Anyone who eats at McDonald’s (MCD) in the U.S. next week—and 25 million people do on any given day—will get a chance to experience the angst that New Yorkers have felt for four years. Calories, those enigmatic numbers that often seem to correlate strongly with taste and health (though in opposite ways), are about to debut on the fast-food chain’s menu boards nationwide.

On the bright side, data suggest McDonald’s customers will eat less. That’s what happened in New York City after April 2008, when every morsel a chain restaurant sold had to suddenly have its calories posted for all to see. Stanford researchers found that, at Starbucks (SBUX) at least, the move resulted in customers eating 6 percent fewer calories per transaction. (The finding only applied to food. When it came to gulping back a venti white chocolate mocha with whipped cream, consumers didn’t care about the 620 calories that came with their caffeine fix.)

Calories can inspire a range of emotions that may or may not reflect on fears about weight. I happened to be in line at Qdoba (JACK) on the day the “fresh Mex” chain first posted its calories in Manhattan. The impact was dramatic. How, we wanted to know, could a simple burrito vary by several hundred calories, to the point where two burritos could exceed many adults’ average daily needs? The answer, of course, was in the guacamole and the sour cream and the cheddar cheese, along with a little cilantro-lime rice, black beans, and shredded beef. My friend decided to skip the guacamole and added some zero-calorie lettuce to bulk it up. I said no to sour cream, which I’d never liked that much in the first place. Neither of us, for some reason, ever ate at Qdoba again.

A lot of Americans are already used to digesting calorie counts with their fast food, thanks to laws in states such as California and Vermont, as well as the policies of heart-hugging chains like Panera Bread (PNRA). But it could take years to figure out what this knowledge does to your mind. Subway, for some of my friends, will never be a splurge—no matter how much melted cheese they put on a meatball sandwich. They’ve seen too much of Jared Fogle, the man who dropped several pants sizes by eating there twice a day, and posters hawking a half-dozen sandwiches with no more than 6 grams of fat. For others, fried chicken never tasted the same once they knew their lunch put them in the four-digit calorie range.

Even this morning, as I looked over the baked goods tray at Starbucks, I found myself debating a cake slice for 390 calories vs. a muffin at 360. I went with the slice. I’m not trying to lose weight or gain weight, but somewhere in the back of my mind was the suggestion that 30 extra calories means something tastes better. (Do I recall how many calories came with the chai latte? No, Stanford researchers, I do not.)

Will McDonald’s customers gravitate to “Favorites Under 400” once they feel the full frontal assault of the calorie count for a Big Mac and large fries? Maybe. But anyone operating under the illusion that a mayo-drenched hamburger was health food hasn’t been conscious during the fast-food debates. My bet is that people will continue to get their favorites. The only difference will be their mood at the end of the meal.

Simple Treatments, Ignored

A new federal health analysis has found that 36 million adults in the United States have high blood pressure that is not being controlled even though 32 million of them get regular medical care and 30 million of them have health insurance.

This is not primarily a case of poor, uninsured people unable to get the care they need. It is shocking evidence of how our complicated, dysfunctional health care system can’t deliver recommended care to many patients who could benefit, because their doctors are asleep at the switch. As a result, patients go on to suffer medical harm and their care inflicts big costs on the health care system.

Health authorities recommend that people whose blood pressure reaches 140/90, a condition known as hypertension, take steps to bring it down by dietary changes, exercise or medications. The reasons are compelling. People with high blood pressure are four times as likely to die of stroke and three times as likely to die of heart disease as people with normal blood pressure. They are also prone to kidney failure. Their health care costs related to high blood pressure exceed $130 billion year.

The new analysis, issued last Tuesday by the Centers for Disease Control and Prevention, found that 67 million Americans had high blood pressure and that 31 million of them were being treated with medicines that reduced their blood pressure to a safe level. The remaining 36 million fell into three groups: people who were not aware of their hypertension, people who were aware but were not taking medication, and those who were aware and were treated with medication but still had hypertension.

