Healthy Future US Blog

The American Academy of Pediatrics just came out in favor of powerful prescription drugs (which must be taken lifelong to avoid weight regain & chronic disease) for adolescents--and potentially for pre-teens (ages 8-11)--with moderate to severe obesity. Bari atric surgery (permanently reengineering kids’ gastrointestinal systems) should also be considered for adolescents with severe obesity .  (The Academy also recommends "nutrition support, physical activity, and behavioral therapy"--but as with so many other areas of US chronic disease management, we can see where default treatments are headed: drugs & surgical procedures.) Such radical treatment recommendations created the usual (and temporary and ineffectual) tsunami of news & social media shock and indignation. The decades-long performative reaction to the increasingly bad news on dangerous levels of early obesity–and now 1 in 3 teens with prediabetes, across ethnicities & income levels–is itself sicken...

[It’s been a while since our last blog post.  A lot has happened since– including some “miracles” ! So we’re going to do two posts in a row…] Normally we should all be happy about miracle drugs... shouldn't we ? Yes, there is lots of upside from taking semaglutide (Ozempic, Wegovy), tirzepatide (Montjaro)--and upcoming new, even-more-miraculous drugs TBD:  losing huge amounts of weight quickly, a much lower risk of diabetes–and probably less heart disease and other chronic conditions as well.  But what if the “miracle” requires:   $200-300/week, with a lifetime cost of hundreds of thousands of dollars…  a drug that you can never quit…because if you stop taking it, you gain back all the weight it helped you lose–not to mention the chronic diseases which the drugs kept at bay… and it leaves your face (and the rest of your skin?) sagging …    (plus, it’s so new at such high dosages– who knows what happens after years of use…? ) No doubt, in spit...

No pain no gain?  Preliminary research implies that we may have been badly mistaken in our fight to reduce inflammation with instant pain-relief gratification, in the form of antiinflammatories such as NSAIDs (ibuprofen, Advil, etc) and corticosteroids (e.g. dexamethasone & prednisone).  Not surprisingly, this research finds that there is actually an essential biological reason for inflammation–including the body marshaling white blood cells to jumpstart our natural healing process.  So, ironically, by aggressively fighting inflammation artificially, we may be reducing white blood cells and limiting healing: gaining short-term pain relief at the cost of long-term pain…and lifelong dependence on painkillers. How does that relate to school health & wellness? Let me make an analogy: By maximizing seat-time to boost reading and math test scores short-term, we have not only failed to increase test scores, but we have sacrificed our children’s long-term health. By no l...

What would you do, if your teenage child or grandchild had prediabetes–with a strong chance of developing diabetes within the next 10 years?  Not likely, you think–but you are wrong.  According to a brand new JAMA Pediatrics study , there is a greater than 1 in 4 chance that your teen has prediabetes .  This is up even more from a recent study showing 1 in 5 at risk–and more than twice as high as 20 years ago.   What really took my breath away is that 1 in 4 white teens and 1 in 4 teens from higher-income families and 1 in 4 normal weight teens have prediabetes! People have been assuming that those kids are unlikely to develop Type 2 diabetes early in life...  Well, you can toss that stereotype out the window now.   If your teen has been inactive and had poor nutrition for years, you should perhaps consider checking their blood sugar level – and take action now to get them moving and eating & drinking healthier . Since research show...

During the main panel discussion at highly influential Modern Healthcare magazine’s Leadership Symposium recently, prominent industry CEOs shared their frustrations on the need for change in health care but the lack of progress.  Of all the comments made in a poll of attendees, Modern Healthcare highlighted one by Erin Hammond, a senior value-based programs professional at Humana [ emphasis added by me]:  “Medicare Advantage and Medicare should start for high-risk communities the first day of preschool .  That way the government and healthcare orgs have an entire lifetime to shape healthy habits that will impact the high cost of the elderly population.  Between that and a sugar tax and increasing the quality of food we make available to our population...we would not only see the quality and healthy days of our citizens enhance as they get older, but much lower medical costs .”   Even if you don’t believe in a single cradle-to-grave health plan for all or tax...

