Occam’s Razor

Solving the obesity crisis

I read two items in the news that are guaranteed to make obese people and the parents who raise them feel guilty. First, obese people are contributing disproportionately to global warming. Apparently, because obese people are larger, they need more calories to sustain their weight. This also translates into the need for more fuel to move them around on cars and public transportation. According to the London School of Hygiene and Tropical Medicine, obese people on average require eighteen percent more calories than people of the same height and age of normal weight.

The second story (and to me the more frightening one) is the lead story in today’s Washington Post, Obesity Threatens a Generation. Apparently, the youth of today who are obese or even overweight have a much higher likelihood of developing chronic diseases earlier in life.

Doctors are seeing confirmation of this daily: boys and girls in elementary school suffering from high blood pressure, high cholesterol and painful joint conditions; a soaring incidence of type 2 diabetes, once a rarity in pediatricians’ offices; even a spike in child gallstones, also once a singularly adult affliction. Minority youth are most severely affected, because so many are pushing the scales into the most dangerous territory.

I am worried not only for the children out there who are overweight but also for my own daughter. She had times in her childhood when she was technically obese. For a few years, we enrolled her in Taekwondo. During that time, she had a normal weight and was in great physical condition. Eventually chose to give up the sport to concentrate on her academics. We encouraged her to exercise but she got out of the habit.

Now that she is eighteen and is earning her own money, she has the freedom to buy whatever she wants. Apparently, our choice of junk foods is very modest, so she has begun to buy her own food. Her food choices have been discouraging. She eats what most in her generation eat: a preponderance of junk food. My wife and I have of course registered of concern, but are being careful not to overdo it. As a young adult, she has the right to make her own choices and too much nagging is likely to be counterproductive. Fortunately, her job at a bookstore provides exercise simply because associates are so often on their feet. That helps.

Obesity runs in my wife’s side of the family. I am hoping my daughter did not pick up that particular gene. Given that my wife is one of many Americans struggling with obesity, I cannot help but wonder if ten or twenty years down the line, or perhaps even sooner, my daughter will be struggling with the same issues. I hope of course that she will emulate me and eat better, and exercise regularly. Like most teenagers, she thinks she is immortal. She realizes she may have to eat better and exercise regularly someday, but for now, she chooses to ignore the issue.

As do a preponderance of our youth, apparently. I am skeptical that today’s youth will find the wherewithal to address the problem as adults. I think without some major societal intervention that it is much more likely that they will stick with their current eating and exercise choices, because it has the feeling of familiarity and thus provides the illusion of comfort in a confusing world.

The consequences for these latest generations are truly dire. Yet there is little in the way of planned action to address these chronic problems. It appalls me to think that I may live to an older age than my daughter, primarily because my mother fed us healthy and nutritious food. Single parent families or dual income families are disproportionately raising today’s generation. That was true for our daughter. We both had full time jobs when our daughter was growing up. Living on one income, however modestly, was out of the question until the last few years. Our daughter ate most of her lunches in the school cafeteria, where she could safely consume the foods she wanted, like pizza, rather than the foods she needed. She fit right in. Her friends largely did the same thing.

I think dual income parenting contributed a lot toward the obesity epidemic. With family time so squeezed, it is not surprising that parents often rustled up meals from of a box or out of a fast food bag. It was also not surprising that our children tended to prefer these meals too. Food vendors do not stay in business by making uninteresting food. In order to attract more business, food had to be jazzed up. In that sense, American capitalism succeeded very well. Over time, we developed strong preferences for this unhealthy kind of food.

Congress may have inadvertently done our kids in too. Our agricultural subsidies, most of which went to subsidizing grains that could rarely turn a profit, made grain incredibly cheap. When certain types of food are cheap to purchase, many of us feel inclined to consume more of them than we used to. It used to be that we would rotate through seasonal foods over the course of a year. With grain cheap all year round, we added more and more grain to our diets. With sugar also artificially cheap, we had a deadly combination: cereals and breads laced with sugars. Cheap grain also encouraged us to give it to our livestock, making the price of meat cost less too. Most foods served in America were relative bargains throughout the latter half of the 20th century. There was little reason for restaurants not to super-size our portions when the ingredients were so cheap.

