Re: Obesity Rating for Every American Must Be Included in Stimulus-Mandated Electronic Health Records, Says HHS

July 20, 2010

ThatÂ is a terrible idea.Â Because BMI is NOT an indicator of fat for EVERY

person, it's really only a tool for population statistics.Â My BMI is 25.Â

ButÂ I

am not OBESE (I have a lot of muscle for my frame).Â

Holly

Â ----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa <rd-usa >

Sent: Tue, July 20, 2010 3:25:28 PM

Subject: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

Â

http://cnsnews.com/news/article/69436

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

July 20, 2010

I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written

by Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but

it looks like they have documented every statement they make.........

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

Subject: Re: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

To: rd-usa

Date: Tuesday, July 20, 2010, 6:16 PM

That is a terrible idea. Because BMI is NOT an indicator of fat for EVERY

person, it's really only a tool for population statistics. My BMI is 25. But I

am not OBESE (I have a lot of muscle for my frame).

Holly

----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa <rd-usa >

Sent: Tue, July 20, 2010 3:25:28 PM

Subject: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

http://cnsnews.com/news/article/69436

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

July 20, 2010

I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written

by Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but

it looks like they have documented every statement they make.........

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

Subject: Re: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

To: rd-usa

Date: Tuesday, July 20, 2010, 6:16 PM

That is a terrible idea. Because BMI is NOT an indicator of fat for EVERY

person, it's really only a tool for population statistics. My BMI is 25. But I

am not OBESE (I have a lot of muscle for my frame).

Holly

----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa <rd-usa >

Sent: Tue, July 20, 2010 3:25:28 PM

Subject: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

http://cnsnews.com/news/article/69436

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

July 20, 2010

I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written

by Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but

it looks like they have documented every statement they make.........

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

Subject: Re: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

To: rd-usa

Date: Tuesday, July 20, 2010, 6:16 PM

That is a terrible idea. Because BMI is NOT an indicator of fat for EVERY

person, it's really only a tool for population statistics. My BMI is 25. But I

am not OBESE (I have a lot of muscle for my frame).

Holly

----------

Holly Lee Brewer, MS RD CDE

Pediatric Dietitian, Diabetes Educator

Medical Nutrition Therapist, Las Vegas, NV

Maj Holly Brewer, USAFR BSC http://hollyinbalad.blogspot.com

301st MDS, NAS JRB Fort Worth (Carswell), TX

Joint Base Balad, Iraq (Jan-Jul 2009)

________________________________

To: rd-usa <rd-usa >

Sent: Tue, July 20, 2010 3:25:28 PM

Subject: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

http://cnsnews.com/news/article/69436

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

July 21, 2010

I work with Alaskan natives and the words wasted cacheix almost always go with a

BMI of 22 or less. When I worked in El Paso I found the older larger boned

Hispanics also looked wasted etc at a BMI of 22. It is not the gold standard

that the public is being lead to believe.

Jackie Chase RD

Dillingham AK

>

> I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written by

Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but it

looks like they have documented every statement they make.........

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>

July 21, 2010

I work with Alaskan natives and the words wasted cacheix almost always go with a

BMI of 22 or less. When I worked in El Paso I found the older larger boned

Hispanics also looked wasted etc at a BMI of 22. It is not the gold standard

that the public is being lead to believe.

Jackie Chase RD

Dillingham AK

>

> I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written by

Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but it

looks like they have documented every statement they make.........

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>

July 21, 2010

I work with Alaskan natives and the words wasted cacheix almost always go with a

BMI of 22 or less. When I worked in El Paso I found the older larger boned

Hispanics also looked wasted etc at a BMI of 22. It is not the gold standard

that the public is being lead to believe.

Jackie Chase RD

Dillingham AK

>

> I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written by

Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but it

looks like they have documented every statement they make.........

