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Christine Collins knows dementia is rapidly stealing her mothers final days, robbing her of precious hours with her family and also care they could provide for her.

But so far, dementia hasnt counted as an end-of-life situation or sudden medical decline that would justify in-person visits with the 94-year-old, who lives in a nursing home.

She is actively dying every single day. I dont know when my last day with my mom is. Are they going to wait until shes in a coma? said Collins, who lives in York County.

Collins hasnt been in the same room with her mom since March, when the state shut down nursing home visitation because of COVID-19.

Shes part of a growing movement of people in Pennsylvania running out of patience with restrictions that prevent them from hugging or holding their loved ones hand in a long-term care facility and helping overburdened staffs care for them. They argue isolation, more than COVID-19, poses the gravest threat to people in long term care facilities.

Experts agree lack of close contact with loved ones makes nursing home residents vulnerable to depression, weight loss and other medical problems, and loss of will to live.

At the same time, nearly 70% of Pennsylvanias deaths from COVID-19 involve people in long-term care facilities. Facilities all over the country locked down because of COVID-19, which is highly contagious and especially deadly for older people because of their weakened immune systems.

Diane Menio, an advocate for people in long-term care and their families, points to a recent 20% increase in deaths among people with Alzheimers and dementia. Experts believe its linked to pandemic fallouts such as isolation, stress and lapses in care resulting from overworked nursing home staffers.

Its going on eight months and we havent been able to touch or hug our loved ones, said Shirley Shippey of Bedford County. They are declining. The isolation is killing them as much as COVID.

Shippey, whose 80-year-old mother lives in a nursing home, is the administrator for the Pennsylvania branch of Caregivers for Compromise.

Caregivers for Compromise was founded by a Florida woman who took a job as a dishwasher in a facility so she could see her husband. The Pennsylvania group has grown quickly and now has over 500 members.

The long-term care industry and government dont dispute the dangers posed by isolation.

In early September, the Pennsylvania Department of Health announced it would permit compassionate care visits in situations where a nursing home resident experiences a major health decline documented by medical records. One of the purposes was to allow family members to help with the care of their loved one.

However, Shippey said the visits havent materialized for many in her group. They describe barriers including difficulties in obtaining medical records, nursing home administrators claiming lack of knowledge of the process, and facilities saying they have to wait for their corporate owner to permit visits.

But then, on Sept. 17, the federal Centers for Medicare Services expanded the definition of compassionate care and told nursing homes they must allow visitation or face penalty.

Nursing homes must allow compassionate care visits in situations such as a normally talkative resident who has become withdrawn or begins crying frequently, a resident who needs cues from a loved one in order to eat and drink sufficiently, and a resident grieving the loss of a loved one. The policy is aimed at allowing visits by people who had formerly played a role in the care of the nursing home resident.

Zach Shamberg, CEO of the Pennsylvania Health Care Association, which represents long-term care facilities, said nursing homes regard the federal definition of compassionate care as almost all-encompassing It could really be applied in almost every situation.

Nursing homes were given 30 days to comply with the Sept. 17 directive, according to the association.

In essence, CMS has told nursing homes they must facilitate outdoor visits in virtually all situations. Further, they must allow indoor visits unless the facility has had a COVID-19 outbreak within the past 14 days or is investigating a possible outbreak, or the rate of positive COVID-19 tests in the local county is above 5%.

Still, CMS gives nursing homes latitude to impose conditions and refuse visits. For example, the homes can require visitors to pass temperature checks, impose time limits and other controls on visits, and eject people who dont follow infection control rules.

CMS also continues to encourage nursing homes to use outdoor visits whenever possible. Facilities should create accessible and safe outdoor spaces for visitation, such as in courtyards, patios, or parking lots, including the use of tents, if available, CMS wrote.

Members of Shippeys group are tired of window visits which, along with video visits, have been widely used in Pennsylvania as a substitute for direct visits. They say both can do more harm than good for people with Alzheimers or dementia.

Collins said her mother couldnt grasp why visitors remained outside. Her mothers distress was unbearable to watch, putting an end to the visits. Shippey describes a similar result.

Plus, with cold weather arriving, it wont be long before outdoor visits arent practical.

Shippey said as of late last week, most of the people shes heard from have been unable to arrange an in-person visit.

Diane Menio, an advocate for seniors, said recent guidance from the federal government should make it easier for families to visit loved ones in long-term care facilities.

Still, Menio, of the CARIE advocacy group, regards the recent CMS directive as major progress and expects people will soon be able to spend time at facilities and begin offsetting the harms of the isolation.

I think its taking a while. I think the facilities are very cautious, she said. Weve convinced [the government] its dangerous to isolate people .. its not perfect, but its certainly better than we had before.

Pennsylvania health department spokeswoman Maggi Mumma said the CMS rules supercede the health departments early compassionate care policy. She said the department is revising its own rules to align with CMS. She said nursing homes should follow the CMS rules for now.

