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Aired 6/29/17 on KPBS Midday Edition

Medicare To Pay $450 To Help Seniors Lose Weight, Avoid Diabetes

GUEST:

Dr. Athena Philis-Tsimikas, vice president, Scripps Whittier Diabetes Institute

Transcript

Aired 6/29/17 on KPBS News

Some 86 million Americans live with prediabetes, which can progress to diabetes, a costly and debilitating disease. A new program can help people lose weight, a proven way to reduce the risk of getting the disease.

Oscar and Teri Lara of Rancho Bernardo were diagnosed with prediabetes a few months ago, a condition 86 million Americans share.

That means the retired couple lives with a greater chance they will develop diabetes, which can lead to heart, nerve, kidney and eye disease, and an early death.

The Laras are lucky. Nine in 10 Americans do not know they have prediabetes, but the Laras were caught early. They have an opportunity to alter their diets, reduce their sugar intake and lose weight, and likely postpone or prevent that trajectory.

On advice from their doctors, they enrolled in a special lifestyle class, part of the Scripps Diabetes Prevention Program, much like the curriculum that will be offered to Medicare beneficiaries across the country, free of charge, starting Jan. 1.

This class changed my thinking about what I eat, how much I eat, how to stay focused, and how to maintain a healthy regimen of proper nutrients to put into my body, Oscar Lara said. Instead of chomping down on bread and burritos, it is broccoli, Brussels sprouts and salads.

$450 for a few pounds of flesh

Providers who run Medicares year-long programs will receive up to $425 per participant if attendees take all the classes and lose 5 percent of their body weight during the year; $450 if they lose 9 percent. If attendees miss classes, drop out, or fail to lose that much or gain it back the programs will be paid incrementally less.

In 2012, the direct medical costs for 29 million people diagnosed with diabetes in the U.S. was an estimated $176 billion, including hospital, drug, and physician services. That is why the issue is so critical and why the agency that runs Medicare wants to put a dent in that spending.

After all, 21 percent of patients with diabetes are Medicare eligibles diagnosed after they turn 65.

Numerous studies going back 16 years have shown that people can delay or prevent diabetes by losing weight; a drop of a few pounds improves the bodys ability to manage sugar intake.

Looking out for fraud

The Centers for Medicare and Medicaid Services (CMS) has made it clear it will be looking for cheaters: those providers who enroll people without documented prediabetes, or who falsify weight loss or attendance. CMS can track much of that through inconsistencies in subsequent billing. It referenced the word fraud 13 times in the latest rules for the program.

But federal officials believe the program is worth the risk because weight loss in a population with prediabetes has the potential to save that much more money.

For Ann Albright, PhD, RD, director of the diabetes program at the Centers for Disease Control and Prevention (CDC) which is helping to write the programs rules, said the incentive payments are long overdue.

We have a medication distribution system in this country, but not a lifestyle distribution system, and thats what this program is going to do, she said.

Dr. David Nathan, a Massachusetts General Hospital diabetes expert whose 2002 study proved the lifestyle intervention concept works, called the program extremely extraordinary.

Researchers in his multicenter study randomized thousands of overweight people with prediabetes. They were divided into three groups. One third received a series of individualized lifestyle sessions, one third received the drug metformin, which controls blood sugar levels, and one-third received no intervention.

The result? Lifestyle intervention not only resulted in greater weight loss, but it also delayed or prevented many people from progressing to diabetes, and had an even greater beneficial impact on seniors.

We know our program works, Nathan said.

Churches and supermarkets

Some 1,425 settings including 13 in San Diego County have applied for certification. They include hospitals systems, physician practices and clinics, pharmacies, wellness centers, hospital systems, county governments, Jenny Craigs, and even churches and Albertsons supermarkets.

CDC diabetes communications specialist Josh Petty said many others are being processed to meet what is hoped to be a huge national demand.

The centers must have CDC certification, but the rules to date do not specify how instructors should be trained.

Diabetes prevention programs have used federal grants or private insurance in the past. The YMCA-USA version used an $11 million federal grant to enroll 7,000 Medicare beneficiaries in eight states for a three-year program. It realized savings of $278 per person in costs for hospitalizations and emergency room visits.

But the new program is the first to tackle all Medicare beneficiaries with blood glucose levels indicating prediabetes and who have a BMI of at least 25, or for Asians, at least 23.

Is the money enough?

It is hard to get some people to schedule time or feel comfortable discussing weight gain and intimate health problems in group settings. And many physicians worry that programs will fall apart if patients do not enroll and stick to the plan.

Oscar Lara had a lot of incentive. Awhile back, he had a stroke, and has survived cancer. Prior to this program, I felt I could eat whatever I wanted. Sugar, carbohydrates, the things that spike glucose, he said. Now this class has kept me focused. Its really been a lifestyle change.

Athena Philis-Tsimikas, MD, vice president of the San Diego-based Scripps Diabetes Care and Prevention program in La Jolla, is optimistic, and now is running a year-long trial program with 100 participants, which the Laras now attend.

But she is frankly worried that $450 will not pencil out to hire enough staff to support, phone and remind participants, and there is data collection and submission requirements too.

Theres a lot of ifs in this, she said. And its hard to tell right now, with $450 per participant, if were going to be able to do that. It would mean we would have to run a really lean operation.

