The Daily Meds

Obesity is Catching

Your friends and family are making you fat.

That's the news from a new Harvard study which will come out tomorrow in the New England Journal of Medicine. From the Washington Post, in explaining how "social networks" seem to play a role in weight gain:

The researchers found that when one spouse became obese, the other was 37 percent more likely to do so in the next two to four years, compared to other couples. If a man became obese, his brother's risk rose by 40 percent.

The risk rose even more sharply among friends -- between 57 and 171 percent, depending on whether they considered each other mutual friends. Moreover, friends affected friends' risk even when they lived far apart, and the influence cascaded through three degrees of separation before petering out, the researchers found.

Everyone's heard the adage about how getting married makes you gain weight, but this business about the role friends play in one another's weight gain is more interesting -- but not all that surprising, when you really think about it.

I certainly understand it for women -- afterall, who hasn't called up their best gal pal after a bad day, only to hear her say, "It's OK -- have some ice cream! You'll feel better!", or conned a dieting friend into breaking her willpower to split a pizza -- but I'm curious about how all that pans out among guys. Is it eating in business situations, where everyone's gathered around a buffet trough at an office meeting? Sports food, like heaps of nachos and popcorn at the stadium?

I've noticed a few different food-related social themes in my own professional and social life.

First, there's food as bonding, like the nights my co-workers and I spent gorging on a table full of food late each night at my college newspaper. It was awful stuff -- giant hunks of cheese with buttery Ritz crackers, Little Debbie snacks like Zebra Cakes, chocolate chip cookies, and maybe the occasional pack of baby carrots thrown in for piety's sake. And we ate it way past the witching hour when our bodies might have known what to do with that amount of gluttony. We ate this crap not so much because we were hungry at midnight, but because it was just, well, what you did. It was a ritual.

Then there's food (and calorie-laden cocktails) as a getting-to-know-you device. Afterall, what's the thing you do when you're making new friends and want to "audition" them? Head out for a bite to eat or a few drinks. And I can't say I've ever seen anyone order a salad in those situations. I've even been on job interview lunches where stuffing my face seemed to be part of the test!

My personal favorite: Food as celebration. Because my husband often travels for work, we tend to treat the the time he gets to spend at home like an ongoing reason to celebrate. So we go to fancy brunches and unabashedly rich dinner spots, and we each get appetzers, entrees and dessert. Clearly, no good can come of this!

There's also the comfort calories, gobbled up when you're wallowing in some sort of self-piteous sea. You're planted in front of the TV with a girlfriend or two, watching "Sixteen Candles" for the 1,219th time, passing a bowl of popcorn or a three-quarters-empty pie plate back and forth, and it just feels so... right. Because you can always get back on the healthy-eating wagon tomorrow, right?

Wrong, according to the study, whose authors found evidence that obesity is "a kind of social contagion." I'm heading to Chicago tomorrow for a conference, and I know there will be ample opportunities for food-related bonding while I'm there. I can't promise I'll back completely away from all the tasty vittles, but I'll be watching closely to see this news in action!

Kiddie Olympians

For nearly 12 years, I smelled like chlorine almost constantly. The pool chemicals turned my hair into a split-ended tangle of straw, my arms felt like noodles from pulling my way through endless yardage, and I spent far too many hours shivering in a wet bathing suit.

But under the water, I felt freer than anyplace I'd ever known.

I was a competitive swimmer, and all the years I spent doing it were, I think, among the most important things I've ever done. I wasn't a superstar, but I was good enough to win races every now and again, and since I swam distance events, I felt secretly much stronger and braver than the 95 percent of the human race who can barely  paddle from one end of a pool to the other without tip-toeing on the bottom. I learned how to compete graciously,  how to stand up to disappointment, and in the later years, as a varsity team captain, how to lead and inspire others.

Those are life skills I use everyday as an adult, and although I never dabbled seriously in any other sports as a kid or a teenager, I have no doubt that other types of athletics offer the same lessons. But youth athletics is a different ballgame than it was in the late 1980s and early 1990s when I was coming up, and I've got to wonder if the crazed intensity is much of a good thing. This article in the New York Times details one new trend among young athletes:

Because many team coaches don’t have the time or the expertise in exercise science to make their troops faster and stronger, specialty programs — part gym, part pro-training camp — have stepped in to fill the need. For roughly $35 a session, they provide rigorous conditioning for any aspiring child, regardless of ability, using the kinds of practices that have set apart athletes like Tiger Woods and the Williams sisters.

The story raises the all-important issue of burnout. Some kids, assuredly, can hack it for the long haul, but for many, killing themselves with endless hours of practice as kids may lead to total distaste for the sport come the end of high school -- to say nothing of the physical risks associated with such intense training during childhood.

I remember standing in a hallway outside the YMCA locker room when I was about 10 before swim practice one night. A klatsch of parents were hanging around oohing and ahhing over each of their budding Olympians' exploits in the pool. One of them fervently remarked, "Well, we pray every night for Atlanta in '96," as if ear plugs and latex swim caps were the idols to worship in their home. All the other parents murmured their agreement. It all seemed kind of ... strange. (Said youngster, it must be noted, did not go to the Olympics, and despite his apparent prowess as a teen, I'm not sure had any aquatic success after high school at all.)

