Volume 6 October 1, 2009 Obesity, Swine Flu

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“Obesity is all in your head…in your brain actually”
– Lee Kaplan, MD, Director MGH Weight Center, Harvard Medical School
in explaining the concept of the body’s “set point” for
energy/weight balance which controls our body mass.
.
.
.      As I resume the “list” format after my September essay, it is appropriate to start out with some more facts on obesity from the August 9, 2009 Harpers List itself:
.
Percentage rate of U.S. obesity that DHHS hopes to achieve by 2011:  15
Number of states where less than 20 per cent of the population is obese:  1
Number of states where the obesity rate declined last year:  0
Average number of calories by which Americans underestimate total calories in a burger & fries: 463
Per cent lower cardiac death rate of those who eat chocolate two or more times a week: 66
Per cent protection against cardiac death from other kinds of sweets: 0 (1)
Increased per cent chance that you will become obese if your spouse is obese:  37 (2)
Increased per cent chance that you will become obese if your friend becomes obese: 171
Number of genes that have been identified as associated with body weight: > 100
Difference in energy intake between obese and lean people once weight is stable: 0 (3)
Number of years of life obese young adults can lose due to their weight: 20
Per cent reduction of mortality in patients who underwent gastric bypass surgery: 40 (4)
Average cost of gastric bypass surgery (bariatric surgery) in 2007: $20,000 (5)
Year that Great Moves, a Childrens’ Hospital weight loss program that demonstrated
.        stable weight in 70% of participants, was unfunded because it did not meet
.        the ROI (return on investment) goal of the insurance company underwriting it: 2009
.             With families changing insurance companies every three years on average,
.             the insurance company incurs costs, but does not reap any benefits from making
.             a child less obese. Another insurance company will enjoy the future benefits of
.             less health care costs by that person’s avoidance of diabetes, cardiac problems,
.             and other complications of obesity. (6)
.          SOUNDS LIKE ANOTHER ARGUMENT IN FAVOR OF A SINGLE PAYER TO ME.
A single payer system could enhance the ability of any insurer to insure someone
“for life”, so that a company would feel inclined to spend money on prevention in order to
receive the ROI from better health and lower health care costs in the future.

The new phrase from the CDC for quarantining children with flu symptoms:  ”social distancing”
Decreased days of flu symptoms in children treated with anti-viral drugs:  1  (7)
Number of hours a child is already contagious before he/she shows flu symptoms: 24
Number of days after fever resolves that children with flu-like symptoms can go to school: 1
Number of people in U.S. who usually get a winter flu shot:  about 100 million
Number of H1N1 (Swine) flu vaccine doses ordered so far this year: 251 million
Language in which swine flu was first detected on the web by HealthMap.org:  Spanish
Number of types of H1N1 flu vaccines:  3
.           inactivated virus from multi-dose vial with thimersol preservative for injection
.           inactivated virus from single dose vial without thimersol preservative for injection
.           attenuated live virus with no preservative given as a nasal spray
Number of adjutants (additives) in 2009 H1N1 vaccine:  0
.            The 2009 H1N1 flu vaccine is being manufactured using the same process
.            by whichseasonal flu vaccines have been manufactured since 1980, which
.            is different from the manufacturing process of the 1976 swine flu vaccine.
Per cent effective immunizations for seasonal flu in 2008 by injectable virus: 73
Per cent effective immunizations for seasonal flu in 2008 by nasal mist virus:  51 (8)
.       True only for adults. Nasal mist is more effective in children.(9)
.               Gullian-Barre Syndrome (GBS) usually follows a viral (including
.                flu) or bacterial infection. It includes muscle weakness that can
.                lead to paralysis due to auto-immune damage to nerves starting
.                in the feet and ascending to the chest. It resolves by itself, but
.                30% of patients may have minor muscle weaknesses a year later.
Incidence of GBS in the general population in 1976: 1.5 per 100,000
Incidence of GBS in flu vaccine recipients in 1976: 2.5 per 100,000 (10)
Number of other names given to the Guillian-Barre Syndrome: 4
.                  (indicates our lack of understanding of its cause)
Most common age group suffering from GBS in 1976:  30 – 50 yr
.                  (the lowest priority age group for H1N1 vaccine today)

References
1. J Intern Med 2009 Sept; 266:248
2. Social Networking, Framingham Heart Study, N. Christakis, J. Fowler, Wired Mag 8/09
3. NEJM 359;24 12/08, R. Leibel
4. NEJM 361;5 7/30/09, M. Robinson
5. D.B. Jones, Director of Bariatric Surgery, BI Deaconess Med Ctr
6. Roberta Clarke, Assoc. Prof BU, Bos Globe Op Ed 9/24/09
7. BMJ 2009 Aug 10; 339:b3172, M. Shun-Shin
8. NEJM 361;13: 1260-7 , 9/24/09  A.S. Monto
9. Ped Inf Dis J 2006;25:860-9  DM Fleming
10. Am Acad of Neurology newsletter 8/09;  Am Jour Neur 8/79


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