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The medical profession has issued new guidelines for fighting the nation’s obesity epidemic, and they urge physicians to be a lot more aggressive about helping patients drop those extra pounds.
Doctors should calculate your body mass index, a weight-to-height ratio. And if you need to lose weight, they should come up with a plan and send you for counseling.
“We recognize that telling patients to lose weight is not enough,” said Dr. Donna Ryan, co-chair of the guidelines committee.
The good news? By next year, most insurance companies are expected to cover counseling and other obesity treatments, following in the steps of the Medicare program, which began paying for one-on-one help last year.
More than a third of U.S. adults are obese, and that’s been the case since the middle of the last decade. Officials define someone with a BMI of 30 or higher as obese. A 5-foot-9 person would be obese at 203 pounds.
Doctors are well aware that excess weight can trigger diabetes and lead to heart disease and other health problems. Yet surveys have shown that only about a third of obese patients recall their doctor talking to them about their BMI or counseling them about weight loss.
The guidelines were released this week by a group of medical organizations that include the American Heart Association, the American College of Cardiology and the Obesity Society.
They come amid a spate of important developments in the fight against obesity.
Last year, the Food and Drug Administration approved two more obesity-fighting drugs. And this year, the AMA labeled obesity a disease, a measure intended to get doctors to pay more attention to the problem and prod more insurers to pay for treatments.
Yet many people have been on their own when it comes to slimming down, left to sift through the myriad diets and exercise schemes that are promoted for weight loss. And most doctors have little training in how to help their obese patients, other than telling them it’s a problem and they need to do something about it.
“I feel for these guys,” said Dr. Tim Church, a researcher at Louisiana State University’s Pennington Biomedical Research Center. “They have patients who come in and ask them about the latest fad diet. They’re not trained in this stuff and they’re not comfortable” recommending particular diets or weight-loss plans.
The guidelines advise doctors to:
– At least once year, calculate patients’ BMI, measure their waists and tell them if they are overweight or obese.
– Develop a weight-loss plan that includes exercise and moderate calorie-cutting.
– Consider recommending weight-loss surgery for patients with a BMI of 40 or for those with a BMI of 35 who also have two other risk factors for heart disease such as diabetes or high blood pressure.
– Refer overweight and obese patients who are headed for heart problems to weight-loss programs. Specifically, discuss enrolling them in at least 14 face-to-face counseling sessions over six months with a registered dietitian, psychologist or other professional with training in weight management.
Web or phone-based counseling sessions are considered a less effective option.
Diane LeBlanc said the new guidelines are overdue.
More than year ago, the Baton Rouge, La., woman sat down with her longtime family doctor to talk about her weight and get a referral for some kind of help. She had tried dieting without success for more than a decade, had high blood pressure and was about to hit a dress size of 20.
She said the doctor smiled and told her: “There’s a lot of programs out there. But really, you just have to eat less.”
“It just devastated me,” LeBlanc recalled. “He was saying, `It’s all in your mind.’ I was thinking, `If I could do that, don’t you think I would have done it by now?'”
She changed doctors and has lost 40 pounds from her 5-foot-4 frame since May after getting into an intensive Pennington weight-loss program that includes counseling sessions.
Doctors “need to get the message,” “LeBlanc said. “Just telling someone you need to push the plate away is not going to work for everyone.”
The number of first-year medical students exceeded 20,000 for the first time in 2013, reaching 20,055, the Association of American Medical Colleges (AAMC) said Thursday in its annual report on medical school enrollment and applications.
Meanwhile, first-year student enrollment at osteopathic medical colleges increased 11.1% in 2013, to 6,449, according to the American Association of Colleges of Osteopathic Medicine (AACOM).
The two organizations increased their pleas for Congress to provide more money for graduate medical education and funding residency training slots to handle the newly minted doctors.
“We think, that as much as we see gridlock in Washington, that is something that we need to attend to sooner rather than later,”Atul Grover, MD, PhD, chief public policy officer at AAMC, said during a congressional briefing Thursday.
First-time medical school enrollment jumped 2.8% this year and is up 21.6% since 2002, according to the AAMC. The group attributed the increase to four medical schools opening their doors this year and an additional 14 increasing their class sizes by more than 10%.
Total medical school applications are up 6.1% to 48,014, this year while first-time applicants have grown 5.8%, the AAMC said. First-time female applicants increased 6.9%, after remaining flat in 2012. Hispanics attendance at medical schools increased 5.5%.
