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The Neuroscience of Anorexia Reveals Why It’s So Hard to Treat

Photo: Getty Images

Photo: Getty Images

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Most of the anorexia patients Dr. Joanna Steinglass sees in the inpatient eating-disorders unit at the New York State Psychiatric Institute have been to treatment before. While in the hospital or a residential treatment center, they generally gained weight and began to eat a wider variety of foods. But after they left, their old anorexic habits returned. They began skipping meals again or returning to their extreme exercise routines. All too soon, it seemed, the gains made in treatment and the hope for recovery that went along with it began to evaporate.

According to the conventional wisdom around eating disorders, these relapses were really a misguided search for control. Or maybe the patients just weren’t ready for recovery yet. Or perhaps these were signs of self-control gone awry, spurred on by friends who marvel at their seemingly endless willpower. Interesting theories, and yet Steinglass disagreed. “Even when people show up at our hospital and want to make changes, they find it tough,” she said.

Now a new study in Nature Neuroscience — which Steinglass co-authored — reveals why people with anorexia often struggle so much to integrate new ways of eating into their lives. In the brain, the behaviors associated with anorexia act a lot like habits, those daily decisions we make without thinking. And habits, according to both the scientific evidence and the colloquial wisdom, are phenomenally difficult to break. This new finding helps explain why anorexia has historically been so hard to treat: Anorexic patients are essentially fighting their own brains in an uphill battle for wellness. But more important, the new research may also point toward new and better ways to help those with the eating disorder overcome it.

Relapses among anorexic patients are all too common; about half of patients who initially respond well to treatment will eventually go back to disordered eating, according to some estimates. “We have little in the way of proven effective treatments for anorexia,” said Walter Kaye, director of the Eating Disorder Treatment and Research Program at the University of California, San Diego. (Kaye was not involved in this new study.) “If we had a better understanding of the cause of anorexia, this would aid in developing better treatment.”

Typically, Steinglass said, when patients are admitted, they tend to frequently eat only small amounts of a very limited variety of low-calorie foods. Part of the recovery process, as recounted in a 2008 study in theAmerican Journal of Clinical Nutrition, is helping them enlarge that variety, and also getting them to include more energy-dense foods (that is, foods that are higher in calories). What Steinglass wanted to know was why so many anorexia sufferers found that step so difficult. In her mind, helping people with anorexia make better decisions about food was a key goal of treatment. But when she searched the literature to find out more about this decision-making process, she came up empty-handed.

To fill that gap, Steinglass and her colleagues at NYSPI decided to conduct a study of their own to figure out how people with anorexia made decisions about what to eat, and whether those findings could provide new ways to help them get well and stay well. Steinglass recruited a group of women recently hospitalized for anorexia (although men do get anorexia, the researchers excluded them from the study to prevent any sex or gender influences on the results) and a similar number of healthy controls. First, she had them rate a series of 76 foods on healthfulness and tastiness. After the participants made their ratings, the researchers took one of the items that they deemed neutral on both qualities. With that item serving as a kind of baseline, the researchers then asked each participant to choose between that food and two other foods, a low-fat option (like carrots) and a high-fat option (like chocolate cake) while their brains were being scanned by fMRI. To make sure the decisions were as accurate as possible, the researchers then required each person to eat the food they had chosen as a snack.

Not surprisingly, the women with anorexia were significantly less likely to choose the cake than the healthy controls. But the brain-imaging data were much more striking. Individuals without eating disorders typically evaluate a variety of criteria when deciding what to eat, such as how hungry they are and how much they like the foods on offer, and their brain-imaging data reflected this. Those with anorexia, however, showed increased activity in the area of the brain called the dorsal striatum, which plays a role in decision-making, reward, and, importantly, habitual behaviors. “It seems that once people get sick, decision-making shifts to a different part of the brain that makes it more difficult to make a nuanced choice. Instead, you see the food and you automatically make a specific choice,” Steinglass said.

