American College of Physicians: Internal Medicine — Doctors for Adults ®

Friday, April 6, 2012

Dads, dudes, diabetes and duty

I am, and have long been, on the masthead at Men's Health magazine as an editorial advisor, with contributions focused principally on weight control. Proud of it, too.

I do note, in passing, that I don't always agree with my good friends there. They seem to feel that a hefty dose of bacon can cure just about anything that may ail you, and I beg to differ. I submit as evidence in defense of my position a 50-year-old body (Well, 49; but who's counting?) with an elusive "six-pack" built and maintained on "mostly plants." But I digress.

More relevant is that I am a father of five kids, and editor-in-chief of the peer-reviewed journal Childhood Obesity.

I am here to talk to my fellow fathers about kids. Paternity, posterity, peril, and promise if you will.

Dads, dudes, countrymen (and city men, for that matter) lend me your ears! Manly middles, portly posteriors, and notoriously thick skulls can come along for the ride. I am talking to you, mano a mano. Ladies, please do listen in. If nothing else, you may want to print this out, roll it up, and smack some guy in the head with it when we're done here.


We know that women are the guardians of the family health. We know that women, wives, mothers tend to do the heavy lifting when it comes to medical care, preventive services and diet. We know, consequently, by process of elimination if nothing else, that men tend to stand idly by and watch the women in their lives do this heavy lifting mostly on their own. Not very chivalrous, but it is what it is. Men often turn up at their own medical appointments only because a wife or girlfriend "made them" do it. Pitiful!

This is even true regarding the health of kids we helped make. And it's not acceptable.

I trust you've heard the familiar litany of bad news about the health of our kids. Childhood obesity is more prevalent in the U.S. than in virtually any other place on the globe, and more prevalent now than ever in history. The fattening of our children propels them to an ever greater burden of ever more dire chronic disease at ever younger ages.

The spread of Type 2 diabetes among children is already yesterday's news. But yesterday, when I went to medical school, this disease was called "adult onset" diabetes to distinguish it from "juvenile onset." On my watch and yours we have witnessed the transformation of a chronic disease of overweight, middle-aged, sedentary adults into a pediatric scourge.

Yesterday's news is bad--a tragedy, in fact. And a travesty. A disease that should never occur in children has become routine among them, and our collective societal response was to change the name to make it ok.

Still, today's news is even worse.

Today's news is the proliferation of cardiac risk factors among children, and their growing need for treatments that until very recently were limited to adults, such as statin drugs and bariatric surgery. And even coronary bypass. Today's news is a 35% increase in the rate of stroke among 5- to 14-year-olds, with no smoking gun on the scene except epidemic childhood obesity to account for it.

What, I wonder, will tomorrow's news be? I think, guys, that it's partly up to us.

In a culture where real men don't eat quiche, where salad is "the girl food," and where a man's man is tough and beefy, it may seem that eating well and being active to protect our health requires us to get in touch with our feminine sides. If so, it would likely do most of us some good, but it's not required. There is another way entirely of looking at this scenario.

The wolves are at your door, fellas, and if you are like most guys, you aren't doing a damn thing about it. You are NOT defending hearth and home. Very "un-guy" like.

The wolves are obesity, insulin resistance, metabolic syndrome, Type 2 diabetes and behavioral disorders--with heart disease, stroke and cancer to follow--stalking our children.

So, grab your (proverbial) muskets, and defend hearth and home! That is what guys do. That is time honored "guy stuff." In all too many cases, these wolves have already sunk their teeth into the tender flesh of our kids.

To cultivate the health of your children, you must cultivate your own. Even if you are too tough and manly to care about the minor inconveniences of open heart surgery or the occasional amputation, no guy gets "toughness" credit for failing to care about, or look out for, his kids.

If your kids love and respect you, they will do as you do. If eating well is too big a bother for you, it will be too big a bother for them. If worrying about health and nutrition is limited to "nutrition nannies" (like me, I suppose), then your children, like you, will roll their eyes at the very choices that could immunize them against a future of foreshortened joy and forestalled opportunity.

If you are too busy, too unconcerned, too manly to exercise, what will motivate your son to be otherwise? If physical activity is not instilled by you as a family value, what will inspire your daughter to seek and gain its incomparable benefits?

I have been taking care of patients for 20 years, so I have met a lot of you guys. If I hadn't--if I were younger, more naive, or simply more hopeful--I might ask you to pursue health for your own sakes. But I have learned the hard way how thick the average guy's skull is. (Ladies, don't worry. If you do roll this up and hit a guy in the head with it, chances are he won't feel a thing.) Most of my male patients get religion about their own health when staring up at the harsh ER ceiling lights from a gurney. Sometimes they get to come down from that gurney and try a new way forward. Sometimes, alas, that chance never comes. But either way, the timing leaves a lot to be desired.

