There is good evidence to support this view. The average American consumes approximately 50 gallons of soda each year, which is a major contributor to the current epidemic of obesity, the details of which I discussed in a previous post. In 2004, the Centers for Disease Control estimated that obesity killed almost as many people in the U.S. per year (about 400,000) as tobacco did, and predicted that it would soon surpass it as the number one cause of death.

Taxes on cigarettes have proven to be very effective at discouraging their use, and early versions of the U.S. health reform bill sought to do the same by taxing sugar-sweetened beverages. In addition to reducing soda consumption, the penny-per-ounce tax would have raised billions of dollars to expand coverage for the uninsured and fund public health campaigns targeting other lifestyle behaviors that lead to obesity, such as physical inactivity.

Using time-tested tactics borrowed from Big Tobacco a generation ago (when Phillip Morris and other tobacco companies openly attacked and distorted the science linking smoking to lung cancer, heart disease, and other causes of death), the beverage industry quickly flooded Washington, DC with lobbyists and challenged research linking soda consumption to obesity. As reported in the Los Angeles Times, an industry-funded coalition calling itself “Americans Against Food Taxes” spent millions of dollars in key states to discourage Congress from including the tax in the bill – and won. State governments lost, too. Earlier this year in New York State and in Washington, DC, websites and airwaves were blanketed with “anti-tax” messages that were so effective at generating political opposition that neither of these proposals even came to a vote.

I admit that connecting soft drinks with obesity and premature death isn’t quite as instinctive as knowing that inhaling a burning carcinogen-delivery system is bad for you. After all, the beverage industry argues, extra calories can come from many sources other than what people drink. But sugar-sweetened beverages are unique among junk foods in that their calories don’t make us feel “full.” We just keep on drinking, adding empty calories in 40-ounce Big Gulp containers or going back to the dispenser for free refills.

The president of the American Academy of Family Physicians recently defended her organization’s decision to accept a grant valued in the hundreds of thousands of dollars from Coca-Cola in order to produce educational content. As a family physician, I disagree. No one expects an organization of family doctors to say that soft drinks are good for you, but in taking Coca-Cola’s money, what we are effectively telling patients (few of whom will ever visit the FamilyDoctor.org website) that soft drinks aren’t really bad for you. That’s the message that smokers were hearing a few decades ago, and most of them aren’t alive today to wish that they had been told otherwise.

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Family Health Guide brings you daily news from well-regarded sources such as JAMA, BMJ, Lancet, BMA, Leading Universities, plus articles from our own editorial team of experts. Join the 105,000 people following @famhealthguide, RSS Feed, Email Newsletter,

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More From Dr Kenneth Lin

1. The doctor will “tweet” you now
2. Postpartum depression in dads? Believe it
3. Does one drink a day keep dementia away?
4. Does the type of birth affect postpartum health?
5. Improving Your Understanding of Health Risks
6. Why you should say no to “routine blood tests”

There’s a lot of evidence that to prevent many serious health conditions, including diabetes, obesity, heart disease, and stroke, making healthy lifestyle changes are just as good, if not better than, taking medications.

Lifestyle changes may consist of stopping unhealthy behaviors such as tobacco and excessive alcohol use, or starting healthy behaviors such as moderate daily exercise and eating adequate amounts of fresh fruits and vegetables.

As anyone who has ever tried to quit smoking or make radical changes to their physical activity or dietary routines will be quick to tell you, though, making healthy lifestyle changes is hard! Family physicians do our best to support patients trying to make these changes. Unfortunately, with the exception of smoking cessation (where a few minutes of advice from your doctor can make a difference), doctors can’t provide nearly enough counseling in the limited time available at a typical visit. Patients trying to change their lifestyles for the better are most likely to succeed when they receive supportive messages again and again and feel that they aren’t alone in their efforts.

Social media tools such as blogs and Twitter offer a new venue to promote healthy and discourage unhealthy lifestyle behaviors. In addition to receiving regular supportive and educational messages, patients can share their own stories with a community of people undergoing the same types of struggles. Smokers who are seeking support to quit the habit can exchange tips with thousands of fellow nicotine addicts at http://www.twitter.com/quitsmoking123; patients with alcohol problems can join a “virtual AA group” at http://www.twitter.com/alcoholicsanony; and anyone interested in improving their physical fitness can find virtual lifestyle coaches and trainers at http://wefollow.com/twitter/exercise.

