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Physicians encouraged to ease guilt, embarrassment in patients with obesity

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Healio interview

Disclosure:
Stanford claims to have received compensation from Currax Pharmaceuticals.

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A new poll suggests the COVID-19 pandemic may have made the obesity epidemic in the United States worse.

Before the pandemic, the obesity prevalence among American adults was 42.4%, according to the CDC. The new survey of 545 adults with a BMI of at least 27 kg / m2 found that just over half had gained some weight during the pandemic. Of these, nearly three in four had gained 10 or more pounds and half had gained 15 or more pounds.

New data suggests that the obesity epidemic worsened during the COVID-19 pandemic.
Photo source: Adobe Stock

The survey also found that almost one in three patients had never spoken to a doctor about their weight, and more than half of those surveyed said they were “uncomfortable”. To make matters worse, according to the authors of a recent study in BMC Family Practice, “obesity management has not been prioritized or effectively handled in primary care. [and] In 2008 less than 5% of home visits were devoted to obesity. “

Fatima Cody Stanford

Healio Primary Care spoke to Peer Perspective board member Fatima Cody Stanford, MD, MPH, FAAP, FACP, FAHA, FAMWA, FTOS, an obesity medicine physician and director of outside counseling services for Weight Center at Massachusetts General Hospital, on how primary care physicians can discuss weight loss with patients. Stanford also discussed a new online resource for obesity patients as well as other topics.

Healio Primary Care: Can you please describe the new online resource center for patients who want to lose weight?

Stanford: The new resource was developed in conjunction with the Why Weight: Communicate campaign. It’s an educational initiative designed to help you start your conversation with your doctor about your weight. Basically how do you implement this, how do you start this conversation in a productive and helpful way? There are videos, there are conversation starters, all of which are freely available to anyone who visits this site to really have this meaningful conversation.

Healio basic care: How can PCPs initiate conversations about obesity while Avoiding discussions that patients perceive as “fat shaming” “?

Stanford: I think we need to work with family doctors and all doctors to design our environment so that it is safe, warm, supportive and caring.

So one of the most important things you say is, “I’ve noticed that you may be struggling with your excess weight. Would you like to start looking at it today? ”Get an idea of ​​where the patient is. Are you ready to have this conversation – as opposed to assuming you are ready for this conversation – and when you are ready for this conversation do you get a feel for what you are trying to address? I think this gives patients the ability to have their voice and agency to address their obesity or other obesity issues.

Healio basic care: What are the limitations of using BMI to determine healthy weight? What other factors should PCPs consider when assessing patient weight?

Stanford: The BMI is just a calculation that was developed based on the Metropolitan Life Insurance table in the 1930s and 1940s based on actuarial data. How many people died or got sick with certain weight conditions, and that’s how they calculated it. The problem with this is that important parts of the population were not recorded. Black people like me, for example, were not considered [and neither were] Hispanic individuals who make up a sizable part of the United States. The BMI only takes height and weight into account. It doesn’t tell me anything about this weight. Is the weight muscle, is it fat? If so, is it fat that is stored around the organs – what we call visceral adipose tissue? What is it? So the BMI does not give us a complete picture.

Other things I use every single visit to my patients are something simple, like measuring their waist circumference with a tape measure. When we carry weight around our core it is much more damaging to our health, and when I carry weight in my bum, which I do, it is actually not damaging. That’s just muscle tissue and buns. But when it is in your midst around important organs like your heart and liver, it leads to metabolic disorders that lead to a myriad of health problems. I think the BMI is a decent population-based measure, meaning it can provide general information about the population as a whole, but when you’re working with a single patient you just want to focus on that patient and make them so happy, the healthiest weight for them instead of assuming they have to reach a number that doesn’t give us a lot of clear information.

Healio basic care: How can PCPs help patients set a healthy weight goal and plan a realistic weight loss journey?

Stanford: So what I do with my patients, what I think is a good strategy, is first, I never give my patients a target weight – and let me tell you, they have been asking for over 17 or 18 years now: “What weight should I have ? ” The reason I don’t do this is because everyone is different, meaning that every body reacts differently to interventions, be it a lifestyle change, taking medication, or having an operation. So I have to see what is the healthiest weight for her. One thing I recommend is to calculate things like total body weight loss from the first visit and calculate it over time. What we do know is that when someone loses between 5% and 10% of their body weight, it can have positive effects on their health. So that’s a percentage. That 5% to 10% would vary for someone weighing 400 pounds versus someone starting at 200 pounds, and that can lead to things like lower blood pressure, improved blood sugar, or improved cholesterol levels. These things are real and tangible, and we know that 5 to 10% can help people transition to a healthier state not only in relation to obesity but also in relation to other disease processes as well. For some we get as high as 45% – so that’s great, but the goal is these small measurable goals, starting with the goal of at least 5% at the beginning and then moving on.