These findings confirmed Steinglass’s clinical hunch: Anorexia may be more about decision-making than some form of extreme willpower. When her patients left treatment, they often returned to their old environment, which was filled with cues related to eating-disorder behaviors. These cues, then, triggered the behaviors that her patients had struggled so hard to break. That these behaviors had become habitual on the neurological level was a key finding, since it meant that many with anorexia were making these decisions without being aware of it. However these habits started (and no one really knows exactly why), they became cemented in place. People with anorexia automatically searched the restaurant menu for the lowest-calorie option without even thinking about it. They cut their food into tiny pieces because it was just how they ate. There was nothing deliberate about it. Their routines had become entrenched and remarkably resistant to change.

Steinglass emphasizes that calling anorexia a “habit,” such as a headline did in the New York Times, doesn’t capture the full story. It’s not just a habit, like biting your nails. Instead, she likes to think of the disorder as being supported by these entrenched routines that must be changed for recovery to occur. And to start helping nudge her patients toward positive progress, Steinglass has begun working with them to change something tiny in their eating routines, like using different cutlery or eating in a new location. These simple switches help shake up the old anorexic routines and make it easier for them to try something new.

Over time, the goal is for the newer, healthier routines to take the place of the older, disordered ones. “It takes time and lots of practice of eating enough to replace the ingrained behavior of restriction. This is critical for understanding why short-term treatment models predicated on insurance coverage are inadequate for creating lasting behavior change,” said Lauren Muhlheim, an eating-disorders therapist in Los Angeles. Ultimately, Steinglass says, the goal of treatment is to make recovery and wellness habits of their own, so that one day returning to the illness will be as incomprehensible as recovery once was.

More from Science of Us:

What It’s Like to Have Anorexia and Autism

Anorexia Sometimes Brings Its Sufferers (Misguided) Happiness, and That Makes It Harder to Treat

The Neuroscience of Being a Selfish Jerk

What It’s Like to Be Allergic to Water

How Food Porn Hijacks Your Brain

When a Kid’s Picky Eating Isn’t Just About Food

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I Always Wanted a Tattoo, But Now I’m Getting Mine Removed

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Image: Courtesy of Popsugar Beauty

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It’s a strange feeling to get a tattoo and realize immediately that you hate it. I got my tattoo two weeks after I graduated from college. In retrospect, it was so clearly a bad idea. I came up with the design a few months earlier: while I knew I wanted an infinity sign, I never actually found a drawing of what I wanted it to look like. I just walked into a tattoo parlor on the beach, paid the man, and walked out 45 minutes later with what I can only describe as a serpent-like infinity sign on my wrist. I don’t even have any photos of the original version to share.

I tried for months to convince myself and others that I liked my tattoo. I even got it touched up at a much nicer shop with the hopes that a slight variation on the design would fix the problem. After three years of hiding it with a watch, I decided that the only option that would make me happy was to get it removed.

The Tattoo

Although the day I got my tattoo was not well thought out, I had been considering the idea for a long time. I’ve always loved tattoos. I’ve seen so many beautiful and inspiring tattoos, and most have a story behind them. I knew that I wanted a tattoo and that I wouldn’t get one unless it had meaning to me.

When I was 19, one of my dear friends was killed in a car accident. I wavered about getting a tattoo to memorialize her. Three years later, I somehow happened upon the infinity sign as the perfect tribute. To me, it represents that your past will always shape you, but time continues to move forward, and it’s important to move with it.

While I love having that reminder, there are a couple reasons I am removing the tattoo. Not only have I never liked the way it looks, but also, when you have a tattoo on your wrist, people ask you about it. I quickly learned that my tattoo is just something I don’t like talking about.

So three years after getting inked, I started the process of removal. Once again, I did not plan well. I chose a laser business a block from my apartment (convenient!) and it only cost $20 per session (cheap!). I went there twice and left the second time with various scars throughout my tattoo, which is not supposed to happen if it is treated properly. I now drive an hour away and pay much more for my treatment, but I feel so much more confident in my care and the results.

tattoo removal

How Does Tattoo Removal Work?

