Tag: Weight loss

Being mildly overweight in older age has its benefits
Judith Graham writes for CNN on the advantages and disadvantages of being mildly overweight in older age. Surprisingly, experts report that some additional weight has its benefits. Of course, there are drawbacks to carrying extra fat as well.

Millions of older Americans are mildly overweight–they are carrying 10 to 15 more pounds than they weighed before having kids, slowing down on physical activities, or developing chronic conditions. But, those extra pounds might not mean they should be taking Ozempic or otherwise focused on losing weight.

Too much excess fat can jeopardize your health and promote heart disease, diabetes and other chronic conditions. And, it’s never healthy to gain weight quickly. But, there’s plenty of evidence showing that 10 to 15 pounds of added weight can protect people when they fall and provide energy to people getting debilitating medical treatment, such as chemotherapy.

As we grow older, we naturally tend to lose muscle and gain fat. And, when we gain fat, it tends to come in our stomachs rather than under our skin. Experts say that this fat in our abdomens is unhealthy and can lead to all sorts of chronic conditions. Adding fat in your hips and rear end is much less concerning.

Keep active: It’s important to walk quickly enough to get your heart-rate up for least half an hour five days a week. It’s also important to lift weights at least two times a week. In fact, physical activity can be more important than losing weight if you don’t have a lot of fat around your middle.

If you continue to eat as you always have and reduce your physical activity, you will gain weight. Yet, the vast majority of people over 65 stop physical activity when they are not working.

If you are even somewhat overweight, it’s particularly important to exercise. Otherwise, you lose your muscle mass and strength. And, then you are likely to become disabled or otherwise physically harmed and you jeopardize your independence.

What happens to muscle when you lose weight? You lose both muscle (25 percent) and fat (75 percent) when you lose weight. So, it’s best to exercise more, rather than eat less, if you want to lose weight.

Carrying a few extra pounds can put you at the lowest risk of early death. Of note, some studies have found that older people who are considered to be of healthy weight are at the highest risk of early death. According to the WHO, “being overweight may be beneficial for older adults, while being notably thin can be problematic, contributing to the potential for frailty.

It matters what you eat: Eat a plant-based diet to the extent possible, with lots of legumes, nuts, vegetables and fruits. Limit your fat intake and stick to fatty foods that have unsaturated fats, if you can.

Here’s more from Just Care:
July 18, 2023
Why doesn’t Medicare cover Ozempic and other drugs for weight loss?
While Medicare covers certain services to treat obesity, Medicare is not allowed to cover Ozempic and other drugs for weight loss under the law establishing Medicare Part D prescription drug coverage. Still, the pressure is on to get Medicare to cover them, Rylee Wilson reports for Becker’s.

To treat obesity, Medicare covers obesity screening, behavioral counseling, and bariatric surgery. But, the Medicare Part D prescription drug law prohibits Medicare from covering weight-loss drugs and a range of other drugs, such as drugs that treat erectile dysfunction. That could change for weight-loss drugs, given the efficacy of new weight-loss drugs and the public pressure to cover them.

GLP-1 drugs, such as Ozempic, are more effective for weight loss than the older drugs. Putting aside these drugs, which come with an enormous price tag, Medicare can’t even cover older weight-loss drugs that cost less. Even when they cost less, spending for all these weight-loss drugs are over the long-term. People generally need to take these drugs indefinitely to sustain their weight loss.

One New England Journal of Medicine study found that covering new weight-loss drugs would increase Medicare spending by more than $25 billion a year. In addition, one of the study’s authors said that these drugs are not cost-effective; they are not so much better than the older generation drugs to justify their huge price tags.

Today, people must pay more than $10,000 out of pocket for GLP-1 drugs to treat weight loss. If Medicare decides to cover these drugs for weight loss, it will mean higher Part D premiums for everyone with Medicare. Given the drug price monopoly that US drug manufacturers still have—without negotiated drug prices—there’s no end to drug company price gouging.

