Heart Association gives UK grant to spur 'food as medicine' effort

By Grace Sowards
University of Kentucky

The Food as Health Alliance at the University of Kentucky has received a grant from the American Heart Association. UK is among the first recipients of AHA’s Health Care by Food Initiative awards.

Alison Gustafson (UK photo by Sabrina Hounshell)

FAHA director Alison Gustafson is a faculty member in the University of Kentucky Martin-Gatton College of Agriculture, Food and Environment. She will use the $386,000 grant over the next year and a half to see how a user-centered design program can improve screening, referral enrollment and engagement in food-as-medicine programs for adults with food insecurity and high blood pressure or other diet-sensitive chronic diseases.

This grant also involves UK HealthCare and Appalachian Regional Healthcare, with key partnerships from Instacart, Kroger Health with Soda Health, Mom’s Meals and Food City.

“We are looking forward to working with our partners across the state to improve screening, referral and enrollment practices to improve patient outcomes,” said Gustafson, a professor in UK's Department of Dietetics and Human Nutrition.  She has partnered with Instacart, Mom’s Meals and Food City on current pilot projects across Kentucky to help develop the infrastructure for patients receiving food-as-medicine programs.

The grant team is developing a referral hub for health-related social needs with key organizations in Kentucky. FAHA is bringing together diverse health-care, managed-care, non-profit and industry collaborators to facilitate screening, referral and enrollment to identify the most suitable and effective model(s) in the short term, while considering design for long-term sustainability.

FAHA seeks to bring together clinical and community research spanning across agriculture, food, health care and nutrition to address food insecurity and diet-related chronic disease. Researchers, community partners, food commodity producers, health care partners and students will explore innovative strategies to improve patient clinical outcomes and Kentuckians’ health.

“This award is an acknowledgment of the tremendous work the Food as Health Alliance has already been doing to address inequities related to food insecurity and chronic disease across Kentucky,” said Carolyn Lauckner, assistant professor in the Department of Behavioral Science at the UK College of Medicine and co-principal investigator on the grant with Gustafson.

“The grant demonstrates an investment in our efforts to use food as medicine to improve individuals’ health by targeting the link between food insecurity and cardiovascular disease,” Lauckner said. “I am thrilled to be working with this outstanding group of scholars and practitioners committed to using innovative, community-engaged research methods to improve the health of all Kentuckians.”

For more information on FAHA, visit https://foodashealthalliance.ca.uky.edu. For more information about the American Heart Association’s Health Care by Food Initiative, visit https://healthcarexfood.org.

Some decongestants spike blood pressure; alternatives available

Photo by September 15, iStock/Getty Images Plus

By Dr. Vincent Sorrell

University of Kentucky

It’s the season for respiratory viruses and the cough, congestion and sore throats they bring. There are many options for over-the-counter (OTC) remedies and relief, but if you have high blood pressure, you may want to take a closer look at the label. Some may contain warnings that advise against taking if you have high blood pressure. Others contain high levels of sodium, which can also increase blood pressure.

Some OTC decongestants contain pseudoephedrine, a drug that works by constricting the blood vessels to reduce nasal swelling. But with those blood vessels narrowed, blood pressure increases. For the 122 million Americans with hypertension, decongestants can raise an already elevated blood pressure to dangerous levels and increase the chance of heart attack and stroke.

Many OTC cold and flu medicines now have a version formulated specifically for those with high blood pressure. Allergy medicines can also relieve stuffy or runny noses without adverse side effects, just as cough medicines and expectorants to help clear mucus.

If you need relief from cold and sinus congestion without medication, try these at-home remedies:

• Use a saline rinse to move saltwater through the nasal passages to clear out mucus.
• Drink extra fluids to help thin the mucus.
• Use a humidifier to moisten the air in your home and help clear your sinuses.
• Get plenty of rest.

If your symptoms persist, and you’re concerned about which decongestant is the best for you, talk to your doctor.

Vincent Sorrell, M.D., is chief of cardiology at UK HealthCare’s Gill Heart & Vascular Institute.

UK study could help Type 2 diabetics who have high blood pressure that doesn't keep the normal rhythm of falling at night

If you're a Type 2 diabetic and have a problem with high blood pressure at night, you might be able to control it by limiting your eating to to a specific window of time during each day. So suggests a study on mice at the University of Kentucky College of Medicine.

The study, published in the Proceedings of the National Academy of Sciences, was conducted by Ming Gong, a professor in the UK Department of Physiology, and Zhenheng Guo, a professor in the Department of Pharmacology and Nutritional Sciences.

“We are excited about these findings and the implications they could have in future clinical studies," Guo said in a UK news release. “In addition to lifestyle changes like diet and exercise, time-restricted eating could have a healthy impact on people with Type 2 diabetes.”

Blood pressure is normally low at night, but that doesn't happen in some people with hypertension and Type 2 diabetes, and is associated with heart and vascular disease.

The study found that imposing time-restricted feeding kept diabetic mice from developing the problem, and restored blood-pressure rhythm in mice that already had the problem.

"Researchers restricted the mice's access to food to eight hours during their typical active awake times every day," the UK release said. "When food availability was increased to 12 hours, the practice was still effective in preventing and treating nondipping blood pressure. Guo says this is evidence that the effects were caused by the timing of feeding and not calorie restriction."

Latest White House report has fewer Kentucky counties in danger zones, drops two points of preventive advice from previous report

Table from White House Coronavirus Task Force report; for a larger version, click on it.

By Al Cross
Kentucky Health News

Kentucky got a better report this week from the White House Coronavirus Task Force.

It has two more counties are in the task force's "red zone" -- for places with more than 100 new cases per 100,000 people, and a positive rate of at least 10 percent in tests for the virus -- but a lot fewer in its "yellow zone," for those with 10 to 100 cases per 100,000 and positive-test rates of 5% to 10%.

And the latest report dropped two recommendations that were in the previous week's report, that Kentucky stop visitation in nursing homes and other long-term-care facilities, and tell people with obesity, diabetes and high blood pressure that they should shelter in place.

The task force sends the report to states with recommendations based on the red and yellow zones. It is dated on Sundays and covers the preceding Saturday through Friday. The Cabinet for Health and Family Services released the report in response to an open-records request from Kentucky Health News, which asked that it be released within one day of receipt from the federal government because it contains time-sensitive material. The request was made on Monday and the cabinet fulfilled it on Tuesday. "We appreciate the prompt response," KHN told the cabinet in an email.