I asked Dr. Rick Noodleman of Age Defying Dermatology, where I am treated, to give me a simplified explanation of the science behind tattoo removal: “The laser breaks up the pigment particles, and then your body digests them [through your bloodstream] and gets rid of them.” Newer lasers break up the ink particles into smaller pieces, which allow them to be more easily digested. In the past, certain colors were more difficult to remove, but as lasers advance, more tattoos are candidates for removal.

While getting my tattoo removed, I picked up some interesting advice from the nurses, as well as theories on what can affect tattoo removal success: namely, that tattoos closer to your heart are easier to remove because there’s more blood flow, that the extra ink in my tattoo may require more sessions, and that a diet high in antioxidants could aid the process. While Dr. Noodleman was quick to refute these as minor to non-factors in aiding removal, I figure taking this dietary advice certainly can’t hurt.

Does It Hurt?

For a typical appointment, you can ice the area for a few minutes before treatment or apply numbing cream about 30 minutes in advance. Because the ink is actually below the surface of the skin, numbing isn’t 100 percent effective, but it does help. The removal is more painful than getting the tattoo, but it is over quickly: my tattoo is a little larger than one square inch, and each session lasts under 30 seconds. After the appointment, it’s important to ice the area and let the tattoo breathe, because covering or wrapping the tattoo can trap the heat from the laser and lead to scarring. It is also important to protect the area from the sun and any physical trauma for a few days after each treatment.

Thinking About Getting Your Tattoo Removed?

Do your research. Choose a place that is reputable, and ask them about the lasers they use. Right now, the best laser available is the Picosure. It’s not necessarily mandatory that an office use this laser, but you want to make sure that they use something modern, as the technology is constantly advancing. The average cost for each tattoo removal session is $40 to $100 per square inch, and most tattoos are removed within four to six sessions. Though this certainly adds up, it’s unwise to choose a place below that price point.

It is important to be more committed to your tattoo removal than you were to your tattoo. The process can take a while and costs a lot, so it can be tempting to give up and try to redo your tattoo. Be sure that it’s the right decision for you and that it’s truly what you want.

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Kids Meals, Toys and TV Ads Add Up to Frequent Fast Food: Study

FRIDAY, Oct. 30, 2015 (HealthDay News) — Television ads for fast-food restaurants that target children have a strong influence on families, especially if they offer a free toy, researchers say.

The more often kids watched TV channels that advertised children’s fast-food meals, the more often their families went to the restaurants running the ads, the new study found.

The study included 100 children, aged 3 to 7, and one of their parents. The parents were asked how often their kids watched four children’s TV channels, if their kids asked to go to the two national fast-food chains that advertised on those channels, if their kids collected toys from those restaurant chains, and how often the families visited those fast-food restaurants.

Almost 80 percent of the two restaurant chains’ child-directed ads aired on those four children’s networks, according to the researchers.

Thirty-seven percent of parents said their families made more frequent visits to the two fast-food chains and 54 percent of kids asked to go to at least one of the restaurants. Of the 29 percent of children who collected toys from the chains, nearly 83 percent asked to go to one or both of the restaurants, the investigators found.

Factors associated with more frequent visits to the fast-food chains included having more TVs in the home, a TV in a child’s bedroom, children watching TV during the day, and spending more time watching the children’s networks that aired most of the child-targeted ads.

The findings, published online Oct. 30 in The Journal of Pediatrics, show that fast-food restaurant ads on children’s TV channels can exert a significant influence on youngsters, said study author Jennifer Emond, of Dartmouth College’s Geisel School of Medicine in New Hampshire, and colleagues.

“For now, our best advice to parents is to switch their child to commercial-free TV programming to help avoid pestering for foods seen in commercials,” Emond said in a journal news release.

More information

The American Academy of Pediatrics has more about children’s nutrition.





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Many Patients With Acne Take Antibiotics Too Long: Study

FRIDAY, Oct. 30, 2015 (HealthDay News) — Many patients with severe acne remain on antibiotics too long before they are prescribed more effective medication, researchers say.

