The Morning Drill: August 18, 2011

A collection of dentistry and health related links/comments for your day.

Being Overweight May Take Years Off Seniors' Lives

Elderly people with extra body fat may not live as long as those who maintain a normal weight, according to a new study that contradicts previous research.

In following seniors over an extended period of time and accounting for changes in their weight, researchers found a higher body mass index (BMI), or height-to-weight ratio, is associated with a shorter life expectancy.

"We had a unique opportunity to do 29 years of follow-up with a cohort that was also followed for mortality outcomes," said study lead author Pramil N. Singh, associate professor in the School of Public Health at Loma Linda University, in a university news release. "Across this long period of time, we had multiple measures of body weight, which provided a more accurate assessment."

For the study, recently published in the Journal of the American Geriatrics Society, researchers examined 6,030 healthy adults who never smoked. They found that men older than 75 years with a BMI greater than 22.3 would live nearly four years less than those with a lower BMI.

Similarly, women older than 75 years with a BMI greater than 27.4 would live roughly two years less than other women their age who were of normal weight.

A BMI between 18.5 and 24.9 is considered normal weight. A BMI of 25 to 29.9 is considered overweight, and a BMI of 30 or higher is considered obese.

The study pointed out, however, that the negative effects of excess weight kick in for men and women at different BMIs. Men experienced a greater risk of dying beginning with a BMI of 22.3, while this risk did not appear for women until they had a BMI of 27.4.

The study authors suggested this difference may be because in postmenopausal women body fat is the main source of estrogen, which may help protect them from heart disease and hip fractures.

These findings contradict previous studies, which concluded that overweight elderly people live longer than their thinner peers. The authors of the current study said previous findings are limited because they do not account for participants' weight changes over an adequate length of time and consider how these fluctuations in weight might affect their life expectancy.

70% Indonesians have tooth decay: Association

Nearly 70 per cent of Indonesians have tooth decay and yet only 1.6 per cent of them have sought treatment, an association has said.

School of Dentistry Association chairman Eky S. Soeria Soemantry said Tuesday in Jakarta that the figures covered children and adults.

He added that up to 89 per cent of children under the age of 12 had tooth cavities.

"People are reluctant to have regular dental checks because they're afraid it'll hurt and they think it's costly," Eky said.

He said that the modern equipment in dental clinics and hospitals enabled treatment for tooth decay to be relatively painless.

He added that the cost should not be too high if patients visited dentists before the tooth decay became severe, tempointeraktif.com reported.

From omnivore to vegan: The dietary education of Bill Clinton

By the time he reached the White House, Bill Clinton's appetite was legend. He loved hamburgers, steaks, chicken enchiladas, barbecue and french fries but wasn't too picky. At one campaign stop in New Hampshire, he reportedly bought a dozen doughnuts and was working his way through the box until an aide stopped him.

Former President Clinton now considers himself a vegan. He's dropped more than 20 pounds, and he says he's healthier than ever. His dramatic dietary transformation took almost two decades and came about only after a pair of heart procedures and some advice from a trusted doctor.

His dietary saga began in 1993, when first lady Hillary Clinton decided to inaugurate a new, healthier diet for her husband. In a meeting, she asked Dr. Dean Ornish to work with the White House chefs, who were accustomed to high fat, French cuisine.

"The president did like unhealthy foods, and we were able to put soy burgers in White House, for example, and get foods that were delicious and nutritious," said Ornish, director and president of the Preventive Medicine Research Institute in Sausalito, California. Other new menu items included such healthy fare as stir fry vegetables with tofu, and salmon with vegetables.

Even with the revamped White House menu, Clinton battled his weight throughout his two terms as president. At his annual physical in 1999, the White House physician noted the president had put on 18 pounds since a checkup two years earlier. The prescription: refocus on exercise and a low-calorie diet.

Clinton didn't know it, but weight was not his biggest health concern. The 42nd president has a family history of heart disease, and plaque was building up in the coronary arteries leading to his heart, undetected by White House doctors.

Most Physicians Will Be Sued for Malpractice by Age 65

The risk of getting sued for malpractice in any given year ranges from 2.6% for psychiatrists to 19.1% for neurosurgeons, but over a medical lifetime, most physicians across all specialties can expect to face at least 1 lawsuit, according to an article published today in the New England Journal of Medicine (NEJM).

The findings, drawn from the files of a major malpractice insurance carrier with clients across the country, represent more fodder for the ongoing debate on tort reform, a subject dear to organized medicine.

Physicians in the 5 least-sued specialties — psychiatry, pediatrics, a category called "other specialties" in the study, family medicine, and dermatology — have a 75% chance of getting sued by age 65. The odds increase to 99% for physicians in the 5 most-sued specialties: neurosurgery, thoracic cardiovascular surgery, general surgery, orthopaedic surgery, and plastic surgery.

Despite physicians having a high lifetime risk for malpractice litigation, most plaintiffs do not receive a payment in the form of a settlement or jury award, write lead author Anupam Jena, MD, PhD, from Harvard Medical School, Boston, Massachusetts, and coauthors, echoing what other students of medical liability have found. On a yearly basis, 7.4% of all physicians are hit with a malpractice claim, but only 22% of these claims lead to a payment. Through age 65, physicians in the low-risk specialties run a 19% risk of facing a suit that pays off for the plaintiff, compared with a 71% risk for the high-risk specialties.

The size of average payments across specialties also was all over the map, ranging from $117,832 for dermatologists to $520,923 for pediatricians. However, this variability does not appear related to how often a particular specialty is sued. Neurosurgeons, for example, are roughly 6 times more likely to face a malpractice suit than pediatricians, but their average payment of $344,811 is substantially lower.

Enjoy your morning!