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Unhealthy Heart Behaviors: Getting Ahead of the Curve

Unhealthy Heart Behaviors: Getting Ahead of the Curve

The American Heart Association (AHA) has set a 2020 goal of improving the heart health of all Americans by 20% while reducing deaths from cardiovascular disease (CVD) and stroke by 20%. The AHA’s 2020 goals were designed strategically to help all individuals prevent declines in their current health behaviors and take a step toward better heart health by progressing toward ideal healthy lifestyle behaviors. “To achieve these goals, prevention is the top priority,” says Bonnie Spring, PhD. “Major strides have been made toward reducing risks for CVD and stroke, but the significant economic toll linked to these health challenges necessitates a new approach.” According to recent estimates, direct annual CVD-related costs are projected to triple, rising from $272 billion in 2010 to $818 billion in 2030. A Call to Action In 2013, the AHA released a science advisory, published in Circulation, emphasizing the importance of greater efforts to preserve cardiovascular health from childhood and to treat health risk behaviors into older ages. The call-to-action statement addresses three novel approaches to attain the AHA’s 2020 goals: 1. Preserving positive cardiovascular health by promoting healthy lifestyle behaviors. 2. Treating unhealthful behaviors in addition to risk biomarkers. 3. Combining individual-level and population-based health promotion strategies that steer the public toward the next level of improved cardiovascular health. “Clinicians need to treat unhealthy behaviors as aggressively as they treat high blood pressure (BP), cholesterol, and other CVD risk factors,” says Dr. Spring, who was lead author of the AHA statement. “It’s a paradigm shift from only treating biomarkers to also helping people change unhealthy behaviors.” Clinicians already treat physical risk factors, but people...
Substance & Alcohol Use After Weight Loss Surgery

Substance & Alcohol Use After Weight Loss Surgery

Weight loss surgery (WLS) has been an effective treatment for many patients with clinically severe obesity and comorbid medical con­ditions. Despite its merits, WLS requires major lifestyle changes for potential candidates, and many patients may not be adequately prepared to make such changes. Studies have suggested that substance and alcohol abuse is more common among patients undergoing WLS, but this research has been limited by the lack of preoperative baseline data as well as longitudinal data. The symptom substitution theory states that eliminating a particular symptom without treating the underlying cause will lead to the development of a substitute symptom. Under this theory, it’s possible that the risk of substance use may rise after WLS; while the surgery helps eliminate excessive eating, it doesn’t address any potential underlying psychopathology. Since drugs, alcohol, and other substances trigger responses in the brain similar to that of food, it’s possible that they can serve as a food substitute in the WLS population. A Closer Look At Substance Use After Weight Loss Surgery My colleagues and I had a study published in JAMA Surgery that examined the likelihood of WLS patients to develop substance use—specifically alcohol, cigarettes, and recreational drugs—after their operation. We analyzed 155 patients undergoing WLS—100 who underwent laparoscopic Roux-en-Y gastric bypass (RYGB) surgery and 55 who received laparoscopic adjustable gastric band (AGB) surgery. Participants undergoing either RYGB or AGB surgery reported significant increases in the frequency of substance use—using a composite of drug use, alcohol use, and cigarette smoking—when assessed 2 years after surgery. Notably, patients in the RYGB group reported a significantly higher frequency of alcohol use at 2...
Can Financial Incentives for Patients Induce Weight Loss?

Can Financial Incentives for Patients Induce Weight Loss?

