A new survey suggests patients’ sleep problems often go untreated

Most people with a health condition have a hard time sleeping well.  And one of the overwhelming reasons why sleep is difficult?  They’re stressed.

So say the results of a recent survey of more than 5,200 patients by the online network PatientsLikeMe. The findings make sense, right?  Yet the issue of sleep deprivation can be hard to spot and quantify among patients already suffering from other ills. Its causes are complex and varied, including factors like anxiety, pain and depression. And our specialty-centric medical system makes it difficult to design a comprehensive treatment.

PatientsLikeMe has been studying sleep issues for more than five years now, amassing patient-specific sleep data representing the experiences of 65,000 patients.  The recent survey revealed that most respondents – 64% – say they think they have a sleep problem, with over half saying they’d suffered for a year or more.  Only 13% had been diagnosed with insomnia, though the majority reported symptoms as defined by the National Sleep Foundation.

“While a common factor among the chronically ill, sleep problems are not generally on the clinical visit menu, even in questions where sleep is really critical like epilepsy,”  says Jamie Heywood, PatientsLikeMe’s co-founder and chairman and a TEDMED 2009 speaker. “There are a lot of things we think we know in medicine, but they aren’t measured in any way that allows you to do comparisons.”

Looking at multifaceted factors among a large population is one of the biggest challenges in medicine, he adds.

“Medicine stores data in largely a storytelling or narrative format, so when you talk to an endocrinologist, for example, and you ask them if their patients have sleep problems, they say a lot of them do. But they would not be able to say quantitatively how many do, or if there are treatments that are more or less effective for that population.

“We built PatientsLikeMe to advance understanding of the many variables of health across conditions” Heywood says. “Because we run these cross-condition studies, we can create much greater value than the current silo-based model creates.”

Stress Contributes to Sleep Problems, Makes Normal Functions Difficult

Stress was reported as one of the biggest sleep loss factors – again, a likely outcome but one with a surprising impact.  Of survey respondents who reported sleep problems of at least mild severity, 89% of women and 84% of men said their sleeping problems are caused by stress or anxiety.  And those with stress-induced sleeping problems reported that it had a significant impact on their ability to work.  (Click here for the data.)

PatientsLikeMe Study: Stress And Lack of Sleep Significantly Affect People With Health Conditions
PatientsLikeMe Study: Stress And Lack of Sleep Significantly Affect People With Health Conditions

The study aimed to measure sleep quality against the holistic backdrop of a patient’s life environment, such as work and living conditions. Going forward, PatientsLikeMe also plans to look more closely at data relating insomnia to chronic fatigue, depression, pain, and diet, and to delve into nuances such as a patient’s feelings of empowerment and how it may relate to his or her symptoms.

“These are important variables about how people live with disease,” Heywood says.  “Every one of these is a complicated sub-domain where understanding the compounding factors and context is extremely important. For us to move into this next generation of personalized medicine, we first have to understand mathematically what the human condition is.”

PatientsLikeMe also launched the Open Research Exchange this summer, an online platform to help researchers design, test and share new ways to measure diseases and health issues, and to open the research process to patient input, including developing and critiquing questions.

A traditional research model with a principal investigator collecting subjects and restricting access leads to conditions without good outcome measures, particularly those for rare diseases, Heywood says. Instead, Open Research Exchange uses crowd-sourcing concepts to help researchers develop new health outcome measures and more fully understand diseases in a patient-centered way.

“Look at the BECK Depression Inventory – that was developed in just over a week.  The idea that our whole understanding of depression is based on something that was developed in a week without patient input, and hasn’t evolved since, is just wrong. We have patients tell us all the time how to make our scales better, and now we’re going to give them the ability to do it,” Heywood says.

Jamie Heywood will be a participant at this week’s live online Google+ Hangout, discussing the causes and effects of sleep deprivation. It’s tomorrow at 2PM Eastern. Click here for more information and to register.

A live online event: Unraveling dementia

Today, one in three seniors dies with Alzheimer’s or another related dementia, and by 2050 we may see some 13.8 million patients with Alzheimer’s as our population ages.*

Join a live online discussion, “Unraveling Dementia,” this Thursday at 2 pm EDT.
Join a live online discussion, “Unraveling Dementia,” this Thursday at 2 pm EDT.