Healio basic care: What are the best strategies PCPs can share with patients to combat food cravings?

Stanford: I think one of the best strategies family doctors can use is to emphasize the need to consume unprocessed foods. Some of the things that really drive our cravings is the processing of our food; We want our food to look like it does in nature. I take on Cheez-It, for example: they look like nothing in nature, which means they’re probably processed. We want lean protein, whole grains, fruits and vegetables, whole grain breads. If this is our predominant consumption, it can help with our cravings.

For those who are still having problems, they may need medications like Contrave, a drug used to change some of these food cravings. But we have to start with our lifestyle first and then move on to other strategies. And for some, they may even need surgery, and we should realize that different people may need different treatment strategies, but we want to start lifestyle changes at the base of the pyramid and have this meaningful conversation.

Healio basic care: What prescription weight loss treatments do you use in practice? What results have you seen with these treatments?

Stanford: As an obesity medicine doctor, I use every drug currently FDA cleared for the treatment of obesity here in the United States. There are a number of therapies. This campaign is run by the pharmaceutical company Currax, which makes Contrave – a combination of two drugs called bupropion and naltrexone. But on top of that I use all the other active ingredients: Qsymia, a combination of phentermine and topiramate; and Saxenda, a liraglutid, for example.

My goal is to find out what works for the patient, and I can tell you, as someone who has probably prescribed more obesity drugs than most people in this country, that everyone reacts differently to each drug, and sometimes we have to even combine active ingredients. My goal is to simply find out what works for that person and whatever we need to do to work safely for that person to help them achieve a healthy weight and improve their overall health. That is the strategy that we will maintain.

References:

Hales CM et al. Data overview from the National Center for Health Statistics. Obesity and severe obesity prevalence in adults: United States, 2017–2018. https://www.cdc.gov/nchs/products/databriefs/db360.htm. Accessed June 25, 2021.

Hruby A and Hu FB, Pharmaceutical Economics. 2015; doi: 10.1007 / s40273-014-0243-x.

Orjulea-Grimm M, et al. BMC Fam practice. 2021; doi: 10.1186 / s12875-021-01484-j.

Y. Wang et al. Int J Epidemiol. 2020; doi: 10.1093 / ije / dyz273.

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Harness the power of the body’s hormones for better health

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When a hormone is out of whack, you can feel like you’re stuck in the mud or strapped to a runaway horse. Just ask someone with untreated Graves’ or Hashimoto’s disease (these are high or low thyroid levels), hypogonadism (low testosterone or estrogen deficiency), or uncontrolled diabetes. Because hormones are the chemical messengers of your body and have a direct influence on your metabolism, energy level, hunger, cognition, sexual function / reproduction and mood.

There are around 50 hormones in your body and many more hormone-like substances (brain neurotransmitters like serotonin and active vitamin D2 for example). Your pituitary is the “master gland,” it tells other glands to secrete hormones. The other hormone-producing glands are the pineal and adrenal glands, as well as the thymus, thyroid and pancreas – men also produce hormones in their testicles (testosterone) and women in their ovaries (estrogen, progesterone and testosterone). Aside, about 25% of testosterone in women is produced in the ovaries, a quarter in the adrenal gland and half in the peripheral tissue.

It only takes a tiny amount of a few hormones to make big changes in every inch of your body. Therefore, if they are out of whack, it can cause you serious problems. In America, type 2 diabetes is the most common hormone-related disease. This happens when you become insulin resistant and this hormone, which is produced in the pancreas, can no longer regulate blood sugar levels, causing a cascade of health problems from atherosclerosis to neuropathy to kidney disease.

Here’s how you can calm your hormones – and restore your health:

Eat Smartly. The endocrine glands are happy when you eat healthy fats like olive oil, avocado, nuts, and seeds; high fiber foods like fruits and vegetables; lean animal protein such as salmon; and plant-based proteins like 100% whole grains and legumes / beans. This mix of nutrients lets your appetite regulating hormones leptin (I’m full) and ghrelin (I’m hungry) signal you accordingly so you don’t overeat. Overeating and obesity regulate many hormonal systems.

