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Health Care

Coffee Drinkers Might Live Longer

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I’m sure the folks at Starbucks are rejoicing at yesterday’s headlines announcing that “coffee drinkers might live longer.” Women who drank more than six cups of coffee a day were found to have a 17 percent lower risk of dying from heart disease, cancer, and other illnesses over 24 years of follow-up compared with those who drank less than one cup a month. My editor had a big smile on her face when she heard this news and happily told me that she downs eight cups of freshly brewed coffee every morning before she comes to work. Though I hate to burst her bubble, I have to point out that women who drank four to five cups per day actually had better protection: a 26 percent lower risk of dying.

Being a two-cup-a-day person myself, I think the findings of this study are more reassuring than life altering. The researchers carefully phrased their conclusion that “regular coffee consumption was not associated with an increased mortality rate” and that evidence of modest benefits needs to be studied further. Certainly, women shouldn’t add coffee to their list of nutritious foods that they have to get more of. After all, male coffee drinkers in the study didn’t enjoy a lower death rate, and too much caffeine can cause temporary increases in blood pressure—not good for those with hypertension or heart disease.

JoAnn Manson, chief of preventive medicine at Harvard’s Brigham and Women’s Hospital, agrees. “The evidence isn’t up to the level where people should be encouraged to take up coffee drinking for the purpose of improving their health.” She’s one of the researchers on the Nurses’ Health Study, which provided the data for the current study, and notes that it simply observed the lifestyle habits of people rather than randomly giving coffee to some and not to others. “It’s quite possible that people who drink coffee regularly drink less of other beverages like sugar-sweetened sodas, so it’s really open to question as to whether these are direct benefits from the coffee itself.”

Pregnant women also need to be wary of how much coffee they drink. Studies have flip-flopped over whether caffeine can cause miscarriages, but one compelling finding that my colleague Ben Harder blogged about in January suggests that drinking as little as 200 milligrams of caffeine a day—equivalent to about two cups of brewed coffee—doubles the rate of miscarriages. Many experts advise pregnant women to abstain from coffee if they can or at least to limit consumption to about one cup a day.

But coffee certainly never earned its “sinful food” reputation either. A growing body of research has shown that, like tea, coffee packs a wallop of antioxidants that can protect against diseases like diabetes, Parkinson’s, gallstones, and some cancers, as U.S. News previously reported. And an April study found that small amounts of caffeine could help counteract the increased Alzheimer’s disease risk found in those with high cholesterol levels. Though caffeine has been linked to bone loss in elderly women, additional findings show that this poses a problem only for those who don’t get enough calcium.

“I think the bottom line is that coffee is not deleterious to health and may even have some health benefits,” Manson says. “For those who are regular coffee drinkers, that’s good to know.”

Weight loss diet for man and women

Why We’re So Fat: What’s Behind the Latest Obesity Rates

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The connection between health, wealth, and everything else

It used to be that rich and fat were terms associated with people, not dessert. A portly shape, in fact, signaled the good life. If you ever saw the musical Oliver!, you may recall the number, “Food, Glorious Food,” in which a stage full of scrawny orphans pine for the gluttony that money can buy: “Rich gentlemen have it boys, In-di-gestion!” Today, however, we often see the reverse scenario: the leaner your wallet, the fatter you are.

“You have this coexistence of obesity and food insecurity in America,” says Susan Blumenthal, former U.S. assistant surgeon general, clinical professor at Georgetown and Tufts University medical schools, and director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress. Finding, and affording, healthy food along with safe places to exercise, are among the challenges that low-income populations face.

So perhaps it’s not surprising that the statistics released Monday by the Centers for Disease Control and Prevention (CDC) showed that Mississippi, the poorest state in America, has the nation’s highest obesity rate, at 34.9 percent. States in the South and Midwest, which, in some cases, represent the poorest parts of the country, showed the highest incidences of obesity. While financial health has a bearing on physical health, the correlation is a complicated one. Culture, gender, education, biology, and even politics, play a role. America’s so-called “red” states tend to have higher rates of obesity, experts note. Plus, the prevalence of cheap, processed foods, the layout of our neighborhoods, and access to parks and public transportation also factor into one’s risk for obesity and, consequently, disease. And while poor Americans may find it especially challenging to access the ingredients of a healthy lifestyle, obesity is clearly not limited to the province of the poor. More than one-third of the nation is obese, according to some data sets, and that cuts across all income levels.

