Monday, March 26, 2018

The Medicare Diabetes Prevention Program

The National Institute of Diabetes and Digestive and Kidney Diseases (NIKKD) conducted a study to determine if weight loss could prevent type 2 diabetes. The study was called the Diabetes Prevention Program (DPP). The researchers concluded that a relatively small amount of weight loss can prevent type 2 diabetes for those people with prediabetes. Because of positive results from the study and other studies related to the DPP study, Medicare will offer its own type 2 diabetes prevention program. That program is called the Medicare Diabetes Prevention Program (MDPP).

The Diabetes Prevention Program or DPP trial was initiated in 1996 by the NIKKD to determine if weight loss could be used to prevent type 2 diabetes in persons with prediabetes. The study was a randomized trial consisting of three groups. All three groups contained prediabetic subjects that were overweight but not obese. Results from the trials were reported in 2002.

Subjects in one of the groups received placebo treatment for type 2 diabetes treatment. Subjects in another group were given the diabetes drug metformin. And subjects in the third group were provided intensive lifestyle intervention, with the goal of a 7% weight loss using diet, exercise and lifestyle modification.

The specific goal of the study was to determine if individuals with prediabetes could avoid type 2 diabetes by losing 7% of their weight through diet, exercise, and lifestyle modification. Actually, all three groups lost weight. At one point in the study, the subjects in the intensive lifestyle group lost 15.4 pounds, compared to 5.5 pounds for the metformin treatment group, and about 2.2 pounds for the placebo  group.

During the 2.8 years of the study, it was found that the intensive lifestyle subjects experienced a 58% reduction in the incidence of type 2 diabetes, and the metformin group experienced a 31% reduction compared to the placebo group. And after ten years, the type 2 incidence "was reduced by 34% ... in the lifestyle group and 18% .. in the metformin group compared with placebo." Furthermore, another study, looking at results from the original DPP study and  a follow-on study called the DPP Outcomes Study (DPPOS), concluded that DPP treatment was cost-effective when compared to metformin or placebo treatment.

And finally, a study called the Diabetes Education & Prevention with a Lifestyle Intervention Offered at the YMCA  or DEPLOY, was carried out in  two YMCAs in greater Indianapolis. The researchers concluded that "YMCA wellness instructors can be trained to deliver a group-based DPP lifestyle intervention and achieve changes in body mass after 6 and 12 months that are comparable to the DPP study."

Based on the DEPLOY positive results, Medicare carried out its own test to determine if the DPP method could be cost effective for Medicare beneficiaries. The MDPP test program was implemented in 17 YMCAs in the U.S. Based on positive results from its study, Medicare decided to expand the program to all prediabetic Medicare beneficiaries who satisfy criteria established by Medicare. That program is set to start in April of 2018. The program is called the Medicare Diabetes Prevention Program or MDPP.

The program uses CDC trained coaches to engage with the beneficiaries to help them adhere to the guidelines of the program. The settings for the MDPP could be within a typical healthcare organization or within some community organization, such as the YMCA. Healthcare providers can refer Medicare beneficiaries to organizations offering the MDPP.

Since Medicare will reimburse organizations that provide the program, there is an opportunity for primary care physicians, who want to improve the outcomes of their prediabetic patients, to play an important role in their patients' care.

Thursday, March 22, 2018

It Is Possible to Lose and Maintain Weight Loss Long-Term

It is believed by most people that no one can lose weight and maintain weight loss long-term. Further, it is often stated that there is no way to predict who will be successful at losing weight. However, a long-term study, called the Look AHEAD study, showed that it is possible to lose weight and maintain the weight loss long-term. The study results also showed that it is possible to predict who will be the most successful at losing weight.

“The Look AHEAD (Action for Health in Diabetes) study [was] a multi-center, randomized controlled trial, designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes.” The study consisted of over 5000 subjects, and ran for about ten years.

It was found that for 42% of the persons, who lost at least 10% of their weight during the first year of the weight loss program, were able to maintain the weight loss for at least four years. Further, it was concluded that those participants who lost at least 5% of their body weight, at the end of the first month of a weight loss program, were more likely to lose at least 10% of their weight after one year compared to those participants who lost less than 2% of their weight at one month.

At any rate, it appears that providers should resist the temptation to tell people that weight loss and long-term weight-loss maintenance are virtually impossible. It is possible to lose and maintain weight loss as the above mentioned study shows. And those individuals most likely to lose appreciable weight can be identified early in the weight loss program.

Finally, weight loss lessens the risk of negative cardiovascular outcomes. A study, which was a follow-on study to the Look AHEAD study, found that 85% of the Look AHEAD subjects experienced a significant reduction in cardiovascular events as a result of the weight loss. Although 15% of the subjects did experience negative outcomes, for those subjects, the negative outcomes may be associated with depression. Also, the subjects' "substantially poorer compliance with the exercise portion of the intervention" may have played a role in the negative outcomes.

