May 5th, 2008 by Dr. Val Jones in Health Policy, Health Tips
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Do you know your state’s momScore? Revolution Health and I have teamed up with leading medical experts and mommy bloggers to create a new health index just in time for Mother’s Day: the momScore.
Check out this fun interactive map that ranks states by 10 key maternal health variables*:
- Access to prenatal care
- Availability of childcare services
- Number of insured moms
- Maternal mortality
- Affordability of childrens’ health insurance
- Air quality
- Family paid leave policy
- Infant mortality
- Risk of pregnancy complications
- Violent crime rate
We also created a combined average of these variables (weighted according to expert perceived importance) to get an overall ranking. So, do you know where it’s best to be a mom in the United States?
Apparently, Vermont ranks most favorably (on average) in all of these variables. Don’t live in Vermont? Check out how your state compares.
Would you like to discuss your state’s rankings with others or debate the momScore? You can post your comments in our interactive momScore community. This is a really exciting opportunity to discuss women’s health issues in a fresh new way. I hope that the momScore will challenge states to strengthen their efforts to keep moms and babies healthy. At the very least, we’ve made a lot of Vermonters quite smug.
*Variables are based on state reporting to the Environmental Protection Agency (EPA), the Centers for Disease Control and Prevention (CDC), and the United States Census Bureau, as well as leading non-profit organizations such as the Kaiser Family Foundation and the American College of Obstetricians and Gynecologists. For more information about momScore methodology, click here.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 25th, 2008 by Dr. Val Jones in Expert Interviews
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Women in their 40’s are at an advantage when it comes to weight control and fitness. How so? I asked three of my favorite medical experts to explain what it means to be fit and forty, and how you can get there.
Myth-busting With Dr. Dickerson
Dr. Val: I know that many women in their 40’s complain of having gained weight. What causes that weight gain? Is it inevitable?
Dr. Dickerson: Many women don’t gain weight in their 40’s so it’s certainly not inevitable. There are a few common misconceptions about weight gain and aging that I’d like to address.
First, hormone supplements don’t cause weight gain – menopause, in general, with or without hormones, is associated with about a 10 pound gain. This often starts in perimenopause so it could occur as early as the 40’s.
Second, lean muscle mass decreases slowly from mid-30’s probably until menopause when it decreases more steeply. So women in their 40’s don’t experience too large a change in their metabolism.
Third, the weight that women have in their 40’s is often about how many babies they have had. Data show us that women retain about 10 pounds per pregnancy. Weight begins to shift as the perimenopause era begins – more towards the abdomen and the hips and thighs.
And finally, weight gain is not due to hormonal or metabolic changes, but may be more about emotional eating. Women often experience the empty nest syndrome in their late 40’s and change their eating habits to constant “snacking” – they tend not to count these calories when adding things up
Dr. Vivian Dickerson, Past President of the American College of Obstetricians and Gynecologists, Medical Director, women’s health programs and care, Hoag Hospital, Newport Beach, CA.
Increasing physical activity is the key to success
Dr. Val: How can women in their 40’s counteract potential weight gain? What’s the most effective strategy to stay trim and fit?
Dr. Hall: While it is true that body remodeling and loss of muscle mass probably starts in the late 30’s it is almost completely a matter of now much physical activity is taking place. Much of the perceived change in body image, (gravity-dependent “sagging”) is also accentuated with decreased muscle tone in the sedentary woman. Weight gain, on the other hand is quite related to caloric intake. It is greatly modulated by the degree of physical activity as well.
My general feeling is that most diets do not work, and the older you are, the truer that is. After age 40 women cannot consistently lose weight and keep it off without a plan of regular physical activity (aerobic) plus some resistance work (weights, bands) to improve body tone.
Dr. Bill Hall, Past President of the American College of Physicians and Director of the Center for Healthy Aging, Rochester, NY.
The 40’s: no better time to get trim and fit
Dr. Val: Do women in their 40’s have an advantage in losing weight?
Dr. Dansinger: Your 40’s are a great time to take lifestyle changes to new heights. Whether for weight loss, or prevention of diabetes or other related medical problems, many women who struggled in their 20’s and 30’s finally find success in their 40’s. For many women at this age, previously insurmountable logistical barriers such as raising preschool age children, or inflexible work schedules, often improve somewhat. Such expertise in schedule-juggling, when combined with a renewed commitment toward preventing health problems, often gives such ambitious women the strength and experience to finally achieve consistency with an effective exercise and healthy eating routine that produces long-lasting results.
