Tag Archives: healthcare

Late Lunching Can Slow Weight Loss

A new study suggests if you are trying to lose weight, then you shouldn’t just keep an eye on the calories you consume, but also when you consume them: if lunch is your big meal of the day, then a tendency to eat it later means you will lose weight more slowly and lose less of it, than if you ate it earlier.

In other words, the later you eat your main meal of the day, the harder it is to lose weight, say researchers from Brigham and Women’s Hospital (BWH) and Tufts University in Boston in the US, and the University of Murcia in Spain, who write about their findings in the 29 January online issue of the International Journal of Obesity.

Senior author Frank Scheer, director of the Medical Chronobiology Program and associate neuroscientist at BWH, says in a statement:

“This is the first large-scale prospective study to demonstrate that the timing of meals predicts weight-loss effectiveness.”

“Our results indicate that late eaters displayed a slower weight-loss rate and lost significantly less weight than early eaters, suggesting that the timing of large meals could be an important factor in a weight loss program,” adds Scheer, who is also assistant professor of medicine at Harvard Medical School.

The researchers were interested in doing the study because while there is lots of evidence from animal research of a link between timing of food intake and weight regulation, there is scarcely any to show whether this is true of humans.

For their investigation, Scheer and colleagues looked at data on 420 overweight people who took part in a 20-week weight loss program in Murcia, Spain, where the main meal of the day in this Mediterranean region is lunch. For this population, lunch also accounts for about 40% of daily calorie intake.

About half the participants were female, their average age was 42, and around half ate lunch early (up to 3 pm) and half ate it late (after 3 pm).

The researchers found those who ate lunch early lost significantly more weight than those who ate it late.

The late-eaters also showed a much slower rate of weight loss, and a lower estimated rate of insulin sensitivity, which is a known risk factor for diabetes.

The study also looked at other factors that can influence weight loss, for example total calories consumed, energy burned, levels of appetite hormones (leptin and ghrelin), amount of sleep, and presence of clock gene (which has been linked to difficulty in losing weight).

The researchers found no significant differences between the two groups when they took these factors into account.

The timing of other meals, which were much smaller than lunch, also made little difference to the rate and quantity of weight loss, but the researchers noted that:

“Nevertheless, late eaters were more evening types, had less energetic breakfasts and skipped breakfast more frequently that early eaters.”

Lead author Marta Garaulet, professor of Physiology at the University of Murcia, says their findings show that timing of food intake may play a significant role in weight regulation in humans, and weight loss programs should therefore take into account not only “the caloric intake and macronutrient distribution, as it is classically done, but also the timing of food”.

It is not clear, however, from these study results, how applicable the findings would be to populations where a significant proportion of calories is consumed outside mealtimes. For instance, in the US, snacking accounts for 25% of calorie intake.

Can Too Much Preventive Care Be Hazardous to Your Health?

Politicians and pundits everywhere call for more disease prevention as a way to reduce healthcare costs. Certainly you cannot argue with the logic that “an ounce of prevention is worth a pound of cure.”

Or can you? It turns out that you can not only argue against that so-called logic, but – just as with cancer detection, which may have been done to excess in some protocols — you can mathematically prove that, at least for asthma, it takes a pound of prevention to avoid an ounce of cure.

The database of the Disease Management Purchasing Consortium Inc. (www.dismgmt.com) tracks both asthma drugs and visits to the emergency room (ER) and hospital stays associated with asthma. The average cost of an attack requiring an ER visit or inpatient stay is about $2000. The average cost to fill a prescription to prevent or recover from an asthma attack is about $100. It turns out that asthma attacks serious enough to send someone to the ER or hospital are rare indeed. In the commercially insured population, these attacks happen only about 3-4 times a year for every thousand people. (The rate is much greater for children insured by Medicaid; additional resources spent on prevention could very well be cost-effective for them.) Continue reading Can Too Much Preventive Care Be Hazardous to Your Health?

Can Quality Be on India’s Health Care Agenda? Should it Be?

Currently, India spends about $20 per person per year on healthcare and spending more once seemed like a peripheral concern, taking a back seat to basics like food and sanitation.  However, in the past decade, as the Indian economy has grown and wealth followed, Indians are increasingly demanding access to “high quality” healthcare.  But what does “high quality” mean for a country where a large proportion of the population still goes hungry?  Where access to sanitation is so spotty that the Supreme Court recently had to decree that every school should have a toilet?  What is “high quality” in a setting where so many basics have not been met?

It turns out that “high quality” may mean quite a lot, especially for the poor.  A few weeks ago I spent time in Delhi, meeting with the leadership of the Indian health ministry.  I talked to directors of new public medical schools and hospitals opening up around the country and I met with clinicians and healthcare administrators at both private and public hospitals.  An agenda focused on quality rang true with them in a way that surprised me. Continue reading Can Quality Be on India’s Health Care Agenda? Should it Be?

UK’s First TAVR Patient Gets Health Boost for His 82nd Birthday

 When he learned a valve in his heart needed to be replaced, 81-year-old Robert Kraus was totally against it. He was adamant doctors would not perform an open-chest procedure on him. Not at his age.

Fortunately for Kraus, he landed at the right place at just the right time and became the first patient at the University of Kentucky to receive a TAVR – a Transcatheter Aortic Ventricular Replacement device.

“One of the things having to do with having your chest opened – when you get to be my age, most of the people you know who have it done don’t do very well,” said Kraus who himself is a doctor, a psychiatrist at UK. “I’ve met a lot of guys who didn’t do very well — they wind up depressed or demented, and it took them a year or more to recuperate. So I was against it.”

After learning of his patient’s insistence against open-heart surgery, Dr. John Gurley presented Kraus with an alternative – the new minimally invasive TAVR procedure. When Gurley told Kraus that he would be a candidate for the first such procedure done at UK HealthCare, Kraus agreed to the surgery. Continue reading UK’s First TAVR Patient Gets Health Boost for His 82nd Birthday