School-Based BMI Reporting: A- (up from B in 2012) – Promising new evidence suggests that the state’s school-based BMI program is creating positive results for students and families. Despite this, there has been pushback from legislators based on media reports and parent misunderstanding.
*Primary Care: B+ (up from B) – The new state health care law creates special incentives for developing strong, patient-centered primary care in Massachusetts. The Executive Office of Health and Human Services (EOHHS) has set the goal for all primary care practices to become patient-centered medical homes by 2015.
*Healthy School Meals: B (up from B-) – The Commonwealth is now fully implementing the most stringent requirements in the country for the sale of ‘competitive’ foods in schools. USDA regulations governing school lunch and breakfast programs were amended by the Healthy-Hunger Free Kids Act of 2010. Rules and regulations are being finalized, with state implementation ongoing.
Healthy Transportation Systems: B- (up from C) – The Legislature passed revenue measures to address the shortfall in funding for transportation and to improve the performance of state transportation agencies; it has not yet provided any long-term stability in financing. The state continues a promising start to healthy transportation planning. Continue reading
Check out Rachel Gotbaum’s very nice profile of Doug Melton, Harvard’s influential stem cell scientist, on WBUR today.
Melton’s certainly had his share of media attention — he was at the center of the controversy over embryonic stem cell research, which anti-abortion activists tried to stop during the Bush administration. But Gotbaum’s story focuses on a more personal aspect of the biologist’s work: trying to find a cure for diseases like diabetes, which afflicts both of his children. Melton’s career trajectory underwent a radical shift shortly after he and his wife learned their infant son was sick:
In 1981, Melton was recruited by Harvard, where he focused on molecular biology and embryology. But all that changed 10 years later when Melton’s infant son, Sam, became ill. His wife, Gail O’Keefe, says their son, who was 6 months old at the time, was not thriving.
“I started noticing that he wasn’t making any eye contact; something was clearly amiss but I couldn’t really put my finger on it,” O’Keefe said. “And then one morning he woke up and he was projectile vomiting.”
“We took him to the hospital and for a while no one could figure out what was wrong with him and it looked quite dire,” Melton recalled. “We now know that he was in extreme ketoacidosis, which is the stage before a person goes into a coma.”
The couple watched for hours as doctors at Boston Children’s Hospital tried to figure out what was wrong with Sam. Continue reading
You may be feeling a little gooey and edgy from the great media shower of candy, hearts and flowers today, so forgive me for piling on, but today’s reason to exercise is about love.
Not that hyped, romantic love, though, but the sane self-love that prompts us to make healthy choices like working out. Okay, end of Oprah segment. But I just wanted to share my favorite section of a book we recently featured, Eating To Lose: Healing From a Life of Diabulimia.
The author, Maryjeanne Hunt of Millis, MA, has Type 1 diabetes and used to skip the insulin she needed, despite huge risks, in order to lose weight. She also got deeply into fitness, as both participant and instructor, and says she “abused” exercise as well. But at least exercise is generally healthy — and regular exercise remains part of her far saner approach to her weight these days. With her permission, this comes from the section of her book titled “Cookie Power:”
It was a Friday morning at 6:30 a.m., several years later in July. My cardio interval class had just ended.
“Thanks,” one of the participants sighed breathlessly as she toweled off the sweat from her face and neck. “That was a great workout! I really needed that today.”
I turned to face the woman, whose voice I didn’t recognize, and smiled. “I think we all did.”
“I’ve been in a slump,” she continued. “This was the first week since New Year’s that I’ve actually made it to the gym all five days?”
“Well, congratulations, then. And by the way, Happy New Year!” We chuckled and continued walking toward the lockers.
“How many days a week do you work out?” she asked.
“Almost every day.”
“So if I do this every day, how long will it take me to have legs like yours?”
You could say it began with a big bowl of chocolate pudding. After days on a starvation diet, 14-year-old Maryjeanne broke down and devoured the whole bowl, spooning the forbidden chocolate sweetness into her mouth straight from the fridge.
Then the regret hit, and the shame. She had failed her 600-calorie-a-day diet. What to do now? She’d had Type 1 diabetes since age 10, and knew she should take some extra insulin to counterbalance all the pudding she’d just eaten. Or she could make a darker choice. She writes in her recent memoir, Eating to Lose:
I skipped my insulin that night. It was my penance.
The next day I lay in my hospital bed with five intravenous tubes connecting the insides of my arms, ankles, and neck to the stark walls of that room. There was not a single ounce of energy left in me. My mouth was drier than Arizona sand. My stomach felt as though it had expelled every morsel of food I had ever eaten. The muscles along my torso felt bruised from endless violent heaving; my insides now entirely evacuated. The combination of this torturous diet and the resulting chocolate pudding binge had cost me two collapsed lungs and nearly ten pounds of weight loss, consisting not of fat, mind you, but primarily of essential bodily fluids.