The Department of Health must ensure the safety and well-being of nursing home staff and residents as the first priority, especially during the COVID-19 pandemic which has disproportionately affected older populations, Mumma wrote in an email.

She didnt directly answer a question about when people should expect the compassionate care visits to begin.

Meanwhile, facilities remain responsible for protecting their residents from COVID-19, a threat that is considered likely to grow again during fall and winter. If the overall positivity rate of COVID-19 tests within a county is above 5%, CMS advises nursing homes to test visitors.

An ongoing shortage of rapid testing could interfere with indoor visits, Shamberg said. Beyond that, uncertain supplies of protective clothing could interfere. Plus, thinly-stretched staffs will have to schedule and supervise visits, taking time away from caring for residents.

Even as Shippey pushes for an end to her separation from her 80-year-old mother, she worries about the impact on staff.

They dont have time for all that. The COVID has given them so much more to do and they are short on staff, Shippey said.

Meanwhile, Collins is acutely aware of precious days slipping away.

She points out that staff and people making deliveries enter her mothers nursing home daily. She says she would gladly take the same precautions.

I can do the same thing for my mom and be responsible, she said.

More:

Another big increase in COVID-19 cases at the Allenwood medium-security prison

Shippensburg University reports 10 COVID-19 cases in last week of September

Excerpt from:
The isolation is killing them: Nursing home residents need visitors despite pandemic, Pa. group says - PennLive

Shutterstock straining pasta in sink

When it comes to choosing a diet to follow, there are a lot of options out there. And while anyone can pick a diet that works well for their lifestyle, Rachel Paul, PhD, RD from CollegeNutritionist.com, says that there's one diet, in particular, that would be considered the worst diet for weight loss. She says a diet focused on low-protein, low-fat, and high-carb generally doesn't work well for people.

"Weight loss comes from being in a calorie deficit, and since higher fat and protein diets are more physically filling than low-fat diets, a person on a calorie-restricted, high carb diet will be more likely to be very hungry," says Paul.

Paul does recognize that different ways of eating certainly work for different people. But when looking at a high-carb diet that is low in protein and fat, she says it generally won't work for peopleparticularly when looking at satiety levels.

"When a person is losing weight, and then maintaining that lost weight, it's much easier to continue on with a way of eating if they're physically satiated," says Paul.

Here's a deeper look at why a diet focused on only carbs won't work, and what you should focus on instead. And for more healthy eating tips, be sure to check out our list of 21 Best Healthy Cooking Hacks of All Time.

Read the original article on Eat This, Not That!

First, it's important to note the types of carbs that are consumed. Even though low-carb and keto diets have become popular over the past few years, it's not bad for your body to have carbs. In fact, complex carbohydrateslike oats and beansare some of the best ways to get dietary fiber in your diet, which is incredibly important for overall weight loss.

However, if a high-carb diet was filled up with simple, refined carbs, it would be harder for the dieter to lose weight long term. A diet that is full of carbohydrates that have been stripped of their natural dietary fiber won't leave you feeling full, and will cause you to be even hungrier. Especially if you're not mixing in protein and healthy fats.

Video: Intermittent Fasting Really Can Help With Weight Loss (Buzz60)

Intermittent Fasting Really Can Help With Weight Loss

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No.

While there are a lot of studies and books that show you why a focus on a low-carb diet works for weight loss, diets focused on high-protein, high-fat, and low-carb generally don't have enough fiber in it. And fiber is important for digestion, warding off autoimmune disease, and weight loss in general.

Even though carbohydrates are not considered an "essential" food, according to Healthline, there are a lot of foods with carbohydrates that are full of good nutrients for your bodylike fruits and vegetables.

Now that we've debunked this myth, hereare 15 Carbs Myths That Are Totally Bogus.

Time-and-time again, a diet that focuses on the combination of all the macronutrients works well for weight loss. So if a high-carb diet is the worst diet for weight loss, then a medium-carb, medium-protein, and medium-fat diet would be the bestsimilar to how you would follow the best overall diet for weight loss.

Having all three macronutrients in your diet is key for overall satiety from your meals, so without them, your body is less likely to feel full with just carbohydrates. Especially if those carbohydrates are refined and processed.

Having protein in your diet helps to reduce the hunger hormone ghrelin.

Foods that are high in fat are the last to leave your digest tract, so by having a good amount of healthy fats in your dietlike avocadosyou'll feel full for longer periods of time.

And lastly, carbohydrates that are high in dietary fiber will release leptin, which is the hunger hormone that turns on your body's fullness switch. Plus, fiber also moves slowly in your digestive tract.

So if you're enjoying a smashed avocado on a slice of whole-grain toast, you're going to feel full for hours. Add a fried egg on top and you have yourself the perfect meal. And for more healthy carbs to add to your diet, bookmark our list of28 Carbs That Won't Make You Fat.

See more here:
This Is The Worst Diet for Weight Loss - msnNOW

WashingtonControlling blood sugar levels improved the ability to clearly think, learn and remember among people with type 2 diabetes who were overweight, a new study shows.

