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New weight-loss program may help low-income Americans, study says

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Lifestyle interventions can help people lose weight, but experts have worried whether such programs can work in low-income communities where obesity rates can be high and access to health care can be limited.

Until now.

A new study found that when these programs are made accessible, meaningful weight loss can be achieved.

The research team, led by Peter Katzmarzyk, from the Pennington Biomedical Research Center in Baton Rouge, studied around 800 patients with obesity across Louisiana who were racially diverse and mostly low-income.

Since most Americans have access to a clinic or physician for primary care, the researchers looked at whether primary care facilities that treat low-income patients could implement an effective weight-loss program to treat obesity.

“A lot of people, especially low-income people, have a lot of barriers to receiving treatment,” Katzmarzyk explained. “So we really wanted to test a program that would be kind of embedded in their primary care clinics — an environment that they are already familiar with.”

Around half of the study’s participants were randomly assigned to take part in a weight-loss program that consisted of weekly sessions with a health coach for the first six months of the study, followed by monthly sessions for the remaining 18 months. The sessions focused on setting goals and developing plans to lower caloric intake and increase physical activity.

The researchers then compared the progress of those in the program with the other study participants, who were only given routine medical care.

The people who participated in the program lost significantly more weight — an average of 5% of their body weight — compared to those who did not, who lost less than 1% of their body weight on average.

And many were able to keep off the pounds. Half of the patients enrolled in the program maintained at least a 5% decrease in body weight, even two years after the study concluded.

Shedding 5% of your body weight may not seem like a lot, especially for someone who is already overweight. For a 200-pound person, 5% would only amount to 10 pounds.

But Katzmarzyk and Penny Kris-Etherton, a dietitian and professor of nutrition at Penn State University, emphasized that even a small amount of weight loss can yield significant health benefits for people with obesity. A 5% weight reduction, according to Kris-Etherton, could help lower a patients’ risk of developing heart disease, stroke, high blood pressure, and diabetes — all conditions that are linked to obesity.

“So they’re not only losing 10 pounds, but they’re lowering their risk of cardiometabolic diseases,” said Kris-Etherton, who was not involved in the study. “Most people have more than 5% to lose, but if they could just lose that 5%, it would be very meaningful in terms of their health.”

And Katzmarzyk highlighted that the participants were largely able to keep off the pounds throughout the two-year-long study. “A lot of people who are on diets lose weight and then regain it,” he said. “So, this is showing that this is a fairly durable program, and someone can lose weight and maintain that weight loss over two years.”

The findings, published online Sept. 3 in the New England Journal of Medicine, suggest a broader implementation of accessible weight-loss programs across the country is the next step.

According to the study authors, primary care providers have been slow to adopt these intensive programs, and the number of obese patients who receive this kind of treatment has declined in recent years. While they acknowledged that these facilities should not be the sole deliverers of obesity treatment, they are a good place to start.

“This study emphasizes that weight loss in primary care settings is possible, but it’s just not being implemented,” Katzmarzyk said. “It really shows that it’s feasible — it can be done.”

Physicians may be resistant to hosting these programs because they take time away from routine patient care, and the necessary behavioral counseling is outside of their area of expertise. But this type of weight-loss program alleviates the burden on physicians by utilizing a referral method, in which the primary care physician refers a patient to a trained health coach, Katzmarzyk said.

Kris-Etherton added that this study is a counterpoint against some of the cynicism surrounding weight-loss programs. “Our guidelines recommend intensive lifestyle intervention,” she said. “And so many people say, ‘Oh, my patients won’t do that. This is much too intensive.’ But that’s what it’s going to take to get people to successfully lose weight.”

More information

There’s more about obesity at the U.S. Centers for Disease Control and Prevention.

Copyright 2020 HealthDay. All rights reserved.



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Low-dose electrical stimulation helps adults with dyslexia read, study finds

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Sept. 8 (UPI) — Electrical stimulation of the brain improves reading accuracy in adults with dyslexia, according to a study published Tuesday by PLOS Biology.

Transcranial alternating current stimulation, a non-invasive procedure that delivers low-dose electricity to the brain over a period of 20 minutes, was found to improve phonological processing — or ability to discern how words sound or are pronounced — and reading accuracy in 15 adults with dyslexia, the researchers said.

The beneficial effect on phonological processing was most pronounced in those individuals who had poor reading skills, while a slightly disruptive effect was observed in very good readers, they said.