Our additional eating was one part of the equation. Lack of exercise was the other part. When I was a youth, we were free to roam neighborhoods at will as long as our homework was done and we returned home in time for dinner. Neighborhoods were assumed safe. My parents gave little thought to where we were as long as we were in the neighborhood. We also lacked modern indoor distractions like computers and videogames. Going outside and playing with the kids on the block was a compelling alternative to the drudgery of being home. Modern parents perceive that if they give the same freedom to their children that their children are at risk from child molesters. Parents believe it is safer to keep children at home rather than let them roam the neighborhood. To make this unfortunate reality easier to swallow, we provided indoor amusements for them. The combination of a poor diet and reduced exercise appears to be toxic.

Few of our children are likely to end up in professions where exercise will be built into the jobs. Most are likely to spend their lives much as we do: in offices living sedentary work lives much like Dilbert’s. Perhaps in their off hours they will be able to grab some exercise. That seems unlikely, for they will likely have children of their own at home, and these children will have to be fed and protected.

Our society desperately needs a culture shift. We may need to reduce our workweeks to 35 hours a week simply to allow adults to have time for physical fitness and parenting. An hour-long workout may not be enough, but it is a start. Employers may need to be required to offer exercise facilities to their employees to use at work. Just as you cannot keep horses in the stables for days on end, neither should humans be trapped in cubicles, cars and their homes for days on end. We are built to move, not to sit.

Exercise needs to be seen as a necessary and critical part of being a human being. What has changed over the last generation or two is that most Americans must now dedicate time for exercise. It should be encouraged by our leaders and our employers. Health insurance premiums should be substantially discounted for people who participate in monitored exercise programs. Our children need more than recess and occasional PE classes. They need regular and more vigorous exercise at school, extending the school day if needed, as well as more healthful food in school cafeterias. Since they are children, their weekly exercise should be monitored and tracked by school officials. It may seem offensive to some to require our children to be regularly weighed and tested for their physical fitness at school. However, these prosaic activities also encourage children toward a lifelong appreciation toward the necessity of exercise and healthy eating.

My suspicion is that these are the sorts of steps that must be taken to keep future generations of Americans from being obese, dying prematurely and the obscene health care costs that are associated with obesity. They may seem Big Brotherish, but for the sake of our children, we need to do it.

May 18th, 2008 at 08:47pm Posted by Mark | Sociology | no comments

McCain’s health care non-solution

Presumptive Republican presidential nominee John McCain is in the news today. He unveiled his comprehensive health care proposal: a $2500 tax credit for individuals and a $5000 tax credit for families to allow them to buy the health insurance plan of their choice. He believes that with such an approach that competition and the free market will make health care affordable so we can all be insured.

If men are from Mars and women are from Venus, Republicans like McCain must be from Pluto. It is amazing that reporters do not laugh him off the podium. McCain is not the first Republican to advance such a free market non-solution to our health care crisis. His proposal though is truly worthy of derision.

First, his plan is hazy on what to do with people with pre-existing conditions. He wants states to form insurance pools for these people, but his plan does not require any insurance company to be non-discriminatory. He also allows people to continue with their employer-based health insurance if they want. However, his plan would give employers incentive to ditch their health insurance plans altogether. Why should they pay for health care costs when the government will instead?

So assuming you do not have health insurance and an insurer will agree to sell you a health care plan then after your tax credit you will have to pay all the excess premiums, deductibles and co-pays. Naturally, your premiums will tend to be higher if you are older, have unhealthy habits or have a history of chronic health problems. I did price individual health plans on this web site. I checked plans in my zip code for a hypothetical couple age 40. The only plan I could find without any deductible was a plan with the HMO Kaiser Permanente. It costs $542 a month, limits you to their physicians and comes with a $20 co-pay any time you want to see a doctor. Generic drugs come with a $10 co-pay. Brand name drugs come with a $30 co-pay. So assuming you never see a doctor or take any medicines then after your tax credit you and your spouse will still have to pay $1504 a year. You can expect that as you age your premiums will go up. How much? If the same couple were 50 years old, they would have to cough up $872 a month, or $5464 after their tax credit.