Furthermore, total enrollment at osteopathic medical schools increased to 4.9% over 2012, growing to more than 22,000 students. New osteopathic medical schools opened in the last year in Alabama, North Carolina, and Indiana.
“Because large numbers of new osteopathic physicians become primary care physicians, often in rural and underserved areas, it is evident that the osteopathic medical profession will help the nation alleviate a primary care physician crisis,” Stephen Shannon, DO, MPH, AACOM president and chief executive, said in a statement. “And colleges of osteopathic medicine are expanding and increasing to meet this demand.”
But the increase in enrollment will mean little in the fight to ease the nation’s physician shortage unless teaching hospitals have a greater ability to train physicians, the AAMC and AACOM said. The AAMC projects a shortage of more than 90,000 doctors by 2020.
“Unless Congress lifts the 16-year-old cap on federal support for residency training, we will still face a shortfall of physicians across dozens of specialties,” AAMC President and Chief Executive Darrell Kirch, MD, said in a release. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment. Now Congress needs to do its part and act without delay to expand residency training to ensure that everyone who needs a doctor has access to one.”
The Balanced Budget Act of 1997 limited the number of residencies Medicare would support. But seeing the pending shortage of physicians coming, the AAMC pleaded with its members in 2006 to increase its enrollment, which was mostly flat between 1980 and 2006.
While medical schools have complied, the number of residency training positions has remained the same. Nearly 1,000 graduates initially were unmatched last year, a number that was eventually whittled down to 520.
“We should probably be training another 4,000 doctors per year,” Grover said.
With 26,504 medical students starting in 2013 between osteopathic and allopathic medical schools, only 26,392 first-year residency slots existed in 2013, Grover said.
“We hear from our educators and our teaching hospitals the way that clinical revenues have been compressed, they don’t have the resources for additional positions anymore,” he added.
Legislation is pending in both chambers — H.R. 1201 and S. 577 — that would increase the number of residency slots Medicare would support by 15,000 over 5 years. The legislation would cost about $9 billion over 10 years, Grover said.
It costs about $145,000 a year to train a physician, but Medicare supports only about $3.2 billion annually of the roughly $15 billion it takes to train physicians nationwide.
A three-year-old Colorado boy born without a brain has died after living what doctors called a miracle life.
While most children with this condition die shortly after their birth, Nickolas far exceeded that sentence.
“Nickolas Coke suffered from a rare condition known as anencephaly which meant he was only born with a brain stem
Children with the very rare condition are considered unable to think or have emotions
His family believed he was growing both physically and mentally”
Surviving on little else than pain medication, Nickolas lived what his family called an incredible life.
‘He was never hooked up to any machines, no tubes, no nothing,’ Sherri Kohut, Nickolas’s grandmother, told KOAA in Colorado.
‘He taught us everything, he taught the love, how to be family. He taught us everything.’
Kohut, who was with Nickolas when he died, said the boy stopped breathing after having difficulties doing so all morning.
Medical officials attempted to revive him using CPR, but after three failed attempt, he was pronounced dead.
‘They told us “no more, let him go”,’ Kohut said. ‘So he died at 12:40 today. Peacefully.’
Nickolas was apparently in good spirits just days before his death. Recent photographs posted on Facebook show the boy smiling and laying in a pumpkin patch.
‘He was laughing because he thought it was funny that we couldn’t get him to stay still enough to roll off the pumpkins,’ Kohut said.
The family made an effort to get Nickolas out as much as possible, taking him on trips to the zoo and going camping.
Anencephaly occurs in about 1 in every 10,000 births, according to the National Center of Biotechnology Information.
Children with anencephaly are considered unable to think or have emotions.
Without a brain, Nickolas couldn’t speak, eat or walk and frequently suffered from debilitating seizures.
Still his family believed the boy was growing both physically and mentally.
‘He was our hero because he showed the strength if I can do this anything can be done,’ Kohut said.
‘He will always be remembered.’
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Driven by an aging population and increased access to health insurance, the U.S. will need more doctors by 2025, says a new study.
The expected rise in demand varies by state and medical specialty, according to the study’s lead author.
“What’s happening at the state level can be very different than what’s happening at the national level,” Timothy Dall told Reuters. He is a managing director at the research and information service firm IHS in Washington, D.C.
The new study, published in Health Affairs, looks at future demands for primary and specialized health care providers. Those specialists include cardiologists, neurologists and urologists.