This is an abysmal record for a condition that is easy to detect and treat. In some cases, patients had multiple high blood pressure readings entered into their electronic medical records but nobody told them about their condition or put their names on a list to be contacted for treatment. They fell between the cracks, even in some of the nation’s most respected health care systems, mostly because overburdened doctors did not give hypertension high priority.

Dr. Thomas Frieden, director of the C.D.C., said health care providers who make reducing high blood pressure among patients a top priority can quickly bring it under control. He pointed to Kaiser Permanente, a multistate managed care consortium, as one that has had real success on this front.

Kaiser Permanente says that in Northern California it increased the percentage of patients whose hypertension was under control from 44 percent in 2001 to 87 percent in 2010. Over approximately the same period, stroke mortality declined by 42 percent, heart attacks by 24 percent and the most serious type of heart attack by 62 percent. The organization created a hypertension registry to track patients and the care they were getting; eased the burden on doctors by using pharmacists to initiate drug therapy and medical assistants to monitor patients’ progress; made it easy for patients to get free blood pressure checks; and showed doctors how their record on controlling blood pressure compared with others in the system.

Federal health officials have set an ambitious goal to reduce the population with uncontrolled high blood pressure by 10 million within five years. In most cases, they believe, medication will need to be part of the treatment. There is little doubt that drugs are beneficial in treating patients who have severe cases of hypertension (a systolic blood pressure of 160 or more). But for some patients who have milder hypertension (systolic blood pressure from 140 to 159), the benefits may not be as obvious or may be outweighed by drug side effects.

The United States Preventive Services Task Force, a group of independent health experts that advises the Department of Health and Human Services, has found good evidence that treating high blood pressure with medication would decrease cardiovascular problems while causing few major problems. It also supports other approaches, like weight loss, increased physical activity, lower sodium and alcohol consumption, and stress management. The benefits of reducing high blood pressure — not to mention the cost savings — are obvious. The wonder is that the health care system has done such a bad job of delivering those benefits.

Weight training may help to prevent diabetes, a new study shows.

Doctors routinely recommend regular aerobic exercise to reduce the risk of Type 2 diabetes. But for those who prefer resistance training to running on a treadmill, a new study shows that weight training can protect against diabetes as well.

The researchers found that doing at least two and a half hours a week of either aerobic exercise or weight training substantially lowered the risk of Type 2 diabetes. But more than anything else the study provided an endorsement for doing both. Those who combined weights with cardio had the greatest reduction in risk compared with their non-exercising peers. The study subjects were men, but the researchers believe the results apply to women as well.

“We found that in the group that did fairly large amounts of both, there was about a 60 percent reduced risk of diabetes, which is huge,” said Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health and an author of the study. “It’s clear that the best thing is to get a combination of the two. But some people really can’t get aerobic exercise in their life, and we found that even a small amount of resistance exercise can make a difference.”

Plenty of research has shown that regular physical activity greatly lowers the odds of developing Type 2 diabetes, a disease that afflicts nearly 26 million Americans, many of them overweight. While there have been studies showing that resistance training can help improve control of blood sugar levels in people with Type 2 diabetes, nearly all of the research on preventing the condition has involved aerobic exercise.

So to figure out whether time spent in the weight room could have the same preventive benefits as other exercise, Dr. Willett and his colleagues analyzed data on 32,000 men who were followed for almost two decades as part of the Health Professionals Follow-Up Study, a long-running project looking at the health of medical professionals. The study, published in Archives of Internal Medicine, was designed to be the male complement to the well known Nurses’ Health Study, which includes only women.

Poring over data from an 18-year study window, the researchers found that 2,278 of the men developed Type 2 diabetes. After controlling for many variables, including age, body mass and alcohol intake, the researchers found that engaging in aerobic exercise for at least 150 minutes a week lowered the risk of developing the disease by 52 percent. Doing the same amount of weight training, meanwhile, was associated with a 34 percent lower risk, independent of any aerobic exercise. But doing both led to the greatest reduction in risk.