Maryjeanne had entered the world of “diabulimia,” an eating disorder specific to people with Type 1 diabetes, usually young women. The “bulimia” in the name refers to a diabetic method for purging calories: Instead of vomiting up food as typical bulimics do, someone with diabulimia skips or skimps on insulin, so that blood sugar is “purged” in urine instead of being absorbed and used for energy by the body’s tissues.
The effect can be instant weight loss. Also instant medical crisis, and devastating long-term damage.
Diabulimia offers perhaps the starkest example there is of the harsh “logic” of an eating disorder, an urge to lose weight so overwhelming that health no longer seems to matter. And young women with Type 1 diabetes are two to three times more prone to eating disorders than those without, research finds. The overall prevalence of diabulimia is estimated at up to 1.4 million Americans.
If a young woman is already at risk for an eating disorder, and then she experiences weight loss in a day or two from skipping insulin, “It’s outrageously reinforcing,” said Dr. Ann Goebel-Fabbri of the Joslin Diabetes Center. “That’s a more powerful and dangerous calorie purge than any other eating disorder symptom.”
The price is also exceptionally high. Continue reading
A new study by researchers at the Harvard School of Public Health adds to growing evidence that vitamin D plays a critical role in maintaining overall health.
The new government-funded study, published online in the American Journal of Epidemiology, suggests that a simple intervention — having adequate levels of vitamin D during young adulthood — may cut the risk of developing adult-onset, type 1 diabetes by as much as 50 percent.
Here’s some of the Harvard news release:
This study provides the strongest findings to date to suggest that vitamin D may be protective against type 1 diabetes.
In type 1 diabetes (once called juvenile-onset or insulin-dependent diabetes), the body’s immune system attacks and permanently disables the insulin-making cells in the pancreas. About 5% of the estimated 25.8 million people in the United States with diabetes have type 1, according to the American Diabetes Association. Although it often starts in childhood, about 60% of type 1 diabetes cases occur after age 20.
Previous studies have suggested that a shortage of vitamin D might boost type 1 diabetes risk, although those studies mostly examined the link between vitamin D levels in pregnancy or childhood and the risk of type 1 diabetes in children. Other research, in young adults, uncovered an association between high vitamin D levels and a lowered risk of multiple sclerosis—an autoimmune disease genetically and epidemiologically related to type 1 diabetes—suggesting that inadequate vitamin D in adulthood may be an important risk factor for autoimmune diseases in general…
The researchers conducted a prospective case-control study of U.S. military personnel on active duty, Continue reading
Diabulimia? At first I thought it might refer to purging with laxatives. But no, it refers to young women with diabetes who cut back on the insulin they need in order to lose weight. “Diabetes Health” offers some excellent background here, including the explanation that “when insulin is omitted, calories are purged through the loss of glucose in the urine.”
The BBC reports today that a British charity called Diabetics with Eating Disorders is now pushing to have diabulimia recognized officially as a mental illness. The report warns that side effects of not taking enough insulin can range from “eye sight loss to kidney damage and if left untreated can even kill.”
Leading doctors and psychiatrists say diabulimia is most common with young women who have type 1 diabetes…
Figures show, in the 12 months up to last March, more than 8,000 people were admitted to hospital in England and Wales, with symptoms of not taking enough insulin. Continue reading
A word of advice for Boston Mayor Thomas Menino from a top specialist: Diabetes is no reason to retire. And another bit of wisdom: When you’re back in the office, schedule exercise into your day as you would a demanding constituent.
Mayor Menino’s doctors disclosed last week that during his recent weeks-long hospital ordeal of infection, blood clot and fractured vertebra, the mayor was also diagnosed with Type 2 diabetes. (That makes him a rarity in American politics; lists of famous diabetics abound, but the only other politician who has been open about Type 2 diabetes that I can find is Mike Huckabee of Arkansas.)
Mayor Menino is now recuperating at Spaulding Rehabilitation Hospital and sounded very much like himself in a recent press conference (Retire? “I checked my retirement. It wasn’t good enough.”) and a public letter about the fiscal cliff. But his ailments triggered calls for him to retire in Boston Globe columns and elsewhere.
We’ve written repeatedly about the explosive rise in Type 2 diabetes prevalence, now at 26 million Americans and expected to rise by another 50 percent in the next decade or two.
But I suddenly realized that I didn’t actually understand what it means to have Type 2 diabetes. Both my grandfathers had it. One, a stocky former boxer, was felled by its complications, first knocked down to a wheelchair and then into an early grave. The other didn’t seem bothered by it at all. So how hard is diabetes? Is it in fact relevant to any decision the mayor might make about his next political move?
According to Dr. Martin Abrahamson, chief medical officer of the Joslin Diabetes Center, the answer is an emphatic “No.” I spoke with Dr. Abrahamson just after he gave an overview of the current state of diabetes treatments to some 500 doctors as part of a Harvard Medical School continuing education course. Our conversation, lightly edited:
So we’ve just learned that Mayor Menino has Type 2 diabetes. What does that mean, both physiologically and in terms of — well — living?