In addition, as recently reported in the Los Angeles Times , there has been a recent explosion in the number of consumer healthcare applications for smart phones. Many of these free or low-cost apps are designed to help improve physical fitness or encourage weight loss. Although their track records are slim, and none have yet been proven to be effective in changing behaviors, it’s probably worth giving them a try. I would recommend checking with your family doctor first to make sure that an app that you are considering provides reliable information.

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Family Health Guide brings you daily news from well-regarded sources such as JAMA, BMJ, Lancet, BMA, Leading Universities, plus articles from our own editorial team of experts. Join the 105,000 people following @famhealthguide, RSS Feed, Email Newsletter,

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More From Dr Kenneth Lin

1. Postpartum depression in dads? Believe it
2. Does one drink a day keep dementia away?
3. Does the type of birth affect postpartum health?
4. Improving Your Understanding of Health Risks
5. Why you should say no to “routine blood tests”

While vitamin D has always been thought to play an important role in keeping bones strong, researchers are suggesting that low levels may increase one’s risk for a variety of diseases, including cancer and cardiovascular disease.

Before you go out to your local drugstore to buy mega-doses of vitamin D supplements, though, there are at least two good reasons to proceed with caution. First, association does not always translate into causation. In other words, just because people with a low (or high) level of a nutrient are more likely to suffer from a particular illness doesn’t mean that the abnormal level caused the illness, nor does it mean that restoring a normal level will cure it. For example, studies have showed that high homocysteine levels are associated with an increased heart attack risk. When I was in residency training, cardiologists routinely prescribed folate supplements to patients who had had heart attacks in order to lower their homocysteine levels and reduce their risk of having another heart attack. However, subsequent studies determined that lowering homocysteine levels does absolutely nothing for these patients.

The second reason to be wary of the vitamin D hype is that we’ve been down this road before, with vitamins A, B, C, and E. An editorial published recently in the American Journal of Epidemiology provides a sobering summary of initial high hopes placed in each “anticancer vitamin du jour” that were subsequently dashed by randomized controlled trials. In the case of vitamin E, high doses actually appear to be harmful.

There’s a lot we don’t know about vitamin D, as an exhaustive review of the evidence for the U.S. Institute of Medicine concluded last year. Although most studies suggest that vitamin D supplements reduce the risk of fractures and falls in older adults, it’s not at all clear what the best dose should be; in a recent study, older women taking a single large dose of vitamin D each year suffered more fractures and falls than women who didn’t. In the meantime, there are many other things that you can do to keep your bones healthy, including regular weight-bearing exercise, not smoking, and eating a balanced diet that includes two to three servings of dairy products each day.

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Family Health Guide brings you daily news from well-regarded sources such as JAMA, BMJ, Lancet, BMA, Leading Universities, plus articles from our own editorial team of experts. Join the 100,000 people following @famhealthguide, RSS Feed, Email Newsletter,

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More From Dr Kenneth Lin

1. Postpartum depression in dads? Believe it
2. Does one drink a day keep dementia away?
3. Does the type of birth affect postpartum health?
4. Improving Your Understanding of Health Risks
5. Why you should say no to “routine blood tests”

After all, dads don’t have to endure the physical changes of pregnancy, the ordeal of labor and delivery, or the challenges that sometimes accompany the initiation of breastfeeding. Unlike moms, dads typically take little time off from work and experience less of the social isolation that some believe contributes to the postpartum depression.

When my second child, a daughter, was born two years ago, I had been practicing family medicine for several years and had never diagnosed a single case of postpartum depression in a man. Not long after my daughter’s birth, I became irritable and emotionally withdrawn, unable to enjoy fatherhood the way I had after my first child was born. After a few months of worsening mood swings, my wife (who’s also a family physician), suggested that I take a look at a website devoted to depression in dads. I took the results of the screening test to my personal physician, who started me on antidepressant medication and counseling.

