin is an appetite stimulant that is activated after no intake of foot for a while eating and ghrelin, an appetite suppressant, is repressed under the same circumstances. Therefore, when a person finally eats, the stage is set for them to overeat and in particular crave foods with a high sugar content.  This same hormonal process goes into effect when a person does not get enough sleep and so inadequate sleep, typically less than 7 uninterrupted hours, may also contribute to obesity.

In his recent book Willpower, Robert Baumeister states that decreased blood sugar levels contribute to depleted neurotransmitters leading to poor decision-making. Exhausted capacity for decision-making leads to bad food choices later in the day, often including fast-food takeaways.  It is claimed that sumo wrestlers gain their enormous girth by starving themselves all day, then consuming heavy fats and carbohydrates dinners and then immediately going to bed. Although I am unaware of any scientific evidence for this anecdote, it is consistent with what happens when one does not eat all day and overeats at dinner.

For some people the cause of their obesity may be that they just love food so much that unlike their European counterparts who are said to eat to live, these individuals simply live to eat.  Finally, some obese individuals and this is particularly true for children, have little choice but to consume obesigenic foods because their parents either are ignorant regarding the consequences of such diets, misinformed to believe that they can only afford to offer such unhealthy foods, or are hard-pressed for time to prepare healthy meals. Of course, schools offering similar fare such as pizza and French fries are major contributors to the problem as well.  In fact, last week, some congressman tried to keep pizza on school menus claiming that the tomato sauce used to make the pizza qualified it as a vegetable. The french fries won as potatoes.

Finally, food and supplement marketers, media reporting of inconclusive and mostly observational  studies,  coupled with well-intentioned but misguided populist bromides coming forth from media personalities like Dr. Oz, has completely confused the American population. For example, last week I spoke to a Medicare patient who came in for her 100% covered Annual Wellness Visit. AS part of her visit, I reviewed her supplements and vitamins. She brought them with her and included was Milk Thistle, which she was taking to promote liver health because she heard Dr. Oz say to do it. I suggested otherwise, in the face of the absence of her having any known liver disease.  She also had a bottle labeled sleeping pills which actually contained diphenhydramine, an ant--histamine typically used to control cold, flu, and allergy symptoms. Again, my patient was immediately advised to stop taking it.  In addition, she was taking Vitamin D and calcium from three different sources which were contributing to potential toxicity and she was advised to take only one.  This experience has been repeated multiple times because patients have never had a good resource to identify what supplements if any, they really need.  In a recent Time Magazine article, a writer by the name of John Cloud did his own social science experiment by taking some 3000 supplements over a 5 month period.  He gained over ten pounds because of what he describes as the “licensing effect,” a misguided belief that while taking such pills he had the license to eat unhealthy and weight contributing foods regardless of the consequences.  

So what is America to do under the weight of this problem?  The answer is obviously not simplistic or solutions would have been widely implemented already.

As the United States Preventive Services Task Force recommends, the first step is medical assessment by a primary care practitioner to rule out an underlying clinical condition as the potential root cause of the obesity.  Secondly, I recommend a consultation with a psychologist to rule out any psychosocial reasons for the excessive weight.  If the trained professionals do not identify any medical or psychosocial reasons for the problem, then I recommend consultation with a registered dietitian and exercise physiologist to develop a nutrition as well as exercise plan.  In addition to private consultations, I firmly believe that group sessions are critical to achieving meaningful weight loss. The dynamics of group interaction and peer pressure, as well as a nurturing, non-judgmental, and supportive environment provide the critical and practical information needed to change one’s lifestyle and achieve improved health and weight loss is a clinically proven approach.

As referenced earlier, for Medicare beneficiaries, there is great news because Medicare now covers weight loss counseling by a primary care practitioner in a primary care setting at no cost to the qualified beneficiary.  It is hoped that other insurances will follow Medicare’s lead and implement such coverage in the near future.

So if you have Medicare and need to lose weight, MDPrevent can help.  If you don’t have Medicare, we have a similar program offered at an affordable price. We call our clinically proven program LEAN  (Lifestyle Education And Nutrition) Weight Loss. Our program was developed off a very successful program developed by the Veterans Health Administration which we enhanced. Our team of Preventioneers, so called because we are pioneering new approaches to prevention includes MDs, nurse practitioners, health psychologists, nutritionists/registered dietitians, exercise physiologists, certified yoga instructors, and health educators who are ready to help you.

So if you are interested in learning how you can improve your health, take control of your weight, and live a more fulfilling life, call us today at (561) 807-2561 or visit us at www.mdprevent.net .

About MDPrevent

MDPrevent is a new concept in primary care and preventive medicine. The healthcare services and education company helps Americans reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare for seniors) or self-paid Total Health Assessments, and the development of a five- to 10-year prevention plans. Its MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, exercise physiologists, fitness and yoga instructors and educators also provide interactive group courses on health, diet and nutrition, fitness and exercise, stress management, relationship and social network building, and other key elements of a healthy life. The company also offers the LEAN (Lifestyle Education and Nutrition) program which helps people of all ages not only get healthier, but lose weight, while having fun and decreasing dependence on medications. The goal: to improve aging and well-being by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, dementia and some forms of cancer. Learn more at www.MDPrevent.net.