Dr. Jacqueline Olds and Dr. Richard Schwartz
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
2 days ago
- Medscape
GLP-1s Only Opening Act: Experts Unveil Diet-Exercise Guide
The weight loss seen with GLP-1 receptor agonists is only half the story. Long-term success hinges on integrating medication with individualized nutrition and physical activity counseling, a trio of experts remind clinicians in a new paper. GLP-1 medications and dual receptor agonist medications are 'very effective in terms of weight loss, achieving about 20% weight loss or more,' JoAnn Manson, MD, MPH, professor of medicine, Harvard Medical School and Brigham and Women's Hospital, both in Boston, told Medscape Medical News . However, the loss of muscle mass and lean body mass is also 'quite common, sometimes accounting for 25% or more of the total weight loss.' Lifestyle factors are 'crucial' to optimize outcomes for patients on GLP-1 medications, Manson said. She and her coauthors offered advice on integrating diet and physical activity and managing potential side effects in patients with obesity starting a GLP-1 medication in a brief two-page 'Clinical Insights' article in JAMA Internal Medicine. There is also companion 'Patient Page.' Monitor Weight Loss Clinicians should track weight monthly during GLP-1 dose escalation and at least quarterly thereafter, intervening if patients lose too little or too much weight, the authors advised. For those with < 5% weight loss after 12-16 weeks, options include continuing standard dose escalation and documenting progress, given that standard titration periods (at least 17 weeks) may not work for all individuals; checking for missed doses and adjust dose titration as needed to maximize adherence; or switching to an alternative GLP-1 drug if the maximum tolerated dose is not effective, they said. It's also important to monitor for excessive weight loss, the authors said. Indications that weight loss may be excessive or harming overall health include a BMI < 18.5, anorexia (consuming < 800 calories/d), or very low protein intake. In a patient with excessive weight loss, it's important to rule out secondary causes such as eating or endocrine disorders or malignant tumors, assess for correlated harms including nutrient deficiencies and hormonal imbalances, assess psychological function with referrals to specialists as needed, and consider dose reduction or stopping the medication temporarily, the author advised. Assess Diet, Manage Nutrient Intake If available, patients should see a registered dietitian initially, with follow-up visits every 2-3 months during dose escalation. If this is not feasible, clinicians can administer the Rapid Eating Assessment for Participants-Shortened, a brief nutritional assessment tool. The authors emphasized that nutrient quality is more important than rigid calorie counting. However, patients may also benefit from periodic tracking of their food and fluid intake through smartphone applications, manual food logs or taking photos of their food to help guide dietary adjustments. For patients comfortable with tracking their calories, target calorie ranges should be individualized based on weight goals and activity level. To minimize muscle loss, patients should be advised to maintain adequate protein intake of 60-75 g/d (1.0-1.5 g/kg; > 1.5 g/kg for older or post-bariatric surgery patients) and engage in structured physical activity (aerobic and strength training). To maintain energy balance, smaller, nutrient-dense meals rather than calorie restriction is advised. Whole grains for satiety and sustained energy and healthy fats to support fat-soluble vitamin absorption and reduce cholestasis are recommended. Manson noted that 'gastrointestinal symptoms — such as nausea, constipation, and reflux — can limit the use of these medications, lead to drug discontinuation, and subsequently results in weight regain.' To help ward off constipation, patients should be advised to increase fiber intake and take in more than 2-3 L of fluid a day and use over-the-counter laxatives if needed. For nausea, they should avoid fried foods and carbonated drinks. For reflux, eating smaller portions, not lying down for 2-3 hours after meals and limiting high-fat and irritating spices may help. Because appetite suppression induced by GLP-1 medications can unmask hidden micronutrient deficiencies, clinicians could consider assessment of vitamin D, iron, B-vitamins, and other micronutrients and add a multivitamin when intake is chronically low, the authors said. Physical Activity: Start Slow and Add-On The authors recommend a three-step approach to counseling patients on physical activity. First, introduce regular movement gradually and work up to 150 minutes of moderate (or 75 min of vigorous) activity weekly. Second, incorporate resistance training, aiming for 60-90 min/wk. Third, maintain 30-60 minutes per day of aerobic exercise combined with resistance training two to three times per week for optimal long-term weight and metabolic outcomes. Balance and mobility training for older adults can be especially helpful, the author said. Clinicians may also consider assessing muscle strength and function, such as the grip strength or 6-minute walk test, the authors said. Weight Regain Patients who discontinue GLP-1 therapy may regain weight and this should be discussed with patients at the start of treatment, the authors said. Specifically, in randomized controlled trials, weight rebound of roughly 7%-12% has been observed within 1 year of stopping GLP-1 therapy and that lifestyle habits put in place early will be the main defense if dose reductions or discontinuation are attempted. The authors noted that all patients will reach a weight-loss plateau, but weight maintenance protocols for GLP-1 drugs have yet to be established. 