Most likely, you have other bills to pay. You would want to reduce premiums and pay a yearly deductible instead. What is out there? Blue Cross/Blue Shield would be preferred. A 40-year-old couple would pay $259 a month for a plan with a $1000 a year deductible with an Anthem BC/BS plan. Unless you see the same doctor more than three times, co-pays are $30 a visit. If you see someone out of the network, the insurance company will pay 70% of what it considers a reasonable and customary fee. If your out of network doctor charges you $125, you file for reimbursement and your insurer considers $75 reasonable and customary, your costs come to $22.50 plus the amount over $75, or $72.50 a visit. This is of course after you have satisfied your annual deductible. If you see one of their preferred doctors then you just pay the co-pay. However, you may find, as I have, that a family member needs faster or better care than what you can get through a preferred provider. This plan costs $3108 a year if you never get sick or never need a prescription drug. In theory, you and your wife could pocket close to $2000 a year. If you are like most of us and get more than the sniffles once a year, you can probably add on that $1000 deductible, plus other co-pays for prescriptions. It’s hard to imagine that a tax credit will cover your health costs. If you and your spouse are age 50, the price rises to $333 a month.

Who is not paying? If you take the tax credit, your employer is not paying anything. Perhaps the money they might have spent to subsidize your health insurance will go to giving you a higher salary, but I would not hold your breath. Anyhow, I suspect the optimal cases I outlined are not close to your situation and you will need more health care. If I had to guess, I would guess that a typical family would be out $5000 to $10,000 a year on health care costs after their tax credit. I bet this is where most of us are at right now. In short, it will not necessarily improve your bottom line at all. Nor does it do anything to address the problem of rising health insurance. All this free market ideology sounds great but if it is so great why has it not worked so far? The same health insurance companies we have today are going to be offering roughly the same insurance they do now under McCain’s plan. By that time, of course it will be pricier.

Moreover, the older you get the more expensive insurance will become. You can try buying a less expensive health care plan, if you can find one, but health insurance is like sitting on a beanbag chair. If you pay a smaller premium, you get astronomical deductibles or unacceptable conditions and exclusions instead. It could mean, for example, that you cannot get the kind of health care you need when you need it, such as an organ transplant.

McCain’s health care plan also begs the question of how the tax credit will be paid for. He has already ruled out raising any new taxes. In fact, he wants to keep the tax cuts for the wealthy that he once denounced. It would probably help if we got out of Iraq but he has been quoted as saying he would be fine if we stayed there a hundred years. Even if we did get out of Iraq, the government would still be spending hundreds of billions of dollars a year more than it receives in revenues. Consequently, the cost of this health care tax credit would likely come from borrowed money. In some of my earlier blog posts, I pointed out that when the government borrows money from foreigners the effect is inflationary. It explains part of the high cost of commodities like gasoline. McCain talks about finding savings by cutting the size of government. However, every president these days says he will do it and none of them has yet succeeded. In any event, the real cost of government is not in running agencies like HHS or even the Pentagon. That’s pocket change. It is in programs considered largely untouchable, like Medicare, Medicaid and agricultural subsidies. The closest modern president to constrain the size of government was a Democrat: William Jefferson Clinton.

Clearly, this proposal is just more smoke and mirrors, providing the illusion that health care can be made affordable with doing nothing to address the underlying problems causing costs to spiral.

What will work? Many first world countries have nationalized health insurance. They offer universal quality health insurance and are doing it for a fraction of what we pay. If you have the time, you should watch Frontline’s Sick Around the World. You can watch the entire show on your computer. Washington Post Reporter T.R. Reid goes for Frontline to the United Kingdom, Japan, Switzerland, Germany and Taiwan to see how these countries provide universal health insurance. The mechanics of course vary by country, but it is clear that not all solutions require turning all health care professionals into civil servants or under-compensating physicians and health care professionals. I found Japan’s approach the most interesting. We could pick any of these models, have high quality and universal health insurance and pay considerably less per capita than we are currently paying, all without ever worrying about whether we could afford it.

Or we could put yet another Band-Aid on the problem, keep letting costs spiral out of control and believe that we can really cover everyone with tax credits, which is John McCain’s “solution” to our health care problem.

April 29th, 2008 at 07:36pm Posted by Mark | Politics 2008 | no comments

Taking pleasure in hand

(Warning: This blog entry is rated R.)

We are told that if something is too good to be true, it is. There is no such thing as a calorie free brownie. We wanted to believe we could eat potato chips made with Olestra and never get fat. Even if the fat passes through you, you still absorb the carbohydrate calories. Moreover, this manufactured non-absorbent fat gives many people abdominal cramping and loose stools.