But losing weight, especially for people who were obese, and increasing physical activity produced mixed results.

Its important to properly control your blood sugar to avoid the bad brain effects of your diabetes, said Owen Carmichael, Ph.D., Professor and Director, Biomedical Imaging at Pennington Biomedical Research Center.

Dont think you can simply let yourself get all the way to the obese range, lose some of the weight, and everything in the brain is fine. The brain might have already turned a corner that it cant turn back from, added Carmichael.

The new paper examined close to 1,100 participants in the Look AHEAD (Action for Health In Diabetes) study. One group of participants was invited to three sessions each year that focused on diet, physical activity, and social support.

The other group changed their diet and physical activity through a program designed to help them lose more than 7 per cent of their body weight in a year and maintain that weight loss. Cognitive tests tests of thinking, learning, and remembering were given to participants between 8 to 13 years after they started the study.

The research team theorized that people with greater improvements in blood sugar levels, physical activity and weight loss would have better cognitive test scores.

This hypothesis proved partially true. Reducing your blood sugar levels did improve test scores. But losing more weight and exercising more did not always raise cognitive test scores.

Every little improvement in blood sugar control was associated with a little better cognition, Dr. Carmichael said. Lowering your blood sugar from the diabetes range to prediabetes helped as much as dropping from prediabetes levels to the healthy range.

More weight loss was either better or worse depending on the mental skill involved, Dr. Carmichael said. People who lost more weight improved their executive function skills: short-term memory, planning, impulse control, attention, and the ability to switch between tasks. But their verbal learning and overall memory declined.

The results were worse for people who had obesity at the beginning of the study. Thats a too little, too late type of message, he said. People with diabetes who let their obesity go too far, for too long may be past the point of no return, cognition-wise.

Increasing physical activity also generated more benefits for people who had overweight compared to those with obesity, the study shows.

Finding a way to offset the health effects of type 2 diabetes is vital. More than 25 percent of U.S. adults 65 or older have type 2 diabetes. The disease doubles the risk of cognitive impairment and dementia, including Alzheimers disease, and greatly increases health care needs and costs. (ANI)

See more here:
Enhancing blood sugar control boosts brain health for people with type 2 diabetes - India New England

October 03, 2020

WILKES-BARRE Teri Ooms, executive director of The Institute for Public Policy & Economic Development at Wilkes University, said this years Health and Health Care Task Force decided to focus on child abuse and neglect.

It is a topic that no one wants to really learn about, but it exists in Northeastern PA, Ooms said. It is fueled by poverty and all of the issues associated with poverty unstable housing, food insecurity, lack of health care, etc. and substance abuse and untreated/undiagnosed mental health issues.

Ooms said the Task Force study is really a primer. She said there are so many avenues of research and there are so many heroes in the region dealing with this, such as C&Y in both Lackawanna and Luzerne counties, the Childrens Advocacy Center, the Family Services Association of Wyoming Valley, Womens Resource Center, Childrens Services Center and CASA to name a few.

Child abuse and neglect are one form of adverse childhood experiences (ACEs) that can have an immediate and long-term impact on children, Ooms said. The Center for Disease Control and Prevention (CDC) reports that one in seven children have experienced child abuse and/or neglect in the past year, which is likely an underestimate.

Ooms said one out of every four girls and one out of every six boys will be sexually assaulted before they reach age 18. She said 90 percent of sexual abuse happens at the hands of someone the child knows.

The CDC also reports that children who live in poverty are five times more likely to experience abuse and neglect than those with higher socio-economic status.

In the Lackawanna and Luzerne County region, Ooms said the reports of child abuse have steadily increased annually since 2013, while the percent of substantiated reports has declined.

This increase was partly due to the changes made in Pennsylvania legislation in 2014, which led to an increase in reports as public awareness of child abuse and neglect increased and improvements were made in mandated and permissive reporter requirements, Ooms explained.

According to the PA Department of Human Services Child Protective Services 2018 Annual Report, there were over 44,000 reports of child abuse statewide in 2018, including nearly 2,000 reports in Lackawanna and Luzerne County, and 12 percent of these reports were substantiated.

Overall, there were over 5,000 victims of child abuse statewide in 2018 and 233 children in our region.

In Lackawanna County, 2.5 out of 1,000 children were victims of child abuse, and 2 children out of 1,000 were victims in Luzerne County.

Tragically, seven childrens lives were lost to child abuse in this region from 2016-2018, and six of those deaths occurred in Luzerne County.

According to Megan Stachowiak, Research Analyst at The Institute, Awareness and action can help children. Knowing the signs of child abuse and reporting it can save a childs life.

According to the Task Force report:

The majority of child abuse victims are female, and children ages 5 to 8 make up the largest age group of substantiated cases of abuse, accounting for 26 percent of abuse victims regionally in 2018.

The proportion of victims ages 9 to 11 also increased noticeably in our region, accounting for 22 percent of victims. In nearly half of all substantiated reports of child abuse statewide from 2016 to 2018, the perpetrator was the childs mother or father.

