6 WAYS OBESITY CAN WEIGH ON THE BRAIN

Obesity not only impacts your physical health; it also impacts your brain. An assistant professor at Texas A&M Health Science Center School of Public Health, who’s received National Institute on Aging funding to study obesity’s effects on brain function in seniors, notes obesity can change the structure of the brain and cause atrophy.

1.     A higher BMI is associated with poorer episodic memory – or difficulty recalling past events – in young adults ages 18 to 35. The findings in a research article published in The Quarterly Journal of Experimental Psychology suggested that people who are overweight may experience memory slightly less vividly or in less detail. Other evidence indicates memory plays an important role in regulating what we eat; and clouded memory can make it harder to watch what one eats and lose weight.

2.     Midlife obesity is associated with a higher risk of dementia. Being obese in one’s 40’s through 60’s is associated with a higher risk of dementia as you age. It’s linked to an increased risk of Alzheimer’s, the most common form of dementia, and a leading cause of death in the US. The true cause is not clear, but it is clear that added pounds negatively affect cardiovascular health, which plays a significant role in brain function.

3.     Obesity in older individuals is associated with changes in brain activity that affect neuromuscular function – including making it harder to grab/grasp onto things. If your grip is not reliable, people can become a much higher risk of falls. It should also be noted, in studies where this information was proposed, obese individuals’ grasping ability was further impaired under stress.

4.     Researchers found obese subjects also expended more mental resources when walking, even though they were able to walk as well as non-obese test subject. And stress further taxed the brain of obese individuals, compared to their normal-weight counterparts. In addition to the physical challenge, the added mental burden of obesity might also lead individuals to tire more quickly.

5.     Being overweight may dull your ability to experience pleasure. One previous study published in the Journal of Neuroscience noted that an area of the brain called the striatum was less activated in women after they had gained weight. The striatum plays a key role in encoding the reward we get from eating certain foods, like those high in sugar that are associated with the release of the brain chemical dopamine, causing us to feel pleasure. In addition to high-fat, high sugar diets leading to being overweight has been associated with this same dulling effect, which experts say can lead a person to overeat to regain that fleeting sense of pleasure.

6.     Obesity raises the risk of depression, and depression can raise the risk of obesity. We definitely know it contributes, and it may also contribute to bipolar disorder.

Health experts say losing weight typically has a positive impact on brain health. Lifestyle changes, including partaking in a heart-healthy diet and exercising regularly, have also proven a beneficial strategy to optimize mental function. As the obesity epidemic rages on, more studies are underway to shed light on those negative effects – and to shed light to help us better understand how to prevent or reverse them. 

1/3 OF THE WORLD IS WHAT?

If you're overweight or obese, you're definitely not alone. In fact, new research shows there are billions of people just like you – and it's concerning the public health community.

A New England Journal of Medicine study, published Monday, finds that more than 2 billion people – or one-third of the world's population – fall into the obese-or-overweight categories, CNN reports. What's more: Their weight is causing them to endure health problems.

The New York Times reports the per capita death rate has ticked up 28 percent since 1990, and40 percent of these deaths occurred among overweight people not heavy enough to be obese. In 2015, extra weight was a factor in 4 million deaths from conditions such as heart disease and diabetes.

More than 710 million people are considered obese, which translates to 10 percent of the global population.

For the purposes of the study, being obese meant having a body mass index of 30 or higher, while being overweight was defined as having a BMI between 25 and 29. The Institute for Health Metrics and Evaluation at the University of Washington led the Gates Foundation-backed study.

The U.S. earned the dubious distinction of having the highest percentage of obese children and young adults relative to the overall population (13 percent), while Egypt had the highest percentage of obese adults, with nearly 35 percent.

Looking beyond percentages at the actual numbers: The U.S. was home to the most obese adults (79.4 million), and China was home to the most obese children (15.3 million).

These findings are unsettling to experts, who worry about the health consequences of the world's expanding waistline. "People who shrug off weight gain do so at their own risk – risk of cardiovascular disease, diabetes, cancer, and other life-threatening conditions," Dr. Christopher Murray, study author and director of the Institute for Health Metrics and Evaluation at the University of Washington, told CNN.