A team led by Dr. Seth Orlow, chair of dermatology at NYU Langone Medical Center in New York City, reviewed the medical records of 137 patients over the age of 12. All were treated for severe acne at Langone between 2005 and 2014.

On average, the patients were kept on antibiotics for 11 months before their doctors decided the antibiotics were not effective. Patients were then switched to the acne medication isotretinoin (brand name Accutane).

The study also found that it took an average of nearly six months from the time doctors first mentioned Accutane until patients began taking the drug.

Reasons for the long delay included strict controls placed on Accutane due to its risk of causing birth defects, and concerns about other potential side effects such as depression.

The study, published online Oct. 30 in the Journal of the American Academy of Dermatology, received no funding from the pharmaceutical industry.

“Our study suggests that physicians need to recognize within weeks, not months, when patients are failing to respond to antibiotic therapy in cases of severe acne,” Orlow said in a Langone news release.

Two dermatologists agreed that patients should talk with their physician early on about Accutane.

“Patients often feel as though oral antibiotics are much safer than isotretinoin,” said Dr. Meera Sivendran, instructor in dermatology at the Icahn School of Medicine at Mount Sinai Hospital in New York City.
“Though the risks of side effects of isotretinoin are real, the potential side effects of long-term antibiotic use are often overlooked and can also be serious.

“It’s important to start the discussion on isotretinoin early in your relationship with the patient,” she added. “If I see a patient with cystic acne, I will discuss oral antibiotics as well as isotretinoin on the first or second visit. This way they have time to read the literature on isotretinoin and address any concerns at the follow-up visit.”

Dr. Katy Burris, a dermatologist at North Shore-LIJ Health System in Manhasset, N.Y., agreed.

“We need to recognize those patients who are not responding to oral antibiotics sooner rather than later, to minimize overexposure to antibiotics as well as potential scarring, and initiate successful therapy,” she said.

The experts and study authors also pointed to another possible consequence of extending antibiotic treatment too long: the growing problem of antibiotic resistance.

“Long-term use of antibiotics is associated with bacterial resistance, and often, these patients will ultimately end up needing treatment with isotretinoin anyway,” Burris said.

Lead investigator and Langone dermatologist Dr. Arielle Nagler said, “Acne remains the number one reason for young people to visit a dermatologist, and there are no other medications as effective as isotretinoin for treating severe cases of the skin condition.

“We need to find a better balance between trying antibiotics that may work and getting isotretinoin quickly to patients for whom antibiotics are not working,” she said.

More information

The American Academy of Family Physicians has more about acne.





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Giving Birth, Breast-feeding May Help Women’s Long-Term Health

FRIDAY, Oct. 30, 2015 (HealthDay News) — Having babies and breast-feeding may extend a woman’s life, new research suggests.

Other beneficial factors appear to include starting menstruation at a later age and using birth control pills.

Researchers analyzed data from nearly 323,000 women in 10 European countries who were followed for an average of about 13 years. During that time, more than 14,300 of the women died. Nearly 6,000 died of cancer and more than 2,400 from circulatory system diseases.

The study found fewer deaths among women who gave birth between the ages of 26 and 30 than among those who were older or who gave birth at age 20 or younger. Women who breast-fed also lived longer than those who did not.

The risk of cancer death was lower in women who had given birth than among those who had not, and was lower among those who gave birth to two or three children than among those with one child. Among women who never smoked or were former smokers, those who used birth control pills were less likely to die of cancer than those who did not.

The study also found that women who had given birth, breast-fed and started menstruating when they were 15 or older had a lower risk of death from circulatory diseases, and those who had given birth and breast-fed had a reduced risk of death from heart disease.

While the study found an association between childbirth, breast-feeding and life span, it did not prove a cause-and-effect relationship.

The study was published Oct. 29 in the journal BMC Medicine.

Changes in hormone levels may explain the reduced risk of death among women who had children, breast-fed or used birth control pills, according to Melissa Merritt, a research fellow in the School of Public Health at Imperial College London in England, and colleagues.