'Clinicians should base treatment decisions on the premise that obesity is a chronic condition typically requiring long-term management, similar to hypertension,' they advised. When a decision to taper the medication is made, options include reducing the dose or frequency of injections or tapering off treatment completely with progressively less monitoring (weekly to biweekly, followed by monthly, then quarterly) over at least 20 weeks. 'Clinicians should continue to assess weight, metabolic health, diet and activity levels, appetite, sleep patterns, mood changes, and muscle strength. Medication reinitiation or dose increase should be considered if weight regain exceeds 5%,' they advised. Manson told Medscape Medical News she hopes this information will be a 'good resource that will result in better care for patients on GLP-1 medications and better outcomes.'
WebMD
3 days ago
- WebMD
Why Losing Your Health Insurance Is a Health Risk in Itself
July 24, 2025 – Health insurance is in the spotlight these days, especially the risk of losing it. The recently passed federal budget bill that includes significant Medicaid cuts is projected to leave millions uninsured over the next decade. An additional 4.2 million Affordable Care Act enrollees may be priced out, as premiums are expected to rise sharply for next year. But here's what you may not have heard: Tens of millions of Americans – about 7.6% of the population, according to the most recent data – already lack insurance, whether they've lost their job, can't afford a health plan, or have trouble signing up. Losing insurance doesn't just pose a financial burden – research shows it can directly harm your health. Fortunately, there's a lot you can do right now to protect both your health and your coverage. How Losing Insurance Hurts Your Health "When people don't have insurance, they stop seeking regular health care," said Joel Shalowitz, MD, a retired professor at Northwestern University's Kellogg School of Management. That's not just speculation. Research shows that when coverage disappears, people struggle to afford care and skip health services and medications. The upshot: fewer checkups, missed vaccinations, and gaps in treatment for chronic conditions like high blood pressure and diabetes – issues that can become serious problems if left unchecked. "Chronically ill individuals are going to be more at risk from health care cuts," said Adam Gaffney, MD, a public health expert at Harvard Medical School. But even the healthy face risks if they fall behind on preventive care. A study from the American Cancer Society found that disruptions in coverage led to fewer preventive services and screenings among participants. The findings for cancer patients were stark: Those with gaps in Medicaid coverage were more likely to have advanced stages of disease and die earlier, compared with those who remained covered – demonstrating the life-or-death consequences of coverage loss. New mothers can face serious outcomes too: In a 2024 study, those who lost insurance were 19% less likely to attend postpartum visits and 14% less likely to be screened for postpartum depression – an oversight with serious mental health impacts for both mothers and their children, as a wide body of research shows. How to Protect Your Health and Your Coverage If you have coverage now, don't put off preventive care, said Shalowitz. Stay up to date on mammograms, colonoscopies, Pap smears, and other routine screenings. Likewise, schedule appointments you've been putting off, and refill your prescriptions. That will help head off the possibility of health problems during an uninsured period – but keep in mind, it's no guarantee. "At the end of the day, health is ultimately unpredictable," Gaffney said. "None of us know when the next problem is coming down the pike at us, and that's why we need lifelong, seamless coverage, because health problems are something everyone will ultimately face." Consider these steps: If you're on Medicaid … What to do: Stay in touch with your state Medicaid agency. "The biggest provision that's going to impact people with Medicaid is the [introduction of] work requirements," said Gaffney. By 2027, many on Medicaid will need to prove they've completed 80 hours of work or community service per month, or that they've