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Why Docs Should Ditch ‘Just Lose Weight’ Advice

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By LEIGH BEESON-U. GEORGIA

Current medical training focuses on weight and body mass index (BMI), exacerbating anti-obesity bias and increasing the risk of eating disorders, the authors say. And it doesn’t give future doctors adequate education on how to encourage healthier eating habits.

“Mainstream medicine is still very focused on linking weight to health,” says Kearney Gunsalus, lead author of the paper and an assistant professor at the Augusta University/University of Georgia Medical Partnership.

“Because people with obesity and higher body weights are more likely to have health problems, it’s easy to jump to the conclusion that the weight itself is causing those problems. And if you assume that the weight is causing the problems, it seems logical to assume that weight loss is the solution.”

Research has shown that being overweight may not mean being unhealthy, the researchers say.

The researchers advocate that small changes to medical education and in how health care providers interact with their patients could have a real impact on some of the greatest health challenges facing the world today.

BMI ISN’T AN ACCURATE PICTURE OF HEALTH

BMI has long been the standard for sorting individuals into four main categories: underweight, healthy weight, overweight, or obese. And it’s taught in medical school as a way of gauging a patient’s general health.

The problem is it’s not accurate, the researchers say. BMI overestimates the number of people who are unhealthy.

Medical education on nutrition should instead focus on objective measures of cardiometabolic health.

Cardiometabolic health includes things like blood pressure, insulin resistance, cholesterol levels, and more. And it is a much stronger predictor of overall health.

Previous research demonstrated that almost half of Americans deemed overweight by BMI standards are actually metabolically healthy. About one in three whose BMI is in the “healthy” range are actually unhealthy when assessed by more comprehensive measures.

“When you look at some of the newest studies on obesity surgeries and the use of medications like Ozempic and Wegovy, it appears that patients can see health benefits even without weight loss,” says Ellen House, coauthor of the paper and an associate professor at the Medical Partnership.

“We really love things that are clear-cut and black and white in medicine. But if the benefits precede and appear to be independent of weight loss, we need to shift the conversations physicians have with their patients to focus more on health and not weight loss.”

ANTI-FAT BIAS

In addition to focusing exclusively on weight loss and BMI, current medical education often neglects to address weight stigma, the researchers say.

Weight stigma connects obesity with moral failures, laziness, and gluttony without accounting for the biologic and systemic factors that intersect with weight. These factors include availability of fresh, healthy foods, the ability to afford those foods, and access to safe spaces to exercise, among others.

This bias may lead physicians to be less empathetic toward their overweight patients and to provide lower quality care.

“Overweight patients are less likely to get the appropriate screenings or treatments for their medical concerns,” says House, who is also a board-certified psychiatrist. “Physicians will miss the asthma, they’ll miss the cancer, because they attribute symptoms to weight when weight isn’t what’s causing the patient’s concerns.”

Those negative interactions where health concerns are dismissed with a simple “just lose weight” demoralizes patients and can make them less likely to share problems going forward. Shaming patients for their weight can sour patients on the health care system in general, prompting them to stop seeking medical care even when they really need it, the researchers say.

Reframing the conversations between doctor and patient to focus on healthful behaviors, such as moving more and avoiding labeling foods as inherently “good” or “bad,” can go a long way in encouraging individuals to move toward health.

“I think doctors are trying to help people be healthier by advising them to lose weight; they’re just not aware of the harms that can be done by that advice,” Gunsalus says.

“If I could wave a magic wand and have doctors do one thing differently when interacting with their patients, it would be to start from the assumption that every patient wants to be and is capable of being healthy.”

The paper appears in Medical Science Educator.

Source: University of Georgia

Previously Published on futurity.org with Creative Commons License

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Many Young Adults Who Began Vaping as Teens Can’t Shake the Habit

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By John Daley, Colorado Public Radio

G Kumar’s vaping addiction peaked in college at the University of Colorado, when flavored, disposable vapes were taking off.

“I’d go through, let’s say, 1,200 puffs in a week,” Kumar said.

Vaping became a crutch for them. Like losing a cellphone, losing a vape pen would set off a mad scramble.

“It needs to be right next to my head when I fall asleep at night, and then in the morning, I have to thrash through the sheets and pick it up and find it,” Kumar recalled.

They got sick often, including catching covid-19 — and vaping through all of it.

