Monthly Archives: November 2013

Changes in Household Routines Help Reduce Kids’ Obesity

Changes in Household Routines Help Reduce Kids’ Obesity: Study

Parents who limited kids’ TV time, increased sleep time saw less excess weight gain in children

By Kathleen Doheny
HealthDay Reporter

TUESDAY, Sept. 10 (HealthDay News) — Small changes in household routines, such as limiting TV time and increasing sleep time, can help minimize excess weight gain in young children at high risk of obesity, according to new research.

“Improving household routines led to a reduction of the risk of childhood obesity,” said study researcher Dr. Elsie Taveras, chief of general pediatrics at Massachusetts General Hospital for Children in Boston.

“We were able to improve sleep time (and) reduce time spent watching television, and we were able to show that in the intervention group, children had a lower rate of weight gain,” Taveras said.

About 17 percent of American children and teens are obese, according to the U.S. Centers for Disease Control and Prevention. And lower-income kids are at particular risk.

“Already by age 2, we see higher rates of obesity among low-income, racial and ethnic minority families,” Taveras said.

Both lack of sleep and too much “screen time” are linked to childhood obesity. So Taveras wanted to see if simple changes in household routines could make a difference.

Her team recruited 121 families with 2- to 5-year-old children and assigned half to make these small changes with the help of “health coaches,” who made a few home visits and phone calls. The other families got information on child development, such as playing with a child to prepare him or her for school.

Close to half of the children were already overweight for their age and sex, the study authors noted.

After six months, children in the intervention group were sleeping about three-quarters of an hour more at night and watching TV for one hour less on weekends, according to the study published online Sept. 9 in JAMA Pediatrics.

What’s more, they had a slower rate of weight gain: After six months, their body mass index (BMI) — a measure of weight in relation to height — had dipped. Weight loss was not the goal, the researchers stressed — just healthier weight gain.

“We would not expect them to lose weight,” Taveras said. “They are growing in height and weight. We aimed to slow down the rate of their gaining.”

The changes that families made were simple, Taveras said. To encourage more sleep, parents could give their child a warm bath or read a book before bed, acclimating the children to the routine and a consistent bedtime. (Experts say 2- to 5-year-olds need 11 or more hours of sleep to be well-rested.)

Parents said they often used TV as a way to occupy their children while they did household chores. So the researchers supplied the families with simple arts-and-crafts sets and suggested they substitute that for TV.

The researchers also mapped out each family’s neighborhood, to help them find nearby playgrounds and parks, as an alternative to TV time.

Taveras said pediatricians and other health care providers might consider suggesting the program — minus the coaches — to their patients.

The study is an important one, said Dr. Thomas Robinson, a professor of pediatrics and medicine at Stanford University and Lucile Packard Children’s Hospital at Stanford.

“It demonstrates that it may be possible to influence some important health-related behaviors — sleep and TV watching time — along with body mass index, with a counseling program for the parents of preschoolers,” he said.

“These behaviors and BMI have not been easy to change in a world where junk food and screen time are so heavily marketed, and families are dealing with tremendous financial and social challenges,” Robinson said. “I think it is exciting to see studies like this one showing positive results.”

Much more research on “possible solutions” is still needed, Robinson said. “But studies like this one demonstrate that the science is progressing and can help us design programs to help slow and hopefully reverse the obesity epidemic.”

The families in the study were mostly minority: Just over half of the children were Hispanic, one-third were black, and about 15 percent were classified as “other.” The intervention worked equally well across those groups, Taveras said, but it is not clear how well it would work for more-advantaged families.

Another expert who reviewed the findings noted that the study had limitations.

“I think the study findings are encouraging,” said Simone French, professor of epidemiology and community health director of the University of Minnesota Obesity Prevention Center. “Researchers are starting to realize that the home environment is an important setting to try to intervene with parents.”

However, she said, limitations of the study include the self-reports of changes, although that is a standard way of measuring the behaviors. The challenges, she said, include obtaining funding for the home visits so parents can have support in making the changes.