The researchers used a computer model to estimate future health care demand by taking into account a growing and aging population and increased access to health insurance due to the Affordable Care Act – commonly known as Obamacare.
The U.S. Census Bureau projects the country’s population will increase by 9.5 percent between 2013 and 2025. The Congressional Budget Office also estimates that an additional 28 million people will have health insurance by 2023.
The researchers found the expected increase in doctor demand was largely attributed to a growing number of diseases among an older population. Obamacare, on the other hand, was linked only to an increase of a few percentage points.
Overall, the researchers found the demand for primary care or family doctors will grow by 14 percent by 2025. That’s less than the expected growth among some medical specialties.
Dall and his colleagues estimate that demand for vascular surgeons – who perform bypass surgeries and insert stents, for instance – will increase by about 31 percent and demand for cardiologists will increase by 20 percent.
But those estimates vary by state.
For example, though the demand for cardiologists is estimated to grow by 51 percent in Nevada, demand in West Virginia is only estimated to grow by 5 percent.
Dall cautioned that the estimates are subject to change based on health care delivery systems and behaviors.
For example, Dr. Reid Blackwelder, president of the American Academy of Family Physicians, said conditions that would drive people to see specialists are largely preventable with adequate primary care. Focusing on prevention and primary care would be expected to shift demand toward family doctors.
“As we start to recognize the foundational nature of true primary care and prevention, we’re going to need more primary care providers to be that foundation,” Blackwelder told Reuters.
Blackwelder, who was not involved with the new study, is also affiliated with East Tennessee State University’s James H. Quillen College of Medicine in Johnson City.
“The bottom line is that care delivery patterns will change,” Dall said.
He told Reuters the new study can’t say whether the U.S. will experience a shortage of doctors by 2025.
Previously, the Association of American Medical Colleges estimated that the U.S. doctor shortage will grow to more than 130,000 by 2025.
“It’s important that we continue to update projections and not wait a decade before we update them because things are continually changing,” Dall said.
The Food and Drug Administration is recommending new restrictions on prescription medicines containing hydrocodone, the highly addictive painkiller that has grown into the most widely prescribed drug in the U.S.
In a major policy shift, the agency said in an online notice Thursday that hydrocodone-containing drugs should be subject to the same restrictions as other narcotic drugs like oxycodone and morphine.
The move comes more than a decade after the Drug Enforcement Administration first asked the FDA to reclassify hydrocodone so that it would be subject to the same restrictions as other addictive painkilling drugs. The FDA did not issue a formal announcement about its decision, which has long been sought by many patient advocates, doctors and state and federal lawmakers.
For decades, hydrocodone has been easier to prescribe, in part because it is only sold in combination pills and formulas with other non-addictive ingredients like aspirin and acetaminophen.
That ease of access has made it many health care professionals’ top choice for treating chronic pain, everything from back pain to arthritis to toothaches.
In 2011, U.S. doctors wrote more than 131 million prescriptions for hydrocodone, making it the most prescribed drug in the country, according to government figures. The ingredient is found in blockbusters drugs like Vicodin as well as dozens of other generic formulations.
It also consistently ranks as the first or second most-abused medicine in the U.S. each year, according to the DEA, alongside oxycodone. Both belong to a family of drugs known as opioids, which also includes heroin, codeine and methadone.
Earlier this year the Centers for Disease Control and Prevention reported that prescription painkiller overdose deaths among women increased about fivefold between 1999 and 2010. Among men, such deaths rose about 3.5-fold. The rise in both death rates is closely tied to a boom in the overall use of prescribed painkillers.
The FDA has long supported the more lax prescribing classification for hydrocodone, which is also backed by professional societies like the American Medical Association.
But the agency’s top drug regulator, Dr. Janet Woodcock, said in a statement Thursday: “The FDA has become increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States.”
The FDA says it will formally request in early December that hydrocodone be rescheduled as a Schedule II drug, limiting which kinds of medical professionals can write a prescription and how many times it can be refilled.
The Controlled Substances Act, passed in 1970, put hydrocodone drugs in the Schedule III class, which is subject to fewer controls. Under that classification, a prescription for Vicodin can be refilled five times before the patient has to see a physician again. If the drug is reclassified to Schedule II, patients will only be able to receive one 90-day prescription, similar to drugs like OxyContin. The drug could also not be prescribed by nurses and physician assistants.
The FDA’s request for reclassification must be approved by officials in other agencies within the Department of Health and Human Services.