We court our spouses anticipating that they are our perfect mental, emotional and sexual match. Typically we do not discover until sometime after we are married that they have as many faults and foibles as we do. We men want to have sex on demand with them, but quickly learn that except for a freakish few of them and certainly no one you would happen to marry (although during courtship you may be misled), women don’t work that way. Moreover, women have this inconvenient time of the month when they are sexually out of commission. Should our wives or girlfriends turn into sexual ice cubes, we must weigh the potential consequences on being non-monogamous like sexually transmitted diseases and frying pans flying at us from across the kitchen. Use a condom and sex is suddenly 30% as pleasurable as it could be. Regardless of the pitch, we have learned through bitter experience that somewhere in the fine print is a gotcha. If we knew about it going in, we might have avoided the pleasurable activity altogether.

Not any more, I am happy to say, at least if you are a man. There is definitely at least one activity in life where you can truly have your cake and eat it too. This is absolutely true if I am to believe this article and since I found it on Yahoo News then it must be true. This activity that is both exquisitely fun and pleasurable. The more you do it, the healthier you are likely to be. It is not only completely harmless but also is good for your health. One small side effect is that it does have a tendency to be a bit messy. We are talking about that often lifetime habit of men married and single which can be as addictive as cocaine and just as fun: masturbation.

Frequent masturbation may help men cut their risk of contracting prostate cancer, Australian researchers have found. It is believed that carcinogens may build up in the prostate if men do not ejaculate regularly, BBC News reported on Wednesday. The researchers surveyed more than 1,000 men who had developed prostate cancer, and 1,250 men who had not. They found that men who had ejaculated the most between the ages of 20 and 50 were the least likely to get cancer. Men who ejaculated more than five times each week were a third less likely to develop prostate cancer.

This is exciting news for both men and pimply faced boys across the world. No longer do you need to feel that your secret vice is sinful. Now it is healthy. When I was growing up, if you could muster the courage, you would confess your masturbation habit to your local parish priest. I never did, of course, but I strongly suspect saying three Hail Marys would not absolve me of my sin. I am confident that my priest would have prayed to Jesus so that I would avoid the near occurrence of this dreadful sin. Perhaps times have changed in the last forty years. However, I also know that there are few things that the Catholic Church is more obsessed over that the sanctity of life. We are supposed to prolong our lives as much as humanly possible. Since prostate cancer is almost universal in men that reach a certain age, we now have a safe way to significantly lower our risks and it is completely drug free! Yes, it is time to get out the Penthouse, head to the bathroom five or more times a week and beat off. By doing so, we cut our risk of prostate cancer by up to a third.

Our wives might prefer that we make love to them five or more times a week rather than masturbate. That suits me fine, but I confess at age 51 I am not entirely sure I could partake in such an intimately pleasurable act five or more times a week for weeks on end. Actually, I am not sure even that with lots of glossy Playboys, Penthouses and even saucy Penthouse Forum Variations whether I could feel quite that sexual over the course of the week. Yet it sounds like I should try this therapy. If my wife is not in the mood, well, excuse me dear while I head to the bathroom or shut the bedroom door while I get off. Doctor’s orders.

I have no idea how much it costs to treat prostate cancer, but I bet it is expensive and scary as hell. I know prostate cancer is a very slow growing cancer. I know we all have to die of something. I also know one of the frequent side effects of removal of the prostate is impotence, although frequent loss of urinary control that also occurs does not sound appealing either. So why take the chance? Better to find some ready pornography and maybe prevent this cancer from occurring altogether.

There may even be some taxable benefits. If the dirty magazines weren’t cutting it, maybe my doctor would prescribe the Real Doll™. According to their web site, I can select from ten bodies, my choice of eye color and even select my doll’s preferred pubic hair style. Moreover, I can guarantee you that I never knew a woman in the biblical sense who came anywhere close to being attractive as these dolls. If I get sick of the same face, well apparently you can order extra faces with your Real Doll™. The standard female is only $6,499 plus shipping and handling, but at least it would be tax deductible. It has to be less costly than prostate surgery.

Somehow, I suspect the Catholic Church would find something sinful in my suggestions. By blogging about this I am probably sinning because I am inspiring lust. Perhaps if I saved my lust for marriage rather than masturbated during my teenage years like every other boy with hands was doing it would have made my wife that much hornier for my body. Consequently, we could procreate more children and bring more souls to God. Even my priest might have to concede the validity of this latest medical research.

No matter. While I was raised a Catholic, that was then. Now I am a free agent spiritually. I am generally cautious by nature but if my doctor tells me that masturbation is safe and news reports like this one tell me it is not only safe, but healthy, I’m in.