In addition, a healthy diet will nourish your thyroid hormones, which also help regulate weight. Perhaps most importantly, a healthy diet regulates the work of trillions of microbes in your gut biome that help regulate hormone production and produce hormone-like substances.

Cope with stress, sleep peacefully. Cortisol is a hormone released by the adrenal gland in response to stress. When chronically elevated, it can reduce the activity of your hypothalamus, which in turn can lead to imbalances in the messenger substances that affect sleep, eating, sexual activity, and cognition and mood. Then you can get tired and gain weight. Therefore, it is important to regularly exercise, meditate, take deep breaths, hang out with friends, volunteer to help others, and / or talk to a therapist. Healthy sleeping habits are also important for reducing stress and regulating hormones. Growth hormones, testosterone, cortisol and insulin are released during sleep. And studies show a link between chronic lack of sleep and depression and weight gain. For sleep hygiene information, visit DoctorOz.com.

Reduce Chronic Inflammation. Chronic inflammation occurs when your immune response is overstimulated to conditions that interfere with the peaceful functioning of your body. This can happen if you are overweight or obese, addicted to sugar and fast foods, smoke or drink too much, or are constantly under stress. These factors can trigger hormonal changes, such as insulin resistance, low testosterone and vitamin D levels, and increased cortisol, and they power your sympathetic nervous system, increasing your heart rate, blood pressure, breathing rate, and pupil size, and making your blood vessels narrow .

Plus: Eating healthy foods and managing stress and sleep will help reduce inflammation throughout your body and stabilize your hormones, but you can’t get real success if you’re sitting – 150 minutes or more of exercise per week is essential.

So make friends with your hormones and these powerful messengers will send you good news about your energy levels, sleep satisfaction, aging rate, and happiness.

Mehmet Oz, MD is hosting “The Dr. Oz Show,” and Mike Roizen, MD is the Cleveland Clinic’s Chief Wellness Officer Emeritus. For the healthiest way to live, tune in to The Dr. Oz Show or visit sharecare.com.

(c) 2021 Michael Roizen, MD

and Mehmet Oz, MD

King Features Syndicate

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Types of Millets And How Beneficial it is in Losing Weight

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Weight Loss Tips: Millet is an essential part of the whole grain family like rice, oats or quinoa. It is originally grown in Asia thousands of years ago. It’s gluten-free, filled with protein, fiber, and antioxidants. Millet is not only famous in India but has also gained in value in western countries.Read also – Weight Loss in Real Life: I was 104 kg, a visit to my daughter’s school changed everything

Millet is high in protein. It contains five grams of protein and one gram of fiber. Both of these ingredients help keep the stomach fuller for longer and reduce the snack habit between meals. This helps in shedding those extra pounds without compromising on your diet. Also Read – Weight Loss: Is It Safe To Eat Only Liquid Food When Losing Weight? Expert speaks | Exclusive

What Are The Health Benefits Of Millet?

Millet is high in antioxidants that help flush harmful radicals out of the body. It contains antioxidant components like quercetin, curcumin, ellagic acid, and other beneficial catechins. These help in eliminating toxins and neutralizing enzymes. It prevents health problems. Also Read – 6 Possible Reasons For Unexpected Weight Gain Explains The Nutritionist

Not only is millet very nutritious, it also has a good amount of fiber stored in it. It helps with digestion and prevents constipation, gas and acidity. It helps avoid digestive problems and prevents gastrointestinal cancer and kidney / liver problems.

  • Reduction of cardiovascular risks

Millet is high in and essential fats that help provide the body with natural fats. It also helps in preventing fat from being stored in the body. Along with this, it lowers the risk of high cholesterol, paralysis, and other heart problems. It contains potassium, which helps to keep an eye on blood pressure and increases blood flow.

What are the different types of millet?

Ragi is known for its iron content. It helps in the production of hemoglobin in red blood cells. It is high in calcium and potassium. Due to the high proportion of fiber, it keeps the stomach fuller for a longer period of time.

Jowar is loaded with nutrients like vitamin B, magnesium, and antioxidants like flavonoids, phenolic acids, and tannins. It helps boost metabolism and improves the quality of hair and skin. The presence of magnesium helps in strengthening bone and heart health.

Bajra is high in protein, fiber, magnesium, iron, and calcium. It’s low in calories and considered the best grain for shedding pounds. It keeps your stomach fuller for a long period of time without increasing your daily calorie count.