“There is no single, simple answer to explain the obesity patterns” in America, says Walter Willett, who chairs the department of nutrition at the Harvard School of Public Health. “Part of this is due to lower incomes and education, which result in purchases of cheap foods that are high in refined starch and sugar. More deeply, this also reflects lower public investment in education, public transportation, and recreational facilities,” he says. The bottom line: cheap, unhealthy foods mixed with a sedentary lifestyle has made obesity the new normal in America. And that makes it even harder to change, Willett says.

In 1990, not one U.S. state had an obesity rate greater than 14 percent, according to the CDC. Ten years later, 23 states reported an obesity rate between 20 to 24 percent. And in 2010, 36 states had an obesity rate of at least 25 percent, with 12 states reporting an obesity rate beyond 30 percent. (The CDC notes that it used a new methodology for its 2011 survey, rendering comparisons with past years rather rough.)

“We now see that life expectancy is for the first time decreasing in many parts of the South and Southeast,” says Willett.

Obesity puts people at risk for heart disease, stroke, diabetes, and cancer. These illnesses, of course, exact a financial toll too. In 2008, this country spent approximately $147 billion on medical costs, the CDC says. If every American were to lose an average of 10 pounds, the United States would save roughly $29 billion a year within five years, says Jeffrey Levi, executive director of the Trust for America’s Health, a nonprofit organization promoting national health. “If you really want to bend the cost curves, it isn’t doing things at the margins” that counts, he says, but “taking on the fundamental challenge of preventing and reversing chronic disease.”

But the CDC’s state-by-state picture of America’s obesity epidemic may not be the best way to understand, let alone tackle, the issue.

Obesity is tied not to states, per se, but to certain populations who reside in those states, says Barbara Ormond, senior research associate at the Health Policy Center of the Urban Institute, a Washington, D.C.-based think tank. Each of these populations grapple with specific problems, she explains. “Take, for example, comfort food, she says, which varies by culture and nutritional quality.

According to the CDC, non-Hispanic blacks have the highest rates of obesity, followed by Mexican Americans, all Hispanics, and non-Hispanic whites. When it comes to socioeconomic status, the data differ by gender. For example, college-educated women and women who earn higher incomes are less likely to be obese than women who didn’t graduate high school or earn lower salaries. However, such correlations don’t exist among men, for whom obesity is roughly the same across income levels. In fact, higher incomes were associated with increased obesity rates among non-Hispanic black and Mexican-American men, the CDC reports.

Such complexities explain Ormond’s caveat against labeling obesity a poverty problem. It’s a “shorthand way of looking at it” that reduces it almost to something that’s hard to do anything about, she says. “You can’t make everybody not poor, but you could give them good schools, or you could make sure the school lunch you’re serving is nutritious.”

Fixing this problem is going to take a proverbial village, public health experts say.

“We need to mobilize all sectors of society,” Blumenthal says, calling for policies that will create more places to walk and exercise, as well as physical and health education in schools and healthier choices in vending machines, for example. But communities can begin the intervention, she says, noting the Affordable Care Act’s Prevention and Public Health Fund, which can seed local efforts. Neighborhoods might come together to organize a health fair, coordinate a race to motivate community weight loss, or plant community gardens, she advises.

And beyond that, those working to fight obesity in this country ought to be patient and persistent, Ormond says. “It took us many, many years to get as fat as we are as a nation, and it’s going to take us a similar number of years, or certainly a lot of effort to reverse that trend.”