In 50 percent of cases, the child was living in a single parent home at the time of the abuse.

The majority of allegations in Lackawanna County relate to physical abuse (51 percent) while the allegations in Luzerne County (64 percent) and statewide (47 percent) are predominantly related to sexual abuse.

General protective services (GPS) reports related to neglect outpace reports of child abuse. According to the PA Department of Human Services Child Protective Services 2018 Annual Report, there were nearly 170,000 GPS reports received statewide in 2018, an increase of 12 percent from 2016. Of these reports, 24 percent were found to be valid, amounting to over 40,000 victims of neglect statewide.

In Lackawanna and Luzerne Counties, there were over 8,300 GPS reports in 2018, an increase of 19 percent from 2016 26 percent were valid, resulting in over 2,100 victims of neglect regionally.

According to statewide data on GPS reports, children ages 5 to 9 are the most common victims, accounting for 27 percent of reports. Another quarter of victims are between ages 10 and 14, and 22 percent are between ages 1 and 4.

The most common GPS allegations in the region related to parent substance abuse, followed by parental conduct that places the child at risk, homelessness/inadequate shelter, and child and parent behavioral health concerns.

An analysis of data on substantiated child abuse and neglect cases shows that across the Commonwealth, counties that have smaller populations and are classified as rural generally have higher rates of child abuse than those counties that are larger or urban. Higher rates of abuse are also correlated with higher levels of poverty and lower median income.

Child abuse and neglect does not just have immediate adverse effects it is devastating and can be debilitating for victims as they get older,Stachowiak said, Past research has found a causal relationship between experiencing early adversity and later in life health, social, and behavioral complications. These subsequent, lasting impacts of ACEs include injury, mental and maternal health, infectious and chronic disease, risk behaviors, and lost opportunities.

Furthermore, Stachowiak said there are societal costs.

Poverty and abuse are closely correlated; both are also highly inter-generational, she said. If families, parents, and children do not unlearn learned abusive behavior with help of social services they may fall back into the cycle of poverty and abuse and may also write the fate of their future generations.

Stachowiak said there is also an economic impact associated with child abuse and neglect. Research has shown that ACEs can negatively impact education and job opportunities.

According to the CDC, the total lifetime economic burden associated with child abuse and neglect was approximately $428 billion in 2015 in the United States, Stachowiak said. However, treatment and prevention programs are estimated to have a positive economic impact, potentially eliminating some of the damaging consequences of abuse and neglect.

Throughout this analysis, service shortages, gaps, and barriers to preventing and treating child abuse and neglect were identified. They included a high workforce turnover rate among employees of agencies providing welfare services, a lack of parental skill training, a lack of mental health services and therapy services for children, and barriers in accessing basic needs, including housing, transportation and childcare.

In order to address the challenges identified in this analysis and improve efforts to address and prevent child abuse and neglect, The Institute proposes a variety of recommendations:

Reduce gaps and shortages in services.

Provide training to enhance parenting skills.

Improve awareness and understanding of child abuse.

Explore centralization, regionalization, or coordination of child welfare services.

Increase availability of mental health services and support.

Expand access to treatment to lessen the harms of abuse and neglect.

Increase support for stronger family engagement programs.

Improve data collection and reporting.

COVID-19 effects

During primary data collection and writing this report, COVID-19 began to affect the area with school closures, mandated closures of non-life sustaining businesses, and shelter-in-home policies. The effects of these on child abuse are not yet known but all of the individuals and groups who were interviewed noted how they believe these safety precautions will cause spikes in child abuse and subsequent reports once schools re-open and normal life begins again. These effects cannot yet be quantified or verified.

All parties contacted for this study made sure to note that rates of child abuse and neglect would unquestionably be affected by COVID-19. Many noted that the rates would exponentially rise as not only are children home as school has been relegated to the home but because many parents may have lost jobs, are unable to pay bills and provide basic needs, lost childcare, are now having to home school children, have unstable transportation, and much more. Some stated that rates would rise but there would be a delay in reporting as children are not able to visit with friends, go to school and interact with teachers, or attend extracurricular activities during which mandated and permissive reporters might notice a change in a child or would be told by the child that some type of abuse had occurred.

There have been several reports on the national level that the rates of child abuse and domestic violence would be on the rise during stay at home orders and after people were furloughed or laid off. Though, again at the national level, these assumptions have been confirmed, reports from the Womens Resource Center counter this; they have stated that their phones are not ringing when they fully expected them to do so. There could be several reasons for this but one may be if a victim is living and quarantined with their abuser they may be unable to report due to proximity to abuser and/or being provided for by abuser in these strange, trying times.

Data is sourced from the PA Department of Human Services (2018, 2020) and the CDC (2020), (National Sexual Violence Resource Center, 2015), Childrens Advocacy Center of NEPA, 2020; Darkness to Light, 2015 and interviews from a variety of regional organizations

Originally posted here:
Beyond the Byline: Give me a few like Bob Gibson - Wilkes Barre Times-Leader

When it comes to choosing a diet to follow, there are a lot of options out there. And while anyone can pick a diet that works well for their lifestyle, Rachel Paul, PhD, RD from CollegeNutritionist.com, says that there's one diet, in particular, that would be considered the worst diet for weight loss. She says a diet focused on low-protein, low-fat, and high-carb generally doesn't work well for people.

