Racial and Ethnic Stereotypes May Contribute to Obesity Among Hispanics

adults-obese-largeMaintaining a healthy weight can be much harder for Hispanics than for their white counterparts, according researchers at Rutgers University-Newark.

Minorities in the U.S. are often confronted with negative stereotypes and messages that suggest those groups are inferior. These attitudes can prevent people from doing what is needed to care for their health.

“When you are exposed to negative stereotypes, you may gravitate more toward unhealthy foods as opposed to healthy foods,” explains lead author and social psychologist Luis Rivera. The study appears in this summer’s edition of the Journal of Social Issues. Rivera was also a co-editor of the publication. “You may have a less positive attitude toward watching your carbs or cutting back on fast food, and toward working out and exercising.”

He says the resulting difference in motivation may help explain – at least in part – higher rates of obesity in the United States among members of minority groups than among whites.

Hispanics in the study who strongly self-stereotyped were more than three times as likely to be overweight or obese as those who did not. The data suggest that self-stereotypes diminish self-esteem – and therefore the motivation that might have helped them follow a healthier lifestyle.

Demeaning stereotypes come from many sources. For example, television and other mass media frequently carry harmful messages, such as Latinos are lazy or Latinos are unintelligent. “And then,” Rivera adds, “there are more subtle ways in conversations and interactions with others.”

There is some evidence that Latinos born in this country tend to have a poorer self-image than many recent Hispanic immigrants – suggesting that stereotypes ingrained in U.S. culture are especially potent – and that the design of his research reinforces that view, he said.

Aside from ethnicity, study participants were nearly identical. They lived in the same neighborhood, had comparable incomes, had similar access to healthy foods and were asked the same questions – additional evidence that if the whites and the Latinos saw themselves differently, society’s prejudice against Latinos was the underlying reason, he said.

So how does a person discouraged by stereotypes overcome them? According to Rivera, research suggests that exposure to positive racial and ethnic role models might help. Something else worth trying, he said, could be designing approaches to weight loss that emphasize the person’s positive qualities – as a way to counteract the corrosive effects of prejudice.

“It has been shown that when you remind people what they’re good at, it works to immunize them from the effect of stereotypes,” Rivera said. “It releases their anxieties and allows them to focus on the task before them and perform to their ability.”

Multiple Lifestyle Interventions May Help Those at Risk for Alzheimer’s

afternoon stroll-cRobert wallace

image: Robert Wallce, Flickr Creative Commons

Physical activity, nutritional guidance, cognitive training, social activities and management of heart health risk factors improved cognitive performance, according to Finnish researchers.

Data from a two year clinical trial in Finland of a multi-component lifestyle intervention, known as the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) Study showed both overall and in separate measures of executive function, such as planning abilities, and the relationship between cognitive functions and physical movement. The  two-year randomized controlled trial of 1,260 participants age 60 to 77 with modifiable risk factors for cognitive impairment and Alzheimer’s. Results were presented at the Alzheimer’s Association International Conference in Copenhagen this past week.

Participants were divided into two groups; one received an intervention that included nutritional guidance, physical exercise, cognitive training, social activities, and management of heart health risk factors, while the control group received regular health advice. After two years, the intervention group performed significantly better on a comprehensive cognitive examination. In addition to performing better overall, the intervention group did significantly better on specific tests of memory, executive function (complex aspects of thought such as planning, judgment, and problem-solving), and speed of cognitive processing.

“This is the first randomized control trial showing that it is possible to prevent cognitive decline using a multi-domain intervention among older at-risk individuals. These results highlight the value of addressing multiple risk factors in improving performance in several cognitive domains,” said lead researcher Miia Kivipelto, M.D., Ph.D., Professor at the Karolinska Institutet, Sweden and the National Institute for Health and Welfare, Helsinki, Finland,  “Participants told us their experience was very positive, and dropout rate only 11 percent after two years.”

“This new data is very encouraging, and we look forward to further studies to confirm and extend these findings,” said Keith Fargo, Ph.D., Alzheimer’s Association director of Scientific Programs & Outreach.