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Best to Be Overweight, but Not Obese? Higher Levels of Obesity Associated With Increased Risk of Death

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In an analysis of nearly 100 studies that included approximately 3 million adults, relative to normal weight, overall obesity (combining all grades) and higher levels of obesity were both associated with a significantly higher all-cause risk of death, while overweight was associated with significantly lower all-cause mortality, according to a study in the January 2 issue of JAMA.

“Estimates of the relative mortality risks associated with normal weight, overweight, and obesity may help to inform decision making in the clinical setting,” according to background information in the article.

Katherine M. Flegal, Ph.D., of the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md., and colleagues conducted a study to compile and summarize published analyses of body mass index (BMI) and all-cause mortality that provide hazard ratios (HRs) for standard BMI categories. For the review and meta-analysis, the researchers identified 97 studies that met inclusion criteria, which provided a combined sample size of more than 2.88 million individuals and more than 270,000 deaths. Regions of origin of participants included the United States or Canada (n = 41 studies), Europe (n = 37), Australia (n = 7), China or Taiwan (n = 4), Japan (n = 2), Brazil (n = 2), Israel (n = 2), India (n = l), and Mexico (n = l).

All-cause mortality HRs for overweight (BMI of 25-<30), obesity (BMI of ≥30), grade 1 obesity (BMI of 30-<35), and grades 2 and 3 obesity (BMI of ≥35) were calculated relative to normal weight (BMI of 18.5-<25).

The researchers found that the summary HRs indicated a 6 percent lower risk of death for overweight; a 18 percent higher risk of death for obesity (all grades); a 5 percent lower risk of death for grade 1 obesity; and a 29 percent increased risk of death for grades 2 and 3 obesity.

The authors note that the finding that grade 1 obesity was not associated with higher mortality suggests that that the excess mortality in obesity may predominantly be due to elevated mortality at higher BMI levels.

The researchers add that their findings are consistent with observations of lower mortality among overweight and moderately obese patients. “Possible explanations have included earlier presentation of heavier patients, greater likelihood of receiving optimal medical treatment, cardioprotective metabolic effects of increased body fat, and benefits of higher metabolic reserves.”

The use of predefined standard BMI groupings can facilitate between-study comparisons, the authors conclude.

Editorial: Does Body Mass Index Adequately Convey a Patient’s Mortality Risk?

“Can overweight as defined by BMI actually have a protective association with mortality?” write Steven B. Heymsfield, M.D., and William T. Cefalu, M.D., of the Pennington Biomedical Research Center, Baton Rouge, La., in an accompanying editorial.

“The presence of a wasting disease, heart disease, diabetes, renal dialysis, or older age are all associated with an inverse relationship between BMI and mortality rate, an observation termed the obesity paradox or reverse epidemiology. The optimal BMI linked with lowest mortality in patients with chronic disease may be within the overweight and obesity range. Even in the absence of chronic disease, small excess amounts of adipose tissue may provide needed energy reserves during acute catabolic illnesses, have beneficial mechanical effects with some types of traumatic injuries, and convey other salutary effects that need to be investigated in light of the studies by Flegal et al and others.”

“Not all patients classified as being overweight or having grade 1 obesity, particularly those with chronic diseases, can be assumed to require weight loss treatment. Establishing BMI is only the first step toward a more comprehensive risk evaluation.”

Health Care

How Healthcare Is Changing—for the Better

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Sarah Holobaugh, 80, has diabetes, heart disease, hypertension, and chronic obstructive pulmonary disease. To keep her safe and out of the hospital, a team of healthcare providers—a doctor, high-risk home healthcare nurse, social worker, and patient care manager—monitors her blood pressure, blood sugar, and other vitals daily. With the help of people in her Peoria, Ill., community, they’re also arranging for a new roof. For free.

Welcome to one of several experiments going on across America, transforming the way healthcare is delivered. One big problem that health reform has taken on is the fee-for-service payment system, which tends to encourage a piling-on of tests and treatments when less care (and preventive care and better-coordinated care) would often produce better results at lower cost. Now, health insurers and Medicare are beginning to turn that system on its head, paying doctors and hospitals based on how successfully they treat patients and keep them out of the hospital. “They are all so concerned personally,” Holobaugh says of her team’s determination to make sure that mold caused by a leaky roof doesn’t worsen her lung disease. Holobaugh is served by OSF Healthcare System, which includes eight hospitals and more than 600 doctors.