However, more research is needed to determine how the reproductive factors identified in this study may extend life. That knowledge could lead to new ways to improve women’s long-term health, the investigators said.

More information

The U.S. National Library of Medicine has more about women’s health.





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Study Sees No Link Between Antibiotics in Early Pregnancy and Birth Defects

FRIDAY, Oct. 30, 2015 (HealthDay News) — A new Canadian study did not find any association between two common types of antibiotics taken during pregnancy and a higher risk of adverse effects to the baby.

Four out of 10 pregnant women are prescribed antibiotics, with azithromycin and clarithromycin being the most common. They belong to a class of drugs called macrolides.

“With penicillin, macrolides are amongst the most used medications in the general population and in pregnancy. However, debate remained on whether it is the infections or in fact the macrolides used to treat them that put women and their unborn child at greater risk of adverse pregnancy outcomes, including birth defects,” said study co-leader Anick Berard, a professor of pharmacy at the University of Montreal.

“We therefore aimed to estimate the risk of major congenital malformations after fetal exposure to the two most commonly used macrolides, and failed to find any,” she said in a university news release.

The researchers reviewed more than 135,000 pregnancies in the province of Quebec. About 2 percent of the women were prescribed macrolides during the first trimester of pregnancy. Major birth defects occurred in about 10 percent of the babies.

The researchers did not find an association between use of macrolides and the risk of birth defects, according to the study published Oct. 30 in the journal Pharmacoepidemiology and Drug Safety.

The researchers said previous confusion about the safety of macrolides during pregnancy might stem from several overlooked factors. For example, azithromycin is often used to treat chlamydia infections, which are associated with birth defects, the researchers said.

They added that further studies are needed to confirm the safety of antibiotics less often prescribed to pregnant women.

More information

The U.S. Office on Women’s Health has more about medicines and pregnancy.





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Ex-NFL Star Helps Spread the Word on Risks Posed by Painkillers

By Alan Mozes
HealthDay Reporter

FRIDAY, Oct. 30, 2015 (HealthDay News) — During his 12 seasons as a fullback with the Tampa Bay Buccaneers, 6-foot-1, 250-pound Mike Alstott was known as “The A-Train” — a punishing runner and blocker and fan favorite.

From 1996 to 2007, Alstott racked up an impressive National Football League resume: 5,088 yards rushing; 71 touchdowns (the most in team history); six Pro Bowls; and a Super Bowl championship ring in 2002.

But the awards and accolades came with a price that’s very familiar to many Americans: debilitating aches and injuries and a whole lot of pain medication.

“One hundred million Americans suffer from chronic pain,” said Dr. Anita Gupta, associate professor of anesthesiology at Drexel University College of Medicine in Philadelphia. “It’s a really staggering figure that’s been rising year after year, so that today there are more people struggling with pain than with heart disease, diabetes and cancer combined.”

The good news: Whether a professional athlete like Alstott or just a weekend warrior, pain sufferers now have access to more medication options than ever before. Often, such treatments take the form of prescription opioids — also known as narcotics — that include well-known painkillers such as OxyContin, Percodan, Percocet and Vicodin.

The bad news: “Every day 44 people die from prescription opioids because they are not taking their medications safely,” said Gupta. “And this is not a question of illicit use or drug abuse. Eighty percent of these deaths are unintentional and preventable. This is about very simple things, like not taking a medication as directed, or not understanding how multiple drugs can interact and cause problems, such as an accidental overdose.”

Underscoring the threat posed by improper use of potent painkillers, the U.S. National Vital Statistics System revealed this month that more American adults are now dying from prescription narcotics abuse than ever before. The analysis found that while 4.5 out of every 100,000 Americans died from a related overdose in 2003, that figure had risen to 7.8 by 2013.

To address that growing threat, the 41-year-old Alstott, his playing days behind him, has taken on the role of pain educator, tackling the opioid problem head on as part of a new public information campaign titled “America Starts Talking.”