San Diego endocrinologist Dr. Paul Speckart thinks the best way to get people to lose weight to prevent diabetes is to pay them directly.

Its almost an article of faith that talking and lectures dont work to get patients to lose weight, he said People dont. We almost always have to move to pharmaceutical solutions.

What might be more effective, he said, is to give people with prediabetes brochures about diet and exercise, but pay them $200 every month their observed weight drops another 1 percent from baseline for a year. His rule: Failure in any one month would get them expelled.

More patients screened

A key to success of the program is to ensure that physicians aggressively screen Medicare beneficiaries for prediabetes.

People who read their blood test results should look for a fasting glucose of 100 and 125 mg/dL or an A1c between 5.7 and 6.4 percent to see if they have prediabetes.

A element critical to the program is that doctors explain the the seriousness of the condition and refer patients. Counseling people to lose weight is not something doctors like to do, and some question whether they would be paid for the extra time.

But Elizabeth Joy, MD, clinical champion for the Intermountain Diabetes Prevention Program at Intermountain Health in Salt Lake City, said she thinks physicians should welcome the extra help to support at-risk patients to lose weight.

Its pretty unethical to screen people for a condition for which we have no treatment, she said. Now we actually have a treatment with proven efficacy.

Doctors can keep it simple, saying that based on a patients weight and testing, they scored as high risk. You scored a 10. I would like you to go to this program, and my care manager is going to help set that up.

Dr. R. James Dudl, a diabetes expert with Kaiser Permanente Research in San Diego, said patients who develop prediabetes should get the word directly from their physician in person, rather than from a staff person. That conveys the urgency of the situation, he said, advising physicians, Doctor, you do not get off the hook.

American Diabetes Association president-elect Dr. Jane Reusch is hopeful this program can work.

A variety of prevention programs have been tried, with or without insurance payments, copayments and deductibles, and federal and state funding, she said.

But a lot of them fail to stick because there hasnt been a carrot there. Now, with $450, theres a monetary resource.

For the Laras, the program has gotten results.

Oscar Lara goes to the gym three times a week, plays softball and golf, and has lost 35 pounds. And vegetables and lean meats have replaced a lot of the carbohydrates he and his wife used to eat. The sugar levels in his blood are back to normal range.

Teri Lara has also lost weight and she walks every day as much as arthritis permits.

Im not on a diet, Oscar Lara said. Ive just changed the way I look at things and changed the way I look at food.

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You were just about at your goal weight, but then those last five pounds just keep lingering. Dont they know theyve overstayed their welcome? How rude.

If youve been in a clean-eating zone and youre spending more time with your spin instructor than your spouse, but you just cant shake those last few pounds, you may need to do a little digging to find out what's going on. Here are six things to think about:

You were diligent when it came to losing 20 pounds (or 10 pounds), and youre just as focused now, so what gives? Those pesky last five pounds can often be the toughest and you may need to take it up a notch. Yes, even more.

No, you don't have to start counting calories or drinking only lemon water, but when it comes to dropping the last few pounds, even the piece of candy here (perhaps while getting a manicure?) to the extra bites of chocolate there (think chocolates on your pillow) can make a world (or five pounds) of a difference.

How to take note of these mindless quick treats? Food journal like its your job. Write down everything and you will likely find those places where extras are sneaking in. Already have a diet that rivals a fitness model's daily meals? Try switching up your workout to something new.

Theres a lot of science that shows your gut health can majorly affect your overall health. What does this mean for weight loss? Healthy gut equals a healthy bod, making sure that all systems are a "go" for getting rid of those last few pounds. The best way to do it? Eating as many fibrous veggies (microbes feast on the prebiotic fiber) and fermented foods as possible is key (think sauerkraut, kimchi and kefir), and consider taking a high-quality probiotic, since it can also benefit your digestive and immune systems.

Sleep is important for weight loss (and living a healthy life) as is eating from an empowered place and adding sweat sessions to your weekly routine. The research is pretty clear. If youre not getting enough zzzs (or enough quality zzzs) it could be the one factor holding you back from shedding those last few pounds.

Create a bedtime routine that you can do every night. Your mind will begin to get used to preparing for bed, helping your body feel more ready to relax and sleep. This could include having a cup of chamomile tea, lavender bath or even taking a magnesium supplement.

Excess and added sugars hide in all forms under the wrapping of most packaged foods. This one sneaky ingredient can be whats holding you back from feeling amazing after zipping up that little black dress. Do your own sugar detox. Read your labels and avoid all added sugar (yes, even your jarred pasta sauce, yogurt and ketchup are culprits of sneaking in the sweet stuff). Eat as many whole, real, unprocessed foods as possible and youll automatically be reducing your added sugar intake.

A diet laden with sodium causes your body to retain water. You know that feeling after a sushi meal? Yes, bloating and sluggishness, but the puffy feeling that lasts into the next morning is water retention. The last few pounds of weight youre trying your hardest to get rid of could be caused solely by fluid. Getting rid of it for good can make all of the difference in how good you feel when you throw on your favorite jeans in the morning.

Toss the salt shaker and hit the spice rack to your heart's content. High-sodium culprits include canned soup and cured meats like deli meat, which also contain nitrates (compounds that cause inflammation). If meat is a staple in your diet, skip the deli slices and grill your own at home with a low-sodium marinade, or use spices to make your own dry rub.