Researchers used data from the Global Burden of Disease study in their analysis, which included 68.5 million people tracked between 1980 and 2015. They reported that in 73 countries, the obese population had doubled since 1980. Women had higher obesity levels than men no matter the age group, a finding that echoes previous research.

So, what comes next?

"We need to control the consequences of obesity much better globally ... and help people who are obese to lose weight," Goodarz Danaei, a professor at the Harvard T.H. Chan School of Public Health who didn't work on the study, told CNN. "That's where we need research and public health interventions."

But such interventions could prove complicated, particularly when it comes to increasing access to healthy food. "Unhealthy foods cost less; healthier foods often cost more. People eat what they can afford," Adam Drewnowsk, director of the Center for Public Health Nutrition at the University of Washington, told The New York Times. He also didn't work on the study.

It remains unclear what rising obesity rates mean for children. "We don't really know what the long-term effects will be if exposed to high BMI over 20, 30, 40 years," Danaei told CNN. "It may be larger than we have already seen."

5 HYDRATION MYTHS BUSTED

1. Caffeine Dehydrates You

Let’s start these myths off on a positive note: Your morning cup of coffee can boost your hydration levels. While experts have long believed that caffeine, like that contained in coffee, acts as a diuretic to dehydrate the body, recent research published in PLOS ONE found that in people who drink up to four cups of caffeinated Joe per day, coffee is just as hydrating as H2O.

It's important to remember that hydration levels tend to be lowest in the morning, since you spend all night sleeping, not drinking. So if what you want first thing in the morning is a cup (or two) of coffee, go for it, says registered dietitian and board-certified sports dietitian Georgie Fear, author of “Lean Habits for Lifelong Weight Loss.”

2. You Need to Drink Eight Glasses of Water Per Day

There are multiple reasons why this well-meaning guideline falls short of guaranteeing good hydration. For starters, every person’s hydration needs are unique. Age and sex are two big factors: The National Academies of Sciences, Engineering, and Medicine recommends that while men and women ages 19 to 30 consume 15.6 cups and 11.4 cups of water per day, respectively, toddlers need as little as 4 cups per day. Climate, exercise as well as pregnancy and lactation all move the needle, too.

Here’s how popular functional waters, which promise benefits beyond hydration, stack up.

But this next part is also important: All of that water doesn’t have to come in beverage form. According to the National Academies, roughly 20 percent of the average adult’s water consumption actually comes from food. “If you eat more of a plant-based diet, it could contribute even more,” says registered dietitian Betsy Opyt, creator of Betsy’s Best. She notes that fruits and veggies such as watermelon, cucumbers, celery and star fruit are more than 90 percent water.

3. As Long as You Aren’t Thirsty, You’re Well-Hydrated

Think of thirst like sunburns – it doesn’t pop up until it’s too late. “People are typically dehydrated by about 2 to 3 percent of their body weight, which is enough to impact physical and mental performance, before thirst kicks in,” explains registered dietitian and board-certified sports dietitian Marie Spano. Plus, the body’s biological thirst mechanisms tend to become even more faulty with age, so it’s especially important for older adults not to count on thirst as a hydration gauge.

While many experts like to use the guide, “as long as your urine is pale yellow or clear, you’re well hydrated,” it’s important to remember that everything from medications and supplements to the foods you eat can influence your urine color, Spano notes. Her bathroom rule: If you need to pee once every few hours, you’re likely well-hydrated.

4. The More Water You Can Drink in a Day, the Better

“If you really push the fluids, you can dilute the concentrations of electrolytes in your blood." “Hyponatremia, or low blood levels of sodium, is a dangerous condition, even life-threatening. Some unfortunate deaths have occurred as a result of drinking a gallon of water as part of a contest, or among marathoners who drank too much water without taking in any electrolytes.”

While, fortunately, these tragedies are uncommon, the National Academies similarly notes that acute water toxicity can occur by drinking excessively more fluid than your body can excrete in a given timeframe – about 3 to 4 cups per hour.

5. Sports Drinks Are Always Superior to Water

Sports drinks are great for their electrolytes (think: calcium, magnesium, potassium, sodium, phosphate and chloride), helping to prevent issues such as fatigue, nausea, headache, impaired muscle function as well as severe hyponatremia – all of which are possible when you’re sweating out electrolytes and drinking plain ’ol water. Meanwhile, they also contain simple sugars and calories that are meant to keep the body primed with energy when you’re in the middle of a long endurance workout.