The clock is ticking.  Can we possibly avoid a catastrophic dementia tsunami? What have we learned about dementia-causing diseases to date?  And what are our best prospects yet for prevention, better diagnoses and a cure?

Research focal points of late include:

  • Working toward a better understanding and a neural map of the brain, including projects like the BRAIN Initiative, described at TEDMED 2013 by Dr. Rafael Yuste.
  • Genetic risk profiling.  If we can identify those at greatest risk for dementia earlier, can we develop drugs that can prevent it?
  • Discovering and testing drugs that may prevent the onset of Alzheimer’s.  Current testing takes aim at beta amyloid, a protein associated with the plaque that forms in the brain in Alzheimer’s patients.
  • Evaluating evidence that supplements and lifestyle interventions may reduce dementia risk.  Can fish oil prevent cognitive aging?  What about caffeine?  How about herbs and antioxidants?  Exercise?  A good sleep?  Current science seeks to separate sound, healthy interventions from myths.

Join TEDMED and invited guests this Thursday at 2pm ET to discuss these issues and others related to dementia and Alzheimer’s. Tweet your questions to #GreatChallenges, and we’ll answer as many as we can on air. Just click here to sign up and get started.

Guy Eakin, Vice President of Scientific Affairs at the American Health Assistance Foundation and a TEDMED Great Challenges team member, talks about advances in basic research related to dementia.


*Source: Alzheimer’s Association

Reducing medical errors will require better reporting tools, engaged patients and – you guessed it – culture change


Reprinted with permission from MedCityNews

“Culture change.” Those words just keep coming up again and again in talk about what’s needed to reduce healthcare costs, to make better use of health information technology, and in this case to stop preventable medical errors that harm patients.

Patient Safety America founder John James recently published a study in the Journal of Patient Safety that estimated the annual number of medical errors in U.S. at up to four times the number the Institute of Medicine estimated in 1999. He joined other experts representing vendors, providers and pharmacists on Thursday for a TEDMED Great Challenges Google+ hangout focused on eliminating medial errors.

Conversation about how and why he compiled the report was a jump-off point for some specific ideas around how physicians, vendors and patients can incite culture change.

Better reporting tools

Hospitals currently use something called the IHI Global Trigger Tool to flag and measure adverse events. Dr. Michael Victoroff, a family physician and risk management consultant, said hospitals shouldn’t just be collecting data on errors but looking deeper into the kinds and causes of errors that are happening. That could be especially useful for identifying places that have figured out how to prevent a particular type of error.

Ana Hincapie, an assistant professor of clinical sciences at California Northstate University College of Pharmacy, noted that there are many medical errors that happen outside of the hospital setting, such as at the pharmacy, that aren’t being accounted for. Victoroff added that a lot of great data on medical errors is being captured in the form of lawsuits and complaints, but attorneys and hospitals keep that data private.

Include patients in reporting

One idea thrown out was the inclusion of patient input in determining medical errors. Perhaps, for example, in the same way that hospitals administer patient satisfaction surveys, what if someone develops a standard survey instrument that patients were expected to complete after visiting a provider? Or, better yet, what if patients were prompted to review their medical records after every visit, to ensure that what’s been recorded accurately reflects the care they received?

“When patients have access to their own records, they start looking at what’s in there,” said Victoroff. “They become one of the main safety tools for the entire system. They’re the only ones in many instances that can reconcile the accuracy of their record with the truth.”

James chimed in that sometimes, though, it takes years for diagnostic errors to be uncovered. “There are things that you don’t realize about your care until it’s put in perspective,” he said. That implies the need for a long-term strategy for incorporating patient feedback into medical record keeping.

Foster a culture that values patient education

Physicians have limited time to spend with patients, but that doesn’t mean they have to skimp on education. James suggested that providers stay efficient by keeping on hand a set of prepared videos that objectively explain complex topics that doctors often have to explain to patients, and usually do so with a certain bias. That might include things like next steps for a patient with an elevated PSA level, or guidance for a patient who’s debating breast cancer screening.