This is the easiest way to feel empowered eating until youre satisfied without piling on excess unwanted calories. Youll also reap the benefits of antioxidants from these nutrient-rich foods. Non-starchy vegetables are also water dense, meaning that youll get the extra dose of hydration, which keeps your metabolism revving at full speed, and that much closer to losing those last five pounds.

Originally posted here:
How to lose those last 5 pounds - Today.com

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It's also known as the Navy diet, the Army diet and sometimes the ice cream diet, because in addition to hot dogs and tuna fish, you get to eat ice cream on all three days of the program.

Smells fishy, right? Well, hold your nose. It's about to get really stinky.

The military diet is a variation of the ever-popular three-day diet, a crash plan of "fill-in-the-blank" foods to eat if you want to lose weight fast. These diets typically claim that you can lose about 10 pounds in three days to a week if you follow their blueprint to the letter. The meal plans are usually extremely basic and calorie-restrictive, because let's face it, that's how you lose weight.

But are these diets healthy? Will the weight stay off?

Breakfast is a cup of caffeinated coffee or tea, one slice of toast with 2 tablespoons of peanut butter and half a grapefruit. That's 308 calories.

Lunch is another cup of coffee or tea, a bare-bones slice of toast (whole-wheat is best, they rightly say) and a half-cup of tuna. This meal is tiny, only 139 calories.

Dinner is 3 ounces of any meat (that's about the size of a playing card), a cup of green beans, half of a banana and a small apple (not a large apple, even though the calorie difference is minuscule), but wait: You get a whole cup of vanilla ice cream! If you choose steak instead of a lean chicken breast as your entree, this meal equals 619 calories.

But even with the steak and the cup of full-fat ice cream, the day adds up to a mere 1,066 calories. No snacks allowed.

Here's day two's repast. It adds up to only 1,193 calories, even if you pick some higher-fat options.

Breakfast is another dry piece of toast, one egg cooked however you like and half of a banana. Let's say you fry your egg in oil. That's 223 calories.

Lunch is a hard-boiled egg, five saltine crackers and a cup of cottage cheese. If you choose full-fat cottage cheese, the total is 340 calories.

Dinner is half of a banana, a half-cup of carrots, a full cup of broccoli, two hot dogs (that's right!) and another treat: a half-cup of vanilla ice cream. The meal totals 630 calories (if you eat a full-fat pork or beef dog).

How does this fare fair?

"Ice cream is not a good use of the meager calories," she added. "You could have 3 cups of salad and only eat 100 calories, or other nutritious foods that will be satisfying and hold back the hunger."

Day three is the most restrictive, only 762 calories.

Breakfast is a slice of cheddar cheese with five saltines and a small apple. That's 232 calories.

Lunch is grim: one dry slice of toast and an egg. Even if you fry the egg in oil again, that's a total of 170 calories.

Dinner is 460 calories and a stomach-turning combination of half a banana, a full cup of tuna and another cup of ice cream. Maybe they think that by now, you're so hungry, you'll be willing to eat those foods together.

The websites promoting the military diet say that eating certain food combinations will boost your metabolism.

"There is no truth behind claims that the food combinations in the first few days will increase your metabolism and burn fat," Magee said.

"There's no research I know of behind those claims," Drayer agreed.

And what about the rest of the week?

You round out your week by eating what you like, so long as it's less than 1,500 calories a day. Then you can start on the three-day restrictions again.

Best of all, no exercise -- zero, zip, nada -- is said to be needed on this diet.

"Yet another fad diet that won't lead to healthy or sustainable weight loss!" Magee said with passion, adding that exercise is "key to lasting weight loss."

She also feels there are potential physical and emotional ramifications to diets that restrict and deprive you to this extent.

"It can lead to weight cycling, a quick loss and regain of weight, that can weaken your immune system, mess with your metabolic rate and increase the risk of other health problems, such as gallstones and heart trouble," Magee said.

"We did not develop this. We do not use it. It has absolutely no resemblance to the real military diet. Even our rations are healthier and more nutritionally sound," Deuster said. "It looks like they just took the name 'military' and added it to the diet and capitalized on it."

"The Birmingham Hospital Diet did not originate with the University of Alabama at Birmingham, and we do not support or recommend it," university public relations manager Bob Shepard said. "This diet has absolutely no connection to UAB Hospital other than the often repeated but false Internet rumors."

Oh?

"It is unfortunate our name has been associated with this diet," the Cleveland Clinic said in a statement. "We have never endorsed this meal plan, and it does not meet the standards for what we would consider a healthy diet for heart health or overall well-being."

And?

"The American Heart Association is not -- and never has been -- associated with this diet."

"This didn't come from us, despite the use of the word Kaiser. Kaiser Permanente supports a balanced diet, rich in fruits, vegetables and whole grains."

Oh, and there are lots of ads.

But nowhere on the page is there an author, an expert, a nutritional guru. No one takes ownership of this information or gives you any credentials to prove their expertise.

"That's a red flag," Drayer said. "Any helpful diet plan should be created or supported by a credible person or resource or organization. If something is out there without any author or inventor, anyone can say anything and not know how the body works."

Trying to track down the owners of three of the most popular military diet sites proved to be a dead end. Emails and calls to listed numbers got no responses.

Add to that the fact that science still doesn't have the "perfect" solution for weight loss and maintenance, he said, and you've got an area that is ripe for exploitation.