The latest report puts 18 counties in the red zone, two more than in the previous week's report, which but has only 34 counties, down from 58 the week before. Taken together, the number of the state's counties in a danger zone is 52, down from 74.

While the number of red-zone counties didn't change much, the names of the counties did. The latest report added the entire metropolitan areas of Louisville and Evansville, including Owensboro and Henderson. Those additions were expansions from Jefferson and Daviess counties, which were already in the red zone. Jefferson County has seen a major surge in cases the last three weeks.

Chart from White House Coronavirus Task Force report, relabeled by Kentucky Health News

The other red-zone counties, largely in the order listed by the task force, are Warren, Oldham, Graves, Barren, Scott, Laurel, Henderson, Casey, Knox, Adair, Spencer, Henry, Anderson, Metcalfe, Monroe, Cumberland and Fulton. The last three jumped directly into the red zone without having been in the yellow zone, illustrating how quickly the virus can spread.

Shelby and Ohio counties moved from the red zone into the yellow zone. Carroll County, which had been in the red zone, isn't even in the yellow zone in the latest report. Counties that were unlisted in the previous report but are now in the yellow zone are Garrard, Lawrence, Perry, Pulaski and Taylor.

Counties moving out of the yellow zone in the latest report were Allen, Boyle, Butler, Clinton, Fleming, Franklin, Gallatin, Grant, Grayson, Green, Hancock, Harrison, Hart, Hickman, LaRue, Livingston, Martin, Mason, Nicholas, Owsley, Todd, Trigg, Trimble, Union and Washington.

The report says 7.2% of the state's nursing homes had at least one infected resident, an increase of 0.6 percentage points from the previous week.

"The nursing home facilities with more than two confirmed or suspected covid-19 cases are largely in red and yellow zones," the report says. "Preventing further spread in these areas is critical to protect the vulnerable nursing-home population. Protect vulnerable populations in assisted living and long-term care facilities through weekly testing of all workers and requiring masks. In facilities with workers who tested positive, ensure all residents have been promptly tested and appropriate cohorting measures are in place. Conduct on-site inspections to ensure covid-19 safety guidance and considerations are being implemented."

Overall, Kentucky had 95 new cases per 100,000 population in the past week, compared to a national average of 137 per 100,000. That put it just out of the red zone for cases.

The report's statewide recommendations say the state should keep its mask requirement in place and "work with local communities to ensure high usage rates; identify mechanisms to assess compliance with local regulations."

Enforcement of the mask mandate is largely up to businesses. They are supposedly monitored by local health departments, but Gov. Andy Beshear acknowledged July 27 that enforcement needs to improve. His office has not responded to questions from Kentucky Health News about what he has done to improve enforcement and any results from any such actions.

Maps from White House Coronavirus Task Force report for July 25-31; for a larger image, click on it.

July 26 federal report said that in most of Ky., nursing-home visits should stop, and obese, diabetics, hypertensive should stay home

Chart from White House report, adapted by Kentucky Health News; for a larger version, click on it.

This story has been updated.

By Al Cross
Kentucky Health News

The latest weekly report to states from the White House Coronavirus Task Force contains many recommendations for state and local officials that Kentucky officials have not implemented or even revealed.

For example, it recommends that the state prohibit visitation at long-term-care facilities in most Kentucky counties, those in the red and yellow danger zones as defined by the task force.

It recommends that people with obesity, diabetes and high blood pressure in those counties shelter in place, much as Gov. Andy Beshear ordered Kentuckians to do from late March to early May.

Beshear spokeswoman Crystal Staley told Kentucky Health News Monday morning that Beshear met with Dr. Deborah Birx, the task force's response coordinator, "to gather recommendations directly, and the actions taken by Gov. Beshear follow her advice. She would agree that too many Kentucky counties are in danger and that action was needed statewide."

Still, the recommendation to stop visitation at long-term-care facilities will be at the top of the agenda for Tuesday's meeting of the task force that the state has assembled to help the facilities get through the pandemic, task-force coordinator Keith Knapp said Monday morning.

The White House report also recommends that public officials "Ensure that all business retailers and personal services require masks," something that is not being done in much of the state, if anecdotal reports of limited mask wearing and enforcement in many businesses are indicative.

Beshear has acknowledged the need for better enforcement by businesses, and backup enforcement by health departments. "There's not been enough enforcement out there; we can admit to that," he said July 27.

Beshear has gone farther than the recommendations in at least one case, limiting social gatherings to 10 people -- something the task force recommended by done only in red zones.

The latest White House report, dated July 26, was sent to state officials. It was obtained and published by The New York Times. Kentucky officials have not responded to requests for a copy of the report; one of Beshear's emergency pandemic orders gives custodians of public records 10 days to respond to requests for records instead of the usual three.

Here are the recommendations to red and yellow zones in Kentucky in the July 26 report. Most are the same for both zones; this list notes major differences.

Public Messaging
Wear a mask at all times outside the home and maintain physical distance
Limit social gatherings to 25 people or fewer (10 in red zones)
Do not go to bars or nightclubs
Use takeout, outdoor dining (indoor dining in yellow zones when strict social distancing can be maintained)
Protect anyone with serious medical conditions at home by social distancing at home and using high levels of personal hygiene (in red zones, handwashing and surface cleaning are emphasized)
Reduce your public interactions and activities to 50% of your normal activity (25% in red zones)
Public Officials
Limit gyms to 25% occupancy and close bars until percent positive rates are under 3; create outdoor dining opportunities with pedestrian areas (gyms in red zones should be closed)
Institute routine weekly testing of all workers in assisted living and long-term care facilities; require masks for all staff and prohibit visitors
Ensure that all business retailers and personal services require masks and can safely social distance Increase messaging on the risk of serious disease for individuals in all age groups with pre-existing obesity, hypertension and diabetes, and recommend to shelter in place
Work with local community groups to provide targeted, tailored messaging to communities with high case rates, and increase community-level testing
Recruit more contact tracers as community outreach workers to ensure all cases are contacted and all positive households are individually tested within 24 hours
Provide isolation facilities outside of households if positive individuals can't quarantine successfully
Testing
Move to community-led neighborhood testing and work with local community groups to increase access to testing (in red zones, increase community-level testing)
Surge testing and contact-tracing resources to neighborhoods and ZIP codes with highest case rates
Diagnostic pooling: Laboratories should use pooling of samples to increase testing access and reduce turnaround times to under 12 hours; consider pools of three to five individuals
Surveillance pooling: For family and cohabiting households, screen entire households in a single test by pooling specimens of all members into single collection device

The report also includes, for each state, four maps showing new cases, positive-test rates and the change in each from week to week. Here are Kentucky's maps from the July 26 report, comparing the week of July 18-24 with the previous week, July 11-17. For a larger version of the image, click on it.