Dr. Willett said the mechanism behind weight training’s beneficial effect on diabetes most likely stems from its effect on insulin receptors. Resistance training builds muscle mass, a process that can take weeks. But it also improves the sensitivity of insulin receptors, so that muscle cells can absorb their fuel, glucose, more easily. This process results almost immediately from doing resistance exercise, and the effect can last for days.

“You’re essentially allowing the fuel to pass into the muscles more quickly, which is exactly what you need to happen if you’re putting those muscles to use,” Dr. Willett said.

The study found the largest effect among men doing the most resistance training, but even 10 minutes a day of resistance work — whether at the gym or at home doing push-ups or using resistance bands — is enough to produce a benefit, he added.

The study did have a limitation in that it involved only men, and most of them were white. But Dr. Willett said he was “virtually sure” the results were universally applicable. Just as aerobic exercise benefits everyone, he said, weight training should as well.

“Muscle physiology is pretty similar across ethnic groups and gender,” he said. “There may be some subtle variations, but the basic biology is similar.”

Workplace insurers are accustomed to making billions of dollars in payments each year, with the biggest sums going to employees hurt in major accidents, like those mangled by machines or crushed in building collapses.

Now they are dealing with another big and fast-growing cost — payouts to workers with routine injuries who have been treated with strong painkillers, including many who do not return to work for months, if ever.

Workplace insurers spend an estimated $1.4 billion annually on narcotic painkillers, or opioids. But they are also finding that the medications, if used too early in treatment, too frequently or for too long, can drive up associated disability payouts and medical expenses by delaying an employee’s return to work.

Workers who received high doses of opioid painkillers to treat injuries like back strain stayed out of work three times longer than those with similar injuries who took lower doses, a 2008 study of claims by the California Workers Compensation Institute found. When medical care and disability payments are combined, the cost of a workplace injury is nine times higher when a strong narcotic like OxyContin is used than when a narcotic is not used, according to a 2010 analysis by Accident Fund Holdings, an insurer that operates in 18 states.

“What we see is an association between the greater use of opioids and delayed recovery from workplace injuries,” said Alex Swedlow, the head of research at the California Workers Compensation Institute.

The use of narcotics to treat occupational injuries is part of a broader problem involving what many experts say is the excessive use of drugs like OxyContin, Percocet and Duragesic. But workplace injuries are drawing particular interest because the drugs are widely prescribed to treat common problems like back pain, even though there is little evidence that they provide long-term benefits.

Along with causing drowsiness and lethargy, high doses of opioids can lead to addiction, and they can have other serious side effects, including fatal overdoses.

Between 2001 and 2008, narcotics prescriptions as a share of all drugs used to treat workplace injuries jumped 63 percent, according to insurance industry data. Costs have also soared.

In California, for example, workplace insurers spent $252 million on opioids in 2010, a figure that represented about 30 percent of all prescription costs; in 2002, opioids accounted for 15 percent of drug expenditures.

As a result, states are struggling to find ways to reverse the trend, and some of them have issued new pain treatment guidelines, or are expected to do so soon. These states include New York, Colorado, Texas and Washington. Insurers are also trying to influence how physicians prescribe the drugs.

Doctors in four states — Louisiana, Massachusetts, New York and Pennsylvania — appear to be the biggest prescribers of the drugs for workers’ injuries, according to a review of data from 17 states by the Workers Compensation Research Institute, a group in Cambridge, Mass.

Painkiller-related costs are also hitting taxpayers, who underwrite coverage for public employees like police officers and firefighters, experts say. In February, one major underwriter, the American International Group, said that it would no longer sell backup coverage to workplace insurers, citing rising pain treatment expenses as one reason.

There is little question that strong pain medications can help some patients return to work and remain productive. But injured workers who are put on high doses of the drugs can develop chronic pain and face years of difficult treatments. It is not clear how, or if, the drugs are involved in the process, but when pain becomes chronic, the cost of a commonplace injury can equal a crippling one, experts said.

“Some of these claims look like someone who fell down an elevator shaft and had multiple injuries,” said Dr. Edward J. Bernacki, the director of the division of occupational and environmental medicine at Johns Hopkins University in Baltimore.

