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The Affordable Care Act in Connecticut
What It Is and What It Means For Naturopathic Medicine
written by Shawn M. Carney, ND
We are now at the doorstep to monumental changes in healthcare, as the health insurance exchanges created under the of The Affordable Care Act are in the final stages of development before being opened to the public on October 2013; this has meant a flurry of activity for insurers, regulators, legislators, physicians, hospitals, business owners, professional associations and other interested healthcare stakeholders as compliance for these changes is sought. As a way to address concerns, U.S. Senator Chris Murphy hosted a forum in Hartford on July 2nd regarding this transition and was joined by U.S. Senator Richard Blumenthal and representatives from federal and state agencies involved with the process. They brought up many new features of the law including the creation of accessible marketplaces for plans that meet a qualified minimum level of coverage, reforming industry practices like denials based on pre-existing conditions, incentives for consumer coverage as tax credits and penalties and increased protection under Medicare with expansion of Medicaid. Connecticut is also one of six “Early Innovator” states and has volunteered to develop its own exchange without relying on management from the federal Department of Health and Human Services (“HHS”). This makes the changes happening in Connecticut particularly exciting, as they may forecast the feasibility of implementing similar programs through the rest of the country; and it is not without its rewards, the State has received $117,184,326 in grants for research, planning, information technology development, and implementation of the Affordable Care Act, with the expectation that Connecticut disseminates its design successes to other states in the coming years.
A New Marketplace For Insurance
The Patient Protection and Affordable Care Act of 2010, more commonly referred to as ‘The Affordable Care Act’ (“ACA”), requires the creation of two types of state-based health insurance exchanges, which must be in operation by January 1, 2014. The American Health Benefit Exchanges for individuals will vary state to state and is being called “Access Health CT” in Connecticut, while the Small Business Health Options Program (“SHOP”) Exchanges will be for business owners to offer to employees. Though the federal government will set minimum standards, primarily through HHS, the law makes primary responsibility for governance and operations that of the states. Thus states have considerable flexibility in how they want to implement these programs and if they choose to partner with other states and form regional exchanges, or form multiple exchanges within their state, they are able to do so. However, if HHS discovers that exchanges are not operational by the deadline, then HHS must operate the exchange or find a non-profit entity to do so.
The health insurance exchanges are intended to be more than just clearinghouses from which consumers choose plans, they also aim to improve the quality of these plans while controlling cost. Only “qualified” plans will be allowed to be offered on the exchange and they must meet several criteria. All plans posted on the exchange must include a robust network of doctors and clinics and a minimum “essential health benefits” package which includes: emergency services, hospitalization, maternity and newborn care, mental health, substance abuse, prescription drugs, laboratory services, pediatric coverage and preventative services, as well as chronic disease management, among others. Different levels in the plans vary by the percentage cost of care that they cover, ranging from bronze at 60%, through silver and gold, up to platinum at 90%. Benefit levels are based on “actuarial value”, which is a summary measure of the amount of medical claims paid by the health plan (excluding a member’s point-of-service cost sharing), expressed as a percentage of the total medical claims incurred for a standard population. These statistical calculations are what insurance companies do when assessing risks and premiums, and are used in determining deductible amounts required on different plans. The ACA seeks to set limits on the maximum annual deductible for health plans purchased by small employers so that the annual deductible may not exceed $2000 for single coverage or $4000 for family coverage, though these limits do not apply on the individual market, which has other parameters. One of the enticing features of the exchanges is that “[n]o one will pay more than 9.5 percent of household income on health insurance and many will be capped at just two or three percent”, per the Access Health CT document ‘10 Things You Need to Know About Health Insurance Exchanges’. The State is expecting to meet ambitious goals like this by using competition between the insurance companies in the new marketplace, as well as tax credit incentives, as ways of keeping costs down over time. If enough people join the exchange in a given state, it has better odds of working and staying affordable, hence motivators like premium subsidies and tax credits are only available to people who have gotten health insurance through a qualified plan within the exchange, and not through one of the grandfathered plans that exists outside of the exchange, which don’t have to offer a qualified benefits package. Grandfathered plans, or plans that were in existence prior to the law’s enactment, are exempt from many of the new requirements, including the new rating rules and the requirement to offer a minimum essential benefit package. Other plans, such as large-group or self-insured plans, are also exempt from many of the the new rules.