Adult obesity in Ky. reaches all-time high of 36.6%, fifth in U.S.; doctor says insurance needs to start covering obesity prevention

By Melissa Patrick
Kentucky Health News

Kentucky adults just keep getting larger, reaching an all-time high for the number of obese adults in the state, ranking it fifth in the nation.

"As a society, as a whole, we're not quite convinced yet what a major problem this is," said Dr. Barbara Fleming-Phillips, an internist who helps run the weight management clinic at UK Healthcare's Barnstable Brown Diabetes Center.

Kentucky's adult obesity rate in 2018 was 36.6 percent, according to an annual report by Trust for America's Health and the Robert Wood Johnson Foundation. That's an increase of 6.7% , and 2.3 percentage points, from last year's rate of 34.3%, eighth highest in the nation.

The report says Mississippi and West Virginia have the highest rates of adult obesity, at 39.5%, and Colorado the lowest at 23%.

That said, all the state rates could actually be higher, says the report, since their numbers are based on the Behavioral Risk Factor Surveillance System, a continuous national poll; people self-report, and tend to over-report their height and under-report their weight. Obesity is calculated through body mass index, essentially a ratio of height to weight.

Supporting that theory, the national adult obesity rate is 39.6%, which comes from actual body measurements from the National Health and Nutrition Examination Survey.

The report for Kentucky shows that 68.5% adults in the state are either obese or overweight.

"Clearly things are going in the wrong direction in Kentucky just as they are in the rest of the country," said Fleming-Phillips. "And it's really a systemic, overall-society problem; it's not just a matter of counseling individual people on weight loss, which we do with my job, but it's a matter of looking at the entire system."

Strategies to combat obesity

Fleming-Phillips said it will take a "multi-pronged approach" to tackle excessive weight in Kentucky and the nation. She said that from her clinical experience, the most important contributor to weight loss is the diet, but added that exercise is definitely a component.

Nutritional education is needed in childhood, but adults also need nutrition education that teaches them to choose "real foods" over convenient, processed foods, Fleming-Phillips said.

As for exercise, she said because we are such a sedentary society with sedentary jobs, exercise must become a habit early on in a person's life; otherwise they will have to decide it is important.

Kentuckians don't exercise much. The report says Kentucky ranks No. 1 in the share of adults who say they are physically inactive: 32.3%.

The state also recognizes the need to focus its obesity efforts on children. That's because a child who is overweight when they start kindergarten is three times as likely to become obese by middle school compared to their peers, Christina Dettman, spokeswoman for the Cabinet for Health and Family Services, said in an e-mail.

For example, she said the State Physical Activity and Nutrition Program works to increase breastfeeding in birthing facilities, since studies show children who have been breast-fed are less likely to be obese. The program also works to implement healthy-food guidelines in work and community settings; to integrate nutrition and physical-activity standards into early-care and education systems; and to improve sidewalks, paths and bicycle routes throughout the state.

Dettman added that Kentucky has received a federal grant that can be used for evidence-based strategies at the local level to improve nutrition and physical activity. It will be allocated to 11 community health departments in Eastern and Western Kentucky. They include health departments in the Purchase District, Pennyrile District, Kentucky River District, the Cumberland Valley District, and Muhlenberg, Todd, Calloway, Christian, Pike, Floyd and Whitley counties. According to the Centers for Disease Control and Prevention, the grant is for $856,326.

The report notes that obesity levels are closely tied to social and economic conditions, finding that those with lower incomes are at higher risk of being obese as are people of color.

The obesity rate for blacks in Kentucky is 39.3%; for Latinos it is 30.9%; for whites it is 35.2%. About the same number of men and women are obese.

Baby boomers have the highest obesity rate at 43.8%, followed by those between the ages of 25 and 44 at 40%, seniors at 30.8% and those between 18 and 24 at 18.5%.

The report includes 31 recommendations for policy actions that are largely designed to improve access to nutritious foods, provide safe places for physical activity and to minimize the harmful marketing and advertising tactics that currently exist.

A few examples of its recommendations include the expansion of the Special Supplemental Nutrition Program for Women, Infants and Children to age 6 for children and for two years after birth for mothers, fully funding the WIC Breastfeeding Peer Counseling Program and taxing sugary drinks.

The push to expand WIC services is supported by an obesity decline seen in 31 states among 2- to 4- year-olds enrolled in the program between 2010 and 2014. Kentucky, with a decline of 18.2% to 13.3% respectively, was one of those states.

That said, Kentucky's older children haven't fared so well, with those between the ages of 10 and 17 having the third highest obesity rate in the nation, at 19.3%. And just like the state's adults, obesity rates among Kentucky's high school students continues to creep up and at 20.2% this group also ranks third in the nation for this measure.

Charts from report show figures from earlier years about childhood obesity in Kentucky, by age group

The latest Kentucky Health Issues Poll that asked about childhood obesity found that 56% of Kentucky adults saw childhood obesity as a serious problem for the state; another 35% said it was a problem, but not serious; and 6% saw it as no problem at all.

Obesity treatment and insurance

The American Medical Association recognized obesity as a disease in 2013, with hopes that the designation would change the way the medical community treats obesity, including how insurance companies would pay for the treatment.

But that has not happened, Fleming-Phillips said. Dedication to nutritional education and obesity prevention is still not a priority "anywhere in the medical system," she said.

"It's kind of baffling that obesity has been declared a disease -- and obviously there is a giant problem with obesity -- but insurance companies are not paying for obesity education and prevention or even treatment of the disease, medical treatment of the disease of obesity," she said.