Kumar, now 24, eventually quit. But many of their generation can’t shake the habit.

“Everyone knows it’s not good for you and everyone wants to stop,” said Jacob Garza, a University of Colorado student who worked to raise awareness about substance use as part of the school’s health promotion program.

“But at this point, doing it all these years … it’s just second nature now,” he said.

Marketing by e-cigarette companies, touting the allure of fruity or candy-like flavors and names, led many teens to try vaping. As more high schoolers and younger kids experimented with e-cigarettes, physicians and researchers warned it could lead to widespread addiction, creating a “Generation Vape.”

Research has shown nicotine is highly rewarding to the brains of young people.

New data on substance use among adults ages 18-24 suggests that many former teen vapers remain e-cigarette users. National vaping rates for young adults increased from 7.6% in 2018 to 11% in 2021.

It’s not surprising that many of them start in high school for social reasons, for all sorts of reasons,” said Delaney Ruston, a primary care physician and documentary filmmaker. “And many of them now — we’re seeing this — have continued to college and beyond.”

Her latest film is “Screenagers Under the Influence: Addressing Vaping, Drugs & Alcohol in the Digital Age.”

In Colorado, the share of those 18 to 24 who regularly vaped rose by about 61% from 2020 to 2022 — to nearly a quarter of that age group.

“That’s an astounding increase in just two years,” Ruston said.

Trends in that state are worth noting because, before the pandemic, Colorado led the nation in youth vaping among high school students, surpassing 36 other states surveyed.

Nationally, vaping rates among high schoolers dropped from 28% in 2019 to 10% in 2023, according to the Annual National Youth Tobacco Survey. But for many young people who started vaping at the height of the trend, a habit was set.

At Children’s Hospital Colorado, pediatric pulmonologist Heather De Keyser displayed on her screen a clouded X-ray of the lung of a young adult damaged by vaping.

For years, doctors like her and public health experts wondered about the potentially harmful impact of vaping on pre-adult bodies and brains — especially the big risk of addiction.

“I think, unfortunately, those lessons that we were worried we were going to be learning, we’re learning,” said De Keyser, an associate professor of pediatrics in the Breathing Institute at Children’s Hospital Colorado.

“We’re seeing increases in those young adults. They weren’t able to stop.”

It’s no coincidence the vaping rates soared during the pandemic, according to several public health experts.

For the past couple of years, undergraduates have talked about the challenges of isolation and using more substances, said Alyssa Wright, who manages early intervention health promotion programs at CU-Boulder.

“Just being home, being bored, being a little bit anxious, not knowing what’s happening in the world,” Wright said. “We don’t have that social connection, and it feels like people are still even trying to catch up from that experience.”

Other factors driving addiction are the high nicotine levels in vaping devices, and “stealth culture,” said Chris Lord, CU-Boulder’s associate director of the Collegiate Recovery Center.

“The products they were using had five times more nicotine than previous vapes had,” he said. “So getting hooked on that was … almost impossible to avoid.”

By “stealth culture,” Lord means that vaping is exciting, something forbidden and secret. “As an adolescent, our brains are kind of wired that way, a lot of us,” Lord said.

All over the U.S., state and local governments have filed suits against Juul Labs, alleging the company misrepresented the health risks of its products.

The lawsuits argued that Juul became a top e-cigarette company by aggressively marketing directly to kids, who then spread the word themselves by posting to social media sites like YouTube, Instagram, and TikTok.

“What vaping has done, getting high schoolers, in some cases even middle schoolers, hooked on vaping, is now playing out,” said Colorado Attorney General Phil Weiser.

Juul agreed to pay hundreds of millions in settlements. The company did not respond to requests for comment on this article.

R.J. Reynolds, which makes another popular vape brand, Vuse, sent this statement: “We steer clear of youth enticing flavors, such as bubble gum and cotton candy, providing a stark juxtaposition to illicit disposable vapor products.”

Other big vape companies, like Esco Bar, Elf Bar, Breeze Smoke, and Puff Bar, didn’t respond to requests for comment.

“If we lived in an ideal world, adults would reach the age of 24 without ever having experimented with adult substances. In reality, young adults experiment,” said Greg Conley, director of legislative and external affairs with American Vapor Manufacturers. “This predates the advent of nicotine vaping.”