attended school. Some will lose coverage if they don't comply. "But it will very likely sweep in many, many people who are in compliance but struggle to meet the administrative burden to prove they're in compliance," said Elizabeth Kaplan, JD, director of health care access at Harvard Law's Center for Health Law and Policy Innovation. "Individuals with Medicaid are going to have to be really careful not to miss any communications from their states," she said. So make sure your state Medicaid agency (and Medicaid managed care organization, if you have one) has your up-to-date contact information. Respond promptly to notices regarding actions to maintain your insurance. What documents might your state require? We may not know for sure for another year. In Georgia, which already has similar requirements, beneficiaries are asked to submit work pay stubs or signed letters on official letterhead from organizations where they volunteer. If you're on Medicare … What to do: Follow the news, stay informed, and check your Part D plan costs during annual enrollment. The new bill didn't introduce major cuts to Medicare, but recipients may still see indirect impacts in the coming years. That's because the new law raises the deficit, triggering sequestration rules, or automatic spending cuts, said Gaffney. That could lead to $500 billion in Medicare cuts over the next decade, unless Congress acts to stop it. If you're on Medicare and Medicaid, you may be affected sooner. While the new Medicaid work requirements may not apply to you, the law's other Medicaid provisions could – like cuts to state funding or new cost-sharing for services. Because Medicaid helps offset out-of-pocket costs for many on Medicare, losing it could render care and prescription drugs unaffordable, he said. One thing you can do is maximize your Medicare coverage without overpaying. Shalowitz recommends reviewing prescription coverage (Medicare Part D) options annually, even if you auto-renew. The reason: Your health status and medications can change, so the plan you had last year might not be the most cost-effective option now. Plus, "a lot of plans will give a lower rate one year to get you to sign up, and then they'll increase it dramatically the next year," he said. Simply taking the time to compare plans on could save you hundreds of dollars a year. If you buy insurance through the ACA marketplace … What to do: Anticipate higher premiums and start saving. The new bill didn't extend subsidies that lower the price of marketplace plans. "The majority of people with ACA plans get subsidies, meaning the premium is lower than it would be if they were just paying the market price," said Gaffney. Premiums will likely rise in January. And eligibility requirements are getting stricter, too. During open enrollment, pay close attention to both the costs and the documents required to enroll as soon as the information is available. It might help to have a copy of your latest tax return handy, for example. Enrollees will be asked to verify their household and family size, immigration status, health coverage, and place of residence. If you have employer-based coverage … What to do: Pay attention to changes in your local hospitals and clinics – and speak up if you're concerned. "All of us may be worse off if these Medicaid cuts lead to hospital closures or limits on access to care for everybody," said Sherry Glied, PhD, a public service expert at New York University. Emergency departments, especially in low-income areas, might have to treat more uninsured patients for free, which will hurt their bottom line. "People have talked about rural hospitals, but it's not just rural hospitals – it's urban, suburban, and rural hospitals that predominantly take care of working-class people," said Gaffney. These facilities are "more reliant on Medicaid revenues in order to stay afloat." When Medicaid revenues go down, uncompensated care costs from uninsured patients go up, he said. Hospitals then face the choice of cutting staff or services or even closing altogether. The downstream effects could hit your paycheck in 2027 and beyond. To offset the free care they provide, hospitals will probably charge private insurers higher rates for services, said Shalowitz. That could mean higher premiums for employers – which in turn could mean higher premiums for you if your employer asks you to kick in more each month to cover the cost. Your moves: Stay informed, use preventive care, and reach out to elected officials if you're concerned. Your voice can help shape how these changes unfold, the experts agreed. If you don't have insurance … What to do: Take advantage of free clinics. These facilities, which are often funded through government grants, funds from community and private foundations, or donor support, provide care for people who are uninsured or underinsured. Check the National Association of Free and Charitable Clinics' searchable directory of clinics across the country and the Health Resources and Services Administration's list of its funded health centers.