Drayer agreed. "I think a lot of people just want to know the next dieting magic bullet, quick fix, and they just go for these fad things."

But why are so many of us fooled in the first place?

The failure of some people's "BS detectors" when they encounter fake information can be explained, Southwell said, by what science now knows about how the brain processes data. Instead of sorting the good from bad as the information arrives, the brain accepts it all, "and then in another part of the brain, it's tagged as true or false."

"It leaves open this window of opportunity," he explained, "so people believe just long enough and then get tired, distracted, and what happens? They get sucked in. They might be skeptical at first but fail to do the research and think, 'well, maybe this will work. This might be my solution.' "

The fact that so many of us share our discoveries with friends and loved ones on social accounts fuels the misinformation fire. Southwell calls it "social contagion."

"It's like the dynamics of infectious disease. You've spread the disease before you've even come down with it, " he explained. "You find it, you share, you read more and find out that it's not effective, or you try it out and you're disappointed. But the genie is out of the bottle already."

According to Southwell, that's exactly what many of these sites are counting on.

"It doesn't matter if it ultimately gets debunked, because it's going to take a while for it to reach the same numbers of people as the original rumor or fake diet," he explained. "And the debunking is not as sexy as the original diet lure.

"In the meantime, you might see the spread of unhealthy dieting behavior, and for some people with certain diseases or conditions, that can cause real harm," Southwell said, such as heart disease or diabetes. "But it can't be traced back. Who is culpable for that?"

Let's face it. We still want a quick way to lose 5 or 10 pounds fast, just in time for that special occasion. Is it possible to do so in a healthy way?

"I will prescribe a modified three-day diet just to jump-start weight loss," Drayer said. "I typically recommend increasing your water intake and eliminating all starchy carbs like breads, pasta, cereal and rice, as well as sweets and treats for one week. Doing this not only cuts calories, but you also shed some extra water too, which can be motivating as the numbers on the scale go down."

For those who drink their calories, Drayer recommends slashing sugary beverages such as sodas, flavored lattes, fruit juices and smoothies, "as the calories from these beverages can really add up."

Magee prefers to trick the body into losing weight, to avoid what she calls a starvation backlash.

"When you decrease your calories so severely as they do in the three-day military diet, your body tends to go into conservation mode and actually burns fewer calories," she said, "because it thinks you are entering a potato famine or similar, and it wants to survive.

"I think it's better to trick your body into burning calories by decreasing the calories you eat a little, increasing exercise to burn more calories, to create a daily deficit of about 250 calories a day," she explains. "It's slower but more sustained weight loss, and you are more likely to lose body fat rather than muscle tissue and water."

Regardless of what method you try, said Drayer, remember that any diet should be cleared by your nutritionist or doctor before you begin. And when it comes to the three-day military diet, she concluded: "I can't imagine any doctor or expert endorsing the military diet as healthy or beneficial in any way."

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Military diet: 3-day diet or dud? - CNN

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You may not expect a mental health practitioner to prescribe a healthy eating plan, but that approach may not be far off. In recent years, scientists have been studying the link between food and mood more closely. They've found that there may be a relationship between the risk of common mental health issues - including depression and anxiety - and our diet quality.

"The role of diet in mental health may be particularly important for populations who are vulnerable to nutritional shortfalls, such as infants and the elderly, and those consuming a less-than-optimal diet," says Robin Kanarek, PhD, a Tufts University psychology professor studying the interaction of nutrition and behavior at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Far too many people fall into the latter category. But with a little effort, people generally can improve their eating habits.

When looking at the quality of your diet, consider both foods to eat more of and those to limit. Observational studies show that healthy eating patterns that include plenty of nutrient-rich plant foods, such as vegetables, fruits and whole grains, and omega-3-rich foods, such as salmon and flax seeds, are associated with decreased risk of depression and anxiety.

On the other hand, a Western-style diet - rich in foods high in refined carbohydrates (sugar and white flour), highly processed foods and sugary beverages - is associated with increased risk of depression and anxiety.

"While the results of earlier studies suggest a relationship between nutrient intake and mood, research that actually examines the effects of diet on measures of mental health is needed to confirm a causal relationship between food and mood," Kanarek says. That will require rigorous intervention studies. The first controlled trial explicitly designed to test dietary improvements in people with depression, dubbed the SMILES trial, was recently published in BMC Medicine. It suggests dietary approaches to improving mental health warrant further study.

The three-month trial was led by scientists at Deakin University in Australia. They enrolled 67 adults with relatively poor-quality diets and moderate to severe depression (under medical treatment). They reported a low intake of fruits, vegetables, lean proteins and fiber but a high intake of sweets, processed meats and salty snacks.

Half of the people were asked to follow a modified Mediterranean diet ("Modi-Med Diet," above) and complete nutrition counseling sessions. The other half (the control group) attended general social support sessions but received no diet advice.

Compared to the control group, those in the diet group had significant improvements in depression and anxiety symptoms. The greatest benefits were seen in those who improved their diet the most. At the end of the trial, 32% of people in the Modi-Med Diet group no longer met criteria for depression. In comparison, only 8% of those in the control group had remission of their depression. These findings are very encouraging but now need to be replicated in larger studies.