For me, swimming was more about participating, about belonging to something, than it was about winning. I'm sure that sounds hopelessly earnest and Mr. Rogers-ie, and maybe I'll feel differently someday when I'm hauling a child around in an SUV stuffed with giant bags of ice hockey equipment or something.

Tell me, though, how you feel about kids and competition. How do you set rules about how often your kids can practice? Any things you've observed among other parents or coaches that bother you? What might you have learned from your own experiences as a young athlete?

Jump, Jive and Wail (The Tao of the Restless Legs)

Have you ever had something wrong with you that, when you explained it to people, made them look at you a little funny? Like, is she a total hypochondriac, or what?

I'm a generally healthy person -- never had any major ailments, and have managed to stay out of the hospital except for having my tonsils and adenoids clipped out at age seven and one harrowing ER visit when I broke my tail bone at 20 (a hideous, miserable pain that makes me wince mere to recall it).

But in 2005, I became stricken with an ailment that fits into a weird category of medicine -- you're not sick, exactly, and for that you are thankful, but things are nonetheless Not Good. It was restless legs syndrome, and it kept me awake at night, every night -- busy rearranging my legs hither and yon in the bed, propping them up on pillows and generally searching totally in vain for the one position that would just let me snooze.

But it felt like there were bugs crawling underneath my skin, and the sensation only went away when I moved my legs around. It was evil. And people thought it was weird, and probably silently wondered if I was hooked on hallucinogens. Other people I told about it nodded vigorously and shared their own tales of leg terror in the night.

My mom had suffered this same thing off and on for years, as had my grandmother. Two new studies, out this week, find that lo, RLS is genetic. Plenty of questions remain, though, about how to treat it and who actually meets the diagnostic criteria ... of which there really isn't one.

In the name of good journalism -- and a good night's sleep -- I wound up joining a restless legs syndrome treatment study at the Coastal Carolina Research Center in the fall of 2005. For several months, I took a study medication each night (it was either a time-release version of Requip, a Parkinson's disease drug that appeared to help RLS sufferers, too, or a placebo -- I still don't know which), fastidiously recorded my symptoms in a three-ring binder, and came for regular office visits to be monitored with blood work and physicals.

My symptoms ebbed and flowed over the course of the study, which I wrote a three-part series about for the P&C. My goal was larger than just getting a good night's sleep -- I also wanted to tell people about what it's like to be part of a medical research study, which are essential to testing any drugs or treatments before they can gain FDA approval or become widely used.

During the study, I obsessed constantly, about whether I was taking the real drug or a fake, and endlessly analyzed what other life factors -- stress, my husband being out of town, feeling overtired, etc. -- might be causing my jumpy legs. Although I was a model of patient compliance, I probably wasn't the ideal study participant, since I couldn't seem to let go of the mystery about which drug I was taking. And that obsession probably didn't help settle my legs down any.

When ads for Restoril started popping up all over TV and magazines later that year, I felt oddly vindicated. It was like, My pain is real! Except, by that time, my RLS had mysteriously disappeared, for which I was endlessly thankful. It pops out every now and again still today, but it's by no means the all-consuming trial it felt like a few years ago.

I went to a conference for health care journalists last spring at Dartmouth, and a trio of energetic doctors from the college's medical school (one of whom wrote this very cool book, which I recommend that everybody with, well, a body, should read) gave a talk about disease mongering, and the media's role in making people nutty and paranoid about diseases they probably don't actually have. Their case study? RLS. They make a compelling case that while it's likely a real disorder, it's probably over-diagnosed, scribbled on the chart of anyone who complains about having trouble sleeping and begs for a prescription for the meds they saw on TV.

When I wrote my RLS study series, though, I got an avalanche of email from people sharing their own stories with the disorder, or at least some convincing facsimile of it. Are any such folks out there now? What have you been doing to slay your own itchy-scratchy-bug-crawling legs?

A Sad Double Standard

I read a survey today, conducted by Mental Health America, that made me a little sad. Well, a lot sad. There was some good news, to start: Ten years ago, only 38 percent of Americans viewed depression as a serious medical problem. But today, nearly 75 percent do.

Still, Americans underestimate the serious toll the disease can have -- 46 percent of those polled described suicide as a personal or emotional weakness, and most people believe homicides outnumber suicides. But that's not true. In fact, some 30,000 people commit suicide each year in the United States, compared with the 18,000 who are murdered.

And then there was the part that made me especially sad:

Americans are comfortable having a friend (91%), next-door neighbor (91%) or coworker (68%) with depression, but are less so with having a teacher (39%), romantic partner (47%) or elected official (51%). The same pattern was evident with bipolar disorder and schizophrenia, only more so, as people are only comfortable with someone with this condition as a teacher 20% of the time, as an elected official 29% of the time and as a date 23% of the time.

