Monday, May 25, 2020

Weight Loss Through Diet and Exercise for Osteoarthritis

Weight loss through diet and exercise may be an effective treatment for osteoarthritis. Osteoarthritis can result from wear and tear on your joints. The wear and tear can be a consequence of a number of  conditions, including injuries, age or obesity. And weight loss, resulting from diet, exercise, and lifestyle changes, may improve osteoarthritis symptoms.

A past study concluded that "obese individuals have significantly more severe joint degeneration in the knees compared with normal weight or underweight individuals." Furthermore, the investigators indicated that "Weight loss can prevent onset of osteoarthritis, relieve symptoms, improve function and increase quality of life."

In another study, the importance of weight loss was further confirmed. In the study, where 380 overweight men and women were investigated in the ninety-six month analysis, the researchers determined that "cartilage degeneration was significantly lower among people who lost weight through diet and exercise or diet alone." It should be noted, however, that "weight loss through exercise alone showed no significant difference in cartilage degeneration..."

There is evidence that  obesity is a risk factor for  total knee replacement (TKR) caused by osteoarthritis. And in one study, investigators looked at the effects of intentional weight loss on total knee replacement caused by osteoarthritis. Using intensive lifestyle intervention (ILI) methods, the investigators concluded that engaging in "physical activity, dietary restrictions and behavior to lose weight may be "effective in preventing TKR prior to the development of knee pain."

So, weight loss and maintaining a healthy weight can be beneficial in the treatment of osteoarthritis. Healthcare providers should use this evidence based information in counseling sessions. The providers can advise patients that weight loss through diet, exercise and lifestyle changes can improve the symptoms of osteoarthritis. Knowing that there is action that patients, suffering from osteoarthritis, can take to relieve the symptoms of osteoarthritis can be very helpful to the patients. 


Friday, May 15, 2020

Under Some Conditions, Prediabetes Can Predict Cognitive Decline

Prediabetes is a serious condition, affecting more than 84 million Americans. And many Americans are not even aware that they have the condition. Prediabetes puts one at high risk for type 2 diabetes, and the condition raises the risk for heart and kidney problems. And one study shows that prediabetes combined with other disorders, such as obesity, may predict cognitive decline.

Prediabetes or hyperglycemia may generally be defined as abnormally high blood glucose, but blood glucose not high enough to be called type 2 diabetes. The clinical tests for prediabetes are typically an A1c test, a fasting glucose test or an impaired glucose test. The investigators in the study mentioned above showed that prediabetes combined with central obesity may predict cognitive decline in those who are less than 87 years of age.

In the study, the investigators looked at 478 individuals who were 65 years of age and older. The investigators looked at markers for glycemia, such as glucose, A1c and insulin resistance. And the investigators looked at markers for obesity such as resistin , adiponectin, glucagon-like peptide-1, and inflammation. They then modeled the markers, while adjusting for age education, sex waist-hip ratio and other parameters. The investigators then used machine learning techniques to perform the analysis.

The investigators concluded that “in individuals younger than 88 years with central obesity, even modest degrees of hyperglycemia might independently predispose faster cognitive decline.”

So, while prediabetes puts one at high risk for type 2 diabetes, and can raise the risk for heart and kidney problems, the abnormally high glucose may also be a risk factor for increased cognitive decline in individuals who are younger than 88 years of age.

This is useful information. Providers, counseling patients between the ages of 65 and 88 years old, should work with patients who have prediabetes and central obesity to help the patients lower their glycemic numbers. The action may impede cognitive decline.


Monday, April 27, 2020

Medicare's Diabetes Prevention Program Implementation Can be a Model

Some of the difficulties associated with implementing new practices in a healthcare organization are the problems related to meshing the practices with the existing organization's operations. In taking steps to minimize difficulties associated with implementing the CDC's evidence-based Diabetes Prevention Program services, Medicare has provided some guidance on how to overcome obstacles associated with integrating new healthcare services into existing healthcare services.

The CDC’s Diabetes Prevention Program (DPP) study was an evidence-based study. The results of the study were published in 2002. After additional research, following the DPP study, including Medicare’s own Medicare Diabetes Prevention Program test study, Medicare started reimbursing suppliers for diabetes prevention services. The Medicare DPP or MDPP is an adaptation of the original DPP study. The Medicare services can be delivered in healthcare, faith-based, community and other settings. 

