Matt Masiello, M.D., MPH

Category: Nutrition and Wellness

  • Food Stamps, Poverty, and the Terribly Ignorant and Uncaring U.S. Politician

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    Poverty is increasing in America, with 17% of our citizens living in poverty, including 16 million of our children-our future. In several of our southern states, nearly 25% of the population lives in poverty. These states come close to Romania, considered an industrialized country, where their poverty rate is 25%. According to UNICEF, one American child in four is poor. When an educational minister from Finland, the country with the best educational system in the world, was asked what he could offer the United States as advice to enhance the educational status of the United States, his response was sobering – “nothing, there is too much poverty.”

    One shining light is the slow gains we have made in health care. For the first time in 37 years there are more Americans enrolled in a health care system. College students who will be buried in college loans now have affordable health care available to them. Our most vulnerable population now can enroll in a health care system with a pre-condition such as chronic illness; health promotion, wellness and disease prevention now are gaining some traction over the costly business of the latest and best technology, new and questionably safe medication; the unnecessary growth of some medical subspecialties and hospital surgical units, emergency rooms, and hospital executive office suites.

    So, what is our political response to this? Let’s randomly cut food stamps without offering a positive and sustainable alternative. The poor will work it out as the politicians go home to their comfortable homes and excellent health insurance, the best in the world in fact. And, this is their alternative; keep your food stamps, but let’s stop funding health care, even changes that have helped and will continue to help millions of our most needy.

    So, what should our response be as these politicians go home to their comfortable well- kept family and homes? Our educators and physicians, especially pediatricians, need to speak up. This, however, is a challenge and I will offer my opinion why in my next blog message on our ignorant and uncaring politicians.

  • Local programs offer incentive for healthy living

    20120518-174043.jpgPrevention of heart disease begins young, experts say, encouraging parents to instill proven nutrition and exercise lifestyles from infancy.

    But with childhood obesity rates tripling in the past 30 years, many worry that Americans are losing the battle.

    “This is the first generation of Americans that will not live as long as the generation before,” said Dr. Lawrence Rosenberg, a pediatrician with Conemaugh Physicians Group of Johnstown.

    Rosenberg urges parents to be proactive by creating a healthy environment in their homes and getting the whole family involved.

    Fellow pediatrician Dr. Matthew Masiello, chief wellness officer at Windber Research Institute, takes the advice a step further. Healthy patients begin with healthy doctors, Masiello said.

    “You have to get yourself fit,” Masiello said. “Then you are able to help your patients. As physicians, we have to start taking care of ourselves.”

    The strategy has been proven by the decrease in tobacco use. As more doctors quit smoking, Masiello said, they were able to help more of their patients find strategies to quit. As government policies and businesses continued to limit opportunities to smoke, tobacco use has declined even more.

    “It comes down to education and policy,” Masiello said.

    For parents, education should begin even before the baby is born, he said.

    “When I was training, breastfeeding was an issue we talked about in terms of the antibodies and the extra vitamins and minerals that came from the mother,” Masiello said.

    “We now know that breastfeeding is much more than that. Those kids are going to have better weight control when they get older. It is going to have a positive effect throughout their lives.”

    Part of the benefit, doctors believe, comes from getting mothers thinking about nutrition and wellness early.

    “Parents are more cognizant of weight issues,” Masiello said. “When parents absorb the educational aspects of breastfeeding, there is a connection with good nutrition later in life.”

    Health education for parents is vital to any program addressing childhood wellness and disease prevention, Rosenberg said, recalling earlier attempts to stem the obesity epidemic. When leaders first recognized the rise in the obesity rate, he said, hundreds of different programs were introduced addressing the issue at various levels, such as psychology, nutrition, medicine and education.

    “They were all uniformly unsuccessful,” Rosenberg said. “Then a study by the University of Washington showed you have to have the whole family buy into a program. It is pivotal for success.”

    Several local health-care organizations are offering evidence-based programs based on findings such as the Washington study.

    Memorial Medical Center is bringing the Edwards LifeSciences spring wellness events back to four locations in Cambria and Somerset counties, with outreach to more than 30 schools.

    Families will be invited to come together to the one-day events, coordinator Michelle George said.

    The programs will provide health screenings and information to parents while children participate in a fun, healthy activity.

    “We try to encourage healthy behavior through physical activity, even among those who don’t normally play basketball or football,” George said.

    A schedule for the spring wellness events will be announced soon, she said.