Now excuse me, I need a little privacy.

April 23rd, 2008 at 08:49pm Posted by Mark | Sociology | no comments

More intimations of mortality

Doctors are busy people. Generally, if I get a phone call from our doctor’s office, it is some nurse giving me the banal details of some lab results. When out of the blue your doctor gives you a call it feels unnatural. If your heart does not start racing a bit, it should.

My doctor left a message on my voice mail at work on Wednesday asking me to call her back. I was at home attending my wife, who was recuperating from back surgery. I was not aware she had even called until Thursday morning when I got to the office. We played more telephone tag but she eventually called me at home on Thursday evening. She said that she received copies of my sonogram. Recently I had a sonogram of my bladder and kidneys. It was precautionary and part of some steps I had taken dealing with my annoying lower back pains.

While the technician was examining my kidneys, my liver must have been close by. The sonogram turned up some sort of lesion on my liver. My doctor felt that it was probably nothing to worry about. Most likely, it was some sort of benign cyst. Just to be on the safe side she wanted me to get a CT scan of my liver.

My wife would shrug off a CT scan. Her body has been scanned, poked, prodded and examined repeatedly from all sorts of directions for much of her adult life. She has had CT scans as well as MRIs and is something of a pro at this business. (”Close your eyes when they put you in the machine and try not to move.”) She expects things to go wrong. Me, I expect things to go right. There is a reason I hit the health club regularly, ride my bike to work and pop baby aspirins at night. I expect to remain healthy. I do not particularly like my minor back pain and my slightly enlarged prostate. However, these are all normal and almost predictable conditions for middle-aged men. What I do not expect is anything weird to be going on inside my body.

A cyst on my liver is not normal. On the other hand, neither is it all that abnormal. Thanks to the power of Google, I have learned that many people have cysts on their liver. At any one time, approximately 5% of the population has them and they are largely benign. I may have had one for decades. It is only now with sufficiently advanced medical devices that these things are even noticed. So it is probably just a benign blood cyst. Yet undeniably, it could be something more dreadful, like the early stages liver cancer. My maternal grandfather died of liver cancer. Of course, he did not die until his late 80s, which was a remarkable lifespan for someone born in the 19th century.

Women get cysts all the time, particularly on their ovaries. Gynecologists just keep an eye on them. In fact, women deal with all sorts of medical crap, from ovarian cysts to fibroid tumors, PMS, menopause as well as breast and cervical cancer. We middle aged men think it is unfair because our enlarged prostates make us run to the bathroom a couple times during the night. We are such whiners. Women learn to deal with their bodies giving them abuse. They have had a chance to get comfortable with their own mortality. For me the back problem and the enlarged prostate are mere annoyances. A lesion on my liver though, is a cause for concern. I wonder if I should be panicking.

I do not like prolonged periods of ambiguity yet I must wait. I must wait to get time inside a CT machine. I must wait for a radiologist report and for my doctor to ponder what it means, if anything. I should feel grateful for all this wonderful modern technology. This sonogram might have been a blessing in disguise by locating a problem before it turned into a much larger or life threatening one.

Or I could be one of these men whose life’s clock much shorter than they think it is. For me September 11th is memorable for two reasons. The first reason is obvious. I worked in Washington D.C. and saw the smoke rise from the Pentagon. I was part of the fear and chaos that marked that day, although somewhat tangentially. The second was because I was commuting in a vanpool at the time. The driver and owner, Dan, drove us all back early, fighting hellacious traffic to get us out of the city. In retrospect, his actions were almost heroic. Yet it would be the last day Dan would ever drive the vanpool or even go to work. He was complaining of stomach pains. It turned out he had pancreatic cancer. He was dead within a month. He was 48.

Life is a roll of the dice. In general, I inherit good genetics from both my parents so I know that my chances of premature death are slim. I am and feel very healthy which explains why this all feels so surreal to me. If I had some potentially major affliction I sense I would know about it somehow. Most likely, that is not how these things happen. More likely, you move through life in ignorance then discover rather suddenly that you were deluding yourself.

Overall, I am taking this news is stride. I am concerned but not anxious. Logically I know the odds are small that I have any condition that could be either serious or fatal. The emotional part of my brain is not quite so sanguine and is hyper vigilant. I am hoping in a week or so this ambiguity will be gone and I will resume enjoying life to its fullest.

March 2nd, 2008 at 02:00pm Posted by Mark | Life 2008 | one comment