What will this movement mean for you? “It means getting to see a doctor the same day you have a problem,” says Elliott Fisher, director of the Center for Population Health at the Dartmouth Institute for Health Policy and Clinical Practice. It means more timely responses from your healthcare team by E-mail, text, or telemedicine. It may mean you have a personal health coach, and that you notice your doctor nudging you more energetically about that flu shot and less-than-ideal blood pressure and working harder to keep you exercising and eating well; Holobaugh’s team has connected her with local food pantries, for instance. You shouldn’t even be surprised to see house calls come back. Here’s a sampling of places where healthcare is changing for the better.

A pioneering spirit. “This is how healthcare should be,” says Emily Hill, the OSF nurse who is Holobaugh’s patient care manager. Whereas most hospitals and doctors are paid only for providing direct care, and not for any time and effort they spend trying to prevent illness, doctors here are rewarded in part for making sure people suffering from diabetes or other chronic maladies are taking the steps they need to take to keep their conditions in check. Patient satisfaction counts in the compensation equation, as does how quickly people can get appointments. So, for instance, heart failure patients are contacted within two days of their discharge from the hospital to be sure they’re taking their medicine and have scheduled follow-up doctor appointments. Care managers like Hill track children’s immunization history in electronic patient registries and call families that fall behind schedule to remind them to come in. Aligning payment with the interests of patients and payers makes providers more accountable, experts say—one big goal of health reform.

Medicare, the nation’s largest health insurer, has committed to a new payment system based on the principle that an ounce of prevention is much more cost-effective than a pound of cure. In January, program officials formally gave OSF, Partners HealthCare in Boston, Presbyterian Healthcare Services in New Mexico, and 29 other hospitals, large physician groups, and health systems the designation “Pioneer Accountable Care Organizations” along with the flexibility to figure out how to better organize care delivery around patients’ best interests. The agency is tracking their performance on 33 quality and performance measures, from patient satisfaction to hospital readmission rates to how reliably people with asthma, for example, get the care they need.

Already, some 20 percent of the money OSF receives from Medicare and other insurers is for performance-based care. As more insurers fall into step, the goal is to expand high-touch prevention to all patients, and add coaching, house calls, and greater attention to the realities of daily life—like transportation and financial issues and Holobaugh’s leaky roof—that hinder people from staying well.

Vermont’s blueprint for health. Retired IBM engineer Stephen Hennessey of Essex Junction, Vt., is “very, very happy” with his internist, Lucy Miller, especially since she helped him get serious about a lifestyle overhaul by providing him with extra attention, at no cost to him, from a nurse, medical social worker, health coach, and dietitian. Like many of Vermont’s primary care practices, Miller’s is organized as a “patient-centered medical home,” where people build relationships with the doctors and can count on getting quick attention to their acute and preventive medical needs, coordinated care when specialists are warranted, and guidance in taking care of themselves. Last fall, when Miller diagnosed Hennessey, 60, with type 2 diabetes, she prescribed medicine and a better diet plus exercise. She then connected Hennessey with one of the state’s new local community health teams that works in conjunction with her practice to coordinate Hennessey’s care and cheerlead as he develops healthier habits. So far, Hennessey has lost 30 pounds and soon expects to stop taking two of his four drugs.

Community health teams now dot Vermont, helping to extend the reach and preventive power of primary care practices. You don’t have to be served by Medicaid or have particular private health coverage to qualify; the teams take “all comers,” says Lisa Dulsky Watkins, associate director of Vermont Blueprint for Health, the state’s initiative to transform healthcare delivery. Early evidence suggests that Blueprint is working to contain costs. A four-year review of hospital data showed that the growth in inpatient admissions and emergency department visits has slowed.

