It's a Messed-Up, Unhealthy World

Americans are fatter than ever.  Nearly a third are obese, and two thirds are overweight.  Michelle Obama leads a campaign against obesity.  And yet, the same US government has funded Domino's Pizza to produce a pizza with 40% more cheese, of which one slice has two-thirds of the limit of artery-clogging saturated fat as a person should consume in an entire day.  And you can bet that slice of pizza is loaded with sodium, leading to elevated blood pressure and increased risk of heart attack and stroke.

You'd think we would feed our kids healthy meals in school?  And yet, the National School Lunch Program meals are laden with animal fat and fried foods.  A third of kids are overweight and obese, and half of all children between the ages of 2 and 15 have fatty streaks in their arteries.  Often, the meals that a child gets in school are the only meals that he or she eats in an entire day.

And, being busier than ever, Americans are eating more food outside the home than ever.  In one fast food meal, there may be more than a day's worth of blood-pressure raising sodium and a huge quantity of artery-clogging trans and saturated fats.

There's a big lack of physical activity, which leads to health problems.  Only half of Americans exercise regularly, and the definition of "regular exercise" is a pathetic three sessions per week of thirty minutes of exercise.

And then, as a result of being heavy and eating all this junk and not exercising, our patients come in and they're obese, and their blood pressure is high, and their cholesterol is too high.  What do most doctors do?  Do we ask what our patients are eating?  Do we ask if they're exercising?

No, usually we don't.  We look at the unfit, overweight specimen in front of us and we assume, often incorrectly, that this person is set in his ways, that he doesn't have the capacity to change.  We as doctors might even have the same physique as our unfit patient.

We reach for that magic cholesterol-lowering pill that we can give "when diet and exercise aren't enough," a medicine that might very well give our patient debilitating muscle cramps.  And, your doctor probably won't tell you this, but if you have never had coronary artery disease, that magic pill likely won't prevent an event. 

In low-risk patients with elevated cholesterol levels and no prior heart problems, you would need to treat 250 of them with a cholesterol-lowering statin pill every day for five years to prevent a single cardiac event!  In the most optimistic of studies, you would need to give a statin drug to 40 people every day over the next five years to prevent just one event.  This pill won't prolong your life and probably won't improve your quality of life either.  This is why I rarely prescribe statins for primary prevention of heart disease.

And then rather than counsel our patients on the benefits of fruits and vegetables and decreasing dietary sodium intake, we hand over a prescription for atenolol, the most commonly prescribed blood pressure medicine.  Atenolol lowers blood pressure in the arms and legs but not the pressure seen by the heart and brain, increases risk of diabetes and stroke, and does nothing to reduce risk of cardiovascular events.  Or, the second most prescribed blood pressure medicine, hydrochlorothiazide, also known as HCTZ, which when given at "appropriate doses" raises glucose levels and increases risk of diabetes, has limited evidence to demonstrate prevention of cardiovascular disease.

Or maybe your doctor does tell you to eat healthy, exercise and lose weight.  But what's the drug rep bringing the doctor and his or her staff for lunch today?  Pizza?  Barbecued ribs?  A tray full of cookies and brownies?  Take a peek in the break room.  You may be surprised by what you see.

We seem to have become a pill-pushing profession.  We give our patients a band-aid in the form of atorvastatin or atenolol, and we refuse to address the poor lifestyle habits that make our patients sick in the first place.  And as a whole, we're pretty lousy role models too.

I believe we have clout.  I believe our patients aren't stupid, and I believe they're receptive to us.  If we with our MD or DO or NP or PA initials after our names talk to our patients, I think they'll listen.  And, if more of us do this, then I think we have the power to heal.