Reforming the Insurance Industry
Beyond the exchanges, the ACA attempts to alter and reform entrenched health insurance practices both in and out of the exchange. These include guaranteed issue and renewability of coverage, banning premium variation based on health status or gender, prohibiting pre-existing condition exclusions and annual or lifetime limits, requiring coverage of preventative health services without cost-sharing, and many others. Among the changes, is the first-time creation of a mandated external appeals process for people in self-funded plans, so they have the right to an external review.
Another significant change to the health insurance industry comes in the form of increased transparency and accountability. To ensure premium dollars are spent primarily on medical care, the law’s “80/20” rule requires that at least 80% of premium dollars collected by insurance companies for individuals and small employers must be spent on benefits and quality improvement.
Incentives for Participation
Incentives for participation in the healthcare exchanges will come in two forms: tax credits and tax penalties. Lower and middle income individuals and families with income up to four times the Federal Poverty Level (“FPL”) may be eligible for subsidized health insurance. If you earn up to $45,960 a year, or if you are a family of four, for example, earning up to $94,200 a year, you may qualify for a monthly discount. Small businesses that qualify will also benefit from tax credit discounts; however, they receive their credit after filing income taxes in 2015 for the 2014 calendar year. The federal government will start fines for individuals that don’t sign up for health insurance in 2014 at $95 or 1% of income, whichever is greater. This increases over 2015 and 2016 up to $325, or 2% of income, and then to $695, or 2.5% of income, respectively. It should be noted that the exchanges can certify individuals who are exempt from the new requirement and penalty based on economic hardship or having short gaps in coverage. Small businesses with fewer than 50 employees are not required to provide insurance. For those that already have coverage through employers, private insurance, Medicare, Medicaid, Tricare, etc., no action is required and no penalty is accrued.
Connecticut is also being particularly creative in ways to increase participation. This is the only state that plans on opening retail stores to aid in getting consumers educated and enrolled. They have also developed a program called “Navigators”, run by organizations around the state and managed by the Office of the Healthcare Advocate, which aims to help people select and enroll in plans on the exchange.
Increased Protection Under Medicare and Expansion of Medicaid
The ACA is also improving Medicare and expanding Medicaid services. The law eliminates cost sharing for preventative services under Medicare coverage and also begins to close the prescription drug Medicare Part D coverage gap on prescriptions, informally called “the donut hole”. People who fall within the donut hole should be receiving a $250 rebate within three months of reaching the coverage gap, to help with payments. HHS began mailing rebate checks in 2010 and by the year 2020, the donut hole will be completely phased out. As of this writing, Connecticut residents have received more than $53 million in help with their prescription drug costs under ACA. Meanwhile, all Connecticut citizens in households under a certain income level – up to $15,400 for a single person or $31,809 for a family of four – will be eligible for Medicaid. States are receiving 100% federal funding for the first three years to support this expanded coverage, phasing to 90% federal funding in subsequent years.
Access Health CT
Access Health CT was created by the Connecticut Legislature in 2011 and is a quasi-public agency established to satisfy requirements of the ACA. Its mission is to increase the number of insured residents in the state, promote health, lower costs, and eliminate health disparities. It will try to achieve these goals through accessible online and community-based enrollment experiences throughout the State. Access Health CT is operating with an initial grant from HHS under the ACA, which mandates that the state’s exchange must be self-sustaining by January 2015. In December 2012, Access Health CT asked all insurers in the state to notify them if they intended to participate. Nine carriers (five medical and four dental) submitted requests to be included and are working towards being included as enrollment options later this year.
ACA and Naturopathic Medicine
There is a specific section in the new law, section 2706, which serves as a ‘nondiscrimination provision’. It states that “… a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license …”. Though this section does not require that a health insurance issuer contract with any and all providers or work with practitioners in unlicensed states, it does mandate that insurers be consistent in the services they reimburse for; they are not allowed to cover a service when provided by one class of licensed providers and then deny coverage for a different class of providers performing the same billable service.