However, a quick jog around the block doesn’t qualify. “Unless you’re exercising for more than 90 minutes or in extremely hot and humid conditions, water will do,” says Fear, noting that downing sports drinks when you really don’t need them is why many people who take up running gain, rather than lose, weight.

BREAST-FEEDING CAN LIMIT MOM'S RISK OF HEART ATTACK, STROKES

You've heard before about how healthy breast-feeding is for your baby. But what if it could aid your long-term health, too?

The latest findings published Wednesday in the Journal of the American Heart Association suggest that breast-feeding could reduce a mother's risk for developing a heart attack and stroke later in her life. Specifically, the Chinese study discovered breast-feeding mothers lowered their heart disease or stroke risk by approximately 10 percent.

It's important to note that the study was just observational (i.e. no cause-and-effect conclusions are available).

While short-term health benefits have been known – think weight loss and lower cholesterol – the long-term effects haven't been clear when it comes to cardiovascular diseases in mothers. University of Oxford, the Chinese Academy of Medical Sciences and Peking University researchers took into account data from 289,573 Chinese women, average age of 51, for the study. 

That data came from another study, where women (almost all were mothers, and none of them had cardiovascular disease) provided details regarding their reproductive history and lifestyle factors. There were 16,671 cases of coronary heart disease (including heart attacks) and 23,983 cases of stroke within eight years of follow-up. Mothers who breast-fed saw a 9 percent lower heart disease risk and an 8 percent lower stroke risk, all compared to those who had never breast-fed. Those who breast-fed for two years or more saw an 18 percent lower heart disease risk and 17 percent lower stroke risk.

Researchers accounted for cardiovascular disease risk factors like smoking, obesity and diabetes when putting together these results. Live Science notes the study couldn't account for factors like women's diet that might contribute to heart disease risk.

As for what researchers hope comes out of this? More breast-feeding.

"The findings should encourage more widespread breast-feeding for the benefit of the mother as well as the child," Zhengming Chen, senior study author and professor of epidemiology at the University of Oxford, said in a statement. "The study provides support for the World Health Organization's recommendation that mothers should breast-feed their babies exclusively for their first six months of life.

"Although there is increasing recognition of the importance of exclusive breast-feeding, genuine commitment from policy makers is needed to implement strategies in the healthcare system, communities and families and the work environment that promote and support every woman to breast-feed," the authors wrote.

7 EXERCISES YOU CAN DO NOW TO SAVE YOUR KNEES LATER

1. You have healthy knees – and you’d like to keep it that way. That’s not a job you can tackle sitting down, though getting into a 90-degree position could help. First, though, you’ll want to heed a simple but central lesson roughly adapted from age-old song lyrics: “The hip bone’s connected to the knee bone.” Physical activities that strengthen your hips, quads, calves, and ankles are also good for your knees, while weakness in any of those areas can increase knee strain and risk of injury. So think “holistic” leg health.

2. Indelicate squat discussion first. You’re going to be doing that kind of loading on the knee joint just to get on and off the toilet. It’s important to do exercises that prepare the knee for regular day-to-day activities. Squatting really affects all the muscles around the knee joint, including strengthening the muscles around the knee joint. Haven’t done squats in a while – or ever? Start by doing at least 8-12 reps with just your weight, going down to just above 90 degrees, or right at 90 degrees if you don’t have any discomfort, injuries or issues that prevent that. Alternative: try leg press if you have back problems or other issues preventing you from doing squats.

3. Like squats, lunges can also be an excellent exercise to improve strength in your quads and butt o help support your knees. With both exercises, he notes, make sure you’re in good position – feet firmly planted. So that you’re not coming too far forward and putting more stress on the joint. Talk to your doctor before doing lunges if you’re concerned about a preexisting issue, like osteoarthritis or a knee injury, to keep from exacerbating it.

4. Whether you’re familiar with step-ups or not, you get the general idea. You’re lifting your body weight using one hip, one leg to get that weight, like you’re going up the stairs. Keeping the hip joint muscles strong and well-conditioned along with muscles around the ankle strong and well-conditioned will help minimize the risk of injury at the knee joint. To get started with step-ups, place your foot on a high step, weight bench or plyo boxes, so that your leg is bent at about a 90-degree angle. Then bring your other foot up onto the surface. Repeat for 12-15 reps, and add weight as you’re able.