    Somerset Hospital has been conducting KidShape programs for several years in Somerset County, with funding from the Highmark Foundation. Windber Research Institute is reintroducing KidShape for Cambria County families.

    The Windber program is being held at Greater Johnstown YMCA, with support from the YMCA and Alternative Community Resource Program.

    KidShape targets children in the 85th percentile and above on body mass index screenings conducted at all schools, Masiello said.

    “That is the public health approach: To gather all these players together to bring these programs into focus.”

    Parents attend two-hour sessions each week for nine weeks with their children, meeting with nutrition, exercise, and mental-health professionals during every session. Participants move through seven different stations addressing all aspects of weight loss and healthy lifestyle, exercise physiologist and program coordinator Mike Seibert said from Somerset Hospital.

    “Parents learn as the kids learn,” Seibert said. “They tell us, ‘we want to do better; we just don’t know how.’ ”

    Working together with other families is an important part of the KidShape mission, fitness director Debbi Smith said at the YMCA

    “This just a starting point for these kids who are changing their lives,” Smith said. “We get the kids into the environment where they are surrounded by like-minded individuals, trying to make themselves healthy and to have fun.”

    Parents learn how to take better care of themselves and create healthier homes, Seibert said.

    “What I am asking the families to do is take the lead again,” Seibert said.

    “Take an active role in their kids’ health. The kids are counting on the parents to be the food cookers and shoppers.”

    Program director Vicki Clark said KidShape fits well into the YMCA’s new national focus: “For Youth Development; For Healthy Living; For Social Responsibility.”

    “KidShape hits all those components for us,” Clark said.

    Facilitators check in with families after three months, then six months and then a year after the final session.

    “If the families are held accountable, and they are working together, it works,” Seibert said.

    “We are hoping that we connect with these kids so when they are in the grocery store, they start looking at what is on the labels. Instead of sitting around watching TV, we encourage them to go outside.”

    Enrollment information

    • KidShape, Somerset County.

    Mike Seibert at 445-3330.

    • KidShape, Cambria County.

    Windber Research Institute KidShape line 361-6966.

    • Memorial Medical Center, Edwards LifeSciences screenings.

    (866) 839-3867.

    Consumer advice

    Here are some shopping and nutrition tips from Dr. Lawrence Rosenberg, a pediatrician with Conemaugh Physicians Group of Johnstown:

    • Shop on a full stomach, with a list and not with children.

    • Everybody older than 2 should drink skim milk.

    • Start meals with salads or light soup, lingering with 15 minutes of conversation at the dinner table.

    • Serve all meals on salad plates, with salad forks.

    • Get rid of frying.

    • Limit protein to a serving the size of your palm, and cook only one serving for each person. The rest is vegetables you will eat if you are hungry.

    • Snack on fresh-cut carrots or other vegetables in front of the television.

    • Mix children’s sugary cereal with more healthy cereal, gradually reducing the sugar content until it’s gone.

    **This article was published in the Tribune Democrat on 2/25/12

    http://tribune-democrat.com/local/x1875167287/Local-programs-offer-incentive-for-healthy-living

  • Local experts weigh in on health-care reform

    20120517-164136.jpgLocal medical leaders are closely watching health-care reform legislation developing in Washington. While most agree with the importance of providing affordable options to the estimated 45 million to 50 million uninsured Americans, they have different views on how the insurance should be structured and what additional changes should be addressed.

    “The question is: How are we going to pay for that expanded coverage?” said Scott Becker, president and chief executive officer of Conemaugh Health System. “The real interesting debate is going to be how far do they go with this public option. The key is how the benefits package is shaped.” Answers to those questions could change the structure of how health insurance is delivered in the United States, Becker said.

    The public option, or government-sponsored health care plan, would be available as an option along with private insurance company plans, Democratic Sen. Robert P. Casey Jr. said during a teleconference announcing one of the bills had been approved by committee and sent to the full Senate.

    In the Health, Education, Labor and Pension committee’s bill, the public option is a gateway to getting access, Casey said, adding it is expected many would move on to traditional private plans. But the public option is crucial to controlling costs. “I believe big, powerful insurance companies need to be held accountable.” Casey said. Under the committee’s bill, the gateway program would be launched with federal money but managed by a nonprofit cooperative, he said. “It’s meant to be a self-sustaining entity that can be competitive in the marketplace,” Casey said.