As it turns out, my story was hardly unusual. A meta-analysis of 43 studies published last month in the Journal of the American Medical Association estimated that 10.4% of fathers experienced depression during their partner’s pregnancy or after the birth of their child, with 1 in 4 reporting symptoms between 3 to 6 months postpartum. (The incidence of depression in all men is considerably lower, at 4.8% per year.)

Why isn’t this condition recognized more often? As the Dr. James Paulson, lead author of the analysis, explained to a Scientific American reporter, most screening questions for depression ask about symptoms such as sadness and crying, which depressed men are less likely to experience or acknowledge to a physician. That’s unfortunate, since some studies suggest that a depressed dad can affect his child’s early behavioral development as negatively as if there was no dad in the picture at all.

I was lucky to get help when I did; within several weeks, I was feeling much better, and my family noticed the difference. And since then, I’ve tried to pay as much attention to the emotional and psychological needs of expectant dads as those of expectant moms.

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Family Health Guide brings you daily news from well-regarded sources such as JAMA, BMJ, Lancet, BMA, Leading Universities, plus articles from our own editorial team of experts. Join the 95,000 people following @famhealthguide, RSS Feed, Email Newsletter,

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More From Dr Kenneth Lin

1. Does one drink a day keep dementia away?
2. Does the type of birth affect postpartum health?
3. Improving Your Understanding of Health Risks
4. Why you should say no to “routine blood tests”

The standard answer, that obesity results from a failure in willpower, is reinforced by popular television shows such as “The Biggest Loser,” where overweight contestants are removed from their natural environments and placed on super-intensive dietary and exercise regimens that lead to, in some cases, hundreds of pounds of weight loss over several weeks. But as Atlantic correspondent Marc Ambinder noted in a recent magazine article, this type of program is out of reach for all but the wealthiest individuals who can afford celebrity personal trainers.

Family doctors can certainly provide support and assistance to patients who want to lose weight, but there are limits to what we can do, given the time we have to devote to counseling and the extremely limited training we receive on practical strategies to assist with weight loss. For an increasing number of obese people (including Ambinder himself), bariatric (weight loss) surgery has achieved what medicine can’t – but even the recent explosion of bariatric surgery centers can’t possibly come close to treating one quarter of the adult population.

Obesity is as much a public health problem as a medical problem. Obstacles to living a healthy lifestyle include rising serving sizes and television screen time, combined with a lack of access to nutritious foods and safe places to be physically active in many towns and cities. The announced intention of U.S. First Lady Michelle Obama to tackle obesity in children shows how difficult and sustained an effort will be necessary to reverse the overall obesity epidemic. In May, the President’s Task Force on Childhood Obesity made a series of recommendations for wide-ranging action in institutions such as hospitals, restaurants, schools, grocery stores, and parks. Most of these changes will require more than just exhortation, but policy changes in local and national levels.

So I encourage you think about this question: what can you do to fight obesity in your family, friends, and community?

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More From Dr Kenneth Lin

1. Does one drink a day keep dementia away?
2. Does the type of birth affect postpartum health?
3. Improving Your Understanding of Health Risks
4. Why you should say no to “routine blood tests”

What you may not know is that one in twenty adults will develop colorectal cancer (cancer of the large intestine) during their lifetimes. Even though this cancer is far more curable if it’s detected early than are breast or prostate cancer, 57,000 people in the U.S. still die from it every year.

There are three effective ways to screen for colorectal cancer: fecal occult blood tests (checking for microscopic evidence of blood in stool samples applied to specially treated cards), flexible sigmoidoscopy (visualizing the lower one-third of the large intestine), and colonoscopy (visualizing the entire large intestine, a procedure that is usually performed under anesthesia). The U.S. Preventive Services Task Force (USPSTF) recommends that all men and women undergo some form of periodic screening starting at age 50 and continuing until age 75, regardless of risk factors.

But what if you already know that someone else in your family has had colorectal cancer? In a 2005 article in the Annals of Internal Medicine, Dr. Glenn Eisen from the Oregon Health and Science University in Portland and Dr. David Weinberg from the Fox Chase Cancer Center in Philadelphia reviewed recommendations for screening patients with family histories of colorectal cancer and outlined recent developments in screening technologies.