Amaranth is high in fiber, protein, magnesium, phosphorus, and iron. It helps improve brain function and prevents certain neurological diseases. It helps build muscle and maintain digestive health. It is also noted that amaranth has more nutrients than quinoa.

Kangni is known as semolina or rice flour. It helps in strengthening the immune system and balancing blood sugar levels as it is high in iron and calcium. It also serves as a better option for shedding those extra pounds. It usually includes low cholesterol, good digestion, and helps in building good heart health.

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Adherence To a Mediterranean Diet Lowers Risk of Diabetes

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Author: Kenya Henderson, 2021 PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

The Role of the Mediterranean Diet: Eating a healthy diet and maintaining a healthy weight can potentially reduce the risk of developing diabetes for the US population.

A Mediterranean diet is one of the few healthy eating habits that has been linked to significant health improvements. It is high in fruits, vegetables, whole grains, fish, legumes, and olive oil and is more common in European countries. It is recommended by the American Heart Association, the American Diabetes Association, and the Dietary Guidelines for Americans to help reduce the risk of chronic disease. In addition, it is linked to a reduced risk of diabetes in Mediterranean and European countries. However, it is unclear that the Mediterranean diet reduces the risk of developing diabetes in the US population. In a large US cohort study with black and white men and women, this study investigated whether Mediterranean eating behavior is linked to the risk of diabetes.

This study was a prospective cohort study that included patients in previous research, the Atherosclerosis Risk in Communities (ARIC) Study, which looked at the causes of heart disease in over 400,000 adults in the United States. In this study, data were collected from 11,991 participants on their first visit. Participants were excluded if they were Asian or Indian due to the small sample size; were black and from Maryland and Minnesota, unable to decipher the influence of geographic region on race; if they have a history or history of cardiovascular disease, diabetes or cancer; or if they were derived from the answers to the Food Frequency Questionnaire (FFQ) or if they had ten or more missing FFQ elements.

One of the statistical methods was an FFQ questionnaire to record the food intake of each patient on their first and third visits. The data recorded from the survey was used in the scores for the Mediterranean Alternative Diet (aMed). The scores ranged from 0 to 9 points, with 1 point being awarded if the patient reported consuming vegetables, fruits, or legumes himself, and 1 point if the patient reported consuming red or processed meat. The higher the aMed score, the higher the adherence to a Mediterranean diet. They also used Cox’s proportional hazard regression models to estimate the hazard ratios and confidence intervals for the associations between aMed scores and incidents of diabetes. Incidence diabetes was defined as: if the patient was diagnosed by a doctor, had taken diabetes medication in the past two weeks, had a fasting blood sugar of 126 mg / dL or more, or a non-fasting blood sugar of 200 mg / dL or above. Variables were also used in the Cox regression analyzes, including energy intake, age, gender, race, educational level, smoking status and physical activity, and clinical mediators of diabetes. They were all stratified by race and body mass index (BMI).

During a median follow-up of 22 years, this analysis found 4,024 cases of diabetes among the 11,991 participants. In summary, aMed scores and incidents of diabetes were higher in blacks than whites, but the risk of diabetes was reduced by up to 17% in both races. In addition, the associations between aMed scores and incidents of diabetes were found to be stronger in patients with a healthy baseline BMI, indicating that obesity or overweight outweighs the benefits of a healthy Mediterranean diet, as shown in the ARIC study and other U.S. Population. Therefore, the results of this study indicate that following a Mediterranean diet without weight loss may not reduce the risk of diabetes in overweight or obese populations. While following a Mediterranean diet could lower the risk of diabetes in people with healthy BMI, the discussion about restricting calories to achieve and maintain a healthy weight should remain one of the most important tasks of diabetes prevention. Overall, eating and following a Mediterranean diet lowers the risk of diabetes in a community-based US population, especially for black and normal weight individuals. Future studies should be conducted to determine whether a Mediterranean diet that results in clinically meaningful weight loss can reduce the future risk of diabetes in those who are overweight or obese.

Practice pearls:

  • Diets high in fiber, fruits, vegetables, fish, and olive oil have been linked to a lower risk of developing diabetes in the US population.
  • There are stronger associations between adherence to the Mediterranean pattern and incidents of diabetes among blacks compared to the US white population.

O’Connor, LE, Hu, EA, Steffen, LM et al. Adherence to Mediterranean eating habits and risk of diabetes in a prospective US cohort study. Nutr. Diabetes 10, 8, (2020). https://doi.org/10.1038/s41387-020-0113-x

Kenya Henderson, 2021 PharmD. Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

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