The FDA banned flavored vape cartridges in 2020 to crack down on marketing to minors, but the products are still easy to find.

Joe Miklosi, a consultant to the Rocky Mountain Smoke-Free Alliance, a trade group for vape shops, contends the shops are not driving vaping rates among young adults in Colorado. “We keep demographic data in our 125 stores. Our average age [of customers] is 42,” he said.

He has spoken with thousands of consumers who say vaping helped them quit smoking cigarettes, he said. Vape shops sell products to help adult smokers quit, Miklosi said.

Colorado statistics belie that claim, according to longtime tobacco researcher Stanton Glantz. The data is “completely inconsistent with the argument that most e-cigarette use is adult smokers trying to use them to quit,” said Glantz, the former director of the Center for Tobacco Control Research and Education at the University of California-San Francisco.

For recent college graduate G Kumar, now a rock climber, the impetus to quit vaping was more ecological than health-related. They said they were turned off by the amount of trash generated from used vape devices and the amount of money they were spending.

Kumar got help from cessation literature and quitting aids from the university’s health promotion program, including boxes of eucalyptus-flavored toothpicks, which tasted awful but provided a distraction and helped with oral cravings.

It took a while and a lot of willpower to overcome the intense psychological cravings.

“The fact that I could just gnaw on toothpicks for weeks on end was, I think, what kept me sane,” Kumar said.

This article is from a partnership that includes CPR News, NPR, and KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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This story can be republished for free (details).

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

Previously Published on kffhealthnews.org

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What Makes Some People Bigger Mosquito Magnets?

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What makes some people more attractive to mosquitoes? Researchers have answers for you.

 

By JAMES URTON-U. WASHINGTON

Summer is just around the corner, and with it, more opportunities to have fun and frolic in the sun. But more time outside means more chances for another common warm-weather annoyance: mosquito bites.

University of Washington researchers are hoping those itchy bumps could soon become a thing of the past.

Jeffrey Riffell, a professor of biology, studies mosquito sensory systems, particularly their sense of smell. He and his team want to understand how mosquitoes find food, whether it be males—who drink nectar—or females, who drink blood when they are trying to produce eggs.

Riffell’s research has shown that hungry female mosquitoes find us by following a trail of scent cues, including chemicals exuded by our skin and sweat, as well as the carbon dioxide gas we exhale with each breath.

Mosquitoes also like colors, at least certain ones. His team is investigating how the visual and olfactory senses work together to help a mosquito zero in for the final strike and get her blood meal.

In the United States, climate change is opening new habitats for mosquitos. Washington currently boasts 20 species, including ones that can transmit West Nile virus.

Knowing what attracts mosquitoes—males to flowers, females to people—can help develop better control and containment efforts against these insects, whose bites can also transmit malaria, Zika, dengue, yellow fever, and other diseases.

Traps that kill or poison mosquitoes, for example, would be more effective if they released a mosquito-attracting scent.

Mosquito-borne illnesses kill hundreds of thousands of people each year. Riffell and his team hope their efforts can help take a bite out of those numbers.

Source: University of Washington

Previously Published on futurity.org with Creative Commons License

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Colon Cancer Rates Are Rising in Young Americans, but Insurance Barriers Are Making Screening Harder

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More than 53,000 Americans are projected to die from colorectal cancer this year. Although colorectal cancer is the second-most common cause of cancer deaths in the United States, it can be cured if caught early. Detecting a tumor as soon as possible can help you get treatment as soon as possible, giving you the best chance for survival.

In my work as a gastroenterologist, I treat patients from every background and walk of life. Uniting them are a growing number of insurance barriers threatening access to timely care. All too often, payers take a long time to make coverage determinations, or they even deny them outright.

With the alarming rise of colorectal cancer diagnoses among Americans under 50, it is more important than ever for people to know their cancer risk and when to get screened.

Here are common questions I and other gastroenterologists get from patients about colorectal cancer:

What is my colorectal cancer risk?

Anybody at any age can develop colorectal cancer. However, some people may be more likely to get the disease than others.

For example, people with a family history of colorectal cancer or a personal history of polyps, which are abnormal growths in the tissue of the colon or rectum, may have a higher risk.

Inflammatory bowel diseases like Crohn’s and ulcerative colitis can also increase your risk of developing colorectal cancer. This is because the chronic inflammation associated with these diseases can promote the development of abnormal growths.