At any rate, it is possible to lose weight and maintain the weight loss for a long period of time.

Monday, February 26, 2018

Weight Loss and Arthritis


Weight loss through diet and exercise may be an effective treatment for arthritis, specifically, rheumatoid arthritis and are osteoarthritis. First of all, there are important differences between rheumatoid arthritis (RA) and osteoarthritis. “RA is an auto immune disease. That means the immune system attacks parts of the body.” Whereas “osteoarthritis results from “wear and tear” on your joints ... .“ Osteoarthritis can result from injuries, age or obesity. Weight loss, or at least, maintaining a healthy weight can improve the symptoms of RA and osteoarthritis.

For a time, it was believed that obesity actually lowered the risk of death from rheumatoid arthritis. However, that belief may be in error based on one study. Indeed, maintaining a healthy weight may be warranted when a person has rheumatoid arthritis. One of the researchers of the study indicated that healthy weight loss may be beneficial to RA patients.

And with respect to osteoarthritis, one report suggested that "obese individuals have significantly more severe joint degeneration in the knees compared with normal weight or underweight individuals." Further, the report concluded that "Weight loss can prevent onset of osteoarthritis, relieve symptoms, improve function and increase quality of life."

And in another study, where 380 overweight men and women were investigated in a 96 months analysis, it was found that "cartilage degeneration was significantly lower among people who lost weight through diet and exercise or diet alone. [However,] weight loss through exercise alone showed no significant difference in cartilage degeneration..."

So, weight loss and maintaining a healthy weight can be beneficial in the treatment of arthritis. Healthcare providers can use this information in counseling sessions. The providers can advise patients that weight loss and weight maintenance can improve the symptoms of arthritis -- especially rheumatoid arthritis and osteoarthritis. Knowing that there is something that patients, suffering from arthritis, can do to relieve the symptoms of arthritis can be very helpful to the patients.

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Sunday, February 25, 2018

Childhood Obesity and Asthma

Childhood obesity creates many problems. Those problems exist in childhood, and may continue into adulthood. The problems include hypertension, type 2 diabetes, and other illnesses. One illness that often receives little attention in relation to childhood obesity is asthma. It has long been believed that obesity during childhood can have negative effects on asthma, and now more has been uncovered about the childhood obesity-asthma relationship.

One study concluded that what a mother eats during pregnancy, and what a child eats during his or her early live can raise the risk of asthma during childhood.  If a mother consumes drinks with high levels of sugar and fructose corn syrup while pregnant, and if the child consumes large quantities of sugar and fructose corn syrup in drinks, the child's risk of asthma increases.

Indeed, the researchers performing the study indicated that "women who consumed the most soda and sugary beverages during pregnancy were 70 percent more likely to have a child diagnosed with asthma by mid-childhood than mothers who never or rarely had sodas during pregnancy." Further, the researcher suggested that "kids who had the most total fructose in their diets earlier in childhood were 79 percent more likely to develop asthma than children who rarely or never had fructose."

And some of the consequences of asthma on a child during his or her childhood have been established. It has been determined for example that "Compared to healthy-weight peers, asthma sufferers who were untreated and overweight suffered 37 more symptom-days -- more than five extra weeks -- per year."

So, healthcare providers should counsel patients on the risks of sugar sweetened beverages to children in general, and the asthma risks in particular. The providers should counsel pregnant mothers to limit their intake of sugar sweetened beverages, and discourage the use of sugar sweetened beverages by their children. 

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Thursday, January 25, 2018

Preventing Dementia and Alzheimer’s Is a Complex Problem That Has No Easy Solution


Past studies have indicated that exercise and some other interventions can have a positive effect on brain function. Therefore, it is hoped that an intervention such as exercise, diet, or medication can be used in the treatment of diseases that affect the brain. And because of our ageing population and the impact of dementia and Alzheimer’s disease on this population, the diseases are receiving a great deal of focus. However, a recent study indicates that no single intervention appears to be a “magic bullet” in the prevention of Alzheimer’s or dementia. But there is reason for hope.

In a study where 120 older adult were investigated, the researchers concluded that exercise can have a positive effect on the brain. Indeed the researchers suggested that “aerobic exercise training is effective at reversing hippocampal volume loss in late adulthood, which is accompanied by improved memory function.”

And in another study, where 40 students were subjected to low, moderate and high intensity treadmill exercise, the investigators concluded that “In adolescents, whose brains are still developing, aerobic exercise of moderate to high intensity levels seems to have a positive effect on … cognitive functioning."