For decades, workers’ compensation plans, which vary by state, have been plagued by problems like lengthy legal battles over an injury’s financial value. But it is in recent years that opioid painkillers have emerged as a major driver of costs, experts said.

Accident Fund Holdings examined its claims and found that the cost of a typical workplace injury — the sum of an employee’s medical expenses and lost wage payments — was about $13,000. But when a worker was prescribed a short-acting painkiller like Percocet, that cost tripled to $39,000 and tripled again to $117,000 when a stronger longer-acting opioid like OxyContin was prescribed, said Jeffrey Austin White, an executive with the insurer, which is based in Lansing, Mich.

In a sense, insurers are experiencing the consequences of their own policies. During the last decade, they readily reimbursed doctors for prescribing painkillers while eliminating payments for treatments that did not rely on drugs, like therapy.

Those policies may “have created a monster,” said Dr. Bernyce M. Peplowski, the medical director of the State Compensation Insurance Fund of California, a quasi-public agency.

For patients, such policies had consequences.

Dr. Eugenio Martinez, a physician in the Boston area who specializes in rehabilitative medicine, said one patient, a former waitress who hurt her back five years ago in a fall, recently won a court fight to force her insurer to pay for physical therapy. The insurer had cut off those payments five years ago after a few sessions, and the woman, now disabled, had no option but to take strong painkillers, Dr. Martinez said. “It certainly did not help that she was cut off,” he said.

Nationwide, data suggests that a vast majority of narcotic drugs used to treat occupational injuries are prescribed by a tiny percentage of doctors who treat injured workers; in California, for example, that figure is just 3 percent. Also, the bulk of such prescriptions go to a relatively small percentage of injured workers, including those who might be addicted to the drugs or those who sell them, experts said.

Several companies, like Accident Fund Holdings and Liberty Mutual, have set up programs in which pain experts contact doctors identified as high prescribers to discuss their practices. The State Compensation Insurance Fund of California has also instituted a policy that requires approval for a doctor to prescribe an opioid for over 60 days.

Insurers say they are making progress in reducing overuse of the drugs. But their ability to influence physicians is limited because workers’ compensation plans can allow employees to see any doctor. So several states have or will soon adopt new pain treatment guidelines for doctors who treat workers.

In New York, one proposal would require a doctor to refer a patient who is not improving to a pain specialist when an opioid dose exceeds a certain level, said Dr. Elain Sobol Berger, the associate medical director of the state’s workers’ compensation board. Washington State has already adopted such a policy.

Dr. Sobol Berger added that the New York rules, which are expected to be proposed this year, will also emphasize nondrug treatments for pain. “We know that there is a significant problem with the management of chronic pain and the use of opioids,” she said.

Some insurers, like the California state fund, have also started paying for alternative approaches like specialized psychotherapy or are trying to get addicted workers into treatment. Other companies are also checking on long-disabled workers.

Mark Kulakowski, a 57-year-old former warehouse worker from Peabody, Mass., injured his back more than three decades ago while lifting a box. He has not worked since 1995. Since his injury, he has taken narcotic painkillers and has had a long list of failed treatments.

Recently, his insurer, Liberty Mutual, sought to have a nurse accompany him to his next doctor’s appointment, a suggestion he welcomed if it could lead to taking fewer painkillers.

“It just drains everything out of you,” he said.

Click on link to go to the link that features the open letter in the format of a cartoon.

SOME people cannot travel without Advil or a neck pillow. Dr. David M. Eisenberg, an associate professor at the Harvard Medical School and the Harvard School of Public Health, feels incomplete without his beloved paring knife and eight-inch Wüsthof cleaver.

He was wielding both with sweaty zeal the other day on the dais of the Culinary Institute of America at Greystone, demonstrating a stir-fry with perfectly browned shiitake mushrooms and a heavy dose of sake to the 400 or so pediatricians, endocrinologists, dietitians and other health practitioners who were spending three and a half days in the Napa Valley learning how to cook. “This isn’t neurosurgery,” Dr. Eisenberg said as he whacked a garlic clove with the cleaver. “This is hearty, affordable, cravenly delicious food.”