Heart Care at Home. The first month after a hospital discharge is a vulnerable time for many people, since post-hospital care is often chaotic—even if patients are not left entirely on their own. Insurers typically have not reimbursed hospitals or doctors for coordinating care after a person leaves, and frequently have had to pay instead for costly readmissions. Approximately 1 in 4 people with heart failure are back for return visits within a month of being sent home, for example. As of October 1, Medicare starts financially dinging hospitals when certain patients are readmitted within 30 days.

The Cleveland Clinic’s two-year-old Heart Care at Home program aims to bring those numbers down. When Richard Jones of Niles, Ohio, 70, was discharged in May, he was sent home with a digital scale to flag any weight fluctuations (a possible sign of fluid buildup), a blood pressure cuff, and other monitoring equipment tied into the hospital system. He was also assigned a telemonitoring support team of nurses, social workers, nutritionists, therapists, and doctors who would check his vital signs daily, remotely or in person, for up to 40 days. In phone and house calls, the team coordinated follow-up doctor visits and counseled the lifelong cheeseburger-and-fries fan on worrisome symptoms to watch for and how to make lifestyle changes stick.

“I’ve stopped smoking, and all these things they told me to do, I’ve done,” says Jones. “Without them, I don’t know how I would have got through this.” Cleveland Clinic is not paid directly for Heart Care at Home, and does not charge patients. But so far the readmission rate for participants is running 4 percent lower than for the hospital’s Medicare heart failure patients overall. And, says David Longworth, chairman of the Cleveland Clinic’s Medicine Institute, it’s “the right thing to do.”

Patients as partners. People with complex and even life-threatening medical problems often handle them this way: The doctor diagnoses a condition and recommends a treatment, and the patient complies. Now institutions like Massachusetts General Hospital in Boston, Dartmouth-Hitchcock Medical Center in New Hampshire, and Mercy Clinics in Iowa are adding a step to the process. They’re educating patients about their options, and asking them what they think. “I felt I had a choice,” says David Wunsch, a Belmont, Mass., retiree who was referred by his Mass General primary care doctor to an orthopedic surgeon last March after the pain in his left knee became “intolerable.” The doctor also e-prescribed a video highlighting the pros and cons of different knee pain treatment options, from pain shots to full knee replacements.

“Shared decision-making” formalizes a partnership between patients and their providers, says Leigh Simmons, co-director of Mass General’s program. Jointly, they make the call on treatment paths, taking into account both the scientific evidence and the patient’s values and preferences. The hospital’s electronic medical records system prompts doctors when a treatment decision needs to be made for one of 35 conditions, reminding them to order educational DVDs for patients through a Netflix-type system and to invite the patients to bring up any questions. Dartmouth-Hitchcock has a shared decision-making center where patients can discuss options with staffers and consult educational aids. Mercy Clinics’ health coaches meet with patients to distribute resource material and answer questions; patients then meet with their healthcare providers to plot the right path.

Wunsch watched his video and got a better understanding of his options and what surgery would entail. He opted to get his left knee replaced this spring.

Weight loss diet for man and women

What Is the ‘Best Diet’ for You?

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We’ve named some standouts, but you have to decide for yourself which diet is the best fit for you

What makes a diet best? In Best Diets 2012, the latest set of exclusive rankings from U.S. News, the DASH diet beat out 24 others, among them Atkins, Jenny Craig, and Slim-Fast, to win the “Best Diets Overall” crown. Among the 12 commercial diet programs marketed to the public, Weight Watchers came out on top. (Our methodology explains how.) We also ranked the diets on likelihood of weight loss, ability to prevent and control diabetes and heart disease, healthiness, and how easy they are to follow.

Our analysis puts hard numbers on the common-sense belief that no diet is ideal for everybody.

Take DASH, the Best Diets Overall winner. It wasn’t created as a way to drop pounds, but as a means of combating high blood pressure (it stands for Dietary Approaches to Stop Hypertension). The federal government, which funded the research behind DASH, doesn’t even call it a diet—it’s an “eating plan.” If losing weight is your No. 1 goal, a diet in our Best Weight-Loss Diets rankings would be a more likely choice. Or if you have diabetes, you might want to look especially hard at Best Diabetes Diets.