If possible, your doctor will want to find out your affected relative’s age at diagnosis, location and number of lesions found, medical histories of second-degree and distant relatives, and a history of other family cancers. Most experts recommend beginning colorectal cancer screening at age 40 in patients with affected first-degree relatives, or (if earlier) 10 years before the relative’s age at diagnosis. In contrast to the multiple screening options available to average-risk persons, patients with family histories of colorectal cancer should undergo colonoscopy every 5 years. Newer screening technologies such as computed tomographic colonography (also known as “virtual colonoscopy”) and stool DNA testing have demonstrated promise but are not considered ready for “prime time” use.

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More From Dr Kenneth Lin

1. Does one drink a day keep dementia away?
2. Does the type of birth affect postpartum health?
3. Improving Your Understanding of Health Risks
4. Why you should say no to “routine blood tests”

Although heavy drinking is bad for your health, some studies have suggested that drinking “moderately,” defined as up to two alcoholic beverages per day, may actually be beneficial for the mind. In a 2005 study in the New England Journal of Medicine, Dr. Meir Stampfer and colleagues from Harvard Medical School examined the relationship between moderate drinking and measures of brain function in women age 70 years and older.

Women in the study completed six dietary questionnaires between 1980 and 1998, including questions about frequency and type of alcohol use. They were classified into three groups based on average daily alcohol consumption: non-drinkers (55 percent of participants), those who drank up to one drink daily (44 percent), and those who drank one to two drinks per day (5 percent).

Specially trained nurses, who were not given information about the womens’ drinking habits, tested their memory and cognition in telephone interviews between 1995 and 1997. While nondrinkers and women who consumed one to two drinks daily had similar cognitive scores, women who consumed less than one drink daily had higher average scores, and their risk of being classified as cognitively “impaired” was 20 percent less than that of nondrinkers. The type of alcoholic beverage consumed did not affect the results.

Since it would be unethical to perform an experimental study where one group of women was randomly assigned to drink alcohol and another group was randomly assigned to be teetotalers, it is unlikely that we will ever know conclusively if any amount of alcohol is good for the mind, and if so, how much. The observational design of the Harvard study leaves open the possibility that women with better cognitive scores were more likely to consume moderate amounts of alcohol, rather than the other way around. On the other hand, this study suggests that women who drink up to two alcoholic beverages per day will be no worse off, and may possibly fare better, than their nondrinking peers.

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More From Dr Kenneth Lin

1. Does the type of birth affect postpartum health?
2. Improving Your Understanding of Health Risks
3. Why you should say no to “routine blood tests”

My daughter, who turns two years old next month, is becoming something of a medical rarity. This isn’t because she is showing signs of a late-developing handicap or extraordinary ability for her age – it’s because she came into the world as a vaginal birth after Cesarean section (VBAC).

Although more than three-quarters of women who choose a trial of labor over a repeat Cesarean section (including my wife) successfully deliver vaginally, studies showing slightly elevated risks of rupture or infection of the uterus with VBAC, pressure from insurance companies concerned about lawsuits, and restrictive medical guidelines discourage most women from even trying.

After reaching a high in 1996 of 28.3 percent of U.S. women who previously delivered by Cesarean, the VBAC rate today is fewer than 1 in 10. Surgical deliveries are rapidly becoming the norm rather than the exception in the U.S. and the U.K., reaching record highs of 32 and 24 percent of all births in their respective nations in 2008.

The rising number of surgical deliveries is troubling, given that more than three-quarters of first-time mothers who are employed during pregnancy will return to the workforce within their infant’s first year of life. In a 2006 study in the Annals of Family Medicine, Dr. Pat McGovern and her colleagues at the University of Minnesota reported the relationship between delivery type and measures of postpartum health 5 weeks after childbirth.

Participants were 817 employed women who gave birth to single healthy infants at one of three Minneapolis-St. Paul community hospitals in 2001. Study personnel telephoned each woman to conduct an interview that lasted approximately 45 minutes. The interviews assessed overall physical and mental health as well as typical postpartum symptoms, including fatigue, decreased interest in sex, back and neck pain, constipation, hemorrhoids, and appetite problems.