The initiative offers consumers access to online drug discussion guides and interactive education materials. It’s a “do” and “don’t” safety resource compiled in collaboration with the American Academy of Pain Management, the American Chronic Pain Association, The Pain Community, and the U.S. Pain Foundation.

“I was very lucky,” said Alstott, who now serves as head coach for a high school football team in St. Petersburg, Fla. “Yes, I experienced 47 documented injuries throughout my playing days. Which is a lot. And yes, I had to take opioids to manage the pain. But I always had people on my side who guided me through the process and were on top of me. And I always had consistency, as far as trainers and physicians, who helped me understand how to take them safely, as directed. So my experience was good.”

But Alstott knows that others might not be so lucky. “They might not know the risks. They might not be aware of the protocols. They might even be scared to talk it over with their physician. They might not know that drug poisoning deaths, primarily by prescription drugs, are the leading cause of accidental death in the U.S., surpassing motor vehicle collisions.

“So we need an educated conversation about this,” Alstott added. “We need to be upfront, and truthful, and help people be able to start the conversation with their doctors, so they can find out what they need to know.”

And that, he said, is where America Starts Talking comes in.

“The discussion guides and information about opioids — and also about how to respond if there’s an emergency — are not only for patients or doctors,” Alstott explained. “They’re also for loved ones, because they also need to be aware of the situation. I mean, I have three children. And I police any medication we give our kids. But if I don’t know what I need to know and what to look for, that could be a problem.”

“So this is about getting information,” he added. “And being prepared.”

The America Starts Talking campaign is spearheaded by the pharmaceutical company Kaleo, which makes an auto-injector called Evzio that’s used to reverse the effects of an opioid overdose.

More information

To learn more about the America Starts Talking campaign, click here.





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In Its Third Year, Obamacare Faces Growing Pains

By Karen Pallarito
HealthDay Reporter

FRIDAY, Oct. 30, 2015 (HealthDay News) — America’s scramble for health insurance coverage under Obamacare may be slowing to a crawl.

The sign-up period for 2016 coverage under the Affordable Care Act begins Nov. 1. But federal health officials are predicting tepid enrollment growth, a nod to how difficult it will be to continue to persuade more uninsured adults — including many younger and poorer people — to buy and maintain coverage.

“They’ve gotten the low-hanging fruit, the people who really wanted coverage, who needed it and were quick to sign up,” said Peter Cunningham, professor of health care policy and research at Virginia Commonwealth University in Richmond, Va.

In 2014, the first year of expanded coverage under the Affordable Care Act, 8 million people signed up for coverage. That influx occurred despite computer snafus and other enrollment glitches plaguing the federal HealthCare.gov website and several state online “marketplaces.” HealthCare.gov handles enrollment in 38 states, while the remaining states operate their own online insurance marketplaces.

By the end of 2016, roughly 10 million people will be enrolled in a marketplace plan, according to updated projections from the U.S. Department of Health and Human Services (HHS). That’s up from the 9.1 million people who will have coverage in place by the end of 2015, officials said.

The health law, sometimes called Obamacare, is credited with helping to shrink the nation’s uninsured rate to its lowest level in decades — just over 9 percent of the population, according to the U.S. National Center for Health Statistics.

But, health plan premiums offered by HealthCare.gov and state marketplaces for 2016 are rising sharply in many regions of the country, reflecting actual costs under the Affordable Care Act.

On Monday, federal officials said “benchmark” health plans in 37 of the 38 HealthCare.gov states are raising rates an average of 7.5 percent in 2016. The rates charged by benchmark plans are used to calculate federal subsidies that help some people pay their monthly premiums.

Michael Stahl, a senior vice president with HealthMarkets, Inc., in Dallas/Fort Worth, one of the nation’s largest health insurance agencies serving individuals, is seeing rate hikes for Obamacare plans in the high single- to double-digit range.

“They’re not immaterial, and it’s only going to put more pressure on people in terms of being able to afford it,” he said.

Consumers who remain uninsured next year and don’t have an exemption from the law’s coverage mandate may be surprised to learn of increased penalties for 2016. The fee is 2.5 percent of annual household income or $695 per person (half of that for children), whichever is higher. This compares to 2 percent of income or $325 per person in 2015.

