Continence Coach: Fitter, Not Fatter

  In early February, the Journal of the American Medical Association published an alarming study¹ in which researchers concluded that, without a doubt, America’s baby boomers — the generation born in the two decades after the end of World War II — are less healthy than their parents’ generation. Lead author and family practice physician Dana King and his colleagues at the West Virginia University School of Medicine used data from the federally funded National Health and Nutrition Examination Survey (NHANES) to compare the answers of people who were 46 to 64 years old between 1988 and 1994 to those of baby boomers in the same age range between the years 2007 and 2010. The two population groups were similar demographically except for culture and race; non-Hispanic blacks and Hispanics represented a slightly higher percentage in the 2007 and 2010 period, reflective of the overall shift in US population.   In the baby boomer group, 13% self-reported being in “excellent” health in middle age, compared to 32% of the previous generation who said the same thing at the same stage of their lives. But it was the degree of obesity and disability that shocked even the researchers. Overall, 39% of baby boomers are obese, compared with 29% of the previous generation, a significant and large change in just 20 years. The data also showed baby boomers were more than twice as likely as people from the previous generation to use a cane or walker. Despite the fetish with gym memberships, home exercise equipment, and “action sports,” baby boomers were less likely to get regular exercise. In other words, the baby boomer generation is not the physically active generation it is portrayed or pretends to be. Physicians know this intuitively because of what they see daily in their medical practices: approximately 16% of baby boomers in the study have diabetes, compared with 12% percent of the previous generation, and current baby boomers are more likely to have elevated cholesterol levels and high blood pressure. However, medications help keep chronic cardiovascular disease in check, so baby boomers are less likely to experience a heart attack. Also on the healthier side of the balance sheet, researchers saw from the data that today’s middle age Americans do not smoke tobacco as much as the previous generation and thus are less likely to have the lung disease emphysema.

  We are automobile-oriented: many Americans use drive-thru banking, drive-thru dry cleaning, drive-thru pharmacy pick-ups, drive-thru fast food purchases, and drive-thru school carpooling, — that is, when we are not conducting business online. We go out of our way not to park, get out of the car, and walk. Although there are exceptions — ie, persons living in Manhattan where urban dwellers don’t own cars and commute on foot — the large majority of us relies on wheels rather than our own bodies for transport. Even nurses, who once were noted for an average of 6 miles they walked each day in delivering patient care, now often are desk-bound and more specifically computer-bound. At the end of a stressful day, instead of working out to relieve stress, many reach for the “clicker” and settle in to several hours of television before falling asleep. Even cooking is less physical than it used to be for earlier generations; food is prewashed, prechopped, and often precooked.

  Then there is the American diet. To combat the obesity epidemic across our country, health experts such as those from the Center for Science in the Public Interest are calling on the Food and Drug Administration (FDA) to set a safe limit for caloric sweeteners in carbonated beverages, the biggest source of sugar in the American diet.² Can we not find a flavorful, healthier substitute for what the British refer to as “fizzy drinks,” such as naturally sweetened fruit and vegetable juices? What about milk? Or even water? In fairness, beverage manufacturers accurately point out that consumption of added sugars in beverages is actually down: according to dietary data from the NHANES³ analyzed over the cited period, two thirds of the 23.4% decline in the intake of added sugars between 1999 and 2000 and 2007 and 2008 resulted from decreased soda consumption.

  We have to blame lifestyle, not just food. The problem is how and when we eat, as well as how sedentary our lives have become. Grazing is rampant. Baby boomers are eating in cars while driving and texting. How many food crumbs are nestled in your computer’s keyboard?

  What does this have to do with continence? All the data are not-so-subtle reminders that obesity is a well-established risk factor for urinary urgency and stress incontinence. Moreover, in the obese patient, losing just a small fraction of body weight can have a dramatic impact on the severity of symptoms.⁴

  We are the problem. Change has to start not with more regulation but with more personal responsibility, discipline, and self-dedication to alter how we live and to show greater respect for one of the true miracles of life — our human body. Promise yourself to make this year your turnaround year for a fitter, not fatter, and healthier you. Spring (excuse the pun) into action. It might just positively influence others around you.

Dr. Muller is the Executive Director, National Association For Continence (NAFC). The NAFC is a national, private, nonprofit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence. This article was not subject to the Ostomy Wound Managment peer-review process.

1. King DE, Matheson E, Chirina S, Shankar A, Broman-Fulks J. The status of baby boomers’ health in the United States: the healthiest generation? JAMA Intern Med. 2013:1–2. doi:10.1001/jamainternmed.2013.2006.

2. Stromm S. Health Officials Urge FDA to Limit Sweeteners in Sodas. The New York Times. February 14, 2013. Available at: www.nytimes.com/2013/02/14/business/health-officials-urge-fda-action-on-soft-drinks.html?_r=0 B3. Accessed February 15, 2013.

3. Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States. Am J Clin Nutri. 2011;94(3):726–734.

4. Subak LL, Wing R, West DS, Franklin F, Vittenghoff E, Creasman JM, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–490.