To integrate evidence-based services into a healthcare organization, the organization must often look for ways to deliver the services without negatively affecting the desired outcomes. And that’s what Medicare did before deciding to reimburse for the DPP services offered to Medicare beneficiaries.

Medicare worked with YMCAs in eleven states to test the delivery of the DPP services in YMCA settings. The test program was  the CMS DPP Model test. The DPP services were delivered by non-licensed YMCA workers to Medicare beneficiaries in a group format. Delivery by non-licensed workers in a group format can be a cost saving way to deliver the program.

At the conclusion of the model test, Medicare determined that $278.00 could be saved per Medicare beneficiary per quarter with the implementation of the MDPP for Medicare beneficiaries in healthcare and community settings. Medicare expanded the test program, and started reimbursing for MDPP services in April of 2018.

The Medicare approach to the implementation of the MDPP is, perhaps, a model for how other healthcare services might be delivered using out-of-the-box methods. For example, Medicare is reimbursing for services delivered by non-licensed workers. This delivery approach can save money while providing desired outcomes. Maybe, other reimbursable healthcare services can be delivered using methods similar to those used in the MDPP.

Saturday, April 25, 2020

Obesity Impacts Productivity in the Workplace

Obesity is a pressing problem in the United States. Obesity is associated with a great number of comorbidities which negatively affect the health of many Americans. And obesity has a cost associated with it— both healthcare costs and workplace costs. The obesity-related healthcare costs result from the associated comorbidities that are diagnosed and treated. The obesity-related workplace costs result from low productivity in the workplace.

One review study, reported on in 2017, looked at 50 studies pertaining to the costs associated with obesity. The investigators indicated that absenteeism and presenteeism (where a worker is at work, but his or her productivity is low), contributed to increased costs.

And the investigators concluded that “the evidence [from the review] predominantly confirms substantial short-term and long-term indirect costs of overweight and obesity in the absence of effective customized prevention programs and thus demonstrates the extent of the burden of obesity beyond the healthcare sector.”

Another more recent study shows that absenteeism and disability associated with obesity lead to increased costs due to productivity loss. Indeed, the researchers concluded that for "men, BMI and waist circumference accounted for approximately 60% and approximately 30% of retirement [respectively,] due to disability." And for women, BMI and waist circumference accounted for "approximately 19% and approximately 8%," respectively, due to disability.

The researchers went on to conclude that “total and abdominal obesity were responsible for increased costs from productivity loss due to early retirement among adults 50 years old or older.”

So, many healthcare providers and those in the workplace may be aware of the productivity loss associated with obesity and overweight. And some employers are taking action to curb obesity within the organization by offering wellness programs. Let’s hope that healthcare providers and employers can work together to halt the obesity epidemic. Healthcare providers, employers and employees will benefit.

Saturday, March 28, 2020

Using Teleconferencing to Deliver the Diabetes Prevention Program

For health related programs that require intensive intervention, the intervention can be costly because there are many barriers to delivering the programs. One of these health-related programs is the CDC's National Diabetes Prevention Program or NDPP. It can be difficult for program participants to attend enough in-person sessions to meet their weight loss and other goals. Teleconferencing, which can be used for telehealth, can eliminate many of the barriers hindering attendance at in-person sessions. One study, called SHINE for “Support, Health Information, Nutrition and Exercise,” has shown that teleconferencing can be effective in delivering a version of the CDC’s NDPP for weight loss. It should be noted that in this article, teleconferencing is performed via the telephone.

The NDPP program is a year-long program, consisting of a set of 16 weekly core sessions during the first six months, and a set of core maintenance sessions during the last six months. The NDPP is based on the Diabetes Prevention Program (DPP) study carried out between 1996 and 2001.  In the above mentioned SHINE study, the sessions lasted two years rather than one year. The 16 session curriculum, taken from the original CDC DPP study, was used during the first year of the SHINE study, and a modified version of the curriculum was used for the second year of the SHINE sessions.

Unlike the original DPP study, where the primary outcome was type 2 diabetes, the primary outcome of the SHINE study was weight loss.  For the study, the participants were randomized to two groups – an individual call (IC) group, and a conference call (CC) group. Individuals in the IC-groups received individual telephone calls from a counselor, and individuals in the CC-group received calls from the counselor in a teleconference.