The penalties will kick in when people file their federal tax returns in 2017.

“I think there will definitely be some sticker shock when that happens,” Cunningham said.

Targeting younger, poorer adults

Currently, about 10.5 million uninsured people are still believed to be eligible for coverage through the federal and state marketplaces.

Nearly half are young adults, who tend to think they don’t need health insurance or think they can’t afford it.

“I’ve had a number of ‘young invincibles’ who just don’t want to spend the money on coverage and don’t care about the penalty,” said Robert Slayton, a Naperville, Ill.-based health insurance broker.

What’s more, many uninsured Americans still don’t know that they may qualify for federal subsidies to lower the cost of coverage, federal officials acknowledged.

Almost 40 percent of the uninsured who are qualified to enroll in an Affordable Care Act plan have incomes between 139 percent and 250 percent of the federal poverty level, or roughly $34,000 to $61,000 for a family of four. More than one-third are people of color, HHS officials said.

“Our research tells us they’re going to be harder to reach,” HHS Secretary Sylvia Mathews Burwell acknowledged during a recent speech at Howard University in Washington, D.C., highlighting the health-reform law’s successes and goals for the upcoming enrollment period.

Obstacles include a lack of knowledge about eligibility for coverage, language barriers and the affordability concerns.

HHS is focusing its enrollment efforts in several large urban markets, including Chicago, Dallas, Houston, Miami and northern New Jersey.

The federal government’s 10 million enrollment estimate for 2016 is sharply lower than the 21 million that the nonpartisan Congressional Budget Office projected in a report in March.

Earlier independent enrollment projections assumed that many people would switch from employer-sponsored health coverage into marketplace plans offered through Obamacare, but that hasn’t happened, HHS noted.

Mark Pauly, a professor of health care management, business economics and public policy at the University of Pennsylvania’s Wharton School in Philadelphia, said he never thought there would be significant migration from employer-sponsored coverage into marketplace plans.

“If your current plan at your job is decent, I think most people want to ‘set it and forget it,'” he said.

Holdouts, dropouts and switchers

If enrollment in Obamacare health plans grows in 2016, it will be due to multiple factors. The federal government’s enrollment projections for 2016 reflect a combination of people signing up, dropping out or switching to marketplace plans.

By the end of open enrollment on Jan. 31, 2016, an estimated 11 million to 14 million people will have selected a health plan. But, HHS said that only 9.4 million to 11.4 million are expected to pay their premiums and maintain coverage throughout the year.

HHS officials said they always expected that people would move into and out of Obamacare health plans as their life circumstances change — such as getting married, having a child, or re-evaluating the state of their finances.

“Sometimes you get to the end of the month for certain people and you’ve got rent or your health insurance payment,” Stahl explained. Some consumers drop coverage in the middle of the year and come back at open enrollment later in the year, he said.

As of February, 11.7 million people were signed up for coverage under the Affordable Care Act. That number slid to 10.2 million in June. And by the end of the year, 9.1 million will be enrolled, federal officials predict.

The federal government has yet to publicly disclose demographic data on the people who are losing or dropping coverage. Keeping young, healthy adults enrolled is considered crucial to keeping premiums affordable for older and sicker adults.

If healthy adults don’t sign up, Obamacare is headed for a “death spiral,” some critics of the law warn.

“I think our view is there’s certainly a lot of turmoil,” Stahl said. “But we think the [Affordable Care Act] is here to stay.”

More information

Consumers who want more information on enrolling in marketplace coverage should visit HealthCare.gov. Dec. 15 is the last day to enroll or switch health plans for coverage effective Jan. 1. And Jan. 31 is the final day to enroll in coverage for 2016.





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Prepare Yourself for Cold, Flu Season

THURSDAY, Oct. 29, 2015 (HealthDay News) — Cold and flu season has arrived, but there are a number of things you can do to protect yourself from infection, an expert says.