The son of a Brooklyn baker, Dr. Eisenberg is the founder and chief officiant of “Healthy Kitchens/Healthy Lives,” an “‘interfaith marriage,” as he calls it, among physicians, public health researchers and distinguished chefs that seeks to tear down the firewall between “healthy” and “ crave-able” cuisine. Although physicians are on the front lines of the nation’s diabetes and obesity crises, many graduate from medical school with little knowledge of nutrition, let alone cooking. It is a deficiency that is becoming increasingly apparent as the grim statistics climb. (By 2050, for example, as many as 1 in 3 adults will develop diabetes if current trends continue.)

To Dr. Eisenberg, flavor is a health issue. Now in its eighth year, the sold-out event is in the vanguard of a major shift in attitude among a young generation of medical professionals who grew up with farmers’ markets. Their ranks include students at the Baylor College of Medicine in Houston, who have hired a chef to teach cooking skills, and a doctor in suburban Chicago who was so inspired by “Healthy Kitchens/Healthy Lives” that he went home and installed a demonstration kitchen in his medical office.

Doctors like Jim Fox, a 51-year-old cardiologist from Traverse City, Mich., exchanged stethoscopes for chefs’ toques to immerse themselves in the fine arts of “Mastering Healthy Marinades and Grilling Techniques” and “Healthy Cooking With Nuts and Legumes.”

“I want to help my patients not need my services,” Dr. Fox said as he chopped rosemary for a mustard-crusted seared lamb loin. “I’d love to be put out of work.”

In a place that celebrates perfect pairings (say, a riesling with a spicy chicken Madras), the combination of James Beard Award-winning chefs with heavy guns from the Harvard School of Public Health, including Dr. Walter Willett, an epidemiologist and international authority on the health consequences of food choices, could at times feel surreal.

A sold-out session called “Wine: The Latest Research on the Health Impacts Plus a Guided Tasting,” taught by John Buechsenstein, a winemaker, and Eric B. Rimm, a cardiovascular epidemiologist from Harvard, preceded a tasting of a Washington State gewürztraminer and other wines accompanied by a geeky PowerPoint presentation. It detailed an experiment in which mice with lousy diets were given the equivalent of 8 to 10 bottles of wine a day (they did as well as regular mice). Cheers!

At a knife-skills class, Dr. Kriston J. Kent, a facial plastic surgeon from Naples, Fla., learned to make incisions in potatoes and celery. “Easier than avoiding important blood vessels,” he said. He is now pursuing a public health degree. “The emphasis shouldn’t all be on the knife,” he said of his practice. “How you look has a lot to do with how you feel.”

Satiety (rhymes with anxiety) was the mantra of the $1,200 conclave, which serves as continuing medical education despite pleasures like chocolate-dipped apricots (a healthy snack) and recipes by well-known chefs like Suvir Saran, late of the restaurant Devi in New York. Mr. Saran prepared guacamole with toasted cumin seeds, a touch he called “the Indian version of bacon bits.”

“I think they’re hungry,” he said of the medical crowd. “Many doctors treat food as a clinical procedure rather than the sensual act it ought to be.”

For Dr. Eisenberg, 56, a passionate cook who spent weekends as a child filling cream puffs and sprinkling cinnamon and nuts on rugelach in his father’s bakery, deprivation in the form of low-fat diets and bland overcooked vegetables is an enemy of doctors and patients. “For years we’ve told people ‘Don’t eat that’ or ‘Here’s your problem,’ ” he said of the physicians’ party line. “Sometimes,” he added of his own thrice-yearly yearning for steak, “you have to feed your inner jerk.”

His commitment to healthy food began when his father, a cake artist who “always smelled like a cross between a cinnamon stick and a whiff of Old Spice,” died of a heart attack when Dr. Eisenberg was 10. An expert on integrative medicine, Dr. Eisenberg was one of the first United States medical exchange students to the People’s Republic of China. He started “Healthy Kitchens/Healthy Lives” in partnership with the Culinary Institute and the Harvard School of Public Health, based on the radical notion that if doctors could learn to channel their inner Julia Child (sans butter), they could serve as role models and cheerleaders for their patients.