Scientists also are taking a closer look at why diet might impact mental health. Some possibilities theyre exploring include diets effects on the gut microbiota (bacteria and other microbes), inflammation, oxidative stress (cell damage) and brain plasticity (changing structure, wiring and function).

While scientists work out the details linking diet and mood, dont wait to adopt a healthy eating pattern. We already know it could benefit your physical health. Its potential to lift your mood may be a bonus.

View original post here:
Connecting Food And Your Mood - HuffPost

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High Altitude Health Deborah Holmes MedX of Estes

It's summer time and I've found myself deciding that it's ok to indulge in some of these wonderful things that only come around during the summer. I'm thinking of s'mores next to the fire, ice cream, hot dogs on the grill, staying up a little later and enjoying the warm summer evenings on the deck with a glass of wine! Its O.K. don't you think?

Life can't be all strict and no flex, at least I don't think. Life is about moderation. Moderation allows us to enjoy some of the things that make life sweeter, more fun and enjoyable, especially during this summer time.

Moderation should be our motto for life and specifically when it comes to our health. I believe moderation is the key to a healthy, long and happy life.

I think back to a friend of mine from college, who jumped all over me one night for not eating a piece of pizza because I was "on a diet." Her comment to me was "like you are never going to eat another piece of pizza in your life."

Of course, I know that there is a difference between eating a piece of pizza and eating an entire pizza. Moderation.

With all these "fads" happening in the world, we see things come and go in the health and fitness world. Everyone is trying to come up with the perfect diet, the perfect exercise machine, the perfect solution. Something new or some new idea on dieting and exercise and encourage you to do it to the extreme. They want complete control and dominance over your choices making you over-indulge on the diet plan or take the workout to the extreme claiming it's the only way it will work. How many of these programs really stick around? Not many. How many of these programs are successful? Not many. How many of these programs really focus on your health? Not many.

The bottom line for every diet program that I know, begins and ends with moderation. Eating moderate portions of food, eating moderate amounts of each food group that provides necessary nutrients for our bodies and eating within moderate time frames throughout the day. Even the Atkins, South Beach and State of Slim diets, which all direct your diet intake away from carbohydrates for an amount of time, will eventually lead you back into including carbohydrates in your diet but only to be eaten in moderation.

Still the most successful diet program around today, is Weight Watchers. Why, because they incorporated individual choice and moderation into their philosophy a long time ago!

Even in exercise you need to exercise for health, not to body build or to run a marathon. Those are unrealistic goals for almost all of us. However, strength training and walking/jogging for health is realistic and it includes moderation.

Research continues to show that exercise done in moderate amounts of time and intensity will provide the best outcome for a long and healthy life. Those who practice moderation, tend to keep a healthy outlook about exercise (and eating) and maintain their exercise all their lives. They exercise for life, function and overall health.

Those who practice moderation also tend to have fewer injuries that are often associated with more extreme exercise, which also favors long term consistency and dedication.

Just think about it. Coffee, alcohol and juices, enjoy them with moderation. Chocolate and sweets? Go ahead and eat them, with moderation. Carbohydrates, fat and fiber, all very important in your diet, with moderation. Television, video games, computers; sure, with moderation. Dining out, shopping and spending money, fun to do but needs to be done with moderation. Hobbies, interests and desires make up our personalities, yet should not become obsessive. Therefore, practice moderation.

Hopefully, you got my intended message with this article. It is such a real issue in life. We all need to enjoy the good things in life and not feel guilty about it. We all need to experience life to its fullest without becoming obsessive. We all need to live healthier without making it so difficult. It's all about moderation, in everything we do.

The rest is here:
A motto for life moderation - Estes Park Trail-Gazette

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Kent Maurer used to be a meat and potatoes kind of guy.

"I grew up having my bacon and eggs for breakfast," he said. "I'd have my burger and fries for lunch, my steak for dinner and my ice cream for dessert."

The 61-year-old now adheres to a different diet. Rather than grilling chicken or making pot roast, Maurer often prepares a hearty salad and baked potato for dinner. He said his decision to stick to a plant-only diet changed his health and his life.

The Park City resident feels everyone can benefit from the choice to abstain from meat, dairy and other animal products. Not only does being vegan help protect people from heart disease, he said, it also benefits the environment by cutting down on resources used to feed and transport livestock.

If you look around, all the biggest, fastest and strongest animals on the planet

including the animals were eating

are plant-eaters.

"If you look around, all the biggest, fastest and strongest animals on the planet including the animals we're eating are plant-eaters," he said.

Getting introduced

Maurer was a little apprehensive about the diet when he was introduced to it, which is something that isn't uncommon, he stressed.

When the Colorado native lived in California in the '80s, he found regular work as a stunt man for the action-adventure show "A-Team" and befriended one of the program's stars, Dirk Benedict.

Between faking death during staged explosions and rappelling down buildings, Maurer would chat with Benedict, especially during lunch breaks.

"I always noticed his plate of food," Maurer said. "His plate of food was brown rice and steamed vegetables. Mine was a burger and fries."

Curiosity got the best of Maurer, and he asked the actor why he ate the same meal every day. Limiting his consumption of meat, Benedict was on a macrobiotic diet and mostly munched on grains and vegetables.

The actor explained to Maurer his reasoning for following a mostly vegetarian diet, telling the stunt man the diet helped him heal from prostate cancer.

