Public health extremism (Obama Care, Health Law, and Bioethics)

Johns Hopkins University Press Blog

Guest post by Maxwell J. Mehlman

In a November article for the New England Journal of Medicine, Harvard law professors Michelle Mello and Glenn Cohen argue that in upholding the Affordable Care Act’s individual insurance mandate as a tax the Supreme Court “has highlighted an opportunity for passing creative new public health laws.” As a bioethicist who writes extensively on the question of coercive public health this troubled me on several fronts.  In this case, Mello and Cohen give an example of the laws that they have in mind: higher taxes on people whose body-mass index falls outside of the normal range, who do not produce an annual health improvement plan with their physician, who do not purchase gym memberships, who are diabetic but fail to control their glycated hemoglobin levels, and who do not declare that they were tobacco-free during the past year.

Some of these suggestions seem ineffectual…

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Obese Doesn’t Always Mean Unhealthy, UMDNJ Research Shows

“…metabolically healthy obese individuals may represent as much as 20 to 30 percent of obese population…“

From the 17 June Medical News Today Web page

It’s become an axiom of health that overweight and obese people are not as healthy as their normal weight counterparts. In fact, obesity has been targeted as one of the country’s most serious public health problems, with predictions of widespread heart disease, diabetes and cancer among the growing number of Americans who are overweight. But what if that’s not always correct? Is it possible for some people to be overweight or even obese and still be healthy? Researchers from the Weight Management Services Program at the UMDNJ-School of Osteopathic Medicine think so, and they have some surprising statistics to back that opinion up.

The researchers analyzed the records of 454 individuals who were seen as patients at the medical school. Each of the individuals in the study had a body mass index (BMI) greater than 30, a standard for defining obesity, and the group’s average body fat percentage was over 46 percent. The UMDNJ analysis revealed a distinct sub-group of 135 metabolically healthy obese (MHO) individuals who, despite their high BMIs and body fat percentages, had essentially none of the measureable health risks high blood pressure or elevated blood sugar or cholesterol levels normally associated with obesity. Another sub-group of 167 individuals was categorized as medically unhealthy obese (MUO) because their corresponding results for the same measurements indicated an elevated risk for chronic disease.

“Our results indicate that metabolically healthy obese individuals may represent as much as 20 to 30 percent of obese population,” [Flahiff’s emphasis]  said Dr. Adarsh Gupta, director of Weight Management Services at the UMDNJ-School of Osteopathic Medicine, who, along with Dr. Gwynn Coatney, conducted the research. “This highlights the need for clinicians to be cautious when using obesity as a criterion for prescribing treatment. Researchers, too, need to be careful to distinguish between the metabolically healthy and metabolically unhealthy when analyzing data involving a group of obese individuals.”

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A related Web site – Obesity (Partners in Information Access for the Public Health Workforce)

From the press release

A new topic page on Obesity is now available on PHPartners.org at http://phpartners.org/obesity.html.

The topic page links to obesity information and resources including government, professional and research organizations that focus obesity issues; reports, publications and guidelines; obesity programs and campaigns; child obesity information; data and statistics; legislation and policy issues; grants and funding opportunities; training and continuing education; and upcoming conferences and events.

The Partners in Information Access for the Public Health Workforce, PHPartners.org<http://phpartners.org/>, is a collaboration of U.S. government agencies, public health organizations, and health sciences libraries. The mission of PHPartners is to help the public health workforce find and use information effectively to improve and protect the public’s health.

PHPartners.org welcomes suggestions of new links to post. Please suggest links at http://phpartners.org/suggestlink.html.

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Stretching before a run does not prevent injury

Stretching before a run does not prevent injury
However, runners who typically stretch should continue, or risk injury

This image was originally posted to Flickr by SteelCityHobbies at http://flickr.com/photos/94767754@N00/1394011566.

From the February 18 2011 Eureka news alert

Stretching before a run neither prevents nor causes injury, according to a study presented today at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

More than 70 million people worldwide run recreationally or competitively, and recently there has been controversy regarding whether runners should stretch before running, or not at all. This study included 2,729 runners who run 10 or more miles per week. Of these runners, 1,366 were randomized to a stretch group, and 1,363 were randomized to a non-stretch group before running. Runners in the stretch group stretched their quadriceps, hamstrings, and gastrocnemius/soleus muscle groups. The entire routine took 3 to 5 minutes and was performed immediately before running.

The study found that stretching before running neither prevents nor causes injury. In fact, the most significant risk factors for injury included the following:

• history of chronic injury or injury in the past four months;
• higher body mass index (BMI); and
• switching pre-run stretching routines (runners who normally stretch stopping and those who did stretch starting to stretch before running).

“But, the more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured,”

“As a runner myself, I thought stretching before a run would help to prevent injury,” said Daniel Pereles, MD, study author and orthopaedic surgeon from Montgomery Orthopedics outside Washington, DC. “However, we found that the risk for injury was the same for men and women, whether or not they were high or low mileage runners, and across all age groups. But, the more mileage run or the heavier and older the runner was, the more likely he or she was likely to get injured, and previous injury within four months predisposed to even further injury,” he added.

Runners who typically stretch as part of their pre-run routine and were randomized not to stretch during the study period were far more likely to have an injury. “Although all runners switching routines were more likely to experience an injury than those who did not switch, the group that stopped stretching had more reported injuries, implying that an immediate shift in a regimen may be more important than the regimen itself,” he added.

The most common injuries sustained were groin pulls, foot/ankle injuries, and knee injuries. There was no significant difference in injury rates between the runners who stretched and the runners who didn’t for any specific injury location or diagnosis.