Time Magazine
4 days ago
- Time Magazine
Why So Many Seniors Can't Afford Long-Term Care
Aisha Adkins' mother Rosetta was adamant that she wanted to age at home. So when Rosetta's dementia started worsening at age 59, Aisha started looking around for options. She quickly found that round-the-clock at-home care was extremely costly, and that her mother didn't qualify for government assistance. Stuck in the middle, Aisha, who was 29 at the time, ended up quitting her job to take of her mother care of her herself. At first, Rosetta just needed help preparing meals and reminders to take her medication. But as her care needs deepened, Aisha had to learn how to bathe and dress and feed her mother. She and her father hired a home health aide for a few hours a week when they could, but most of the care fell to the two of them until her mother finally qualified for Medicaid through a complicated process called spousal impoverishment protection, which allowed her father to keep some assets. 'We faced so many challenges; it was really a struggle,' says Adkins. She ended up caring for her mother for ten years on both a full-time and part-time basis, until her mother passed away in 2023. Many middle-income seniors are unable to afford care As the U.S. population ages, many families are facing the same challenges. Long-term care, which is assistance with the activities of daily living either in a person's home or in a facility, is expensive. Most people pay for it either out of their savings, or by spending down those savings until they qualify for Medicaid, which covers long-term care for indigent seniors. (Medicare does not cover senior housing or long-term care.) But there's a large group of people who are stuck in-between: they are 'too rich' to qualify for the Medicaid benefits that enable them to hire at-home help or put loved ones in a nursing home, but they do not have enough money to pay for the in-home, all-hours care their loved one needs. It then falls to family members to make up the difference. Around two-thirds of caregiving hours for older adults in the U.S. are provided by informal and unpaid caregivers. On one end of the spectrum, there are many expensive communities for seniors with deep pockets who want to start out in apartments and continue on to assisted living or more extensive care. On the other end, there are nursing home spots available for people who qualify for Medicaid, the government payor of last resort, which is strictly for low-income seniors or people who have spent down their savings. Read More: How Health Insurance Monopolies Affect Your Care But 'there aren't a lot of middle-income options on the market, so inevitably people rely on family care and out-of-pocket home care until they end up qualifying for Medicaid,' says David Grabowski, a health care policy professor at Harvard Medical School and one of the authors of a 2019 study about middle-income seniors. His research predicts that as the U.S. ages, many seniors will have insufficient resources for housing and health care needs. People like Rosetta Adkins are often referred to as the 'missing middle' or 'forgotten middle'—the seniors who aren't wealthy but who also aren't poor. There just aren't a lot of options for these seniors in the middle who need care. One 2021 study estimated that a nursing home in the U.S., on average, costs $100,740 per year for a semi-private room, and that home care for six hours a day, five days a week costs $42,120 a year. The costs have only gone up since then. By 2033, researchers at the University of Chicago estimate, there will be 16 million middle-income seniors who can't afford to pay for the health, personal care, and housing services they need. They will have to rely on family members—or on themselves—until they can qualify for Medicaid. There may be even more people in this situation going forward, after the giant cuts to Medicaid in the Trump economic plan recently approved by Congress go into effect. Home and community-based care for low-income seniors is considered an optional program in Medicaid, so states can cut it when their budgets are thin. That may mean that in some states, it will take even longer for people like Rosetta Adkins to qualify for care through Medicaid, putting even more pressure on family members to help out. 'When a state's Medicaid budget is constrained, which is absolutely going to happen because of this bill, there will be limits on some of these home-based services,' says Allison Orris, a senior fellow at the Center on Budget and Policy Priorities, a national research and policy institute. A lack of options puts stress on family members Family members already face intense pressure to provide care for their ailing loved one while still maintaining their careers and taking care of children. One recent report by researchers at Columbia University's Mailman School of Public Health found that nearly half of U.S. states are on the brink of an unpaid family caregiving emergency. That means that in many states, unpaid family caregivers are contributing hundreds of billions of dollars of unpaid labor. The report found that dementia care—like the kind sought by the Adkins family—is driving a lot of the labor. 