Davis Square Family Practice Newsletter
In This Issue
Obesity "Epidemic"
Healthcare Reform Update
Summer Safety and Health
Deborah Bershel, M.D.
 Marie Botte, N.P.
Robert Love, N.P.
Anne Roche
Office Manager
Qianna Price
Lead Medical Assistant
Kristen O'Callaghan
Medical Assistant
Randi Baxter
Medical Assistant
 Monica Pereira
Jason Joyce
Dorothy Anderson
Issue #9May 24, 2010
Sneezing boy

Please view this as YOUR newsletter. All comments/suggestions are welcome as they may serve to enhance this newsletter for everyone.
Deb Bershel, MD
The Obesity Epidemic - What Can Be Done?
This is such a complex issue. First, I have intentionally avoided having any pictures of overweight individuals because I think that there's an implied mockery or blame associated with photos. I have a link CDC Obesity Maps 1990-2008 that shows in vivid detail how dramatically  obesity (defined as a BMI of 30 or greater or about 30 lb. overweight) has approximately doubled in less than 20 years.
How can this be? Have we all become couch potatoes during the last 20 years? I doubt it. My personal bias is that this increase is a societal problem brought on by the combination of inexpensive food and a mass media push to suggest that we can eat our way to happiness. I'm being a real spoil-sport here but I think that our society needs to embrace the philosophy of 'let's eat in order to live' and step away from the Food Channel perspective of 'let's live to eat'.
Every study that has been conducted on calorie restriction (from single-celled yeast to mice and now rhesus monkeys) has shown that calorie restriction leads to healthier animals and longer life. The latest article on 76 rhesus monkeys who had a 30% calorie restriction over 20 years showed a 50% reduction in cardiovascular disease and cancer. None of these calorie restricted (CR) monkeys developed diabetes or prediabetes whereas the monkees with an unrestricted diet had a 42% incidence of those entities. Additionally CR monkees had more muscle mass and had less loss of grey matter in the areas of the brain that are associated with executive function. Human studies of calorie restriction have begun at Tufts.
My feeling is that we should not bash our kids over the head about obesity. Kids have a low enough self-esteem to begin with. We need to model healthy eating in our own lives and hope that our children will follow suit somewhere down the road. If we show respect for our health by exercising, eating a balanced  diet without excessive calories and quit smoking then at least our kids won't think that we've set up a different standard for them than we have for ourselves.
More specifically, before starting a diet change you should find out whether your current weight is in a healthful range. BMI is a mediocre standard in my book as it does not take into consideration body frame or body shape. BMI was designed to 'keep it simple' and it unduly stigmatizes big-framed and muscular people. The waist to hip ratio has been shown to be more accurate and will allow big-framed and pear-shaped people (those with relatively large hips) to not fall into an unhealthy category. In the office we can show you on the charts where you lie and perhaps ease some of your concerns. If you are indeed overweight we can make some suggestions as to how you may begin to address the problem. The solution has to be longterm and should include diet and exercise (but exercise alone rarely does the trick). Most anybody can lose 10 or 20 lbs in a month but the trick is to find an approach that works for you - one that you know you can stick with for a lifetime. Ironically, when it comes to dieting the more rigorous programs seem to work better than 'I'll just cut back'. 'I'll just cut back' works fine until the Holidays come, or your birthday comes or my 'boss was on my case' comes and then you're back to your old ways again.
So give us a call if you want to contemplate some big (or small) changes and Marie Botte, Bob Love or I would be delighted to help.
Healthcare Reform - update
Healthcare Reform 

So healthcare reform has passed and now what happens. It's somewhat complicated but the Health Reform Highlights link will give you a good summary of what are the main features of the plan.  The Timeline for Implementation Link will let you know whaen the major components will be inacted. We in Massachusetts already have implemented much of what expands healthcare access for the uninsured. But there are some actions on the federal level that will be very nice going forward. The  doughnut hole for Medicare prescrition coverage will begin to close this year ($250 rebate if you reach the hole). It appears that coverage for children who are 26 and don't have a plan will be eligible to be covered. Call your insurance company NOW and find out if you can get your child covered. Medicare will begin covering preventive medicine exams and standard insurance will have to cover some preventive healthcare without deductibles. Shortly, there will be no exclusion allowed for preexisting conditions

 (this apopears to becoming implemented by the insurance industry ahead of schedule). In 2011 you will be able to contribute to a longterm care plan that will help you and your loved ones if you should become chronically ill and dependent.
As I said in a previous article on the subject -this is a start, it's not perfect but it's sure a lot better than what we had.
Summer Safety and Health
Summer Safety Tips
The following are some random common sense ideas that all parents might want to consider. The link at the bottom of the article is the AAP recommendations for sun protection/ pool sand exercise safety for kids. In addition I recommend:
No flipflops if you're carrying your child.
Consider sunglasses for children even if they don't want them. Let them choose a cool pair because better eye protection may lower the incidence of cataracts down the road.
Don't forget to do tick checks. If on for 24 hours or more ask us to prescribe antibiotics.
If you or your kids are in an airconditioned facility you don't have to drink extra liquids during a heat emergency.
Grilling food is tasty but it should be done in moderation if you don't use fresh lava stones, wood or charcoal. The crusted-on superheated fat that rises up from old charcoal is most likely carcinogenic (cancer promoting).
Set a good example for your kids and always wear a seatbelt.
I liked this info page about avoiding lightening. I thought the admonish about 'don't carry a lightening rod (golf club or fishing pole) to be cute.
PS - don't forget to call early for those school physicals!!!
We have a wonderful website that offers many services to help enhance your patient care experience with us.  Please logon to www.dsfamilypractice.com to see all our site has to offer. 
Anne M. Roche
Office Manager
Davis Square Family Practice