Race and ethnicity may also affect colon cancer risk. Black and Indigenous Americans are significantly more likely to develop – and die from – colorectal cancer. While genetics does play a role in disease development, much of the risk of colorectal cancer is linked to environmental factors. These include a person’s income level, types of food and groceries available in the neighborhood, access to primary care providers and specialists, and a wide variety of other social determinants of health.

Lifestyle factors like smoking, not exercising regularly and poor diet can also increase your colon cancer risk. Researchers have shown that red meat releases chemicals that can cause inflammation, while high-fiber foods and vegetables can help lower inflammation. Similarly, a sedentary lifestyle can also increase inflammation. Smoking can lead to harmful genetic changes in colon cells.

What are my screening options?

People with colorectal cancer usually don’t exhibit symptoms until the disease progresses to a later stage. That is why early and regular screening is critical.

The U.S. Preventive Services Task Force recommends Americans begin regular screenings at age 45. Recognizing that the incidence of colorectal cancer has grown among younger adults, the task force lowered the age from 50 in 2021. Screening may start earlier and occur more frequently for people who have an increased risk of colon cancer.

There are various screening methods, and your medical provider can recommend procedures based on your risk factors.

Many people choose to get a colonoscopy, which is a screening test that can also prevent cancer by removing precancerous polyps. It involves using a long, flexible tube with a light and a camera on the end to visually inspect the colon for signs of cancer, abnormalities in the colon lining, or growths such as polyps. Ultimately, colonoscopy screening can significantly reduce the incidence and mortality of colorectal cancer.

At-home fecal immunochemical tests look for trace amounts of blood in the stool.

Other screening strategies include noninvasive stool testing, imaging scans and a combination of endoscopic visualization with stool-based testing.

Your doctor can help you select a test that aligns with your preferences, values and risk factors. Suggested screening approaches in people with an average colon cancer risk include a colonoscopy every 10 years, stool-based testing every one to three years, or CT scans every five years for those who are unable to have a colonoscopy as an initial screening test. A positive test result for these alternative approaches should be followed by a colonoscopy.

With routine screening, one out of every three colorectal cancer deaths can be avoided.

Why won’t my health insurance pay for my colonoscopy?

While colorectal cancer screening is free as a preventive service under the Affordable Care Act, some insurers are making it harder for people to get care.

For example, Blue Cross Blue Shield of Massachusetts proposed a 2024 policy that would have deemed the use of anesthesia in endoscopies, colonoscopies and other vital procedure as medically unnecessary. This meant patients would have had to pay out of pocket to cover the anesthesia needed for colorectal cancer screenings, potentially creating major cost barriers. The insurance company only reversed course after an outcry from physicians and patients.

Another troubling trend is expanded use of prior authorization, a process some health insurers use to determine if they will cover the cost of a medical procedure, service or medication. Insurers can delay or deny coverage of medically necessary care that physicians and medical guidelines recommend because they deem certain health care services unnecessary for a patient or too expensive to cover.

In 2023, UnitedHealthcare proposed a policy that would have required the 27 million people under their plan to obtain insurance approval before they could get diagnostic or follow-up colonoscopies. After protests from physicians and patients, the insurer put the policy on hold.

UnitedHealthcare has also made plans to introduce a program in 2024 that could involve prior authorization for colonoscopies. The insurer has released little information about why it feels such requirements are necessary, what services would require prior authorization and how it would protect patients from unnecessary delays and denials.

How can I lower my risk of colorectal cancer?

If you haven’t already, look into getting screened for colorectal cancer. Talk with your doctor’s office and check with your insurance company to understand what will be covered before your procedure. If you’re 45 or older, a colonoscopy can screen for and prevent colorectal cancer.

Younger adults can take steps to reduce their risk of colon cancer by adopting healthy eating and lifestyle behaviors. Being aware of personal risk factors and seeking medical attention for symptoms – such as changes in bowel habits, rectal bleeding, abdominal pain or unexplained weight loss – can help you discuss screening options with your health care provider.

If you have already had a colonoscopy and had polyps removed, make sure you know when you are due to return for a follow-up colonoscopy. It could save your life.The ConversationThe Conversation

Andrea Shin, Associate Professor of Medicine, University of California, Los Angeles

This article is republished from The Conversation under a Creative Commons license. Read the original article.





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