More information

To learn more about childhood obesity, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Elsie Taveras, M.D., M.P.H., chief, general pediatrics, Massachusetts General Hospital for Children, Boston; Thomas Robinson, M.D., M.P.H., professor, pediatrics and medicine, director, Center for Healthy Weight, Stanford University and Lucile Packard Children’s Hospital at Stanford, Calif.; Simone French, Ph.D., professor, epidemiology, and community health director, University of Minnesota Obesity Prevention Center, University of Minnesota School of Public Health, Minneapolis; Sept. 9, 2013, JAMA Pediatrics, online

Last Updated: Sept. 10, 2013

Copyright © 2013 HealthDay. All rights reserved.

‘Minor infection’ impacts women’s social lives

‘Minor infection’ impacts women’s social lives

 

11 September 2013

Credit: ThinkStock

Credit: ThinkStock

New research has shown that a common vaginal infection, often regarded as minor, is having a major effect on women’s lives, with recurrent sufferers avoiding sex and even social activities.

In a study published in PLOS One, researchers at Monash University, The University of Melbourne, Melbourne Sexual Health Centre and The University of Sydney interviewed women aged 18-45 with recurrent bacterial vaginosis (BV), an infection caused by an imbalance in vaginal flora. They found the impacts went beyond physical discomfort.

Approximately one in three Australian women will experience BV at some point in their lives. Symptoms include an abnormal ‘fishy’ odour and increased vaginal discharge. Longer term it has been associated with increased risks of miscarriage and preterm delivery, and susceptibility to HIV or other STDs. It is more common in women who have sex with women, who have a one in two chance of experiencing the condition.

Dr Jade Bilardi of the Monash University Department of Epidemiology and Preventive Medicine and Melbourne Sexual Health Centre led the study.

“Our study is the first to show how much recurrent BV is impacting on the lives of women in Australia,” Dr Bilardi said.

“Our findings show that while BV is often considered a minor and common vaginal condition by clinicians, its recurrent nature and the substantial impact it can have on women’s social, sexual and emotional lives means that women’s experiences can extend far beyond the physical symptoms.”

Unfortunately for many women, even after treatment with antibiotics, BV often comes back again within 12 months. The new study has shown that women who experience recurrent BV are susceptible to poor self-esteem, sexual withdrawal, self-isolation and feelings of self-blame as a result of having recurrent BV.

Researchers found that the symptoms of BV – in particular abnormal odour – left many women feeling too embarrassed and self-conscious to engage in normal sexual activities. Some women even reported avoiding social or recreational activities or sitting too close to others at work or social events for fear that others would notice their odour.

While a third of women were not overly concerned by having recurrent BV, describing it as no worse than thrush, the remainder felt it had a substantial impact on them. The degree to which it impacted on women physically, emotionally, sexually and socially often depended on the frequency of episodes and severity of symptoms.Overall, recurrent BV left many women feeling ashamed, dirty, unattractive, insecure and confused and frustrated.

The Cholesterol Controversy

This is a very measured and balanced opinion from my College, the RACGP. I am still on my Crestor, following the strong recommendation from my cardiologist, whom I trust (having chosen him very carefully).

College Crest
RACGP response to ABC
Catalyst programme

7 November 2013

The RACGP is a supporter of informed and unbiased public scrutiny of medical issues, with high level critical analysis and balanced debate cultivating community confidence in medicine and the RACGP itself.

The two part ABC Catalyst edition ‘Heart of the Matter’ (aired on 24 and 31 October 2013) expressed unsubstantiated theories on the causation of heart disease, and was selective in the presentation of evidence on the effectiveness of cholesterol therapy.

The Catalyst programme contained a number of misleading statements regarding nutritional claims on co-enzyme Q and heart health, and the claim that statins do not cause reduction in mortality in primary prevention, the latter of which is refuted by Cochrane reviews.

