10 Health Questions With A Doctor

Adam:  What do you do (Professionally)?

Chris Hogrefe: I split my time between practicing Emergency Medicine and Primary Care Sports Medicine in an academic, University setting.  I have the privilege of caring for some of the most ill people in our state on one day, and then caring for a wide-variety of athletes ranging from Division I athletes to 70 year-old Ironman participants to middle school kickball extraordinaires.  Sprinkle in a little healthcare information technology and one has loosely described my professional responsibilities.

Adam:   Are health-related New Year’s resolutions a good stepping stone or just Holiday Remorse?

CH: I actually do not think that New Year’s resolutions constitute “Holiday Remorse”.  A large number of people formulate health-related resolutions (specifically weight loss topping the list), which could certainly be construed as a reflex after binging on homemade cookies, turkey, etc. over the holidays.  But, if you focus on the frequently cited weight loss resolution, the fact of the matter is that obesity is a rapidly growing problem in the United States (Please excuse the pun.).  If you polled Americans on July 1^st for a Mid-New Year’s Resolution, contextually withdrawn from the calorie-laden holiday season, I surmise that weight loss or health-related resolutions would still top the list.  The start of a new year is simply a prime opportunity to wipe the slate clean and tackle the biggest issues in our lives that warrant improvement (Again, pardon the pun.).  Perhaps the most difficult issues to fix, and implement on a long-term basis, involve our health.

Adam:     What is one thing that you think that everybody should do for their health?

CH: Full body massages with Hans or Gretchen, your pick.  No, actually that is a difficult question.  Common replies immediately jump to mind, including walk as much as possible; exercise every day; eat a hardy breakfast, a reasonably-sized lunch, and a small dinner; never smoke; the list goes on and on.  But, let me go off the board and say that one should stop eating when he or she is 80% full.  While difficult to judge at times, if people could master that idea (and therefore avoid gorging oneself), as a society we would be well on our weight to addressing the obesity epidemic.

Adam:  Sports Medicine is a relatively new piece in health care, only emerging since the latter half of the 20^th Century. How is it different than general healthcare?

CH: Sports Medicine is a subspecialty just like Geriatrics, Cardiology, Critical Careh, etc. in focusing on a specific subset of the population.  We focus on the injuries, disease, and disorders that affect athletes.  Athletes is a loose term, it does not necessarily imply that we only provide care for elite, Division I athletes destined for the professional ranks.  Of course, we do care for the professional and collegiate athletes, but we also provide care for the weekend warriors, high school participants, and even the middle school tetherball players.  Some Sports Medicine physicians also dabble in music performance, as those highly-skilled individuals have conditions (e.g. repetitive use injuries, etc.) that require medical expertise as well.  In short, Sports Medicine provides another level of expertise for the population described above.  It is the case that some physicians without Sports Medicine training can provide similar care.  But, the analogy that comes to mind is that as an Emergency Medicine physician I am certainly able to deliver your child.  However, if given the choice, you would much prefer an Obstetrician to perform that complicated procedure.  And truth be told, I would be just fine with that as well.

Adam: What is the biggest concern for a student athlete that doesn’t move on to professional sports?

CH: First of all, I am not sure that my experience level is sufficient to provide a truly insightful or particularly novel response to this question.  With that caveat asserted, I will not completely duck the question.  I do think that the vast majority of students that do not advance/pursue the professional ranks have significant issues being successful in life outside of sports.  The same drive that propelled them to succeed in the athletic realm often leads them to prosper after sports.  But, there can be issues regarding weight/metabolism.  The obvious examples involve larger athletes (e.g. football lineman) who cannot possibly remain healthy carrying 300 pounds of weight around on a daily basis.  However, the inverse can be just as dangerous.  Consider the health implications of the significantly underweight track or cross country runner.  While obesity is cited as a major health epidemic, and rightfully so, having a BMI (body mass index) that is too low actually carries a higher mortality rate than being obese.  The point here is that athletes need to remember to adjust their diets after their playing days have concluded.  For instance, while working as an intern at a local business consuming 4,000 calories a day is probably a bit excessive.  However, six months earlier that would be a completely normal daily allotment while playing competitive basketball for three to four hours per day.

Adam:     In 2011, obesity overtook smoking as the #1 affect for the most preventable health conditions. Like smoking, should a person’s weight affect people’s health plan?