The researchers say an extended, seven-year follow up study is planned, and will include measures of dementia/Alzheimer’s incidence and biomarkers including brain imaging with MRI and PET.

Drug Risks Outweigh Benefits for Some Type 2 Diabetes Patients

670px-Cure-Dry-Mouth-Step-1For patients with type 2 diabetes – especially those over age 50 – the negative impact of side effects like weight gain and burdens like frequent insulin shots trumps the benefits of drugs, says a new study by the University of Michigan Health System, the VA Ann Arbor Healthcare System, and University College London.

The findings, which appear in today’s Journal of the American Medical Association Internal Medicine, show that for many, the benefits of taking diabetes medications are so small that they are outweighed by the minor hassles and risks.

These findings suggest that, contrary to current guidelines for type 2 diabetes that recommend intensifying treatment until a person’s blood sugar level reaches a certain goal, the overall benefit of taking a new medicine depends less on blood sugar and more on the hassles, safety and side effects of taking the treatment.

“For people with type 2 diabetes, the goal of managing blood sugar levels is to prevent associated diabetes complications, such as kidney, eye and heart disease, but it is essential to balance complication risks and treatment burdens when deciding how aggressively to treat blood sugars,” says lead author Sandeep Vijan M.D., M.S., professor of Internal Medicine at the U-M Medical School and research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.

“If you’re a patient with fairly low complication risks, but are experiencing symptoms from low blood sugar, gaining weight or find frequent insulin shots to be disruptive to your daily life, then the drugs are doing more harm than good. Prescribing medicine isn’t just about reducing risks of complications, but also about helping patients improve their quality of life.”

Vijan notes that for many patients, once moderate levels of glucose control are achieved, there is little additional benefit to intensive blood sugar treatment, but treatment costs, burdens and risks increase substantially. The study finds that the benefits of treatment decline with age and by age 75 the harms of most treatments are likely to outweigh any benefits.

The findings exclude the 15-20 percent of people with type 2 diabetes who have very high blood glucose levels (which are defined by what’s called an A1c test ) and need more aggressive treatment to manage the disease.

Individualized treatment recommendations determined by patients’ estimated risk of diabetes complications – influenced by their age and degree of blood glucose elevation – and considering the side effects and amount of safety data of the medication being considered, is a much better approach than focusing solely on glucose goals, the researchers argue.

“Drugs that lower blood sugar levels are extremely beneficial in some patients but offer almost no benefit for others. These results have major implications for the millions of people who are currently being told that they need to increase medication in order to achieve their ‘glucose goal,’” says senior author Rodney Hayward, M.D., professor of medicine in the U-M Medical School and senior research scientist at the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.

“Current quality measures do not allow doctors and patients to make good decisions for each patient because they emphasize reaching targets instead of thinking of the risks and benefits of starting new medications based on individual circumstances and preferences.”

The study is the latest to challenge “treat-to-target” guidelines in medicine. Research concluding that risks outweighed benefits of drugs intended to achieve specific blood pressure goals in some patients prompted a significant change in hypertension guidelines last year and similar recommendations were implemented for lipid-lowering therapy.

International Federation for Diabetes guidelines for treating older people says the emphasis should be on managing complexity and quality of life issues — especially for frail elderly and those with dementia. “There is a need to individualize the medication
regimen to balance the imperative to control disease states with
the imperative to avoid/minimize medicine related adverse events.
Medicines are associated with significant risks in older people such
as falls, confusion and other cognitive changes, and admission to
hospital or emergency departments could be avoided if medicines are
managed optimally.”

Both Vijan and Hayward are members of the Institute for Healthcare Policy and Innovation.

Most Breast Cancer Patients May Not Be Getting Enough Exercise

Running_womanA new study in the journal CANCER, a peer-reviewed journal of the American Cancer Society, finds that most participants in a large breast cancer study did not meet national physical activity guidelines after diagnosis. African-American women were less likely to meet the guidelines than white women.