After randomization of subjects to one of the two groups, the IC-group consisted of 129 participants and the CC-group consisted of 128 participants. Measurements, including weight, were taken at baseline, six months, 12 months and 24 months. And the average weight loss for CC-group  was more at the 6, 12 and 24 month assessments than  the average weight loss for the IC-group.  At 6 months, the CC-group average weight loss was 4.0 %  compared to 3.9% for the IC group. At 12 months, the CC-group average weight loss was 4.5% compared to 4.2% for the IC-group. And at the two year period, the CC-group average weight loss was 5.6% compared to 1.8% for the IC-group.

So using teleconferencing is a viable option for weight loss. And a version of the CDC's DPP program curriculum, including the NDPP, can be used to deliver the weight loss program. Those wanting to deliver a version of the DPP should consider using teleconferencing to deliver the program to improve attendance and weight loss.

Thursday, March 19, 2020

A Low-Carbohydrate Diet in Conjunction with Alternate Day Fasting May be Feasible

Intermittent fasting, an eating pattern technique where an individual follows a zero calorie or very low-calorie diet on some days of the week, and follows a regular eating pattern on the other days, is a recognized method for weight loss and glycemic improvement. Low carbohydrate diets are also recognized as a way to lose weight and improve glycemic control. And one study has combined intermittent fasting, in the form of alternate day fasting, with low carbohydrate diets to improve weight and other metabolic processes.

The study combined ADF with a low carbohydrate diet. Ninety-four subjects with obesity (BMIs pf 30 to 49.9) in the Chicago area were selected for the study. Thirty-one subjects completed the study. For the ADF design of the diet, participants ate 600 calories during the fasting days, consisting of 30% carbohydrates, 35% protean, and 35% fat. For the low-calorie design of the diet, participants chose their food ad libitum during the “feast” days, to form a diet, again, consisting of 30% carbohydrates, 35% protean, and 35% fat.

The weight loss study lasted six months, with the first three months being a weight loss period. And the last three months being a weight maintenance period. Meal replacements were used to enable the study participants to take in the desired macronutrient content during the six month study period, while adhering to the 600 calorie limit during the fast days.

At the six month period average weight loss was 6.3%, total cholesterol was reduced by 6% and the LDL was decreased by 8%. There was a decrease in systolic blood pressure by 7 mmHg, and there was a decrease in fasting insulin of 8%.

The investigators concluded that while more research is required, the “findings suggest that ADF combined with the low carbohydrate diet is effective for weight loss, weight maintenance, and improving certain metabolic disease risk factors such as LDL-cholesterol, blood pressure, and fasting insulin.” The study shows that ADF plus low carbohydrate diet is an eating pattern that probably should be given some consideration by healthcare providers.

Wednesday, February 26, 2020

Intentional Weight Loss to Lower Cancer Risks

Studies have shown that there is a high correlation between obesity and cancer. Indeed, according to epidemiologic studies, there are at least 11 cancers that are associated with obesity. However, an important question is the following: Can intentional weight loss lower the risk of cancer? And a recent study appears to indicate that for some demographics, the answer is yes.

Most experts agree that a healthy diet, physical activity and healthy lifestyle changes will likely contribute to lowering the risk of many illnesses, including cancer. Along with the above-mentioned behaviors, to lower cancer risk, an individual should abstain from the use of alcohol, or limit alcohol consumption. And the study, mentioned above, sheds light on the effects of intentional weight loss in cancer risk reduction.

The study looked at postmenopausal women’s weight and waist circumference at baseline, and three years later. There were 50,667 subjects in the study. Since a 5% weight loss has been shown to have health benefits for some disease conditions, a 5% weight loss was used in the study. The following three subject categories were established for the study: Individuals who intentionally lost at least 5% of their weight or waist circumference (WC), individuals who unintentionally lost 5% of their weight, and individuals who lost or gained less than 5% of their weight.

The investigators concluded that for the postmenopausal women who had at least a 5% intentional weight loss, the cancer risk was reduced compared to those women who unintentionally lost at least 5% of their weight or WC, and compared to those women who lost or gained less than 5% of their weight or WC.

So this study does indicate that intentional weight loss can lower cancer risk— at least in postmenopausal women. And since intentional weight loss of at least 5% has been proven to be beneficial in other health areas for most demographic groups, it is quite possible that a 5% intentional weight loss or WC loss may lower cancer risk for demographic groups other than postmenopausal women.

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