Medicare does cover Ozempic and related drugs to treat diabetes.

Note: Medicare Part D drug coverage will have a $2,000 out-of-pocket cap beginning in 2025. For some people, that’s a huge benefit. But, $2,000 is still unaffordable for a large cohort of people with Medicare. And, as Part D premiums rise, more and more people with Medicare will struggle to afford the premiums for their prescription drug coverage.

Here’s more from Just Care:
June 14, 2023
Herbal remedies, including supplements, can cause serious harm
More than 150 million Americans take dietary supplements and herbal remedies. Most of them fail to realize that herbal remedies and supplements, can cause serious harm, even death. Kaiser Health News reports on one woman’s death from taking a mulberry leaf supplement.

In December 2021, Lori McClintock, Congressman Tom McClintock’s wife, died after consuming an herb from a white mulberry tree that people tend to think is safe and use to treat diabetes, obesity and high cholesterol. There’s evidence that this herb lowers blood sugar levels. McClintock was 61.

Dehydration resulting from gastroenteritis was the cause of death for McClintock, according to the coroner’s report. Gastroenteritis inflames the stomach and intestines. In McClintock’s case, eating mulberry leaf caused the
gastroenteritis.

The autopsy report did not say whether Lori McClintock took a white mulberry leaf dietary supplement, drank tea brewed from the mulberry leaf or ate fresh or dried leaves. But, it did find a piece of white mulberry leaf in her stomach.

Rep. McClinton said his wife had been dieting and going to the gym to lose weight. She had complained of an upset stomach the day before she died. Side effects of the white mulberry leaf include nausea and diarrhea.

No one has reported a death from consuming white mulberry leaf in the last 10 years, according to the American Association of Poison Control Centers. Of the 148 reported cases of accidental consumption, only one needed follow-up medical care. Since 2004, the FDA has received only two reports of people who got sick from the mulberry leaf; one or both of them needed hospitalization.

Supplement manufacturers can include all sorts of ingredients in their products. And, these ingredients can be harmful on their own or cause harmful interactions with medications you are taking. What’s worse is that the FDA does not subject supplements to the kinds of safety testing that prescription drugs and over-the-counter medicines are subject to.

Four in five Americans use supplements. Notwithstanding the risks supplements pose, it’s a $54 billion market in the US. No one tracks the number of supplement products on the market, but the FDA estimates 40,000-80,000.

Sen. Richard Durbin (D-Ill.) and Sen. Mike Braun (R-Ind.) have introduced legislation to strengthen oversight of dietary supplements. They want to require supplement manufacturers to register with the FDA and publicly list all ingredients in their products. The dietary supplement industry, for its part, is opposed. Moreover, it wants you to believe that the white mulberry leaf supplement was not responsible for McClintock’s death, suggesting that any number of things might have caused her dehydration.

Here’s more from Just Care:
August 30, 2022
Does exercise make you hungrier?
Gretchen Reynolds reports for The New York Times on a new study that speaks to the effects of exercise on hunger. As you might expect, you are not likely to lose weight simply by exercising moderately, if you are not otherwise active. But, you are not likely to gain weight either.

Researchers looked at how moderate exercise affects the appetite of overweight men and women between the ages of 18 and 55 who don’t tend to move their bodies. It found that while they did not eat more afterwards, even when offered “enticing” food, they did eat heartily. In short, exercise did not lead them to eat less.

The data suggest that when you begin exercising, you are not likely to lose the weight that you think you might, given the calories you burn from exercising. Our bodies do not release our fat easily or quickly. It can take months. Some earlier studies have found that exercise can decrease people’s appetites in the short-term. But others show that exercise can lead people to eat more, to have bigger appetites.

Differences in study results are to some extent a function of who the participants are. If participants are young and active, the results could easily differ.

In short, if you’re mildly overweight and take up walking or light weightlifting, you are not likely to lose weight. Study participants burned about 300 calories each time they were active. But, they ate about 1,000 calories at lunch. Still, you can take heart that exercise should not lead you to eat more and gain weight.

