Saturday, July 21, 2018

A Recent CDC Survey Gives More Evidence That Diet Is More Important in Weight Loss Than Exercise

A 2015 New York Time magazine article suggests that exercise does not promote an appreciable amount of weight loss compared to diet. The article's author concludes that for the most part, it is the food you eat that counts in weight loss and not your physical activity. Most people who have looked at weight loss studies would say that exercise, alone, is not as effective, in losing weight, as exercise plus a low calorie diet. And a 2018 CDC survey provides more evidence that exercise is probably less important than diet in weight loss.

According to the survey, obesity rates continued to rise from 1997 until 2017, while physical activity has been on an uptrend from 2009 to 2017. In fact, over 50 percent of Americans are meeting the CDC guidelines for physical activity. Thus, the increase in physical activity is not curbing the obesity epidemic. This seems to indicate that diet is the missing element in most people's weight loss program.

The survey results promote the approach that most weight loss programs use: Diet plus exercise is an important combination in weight loss and weight loss maintenance. Diet may be even more important during the initial months of a weight loss programs than in the later months.  

Exercise may not be as effective as we might expect it to be because the human body has built up defenses over time. According to some research, our bodies have learned to adjust, for example, to reduced energy intake. Millions of years of evolution enable our bodies to "adapt to our daily routines and find ways to keep overall energy expenditure in check.”

Still, exercise is an important part of losing weight and maintaining the weight loss in the long-term. Furthermore, even without weight loss, exercise is very important to our health. So, combining a healthy, low calorie diet with frequent exercise is a winning approach to long-term good health. This combination is also key to weight loss maintenance. Weight loss service providers should always make this clear.

When diet is combined with exercise by most in the U.S., we may see a decline in obesity.

Wednesday, June 27, 2018

Bundled Payments May Improve Accountability and Lead to More Efficient EHR Use

Electronic health records are supposed to help cut medical costs, but EHRs still have a way to go to achieve the cost-cutting goal. Healthcare – Medicare in particular -- is moving from volume to value. This means that healthcare payers are going to be more inclined to assess what they get for their money. The payers are going to look at value. One approach to increasing value is the use of a bundled payment system. The bundle payment system could also improve EHR utilization.

Bundled payments may be defined as “A single comprehensive payment made to healthcare providers—hospitals and physicians—for a group of related services, based on the expected costs for a clinically defined episode of care.”

So, the use of bundled payments can improve accountability by outlining the required services and letting the payer know what the specific cost per care, or the cost for the bundled services will be. The use of bundled payments can also simplify the payment process. A single payment method could increase the effectiveness of electronic health records.

At the present, many believe that EHRs are not reducing the cost of medical care. EHRs are not reducing medical costs, some feel, because of the inefficiencies of data input, the difficulties of interoperability, and other problems. Concerning data input, the movement from volume to value that includes the use of bundled payments may make EHR data input easier.

Indeed, one study suggested that a bundled payment system, “where there is one negotiated price for a specific condition covering everything from the patient’s co-pay to any medication needed during the procedure,” might make EHR data input less complicated.

At any rate, the movement from volume to value may be beneficial to the patient, the payer and the healthcare provider, especially as that movement includes bundled payment systems. Data entry costs may also decrease, and payers may have a better idea of what they are getting for their money.

Friday, June 22, 2018

Childhood Obesity and Cancer

Childhood obesity continues to receive a lot of attention. Childhood obesity receives attention because reducing childhood obesity will lower the number of adults with obesity, since obesity in childhood increases the risk of obesity in adulthood. Childhood obesity may lead to type 2 diabetes, heart problems, strokes, asthma and some forms of cancer. And the association between obesity and cancer has received increased consideration recently.

Currently, experts believe that at least 13 cancers are associated with obesity. And 9 of the cancers are increasing in young adults. 

“The nine cancers, and the percentage of new cases in people from 20 to 44, include:

Breast cancer -- 10.5 percent
Colon and rectal cancer -- 5.8 percent
Kidney cancer -- 7.8 percent
Endometrial cancer -- 7.3 percent
Thyroid cancer -- 23.9 percent
Liver cancer -- 2.5 percent
Gastric cardia (cancer at the top of the stomach) -- 6.2 percent
Meningioma (cancer in the lining of the brain and spinal cord) -- 16.8 percent
Ovarian cancer -- 10.6 percent.”