The report also addresses coverage for obesity prevention, saying that while the law requires most insurance plans to cover preventive services, "there is great variability of actual implementation or uptake of these recommendations across insurers."

Chart from report shows the diabetes rate in Kentucky is up.

Being overweight or obese greatly increases the risk of developing other chronic diseases, like type 2 diabetes, high blood pressure, heart disease, stroke, and many types of cancer -- all conditions that plague Kentucky. Obesity is estimated to increase national healthcare spending by $149 billion annually, says the release.

About 14% of Kentucky's adults reported having diabetes, ranking the state seventh highest for this measure, and 39% of them reported having high blood pressure,which put the state at No. 5, the same rank it has for adult obesity.

Study suggests kids with hypertension more likely to have heart disease as adults; Ky. teens 3rd in U.S. in top risk factor, obesity

Parents.com photo

By Melissa Patrick
Kentucky Health News

Just like adults, children can have high blood pressure. The only way to know is to check for it, and it's important because children with hypertension are more likely to grow up to be adults with heart disease -- the number one killer of adults in Kentucky. And in the biggest risk factor for heart disease, obesity, Kentucky high-school students are the third most likely in the U.S. to be obese.

"Children don't have a lot of symptoms with high blood pressure, so we don't know they have it until we check," said Dr. Donna Grigsby, chief of general pediatrics at UK HealthCare. " If they don't get it under control when they are young it's likely to persist into adulthood. . . . There are a lot of long-lasting consequences to living with high blood pressure that is not well-managed."

Untreated hypertension in adults can lead to heart disease, heart failure, vision loss, stroke and kidney disease.

Grigsby noted that the American Academy of Pediatrics issued new blood-pressure guidelines for children in 2017, and that diagnosing hypertension in children is a little trickier than diagnosing it in adults because it varies by a child's age, height and gender. She stressed that health-care providers have to do more than just take a child's blood pressure; they also have to interpret it.

A recent study in the American Heart Association journal Hypertension suggests kids with hypertension are at a higher risk of heart disease as adults.

Using data from nearly 4,000 children who were followed for 36 years, the study found that the newer guidelines classified 11% of children as having hypertension; the old guidelines classified 7%.

It also found that 19% of the children with high blood pressure according to the new guidelines had an enlarged heart (left ventricular hypertrophy, or LVH) as adults. Under the old guidelines, it was only 12%.

Sperling's Best Places map

A possible pitfall in the study was that all of the children in this study come from one community: Bogalusa, Louisiana, just across the Pearl River from Mississippi, a town of 12,000 with a 57% white and 41% population. Also, the study used no information about actual heart attacks and stroke.

Overall, the study found that 8% of the children who were reclassified to having high blood pressure under the new guidelines were more likely than those without hypertension to develop heart disease as adults; and the children who were reclassified to the lower blood-pressure categories with the new guidelines had similar results as those who had never been diagnosed with hypertension.

"Children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of hypertension, metabolic syndrome and LVH in later life," the report says.

Metabolic syndrome is a group of risk factors that raises a person's risk for heart disease, stroke and diabetes. They include high blood pressure, excess fat around the waist, high blood-sugar levels, high triglyceride levels and low levels of good cholesterol, or HDL. Having any three of these risk factors produces a diagnosis of metabolic syndrome.

Grigsby said all children should start having their blood pressure checked at age 3, and children who are considered at higher risk of developing high blood pressure should have it done sooner, including those who were born prematurely or who have kidney or heart disease.

The Centers for Disease Control and Prevention reports that an estimated 1.3 million youth between the ages of 12 and 19 have hypertension under the new guidelines, which is about 4% of the population. For example, the CDC says that in a classroom of 30, one would have high blood pressure and about three more would have "elevated blood pressure," once called "prehypertension."

Kentucky-specific data were not available, but the primary risk factor for high blood pressure in children is obesity, and that's a real problem in Kentucky. According to the State of Obesity report, one in five, or 20.2%, of the state's high-school students are obese, the third highest in the country.

"The children that we worry about are the children who are overweight and obese because we know that is a big risk factor for having high blood pressure," Grigsby said.

She said high blood pressure in children is primarily treated with lifestyle changes, like decreasing screen time, increasing activity, and improving diets -- and these changes are most successful when the whole family makes them.

"Instead of diet and weight loss, we talk a lot about healthy lifestyles because this is a change that they are going to have to be able to sustain," she said.

The Kentucky Department for Public Health suggests the 5-2-1-0 prescription to significantly reduce childhood obesity, which says to eat five or more servings of fruits and vegetables each day; limit screen time to no more than two hours a day; be physically active for at least one hour a day; and drink zero sweetened beverages. The website offers free resources to help meet these goals.

This is Heart Month, and it's still winter, so here's a reminder of the need to be physically active for cardiovascular health

February is American Heart Month, so the state Department for Public Health is encouraging Kentuckians to increase their physical activity to reduce the risk of heart disease and stroke. It is promoting the hashtag #MoveWithHeart on social media to connect with others and get information about exercise, physical activity and improving cardiovascular health.

"Heart disease is the second leading cause of death among Kentuckians, with more than 10,000 people dying each year from heart disease," the department said in a news release. "A major risk factor for heart disease is physical inactivity. Research shows that being physically active can help lower the risk of heart disease and stroke. When we protect our hearts, we care for our cardiovascular health. During the cold months, physical activity can be even more challenging. It’s important that Kentuckians make an effort to move more throughout the day. "

Federal guidelines suggest physical activity that gets our hearts beating faster and leaves us a little breathless for at least 2.5 hours each week. "You can break up that activity into small manageable chunks: 10 minutes here, 20 minutes there, it all adds up," the health department says. "In addition to physical activity, these healthy changes can help Kentuckians lower their risk of developing heart disease:" 

• Watch your weight.
• Quit smoking and stay away from secondhand smoke.
• Control your cholesterol and blood pressure.
• If you drink alcohol, drink only in moderation.
• Get active and eat healthy.

Bonita Bobo, the health department's coordinator for heart disease and stroke prevention, said “All Kentucky children, women and men should try to build activity into your day by taking the stairs, parking farther away from your destination, and stepping away from that computer screen.”

