Warnings on over-reliance — on a common drug and a routine health measure

Easy. Quick. Convenient. Cheap. These are great characteristics of products and services Americans desire. But when it comes to health care,  we need to add two other attributes: common sense and moderation. Just consider what we’re learning about excess reliance on two disparate items: over-the-counter heartburn medications and a ubiquitous health measure known as the Body Mass Index or BMI.

Proton pump inhibitors

For those who suffer heartburn, proton pump inhibitors (PPIs)─more commonly known by their brands, including Nexium, Prevacid, and Prilosec─have become some of the most taken drugs in the United States. But as the New York Times reports, experts are growing more wary of them  because:

[S]cores of studies have reported associations between prescription P.P.I. use and an array of health problems, including bone fractures, low magnesium levels, kidney injuries and possibly cardiovascular drug interactions. They are also linked to infections, like the stubborn Clostridium difficile and pneumonia. Reducing the acidity of the stomach, researchers believe, allows bacteria to thrive and then spread to other organs like the lungs and intestines.

A new study raises concerns with the drugs and chronic kidney disease. Although the many commercials for PPI provide a fast, terse, required warning that the drugs are not recommended for use longer than 14 days at a stretch, experts say too many Americans gulp them down more often and for months or years instead of a few weeks. The studies warning about PPIs, so far, show correlations and associations but not direct harms from the drug. Still, the kidney disease research on PPIs found that: “The risk of chronic kidney disease rose 15 percent among those taking the drug once a day, but 46 percent in those taking it twice daily, compared with nonusers,” leading researchers to term this a likely “causal” link, the Times said.

As we age, a muscle that prevents acid from rising from the stomach to irritate the esophagus weakens; the incidence of acid reflux rises sharply, leading millions to seek relief. PPIs are prescribed and taken over the counter extensively by older Americans─even though the American Geriatrics Society put them on a major list of potentially inappropriate drugs for seniors. And while some patients have taken the meds under doctors’ order and supervision for long periods and they have done fine, the meds’ increasing use─and potential for increasing patients’ risk─only grows.

This situation also should serve as a reminder: don’t pop over-the-counter drugs casually. Just because you can get them without prescription doesn’t mean they can’t harm you and that they’re not powerful. They’re not candy and some can pack a wallop and be dangerous.

Misguided about a health measure?

Whip out a tape measure, hop on a scale, and presto: Americans have been led to believe they can do simple math (or tap into an online calculator) and get a great sense of their health through a now ubiquitous measure known as the Body Mass Index, or BMI. The BMI has provided a solid way for caregivers to talk to us all about obesity, exercise, nutrition, and diet. In some gyms and health clubs, trainers and members toss the figure around more freely than horoscope signs. The metric has become so accepted that the federal Equal Employment Opportunity Commission has proposed rules allowing employers to penalize employees up to 30 percent of health insurance costs if they fail to meet two dozen “health” criteria such as reaching a specified BMI.

Whoa,  some UCLA researchers say. They report in a published study that BMI may mislabel as many as 54 million Americans as obese or overweight. As the Los Angeles Times reported:

[Researchers] analyzed data from 40,420 individuals who participated in the 2005-2012 National Health and Nutrition Examination Survey. They looked at individuals’ blood pressure, triglycerides, cholesterol, glucose, insulin resistance and C-reactive protein data — markers that are linked to heart disease and inflammation, among other issues. …nearly half (47.4 percent) of overweight people and 29 percent of obese people were, from a metabolic standpoint, quite healthy. On the flip side, more than 30 percent of individuals with “normal” weights were metabolically unhealthy.

The speed and convenience of the BMI measurements, the researchers say, should not make it such a determining factor in important decisions about health, especially since other relatively easy indicators, such as blood pressure, can give equally valuable and valid decision-making insights. Your health is a complex concern. You wouldn’t total your car if a red light went on the dash.  Weight gain and obesity are significant issues for us all and we should use BMI as it was meant to be─one of many gauges of how we can be healthier.

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