"He goes, 'I grew up in a cattle ranch in Montana. And at 29 years old, I got prostate cancer,'" Maurer said, adding that Benedict seemed to correlate his cancer with eating meat.

"That was the last I thought about it after that," Maurer said.

The stunt man grew homesick when he was in California and decided to return to his roots to work in Aspen, Colorado. There, he became a personal trainer and focused on staying fit, which is something that has always been important to him.

"When I was a kid, I wasn't the fastest or the biggest or the strongest," Maurer said. "I started exercising and tried to get better. It paid off."

He stayed in Aspen for a while. But after he married wife Laura in 1987, the couple decided the Aspen lifestyle was too expensive.

"We wanted to have a family," Maurer said.

They moved to Tucson, Arizona, and Maurer took a job as spa director at Canyon Ranch, a ritzy health resort.

Once again, the vegan lifestyle seemed to knock at Maurer's door. He noticed meals prepared at the spa closely mirrored Benedict's macrobiotic diet. He said he made a correlation between eating veggie-heavy meals and staying healthy, but he remained committed to eating the starches and proteins he grew up enjoying.

Making a lifestyle change

After a move back to the Golden State, Maurer jumped on the plant-only bandwagon when he once again became a personal fitness instructor, which had its challenges, he said.

The trainer was able to help clients build muscle and lose weight, but he wanted to do more.

"I got people stronger and fitter," he said. "I also had people who were getting heart disease and cancer. I even had clients that would die because of these diseases.

"I felt like I wasn't doing any good for these people who I've gotten so close to, so I started looking outside the box I was comfortable with."

Maurer was in his 40s when he decided to try a diet that had followed him, almost like a shadow, during his adult life. He started traveling from his residence in San Diego to Los Angeles to attend conferences on veganism. After Maurer discovered he had high cholesterol, he decided to challenge himself.

"I said, 'OK, I'm going to try this for a month," Maurer said. "I can always go back to my old way of eating if I get weak or if I can't handle it."

He stuck to a diet of oatmeal in the morning, burritos in the afternoon and salads in the evening. In between meals, he snacked on fruits and nuts. He said the results from eating veggies, grains, fruits and nuts shocked him.

"My cholesterol was almost 300, because even though I looked good, my internal organs were starting to pile up with all that saturated fat and cholesterol I'd been eating my whole life," Maurer said. "So after one month, I went back to the doctor and my cholesterol went from 298 down to 160."

Maurer cut meat out of his life 21 years ago. His wife and two kids also jumped on board. Now, his mission is to encourage Parkites to adopt a vegan lifestyle.

Maurer's calling

Since moving to Park City in 2007, Maurer still a personal trainer has challenged locals to follow a plant-only diet.

"I ask them to stop eating animals for 10 days and see what happens," he said. "I take them to a grocery store and show them how to read labels and what foods to eat. I also take them on hikes, so they can talk to me and ask some questions."

The Parkite who, in addition to spreading his vegan motto, loves to hike and enjoys watching documentaries wants people to know he feels eating a plant-only diet has more pros than cons.

Yes, a stand against the mistreatment of cows and chickens is a reason to refrain from eating meat and animal byproducts, he said, but his main drive is his belief that the livestock industry could one day lead to a global crisis, which is something he feels can be avoided.

Maurer said the water it takes to nourish plants fed to animals should instead be used for plants grown for human consumption.

"There is only 1 percent of water that we can drink that's not salt water or not frozen, and the whole planet has to share it," Maurer said, adding he thinks the next big war will be over available water.

Installing solar panels or investing in other renewable sources takes money, Maurer said, but people can conserve a valuable resource by changing their diets.

"I think it all starts with what we're eating," he said. "Peace starts at our dinner table."

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Want to drop some pounds? Eat less, lose weight has always been the simple answer. And here's another proven diet tip: Since one pound of fat is equal to roughly 3,500 calories, simply delete this amount of food from your weekly diet and the scale will go down.

Right?

Well, there are a few more factors to consider when it comes to calorie counting in order to shrink your waistline. For one thing, not all calories are created equal.

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"Calories matter when it comes to weight loss and maintenance, and in order to lose weight, you must take in less energy than you expend," says Erin Palinski-Wade, RD, CDE, author of Belly Fat Diet for Dummies. "And how much energy you burn each day is dependent on your metabolic rate, as well as your physical activity."

She further explains that part of your metabolic rate is determined by the number of calories you burn during digestion. "This is where the calorie equation becomes tricky," continues Palinski-Wade. "A calorie from a simple to digest sourcefor example, a calorie from a simple sugar, like sodacan be converted into energy easily. Therefore, your body won't have to burn much energy at all to utilize and store energy coming from a simple sugar."

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However, a calorie that derives from a resistant starch (such as fiber-rich pulses, like beans, lentils, chickpeas, and peas) or from lean protein are harder for the body to breakdown and convert into energy. "And this means more energy will be burnt up during the digestion of these foods, increasing the total amount of calories you burn during the day."

Palinski-Wade breaks it down with numbers: For example, if you consume a 1,600 calorie diet rich in simple sugars, an estimated 100 calories would be needed to digest this food. "But if your diet is made up of 1,600 calories from fiber and protein-rich foods, you may burn closer to 300 calories during digestion," she states. "And that difference in calorie expenditure during digestion can have a big impact on body weight over time."