Study: Combination of a low-salt and heart-healthy diet is as good as drug therapy for many adults with high blood pressure

A new study finds that cutting back on salt and following the heart-healthy DASH diet can lower blood pressure, a disease that affects almost two out of every five Kentuckians.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—anti-hypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” Dr. Stephen Juraschek, a study co-author, said in a news release. Juraschek is an instructor of medicine at Harvard Medical School and an adjunct assistant professor at Johns Hopkins University School of Medicine.

Previous guidelines defined high blood pressure as 140/90 milligrams of mercury (mm/Hg) or higher, but guidelines released this year have re-defined it as 130/80 mm/Hg or higher. High blood pressure increases the risk of stroke, kidney disease, heart attacks and heart failure.

The four-week study, published in the Journal of the American College of Cardiology, included 412 adults between the ages of 23 and 76 who had high blood pressure or were at risk of having it. They were asked to either stay on a "regular" diet or to switch to the Dietary Approaches to Stop Hypertension, or DASH, diet. DASH limits foods high in saturated fat and sugar, and is high in fruits, vegetables, whole grains, low or fat-free dairy, fish, poultry, beans, seeds and nuts.

They were also divided into three groups that received varying amounts of salt. One was allowed about a half a teaspoon per day, another was allowed about a teaspoon per day and the third group was allowed about 1.5 teaspoons a day. To reduce the risk of heart disease and stroke, the U.S. Food and Drug Administration recommends a maximum of about 2,300 mg of sodium per day, which is nearly one teaspoon of salt.

None of the study participants took blood-pressure medicines. Their baseline systolic blood pressures (the top number) ranged from 120 to 159 and their diastolic blood pressure (the bottom number) was between 80 and 95.

The participants were sorted into four groups: 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and 150 mm Hg or greater.

The results varied based on which regimen the participants followed.

Those who followed the DASH diet with high sodium and had a systolic pressure of 150 or greater, had an 11-point average drop in systolic pressure. The effect was much less, a 4-point drop, among those whose beginning systolic pressure was less than 130.

The effect was even greater for those who were on the low-sodium DASH diet. Those who started with a systolic pressure of less than 130 had a 5-point drop in pressure; those who started between 130 and 139 had a 7-point drop; and those who began between 140 and 149 had a 10-point reduction.

The biggest impact was among those who followed the low-sodium DASH diet and started out with a systolic blood pressure of 150 or greater. They had an average drop of 21 points.

Juraschek called the findings "huge" and said they suggest that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

The researchers said further research is needed to determine how the combination diet affects people with systolic blood pressure of 160 or greater or in persons with prior heart disease or diabetes.

Americans eat way too much salt, mostly from 25 commonly consumed foods; cutting back reduces risk of high blood pressure

Americans eat too much salt, and a new study found that most of it comes from 25 commonly consumed foods. The top five culprits are bread, pizza, sandwiches, cold cuts and other cured meats, and soup. Salty snacks came in seventh, behind burritos and tacos, says the study.

Salt helps the body maintain its fluid balance, but too much of it increases the risk for high blood pressure, which then increases the risk for heart attack and stroke. Thirty-nine percent of Kentucky adults have high blood pressure and the state ranks 47th for heart disease, according to America's Health Rankings.

Hypertension in Kentucky adults, 2013-2015 (Map and chart from www.KentuckyHealthFacts.org)

The study found that in 2013-14, Americans ate about 3,400 mg of salt daily, far exceeding the Healthy People 2020 goal of 2.300 mg and the "ideal limit" of 1,500 mg recommended by the American Heart Association.

"If everyone reduced the amount of sodium in their diet by 1,200 mg per day, up to 99,000 heart attacks and 66,000 strokes could be prevented in the United States every year," according to the CDC.

Data for the Centers for Disease Control and Prevention study comes from the 2013-14 National Health and Nutrition Examination Survey. It only measured salt consumed in foods and did not take into account any salt added at the table. One teaspoon of table salt has 2,300 mg of sodium.

The study found that most dietary salt (61 percent) comes from packaged, processed and restaurant foods, the report said.

While most foods have a moderate amount of salt, the problem is that they are eaten all day long, Zerleen Quader, lead researcher, told Steven Reinberg of HealthDay.

"When cooking at home, use fresh herbs and other substitutes for salt. When eating out, you can ask for meals with lower salt," she said, adding that it's important to read food labels, and to choose the lowest salt option available. She also said the food industry needs to lower the amount of salt it adds to its products.

The study found that 44 percent of the salt people eat comes from just 10 foods and 70 percent of salt in the diet comes from 25 foods. Some other foods in the top 25 include bacon, casserole type dishes, salad dressing, French fries and cereal

Samantha Heller, a senior clinical nutritionist at New York University Medical Center in New York City, said that processed foods not only raise blood pressure, but may also increase the risk for cancer, noting that the World Health Organization classifies processed meats, like bologna, ham, bacon, sausages and hot dogs, as carcinogens.

"Parents need to understand that feeding hot dogs, fries, and ham and cheese sandwiches to their kids (and themselves) is significantly increasing their risk for certain cancers, hypertension and heart disease," Heller told Reinberg.

The CDC offers tips for reducing salt intake:

• Choose a heart-healthy diet like the "Dietary Approaches to Stop Hypertension," diet (DASH). Click here for more details.
• Buy fresh, frozen or no salt canned vegetables
• Use fresh meats, rather than canned or processed meats
• Read labels, choose product with lowest sodium content
• If you eat two servings, then account for two servings of salt
• Limit sauces, mixes and "instant" product"
• Choose spices and seasonings that do not list sodium on their label

When eating out:

• Choose restaurants that offer low-sodium options
• Ask server if sodium information is available
• Request that no salt be added to your food
• Ask for salad dressings and sauces on the side

Is sugar our nutritional enemy? New book claims it is

For about a decade as the century started, more and more Americans appeared to obey the U.S. Department of Agriculture's advice to eat less sugar.

But that trend of improvement has leveled off, according to statistics released Thursday by the federal Centers for Disease Control and Prevention. The data show that about half of American adults drink at least one sugar-sweetened beverage daily and the average adult consumes about 150 calories from sodas or other sugary drinks each day.