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>

July 21, 2010

Before we go off on a tangent here, I'd like to suggest that we jump

for joy over the inclusion of BMI calculators in EMRs. It's what we

wanted, folks. First, we complained that patients weren't being

weighed or measured on admission to the hospital. You can build your

system so that there's a stop if height and weight aren't entered. If

you're afraid that stated or " guessed " values will be entered, add a

qualifier that says " actual " or " stated " or " estimated " , which puts

the person entering information on alert that not actually measuring

will be identified. So, now you have height and weight on admission!

Second, we wanted to be included as a valued member of the healthcare

team. Here's the chance.

Clinical systems are really just super duper calculators sometimes.

So, rather than the RD or DTR spending time with a calculator figuring

out the BMI for all those inpatients, the system will do it for you.

We are not the only providers who care about BMI. Systems don't

diagnose, people do, so the affixing of a diagnosis associated with

the BMI is the responsibility of the provider, hopefully with input

from the RD.

So rather than bemoaning this awful (????) turn of events, how about

working with your system design team to include the information you

want to diagnose appropriately? After all, there is additional payment

for obesity-related conditions under prospective payment. The flip

side of that is you have to avoid misdiagnosing, so here's where the

expert RD can really shine.

Have a good day.

pam

Pam Charney, PhD, RD

Affiliate Associate Professor

Pharmacy

MS Student

Clinical Informatics and Patient Centered Technology

School of Nursing

University of Washington

Seattle, WA

pcharney@...

http://www.linkedin.com/in/pamcharney

> I work with Alaskan natives and the words wasted cacheix almost

> always go with a BMI of 22 or less. When I worked in El Paso I found

> the older larger boned Hispanics also looked wasted etc at a BMI of

> 22. It is not the gold standard that the public is being lead to

> believe.

>

> Jackie Chase RD

> Dillingham AK

>

> >

> > I agree Holly........on a related note............this was just

> released this month.....an easy to read synopsis of the health care

> bill as written by Senators Tom Coburn MD and Barrasso MD......

> I've only skimmed it, but it looks like they have documented every

> statement they make.........

> >

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

> >

>

July 21, 2010

Pam - agree with you completely....BMIs are already going into

whatever charting systems are being used....

> Before we go off on a tangent here, I'd like to suggest that we jump

> for joy over the inclusion of BMI calculators in EMRs. It's what we

> wanted, folks. First, we complained that patients weren't being

> weighed or measured on admission to the hospital. You can build your

> system so that there's a stop if height and weight aren't entered. If

> you're afraid that stated or " guessed " values will be entered, add a

> qualifier that says " actual " or " stated " or " estimated " , which puts

> the person entering information on alert that not actually measuring

> will be identified. So, now you have height and weight on admission!

> Second, we wanted to be included as a valued member of the healthcare

> team. Here's the chance.

>

> Clinical systems are really just super duper calculators sometimes.

> So, rather than the RD or DTR spending time with a calculator figuring

> out the BMI for all those inpatients, the system will do it for you.

> We are not the only providers who care about BMI. Systems don't

> diagnose, people do, so the affixing of a diagnosis associated with

> the BMI is the responsibility of the provider, hopefully with input

> from the RD.

>

> So rather than bemoaning this awful (????) turn of events, how about

> working with your system design team to include the information you

> want to diagnose appropriately? After all, there is additional payment

> for obesity-related conditions under prospective payment. The flip

> side of that is you have to avoid misdiagnosing, so here's where the

> expert RD can really shine.

>

> Have a good day.

> pam

>

> Pam Charney, PhD, RD

> Affiliate Associate Professor

> Pharmacy

>

> MS Student

> Clinical Informatics and Patient Centered Technology

> School of Nursing

>

> University of Washington

> Seattle, WA

> pcharney@...

> http://www.linkedin.com/in/pamcharney

>

>> I work with Alaskan natives and the words wasted cacheix almost

>> always go with a BMI of 22 or less. When I worked in El Paso I found

>> the older larger boned Hispanics also looked wasted etc at a BMI of

>> 22. It is not the gold standard that the public is being lead to

>> believe.