Patient concern has been high since the airing of the programme. In order to address patient safety and concern, the RACGP has distributed a media release requesting patients continue to take any cholesterol-lowering medications as prescribed and to discuss any concerns with their regular GP.

The RACGP supports a multiple risk factor approach to cardiovascular disease prevention, with cholesterol being only one of a number of risk factors that lead to heart disease. It is known that patients with a history of cardiovascular disease (CVD) are at high risk of further episodes, and will generally have a net benefit from statin and other preventive treatments; patients with no prior history of cardiovascular disease should have a cardiovascular disease risk assessment that will guide preventive therapy decisions.

The RACGP supports the National Vascular Disease Prevention Alliance Guidelines which base treatment decisions on a patients’ absolute cardiovascular risk, with the exception of familial hypercholesterolemia where practitioners should not base treatment decisions on cholesterol levels alone.

The RACGP does however recognise that certain issues raised in the programme are of genuine concern. These include:

  • inappropriate usage of statins in low and moderate risk groups
  • the need for promotion of non drug interventions (non smoking, exercise, Mediterranean diet) in the management of cardiovascular disease
  • the concern of drug company influence on clinical trials, and these companies withholding data from such trials
  • doctors with ties to the pharmaceutical industry that have substantial influence in guideline groups, and the need for open disclosure standards
  • the role of drug companies influencing prescribing of practitioners
  • the dangers of changing ‘disease definitions’, specifically what level of cholesterol is considered ‘abnormal’, that results in more drug use
  • over diagnosis becoming a significant issue in health.

It is these issues that are of serious concern and the RACGP believe that these should be considered and debated in the community at large.

Since its formation, the RACGP has been and remains a strong advocate for preventive health and evidence-based medicine. The RACGP urges all GPs to follow guidelines outlined in its Guidelines for preventive activities in general practice (8th edition) (red book) and for patients to see their GP regularly and adopt a healthy lifestyle.

Other useful resources include:

National Vascular Disease Prevention Alliance Guidelines

Absolute cardiovascular risk calculator

Cochrane review – Statins for the primary prevention of cardiovascular disease

The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials

Statins(cholesterol lowering Tabs) reduce effects of aging.

Statins may slow human aging by protecting against telomere shortening: A feature of senescent cells
EurekAlert!, 08/30/2013

New research in The FASEB Journal suggests that statins protect against DNA shortening by telomerase activation and promote healthy aging free of age–related diseases like heart disease, diabetes and cancer. Not only do statins extend lives by lowering cholesterol levels and reducing the risks of cardiovascular disease, but new research in the September 2013 issue of The FASEB Journal suggests that they may extend lifespans as well. Specifically, statins may reduce the rate at which telomeres shorten, a key factor in the natural aging process. This opens the door for using statins, or derivatives of statins, as an anti–aging therapy. “By telomerase activation, statins may represent a new molecular switch able to slow down senescent cells in our tissues and be able to lead healthy lifespan extension,” said Giuseppe Paolisso, M.D., Ph.D., a researcher involved in the work from the Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine at Second University of Naples in Naples, Italy.

Cholesterol and Statins.

I viewed the Catalyst program with great interest, as I take a statin (Crestor) on the advice of my cardiologist, to lower my cholesterol. Like many of you, I need to decide whether I really need to be on it.

My opinion is that too many people are on statins unnecessarily, especially women, as they are less effective in women. However, some people do need it as they are very effective in some in reducing the chance of a heart attack. Read on….

4 November 2013, 9.35pm AEST

Viewing Catalyst’s cholesterol programs through the sceptometer

On the past two Thursdays, the ABC’s Catalyst program set off a chain reaction of protest from sections of the medical community, aghast that the non-medical media would question the accepted wisdom that dietary saturated fats kill people and statins – medication to lower cholesterol – save lives. Professor…

What should we make of the claims about saturated fats and cholesterol-lowering drugs? Image from shutterstock.com

On the past two Thursdays, the ABC’s Catalyst program set off a chain reaction of protest from sections of the medical community, aghast that the non-medical media would question the accepted wisdom that dietary saturated fats kill people and statins – medication to lower cholesterol – save lives.

