Friday, December 15, 2006

Maccas puts gyms on children's menu

Good capitalism: Anything to keep the customers happy

US fast-food giant McDonald's, often accused of catering to expanding waistlines, has a new item on its menu for kids - gyms. The company is testing R Gyms - in-restaurant mini-gyms with stationary bicycles hooked to video games, obstacle courses and aerobics exercises - in seven of its restaurants to help customers age 4 to 12 fight flab as they ingest calories. The latest R Gym, named for the restaurant's advertising mascot Ronald McDonald, opened in California earlier this month and the company is hoping to spread the concept across the United States and possibly overseas.

But critics say the mini-gyms are merely an attempt by the burger giant to polish its image at a time when people are increasingly aware of the health hazards linked to obesity. "What we've been able to do with the R Gym is to provide our youngest customers with a more relevant contemporary experience, including games and activities that are more suitable to children's lifestyles today and of course tomorrow," Danya Proud, a spokeswoman for McDonald's said.

The experts are skeptical. "The number of calories that a child is likely to burn in one of those gyms is quite small compared to what they can eat, even in a small meal," said Kelly Brownell, director of the Rudd Centre for Food Policy and Obesity at Yale University. It would take a child, for example, more than three hours of exercise to burn off a 200-calorie milkshake.

The new gyms would eventually replace play areas currently available in some 5500 McDonald's outlets throughout the country. McDonald's is also considering R Gyms for its restaurants overseas.

But specialists like Prof Brownell warn the gyms could have an adverse effect in that they could lull people into believing they can eat more since they're exercising. "One risk is that the children or parents overestimate how much benefit they are getting from the exercise and feel licensed to eat more - a larger order of French fries or an ice cream cone," he said.

Ms Proud answers such criticism by saying that McDonald's has "always been concerned about health". "McDonald's has been providing nutritious menu options to all of our customers for 52-plus years," she said.

According to health experts, about one-third of children in the United States are either overweight or obese and trends are showing the numbers increasing. Studies have also said one in five Australian children is overweight or obese, with the figure set to expand to one in two by 2020, according to some predictions. The US Centres for Disease Control and Prevention (CDC) recently identified fast food as a significant factor in that country's obesity epidemic. According to the CDC, nearly 19 per cent of American children between the ages of 6 and 11 are overweight and some 14 per cent are in that category before the age of 5.

Prof Brownell said with that in mind, McDonald's R Gyms could be an attempt by the company to ward off class-action lawsuits from public-health advocates who see fast food as their new target after tobacco. "McDonald's is not in the business of getting the population more physically active but if they appear to be on the right side of the issue, they may be able to forestall litigation, legislation that hurts them and just bad public opinion in general," he said.


Stent problems

In medicine, yesterday's breakthrough technology is today's safety worry. Case in point: the drug coated stents that will be examined at a potentially contentious and controversial session convened today by the Food and Drug Administration. Comprised of many of America's top heart doctors, the group will consider the quandary that has emerged around these tiny tubes of metal mesh, used in a non-invasive alternative to open-heart surgery: Do they help more patients then they hurt?

It's a crucial question. Since Merck pulled its painkiller Vioxx from the two years ago, the drug business has been beset by controversies about the safety of the medicines it makes. The device industry has not been hit as hard by safety concerns--until now. A new focus on the risks of devices, as well as their benefits, could be a big change for companies such as Johnson & Johnson, Boston Scientific and Medtronic.

What the panel will decide after the two-day session in Gaithersburg, Md., is anyone's guess, but it is likely the stents, which generate $5 billion a year in annual sales, will remain on the market with at least some new restrictions on their use. "I don't think it's in the cards that they're going to take them off the market," says Deepak Bhatt, a researcher at the Cleveland Clinic. "They've been studied, and they work very well. But there may be some specific guidance given as to which patients should receive the drug-coated stents."