“Some of these standard things that patients don’t understand the nuances of very well I think need to be put into a video format and actually the doctor doesn’t need to be there,” he said. “He tells his patient, go watch this and come back to me with your questions. There are no bright, clear answers here.”

Victoroff agreed and took that idea a step further. “The internet is the most powerful tool ever invented to help patients collaborate with doctors and care systems,” he said. “It only takes me 10 minutes on the internet to find downloads, guidelines, checklists, questions to ask your doctor, video, and also very valuable blogs and patient comments from people who have had the same thing or similar […] All (administrators) have to do is point patients in the direction of it and give patients a little guidance on how to filter out the nonsense.”

Foster a culture that values active prevention of errors

In his own practice, Victoroff offered a $50 reward to anyone who caught him about to “do something terrible,” he said. Hospitals should convey encouragement to employees to speak up if they see something suspicious.

Push industry players to do their part

John Cox co-founded a health IT company focused on patient-physician communication called Visible Health. He said that in talking to pharmaceutical and medical device companies, he’s been encouraged by their increasing desire to bake patient safety initiatives into the products and services that they offer. For example, a pharma company wants to develop a mobile tool to make patients more aware of the clinical protocols around a condition. “I think there’s a great opportunity for them to be leaders because they do have the economic capabilities to do so,” he said.

A live online event: How can patients help track medical errors?

Why is it so difficult to assess the number of patients that are harmed by medical care errors in hospitals?  And what can patients do to help make sure potentially harmful incidents are accurately reported?

shutterstock_2833913A report published this month in the Journal of Patient Safety says that mistakes contribute to the deaths of some 440,000 hospital patients each year – roughly two to four times as many as previous estimates. Why the wide variance?  As Marshall Allen of ProPublica reported via the NPR Shots blog, a number of studies have given vastly different numbers of fatality rates, including the Institute of Medicine’s (IOM) oft-quoted 1999 report, “To Err is Human.”

John T. James, PhD, a toxicologist at NASA,  compiled numbers for the new study using a weighted average of four reports, including the IOM’s, and according to the Global Trigger Tool, a method of reviewing medical records. That total pointed to a lower limit of 210,000, but James theorizes that life-shortening errors of omission due to failure to follow medical guidelines, as well as diagnostic failures, are under reported. The real number of fatalities, he says, is more than twice that, comprising about one-sixth of all deaths each year in the U.S.

James wrote a book, “A Sea of Broken Hearts,” after the death of his son, which he claims is the result of preventable errors by a cardiologist unit. He also founded an advocacy group called Patient Safety America.  The biggest reason for under reporting at an organization level, he maintains, is “the pride of not being willing to admit an error. Others are failure to recognize any error occurred and fear that your colleagues will know about your error,” he says.

While all parties would like to eliminate errors, James writes in the report, reducing medical errors in our complex and fragmented medical system can only be done with the help of patients, who are constants in this equation. As he says in the study:

All evidence points to the need for much more patient involvement in identifying harmful events and participating in rigorous follow-up investigations to identify root causes.Even for those harms identified in the medical records of Medicare patients, only 14% become part of the hospital’s incident reporting system.

He acknowledges that without a system overhaul, though, that will be difficult. “[Patients] may assume that harm is part of trying to get medical care. They may not know how to report errors or they may fear the confrontation that could be involved. I can tell you personally that loss of a child from medical errors leaves you devastated physically and emotionally. A survivor may simply not have the emotional reserve to deal with the system that, in my opinion, does a great job of protecting the one who made the error,” he says.

John James will be our featured guest in a live online conversation tomorrow as we explore the issues surrounding medical errors reporting. Marshall Allen (@Marshall_Allen), who reports often on patient safety issues, will moderate the group. Ask questions via Twitter using #GreatChallenges, and we’ll answer as many as we can on air. Click here to sign up.


Marshall Allen, Reporter, ProPublica and the ProPublica Patient Harm Community

John T. James, PhD, Chief Scientist of Space Toxicology, NASA Johnson Space Center

John Cox, Co-Founder, President and Chief Executive Officer, Visible Health, Inc.