Fasten your statistical seatbelts & prepare for a "wonky" longer-than-normal post: New National Survey of Children’s Health (NSCH) data claim an improvement in child obesity in Arizona over the last five years--to the extent that AZ supposedly now has the 2nd lowest child obesity for 10-17 year olds in the USA !?  Per the NSCH-based rankings, this implies that Arizona has less child obesity & much better trends than even perennial health leaders Colorado or Utah--in spite of those states having much less poverty & much lower adult obesity than Arizona.  Few states except perhaps North Dakota(!?) & Nebraska(!?) show as much of a decline over the last five years (2016-2020) among children, according to these NSCH data. These parent-self-reported statistics contradict the Youth Risk Behavior Survey (YRBS) data , which are self-reported by high school students themselves--and which do not show an improvement in teen obesity in Arizona (or in Nebraska or North D...

Many people are promoting a false dichotomy for who/what to “blame” for decades of pervasive inactivity & unhealthy nutrition--the key preventable factors which have led to the majority of adults developing chronic disease. Some believe that people with preventable chronic diseases made a series of unhealthy choices for decades, for which they need to accept personal responsibility for the consequences. On the other side, a growing number of policymakers focus on the “social determinants of health.”  In other words, there are many things beyond your control, which impact what you eat & drink and how active you are.  This includes factors such as your family, neighborhood, school, employer, transportation, public safety, housing, community layout, etc. etc.  It’s those external social factors which determine your health destiny.   Actually, the personal and social are inextricably connected--not opposite ends of the spectrum.  Let’s consider the role...

The rarely sung second verse of America The Beautiful contains these words:        America!  America!        God mend thine every flaw,        Confirm thy soul in self-control,        Thy liberty in law! At a time when criticisms of US history are condemned as un-American, it’s worth listening to this.   As we noted in a previous blog post, the Founding Fathers expected a number of flaws in our country--and created a constitutional process to address them.  Often, this process requires prolonged citizen pressure to get political leaders to address a major neglected issue, such as gender inequality, voting issues or racism...or a multidecade child health epidemic and a crushingly expensive health system--both fueled by government mismanagement.   Unfortunately, our advocacy experience so far reinforces this.  Why a...

Dutch citizens recently won what could be a game-changing legal verdict against the Shell Oil Company.  Shell is being held accountable for its role in a range of problems created by global climate change.   Going from the gas pump into the convenience store:  are those making & selling unhealthy food & beverages liable for the growing pandemic of diabetes & heart disease--caused to a major extent by unhealthy nutrition?   Given the past success of tobacco, vaping and opioid litigation in the USA, it seems that companies which profit from popular products that harm people may not get a free ride forever.   Of course, many argue that individual consumers are choosing to eat & drink unhealthy stuff.  If they want to do that, let them--and don’t blame the companies who supply them.  The problem is: those individuals often do not have the money to pay for their lifelong chronic diseases.  So those with healthy lifestyles...

We don’t usually think of Germans as being litigious--but desperate situations breed desperate measures.  The youth of Germany just won a major legal victory , in which they sued the government, dominated by older Germans such as Chancellor Merkel, over climate issues.  Younger Germans allege that those in power are not doing enough to prevent a future climate catastrophe, which would harm today’s youth much more than today’s elderly--who will be long dead by the time the full force of climate change hits Germany. Which makes me wonder: what if GenZ-ers and Millennials sued our ruling-class Boomers over their gross neglect of youth health?   Our older generations have allowed younger generations to develop epidemic levels of chronic disease. Across the country, our “leaders” wantonly permitted schools to slash physical & health education & recess.  This has been a major factor in today’s pervasive child inactivity, obesity & unfitness--inevitably lea...

OK, so we've been doing a lot of blog-tificating.  But what is it that we are doing to make things better?  And are we really still needed--if we ever were? When I founded what became Healthy Future US, I knew our task was extremely difficult. (As they say: “if it was easy, it would have been done already.”)  But I thought it would be quicker & easier than it has been.  After all, wasn't it increasingly obvious that our health and related costs were devastatingly out of control, with an urgent need to address the primary root causes of inactivity & unhealthy nutrition? As we enter Year 8 of full-time social entrepreneurship & advocacy, it's helpful to review our track record and rethink our future based on lessons learned.  This blog format is not great for lengthy explanations, but here are a few key points: - Start-ups always take longer and cost more than you think--even more so in the social sector, where public-policy timeframes stretch into dec...

