Although more research needs to be done, it has been estimated that 1 percent to 2 percent of the general population have BDD. In addition, BDD exists among:

Four percent to 5 percent of people seeking care in general doctors’ offices
Seven percent to 15 percent of patients seeking cosmetic surgery
Eight percent of people with depression
Up to 12 percent of people seeking care in general outpatient psychiatric offices and clinics
In the United States, this translates into millions of sufferers. At the same time, it is important to realize that even among those going for medical care the diagnosis is rarely made. The majority of the time, these disorders go unnoticed and undetected because the sufferers are too embarrassed to reveal their problems, even to their own physicians or mental health specialists.

Although rare childhood cases have been reported, most people develop BDD in their early or middle teens, with two-thirds of cases starting between ages 9 and 24.

Although most seem to start gradually, about 25 percent start abruptly, from no concern to full blown concern within a matter of moments or days.

Current information, though still rather limited, suggests that BDD is roughly equally common among men and women. Although many similarities exist between the number and type of areas that concern both sexes, the nature of their concerns differ to some degree. Whereas both men and women often report being concerned about their hair, men fear losing their hair and women are concerned about having body hair. Only men report concerns about the appearance of their genitals.

Between 1990 and 1996, researchers from the Centers for Disease Control and Prevention in Atlanta examined trends in fruit and vegetable consumption by Americans over 18 years of age. They analyzed data from three national surveys on fruit and vegetable consumption in 16 states. Survey respondents were asked about their age, sex, educational level, height, weight and physical activity, as well as how often they ate various fruits and vegetables each day.

In the 1996 survey, researchers found that 23 percent of Americans reported eating at least five servings of fruits and vegetables per day, up from 19 percent in 1990. The investigators reported that much of this increase came from those who ate a lot of fruits and vegetables in 1990 and continued increasing their intake. Thus, to a large extent, those who ate less fruits and vegetables in the earlier surveys did not report increasing their consumption.

Compared with men, women tended to eat more fruits and vegetables, and over the time of the surveys, tended to increase their intake to a greater extent. Similarly, women who reported more physical activity increased their fruit and vegetable intake more — by 8 percent — than did inactive men or women. In addition, the researchers found the proportion of respondents who reported eating five or more servings of fruits and vegetables increased in all groups except the obese. Obese subjects’ fruit and vegetable consumption decreased slightly — by 0.1 percent — between 1990 and 1996.

In their summary, the authors concluded that while “progress from 1990 to 1994 was encouraging (3.1 percent increase), there was little change between 1994 and 1996 (0.6 percent increase). These data suggest that additional efforts are needed, especially among inactive and obese persons” to increase the consumption of fruits and vegetables by American adults.

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In a series of studies, researchers found that teens who exercised to the point of exhaustion without breaks pushed themselves to anaerobic states, where large amounts of free radicals were released within tissues and damaged healthy cells, thus curbing normal growth. Teens who exercised at a high-intensity with breaks every two minutes reached comparable performance levels but did not reach anaerobic states.

Teens can prevent exercise-induced stunting by exercising and conditioning in gradual levels, and avoid exercising intensely in short bursts or way above normal limits.

Teen bodybuilders and wrestlers are at most risk of exercise-induced stunting because they usually participate in high-intensity weight-training.

The study evaluated 347 men whose average age was 75. The men’s mental functioning was assessed, along with their daily exercise. Participants were also tested for the so-called Alzheimer’s gene (apolipoprotein e4 allele), which is associated with an increased risk of Alzheimer’s disease.

Mental decline was associated with the less-active men in the study, and even more strongly associated with the less-active men who carried the Alzheimer’s gene. While the least-active men (who exercised one hour or less each day) had twice the risk of mental decline than men who exercised more than one hour daily, the least active men who also carried the Alzheimer’s gene had a nearly four times greater risk of mental decline than active men without the gene.

Researchers suggest that the association between exercise and mental decline may be explained by the role exercise plays in overall brain health. Examples of this include that exercise improves oxygen transport to the brain, may stimulate nerve cell regeneration and reduce levels of stress hormone.

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Also, many members join a medical facility after having participated in a clinically based program, such as cardiac rehabilitation or outpatient physical rehabilitation. “Most of our members are looking for a way to improve their health and take advantage not only of the fitness portion of our memberships,” explains Wing,”but also many of the health-risk modification programs offered through our centers.”

Probably one of the strongest differentiators of medically based fitness facilities, notes Wing, is the integration of the fitness facility within the continuum of healthcare services offered by a health system.

A growing percentage of members come from direct physician referral as follow-up to a condition found in either an office visit or an inpatient stay.

Half switched banking institutions. The other half,which stayed with their present lenders, felt they would not have received the more attractive financing terms if they had not been proactive and had notcreated a competitive environment. All facilitiesbenefitted from lower interest rates; some lowered the rate by 1 percent, and several by 1.5 to 2 percent. Most were tied to either the bank’s prime rate or LIBOR (London Interbank Offering Rate).