Ana Hincapie, PhD, Assistant Professor of Clinical Sciences, California Northstate University College of Pharmacy

Michael Victoroff, MD, Executive Vice President and Chief Medical Officer, Lynxcare

Where Health Begins: Lessons from TEDMED’s Great Challenges

Reprinted with permission from HealthLeadsUSA.org.

On September 12th, Health Leads Chief of Staff Sonia Sarkar took part in the TEDMED Great Challenges Google Hangout, “Where Health Begins,” to discuss the role social determinants play in patients’ health.  Special guest Mindy McGrath, Director of Government Relations at the Association of Academic Health Centers (AAHC), kicked off the discussion by sharing the AAHC’s new online social determinants of health toolkit for clinicians, patients, and community members to access best practices for addressing the social determinants of health.  Here are some of our key takeaways from the discussion:

  • The primary access point of care should be within the doctor’s office. While key contributors to health exist outside the doctor’s office, the clinic can still be the place where patients connect to the resources they need to be healthy.  As Sonia pointed out during the discussion, the doctor’s office can effectively be the hub for both medical care and social service connections:

What we’ve been focused on at Health Leads is ensuring that patients have access to the information they need to be healthy within the context of the healthcare setting.  What is important about this particular access point of care is that…it enables us to think about the interplay between where patients get access to resources and where they get access to healthcare.  You can bring those two things together, rather than having the two systems remain separate.

  • We must train health professionals for the new 21st century model of healthcare. As more and more institutions seek out ways to address social determinants, future healthcare professionals must be aware of and understand the full set of factors that affect their patients’ health.  Doctors need to have the knowledge and resources they need to have these tough conversations with patients.
  • We can repurpose the traditional clinic to meet patients’ non-medical needs.  From standard screening paperwork and the prescription pad to electronic medical records, there are a number of tools already in place within healthcare that can be reinvented to address patients’ non-medical needs in conjunction with medical care.

At Health Leads, we are excited to be a part of these important conversations on the social determinants of health.  While we recognize that a number of factors that affect patients’ ability to get and stay healthy exist outside the clinic walls, our vision for healthcare includes the idea that the doctor’s office can be re-imagined to be the place where patients go to address these most basic resource needs.

Watch the TEDMED Great Challenges discussion.  Read more about the Association of Academic Health Centers’ Toolkit.

Panelists included Dr. Bob Atkins, Associate Professor of Nursing at Rutgers University, Dr. Sandeep Kishore, Co-chair of the Young Professionals Chronic Disease Network, Dr. Anne Beal, COO of Patient-Centered Outcomes Research Institute, and Mindy McGrath, Director of Government Relations at the AAHC. The panel was moderated by Amy Lynn Smith, healthcare communications writer and strategist.    

A Great Challenges Online Event: Shopping for Health

Note:  This online event, originally scheduled for September 19th at 11 am ET, has been postponed.  We will announce the new day and time here and via #GreatChallenges.

“Let food by thy medicine,” Hippocrates once said, and thousands of years later, grocery stores are apparently embracing his philosophy.

In a new trend for the industry, a majority of food stores who responded are offering wellness (56%), cooking (46%) or weight management classes (28%) according to the Shopping for Health 2013 survey, conducted by the Food Marketing Institute (FMI) and published by Prevention magazine.

The survey covered thirty-nine FMI member companies, representing thousands of grocery stores nationwide, and is the 21st in a series of annual reports on America’s food shoppers.

Screen Shot 2013-09-16 at 11.34.44 AM

Retailers are offering other benefits like dietitian tips, store tours that focus on health eating (81%) and events that promote immunizations and health screenings.

The rub: Though stores are beginning to offer health services, shoppers haven’t really caught on. The survey shows two-thirds of shoppers said they have not seen any health related information or classes offered in the supermarket.

“It suggests that while retailers are doing all these great things for their customers, consumers aren’t looking in the aisles.  Aside from grabbing them and taking them into a class, how do we interact with them?  How do we make it exciting?” says Susan Borra, RD, FMI’s senior vice president of communications and strategic planning.