Physical activity after breast cancer diagnosis has been linked with prolonged survival and improved quality of life, and the findings indicate that efforts to promote physical activity in breast cancer patients may need to be significantly enhanced.

The US Department of Health and Human Services, as well as the American Cancer Society, recommends that adults engage in at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity (or an equivalent combination thereof) each week for general health benefits and for chronic disease prevention and management.

Brionna Hair, a doctoral candidate in epidemiology at the University of North Carolina at Chapel Hill, and her colleagues examined levels of and changes in physical activity following breast cancer diagnosis, overall and by race, in a population-based study of breast cancer patients. The study assessed pre- and post-diagnosis physical activity levels in 1,735 women aged 20 to 74 years who were diagnosed with invasive breast cancer between 2008 and 2011 in 44 counties of North Carolina.

The researchers found that only 35 percent of breast cancer survivors met current physical activity guidelines post-diagnosis. A decrease in activity approximately six months after diagnosis was reported by 59 percent of patients, with the average participant reducing activity by 15 metabolic equivalent hours—equivalent to about five hours per week of brisk walking.

When compared with white women, African-American women were about 40 percent less likely to meet national physical activity guidelines post-diagnosis, although their reported weekly post-diagnosis physical activity was not significantly different from that of White women (12 vs 14 metabolic equivalent hours). Ms. Hair noted that it’s important to realize that African-American women experience higher mortality from breast cancer than other groups in the United States.

“Medical care providers should discuss the role physical activity plays in improving breast cancer outcomes with their patients, and strategies that may be successful in increasing physical activity among breast cancer patients need to be comprehensively evaluated and implemented,” she said.

 

Providers hesitant to discuss end-of-life care with some patients

senior doc checkupWho should discuss end of life care with patients, and when?

Providers are unsure when to approach this issue and whether it’s the role of the primary provider or the heart specialist, according to a study presented at the American Heart Association Healthcare Quality of Care and Outcomes Research 2014 Scientific Sessions. Researchers found reluctance on the part of clinicians to have this conversation with heart failure patients and their families because they feel uncomfortable broaching the topic or lack time.

A survey of 50 physicians and 45 nurse practitioners or physician assistants at three practices at the Mayo Clinic in Rochester, Minnesota and the Mayo Clinic Health System found:

  • Only 12 percent of the healthcare providers reported having routine yearly discussions about end-of-life care as advocated by the American Heart Association.
  • Thirty percent of the group reported having little confidence in discussing or providing end-of-life care.
  • Among the 52 percent who said they felt hesitant mentioning end-of-life-care, 21 percent cited their perceptions that patients weren’t ready to talk about the issue; 11 percent said they felt uncomfortable bringing it up; 9 percent said they worried about destroying a sense of hope; and 8 percent said they lacked time.

Healthcare providers were often unsure about who should bring up end-of-life care: 63 percent of heart failure specialists and 58 percent of community cardiology clinicians thought end-of-life care discussions were the responsibility of heart failure cardiologists, while 66 percent of primary care providers felt it was their responsibility.

Despite these perceptions, heart failure specialists and community cardiology clinicians were far more likely to have referred heart failure patients to palliative care within the past year than primary care physicians (89 percent versus 21 percent).

“Providers did express an interest in receiving additional training to develop the skills and confidence to talk about end-of-life care with their patients with heart failure,” said Shannon Dunlay, M.D., M.S., the study’s lead researcher and a cardiologist at the Mayo Clinic in Rochester, Minnesota.

There is no evidence that bringing up end-of-life care ruins hope, and it may ease anxiety for some patients and families, Dunlay said.

About 5.1 million Americans have heart failure and about half of those die within five years of their diagnosis, according to American Heart Association statistics.

“Communication is key but in many hospitals and health systems this can be difficult as patients often have multiple healthcare providers,” Dunlay said. “Sometimes it’s helpful to pick up the phone and have a provider-to-provider conversation so that everybody is on the same page. Incorporating end-of-life conversations into the ongoing, routine care of the patient is important as goals and preferences can change over time and patients and their families can feel more comfortable and confident in relaying their wishes to multiple providers.”