Gary Taubes
(Photo from Twitter)

That's a big problem, says Gary Taubes, author of The Case Against Sugar. The book points to sugar to explain why two-thirds of American adults are overweight or obese, one in seven is diabetic and about one in five will die from cancer, Jere Downs writes for The Courier-Journal.

The book makes sugar the villain in "metabolic syndrome," a term coined by medical researchers as early as 1987. Metabolic syndrome is the name for a group of risk factors that raises a person's risk for heart disease and other health problems, such as diabetes and stroke, according to the National Institutes of Health. Risk factors are traits, conditions, or habits that increase the likelihood of developing a disease.

Taubes's book points to sugar as the culprit
behind obesity, diabetes, and other lifestyle-
related diseases. (Photo via garytaubes.com)

"If you are overweight with a thickening middle and especially if you are approaching middle age or older, chances are good your body is wrestling with the effects of prolonged exposure to too much sugar," Downs notes.

The body manufactures insulin, a hormone that unlocks sugar's energy at the cellular level, in response to consuming sugar. Insulin can be elevated in the blood for years before the onset of Type 2 diabetes, as the pancreas produces more of the hormone to cope with the excess sugar. Even if the pancreas remains strong and diabetes does not develop, elevated insulin turns up blood pressure and levels of triglycerides, Downs writes. Such disturbances create and aggravate inflammation and hardening of the arteries.

Taubes's book, like others before it, attempts to dispel the myth that all calories are created equal, whether they come from candy bars or carrots. Straight sugar and highly refined carbohydrates, like white bread, trigger metabolic syndrome, which tells the body's cells to hoard fat, which in turn keeps a person overweight and sick, Downs notes.

"Remove the sugar and the insulin resistance improves, and weight is lost," Taubes told Downs.

However, there has been no definitive proof of sugar's role in metabolic syndrome, obesity, diabetes, and other illnesses and it is not likely to come soon. There are only a handful of small, limited clinical trials underway exploring sugar’s direct role in metabolic disease in the U.S., Taubes told Downs. Long-term lifestyle studies are expensive and face opposition from the sugar industry and other lobbies.

As far back as 1977, some Department of Agriculture researchers were so convinced of sugar's role in diabetes and heart disease that they called for Americans to reduce consumption by 60 percent, Downs writes. The average American today consumes 100 to 130 pounds of sugar a year; the estimates vary with the source of information.

In an effort to help combat the problem, new food labels emphasizing "added sugar" in packaged products are supposed to become mandatory on July 26. Whether the Food and Drug Administration will continue the Obama-era mandate under the new Trump administration is unclear.

Percentage of adults 20 and older who consumed sugary beverages on a given day, 2011-14 (Source: CDC)

Study finds a genetic marker determines a love for salty foods; says they should be considered a treat, like dessert

Heart-disease death rate for Kentuckians over 35 in 2012-14 (CDC map)

A person's desire for salty foods may be determined by their genes, and that could spell trouble for their heart, according to a recent study at the University of Kentucky.

The College of Nursing study found that individuals with a certain "taste perception genotype" were more likely to eat more than the recommended amount of daily sodium than people without the genotype, says a UK news release.

This matters because too much salt in your bloodstream can cause high blood pressure, or hypertension, one of the major risk factors for heart disease. And heart disease is the leading cause of death in the United States, killing about 610,000 Americans a year, or one in every four deaths, according to the federal Centers for Disease Control and Prevention.

Kentucky leads the nation in both heart disease and hypertension rates. Its death rate from heart disease is 394 per 100,000 people; the national rate is 328. Kentucky ranks sixth in the number of people diagnosed with hypertension, at 39 percent, according to the State of Obesity report. The report also projects that about 1.3 million Kentuckians will be diagnosed with heart disease by 2030.

Sources of salt you may not have thought about

The release notes that the study paves the way toward future prevention opportunities, and that future research will help develop targeted approaches to reduce salt intake by people who are genetically predisposed to salty foods.

The American Heart Association recommends that most people eat no more than 2,300 milligrams of sodium per day (that's one teaspoon of salt) and ideally no more than 1,500 mg. The AHA says about 77 percent of a person's salt intake comes from prepared, packaged and restaurant foods.

An AHA graphic of "The Salty Six" shows six popular foods to pay attention to if you are watching your salt intake because they can add high levels of salt to your diet, including cold cuts and cured meats, pizza, soup, breads and rolls, chicken and burritos and tacos.

The UK release also offers some tips on how to reduce your sodium intake:

• Keep a journal of your salt intake (1/4 teaspoon salt = 575 mg sodium; 1/2 teaspoon salt = 1,150 mg sodium)
• Cook with minimal amounts of added salt, using herbs and spices instead. 
• Read food labels.
• Opt for home-cooked meals so that you can control salt amounts
• Consider salty foods a treat, much like you would consider sugary treats

The AHA adds: "One estimate suggested that if the U.S. population moved to an average intake of 1,500 mg/day sodium from its current level, it could result in a 25.6 percent overall decrease in blood pressure and an estimated $26.2 billion in health care savings. Another estimate projected that achieving this goal would reduce deaths from cardiovascular disease by anywhere from 500,000 to nearly 1.2 million over the next 10 years."

Tackling obesity in Kentucky can be a touchy subject

KentuckyHealthFacts.org map; click on it for larger version

SLADE, Ky. -- Among the topics covered in "Covering Health: A News Workshop" Nov. 11 at Natural Bridge State Resort Park was one of Kentucky's biggest pairs of health problems: obesity and diabetes.

Reporting on obesity can be intimidating for journalists, said Danielle Ray, graduate intern at the Institute for Rural Journalism and Community Issues, who presented on the topic. "It’s a really awkward topic to approach," she said. "You feel like you’re embarrassing people." Reporting the facts about obesity is not intended to shame people, she said, noting that readers, viewers and listeners are at risk for life-threatening, yet preventable obesity-related illnesses, especially those in rural Kentucky counties.

Kentucky's obesity rate is the nation's fifth highest, with nearly 35 percent of adults categorized as obese on the basis of their height and weight. That number has been rapidly climbing for more than 25 years, according to the State of Obesity report. In 2000, about 22 percent of Kentuckians were obese; in 1990 the figure was less than 13 percent.