5. A weak back and stomach can put extra stress on the joints that support your body. A good core strengthening program is important and paramount to the health of your knees, hips, and lower extremities. It’s important to do plenty of back and abdominal strengthening exercises. A range of activities can help in core strengthening, experts say, while improving flexibility, balance, stability, which are also protective of joint strength.

6. Running has taken a pounding for the pounding it can take on the knees. For most people, it’s a safe activity. It’s easy, low cost, and we’re all designed to run for the most part. IT’s just being smart about what you can tolerate. That goes for not ramping up too quickly to longer distances or pushing through the pain of an injury – and taking time off to heal as needed. While some who have arthritis in their knees are still able to run, experts say it’s important to talk with a physician about any existing knee issues to determine what’s safe, including when walking might be more appropriate.

7. Whether you’re biking with friends or riding alone, racing the clock or just catching a cool breeze, taking to two wheels can strengthen your quads and calves – and even improve overall leg strengthening to bolster the knee health. Cycling is also a low-impact activity. The circular, rhythmic pedaling is easy on the knees and it can provide a great aerobic workout to boot.

8. Though many do just fine running on a treadmill, trying alternating an elliptical machine for an aerobic workout that works the legs while being easy on the knees. With your foot planted against a platform, there’s not repetitive impact that leads to the degredation of cartilage over time. And! It can help maintain muscular endurance.

9. While certain exercises target muscles are the joint, at the end of the day any strength training or aerobic exercise that helps you maintain a healthy weight reduces pressure on your knees. When you stand on one foot, 5-8x your body weight goes through your knee joint. If you gain 5 pounds, that’s an extra 25-40 pounds of pressure going through your knee joint. If for no other reason, exercise to keep your weight in check to decrease the stress on joints. That goes for knee-friendly exercises ranging from the elliptical machine to cycling, experts say, and anything else that gets you moving. 

3 REASONS TO SEE A PHYSICAL THERAPIST EVEN IF YOU'RE NOT HURT

1. You want to boost your ‘athletic’ performance.

We are all athletes. Whether you aspire to play sports in college or just like shooting hoops on weekends, you’re an athlete in my book. Maybe gardening is your thing. If you don't think those dance classes you go to involve athletic ability, just consider how much more clumsy you felt when you first enrolled. Yes, we are all athletes. 

But is your body getting what it needs to move most effectively? Is everything that should be moving moving well? Are the parts that should be nice and stable actually holding things together?

SPJs have the power to keep you running at top speed, no matter what your favorite activities are. They just have to watch you move to see the unseen. It's common to see an SPJ quickly identify a seemingly unrelated part of the body that winds up having a huge impact on your athletic ability – whatever that means to you. SPJs know where to push and pull and allow your body to do the rest. 

2. You don’t want to get injured. 

What if you don't hurt or only hurt "a little?” While it's not always necessary to seek care for the bumps and bruises that come from normal activity, it’s useful to become educated and get answers when small pains begin to stack up and change the way you move normally. 

Our bodies already have a few superpowers. For example, they’re immensely resilient and have an impressive capacity to heal. More often than not, fear of re-injury and compensating for a previous injury by, say, changing your gait slightly, actually leads to more persistent pain. SPJs are great to have around in these cases because they know exactly when and where to apply stress to the body to speed up healing, as well how to help people best understand how to heal themselves. 

3. You want to save money and time. 

Surgery can be expensive, timely and require a frustrating amount of recovery time. But what if I told you that mounting evidence shows that, in some cases, an SPJ’s management is as effective as many surgical treatments for hip, back, shoulder and knee pain? Believe it. Not only can SPJs save people from some unnecessary surgeries, but good SPJs can also be more cost-effective than the many expensive diagnostic tools typically used to "take a look" at those painful areas. Even if surgery is the best option, a well-trained SPJ can guide you along the healing process and get you back to your favorite activities in no time.

