Conclusion Among patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.
In the future, remote monitoring of health data using wireless–enabled devices that measure a person’s weight, blood pressure, blood sugar, pulse, and heart rhythm could further advance telehealth’s promise.
“I imagine a world where we are continuously monitoring key health factors and using artificial intelligence to monitor those signals,” says Dr. Schwamm.
From a patient’s perspective, virtual visits save a lot of time. You don’t need to take time off work or other commitments to drive, park, and sit in a waiting room before your visit. And even though you’re not in the same room, you may actually get more direct eye contact with your physician, thanks to the face-to-face nature of video calling.
Another advantage: you may be able to have another person — such as a family member who lives across town or across the country — join the video call. That could be especially helpful if you’re facing an upcoming procedure or discussing a serious health concern. Just as with in-person visits, it’s nice to have another person listening, asking questions, and taking notes.
ABDOMINAL (VISCERAL) FAT KILLS. The following post tells you how, and suggests what you might do to prevent this scourge, which is gradually becoming an epidemic in America.
OBESITY is an energy imbalance problem. MORE CALORIES ARE CONSUMED THAN ARE NEEDED AND CAN BE UTILIZED. A Good quality Diet, with lots of natural (rather than processed) foods, especially vegetables and fruits, have lots of FIBER that takes up space and makes you feel full.
Fiber also feeds the MICROBIOME. If the foods are DIVERSE, the microbiome will also be diverse and help utilize the calories you eat. A healthy Microbiome also contributes to your health by manufacturing neurotransmitters, vitamins, and other factors that are just starting to be appreciated. Diet QUALITY, as well as quantity, is important.
EXERCISE is critical for more than utilizing calories. It increases ADIPONECTIN which guides fat to fat stores where they belong, rather than to the liver, and IRISIN which favors the production of BROWN FAT, thus utilizing energy. The opposite of exercise, the SEDENTARY LIFESTYLE, is now considered a disease system in itself.
Lack of SLEEP favors obesity in a number of ways; at the very least, you can’t eat while asleep. Abdominal fat contains INFLAMMATORY cells which go directly to the Liver via the hepatic portal system to cause metabolic disruption. Insulin sensitivity falls, blood sugar, LDL and triglycerides rise. DIABETES and the METABOLIC SYNDROME result.
The excessive weight also causes back, hip and knee problems which contribute to the 10% increase in overall medical costs due to Obesity.
We have no photographs, abdominal, navel-level girth measurements, CTs, BMIs or death certificates to prove it, but it is highly unlikely that Paleolithic Humans suffered from excessive abdominal fat. They had no refrigerators, deliciously packaged snacks, sugary, fructose-containing soft drinks and candy, nor did they have cave-lighting to extend their daylight eating hours and disrupt their diurnal rhythm.
They had to walk or run long distances to obtain their meagre food supplies, which tired them out so that they most likely had a good night’s sleep. SLEEP, DIET and EXERCISE are built into our Metabolism by Darwinian Evolution. Paleolithic humans didn’t live long lives and succumb to cancer and heart disease.
They died most often by violence, which made Blood clotting a survival benefit, rather than the Risk factor for stroke and heart attacks that coagulation is to us now. It is not all our fault that OBESITY is steadily increasing over the last few decades.
CAPITALISM is driven to provide us with ever increasingly available and tasty food. Both consumers and purveyors scream when even the most logical political check on OVEREATING is legislated: Taxing of sugary, fructose-containing, nutritionless soft drinks was tried in Philadelphia to a chorus of complaints. To my knowledge the tax has survived, reduced sugary drink consumption, and was helpful in reducing the weight of Philadelphia residents. Not many cities were brave enough to follow suit.
GENETIC Influences can also conspire against weight control. The FTO gene, while relatively infrequent does have an influence, as shown in twin studies. And there seems to be a SET POINT in weight that makes it difficult to take off the pounds and keep them off. 2 years after almost all diets, the weight has returned. Eating HABITS, once established are hard to change.
BARIATRIC SURGERY has been shown to help Obesity, as well as Metabolic syndrome and Diabetes .I hope it will survive the test of time. Weight gain is easier to PREVENT than it is to treat. Somehow, society must get to the children, and keep them from gaining weight in the first place. Even children are now becoming obese.
INTERMITTENT FASTING can help contain Obesity. My own version is TIME-RESTRICTED EATING. I limit my eating to 6 hours a day, from Noon (usually 1PM) until 6PM. This has resulted in a modest weight loss from 142 pounds to 137 pounds. My son lost some 30 pounds in a 30 day, 1000 calorie “crash” diet to fend off advised Back Surgery. He exercised a lot of SELF CONTROL both to lose the weight, and to keep it off.