Other surprises were shopper perceptions of their family’s health and food preparation. Ten percent of shoppers with children 6 to 18 think of their children as overweight, but some 33 percent of those aged 6 to 19 are overweight or obese, according to the CDC.


“There’s a lot of issues with obesity that we’ve been seeing year over year, and we have 21 years of data in this report,” Borra says.

On the plus side, almost 90 percent of stores surveyed provided healthy recipes, and more than half of the respondents had tried one.  And confusion about what’s actually healthy – and what’s not – has lessened.

“For the first time in a long time consumers are really feeling like they are making improvements in their lives. They feel like they’re going somewhere on this path to health,” Borra says.

What’s behind the decisions and perceptions each shopper makes when he or she enters a food store?  How do they try to achieve healthy eating, and how have their attitudes towards it changed?  How can businesses acquire a competitive edge in health and wellness in a responsible way?

To discuss these and other issues around shopping for health, join TEDMED’s Great Challenges Google Hangout; we’ll announce the time and date soon. Susan Borra, as our guest, will examine more key findings from the survey*. Follow FMI on Twitter @FMI_ORG.

Sally Squires, Senior Vice President and Director of Health and Wellness at Powell Tate/Weber Shandwick, will moderate the conversation. Squires is a nationally syndicated columnist, web chat host, Lean Plate Club creator, and health/nutrition writer.  Follow Sally on Twitter @sallysquires.

*A free download of the 2013 Shopping for Health report will be made available to participants following the event.

Join a Great Challenges Online Discussion: Where Health Begins


How much of a role do social determinants — genetics, life circumstances,environmental conditions, and behavior — play in overall health?

While these factors aren’t part of disease outcome data, healthcare providers and organizations have realized they may be, in fact, the ultimate contributors to health status. The World Health Organization has made attention to social determinants part of the fundamentals of its work and a priority area in its general program from 2014-2019.  And according to the Association of Academic Health Centers (AAHC), medical care alone accounts for less than 25% of a population’s health status, with the balance being determinants like environment or behavior.

The great healthcare population, however, may still be grappling with how to view and measure social determinants of health. To that end, the AAHC has put together an online toolkit, partially funded by the Robert Wood Johnson Foundation (RWJF) (which also funds TEDMED’s Great Challenges Program), to help organizations address the social determinants of health. Created with contributions from the AAHC, RWJF, the WHO and the Centers for Disease Control and Prevention, it includes best practices and case studies from academic health centers across the U.S., and a self-assessment questionnaire.

“There’s a growing understanding in the clinical community of the importance of the social determinants of health,” says Mindy McGrath, Director of Government Relations at the AAHC.

One reason may be implementation of the Affordable Care Act (ACA), she says. While the ACA is focused on insurance coverage, “There are many pilot programs, demonstration projects and side goals of the legislation that look at how to organize and pay for care in ways that are more focused on health outcomes. The next step will be:  How do we reform our delivery systems to be more geared toward keeping people healthy?”

Toward that end, a number of organizations report using theToolkit to good effect, including Health Leads, which helps connect patients to basic resources. (Read more about healthcare’s growing awareness of social determinants from Rebecca Onie, Health Lead’s Co-Founder and CEO.)

McGrath will join TEDMED in an online discussion, “Where Health Begins,” this Thursday at 2 pm ET to discuss social determinants, the AAHC’s efforts, and related Great Challenges such as the role of poverty in health. Our moderator is Amy Lynn Smith, a healthcare communications writer and strategist.

Join us for the discussion and post questions on Twitter #GreatChallenges; we’ll answer as many as possible on air and Twitter.

Follow AAHC on Twitter @aahcdc; follow Amy on Twitter @alswrite.

Visionaries: Elissa Epel on why toxic stress is public health enemy #1

Elissa Epel

TEDMED 2011 speaker Elissa Epel, a UCSF psychologist, has studied the health impacts of stress, from its effects on our DNA to its relationship to overeating, for two decades.

Q Some of your research has centered on the way that stress hormones contribute to increasing our drive to eat, particularly high-carbohydrate and high-fat “comfort foods.” To what degree is stress contributing to our national obesity crisis, in your opinion?