It seems like every social sector organization is providing "systemic" solutions nowadays. (That's a sure sign that funders are demanding that we address root causes more--not just programs as a temporary band-aid for symptoms of persistent major underlying problems.)   Of course, if everyone really were providing systemic solutions, we wouldn't have any problems anymore.  Instead, many problems are getting worse.  So, what are we missing?  What about truly catastrophic long-running and ever-worsening systemic issues like epidemic teen prediabetes & social-emotional unwellness, adult diabetes & overwhelming stress, and profound income & racial health disparities? The social determinants of health (SDOH) framework shows us how complex such issues are.  But it's hard enough to reform one systemic cause of inactivity and unhealthy nutrition and disabling trauma--much less trying to tackle a dozen at once.   This is where we can bring in a...

The massive new Affordable Care Act subsidies in the $1.9T American Rescue Plan are still not enough.   They never will be. "By next year, taxpayers will shell out more than $8,500 for every American who gets a subsidized health plan through insurance marketplaces created by the ACA, often called Obamacare."  Yet many with those plans will still have a $6,000 or so out-of-pocket deductible, on top of their subsidized premiums.  That  recent analysis  by NPR & Kaiser Family Foundation reinforces our previous blog posts.  Many people will be better off with a lower salary and "free" Medicaid coverage than a higher salary--even with highly subsidized ACA health insurance plans.  And "affordability" does not mean throwing unlimited federal money at something that is too expensive to begin with.   Let's face it (even though we still don't want to)--a s long as we are this unhealthy, we can't afford our health care.   So let's ge...

The US Preventive Services Task Force just recommended that people get tested for diabetes at a younger age: 35. Early detection will help prevent complications from untreated diabetes. “The lowered recommended age for screening ‘has really been driven by the obesity epidemic—greater rates of obesity in young people.’” (WSJ, 3/16/2021) If this preliminary draft recommendation is approved, many insurers will provide this testing for free. Actually, with about 20% of teens estimated to have prediabetes & 10% with severe obesity already, & 1/3 lower-income kids & children of color headed for diabetes, testing should start much earlier for at-risk young adults--perhaps @25 years old. The more I think about these statistics, the angrier I get. We should have declared a national child health emergency in the late 1970s, when the child obesity epidemic began. If those kids had been upper-income white children, we would have dealt with it much sooner. Yet in spite of some imp...

Are you an idiot for going to college?   We've been told for decades: get a college degree and make a lot more money. Then over the last decade or two, we started hearing about millions of people overwhelmed with college debt, whose post-college salary could not pay off their loans.  Living in their parents' basement.  Bankrupt. But it's even worse:  To calculate your disposable income post-college, you should subtract out your college debt repayments & lost wages while attending college & your portion of employer-provided health insurance (premiums, co-pays, out-of-pocket costs).  Then look at your "real" salary.   Ouch!   Particularly if you or someone in your family is at-risk of a chronic condition , you could have been better off with a low-paying job and being on Medicaid (free government health coverage). For example, if you attended a state university in Arizona, the median salary in 2018 was $51,197. But subtract colle...

Why is it that so many "solutions" to chronic disease are good-news/bad-news? Take great news about the "miracle-drug" semaglutide.  Originally for people with type 2 diabetes, a  recent study  shows it can reduce weight by 10-20%+ for those with obesity--with minimal side-effects, and requiring only a weekly subcutaneous (just-under-the-skin) self-administered injection.  That amount of weight loss is also often enough to reverse prediabetes & even type 2 diabetes! So what's the bad news?   Semaglutide is a proprietary biologic pharmaceutical.  It costs close to  $1000/month  for the smaller dose needed to manage diabetes.  Extrapolating this, the larger dose used in the study to reduce obesity could cost $2000+/month!  R educing the cost substantially could be a challenge.  B iologics are typically more complex & expensive to manufacture than traditional pharmaceuticals. And BTW: if you stop taking semaglutide after l...

We want to reduce the stigma of obesity.  And we want to improve health.  So how about focusing on fitness not "fatness"?   As we head toward the majority of adults with obesity in the coming decades, it is increasingly self-harming for our society to stigmatize large bodies.  Yet as our health worsens, we need to take urgent sustained action to develop healthier habits.  How do we reconcile these two seemingly contradictory issues? I wouldn't be surprised if a large portion of anxiety & depression among Americans, especially teens, is due to weight & body shape.  The increase in child & adult obesity is spreading the stress, even as it becomes more normal to be obese.  At the same time, as obesity becomes more widespread, some of the stigma is receding--with the potential good-news/bad-news downside of less motivation for people to do something about dangerous extra weight causing metabolic syndrome, diabetes, heart disease, etc....