>>

>> Jackie Chase RD

>> Dillingham AK

>>

>> >

>> > I agree Holly........on a related note............this was just

>> released this month.....an easy to read synopsis of the health care

>> bill as written by Senators Tom Coburn MD and Barrasso MD......

>> I've only skimmed it, but it looks like they have documented every

>> statement they make.........

>> >

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>> >

>>

July 21, 2010

Have you seen how (if) they will adjust the BMI formula to account for

amputations?

>

> Pam - agree with you completely....BMIs are already going into

> whatever charting systems are being used....

>

> On Wednesday, July 21, 2010, Pam Charney <pcharney@...

> <mailto:pcharney%40mac.com>> wrote:

> > Before we go off on a tangent here, I'd like to suggest that we jump

> > for joy over the inclusion of BMI calculators in EMRs. It's what we

> > wanted, folks. First, we complained that patients weren't being

> > weighed or measured on admission to the hospital. You can build your

> > system so that there's a stop if height and weight aren't entered. If

> > you're afraid that stated or " guessed " values will be entered, add a

> > qualifier that says " actual " or " stated " or " estimated " , which puts

> > the person entering information on alert that not actually measuring

> > will be identified. So, now you have height and weight on admission!

> > Second, we wanted to be included as a valued member of the healthcare

> > team. Here's the chance.

> >

> > Clinical systems are really just super duper calculators sometimes.

> > So, rather than the RD or DTR spending time with a calculator figuring

> > out the BMI for all those inpatients, the system will do it for you.

> > We are not the only providers who care about BMI. Systems don't

> > diagnose, people do, so the affixing of a diagnosis associated with

> > the BMI is the responsibility of the provider, hopefully with input

> > from the RD.

> >

> > So rather than bemoaning this awful (????) turn of events, how about

> > working with your system design team to include the information you

> > want to diagnose appropriately? After all, there is additional payment

> > for obesity-related conditions under prospective payment. The flip

> > side of that is you have to avoid misdiagnosing, so here's where the

> > expert RD can really shine.

> >

> > Have a good day.

> > pam

> >

> > Pam Charney, PhD, RD

> > Affiliate Associate Professor

> > Pharmacy

> >

> > MS Student

> > Clinical Informatics and Patient Centered Technology

> > School of Nursing

> >

> > University of Washington

> > Seattle, WA

> > pcharney@... <mailto:pcharney%40mac.com>

> > http://www.linkedin.com/in/pamcharney

> >

> >> I work with Alaskan natives and the words wasted cacheix almost

> >> always go with a BMI of 22 or less. When I worked in El Paso I found

> >> the older larger boned Hispanics also looked wasted etc at a BMI of

> >> 22. It is not the gold standard that the public is being lead to

> >> believe.

> >>

> >> Jackie Chase RD

> >> Dillingham AK

> >>

> >> >

> >> > I agree Holly........on a related note............this was just

> >> released this month.....an easy to read synopsis of the health care

> >> bill as written by Senators Tom Coburn MD and Barrasso MD......

> >> I've only skimmed it, but it looks like they have documented every

> >> statement they make.........

> >> >

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

> >> >

> >>

July 21, 2010

I agree. The BMI also doesnt work all the time with elderly and Asian ppl. And

what do you do with African american ppl who tend to be on the higher levels?

Genetics play a role, we all know that and look at us as numbers is not the

right approach. This is yet another way of the Gov to run our lives. I bet

Jordan and LeBron are having high BMI but I would not call then

obese....

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

To: rd-usa

From: jackiechase66@...

Date: Wed, 21 Jul 2010 06:14:09 -0800

Subject: Re: Obesity Rating for Every American Must Be Included in

Stimulus-Mandated Electronic Health Records, Says HHS

I work with Alaskan natives and the words wasted cacheix almost always go

with a BMI of 22 or less. When I worked in El Paso I found the older larger

boned Hispanics also looked wasted etc at a BMI of 22. It is not the gold

standard that the public is being lead to believe.