EE We can’t quantify exactly how big of a role stress plays. It could be huge. It’s invisible and it’s easy to ignore; it’s pervasive. Most of us have gotten so used to living in a matrix of stress – time pressure, demands, rushed social interactions, rushed eating – that we don’t even notice it. So we might not realize how stressed our body really is. But the effects of stress can still stimulate our appetite, and shift us to choosing more ‘white food’ – what we call “comfort food,” – high-calorie, high-fat food. This promotes metabolic disease because it causes us to store calories in the visceral area and liver. And that stored fat is at the core of many chronic diseases, not just diabetes.

Q I was surprised to see your study showing educational attainment is also related to telomere length. What might the mechanisms for that be?

EE That relationship is multi-layered and needs to be unpacked. One common theme in trying to understand health disparities is testing whether part of it stems from  greater stress exposure or reactivity over a lifetime. For example, the effects of more years of education early in life can be seen decades later, in longer telomere length. Higher education, or maybe it’s the quality of education, can create an infrastructure in the brain for more adaptive coping – it can help with strengthening what we call ‘executive function’ –which helps us think clearly under stress.

Conversely, there are many active ingredients in the milieu of low socioeconomic status that cause wear and tear. Interestingly, though, perception can play a large role here. We have measured this by giving people a picture of a ladder and asking them to place themselves on a rung (the bottom rung being the lowest status).  Rating oneself as low, regardless of actual income or education, relates to poor adaptation to stress.  Specifically, when given the same task to do in the lab, people low on the ladder reacted hotly each time, as if it were new, instead of habituating to it. There is also the built environment of low socioeconomic status, which doesn’t leave opportunities for buying healthy food and places for exercise or safe walking. And the built environment can feed back and affect how people feel.  For example, fewer parks or more liquor stores predict a decreased feeling of neighborhood trust and cooperation.

Q There seems to be a big disconnect between what people know is good for their health, and their actual behaviors. Is mindfulness – focusing on what we’re doing right now, in the present moment – the missing link, do you think?

EE I think that’s right on. We can’t possibly regulate our behavior and feelings, and suppress those pesky but strong impulses and other distractors, if we are not paying attention. In a high-stress environment, our brain activity shifts toward the limbic system and the emotional stress response, and away from the parts of the pre-frontal cortex that house executive control systems, the rational and analytical drivers of our behavior. So we react automatically and impulsively when we are under stress and not paying full attention.

Watch: The Mindful Human Genome

And even if we are focusing a lot of effort on eating better or exercising, but in a really self-critical way, this can sabotage our efforts as well. Very few people meet their exercise, sleep, and nutrition goals each day. So mindful attention includes both an intention and a kind attitude, and these help clear our mind of unhelpful or intrusive thoughts, and improve our ability to carry out our intentions.

Eating is an interesting example of a behavior that is not under our full conscious control, although we have not admitted that yet. Eating is something that we can do without paying attention. Otherwise, if it took focus and effort, that wouldn’t be part of adaptive evolution. Overeating is related to stress but also altered neurobiology of the reward system, the source of our strongest motivational drives. This reward area responds to palatable food. This can drive compulsive behavior that feels out of control, an experience similar to being a drug addict for some people. We have to better understand how powerful certain types of foods can be, and that certain conditions, including stress, make people especially susceptible.

In some of our studies, we are trying to help low-income people who feel very little control over their life, with their weight. We are teaching mindfulness to pregnant women, and it looks like the training might be helping not only them but also their babies. We have to think of ‘stress reduction’ where it matters most – which includes the womb. Prenatal stress exposure can affect a child’s health for a long time, possibly a lifetime. For example, mothers who have experienced major stresses while pregnant have offspring with shorter telomeres.

Q One of many intriguing facts you mentioned in your TEDMED 2011 talk was that technology can actually increase stress in various ways. At the same time, we’re seeing a slew of new apps aimed at helping us to calm down.

