Wednesday, August 22, 2018

Waist Related Measurements Can Be Useful in Healthcare

Body mass index or BMI is probably the most frequently employed measurement of excess, possibly harmful, body fat. A BMI greater than or equal to 30 is considered to be an indication of obesity. However, other measurements of excess harmful body fat have been put forward. These measurements include waist circumference and waist-to-height ratio. The measurements focusing on waist may provide more useful health information than BMI alone, in many ways, since belly fat can cause many problems, including heart problems.

A study consisting of 1700 subjects done by researchers at the Mayo Clinic indicated that “those with a normal BMI, but high levels of belly fat were about twice as likely to have a heart attack, procedures to open blocked arteries, or to die from heart problems during the follow up than people without belly fat."

An acceptable waist circumference is equal to or less than 35 inches for women and equal to or less than 40 inches for men. Acceptable waist-to-height ratios are generally less than .6. In fact, in one study the "Cut-points for predicting whole body obesity were 0.53 in men and 0.54 in women. The cut-point for predicting abdominal obesity was 0.59 in both sexes."

Healthcare providers need to take waist related measurements, and use the measurements for diagnoses and counseling sessions. If a patient has too much belly fat, the provider should encourage the patient to follow a diet and engage in physical activity that can lead to weight loss.

BMI is a good all-around measurement of overweight and obesity. The measurement is widely used, so comparison studies can be readily performed. But waist related measurements should also be taken so that a more complete assessment of excess, harmful body fat can be made.

Both healthcare providers and patients should recognize the importance of waist related measurements. Healthcare providers should make taking waist related measurements a part of their normal intake process. These measurements are relatively easy to perform. Providers should use every tool available to fight overweight and obesity.

Tuesday, August 14, 2018

Let’s Not Minimize the Seriousness of Obesity

Obesity is a major U.S. and world problem. Obesity raises the risk of hypertension, type 2 diabetes, asthma, high cholesterol, some forms of cancer, and other illnesses. However, two often-held beliefs may undercut the drive to reduce obesity in the world. One of these beliefs is that body positivity should be embraced in the extreme and the other belief is that there are “metabolically healthy individuals.”

Body positivity “is a feminist movement that encourages people to adopt more forgiving and affirmative attitudes toward their bodies, with the goal of improving overall health and well-being.”
Body positivity empowers “women of non-Barbie proportions to feel good about themselves.…” And a lot of good has come out of the body positivity movement. Unhealthy diets are getting more scrutiny, for example.

However, some proponents of the movement are taking the body positivity idea to the extreme. For example, some proponents argue that it is okay to be fat. “The comedian, Sophie Hagan, recently accused Cancer Research of bullying fat people, after the charity launched a campaign to raise awareness about the link between cancer and obesity.” There is a link between cancer and obesity and a number of other diseases. And it is appropriate for healthcare professionals to alert the public.

Concerning the metabolically healthy obese individuals (MHOs), the belief that there are healthy obese persons does hold some water. In fact, an individual may be metabolically healthy for a while. The individual may be free of high blood pressure, high cholesterol, diabetes or other obesity related diseases. But obese persons, not exhibiting any of these diseases, are still more likely to suffer from cardiovascular diseases than normal-weight individuals later in life.

The belief that body positivity can be a healthy endeavor is correct, but only when not taken to the extreme. Obesity, in general, is not healthy for the long term. This is similar to MHOs. MHOs can be healthy for a while, but probably not later in life because of the obesity. And healthcare professionals should make these points clear to their patients.

Friday, July 27, 2018

Less Common Weight Loss Methods

Diet, exercise, lifestyle modification, and anti-obesity drugs are the most common methods employed in the fight against overweight and obesity. Other less commonly used weight loss approaches include bariatric surgery, endoscopic approaches and methods that interrupt the nerve that carries hunger signals to the brain. One new nerve-interrupting approaches freezes that nerve.

Bariatric surgical approaches either shrink the size of the stomach or prevent calories from entering the digestive system. Examples of bariatric surgery include gastric bypass surgery and the sleeve gastrectomy. Endoscopic weight loss approaches are "performed entirely through the gastrointestinal (GI) tract using flexible endoscopes ..." Usually there is no surgical incision associated with Endoscopic weight loss methods. Many of the methods mimic the functions of bariatric surgery.

An example of the hunger-signaling nerve interrupting method is the Vagal Blocking Therapy or VBLOC. VBLOC was developed by EnteroMedics Inc., based in Minnesota. “VBLOC therapy works to control sensations of hunger using a pacemaker-like device your doctor is able to implant during a minimally invasive procedure. This device empowers you to eat less, make healthier choices and lose weight, without the lifestyle implications of traditional weight loss surgeries.”

Another example of the hunger-signaling nerve interrupting approach is one where one of the nerves that carry hunger signals to the brain is frozen. “During the procedure, an interventional radiologist inserts a needle through the patient's back and, guided by live images from a CT scan, uses argon gas to freeze the nerve, known as the posterior vagal trunk. This nerve, located at the base of the esophagus, is one of several mechanisms that tells the brain that the stomach is empty.”

In a preliminary study consisting of ten subjects with a BMI range of 30 to 37, the average weight loss was 3.6 percent.  According to the investigators, “Freezing the nerve that carries hunger signals to the brain may help patients with mild-to-moderate obesity lose weight ... . The treatment was determined safe and feasible in the initial pilot phase.”

More studies are planned. And if the nerve-freezing approach is effective, we will have another tool in our weight loss arsenal. 

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.

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