Jackie Chase RD

Dillingham AK

>

> I agree Holly........on a related note............this was just released this

month.....an easy to read synopsis of the health care bill as written by

Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it, but it

looks like they have documented every statement they make.........

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>

July 21, 2010

Just because they are recording the BMI in the electronic charts, doesn't

mean they are going to interpret it. It's ridiculous to think that an

athlete would be considered obese. I think this is just another thing that

everyone is getting worked up over before it's even in practice.

>

> I agree. The BMI also doesnt work all the time with elderly and Asian ppl.

> And what do you do with African american ppl who tend to be on the higher

> levels? Genetics play a role, we all know that and look at us as numbers is

> not the right approach. This is yet another way of the Gov to run our lives.

> I bet Jordan and LeBron are having high BMI but I would not call

> then obese....

>

> Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

>

> To: rd-usa

> From: jackiechase66@...

> Date: Wed, 21 Jul 2010 06:14:09 -0800

> Subject: Re: Obesity Rating for Every American Must Be Included in

> Stimulus-Mandated Electronic Health Records, Says HHS

>

> I work with Alaskan natives and the words wasted cacheix almost always

> go with a BMI of 22 or less. When I worked in El Paso I found the older

> larger boned Hispanics also looked wasted etc at a BMI of 22. It is not the

> gold standard that the public is being lead to believe.

>

> Jackie Chase RD

>

> Dillingham AK

>

> >

>

> > I agree Holly........on a related note............this was just released

> this month.....an easy to read synopsis of the health care bill as written

> by Senators Tom Coburn MD and Barrasso MD...... I've only skimmed it,

> but it looks like they have documented every statement they make.........

>

> >

>

> >

>

> >

>

http://www.drhotze.com/CMSPages/GetFile.aspx?nodeguid=751b6d91-ccfe-4e23-bd75-1d\

750a68eb31

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

> >

>

July 21, 2010

yes Pam,this could be a nice entry for us to have more clients however, this is

not the right motivation for the public to get in shape. and it may just end up

with people assessed and treated by chiropractors/physical trainer/MD/RN .

Unfortunately, their lobbies are stronger then ours, thus far. and in states,

like NY where there is no legislation for license it may not make a different

for us, unless ADA (local and national) would work harder in improving our PR

and the knowledge of the public of who we are and why we are the ONLY specialist

in that area.But - aside of it - it may be heading to more regulation on food

items that are considered less healthy, like the attempt to ban salt in all

restaurants in NY. So if that will be the rout - item like butter, coffee, red

meat will be regulated in means that will increase taxation.Again, this is not

an educational tool. It is not like the case of cigarets. MAny smokes find ways

to cheeper cigarets, if they still choose to smoke, but still many quit smoking,

which, no doubt - is good. But I don't need and don't want to " quit " steaks and

butter. I eat them occasionally and I am sure ou can agree with me that there is

nothing wrong with it.I just disagree with the approach of gov control of every

bite. If I like my Foie Gras, I should be able to enjoy it without paying

enormous $$$ for it, so it becomes the food of the rich. But rather, there

should be a better way, and there are, to teach the public to eat cheeseburger

and cheesecake, and chocolate and grilled-cheese sandwich loaded with butter -

as long at these items are consume sporadically. I don't want big brother to

tell me that I am not allowed, period. I don't want to be punished with harsh

taxes when I eat those itms, bc that takes away my pleasure. i don't want to

take a loan to be able to eat in my favorite restaurant, just because I choose

to eat something else then grilled fish and salad. When I eat out I like to eat

those things I don't eat normally at home and I should be able to afford it just

like Warren Buffet would (while I can live with the fact that he can afford

other things in life that I cannot, I would still like to maintain a certain

lifestyle).

Merav Levi, RD, MS, CDNhttp://www.linkedin.com/in/meravlevi

> To: rd-usa

> From: pcharney@...

> Date: Wed, 21 Jul 2010 08:19:19 -0700