EE I think mobile apps for stress reduction are a fabulous potential use of technology, if they really work. For example, we could be using our mobile phones to remind us to rejoin with the moment, and to breathe fully, to notice our physical body and become embodied again. We live mired in our thoughts, above the neck, and this is made worse by multitasking.

But technology devices can become part of multitasking, thus adding to the strain on our limited attention, splitting it yet one more way. There are a lot of wellness apps out there, but I also think that we need data. Almost none of them are evaluated so although they seem promising, do people really benefit from them in a way that would lead to meaningful change? This is a powerful way to reach people, and I admit that even I am involved in an effort to test a stress reduction app!

There are so many answerable questions: Can we take people deeper into a meaningful life, or do these technology interventions contribute to fractured attention and more shallow social interactions? Do people stick with them? Do the apps make a dent in chronic stress arousal over time? As a society we desperately need stress reduction. Let’s hope we can use technology to get there.

Q If you had the power to enforce one public health measure based on your research, what would it be?

EE Public policy makers try to use their resources well to help people, but don’t always think about how to make policy motivating to an individual, nor take into account fundamental causes of societal and individual stress. Stress is caused by a perception of lack of control and unpredictability. Policymakers can promote empowerment, helping disadvantaged people gain a sense of control over their daily life.  Social scientists understand which social and structural factors need to change to help individuals change.

A main message of research today, from epigenetics in basic models to epidemiology, is that adult health is shaped early in life, in important ways we can no longer ignore. So resources are best spent early in life, with the goal of promoting good health and habits, and preventing disease. Good quality education is critical, particularly for girls. It directly translates to better health behaviors and eventually health for the next generation. Resources are just much less effective when applied to diseases that are incurable and costly to manage. Our money is spent in an unbalanced and illogical way. We skimp on education — particularly in California — and spend a tremendous amount of money and time trying to cure incurable diseases such as obesity. Instead, we spend big money on bariatric surgery and costly band-aid procedures.

Q Has your research changed any of your own personal or work habits?

EE It has, but only in an incremental way over many years. I have been studying the field of stress for almost 20 years, so I know all too well what we should be doing, and how my behaviors such as curtailing sleep and having too many demands placed on me affects my daily physiology, and cellular stress. Does that mean I get enough sleep, exercise, meditate every day, keep work manageable, and prioritize the things that are most meaningful, versus the most urgent? No. I am closer to that than I used to be, and maybe in another stage of life… I still experience plenty of challenging situations, and have my reactions, but now in a more mindful way, and that is a qualitatively different experience. Like most people, I am a work in progress.

–Interview by Stacy Lu


What’s really causing our obesity epidemic?

What are the top 10 contributing factors to our nation’s struggle with obesity?

TEDMED’s Great ChallengesTeam Leaders, who address the problem every day from their top posts in advocacy, academia and public health, had varied perspectives on what’s causing this vast, relatively recent, and growing health threat.

A big part of the issue is that we oversimplify the problem, says Joe Nadglowski,  President of the Obesity Action Coalition. Gaining or losing weight is not just a matter of calories in, calories out, he says, but a matter of what does get consumed, and when.

Professor Christine Ferguson of the School of Public Health and Health Services at George Washington University, pointed out that interventions for children’s health may be the most effective way to stem the tide of obesity, and that working at less than peak health impacts our workforce and hence, our economy.

Dan Callahan of the Hastings Center pointed out industry influence as a factor, including resistance to resistance to regulation and taxation of unhealthy food and beverages, and large restaurant and sugared beverage portions.

Maya Rockeymoore, President and CEO of Global Policy Solutions, singled out portion sizes and the easy access to high-fat and sugary foods as causes, while adding that for many neighborhoods, access to healthy food was also a major barrier.

And Rebecca Puhl, Director of Research and Weight Stigma Initiatives at the Rudd Center for Food Policy & Obesity at Yale University, added agricultural policy, commodities pricing and the built environment to her broad-view perspective on the issues.

Click here see their full responses and comments from the rest of the team members on the Great Challenge of obesity.

Great Challenges: Conversations Continue

The top 20 Great Challenges were announced yesterday. Perhaps one of the most exciting things to come out of the Great Challenges program, sponsored by the Robert Wood Johnson Foundation, was the amazing conversations that these topics catalyzed. Below are highlights from conversations with advocates for some of the top 20 Challenges.

