HEALTH MATTERS: Your health questions answered

Q. Isn’t it true that the United States spends more on health care than any other nation, and that our health outcomes are no better? What is the explanation?

A. Now that’s a critically important but complex question that I’ll try to answer. Yes, we spend much more on health care in both absolute and relative terms than any other country on Earth. We spend around 17 percent of our GDP (gross domestic product) on health care, while for many other countries the figure is around 9 percent. So we’re spending almost twice as much in relative terms, but many do not feel that we get twice the value. Part of the reason is that a lot of the “extra” care in the United States affects quality of life, but doesn’t necessarily affect things like life expectancy.

We don’t live longer than people in similar countries, and thus many of our health outcomes are the same. Let me use an example from my field of cardiology. If we compare our use of stents and bypass surgery to our neighbor to the north, we use these procedures more than our Canadian colleagues. What do we get for this added expense? Our patients don’t live longer or have fewer heart attacks, but they do have greater relief from chest pain (angina) due to blockages. Is it worth the money? It partly depends on whether you are the one with the blockage. But care also is more expense in the United States because we use technology more than other countries. Many of us probably have had a CT or MRI scan (I know I have), and tests like these are hugely expensive when taken in aggregate. One thing is certain—we cannot afford the continuing growth in health care expenditures that we’ve seen for the past several decades.

Q. I’m overweight, have tried many diets, and can’t seem to lose weight. While I’m successful for a few months, I can’t seem to keep the weight off permanently. Any suggestions?

A. There has been an explosion of obesity in this country over the past 20 years or so. We use a term called BMI (body mass index) to define levels of obesity. Normal weight is a BMI between 18.5 and 24.9; overweight is between 25 and 29.9; and obesity is a BMI of 30 and over. You can calculate your own BMI using this calculator: www.nhlbisupport.com/bmi/bmicalc.htm. I just checked mine, and I’m embarrassed to say that I’m just in the overweight range with a BMI of 25.6. I’ve been unable to jog for the past three months due to a back injury, so that probably explains it. I’m almost 10 pounds over my ideal weight. So what works for weight loss? The best answer is that there are no easy answers, and it’s a struggle for many who are overweight. But what works best? It’s a combination of diet, exercise, and behavioral therapy, including support and coaching. Most of us can’t lose weight using just one approach; optimally, you need to do all three. Thus, many use one of the commercial programs out there (e.g., Jenny Craig or Weight Watchers) that combine all three (or at least diet along with behavioral therapy, support, and coaching). Good luck!

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 N. Columbia Rd, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

Tags: life, health