Although there is no hard data to show exactly how obesity during childhood causes cancer later in life, it is known that obesity raises the levels of inflammation, insulin and sex hormones. Obesity also causes epigenetic changes (changes in DNA). And according to researchers, “Those kinds of changes may be lasting, even if someone who was heavy as a child loses weight … “

Some research has given us insight into how obesity, early in life, can affect an individual later in life. “For instance, a 2-year-old who is obese has a 75% chance of being obese at age 35,” according to some investigators. Using this insight, healthcare providers can counsel parents on what to do to prevent childhood obesity, and thus reduce a child’s risk of cancer.

Therefore, healthcare providers should counsel parents on the risks of sugar sweetened beverages and other unhealthy activities. The providers would do well to counsel pregnant mothers, for example, on the importance of following a healthy diet, and encouraging their children to follow a healthy diet. Healthcare providers should emphasize the importance of physical activity. These actions could lessen the risk of obesity related diseases such as type 2 diabetes, heart problems, strokes, asthma and some forms of cancer.

Sunday, May 27, 2018

Intermittent Fasting Can Benefit Weight Loss, Type 2 Diabetes and the Cardiovascular System

Investigations such as the Diabetes Prevention Program (DPP) trial and the Look AHEAD study have shown that a low calorie diet, physical activity of at least 150 minutes per week, and lifestyle modification can lead to beneficial weight loss. Both these studies highlight the importance of diet and physical activity. But it appears that diet is more important than physical activity – at least in the early stages of a weight loss program. Since diet is a key element in weight loss, weight maintenance, and overall health, a lot of research has gone into looking at different types of diets. One diet approach that has received much attention in the past years is the intermittent fasting (IF) diet.

Usually in the IF diet, an individual follows a very low or zero calorie plan for some days of the week, and a normal eating plan for the other days of the week. The IF diet has been shown to lead to weight loss, improvement in type 2 diabetes and cardiovascular disease. One very popular version of the IF diet is presented in the book, "The FastDiet," sometimes referred to as the 5:2 diet.

In the book, Michael Moseley, the author, concludes that a man, trying to lose weight, can achieve weight loss by restricting his diet to 600 calories a day for two days. And that a woman, trying to lose weight, can achieve weight loss by restricting her diet to 500 calories a day for two days. On the remaining five days of the week, both the man and the woman should eat normally. This form of IF is apparently effective for some individuals as indicated by the reviews of Moseley’s book on Amazon.com.

Another version of IF is called alternate day fasting (ADF). In ADF, a person follows a very low calorie diet on alternate days of the week, while following a normal diet on the remaining days of the week. ADF may enable an individual to lose weight. Further, one study suggests that ADF might not only lead to weight loss, but the dieting approach can lead to improvements in type 2 diabetes.

And finally, a recent study has indicated that the 5:2 diet allows an individual to lose weight and lower the risk of cardiovascular disease. In fact, the study’s investigators “found that following weight loss, participants in the 5:2 group continue to eliminate fats (triglycerides) faster and more effectively than other volunteers. Scientists have also noticed a greater reduction in arterial systolic pressure associated with decreased risk of heart attack and stroke.”

So, healthcare providers might want to include IF among their weight loss tools. Not only could IF enable some patients to lose weight, but the weight loss approach might lead to improvement in type 2 diabetes and cardiovascular conditions.

Sunday, May 20, 2018

Why are US Healthcare Costs So High and What Can We Do about it?

Frequently, there are stories in the news related to the rising US healthcare costs, and the low quality of US healthcare compared to many other industrialized countries. It is often stated that US healthcare costs are high because of over utilization of healthcare services. But one study questions the validity of the over-utilization assertion as a reason for the high costs. Also, one approach to lowering the cost of healthcare in the US is gaining momentum. The approach is to form partnerships between healthcare organizations and community organizations to deliver healthcare services.

In 2014, The Commonwealth fund, a private organization that promotes high-quality healthcare, concluded that the US had the worst healthcare system among 11 developed nations. These nations were the United Kingdom, Switzerland, Norway, Sweden, New Zealand, the Netherlands, Canada, France, Australia, Germany, and the United States. Not only is US healthcare quality a problem, but the high cost of healthcare in the US is also a great concern.

So the US healthcare quality is poor and the cost is high. But is the cost high because of over healthcare utilization? At least one study concludes that the answer is no. The investigators assert that healthcare providers in the US are paid too much. US healthcare providers are paid twice as much as providers in some other countries.

Now some experts would argue that providers are paid more in the US because of the physicians' medical school debt. But according to the above-mentioned study, this is not the case. The investigators indicated that “taking into account tuition costs didn’t explain the difference in earnings.” This might mean that healthcare providers’ salaries should be lowered and that less expensive providers should be sought in many instances.