Unfortunately, Self Control is in short supply in our present SOCIETY OF EXCESS. Good luck in your quest, if you choose to embark on weight reduction. And good luck with your health if you don’t. I recommend “the secret life of fat” by Sylvia Tara in either case. Also, search for intermittent fasting in DWWR.
COMMENTARY:
Water, the miracle molecule, proteins and fats are the very essence of life. Water does not dissolve fat, allowing for the cell membranes, and the compartmentalization of metabolic activity that allows life to happen.
FAT IS ESSENTIAL TO LIFE. Alas, all fats are not equally beneficial to nutrition, as the article stresses. Trans-fats, partially hydrogenated fatty acids produced mainly by industry, are the worst, acting to stimulate cholesterol synthesis, produce inflammation and damage the endoplasmic reticulum.
Their use has been banned in most countries. Saturated fat has been widely condemned, is not as good as the mono- and polyunsaturated fats, but not as bad as trans-fats. Some of life’s most delicious foods, such as cheeses, contain saturated fats, but it is best to keep down their consumption.
Remember that the first bite of something savory tastes the best; prevent habit from shoveling it down. Unsaturated fats are found in oily fish, which should be part of your diet.
Vegetables such as nuts, seeds, olives, and avocados are sources of “good fat” and should comprise 10-15% of your calories. Fats, compared to carbohydrates, contribute almost twice as many calories to your diet on a weight basis, and it’s easy to get carried away.
Total calories must be kept under control. STAY HEALTHY!
A growing number of hospitals are relying on remote ICUs to monitor and evaluate patients virtually, which helps to cope with an unrelenting COVID-19 caseload.
The Journal Science recently reported on nearly 77,000 patients hospitalized with Covid 19. 29% were overweight and 48% were Obese. A total of 77% of admissions for Covid were overweight or worse.
Overweight was defined as BMI of 25-29.9 Kg. per Square Meter, and Obese was defined as BMI of 30 or greater. Another way of stating the data is giving the rate of Hospital admissions per 10,000 People.
BMI calculators are everywhere to be found on the internet. Put in your weight and height, and find your BMI displayed.
These are striking figures, the more so because of the LARGE SAMPLE, and the LINEAR Relationship; the greater the overweight, the greater the hospitalization rate.
Every way you look at it, obesity is hazardous. More hip and knee replacements, harder to exercise, find comfortable seats, more difficult to do surgery, more diabetes, heart attacks, stroke, Hypertension, Sleep apnea, worse immunity, and now, confirming previous suspicions, clearly higher risk of being hospitalized (and dying) with Covid.
I realize that nobody chooses to be Obese; in addition to the health problems, overweight people are Subjected to discrimination.
Obesity is notoriously hard to treat; one of the few, seldom mentioned medical truths is that Diets fail long term. Starting and maintaining a diet takes Herculean Will Power, which is in short supply in our overindulgent, overadvertised, and overfed society.
If I were morbidly Obese, I might opt for Bariatric Surgery, and try my best to hold the short term weight loss, since even with surgery the pounds tend to creep back on over time.
The best way to treat Obesity is to treat it as the Plague it is. CHILDHOOD OBESITY should be treated aggressively. Keep the Obese Child from becoming an obese adult, and maybe carry yourself along with the Family.
Better yet, Good SLEEP, DIET, and EXERCISE come as an interactive mutually reinforcing package deal. Prevention always beats treatment.
My article on ABDOMINAL FAT is suggested reading, and there is a link to the Infographic which Displays the above date in graphic form.
Diabetologia (Sept 8, 2020) – Insomnia with objective short sleep duration has been associated with an increased risk of type 2 diabetes in observational studies [27, 28]. The present MR study found strong and suggestive evidence of a causal association of insomnia and short sleep duration, respectively, with increased risk of type 2 diabetes.
The present study verified several previously reported risk factors and identified novel potential risk factors for type 2 diabetes. Prevention strategies for type 2 diabetes should be considered from multiple perspectives on obesity, mental health, sleep quality, education level, birthweight and smoking.
COMMENTARY
This was a laborious and apparently objective study.
The discovery of insomnia as a unique risk factor is no surprise, and reinforces the restorative IMPORTANCE of SLEEP.
I was surprised to see docosohexanoic and Eicosapentanoic acids in the risk column and LDL in the good column. However they were studying type 2 diabetes, and not vascular health. I will continue to take my fish oil, and enjoy my HDL, which is in the good column.
—Dr. C.
Doctors Without Waiting Rooms 