Although the metabolism slows gradually throughout adulthood, the effectiveness of lifestyle changes for health improvements remains strong throughout life, and may actually become most beneficial as we grow older. Gaining muscle and bone strength through weight-lifting type exercise may help a woman in her 40’s reduce the risk of muscle and bone loss that typically affected women of her mother’s generation.
Dr. Michael Dansinger, Lifestyle Medicine Physician/Researcher, Tufts Medical Center, Boston. Nutrition and fitness advisor to NBC’s Biggest Loser.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 11th, 2008 by Dr. Val Jones in News
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I was surprised by recent recent findings from the CDC’s National Health and Nutrition Examination Survey– one in four teenage girls (ages 14-19, chosen at random in the US) tested positive for some sort of sexually transmitted disease, most commonly HPV (human papilloma virus) (18%), followed by chlamydia (4%), trichomonas (2.5 %), and herpes (2%).
I asked Revolution Health expert, Dr. Iffath Hoskins, (Senior Vice President, Chairman and Residency Director in the Department of Obstetrics and Gynecology at Lutheran Medical Center in Brooklyn, N.Y.) what she thought of this news.
“This relatively high infection rate is cause for concern. We need to increase our education efforts so that teenagers are more aware of the risks of sexually transmitted diseases, especially since women’s reproductive futures are at stake. Chlamydia infections can substantially decrease fertility rates, long after the infection has been fully treated with antibiotics.
As far as the high HPV rates are concerned, I’m not surprised since previous research has estimated that 80-90% of adults have been infected with at least one of 80 subtypes of this very common virus. Only 6 of these 80 are known to predispose women towards cervical cancer. But the HPV vaccine can substantially reduce the risk for contracting those 6, so it’s important to vaccinate young girls against this virus.
No teenage girl should be walking around with chlamydia or trichomonas. They are treatable with antibiotics.”
The study also found racial differences between STD infection rates in teenage girls, with blacks being infected at twice the rate of white or Hispanic girls. The CDC is calling for educational outreach to at-risk groups, and the American Academy of Pediatrics supports confidential teen screening.
I hope that these staggering statistics act as a wake up call to health care providers who may not have thought to screen their teen patients for STDs. Apparently, these infections are more common than we realized.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 6th, 2008 by Dr. Val Jones in Expert Interviews
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I must admit that I was a bit skeptical of the conclusions drawn by the media about the latest analysis of the Women’s Health Initiative (WHI) data. The WHI study has generated many different spin-off articles about hormone replacement therapy and its potential link to breast cancer. This latest review suggests that the increased risk for cancer persists up to five years after stopping HRT treatment for menopausal symptoms. I asked Revolution Health expert and past president of the American College of Obstetricians and Gynecologists, Dr. Vivian Dickerson, to help us put this new article into context.
Dr. Val: What does this new study contribute to our understanding of the risks of HRT?
Dr. Dickerson: First of all the women in this study were not on estrogen alone (the usual treatment for women who have had hysterectomies). Their HRT consisted of a combination of Premarin (estrogen) and Provera (progesterone). The original study indicated a slightly higher (barely statistically significant) increased risk for cardiovascular disease (CVD) and a statistically significant increased risk in breast cancer (but relative risks were less than 1.5 for both, which is very small).
Now all this new analysis tells me is that the CVD risk appears to extinguish or become negligible after three years though there is still an increase in breast cancers (compared to placebo) but the difference was not statistically significant. This is interesting in that it does add some plausibility to the claim that the reason breast cancer rates declined so significantly in the year(s) after WHI is because of all the women who quit taking HRT. It doesn’t prove anything, but just more grist for the mill. (Unfortunately I don’t see sub-group analyses of the women who chose to continue HRT after the end of WHI and those who quit from the treatment group.)
The study authors used some fancy math to demonstrate that there was a statistically significant increase in all-cause mortality (including breast cancer) for the women in the HRT group. Since the relative risk is so low, all they can say is that there is no reason to use HRT as a protective or primary preventive measure against heart disease, which we’ve known for many years now.