Also, calories count when it comes to hunger and satiety. Palinski-Wade refers to a study published in the journal Nutrition Journal, which concluded that pea protein was more effective at starving off hunger than whey protein. "And if the majority of your calories come from simple sugars, like Twinkies, you will most likely be left feeling hungry and unsatisfied, which will impact your ability to keep weight off long termnot to mention the negative health impact of consuming all of those empty calories and added sugars," she says.

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But generally speaking, there are benefits to becoming more mindful about the number of calories you're consuming on a regular basis.

"Determining the right number of calories for your body is highly educational if you have never paid much mind to calories before," says Elizabeth M. Ward, MS, RD, author of Expect the Best: Your Guide to Healthy Eating Before, During, and After Pregnancy. "It's great to be aware of calorie needs because it forces you to measure portions, so if you can learn how many portions you need for a healthy weight, you can quit thinking about every calorie."

And while cutting back on calories will most likely lead to a smaller number on the scaleespecially if you have a BMI (body mass index) that falls into the overweight or obese categorythis strategy will only work for a period of time. "That's where physical activity and a regular re-calculation of calorie needs comes in," continues Ward.

Calories count when it comes to hunger and satiety.

So what's the bottom line when it comes to calories and weight loss?

"Be aware of your total calories needs and intake," encourages Palinski-Wade. "Focus on a meal plan rich in fiber, plant-based fats, and lean proteins to promote satiety, which will naturally help you to control your portions and lose weight while taking in nutrients that promote health."

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"The most important thing to remember is that eating healthier, less processed foods will probably help you lose weight and improve your energy leveland consulting ChooseMyPlate.gov is a great place to start," says Ward. She suggests following the simple icon on the site, which advises filling half your plate with fruits and vegetables, one-quarter of the plate with protein, and the rest with grains.

"I would like the grains to be whole grains because they're filling and more nutritious," she concludes. "Round it out with a glass of milk or a cup of yogurtand no calorie counting needed."

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CHI Memorial Medical Group welcomes Jaime Ponce, M.D. Dr. Ponce earned his medical degree at Escuela De Medicinia Ignacio a Santos, Instituto Tecnologico Y De Estudios Superiores De Monterrey in Monterrey, Mexico. He completed his internship and residency in general surgery at East Tennessee State University.

Dr. Ponce is board certified in general surgery by the American Board of Surgery. He is bilingual with fluency in English and Spanish.

Dr. Ponce has been practicing bariatric surgery since 1998 and has extensive experience with gastric bypass, laparoscopic adjustable gastric band, gastric sleeve procedures, and endoscopic procedures like the intragastric balloon and revisional surgeries. He is medical director of CHI Memorial Weight Management Center.

Many in our community struggle with weight issues and the impact that has on their overall health, says Glyn Hughes, president, Mountain Management. Dr. Ponce understands the struggle and works with each person to develop the best plan for long-term weight loss success, leading to better overall health.

CHI Memorial Metabolic and Bariatric Care is at 7405 Shallowford Road, Suite 160, Chattanooga, TN 37421. Office hours are MondayThursday, 9 a.m.5 p.m. and Friday, 9 a.m.1 p.m. For more information, to make an appointment, or to register for a free informational seminar, visit http://www.ChattanoogaBariatrics.com or call 899-1000.

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Louise Yates, 34, ballooned to a size 22 and had "no energy", but decided to overhaul her lifestyle and slim down.

Speaking about her life before the weight loss, Louise said: "Before losing the weight I felt so sluggish and my feet used to burn if I used to go shopping or walk for a while.

"I had no energy and used to dread being invited out socially due to the stress of having to find something to wear, I felt self-conscious and shy, and pretty much miserable."

Describing the turning point that spurred her weight loss, Louise said: "March 2012 I was feeling miserable, I realised I was getting bigger and bigger and things had got out of control. I decide enough was enough, and it was time to make a lifestyle change.

"At the time I was choosing quick fix meals like takeaways maybe four times a week, I have always enjoyed my food and would eat huge portions - enough for two people."

Louise decided to try a combination of SlimFast and exercise to lose weight.

She explained: "I decided to give SlimFast a go because I had tried every other diet going and I was unable to stick to any of them.

"SlimFast was a great option because I needed to be able to quickly grab things for lunch and breakfast rather than having to think about it. SlimFast took away all the hassle of deciding what to eat and when but it still gave me the opportunity to have things I enjoyed for snacks and dinner whilst sticking within my calories.

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Paleo, Durkin & Atkins, the most popular diets explained

"I was shocked me at first to see how many calories I was consuming in some of my favourite foods."

Revealing her exercise plan, Louise said: "Ive shocked myself by taking up running and Im so proud of myself. I can now run 5k thanks to my perseverance.

"I also go to Clubbercise (cardio in the dark with glow sticks - great fun!) and Poundfit (drumming cardio using weighted drum sticks), which since losing weight I have been even more confident go to."

Starting out at 17st 5lbs, Louise got down to 11st albs in June 2014 - but gained five stone whilst pregnant.

SlimFast

I never imagined I would be a size 12, Im now comfortable in my own skin and feel fantastic

Louise Yates

After turning her life around with a sensible diet and exercise plan, Louise has now lost six stone, and is a dress size 12.

She said: "I never imagined I would be a size 12, Im now comfortable in my own skin and feel fantastic.

