Study Money can prod one to lose weight
Mon, 24 Sep 2007 20:38:53 GMTBy ELIZABETH DUNBAR, Associated Press Writer
RALEIGH, N.C. - People will lose weight for money, even a little money, suggests a study that offers another option for employers looking for ways to cut health care costs.
The research published in the September issue of the Journal of Occupational and Environmental Medicine found that cash incentives can be a success even when the payout is as little as $7 for dropping just a few pounds in three months.
Unlike providing onsite fitness centers or improving offerings in the company cafeteria, cash rewards provide a company with a guaranteed return, the researchers said.
"They really can't be a bad investment because you don't pay people unless they lose weight," said Eric A. Finkelstein, the study's lead author and a health economist at RTI International, a research institute based in nearby Research Triangle Park.
The study involved about 200 overweight employees at several colleges in North Carolina, divided into three groups. One group received no incentives while the other two groups received $7 or $14 for each percentage point of weight lost.
For example, someone in the middle group weighing 200 pounds who lost 10 pounds, or 5 percent, would get $35.
Participants didn't get any help on how to lose weight. In the end, employees who received the most incentives lost the most weight, an average of nearly 5 pounds after three months. Those offered no incentives lost 2 pounds; those in the $7 group lost about 3 pounds.
Those in the $14 group were more than five times as likely to lose 5 percent of their weight — the amount research has shown to be clinically significant, according to the study.
Finkelstein and co-authors Laura Linnan and Deborah Tate, professors at the University of North Carolina at Chapel Hill's School of Public Health, are currently analyzing data from a follow-up study that observed about 1,000 participants for a year. In that study, financial incentives were tested against a Web-based weight-loss program and changes in the office environment, such as healthier cafeteria food.
Linnan said more research is needed to determine the ideal dollar amount and whether incentives work in the long term.
"It's clear that one of the biggest challenges is to help people who lose weight keep the weight off," she said.
Plant worker Vonderahe Rivera said the financial incentives offered by her employer have helped her lose a total of 50 pounds and keep it off. Over the past five years, the O'Fallon, Mo.-based VSM Abrasives, which makes sandpaper, has been rewarding its 125 employees with cash for trimming their weight and an extra day off each year if they don't gain it back.
"The money is great and the day off is great," said the 51-year-old Rivera.
This year, she lost 25 pounds and got $125 when her employee team reached their weight-loss goal. She used the money for some new outdoor furniture. Being part of a group also keeps her motivated, Rivera said.
While there are some federal guidelines on offering cash incentives, the idea is relatively new and will likely require further study before many employers are willing to try such a program, said Dr. Jeffrey Dobro, a consultant with the human resources consulting firm Towers Perrin.
"To actually pay people for results is a little bit problematic ... if you don't give people an equal opportunity," he said.
To compensate, employers could offer similar incentives to staff who maintain a healthy weight, he said.
So far, the trend among larger companies has been to provide incentives for employees who do things like complete a health risk assessment or attend coaching sessions for weight management, said LuAnn Heinen, director of an institute that studies the costs and effects of obesity for the National Business Group on Health, which represents mainly Fortune 500 companies.
But Heinen said the study will be welcomed by employers who realize participation in other health programs remains low, or that they're paying for people to lose the same 10 pounds over and over again.
"I think over time companies will start looking for something with a little more teeth," she said.
ASCO pushes cancer survivors checklist
Mon, 24 Sep 2007 20:08:04 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - You've finished the surgery, the radiation, the chemotherapy. You're a winner, a cancer survivor. Now what? A new push is on to provide patients with "survivor plans," long-awaited blueprints for the customized follow-up care they'll require for years.
Few today get that careful send-off as they leave cancer specialists and head back to their regular doctors, even though the Institute of Medicine alerted the nation two years ago that these survivors' special needs weren't being met.
Now a major doctors' group is creating easy-to-fill-out checklists that survivors can hand to future physicians — what checkups to get and when, what late side effects their treatment may trigger, what new symptoms to watch for.
The American Society for Clinical Oncology recently posted the first such documents — for colorectal and breast cancer — on its Web site, free to copy and customize. ASCO is developing guides for other leading malignancies — lung cancer is next — and a more general plan for less common cancers.
"We're at the cusp of a very dramatic change in the way we're going to be delivering coordinated care for cancer survivors," predicts Dr. Patricia Ganz of the University of California, Los Angeles, a cancer survivorship specialist who spearheaded the ASCO guides.
Today, "the patient feels lost," she explains. "If everybody has the same marching orders, it will be a lot easier."
There are roughly 10 million cancer survivors, a population rapidly growing thanks to advances in early detection and treatment.
When active treatment ends, those people too often don't realize their simmering health risks. It's not just the possibility of the initial cancer returning or a new one forming. Treatment may have left infertility, memory or mobility damage, impaired organ function. Some side effects may not appear for years. Then there are psychosocial consequences, from depression to problems keeping health insurance.
Consider the contrasts: Have a baby and you're sent home with care instructions, including when mom and child are to check in with their respective doctors. Have heart surgery, and likewise you receive nutrition and exercise rules, a list of worrisome symptoms and a checkup date.
Cancer treatment typically is far lengthier and complicated. Yet oncologists until now have had no standard way to offer a similar guide. Doctors like Ganz have pioneered survivor plans at specially designated cancer centers, but few people are treated at such hospitals.
"A lot of patients get dropped," says Dr. Aziza Shad, who directs Georgetown University Hospital's cancer survivorship program and writes survivor plans for her own patients.