Dr. Val: Would you change your HRT recommendations based on this new analysis of the WHI data?
Dr. Dickerson: I wouldn’t change a thing that I am doing or counseling. These data are weak and the differences are not robust in any parameter.
***
So there you have it, ladies. No need for heightened alarm based on this analysis of the WHI data, especially if you have never been on the Premarin/Provera cocktail. It would be really helpful to compare breast cancer rates in women who stopped HRT versus those who continued it after the initial WHI data were released. Let’s keep our fingers crossed that this subgroup analysis is next up for publication.
Addendum: My friend and HRT expert, Dr. Avrum Bluming, kindly wrote me an email to further underscore the dubious nature of this study’s findings. Here’s what he said:
“The paper reads more like a lawyer’s presentation then a scientific article (i.e. it makes points followed by the disclaimer that the findings represented are not statistically significant—but the points have been registered). Instead of concluding that the very small increased risk of harm associated with estrogen and progesterone combination therapy (reported in the original studies, which were of questionable significance in the first place) are not found 2+ years after HRT was stopped, they find new risks (lung cancer) to allow them to conclude that administration of HRT results in delayed increased risks.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2008 by Dr. Val Jones in Health Tips, Opinion
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I’ve wrestled with this question for many years: “When is weight loss surgery an appropriate option?” I used to do weight loss research prior to working at Revolution Health. My studies focused on using “natural” methods to reverse type 2 diabetes – in other words, weight loss via diet and exercise. My study subjects were all obese, and most had struggled with weight for decades.
At some point during the trial, people would often ask: “Can’t I just have surgery for this and not have to struggle so much?” And I would gently remind them that surgery was no picnic, and to try diet and exercise first. “But it’s so hard!” they would say. I would acknowledge their difficulties and offer lots of empathy, and firmly encourage them to stick with their diet. In the end I found that only half of my study subjects could manage to stay on the diet for months at a time. So what should the other half do? Give up and let their diabetes ravage their bodies?
My friend and colleague Dr. Charlie Smith rightly points out that weight loss surgery can dramatically improve the health of people who have been unsuccessful at losing weight through diet and exercise. Heart disease, diabetes, and cancer rates were dramatically improved for morbidly obese people after weight loss surgery. So there is a clear benefit for some people to have the procedure.
However, the caveats should not be overlooked. First of all, weight loss surgery does not guarantee long term weight loss. It’s possible to gain back all the weight lost if eating behaviors are not changed. The human stomach is amazingly stretchy, and even if it’s surgically reduced in size, with repeated overeating it can eventually stretch to accommodate large meals again. Secondly, some types of weight loss surgery (like gastric bypass) can affect the body’s ability to absorb critical vitamins. Without enough of these nutrients, one can end up severely anemic, and osteoporotic just to name a few serious side-effects. And finally, the surgery itself is quite dangerous, carrying with it a potential risk of death as high as 1 in 200!
So weight loss surgery can be life-threatening, and is not a quick fix for a long term problem. However, morbid obesity itself is so dangerous (with the increased risk of heart disease, diabetes, and cancer) that it may require this extreme intervention to actually save lives. For people who have more than 100 pounds to lose, and have sincerely tried diet and exercise without success for a prolonged period, then weight loss surgery may be an appropriate option. For those whose lives are not at risk because of severe obesity, it doesn’t make sense to undergo such a risky procedure.
Are some people successful at losing a large amount of weight and keeping it off without surgery? Yes! The National Weight Control Registry keeps a list of thousands of Americans who have lost at least 30 pounds and kept them off for at least 6 years. What’s their secret? You guessed it – regular exercise and a calorie controlled diet. Some other things that these “successful losers” have in common: 1) they eat breakfast 2) they have a cardio machine at home 3) they weigh themselves regularly.
If you’d like to meet a group of people who are working towards long-term weight loss success, feel free to join my weight loss support group. We have weekly challenges, tools and trackers, a vibrant discussion group, and free medical insights to help you along your way. Weight loss is really hard to achieve by yourself. It takes encouragement, support, and a community of like-minded folks who are determined to make a difference. You can do it!… and I’d be honored to support you along the way.
P.S. There’s a special group forming at Revolution Health for folks who need to lose 100 or more pounds. It’s called “Overweight But Not Giving Up.” Check it out.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