"Weight loss comes from being in a calorie deficit, and since higher fat and protein diets are more physically filling than low-fat diets, a person on a calorie-restricted, high carb diet will be more likely to be very hungry," says Paul.

Paul does recognize that different ways of eating certainly work for different people. But when looking at a high-carb diet that is low in protein and fat, she says it generally won't work for peopleparticularly when looking at satiety levels.

"When a person is losing weight, and then maintaining that lost weight, it's much easier to continue on with a way of eating if they're physically satiated," says Paul.

Here's a deeper look at why a diet focused on only carbs won't work, and what you should focus on instead. And for more healthy eating tips, be sure to check out our list of 21 Best Healthy Cooking Hacks of All Time.

First, it's important to note the types of carbs that are consumed. Even though low-carb and keto diets have become popular over the past few years, it's not bad for your body to have carbs. In fact, complex carbohydrateslike oats and beansare some of the best ways to get dietary fiber in your diet, which is incredibly important for overall weight loss.

However, if a high-carb diet was filled up with simple, refined carbs, it would be harder for the dieter to lose weight long term. A diet that is full of carbohydrates that have been stripped of their natural dietary fiber won't leave you feeling full, and will cause you to be even hungrier. Especially if you're not mixing in protein and healthy fats.

Story continues

No.

While there are a lot of studies and books that show you why a focus on a low-carb diet works for weight loss, diets focused on high-protein, high-fat, and low-carb generally don't have enough fiber in it. And fiber is important for digestion, warding off autoimmune disease, and weight loss in general.

Even though carbohydrates are not considered an "essential" food, according to Healthline, there are a lot of foods with carbohydrates that are full of good nutrients for your bodylike fruits and vegetables.

Now that we've debunked this myth, hereare 15 Carbs Myths That Are Totally Bogus.

Time-and-time again, a diet that focuses on the combination of all the macronutrients works well for weight loss. So if a high-carb diet is the worst diet for weight loss, then a medium-carb, medium-protein, and medium-fat diet would be the bestsimilar to how you would follow the best overall diet for weight loss.

Having all three macronutrients in your diet is key for overall satiety from your meals, so without them, your body is less likely to feel full with just carbohydrates. Especially if those carbohydrates are refined and processed.

Having protein in your diet helps to reduce the hunger hormone ghrelin.

Foods that are high in fat are the last to leave your digest tract, so by having a good amount of healthy fats in your dietlike avocadosyou'll feel full for longer periods of time.

And lastly, carbohydrates that are high in dietary fiber will release leptin, which is the hunger hormone that turns on your body's fullness switch. Plus, fiber also moves slowly in your digestive tract.

So if you're enjoying a smashed avocado on a slice of whole-grain toast, you're going to feel full for hours. Add a fried egg on top and you have yourself the perfect meal. And for more healthy carbs to add to your diet, bookmark our list of28 Carbs That Won't Make You Fat.

Read the original here:
This Is The Worst Diet for Weight Loss, According to a Dietitian - Yahoo News

At some point, we've all wished we had an opportunity to talk to a nutritionist about the healthiest way to eat to lose weight, build muscle, and if what we're eating will helpachieve our long term health and weight loss goals. The Beet made this happen on video (below) whenEditorial Director, Lucy Danziger hosted a live chatwith Registered Dietitian Nicole Osinga,who created The VegStart DietforThe Beet,a 2-week plant-based plan that helps you get healthy, and lose weight, easily and naturally.

On the live video, viewers asked any question they liked about diet, weight loss, and calorie counting. To give you an idea, a few questionsasked were: "What's the healthiest oils to cook with?" "What's the best source of vegan protein?" "How many calories should I eat to lose weight?" And, "How would you explain your diet: Are you vegan or plant-based?"

Nicole shared her expert advice onthese topics andexplained why 1,500 caloriesis the baseline for weight loss on The VegStart Diet. She elaborated on which is healthier: Keto, Paleo, or Plant-Based, and helped everyone better understand the importance of meal prep.

This video is like a free one-on-one session with a nutritionist who answers all your pressing diet questions. In case you missed it, the video is posted below. And, if you have any questions you would like to ask Nicole, send us an Instagram DM or email at info@thebeet.com andshe will get back to you soonest. Now sign up for The VegStart Diet and get your 100-page e-Book with 56 recipes, 15 must-try tips, and helpful fun graphics, and start your easy, healthy plant-based journey today, and lose weight in just two weeks.

If you want to chat about The VegStart Diet with others who are on their plant-based journey, join the free Facebook group for daily information, group chats, and advice from beginners who are testing out a plant-based diet for the first time.