This has vast implications for naturopathic physicians in licensed states that have not been allowed to bill health insurance companies and has many naturopathic physicians and advocates around the country excited; however the ACA also has new relevance for insurance-billable states like Connecticut. The American Association of Naturopathic Physicians (“AANP”) has been working hard to organize members and has made this the focus of several statewide conference calls and a webinar. The ACA has opened the door in these states to allow insurance coverage when it wasn’t available before. It also mandates things like “network adequacy”, which means a significant amount of practitioners must be in-network on a given plan, something which should be enforced by state’s Insurance Department. Furthermore, since the state Insurance Departments are responsible implementing the 2706 non-discrimination division, it is well worth healthcare stakeholders like naturopathic physicians meeting with these departments and commissioners to help assure proper representation and favorable interpretation in the new landscape. This is vital in licensed states where there has been no insurance coverage; however, it is also important in states like Connecticut, where insurance coverage has existed, because another change the ACA brings is reeling the self-funded ERISA plans under the control of Insurance Commissioner. Historically, self-funded plans, or plans that are merely managed by a health insurance company but are being financed directly by a large corporation, have been a kind of ‘pseudo-insurance’ and not been under the jurisdiction of the state Insurance Department. According to the AANP, the ACA is the first legislation which changes this and makes them answerable to state mandates, including enforcing coverage for naturopathic physicians under these plans, which have historically denied reimbursement.
The ACA is an ambitious attempt to increase healthcare coverage for people throughout the country and improve the quality of products offered by health insurance companies; however, its success is not certain. To be self-sufficient, exchanges like Access Health CT will have to retain many consumers, but if penalties do not outweigh the added costs of the insurance, doubtlessly, some people won’t sign up. Also, if the exchanges have monthly premiums that are high and tax credits that are not significant, the “Affordable” Care Act may not be too affordable. Case in point, at the July 2nd meeting, when a clinic director commented to the panel that some monthly premiums listed on the calculator are over $1000, specifically for household sizes 7 or greater with annual earnings over $132,000, Senator Murphy tried to soften the blow by stating that the figures on the calculator don’t include the tax credit. But this consolation may not go far, as Christie Hager, the Regional Director of HHS for New England, had stated earlier that day she expects over 47,000 Connecticut residents to get rebates averaging $160. Most readers would probably agree that this is not a significant incentive on a $1,045 monthly bill. Another question asked at the meeting without a sufficient answer was regarding specialists, and how well the different ones are being covered in the various plans. Since this remains to be seen, it would be prudent for all specialists, including naturopathic physicians, and their patients, to be supporting the state associations in efforts to engage regulators and insurance companies, so that bridges of communication are created and potential problems are alleviated before the new law comes to its next state of fruition.
Dr. Shawn M. Carney is a naturopathic physician licensed in both Connecticut and Vermont. He is on the Board of Directors with the Connecticut Naturopathic Physicians Association and practices in Newtown, CT.
The following articles have been featured in The Natural Nutmeg. These articles may not be reproduced or copied without the written permission of Dr. Shawn M. Carney.
“There’s New Light At The End Of The Carpal Tunnel”
Carpal tunnel syndrome (CTS), a condition marked by abnormal sensations in one or both hands due to compression of the median nerve, is arguably the most common peripheral mono-neuropathy and has now been shown to be effectively treated by combining a time-honored antioxidant with an essential fatty acid.
In a European clinical trial published this year (1), 112 patients with severe CTS were divided into two groups for 90 days: one receiving a combination alpha-lipoic acid (ALA) 600 mg/day with gamma-linolenic acid (GLA) 360 mg/day while the other group ingested a multivitamin B complex which contained 150 mg of B6, 100 mg of B1, and 500 micrograms of B12. The ALA/GLA group did substantially better than the other group when assessed from multiple perspectives, including significant reductions in both reported symptoms and functional impairment using scales and questionnaires that have demonstrated reliability in previous studies (2). Electromyography, which detects the electrical potential generated by muscle cells, also showed a statistically significant improvement in the ALA/GLA group but not the multivitamin group.
For those unacquainted with these nutrients, both ALA and GLA have impressive histories of clinical application. Alpha-lipoic acid is a water-soluble and fat-soluble anti-oxidant which has the ability to recycle other antioxidants, such as ascorbic acid and glutathione, thereby ultimately recycling vitamin E. It is well established for improving glucose tolerance and insulin sensitivity and was even successfully used to mitigate oxidative stress and improve organ function among children who were exposed to radiation during the Chernobyl disaster (3). Gamma-linolenic acid is an omega-6 essential fatty acid shown to help relieve premenstrual breast pain, premenstrual syndrome of bloating, irritability, and depression (4) as well as have positive effects on eczema and slowing deterioration in multiple sclerosis(5).