Suzanne Geffen Mintz, National Family Caregivers Association, and Lincoln Smith, President and CEO of Altarum Institute

“Patients themselves might not have the capacity to engage in their own care,” said Lincoln Smith, President of the Altarum Institute. “It’s draining.” Challenge #34, The Caregiver Crisis, came out second in the list of top 20 Great Challenges. The bad news is that health outcomes may be worse for caregivers because of the time, financial and stress burdens they face. Suzanne Geffen Mintz, National Family Caregivers Association Co-founder and advocate for Challenge #34, said what she wants most as a caregiver herself is for someone to, “document what we do. We’re like illegal aliens. We need to be in medical records — both in the patient’s records and in our own.”

This would help identify who needs support and resources, and help to connect them with what they need. Businesses lose billions of dollars in productivity due to caregiver struggles, said Geffen Mintz, and that’s because, “It impacts every sector of society and no family is immune.”

Christine Ferguson, Challenge Advocate, with newfound TEDMED friends Marty Kearns and Patrick McCrummen

Challenge #2 brings attention to another pervasive problem at crisis levels, Coming to Terms with the Obesity Crisis. “It’s interesting,” said Christine Ferguson, JD, Director of the STOP Obesity Alliance and Challenge #2 advocate, “when we have cancer affecting around 8% of the population, diabetes around 10% and obesity 35% — what has preventing us from addressing it?” Barriers include the perception that the problem is too complicated, or that it’s just a matter of willpower, she said. The “pull yourself up by the bootstraps” mentality that used to exist for mental health issues too, needs to go away before we can truly make progress, said Ferguson. She quoted some startling statistics — over 70% of obese people know all of the relevant health messages such as portion size, and have tried to change at least once; while 70% of primary care providers say no one in their office had any training on helping overweight and obese people get healthier. People are motivated and trying, but they don’t have the resources or support for change.

Marty Kearns, Project Director of PreventObesity.net, a project of the Robert Wood Johnson Foundation, said his organization is working to change policies and environments to help children and families eat well and move more, and by fostering, engaging and connecting a base of advocates who are willing to take action. Partick McCrummen, Senior Director for Corporate Contributions at Johnson & Johnson, also talked about the value of collaboration, and said J&J is hoping to serve as a convener for thought leaders and global organizations.

As we’re working so hard to improve the health of the world, what’s the one thing we’re all forgetting? “It’s the secret health crisis that’s right in front of our face,” said Russell Sanna, PhD, Executive Director of Harvard Medical School Division of Sleep Medicine and advocate for surprise add, Challenge #51. The big culprit? Sleep. We all know we need it, and none of us get enough. Why not? “There is an uncoordinated conspiracy against sleep health,” said Sanna. Feeding the conspiracy are Facebook, mobile phones, entertainment, an over-achieving society and pervasive sleep illiteracy. Embarrassingly, Sanna quickly uncovered this reporter’s own sleep illiteracy — sleep bulimia (“I’ll catch up on sleep this weekend”) doesn’t work? The color blue triggers your circadian rhythm (think Facebook), keeping you up when you should be winding down?

“There’s hope,” said Sanna. NBA stars are now hiring sleep consultants to ensure better performance despite hectic schedules (sound familiar?). Sanna hopes this is the start of a massive culture shift that will no longer encourage or allow bad sleep habits. Possible solutions: encourage employers to trigger a “go-dark” period on company Blackberries, and Facebook to turn its blue background grey at a user-specified hour as a reminder to shut down and get some sleep.

But every solution won’t necessarily work for every person. “Each individual has different health risks,” said Rebecca Sutphen, President and Chief Medical Officer of InformedDNA and advocate for Challenge #4, Shaping the Future of Personalized Medicine. “The genome is the key to paying attention to the right things,” said Sutphen, who urged us as a society to move medicine forward by unlocking the solutions that lie within our own bodies.

We spoke with many more advocates and overheard some fascinating conversations. Stay tuned for more on the 20 Great Challenges throughout the year.