Stay tuned for more from Nicole Osinga on The Beet andsign up for The VegStart Diet to make a difference in your body, your mind, and your life.

The rest is here:
How to Lose Weight on a Plant-Based Diet, From a Nutritionist - The Beet

By PA/TPN, in Lifestyle 02-10-2020 01:00:00 0 Comments

We're frequently told that the key to weight loss is simple - just eat less and move more. Yet with obesity rates as they are, it's clear that for many people, it's really not that simple at all.

There is, of course, another option for those who are seriously obese or overweight and conservative methods alone haven't worked - and that's weight loss surgery, also known as bariatric or metabolic surgery.

But why is surgery sometimes deemed necessary, and what does it involve? Here, metabolic surgery pioneer Professor Francesco Rubino, lead of The London Bridge Hospital Metabolic and Bariatric Centre, part of HCA Healthcare UK, and chair of bariatric and metabolic surgery at King's College London, shares his views...

Why can it be so hard for some people to lose weight and keep it off?

"Severe obesity is a disease, not a lifestyle choice. Research shows that when we lose weight by diet, our body reacts by activating mechanisms that defend against that. In fact, hunger-stimulating hormones typically increase after diet-induced weight loss and our body also tends to reduce the amount of energy it utilises, making it difficult to maintain weight loss in the long-term," says Rubino.

"These effects are not under control of our willpower and are ingrained in our biology. This explains why people who try diets almost invariably regain weight at some point. This isn't necessarily a lack of self-discipline, or a person's fault, as most people think, but the result of the way our biology works, defending a set, narrow range for body weight. In people with severe obesity, this set point is too high but the mechanisms that normally defend against weight loss are still working and powerful, thus frustrating voluntary efforts to lose weight by eating less and exercising more."

What is weight loss surgery?

There are different variations of weight loss surgery. The two most common are gastric bypass surgery, which divides the stomach into two smaller pouches and re-routes the small intestine, and sleeve gastrectomy surgery, a procedure that removes part of the stomach and shapes it as a tube or 'sleeve'.

"They were originally designed to reduce the size of the stomach but they actually change the physiologic mechanisms that regulate appetite, satiety and sugar metabolism," Rubino explains. "There isn't a single procedure that fits everyone's needs. Different procedures have different actions, which may result in different potential to improve metabolic conditions associated with obesity, beyond weight loss," he adds. "Hence, the choice of procedure needs to be thoroughly discussed with a specialist and must be tailored to the individual patient's need."

Why is weight loss surgery so effective?

"In the 1950s, when bariatric surgery was first introduced, understanding of the functions of the gastrointestinal (GI) tract was quite rudimental - it was considered a mere digestive organ. So it made logical sense to think that by physically limiting the size of the stomach, or bypassing large portions of the intestine, one would be able to reduce the amount of food you can eat or the calories the body can absorb. Research over the last two decades, however, has shown this isn't true," Rubino explains.

"The GI tract is a complex, sophisticated endocrine and metabolic organ, something akin to a computer - some call it the 'second brain' - that receives input from the food we eat and sends signals to other organs to regulate body weight as well as sugar metabolism. Signals from the gut can inform the brain about calorie intake and accordingly regulate hunger and satiety. Other signals reach the liver and pancreas, where they can influence the production or action of insulin.

"This explains why gastrointestinal - bariatric/metabolic - surgery is so effective in inducing and maintaining weight loss, and also why it can dramatically improve other metabolic diseases, especially type 2 diabetes. Research has clearly shown bariatric surgery reduces or abolishes the very mechanisms that normally resist weight loss. In fact, the changes in hunger and satiety hormones that follow bariatric surgery are exactly opposite to those elicited by dietary interventions."

Is metabolic surgery really just a lazy way of losing weight?

"Some argue that diet and exercise, rather than expensive surgery, should be used to treat diabetes or severe obesity. This idea is both ill-conceived and ill-informed. In fact, there's definitive evidence that where surgery is indicated by current guidelines, lifestyle interventions alone are no longer sufficient to achieve adequate disease control," says Rubino. "On the other hand, in people with mere overweight or mild, uncomplicated obesity (BMI under 35 without other metabolic disease), surgery isn't indicated and isn't a replacement for a healthy lifestyle, which can still be effective in preventing progression towards more severe obesity.

"Hence, suggesting lifestyle interventions and not surgery should be the way to treat severe obesity is at odds with both scientific evidence and logic. Suggesting use of only lifestyle interventions in people with severe obesity (a full-blown disease) is tantamount to suggesting one should use lifestyle changes instead of surgery or chemotherapy to treat cancer."

Who can have the surgery?

There's a range of criteria for having weight loss surgery on the NHS. These include having a BMI of over 40, or having a BMI of 35-40 if you've already developed health complications that may improve with weight loss. Patients will need to be committed to long-term healthy changes after the surgery too.