County-level map from KentuckyHealthFacts.org

Obesity is associated with diabetes and hypertension, or high blood pressure. Kentucky ranks fourth in the nation for diabetes, with more than 13 percent of the adult population diagnosed with type 2 diabetes.

The state ranks sixth highest in the nation for hypertension, with 39 percent or 1.8 million Kentuckians diagnosed with high blood pressure.

Hypertension, like diabetes, puts people at risk for other serious medical problems, including stroke, heart attack, renal disease and dementia.

Obesity also increases a person's likelihood of developing other conditions like heart disease, arthritis and cancer.

Childhood obesity may be an even greater problem in the state. Kentucky has the third highest rate of obese high-school-aged children, nearly 20 percent. Childhood obesity becomes intertwined with other factors that make the cycle hard to break. Most notably, children from low-income families are at a greater risk of obesity and its subsequent health problems, the report notes.

The workshop was presented with support from the Foundation for a Healthy Kentucky, which funds the rural-journalism institute to produce Kentucky Health News. The institute is part of the School of Journalism and Media in the College of Communication and Information at the University of Kentucky.

To find local information on obesity, visit Kentucky Health Facts or County Health Rankings.

Kentucky is one of only 2 states where adult obesity rose last year; now we're fifth in the nation; state diabetes rate highest ever

By Melissa Patrick
Kentucky Health News

We're fat, and getting fatter. And that's making us sicker.

More than one-third of Kentucky adults are obese, placing the state fifth in the country in obesity, a big jump from 12th the year before. Kentucky was one of only two states where obesity rates increased from 2014 to 2015, according to the latest State of Obesity report.

Graphics are from the State of Obesity report

Kentucky's adult obesity rate increased to 34.6 percent in 2015, up from 31.6 percent in 2014. In 1990, only 12.7 percent of Kentucky adults were obese. Get the adult obesity rate in your county at KentuckyHealthFacts.org.

“Obesity remains one of the most significant epidemics our country has faced, contributing to millions of preventable illnesses and billions of dollars in avoidable health care costs,” Richard Hamburg, interim president and CEO for Trust for America's Health, said in a news release.


"Obesity continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year," says the release.

The report, "The State of Obesity: Better Policies for a Healthier America," is conducted by Trust for America's Health and the Robert Wood Johnson Foundation and is based on data from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a continuous national poll.

Most obese Kentuckians fall between the ages of 26 and 64, with 36.8 percent of those aged 26-44 obese and 40.5 percent of those aged 45 to 64 obese, says the report.

The report found that black Kentucky adults were the most likely to be obese, at almost 43 percent, followed by whites (32.9 percent) and Latinos (24.3 percent). There was little difference between men and women.

The report also measured obesity-related health issues, such as diabetes and high blood pressure.

Kentucky's reported diabetes rate is at its highest ever, 13.4 percent, which places it fourth in the nation. This is up from 12.5 percent in 2014 and 10.6 percent in 2013. The report projects that almost 600,000 Kentuckians will have diabetes in 2030.

"Diabetes is the seventh leading cause of death in the United States, accounting for around $245 billion in medical costs and lost productivity each year," says the report.

The state's high-blood-pressure rate, at 39 percent, is about the same as the year before. The state ranks sixth in this measure. The report projects that 1,175,750 Kentuckians will have high blood pressure in 2030.

"Approximately 30 percent of hypertension cases may be attributable to obesity, and the figure may be as high as 60 percent in men under age 45," the report says. "People who are overweight are more likely to have high blood pressure, high levels of blood fats and high LDL (bad cholesterol), which are all risk factors for heart disease and stroke."

The report also updated high-school obesity rates and found that Kentucky's 18.5 percent was about the same as the last time such data were gathered in 2013. But because some other states' rates went up, Kentucky no longer ranks first in the nation. We're third.

The report notes that Kentucky adults fall into the top 10 states for the highest rates of physical inactivity (32.5 percent); states with the highest rates of obese 10- to 17-year olds (19.7 percent); and states with the highest rates of obesity among 2- to 4-year-olds (15.5 percent).

Kansas and Kentucky were the only two states to see obesity increases in 2015. Most remained steady, and four states saw a drop: Minnesota, Montana, New York and Ohio.

Nine of the 11 most obese states are in the South, and 22 of the top 25 are in the South and Midwest. Louisiana has the highest obesity rate, 36.2 percent.

More than half the states have obesity rates at or above 30 percent, with four above 35 percent. Obesity rates are above 20 percent in every state; in 1991, no state had a rate above 20 percent.

The authors outline a set of policy recommendations to combat obesity, including: investment in obesity prevention; focusing on early-childhood and school-based policies and programs that support healthier meals, physical activity and less screen time; prioritizing active transportation planning and access to healthy foods in communities; and covering a full range of obesity prevention, treatment and management services under all public and private health plans.

“These new data suggest that we are making some progress but there’s more yet to do. Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts," Hamburg said. "Improving nutrition and increasing activity in early childhood, making healthy choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up."

CDC boss Tom Frieden, at SOAR, gives examples of how communities can improve health, such as smoking bans

By Al Cross
Kentucky Health News

PIKEVILLE, Ky. -- Speaking to a region with some of the nation's poorest health, the top federal public-health official gave examples of how individual communities and states have made themselves healthier.

"Health is not just about health, it's about society," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, told more than 1,000 people at the Shaping Our Applalachian Region Innovation Summit in Pikeville. "Healthy societies are more productive, and productive societies are more healthy."

Referring to Kentucky's high rates of disease and factors that cause them, Frieden said bringing Eastern Kentucky's health statistics up to the national average would save more than 1,000 lives a year.

Frieden cited six communities that have tackled specific health issues, such as obesity, lack of physical activity, heart health, smoking and teen pregnancy.

Obesity is one of SOAR's three main health targets, but it's not an easy one, Frieden said. He said Somerville, Mass., reduced obesity in children under 6 by 21 percent by making it a community issue, with creation of farmers' markets for local produce, construction of walking paths and the mayor leading community walks.

"Physical activity is the closest thing to a wonder drug," Frieden said, because it helps prevent heart disease, strokes, diabetes and cancer, improved mood and lengthens life.

The leading preventable cause of death is smoking, Frieden said, calling for ordinances and laws making workplaces smoke-free. "Nobody should have to risk getting cancer to come to their job," he said.