Dyslexia, known commonly as a reading disorder, affects up to 10% of the population, and is characterized by lifelong difficulties with written material,” according to the researchers, who are from the University of Geneva in Switzerland.

Although several possible causes have been proposed for dyslexia, the predominant one is a phonological deficit, or a difficulty in processing word sounds, the researchers said.

The phonological deficit in dyslexia is associated with changes in rhythmic or repetitive patterns of electrical activity in the brain, specifically “low-gamma” oscillations, measuring at 30 hertz or volts, in the left auditory cortex, they said.

However, studies have yet to prove that these these oscillations affect a person’s ability to process word sounds and cause dyslexia, the researchers said.

For this study, the researchers applied transcranial alternating current stimulation over the left auditory cortex in 15 adults with dyslexia and 15 fluent readers for 20 minutes.

At a dose of 30 hertz or volts, the approach resulted in significant improvement in reading accuracy in those with dyslexia, the researchers said.

However, the same improvements were not seen following application of a higher, 60-hertz dose, they said.

The results demonstrate for the first time that low-gamma oscillatory activity causes deficits in phonemic processing and may pave the way to non-invasive treatments aimed at normalizing oscillatory function in auditory cortex in people with dyslexia, the researchers said.

They plan “to investigate whether normalizing oscillatory function in very young children could have a long-lasting effect on the organization of the reading system [and] explore even less invasive means of correcting oscillatory activity,” study co-author Silvia Marchesotti, a post-doctural researcher at the University of Geneva, said in a press release.



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Surgery may help sleep apnea patients who struggle with CPAP

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Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



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COVID-19-related heart, lung issues ease over time in survivors, study shows

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Long-term heart and lung damage can occur in COVID-19 patients, but it may ease with time, according to a new study.

A second study found that COVID-19 patients recover faster if they begin rehabilitation as soon as possible after getting off a respirator or leaving intensive care.

“The bad news is that people show lung impairment from COVID-19 weeks after discharge the good news is that the impairment tends to ameliorate over time, which suggests the lungs have a mechanism for repairing themselves,” said researcher Sabina Sahanic, a clinical Ph.D. student at University Clinic in Innsbruck, Austria.

“The findings from this study show the importance of implementing structured follow-up care for patients with severe COVID-19 infection. Importantly, CT unveiled lung damage in this patient group that was not identified by lung function tests,” she said.

Both studies were presented at a virtual meeting of the European Respiratory Society.

Sahanic’s research included 86 hospitalized COVID-19 patients in Austria who were enrolled between April 29 and June 9.

The patients, average age 61, were evaluated six, 12 and 24 weeks after leaving the hospital. At their first visit, more than half had at least one persistent symptom — mainly breathlessness and coughing. CT scans showed that 88% still had lung damage.

By their second visit at 12 weeks, patients’ symptoms had improved and 56% had signs of lung damage. Findings from the evaluations at 24 weeks weren’t available yet.

“Knowing how patients have been affected long-term by the coronavirus might enable symptoms and lung damage to be treated much earlier and might have a significant impact on further medical recommendations and advice,” Sahanic said in a meeting news release.

The other study included 19 patients with severe COVID-19. They spent an average of three weeks in intensive care and two weeks in a pulmonary ward before being transferred to a clinic for about three weeks of pulmonary rehabilitation.

A walking test evaluated their weekly progress. At the start of rehab, they could walk only an average of 16% of the distance they should manage to walk if healthy.

That average increased to 43% after three weeks of rehab. While a significant improvement, it’s still far below normal, the researchers noted.

“The most important finding was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward where they remained inactive,” said study author Yara Al Chikhanie. She’s a Ph.D. student at the Dieulefit Santé clinic for pulmonary rehabilitation and the Hp2 Lab at Grenoble Alps University in France.

“The sooner rehabilitation started and the longer it lasted, the faster and better was the improvement in patients’ walking and breathing capacities and muscle gain,” Al Chikhanie said in the release.

Patients who started rehabilitation in the week after coming off their ventilators progressed faster than those who were admitted after two weeks, she added. But how soon they can start rehab depends on when their doctors deem them medically stable.

“Despite the significant improvement, the average period of three weeks in rehabilitation wasn’t enough for them to recover completely,” Al Chikhanie said.

Data and conclusions presented at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19.

Copyright 2020 HealthDay. All rights reserved.



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