    While any government-funded health insurance is meeting stiff opposition from Republicans, none of the local experts interviewed was ready to totally dismiss the idea. “I think the good thing is we are trying to develop coverage for 45 million people who don’t have insurance”, Becker said. “It is going to create a level playing field, but you are not going to get that for nothing.”

    The final structure of a new public option will be developed after both the House and Senate pass bills and they are sent for reconciliation. Until then, Conemaugh is taking a wait-and-see attitude. “As they say: The devil is in the details,” he said. Lack of details has many in the insurance industry worried, Highmark spokesman Michael Weinstein said. Government insurance plans such as Medicare and Medicaid have traditionally paid physicians and hospitals less than private companies.

    “There is a natural advantage to government-run plans: They dictate the payments to doctors and hospitals,” Weinstein said. “It is going to drive up the cost.” If the government-funded plan does not pay enough to cover expenses for hospitals and doctors, he said, the medical organizations will shift those costs to private plans such as Highmark. As those rates go up, insurance companies fear more employers will drop private plans and put their workers into the government plan. Bringing down costs must be part of any plan. Highmark supports a plan that would base payments more on outcomes, Weinstein said. “We haven’t seen enough debate on this: How doctors and hospitals are paid,” he said. “The way Medicare works, the more tests a patient has, the higher the cost. It doesn’t guarantee better outcomes.”

    Some local preventive medicine advocates agreed that reform should include restructuring the way doctors and hospitals are reimbursed. “The good thing about the discussion is we are going to look at policy change,” Dr. Matthew Masiello, chief wellness officer, said from Windber Research Institute. “It opens up the doors with universal health care to look at policy we have not dared address in a serious way before. ”Smoking, obesity and nutrition can be addressed by adding financial incentives for physicians who direct patients into programs that help them overcome unhealthy habits”. Although Casey said his committee’s bill addresses preventive medicine and wellness, Masiello says all the proposed reform falls short.

    “I see very little in there to support developing a substantial health-promotion, disease-prevention infrastructure,” Masiello said. “For that reason we are going to see higher cost of health care until we develop significant infrastructure.” Adding 45 million to 50 million people to the insured “pool” will be expensive, especially because many of those uninsured have chronic conditions that may be undiagnosed because they haven’t been seeing doctors.

    Windber Research Institute is part of a study using electronic medical records to identify patients with unhealthy behavior and direct them into intervention programs. “Those kind of things should be on the front burner,” Masiello said. “Down the road you are going to get the results that will allow a reduction in the cost of health care.” The research institute’s top dog is more blunt. “This isn’t health-care reform,” said Tom Kurtz, Windber’s president and chief executive officer. “It is misnamed. They are going after an insurance product.” The 45 million or more people are just a symptom of a larger issue, he said. “It addresses nothing of the underlying problems of the health-care system.” Kurtz said, adding it might even be time to ask why the U.S. health insurance structure is based on employers. Recent layoffs highlighted the issue. “They need to revamp the system,” Kurtz said. “No one has even addressed the basic questions: Is health care a right? Is it an entitlement? What should be covered?”

    Other countries have addressed many of these issues successfully, he said, adding “Japan is a good example.” But it’s tough to legislate behavior, Becker warns. Insurance companies could, however, charge higher premiums for those with greater health risks.

    For now, Congress and the health-care industry should look at focusing on improving access to primary care doctors, Becker said. The current system pushes more money toward specialists, but family physicians are the front line of prevention. “It’s a cultural challenge we face now,” Becker said. “We need to open up roads and create incentives for more physicians to go into primary care.” Like his former Windber colleagues, health-care consultant F. Nicholas Jacobs believes the reform does not go far enough. “Tort reform, intelligent efforts toward stemming the continued surge of illegal aliens, a wellness rather than a sickness reimbursement system, acceptance of hospice and palliative care for end-of-life care, electronic medical records and new efforts to bolster our medical school attendance are just a few of the changes needed to allow health-care reform to gain meaningful traction,” Jacobs said in a statement.

    The former president and chief executive officer of both Windber Research Institute and Windber Medical Center worries that current proposals have been watered down too much to appease conservatives and others. “Health reform is critical,” Jacobs wrote.
    “But meaningful, ethical leadership is much more critical and both seem to have been on life support for a very long time.”

    **This article was published in the Tribune Democrat on July 19, 2009

    http://tribune-democrat.com/local/x914502174/Local-experts-weigh-in-on-health-care-reform