“People over the age of 65 should get a high-dose flu shot. People under the age of 65 should get a regular flu shot. People who are under 65 and allergic to eggs should get nasal flu spray,” Dr. Howard Selinger, chair of family medicine in the School of Medicine at Quinnipiac University in Connecticut, said in a university news release. “Flu shots are safe, last for a year and are covered by insurance.”

People with chronic illnesses require even more protection, Selinger said.

“People over 65 with any type of chronic illness, such as diabetes, high blood pressure or heart disease, should get two pneumonia vaccines: Pneumovax and Prevnar. These vaccinations are given separately and protect from 36 strains of pneumococcal pneumonia. After getting vaccinated, patients should be sure to continue treating underlying conditions,” Selinger said.

Other ways to protect yourself from cold and flu viruses include regular hand washing and getting enough sleep.

If you do get a cold or the flu, don’t go to work or school until your symptoms improve, Selinger said. Stay hydrated by drinking lots of liquids; take fever medicines such as acetaminophen or ibuprofen and decongestants; use cool mist vaporizers; and keep your head elevated.

Antibiotics are not effective against cold and flu viruses, Selinger explained.

“Treating these conditions with antibiotics can be tempting, but antibiotics are for bacterial infections and their overuse for viruses can lead to antibiotic resistance for individuals and society,” Selinger said.

“People who are otherwise healthy should wait five to seven days before visiting their physician to investigate the possibility that they are suffering from a bacterial infection that will respond to antibiotics rather than a virus that will not respond. If you go to your doctor and are offered antibiotics, ask why,” he advised.

More information

The American Academy of Family Physicians has more about colds and flu.





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Low-Fat Diets No Better Than Other Plans: Study

By Kathleen Doheny
HealthDay Reporter

THURSDAY, Oct. 29, 2015 (HealthDay News) — Low-fat diets are often promoted as a superior way to lose weight, but they’re no more effective than other types of diets, a new review indicates.

“We found that low-fat diets were not more effective than higher-fat diets for long-term weight loss,” said study leader Deirdre Tobias, an associate epidemiologist at Harvard Medical School and Brigham and Women’s Hospital in Boston.

The key to success seems to have more to do with adherence than a specific weight-loss plan, Tobias said. “Being able to stick to a diet in the long term will probably predict whether or not a diet is successful for weight loss,” she said.

The new analysis was published online Oct. 30 in The Lancet Diabetes & Endocrinology journal. The research was supported by the American Diabetes Association and the U.S. National Institutes of Health.

In conducting their analysis, Tobias and her colleagues looked at 53 published studies involving more than 68,000 adults. Those on low-fat diets did lose weight. But, those on low-carbohydrate diets were slightly more than 2 pounds lighter than those on low-fat diets after a follow-up of at least one year. The average weight loss across all groups was 6 pounds, the researchers said.

The take-home message, Tobias said, is not to eat fatty foods with abandon. Rather, there are a variety of weight-loss plans and “there isn’t one that floats to the surface as the optimal diet for weight loss.”

She advised that anyone wanting to lose weight find a sound weight-loss program that fits their preferences and cultural needs.

The low-fat diets in the studies ranged from very low-fat, 10 percent or less of calories from fat, to more moderate plans that allowed 30 percent or less of calories from fat.

Connie Diekman is director of university nutrition at Washington University in St. Louis. She said, “The result of this study on diet composition and weight loss seems to support results that have been observed in other studies.

“The conclusion from this, and similar studies, is that weight loss is not a result of limiting one calorie nutrient over another, and that achieving weight loss is likely a matter of calorie control, in a manner that works for the individual,” she added.

Diekman said the study did have several limitations. Among them: many of the studies included in the review had “high levels of subjects drop out, making it difficult to know if the diet itself made adherence challenging.”

For successful weight loss, Diekman advises talking with a registered dietitian “who can design an eating plan for weight loss that meets your lifestyle.”

Add physical activity to your daily routine, she added, and think about weight loss as part of your long-term health goals, and not just a quick fix.

More information

To learn more about healthy weight, see Harvard School of Public Health.





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