'It is repeatedly the family caregiver who shoulders the immense pressures generated by health care shortages and rising dementia cases,' says John McHugh, lead researcher of the study and an adjunct assistant professor of health policy and management at Columbia University's Mailman School of Public Health. Read More: The Surprising Reason Rural Hospitals Are Closing Aisha Adkins, for instance, set aside her career so she could care for her mother. Her life choices for the next decade were determined by what her mother needed: picking a graduate school nearby and then finding a job that would allow her to work remotely. Aisha, who is only 40, is already worried about how she will pay for her own long-term care when she ages because she was out of the workforce so long caring for her mother. This, too, is not uncommon. 'Many times, family members are reducing their own incomes because they're taking time out of the workforce, or they're working less,' says Amber Christ, managing director of health advocacy at Justice in Aging, a nonprofit that advocates on behalf of low-income seniors. 'They're risking their future retirement, which increases the likelihood they'll age into poverty. So it's really a multigenerational impact.' There's a reason there aren't many options for middle-income seniors: companies can't make money providing it. Over the past few decades, many expensive aging facilities have opened as investors put money into options for Baby Boomers who have extensive savings. But those places are out of reach for many seniors. 'The million-dollar model seems to work,' says Grabowski. 'But middle-income models don't seem to thrive.' Though there are options for nursing homes and facilities for seniors on Medicaid, they often provide a relatively low quality of care, with sparse staffing and dilapidated facilities. Options for middle-income seniors are also limited because many people want to age at home, but at-home care is expensive and there are vast staff shortages, especially in rural areas. The industry is plagued by low compensation, unpredictable scheduling, and high turnover. Analysts predict this shortage will only worsen, with an estimated 4.6 million unfilled jobs by 2032. Aisha Adkins says that even when her mother qualified for Medicaid, it was extremely difficult to get aides to consistently come to the house and provide care. Inexperienced caregivers didn't know how to handle her mother's dementia, so Aisha or her father still had to stay in the home even when a caregiver was around. 'It really fell to my father and myself to ensure that she was safe at all times, even sometimes when the caregiver was in the home,' she says. Solutions for middle-income seniors are expensive Adkins says she now advises friends to look into long-term care insurance or think more carefully about putting aside more money for when they age. But even long-term care insurance, which requires people to pay monthly premiums as they age so they can have care when they need it, has proven so inadequate that only about 4% of Americans 50 and older pay for a policy. Though most people spend down their savings to qualify for Medicaid, elder law attorneys can sometimes help people protect their savings from long-term care costs. "It's worth meeting with and listening to an elder law attorney to find out how to protect your resources," says Eric Einhart, president of the National Academy of Elder Law Attorneys. A few states have tried to help people pay for long-term care by establishing state programs. The WA Cares Fund, in Washington State, is a mandatory program that takes a small percentage of the paychecks of working Washingtonians and then allows them to access benefits of up to $36,500 to pay for long-term care services. But that amount of money won't last them very long if they need more than a few months of care. The lack of long-term care planning in the U.S. is a contrast to many other countries. The Netherlands, for instance, has long included long-term care in its universal health care system, and requires that taxpayers contribute a chunk of their income towards insurance premiums. In 2019, Singapore introduced a mandatory long-term care insurance program. Japan has had a mandatory long-term care insurance system since 2000; it requires people 40 and over to contribute. Read More: America's Dental Health Is in Trouble Most experts agree that the U.S. needs some sort of plan to help more seniors pay for long-term care, especially as Baby Boomers age. Otherwise, many people will spend down their savings until they qualify for Medicaid, which is going to get very expensive for the U.S. government. 'We're going to be swamped by just the pure number of individuals in the system who need long-term care going forward,' says Grabowski. 'We're not at a place politically today to talk about this,' he says—because recently so much discussion has been focused on cutting services, rather than adding them—'but in the longer run, it's a discussion we really need to have.' It's something Aisha Adkins knows at her core. Although her mother passed away in 2023, Adkins is gearing up for another struggle. Her father was recently diagnosed with a type of dementia, too. He spent almost all of his savings paying for Rosetta's care. Now, Aisha is starting to look into options for him. She knows, from experience, that they will be limited.