Heart disease is the most preventable major cause of death, Frieden said, explaining how Minnesota and Grace Community Health Centers in Knox, Clay, Leslie and Bell counties have improved heart health by improving treatment of high blood pressure, or hypertension. "It's the single most important thing" to do for heart health, and it's simple, Frieden said, because the medicine is inexpensive and taken once a day with few if any side effects.

Frieden said the CDC thinks a lot about teen pregnancy because "Teen pregnancy perpetuates a cycle of poverty." He said Spartanburg, S.C., reduced teen pregnancy by 61 percent from 2001 to 2014 partly because South Carolina's Medicaid program paid for long-acting, reversible contraception immediately after delivery, and was the first state to give full reimbursement for post-partum insertion of intrauterine devices for birth control. Kentucky Medicaid doesn't cover such services.

Even nicotine-free electronic cigarettes can damage lungs; parents urged to warn teens about dangers of e-cig smoking

Kentucky has one of the nation's highest smoking rates, but electronic cigarettes, or e-cigs, are becoming more popular. These battery-powered vaporizers produce a vapor that usually does not contain nicotine. Some have claimed that e-cigs can help people quit smoking because the amount of nicotine can be reduced until it isn't present in the vapor. However, new research shows that other substances in e-cigs may damage the lungs.

Research has found that nicotine in any form damages the endothelial cells that line the lungs, and can cause them to become inflamed or injured. The new research has found that e-cigarette solutions without nicotine contain other substances like acrolein, which damage the lungs in other ways.

"This research reports that components found in commercially available e-cigarette solutions and vapors generated by heating them may cause lung inflammation," said lead researcher Irina Petrache. Long-term effects haven't yet been studied, but the results of this study warn that e-cig inhalation may involve adverse effects on lung health, she said.

Centers for Disease Control and Prevention research shows that e-cigarette use among middle and high school students has tripled. "The development and marketing of e-cigarettes has the potential of hooking a whole new generation on nicotine," Garry Sigman, director of the Loyola University Health System Adolescent Medicine Program, said. It's very addictive and can lead to health issues such as lung disease, heart disease, hypertension and nervous system problems, he said.

Sigman said parents need to made sure their children understand that e-cigarettes are just as addictive as other substances. "Nicotine is so addictive that with only a few inhales, it can create an addiction," he said. Because adolescents enjoy and use technology so much, the modern qualities of the e-cigs might make them seem cool. "Setting rules and monitoring behavior is essential to keeping our teens safe," Sigman said.

Kentucky ranks fifth in obesity and its high-schoolers rank first

By Melissa Patrick
Kentucky Health News

Obesity and health problems go hand in hand, and Kentuckians are known for both.

Kentucky now has the fifth highest adult obesity rate in the nation, up from ninth last year, and Kentucky's high-school students are the nation's most obese, according to a report by the Trust for America's Health and the Robert Wood Johnson Foundation.

At least one out of every three adults in Kentucky is considered obese (33.2 percent). This rate keeps going up; significantly higher than the 25.3 percent rate in 2004 or the 12.7 percent rate in 1990.

Baby boomers are the heaviest adults, with 37.1 percent of them considered obese. The report also found that 42 percent of black adults, 24.5 percent of Latino adults and 31 percent of white adults are obese.

Kentucky is joined by 20 other states with obesity rates of at least 30 percent. In 1980, no state was above 15 percent, according to the report, but times have changed. West Virginia and Mississippi tied for the highest rates of adult obesity at 35.1 percent and Colorado has the lowest rate at 21.3 percent, well above that long ago 15 percent.

Not only are the adults in Kentucky obese, so are its children, and kids who are heavy, tend to remain heavy as adults.

Kentucky's high schoolers have the worst obesity rate in the nation at 18 percent. The national average, according to the Youth Risk Behavior Surveillance System, is 13.7 percent. Utah has the fewest obese kids with only 6.4 percent of its high schoolers considered obese.

Obesity rates among 10-to 17-year-olds in Kentucky is also high, ranking 8th with 19.7 percent considered obese. Mississippi ranks highest in this category at 21.7 percent. Obesity rates among Kentucky's 2-to 4-year-olds from low-income families also fall in the top ten of most obese, ranking sixth with a rate of 15.5 percent.

Why does it matter? Obesity takes a huge toll on health, particularly with diabetes, high blood pressure, heart disease, arthritis and certain cancers. Kentucky struggles with each of these diseases.

Kentucky ranks 17th in diabetes. The foundation projects an increase of 51 percent of people with diabetes by 2030, going from 394,029 people with diabetes in 2010 (or 10.6 percent) to 594,058. More than 80 percent of people with diabetes are overweight or obese, says the report.

The projection for high blood pressure in Kentucky is an increase of 33 percent by 2030, going from 881,343 people with high blood pressure in 2010 to 1,175,750 in 2030. Kentucky ranks fifth among states for high blood pressure. High blood pressure is a leading cause of stroke and people who are overweight are more likely to have high blood pressure, says the report.

The foundation projects a whopping 382 percent increase in heart disease in Kentucky by 2030, going from 264,958 people with heart disease in 2010 to 1,278,342 in 2030. Heart disease is the leading cause of death - responsible for one in three deaths - in the U.S., says the report.

Obesity related cancer is expected to increase 158 percent, from 68,075 cases to 176,260 in 2030. Approximately 20 percent of cancer in women and 15 percent of cancer is attributable to obesity, says the report.

Arthritis, however, is projected to decrease by 15 percent from 876,143 cases in 2010 to 748,558 cases in 2030. Almost 70 percent of individuals with arthritis are overweight or obese, says the report.

“Obesity in America is at a critical juncture. Obesity rates are unacceptably high, and the disparities in rates are profoundly troubling,” Jeffrey Levi, executive director of Trust for America’s Health, said in a release. “We need to intensify prevention efforts starting in early childhood, and do a better job of implementing effective policies and programs in all communities – so every American has the greatest opportunity to have a healthy weight and live a healthy life.”

The annual report, titled "The State of Obesity: Better Policies for a Healthier America," was formerly known as "F as in Fat." Adults in the study are considered obese if their BMI is 30 or more.Children are graded on the curve, so to speak; a child is considered obese if his or her BMI is above the 95th percentile for children of the same age and sex.

Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)