(1) Di Geronimo G, Caccese AF, Caruso L, et al. Treatment of carpal tunnel syndrome with alpha-lipoic acid. Eur Rev Med Pharmacol Sci. 2009 March-April;13(2):133-139.
(2) Giannini F, Cioni R, Mondelli M, et al. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clin Neurophysiol. 2002 Jan;113(1):71-77.
(3) Packer L, Witt EH, Tritschler HJ, et al. Alpha-lipoic acid as a biological antioxidant. Free Radic Biol Med. 1995;19:227-250.
(4) Pizzorno JE, Murray MT. Textbook of Natural Medicine. 3rd ed. St. Louis: Churchill Livingstone Elsevier. 2006 (943).
(5) Van Meeteren ME, Baron W, Beermann C, et al. Polyunsaturated fatty acid supplementation stimulates differentiation of oligodendroglia cells. Dev Neurosci. 2006;28(3):196-208.
“Indian Spices and Vitamin D for Dementia”
Vitamin D continues to be full of surprises. Its role as a hormone in the body seems to be the subject of an ever-expanding volume of research. One of the most recent contributions to better understanding and more adeptly using this nutrient comes to us from the synergistic realms of neurology and immunology where it has been discovered that vitamin D3 has the ability to augment the immune system’s removal of the pathologic plaque debris found in Alzheimer’s disease (AD) patients (1).
Curcumin, derived from the yellow curry spice tumeric, has a well-established role as both antioxidant and anti-inflammatory and can cross the blood-brain barrier (2). It is therefore consistent and has been clinically demonstrated that curcumin can suppress oxidative damage, inflammation and cognitive deficits in the brain. Furthermore, curcumin has also been shown to have a molecular structure conducive for binding to the amyloid beta plaques associated with AD patients and was shown to reduce amyloid accumulation more effectively than either ibuprofen and naproxen (2,3). Encouraging as this is, there is the potential for greater therapeutic results if the curcumin can enlist more of the immune system in reversing the accumulation of plaques, for curcuminoids have been shown to stimulate only some types of immune system macrophages, not all.
Now what happens when blood samples from AD patients are taken and incubated with amyloid, curcumin, and vitamin D3? The results showed, as above, curcumin facilitates the binding of amyloid beta to some macrophages; however, the presence of vitamin D3 further enhanced this reaction, so that macrophages had an increased ability to clear the amyloid. Furthermore, the macrophages not stimulated by curcumin were now also prompted to similar amyloid debris removal, thereby resulting in an increased effectiveness in immune system activity.
(1) Masoumi A, Goldenson B, Ghirmai S, et al. 1alpha, 25-dihydroxyvitamin D interacts with curcuminoids to stimulate amyloid-beta clearance by macrophages of Alzheimer’s disease patients. J Alzheimers Dis. 2009 May 11. [Epub ahead of print].
(2) Yang F, Lim GP, Begum AN, et al. Curcumin inhibits formation of amyloid beta oligomers and fibrils, binds plaques, and reduces amyloid in vivo. J Biol Chem. 2005 Feb 18;280(7):5892-901.
(3) Lim GP, Chu T, Yang F, et al. The curry spice curcumin reduces oxidative damage and amyloid pathology in an Alzheimer transgenic mouse. J Neurosci. 2001 Nov 1;21(21):8370-7
Trying to Reduce Both Depression and Anxiety? Kava can!
Last year the journal of Psychopharmacology released a study showing that aqueous preparations of Kava (Piper methysticum) were safely used to reduce anxiety and depression. Their conclusion found Kava’s abilities “highly significant” with a “substantial effect size”, when compared with the effectiveness of a placebo, and without adverse effects on the liver when used for a short duration.
This study was reportedly the first human clinical trial to assess anti-depressive and anxiety lowering effects from ingesting tablets made from an aqueous extract of Kava while also assessing liver safety. Researchers gathered 60 adult participants who had suffered with at least one month of elevated generalized anxiety for this 3-week, placebo-controlled, double-blind crossover trial. Dubbed the “Kava Anxiety Depression Spectrum Study”, participants had either five placebos or five tablets of Kava a day, which each had 50 mg of kavalactones for a therapeutic daily total of 250 mg of kavalactones a day. Kavalactones, also called “kava pyrones”, come from a resin of the Kava’s dried root, which originates from islands in the Pacific Ocean. They are believed to be the most therapeutically significant constituent of the plant and are accordingly the benchmark by which standardization of supplements is made.