"I still follow the SlimFast plan and have the occasional treat at weekends, which allows me to have a balanced life style.

"Family have noticed my weight loss, my partner met me when I was a size 22, and now Im a size 12 he feels like hes dating a new person as I look so different."

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A new study out of the Cleveland Clinic found that obesity robs us of more years of our lives than any other preventable health issue. That means that of all the top lifestyle-related killers that are in our power to modify or treat including smoking, high blood pressure and high cholesterol obesity shortens life the most.

That is bad news for the 13 million adults aged 65 and over who are obese, which is more than a third of that age group. While a few extra pounds on older adults are not a health issue and may even be beneficial, too much excess weight can contribute to a variety of health problems, including inflammation, diabetes, heart disease, stroke, certain cancers, joint problems and even cognitive impairment.

Additionally, obese older adults are admitted to the hospital and emergency room more than their non-obese counterparts.

The good news is that while obesity can lead to lost years or unhealthy years, you have the power to get those years back. Even losing as little as 3% of your total body weight can make a difference if you maintain it.

Usually, people who have a body mass index (BMI) of 30 or more are considered obese and those with a BMI between 25 and 29.9 are overweight. Your BMI is an estimate of your body fat based on height and weight.

However, there are other factors to consider in addition to, or instead of, your BMI.

Dr. Tiffany Lowe-Payne, a family practitioner in Raleigh, N.C., with a board certification in obesity medicine, says that defining obesity can be tricky for older adults.

With age, we tend to lose muscle mass, which weighs more than fat. So, while your weight or BMI may not change, your body fat stores may increase as well as your risk for obesity-related diseases. On the other hand, older adults often lose inches in their height and may be classified as obese because their BMI has increased but their weight has stayed the same.

You need to look at multiple factors. We look at waist circumference and waist-to-hip ratio, explains Lowe-Payne. (Abdominal fat increases the risk for heart disease.) We can track those measurements over time to see if patients have reduced their health risks even if the number on the scale is the same.

Some adults have always had weight issues. Others find the number on the scale climbs as their metabolism and energy levels slow and their eating habits change or perhaps, unwisely, dont.

Lifestyle changes may be a factor as well. If youre a widow or widower, you may not cook or visit the grocery store as frequently as in the past. Registered dietitian Maureen Janowski, a certified specialist in gerontological nutrition and fellow of The Academy of Nutrition and Dietetics explains that fear of falling or low energy levels may prevent older adults from shopping regularly for fresh produce and healthy food.

Instead, they may stock up on unhealthy processed foods that have a longer shelf life or resort to fast-food options. Additionally, medications for other health issues, such as heart disease and high blood pressure, may cause weight gain.

Lowe-Payne points out that menopause for women and declining testosterone levels for men can alter hormonal balances that can also contribute to weight gain.

While the health benefits of losing weight for younger people are clear cut, there is some debate in the medical community when it comes to excess weight in older adults. In some cases, obesity or some excess weight is thought to be protective.

In some individuals, especially those with heart disease, we see that excess weight can stop them from having an acute cardiac episode, says Lowe-Payne.

The problem is that losing weight leads to muscle loss. Older adults are already prone to losing muscle mass, a condition called sarcopenia. Low muscle tone can lead to falls, low energy and less activity. In fact, Janowski says that she doesnt counsel her patients to lose weight unless they are very obese. For overweight adults, I tell them to maintain their weight and stay active, she says.

Excess weight can also be protective in the case of prolonged hospitalization or illness, which usually leads to weight and muscle loss. But the amount of excess weight that is helpful is still in question, says Lowe-Payne.

We dont know how much excess weight is beneficial and we also dont know exactly why its beneficial, she says.

Losing weight for older adults can be slightly more complicated than your basic eat less, exercise more formula. Lowe-Payne strongly advises working with a doctor to determine a safe and effective exercise and weight-loss plan. Additionally, a physician can review your medications to see if any may cause weight gain. Some general guidelines to help older people lose weight effectively and safely include:

Cardiovascular exercise: The Centers for Disease Control and Prevention (CDC) recommends 150 minutes of moderate-intensity exercise every week.If you havent exercised before or in a while, its important to start slowly. Its not necessary to strap on running shoes or grab a tennis racquet. Lowe-Payne says walking or even gardening can be beneficial.

Strength training: Its important to make sure that any weight-loss program includes strength training (at least twice a week, recommends the CDC) to prevent muscle loss. Again, no need to bench press dozens of pounds. Simple exercise bands or even lifting household items such as soup cans will have an effect, says Janowski.

Protein: Its essential for preserving and building muscles, and some research suggests that older adults need more protein than their younger counterparts. Try eating a serving of protein at every meal, including yogurt or eggs for breakfast.

Hydration: Its important to stay hydrated for health reasons and also because thirst is sometimes confused with hunger. Drinking water all day long can help you feel fuller and prevent dehydration. You can jazz up your water by adding lemon, lime or another type of fruit for a boost of flavor.

Portion control: A simple way to remember how much of each type of food you need per meal, or what constitutes a portion, is to use the U.S Department of Agriculture My Plate visual. Fill half your lunch or dinner plate with fruits and vegetables, a quarter with whole grains such as quinoa or brown rice and the other quarter with a lean protein. If you buy packaged goods, read the label so you understand the portion sizes.

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