Demystifying Medicine One Month at a Time

Tag: CDC

Indiana: 1 out of 2

Indiana passed a “Religious Freedom” law last week, signed by Governor Mike Pence.

Reaction to the law has been swift and furious. The law purports to enhance religious freedom by allowing business owners to cite their religious beliefs as a legitimate reason for discrimination. Many national organizations, both religious and commercial, have declared their intent to cease doing business in Indiana.

Judging by the news cycle and social media reactions to the law’s passage, you could say Governor Pence has made a very poor choice.

cleanneedlesInterestingly, the same week, he went against his own stated principles and made, from a public health viewpoint, a resoundingly good and evidence-based choice about another matter affecting his state.

Rural Scott County, in southeast Indiana, has reported more than six dozen new cases of HIV in 2015 alone. In public health terms, this is an epidemic spread, given the very low population density of the county. In a typical year, Scott County might see five new HIV cases. In just the first quarter of this year, the county’s reported a nearly 16-fold increase over the annual rate, leading Governor Pence to acknowledge that Scott County is facing a “Public Health Emergency.”

To combat the spread of HIV, which is due to the sharing of needles for injection drug use, Governor Pence’s emergency order permits public health officials to immediately begin a clean needle exchange as per CDC recommendations.

Pence has spoken out against a statewide or permanent needle exchange program, instead limiting the effort only to Scott County on a temporary basis. NPR quoted the governor as follows: “I don’t believe that effective anti-drug policy involves handing out paraphernalia to drug users by government officials,” he says. “I reject that.”

It’s easy to see why someone could reject clean needle programs on the basis of not wanting to subsidize or potentiate illicit drug use. Yet when faced with such an emergency, Governor Pence has yielded to experts wielding scientific evidence.

That’s what public health is all about. We may not like people’s behavior or habits, but in truth, preaching or punishing has shown to be of limited (if any) value. Acknowledging that there’s a problem without resorting to judgment, and designing programs to protect the public’s health, is sound medicine and policy.

American Heft

This week the CDC released its latest report on obesity in the U.S.

The report generated copious media attention, with the usual hand-waving about the issue. A quick web search reveals mostly local stories along the lines of “Our state’s collective girth is increasing and we need to do better” or “Phew! Our state isn’t as fat as those other states….”

To visualize the magnitude of the problem, look at the CDC’s visual map below. Note how the percentage of obese Americans has continually risen over the last twenty-five years. If you click on the right arrow button in the embedded map, you’ll see year after year of increasing percentages of obese people in nearly every state. [Interestingly, the color choices go from white (no data) to blue (10-20% obesity) to orange/red (>20% obesity)…Is there a coded message here?]:

[One big take home: What’s Colorado’s secret?]
What gets lost in all of the superficial coverage of “Fat state vs. Not-as-fat state” is how obesity is measured.

In health care we use the BMI, or body mass index, as the determinant. The BMI is a measurement that adjusts weight for height: the taller you are, the more weight you’re ‘allowed’ to carry. The calculation is straightforward: Take your height (in meters squared) divide by your weight (in kilograms). It gives a you a number, and the range is as follows:

  • BMI                 classification
  • <18.5              underweight
  • 18.5-24.9           normal
  • 25-29.9            overweight
  • 30-35                 obese
  • >35                morbidly obese

There are many reputable BMI calculators out there that we use in our office all the time. In fact, I’m embedding one below that will let you enter your height and weight in our usual units (feet, inches, and pounds). It’ll do the converting for you. Just enter the numbers and click “Calculate.”

Write down the number and bring it to your next visit with a health care provider. They’ll be impressed that you know about this. Especially if it motivates you to do something about it.

BMI For Adults Widget

To GlassHospital readers that are bodybuilders or football players, know that BMI is NOT reliable for you in determining obesity. For those with a large percentage of body mass from muscle, the BMI is inaccurate. It’s far from perfect, but for the general population it’s a reasonable guide.

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