April, 2012

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Childhood Obesity Speeds the Onset of Puberty in Girls

Tuesday, April 24th, 2012

When I was young, even though my Dad wanted to “plump up” me and my sisters so that we would be less attractive to boys, for the most part, sitting down at the family table meant eating a well-balanced meal and reconnecting with each other after a busy day.  This time wasn’t just important for the bonding opportunity it provided, but for the proper nutrition it allowed my sisters and I to receive.  It was there that we learned what a balanced diet was and to appreciate the food we had.  Snacking throughout the day was a privilege and eating snacks between meals was a luxury a poor person could ill afford. Unfortunately now days, it seems that many parents don’t have time for traditional dinners or are unwilling to make time for time them.  Snacks are cheap, ubiquitous and filled with carbohydrates. With so many people reaching for the quickest, easiest foods, families are moving to a culture of convenience and their kids are paying the price.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m2 increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.







No Breastfeeding; No Guilt

Thursday, April 19th, 2012

I was raised in an era when children were fed Karo Syrup and evaporated milk, and nobody gave my mother a guilt-trip for doing so.  As with many low-income families, she spent much of her time working to provide for our family and would not have been able to stay home to breastfeed.  Somehow though, we all grew up to be healthy, happy adults.  In fact, two of my sisters are doctors and the other is a lawyer and Ph. D., so I’d say we turned out pretty well.  The American Academy of Pediatrics (AAP) though, would like moms to believe otherwise.

When an organization like the AAP recommends breastfeeding, new moms are likely to trust in their expertise and follow suit, assuming the organization has conducted years of research and found conclusive results in favor of breastfeeding.  Unfortunately, that just isn’t the case.  That hasn’t stopped them from publishing an executive summary of their recommendations though.

In their most recent Executive Summary on Breastfeeding and the Use of Human Milk, the AAP cited, “a variety of government data sets, including the Centers for Disease Control and Prevention (CDC) National Immunization Survey, the NHANES, and Maternity Practices in Infant Nutrition and Care.”  These studies merely show how many people are breastfeeding in developed countries, not whether or not this has been beneficial for the children involved.

In fact, there has so far only been one scientific study performed and this is where all of their data is coming from.  Also, the study itself admits that, “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”  In other words, they gathered their information from other reports and performed a scientific analysis, but did not do any controlled experiments themselves, so they can’t be certain that the relationship between the health of children and the rate of breastfeeding are actually related.  Even more shocking is the AAP’s blatant disregard for some of the findings in the study.  The AAP Summary reports that, “Adjusted outcomes for intelligence scores and teacher’s ratings are significantly greater in breastfed infants.”  While the study they are citing actually says, “There was no relationship between breastfeeding in term infants and cognitive performance.”  Human breast milk is deficient in iron and Vitamin D; yet, those deficiencies are rarely mentioned when it comes to comparing breastfeeding and formula feeding.  Moreover, the touted immunity conferred to the newborn from breastfeeding has not resulted in better outcomes for breastfed infants.

So why are they so adamant about it?  It turns out; they have spent the past several years urging the Senate to carry out a $15 million campaign to promote breastfeeding at maternity care practices, community-based organizations, and hospitals.  In other words, wherever mothers might be giving birth or receiving pediatric care, their physicians are flooded with propaganda pushing the importance of breastfeeding.  This has led to a lot of pressure on moms who have chosen not to breastfeed, and consequently, a lot of unnecessary guilt.  Mothers have the right to choose the method they feel most comfortable with, and shouldn’t have to feel guilty for that choice.

— Yvonne S. Thornton, M. D., M. P. H.





Great Scores Don’t Necessarily Mean Great Doctors

Monday, April 16th, 2012

If you’re planning to go into the medical field like I did, then you’re probably aware of the strict application process most medical schools will put you through.  If you don’t have the right grades or MCAT scores, you might not get into the school of your choice, no matter how badly you want to help people.  Unfortunately, this means top medical schools are letting in bright students who are great test takers, but who can’t take care of patients.

Being a physician is about much more than memorizing information from medical encyclopedias and science classes.  I’ve found that a strong sense of empathy and compassion for others, as well as a generosity of spirit has been crucial to my success in medicine.  It allows me to put myself in my patients’ shoes, which in turn gives me a better sense of what to ask and what to look for.

Many aspiring doctors don’t have the grades to get them into the top schools, but they may have more emotional intelligence than the students who beat them out for those spots.  Eventually, the positions of physicians are filled with very smart people who just don’t seem to take the time or care patients need.  It takes patience to listen to everything a patient has to say and then to dig even deeper.  It’s not about solving a puzzle as fast as possible.  It’s about understanding underlying issues that may not be obvious at first glance and knowing how to uncover them tactfully. It all goes back to bedside manner, which seems to have disappeared in an absurd dichotomy of doctors having the attitude “I know it all and you know nothing”. Doctors must listen to patients. Our patients know their bodies better than their doctors do. After all, patients live in their bodies. We only visit those bodies.

Luckily, after three years of study, the American Medical Association has realized this and is encouraging medical schools to look deeper into their potential students than just their test scores.  As a result, many are adding comprehensive interviews that attempt to find out who the applicant is as a person, not just as a student.  The Association of American Medical Colleges has also announced that it will be changing the scope of the MCAT exam to include more emphasis on psychology, sociology, and biology.  President of the AAMC, Darrell Kirch, said about the changes, “Being a good doctor is about more than scientific knowledge.  It also requires an understanding of people.”  I couldn’t agree more, and I hope this changing philosophy will help bring patients more compassionate and effective doctors.

— Yvonne S. Thornton, M. D., M. P. H.

Uterine Artery Embolization for Fibroids (Myoma)

Friday, April 6th, 2012

I have been asked many times the best approach to the treatment of myoma (the correct term for the common term “fibroid”. There are many approaches, most include surgery, i.e., hysterectomy or myomectomy. Recently, a less invasive management has been offered and should be considered prior to surgery. It is Uterine Artery Embolization.

Uterine Artery Embolization (UAE) as another alternative treatment for fibroids (myoma): This latest less radical approach to reducing myoma (fibroids) was first tried in France and has been available in the United States for over a decade.

The procedure entails inserting a catheter (long hollow tube) in the major arteries of the thigh (femoral artery) and threading the catheter to the area of the fibroids. Using an inert material (polyvinyl alcohol) in the form of beads or particles, this material essentially cuts off the blood supply to the growing myoma (fibroid) resulting in shrinkage of the fibroid. Interventional radiologists have promoted this procedure as opposed to gynecologists who have proceeded with much more caution. The known side-effects have been serious systemic infection, excessive bleeding from the catheter insertion site, chronic pelvic pain after the procedure and, in some patients, early onset of menopause. Uterine artery embolization has been associated with decreased fertility.

In August, 2010, the conclusion of a 5-year outcome study from the embolization versus hysterectomy randomized clinical trial (EMMY) was that UAE is a well-established alternative to hysterectomy about which patients should be counseled.

So, if you are a candidate for myomectomy or hysterectomy because of myoma, perhaps a discussion about UAE would be helpful.

——Yvonne S. Thornton, MD, MPH