Many of the loans were for shorter periods (five or 10 years), or longer terms with 10- to15-year call provisions. Besides the obvious “hard” collateral, about half were successful in eliminating personal guarantees.

Typically, the process required an independent appraisal and took several months, or longer. For asset-based lending, few covenants and restrictions were imposed. Most fitness centers also sought additional banking relationships, including other loans, lines of credit, working capital loans and equipment loans, and provided various types of deposits (e.g., money market accounts, 401k accounts and letters of credit).

• restricting food intake
• fasting
• binge eating (overeating)
• purging (vomiting and using laxatives, diuretics or enemas; excessive exercise)
• taking diet pills

Some girls may develop true anorexia nervosa or bulimia nervosa but they don’t require a diagnosis of one of these eating disorders to have what’s called disordered eating.

That’s a very important point: Girls may say “I’m not anorexic,” or “I’m not bulimic,” but they don’t have to be in order to have disordered eating. That’s precisely why this component of the triad was named “disordered eating” and not “eating disorder.”

Other factors may contribute to disordered eating, such as the desire for perfection and the desire to excel and win at any cost. Some girls may also be influenced by low self-esteem, depression, family dysfunction, and physical or sexual abuse.

Behavioral signs of disordered eating include:

• Preoccupation with food and weight.
• An expressed concern over being too fat.
• Frequently eating alone.
• Trips to the bathroom during or right after eating.
• Increasing self-criticism.
• Feet facing backward in bathroom stall — bulimics may vomit so quietly it sounds like urination.

Unfortunately, many athletes think these types of eating practices are OK. They may have been told that losing weight enhances performance. The truth is that these eating behaviors are dangerous and that inadequate caloric intake and being underweight can actually worsen their physical performance. An athlete with disordered eating just won’t have the energy to perform at her best.

The health effects of disordered eating include:

• weight loss
• amenorrhea
• constipation
• dizziness
• hair loss
• yellow skin
• decreased body temperature
• bradycardia (low heart rate)
• hypotension (low blood pressure)
• acrocyanosis (blue fingers and toes)
• edema (swelling)
• dry skin
• cold extremities
• loss of muscle mass
• dehydration
• hypoglycemia (low blood sugar)
• fluid and electrolyte abnormalities, such as low potassium
• cardiac arrhythmia (abnormal heart rhythm)
• anemia
• osteoporosis
• psychological problems, such as depression and anxiety

Small exercise groups can be formed based on interests (e.g., beginner walking, stretching, beginner cycling), andsubgroupscan beformedbased on age,availability, etc. Members can have the opportunity toeither stay with one group, or “mix and match.” Warm-up themes (e.g., boxing, jump roping, walking) can be used, and variety can easily be added. Remember, only a small amount of staff time needs to be used for facilitation. After that, members wind up supporting each other.Additionally, when more experienced exercisers are asked tovolunteer to be a beginner group facilitator, there is usually a large turnout.

Summary

The feeling of being part of a loosely formed, non-judgmental, small group that has similar goals and a willingness to support eachother is an invaluable addition to the advancement of exercise maintenance and member longevity.The simple actions you can take to put new and returning exercisers into a non-threatening social situation will pay clear dividends.

The most efficient of all support techniques may be ones that you initially facilitate, but thatgradually take on a life of their own. In checking back with facilities where I have promoted such methods, it seems that a number of long-term, resilient, interpersonal bonds have been made. Certainly, your new memberswill have your facility as their common ground. They will have succeeded at incorporating regular exercise into their lives, and your fitness center, where all this positive energy originated, will be viewed as the centerpiece of their success. As this member-support culture expands, you and your new members reap the benefits, long-term.

Recent polls indicate that the No. 1 senior healthcare issue is the growing cost of prescription drugs. The average 15-percent-per-year increases in prescription drug costs for seniors, who do not have outpatient drug coverage under the traditional Medicare program, are adding up to become a real burden.

Clinton and Gore staked out the debate last year by proposing a new Medicare drug benefit in response to this growing senior anxiety. They have proposed adding a first-dollar prescription drug benefit to Medicare that would pay 50 percent of a senior’s outpatient drug charges to a first-year maximum payout of $1,000, which would ultimately grow to a $2,500 maximum payout. Seniors would be responsible for 50 percent of the cost of the program — $26 per month in premiums in the first year. Seniors below 150 percent of the poverty level would not have a co-payment. Clinton and Gore would pay for the federal share of the cost by using projected budget surpluses.

Until recently, the pharmaceutical industry was taking the point in running national ads questioning the creation of one giant new government program that covered all seniors alike. But all of that suddenly changed when the industry shifted its position and announced that it supported passage of a prescription drug plan — albeit one that was not part of a Clinton/Gore Medicare plan that they believe could ultimately result in pharmaceutical price controls.