Results from the study were very impressive with the aqueous extract of Kava showing highly significant relative reductions of anxiety and depression across several scaling systems. The data used for evaluation was collected on weekly clinical assessments and self-rating questionnaires. Scoring systems used in the assessment included the Hamilton Anxiety Score, which has been widely used for decades in both clinical and research settings, with participants’ symptoms being reduced by -9.9 when compared with the placebo, which lowered scores only -0.8. Other highly significant improvements were observed using the Beck Anxiety Inventory and the Montgomery-Asberg Depression Rating Scale.
Findings such as these are not new to research with Kava. The efficacy of standardized kava liquid extracts, which use alcohol as a solvent and preservative, has been well documented in animal and human studies. It has repeatedly been shown to decrease anxiety and relax the body without loss of mental acuity. In fact, Kava has traditionally been used for centuries in its indigenous areas as a ceremonial and intoxicating drink. It was even commented on by the famous eighteenth century explorer Captain James Cook during his voyage through the South Seas. However, this study reported being the first clinical trial to specifically examine the anti-anxiety and anti-depressive abilities of an aqueous extract from Kava.
Another purpose of this study was to address the ongoing controversy over Kava’s potentially toxic effects on the liver, called hepatotoxicity. In recent years, Kava has been withdrawn from European, Canadian, and British markets due to concerns over hepatotoxicity and the World Health Organization recommended further research into aqueous extracts of the herb. Many professionals believe hepatotoxicity is very rare and such regulations excessive. For example, in 2008 The European Journal of Gastroenterology and Hepatology published a study which reviewed causal relationships among 26 patients who experienced liver damage while using Kava. Causality was assessed using criteria of the Council for International Organizations of Medical Sciences for objective probability scoring. Ultimately, only one case was unequivocally verified because others had not adhered to the regulatory recommendations for the prescribed dosing, duration time of treatment, or had cases clouded by use of other medications at the time of liver injury.
While the three-week Kava Anxiety Depression Spectrum Study raised no major health concerns regarding the extract used, researchers believed larger studies were required to confirm the herb’s safety. The lead researcher, in an interview posted on www.elements4health.com, implicated an erroneous extraction process itself as the possible cause of health concerns with Kava in recent years. “Ethanol and acetone extracts, which sometimes use the incorrect parts of the Kava, were being sold in Europe. That is not the traditional way of prescribing Kava in the Pacific Islands. Our study used a water-soluble extract from the peeled rootstock of a medicinal cultivar of the plant, which is approved by the Therapeutic Goods-Administration of Austrailia and is currently legal in Austrailia for medicinal use”.
Kava, which is still available in the U.S., is certainly not the first botanical medicine to get a bad reputation and be outlawed due to rare and controversial cases of toxicity and I would like to remind proponents of such regulations to review the facts around acetaminophen and liver toxicity, just to put things in perspective. Acetaminophen is one of the best-selling pain relievers in the country and is sold over-the-counter to over 200 million Americans a year, under brand names such as Tylenol. Yet it is one of the leading causes of acute liver failure in the United States, accounting for more than 56,000 emergency room visits, 2,600 hospitalizations, and an estimated 450 deaths per year. Most cases occur among people that have exceeded the recommended amount of medication but a study by the U.S. Food and Drug Administration (FDA) showed that about 20% of people with acetaminophen-related liver toxicity had taken less than the recommended daily amount.
In conclusion, while the research continues to mount on the safety and efficacy of Kava, therapeutic use of the herb should be done under the guidance of a knowledgeable physician who is adequately trained in botanical medicine.
Let Your Mind and Body Heal with Chamomile
“The window was too small for Mr. McGregor, and he was tired of running after Peter. ... I am sorry to say that Peter was not very well during the evening. His mother put him to bed, and made some chamomile tea; and she gave a dose of it to Peter!”
---- Beatrix Potter, The Tale of Peter Rabbit, 1902
Feeling anxious with difficulty sleeping, aches and pains after a hard day at the office - or farm for that matter? Then turn your attention to some traditional wisdom which has withstood the test of time, being shown effective in both clinical trials and rabbit testimonials.