"I personally think it's the responsibility of every treating oncologist to have this information available," Shad adds. "You did the treatment. ... Your responsibility is also the aftercare."
The new guides come in two parts. First is a detailed treatment summary: The cancer's type and stage; tests of lymph nodes, genes and other indicators of prognosis; how much chemotherapy patients actually received, as side effects often mean skipped or lowered doses.
The second part is a consumer-friendly list of future exams and what symptoms to watch for.
A written document is crucial because even when doctors patiently explain cancer treatment, "patients are notoriously overwhelmed and not hearing half of what was said," says Ellen Stovall of the National Coalition for Cancer Survivorship, herself a repeat survivor.
How can it make a difference?
_Say a woman suffers some shortness of breath. Does her family doctor assume it's the 20 pounds she just gained — or do a more sophisticated heart exam because she's a breast cancer survivor? Certain chemotherapy can cause serious heart damage.
_Say a breast cancer survivor later gets lymphoma. Her new oncologist would need to know exactly how much of the powerful chemo adriamycin she received before to know if it was safe to try again.
_Ganz saw a patient last week who had beaten lymphoma at age 29 with chest radiation, but now has breast cancer in her 50s. She wanted just the tumor removed, but that requires radiation therapy and it's often impossible to radiate the same spot again. Amazingly, the hospital found her old radiation records — and doctors could tell the new rays wouldn't overlap the old, letting her keep her breast.
_And Georgetown's Shad recounts a child who disappeared from her clinic's follow-up care for five years — only to reappear with a drastically lopsided face. Radiation had stopped short the bone growth on one side of his body, something his new doctors hadn't anticipated in time to treat.
"Thank god we have plastic surgery," she says with a sigh.
The concern is whether busy oncologists will embrace the guides; they do create more work. Legislation is pending in Congress that would require Medicare to pay for cancer-survivor plans.
"It's going to require a real shift in doctors thinking about how they spend their time with their patients and what they need to know," says Stovall — who urges patients to ask for the guides.
___
EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
On the Net:
New survivorship documents: http://asco.org/treatmentsummary
Seniors balk at ban on free doughnuts
Sun, 23 Sep 2007 17:48:06 GMTBy JIM FITZGERALD, Associated Press Writer
MAHOPAC, N.Y - It was just another morning at the senior center: Women were sewing, men were playing pool — and seven demonstrators, average age 76, were picketing outside, demanding doughnuts.
They wore sandwich boards proclaiming, "Give Us Our Just Desserts" and "They're Carbs, Not Contraband."
At issue is a decision to refuse free doughnuts, pies and breads that were being donated to senior centers around Putnam County, north of New York City. Officials were concerned that the county was setting a bad nutritional precedent by providing mounds of doughnuts and other sweets to seniors.
The picketers said they were objecting not to a lack of sweets but that they weren't consulted about the ban.
"Lack of respect is what it's all about," said Joe Hajkowski, 75, a former labor union official who organized the demonstration. He said officials had implied that seniors were gorging themselves on jelly doughnuts and were too senile to make the choice for themselves.
C. Michael Sibilia said, "I'm 86, not 8."
Inside, some seniors said they missed the doughnuts but others said they were glad to see them go.
"It was disgusting the way people went after them," said 80-year-old Rita Jorgensen. "I think the senior center did them a favor by taking it away."
Stan Tuttle, coordinator of nutritional services for the county's Office for the Aging, said the program had gotten out of control. As many as 16 cases of breads, cakes and pastries were delivered, by various means, to the William Koehler Memorial Senior Center each day. Some were moldy and some had been stored overnight in the trunks of volunteers' cars, he said.
Caregivers there and elsewhere say the doughnut debate illustrates the difficulty of balancing nutrition and choice when providing meals to the elderly.
"Senior citizens can walk down to the store and buy doughnuts. Nobody's stopping them," said Michael Jacobson, executive director of the Center for Science in the Public Interest in Washington.
But he notes that older people have high rates of heart disease and high blood pressure and says senior citizen centers, nursing homes and assisted-living centers should not be worsening the health problems of seniors.
At the North East Bronx Senior Citizen Center, lunch is served five times a week .
"We don't tell them what to do, we don't force them to eat what's good for them. But we certainly don't give them anything that's bad for them," said center director Silvia Ponce.
The church-basement senior center, one of 325 under the New York City Department for the Aging, has a mostly Italian-American clientele, a Naples-born cook and a menu that includes eggplant parmigiana, linguini with clams and manicotti.
"We try to give them what they like," said the cook, Stella Bruno.
The lunches have to supply one-third of the federal minimum daily requirements in such categories as calories, protein, vitamin C and vitamin A, said Chris Miller, spokesman for the department.
The Bronx center offers coffee, tea, bagels and rolls in the morning, but nothing in the doughnut family.
"The sweetest thing here is the raisin in the raisin bagel," said Nicholas Volpicella, 87.
Maureen Janowski, director of nutrition resources for Morrison Senior Dining in Atlanta, which provides meals at more than 370 senior living communities, says residents' food preferences depend somewhat on their age. Those born between 1901 and 1925 generally prefer meat and potatoes, and those born between 1925 and 1942 are "a little more trendy, a little more adventurous, a lot more nutrition-savvy," she said.
"They have choices, and we show them how to make good choices," she said.
At the Bronx center, Bruno said she tries to help the seniors avoid the bad buffet choices when they take a trip to Atlantic City. As a group was departing, she handed them bag lunches — with a roast beef sandwich, cranberry juice and carrot sticks.
"Protein, vitamin C, vitamin A," she said.