SELF-REFERRAL FOR BACK PAIN IS CHEAPER FOR OUR PATIENTS

Patients who receive care from self-referring physicians for the treatment of low back pain (LBP) are more likely to be referred for some form of physical therapy, but that's just part of the story. According to newly published research, LBP patients who are self-referred receive fewer physical therapy visits and more ineffective passive modalities than patients who aren't self-referred—and all at a higher overall cost. The state of Kansas accepts self-referral for physical therapy! 

In the study, researchers analyzed 158,151 LBP episodes in private health insurance claims records for nonelderly individuals enrolled in plans offered by Blue Cross Blue Shield of Texas. They found that physicians who "self-referred"—that is, referred their patients to a business with which they have a financial relationship—referred 26% of their patients to physical therapy. That rate was 16 percentage points higher than among non-self-referrals. Overall physical therapy was referred at a rate of 14%. 

But the higher rate of referrals doesn't tell the whole story, according to the study's authors, who analyzed what happened next—and how much it wound up costing. Results of the study were e-published ahead of print in the Forum for Health Economics and Policy (abstract only available for free). 

What they found was that the self-referred patients received, on average, 2 fewer physical therapy visits and 10 fewer 15-minute physical therapy service units compared with treatments by providers who did not self-refer. And when self-referred patients did receive physical therapy, they were treated differently from their non-self-referred counterparts, with an increased use of passive modalities such as hot and cold packs, mechanical traction, ultrasound, and electrical stimulation—approaches authors describe as "ineffective" in treatment of LBP.

Looking more closely at Healthcare Common Procedure Coding System (HCPCS) records, authors found that about 46% of physical therapy services rendered during non-self-referred episodes included individualized exercises to develop strength, endurance, range of motion, and flexibility, compared with a 31.5% rate among the self-referred episodes. Significant differences were also found in the use of dynamic activities designed to improve function, which occurred at a 6.7% rate for non-self-referred episodes but in only 4.2% of the self-referred episodes. Conversely, electrical stimulation accounted for almost 9% of the physical therapy services in self-referring episodes. Among the non-self-referred episodes, use of that passive modality was 1.4%.

Authors write that the use of exercise and dynamic activities "implies that [LBP] patients treated by non self-referring providers received skilled one-on-one care," and that "patients seen by self-referring providers received higher proportions of passive treatments." According to the authors, these passive treatments "can be easily performed by non physical therapists (medical assistants or technologists) in physicians' offices," and billed as physical therapy services under the "incident to" rule.

And what about overall cost? It turns out that fewer physical therapy sessions and a greater use of passive modalities doesn't wind up saving money—in fact, the LBP episodes addressed through self-referral averaged $889 in insurer-allowed costs, compared with $602 for non-self-referred episodes—a 49% difference. As for spending on individual physical therapy services, self-referral episodes averaged costs that were double non-self-referrals—an average of $144 for the self-referring provider, compared with $73 for the non-self-referring provider.

Results of the study not only inform physical therapist practice, but they help to clarify issues that have been at the heart of a policy debate over the reach of the Stark law, a law intended to prohibit referrals to a business that has a financial relationship with the referring provider under Medicare. That prohibition applies to most in-office ancillary services, but there a few exceptions: physical therapy is one of them. APTA has made elimination of these exceptions one of its public policy priorities.

The new study also fills in some of the gaps left in a 2014 report from the US General Accountability Office (GAO), which looked at self-referral for physical therapy across all health conditions under Medicare. That report found a higher rate of referral to physical therapy (and fewer physical therapist services received) among self-referred cases, but was limited in its scope. Authors of the new study cite a number of "deficiencies" in the report, including its focus only on elderly patients, and the lack of any analysis of the types and quality of physical therapist services rendered.

“The results of this study further confirm what APTA has firmly believed for years now,” said APTA President Sharon L. Dunn, PT, PhD, OCS, in an APTA news release. “Referral for profit leads to health care practices that benefit the provider and remove the focus from where it should be; the patient. APTA has long advocated for the elimination of referral for profit for physical therapist services from health care.” 

For their part, the study's authors keep the focus on the ways in which the quality of physical therapy services differ between self-referred and non-self-referred episodes.

"An important contribution of this study is the finding that the composition of physical therapy services rendered to [LBP] differs between self-referring and non self-referring practices," authors write. "The care provided by independent therapists is comprised of more active, hands on treatments which appear to be appropriate in light of empirical evidence showing that passive procedures are not effective treatments for LBP."