In August of 2009, The Journal of Clinical Psychopharmacology published what was reportedly the first controlled clinical trial of chamomile extract for generalized anxiety disorder (GAD). The researchers’ conclusion, consistent with other findings for anxiety and insomnia, suggested that chamomile was effective in helping to ease concerns among persons with mild to moderate GAD.
The study was conducted as a randomized, double-blind, placebo-controlled efficacy and tolerability trial of Matricaria recutita, commonly known as ‘German Chamomile’, among patients with mild to moderate anxiety. Approximately 60 patients were divided between the placebo and intervention groups for a duration of 8 weeks. Subjects in the intervention group were started with 220 mg/day of chamomile extract, standardized to 1.2% apigenin, for the first week. This dose was then doubled to 440 mg/day during the second week, with participants being evaluated using the Hamilton Anxiety Rating (HAR) scoring system. If a participant’s HAR did not decrease by more than 50%, the therapeutic dose prescribed would be increased by 220 mg/day each week until the maximum dose allowed was attained, which was 1100 mg/day.
The researchers reported a significantly greater reduction in mean total anxiety ratings among those on the chamomile therapy, compared with that from the placebo group (50% vs. 30%). Also, no serious side effects were reported among study participants.
Chamomile has a long history of safe use for a wide variety of conditions, with different preparations for different populations. It has been used for anxiety, insomnia, menopausal depression, gastric ulcers, stomachache, diarrhea, colic, muscle pains from flu infections, inflamed skin, hives, and teething among children, to name a few. It is recommended to seek the care of a licensed healthcare professional when treating any such ailment with botanical medicines.
“Recipes for Weight Loss: 1 part Exercise but 3 parts Diet”
A recent study from the United Kingdom examined success variability among weight loss program participants who underwent intense exercise protocols while eating different amounts of food (1). Their conclusion was that despite consistent rigorous exercise, a strategic Mediterranean style diet was more influential in determining the ultimate amount of weight lost.
The researchers above considered how appetite and food choices, or “energy intake”, affected people in a supervised and monitored five day a week fitness protocol. The study consisted of fifty-eight obese men and women who were prescribed exercise, at an expenditure of up to 500 kilocalories per session with a frequency of five times a week for twelve weeks and an intensity of 70% maximum heart rate. Note that while the 500 kilocalories per session stipulation translates into approximately an hour of jogging at 5 mph, digging and gardening, active swimming, using a cross country ski machine, or hiking (2), the intensity stipulation helps to ensure that the activity is being done at an adequate and fruitful level. Body weight, composition and foods consumed were recorded four times through the duration of the study.
Though the average reduction in body weight was 7.04 lbs (+/- 4.3 lbs) and considered statistically significant, there was substantial individual variability (-32.34 to +5.94 lbs). “This large variability could be ... attributed to the differences in energy intake over the twelve week intervention. Those participants who failed to lose meaningful weight increased their food intake and reduced intake of fruits and vegetables”. Thus the authors concluded that regardless of high energy expenditure, adherence to strategic eating patterns is a better indicator for successful weight loss and that eating patterns associated with the Mediterranean diet were notably beneficial. In this way, even if one part of your strategy is daily strenuous exercise, successful weight loss relies more on mindful dietary patterns used with three meals a day and carefully chosen snacks between.
The Mediterranean diet has been clinically demonstrated to protect against cardiovascular disease, diabetes, metabolic syndrome, cancer and now even improve weight loss (3). It consists of daily fruits, vegetables, beans, nuts, olive oil, and grains while animal products are greatly minimized: fish or fowl being consumed weekly and red meat monthly. As a dietary strategy, it has also been compared with many alternative ways to lose weight and shown to be the most efficacious (4), especially when combined with medical food meal replacements which have additional ways to optimize physiologic reactions conducive to losing weight and ingredients shown to lower cholesterol, stabilize blood sugar, and help normalize hormones.
A renowned program which ties together exercise, the Mediterranean diet, medical food meal replacements and low glycemic food choices is called FirstLine Therapy. This medically supervised program consists of a series of office visits to assess changes in body tissues, construct sample menus, and offer support such as recipe ideas. Readers can go to http://www.metagenics.com/patients to find a practitioner certified in FirstLine Therapy in their area.
(1) Caudwell P, Hopkins M, King NA et al. Exercise is not enough: weight loss also needs a healthy (Mediterranean) diet. Public Health Nutrition. 2009 Sept; 12(9A): 1663- 1666.