For me, it's a personal loss every time something bad happens to someone good who just couldn't be bothered. Who only ever really cared about preventing a heart attack--or stroke or cancer--after the diagnosis. The unnecessary loss of years from life and life from years is the recurrent tragedy against which I channel my every effort. But you know what they say: You can lead a horse to water. So I fail all too often; the teachable moment comes after the calamity and the cycle of preventable loss and lamentation goes on.

So I pin little faith on talking you into taking better care of yourselves for your own sakes, but I think I can count on the sacred and inalienable bonds of fatherhood to call on you to do it for your children's sake. Is avoidable loss and preventable lamentation something you can countenance paying forward to your daughter or son? No father worthy of the title could say "yes."

Gentlemen: You are role models for your children. Like it or not, you are playing follow the leader, and you are the leader (or one of them). Lead toward health, your children will follow you there. Lead elsewhere, they will follow you elsewhere. They will do as you do. So do the right thing for their sake. Eat well and be active for their sake. Be part of their solution or you will be part of their problem.

The mission need not be complicated. Simply acknowledge health as a worthy goal and a priority. Let your kids know that you want them to eat well because you love them, because you want them to be healthy, and healthy people have more fun. Then, make a conscious effort to eat well, too. No need to make perfect the enemy of good, just some movement. I'm sure you know the basics of the route, but if not, you can always ask for directions, right?

Just by letting your kids know that you don't want the growing body of a son or daughter that you love constructed out of junk, the mission will be advanced.

Physical activity is even easier. Just walk the literal walk. Be active with your kids. The older and more capable they become, the greater the options, but you can start when they're still in the cradle.

Every aspect of stepping up and being a healthy role model for your children is part of a virtuous circle. By setting the example your kids need for the greatest likelihood of their own healthy future, you'll be laying the groundwork for yours. Just as well, because when those kids grow up and have kids of their own, you may want to be around for it. You don't want to be that guy seeing revelations among the overhead lights in the ER. By making health a shared pursuit, you'll have things to talk to your kids about and things to do together.

As fathers, we are charged with no responsibility more sacred than protecting our children. So I am asking you, mano a mano, to protect yours. Their future vitality--their future joy or misery--will be determined in part by the choices you make.

For all the guys out there too tough to care about their own health until it's too late, how about setting a healthy example to defend your kids? It's classic, time-honored guy stuff. It's got "Dad," and "dude,'" written all over it.

It is, in a word, our duty. So let's man up and do it!

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Anonymous Leo Voisey said...

Stem cells are “non-specialized” cells that have the potential to form into other types of specific cells, such as blood, muscles or nerves. They are unlike "differentiated" cells which have already become whatever organ or structure they are in the body. Stem cells are present throughout our body, but more abundant in a fetus.
Medical researchers and scientists believe that stem cell therapy will, in the near future, advance medicine dramatically and change the course of disease treatment. This is because stem cells have the ability to grow into any kind of cell and, if transplanted into the body, will relocate to the damaged tissue, replacing it. For example, neural cells in the spinal cord, brain, optic nerves, or other parts of the central nervous system that have been injured can be replaced by injected stem cells. Various stem cell therapies are already practiced, a popular one being bone marrow transplants that are used to treat leukemia. In theory and in fact, lifeless cells anywhere in the body, no matter what the cause of the disease or injury, can be replaced with vigorous new cells because of the remarkable plasticity of stem cells. Biomed companies predict that with all of the research activity in stem cell therapy currently being directed toward the technology, a wider range of disease types including cancer, diabetes, spinal cord injury, and even multiple sclerosis will be effectively treated in the future. Recently announced trials are now underway to study both safety and efficacy of autologous stem cell transplantation in MS patients because of promising early results from previous trials.
Research into stem cells grew out of the findings of two Canadian researchers, Dr’s James Till and Ernest McCulloch at the University of Toronto in 1961. They were the first to publish their experimental results into the existence of stem cells in a scientific journal. Till and McCulloch documented the way in which embryonic stem cells differentiate themselves to become mature cell tissue. Their discovery opened the door for others to develop the first medical use of stem cells in bone marrow transplantation for leukemia. Over the next 50 years their early work has led to our current state of medical practice where modern science believes that new treatments for chronic diseases including MS, diabetes, spinal cord injuries and many more disease conditions are just around the corner. For more information please visit

April 10, 2012 at 5:57 AM  
Anonymous Diyan said...

Excellent article! I hope more people to read it and to find a way to constantly remind themselves the things you've said. I always say to my friends and acquaintances that they are responsible not only for their health, but for the health and well-being of their children, too. And this is true especially for future dads, because if their children would likely to be predisposed to some chronic diseases, the reason would most likely be the health status of their parents, i.e. the quality of their lifestyle.

April 17, 2012 at 12:18 PM  
Anonymous A Cerrato said...

A great article. I'm with you!

My sister had a baby last year, a boy. Both of his parents are on the large side (as are myself and a lot of our family) but I am determined to make sure he doesn't suffer the same fate. I know the pain of teenage weight problems and don't want him to suffer from low self esteem or even worse, diabetes. So I will be regularly taking him outside to exercise!

May 3, 2012 at 3:14 PM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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