That’s why we’re giving you lots of tools. Each diet was scored by a panel of experts in short-term and long-term weight loss, on how easy it is to follow, how well it conforms to current nutrition standards, and on health risks it may pose—plus its soundness as a diabetes and as a heart diet. On the data page, you can reorder the 25 diets in any of these categories with the click of a mouse.

Besides the rankings and data, each diet has a detailed profile that tells you how it works, what evidence supports (or refutes) its claims, a nutritional snapshot, right down to daily milligrams of potassium, and, of course, a close look at the food you’d eat—with photos. All of it is reliable and easy to understand.

These tools will be at least a start at helping you, your mother, your brother—whoever—find that elusive perfect-for-me diet. Once you’ve whittled down your eligible diets to a few, consider your personality and lifestyle. If you’re a foodie, you probably won’t be happy with a plan built around frozen dinners, like Nutrisystem and Jenny Craig, or mostly just-add-water meals, like Medifast. If cutting carbs will just make you cranky and resentful, you’ll want to stay away from low-carb diets like Atkins and South Beach.

Then think about what did and didn’t work the last time you were on a diet. Was it too restrictive? Lots of diets we covered don’t consider any food off-limits. Didn’t provide enough structure? Some plans will tell you exactly what to eat and when.

With any diet, ask yourself: How long can I stay on this? No matter how good it looks (or how good it might make you look), if you can’t stick with it in the long run, you’ll be right back where you started after a couple of months.

And consider physical activity, an important component of any healthy lifestyle. Does your plan lay out a specific exercise program, or are you on your own?

The questions are endless. Right now you may have no idea what will or won’t work for you. That’s what we’re here for. We’re not going to tell you what diet you should be on, but we can help lead you to a winner—the Best Diet for you.

Health Care

Men With Erection Problems Are Three Times More Likely to Have Inflamed Gums, Study Finds

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Men in their thirties who had inflamed gums caused by severe periodontal disease were three times more likely to suffer from erection problems, according to a study published in the Journal of Sexual Medicine.

Turkish researchers compared 80 men aged 30 to 40 with erectile dysfunction with a control group of 82 men without erection problems.

This showed that 53 per cent of the men with erectile dysfunction had inflamed gums compared with 23 per cent in the control group.

When the results were adjusted for other factors, such as age, body mass index, household income and education level, the men with severe periodontal disease were 3.29 times more likely to suffer from erection problems than men with healthy gums.

“Erectile dysfunction is a major public health problem that affects the quality of life of some 150 million men, and their partners, worldwide,” says lead author Dr. Faith Oguz from Inonu University in Malatya, Turkey.

“Physical factors cause nearly two-thirds of cases, mainly because of problems with the blood vessels, with psychological issues like emotional stress and depression accounting for the remainder.

“Chronic periodontitis (CP) is a group of infectious diseases caused predominantly by bacteria that most commonly occur with inflammation of the gums.

“Many studies have reported that CP may induce systemic vascular diseases, such as coronary heart disease, which have been linked with erection problems.”

The average age of the men in both groups was just under 36 and there were no significant differences when it came to body mass index, household income and education.

Their sexual function was assessed using the International Index of Erectile Function and their gum health using the plaque index, bleeding on probing, probing depth and clinical attachment level.

“To our knowledge, erectile dysfunction and CP in humans are caused by similar risk factors, such as aging, smoking, diabetes mellitus and coronary artery disease,” says Dr. Oguz.

“We therefore excluded men who had systemic disease and who were smokers from this study.

“We particularly selected men aged between 30 and 40 to assess the impact of CP on erectile dysfunction without the results being influenced by the effects of aging.

“The result of our study support the theory that CP is present more often in patients with erectile dysfunction than those without and should be considered as a factor by clinicians treating men with erection problems.”