"Recent clinical trials have shown that in patients with type 2 diabetes and obesity, metabolic surgery is more effective than any other available therapy," says Rubino. "Currently, the National Institute for Health and Care Excellence (NICE) and international guidelines recommend metabolic surgery be considered to treat type 2 diabetes patients and those with a BMI of 30 or over. However, only 0.2% or less of eligible patients have access to such surgery."

Who shouldn't have the surgery?

A number of factors can deem people unsuitable for surgery too, including: "People who don't suffer from severe obesity or its complications. Bariatric surgery is generally safe but this doesn't mean it's an appropriate or proportionate approach to deal with less severe overweight levels, where lifestyle changes have been shown to prevent progression toward severe obesity or diabetes in many patients," says Rubino.

"Also, people who are candidates for surgery but would be unsafe to operate on. Though bariatric surgery is less life-threatening than obesity or diabetes, it's still major surgery and requires general anaesthesia," he adds. "And people with conditions that can undermine compliance with nutritional supplementation. Bariatric surgery can alter the absorption of certain vitamins and micronutrients, s o patients need to rigorously take nutrient supplements, lifelong."

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When is it time for weight loss surgery? - The Portugal News

The best way to eat now is under much debate, as keto dieters line up against plant-based eaters, the low-fat camp has their studies to wave at the low-carb believers. So, we turned to Dr. Andrew Freeman, a well-respected cardiologist, for his expert advice on how to eat to be heart-healthy, avoid cancer, lose weight, and feel great. Dr. Freeman, who is in the Division of Cardiology andDepartment of Medicine at the National Jewish Health in Denver, says you have to try to eat the way our ancestors did: Mostly plant-based, avoiding processed foods and eat as manynatural foods as possible. "They were hunter-gatherers, but mostly gatherers," Freeman explains.

When it comes to whether to try to follow a ketogenic diet and avoid carbs, his view is: "Avoid Carbage, which is the carbs that are garbage," or highly processed foods like white bread, white rice, packaged foods, and added sugar. When it comes to trying to lose weight and be healthy, he adds, rather than cut out an entire food group like carbs, take what he calls the Goldilocks approach: Not too many carbs and not too few, but just the right amount, and focus on legumes, whole grains, vegetables, and fruit, especially the kind you could pick.

First, it's important to analyze your lifestyle and dietary habits and cut out the processed food, the sodas, or the chips, packaged snacks, or sugary sweets. I would advise someone to look at the easy fixes first. When people realize they are consuming 1,000 calories a day in soda, that's an easy one to cut out. I would encouragesomeone who wants to be heart-healthy to go as plant-based as possible. If you think about how our ancestors ate: Back then you ate what you found and it was mostly plant-based foods.

I would not say the modern ketogenic diet is terrible, but for most people, the implementation of keto is hardly healthful. It usually involves a lot of processed meat, like bacon. Plus, eliminating foods that we know are beneficial like vegetables and fruitsbecause they have carbohydratesturns out not to behealthyeither.

We know that processed meatcontains carcinogens, and you want to stay away from carcinogens since they cause cancer. When it comes to keto dieting I have nothing against it specifically, but it's the way most people do it that does not make sense to me. They wrap scallops in bacon and eat lots of processed meat. They lose weight but eventually, their cholesterol goes up. We don't know enough about the ketogenic diet, long term, to say it is unhealthy in itself. But the foods that people eat on it have been studied, and there is plenty of research that shows processed meat leads to heart disease and a higher risk of cancer.

There are some people who don't do well with keto. Some end up with digestive issues. So while we don't have enough data to say keto itself is the problem, it's well known that a diet high in meat and dairy leads to diseases like heart disease and cancer. So it's great to be skinny but it's not great to be skinny and get cancer.

The data we have from some years ago shows that a lower carbohydrate diet is worse for you in terms of health outcomes. I tell people: Don't go too low in carbs, since it appears to be unhealthy to eat all thatfat and protein. Take the Goldilocks approach to carbs, which is not too little... Not too much. Just the right amount. And make sure those carbs come from whole grains, from vegetables, fruit, and from legumes.

There are enormous health benefits from eating legumes, like lentils, beans, and pulses. The end of the day human physiologybenefits from these types of natural foods, and we arerapidly moving toward recommending a diet that is plant-rich and low in processed food. I would also recommend that for weight loss, add bouts of intermittent fasting. That's how humans lived. Long ago,theyhad to survive in the natural world, and they ate things they could find in nature or they grew them. It turns out that beans are some of the healthiest foods you could eat, especially lentils. These are high in fiber, fill you up, and have plenty of protein.

Our ancestors lived the way we are supposed to live: from the food you could gather. The natural way to eat is plant-based, with a little intermittent fasting thrown in. It turns out this is how our ancestors ate and it works. They had to be hunter-gatherers but they were much more likely to be gatherers. If they did get a piece of meat it was a rarity and a small amount.

If you combine a mostly plant-based diet with intermittent fasting, you will be healthy and maintain a healthy weight. That's how I eat (though I don't quite do intermittent fasting). I'm up early and cranking all day but if I had a less demanding lifestyleI would do that every day. And I do make it a point to exercise and try to be mindful. But back to our ancestors: Back then, you ate what you found.