It’s not about ego. Over the years, research has shown that doctors who practice healthful behaviors like exercising, using sunscreen and not smoking have a greater likelihood of advising patients to do the same. A study last month in the journal Obesity reported that overweight doctors may be less prone than other physicians to discuss diet and exercise with their patients. “We’re all human,” said Dr. Matt Everett, a now-gangly 55-year-old physician from Marysville, Ohio, who was inspired to lose weight after seeing patients in their 40s and 50s having strokes and heart attacks. “We all struggle with the same things.”

For doctors like Martin Abrahamson, the chief medical officer for the Joslin Diabetes Center in Boston, there were revelations within Greystone’s cool, monasterylike stone walls, where chefs in white glide up and down staircases with nary a glance at the school’s historic corkscrew collection. “I’ve never cooked in my life,” he said, wearing a pinstripe suit beneath his apron, his hands drenched in marinade.

Dr. Abrahamson and his cronies listened raptly as the chef Tucker Bunch talked about “the little worm that unfurls” in overcooked quinoa (he advocates toasting it). “Doctors treat salt like an exacerbator of disease,” Mr. Bunch observed somewhat wryly. “So they under-season food with religious fervor.”

Nevertheless, they soaked up the dazzling feats of culinary derring-do, especially when the chef Patrick Clark sliced an onion in 10 seconds that fell into Sydney Opera House-like curves on the cutting board.

The collaboration between the Culinary Institute and Harvard epidemiologists and nutritionists goes back to 2002, when Dr. Willett, chairman of the institute’s scientific advisory board, began researching the health benefits of the Mediterranean diet. The team is now working with chefs from mega-chains like Applebee’s, Starbucks and Subway, to encourage them to reduce sodium and add more whole grains, nuts, legumes and healthier oils to their menus.

Dr. Eisenberg would like to see teaching kitchens in the places that need them most: medical schools, hospitals, universities, public schools and military bases. “What if teaching kitchens were as prevalent as computer labs in schools?” he asked. (He is working on a prototype.) Nutritionists often don’t know how to cook, Dr. Eisenberg pointed out, “which is a little bit like psychiatrists who are all screwed up.”

Yet after three days of thinking deep thoughts, all the while gorging on aromatic wheat-berry salads and peanut limeade (sounds revolting, tastes great), there was a palpable sense of a wellness tide turning.

For instance, Dr. John Principe of Palos Heights, a Chicago suburb, said that he seriously thought about quitting medicine, fed up with “a pill for every ill.” Fantasizing about a second career as a chef, he attended “Healthy Kitchens” five years ago and realized that he might be able to combine the two.

He now holds a culinary boot camp in the 2,400-square-foot kitchen and lecture room he built below his medical office, where he teaches people how to whip up cauliflower crust pizza and other dishes. (The sessions qualify for insurance under the group medical appointment model.) “Instead of being in the downtrodden mode, it’s given me a zest for life,” he said.

At the Baylor College of Medicine, Jasdeep Mangat, a 24-year-old medical student, was a founder of Choosing Healthy, Eating Fresh (CHEF), enlisting a chef from a local bistro to teach classes for 20 students using five portable gas burners in the student lounge. “We need to walk the talk,” he said.

And seven years ago, Dr. Daniela Connolly, now 40, and her husband, Patrick, bought a farm in Chester, N.H., to feed their five children healthy and reliable food.

She often runs into her patients while selling eggs at the farmers’ market and sometimes when they unknowingly show up at the house to pick up their Field to Fork Farm C.S.A. boxes. They are invariably surprised by how dirty she is.

After three days of “Healthy Kitchens,” she is now convinced she needs to teach her patients healthy cooking. “In a perfect world, I would have my patients meet me at the farm,” she said. “That would make me a really happy doctor.”