What could result are new limits on when the devices should be used. Right now, drug-coated stents still account for the vast majority of the market. But some doctors say it may be possible to screen out a third of the patients who receive the newer stents for whom the benefits really don't outweigh the risk, denting sales. Also, the panel could instruct physicians to make sure patients take blood-thinners like Plavix, from Bristol-Myers Squibb and Sanofi-Aventis, for years after the operation if the drug-coated stents are used. A large number of patients don't continue to take their medicine, putting themselves at risk; doctors might want to avoid giving drug-coated stents to people who won't take their pills.

Stents are used to open blockages in coronary arteries caused by the buildup of plaque, which can block blood flow, causing heart attacks and chest pain. The devices have been around for a decade, but these new versions, from Johnson & Johnson and Boston Scientific, are coated with medicines intended to cut down the number of repeat procedures and return trips to the hospital.

The drug-coated stents have been implanted in 4 million patients since Johnson & Johnson launched the first one in 2003. But now it is becoming clear that people who get the devices are more likely to have dangerous blood clots form in the stent, causing the very heart attacks the stents are designed to prevent. Using conservative estimates, the devices might cause 4,000 heart attacks a year.

Defenders say they actually prevent as many heart attacks and deaths as they cause, because all those return trips to the hospital, and the chance of reclosed arteries expose patients to risk. And the risk, they point out, is small for any individual patient. A recent Cleveland Clinic paper put it at one clot per 250 patients each year; analyses of the companies' own clinical trials show a risk of about one in 500 patients per year. The biggest challenge for the experts: There really isn't enough data to draw a conclusion. They are likely to focus on two main questions: who should get the drug-coated devices, as opposed to the older bare-metal stents, and how long do these patients need to take the blood thinner Plavix, which seems to reduce the risk of the dangerous clots.

There may also be controversy about who was included in the expert panel. Bruce Nudell, an analyst at Sanford C. Bernstein, said that some panelists, notably Steven Nissen of the Cleveland Clinic and Eric Topol of Scripps Clinic, the cardiologists who initially drew attention to the dangers of Vioxx, might create "a bit of a hostile air." But Nudell thinks the FDA will not, at the end of the day, aggressively limit the use of either stent. Still, the inclusion of Nissen and Topol has made some Wall Street analysts nervous.

Right now, says Sanjay Kaul of Cedars-Sinai Medical Center, about 60% of use of drug-coated stents does not match up with the clinical studies of the drugs that have been evaluated by the FDA. Speaking conservatively, he says, one would limit the use of the devices to those patients in whom they had been studied. He also says that new trials should be conducted to find out how long patients need to take Plavix and exactly which patients should get the drug-coated stents.

There are also larger questions. Stents are used in a medical procedure called angioplasty, in which a balloon is used to prop open a clogged artery. Sometimes this is done during a heart attack, and at these times the procedure has been shown to save lives. But most angioplasties are done to reduce symptoms of chest pain that come from clogged arteries. Some doctors say many of these patients should be treated with medicine, not surgery.



Will thin people soon be in trouble too?

It used to be said that inside every fat person was a thin person trying to get out. Now it seems it could be other way around. A scanning technique pioneered by British doctors has found that many slim people are storing up dangerous levels of fat in their bodies. Jimmy Bell, head of the molecular imaging group at the Medical Research Council's centre at Imperial College, London, said this hidden fat could trigger heart conditions and diabetes.

"The important message is people shouldn't be happy just because they look thin . You can look healthy but have a lot of fat internally, which can have a detrimental effect on your health."

Professor Bell and his team began using a magnetic resonance imaging scanner to seek internal fat while researching type 2 diabetes - the version of the disease that develops later in life and is normally associated with obesity. His suspicions arose when several slim people in the study were found to have the medical markers for type 2 diabetes.

The findings raise questions about the body mass index, the indicator of obesity used by most doctors and public health campaigners. The index is a relatively crude measure in which a person's weight in kilograms is divided by the square of their height in metres. Some doctors believe the index is flawed because it pays no attention to the nature of the weight. A rugby player, for instance, with heavier than usual muscles, will come out with a high score on the index and could be classified as overweight, even though he has low levels of internal fat.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter? It is just about pure fat. Surely it should be treated as contraband in kids' lunchboxes! [/sarcasm].

9). For a summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and no lasting harm from them has ever been shown.


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