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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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Healthy diet, exercise good for heart regardless of medication use

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No matter how many medications you take, eating a healthy diet, not smoking and getting plenty of exercise will help keep you alive, a new study finds.

“We’ve long known about the benefits of leading a healthy lifestyle. The results from our study underscore the importance of each person’s ability to improve their health through lifestyle changes even if they are dealing with multiple health issues and taking multiple prescription medications,” said researcher Neil Kelly. He’s a medical student at Weill Cornell Medicine of Cornell University in New York City.

For the study, Kelly’s team collected data on more than 20,000 people who took part in a study on racial differences in stroke.

At the start of the study, 44% of participants were taking four or fewer prescription medications, 39% were taking five to nine, and 17% were taking 10 or more medications.

After about 10 years, the researchers found that a healthy lifestyle reduced the risk of death during the study period regardless of the number of medications a person was taking, and the more healthy lifestyle habits one had, the lower the risk of death.

The findings were scheduled for presentation at the American Heart Association’s virtual annual meeting, Nov. 13 to 17. Such research should be considered preliminary until published in a peer-reviewed journal.

“It’s especially important for health care professionals to counsel patients and develop interventions that can maximize healthy lifestyle behaviors, even among patients with several prescription medications,” Kelly said in an AHA news release.

“It’s important for the public to understand that there is never a bad time to adopt healthy behaviors. These can range from eating a healthier diet to taking a daily walk in their neighborhood,” he added. “A healthier lifestyle buys more time.”

More information

For more on a healthy lifestyle, head to the American Heart Association.

Copyright 2020 HealthDay. All rights reserved.



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Bacteria in lungs may play role in cancer development, study says

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Lung cancer patients who harbor certain bacteria in the airways may have a poorer prognosis, a new study finds, adding to evidence that the body’s “microbiome” may play a role in cancer patients’ outlook.

The microbiome refers to the trillions of bacteria and other microbes that naturally dwell in the body. Research in recent years has been revealing how important those bugs are to the body’s normal functions, including immune system defenses.

When it comes to cancer, studies have hinted that the microbiome can influence tumor progression, and patients’ likelihood of responding to certain treatments.

For example, a number of cancers can be treated with immunotherapy — various approaches to boosting the immune system’s natural tumor-fighting capacity. Research has found that patients who respond well to immunotherapies tend to have a different makeup in the gut microbiome, compared to patients who do not respond.

The new study, published this week in Cancer Discovery, took a different view. Instead of focusing on the gut microbiome, researchers analyzed lung microbes of patients with newly diagnosed lung cancer.

In microbiome research, “the lung has really been ignored,” said lead researcher Dr. Leopoldo Segal, director of the Lung Microbiome Program and an associate professor at New York University Grossman School of Medicine in New York City.

Traditionally, he explained, the lungs were believed to be “sterile.” But recent research has shown that even in healthy people, the lungs can harbor low amounts of bacteria — drawn in from the air or the mouth.

Segal’s team wanted to see whether lung bacteria corresponded to lung cancer patients’ prognosis.

Looking at tissue samples from 83 patients, the researchers found that those with advanced-stage cancer carried more microbes than patients in the early stage of disease.

And when patients did have “enrichment” with certain bacteria types, their odds of survival were lower — even those with earlier-stage cancer.

Specifically, patients harboring Veillonella, Prevotella and Streptococcus bacteria had a worse prognosis. They also showed signs of an inflammatory immune response that, based on past research, may worsen lung cancer patients’ outlook.

None of that proves the bacteria, themselves, were to blame, Segal said. The cancer itself might make the lungs more “receptive” to being colonized with bacteria.

So the researchers turned to lab mice. They transferred Veillonella bacteria into mice with lung cancer and found that the microbes revved up “bad” inflammation, fed tumor growth and shortened the animals’ survival.

That suggests lung bacteria might modulate the immune response in a way that affects lung cancer progression, according to Segal.

But the microbiome is complicated, and it’s hard to draw conclusions from mouse findings, according to Dr. Thomas Marron of Mount Sinai’s Tisch Cancer Institute in New York City.

Right now, he said, there is a “huge interest” in understanding the microbiome’s influence in cancer.

“Studies like this are really interesting,” said Marron, who was not involved with the research, “but we’re probably a few decades away from being able to alter the microbiome to treat cancer.”