Well, it means that his ability to metabolize glucose is impaired, and the glucose levels in his blood have risen, and probably for two reasons: Firstly. he has less ability to dispose of glucose in the cells compared to people who have normal metabolism, and that comes about because the insulin in his body is less effective. And secondly, he is not producing as much insulin as normal people do. Insulin, as you know, is a hormone that pushes glucose into the cells, and the cells use the glucose for their energy on a daily basis. So it means that he has elevated glucose levels.
However, there’s a lot that he can do about it. He can treat his diabetes through a variety of ways, the first of which is modifications in lifestyle, increasing exercise, watching his diet and losing some weight. And second, there are medications that can be taken, either by mouth or injectable ones, that can either help the body use insulin more effectively to dispose of glucose, or enhance the amount of insulin that the body produces to promote glucose uptake into the cells.
So the first-line treatment tends to be lifestyle changes — diet and exercise — and then it sounds like very typically you prescribe Metformin, which is just a pill, right? And then, I believe you said, by about six years out, about half of people with diabetes need insulin? Continue reading
After a month-long stint in the hospital, where he reportedly continued making city policy decisions from his bed, Boston Mayor Thomas Menino is on his way to rehab, and has been diagnosed with Type 2 diabetes, the Associated Press reports:
Menino, 69, the longest-serving mayor in Boston’s history, was first hospitalized Oct. 26 after cutting short a vacation in Italy because of a respiratory infection. While at Brigham and Women’s Hospital, he suffered a compression fracture in a vertebra in his spine and also was treated for a blood clot that moved from his leg to his lungs. Dr. Charles Morris said that while Menino was hospitalized, doctors also discovered an infection in his back and diagnosed him with Type 2 diabetes.
WBUR’s Delores Handy discussed the mayor’s hospitalization on Radio Boston today. She says it’s not yet clear when the mayor will be able to go home from rehab, and notes that the mayor’s doctors say his diabetes could have played a role in the recent back infection he suffered.
Overall, they say, he’s in good health and he’ll be working on his exercise and diet to help fight the diabetes, Delores reports. So many people have diabetes these days, she notes; he may serve as a helpful role model for managing diabetes.
True. The diabetes rates have been skyrocketing, in Boston and elsewhere. So we’d like to issue a public invitation to the mayor:
Dear Mayor Menino: Congratulations on the end of this long hospital ordeal. You’ve been wonderfully open about your own struggles with weight, and we’d like to invite you to chronicle your progress on beating back your diabetes. A great many Bostonians with diabetes could draw inspiration from your reports, and if you’d like to post them on a platform that a couple of hundred thousand people a month read, well, we’ve got one…
These eye-popping numbers should make every U.S. citizen rush outside immediately for a brisk walk and eat a leafy green salad for dinner (hold the blue cheese dressing).
The CDC reports that diabetes cases are increasing at a staggering clip throughout the U.S., with an increase of 100 percent or more in some states between 1995 and 2010.
From the CDC news release:
The prevalence of diagnosed diabetes increased in all U.S. states, the District of Columbia, and Puerto Rico between 1995 and 2010, according to a study from the Centers for Disease Control and Prevention (CDC). During that time, the prevalence of diagnosed diabetes increased by 50 percent or more in 42 states, and by 100 percent or more in 18 states. [My bold.]
The report, appearing in CDC’s Morbidity and Mortality Weekly Report, finds that states with the largest increases are Oklahoma (226 percent), Kentucky (158 percent), Georgia (145 percent), Alabama (140 percent), and Washington (135 percent).
“Regionally, we saw the largest increase in diagnosed diabetes prevalence in the South, followed by the West, Midwest, and Northeast,” said Linda Geiss, a statistician with CDC’s Division of Diabetes Translation and lead author of the report. “These data also reinforce findings from previous studies, which indicate that the prevalence of diagnosed diabetes is highest in the southern and Appalachian states.” Continue reading
HealthDay News reports:
People with diabetes who boost their level of physical activity can reduce their risk of premature death…
And a separate study found that weight training alone may reduce the risk of developing diabetes in the first place.
The first study, which involved nearly 6,000 people with diabetes, found that those who were moderately physically active had the lowest risk of death.
Leisure-time physical activity — such as biking, gardening and housework as well as walking — was also associated with lower risk of death, found researcher Diewertje Sluik of the German Institute of Human Nutrition Potsdam-Rehbrucke, and colleagues.
In the other study, which included more than 32,000 men, researchers found weight training alone — without aerobics — can help prevent type 2 diabetes, possibly by increasing muscle mass and improving insulin sensitivity.
However, a combination of weight training and aerobic exercise provided the most preventive benefit. Continue reading