Professor Emily Banks, chair of the Advisory Committee on the Safety of Medicines, warned the ABC to pull the second program. Yet the show went on: as befits a catalyst, it remained unaffected by the reaction it had produced.

Australian Medical Association president Dr Steve Hambleton claimed the programs “gave extraordinary weight to an opinion that is a minority view,” while his predecessor Professor Kerryn Phelps put her weight behind the minority view, tweeting “Time for Australian therapeutic guidelines on cholesterol and statins to be revisited.”

Plenty of fat spitting from the frying pan in all directions – so what is a non-expert to make of it?

As a GP who has no intention of ever doing a PhD on sub-types of fat (for fear of brain supersaturation), in these situations I whip out my most discriminating organ: my sceptic’s eye.

The result? Surprisingly, the two Catalyst programs scored almost polar opposites on the sceptometer.

The first program starts with a fellow called Dr Jonny Bowden saying:

I think it’s a huge misconception that saturated fat and cholesterol are the demons in the diet, and it is 100% wrong.

At the phrase 100%, my sceptometer already gives a twitch. Just who is this confident expert?

A quick search reveals that Jonny describes himself as the Rogue Nutritionist to promote his 14 diet books. His website contains 20 pages of online shopping for bottled pills for anti-aging, detox, liver clearing, immune support and brain power.

Next up, cardiologist Dr Stephen Sinatra: at least he should know a thing or two about cardiovascular risks. But it doesn’t bode well that the home page of his website serves as a shop front to sell his own personalised brand of vitamin pills. You can buy Dr Sinatra T-support or click through to “anti-aging bombshell” Longevity Plus, before spending $55 on an “energy booster to refuel your cellular engines”. Er, no thanks, my engines are fine.

The next expert is US diet-book author and infomercial developer Dr Michael Eades. His website suggests that your weight loss solution is Metabosol™ Ultimate Success Pack, full of Diet Aid natural ingredients. And he’ll sell it to you for just US$209.95. Have these guys never heard of broccoli?

During Catalyst, Dr Eades questions the motives of the multibillion dollar food industry fuelling our phobia of fat in the diet. “That’s not science. That’s marketing,” he explains. At last: a statement where I can unreservedly accept that he would be an expert.

Honestly, even at this early point, I give up. The sceptometer has blown a fuse.

Saturated fat isn’t a “demon in the diet”, according to Dr Jonny Bowden, the Rogue Nutritionist. FLICKR/Dave77459

The quality of the messengers has me doubting their counterintuitive message. For now, I’ll stick with the 2012 Cochrane Review that suggested a modest (14%) reduction in heart attacks when participants tried to lower their saturated fat intake, although no conclusion could be drawn on overall risk of death. Certainly no reason to change mainstream dietary advice.

With a heavy heart (probably the trans-fats) I awaited the second Catalyst on statins, but to my pleasant surprise, the first commentator is respected academic Professor Rita Redberg, who prefers editing JAMA Internal Medicine to selling vitamin cure-alls. I have long been a fan of her Less is More series, which applies the blowtorch of best-available evidence to common medical interventions which our profession probably over-uses.

It’s hard to quibble with anything in her opening gambit:

The marketing concentrates on the fact that you can lower your cholesterol as if that was the end in itself, which it is not. Cholesterol’s just a lab number. Who cares about lowering cholesterol unless it actually translates into a benefit to patients?

The crucial question, then, comes down to mortality data in randomised control trials (RCTs). As end points go, death is easily measured, and all my patients consider it suitably clinically relevant.

Says Redberg:

One or two people in a hundred will benefit from taking a statin. What people don’t understand is that means the other 98 will get no benefit at all. It’s not going to reduce their chance of dying.

Despite the shocked reaction to the Catalyst episodes, the science behind the claim that we overprescribe statins — the world’s most profitable drug class ever — has been steadily building for years.