News of the FDA decision was applauded by lawmakers from states that have been plagued by prescription drug abuse, many who have been prodding the agency to take action for months.
“Today was a tremendous step forward in fighting the prescription drug abuse epidemic that has ravaged West Virginia and our country,” said Democratic Sen. Joe Manchin, in a statement. “Rescheduling hydrocodone from a Schedule III to a Schedule II drug will help prevent these highly addictive drugs from getting into the wrong hands and devastating families and communities
Sen. Charles Schumer of New York noted that the FDA’s own expert panel recommended the reclassification more than nine months ago.
“Each day that passes means rising abuse, and even death, at the hands of hydrocodone-based drugs,” Schumer said in a statement.
Still, Thursday’s action immediately sparked criticism from some professional groups that said that the tighter restrictions could have unintended consequences, such as burdening health care workers and patients.
“The FDA’s reported decision will likely pose significant hardships for many patients and delay relief for vulnerable patients with legitimate chronic pain, especially those in nursing home and long-term care,” said Kevin Schweers, a spokesman for the National Community Pharmacists Association.
Human breast milk is sold for babies on several online sites for a few dollars an ounce, but a new study says buyer beware: Testing showed it can contain potentially dangerous bacteria including salmonella.
The warning comes from researchers who bought and tested 101 breast milk samples sold by women on one popular site. Three-fourths of the samples contained high amounts of bacteria that could potentially sicken babies, the researchers found. They did not identify the website.
The results are “pretty scary,” said Dr. Kenneth Boyer, pediatrics chief at Rush University Medical Center in Chicago, who was not involved in the study. “Just imagine if the donor happens to be a drug user. You don’t know.”
The research published in medical literature cites several cases of infants getting sick from strangers’ milk.
Breast milk is also provided through milk banks, whose clients include hospitals. They also charge fees but screen donors and pasteurize donated milk to kill any germs.
With Internet sites, “you have very few ways to know for sure what you are getting is really breast milk and that it’s safe to feed your baby,” said Sarah Keim, the lead author and a researcher at Nationwide Children’s Hospital in Columbus, Ohio. “Because the consequences can be serious, it is not a good idea to obtain breast milk in this way.”
The advice echoes a 2010 recommendation from the federal Food and Drug Administration.
“When human milk is obtained directly from individuals or through the Internet, the donor is unlikely to have been adequately screened for infectious disease or contamination risk,” the FDA says. “In addition, it is not likely that the human milk has been collected, processed, tested or stored in a way that reduces possible safety risks to the baby.”
The researchers believe theirs is the first study to test the safety of Internet-sold milk, although several others have documented bacteria in mothers’ own milk or in milk bank donations. Some bacteria may not be harmful, but salmonella is among germs that could pose a threat to infants, Boyer said.
Sources for bacteria found in the study aren’t known but could include donors’ skin, breast pumps used to extract milk, or contamination from improper shipping methods, Keim said.
The study was published online Monday in the journal Pediatrics.
There are many milk-sharing sites online, including several that provide milk for free. Sellers or donors tend to be new mothers who produce more milk than their own babies can consume. Users include mothers who have difficulty breast-feeding and don’t want to use formula and people with adopted infants.
Breanna Clemons of Dickinson, N.D., is a donor who found a local woman who needed breast milk through one of the online sites where milk is offered free.
“A lot of people are like, ‘It’s weird,’ but they haven’t been in a situation where they didn’t want their child to have formula,” or couldn’t produce enough milk, Clemons said. She said she shared her medical history with the recipient.
Clemons is breast-feeding her 7-month-old and stores excess milk in her freezer. Every few weeks, she meets up with the recipient and gives her about 20 6-ounce bags. Clemons said the woman has a healthy 9-month-old who “loves my milk.”
Keim said it’s unclear if milk from sites offering donated milk would have the same risks because donors might be different from those seeking money for their milk. And in a comparison, the researchers found more bacteria in breast milk purchased online than in 20 unpasteurized samples donated to a milk bank.
Bekki Hill is a co-founder of Modern Milksharing, an online support group that offers advice on milk donation. She said there’s a difference between milk sellers and donors; milk donors “don’t stand to gain anything from donating so they have no reason to lie about their health.”
Hill, of Red Hook, N.Y., used a donor’s milk for her first two children and plans to do so for her third, due in February, because she doesn’t produce enough of her own.
“Breast milk is obviously the preferred food” for babies, she said.