Successful Psychologist Tactics For Losing Weight
Last summer the professional journal “Nutrition” published a study assessing the effectiveness of cognitive-behavioral therapy for treating obesity when a Mediterranean dietary pattern is used (1). Their findings not only showed that behavioral therapy based on Mediterranean dietary principles was a successful way to lose weight, but also illustrated the fruitfulness of practical clinically orientated techniques, such as recording food intake and attendance of group therapy.
Both cognitive-behavioral therapy and the Mediterranean diet have been well documented to be clinically effective for achieving different ends and research integrating the practices was perhaps an inevitable strategy for attaining desirable results. Cognitive-behavioral therapy is a form of interventional psychology which emphasizes utilizing formulated strategies, cultivated through self-awareness, to alter specific behaviors. It is a blend of two different psychotherapy theories which ultimately share an emphasis on using the present moment to re-structure our ways of being in the world, whether the emphasis is on thoughts or behaviors or both. This action-orientated method has been widely researched for decades and empirically shown to be beneficial in many different clinical conditions (2). The Mediterranean diet, as a strategy for eating, consists of abundant and minimally processed plant foods, with fresh fruit as a typical daily dessert and olive oil as the primary source of lipids; there is little by way of meat or dairy products. Adherence to the Mediterranean diet decreases risk of cardiovascular disease, cancer, diabetes, increases longevity, and can improve outcomes for people with autoimmune disease, Alzheimer’s disease, allergies, and arthritis, as shown in epidemiological, clinical, and pharmacological studies (3-9).
In terms of this study, the principals of cognitive-behavioral therapy were employed when determining barriers to losing weight as well as individuals formulating strategies based off those identified barriers. The researchers enlisted 1,406 obese individuals between the third and seventh decades of life from southeastern Spain to participate in the weight loss program. Obstacles to success were identified using a “Barriers to Weight Loss” checklist. Progress was tracked by assessing weight, body fat distribution, biochemical variables, blood pressure changes, average duration of treatment, percentage attrition, and one’s ability to fulfill a Mediterranean diet plan.
The results were favorable though not overly impressive, with an average weight loss of almost 17 lbs over a treatment duration of 34 weeks. Eighty-nine percent of subjects fulfilled the Mediterranean principles during the program, and all the variables studied were significantly improved. Stress was the most frequent reason for participants not seeing the study through to completion and the main obstacles to weight loss were “losing motivation”, being “prone to stress-related eating”, and being liable to eat when bored. Keeping written records of what was eaten through the day as well as attending group therapy were considered factors contributing to the success of many participants.
In light of research such as this, people considering temporary and extreme “fad” diets may want to opt instead for a more sustainable approach which has multiple documented health benefits and can comfortably be modified into a successful lifestyle adjustment.
(1) Corbalan MD, Morales EM, Canteras M, et al. “Effectiveness of cognitive-behavioral therapy based on the Mediterranean diet for the treatment of obesity”. Nutrition. 2009 Jul-Aug; 25 (7-8): 861-869.
(2) Butler AC, Chapman JE, Forman EM, Beck AT (January 2006). "The empirical status of cognitive-behavioral therapy: a review of meta-analyses". Clin Psychol Rev 26 (1): 17–31.
(3) S., de Lorgeril M., Delaye, J. (1995). Cretan mediterranean diet for the prevention of coronary heart disease. Am J Clin Nutr 1995. 61:1360S-7S.
(4) De Lorgeril, et. al. (1994). Mediterranean alpha-linolenic acid rich diet in secondary prevention of coronary heart disease. 343:1454-9.
(6) Martinez-Gonzalez, M.A. et. al. (2008). Adherence to a Mediterranean Diet and risk
of developing diabetes: prospective cohort study. BMJ. 336: 1348- 1351.
(7) Hagfors, L. 2005. Fat intake and composition of fatty acids in serum phospholipids in a randomized, controlled, Mediterranean dietary intervention study on patients with rheumatoid arthritis Nutrition & Metabolism. 2:26
(8) Scarmeas, N. et. al. 2007. Mediterreanean diet and Alzheimers disease mortality.
(9) Chatzi, L. et. al. 2007. Protective effect of fruits, vegetables and the Mediterranean diet on asthma and allergies among children in Crete. Thorax.62(8):677-83.