This may be a revelation for the general public. And for doctors who rely on pharmaceutical reps for a substantial portion of their medical education. However, we learnt this back in 2010 from a meta-analysis of 11 RCTs looking at the ability of medications to reduce the risk of death in people who were at high risk of heart attack (but who had no history of heart attacks).

Its conclusion was fairly unambiguous: it did not find evidence that cholesterol-lowering drugs reduced the risk of death in people at high risk of heart attack.

Statins have been prescribed to over 40 million people FLICKR/ACJ1

Is this enough to show statins simply “don’t work”? No. But it is more than enough to make one suspect we may have overstepped the mark with many of the 40 million people currently prescribed statins.

And the mark — the cutoff point recommended by expert panels — keeps shifting lower, encouraging more treatment. Catalyst pointed out that eight out of nine of the 2004 US guideline panel members had a direct conflict of interest after declaring financial ties to the companies that manufactured statins.

This “guideline” conflict is, if anything, worsening. According to a September 2013 BMJ report:

… widespread financial conflicts of interest among the authors and sponsors of clinical practice guidelines have turned many guidelines into marketing tools of industry. Financial conflicts are pervasive, under-reported, influential in marketing, and uncurbed over time.

Because of their popularity and the sheer enormity of the profits involved, statins provide one of the most concerning examples of this type of market engineering.

This second Catalyst episode goes on to mention publication bias, pharmaceutical sponsorship potentiating biased reporting of outcomes, withheld trial data (see the AllTrials campaign) and the distasteful phenomenon of Key Opinion Leaders. These are specialist doctors identified and sponsored by the pharmaceutical industry to educate other doctors about diseases for which there is a branded treatment.

So was Catalyst wrong to air a program which, as National Heart Foundation CEO Dr Lyn Roberts pointed out, might encourage some people to stop taking their statins without consulting their GP?

No; the more likely effect is that people will start raising the issue with their GP, which is a good thing.

Although I can understand the NHF’s concern after suffering through the snake-oil salesmen in the first program, I think the second chapter effectively introduced an important debate — and certainly everybody is now talking about it.

So in the end, I’m glad I sat down for the sequel, despite my overheated sceptometer warning against it.

I did have to watch the dial anxiously when Jonny the Rogue Nutritionist returned to plug his Coenzyme-Q10 pills. But then, I’d also watch the dial if I ever attended a GP educational session and discovered that the specialist talking was a Key Opinion Leader and his topic was statins.

Finding it difficult to lose weight?

Marcelle Pick, OB/GYN NP on The Core Balance Diet

Do you have weight loss resistance?

by Marcelle Pick, OB/GYN NP

As a culture, we believe that if you simply stop eating so much and just get more exercise, you can always lose weight. Personal trainers, nutritionists, and even well-intentioned healthcare practitioners relay this message to women every day. Yet there are still women out there who can’t lose weight. Are they lying about what they eat and about how much they exercise? I don’t think so — because I was one of these women.

When I was 19, I joined Weight Watchers and drove myself crazy weighing and measuring every morsel of food I put in my body. I never missed a workout, never cheated with food, and every time I got on the scale, I’d find I only lost a mere half-pound or even gained. I know that Weight Watchers works well for some people, but it didn’t work for me. And now I know it was because I had something called weight loss resistance.

Questions

I talk to women every day who spend hours at the gym, who starve themselves regularly, and just can’t figure out why they aren’t losing weight. Weight loss resistance is extremely frustrating, and often isolating. If this sounds like you, the first thing I want to say is I believe that you are not a closet eater and that you are doing everything you can. The reality is, there may be a metabolic imbalance blocking you from weight loss, and once you resolve it, the weight will melt away, stay away, and allow you to maintain a healthy weight.

What is weight loss resistance?

Weight loss resistance arises when a woman develops or has a preexisting metabolic imbalance that makes losing weight and maintaining healthy weight extremely challenging, despite her best efforts to eat less and exercise more.

Could weight-gain be in your genes?