In one report where 17 studies were reviewed concerning the effect of exercise on memory, it was concluded that “Acute and chronic exercise appears to play a pronounced effect on memory function among young to middle-aged adults.” And finally, in a study, it was suggested that since “Type 2 diabetes is associated with impaired episodic memory functions and increased risk of different dementing [disorders. Diet] and exercise may potentially reverse these impairments.”

So, the above studies do give us hope that perhaps exercise, diet, and other lifestyle interventions may be prescribed to reduce the effects of dementia and Alzheimer’s. But no one type of intervention should be viewed as a way to prevent dementia or Alzheimer’s.  But, still one investigator said that eating right, being active and living a healthy lifestyle “may benefit the brain…”

While there is no magic bullet to prevent dementia or Alzheimer’s, there may be actions we can take in our lives to possibly delay the effects of dementia and Alzheimer’s. And health care providers, especially obesity medicine specialists, can play a role here.

Sunday, January 21, 2018

The U.S. Obesity Problem Will Likely Worsen in Coming Years

Childhood obesity receives a lot of attention, because obesity during childhood can lead to adult health problems. Childhood obesity increases the risk of adult obesity. And one study implies that living in the U.S. increases a child's chances of being obese during adulthood.

In the study, simulation was used to look at the life trajectories of 41,567 children and adults. And it was concluded that "Given the current level of childhood obesity, the models predicted that a majority of today’s children, [approximately 57%] will be obese at the age of 35 years, and roughly half of the projected prevalence will occur during childhood."

This means that we should continue to pay attention to methods that motivate children to follow a healthy diet and increase physical activity. We should also focus on children's families because families can induce children to engage in activities that can help the children maintain a healthy weight.

Indeed “A new study shows that when parents model a healthy lifestyle, that lifestyle is more effective than just talking to teens when it comes to obesity topics…” And an Institute of Medicine study has shown that with the right environment in the home, a child’s defensiveness, associated with being overweight for example, can be lessened. This lessening of defensiveness combined with support from the family can greatly increase the child's likelihood of engaging in a healthier lifestyle.

By taking actions to address overweight while a child is young, weight loss providers might be more successful at helping a child maintain a healthy weight. Appropriate action may lead to better health in adulthood. And the earlier some action is taken, the better. In fact, “Weight-loss programs can help even very young children slim down, and it appears that acting early may improve the odds of success…”

Finally, since being a child in the U.S. raises a child's risk of obesity before the age of 35, parents and healthcare providers should take note of this risk, even if a child is of normal weight. And steps should be taken to insure that even the normal weight child is advised to get exercise and follow a healthy diet.

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Thursday, December 28, 2017

Overfat Assessments May Be As Beneficial As BMI Assessments

Obesity is a critical issue in the United States and in other parts of the world. And the most employed measurement for obesity is body mass index or BMI. If a person’s BMI is greater than 30 kg/m², the person may be identified as obese. However, there are times when a person's BMI may be greater than 30, while the person may not have excess body fat or be overfat.

An athlete who is very muscular may have a higher BMI than the average person of the athlete’s height. But the athlete may have no unhealthy fat, while the person with the normal weight and acceptable BMI may have excess, unhealthy fat. Therefore, a new term, called overfat, is coming into usage to describe the unhealthy, excess fat condition. This new term would exclude the healthy muscular individual whose BMI is abnormal, and bring attention to the unhealthy individual whose BMI is within the normal range, but whose body is carrying excess, unhealthy fat.

Indeed, most people in the US and in many industrialized companies are overfat. One study concludes that “up to 90 percent of adult males and 50 percent of children may be overfat.” Further, the report concludes that “80% of the women may fall into [the overfat] category.” Because of this, some experts suggest that instead of using BMI as a measurement of too much fat, we should use measurements that focus on the fat around the waist, because this fat is the most harmful.

The fat around the waist, or belly fat, is associated with type 2 diabetes, heart problems, and other ailments. According to a CNN article, the belly fat is very dangerous because it can make the body insulin resistant, which can lead to type 2 diabetes. And belly fat can cause inflammation which is associated with Alzheimer’s, cancer, and other health problems.

Therefore, methods to assess fat around the waist can be useful. The waist-to-height ratio is an example. If a person’s waist is half or less than half the person’s height the person would be viewed as having a healthy amount of fat on his or her body. But if the person’s waist measurements were more than half his or her height, the person would be viewed as having an unhealthy amount of fat.

The person would be overfat. In fact, waist measurement, alone, is considered to be a pretty good measurement of overfat. If a person’s waist is bigger than the person’s hips, the person likely has unhealthy body fat. And a healthcare provider can make this assessment by simply observing the individual.

So monitoring patients’ BMI is a useful procedure. But monitoring patients’ waist may be at least as useful, because a waist assessment can give a provider insight into unhealthy fat or overfat. And this insight might enable the provider to prevent or lessen the severity of future diseases. Healthcare providers might want to consider waist measurements as an important health indicator.

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