CH: You have asked me to tread on controversial ground here, sir.  I think that a person’s health plan should be affected by his or her weight but in an incentive-laden fashion as opposed to a punitive one.  For instance, I think that people are more apt to adopt healthy practices (e.g. increased exercise, better dining choices, smoking cessation, etc.) when they are rewarded for these behaviors (e.g. an insurance premium reduction, etc.) as opposed to a tiered system charging overweight or obese individuals higher rates.  This may seem like semantics, but if you think about it there is a key fundamental difference.  With all that said, there is another underlying difference between smoking and obesity, the examples that you provide.  The science of genetics is evolving, and there does appear to be a congenital component to obesity, at least on some level.  This is not a nature versus nurture argument, but more likely a case of both nature and nurture combining to contribute to the obesity epidemic.  Penalizing people, prima fascia, for a component of their health that may be partially out of their direct control seems punitive.  Hence the more incentive-based approach to health plans.  To date, the science linking nicotine dependence to genetic factors is less concrete, seemingly place more of the control in the hands of the individual.  As a caveat, there are genetic studies suggesting that some individuals are more prone to addiction, but again, that is less proven to date.

Adam:  Healthy options are more accessible than ever; why is the US getting fatter?

CH: Are healthy options really more accessible to everyone?  I would argue that a lot of folks do not have ready access to fresh fruits and vegetables.  But, if I take the premise at face value, a few factors play into the increasing girth of US citizens.  Habit obviously plays a role.  If one grew up on the “typical” American fare (pizza, hamburgers, french fries, etc.), these eating habits are hard to break.  Let us face it…These foods taste good.  However, I think that the biggest contributing factor to the dilemma you pose is cost.  While McDonalds, Burger King, Taco Bell, etc. have healthier options than were available even ten years ago, I have yet to see snap peas, fruit salad, or even low-fat hamburgers on the dollar menus.  The food that often tastes the best is also often the cheapest.  That is a dangerous combination in the face of a growing obesity epidemic.

Adam:    We both have young children; How do you feel about schools with vending machines?

CH: The strict paternalist in me thinks that they should be removed from school on the back end of the largest tractor available.  You are dealing with a captive audience that is growing and constantly hungry.  One can reinforce good eating habits at home until he/she is blue in the face.  But children spend most of their time at school.  Flashing high fat, high sugar foods and soft drinks in front of them all day will trump good home eating practices most of the time.

But, then I realize that we live in a capitalistic society and as soon as my son or daughter strolls out of school they will walk past a convenience store with vending machines chalk full of the same things I suggest should be removed from schools.  In the end, I think the most important principle I attempt to implement is steeped in pragmatism.  Individually, I will not be able to remove my children from the omnipresence lure of a Reese’s Peanut Butter Cups drowned in a Code Red: Mountain Dew.  But I can teach them about self-restraint, a principle that will serve them well on numerous fronts.  Outlawing these treats is likely not the answer, but reinforcing the notion that they are just that…treats, something to be enjoyed occasionally.  As Aristotle once wrote, “Everything in moderation…”

Adam:  How do you stay healthy in your life?

CH: I enjoy long walks on the beach…Wait, that was for a different blog…

In all honesty, chasing around two toddlers keeps me fairly fit.  So, I suggest everyone get a pair.  Check Craig’s List.  No, besides helping to rear my kids, I play basketball approximately three times a week.  My family and I take regular walks for extended periods of time as well.  I still take on the whippersnappers in Intramural sports regularly as well (flag football, basketball, dodgeball, and softball).  But there are a lot of little things that I do outside of exercise as well.  We try to frequent the local Farmer’s Markets.  This infuses fresh produce into our diets while supporting the community.  While remarkably difficult for a bread –loving clan like ours, we do attempt to trim down our carbohydrate intake.  And lastly, I have found that standing while working has increased my activity level and the number of calories that I have burned daily.  There are actually a handful of studies in the recent literature that have espoused the virtues of this workplace modification.

Adam:  How do you stay motivated?

CH: Likely attributed to my father, for as long as I can remember I have been a fairly self-motivated individual.  I genuinely do whatever it is I do because it seems to be the right thing to do.  Often times I would have a difficult time placing my finger on the exact reason for my choices/behaviors.  But now, as I have “matured” in life and have a fantastic wife and two amazing children, I find them to be my greatest motivation.  Wanting to exhibit good behaviors to role model for them and to be around for them as a resource for as long as possible is my ultimate motivation.  My wife, on the otherhand, may have other plans.