Here’s more from Just Care:
November 30, 2021
Five things to know about gout
Gout can be a painful health condition, often a type of arthritis, which generally involves swelling in the joints and can be extremely painful. About 9.2 million Americans live with gout. With gout, your body produces more uric acid than your kidneys are able to filter out. Fortunately, gout can usually be treated, and you can live a productive life. Here are five things you should know about gout:
1. Who is likely to get gout?
  - About nine million adults experience gout at some point in their lives. Adults are prone to get gout, particularly men between 40 and 50. Current thinking is that gout runs in families, so whether you get it may spend on your genes. People who are overweight, who drink a lot of alcohol, or eat a lot of purines, such as high-fructose corn syrup, beer and scallops, are also more prone to gout.
  - Older people are also more likely to get gout because their kidneys are not working effectively to remove uric acid in their systems. And some medications, such as diuretics, also can lead to gout.
2. What causes gout? When you have an excess of uric acid in your system, needle-like crystals of uric acid can build up and end up in your joints or soft tissues. There, they cause gout, an inflammation and swelling, redness, heat, and stiffness in the joints that can be very painful.
3. What are the symptoms of gout? Often, people get gout first in the big toe, but not always. Sometimes, people get gout in their feet or ankles, knees or wrists, fingers and elbows. And sometimes the uric acid crystals end up in the kidneys and cause kidney stones. You can have an excess of uric acid without experiencing any symptoms, and then there’s generally no cause for concern or treatment. Treatment is needed when there is intense swelling or pain in the joints.
4. What are the triggers for painful symptoms of gout? Alcohol, drugs and stress are often triggers for a painful attack of gout, which usually begins at night and can last for three to ten days. The pain will typically end on its own, without treatment, but the swelling and pain can return at any time. There is an advanced and disabling stage of gout, in which the joints are permanently affected. With proper treatment, however, most people with gout never experience this stage.
5. How is gout treated? Gout is commonly treated with Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), which are taken by mouth, or corticosteroids, which are taken by mouth or by injection. With proper treatment, most people with gout can live pain-free or close to it.
Here’s more from Just Care:
November 16, 2020
Where’s your body fat?
Nicholas Bakalar reports for The New York Times on how extra fat in different parts of your body could affect your life expectancy. With fat in some places, you reduce your life expectancy. With fat in other places, you increase your life expectancy.

Generally, if you have body fat, no matter where it sits, you are likely to be at higher risk of dying younger. But, a meta-analysis of an enormous amount of research found that your risk varies based on where the extra body fat is located.

Researchers looked at 72 studies involving a total of 2.5 million people. They found that people with a lot of body fat in their waists, in the abdomen, were most likely to die prematurely. And, the amount of extra fat around your waist matters. An additional four inches added an 11 percent greater likelihood of dying prematurely.

Large waist size often means a higher likelihood of heart disease. It also can mean a higher risk of diabetes, cancer and Alzheimer’s disease.

What’s interesting is that the researchers found that there are some locations where extra fat increases your life expectancy. People with large thighs are less likely to die prematurely. Every two inches in thigh circumference means a 19 percent lower risk. People with larger thighs have more protective muscle.

For women, every four inches extra in hip circumference reduced risk of death by 10 percent. Women with larger hips have subcutaneous fat, not visceral fat, and that can be helpful.

The researchers also looked at people who had both larger waists and larger hips. They found that people with both still had a greater risk of dying early.

You might wonder how people who have less than the normal about of fat on their waists fare when it comes to life expectancy. There’s not as much research. But, what the data show is that, within a range, less waist fat could improve life expectancy. Outside that range, it’s unclear.

What can you do to extend your health and life expectancy? Focus less on your overall weight and more on your waist size!

Here’s more from Just Care:
October 5, 2020
Good news for anyone looking for help losing weight
Many of us are overweight, struggling to figure out how to shake off some pounds. And, it’s never easy. The good news is that Medicare pays the full cost of weight-loss counseling for people needing help losing weight. The bad news is that only a very small percentage of the people who might benefit from weight counseling are taking advantage of it.