This also might mean that the move by some healthcare organizations to lower costs and improve outcomes by aligning themselves with community organizations might be a promising approach to the US healthcare cost and, perhaps, the quality problems. Medicare, for example, is partnering with the YMCA and other organizations to provide a diabetes prevention program (MDPP). The approach used to deliver the prevention program has been shown to be effective and less costly than the treatment offered in the normal clinical environment.

Partnerships between healthcare organizations and community organizations may be feasible for other illnesses – especially in the treatment of chronic illnesses such as obesity. In fact, the CDC is suggesting that more research be directed at community programs, such as Weight Watchers and Jenny Craig along with randomized controlled trials (RCTs), to come up with practical methods for dealing with overweight and obesity.

Friday, April 27, 2018

Primary Care Can Fight Obesity with the Help of the Community

In a recent post, we discussed the MDPP or the Medicare Diabetes Prevention Program. In our discussion, we indicated that the program’s purpose is to treat Medicare beneficiaries who are prediabetic. Further, we said that the program would be administered in community settings such as YMCAs. Based on past studies, it has been concluded that a partnership between healthcare organizations and community organizations can effectively address prediabetes in Medicare beneficiaries. This kind of partnership could also be cost effective in addressing obesity.

Cost-effectiveness is of the utmost importance in healthcare. Weight loss and weight loss maintenance are extremely difficult to accomplish. It requires frequent interventions with the obese individual. And it is costly for a healthcare provider, such as a physician, nurse practitioner or physician assistant to engage the patient in a way that causes the patient to lose and maintain weight loss on a long-term basis. This is where partnerships between healthcare providers and community organizations could make a difference.

Indeed, in an article entitled “Collaborations Between PCPs, Community, Needed to Tackle Obesity Epidemic,” a primary care physician indicated how he set up a weekly obesity class with community help. He used a high school coach to give weight loss related pep talks at each one of the weekly sessions. The physician said that 25% of the program’s participants lost at least 6 pounds during six months, and that he received Medicare reimbursements of $19,000 during the first year of the program.

The AAFP (American Academy of Family Physicians) recognizes the importance of partnerships between healthcare providers and the community. In an article entitled, “Integration of Primary Care and Public Health,” the AAFP indicated that “Family Medicine within the Primary Care specialties must co-align with the public health sector, two fields with a common interest yet functioning independently for the last century.”

Since obesity is one of the biggest problems facing our society, it makes sense to create relationships between healthcare organizations and community organizations to address the problem. These relationships will benefit PCPs, patients, and the community as a whole.

Tuesday, April 24, 2018

The Importance of Protein in Our Diet

We all know that macronutrients are important components of any diet. The macronutrients are protein, fat and carbohydrates. One must consider the quantities of these nutrients when trying to determine the most effective diet. Experts often delineate the amount of fats and carbohydrates that one should consume on a daily basis for good health. Some experts will weigh the merits of a low fat diet compared to a low carbohydrate diet for example. But while there is some question as to what a high or low protein diet is, with few exceptions, experts don’t often recommend a very low protein diet. That’s because there is agreement that protein confers many health benefits on an individual.

There are at least two ways to determine the amount of protein required for good health. It can be done with respect to body weight or with respect to daily food intake. With respect to body weight, the recommended daily protein allowance for a person is .8 grams of protein for each kilogram (2.2046 lbs.) of body weight. That means that for a sedentary woman weighing 140 pounds, the recommended protein daily allowance is a little over 50 grams of protein. With respect to daily food intake, a healthy diet should consist of between 10 and 35% of a person’s intake. 

A high protein diet is considered by some to be conducive to weight loss. In one study, consisting of 105 participants, 51 of the participants were on a standard protein diet, and 54 of the participants were on a high protein diet. It was determined that the high-protein participants lost more weight than the standard-protein participants.

Another study indicated that a 35% protein diet, which is considered to be a high protein diet, will lead to improved triglycerides. And in one study, the researchers reasoned that whey protein promoted weight loss in female patients who were regaining weight after gastric bypass surgery. Indeed, the researchers stated that “Whey protein supplementation promoted body weight and FM [fat mass] loss in women with long-term weight regain following RYGB [Roux-en-Y gastric bypass].”

Finally, in a study looking at protein intake for patients in ICU settings, it was found that critically ill patients (CIPs) often don’t receive the amount of protein needed to maintain health.  Investigators determined that “energy and protein intakes in CIPs are low, disproportionate to their requirements. Therefore, actual dietary intake records, individual dietary requirement calculation, and individual dietary planning in relation with the patients' disease and stress should be considered. Such an accurate nutritional care process can promote patient safety.”

Based on the studies mentioned above, both health care providers and patients should pay close attention to daily protein intake.

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