Several studies have suggested that financial incentives appear to help overweight and obese patients continue to participate in weight-loss programs longer and lose more weight than counterparts who do not receive such incentives. However, when financial incentives are removed, patients tend to regain the weight they had lost. “People are hard-wired to make choices that provide immediate gratification, even if it’s known that they will regret those choices in the long term,” says Steven L. Driver, MD, MPH. “The same is true when people are motivated to make healthy decisions.” Testing a Financial Incentive Approach At the American College of Cardiology’s 2013 annual meeting, Dr. Driver and colleagues presented data from a study that investigated whether providing continuous financial incentives for 1 year would encourage participants to achieve and maintain weight loss. “We hypothesized that financial incentives would help participants stick with the healthy behaviors they know they should practice more often,” Dr. Driver says. “This could therefore help them achieve sustainable weight loss.” For the study, 100 patients between the ages of 18 and 63 with a BMI of 30 kg/m2 to 39.9 kg/m2 were randomized to education with or without financial incentives or to education plus a structured behavior modification plan with or without financial incentives. “All participants were given a weight loss goal of 4 lbs per month, which was adjusted based on the previous months’ weight,” explains Dr. Driver. Participants in the incentive arms could earn $10 for attending monthly weigh-ins. An additional $20 could be earned by those who met their goal weight for the month. However, those who failed to meet their goal...
Innovative Techniques to Address Bariatric Surgery Complications

Innovative Techniques to Address Bariatric Surgery Complications

Millions of patients find it extremely difficult to achieve durable weight loss without medical intervention. Many opt for bariatric surgery to achieve a healthier weight, but up to 30% of patients who undergo these procedures regain weight. There are a variety of reasons for regaining weight after bariatric surgery. In some cases, there may be dysfunction of the stomach pouch that was surgically created. Others may experience dangerous and painful complications, such as fistulas and leaks. Patients who experience these types of post-bariatric surgical problems are reluctant to undergo another invasive procedure to correct the issues. Alternatives to Bariatric Surgery Complications In recent years, an important treatment alternative has emerged for this patient population thanks to advanced endoscopy. Using this approach, we can address post-bariatric surgery problems like fistulas, ulcers, and lap band erosion with less invasive endoscopic surgery techniques. Advanced endoscopy enables clinicians to: Locate and repair defects. Close leaks and fistulas with endoscopic sutures. Reduce patient discomfort. Reduce postoperative recovery time. Help re-establish proper pouch dimensions. Help stop weight gain and aid in weight loss. With advanced endoscopy, we’re able to perform endoscopic pouch reduction surgery to restore the stomach pouch to its original post-surgery dimensions and halt weight gain. These procedures help patients experience less postoperative discomfort, as there is minimal to no blood loss, no external cuts, and no need to re-route the existing anatomy. This results in shorter hospital recovery times, with most patients going home the same day. Advanced endoscopic techniques can be beneficial to manage complications after bariatric surgery. These include repairing and/or addressing gastric pouch dysfunction/defects, esophageal and gastric fistulas, sleeve...

Can Dreaming About Exercising Lead to Weight Loss?

I was about to write one of my infrequent but famous spoof articles, and the subject was going to be losing weight by dreaming about exercising. For fun, I decided to search the Internet to see if anyone else might have had the same notion. To my surprise, they had. Here’s what I discovered: To be able to exercise while asleep, one must be able to have a so-called “lucid dream,” which is described as being aware that one is dreaming while dreaming. According to a paper by Daniel Erlacher, 51% of 919 Germans who were questioned said they had experienced at least one lucid dream. Apparently, some lucid dreamers can also control the content of their dreams. In the Harvard Business Review, Erlacher says, “In one experiment we asked participants to dream about doing deep knee bends. Even though their bodies weren’t moving, their heart and respiration rates increased slightly as if they were exercising.” We need to find a group of overweight people who are also lucid dreamers. Finding the former should be easy. If there aren’t enough of the latter, subjects can be taught how to have lucid dreams in only 16 simple steps. After explaining what a triathlon is, we tell them to dream about doing one every night for the next, say, 10 years. Would that work? Probably not. A more scientific discussion of whether calories are actually burned while dreaming appeared in a blog called “The Naked Scientists.” Someone asked whether running in a dream burned calories. They explained that while brain metabolic activity increases and a few calories are expended while dreaming,...
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