The Centers for Disease Control reports that more than three in 10 people with Medicare are obese. And, obesity contributes to chronic health conditions, including heart disease, some types of cancer and diabetes. Studies show that counseling can help people take steps to lose significant weight.

Medicare covers weight-loss counseling for everyone with a body mass index of 30 or more, under Part B. To be covered, only primary care doctors or the nurse practitioners and physicians’ assistants who practice in their offices can provide the benefit.

The Medicare obesity-counseling benefit includes a weekly session for the first month and a session every two weeks for the next five months. Another six months of counseling, one visit each month, is covered for people who lose at least 6.6 pounds during the first six months of counseling.

Medicare covers weight-loss counseling at no cost to you if you see a doctor who accepts “assignment,” accepts Medicare’s approved rate as payment in full. Medicare sometimes covers gastric bypass surgery or laparoscopic banding surgery for people who are morbidly obese.

For reasons that are unclear, only a very small percentage of people with Medicare have taken advantage of the obesity-counseling benefit. They may not be aware of the obesity-counseling benefit or they may not be able to find doctors who will provide the counseling services. In sharp contrast, 250,000 people with Medicare have taken advantage of smoking-cessation counseling, which Medicare also covers.

(This post, originally published on March 24, 2015, has been updated.)

Here’s more from Just Care:
December 9, 2019
Top predictor for a longer life: close relationships
Only one in 5,000 people in the U.S. reach the age of 100. But, there are places where five to ten times as many people live to 100. Some researchers say that the top predictor for a longer life is have at least a few close relationships.

People live longer when they are surrounded by friends and family who care for them, in places where old age is respected. Some analysts say that between 10 and 25 percent of a person’s life span can be explained by the person’s genes; the remaining 75-90 percent of the person’s longevity is determined by lifestyle. Based on his studies, Dan Buettner explains in his TedTalk, that people with a plant-based diet, who are socially engaged and have purpose, live longer.

Buettner found that Seventh Day Adventists in Loma Linda, California and Okinawans who wake up in the morning with a sense of purpose and little stress, and who connect with their families and friends regularly, are more likely to live longer than others. They surround themselves with people who are “trusting and trustworthy.”

According to Buettner, both men and women in the highlands of Sardinia live into their 100’s far more often than people in the U.S. There are ten times as many centenarians there than here. These Sardinians are surrounded by multi-generations of family members and friends. Their diets and daily physical activity may help explain their long lives. Mostly, it’s their social networks, their personal interactions with family, friends and neighbors.

Psychologist Susan Pinker also studied Sardinians to understand why they live longer than people in the U.S. She notes in her TedTalk that women typically live six to eight years longer than men in the US. Women are more likely than men to spend time with their friends and family, talking to them, dining with them and bonding with them.

For a longer, healthier life, Pinker argues that it’s important to have at least three stable relationships. These relationships can lower your stress level and rates of dementia. They can make it more likely for you to survive a disease. She says that “social isolation is the public health risk of our time.”

You don’t have to be positive or upbeat to enjoy a long life. You need to be socially engaged, surrounded by people who love you and care about you. To promote a longer life with fewer chronic conditions, we benefit from buddies on whom we can rely to spend time with us. Casual contacts with the postman and the grocery store clerk also are valuable. So are dogs and other pets.

Of course, diet, exercise, maintaining a healthy weight, and not smoking or drinking too much alcohol all contribute to a healthy, longer life. But, the most likely way to improve your odds of living a long life is to have buddies, people with whom you are socially interacting regularly, people you can count on to take care of you, people you can share stories with.

And, to be clear, we thrive with face-to-face contact–eye contact, physical contact. This contact releases oxytocin, lowers stress, generates dopamine–gives us a little high. It’s far different from online activity.

A version of this post was published on August 20, 2017.