Instead, the pharmaceutical industry seems to be leaning toward a plan written by Senators Olympia Snowe and Ron Wyden that would create separate, competing, private-sector pharmacy plans. Their program would fully subsidize low-income seniors (under 150 percent of poverty) and pay at least 25 percent of the cost for all seniors buying the plan — insurance plans that would pay “market rates” for greater access to drugs. Medigap issuers could issue pharmacy plans and would have to comply with new rules to offer pharmacy benefits within a Medigap plan.

The upshot is that Clinton/Gore, Bill Bradley and the pharmaceutical industry all have drug programs for seniors while many of the Republican presidential candidates are calling for expanded pharmacy options for seniors. On the other hand, the Republican congressional leadership has no pharmacy plan.

The Republican leadership is now saying they are going to develop one — most likely along the lines of the drug industry-favored Snowe/Wyden outline that keeps any new programs in the private sector. In the Senate, they will bring their drug plan forward as part of a comprehensive Medicare reform proposal similar to the one developed by the Bipartisan Medicare Commission last year.

Election-Year Patient Rights or Prescription Drug Legislation?
In both patient rights and drug benefits for seniors, the congressional Republican leadership is being driven farther than they want to be by the presidential election and the positions their candidates are finding they have to take in order to be responsive to voters.

The wild card for Republicans will be the election year process.

If it becomes clear to the Republican members of Congress, during their re-election campaigns, that there is no choice but to pass a patient rights bill or a prescription drug bill that Clinton will sign, then we will get one.

Today, the only patient rights or prescription drug bill Republicans would pass would be a bill that Clinton would be eager to veto. And, the Republicans would love to see him veto their bills — all the better to take the high ground on healthcare in an election year. If Clinton vetoes a Republican healthcare bill, Republicans would argue, the Democrats could no longer claim they were running against a “do-nothing” Congress or that the Republicans were the ones obstructing health reform.

You should expect that the next few months will produce a series of attempts at healthcare one-upmanship as each side tries to outflank the other on patient rights, prescription drugs and the uninsured.

Clinton Keeps Healthcare Pressure on Republicans
The Democrats intend to attack the Republicans on the healthcare issue throughout the campaign.

Clinton dramatized this in his State of the Union address reminding Congress of numerous Clinton/Gore healthcare proposals left over from last year’s budget debate, as well as formally introducing some of the new ideas Gore has advocated on the campaign trail.

In addition to his support for the Norwood-Dingell patient rights bill and the Clinton/Gore Medicare plan, Clinton proposed what is essentially an abbreviated Gore campaign program to reduce the 44 million uninsured. He proposed spending $110 billion over 10 years from future projected budget surpluses to create a number of new health insurance options to reduce the number of uninsured (Gore estimates his plan for the uninsured costs $146 billion over 10 years)

FamilyCare — an expansion of Medicaid to provide higher matching state payments to expand coverage of uninsured parents of children covered under Medicaid. This is essentially one of Gore’

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By compromising, Democrats would eliminate important components of the healthcare issue from the election year debate. If they compromise with Republicans on patient rights or prescription drugs, they are in effect saying that the Republicans weren’t so bad on the issue after all. Politically, many Democrats believe they are better off if they can hammer the Republican-controlled Congress for not passing an acceptable bill.

By compromising, Republicans are afraid they will get what conservatives have criticized them for doing before: going too far in doing a deal with the Democrats. The 1995/1996 Medicare budget changes, KidCare and Kennedy/Kassebaum are all examples of what many Republicans consider sellouts to the Democrats that later reinforced the voters’ perception that the Democrats are the ones to be trusted on the healthcare issue.

Republicans believe they have saleable positions on patient rights and prescription drugs and are just as eager to take those ideas to the voters in the hope that they will have a Republican Congress and a Republican president in less than a year.

But both sides are going to spend the spring posturing on patient rights and generic drugs. How else to get the political leverage out of them?

Patient Rights
Like the Republican presidential candidates who have supported the patient’s right to sue, we are beginning to see members of the Republican congressional leadership also change their tune on patient rights. First, standing firmly against any bill that included such a provision, we are now hearing likes of Republican House Majority Leader Dick Armey saying that we could well have a right-to-sue bill pass Congress this year.

However, the devil is in the details. A right-to-sue provision only after all appeals have been exhausted and part of a bill loaded down with Republican proposals to reach more of the uninsured with such things as expanding medical savings accounts and creating small business buying coalitions, called HealthMarts, could well pass both Republican houses of Congress but could also be veto bait for Clinton. Clinton has already said that he would not let such a bill become law.

Look for the Republican congressional leadership to do exactly what their candidates are doing: Voice strong support for patient rights (now including the right for a patient to sue his or her HMO), as well as expanding the prescription drug options for seniors. We will likely see the Republican-controlled House and Senate pass a patient rights conference bill written by conferees the Republican leadership hand picked.

But a distinctly Republican patient rights conference bill will not become law so long as President Clinton and the Democratic leadership believe vetoing it will help their chances in November.