The authors found that women who delivered by cesarean section reported significantly worse physical health 5 weeks after birth than women who delivered vaginally, although mental health scores were similar between the two groups. This is important to know, since while surgical deliveries aren’t always avoidable, there are some simple things that a woman can do to reduce her risk (such as asking her obstetrician, family physician, or midwife what the practice’s average c-section rate is and their most common reasons for doing one). If you want more information, I refer you to a website that pulls no punches with the facts about how to avoid an unnecessary cesarean.

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More From Dr Kenneth Lin

1. Improving Your Understanding of Health Risks
2. Why you should say no to “routine blood tests”

Just as making rational decisions about traveling requires knowing the type and magnitude of risks involved, making informed decisions about your health requires understanding the risks associated with health conditions and treatments. In a 2007 study in the Annals of Internal Medicine , researchers examined how providing patients with an educational booklet about health risks improved their skills in interpreting medical information.

The study recruited 500 healthy adults between the ages of 35 and 79 from both high and low educational backgrounds and randomly assigned them to receive either an 80-page primer titled “Know Your Chances: Understanding Health Statistics” or a generic booklet containing general health advice. Steven Woloshin, Lisa Schwartz, and H. Gilbert Welch of Dartmouth Medical School were interested in seeing if their primer (which they revised and published in book form last year) improved patients’ medical decision-making abilities.

Since the researchers could not ethically use information about real-life medical situations, they instead gave participants an 18-item test of medical data interpretation drawn from hypothetical advertisements, news stories, and imaginary clinical scenarios. Possible scores ranged from 0 to 100, with 75 considered “passing” and 90 (the average score of physicians who teach academic medicine) considered “outstanding.”

On average, the group that received the risk primer scored 6 to 7 points higher on the test than the other group – an achievement gap that is equal to about one-third of the difference between the scores of medical experts and people with other graduate degrees. The researchers concluded that their primer improved participants’ data interpretation skills, and that the effect was similar across two groups with different educational backgrounds.

The bottom line? Doing a little homework before going to see the doctor (by reading the book or another source of reliable information on health risks) could substantially improve your chances of making good health decisions.

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More From Dr Kenneth Lin

1. Why you should say no to “routine blood tests”

Your doctor briefly reviews your medical history, performs a physical examination, says a few encouraging words about eating a healthier diet and exercising more, and then you’re done.

You picked this doctor out of the five in the practice because your friend told you he was a sharp young fellow, but now you’re not so sure. What about the blood work? You don’t need any blood work, he says. Not even a urine sample? This is confusing. You’ve always had blood work and urine tests at your other physicals, and your insurance is footing the bill, after all. You wonder if this doctor really knows what he’s doing.

This is a common situation that I faced while working as a physician in private practice in northern Virginia a few years ago. For years, patients have been used to having blood samples drawn even if they felt completely well. Even today, when we know better (or ought to), up to one-third of primary care physicians still perform “routine blood work” (usually consisting of a complete blood count, a chemistry panel, liver function tests, thyroid tests, and a urine analysis) at adult physical examinations. So why is this such a bad idea? In 2007, I co-authored an editorial in the journal American Family Physician about this topic. We wrote:

“‘Big-ticket’ tests [such as CT scans and MRIs] are easy targets for those seeking to reduce waste in health care. But what about the seemingly innocuous practice of performing routine tests such as a complete blood count (CBC) or urinalysis? … These tests would be useful only if they provided additional diagnostic information that would not otherwise be obtained during a history and physical examination. In fact, large prospective studies performed in the early 1990s concluded that these tests rarely identify clinically significant problems when performed routinely in general outpatient populations. Although the majority of abnormal screening test results are false positives, their presence usually mandates confirmatory testing that causes additional inconvenience, and occasionally physical harm, to patients.”

Don’t misunderstand me. There are certain situations in which targeted screening tests can provide valuable information for the early detection of diseases. To learn more about which tests are recommended for your or your family members, I recommend that you visit the excellent website Healthfinder.gov. But the next time you go to a doctor’s office and he or she proposes to check some “routine blood work,” be sure to ask what these tests are for and what would happen if any of them turn out to be positive, so that you can make an informed choice about what’s right for you.

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