Here’s more from Just Care:
October 28, 2019
Eat better, spend less on health care
So long as the US population is aging, health care costs will continue to increase no matter what happens with health care reform. An op-ed in the New York Times, by Dariush Mozzafarian and Dan Glickman, argues that the food we eat drives up health care costs. If Americans ate better and became healthier, we would spend far less on health care.

Today, tens of millions of Americans suffer from one or more chronic conditions. Close to one third of the US population, more than 100 million adults, have pre-diabetes or diabetes. More than one third of the population, more than 120 million adults, have cardiovascular disease. And three quarters of the adult population is obese. These chronic conditions are responsible for hundreds of billions of dollars in health care spending, as well as lost productivity. (Note: Medicare covers a diabetes prevention program, weight-loss counseling and nutrition counseling.)

We know that people who eat healthy diets feel better and have lower health care costs. But, that’s different from knowing how to change people’s diets so that they eat better, especially when the food industry giants invest heavily in getting people to eat unhealthy diets. What would it take to improve population health through better nutrition?

The authors suggest a number of ways to improve people’s diets. They propose that electronic health records include nutrition; health care providers could focus more on eating well and prescribe people fruits and vegetables; health care providers also could design healthy meals for people in poor health. One recent study shows that, for each person in poor health, these healthy meals alone would save $9,000 a year in health care costs.

Of course, behavior change, whether for a health care provider or a patient, is challenging. And, the food industry will do what it can to make change in people’s eating habits difficult. The food industry has done a great job of keeping sugary beverages and junk food from being taxed more, even though these foods have no health benefits and drive up health costs.

The authors also suggest that the government subsidize the cost of healthy foods, such as vegetables, fruits, nuts, beans, whole grains and fish. They suggest government regulatory safety standards for processed foods to reduce sugar, sodium and transfats, if not voluntary action by industry. And, SNAP, which helps about 12 percent of Americans with the cost of food, could focus more on a healthy diet.

Government has a big role to play in helping people to eat healthy diets. But, no presidential candidates are talking about food policy and few journalists are asking about it. Government action in this area may be a long time coming.

Here’s more from Just Care:
August 28, 2019
Keeping mentally and physically healthy and engaged may prevent dementia
A 2017 study by a worldwide team of dementia experts, published in Lancet, lays out the latest research findings on dementia, and the news is better than you might expect. There are a range of proven ways, particularly through mental and physical stimulation, to prevent or delay dementia.

Dementia literally translates from the Latin to mean “out of mind.” It is a brain disorder that affects memory and the ability of people to process information. In 2015, 47 million people around the world, mostly people over 65, were living with dementia at a cost of $818 billion. By 2050, there are expected to be almost 150 million people living with dementia. Today, one in three older people die with dementia.

Though there is no cure for dementia, people’s daily activities may delay or prevent its onset. And, for people diagnosed with dementia, there are ways to slow down the course of the disease and improve quality of life. The data suggest that people who are better educated, as well as more mentally and physically active and socially engaged, are less likely to be diagnosed with dementia.

Not surprisingly, social isolation, not having friends or family to talk to and spend time with, and poor education, increases the risk of dementia. In addition, people with hearing loss who are not managing that condition are prone to getting dementia.

Here are a few ways that have been found to delay or prevent dementia:
- Treatment for hypertension or high blood pressure is important since high blood pressure has been found to cause dementia.
- It is possible that more than one in three cases of dementia can be delayed or prevented through exercise, having a social network, and engaging your mind.
- Smoking less.
- Managing hearing loss,
- Keeping your blood sugar level under control if you have diabetes.
- Maintaining a healthy weight; and,
- Treating depression.
Getting a diagnosis of dementia in its early stages can allow for treatment interventions that maximize memory and cognition, and reduce stress and depression. There are many people living with dementia who are able to drive and function independently. You can learn more about the living with dementia movement, here.

Here are ways to help people living with dementia remain independent. And, here are best practices for communicating with a person with dementia.

Here’s more from Just Care:
March 25, 2019