Individuals vary in their microbiome makeup, and that’s determined by things like genetics and the immune system, Marron explained. So even if the body’s microbial communities directly affect cancer prognosis, he said, it will be a long time before researchers can turn that into therapy.

“We still don’t know how we could effectively target the microbiome,” Marron said.

He pointed to one question from the new findings: Is there any link between the lung microbiome and patients’ likelihood of responding to immunotherapy?

Segal said his team plans to study that.

Dr. John Heymach chairs thoracic/head and neck medical oncology at M.D. Anderson Cancer Center in Houston. He called the findings “a compelling starting point,” but also emphasized the long research road ahead.

“At this point, we’re not ready to directly act on this in the clinic, by either trying to kill ‘bad’ bacteria, or add back ‘good’ bacteria,” said Heymach, who was not part of the study.

So far, he noted, studies have reached different conclusions as to exactly which types of bacteria are related to better cancer outcomes — which might be due to differences in how studies look for the microbes.

And like Marron, Heymach pointed to the microbiome’s complexity: It generally differs from one large population to the next and among individuals — based on numerous factors.

Still, Heymach said the recent “explosion” in microbiome research could eventually lead to applications in cancer treatment. Besides the possibility of altering the microbiome, he said doctors might be able to use patients’ microbiome makeup as a “biomarker” of their risk of progression.

More information

The American Cancer Society has more on cancer immunotherapy.

Copyright 2020 HealthDay. All rights reserved.



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Study: More than 4 million potential years of life lost to cancer in the U.S.

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Nov. 13 (UPI) — Deaths from cancer accounted for more than 4 million potential years of life lost in 2017 in the United States, striking down young adults in particular well before average life expectancy, an analysis published Friday by the journal Cancer Epidemiology, Biomarkers & Prevention found.

There were 599,099 cancer deaths nationally in 2017, based on death certificate data from the National Center for Health Statistics.

Lung cancer, the most deadly cancer in the United States, accounted for approximately 24% of cancer deaths nationally and 21% of potential years of life lost, while colon and rectal cancer made up 9% of deaths and 10% of potential years of life lost, the data showed.

In addition, pancreatic cancer was the cause of just over 7% of cancer deaths nationally and 7% of potential years of life lost and breast cancer accounted for 7% of deaths and 9% of potential years of life lost.

“Potential years of life lost is a useful complementary measure to cancer mortality rates,” study co-author Dr. Minkyo Song said in a statement.

“Together, they provide a more detailed picture of the social and economic toll of cancer,” said Song, a research fellow at the National Cancer institute, part of the National Institutes of Health.

More than 600,000 people in the United States have died or will die from cancer in 2020, according to the National Cancer Institute.

Potential years of life lost is an estimate of the average years a person would have lived if he or she had not died prematurely.

Average life expectancy in the United States is about 79 years, and cancer is the leading cause of death in those younger than 80 years.

For this study, the researchers used national mortality data from the U.S. National Center for Health Statistics, and defined potential years of life lost as the number of years lost prior to age 75 to quantify how many years of life were prematurely lost.

Nearly 4.3 million years of life were prematurely lost due to cancer in 2017, the data showed.

Ethnic and racial minority groups account for a disproportionate share of the burden of premature cancer death in 2017, with 78% occurring in non-Hispanic Whites with only 70% of potential years of life lost.

Conversely, Hispanic people accounted for 7% of cancer deaths and 10% of potential years of life lost, while Black people made up 12% of cancer deaths and 15% of potential years of life lost, the data showed.

Testicular cancer had the highest potential years of life lost per death, with an average of 34 years lost, followed by bone cancer, with an average of 26 years lost and endocrine cancers including thymus cancer, with an average of 25 years lost, the researchers said.

The total number of potential years of life lost increased slightly from 1990, despite an overall decrease in cancer deaths, researchers said.

In 1990, 4.26 million potential years of life were lost, compared with the 4.28 million in 2017, the data showed, with the increase likely due to the growth of the U.S. population.

For the most part, potential years of life lost mirrored overall U.S. cancer mortality trends, but one exception to this pattern was prostate cancer — which caused about 5% of U.S. cancer deaths in 2017 but only 2% of potential years of life lost.

“Potential years of life lost can be used to estimate the impact of cancer death in younger populations,” Song said. “This metric highlights the enormous loss of life due to certain cancers that occur at younger ages, even if they occur infrequently.”



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