New research in genetics is helping us to understand that genes cause some to metabolize fat differently than others. This means that certain kinds of food and exercise may be better for some than others.

While some women may lose weight on a lower-fat diet, others may benefit from a more Mediterranean-style diet. While some women lose more weight with endurance-style exercise, others may do better with strength training. In other words, we’re all different!

The good news is that there are always dietary and lifestyle measures that can powerfully influence your genetic propensity, but if you would like to explore your genetic profile in more depth, we offer testing through our clinic.

I’m not sure why our culture is always trying to put us in a box, one where the same solutions work for every person. Mother Nature proves to us again and again that we are all unique. What works for you may not work for your girlfriend or your sister. Our differences in shape, size, color, genetics, and personality are all worthy of embrace and celebration. You deserve to find out what’s lying at the core of your weight loss puzzle and we can help you get there.

Here are the six core systemic imbalances that greatly contribute to weight loss resistance in women:

Six ways to address weight loss resistance

We often see a combination of the above imbalances in stubborn weight loss resistance, but as we begin to work with a woman, we see one that generally predominates. Here are six fundamental measures you can begin to apply today. We have found each of these beneficial to a woman’s efforts — no matter how entrenched her weight loss resistance.

1) Understand your unique physiology. Work with a functional medicine practitioner or join a program like our Personal Program for Weight Loss Resistance to identify any metabolic imbalances keeping you from weight loss. Once you find out what your imbalance is, you can tailor your nutritional plan and lifestyle changes to re-balance your system.

smoothie

2) Get the best raw materials. I suggest eating three well-balanced meals and two snacks each day. Organic fruits and vegetables are always good choices, but also be sure each meal and snack includes some high-quality protein like legumes, nuts, fish, or lean organic meats. If you are often on the go, a snack shake made of whey protein and almond milk or water is also a great choice. Our WheySational shake is a great option. It helps support your metabolism, while satisfying cravings.

Along with regular meals and snacks, successful weight loss is facilitated by including certain vitamins, minerals, and cofactors in your diet. In particular, chromium, zinc, vitamin C, D3, and the B vitamins are essential for healthy metabolism. So be sure to include a high-quality multivitamin–mineral complex like the one we offer in our Personal Programs to support your weight loss efforts.

3) Move your body. Even if you’ve felt discouraged by your fruitless workouts of the past, regular exercise is integral to a woman’s health — especially to shake off extra pounds and maintain that healthy weight. Overcoming weight loss resistance and resetting your metabolism will generally require a little sweat — but for those short on time, bursting or interval training is a super-efficient option.

4) Address stress and emotional health. For some, rebalancing your body may be as easy as ending a troubling relationship! I had one patient whose weight loss resistance was rooted in stress. Her husband was cheating on her and embezzling money from her. Dumping him helped her to lose 40 pounds without doing anything else! So take the time to explore what’s working and not working in your life, because these things truly do influence your make changes and sustain healthy habits.

5) Find time to restore and SLEEP. Quality sleep is something we all compromise when we’re overscheduled. But if you’re serious about losing weight, sleep has to become a top priority. Not only does a good night’s sleep allow our body time to restore itself, sleep plays an integral role in how hungry we feel. Studies show that getting too little sleep causes us to consume more calories. Eight hours of sleep between the hours of 10:00 PM and 6:00 AM is ideal when you want to overcome weight loss resistance.

holding hands

6) Gain the benefit of a supportive social network. Research shows that people who join together in their weight loss efforts are more successful. Whether you find a partner to start your new weight loss plan with, join a larger group, or simply take advantage of our Member Advocates and Wellness Coaches, gaining connection with others can really help you lose weight.

It’s time to solve your weight loss puzzle

I know that you may have been struggling with weight loss for a very long time, and that you probably feel discouraged, disheartened, and maybe even guilty. Please take these feelings and release them for good, from your body, soul, and mind. weight loss resistance is not your fault. It’s an underlying imbalance that is keeping you from losing weight. Once this imbalance is addressed, the weight will come off — I promise.