The study was funded in part by the Foundation for Physical Therapy and the National Institute on Aging.

NON-OPIOID TREATMENT AFTER SURGERIES

The results of a recent consumer survey found that 79% of patients who have undergone surgery would choose a non-opioid option for treatment of pain over opioids. These findings make clear the high level of interest patients have in nonopioid treatment after surgery, despite the nation’s growing opioid epidemic.

The survey (Opioid Addiction and Dependence after Surgery Is Significantly Higher Than Previously Known- June 13, 2016) provides valuable insight into the issue, and suggests more patient education is needed.

The study polled 500 adults in the United States who had orthopedic surgery or soft tissue surgery in June 2016, and was conducted in support of the Plan Against Pain campaign, an effort designed to educate patients about their choices in managing pain following a surgical procedure. 

According to the Centers for Disease Control and Prevention (CDC), sales of prescription opioids have quadrupled in the United States. In response to the growing epidemic, the CDC released opioid prescribing guidelines in March 2016, urging prescribers to reduce the use of opioids in favor of safe alternatives like physical therapy.

Physical therapists partner with patients, their families, and other health care professionals to manage pain through movement and exercise.

The American Physical Therapy Association launched a national campaign to raise awareness about the risks of long-term use of opioids and the fact that physical therapy is safe alternative pain management. Learn more at our #ChoosePT page.

EXERCISE OVER PHARMACEUTICALS FOR CANCER - RELATED FATIGUE

The results of a recent systematic review in Jama Oncology validated the use of exercise as treatment over pharmacological interventions for cancer-related fatigue (CRF).

These findings (Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-Analysis – March 2, 2017) are important, as CRF is a prevalent adverse reaction in patients during or after cancer treatment.

Authors reviewed 113 studies and compared the effect of the 4 most commonly recommended treatments for CRF: exercise, psychological, combined exercise and psychological, and pharmaceutical treatments. Exercise intervention had the largest overall improvement in reducing CRF and significantly better than pharmaceutical options. Clinicians were recommended to prescribe exercise interventions as first-line treatments for CRF. 

Exercise prescribed and supervised by physical therapists can help patients exercise safely and comfortably during cancer treatment. It may also relieve many of the side effects of cancer treatment. 

UNDERSTANDING PAYMENT FOR PHYSICAL THERAPY

Physical therapists are professional health care providers who are licensed by the state in which they practice. You can check with your state agency overseeing physical therapy licensure to make sure that your physical therapist is licensed and in good standing or with the state's physical therapy chapter. The following are common questions and answers pertaining to payment and insurance for physical therapy services.

Does insurance cover physical therapy services?

Most insurance plans, including Medicare, workers’ compensation, and private insurers, pay for physical therapy services that are medically necessary and that are provided by or under the direction and supervision of a physical therapist.  Your physical therapist or your insurance company can tell you whether your insurance covers the recommended services and how much your out of pocket costs will be if there are any.

What if your physical therapist doesn’t participate in your insurance plan?

Most insurance companies, with the exception of Medicare and many HMOs, allow members to go "out of network" for health care services.  Going out of network means that you can choose to see a physical therapist who is not a participating provider with your insurance company. In most cases, the amount paid by the insurance company will be less, and you will be responsible for paying the difference between what the physical therapist charges and what the insurance company pays. Many patients choose to receive services out of network in order to see the physical therapist of their choice.  Your physical therapist can let you know in advance of your treatment what your out of pocket costs will be.

What if you don’t have insurance?

If you don't have health insurance that covers physical therapy services, you can still receive services from a physical therapist by paying for the services directly.   If cost is a barrier, you may want to ask your physical therapist to modify your program so that you can do more of your treatment on your own.  Ask about establishing a payment plan so that you can get the care that you need when you need it most.

Are there some services that physical therapists provide that are not covered by insurance?

Some physical therapists provide services that may not be covered by insurance plans. Examples of these services include fitness and wellness programs, sports performance enhancement, health education classes, and some prevention programs. Many individuals find these services to be of tremendous value and readily pay out of pocket for them.  Your physical therapist can let you know whether these services are covered by your insurance and can give you information about their cost in advance.