Which is basically saying, OK, it's cool if you're depressed and in my life, and I'll support you, as long as you're not REALLY in my life, like as my spouse or someone who's in a position to teach my child or govern my community or state. Obviously, people know that dealing with mental illness is hard, but what this part of the survey says to me is that they're not prepared to really confront it in their own lives. Chances are, though, they already know plenty of people occupying those roles in their lives who are depressed -- they just don't choose to share that information. Would they think less of those people if they knew the truth? I hope not.

And then there's the double standard -- just about all those people who are freaked out by people in their lives being depressed reported that they'd be OK with those people having cancer or diabetes. Because, what, it's somehow easier to support someone who's riddled with tumors or has to take insulin shots every day than to be there for someone who's in therapy or taking anti-depressants?

I'm glad, though, that whatever the result of the discussion, people are talking more about depression and other types of mental illness. I think the Internet -- blogs especially -- have helped open the discussion. It may still feel a little wiggy to talk about something like this around the water cooler, but online -- in blogs or chat forums -- maybe people feel safer letting it all hang out. Lots of smart folks have so eloquently and honestly shared their experiences about dealing with depression, and it often generates a wellspring of comments from people thanking them, or talking about their own experiences for the first time.

At the risk of sounding like a PSA, I can't help but mention: If this is happening to you, don't be afraid. Get help. The Charleston area's National Alliance on Mental Illness group runs several support groups each for people dealing with mental illness and their families and friends. The next meeting will be held on June 25 at MUSC’s Institute of Psychiatry in downtown Charleston on the corner of President and Doughty streets. For more information, call 727-6405, or send an email to one of the organizers.

TB Fugitive Says He's Sorry

Andrew Speaker, the "tuberculosis fugitive" that has dominated news coverage this week, wants you to know he's sorry. He apologizes if you were on any of his flights as he traipsed across Europe for his wedding and honeymoon. Apologizes for putting you at at risk of catching the deadly disease he carried with him.

Hmph. I'm guessing that's just not good enough for the group from USC-Aiken who flew with him (or any one else who ran into him during his travels). They're spending this week waiting to see if the if the TB tests on their arms show the tell-tale red, bumpy signs of infection. Here's what one of them, Jason Vik, had to say, courtesy CBS News:

"(Speaker) affected us for the next five years of our lives. We have to keep going back (for testing) because we were on a plane with some selfish guy who didn't want to give up his wedding."

Indeed. This story just gets stranger and stranger, especially with yesterday's revelation that his new father-in-law is a TB researcher. And he's a lawyer. A personal-injury attorney. The ironies just keep on coming. Stay tuned, I suppose, for the TV movie version of the tale ... and hopefully, a serious crackdown on all the holes in the health-care, airline and border security systems that allowed this to happen. 

Worst Case Scenario

OK, so, let me get this straight: A guy from the Atlanta area has tuberculosis. A very rare strain of TB that is resistant to most antibiotics and could KILL other people who become infected. He's being treated, but he's also got his wedding on the docket. In Greece. Followed by an Italian honeymoon. He says no one told him -- this infectious, diseased vector of a guy -- that he couldn't travel.

Then he found out that he wasn't supposed to have left town in the first place, that his passport had been flagged, his name had been put on a "no-fly" list and the CDC had tracked him down in Italy and ordered him to turn himself in to authorities to be put in quarantine for treatment. Instead, he and his new wife decided to run, fearing that "unsuccessful treatment in Italy would have doomed him ... because he said they lacked the expertise." They managed to fly into Canada and drive into the US before letting the CDC know he was back, whence they ferried him back to Atlanta and put him in a hospital isolation ward.

Hmmm. So much to contemplate here. Is his story about not being told he shouldn't travel true? Which is to say, did health authorities knowingly let this guy traipse his contagious -- TB is spread through the air, even through casual contact -- body halfway across the globe and back again? This story in the Atlanta Journal Constitution has the best tracing of the guy's travels I've seen, including a map showing the path of his various stops. Been to Paris lately? Athens? Rome? Prague? Montreal? Here's hoping you weren't on his flight (though the CDC's advisory for travelers on his flights only applies to the crew and those passengers who sat two seats ahead or behind him). The good news is that most healthy people who are exposed to TB bacteria are able to fight it off -- they carry the bacteria but don't actually "convert" to having the "active" form of the disease.

But even so -- sheesh. Talk about a souvenir you didn't mean to bring home!

(From the Not Necessarily Meaning to Scare Anyone Files: Because of good surveillance and treatment, TB is not a huge problem in the United States these days. But it does remain the world's leading infectious disease killer, taking the lives of about three million people each year, according to the S.C. Department of Environmental Control. It's much more prevalent in third-world countries. Here in South Carolina, there were about 222 cases of it identified last year -- the lowest number in a decade. But it's serious enough that if you don't comply with treatment, the courts can hold you to it -- otherwise, you put everyone you come in contact with at risk.)

More on how this plays into my own travel neurosis (and maybe yours, too!) after the jump....