You need to get exercise every day. Think about this: We know that all-natural food looked different way back then. Try picking organic strawberriesthey are tiny nothings. So we spent a lot of time and effort picking fruit. Things didn't look like they do today in the store. The natural food was smaller and had more nutrients. But it took energy to pick those berries and get enough calories to survive. So when you look at our ancestors they were using a lot of energy to get their food. Not like today when you walk into a store and it's all laid out for you.

When you look at the healthiest people in the Blue Zones [Dan Buettner's book about longevity patterns and what people who live long healthy lives have in common] they all are physically active, have strong social networks, enjoy quality sleep. If you look at their diet, the one commonality is that they don't drink too much alcohol and they eat mostly plants.

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The Healthiest Way to Eat to Prevent Disease, Says a Cardiologist - The Beet

As you get older, you need to work out and stay active and healthy as best as possible.

The most obvious reason would be to prioritize our health. Health is undeniably wealththats not up for debate.

But have you ever wondered what staying active does to our bodies and mind as we grow older? Very few people think long term when it comes to our bodies.

The fact is that weight training as we get older not only builds strength and muscle, but also builds motivation, confidence, improved blood flow, improved cardiorespiratory endurance, brain function, mobility and so much more. Cardio is also still important and should be continued for its health benefits. Interval training, which involves high intensity cardio with easier periods create the after-burner effect, pumps up the fat burn.

Ask yourself this: Wouldnt it be nice to look better and feel better? Or even walk up two flights of stairs without panting for breath? Or dramatically reduce the chances of lifestyle diseases, such as various cancers, obesity, blood clots, and fragile bones?

Its actually very straightforward, but its your choice whether you ignore healthy benefits by sitting on the chair watching Netflix or spend an hour a day improving your health and strength now and in the long term.

Theres is something uniquely beautiful and inspiring about a person who grows from their struggles and uses the lessons they learn in life to spread wisdom. To me it doesnt matter what you went through or how far you fell, but about you being an example that shows the outside world that its possible to rise, win and succeed regardless of your age.

Health is wealth folks, dont take it for granted. If you feel lost in the jungle of weight loss and finding a sustainable lifestyle, then do some research and choose a routine suited for your lifestyle.

Stop being afraid of what could go wrong. The truth is that most of the things you worry about, dont happen. And of the few things that do happen, the majority of people they happen to discover they could handle them better than they would have imagined possible. This means that much of what we worry about is just our fearful mind punishing us with misconception. If we worry less and do more, everything will turn out just fine. And if it doesnt, you just learnt a valuable lesson.

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Staying active is a long term investment - Stabroek News

According to the findings of a new study, controlling blood sugar levels improved the ability to clearly think, learn and remember among people with type 2 diabetes who were overweight. But losing weight, especially for people who were obese, and increasing physical activity produced mixed results.

"It's important to properly control your blood sugar to avoid the bad brain effects of your diabetes," said Owen Carmichael, Ph.D., Professor and Director, Biomedical Imaging at Pennington Biomedical Research Center."Don't think you can simply let yourself get all the way to the obese range, lose some of the weight, and everything in the brain is fine. The brain might have already turned a corner that it can't turn back from," added Carmichael. The new paper examined close to 1,100 participants in the Look AHEAD (Action for Health In Diabetes) study. One group of participants was invited to three sessions each year that focused on diet, physical activity, and social support.

The other group changed their diet and physical activity through a program designed to help them lose more than 7 per cent of their body weight in a year and maintain that weight loss. Cognitive tests - tests of thinking, learning, and remembering - were given to participants between 8 to 13 years after they started the study. The research team theorised that people with greater improvements in blood sugar levels, physical activity and weight loss would have better cognitive test scores.

This hypothesis proved partially true. Reducing your blood sugar levels did improve test scores. But losing more weight and exercising more did not always raise cognitive test scores."Every little improvement in blood sugar control was associated with a little better cognition," Dr Carmichael said. "Lowering your blood sugar from the diabetes range to prediabetes helped as much as dropping from prediabetes levels to the healthy range." More weight loss was either better or worse depending on the mental skill involved, Dr Carmichael said. People who lost more weight improved their executive function skills: short-term memory, planning, impulse control, attention, and the ability to switch between tasks. But their verbal learning and overall memory declined.

"The results were worse for people who had obesity at the beginning of the study. That's a 'too little, too late' type of message," he said. "People with diabetes who let their obesity go too far, for too long may be past the point of no return, cognition-wise." Increasing physical activity also generated more benefits for people who had overweight compared to those with obesity, the study shows.

Finding a way to offset the health effects of type 2 diabetes is vital. More than 25 per cent of U.S. adults 65 or older have type 2 diabetes. The disease doubles the risk of cognitive impairment and dementia, including Alzheimer's disease, and greatly increases health care needs and costs. (ANI)

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Study reveals enhancing blood sugar control boosts brain health for people with type 2 diabetes - Devdiscourse

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