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Local Seniors Look to Exercise More, Eat Better in 2019 Clover Health Survey Highlights Resolutions by Older Nashvillians Recently released survey results from Clover Health highlight the most popular New Year’s resolutions for Nashville area seniors, namely that 66 percent of local residents 60 and older cite exercising more frequently as one of their top health goals in 2019, while 62 percent resolve to improve their diet. Nationally, 63 percent of seniors surveyed cited exercising more frequently followed by eating better (60 percent) as their top health goals for the year ahead. The survey also found that:  • 24 percent of Nashville seniors aim to reduce chronic pain in 2019, while 21 percent would like to increase the ability to get around by themselves.

• Just 7 percent of those 60 and older surveyed in Nashville cited quitting smoking as a top health goal in 2019. • Visiting the doctor more frequently and quitting drinking were the least common New Year’s resolutions, chosen by 5 percent and 1 percent of local seniors, respectively “We are encouraged to see that the majority of Middle Tennessee seniors are planning to improve their exercise and diet habits heading into 2019,” said Clover Health Chief Scientific Officerv Kumar Dharmarajan, MD. “Maintaining good physical fitness and nutrition is especially important for older adults looking to stay healthy and active throughout their

golden years.” The vast majority of New Year’s resolutions fail by the second week of January, making it important for providers, family members and caregivers to support those trying to make lifestyle changes. Clover Health officials offered tips to help ensure good intentions become healthy habits that stick: Prepare meals in advance. It can be overwhelming to figure out and manage the nutrients needed in a healthy diet at dinnertime, which is why it’s important to plan meals in advance. Consider preparing a week’s worth of dinners to put in the freezer, then pull them out individually as needed. Start with simple food substitutions,  such as switching out butter or

margarine for unsweetened applesauce in baked goods or trying garlic powder instead of salt while cooking to lower sodium intake. Incorporate cardio, strength, and mobility training into a weekly exercise routine to achieve maximum benefits. Even Nashville seniors with limited mobility can try chair yoga, light water aerobics, or walking to stay active. The study from  Clover, which utilizes technology to impact outcomes, was conducted by Wakefield Research of 300 adults age 60 and older in the Nashville area. The national survey was of 1,000 adults 60-plus throughout the country.

Medical Weight Loss & the Science Behind Surgery, continued from page 1 “We’re fighting a disease, and like many others it requires certain dietary restrictions,” he said. “Surgery helps make those restrictions more plausible.” By the time patients arrive in a surgeon’s office, they are often physically and emotionally exhausted from the weight loss roller coaster. And while others may see bariatric surgery as a cop-out, studies show that patients with severe forms of obesity have a less than 4 percent chance of success going it alone when it comes to losing weight and keeping it off. Hannah Richards, PA-C, is often the first face patients see at Saint Thomas Medical Partners Center for Surgical and Medical Weight loss. She also regularly discusses the misconception of surgery as a one-step fix for weight loss. “Obesity is a long-term disease, and patients will still strugHannah Richards gle after surgery,” she said. “I talk to patients about complying with nutrition, behavioral modifications and the importance of a good support system to help them reach their end goal.” Richards discusses the importance of taking action before a person develops comorbidities like heart disease and sleep apnea, which often aren’t on the radar for younger patients. Bariatric surgery also is a proven treatment for metabolic syndrome.

Medically Assisted Weight Loss

Most insurance policies do require some attempt at weight loss prior to surgery, often followed by medically assisted weight loss. Periodically, a program may require medical weight loss, as well, typically to lower an extremely high body mass index. That usually involves extensive counseling regarding food choices, behavior and exercise, along with prescription appetite suppressants and weight loss medications. While medically assisted weight nashvillemedicalnews


loss is effective for many, medications are often not covered by insurance, making surgery a more affordable and manageable option long-term.

The Disappearance of Lap-Band

Once considered the gold standard for weight loss surgery, Lap-Band fizzled out after failing to tackle the root cause of obesity: hunger. “The problem with simple restriction offered by the Lap-Band is that you could still overeat,” Olsen explained. “What gives the feeling of fullness are nerves and tissues, because the nerves feel that stretch and send a message to the brain. If the stomach is constantly stretched, those nerves go numb and don’t send the message.” While all forms of bariatric surgery utilize the idea of restriction, today’s more effective methods are rooted in the idea of borrowing the normal response humans have to control calorie consumption – feeling satisfied after a meal and shutting down the appetite center until the next meal time. Today, Roux-en-Y gastric bypass and gastric sleeve surgery are the most common bariatric procedures yielding lasting results.

Roux-en-Y Gastric Bypass

In Roux-en-Y gastric bypass, a small stomach pouch roughly the size of an egg is created. The pouch bypasses a small portion of the small intestine and is reconnected to a lower limb of bowel. “The biggest component in this procedure is the hormonal influence, because the patient has to remind himself to eat,” Olsen said. “It gives patients a whole lot more power to help them achieve weight loss.” Richards said patients with acid reflux may also experience improvement of GERD symptoms after surgery. Patients with diabetes experience an 80 percent remission of symptoms following gastric bypass.

Gastric Sleeve Surgery

During gastric sleeve surgery, the surgeon removes 70 to 80 percent of the

stomach, leaving a stomach roughly the size of a banana. Olsen likens it to a two or three lane highway that narrows to one lane, slowing the ability of food to fill the new pouch. The laparoscopic procedure involves less rearranging of the anatomy but also can increase heartburn, making it less attractive for reflux patients. However, reduction or resolution in co-morbid conditions like hypertension, diabetes and sleep apnea is upwards of 70 percent.

Duodenal Switch

A less common procedure reserved for the most severe cases is the duodenal switch, in which the surgeon bypasses two-thirds of the small intestine and severely alters the way the body digests food. The surgery puts patients at increased risk for malabsorption and wasted nutrients, which is countered with correct diet and additional vitamin and mineral supplementation.

Life After Surgery

Patients typically experience acute

weight loss for 18 months following surgery. The goal for both sleeve and gastric bypass surgery is 75 to 80 percent loss of excess weight, while the duodenal switch typically achieves 80 to 85 percent. It’s also not uncommon for patients to regain 10 percent of lost weight five to 10 years out. Standard guidelines for post-surgical patients include avoiding liquid calories, no snacking between meals, and adopting a protein-based diet. Patients also take multivitamins along with calcium, vitamin D and iron supplements for life and receive regular screenings indefinitely. Some patients also benefit from medically-assisted weight loss after surgery. Providers have said the key to long-term success is staying plugged into the program and annual follow-ups with the surgeon. “Obesity is a multi-factorial disease characterized by food addiction, which is an eating disorder,” Olsen concluded. “Surgery doesn’t take that away, so patients have to learn to put all the pieces together to make it work. Through a process of life changes, they learn to stick to it and be healthier.”

Blog Log The Nashville Medical News Blog features additional insights and information from a cross-section of industry leaders. The blog can be accessed directly through NashvilleMedicalNews.Blog or from the homepage of the main website.

NEW IN JANUARY Linda Britton, MD, FACP, Southeast regional vice president and senior medical director for UnitedHealthcare, shares tips to help your patients … and you … stick to those New Year’s resolutions. Don Baham, CISSP, CISA, MCSE, president of Kraft Technology Group, shares steps to improve cybersecurity in 2019 for practices of all sizes. George Buck, president emeritus, and Judd Peak, chief compliance officer and general counsel, with Frost-Arnett Company, take a vendor’s perspective to drill down on “Laws and Regulations Continue to Affect Patient Pay: The Fair Debt Collection Practices Act.” In part four of this six-part series, the authors look at the Fair Credit Reporting Act.




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